Articoli di riviste sul tema "577.098 82"
Segui questo link per vedere altri tipi di pubblicazioni sul tema: 577.098 82.
Cita una fonte nei formati APA, MLA, Chicago, Harvard e in molti altri stili
Vedi i top-50 articoli di riviste per l'attività di ricerca sul tema "577.098 82".
Accanto a ogni fonte nell'elenco di riferimenti c'è un pulsante "Aggiungi alla bibliografia". Premilo e genereremo automaticamente la citazione bibliografica dell'opera scelta nello stile citazionale di cui hai bisogno: APA, MLA, Harvard, Chicago, Vancouver ecc.
Puoi anche scaricare il testo completo della pubblicazione scientifica nel formato .pdf e leggere online l'abstract (il sommario) dell'opera se è presente nei metadati.
Vedi gli articoli di riviste di molte aree scientifiche e compila una bibliografia corretta.
1
Uno, Yuji, Naoko Akiyama, Sayaka Yuzawa, Masahiro Kitada e Hidehiro Takei. "The value and practical utility of intraoperative touch imprint cytology of sentinel lymph node(s) in patients with breast cancer: A retrospective cytology-histology correlation study". Cytojournal 17 (12 maggio 2020): 11. http://dx.doi.org/10.25259/cytojournal_80_2019.
Abstract (sommario):
Objective: Intraoperative evaluation of sentinel lymph nodes (SLNs) for patients with breast cancer is widely performed with frozen section (FS), cytology, or a combination of both. Touch imprint cytology (TIC) reportedly has an equivalent sensitivity to FS. We studied its diagnostic utility to detect SLN metastases. Materials and Methods: Cases of 367 patients with breast cancer who underwent intraoperative valuation of SLNs (507 LNs) were evaluated. All FS and corresponding TIC slides of SLNs of each case were reviewed microscopically for the presence of metastases of any size. If present, the metastatic focus was measured on the FS. Results: Of these 507 SLNs, 82 LNs (16.2%) from 69 women were found to have metastases in the FS and consisted of 5 LNs of isolated tumor cells, 15 of micrometastasis, and 62 of macrometastasis. TIC identified metastases in 69 of these 82 SLNs (sensitivity: 84.1%, specificity: 100%, and accuracy: 97.4%). All macrometastases could be detected by TIC, whereas TIC identified approximately 50% of micrometastases and none of isolated tumor cells. The size detection limit of metastatic foci, defined as the smallest dimension of metastasis detected without false negatives, was 2 mm. The smallest metastatic focus identified was 0.8 mm. Conclusions: TIC of SLNs is of great use given its negative predictive value of 100% for identification of macrometastasis in our study. For intraoperative evaluation of SLNs, based on our data, a practical two-step approach is proposed: SLN evaluation should be initially performed by TIC and then proceed to FS histological analysis only when cytologically positive to determine the size of metastatic focus.
2
Sasaki, Koji, Ildefonso Ismael Rodriguez-Rivera, Hagop M. Kantarjian, Susan O'Brien, Elias Jabbour, Gautam Borthakur, Farhad Ravandi, Michael J. Burke, Patrick A. Zweidler-McKay e Jorge E. Cortes. "Correlation of Lymphocyte Count with Treatment Response to Tyrosine Kinase Inhibitors in Newly Diagnosed Chronic Myeloid Leukemia in Chronic Phase". Blood 124, n. 21 (6 dicembre 2014): 4538. http://dx.doi.org/10.1182/blood.v124.21.4538.4538.
Abstract (sommario):
Abstract Background: Total lymphocyte count (TLC) has been shown to correlate with outcomes in patients (pts) with acute leukemia. The clinical correlation to TLC in pts with chronic myeloid leukemia in chronic phase (CML-CP) who were treated with a tyrosine-kinase inhibitor (TKI) is unclear. Methods: Lymphocyte data in pts with newly diagnosed CML-CP who were enrolled in consecutive or parallel clinical trials with front-line imatinib (IM), nilotinib (Nilo), or dasatinib (Dasa) were collected at the time of diagnosis, and 3 and 6 months (M) after the start of TKI. Relative lymphocytrosis (RLC) was defined as lymphocyte >150% at 3 or 6M compared with baseline at diagnosis. Absolute lymphocytosis (ALC) was defined as lymphocyte > 4,000 /µL at 3 or 6M after the start of TKI. Pts were assessed for response, overall survival (OS), event-free survival (EFS), transformation-free survival (TFS), and failure-free survival (FFS) based on ALC and RLC. The Kaplan-Meier method was used to calculate OS, EFS, TFS, and FFS. A log-rank test and Cox regression were used for univariate (UVA) and multivariate analysis (MVA), respectively. Results: A total of 483 pts were enrolled in this study: 271 in IM, 105 in Nilo, and 107 in Dasa. Patient characteristics and outcomes are summarized in Table 1. Median age at diagnosis was 48 years, and median follow-up was 85M and ongoing (5-154+). Time from diagnosis to start of TKI, Sokal risk score, and ALC at baseline between groups did not differ clinically. Of 481 pts, 93 (19%) developed RLC at 3 or 6M; IM, 38 (14%); Nilo, 23 (22%); Dasa, 32 (30%) (p= .001). ALC at 3 or 6M was observed in 15 (3%); IM, 3 (1%); Nilo, 1 (1%); Dasa, 11 (10%) (p<.001). Overall, cumulative incidence of complete cytogenetic response (CCyR) at 6M, major molecular response (MMR) at 12M, molecular response with 4.5 log reduction by IS (MR4.5) at 24M did not differ significantly between RLC and non-RLC (3 or 6M), or between ALC and non-ALC (3 or 6M). 5-y TFS, EFS and OS in ALC group were significantly worse than those in non-ALC group (p= .002, p=.016, p=.008, respectively). By UVA and MVA related to OS, age [p <.001; Hazard ratio (HR), 1.062; 95% confidence interval (95%CI), 1.036-1.089], presence of ALC at 3 or 6M [p = .028; HR, 10.948; 95%CI, 1.297-92.415], absence of MMR at 24M [p=.016; HR, 2.263; 95%CI, 1.165-4.393] were identified as adverse prognostic factors for OS. Conclusion: The presence of ALC ≥4,000/µL at 3 or 6M of TKI therapies is rare but is adversely associated with overall survival. Table 1. Patient Characteristics and Outcomes (N=483)a Overall [n= 481] IM [n= 271] Nilo [n= 105] Dasa [n= 107] Age, (year) 48 (15-85) 48 (15-85) 49 (17-82) 48 (16-83) Sokal Risk, No. (%) Low 334 (69) 175 (65) 79 (75) 80 (75) Intermediate 114 (24) 74 (27) 18 (17) 22 (21) High 32 (7) 20 (7) 8 (8) 4 (4) Time from diagnosis to start of TKI, (M) 0.9 (0-12.6) 1.0 (0-12.6) 0.5 (0-5.6) 0.7 (0.1-7.8) ALC at baseline, (/109L) 2.5 (0-86.6) 2.4 (0-16.7) 2.6 (0.4-9.2) 2.7 (0.3-86.6) Incidence of Relative Lymphocytosis, No. (%) At 3M 65 (14) 25 (9) 16 (15) 24 (22) At 6M 76 (16) 32 (12) 20 (19) 24 (22) Overall 93 (19) 38 (14) 23 (22) 32 (30) Incidence of Absolute Lymphocytosis, No. (%) At 3M 8 (2) 1 (0) 0 7 (7) At 6M 11 (2) 3 (1) 1 (1) 7 (7) Overall 15 (3) 3 (1) 1 (1) 11 (10) Outcomes of RLC and ALC at any time in each group, +/- (%/%) (p) <10% BCR-ABL/ABL at 3M RLC 36/40 (.596) 22/44 (.213) 50/37 (.280) 31/38 (.537) ALC 38/39 (.952) 0/42 (.394) 100/39 (.214) 36/35 (.952) Cumulative CCyR at 6M RLC 75/75 (.288) 50/66 (.063) 96/90 (.413) 90/87 (.628) ALC 67/75 (.711) 33/64 (.276) 0/92 (.001) 82/89 (.599) Cumulative MMR at 12M RLC 67/74 (.406) 53/70 (.030) 83/82 (.921) 72/74 (.903) ALC 60/73 (.488) 33/68 (.197) 0/83 (.033) 73/74 (.745) Cumulative MR4.5 at 24M RLC 46/52 (.564) 37/50 (.139) 57/55 (.889) 50/57 (.729) ALC 33/52 (.332) 33/48 (.610) 0/56 (.264) 36/57 (.252) 5-y FFS RLC 61/71 (.133) 56/69 (.167) 62/70 (.710) 61/74 (.285) ALC 50/69 (.076) 0/68 (<.001) 0/70 (<.001) 71/70 (.974) 5-y TFS RLC 90/93 (.369) 88/93 (.597) 91/88 (.115) 91/99 (.213) ALC 72/93 (.002) 67/93 (.014) 0/90 (<.001) 80/97 (.121) 5-y EFS RLC 80/86 (.213) 71/83 (.154) 84/87 (.450) 86/93 (.486) ALC 64/85 (.016) 33/82 (<.001) 0/87 (<.001) 80/92 (.574) 5-y OS RLC 89/93 (.068) 81/94 (.007) 100/84 (.126) 96/99 (.207) ALC 82/93 (.008) 67/93 (.001) 100/88 (.847) 83/99 (.040) a Two in IM and 1 in Dasa were not evaluable due to lack of differential data at 3 and 6M. Figure 1. OS in Pts with ALC Figure 1. OS in Pts with ALC Disclosures O'Brien: Amgen, Celgene, GSK: Consultancy; CLL Global Research Foundation: Membership on an entity's Board of Directors or advisory committees; Emergent, Genentech, Gilead, Infinity, Pharmacyclics, Spectrum: Consultancy, Research Funding; MorphoSys, Acerta, TG Therapeutics: Research Funding.
3
Miranda, Vanessa Costa, Angelo Bezerra de Sousa Fede, Carlos Henrique Dos Anjos, Juliana Ribeiro da Silva, Fernando Barbosa Sanchez, Lyvia Rodrigues da Silva Bessa, Jesus Paula Carvalho et al. "Neoadjuvant chemotherapy with six cycles of carboplatin and paclitaxel in advanced ovarian cancer patients not candidates for optimal primary surgery: Safety and effectivenes." Journal of Clinical Oncology 31, n. 15_suppl (20 maggio 2013): 5540. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.5540.
Abstract (sommario):
5540 Background: Primary debulking surgery (PDS) has been considered the standard of treatment in advanced ovarian cancer, while neoadjuvant chemotherapy, three cycles followed by interval debulking (ID) surgery, is a valid treatment alternative for patients with non-resectable disease. This study aimed to show the efficacy and safety of six cycles of neoadjuvant chemotherapy (N-CT) followed by cytoreduction, a single institution experience. Methods: Aretrospective analysis was performed of all patients (pts) with advanced ovarian cancer treated with platinum based N-CT, between January/2004 and February/2012. Results: 97 pts underwent N-CT in our institution; 78.1% and 18.8% the patients had extensive stage IIIC or IV disease at diagnosis, respectively. Median age 60 years (36 – 82). Histologic types: serous 84.5%, adenocarcinoma not specified 11.3%, endometrioide 1.0%. A median of six cycles of chemotherapy were performed. Patients did not received chemotherapy after debulking surgery. During the treatment 31.4% had grade 3/4 toxicity, the most commonly observed toxicities were hematologic toxicities and nausea, four (4.1%) patients died during chemotherapy due to disease progression. After N-CT 24.7% achieved clinical complete response, 57.7% partial response and 12.4% disease progression. From this cohort 63.1% underwent a complete resection of all macroscopic and microscopic disease (R0). Median length of hospital stay and postoperative ICU stay was 5 and 0.8 days respectively, surgical complications were not common however five (7.1%) patients needed second surgery due to operatory complications and 19 pts (27.1%) needed blood transfusion after debulking. With a median follow up of 21.8 months (0.5-139.7), median overall survival and chemotherapy-free interval were 57,7 and 9,5 months, respectively. Conclusions: Six cycles of neoadjuvant carboplatin and paclitaxel is safe, effective and does not increase perioperative and postoperative complications for patients with stage IIIC-IV not candidates for optimal/R0 PDS. The overall survival of this cohort is higher than those treated with interval debulking surgery.
4
Tillett, W., V. Navarro-Compán, N. Booth, T. Holzkaemper, J. Hill, E. Lubrano e T. Truer. "AB0548 EFFECTIVENESS OF IXEKIZUMAB IN PATIENTS WITH PSORIATIC ARTHRITIS: RESULTS FROM A REAL-WORLD EUROPEAN SURVEY". Annals of the Rheumatic Diseases 80, Suppl 1 (19 maggio 2021): 1307–8. http://dx.doi.org/10.1136/annrheumdis-2021-eular.2001.
Abstract (sommario):
Background:Limited real world (RW) data are available for IL-17A blocker ixekizumab (Ixe), approved for psoriatic arthritis (PsA) in EU Feb 2018.Objectives:Describe RW outcomes for PsA patients (pts) receiving Ixe.Methods:Cross-sectional, observational study of PsA pts treated with Ixe in the 2020 Adelphi PsA Plus Program (FR, DE, ES & UK). Rheumatologists recruited the first 6 consecutive consulting Ixe pts and provided demographics, PsA manifestations, clinical measures (66 swollen joint count (SJC), 68 tender joint count (TJC), psoriasis area and severity index [PASI], body surface area [BSA] affected by psoriasis [PsO]), rheumatologist-recorded pt measures (skin/joint pain & fatigue [0-10 numeric rating scales (NRS)], health assessment questionnaire [HAQ-DI]) & prescribed dose. All outcomes recorded for pts with scores available at Ixe initiation (II) & at last assessment (LA).Results:124 rheumatologists provided data for 698 Ixe pts, mean age 49 years (19-79), 48% female, mean BMI 27 (18-44), 56% dermatologist co-managed and mean time diagnosed 6 years (0-35). At Ixe initiation, 78% of pts with known BSA had concomitant mod-sev-PsO defined as BSA≥10% (mean 19.8, n=428) and mean PASI 26.3 (n=164). The predominant PsA phenotype was polyarthritic in 49% (n=345), mono/oligoarthritic in 30% (n=208), axial in 12% (n=81) and enthesitic in 8% (n=55). Previous treatment before Ixe included ≥1 conventional synthetic DMARD (csDMARD) for 71% of pts. Of bio-experienced pts (57%), 40% had received ≥2 biologics. Mean Ixe treatment duration (n=698) 39.4 weeks (wks, 0-170), of which 575 (82%) had received >12 wks of Ixe. 71% of pts received label recommended dose (80mg every 4wks). 52% pts received csDMARD in combination with Ixe. In the RW, Ixe improved TJC, SJC, joint pain, BSA, fatigue and HAQ-DI, Table 1.Table 1.Outcomes for pts receiving Ixe >12weeks (n=575)OverallBSA ≥10% at Ixe initiationMod-sev-PsO physician judgementPredominant mono/oligo arthritisPredominant polyarthritisWith csDMARDWithout csDMARDBSA, n35627025498184188168mean [SD]Ixe initiation (II)19.8 [14.8]24.7 [13.5]23.1 [13.6]17.4 [15.0]20.9 [15.0]21.8 [15.0]17.4 [14.2]Last Assessment (LA)6.6 [7.5]9.3 [8.7]7.9 [7.9]5.0 [6.0]7.6 [8.4]7.3 [7.9]5.9 [7.1]Mean weeks on Ixe43414150414146TJC*, n125728639725669mean [SD, %<5]II12.2 [10.6, 29]14.4 [11.3, 18]12.9 [11.1, 21]6.4 [8.2, 59]15.4 [10.8, 12]13.0 [9.9, 25]11.5 [11.1, 32]LA4.1 [6.4, 77]5.2 [7.7, 71]3.6 [6.3, 80]1.1 [1.4, 97]6.2 [7.7, 64]3.4 [3.9, 73]4.6 [7.8, 80]SJC*, n1458210244846085mean [SD, %<5]II14.8 [13.5, 33]18.8 [14.4, 22]16.3 [13.8, 26]7.2 [8.5, 68]18.2 [13.6, 12]14.5 [12.0, 37]15.1 [14.8, 31]LA4.8 [8.7, 79]7.0 [10.7, 66]5.1 [9.3, 75]0.9 [1.9, 95]6.6 [9.0, 68]3.1 [7.8, 90]5.9 [9.1, 71]Joint pain (NRS 0-10), n575270349166291294281mean [SD]II6.6 [1.7]6.7 [1.7]6.7 [1.7]6.2 [1.8]7.0 [1.5]6.6 [1.7]6.6 [1.6]LA2.7 [1.9]3.0 [2.1]2.8 [2.0]2.1 [1.6]3.0 [2.1]2.8 [1.9]2.5 [1.9]Fatigue (NRS 0-10), n575270349166291294281mean [SD]II5.4 [2.5]5.8 [2.4]5.7 [2.5]4.7 [2.5]5.7 [2.4]5.7 [2.4]5.1 [2.5]LA2.6 [2.1]2.7 [2.1]2.7 [2.2]2.0 [1.9]2.9 [2.2]2.7 [2.1]2.6 [2.1]HAQ DI, n59414210283128mean [SD, %<0.5]II1.8 [0.7, 5]1.9 [0.6, 0]1.8 [0.7, 2]1.9 [0.7, 10]1.8 [0.8, 7]1.9 [0.6, 3]1.7 [0.8, 7]LA0.8 [0.6, 41]0.8 [0.6, 32]0.8 [0.7, 45]0.7 [0.7, 60]0.7 [0.6, 36]0.7 [0.5, 32]0.7 [0.8, 50]*Additional analysis for pts whose fatigue/joint pain rating improved (from ≥4 at Ixe initiation to ≤3 at LA), their mean TJC was 2.7 & SJC 4.3 at LA for fatigue, TJC 1.7 & SJC 2.7 at LA for joint pain.When BSA was not recorded, physician judgement of PsO severity was used. No imputation of missing data.Conclusion:We report RW outcome data amongst pts treated with Ixe including mono/oligo arthritis and a limited sample of enthesitis and dactylitis pts. Our results are consistent with clinical trial populations across disease domains, including an improvement in joint pain.Disclosure of Interests:William Tillett Speakers bureau: AbbVie, Amgen, Celgene, Lilly, Janssen, Novartis, Pfizer Inc. and UCB, Consultant of: AbbVie, Amgen, Celgene, Lilly, Janssen, Novartis, MSD, Pfizer Inc. and UCB, Grant/research support from: AbbVie, Celgene, Eli Lilly & company, Janssen and UCB, Victoria Navarro-Compán Speakers bureau: AbbVie, BMS, Janssen, Eli Lilly & Co, MSD, Novartis, Pfizer, Roche and UCB, Consultant of: AbbVie, BMS, Janssen, Eli Lilly & Co, MSD, Novartis, Pfizer, Roche and UCB, Grant/research support from: AbbVie, BMS, Janssen, Eli Lilly & Co, MSD, Novartis, Pfizer, Roche and UCB, Nicola Booth: None declared., Thorsten Holzkaemper Shareholder of: Eli Lilly & Company, Employee of: Eli Lilly & Company, Julie Hill Shareholder of: Eli Lilly & Company, Employee of: Eli Lilly & Company, Ennio Lubrano Speakers bureau: Alfa-Sigma, Abbvie, Galapagos, Janssen Cilag, Lilly., Consultant of: Alfa-Sigma, Abbvie, Galapagos, Janssen Cilag, Lilly., Tamas Truer Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company.
5
Omelchenko, T., O. Burianov, A. Liabakh, E. Levitskyi e O. Turchin. "AB1226 AUTOLOGOUS MOSAIC OSTEOCHONDROPLASTY IN THE TREATMENT OF TALAR OSTEOCHONDRAL DEFECTS". Annals of the Rheumatic Diseases 81, Suppl 1 (23 maggio 2022): 1725.3–1726. http://dx.doi.org/10.1136/annrheumdis-2022-eular.4901.
