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Gurumurthy S, Srinivasan B, Agarwal S, Matai H, Angayarkanni N, Iyer G. Unique cytokine signature in ocular Stevens-Johnson syndrome non-responders. Ocul Surf 2024:S1542-0124(24)00036-3. [PMID: 38490474 DOI: 10.1016/j.jtos.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 03/06/2024] [Accepted: 03/12/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE To clinically define a subset of patients with chronic ocular Stevens-Johnson syndrome non-responders (SJS-NR) and analyze their cytokine profile compared to clinical responders (SJS-CR). METHODS A total of 32 SJS cases (n = 32, 64 eyes) managed over a period of three years were segregated into clinical responders (n = 24, 48 eyes) and non-responders (n = 8, 16 eyes). Cases were determined as non-responders based on persistent, refractory, and non-mechanical inflammation of the conjunctiva. Age- and sex-matched healthy controls (n = 25, 50 eyes) were recruited. Tear specimens collected using Schirmer's strip were profiled for 27 cytokines using an immunoassay-based 27-bioplex array. RESULTS Tear cytokine profiling revealed 18 cytokines to be differentially expressed in SJS-NR compared to SJS-CR. While PDGF-BB, IL-4, IL-1β, VEGF, IL-12p70, IFN-γ, IL-9, and IL-1RA were upregulated, GM-CSF, eotaxin, IP-10, IL-10, MCP-1, G-CSF, IL-6, IL-13, and bFGF were downregulated in SJS-NR compared to SJS-CR. The cytokines IL-13, IL-10, and IP-10 were decreased in both SJS-NR and SJS-CR compared to controls. CONCLUSION The inflammation in SJS-NR continues to worsen despite the correction of mechanical causes, resulting in progressive deterioration of the cornea. The cytokine profile of SJS-NR was remarkably different from that of SJS-CR, indicating a T helper 2-type protective proliferative response and an impaired migratory potential of the conjunctival epithelium. These factors could possibly lead to poor healing of the corneal epithelium in a markedly pro-inflammatory and pro-angiogenic milieu. The top four differentially expressed cytokines, PDGF-BB, IL-4, IL-10, and IL-6, are proposed as potential biomarkers of SJS-NR.
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Affiliation(s)
- Srividya Gurumurthy
- R. S. Mehta Jain Dept. of Biochemistry and Cell Biology, KBIRVO, Vision Research Foundation, Chennai, 600 006, India
| | - Bhaskar Srinivasan
- C. J. Shah Cornea Services, Dr. G Sitalakshmi Memorial Clinic for Ocular Disorders, SN-Sanmar Center of Excellence for SJS, Medical Research Foundation, Sankara Nethralaya, Chennai, 600 006, India
| | - Shweta Agarwal
- C. J. Shah Cornea Services, Dr. G Sitalakshmi Memorial Clinic for Ocular Disorders, SN-Sanmar Center of Excellence for SJS, Medical Research Foundation, Sankara Nethralaya, Chennai, 600 006, India
| | - Hiren Matai
- C. J. Shah Cornea Services, Dr. G Sitalakshmi Memorial Clinic for Ocular Disorders, SN-Sanmar Center of Excellence for SJS, Medical Research Foundation, Sankara Nethralaya, Chennai, 600 006, India
| | - Narayanasamy Angayarkanni
- R. S. Mehta Jain Dept. of Biochemistry and Cell Biology, KBIRVO, Vision Research Foundation, Chennai, 600 006, India.
| | - Geetha Iyer
- C. J. Shah Cornea Services, Dr. G Sitalakshmi Memorial Clinic for Ocular Disorders, SN-Sanmar Center of Excellence for SJS, Medical Research Foundation, Sankara Nethralaya, Chennai, 600 006, India.
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Valverde-Monge M, Sánchez-Carrasco P, Betancor D, Barroso B, Rodrigo-Muñoz JM, Mahillo-Fernández I, Arismendi E, Bobolea I, Cárdaba B, Cruz MJ, Del Pozo V, Domínguez-Ortega J, González-Barcala FJ, Olaguibel JM, Luna-Porta JA, Martínez-Rivera C, Mullol J, Muñoz X, Peleteiro-Pedraza L, Picado Valles C, Plaza V, Quirce S, Rial MJ, Soto-Retes L, Valero A, Sastre J. Comparison of Long-term Response and Remission to Omalizumab and Anti-IL-5/IL-5R Using Different Criteria in a Real-life Cohort of Severe Asthma Patients. Arch Bronconeumol 2024; 60:23-32. [PMID: 38042707 DOI: 10.1016/j.arbres.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/18/2023] [Accepted: 11/20/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Evaluation of biologic therapy response is vital to monitor its effectiveness. Authors have proposed various response criteria including good responder, super-responder, non-responder, and clinical remission. OBJECTIVES To ascertain the prevalence of response and clinical remission after long-term treatment (>6 months) of anti-IgE and anti-IL-5/IL-5Rα biologics, compare these results with existing criteria, and identify predictors for non-responders and clinical remission. METHODS A multicenter, real-life study involving severe asthma patients in Spain. Various outcomes were assessed to gauge response and clinical remission against established criteria. RESULTS The study included 429 patients, 209 (48.7%) omalizumab, 112 (26.1%) mepolizumab, 19 (4.4%) reslizumab and 89 (20.7%) benralizumab, with a mean treatment duration of 55.3±38.8 months. In the final year of treatment, 218 (50.8%) were super-responders, 173 (40.3%) responders, 38 (8.9%) non-responders, and clinical remission in 116 (27%), without differences among biologics. The short-term non-responders (<6 months) were 25/545 (4.6%). Substantial variations in response and clinical remission were observed when applying different published criteria. Predictors of non-response included higher BMI (OR:1.14; 95% CI:1.06-1.23; p<0.001), admissions at ICU (2.69; 1.30-5.56; p=0.01), high count of SAE (1.21; 1.03-1.42; p=0.02) before biologic treatment. High FEV1% (0.96; 0.95-0.98; p<0.001), a high ACT score (0.93; 0.88-0.99; p=0.01) before biologic treatment or NSAID-ERD (0.52; 0.29-0.91; p=0.02) showed strong associations with achieving clinical remission. CONCLUSION A substantial proportion of severe asthma patients treated long-term with omalizumab or anti-IL5/IL-5Rα achieved a good response. Differences in response criteria highlight the need for harmonization in defining response and clinical remission in biologic therapy to enable meaningful cross-study comparisons.
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Affiliation(s)
- Marcela Valverde-Monge
- Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
| | | | - Diana Betancor
- Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Blanca Barroso
- Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - José Manuel Rodrigo-Muñoz
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Immunology Department, Instituto de Investigación Sanitaria Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Ignacio Mahillo-Fernández
- Epidemiology and Biostatistics Department, Instituto de Investigación Sanitaria Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Ebymar Arismendi
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Allergy Unit & Severe Asthma Unit, Pneumonology and Allergy Department, Hospital Clínic, Barcelona, Spain; IDIBAPS, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain
| | - Irina Bobolea
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Allergy Unit & Severe Asthma Unit, Pneumonology and Allergy Department, Hospital Clínic, Barcelona, Spain; IDIBAPS, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain
| | - Blanca Cárdaba
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Immunology Department, Instituto de Investigación Sanitaria Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - María Jesús Cruz
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Cellular Biology, Physiology and Immunology Department, Universitat Autónoma de Barcelona, Barcelona, Spain; Pneumology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - Victoria Del Pozo
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Faculty of Medicine, Universidad Autónoma de Madrid, Spain; Immunology Department, Instituto de Investigación Sanitaria Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Javier Domínguez-Ortega
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Pneumology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - Francisco Javier González-Barcala
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Pneumology Department, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, La Coruña, Spain
| | - José María Olaguibel
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Allergy Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Juan Alberto Luna-Porta
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Allergy Department, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Carlos Martínez-Rivera
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Pneumology Department, Hospital Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Badalona, Barcelona, Spain; Universitat Autónoma de Barcelona, Spain
| | - Joaquim Mullol
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Universitat de Barcelona, Barcelona, Spain; Rhinology Unit & Smell Clinic, ENT Department, Hospital Clinic, Barcelona, Spain; Clinical and Experimental Respiratory Immunoallergy (IDIBAPS), Barcelona, Spain
| | - Xavier Muñoz
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Pneumology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - Lorena Peleteiro-Pedraza
- Pneumology Department, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, La Coruña, Spain
| | - Cesar Picado Valles
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Allergy Unit & Severe Asthma Unit, Pneumonology and Allergy Department, Hospital Clínic, Barcelona, Spain; IDIBAPS, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain
| | - Vicente Plaza
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Pneumology and Allergy Department, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Universidad Autónoma de Barcelona, Barcelona, Spain; Departamento de Medicina, Universidad de Autónoma, Barcelona, Spain
| | - Santiago Quirce
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Allergy Department, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Manuel Jorge Rial
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Allergy Department, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Lorena Soto-Retes
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Pneumology and Allergy Department, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Universidad Autónoma de Barcelona, Barcelona, Spain; Departamento de Medicina, Universidad de Autónoma, Barcelona, Spain
| | - Antonio Valero
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Allergy Unit & Severe Asthma Unit, Pneumonology and Allergy Department, Hospital Clínic, Barcelona, Spain; IDIBAPS, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain
| | - Joaquín Sastre
- Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Faculty of Medicine, Universidad Autónoma de Madrid, Spain
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Kaltseis K, Filippi V, Frank F, Eckhardt C, Schiefecker A, Broessner G. Monoclonal antibodies against CGRP (R): non-responders and switchers: real world data from an austrian case series. BMC Neurol 2023; 23:174. [PMID: 37118682 PMCID: PMC10142255 DOI: 10.1186/s12883-023-03203-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 04/10/2023] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVE Assessement of the responder and non-responder rate to consecutive monoclonal CGRP-antibody (CGRP-mAb) treatment, the presence of side effects, analysis of predictors of response and loss-of-effectiveness evaluation over time. METHODS We conducted a retrospective analysis including 171 patients with episodic (EM) or chronic migraine (CM), who received one, two or three different CGRP-mAbs. Non-response was defined as ≤ 50% reduction of monthly migraine days (MMDs) in EM and ≤ 30% reduction of MMDs in CM after 3 months of treatment. RESULTS 123 (71.9%) responded to the first mAb. Side effects led to treatment discontinuation in 9 (5.3%) patients. Of the 26 patients who did not respond to the first mAb or experienced a loss of efficacy over time, 11 (42.3%) responded to the second and two (28.6%) of 7 to the third monoclonal antibody. Poor response to therapy was associated with a higher monthly migraine frequency (p = 0.028), a higher number of prior preventive migraine therapies (p = 0.011) and medication overuse (p = 0.022). CONCLUSION Our findings support mAb-class switch in non-responders or in patients experiencing a loss of effectiveness. The use of a third CGRP-mAb could be beneficial for some patients.
