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Mannose-coupled AAV2: A second-generation AAV vector for increased retinal gene therapy efficiency. Mol Ther Methods Clin Dev 2024; 32:101187. [PMID: 38327809 PMCID: PMC10847035 DOI: 10.1016/j.omtm.2024.101187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/12/2024] [Indexed: 02/09/2024]
Abstract
Inherited retinal diseases are a leading and untreatable cause of blindness and are therefore candidate diseases for gene therapy. Recombinant vectors derived from adeno-associated virus (rAAV) are currently the most promising vehicles for in vivo therapeutic gene delivery to the retina. However, there is a need for novel AAV-based vectors with greater efficacy for ophthalmic applications, as underscored by recent reports of dose-related inflammatory responses in clinical trials of rAAV-based ocular gene therapies. Improved therapeutic efficacy of vectors would allow for decreases in the dose delivered, with consequent reductions in inflammatory reactions. Here, we describe the development of new rAAV vectors using bioconjugation chemistry to modify the rAAV capsid, thereby improving the therapeutic index. Covalent coupling of a mannose ligand, via the formation of a thiourea bond, to the amino groups of the rAAV capsid significantly increases vector transduction efficiency of both rat and nonhuman primate retinas. These optimized rAAV vectors have important implications for the treatment of a wide range of retinal diseases.
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1381P A transcriptomic signature of AR activity prognosticates development of castration-resistance following metastasis-directed therapy in oligometastatic castration-sensitive prostate cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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POS0423 CYCLIC CITRULLINATED PEPTIDE APTAMER TREATMENT ATTENUATES COLLAGEN INDUCED ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundAnti-citrullinated peptide antibodies (ACPA) appear 10–15 years before the diagnosis of rheumatoid arthritis (RA) and are associated with a more severe disease course. In previous work, we rationally designed and screened ACPA-binding peptide aptamer sequences in silico and constructed a nanoparticle with chitosan and hyaluronic acid(1). A developmental stage version of this nanoparticle was able to reduce disease activity in the collagen-induced arthritis (CIA) and the serum transfer arthritis mouse models (2).ObjectivesHere, we investigated the effect and potential toxicity of three different versions of the aptamer nanoparticle (loading of 20%, 10% and 5% aptamer, respectively) in the CIA rat model.MethodsWistar rats (males and females) were given a single intravenous dose (100 mg/kilo) of type II collagen in PBS in the tail vein. The dosing was repeated three times with one day interval, followed by blood sample collection at day 7 after the initial collagen injection. To evaluate route of administration and dosing, we injected a single intravenous and subcutaneous dose (2.5 mg/kg) of aptamer-nanoparticles (A/N ratio 20%) in PBS in the tail vein/abdomen, and plasma concentration−time profiles were followed for 2 days after dosing with weekly blood sampling. To evaluate organ uptake, rats were given a single intravenous and subcutaneous dose (2.5 mg/kg) of aptamer-nanoparticles (A/N ratio 20%) in PBS in the tail vein/abdomen. The procedure was repeated after 24 hours. Blood and urine samples were taken once a week. A group of 10 animals was sacrificed every week over a three-week period, and the organs were processed. To examine efficacy, rats were given a single subcutaneous dose (2.5 mg/kilo) of aptamer-nanoparticles and nanoparticle controls without aptamer or PBS alone in the abdomen. The procedure was repeated once a week over a course of three weeks. Weight, joint measurement, blood, and urine samples were taken once a week. Paw swelling was measured on a weekly basis. In the plasma samples we measured CPEP2 and anti-collagen II by enzyme linked immunosorbent assay (ELISA).ResultsUsing a rather high dose of collagen (100 mg/kilo) via an intravenous administration route, ACPA was measurable in all CIA rats with rapid development of RA in 82% of the included animals. Intravenous administration resulted in an immediate high plasma concentration post injection, which decreased rapidly to low levels. The s.c. administration route gave a steady, long-term aptamer release with a maximum availability 8 hours post-injection. After three aptamer-nanoparticle doses (2.5 mg/kg; either 20%, 10% or 5% aptamer), we observed a dose-dependent reduction in swollen joint count for the aptamer-nanoparticle treated groups (10 rats in each group) compared with the healthy control group (10 rats) (P-value = 2,1E-6). We observed decreased ACPA IgG levels in the rats treated with aptamer-nanoparticle. The decrease in ACPA levels correlated with the aptamer-nanoparticle having higher loading. Anti-collagen II IgG levels slightly increased towards the end of the study.ConclusionWe developed and tested a novel peptide aptamer-based drug candidate for seropositive rheumatoid arthritis in CIA rats. Over a 3-week course of treatment with subcutaneous administration of aptamer-nanoparticles, joint swelling was decreased during treatment, and completely reversed at the end of the observation period. The reduction of joint swelling was associated with decreased levels of ACPA in the blood.References[1]Khatri S, Hansen J, Mendes AC, et al. Citrullinated Peptide Epitope Targets Therapeutic Nanoparticles to Human Neutrophils. Bioconjug Chem. 2019;30(10):2584-2593. doi:10.1021/acs.bioconjchem.9b00518[2]Khatri S, Hansen J, Clausen MH, et al. LB0002 A FIRST IN CLASS THERAPEUTIC NANOPARTICLE FOR SPECIFIC TARGETING OF ANTI-CITRULLINATED PROTEIN ANTIBODY AMELIORATES SERUM TRANSFER AND COLLAGEN INDUCED ARTHRITIS. Annals of the Rheumatic Diseases 2020;79:212.Disclosure of InterestsSangita Khatri: None declared, Jonas Hansen: None declared, Nadia Pedersen: None declared, Sanne Gram-Nielsen: None declared, Ana Mendes: None declared, Ioannis Chronakis: None declared, Ulrik Keiding: None declared, Bence Réthi: None declared, Mads Hartvig Clausen Shareholder of: affiliated with IBIO TECH ApS, Tue Wenzel Kragstrup Shareholder of: affiliated with IBIO TECH ApS, Speakers bureau: TWK received speaking fees from Pfizer, Bristol-Myers Squibb, Eli Lilly, Novartis, UCB, and Abbvie., Consultant of: Consultancy fees from Bristol-Myers Squibb and Gilead, Grant/research support from: Received research grant from Gilead, Kira Astakhova Shareholder of: KA is affiliated with iBio tech.
