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Stereotactic Body Radiation Therapy and High-Dose Rate Brachytherapy Boost in Combination with Intensity Modulated Radiation Therapy for Localized Prostate Cancer: A Single-Institution Cohort Study. Int J Radiat Oncol Biol Phys 2023; 117:e362. [PMID: 37785245 DOI: 10.1016/j.ijrobp.2023.06.2452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The use of dose-escalated external beam radiation (EBRT) and brachytherapy (BT) boost with ADT has emerged as an option with superior biochemical control compared to dose-escalated EBRT alone. BT is traditionally delivered using low-dose rate techniques, but more recently high-dose rate (HDR) BT has also emerged as a boost option for these patients with promise of low toxicity rates. SBRT is a favorable modality for monotherapy for low and intermediate risk group patients, however its safety and efficacy as a boost in combination with EBRT is less well understood. The aim of this study is to compare SBRT boost, HDR boost and LDR boost for localized prostate cancer. MATERIALS/METHODS A single-institution retrospective chart review was performed of men receiving EBRT delivered using intensity modulated RT and either SBRT boost (650cGy x 3), HDR-BT boost (1500cGy x 1), or LDR boost with I-125 (110Gy). Of patients treated w/ SBRT boost, 39 (80%) were treated with an SIB to the MRI-detectable lesion(s) to 700cGy x 3. Treatment characteristics for each strategy were reviewed and on-treatment toxicity outcomes for each of the cohorts were compared using Chi-square tests. RESULTS From 2017-2022, 49 patients were treated with EBRT+SBRT boost, 44 patients received EBRT+ HDR-BT boost, and 46 patients received EBRT+ LDR-BT boost. The average age of patients included in the study was 71.2 years (median age 69.55 years, range 51.42-83.70 years) with average baseline PSA of 11 (median 7.6, range 3.3-64). In addition, 55% of the patients had high-risk/very high-risk disease, 39% had unfavorable intermediate disease and 6% had favorable intermediate disease. 139 patients received androgen deprivation therapy (93%). There were no differences in these baseline demographics and clinical or treatment factors between SBRT, HDR and LDR boost (p>0.05). The median dose/fx of EBRT was 4500cGy/25 fx (range 4500-5040cGy/23-28 fractions). At the end of treatment, 69% of the patients had 0-1 change in nocturia. There is an increase in nocturia episodes of 2-3 from baseline in 27% of the patients, while 4% had an increase in nocturia episodes of 4 or more from baseline with no difference between the SBRT, HDR and LDR boost. At baseline 36 patients (26%) reported urinary frequency symptoms, increasing to 80 patients (58%) by end of treatment with no difference between the SBRT, HDR and LDR boost. Similarly, there was a trend to increased use of urinary modifiers at end of treatment in patients treated with EBRT+HDR boost compared to EBRT+SBRT and EBRT+ LDR boost (89% vs. 71% v 72% respectively). CONCLUSION There was no significant difference in acute urinary toxicity and nocturia between SBRT, HDR and LDR boost (p>0.05).
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Progressive multifocal leukoencephalopathy outcomes in patients with multiple sclerosis treated with dimethyl fumarate. Mult Scler J Exp Transl Clin 2022; 8:20552173221132469. [PMID: 36387034 PMCID: PMC9661630 DOI: 10.1177/20552173221132469] [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: 04/21/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background and objectives Dimethyl fumarate (DMF), an oral disease-modifying therapy with an established benefit and well-described safety profile, is among the most commonly used therapies for relapsing forms of multiple sclerosis. As of 31 December 2021, >560,000 patients have been treated with DMF, representing >1,190,000 person-years of exposure. Of these, 6413 patients (14,292 person-years) were from clinical trials. Methods and results Progressive multifocal leukoencephalopathy (PML) has occurred in the setting of lymphopenia (<0.91 × 109/L) in patients treated with DMF. We present detailed clinical characteristics and outcomes of the 12 confirmed PML cases occurring in MS patients on DMF as of 21 July 2021. The PML incidence in DMF-treated patients is 1.07 per 100,000 person-years of DMF exposure. Lymphopenia is the common risk for PML in DMF treatment. Discussion DMF-related PML is rare but has occurred in the setting of lymphopenia, supporting the current recommendations for absolute lymphocyte count monitoring in all patients, regardless of age and time on therapy.
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Comparison of CT acquired valvular calcification scores in hemodialysis vs peritoneal dialysis patients undergoing open heart surgery. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2613] [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
Several factors have been identified as independent risk factors for cardiac valvular calcification (CVC), including but not limited to age, inflammatory conditions, loss of calcification inhibitors, and dysregulated bone mineral metabolism. However, data is scarce regarding which dialysis modality portends more severe CVC.
Purpose
Our aim was to compare the degree of valvular calcification in hemodialysis (HD) and peritoneal dialysis (PD) patients prior to open heart surgery (OHS) using a computed CT calcium score.
Methods
Dialysis patients who underwent OHS at our institution from 2009–2019 who had a pre-surgical cardiac CT were grouped according to duration of dialysis modality prior to their surgical date. There were two study cohorts to evaluate outcomes of interest: mitral and aortic calcification. We included the first surgical record per patient for patients undergoing isolated CABG, or CABG+valve surgery (repair or replacement), or valve-only surgery (repair or replacement). To evaluate mitral calcification, we excluded any patients undergoing any mitral valve surgery (repair or replacement). We also excluded patients with a history of mitral valve repair/replacement. To evaluate aortic calcification, we excluded any patients undergoing any aortic valve surgery (repair or replacement). We also excluded patients with a history of aortic valve repair/replacement. Mitral annular and aortic valvular calcification were assessed using the Agatston score. Logistic regression was performed to test for the association of PD and HD cumulative dialysis duration with presence of valvular calcification.
Results
A total of 296 patients met inclusion criteria for at least one of the strata in our study. Of those, 214 met inclusion for the mitral strata, and 166 met criteria for the aortic strata (Table 1). In the logistic regression model for the mitral strata, age and female sex were associated with higher odds of presence of mitral calcification (Figure 1). Cumulative years on PD and cumulative years on HD were not significantly associated with presence of mitral calcification. In the logistic regression model for the aortic strata, age was associated with higher odds of presence of aortic calcification, while female sex was associated with lower odds (Figure 1). Cumulative years on PD and cumulative years on HD were not significantly associated with presence of aortic calcification.
Conclusion
Presence of mitral and aortic calcification for patients undergoing OHS was not significantly associated with cumulative length of PD or HD after adjusting for age and gender, suggesting that there may be more factors at play in the progression of valvular calcification in end stage renal disease patients than what was previously thought.
Funding Acknowledgement
Type of funding sources: None.
