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Paton NI, Stöhr W, Arenas-Pinto A, Clarke A, Williams I, Johnson M, Orkin C, Chen F, Lee V, Winston A, Gompels M, Fox J, Sanders K, Dunn DT. Long-term efficacy and safety of a treatment strategy for HIV infection using protease inhibitor monotherapy: 8-year routine clinical care follow-up from a randomised, controlled, open-label pragmatic trial (PIVOT). EClinicalMedicine 2024; 69:102457. [PMID: 38361989 PMCID: PMC10867418 DOI: 10.1016/j.eclinm.2024.102457] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 02/17/2024] Open
Abstract
Background Treatment-simplification strategies are important tools for patient-centred management. We evaluated long-term outcomes from a PI monotherapy switch strategy. Methods Eligible participants attending 43 UK treatment centres had a viral load (VL) below 50 copies/ml for at least 24 weeks on combination ART. Participants were randomised to maintain ongoing triple therapy (OT) or switch to a strategy of physician-selected PI monotherapy (PI-mono) with prompt return to combination therapy if VL rebounded. The primary outcome, previously reported, was loss of future drug options after 3 years, defined as new intermediate/high level resistance to at least one drug to which the participant's virus was considered sensitive at trial entry. Here we report resistance and disease outcomes after further extended follow-up in routine care. The study was registered as ISRCTN04857074. Findings We randomised 587 participants to OT (291) or PI-mono (296) between Nov 4, 2008, and July 28, 2010 and followed them for a median of more than 8 years (100 months) until 2018. At the end of this follow-up time, one or more future drug options had been lost in 7 participants in the OT group and 6 in the PI-mono group; estimated cumulative risk by 8 years of 2.7% and 2.1% respectively (difference -0.6%, 95% CI -3.2% to 2.0%). Only one PI-mono participant developed resistance to the protease inhibitor they were taking (atazanavir). Serious clinical events (death, serious AIDS, and serious non-AIDS) were infrequent; reported in a total of 12 (4.1%) participants in the OT group and 23 (7.8%) in the PI-mono group (P = 0.08) over the entire follow-up period. Interpretation A strategy of PI monotherapy, with regular VL monitoring and prompt reintroduction of combination treatment following rebound, preserved future treatment options. Findings confirm the high genetic barrier to resistance of the PI drug class that makes them well suited for creative, patient-centred, treatment-simplification approaches. The possibility of a small excess risk of serious clinical events with the PI monotherapy strategy cannot be excluded. Funding The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Nicholas I. Paton
- MRC Clinical Trials Unit at University College London, London, UK
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wolfgang Stöhr
- MRC Clinical Trials Unit at University College London, London, UK
| | | | - Amanda Clarke
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | | | - Chloe Orkin
- Barts and the Royal London Hospital NHS Trust, London, UK
| | | | | | | | | | - Julie Fox
- Guys and St. Thomas' Hospital, London, UK
| | - Karen Sanders
- MRC Clinical Trials Unit at University College London, London, UK
| | - David T. Dunn
- MRC Clinical Trials Unit at University College London, London, UK
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Van Geert E, Frérart L, Wagemans J. Towards the most prägnant Gestalt: Leveling and sharpening as contextually dependent adaptive strategies. Mem Cognit 2023:10.3758/s13421-023-01445-z. [PMID: 37490231 DOI: 10.3758/s13421-023-01445-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 07/26/2023]
Abstract
Gestalt psychologists posited that we always organize our visual input in the best way possible under the given conditions. Both weakening or removing unnecessary details (i.e., leveling) and exaggerating distinctive features (i.e., sharpening) can contribute to achieving a better organization. When is a feature leveled or sharpened, however? We investigated whether the importance of a feature for discrimination among alternatives influences which organizational tendency occurs. Participants were simultaneously presented with four figures composed of simple geometrical shapes, and asked to reconstruct one of these figures in such a way that another participant would be able to recognize it among the alternatives. The four figures differed either qualitatively or only quantitatively (i.e., far or close context). Regarding quantitative differences, two feature dimensions were varied, with one manifesting a wider range of variability across the alternatives than the other. In case of a smaller variability range, the target figure was either at the extreme of the range or had an in-between value. As expected, the results indicated that sharpening occurred more often for the feature with an extreme value, for the feature exhibiting more variability, and for the features of figures presented in the close context, than for the feature with a non-extreme value, exhibiting less variability, or in the far context. In line with Metzger's (1941) definition of prägnant Gestalts, the essence of a Gestalt is context-dependent, and this will influence whether leveling or sharpening of a feature will lead to the best organization in the specific context.
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Affiliation(s)
- Eline Van Geert
- Laboratory of Experimental Psychology, Department of Brain and Cognition, Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102 - box 3711, BE-3000, Leuven, Belgium.
| | - Liesse Frérart
- Laboratory of Experimental Psychology, Department of Brain and Cognition, Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102 - box 3711, BE-3000, Leuven, Belgium
- Research Group of Quantitative Psychology and Individual Differences, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Johan Wagemans
- Laboratory of Experimental Psychology, Department of Brain and Cognition, Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102 - box 3711, BE-3000, Leuven, Belgium
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Neumiller JJ, Munshi MN. Geriatric Syndromes in Older Adults with Diabetes. Endocrinol Metab Clin North Am 2023; 52:341-353. [PMID: 36948783 DOI: 10.1016/j.ecl.2022.10.004] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Over one-quarter of adults ≥65 years old have diabetes in the United States. Guidelines recommend individualization of glycemic targets in older adults with diabetes as well as implementing treatment strategies that minimize risk for hypoglycemia. Patient-centered management decisions should be informed by comorbidities, the individual's capacity for self-care, and the presence of key geriatric syndromes that may impact self-management and patient safety. Key geriatric syndromes include cognitive impairment, depression, functional impairments (eg, vision, hearing, and mobility challenges), falls and fractures, polypharmacy, and urinary incontinence. Screening for geriatric syndromes in older adults is recommended to inform treatment strategies and optimize outcomes.
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Affiliation(s)
- Joshua J Neumiller
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, 412 East Spokane Falls Boulevard, Spokane, WA 99210, USA.
| | - Medha N Munshi
- Geriatric Diabetes Program, Joslin Diabetes Centre, Harvard Medical School, 1 Brookline Place, Suite 230, Brookline, MA 02445, USA
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Compagnucci A, Chan MK, Saïdi Y, Cressey TR, Bamford A, Riault Y, Coelho A, Nolan A, Chalermpantmetagul S, Morkunaite G, Amuge P, Musiime V, Violari A, Cotton M, Kekitiinwa AR, Kaudha E, Groenewald M, Liberty AA, Kanjanavanit S, Volokha A, Bologna R, Pavia Ruz N, Prieto Tato L, Paioni P, Marques L, Reliquet V, Niehues T, Welch SB, Ford D, Giaquinto C, Gibb DM, Babiker A, Ramos Amador JT. Nucleoside/nucleotide reverse transcriptase inhibitor sparing regimen with once daily integrase inhibitor plus boosted darunavir is non-inferior to standard of care in virologically-suppressed children and adolescents living with HIV - Week 48 results of the randomised SMILE Penta-17-ANRS 152 clinical trial. EClinicalMedicine 2023; 60:102025. [PMID: 37304494 PMCID: PMC10251070 DOI: 10.1016/j.eclinm.2023.102025] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/11/2023] [Accepted: 05/11/2023] [Indexed: 06/13/2023] Open
Abstract
Background Integrase inhibitor (INSTI) with boosted darunavir (DRV/r), a regimen with a high-resistance barrier, avoiding NRTI toxicities, might be a switching option in children living with HIV (CLWHIV). Methods SMILE is a randomised non-inferiority trial evaluating safety and antiviral efficacy of once-daily INSTI + DRV/r vs. continuing on current standard-of-care (SOC) triple ART (2NRTI + boosted PI/NNRTI) in virologically-suppressed CLWHIV aged 6-18 years. The primary outcome is the proportion with confirmed HIV-RNA ≥50 copies/mL by week 48, estimated by Kaplan-Meier method. Non-inferiority margin was 10%. Registration number for SMILE are: ISRCTN11193709, NCT #: NCT02383108. Findings Between 10th June 2016 and 30th August 2019, 318 participants were enrolled from Africa 53%, Europe 24%, Thailand 15% and Latin America 8%, 158 INSTI + DRV/r [153 Dolutegravir (DTG); 5 Elvitegravir (EVG)], 160 SOC. Median (range) age was 14.7 years (7.6-18.0); CD4 count 782 cells/mm3 (227-1647); 61% female. Median follow-up was 64.3 weeks with no loss to follow-up. By 48 weeks, 8 INSTI + DRV/r vs. 12 SOC had confirmed HIV-RNA ≥50 copies/mL; difference (INSTI + DRV/r-SOC) -2.5% (95% CI: -7.6, 2.5%), showing non-inferiority. No major PI or INSTI resistance mutations were observed. There were no differences in safety between arms. By week 48, difference (INSTI + DRV/r-SOC) in mean CD4 count change from baseline was -48.3 cells/mm3 (95% CI: -93.4, -3.2; p = 0.036). Difference (INSTI + DRV/r-SOC) in mean HDL change from baseline was -4.1 mg/dL (95% CI: -6.7, -1.4; p = 0.003). Weight and Body Mass Index (BMI) increased more in INSTI + DRV/r than SOC [difference: 1.97 kg (95% CI: 1.1, 2.9; p < 0.001), 0.66 kg/m2 (95% CI: 0.3, 1.0; p < 0.001)]. Interpretation In virologically-suppressed children, switching to INSTI + DRV/r was non-inferior virologically, with similar safety profile, to continuing SOC. Small but significant differences in CD4, HDL-cholesterol, weight and BMI were observed between INSTI + DRV/r vs. SOC although clinical relevance needs further investigation. SMILE data corroborate adult findings and provide evidence for this NRTI-sparing regimen for children and adolescents. Funding Fondazione Penta Onlus, Gilead, Janssen, INSERM/ANRS and UK MRC. ViiV-Healthcare provided Dolutegravir.
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Affiliation(s)
| | | | - Yacine Saïdi
- INSERM SC10-US19, Essais Thérapeutiques et Maladies Infectieuses, Villejuif, France
| | - Tim R. Cressey
- AMS-CMU & IRD Research Collaboration, Faculty of Associated Medical Sciences (AMS), Chiang Mai University, Thailand
| | - Alasdair Bamford
- MRC Clinical Trials Unit at UCL, London, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Yoann Riault
- INSERM SC10-US19, Essais Thérapeutiques et Maladies Infectieuses, Villejuif, France
| | - Alexandra Coelho
- INSERM SC10-US19, Essais Thérapeutiques et Maladies Infectieuses, Villejuif, France
| | | | - Suwalai Chalermpantmetagul
- AMS-CMU & IRD Research Collaboration, Faculty of Associated Medical Sciences (AMS), Chiang Mai University, Thailand
| | | | - Pauline Amuge
- Baylor College of Medicine Children's Foundation, Kampala, Uganda
| | - Victor Musiime
- Joint Clinical Research Centre, Lubowa, Kampala, Uganda
- Makerere University, Department of Paediatrics and Child Health, Kampala, Uganda
| | - Avy Violari
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark Cotton
- FAMCRU, Department of Paediatrics & Child Health, Family Center for Research with Ubuntu, Stellenbosch University, South Africa
| | | | | | - Marisa Groenewald
- FAMCRU, Department of Paediatrics & Child Health, Family Center for Research with Ubuntu, Stellenbosch University, South Africa
| | - Afaaf A. Liberty
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Alla Volokha
- Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | | | - Noris Pavia Ruz
- Clínica para niños con VIH, UNAM/HGM; Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | | | - Paolo Paioni
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Laura Marques
- Centro Materno-Infantil do Norte, CHU Porto, Porto, Portugal
| | - Véronique Reliquet
- Infectious Diseases Department, CHU Hôtel Dieu and INSERM UIC 1413, Nantes University, Nantes, France
| | - Tim Niehues
- Centre for Child Health and Adolescence, Helios Klinikum Krefeld, Academic Hospital, RWTH Aachen, Krefeld, Germany
| | - Steven B. Welch
- Department of Paediatrics, Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
| | | | - Carlo Giaquinto
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | | | | | - Jose Tomas Ramos Amador
- Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC); Fundación para la Investigación Biomédica HCSC; Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
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Alexopoulos AS, Soliman D, Lewinski AA, Strawbridge E, Steinhauser K, Edelman D, Crowley MJ. Simplifying therapy to assure glycemic control and engagement (STAGE) in poorly-controlled diabetes: A pilot study. J Diabetes Complications 2023; 37:108364. [PMID: 36525906 PMCID: PMC9839589 DOI: 10.1016/j.jdiacomp.2022.108364] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/08/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022]
Abstract
In this single-arm pilot study, we demonstrated feasibility and acceptability of an insulin simplification intervention in patients with persistent, poorly-controlled type 2 diabetes on complex insulin regimens. While not powered to assess clinical outcomes, we observed neither worsened glycemic control nor increased hypoglycemia.