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Monitoring non-small cell lung cancer progression and treatment response through hyaluronic acid in sputum. Braz J Med Biol Res 2022; 55:e11513. [PMID: 35320334 PMCID: PMC8851905 DOI: 10.1590/1414-431x2021e11513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/04/2021] [Indexed: 11/22/2022] Open
Abstract
We evaluated whether hyaluronan (HA) levels in the sputum could be used as a
noninvasive tool to predict progressive disease and treatment response, as
detected in a computed tomography scan in non-small cell lung cancer (NSCLC)
patients. Sputum samples were collected from 84 patients with histological
confirmation of NSCLC, 33 of which were in early-stage and 51 in advanced-stage
disease. Patients received systemic chemotherapy (CT) after surgery (n=36),
combined CT and immunotherapy (IO) (n=15), or targeted therapy for driver
mutation and disease relapse (N=4). The primary end-point was to compare sputum
HA levels in two different concentrations of hypertonic saline solution with
overall survival (OS) and the secondary and exploratory end-points were
radiologic responses to treatment and patient outcome. Higher concentrations of
HA in the sputum were significantly associated to factors related to tumor
stage, phenotype, response to treatment, and outcome. In the early stage,
patients with lower sputum HA levels before treatment achieved a complete tumor
response after systemic CT with better progression-free survival (PFS) than
those with high HA levels. We also examined the importance of the sputum HA
concentration and tumor response in the 51 patients who developed metastatic
disease and received CT+IO. Patients with low levels of sputum HA showed a
complete tumor response in the computed tomography scan and stable disease after
CT+IO treatment, as well as a better PFS than those receiving CT alone. HA
levels in sputum of NSCLC patients may serve as a candidate biomarker to detect
progressive disease and monitor treatment response in computed tomography
scans.
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Emerging Prognostic Groups Across the Spectrum of Metastatic Castration-Sensitive Prostate Cancer: Disease Outcomes and Genomics. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Patient-level costs in intensive care: a case report of a standardized and scalable approach. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Intensive care units (ICU) costs account to up to 30% of hospital budgets. Nevertheless, determination of their costs is complex and without agreed methodology, specially when considering patient-level costs (Value-Based Healthcare).
Methods
Case report of a costing methodology implementation, in a 15-bed ICU, in a public, teaching hospital at Teresina/Piauí-Brazil (as part of a broader initiative, with 10 hospitals from all Brazilian regions). All costs incurred during ICU stay were measured from the hospital perspective, applying absorption costing method, by using a standardized approach and a specific central IT system. The study was carried out from Oct/19-Sep/20, including 613 patients, and a team of 10 researchers working with 4 teams of the local hospital (costs, IT, ICU and managers).
Results
ICU fixed costs (personnel, overheads, energy/water, depreciation, non-tracked drugs/medical materials), were divided by service capacity (total bed-hours) for calculation of the costs/minute. Costs were then allocated in the patient level multiplying costs/minute by the ICU length of stay. Variable costs (lab/image tests, transfusions, hemodialysis, and traceable medical materials/drugs) were directly allocated, multiplying the unit cost by the volume consumed per patient. A mini-survey applied 1-year after showed that both cost researchers and hospital staff agreed on the main challenges in measuring patient-level costs (fragmented process; fixed costs available only at the hospital level; lack of control on cost-drivers; indirect costs not considered; any reference for lab/image costs) and that the approach was sufficient to overcome them. The local team also reported increased awareness about the importance of patient-level costs after the experience.
Conclusions
The proposed costing approach allowed the assessment of estimated total costs of each ICU admission. We believe this model can be easily and quickly replicated in other similar scenarios.
Key messages
ICU costs account to up to 30% of hospital budgets. Nevertheless, determination of their costs is complex and without agreed methodology, specially when considering patient-level costs. The proposed costing approach allowed the assessment of estimated total costs of each ICU admission. We believe this model can be easily and quickly replicated in other similar scenarios.
