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Yoon, Min Yong, e Hyung Ook Kim. "Treatment of colorectal liver metastasis: Comparison of radiofrequency ablation and hepatic resection." Journal of Clinical Oncology 30, n. 4_suppl (1 febbraio 2012): 637. http://dx.doi.org/10.1200/jco.2012.30.4_suppl.637.
Abstract (sommario):
637 Background: Hepatic resection is the mainstay of management for colorectal liver metastases. But, the treatment for colorectal liver metastases requires a multidisciplinary therapeutic strategy. The aim of this study was to compare recurrence and survival rates for patients treated with hepatic resection or radiofrequency ablation (RFA) for colorectal liver metastases. Methods: Between July 2002 and September 2010, 52 patients underwent hepatic resection and 58 underwent RFA for synchronous or metachronous colorectal liver metastases. A retrospective analysis was performed. Patients with extrahepatic metastases were excluded. Results: The two groups had similar mean age, comorbid medical conditions, primary disease stage, and number of tumors. Preoperative median serum carcinoembryonic antigen (CEA) level was significantly higher in the resection group (13.8 ng/mL vs. 3.1 ng/mL; p = 0.001). Median diameter of main tumors was significantly greater in resection group (4.1 cm vs. 2.0 cm; p = 0.002). Recurrence rate after treatment was 46.2% (24/52) in the resection group and 70.7% (41/58) in the RFA group. Marginal recurrence after resection or RFA was observed in 7.6% (4/52) and 46.6% (27/58), respectively (p = 0.003). Median recurrence free survival (28.0 vs. 12.0 months; p = 0.007) and median overall survival (43.0 vs. 26.0 months; p = 0.023) were significantly longer in the resection group. Conclusions: Hepatic resection is the treatment of choice for colorectal liver metastases. RFA for colorectal liver metastases was associated with higher marginal recurrence rate and shorter recurrence free and overall survival.
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Yang, Mo, Huixia Deng, Liuming Yang, Liang Li, Jieyu Ye, Yucai Cheng, Yafang Tan, Beng H. Chong e Qiang Li. "Coagulation Dysfunction and Hematological Changes in 633 Patients with COVID-19". Blood 136, Supplement 1 (5 novembre 2020): 22–23. http://dx.doi.org/10.1182/blood-2020-140274.
Abstract (sommario):
Background: A previously unknown beta-coronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. The virus was named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by the international committee for the classification of viruses (ICTV). The disease caused by this virus was named as coronavirus disease 2019 (COVID-19). In addition to pulmonary manifestations, hematological changes such as lymphocytopenia, thrombocytopenia, and coagulation dysfunction can also be found in COVID-19 patients, and the mechanism is still unclear. Case data and methods: A total of 633 COVID-19 patients from Wuhan hospital of China were retrospectively analyzed. Clinical case data of all patients were collected, including gender, age, chronic underlying diseases, outcome, and blood laboratory test results. The hematological features of COVID-19 patients and the factors affecting their outcome were analyzed. Results: Of 633 patients with COVID-19, the median age was 62 years (interquartile range, IQR, 51.0-70.0) and 330 (52%) were men. Lymphocytopenia (lymphocyte count, 1.0 ×109 / L [IQR, 0.7-1.4]) occurred in 317/607 patients (52%), thrombocytopenia (platelet count <100 × 109/ L) occurred in 14/62 death patients (23%), prolonged prothrombin time (13.8 seconds [IQR, 13.1-15.1]) in 289/486 patients (59%), increased D-Dimer level (0.7 mg/L[IQR, 0.2-2.9]) in 230/411 patients (57%) and increased C-reactive protein levels (10.7 mg/L [IQR, 2.2-49.7]) in 217/426 patients (51%) . Compared with the survival patients, death patients have higher white blood cell count (11.7 × 109/L [IQR, 8.4 to 15.6]), neutrophil count (10.8 × 109/L [IQR, 7.8 to 13.9]), neutrophil count/lymphocyte count (20.5 [IQR, 12.4-34.2]), activated partial thromboplastin time (36.8 seconds [IQR, 31.3-42.3]), prothrombin time (17.1 seconds [IQR, 14.7 to 19.7]), D-Dimer level (4.6 mg/L [IQR, 1.0 to 7.8]), C-reactive protein level (111.8 mg/L (IQR, 53.1 to 196.6), and low lymphocyte count (0.5 × 109/L [IQR, 0.3 to 0.7]). The results of logistic multivariate regression analysis showed that age, neutrophil count, prothrombin time, and C-reactive protein were risk factors for patients with COVID-19. Conclusion: Hematological changes are common in patients with COVID-19. The early stage of the disease is mainly characterized by lymphocytopenia, thrombocytopenia, and the late stage may be characterized by more severe lymphocytopenia, even neutrophils elevation, elevated C-reactive protein, and severe coagulation disorder. The pathogenesis may be mediated by a direct viral infection and/or indirect immunopathology. Disclosures No relevant conflicts of interest to declare.
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Forcadell Escouffier, Albert, e Christian Navarro Díaz. "Compatibilidad del control de convencionalidad con la superación del control de constitucionalidad". IUSLabor. Revista d'anàlisi de Dret del Treball, n. 1 (22 aprile 2020): 141–56. http://dx.doi.org/10.31009/iuslabor.2020.i01.05.
Abstract (sommario):
Comentario de la sentencia del Tribunal Superior de Justicia de Cataluña de 17 de enero 2020, que determina la inaplicabilidad- antes de ser derogado- del artículo 52 d) ET, por el que se establecía como causa válida del despido las ausencias intermitentes en un plazo de dos meses siempre que concurran determinados requisitos. Declaración de improcedencia pese a constatar que en el supuesto analizado concurren todos los requisitos que establecía el artículo 52 d) ET. El Tribunal considera que dicha norma, aunque haya superado recientemente el control de constitucionalidad, no cumple con los estándares superiores de protección que dispensan normas de derecho internacional, (artículos 6.1 del Convenio 158 OIT; artículo 4.1 y 5 del Convenio 155 OIT; artículo 3 de la Carta Social Europea; Artículo 11 del Convenio sobre la eliminación de todas las formas de discriminación contra la mujer de 18/09/1979). Se aplica el control de convencionalidad, manifestación del principio de jerarquía normativa y que forma parte del juicio de aplicabilidad o de selección de la norma aplicable que, a diferencia del juicio de constitucionalidad, corresponde a la jurisdicción ordinaria.
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Patronek, Gary J., Alan M. Beck e Lawrence T. Glickman. "Dynamics of dog and cat populations in a community". Journal of the American Veterinary Medical Association 210, n. 5 (1 marzo 1997): 637–42. http://dx.doi.org/10.2460/javma.1997.210.05.637.
Abstract (sommario):
Objective— To describe dynamics of the pet dog and cat populations in a single community in terms of reproductive patterns and turnover. Design— Cross-sectional, random-digit dial telephone survey. Sample Population— Information gathered from 1,272 households in St Joseph County, Ind that owned a dog or cat between Dec 1, 1993 and Nov 30, 1994 was compared with data on 9,571 dogs and cats received by the Humane Society of St Joseph County during the same period. Results— Prevalence of pet ownership was lower than expected, compared with consumer panel surveys. Eight hundred forty-three of 1,335 (63.1%) dogs were neutered, compared with 816 of 1,023 (79.8%) cats. Cost was cited as a reason that 35 of 441 (7.9%) dogs and 34 of 132 (25.8%) cats were not neutered. Only 33 of 968 (3.4%) dog-owning households reported that their dog had had a litter during the past year, whereas 52 of 662 (7.9%) cat-owning households reported their cat had had a litter of kittens. Most cat litters were unplanned, whereas two thirds of dog litters were planned. Annual turnover in owned pets was 191 of 1,354 (14.1%) dogs and 194 of 1,056 (18.4%) cats. Pet owners underreported relinquishing pets to a shelter in the telephone survey. Clinical Implications— A combination of animal shelter- and human population-based data are needed to describe pet population dynamics in a community. Information about species-specific reproductive patterns is essential in designing population control programs. (J Am Vet Med Assoc 1997;210:637–642)
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Moreno Gené, Josep. "Cual Cid Campeador, la antigua causa de despido por absentismo sigue ganando batallas después de su derogación: la STS de 29 de marzo de 2022 proclama su adecuación a la normativa internacional". IUSLabor. Revista d'anàlisi de Dret del Treball, n. 2 (1 luglio 2022): 190–225. http://dx.doi.org/10.31009/iuslabor.2022.i02.06.
Abstract (sommario):
Pocos días antes de la derogación del art. 52 d) ET, se dictó la STSJ de Cataluña de 17 de enero de 2020, la cual, revocando la sentencia dictada en instancia, concluía que dicho precepto era contrario a diferentes normas internacionales, en particular, al art. 6.1 del Convenio núm. 158 OIT, sobre la terminación de la relación de trabajo, a los arts. 4.1 y 5 del Convenio núm. 155 OIT, sobre seguridad y salud de los trabajadores, al art. 3 de la Carta Social Europea y, finalmente, al art. 11 Convención sobre la eliminación de todas las formas de discriminación contra la mujer, hecha en Nueva York el 18 de diciembre de 1979 y, por tanto, no resultaba de aplicación al supuesto enjuiciado. La posterior STS de 29 de marzo de 2022, sin embargo, ha venido a casar la referida STSJ de Cataluña de 17 de enero de 2020, permitiendo, una vez más, que la antigua causa de despido por absentismo del trabajador prevista en el art. 52 d) ET haya salido indemne de este embate jurídico. En este estudio se analizan los argumentos invocados por la STSJ de Cataluña de 17 de enero de 2020 para inaplicar el art. 52 d) ET, así como aquellos que han llevado al Tribunal Supremo a casar dicha resolución.
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van Gestel, Yvette, Myrthe van Herk-Sukel, Ignace de Hingh, Harm Rutten, Geert-Jan Creemers e Valery E. P. Lemmens. "Distant recurrences of colorectal cancer: Incidence, systemic treatment, and survival in daily practice." Journal of Clinical Oncology 31, n. 4_suppl (1 febbraio 2013): 441. http://dx.doi.org/10.1200/jco.2013.31.4_suppl.441.
Abstract (sommario):
441 Background: To provide population-based data on the patterns, risk factors, treatment, and survival of distant recurrences of colorectal cancer (CRC). Methods: All patients (n=6,066) diagnosed with CRC M0 in 10 large Dutch non-academic hospitals between 2003 and 2008 were included. By means of active follow-up, data on distant recurrences and systemic treatment were collected. Median follow-up was 4.4 year. Results: 1,074 (18%) patients were diagnosed with distant recurrent disease during follow-up of which 85% within 3 years. Most common affected sites were liver (60%), lung (39%), extra-regional lymph nodes (22%) and peritoneum (19%) (multiple sites possible). Male sex (female=ref (17%), 19%/HR 1.1 95%CI 1.0-1.3), advanced primary tumor stage (T1=ref (4%), T2 9%/HR 3.0 95%CI 1.8-4.9, T3 21%/HR 6.1 95%CI 3.8-9.9, T4 29%/HR 11.0 95%CI 6.7-18.1), advanced lymph node stage (N0=ref (11%), N1 29%/HR 2.8 95%CI 2.4-3.3, N2 41%/HR 4.5 95%CI 3.7-5.4), primary tumor localization (left colon=ref (17%), right colon 16%/HR 0.8 95%CI 0.7-1.0, rectum 25%/HR 1.2 95%CI 1.0-1.4), and tumor differentiation grade (well differentiated=ref [16%], poorly differentiated 26%/HR 1.4 95%CI 1.2-1.7) were associated with increased risk recurrences while chemotherapy for the primary tumor was associated with reduced risk (HR 0.8 95%CI 0.7-0.9). Recurrence rates did not differ between hospitals. 52% of patients with recurrences received systemic therapy, ranging from 34-62% between the 10 hospitals (p<0.01). Half of these patients (52%) was also treated with bevacizumab, ranging from 39-73% between hospitals (p<0.05). Median survival since diagnosis of recurrence was 31 months for patients with lung metastases only, 16 months for liver metastases only, 14 months for lung metastases only, and 5 months for metastases confined to the peritoneum. Conclusions: The development of distant recurrent disease was strongly related to tumor characteristics, but not correlated with hospital of primary treatment. Population-based data on distant recurrences may ultimately contribute to more accurate patient information, and more efficient follow-up schemes.
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Robertson, Neil. "Edited by Kenneth D. Karlin(series editor) and Edward I. Stiefel(volume editor). Progress in Inorganic Chemistry Vol 52. Dithiolene Chemistry: Synthesis, Properties and Applications. Wiley–VCH, 2004, 738 pp; ISBN 0-471-37829-1". Applied Organometallic Chemistry 18, n. 8 (agosto 2004): 427. http://dx.doi.org/10.1002/aoc.639.
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Perera, A., D. Rajashekar, E. Pereira e A. Shtaya. "TM3-6 Symptomatic intracranial arachnoid cysts: a centre series". Journal of Neurology, Neurosurgery & Psychiatry 90, n. 3 (14 febbraio 2019): e16.3-e17. http://dx.doi.org/10.1136/jnnp-2019-abn.52.
Abstract (sommario):
ObjectivesTo study the presentation, management and outcomes of symptomatic intracranial arachnoid cysts.DesignRetrospective records review.SubjectsAll cases coded as intracranial cysts.MethodsPatients admitted between Jan-2012 and Sep 2017. Of 56 cases, only 24 were arachnoid cysts. Median age 57 (range 8–81). Mean 49.1±5.0 years, 8 males and 16 females.ResultsMales were significantly younger (34.3±9.1 vs 56.5±5.2 year-old, p=0.03) and outnumbered females. Mean size of cysts was 58.8±6.1 mm (range 18.5–126 mm). Five were located frontally, one fronto-temporal and another fronto-parietal, two parietal and two parieto-occipital, two within third ventricle, one intraventricular, one supra sellar and one intra sellar while eight were posterior fossa. 12 patients had headache, five presented with cognitive and memory issues, five had visual problems, four with limb weakness and two had cerebellar signs. Eight had open fenestration, five endoscopic fenestration, four had aspiration with reservoir, two aspiration only, two marsupialisation, two received ICP monitor and one had no treatment. One reservoir was aspirated three times and another open fenestration had another surgical fenestration. Two had transient infection, two needed VP shunts and one had cysto-peritoneal shunt. mRS (0–2) improved significantly after the treatment (62.5% pre-surgery to 91.7% post-surgery, p=0.016).ConclusionsSymptomatic arachnoid cysts are more common in young males. In the literature, the most common location is middle cranial fossa which is not the case in symptomatic arachnoid cysts as in our series. Although intervention is variable, they are associated with very good outcomes.
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Kang, Jiyeon, e Jinkook Tak. "Development and validity of the communication competence scale of middle managers". Korean Journal of Industrial and Organizational Psychology 32, n. 4 (30 novembre 2019): 439–71. http://dx.doi.org/10.24230/kjiop.v32i4.439-471.
Abstract (sommario):
This study was intended to develop the communication competence scale for middle manager in organizations and examine its validity. To develop the communication competence scale of middle managers, first, 632 items were extracted through literature review, expert interview and open surveys for middle managers. In the process of developing the items, it was found that there were differences in competencies between communication with superiors and communication with subordinates. Thus it was decided to develop two different scales for each of middle managers’ communication competencies with superior and communication competencies with subordinate. Based on experts’ evaluations on content validity of the items, 81 items for the communication competencies with superior and 78 items for the communication competencies with subordinates were selected. In the first preliminary survey obtained from 338 middle managers, 10 factors and 69 items were selected for the communication competencies with superior and 8 factors and 54 items were obtained for the communication competencies with subordinate. In second preliminary survey obtained from 206 middle managers, 8 factors and 64 items for the communication competencies with superior and 7 factors and 45 items for the communication competencies with subordinate were obtained. To verify validity of the scale, the total sample was divided into two groups. Exploratory factor analyses were conducted for group 1, and a confirmatory factor analysis was conducted for the other group. The results showed that the exploratory factor analysis extracted 8 factors (persuasion, self-confidence, manner, listening, honesty, confirm, logicality, wisdom) and 52 items for the communication competencies with superior, and 7 factors (listening, humor, emotion regulation, modesty, non-verbal expression, consideration, clarity) and 37 items for the communication competencies with subordinate. In the confirmatory factor analysis using structural equation modeling, the models fit the data well. Also the communication competencies of the middle manager were significantly correlated with the criterion variables such as interpersonal relationship competencies and conflict management, and confirming criterion related validity of the scale. Finally, implications, limitatons and directions for future research were discussed.
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Koç, A., e K. Kizilkaya. "Some factors influencing milk somatic cell count of Holstein Friesian and Brown Swiss cows under the Mediterranean climatic conditions". Archives Animal Breeding 52, n. 2 (10 ottobre 2009): 124–33. http://dx.doi.org/10.5194/aab-52-124-2009.
