Healthcare utilization and economic burden in systemic sclerosis: a systematic review

OBJECTIVE

Systemic Sclerosis (SSc) is characterized by vasculopathy, fibrosis of skin and internal organs, and autoimmunity with complications including interstitial lung disease, pulmonary hypertension, and digital ulcers with substantial morbidity and disability. Patients with SSc may require considerable healthcare resources with economic impact. The purpose of this systematic review was to provide a narrative synthesis of the economic impact and healthcare resource utilization associated with SSc.

METHODS

MEDLINE and EMBASE were searched from inception to January 20th, 2021. Studies were included if they provided information regarding the total, direct and indirect cost of SSc. The cost of SSc subtypes and associated complications was determined. Risk of bias assessments through the Joanna Briggs Institute cross-sectional and case series checklists, and the Newcastle-Ottawa Cohort and Case-Control study scales were performed. A narrative synthesis of included studies was planned.

RESULTS

1777 publications were retrieved, of which 33 were included representing 20 cross-sectional, 10 cohort, and 3 case-control studies. Studies used various methods of calculating cost including prevalence-based cost-of-illness approach and health resource units cost analysis. Overall SSc total annual cost ranged from USD$14 959-$23 268 in USA, CAD$10 673-$18 453 in Canada, €4,607-€30 797 in Europe, and AUD$7,060-$11 607 in Oceania. Annual cost for SSc-associated interstitial lung disease and pulmonary hypertension was USD$31 285-$55 446 and $44 454-$63 320, respectively.

CONCLUSION

Cost-calculation methodology varied greatly between included studies. SSc represents significant patient and health resource economic burden. SSc-associated complications increase economic burden and are variable depending on geographical location, and access.

Some Observation on Nickel(IV) Periodate

Variable temperature EPR spectra of KNiIO6 · 0.5 H2O have established that the paramagnetic behavior of this compound (~ 1 BM) is due to the presence of nickel(III) atoms which have occupied some nickel(IV) sites in the crystal lattices. Change of spectral pattern from rhombic (77 K) to isotropic (300 K) is due to a dynamic Jahn-Teller effect. Electrical conductivity measurement has shown it to be a poor semiconductor. KNiIO6 · 0.5 H2O on heating at 300 °C forms K2Ni2I2O9 which is stable in the temperature range 300-400 °C. Chemical reactivities and reflectance spectrum of this compound have indicated it to be K2Ni2 III2 VIO9.

Abstract P6-15-12: Preclinical Evaluation of a STAT3 Inhibitor in Breast Cancer

Breast cancer often arises from inappropriate activation of transcription factors involved in normal mammary development, such as the signal transducers and activators of transcription (STAT) family of transcription factors. STAT3, which plays an important role in mammary remodeling, is activated (as assessed by tyrosine phosphorylation) in approximately 70% of primary breast cancers, with many of these tumors being highgrade. Furthermore, inhibition of STAT3 leads to a loss of tumorigenicity of breast cancer cells. Therefore, targeting STAT3 in breast cancer would be a potentially beneficial form of therapy.

To identify small molecule STAT3 inhibitors, we developed a high throughput cell-based assay to identify compounds that inhibit STAT3- dependent transcriptional activity. We screened approximately 200,000 compounds, and specificity for STAT3 was ensured by eliminating molecules that inhibited either STAT1- or NF-kappaB-dependent transcriptional activity. From this screen, we identified 4-[4-(phenylmethyl) piperidin-1-yl] thieno[2,3-d]pyrimidine (PMPTP) (Probe ID ML116) as a potent inhibitor of STAT3 transcriptional activity, which has no effect on STAT1 or NF-kappaB-dependent transcriptional activity. Treatment with PMPTP of MDA-MB-468 breast cancer cells, which contain constitutively activated STAT3, leads to inhibition of expression of STAT3 target genes including bcl-x and mcl1. Furthermore, PMPTP is a potent inhibitor of viability of MDA-MB-468 breast cancer cells. By contrast, SK-BR-3 cells, which do not contain constitutively active STAT3, were only minimally affected. This suggests that PMPTP reduces the viability of cells that depend on constitutively active STAT3. PMPTP has no effect on STAT3 tyrosine or serine phosphorylation or STAT3 nuclear translocation, suggesting that PMPTP may be inhibiting STAT3 at the level of DNA binding or co-factor recruitment.

Importantly, PMPTP lowers the apoptotic potential of breast cancer cells thereby making them more susceptible to other forms of therapy. Building on this observation, we identified a number of beneficial combinations of PMPTP with cytotoxic drugs currently used in breast cancer therapy as well as novel anti-cancer agents. Additionally, we analyzed a number of structural analogues of PMPTP, and we identified two compounds that had approximately 4-fold increased potency in inhibiting the viability of breast cancer cells containing STAT3 activation.

Taken together, these findings identify PMPTP as a potential new form of therapy for breast cancers containing activated STAT3, which can be enhanced using conventional and non-conventional chemotherapy.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-15-12.

Temporal trends in adults' sports participation patterns in England between 1997 and 2006: the Health Survey for England

OBJECTIVE

To examine temporal trends in participation in sport and exercise activities in England between 1997 and 2006 while taking into account wider societal changes.