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Encephalitis in non-small-cell lung cancer. Pulmonology 2021; 27:582-583. [PMID: 34429276 DOI: 10.1016/j.pulmoe.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022] Open
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P-190 Exploring possible predictors of survival in hepatocellular carcinoma. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Mepolizumab for severe eosinophilic asthma - A one-year real life Portuguese study. Pulmonology 2021; 27:579-581. [PMID: 34219042 DOI: 10.1016/j.pulmoe.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022] Open
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[International Consensus on Antinuclear Antibody Patterns in Portugal]. ACTA MEDICA PORT 2021; 34:347-354. [PMID: 34253282 DOI: 10.20344/amp.13121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/17/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Screening for autoantibodies in HEp-2 cells by indirect immunofluorescence is currently accepted as the gold-standard test for the diagnosis of systemic autoimmune diseases. The main objective of the International Consensus on ANA Patterns is to achieve a consensus on the nomenclature and description of antinuclear antibody morphological patterns. This work aims to build on the International Consensus on ANA Patterns project to establish a nomenclature consensus in Portugal, thus contributing to harmonization in autoimmune diagnosis and promoting diagnostic quality in autoimmune systemic rheumatic diseases. MATERIAL AND METHODS Participating laboratories identified all the nuclear and cytoplasmic pattern designations in the International Consensus on ANA Patterns (including the anti-cell pattern code), and matched them with the corresponding Portuguese nomenclature in use. The results were aggregated and used as a foundation for nomenclature harmonization work. Consensus meetings followed an iterative process, until a final consensual proposal was drafted. RESULTS Prior agreement between laboratories was over 75% for 23 of the total 29 anti-cell patterns. The degree to which each laboratory is aligned with the International Consensus on ANA Patterns international reference ranges from 22.1% to 100%. It was possible to write a consensual version of the International Consensus on ANA Patterns nomenclature for Portugal. DISCUSSION There was a good consensus basis for the nomenclature in the International Consensus on ANA Patterns, despite relevant differences with some translations. The study highlights the need for collaboration among laboratories towards an unambiguous description of laboratory results. CONCLUSION This study shows that there is good potential for collaboration between laboratories in order to produce the consensus needed to improve diagnosis and patient follow-up.
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Decidual NK cell-derived conditioned medium from miscarriages affects endometrial stromal cell decidualisation: endocannabinoid anandamide and tumour necrosis factor-α crosstalk. Hum Reprod 2021; 35:265-274. [PMID: 31990346 DOI: 10.1093/humrep/dez260] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/04/2019] [Accepted: 11/11/2019] [Indexed: 12/15/2022] Open
Abstract
STUDY QUESTION What are the effects of endocannabinoid anandamide (AEA) in uterine natural killer (unK) cells from miscarriage decidua, regarding their cytokine profile and endometrial stromal cell (ESC) crosstalk? SUMMARY ANSWER uNK-conditioned media from miscarriage samples present high TNF-α levels which inhibit ESC decidualisation. WHAT IS KNOWN ALREADY AEA plasma levels are higher in women who have suffered a miscarriage. Moreover, AEA inhibits ESC proliferation and differentiation, although the levels and impact on the uNK cell cytokine profile at the feto-maternal interface remain elusive. STUDY DESIGN, SIZE, DURATION This laboratory-based study used human primary uNK cells which were isolated from first-trimester decidua (gestational age, 5-12 weeks) derived from 8 women with elective pregnancy termination and 18 women who suffered a miscarriage. PARTICIPANTS/MATERIALS, SETTING, METHODS The first-trimester placental tissues were assayed for AEA levels by UPLC-MS/MS and respective enzymatic profile by western blot. The uNK cells were isolated and maintained in culture. The expression of angiogenic markers in uNK cells was examined by quantitative PCR (qPCR). The uNK-conditioned medium was analysed for IFN-γ, TNF-α and IL-10 production by enzyme-linked immunosorbent assay, and the impact on ESC differentiation was assessed by measuring decidual markers Prl, Igfbp-1 and Fox01 mRNA expression using qPCR. MAIN RESULTS AND THE ROLE OF CHANCE AEA levels were higher in miscarriage decidua compared with decidua from elective terminations. The uNK cell-conditioned medium from the miscarriage samples exhibited high TNF-α levels and interfered with the decidualisation of ESCs. Exacerbated inflammation and elevated TNF-α levels at the feto-maternal interface may trigger AEA signalling pathways that, in turn, may impact decidualisation and the angiogenic ability of uNK cells. LARGE-SCALE DATA N/A. LIMITATIONS, REASONS FOR CAUTION Primary uNK cell responses are based on a simple in vitro model. Thus, in complex microenvironments, such as the feto-maternal interface, the mechanisms may not be exactly the same. Also, the inflammatory events of miscarriage that, in this study, have happened prior to processing of the samples may cause different responses to that observed. In addition, the magnitude of the inflammatory response, required to trigger the AEA pathways that impact decidualisation and the uNK angiogenic ability in vivo, is still unclear. WIDER IMPLICATIONS OF THE FINDINGS The endocannabinoid AEA is a modulator of reproductive competence. AEA not only may contribute to neuroendocrine homeostasis but also can take part in uterine changes occurring during early pregnancy. STUDY FUNDING/COMPETING INTEREST(S) The work was supported by UID/MULTI/04378/2019 with funding from Fundação para a Ciência e a Tecnologia (FCT)/MCTES through national funds and PORTUGAL 2020 Partnership Agreement, NORTE-01-0145-FEDER-000024. S.C. Cunha acknowledges FCT for the IF/01616/2015 contract. There are no conflicts of interest.