Abstract (sommario):
Abstract. The aim of this study was to determine the influencing factors on somatic cell count (SCC) in the milk of Holstein Friesian (HF) and Brown Swiss (BS) cows raised on three dairy farms under the Mediterranean climatic conditions in Turkey. For a two-year period, farms were visited monthly to measure daily milk yield (DMY) and collect milk samples from each cow during the morning and evening milking. Total of 1 429 SCC readings from 67 HF and 16 BS cows were analyzed by using repeated measures. Breed (P<0.01), lactation number (LN) (P<0.01), milking time (MT) (P<0.05), lactation month (LM) (P<0.01) and the interactions of breed-LM (P<0.05), herd-LM (P<0.01) and LN-LM (P<0.01) effects on SCC were statistically significant as did the co-variable DMY effect (P<0.01). The effect of herd and herd-MT interactions on SCC were statistically insignificant (P>0.05). The SCC means for BS and HF cows were 5.464±0.060 (291 072 cells/ml) and 5.654±0.029 (450 817 cells/ml), respectively. The SCC mean for morning milking (338 065 cells/ml) was 25 850 cells/ml lower than that of evening milking. The LN4 had the highest SCC mean (490 908 cells/ml) and was statistically different from those of LN1 (P<0.01) and LN2 (P<0.05). The SCC level was the highest in the first LM (601 174 cells/ml) and this level then decreased in the later months. Possible reasons for the difference in SCC means between the breeds are different resistance mechanisms against mastitis, different morphological conformations of udders and different milk yields between these two breeds. The insignificant differences found among herds show the similarities of management, milking hygiene and barn conditions. In order to decrease SCC in milk and increase udder health, some precautions need to be taken like improving milking management, hygiene and barn conditions, milking the cow at uniform intervals, feeding the cows after the milking and applying a mastitis control program.
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Grassinger, Julia Maria, Andreas Floren, Tobias Müller, Argiñe Cerezo-Echevarria, Christoph Beitzinger, David Conrad, Katrin Törner, Marlies Staudacher e Heike Aupperle-Lellbach. "Digital Lesions in Dogs: A Statistical Breed Analysis of 2912 Cases". Veterinary Sciences 8, n. 7 (17 luglio 2021): 136. http://dx.doi.org/10.3390/vetsci8070136.
Abstract (sommario):
Breed predispositions to canine digital neoplasms are well known. However, there is currently no statistical analysis identifying the least affected breeds. To this end, 2912 canine amputated digits submitted from 2014–2019 to the Laboklin GmbH & Co. KG for routine diagnostics were statistically analyzed. The study population consisted of 155 different breeds (most common: 634 Mongrels, 411 Schnauzers, 197 Labrador Retrievers, 93 Golden Retrievers). Non-neoplastic processes were present in 1246 (43%), tumor-like lesions in 138 (5%), and neoplasms in 1528 cases (52%). Benign tumors (n = 335) were characterized by 217 subungual keratoacanthomas, 36 histiocytomas, 35 plasmacytomas, 16 papillomas, 12 melanocytomas, 9 sebaceous gland tumors, 6 lipomas, and 4 bone tumors. Malignant neoplasms (n = 1193) included 758 squamous cell carcinomas (SCC), 196 malignant melanomas (MM), 76 soft tissue sarcomas, 52 mast cell tumors, 37 non-specified sarcomas, 29 anaplastic neoplasms, 24 carcinomas, 20 bone tumors, and 1 histiocytic sarcoma. Predisposed breeds for SCC included the Schnauzer (log OR = 2.61), Briard (log OR = 1.78), Rottweiler (log OR = 1.54), Poodle (log OR = 1.40), and Dachshund (log OR = 1.30). Jack Russell Terriers (log OR = −2.95) were significantly less affected by SCC than Mongrels. Acral MM were significantly more frequent in Rottweilers (log OR = 1.88) and Labrador Retrievers (log OR = 1.09). In contrast, Dachshunds (log OR = −2.17), Jack Russell Terriers (log OR = −1.88), and Rhodesian Ridgebacks (log OR = −1.88) were rarely affected. This contrasted with the well-known predisposition of Dachshunds and Rhodesian Ridgebacks to oral and cutaneous melanocytic neoplasms. Further studies are needed to explain the underlying reasons for breed predisposition or “resistance” to the development of specific acral tumors and/or other sites.
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Al-Hilali, B. M. I., L. A. Hameed, M. A. Theyab, B. Balci, M. M. Rajab, S. S. Mohammed e S. A. Fadel. "Heavy metals removal using natural zeolite adsorption from Tigris river water at Samarra city (Iraq)". Naukovyi Visnyk Natsionalnoho Hirnychoho Universytetu, n. 6 (25 dicembre 2022): 112–16. http://dx.doi.org/10.33271/nvngu/2022-6/112.
Abstract (sommario):
Purpose. The current study was conducted to evaluate the heavy metals adsorption and sorption rate when removing them from water and processing it in the Tigris River in Samarra city, Salah El-deen, Iraq in 20212022 and evaluate the efficiency of zeolite for removing heavy metals, as well as to determine the high and low adsorption percentage from all heavy metals found in the river. Methodology. The study included the analysis and measurement of physical and chemical properties with low-cost natural processing with no side effects to reduce the heavy metal in the Tigris River. Finding. The results of the present study showed that the conductivity and turbidity of water decreased from 1596 to 727 c/cm, from 343 to 22 naphthalene unit (NTU), respectively, and turbidity decreased from 633 to 491 ml/L. The concentrations of biological dissolved oxygen, total suspended solid, and total dissolved solid increased, while those of preprocessing nitrates (12.2mg/l) differed significantly from the results of post processing (52 mg/l). Repetitive measurements showed good results for heavy metals such as Cr3+, Cd2+, Cu2+, Pb2+, Zn2+, Ni2+ and Co2+ with 16.3, 23.1, 6.3, 14.4, 8.1, 12.5 and 17.4 mg/l, respectively; the adsorption percentage was 81.6, 81.5, 86.7, 87.3, 76.4, 89.5 and 79.7%, respectively. Originality. The work showed the efficient processing of sewage water when treated with zeolite rocks powder being low cost and easy to use to adsorb heavy metals from water. Practical value. Zeolite as a powder ground in different sizes could be used as a layer in the filter that purifies the water to become a drinking water with low heavy metal concentrations as well as with some other factors.
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Acevedo-Godoy, M., S. J. Perdomo, W. Bautista-Molano, L. Chila, O. J. Calixto, J. M. Bello-Gualtero e C. Romero-Sánchez. "POS0137 FREQUENCIES OF WNT PATHWAY GENE VARIANTS ASSOCIATED WITH ANTI CARBAMYLATE PROTEIN IN EARLY RHEUMATOID ARTHRITIS". Annals of the Rheumatic Diseases 81, Suppl 1 (23 maggio 2022): 295.2–296. http://dx.doi.org/10.1136/annrheumdis-2022-eular.4219.
Abstract (sommario):
BackgroundIncreased bone resorption and impaired bone formation characterize the pathogenesis of rheumatoid arthritis (RA). Wnt/β-catenin pathway regulates osteoblast function. Since bone mineral density (BMD) and RA joint destruction are partially inherited, we studied the association of Dickkopf-1 (DKK-1), sclerostin (SOST), Kremen-1 and lipoprotein receptor-related protein-5 (LRP-5) genes single nucleotide polymorphisms (SNPs).ObjectivesTo establish the genotypic frequency of variants of the DKK-1 (rs1896368, rs1896367, rs1528873), SOST (rs6503475), Kremen-1 (rs132274) and LRP-5 (3736228) genes in patients with early RA (eRA) and first degree relative (FDR) with healthy controls (HC), and its association with autoimmunity profile.MethodsColombian individuals were matched by age and gender. Serological and clinical indices were measured. Variants associated with the Wnt pathway; DKK-1, SOST, LRP-5, and Kremen were analyzed using High Resolution Melting and confirmed by Sanger sequencing. A bivariate analysis was conducted in eRA and FDR. A logistic regression was performed.Results232 individuals were evaluated; 66 eRA patients, 50 FDR, and 116 HC. For eRA, 78.8% were female, with a median age 52 years (IQR: 38,8-56). Higher levels of CRP: 4,2 (IQR: 1,6-11,6), RF: 30,2 (IQR: 1,2-74,1), anti-CCP: 7,81 (IQR: 7,81-104,9) and anti-Carbamylate protein (CarP): 17,7 (IQR: 12,3-31,8) were observed.Among eRA, FDR, and HC genotypic frequencies are listed in Table 1, there were significant differences among DKK-1 rs1528873 GA and AA (p<001), Kremen GG and GA (p<0,001), and LRP5 GG and GA (p=0,038), and GG with AA (p=0,023). In haplotype analysis between eRA and HC for DKK-1 rs1896368 GA and LRP-5 AA (p=0,033) and for LRP5 GG and AA DKK-1 rs1528873 (p<0,001).Table 1.Population genotypic frequencieseRAFDRHCn(%)n(%)n(%)p value*DKK-1 rs189636727 (40,9)25 (50)57 (49,1)GG Native39 (59,1)25 (50)59 (50,9)0,528GA Homozygous4 (6,1)4 (8)8 (6,9)0,890AA Heterozygous23 (34,8)21 (42)49 (42,2)0,597DKK-1 rs189636859 (89,4)45 (90)98 (84,5)GG Native7 (10,6)5 (10)18 (15,5)0,543GA Homozygous30 (45,5)21 (42)54 (46,6)0,882AA Heterozygous29 (43,9)24 (48)44 (37,9)0,450DKK-1 rs152887325 (37,9)24 (48)59 (50,9)TT Native42 (62,1)26 (52)57 (49,1)0,233TG Homozygous24 (36,4)5 (10)6 (5,2)<0,001GG Heterozygous1 (1,5)19 (38)53 (45,7)<0,001SOST rs650347551 (77,3)35 (70)85 (73,3)GG Native15 (22,7)15 (30)31 (26,7)0,657GA Homozygous13 (19,7)9 (18)28 (25)0,580AA Heterozygous38 (57,6)26 (52)56 (48,3)0,488KREMEN rs13227462 (93,9)28 (56)102 (87,9)CC Native4 (6,1)22 (44)14 (12,1)<0,001CT Homozygous35 (53)6 (12)54 (46,5)<0,001TT Heterozygous27 (40,9)22 (44)48 (41,4)0,953LRP-5 rs373622823 (34,8)16 (32)22 (19)CC Native43 (65,2)34 (68)94 (81)0,038CT Homozygous3 (4,5)10 (20)3 (2,6)0,038TT Heterozygous20 (30,3)6 (12)19 (16,4)0,023In eRA SOST rs6503475 was associated with anti-CarP (AOR 3,4 [95%IC 1,1-10,8] p=0,037). LRP-5 with former smoking (AOR 8,6 [95%IC 2,0-36,4] p=0,004). Additionally, in patients with a combination of at least three SNPs with a lower frequency of anti-Carp peptide (AOR 0,09 [95%IC 0,012-0,608], p=0,014), meanwhile a combination of at least five SNPs with a higher frequency of anti-Carp (AOR 4,7 [95%IC 1,27-17,1] p=0,020) were observed. There were no differences in FDR group.ConclusionSignificant associations between Wnt pathway genes variants, haplotypes, and antibody profile could reinforce evidence to relation of high titters of anti-CarP with decreased BMD in eRA patients.AcknowledgementsHospital Militar Central - Universidad El BosquDisclosure of InterestsNone declared
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Benevolo, Giulia, Alessandra Iurlo, Gabriele Gugliotta, Alessia Tieghi, Gianluca Gaidano, Giuseppe Tagariello, Bruno Martino et al. "Patients with Unexplained Thrombosis Require a Prompt Investigation to Search a Chronic Myeloproliferative Neoplasm (MPN), Even If Platelet Count Is <600x109/L. Analysis on 129 Patients from Registro Italiano Trombocitemie (RIT)". Blood 126, n. 23 (3 dicembre 2015): 5181. http://dx.doi.org/10.1182/blood.v126.23.5181.5181.
Abstract (sommario):
Abstract Background In patients with Ph-negative MPN, a prior thrombosis (PrTh) occurs in around 1/5 of cases, with variable platelet (PLT) count and variable distance from diagnosis. Objective To investigate the influence of PLT count at PrTh on diagnostic and therapeutic approach in MPN patients. Material and methods We evaluated 129 MPN patients from RIT, reclassified according to WHO 2008 criteria as ET (n70), initial-primary myelofibrosis (n29), early-PV (n10), and unclassifiable-MPN (n20). Results Patients, 60 males and 69 females, showed following PrTh: 91(71%) major arterial (37 AMI, 4 angina, 24 stroke, and 26 TIA); 12(9%) minor arterial; 22(17%) major venous (8 DVT, 7 splanchnic, 4 cerebral sinus, 3 pulmonary embolism); and 4(3%) minor venous events. PrTh occurred at a median distance of 4.1 months (range 0.1-118) from MPN diagnosis. This distance was >24 months in 21(16%) patients. At occurrence of PrTh, median age was 58 years. PLT count (x109/L) had a median value of 661 (range 150-2200), and was ≤450, 451-600, 601-700, 701-1000, and >1000 in 15(12%), 35(27%), 26(20%), 43(33%), and 10(8%) patients, respectively. Median white blood cell (WBC) count was 9.0 x 109/L and median hematocrit (HCT) value was 46% in males, and 41% in females. Median time (months) from PrTh to diagnosis of MPN was higher (p0.004) in patients with lower PLT count (x 109/L): ≤450 (50.2), 451-600 (11.7), 601-700 (2.7), 701-1000 (1.8), and >1000 (1.4). After occurrence of PrTh, all patients received conventional anti-thrombotic treatment, but in 7(5.4%) patients 9 recurrent thrombosis were reported before MPN diagnosis (11/100 pt-years). At MPN diagnosis, clonality was documented in 101(78%) patients (JAK2 V617F mutation in 96 cases, 74%). The age was >60 years in 61(47%) patients. PLT count (x109/L) had a median value of 720 (166-2440), and was ≤450 (n 7, 5%), 451-600 (n 21, 16%), 601-700 (n 28, 22%), 701-1000 (n 58, 45%), >1000 (n15, 12%). WBC count (109/L) had a median value of 8.9, and was >10 in 40 (31%) cases. Median HCT level (%) was 45.6 in males and 42.1 in females. Cardiovascular risk factors (CVRF), comorbidities and symptoms were documented in 103(80%), 97(75%), and 57(44%) cases, respectively. Thrombotic risk (IPSET-Th) was high in 97.5%, and intermediate in 2.5% of cases. All 129 patients received anti-thrombotic drugs (low dose aspirin in 95% of cases) and, immediately after the diagnosis, they started a cytoreductive treatment (hydroxycarbamide 89%, anagrelide 8%, interferon-alpha 3%). Patients with a PLT count (x109/L) at PrTh ≤600(n 50), as compared with those with a PLT count >600(n 79), showed a longer median time to the MPN diagnosis (16.7 vs 2.0 months, p<0.001). No significant difference was found in the rate of: arterial PrTh (80% vs 79.7%, p0.97); recurrence of thrombosis before the diagnosis (8% vs 4%, p0.69); JAK2 V617F mutation (80% vs 71%, p0.29); age >60 years (52% vs 44%, p0.39); CVRF (82%vs79%, p0.63); WBC >10 x109/L (23% vs 39%, p0.07); HCT high level [>47% in males, >44% in females](28% vs 36%, p0.37), and high thrombotic risk [IPSET-Th] (96%vs99%, p0.56). During follow-up (median 7.9 years) they showed a higher incidence of thrombosis recurrence (30%vs15%, p0.04; 4.5 vs 1.7/100 pt-y, p<0.01) Conclusion Time to MPN diagnosis was significantly longer in patients with PLT count (x109/L) at PrTh ≤600 vs >600, and this time to diagnosis was characterized by a not negligible thrombosis recurrence. Moreover, during follow-up they showed a higher incidence of thrombosis recurrence. This analysis strongly suggests that a PLT count <600 or even <450 x109/L, in patients with unexplained thrombosis, deserves the search of a probable MPN, in order to promptly start cytoreductive treatment in addition to a conventional anti-thrombotic therapy. Disclosures Passamonti: Novartis: Consultancy, Honoraria, Speakers Bureau. Vannucchi:Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Novartis: Other: Research Funding paid to institution (University of Florence), Research Funding; Shire: Speakers Bureau; Baxalta: Membership on an entity's Board of Directors or advisory committees.
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Suarez Ferrer, C. J., F. Mesonero, B. Caballol, M. P. Ballester, I. Baston Rey, A. Castaño Garcia, J. Miranda Bautista et al. "P523 Effectiveness of biological treatments for inflammatory bowel disease in the elderly patients". Journal of Crohn's and Colitis 16, Supplement_1 (1 gennaio 2022): i478—i479. http://dx.doi.org/10.1093/ecco-jcc/jjab232.650.