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Incidence and predictors of transthyretin cardiac amyloidosis in patients with degenerative aortic stenosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1619] [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 approval of new therapies for treating transthyretin (TTR) cardiac amyloidosis has led to significant interest in identifying patients at high risk for this disease. Investigators have identified a correlation between severe degenerative aortic stenosis (AS) and TTR cardiac amyloidosis in older patients, with several studies finding up to 20% of patients who undergo transcatheter aortic valve replacement (TAVR) having TTR cardiac amyloidosis. These initial TAVR studies were conducted when TAVR was performed almost exclusively in high surgical risk populations. Therefore, the true incidence of TTR cardiac amyloidosis in an all-comers with severe degenerative AS referred for TAVR is unknown.
Purpose
To identify the true burden of TTR cardiac amyloidosis in a contemporary population of severe degenerative AS undergoing TAVR screening.
Methods
All patients ≥70 years with severe native valve degenerative AS seen in a multidisciplinary valve clinic were referred for technetium-99m pyrophosphate cardiac scintigraphy (PYP scan) for evaluation of cardiac amyloidosis. Diagnosis was made via combination of planar grade and heart to contralateral lung ratio, confirmed on single positron emission computed tomography/computed tomography (SPECT/CT). Patients with a positive PYP scan were referred to a heart failure clinic where they underwent testing for AL amyloidosis.
Results
Over a 10 month period, 247 patients seen in valve clinic underwent a PYP scan. Of this cohort, 203 patients ultimately underwent TAVR, 15 surgical aortic valve replacement, and 2 balloon valvuloplasty with 27 patients having not yet undergone a procedure. The positivity rate was 4% (10/247) with 1 patient having an equivocal result. The patients with a positive PYP scan had higher rate of low-flow low-gradient (LFLG) AS (64% vs 29%, p=0.006) and classical LFLG AS (27% vs 8%, p=0.02). Echocardiographic measures associated with a positive PYP scan include a lower global longitudinal strain (−10.0% vs −16.1%, p=0.008), lower average e' (4.5 vs 6.5, p=0.003), and an increased E/A ratio (1.8 vs 1.1, p=0.018).
Conclusions
The incidence of TTR amyloidosis in a contemporary, severe AS population ≥70 years undergoing TAVR screening appears much lower than previously described in the literature. Echocardiographic traits may be able to predict which patients with severe AS should undergo evaluation for TTR cardiac amyloidosis.
Funding Acknowledgement
Type of funding sources: None.
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137 Impact of absolute lymphocyte count (ALC) frequency on detection of dimethyl fumarate–associated lymphopenia. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn2.181] [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
IntroductionLymphopenia is a known adverse event of dimethyl fumarate (DMF) with treatment dis- continuation recommended for patients with severe prolonged (≥6 months) lymphopenia. Because of the COVID-19 pandemic burden on healthcare systems, we retrospectively examined the impact of absolute lymphocyte count (ALC) monitoring frequency (every-3-months vs every-6-months) on lym- phopenia detection.MethodsSamples from patients enrolled in phase 3 trials (DEFINE/CONFIRM) and the extension study (ENDORSE) were retrospectively analysed using 3-month or 6-month intervals. Lymphopenia was defined as ALC <0.91x109/L and severe lymphopenia as ALC <0.5×109/L. Times to the first lymphopenia event and first severe lymphopenia event were estimated using Kaplan-Meier methods.ResultsThe analysis included 741 patients. There were 355 lymphopenia cases (76 severe) with 3-month monitoring, and 314 cases (70 severe) with 6-month monitoring. Over 120 months, incidence of first lympho- penia event was significantly different for 3-month vs 6-month monitoring (difference range: 2.64%–6.54%; P=0.0088). Incidence of first severe lymphopenia event was not significantly different for the two intervals (P=0.5866). Proportions of patients with severe prolonged lymphopenia with 3-month and 6-month moni- toring were similar (4.0% vs 4.2%).ConclusionsThe results of this study may be informative to clinicians managing pandemic-related health- care resource burdens. Support: Biogen. Disclosures on poster.
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Abstract 1899: TrialMatch: A computational resource for the management of biomarker-based clinical trials at a precision oncology center. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-1899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: The adoption of routine tumor sequencing, and the incorporation of biomarker-based clinical trials in the treatment of cancer has been steadily rising over the past few years. Access and ability to participate in clinical trials is a key element in providing therapeutic options for cancer patients.At the Avera Cancer Institute, options of biomarker-based clinical trials are routinely presented to the treating clinicians at the molecular tumor board (MTB). With everincreasing numbers of trials, a systematic method for keepingtrack of available trials andevaluating patients for trial options was needed. A search for solutions led to only one open-source tool, MatchMiner, but it did not meet our needs.
Methods and Results: We developed an open-source web application, TrialMatch, that has the ability to (i) add trials through a semi-automated curation interface, (ii) browse and search trials, (iii) and match patients to biomarker-based trials.TrialMatch is an R Shiny application that uses a mongo database to store the trial data. Software installation and application instantiation is managed through Docker. Curate This section has fields for a user to enter trial name and a NCT ID from clinicaltrials.gov. It then queries the clinicaltrials.gov API and fetches data about the sponsor, treatment, etc.Although disease and biomarker data are available on clinicaltrials.gov, they are not stored as discrete fields that can be queried, and hence require manual input. The user provides disease type based on the OncoTree classification, as well as biomarker information for mutations, copy numbers, fusions, TMB, MSI status, PD-L1 status, RNA expression, and disease specific markers such as ER/PR/HER2 status.All information for a particular trial is entered in a mongo database collection, with each trial stored as a document. The ability to add and edit data fields can be restricted to specific users. Browse This section allows the user to browse through all trials with key information such as NCT ID, trial name, disease, and biomarkers. Each row represents one trial and can be expanded to show more detailed information. This is useful to keep track of trials, and to quickly filter trials to a specific disease or biomarker. Match This section displays a patient-centric view of the trials that each patients’ age, sex, disease, and biomarkers have matched to. The matching can be automated for scheduled recurrentruns. At Avera, this is used during MTB to evaluate treatment options, but can also be used by clinicians to get a sense of the trials available for their patients, while awaiting formal review.
Conclusion: We believe that this computational tool fulfills a crucial need in the clinical application of precision oncology, and will ultimately increase clinical trial enrollment for patients.
Citation Format: Anu Amallraja, Shivani Kapadia, Padmadpriya Swaminathan, Casey Williams, Tobias Meissner. TrialMatch: A computational resource for the management of biomarker-based clinical trials at a precision oncology center [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1899.
