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Weizman O, Mika D, Geneste L, Cellier J, Trimaille A, Pommier T, Panagides V, Chaumont C, Karsenty C, Duceau B, Sutter W, Fauvel C, Pezel T, Bonnet G, Cohen A, Waldmann V. Cardiovascular Comorbidities and Covid-19 in Women. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2021. [PMCID: PMC8719934 DOI: 10.1016/j.acvdsp.2020.10.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background While women account for 40-50 % of patients hospitalized for coronavirus disease 2019 (Covid-19), no specific data have been reported in this population. Purpose Assess the burden of cardiovascular comorbidities on outcomes in women hospitalized for Covid-19. Methods We conducted a retrospective observational multicenter study from February 26 to April 20, 2020 in 24 French hospitals including all adults admitted for Covid-19. Primary composite outcome included transfer to intensive care unit (ICU) or in-hospital death. Results Among 2878 patients hospitalized for Covid-19, 1212 (42.1 %) were women. Women were significantly older (68.3 ± 18.0 vs. 65.4 ± 16.0 years, P < 0.001) but had less prevalent cardiovascular comorbidities than men. Among women, 276 (22.8 %) experienced the primary outcome, including 161 (13.3 %) transfer to ICU and 115 (9.5 %) deaths without transfer to ICU. The survival free from death or transfer to ICU was higher in women (HR 0.63, 95 %CI 0.53-0.73, P < 0.001), whereas the observed difference in in-hospital deaths did not reach statistical significance (P = 0.18). The proportion of women that experienced the primary outcome were 37.8 % in women with heart failure (n = 112), 30.9 % in women with coronary artery disease (n = 81), 29.1 % in women with diabetes (n = 254), 26.1 % in women with dyslipidemia (n = 315), and 26.0 % in women with hypertension (n = 632). Age (HR 1.05, 5 years increments, 95 %CI 1.01-1.10), body mass index (HR 1.06, 2 units increments, 95 %CI 1.02-1.10), chronic kidney disease (HR 1.57, 95 %CI 1.11-2.22), and heart failure (HR 1.52, 95 %CI 1.04-2.22) were independently associated with the primary outcome (Fig. 1). Conclusions Women hospitalized for Covid-19 were older and had less prevalent cardiovascular comorbidities than men. While female sex was associated with a lower risk of transfer to ICU or in-hospital death, Covid-19 remains associated with considerable morbi-mortality in women, especially in those with cardiovascular diseases.
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Fauvel C, Weizman O, Trimaille A, Mika D, Pace N, Douair A, Barbin E, Fraix A, Bouchot O, Benmansour O, Godeau G, Mecheri Y, Le Bourdon R, Yvorel C, Duceau B, Sutter W, Waldmann V, Bonnet G, Cohen A, Pezel T. Pulmonary Embolism in Covid-19 patients: A French Multicentre Cohort Study. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2021. [PMCID: PMC8719940 DOI: 10.1016/j.acvdsp.2020.10.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background While pulmonary embolism (PE) appears to be a major issue in Covid-19, data remain sparse. Purpose We aimed to describe the risk factors and baseline characteristics of patients with PE in a large cohort of Covid-19 patients. Methods In a retrospective multicentric observational study, we included consecutive hospitalised patients for Covid-19. Patients without computed tomography pulmonary angiography (CTPA)-proven PE diagnosis, those who were directly admitted to an intensive care unit (ICU), and those still hospitalised without PE experience were excluded. Results Among 1240 patients (58.1% men, mean age 64 ± 17 years), 103 (8.3%) patients had PE confirmed by CTPA. The ICU transfer requirement and mechanical ventilation requirement were significantly higher in the PE group (P < 0.001 and P < 0.001, respectively). In an univariable analysis, traditional venous thromboembolic risk factors were not associated with PE (P > 0.05), while patients under therapeutic-dose anticoagulation before hospitalisation or prophylaxis-dose anticoagulation introduced during hospitalisation had lower PE occurrence (OR 0.40, 95%CI(0.14-0.91); P = 0.04 and OR 0.11, 95%CI(0.06-0.18); P < 0.001, respectively). In a multivariable analysis, the following variables (also statistically significant in univariable analysis) were associated with PE: male gender (OR 1.03, 95%CI(1.003-1.069); P = 0.04), anticoagulation with prophylaxis-dose (OR 0.83, 95%CI(0.79-0.85), P < 0.001) or therapeutic-dose (OR 0.87, 95%CI(0.82-0.92), P < 0.001), C-reactive protein (OR 1.03, 95%CI(1.01-1.04), P = 0.001) and time from symptom onset to hospitalisation (OR 1.02, 95%CI(1.006-1.038), P = 0.002) (Table 1). Conclusion Pulmonary embolism risk factors in Covid-19 context do not include traditional thromboembolic risk factors but rather independent clinical and biological findings at admission, including a major contribution to inflammation.