Abstract (sommario):
Abstract Background Biological treatments used for the treatment of inflammatory bowel disease (IBD) have demonstrated their efficacy and safety, although these results were obtained from studies that mostly include young people generally included in clinical trials. The objective of our study is to assess the efficacy of these treatments in the elderly population in real life Methods Patients have been retrospectively included with established diagnosis of IBD aged 65 years or older at the time of initiating biological treatment(Infliximab, Adalimumab, Golimumab, Ustekinumab or Vedolizumab).Among the patients included, the clinical response (at the discretion of the researcher)after induction(around 12 weeks of treatment)and at 52 weeks was assessed.When that were available, the data related to endoscopic response at week 52 were collected(endoscopic activity was classified as moderate, mild or severe, according to the researcher) Results A total of 1090 patients were included(707 CD and 383 UC).The indication for biologic in our experience was lack of response to immunosuppressants(292, 27.1%), corticodependence(318, 29.5%), perianal disease(31, 2.9%), treatment for postoperative recurrence(76, 7.0%), severe corticorefractory ulcerative colitis(59, 5.5%), others(303, 28.1%).After induction, at approximately 12–14 weeks of treatment, 419(39.6%) were in clinical remission, 502(47.4%) had a response without remission, and 137 patients(12.9%) had no response.The percentages of remission with the different biologics were: infliximab 159 patients(42.6%), adalimumab 118 patients (38.4%), golimumab 9 patients(32.1%), ustekinumab 50(32.7%), vedolizumab 84(40.6%)(p = 0.3).At 52 weeks of treatment 442 patients(50.63%) clinical remission, 249 patients had a response (28.5%) and 53 patients had no response (6.1%). Before one year of treatment, 129 patients(14.8%) had suspended treatment due to ineffectiveness, being significantly higher(p <0.0001) for golimumab 9 patients(37.5%) compared to the rest of the biological treatments analyzed.We analyzed the percentages of clinical response to the different biological treatments, without identifying statistically significant differences between the remission rates: infliximab 160 (51.3%), adalimumab 131(50.9%), golimumab 10(41.7%), ustekinumab 49(44.9%) and vedolizumab 92(53.8%).In colonoscopy at 52 weeks(performed 218 patients), 35.8% endoscopic remission(78 patients), 32.1% mild activity(70 patients), 26.1% moderate activity(57 patients) and 6.0% severe activity(13 patients). Conclusion Biological drugs have response rates in elderly patients similar to those described in the general population. In our experience, golimumab was the drug that had to be discontinued most frequently due to ineffectiveness.
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Correa-Burrows, Paulina, Estela Blanco, Sheila Gahagan e Raquel Burrows. "Cardiometabolic health in adolescence and its association with educational outcomes". Journal of Epidemiology and Community Health 73, n. 12 (1 ottobre 2019): 1071–77. http://dx.doi.org/10.1136/jech-2019-212256.
Abstract (sommario):
AimTo explore the association of selected cardiometabolic biomarkers and metabolic syndrome (MetS) with educational outcomes in adolescents from Chile.MethodsOf 678 participants, 632 (52% males) met criteria for the study. At 16 years, waist circumference (WC), systolic blood pressure, triglycerides (TG), high-density lipoprotein and glucose were measured. A continuous cardiometabolic risk score (zMetS) using indicators of obesity, lipids, glucose and blood pressure was computed, with lower values denoting a healthier cardiometabolic profile. MetS was diagnosed with the International Diabetes Federation/American Heart Association/National Heart, Lung, and Blood Institute joint criteria. Data on high school (HS) graduation, grade point average (GPA), college examination rates and college test scores were collected. Data were analysed controlling for sociodemographic, lifestyle and educational confounders.ResultzMetS, WC, TG and homeostatic model assessment of insulin resistance at 16 years were negatively and significantly associated with the odds of completing HS and taking college exams. Notably, for a one-unit increase in zMetS, we found 52% (OR: 0.48, 95% CI 0.227 to 0.98) and 39% (OR: 0.61, 95% CI 0.28 to 0.93) reduction in the odds of HS completion and taking college exams, respectively. The odds of HS completion and taking college exams in participants with MetS were 37% (95% CI 0.14 to 0.98) and 33% (95% CI 0.15 to 0.79) that of participants with no cardiometabolic risk factors. Compared with adolescents with no risk factors, those with MetS had lower GPA (515 vs 461 points; p=0.002; Cohen’s d=0.55). Adolescents having the MetS had significantly lower odds of passing the mathematics exam for college compared with peers with no cardiometabolic risk factors (OR: 0.49; 95% CI 0.16 to 0.95).ConclusionIn Chilean adolescents, cardiometabolic health was associated with educational outcomes.
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Cabral, Norberto Luiz, Vivian Nagel, Adriana B. Conforto, Pedro SC Magalhaes, Vanessa G. Venancio, Juliana Safanelli, Felipe Ibiapina et al. "High five-year mortality rates of ischemic stroke subtypes: A prospective cohort study in Brazil". International Journal of Stroke 14, n. 5 (9 ottobre 2018): 491–99. http://dx.doi.org/10.1177/1747493018806197.
Abstract (sommario):
Background Studies regarding long-term outcomes of ischemic stroke subtypes are scarce in low- and middle-income countries. We aimed to measure the five-year prognosis of ischemic stroke subtypes in Joinville, Brazil. Methods All first-ever ischemic strokes that occurred in Joinville in 2010 were followed-up for five years. Results We included 334 ischemic stroke patients. Over five years, 156 died, 51 had a recurrent stroke, and 128 were free of recurrent stroke. The overall cumulative risk of death was 17% (95% CI, 13% to 22%) at 30 days and 47% (95% CI, 41% to 52%) after five years. Undetermined with incomplete investigation ischemic stroke had a significantly worse survival probability (β −4.91; 95% CI, −6.31 to −3.50; p < 0.001), followed by cardioembolic ischemic stroke (β −3.07; 95% CI, −4.32 to −1.83; p < 0.001) and large artery disease ischemic stroke (β −1.95; 95% CI, −3.30 to −0.60; p = 0.005). The survival probability of undetermined with negative investigation or cryptogenic ischemic stroke did not differ significantly from small artery disease ischemic stroke (β −1.022; 95% CI, −3.37 to −1.43; p = 0.414). The five-year mortality for small artery disease ischemic stroke was 30% (95% CI, 22% to 39%) and 47% (95% CI, 35% to 60%) for large artery ischemic stroke. The risk of stroke recurrence was 2% in the first year and 5% in the second year. The proportion of disability among survivors in the first month ranged from 8% (95% CI, 3–15) for small artery disease ischemic stroke to 40% (95% CI, 30–52) for cardioembolic ischemic stroke patients. Conclusions Cardioembolic and undetermined with incomplete investigation ischemic stroke sub-types have a poor long-term prognosis. An alarming finding was that our patients with both small and large artery ischemic stroke had higher five-year mortality rates compared with subjects from high-income countries.
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Piatkowski, Uwe, e Klemens Pütz. "Squid diet of emperor penguins (Aptenodytes forsteri) in the eastern Weddell Sea, Antarctica during late summer". Antarctic Science 6, n. 2 (giugno 1994): 241–47. http://dx.doi.org/10.1017/s0954102094000374.
Abstract (sommario):
The data presented provides new information on the distribution of Antarctic squids and on the summer diet of the emperor penguins. The diet of 58 adult emperor penguins (Aptenodytes forsteri) on the fast ice of the Drescher Inlet, Vestkapp Ice Shelf (72°52′S, 19°25′W) in the eastern Weddell Sea was investigated. Prey consisted principally of squid, fish, krill, amphipods and isopods. Squids were identified by the lower beaks and allometric equations were used to estimate the squid biomass represented. Beaks occurred in 93% of the stomach samples. Each sample contained a mean of 27 beaks (range 1–206). Ninety-two percent of the squids could be identified by the lower beaks and belonged to four families (Onychoteuthidae, Psychroteuthidae, Neoteuthidae and Gonatidae). The most abundant squid was Psychroteuthis glacialis which occurred in 52 samples with lower rostral lengths (LRL) ranging from 1.4–7.2 mm. Forty-five samples contained Alluroteuthis antarcticus (LRL range 1.8–5.8 mm), 17 Kondakovia longimana (LRL range 4–12.1 mm), and four Gonatus antarcticus (LRL range 4.1–6.1 mm). In terms of biomass K. longimana was the most important species taken by the penguins comprising 50% of total estimated squid wet mass (245348 g) in 1990 and 48% in 1992 (154873 g). However, if only fresh beaks were considered for estimations of squid consumption, i.e. beaks that have been accumulated for not longer than 5–6 days in the stomachs, squid diet was of minor importance. Then total squid wet mass accounted for only 4809 g in 1990 and 5445 g in 1992 which implies that one penguin took c.30 g squid d−1 with P. glacialis and A. antarcticus being the most important by mass. The prey composition suggests that emperor penguins take squid at the steep slope regions of the eastern Weddell Sea.
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Alom, Modar, Ilija Aleksic, Brian Ruhle, Peter Iannotta, Colin Okeefe, Vladimir Mouraviev, David Albala e Christopher Michael Pieczonka. "Accuracy of NaF PET/CT scan to detect bone metastases in CRPC." Journal of Clinical Oncology 32, n. 4_suppl (1 febbraio 2014): 186. http://dx.doi.org/10.1200/jco.2014.32.4_suppl.186.
Abstract (sommario):
186 Background: The current standard for imaging Castration Resistant Prostate Cancer (CRPC) is aimed at detecting metastatic lesions to the bones. However, discovery, validation, and implementation of new imaging modalities have fallen considerably behind that of new therapies for this population. Recent studies have shown the NaF PET/CT Scans are significantly more sensitive and accurate in detecting bone lesions than conventionally used Bone Scintigraphy with Technetium-99 (Tc-99). This study conducted retrospective analysis to compare the competence of these two methods for identifying bone metastases. Methods: We conducted a charts review of 613 patients being currently treated with androgen deprivation therapy (ADT) and identified 55 patients who obtained a Na18F PET/CT Scan. Results: The median age was 75.5 years with a range of 52-89, for our cohort. Of these 55 patients, 5 (11.9%) were determined to have metastasis with Tc-99 Bone Scintigraphy alone while 27 (49.1%) were determined to have metastases with NaF Scan (p<0.005). 8 (19%) patients had equivocal findings on Tc-99 Bone Scintigraphy. Therefore, for all of them we performed NaF scan to define a bone metastatic disease that demonstrated in 5 (62.5%) cases of these as having no bone involvement and 3(37.5%) as positive for bone lesions (Table). However, data of NaF scan also indicated 5(9%) patients as having equivocal findings for metastatic disease. Conclusions: According to our data, NaF is more sensitive for detecting bone lesions (11.9 vs. 49.1%). It was also able to delineating equivocal TC-99 Bone Scintigraphy findings, where it deemed 62.5% as negative and 37.5% as positive for bone lesions. NaF PET scan is a feasible option for CRPC for detecting bone metastases, early in disease progression. With coverage of this procedure by Medicare patients have more sensitive and specific tool for early diagnosis and monitoring of treatment of CRPC. [Table: see text]
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Raposo, M. R., V. Ivanov, I. Martínez, A. L. González, M. D. Piqueras, A. Busaileh, J. B. Murcia et al. "Alcohol and dual disorder. Paliperidone palmitate effectiveness". European Psychiatry 33, S1 (marzo 2016): S314—S315. http://dx.doi.org/10.1016/j.eurpsy.2016.01.1074.
Abstract (sommario):
IntroductionAlcohol use is a common behavior in most people in our society. A first episode of alcoholism can be fully recovered through specialized treatment and other protective factors and need not become a relapse later.ObjectivesWhether there are differences in alcohol use after 1, 3 and 6 months after the administration of paliperidone palmitate extended-release injectable suspension in a sample of patients.Material and methodsThis is a descriptive study that analyzed the differences observed with respect to alcohol use after administration of paliperidone palmitate in a sample of 98 patients attending in a Mental Health Centre, in the Unit for drug dependency to present pathology dual.ResultsThe percentage of alcohol use at baseline is 56.1% of the total sample.One month after treatment with paliperidone palmitate the percentage of use is reduced to 31.6%. At 3 months of treatment the reduction is more significant assuming only the 6.1% of the total sample. Finally after 6 months of treatment the percentage of patients maintaining alcohol use is 4.1%, which represents a 52% reduction compared to the initial rate of use.ConclusionsThe data reflect a 92% reduction in alcohol use after 6 months of the administration of paliperidone palmitate.We can say that paliperidone palmitate is effective in reducing alcohol use in patients with dual diagnosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Sellem, Baptiste, Basma Abdi, Minh Lê, Roland Tubiana, Marc-Antoine Valantin, Sophie Seang, Luminita Schneider et al. "Intermittent Bictegravir/Emtricitabine/Tenofovir Alafenamide Treatment Maintains High Level of Viral Suppression in Virally Suppressed People Living with HIV". Journal of Personalized Medicine 13, n. 4 (27 marzo 2023): 583. http://dx.doi.org/10.3390/jpm13040583.
Abstract (sommario):
In this observational study, we aimed to evaluate whether bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) administered 5 or 4 days a week is able to maintain viral suppression in people living with HIV (PLHIV). We enrolled 85 patients who initiated intermittent B/F/TAF between 28 November 2018 and 30 July 2020: median (IQR) age 52 years (46–59), duration of virological suppression 9 years (3–13), CD4 633/mm3 (461–781). Median follow-up was 101 weeks (82–111). The virological success rate (no virological failure [VF]: confirmed plasma viral load [pVL] ≥ 50 copies/mL, or single pVL ≥ 200 copies/mL, or ≥50 copies/mL with ART change) was 100% (95%CI 95.8–100) and the strategy success rate (pVL < 50 copies/mL with no ART regimen change) was 92.9% (95%CI 85.3–97.4) at W48. Two VF occurred at W49 and W70, in 2 patients self-reporting poor compliance. No resistance mutation emerged at time of VF. Eight patients presented strategy discontinuation for adverse events. There was no significant change in the CD4 count, residual viraemia rate, neither body weight during follow-up, but a slight increase in CD4/CD8 ratio (p = 0.02). In conclusion, our findings suggest that B/F/TAF administered 5 or 4 days a week could maintain the control of HIV replication in virologically suppressed PLHIV while reducing cumulative exposition of ART.
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Alvarez Santana, R. A., D. Garcia, J. Santana Peralta, A. Cornelio, T. Polanco Mora, L. Concepción Sanchez, I. Paulino et al. "AB0217 FREQUENCY OF SEXUAL DYSFUNCTION IN RHEUMATOID ARTHRITIS, SANTO DOMINGO, DOMINICAN REPUBLIC". Annals of the Rheumatic Diseases 81, Suppl 1 (23 maggio 2022): 1236.2–1237. http://dx.doi.org/10.1136/annrheumdis-2022-eular.4202.
Abstract (sommario):
BackgroundRheumatoid arthritis (RA) is an inflammatory, autoimmune systemic disease that affects the synovial membrane of small joints.1 Kamissoko et al found the frequency of sexual dysfunction in RA to be 69.2%.2 Pain is considered to have a fundamental role associated with the decrease in the frequency of sexual intercourse.3 The CSFQ-14 (Changes in Sexual Functioning Questionnaire), evaluates the changes in sexual functioning due to a disease and/or treatment in 5 domains with a score range of 14-70; cut-off point indicating sexual dysfunction <41 men and <47 women.4ObjectivesTo evaluate the frequency and degree of sexual dysfunction in patients with rheumatoid arthritis.MethodsProspective, observational, cross-sectional study of a cohort of patients of the Rheumatology Service at Hospital Docente Padre Billini. Patients were interviewed in July 2021. Inclusion criteria: > 18 years, diagnosis of RA according to the ACR/EULAR 2010 classification criteria, at least 1 sexual intercourse. Exclusion criteria: previous diagnosis of another autoimmune disease, depression, diabetes, treatment with antidepressants, antiepileptics, narcotics. Scales measured: CSFQ-14, DAS28. Statistical analysis was performed with the Pearson correlation (rp) with p>0.05. Data were analyzed in IBM-SPSS v23.ResultsOf the RA cohort, 483 met inclusion criteria. 93.4% (451) female, mean age 58±12.6 years, mean duration of diagnosis 8 years, married 53.8% (260), single 27.7% (134), widowed 16.6% (80), hypertension 73.9% (357), dyslipidemia 21.5% (104), obesity 18.0% (87), smoking 9.9% (48). Frequency of sexual dysfunction 61.3% (296). Sexual dysfunction in women 93.9% (278) and men 6.1% (18). Global domains: desire/interest 55.7% (165), desire/frequency 56.4% (167), pleasure 58.1% (172), arousal/excitement 67.2% (199), orgasm/completion 50.0% (148). Female: desire/interest 94.5% (156), desire/frequency 93.4% (156), pleasure 93.6% (161), arousal/excitement 93.0% (185), orgasm/completion 93.9% (139). Male: desire/interest 5.5% (9), desire/frequency 11.6% (11), pleasure 6.4% (11), arousal/excitement 7.0% (14), orgasm/completion 6.1% (9). Desire/interest dysfunction: DAS28 remission or low activity 28.5% (47), moderate 53.3% (88), high activity 4.8% (8). Desire/frequency: DAS28 remission or low activity 35.3% (59), moderate 47.3% (79), high activity 3.6% (6). Pleasure: DAS28 remission or low activity 30.2% (52), moderate 50.0% (86), high activity 2.9% (5). Arousal/excitement: DAS28 remission or low activity 25.1% (50), moderate 55.8% (111), high activity 6.0% (12). Orgasm/completion: DAS28 remission or low activity 43.2% (64), moderate 38.5% (57), high activity 6.1% (9).ConclusionThe study showed a high frequency of sexual dysfunction, observing greater dysfunction in females. In the population, the most affected global domain was arousal/excitement, and it was the most frequent in female and male.References[1]Gomero García, D., 2018. Artritis reumatoide, epidemiología, fisiopatología, criterios diagnósticos y tratamiento. Revista de Medicina e Investigación Universidad Autónoma del Estado de México, 6(2).[2]Kamissoko, A.B., Edikou, T.N.R., Barry, A., Sanda, M., Fofana, K., Irie, L.N.E., Diallo, M.L. and Oniankitan, O. (2021) Sexuality of Women with Rheumatoid Arthritis in a West African Hospital. Open Journal of Rheumatology and Autoimmune Diseases, 11, 152-159[3]Bay, L. et al. Sexual Health and Dysfunction in Patients With Rheumatoid Arthritis: A Cross-sectional Single-Center Study. Sexual Medicine, 8(4), pp.615-630.[4]Clayton AH, McGarvey EL, Clavet GJ. The Changes in Sexual Functioning Questionnaire (CSFQ): development, reliability, and validity. Psychopharmacol Bull. 1997;33(4):731-45. PMID: 9493486.Disclosure of InterestsNone declared
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Goldstein, Rebecca, Christine Karbowski, Anja Henn, Petra Deegen, Joachim Wahl, Katja Matthes, Christoph Dahlhoff et al. "Abstract 6313: Evaluation of a dual CD123-FLT3 BiTE molecule for acute myeloid leukemia". Cancer Research 82, n. 12_Supplement (15 giugno 2022): 6313. http://dx.doi.org/10.1158/1538-7445.am2022-6313.
