O-142 SARS-CoV-2 vaccination and IVF cycle outcomes

Study question

Does recent mRNA SARS-CoV-2 vaccination effect IVF pregnancy rate?

Summary answer

We observed no influence of mRNA SARS-CoV-2 vaccine on patients’ IVF cycle outcomes; vaccination did not change pregnancy rates.

What is known already

Two recent studies showed that the BNT162b2 mRNA SARS-COV-2 vaccine does not appear to have negative effects on oocytes during controlled ovarian stimulation. Assessment of follicular fluid after vaccination (1) concluded that there was no affect on the follicle quality or function. An additional study of 36 patients that underwent IVF both immediately before and immediately after vaccination found no change in ovarian yield or embryo quality (2).

Study design, size, duration

A retrospective case control study including 385 women from January 1, 2021 to May 31st of the same year.

Participants/materials, setting, methods

The study group included patients that received 2 doses of the Pfizer SARS-COV-2 vaccine between 7-180 days prior to starting IVF and without a history of COVID infection. Controls included unvaccinated patients from the same time period and historical age matched patients from our hospital from the same months in prior years. 385 patients under the age of 40 years met the inclusion criteria, 349 in the control and 36 in the vaccinated group.

Main results and the role of chance

Demographic and clinical characteristics were comparable between groups. The pregnancy rate was 33.3% (n = 12) in the vaccinated group vs 31.8% (n = 111) in the control group (p > 0.1). There were no statistically significant differences between the control and vaccine groups with a small non-significant trend to higher pregnancy rates in vaccinated patients: pregnancy rate OR for vaccination group was 1.17 (95% CI 0.56-2.44). 

Limitations, reasons for caution

Our study size was small and was observational leaving it open to confounding and selection bias regarding who chose to receive the vaccine and those in high risk groups for COVID infection. Additionally, longterm effect of the vaccine and booster were not assessed.

Wider implications of the findings

We did not observe any effect of this vaccine regimen on IVF outcomes or pregnancy rates. This underscores worldwide data and physiologic reasoning that there should not be significant effects of this COVID vaccine on developing gametes quality and function and is a good option for those trying to conceive.

Trial registration number

LND 0031-21

The thalamus and its subregions – a gateway to obsessive-compulsive disorder

Introduction

Higher thalamic volume has been found in children with obsessive-compulsive disorder (OCD) and children with clinical-level symptoms within the general population (Boedhoe et al. 2017, Weeland et al. 2021a). Functionally distinct thalamic nuclei are an integral part of OCD-relevant brain circuitry.

Objectives

We aimed to study the thalamic nuclei volume in relation to subclinical and clinical OCD across different age ranges. Understanding the role of thalamic nuclei and their associated circuits in pediatric OCD could lead towards treatment strategies specifically targeting these circuits.

Methods

We studied the relationship between thalamic nuclei and obsessive-compulsive symptoms (OCS) in a large sample of school-aged children from the Generation R Study (N = 2500) (Weeland et al. 2021b). Using the data from the ENIGMA-OCD working group we conducted mega-analyses to study thalamic subregional volume in OCD across the lifespan in 2,649 OCD patients and 2,774 healthy controls across 29 sites (Weeland et al. 2021c). Thalamic nuclei were grouped into five subregions: anterior, ventral, intralaminar/medial, lateral and pulvinar (Figure 1).

Results

Both children with subclinical and clinical OCD compared with controls show increased volume across multiple thalamic subregions. Adult OCD patients have decreased volume across all subregions (Figure 2), which was mostly driven by medicated and adult-onset patients.

Conclusions

Our results suggests that OCD-related thalamic volume differences are global and not driven by particular subregions and that the direction of effects are driven by both age and medication status.

Disclosure

No significant relationships.

Nivolumab in gastric/gastroesophageal junction cancer: real-world data from UK Early Access to Medicines Scheme

Aim: This study provides real-world insight into patient profile, clinical effectiveness and health-related quality of life among patients with advanced gastric/gastroesophageal junction (GEJ) adenocarcinoma treated with nivolumab. Materials & methods: Data were collected from medical records of patients with advanced GEJ adenocarcinoma treated with nivolumab in a UK Early Access to Medicines Scheme and from the patient-reported EuroQoL five dimensions questionnaire. Results: Evaluable patients (n = 113; median age 62 years) were predominantly male (76.1%), White (87.4%) and with GEJ adenocarcinoma (61.9%). Median follow-up was 2.8 months. The 6-month progression-free survival and overall survival were 31.6 and 56.7%, respectively. Mean EuroQoL five dimensions questionnaire index utility scores at baseline, 8, 16 and 24 weeks were 0.795, 0.831, 0.870 and 0.793, respectively. Conclusion: Progression-free survival was consistent with trial results and health-related quality of life remained stable over time.

Vedolizumab and Anti-Tumour Necrosis Factor α Real-World Outcomes in Biologic-Naïve Inflammatory Bowel Disease Patients: Results from the EVOLVE Study

BACKGROUND AND AIMS

This study aimed to compare real-world clinical effectiveness and safety of vedolizumab, an α4β7-integrin inhibitor, and anti-tumour necrosis factor-α [anti-TNFα] agents in biologic-naïve ulcerative colitis [UC] and Crohn's disease [CD] patients.

