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Ray, Dr Debansu. "Market Sensitivity of the IT stocks : A comparison of the pre and post recessionary period." International Journal of Scientific Research 1, no. 7 (June 1, 2012): 109–11. http://dx.doi.org/10.15373/22778179/dec2012/41.
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Yamamoto, Rain, Migaku Teramoto, Ikuo Hayasaka, Koki Ikeda, Toshikazu Hasegawa, and Takafumi Ishida. "Reactivation of lymphocryptovirus (Epstein–Barr virus chimpanzee) and dominance in chimpanzees." Journal of General Virology 91, no. 8 (August 1, 2010): 2049–53. http://dx.doi.org/10.1099/vir.0.022376-0.
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Nine male chimpanzees originally reared in solitary cages were set up to form a group. Plasma viral load of the lymphocryptovirus (LCV) of chimpanzee [Epstein–Barr virus chimpanzee (EBVcmp)] was measured by real-time PCR. In the group formation (Form) period, the first-ranking male showed an imminent increase in plasma EBVcmp load compared with 1 week before (pre-Form) and 3 months after (post-Form) group formation. Other upper-ranking males such as the second-, third- and fourth-male also showed the highest level of viral load in the Form period. The kinetics of EBVcmp load in the Form period were statistically different from other periods (against pre-Form, t=−4.878, P<0.001; against post-Form, t=6.434, P<0.001). The effect of the male dominance rank did not differ between the pre-Form and post-Form periods (t=−1.557, P=0.12). Reactivation of LCV (EBV) as an immunological stress marker for humans might also be applied to chimpanzees.
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Jaggar, Jessica, Kerry O. Cleveland, Jennifer D. Twilla, Shanise Patterson, and Athena L. V. Hobbs. "Leveling Up: Evaluation of IV v. PO Linezolid Utilization and Cost after an Antimicrobial Stewardship Program Revision of IV to PO Conversion Criteria within a Healthcare System." Pharmacy 11, no. 2 (April 5, 2023): 70. http://dx.doi.org/10.3390/pharmacy11020070.
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The CDC’s Core Elements of an Antimicrobial Stewardship Program (ASP) lists intravenous (IV) to oral (PO) conversion as an important pharmacy-based intervention. However, despite the existence of a pharmacist-driven IV to PO conversion protocol, conversion rates within our healthcare system remained low. We aimed to evaluate the impact of a revision to the current conversion protocol on conversion rates, using linezolid as a marker due to its high PO bioavailability and high IV cost. This retrospective, observational study was conducted within a healthcare system composed of five adult acute care facilities. The conversion eligibility criteria were evaluated and revised on 30 November 2021. The pre-intervention period started February 2021 and ended November 2021. The post-intervention period was December 2021 to March 2022. The primary objective of this study was to establish if there was a difference in PO linezolid utilization reported as days of therapy per 1000 days present (DOT/1000 DP) between the pre- and post-intervention periods. IV linezolid utilization and cost savings were investigated as secondary objectives. The average DOT/1000 DP for IV linezolid decreased from 52.1 to 35.4 in the pre- and post-intervention periods, respectively (p < 0.01). Inversely, the average DOT/1000 DP for PO linezolid increased from 38.9 in the pre-intervention to 58.8 for the post-intervention period, p < 0.01. This mirrored an increase in the average percentage of PO use from 42.9 to 62.4% for the pre- and post-intervention periods, respectively (p < 0.01). A system-wide cost savings analysis showed projected total annual cost savings of USD 85,096.09 for the system, with monthly post-intervention savings of USD 7091.34. The pre-intervention average monthly spend on IV linezolid at the academic flagship hospital was USD 17,008.10, which decreased to USD 11,623.57 post-intervention; a 32% reduction. PO linezolid spend pre-intervention was USD 664.97 and increased to USD 965.20 post-intervention. The average monthly spend on IV linezolid for the four non-academic hospitals was USD 946.36 pre-intervention, which decreased to USD 348.99 post-intervention; a 63.1% reduction (p < 0.01). Simultaneously, the average monthly spend for PO linezolid was USD 45.66 pre-intervention and increased to USD 71.19 post-intervention (p = 0.03) This study shows the significant impact that an ASP intervention had on IV to PO conversion rates and subsequent spend. By revising criteria for IV to PO conversion, tracking and reporting results, and educating pharmacists, this led to significantly more PO linezolid use and reduced the overall cost in a large healthcare system.
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DAHAL, MAHESH, and Joy Das. "MERGER AND ACQUISITION ANNOUNCEMENT OF INDIAN BANKING SECTOR: A PRE-POST ANALYSIS OF STOCK MARKET REACTION." Review of Finance and Banking 14, no. 2 (December 31, 2022): 89–105. http://dx.doi.org/10.24818/rfb.22.14.02.01.
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With the recommendation of the Narasimham Committee (1991), the Indian banking sector saw a soar in M&A with the objective of value creation, but the existing literature does not provide any conclusive evidence in respect of value creation for sharehold- ers. Therefore, in the present study, an attempt has been made to investigate whether the M&A announcement generates value to the shareholders or not. By employing event study methodology, the study observed signiÖcant negative abnormal returns during the post-M&A announcement period for both overall market and individual banking sector stock. The re- turns further deteriorated in the long run with signiÖcant negative BHAR. Thus, the study concludes that the M&A did not create value to the shareholders; instead, it deteriorate the shareholdersívalue
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Cash, James M., Ben Langford, Chiara Di Marco, Neil J. Mullinger, James Allan, Ernesto Reyes-Villegas, Ruthambara Joshi, et al. "Seasonal analysis of submicron aerosol in Old Delhi using high-resolution aerosol mass spectrometry: chemical characterisation, source apportionment and new marker identification." Atmospheric Chemistry and Physics 21, no. 13 (July 7, 2021): 10133–58. http://dx.doi.org/10.5194/acp-21-10133-2021.
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Abstract. We present the first real-time composition of submicron particulate matter (PM1) in Old Delhi using high-resolution aerosol mass spectrometry (HR-AMS). Old Delhi is one of the most polluted locations in the world, and PM1 concentrations reached ∼ 750 µg m−3 during the most polluted period, the post-monsoon period, where PM1 increased by 188 % over the pre-monsoon period. Sulfate contributes the largest inorganic PM1 mass fraction during the pre-monsoon (24 %) and monsoon (24 %) periods, with nitrate contributing most during the post-monsoon period (8 %). The organics dominate the mass fraction (54 %–68 %) throughout the three periods, and, using positive matrix factorisation (PMF) to perform source apportionment analysis of organic mass, two burning-related factors were found to contribute the most (35 %) to the post-monsoon increase. The first PMF factor, semi-volatility biomass burning organic aerosol (SVBBOA), shows a high correlation with Earth observation fire counts in surrounding states, which links its origin to crop residue burning. The second is a solid fuel OA (SFOA) factor with links to local open burning due to its high composition of polyaromatic hydrocarbons (PAHs) and novel AMS-measured marker species for polychlorinated dibenzodioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs). Two traffic factors were resolved: one hydrocarbon-like OA (HOA) factor and another nitrogen-rich HOA (NHOA) factor. The N compounds within NHOA were mainly nitrile species which have not previously been identified within AMS measurements. Their PAH composition suggests that NHOA is linked to diesel and HOA to compressed natural gas and petrol. These factors combined make the largest relative contribution to primary PM1 mass during the pre-monsoon and monsoon periods while contributing the second highest in the post-monsoon period. A cooking OA (COA) factor shows strong links to the secondary factor, semi-volatility oxygenated OA (SVOOA). Correlations with co-located volatile organic compound (VOC) measurements and AMS-measured organic nitrogen oxides (OrgNO) suggest SVOOA is formed from aged COA. It is also found that a significant increase in chloride concentrations (522 %) from pre-monsoon to post-monsoon correlates well with SVBBOA and SFOA, suggesting that crop residue burning and open waste burning are responsible. A reduction in traffic emissions would effectively reduce concentrations across most of the year. In order to reduce the post-monsoon peak, sources such as funeral pyres, solid waste burning and crop residue burning should be considered when developing new air quality policy.
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Bhardwaj, Bikram, Ava Dipan Desai, Bijal Manish Patel, Chetna Deepal Parekh, and Shilpa Mukesh Patel. "Prevalence of hypomagnesemia in patients undergoing gynecological oncology surgery in tertiary care cancer institute of India." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, no. 10 (September 23, 2017): 4355. http://dx.doi.org/10.18203/2320-1770.ijrcog20174404.
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Background: Hypomagnesemia is an important but unknown risk factor for post-operative complications in patients undergoing surgery for presumed gynecological malignancy. This study aims to evaluate the prevalence of hypomagnesemia in patients undergoing surgery for presumed gynecological cancers referred to our tertiary care Cancer Institute.Methods: This is a prospective observational study of 100 patients admitted with provisional diagnosis of malignancy. They underwent surgery in one of the Gynecologic Oncology units at The Gujarat Cancer Research Institute, Ahmedabad from October 2016 to April 2017. Hypomagnesemia was defined a serum magnesium levels less than 1.8mg/dl.Results: The incidence of pre-operative hypomagnesemia in the entire cohort was 35%. Sixty three percent patients had normal pre-operative magnesium levels and hypermagnesemia was seen in 2% of study population. Patients with benign disease had 29.6% pre-operative hypomagnesemia compared with 39.6% in patients with gynecologic malignancy. Pre-operative hypomagnesemia and even falling levels in post-operative period are an important predictive marker for post-operative complications like increased post-operative pain, post-operative ileus, hypertension and even post-operative hypokalemia. Age, body mass index, hematocrit, surgical indication and length of hospital stay were not associated with hypomagnesemia. Patients undergoing neo-adjuvant chemotherapy before surgery had significant incidence of hypomagnesemia both pre-operatively and post-operatively.Conclusions: Hypomagnesemia is quite prevalent in patients of gynecologic-oncology undergoing surgery. Pre-operative hypomagnesemia and even falling levels in post-operative period have a bearing on the final surgical outcome. Hence pre-operative and post-operative magnesium levels may be included as a valuable marker in all patients undergoing surgery for gynecologic malignancy.
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Ning, Mao, Yihan Zhao, Zhixin Li, and Jie Cao. "Ketosis Alters Transcriptional Adaptations of Subcutaneous White Adipose Tissue in Holstein Cows during the Transition Period." Animals 12, no. 17 (August 30, 2022): 2238. http://dx.doi.org/10.3390/ani12172238.
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Ketosis is a common nutritional, metabolic disease during the perinatal period in dairy cows characterized by elevated blood β-hydroxybutyrate (BHBA). In this study, RNA sequencing (RNA-seq) was performed to investigate adaptive changes in adipose tissue during the perinatal period of dairy cows. Blood and tailhead subcutaneous white adipose tissue (sWAT) were obtained from ketotic cows (Ket = 8, BHBA ≥ 1.4 mmol/L) and non-ketotic cows (Nket = 6, BHBA < 1.4 mmol/L) 21 d pre-partum and 10 d post-partum. Compared with pre-partum, decreased lipid synthesis due to down-regulation of PCK1 may be in a strong association with clinical ketosis. Simultaneously, PCK2 was downregulated in the Ket postnatally compared to its expression prenatally, and the expression of PCK2 was 2.7~4.2 times higher than that of PCK1, implying a more severe lipid storage impairment in the Ket. Moreover, compared to pre-partum, the upregulated differentially expressed genes post-partum in the Ket were enriched in the inflammatory response biological process. The higher expression of TNC (tenascin C) in the post-partum Ket relative to the Nket suggested that the adipose tissue of ketotic cows might also be accompanied by tissue fibrosis. Notably, pre-partum CD209 was higher in the Ket than in the Nket, which might be used as a candidate marker for the pre-partum prediction of ketosis. Combined with published gene expression traits, these results suggested that inflammation leads to a more widespread downregulation of the lipid synthesis gene network in adipose tissue in ketotic cows. Additionally, sWAT in post-partum cows with ketosis might also be accompanied by tissue fibrosis which could make the treatment of ketosis more difficult.
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AYDIN, Altan, Hakan BULUŞ, Alper YAVUZ, Mehmet Berksun TUTAN, Murat ALIŞIK, and Özcan EREL. "Comparison of Pre-Operative and Post-Operative Thiol-Disulfide Levels in Acute Abdomen Patients." Journal of Contemporary Medicine 13, no. 2 (March 22, 2023): 247–50. http://dx.doi.org/10.16899/jcm.1244258.
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Aim: To evaluate role of thiol and disulfide homeostasis, a novel marker of oxidative stress, in the follow-up acute abdomen.
Material and Method: This prospective study included 107 patients (62 men and 45 women) with a diagnosis of acute abdomen (AA). In all patients, age, gender and cause of acute abdomen were recorded. In addition, native thiol (-SH), total thiol (tSH) and disulfide (-S-S-) levels at baseline, admission and on postoperative day 3 were prospectively recorded and -SS-/-SH, -S-S-/tH and -SH/tSH ratios were calculated.
Results: When the causes of acute abdomen were assessed, it was seen that 72 patients (67.29%) underwent surgery due to appendicitis while 5 patients (4.67%) due to lower GIS perforation, 7 patients (6.54%) due to perforated peptic ulcer, 5 patients (4.67%) due to sigmoid volvulus, 4 patients (3.74%) due to strangulated hernia and 14 patients (13.08%) due to miscellaneous reasons. When thiol and disulfide levels were assessed as a single parameter, mean thiol level was 316.71±78.16 (327.5) at preoperative period and 264.00±72.85 (278.30) at postoperative period. The mean thiol level was significantly decreased at postoperative period (p
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Shahaf, Goded, Pora Kuperman, Yuval Bloch, Shahak Yariv, and Yelena Granovsky. "Monitoring Migraine Cycle Dynamics with an Easy-to-Use Electrophysiological Marker—A Pilot Study." Sensors 18, no. 11 (November 14, 2018): 3918. http://dx.doi.org/10.3390/s18113918.