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099 Safety and effectiveness of dimethyl fumarate in multiple sclerosis patients treated over 5 years. Journal of Neurology, Neurosurgery and Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
IntroductionIn clinical studies, delayed-release dimethyl fumarate (DMF) demonstrated a favorable benefit-risk profile in patients with relapsing-remitting multiple sclerosis (MS). Real-world studies enable char- acterization of risks that may emerge with long-term exposure in clinical practice. ESTEEM (NCT02047097) is an ongoing 5-year study characterizing real-world long-term safety and effectiveness of routinely pre- scribed DMF in MS patients.MethodsPatients treated with DMF were recruited from ~380 sites. The primary objective was to determine incidence, type, and pattern of serious adverse events (SAEs), and AEs leading to DMF discontinuation.ResultsAs of April 3, 2019, 5804 patients had ≥1 dose of DMF. SAEs were experienced by 245 (4.8%) patients, with infections (n=64; 1.3%) and nervous system disorders (n=35; <1%) the most common. There were 1676 (33.0%) permanent treatment discontinuations. Annualized relapse rate over the period of up to 5 years was significantly lower than in the year prior to baseline (risk reduction 88.6% [95% confidence interval: 87.7–89.4]; P<0.0001).ConclusionsThese results reveal low risk of SAE and beneficial therapeutic effects over up to 5 years of real-world DMF use. Updated safety and efficacy results for DMF patients in the United Kingdom will be presented.Support.Biogen. Disclosures: Included on the poster. Ben.newth@biogen.com
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010 Safety and efficacy of long-term dimethyl fumarate treatment. Journal of Neurology, Neurosurgery and Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
IntroductionENDORSE (NCT00835770) evaluated the safety and efficacy of dimethyl fumarate (DMF) treatment for ≥10 years (Y) in relapsing-remitting MS (RRMS) patients.MethodsPatients treated continuously with DMF 240 mg BID in DEFINE/CONFIRM and ENDORSE were assessed for relapse, confirmed disability progression (CDP), serious adverse events (SAEs), and patient- reported outcomes (PROs): (36-item short form health survey [SF-36]; 5-dimension QoL [EQ-5D]).ResultsOf 618 patients treated for ≥10Y, 38%(192/501) were continuously-treated BID. Mean (SD) age 41.6 (8.7) Y; 68% female. Most (51%[98/192]) patients remained relapse-free or had ≤1 relapse, 73%(141/192); median time-to-first-relapse was 58 weeks. Mean baseline (SD) EDSS score was 2.24 (1.18); patients with EDSS ≤3.5: Y2 89%(164/184), Y8 80%(148/184), Y10 79%(146/184). From Y0–10, 64%(122/191) patients had no CDP. Seventy-seven (40%) patients experienced SAEs; primarily MS relapse 18%(34/192) or infections 6%(12/192). From Y0–10, serious infection incidence did not increase and SF-36 and EQ-5D remained stable.ConclusionsPatients continuously treated with DMF BID for ≥10Y had low incidence of relapses; the pro- portion of patients with EDSS ≤3.5, patients with CDP, PROs, and incidence of serious infections remained stable over 10Y reinforcing the safety and efficacy of long-term DMF treatment for RRMS patients.SupportBiogen; disclosures detailed on poster.g.giovannoni@qmul.ac.uk
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Impact of changes in tricuspid regurgitation on clinical outcomes following mitral valve teer compared to guideline-directed medical therapy: a sub-analysis of the COAPT trial. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.206] [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
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT)
Background
Prior studies suggest tricuspid regurgitation (TR) diminishes/resolves following mitral valve surgery and thus do not require treatment and may not influence outcomes.
Purpose
We sought to evaluate the change in TR (ΔTR) and its association with outcomes after transcatheter edge-to-edge repair (TEER) compared with guideline-directed medical therapy (GDMT) in the COAPT trial.
Methods
Patients from the COAPT trial with echo core lab TR assessment at baseline and 30-day follow-up (n = 504) were included and divided into 2 groups: those whose TR worsened (ΔTR-INC) and those with no change or improvement in TR (ΔTR-SAME/DEC). Two-year composite endpoints of death or heart failure hospitalization (HFH) and the individual components were analyzed, after excluding events occurring within the first 30 days.
Results
ΔTR-SAME/DEC occurred in 430 pts (228 TEER, 202 GDMT) while ΔTR-INC was noted in 74 pts (38 TEER, 36 GDMT) (Figure 1A). From 30 days to 2 years, ΔTR-INC pts had a higher rate of the composite outcome of death or HFH compared with ΔTR-SAME/DEC (p = 0.006, Figure 1B). Both 2-year death (HR 1.52, 95% CI 1.01-2.27; p = 0.04) and HFH (HR 1.52, 95% CI 1.04-2.22; p = 0.03) were associated with ΔTR-INC. Assessed by treatment group (Figure 1C and 1D), the relationship between ΔTR-INC and composite death or HFH was significant in GDMT alone pts (HR 1.86, 95% CI 1.21-2.86) but not in TEER pts (HR 1.33, 95% CI 0.79-2.23), although interaction testing demonstrated consistency between the two treatments (Pint = 0.31).
Conclusions
Worsening TR at 30 days occurred in ∼15% of pts in the COAPT trial whether they were treated with TEER or GDMT alone. DTRINC was associated with increased death and HFH during 2-year follow-up. Abstract Figure 1
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Real-world effectiveness of dimethyl fumarate versus fingolimod in a cohort of patients with multiple sclerosis using standardized, quantitative outcome metrics. Mult Scler J Exp Transl Clin 2022; 8:20552173211069852. [PMID: 35024161 PMCID: PMC8744178 DOI: 10.1177/20552173211069852] [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: 02/18/2021] [Revised: 12/03/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022] Open
Abstract
Background Prior studies suggest comparable effectiveness of dimethyl fumarate (DMF) and
fingolimod (FTY) in multiple sclerosis (MS) using relapse, Expanded
Disability Status Score (EDSS), and magnetic resonance imaging (MRI) lesion
metrics. Objective Compare the real-world effectiveness of DMF versus FTY using quantitative,
validated neuroperformance tests, MRI, and serum neurofilament light chain
(sNfL) outcomes while controlling for between-group differences. Methods Patients were eligible if on DMF or FTY when first enrolled in the MS
Partners Advancing Technology and Health Solutions (MS PATHS) network and
had ≥1-year follow-up in MS PATHS. Sensitivity analysis included a subgroup
who started DMF/FTY ≤2 years from enrolment. After propensity score
weighting, differences in means and in mean 1-year change of
neuroperformance and MRI outcomes were compared. sNfL levels were assessed.
This was a non-randomized comparison. Results In the overall cohort, no significant differences were observed between DMF
(n = 702) and FTY (n = 600) in
neuroperformance or MRI outcomes including brain volume loss; mean time (SD)
since treatment initiation was 1.98 (0.68) years for DMF and 2.02 (0.75)
years for FTY. A sensitivity analysis controlling for DMF and FTY treatment
duration yielded similar results. Conclusion In this study, DMF and FTY demonstrated similar effects on physical and
cognitive neuroperformance and MRI outcomes. Direct comparisons to other
fumarates and S1P receptor modulators were not conducted.
