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Pace of Aging in older adults matters for healthspan and lifespan. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.25.24306359. [PMID: 38712264 PMCID: PMC11071564 DOI: 10.1101/2024.04.25.24306359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
As societies age, policy makers need tools to understand how demographic aging will affect population health and to develop programs to increase healthspan. The current metrics used for policy analysis do not distinguish differences caused by early-life factors, such as prenatal care and nutrition, from those caused by ongoing changes in people's bodies due to aging. Here we introduce an adapted Pace of Aging method designed to quantify differences between individuals and populations in the speed of aging-related health declines. The adapted Pace of Aging method, implemented in data from N=13,626 older adults in the US Health and Retirement Study, integrates longitudinal data on blood biomarkers, physical measurements, and functional tests. It reveals stark differences in rates of aging between population subgroups and demonstrates strong and consistent prospective associations with incident morbidity, disability, and mortality. Pace of Aging can advance the population science of healthy longevity.
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Mutational Landscape of ER Receptor Negative Endometrial Cancer Patients Categorized as No Specific Molecular Profile (NSMP). Int J Radiat Oncol Biol Phys 2023; 117:S9-S10. [PMID: 37784600 DOI: 10.1016/j.ijrobp.2023.06.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The endometrial cancer (EC) molecular classification introduced by The Cancer Genome Atlas (TCGA) has initiated molecular-based classification with clear prognostic value. Four major tumor subtypes exist: 1) TP53 mutation (p53abn); 2) POLE mutation (POLEmut); 3) mismatch repair protein deficient (MMRd); and 4) no specific molecular profile (NSMP). Of these subtypes, p53abn patients exhibited the worst prognosis. Recently, a prognostic refinement of NSMP EC using estrogen receptor (ER) status, from PORTEC-III trial data, showed that (ER-) NSMP patients had a strikingly poor prognosis, similar to p53abn patients. Currently, drivers of NSMP (ER-) disease are unknown and require genomic characterization. In this study, we perform an integrated molecular analysis to characterize this aggressive and poorly understood cohort. MATERIALS/METHODS RNAseq and mutational data was downloaded from the TCGA, PanCancer Atlas, Uterine Endometrial Carcinoma dataset via the genomic data commons (GDC). All patients in this cohort demonstrated endometrioid histology. P53abn, and POLE mutated patients were filtered using mutational data. MMRd and NSMP ESR1 gene low expressors (ER Low) were filtered using Z-score cutoffs of RNAseq expression data. Survival analysis was performed using the Survival R-package. Gene expression testing was performed using the EdgeR R-package. Pathway Enrichment analysis was conducted using EnrichR software. RESULTS Forty-two patients out of 529 samples met our GDC NSMP (ER low) filtering criteria (7%), similar to the 5% of PORTEC-III patients classified as NSMP (ER -). Strikingly 83% percent of GDC NSMP (ER low) patients harbored a mutation in the PI3K-AKT-mTOR signaling pathway, with 48% of GDC NSMP (ER low) patients carrying a mutation in the p110 alpha (PIK3CA) gene. Interestingly, of the patients with PIK3CA mutant tumors, 2/20 patients died in 5 years (10%), compared to 9/22 patients whose tumors were PIK3CA WT (41%) (p = 0.02). Among GDC NSMP (ER low) patients with PIK3CA WT tumors gene expression signatures were enriched for MYC target genes (p = 1.1e-51), DNA replication (p = 4.3e-30), cell cycle (p = 9.32e-20), and cell cycle checkpoints (p = 6.4e-20) pathways. Additionally, strongly in PIK3CA WT tumors are mitochondrial membrane proteins (p = 1.63e-37) and ribosomal proteins (2.9e-24). CONCLUSION In this analysis, we show that GDC NSMP (ER low) tumors nearly all harbor a mutation in the PI3K-AKT-mTOR signaling pathway. Further we demonstrate that the most common gene mutation in the cohort, PIK3CA, is counterintuitively a marker of improved survival. Additionally, we show that within that this subpopulation, PIK3CA WT patients exhibit robustly upregulated gene expression programs dedicated to energy production, cell cycling, and division.
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AI-aided holographic flow cytometry for label-free identification of ovarian cancer cells in the presence of unbalanced datasets. APL Bioeng 2023; 7:026110. [PMID: 37305657 PMCID: PMC10250050 DOI: 10.1063/5.0153413] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 05/15/2023] [Indexed: 06/13/2023] Open
Abstract
Liquid biopsy is a valuable emerging alternative to tissue biopsy with great potential in the noninvasive early diagnostics of cancer. Liquid biopsy based on single cell analysis can be a powerful approach to identify circulating tumor cells (CTCs) in the bloodstream and could provide new opportunities to be implemented in routine screening programs. Since CTCs are very rare, the accurate classification based on high-throughput and highly informative microscopy methods should minimize the false negative rates. Here, we show that holographic flow cytometry is a valuable instrument to obtain quantitative phase-contrast maps as input data for artificial intelligence (AI)-based classifiers. We tackle the problem of discriminating between A2780 ovarian cancer cells and THP1 monocyte cells based on the phase-contrast images obtained in flow cytometry mode. We compare conventional machine learning analysis and deep learning architectures in the non-ideal case of having a dataset with unbalanced populations for the AI training step. The results show the capacity of AI-aided holographic flow cytometry to discriminate between the two cell lines and highlight the important role played by the phase-contrast signature of the cells to guarantee accurate classification.
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Inpatient target discharge weight for early-onset anorexia nervosa: Restoring premorbid BMI percentile to improve height prognosis. Clin Nutr ESPEN 2023; 54:150-156. [PMID: 36963857 DOI: 10.1016/j.clnesp.2023.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/11/2022] [Accepted: 01/20/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Early-onset anorexia nervosa (EO-AN) is characterized by restricted food intake leading to low body weight, emerging before 14 years old. Most patients reaching a target body mass index (BMI) around the 25th percentile at hospitalization discharge display an incomplete prospective height catch-up. A better understanding of height prognosis determinants is required. METHODS In 74 children with an EO-AN, we collected height and weight premorbidly, at hospitalization, and at discharge, 6 months, 12 months, and at longer-term follow-up of 36 months. We defined a height prognosis parameter (HPP) as the difference between the height percentile at follow-up times and the premorbid height percentile. We explored the relationship between weight parameters and height catch-up at follow-up with linear regression analyses. RESULTS A higher weight suppression (WS) - i.e., difference between premorbid and current BMI - at admission and discharge was associated with lower HPP - i.e., a greater loss of height - at 12 months and 36 months follow-up. Similarly, a higher premorbid BMI percentile was associated with a lower HPP at 12 and 36 months. CONCLUSION Target discharge weight for EO-AN patients should be tailored and based on premorbid BMI trajectory to improve height prognosis.
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Atezolizumab-induced psoriasiform drug eruption successfully treated with ixekizumab: a case report and literature review. Dermatol Online J 2023; 29. [PMID: 37040912 DOI: 10.5070/d329160215] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 02/27/2023] Open
Abstract
Immune-related cutaneous adverse events (ircAE) are commonly seen with immune checkpoint inhibitors such as atezolizumab. Atezolizumab-induced psoriasis has been previously reported as an ircAE, especially in patients with pre-existing psoriasis. The severity of the reaction influences treatment of the cutaneous eruption. Biologics should be considered as a treatment option for severe refractory psoriasiform eruptions even in patients with complex medical conditions like chronic infections and malignancy. This is the first reported case of successful treatment of atezolizumab-induced psoriasiform eruption with ixekizumab, a neutralizing IL17A monoclonal antibody, to the best of our knowledge. Herein, we present a 63-year-old man with a history of human immunodeficiency virus and psoriasis who presented with atezolizumab-induced psoriasiform eruption while being treated for metastatic hepatocellular carcinoma. After initiating ixekizumab, atezolizumab was restarted without cutaneous eruption.