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Affiliation(s)
- Katharina Kaltseis
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Vera Filippi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Florian Frank
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christine Eckhardt
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alois Schiefecker
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gregor Broessner
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
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Hu Y, Han Y, Shen Y, Chen J, Chen Y, Chen Y, Tang J, Xue M, Hong L, Cheng W, Wang D, Liang Z, Wang Y, Zhang Q, Xing H, Zhang Y, Yi C, Yu Z, Chen Y, Cui M, Ma C, Yang H, Li R, Long P, Zhao Y, Qu P, Tao G, Yang L, Wu S, Liu Z, Yang P, Lv W, Xie X, Ma D, Wang H, Li K. Neoadjuvant chemotherapy for patients with international federation of gynecology and obstetrics stages IB3 and IIA2 cervical cancer: a multicenter prospective trial. BMC Cancer 2022; 22:1270. [PMID: 36471257 PMCID: PMC9724322 DOI: 10.1186/s12885-022-10355-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Preoperative neoadjuvant chemotherapy (NACT) has been widely used in developing countries for the treatment of patients with International Federation of Gynecology and Obstetrics (FIGO) stages IB3 and IIA2 cervical cancer. However, the effectiveness of NACT and treatment options for NACT-insensitive patients have been concerning. This study will assess prognostic differences between NACT and primary surgery treatment (PST), determine factors associated with prognosis, and explore better adjuvant treatment modalities for NACT-insensitive patients. METHODS This study analyzed clinical characteristics, pathological characteristics, treatment options, and follow-up information of 774 patients with FIGO stages IB3 and IIA2 cervical cancer from 28 centers from January 2016 to October 2019 who participated in a multicenter, prospective, randomized controlled trial. RESULTS For patients undergoing NACT, the 5-year OS and PFS rate was 85.8 and 80.5% respectively. They were similar in the PST group. There was no significant difference in OS and PFS between clinical response (CR)/partial response (PR) groups and stable disease (SD)/progressive disease (PD) groups. Apart from deep cervical invasion (p = 0.046) affecting OS for patients undergoing NACT, no other clinical and pathological factors were associated with OS. 97.8% of NACT-insensitive patients opted for surgery. If these patients did not have intermediate- or high-risk factors, whether they had undergone postoperative adjuvant therapy was irrelevant to their prognosis, whereas for patients with intermediate- or high-risk factors, adjuvant chemotherapy resulted in better PFS (chemotherapy vs. no therapy, p < 0.001; chemotherapy vs. radiotherapy, p = 0.019) and OS (chemotherapy vs. no therapy, p < 0.001; chemotherapy vs. radiotherapy, p = 0.002). CONCLUSIONS NACT could be a choice for patients with FIGO stages IB3 and IIA2 cervical cancer. The main risk factor influencing prognosis in the NACT group is deep cervical invasion. After systematic treatment, insensitivity to NACT does not indicate a poorer prognosis. For NACT-insensitive patients, Chinese prefer surgery. Postoperative adjuvant therapy in patients with no intermediate- or high-risk factors does not improve prognosis, and chemotherapy in patients with intermediate- and high-risk factors is more effective than radiation therapy and other treatments. TRIAL REGISTRATION The study was prospectively registered on ClinicalTrials.gov (NCT03308591); date of registration: 12/10/2017.
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Affiliation(s)
- Yingjie Hu
- grid.33199.310000 0004 0368 7223Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Yingyan Han
- grid.33199.310000 0004 0368 7223Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Yuanming Shen
- grid.13402.340000 0004 1759 700XDepartment of Gynecologic Oncology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang China
| | - Jing Chen
- grid.33199.310000 0004 0368 7223Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Yaheng Chen
- grid.33199.310000 0004 0368 7223Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Yile Chen
- grid.216417.70000 0001 0379 7164Department of Gynecologic Oncology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan China
| | - Junying Tang
- grid.452206.70000 0004 1758 417XDepartment of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Min Xue
- grid.431010.7Department of Gynecology and Obstetrics, The Third Xiangya Hospital of Central South University, Changsha, Hunan China
| | - Li Hong
- grid.412632.00000 0004 1758 2270Department of Obstetrics and Gynaecology, Renmin Hospital of Wuhan University, Wuhan, Hubei China
| | - Wenjun Cheng
- grid.412676.00000 0004 1799 0784Department of Gynecology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu China
| | - Danbo Wang
- grid.459742.90000 0004 1798 5889Department of Gynecology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning China
| | - Zhiqing Liang
- grid.410570.70000 0004 1760 6682Department of Obstetrics and Gynecology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yifeng Wang
- grid.417404.20000 0004 1771 3058Department of Gynecology, Obstetrics and Gynecology Center, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong China
| | - Qinghua Zhang
- grid.33199.310000 0004 0368 7223Department of Obstetrics and Gynecology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Hui Xing
- grid.452911.a0000 0004 1799 0637Department of Obstetrics and Gynaecology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei China
| | - Yu Zhang
- grid.216417.70000 0001 0379 7164Department of Gynecology, Xiangya Hospital, Central South University, Changsha, Hunan China
| | - Cunjian Yi
- grid.459509.4Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei China
| | - Zhiying Yu
- grid.452847.80000 0004 6068 028X Department of Gynecology, The First Affiliated Hospital of Shenzhen University, Health Science Center; Shenzhen Second People’s Hospital, Shenzhen, Guangdong China
| | - Youguo Chen
- grid.429222.d0000 0004 1798 0228Department of Obstetrics and Gynecology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu China
| | - Manhua Cui
- grid.452829.00000000417660726Department of Gynecology and Obstetrics, The Second Hospital of Jilin University, Changchun, Jilin China
| | - Cailing Ma
- grid.412631.3Department of Gynecology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang China
| | - Hongying Yang
- grid.452826.f Department of Gynecology, Yunnan Tumor Hospital and The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan China
| | - Ruizhen Li
- Department of Gynecology and Obstetrics, Shenzhen Hospital of Beijing University, Shenzhen, Guangdong China
| | - Ping Long
- The Second People’s Hospital of Jingmen, Hubei Jingmen, China
| | - Yu Zhao
- grid.417384.d0000 0004 1764 2632Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang China
| | - Pengpeng Qu
- grid.410626.70000 0004 1798 9265Department of Gynecology Oncology, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin, China
| | - Guangshi Tao
- grid.452708.c0000 0004 1803 0208Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University, Changsha, Hunan China
| | - Lihua Yang
- grid.285847.40000 0000 9588 0960Department of Obstetrics and Gynecology, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan China
| | - Sufang Wu
- grid.16821.3c0000 0004 0368 8293Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhihua Liu
- grid.284723.80000 0000 8877 7471Department of Gynecology, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong China
| | - Ping Yang
- grid.411680.a0000 0001 0514 4044Department of Obstetrics and Gynecology, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, Xinjiang China
| | - Weiguo Lv
- grid.13402.340000 0004 1759 700XDepartment of Gynecologic Oncology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang China
| | - Xing Xie
- grid.13402.340000 0004 1759 700XDepartment of Gynecologic Oncology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang China
| | - Ding Ma
- grid.33199.310000 0004 0368 7223Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Hui Wang
- grid.13402.340000 0004 1759 700XDepartment of Gynecologic Oncology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang China
| | - Kezhen Li
- grid.33199.310000 0004 0368 7223Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
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Thana K, Sikorskii A, Lehto R, Guhaniyogi P, Brewer S, Victorson D, Pace T, Badger T, Wyatt G. Family caregivers of those with cancer: quality of life outcomes from a sequential multiple assignment randomized trial. Support Care Cancer 2022; 30:5891-5902. [PMID: 35378595 DOI: 10.1007/s00520-022-07012-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 03/24/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To conduct a secondary analysis focused on health-related quality of life (HRQOL) among caregivers engaged in a 12-week complementary therapy sequential multiple assignment randomized trial (SMART) of reflexology and/or meditative practices (MP), to manage cancer patients' symptoms. METHODS In this SMART, patient-caregiver dyads were initially randomized to 4 weeks of caregiver-delivered reflexology for the patient (N = 150), MP with the patient (N = 150), or control (N = 47). After 4 weeks, dyads with patients not improving on fatigue (non-responders, n = 69 to reflexology and n = 57 to MP) were re-randomized to continue the same therapy or add the other therapy for an additional 4 weeks. Week-12 caregiver HRQOL was measured using the Patient Reported Outcomes Measurement Information System (PROMIS) Profile-29 and the Caregiver Reaction Assessment Tool (CRAT) for caregiver burden; scores were analyzed using general linear models. RESULTS In the comparison of 4 adaptive intervention sequences: reflexology for 8 weeks, reflexology for 4 weeks followed by MP for 4 weeks if no response to reflexology, MP for 8 weeks, and MP for 4 weeks followed by reflexology for 4 weeks if no response to MP, there were no differences in PROMIS-29 scores. However, CRAT domains of impact on schedule, family support, and finances worsened when adding reflexology after the first 4 weeks of MP. The CRAT domain of health worsened by adding either intervention compared to continuing the same one. CONCLUSIONS Clinicians should be aware that caregiver engagement in more than one complementary therapy may increase caregiver burden in some domains but not affect other HRQOL domains. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02759146.