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Shtull-Trauring E, Cohen A, Ben-Hur M, Tanny J, Bernstein N. Reducing salinity of treated waste water with large scale desalination. WATER RESEARCH 2020; 186:116322. [PMID: 32854030 DOI: 10.1016/j.watres.2020.116322] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/07/2020] [Accepted: 08/19/2020] [Indexed: 06/11/2023]
Abstract
Agriculture, the largest global water consumer, accounts for ~70% of freshwater use thereby considerably influencing water availability. The use of treated wastewater [TWW] for agricultural irrigation has been suggested as a possible solution to help mitigate water scarcity without disrupting food production. However, despite the benefits of TWW irrigation, it is often characterized by high salinity that can reduce crop performance and damage soil structure. In Israel, over 50% of the water used for irrigation is TWW, and a third of the produced TWW undergoes soil aquifer treatment [SAT], i.e., infiltration and percolation to groundwater through the soil before utilization for irrigation. In parallel, seawater desalination provides about 80% of the urban and industrial sector water use. These developments in Israel's water economy during the last three decades, accompanied by extensive governmental monitoring, enabled us to harness high-resolution nation-wide datasets to study the effects of the large-scale introduction of desalination and SAT on TWW quality and salinity in particular. The analyses revealed that large-scale desalination considerably reduced the salinity of TWW to levels similar to freshwater (up to 70% and 60% for Cl and Na, respectively). However, sodium absorption ratio remained unchanged due to the concurrent reductions of Na, Ca and Mg. Mg was reduced to levels that can potentially harm both crops and human health, while B concentrations increased to levels of possible toxicity to crops, suggesting the need for stringent requirements in the post-treatment process. Salinity of groundwater was increased by SAT in the long-term, but was reduced after the introduction of desalination. The results, encompassing almost three decades of water monitoring, suggest that high-quality TWW with a significant portion of desalinated base-water can provide groundwater salinity remediation services.
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Levin G, Meller N, Komem D, Cohen A, Abu-Bandora E, Mohr-Sasson A, Cohen S, Mashiach R, Meyer R. Predictive Factors for Recurrence of Adnexal Torsion. J Minim Invasive Gynecol 2020. [DOI: 10.1016/j.jmig.2020.08.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Soulat-Dufour L, Benhamou-Tarallo I, Lang S, Ederhy S, Ancedy Y, Adavane-Scheuble S, Chauvet-Droit M, Nhan P, Jean M, Ben Said R, Scheuble A, Boccara F, Addetia K, Lang R, Cohen A. Restoration of normal sinus rhythm in atrial fibrillation: impact of reverse remodelling of right chambers on tricuspid regurgitation severity. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The severity of tricuspid regurgitation (TR) in patients with restored normal sinus rhythm (SR) after atrial fibrillation (AF) has been poorly assessed.
Purpose
Our study aimed to assess (1) right chamber remodelling and (2) TR severity in patients with AF who have had their rhythms restored to normal sinus.
Methods
We prospectively evaluated 94 consecutive patients hospitalized for AF who received either ablation, direct current cardioversion, or pharmacological therapy. Patients were divided into two groups according to their cardiac rhythm at 6 months follow up (6M): restoration to SR (SR group, n=54), persistence of AF (AF group, n=40). TR vena contracta (VC), TR grade severity was divided into 4 grades using an integrated approach (0: none or trace; 1: mild; 2: moderate; 3: severe TR). Two dimensional (2D) end diastolic (ED) tricuspid annulus (TA) diameter in the apical 4 chambers view, three-dimensional (3D) indexed volumes (3D Vi) of the right atrium (RA) and right ventricle (RV) in end systole (ES) and ED were acquired using transthoracic echocardiography at admission and at 6M.
Results
At 6M, in the SR group a significant improvement in TR VC (Figure A) and TR grade (Figure B) were noted, whereas there was no differences in the AF group (0.41 vs. 0.42cm, p=0.24 for TR VC; 1.70 vs. 1.76, p=0.16 for mean TR grade). In the SR group a significant reduction in 3D ES RV Vi, 2D ED TA diameter, 3D ES and ED Vi of the RA (Table) were observed. Regression of TR VC was correlated with regression of right cavities parameters (ρ=0.47, p<0.001 for 2D ED TA diameter; ρ=0.34, p<0.005 for 3D ES RA Vi; ρ=0.33, p<0.005 for 3D ED RV Vi; ρ=0.29, p<0.005 for 3D ES RV Vi).
Conclusion
Restoration of normal SR in patients with AF results in beneficial remodelling of right cavities at 6M of follow-up which were associated with a significant decrease in TR severity. Strategies for normal SR restoration in patients with AF and TR should be vigorously attempted.
TR Evolution
Funding Acknowledgement
Type of funding source: None
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Lombardi Y, Boccara F, Baldet K, Lang S, Ederhy S, Nhan P, Riller Q, Chauvet-Droit M, Jean ML, Adavane-Scheuble S, Azoyan L, Cohen A. Prognosis of acute kidney injury during acute heart failure: the role of diuretics. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Acute kidney injury (AKI) frequently occurs after diuretic treatment initiation during acute heart failure (AHF). Treatment-induced hemoconcentration seems associated with improved prognosis. Transient AKI, with or without hemoconcentration, is of unsettled prognosis.
Purpose
We aimed to determine the independent prognostic values of transient AKI, persistent AKI and hemoconcentration in the context of hospitalized AHF.
Methods
Data were obtained from our institution's Clinical Data Warehouse. Patients that visited our unit at least once were screened. All hospitalizations in our institution were examined (>30 hospitals). Inclusion criteria were: ≥1 hospitalization with ≥1 recorded furosemide administration and ≥1 AHF ICD-10 code. Only the first hospitalization fulfilling these criteria was considered. AKI during 1–13 days following first furosemide administration was defined based on Kidney Disease Improving Global Outcome guidelines. Hemoconcentration was defined as an increase in serum proteins ≥5 g/l during the same period. We performed multivariate logistic regression to determine which characteristics were predictive of AKI. We used Cox regression of 100-days all-cause mortality using several confounders to determine the prognostic values of transient AKI (lasting <14 days), persistent AKI (lasting ≥14 days) and hemoconcentration. To account for immortality bias, AKI and hemoconcentration were treated as time-dependent covariates.