Abstract (sommario):
BackgroundOsteochondral defects of the talus (ODT) is a relatively rare, mostly traumatic pathology, in 6.5 % of cases complicate the course of inversion and eversion injuries of the foot and ankle [1].ObjectivesTo conduct a clinical analysis of the effectiveness of autologous mosaic osteochondroplasty in the treatment of patients with osteochondral defects of the talus on the basis of determining the dynamics of pain and restoring the amplitude of ankle movements.MethodsThe study included 34 patients with post-traumatic osteochondral defects of the talus (27 men, 7 women, mean age 24.8 ± 2.1 years) who underwent osteochondroplasty. The duration of painful clinical symptoms before osteochondroplasty ranged from 4 to 18 months. Functional treatment outcomes were assessed over a period of 12 to 36 months using the International Foot and Ankle Surgery Scale (AOFAS), pain dynamics were assessed using the Visual Analog Scale (VAS), and ankle movement recovery dynamics were determined.ResultsOsteochondral autologic grafts were removed from the lateral condyle of the ipsilateral femur. Defect sizes: square from 82 to 129 mm2 (110,3 ± 0.8 mm2), depth from 7 to 16 mm (12 ± 0,8 mm). Incorporation of the graft in the recipient bed occurred within 1,5 – 3 months. Long-term follow-up was 12 – 36 months (22,8 ± 3,8 months). The level of pain was decreased from 5,7 ± 0,3 before to 0,9 ± 0,3 after the operation (p < 0.001; paired t-test). Improving of foot function according to AOFAS scale (hindfoot section) was established from 64,9 ± 1,4 to 95,9 ± 1,1 (p < 0.001; paired t-test). Extension increasing from 15,0 ± 0,9 to 18,4 ± 0,7 and flexion increasing from 22,9 ± 1,2 to 30,7 ± 1,1 was registered. There were no cases of implants failure or their instability neither the increasing of degenerative changes in the ankle joint.ConclusionOsteochondroplasty is the effective method of congruity restoration in cases of post-traumatic talus osteochondral defects, promotes a significant reduction in pain syndrome and an improvement in the function of the ankle. The unknown mechanism of the analgesic effect of osteochondroplasty requires further research.References[1]O’Loughlin PF, Heyworth BE, Kennedy JG. Current concepts in the diagnosis and treatment of osteochondral lesions of the ankle. Am J Sports Med. 2010;38:392-404. doi: 10.1177/0363546509336336.Disclosure of InterestsNone declared
6
Manolakis, Al, C. Ionescu, M. Cambrea, P. Bordei e D. Iliescu. "Relations between the tracheal and pulmonary trunk bifurcations". ARS Medica Tomitana 20, n. 2 (1 maggio 2014): 110–14. http://dx.doi.org/10.2478/arsm-2014-0020.
Abstract (sommario):
Abstract The bifurcation of the pulmonary trunk and trachea were followed on 52 cases being appreciated on the dissection and corrosion pieces and CT examinations, the arterial bifurcation being made under an very variable angle, its value ranging from 30-1080. In 82% of cases the tracheal bifurcation was done under an acute angle, with lower value than the arterial bifurcation angle. In 41 cases (78.85% of cases) the pulmonary trunk bifurcation is done under the bifurcation of the trachea, at a distance of between 0,4 - 2,8 cm, and in 8 patients (15.38% of the cases) the two bifurcations was located at the same level. Only in 3 cases (5.77% of cases), all on CT angiography, we encountered the pulmonary trunk bifurcation above tracheal bifurcation, with 0.3-0.8 cm, bifurcation of the pulmonary trunk being left lying of the tracheal bifurcation. In these cases, the bifurcation angle of the pulmonary trunk is always greater than the angle of the trachea bifurcation. On the dissected and the corrosion pieces is found that when the bifurcation is situated at different levels, the tracheal one being located cranial, the most commonly between them form a rectangular area: rhombus, more frequently, and rectangular or trapezium and rarely a pentagon or triangle. Any geometric shape to be formed between the two junctions, it is often asymmetric.
7
MacIntyre, C. Raina, Marianne Empson, Claire Boardman, Doungkamol Sindhusake, Julie Lokan e Graham V. Brown. "Risk Factors for Colonization With Vancomycin-Resistant Enterococci in a Melbourne Hospital". Infection Control & Hospital Epidemiology 22, n. 10 (ottobre 2001): 624–29. http://dx.doi.org/10.1086/501833.
Abstract (sommario):
AbstractObjective:To determine risk factors for colonization with vancomycin-resistant enterococci (VRE) in a hospital outbreak.Design:Outbreak investigation and case-control study.Setting:A referral teaching hospital in Melbourne, Australia.Participants:Cases were inpatients colonized (with or without clinical disease) with VRE between July 26 and November 28, 1998; controls were hospitalized patients without VRE.Methods:Five cases of VRE were identified between July 26 and November 8, 1998, by growth of VRE from various sites. Active case finding by cultures of rectal swabs from patients surveyed in wards was commenced on July 26, after the first isolate of VRE.Results:There were 19 cases and 66 controls. All the VRE identified werevanB, and all wereEnterococcus faecium.One molecular type predominated (18/19 cases). In a logistic-regression model, being on the same ward as a VRE case was the highest risk factor (odds ratio [OR], 82; 95% confidence interval [CI95], 5.7-1,176;P=.001). Having more than five antibiotics (OR 11.9; CI95, 1.1-129.6;P<.05), use of metronidazole (OR 10.9; CI95, 1.7-69.8;P=.01), and being a medical patient (OR 8.1; CI95,1.4-47.6;P<.05) also were significant. Intensive care unit admission was associated with decreased risk (OR, 0.1; CI95, 0.01-0.8;P<.05).Conclusion:Our findings are consistent with an acute hospital outbreak. Monitoring and control of antibiotic use, particularly metronidazole, may reduce VRE in our hospital. Ongoing surveillance and staff education also are necessary.
8
Kamal, Mustafa, Abdur Rahim, Muhammad Tanvir Muhith, Shaoun Barua, Md Abdullah Yusuf e Hafez Muhammad Nazmul Ahsan. "Clinical Profiles of Chikungunya Fever Patients Attending at OPD of a Teaching Hospital in Dhaka City". Journal of National Institute of Neurosciences Bangladesh 5, n. 2 (7 settembre 2019): 148–51. http://dx.doi.org/10.3329/jninb.v5i2.43020.
Abstract (sommario):
Background: Chikungunya virus was introduced into the Dhaka city of Bangladesh and triggered a massive outbreak which affected millions of lives and forced upon significant damages in socioeconomic factors.
Objectives: This community based descriptive study was conducted in selected area of Dhaka city to see the clinical profiles of chikungunya patients in Dhaka city.
Methodology: This prospective observational study was carried out in the Department of Medicine OPD at Shaheed Suhrawardy Medical College & Hospital (ShSMC), Dhaka, Bangladesh. This cross-sectional study was conducted during the peak of chikungunya outbreak (1st March to 31st August, 2018) to document the clinical profiles of confirmed cases (laboratory test positive) and probable cases diagnosed by medical practitioners.
Results: The study included 1133 patients (Male 51.9%and Female 48.1%). The main symptoms were Fever (66%), higher in patients with Joint pain (82%), Rash (21.3%) and others (10.1%).Sensitivity of the patients by acute chikungunya 14.3% and other 85.7%. Patients had post chikungunya complications 14.3% and no complications 85.7%. Chikungunya patients increasing month are March 0.5%, April 0.5%, May 3.4%, June 25.8%, July 50.8%, August 19.1%. In Dhaka cities the affected area were Mirpur 41.7%, Mohammadpur 28.9%, Agargaon 8.8%, Tejgoan 5.9%, Shamoly 5.7%, Adabar 4.4%, Savar 2.0%, Rayerbazar 0.9%, Dhanmondi 0.8%, Mohakhali 0.8%.
Conclusions: The result found that gender and age are significantly associated with Chikungunya infection. This study will also help to provide support and services to public health science which will eventually contribute the country for the diagnosis, prevention and control of Chikungunya and similar viral diseases. Overall, it necessitates the importance of utilizing appropriate and reliable diagnostic methods, proper surveillance system and effective control measures that must be implemented to manage the disease outbreak situations.
Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 148-151
9
Cintean, Raffael, Alexander Eickhoff, Carlos Pankratz, Beatrice Strauss, Florian Gebhard e Konrad Schütze. "Radial vs. Dorsal Approach for Elastic Stable Internal Nailing in Pediatric Radius Fractures—A 10 Year Review". Journal of Clinical Medicine 11, n. 15 (31 luglio 2022): 4478. http://dx.doi.org/10.3390/jcm11154478.
Abstract (sommario):
Background: Forearm fractures are one of the most common fractures in children. Over the last years, a tendency towards surgical treatment was seen, especially closed reduction and internal fixation with elastic stable internal nailing (ESIN). Despite an overall low complication rate being described, a risk of intraoperative complications remains. Material and Methods: A total of 237 patients (mean age 8.3 ± 3.4 (1–16) years) with forearm or radius fractures treated with ESIN between 2010 and 2020 were included in the study. The retrospective review of 245 focused on fracture pattern, pre- and postoperative fracture angulation, intra- and postoperative complications, and surgical approach for nail implant. The fracture pattern and pre- and postoperative angulation were measured radiographically. Complications such as ruptures of the extensor pollicis longus (EPL) tendon and sensibility disorders of the superficial radial nerve were further analyzed. Results: In 201 cases (82%), we performed a dorsal approach; 44 fractures (17.9%) were treated with a radial approach. In total, we found 25 (10%) surgery-related complications, of which 21 (8.6%) needed further surgical treatment. In total, we had 14 EPL ruptures (5.7%), 4 sensibility disorders of the superficial radial nerve (1.6%), 2 refractures after implant removal (0.8%), 2 superficial wound infections (0.8%), and 1 child with limited range of motion after surgery (0.4%). No statistical significance between pre- and postoperative angulation correlated to fracture patterns or diameter of the elastic nail was seen. As expected, there was a significant improvement of postoperative angulation. Using radial approach in distal radial fractures showed a lower rate of surgical related complications, 2.3% of which need further surgical treatment as well as better postoperative angulations compared to the dorsal approach (8.5%). Conclusion: Especially due to the low risk of damaging the EPL tendon, the radial approach showed a lower complication rate which needed further surgical treatment. The risk of lesions of the superficial radial nerve remains.
10
Dimian, Caroline O., Michael J. O'Doherty, David Asboe, Christopher J. Page, Kate Entwisle e James S. Bingham. "Radioactively labelled diethylene triamine penta acetate lung scan in Pneum ocystis carinii pneumonia and asymptomatic HIV-positive patients". International Journal of STD & AIDS 8, n. 8 (1 agosto 1997): 482–88. http://dx.doi.org/10.1258/0956462971920622.
Abstract (sommario):
The objective of this study is to establish normal ranges for the assessment of lung permeability, using 99mTc DTPA (diethylene triamine penta acetate) aerosol by measuring the half-time of transfer from the lung in asymptomatic HIV-positive patients. Also to audit the use of the test in the clinical management of outpatients with symptoms suggestive of Pneumocystis carinii pneumonia (PCP). A retrospective analysis of data from outpatients' notes for the audit of symptomatic patients, and prospective acquisition of 'normal' data for HIVpositive asymptomatic patients who were non-smokers and smokers was performed. Over a period of 8 years, DTPA scans were performed on 400 asymptomatic HIV-positive patients (121 non-smokers and 279 smokers) and 188 symptomatic HIV-positive patients with symptoms suggestive of PCP. A biphasic curve of transfer of 99mTc DTPA with a half-time of less than 4 min, was considered diagnostic of PCP. The mean half-times ( SEM) for asymptomatic non-smokers was 61.4 3 min and for smokers was 21.9 0.8 min. In the symptomatic patients, 106 were treated for PCP and in 97 (91.5%) of these, the transfer was biphasic. Of the remaining 82 patients with respiratory pathology other than PCP, 71 (86.6%) had normal scans. The results show that smokers may have abnormal baseline scans 16/ 279 (5.7%) and therefore a baseline scan before symptoms should be recorded or a higher false positive rate can be expected. The test is however highly sensitive for the detection of PCP and allows the attending physician to initiate PCP treatment without delay.
11
Vuillard, Constance, Fadia Dib, Jallal Achamlal, Stéphane Gaudry, Damien Roux, Myriam Chemouny, Nicolas Javaud, Didier Dreyfuss, Jean-Damien Ricard e Jonathan Messika. "Longer symptom onset to aspiration time predicts success of needle aspiration in primary spontaneous pneumothorax". Thorax 74, n. 8 (12 giugno 2019): 780–86. http://dx.doi.org/10.1136/thoraxjnl-2019-213168.
Abstract (sommario):
BackgroundNeedle aspiration (NA) is recommended as first-line treatment of primary spontaneous pneumothorax (PSP). We aimed to assess NA success and the effect of a longer symptom onset to NA time.MethodsA discovery phase was retrospectively conducted in the intensive care unit of Louis Mourier Hospital (January 2000 to December 2011) followed by a prospective validation cohort (January 2012 to August 2015). The primary outcome was immediate NA success defined by the absence of need for chest tube insertion within 24 hours of the procedure.ResultsIn the discovery phase, 130 patients were admitted for PSP and 98 had NA as first-line treatment (75%). The immediate success rate of NA was 34.7% and was higher when it was performed ≥48 hours after symptom onset (57.7% vs 25%; p=0.004). In the prospective cohort, 87 patients were admitted for PSP; 71 (82%) had NA as first-step treatment. The immediate success rate was 40.8%. NA was more successful when it was performed after 48 hours of symptoms’ onset (34.5% vs 7.1%; p=0.005). A delay between the first symptom and NA procedure ≥48 hours was associated with a higher success of NA (OR=13.54; 95% CI 1.37 to 133). A smaller pneumothorax estimated by Light’s index was associated with NA success (OR=0.95; 95% CI 0.92 to 0.98). To what extent some of these pneumothoraces would have had a spontaneous resolution remains unknown.ConclusionWhen managing PSP with NA, a longer symptom onset to NA time was associated with NA success.Trial registration numberNCT02528734.
12
Lohankova, L. A., Yu V. Kotovskaya, A. S. Milto e Zh D. Kobalava. "The structural and functional features of the microcirculatory bed in patients with arterial hypertension and type 2 diabetes mellitus". "Arterial’naya Gipertenziya" ("Arterial Hypertension") 11, n. 3 (28 giugno 2005): 177–80. http://dx.doi.org/10.18705/1607-419x-2005-11-3-177-180.
Abstract (sommario):
The structural and functional features of the microcirculatory heel (MCB) were studied in patients with arterial hypertension (AH) in relation to the presence or absence of type 1 diabetes mellitus (DM). Two hundred and twelve patients were examined. These included 110 patients with grades 1 and 2 arterial hypertension (AH) and type 2 DM, 82 patients with AH without type 2 DM, and 20 apparently healthy individuals. Laser Doppler flowmetry (LDF) was used to estimate basal blood flow, the loading test parameters characterizing the structural and functional status of MCB, and the incidence of hemodynamic types of microcirculation. Patients with AH concurrent with type 1 DM were found to have the following microcirculatory features: an increase in perfusion blood flow (microcirculation index, 8,8±1,8 perf. units versus 4,9±0,8 perf, units in patients with AH without DM and 6,7±0,9 perf. units in the control group), a drastic reduction in myogenic activity to 13,2±5,7 % versus 16,7±6,8 and 25,2±6,4 %, respectively, a decrease in vascular resistance, impairment of autoregulation, and low reserve capacities (reserve capillary blood flow was 197,8±31,6 % versus 429,9±82,01 % in the group of AH without DM and 302,8±50,1 % in the control group), a predominance of the hyperemic hemodynamic type (58,8 % in patients with AH and DM, 20,9 % in those with AH without DM, and 20,0 % in the controls). The specific features of the altered microcirculatory bed in patients with AH concurrent with type 2 DM were ascertained. These included the predominance of hyperemic microcirculation, impaired autoregulation. diminished microvascular resistance, and the low reserve capacities of the microcirculatory bed.
13
Ohji, Madoka, Hiroya Harino e William John Langston. "Differences in bioaccumulation and transfer ability between tributyltin and triphenyltin from parental female to offspring in viviparous surfperch Ditrema temmincki". Journal of the Marine Biological Association of the United Kingdom 98, n. 8 (22 agosto 2017): 2113–20. http://dx.doi.org/10.1017/s0025315417001436.
Abstract (sommario):
To examine the risk of transgenerational transfer of organotin compounds (OTs) in fish, tributyltin (TBT) and triphenyltin (TPT) compounds and their breakdown products were determined in both parental females and offspring of viviparous surfperch Ditrema temmincki collected from Japanese coastal waters. TBT concentrations (Mean ± SD) in the offspring (34 ± 5.7 ng Sn g−1 wet wt) were significantly higher (10–17 times) than in the parental females (2.8 ± 1.0 ng Sn g−1 wet wt). In the offspring, TBT was the predominant butyltin compound (82 ± 1.6% ∑BTs = TBT + DBT + MBT), and represented a greater proportion than in the parental females (51 ± 9.3% as TBT). TPT concentrations were significantly lower than TBT, and the ratio of TPT in parental females, relative to offspring, was different from TBT. TPT concentrations in the offspring (0.8 ± 0.3 ng Sn g−1 wet wt) were almost identical to those in the parental females (1.0 ± 0.5 ng Sn g−1 wet wt). TPT was the predominant phenyltin (∑PTs = TPT + DPT + MPT) in both offspring (73 ± 12% as TPT) and parental females (72 ± 18% as TPT). Results suggest that the transfer rate of TBT from parent to offspring could be much faster than its degradation rate in the offspring, accounting for higher accumulation of TBT in the latter. In contrast, the transfer rate of TPT is slower than its biodegradation, leading to a lower concentration of TPT in the offspring. It is therefore likely that the offspring might be at a higher risk from TBT than the parental females during their early growth stage in ovary in the viviparous surfperch whereas exposure to TPT is comparable in both generations.
14
Li, Yahan, Xue Sun, Xin Wang e Xiaosheng Fang. "Combination of NCCN Risk Stratification System and Pre-Transplant Minimal Residual Disease Levels for the Prognosis of Acute Myeloid Leukemia after Allogeneic Hematopoietic Stem Cell Transplantation". Blood 138, Supplement 1 (5 novembre 2021): 3434. http://dx.doi.org/10.1182/blood-2021-149479.
Abstract (sommario):
Abstract Background Numerous studies have confirmed that National Comprehensive Cancer Network (NCCN) risk stratification or pre-transplant minimal residual disease (MRD) levels can predict the risk of recurrence and survival after transplantation. But it is unclear whether combining these two parameters can more accurately predict prognosis. Methods We retrospectively analyzed 85 patients with acute myeloid leukemia (AML) who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) and constructed a new risk stratification tool combining NCCN risk stratification and pre-MRD levels. All patients were grouped by NCCN risk stratification (favorable/intermediate prognosis and poor prognosis group), pre-MRD levels (MRD (-) group (<0.1%) and MRD (+) group (≥0.1%)) and a combination of the above (low, intermediate and high risk groups), and graft-versus-host disease (GVHD) and prognosis were compared between groups. Results Relative to the favorable/intermediate prognosis group, OS and RFS were poorer in the poor prognosis group (71% vs 82%, P= .156; 60% vs 74%, P= .101) and CIR (29% vs 20%, P= .229) and NRM (23% vs 14%, P= .200) were better. The incidence of aGVHD and cGVHD was slightly lower in the favorable/intermediate prognosis group than in the poor prognosis group (38% vs 46%, P= .415; 10% vs 11%, P=. 572). Relative to the MRD (+) group, the MRD (-) group had significantly better OS and RFS (89% vs 59%, P= .002; 79% vs 50%, P= .003), lower CIR and NRM (15.1% vs 37.5%, P= .011; 11.3% vs 28%, P= .040), and a lower incidence of cGVHD (6% vs 19%, P= .022). The new risk stratification tool stratified patients into low, intermediate and high risk groups. Patients in the high-risk group had the highest incidence of aGVHD and cGVHD (42% vs 35% vs 53%, P= .606; 6% vs 11% vs 20%, P= .157). The difference in cGVHD between the low- and high-risk groups was significant (P= .038). Three-year OS was 93.9%, 70% and 60% (P= .011) and RFS was 85%, 62% and 46.7% (P= .009) for low-, intermediate- and high-risk patients, respectively. The differences in OS and RFS between the low- and intermediate-risk groups were statistically significant (P= .010; P= .025), as were the differences in OS and RFS between the low- and high-risk groups (P= .001; P= .001). Patients in the high-risk group had the highest CIR and NRM relative to those in the low- and intermediate-risk groups (9% vs 32% vs 33.3%, P= .027; 6% vs 24.3% vs 26.7%; P= .059). The differences in CIR (P= .012) and NRM (P= .028) were statistically significant in both the low-risk and intermediate-risk groups, as well as in the low- and high-risk groups (CIR: P= .028; NRM: P= .021). Multivariate analysis indicated that time to ANC recovery, time from diagnosis to transplantation, and novel risk stratification were independent prognostic factors. Conclusions Both pre-MRD levels and NCCN risk stratification predict AML prognosis after allo-HSCT, and combining the two can more accurately predict post-transplant prognosis. Disclosures No relevant conflicts of interest to declare.
15
Filippov, E. G., A. A. Dontsova, D. P. Dontsov, E. S. Doroshenko, R. N. Bragin e I. M. Zasypkina. "Spring barley variety ‘Azimut’". Grain Economy of Russia, n. 5 (16 novembre 2022): 91–97. http://dx.doi.org/10.31367/2079-8725-2022-82-5-91-97.