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Affiliation(s)
- Kanjana Thana
- College of Nursing, Michigan State University, 1355 Bogue Street, East Lansing, MI, 48824, USA
- Faculty of Nursing, Chiang Mai University, 110/406 Inthawaroros Road, Chiang Mai, 50200, Thailand
| | - Alla Sikorskii
- Department of Psychiatry, Michigan State University, 909 Wilson Road, Room 32, East Lansing, MI, 48824, USA
| | - Rebecca Lehto
- College of Nursing, Michigan State University, 1355 Bogue Street, East Lansing, MI, 48824, USA
| | - Pratim Guhaniyogi
- Department of Statistics and Probability, Michigan State University, 619 Red Cedar Road, East Lansing, MI, 48824, USA
| | - Sarah Brewer
- Department of Epidemiology and Biostatistics, Michigan State University, 909 Wilson Road, East Lansing, MI, 48824, USA
| | - David Victorson
- Northwestern University Feinberg School of Medicine, Evanston, IL, 60208, USA
| | - Thaddeus Pace
- University of Arizona College of Nursing, 1305 N. Martin Ave, PO Box 210203, Tucson, AZ, 85721, USA
| | - Terry Badger
- University of Arizona College of Nursing, 1305 N. Martin Ave, PO Box 210203, Tucson, AZ, 85721, USA
| | - Gwen Wyatt
- College of Nursing, Michigan State University, 1355 Bogue Street, East Lansing, MI, 48824, USA.
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Krüttgen A, Haase G, Haefner H, Imöhl M, Kleines M. Large inter-individual variability of cellular and humoral immunological responses to mRNA-1273 (Moderna) vaccination against SARS-CoV-2 in health care workers. Clin Exp Vaccine Res 2022; 11:96-103. [PMID: 35223670 PMCID: PMC8844675 DOI: 10.7774/cevr.2022.11.1.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/06/2021] [Accepted: 10/01/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Studies on the immune responses to severe acute respiratory syndrome coronavirus 2 vaccines are necessary to evaluate the ongoing vaccination programs by correlating serological response data and clinical effectiveness data. We performed a longitudinal immunological profiling of health care workers vaccinated with mRNA-1273 (Moderna, Cambridge, MA, USA). Half of these vaccinees had experienced a mild coronavirus disease 2019 (COVID-19) infection in the spring of 2020 ("COVID-recovered" cohort), whereas the other half of the vaccinees had no previous COVID-19 infection ("COVID-naive" cohort). MATERIALS AND METHODS Serum was drawn at multiple time points and subjected to assays measuring anti-Spike immunoglobulin G (IgG), avidity of anti-Spike IgG, avidity of anti-receptor binding domain (RBD) IgG, virus neutralizing activity, and interferon-γ release from stimulated lymphocytes. RESULTS Between both cohorts and within each cohort, we found remarkable inter-individual differences regarding cellular and humoral immune responses to the Moderna mRNA-1273 vaccine. CONCLUSION First, our study indicates that the success of mRNA-1273 vaccinations should be verified by serological assays in order to identify "low-responders" to vaccination. Second, the kinetics of anti-S IgG and neutralizing activity correlate well with clinical effectiveness data, thus explaining incipient protection against infection 2 weeks after the first dose of mRNA-1273 in COVID-naive vaccinees. Third, our IgG-avidity data indicate that this incipient protection is mediated by low-avidity anti-RBD IgG and low-avidity anti-S IgG.
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Affiliation(s)
- Alexander Krüttgen
- Laboratory Diagnostic Center, University Hospital RWTH Aachen, Aachen, Germany
| | - Gerhard Haase
- Laboratory Diagnostic Center, University Hospital RWTH Aachen, Aachen, Germany
| | - Helga Haefner
- Laboratory Diagnostic Center, University Hospital RWTH Aachen, Aachen, Germany
| | - Matthias Imöhl
- Laboratory Diagnostic Center, University Hospital RWTH Aachen, Aachen, Germany
| | - Michael Kleines
- Laboratory Diagnostic Center, University Hospital RWTH Aachen, Aachen, Germany
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Khaimova R, Fischetti B, Cope R, Berkowitz L, Bakshi A. Serological response with Heplisav-B® in prior Hepatitis B vaccine non-responders living with HIV. Vaccine 2021; 39:6529-6534. [PMID: 34600748 DOI: 10.1016/j.vaccine.2021.09.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/10/2021] [Accepted: 09/20/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND As people living with HIV (PLWH) are at risk for contracting Hepatitis B Virus (HBV), they should be screened for HBV and vaccinated if not immune. Seroconversion rates in PLWH receiving traditional recombinant HBV vaccines (Engerix-B® and Recombivax-HB®) have historically been low with at most 70% achieving immunity. In 2017, a recombinant, adjuvanted HBV vaccine (Heplisav-B®) was approved for use in HIV-negative patients. Heplisav-B® has shown superior seroprotection in this population compared to Engerix-B® and Recombivax-HB®, as well as interim analysis showing higher seropositivity rates in patients undergoing dialysis. However, its efficacy in PLWH is currently unknown. This study evaluates the rate of seroconversion following Heplisav-B® administration in PLWH with previous HBV vaccination failure. METHODS Retrospective, cross-sectional study at The Brooklyn Hospital Center's HIV primary care clinic in Brooklyn, NY. HIV-positive adults who received at least two doses of Heplisav-B® and had previously failed to seroconvert after vaccination with Engerix-B® or Recombivax-HB® were included. The primary outcome is the percentage of PLWH who became seropositive following Heplisav-B®. RESULTS A total of 67 patients met the inclusion criteria. Twenty-five (37.3%) PLWH had failed at least 2 courses of recombinant vaccines. Fifty-eight (86.6%) PLWH became seropositive (Anti-HBs > 10 mIU/mL) at least two months after completing Heplisav-B®. For the 9 (13.4%) patients that did not develop immunity, 3 (33%) had a detectable HIV RNA and 3 (33%) had a CD4 count < 200 cells/uL3. CONCLUSIONS Heplisav-B® was highly effective in achieving immunity to HBV in PLWH who failed non-adjuvanted recombinant vaccines.