Results
We included 579 patients in the study. Median follow-up was 114 days. AKI following furosemide initiation occurred in 234 patients (40.4%). Patients that experienced AKI more frequently suffered from chronic kidney disease (43.6% vs. 33%, p=0.01) or presented with right ventricular dilatation (12% vs. 6.7%, p=0.04). Independent predictors of AKI were arterial hypertension (adjusted OR: 1.86 [1.08–3.22]), elevated serum creatinine at baseline (adjusted OR: 1.07 [1.01–1.14] per 10 μmol/l increase) and initial intravenous furosemide (adjusted OR: 2.42 [1.39–4.29]). Death during follow-up occurred in 35% of patients in the AKI group compared to 21% in the non-AKI group (p<0.001). In Cox regression, persistent AKI was independently associated with increased mortality in a period of 100 days following furosemide initiation (adjusted HR: 2.31 [1.07–4.99]). Transient AKI was not significantly associated with mortality (adjusted HR: 0.64 [0.34–1.19]). Hemoconcentration was independently associated with decreased mortality (adjusted HR: 0.46 [0.27–0.79]).
Conclusion
In the context of hospitalized AHF, AKI that developed 1–13 days after furosemide initiation and that lasted ≥14 days was independently associated with decreased 100 days survival. Hemoconcentration, using a clinically relevant definition, was independently associated with improved survival. These findings show that serum creatinine and proteins, routinely used and with limited cost, accurately stratify mortality risk during AHF.
Kaplan-Meier curves
Funding Acknowledgement
Type of funding source: None
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Philabout P, Soulat-Dufour L, Benhamou-Tarallo I, Lang S, Ederhy S, Ancedy Y, Adavane-Scheuble S, Chauvet-Droit M, Nhan P, Jean M, Ben Said R, Boccara F, Addetia K, Lang R, Cohen A. Impact of rhythm in non-valvular atrial fibrillation on four cardiac chamber deformation imaging. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Few studies have assessed the evolution of cardiac chambers deformation imaging in patients with atrial fibrillation (AF) according to cardiac rhythm outcome.
Purpose
To evaluate cardiac chamber deformation imaging in patients admitted for AF and the evolution at 6-month follow-up (M6).
Methods
In forty-one consecutive patients hospitalised for AF two-dimensional transthoracic echocardiography was performed at admission (M0) and after six months (M6) of follow up. In addition to the usual parameters of chamber size and function, chamber deformation imaging was obtained including global left atrium (LA) and right atrium (RA) reservoir strain, global left ventricular (LV) and right ventricular (RV) free wall longitudinal strain. Patients were divided into three groups according to their cardiac rhythm at M0 and M6: AF at M0 and sinus rhythm (SR) at M6 (AF-SR) (n=23), AF at M0 and AF at M6 (AF-AF) (n=11), SR at M0 (spontaneous conversion before the first echocardiography exam) and SR in M6 (SR-SR) (n=7)
Results
In comparison with SR patients (n=7), at M0, AF patients (n=34)) had lower global LA reservoir strain (+5.2 (+0.4 to 12.8) versus +33.2 (+27.0 to +51.5)%; p<0.001), lower global RA reservoir strain (+8.6 (−5.4 to 11.6) versus +24.3 (+12.3 to +44.9)%; p<0.001), lower global LV longitudinal strain (respectively −12.8 (−15.2 to −10.4) versus −19.1 (−21.8 to −18.3)%; p<0.001) and lower global RV longitudinal strain (respectively −14.2 (−17.3 to −10.7) versus −23.8 (−31.1 to −16.2)%; p=0.001). When compared with the AF-SR group at M0 the AF-AF group had no significant differences with regard to global LA and RA reservoir strain, global LV and RV longitudinal strain (Table). Between M0 and M6 there was a significant improvement in global longitudinal strain of the four chambers in the AF-SR group whereas no improvements were noted in the AF-AF and SR-SR group (Figure).
Conclusion
Initial atrial and ventricular deformations were not associated with rhythm outcome at six-month follow up in AF. The improvement in strain in all four chambers strain suggests global reverse remodelling all cardiac cavities with the restoration of sinus rhythm.
Evolution of strain between M0 and M6
Funding Acknowledgement
Type of funding source: None
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Cohen A, Reijman M, Kraan GA, Mathijssen NMC, Koopmanschap MA, Verhaar JAN, Mol S, Colaris JW. Clinically SUspected ScaPhoid fracturE: treatment with supportive bandage or CasT? 'Study protocol of a multicenter randomized controlled trial' (SUSPECT study). BMJ Open 2020; 10:e036998. [PMID: 32994236 PMCID: PMC7526317 DOI: 10.1136/bmjopen-2020-036998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Some scaphoid fractures become visible on radiographs weeks after a trauma which makes normal radiographs directly after trauma unreliable. Untreated scaphoid fractures can lead to scaphoid non-union progressing to osteoarthritis. Therefore, the general treatment for patients with a clinically suspected scaphoid fracture and normal initial radiographs is immobilisation with below-elbow cast for 2 weeks. However, most of these patients are treated unnecessarily because eventually less than 10% of them are diagnosed with an occult scaphoid fracture. To reduce overtreatment and costs as a result of unnecessary cast treatment in patients with a clinically suspected scaphoid fracture and normal initial radiographs, we designed a study to compare below-elbow cast treatment with supportive bandage treatment. We hypothesise that the functional outcome after 3 months is not inferior in patients treated with supportive bandage compared to patients treated with below-elbow cast, but with lower costs in the supportive bandage group. METHODS AND ANALYSIS The SUSPECT study is an open-labelled multicentre randomised controlled trial with non-inferiority design. A total of 180 adult patients with a clinically suspected scaphoid fracture and normal initial radiographs are randomised between two groups: 3 days of supportive bandage or 2 weeks of below-elbow cast. We aim to evaluate the functional outcome and cost-effectiveness of both treatments. The primary outcome is the functional outcome after 3 months, assessed with the Quick Disability of the Arm, Shoulder and Hand score. Secondary outcomes include functional outcome, recovery of function, pain, patient satisfaction, quality of life and cost-effectiveness measured by medical consumption, absence from work or decreased productivity. ETHICS AND DISSEMINATION The Medical Ethics Committee of the Erasmus MC Medical Centre, Rotterdam, approved the study protocol (MEC-2017-504). We plan to present the results after completion of the study at (inter)national conferences and publish in general peer-reviewed journals. TRIAL REGISTRATION NUMBER NL6976.