Abstract (sommario):
Abstract Acute myeloid leukemia is a grievous illness. BiTE® (bispecific T cell engager) molecules redirect T cells by engaging CD3 and a tumor-associated antigen (TAA). These molecules have shown clinical efficacy but one mechanism of resistance is loss of a single TAA. We hypothesized that a BiTE® molecule targeting >1 TAA could reduce relapse frequency. FLT3 and CD123, were selected for a dual-targeting BiTE® (dBiTE࣪) molecule.A half-life extended (HLE) CD123-FLT3 dBiTE࣪ molecule was evaluated in vitro, in mouse xenografts, and in non-human primate (NHP) tolerability studies. The molecule had nM affinity for human and NHP FLT3, CD123, and CD3, and pM efficacy in cytotoxicity assays using human T cells or NHP PBMCs. The molecule achieved 100% killing against single-positive (sp) cells (CRISPR-generated isogenic cell lines) at potencies like those of double-positive (dp) cells (7.4 ±. 4.1 pM FLT3sp, 7.1 ±. 3.8 pM CD123sp and 3.4 ±. 1.5 pM dp, n=3). In a mouse xenograft model, the molecule induced significant activity and extended survival > 3 weeks (1.0, 0.1, and 0.01 mg/kg (p ≤ 0.001)). In mice with sp tumors, survival benefit could not be calculated due to high survival, demonstrating that both arms of the molecule are active. In NHP, the molecule had a half-life of 52 hours (0.3 or 3 µg/kg). FLT3 mRNA levels, a marker of FLT3-expressing cells, decreased in blood following dosing. Repeat dosing was not tolerated, and cytokine release was observed. Some cytokines were reduced while others increased. CD123 is reportedly expressed on endothelial cells (ECs), with increased expression in inflammatory conditions. An immunohistochemical survey found that CD123 is expressed on human and NHP monocyte/macrophages and ECs with limited distribution in lymphoid tissues and lamina propria of the gut. We hypothesized that cytokine release following administration may result in increased CD123 expression and in turn, further increased cytokine levels with repeat dosing. CD123 was detected on primary human umbilical vein ECs (HUVECs). In co-cultures of HUVECs and T cells, a CD123 BiTE® molecule induced expression of CD123 on HUVEC cells at concentrations that elicited redirected lysis (12.5 pM), T cell activation, and cytokine secretion. To better understand BiTE®-induced upregulation of CD123 on ECs, HUVECs were cultured with supernatants (SN) from a TDCC assay or recombinant IL-3, IL-6, TNFα, or IFNγ. Assay SN and TNFα induced >2-fold CD123 expression on HUVECs, but not on CD123-negative primary human pulmonary microvascular ECs. These data demonstrate that CD123 expression on ECs was increased upon exposure to a CD123 mono-targeting BiTE® molecule, potentially through BiTE®-induced secretion of TNFα. Additional studies are ongoing.In sum, a CD123-FLT3 HLE dBiTE࣪ molecule was active against both dp- and sp-positive target cells in vitro and in vivo. Careful selection of TAA for dBiTE࣪ molecules is necessary to increase efficacy and maintain safety. Citation Format: Rebecca Goldstein, Christine Karbowski, Anja Henn, Petra Deegen, Joachim Wahl, Katja Matthes, Christoph Dahlhoff, Brooke Rock, Sabrina Benchaar, Katie Hsu, Brandy Alexander, Matthias Friedrich, Joan Lane, Xiaoting Wang, Jonas Anlahr, Markus Muenz, Tobias Raum, Tara L. Arvedson. Evaluation of a dual CD123-FLT3 BiTE molecule for acute myeloid leukemia [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 6313.
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Sousa, Alana P., Silvia H. P. Alencar, Luisa M. Rebull, Catherine C. Espaillat, Nuria Calvet e Paula S. Teixeira. "A study of accretion and disk diagnostics in the NGC 2264 cluster". Astronomy & Astrophysics 629 (settembre 2019): A67. http://dx.doi.org/10.1051/0004-6361/201935563.
Abstract (sommario):
Context. Understanding disk dissipation is essential for studying how planets form. Disk gaps and holes, which almost correspond to dust-free regions, are inferred from infrared observations of T Tauri stars (TTS), indicating the existence of a transitional phase between thick accreting disks and debris disks. Transition disks are usually referred to as candidates for newly formed planets. Aims. We searched for transition disk candidates belonging to NGC 2264. Using stellar and disk parameters obtained in the observational multiwavelength campaign CSI 2264, we characterized accretion, disk, and stellar properties of transition disk candidates and compared them to systems with a full disk and diskless stars. Methods. We modeled the spectral energy distribution (SED) of a sample of 401 TTS, observed with both CFHT equipped with MegaCam and IRAC instrument on the Spitzer, with Hyperion SED fitting code using photometric data from the U band (0.3 μm) to the Spitzer/MIPS 24 μm band. We used the SED modeling to distinguish transition disk candidates, full disk systems, and diskless stars. Results. We classified ∼52% of the sample as full disk systems, ∼41% as diskless stars, and ∼7% of the systems as transition disk candidates, among which seven systems are new transition disk candidates belonging to the NGC 2264 cluster. The sample of transition disk candidates present dust in the inner disk similar to anemic disks, according to the αIRAC classification, which shows that anemic disk systems can be candidate transition disks. We show that the presence of a dust hole in the inner disk does not stop the accretion process since 82% of transition disk candidates accrete and show Hα, UV excess, and mass accretion rates at the same level as full disk systems. We estimate the inner hole sizes, ranging from 0.1 to 78 AU, for the sample of transition disk candidates. In only ∼18% of the transition disk candidates, the hole size could be explained by X-ray photoevaporation from stellar radiation.
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Montroni, Isacco, Giampaolo Ugolini, Antonino Spinelli, Giorgio Ercolani, Michael T. Jacklitsh, Siri Rostoft, Ponnandai Sadasivan Somasundar et al. "Outcomes that matter to patients: The Geriatric Oncology Surgical Assessment and Functional rEcovery after Surgery (GOSAFE) study—Analysis of 471 patients." Journal of Clinical Oncology 37, n. 15_suppl (20 maggio 2019): 11511. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.11511.
Abstract (sommario):
11511 Background: Older cancer patients value functional outcomes as much as survival but surgical studies lack functional recovery (FR) data. The international, multicenter GOSAFE study (ClinicalTrials.gov NCT03299270) aims to evaluate patients’ quality of life (QoL)and FR after cancer surgery and to assess predictors of FR. Methods: GOSAFE prospectively collects functional and clinical data before and after major elective cancer surgery on senior adults (≥70 years). Surgical outcomes are recorded (30 days, 90 days, and 180 dayspost-operatively) with QoL(EQ-5D-3L) and FR (Activities of Daily Living (ADL) + Timed Up and Go (TUG) + MiniCog), 28centers are prospectively enrolling patients; accrual ends February 2019. Results: 643 patients underwent major cancer surgery with curative(94%) or palliative (6%) intent (February 2017-September 2018). Median age was 78(range 70-94); 51.6% males, ASA III-IV 52%. Patients dependent (ADL < 5) were 8%. Frailty was detected by G8 > 14 in 32% and fTRST≥2 in 36% of patients. 639 (99%) lived at home, 32% lived alone, and 88% were able to go out. Major comorbidities (CCI > 6) were detected in 36% and 22% had cognitive impairment according to MiniCog (5% self-reported). 26% had > 3 kg weight loss, 30% were hospitalized in the last 90 days, 45% had ≥3 medications (6% none). For 471 patients, a 90-day comprehensive evaluation was available. Postoperative morbidity was 42% (30 day) and 63.3% (90 day), but Clavien-Dindo III-IV complications were only 11.2% and 17.6%. 90-day mortality was 7.4% (5% 30-day). QoL improved 90 days after surgery (mean EQ-5D index from 0.76 to 0.80). Patients with EQ-5D VAS score > 60 raised from 73.9% at baseline to 82.8% at 90 days. 29% had complete FR (ADL score > 4, MiniCog > 2, TUG < 20). Decreased functional capacity was seen in 23.4% of patients alive at 90-days. Conclusions: GOSAFE is the largest prospective study on older cancer patients undergoing major surgery. Interim analysis reports decreased functional capacity in a quarter of patients. The study will allow clinicians to associate clinical outcomes with individual factors of the preoperative assessment and create a user-friendly tool to predict outcomes that matter to patients.
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Fanchini, Maurizio, Ivan Ferraresi, Roberto Modena, Federico Schena, Aaron J. Coutts e Franco M. Impellizzeri. "Use of the CR100 Scale for Session Rating of Perceived Exertion in Soccer and Its Interchangeability With the CR10". International Journal of Sports Physiology and Performance 11, n. 3 (aprile 2016): 388–92. http://dx.doi.org/10.1123/ijspp.2015-0273.
Abstract (sommario):
Purpose:To examine the construct validity of the session rating perceived exertion (s-RPE) assessed with the Borg CR100 scale to measure training loads in elite soccer and to examine if the CR100 is interchangeable and can provide more-accurate ratings than the CR10 scale.Methods:Two studies were conducted. The validity of the CR100 was determined in 19 elite soccer players (age 28 ± 6 y, height 180 ± 7 cm, body mass 77 ± 6 kg) during training sessions through correlations with the Edwards heart-rate method (study 1). The interchangeability with CR10 was assessed in 78 soccer players (age 19.3 ± 4.1 y, height 178 ± 5.9 cm, body mass 71.4 ± 6.1 kg) through the Bland–Altman method and correlations between change scores in different sessions. To examine whether the CR100 is more finely graded than the CR10, the proportions of responses corresponding to the verbal expressions were calculated (study 2).Results:Individual correlations between the Edwards method and s-RPE were large to very large (.52–.85). The mean difference between the 2 scales was –0.3 ± 0.33 AU (90% CI –0.41 to –0.29) with 95% limits of agreements (0.31 to –0.96 AU). Correlations between scales and between-changes scores were nearly perfect (.95 and .91–.98). Ratings corresponding to the verbal anchors were 49% in CR10 and 26% in CR100.Conclusions:The CR100 is valid for assessing the training load in elite soccer players. It can be used interchangeably with the CR10 and may provide more-precise measures of exercise intensity.
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Gupta, Abha A., Elizabeth Lyden, James Robert Anderson, Carola A. S. Arndt, David Anthony Rodeberg, Jeff M. Michalski, David Parham, William H. Meyer, Douglas S. Hawkins e Brenda Weigel. "Patterns of toxicities and outcome in children versus adolescents/young adults (AYA) with metastatic rhabdomyosarcoma (RMS): A report from the Children’s Oncology Group (COG) Soft Tissue Sarcoma Committee." Journal of Clinical Oncology 31, n. 15_suppl (20 maggio 2013): 10554. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.10554.
Abstract (sommario):
10554 Background: Age at diagnosis is a prognostic factor in patients with RMS. We sought to determine whether AYA with metastatic alveolar (ARMS) or embryonal (ERMS) RMS had a different failure-free survival (FFS) compared to younger patients, and to identify treatment related factors that may be associated with outcome. Methods: COG ARST0431 patients were reviewed. The incidence of toxicities (AE, grade3/4 using CTCAEv3) by age was determined in 4 reporting periods (RP: wks 1-6; RP2:7-19; RP3: 20-34; RP4: 35-54). The AEs in younger patients (<=13 years) were compared with those in AYA. Fisher’s exact test was used to compare differences between the groups. Results: Of 109 patients, 60 (55%) were AYA. In RP1, they were more likely to have nausea/vomiting (4.1 vs. 16.9%, p=0.06), pain (6.1 vs. 20.3%, p=0.05), and metabolic disturbances (4.1 vs. 20.3%, p=0.02) compared to younger patients. In RP4, older patients trended to have less infection (15.8 vs. 30.1, p=0.07). All other toxicities were similar between the two age cohorts in the other RPs. AYA were less likely to complete therapy (52 vs. 73%, p=0.03) and more likely (in RP 4) to have unplanned dose modifications (outside of protocol guidelines) (23 vs. 2.7%). Of patients that completed therapy, there was no age-related difference in the time to completion. As shown in the table, younger patients had better 3-yr FFS, driven by a lower FFS for AYA with ARMS. Conclusions: This evaluation suggests that AYA with RMS were less likely to complete therapy and experienced a higher prevalence of pain and nausea compared to younger patients; the role of reporting bias and reasons for treatment discontinuation need further study. Children were more likely than AYA to have infection. Inferior FFS was only seen in AYA with ARMS suggesting a clear need for novel therapies for these patients. This study may be underpowered to demonstrate significant differences in other toxicities or in FFS among ERMS patients. [Table: see text]
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Scheepers, L., Y. Yang, Y. Chen e G. Jones. "POS0842 GLUCOCORTICOID USAGE AFTER JANUS KINASE INHIBITOR (JAKI) AND OTHER BIOLOGIC DMARDS INITIATION AND IMPACT OF COMEDICATION OF CONVENTIONAL DMARDS ON TREATMENT PERSISTENCE IN RHEUMATOID ARTHRITIS PATIENTS: RETROSPECTIVE STUDY IN THE AUSTRALIAN POPULATION". Annals of the Rheumatic Diseases 82, Suppl 1 (30 maggio 2023): 719–20. http://dx.doi.org/10.1136/annrheumdis-2023-eular.1240.
Abstract (sommario):
BackgroundJanus Kinase inhibitors (JAKi) and biologic disease modifying anti-rheumatic drugs (bDMARDs) are routinely used in the management of rheumatoid arthritis (RA) patients for whom conventional (c)DMARDs have failed. The usage of glucocorticoids after DMARD initiation and the influence of comedication on treatment persistence, used as a surrogate for treatment effectiveness, remains unkown.ObjectivesTo assess glucocorticoids usage after treatment initiation and to compare the impact of comedication on the persistence of JAKi and bDMARDs in Australian RA patients.MethodsA retrospective observational study was conducted among 4,521 RA patients in the Australian Medicare Database (from 2011 to 2022), aged ≥18 and for whom a JAKi or bDMARDs were dispensed. A deidentified 10% sample of the database was taken as a random representation of RA patients in Australia. Kaplan-Meier analysis was used to calculate drug persistence rates, defined as the time from treatment initiation until the date of the last dose when there had not been a script dispensed for 6 months. Wilcoxon Singed Rank test was used to compare glucocorticoid dose changes from 1-year prior to 1 and 1 – 2 years after initiation of the DMARDs. Only patients who had persisted on DMARDs for 2 years were included for analysis. Log-rank test was used to compare time on a particular DMARDs treatment between the following sub-groups: (a) monotherapy; (b) combination MTX; and (c) combination cDMARDs.ResultsA total of 634 met the inclusion criteria for the glucocorticoids analyses, average dose of glucocorticoids decreased from 4.1 mg/day at 1 year prior to initiation of DMARD, to 2.9 mg/day and 2.0 mg/ day at 1- and 1–2-years post-initiation, respectively (Figure 1). Daily dose changes were statistically significant for all RA DMARDs combined, tofacitinib and baricitinib combined (1–2 years post initiation only), TNFi, abatacept, and tocilizumab. The proportion of patients with a decrease in glucocorticoids dose from 1 year prior to 1 and 1–2 years after DMARD initiation was 62% and 70% for ‘all DMARDs’ (n=634), 35% and 52% for baricitinib (n=23), 58% and 63% for tofacitinib, 59% and 61% for abatacept (n=87), 65% and 78% for tocilizumab (n=148), and 62% and 70% for TNFi (n=387), respectively.For each drug individually, treatment persistence rates were higher in combination with MTX and in combination with other cDMARDs, compared to monotherapy (Table 1). Statistical significance was only reached when comparing baricitinib combined with cDMARD to monotherapy baricitinib (65% [p=0.04]vs52%), tofacitinib combined with MTX and combined with other cDMARDs to monotherapy tofacitinib (56% [p=<0.01] and 55% [p=<0.01] vs. 45%); and TNFi combined with MTX and combined with other cDMARDs to monotherapy TNFi (63% [p=<0.0001] and 65% [p=<0.0001] vs. 43%).ConclusionThis real-world data showed that among Australian RA patients glucocorticoids dosage decreased with JAKi and bDMARD use. When treatment was combined with MTX or other cDMARDs persistence rates were not sig. different when comparing upadacitinib, baricitinib and TNFi. Tofacitinib had similar persistence rates to TNFi.Average daily glucocorticoids usage.Figure 1.Table 1.Persistence rates at 12 months post-initiation, based on KM-estimatesAllMonotherapyCombination methotrexateCombination cDMARDnEstimate95% CInEstimate95% CInEstimate95% CInEstimate95% CIBaricitinib55361%(58 – 67)8652%(44 – 65)19964%(58 – 72)37365%(61 – 71)Tofacitinib123053%(68 – 76)16145%(38 – 54)48056%(52 – 61)81355%(52 – 59)Upadacitinib57472%(68 – 76)7870%(60 – 82)23675%(69 – 81)37174%(70 – 79)Abatacept94149%(46 – 53)16544%(38 – 53)42149%(45 – 55)67149%(47 – 55)Tocilizumab113955%(54 – 60)27352%(47 – 59)42356%(52 – 62)74858%(57 – 64)TNFi*350158%(57 – 61)89943%(41 – 48)138163%(62 – 67)216965%(63 – 67)* Subcutaneous anti-tumor necrosis factor, including adalimumab, certolizumab, etanercept, and golimumabAcknowledgementsL. Scheepers receives funding from The Farrell Family Foundation.Disclosure of InterestsLieke Scheepers Grant/research support from: ASPIRE Grant 2020, Pfizer, Employee of: AstraZeneca 2017 till 2020, Yifei Yang: None declared, Yi Chen: None declared, Graeme Jones: None declared.
