S1PR3 agonism and S1P lyase inhibition rescue mice in the severe state of experimental sepsis

Sepsis is characterized as life-threatening organ dysfunction caused by a dysregulated host response to an infection. Despite numerous clinical trials that addressed this syndrome, there is still no causative treatment available to dampen its severity. Curtailing the infection at an early stage with anti-infectives is the only effective treatment regime besides intensive care. In search for additional treatment options, we recently discovered the inhibition of the sphingosine 1-phosphate (S1P) lyase and subsequent activation of the S1P receptor type 3 (S1PR3) in pre-conditioning experiments as promising targets for sepsis prevention. Here, we demonstrate that treatment of septic mice with the direct S1P lyase inhibitor C31 or the S1PR3 agonist CYM5541 in the advanced phase of sepsis resulted in a significantly increased survival rate. A single dose of each compound led to a rapid decline of sepsis severity in treated mice and coincided with decreased cytokine release and increased lung barrier function with unaltered bacterial load. The survival benefit of both compounds was completely lost in S1PR3 deficient mice. Treatment of the murine macrophage cell line J774.1 with either C31 or CYM5541 resulted in decreased protein kinase B (Akt) and stress-activated protein kinase/c-Jun N-terminal kinase (SAPK/JNK) phosphorylation without alteration of the mitogen-activated protein kinase (MAPK) p38 and p44/42 phosphorylation. Thus, activation of S1PR3 in the acute phase of sepsis by direct agonism or S1P lyase inhibition dampened Akt and JNK phosphorylation, resulting in decreased cytokine release, improved lung barrier stability, rapid decline of sepsis severity and better survival in mice.

Estimated impact and value of blood-based colorectal cancer screening at varied adherence compared with stool-based screening

OBJECTIVE

This analysis estimated the outcomes of triennial blood-based colorectal cancer (CRC) screening at various adherence, including perfect adherence, compared with triennial multi-target stool DNA (mt-sDNA) screening at the reported real-world adherence rate.

METHODS

The validated CRC-AIM model simulated a US cohort of average-risk individuals receiving triennial screening with mt-sDNA or blood-based test from ages 45 to 75 years. Modeled specificity and sensitivity were based on reported data. Adherence was set at a real-world rate of 65.6% for mt-sDNA and at 65.6%, relative 10% incremental increases from 65.6%, or 100% for the blood-based test. Costs of mt-sDNA and the blood-based test were based on prices for clinically available tests ($508.87 and $895, respectively). Value-based pricing was estimated at a willingness-to-pay threshold of $100,000.

RESULTS

Both tests resulted in life-years gained (LYG), reduced CRC cases, and reduced deaths versus no screening. With adherence for mt-sDNA set at 65.6% and for blood-based test set at 100%, mt-sDNA resulted in 30% more LYG, 52% more averted CRC cases, and 32% more averted CRC deaths. At reported sensitivity and specificity rates, mt-sDNA at 65.6% adherence dominates (is more effective and less costly) the blood-based test at any adherence. There was no price at which triennial screening with the blood-based test at any adherence was cost-effective compared with mt-sDNA at 65.6% adherence.

CONCLUSIONS

Triennial screening with mt-sDNA resulted in better clinical outcomes at a lower cost compared with the modeled blood-based test even at perfect adherence, supporting application of blood-based tests only as a secondary screening option.

Differential Impact of Social Distancing on COVID-19 Spread in the U.S.: By Rurality and Social Vulnerability

Background

To quantify lessons learned to better prepare for similar pandemic crisis in the future, we assess the overall impact of social distancing on the daily growth rate of COVID-19 infections in the U.S. during the initial phase of the pandemic and the impacts' heterogeneity by urbanity and social vulnerability of the counties. The initial phase is chosen to purposely identify the essential and largest impact of the first-line of defense measure for similar pandemic: social distancing.

Methods

Spatial Durbin models with county fixed effects were used to account for spatial dependencies and identify spatial spillover effects and spatial heterogeneity.

Results

Besides the substantial curve flattening effects of social distancing, our results show significant spillover effects induced by neighboring counties' social distancing levels even in the absence of significant within-county effects. Urban and areas with high social vulnerability are the ones benefit the most from social distancing and high level of compliance is needed. Moderate level is enough in reaching the peak marginal impact in rural and areas with low social vulnerability.

Evaluation of four disease management programs: evidence from blue cross blue shield of Louisiana

Aims: Chronic diseases impose a substantial healthcare burden. This study sought to evaluate the clinical and economic impact of new disease management (DM) programs, targeting four major chronic disease groups: diabetes, coronary heart disease (CHD)/hypertension (HTN), asthma/chronic obstructive pulmonary disease (COPD), and congestive heart failure (CHF)/chronic kidney disease (CKD).Materials and methods: Between March 1, 2015, and February 28, 2018, members with Blue Cross Blue Shield of Louisiana insurance were contacted and enrolled in a DM program if they were aged 18 years through 64 years, eligible for a DM program, and had not been previously enrolled in a DM program. Active enrollees of a DM program ("IN" group) were compared to members who were not yet enrolled ("OUT" group). Average per member per month (PMPM) costs were aggregated annually to document any descriptive trends. Multivariable model estimates were used to compare PMPM costs for all IN subjects and all OUT subjects. Total medical savings were evaluated for the following time intervals: 1-12 months, 13-24 months, and 25-36 months.Results: For all four DM programs, average costs PMPM trended upward over time for the OUT cohort, while they remained relatively stable for the IN cohort. Some evidence also showed that DM programs improved clinical outcomes, such as hemoglobin A1c values. A difference in difference analysis showed PMPM savings for all four programs combined of $31.61, $50.45, and $53.72 after 1, 2, and 3 years, respectively. Multivariable modeling results showed total savings after 3 years of $14,460,174 for all DM programs combined.Limitations: Although multivariable models adjusted for several clinical, demographic, and economic characteristics; it is possible that some important confounders were missing due to lack of data.Conclusions: DM programs implemented to control diabetes, CHD/HTN, CHF/CKD, and asthma/COPD are cost-effective and show some evidence of improved clinical outcomes.