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Affiliation(s)
- Anastasia-Stefania Alexopoulos
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC 27710, United States; Department of Medicine, Division of Endocrinology, Duke University Medical Center, Rd, Durham, NC 27710, United States.
| | - Diana Soliman
- Department of Medicine, Division of Endocrinology, Duke University Medical Center, Rd, Durham, NC 27710, United States
| | - Allison A Lewinski
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC 27710, United States; School of Nursing, Duke University, Durham, NC 27710, United States
| | - Elizabeth Strawbridge
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC 27710, United States
| | - Karen Steinhauser
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC 27710, United States; Department of Population Health Sciences, Duke University, Durham, NC 27710, United States
| | - David Edelman
- Department of Population Health Sciences, Duke University, Durham, NC 27710, United States; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, United States
| | - Matthew J Crowley
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC 27710, United States; Department of Medicine, Division of Endocrinology, Duke University Medical Center, Rd, Durham, NC 27710, United States
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Li S, Guo W, Ren Z, Tan L, Fan L, Zhu M, Wei H, Zhang W. The simplified iodine-specific food frequency questionnaire can evaluate iodine intake in Chinese adults. Nutr Res 2023; 109:47-57. [PMID: 36586289 DOI: 10.1016/j.nutres.2022.12.001] [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: 08/27/2022] [Revised: 11/29/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022]
Abstract
We hypothesized that an effective iodine-specific food frequency questionnaire (I-FFQ) simplification method could expand the application of the I-FFQ in evaluating long-term iodine intake. An adult I-FFQ was developed and was simplified by deleting food items with iodine contribution rates ≤0.1%, combining food items with similar species and iodine contribution rates, and calculating the iodine content of combined food by a weighted calculation method. A 3-day (3-d) diet diary tested the validity of the I-FFQ. We evaluated the relationship between iodine intake estimated using the I-FFQ and the urinary iodine to creatinine ratio, thyroid volume (Tvol), and thyroid function. The Kappa value was 0.62 for the original I-FFQ and the 3-d diet diary (P < .001), 0.78 for the short-version I-FFQ and the 3-d diet diary (P < .001), and 0.76 for the original I-FFQ and the short-version I-FFQ (P < .001). The mean difference before and after simplification was 27.1 µg/d. The Tvol was different between the I-FFQ groups and showed an upward trend (P for trend = .01). Tvol was higher in the 284 <I-FFQ <347 µg/d (β = 0.55; 95% CI, 0.06-1.03; P = .03) and I-FFQ >347 µg/d (β = 0.72; 95% CI, 0.16-1.28; P = .01) groups after simplification. The I-FFQ is an effective method for evaluating iodine nutritional status in adults. After streamlining, the food items were reduced from 58 to 15, which shortened the investigation time while retaining evaluation efficiency; it is also easier to get the cooperation of the subjects and improve the availability of I-FFQ.
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Affiliation(s)
- Shaohan Li
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Wenxing Guo
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Zhiyuan Ren
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Long Tan
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Lili Fan
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Mei Zhu
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Hongyan Wei
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Wanqi Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, 300070, China; Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, 300052, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, 300070, China; Tianjin Key Laboratory of Hormones and Development (Ministry of Health), Tianjin, 300384, China.
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Maggiolo F, Gulminetti R, Pagnucco L, Digaetano M, Cervo A, Valenti D, Callegaro A, Mussini C. Long-term outcome of lamivudine/dolutegravir dual therapy in HIV-infected, virologically suppressed patients. BMC Infect Dis 2022; 22:782. [PMID: 36224538 PMCID: PMC9558382 DOI: 10.1186/s12879-022-07769-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 05/24/2022] [Accepted: 10/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background The use of DTG-containing two-drug regimens is one of the most promising solutions to the need to ease the management of HIV treatment without harming its efficacy and safety. We report long- term results in patients switched, while virologically suppressed, to the combination of dolutegravir (DTG) plus lamivudine (3TC). Methods This is a prospective, clinical, uncontrolled cohort enrolling ART-experienced people living with HIV (PLWH) with HIV-RNA < 50 copies/ml for 6 months or longer, negative hepatitis B virus surface antigen, and without known M184V/I mutations. Kaplan-Meiers curves are used to describe persistency of virological suppression on therapy and a Cox regression model to evaluate baseline characteristics and the risk of stopping therapy. Results 218 individuals switched their regimen since 2015. The mean estimated follow-up was of 64.3 months (95% CI 61.3–67.3) for approximately 1000 patient/years. After 5 years of follow-up, 77.1% were still on the DTG-3TC combination. No virologic failure was detected throughout the whole study period, and only 15 subjects presented single isolated viral blips above 50 copies/ml. Most patients stopped therapy because of reasons unrelated to study drugs (lost to follow-up; patients’ decision; moved to other Centers), but due to the unselected nature of the casuistry; 11 subjects died in the 5 years of follow-up mostly because of pre-existing co-morbidities (6 neoplastic diseases and 2 end-stage liver disease). The median baseline CD4 count was 669 cells/mcl (IQR 483–927). After 5 years it raised to 899 cells/mcl (IQR 646–1160) (P < 0.001) without a significant change of CD8 counts that lowered from 767 cells/mcl (IQR 532–1034) to 683 cells/mcl (IQR 538–988). Consequently, the CD4/CD8 ratio varied from 0.93 (IQR 0.60–1.30) to 1.15 (IQR 0.77–1.45) (P < 0.0001). A non-significant (P = 0.320) increment of mean creatinine, 0.06 mg/dl in magnitude, was observed over the whole follow-up. Conclusion These long-term results over 5 years reinforce the durability and good tolerability of DTG-3TC. Our results continue to support the recommended switch use of this 2DR as a well-accepted treatment option for ART-experienced PLWH.
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Affiliation(s)
- Franco Maggiolo
- Division of Infectious Diseases, ASST Papa Giovanni XXIII, Bergamo, Italy.
| | - Roberto Gulminetti
- Division of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Layla Pagnucco
- Division of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Adriana Cervo
- Division of Infectious Diseases, University of Modena, Modena, Italy
| | - Daniela Valenti
- Division of Infectious Diseases, ASST Papa Giovanni XXIII, Bergamo, Italy.,Fondazione FROM, Bergamo, Italy
| | - Annapaola Callegaro
- Microbiology and Virology Laboratory, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Cristina Mussini
- Division of Infectious Diseases, University of Modena, Modena, Italy
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Ivchenko O, Grabar N. Impact of the Text Simplification on Understanding. Stud Health Technol Inform 2022; 294:634-638. [PMID: 35612166 DOI: 10.3233/shti220546] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The reduction of the linguistic complexity of medical texts to make them more understandable to a larger population is an important task. The simplification of texts involves several steps, among which our study focuses on the definition of complex constructions and on study of the impact of the simplification. For this study, we selected 20 texts from the medical domain on different topics, namely drugs, diseases, substances, and medical institutions. We identified complex linguistic constructions and carried out their manual simplification at syntactic, lexical and semantic levels. We then designed a questionnaire to test comprehension of the texts and conducted a study with 26 participants. The results of this study shows that simplified texts obtained higher number of correct answers than technical texts. This difference is statistically significant. The self-evaluation questionnaire, done at the beginning of the test, indicates that the participants tend to overestimate their understanding of medical information. Besides, there is no correlation between the time taken to complete the interview and the correct answers provided.
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Affiliation(s)
- Oksana Ivchenko
- CNRS, Univ. Lille, UMR 8163 - STL - Savoirs Textes Langage, F-59000 Lille, France
| | - Natalia Grabar
- CNRS, Univ. Lille, UMR 8163 - STL - Savoirs Textes Langage, F-59000 Lille, France
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9
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Matsumura Y, Lima SP, Rafael JA, Câmara JT, Beutel RG, Gorb SN. Distal leg structures of Zoraptera - did the loss of adhesive devices curb the chance of diversification? Arthropod Struct Dev 2022; 68:101164. [PMID: 35468454 DOI: 10.1016/j.asd.2022.101164] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/15/2022] [Accepted: 03/24/2022] [Indexed: 06/14/2023]
Abstract
The distal leg structures of Zoraptera are documented and discussed with respect to their functional morphology and evolutionary aspects. We investigated eight species using scanning electron microscopy. We analyzed material compositions of the tarsus in three representative species using confocal laser scanning microscopy. When possible, we included both sexes, wing morphs, and nymphs and compared the structures among them. The distal leg structure is unusually uniform across zorapterans regardless of the sex, morphs, and developmental stages. The observed features combine simplification with innovation. The former is likely partially correlated with cryptic microhabitats and miniaturization. Innovation includes a protibial cleaning organ. This is very likely an autapomorphy of Zoraptera. The tarsi are composed of two tarsomeres covered with setae. The pretarsus distally bears an unguitractor plate and well-sclerotized claws. The tarsomeres appear less-sclerotized than the covering setae. The articulation between the basitarsus and tarsomere 2 is hinge-like, implying that tarsomere 2 moves only mediolaterally. The simplified and specialized tarsal morphology is likely suitable for the typical zorapteran microhabitat, under bark. However, the irreversible complete loss of adhesive devices prevented zorapterans to make use of a broader spectrum of environments and was presumably one reason for the species paucity of the group.
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Affiliation(s)
- Yoko Matsumura
- Department of Functional Morphology and Biomechanics, Zoological Institute, Kiel University, Kiel, Germany; General and Systematic Zoology, Zoological Institute and Museum, University of Greifswald, Greifswald, Germany.
| | - Sheila P Lima
- Instituto Nacional de Pesquisas da Amazonia, Manaus, Brazil
| | - José A Rafael
- Instituto Nacional de Pesquisas da Amazonia, Manaus, Brazil
| | | | - Rolf G Beutel
- Entomology Group, Institut für Zoologie und Evolutionsforschung, Friedrich-Schiller-Universität Jena, Jena, Germany
| | - Stanislav N Gorb
- Department of Functional Morphology and Biomechanics, Zoological Institute, Kiel University, Kiel, Germany
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Abstract
We propose a novel approach for processing diffusion MRI tractography datasets using the sparse closest point transform (SCPT). Tractography enables the 3D geometry of white matter pathways to be reconstructed; however, algorithms for processing them are often highly customized, and thus, do not leverage the existing wealth of machine learning (ML) algorithms. We investigated a vector-space tractography representation that aims to bridge this gap by using the SCPT, which consists of two steps: first, extracting sparse and representative landmarks from a tractography dataset, and second transforming curves relative to these landmarks with a closest point transform. We explore its use in three typical tasks: fiber bundle clustering, simplification, and selection across a population. The clustering algorithm groups fibers from single whole-brain datasets using a non-parametric k-means clustering algorithm, with performance compared with three alternative methods and across four datasets. The simplification algorithm removes redundant curves to improve interactive visualization, with performance gauged relative to random subsampling. The selection algorithm extracts bundles across a population using a one-class Gaussian classifier derived from an atlas prototype, with performance gauged by scan-rescan reliability and sensitivity to normal aging, as compared to manual mask-based selection. Our results demonstrate how the SCPT enables the novel application of existing vector-space ML algorithms to create effective and efficient tools for tractography processing. Our experimental data is available online, and our software implementation is available in the Quantitative Imaging Toolkit.