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The Patient and Clinician Assessment of Gastrointestinal (GI) Related Adverse Events Associated with Oral Disease-Modifying Therapies in Multiple Sclerosis: A Qualitative Study. Adv Ther 2022; 39:5072-5086. [PMID: 36053450 PMCID: PMC9438375 DOI: 10.1007/s12325-022-02250-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/29/2022] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Current guidelines for relapsing-remitting multiple sclerosis (RRMS) call for treatment with disease-modifying therapies (DMTs) early in the disease to prevent relapses and accumulation of neurologic impairment and disability. However, patients taking certain oral DMTs may experience gastrointestinal (GI)-related adverse events (AEs), particularly at dose titration. We conducted qualitative research with healthcare professionals (HCPs) and patients in Canada to contextualize their experiences with three oral DMTs: dimethyl fumarate (Tecfidera®), fingolimod (Gilenya®), and teriflunomide (Aubagio®). The objectives of this study were to (1) gather qualitative data to better understand the patient and HCP experience of GI AEs in oral MS DMT treatment in Canada and (2) determine to what extent two patient-reported outcome (PRO) instruments used in recent oral DMT trials capture what is important to patients regarding GI AEs in oral MS DMT treatment (content validity) and to provide qualitative data to help interpret PRO scores. METHODS This was a qualitative, non-interventional, descriptive, cross-sectional study comprising HCP and patient interviews conducted in English and French, using a 1:1 semi-structured interview approach. RESULTS Patients reported 16 unique GI AE concepts related to oral DMTs. The most commonly reported symptoms were diarrhea, indigestion, and nausea. While patients acknowledged the negative impact associated with GI-related AEs, most characterized the treatment experience as positive, focusing on preference for oral administration, perceived efficacy of DMTs in terms of lack of MS relapses, slowed progression of their disease, and improvement in MS symptoms. Results supported the content validity (relevance, comprehension, and comprehensiveness) of the two PROs assessed. HCP feedback reinforced patient perspectives on both GI concepts and the two PRO instruments. CONCLUSION Outcomes of these research activities include experiential data on the symptom and impact experience of oral DMTs in MS from both patients and HCPs that contribute to the process of determining therapeutic value.
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Impact of new-onset left bundle branch block on clinical and echocardiographic outcomes after TAVR with SAPIEN-3 valve. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2179] [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
New left bundle branch block (LBBB) is a common finding after transcatheter aortic valve replacement (TAVR) that can result in worse outcomes after TAVR. We aim to investigate the impact of new-onset LBBB after TAVR using the SAPIEN-3 (S3) valve.
Methods
Consecutive patients who underwent transfemoral-TAVR with S3 valve between April 2015 and December 2018 were included. Exclusion criteria included pre-existing LBBB, right bundle branch block, left anterior hemiblock, left posterior hemiblock, wide QRS ≥120 msec, prior permanent pacemaker (PPM), and non-transfemoral access.
Results
Among 612 patients, 11.4% developed new-onset LBBB upon discharge. Implantation depth was the only predictor of new-onset LBBB (OR 1.294; 95% CI 1.121–1.493; p<0.001). The median (IQR) length of stay was longer with new-onset LBBB [3 (2–5) days vs. 2 (1–3) days; p<0.001]. New-onset LBBB was associated with higher thirty-day PPM requirement (18.6% vs. 5.4%; p<0.001) including those implanted after discharge (4.3% vs. 0.9%; p=0.02). There was no difference in 3-year all-cause mortality between both groups (30.9% vs. 30.6%; log-rank p=0.829). Further, new-onset LBBB was associated with lower left ventricular ejection fraction (LVEF) at both 30 days (55.9±11.4% vs. 59.3±9%; p=0.026) and 1 year (55±12% vs. 60.1±8.9%; p=0.002) despite no differences at baseline. These changes were still present when we stratified patients according to baseline LVEF (≥50% or <50%). We also noted higher mean LV end-diastolic volume index (51.4±18.6 vs. 46.4±15.1 ml/m2; p=0.036), and LV end-systolic volume index (23.2±14.1 vs. 18.9±9.7 ml/m2; p=0.009) with new-onset LBBB at 1 year. Lastly, there were significantly higher rates of heart failure readmissions at 1 year with new-onset LBBB (10.7% vs. 4.4%; log-rank p=0.033).
Conclusion
Among our cohort of S3 recipients, new-onset LBBB was associated with higher PPM requirement, worse LVEF, higher LV volumes and increased risk of heart failure hospitalizations. However, it did not affect mortality in the short-to-intermediate post-TAVR period.
Funding Acknowledgement
Type of funding sources: None. Figure 1. All-cause Survival
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Impact of doppler velocity index after transcatheter aortic valve replacement using Sapien-3 valve – a single centre experience. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2178] [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
Little is known about the hemodynamic performance of Edwards Sapien-3 (S3) valve after Transcatheter Aortic Valve Replacement (TAVR). Doppler velocity index (DVI) is a better indicator of prosthetic valve function as it is independent of valve size and flow, unlike mean gradient and peak velocity which are flow-dependent.
Methods
In this study, we compare outcomes based on differences in DVI among a consecutive series of patients who underwent S3 TAVR between April 2015 and December 2018. Our institutional review board approved the study and informed consents were obtained from the subjects.
Results
Among 921 patients who had follow-up echocardiograms within 30 days after TAVR, 60.8% had DVI ≤0.5, while 39.2% had DVI >0.5. The median 30-day DVI was 0.47 with a standard deviation of 0.11 and mean 0.49 and interquartile range 0.41–0.55. The baseline clinical and procedural characteristics were similar between both groups with the exception of less post-dilation (36.8% vs. 47.4%; p=0.001) and greater implantation depth (2.59±1.99 vs. 2.31±1.9mm; p=0.031) with DVI ≤0.5. The rates of aortic valve calcification, pre dilation, pre-TAVR aortic regurgitation (AR) were similar. At baseline, there were no differences between both groups in mean or peak gradients or aortic velocity time integral (VTI). At 1 year, mean gradients were higher with DVI ≤0.5 (12.7±5.6 vs. 11.1±4.6 mmHg; p=0.001). DVI ≤0.5 was associated with higher peak gradients (24.2±10.2 vs. 21.4±8.7 mmHg; p=0.002), and aortic VTI (51.4±13.5 vs. 46.8±12.2 cm; p<0.001) at 1 year, especially with the 26mm and 29mm prostheses. Compared with DVI>0.5 group, patients in DVI<0.5 group had lower baseline left ventricular ejection fraction (LVEF) (54.5±12.2% vs. 58.9±11.2%; p<0.001), higher left ventricular end-diastolic volume index (LVEDVi) (54.3±20.9 vs. 49.4±17.4 ml/m2; p=0.001), higher LV end-systolic volume index (LVESVi) (25.2±16.5 vs. 21.3±12.7 ml/m2; p=0.001), and similar LV mass index (110.7±31.9 vs. 106.9±32.7 g/m2; p=0.134). 1-year mortality rates among patients who had DVI ≤0.5 compared to DVI >0.5 were lower (6.6% vs. 10.6%; log-rank p=0.033), however no difference was noted at both 2 years (17.3% vs. 20.1%; log-rank p=0.151), and 3 years after TAVR (30.7% vs. 31.2%; log-rank p=0.333).