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Hassan, Fayyaz, Khalil Ahmad, Saeed Bin Ayaz e Heyyan Bin Khalil. "SPECTRUM OF FINDINGS IN PATIENTS PRESENTING FOR UPPER GASTROINTESTINAL ENDOSCOPY AT A TERTIARY CARE HOSPITAL AND THE INFLUENCE OF AGE AND GENDER". PAFMJ 71, n. 3 (29 giugno 2021): 744–48. http://dx.doi.org/10.51253/pafmj.v71i3.2940.
Abstract (sommario):
Objective: To determine the spectrum of findings in patients presenting for upper gastrointestinal (UGI) endoscopy and investigate role of age and gender.
Study Design: Cross-sectional study.
Place and Duration of Study: Department of Gastroenterology & Internal Medicine, Combined Military Hospital Kharian, from Jul 2017 to Mar 2019.
Methodology: The data regarding 638 consecutive patients who underwent upper gastrointestinal endoscopy in the department were collected from the computer-based database and patients were stratified into two groups according to their age: ≤50 and >50 years.
Results: The mean age was 50.2 ± 17.4 (range: 7-100) years. There were 431 males and 207 females. The commonest presenting complaint was decompensated chronic liver disease (CLD) 162 (25.4%). The upper gastrointestinal endoscopy was normal in 306 (48%) and abnormal in 332 (52%) patients. The commonest abnormality seen on upper gastrointestinal endoscopy was esophageal varices seen in 167 (26.2%) followed by non-specific gastropathy, and hiatal hernia seen in 28 (4.4%) and 21 (3.3%) patients respectively. No significant differences were observed among males and females for a positive upper gastrointestinal endoscopy. Significantly large number of patients of age >50 years had an abnormal upper gastrointestinal endoscopy (p<0.001). The commonest upper gastrointestinal endoscopic abnormalities were similar in both genders and age-groups.
Conclusion: The commonest finding on upper gastrointestinal endoscopy were esophageal varices and non-specific gastropathies. Females and patients ≤50 years had a higher prevalence of a normal upper gastrointestinal endoscopy. The commonly observed upper gastrointestinal endoscopy findings were generally similar among the genders and the age-groups.
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Gulle, S., Y. Erez, A. Karakas, T. Yüce İnel, S. B. Kocaer, T. Demirci Yildirim, G. Can, İ. Sari, M. Birlik e F. Onen. "AB0708 HIGH DRUG RETENTION RATES DESPITE B/TSDMARD INTERRUPTIONS IN COVID-19 PANDEMIC CHAOS". Annals of the Rheumatic Diseases 80, Suppl 1 (19 maggio 2021): 1386.1–1386. http://dx.doi.org/10.1136/annrheumdis-2021-eular.4068.
Abstract (sommario):
Background:A significant increased risk of COVID-19 related adverse outcomes of the biological or target-directed synthetic DMARDs (b/tsDMARDs) has not yet been reported. For this reason, it is recommended to continue b/tsDMARD treatments with maximum compliance with pandemic measures.Objectives:The aim of this study was to evaluate the effects of patients using b/tsDMARDs on drug survival and rheumatic disease control during pandemic.Methods:In this study, patients diagnosed with rheumatic disease using b/tsDMARDs and who were followed up during the 12-month period (January 2020-2021) including the onset of the Covid-19 pandemic at Dokuz Eylul University Faculty of Medicine Rheumatology Clinic were evaluated. In the first 3 months of the pandemic (March-June 2020), the patients skipped at least 2 cycles of treatment with the fear of Covid-19 infection except for infection / surgical reasons was considered as a disruption of the drug. The drug retention rates of the patients on b/tsDMARDs treatments during the pandemic process and the factors affecting this situation were evaluated.Results:The rate of disrupting their b/tsDMARDs was higher in patients> 65 years of age, with a diagnosis of RA and who needed to come to the hospital for bDMARD treatment (p=0.007, p=0.015 and p=0.004, respectively).The overall 1-year b/tsDMARD retention rates was found 91%. It was determined that a history of interruption in b/tsDMARD treatments in the first 3 months of the pandemic [OR: 1.28 (CI: 1.042-8.71), p=0.014] and the need to come to the hospital to receive bDMARD [OR: 0.59 (CI: 0.64-13.11), p=0.041] caused unresponsiveness to return to the same bDMARD treatment and a significant increase in the risk of discontinuation of the biologic treatment.Conclusion:We conclude that it is important for patients to continue taking b/tsDMARD treatments without interruption in the days past abnormal periods such as pandemic conditions and to make sufficient effort for minimum dose of CS and low disease activity by determining patient-based risk.Table 1.Demographic and clinical characteristics of b/tsDMARDs patientsTotal (n=521)b/tsDMARD Continue (n=424) (82.4%)b/tsDMARD Interruption (+) (n=97) (17.6%)PMedian (Min./Max.)Median (Min./Max.)Median (Min./Max.)Age, years48 (18/86)47 (18/82)52 (21/81)0.008tDisease Duration, years11,2 (2/43.3)130 (22/490)142 (22/519)0.41tb/ts DMARD Duration, months40 (12/192)40 (12/192)40 (12/156)0.176tn (%)n (%)n (%)Female278 (53.4)225 (53.1)53 (54.6)0.826Most common rheumatic diseases AxSpa or other SpA283 (54.3)232 (54.7)51 (52.6)0.737 RA134 (25.7)100 (23.6)34 (35.1)0.015l PsA44 (8.4)40 (9.4)4 (4.1)0.109 Vasculitis32 (6.1)27 (6.4)5 (5.2)0.817 Others28 (5.4)25 (5.9)3 (3.1)0.338b/tsDMARD at Hospital/Health center140 (26.9)102 (24.1)38 (39.2)0.004l(OR: 0.59)b/tsDMARD administration route (IV)137 (26.3)100 (23.6)37 (38.1)0.005lActive/Progressive Disease92 (17.7)14 (3.3)78 (80.4)<0.001l(OR: 4.8)Start/continue with the same b/tsDMARD55 (10.6)3 (0.7)52 (53.6)<0.001pUnresponsiveness, b/tsDMARD switch16 (3.1)9 (2.1)7 (7.2)0.017pb/tsDMARD stopped permanently/deceased29 (5.6)9 (2.1)20 (20.6)<0.001ffb/tsDMARD retention (Total)474 (91)406 (95.8)68 (70.1)<0.001tIndependent Samples t Test (Bootstrap), pPearson Chi-Square Test (Monte Carlo), ffFisher freeman Halton Test (Monte Carlo), lLinear-by-Linear Association Test(Monte Carlo, Exact), SD.: Standard deviation; * OR, Odds Ratio,Disclosure of Interests:None declared
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Jalali, Farzad, Farbod Hatami, Mehrdad Saravi, Iraj Jafaripour, Mohammad Taghi Hedayati, Kamyar Amin, Roghayeh Pourkia et al. "Characteristics and outcomes of hospitalized patients with cardiovascular complications of COVID-19". Journal of Cardiovascular and Thoracic Research 13, n. 4 (6 dicembre 2021): 355–63. http://dx.doi.org/10.34172/jcvtr.2021.53.
Abstract (sommario):
Introduction: To address cardiovascular (CV) complications and their relationship to clinical outcomes in hospitalized patients with COVID-19. Methods: A total of 196 hospitalized patients with COVID-19 were enrolled in this retrospective single-center cohort study from September 10, 2020, to December 10, 2020, with a median age of 65 years (IQR, 52-77). Follow-up continued for 3 months after hospital discharge. Results: CV complication was observed in 54 (27.6%) patients, with arrhythmia being the most prevalent (14.8%) followed by myocarditis, acute coronary syndromes, ST-elevation myocardial infarction, cerebrovascular accident, and deep vein thrombosis in 15 (7.7%), 12 (6.1%), 10(5.1%), 8 (4.1%), and 4 (2%) patients, respectively. The proportion of patients with elevated high-sensitivity troponin I, N-terminal pro-B-type natriuretic peptide, left ventricular diastolic dysfunction, and heart failure with preserved ejection fraction was greater in the CV complication group. Severe forms of COVID-19 comprised nearly two-thirds (64.3%) of our study population and constituted a significantly higher share of the CV complication group members (75.9%vs 59.9%; P=0.036). Intensive care unit admission (64.8% vs 44.4%; P=0.011) and stay (5.5days vs 0 day; P=0.032) were notably higher in patients with CV complications. Among 196patients, 50 died during hospitalization and 10 died after discharge, yielding all-cause mortality of 30.8%. However, there were no between-group differences concerning mortality. Age, heart failure, cancer/autoimmune disease, disease severity, interferon beta-1a, and arrhythmia were the independent predictors of all-cause mortality during and after hospitalization. Conclusion: CV complications occurred widely among COVID-19 patients. Moreover,arrhythmia, as the most common complication, was associated with increased mortality.
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Fasoranti, Zarek, Alexander Enrique, Katie Hunzinger, Kelsey Bryk, Thomas Kaminski e Thomas A. Buckley. "Concussion History Does Not Adversely Affect Trail Making Test Performance". Neurology 95, n. 20 Supplement 1 (16 novembre 2020): S12.2—S12. http://dx.doi.org/10.1212/01.wnl.0000719984.77986.de.
Abstract (sommario):
ObjectiveTo determine the effect of concussion history on the electronic version of the Trail Making Test (TMT) A and TMT-B performance.BackgroundThe effects of concussion history on cognitive performance when the individual is still young has received limited attention. There are inconsistent results in prior studies using computerized neurocognitive tests however the TMT assesses divergent neurologic systems including working memory, horizontal and vertical saccades, attention, cognitive processing, and executive function. While the TMT has routinely identified deficits acutely post-concussion, the long-term effect of prior concussions has not been established.Design/MethodsThis study utilized a cross-sectional design of 50 current intercollegiate division I athletes (56% female, age: 19.8 ± 1.3 y.o.). Participants completed a reliable concussion history questionnaire as well as the TMT-A and TMT-B on an iPad at baseline. The independent variable was concussion history and the dependent variables were total time on TMT-A and TMT-B which were compared by independent samples t-tests or Mann-Whitney U test.ResultsOf the 50 student athletes 26 (52%) reported at least one previously diagnosed concussion. There was no significant difference between groups for the TMT-A (No prior concussion: 22.9 + 6.1 sec and Concussion history: 19.7 + 4.1, U = 227.0, p = 0.10) or TMT-B (No prior concussion: 42.1 + 13.2 sec and concussion history: 38.1 + 11.3, t = 1.17, p = 0.25).ConclusionsThe results of this study suggest that while still in college, a history of one or more prior concussions, did not adversely affect neurocognitive performance on either the TMT-A or B test. As concussion history is sometimes associated with later life neurocognitive performance, future studies should assess TMT-A and B across the lifespan.
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Tomita, Kosei, Rinko Akamine, Kazuya Morino, Mami Kusaka e Masayuki Akimoto. "Short-Term Postoperative Outcome of Baerveldt Glaucoma Implant with Two Tubes Inserted into the Vitreous Cavity". Surgeries 3, n. 4 (19 novembre 2022): 323–33. http://dx.doi.org/10.3390/surgeries3040035.
Abstract (sommario):
Here, we report a new surgical technique designed to increase filtration volume and reduce intraocular pressure (IOP) in glaucoma and its one-year outcome. Two tubes were created from a single Baerveldt glaucoma implant (BI) by folding the tube in a U-shape and incising only the outer edge of the stretched loop tip. The tubes were placed into the vitreous cavity via the pars plana through a long scleral tunnel, without a scleral valve or graft patch. Twenty eyes of 18 patients with neovascular glaucoma were included. This technique was performed in 10 eyes of 10 patients (double group), and outcomes were compared to 10 eyes of eight patients in which a single tube BI was inserted (single group). The primary outcome measures included IOP, supplemental medical therapy score (SMTS), and intraoperative and postoperative complications before and after surgery at 12 months. The mean IOP (SMTS) were 32.0 ± 11.33 mmHg (4.1) in the double group and 29.7 ± 6.31 mmHg (5.7) in the single group, preoperatively reduced to 11.8 ± 2.70 mmHg (0.2) (63% reduction, p < 0.004) and 14.2 ± 4.05 mmHg (1.1) (52% reduction, p < 0.002) after 12 months, respectively. SMTS showed 95% (p = 0.005) and 89% (p = 0.005) reductions, respectively. Although there was no significant difference in IOP between the two groups at 12 months (p = 0.16), there were significant differences in the SMTS between the two groups before, and 6 and 12 months after, surgery (p = 0.01, 0.04 and 0.04, respectively). A reduction in the SMTS suggests that increasing filtration volume by placing two tubes has the potential to further reduce IOP as compared with a single tube.
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Tummala, Raj, Gabriel Abreu, Lilia Pineda, M. Alex Michaels, Rubana N. Kalyani, Richard A. Furie e Eric F. Morand. "Safety profile of anifrolumab in patients with active SLE: an integrated analysis of phase II and III trials". Lupus Science & Medicine 8, n. 1 (febbraio 2021): e000464. http://dx.doi.org/10.1136/lupus-2020-000464.
Abstract (sommario):
ObjectiveIn phase II and III trials, anifrolumab, a human monoclonal antibody that binds type I interferon receptor subunit 1, has shown efficacy in adults with moderate to severe SLE. We evaluated the safety and tolerability of anifrolumab using data pooled from these trials to more precisely estimate the rate and severity of adverse events (AEs).MethodsData were pooled from patients receiving monthly intravenous anifrolumab 300 mg or placebo in MUSE, TULIP-1 and TULIP-2. Key safety endpoints included percentages and exposure-adjusted incidence rates (EAIRs) of patients who experienced AEs, serious AEs (SAEs), AEs leading to discontinuation and AEs of special interest.ResultsDuring treatment, 86.9% of patients receiving anifrolumab 300 mg (n=459) experienced AEs (≥1) versus 79.4% receiving placebo (n=466), and 4.1% versus 5.2% experienced an AE leading to discontinuation of investigational product. SAEs (≥1) were experienced by 11.8% and 16.7% of patients receiving anifrolumab and placebo, respectively (EAIR risk difference (95% CI) −7.2 (−12.5 to –1.9)), including lupus exacerbations classified as SAEs (1.5% and 3%, respectively). Infections occurred in 69.7% and 55.4% of patients receiving anifrolumab and placebo, respectively; difference in reported rates was driven by herpes zoster (HZ) and mild and moderate respiratory (excluding pneumonia) infections. The risk of HZ was increased with anifrolumab versus placebo (6.1% vs 1.3%, respectively; EAIR risk difference (95% CI) 5.4 (2.8 to 8.4)); most HZ events were mild or moderate, cutaneous and resolved without treatment discontinuation. Serious infections occurred in 4.8% and 5.6% of patients receiving anifrolumab and placebo, respectively.ConclusionsIn this pooled analysis of 925 patients with moderate to severe SLE, monthly intravenous anifrolumab 300 mg was generally well tolerated over 52 weeks with an acceptable safety profile. Anifrolumab was associated with an increased incidence of HZ and respiratory tract infections and lower reported rate of SLE worsening as SAEs.
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Ulrich, Silvia, Stéphanie Saxer, Michael Furian, Patrick R. Bader, Paula Appenzeller, Philipp M. Scheiwiller, Maamed Mademilov et al. "Pulmonary haemodynamic response to exercise in highlanders versus lowlanders". ERJ Open Research 7, n. 2 (4 febbraio 2021): 00937–2020. http://dx.doi.org/10.1183/23120541.00937-2020.