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Affiliation(s)
- Ryan P Cabeen
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA.
| | - Arthur W Toga
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - David H Laidlaw
- Department of Computer Science, Brown University, Providence, RI, USA
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11
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Abstract
Easy access to medical and health information for children, foreigners and patients is an important issue for the modern society and research. Indeed, misunderstanding of medical and health information by patients may have a negative impact on their healthcare process and health. Even if several simplification guidelines exist, they are difficult to use by medical experts (i.e. lack of time, difficulty to respect the criteria). Existing simplification systems mainly address some lexical or syntactic transformations. We propose to combine lexical and syntactic simplifications within one rule-based system and to make the process fine-grained thanks to a better control of the grammaticality of sentences.
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12
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Gold N, Watson R, Weston D, Greaves F, Amlôt R. A randomized controlled trial to test the effect of simplified guidance with visuals on comprehension of COVID-19 guidelines and intention to stay home if symptomatic. BMC Public Health 2021; 21:892. [PMID: 33971855 PMCID: PMC8108739 DOI: 10.1186/s12889-021-10787-9] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/17/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In the COVID-19 pandemic, it is imperative that people understand and comply with self-isolation guidelines. We tested whether a simplified version of the guidelines and a simplified version with visual aids would affect comprehension and intention to self-isolate during the containment phase of the pandemic in the UK, in March 2020, compared to the standard guidelines. METHODS We conducted an online, three-armed parallel randomized controlled trial. Participants were English and over 18. The survey software randomized them into conditions; they were blind to condition. The control group read the 7-page standard guidelines (the current version at the time of the trial). The intervention groups were given either a 3-page simplified version, with a summary box on the front page and numbered bullet points, or the same simplified version with pictograms illustrating the points in the box. Primary outcomes were comprehension of the guidelines, as measured by the number of correct answers given to six questions about the content, and the proportion who answered that they would 'definitely' stay at home for 7 days if symptomatic. FINDINGS Recruitment was from 13 to 16 March 2020, with 1845 participants randomised and all data analysed. The Control group averaged 4.27 correct answers, the Simplified 4.20, and the Simplified + visual aids 4.13, out of a possible total of 6 correct answers. There were no differences in comprehension in the unadjusted models; however, when the model was adjusted for demographic variables, there was lower comprehension in the simplified + visual aids condition than in the control, (ß = - 0.16, p = 0.04998). There were no statistically significant differences in intention to stay home: Control was 85%, Simplified 83%, and Simplified + visual aids condition 84%. CONCLUSION Simplified guidance did not improve comprehension compared to the standard guidance issued in the containment phase of the COVID-19 pandemic in March 2020, and simplified guidance with visual aids may even have worsened comprehension. Simplified guidance had no effect on intention to stay home if symptomatic. This trial informed COVID-19 policy and provides insights relevant to guidance production in the acute phase of a major public health emergency.
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Affiliation(s)
- Natalie Gold
- Public Health England Behavioural Insights, Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK.
- Centre for Philosophy of Natural and Social Science, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
| | - Robin Watson
- Public Health England Behavioural Insights, Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
- Department of Anthropology, Durham University, Dawson Building, South Road, Durham, DH1 3LE, UK
| | - Dale Weston
- Behavioural Science Team, Emergency Response Department Science and Technology, Health Protection Directorate, Public Health England, Porton Down, Salisbury, Wilts, SP4 0JG, UK
| | - Felix Greaves
- Department of Primary Care and Public Health, Imperial College London, South Kensington, London, SW7 2AZ, UK
| | - Richard Amlôt
- Behavioural Science Team, Emergency Response Department Science and Technology, Health Protection Directorate, Public Health England, Porton Down, Salisbury, Wilts, SP4 0JG, UK
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13
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Fagiuoli S, Ruggeri M, Aragao F, Blissett R. Clinical and economic benefits of a new paradigm of HCV diagnosis and treatment. Glob Reg Health Technol Assess 2021; 8:58-66. [PMID: 36627870 DOI: 10.33393/grhta.2021.2183] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 02/15/2021] [Indexed: 01/13/2023] Open
Abstract
Introduction The current paradigm (CP) of hepatitis C virus (HCV) diagnosis and treatment in Italy's National Health Service system has numerous steps. The European Association for the Study of the Liver recommends initiation of a pan-genotypic direct-acting antiviral regimen after a simple diagnostic process. The present study estimated the efficiency gains resulting from two simplified pathways from diagnosis to treatment of chronic hepatitis C patients in Italy over the next 5 years from a societal perspective. Methods The CP, a New Paradigm 1 (NP1), and a New Paradigm 2 (NP2) were evaluated in a Markov model. The NP1 model simplifies monitoring and laboratory test requirements in the diagnosis and treatment phases. The NP2 model also eliminates the primary care referral requirement. Results Treatment process time for non-cirrhotic patients was 48, 43, and 25 weeks in the CP, NP1, and NP2, respectively, and in cirrhotic patients was 49, 46, and 37 weeks. Under the CP, 19% of patients/year would be lost to follow-up, which decreases by 11% in NP1 and 100% in NP2. Compared with the CP, implementation of NP1 at 5 years would reduce compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, and liver-related deaths by 12.6%, 12.4%, 8.1%, and 8.8%, respectively; these cases would be reduced by 94.0%, 93.8%, 61.0%, and 58.4% in NP2. Total 5-year costs with the CP, NP1, and NP2 are estimated at 135.6€ million, 110.5€ million, and 80.5€ million, respectively. Conclusions Simplification of HCV diagnosis and monitoring requirements would allow Italy to move closer to international guidelines with significant health benefits and economic gains.
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Mangia A, Albanese AP, Bourliére M, Craxi A, Dieterich D, Solomon S, Vanstraelen K, Hernandez C, Turnes J. Guidelines Have a Key Role in Driving HCV Elimination by Advocating for Simple HCV Care Pathways. Adv Ther 2021; 38:1397-403. [PMID: 33590446 DOI: 10.1007/s12325-021-01636-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/23/2021] [Indexed: 12/12/2022]
Abstract
The availability of pangenotypic direct-acting antivirals for treatment of hepatitis C (HCV) has provided an opportunity to simplify patient pathways. Recent clinical practice guidelines have recognised the need for simplification to ensure that elimination of HCV as a public health concern remains a priority. Despite the move towards simplified treatment algorithms, there remains some complexity in the recommendations for the management of genotype 3 patients with compensated cirrhosis. In an era where additional clinical trial data are not anticipated, clinical guidance should consider experience gained in real-world settings. Although more experience is required for some pangenotypic therapeutic options, on the basis of published real-world data, there is already sufficient evidence to consider a simplified approach for genotype 3 patients with compensated cirrhosis. The coronavirus disease 2019 (COVID-19) pandemic has highlighted the need to minimise the need for complex patient pathways and clinical practice guidelines need to continue to evolve in order to ensure that patient outcomes remain optimised.
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Rolle CP, Nguyen V, Hinestrosa F, DeJesus E. Clinical outcomes of HIV-1 infected patients switched from complex multi-tablet regimens to tenofovir alafenamide based single-tablet regimens plus a boosted protease inhibitor in a real-world setting. J Virus Erad 2020; 6:100021. [PMID: 33329900 PMCID: PMC7670251 DOI: 10.1016/j.jve.2020.100021] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 10/21/2020] [Accepted: 10/23/2020] [Indexed: 11/29/2022] Open
Abstract
Background Multi-tablet regimens (MTRs) are associated with increased adverse events and non-adherence. Single tablet regimens (STRs) plus boosted protease inhibitors (PIs) are a simplification option for MTR-treated patients; however, data is needed to validate this therapeutic strategy. Methods This retrospective analysis included all HIV-1 infected patients seen at a single center from March 2016 to December 2017 who were switched from twice-daily (BID) regimens or regimens containing ≥ 3 pills daily to elvitegravir/cobicistat/emtricitabine/tenofovir-alafenamide (E/C/F/TAF) plus darunavir (DRV) or rilpivirine/emtricitabine/tenofovir-alafenamide (RPV/F/TAF) plus DRV boosted with ritonavir or cobicistat (DRV/r-c). Eligible patients had baseline HIV-1 RNA<200 copies/mL and were followed for 48 weeks. The primary endpoint was HIV-1 RNA≥50 copies/mL at Week 48. Adherence and safety data were recorded throughout the study. Results Of 61 patients included, median age was 53 years, the median number of pills taken daily (range) was 5 (3–9), 80% were taking BID regimens, 97% had baseline HIV-1 RNA<50 copies/mL, 56 (92%) were switched to E/C/F/TAF plus DRV and 5 (8%) to RPV/F/TAF plus DRV/r-c. At Week 48, 2 patients (3%) had HIV-1 RNA≥ 50 copies/mL, both were treated with E/C/F/TAF plus DRV and neither had evidence of treatment-emergent resistance. Fifty-nine (97%) had an HIV-1 RNA<50 copies/mL. Adverse drug reactions (ADRs) occurred in 3/61 (5%) (all Grade 2) leading to 3/61 (5%) ADR-related discontinuations. Conclusion In this real-world cohort of MTR-treated patients, switching to a TAF-based STR plus boosted PI maintained virologic control in 97% and was well-tolerated, supporting potential use of this strategy for regimen simplification.
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Affiliation(s)
- Charlotte-Paige Rolle
- Orlando Immunology Center, Orlando, FL, USA.,Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Vu Nguyen
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Federico Hinestrosa
- Orlando Immunology Center, Orlando, FL, USA.,University of Central Florida College of Medicine, Orlando, FL, USA
| | - Edwin DeJesus
- Orlando Immunology Center, Orlando, FL, USA.,University of Central Florida College of Medicine, Orlando, FL, USA
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16
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Ishizu Y, Ishigami M, Honda T, Kuzuya T, Ito T, Komada T, Fujishiro M. Simplification of balloon-occluded retrograde transcatheter obliteration procedure using a coaxial double balloon catheter compared with a single-balloon catheter. Jpn J Radiol 2020; 39:296-302. [PMID: 33128698 DOI: 10.1007/s11604-020-01060-x] [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: 06/12/2020] [Accepted: 10/15/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE This study aimed to evaluate the usefulness of a coaxial double balloon catheter for simplification of the balloon-occluded retrograde transcatheter obliteration (BRTO) procedure compared with a single-balloon catheter. MATERIALS AND METHODS Thirty-three patients who underwent BRTO with a single-balloon catheter (Single-balloon group, n = 15) or a coaxial double balloon catheter (Coaxial group, n = 18) were included, retrospectively. The frequency of additional procedures for stagnation of sclerosant including ethanol injection, coil embolization, and additional balloon occlusion for collateral draining veins; the dose of ethanolamine oleate (EO); and the complication rate and the success rate of sclerosant stagnation were evaluated. RESULTS Additional procedures were needed in four patients in the Coaxial group, which was significantly lower than that in the Single-balloon group (nine patients, P = 0.038). The dose of EO in the Coaxial group (11.2 ± 6.6 g) was lower, but not significantly different than that in the Single-balloon group (14.4 g ± 6.1 g, P = 0.184). The complication rate and the success rate of sclerosant stagnation were not different between the two groups. CONCLUSION The use of a coaxial double balloon catheter can simplify the BRTO procedure compared with a single-balloon catheter.