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Migraine attacks can cause significant discomfort and reduced functioning for days at a time, including the pre-ictal and post-ictal periods. During the inter-ictsal period, however, migraineurs seem to function normally. It is puzzling, therefore, that event-related potentials of migraine patients often differ in the asymptomatic and inter-ictal period. Part of the electrophysiological dynamics demonstrated in the migraine cycle are attention related. In this pilot study we evaluated an easy-to-use new marker, the Brain Engagement Index (BEI), for attention monitoring during the migraine cycle. We sampled 12 migraine patients for 20 days within one calendar month. Each session consisted of subjects’ reports of stress level and migraine-related symptoms, and a 5 min EEG recording, with a 2-electrode EEG device, during an auditory oddball task. The first minute of the EEG sample was analyzed. Repetitive samples were also obtained from 10 healthy controls. The brain engagement index increased significantly during the pre-ictal (p ≈ 0.001) and the ictal (p ≈ 0.020) periods compared with the inter-ictal period. No difference was observed between the pre-ictal and ictal periods. Control subjects demonstrated intermediate Brain Engagement Index values, that is, higher than inter-ictal, yet lower than pre-ictal. Our preliminary results demonstrate the potential advantage of the use of a simple EEG system for improved prediction of migraine attacks. Further study is required to evaluate the efficacy of the Brain Engagement Index in monitoring the migraine cycle and the possible effects of interventions.
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Wassie, Molla Mesele, Lisa N. Yelland, Lisa G. Smithers, Enzo Ranieri, and Shao Jia Zhou. "Comparison of iodine status pre- and post-mandatory iodine fortification of bread in South Australia: a population study using newborn thyroid-stimulating hormone concentration as a marker." Public Health Nutrition 22, no. 16 (August 9, 2019): 3063–72. http://dx.doi.org/10.1017/s1368980019001915.
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AbstractObjective:The present study aimed to evaluate the effect of mandatory iodine fortification of bread on the iodine status of South Australian populations using newborn thyroid-stimulating hormone (TSH) concentration as a marker.Design:The study used an interrupted time-series design.Setting:TSH data collected between 2005 and 2016 (n 211 033) were extracted from the routine newborn screening programme in South Australia for analysis. Iodine deficiency is indicated when more than 3 % of newborns have TSH > 5 mIU/l.Participants:Newborns were classified into three groups: the pre-fortification group (those born before October 2009); the transition group (born between October 2009 and June 2010); and the post-fortification group (born after June 2010).Results:The percentage of newborns with TSH > 5 mIU/l was 5·1, 6·2 and 4·6 % in the pre-fortification, transition and post-fortification groups, respectively. Based on a segmented regression model, newborns in the post-fortification period had a 10 % lower risk of having TSH > 5 mIU/l than newborns in the pre-fortification group (incidence rate ratio (IRR) = 0·90; 95 % CI 0·87, 0·94), while newborns in the transitional period had a 22 % higher risk of having TSH > 5 mIU/l compared with newborns in the pre-fortification period (IRR = 1·22; 95 % CI 1·13, 1·31).Conclusions:Using TSH as a marker, South Australia would be classified as mild iodine deficiency post-fortification in contrast to iodine sufficiency using median urinary iodine concentration as a population marker. Re-evaluation of the current TSH criteria to define iodine status in populations is warranted in this context.
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Tarasova, Irina Aleksandrovna, Alexey Leonidovich Shestakov, and Vladimir Vladimirovich Nikoda. "Post-operative insulin resistance." Diabetes mellitus 20, no. 2 (June 20, 2017): 119–25. http://dx.doi.org/10.14341/7637.
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Post-operative insulin resistance (IR) is a recognised marker of surgical stress. However, the reasons underlying post-operative IR and its clinical value are still unclear. IR has been described as a pathological condition, in which organs and tissues fail to respond to the hormone insulin, resulting in acute hyperglycaemia. Post-operative IR in patients without type 2 diabetes has been identified as an independent, negative predictor of post-operative outcome. Studies have shown a direct relationship between post-operative morbidity (including complications from infection) and total mortality in patients with acute hyperglycaemia compared with diabetic patients. IR and stress-induced hyperglycaemia in the early post-operative period may be corrected by insulin infusion; however, this has often been associated with hypoglycaemia. Detection and modification of risk factors in the pre- and intra-operative periods may decrease the frequency of IR and hyperglycaemia and eliminate the use of insulin. In this literature review, the mechanisms underlying the development and prevention of post-operative IR, and its clinical value are discussed. This study demonstrates the relationship between IR and post-operative morbidity, highlighting the benefits of a complex approach to prevent the adverse events of post-operative IR and stress-induced hyperglycaemia.
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Siracusa, C., X. Manteca, J. Cerón, S. Martínez-Subiela, R. Cuenca, S. Lavín, F. Garcia, and J. Pastor. "Perioperative stress response in dogs undergoing elective surgery: variations in behavioural, neuroendocrine, immune and acute phase responses." Animal Welfare 17, no. 3 (August 2008): 259–73. http://dx.doi.org/10.1017/s0962728600032188.
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AbstractThe aim of this trial was to describe the behavioural, neuroendocrine, immune and acute phase stress responses in dogs undergoing elective surgery in normal, clinical practice conditions. Sixteen dogs were submitted to elective orchiectomy or ovariohysterectomy using a standardised surgical protocol. Each animal was confined to the Intensive Care Unit during pre- and post-surgery and perioperative behavioural, neuroendocrine, immune and acute phase responses were studied. Behavioural categories, cortisol, prolactin, white blood cell, C-reactive protein and haptoglobin variation were evaluated. Values at different times were compared with basal values shown by the dog in its usual environment. Communicative and explorative behaviours showed high occurrence pre-surgery and were inhibited post-surgery. Decreases in post-surgery activity, interactive behaviours and changes in waking/sleeping patterns were observed. The most sensitive marker of psychological stress, cortisol, in comparison with basal values, showed a significant increase both during pre- and post-surgery confinement in the ICU cage. Prolactin values were characterised by a significant decrease early into the post-surgery period. The immune response was characterised by long-term neutrophilia and monocytosis, but by short-term lymphopaenia and eosinopaenia, limited to the early post-operative period. With regard to the acute phase response, both C-reactive protein and haptoglobin showed a long-term increase, post-surgery. Changes in behavioural, haematological and biochemical markers showed that perioperative stress represents a major challenge to dog welfare.
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Kim, Heeje, Jae-Ho Yoon, Seung-Ah Yahng, Sung-Eun Lee, Seung-Hwan Shin, Byung-Sik Cho, Jong-Wook Lee, and Woo-Sung Min. "Clinico-Immunobiologic Study By a Prospective Open-Label Clinical Trial of Deferasirox before & after Allogeneic HSCT in Adult Patients with AML - Preliminary Analysis Focusing on Outcomes with Immunocyte Subsets (I) -." Blood 124, no. 21 (December 6, 2014): 2543. http://dx.doi.org/10.1182/blood.v124.21.2543.2543.
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Abstract Background: The ferritin contents in immature myeloid cells could be detected in both iron overload and in AML. Ferritin itself in leukemic cells could be regarded as an important marker for leukemic activity. Serialreports have shown that the serum ferritin level in patients with acute leukemia and myelodysplastic syndrome is a critical prognostic factor after hematopoietic stem cell transplantation (HSCT). However, the exact mechanism itself is not clear. Methods: We evaluated the iron chelating efficacy and the immunomodulatory effect of deferasirox therapy as assessed by regular monitoring of serum ferritin levels and immunocyte subsets from the post-induction period to post-HSCT. In addition, we tried to reveal the effects of deferasirox on various clinical outcomes in patients with adult AML who were expected to receive allogeneic HSCT. A total of sixty-six consecutive adult patients with de novo AML who received allogeneic HSCT were prospectively enrolled during the period 2009 to 2011. Serum ferritin levels were monitored from initial diagnosis to the post-HSCT period from both the iron-chelated group (IC, n=28) and the non-treated group (NT, n=38) of patients. Among the patients of the IC group, the final 20 AML patients were followed and were collected peripheral blood samples until minimum 6 months post-HSCT. The overall median follow-up for total survivors (IC) was 58 months (range: 48~66). Deferasirox treatment was initiated at the outpatient clinic both after induction chemotherapy and post-HSCT 1 month. Various clinical outcomes in association with multiple parameters including serum ferritin levels and multiple immunocyte subsets of CD4, CD8, CD16, CD56, invariant NKT, Treg, central/effector memory T cells were simultaneously analyzed, mainly in the IC group of patients, with the usage of the multi-color flow cytometer at pre- and post-HSCT periods. Results: The median duration of total (pre- + post-HSCT) medication in IC group of patients was 241 days (109-452). The median ferritin levels at diagnosis (IC, 651 ng/mL vs. NT, 667 ng/mL) and at peak levels (IC, 3,090 ng/mL vs. NT, 3,685 ng/mL) during chemotherapy did not differ significantly between groups. However, pre-HSCT levels were different between groups, as the median level of 1,555 ng/mL (335-3,800) (IC) vs. 964 ng/mL (229-7,360) (NT). The 5-year overall survival (OS) and event-free survival (EFS) rates of total AML patients were 63.6% and 60.6%, respectively. The Kaplan-Meier estimates of OS/EFS rates were all significantly different in pre-HSCT ferritin levels (P=0.0247, 0.0212) and duration of deferasirox treatment both pre- (P=0.028, 0.0166) and post-HSCT (P=0.0102, 0.0064). The levels of CD4+CD62L-CD44+ (P=0.027) and CD8+CD62L-CD44+ cells (P=0.006) post-induction chemotherapy were significantly associated with the duration of deferasirox treatment before HSCT. To note, the levels of CD4+ cells at 1 month post-HSCT deferasirox treatment (P=0.017), CD4+ effector memory T (TEM)-cells pre-HSCT (P=0.029), and CD8+CD62L-CD44+ cells post-HSCT 1 month (P=0.003) and 6 months (P=0.021) were closely related to the relapse of AML. Most of all, regulatory T (Treg) cells both pre-HSCT (P=0.002) and post-HSCT (P <0.001) periods after deferasirox therapy showed a very close correlation with various clinical outcomes, specifically with lower rates of relapse in patients with low levels of Treg after at least 120 days in total use of deferasirox before and after HSCT. Interestingly, patients who received deferasirox therapy for a sufficient duration showed consistently lower levels of Treg cells as well as higher levels of CD16+ NK cells along the timeline of chemotherapy and HSCT compared to those who did not. Furthermore, we found a marginal significance in the increased levels of CD4+CD161+ NKT cells at post-induction chemotherapy when patients received deferasirox before HSCT (P=0.056). Conclusion: Our data suggest that despite small sample numbers, iron-chelation therapy for adult AML patients with hyperferritinemia pre- and post-HSCT is very closely related to the outcomes of allogeneic HSCT, and that it is especially associated with the modulation of immunobiologic properties during the period of immune reconstitution. Therefore, more cautious approaches to reduce iron overload by using iron chelating agents, such as deferasirox, may be warranted both before and after allogeneic HSCT. Disclosures Kim: Novartis Korea: Research Funding.
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Koroukian, Siran M., Weichuan Dong, Kirsten Eom, Uriel M. Kim, Johnie Rose, Jeffrey Albert, Cynthia Owusu, Kristine Zanotti, Gregory S. Cooper, and Jennifer Tsui. "Abstract A061: Receipt of standard treatment by breast cancer patients on Medicaid, pre- and post-expansion." Cancer Epidemiology, Biomarkers & Prevention 32, no. 1_Supplement (January 1, 2023): A061. http://dx.doi.org/10.1158/1538-7755.disp22-a061.
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Abstract Background: Medicaid expansion in Ohio went into effect in 2014. While prior studies have shown earlier breast cancer stages at diagnosis post-expansion, its impact relative to receipt of standard treatment remains understudied. Here, we examined changes in stage-appropriate standard treatment by women with invasive incident breast cancer pre- and post-expansion, and by their timing of enrollment in Medicaid relative to cancer diagnosis – a key marker of inadequate access to care. Methods: We used 2011-2017 Ohio Cancer Incidence Surveillance System (OCISS) data linked with Medicaid enrollment and claims files. Our study population included women 18-65 years of age diagnosed with local- or regional-stage cancer (n=1,053 and n=2,264 women in the pre- and post-expansion periods, respectively). We identified women as Previously Enrolled if they enrolled in Medicaid at least 3 months prior to cancer diagnosis and remained continuously enrolled for 4 months post-diagnosis, and as Newly Enrolled if they enrolled in Medicaid in the 3 months before or after cancer diagnosis. We used the OCISS for sociodemographic and treatment data. We defined standard treatment as the receipt of mastectomy, or lumpectomy and radiation in all women. In those with regional-stage cancer, we required standard treatment to also include chemotherapy; and for those with positive hormonal status, we required hormonal therapy. From claims data, we identified comorbid conditions, grouped as none, physical conditions only, mental conditions only, and physical and mental conditions, with or without substance abuse. In addition to descriptive analysis, we conducted multivariable logistic regression analysis to evaluate the independent association between Medicaid expansion and receipt of standard treatment, after adjusting for patient demographics, tumor characteristics, and comorbid conditions. Results: The median age was 50.6 years and 51.8 years in the pre- and post-expansion periods. The percent of Newly Enrolled women relative to the total decreased from 24.8% to 18.9%. Women in this group were healthier than those in the Previously Enrolled group, as evidenced by the higher percent of women with no comorbid conditions (43.3% and 42.4% vs. 21.7% and 22.5%, Pre- and Post-expansion, respectively). From Pre- to Post-Expansion, receipt of standard treatment increased from 52.3% to 58.8% and from 58.6% to 61.6% among the Previously and Newly Enrolled, respectively. Results from the multivariable logistic regression analysis showed that compared to women diagnosed in the pre-expansion period, those diagnosed in the post-expansion period had 10% higher odds to receive standard treatment, after adjusting for patient covariates. Conversely, the timing of enrollment in Medicaid relative to cancer diagnosis was not associated with our outcome of interest. Conclusion: Medicaid expansion in Ohio was associated with improvements in receipt of stage-appropriate standard treatment for breast cancer. Future studies should elucidate the mechanisms at play. Citation Format: Siran M. Koroukian, Weichuan Dong, Kirsten Eom, Uriel M. Kim, Johnie Rose, Jeffrey Albert, Cynthia Owusu, Kristine Zanotti, Gregory S. Cooper, Jennifer Tsui. Receipt of standard treatment by breast cancer patients on Medicaid, pre- and post-expansion [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A061.