Abstract (sommario):
Improvement of feed grain production is an important link in Russia’s food security. Considerable opportunities for solving this problem lie in the cultivation of new domestic varieties of barley. Breeding work in this direction has been carried out for a long time in the Don area by the FSBSI “ARC “Donskoy” (Department of winter and spring barley breeding and seed production). The purpose of the study was to breed a new spring barley variety for regions with high signs of aridy, which has fairly large productivity and its stability in different years. The result of the breeding program 0706-2019-0002 was the development of the spring barley variety ‘Azimut’ of universal use, i.e. for feed, groats and for brewing purposes. The paper has described the morphology of plants and the main biological and valuable economic traits of the new spring barley variety ‘Azimut’, which has been included in the State List of Breeding Achievements of Russia since 2022. There has been found that a remarkable feature of this variety is early maturity (through three contrast years (2017–2019) it ripened on average earlier than the standard variety ‘Ratnik’ on 4 days and the best variety ‘Format’ on 2 days), which is an extremely important indicator in modern climatic conditions. There was found that, on average, over the years, the new variety produced 5.7 t/ha and 52.0 g of 1000-grain weight, exceeding the standard on 0.8 t/ha and 6.5 g, as well as the best variety ‘Format’ on 0 .2 t/ha and 3.8 g, respectively. It has been established that the variety ‘Azimut’ has a certain important set of biologically useful and economically valuable properties and traits.
16
Bazylev, V. V., R. M. Babukov, F. L. Bartosh e A. V. Gorshkova. "Comparison of the hemodynamic parameters of transaortic blood flow in patients with aortic stenosis depending on the bicuspid or tricuspid valve structure". Medical Visualization 24, n. 4 (12 dicembre 2020): 74–80. http://dx.doi.org/10.24835/1607-0763-2020-4-74-80.
Abstract (sommario):
Purpose: comparison of hemodynamic parameters of transaortic blood flow in patients with aortic stenosis depending on the bivalve or tricuspid structure of the aortic valve.Materials and methods. A study of 180 patients with isolated aortic valve stenosis (AC) with two – and threeleaf structure was conducted. Patients were ranked into 3 comparison subgroups by the area of the effective AC opening from 4 to 1.5 cm2; 1.5 to 1 cm2 and less than 1 cm2. An echocardiographic study was performed with the calculation of all the necessary parameters for the study.Results. The comparison subgroups were comparable in terms of effective orifice area (AVA), effective orifice area index (IAVA), body mass index (BMI), LV UO index, and LV FV (p > 0.05). However, the indicators Vmax, Gmean, and AT in patients with a bivalve AK structure in all comparison subgroups were significantly higher than in patients with a tricuspid structure. Comparison subgroup with AVA from 4 to 1.5 cm2: Vmax 2.8 ± 9 m/s and 2.5 ± 6 m/s p = 0.02. Gmean 18.6 ± 7.2 mm Hg and 15 ± 6 mm Hg p = 0.03, AT 82 ± 12 ms and 70 ± 10 ms p = 0.002. Comparison subgroup with AVA from 1.5 to 1 cm2: Vmax 3.7 ± 0.8 m/s and 3.5 ± 0.6 m/s p = 0.02. Average transaortic gradient 37 ± 10 mm Hg and 29 ± 5 mm Hg p = 0.04, AT 103 ± 11 ms and 94 ± 10 ms p = 0.02. Comparison subgroup with an effective area of less than 1 cm2: Vmax 5.7 ± 1.2 m/s and 4.7 ± 0.7 m/s p = 0.001, Gmean 54 ± 15 and 43 ± 11 mm Hg p < 0.001, AT 127 ± 20 ms and 112 ± 10 ms p = 0.002.Conclusion. Echocardiographic indicators of Vmax and Gmean in patients with bivalve AC structure have higher values than in patients with tricuspid AC structure with a comparable opening area.
17
Szewczyk, Adam, Janina Kaniuczak, Edmund Hajduk e Renata Knap. "Physical and chemical properties of selected soils from the surroundings of the Magura National Park (southern Poland) / Właściwości fizykochemiczne i chemiczne wybranych gleb z otoczenia Magurskiego Parku Narodowego". Soil Science Annual 66, n. 1 (1 marzo 2015): 36–44. http://dx.doi.org/10.1515/ssa-2015-0017.
Abstract (sommario):
Abstract The aim of the study was to investigate the basic physicochemical and chemical properties of six soil profiles located in the surrounding of the Magura National Park (S Poland). The type of agricultural use and terrain relief were the main criteria for choosing the soil profiles. The research identified the following types or sub-types of soils: Eutric Gleysols, Dystric Cambisols, Eutric Cambisols, Gleyic Luvisols. The analyzed soils were characterized by particle size distribution of a silty clay or silt. They were usually strongly acidified as evidenced by low pH (in 1M KCl, values ranged from 3.8 to 5.8), high values of hydrolytic acidity (from 0.8 up to 10 cmol(+)·kg-1) and exchangeable acidity (from 0.05 to 4.05 cmol(+)·kg-1), as well as remarkable concentration of exchangeable aluminum (from 0 to 3.96 cmol(+)·kg-1). The organic carbon content in studied profiles did not exceed (except from gley soil in profile ) 30 g·kg-1 and it decreased along with the depth to several g·kg-1 in parent rock. These soils were characterized by not very high content of total nitrogen (from 0.3 to 9.39 g·kg-1) and low available phosphorus concentration (from 3.5 to 90.3 mg P2O5·kg-1). Contents of available potassium (from 82 to 570 mg K2O·kg-1) and magnesium (from 33 to 412 mg Mg·kg-1) allow for classifying the profiles studied as soils moderately or highly abundant in K and Mg. The highest levels of biogenic elements were determined in surface horizons. Studied soils were characterized by high total sorption capacity (T) - from 7.04 to 63.4 cmol(+)·kg-1. Sum of base cations (S) reached values from 3.01 to 61.2 cmol(+)·kg-1, which resulted in high base saturation (V) (maximum over 96%). The base saturations in profiles of the soils increased along with depth.
18
Rose, P. G., J. A. Blessing, A. R. Mayer e H. D. Homesley. "Prolonged oral etoposide as second-line therapy for platinum-resistant and platinum-sensitive ovarian carcinoma: a Gynecologic Oncology Group study." Journal of Clinical Oncology 16, n. 2 (febbraio 1998): 405–10. http://dx.doi.org/10.1200/jco.1998.16.2.405.
Abstract (sommario):
PURPOSE A phase II trial was conducted to determine the activity of prolonged oral etoposide in platinum-resistant and platinum-sensitive ovarian carcinoma. PATIENTS AND METHODS Platinum-resistant disease was defined as progression on platinum-based chemotherapy or recurrence within 6 months of completing therapy. The starting dose was 50 mg/m2/d (30 mg/m2/d for prior radiotherapy) for 21 days, every 28 days. A dose escalation to a maximum dose of 60 mg/m2/d was prescribed. RESULTS Of 99 patients entered, 97 were assessable for toxicity and 82 were assessable for response. Among 41 platinum-resistant patients a 26.8% response rate (7.3% complete response [CR] and 19.5% partial response [PR] rate) occurred. The median response duration was 4.3 months (range, 1.3 to 8.7), median progression-free interval (PFI) was 5.7 months (range, 0.8 to 30.8+), and median survival time was 10.8 months (range, 1.9 to 45.8). Twenty-five of 41 platinum-resistant patients had also previously received paclitaxel; of which eight (32%) responded. Among 41 platinum-sensitive patients, a 34.1% response rate (14.6% CR and 19.5% PR rate) occurred. The median response duration was 7.5 months (range, 1.9 to 15.2+), median PFI was 6.3+ months (range, 0.9 to 20.4), and median survival time was 16.5+ months (range, 0.9 to 34.8). Of 97 patients assessable for toxicity, grade 3 or 4 hematologic toxicity was common, with leukopenia occurring in 41.2% (grade 3, 29%; grade 4, 12%), neutropenia in 45.4% (grade 3, 20%; grade 4, 25%), thrombocytopenia in 9% (grade 3, 5%; grade 4, 4%), and anemia in 13.4%. Three treatment-related deaths occurred: two from neutropenic sepsis and one from thrombocytopenic bleeding after an overdose. One patient developed leukemia. CONCLUSION This regimen is active in platinum-resistant and platinum-sensitive ovarian carcinoma. Additionally, the regimen is active in paclitaxel-resistant ovarian carcinoma.
19
Nadali, G., F. Vinante, A. Ambrosetti, G. Todeschini, D. Veneri, R. Zanotti, V. Meneghini, M. M. Ricetti, F. Benedetti e A. Vassanelli. "Serum levels of soluble CD30 are elevated in the majority of untreated patients with Hodgkin's disease and correlate with clinical features and prognosis." Journal of Clinical Oncology 12, n. 4 (aprile 1994): 793–97. http://dx.doi.org/10.1200/jco.1994.12.4.793.
Abstract (sommario):
PURPOSE To evaluate the serum levels of the soluble form of the CD30 molecule (sCD30) in patients with Hodgkin's disease (HD) to establish whether there is a correlation with clinical features at presentation and prognosis. PATIENTS AND METHODS The sCD30 serum levels of 117 patients were measured at diagnosis with a commercial sandwich enzyme-linked immunoadsorbent assay (ELISA) test kit, and in 78 of these patients the sCD30 levels were also recorded during the follow-up period. RESULTS sCD30 levels at diagnosis were increased (> 20 U/mL) in a high proportion of patients (87.2%; mean +/- SD, 108 +/- 134 v 5.3 +/- 5.7 U/mL in controls, P < .0001) and correlated with stage (stages I + II, 73 +/- 97 U/mL; III + IV, 162 +/- 165 U/mL; P < .0001), with presence of B symptoms (stage A, 69 +/- 82 U/mL; stage B, 162 +/- 171 U/mL; P < .0001), and, to some extent, with tumor burden (bulky presentation, 141 +/- 129 U/mL; nonbulky, 91 +/- 133 U/mL; P = .058). Patients with sCD30 levels greater than 100 U/mL at diagnosis had a significantly higher rate of poor outcome in terms of failure to achieve a complete remission (CR) or disease relapse after CR achievement. In fact, the event-free survival (EFS) duration of patients with sCD30 levels greater than 100 U/mL was significantly worse (P = .0016). Using multivariate analysis, an sCD30 level greater than 100 U/mL retained its significance after adjustment for other prognostic parameters. CONCLUSION sCD30 in HD at presentation strictly correlates with clinical features. Serum levels greater than 100 U/mL at diagnosis entail a significantly higher risk of treatment failure, a factor that is independent of other prognostic parameters.
20
Ho, Kay Woon, Ru San Tan, Keng Yean Wong, Teng Hong Tan, Sriram Shankar e Ju Le Tan. "Late Complications Following Tetralogy of Fallot Repair: The Need for Long-term Follow-Up". Annals of the Academy of Medicine, Singapore 36, n. 11 (15 novembre 2007): 947–53. http://dx.doi.org/10.47102/annals-acadmedsg.v36n11p947.
Abstract (sommario):
Introduction: We report a series of operated tetralogy of Fallot (TOF) patients focusing on complications and outcomes. Materials and Methods: Data from TOF patients seen at our centre’s adult congenital heart disease clinic was analysed. Results: There were 21 patients: the mean age was 32.2 ± 12.4 years; the age at first operation was 9.0 ± 7.9 years; the mean postoperative follow-up duration was 23.5 ± 12.1 years; and the current New York Heart Association (NYHA) status: I, 82%; II, 4%; III, 14%. Fourteen patients had complete operative notes. All these patients underwent total TOF correction; 2 had staged aortopulmonary shunt with total correction at a mean of 3.2 years later, pulmonary artery patch augmentation in 8 patients and pulmonary valvotomy in 8 patients. Three patients required pulmonary valve homograft replacement for severe pulmonary regurgitation (PR) at 13, 28 and 36 years after the initial corrective operation. Current investigations: RBBB on ECG (91%), QRS duration 137 ± 29 ms. Echocardiography showed dilated right ventricular end-diastolic (RVED) diameters (3.2 ± 0.8 cm); severe PR (67%), residual right ventricular outflow tract obstruction (RVOTO) (42%) and VSD patch leakage (9%). Cardiac magnetic resonance (CMR) (8 patients) showed dilated RVED volumes 252.6 ± 93.8 mL, indexed RV volume 165.7 ± 34.8 mL; RV systolic function was preserved in most patients with a RV ejection fraction of 49.5 ± 5.7%. One patient had atrial tachycardia and another had frequent non-sustained ventricular tachycardia that required radiofrequency ablation. Conclusion: Patients with TOF who had full corrective surgery during childhood are now surviving into adulthood. Many challenges arising from complications in the postoperative period remain. It is imperative that adult TOF patients should have regular followup to monitor development and subsequent management of these complications. Key words: Cardiovascular abnormalities, Congenital, Heart defects
21
Buda, Gabriele, Alessandro Martino, Daniele Campa, Juan Sainz, Rui Manuel Vieira Reis, Ramón García-Sanz, Krzysztof Jamroziak et al. "Polymorphisms in Regulators of Xenobiotic Transport and Metabolism Genes NR1I2 and NR1I3 and Multiple Myeloma Risk: A Case-Control Study in the Context of IMMEnSE Consortium". Blood 118, n. 21 (18 novembre 2011): 5014. http://dx.doi.org/10.1182/blood.v118.21.5014.5014.
Abstract (sommario):
Abstract Abstract 5014 Exposure to toxic compounds and pesticides leads to an increased risk to develop Multiple Myeloma (MM). The metabolism and the excretion of xenobiotics are mediated by the enzymes and transporters acting in the detoxifying/elimination process. The nuclear receptors NR1I2 (or PXR) and NR1I3 (or CAR) act as xenosensor activating the detoxifying/elimination process in response to the intracellular levels of xenobiotics. It has been hypothesized that part of the individual variability in drug metabolism efficiency could be due to the genetic variations within these regulator genes affecting their expression and/or function. To investigate the impact of genetic variation within these genes on MM susceptibility, we selected and genotyped 10 tag Single Nucleotide Polymorphisms (SNPs) in the PXR gene and 7 tag SNPs in the CAR gene in 627 MM cases (320 males and 307 females) and 883 (459 males and 424 females) controls from different European populations. All the SNPs were in Hardy-Weinberg equilibrium (p>0.001), with the exception of the PXR SNP rs2461818 that was therefore excluded from the analysis. We found no association of any of the genotyped SNPs with MM risk. In the same way, haplotype distribution showed no differences between cases and controls. This was the first comprehensive investigation of genetic variation in xenobiotic regulators genes PXR and CAR in relation to MM risk and our data suggest that common variants in these genes have no impact in modifying MM risk. Table I. Genotype distribution of the PXR and CAR SNPs among MM cases and controls. SNP (rs) Cases (%) Controls (%) OR* 95%C.I. p-value p-trend PXR C/C 429 (69.5) 623 (70.7) 1.00 Ref 0.423 rs10511395 A/C 160 (25.9) 228 (25.9) 1.02 0.81 – 1.30 0.851 A/A 28 (4.6) 30 (3.4) 1.38 0.81 – 2.35 0.232 PXR C/C 452 (74.0) 656 (74.8) 1.00 Ref 0.451 rs1054190 C/T 137 (22.4) 200 (22.8) 1.00 0.78 – 1.28 0.993 T/T 22 (3.6) 21 (2.4) 1.56 0.84 – 2.88 0.155 PXR C/C 412 (65.9) 591 (67.2) 1.00 Ref 0.819 rs11917714 C/T 190 (30.4) 250 (28.5) 1.07 0.85 – 1.35 0.535 T/T 23 (3.7) 38 (4.3) 0.84 0.49 – 1.44 0.536 PXR C/C 223 (36.3) 296 (33.7) 1.00 Ref 0.126 rs12488820 C/T 289 (47.0) 407 (46.4) 0.93 0.74 – 1.18 0.574 T/T 103 (16.7) 175 (19.9) 0.79 0.58 – 1.06 0.119 PXR G/G 430 (69.6) 593 (67.4) 1.00 Ref 0.807 rs13071341 A/G 166 (26.9) 269 (30.6) 0.85 0.67 – 1.07 0.158 A/A 22 (3.5) 18 (2.0) 1.70 0.90 – 3.22 0.102 PXR A/A 352 (58.7) 516 (39.4) 1.00 Ref 0.981 rs3237359 A/G 209 (34.8) 291 (33.5) 1.04 0.83 – 1.30 0.720 G/G 39 (6.5) 62 (7.1) 0.90 0.59 – 1.37 0.619 PXR C/C 255 (41.2) 383 (43.6) 1.00 Ref 0.815 rs13059232 C/T 299 (48.3) 390 (44.4) 1.16 0.93 – 1.44 0.192 T/T 65 (10.5) 106 (12.0) 0.94 0.66 – 1.33 0.711 PXR A/A 300 (48.7) 437 (49.7) 1.00 Ref 0.258 rs3732357 A/G 240 (39.0) 361 (41.0) 0.94 0.75 – 1.17 0.589 G/G 76 (12.3) 82 (9.3) 1.31 0.92 – 1.85 0.130 PXR T/T 328 (53.6) 463 (52.9) 1.00 Ref 0.424 rs1357459 C/T 249 (40.7) 345 (39.4) 1.02 0.82 – 1.27 0.850 C/C 35 (5.7) 67 (7.7) 0.75 0.49 – 1.17 0.206 CAR A/A 218 (35.4) 335 (38.1) 1.00 Ref 0.571 rs3003596 A/G 296 (48.0) 393 (44.7) 1.16 0.93 – 1.46 0.191 G/G 102 (16.6) 151 (17.2) 1.04 0.77 – 1.41 0.799 CAR G/G 264 (42.7) 371 (42.0) 1.00 Ref 0.642 rs3813627 G/T 276 (44.7) 392 (44.4) 0.98 0.79 – 1.23 0.882 T/T 78 (12.6) 120 (13.6) 0.91 0.66 – 1.26 0.581 CAR A/A 441 (73.1) 635 (73.5) 1.00 Ref 0.911 rs11265571 A/T 147 (24.4) 207 (24.0) 1.01 0.79 – 1.29 0.911 T/T 15 (2.5) 22 (2.5) 0.97 0.49 – 1.89 0.921 CAR T/T 404 (64.2) 575 (65.7) 1.00 Ref 0.836 rs2307418 G/T 193 (31.1) 268 (30.6) 1.02 0.81 – 1.27 0.879 G/G 23 (3.7) 32 (3.7) 1.05 0.60 – 1.83 0.863 CAR C/C 348 (56.6) 508 (57.7) 1.00 Ref 0.527 rs2502805 C/T 220 (35.8) 313 (35.6) 1.05 0.84 – 1.30 0.693 T/T 47 (7.6) 59 (6.7) 1.16 0.77 – 1.74 0.484 CAR A/A 245 (39.8) 346 (39.4) 1.00 Ref 0.770 rs4073054 A/C 291 (47.2) 412 (46.9) 0.98 0.78 – 1.22 0.855 C/C 80 (13.0) 120 (13.7) 0.94 0.68 – 1.31 0.720 CAR C/C 360 (57.6) 524 (59.8) 1.00 Ref 0.391 rs4233368 A/C 225 (36.0) 302 (34.4) 1.09 0.88 – 1.36 0.439 A/A 40 (6.4) 51 (5.8) 1.15 0.74 – 1.78 0.538 Genotype distribution among MM cases and controls in the overall population. * OR are adjusted for age, gender and region of origin. Differences in samples numbers are due to failures in genotyping. Disclosures: No relevant conflicts of interest to declare.
22
Weber, Myriam C., Martin Risch, Sarah L. Thiel, Kirsten Grossmann, Susanne Nigg, Nadia Wohlwend, Thomas Lung et al. "Characteristics of Three Different Chemiluminescence Assays for Testing for SARS-CoV-2 Antibodies". Disease Markers 2021 (6 gennaio 2021): 1–13. http://dx.doi.org/10.1155/2021/8810196.