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Ou Z, Spring L, Nohria A, Seeger J, Doucette J, Cohen A, Murimi-Worstell I. PCN83 Real-World Prescription Patterns of HER2+/HR- Metastatic Breast Cancer Patients after Ado-Trastuzumab Emtansine Approval: A Retrospective Cohort Study Using Electronic Health Record DATA with Cancer Registries. Value Health Reg Issues 2020. [DOI: 10.1016/j.vhri.2020.07.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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De Marchis E, Adler N, Clark C, Cohen A, Fleegler E, Hessler D, Lindau S, Pantell M, Prather A, Ommerborn M, Tung E, Gottlieb L. Screening for Social Risk Factors: A Comparison of Two Multi‐Domain Social Risk Screening Tools. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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De Marchis E, Cohen A, Fichtenberg C, Fleegler E, Hessler D, Huebschmann A, Lindau S, McCaw B, Tung E, Gottlieb L. Screening for Interpersonal Violence: Potential Harm of Modifying Tools. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Tsironis G, Liontos M, Kyriazoglou A, Koutsoukos K, Tsiara A, Kaparelou M, Zakopoulou R, Cohen A, Skafida E, Fontara S, Zagouri F, Bamias A, Dimopoulos MA. Axitinib as a third or further line of treatment in renal cancer: a single institution experience. BMC Urol 2020; 20:60. [PMID: 32487200 PMCID: PMC7265645 DOI: 10.1186/s12894-020-00618-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 04/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Kidney cancer is a lethal neoplasm that affects several thousands of people every year. Renal cell carcinoma (RCC) is the most common histologic type. Recent developments in the therapeutic approach include antiangiogenic targeted approaches and Immunotherapy. Thus, the therapeutic algorithm of RCC patients and the survival outcomes have changed dramatically. METHODS Herein we present a retrospective study of the patients treated in our Department with an antiangiogenic agent -Axitinib, a tyrosine kinase inhibitor- as a third or further line treatment. Statistical analysis was performed with SPSS, including the available clinicopathological data of the patients included. RESULTS Axitinib was found to be active in patients who received this treatment beyond second line. The toxicity profile of this regimen did not reveal any unknown adverse events. CONCLUSIONS Our real world data reflect that axitinib is a safe and effective option, even beyond the second line.
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Watad A, Mcgonagle D, Bragazzi NL, Comanesther D, Cohen A, Lidar M, Amital H. SAT0603 SYSTEMIC SCLEROSIS IS AN INDEPENDENT RISK FACTOR FOR ISCHEMIC HEART DISEASE WITH AN ADDITIONAL RISK IN THOSE POSITIVE FOR CERTAIN ANTI-PHOSPHOLIPID ANTIBODIES: A VERY LARGE CASE-CONTROL STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:A higher prevalence of ischemic heart disease (IHD) in patients with systemic sclerosis (SSc) was reported. However, contrasting findings were published concerning the role of SSc-related autoantibodies in IHD risk which remains controversial.Objectives:The current study explored the link between SSc and IHD, impact of putative links on SSc mortality and the role of SSc-related and antiphospholipid autoantibodies in disease associated IHD.Methods:A large cohort study utilising the Clalit-Health-Service (CHS) database was conducted on 2,431 SSc patients and 12,710 age- and sex matched controls. The proportion of IHD was compared between patients diagnosed with SSc and age- and gender-matched controls. The role of SSc-linked and antiphospholipid autoantibodies in disease associated IHD was assessed.Results:The rate of IHD was significantly higher in SSc than controls (20.4%vs15.0%, p<0.001). At the multivariate analysis, SSc was an independent predictor of IHD with an OR of 1.91 (95%CI 1.57-2.31, p<0.0001). SSc patients with IHD had a higher mortality rate with an HR of 2.67 (95%CI 2.03-3.53, p<0.0001) than those without IHD. SSc patients with positive anti-beta2GPI (IgM-isotype) or anti-cardiolipin (aCL) (IgA-isotype) exhibited a higher risk of IHD than SSc patients without these antibodies with an OR 1.89 (95% 1.04-3.45, p=0.0369) and OR of 3.72 (95% 1.25-11.11, p=0.0184), respectively.Conclusion:Patients with SSc are at higher risk for developing IHD with an additional risk for the latter in those positive for aCL or anti-beta2GPI. A high degree of suspicion is needed during routine patient follow-up and pre-emptive screening should be considered.Disclosure of Interests:Abdulla Watad: None declared, Dennis McGonagle Grant/research support from: Janssen Research & Development, LLC, Nicola Luigi Bragazzi: None declared, Doron Comanesther: None declared, Arnon Cohen: None declared, Merav Lidar: None declared, Howard Amital: None declared