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Affiliation(s)
- Rebecca Khaimova
- Pharmacy Practice, The Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, 1 University Plaza, Brooklyn, NY 11201, United States.
| | - Briann Fischetti
- Division of Infectious Diseases, The Brooklyn Hospital Center, 121 Dekalb Ave, Brooklyn, NY 11201, United States; Pharmacy Practice, The Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, 1 University Plaza, Brooklyn, NY 11201, United States.
| | - Rebecca Cope
- Division of Infectious Diseases, The Brooklyn Hospital Center, 121 Dekalb Ave, Brooklyn, NY 11201, United States; Pharmacy Practice, The Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, 1 University Plaza, Brooklyn, NY 11201, United States.
| | - Leonard Berkowitz
- Division of Infectious Diseases, The Brooklyn Hospital Center, 121 Dekalb Ave, Brooklyn, NY 11201, United States.
| | - Anjali Bakshi
- Division of Infectious Diseases, The Brooklyn Hospital Center, 121 Dekalb Ave, Brooklyn, NY 11201, United States.
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Khademi B, Khorrami M, Ayromlou H, Rikhtegar R, Moghadam EA, Tahmasebivand M, Mousavi SR, Kheirollahi M, Fakhr F, Alizadeh-Ghodsi M, Emamalizadeh B. An interdependence between GAPVD1 gene polymorphism, expression level and response to interferon beta in patients with multiple sclerosis. J Neuroimmunol 2021; 353:577507. [PMID: 33548618 DOI: 10.1016/j.jneuroim.2021.577507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/02/2021] [Accepted: 01/27/2021] [Indexed: 11/21/2022]
Abstract
Interferon-β (IFN-β) is among the first drugs used for reducing the symptoms of multiple sclerosis (MS). Many studies show that the genetic predisposition of patients might modulate their response to IFN-β treatment. In this study GAPVD1 gene expression and the genotyping of rs2291858 variant were analysed in 100 responder and 100 non-responder patients with MS treated using IFN-β. Moreover, rs2291858 genotyping was performed for 200 patients with MS and 200 healthy controls. GAPVD1 expression was significantly increased in the responder patients than in non-responders and the distribution of rs2291858 polymorphism was significantly different between them. The GAPVD1 expression level in AA genotype of the responder group was higher than that in other genotypes of these two groups. The results show that the GAPVD1 expression level and rs2291858 genotype probably affect the response to IFN- β in patients with MS.
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9
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Blanchette M. Cardiac resynchronization therapy setting personalization utilizing noninvasive hemodynamics. Heart Lung 2020; 50:165-167. [PMID: 32711894 DOI: 10.1016/j.hrtlng.2020.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) has been an important adjunct to goal directed medical therapy in heart failure patients who qualify for this device. Too often, when heart failure patients complain about severe fatigue, beta-blockers are immediately reduced. Personalization of settings, verified by noninvasive hemodynamics, can allow for maximizing medical therapy. CASE A newly diagnosed 40 year-old male presented to the heart failure clinic post hospital discharge with a severely dilated, non-ischemic cardiomyopathy. Even with an ejection fraction (EF) of 15-20%, he reports "feeling great". Increasing medications resulted in excessive fatigue. Non-invasive studies showed an average cardiac index (CI) of 1.5l/min/m2. It was decided to personalize his settings. Changes made increased his CI to 3.9l/min/m2. CONCLUSION Combining current available technology with noninvasive studies significantly improved his CI and no reduction in beta-blocker therapy was necessary. CRT personalization can be of significant value for the heart failure patient.
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Affiliation(s)
- Michael Blanchette
- Sarasota Memorial Health Care System, Heart Failure Center, 1700 South Tamiami Trail, Sarasota, FL 34239, United States.
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10
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Decaro N, Buonavoglia C, Barrs VR. Canine parvovirus vaccination and immunisation failures: Are we far from disease eradication? Vet Microbiol 2020; 247:108760. [PMID: 32768213 PMCID: PMC7295477 DOI: 10.1016/j.vetmic.2020.108760] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 01/22/2023]
Abstract
Despite extensive vaccination, canine parvovirus (CPV) still represents one of the major causes of pups’ mortality. CPV immunisation failures occur frequently and recognize different reasons. Interference by maternally-derived antibodies is the main cause of CPV immunisation failures. Eradication of CPV infection is a challenge for the future, but it will not be achieved in a short time
Despite extensive vaccination, canine parvovirus (CPV) remains a leading infectious cause of canine mortality, especially among juveniles. This review provides an update on CPV vaccine types and vaccination protocols. The design of CPV prevention strategies and vaccination programs with a goal of herd immunity has been hampered by deficiencies of studies that model companion animal viral infections and inform an understanding of the basic reproduction number. However, the most important issue in eradication of CPV disease is represented by immunisation failures including: i) the presence of interfering titres of maternally-derived antibodies; ii) the presence of non-responders; and iii) possible reversion to virulence. In contrast, the role of the CPV variants in immunisation failures is widely debated. Taking into account the reduced circulation of canine distemper virus and canine adenovirus type 1 in countries where extensive vaccination is carried out, more effort should be made to aim for CPV eradication, including antibody testing to determine the optimal time for vaccinations of pups and adults and homogeneous vaccine coverage of dog population.
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Affiliation(s)
- N Decaro
- Department of Veterinary Medicine, University of Bari, Valenzano (Bari), Italy.
| | - C Buonavoglia
- Department of Veterinary Medicine, University of Bari, Valenzano (Bari), Italy
| | - V R Barrs
- City University of Hong Kong, Department of Infectious Diseases & Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, Kowloon, Hong Kong SAR, China
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Sieniewicz BJ, Gould J, Porter B, Sidhu BS, Teall T, Webb J, Carr-White G, Rinaldi CA. Understanding non-response to cardiac resynchronisation therapy: common problems and potential solutions. Heart Fail Rev 2019; 24:41-54. [PMID: 30143910 DOI: 10.1007/s10741-018-9734-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Heart failure is a complex clinical syndrome associated with a significant morbidity and mortality burden. Reductions in left ventricular (LV) function trigger adaptive mechanisms, leading to structural changes within the LV and the potential development of dyssynchronous ventricular activation. This is the substrate targeted during cardiac resynchronisation therapy (CRT); however, around 30–50% of patients do not experience benefit from this treatment. Non-response occurs as a result of pre-implant, peri-implant and post implant factors but the technical constraints of traditional, transvenous epicardial CRT mean they can be challenging to overcome. In an effort to improve response, novel alternative methods of CRT delivery have been developed and of these endocardial pacing, where the LV is stimulated from inside the LV cavity, appears the most promising.
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12
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Iyer PC, Rosenberg A, Baynard T, Madhavan S. Influence of neurovascular mechanisms on response to tDCS: an exploratory study. Exp Brain Res 2019; 237:2829-2840. [PMID: 31455998 DOI: 10.1007/s00221-019-05626-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/08/2019] [Indexed: 10/26/2022]
Abstract
The beneficial effects of transcranial direct current stimulation (tDCS) for stroke rehabilitation are limited by the variability in changes in corticomotor excitability (CME) after tDCS. Neuronal activity is closely related to cerebral blood flow; however, the cerebral hemodynamics of neuromodulation in relation to neural effects have been less explored. In this study, we examined the effects of tDCS on cerebral blood velocity (CBv) in chronic stroke survivors using transcranial Doppler (TCD) ultrasound in relation to changes in CME and described the neurovascular characteristics of tDCS responders. Middle cerebral artery (MCA) CBv, cerebrovascular resistance (CVRi) and other cerebral hemodynamics-related variables were continuously measured before and after 15 min of 1 mA anodal tDCS to the lesioned lower limb M1. tDCS did not modulate CBv in the whole group and upon TMS-based stratification of responders and non-responders. However, at baseline, responders demonstrated lower CME levels, lower CBv and higher CVRi as compared to non-responders. These results indicate a possible difference in baseline CME and CBv in tDCS responders that may influence their response to neuromodulation. Future trials with a large sample size and repeated baseline measurements may help validate these findings and establish a relationship between neuromodulation and neurovascular mechanisms in stroke.
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Affiliation(s)
- Pooja C Iyer
- Graduate Program in Rehabilitation Science, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Alexander Rosenberg
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, USA.,Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Tracy Baynard
- Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Sangeetha Madhavan
- Brain Plasticity Laboratory, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, 1919 West Taylor Street, Chicago, IL, 60612, USA.