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Abstract
BACKGROUND Andexanet alfa is a modified recombinant inactive factor Xa (FXa) designed to reverse FXa inhibitors. ANNEXA-4 (Andexanet Alfa, a Novel Antidote to the Anticoagulation Effects of Factor Xa Inhibitors) was a multicenter, prospective, phase-3b/4, single-group cohort study that evaluated andexanet alfa in patients with acute major bleeding. The results of the final analyses are presented. METHODS Patients with acute major bleeding within 18 hours of FXa inhibitor administration were enrolled. Co-primary end points were anti-FXa activity change from baseline during andexanet alfa treatment and excellent or good hemostatic efficacy, defined by a scale used in previous reversal studies, at 12 hours. The efficacy population included patients with baseline anti-FXa activity levels above predefined thresholds (≥75 ng/mL for apixaban and rivaroxaban, ≥40 ng/mL for edoxaban, and ≥0.25 IU/mL for enoxaparin; reported in the same units used for calibrators) who were adjudicated as meeting major bleeding criteria (modified International Society of Thrombosis and Haemostasis definition). The safety population included all patients. Major bleeding criteria, hemostatic efficacy, thrombotic events (stratified by occurring before or after restart of either prophylactic [ie, a lower dose, for prevention rather than treatment] or full-dose oral anticoagulation), and deaths were assessed by an independent adjudication committee. Median endogenous thrombin potential at baseline and across the follow-up period was a secondary outcome. RESULTS There were 479 patients enrolled (mean age, 78 years; 54% male, 86% White; 81% anticoagulated for atrial fibrillation at a median time of 11.4 hours since last dose, with 245 (51%) on apixaban, 176 (37%) on rivaroxaban, 36 (8%) on edoxaban, and 22 (5%) on enoxaparin. Bleeding was predominantly intracranial (n=331 [69%]) or gastrointestinal (n=109 [23%]). In evaluable apixaban patients (n=172), median anti-FXa activity decreased from 146.9 ng/mL to 10.0 ng/mL (reduction, 93% [95% CI, 94-93]); in rivaroxaban patients (n=132), it decreased from 214.6 ng/mL to 10.8 ng/mL (94% [95% CI, 95-93]); in edoxaban patients (n=28), it decreased from 121.1 ng/mL to 24.4 ng/mL (71% [95% CI, 82-65); and in enoxaparin patients (n=17), it decreased from 0.48 IU/mL to 0.11 IU/mL (75% [95% CI, 79-67]). Excellent or good hemostasis occurred in 274 of 342 evaluable patients (80% [95% CI, 75-84]). In the safety population, thrombotic events occurred in 50 patients (10%); in 16 patients, this occurred during treatment with prophylactic anticoagulation that began after the bleeding event. No thrombotic episodes occurred after oral anticoagulation restart. Specific to certain populations, reduction of anti-FXa activity from baseline to nadir significantly predicted hemostatic efficacy in patients with intracranial hemorrhage (area under the receiver operating characteristic curve, 0.62 [95% CI, 0.54-0.70]) and correlated with lower mortality in patients <75 years of age (adjusted P=0.022; unadjusted P=0.003). Median endogenous thrombin potential was within the normal range by the end of andexanet alfa bolus through 24 hours for all FXa inhibitors. CONCLUSIONS In patients with major bleeding associated with the use of FXa inhibitors, treatment with andexanet alfa reduced anti-FXa activity and was associated with good or excellent hemostatic efficacy in 80% of patients. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02329327.
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Four chambers strain analysis in patients with heart failure: Towards a new standard? ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2023. [DOI: 10.1016/j.acvdsp.2022.10.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Analyse exploratoire des profils à haut risque dans le syndrome primaire des antiphospholipides par l’analyse de clusters : étude de cohorte multicentrique française. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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8999 Reproductive Outcomes and Overall Prognosis of Patients with Asherman's Syndrome Undergoing IVF Cycles. J Minim Invasive Gynecol 2022. [DOI: 10.1016/j.jmig.2022.09.528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Artificial Intelligence Vision Based Analysis and Key Steps Identification Feasibility Study in Laparoscopic Hysterectomies. J Minim Invasive Gynecol 2022. [DOI: 10.1016/j.jmig.2022.09.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abnormal immune activation and fibrosis of epicardial adipose tissue in people living with HIV: results from the PIECVIH study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Increased Epicardial Adipose Tissue (EAT) volume has been associated with increased risk of CAD in people living with HIV (PLWH). However, the underlying mechanisms remain unknown.
Purpose
We conducted the PIECVIH study to compare EAT properties in relation with CAD between PLWH and HIV-negative patients, all undergoing coronary artery bypass graft (CABG).
Methods
The PIECVIH study is a cross sectional prospective study performed in a single center enrolling 11 ART-controlled PLWH and 11 matched (age ± 3 years and sex) HIV-negative patients requiring CABG. During surgery, EAT and thoracic subcutaneous fat samples were taken. Gene expression was analyzed in samples with sufficient mRNA quality (7 PLWH and 7 HIV− for subcutaneous fat, 9 PLWH and 8 HIV− samples for EAT). The expression of 30 genes, mainly related to inflammation, immune activation, fibrosis and adipokines, was evaluated and related to the expression of the reference gene 18S.
Results
The mean age of the cohort was 59.8 years (100% male). The cardiovascular risk profile was quite similar between both groups including 66% smokers, 64% hypercholesterolemia, 36% hypertriglyceridemia and 56% hypertension. However, HIV− subjects had a higher prevalence of diabetes (73% vs 18%, p=0.002) and a higher body mass index than HIV− (23,2 vs 27.5 kg/m2, p=0.017). The level of gene expression of all tested genes was not different between PLWH and HIV− subjects in subcutaneous fat. Conversely, in EAT, the relative expression of IL-6 and CCL2 was 3–5-fold higher in samples issued from PLWH than from HIV−: respectively 0.46 vs 0.13 (p=0.03) and 1.13 vs 0.24 (p=0.03). Moreover, only in EAT, and only in PLWH, the expression of the chemokines CCL2 and CCL5 and of the macrophage immune activation markers (CD68, CD163, CD206), was globally related to the expression of genes involved into fibrosis: collagen genes (COL1A1, COL3A1, COL3A1, COL6A2, COL6A3), TGFB, LOX (lysyl-oxidase) and ASAH1 (acid ceraminidase). Only in EAT and only in PLWH, the expression of IGF1 and CES (carboxylesterase 1), two genes associated with increased cardiovascular risk, was related to the expression of genes associated with immune activation, fibrosis and vascularization (VEGFA). Only in PLWH, the Gensini score, evaluating the severity of CAD, was associated with EAT expression of collagen 6 and of the CV risk factors IGF1 and CES.
Conclusion
In very high CV risk subjects undergoing CABG, inflammation/immune activation of EAT was higher in PLWH as compared to controls. In EAT of PLWH, immune activation was strongly associated with fibrosis stressing for a dysfunctional EAT. Moreover, the severity of CAD, as addressed by the Gensini score, was associated with collagen 6 expression, a deleterious collagen in the context of EAT fibrosis. We propose that in PLWH, altered EAT immune profile and fibrosis could be responsible for reported accelerated CAD.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): French Agency for Research on AIDS and Viral Hepatitis
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Coronary artery calcium score in people living with HIV. Results from the French CAC study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2608] [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: 11/12/2022] Open
Abstract
Abstract
Background
People living with HIV (PLWH) have a higher risk of CAD. Whether coronary artery calcification (CAC) score could better stratify the CV risk remains debated in this middle age population.
Purpose
We conducted the French CAC score study to compare the CAC score between PLHIV and HIV− subjects at intermediate risk.
Methods
689 subjects (257 PLHIV and 432 HIV−) were consecutively addressed for CV risk evaluation including CAC score assessment in 2 centers between 2013 and 2019. Subjects were included if they were 18 years'old or older, had no known cardiovascular disease and had a CAC score along with cardiometabolic assessment.