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Iliopoulos, Ilias, Matthew N. Alder, David S. Cooper, Enrique G. Villarreal, Rohit Loomba, Rashmi D. Sahay, Lin Fei, Paul E. Steele, and Saul Flores. "Pre-operative neutrophil–lymphocyte ratio predicts low cardiac output in children after cardiac surgery." Cardiology in the Young 30, no. 4 (March 5, 2020): 521–25. http://dx.doi.org/10.1017/s1047951120000487.
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AbstractNeutrophil–lymphocyte ratio has been associated with clinical outcomes in several groups of cardiac patients, including patients with coronary artery disease, cardiac failure, and cardiac transplant recipients. We hypothesised that pre- and/or post-operative haematological cell counts are associated with clinical outcomes in children undergoing cardiac surgery for CHD. We performed a post hoc analysis of data collected as part of a prospective observational cohort study (n = 83, data available n = 47) of children evaluated for glucocorticoid receptor levels after cardiac surgery (July 2015–January 2016). The association of neutrophil–lymphocyte ratio with low cardiac output syndrome, time to inotrope free, and vasoactive-inotropic score was examined using proportional odds analysis, cox regression, and linear regression models, respectively. A majority (80%) of patients were infants (median/interquartile range 4.1/0.2–7.6 months) with conotruncal (36%) and left-sided obstructed lesions (28%). Two patients required mechanical circulatory support and three died. Higher pre-operative neutrophil–lymphocyte ratio was associated with higher cumulative odds of severe/moderate versus mild low cardiac output on post-operative day 1 (odds ratio 2.86; 95% confidence interval 1.18–6.93; p = 0.02). Pre-operative neutrophil–lymphocyte ratio was not significantly associated with time to inotrope free or vasoactive-inotrope score. Post-operative neutrophil–lymphocyte ratio was also not associated with outcomes. In children after congenital heart surgery, higher pre-operative neutrophil–lymphocyte ratio was associated with a higher chance of low cardiac output in the early post-operative period. Pre-operative neutrophil–lymphocyte ratio maybe a useful prognostic marker in children undergoing congenital heart surgery.
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Nikonenko, A. S., and O. O. Tanska. "The ST2 diagnostic value in selection of patients for heart transplantation and post-transplant period." Modern medical technologies 40, no. 1 (February 19, 2019): 4–11. http://dx.doi.org/10.34287/mmt.1(40).2019.1.
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Purpose of the study. Study ST2 diagnostic marker in the development and severity of heart failure, evaluation of transplant status and the risk of developing a rejection crisis, as well as the risk of death in patients with cardiovascular disease.Material and methods. There were 41 patients under observation. The cases were conventionally divided into two groups: the first group of patients with chronic heart failure (n = 28), and the control group who performed orthotopic transplantation of the heart (n = 13).Results and discussion. These results suggest that ST2 is a real marker of chronic heart failure or a good predictor of mortality in decompensated patients. Changes in ST2 levels in patients after orthotopic cardiac transplantation may be potentially useful in detecting acute cellular rejection, as well as in controlling rejection therapy. The article is devoted to the analysis of the prognostic role of the ST2 biomarker in the pre and post-transplantation period. ST2 is one of the most promising diagnostic markers for the development and severity of heart failure, as well as the risk of death in patients with cardiovascular disease. ST2 is expressed in cardiomyocytes in response to pathological processes and various mechanical damage in the heart, which allows to diagnose cardiovascular diseases even before clinical manifestations. It is likely that ST2 level measurement of heart transplantation may have a diagnostic and prognostic value when evaluating the graft state and the risk of developing rejection.Conclusions. ST2 is one of the most promising diagnostic markers of development and severity of heart failure, as well as the risk of death in patients with cardiovascular disease. ST2 is expressed in cardiomyocytes in response to pathological processes and various mechanical damage in the heart, which allows to diagnose cardiovascular diseases even before clinical manifestations. Measuring the level of ST2 for heart transplantation may have a diagnostic and prognostic value in evaluating the condition of the graft and the risk of developing rejection. Keywords:heart failure, ST2, heart transplantation, rejection crisis.
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Safyan, Rachael A., Matthen Mathew, Enrica Marchi, and Melissa Kate Accordino. "Bone marrow aspirate quality assessment." Journal of Clinical Oncology 35, no. 8_suppl (March 10, 2017): 76. http://dx.doi.org/10.1200/jco.2017.35.8_suppl.76.
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76 Background: Bone marrow evaluation is the cornerstone of diagnosis, staging, and measurement of treatment response for many hematologic diseases. Aspirate adequacy is defined by whether the procedure results in a specimen of sufficient quality for pathologic review. Between July 1, 2014 and June 30, 2015, 49.3% of inpatient bone marrow aspirates performed by Hematology/Oncology fellows at Columbia University Medical Center were classified as suboptimal. Methods: We used the Plan-Do-Study-Act methodology to 1) understand the factors contributing to suboptimal aspirates, 2) evaluate the scope of the problem at both fellowship and institutional levels, 3) develop a training seminar to educate fellows on the procedure techniques, and 4) monitor for improvement post-intervention. We identified inpatient bone marrow biopsies performed by Hematology/Oncology fellows between July 1, 2015 and June 30, 2016 and tabulated aspirate adequacy as noted in the reports. A faculty-led educational seminar was held on February 1, 2016. Fellows completed a pre- and post-intervention survey to assess knowledge and experience with bone marrow aspirates. Bone marrow biopsy billing data was used as a surrogate marker for attending supervision. Results: All Hematology/Oncology fellows (n = 19) at Columbia University Medical Center participated. The pre-intervention survey (18 responses; 94.7%) revealed 76.5% of fellows had formal bone marrow aspirate training, 66.6% had supervision 25% to 75% of the time, and 52.9% were uncomfortable performing the procedure alone. Of the 43 aspirates from the pre-intervention period, 22 (51.2%) were adequate. 94.7% of fellows attended the training seminar. Post-intervention, 27 of 50 (54%) bone marrow aspirates were adequate. The post-intervention survey (16 responses; 84.2%) showed 93.3% of fellows were confident performing the procedure alone. There were fewer procedures billed in the post-intervention period (20.9% pre vs 8% post). Conclusions: A formal educational seminar on bone marrow aspirate technique increased fellow comfort with the procedure and trended toward improved aspirate adequacy. The next study phase will institute an annual training session for incoming fellows and create a bone marrow specimen preparation checklist.
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Lan, Yuming, Junjie Lu, Guohong Qiao, Xuhua Mao, Jianxin Zhao, Gang Wang, Peijun Tian, and Wei Chen. "Bifidobacterium breve CCFM1025 Improves Sleep Quality via Regulating the Activity of the HPA Axis: A Randomized Clinical Trial." Nutrients 15, no. 21 (November 6, 2023): 4700. http://dx.doi.org/10.3390/nu15214700.
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Psychobiotics, a newly identified category of probiotics primarily targeting the gut–brain axis, exhibit tremendous potential in improving sleep quality. In this study, the clinical trial was registered in advance (identifier: NO. ChiCTR2300067806). Forty participants who were diagnosed with stress-induced insomnia were chosen and randomly divided into two groups: one received CCFM1025 at a dose of 5 × 109 CFU (n = 20), while the other was administered a placebo (n = 20), over a period of four weeks. The results revealed that compared to the placebo group (pre: M = 10.10, SD = 2.292; post: M = 8.650, SD = 2.793; pre vs. post: F (1, 38) = 15.41, p = 0.4316), the CCFM1025-treated group exhibited a significant decrease in Pittsburgh Sleep Quality Index (PSQI) scores from baseline (pre: M = 11.60, SD = 3.169; post: M = 7.750, SD = 3.697, F (1, 38) = 15.41, p = 0.0007). Furthermore, the administration of CCFM1025 was associated with a more pronounced reduction in stress marker concentrations. This effect could potentially be linked to changes in serum metabolites induced by the probiotic treatment, notably daidzein. In conclusion, B. breve CCFM1025 demonstrates promise as a psychobiotic strain for enhancing sleep quality.
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Eros, E. "Premenstrual syndrome as a possible presymtomatic marker for negative outcomes of pregnancy." European Psychiatry 65, S1 (June 2022): S105. http://dx.doi.org/10.1192/j.eurpsy.2022.299.
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Introduction Hungarian Family Planning Service’s mission is decreasing the negative outcomes of pregnancy, including perinatal depression. Objectives Childbirth as a great irreversible life event is a normative crisis of the life, thus pregnancy and post-partum period are times of high risk for psychiatric symptoms. Stress in pre- and post-natal period has short and long-term effect on offspring. Women participating in family planning program should be evaluated for the high risk and specific preventive program are provided for them. Methods Between 2015-2018, 446 women were participating in family planning service. They were screened for premenstrual syndrome by using the shortened form of PAF questionnaire. We compared healthy and PMS affected patients’ data in according to the prevalence of PPD, spontaneous abortion and period needed for conception. Results Prevalence of PMS in our sample was 51.4%. Overage duration between wished and realized conception was 6.1 months in healthy group vs 9.2 months in PMS group. Post-natal depression was screened by Edinburgh Post-natal Scale and it showed about 4-times higher prevalence between affected women by PMS. Surprising the rate of spontaneous abortion was 2-times higher, although the absolute number is rather low for statistical validation. Conclusions Women affected by PMS can be considered as high risk for perinatal mood disorders and negative outcomes of pregnancy. PMS can be useful as a presymptomatic marker of perinatal depression and may be increased risk for spontaneous abortion. Psychological aspect should be included into the periconceptional care. Family planning may be an optimal solution to prevent perinatal depression and its complication. Disclosure No significant relationships.
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Sailo, Lalrintlingi, Apurba Sarkar, and Suresh Babu. "A STUDY ON STATUS OF URINARY HYDROXYPROLINE IN POST MENOPAUSAL WOMEN." International Journal of Advanced Research 9, no. 03 (March 31, 2021): 136–46. http://dx.doi.org/10.21474/ijar01/12566.
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Introduction: WHO and the Stages of Reproductive Aging Workshop have defined menopausal transition as the time of an increase in follicle-stimulating hormone and either increased variability in menstrual cycle length, two skipped menstrual cycles with 60 days or more of amenorrhea, or both. It concludes with the final menstrual period. Post-menopause begins at that time, although it is not recognized until after 12 months of amenorrhea. During menopause, women face various physiological, psychological, and biochemical changes. Laboratory medicine has given a new background to overcome the clinicianÂÂs diagnostic dilemma. Hydroxyproline is mainly found in collagen and accounts for 13% of total amino acid content and derived from proline by post-translational hydroxylation. Hydroxyproline is derived from another amino acid such as proline. Direct urinary assay of hydroxyproline to measure bone resorption have clinical applications as part of screening programs to assess the risk of osteoporotic fractures. Method: A total of seventy patients with regular medical follow-up records, The Patients were pre and post-menopausal women (35 each) recruited for this study. Patient details like body mass index, education, smoking, alcohol intake, dietary habits, and family history were considered before selecting the patients. Analytical Methods: Urinary Hydroxyproline and Urinary creatinine was estimated by Modified Neumann et al and Spectrophotometric JaffeÂÂs reaction respectively. Result: The study population consisted of 70 participants of premenopausal (n=35) and postmenopausal women (n=35), mean age of 38.11 ± 4.3 and 54.40 ± 4.6 respectively. The bone mineralization marker urinary total hydroxyproline was quantified in pre and post-menopausal women, which is 80.3 ± 75mg/L and 136 ± 103mg/L respectively. The urinary creatinine level in pre and post-menopausal women was 53.7 ± 14.2mg/dL and 37.0 ± 27.3 respectively. The hydroxyproline: creatinine ratio (HCR) was 41% to 69% against the normal reference interval in pre and post-menopausal women. Conclusion: The obtained normative data for the premenopausal woman population would be a new reference range in Indian sub-population or otherwise general population normative reference range commonly being used as a reference interval in all kind of pathophysiological disorders. Hence, the derived parameter confirmed that HCR is the most prognostic significant diagnostic marker in pre and post-menopausal patients.
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Shrivastava, Mayank, Anoop Kumar Dhanak, Ajay Mathur, and Ramji Sharma. "Brain natriuretic peptide: new surrogate marker for adequacy of anti-hypertensive treatment." International Journal of Advances in Medicine 4, no. 1 (January 23, 2017): 214. http://dx.doi.org/10.18203/2349-3933.ijam20170114.