METHODS

This was a 24-month retrospective medical chart study in adult UC and CD patients treated with vedolizumab or anti-TNFα in Canada, Greece and the USA. Inverse probability weighting was used to account for differences between groups. Primary outcomes were cumulative rates of clinical effectiveness [clinical response, clinical remission, mucosal healing] and incidence rates of serious adverse events [SAEs] and serious infections [SIs]. Secondary outcomes included cumulative rates of treatment persistence [patients who did not discontinue index treatment during follow-up] and dose escalation and incidence rates of disease exacerbations and disease-related surgeries. Adjusted analyses were performed using inverse probability weighting.

RESULTS

A total of 1095 patients [604 UC, 491 CD] were included. By 24 months, rates of clinical effectiveness were similar between groups, but incidence rates of SAEs (hazard ratio [HR] = 0.42 [0.28-0.62]) and SIs (HR = 0.40 [0.19-0.85]) were significantly lower in vedolizumab vs anti-TNFα patients. Rates of treatment persistence [p < 0.01] by 24 months were higher in vedolizumab patients with UC. Incidence rates of disease exacerbations were lower in vedolizumab patients with UC (HR = 0.58 [0.45-0.76]). Other outcomes did not significantly differ between groups.

CONCLUSION

In this real-world setting, first-line biologic therapy in biologic-naïve patients with UC and CD demonstrated that vedolizumab and anti-TNFα treatments were equally effective at controlling disease symptoms, but vedolizumab has a more favourable safety profile.

Real-world clinical effectiveness and safety of vedolizumab and anti-tumor necrosis factor alpha treatment in ulcerative colitis and Crohn's disease patients: a German retrospective chart review

Background

Real-world comparisons of biologic treatment outcomes for ulcerative colitis (UC) or Crohn’s disease (CD) patients are limited. We sought to evaluate the real-world effectiveness of vedolizumab (VDZ) and anti-tumor necrosis factor alpha (anti-TNFα) in UC and CD patients in Germany.

Methods

A retrospective chart review (15 sites) investigated UC and CD patients who were biologic-treatment naïve (biologic-naïve) or had received no more than one prior anti-TNFα before initiating treatment with VDZ or anti-TNFα between 15 July 2014 and 20 October 2015. Kaplan-Meier analyses assessed time to first chart-documented clinical remission (CR) and symptom resolution (UC: rectal bleeding [RB], stool frequency [SF]; CD: abdominal pain [AP], liquid stools [LS]) and outcome duration.

Results

A total of 133 UC (76 VDZ; 57 anti-TNFα) and 174 CD (69 VDZ; 105 anti-TNFα) patients were included. By Week 26, estimated cumulative rates of patients achieving CR or symptom resolution with VDZ vs anti-TNFα treatment were for UC: CR, 53.7% vs 31.7%; RB, 66.8% vs 55.8%; and SF, 59.8% vs 50.7%, respectively; and for CD: CR, 14.4% vs 32.8%; AP, 62.5% vs 56.0%; and LS, 29.9% vs 50.3%, respectively. Outcomes were sustained similarly between treatments, except RB (VDZ vs anti-TNFα: median 38.1 vs 15.1 weeks, P = 0.03). Treatment-related adverse events occurred in 5.3% vs 7.0% (UC) and 8.7% vs 19.0% (CD) of VDZ vs anti-TNFα patients, respectively.

Conclusions

Although there were differences in CR, symptom resolution, and safety profiles, real-world data support both VDZ and anti-TNFα as effective treatment options in UC and CD.

Dabrafenib plus trametinib is effective in the treatment of BRAF V600-mutated metastatic melanoma patients: analysis of patients from the dabrafenib plus trametinib Named Patient Program (DESCRIBE II)

In clinical trials, dabrafenib plus trametinib improved overall survival (OS) compared with single-agent BRAF inhibitors (BRAFi) in patients with BRAF V600-mutant unresectable or metastatic melanoma. We investigated dabrafenib plus trametinib therapy in a compassionate-use setting [Named Patient Program (NPP); DESCRIBE II]. A retrospective chart review of patients with BRAF V600-mutated unresectable stage III/IV melanoma receiving dabrafenib plus trametinib as compassionate use was conducted. Treatment patterns and duration, clinical outcomes, and tolerability were evaluated. Of 271 patients, 92.6% had stage IV melanoma, including 36.5% with brain metastases. Overall, 162 patients (59.8%) were BRAFi naive and 171 (63.1%) received first-line dabrafenib plus trametinib. Among BRAFi-naive patients, the overall response rate (ORR) was 67.3%, median OS (mOS) was 20.0 months, and median progression-free survival (mPFS) was 7.5 months. In BRAFi-naive patients with known brain metastases (n = 62), ORR was 61.3%, mOS was 15.5 months, and mPFS was 6.2 months. Eighty-four patients received BRAFi monotherapy for >30 days and switched to dabrafenib plus trametinib prior to progression. Of these 84 patients, 63 had known disease status at the time of switch, and 22 improved with the combination therapy. No new safety signals were identified, and dabrafenib plus trametinib was well tolerated. Dabrafenib plus trametinib showed substantial clinical activity in NPP patients with BRAF V600-mutated unresectable or metastatic melanoma. Analysis of treatment patterns demonstrated the effectiveness of the combination in patients with brain metastases and across lines of therapy with a well tolerated and manageable safety profile.