Abstract (sommario):
Several tests based on chemiluminescence immunoassay techniques have become available to test for SARS-CoV-2 antibodies. There is currently insufficient data on serology assay performance beyond 35 days after symptoms onset. We aimed to evaluate SARS-CoV-2 antibody tests on three widely used platforms. A chemiluminescent microparticle immunoassay (CMIA; Abbott Diagnostics, USA), a luminescence immunoassay (LIA; Diasorin, Italy), and an electrochemiluminescence immunoassay (ECLIA; Roche Diagnostics, Switzerland) were investigated. In a multigroup study, sensitivity was assessed in a group of participants with confirmed SARS-CoV-2 ( n = 145 ), whereas specificity was determined in two groups of participants without evidence of COVID-19 (i.e., healthy blood donors, n = 191 , and healthcare workers, n = 1002 ). Receiver operating characteristic (ROC) curves, multilevel likelihood ratios (LR), and positive (PPV) and negative (NPV) predictive values were characterized. Finally, analytical specificity was characterized in samples with evidence of the Epstein–Barr virus (EBV) ( n = 9 ), cytomegalovirus (CMV) ( n = 7 ), and endemic common-cold coronavirus infections ( n = 12 ) taken prior to the current SARS-CoV-2 pandemic. The diagnostic accuracy was comparable in all three assays (AUC 0.98). Using the manufacturers’ cut-offs, the sensitivities were 90%, 95% confidence interval [84,94] (LIA), 93% [88,96] (CMIA), and 96% [91,98] (ECLIA). The specificities were 99.5% [98.9,99.8] (CMIA), 99.7% [99.3,99.9] (LIA), and 99.9% [99.5,99.98] (ECLIA). The LR at half of the manufacturers’ cut-offs were 60 (CMIA), 82 (LIA), and 575 (ECLIA) for positive and 0.043 (CMIA) and 0.035 (LIA, ECLIA) for negative results. ECLIA had higher PPV at low pretest probabilities than CMIA and LIA. No interference with EBV or CMV infection was observed, whereas endemic coronavirus in some cases provided signals in LIA and/or CMIA. Although the diagnostic accuracy of the three investigated assays is comparable, their performance in low-prevalence settings is different. Introducing gray zones at half of the manufacturers’ cut-offs is suggested, especially for orthogonal testing approaches that use a second assay for confirmation.
23
Seah, Xue Fen Valerie, Yue Ling Rina Ong, Wei Ming Cedric Poh, Shahul Hameed Mohamed Siraj, Kai-Qian Kam e Koh Cheng Thoon. "137. Impact of Antimicrobial Stewardship Interventions on Post-Elective Caesarean Antibiotic Prophylaxis and Surgical Site Infections". Open Forum Infectious Diseases 8, Supplement_1 (1 novembre 2021): S182. http://dx.doi.org/10.1093/ofid/ofab466.339.
Abstract (sommario):
Abstract Background Antimicrobial stewardship programs (ASP) aim to improve appropriate antimicrobial use. Post-operative antibiotics are generally not necessary, especially those without surgical site infections risk factors (e.g. obesity). Few studies have described the impact of ASP interventions on patient outcomes especially in unique populations such as obstetrics. This study aims to evaluate the impact of ASP interventions on post-elective caesarean (eLSCS) oral antibiotic prophylaxis use and patient outcomes including SSI rates. Methods This pre-post quasi-experimental study was conducted over 9 months (2 months pre- and 7 months post-intervention) in all women admitted for eLSCS in our institution. Interventions included eLSCS surgical prophylaxis guideline dissemination, where a single antibiotic dose within 60 minutes before skin incision was recommended. Post-eLSCS oral antibiotics was actively discouraged in those without SSI risk factors. This was followed by ASP intervention notes (phase 1) for 3 months, and an additional phone call to the ward team for the next 7 months (phase 2). Phase 3 (next 6 months) constituted speaking to the operating consultant. The primary outcome was post-operative oral antibiotics prescription rates. Secondary outcomes included rates of 30-day post-operative SSI. Results A total of 1751 women was reviewed. Appropriateness of pre-operative antibiotic prophylaxis was 98% in our institution. There were 244 women pre-intervention, 274 in post-intervention phase 1, 658 in phase 2 and 575 in phase 3. Pre-intervention post-eLSCS antibiotic prescribing rates was 82% (200), which reduced significantly post-intervention to 54% (148) in phase 1, 50% (331) in phase 2 and 39% (226) in phase 3 (p< 0.001). There was no significant difference in patients who developed post-operative SSI pre-post intervention (0.8%, 2 of 242 vs. 1.9%, 28 of 1479, p=0.420) and among who received post-operative oral antibiotics compared to those without (1.9%, 17 of 905 vs. 1.5%, 13 of 846, p=0.582). Conclusion ASP interventions can reduce post-eLSCS antibiotic prophylaxis rates without adversely impacting patient safety. Disclosures All Authors: No reported disclosures
24
Jack, Darby W., Kenneth Ayuurebobi Ae-Ngibise, Carlos F. Gould, Ellen Boamah-Kaali, Alison G. Lee, Mohammed Nuhu Mujtaba, Steven Chillrud et al. "A cluster randomised trial of cookstove interventions to improve infant health in Ghana". BMJ Global Health 6, n. 8 (agosto 2021): e005599. http://dx.doi.org/10.1136/bmjgh-2021-005599.
Abstract (sommario):
IntroductionHousehold air pollution from solid fuel combustion for cooking and heating is a leading cause of childhood morbidity and mortality worldwide. We hypothesised that clean cooking interventions delivered during pregnancy would improve child health.MethodsWe conducted a cluster randomised trial in rural Ghana to test whether providing pregnant women liquefied petroleum gas (LPG) cookstoves or improved biomass cookstoves would reduce personal carbon monoxide and fine particulate pollution exposure, increase birth weight and reduce physician-assessed severe pneumonia in the first 12 months of life, compared with control participants who continued to cook with traditional stoves. Primary analyses were intention-to-treat. The trial was registered with ClinicalTrials.gov and follow-up is complete.ResultsEnrolment began on 14 April 2014, and ended on 20 August 2015. We enrolled 1414 pregnant women; 361 in the LPG arm, 527 in the improved biomass cookstove arm and 526 controls. We saw no improvement in birth weight (the difference in mean birth weight for LPG arm births was 29 g lighter (95% CI −113 to 56, p=0.51) and for improved biomass arm births was 9 g heavier (95% CI −64 to 82, p=0.81), compared with control newborns) nor severe child pneumonia (the rate ratio for pneumonia in the LPG arm was 0.98 (95% CI 0.58 to 1.70; p=0.95) and for the improved biomass arm was 1.21 (95% CI 0.78 to 1.90; p=0.52), compared with the control arm). Air pollution exposures in the LPG arm remained above WHO health-based targets (LPG median particulate matter less than 2.5 microns in diameter (PM2.5) 45 µg/m³; IQR 32–65 vs control median PM2.5 67 µg/m³, IQR 46–97).ConclusionsNeither prenatally-introduced LPG nor improved biomass cookstoves improved birth weight or reduced severe pneumonia risk in the first 12 months of life. We hypothesise that this is due to lower-than-expected exposure reductions in the intervention arms.Trial registration numberNCT01335490.
25
Мирсаева, G. Mirsaeva, Камаева, E. Kamaeva, Андрианова, O. Andrianova, Ибрагимова e L. Ibragimova. "Effective treatment of obesity in women of reproductive age". Journal of New Medical Technologies. eJournal 9, n. 4 (8 dicembre 2015): 0. http://dx.doi.org/10.12737/16777.
Abstract (sommario):
The study included 82 women aged from 18 to 49 years old (mean age 29,7±5,7 years). A clinical examination, the study of body composition by bioimpedance measuring, questioning were carried out. Statistical analysis was performed using the program Microsoft Exel, "Statistica 7,0". Analysis of the diet revealed the excess of the daily energy value of food intake over energy requirements of 650±250 kcal/day in the group of persons with obesity in comparison with healthy. Disorders of balanced daily diet were noted. To improve motivation and compliance in the "School of overweight correction" the patients with obesity and healthy were trained in groups and individually. After training, the authors observed favorable trends in nutrition of patients, reducing the fat consumption in 7,2±0,8 g/day and refined carbohydrates to 8,2±0,5 g/day. In the treatment the authors used the drug The Reduxine (sibutramine in combination with microcrystalline cellulose) at a dose of 10 mg. The Observation lasted 24 weeks. Caloric value of daily ration decreased by 20-28% from initial, average weight loss was 8,9±1,6 kg, waist circumference decrease was 11,4±1,8 cm. Patients with risk of diabetes took the Sibutramine + microcrystalline cellulose (the Reduxine) at a dose of 10 mg and the Metformin at a dose of 500 mg. There is increase dose weekly by 500 mg to dose of 1500 mg. Energy intake decreased by 28 ± 7% of the original (p <0,05) on combination therapy. As a result of the combined therapy the Reduxine at a dose of 10 mg and the Metformin at a dose of 1500 mg, the authors revealed a decrease in body weight - 9,7 ± 1,5 kg (p<0,05), waist circumference - 11,4±1,8 cm (p<0.05). The therapy by the Reduxine at a dose of 10 mg for 6 months and combined therapy with the Reduxine 10 mg and the Metformin 1500 mg led to the control of feeding behavior, improvement in metabolic parameters, target weight loss. This therapy is effective and safety.
26
Murias, Juan M., Kenneth N. Grise, Mao Jiang, Hana Kowalchuk, C. W. James Melling e Earl G. Noble. "Acute endurance exercise induces changes in vasorelaxation responses that are vessel-specific". American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 304, n. 7 (1 aprile 2013): R574—R580. http://dx.doi.org/10.1152/ajpregu.00508.2012.
Abstract (sommario):
The dynamic adjustment and amplitude of the endothelium-dependent vasorelaxation of the carotid, aorta, iliac, and femoral vessels were measured in response to acute low- (LI) or high-intensity (HI) endurance exercise. Vasorelaxation to 10−4 M ACh was evaluated in 10 control, 10 LI, and 10 HI rats. Two-millimeter sections of carotid, aorta, iliac, and femoral arteries were mounted onto a myography system. Vasorelaxation responses were modeled as a monoexponential function. The overall τ (control, 10.5 ± 6.0 s; LI, 10.4 ± 5.7 s; HI, 11.0 ± 6.9 s) and time-to-steady-state (control, 47.6 ± 24.0 s; LI, 46.2 ± 22.8 s; HI, 49.1 ± 28.3 s) was similar in LI, HI, and control ( P > 0.05). The overall (average of four vessel-type) % vasorelaxation was larger in LI (73 ± 16%) and HI (73 ± 16%) than in control (66 ± 19%) ( P < 0.05). The overall rate of vasorelaxation was greater in LI (1.9 ± 0.9%·s−1) and HI (1.9 ± 1.1%·s−1) compared with control (1.6 ± 0.7%·s−1) ( P < 0.05). The vessel-specific responses (average response for the three conditions) showed that carotid displayed a slower adjustment (τ, 18.9 ± 4.4 s; time-to-steady-state, 80.4 ± 18.4 s) compared with the aorta (τ, 10.3 ± 3.8 s; time-to-steady-state, 46.3 ± 15.2 s), the iliac (τ, 6.3 ± 2.1 s; time-to-steady-state, 30.3 ± 9.0 s), and the femoral (τ, 6.0 ± 1.9 s; time-to-steady-state, 29.3 ± 8.4 s). The % vasorelaxation was larger in the carotid (82 ± 14%) than in the aorta (67 ± 16%), iliac (61 ± 13%), and femoral (71 ± 19%) ( P > 0.05). The rate of vasorelaxation was carotid (1.1 ± 0.2%·s−1), aorta (1.5 ± 0.4%·s−1), iliac (2.2 ± 0.8%·s−1), and femoral (2.6 ± 1.0%·s−1). In conclusion, an acute bout of endurance exercise increased vascular responsiveness. The dynamic and percent adjustments were vessel-specific with vessel function likely determining the response.
27
Rivera Teran, V., D. Alpizar-Rodriguez, S. Sicsik, F. Irazoque-Palazuelos, D. Miranda, D. Vega-Morales, J. C. Casasola et al. "FRI0546 GENDER DIFFERENCES OF RHEUMATIC DISEASES IN MEXICAN POPULATION: DATA FROM THE MEXICAN BIOLOGICS REGISTRY". Annals of the Rheumatic Diseases 79, Suppl 1 (giugno 2020): 874–75. http://dx.doi.org/10.1136/annrheumdis-2020-eular.6091.
Abstract (sommario):
Background:Most autoimmune diseases are more prevalent in women. Symptom severity, disease progression, response to therapy and overall survival differ between males and females with rheumatic diseases.Objectives:To identify the characteristics of autoimmune diseases presentation and treatment between male and female population using information from the Mexican Adverse Events Registry (BIOBADAMEX).Methods:BIOBADAMEX is a Mexican ongoing cohort that collects the information of patients using biologic and biosimilar drugs since 2016. For this study we included all patients enrolled in the registry and compared baseline clinical and disease characteristics, treatment and presence of adverse events between genders. We used logistic regression to analyze univariable associations.Results:A total of 655 participants were analysed, of which 82% were female (Table 1). We found women were older with a median of 53 years compared to 46 years in men (OR 1.02, CI 1.0-1.1). Smoking was higher in men (16%) compared to women (5%), (OR 0.3, CI 0.2-0.6). Women had longer disease duration, 9 years compared to 7 years in men (OR 1, CI 1.0-1.1). Rheumatoid arthritis (RA) was more prevalent in women (OR 2.7, CI 1-6.9), while ankylosing spondylitis (AS) and psoriatic arthritis (PsA) were more prevalent in men (OR 0.2, CI 0.1-0.4, and OR 0.3, CI 0.1-0.9 respectively). Women had more comorbidities than men (OR 1.8, CI 1.1-2.8) and used steroids more frequently (OR 1.7, CI 1.1-2.7). Differences in disease activity were not found, however we noticed high activity scores among participants.Table 1.Baseline characteristics in the cohort by sexWomenn=532 (82%)Menn=123 (18%)UnivariableaOR(95%CI)Age, median (IQR)53 (44-60)47 (34-55)1.02 (1.0-1.1)*Body Mass Index, median (IQR)27 (23-31)26 (23-30)1.0 (0.9-1.1)Smoking, n(%)28 (5)18 (16)0.3 (0.2- 0.6)*Disease duration, median (IQR)9 (4-16)7 (2-13)1.0 (1.0-1.1)*Diagnosis, n(%): RA414 (78)37 (30)2.4 (1.0-5.7)* AIJ12 (2)5 (4)0.5 (0.1-1.9) AS37 (7)56 (46)0.1 (0.1-0.4)* PsA19 (4)15 (12)0.3 (0.1-0.8)* SLE17 (3)3 (2)1.2 (0.3-5.2) Others33 (6)7 (6)1Disease Activity indexes, median (IQR) DAS28a4.9 (3.6-5.9)4.9 (3.0-5.9)1.1 (0.9-1.3) BASDAIb4.8 (2.9-8)5.3 (2.8-7.5)0.9 (0.8- 1.1) ASDASc3.2 (1.9-4.5)3.9 (2.5-4.7)0.8 (0.6-1.2) SLEDAId14.5 (5.0-19.5)25 (25.0-31.0)0.6 (0.4-1.1)High blood pressure, n(%)77 (15)14 (12)1.3 (0.7-2.4)Diabetes mellitus, n(%)46 (9)7 (6)1.5 (0.7-3.5)High cholesterol, n(%)41 (8)8 (7)1.2 (0.4-2.6)Other comorbidities, n(%):173 (33)26 (21)1.8 (1.1 -2.8)*Use of previous biologic, n(%):216 (40)44 (36)1.2 (0.8- 1.8)Use of steroids, n(%):215 (42)34 (29)1.7 (1.1 -2.7)*Use of DMARD, n(%):418 (79)89 (72)1.4 (0.9-2.2)Adverse eventsb, n(%):69 (13)14 (11)1.2 (0.7-2.1) Severeb, n(%):12 (17)3 (21)0.8 (0.2-3.1)Univariable logistic regression analysis. *p<0.05.an=469,bn=99,cn=71,dn=19,Table 1.Analysis of association between change (Δ) in FMD and relevant parameters by univariate and multivariate linear regression analysis.UnivariateRho (p)MultivariateBeta (p)Δ FMD (%)(r2=0.30)ChangeADMA (µmol/l)-0.63 (<0.001)-0.25 (0.01)MDA (nmol/ml)-0.58 (<0.001)-0.18 (0.02)SOD (U/ml)0.48 (<0.001)NSGSH (U/ml)0.02 (0.75)NSHOMA-0.21 (0.001)NSeGFR (ml/min/ 1.73 m2)-0.03 (0.62)NShsCRP (mg/l)-0.45 (<0.001)NSPTX3 (ng/ml)-0.49 (<0.001)-0.21 (0.01)SBP (mmHg)-0.26 (<0.001)NSDBP (mmHg)-0.11 (0.12)NSHemoglobin (g/dl)0.07 (0.32)NSTotal Cholesterol (mg/dl)-0.05 (0.49)NSTriglyceride (mg/dl)-0.11 (0.12)NSLDL (mg/dl)-0.12 (0.07)NSHDL (mg/dl)0.02 (0.82)NSHbA1c (%)-0.26 (<0.001)NSFigure 1.Scatter-plot graphs between FMD and ADMA, MDA, CuZn-SOD, PTX-3.Conclusion:In our study we found sex differences regarding age and disease duration, being higher in women. As expected, the prevalence of RA was higher in women and AS and PsA in men. Overall, women used more steroids than men. An interesting finding was that patients had high disease activity. Future longitudinal analyses will allow us to analyse sex differences in disease progression and treatment response.References:[1] Ortona E et al. Ann Ist Super Sanita 2016;52(2):205-12[2] Ngo ST et al. Front Neuroendocrinol 2014;3(3):347-69Disclosure of Interests:Vijaya Rivera Teran: None declared, Deshire Alpizar-Rodriguez: None declared, Sandra Sicsik: None declared, Fedra Irazoque-Palazuelos Consultant of: Bristol-Myers Squibb, Janssen, Pfizer Inc, Roche and UCB, Dafhne Miranda: None declared, David Vega-Morales: None declared, Julio Cesar Casasola: None declared, Sandra Carrilo: None declared, angel castillo: None declared, Sergio Duran Barragan: None declared, Omar Muñoz: None declared, Aleni Paz: None declared, Angélica Peña: None declared, Alfonso Torres: None declared, Daniel Xavier Xibille Friedmann Consultant of: Lilly, Abbvie, Speakers bureau: Lilly, Abbvie, Azucena Ramos: None declared, José Francisco Moctezuma: None declared, Francisco Aceves: None declared, Estefania Torres: None declared, Natalia Santana: None declared, Miguel Vazquez: None declared, Erick Zamora: None declared, Francisco Guerrero: None declared, Claudia Zepeda: None declared, Melanea Rivera: None declared, Kitzia Alvarado: None declared, Cesar Francisco Pacheco Tena: None declared
28
Humphreys, J., K. Dempsey, O. Phelan, L. Boothman, L. Cook e W. Dixon. "THU0551 SOCIAL CARE USE IN PEOPLE WITH CHRONIC PAIN IN THE UNITED KINGDOM". Annals of the Rheumatic Diseases 79, Suppl 1 (giugno 2020): 516–17. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2321.
Abstract (sommario):
Background:Chronic pain is a common and disabling health problem and those affected may need support with their activities of daily living (ADLs). Currently there are no data quantifying how much social care support people with chronic pain need.Objectives:To describe formal and informal social care use in people with chronic painMethods:Between June-July 2019, previous participants of theCloudy with a Chance of Painstudy were invited to take part in an online survey, adapted from a validated Personal Social Services Research Unit interview survey. It collected data on whether participants with chronic pain needed help with ADLs, how frequently help was needed and who provided it (formal and informal social care). Additional data was collected on demographics, employment status, pain diagnosis, and comorbidities. Descriptive statistics described the burden of social care need and multivariable logistic regression identified factors associated with social care need.Results:There were 981 respondents; 791 (81%) were female, median age 59 years (table 1). In the last month 527(61%) respondents reported needing help with ADLs. Over three-quarters of help was provided informally by family and friends (408 (77%)). For 309 (59%) respondents, help was needed at least daily. In the multivariable logistic regression model, needing help was lower with older age, (OR (95% CI) 0.96 (0.94-0.98), but higher in female gender (OR (95% CI) 1.96 (1.27-3.01), fibromyalgia (OR(95% CI) 2.75(2.53-5.54)), osteoarthritis (OR (95% CI) 1.56 (1.11-2.19)) and multi-morbidity OR (95% CI) 2.13 (1.51-3.01)). Compared to full-time work, respondents who were retired or unable to work were also significantly more likely to need help with ADLs, respective OR (95% CI) 2.16 (1.21-3.84) and 6.98 (3.72-13.08).Table 1.All respondentsn=981Need help$n=527No help$n=337MissingAge med (IQR)59 (50-66)57 (47-64)61 (52-68)5Female n (%)791 (81)452 (86)251 (74)11Employment statusn (%)FTPTSelf-employedStudentHomemakerRetiredUnable to workUnemployed134 (14)169 (17)50 (5)7 (0.7)23 (2)360 (37)221 (23)16 (1.6)54 (10)79 (15)26 (5)4 (0.8)12 (2)151 (29)188 (36)12 (2)70 (21)69 (20)19 (6)2 (0.6)10 (3)143 (42)21 (6)3 (0.9)1Diagnosis reportedn (%)*OsteoarthritisFibromyalgiaRheumatoid arthritisArthritis (type not specified)Ankylosing SpondylitisGoutMigraine/chronic headacheNeuropathic painOther (inc Psoriatic arthritis, hypermobility)929 (95)482 (49)265 (27)205 (21)128 (15)56 (6)18 (2)115 (13)155 (18)272 (29)516 (98)269 (51)207 (39)115 (22)73 (14)33 (6)13 (2)82 (16)120 (23)209 (39)313 (93)160 (47)40 (12)73 (22)55 (16)23 (7)5 (1)33 (10)35 (10)63 (19)11Any MSk diagnosisn (%)828 (95)460 (87)279 (83)64Multi-morbidity∞n (%)712 (82)473 (90)54 (36)0med - median, IQR - interquartile range, MSk – musculoskeletal$117 respondents did not answer the question about whether they did or did not need help with ADLs*some participants reported more than one diagnosis for their painincludes MSK diseases above and the following chronic diseases listed in questionnaire: angina, heart attack, stroke, COPD, diabetes, cancer, parkinson’s, multiple sclerosis, depression, other (participants asked to specify)Conclusion:A high proportion of people with chronic pain needed support with ADLs; for more than half, on a daily or more frequent basis. Interestingly, younger patients were more likely to need help which may reflect responder bias (younger patients with severe pain potentially more likely to respond than those with milder pain). The majority of support was provided informally, and this could be for a number of reasons. For example, lack of awareness/not meeting eligibility/unable to afford formal social care, or preference to be cared for by familiar persons. This should be explored in future research. These results demonstrate the burden of social care may be significantly greater than government and social care organisations are aware, with important implications for policy and planning.Disclosure of Interests:Jenny Humphreys: None declared, Katy Dempsey: None declared, Ollie Phelan: None declared, Laura Boothman: None declared, Louise Cook: None declared, William Dixon Consultant of: Bayer and Google
29
Abro, Brooj, e Ronald Jackups. "Establishing a Nucleated Count Reflex Trigger for Performing Cell Differential on Cerebrospinal Fluid in Pediatric Patients". American Journal of Clinical Pathology 154, Supplement_1 (ottobre 2020): S9—S10. http://dx.doi.org/10.1093/ajcp/aqaa137.016.