Results
The mean age of the cohort was 59.3 years ± 10.7 and predominantly male (54%). PLHIV were younger (55.8 years ± 9.1 vs 61.3±11.3, p<0.004), with a lower rate of diabetics (18% vs 26%, p=0.009) and lower levels of total cholesterol, LDLc, and HDLc (2.0 mmol/l vs, 2.2 mmol/l; 1.2 mmol/L vs 1.3 mmol/L; and 1.2 mmol/L vs 1.4 mol/L respectively, all p<0.001). The prevalence of hypertension, dyslipidemia and obesity was similar between PLHIV and the HIV− group (40%, 43% and 21%, respectively). No differences were observed in CV therapies prescribed including antihypertensive drugs and statins between PLHIV and the HIV− group (39% vs 37%, p=0.54 and 46% vs 39%, p=0.065). In contrast, PLHIV had higher rate of triglycerides (1.4 mmol/L vs 1.2 mmol/L, p=0.01), higher rate of active smoking (28% vs 14%, p<0.001), CRP level (4.0 mg/L vs 2.9 mg/L, p<0.001) along with higher black ethnicity representation (17% vs 5%;, p<0.001). 96% of PLHIV were under antiretroviral therapy at the time of enrollment with 88% who had been exposed to protease inhibitors. In subjects who had carotid and/or limb ultrasound evaluation (67% and 45% respectively in PLHIV and HIV), no increased rate of arterial stenosis >50% was found (13% vs 8%, p=0.16). Concerning, CV risk estimation using 10-year ASCVD and HEART scores, we observed that the median ASCVD score was similar between PLHIV and HIV− group (10.7% vs 9.8, p=0.15) but that PLHIV had a higher HEART score (3.0% vs 2.0%, p<0.001). The repartition between the ASCVD or HEART scores classes between the 2 groups was similar with 80% of the cohort classified as low or intermediate CV risk with the ASCVD score and 88% at intermediate or borderline CV risk with the HEART score. However, no statistically significant differences was found between the 2 groups regarding the prevalence of CAC = 0 (41% vs 44%, p=0.52) and the median CAC score (7.7 vs 8.2, p=0.81).
Conclusion
In this cohort of subjects at intermediate CV risk according to CV risk scores estimation (ASCVD or HEART scores), PLHIV had a similar prevalence of CAC = 0 and median CAC scores as compared to HIV− subjects despite a younger age (6 years). Longitudinal follow up will explore whether this similar CAC score evaluation will be translated into higher CV events.
Funding Acknowledgement
Type of funding sources: None.
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232 Emergency Medicine Services Handoff of Patients in Cardiac Arrest in the Emergency Department: A Retrospective Video Review Study of Duration and Frequency of Communication. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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625 Manufacturing and device development for SPL84-23-1, an inhaled antisense oligonucleotide, supporting a first-in-human clinical study in people with cystic fibrosis carrying the 3849+10 kb C-to-T mutation. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01315-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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263 Emergency Department Care Transition Barriers: A Qualitative Study of Care Partners of Older Adults With Cognitive Impairment. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Development of a topical bacteriophage gel targeting
Cutibacterium acnes
for acne prone skin and results of a phase 1 cosmetic randomized clinical trial. SKIN HEALTH AND DISEASE 2022; 2:e93. [PMID: 35677920 PMCID: PMC9168013 DOI: 10.1002/ski2.93] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/02/2022] [Accepted: 01/04/2022] [Indexed: 11/11/2022]
Abstract
Background Topical antibiotics are frequently used to treat acne vulgaris. Their prolonged use, often for longer durations than recommended, has led to antibiotic resistance in Cutibacterium acnes (C. acnes), a bacterium implicated in acne pathophysiology. Bacteriophage (phage), which specifically target C. acnes by a different mechanism of action and do not harm potentially beneficial bacteria, may offer an alternative approach for improvement of the appearance of acne prone skin. Objectives To identify and characterize C. acnes targeting phage, carry out a comprehensive preclinical safety evaluation of phages selected for further development and examine their safety, tolerability and ability to target facial C. acnes when applied topically in a cosmetic clinical study including participants with mild‐to‐moderate acne. Methods Phages were isolated by conventional microbiological methods also used to examine their breadth of host range on different C. acnes strains and specificity to this bacterial species. Safety assessment of three selected phages was carried out by complete genomic analysis to assure the absence of undesired sequences and by ex vivo models employed to evaluate the safety, irritability and potential systemic bioavailability of phage applied topically. A randomized, controlled clinical study assessed safety, tolerability and efficacy in targeting facial C. acnes. Results Wide host range phages that also target antibiotic resistant C. acnes were identified. Their genomes were shown to be free of undesired genes. The three‐phage cocktail, BX001, was not irritant to human skin or ocular tissues in ex vivo models and did not permeate through human epidermis. In a cosmetic clinical study, topically applied BX001 was safe and well tolerated and reduced the facial burden of C. acnes. Conclusions Combined in silico and ex vivo approaches successfully predicted the observed safety and efficacy of C. acnes targeting phage when these were topically administered in a well‐controlled cosmetic clinical study.
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WS18.01 Manufacturing and device development of SPL84-23-1, an inhaled antisense oligonucleotide, supporting first-in-human clinical study in cystic fibrosis patients carrying the 3849 mutation. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00255-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Predictors of patient post-discharge opioid use after cesarean delivery: a prospective study. Int J Obstet Anesth 2022; 50:103249. [DOI: 10.1016/j.ijoa.2021.103249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 11/29/2021] [Accepted: 12/23/2021] [Indexed: 10/19/2022]
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Cardiovascular manifestations secondary to COVID-19: A narrative review. Respir Med Res 2022; 81:100904. [PMID: 35525097 PMCID: PMC9065692 DOI: 10.1016/j.resmer.2022.100904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 02/07/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has spread rapidly, becoming a major threat to global health. In addition to having required the adaptation of healthcare workers for almost 2 years, it has been much talked about, both in the media and among the scientific community. Beyond lung damage and respiratory symptoms, the involvement of the cardiovascular system largely explains COVID-19 morbimortality. In this review, we emphasize that cardiovascular involvement is common and is associated with a worse prognosis, and that earlier detection by physicians should lead to better management. First, direct cardiac involvement will be discussed, in the form of COVID-19 myocarditis, then secondary cardiac involvement, such as myocardial injury, myocardial infarction and arrhythmias, will be considered. Finally, worsening of previous cardiovascular disease as a result of COVID-19 will be examined, as well as long-term COVID-19 effects and cardiovascular complications of COVID-19 vaccines.
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Omaveloxolone attenuates squamous cell carcinoma growth and disease severity in an Epidermolysis Bullosa mouse model. Exp Dermatol 2022; 31:1083-1088. [DOI: 10.1111/exd.14564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/15/2022] [Accepted: 03/08/2022] [Indexed: 11/27/2022]
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In premenopausal women with idiopathic osteoporosis, lower bone formation rate is associated with higher body fat and higher IGF-1. Osteoporos Int 2022; 33:659-672. [PMID: 34665288 PMCID: PMC9927557 DOI: 10.1007/s00198-021-06196-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
UNLABELLED We examined serum IGF-1 in premenopausal IOP, finding relationships that were opposite to those expected: higher IGF-1 was associated with lower bone formation and higher body fat, and lower BMD response to teriparatide. These paradoxical relationships between serum IGF-1, bone, and fat may contribute to the mechanism of idiopathic osteoporosis in premenopausal women. INTRODUCTION Premenopausal women with idiopathic osteoporosis (IOP) have marked deficits in bone microarchitecture but variable bone remodeling. We previously reported that those with low tissue-level bone formation rate (BFR) are less responsive to teriparatide and have higher serum IGF-1, a hormone anabolic for osteoblasts and other tissues. The IGF-1 data were unexpected because IGF-1 is low in other forms of low turnover osteoporosis-leading us to hypothesize that IGF-1 relationships are paradoxical in IOP. This study aimed to determine whether IOP women with low BFR have higher IGF-1 and paradoxical IGF-1 relationships in skeletal and non-skeletal tissues, and whether IGF-1 and the related measures predict teriparatide response. METHODS This research is an ancillary study to a 24 month clinical trial of teriparatide for IOP. Baseline assessments were related to trial outcomes: BMD, bone remodeling. SUBJECTS Premenopausal women with IOP(n = 34); bone remodeling status was defined by baseline cancellous BFR/BS on bone biopsy. MEASURES Serum IGF-1 parameters, compartmental adiposity (DXA, CT, MRI), serum hormones, and cardiovascular-risk-markers related to fat distribution. RESULTS As seen in other populations, lower BFR was associated with higher body fat and poorer teriparatide response. However, in contrast to observations in other populations, low BFR, higher body fat, and poorer teriparatide response were all related to higher IGF-1: IGF-1 Z-score was inversely related to BFR at all bone surfaces (r = - 0.39 to - 0.46; p < 0.05), directly related to central fat (p = 0.05) and leptin (p = 0.03). IGF-1 inversely related to 24 month hip BMD %change (r = - 0.46; p = 0.01). CONCLUSIONS Paradoxical IGF-1 relationships suggest that abnormal or atypical regulation of bone and fat may contribute to osteoporosis mechanisms in premenopausal IOP.