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Asthma App Use and Interest Among Patients With Asthma: A Multicenter Study. J Investig Allergol Clin Immunol 2021; 30:137-140. [PMID: 32327403 DOI: 10.18176/jiaci.0456] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Data integration for infrastructure asset management in small to medium-sized water utilities. WATER SCIENCE AND TECHNOLOGY : A JOURNAL OF THE INTERNATIONAL ASSOCIATION ON WATER POLLUTION RESEARCH 2020; 82:2737-2744. [PMID: 33341766 DOI: 10.2166/wst.2020.377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Water utilities collect, store and manage vast data sets using many information systems (IS). For infrastructure asset management (IAM) planning those data need to be processed and transformed into information. However, information management efficiency often falls short of desired results. This happens particularly in municipalities where management is structured according to local government models. Along with the existing IS at the utilities' disposal, engineers and managers take their decisions based on information that is often incomplete, inaccurate or out-of-date. One of the main challenges faced by asset managers is integrating the several, often conflicting, sources of information available on the infrastructure, its condition and performance, and the various predictive analyses that can assist in prioritizing projects or interventions. This paper presents an overview of the IS used by Portuguese water utilities and discusses how data from different IS can be integrated in order to support IAM.
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Sex-specific association between vitamin D deficiency and COVID-19 mortality in older patients. Osteoporos Int 2020; 31:2495-2496. [PMID: 33048168 PMCID: PMC7552596 DOI: 10.1007/s00198-020-05677-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 10/07/2020] [Indexed: 01/28/2023]
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Initial Clinical Experience Treating Patients with Lung Cancer on a 6MV Flattening Filter Free O-Ring Linear Accelerator. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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When Failure is Final: Subsequent Outcomes of Patients with Stage I NSCLC who Fail Initial Stereotactic Body Radiation Therapy Monitored with Circulating Tumor Cells. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Prognostic value of kappa free light chains determination in first-ever multiple sclerosis relapse. J Neuroimmunol 2020; 347:577355. [PMID: 32795735 DOI: 10.1016/j.jneuroim.2020.577355] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/16/2020] [Accepted: 07/31/2020] [Indexed: 02/02/2023]
Abstract
Given its highly variable clinical course, an unmet need for objective prognostic assessment in Multiple Sclerosis (MS) persists. In this work, we suggest that CSF kappa free light chains (KFLC) determination at first relapse may provide insight into future disease activity and disability worsening. We quantified KFLC by nephelometry in paired CSF/serum samples of 28 patients, collected within one month of first-ever MS relapse, and explored correlations with clinical data on disease activity, retrospectively registered across a median follow-up time of 79 months. We documented KFLC ratio (CSF-FKLC/Serum-KFLC) as an independent predictor of second relapse occurrence and disability worsening at follow-up, in this cohort.
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Clearance and persistence of SARS-CoV-2 RNA in patients with COVID-19. J Med Virol 2020; 92:2227-2231. [PMID: 32484958 PMCID: PMC7301002 DOI: 10.1002/jmv.26103] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 01/08/2023]
Abstract
Patients with coronavirus disease‐2019 may be discharged based on clinical resolution of symptoms, and evidence for viral RNA clearance from the upper respiratory tract. Understanding the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) viral clearance profile is crucial to establish a re‐testing plan on discharge and ending isolation of patients. We aimed to evaluate the number of days that a patient needed to achieve undetectable levels of SARS‐CoV‐2 in upper respiratory tract specimens (nasopharyngeal swab and/or an oropharyngeal swab). The clearance and persistence of viral RNA was evaluated in two groups of positive patients: those who achieved two negative reverse transcription‐polymerase chain reaction (RT‐PCR) tests and those who kept testing positive. Patients were organized thereafter in two subgroups, mild illness patients discharged home and inpatients who had moderate to severe illness. Results from RT‐PCR tests were then correlated with results from the evaluation of the immune response. The study evidenced that most patients tested positive for more than 2 weeks and that persistence of viral RNA is not necessarily associated with severe disease but may result from a weaker immune response instead. Viral RNA was evaluated in two groups of patients: those who achieved two negative RT‐PCR tests and those who kept testing positive. Patients were organized thereafter in two subgroups, mild and moderate/severe illness patients. Most patients from either group tested positive for more than two weeks. Mild illness patients maintained viral RNA for a longer period of time and presented lower IgG titers than moderate/severe illness patients. We hypothesize that the exposition of mild illness patients to SARS‐CoV‐2 did not elicit an effective immune response, explaining the need of more time to viral RNA clearance.