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Affiliation(s)
- Yoji Ishizu
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takashi Honda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Teiji Kuzuya
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takanori Ito
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tomohiro Komada
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
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17
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Hu Q, Zhang Z. Comment on ″Exponential and logistic functions: The two faces of the Bohart-Adams model″. J Hazard Mater 2020; 394:122508. [PMID: 32248027 DOI: 10.1016/j.jhazmat.2020.122508] [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] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/20/2020] [Accepted: 03/08/2020] [Indexed: 06/11/2023]
Abstract
The Bohart-Adams model has been one of the most widely used breakthrough models for the modeling of dynamic adsorption behaviors of water pollutants in a fixed-bed column. However, the fitting quality was often questioned by many researchers when the Bohart-Adams model was correlated with the experimental data. Recently, Chu (2020) discussed the two simplified forms of the Bohart-Adams model and tested their applicability. In fact, in our previous study (Hu et al., 2019), it has been proved that the two forms represented the logistic and exponential functions in mathematical nature, respectively. The fitting quality depended on whether the experimental data approached the shape of the model curve. Besides, the curve characteristics and fitting ability of the original Bohart-Adams model were not revealed, and how to analyze asymmetrical breakthrough curve remained to be solved. This comment tried to expound the Bohart-Adams model completely. The authors hope that this work will be helpful for readers who are interested in the adsorption studies.
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Affiliation(s)
- Qili Hu
- College of Ecology and Environment, Chengdu University of Technology, Chengdu 610059, China; Graduate School of Life and Environmental Sciences, University of Tsukuba, Ibaraki 305-8572, Japan.
| | - Zhenya Zhang
- Graduate School of Life and Environmental Sciences, University of Tsukuba, Ibaraki 305-8572, Japan
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18
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Ceballos LA, Vercellino D, D’Errico V, Barzanti P, Decastelli L, Nicolandi L, Negro M, Ru G. Hazard perception and possibility of simplifying food safety management systems in small businesses in Piedmont region, Italy. Ital J Food Saf 2020; 9:8273. [PMID: 32300560 PMCID: PMC7154610 DOI: 10.4081/ijfs.2020.8273] [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: 05/08/2019] [Accepted: 12/23/2019] [Indexed: 11/23/2022] Open
Abstract
Small food businesses, because of their limited resources, are hard pressed to comply with the requirements of a conventional food safety management system (FSMS). To overcome it, the European legislation provides some flexibility in the application of FSMS. With this study, we evaluated the change in the perception and awareness of hazards in food production and in the attitudes of food business operators (FBOs) after a regional regulation was introduced to allow flexibility and a campaign of training activities on the FSMS simplification opportunities. Training activities targeting various stakeholders have been carried out in Piedmont region since 2014. A total of 283 FBOs from the dairy and the meat supply chains were recruited for a two-round survey. Overall, the majority of the FBOs believed that application of an FSMS helps to overcome official controls, to produce healthy foods, to better manage the production process, and for staff training; its usefulness for enhancing customer trust was judged of limited value. FBO knowledge on the possibility of simplifying the FSMS activities increased significantly between surveys, suggesting the success of the information campaigns. Over time, simplification increased in the meat but not in the dairy supply chain, where it involved nearly 70% of FBOs. The cost of FSMS (mainly due to microbiological analysis) and the time it takes were the main reasons for FBO resistance to its application. Simplification of FSMS procedures were welcomed by the vast majority (>90%) of FBOs. The perception of hazards was low and generic, suggesting the need for targeted training activities.
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Affiliation(s)
- Leonardo A. Ceballos
- Experimental Zooprophylactic Institute of Piedmont, Liguria and Aosta Valley, Turin
| | - Davide Vercellino
- Experimental Zooprophylactic Institute of Piedmont, Liguria and Aosta Valley, Turin
- Hygiene Service for Livestock and Zootechnical Production, ASL AT, Asti
| | - Valeria D’Errico
- Experimental Zooprophylactic Institute of Piedmont, Liguria and Aosta Valley, Turin
- Service for Animal Health, ASL TO5, Turin
| | - Paola Barzanti
- Experimental Zooprophylactic Institute of Piedmont, Liguria and Aosta Valley, Turin
| | - Lucia Decastelli
- Experimental Zooprophylactic Institute of Piedmont, Liguria and Aosta Valley, Turin
| | - Luca Nicolandi
- Hygiene Service for Livestock and Zootechnical Production, ASL TO4, Turin
| | - Mauro Negro
- Hygiene Service for Food of Animal Origin, ASL CN1, Cuneo, Italy
| | - Giuseppe Ru
- Experimental Zooprophylactic Institute of Piedmont, Liguria and Aosta Valley, Turin
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Abstract
Transcatheter aortic valve implantation (TAVI) is a therapeutic option widely used for the treatment of severe aortic stenosis in the elderly. Careful pre-procedural screening, operator experience, and technological innovations, accounted for a safe, reliable, and standardized procedure. To further decrease post-operative complications, few steps are important: careful planning of the procedure by the Heart Team, clinical and diagnostic evaluation including electrocardiogram, echography, and computed tomography of the heart and great vessels. This approach will allow a selection of ideal candidates for the procedure, the best vascular approach, the selection of patients candidates for early discharge, and last but not least, simplification of the TAVI procedure. Although the procedure is reaching the ‘simplicity’ of coronary interventions, it should always be kept in mind the possibility, albeit remote, that life-threatening complication could ensue, requiring the prompt intervention of the cardiovascular surgeon.
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Affiliation(s)
| | - Marco Barbanti
- CAST-Ospedale Policlinico, Cardiologia, Università degli Studi di Catania, Italy
| | - Corrado Tamburino
- CAST-Ospedale Policlinico, Cardiologia, Università degli Studi di Catania, Italy
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20
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Fontana RJ, Lens S, McPherson S, Elkhashab M, Ankoma-Sey V, Bondin M, Dos Santos AGP, Xue Z, Trinh R, Porcalla A, Zeuzem S. Efficacy and Safety of 8 Weeks of Glecaprevir/Pibrentasvir in Treatment-Naïve, HCV-Infected Patients with APRI ≤ 1 in a Single-Arm, Open-Label, Multicenter Study. Adv Ther 2019; 36:3458-3470. [PMID: 31646465 PMCID: PMC6860464 DOI: 10.1007/s12325-019-01123-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The presence or absence of cirrhosis in patients with chronic hepatitis C virus (HCV) infection influences the type and duration of antiviral therapy. Non-invasive markers, like serum aspartate aminotransferase (AST) to platelet ratio index (APRI), may help identify appropriate HCV treatment-naive patients for 8-week treatment with the pangenotypic regimen of glecaprevir/pibrentasvir. METHODS This single-arm, open-label, international, prospective study (NCT03212521) evaluated the efficacy and safety of 8-week glecaprevir/pibrentasvir regimen in HCV treatment-naïve adults with chronic HCV genotypes 1-6 infection, APRI ≤ 1, and no prior evidence of cirrhosis. The primary and secondary outcomes were sustained virologic response at 12 weeks post-treatment (SVR12) by modified intent-to-treat (mITT) and intent-to-treat (ITT) analyses, respectively. Additional endpoints included virologic failures, treatment adherence, and genotype-specific SVR12 rates. RESULTS Among the 230 patients enrolled, most were less than 65 years old (90%); 37% and 43% had a history of injection drug use or psychiatric disorders, respectively. SVR12 rates were 100% (222/222; 95% CI 98.3-100%) and 96.5% (222/230; 95% CI 94.2-98.9%) by mITT and ITT analyses, respectively. There were no virologic failures. ITT SVR12 rates were greater than 94% for all HCV genotypes. In patients with available data, treatment adherence was 99% (202/204). There were no grade 3 or higher laboratory abnormalities in alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin, and low rates of serious adverse events (2%). CONCLUSIONS Glecaprevir/pibrentasvir was highly efficacious and well tolerated in HCV treatment-naïve patients with APRI ≤ 1 and no prior evidence of cirrhosis. TRIAL REGISTRATION ClinicalTrials.gov number, NCT03212521. FUNDING AbbVie. Plain language summary available for this article.
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Affiliation(s)
- Robert J Fontana
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA.
| | - Sabela Lens
- Liver Unit, Hospital Clinic, IDIBAPS and CIBERehd, University of Barcelona, Barcelona, Spain
| | - Stuart McPherson
- Liver Unit, The Newcastle upon Tyne Hospitals NHS Foundation and Trust and Newcastle University, Newcastle upon Tyne, UK
| | | | - Victor Ankoma-Sey
- Division of Gastroenterology, Sherri and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist, Houston, TX, USA
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21
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Akodad M, Lefèvre T, Lounes Y, Leclercq F. [TAVI simplification: A focus]. Ann Cardiol Angeiol (Paris) 2019; 68:418-422. [PMID: 31668597 DOI: 10.1016/j.ancard.2019.09.017] [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: 09/17/2019] [Accepted: 09/20/2019] [Indexed: 11/29/2022]
Abstract
After a first procedure carried out in 2002 by Pr Cribier's, Transcatheter Aortic Valve Replacement or TAVR revolutionized the management of aortic stenosis with a constant increase in the number of procedures performed worldwide. Experience of operators and teams and evolution of the technique has been accompanied by a drastic reduction in complications in patients at lower surgical risk. In parallel, the procedure was considerably simplified, carried out more and more under local anesthesia, with percutaneous femoral approach, secondary radial approach, prosthesis implantation without predilatation, rapid pacing on left ventricle wire and early discharge. Thus, the "simplified" TAVR adopted in most centers nowadays is a real revolution of the technique. However, simplified TAVR must be accompanied upstream by a rigorous selection of patients who can benefit from a minimalist procedure in order to guarantee its safety.
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Affiliation(s)
- M Akodad
- Service de cardiologie, centre hospitalier universitaire Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France; PhyMed Exp, université de Montpellier, Inserm U1046, CNRS UMR 9214, 34295 Montpellier cedex 5, France.
| | - T Lefèvre
- Ramsay générale de santé, institut cardiovasculaire Paris Sud, 91300 Massy, France
| | - Y Lounes
- Service de chirurgie vasculaire, centre hospitalier universitaire Arnaud-de-Villeneuve, 34295 Montpellier, France
| | - F Leclercq
- Service de cardiologie, centre hospitalier universitaire Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France; PhyMed Exp, université de Montpellier, Inserm U1046, CNRS UMR 9214, 34295 Montpellier cedex 5, France
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Taybani Z, Bótyik B, Katkó M, Gyimesi A, Várkonyi T. Simplifying Complex Insulin Regimens While Preserving Good Glycemic Control in Type 2 Diabetes. Diabetes Ther 2019; 10:1869-1878. [PMID: 31347100 PMCID: PMC6778557 DOI: 10.1007/s13300-019-0673-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 06/17/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Type 2 diabetic patients suffering from severe hyperglycemia are often assigned a regimen involving multiple daily injections (MDI) of insulin. If the glucose toxicity resolves, the regimen can potentially be simplified, but there are no guidelines for this, and many patients are left on the MDI regimen. We aimed to prospectively examine the safety and efficacy of switching from MDI to once-daily IDegLira, a fixed-ratio combination of insulin degludec and liraglutide, in relatively well controlled (HbA1c ≤ 7.5%) subjects with type 2 diabetes on a low total daily insulin dose (TDD). METHODS 62 adults with type 2 diabetes (baseline age 64.06 ± 10.24 years, HbA1c 6.42 ± 0.68%, BMI 33.53 ± 6.90 kg/m2, body weight 93.81 ± 19.26 kg, TDD 43.31 ± 10.99 IU/day, insulin requirement 0.47 ± 0.13 IU/kg, duration of diabetes 10.84 ± 7.50 years, mean ± SD) treated with MDI ± metformin were enrolled in our study. Previous insulins were stopped and once-daily IDegLira was started. IDegLira was titrated by the patients to achieve a self-measured pre-breakfast blood glucose concentration of < 6 mmol/L. RESULTS After a mean follow-up period of 99.2 days, mean HbA1c had decreased by 0.30% to 6.12 ± 0.65% (p < 0.0001), body weight had decreased by 3.11 kg to 90.70 ± 19.12 kg (p < 0.0001), and BMI had reduced to 32.39 ± 6.71 kg/m2 (p < 0.0001). After 3 months of treatment, the mean dose of IDegLira was 20.76 ± 6.60 units and the mean insulin requirement had decreased to 0.23 ± 0.08 IU/kg. IDegLira ± metformin combination therapy was found to be safe and generally well tolerated. During the month before the baseline visit, 28 patients (45%) had at least one episode of documented or symptomatic hypoglycemia, while only 6 (9.67%) patients reported a total of 13 documented episodes during the follow-up. CONCLUSION In everyday clinical practice, switching from low-dose MDI to IDegLira in patients with well-controlled type 2 diabetes is safe, may result in weight loss and similar or better glycemic control, and substantially reduces the insulin requirement. Simplifying complex treatment regimens decreases treatment burden and may improve adherence to therapy. CLINICAL TRIAL NUMBER NCT04020445.