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Background: High blood pressure (hypertension) is one of the preventable causes of premature morbidity and mortality. The objective of this study was to assess the difference in mean BNP level at baseline and 3months after start of treatment among newly diagnosed hypertensive cases up to 35 years.Methods: Study was carried out on fifty newly diagnosed hypertensive patients over a period of three months satisfying inclusion criteria. Pre and post treatment BNP level were measured and analysed.Results: 39 (78%) cases out of 50 cases have high BNP in which 5 (10%) cases are in <30 year age group and 34 (68%) cases are in <30 year age group, High BNP level are significant in both age group with p value <0.01. 10 (20%) cases of age <30 year have normal BNP after antihypertensive treatment and 40 (80%) cases of age <30 year out of which 31 (62%) have normal BNP level and 9 (18%) cases have abnormal BNP level after antihypertensive treatment. Mean BNP level in pre antihypertensive treatment is (143.92±25.19) and post treatment is (117.26±11.20), And Mean change in BNP level pre and post treatment is (26.66±20.75) with p value <0.001which is statistically highly significant.Conclusions: Out of many risk factors for raised BNP level, hypertension is also one of the most prevalent factors for raised BNP level. Positive correlation was found between Blood pressure and BNP level reduction after antihypertensive treatment which is highly significant. Thus Potential clinical application of BNP can be expanded, regarding monitoring the adequacy of treatment. By which we can prevent or delay the progression of disease (hypertension).
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Rizzuto, MA, A. Allard Brown, K. Kim, K. So, N. Manouchehri, M. Webster, S. Fisk, et al. "P.187 Evaluating congruency between intramedullary and subdural pressure in a porcine model of acute spinal cord injury." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 48, s3 (November 2021): S74. http://dx.doi.org/10.1017/cjn.2021.463.
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Background: Clinical guidelines recommend MAP maintenance at 85-90 mmHg to optimize spinal cord perfusion post-SCI. Recently, there has been increased interest in spinal cord perfusion pressure as a surrogate marker for spinal cord blood flow. The study aims to determine the congruency of subdural and intramedullary spinal cord pressure measurements at the site of SCI, both rostral and caudal to the epicenter of injury. Methods: Seven Yucatan pigs underwent a T5 to L1 laminectomy with intramedullary (IM) and subdural (SD) pressure sensors placed 2 mm rostral and 2 mm caudal to the epicenter of SCI. A T10 contusion SCI was performed followed by an 8-hour period of monitoring. Axial ultrasound images were captured at the epicenter of injury pre-SCI, post-SCI, and hourly thereafter. Results: Pigs with pre-SCI cord to dural sac ratio (CDSR) of >0.8 exhibited greater occlusion of the subdural space post-SCI with a positive correlation between IM and SD pressure rostral to the injury and a negative correlation caudal to the epicenter. Pigs with pre-SCI CDSR <0.8 exhibited no correlation between IM and SD pressure. Conclusions: Congruency of IM and SD pressure is dependent on compartmentalization of the spinal cord occurring secondary to swelling that occludes the subdural space.
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Porta, Alberto, Angela Fantinato, Vlasta Bari, Francesca Gelpi, Beatrice Cairo, Beatrice De Maria, Enrico Giuseppe Bertoldo, et al. "Evaluation of the impact of surgical aortic valve replacement on short-term cardiovascular and cerebrovascular controls through spontaneous variability analysis." PLOS ONE 15, no. 12 (December 10, 2020): e0243869. http://dx.doi.org/10.1371/journal.pone.0243869.
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We assessed the effect of surgical aortic valve replacement (SAVR) on cardiovascular and cerebrovascular controls via spontaneous variability analyses of heart period, approximated as the temporal distance between two consecutive R-wave peaks on the electrocardiogram (RR), systolic, diastolic and mean arterial pressure (SAP, DAP and MAP) and mean cerebral blood flow (MCBF). Powers in specific frequency bands, complexity, presence of nonlinear dynamics and markers of cardiac baroreflex and cerebral autoregulation were calculated. Variability series were acquired before (PRE) and after (POST) SAVR in 11 patients (age: 76±5 yrs, 7 males) at supine resting and during active standing. Parametric spectral analysis was performed based on the autoregressive model. Complexity was assessed via a local nonlinear prediction approach exploiting the k-nearest-neighbor strategy. The presence of nonlinear dynamics was checked by comparing the complexity marker computed over the original series with the distribution of the same index assessed over a set of surrogates preserving distribution and power spectral density of the original series. Cardiac baroreflex and cerebral autoregulation were estimated by assessing the transfer function from SAP to RR and from MAP to MCBF and squared coherence function via the bivariate autoregressive approach. We found that: i) orthostatic challenge had no effect on cardiovascular and cerebrovascular control markers in PRE; ii) RR variance was significantly reduced in POST; iii) complexity of SAP, DAP and MAP variabilities increased in POST with a greater likelihood of observing nonlinear dynamics over SAP compared to PRE at supine resting; iv) the amplitude of MCBF variations and MCBF complexity in POST remained similar to PRE; v) cardiac baroreflex sensitivity decreased in POST, while cerebrovascular autoregulation was preserved. SAVR induces important changes of cardiac and vascular autonomic controls and baroreflex regulation in patients exhibiting poor reactivity of cardiovascular regulatory mechanisms, while cerebrovascular autoregulation seems to be less affected.
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Nakamae, Mika, Hirohisa Nakamae, Hideo Koh, Takahiko Nakane, Mitsutaka Nishimoto, Asao Hirose, and Masayuki Hino. "Prognostic Value for Survival of Serum Ferritin Levels Over Time After Allogeneic Hematopoietic Cell Transplantation." Blood 120, no. 21 (November 16, 2012): 4466. http://dx.doi.org/10.1182/blood.v120.21.4466.4466.
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Abstract Abstract 4466 A significant association between iron overload prior to allogeneic hematopoietic cell transplantation (HCT) and worse prognosis following HCT has been reported. In most previous reports, the serum ferritin level before HCT was used as a surrogate marker of iron load. However, serum ferritin level is known to be increased by acute inflammation, including that due to infection, and/or active hematological diseases. The prognostic value of serum ferritin level has not been evaluated taking into consideration the influence of acute inflammation. In addition, little is known about changes in serum ferritin levels following HCT or the prognostic value for survival after HCT, particularly in the late period post HCT. Here we comprehensively evaluated the impact of serum ferritin level after HCT as well as pre HCT on survival. We retrospectively studied 204 evaluable patients who had undergone HCT in our institute between February in 2004 and December in 2011, and who had available serum ferritin data pre HCT (median age 46, males 114 and females 90). The median follow-up period among surviving patients was 1023 days. We analyzed the impact of serum ferritin level pre HCT on overall survival after adjusting for various positive and negative acute phase reactants including haptoglobin, fibrinogen, CRP and serum albumin levels in multivariate analysis. On univariate analysis, serum ferritin level pre HCT significantly affected overall survival (ferritin per 100 ng/ml, HR: 1.003, p=0.008) and overall survival significantly worsened as serum ferritin level pre HCT increased (p for trend =0.01). However, after adjustment for haptoglobin or serum albumin levels, the relationship between serum ferritin pre HCT and survival was no longer statistically significant. Disclosures: No relevant conflicts of interest to declare.
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Powell, D. J., S. G. Velleman, A. J. Cowieson, and W. I. Muir. "Methionine concentration in the pre-starter diet: its effect on broiler breast muscle development." Animal Production Science 57, no. 3 (2017): 448. http://dx.doi.org/10.1071/an15479.
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The effect of feeding diets of variable methionine concentration on breast muscle development was assessed in Ross 308 broiler chicks. Four isonitrogenous and isoenergetic starter diets were formulated to contain 7.8, 5.9, 4.6, and 3.4 g methionine/kg diet, and were provided for the first 7 days post-hatch. At 7 days of age all birds were placed on an industry standard starter diet with 5.9 g methionine/kg diet until 14 days, and then provided standard broiler grower (until 28 days) and finisher (until 42 days) diets. Birds were weighed periodically throughout the study and feed intake and feed conversion ratio were determined. Ten birds per treatment were sacrificed and weighed on 0, 1, 4, 7, 14, 21, 28, 35, and 42 days. The pectoralis major (breast muscle) was then removed from the carcass and weighed. Samples of breast muscle were collected for genetic and histological analysis. Expression of the myogenic marker genes, myogenic differentiation factor 1 and myogenin, which regulate satellite cell activity, and the adipogenic marker gene, peroxisome proliferator-activated receptor gamma (PPARγ), was measured. Histological assessment of breast muscle morphology and fat deposition morphology was also performed. No effect of dietary treatment was observed on body or breast muscle weight, feed intake or feed conversion ratio. Marker gene expression was also similar in all treatment groups, except for PPARγ. Significantly higher expression of PPARγ was observed at 0 days in the 5.9 g methionine/kg diet treatment, before dietary treatments were provided. Expression of PPARγ did not differ among treatment groups on any subsequent day. Methionine dietary treatment had no effect on the morphological structure of the breast muscle, or intramuscular fat deposition. These results suggest that under the conditions of this study, satellite cell activity in the early post-hatch chick, and subsequent muscle development, were not responsive to the variable methionine manipulations tested in the pre-starter period.
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Entedhar R. Sarhat, , Nawal A. Al- Madani, and Nazar. A. Naji. "Evaluation of Serum Paraoxonase and Lipid Profile in Patients with Chronic Renal Failure Pre and post Hemodialysis." Tikrit Journal of Pure Science 22, no. 2 (January 21, 2023): 48–53. http://dx.doi.org/10.25130/tjps.v22i2.628.
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Chronic Renal Failure (CRF) is the progressive and irreversible loss of normal functioning of kidneys. this is associated with increased levels of some biochemical parameters and decreased others. This study aims to evaluate the value of serum paraoxonase-1 (PON1) activity as biochemical marker for patients with chronic renal failure (CRF) before and after hemodialysis (HD).
The samples of this study consists of 100 patients (55 males, 45 females) and 100 apparently healthy individuals (57 males, 43 females) from 20 - 70 years old of age. All patients included in this study were those who were receiving hemodialysis therapy in the dialysis unit in Kirkuk general Hospital from the period between February 2013 and May 2014. Serum PON1, BU, Cr, TC, TG, HDL, LDL levels were measured by spectrophotometric methods.Paraoxonase1 activity level was significantly lower in cases of CRF patients than in normal healthy control in pre hemodialysis (HD). It's level was significantly increased in post HD (P> 0.05). The blood urea (BU), serum creatinine (Cr), total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL) and very low density lipoprotein (VLDL) were significantly higher than normal healthy control in pre HD (P˂ 0.05), In post HD their levels were significantly decreased as compared to the pre HD (P˂ 0.05) but still lower than normal control, the serum high density lipoprotein (HDL) of CRF patients was significantly lower than normal controls (P˂ 0.05) in pre HD and was significantly increased in post HD as compared to pre HD but remained lower than normal healthy control. Conclusion: PON1 activity was significantly decreased in CRF patients before HD and significantly increased after HD but remained lower than controls. PON1 was significantly and negatively correlated with the age, BMI, duration of disease, BU, Cr, TC, TG, LDL, and VLDL. This study demonstrates that there is an increased risk of cardiovascular complications in CRF patients undergoing hemodialysis by increasing TC, TG, LDL, VLDL and decreasing HDL.
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Hohneck, Anna, Christina Reyser, Kirsten Merx, Simone Weingärtner, Athanasios Mavratzas, Gerhard Schumacher, Christoph Linhuber, Wolf-Karsten Hofmann, Iris Burkholder, and Ralf-Dieter Hofheinz. "Differential Effects of Sound Intervention and Rest on Cardiovascular Parameters in Cancer Patients: A Randomized Cross-over Trial." Integrative Cancer Therapies 20 (January 2021): 153473542199523. http://dx.doi.org/10.1177/1534735421995239.
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Background: Music therapy or sound interventions were shown to confer beneficial effects in patients with cancer for instance in terms of pain or fear relief and improvement of other patient reported outcomes. Cardiovascular parameters, especially heart rate variability (HRV) were found to have prognostic implications in cancer patients. In this trial we aimed to investigate the effects of a sound intervention on cardiovascular parameters compared to rest in patients with cancer. Methods and results: Using a randomized cross-over design, 52 patients (male 13, female 39) with cancer were recruited to receive both a 15-minute sound intervention and a 15-minute rest intervention within 4 weeks with at least a one-week blanking period. Cardiovascular parameters (among others HRV, aortic pulse wave velocity [PWV], augmentation index [Aix], aortic blood pressure [BP], heart rate [HR]) were assessed immediately before (pre) and after (post) the intervention had taken place. HRV (Root mean square of successive RR interval differences [RMSSD, ms]) significantly increased, during sound intervention (median RMSSD pre 24 [range 5-112] vs post 22 [range 9-141], P = .03). Likewise, median PWV, as a direct marker of arterial stiffness, was significantly reduced by sound intervention ([m/s] pre 8.5 [range 5.6-19.6] vs post 8.3 [range 5.6-15.6], P = .04). For both parameters no statistically significant change during rest was observed. HR was lowered by both, rest ( P < .0001) and sound intervention ( P = .02), with a more pronounced effect by rest. A significant increase in systolic aortic blood pressure was shown by rest ([mmHg] median 101 [range 78-150] vs post median 103 [range 71-152], P = .04) but not during sound intervention ( P = .59), while rest intervention led to a decrease in resistance index (pre median 33 [range 13-92] vs post median 32 [11-84], P = .02). Conclusion: In comparison with rest, a single sound intervention in patients with cancer improved cardiovascular parameters commonly associated with increased stress levels. Studies with longer follow-up and multiple interventions are warranted. Trial Registration: ISRCTN registry 70947363.