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AB0983 LIPID METABOLISM AND DISEASE ACTIVITY IN JSLE PATIENTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Systemic lupus erythematosus (SLE) is an autoimmune systemic disease associated with premature atherosclerosis. Risk factors include dyslipoproteinemia, inflammation, oxidized low-density lipoprotein (LDL), hyperhomocysteinemia and antiphospholipid antibodies. Hyperlipidemic condition is being reported to promote the production of proinflammatory cytokines such as IL-1β, IL-6, and IL-27 and lowering blood lipid levels improves the disease. Oxidative stress is elevated, mainly due to mitochondrial dysfunction, further disrupting lipid metabolism. Some drugs also have an impact on lipid profile, such as chronic steroid use, which worsens LDL, HDL, and TG levels.Objectives:To assess the relationship between lipid profile and disease activity in juvenile SLE (jSLE) patients.Methods:Retrospective study of jSLE patients, fulfilling both 2012 and 2019 EULAR/ACR classification criteria for SLE. Juvenile-onset was defined as age at diagnosis <18 years. Demographics and clinical characteristics were collected. To evaluate the activity of jSLE, the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) was used. Statistical analysis was performed with SPSS®. Spearman’s rank non-parametric test or Pearson’s parametric test were used to assess the bivariate correlation for inflammatory and metabolic variables. P value <0.05 was considered significant for all the statistical tests.Results:35 patients were included, with current median (min-max) age of 22 (16-35) years, mean (SD) age of diagnosis of 15.8 (2.4) years; 91.4%female. Median ESR was 19 (2-75) mm/h, CRP 1.65 (0.1-9.6) mg/L, albumin 41.6 (16.7-46.3) g/L, proteinuria 0.2 (0-3) g/dL, leukocyturia 0 (0-1362.7)/uL, erythrocyturia 0 (0-501.9)/uL and anti-double stranded DNA 89.3 (10-800) U/mL. Mean C3 was 102.1 (21.6), C4 17.1 (7.4) mg/dL and creatinine 0.63 (0.1) mg/dL. Median SLEDAI was 2 (0-12). All were ANA positive, 40 % positive for antinucleossome antibodies, 25.7% anti-ribossomal P protein antibody, 11.4% anti-Sm, 8.6% autoantibodies againstβ2-glycoproteinI, 8.6% anti-cardiolipin, 14.3% lupus anticoagulant, 37.1% anti-SSA and 8.6% anti-SSB. Articular manifestations were present in 48.6%, mucocutaneous in 77.1%, haematological in 45.7%, lupus nephritis in 42.9%, serositis in 8.6% and pulmonary interstitial disease in 2.9%. Mean (SD) total cholesterol values (TC) was 165.5 (44.7) mg/dL and LDL 94.5 (29.9) mg/dL. Median high-density lipoprotein was 52 (28-92) and triglycerides (TG) 81.5 (41-253) mg/dL. Median daily prednisolone dose was 5 (0-40) mg. 88.6% were treated with hydroxychloroquine, 31.4% with mychophenolate mophetil and 14.3% with azathioprine. TC was negatively correlated with serum albumin (p=0.043, rho=-378) and positively with SLEDAI (p=0.032; rho= 0.392), proteinuria (p=0.009; rho= 0.469) and leukocyturia (p=0.031; rho= 0.394). A positive correlation was found between LDL and proteinuria (p=0.043; rho= 0.385) and between TG and CRP (p=0.001; rho= 0.575). TG were also positively correlated with prednisolone daily dose (p=0.035; rho= 0.394). Mean LDL was higher in anti-Sm positive patients (p=0.022). No differences were found regarding anti-phospholipids antibodies. Nephritic lupus patients had worse lipid metabolism, but this did not reach statistical significance.Conclusion:In out cohort, increased expression of TC, LDL and TGs is associated with disease activity in SLE. As expected, higher doses of prednisolone also correlated with lipid metabolism.References:[1]Machado D et al. Lipid profile among girls with systemic lupus erythematosus. Rheumatol Int. 2017 Jan;37(1):43-48Disclosure of Interests:None declared
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EP1.16-16 Pembrolizumab as First Therapeutic Line in Non-Small Cell Lung Cancer – The Experience of a Portuguese Tertiary Hospital. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.2381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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EP1.04-10 Nivolumab in Non-Small Cell Lung Cancer (NSCLC): A Real-Life Study. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.2140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pre-Treatment Circulating Tumor Cell Levels Correlate with Regional and Distant Failure Rates Following Stereotactic Body Radiation Therapy for Early Stage Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sleep disturbances in Parkinson's disease are associated with central parkinsonian pain. J Pain Res 2019; 12:2137-2144. [PMID: 31372031 PMCID: PMC6635894 DOI: 10.2147/jpr.s206182] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/17/2019] [Indexed: 12/21/2022] Open
Abstract
Introduction Sleep disturbances and pain are common non-motor symptoms in Parkinson’s disease (PD). This study aimed to explore the association between these two symptoms in a cohort of patients with PD. Materials and methods The Parkinson’s Disease Sleep Scale (PDSS-2) was used to identify sleep disturbances in a series of 229 PD patients. The identification and characterization of pain was performed by a semi-structured interview and by the application of the Ford classification and the Brief Pain Inventory (BPI). The Unified Parkinson’s Disease Rating Scale-III, Hoehn & Yahr (H&Y), and Schwab and England Independence Scale were used to assess motor symptoms and functional independence in off and on conditions. The Hospital Anxiety and Depression Scale (HADS) and SF-36 were applied to screen for anxiety and depression and to evaluate the quality of life. Non-parametric tests were used for group comparisons and logistic regressions were applied to explore predictors of sleep disturbances. Results Seventy-five (33%) patients had clinically relevant sleep disturbances (PDSS-2≥18) and 162 patients (71%) reported pain. Of those with pain, 38 (24%) had central parkinsonian pain. PD patients with sleep disturbances experienced more pain and had more severe motor symptoms, lower functional independence, more anxiety and depression symptoms, and worst quality of life. Among patients with pain, central parkinsonian pain was the subtype of pain with the highest odds of sleep disturbances, even when taking into account motor symptoms (H&Y off), motor fluctuations, intensity of pain (BPI), and symptoms of anxiety and depression (HADS). Conclusions The association between pain and sleep disturbances in PD appears to be dependent on subtype of pain. The close relationship between central parkinsonian pain and sleep disturbances in PD raises the possibility of common pathophysiological mechanisms. A better understanding of the relationship between sleep disturbances and central parkinsonian pain may contribute to the development of new care strategies in PD patients.