Abstract (sommario):
Abstract Introduction Analysis of cerebrospinal fluid (CSF) assists in the diagnosis of several disease processes affecting the central nervous system (CNS). Nucleated cell (NC) count and cell differential are two important components of laboratory testing performed to analyze CSF samples. These tests can help diagnose conditions such as infection, inflammation, and malignancy involving the CNS; however, the cell differential, performed manually on a cytospin, is labor-intensive and may divert laboratory resources. Currently, the laboratory at our tertiary care pediatric hospital performs both NC count and cell differential on all specimens submitted for CSF cell count analysis. We hypothesized that when the NC count is low (<10/mcl), performing manual cell differential does not provide clinically meaningful information and leads to unnecessary testing, increasing the turnaround time and decreasing precision. In this study, we investigated the utility of performing a manual differential on CSF when the NC count is ≤10/mcl and the need to establish reflex criteria for performing a cell differential. Methods Data were extracted from our electronic medical record database. We searched for all CSF samples that were submitted to our pediatric hospital’s laboratory for cell count analysis from September 2019 to January 2020. NC count, red blood cell (RBC) count, and number of cells available for differential (€œcells diffed) on cytospin, to a maximum of 100 cells per specimen, were obtained for each sample. Results A total of 577 CSF samples from 332 patients were submitted and analyzed for cell counts, of which 471 (82%) had NC count ≤10/mcl. There was a significant moderate positive correlation between NC count and cells diffed (Pearson correlation coefficient, 0.45, P-value <0.001). Of these 471 samples, 24 (5%) showed evidence of peripheral blood contamination (>500/mcl RBCs in samples with NC = 0/mcl, >500 x (NC count)/mcl RBCs in samples with NC > 0/mcl). A total of 4 cases from two patients with NC ≤10/mcl (0.8%) showed blasts on manual differential. Both patients had B-lymphoblastic leukemia/lymphoma and were being evaluated for CNS involvement with concurrent cytology. One patient was diagnosed as negative for CNS involvement by cytology. The sample for manual differential was contaminated by peripheral blood, hence the presence of blasts did not represent CNS disease. The second patient had the remaining 3 positive samples and was diagnosed with CNS involvement by cytology on multiple follow-ups. Conclusion Performing CSF manual differential when NC < 10/mcl does not provide additional clinically actionable information and is associated with a lower cell yield on the cytospin. Establishing a NC count cutoff for performing manual differential will prevent unnecessary testing, decrease turnaround time, and increase precision. Exceptions may be necessary for oncology patients at high risk for CNS involvement.
30
Meadows, Meghan, Meredith Ray, Matthew Smeltzer, Nicholas Faris, Carrie Fehnel, Olawale Akinbobola, Bianca Jackson et al. "A comparison of two models of multidisciplinary lung cancer care within a community-based healthcare system." Journal of Clinical Oncology 38, n. 29_suppl (10 ottobre 2020): 36. http://dx.doi.org/10.1200/jco.2020.38.29_suppl.36.
Abstract (sommario):
36 Background: The Multidisciplinary Thoracic Oncology Conference (MTOC) model is easier to implement than the Multidisciplinary Clinic (MDC) model, but does not directly involve patients in decision-making. We compared the processes and outcomes of lung cancer care between patients discussed in a weekly MTOC versus those seen in a MDC. Methods: Prospective observational study of thoroughness of staging, stage confirmation (defined as biopsy of the stage-defining lesion), National Comprehensive Cancer Network guideline-concordant treatment, overall (OS) and event-free (EFS) survival of lung cancer patients in a community healthcare system’s MDC and MTOC from 2014-2019. We used the chi-square test and multivariable logistic regression to evaluate guideline-concordant treatment and stage confirmation; Kaplan-Meier curves and multivariable Cox regression were used to evaluate OS and EFS. We adjusted models for age, sex, race, insurance, smoking status, and histology. Results: 614 patients received care in MDC; 571 in MTOC. MDC patients were older (median age: 69 vs. 67); less likely to be active smokers (44% vs. 47%; p=0.03); more likely to have bimodal (98% v 95%, p=0.02) and trimodal staging (60% v 46%, p<0.0001). The stage-confirmation rate (OR: 1.55; 95% CI: 1.22-1.96) and mediastinal stage confirmation rate (OR: 1.55; 95% CI: 1.23-1.95) were both significantly higher in MDC, even after adjustment (aOR: 1.60; 95% CI: 1.25-2.03); (aOR: 1.58, 95% CI: 1.25-2.00). A higher proportion of patients received guideline-concordant treatment in MDC than in MTOC (82% vs. 73%; OR: 1.63; 95% CI: 1.21-2.20) even after adjustment (aOR: 1.64; 95% CI: 1.20-2.24). However, MTOC patients had significantly better OS (p=0.03) and EFS (p=0.001) than MDC patients and a lower hazard of death (HR: 0.81; 95% CI: 0.67-0.98), even after adjusting for confounding variables (aHR: 0.79 95%CI: 0.66-0.95). Conclusions: Although the processes of lung cancer care delivery were better in MDC than in MTOC, survival was better in MTOC. Patient selection may have played a role in these survival differences. The MTOC model, as implemented, seems competitive with the MDC model and is worthy of further exploration as a more feasible model of multidisciplinary care. [Table: see text]
31
Barzi, Afsaneh, Mariana C. Stern, Juanjuan Zhang, Heinz-Josef Lenz, Syma Iqbal e Lihua Liu. "Gastric cancer (GC) in California Cancer Registry (CCR): One disease, many faces." Journal of Clinical Oncology 32, n. 3_suppl (20 gennaio 2014): 30. http://dx.doi.org/10.1200/jco.2014.32.3_suppl.30.
Abstract (sommario):
30 Background: In the US there are approximately 21,000 newly diagnosed GCs with California having the highest number of reported cases per year. Given the disparity in the incidence of the disease among Asians and Hispanics we conducted an analysis of GCs in the CCR to assess the differences in the presentation and outcome of the reported cases from 2000 to 2010. Methods: We identified 26,645 GCs inclusive of Asian, Hispanic, and non-Hispanic whites (NHW); 20% of our population is Asian and 30% of is Hispanic. We examined the tumor characteristics (demographics, stage, anatomical subsite), age adjusted incidence rates (AAIR), and survival among Asian and Hispanic patients as compared to NHW. Results: AAIR per 100,000 individuals is 5.87 (95% CI: 5.77-5.97) for NHW, 11.74 (95% CI: 11.46-12.02) for Hispanics and 13.31 (95% CI: 12.96-13.66) for Asians. Among Asians, Koreans have the highest rate and lowest median age of presentation (67ys). In the patients with known stage of the disease (82%) most patients present with stage IV (38%) with no differences in the stage of presentation among different racial/ethnic groups. The male/female (M/F) ratio is different among different racial/ethnic groups. M/F among NHWs is 2.2, followed by 1.8 in Hispanics, and 1.6 in Asians. Among NHW proximal GC (cardia and fundus) is the most common site of presentation (44%), whereas in Asians and Hispanics proximal GC are reported in 14% and 18% respectively. Hazard ratios from Cox regression models adjusted for age, gender, socioeconomic status, nativity, stage, anatomical subsite, and type of treatment received, showed that being of Mexican origin is associated with greater risk of cancer death compared to being NHW (HR = 1.3; 95% CI = 1.2-1.4; p<0.001). In contrast Koreans have better survival than NHW (HR = 0.9; 95% CI = 0.8-0.9; p=0.003). Prognostic factors for death from gastric cancer included age > 65 and immigration status, with immigrants doing better than US born. Conclusions: The observed disparity in the incidence, presentation, and outcome of GC in CCR suggests possible different etiologies that may have implications for the diagnosis and treatment of GC and deserve further exploration.
32
Hua, Sophia V., Joshua Petimar, Nandita Mitra, Christina A. Roberto, Erica L. Kenney, Anne N. Thorndike, Eric B. Rimm, Kevin G. Volpp e Laura A. Gibson. "Philadelphia Beverage Tax and Association With Prices, Purchasing, and Individual-Level Substitution in a National Pharmacy Chain". JAMA Network Open 6, n. 7 (13 luglio 2023): e2323200. http://dx.doi.org/10.1001/jamanetworkopen.2023.23200.
Abstract (sommario):
ImportanceTaxes on sweetened beverages are being implemented around the globe; an understanding of these taxes on individual-level behavior is necessary.ObjectiveTo evaluate the degree to which the sweetened beverage tax in Philadelphia, Pennsylvania, was associated with changes in beverage prices and individual-level purchasing over time at a national pharmacy chain in Philadelphia compared with Baltimore, Maryland.Design, Setting, and ParticipantsUsing a difference-in-differences approach and generalized linear mixed models, this cohort study examined beverage purchases made by loyalty cardholders at a national chain pharmacy retailer with stores in Philadelphia and Baltimore (control city) from before tax to after tax. Beverage sales (in US dollars) were linked by unique loyalty card numbers to enable longitudinal analyses. Data were collected from January 1, 2015, through December 31, 2017 (2 years before tax and 1 year after tax); data analyses were conducted from January through October 2022.ExposureImplementation of Philadelphia’s 1.5 cents/oz tax on sweetened beverages.Main Outcomes and MeasuresThe outcomes were the change in mean beverage price per-ounce and mean beverage volume purchased per cardholder transaction. Individual-level point-of-sale scanner data from all beverage purchases were analyzed.ResultsA total of 1188 unique beverages were purchased from the same stores before tax and after tax. There were 231 065 unique cardholders in Philadelphia and 82 517 in Baltimore. Mean prices of taxed beverages (n = 2 094 220) increased by 1.6 (95% CI, 1.3-2.0) cents/oz (106.7% pass-through) in Philadelphia compared with Baltimore from before tax to after tax. Philadelphia cardholders purchased 7.8% (95% CI −8.1% to −7.5%) fewer ounces of taxed beverages and 1.1% (95% CI, 0.6%-1.7%) more ounces of nontaxed beverages per transaction. Taxed beverages made up a smaller percentage of cardholders’ overall beverage purchases after tax (−13.4% [95% CI, −14.2% to −12.6%]), while nontaxed beverages made up a larger share (9.3% [95% CI, 7.7%-10.7%]).Conclusions and RelevanceIn this longitudinal cohort study of the Philadelphia beverage tax, the tax was completely passed through to prices and was associated with a 7.8% decline in ounces of taxed beverages purchased at a national pharmacy chain.
33
Pascottini, O. B., M. Probo, S. LeBlanc, G. Opsomer e M. Hostens. "96 Association between metabolic diseases and fertility of high-yielding dairy cows in a transition management facility using survival analysis and machine-learning models". Reproduction, Fertility and Development 31, n. 1 (2019): 174. http://dx.doi.org/10.1071/rdv31n1ab96.
Abstract (sommario):
This study aimed to evaluate the association between individual and multiple metabolic diseases (MD and MD+) diagnosed during the transition period (±3 wk relative to calving) and the probability of pregnancy until 210 days in milk (DIM) in Holstein-Friesian dairy cows. Disease and reproductive data from a dairy herd with 1946 calvings (n=542 primiparous and n=1404 multiparous cows) were analysed using a 1-year cohort. The recorded MD were milk fever, ketosis, displaced abomasum, retained placenta, metritis, twinning, and clinical mastitis. The association between the 210-DIM pregnancy risk and the MD was evaluated as MD cows (uncomplicated cases) v. MD+ cows (complicated cases) v. healthy cows (3 groups of cows). Univariable survival models were used to analyse the association of MD and MD+ with pregnancy until 210 DIM, accounting for parity. Univariable Cox proportional hazard models were used to quantify the relative risk of pregnancy per day. A hierarchically ordered decision tree and a random forest model were built to explore the importance of MD and parity on the pregnancy risk within the first 210 DIM. Parity affected the 210-DIM pregnancy risk (P<0.001); therefore, all further analyses were stratified by parity. The incidence of MD and MD+ for primiparous and multiparous cows were 29 (n=159) and 9% (n=48), and 23 (n=317) and 11% (n=160), respectively. The overall 210-DIM pregnancy risk was 77% (n=415) for primiparous cows and 62% (n=879) for multiparous cows. Among healthy cows (no MD) the 210-DIM pregnancy risk was 80% (n=269) for primiparous cows and 82% (n=537) for multiparous cows. Conversely, the 210-DIM pregnancy risk for cows with MD or MD+ were 73 (n=116) and 63% (n=30) for primiparous and 48 (n=152) and 46% (n=74) for multiparous cows, respectively. Using the healthy cows as the reference, the 210-DIM hazard ratios for conception were 0.8 for MD [95% confidence interval (CI)=0.6-1.0; P=0.05] and 0.5 for MD+ (95% CI=0.4-0.8; P=0.005) for primiparous cows and 0.5 for MD (95% CI=0.4-0.6; P<0.001) and 0.4 for MD+ (95% CI=0.3-0.6; P<0.001) for multiparous cows. Parity had profound effect on the 210-DIM pregnancy risk. The hazard ratio for conception was reduced when a MD was complicated with another MD (MD+) in both primiparous and multiparous cows. Both the decision tree and random forest analysis also indicated that parity was the most influential variable reducing fertility among cows, followed by (in order of magnitude of effect) milk fever, displaced abomasum, ketosis, and clinical mastitis. Including multiple disease interactions into multivariable Cox proportional hazard models are highly likely to violate the proportional hazards assumption due to complex disease interactions. Machine-learning models represent a valid alternative to accommodate large datasets in the presence of missing values and intricate dependencies among explanatory variables.
34
Kulkarni, Samar, Mark Ethell, Jennifer Treleaven, Radovan Saso, Joy Brennan, Pawel Kaczmarek, Caroline Alvares et al. "Pregnancy Outcome Following Haematopoietic Stem Cell Transplantation." Blood 108, n. 11 (16 novembre 2006): 3367. http://dx.doi.org/10.1182/blood.v108.11.3367.3367.
Abstract (sommario):
Abstract Between March 1973 and August 2003, 747 patients (M: 430, F:317; median age: 29yr, range:1–65) who survived for at least 1 yr. post stem cell transplant and were 15 to 65 years of age (median: 38, range:15–71) at the time of last follow-up (LFU) were analysed to study the incidence and outcome of pregnancies. At the time of transplantation, 138 patients were pre-pubertal (M: 79, F: 59, p=0.8). Transplants were allogeneic (n=429, median age: 28yr), autologous (n=304, median age: 32) or syngeneic (n=14, median age: 37) and were performed for Ac. Leukaemia (n=583), Chr. Leukaemia (n=82) or other diseases (n=82). Patients with Myeloma who received Autograft were not included. Conditioning included TBI in 561 patients using either single fraction (n=478) or a fractionated schedule (n=83) and 168 patients also received cranial radiation. Stem cell source was marrow (n=573), PBSC (n=166) or both (n=8). GVHD prophylaxis was CyA alone (n=188), CyA with another agent (n=227) or other measures (n=14). 79 patients received more than one transplant. The probability of overall survival in this group of patients was 65% at 10yr. Median follow-up was 7 yr. (range: 1–33). Twenty seven patients (10 females and 17 partners of male patients) had 41 pregnancies and sired 45 children, including 4 twin pregnancies. The probability of conception was 4% at 10yr. Pregnancies occurred in 17/429 allografts (3.96%; 6/186 females; 11/243 males), 8/304 autograft patients (2.63%; 4/123 females, 4/181 males) and 2/14 syngeneic transplants (14.3%; 0/8 females, 2/6 males). Amongst 10 female patients 3 had assisted conception and 7 had natural pregnancy. Amongst 17 partners of male patients, 5 had assisted conception, 11 had natural conception and 1 had assisted conception followed by natural pregnancy. In uni-variate analysis chances of becoming pregnant were higher with age> 15yr. at transplant (5% vs. 1% at 10 yr., p<0.001), non-TBI conditioning (9% vs. 2%, p=0.001), age between 20–45 at LFU (5% vs. 2%, p=0.005) and use of PBSC for transplant (8% vs. 5%, p<0.001). The highly significant correlation between use of PBSC and use of non-TBI conditioning probably explains why PBSC had a significant association with pregnancy on univariate analysis. On multi-variate analysis non-TBI conditioning (RR: 3.7, 95% CI: 1.7–8.3, p=0.0014), age at transplant>15 yr. (RR: 11.6, 95% CI: 1.6–86.3, p=0.02) and age of 20–45 at LFU (RR: 5.53, 95% CI: 1.9–16.1, p=0.002) were independently associated with higher chances of conception. Two pregnancies resulted in miscarriages leading to 3 foetal deaths (2/42, 5%; 3/45, 7%). Four babies were born prematurely and required admission to neonatal unit and 2 died after 6 weeks. None had congenital malformations. Currently, 40 children are alive and well; 26 after natural conception and 14 after assisted fertilization. In conclusion, even though the chances of conception are lower in patients undergoing transplant, especially after TBI conditioning, pregnancy outcomes following natural and assisted conception are likely to be similar in terms of chances of successful outcome.
35
Rubalcava, Luis Felipe Felipe, Gabriela Cesarman-Maus e Ana Florencia Ramirez-Ibarguen. "A Latin-American Cancer Center Experience in the Treatment of Hodgkin's Lymphoma during a Drug Shortage". Blood 138, Supplement 1 (5 novembre 2021): 1919. http://dx.doi.org/10.1182/blood-2021-153608.