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Affiliation(s)
- Zoltán Taybani
- 1st Department of Endocrinology, Dr. Réthy Pál Member Hospital, Békés County Central Hospital, Gyulai street 18, Békéscsaba, 5600, Hungary.
| | - Balázs Bótyik
- 1st Department of Endocrinology, Dr. Réthy Pál Member Hospital, Békés County Central Hospital, Gyulai street 18, Békéscsaba, 5600, Hungary
| | - Mónika Katkó
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary
| | - András Gyimesi
- 1st Department of Endocrinology, Dr. Réthy Pál Member Hospital, Békés County Central Hospital, Gyulai street 18, Békéscsaba, 5600, Hungary
| | - Tamás Várkonyi
- 1st Department of Internal Medicine, University of Szeged, Korányi fasor 8, Szeged, 6720, Hungary
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Baldin G, Ciccullo A, Rusconi S, Capetti A, Sterrantino G, Colafigli M, d'Ettorre G, Giacometti A, Cossu MV, Borghetti A, Gennari W, Mussini C, Borghi V, Di Giambenedetto S. Long-term data on the efficacy and tolerability of lamivudine plus dolutegravir as a switch strategy in a multi-centre cohort of HIV-1-infected, virologically suppressed patients. Int J Antimicrob Agents 2019; 54:728-734. [PMID: 31521809 DOI: 10.1016/j.ijantimicag.2019.09.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 05/23/2019] [Revised: 08/08/2019] [Accepted: 09/08/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Results from clinical trials and observational studies suggest that lamivudine plus dolutegravir (3TC+DTG) could be an effective and tolerated option for simplification in human immunodeficiency virus (HIV)-1-positive patients. MATERIALS AND METHODS This observational study enrolled HIV-1-infected, virologically suppressed patients switching to 3TC+DTG. Kaplan-Meyer survival analysis was performed to evaluate time to virological failure (VF; defined by a single HIV-RNA determination ≥1000 copies/mL or by two consecutive HIV-RNA determinations ≥50 copies/mL) and time to treatment discontinuation (TD; defined as interruption of either 3TC or DTG), Cox regression was performed to assess predictors, and linear mixed model was performed for repeated measures to measure changes in immunological and metabolic parameters. RESULTS Five hundred and fifty-six patients were eligible for analysis. Their median CD4+ count at baseline was 668 cells/mm3 and median time of virological suppression was 88 months. Estimated probabilities of maintaining virological suppression at 96 and 144 weeks of follow-up were 97.5% [standard deviation (SD) 0.8] and 96.5% (SD 1.0), respectively. Years since HIV diagnosis was the only predictor of VF. In patients with time of virological suppression <88 months, the rate of VF was higher in the presence of the M184V mutation. Estimated probabilities of remaining on 3TC+DTG at 96 and 144 weeks of follow-up were 79.2% (SD 1.9) and 75.2% (SD 2.2), respectively. A significant increase in CD4 cell count (+44 cells/mm3, P=0.015), CD4/CD8 ratio (+0.10, P=0.002) and high-density lipoprotein cholesterol (+5.4 mg/dL, P=0.036) was found at 144 weeks of follow-up; meanwhile, total cholesterol (-9.1 mg/dL, P=0.007) and triglycerides (-2.7, P=0.009) decreased significantly. CONCLUSIONS These findings confirm the efficacy and tolerability of 3TC+DTG in virologically suppressed patients.
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Affiliation(s)
- Gianmaria Baldin
- Institute of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy; Mater Olbia Hospital, Olbia, Italy
| | - Arturo Ciccullo
- Institute of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy.
| | - Stefano Rusconi
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Amedeo Capetti
- Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - Gaetana Sterrantino
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Manuela Colafigli
- Infectious Dermatology and Allergology Unit, IFO S. Gallicano Institute (IRCCS), Rome, Italy
| | - Gabriella d'Ettorre
- Department of Public Health and Infectious Diseases, Azienda Policlinico Umberto I, Rome, Italy
| | - Andrea Giacometti
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona, Italy
| | - Maria Vittoria Cossu
- Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - Alberto Borghetti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Malattie Infettive, Rome, Italy
| | - William Gennari
- Azienda Ospedaliero Universitaria di Modena Laboratorio di Microbiologia e Virologia, Modena, Italy
| | - Cristina Mussini
- Azienda Ospedaliero Universitaria di Modena, Clinica Malattie Infettive e Tropicali, Modena, Italy
| | - Vanni Borghi
- Azienda Ospedaliero Universitaria di Modena, Clinica Malattie Infettive e Tropicali, Modena, Italy
| | - Simona Di Giambenedetto
- Institute of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Malattie Infettive, Rome, Italy
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Hung TC, Chen GJ, Cheng SH, Chen JH, Wei JL, Cheng CY, Hung CC. Dual therapy with ritonavir-boosted protease inhibitor (PI) plus lamivudine versus triple therapy with ritonavir-boosted PI plus two nucleos(t)ide reverse-transcriptase inhibitor in HIV-infected patients with viral suppression. J Microbiol Immunol Infect 2019; 52:865-871. [PMID: 31422059 DOI: 10.1016/j.jmii.2019.07.002] [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] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 07/08/2019] [Accepted: 07/16/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Dual antiretroviral regimens are attractive options to optimize the combination antiretroviral therapy in light of potential toxicities with long-term cumulative exposure to nucleos(t)ide reverse-transcriptase inhibitors (NRTIs). METHODS In this retrospective observational study, we included HIV-infected patients on suppressive antiretroviral therapy with plasma viral load (PVL) < 200 copies/mL for at least 6 months who were switched to dual regimens containing lamivudine (3TC) (150 mg twice daily or 300 mg once daily) plus lopinavir/ritonavir (LPV/r) 250/50 mg twice daily or darunavir/ritonavir (DRV/r) 800/100 mg once daily. Patients maintaining on suppressive triple therapy with DRV/r or LPV/r plus two NRTIs were included for comparisons. The primary endpoint was the proportion of patients with PVL <50 copies/mL after 48 weeks of follow-up. RESULTS In total, 364 patients were included with 93 (25.5%) switched to dual therapy After 48 weeks of observation, PVL <50 copies/mL was observed in 96.8% and 94.1% of dual-therapy and triple-therapy group, respectively, in per-protocol analysis (difference 2.7%; 95% CI -2.5%-7.9%). Nineteen patients (3 [3.2%] in dual-therapy and 16 [7.6%] in triple-therapy group) developed virologic failure, with none having emergent M184V resistance-associated mutation. A statistically significant increase of cholesterol level (13 mg/dL versus 2 mg/dL, p = 0.003) and high-density lipoprotein (3 mg/dL versus -2 mg/dL, p = 0.019) were observed in dual-therapy than in triple-therapy group. Changes of triglyceride, low-density lipoprotein and glycated hemoglobin levels were similar between the two groups. CONCLUSION Dual therapy with DRV/r or LPV/r plus lamivudine demonstrated similar effectiveness in maintaining viral suppression to triple therapy.
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Affiliation(s)
- Tung-Che Hung
- Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Guan-Jhou Chen
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan; Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shu-Hsing Cheng
- Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan; School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Jhen-Hong Chen
- Department of Pharmacy, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Jheng-Lun Wei
- Department of Pharmacy, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Chien-Yu Cheng
- Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan; School of Public Health, National Yang-Ming University, Taipei, Taiwan.
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan
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Galindo Puerto MJ. Symtuza ® (DRV/c/FTC/TAF) in the management of previously treated patients. Enferm Infecc Microbiol Clin 2018; 36 Suppl 2:22-30. [PMID: 30545468 DOI: 10.1016/S0213-005X(18)30394-X] [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] [Indexed: 11/21/2022]
Abstract
Because of the development of antiretroviral therapy (ART) in the last few years, we now have safe, effective short- and long-term options and also simple regimens, with most combinations being administered once daily in one or 2 tablets and almost no treatment failures. Nevertheless, there are still reasons to switch an effective ART in patients who have been suppressed, a switch that must always be made without losing virological efficacy. With longer survival and the need for lifelong treatment, it is important to have simple and safe treatment options to improve the quality of life in patients with HIV. The EMERALD clinical trial demonstrates the non-inferiority of the switch to Symtuza®, a combination of darunavir, cobicistat, emtricitabine and tenofovir alafenamide in a single tablet, in patients with sustained viral suppression. Supplement information: This article is part of a supplement entitled "Co-formulated cobicistat-boosted darunavir, emtricitabine, and tenofovir alafenamide for the treatment of HIV infection", which is sponsored by Janssen.
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Salsabili N, Santiago López J, Prieto Barrio MI. Simplifying the human lumbar spine (L3/L4) material in order to create an elemental structure for the future modeling. Australas Phys Eng Sci Med 2019; 42:689-700. [PMID: 31183739 DOI: 10.1007/s13246-019-00768-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 06/02/2019] [Indexed: 10/26/2022]
Abstract
The human lumbar spine incorporates the best joints in nature due to its optimal static and dynamic behavior against the internal and external loads. Developing an elemental structure based on this joint requires simplification in terms of the materials employed by keeping the mechanical and anatomical behaviors of the human lumbar spine. In the present study, the finite element (FE) of two motion segments of the human lumbar spine (L3/L4) was developed based on the CT scan data as the base for vertebrae geometry, verified geometry properties for another part of two motion segments, and combination of materials and loads obtained from the validated resources. Then, simplification occurred in four continuous steps such as omitting the annual fibers of annual matrix, representing the material of the annual matrix to the nucleus, demonstrating the material of annual matrix to the endplates too, and omitting the trabecular part of vertebrae. The present study aimed to propose the method for developing the basic structure of the human lumbar spine by simplifying its materials in the above-mentioned steps, analyzing the biomechanical effects of these four steps in terms of their internal and external responses, and validating the data obtained from the FE method. The validated simplified way introduced in this study can be used for future research by making implants, prosthesis, and modeling based on the human lumbar spine in other fields such as industrial design, building structures, or joints, which results in making the model easier, cheaper, and more effective.
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Abstract
PURPOSE OF REVIEW Simplification of antiretroviral therapy is a strategy aiming to reduce pill burden, drug interactions, and toxicity. This review focuses on the most recent and important studies evaluating a reduction on the number of drugs for HIV treatment, both in naive and virologically suppressed patients. RECENT FINDINGS Interesting studies have been performed in the past years testing dual therapy and monotherapy, with variable rates of virological control. Novel therapeutics like immunotherapy or long-acting antiretrovirals can also be considered for simplification. Reducing the number of drugs for HIV treatment can be an option for selected patients. Current available evidence favors dual therapy over monotherapy. Future research should seek to identify the best candidates for simplification.