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Haddad A, Gazitt T, Feldhamer I, Feld J, Cohen A, Zisman D. AB0780 TREATMENT PERSISTENCE OF BIOLOGICS AMONG PATIENTS WITH PSORIATIC ARTHRITIS (PsA). Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Persistence in biologic therapy in psoriatic arthritis is critical to optimize symptom remission, functional capacity and health care costs.Objectives:To estimate the persistence to biologic treatment prescribed to PsA patients in a real-life setting as well as factors associated with improved biologic drug survival in these patients.Methods:Patients with PsA from a large health care provider database with at least two consecutive dispensed prescriptions of a biologic agent indicated for PsA from January 1st, 2002 until December 31st, 2018 were identified and followed until medication stop date or the end of observation period. Patients were considered non-persistent whenever a new prescription was dispensed and a permissible gap of 6 months was exceeded prior to starting on this biologic agent from the prescription date. Treatment changes were based on physician decisions and patient preferences.Demographic data including age, sex, BMI, ethnicity, smoking history and socioeconomic status as well as Charlson comorbidity index were retrieved. Data regarding use of steroids and non-biologic disease-modifying anti-rheumatic drugs were also extracted. Descriptive statistics, including means (standard deviations) for continuous variables and frequencies (%) for categorical variables, were used. Persistence estimates were derived using non-parametric survival analysis using Kaplan-Meier functions, with treatment discontinuations as failure events. Cox regression hazard ratio models were conducted to investigate factors associated with drug persistence.Results:2301 PsA patients with 2958 treatment periods were identified and included in the analyses. The mean age was 50.9±14 years of whom 54% were females, 70.4% of the study population had a BMI>25, and 36% were obese(BMI>30), 40% were current smokers, and 76% had a Charlson comorbidity index higher than 1. The most commonly prescribed drug was etanercept, followed by adalimumab, golimumab, secukinumab, ustekinumab and infliximab at 33%, 29%, 12%, 10%,8% and 8%, respectively. Only about 20% of patients remained on a particular biologic agent after 5 years, whereas about 40% persisted on therapy following 20 months of treatment. A Kaplan-Mayer survival analysis with pairwise comparisons of all treatment choices with respect to lines of therapy was conducted. When analyzing the data for all treatment periods and taking into account all lines of therapy, secukinumab had a higher persistency than adalimumab, infliximab and ustekinumab, with a Log Rank of 0.022, 0.047 and 0.001, respectively, as is shown in figure 1. Female sex and smoking were associated with lower drug persistence (HR=1.25, 95%CI 1.13-1.38 and HR=1.109, 95%CI 1.01-1.21, respectively). When analyzing the data regarding second-line biologic agents, secukinumab was found to be superior to adalimumab, etanercept, infliximab and ustekinumab but not to golimumab with a Log-Rank P value of 0.001, 0.004, 0.025 and 0.002, respectively (figure 2). On analyzing the data using only the first indicated biologic line, no superiority of any single anti-Tumor Necrosis Factor-alpha (anti-TNFα) agent was observed.Conclusion:In this large observational cohort, in the era of biologic therapy, a relatively low persistence was observed, with female sex and smoking having a negative impact on persistency. None of the anti-TNFα agents as first line therapy was found to be more persistent than others, while secukinumab was found to be superior to other biologics when indicated as second line of therapy.References:NoneFigure 1.Figure 2.Acknowledgments:noneDisclosure of Interests:None declared
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Ben-Shabat N, Dar L, Tiosano S, Watad A, Comanesther D, Cohen A, Amital H. OP0143 CANCER IN GIANT-CELL ARTERITIS PATIENTS: A LARGE NATIONWIDE STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The association between giant-cell arteritis (GCA) and malignancy is controversial.Objectives:To asses malignancy rates and risk in GCA patients in a large-scale population-based study.Methods:We utilized the medical database of Clalit-Health-Services for this retrospective cohort study. Follow-up was from January 1,2002 and continued until death or end of follow-up on September 1,2018. Incident GCA patients were compared with age-and-sex-matched controls. Hazard-ratios for subtypes of malignancies were obtained by the Cox proportional-hazard model, adjusted for socio-demographic variables and cancer risk factors.Results:The study population included 7,213 GCA patients and 32,987 age- and sex-matched controls who were not diagnosed with the disease. The mean age of GCA diagnosis was 72.3±9.9 years (median 73.1 years) and 69.1% were women. At Kaplan–Meier survival analysis, assessing cumulative cancer-free survival in GCA patients and controls, GCA patients had worse curve than controls (chi-squared = 49.84; degrees of freedom = 1; p < 0.0001; Figure 1). At the cox-survival analysis adjusted for age, sex, SES and cancer risk factors GCA patients showed increased risk for overall cancer (HR 1.29 [95%CI 1.20-1.39]), kidney cancer (HR 1.60 [95%CI 1.15-2.23]), sarcoma (HR 2.14 [95%CI 1.41-3.24]), acute-leukemia (HR 1.81 [95%CI 1.06-3.07]), chronic-leukemia (HR 1.82 [95%CI 1.19-2.77]), Hodgkin’s lymphoma (HR 2.42 [95%CI 1.12-5.20]), non-Hodgkin’s lymphoma (HR 1.66 [95%CI 1.21-2.29]) and multiple myeloma (HR 2.40 [95%CI 1.63-3.53) (Table 1). The time (mean [months] ± SD) to the diagnosis of any malignancy was significantly shorter in GCA patients (48.6 ± 41.3) compared to controls (58.1 ± 43.6; p<0.001).Table 1.Cox survival analysis assessing crude and adjusted hazard for cancer in GCA patients compare to controlsType of malignancyAdjusted HRHR95% CIAny malignancy1.291.20, 1.39Oropharyngeal cancer0.960.69, 1.35Thyroid cancer1.200.66, 2.16Breast cancer0.930.75, 1.14Lung cancer1.260.99, 1.59Esophagus cancer1.860.93, 3.75Stomach Cancer0.610.37, 0.98Colorectal Cancer1.120.93, 1.36Liver and bile ducts cancer1.060.69, 1.62Kidney cancer1.601.15, 2.23Bladder cancer1.150.88, 1.50Uterus cancer0.850.55, 1.30Cervical cancer of the uterus0.450.37, 1.46Ovary Cancer0.960.58, 1.59Prostate Cancer1.070.80, 1.43Sarcoma2.141.41, 3.24Melanoma1.110.80, 1.55Acute Leukemia1.811.06, 3.07Chronic Leukemia1.821.19, 2.77Myelodysplastic syndrome1.840.94, 3.60Hodgkin’s Lymphoma2.421.12, 5.20Non-Hodgkin’s Lymphoma1.661.21, 2.29Multiple Myeloma2.401.63, 3.53Figure 1.Kaplan-Meier cancer-free survival curveConclusion:GCA patients are at increased risk for sarcoma, kidney cancer, hematological malignancies and overall malignancies compared to age-and-sex matched controls from the general population.References:[1]Watad A, McGonagle D, Bragazzi NL, Tiosano S, Comaneshter D, Shoenfeld Y, et al. Autoantibody status in systemic sclerosis patients defines both cancer risk and survival with ANA negativity in cases with concomitant cancer having a worse survival. Oncoimmunology 2019;8:e1588084.[2]Ben-Shabat N, Tiosano S, Shovman O, Comaneshter D, Shoenfeld Y, Cohen AD, et al. Mortality among patients with giant-cell arteritis: A large-scale population-based cohort study. J Rheumatol 2019;Disclosure of Interests:None declared
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Watad A, Mcgonagle D, Lidar M, Bragazzi NL, Comanesther D, Cohen A, Amital H. OP0253 AUTOANTIBODY STATUS IN DERMATOMYOSITIS AND POLYMYOSITIS PATIENTS DEFINES BOTH CANCER RISK AND SURVIVAL WITH ANA NEGATIVITY IN CASES WITH CONCOMITANT CANCER HAVING A WORSE SURVIVAL. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:We previously reported that ANA-negative cases with systemic sclerosis (SSc) and concomitant cancer had a worse survival than ANA-positive cases with associated cancer possibly suggesting that humoral mediated autoimmunity conferred a survival advantage (1). Dermatomyositis (DM) and polymyositis (PM) are two immune-mediated myopathies associated with numerous autoantibodies.Objectives:The present large-scale, population-based study tested the hypothesis that humoral autoimmunity associated with cancer in solid/haematological malignancies impacted on DM/PM patient survival.Methods:Over 2000 cases with either DM or PM were recruited from the Clalit Health Service (CHS) chronic diseases registry, one of the largest healthcare maintenance Israeli organization, serving approximately half of the entire country’s population. Over 10000 matched controls were recruited. The data collected range from 2000 to 2018.Results:Altogether 12,278 subjects were recruited (2,085 cases, and 10,193 controls, 5,042 males, 41.1%, and 7,236 females, 58.9%). Among cases, 1,475 individuals (70.7%) were diagnosed with DM, whereas 610 (29.3%) with PM. Mean age was 47.81±22.51 years. 1,379 cases of cancers (11.2%) were diagnosed. At the univariate analysis and as expected, the rate of malignancies was significantly (p<0.0001) higher in DM/PM (n=361, 17.3%) with respect to controls (n=1,018, 10.0%).Concerning prognosis, ANA positivity in PM/DM was associated with a better prognosis for all cancers (OR 0.39 [95% 0.24-0.63], p=0.0001). For individual cancer types; thyroid cancer (OR 0.39 [95% 0.24-0.63], p=0.0001), gastric cancer (OR 0.40 [95% 0.25-0.64], p=0.0001), kidney cancer (OR 0.39 [95% 0.24-0. 62], p=0.0001), acute leukaemia (OR 0.40 [95% 0.25-0.65], p=0.0002), non-Hodgkin’s lymphoma (OR 0.39 [95% 0.25-0.63], p=0.0001), but not for myelodysplastic syndrome.The main cancers linked to PM/DM were thyroid cancer (OR 3.17 [95%CI 2.27-4.43]), gastric cancer (OR 5.96 [95%CI 4.24-8.38]), kidney cancer (OR 3.83 [95%CI 1.02-14.31], p=0.0462), and myelodysplastic syndrome (OR 2.01 [95%CI 1.17-3.46], p=0.0111). Regarding gastric cancer, positivity for anti-RNP (OR 5.68 [95%CI 3.02 to 10.71], p<0.0001), anti-SSA (OR 21.99 [95%CI 11.21 to 43.14], p<0.0001), and anti-Jo1 (OR 12.23 [95%CI 7.12 to 21.01], p<0.0001) was associated with a higher risk of cancer development.Conclusion:ANA positivity is an independent predictor of favorable prognosis in PM/DM patients with cancer, possibly suggesting that cancer directed humoral autoimmunity may have some benefit. Therefore, humoral autoimmunity in SSc and PM/DM is a broad mechanism that confers a survival advantage and is relevant for disease understanding and elucidating optimal anti tumoural immunity in the current age of cancer immunotherapy.References:[1]Watad A, McGonagle D, Bragazzi NL, Tiosano S, Comaneshter D, Shoenfeld Y, Cohen AD, Amital H. Autoantibody status in systemic sclerosis patients defines both cancer risk and survival with ANA negativity in cases with concomitant cancer having a worse survival. Oncoimmunology. 2019 Mar 24;8(6):e1588084.Disclosure of Interests:Abdulla Watad: None declared, Dennis McGonagle Grant/research support from: Janssen Research & Development, LLC, Merav Lidar: None declared, Nicola Luigi Bragazzi: None declared, Doron Comanesther: None declared, Arnon Cohen: None declared, Howard Amital: None declared