Timing of GLP-1 Receptor Agonist Initiation for Treatment of Type 2 Diabetes in the UK

Introduction

Patients with type 2 diabetes mellitus (T2DM) who fail to meet glycaemic control are at increased risk of diabetes complications. For patients who cannot maintain glycaemic control with oral medication, one recommended option is to add an injectable glucagon-like peptide-1 receptor agonist (GLP-1 RA) to their treatment regimen. The purpose of this study was to examine time to treatment intensification with GLP-1 RAs, including the duration of time that patients did not maintain glycaemic control with oral medication.

Methods

This was a medical record review conducted in the UK via a physician survey. Patients eligible to have their records reviewed were required to be ≥ 18 years of age, have a confirmed T2DM diagnosis, and have initiated GLP-1 RA treatment for T2DM in the past 6 months. All glycated haemoglobin (HbA1c) values within 5 years prior to GLP-1 RA initiation were collected.

Results

A total of 113 physicians contributed data for 1096 patients (mean age at the time of GLP-1 RA initiation was 54.9 years, 55.4% were male, and 71.4% were White). Median time from T2DM diagnosis to GLP-1 RA initiation was 6.1 years. Median consecutive time patients taking oral regimens were not under glycaemic control (HbA1c > 7.0%) prior to GLP-1 RA initiation was 13.5 months. Patients treated by general practitioners (GPs) had a significantly longer duration of time with insufficient glycaemic control prior to GLP-1 RA initiation compared with patients treated by diabetes specialists (median time for specialists was 11.0 months vs. 17.0 months for GPs; p = 0.038).

Conclusions

Results suggest that treatment intensification is often delayed despite consistently poor glycaemic control for more than 12 months, contrary to treatment guideline recommendations. Findings from this study highlight that some T2DM patients may benefit from more rapid treatment intensification, which could improve glycaemic control and reduce the risk for many short- and long-term health complications.

Consumer Perception Towards the Enhanced Color of Atypical Dark-Cutting Beef by Nitrite-Embedded Packaging

ObjectivesMeat color is often seen by consumers as an indicator of freshness and wholesomeness. Nitrite-embedded (NE) packaging forms nitric oxide myoglobin, which imparts a bright red color similar to oxymyoglobin. However, limited research has determined the effects of NE packaging to improve the appearance of atypically dark cutting beef. Consumers’ perception of NE packaging ultimately determines its success in the market. Educating consumers through infographics can transfer knowledge more effectively than text alone, potentially being a useful method to introduce and simplify the complexity of NE packaging’s role in improving the surface color of beef steaks. The objectives of this study were to evaluate FreshCase® nitrite-embedded packaging’s effect on atypical dark-cutting beef steaks and to evaluate student consumer perception of nitrite-embedded packaging improving the surface color of beef before and after exposure to infographics containing equal content.Materials and MethodsAtypical dark-cutting (n = 13, pH 5.70 ± 0.09) and normal-pH (n = 13, pH = 5.57 ± 0.1) USDA Low Choice beef strip loins were selected 3 d postharvest. Atypical dark-cutting loins were cut into 2.54 cm thick steaks and randomly packaged in polyvinyl chloride film (PVC) or NE film. Normal-pH control loins were cut 2.54 cm and randomly packaged in PVC overwrap. Packages were placed in a coffin-style retail case under fluorescent lighting for 6 d. Instrumental color was observed every 24 h using a HunterLab MiniScan XE spectrophotometer. The color was determined as a* values and chroma. In the second objective, surveys using a ten-point Likert sliding scale (0 = not familiar at all, 10 = extremely familiar) were randomly allocated and emailed via Qualtrics to students enrolled in the Introduction to Animal Science course at Oklahoma State University. These surveys used a pre-questionnaire to evaluate students’ pre-perception of their knowledge of beef color and NE packaging. After the pre-perception questionnaire students were provided one of the following: a static infographic presented as a still image with annotated graphics, a 46 s video infographic with audio and animated graphics, or both infographic formats. A post-questionnaire followed exposure to students’ respective infographic to evaluate changes in the perception of knowledge.ResultsAtypical dark-cutting steaks treated in NE packaging had higher (P < 0.05, more red intensity) chroma and a* values compared to atypical dark-cutting steaks in PVC on d 4, 5, and 6. There was a significant difference (P < 0.05) in the students’ (n = 288) pre- and post-questionnaire self-assessment of their familiarity with NE packaging. Prior to randomly viewing infographics, students were less familiar (= 3.18) with NE packaging than after viewing infographics (= 6.46). However, there was no significant difference in perceptions (P = 0.22) between viewing the different infographic formats.ConclusionThe results suggest that NE packaging with consumer education can improve their perceptions and knowledge and enhance the appearance of atypical dark-cutting beef.