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Blondeau P, Hamid M, Ghalie Z. Prospective randomized clinical trial on the effects of latanoprost, travoprost and bimatoprost on latanoprost non-responders. J Fr Ophtalmol 2019; 42:894-899. [PMID: 31164290 DOI: 10.1016/j.jfo.2019.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 02/02/2019] [Accepted: 02/04/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To determine whether a patient who is non-responder to latanoprost after one month of use should continue using latanoprost or switch to either bimatoprost or travoprost. PATIENTS AND METHODS Prospective randomized clinical trial. We recruited new patients who were felt to require intraocular pressure reduction. Patients who had≤20% intraocular pressure reduction after one month of latanoprost treatment were randomly assigned to another month of treatment with latanoprost or a switch to bimatoprost or travoprost for an additional month. RESULTS Overall, 83 non-responders to latanoprost after one month of treatment were included in the study. Before latanoprost treatment, the mean intraocular pressure was 23.7±4.7mmHg. At randomization on latanoprost, mean intraocular pressure was 21.5±4.5mmHg. One month after the switch of medication, the mean reduction in intraocular pressure was not significantly different between the groups (P=0.148) and was -0.9mmHg, -2.10mmHg and -2.5mmHg, for latanoprost, bimatoprost and travoprost respectively. One month after randomization, 32 (38.5%) of the patients had become responders, with IOP reduction>20%. Of those patients, 9 (31%) were using latanoprost, 13 (41.9%) bimatoprost and 10 (43.5%) travoprost. The number of new responders was similar between the three groups (P=0.584). CONCLUSION There is no added benefit of switching latanoprost to another topical prostaglandin for patients who are initially non-responders. Regression towards the mean and the Hawthorne effect are probably important factors explaining the additional IOP reduction obtained after randomization and explain the result of most switch studies.
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Affiliation(s)
- P Blondeau
- Department of Ophthalmology, University of Sherbrooke, CHUS, Sherbrooke, Canada.
| | - M Hamid
- Department of Ophthalmology, University of Sherbrooke, CHUS, Sherbrooke, Canada
| | - Z Ghalie
- Department of Ophthalmology, University of Sherbrooke, CHUS, Sherbrooke, Canada
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Oskis A, Smyth N, Flynn M, Clow A. Repressors exhibit lower cortisol reactivity to group psychosocial stress. Psychoneuroendocrinology 2019; 103:33-40. [PMID: 30639935 DOI: 10.1016/j.psyneuen.2018.12.220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/10/2018] [Accepted: 12/14/2018] [Indexed: 02/01/2023]
Abstract
Repressors are well-known to monitor potential psychosocial threats to their self-esteem and self-concept. In research, repressors are traditionally categorised as those scoring low on trait anxiety and high on defensiveness (as measured by social desirability scales). Examining repressors' cortisol reactivity to a group socio-evaluative laboratory stressor could be an important way to extend work on the classic 'repressor dissociation', which proposes that this group experience higher levels of physiological stress, but lower levels of subjective affect, during stressful situations. Research however has focused mainly on repressors' higher, more risk-prone levels of autonomic, rather than hypothalamic-pituitary-adrenal (HPA), reactivity to stressful stimuli. We assessed cortisol reactivity using a group-based acute psychosocial stressor, the Trier Social Stress Test for groups (TSST-G), which required participants to individually perform public speaking and mental arithmetic tasks in front of up to six other group members, as well as an evaluative panel of judges. Seventy-seven healthy young females (mean age ± SD: 20.2 ± 3.2 years) took part, of which 64 met the conventional criterion for a response to the TSST-G (<15.5% increase from baseline sample). The Stress-Arousal Checklist was completed pre- and post-TSST-G. Participants also completed the Perceived Stress Scale, the Trait Anxiety Inventory and the Marlow-Crowne Social Desirability Scale. The latter two measures were used to provide a categorisation of repressive coping style. Participants identified as repressive copers exhibited significantly lower cortisol reactivity during the TSST-G. Repressors also self-reported less subjective stress. These findings provide some evidence against the notion of the repressor dissociation and are discussed in terms of how cortisol hyporeactivity may be a pathway through which repressive coping adversely affects health.
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Affiliation(s)
- A Oskis
- Department of Psychology, Faculty of Science and Technology, Middlesex University, London, NW4 4BT, UK.
| | - N Smyth
- Psychophysiology and Stress Research Group, Department of Psychology, University of Westminster, 115 New Cavendish Street, London, W1W 6UW, UK
| | - M Flynn
- Psychophysiology and Stress Research Group, Department of Psychology, University of Westminster, 115 New Cavendish Street, London, W1W 6UW, UK
| | - A Clow
- Psychophysiology and Stress Research Group, Department of Psychology, University of Westminster, 115 New Cavendish Street, London, W1W 6UW, UK
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Nagashima S, Yamamoto C, Ko K, Chuon C, Sugiyama A, Ohisa M, Akita T, Katayama K, Yoshihara M, Tanaka J. Acquisition rate of antibody to hepatitis B surface antigen among medical and dental students in Japan after three-dose hepatitis B vaccination. Vaccine 2018; 37:145-151. [PMID: 30449632 DOI: 10.1016/j.vaccine.2018.11.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/28/2018] [Accepted: 11/07/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Health care workers (HCWs) are at high risk of contracting blood-borne infections including hepatitis B virus (HBV) infection. In Japan, all HCWs are required to receive HB vaccination before beginning work. This study aimed to investigate the dynamics of the HB surface antibody (anti-HBs) titer after a three-dose HB vaccination in HCWs and to determine effective scheduling of HB vaccination for non-responders. METHODS Subjects included 832 medical and dental students who had received a three-dose HB vaccination (Bimmugen® 0.5 ml/vial). Anti-HBs was measured three times (before the third dose and 1 and 5 months after the third dose) using the CLIA method. The cut-off value of anti-HBs acquisition was 10 mIU/mL. After booster doses (three maximum) were administered to non-responders, the anti-HBs titers were measured again. RESULTS Out of 832 students, 491 were analyzed, of which 58.9% (289) were male. Anti-HBs-positive rates before the third dose and 1 and 5 months later were 47.9%, 95.9%, and 89.0%, respectively. The relationship between the antibody titer at one month (x) and 5 months (y) was estimated by log10y = log10x - 0.134 (P < 0.0001). Twelve non-responders were followed-up, all of which acquired a protective anti-HBs titer after revaccination with a three-dose booster. CONCLUSION Anti-HBs titer decreases by an average of 20% within 4 months between the 1st and 5th month after the third dose. Therefore, anti-HBs titer should be measured periodically after completing the three-dose vaccination. Additionally, results suggested that booster doses are effective if administered with the same schedule as primary vaccination.
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Affiliation(s)
- Shintaro Nagashima
- Department of Epidemiology, Infectious Disease Control and Prevention, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Chikako Yamamoto
- Department of Epidemiology, Infectious Disease Control and Prevention, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Ko Ko
- Department of Epidemiology, Infectious Disease Control and Prevention, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Channarena Chuon
- Department of Epidemiology, Infectious Disease Control and Prevention, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Aya Sugiyama
- Department of Epidemiology, Infectious Disease Control and Prevention, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Masayuki Ohisa
- Department of Epidemiology, Infectious Disease Control and Prevention, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Tomoyuki Akita
- Department of Epidemiology, Infectious Disease Control and Prevention, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Keiko Katayama
- Department of Epidemiology, Infectious Disease Control and Prevention, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | | | - Junko Tanaka
- Department of Epidemiology, Infectious Disease Control and Prevention, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
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Juto H, Gärtner Nilsson M, Möller M, Wennergren D, Morberg P. Evaluating non-responders of a survey in the Swedish fracture register: no indication of different functional result. BMC Musculoskelet Disord 2017; 18:278. [PMID: 28659134 PMCID: PMC5490217 DOI: 10.1186/s12891-017-1634-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 06/19/2017] [Indexed: 11/10/2022] Open
Abstract
Background The Swedish Fracture Register (SFR) currently contains information on more than 190,000 fractures. Patient Reported Outcome Measures (PROMs) are used for monitoring functional results after fracture treatment. One weakness, as in many surveys, is a low response rate. The aim of the current study was to examine if non-responders of a survey in the SFR differ in PROMs scores, how age and gender influence the response rate and reasons for not responding. Methods Patients with fractures of radius, ulna or humerus between June and August 2013 and registered in the SFR were included in the study. The non-responders to both the pre-injury and the 1-year survey were contacted by phone and reminded to reply. A comparison of the results of both EQ-5D and Short Musculoskeletal Function Assessment (SMFA) could be made between the responders after a phone reminder and the initial responders. The response rate for the register as a whole was extracted in order to identify how age and gender affect the response rate. Results Three hundred seventeen of the patients included in the study responded initially. After phone reminder another 94 patients answered the pre-injury survey. Two hundred sixty eight responded initially to the 1-year follow-up survey and 42 after phone reminder. No significant difference was identified in the score of the pre-injury survey between initial responders and responders after phone reminder neither in the EQ-5D nor in the Short Musculoskeletal Function Assessment (SMFA). Regarding the 1-year survey, responders after a phone reminder reported a significantly better outcome in crude data of SMFA score. This difference disappeared after controlling for confounding factors through case control matching. The highest response rate to PROMs in the SFR was among females in the age range 60–69 years. Conclusion This study indicates that both in the preinjury survey as well as in the 1-year survey the non-responders in the SFR report similar function compared to the initial responders. Age and gender of patients affect the response rate of the survey which needs to be taken into consideration in analysis of data from the SFR.