Abstract (sommario):
Abstract The treatment of Hodgkin's lymphoma has been characterized by a story of success with the use tried-and-true protocols. During the second half of 2019 to the first-half of the 2021 the Mexican health system experienced a shortage of drugs, which compromised the possibility of using in most of the common protocols for this cancer: ABVD, BEACOPP, IGEV, ESHAP, DHAP, GEMOX. Clinician had option of using a common protocol with incomplete doses or applying an alternative complete CHOEP protocol, which has been used with some success in exploratory studies [1,2]. For 12 months, we treated a total of 58 patients of which we compared the base characteristics and response rates to 10-year compiled data from pre-shortage patients (PS) (total 475). The baseline characteristics of the PS vs shortage (S) group showed a statistical similar gender distribution (males 55.2% vs 63.8%, P 0.21), histologic subtype (P 0.24), international prognostic score (IPS ≥3 57.7% vs 58.6%, P 0.89) and clinical stage (advanced 78.1% vs 84.5%, P 0.26). The S patients did show higher frequency of B symptoms (P 0.002), extranodal disease (P 0.0001), while the PS group had a higher frequency of bulky disease (P 0.001), ABVD protocol (96% vs 63.8%, P 0.0001) and radiotherapy use. In the S group a total of 37 ABVD (29 incomplete), 7 BEACOPP (5 incomplete) and 14 CHOEP protocols (1 incomplete) were infused, it means only 10 (17.7%) were able to receive a standard complete treatment, while the rest received an incomplete or alternative treatment. Complete response for the PS and S group were 71.4% vs 56.9% with the corresponding therapeutic failure 28.6% vs 43.1% (p 0.023) respectively. Analyzing the response rate of each chemotherapy protocol in the S group, the complete ABVD vs incomplete ABVD demonstrated an 87.5% vs 69% (p 0.28) respectively. The complete BEACOPP vs incomplete showed 50% vs 40% (p 0.7) and CHOEP exhibited an unexceptional complete response rate of 21.4%. The median follow up was 48 months (1-148) for all cohort. One year OS were 98% vs 82% on PS vs S group respectively (log rank 0.0001). One year-PFS for the PS and S group were 96% and 61% respectively (log rank 0.003). The risk factors associated with lower PFS were B symptoms (OR 1.7, 1.1-2.6), advanced disease (OR 1.66, 1-0-2.7) and IPS≥3 (OR 2.1, 1.4-3.3); as favorable factors we observed radiotherapy (OR 0.07, 0.6-0.8) and the PS group (OR 0.5, 0.3-1.0); however, in the Cox regression, only the IPS≥3 remained as an independent unfavorable factor (HR 1.8, 1.2-2.6), as did radiotherapy (HR 0.4, 0.3-0.6) as favorable. For the OS the drug shortage were an independent risk factor (HR 2.2, 1.1-4.3) like IPS ≥3 (HR 2.8, 1.5-5.1). Analyzing the 1-year PFS in the S group according to which chemotherapy protocol they received, those with ABVD or BEACOPP (regardless of the complete dose status) was of 72%, compared to 20% (P 0.001) in the CHOEP regimen. CHOEP regimen in LH patients is ineffective treatment. In times of shortages, continuing with incomplete standard schemes offers better response rates than alternative schemes. Despite Hodgkin's lymphoma is considered a neoplasm with high cure rates when an economic recession followed by an international event (for example a global pandemic) limited our availability for the use of standard treatments, an area of opportunity for considering alternative protocols has risen for resource-limited countries and institutions. [1] Walewski J,et al. CHOP-21 for unfavorable Hodgkin's lymphoma. An exploratory study. Med Oncol. 2010;27(2):262-7 [2] Kolstad A, et al. Standard CHOP-21 as first line therapy for elderly patients with Hodgkin's lymphoma. Leuk Lymphoma. 2007;48(3):570-6 Disclosures No relevant conflicts of interest to declare.
36
Velho, A. C., M. J. Stadnik, L. Casanova, P. Mondino e S. Alaniz. "First Report of Colletotrichum karstii Causing Glomerella Leaf Spot on Apple in Santa Catarina State, Brazil". Plant Disease 98, n. 1 (gennaio 2014): 157. http://dx.doi.org/10.1094/pdis-05-13-0498-pdn.
Abstract (sommario):
Glomerella leaf spot (GLS) is an emerging disease of apple (Malus domestica Borkh.) that has been reported in regions with a humid subtropical climate, such as southern Brazil, the southeastern United States, and more recently eastern China. GLS is favored by high humidity and temperatures between 23 and 28°C and can result in extensive defoliation when the severity is high. The disease was first reported 1988 in Brazil on cvs. Gala and Golden Delicious in orchards in Paraná State (3), but now is widespread in the country's producing areas. Two Colletotrichum species of different complexes have been associated with GLS, C. gloeosporioides (Penz.) Penz. & Sacc. and its sexual stage Glomerella cingulata (Stoneman) Spaulding & Scherenk, and C. acutatum J. H. Simmonds, although GLS is more commonly associated with the former. In the summer of 2012, necrotic spots were observed on apple leaves (cv. Gala) in Santa Catarina state, Brazil. The first symptoms were reddish-brown spots, evolving to small necrotic lesions 1 to 10 mm long at 7 to 10 days after symptoms were first noted. Pure cultures were obtained by monosporic isolation and grown on PDA at 25°C and with a 12-h photoperiod under fluorescent light. The color of the upper surface of the colony varied from white to gray and the reverse was pink. The conidia length and width ranged from 9.1 to 17.1 μm ([Formula: see text] = 12.8) and from 2.9 to 6.8 μm ([Formula: see text] = 4.9), respectively, and were cylindrical, hyaline, and straight. After germination, conidia formed oval or circular appressoria measuring between 4.0 and 10.0 ([Formula: see text] = 6.3) × 3.0 and 9.0 ([Formula: see text] = 5.7). To confirm pathogenicity, susceptible apple seedlings (cv. Gala) were inoculated with a suspension of 1 × 106 conidia.mL–1. Seedlings sprayed with sterile distilled water served as controls. Seedlings were incubated in a moist chamber at 25°C and 100% RH for 48 h. First symptoms appeared 4 days after inoculation and were similar to those observed in the field. The control treatment remained symptomless. The pathogen was reisolated from lesions, confirming Koch's postulates. Fungus was molecularly characterized by sequencing the internal transcribed spacer (ITS) rDNA and glyceraldehyde-3-phosphate dehydrogenase (GAPDH), and the nucleotide sequence was deposited in the GenBank database (KC876638 and KC875408). C. karstii, considered as part of the C. boninense species complex (1), was identified with 100% sequence homology. This species was previously reported in China (4), Thailand, and the United States, affecting Orchidaceae plants (2), and in Brazil it has been reported affecting Carica papaya, Eugenia uniflora, and Bombax aquaticum (1). To our knowledge, this is the first report of C. karstii causing GLS on apple in Brazil. The development of pre-harvest management practices may be warranted to manage this disease. References: (1) U. Damm et al. Stud. Mycol. 73:1, 2012. (2) I. Jadrane. Plant Dis. 96:1227, 2012. (3) T. B. Sutton. Plant Dis. 82:267, 1998. (4) Y. Yang. Cryptogamie Mycologie 32:229, 2011.
37
Almodovar González, R., A. Bueno, P. Zarco-Montejo, C. López-Medina, A. Benito Ysamat, J. F. Garcia Llorente, F. Diez Renovales et al. "AB0984 SACROILIAC MRI FINDINGS IN PATIENTS WHO WERE REQUESTED A SACROILIAC STUDY: SACROILIITIS AND OTHER DIAGNOSES". Annals of the Rheumatic Diseases 82, Suppl 1 (30 maggio 2023): 1712.1–1712. http://dx.doi.org/10.1136/annrheumdis-2023-eular.2484.
Abstract (sommario):
BackgroundMagnetic resonance imaging (MRI) is the most sensitive imaging modality for the detection of sacroiliitis. Diagnosing sacroiliitis on MRI is not always straightforward and can be challenging in some cases.ObjectivesTo evaluate the prevalence of sacroiliitis (according to ASAS criteria) and other diagnoses in sacroiliac MRI. To analyse/compare these diagnoses by sex, age and service requesting the study.MethodsThis is a cross-sectional, multicentre, descriptive, retrospective study in a hospital and/or specialised care setting. Consecutive MRI examinations (in adults) of the sacroiliac joints (SIJ) performed between 1 de Enero de 2019 y el 31 de Diciembre del 2019 were retrospectively evaluated for the presence of structural and active sacroiliitis findings according to the Assessment of SpondyloArthritis International Society guidelines. Alternative diagnoses, including degenerative changes, diffuse idiopathic skeletal hyperostosis (DISH), osteitis condensans ilii (OCI), septic sacroiliitis/discitis, stress reaction and anatomic variants, were registered.ResultsWe evaluated 1,283 MRI examinations, 526 (41%) males, average age 46.7 ± 14 years. 71.6% of the requests are from the Rheumatology service, 15.8% from Orthopedic Surgery and Traumatology and 12.5% from other services. 70% of the MRIs were reported by a radiologist expert in the locomotor system. Findings suggestive of axial spondyloarthritis were found in 353 (27.5%). Sacroiliitis was found in 71 examinations (25%) and alternative diagnoses were suggested in 87 (31%) (OCI 8.9%, anatomic variants 5.3%, septic sacroiliitis/discitis 5.3%, degenerative findings 4.3%, DISH 1.5%, stress reaction 0.7%, tumor 0.3%). A normal examination was found in the remaining 123 examinations. Patients with alternative diagnoses were older than those with sacroiliitis (62 vs. 47 years of age, respectively, P > 0.05). Alternative diagnoses in the SIJ were significantly more common in females (66) than in males (21), P < 0.05.Table 1.MRI DiagnosisPrincipal2nd3rd diagnWithout alterations452 (35.2)6 (0.5)3 (0.2)Degenerative changes of the SIJ152 (11.8)37 (2.9)5 (0.4)Sacroiliitis with erosions147 (11.5)Sacroiliitis BME + erosions157 (12.2)11 (0.9)Degenerative disc disease L5-S1103 (8)141 (11)12 (0.9)BME (without ASAS criteria)82 (6.4)32 (2.5)4 (0.3)Sacroilitis with BME73 (5.7)Other40 (3.1)29 (2.3)7 (0.5)Lumbosacral transition abnormality18 (1.4)27 (2.1)10 (0.8)Osteitis condensans ilii17 (1.3)7 (0.5)2 (0.2)Fracture12 (0.9)2 (0.2)Tumor16 (1.2)4 (0.3)Diffuse idiopathic skeletal hyperostosi (DISH)6 (0.5)1 (0.1)1 (0.1)Anatomical variants of SIJ6 (0.5)11 (0.9)1 (0.1)Septic Arthritis2 (0.2)Gout1 (0.1)ConclusionA substantial proportion of patients with suspected sacroiliitis had normal SIJ while the rest were more commonly diagnosed with pathologies other than inflammatory sacroiliitis. A referral by an experienced rheumatologist may improve the sensitivity and specificity of this important examination.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.
38
Kachuri, Linda, Rebecca E. Graff, Sonja I. Berndt, Mitchell Machiela, Neal D. Freedman, Stephen J. Chanock, John P. Shelley et al. "Abstract 1441: Genetic determinants of PSA levels improve prostate cancer screening". Cancer Research 82, n. 12_Supplement (15 giugno 2022): 1441. http://dx.doi.org/10.1158/1538-7445.am2022-1441.
Abstract (sommario):
Abstract Prostate-specific antigen (PSA) screening for prostate cancer (PCa) remains controversial due to poor sensitivity and specificity that lead to overdiagnosis and overtreatment. The aim of our study is to characterize genetic determinants of PSA levels in cancer-free men in order to personalize PCa screening. We hypothesize that test accuracy may be improved by accounting for PSA variation that is due to genetic factors and does not reflect PCa. We conducted the largest ever genome-wide association study (GWAS) of PSA in men without PCa (N=95,768; 85,924 predominantly European ancestry) using data from the UK Biobank, BioVU, PLCO, and Kaiser Permanente cohorts. Our GWAS discovered 129 PSA-associated variants (P<5×10-8), 82 of which were novel. A polygenic score (PGSPSA) comprised of these 129 variants was successfully validated in two cancer prevention trials: PCPT (n=5737) and SELECT (n=22,247). PGSPSA explained 7.3% (p=7.0×10-98) of variation in baseline PSA in PCPT and 8.7% (p=7.0×10-476) in SELECT. Importantly, PGSPSA was not associated with PCa status in PCPT (OR=0.98, p=0.71) or SELECT (OR=1.04, p=0.98), which confirms that it reflects benign PSA variation. Potential clinical utility of PSA genetic adjustment was explored by examining reclassification at thresholds used for biopsy referrals in a real-world setting at Kaiser Permanente. We estimated that correction using PGSPSA would have avoided 21.2% of negative biopsies in non-cases. Reclassification below the biopsy referral threshold was also more common in cases, particularly with low-grade disease with Gleason score <7 (7.3% below vs. 2.6% above). Overall, genetic correction of PSA appeared to improve the accuracy of referral decisions, with a Net Reclassification Index of 0.148. Next, we evaluated genetically adjusted PSA in the context of detection of aggressive PCa, defined as Gleason score ≥7, PSA ≥10 ng/mL, T3-T4 stage, and/or distant or nodal metastases. Genetically adjusted baseline PSA was more robustly associated with aggressive PCa than observed PSA and yielded a higher area under the curve (AUC) in PCPT (OR=3.03, p=3.5×10-7; AUC: 0.72 vs. 0.68) and SELECT (OR=3.37, p=3.5×10-11; AUC: 0.78 vs. 0.74) when added to a baseline model with age and trial arm. Furthermore, genetically adjusted PSA provides complementary information to PCa risk variants. In PCPT, a logistic regression model that included genetically corrected PSA and the 269-variant PGSPCa achieved a significantly higher AUC than PGSPCa-269 alone for aggressive PCa (AUC: 0.73 vs. 0.65, p=3.3×10-4) and overall PCa (AUC=0.69 vs. 0.66, p=3.3×10-6). Our work provides evidence that accounting for genetic determinants of PSA has the potential to reduce unnecessary testing and overdiagnosis of low-risk PCa, as well as increase detection of aggressive disease. Larger and more diverse study populations are required to fully characterize the genetic basis of PSA variation and optimize its clinical utility. Citation Format: Linda Kachuri, Rebecca E. Graff, Sonja I. Berndt, Mitchell Machiela, Neal D. Freedman, Stephen J. Chanock, John P. Shelley, Kerry Schaffer, Jonathan D. Mosley, Phyllis J. Goodman, Cathee Till, Ian Thompson, Robert J. Klein, Stephen K. Van Den Eeden, Thomas J. Hoffmann, John S. Witte. Genetic determinants of PSA levels improve prostate cancer screening [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1441.
39
Halphen, Isabelle, Caroline Elie, Valentine Brousse, Muriel Le Bourgeois, Damien Bonnet e Mariane De Montalembert. "Children with Sickle Cell Anemia Experience Severe Oxygen Desaturation During Night and After Six-Minute Walk Distance Test". Blood 120, n. 21 (16 novembre 2012): 4766. http://dx.doi.org/10.1182/blood.v120.21.4766.4766.
Abstract (sommario):
Abstract Abstract 4766 Background: Respiratory complications are the first causes of death among adult patients with sickle cell anemia (SCA). Finding risk factors for children is important. We study clinical, biological, respiratory and heart parameters, as well as exercise and sleep oxygen saturation in SCA children. Patients and Methods: We conducted a prospective study in homozygous SS or S/beta 0 thalassemic children. A chronic transfusion program was an exclusion criterion. We recorded the number of vaso-occlusive crises (VOC) the year before and after inclusion, past history of acute chest syndrome (ACS), hydroxyurea treatment, tonsils size, baseline heart rate and blood pressure, baseline hemoglobin (Hb), reticulocytes, fetal Hb levels, leukocytes and platelets counts, total bilirubin, aspartate aminotransferase (AST), lactate deshydrogenase (LDH). All patients underwent respiratory function testing (RFT), echocardiography assessing tricuspid regurgitation velocity jet (TRV). We measured daytime oxygen saturation using a Radical Masimo set ® pulse oximeter. All patients underwent a non-encouraged six-minute walk test (6MWT). Nocturnal pulse oximetry was recorded using a Nonin ® device during 3 consecutive nights for 30 patients. We considered the average night-time oxygen saturation and the percentage of sleep time with oxygen saturation less than 90%. Statistical analysis was conducted using the Fisher exact test for categorical variables and the Wilcoxon test for continuous variables. Results: Forty-two unselected SCA children were enrolled. Three patients were secondarily excluded because the echocardiography revealed asymptomatic cardiac anomalies (two pulmonary valve stenosis and one persistent arterial canal). In the remaining 39 patients, 38 were SS and one was S/beta 0 thalassemic. Median age was 10.8 years (range 5.7–17); 25 patients were females (64%). The median number of VOC was 0 the year before inclusion (range 0–6), and 0 the year after (range 0–7). Fifteen patients (38%) had displayed at least one ACS. Nine patients (23%) were receiving hydroxyurea treatment. Sixteen patients (43%) had tonsillitis enlargement. Median basal heart rate was 97 bpm (range 75–122). Mean systolic blood pressure was 107 ± 11.3 mm Hg and mean diastolic blood pressure was 64 ± 6.6 mm Hg. Mean Hb was 7.9 ± 1.2 g/dL, mean reticulocyte count was 236 ± 82 Giga/L, median HbF was 9.2 % (range 0.8–28), mean leukocyte count was 11.1 ± 3.2 Giga/L, mean platelet count was 407 ± 132 Giga/L. Median total bilirubin, AST, and LDH were, respectively, 41.5 mg/dL (range 13–163), 62 UI/l (range 35–132), and 1421 UI/l (range 618–1893) (normal range for LDH in our lab 125–243). Fifteen patients (38.5%) had abnormal RFT: 4 had obstructive pattern, 3 had restrictive pattern, and 3 had both. Left ventricular diastolic function was normal for all patients. Six patients had a TRV above 2.6 m/s. Median daytime oxygen saturation was 97 % (range 89–100). One patient had a daytime saturation below 92%. Median nocturnal oxygen saturation was 94.7 % (range 87.7–99.5). Ten patients (33%) displayed average night-time saturation below 92%. Eleven patients (37%) spent more than 10% of their sleep time with oxygen saturation below 90%. Mean six-minute walk distance (6MWD) was 547 ± 99 m. After the 6MWT, 14 patients (35%) had an oxygen saturation below 92%. Median difference in oxygen saturation before and after the test was 2% (range −57, +2). Nocturnal hypoxemia was not associated with age, gender, tonsils size, hydroxyurea treatment, past history of ACS, RFT pattern, number of VOC, leukocytes, platelets, LDH, bilirubin nor AST. It was associated with Hb level (7.2±1.2 g/dL if nocturnal hypoxemia vs 8.4±1.1, p=0.02), daytime oxygen saturation (94% [range 92–99] if nocturnal hypoxemia vs 98% [range 89–100], p=0.03), and oxygen saturation after 6MWT (91% [range 40–99] if nocturnal hypoxemia vs 96% [range 79–100], p=0.03). Children with a TRV above 2.6m/s had a significantly lower Hb level (7.4 g/dL [6.4–8.1] vs 8.5 [6.5–10.6]). Conclusions: Our study emphasizes the frequency of night-time oxygen desaturation in SCA children. It shows that a simple effort can induce a significant decrease in oxygen saturation. The consequences of hypoxemia are difficult to assess given the small sample size. One can hypothesize that hypoxemia and hypoxia/reoxygenation cycles both contribute to the pathophysiology of the disease through inflammation and vascular injury. Disclosures: No relevant conflicts of interest to declare.
40
Testa, Stefano, Benjamin D. Hu, Natalie L. Saadeh, Allison Pribnow, Sheri L. Spunt, Gregory W. Charville, Nam Q. Bui e Kristen N. Ganjoo. "A Retrospective Comparative Analysis of Outcomes and Prognostic Factors in Adult and Pediatric Patients with Osteosarcoma". Current Oncology 28, n. 6 (12 dicembre 2021): 5304–17. http://dx.doi.org/10.3390/curroncol28060443.
Abstract (sommario):
Osteosarcoma is the most common primary bone malignancy in both children and adults. Despite introduction of intensive multimodal treatment with chemotherapy and surgery, outcomes are still poor, especially for patients with metastatic disease and adults. Hence, there is an ongoing need for better prognostic markers and outcome data to inform management decisions in both the adult and pediatric setting. Here, we retrospectively analyzed 112 patients with bone osteosarcoma treated at two large adult and pediatric tertiary academic centers between 1989 and 2019. Patients were divided into an adult (≥18 years) and pediatric (<18 years) cohort for comparison. Our aim was to evaluate predictors of outcomes in pediatric and adult patients, with a specific focus on the role of methotrexate when added to a combination of doxorubicin-cisplatin; the prognostic value of tumor necrosis after neoadjuvant chemotherapy; and outlining any differences in outcomes between adults and pediatric patients that could inform clinical management. Adult patients treated with methotrexate-doxorubicin-cisplatin and those treated with doxorubicin-cisplatin had similar 5-year PFS (26%, 95%CI: 45.5%–10% vs. 50%, 95%CI: 69.6%–26.2%, p = 0.1) and 5-year OS (63%, 95%CI: 82%–34%, vs. 78%, 95%CI: 90.6%–52.6%, p = 0.5). In the adult cohort, there was no difference between patients with ≥90% necrosis and <90% necrosis in either 5-year PFS (42%, 95%CI: 71.1%–11.3% vs. 38%, 95%CI: 57.7%–18.2%, p = 0.4) or 5-year OS (85%, 95%CI: 97.8%–33.4% vs. 56%, 95%CI: 76.8%–27.6%, p = 0.4). In the pediatric cohort, compared to patients with <90% necrosis, those with ≥90% necrosis had significantly better 5-year PFS (30%, 95%CI: 49.3%–14.1% vs. 55%, 95%CI: 73.9%–38.5%, p = 0.003) and 5-year OS (64%, 95%CI: 80.8%–41.1% vs. 78%, 95%CI: 92%–60.9%, p = 0.04). Adult and pediatric patients had similar 5-year OS (69%, 95%CI: 83.2%–49.8% vs. 73%, 95%CI: 83.2%–59.3%, p = 0.8) and 5-year PFS (37%, 95%CI: 52.4%–22.9% vs. 43%, 95%CI: 56.2%–30.4% p = 0.3) even though the proportion of patients with ≥90% necrosis after neoadjuvant chemotherapy was higher for children compared to adults (60.3% vs. 30%, OR: 3.54, 95%CI: 1.38–8.46, p = 0.006). In conclusion, in adult patients, the addition of methotrexate to doxorubicin and cisplatin did not correlate with a significant survival benefit, questioning the therapeutic value of methotrexate overall. Our study confirms the prognostic utility of percent tumor necrosis after neoadjuvant chemotherapy in pediatric patients but not in adult patients. Lastly, this is one of the few reported studies where patients with osteosarcoma younger and older than 18 years had similar PFS and OS.