Extracting data from a chemotherapy prescription platform for real-world oncology research in the UK: a pilot study

Aim: In the UK, there are limited data sources for evaluating real-world research questions related to oncology therapy. We conducted a pilot study to investigate the feasibility of extracting data directly from a chemotherapy prescription platform (ChemoCare^®) utilized in standard care. Patients & methods: Concordance was compared with data extracted manually for patients with advanced melanoma as part of a concurrent chart review (gold-standard) using Cohen's kappa and the intraclass correlation coefficient. Results: There was high concordance between data automatically extracted from the prescription platform and chart review data. Conclusion: This pilot can be used as a framework for future studies using direct, automated extraction from prescription platforms.

High-fructose diet during adolescent development increases neuroinflammation and depressive-like behavior without exacerbating outcomes after stroke

Diseases, disorders, and insults of aging are frequently studied in otherwise healthy animal models despite rampant co-morbidities and exposures among the human population. Stressor exposures can increase neuroinflammation and augment the inflammatory response following a challenge. The impact of dietary exposure on baseline neural function and behavior has gained attention; in particular, a diet high in fructose can increase activation of the hypothalamic-pituitary-adrenal axis and alter behavior. The current study considers the implications of a diet high in fructose for neuroinflammation and outcomes following the cerebrovascular challenge of stroke. Ischemic injury may come as a "second hit" to pre-existing metabolic pathology, exacerbating inflammatory and behavioral sequelae. This study assesses the neuroinflammatory consequences of a peri-adolescent high-fructose diet model and assesses the impact of diet-induced metabolic dysfunction on behavioral and neuropathological outcomes after middle cerebral artery occlusion. We demonstrate that consumption of a high-fructose diet initiated during adolescent development increases brain complement expression, elevates plasma TNFα and serum corticosterone, and promotes depressive-like behavior. Despite these adverse effects of diet exposure, peri-adolescent fructose consumption did not exacerbate neurological behaviors or lesion volume after middle cerebral artery occlusion.

Activation of the Fibrinolytic System in Patients with Coronary Artery Disease and Hyperfibrinogenemia

Elevated fibrinogen levels as well as an impaired activity of the fibrinolytic system are regarded as important cardiovascular risk factors. To elucidate a potential interrelation between fibrinogen as an indicator of a hypercoagulable state and the endogenous fibrinolytic function hemostatic and rheological as well as lipid parameters were determined in 224 consecutive patients, who underwent elective coronary angiography. In the selected study population of 81 men and 19 women with fibrinogen concentrations either ≥3.5 g/1 (n = 70) or ≤2.5 g/1 (n = 30) hyperfibrinogenemia was found to be significantly associated with increased concentrations of plasmin-α2-antiplasmin complex [PAP [median (25.-75. percentile)], 534 (361-680) μg/l vs. 289 (243-440) μg/1; p <0.001] and tissue plasminogen activator (t-PA) antigen [9 (6-11) μg/1 vs. 8 (5-9) |xg/l; p <0.05] while this association was lost in the subgroup of patients with angiographically normal coronary arteries (n = 26). In addition to these findings fibrinogen was significantly correlated with PAP (r = 0.40, p <0.001; n = 224) and t-PA antigen (r = 0.2, p <0.01; n = 224) after adjustment for age, diabetes mellitus, lipid parameters and leucocyte counts. It can be argued that elevated fibrinogen levels in patients with coronary artery disease are concomitant with an activation of the fibrinolytic system.

Quantitative biomarkers for liver metastases: comparison of MRI diffusion-weighted imaging heterogeneity index and fluorine-18-fluoro-deoxyglucose standardised uptake value in hybrid PET/MR

AIM

To investigate the ability of apparent diffusion coefficient (ADC) heterogeneity index to discriminate liver metastases (LM) from normal-appearing liver (NAL) tissue as compared to common magnetic resonance imaging (MRI) metrics, and to investigate its correlation with 2-[¹⁸F]-fluoro-2-deoxy-d-glucose (¹⁸F-FDG) positron-emission tomography (PET) standardised uptake value (SUV).

MATERIALS AND METHODS

Thirty-nine liver metastases in 24 oncology patients (13 women, 11 men; mean age 56±13 years) with proven LM from heterogeneous sources were evaluated on a PET/MRI system. Abdominal sequences included Dixon and diffusion-weighted imaging (DWI) protocols with simultaneous PET. Tissue heterogeneity was calculated using the coefficient of variance (CV) of the ADC, and compared in LM and in NAL tissue of the same volume in an adjacent portion of the liver. The correlations between various ADC measures and PET SUV in distinguishing LM from NAL were evaluated.

