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POS1334 OCULAR CICATRICIAL PEMPHIGOID: IS THERE AN ASSOCIATION WITH AUTOIMMUNE DISEASES? Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1425] [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
BackgroundOcular Cicatricial Pemphigoid (OCP) is an infrequent, systemic cicatricial immune-mediated disease, belonging to the group of membranous-mucosal pemphigoids (MMP). Due to the possibility of coexistence of multiple autoimmune diseases (ADs), OCP could be associated with other diseases. In the literature, association of OCP and ADs is reported in 9-35% of patients, but most reports correspond to MMP.ObjectivesTo assess the prevalence of autoimmune diseases associated with OCP and to analyse clinical, laboratorial and treatment associations between these entities.MethodsA multicentre cross-sectional study of patients with a diagnosis (clinical and/or by biopsy) of OCP derived from ophthalmology was performed.The population was divided into two groups according to their association or not with other ADs. Clinical, laboratorial and treatment variables were described and compared between both groups. In addition, a multivariate descriptive logistic regression analysis was performed to identify variables that could suggest the association between OCP and ADs.ResultsA total of 88 patients were recruited, 66 (75%) females, with a mean age at diagnosis of 64.3 years (SD 11.9). The median follow-up time was 1 year. The diagnosis was done by biopsy in 86,8%. Ocular bilateral disease was present in 95,3% of patients. There was a median delay from symptoms onset to diagnosis of 2 years. A history of malignancy was reported in 13,6%. Extraocular involvement was evidenced in 11,5% (4% compromised skin and 9,1% other mucous membranes). Regarding the previous clinical findings, no statistically significance was found between the groups with and without ADs. Systemic treatment was depicted as follows: oral corticosteroids (60,2%) (p-value < 0.001), corticosteroids pulses (5,7%), dapsone (3,4%), methotrexate (79,5%), mycophenolate (15,9%), azathioprine (23,9%), rituximab (5,7%), immunoglobulin (1,1%); topical corticosteroids (96,6%) and ocular infiltration (2,3%). The group associated ADs included 24 patients (27.3%). Within them, the most prevalent diagnosis was Sjogren’s syndrome (13.6%), followed by Hashimoto´s thyroiditis (9,1%) and rheumatoid arthritis (3,4%). Most of the patients presented Foster stages 1 (45.3%) and 2 (29.3%) at diagnosis. In the ADs group, statistically significant associations were observed with ANA, SS-A and SS-B antibodies, rheumatoid factor, and hypergammaglobulinemia. In the descriptive multivariate logistic regression model, it was detected that hypergammaglobulinemia was associated with ADs and OCP, adjusted for age, sex, smoking, skin and mucosal involvement, and erythrocyte sedimentation rate (OR 8.7; 95% CI 1.6 to 46.8; p= 0.012), Table 1.Table 1.Multiple logistic regression analysis with OCP associated with ADs as dependent variable.ORCI95P valueGender0.20.04 - 1.10.07Age at diagnosis1.020.9 - 1.10.25Smoking0.50.1 - 1.70.26Skin and mucosa compromise1.20.2 - 8.20.83ESR0.980.95 - 1.020.58Hypergammaglobulinemia8.71.6 - 46.80.012ESR: Erythrocyte Sedimentation Rate. OR: Odd Ratio. CI95: confidence intervalConclusionDue to the autoimmune nature of OCP, it could coexist with other ADs. In this research, it was observed that more than a quarter of the population presented with such association and hypergammaglobulinemia could suggest it. A systematic search for this coexistence should be carried out to avoid sequelae or incomplete treatment in pathologies that are currently potentially treatable.References[1]Lamberts A et al. European guidelines on diagnosis and management of mucous membrane pemphigoid, initiated by the European Academy of Dermatology and Venereology – Part I. 2021;1750–64.[2]Schmidt E et al. European Guidelines on diagnosis and management of mucous membrane pemphigoid, initiated by the European Academy of Dermatology and Venereology – Part II. 2021;1926–48.[3]Narla S, Silverberg JI. Associations of pemphigus or pemphigoid with autoimmune disorders in US adult inpatients. J Am Acad Dermato. 2019;15-25.AcknowledgementsOn behalf of the Study Working Group of Rheumatological Ocular Diseases, Argentinian Society of Rheumatology.Disclosure of InterestsNone declared
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Putting patients at the center of kidney care transitions: PREPARE NOW, a cluster randomized controlled trial. Contemp Clin Trials 2018; 73:98-110. [PMID: 30218818 PMCID: PMC6679594 DOI: 10.1016/j.cct.2018.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/28/2018] [Accepted: 09/07/2018] [Indexed: 12/21/2022]
Abstract
Care for patients transitioning from chronic kidney disease to kidney failure often falls short of meeting patients' needs. The PREPARE NOW study is a cluster randomized controlled trial studying the effectiveness of a pragmatic health system intervention, 'Patient Centered Kidney Transition Care,' a multi-component health system intervention designed to improve patients' preparation for kidney failure treatment. Patient-Centered Kidney Transition Care provides a suite of new electronic health information tools (including a disease registry and risk prediction tools) to help providers recognize patients in need of Kidney Transitions Care and focus their attention on patients' values and treatment preferences. Patient-Centered Kidney Transition Care also adds a 'Kidney Transitions Specialist' to the nephrology health care team to facilitate patients' self-management empowerment, shared-decision making, psychosocial support, care navigation, and health care team communication. The PREPARE NOW study is conducted among eight [8] outpatient nephrology clinics at Geisinger, a large integrated health system in rural Pennsylvania. Four randomly selected nephrology clinics employ the Patient Centered Kidney Transitions Care intervention while four clinics employ usual nephrology care. To assess intervention effectiveness, patient reported, biomedical, and health system outcomes are collected annually over a period of 36 months via telephone questionnaires and electronic health records. The PREPARE NOW Study may provide needed evidence on the effectiveness of patient-centered health system interventions to improve nephrology patients' experiences, capabilities, and clinical outcomes, and it will guide the implementation of similar interventions elsewhere. TRIAL REGISTRATION NCT02722382.