Abstract (sommario):
The aim of the study was to investigate the pulmonary haemodynamic response to exercise in Central Asian high- and lowlanders.This was a cross-sectional study in Central Asian highlanders (living >2500 m) compared with lowlanders (living <800 m), assessing cardiac function, including tricuspid regurgitation pressure gradient (TRPG), cardiac index and tricuspid annular plane systolic excursion (TAPSE) by echocardiography combined with heart rate and oxygen saturation measured by pulse oximetry (SpO2) during submaximal stepwise cycle exercise (10 W increase per 3 min) at their altitude of residence (at 760 m or 3250 m, respectively).52 highlanders (26 females; aged 47.9±10.7 years; body mass index (BMI) 26.7±4.6 kg·m−2; heart rate 75±11 beats·min−1; SpO2 91±5%;) and 22 lowlanders (eight females; age 42.3±8.0 years; BMI 26.9±4.1 kg·m−2; heart rate 68±7 beats·min−1; SpO2 96±1%) were studied. Highlanders had a lower resting SpO2 compared to lowlanders but change during exercise was similar between groups (highlanders versus lowlanders −1.4±2.9% versus −0.4±1.1%, respectively, p=0.133). Highlanders had a significantly elevated TRPG and exercise-induced increase was significantly higher (13.6±10.5 mmHg versus 6.1±4.8 mmHg, difference 7.5 (2.8 to 12.2) mmHg; p=0.002), whereas cardiac index increase was slightly lower in highlanders (2.02±0.89 L·min−1versus 1.78±0.61 L·min−1, difference 0.24 (−0.13 to 0.61) L·min−1; p=0.206) resulting in a significantly steeper pressure–flow ratio (ΔTRPG/Δcardiac index) in highlanders 9.4±11.4 WU and lowlanders 3.0±2.4 WU (difference 6.4 (1.4 to 11.3) WU; p=0.012). Right ventricular-arterial coupling (TAPSE/TRPG) was significantly lower in highlanders but no significant difference in change with exercise in between groups was detected (−0.01 (−0.20 to 0.18); p=0.901).In highlanders, chronic exposure to hypoxia leads to higher pulmonary artery pressure and a steeper pressure–flow relation during exercise.
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Lefebvre, Claire E., Kristian B. Filion, Pauline Reynier, Robert W. Platt e Michael Zappitelli. "Primary Care Prescriptions of Potentially Nephrotoxic Medications in Children with CKD". Clinical Journal of the American Society of Nephrology 15, n. 1 (12 dicembre 2019): 61–68. http://dx.doi.org/10.2215/cjn.03550319.
Abstract (sommario):
Background and objectivesPediatric CKD management focuses on limiting kidney injury, including avoiding nephrotoxic medications. Nephrotoxic medication prescription practices for children with CKD are unknown. Our objective was to determine the prevalence and rates of primary care prescriptions for potentially nephrotoxic medications in children with CKD versus without CKD.Design, setting, participants, & measurementsWe conducted a retrospective, matched population-based cohort study of patients aged <18 years, registered at a general practice participating in the UK Clinical Practice Research Datalink (CPRD) from 1997 to 2017. Children with a clinical code indicating an incident diagnosis of CKD were matched 1:4 to patients without CKD on CKD diagnosis date, sex, age, CPRD practice, and number of general practitioner visits in the year before cohort entry. We calculated the prevalence and the rate of potentially nephrotoxic medication prescriptions throughout the follow-up period in patients with versus without CKD. Primary analyses included the following medication classes: aminoglycosides, antivirals, nonsteroidal anti-inflammatory drugs, salicylates, proton pump inhibitors, and immunomodulators. Secondary analyses used an expanded nephrotoxicity definition that also included, among others, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Adjusted prescription rates were calculated using multivariable binomial regression.ResultsFrom 1,535,816 eligible patients, we identified 1018 incident CKD and 4072 non-CKD matches (mean age, 9.8 years [range, 1.1–17.9 years]; 52% male; mean follow-up time, 3.3 years). Overall, 26% of patients with and 15% of patients without CKD were prescribed one or more potentially nephrotoxic medication during follow-up. The overall rate of nephrotoxic medication prescriptions was 71 (95% confidence interval [95% CI], 55 to 93) prescriptions per 100 person-years in patients with CKD and eight (95% CI, 7 to 9) prescriptions per 100 person-years in patients without CKD (adjusted rate ratio, 4.1; 95% CI, 2.7 to 6.1).ConclusionsPotentially nephrotoxic medications are prescribed at high rates to children with CKD.
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Motamed, Cyrus, Gregoire Weil, Chaima Dridi e Jean Louis Bourgain. "Incidence of Severe Hypothermia and Its Impact on Postoperative Surgical Complications and Time Delay to Adjunct Treatments in Breast Surgery Cancer Patients: A Case-Controlled Study". Journal of Clinical Medicine 10, n. 16 (20 agosto 2021): 3702. http://dx.doi.org/10.3390/jcm10163702.
Abstract (sommario):
Introduction: Unintended postoperative hypothermia frequently occurs upon arrival in the post anesthesia care unit (PACU). As part of our quality assurance program in anesthesia, we regularly monitor the incidence of this complication through our anesthesia information management system (AIMS). In this case-controlled retrospective study, our goal was to detect the incidence of unintended severe hypothermia in our breast surgery cancer patients, and subsequently to analyze the consequence of this complication in terms postoperative cutaneous infection, as well as its impact on further complementary treatment, such as radiotherapy and chemotherapy. Methods: This study was a retrospective analysis conducted through our AIMS system from 2015 through 2019, with extraction criteria based on year, type of surgery (breast), and temperature upon arrival in PACU. A tympanic temperature of less than 36 °C was considered to indicate hypothermia. Severe hypothermia was considered for patients having a temperature lower than 35.2 °C (hypothermic) (n = 80), who were paired using a propensity score analysis with a control group (normothermic) (n = 80) of other breast cancer surgery patients. Extracted data included time of surgery, sex, age, ASA status, and type and duration of the intervention. Results: The mean incidence of hypothermia was 21% from 2015 through 2019. The body mass index (BMI) was significantly lower in the hypothermia group before matching, 23.5 ± 4.1 vs. 26.4 ± 6.1 kg/m2 in normothermic patients (p < 0.05). The hypothermia group also had significantly fewer monitoring and active warming devices. No difference was noted for wound complications. Time to complementary chemotherapy and or radiotherapy did not differ between groups (52 ± 21 days in group hypothermia vs 49 ± 22 days in the control group). Conclusion: Severe intraoperative hypothermia remains an important quality assurance issue in our breast surgery cancer patients, but we could not detect any long-term effect of hypothermia.
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Manandhar, Reeju, Amrit Bogati, Dipanker Prajapati, Sheikh Aslam, Taanya Choudhary, Sanjeev Mahat, Binita Tamrakar, Pushpa Neupane e Chandra Mani Adhikari. "Adherence to guideline-directed medical therapy among left ventricular systolic dysfunction patients in Shahid Gangalal National Heart Centre, Kathmandu, Nepal". Nepalese Heart Journal 17, n. 1 (6 maggio 2020): 29–32. http://dx.doi.org/10.3126/njh.v17i1.28804.
Abstract (sommario):
Background and Aims: Heart Failure (HF) with reduced Ejection Fraction (HFrEF) is defined as the clinical diagnosis of HF and left ventricular ejection fraction (LVEF) ≤ 40%, also referred to as systolic HF. Guideline-directed medical therapy (GDMT) has shown to reduce mortality for HFrEF. We aim to evaluate adherence to GDMT treatment in our outpatients.
Methods: It was a cross-sectional observational study. All patients who attended the Department of preventive medicine and cardiac rehabilitation for medical counseling from October 2016 to May 2018 and have already completed 3 months of follow up for HF were included in this study. Performa was designed to collect patient information which included; age, gender, NYHA functional class, LVEF, systolic and diastolic blood pressure, pulse rate, creatinine, potassium and drugs with doses were recorded.
Results: Among the 451 patients, ninety-nine (65.6%) were male and 52 (34.4%) were female. The mean age was 56.2±4.2 years. Most of the patients were in NYHA class II 114 (75.5%) and in Sinus rhythm 119 (79.4%). Mean LVEF was 26.6±6.1%. Dilated Cardiomyopathy was the most common clinical diagnosis in 76 (50.3%). Diuretic, Angiotensin-converting enzyme inhibitor (ACEI)/Angitensin receptor blocker (AB), Aldosterone Antagonist, β-blocker and digoxin were prescribed in 151 (100%), 140 (93.3%), 127 (84.1%), 114 (75.4%) and 46 (30.4%) patients respectively. The mean dose of furosemide, Enalapril, Losartan, carvedilol, bisoprolol and metoprolol succinate was 45.3mg, 4.0mg, 33.2mg, 33.6mg, 18.8mg, 3.0mg, and 27.5mg was respectively.
Conclusion: Our center's adherence to GDMT in HFrEF patients is comparable to international studies. We still need more effort to re-emphasize the importance of GDMT by focusing on the optimization of drug doses during out-patient visits.
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Kaminski, M. S., D. Hamstra, J. Estes e R. Wahl. "The impact of FLIPI on outcome of frontline treatment with single-agent I-131 tositumomab for follicular lymphoma (FL)". Journal of Clinical Oncology 24, n. 18_suppl (20 giugno 2006): 7509. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.7509.
Abstract (sommario):
7509 Background: The FLIPI is potentially useful in predicting clinical outcome and comparing treatment results among clinical studies in FL. We recently reported the results of I-131 tositumomab as frontline treatment in 76 pts with advanced-stage FL (NEJM 325:441, 2005). A single 1-week course resulted in a 95% and a 75% overall and complete response (CR) rate, respectively, and at a median follow-up of 5.1 years median progression-free survival (PFS) was 6.1 yrs. In multivariate analyses, bone marrow involvement was the only baseline variable that had a significant effect on PFS. Methods: To evaluate whether baseline FLIPI scores in this study could predict outcome and to compare this pt population with that in other frontline studies, the records of all 76 patients were reviewed. Results: FLIPI scores were available for 74 of the 76 pts: 11 pts (15%) low risk, 37 (50%) intermediate risk, and 26 (35%) high risk. CR rates for each risk group were 82%, 73%, and 73%, respectively. 5-yr PFS were 63% (35–92%, 95% CI), 63% (47–78%), and 52% (33–71%), respectively, p = 0.322. Grouping low + intermediate risk vs. high for PFS: p = 0.134. 5-yr overall survival (OS) rates were 100%, 95% (87–100%), 78% (62– 93%), respectively, p = 0.072, but grouping low + intermediate risk vs. high p = 0.028. A comparison to other frontline studies is below. Conclusions: The FLIPI did not predict for PFS or OS in FL pts treated with single-agent I-131 Tositumomab. However, an OS difference was seen when low + intermediate risk pts were grouped and compared with high risk pts. The distribution of FLIPI scores amongst pts in this study is similar to that observed in other front-line FL studies. Further studies exploring single-agent radioimmunotherapy vs. chemo/radioimmunotherapy combinations are warranted. [Table: see text] [Table: see text]
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Maciel, Isabella Cristina de Faria, Jeannine P. Schweihofer, Jenifer I. Fenton, Jennifer Hodbod, Melissa McKendree, Kim Cassida e Jason E. Rowntree. "PSXI-18 Influence of Akaushi Genetics on Beef Performance and Carcass Merit in Grain and Grass-finishing Systems". Journal of Animal Science 98, Supplement_4 (3 novembre 2020): 384–85. http://dx.doi.org/10.1093/jas/skaa278.676.
Abstract (sommario):
Abstract The study objective was to investigate the impact of beef genetics and finishing system on beef production and carcass merit. Red Angus (RA, n = 30) and RA x Akaushi (AK, n = 30) were equally assigned to one of two finishing treatments: a mixed-species pasture forage (GRASS) or a total mixed feedlot ration (GRAIN) in three replications. Each finishing treatment had free access to mineral and water, and GRAIN were fed once daily (20% hay and 80% concentrate) over 107 d. The grazing period was 80 d. Body weight (BW) was measured after a 12-hour fasting period at the onset and end of the trial. Animals were slaughtered at 18 and 26 mo (GRAIN and GRASS, respectively), and carcass data was collected 48 h postmortem. Initial and final BW were greater for GRAIN (469.7 and 611.0 kg) than GRASS (439.1 and 548.7 kg). Although steers had different total BW gain (141 kg for GRAIN vs 90 kg for GRASS; P < 0.01), there was no difference for average daily gain between two systems. The GRAIN’s advantage in performance, led to higher HCW (+16%), ribeye area (+10%), and backfat (+52%) compared to GRASS. Dressing and marbling score were greater in GRAIN compared to GRASS (61.2 % and 621 vs 57.8 % and 417). The AK cattle presented higher values for dressing (58.7 vs 60.1%; P < 0.0001), ribeye area (70.2 vs 74.3 cm2; P = 0.02), and marbling (548 vs 490, P = 0.03) compared to RA. There was genetics x diet interaction for internal fat, where AK animals had greater value than RA (2.7 vs 2.3%; P < 0.0001) in the GRAIN treatment. These results indicate that GRAIN had superior performance and carcass merit and that AK enhanced these traits to a greater degree as compared to RA.
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Gorczyca, Iwona, Magdalena Chrapek, Olga Jelonek, Anna Michalska, Agnieszka Kapłon-Cieślicka, Beata Uziębło-Życzkowska, Monika Budnik et al. "Left Atrial Appendage Thrombus Formation Despite Continuous Non-Vitamin K Antagonist Oral Anticoagulant Therapy in Atrial Fibrillation Patients Undergoing Electrical Cardioversion or Catheter Ablation: A Comparison of Dabigatran and Rivaroxaban". Cardiology Research and Practice 2020 (17 settembre 2020): 1–10. http://dx.doi.org/10.1155/2020/1206402.
Abstract (sommario):
Left atrial appendage thrombus (LAAT) may be detected by transesophageal echocardiography (TOE) in patients with atrial fibrillation (AF) despite continuous anticoagulation therapy. We examined the factors predisposing to LAAT in patients treated with the anticoagulants dabigatran and rivaroxaban. We retrospectively evaluated 1,256 AF patients from three centres who underwent TOE before electrical cardioversion (n = 611, 51.4%) or catheter ablation (n = 645, 48.6%) from January 2013 to December 2019 and had been on at least three weeks of continuous dabigatran (n = 603, 48%) or rivaroxaban (n = 653, 52%) therapy. Preprocedural TOE diagnosed LAAT in 51 patients (4.1%), including 30 patients (5%) treated with dabigatran and 21 patients (3.2%) treated with rivaroxaban (p=0.1145). In multivariate logistic regression, predictors of LAAT in patients treated with dabigatran were non-paroxysmal AF (vs. paroxysmal AF) (OR = 6.2, p=0.015), heart failure (OR = 3.22, p=0.003), and a eGFR <60 ml/min/1.73 m2 (OR = 2.65, p=0.012); the predictors in patients treated with rivaroxaban were non-paroxysmal AF (vs. paroxysmal AF) (OR = 5.73, p=0.0221) and heart failure (OR = 3.19, p=0.116). In ROC analysis of the dabigatran group, the area under the curve (AUC) for the CHA2DS2-VASc-RAF score was significantly higher (0.78) than those for the CHADS2, CHA2DS2-VASc, and R2CHADS2 scores (0.67, 0.70, and 0.72, respectively). In the rivaroxaban group, the CHA2DS2-VASc-RAF score also performed significantly better (AUC of 0.77) than the CHADS2, CHA2DS2-VASc, and R2CHADS2 scores (AUC of 0.66, 0.64, and 0.67, respectively). The risk of LAAT was the same for patients in both treatment groups. In all patients, non-paroxysmal AF or heart failure, and in patients treated with dabigatran an eGFR <60 ml/min/1.73 m2, were independent predictors of LAAT. The new CHA2DS2-VASc-RAF scale had the highest predictive value for LAAT in the entire study population.
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du Fay de Lavallaz, Jeanne, Christian Puelacher, Giovanna Lurati Buse, Daniel Bolliger, Dominic Germanier, Reka Hidvegi, Joan Elias Walter et al. "Daytime variation of perioperative myocardial injury in non-cardiac surgery and effect on outcome". Heart 105, n. 11 (12 dicembre 2018): 826–33. http://dx.doi.org/10.1136/heartjnl-2018-313876.
Abstract (sommario):
ObjectiveRecently, daytime variation in perioperative myocardial injury (PMI) has been observed in patients undergoing cardiac surgery. We aim at investigating whether daytime variation also occurs in patients undergoing non-cardiac surgery.MethodsIn a prospective diagnostic study, we evaluated the presence of daytime variation in PMI in patients at increased cardiovascular risk undergoing non-cardiac surgery, as well as its possible impact on the incidence of acute myocardial infarction (AMI), and death during 1-year follow-up in a propensity score–matched cohort. PMI was defined as an absolute increase in high-sensitivity cardiac troponin T (hs-cTnT) concentration of ≥14 ng/L from preoperative to postoperative measurements.ResultsOf 1641 patients, propensity score matching defined 630 with similar baseline characteristics, half undergoing non-cardiac surgery in the morning (starting from 8:00 to 11:00) and half in the afternoon (starting from 14:00 to 17:00). There was no difference in PMI incidence between both groups (morning: 50, 15.8% (95% CI 12.3 to 20.3); afternoon: 52, 16.4% (95% CI 12.7 to 20.9), p=0.94), nor if analysing hs-cTnT release as a quantitative variable (median morning group: 3 ng/L (95% CI 1 to 7 ng/L); median afternoon group: 2 ng/L (95% CI 0 to 7 ng/L; p=0.16). During 1-year follow-up, the incidence of AMI was 1.2% (95% CI 0.4% to 3.2%) among morning surgeries versus 4.1% (95% CI 2.3% to 6.9%) among the afternoon surgeries (corrected HR for afternoon surgery 3.44, bootstrapped 95% CI 1.33 to 10.49, p log-rank=0.03), whereas no difference in mortality emerged (p=0.70).ConclusionsAlthough there is no daytime variation in PMI in patients undergoing non-cardiac surgery, the incidence of AMI during follow-up is increased in afternoon surgeries and requires further study.Clinical trial registrationNCT02573532;Results.