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Anti-centromere antibodies: What has changed in the last 10 years – Retrospective study. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Antinucleolar antibodies and KI-67 - A retrospective study on clinical significance. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Des connaissances, attitudes et pratiques à améliorer face au VIH à la frontière avec le Brésil. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Anti-SSA52 antibodies - A retrospective study on clinical significance from a tertiary hospital. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Omalizumab in chronic spontaneous and inducible urticaria: a 9 year retrospective study in Portugal. Eur Ann Allergy Clin Immunol 2018; 50:169-176. [DOI: 10.23822/eurannaci.1764-1489.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Design and optimization of a simulated moving bed unit for the separation of betulinic, oleanolic and ursolic acids mixtures: Experimental and modeling studies. Sep Purif Technol 2018. [DOI: 10.1016/j.seppur.2017.10.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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31
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Polysomnography versus level III sleep study in women. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Spectral sensitization of TiO 2 with electrodeposited PbSe: improvement of photocurrent stability and light conversion efficiency. Electrochim Acta 2017. [DOI: 10.1016/j.electacta.2017.08.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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ACUTE CARE UNITS FOR ALZHEIMER’S PATIENTS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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FREEDOM OF MOVEMENT: A MULTILEVEL INTERVENTION TO REDUCE PHYSICAL RESTRAINTS USE IN ACUTE CARE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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The Improvement of Mental Health Competences and Skills on a Brazilian Federal University. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.2238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BackgroundThe extension project “UNIRIO is madness: the improvement of mental health competences and skills.” work since 2015 with “Ponto de Cultura Loucura Suburbana” on the promotion of mental health and culture style in Brazil. The project work on the development of psychosocial rehabilitation for psychiatric patients, their families and the community.AimsParticipate on the production and execution on the artistic/therapeutic workshop that demystify the social stigmatizing vision about psychiatric patients.MethodsThe activities developed are: administrative actions; institutional strengthening for social inclusion initiative through work; and the Carnival Block organization.ResultsThis study work on constituting a social inclusion initiative through workshop that generate employment, e.g.: sale material production, financial management, material replacement. Although we do all the preparative to the Carnival Block–“Loucura Suburbana”.ConclusionThe relationship with the psychiatric patients shows that social inclusion through carnival workshop practice is the primary means for the identity of people suffering from mental disorders and contribute to reduce community social stigma.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Analysis of cancer outcomes after desensitization protocols in patients with metastatic disease. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw390.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Genetic diversity and drug resistance profiles of human immunodeficiency virus type 1 (HIV-1) strains infecting pregnant women in the Greater Lisbon. J Clin Virol 2016. [DOI: 10.1016/j.jcv.2016.08.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Preliminary study of the prevalence of hepatitis E virus infection in liver transplant recipients in Portugal. J Clin Virol 2016. [DOI: 10.1016/j.jcv.2016.08.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Electrochemical cell design for the impedance studies of chlorine evolution at DSA(®) anodes. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2016; 87:085113. [PMID: 27587166 DOI: 10.1063/1.4959097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A new electrochemical cell design suitable for the electrochemical impedance spectroscopy (EIS) studies of chlorine evolution on Dimensionally Stable Anodes (DSA(®)) has been developed. Despite being considered a powerful tool, EIS has rarely been used to study the kinetics of chlorine evolution at DSA anodes. Cell designs in the open literature are unsuitable for the EIS analysis at high DSA anode current densities for chlorine evolution because they allow gas accumulation at the electrode surface. Using the new cell, the impedance spectra of the DSA anode during chlorine evolution at high sodium chloride concentration (5 mol dm(-3) NaCl) and high current densities (up to 140 mA cm(-2)) were recorded. Additionally, polarization curves and voltammograms were obtained showing little or no noise. EIS and polarization curves evidence the role of the adsorption step in the chlorine evolution reaction, compatible with the Volmer-Heyrovsky and Volmer-Tafel mechanisms.