RESULTS

A good correlation was found between ADCcv and SUVpeak (r=0.712). Moderate inverse correlation was found between ADCmin and SUVpeak (r=-0.536), and a weak inverse correlation between ADCmean and SUVpeak (r=-0.273). There was a significant difference between LM and NAL when ADCcv (p<0.0001) and ADCmin (p=0.001) were used. Receiver operating characteristic (ROC) analysis of SUV, ADCcv, ADCmin, and ADCmean produced an AUC of 0.989, 0.900, 0.742, and 0.623 respectively.

CONCLUSIONS

The ADCcv index is a potential biomarker of LM with better correlation to ¹⁸F-FDG PET SUVpeak than conventional MRI metrics, and may serve to quantitatively discriminate between LM and NAL.

The effect of P38 MAP kinase inhibition in a mouse model of influenza

PURPOSE

Influenza viruses are a common cause of human respiratory infections, resulting in epidemics of high morbidity and mortality. We investigated the effect of a novel mitogen-activated protein kinase (MAPK) inhibitor in vitro and in a murine influenza model to further explore whether p38 MAPK inhibition could reduce viral replication.

METHODS

In vitro, the antiviral effect of p38 MAPK inhibitor BCT194 was evaluated in differentiated human bronchial epithelial cells (HBECs); in vivo, female BALB/c mice were infected intranasally with 150 pfu of influenza H1N1 A/Puerto Rico/8/34 and treated with BCT197 (a closely related p38 MAPK inhibitor with an IC50 value of<1 µM, currently in clinical testing), dexamethasone or oseltamivir (Tamiflu) starting 24 h post infection. Body weight, bronchoalveolar lavage cells, cytokines, total protein and lactate dehydrogenase as well as serum cytokines were measured; a subset of animals was evaluated histopathologically.Results/Key findings. p38MAP kinase inhibition with BCT194 had no impact on influenza replication in HBECs. When examining BCT197 in vivo, and comparing to vehicle-treated animals, reduced weight loss, improvement in survival and lack of impaired viral control was observed at BCT197 concentrations relevant to those being used in clinical trials of acute exacerbations of chronic obstructive pulmonary disease; at higher concentrations of BCT197 these effects were reduced.

CONCLUSIONS

Compared to vehicle treatment, BCT197 (administered at a clinically relevant concentration) improved outcomes in a mouse model of influenza. This is encouraging given that the use of innate inflammatory pathway inhibitors may raise concerns of negative effects on infection regulation.

Treatment patterns and clinical outcomes with pazopanib in patients with advanced soft tissue sarcomas in a compassionate use setting: results of the SPIRE study. Acta Oncol 2017;56:1769-1775. [PMID: 28723233 DOI: 10.1080/0284186x.2017.1332779]

BACKGROUND

A named patient program (NPP) was designed to provide patients with advanced soft-tissue sarcoma (aSTS) access to pazopanib, a multitargeted tyrosine kinase inhibitor. The SPIRE study was a retrospective chart review of participating patients.

PATIENTS AND METHODS

Eligibility criteria for the NPP and SPIRE mirrored those of the pivotal phase-III study, PALETTE, which compared pazopanib with placebo in patients ≥18 years with aSTS and whose disease had progressed during or following prior chemotherapy or were otherwise unsuitable for chemotherapy. Outcomes of interest included treatment patterns, treatment duration, relative dose intensity, progression-free survival (PFS), overall survival (OS), clinical benefit rate, adverse events (AEs) and reasons for treatment discontinuation.

RESULTS

A total of 211 patients were enrolled (median age 56 years; 60% female). Most patients received pazopanib in second- and third-line therapy (28.0% and 28.4%, respectively), followed by fourth line (19.0%) and ≥ fifth line (18.5%). The median duration of pazopanib treatment was 3.1 months (95% CI: 2.8-3.8), with a mean daily dose of 715 mg equating to 92% of recommended dose. Median OS was 11.1 months and clinical benefit rate was 46%. There was evidence of some clinical benefit across most histological subtypes. At study end, 40% of patients were alive and of these, 18% remained on pazopanib. Thirteen percent (13%) of patients discontinued pazopanib due to AEs.

CONCLUSIONS

The SPIRE study demonstrated activity of pazopanib in heavily pretreated aSTS patients in a compassionate use setting. No new safety concerns were noted. Reassuringly, the relative dose intensity of pazopanib was 92%.

Safety of Anti-TNF Treatment in Liver Transplant Recipients: A Systematic Review and Meta-analysis

BACKGROUND AND AIM

Little is known about the risk of serious infection when combining anti-tumour necrosis factor [TNF] therapy for refractory inflammatory bowel disease [IBD] with immunosuppression after liver transplantation [LT]. Our aim was to investigate the infection risk in this patient group by systematic review and meta-analysis of the available data.

METHODS

A search was conducted for full papers and conference proceedings through September 2015, regarding liver transplant recipients and anti-TNF therapy. All studies were appraised using the adapted Newcastle-Ottawa Scale [NOS]. Two reviewers independently extracted patient data [age, duration of follow-up, number of all infections, number of serious infections, time since transplant]. As an additional control population, primary sclerosing cholangitis [PSC]-IBD patients from the Leiden University Medical Center [LUMC] LT cohort were used. Poisson regression was used to compare serious infections (according to International Conference on Harmonisation [ICH] definition) per patien-year follow-up between the anti-TNF and control groups.