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Pasquau J, de Jesus SE, Arazo P, Crusells MJ, Ríos MJ, Lozano F, de la Torre J, Galindo MJ, Carmena J, Santos J, Tornero C, Verdejo G, Samperiz G, Palacios Z, Hidalgo-Tenorio C. Effectiveness and safety of dual therapy with rilpivirine and boosted darunavir in treatment-experienced patients with advanced HIV infection: a preliminary 24 week analysis (RIDAR study). BMC Infect Dis 2019; 19:207. [PMID: 30819101 PMCID: PMC6396540 DOI: 10.1186/s12879-019-3817-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 11/18/2018] [Accepted: 02/13/2019] [Indexed: 01/01/2023] Open
Abstract
Background The objective was to analyze the effectiveness and safety of dual therapy with rilpivirine plus boosted-darunavir (RPV + bDRV) in real-life patients. Methods Observational, retrospective, multi-center study in HIV+ patients who had received RPV + bDRV for 24 weeks to optimize/simplify their previous antiretroviral treatment. We determined the percentage of patients without virologic failure (2 consecutive viral loads > 50 copies/mL) at 24 weeks of treatment. Results The study included 161 patients from 15 hospitals with median age of 49 years; 29.3% had previous AIDS stage and median CD4+ lymphocyte nadir of 170 cells/uL. They had been diagnosed with HIV for a median of 17 years and had received 14 years of ART, with five previous treatment combinations, and 36.6% had a history of virological failure. The reasons for the switch were simplification/optimization (49.7%), toxicity/intolerance (17.4%), or inadequate effectiveness of previous ART (10.6%). Baseline VL of 50–1000 copies/mL was recorded in 25.5% of the patients. In the“intention-to-treat” analysis at 24 weeks, 87.6% of 161 patients continued the study treatment without virologic failure criteria. In the “on treatment” analysis (excluding patients who discontinued treatment with dual therapy for any reason other than virologic failure) the efficacy was 94.6% (141/149 patients). Conclusions Dual therapy with RPV + DRVb proved to be effective and safe in patients with advanced HIV infection, long exposure to ART, low CD4 nadir, previous virologic failure, and/or history of ineffective ART.
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Affiliation(s)
- Juan Pasquau
- Hospital Universitario Virgen de las Nieves, Granada, Spain.
| | | | | | | | | | | | | | | | - Jorge Carmena
- Hospital Universitario Doctor Peset, Valencia, Spain
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Abstract
ᅟ Some tumor cells can evolve into transmissible parasites. Notable examples include the Tasmanian devil facial tumor disease, the canine transmissible venereal tumor and transmissible cancers of mollusks. We present a hypothesis that such transmissible tumors existed in the past and that some modern animal taxa are descendants of these tumors. We expect potential candidates for SCANDALs (speciated by cancer development animals) to be simplified relatives of more complex metazoans and have genomic alterations typical for cancer progression (such as deletions of universal apoptosis genes). We considered several taxa of simplified animals for our hypothesis: dicyemida, orthonectida, myxosporea and trichoplax. Based on genomic analysis we conclude that Myxosporea appear to be the most suitable candidates for a tumor ancestry. They are simplified parasitic cnidarians that universally lack major genes implicated in cancer progression including all genes with Caspase and BCL2 domains as well as any p53 and apoptotic protease activating factor – 1 (Apaf-1) homologs, suggesting the disruption of main apoptotic pathways in their early evolutionary history. Further comparative genomics and single-cell transcriptomic studies may be helpful to test our hypothesis of speciation via a cancerous stage. Reviewers This article was reviewed by Eugene Koonin, Mikhail Gelfand and Gregory M Woods. Electronic supplementary material The online version of this article (10.1186/s13062-019-0233-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A Y Panchin
- Institute for Information Transmission Problems, Bolshoy Karetniy Pereulok 19/1, Moscow, Russian Federation, 127051.
| | - V V Aleoshin
- Institute for Information Transmission Problems, Bolshoy Karetniy Pereulok 19/1, Moscow, Russian Federation, 127051.,A.N. Belozersky Institute of Physico-Chemical Biology, Moscow State University, Moscow, Russia
| | - Y V Panchin
- Institute for Information Transmission Problems, Bolshoy Karetniy Pereulok 19/1, Moscow, Russian Federation, 127051.,A.N. Belozersky Institute of Physico-Chemical Biology, Moscow State University, Moscow, Russia
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Chopra M, Luk NHV, De Backer O, Søndergaard L. Simplification and optimization of transcatheter aortic valve implantation - fast-track course without compromising safety and efficacy. BMC Cardiovasc Disord 2018; 18:231. [PMID: 30526521 PMCID: PMC6288866 DOI: 10.1186/s12872-018-0976-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 10/03/2018] [Accepted: 12/03/2018] [Indexed: 01/09/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has become an established therapeutic option for patients with symptomatic, severe aortic valve stenosis. Ageing of the Western and Asian population and expansion of indications for TAVI will lead to a substantial increase in the number of TAVI procedures performed worldwide within the next decades. In line with the maturation of TAVI over the past few years, there has also been a significant simplification and optimisation of the TAVI procedure. A minimalist TAVI procedure and fast-track TAVI course have been shown to have distinct advantages over the more traditional TAVI approach. The aim of this manuscript is to discuss strategies of TAVI simplification and optimization, with special focus on fast-track TAVI, without compromising safety and efficacy.
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Affiliation(s)
- Manik Chopra
- The Heart Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Ngai H V Luk
- The Heart Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Lars Søndergaard
- The Heart Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
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Messineo A, Cattaruzza MS, Prestigiacomo C, Giordano F, Marsella LT. Sustainability of prevention practices at the workplace: safety, simplification, productivity and effectiveness. Ann Ig 2018; 29:407-421. [PMID: 28715054 DOI: 10.7416/ai.2017.2173] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Traditional full-time employment has evolved into various types of occupational situations, and, nowadays, new work organization strategies have been developed. Previously overlooked risk factors have emerged, such as traffic accidents while commuting or during work hours, poor work organization, and detrimental lifestyles (like alcohol and substance abuse, although recent statistics seem to show a declining trend for the latter). The global scenario shows greater attention to occupational risks, but also, to the reduced degree of protection. Moreover, the elevated costs, the unacceptably high fatal accident rates in some sectors, the complexity of the prevention systems, the lack of prevention training, the inadequate controls (despite the numerous independent supervisory bodies) and the obsolescence of certain precepts, call for a prompt review of the regulatory system. This is especially needed for general simplification, streamlining certification bodies and minimizing references to other provisions in the legislation that make it difficult for Italian and foreign workers to read and understand the rules "without legal interpreters". "New" occupational diseases and occupational risk factors have also been reported in addition to pollution. There are concerns for continued economic and social destabilization, unemployment, commuting, temporary and precarious contracts. All of these contribute to the lack of wellbeing in the working population. Thus, the timing, duration, and types of prevention training should be carefully assessed, making prevention more appealing by evaluating costs and benefits with a widespread use of indicators that make appropriate actions for health promotion "visible", thus encouraging awareness. Although reducing prevention is never justified, it should still be "sustainable" economically in order to avoid waste of resources. It is also essential to have laws which are easily and consistently interpreted and to work on the ethics of employers and employees to ensure that they conform to the standards of other European countries that currently operate with greater effectiveness and lower costs.
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Affiliation(s)
- A Messineo
- Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Roma, Italy
| | - M S Cattaruzza
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - C Prestigiacomo
- Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Roma, Italy
| | - F Giordano
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - L T Marsella
- Department of Biomedicine and Prevention, Section of Forensic Medicine, Social Security and Forensic Toxicology, Tor Vergata University of Rome, Italy
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Calza L, Cafaggi M, Colangeli V, Borderi M, Barchi E, Lanzafame M, Nicole' S, Degli Antoni AM, Bon I, Re MC, Viale P. Simplification to dual-therapy containing lamivudine and darunavir/ritonavir or atazanavir/ritonavir in HIV-infected patients on virologically suppressive antiretroviral therapy. Infect Dis (Lond) 2017; 50:352-360. [PMID: 29210336 DOI: 10.1080/23744235.2017.1410285] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND The ritonavir-boosted protease inhibitor (PI/r)-based dual regimens are warranted in order to optimize the combination antiretroviral therapy (cART), prevent the long-term toxicity and reduce the cost of treatments. METHODS We performed an observational, retrospective study of HIV-infected patients on suppressive antiretroviral therapy who switched to a dual regimen containing lamivudine (3TC) plus darunavir/ritonavir (DRV/r) 800/100 mg qd or atazanavir/ritonavir (ATV/r) 300/100 mg qd. RESULTS As a whole, 122 well-treated patients (mean age, 45.2 years; mean CD4 T + lymphocyte count, 589 cells/mm3; mean duration of current cART, 3.1 years) were enrolled. Current antiretroviral regimen included tenofovir/emtricitabine in 91 subjects, abacavir/lamivudine in 25, lopinavir/r in 41, DRV/r in 38 and ATV/r in 33. Baseline mean estimated glomerular filtration rate (eGFR) was 94.2 mL/min/1.73 m2, and proteinuria was detected in 46 subjects (38%). Overall 70 subjects switched to 3TC + DRV/r (group A) and 52 to 3TC + ATV/r (group B). After 12 months, 65 patients (92.8%) in group A and 46 (88.4%) in group B showed HIV RNA <20 copies/mL. A significant and comparable increase in eGFR was observed in group A and B (+3.8 and +3.1 mL/min/1.73 m2, respectively), such as a significant decrease in prevalence of proteinuria. A significantly greater increase in total bilirubin concentration was reported in group B than in group A. CONCLUSION In our study, simplification to a dual therapy containing 3TC + DRV/r or ATV/r in virologically suppressed patients was effective and showed a good tolerability profile.
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Affiliation(s)
- Leonardo Calza
- a S. Orsola-Malpighi Hospital , Clinic of Infectious Diseases, 'Alma Mater Studiorum' University of Bologna , Bologna , Italy
| | - Matteo Cafaggi
- a S. Orsola-Malpighi Hospital , Clinic of Infectious Diseases, 'Alma Mater Studiorum' University of Bologna , Bologna , Italy
| | - Vincenzo Colangeli
- a S. Orsola-Malpighi Hospital , Clinic of Infectious Diseases, 'Alma Mater Studiorum' University of Bologna , Bologna , Italy
| | - Marco Borderi
- a S. Orsola-Malpighi Hospital , Clinic of Infectious Diseases, 'Alma Mater Studiorum' University of Bologna , Bologna , Italy
| | - Enrico Barchi
- b Infectious Diseases Unit, S. Maria Nuova Hospital , Reggio Emilia , Italy
| | | | - Stefano Nicole'
- c Infectious Diseases Unit, G.B. Rossi University Hospital , Verona , Italy
| | | | - Isabella Bon
- e Unit of Microbiology, 'Alma Mater Studiorum' University of Bologna, S. Orsola-Malpighi Hospital , Bologna , Italy
| | - Maria Carla Re
- e Unit of Microbiology, 'Alma Mater Studiorum' University of Bologna, S. Orsola-Malpighi Hospital , Bologna , Italy
| | - Pierluigi Viale
- a S. Orsola-Malpighi Hospital , Clinic of Infectious Diseases, 'Alma Mater Studiorum' University of Bologna , Bologna , Italy
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Capetti AF, Cossu MV, Orofino G, Sterrantino G, Cenderello G, De Socio GV, Cattelan AM, Soria A, Rusconi S, Riccardi N, Baldin GM, Niero FP, Barbarini G, Rizzardini G. A dual regimen of ritonavir/darunavir plus dolutegravir for rescue or simplification of rescue therapy: 48 weeks' observational data. BMC Infect Dis 2017; 17:658. [PMID: 28964268 PMCID: PMC5622573 DOI: 10.1186/s12879-017-2755-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [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: 06/21/2017] [Accepted: 09/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dolutegravir (DTG) plus darunavir/ritonavir (DRV/r) is a simple combination of drugs that has the best genetic barrier to HIV-1 resistance and may be fit for salvage therapy. METHODS All HIV-1-infected subjects treated with DTG plus DRV/r between March 2014 and September 2015 in eight Italian centres were included in the analysis. The main metabolic data, efficacy parameters and safety data routinely collected were provided. This observational study is aimed to assess the efficacy of such approach. The primary end-point was the proportion of subjects achieving or maintaining virologic suppression <50 copies/mL at week 24. Secondary end points were maintaining virologic suppression in the follow-up (weeks 48 and 96) and safety. RESULTS One hundred and thirty subjects were followed for a median of 56 months. Reasons for switching were simplification (44.6%), viral failure (30%), toxicity (16.9%), non-adherence (4.6%), persistent low-level viremia (3.1%), and drug-drug interaction (0.8%). At baseline, 118 subjects had documented resistance to 1 to 5 antiretroviral classes while 12 had viral rebound at a time when genotypic tests were not yet available. Seventeen and 14 subjects took DRV/r and DTG twice daily, respectively. One subject was lost to follow-up, one discontinued for liver enzymes' elevation, one died of illicit drug abuse and one of cancer-related complications. The proportion of subjects with ongoing HIV replication dropped from 40% to 6.1%. Those with undetectable viral load increased from 38.5% to 76.2%. At week 48, 17.7% had HIV RNA between 1 and 49 copies/mL. The number of subjects with altered serum glucose, creatinine, ALT, AST, total-, HDL- and LDL-cholesterol, triglycerides and MDRD <90 mL/min decreased by week 48, while those having MDRD <60 mL/min remained 4.6%. Overall 90/283 baseline laboratory alterations returned to normality. CONCLUSIONS Switching to DTG plus DRV/r proved to be safe, suppressing viral replication without metabolic impact.