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Affiliation(s)
- Hans Juto
- Department of Surgical and Perioperative Science (Orthopedics), Sunderby Research Unit, Umeå University, Umeå, Sweden.
| | - Mattis Gärtner Nilsson
- Department of Surgical and Perioperative Science (Orthopedics), Sunderby Research Unit, Umeå University, Umeå, Sweden
| | - Michael Möller
- Department of Orthopedics and Trauma, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
| | - David Wennergren
- Department of Orthopedics and Trauma, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
| | - Per Morberg
- Department of Surgical and Perioperative Science (Orthopedics), Sunderby Research Unit, Umeå University, Umeå, Sweden
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Sun K, Park J, Kim M, Scherer PE. Endotrophin, a multifaceted player in metabolic dysregulation and cancer progression, is a predictive biomarker for the response to PPARγ agonist treatment. Diabetologia 2017; 60:24-29. [PMID: 27717959 PMCID: PMC5136306 DOI: 10.1007/s00125-016-4130-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 09/13/2016] [Indexed: 12/22/2022]
Abstract
Endotrophin is a cleavage product derived from the collagen VI(α3) chain. Collagen VI is expressed in a number of different tissues, but adipose tissue is a particularly prominent source for this extracellular matrix constituent. Mice lacking collagen VI are metabolically healthier due to reduced fibrosis in adipose tissue. Endotrophin seems to be one of the key players of collagen VI-mediated signalling effects, including its pro-fibrotic nature and chemoattractant properties for macrophages, while also playing an important role in cancer progression and the chemoresistance of tumour cells. The glucose-lowering class of thiazolidinediones (TZDs) that mediate their action through the nuclear receptor peroxisome proliferator-activated receptor (PPAR)γ also exerts important effects on endotrophin by reducing the transcription of parental collagen VI molecules. As with many other pharmacological interventions, there is a range of responses observed in a diabetic patient population. In this issue of Diabetologia, Karsdal and colleagues (DOI: 10.1007/s00125-016-4094-1 ) demonstrate that baseline endotrophin levels offer excellent predictive values to indicate individuals who will show an optimised response to TZDs with respect to the lowering of HbA1c and reduced risk of adverse side effects. The identification of a predictive biomarker for optimal responders is an important step in highlighting the continued viability of TZDs as an effective glucose-lowering class of compounds.
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Affiliation(s)
- Kai Sun
- Touchstone Diabetes Center, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-8549, USA
- Center for Metabolic and Degenerative Diseases, The Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jiyoung Park
- Touchstone Diabetes Center, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-8549, USA
- Department of Biological Sciences, School of Life Sciences, Ulsan National Institute of Science and Technology, Ulsan, South Korea
| | - Min Kim
- Touchstone Diabetes Center, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-8549, USA
- National Research Laboratory for Mitochondrial Signaling, Department of Physiology, College of Medicine, Inje University, Busan, South Korea
- Cardiovascular and Metabolic Disease Center, Inje University, Busan, South Korea
| | - Philipp E Scherer
- Touchstone Diabetes Center, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-8549, USA.
- Department of Cell Biology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Tomer S, Chawla YK, Duseja A, Arora SK. Dominating expression of negative regulatory factors downmodulates major histocompatibility complex Class-II expression on dendritic cells in chronic hepatitis C infection. World J Gastroenterol 2016; 22:5173-5182. [PMID: 27298560 PMCID: PMC4893464 DOI: 10.3748/wjg.v22.i22.5173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 04/26/2016] [Accepted: 05/04/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To elucidate the molecular mechanisms leading to development of functionally impaired dendritic cells (DCs) in chronic hepatitis C (CHC) patients infected with genotype 3 virus.
METHODS: This prospective study was conducted on the cohorts of CHC individuals identified as responders or non-responders to antiviral therapy. Myeloid DCs were isolated from the peripheral blood of each subject using CD1c (BDCA1)+ DC isolation Kit. Monocytes from healthy donor were cultured with DC growth factors such as IL-4 and GM-CSF either in the presence or absence of hepatitis C virus (HCV) viral proteins followed by LPS stimulation. Phenotyping was done by flowcytometry and gene expression profiling was evaluated by real-time PCR.
RESULTS: Non-responders [sustained virological response (SVR)-ve] to conventional antiviral therapy had significantly higher expression of genes associated with interferon responsive element such as IDO1 and PD-L1 (6-fold) and negative regulators of JAK-STAT pathway such as SOCS (6-fold) as compared to responders (SVR+ve) to antiviral therapy. The down-regulated genes in non-responders included factors involved in antigen processing and presentation mainly belonging to major histocompatibility complex (MHC) Class-II family as HLA-DP, HLA-DQ (2-fold) and superoxide dismutase (2-fold). Cells grown in the presence of HCV viral proteins had genes down-regulated for factors involved in innate response, interferon signaling, DC maturation and co-stimulatory signaling to T-cells, while the genes for cytokine signaling and Toll-like receptors (4-fold) were up-regulated as compared to cells grown in absence of viral proteins.
CONCLUSION: Underexpressed MHC class-II genes and upregulated negative regulators in non-responders indicate diminished capacity to present antigen and may constitute mechanism of functionally defective state of DCs.
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Chiarenza GA, Chabot R, Isenhart R, Montaldi L, Chiarenza MP, Torto MGL, Prichep LS. The quantified EEG characteristics of responders and non-responders to long-term treatment with atomoxetine in children with attention deficit hyperactivity disorders. Int J Psychophysiol 2016; 104:44-52. [PMID: 27108364 DOI: 10.1016/j.ijpsycho.2016.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 04/18/2016] [Accepted: 04/19/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of our study is to examine quantitative Electroencephalogram (QEEG) differences between ADHD patients that are responders and non-responders to long-term treatment with Atomoxetine at baseline and after 6 and 12months of treatment. Patients with attention deficit hyperactivity disorder (ADHD) received atomoxetine titrated, over 7days, from 0.5 to 1.2mg/kg/day. QEEG and Swanson, Nolan, and Pelham-IV Questionnaire (SNAP-IV) scores were recorded before treatment and after therapy. METHODS Twenty minutes of eyes closed resting EEG was recorded from 19 electrodes referenced to linked earlobes. Full frequency and narrow band spectra of two minutes of artifact-free EEG were computed as well as source localization using Variable Resolution Electrical Tomography (VARETA). Abnormalities were identified using Z-spectra relative to normative values. RESULTS Patients were classified as responders, non-responders and partial responders based upon the SNAP-IV findings. At baseline, the responders showed increased absolute power in alpha and delta in frontal and temporal regions, whereas, non-responders showed increased absolute power in all frequency bands that was widely distributed. With treatment responders' absolute power values moved toward normal values, whereas, non-responders remained at baseline values. CONCLUSIONS Patients with increased power in the alpha band with no evidence of alterations in the beta or theta range, might be responders to treatment with atomoxetine. Increased power in the beta band coupled with increased alpha seems to be related to non-responders and one should consider atomoxetine withdrawal, especially if there is persistence of increased alpha and beta accompanied by an increase of theta.
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Affiliation(s)
- Giuseppe Augusto Chiarenza
- Child and Adolescent Neuropsychiatry Dept., Rho Hospital, Milan, Italy; International Center Learning, Attention and Hyperactivity Disorders (CIDAAI), Milan, Italy.
| | - Robert Chabot
- Brain Research Laboratories, Dept. Psychiatry, New York University, NY, United States
| | - Robert Isenhart
- Brain Research Laboratories, Dept. Psychiatry, New York University, NY, United States
| | - Luciano Montaldi
- Child and Adolescent Neuropsychiatry Dept., Rho Hospital, Milan, Italy; International Center Learning, Attention and Hyperactivity Disorders (CIDAAI), Milan, Italy
| | - Marco Paolo Chiarenza
- International Center Learning, Attention and Hyperactivity Disorders (CIDAAI), Milan, Italy
| | - Maria Grazia Lo Torto
- Child and Adolescent Neuropsychiatry Dept., Rho Hospital, Milan, Italy; International Center Learning, Attention and Hyperactivity Disorders (CIDAAI), Milan, Italy
| | - Leslie S Prichep
- Brain Research Laboratories, Dept. Psychiatry, New York University, NY, United States
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20
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van Gelder BM, Nathoe R, Bracke FA. Haemodynamic evaluation of alternative left ventricular endocardial pacing sites in clinical non-responders to cardiac resynchronisation therapy. Neth Heart J 2015; 24:85-92. [PMID: 26645710 PMCID: PMC4692838 DOI: 10.1007/s12471-015-0773-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Introduction Non response to cardiac resynchronisation therapy (CRT) may be related to the position of the coronary sinus lead. Methods We studied the acute haemodynamic response (AHR) from alternative left ventricular (LV) endocardial pacing sites in clinical non-responders to CRT. AHR and the interval from QRS onset to LV sensing (Q-LV interval) from four different endocardial pacing sites were evaluated in 24 clinical non-responders. A rise in LVdP/dtmax ≥ 15 % from baseline was considered a positive AHR. We also compared the AHR from endocardial with the corresponding epicardial lead position. Results The implanted system showed an AHR ≥ 15 % in 5 patients. In 9 of the 19 remaining patients, AHR could be elevated to ≥ 15 % by endocardial LV pacing. The optimal endocardial pacing site was posterolateral. There was no significant difference in AHR between the epicardial and the corresponding endocardial position. The longest Q-LV interval corresponded with the best AHR in 12 out of the 14 patients with a positive AHR, with an average Q-LV/QRS width ratio of 90 %. Conclusions Acute haemodynamic testing may indicate an alternative endocardial pacing site with a positive AHR in clinical non-responders. The Q-LV interval is a strongly correlated with the optimal endocardial pacing site. Endocardial pacing opposite epicardial sites does not result in a better AHR.