Conclusions
DVI<0.5 was associated with higher peak gradients and lower baseline LVEF. DVI <0.5 group patients had lower 1-year mortality but similar mortality at 2 and 3-years of follow up.
Funding Acknowledgement
Type of funding sources: None. Figure 1. All-cause SurvivalFigure 2. Hemodynamic Data
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Impact of pacing-related differences on clinical and echocardiographic outcomes after TAVR with SAPIEN-3 valve. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2180] [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
Data regarding the impact of pacing on outcomes after transcatheter aortic valve replacement (TAVR) is evolving especially with regards to pre-existing PPM. We examined the impact of new and prior PPM on clinical and hemodynamic outcomes after SAPIEN-3 (S3) TAVR.
Methods
Consecutive patients who underwent transfemoral-TAVR using S3 valve between April 2015 and December 2018 at our Clinic were included.
Results
Among 1028 patients, 10.2% required new PPM within 30 days, while 14% had pre-existing PPM. The presence of either prior or new PPM had no impact on 3-year mortality (log-rank p=0.6), or 1-year major adverse cardiac and cerebrovascular event (MACCE) (log-rank p=0.65). New PPM was associated with lower left ventricular ejection fraction (LVEF) at both 30 days (54.4±11.3% vs. 58.4±10.1%; p=0.001), and 1 year (54.2±12% vs. 59.1±9.9%; p=0.009) compared to no PPM. Similarly, prior PPM was associated with worse LVEF at 30 days (53.6±12.3%; p<0.001) and 1 year (55.5±12.1%; p=0.006) compared to no PPM. Interestingly, new PPM was associated with lower 1-year mean gradient (11.4±3.8 vs. 12.6±5.6 mmHg; p=0.04), and peak gradient (21.3±6.5 vs. 24.1±10.4 mmHg; p=0.01) despite no baseline differences. Prior PPM was also associated with lower 1-year mean gradient (10.3±4.4 mmHg; p=0.001), and peak gradient (19.4±8 mmHg; p<0.001), and higher doppler velocity index (0.51±0.12 vs. 0.47±0.13; p=0.039). Moreover, 1-year LV end-systolic volume (LVESVi) was higher with new (23.2±16.1 vs. 20±10.8 ml/m2; p=0.038), and prior PPM (24.5±19.7; p=0.038) compared to no PPM. Prior PPM was associated with higher moderate-to-severe tricuspid regurgitation (35.3% vs. 17.7%; p<0.001). There were no differences with regards to the rest of the studied echocardiographic outcomes at 1 year.
Conclusion
In this S3 cohort, new and prior PPM did not affect 3-year mortality or 1-year MACCE, however they were associated with worse LVEF, higher LVESVi and lower mean and peak gradients on follow-up compared to no PPM.
Funding Acknowledgement
Type of funding sources: None. Figure 1. All-cause Survival
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Outcomes of transfemoral-transcatheter aortic valve replacement with Sapien-3 valve in liver cirrhosis patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2177] [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
Little is known about the outcomes of liver cirrhosis patients with severe aortic stenosis (AS) who undergo transcatheter aortic valve replacement (TAVR).
Methods
We undertook a retrospective analysis of consecutive patients with severe symptomatic AS who underwent transfemoral-TAVR with Sapien-3 valve at our Clinic between April 2015 and December 2018, yielding 32 patients with liver cirrhosis on imaging including ultrasound and/or computed tomography. Their baseline characteristics, procedural and long-term outcomes after TAVR with the non-cirrhotic group were compared, along with their management strategies as per the hepatology team.
Results
Among 1028 patients, 32 were assigned to the cirrhosis, and 996 were assigned to the non-cirrhosis (control) group. Compared with the control group cirrhotic patients were slightly younger in age (74.5 vs 81.2 years), had a slightly higher BMI (31.3 vs 29.3), and had a higher incidence of prior history of myocardial infarction (38% vs 33%). Baseline variables including the history of smoking, hypertension, diabetes, and atrial fibrillation were comparable in both groups. Among cirrhotic patients (n=32), the most common etiologies were non-alcoholic steatohepatitis (NASH) (37.5%), Alcoholism (18.75%), and Hepatitis C (12.5%). The mean MELD-NA score was 11.8 and 67% of patients were Child PUGH Class A and 33% were Child PUGH Class B and all patients had a Child PUGH score of ≥5. 53% of patients (n=17) in the cirrhosis group were evaluated by Hepatology and 12.5% (n=4) were evaluated for a liver transplant but only 1 patient had a liver transplant post-TAVR. Compared with the control group cirrhotic patients had similar 1-year mortality (12% vs 12%, p=1), had a lower rate of 30-day new pacemaker post tavr (6% vs 9% p=0.85), had a higher rate of 1-year readmission for heart failure (12% vs 5% p=0.12) and similar 1-year major adverse cardiac and cerebrovascular event (MACCE) rate (15% vs 14% p=0.98)
Conclusion
Patients with severe AS undergoing TAVR with concomitant liver cirrhosis demonstrate comparable outcomes compared with their non- cirrhotic counterparts. NASH followed by alcoholic cirrhosis was found to be most common etiology.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Long-term safety and efficacy of dimethyl fumarate for up to 13 years in patients with relapsing-remitting multiple sclerosis: Final ENDORSE study results. Mult Scler 2021; 28:801-816. [PMID: 34465252 PMCID: PMC8978463 DOI: 10.1177/13524585211037909] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dimethyl fumarate (DMF) demonstrated favorable benefit-risk in relapsing-remitting multiple sclerosis (RRMS) patients in phase-III DEFINE and CONFIRM trials, and ENDORSE extension. OBJECTIVE The main aim of this study is assessing DMF safety/efficacy up to 13 years in ENDORSE. METHODS Randomized patients received DMF 240 mg twice daily or placebo (PBO; Years 0-2), then DMF (Years 3-10; continuous DMF/DMF or PBO/DMF); maximum follow-up (combined studies), 13 years. RESULTS By January 2020, 1736 patients enrolled/dosed in ENDORSE (median follow-up 8.76 years (ENDORSE range: 0.04-10.98) in DEFINE/CONFIRM and ENDORSE); 52% treated in ENDORSE for ⩾6 years. Overall, 551 (32%) patients experienced serious adverse events (mostly multiple sclerosis (MS) relapse or fall; one progressive multifocal leukoencephalopathy); 243 (14%) discontinued treatment due to adverse events (4% gastrointestinal (GI) disorders). Rare opportunistic infections, malignancies, and serious herpes zoster occurred, irrespective of lymphocyte count. For DMF/DMF (n = 501), overall annualized relapse rate (ARR) remained low (0.143 (95% confidence interval (CI), 0.120-0.169)), while for PBO/DMF (n = 249), ARR decreased after initiating DMF and remained low throughout (ARR 0-2 years, 0.330 (95% CI, 0.266-0.408); overall ARR (ENDORSE, 0.151 (95% CI, 0.118-0.194)). Over 10 years, 72% DMF/DMF and 73% PBO/DMF had no 24-week confirmed disability worsening. CONCLUSION Sustained DMF safety/efficacy was observed in patients followed up to 13 years, supporting DMF's positive benefit/risk profile for long-term RRMS treatment.