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Graney PL, Ben-Shaul S, Landau S, Bajpai A, Singh B, Eager J, Cohen A, Levenberg S, Spiller KL. Macrophages of diverse phenotypes drive vascularization of engineered tissues. SCIENCE ADVANCES 2020; 6:eaay6391. [PMID: 32494664 PMCID: PMC7195167 DOI: 10.1126/sciadv.aay6391] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 02/10/2020] [Indexed: 05/05/2023]
Abstract
Macrophages are key contributors to vascularization, but the mechanisms behind their actions are not understood. Here, we show that diverse macrophage phenotypes have distinct effects on endothelial cell behavior, with resulting effects on vascularization of engineered tissues. In Transwell coculture, proinflammatory M1 macrophages caused endothelial cells to up-regulate genes associated with sprouting angiogenesis, whereas prohealing (M2a), proremodeling (M2c), and anti-inflammatory (M2f) macrophages promoted up-regulation of genes associated with pericyte cell differentiation. In 3D tissue-engineered human blood vessel networks in vitro, short-term exposure (1 day) to M1 macrophages increased vessel formation, while long-term exposure (3 days) caused regression. When human tissue-engineered blood vessel networks were implanted into athymic mice, macrophages expressing markers of both M1 and M2 phenotypes wrapped around and bridged adjacent vessels and formed vessel-like structures themselves. Last, depletion of host macrophages inhibited remodeling of engineered vessels, infiltration of host vessels, and anastomosis with host vessels.
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Morris T, Sandow T, Gimenez J, Gulotta P, Thevenot P, Nunez K, Gilbert P, Marsala A, Bohorquez H, Cohen A, Kay D, Ramalingam V. 3:36 PM Abstract No. 302 Effect of bridging locoregional therapy on hepatic arterial complications following liver transplant: 3-year, multicenter, retrospective analysis of 608 patients. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Cohen A, Sant’Anna A, Ahmed N. A229 USTEKINUMAB FOR THE TREATMENT OF REFRACTORY PEDIATRIC CROHN’S DISEASE: A SINGLE CENTRE EXPERIENCE. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Despite the well-established efficacy of Tumor Necrosis Factor (TNF) antagonists as treatment options for Crohn’s Disease, many pediatric patients need a change in therapy due to adverse events, as well as primary and secondary loss of response, highlighting the necessity for medications with a different mechanism of action. Ustekinumab, a monoclonal antibody targeting IL-12 and IL-23, has been approved to treat psoriatic arthritis, plaque psoriasis, and adults with Crohn’s disease. While utekinumab has been shown to be effective in inducing clinical remission in adults with Crohn’s disease refractory to anti-TNF agents, minimal data exists in the pediatric population.
Aims
We retrospectively describe 11 pediatric patients who received ustekinumab at the Montreal Children’s Hospital with the goal of assessing its efficacy in inducing clinical, biochemical, and endoscopic remission.
Methods
We abstracted baseline data, prior treatment and response, indications for starting ustekinumab, clinical response, endoscopic data, and laboratory parameters pre- and post- therapy. Clinical response was defined as decrease in abbrPCDAI (Pediatric Crohn’s Disease Activity Index) score.
Results
Patients ranged in age from 12–17 years old upon initiation of treatment with ustekinumab and had all previously failed either one (N=8) or both (N=3) anti-TNF therapies. Follow-up ranged from 6 to 22 months. We examined three indices of response to ustekinumab: symptomatic improvement, biomarker normalization, and endoscopic changes. Five of eleven patients demonstrated a clinical response – two maintained clinical remission across available follow-up data, while the remaining three experienced a secondary loss of response. The other six patients studied were primary non-responders. Two of these patients had normal abbrPCDAI scores upon initiation of ustekinumab and terminated therapy due to persistent stricturing disease. The other four non-responders either remained unwell or demonstrated clinical worsening, as measured by the abbrPCDAI. Of the clinical responders, 3/5 had elevated CRP values prior to initiating ustekinumab therapy, all of which normalized within one month of clinical improvement. Endoscopic data both pre- and post- ustekinumab was available in two responders and two non-responders, with endoscopic improvement seen in both of the responders and in one of the two non-responders.
Conclusions
These results demonstrate that ustekinumab has the potential ability to induce not only clinical and biochemical remission, but also endoscopic improvement, in the pediatric population. An area of concern is the fact that only one patient maintained remission for longer than one year. Future research should focus on maximizing and lengthening the effect of ustekinumab, as well as determining factors that influence response to therapy.