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Affiliation(s)
- B M van Gelder
- Department of Cardiology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - R Nathoe
- Department of Cardiology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - F A Bracke
- Department of Cardiology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
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21
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Walayat S, Ahmed Z, Martin D, Puli S, Cashman M, Dhillon S. Recent advances in vaccination of non-responders to standard dose hepatitis B virus vaccine. World J Hepatol 2015; 7:2503-2509. [PMID: 26523203 PMCID: PMC4621464 DOI: 10.4254/wjh.v7.i24.2503] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 09/28/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatitis B virus (HBV) infection is a global health problem. It is estimated there are more than 2 billion individuals exposed to the virus and 250 million are chronically infected. Hepatitis B is the cause of more than 600000 annual deaths due to cirrhosis and hepatocellular carcinoma. An effective vaccine exists and preventative initiatives center around universal vaccination especially in those at highest risk. Effective vaccination algorithms have led to a significant decline in the development of new infections and its devastating consequences. The vaccine is administered intramuscularly in three doses, with 95% showing long lasting serologic immunity. An additional fourth dose or a repeated higher dose three course regimen is given to those that fail to show immunity. Despite these additional regimens, some remain vulnerable to hepatitis B and are deemed non-responders. Individuals with chronic disease states such as kidney disease, liver disease, diabetes mellitus, as well as those with a genetic predisposition, and those on immunomodulation therapy, have the highest likelihood of non-response. Various strategies have been developed to elicit an immune response in these individuals. These include increased vaccination dose, intradermal administration, alternative adjuvants, alternative routes of administration, co-administration with other vaccines, and other novel therapies. These alternative strategies can show improved response and lasting immunity. In summary, HBV vaccination is a major advance of modern medicine and all individuals at risk should be sought and vaccinated with subsequent adequate titers demonstrated.
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Akmatov MK, Rübsamen N, Schultze A, Kemmling Y, Obi N, Günther K, Ahrens W, Pessler F, Krause G, Mikolajczyk RT. Diverse recruitment strategies result in different participation percentages in a web-based study, but in similar compliance. Int J Public Health 2015; 60:937-43. [PMID: 26370905 DOI: 10.1007/s00038-015-0737-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/01/2015] [Accepted: 09/02/2015] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES We compared participation and compliance with a web-based data collection on infections among population-based samples recruited in different ways. METHODS Individuals were recruited from participants in the German National Cohort study (Group A, n = 279) or persons who were invited to this study but did not participate (Group B, n = 53). A third group was invited to the web-based study only (Group C, n = 145). RESULTS Response varied among groups between 3 % (B), 11 % (C) and 61 % (A), but compliance was similar (81-85 %). Response did not differ by age and sex. Compliance was lower among the youngest and oldest participants. In addition, participants currently not employed were more likely to have better compliance. Semi-parametric group-based modelling identified three distinct compliance trajectories; "poor compliance" (8 %), "improving compliance" (14 %) and "very good compliance" (78 %). CONCLUSIONS Participation differed among modes of recruitment, but compliance was similar among groups and notably high. Different recruitment approaches can be used and collected data can be combined to achieve greater sample sizes for longitudinal web-based studies.
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Affiliation(s)
- Manas K Akmatov
- Department of Epidemiology, Helmholtz Centre for Infection Research, Brunswick, Germany. .,TWINCORE Centre for Experimental and Clinical Infection Research, Hannover, Germany.
| | - Nicole Rübsamen
- Department of Epidemiology, Helmholtz Centre for Infection Research, Brunswick, Germany
| | - Anja Schultze
- Department of Epidemiology, Helmholtz Centre for Infection Research, Brunswick, Germany
| | - Yvonne Kemmling
- Department of Epidemiology, Helmholtz Centre for Infection Research, Brunswick, Germany
| | - Nadia Obi
- University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kathrin Günther
- Department of Epidemiological Methods and Etiologic Research, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Wolfgang Ahrens
- Department of Epidemiological Methods and Etiologic Research, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Frank Pessler
- TWINCORE Centre for Experimental and Clinical Infection Research, Hannover, Germany
| | - Gérard Krause
- Department of Epidemiology, Helmholtz Centre for Infection Research, Brunswick, Germany
| | - Rafael T Mikolajczyk
- Department of Epidemiology, Helmholtz Centre for Infection Research, Brunswick, Germany
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Feld JJ, Jacobson IM, Jensen DM, Foster GR, Pol S, Tam E, Jablkowski M, Berak H, Vierling JM, Yoshida EM, Perez-Gomez HR, Scalori A, Hooper GJ, Tavel JA, Navarro MT, Shahdad S, Kulkarni R, Le Pogam S, Nájera I, Eng S, Lim CY, Shulman NS, Yetzer ES. Randomized study of danoprevir/ritonavir-based therapy for HCV genotype 1 patients with prior partial or null responses to peginterferon/ribavirin. J Hepatol 2015; 62:294-302. [PMID: 25239078 DOI: 10.1016/j.jhep.2014.09.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 08/06/2014] [Accepted: 09/10/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND & AIMS Chronic hepatitis C treatment for prior non-responders to peginterferon (PegIFN)/ribavirin remains suboptimal. The MATTERHORN study evaluated regimens containing ritonavir-boosted danoprevir (danoprevir/r) in prior PegIFN alfa/ribavirin non-responders. METHODS Prior partial responders (N=152) were randomized to 24 weeks of twice-daily danoprevir/r 100/100mg, mericitabine 1000 mg and ribavirin 1000/1200 mg (IFN-free); danoprevir/r plus PegIFN alfa-2a/ribavirin (triple); or danoprevir/r, mericitabine and PegIFN alfa-2a/ribavirin (Quad). Prior null responders (N=229) were randomized to 24 weeks of IFN-free therapy, or quad alone (Quad 24) or quad plus 24-weeks of PegIFN alfa-2a/ribavirin (Quad 48). The primary endpoint was sustained virological response (HCV RNA <25 IU/ml) 24 weeks after end-of-treatment (SVR24). Due to high relapse rates, genotype (G) 1a patients in IFN-free arms were offered additional PegIFN alfa-2a/ribavirin. RESULTS Among prior partial responders, SVR24 rates were 46.2%, 51.0%, and 86.0%, in the IFN-free, Triple and Quad arms, respectively; among prior null responders, SVR24 rates were 45.5%, 80.5%, and 83.8% respectively. Relapse rates were lower and SVR24 rates higher in G1b-infected than G1a-infected patients. SVR24 rates in G1a and G1b patients randomized to Quad were 75.0% and 96.2%, respectively, in the partial Quad arm, and 68.1% and 100%, respectively, in the null Quad 24 arm. Treatment failure was associated with resistance to danoprevir, but not to mericitabine, and was more common in G1a infected patients. Treatment was well-tolerated. CONCLUSIONS Danoprevir/r, mericitabine plus PegIFN alfa-2a/ribavirin was well-tolerated and produced high overall SVR24 rates in prior partial and null responders to PegIFN alfa/ribavirin. In contrast, IFN-free regimens were associated with unacceptably high relapse rates.