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The endocannabinoid 2-arachidonoylglycerol dysregulates the synthesis of proteins by the human syncytiotrophoblast. Biochim Biophys Acta Mol Cell Biol Lipids 2015; 1861:205-12. [PMID: 26698196 DOI: 10.1016/j.bbalip.2015.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 11/18/2015] [Accepted: 12/13/2015] [Indexed: 11/25/2022]
Abstract
In recent years, endocannabinoids emerged as new players in various reproductive events. Recently, we demonstrated the involvement of 2-arachidonoylglycerol (2-AG) in human cytotrophoblast apoptosis and syncytialization. However, 2-AG impact in hormone production by the syncytiotrophoblast (hST) was never studied. In this work, we demonstrate that 2-AG activates cannabinoid (CB) receptors, exerting an inhibitory action on cyclic AMP/protein kinase A (cAMP/PKA) and mitogen-activated protein kinase (MAPK) p38 pathways, and enhancing ERK 1/2 phosphorylation. Furthermore, 2-AG affects the synthesis of human chorionic gonadotropin (hCG), leptin, aromatase, 3-β-hydroxysteroid dehydrogenase (3-β-HSD), and placental protein 13 (PP13). These 2-AG effects are mediated by the activation of CB receptors, in a mechanism that may involve p38, ERK 1/2 and cAMP/PKA pathways, which participate in the regulation of placental proteins expression. To our knowledge, this is the first study that associates the endocannabinoid signalling and endocrine placental function, shedding light on a role for 2-AG in the complex network of molecules that orchestrate the production of placental proteins essential for the gestational success.
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[Practical approach of insomnia in the elderly]. REVUE MEDICALE SUISSE 2015; 11:2098-2103. [PMID: 26727729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Elderly people often suffer from insomnia which is responsible for high comorbidity and lower quality of life in this population. Somatic and psychiatric pathologies must be screened as primary sleep disorders. Chronic sleep disorders and benzodiazepine abuse might be avoided by an early treatment of causal factors. We wished to propose here a practical approach of the insomnia in the elderly going from the diagnosis to the treatment by advancing the not pharmacological approaches, while specifying at best the place of different drugs available and their limits.
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Dental Health and Mortality in People With End-Stage Kidney Disease Treated With Hemodialysis: A Multinational Cohort Study. Am J Kidney Dis 2015; 66:666-76. [DOI: 10.1053/j.ajkd.2015.04.051] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 04/29/2015] [Indexed: 01/28/2023]
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Abstract
The human syncytiotrophoblast (hST) has a major role in the production of important placental hormones. Several molecules regulate hST endocrine function but the role of endocannabinoids in this process is still unknown. Here, we report that the endocannabinoid anandamide (AEA) decreased cAMP levels, impaired human chorionic gonadotropin secretion, placental alkaline phosphatase activity and decreased aromatase mRNA levels and protein expression, through cannabinoid (CB) receptor activation. AEA also downregulated leptin and placental protein 13 transcription, though via a CB receptor-independent mechanism. All this evidence suggests AEA is a novel modulator of hormone synthesis by the syncytiotrophoblast, supporting the importance of the endocannabinoid signalling in placental function.
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Productive performance and carcass traits of Nellore x Aberdeen Angus and Nellore x Red Angus heifers under tropical conditions. REV COLOMB CIENC PEC 2015. [DOI: 10.17533/udea.rccp.v28n3a5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Tissue hyaluronan expression, as reflected in the sputum of lung cancer patients, is an indicator of malignancy. ACTA ACUST UNITED AC 2015; 48:557-67. [PMID: 25992645 PMCID: PMC4470316 DOI: 10.1590/1414-431x20144300] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 11/17/2014] [Indexed: 02/05/2023]
Abstract
Hyaluronan (HA) shows promise for detecting cancerous change in pleural effusion and
urine. However, there is uncertainty about the localization of HA in tumor tissue and
its relationship with different histological types and other components of the
extracellular matrix, such as angiogenesis. We evaluated the association between HA
and degree of malignancy through expression in lung tumor tissue and sputum. Tumoral
tissue had significantly increased HA compared to normal tissue. Strong HA staining
intensity associated with cancer cells was significant in squamous cell carcinoma
compared to adenocarcinoma and large cell carcinoma. A significant direct association
was found between tumors with a high percentage of HA and MVD (microvessel density)
in tumoral stroma. Similarly significant was the direct association between N1 tumors
and high levels of HA in cancer cells. Cox multivariate analysis showed significant
association between better survival and low HA. HA increased in sputum from lung
cancer patients compared to cancer-free and healthy volunteers and a significant
correlation was found between HA in sputum and HA in cancer tissue. Localization of
HA in tumor tissue was related to malignancy and reflected in sputum, making this an
emerging factor for an important diagnostic procedure in patients suspected to have
lung cancer. Further study in additional patients in a randomized prospective trial
is required to finalize these results and to validate our quantitative assessment of
HA, as well as to couple it to gold standard sputum cytology.