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Restorative Rehabilitation of the Cleft Affected Occlusion - A Service Evaluation. THE EUROPEAN JOURNAL OF PROSTHODONTICS AND RESTORATIVE DENTISTRY 2021; 30:49-54. [PMID: 33848409 DOI: 10.1922/ejprd_2210lee06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cleft Lip and/or Palate (CLP) is the most common cranio-facial abnormality thought to be caused by a combination of genetic and environmental factors causing challenges with feeding, dental development and speech. Cleft affected individuals often present a unique set of challenges with regards to their oro-facial and dental development and require multidisciplinary care. This article aims to describe the role of the restorative dentist in the multidisciplinary management of cleft affected individuals and outlines the various clinical presentations and restorative challenges. This article describes the various treatment modalities provided for cleft affected individuals under the National Health Service (NHS) at Liverpool University Dental Hospital (LUDH) and ranges from minimally invasive techniques to conventional fixed and removable prosthodontics.
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Le diroximel fumarate (DRF) chez les patients atteints de sclérose en plaques récurrente-rémittente : résultats intermédiaires de sécurité et d’efficacité de l’étude de phase 3 EVOLVE-MS-1. Rev Neurol (Paris) 2021. [DOI: 10.1016/j.neurol.2021.02.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Dimethyl fumarate treatment shifts the immune environment toward an anti-inflammatory cell profile while maintaining protective humoral immunity. Mult Scler 2020; 27:883-894. [PMID: 32716690 PMCID: PMC8023410 DOI: 10.1177/1352458520937282] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Delayed-release dimethyl fumarate (DMF) demonstrates sustained efficacy and safety for relapsing forms of MS. Absolute lymphocyte count (ALC) is reduced initially, then stabilizes on treatment. Objective: PROCLAIM, a 96-week, prospective, open-label, phase 3b study, assessed lymphocyte subsets and immunoglobulin (Ig) levels during 48 and 96 weeks (W) of DMF treatment. Methods: Patients received 240 mg DMF BID. Endpoints: lymphocyte subset count changes (primary); Ig isotypes and ALC changes (secondary); adverse events and relationship between ALC changes and ARR/EDSS (exploratory); and neurofilament assessment (ad hoc). Results: Of 218 patients enrolled, 158 (72%) completed the study. Median ALC decreased 39% from baseline to W96 (BL–W96), stabilizing above the lower limit of normal (baseline: 1.82 × 109/L; W48: 1.06 × 109/L; W96: 1.05 × 109/L). CD4 + and CD8 + T cells correlated highly with ALC from BL–W96 (p < 0.001). Relative to total T cells, naive CD4 + and CD8 + T cells increased, whereas CD4 + and CD8 + central and effector memory T cells decreased. Total IgA, IgG, IgM, and IgG1–4 subclass levels remained stable. Adverse event rates were similar across ALC subgroups. ARR, EDSS, and neurofilament were not correlated with ALCs. Conclusion: Lymphocyte decreases with DMF were maintained over treatment, yet immunoglobulins remained stable. No increase in infection incidence was observed in patients with or without lymphopenia. Support: Biogen
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Tricuspid Annulus Three-dimensional Geometry And Dimensions In Normal, Degenerative, And Functional Mitral Regurgitation. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.181] [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: 11/25/2022]
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Mitral Annulus Three-dimensional Configuration And Size In Normal, Degenerative, And Functional Mitral Regurgitation. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.180] [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: 10/23/2022]
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Wolf Parkinson White Syndrome- Radiofrequency Ablation in 5 Yr. Old Child. Indian Heart J 2019. [DOI: 10.1016/j.ihj.2019.11.158] [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] Open
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Deadly Pacemaker Related Infection- Treated By New Technique of Lead Extraction. Indian Heart J 2019. [DOI: 10.1016/j.ihj.2019.11.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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P6438Trends of acute kidney injury following percutaneous coronary interventions. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1032] [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
Introduction
Acute kidney injury (AKI) is a significant in-hospital complication in patients undergoing percutaneous coronary interventions (PCI) and has been shown to be associated with poor outcomes. Prior studies have shown an upward trend of AKI post PCI which may be related to a multitude of factors. In this study, we aim to discern whether the recent changes in AKI definition, awareness of risk calculators, and preventive measures have been effective in changing the inclining trend.
Methods
Patients who underwent PCI during hospitalization were identified retrospectively in the Nationwide Readmission Database (NRD) from January 2010 to December 2014. All patients older than 18 years were included in the current study. Patient demographics and comorbidities were identified using appropriate ICD-9 codes. The primary outcome is the temporal trends of AKI following PCI and secondary outcomes are temporal trends in mortality, length of stay and hospitalization cost in patients with AKI. Continuous variables were expressed as means ± standard deviation or median (IQR), and categorical variables were expressed as percentages (%). All statistical tests were two-sided.
Results
Among the 2,712,473 patients who underwent PCI from 2010 to 2014, 162,286 (6%) patients developed AKI post PCI. Mean age was 69.22±12.34 years and 65% of them were males. The percentage of cases with AKI rose almost twofold from 2010 to 2014 (4.8% to 8.1%, p-value <0.005), despite the lack of a significant change in patient's demographics and comorbidities over the years. Among patients with a history of Chronic Kidney Disease (CKD) the incidence of AKI increased from 20.3% to 24.2%, and in patients without CKD history the incidence of AKI almost doubled (2.6% to 5.0%) from 2010 to 2014. There was a slight decrease in in-hospital mortality (9.4% to 8.8%) and median length of stay (7 days to 5 days), and a slight increase in the mean cost of hospitalization ($124,755.1 to $133,902.17) from 2010 to 2014.