Exploring spatially varying demographic associations with gonorrhea incidence in Baltimore, Maryland, 2002-2005

The ability to establish spatial links between gonorrhea risk and demographic features is an important step in disease awareness and more effective prevention techniques. Past spatial analyses focused on local variations in risk, but not on spatial variations in associations with demographics. We collected data from the Baltimore City Health Department from 2002 to 2005 and evaluated demographic features known to be associated with gonorrhea risk in Baltimore, by allowing spatial variation in associations using Poisson geographically weighted regression (PGWR). The PGWR maps revealed variations in local relationships between race, education, and poverty with gonorrhea risk which were not captured previously. We determined that the PGWR model provided a significantly better fit to the data and yields a more nuanced interpretation of "core areas" of risk. The PGWR model's quantification of spatial variation in associations between disease risk and demographic features provides local and demographic structure to core areas of higher risk.

Number needed to treat based on real-world evidence for non-vitamin K antagonist oral anticoagulants versus vitamin K antagonist oral anticoagulants in stroke prevention in patients with non-valvular atrial fibrillation

Aims: Non-vitamin K antagonist oral anticoagulants (NOACs) and vitamin K antagonists (VKAs) are used to prevent stroke in patients with atrial fibrillation (AF). This paper aimed to evaluate the clinical efficacy and safety of NOACs when compared to VKAs by calculating the number needed to treat (NNT) at 2 years using incidence rates and hazard ratios (HRs) derived from a meta-analysis of studies conducted in real-world settings. Materials and methods: HRs were sourced from a published systematic literature review and a meta-analysis of real-world evidence on the use of NOACs vs VKAs. Rivaroxaban, dabigatran, and apixaban vs VKAs were investigated. The efficacy outcomes included: a composite of ischaemic stroke and systemic embolism (IS/SE), ischaemic stroke (IS), and all-cause mortality. The safety analysis assessed major bleeding and intracranial haemorrhage (ICH). Results: Superiority of NOACs vs VKAs was observed in 10/15 comparisons. Treating patients with rivaroxaban and dabigatran was associated with a reduced risk of IS and all-cause mortality compared to VKAs, with one death prevented every 22 and 32 patients, respectively, and one IS prevented every 206 and 166 patients, respectively. Rivaroxaban was significantly associated with a reduced risk of IS/SE compared to VKA (NNT: 107). No significant differences were observed between apixaban and VKAs. Dabigatran and apixaban were associated with a reduced risk of major bleeding compared to VKA (NNT: 59 and 38, respectively). No significant difference was observed between rivaroxaban and VKAs regarding major bleeding. Rivaroxaban, dabigatran, and apixaban were significantly associated with a reduced risk of ICH (NNT: 205, 115, and 108, respectively). Limitations: Heterogeneity in definitions of major bleeding across studies. Conclusions: The NNT calculation, when approached and interpreted properly, is a practical measure of the effectiveness of a treatment. The calculation based on HRs showed that NOACs are safe and effective alternatives to VKAs in real life.

Measuring the effects of reducing subsidies for private insurance on public expenditure for health care

This paper investigates the effects of reducing subsidies for private health insurance on public sector expenditure for hospital care. An econometric framework using simultaneous equation models is developed to analyse the interrelated decisions on the intensity and type of health care use and private insurance. The framework is applied to the context of the mixed public-private system in Australia. The simulation projections show that reducing premium subsidies is expected to generate net cost savings. This arises because the cost savings achieved from reducing subsidies are larger than the potential increase in public expenditure on hospital care.

[Postoperative prognosis in acromegaly: a role of immunohistochemical markers]

The aim of the investigation was to examine the markers of tumor progression in pituitary adenomas in acromegalic patients and to study their relationship to the poor postoperative predictive factors. Case histories were analyzed in 39 arcomegalic patients undergone transphenoidal adenomectomy as the method of choice at the Endocrinology Research Center, Russian Academy of Medical Sciences. The immunohistochemical technique was used to explore Ki-67, CD31, and galectin-3 in the cells of removed adenomas. Young age, high postoperative growth hormone (GH) levels, a large adenoma, and signs of its paracellular dissemination were poor postoperative predictors. Ki-67 was present In 9 (23%) of the 39 patients, CD31 in 16 (31%), galectin-3 in 11 (28%), and prolactin in 9 (23%). The preoperative GH levels were significantly higher in patients with positive immunostaining for the potential malignancy marker galectin3 and the angiogenetic marker CD31. The cell proliferation marker Ki-67 was present only in adenomas positive for prolactin. Positive immunostaining for Ki-67 and prolactin correlated with large adenoma sizes and intracavernous extension.