RESULTS

In all 465 articles and abstracts were identified, of which eight were included. These contained 53 post-LT patients on anti-TNF therapy and 23 post-LT patients not exposed to anti-TNF therapy. From the LUMC LT-cohort, 41 PSC patients with PSC-IBD not exposed to anti-TNF therapy were included as control population. The infection rate for TNF-exposed patients was 0.168 serious infections per patient year, compared with 0.149 in the control patients (rate ratio 1.12 [95% confidence interval: 0.233-5.404, P = 0.886]. When correcting for time since transplant, the infection rate was 0.194 in the TNF-exposed vs 0.115 in the non-exposed [p = 0.219].

CONCLUSIONS

No significant increase in the rate of serious infection was observed in LT recipients with PSC-IBD during exposure to anti-TNF therapy.

Real-world chart review study of adverse events management in patients taking tyrosine kinase inhibitors to treat metastatic renal cell carcinoma

PURPOSE

The purpose is to describe management of adverse events of special interest across tyrosine kinase inhibitors approved for metastatic renal cell carcinoma.

METHODS

We conducted a retrospective chart review in metastatic renal cell carcinoma patients initiating tyrosine kinase inhibitor monotherapy between 15 November 2010 and 15 November 2013, and experiencing ≥ 1 adverse events of special interest (diarrhea, fatigue, hand-foot syndrome, hypertension, or stomatitis/mucositis) within 3 months of initiation. Demographics, medical history, treatment regimens, and adverse events of special interest management data for 3.5 months postonset were collected.

RESULTS

In 220 charts from 27 centers, tyrosine kinase inhibitors prescribed included sunitinib (55%), pazopanib (27%), axitinib (9%), and sorafenib (8%). During the study period, patients experienced 376 adverse events of special interest (13% serious). Fatigue was most common (62% of patients), followed by hypertension (37%), diarrhea (30%), stomatitis/mucositis (29%), and hand-foot syndrome (12%). Over half (56%) the adverse events of special interest were resolved or resolving. Treatment discontinuation due to adverse events of special interest occurred in 15% of patients. Prophylaxis was rarely provided (8%), whereas 59% of patients received adverse events of special interest treatment (pharmacologic (55%) and/or nonpharmacologic (7%)), 27% received tyrosine kinase inhibitor dose management, 23% received both adverse events of special interest treatment and dose management, and 31% received neither. Hypertension was the most treated (72% of all events), and fatigue was the least treated (9%); only 4% of patients received pharmacologic treatment for fatigue.

CONCLUSIONS

Most adverse events of special interest were nonserious and more than half of the patients received pharmacologic and/or nonpharmacologic treatment. Fatigue was the most common yet least frequently treated adverse event of special interest, and few patients received prophylaxis or nonpharmacologic treatment. More emphasis on treatment and prophylaxis options for bothersome adverse events is warranted.

Effects of Intranasal Oxytocin on the Interpretation and Expression of Emotions in Anorexia Nervosa

Altered social-emotional functioning is considered to play an important role in the development and maintenance of anorexia nervosa (AN). Recently, there has been increasing interest in investigating the role of intranasal oxytocin in social-emotional processing. The present study aimed to investigate the effects of intranasal oxytocin on the interpretation and expression of emotions among people with AN. Thirty women with AN and 29 age-matched healthy women took part in the present study, which used a double-blind, placebo-controlled, cross-over design. The participants received a single dose of 40 IU of intranasal oxytocin in one session and a placebo spray in the other. Fifteen minutes after administration, the participants completed the Reading the Mind in the Eyes Test to assess the interpretation of complex emotions and mental states followed by a video task, which assessed expressions of facial affect when they were viewing humorous and sad film clips. The intranasal oxytocin did not significantly influence the expression or interpretation of emotions in the AN or healthy comparison groups. The AN group expressed significantly less positive emotion, spent more time looking away and reported experiencing a significantly more negative affect in response to the film clips. The finding that intranasal oxytocin had little to no effect on the interpretation or expression of emotions in either group supports the notion that the effects of oxytocin on social-emotional processing are not straightforward and may depend on individual and environmental differences, as well as the emotion being processed. Replication of these findings is necessary to explore the effect of timing on the effects of oxytocin before firm conclusions can be drawn. Nonetheless, these findings add to the steady accumulation of evidence that people with AN have reduced emotional expression and avoidance of emotionally provoking stimuli.

The cross-national epidemiology of DSM-IV intermittent explosive disorder

BACKGROUND

This is the first cross-national study of intermittent explosive disorder (IED).

METHOD

A total of 17 face-to-face cross-sectional household surveys of adults were conducted in 16 countries (n = 88 063) as part of the World Mental Health Surveys initiative. The World Health Organization Composite International Diagnostic Interview (CIDI 3.0) assessed DSM-IV IED, using a conservative definition.