AKI Incidence and mortality trend
Conclusion
This large cohort study shows a consistent uptrend of AKI in patients undergoing PCI from 2010 to 2014. Despite this, the mortality and length of stay are decreasing while the cost of hospitalization only slightly increased in patients with AKI. Thus, future drives to implement renal protective measures and advanced studies to identify new preventive therapies are needed to reduce the incidence of AKI post-PCI.
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P5331Aspirin use for prevention of cardiovascular events in patients with high lipoprotein(a): a population-based study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
High lipoprotein(a) [Lp(a)] levels have been shown to increase Myocardial Infarction (MI) and all-cause mortality. However, studies evaluating the optimal preventive measures for that subset of cardiac patients are scarce. This study aims to study the outcomes of aspirin use versus no aspirin for the prevention of all-cause mortality and myocardial infarction in patients with high Lp(a) levels.
Purpose
We sought to determine the effect of Aspirin in reducing the rate of MI and all-cause mortality among patients with high lipoprotein(a) [Lp(a) ≥50mg/dL]
Methods
Patients who attended the preventive cardiology clinic from 2005 to 2016 and included in the Preventive Cardiology Database were included in the current single-center, retrospective, observational cohort study that was conducted according to the guidelines of the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology Statement) checklist. The primary outcome was the incidence of myocardial infarction and the secondary outcome was all-cause mortality. Patients were excluded in cases of I) Lp(a)a <50mg/dL, II) history of malignancy, or III) being on anticoagulation/ dual antiplatelet therapy. The median duration of follow-up was 92 months from time of Lp(a) measurement to the last follow-up. Continuous variables were expressed as means ± standard deviation or median (IQR), and categorical variables were expressed as percentages (%). All statistical tests were two-sided. A propensity score-matched analysis was performed with 1:1 nearest match for Age, Gender, Race, Smoking status, BMI, Diabetes, Peripheral artery disease, Carotid artery disease, coronary artery disease, chronic kidney disease, Heart failure, Hypertension, Dyslipidemia, Stroke, family history of coronary artery disease, Lp (a), LDL, HDL, Triglycerides, glucose and total cholesterol.
Results
1,805 patients fulfilled the inclusion and exclusion criteria out of 7,410 patients initially identified with recorded Lp(a) levels in the Preventive Cardiology Database. Of these, 376 patients were taking aspirin, and 1429 patients were not receiving aspirin. After propensity score matching for different baseline characteristics and comorbidities as mentioned above, 316 patients were matched in each group. Patients who were on Aspirin had a significantly lower rate of MI events compared to patients who were not on aspirin (6.96% vs 12.02%, P=0.03) and a lower rate, however statistically non-significant, of all-cause mortality (2.84% vs 4.11%, P=0.385).
Conclusion
The use of aspirin in patients with elevated Lp(a) levels significantly lowers the rate of myocardial infarction events. Larger randomized clinical trials are warranted to evaluate the use of aspirin for primary and secondary prevention of major adverse cardiovascular events in patients with high Lp(a) levels.
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1139Prognostic impact of aortic valve replacement in contemporary low-gradient aortic stenosis patients with lack of contractile reserve. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1139] [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: 11/14/2022] Open
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Outbreaks of influenza-like illness in care homes in the East of England: impact of variations in neuraminidase inhibitor provision. Public Health 2018; 162:98-103. [PMID: 29990618 DOI: 10.1016/j.puhe.2018.05.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/29/2018] [Accepted: 05/31/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To examine the differences in outcomes related to variable provision of antivirals in care home respiratory outbreaks. STUDY DESIGN This is a retrospective observational study. METHODS Routinely collected outbreak surveillance data reported from care home staff was recorded using a standard template and extracted from the Public Health England health protection electronic records. Data included numbers of people affected, provision of oseltamivir, hospitalization, and deaths during the outbreak in the care home. Oseltamivir provision was categorized by proportion of eligible residents prescribed it on advice. Additional data on microbiological diagnoses were obtained directly from the hospital laboratories. Logistic regression was used to examine associations between oseltamivir provision and hospitalizations and deaths in care homes. RESULTS One hundred and sixty-eight outbreaks were reported from 28th July 2016 until 27th March 2017, affecting 1459 residents and 347 staff. There were 76 hospital admissions and 37 deaths overall. Although deaths and hospital admissions also occurred in outbreaks caused by other respiratory viruses, outbreaks caused by influenza had the highest median number of people affected and a greater proportion of hospital admissions and deaths. Of the 56 outbreaks caused by influenza, there was a significant increase in the odds of the care home reporting deaths when oseltamivir was not used (odds ratio = 8.15, 95% confidence interval = 1.38-48.20, P = 0.02). There were also non-significant reductions in duration of outbreak and hospital admissions in care home outbreaks with oseltamivir treatment. CONCLUSIONS Partial or no provision of oseltamivir was associated with poorer outcomes in laboratory-confirmed influenza outbreaks.
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Panton-Valentine-producing Staphylococcus aureus: what happens to patients after skin decolonization in the community? J Hosp Infect 2018; 100:359-360. [PMID: 29577992 DOI: 10.1016/j.jhin.2018.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 03/19/2018] [Indexed: 10/17/2022]
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P6338Prognostic impact of B-type natriuretic peptide after transcatheter aortic valve replacement in patients with severe aortic stenosis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6338] [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: 11/12/2022] Open
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P493Impact of prior cerebrovascular diseases on treatment strategies and clinical outcomes after percutaneous coronary interventions. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p493] [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: 11/13/2022] Open
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UTILITY OF NT-proBNP LEVELS IN PREDICTING THE SEVERITY OF AORTIC STENOSIS IN MEN. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.288] [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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26CAN PATIENTS USE AND ACCESS THEIR CALL BELL? IMPROVING PATIENTS COMMUNICATION OF THEIR NEEDS. Age Ageing 2015. [DOI: 10.1093/ageing/afv106.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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A case of isolated cutaneous Rosai-Dorfman-Syndrome. Gulf J Oncolog 2013; 1:87-89. [PMID: 23996873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2013] [Indexed: 06/02/2023]
Abstract
UNLABELLED Rosai-Dorfman Syndrome (RDD) is a rare, benign, self-limiting disorder which is characterized by the non-malignant proliferation of distinctive histiocytic cell within lymphatic system. RDD has been described as a dynamic entity in the spectrum of histiocytosis with non-Langerhans cell histiocytosis at one end and Langerhans cell histiocytosis at the other. The exact etiology of this disease is uncertain despite widespread search for infectious or immunological reasons. We present a case of purely cutaneous Rosai-Dorfman Syndrome presenting as abdominal wall swelling. KEYWORDS Rosai-Dorfman Disease, Lymphoma.