DESIGN

A series of annual cross-sectional surveys.

SETTING AND PARTICIPANTS

Nationally representative samples of men (n = 27 217) and women (n = 33 721) aged >or=16 years.

MAIN OUTCOME MEASURES

Any (more than once every 4 weeks) and regular (more than once a week) participation in overall sport and exercise and a number of sport and exercise groupings (eg cycling, swimming, gym and fitness club-based activities (G/FC), racquet sports). Time point (1997/98, 2003/04, 2006) was the main dependent variable.

RESULTS

Age-standardised overall regular participation changed from 40.8% in 1997/98 to 41.2% in 2006 for men (multivariable-adjusted participation OR = 1.11 in 2006, 95% CI 1.03 to 1.19, p<0.001) and from 31.2% to 33.9% for women (1.21, 1.13 to 1.29, p<0.001). Regular G/FC increased from 17.0% to 19.2% for men (1.19, 1.09 to 1.30) and from 15.9% to 18.7% for women (1.23, 1.14 to 1.33) and regular running increased from 2.4% to 4.0% for women only (1.84, 1.56 to 2.18). Overall increases were apparent only in older adults (>or=45 years) (1.25, 1.16 to 1.35, p<0.001). Young men (16-29 years) had reduced ORs for cycling (0.72, 0.58 to 0.88, p = 0.008), dancing (0.60, 0.45 to 0.82, p = 0.001), running (0.78, 0.64 to 0.94, p<0.001) and racquet sports (0.60, 0.42 to 0.86, p = 0.003). In men, increases were pronounced only among men from non-manual social classes, higher income households and white ethnic backgrounds.

CONCLUSIONS

Sports and exercise participation in England has changed between 1997 and 2006 as the result of increases among middle-aged and older adults and decreases among young men. There are no signs that the participation gap between less and more advantaged population groups is narrowing.

An uncommon peripheral nerve injury after penetrating injury of the forearm: the importance of clinical examination

A 22 year old woman presented to the accident and emergency department with a self inflicted stab wound to the radial side of the volar aspect of the left forearm caused by a pen knife. Her wounds were sutured on the day of injury. Over the course of next three weeks her wounds healed well but she noticed difficulty in using the hand. She therefore attended her general practitioner who suspected a possible nerve injury and referred the patient back to the A&E department. On follow up examination, she was noticed to have a loss of finger and thumb extension and weakness of thumb abduction. Active extension of the wrist (with radial deviation) was intact. There was no sensory deficit. Posterior interosseous nerve (PIN) palsy was diagnosed and the patient was referred to the regional hand surgery unit where she underwent exploration of the wound. A complete transection of the PIN in the supinator canal was found and repaired with good functional outcome. This case reflects the importance of clinical examination in uncommon peripheral nerve injuries and appropriate referral to a specialist department in case of doubtful penetrating wound that pose a threat to an underlying important structure.

The influence of surface topography in the adhesion of polystyrene to aluminum

Polymer/metal adhesion has been studied by scanning(SEM) and transmission electron microscopy(TEM). Now with atomic force microscopy(AFM) we can scan the metal's surface and correlate the roughness with adhesion energy. We have chosen aluminum as the metal substrate and polystyrene(PS) as the nonreactive polymer adhesive. A great deal of research has been done on primed metal surfaces which are used to improve adhesion between the metal and the polymer. Our interest is to study the mechanical interlocking of the polymer to the metal without a primer coupling agent.

Aluminum alloy 6061 was cut into plates 25x60x1 mm, cleaned with an alkali cleaner, rinsed with water, etched and anodized. The plates were etched in a solution of Na2Cr2O7·2H2O, H2SO4, and water in a 1:10:30 ratio by weight at 50-52°C for 12-20 min. After etching , they were rinsed, dried and anodized in 10% phosphoric acid solution with 15 V for 20 min, then were rinsed and dried again.A 1% PS solution in toluene was deposited on the prepared aluminum surface and air dried.

Neonatal Salmonella havana meningitis

The clinical features, microbial characterisation and autopsy findings in a premature neonate with Salmonellas havana meningitis is presented. S. havana is a very rare pathogen in India.

Identification of a molybdopterin-containing molybdenum cofactor in xanthine dehydrogenase from Pseudomonas aeruginosa

Xanthine dehydrogenase has been purified from Pseudomonas aeruginosa cultured on a rich medium and induced with hypoxanthine. The enzyme was shown to contain FAD, iron sulfur centers and a molybdenum cofactor as prosthetic groups. Analysis of the molybdenum cofactor in this enzyme has revealed that the cofactor contains molybdopterin (MPT) rather than molybdopterin guanine dinucleotide or molybdopterin cytosine dinucleotide which have previously been identified in a number of molybdoenzymes of bacterial origin. The pterin cofactor in P.aeruginosa xanthine dehydrogenase was alkylated and the resulting product was identified as dicarboxamidomethyl molybdopterin. In addition, the pterin released from the enzyme by denaturation with guanidine-HCl was found to chromatograph on Sephadex G-15 with an apparent molecular weight of 350. These results document the first example of a bacterial enzyme with a molybdenum cofactor comprising molybdopterin and the metal only.