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A141 IS SURGERY STILL THE ONLY TREATMENT OPTION FOR CURABLE RECTAL CANCER? J Can Assoc Gastroenterol 2022. [PMCID: PMC8859336 DOI: 10.1093/jcag/gwab049.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Rectal cancer is curable by standard surgery with Total Mesorectal Excision (TME). However, there are well known associated long-term bowel and sexual dysfunctions. Non-operative management (NOM) is an emerging treatment for patients with operable rectal cancer. There is evidence supporting dose response for tumor control in rectal adenocarcinoma. Aims In the era of modern technologies, Image-guided adaptive endorectal brachytherapy is a means to deliver local radiotherapy boost treatments. We explored its role in a randomized phase II/III trial (NCT03051464) for patients aiming to achieve cure without surgery. Total Mesorectal Excision (TME) free survival at 2 years was the primary endpoint. We now present the interim analysis upon accrual of the first 40 patients. Methods In randomized trial, patients with operable cT2-3ab N0 M0 rectal cancer received 45 Gy in 25 fractions of pelvic external beam radiotherapy (EBRT) with concurrent 5-FU/ Capecitabine. They were randomized to receive either an EBRT boost of 9 Gy in 5 fractions (Arm A), or three weekly adaptive brachytherapy boosts for a total of 30 Gy in 3 fractions (Arm B). Results Forty patients were included (20 per arm). The median age was 66 years; baseline characteristics were well balanced in terms of age, tumor location, T stage and tumor size (Table 1). The acute treatment related toxicities are similar as shown in table 2 but in arm B, there were two deaths: one patient died during his chemotherapy and external beam treatment from congestive heart failure and one patient from a heart attack after treatment prior to salvage TME surgery. The proportion of complete clinical response was 50% (n=10/20) in Arm A and 90% in Arm B (n=18/20). With a median follow-up of 2.2 years, local regrowth at 2 years occurred in 4/10 patients (40%) in Arm A and 4/18 patients (22%) in Arm B. TME-free survival rate at 2 years was 45.9% in Arm A and 85.1% in Arm B (p=0.0036) (Figure 1). Conclusions The interim analysis of this trial suggests that these two strategies of radiation dose escalation are feasible and lead to high chances of organ preservation in patients with operable rectal cancer. The Independent Monitoring Comittee (IDMC) approved the continuation of patient recruitment in the phase III study as planned. ![]()
Funding Agencies Elekta
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NPK in treated wastewater irrigation: Regional scale indices to minimize environmental pollution and optimize crop nutritional supply. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 806:150387. [PMID: 34844305 DOI: 10.1016/j.scitotenv.2021.150387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/07/2021] [Accepted: 09/13/2021] [Indexed: 06/13/2023]
Abstract
Treated wastewater (TWW) is increasingly used for agricultural irrigation, and often contains higher concentrations of the major plant nutrients N, P, and K than freshwater, reducing the need for agricultural fertilization. However, excessive inputs of nutrients to cropping systems can be harmful to crops and the environment. The present study developed and employed six novel indices to assess the sustainability of TWW-irrigation and spatio-temporal trends in NPK loads to TWW-irrigated fields. Three indices relate to regional analysis of TWW-irrigation sustainability: the 'Environmental sustainability' index measures the TWW compliance with environmental irrigation standards; a 'Nutritional sustainability' index assesses whether the TWW satisfy crop fertilization requirements; a 'Basin nutrient surplus' index measures deviations of N or P loads to river basins from allowed levels. Three additional indices assess the environmental impact, potential loss of nutrients and fit of a given TWW for fertilization recommendations. We employed these indices to analyze a decade-long high spatio-temporal resolution data of TWW quality from Israel on a basin scale, for six TWW-irrigated plantation crops. The results reveal that in high-sensitivity hydrological areas, TWW is generally above the environmental standard for N and P; the TWW with lowest nutrient content is irrigated in low-sensitivity areas, leading to a reduced potential for utilization of nutrients in TWW. While the N irrigation standard (25 mg L-1) does not exceed the nutritional requirements of most analyzed crops, the P standard (5 mg L-1) results in excess fertilization for all analyzed crops. Therefore, environmental and nutritional sustainability of TWW-irrigation can be increased by diverting high-quality TWW to high-sensitivity areas and vice versa. Furthermore, development of local environmental standards will allow maximizing TWW NPK utilization in low-sensitivity areas, increasing nutritional sustainability. The indices presented in this study provide a tool to help maximize the nutritional benefits of TWW while minimizing its environmental impact.
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Design, synthesis, and characterization of novel aminoalcohol quinolines with strong in vitro antimalarial activity. Eur J Med Chem 2021; 228:113981. [PMID: 34782182 DOI: 10.1016/j.ejmech.2021.113981] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/04/2021] [Accepted: 11/06/2021] [Indexed: 12/16/2022]
Abstract
Malaria is the fifth most lethal parasitic infections in the world. Herein, five new series of aminoalcohol quinolines including fifty-two compounds were designed, synthesized and evaluated in vitro against Pf3D7 and PfW2 strains. Among them, fourteen displayed IC50 values below or near of 50.0 nM whatever the strain with selectivity index often superior to 100.17b was found as a promising antimalarial candidate with IC50 values of 14.9 nM and 11.0 nM against respectively Pf3D7 and PfW2 and a selectivity index higher than 770 whatever the cell line is. Further experiments were achieved to confirm the safety and to establish the preliminary ADMET profile of compound 17b before the in vivo study performed on a mouse model of P. berghei ANKA infection. The overall data of this study allowed to establish new structure-activity relationships and the development of novel agents with improved pharmacokinetic properties.
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Recurrent Ovarian Torsion and Fixation – Risk Factors and Predictors for Treatment Outcome. J Minim Invasive Gynecol 2021. [DOI: 10.1016/j.jmig.2021.09.493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The Use of Laparoscopy for Suspected Postpartum Uterine Rupture: Changing the Paradigm. J Minim Invasive Gynecol 2021. [DOI: 10.1016/j.jmig.2021.09.292] [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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Expectant Versus Medical Management of Retained Products of Conception after Induced Abortion. J Minim Invasive Gynecol 2021. [DOI: 10.1016/j.jmig.2021.09.149] [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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Does Gas Insufflation during Gynecologic or Urologic Oncologic Laparoscopy Cause Dissemination of Malignant Cells. J Minim Invasive Gynecol 2021. [DOI: 10.1016/j.jmig.2021.09.004] [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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Abstract
Abstract
Background
Atrial fibrillation (AFib) is a major contributor to recurrent but preventable ischemic Stroke (IS)/TIA. However, majority of stroke patients suffer from paroxysmal asymptomatic AFib, which implies stroke health system to implement accurate AFib detection strategies to large scale population. Current practices of AFib screening methods provided by Stroke Units (SU) organization and network in France are currently unknown and uncovered by dedicated guidelines.
Purpose
To assess the methodology of Afib screening in French SU.
Methods
A French Nationwide survey was led (September-November 2020) with on-line structured questionnaires sent to individual targeted stroke-physicians (SP) and heads of SU in France.We analyzed qualitative and quantitative availability and current use of AFib detection tools during acute inhospital and outpatient subacute and chronic post-IS phases.