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Podolin, D. A., T. T. Gleeson e R. S. Mazzeo. "Hormonal regulation of hepatic gluconeogenesis: influence of age and training". American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 270, n. 2 (1 febbraio 1996): R365—R372. http://dx.doi.org/10.1152/ajpregu.1996.270.2.r365.
Abstract (sommario):
The contributions of three major gluconeogenic regulators, glucagon (10(-7) M), alpha-adrenergic agonist phenylephrine (10(-5) M), and beta-agonist isoproterenol (10(-5) M) to hepatic glucose synthesis in liver slices from Fischer 344 rats were examined in relation to age and endurance training. Young (4 mo), middle-aged (12 mo), and old (22 mo) male Fischer 344 rats (n = 66) were divided into trained or sedentary groups. Trained animals were run 10 wk on a treadmill at 75% of maximal capacity, 1 h/day, 5 days/wk. Animals were killed at rest, and sections of liver were removed and sliced in a tissue microtome. Slices were incubated in L-[U-14C]lactic acid, Ringer solution, and one of the aforementioned gluconeogenic regulators. Rates of lactate incorporation into glucose and glycogen were significantly greater in young compared with old animals for all three regulators in both trained and untrained animals. Training elicited a 35, 52, and 63% improvement in lactate incorporation into glucose compared with untrained when the livers of young (16.9 +/- 1.2 vs. 10.9 +/- 1.1 mumol.g protein-1.min-1), middle-aged (12.8 +/- 1.3 vs. 6.1 +/- 1.2 mumol.g protein-1.min-1), and old (11.2 +/- 1.1 vs. 4.1 +/- 0.6 mumol.g protein-1.min-1) animals, respectively, were incubated in glucagon. Rates with phenylephrine followed a similar pattern to that with glucagon across age and training, but absolute rates were significantly lower. No training effect in gluconeogenic rate was found when liver was incubated in the presence of isoproterenol. It is concluded that the gluconeogenic capacity of liver declines with age regardless of the gluconeogenic regulator and that training was able to partially offset age-related declines in glucagon-stimulated and alpha-receptor-mediated gluconeogenesis.
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Erfani, Hadi, Sabrina Woll, Austin Luong, Gage Guerra, Anthony Kharrat, Rebecca Umayam, Anastasia Martynova et al. "Abstract 996: Predicting early mortality in a large ethnically diverse phase I clinical trial program". Cancer Research 84, n. 6_Supplement (22 marzo 2024): 996. http://dx.doi.org/10.1158/1538-7445.am2024-996.
Abstract (sommario):
Abstract Background: Various scoring systems are developed to optimize patient selection for phase I clinical trials. We evaluated the Royal Marsden Hospital (RMH), Princess Margaret Hospital Index (PMHI), and MD-Anderson Cancer Center (MDACC) prognostic scores and compared their power to predict 90-day mortality (90DM) in an ethnically diverse population enrolled in the USC Norris Comprehensive Cancer Center (NCCC) Phase I Program. Methods: We queried our database of patients enrolled in phase I clinical trials at the NCCC from 2015-2022 which includes demographics, treatment details and outcomes. The enrollment occurred at all NCCC sites including the Los Angeles General Medical Center, a safety net hospital. Prognostic scores were calculated: RMH (albumin < 35 g/L, LDH > ULN, > 2 metastatic sites), PMHI (albumin < 35 g/L, ECOG > 0, > 2 metastatic sites), MDACC (albumin < 35 g/L, LDH > ULN, ECOG > 0, > 2 metastatic sites, GI tumor type). Kaplan-Meier analysis was used to calculate median survival in each group. ROC analysis was performed to assess the 90DM prediction. Results: 611 patients (15 breast, 344 GI, 20 GU, 29 GYN, 110 Lung/H&N, 88 other) were accrued to 88 phase I trials. Patients had a median age of 61 (25-87) and a median of 3 prior lines of therapy (0-10). 31.9% of pts were Hispanic, 44.1% non-Hispanic white, 3.7% black, and 20.4% Asian. The 90DM rate was 24.9%. The objective response rate was 8.3%, and 41.5% had stable disease. For all systems, higher scores had shorter survival (p<0.001). The MDACC system had the largest AUC to predict 90DM (AUC: 0.678, p < 0.001). Score of 4-5 (high risk) per MDACC system corresponds to a specificity of 94.5% (91.1-97.2) and positive likelihood ratio of 3.6 (1.8-7.2). Conclusion: In our highly diverse phase I population, higher scores on the RMH, PMHI, and MDACC scoring systems were associated with worse prognosis and 90DM. Careful consideration should be given to potential patients with higher scores prior to enrollment in phase I trials. Characteristics and outcomes of the study participants (N = 611). Variable Median (IQR)/N (%) Scoring system N (%) Median survival days (95% CI) p-Value Age (yr) 61 [54-68] RMH score < 0.001 Female gender 288 (47.1%) 0 151 (36.7%) 505 (378-631) Safety net participant 120 (19.6%) 1 184 (44.8%) 509 (324-693) Non-English speaking 177 (29%) 2 64 (15.6%) 176 (107-244) Performance status ECOG 0 153 (33.3%) 3 12 (2.9%) 44 (12-76) ECOG 1 302 (65.7%) Area under ROC curve (95% CI) 0.650 (0.579-0.721) < 0.001 ECOG 2 5 (1.1%) Number of prior lines 0-2 298 (48.8%) PMHI score < 0.001 >= 3 313 (51.2%) 0 118 (25.7%) 603 (405-800) Tumor type Breast 15 (2.5%) 1 214 (46.5%) 462 (378-545) GI 344 (56.8%) 2 115 (25.0%) 254 (117-390) GU 20 (3.3%) 3 13 (2.8%) 87 (52-122) Gyn 29 (4.8%) Area under ROC curve (95% CI) 0.629 (0.560-0.697) < 0.001 Lung/H&N 110 (18.2%) Others 88 (14.5%) MDACC score < 0.001 Type of trial Chemotherapy 112 (18.3%) 0 (low risk) 26 (7.9%) Not estimated Immunotherapy 227 (37.2%) 1 (low-intermediate risk) 84 (25.5%) 597 (429-768) Targeted therapy 272 (44.5%) 2 (intermediate risk) 116 (35.2%) 471 (115-827) >2 metastatic sites 146 (23.9%) 3 (high-intermediate risk) 75 (22.7%) 297 (142-452) 90-day mortality 152 (24.9%) 4 (high risk) 25 (7.6%) 119 (108-130) Best response by RECIST Stable disease 225 (41.5%) 5 (high risk) 4 (1.2%) Not estimated Partial response 39 (7.2%) Area under ROC curve (95% CI) 0.678 (0.611-0.745) < 0.001 Complete response 6 (1.1%) Progressive disease 272 (50.2%) Citation Format: Hadi Erfani, Sabrina Woll, Austin Luong, Gage Guerra, Anthony Kharrat, Rebecca Umayam, Anastasia Martynova, Laurie Brunette, Lynda Roman, Negeen Izadian, Teshia Bustos, Diana Hanna, Anthony El-Khoueiry, Jacob Thomas. Predicting early mortality in a large ethnically diverse phase I clinical trial program [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 996.
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Baraliakos, X., A. Deodhar, D. Van der Heijde, M. Magrey, W. P. Maksymowych, T. Tomita, H. Xu et al. "POS1103 BIMEKIZUMAB MAINTAINED IMPROVEMENTS IN EFFICACY ENDPOINTS AND HAD A CONSISTENT SAFETY PROFILE THROUGH 52 WEEKS IN PATIENTS WITH NON-RADIOGRAPHIC AND RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS: RESULTS FROM TWO PARALLEL PHASE 3 STUDIES". Annals of the Rheumatic Diseases 82, Suppl 1 (30 maggio 2023): 873.2–874. http://dx.doi.org/10.1136/annrheumdis-2023-eular.1562.
Abstract (sommario):
BackgroundBimekizumab (BKZ), a monoclonal IgG1 antibody that selectively inhibits interleukin (IL)-17F in addition to IL-17A, met all primary/secondary endpoints at Week (Wk) 16 in patients (pts) with active non-radiographic axial spondyloarthritis (nr-axSpA) and radiographic axSpA (r-axSpA; i.e., ankylosing spondylitis), in the parallel phase 3 BE MOBILE 1 and 2 studies, respectively.[1,2]ObjectivesTo assess efficacy and safety of BKZ in these pts up to Wk 52.MethodsBE MOBILE 1 (NCT03928704) and 2 (NCT03928743) both involved a 16-wk placebo (PBO)-controlled and 36-wk maintenance period.[1,2]Pts were randomised to subcutaneous BKZ 160 mg Q4W (BKZ) or to PBO then BKZ from Wk 16 (PBO/BKZ).Results220/254 (86.6%) randomised pts with nr-axSpA and 298/332 (89.8%) with r-axSpA completed Wk 52. Efficacy was sustained to Wk 52 in both studies (Table 1). ASAS40 responses in BKZ-randomised pts increased from Wk 16 (nr-axSpA: 47.7%; r-axSpA: 44.8%; non-responder imputation [NRI]) to Wk 52 (60.9%; 58.4%; NRI) with high levels of efficacy across TNFi-naïve and TNFi-IR populations (Table 1). At Wk 52, ASDAS <2.1 was achieved by 61.6% and 57.1%, and ASDAS <1.3 by 25.2% and 23.4%, of BKZ-randomised pts with nr-axSpA and r-axSpA, respectively (Figure 1). Wk 16 reductions from baseline in objective signs of inflammation (MRI, hs-CRP), and improvements in function (BASFI) and ASQoL, were maintained through 52 wks. Efficacy at Wk 52 was similar in PBO/BKZ-treated and BKZ-randomised pts (Table 1).At Wk 52, 75.0% (183/244) of pts with nr-axSpA and 75.5% (249/330) of pts with r-axSpA had ≥1 treatment-emergent adverse event (TEAE) on BKZ; the most frequent (% pts) TEAEs by preferred term (MedDRA v19.0) were nasopharyngitis (nr-axSpa: 12.3%; r-axSpA 9.1%) and upper respiratory tract infection (9.4%; 6.4%); few COVID-19 infections were reported (7.0%; 2.1%). Incidence (pts/100 pt years) of serious TEAEs were low (4.4; 7.1); no major adverse cardiovascular events, active tuberculosis cases, serious COVID-19 infections, or deaths were reported. Most incidences of fungal infection (19.6; 14.9; none serious or systemic) wereCandida(12.8; 8.3) and mild to moderate; two pts in both studies discontinued the study due toCandidainfections. Incidence of IBD (1.0; 1.0) and uveitis (1.5; 2.4) were low.ConclusionAcross the axSpA spectrum, BKZ resulted in sustained efficacy to Wk 52. No new safety signals were observed, consistent with the Wk 24 safety profile.[1,2]References[1]Deodhar A. Ann Rheum Dis 2022;81:772–3; 2.[2]van der Heijde D. Ann Rheum Dis 2022;81:12–3.Table 1.Efficacy at Wk 52Mean (SE), unless statedBE MOBILE 1BE MOBILE 2PBO→BKZ N=126BKZ N=128PBO→BKZ N=111BKZ N=221ASAS40[NRI]n (%)64 (50.8)78 (60.9)76 (68.5)129 (58.4)ASAS40 in TNFi-naïve[NRI]n (%)58 (53.2)a73 (61.9)b67 (71.3)c108 (58.7)dASAS40 in TNFi-IRe[NRI]n (%)6 (35.3)f5 (50.0)g9 (52.9)f21 (56.8)hASAS20[NRI]n (%)88 (69.8)94 (73.4)89 (80.2)158 (71.5)ASAS PR[NRI]n (%)38 (30.2)38 (29.7)41 (36.9)66 (29.9)ASAS 5/6[NRI]n (%)65 (51.6)71 (55.5)74 (66.7)124 (56.1)BASDAI CfB[MI]–3.5 (0.2)–3.9 (0.2)–4.0 (0.2)–3.6 (0.1)BASFI CfB[MI]–2.6 (0.2)–3.0 (0.2)–2.8 (0.2)–2.8 (0.1)ASDAS-MI[NRI]n (%)37 (29.4)47 (36.7)49 (44.1)71 (32.1)Nocturnal spinal pain CfB[MI]–4.1 (0.2)–4.3 (0.3)–4.6 (0.3)–4.1 (0.2)ASQoL CfB[MI]–5.3 (0.4)–5.9 (0.4)–5.6 (0.4)–5.7 (0.3)SF-36 PCS CfB[MI]11.4 (0.9)12.2 (0.9)12.3 (0.9)12.0 (0.6)BASMI CfB[MI]–0.4 (0.1)–0.6 (0.1)–0.7 (0.1)–0.7 (0.1)Total resolution of enthesitisi[NRI]n (%)41 (44.6)j51 (54.3)c31 (46.3)k67 (50.8)lASDAS-CRP CfB[MI]–1.6 (0.1)–1.8 (0.1)–1.9 (0.1)–1.7 (0.1)SPARCC MRI SIJ score CfB[OC]mMean (SD)–6.4 (10.7)n–7.6 (10.5)o–2.8 (6.1)p–4.7 (8.2)qBerlin MRI spine score CfB[OC]mMean (SD)–0.4 (2.0)k–0.7 (2.5)r–2.1 (3.4)p–2.4 (3.9)shs-CRP, mg/L [MI]Median2.21.72.02.3RS. n:a109,b118,c94,d184;eMax 1 TNFi; n:f17,g10,h37;iMASES=0 in pts with MASES >0 at BL; n:j92,k67;l132;mMRI sub-study; n:n70,o82,p48,q90,r79,s89.AcknowledgementsThis study was funded by UCB Pharma. Medical writing support was provided by Costello Medical, funded by UCB Pharma.Disclosure of InterestsXenofon Baraliakos Speakers bureau: AbbVie, BMS, Chugai, Eli Lilly, Galapagos, Gilead, MSD, Novartis, Pfizer and UCB Pharma, Paid instructor for: AbbVie, BMS, Chugai, Eli Lilly, Galapagos, Gilead, MSD, Novartis, Pfizer and UCB Pharma, Consultant of: AbbVie, BMS, Chugai, Eli Lilly, Galapagos, Gilead, MSD, Novartis, Pfizer and UCB Pharma, Atul Deodhar Speakers bureau: Janssen, Novartis and Pfizer, Consultant of: AbbVie, Amgen, Aurinia, BMS, Eli Lilly, Janssen, MoonLake, Novartis, Pfizer and UCB Pharma, Grant/research support from: AbbVie, BMS, Celgene, Eli Lilly, MoonLake, Novartis, Pfizer and UCB Pharma, Désirée van der Heijde Consultant of: AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, GSK, Janssen, Eli Lilly, Novartis, Pfizer and UCB Pharma, Employee of: Director of Imaging Rheumatology BV, Marina Magrey Consultant of: AbbVie, Eli Lilly, Novartis, Pfizer and UCB Pharma, Grant/research support from: AbbVie and UCB Pharma, Walter P Maksymowych Consultant of: AbbVie, BMS, Boehringer-Ingelheim, Celgene, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer and UCB Pharma, Grant/research support from: AbbVie and Pfizer; educational grants from AbbVie, Janssen, Novartis and Pfizer, Employee of: Chief Medical Officer for CARE ARTHRITIS, Tetsuya Tomita Speakers bureau: AbbVie, Astellas, BMS, Eisai, Eli Lilly, Janssen, Kyowa Kirin, Mitsubishi-Tanabe, Novartis and Pfizer, Consultant of: AbbVie, Eli Lilly, Gilead, Novartis and Pfizer, Huji Xu Speakers bureau: AbbVie, Janssen, Novartis, Pfizer and UCB Pharma, Consultant of: AbbVie, Beigene, BioMap, IASO, Pfizer and UCB Pharma, Employee of: Clinical investigator for Peking-Tsinghua Center for Life Sciences, Marga Oortgiesen Shareholder of: UCB Pharma, Employee of: UCB Pharma, Ute Massow Employee of: UCB Pharma, Carmen Fleurinck Employee of: UCB Pharma, Alicia Ellis Employee of: UCB Pharma, Thomas Vaux Employee of: UCB Pharma, julie smith Employee of: UCB Pharma, Alexander Marten Employee of: UCB Pharma, Lianne S. Gensler Consultant of: AbbVie, Acelyrin, Eli Lilly, Fresenius Kabi, Janssen, Novartis, Pfizer and UCB Pharma, Grant/research support from: Novartis and UCB Pharma paid to institution.
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Walker, Ronald, John Shaughnessy, Jeffery Haessler, Joshua Epstein, Jeffery Sawyer, Elias J. Anaissie, Frits Van Rhee et al. "MRI and Metastatic Bone Survey (MBS) Examinations in Multiple Myeloma (MM): Laboratory Correlates and Prognostic Implications for 611 Patients Receiving Total Therapy 2." Blood 108, n. 11 (16 novembre 2006): 3515. http://dx.doi.org/10.1182/blood.v108.11.3515.3515.