RESULTS

Lifetime prevalence of IED ranged across countries from 0.1 to 2.7% with a weighted average of 0.8%; 0.4 and 0.3% met criteria for 12-month and 30-day prevalence, respectively. Sociodemographic correlates of lifetime risk of IED were being male, young, unemployed, divorced or separated, and having less education. The median age of onset of IED was 17 years with an interquartile range across countries of 13-23 years. The vast majority (81.7%) of those with lifetime IED met criteria for at least one other lifetime disorder; co-morbidity was highest with alcohol abuse and depression. Of those with 12-month IED, 39% reported severe impairment in at least one domain, most commonly social or relationship functioning. Prior traumatic experiences involving physical (non-combat) or sexual violence were associated with increased risk of IED onset.

CONCLUSIONS

Conservatively defined, IED is a low prevalence disorder but this belies the true societal costs of IED in terms of the effects of explosive anger attacks on families and relationships. IED is more common among males, the young, the socially disadvantaged and among those with prior exposure to violence, especially in childhood.

Zachsia zenkewitschi (Teredinidae), a Rare and Unusual Seagrass Boring Bivalve Revisited and Redescribed

The sea-grass borer Zachsia zenkewitschi belongs to a group of economically and ecologically important bivalves, commonly referred to as shipworms. The sole recognized representative of the genus Zachsia, this species displays an unusual life history and reproductive strategy that is now understood to include: environmental sex determination of free swimming larvae, extreme sexual and size dimorphism between males and females, internal fertilization, maintenance of often large harems of male dwarfs within a specialized cavity of the female mantle, and complex maternal care of larvae in specialized brood pouches within the gill. It is also the only shipworm species known to burrow in sea grass rhizomes rather than terrestrial wood. Although Z. zenkewitschi is rare and little studied, understanding of its biology and anatomy has evolved substantially, rendering some aspects of its original description inaccurate. Moreover, no existing type specimens are known for this species. In light of these facts, we designate a neotype from among specimens recently collected at the type location, and undertake a re-description of this species, accounting for recent reinterpretation of its life history and functional anatomy.

Real world chart review of adverse event management in patients taking tyrosine kinase inhibitors (TKIs) for metastatic renal cell carcinoma (mRCC) by line of therapy (LoT)

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Background: This is the first real world study to describe adverse events of special interest (AESI) management for all available TKIs by LoT. A better understanding of optimal AE management can positively impact patient care. Methods: A chart review was conducted largely in community oncology practices in Canada and the US. Patients with mRCC were eligible if they started TKI monotherapy between Nov 15, 2010-Nov 15, 2013 and had ≥ 1 of 5 AESI onset ≤ 3 months post TKI start. AESI included fatigue, hypertension, diarrhea, hand-foot syndrome and stomatitis/mucositis. Data on patient demographics, medical history, drug regimen, and AESI management were collected. Results: 220 patients from 27 centers were included. 63% of patients received TKI in 1st, 22% in 2nd and 15% in 3rd LoT. TKIs included axitinib (9%), pazopanib (27%), sorafenib (8%) and sunitinib (55%). 376 AESI occurred in 220 patients; 87% were non-serious. Fatigue (62%), hypertension (37%), diarrhea (31%), stomatitis/mucositis (29%), and hand-foot syndrome (12%) were reported. 55% of AESI resolved/were resolving within 3.5 months of onset. 8% of patients received AESI prophylaxis (Px) and 59% received treatment (Tx). Incidence of stomatitis/mucositis declined as LoT progressed (37%, 16%, 12%). More patients in 1st vs. ≥ 2nd LoT had AESI related TKI discontinuation (17% vs. 12%), interruptions (17% vs. 12%) and reductions (43% vs. 32%). Fewer patients missed doses as LoT progressed (38%, 25%, 18%). Fatigue was the commonest AESI across LoT, and fatigue as a reason for therapy delay/interruption increased across LoT (7%, 14%, 50%). The rates of Tx or Px for fatigue remained low across LoT. Rates of AESI Px were low across the LoT (10%, 0.4%, 0.3%). More patients in 1st (61%) received AESI Tx vs. 2nd (47%) LoT. Conclusions: Most AESI were non-serious, and over half of patients received some form of AESI Tx. Fatigue was the most common yet least frequently Tx AESI. Very few patients received Px across LoT. More patients in 1st versus 2nd LoT experienced dose modifications/discontinuation and received AESI Tx. More emphasis on Px/Tx options for non-serious bothersome AEs is warranted.

Adjustment disorder with anxiety: Care practice

Adjustment disorder with anxiety (ADWA) is a highly prevalent condition, particularly in primary care practice. Adjustment disorders significantly impair patients’ quality of life, but there are relatively few systematic treatment trials in the area of ADWA, and there are few data on predictors of treatment response. Here we review the limited pharmacotherapy data available on the treatment of ADWA. In primary care settings benzodiazepines are frequently prescribed for psychiatric symptoms, despite their adverse event profile and their potential risk for dependence. The non-benzodiazepine drug etifoxine is a promising agent insofar as it is not associated with dependence. Its efficacy and safety have been evaluated in three double-blind randomized clinical trials in comparison with non-benzodiazepine (buspirone) and benzodiazepines (lorazepam and alprazolam) . The three trials point to the anxiolytic properties of etifoxine, demonstrating an overall clinical improvement of patients, and no risk for dependence or rebound effect. In conclusion, even if benzodiazepines are often used for the treatment of ADWA, other therapeutic options are possible, with a better safety profile.