41
Matveev, V. B., M. I. Volkova, N. L. Vashakmadze e I. S. Stilidi. "Technique and short-term outcomes of surgical treatment in patients with renal cell carcinoma and tumor venous thrombosis: experience of the Urology Clinic, N.N. Blokhin National Medical Research Center of Oncology". Cancer Urology 17, n. 2 (25 luglio 2021): 17–32. http://dx.doi.org/10.17650/1726-9776-2021-17-2-17-32.
Abstract (sommario):
Objective: to describe the technique of nephrectomy and thrombectomy used in patients with renal cell carcinoma (RCC) and tumor venous thrombosis of various levels, and to identify risk factors of in-hospital death among operated patients.Materials and methods. This study included 768 patients with RCC and tumor venous thrombosis who have undergone surgical treatment. Median age was 58 years (range: 16-82 years); the male to female ratio was 2.3:1. The symptoms of venous tumor thrombosis were identified in 199 patients (25.9 %). In the majority of patients (n = 509; 66.3 %), the tumor thrombus originated from the right renal vein. The cranial border of the tumor thrombus was located in the perirenal inferior vena cava (IVC) in 219 patients (28.5 %), subhepatic IVC in 201 patients (26.2 %), intrahepatic IVC in 171 patients (22.3 %), and above the diaphragm in 177 patients (23.0 %). We used an individual approach to choose an optimal method of vascular control and to identify indications for circulatory support. Two-thirds of patients (n = 512; 66.7 %) underwent temporary block of the second renal vein; 268 patients (34.9 %) - temporary block of the hepatoduodenal ligament and right heart; 11 patients (3.2 %) were operated on with cardiopulmonary bypass.Results. The median surgery time was 190 ± 63.6 min; median blood loss was 3,000 ± 71.6 mL (≥50 % of circulating blood in 35.1 % of patients). Intraoperative complications were registered in 23 patients (3.0 %); eight patients (1.0 %) died during surgery with 4 of them died due to pulmonary embolism (0.5 %), 3 died due to hemorrhagic shock (0.4 %), and 1 died due to myocardial infarction (0.1 %). One hundred and ninety individuals (25.0 %) developed postoperative complications with Clavien-Dindo grade III-V complications observed in 115 cases (15.1 %). Forty-one patients (5.3 %) died in the early postoperative period. The causes of death included multiple organ dysfunction (n = 21; 2.8 %), pulmonary embolism (n = 7; 0.9 %), sepsis (n = 6; 0.8 %), stroke (n = 4; 0.5 %), myocardial infarction (n = 2; 0.2 %), and RCC progression (n = 1; 0.1 %). We have identified several independent risk factors for in-hospital mortality, including ascites (hazard ratio (HR) 8.3; 95 % confidence interval (CI) 3.2-21.4; p < 0.0001), preoperative pulmonary embolism (HR 3.5; 95 % CI 1.3-9.4; p = 0.013), supradiaphragmatic thrombi (HR 1.5; 95 % CI 1.1-2.0; p = 0.003). The in-hospital mortality rate was 3.5 % (20/575) among patients with no risk factors, 9.8 % (16/163) among those with 1 risk factor, 40.0 % (10/25) among those with 2 risk factors, and 60.0 % (3/5) among those with 3 risk factors (area under the curve (AUC) 0.705; p <0.0001 for all).Conclusion. The incidence of severe complications and postoperative mortality rate in RCC patients with tumor venous thrombosis who have undergone nephrectomy and thrombectomy were 15.1 and 6.4 %, respectively. Risk factors for perioperative mortality included ascites, preoperative pulmonary embolism, and supradiaphragmatic thrombosis.
42
Buller, Harry R. "Initial Outpatient Treatment of Venous Thromboembolism with Fondaparinux (Arixtra®): The Matisse Trials." Blood 104, n. 11 (16 novembre 2004): 705. http://dx.doi.org/10.1182/blood.v104.11.705.705.
Abstract (sommario):
Abstract Background: The MATISSE trials showed that a single dose regimen of fondaparinux, a synthetic selective factor Xa inhibitor, was at least as effective and as safe as standard therapies in the treatment of venous thromboembolism (VTE). In these trials, outpatient treatment of fondaparinux was encouraged but left at the investigator’s discretion. We analyzed the data in patients who received fondaparinux on an outpatient basis. Methods: Fondaparinux was administered at a once-daily subcutaneous dose of 7.5 mg (5.0 mg and 10.0 mg in patients <50 kg and >100 kg, respectively). In the MATISSE-DVT trial, fondaparinux was compared with twice-daily subcutaneous enoxaparin (1 mg/kg) in patients with deep-vein thrombosis (DVT). In the MATISSE-PE trial, it was compared with adjusted-dose intravenous unfractionated heparin (UFH) in patients with pulmonary embolism (PE). Outpatient treatment of DVT with enoxaparin was possible whereas outpatient treatment of PE with UFH was not feasible. All drugs were given for at least 5 days and until anticoagulation with oral anticoagulants was therapeutic. The primary efficacy and safety outcomes were recurrent VTE during 3 months’ follow-up and major bleeding (MB) and death during the initial treatment period. Results: In MATISSE-DVT, 31.4% and 33.8% of the fondaparinux- and enoxaparin-treated patients, respectively, received therapy on an outpatient basis. In MATISSE-PE, 14.3% of the patients received fondaparinux on an outpatient basis, compared with none in the UFH group. In both MATISSE-DVT and -PE, efficacy and safety data from the patients who received fondaparinux on an outpatient basis were similar to those from the total population (Tables). The rates of recurrent VTE and MB in fondaparinux outpatients were similar to those in enoxaparin outpatients or UFH inpatients. Conclusion: Outpatient initial treatment of both DVT and PE with once-daily fondaparinux is feasible, effective and safe. MATISSE DVT Enoxaparin Fondaparinux All patients Outpatients All patients Outpatients *As treated patients n 1107 374 (33.8%) 1098 345 (31.4%) Age, yr (mean±SD) 61±17 60±16 61±17 58±17 Male/female 578/529 201/173 581/517 197/148 Hospital discharge, days (mean±SD) 7.0±6.2 1.8±1.9 7.6±7.7 1.6±1.7 ≥2 VTE risk factors, n (%) 283 (25.6) 122 (32.6) 293 (26.7) 97 (28.1) VTE, n (%) 45 (4.1) 16 (4.3) 43 (3.9) 7 (2.0) MB*, n (%) 13 (1.2) 3 (0.8) 12 (1.1) 5 (1.5) MATISSE-PE UFH Fondaparinux All patients Outpatients *As treated patients n 1110 1103 158 (14.3%) Age, yr (mean±SD) 62±17 63±16 57±16 Male/female 477/633 501/601 82/76 Hospital discharge, days (mean±SD) 10.2±6.8 9.7±7.7 4.4±2.2 ≥2 VTE risk factors, n (%) 260 (23.4) 241 (21.8) 35 (22.2) VTE, n (%) 56 (5.0) 42 (3.8) 5 (3.2) MB*, n (%) 12 (1.1) 14 (1.3) 0 (0)
43
Zakarija, Anaadriana, H. C. Kwaan, Nicholas Bandarenko, Dilip Pandey, Amul Tevar, John Cursio, Charles Buffie et al. "Preliminary Results from the Surveillance, Epidemiology & Risk Factors for TTP (SERF-TTP) Group: A Prospective Case-Control Study of Idiopathic TTP." Blood 108, n. 11 (16 novembre 2006): 1063. http://dx.doi.org/10.1182/blood.v108.11.1063.1063.
Abstract (sommario):
Abstract SERF-TTP is the first prospective case-control study to investigate epidemiology, risk factors & outcomes in patients with first episode of idiopathic TTP. METHODS: Each case of TTP is identified upon referral for therapeutic plasma exchange (TPE). Exclusion criteria include organ or allogeneic stem cell transplant, anti-neoplastic therapy or malignancy. 2 age & gender-matched controls are identified for each case. Epidemiologic information, lab data & plasma samples are collected from each case. Case & control data are collected by standardized interview. Relative risk & 95% CI computed by chi-squared tests. ADAMTS13 activity & inhibitor are centrally measured on pre-TPE samples. ADAMTS13 activity is measured by FRETS-vWF73 assay (Peptides Int.). ADAMTS13 inhibitor is assessed by Technozym ADAMTS13 INH ELISA (Technoclone). RESULTS: Data is available for 67 cases & 138 controls. The median age of cases is 40, & 82% are female. Medical history & exposures are shown in Table 1. Clinical & lab characteristics vary by ADAMTS13 activity (Table 2). Low titer ADAMTS13 inhibitors are detectable in some patients with normal ADAMTS13 activity. 30 day survival of cases is 95.7%. Adverse reactions to TPE occur in 59% of patients, most commonly allergic(85%) or citrate-related reactions(65%). 14.7% had a venous access complication, 50% were catheter-related thromboses. 10% of all adverse events required an ICU admission. CONCLUSIONS: Preliminary results from the case-control study suggest that predisposing factors for the development of TTP include recent infection or connective tissue disorder. Cardiovascular disease, prior history of venous thrombosis, clopidogrel use and lower income are more common in TTP cases than controls. Patients with normal ADAMTS13 activity are more likely to present with higher platelet count, abnormal renal function and neurologic symptoms. Case & Control Characteristics Cases (n=67) Controls (n=138) Relative Risk (95% CI) Medical History Connective Tissue Disease 11.9% 2.2% 5.4 (1.5–20.0) Cardiovascular Disease 13.4% 3.6% 3.7 (1.29–10.6) Prior Venous Thrombosis 13.4% 2.9% 4.6 (1.48–14.5) Infection (prior 2 wks) 32.8% 10.1% 3.2 (1.77–5.9) Medications (prior 12 wks) Antibiotics 31.3% 17.4% 1.8 (1.08–2.99) Clopidogrel 4.5% 0.7% 6.4 (0.65–62.9) Income Level < $25,000 42% 18% 2.3 (1.47–3.6) $25,000 – 70,000 37.3% 52.9% 0.7 (0.49–0.99) > $70,000 11.9% 24.6% 0.5 (0.24–0.98) Characteristics by ADAMTS13 activity ADAMTS13 activity N ADAMTS13 inhibitor (>15 u/ml) ADAMTS13 inhibitor titer (mean) Platelets (mean) Creatinine (mean) Neurologic symptoms Survival Comparison of ADAMTS13 ≤20% vs > 20%, p-values: * 0.0028, † 0.003, ‡ 0.73, # 0.48. < 5% 18 (37.5%) 100% 80.9 22,350 1.4 44% 94% 5–20% 4 (8.3%) 100% 76.4 20,000 1.1 75% 100% > 20% 26 (54.2%) 57.7% 22.5 58,810* 4.3† 58%‡ 89.5%#
44
Willemze, Roelof, Stefan Suciu, Franco Mandelli, Stijn J. M. Halkes, Jean-Pierre Marie, Boris Labar, Adriano Venditti et al. "High Dose (HD-AraC) Vs Standard Dose Cytosine Arabinoside (SD-AraC) During Induction and IL-2 Vs Observation After Consolidation/Autologous Stem Cell Transplantation in Patients with Acute Myelogenous Leukemia (AML): Final Report of the AML-12 Trial of EORTC and GIMEMA Leukemia Groups on the Value of Low Dose IL-2 Maintenance",. Blood 118, n. 21 (18 novembre 2011): 3612. http://dx.doi.org/10.1182/blood.v118.21.3612.3612.
Abstract (sommario):
Abstract Abstract 3612 The AML-12 randomized phase III trial of the EORTC and GIMEMA Leukemia Groups assessed the efficacy and toxicity of HD-AraC (3 g/sqm/12 hrs for 4 days) combined with daunorubicin (50 mg/sqm/d for 3 days) and etoposide (50 mg/sqm/d for 5 days) vs SD-AraC (100 mg/sqm/d for 10 days) combined with the same drugs, in previously untreated AML < 61 year old patients (APL excluded). Patients (pts) in complete remission (CR) received consolidation consisting of AraC (500 mg/sqm/12 hrs for 6 days) and daunorubicin (50 mg/sqm/d for 3 days). Subsequently an allogeneic (allo-SCT) or autologous stem cell transplantation (auto-SCT) was planned according to donor availability and age. A 2nd randomization was performed after consolidation in pts without a donor: auto-SCT followed or not by low dose IL-2 (4-8 × 106 IU/d s.c. for 5 days per month) during one year. A total of 577 pts were required to be randomized for the 2nd question in order to reach 255 events (relapses or deaths) which would allow to detect a 11.5% increase in the 3-year disease-free survival (DFS) from 50% to 61.5% corresponding to hazard ratio (HR) = 0.70 (2-sided alpha=5%, statistical power=80%). Randomization was performed centrally; the 2nd randomization was stratified for induction treatment, cytogenetic/molecular genetic group, number of courses to reach CR, auto-SCT planned (No/Yes) and center. Intent-to-treat analysis was done in eligible pts. From 9/1999 till 1/2008, 2005 pts were randomized (891 by EORTC-LG and 1114 by GIMEMA). In addition 104 pts (GIMEMA) were registered to receive SD-AraC (+etoposide+daunorubicine) in induction. Due to insufficient reporting, 3 centers, who recruited 63 pts, have been excluded from the analysis. After 1 or 2 courses of induction, CR was achieved in 1500 pts. Between 4/2000 and 5/2008 544 pts have been randomized for the IL-2 question, of whom 528 (222 EORTC, 306 GIMEMA) met the eligibility criteria and were included in the analysis: 263 in IL-2, 265 in Observation (Obs) arm; the remaining pts have not been randomized due to prolonged hypoplasia after consolidation or after auto-SCT, or refusal of the patient or a planned allo-SCT. The two groups were well balanced with respect to the above mentioned stratification factors. Due to prolonged pancytopenia after auto-SCT, severe organ damage or infection after auto-SCT, early relapse or patient refusal, 165 pts actually received IL-2 and 197 pts were adequately documented in the Obs arm. During the first 4 months 82% of the pts in the IL-2 arm received a mean daily dose of 6 × 106 IU and 62% of the pts received the maximally required 20 s.c. injections; the remaining stopped due to relapse (22%) or toxicity (16%). During the second 4 months, out of 103 pts 82% in the IL-2 arm received a mean daily dose of 6 × 106 IU and 76% of the pts received the maximally required 20 s.c. injections; the remaining stopped due to relapse (15%), toxicity/refusal (6%) or other reasons (2%). During the third 4 months, among 79 of the pts in the IL-2 arm 80% received a mean daily dose of 6 × 106 IU and 85% of the pts received the maximally required 20 s.c. injections. Grade 3–4 toxicity was more frequent in the IL-2 compared to Obs arm and consisted of hypersensitivity (3% vs 0%), fatigue (7.9% vs 1%), rigor/chills (6.1% vs 0%), arthralgia/myalgia (3.6% vs 0%). For the total of 528 pts, the median follow-up from the 2nd randomization was 6 years. As of July 2011, a total of 308 events were reported: 150 (IL-2 arm) vs 158 (Obs arm); among them 277 relapses (137 vs 140) and 31 deaths without relapses (13 vs 18). The DFS from 2nd randomization was similar in the 2 groups: the 5-yr DFS rate was 44.2% (IL-2) vs 40.4% (Obs), hazard ratio (HR)=0.95, 95% CI (0.76,1.19), p=0.66. A total of 259 pts died: 128 (IL-2 arm) vs 131 (Obs. arm). The 5-yr overall survival rate was 52.2% (IL-2) vs 50.9% (Obs), HR=0.98, 95% CI (0.77,1.26), p=0.9. The initial remission induction treatment (received/randomized) did not have impact on the results after the 2nd randomization. Conclusion: This study shows that, with a median follow-up of 6 years, low dose IL-2 maintenance does not lead to a prolonged DFS and overall survival in pts with AML in first complete remission treated in the EORTC-GIMEMA AML12 trial. Disclosures: Muus: Amgen: Membership on an entity's Board of Directors or advisory committees. de Witte:Novartis: Consultancy, Honoraria, Speakers Bureau.
45
Picozzi, Vincent J., Raneem Hawari, Anas Najjar, Diala E. Harb, Jens J. Kort e Margaret T. Mandelson. "Impact of pancreatic enzyme replacement therapy (PERT) on clinical outcomes in nonresected pancreatic cancer (PC): Initial results." Journal of Clinical Oncology 39, n. 3_suppl (20 gennaio 2021): 400. http://dx.doi.org/10.1200/jco.2021.39.3_suppl.400.
Abstract (sommario):
400 Background: Current NCCN guidelines recommend PERT use in PC patients (pts) with symptoms of EPI. However, little evidence exists regarding clinical outcomes following PERT use in PC pts, especially those with nonresected disease. We present initial results from PERT use in this pt group regarding disease control and symptom improvement. Methods: Pts with initially nonresected PC were obtained for this study from the Virginia Mason PC Database. Eligibility criteria included:1) pathologically diagnosed nonresected adeno PC from January 2014-December 2019 ; 2) no prior PC anticancer therapy (PCRx) of any kind; 3) ≥2 PGSGA (Patient Generated Global Subjective Assessment ) forms completed with initial PGSGA reporting before 30 days following first PCRx. Pts were stratified by PERT vs non-PERT prescription as validated by the EHR. Clinicians tended to prescribe PERT based on either abnormal fecal elastase and/or clinical symptoms (e.g. diarrhea) as in the PGSGA; no formal criteria for PERT usage existed. Pts were considered to have received PERT if prescribed for the majority of time during the assessment period (i.e. > 30 days) and were analyzed based on an "intent to treat" basis without compliance validation. Results: 344 pts were identified via this method ; 207 (60%)/137 (40%) did/did not receive PERT. > 95% received Creon as PERT. Median time from 1st day PCRx to 1st reassessment was 60 days. 79% pts completed PGSGA prior to and 97% within 2 weeks of 1st day PCRx. Pt characteristics were balanced between PERT/ non PERT groups including race (90% white), age (median 68 yrs), sex (M/F 53%/47%), non-metastatic/metastatic disease 24%/76% . BMI distribution (< 18.5 3%, 18.5-25 40%, 25-30 34%, and >30 23%),and albumin distribution (<3 g/dL 6%, 3-3.4 g/dL 12% and ≥3.5 g/dL 82%). However, mean baseline PGSGA score was higher in the PERT vs non PERT group (9.9 overall, 10.9 (95% CI 10.1-11.7) vs 8.2 (95% CI 7.3 - 9.1), p< 0.01). At 1st reassessment, disease control (PR+SD) (83% overall) was greater in the PERT (87%) vs. non PERT (79%) group (p=0.04).Change from baseline PGSGA was favorable overall (Δ-5.0, 95% CI-5.7--4.3), and in all pt subsets, but with greater improvement in the PERT (Δ-6.0) vs. non PERT (Δ -3.4) group (p< 0.001) and in disease controlled (Δ-5.3) vs. non-disease controlled (Δ- 3.2) pts (p=0.033). Disease controlled vs. non-disease controlled PERT pts did not differ in their PGSGA response (Δ-6.2/-4.8, p=0.98) Conclusions: 1) PERT vs non-PERT pts were similar with respect to basic clinical or nutritional parameters (e.g. BMI, albumin) in this pt cohort. 2) Despite having more adverse baseline PGSGA scores, PERT pts were statistically superior to non PERT pts with respect to both frequency of disease control and magnitude of PGSGA response during initial Rx 3) Further investigation of the detail involving PERT usage and clinical outcomes in nonresected PC is warranted from these data.
46
An, Ran, Yan Wang, Fuchenchu Wang, Akshara Singareeka Raghavendra, Chao Gao, Diana Amaya, Nuhad K. Ibrahim e Jing Li. "Upfront stereotactic radiosurgery for brain metastases from triple-negative breast cancer." Journal of Clinical Oncology 39, n. 15_suppl (20 maggio 2021): e14014-e14014. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e14014.