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Affiliation(s)
- Amedeo F Capetti
- 1st Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Via Giovanni Battista Grassi, 74, pavillion 56, Malattie Infettive, 2nd floor, 20157, Milan, Italy.
| | - Maria Vittoria Cossu
- 1st Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Via Giovanni Battista Grassi, 74, pavillion 56, Malattie Infettive, 2nd floor, 20157, Milan, Italy
| | - Giancarlo Orofino
- 1st Division of Infectious Diseases Amedeo di Savoia Hospital, Torino, Italy
| | | | | | - Giuseppe V De Socio
- Infectious Diseases Clinic, Azienda Ospedaliero-Universitaria di Perugia, Perugia, Italy
| | - Anna Maria Cattelan
- Infectious and Tropical Diseases, Azienda Ospedaliera-Universitaria di Padova, Padova, Italy
| | - Alessandro Soria
- Clinic of Infectious Diseases, San Gerardo Hospital, ASST Monza, University of Milano-Bicocca, Monza, Italy
| | - Stefano Rusconi
- Infectious Diseases Clinic, DIBIC Luigi Sacco, University of Milano, Milano, Italy
| | - Niccolò Riccardi
- Infectious Diseases Clinic, "San Martino" Hospital, Genova, Italy
| | - Gian Maria Baldin
- 2nd Division of Infectious Diseases, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fosca P Niero
- 1st Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Via Giovanni Battista Grassi, 74, pavillion 56, Malattie Infettive, 2nd floor, 20157, Milan, Italy
| | - Giorgio Barbarini
- 2nd Division of Infectious Diseases, "Policlinico San Matteo" Hospital, Pavia, Italy
| | - Giuliano Rizzardini
- 1st Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Via Giovanni Battista Grassi, 74, pavillion 56, Malattie Infettive, 2nd floor, 20157, Milan, Italy.,Whitwaterstrand University, Johannesburg, South Africa
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Arribas JR, DeJesus E, van Lunzen J, Zurawski C, Doroana M, Towner W, Lazzarin A, Nelson M, McColl D, Andreatta K, Swamy R, Szwarcberg J, Nguyen T. Simplification to single-tablet regimen of elvitegravir, cobicistat, emtricitabine, tenofovir DF from multi-tablet ritonavir-boosted protease inhibitor plus coformulated emtricitabine and tenofovir DF regimens: week 96 results of STRATEGY-PI. HIV Clin Trials 2017; 18:118-125. [PMID: 28555519 DOI: 10.1080/15284336.2017.1330440] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Antiretroviral therapy (ART) simplification to a single-tablet regimen can benefit HIV-1-infected, virologically suppressed, individuals on ART composed of multiple pills. OBJECTIVE We assessed long-term efficacy and safety of switching to co-formulated elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate (E/C/F/TDF) from multi-tablet ritonavir-boosted protease inhibitor (PI + RTV) plus F/TDF (TVD) regimens. METHODS STRATEGY-PI was a 96-week, phase 3b, randomized (2:1), open-label, non-inferiority study examining the efficacy, safety, and tolerability of switching to E/C/F/TDF from PI + RTV + TVD regimens in virologically suppressed individuals (HIV-1 RNA <50 copies/mL). Participants were randomized to switch to E/C/F/TDF (switch group) or to continue their PI + RTV + TVD regimens (no-switch group). Eligibility criteria included no resistance to F/TDF or history of virologic failure, and estimated creatinine clearance ≥70 mL/min. RESULTS At week 96, 87% (252/290) of switch and 70% (97/139) of no-switch participants maintained HIV-1 RNA <50 copies/mL (difference: 17%, 95% CI 8.7-26.0%, p < 0.001). Superiority of the switch to E/C/F/TDF vs. no-switch was due to a smaller proportion of both virologic failures (switch, 1% [3/290]; no-switch, 6% [8/139]) and discontinuations for non-virologic reasons (switch, 11% [31/290]; no-switch, 24% [33/139]). No treatment-emergent resistance was observed in switch subjects with virologic failure. Discontinuation rates from adverse events were 3% in both groups (9/293, switch; 4/140, no-switch). Switching from PI + RTV + TVD to E/C/F/TDF was associated with significant improvements in patient-reported outcomes related to gastrointestinal symptoms (nausea and bloating). CONCLUSION E/C/F/TDF is a safe, effective long-term alternative to multi-tablet PI + RTV + TVD-based regimens in virologically suppressed, HIV-1-infected adults, and improves patient-reported gastrointestinal symptoms.
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Affiliation(s)
- Jose R Arribas
- a Hospital Universitario La Paz , IdiPAZ , Madrid , Spain
| | | | - Jan van Lunzen
- c Universitaetsklinikum Hamburg-Eppendorf , Hamburg , Germany
| | | | | | - William Towner
- f Southern California Kaiser Permanente Medical Group , Los Angeles CA , USA
| | | | - Mark Nelson
- h Chelsea and Westminster Hospital , London , UK
| | | | | | - Raji Swamy
- i Gilead Sciences, Inc., Foster City , CA , USA
| | | | - Thai Nguyen
- i Gilead Sciences, Inc., Foster City , CA , USA
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Maggiolo F, Gulminetti R, Pagnucco L, Digaetano M, Benatti S, Valenti D, Callegaro A, Ripamonti D, Mussini C. Lamivudine/dolutegravir dual therapy in HIV-infected, virologically suppressed patients. BMC Infect Dis 2017; 17:215. [PMID: 28302065 PMCID: PMC5356275 DOI: 10.1186/s12879-017-2311-2] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 03/08/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Little is known about the applicability of dual treatments based on integrase inhibitors. We explored the combination of lamivudine + dolutegravir as an option when switching from standard cART in virologically suppressed patients. METHODS In this prospective cohort we enrolled patients previously switched to 3TC + DTG who were 18 years or older, with no previous resistance mutations to the used drugs, having a HIV-RNA <50 copies/ml for 6 months or longer, negative for HBsAg and on a stable (>6 months) cART. RESULTS Ninety-four individuals were included. They were mostly men (77.7%) with a mean age of 53 years. They presented 159 co-morbidities including cardiovascular, bone, hepatic, kidney, and CNS diseases. Because of these pathologies, they took 207 non-ARV drugs (mean 2.2 per patient). Median duration of viral suppression was 77.5 months (IQR 61). All subjects were prospectively followed up to week 24 and all remained on dual therapy during the whole period. Neither virological failure, nor viral blip was detected. The median CD4 count rose from 658 cells/mcl (IQR 403) to 724 cells/mcl (IQR 401) (P = 0.006) without a significant (P = 0.44) change in the CD4/CD8 ratio. A significant (P < 0.0001) increment of median creatinine from 0.87 mg/dl (IQR 0.34) to 0.95 mg/dl (IQR 0.29) was observed in the first 2 months but thereafter leveled on these values (1.00 mg/dl; IQR 0.35) (P = 0.111 compared to 2 months). The lipid profile slightly improved. The daily cost of cART was significantly (P < 0.0001) reduced of 6.89 euros (SD 6.10). DISCUSSION Switching to a dual cART regimen based on lamivudine + dolutegravir maintains virological efficacy up to week 24, and is associated to slight improvements of the immunologic and metabolic status. The strategy allows to freely using concomitant medications for associated pathologies. The dual therapy is less expensive in economic terms. CONCLUSION Although still limited evidence exists, a dolutegravir-based dual therapy in combination with lamivudine shows promising results to be confirmed in larger controlled trials.
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Affiliation(s)
- Franco Maggiolo
- Division of Infectious Diseases, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | - Roberto Gulminetti
- Division of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Layla Pagnucco
- Division of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Simone Benatti
- Division of Infectious Diseases, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | - Daniela Valenti
- Division of Infectious Diseases, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | - Annapaola Callegaro
- Microbiology and Virology Laboratory, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Diego Ripamonti
- Division of Infectious Diseases, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | - Cristina Mussini
- Division of Infectious Diseases, University of Modena, Modena, Italy
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Devic M, Roscoe T. Seed maturation: Simplification of control networks in plants. Plant Sci 2016; 252:335-346. [PMID: 27717470 DOI: 10.1016/j.plantsci.2016.08.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 08/05/2016] [Accepted: 08/21/2016] [Indexed: 05/09/2023]
Abstract
Networks controlling developmental or metabolic processes in plants are often complex as a consequence of the duplication and specialisation of the regulatory genes as well as the numerous levels of transcriptional and post-transcriptional controls added during evolution. Networks serve to accommodate multicellular complexity and increase robustness to environmental changes. Mathematical simplification by regrouping genes or pathways in a limited number of hubs has facilitated the construction of models for complex traits. In a complementary approach, a biological simplification can be achieved by using genetic modification to understand the core and singular ancestral function of the network, which is likely to be more prevalent within the plant kingdom rather than specific to a species. With this viewpoint, we review examples of simplification successfully undertaken in yeast and other organisms. A strategy of progressive complementation of single, double and triple mutants of seed maturation confirmed the fundamental role of the AFL sub-family of B3 transcription factors as master regulators of seed maturation, illustrating that biological simplification of complex networks could be more widely applied in plants. Defining minimal control networks will facilitate evolutionary comparisons of regulatory processes and the identification of an essential gene set for synthetic biology.
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Affiliation(s)
- Martine Devic
- Régulations Epigénétiques et Développement de la Graine, ERL 3500 CNRS-IRD UMR DIADE, Centre IRD de Montpellier, 911 avenue Agropolis BP64501, 34394, Montpellier, France.
| | - Thomas Roscoe
- Régulations Epigénétiques et Développement de la Graine, ERL 3500 CNRS-IRD UMR DIADE, Centre IRD de Montpellier, 911 avenue Agropolis BP64501, 34394, Montpellier, France
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Abstract
Interest in simplification arises from the need to dispense with nucleoside analogs due to their long-term toxicity. Since the first trials analyzing the safety and effectiveness of the strategy with lopinavir/ritonavir (LPV/r) emerged more than 10 years ago, simplification continues to arouse scientific, clinical and economic interest. At present, there is no consensus on recommendations; interpretations of results are discordant: while some emphasize the greater risk of loss of virologic control, others indicate that the possible virological rebound with this strategy is unrelated to a loss of therapeutic options or to the emergence of resistance to ritonavir-boosted protease inhibitors. This scenario governs the recommendations that can be made in clinical practice; almost all groups agree that candidates should be selected for a simplification strategy with fewer drugs.