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The Relationship Between Coronary Arterial Plaque Burden and Lipid Pools: Histological Validation Using Near-Infrared Spectroscopy and Intravascular Ultrasound. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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142 Transcatheter valve-in-valve implantation for failed balloon expandable transcatheter aortic valves. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Toxigenic Corynebacterium ulcerans infection in a veterinary student in London, United Kingdom, May 2010. Euro Surveill 2010; 15:19634. [PMID: 20738991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
We report on a case of toxigenic Corynebacterium ulcerans infection in a fully immunised veterinary student, investigated in London, United Kingdom, in May 2010. There was no ongoing transmission in human contacts. Possible animal sources were identified.
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Toxigenic Corynebacterium ulcerans infection in a veterinary student in London, United Kingdom, May 2010. Euro Surveill 2010. [DOI: 10.2807/ese.15.31.19634-en] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report on a case of toxigenic Corynebacterium ulcerans infection in a fully immunised veterinary student, investigated in London, United Kingdom, in May 2010. There was no ongoing transmission in human contacts. Possible animal sources were identified.
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E-003 Initial experience with a 'timeout' designed for neuroendovascular procedures. J Neurointerv Surg 2010. [DOI: 10.1136/jnis.2010.003251.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract: P1386 LOWERING OF HBAIC IS ASSOCIATED WITH LESS PROGRESSION OF CORONARY ATHEROSCLEROSIS. ATHEROSCLEROSIS SUPP 2009. [DOI: 10.1016/s1567-5688(09)71394-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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116: Lung Transplantation with Direct Bronchial Arterial Revascularization (BAR): Feasible and Effective – Time To Revisit? J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Do the extent and direction of arterial remodelling predict subsequent progression of coronary atherosclerosis? A serial intravascular ultrasound study. Heart 2008; 94:623-7. [DOI: 10.1136/hrt.2007.129965] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Assessment of total thrombus load in symptomatic patients with venous thromboembolism. Clin Appl Thromb Hemost 2006; 12:369-72. [PMID: 16959693 DOI: 10.1177/1076029606291408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pulmonary embolism (PE) and Deep vein thrombosis (DVT) are separate but related aspects of the same dynamic process termed as venous thrombembolism (VTE). The existing Asian literature has shown a wide variation in the prevalence of VTE, with very limited data from the Indian subcontinent. Between January 2001 and July 2004, 1,552 patients with clinically suspected lower limb DVT underwent a combined ascending radionuclide venogram and lung perfusion scan for assessment of the total thrombus burden. Of 744 patients with radionuclide venography proven DVT, 294 (40%) had a high probability lung scan. Nearly half of these patients were asymptomatic for pulmonary embolism. The high prevalence of PE in patients with DVT suggests the need for evaluation of thrombus load in the venous as well as pulmonary circulation. A combination radionuclide ascending venography with lung perfusion scan is a useful and reliable single test for this purpose.
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Snapshots in surgery. Pulsatile scrotum. Br J Surg 2006; 93:1223. [PMID: 17078119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Effect of aspirin on phase gradient of 2F1-F2 distortion product otoacoustic emissions. Hear Res 2006; 205:44-52. [PMID: 15953514 DOI: 10.1016/j.heares.2005.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2004] [Accepted: 02/28/2005] [Indexed: 11/21/2022]
Abstract
It is well known that aspirin consumption temporarily reduces overall otoacoustic emission (OAE) amplitude in humans. However, little is known about changes in the separate components of distortion product otoacoustic emissions (DPOAE), which may be distinguished by examining phase gradients. The effects of aspirin on the phase gradient of the DPOAE 2F1-F2 obtained with fixed frequency ratio sweeps were studied longitudinally in a group of twelve subjects in whom a temporary hearing loss was induced by aspirin consumption. DPOAE were recorded daily for two days pre-aspirin consumption, during the three days of aspirin consumption and two days afterwards. DP-grams were recorded over a restricted frequency range centered on 2,3,4 and 6 kHz with the following stimulus levels: L1/L2 of 60/50-80/70 in 10-dB steps. The effects of aspirin on the phase gradients varied between the subjects and across frequency: the general trend was that the phase gradient became steeper across successive sessions for the higher frequencies, while no significant effect was found at the lower frequencies. These results suggest that aspirin may have more persistent effects on cochlear function than are disclosed by measurements of hearing threshold level or DPOAE amplitude. Particularly, DPOAE phase gradient appears to be increased by aspirin consumption and has not recovered two days after cessation of aspirin intake, despite almost complete recovery of DPOAE amplitude and hearing threshold levels. These findings may suggest differential effects on the distortion and reflection mechanisms considered to underlie DPOAE generation.
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Abstract
When left ventricular outflow tract obstruction develops after aortic valve replacement, few treatment choices have been available until now. We present a patient with prior aortic valve replacement who developed left ventricle outflow tract obstruction that was successfully treated with a percutaneous transcoronary myocardial septal alcohol ablation. This technique is a useful tool for the treatment of obstructive hypertrophic cardiomyopathy, especially in those patients with prior heart surgery.
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Abstract
We describe a case of lead poisoning due to herbal remedies, presenting with an acute abdomen, raised porphyrins and increased liver enzyme activities. We suggest that lead poisoning should be considered in the differential diagnosis of the 'acute abdomen', and that the presence of liver dysfunction points to the possibility of Asian herbal remedies as the source of the lead poisoning.
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Disseminated deep tissue infection with draining sinus tracts in a healthy seven-year-old. Pediatr Infect Dis J 2001; 20:323-6. [PMID: 11303844 DOI: 10.1097/00006454-200103000-00026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Static input-output non-linearity as the source of non-linear effects in maximum length sequence click-evoked OAEs. BRITISH JOURNAL OF AUDIOLOGY 2001; 35:103-12. [PMID: 11314906 DOI: 10.1080/03005364.2001.11742737] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The application of the maximum length sequence (MLS) technique to the recording of click-evoked otoacoustic emissions (CEOAEs) allows for a reduction in test time by one to two orders of magnitude. This is because the technique permits the use of extremely high click rates, as inter-click intervals are not constrained to be greater than the duration of the response. However, increasing the click rate also causes a progressive reduction in amplitude, or 'suppression', of the CEOAE. The origin of this suppression is unclear, with diverse suggestions in the literature as to its nature and mechanism. This paper presents a simple model of the well-known compressive non-linearity of the CEOAE level function, based on a static amplitude non-linearity within each of a number of narrowband frequency channels. The response of the model to MLS stimulation demonstrates suppression broadly of the form and magnitude previously reported in experimental studies. Furthermore, the model exhibits the generation of additional non-linear components that have been speculated on in connection with CEOAE recordings using the MLS technique. It is concluded that the MLS suppression phenomenon is derived largely, if not entirely, from the static non-linearity of the CEOAE level function. The approach to modelling the phenomenon as described here also bears promise for understanding various aspects of non-linearity in MLS-based CEOAE recordings.
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