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Gurrib, Ikhlaas. "Performance of the Average Directional Index as a market timing tool for the most actively traded USD based currency pairs." Banks and Bank Systems 13, no. 3 (August 10, 2018): 58–70. http://dx.doi.org/10.21511/bbs.13(3).2018.06.
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The aim of this study is to test a trading system based on the average directional index, which is complemented with the parabolic stop and reverse indicator. The trend-based system is tested onto the most actively traded USD based foreign currency pairs, using both monthly and weekly data set over 2000–2018. Sharpe and Sortino measures are used to track the performance of the currency pairs, based on total risk and downside risk assumptions. Results are robust tested by decomposing the data into pre and post 2008 financial crisis. Using an investment horizon over 18 years, the reliance upon the monthly model produced lower maximum drawdowns and lesser trades than the weekly model. While Swiss Franc had the best (worse) performance in the monthly (weekly) based model, the Chinese Renminbi witnessed the worse (best) performance in the monthly (weekly) based model. Pre and post financial crisis decompositions suggest the weekly-based system is more reliable than the monthly one with relatively more trades and positive performance, where the Chinese Renminbi and Japanese Yen posted the highest Sharpe and Sortino values of 0.996 and 4.452 respectively in the post crisis period. Proportionately high level of negative returns coupled with relatively low positive Sharpe and Sortino values, however, suggest that a trading system relying on the average directional index and parabolic stop and reverse indicator to be further tested and analyzed at higher frequencies.
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Utami, Indah Wahyu Puji, Ismail Lutfi, Slamet Sujud Purnawan Jati, and Muhammad Yusuf Efendi. "Effectivity of Augmented Reality as Media for History Learning." International Journal of Emerging Technologies in Learning (iJET) 14, no. 16 (August 29, 2019): 83. http://dx.doi.org/10.3991/ijet.v14i16.10663.
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Augmented Reality (AR) as a learning media has a very great potential to help students learn history, including Indonesian ancient history. AR gave the opportunity for students to learn heritages from Indonesian’s ancient history, i.e. from Singhasari period, by scanning a marker that would show a 3D model in their smartphone screen. This research focussing on the effectivity of AR as media for history learning by comparing students’ score in a pre-test – post-test design. 30 students from 10th grade at a vocational high school involved in this quasi-experiment. Overall, the AR is effective as history learning media in improving students’ score.
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Sachan, Rekha, Munna Patel, Meenakshi Singh, Pushpalata Sachan, and Radhey Shyam. "Role of squamous cell carcinoma antigen in monitoring of treatment response of cervical and vaginal malignancies." Asian Journal of Oncology 03, no. 01 (January 2017): 066–70. http://dx.doi.org/10.4103/2454-6798.209338.
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Abstract Introduction: As per GLOBOCAN 2012 report Worldwide fourth most common cancer in the female is cervical cancer and approximately 528,000 new cases was found in 2012 in large majority of global burden was found in less developed country. India, the second most populous country in the world, accounts for 27% of the total cervical cancer deaths. The aim of this study was to assess the efficacy of squamous cells carcinoma antigen (SCC-Ag) in monitoring of response to treatment in cervical and vaginal cancer patients. Materials and Methods: This prospective case–control study was carried out over a period of 1 year in the Department of Obstetrics and Gynecology in collaboration with the Department of Internal Medicine and Pathology. Histopathologically confirmed study group included 8 cases of Stage I, 15 cases of Stage II, 15 cases of Stage III, 8 cases of Stage IV cervical malignancy, and 5 cases of vaginal carcinoma. About 15 healthy cervical cytology-negative women were taken as controls. Results: Out of 51 cancer cases SCC-Ag level were determined in only Stage I, II, III, and IV cases, assess the response to treatment. The mean SCC-Ag level in all four stage groups decreased significantly after post treatment as compared to pre treatment (P < 0.001) and the decrease in post treatment SCC-Ag level increased linearly with stage severity. Similarly, comparing the total or overall (Stage I + Stage II + Stage III) mean change (pre-post) in SCC-Ag level, t-test further revealed significant (P < 0.001) and decrease of 66.2% at posttreatment as compared to pretreatment. Conclusion: SCC-Ag might be a useful marker in monitoring the response to treatment.
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Kilinc, Yurdanur, Ferda Tekinturhan, Birol Guvenc, Refik Burgut, Ilgen Sasmaz, and Bulent Antmen. "Effect of the Erythrocyte Apheresis On Immunological Parameters in Sickle Cell Anemia Patients in Crisis Period." Blood 114, no. 22 (November 20, 2009): 4191. http://dx.doi.org/10.1182/blood.v114.22.4191.4191.
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Abstract Abstract 4191 PURPOSE: Erythrocyte apheresis is an effective therapy in the acute and chronic treatment of sickle cell anemia (SCA). The main goal of erythrocyte apheresis is to improve blood perfusion through reducing Hemoglobin S (HbS) to < %30 and keeping hemoglobin (Hb) at desired level. The aim of this study was to evaluate the effect of the erythrocyte apheresis on immunological parameters in SCA patients with crisis. METHODS Between February 2009 and June 2009, 37 patients (20 female / 17 male) received 44 apheresis treatments at Hemapheresis Unit of Cukurova University School of Medicine, Adana, Turkey. The median age was 22 (Range, 4-56) years and the mean body weight was 51.9±18.6 kilograms. The apheresis procedures were carried out using a Cobe Spectra Cell Separator. A mean of 1.77 body volume calculated red blood cell volumes were exchanged with a mean duration of 125.9±34.9 minutes (Table 1). Sickling negative and leukoreduced packed red cells were used for apheresis treatments. Hemoglobin electrophoreses, complete blood counts, immunoglobins, specific surface markers for T, B and natural killer (NK) cells were performed before and after each procedure. While three patients had a SCA-induced functional asplenia, none of the patients was HIV-seropositive. RESULTS The erythrocyte apheresis resulted in a decrease on white blood cell (WBC) counts as expected. Average pre and post apheresis WBC counts were 12883±5775/mm3 and 8506±3331/mm3 (p<0.001) respectively. Accordingly, a decrease in post procedure lymphocyte, monocyte and granulocyte counts was observed. Because small amounts of patient's plasma were removed with red blood cells during apheresis procedures, serum levels of immuglobulins were also decreased. CD3, CD4 and CD8 for T cells, CD11b for monocytes, CD20 for B cells, CD56 as a NK marker and CD45 for leukocytes were analyzed and all of surface markers showed an increase after erythrocyte apheresis. The average pre apheresis HbS level was 78.90±19.20%, whereas the mean post apheresis HbS level was found to be 23.85±13.27% (p<0.001) (Table 2). CONCLUSIONS The erythrocyte apheresis is an effective and rapid procedure to reduce HbS concentration without increasing blood viscosity. Apheresis treatments have also been found to be beneficial in decreasing the leukocyte counts and serum immunoglobulins levels in the blood. Flow cytometric analyses revealed that T, B and NK cells were increased after apheresis treatment. Interestingly, the change in CD4/CD8 ratio was not statistically significant (p>0.05). This shows that vascular wall integrity is maintained and apheresis can be safely performed in SCA patients. In our study, blood perfusion was restored and blood chemistry was improved to optimal levels after erythrocyte apheresis. As a result, crisis periods were shortened. Disclosures: No relevant conflicts of interest to declare.
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Trojnar, Marcin, Jolanta Patro-Małysza, Żaneta Kimber-Trojnar, Monika Czuba, Jerzy Mosiewicz, and Bożena Leszczyńska-Gorzelak. "Vaspin in Serum and Urine of Post-Partum Women with Excessive Gestational Weight Gain." Medicina 55, no. 3 (March 23, 2019): 76. http://dx.doi.org/10.3390/medicina55030076.
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Background and objectives: Data concerning vaspin in obstetric aspects are limited and conflicting. The aim of the study was to evaluate vaspin concentrations in the serum and urine of women with excessive gestational weight gain (EGWG) in the early post-partum period (i.e., 48 h after delivery), when placental function no longer influences the results. Materials and Methods: The study subjects were divided into two groups of 28 healthy controls and 38 mothers with EGWG. Maternal body composition and hydration status were evaluated by the bioelectrical impedance analysis (BIA) method. Concentrations of vaspin, fatty acid-binding protein 4 (FABP4), leptin, and ghrelin were determined via enzyme-linked immunosorbent assay (ELISA). Results: Serum vaspin levels were lower in the EGWG group, whereas no significant differences were noted between the groups, with regard to the urine vaspin concentrations. In both studied groups, the serum vaspin concentrations correlated positively with the urine FABP4 levels and negatively with gestational weight gain, body mass index gain in the period from pre-pregnancy to 48 h after delivery (ΔBMI), and fat tissue index (FTI). In the multiple linear regression models, the serum vaspin concentrations were positively dependent on the serum FABP4 levels, as well as negatively dependent on triglycerides, FTI, and ΔBMI. Conclusions: Our study revealed that the EGWG mothers were characterized by significantly lower serum vaspin concentrations in the early post-partum period compared with the subjects that had appropriate gestational weight gain. Our observation supports previous hypotheses that vaspin might be used as a marker of lipid metabolism in pregnancy and maternal adipose tissue. Considering the fact that FABP4 is widely referred to as a pro-inflammatory adipokine, further research on the protective role of vaspin seems crucial, especially in the context of its relationship to FABP4.
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Lu, Christine Y., Robert Jin, Fang Zhang, Stephanie Argetsinger, Andrea N. Burnett-Hartman, Jing Hao, Stacey A. Honda, Christine Neslund-Dudas, and Sheila Weinmann. "Tumor marker testing among Medicare beneficiaries with cancer after changes in insurance coverage for testing." Journal of Clinical Oncology 41, no. 16_suppl (June 1, 2023): e13656-e13656. http://dx.doi.org/10.1200/jco.2023.41.16_suppl.e13656.
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e13656 Background: Precision medicine has changed treatment practices for patients with cancer, and clinical guidelines now recommend tumor marker testing. Studies have demonstrated that tumor marker testing increases use of appropriate targeted therapies which is associated with improved survival, particularly among patients with advanced or metastatic cancer. In March 2018, Medicare issued a national coverage determination (NCD) for next-generation sequencing to facilitate tumor marker testing. We conducted a retrospective study to assess tumor marker testing among Medicare beneficiaries with cancer from 03/01/2016 through 02/29/2020. Methods: Data were obtained from the Virtual Data Warehouses of 6 United States (US) healthcare systems in the Health Care Systems Research Network, a well-established distributed data network for cancer research. Together these systems provide care to a diverse population of over 5.5 million people in the US. The index date for each individual was the first observed cancer diagnosis date recorded in the tumor registry during the study period. Subgroup analyses included those with lung, breast, colorectal, or prostate cancers, or those with advanced, metastatic or recurrent cancer. This is part of a larger project that aims to advance methods for scalable and rigorous evaluation of outcomes of coverage policies for genetic tests. Results: We report initial results from three health systems (03/01/2016-02/29/2020) including Medicare beneficiaries ≥65 years and ≥90 enrollment days on/after the index date. There were 10,048 Medicare beneficiaries with cancer in the pre-policy period (48.2% were female and mean [SD] age was 75 [6.9] years), and 7,160 Medicare beneficiaries with cancer in the post-policy period (47.7% were women and mean [SD] age was 75 [6.8] years). In the pre-policy period, 15.4% had a tumor marker test on/after 90 days of the index date, which increased by 1.7% to 17.1% after the policy (p<0.0001); and 47.9% started a cancer drug therapy on/after 90 days of the index date, which increased by 4.1% to 52.1% after the policy (p<0.0001), adjusting for age and sex and cancer type. Among Medicare beneficiaries with advanced, metastatic or recurrent cancer, 20.9% had a tumor marker test within 90 days of the index date in the pre-policy period, which increased by 3.0% to 23.9% after the policy (p= 0.009), and 65.1% started a cancer drug therapy on/after 90 days of the index date, which increased by 6.3% to 71.4% after the policy (p<0.0001), adjusting for age, sex, Charlson score, and cancer type. Conclusions: Tumor marker testing rate among Medicare beneficiaries with cancer in these health systems increased after the implementation of the 2018 Medicare NCD. Analyses are underway to examine changes in tumor marker testing, cancer treatments, and outcomes among Medicare beneficiaries by cancer type after the implementation of the 2018 Medicare NCD.
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Mayur, Manas. "An empirical investigation of market timing behavior: evidence from Indian IPOs." Investment Management and Financial Innovations 13, no. 3 (August 23, 2016): 84–92. http://dx.doi.org/10.21511/imfi.13(3).2016.07.
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The purpose of this paper is to investigate the market timing behavior of issuers of Indian Initial Public Offerings (IPOs). It was found that investor’s expectation that earnings growth will continue after IPO were not even sustained in post IPO period. The constant decline in P/E and M/B suggested that firms took advantage of over-optimism of investors. The deterioration in post IPO performance show that issuer took benefit of pre IPO profit margin knowing that the level would not be continued in the future. Considering that the issuers took advantage of favorable market condition, a multivariate analysis was carried out to examine whether issuers tried to maximize their proceeds through IPO or not. The idea is that any market timing aspect should get reflected in the effort to maximize proceeds in the favorable market condition. The result based on multivariate regression suggest that market timers, identified as firms that go public when the market is hot, tried to maximize the total proceeds at the time of IPO. The hot issue market effect was remarkably robust; it was significant for both firm and industry-level characteristics
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Cavas, Levent, and Leman Tarhan. "Effects of Vitamin-Mineral Supplementation on Cardiac Marker and Radical Scavenging Enzymes, and MDA Levels in Young Swimmers." International Journal of Sport Nutrition and Exercise Metabolism 14, no. 2 (April 2004): 133–46. http://dx.doi.org/10.1123/ijsnem.14.2.133.