Results
67% of 140 heads of SU and 33% of SP responded across all continental and overseas French regions.Main clinical characteristics that lead to search Afib are: TIA/IS recurrence under antiplatelet therapy (97%), patient's age (74%), proximal occlusion of a major cerebral artery (72%). Afib is highly suspected when there is: recent brain IS in multiple vascular territories (100%), previous IS in another vascular territory (98%), left atrial enlargement (96%), burst of supraventricular tachycardia <30s (94%). In-hospital cardiac monitoring is considered to be mandatory by 90% of SU teams but only 1/3 of those possess telemetry out of intensive care unit. Outpatient cardiac monitoring is considered of major interest/necessary by 100% of SP. When first line 24-hour Holter monitor is normal and Afib is highly suspected, 75% of the SP required outpatient noninvasive monitoring (NIM) for at least 7 days and more than half required insertable cardiac monitor (ISC). ISC are implanted each year by SU for <10 patients in 44% and <50 patients in 94%. The delay IS-ICM implantation is <1 month in 10%, 1–3 months in 52%, 3–6 months in 29% and >6 months in 9%. Accessibility to outpatient monitoring modalities is graded: fairly easy for 24/48h-Holter (85%) and ISC (68%); rather difficult/impossible for 3–7 days NIM (51%), 8–21 days NIM (75%) or e-ECG tools (99%). Main obstacles to monitoring abilities development in SU were lack of: manpower (80%), efficient network with cardiologists (56%), familiarity of techniques (42%); and technical equipment cost (44%). 96.5% of SU teams deem necessary practice decision support flowchart with cardiologist partnership but 19% use for it.
Conclusion
The survey raises concern about lack of a systematic strategy and shortcomings for Afib detection capacities. These results are a call to establish practice-guidelines and to promote an improvement plan for AFib detection (selection of the patients, tools and prioritization of the exams) after TIA/IS in France which will require a strong collaboration between neurologists and cardiologists.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): BMS-Pfizer
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Platelet reactivity and immature platelets in patients with Covid-19. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Coronavirus disease 2019 (Covid-19) is associated with high incidence of thromboembolic events, both venous and arterial. Currently, there are no clinical or laboratory markers to guide antithrombotic therapy in COVID-19 patients. Immature platelets represent a population of hyper-reactive platelets associated with arterial thrombotic events.
Objectives
To determine indices of immature platelets and platelet reactivity in Covid-19 patients.
Methods
This prospective study compared consecutive COVID-19 patients (n=47, median age = 56 years) to patients with acute myocardial infarction (AMI, n=100, median age = 59 years) and a group of stable patients with cardiovascular risk factors (n=64, median age=68 years). Immature platelet fraction (IPF) and immature platelet count (IPC) were determined by the Sysmex XN-3000 auto-analyzer on admission and at subsequent time-points.
Results
IPF% on admission was higher in the Covid-19 group than the stable group and similar to the AMI group (4.8% [IQR 3.4–6.9], 3.5% [2.7–5.1], 4.55% [3.0–6.75], respectively, p=0.005 for Covid-19 vs. stable). IPC on admission was also higher in the Covid-19 group than the stable group and similar to the AMI group (10.8×109/L [8.3–18.1], 7.35×109/L [5.3–10.5], 10.7×109/L [7.7–16.8], respectively, P<0.0001 for Covid-19 vs. stable). The maximal IPF% among the Covid-19 group was higher than the stable group and similar to the AMI group. The maximal IPC in the Covid-19 group was higher than the maximal IPC in both the stable and AMI groups (Covid-19: 14.4×109/L [9.4–20.9], AMI: 10.9×109/L [7.6–15.2], P=0.0035, Stable: 7.55×109/L [5.55–10.5], P<0.0001).
Conclusions
Patients with Covid-19 have increased immature platelets indices compared to stable patients with cardiovascular risk factors, and as the disease progresses also compared to AMI patients. Enhanced platelet turnover and reactivity may, therefore, have a role in the development of thrombotic events in Covid-19 patients.
Funding Acknowledgement
Type of funding sources: None. IPF in COVID-19, AMI and stable groups
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Effectiveness and safety of apixaban vs warfarin among older venous thromboembolism patients: a subgroup analysis of age. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Venous thromboembolism (VTE) is the third most common cardiovascular condition in adult patients. Older patients are at an increased risk of VTE. However, they have been underrepresented in clinical trials and evidence on the safety and effectiveness of anticoagulants in older VTE patients, especially very elderly patients (≥80 years), is sparse.
Purpose
To evaluate the risk of recurrent VTE, major bleeding (MB), and clinically relevant non-major (CRNM) bleeding among older VTE patients initiating apixaban or warfarin according to two age sub-groups: 65–79 and ≥80 years.
Methods
Older VTE patients (aged ≥65 years) who initiated apixaban or warfarin were identified from the CMS Medicare database (September 2014–December 2017). To balance the characteristics between apixaban and warfarin patients, stabilized inverse probability treatment weighting (IPTW) was conducted. Post IPTW, a subgroup interaction analysis was conducted to evaluate if there was any difference in treatment effects between the two age subgroups (65–79 vs. ≥80) on recurrent VTE, MB, and CRNM bleeding. Cox proportional hazard models were used to conduct the interaction analysis, and the statistical significance of the interaction was set to p-value <0.10.
Results
A total of 22,135 apixaban and 45,840 warfarin patients with VTE aged ≥65 years were eligible for analysis. Post IPTW, patient characteristics were balanced between the apixaban and warfarin treatment cohorts. Apixaban patients had significantly lower risk of recurrent VTE, MB, and CRNM bleeding compared to warfarin patients (Figure). 42,551 (62.6%) were aged 65–79 years and 25,424 (37.4%) were aged ≥80 years. Among apixaban or warfarin patients, those aged 65–79 years had lower Charlson comorbidity index scores (mean 2.7 vs 3.2) and were less likely to have a diagnosis of anemia (34.7–34.9% vs 42.3–42.5%), cerebrovascular disease (14.7–15.7% vs 20.3–20.5%), or dementia (5.0–6.9% vs 20.4–24.6%) compared to patients aged ≥80 years. Across both age subgroups, incidence rates of recurrent VTE, MB and CRNM bleeding were lower for apixaban vs. warfarin. No significant interaction was observed between the treatment and age on recurrent VTE and MB (Figure). There was a significant interaction between treatment and age on CRNM bleeding. Apixaban trended towards a lower risk of CRNM bleeding across both age groups but the treatment effect on CRNM bleeding was larger for patients aged 65–79 years.
Conclusion
The treatment effects of apixaban vs. warfarin on recurrent VTE and MB were consistently observed across both older age groups in this analysis. More studies are needed to evaluate management of VTE in an older and especially the very elderly population.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Bristol-Myers Squibb Company and Pfizer Inc.
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Immature platelets in patients with Covid-19: association with disease severity. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Coronavirus disease 2019 (Covid-19) is associated with a high incidence of thromboembolic events, both venous and arterial. Currently, there are no clinical or laboratory markers to guide risk-stratification or antithrombotic therapy in Covid-19 patients. Circulating immature platelets represent a population of hyper-reactive platelets, which are associated with arterial thrombotic events.
Objectives
To assess whether the proportion of immature platelets in the circulation is associated with disease severity in patients with Covid-19
Methods
This prospective study evaluated consecutive patients with COVID-19 admitted with various degrees of disease severity, as determined by the standard Covid-19 severity Score. Disease severity was evaluated during hospitalization. Immature platelet fraction (IPF) absolute number and percentage were measured on admission and at additional time points during the hospital course using the SysmexXN-3000 auto-analyzer. The maximal values of IPF% and absolute IPF was analyzed according to disease severity.
Results
A total of 136 consecutive patients with Covid-19 were recruited. Mean age was 60±19 years for patients with mild and moderate disease and 69±14 years for patients with severe disease, 52% with mild and moderate disease and 48% with severe disease were woman, 11% with mild and moderate disease and 20% with severe disease with concurrent cardiovascular disease
The median of IPF% was higher in the severe COVID-19 group compared to patients with mild or moderate disease [4.2 (IQR 2.73–6.45) vs 5.8 (IQR 3.9–8.7), P=0.01, Figure 1)]. The median of IPF absolute number was also significantly higher in patients with severe disease comparing to patients with mild or moderate disease (4.2 (2.85–6.1) vs 5.1 (IQR 3.65–7.35), P<0.0001, Figure 2].