Funding Agencies
None
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Curiale MS, Gangar V, Gravens C, Agin JR, Bound A, Bowles L, Brockman R, Brusatti L, Bulawka CE, Cohen A, Deeks C, Eklund CA, Fukuoka J, Gangar V, Hammer C, Harris L, Hoffman C, Jost-Keating K, Keng JG, Kerdahi K, Krzyanowski W, Manley D, Miller C, Mondon D, Neufang K, Niroomand F, Plante R, Post L, Roman M, Rude D, Raghubeer EV, Ryder J, Smith C, Stoltzner L, Thomas L, Vanderbilt B, Wright T. VIDAS Enzyme-Linked Fluorescent Immunoassay for Detection of Salmonella in Foods: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/80.3.491] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
The VIDAS SLM method for detection of Salmonella was compared with the Bacteriological Analytical Manual (BAM)/AOAC culture method in a collaborative study. Twenty laboratories participated in the evaluation. Each laboratory tested one or more of 6 test products: milk chocolate, nonfat dry milk, dried whole egg, soy flour, ground black pepper, and ground raw turkey. No significant differences (P< 0.05) were observed between the 2 methods. The 2 methods were in agreement for 99% of 1544 samples analyzed. Of the 20 samples out of agreement, 8 were VIDAS SLM positive and BAM/AOAC negative, and 12 were VIDAS SLM negative and BAM/AOAC positive. The VIDAS SLM method for detection of Salmonella in foods has been adopted first action by AOAC INTERNATIONAL.
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Chalard C, Soulat-Dufour L, Lang S, Ederhy S, Ancedy Y, Adavane-Scheuble S, Chauvet-Droit M, Nhan P, Ben Said R, Boccara F, Cohen A. P350 Right atrial remodelling in atrial fibrillation using three dimensional transthoracic echocardiography and strain imaging. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Evaluation of right atrial cavities and right atrial (RA) remodelling in atrial fibrillation (AF) has been poorly studied.
Purpose
The aim of this study was to evaluate in AF, the role of three-dimensional (3D) transthoracic echocardiography (TTE) and strain to refine the evaluation of the RA according to evolution of cardiac rhythm ad mid-term follow-up.
Methods
A complete 2D and 3D TTE was performed in patient hospitalized for AF. In addition to the usual parameters, RA parameters were specifically assessed: 3D RA end-systolic (ES) and end-diastolic (ED) volume, RA ejection fraction (EF) and the global longitudinal strain (GLS) of the RA. A complete clinical evaluation and electrocardiogram were performed at admission (M0) and 6 months after inclusion (M6) to determine the cardiac rhythm at follow-up.
Results
34 consecutive patients hospitalized for AF were analysed. At M0, there was no significant difference between 2D RA ES volume and the 3D RA ES volume. Three groups of patients were individualized according to cardiac rhythm at M0 and M6: AF at M0 and AF at M6 (AF-AF), AF at M0 and sinus rhythm (SR) at M6 (AF-SR), SR at M0 (spontaneous reduction before the admission ECG) and SR at M6 (SR-SR). At M0 echocardiography, in the AF-AF group and AF-SR in comparison with SR-SR group were as follow: the 3D RA ED volume was significantly higher (respectively 21.6 (18.2-26.6) and 26.9 (19.4-36.8) versus 11.3 (6.9-16.6) mL/m2 ; p = 0.0025), the 3D RAEF was significantly lower (42.2 (35.1-44.7) and 34.5 (24.1-38.6) versus 57.6 (53.4-62.2)%; p = 0.0105) and the RA GLS was also significantly lower (7.6 (6.5-10.5) and 9.1 (5.8-11.2) versus 26.6 (22.0-35.0)%; p = 0.0001) (Figure 1).
Conclusion
3D ultrasound and strain could be useful tools for evaluating the anatomical and functional RA remodelling in AF, to be further validated in a larger ongoing study.
Abstract P350 Figure 1
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Cohen A, Angoulvant D. Cardiomyopathie du diabétique, dépistage et épidémiologie. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2019. [DOI: 10.1016/s1878-6480(19)30963-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Dan O, Harel A, Asraf K, Cohen A, Haimov I. The effect of sleep deprivation on emotional facial versus nonfacial stimuli processing in young adults with ADHD. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Keisari Y, Domankevich-Bachar V, Cohen A, Efrati M, Bellia S, Feliciani G, Monti M, Schmidt M, Kelson I. PO-190: Local and systemic abolition of metastatic cancer by alpha particle brachytherapy and immunotherapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(20)30531-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cohen A, Hertz HS, Mandel J, Paule RC, Schaffer R, Sniegoski LT, Sun T, Welch MJ, White E. Total serum cholesterol by isotope dilution/mass spectrometry: a candidate definitive method. Clin Chem 2019. [DOI: 10.1093/clinchem/26.7.0854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
We describe a highly accurate and precise method for determination of total cholesterol in serum by isotope dilution/mass spectrometry. The method was developed for a Study Group of the Committee on Standards of the American Association for Clinical Chemistry, for use in establishing the accuracy of a candidate reference method for total cholesterol, and fulfills their criteria for a definitive method. Cholesterol-d7 is added to serum, with the weight ratio of cholesterol-d7 to total serum cholesterol kept near to 1:1. The esters are hydrolyzed and the cholesterol is separated and converted into the trimethylsilyl ether derivative for measurement by combined gas chromatography/mass spectrometry. The intensity ratio of the molecular ions at m/z 465 and 458 is measured for each sample and for two calibration mixtures, according to a prescribed bracketing protocol. A weight ratio for the sample is obtained by linear interpolation of the ion-intensity ratios, and the total cholesterol is then calculated. The method was applied four times over several weeks to each of five serum pools. Statistical analysis involving consideration of both replication error and variability between weeks gave a coefficient of variation for a single measurement of 0.36%. The absence of interferences in the method was demonstrated by measurements at several other masses.
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