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Sallis A, Bunten A, Bonus A, James A, Chadborn T, Berry D. The effectiveness of an enhanced invitation letter on uptake of National Health Service Health Checks in primary care: a pragmatic quasi-randomised controlled trial. BMC Fam Pract 2016; 17:35. [PMID: 27009045 PMCID: PMC4806508 DOI: 10.1186/s12875-016-0426-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 02/29/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND The National Health Service Health Check (NHS HC) is a population level public health programme. It is a primary prevention initiative offering cardiovascular risk assessment and management for adults aged 40-74 years (every five years). It was designed to reduce the incidence of major vascular disease events by preventing or delaying the onset of diabetes, heart and kidney disease, stroke and vascular dementia . Effectiveness of the programme has been modelled on a national uptake of 75% however in 2012/13 uptake, nationally, was 49%. Ensuring a high percentage of those offered an NHS HC actually receive one is key to optimising the clinical and cost effectiveness of the programme. METHODS A pragmatic quasi-randomised controlled trial was conducted in four general practitioner practices in Medway, England with randomisation of 3511 patients. The aim was to compare attendance at the NHS HC using the standard national invitation template letter (control) compared to an enhanced invitation letter using insights from behavioural science (intervention). The intervention letter includes i) simplification - reducing letter content for less effortful processing ii) behavioural instruction - action focused language iii) personal salience - appointment due rather than invited and iv) addressing implementation intentions with a tear off slip to record the date, time and location of the appointment. Logistic Regression explored the association between control and intervention group and attendance at a health check. RESULTS 29.3% of patients who received the control letter and 33.5% of those who received the intervention letter attended their NHS HC (adjusted odds ratio 1.26, 95% confidence interval 1.09-1.47, p < 0.01). This was an absolute difference in uptake of 4.2 percentage points for those receiving the intervention letter. CONCLUSIONS An invitation letter applying behavioural insights was more effective than the existing national template letter at encouraging attendance at an NHS HC. Making small, no cost behaviourally informed changes to letter invitations can improve uptake of the NHS HC. Further research is required to replicate the effect with more robust methodology and powered for sub-group analysis including socio-economic status. TRIAL REGISTRATION Current Controlled Trials ISRCTN66757664 , date of registration 28/3/2014.
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Affiliation(s)
- Anna Sallis
- Public Health England, 2nd Floor Skipton house, 80 London Road, London, SE1 6LH, UK.
| | - Amanda Bunten
- Public Health England, 2nd Floor Skipton house, 80 London Road, London, SE1 6LH, UK
| | - Annabelle Bonus
- Department of Health, 5th Floor Richmond House, 79 Whitehall, London, SW1A 2NS, UK
| | - Andrew James
- Department of Health, 5th Floor Richmond House, 79 Whitehall, London, SW1A 2NS, UK
| | - Tim Chadborn
- Public Health England, 2nd Floor Skipton house, 80 London Road, London, SE1 6LH, UK
| | - Daniel Berry
- Department of Health, 5th Floor Richmond House, 79 Whitehall, London, SW1A 2NS, UK
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Sarendranath A, Khan R, Tovar N, Marin C, Yoo D, Redisch J, Jimbo R, Coelho PG. Effect of low speed drilling on osseointegration using simplified drilling procedures. Br J Oral Maxillofac Surg 2015; 53:550-6. [PMID: 25921363 DOI: 10.1016/j.bjoms.2015.03.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 07/28/2014] [Accepted: 03/19/2015] [Indexed: 11/18/2022]
Abstract
Our aim was to find out whether simplified drilling protocols would provide biological responses comparable to those of conventional drilling protocols at the low rotational speed of 400rpm. Seventy-eight root form endosseous implants with diameters of 3.75, 4.2, and 5mm were placed into canine tibias and allowed to heal for 3 and 5 weeks. After the dogs had been killed, the samples of implanted bone were retrieved and processed for non-decalcified histological sectioning. Bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO) analyses were made on the histological sections. Implants treated by the simplified protocol resulted in BIC and BAFO values comparable to those obtained with the conventional drilling protocol, and there were no significant differences in the technique or diameter of the drilling. The results suggest that the simplified procedure gives biological outcomes comparable to those of the conventional procedure.
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Affiliation(s)
- A Sarendranath
- Department of Biomedical Engineering, The City College of New York, New York, NY, United States; Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY, United States
| | - R Khan
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY, United States
| | - N Tovar
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY, United States
| | - C Marin
- Department of Dentistry, Division of Oral and Maxillofacial Surgery, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - D Yoo
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY, United States
| | - J Redisch
- Department of Biomedical Engineering, The City College of New York, New York, NY, United States; Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY, United States
| | - R Jimbo
- Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden.
| | - P G Coelho
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY, United States; Department of Periodontology and Implant Dentistry, New York University College of Dentistry, New York, NY, United States
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Abstract
Antiretroviral simplification is a useful strategy to improve adherence and quality of life and prevent or reverse adverse effects in patients with HIV infection. The availability of new drugs with high efficacy and better tolerability in once-daily formulations or in fixed-dose combinations may be a better option for prolonged treatment. Rilpivirine, a new nonnucleoside reverse transcriptase inhibitor (NNRTI), has shown high antiviral efficacy in clinical trials with treatment-naïve patients, with a lower incidence of adverse effects and good tolerability. Its use in simplification regimens has been evaluated after the switch from efavirenz, demonstrating that dose adjustment is not required. In a large randomized study in patients who were receiving protease inhibitors, virological efficacy was maintained, with a lower incidence of adverse effects and improved lipid parameters and cardiovascular risk score. Given the ease of administration and good tolerability of this drug, recent communications at congresses have shown the rapid applicability of the results of studies in daily clinical practice in this scenario.
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Affiliation(s)
- José L Casado
- Departamento de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, España.
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Casado JL, Bañón S, Rodriguez MA, Moreno A, Moreno S. Efficacy and pharmacokinetics of the combination of etravirine plus raltegravir as novel dual antiretroviral maintenance regimen in HIV-infected patients. Antiviral Res 2014; 113:103-6. [PMID: 25460844 DOI: 10.1016/j.antiviral.2014.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 10/07/2014] [Revised: 11/15/2014] [Accepted: 11/17/2014] [Indexed: 10/24/2022]
Abstract
Novel combination antiretroviral regimens may be needed for selected HIV-infected patients with toxicity or resistance. We evaluated prospectively 25 virologically suppressed patients, largely pretreated (15.6 years on therapy) with antiretroviral drug toxicity (n=19) or interactions (n=9, mainly with chemotherapy against non-Hodgkin lymphoma or anti-HCV therapy), who switched to a dual therapy with etravirine (ETR) plus raltegravir (RAL). Patients were required not to have prior virological failure or resistance to both drugs. After a median follow up of 722 days (473-1088: 53.3 patients-year), there were no cases of transient virological replication or failure. Only 1 patient left therapy at day 10 due to a grade 2 rash, and therefore efficacy by intent-to-treat analysis was 96% at 48 weeks. There were no cases of liver toxicity grade 3-4, and total cholesterol (TC) and triglycerides (TG) levels decrease significantly after initiation (TC, -17 mg/dl; p=0.01; TG, -42 mg/dl; p=0.01), as well as the TC/High density lipoprotein-cholesterol ratio (from 4.35 to 4.28). Geometric mean plasma trough level of RAL was 166 ng/ml (IQR, 40-249), well above the inhibitory concentration 90 (IC(90)). In conclusion, a novel dual therapy with ETR plus RAL is effective and well tolerated, and it could be an option to maintain durable viral suppression in hard-to-treat HIV-infected patients.
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Affiliation(s)
- José L Casado
- Department of Infectious Diseases, Ramón y Cajal Hospital, Madrid, Spain.
| | - Sara Bañón
- Department of Infectious Diseases, Ramón y Cajal Hospital, Madrid, Spain
| | | | - Ana Moreno
- Department of Infectious Diseases, Ramón y Cajal Hospital, Madrid, Spain
| | - Santiago Moreno
- Department of Infectious Diseases, Ramón y Cajal Hospital, Madrid, Spain
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Ford N, Swan T, Beyer P, Hirnschall G, Easterbrook P, Wiktor S. Simplification of antiviral hepatitis C virus therapy to support expanded access in resource-limited settings. J Hepatol 2014; 61:S132-8. [PMID: 25443341 DOI: 10.1016/j.jhep.2014.09.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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: 05/29/2014] [Revised: 09/16/2014] [Accepted: 09/16/2014] [Indexed: 02/07/2023]
Abstract
Currently, access to treatment for HCV is limited, with treatment rates lowest in the more resource-limited countries, including those countries with the highest prevalence. The use of oral DAAs has the potential to provide treatment at scale by offering opportunities to simplify drug regimens, laboratory requirements, and service delivery models. Key desirable characteristics of future HCV treatment regimens include high efficacy, tolerability, pan-genotype activity, short treatment duration, oral therapy, affordability, and availability as fixed-dose combination. Using such a regimen, HCV treatment delivery could be greatly simplified. Treatment could be initiated following confirmation of the presence of viraemia, with an initial assessment of the stage of liver disease. A combination DAA therapy that is safe and effective across genotypes could remove the need for genotyping and intermediary viral load assessments for response-guided therapy and reduce the need for adverse event monitoring. Simpler, safer, shorter therapy will also facilitate simplified service delivery, including task shifting, decentralization, and integration of treatment and care. The opportunity to scale up HCV treatment using such delivery approaches will depend on efforts needed to guarantee that the new DAAs are affordable in low-income settings. This will require the engagement of all stakeholders, ranging from the companies developing these new treatments, WHO and other international organizations, including procurement and funding mechanisms, governments and civil society.
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Affiliation(s)
- Nathan Ford
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | | | - Peter Beyer
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
| | | | | | - Stefan Wiktor
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland.
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Kim SM, Jun JK. Simplified protocol of nuchal translucency measurement: Is it still effective? Obstet Gynecol Sci 2013; 56:307-11. [PMID: 24328020 DOI: 10.5468/ogs.2013.56.5.307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 04/19/2013] [Accepted: 05/16/2013] [Indexed: 11/20/2022] Open
Abstract
Objective Nuchal translucency (NT) is the most powerful screening tool for Down syndrome and congenital cardiac anomaly, therefore strict guidelines were established to get accurate NT values. However, to stick to the guideline in all pregnant women is time-consuming and superfluous in majority of low risk population. We undertook this study to investigate whether the simplified protocol enables to select low risk group and is effective in them even if we skip the suggested NT measurement. Methods NT and crown-rump length (CRL) were measured prospectively. First, CRL was measured in the ordinary view that was mid-sagittal section of fetus in neutral position, and NT was measured at the same frozen screen (first measured value, 1MV). Then, NT was measured again according to the Fetal Medicine Foundation (FMF) guideline (second measured value, 2MV). Results There was good correlation between 1MV and 2MV in each case (r = 0.83, P < 0.001). All of the NT values over the 95th percentile in 2MV also belonged to over the 95th percentile in 1MV. NT value of 2 mm in 1MV could be used as a cut-off to obtain over the 95th percentile 2MV by receiver operating characteristic curve (sensitivity 100%, specificity 80.5%). The proportion of 1MV ≥ 2 mm was only 23.8% of all cases, namely we had only to measure 2MV in 23.8% patients. Every 95th percentile or more 2MV could be detected with this simplified protocol. Conclusion If NT is less than 2 mm at ordinary CRL view, we may skip suggested NT measurement according to FMF guideline.
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Loewenstein G, Friedman JY, McGill B, Ahmad S, Linck S, Sinkula S, Beshears J, Choi JJ, Kolstad J, Laibson D, Madrian BC, List JA, Volpp KG. Consumers' misunderstanding of health insurance. J Health Econ 2013; 32:850-862. [PMID: 23872676 DOI: 10.1016/j.jhealeco.2013.04.004] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 04/08/2013] [Accepted: 04/19/2013] [Indexed: 06/02/2023]
Abstract
We report results from two surveys of representative samples of Americans with private health insurance. The first examines how well Americans understand, and believe they understand, traditional health insurance coverage. The second examines whether those insured under a simplified all-copay insurance plan will be more likely to engage in cost-reducing behaviors relative to those insured under a traditional plan with deductibles and coinsurance, and measures consumer preferences between the two plans. The surveys provide strong evidence that consumers do not understand traditional plans and would better understand a simplified plan, but weaker evidence that a simplified plan would have strong appeal to consumers or change their healthcare choices.
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Affiliation(s)
- George Loewenstein
- Carnegie Mellon University, Social and Decision Sciences, 5000 Forbes Avenue, 319 C Porter Hall, Pittsburgh, PA 15213, United States.
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