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The relationship among the enzyme activities of cardiac markers, the antioxidant defense system, and erythrocyte membrane malonyldialdehyde (MDA) levels related to vitamin-mineral supplementation in swim exercise was investigated. Swimmers aged 11–13 years were divided into 2 separate groups as control and vitamin-mineral supplemented. Swimmers participated in a monthly swimming program (4 times/wk) and swam approximately 2–2.5 km/d. Cardiac markers such as creatine kinase (CK), creatine kinase-MB (CK-MB), glutamic oxaloacetic transaminase [GOT (AST)], lactate dehydrogenase (LDH), and antioxidant enzymes such as superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GSH-Px) activities in post-training samples were found to be significantly (p < .05) higher than in pre-training samples. Except for GOT (AST), the activity increases in CK, CK-MB, and LDH in female and male supplemented groups were significantly (p < .05) lower than those of control groups during the 1-month period of swim training. Antioxidant enzyme activity increases in the male vitamin-mineral group were significantly (p < .05) higher when compared with the other groups. Post-training MDA levels were significantly (p < .001) higher than pre-training MDA levels in the control groups, whereas no significant (p > .05) differences were found between the vitamin-mineral supplemented groups. Vitamin-mineral supplementation was found to attenuate cardiac and muscle damage markers while also enhancing antioxidant levels and reducing membrane LPO levels in response to 1 month of swim training.
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Elstrott, Benjamin, Hari H. S. Lakshmanan, Hannah Stowe McMurry, Malinda T. West, Sven Reid Olson, Thomas G. Deloughery, Joseph Aslan, and Joseph J. Shatzel. "Iron Repletion Increases Platelet Aggregation and Reduces Platelet Count in Iron Deficient Premenopausal Women." Blood 138, Supplement 1 (November 5, 2021): 3170. http://dx.doi.org/10.1182/blood-2021-154343.
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Abstract Background: Iron deficiency, heavy menstrual bleeding, and anemia are interrelated conditions with high prevalence in women's health. Together, they impact an estimated 310 million premenopausal women worldwide. Iron deficiency has been associated with development of anemia as well as thrombocytosis. However, the effects of iron deficiency on platelet function remain unknown. Objective: We set out to investigate the impact of IV iron repletion on platelet function, platelet count, and other blood cell indices in iron deficient premenopausal women. Methods: We conducted a prospective single-center study of iron deficient premenopausal women who underwent iron repletion with a single dose of 1000 mg of low molecular weight iron. Pre-infusion and post-infusion blood samples were obtained for laboratory analysis. Standard of care monitoring of iron indices and complete blood counts were also included in the analysis. Pre-infusion rates of anemia and thrombocytosis were calculated using minimum hemoglobin and peak platelet count in the 6 months preceding iron infusion. Platelet function was quantified by Fluorescence-Activated Cell Sorting (FACS) quantification of platelet activation marker antibodies for GPIIb/IIIa (PAC1) and P-selectin (CD62P) after exposure to multiple platelet agonists. Platelet aggregation was assessed by flow of anticoagulated whole blood at a shear rate of 300 s -1 for 5 minutes through chambers coated with type I collagen, imaged with differential interference contrast optics, and quantitatively represented through computation of percent total surface coverage. Pre-infusion and post-infusion cell indices and aggregation data were compared by paired samples t-test. All statistical analyses were performed in GraphPad Prism (Version 8.0.0). Results: Thirteen patients were included in the analysis. Heavy menstrual bleeding was the suspected cause of iron deficiency in 83% of patients. Thrombocytosis was present in 15% of patients at pre-infusion and no patients at post-infusion. Average ferritin was 14 µg/L at pre-infusion and 126 µg/L at post-infusion. The peak platelet count within 6 months pre-infusion was 309 K/mm 3 (±89) vs. 274 (±64) K/mm 3 at post-infusion (p<0.05). The average change to 6-month pre-infusion peak and post-infusion platelet count was -35.2 K/mm 3 (95%CI: -66.2, -5.23). The mean 6-month minimum hemoglobin was 11.9 (±1.9) g/dL vs. 13.3 (±1.1) g/dL at post-infusion (p<0.005). Acquisition of FACS platelet reactivity data are ongoing, with preliminary results for the first 7 consecutively enrolled study patients displayed in Figure 1. Platelet aggregation measured at pre-infusion showed 14% surface coverage, with a significant increase to 29% at post-infusion (p < 0.05). None of the 13 women experienced a thrombotic event during the study period. Conclusion: Correction of iron deficiency results in decreased platelet count and improves platelet aggregation over collagen. Iron repletion may also improve platelet reactivity in response to physiologic agonists. These findings may suggest that iron deficiency impairs hemostasis and that correction of low iron may be even more critical for women with heavy menstrual bleeding. Figure 1 Figure 1. Disclosures Shatzel: Aronora Inc,: Consultancy.
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Badhwar, Ankita, Dania Shakaroun, Seif Bugazia, Arthur Carlin, Timothy Roehrs, and Virginia Skiba. "0580 Predictors of PAP Compliance One Month After Bariatric Surgery." SLEEP 47, Supplement_1 (April 20, 2024): A248. http://dx.doi.org/10.1093/sleep/zsae067.0580.
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Abstract Introduction Obesity is a major risk factor for Obstructive sleep apnea (OSA). Bariatric surgery is a popular treatment modality for sustainable weight loss in obese patients with OSA. Meta-analysis of several randomized controlled trials and observational studies showed that bariatric surgery led to improvement in OSA severity but not cure. These patients will likely need continued treatment for OSA to minimize its complications. It is unclear what factors influence positive airway pressure (PAP) therapy adherence and compliance postoperatively. Our study aims to identify predictors of PAP compliance 1 month after bariatric surgery. Methods Patients who underwent bariatric surgery at our institution between April and October 2023 and had diagnosed obstructive sleep apnea were identified. The 140 patients were followed prospectively through surgery and 30-day post-surgery. Medical health records, polysomnography or home sleep study results, and on-line databases of PAP use were reviewed for each patient. We used Pearson correlation coefficient testing and t-test to examine potential predictors of PAP use in the 30-day post-operative period. Results There are statistically significant correlations (p < 0.05) between post-surgical PAP use and use during 7 days of initial set up (r = 0.642), time spent below 90% SpO2 during sleep testing (r = 0.425), time spent below 88% SpO2 (r = 0.246), pre-operative STOP-BANG (r = 0.200), and time from sleep testing to surgery (r = 0.242). Pre-surgical AHI and having been evaluated by a sleep physician pre-operatively did not show statistically significant association with post-operative PAP use. Conclusion PAP use during 7 days of initial set up is highly predictive of 1-month post-operative PAP use and may serve as a valuable marker to intervene on those patients with low use to improve long-term PAP use. Patients who were diagnosed with OSA close to their surgery had lower PAP use, suggesting patients may benefit from more time to get used to the treatment before having surgery. Support (if any)
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James, L. J., S. E. Allen, and K. M. Peltekian. "A96 PERIOPERATIVE RATE OF CHANGE IN SODIUM CONCENTRATION AND ITS IMPACT ON LENGTH OF STAY IN CRITICAL CARE UNIT POST LIVER TRANSPLANTATION: BENCHMARKING FOR QUALITY MANAGEMENT PROGRAM." Journal of the Canadian Association of Gastroenterology 3, Supplement_1 (February 2020): 111–13. http://dx.doi.org/10.1093/jcag/gwz047.095.
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Abstract Aims The aim of this quality improvement project was to benchmark the rate of change in serum sodium (delta-Na) in the perioperative period for liver transplantation (OLT) to correlate it with neurological complications as well as length of stay in critical care unit. Methods Data for total of 46 patients who underwent liver transplantation in Halifax between January 2015 and December 2016 were extracted from Atlantic Multi-Organ Transplant Program and QEII-HSC Information Systems. Pre-operative, immediate post-operative and 24–48 hours post-operative serum sodium concentrations were entered into EXCEL worksheet. In addition post-transplant neurological complications were identified in addition to length of stay in critical care unit. Results During the review period, 23 males and 23 females underwent OLT. Their mean age was 56 yrs (ranging from 23 - 70 yrs). The primary indication for transplantation was cirrhosis (57%) and hepatocellular carcinoma (35%). Fatty liver disease was most common etiology for cirrhosis (46%), followed by PBC (27%), Alcohol-related (15%). Average natural MELD-Na score was 20 (with a range from 7 – 41). Average OR time was 7hr 23min (range 4hr 15min – 15hr). In 22% of patients, the rate of delta-Na levels were rapid (more than 8 mEq/L) between the pre-operative and immediate post-operative period. Only 2% of patients had more than 8 mEq/L change in their serum sodium levels between the first and second post-operative days. Prior to OLT 21 (46%) patients had hepatic encephalopathy but this was mild or controlled in the majority of patients. In 8 (17%) patients there was multiple-etiology encephalopathy/delirium in the post-operative period. None of these patients developed neurological deficits. Only in 3 patients, tremors were documented (probably multifactorial including calcineurin-inhibitor toxicity). In this project, none of these findings correlated with a high rate of delta-Na. The average number of days in critical care unit was 6 (range 1 – 62 days). There was no clear correlation between length of stay (surrogate marker for neurologic complications) and rate of delta-Na. Conclusions In this benchmarking project, we were unable to identify a specific cut-off rate for delta-Na to correlate with either neurologic complication or length of stay in critical care unit. Rapid correction of serum sodium is often associated with various neurologic complications including central pontine myelinosis. Larger data-base with more numbers of liver transplant patients are needed to show any significant relationship and optimize the electrolyte and volume management. Rapid change in serum sodium could not help with our attempt to classify this benchmarking metric into one of four categories: productivity, quality, time and cost-related. Funding Agencies NoneKEVORK M PELTEKIAN
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FEDORENKO, T. V., N. V. KOLESNIKOVA, and E. F. FILIPPOV. "PRO – AND ANTI-INFLAMMATORY CYTOKINES ARE EARLY MARKERS OF ACUTE REJECTION OF THE TRANSPLANTED KIDNEY." Kuban Scientific Medical Bulletin 25, no. 3 (July 26, 2018): 119–24. http://dx.doi.org/10.25207/1608-6228-2018-25-3-119-124.
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Aim. Determination of diagnostic significance of pro − and anti-inflammatory cytokines in early prognosis of posttransplant renal failure in patients with chronic renal disease.Materials and methods. In the peripheral blood of patients with chronic kidney disease 6 hours before kidney transplantation, multiplex analysis using Simplex ProcartaPlex panel (Bioscience, USA) and xMAP technology (principle of flow cytometry) was used to estimate the content of 10 cytokines: 7 proinflammatory (IL-1b, IL-6, IL-12p70, IL-27, IL-17A, IL-18) and 3 antiinflammatory (IL-1RA, IL-4, IL-13). Identification of HLA-antibodies was carried out with the help of multiplex immunological analysis, using test systems (Gen-Prob, USA), flow analyzer Luminex 200 xMAP technology (bimolecular reactions on the surface of microspheres).Results. The limited diagnostic significance of HLA-antibodies is due to the fact that their detection in the posttransplantation period can be either in the development of acute graft rejection, or in the favorable course of the period after the operation. Meanwhile, the determination of a number of blood cytokines before kidney transplantation allows predicting post-transplantation rejection. In particular, certain criteria favorable course of the period after kidney transplantation by absence of HLA antibodies in patients with chronic renal failure can be considered as the initial (within 6 hours of transplantation) low levels of IL1β, IL6, IL17а. Prognostically the increase in the blood levels of proinflammatory cytokines − IL6, IL17a and anti-inflammatory IL1-RA is a significant marker of acute rejection of a transplanted kidney. Along with this, it is important to note that the appearance of HLA antibodies in patients with a favorable course of the post-transplantation period is associated with an initially elevated level of proinflammatory cytokines such as Il1ß and IL6.Conclusion. Diagnostic value of the evaluated cytokines at the pre-transplant kidney patients determines the feasibility of the inclusion of evaluation of the serum concentration of IL1β, IL6, IL17a, IL1-RA in the programme of pre-transplant laboratory tests .
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Dhillon, Wishwdeep S., Lothe Pooja, Kristine Ward, Pamela A. Crilley, David Topolsky, and Michael Styler. "Mean Platelet Volume Predicts Platelet Engraftment Post Hematopoietic Stem Cell Transplantation." Blood 122, no. 21 (November 15, 2013): 5507. http://dx.doi.org/10.1182/blood.v122.21.5507.5507.