[Aex - the area under the expiratory flow-volume loop]

Preschool children often show total expiration times of less than one second in pulmonary function tests. Therefore, FEV1 cannot be used for evaluation of obstructive pulmonary diseases in small children. Aex, the area under the expiratory flow-volume loop, does not depend on the expiration time. The Aex value varies according to the convex or concave shape of the flow volume loop, can be quantified and is a valuable parameter in the diagnosis of obstructive airway diseases.In this study FEV1 und Aex values of 19882 flow-volume loops were measured and compared. The comparison shows a very high correlation coefficient of r = 0.99.The changes of both parameters in an individual after provocation or bronchospasmolysis also demonstrate a strong correlation. A 20 % change of FEV1 equals an Aex change of 36 %.We conclude that measuring Aex is a good alternative to measuring FEV1 especially if the FEV1 cannot be obtained due to short expiration times.

Barriers to mental health treatment: results from the WHO World Mental Health surveys

BACKGROUND

To examine barriers to initiation and continuation of mental health treatment among individuals with common mental disorders.

METHOD

Data were from the World Health Organization (WHO) World Mental Health (WMH) surveys. Representative household samples were interviewed face to face in 24 countries. Reasons to initiate and continue treatment were examined in a subsample (n = 63,678) and analyzed at different levels of clinical severity.

RESULTS

Among those with a DSM-IV disorder in the past 12 months, low perceived need was the most common reason for not initiating treatment and more common among moderate and mild than severe cases. Women and younger people with disorders were more likely to recognize a need for treatment. A desire to handle the problem on one's own was the most common barrier among respondents with a disorder who perceived a need for treatment (63.8%). Attitudinal barriers were much more important than structural barriers to both initiating and continuing treatment. However, attitudinal barriers dominated for mild-moderate cases and structural barriers for severe cases. Perceived ineffectiveness of treatment was the most commonly reported reason for treatment drop-out (39.3%), followed by negative experiences with treatment providers (26.9% of respondents with severe disorders).

CONCLUSIONS

Low perceived need and attitudinal barriers are the major barriers to seeking and staying in treatment among individuals with common mental disorders worldwide. Apart from targeting structural barriers, mainly in countries with poor resources, increasing population mental health literacy is an important endeavor worldwide.

Psychiatry and mental health research in South Africa: national priorities in a low and middle income context

The recent National Mental Health Summit included discussion of research priorities for South Africa. This paper reviews some of the background literature that is relevant to this key issue. It draws attention to one contested question, the extent to which research in low and middle income countries should address questions about fundamental mechanisms and clinical treatments versus focusing on questions about implementation and systems research? In addressing this question, the paper argues that the boundary between good clinical practice and good academic scholarship is not nearly as distinct as is often assumed (the "research fallacy"); prospective rigorous assessments, retrospective clinical audits, evidence-based medicine, and useful information systems all point to the mutual interdependence of good practice and good scholarship. Finally, some general conclusions that the majority of summit delegates participating in the discussion on research agreed to, are presented.

Childhood trauma in adults with social anxiety disorder and panic disorder: a cross-national study

OBJECTIVES

The influence of childhood trauma as a specific environmental factor on the development of adult psychopathology is far from being elucidated. As part of a collaborative project between research groups from South Africa (SA) and Sweden focusing on genetic and environmental factors contributing to anxiety disorders, this study specifically investigated rates of childhood trauma in South African and Swedish patients respectively, and whether, in the sample as a whole, different traumatic experiences in childhood are predictive of social anxiety (SAD) or panic disorder (PD) in adulthood.

METHOD

Participants with SAD or PD (85 from SA, 135 from Sweden) completed the Childhood Trauma Questionnaire (CTQ). Logistic regression was performed with data from the two countries separately, and from the sample as a whole, with primary diagnoses as dependent variables, gender, age, and country as covariates, and the CTQ subscale totals as independent variables. The study also investigated the internal consistency (Cronbach alpha) of the CTQ subscales.

RESULTS

SA patients showed higher levels of childhood trauma than Swedish patients. When data from both countries were combined, SAD patients reported higher rates of childhood emotional abuse compared to those with PD. Moreover, emotional abuse in childhood was found to play a predictive role in SAD/PD in adulthood in the Swedish and the combined samples, and the same trend was found in the SA sample. The psychometric qualities of the CTQ subscales were adequate, with the exception of the physical neglect subscale.

CONCLUSION

Our findings suggest that anxiety disorder patients may differ across countries in terms of childhood trauma. Certain forms of childhood abuse may contribute specific vulnerability to different types of psychopathology. Longitudinal studies should focus on the potential sequential development of SAD/PD among individuals with childhood emotional abuse.