Abstract (sommario):
e14014 Background: Triple-negative breast cancer (TNBC) is an aggressive subtype with high propensity of brain metastases (BM). Outcomes after upfront stereotactic radiosurgery (SRS) for BM from TNBC patients are not well defined. We evaluated outcomes and identified prognostic factors for such patients. Methods: We reviewed 57 consecutive patients treated with upfront SRS for BM from TNBC in May 2008–April 2018 at a large-volume cancer center. Endpoints were overall survival (OS) from BM diagnosis and freedom from BM progression (FFBMP) after initial SRS. BM progression was defined as local and/or distant brain failure (LBF or DBF) after initial SRS; LBF was radiographic progression of treated lesions, assessed by a neuroradiologist or treating physician excluding post-radiation changes or radiation necrosis. Kaplan-Meier and Cox proportional hazard regression analyses were used to estimate survival outcomes and identify prognostic factors. Results: In this cohort of 57 patients with a median age of 53 y (range 26–82) at BM diagnosis and follow-up time of 12.2 months (mo, range 0.8–97.5), median time to BM development from TNBC diagnosis was 23.7 mo (range 0.7‒271.1). Estimated median OS time from initial BM diagnosis was 13.1 mo (95% CI 8.0‒19.5). In univariate analysis, Karnofsky performance score (KPS) > 70 (p = 0.03), having < 3 BMs (p = 0.016) at BM diagnosis, and BM as first site of metastasis (p = 0.041) were associated with longer OS. On multivariate analysis, KPS ≤70 was associated with higher risk of death (HR 3.0, p = 0.03). Of 46 patients with imaging follow-up for FFBMP assessment, 29 (63%) developed BM progression after initial SRS with an estimated median FFBMP of 7.4 mo (95% CI 5.7–12.7). Median times to LBF and DBF were 10 mo (range 0.3–97) and 5.9 mo (range 0.3–90.8). Estimated cumulative LBF rate was 17.8% (95% CI 2%–31.1%) and DBF 61.1% (95% CI 40.8%–74.4%) at 12 mo. Number of BMs at BM diagnosis (≥3 vs < 3) was not associated with FFBMP (p = 0.7). Of the 29 patients with BM progression, 5 did not receive salvage radiation therapy (RT) and 24 received salvage RT (SRS, whole-brain radiation [WBRT], or both SRS+WBRT). Receipt of salvage RT was associated with longer survival (median 21.7 mo vs. 7.0 mo for no salvage RT, p < 0.0001) and did not differ by type of salvage RT (median OS 18.6 mo for WBRT; 26.2 mo for SRS+WBRT; 35.9 mo for SRS, p = 0.08). Conclusions: We reported a median OS of 13.1 mo and FFBMP of 7.4 mo in TNBC patients with good local control. Good KPS was independent prognostic factor for better OS. FFBMP did not differ by number of SRS-treated brain lesions ( < 3 vs ≥3). Further prospective studies of larger numbers of patients needed for more accurate comparisons of treatment types.
47
Turner, Peter, Maxwell J. Gunter, Brian W. Skelton e Allan H. White. "Crystal Structures of the Pentacoordinate Bromo, Isocyanato, Iodo, Acetato and Isothiocyanato Complexes of the meso-Tetraphenylporphyrinatomanganese Cation". Australian Journal of Chemistry 51, n. 9 (1998): 835. http://dx.doi.org/10.1071/c97150.
Abstract (sommario):
The room-temperature single-crystal X-ray diffraction determined structures of the Mn(tpp)Br.C7H8, Mn(tpp)(NCO), Mn(tpp)I.C7H8, Mn(tpp)(CO2CH3).0·5C7H8, and Mn(tpp)(NCS).0·5C7H8 complexs are described. The monoclinic P21/c unit cell of Mn(tpp)(NCO) has a 14·82(1), b 17·136(5), c 14·576(5) Å, β 111·41(5)°, V 3446(3) Å3, Z 4. The refinement converged with conventional R(|F|) 0·053 for No 3199 (I > 3·0σ(I)) ‘observed’ reflections. The monoclinic P 21/m unit cell of Mn(tpp)Br.C7H8 has a 9·984(1), b 15·453(6), c 13·583(3) Å, β 103·99(2)°, V 2033(1) Å3, Z 2, R 0·039 for No 2668. The Mn(tpp)I.C7H8 structure is triclinic, P-1, with a 22·28(1), b 14·466(4), c 13·555(6) Å, α 76·32(3), β 81·74(4), γ 74·75(3)°, V 4079(3) Å3, Z 4, R 0·050 for No 9039. The triclinic P-1 crystal structures of the Mn(tpp)(CO2CH3).0·5C7H8 and Mn(tpp)(NCS).0·5C7H8 complexes are isomorphous. The Mn(tpp)(CO2CH3).0·5C7H8 structure has a 26·18(1), b 13·503(3), c 12·074(6) Å, α 66·08(4), β 81·36(4), γ 86·71(5)°, V 3858(3) Å3, Z 4, R 0·075 for No 6388. Solvate disorder, requiring a rigid body model, islargely responsible for the relatively high residuals. The Mn(tpp)(NCS).0·5C7H8 structure has a 25·442(6), b 13·746(3), c 12·182(5) Å, α 66·97(3), β 78·59(3), γ 87·90(2)°, V 3839(2) Å3, Z 4, R 0·061 for No 5506. The asymmetric units of the iodo, acetato and isothiocyanato structures each contain two crystallographically independent complex molecules that are sensitive to crystal packing forces. The metal ion displacements from the least-squares planes formed by the pyrrole nitrogen atoms are 0·299(1) and 0·274(1) Å for the Mn(tpp)(NCO) and Mn(tpp)Br.C7H8complexes, and 0·240(1) and 0·252(1), 0·281(1) and 0·278(1), and 0·243(1) and 0·244(1) Å for the independent (a) and (b) complex molecules of Mn(tpp)I.C7H8, Mn(tpp)(CO2CH3).0·5C7H8, and Mn(tpp)(NCS).0·5C7H8 respectively. The axial Mn–X bond lengths are 2·029(5) and 2·490(1) Å for the Mn(tpp)(NCO) and Mn(tpp)Br.C7H8 complexes, and 2·767(1) and 2·730(1), 2·028(5) and 2·010(5), and 2·067(6) and 2·072(5) Å for the (a) and (b) complex molecules of Mn(tpp)I.C7H8, Mn(tpp)(CO2CH3).0·5C7H8, and Mn(tpp)(NCS).0·5C7H8. One of the independent complex molecules in the Mn(tpp)(CO2CH3).0·5C7H8 structure appears to exhibit acetate coordination through a carbonyl oxygen.
48
Eliashevich, Sofia O., Oxana M. Drapkina e Batogab B. Shoibonov. "The circulating level of modified ldl and c3-convertase stabilization among patients with abdominal obesity". Problems of Endocrinology 62, n. 5 (22 settembre 2016): 44–45. http://dx.doi.org/10.14341/probl201662544-45.
Abstract (sommario):
Background. The abdominal obesity is associated with a low-grade chronic inflammatory status, to which the complement system is an important contributor. Recent studies documented the close association between modified low-density lipoproteins (mLDL) and the increase of C3 production in human macrophages. In several reports, C3 and the degree of C3 activation (C3a and C3a-desArg) have been linked to diabetes and cardiovascular disease (CVD). However the studies of C3-convertase functional activity haven’t been taken yet.Aim: to evaluate a potential association between mLDL level and C3-convertase stabilization of the classical pathway of complement system activation in middle-aged individuals with abdominal obesity at low cardiovascular risk.Patients and methods. A pilot study, including 45 patients without evidence of atherosclerosis at low CVD risk in the next 10 years according to SCORE, was designed. Abdominal obesity was detected according to the IDF criteria (2009). All patients underwent a comprehensive clinical evaluation with lipid profile and glucose analyzes. The level of mLDL (U) and the C3-convertase functional activity (%) - a key enzyme complex of the classical pathway complement activation, were assessed by using original techniques. Receiving data have been analyzed and compared in the total sample and separately among patients with abdominal obesity.Results. Analysis included 45 participants (mean age: 41(9) years; body mass index: 27(5) kg/m2; and 47% male). Mean lipid values were as follows: total cholesterol: 5.4 (1) mmol/l; LDL-C: 3.8 (1) mmol/l; HDL-C: 0.98 (0.3) mmol/l; triglycerides 2.5 (1.5–2.1) mmol/l. 27 (60%) participants of the sample had signs of abdominal obesity. Among them 41 % (11) with overweight, 44 % (12) with obesity. There were found significant differences in the mLDL level of patients with abdominal obesity and without it (p< 0,01). The median of mLDL level of patients with abdominal obesity was 15.25 U (12.3 – 24.6), while the median of mLDL level of patients without abdominal obesity was 9 U (5.7 – 12.4). Plasma mLDL levels were associated with smoking and triglycerides (Spearman up to 0.6, p<0.05), independently of low-density lipoprotein-cholesterol and other variables. The activity of stabilized C3-convertase was high (mean 18.5 (7.6)%) in the majority of patients (82%), independently of BMI, waist circumference, blood pressure, levels of TG, LDL-C, HDL-C and mLDL-C. No significant correlation between C3-convertase activity and lipoprotein fractions was found.Conclusion. Our findings underscore the role of mLDL in early atherosclerosis among the asymptomatic middle-age sample with abdominal obesity at low risk of CVD. The observed fact of stabilization of C3 convertase, apparently, can serve as a predictor of the autoimmune nature of abdominal obesity. One product of the enhanced C3 cleavage is C3a-desArg, which is a hormone that stimulates the acylation and triglyceride synthesis. The association between lipid homeostasis, obesity and innate immune system need to be studied in larger samples.
49
Strangfeld, A., B. Manger, M. Worsch, T. Schmeiser, A. Zink e M. Schaefer. "OP0116 ELDERLY PATIENTS ARE NOT AT INCREASED RISK OF SERIOUS INFECTIONS WHEN RECEIVING BDMARDS OR JAK INHIBITORS COMPARED TO CSDMARD TREATMENT". Annals of the Rheumatic Diseases 80, Suppl 1 (19 maggio 2021): 64.2–65. http://dx.doi.org/10.1136/annrheumdis-2021-eular.763.
Abstract (sommario):
Background:Elderly rheumatoid arthritis (RA) patients are generally at increased risk of serious infections (SI). At the same time, treatment with bDMARDs has been associated with a higher SI risk than treatment with csDMARDs (1). However, long-term use of bDMARDs did not increase the risk of SI in a small group of elderly patients over 65 (2). The extent to which elderly patients are exposed to a higher SI risk when treated with JAK inhibitors (JAKi) is an open question.Objectives:To assess the effects of bDMARDs and specifically JAKi on the risk of SI in elderly patients with RA.Methods:The German register RABBIT is a prospective, longitudinally followed cohort of RA patients enrolled with a new start of a DMARD after at least one csDMARD failure. This analysis comprises patients over 70 years of age who were enrolled between 01/2007 and 04/2020 and had at least one follow-up.Results:Of 13,491 patients followed-up in RABBIT, 2274 with an age > 70 years were included in the analysis. 626 SI were observed in 425 of these patients. Baseline characteristics at start of the respective DMARD are shown in Table 1. In most characteristics, patients on JAKi were more comparable to patients under bDMARDs than to those on csDMARDs. JAKi patients received glucocorticoids (GC) less frequently than patients on other treatments. The HR for SI was lower than 1 in patients receiving bDMARDs or JAKi compared to csDMARDs, but without statistical significance (Figure 1). GC use (HR 1.6, 95% CI: 1.2 – 2.2 for ≤ 10 mg/d), higher DAS28-ESR values (HR 1.1, 95% CI: 1.0 – 1.2 per 1 point increase), COPD or pulmonary fibrosis (HR 1. 8, 95% CI: 1.3 – 2.4), chronic kidney disease (HR 1.5, 95% CI: 1.2 – 1.9) and diabetes mellitus (HR 1.3, 95% CI: 1.0 – 1.7) were associated with an increased risk of SI. Better physical capacity was associated with a decreased risk of SI (HR 0.9, 95% CI: 0.88 – 0.98 for a 10 point increase).Table 1.Patient characteristics by treatment at baselineParametercsDMARDsTNFiRTXABAIL-6iJAKiN=758N=840N=209N=147N=212N=108Age (years)75.9 (3.9)75.5 (3.6)74.8 (3.6)76.1 (3.9)75.9 (3.7)76.7 (3.7)Male sex184 (24.3)220 (26.2)50 (23.9)36 (24.5)46 (21.7)28 (25.9)Ever smoker249 (32.8)287 (34.2)77 (36.8)50 (34)73 (34.4)39 (36.1)Disease duration (years)7.9 (8.8)12.3 (11.4)17 (11.1)12.8 (10)13.8 (11.7)11.9 (10.9)Seropositivity487 (64.3)671 (79.9)201 (96.2)126 (85.4)182 (85.8)79 (73.5)Number of previous DMARDs1.4 (0.7)2.5 (1.3)4.2 (1.8)3.6 (1.9)3.3 (1.8)2.6 (1.5)DAS28-ESR4.6 (1.2)5.1 (1.2)5.4 (1.3)5.3 (1.3)5.3 (1.3)5 (1.2)Proportion of full physical function64.8 (23.1)57.1 (23.6)50.4 (23.7)52.9 (23.5)55.3 (24.1)55.2 (23.7)Number of comorbidities3.1 (2.5)3.8 (2.6)4.2 (2.6)4.6 (2.9)3.6 (2.4)3.8 (2.2)No comorbidity52 (6.9)29 (3.5)4 (1.9)4 (2.7)9 (4.2)5 (4.6)Three and more comorbidities385 (50.8)528 (62.9)147 (70.3)107 (72.8)131 (61.8)76 (70.4)COPD or pulmonary fibrosis69 (9.1)89 (10.6)29 (13.9)26 (17.7)12 (5.7)11 (10.2)Chronic kidney disease94 (12.4)151 (18)28 (13.4)21 (14.3)39 (18.4)22 (20.4)Diabetes mellitus151 (19.9)172 (20.5)31 (14.8)23 (15.6)42 (19.8)25 (23.1)GCs (last 6 months)347 (45.8)526 (62.6)143 (68.8)82 (56.2)127 (59.9)44 (40.7)GCs (<5mg)447 (58.9)384 (45.7)101 (48.2)88 (60)118 (55.8)72 (66.7)GCs (5-9mg)252 (33.3)375 (44.6)81 (38.7)43 (29)72 (34.2)27 (25.1)GCs (>=10mg)59 (7.8)82 (9.8)274 (13.1)16 (11)21 (10)9 (8.2)Results are presented as mean ± SD for continuous variables and number (percentage) for discrete variables.Figure 1.Hazard ratios for serious infections with 95% confidence intervalsConclusion:Treatment with JAKi as well as treatment with bDMARDs was not associated with an increased risk of SI in elderly patients above 70 years of age. Key comorbidities such as diabetes mellitus, chronic pulmonary and kidney diseases were associated with increased risk, as was concomitant GC use and higher disease activity.References:[1] Listing J et al., Rheumatology 2013; 52 (1): 53-61.[2] Kawashima H. et al., Rheum. Intern. 2017; 37: 369-376.Acknowledgements:RABBIT is supported by a joint, unconditional grant from AbbVie, Amgen, BMS, Celltrion, Fresenius-Kabi, Gilead, Hexal, Lilly, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi-Aventis, UCB, and Viatris.Disclosure of Interests:None declared
50
Nasonov, E., A. Avdeeva, A. Misiyuk, A. Satybaldyev, V. Sorotskaya, O. Fomina, A. Babaeva, N. Lapkina e A. Lila. "AB0328 SIMILAR EFFICACY OF TOFACITINIB THERAPY IN BIOLOGIC NAIVE AND HAD PRIOR BIOLOGIC USE HISTORY PATIENTS WITH RHEUMATOID ARTHRITIS (OREL REGISTER)". Annals of the Rheumatic Diseases 79, Suppl 1 (giugno 2020): 1462.3–1463. http://dx.doi.org/10.1136/annrheumdis-2020-eular.3052.
Abstract (sommario):
Objectives:To evaluate the efficacy of tofacitinib therapy (TOFA) in biologic naive and had prior biologic use history patients with rheumatoid arthritis (RA) according to OREL registerMethods:Were analyzed the data from Russian national register of patients with RA - OREL treated with TOFA. 138 patients (118 woman, Me;IQR age 55.0 (43.0-63.0) years, disease duration 128.0 (84.0-213.0) months, mean DAS 28 5.5 (4.6-6.2), SDAI 30.5 (21.4-42.9), positive for ACCP (73%)/RF (77%), who were non-responders to MTX at least 15 mg/week and/or other synthetic DMARDs) who received TOFA therapy for more than 1 year were selected for statistical analysis. TOFA used in 26 (18.8%) pts without DMARDs, combination with MTX in 82 (59.4%) pts, leflunomide in 21 (15.2%). Low-dose oral corticosteroids (<10 mg/day prednisone or equivalent) were received by 43 (31.2%) pts. TOFA therapy was started in all pts in dose 5 mg BID per os with dose escalation to 10 mg BID in (86%) pts.Results:The use of TOFA was accompanied by a decrease in the disease activity and the level of acute phase reactants (CRP and ESR) after 12, 24 and 48 weeks of therapy, p<0.05, table 1. Depending on the previous treatment with biological DMARDs, all patients were divided into two groups: had prior biologic use history pts (group 1) (n=51) and biologic naïve pts (group 2) (n=87), table 1.Table 1.Baseline vs month 1ParametersWeeksAll patients (n=138)Had prior biologic use history (group 1) (n=51)Biologic naive (group 2) (n=87)DAS28baseline5,5 (4,6-6,2)5,1 (4,5-5,9)5,7 (4,8-6,5)$week 124,2 (3,1-4,8)*3,9 (2,8-4,8)*4,4 (3,7-4,8)*week 243,4 (2,7-4,4)*3,5 (2,4-4,3)*3,4 (2,8-4,5)*week 483,3 (2,5-4,4)*3,2 (2,4-4,2)*3,4 (2,7-4,4)*SDAIbaseline30,5 (21,4-42,9)28,6 (18,1-36,6)33,1 (22,6-45,9)week 1214,5 (7,1-23,3)*13,1 (5,1-19,1)*16,3 (9,3-25,6)*week 2410,5 (5,1-19,0)*11,0 (5,5-17,6)*9,1 (4,7-20,4)*week 4810,3 (4,9-17,7)*10,2 (3,4-15,8)*10,9 (6,2-18,1)*CDAIbaseline28,2 (20,0-37,1)25,7 (17,0-33,7)30,0 (21,5-40,5)week 1214,9 (8,0-22,5)*13,0 (6,8-18,7)*16,6 (9,0-24,0)*week 2410,0 (5,0-18,0)*11,0 (4,7-16,0)*9,3 (5,0-18,0)*week 4810,1 (5,8-17,0)*10,4 (4,0-16,0)*10,0 (6,0-17,0)*CRP, mg/lbaseline15,6 (6,5-38,0)15,6 (6,0-38,1)15,4 (6,9-36,7)week 125,5 (1,7-12,1)*6,4 (2,7-10,4)*5,2 (1,3-12,8)*week 244,5 (1,0-10,0)*5,0 (0,8-9,8)*4,2 (1,0-10,0)*week 484,0 (0,7-9,0)*2,9 (0,6-9,6)*4,0 (0,8-8,9)*ESR, mm/hbaseline32,0 (23,0-48,0)29,0 (16,0-37,0)32,0 (23,0-49,0)$week 1221,0 (17,0-33,0)*20,0 (12,0-33,0)21,0 (17,0-33,0)*week 2421,0 (12,0-31,0)*13,0 (9,0-28,0)21,0 (12,0-31,0)*week 4816,0 (10,0-27,0)*16,0 (7,0-30,0)*16,0 (10,0-27,0)**p<0.05 from baseline; $p<0.05 between the groups 1 and 2Patients of the second group had a higher disease activity and ESR before therapy. The use of TOFA was accompanied by a decrease in the disease activity and the level of acute phase reactants (CRP and ESR) in both groups of patients. By week 48 of treatment, no significant difference between the groups according to the disease activity was detected.In the first and the second group of pts on the 48-th week of therapy remission/low disease activity was achieved on DAS 28 in 51% and 43% (р=0.57), high disease activity on DAS 28 in 12% and 8% (p=0.48).Conclusion:An analysis of the data from the Russian national register of patients with RA demonstrated similar efficacy of TOFA among patients who received and did not receive previous biological therapy.Disclosure of Interests:Evgeny Nasonov Speakers bureau: Lilly, AbbVie, Pfizer, Biocad, R-Pharm, Anastasia Avdeeva: None declared, Anna Misiyuk: None declared, Azamat Satybaldyev: None declared, Valentina Sorotskaya: None declared, Oxana Fomina: None declared, Aida Babaeva: None declared, N Lapkina: None declared, Alexander Lila: None declared