Conclusions
Patients with severe Covid-19 have a higher level of IPF in the circulation than patients with mild or moderate disease. IPF may serve as a reliable prognostic marker for in-hospital disease severity in patients with Covid-19
Funding Acknowledgement
Type of funding sources: None. Figure 1. IPF% (median, 95% confidence interval)Figure 2. IPF# (median, 95% confidence interval)
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Effectiveness and safety of apixaban vs warfarin among older venous thromboembolism patients stratified by race. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1940] [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: 11/12/2022] Open
Abstract
Abstract
Background
Race has been identified as a risk factor for venous thromboembolism (VTE), with Black individuals having a higher risk of VTE compared to Caucasians. Black patients have been underrepresented in clinical trials evaluating anticoagulants for VTE. There has been limited evidence about the effects of anticoagulants for Black patients with VTE in routine clinical practice.
Purpose
To evaluate the risk of recurrent VTE, major bleeding (MB), and clinically relevant non-major (CRNM) bleeding among VTE patients initiating apixaban or warfarin stratified by race.
Methods
Older VTE patients (≥65 years) who initiated apixaban or warfarin were selected from the CMS Medicare database (September 2014–December 2017). Stabilized inverse probability treatment weighting (IPTW) was used to balance the differences between apixaban and warfarin cohorts. After IPTW, subgroup interaction analysis was conducted to evaluate if treatment effects were different between Black and White patients in the Medicare population. Due to small sample size, other races were not included in the interaction analysis. Cox proportional hazard models were used to evaluate if there was significant interaction (p<0.10) between treatment and race on recurrent VTE, MB, or CRNM bleeding.
Results
A total of 22,135 apixaban and 45,840 warfarin patients with VTE were included in the analysis. Post-IPTW, patient characteristics were balanced between apixaban and warfarin treatment cohorts. Apixaban patients had significantly lower risk of recurrent VTE, MB, and CRNM bleeding compared to warfarin patients (Figure). When stratified by race, 57,008 (83.9%) were White, 7,832 (11.5%) Black, and 3,135 (4.6%) other races. For both treatment cohorts, age was similar between Black (77.0–77.2 years) and White (77.4–77.5 years) patients. However, Black patients were more likely to have an inpatient VTE event (77.3–77.8% vs. 63.1–63.3%), a provoked VTE event (78.6–79.5% vs 69.4–69.6%), and a higher comorbidity index score (mean 4.1 vs. 2.7) compared to White patients with VTE. The incidence rates per 100 person-years of recurrent VTE (2.0–3.3 vs 1.4–2.2) and MB (7.4–10.1 vs 3.5–5.3) were also numerically higher for Black patients compared to White patients. Across both race groups, apixaban patients had a lower incidence rate of recurrent VTE, MB and CRNM bleeding compared to warfarin patients. No significant interaction was observed between treatment and race for recurrent VTE, MB, or CRNM bleeding (Figure). The findings within each race group were consistent with those of the overall VTE population.
Conclusion
Among older VTE patients, disparities were observed in VTE characteristics and clinical outcomes between Black and White patients. Across both race groups, apixaban had lower risk of recurrent VTE, MB, and CRNM bleeding compared to warfarin patients. Further studies are needed to identify optimal management strategies for Black patients with VTE.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Pfizer IncBristol-Myers Squibb Company
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Effectiveness and safety of apixaban vs warfarin among venous thromboembolism patients using five US databases: a subgroup analysis of chronic liver disease. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Venous thromboembolism (VTE) is a serious disease in the United States affecting approximately 1 in 1000 patients each year. Patients with chronic liver disease (CLD) are at an increased risk of VTE and major bleeding (MB). Currently, insufficient clinical and real-world evidence exists on the efficacy/effectiveness and safety of apixaban or warfarin in VTE patients with CLD.
Purpose
To evaluate the risk of recurrent VTE, MB, and clinically relevant non-major (CRNM) bleeding among VTE patients initiating apixaban or warfarin stratified by CLD status.
Methods
VTE patients ≥18 years of age (≥65 years for Medicare) initiating apixaban or warfarin were identified from CMS Medicare and four commercial claims databases. To balance the characteristics between apixaban and warfarin patients, stabilized inverse probability treatment weighting (IPTW) was conducted. Post-IPTW, subgroup interaction analysis was conducted to evaluate whether treatment effects of apixaban vs. warfarin were consistent across patients with and without a diagnosis of CLD. Cox proportional hazard models were used to evaluate the interaction of the treatment (apixaban vs. warfarin) and CLD on recurrent VTE, MB, and CRNM bleeding. The statistical significance of the interaction was set to p-value <0.10.
Results
A total of 60,786 apixaban and 94,333 warfarin patients with VTE were eligible for analysis. Post-IPTW, all patient characteristics were balanced between the apixaban and warfarin treatment cohorts. Apixaban treated patients had significantly lower risk of recurrent VTE, MB, and CRNM bleeding compared to warfarin patients (Figure). In the IPTW weighted population, 4,766 (7.8%) apixaban patients and 6,320 (6.7%) warfarin patients had a diagnosis of CLD. For the apixaban or warfarin patients, those with a diagnosis of CLD were generally younger (mean 64.0–65.2 vs 66.9 years), had higher Charlson comorbidity index scores (mean 3.8–3.9 vs 2.1) and were more likely to have an inpatient VTE event (67.8–69.5% vs 53.0–53.2%) or provoked VTE events (66.2–67.8% vs 55.4–55.5%) compared to patients without a diagnosis of CLD. The incidence rate of recurrent VTE, MB, and CRNM bleeding was higher among VTE patients with CLD than without CLD and was also higher for patients treated with warfarin compared to those treated with apixaban regardless of CLD status (Figure). There were no significant interactions observed between treatment and CLD status for recurrent VTE, MB or CRNM (Figure).
Conclusion
Treatment with apixaban had a lower risk of recurrent VTE, MB, and CRNM bleeding compared to treatment with warfarin. The benefits of apixaban were consistently observed among subgroups of VTE patients with and without CLD. Additional studies are needed to evaluate VTE patients with CLD.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Bristol-Myers Squibb Company and Pfizer, Inc.