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Abstract Introduction The exact duration of thrombocytopenia after stem cell transplantation is difficult to predict. However, studies have shown that the presence of large platelets in the circulation may indicate enhanced platelet production in the bone marrow. The goal of this study was to characterize the relationship between mean platelet volume (MPV) and platelet count recovery in the setting of hematopoietic stem cell transplantation (HSCT) and to characterize how the MPV changes as the bone marrow recovers from the transient aplastic phase. Methods The data was collected by retrospective medical chart review of patients who underwent HSCT at Hahnemann University Hospital between 2007 and 2012. Platelet counts and MPV were obtained from day zero of transplantation until full platelet recovery. Platelet recovery was defined as the first day at which platelet count spontaneously exceeded 20,000/μL, increased consistently, and patients were free of platelet transfusion due to thrombocytopenia. Using the beginning of platelet recovery as a landmark day, the platelet counts were divided into four phases: aplastic phase, pre-recovery phase, early recovery phase, and full recovery phase. MPV during pre recovery and early recovery phase was compared with MPV during aplastic and full recovery phase. Mean, standard deviation (SD), median and range were obtained for age, platelet count, MPV, ANC, Hemoglobin, HCT and white count. Number of observations for gender, transplant, and graft were compared with Chi-squared test, and P-values were reported. Analysis of Variance (ANOVA) with post-hoc analysis was performed to compare MPV measurements between the phases. The level of significance was set at 0.05. Data entry and analysis was performed with SPSS (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp). Results 60 subjects were considered for the study, but 19 were excluded because the day of platelet recovery could not be determined from the available data. Of the 41 evaluable subjects, 22 were male and 19 female. The median age was 56 years (range 23 to 79). 34 patients (88%) underwent autologous and 7 allogeneic HSCT, with 36 getting peripheral stem cells (83%) and 5 getting marrow stem cells. Mean (SD) of MPV (fL) at aplastic, pre-recovery, early-recovery and full-recovery phases were 7.7 (0.67), 8.5 (0.88), 8.6 (0.88) and 7.4 (0.79), respectively. There was a statistically significant increase in MPV between the aplastic and pre-recovery phases (p<0.001), and between aplastic and early-recovery phases (p<0.001). The MPV then declined significantly between pre-recovery phase and full-recovery phase (p<0.001), and between early-recovery phase and full-recovery phase (p<0.001). Conclusions Our study demonstrated that MPV increased during the three-day period prior to start of platelet recovery. The rise in MPV was sustained during the early-recovery phase. The MPV then dropped back down when full platelet recovery was established. Our results show that spikes in MPV can be a useful marker of impending platelet engraftment within a few days of the rise in MPV. This information may be useful to determine the need for directed donor platelet collections. Disclosures: No relevant conflicts of interest to declare.
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Christensen, Brenda, and Lee-Anne Huber. "30 The Effect of Creep Feed Composition and Form on Pre- and Post-weaning Growth Performance of Pigs and the Utilization of Low-quality Nursery Diets." Journal of Animal Science 99, Supplement_1 (May 1, 2021): 21–22. http://dx.doi.org/10.1093/jas/skab054.038.
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Abstract Fifty-six litters standardized to 12 piglets from first-parity sows were used to determine the effects of creep and nursery diet compositions on pre- and post-weaning pig growth performance. At three days of age, litters (initial BW 2.31±0.61kg) were assigned to one of four creep feeding regimens (n=14): [1] commercial creep feed (COM), [2] liquid milk replacer (LMR), [3] pelleted milk replacer (PMR), or [4] no creep feed (NO); creep feeds contained 1.0% brilliant blue as a fecal marker. Fecal swabs were collected every 3±1 days to identify piglets that regularly consumed creep feed. At weaning (18±1 days of age), six pigs per litter that consumed creep feed were placed on either a HIGH- (contained highly digestible animal proteins) or LOW- (contained corn and soybean meal as the main protein sources) quality nursery diet (n = 7) in a three-phase feeding program over 38 days. The LMR disappeared at the greatest rate (37.7 g/pig/d; DM-basis) versus COM and PMR (10.8±1.5 g/pig/d; P < 0.001). Litters that received LMR had the greatest proportion of pigs with blue fecal swabs between study days 4 and 15 (85.0 vs 59.0±0.4%; P < 0.05) and LMR piglets had greater BW at weaning versus all other treatments (6.32, 6.02, 5.92, 5.67±0.14 kg, for LMR, COM, NO, and PMR, respectively; P < 0.001). Over the entire nursery period, pigs that received LOW diets had reduced ADG (399 vs 485±42 g; P < 0.001), ADFI (520 vs 595±37 g; P< 0.001), G:F (0.77 vs 0.82±0.03; P < 0.01), and BW at the end of the nursery period (21.2 vs 24.4±1.6 kg; P < 0.001), with no carryover effects of creep feeding regimen. Providing supplemental nutrition during the suckling period via LMR improved pig body weight at weaning, but did not improve post-weaning growth performance, regardless of nursery diet quality.
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Chauhan, Dr Neelam, Dr Anshu Sharma, and Madhubala Mishra. "The Role of CD4 Count Pattern in HIV Seropositive Patients in Western Part of India." International Journal of Health Sciences and Research 12, no. 11 (November 8, 2022): 1–6. http://dx.doi.org/10.52403/ijhsr.20221101.
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Introduction: Human Immunodeficiency Virus (HIV) infection/acquired immunodeficiency syndrome (AIDS) is the most dreadful disease & a major global health issue affecting mankind.CD4 cell count is one of most important investigations for evaluation of HIV infected patient. Our aim was to assess the CD4 count pattern in seropositive patients. Material &Methods: A study was conducted on 300 seropositive patients attending ICTC in Department of Microbiology at the tertiary care hospital, fulfilling inclusion and exclusion criteria, all above the age of 15 years, were studied for a period of 20months.In this study the CD4 counts estimated at the time of baseline (Pre ART), after 6 months and 12 months of (Post ART). Results: Mean of CD4 count on baseline (Pre ART) was 318.56±230.01. It improved to the 426.16±239.57 cells/mm3 after 6th months and 524.40±246.84 cells/mm3 after 12th months of ART. Mean CD4 counts in males was 298.56 ±220.92 and in females was 346.60 ±240.38 at baseline (Pre ART). Females showed significant improvement than males. Post ART after 6 months there were increase in number of patients from 89 to 149(55.39%) in >350 CD4 cells range, this is further increase to 205 (76.21%) patients after 12 months. Number of patients with an increasing trend of CD4 counts were seen in 224 (83.27%)patients at 6 months and 241 (89.59%) patients at 12th months, whereas 45 (16.73%) patients had a decreased trend in CD4 counts at post 6thmonths and 27 (10.04%) patients at 12th months of ART. Conclusion: The CD4 count is the hallmark surrogate marker for assessing prognosis in HIV infected patients. The programme needs to ensure that maximum number of patients are tested for HIV and linked to the ART centres. Key words: Antiretroviral therapy, CD4 count, HIV, HIV prognosis.
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Neilson, Laura J., James E. East, Praveen T. Rajasekhar, Paul Bassett, Simon Dunn, Roisin Bevan, Shyju Paremal, Shiran Esmaily, and Colin J. Rees. "Sustained colonoscopy quality improvement using a simple intervention bundle." Endoscopy 52, no. 04 (March 2, 2020): 285–92. http://dx.doi.org/10.1055/a-1098-2101.
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Abstract Background Unacceptable variation in colonoscopy quality exists. The Quality Improvement in Colonoscopy (QIC) study in 2011 improved quality by introducing an evidence-based “bundle” of measures into routine colonoscopy practice. The QIC bundle included: minimal cecal withdrawal time of ≥ 6 minutes; hyoscine butylbromide use; supine patient position for transverse colon examination; rectal retroflexion. Colonoscopy quality was measured by adenoma detection rate (ADR). The current study measured whether these effects led to a sustained change in practice 3 years following implementation. Methods This observational study collected data from eight hospital trusts (sites) in the United Kingdom for a 6-month period, 3 years following QIC bundle implementation. Use of the antispasmodic, hyoscine butylbromide, was measured as a marker of bundle uptake. Bundle effectiveness was measured by ADR change. Comparisons were made between data before and immediately after implementation of the bundle. Results 28 615 colonoscopies by 188 colonoscopists were studied. Hyoscine butylbromide use increased from 15.8 % pre-implementation to 47.4 % in the sustainability phase (P < 0.01) indicating sustained engagement with QIC measures. ADR was higher in the sustainability period compared with pre-intervention, but only reached statistical significance among the poorest-performing colonoscopists. Conclusions The introduction of a simple, inexpensive, pragmatic intervention significantly changed practice over a sustained period, improving colonoscopy quality as measured by ADR, particularly in poorer performers. QIC demonstrates that an easy-to-implement quality improvement approach can deliver a sustained change in practice for many years post intervention.
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Kreizenbeck, Karma L., Tracy Wong, Barbara Jagels, Julie C. Smith, Blair Billings Irwin, Barbara Jensen, Kathryn Egan, Heather Noble, and Scott David Ramsey. "A pilot study to increase adherence to ASCO Choosing Wisely recommendations for breast cancer surveillance at community clinics." Journal of Clinical Oncology 38, no. 29_suppl (October 10, 2020): 18. http://dx.doi.org/10.1200/jco.2020.38.29_suppl.18.
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18 Background: ASCO 2012 Choosing Wisely recommends against serum tumor marker tests and advanced imaging for breast cancer survivors who are asymptomatic for recurrence. Our pilot aimed to measure and raise adherence to this recommendation through a patient video at regional community clinics. Methods: Eligibility for study included patients with 1+ long-term follow-up visit within 3 months of end of treatment in the pre- or post-intervention period: Clinic tumor registries were queried for stage I-IIIA breast cancer patients treated with curative intent. The intervention included 1) academic detailing for oncologists at a regular meeting and 2) a video about the recommendation shown to patients at end of active treatment. Surveillance data was manually abstracted. We define adherence as no asymptomatic tests in the first 13 months of surveillance. Results: Advanced imaging adherence was high before and after the intervention (99-100%). Tumor marker (TM) adherence is in the table. Six of seven providers with low (<60%) TM adherence before the intervention maintained low TM adherence after. One provider with low TM adherence and all 3 providers with moderate (60-90%) TM adherence increased to high TM adherence (>90%). TM adherence was better among patients who viewed the video (130 of 145, 90%) than those who did not (452 of 556, 81%) in the post-intervention period. The higher TM adherence among patients who viewed the video and the wide range in adherence among providers suggest that tumor marker use may be both patient- and provider-driven. Population characteristics may explain some of the variation in adherence. Conclusions: While adherence to recommendations regarding high-cost imaging was high, wide variation in tumor marker adherence among providers and high baseline adherence for advanced imaging suggests that interventions targeting surveillance testing may wish to focus primarily on tumor markers and provider outreach. [Table: see text]
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Boisclair, Michael D., David A. Lane, Helen Philippou, Sajila Sheikh, and Beverley Hunt. "Thrombin Production, Inactivation and Expression during Open Heart Surgery Measured by Assays for Activation Fragments Including a New ELISA for Prothrombin Fragment F1+2." Thrombosis and Haemostasis 70, no. 02 (1993): 253–58. http://dx.doi.org/10.1055/s-0038-1649480.
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SummaryActivation of coagulation was studied during the peri-operative period in patients undergoing cardiopulmonary bypass (CPB) surgery using activation markers which have recently become available: prothrombin fragment F1 + 2 (F1 + 2), which is a measure of total thrombin generation, and thrombin-antithrombin complex, which is a measure of inactivation of free thrombin by antithrombin. Levels of the specific marker of fibrin breakdown, D-dimer, were also determined. F1 + 2 levels were assessed using a newly developed ELISA described herein which employs a neoantigen-specific capture antibody raised using a synthetic peptide; the latter antibody has been pre-adsorbed against prothrombin to ensure high specificity for F1 + 2.Increased generation of thrombin during surgery was clearly demonstrated despite maintenance of a high concentration of heparin during the period of extracorporeal blood circulation. There was a close association (r = 0.882) between the generation of thrombin (F1 + 2 levels) and its inhibition (TAT levels). Differences were noted, however, between the information provided by F1 + 2 and TAT, which are interpreted with regard to the different in vivo fates of F1 + 2 and thrombin. The enhanced activation and inhibition of coagulation observed during CPB was suppressed once physiological blood circulation was restored, with F1 + 2 returning to pre-surgical levels within 24 h after surgery. During the post-operative period D-dimer levels, which rose in concert with F1 + 2 and TAT levels, remained highly elevated, suggesting that not all of the generated thrombin was inactivated by antithrombin. It is concluded that heparin is only partially effective as an anticoagulant during CPB surgery. F1 + 2 is an unambiguous marker of thrombin generation and its measurement may be a useful means of evaluating more effective coagulation inhibitors in CPB.
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Skenderi, Papanikolaou, Nomikos, Kotsis, and Tsironi. "Iron Homeostasis in Elite Athletes and Ultramarathon Runners." Proceedings 25, no. 1 (September 3, 2019): 32. http://dx.doi.org/10.3390/proceedings2019025032.
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AIM: The present study was aimed at determining the effect of two different types of exercise (elite athletes playing football and ultramarathon runners on iron metabolism and, especially, the role of hepcidin in iron homeostasis. MATERIAL & METHOD: Two groups of athletes were investigated. The first group consisted of 19 male elite football athletes and the second group of 41 ultramarathon runners. In both cases, blood samples were taken pre-race (t1), immediately post-race (t2), and 24 hours post-race for football athletes or 36-48 hours post-race for ultramarathon athletes (t3). RESULTS: The iron levels in time t3 were found to have statistically significant decreases compared with the iron levels in pre-race and post-race period. Moreover, ferritin levels increased significantly in times t2 and t3. Hepcidin levels increased in time t2 in football players (from 27.45 ± 12.98 to 37.42 ± 13.74 ng/mL) and decreased in time t3. However, in ultramarathon runners, hepcidin levels significantly increased in time t2 (from 29.16 ± 10.92 to 58.81 ± 16.97 ng/mL) and remained increased in time t3 (37.69 ± 16.38 ng/mL), despite a trend for decrease. In football players, sTfR levels did not change, contrary to ultramarathon runners, where sTfR levels were found decreased in times t2 and t3. CONCLUSIONS: Iron metabolism in athletes can be impacted by the type of exercise. Ferritin is not a reliable marker for iron balance because, in the present study, it is more likely an acute-phase protein. The main regulator of iron homeostasis, hepcidin, increased, showing the body’s response to inflammation, by trapping iron in the macrophages and by altering iron absorption. Finally, a strenuous and prolonged exercise can lead to sports anemia.