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Rheumatology telephone advice line - experience of a Portuguese department. ACTA REUMATOLOGICA PORTUGUESA 2015; 40:163-168. [PMID: 25340843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Telephone helplines for patients are tool for information and advice. They can contribute to patient's satisfaction with care and to the effectiveness and safety of treatments. In order to achieve this, they need to be adequately adapted to the target populations, as to incorporate their abilities and expectations. AIMS a) Evaluate the adherence of patients to a telephone helpline managed by nurses in a Portuguese Rheumatology Department, b) Analyse the profile of users and their major needs, c) Analyse the management of calls by the nurses. MATERIAL/METHODS The target population of this phone service are the patients treated at Day Care Hospital and Early Arthritis Clinic of our department. Nurses answered phone calls immediately between 8am and 4pm of working days. In the remaining hours messages were recorded on voice mail and answered as soon as possible. Details of the calls were registered in a dedicated sheet and patients were requested permission to use data to improve the service, with respect for their rights of confidentiality, anonymity and freedom of decision. RESULTS In 18 months 173 calls were made by 79 patients, with a mean age of 47.9 years (sd=9.13). Considering the proportions of men and women in the target population, it was found that men called more frequently (M= 32.7% vs F= 20.4%, p=.016). The reasons for these calls can be divided into three categories: instrumental help, such as the request for results of complementary tests or rescheduling appointments (43.9% of calls); counselling on side effects or worsening of the disease/pain (31.2 %); counselling on therapy management (24.9%). Neither sex nor patient age were significantly related to these reasons for calling. Nurses resolved autonomously half (50.3%) of the calls and in 79.8% of the cases there was no need for patient referral to other health services. CONCLUSIONS About a quarter of patients adhered to the telephone helpline.. Patients called to obtain support in the management of disease and therapy or to report side effects and/or symptom aggravation in addition to reasonable instrumental reasons. This suggests that this service may provide important health gains, in addition to comfort for the patient.
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Longitudinal study of the expression of FcεRI and IgE on basophils and dendritic cells in association with basophil function in two patients with severe allergic asthma treated with Omalizumab. Eur Ann Allergy Clin Immunol 2015; 47:38-40. [PMID: 25781192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Severe asthma is a challenging disease, and omalizumab has been an important tool to help clinicians address more efficiently this problem. Besides reduction of free and total serum IgE levels, there are a number of other immunologic effects of omalizumab that may be of relevance in its therapeutic action. We report two mite-allergic severe asthmatic patients successfully treated with omalizumab for one year. Clinically, patients improved gradually, with no further need for systemic steroids or emergency department visits during that treatment period, and with Asthma Control Test (ACT) scores showing controlled disease, although pulmonary function didn't show any significant improvement. Immunologically, we observed marked down-regulation of surface IgE and FcεRI on basophils, plasmacytoid and myeloid dendritic cells, as well as a reduction of basophil activation after specific allergen stimulation. These effects were clearly evident immediately after one month but were enhanced at 3, 6 and 12 months of omalizumab treatment, suggesting an advantage to continuing this therapy, and raising the hypothesis of some markers being useful to assess immunological responses to omalizumab, which could assist in the clinician's decision to stop or to restart this treatment.
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Long-term efficacy of omalizumab in seven patients with treatment-resistant chronic spontaneous urticaria. Allergol Immunopathol (Madr) 2015; 43:168-73. [PMID: 24731771 DOI: 10.1016/j.aller.2013.11.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 11/06/2013] [Accepted: 11/14/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Monoclonal anti-IgE antibody omalizumab is a promising therapeutic option in patients with chronic urticaria (CU) resistant to non-sedating H1-antihistamines (nsAH). However, data about its long-term efficacy and safety are still scant. OBJECTIVE We retrospectively analysed the clinical course of patients with severe recalcitrant CU that were treated in our department with omalizumab for a period greater than 24 months. METHODS AND PATIENTS Seven patients (six females, median 43 years) treated for a median of 35 months have been evaluated. Before treatment, all suffered from persistent symptoms despite receiving high doses of nsAH [4×/day], leukotriene antagonists and prednisolone (10-30 mg/day for a median duration of 48 months). Response to treatment was assessed using urticaria activity score (UAS) and a combined symptom/medication score. RESULTS There was a complete remission of disease in four patients after the first dose of omalizumab. Before the 5th administration, all patients had a UAS of 0. We found a significant improvement in UAS between pre-treatment and first dose (p=0.017) and a gradual decrease in the symptom/medication score over the course of the first five administrations. Tapering of prednisolone was possible in all patients. Administration intervals were gradually increased, although all experienced resurgence of symptoms in cycles greater than six weeks. There were no reported adverse reactions attributable to the drug. CONCLUSION Omalizumab was a safe and effective corticosteroid alternative for maintaining long-term remission of symptoms in these patients. Treatment intervals required individual patient-by-patient determination. The drug did not seem to alter the natural history of the disease.
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