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127 Bubble Time: Assessing Right Ventricular Function with Point-of-Care Ultrasonography Using Saline Flushes. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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204 A Higher Initial VExUS Score Is Associated With Inferior Outcomes in Septic Emergency Department Patients. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.216] [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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303 The Interrater Reliability of Venous Excess Ultrasound Score by Emergency Physicians. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.317] [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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304 Lack of Early Left Ventricular Outflow Tract Velocity Time Integral Estimated Volume Responsiveness is Associated With Increased Morbidity and Mortality. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.318] [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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INCIDENCE, MITIGATION, AND MANAGEMENT OF NEUROLOGIC ADVERSE EVENTS IN PATIENTS WITH MULTIPLE MYELOMA TREATED WITH CILTACABTAGENE AUTOLEUCEL (CILTA-CEL) IN CARTITUDE-2. Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Rectal prolapse and abdominal compartment syndrome: Formerly unknown complications of hernia repair in a neonate. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Outreach and equity in patient centered outcomes research: Lessons from the adaptable study at Montefiore hospital. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.834] [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: 11/17/2022]
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PRELIMINARY RESULTS OF THE PHASE 2 STUDY OF ZANUBRUTINIB IN PATIENTS WITH PREVIOUSLY TREATED B‐CELL MALIGNANCIES INTOLERANT TO IBRUTINIB AND/OR ACALABRUTINIB. Hematol Oncol 2021. [DOI: 10.1002/hon.42_2880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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OP0219 THE ASSOCIATION OF PSORIATIC ARTHRITIS WITH ALL-CAUSE MORTALITY AND LEADING CAUSES OF DEATH IN PSORIATIC ARTHRITIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Data on the association between PsA and mortality remains conflicting as it has been hampered by small sample size with few events and the potential for confounders of selection and severity biases from clinic-based studies.Objectives:To examine the association between PsA and all-cause mortality in a cohort of PsA patients and matched controls, using data from a population-based large medical record database.Methods:Patients with newly diagnosis of PsA between January 1st, 2003 and December 31st, 2018 from the Clalit Health database were identified. 4 controls without PsA were selected and matched to cases of PsA by age (within 1 year), sex, ethnicity (Jewish vs. non-Jewish), and index date. The two groups were followed from the index date until the first occurrence of death from any cause or end of follow-up (June 30, 2019). Data on mortality and on the immediate cause of death was based on the Notification of Death form legally required by the Israeli Ministry of the Interior for every deceased person in the country. Demographic data including age, sex, ethnicity (Jewish or Arab), and socioeconomic status (SES) at inception were retrieved from the CHS database. Data regarding tobacco use (ever), obesity, body mass index, diabetes mellitus, hyperlipidemia, hypertension, ischemic heart disease, prior cerebrovascular accident, congestive heart failure, chronic renal failure, chronic obstructive pulmonary disease, cirrhosis, prior malignancy, psoriasis, and the concomitant use of glucocorticosteroids, conventional and biologic disease-modifying anti-rheumatic drugs (cDMARDs and bDMARDs, respectively) were extracted from the database.We estimated the attributable fraction of the various causes of death in PsA patients and compared it to the proportionate mortality rate (PMR) of the leading causes of death in Israel during 2014-2016 based on a recently published report by the Central Bureau of Statistics. Cox proportional hazard regression models were used to estimate the crude and the multivariate adjusted hazard ratio (HR) for the association between PsA and all-cause mortality, as well as for factors associated with mortality within the PsA group.Results:A total of 5275 PsA patients were identified between 2003 and 2018 and where matched to 21,011 controls based on age, sex, and ethnicity. The mean age was 51.7 ± 15.4 years of whom 53% were females. More individuals in the PsA group were smokers, obese, with diabetes, hypertension, and dyslipidemia, as well as with a history of ischemic heart disease, cerebrovascular disease, congestive heart failure, chronic obstructive pulmonary disease, chronic renal failure and cirrhosis than patients in the control group, and 38.2% of PsA patients were on b-DMARDS. Overall 471 (8.9%) patients died in the PsA group compared to 1,668 (7.9%) in the control group during a mean follow-up of 7.2 ± 4.4 years. The crude HR for the association of PsA and all-cause mortality was 1.16 (95% CI, 1.042-1.29). However, the association was not significant on multivariate analysis with HR of 1.096 (95% CI, 0.977-1.229).In PsA patients, malignancy was the leading cause of death, constituting 26% of all deaths, followed by ischemic heart disease 15.8%, diabetes 6.2%, cerebrovascular diseases 5.5% and septicemia 5.5%, in keeping with the order of the leading causes of death in the general population of Israel during 2014-2016 as recently reported by the Central Bureau of Statistics.On multivariate model Cox regression analysis, male sex, increased body mass index, increased Charlson comorbidity index scores and history of hospitalization in a year prior to death were associated with higher mortality, whereas treatment bDMARDs and cDMARDs were associated with a lower relative risk of death.Conclusion:No clinically relevant increase in mortality rate was observed in PsA patients from the period 2003-2018. The most common causes of specific proportionate mortality rates in our cohort were similar to those in the general population.Disclosure of Interests:None declared
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Three dimensional right cardiac cavities remodeling and functional tricuspid regurgitation at one year follow up in patients with atrial fibrillation. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2021. [DOI: 10.1016/j.acvdsp.2021.04.032] [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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POS0147 ANALYSIS OF VENOUS THROMBOEMBOLIC RISK AMONG PSORIATIC ARTHRITIS PATIENTS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Psoriatic arthritis (PsA) is a chronic, immune-mediated, systemic inflammatory arthritis associated with comorbidities including metabolic syndrome, cardiovascular risk factors and cardiovascular disease (CVD).Objectives:To evaluate the prevalence of venous thromboembolism (VTE) in a PsA patient cohort using a large health care provider database.Methods:A large health care provider database serving 4.7 million healthcare subscribers was interrogated for an adult patient cohort who were newly diagnosed with PsA between January 2005 (start date) and 31 December 2018 with date of diagnosis considered the index date. A risk set was employed to randomly select 4 controls without PsA as a comparator group to the PsA cohort matched by age, sex, ethnic group, and index date. Both groups were followed from the index date until the first occurrence of VTE event, death, or end of follow-up 31 December 2019, whichever came first. Marginal model with robust covariant estimate counting for the matching was used to estimate the crude and adjusted hazard ratio (HR) for the association between PsA and VTE. Within the group of PSA patients, Cox proportional hazard regression models was used to calculate the risk of having VTE given demographic variables, SES, smoking, selected comorbidities, and conventional vs biologic disease modifying anti-rheumatic drugs (c/bDMARD). Continuous variables were summarized with mean ± standard deviation, and categorical variables were presented as numbers and proportions. All tests were 2-sided; p values of < = 0.05 were considered statistically significant. All data were analyzed using SPSS, 24 (IBM SPSS Statistics for Windows, version 24.0, 2016, Armonk, NY) and SAS, 9.4 (SAS institute Inc, Cary, NC).Results:The PsA cohort consisted of 5,275 patients, 53.2% females with mean age of 51.66 ±15.41. The control group consisted of 21,011 subjects matched for age and sex. In relation to the control group, the PsA cohort had a higher SES (25.1% vs 23.4%, p<0.0001), higher tobacco use (42.2% vs.39.6% p<0.0001) and obesity (33.5% vs 25.8%, p<0.0001). The study group had a statistically significant higher incidence of diabetes (33.8% vs 26.2%, p<0.0001), IHD (10.3% vs 8.6%, p<0.0001), CHF (2.2% vs 1.6%, p=0.004), hypertension (30.1% vs 26.2%, p<0.0001), CVA/TIA (4.6% vs 3.9%, p=0.024) and vascular disease (3.7% vs 3.0%, p=0.005). There were 62 patients (1.2%) diagnosed with VTE in the PsA group as opposed to 176 patients (0.8%) in the control group (p=0.023, HR=1.397, CI 1.05-1.87). The mean age of patients diagnosed with VTE was higher in the PsA group relative to controls (64.90± 13.20 vs 51.54 ± 15.41, respectively, p<0.0001), with higher age, BMI>30, cancer, IHD, vascular disease, and previous VTE found to be associated with VTE in the PsA group relative to controls in both univariate and multivariate analyses. The higher prevalence of VTE in PsA patients relative to controls did not remain statistically significant in multivariate analysis following adjustment for risk factors. Within the PsA group, patients with VTE were more often of older age and with past history of VTE. Both cDMARD and bDMARD were not associated with increased risk of VTE among PsA patients.Conclusion:The prevalence of VTE was higher in PsA group compared to the general population, but after adjustment for comorbidities and risk factors, it no longer remained statistically significant. Among PsA patients, age and previous history of VTE were associated with increased risk of VTE. Addressing VTE risk in the management of patients with PsA is recommended especially in the era of Janus kinase inhibitors.Disclosure of Interests:None declared
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[Use of the SBAR tool: Assessment of the value of a short training course on the quality of communication between caregivers in the short and long term]. ACTA ACUST UNITED AC 2021; 49:823-829. [PMID: 33933673 DOI: 10.1016/j.gofs.2021.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Communication breakdown is one of the main causes of adverse events in clinical routine. The main objective of this study was to assess whether a short training course on medical communication based on the situation-background-assessment-recommendation (SBAR) tool improved the quality of communication in clinical practice. METHODS Interventional study, conducted at the Jeanne de Flandre maternity unit (Lille University Hospital, France) between January 2017 and December 2019. The training sessions lasted 1 hour and consisted of a theoretical part, based on the SBAR tool, and of a practical part (video-stimulated recall and role-play case scenarios). The main outcome measure was the evaluation of the quality of the telephone calls made by a caregiver to the on-call doctor, using a questionnaire completed before (Q1) and remotely from training (Q2). RESULTS One hundred and twenty health professionals were trained (n=120). Following the trainings, there was an improvement in communication in the short term, whether in terms of relevance (64.9 vs. 52.6, P<0.001) or conciseness of the message (36.9 vs. 32.2, P<0.001), but also in terms of long-term in a real clinical situation (Q2: 3.9 vs. Q1: 3.0, P<0.001). Finally, 81% of participants were satisfied with the training. CONCLUSIONS Short training sessions on communication based on the SBAR tool appeared to improve participants' knowledge and skills in the short-term, but also in the longer term in a real clinical situation.