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Palmrich, Pilar, Nadine Haase, Meryam Sugulle, Erkan Kalafat, Asma Khalil, and Julia Binder. "Maternal haemodynamics in Hypertensive Disorders of Pregnancy under antihypertensive therapy (HyperDiP): study protocol for a prospective observational case–control study." BMJ Open 13, no. 6 (June 2023): e065444. http://dx.doi.org/10.1136/bmjopen-2022-065444.
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IntroductionHypertensive disorders of pregnancy (HDP) are associated with a high incidence of maternal and perinatal morbidity and mortality. HDP, in particular pre-eclampsia, have been determined as risk factors for future cardiovascular disease. Recently, the common hypothesis of pre-eclampsia being a placental disorder was challenged as numerous studies show evidence for short-term and long-term cardiovascular changes in pregnancies affected by HDP, suggesting a cardiovascular origin of the disease. Despite new insights into the pathophysiology of HDP, concepts of therapy remain unchanged and evidence for improved maternal and neonatal outcome by using antihypertensive agents is lacking.Methods and analysisA prospective observational case–control study, including 100 women with HDP and 100 healthy controls, which will assess maternal haemodynamics using the USCOM 1A Monitor and Arteriograph along with cardiovascular markers (soluble fms-like kinase 1/placental-like growth factor, N-terminal pro-B type natriuretic peptide) in women with HDP under antihypertensive therapy, including a follow-up at 3 months and 1 year post partum, will be conducted over a 50-month period in Vienna. A prospective, longitudinal study of cardiovascular surrogate markers conducted in Oslo will serve as a comparative cohort for the Vienna cohort of haemodynamic parameters in pregnancy including a longer follow-up period of up to 3 years post partum. Each site will provide a dataset of a patient group and a control group and will be assessed for the outcome categories USCOM 1A measurements, Arteriograph measurements and Angiogenic marker measurements. To estimate the effect of antihypertensive therapy on outcome parameters, ORs with 95% CIs will be computed. Longitudinal changes of outcome parameters will be compared between normotensive and hypertensive pregnancies using mixed-effects models.Ethics and disseminationEthical approval has been granted to all participating centres. Results will be published in international peer-reviewed journals and will be presented at national and international conferences.
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Kudriavtsev, Andrei, Alexia Mirandola, Catalina I. Cofre Muñoz, Raquel Comas Navarro, Marco Macagno, Brice Pastor, Ekaterina Pisareva, et al. "Abstract 1026: Post-surgery sequelae unrelated to disease progression and chemotherapy revealed in follow-up of stage III colon cancer patients." Cancer Research 84, no. 6_Supplement (March 22, 2024): 1026. http://dx.doi.org/10.1158/1538-7445.am2024-1026.
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Abstract A gap currently exists in our understanding of causes of elevated total circulating DNA (cirDNA) levels in cancer patients following tumor resection, and the influence of anesthesia or surgery on cirDNA release. Indeed, the post-surgery dynamics of cirDNA have been largely overlooked to date, despite their importance in determining the optimal timing for assessment of minimal residual disease (MRD). Since cirDNA levels were recently found to be associated with neutrophil extracellular traps (NETs) formation in various cancers, we investigated NETs and cirDNA post-surgery.We conducted two clinical studies to explore the dynamics of cirDNA quantity and of neutrophil extracellular traps (NETs) markers: (1) a peri-surgery study over a duration of up to 72 hours, which involved stage I-III colon (n=10), prostate (n=10), and breast (n=9) cancer patients; and (2) a post-surgery study that extended up to two years post-surgery, and which involved 74 stage III colon cancer patients. We assessed plasma levels of cirDNA using qPCR, and assessed two protein markers of NETs using ELISA, in both cancer patients and control group of healthy individuals (HI) (N=114). This second study is the first prospective, multicenter, blinded study of the dynamics of the total cirDNA post-surgery, for a period of up to two years.We observed that (i), NETs formation contributes to post-surgery conditions; (ii), peri- and post-surgery cirDNA levels were highly associated with NETs formation in colon cancer; (iii), each tumor type showed a specific pattern of the peri-surgery dynamics of cirDNA and NETs markers; peri-operative levels of these markers are significantly lower in breast cancer patients as compared to prostate and colorectal cancer patients; (iv), a significant proportion of patients showed pre- (58.1%) and post-surgery (80.4%) median marker values higher than in HI, even after 2 years following tumor resection, (v) these markers were either equal to or greater (23.2%) than their pre-surgery counterparts; and (vi), elevated values of these markers did not derive from chemotherapy toxicity.We provide evidence that, for cancer patients in the post-surgery period, cirDNA originates mainly from NETs. This finding calls into question the current method of assessing MRD according to the fraction of mutant cirDNA, given that the level of NETs formation appears to be patient dependant. The peri-surgery dynamics of NETs formation and cirDNA release vary according to the surgical procedure and cancer type. In a significant part of patients with colon cancer, NETs continue to persist for more than a year after surgery, irrespective of disease progression or chemotherapy use. Nevertheless, cirDNA and NETs marker levels vary in cases with post-surgery inflammatory/thrombotic adverse events. Our work highlights the existence of long-lasting “sequelae” effects of cancer, previously unreported. Citation Format: Andrei Kudriavtsev, Alexia Mirandola, Catalina I. Cofre Muñoz, Raquel Comas Navarro, Marco Macagno, Brice Pastor, Ekaterina Pisareva, Mireia Sanchis Marin, Javier Gonzalo Ruiz, Anna Sapino, Alice Bartolini, Massimo Di Maio, Cynthia Sanchez, Yann Gricourt, Xavier Capdevila, Gerald Lossaint, Evelyne Crapez, Marc Ychou, Ramon Salazar Soler, Elisabetta Fenocchio, Paula X. Fernandez Calotti, Philippe Cuvillon, Thibault Mazard, Cristina Santos Vivas, Elez M. Elez, Federica Di Nicolantonio, Alain R. Thierry. Post-surgery sequelae unrelated to disease progression and chemotherapy revealed in follow-up of stage III colon cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1026.
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Lacaille, D., J. A. Aviña-Zubieta, Y. Zheng, N. Lu, and H. Xie. "POS0567 COMPARISON OF SURVIVAL ON TREATMENT AMONG NEW USERS OF BIOSIMILAR VS. ORIGINATOR BIOLOGICS IN INFLAMMATORY ARTHRITIS: POPULATION-BASED EVIDENCE FROM A NATURAL EXPERIMENT DUE TO A POLICY CHANGE." Annals of the Rheumatic Diseases 82, Suppl 1 (May 30, 2023): 552.1–552. http://dx.doi.org/10.1136/annrheumdis-2023-eular.3373.
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BackgroundBritish Columbia (BC) health policy mandated the use of biosimilars, when available, for all new anti-TNF prescriptions after June 2017.ObjectivesTo compare drug survival (surrogate marker of effectiveness and safety) after initiation of etanercept and infliximab for inflammatory arthritis in new users of biosimilars vs. originators, using historical controls pre-policy change.MethodsUsing administrative health data, we identified all incident users of a new anti-TNF with rheumatoid arthritis (RA), psoriasis or psoriatic arthritis (Pso/PsA), or ankylosing spondylitis (AS). The biosimilar cohort started etanercept or infliximab between 07/01/2017 and 12/31/2019, were followed until 12/31/2020 (post-policy period). Historical controls started etanercept/infliximab originators between 01/01/2014 and 06/30/2016, were followed until 06/30/2017 (pre-policy period). To control for potential temporal trends, new users of adalimumab (no biosimilar available then) served as comparators. Discontinuation was defined as no prescription renewal for ≥6 mos.Individuals were followed from anti-TNF initiation until discontinuation or censoring due to death, moving out-of-province, or follow-up end, whichever occurred first. We applied weighted Cox Proportional Hazard Models that handle non-proportional hazards combined with propensity overlap weighting to estimate the adjusted hazard ratio (aHR) of discontinuing anti-TNFs, in people who started a biosimilar vs. the respective originator, after controlling for potential confounders. To control for temporal trend, we employed the difference-in-difference (DID) method, comparing drug survival among new biosimilar vs. originator etanercept/infliximab users with adalimumab users post- vs. pre-policy change, computed as the difference between the logarithms of aHRs for etanercept/infliximab and for adalimumab. We report the exponential of DID estimates (i.e. the ratio of the two aHRs).ResultsOur sample included 827 biosimilar etanercept users (RA:576, AS:171, Pso/PsA:80) and 271 infliximab users (RA:150, AS:54, Pso/PsA:67); 1312 etanercept and 230 infliximab originator users; and 2213 adalimumab originator users post- and 1773 pre-policy change.Discontinuation rates per 100 PY are shown in Table 1A. After adjusting for baseline covariates (Table 1B), and accounting for temporal trends (Table 1C), the risk of discontinuation was similar for biosimilar vs. originator etanercept and infliximab users.ConclusionReal-world population-based data in BC shows that incident users of biosimilar etanercept and infliximab for inflammatory arthritis have comparable duration of treatment to users of originators.Table 1.Discontinuation of biosimilar and originator anti-TNFs before and after policy change1A. Discontinuation ratesDrugPeriodDiscontinuation/ NFollow-up YearsRate (per 100 person-year)ADALIMUMABPre-policy808/1773245432.92Post-policy1076/2213295936.36ETANERCEPTOriginator650/1312175237.10Biosimilar381/827102937.02INFLIXIMABOriginator103/23034429.97Biosimilar138/27136437.961B. Hazard Ratio (post- vs. pre- policy change)DrugUnivariate Cox PHMultivariable Cox PH*cHR (95%CI)p valueaHR (95%CI)p valueADALIMUMAB1.08(0.98,1.18)0.111.08(0.98,1.19)0.11ETANERCEPT0.97(0.84,1.10)0.600.97(0.85,1.11)0.65INFLIXIMAB1.10(0.84,1.43)0.501.11(0.86,1.45)0.421C. Ratio of Hazard Ratio**Univariate Cox PHMultivariable Cox PH*Ratio of cHR (95%CI)p valueRatio of aHR (95%CI)p valueETANERCEPT0.90(0.76,1.05)0.190.90(0.76,1.06)0.20INFLIXIMAB1.02(0.77,1.35)0.911.03(0.78,1.37)0.83*Adjusted for age, sex, socioeconomic status, rural vs. urban, health authority, arthritis type, arthritis duration, no. prior biologic agents, comorbidities, steroid and DMARDs use, measured at anti-TNF start.**Ratio of Hazard Ratios of etanercept or infliximab to adalimumab.Figure 1.Kaplan Meier Biologics Survival CurveAcknowledgementsThis research received funding from the Canadian Initiative for Outcomes in Rheumatology cAre (CIORA) via the Canadian Rheumatology Association. Dr. Lacaille is supported by the Mary Pack Chair in Arthritis Research from the University of British Columbia and The Arthritis Society of Canada. Dr. Antonio Avina Zubieta is a BC Lupus Society Research Scholar and a Walter & Marilyn Booth Research Scholar. Dr. Hui Xie is supported by the Milan Ilich/ Merck Chair in Statistics for Arthritis and Musculoskeletal Diseases from Simon Fraser University.Disclosure of InterestsNone Declared.
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Barha, C. K., K. G. Salvante, M. J. Jones, P. Farré, J. Blais, M. S. Kobor, L. Zeng, E. Emberly, and P. A. Nepomnaschy. "Early post-conception maternal cortisol, children’s HPAA activity and DNA methylation profiles." Journal of Developmental Origins of Health and Disease 10, no. 1 (November 15, 2018): 73–87. http://dx.doi.org/10.1017/s2040174418000880.
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AbstractThe hypothalamic–pituitary–adrenal axis (HPAA) plays a critical role in the functioning of all other biological systems. Thus, studying how the environment may influence its ontogeny is paramount to understanding developmental origins of health and disease. The early post-conceptional (EPC) period could be particularly important for the HPAA as the effects of exposures on organisms’ first cells can be transmitted through all cell lineages. We evaluate putative relationships between EPC maternal cortisol levels, a marker of physiologic stress, and their children’s pre-pubertal HPAA activity (n=22 dyads). Maternal first-morning urinary (FMU) cortisol, collected every-other-day during the first 8 weeks post-conception, was associated with children’s FMU cortisol collected daily around the start of the school year, a non-experimental challenge, as well as salivary cortisol responses to an experimental challenge (all Ps<0.05), with some sex-related differences. We investigated whether epigenetic mechanisms statistically mediated these links and, therefore, could provide cues as to possible biological pathways involved. EPC cortisol was associated with >5% change in children’s buccal epithelial cells’ DNA methylation for 867 sites, while children’s HPAA activity was associated with five CpG sites. Yet, no CpG sites were related to both, EPC cortisol and children’s HPAA activity. Thus, these epigenetic modifications did not statistically mediate the observed physiological links. Larger, prospective peri-conceptional cohort studies including frequent bio-specimen collection from mothers and children will be required to replicate our analyses and, if our results are confirmed, identify biological mechanisms mediating the statistical links observed between maternal EPC cortisol and children’s HPAA activity.