Abstract (sommario):
Abstract Background: The Durie-Salmon (DS) staging system represented the first clinically useful classification of MM. While distinguishing patients with differing event-free (EFS) and overall survival (OS), considerable outcome heterogeneity persisted. Patients and Methods: As part of a high-dose melphalan-based tandem transplant trial, Total Therapy 2 (TT2), 611 patients had both MBS and MRI performed at baseline, along with standard prognostic factors and cytogenetics. Results: In a comparison of all areas imaged by both techniques, at least one focal lesion (FL) was detected in 451 (74%) patients by MRI and 344 (56%) by MBS; 128 (21%) had no FL by either technique; 312 (51%) showed FL by both MBS and MRI; of 267 patients without FL on MBS, 139 (52%) had FL on MRI; of 160 without FL on MRI, 32 (20%) had FL on MBS. Mean FL number among those with FL was 13.4 by MRI and 7.8 by MBS. Significantly higher proportions of patients had FL on MRI than MBS in spine (78% vs. 16% p<0.001); pelvis (64% vs. 28%, p<0.001) and sternum (24% vs. 3%, p<0.001). Higher FL number on both MRI and MBS and heterogeneity of diffuse marrow signal on MRI STIR images (indicating micro-nodular disease) were prognostically harmful along with the presence of cytogenetic abnormalities (CA), elevated serum levels of B2M, CRP and lactate dehydrogenase (LDH), presence of hypo-albuminemia and advanced age. On multivariate analysis (MVA), MRI- but not MBS-defined FL number was an independent adverse baseline feature for overall survival (HR=1.73; p<.001), independent of CA (HR=2.11; p<.001) and elevations of LDH (HR=1.56; p=.006) and B2M levels (HR=1.43; p=.026). Hypo-albuminemia and increased CRP levels were prognosis-neutral once the afore-mentioned parameters were accounted for. Clinical complete response (CCR) (MVA: HR, 0.60; p=0.007) and MRI-CR (univariately: HR, 0.58; p=0.004)) were additional favorable features when examined as time-dependent variables along with baseline features. Higher MRI-FL number (>7) was significantly associated with higher serum levels of LDH, CRP and creatinine as well as with hypo-albuminemia, whereas levels of B2M, bone marrow plasmacytosis, hemoglobin, CA, age, gender, race and Ig isotype were not. Conclusion: Our data justify routine application of MRI in MM:as the appropriate imaging tool permitting detection of eventually devastating FL long before osteolytic disease is recognized on MBS,as an independent staging tool with prognostic implications (that should replace MBS-FL used in the Durie-Salmon staging system) after accounting for LDH, B2M and presence of CA;to document a superior state of complete remission (MRI-CR) conferring survival advantage, especially evident in patients with a high focal lesion number at baseline;as a tool for detecting and staging non-secretory and macro-focal MM, with the latter often having minimal or no myelomatous involvement on random bone marrow examination; andas a method of detecting non-secretory or macro-focal relapse that is becoming more common in advanced stages of intensely treated patients.
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Regierer, A., A. Weiß, M. Bohl-Buehler, X. Baraliakos, F. Behrens, G. Schett e A. Strangfeld. "OP0225 DEPRESSIVE SYMPTOMS IN PSA: A CROSS-SECTIONAL ANALYSIS FROM THE NATIONAL GERMAN RABBIT-SPA REGISTRY". Annals of the Rheumatic Diseases 80, Suppl 1 (19 maggio 2021): 135.2–136. http://dx.doi.org/10.1136/annrheumdis-2021-eular.2130.
Abstract (sommario):
Background:Psoriatic arthritis (PsA) is a chronic inflammatory disease affecting the musculoskeletal system as well as skin and nails. The prevalence of depression in psoriasis and PsA is high and ranges from 7-40% [1]. Persistent depressive mood may influence disease activity outcome in PsA, especially patient-reported outcomes.Objectives:To assess the correlation of depressive symptoms with PsA-specific outcome parameters.Methods:RABBIT-SpA is a prospective longitudinal cohort study including PsA patients enrolled at start of a new conventional treatment or b/tsDMARD treatment. In regularly provided follow-up questionnaires, physician- and patient-reported information on the disease course including the depression screening tool WHO-5 to assess mental health is collected. For the current analysis, the WHO-5 score was categorised into 4 groups using validated cut-offs: severe depressive symptoms <13, moderate depressive symptoms 13-28, mild depressive symptoms 29-50, well-being >50. Spearman correlation coefficient was calculated to analyse the relationship between the WHO-5 score and various PsA related outcome parameters.Results:936 PsA patients were included. Baseline characteristics are shown in Table 1. In 411 patients (43.9%) the WHO-5 score indicated well-being, 249 (26.6%) had mild depressive, 203 (21.7%) moderate depressive and 73 patients (7.8%) severe depressive symptoms. WHO-5 results correlated with patient reported skin involvement (DLQI: -0.25, patient assessment skin: -0.17), and the composite scores DAPSA (-0.33) and DAS28 (-0.28) as well as with patient reported pain (-0.43) and patient global disease assessment (-0.42). The highest correlation was found for physician assessed global health status (-0.51) and PSAID (-0.62). No significant correlation was found with CRP, swollen joint count and physician assessed skin involvement including body surface area (BSA).Table 1.Baseline characteristics of patients included in the analysis stratified by WHO-5 categories.ParameterWHO-5 (<13) severeN=73WHO-5 (13-28) moderateN=203WHO-5 (29-50) mildN=249WHO-5 (>50) well-beingN=411TotalN=936Age, mean (SD)52.6 (11.4)51 (11.3)51.4 (12.5)52.8 (12.7)52 (12.2)Female, n (%)52 (71.2)127 (62.6)157 (63.1)227 (55.2)563 (60.1)Disease duration, years, mean (SD)8.3 (8.7)6 (7.9)6.2 (6.7)6.4 (7.5)6.4 (7.5)Dactylitis, n (%)14 (19.7)31 (15.5)46 (18.5)77 (18.8)168 (18.1)Axial involvement, n (%)14 (19.7)54 (26.9)49 (19.7)71 (17.3)188 (20.2)Nail involvement, n (%)34 (47.2)85 (42.3)106 (42.6)158 (38.6)383 (41.1)BMI>=30, n (%)37 (51.4)75 (37.1)98 (39.5)125 (30.9)335 (36.2)CRP of >=5 mg/L, n (%)33 (51.6)84 (45.4)99 (46.5)138 (39.1)354 (43.4)BSA (0-100), mean (SD)10.1 (18.3)9.5 (16.8)8.5 (14.9)8.1 (14.6)8.7 (15.5)Physician assessed global health (NRS 0-10), mean (SD)6.3 (1.5)5.6 (1.8)5.2 (1.7)4.9 (1.9)5.2 (1.9)TJC68, mean (SD)9.9 (7.1)8.6 (7.6)8.2 (7.6)7.3 (8.2)8 (7.8)SJC66, mean (SD)6 (5.2)4.8 (4.9)4.7 (4.4)4.3 (3.8)4.6 (4.4)DAPSA, mean (SD)29.3 (11.1)25.1 (12.9)23.4 (12.1)18.9 (12.4)22.3 (12.8)DAS28-CRP, mean (SD)4.1 (1)3.8 (1.2)3.7 (1.1)3.2 (1.1)3.6 (1.2)Patient assessed global health (NRS 0-10), mean (SD)7.9 (2.1)6.6 (2.1)5.9 (2)4.8 (2.3)5.7 (2.4)Patient assessed pain (NRS 0-10), mean (SD)7.8 (1.8)6.4 (2.1)5.8 (2)4.6 (2.4)5.5 (2.4)DLQI (0-30), mean (SD)8.5 (8.2)7.8 (7.2)5.4 (5.7)4.1 (4.9)5.6 (6.2)PSAID (0-10), mean (SD)6.9 (1.8)5.5 (1.8)4.4 (1.7)3 (1.7)4.2 (2.2)Conclusion:The impact of depressive symptoms on outcome parameters used in rheumatology is increasingly being recognised. Interestingly, direct measures of inflammatory disease activity of joint and skin disease such as BSA, CRP, and swollen joint count were not correlated with depressive symptoms. The highest correlation was found for broader assessments like global health status and PSAID.References:[1]Haugeberg et al. Arthritis research & Therapy, 2020, 22:198Acknowledgements:RABBIT-SpA is supported by a joint, unconditional grant from AbbVie, Amgen, Biogen, Hexal, Janssen-Cilag, Lilly, MSD, Novartis, Pfizer, UCB and Viatris.We thank all participating rheumatologists and patients.Disclosure of Interests:Anne Regierer Grant/research support from: AbbVie, Amgen, Biogen, Hexal, Janssen-Cilag, Lilly, MSD, Novartis, Pfizer, UCB and Viatris., Anja Weiß Grant/research support from: AbbVie, Amgen, Biogen, Hexal, Janssen-Cilag, Lilly, MSD, Novartis, Pfizer, UCB and Viatris., Martin Bohl-Buehler: None declared, Xenofon Baraliakos: None declared, Frank Behrens: None declared, Georg Schett: None declared, Anja Strangfeld Grant/research support from: AbbVie, Amgen, Biogen, Hexal, Janssen-Cilag, Lilly, MSD, Novartis, Pfizer, UCB and Viatris.
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Walker, Ronald, Jeffrey Haessler, Guido Tricot, John D. Shaughnessy, Joshua Epstein, Jeffrey Sawyer, Elias Anaissie et al. "Focal Lesion (FL) Identification by MRI and Metastatic Bone Survey (MBS) in Multiple Myeloma (MM): Laboratory Correlates and Prognostic Implications for 611 Patients Receiving Total Therapy 2 (TT2)." Blood 108, n. 11 (16 novembre 2006): 3496. http://dx.doi.org/10.1182/blood.v108.11.3496.3496.
Abstract (sommario):
Abstract Background: The Durie-Salmon staging system utilizes both laboratory features and information on MBS-FL. We hypothesized that, by detecting FL in the bone marrow prior to MBS-recognizable bone destruction, MRI would provide a biologically and clinically more relevant feature of FL-type MM (Tian et al, NEJM 2003). Patients and Methods: As part of a tandem transplant trial, TT2, MBS, MRI, clinical workup and cytogenetics were performed on 611 cases. Results: In a comparison of all areas imaged by both techniques, at least one FL was detected in 451 (74%) on MRI and 344 (56%) on MBS; 128 (21%) had no FL by either technique while 312 (51%) showed FL on both MBS and MRI. Importantly, of 267 patients without FL on MBS, 139 (52%) had FL on MRI; conversely, among 160 without FL on MRI, 32 (20%) had FL on MBS examination. The mean FL number among those with FL was 13 in case of MRI and 8 with MBS. Significantly higher proportions of patients had FL on MRI than MBS in spine (78% vs. 16% p<0.001), pelvis (64% vs. 28%, p<0.001) and sternum (24% vs. 3%, p<0.001). Higher FL number on both MRI and MBS and heterogeneity of the diffuse marrow signal on MRI STIR (indicating micro-nodular disease), cytogenetic abnormalities (CA), elevated serum levels of beta-2-microglobulin (B2M), C-reactive protein (CRP) and lactate dehydrogenase (LDH), in case of hypo-albuminemia and advanced age, were prognostically negative. On multivariate analysis (MVA), MRI- but not MBS-defined FL number was an independent adverse baseline feature for overall survival (HR=1.73; p<.001), independent of CA (HR=2.11; p<.001) and elevations of LDH (HR=1.56; p=.006) and B2M levels (HR=1.43; p=.026). Clinical complete response (CCR) (MVA HR=0.60; p=0.007) and MRI-CR (univariately: HR, 0.58; p=0.004) were favorable features when examined as time-dependent variables along with baseline features. Higher MRI-FL number (>7) was significantly associated with higher serum levels of LDH, CRP and creatinine as well as with hypo-albuminemia, whereas no correlations were noted with levels of B2M, bone marrow plasmacytosis, hemoglobin, CA, age, gender, race and Ig isotype. Conclusion: MRI examination in MM is justified: as an imaging tool that permits detection of FL long before osteolytic disease is recognized on MBS, as an independent staging tool with prognostic implications (that should replace MBS used in the Durie-Salmon staging system) after accounting for the presence of CA, LDH and B2M; as a means of documenting a superior state of CR (MRI-CR) conferring survival advantage, in patients with a high focal lesion number at baseline; and, not addressed here, as a tool for detecting and staging non-secretory and macro-focal MM, the latter often having minimal or no involvement on random bone marrow examination. Figure Figure
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Newaz, Md Mehedi, Avijit Kumar Sikder e Faruquzzaman. "Comparison of the outcome of management of congenital idiopathic clubfoot treated by ponseti method with modified technique". Bangladesh Medical Journal Khulna 52, n. 1-2 (26 marzo 2020): 7–11. http://dx.doi.org/10.3329/bmjk.v52i1-2.46141.
Abstract (sommario):
Background: Ponseti's technique has become the standard and most effective treatment modality for correction of Congenital Talipes Equinovarus (CTEV) in newborn. With time, little modification has been done in the classic technique.
Objective: Our objective in this study was to compare the outcome in the recent years (modified Ponseti technique) with the results of our previous study (classic Ponseti technique).
Methods: A total number of 976 patients (1553 feet) of Congenital Talipes Equino Varus were treated from October 2009 to February 2019 in Khulna Medical College Hospital and in private hospitals. In this retrospective study (based on convenient sampling), there were two groups. In group A, a total 621 patients (with a total 1033 feet) were treated from October 2009 to August, 2015. In group B, 355 patients (520 feet) were treated from November 2015 to February 2019.
Results: In this study, in group A, approximately 88.6% was in 0-6 months age group. 64.9% was male patients. 3.7% patients had positive family history. In group B, majority of the patients (301, 84.8%) was in 0-6 months age group. 211 patients (59.4%) was male child. In approximately 3.1% (11) patients family history was positive. Approximately in 95.9% (991 out of total 1033) and 96.5% (502 out of total 520) feet respectively in group A and B, tenotomy was required. Dropout rates were 7.6% and 4.1% in respective groups. Minor bleeding was observed in approximately 1.5% (15) and 1.4% (7) feet in respective groups, followed by plaster related complications in approximately 2.2% (23) and 1.0% (5) feet in group A and B. Patients' compliance was found significantly higher in group B in contrast to group A. In group B, it was over 90%, whereas in group A, it was approximately 64.1 %.
Conclusion: The ultimate outcome of Ponseti repair is improving by less requirement of total number of plaster, resistant cases and reduction in overall dropout rate by the newer modification.
Bang Med J (Khulna) 2019; 52 : 7-11
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Khademi, Farzad, Hamid Vaez, Zohreh Neyestani e Amirhossein Sahebkar. "Prevalence of ESBL-Producing Enterobacter Species Resistant to Carbapenems in Iran: A Systematic Review and Meta-Analysis". International Journal of Microbiology 2022 (21 ottobre 2022): 1–11. http://dx.doi.org/10.1155/2022/8367365.
Abstract (sommario):
Background. Carbapenems are the last-line therapy for multidrug-resistant (MDR) infections caused by Enterobacterales, including those caused by Enterobacter species. However, the recent emergence of carbapenem-resistant (CR) and extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae pathogens, which are resistant to nearly all antibiotics, has raised concerns among international healthcare organizations. Hence, because there is no comprehensive data in Iran, the current study aimed to evaluate the prevalence of antibiotic resistance among Enterobacter species, especially CR and ESBL-producing strains, in Iran. Methods. The literature search was performed up to June 21, 2021, in national and international databases using MeSH-extracted keywords, i.e., Enterobacter, antibiotic resistance, carbapenem, ESBL, and Iran. Study selection was done based on the predefined inclusion and exclusion criteria, and data analysis was carried out using the Comprehensive Meta-Analysis (CMA) software. Results. The pooled prevalence of Enterobacter species resistant to various antibiotics is as follows: imipenem 16.6%, meropenem 16.2%, aztreonam 40.9%, ciprofloxacin 35.3%, norfloxacin 31%, levofloxacin 48%, gentamicin 42.1%, amikacin 30.3%, tobramycin 37.2%, tetracycline 50.1%, chloramphenicol 25.7%, trimethoprim/sulfamethoxazole 52%, nalidixic acid 49.1%, nitrofurantoin 43%, ceftriaxone 49.3%, cefixime 52.4%, cefotaxime 52.7%, ceftazidime 47.9%, cefepime 43.6%, and ceftizoxime 45.5%. The prevalence rates of MDR and ESBL-producing Enterobacter species in Iran were 63.1% and 32.8%, respectively. Conclusion. In accordance with the warning of international organizations, our results revealed a high prevalence of ESBL-producing Enterobacter species in Iran, which is probably associated with the high prevalence of Enterobacter species resistant to most of the assessed antibiotics, especially MDR strains. However, the resistance rate to carbapenems was relatively low, and these drugs can still be considered as drugs of choice for the treatment of Enterobacter infections in Iran. Nevertheless, continuous monitoring of drug resistance along with antibiotic therapy based on the local data and evaluation of the therapeutic efficacy of new antibiotics or combination therapeutic strategies, such as ceftazidime/avibactam, meropenem/vaborbactam, plazomicin, and eravacycline, is recommended.