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Affiliation(s)
- Jordan J Feld
- Toronto Centre for Liver Disease, McLaughlin-Rotman Centre for Global Health, Toronto, ON, Canada.
| | - Ira M Jacobson
- Center for the Study of Hepatitis C, Weill Cornell Medical College, New York, NY, USA
| | - Donald M Jensen
- Center for Liver Diseases, University of Chicago Hospitals, Chicago, IL, USA
| | - Graham R Foster
- Queen Mary, University of London, Institute of Cellular and Molecular Sciences, London, UK
| | - Stanislas Pol
- Hôpital Cochin, Université Paris Descartes and INSERM U1610, Paris, France
| | | | | | - Hanna Berak
- Hospital of Infectious Diseases, Warsaw, Poland
| | | | | | - Héctor R Perez-Gomez
- Hospital Civil de Guadalajara, Instituto de Patologia Infecciosa, Universidad de Guadalajara, Guadalajara, Mexico
| | | | | | | | | | | | | | | | | | - Simon Eng
- Genentech, South San Francisco, CA, USA
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Zaffina S, Marcellini V, Santoro AP, Scarsella M, Camisa V, Vinci MR, Musolino AM, Nicolosi L, Rosado MM, Carsetti R. Repeated vaccinations do not improve specific immune defenses against Hepatitis B in non-responder health care workers. Vaccine 2014; 32:6902-6910. [PMID: 25444815 DOI: 10.1016/j.vaccine.2014.10.066] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 09/22/2014] [Accepted: 10/27/2014] [Indexed: 01/28/2023]
Abstract
Hepatitis B is a major infectious occupational hazard for health care workers and can be prevented with a safe and effective vaccine. The serum titer of anti-HBsAg antibodies is the most commonly used correlate of protection and post-vaccination anti-HBsAg concentrations of ≥ 10 mIU/ml are considered protective. Subjects with post-vaccination anti-HBsAg titers of <10 mIU/ml 1-6 months post-vaccination, who tested negative for HBsAg and anti-HBc, are defined as non-responders. The question of whether non-responders should be repeatedly vaccinated is still open. The aim of the study was to (i) evaluate the distribution of lymphocyte subpopulations and the percentage of HBsAg-specific memory B cells in responders and non-responders (ii) assess whether non-responders can be induced to produce antibodies after administration of a booster dose of vaccine (iii) determine whether booster vaccination increases the number of specific memory B cells in non-responders. Combining flow-cytometry, ELISPOT and serology we tested the integrity and function of the immune system in 24 health care workers, confirmed to be non-responders after at least three vaccine injections. We compared the results with those obtained in 21 responders working in the same institution. We found that the great majority of the non-responders had a functional immune system and a preserved ability to respond to other conventional antigens. Our most important findings are that the frequency of HBsAg-specific memory B cells is comparable in non-responders and controls and that booster immunization does not lead either to antibody production or memory B cell increase in non-responders.
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Affiliation(s)
- Salvatore Zaffina
- Health Technology Assessment & Safety Research Unit and Occupational Medicine Service, Department of Laboratories, Ospedale Pediatrico Bambino Gesù, IRCSS, Piazza S. Onofrio 4, 00165 Roma, Italy
| | - Valentina Marcellini
- Immunology Unit, Immunology and Pharmacotherapy Research Area, Ospedale Pediatrico Bambino Gesù, IRCSS, Piazza S. Onofrio 4, 00165 Roma, Italy
| | - Anna Paola Santoro
- Health Technology Assessment & Safety Research Unit and Occupational Medicine Service, Department of Laboratories, Ospedale Pediatrico Bambino Gesù, IRCSS, Piazza S. Onofrio 4, 00165 Roma, Italy
| | - Marco Scarsella
- Immunology Unit, Immunology and Pharmacotherapy Research Area, Ospedale Pediatrico Bambino Gesù, IRCSS, Piazza S. Onofrio 4, 00165 Roma, Italy
| | - Vincenzo Camisa
- Health Technology Assessment & Safety Research Unit and Occupational Medicine Service, Department of Laboratories, Ospedale Pediatrico Bambino Gesù, IRCSS, Piazza S. Onofrio 4, 00165 Roma, Italy
| | - Maria Rosaria Vinci
- Health Technology Assessment & Safety Research Unit and Occupational Medicine Service, Department of Laboratories, Ospedale Pediatrico Bambino Gesù, IRCSS, Piazza S. Onofrio 4, 00165 Roma, Italy
| | - Anna Maria Musolino
- Paediatric Emergency Department, Department of Laboratories, Ospedale Pediatrico Bambino Gesù, IRCSS, Piazza S. Onofrio 4, 00165 Roma, Italy
| | - Luciana Nicolosi
- Department of Pediatrics, Department of Laboratories, Ospedale Pediatrico Bambino Gesù, IRCSS, Piazza S. Onofrio 4, 00165 Roma, Italy
| | - M Manuela Rosado
- Immunology Unit, Immunology and Pharmacotherapy Research Area, Ospedale Pediatrico Bambino Gesù, IRCSS, Piazza S. Onofrio 4, 00165 Roma, Italy.
| | - Rita Carsetti
- Immunology Unit, Immunology and Pharmacotherapy Research Area, Ospedale Pediatrico Bambino Gesù, IRCSS, Piazza S. Onofrio 4, 00165 Roma, Italy; Diagnostic Immunology Unit, Department of Laboratories, Ospedale Pediatrico Bambino Gesù, IRCSS, Piazza S. Onofrio 4, 00165 Roma, Italy.
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25
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Lok AS, Gardiner DF, Hézode C, Lawitz EJ, Bourlière M, Everson GT, Marcellin P, Rodriguez-Torres M, Pol S, Serfaty L, Eley T, Huang SP, Li J, Wind-Rotolo M, Yu F, McPhee F, Grasela DM, Pasquinelli C. Randomized trial of daclatasvir and asunaprevir with or without PegIFN/RBV for hepatitis C virus genotype 1 null responders. J Hepatol 2014; 60:490-9. [PMID: 24444658 DOI: 10.1016/j.jhep.2013.10.019] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 09/24/2013] [Accepted: 10/14/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Patients with chronic hepatitis C virus (HCV) infection and prior null response (<2 log HCV RNA decline after ⩾ 12 weeks of PegIFN/RBV) have limited options. We evaluated daclatasvir plus once- or twice-daily asunaprevir in non-cirrhotic genotype 1 null responders. METHODS In this randomized, phase 2a, open-label, 24-week treatment study, 101 patients received daclatasvir (60 mg) once-daily. In addition, 38 genotype 1b patients received asunaprevir (200mg) twice- (DUAL A1) or once-daily (DUAL A2); 36 genotype 1a and 5 genotype 1b patients received asunaprevir twice- (QUAD B1) or once-daily (QUAD B2) plus PegIFN/RBV; and 18 genotype 1a and 4 genotype 1b patients received asunaprevir twice-daily plus ribavirin (TRIPLE B3). The primary endpoint was undetectable HCV RNA 12 weeks post-treatment (sustained virologic response, SVR12). RESULTS Across all groups, mean HCV RNA was ⩾ 6 log IU/ml, and 99% of patients had a non-CC IL28B genotype. SVR12 rates were 78% (A1), 65% (A2), 95% (B1), and 95% (B2). In B3, most genotype 1a patients experienced virologic breakthrough. The most common adverse events were headache, diarrhea, and asthenia. Grade 3-4 aminotransferase elevations were infrequent and not treatment-limiting. CONCLUSIONS In genotype 1 null responders, daclatasvir plus twice-daily asunaprevir DUAL therapy is effective for most genotype 1b patients, and daclatasvir, asunaprevir, and PegIFN/RBV QUAD therapy is effective for nearly all genotype 1a and 1b patients; but neither DUAL nor TRIPLE therapy is effective for genotype 1a patients. Interferon-free regimens including daclatasvir and twice-daily asunaprevir for genotype 1 null responders should be tailored to subtype.
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Affiliation(s)
- Anna S Lok
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA.
| | | | | | - Eric J Lawitz
- The Texas Liver Institute, University of Texas Health Sciences Center, San Antonio, TX, USA
| | | | | | | | | | | | | | | | | | | | | | - Fei Yu
- Bristol-Myers Squibb, Wallingford, CT, USA
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Abstract
Acute and chronic hepatitis C virus (HCV) infection remains a serious health problem worldwide, however, there has been advancement in the treatment of HCV infection due to standard treatment using pegylated interferon and ribavirin. The literature indicates that therapy for HCV is becoming more individualized. In addition to considering genotype and viral RNA levels before treatment, achievement of an early virologic response (EVR) and a rapid virologic response (RVR) is now possible during therapy. Moreover, problem patients, such as non-responders, relapsers, HIV or HBV co-infected patients, patients with liver cirrhosis, and pre- or post-liver transplantation patients are an increasing fraction of the patients requiring treatment. This article reviews the literature regarding standard treatments and problem patients with acute and chronic HCV infection. It also includes discussion on contraindications and side effects of treatment with interferon and ribavirin, as well as new drug development.
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Affiliation(s)
- Kilian Weigand
- University of Heidelberg, Department of Gastroenterology, Im Neuenheimer Feld 410, Hei-delberg D-69120, Germany
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