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A157 REAL-WORLD TIGHT OBJECTIVE MONITORING WITH ADALIMUMAB LEADS TO EARLIER DOSE OPTIMIZATION AND HIGHER CLINICAL REMISSION RATES AT 12 MONTHS. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Data suggests that tight objective monitoring of inflammatory bowel diseases (IBD) may improve one-year clinical outcomes.
Aims
The goal of this study is to assess the adherence to serial tight objective monitoring, via clinical symptoms and biomarkers, and the effect of such tight monitoring on one year outcome in IBD patients at an academic and an university-affiliated center.
Methods
We retrospectively reviewed the chart of 428 consecutive IBD patients who started adalimumaby at the McGill University Health Center and Jewish General Hospital (Montreal, Canada) between January 1, 2015 and January 1, 2019 [338 Crohn’s disease(CD), 90 ulcerative colitis(UC)]. Clinical symptoms (assessed by Harvey-Bradshaw-Index and partial Mayo), C-Reactive Protein(CRP), and fecal calprotectin(FCAL) were captured at treatment initiation and at 3, 6, 9, and 12 months. Combined adherence was defined as the evaluation of ≥2 of 3 parameters(clinical, CRP, FCAL). Dose optimization and drug sustainability curves were plotted by Kaplan-Meier method.
Results
Clinical symptoms were assessed in nearly all patients at 3 (CD-UC:95-94%), 6 (90-83%), 9 (86-85%) and 12 (96-89%) months. CRP was also available for most patients but the frequency of assessment decreased in CD patients over the study period. In comparison, compliance to serial FCAL testing was low throughout the follow-up period. Clinical remission at one-year was significantly higher in patients who were adherent to early assessment visit at 3 months (p=0.001 both for CD and UC). Adherence to early follow-up also resulted in earlier dose optimisation in both CD and UC patients(pLogrank=0.026 for UC and p=0.09 for CD). However, the overall drug sustainability did not differ.
Conclusions
Clinical assessment and CRP, but not FCAL, were frequently assessed in patients starting adalimumab. Adherence to early objective combined follow-up visits resulted in earlier dose optimization and improved one-year clinical outcomes but did not change drug sustainability rates.
Funding Agencies
None
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Cardiovascular Comorbidities and Covid-19 in Women. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2021. [PMCID: PMC8719934 DOI: 10.1016/j.acvdsp.2020.10.254] [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] [Indexed: 11/05/2022]
Abstract
Background While women account for 40-50 % of patients hospitalized for coronavirus disease 2019 (Covid-19), no specific data have been reported in this population. Purpose Assess the burden of cardiovascular comorbidities on outcomes in women hospitalized for Covid-19. Methods We conducted a retrospective observational multicenter study from February 26 to April 20, 2020 in 24 French hospitals including all adults admitted for Covid-19. Primary composite outcome included transfer to intensive care unit (ICU) or in-hospital death. Results Among 2878 patients hospitalized for Covid-19, 1212 (42.1 %) were women. Women were significantly older (68.3 ± 18.0 vs. 65.4 ± 16.0 years, P < 0.001) but had less prevalent cardiovascular comorbidities than men. Among women, 276 (22.8 %) experienced the primary outcome, including 161 (13.3 %) transfer to ICU and 115 (9.5 %) deaths without transfer to ICU. The survival free from death or transfer to ICU was higher in women (HR 0.63, 95 %CI 0.53-0.73, P < 0.001), whereas the observed difference in in-hospital deaths did not reach statistical significance (P = 0.18). The proportion of women that experienced the primary outcome were 37.8 % in women with heart failure (n = 112), 30.9 % in women with coronary artery disease (n = 81), 29.1 % in women with diabetes (n = 254), 26.1 % in women with dyslipidemia (n = 315), and 26.0 % in women with hypertension (n = 632). Age (HR 1.05, 5 years increments, 95 %CI 1.01-1.10), body mass index (HR 1.06, 2 units increments, 95 %CI 1.02-1.10), chronic kidney disease (HR 1.57, 95 %CI 1.11-2.22), and heart failure (HR 1.52, 95 %CI 1.04-2.22) were independently associated with the primary outcome (Fig. 1). Conclusions Women hospitalized for Covid-19 were older and had less prevalent cardiovascular comorbidities than men. While female sex was associated with a lower risk of transfer to ICU or in-hospital death, Covid-19 remains associated with considerable morbi-mortality in women, especially in those with cardiovascular diseases.
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Pulmonary Embolism in Covid-19 patients: A French Multicentre Cohort Study. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2021. [PMCID: PMC8719940 DOI: 10.1016/j.acvdsp.2020.10.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background While pulmonary embolism (PE) appears to be a major issue in Covid-19, data remain sparse. Purpose We aimed to describe the risk factors and baseline characteristics of patients with PE in a large cohort of Covid-19 patients. Methods In a retrospective multicentric observational study, we included consecutive hospitalised patients for Covid-19. Patients without computed tomography pulmonary angiography (CTPA)-proven PE diagnosis, those who were directly admitted to an intensive care unit (ICU), and those still hospitalised without PE experience were excluded. Results Among 1240 patients (58.1% men, mean age 64 ± 17 years), 103 (8.3%) patients had PE confirmed by CTPA. The ICU transfer requirement and mechanical ventilation requirement were significantly higher in the PE group (P < 0.001 and P < 0.001, respectively). In an univariable analysis, traditional venous thromboembolic risk factors were not associated with PE (P > 0.05), while patients under therapeutic-dose anticoagulation before hospitalisation or prophylaxis-dose anticoagulation introduced during hospitalisation had lower PE occurrence (OR 0.40, 95%CI(0.14-0.91); P = 0.04 and OR 0.11, 95%CI(0.06-0.18); P < 0.001, respectively). In a multivariable analysis, the following variables (also statistically significant in univariable analysis) were associated with PE: male gender (OR 1.03, 95%CI(1.003-1.069); P = 0.04), anticoagulation with prophylaxis-dose (OR 0.83, 95%CI(0.79-0.85), P < 0.001) or therapeutic-dose (OR 0.87, 95%CI(0.82-0.92), P < 0.001), C-reactive protein (OR 1.03, 95%CI(1.01-1.04), P = 0.001) and time from symptom onset to hospitalisation (OR 1.02, 95%CI(1.006-1.038), P = 0.002) (Table 1). Conclusion Pulmonary embolism risk factors in Covid-19 context do not include traditional thromboembolic risk factors but rather independent clinical and biological findings at admission, including a major contribution to inflammation.
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Reducing salinity of treated waste water with large scale desalination. WATER RESEARCH 2020; 186:116322. [PMID: 32854030 DOI: 10.1016/j.watres.2020.116322] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/07/2020] [Accepted: 08/19/2020] [Indexed: 06/11/2023]
Abstract
Agriculture, the largest global water consumer, accounts for ~70% of freshwater use thereby considerably influencing water availability. The use of treated wastewater [TWW] for agricultural irrigation has been suggested as a possible solution to help mitigate water scarcity without disrupting food production. However, despite the benefits of TWW irrigation, it is often characterized by high salinity that can reduce crop performance and damage soil structure. In Israel, over 50% of the water used for irrigation is TWW, and a third of the produced TWW undergoes soil aquifer treatment [SAT], i.e., infiltration and percolation to groundwater through the soil before utilization for irrigation. In parallel, seawater desalination provides about 80% of the urban and industrial sector water use. These developments in Israel's water economy during the last three decades, accompanied by extensive governmental monitoring, enabled us to harness high-resolution nation-wide datasets to study the effects of the large-scale introduction of desalination and SAT on TWW quality and salinity in particular. The analyses revealed that large-scale desalination considerably reduced the salinity of TWW to levels similar to freshwater (up to 70% and 60% for Cl and Na, respectively). However, sodium absorption ratio remained unchanged due to the concurrent reductions of Na, Ca and Mg. Mg was reduced to levels that can potentially harm both crops and human health, while B concentrations increased to levels of possible toxicity to crops, suggesting the need for stringent requirements in the post-treatment process. Salinity of groundwater was increased by SAT in the long-term, but was reduced after the introduction of desalination. The results, encompassing almost three decades of water monitoring, suggest that high-quality TWW with a significant portion of desalinated base-water can provide groundwater salinity remediation services.
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