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Cell-cycle characteristics - alterable determinants of remission duration in a study of 179 standard risk newly diagnosed patients with acute myeloid-leukemia. Int J Oncol 2012; 2:301-7. [PMID: 21573555 DOI: 10.3892/ijo.2.2.301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Prognostic factors were related to remission duration among 179 standard risk newly diagnosed acute myeloid leukemia (AML) patients who received identical induction and consolidation therapies. Following a bromodeoxyuridine infusion, labeling indices of bone marrow aspirate/biopsy, durations of S-phase and cell cycle (Tc) were determined. Patients with slowly cycling myeloblasts had longer remissions (Log rank p=0.03) than those with rapidly cycling myeloblasts. Multivariate analysis demonstrated that both WBC and Tc contributed to remission duration (p=0.01 and 0.005 respectively). Patients with slowly proliferating leukemias have longer remissions probably due to slower regrowth of leukemia between chemotherapy courses.
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DOSE-VOLUME RELATIONSHIP FOR LUNG CANCER INDUCTION AFTER RADIOTHERAPY FOR HODGKIN'S DISE ASE. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)73249-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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158 Respiratory gated radiotherapy in daily practice. Radiother Oncol 2005. [DOI: 10.1016/s0167-8140(05)81134-x] [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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128 Daily patient setup checks using on-board-imaging. Radiother Oncol 2005. [DOI: 10.1016/s0167-8140(05)81104-1] [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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How to improve communication on vaccine issues at the national level? INFOVAC-PED: an example from Switzerland. Vaccine 2001; 20 Suppl 1:S98-S100. [PMID: 11587825 DOI: 10.1016/s0264-410x(01)00305-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
For physicians in private practice, rapid access to relevant and up-to-date objective information is required to better meet their clients' concerns on vaccine-related issues. To meet this need, INFOVAC-PED, an academic network of on call pediatric infectious diseases experts who can be reached free of charge at a central e-mail address, now answers Swiss physicians' questions within 24-48h. INFOVAC-PED also distributes monthly bulletins including news from the Federal Office of Public Health, vaccine producers, literature survey, and answers to most frequently asked questions. The rapid success of this novel initiative underlines the need to better support front line physicians.
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Lack of changes in serum prolactin, FSH, TSH, and estradiol after melatonin treatment in doses that improve sleep and reduce benzodiazepine consumption in sleep-disturbed, middle-aged, and elderly patients. J Pineal Res 2001; 30:34-42. [PMID: 11168905 DOI: 10.1034/j.1600-079x.2001.300105.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
An open pilot study on the safety and efficacy of melatonin in the treatment of insomniac patients was conducted in 22 subjects (16 females), mean +/- S.D. age 60.1 +/- 9.5 years. All patients received 3 mg of gelatin melatonin capsules per os daily for 6 months, 30 min before expected sleep time. Twenty of 22 patients were on benzodiazepine treatment and they continued this treatment for part of or for the entire melatonin administration period. Serum concentrations of prolactin, follicle-stimulating hormone (FSH), thyroid-stimulating hormone (TSH), or estradiol were measured by radioimmunoassay (RIA) in morning samples at the beginning and after 6 months of melatonin administration, and standard clinical laboratory tests for blood components were performed. Urinary 6-sulphatoxymelatonin (aMT6s) excretion was measured by RIA before treatment. Serum concentrations of prolactin, FSH, TSH, or estradiol did not exhibit changes after 6 months of melatonin administration, nor were any indications of hematologic or blood biochemistry alteration found. Melatonin augmented significantly the quality and duration of sleep, and decreased sleep latency and the number of awakening episodes, as assessed from sleep logs filled by the patients (first 21 days) and from structured interviews performed by incumbent physicians (up to 6 months). Estimates of next-day function (i.e., alertness in the morning and during the day) also improved significantly during melatonin treatment. The observed effect lasted for the entire period examined (up to 6 months), with 22 out of 22 patients showing improved sleep at the end of treatment. The urinary excretion of aMT6s before starting administration of melatonin correlated negatively and significantly with age, but not with the intensity of sleep the disorder or the outcome of treatment. In 13 of 20 patients taking benzodiazepines together with melatonin, benzodiazepine use could be stopped, and in another four patients, benzodiazepine dose could be decreased to 25-66% of the initial dose. The results of this open, subacute administration trial indicate that melatonin is a safe and useful treatment for sleep disturbances in middle-aged or elderly patients, either by itself or together with benzodiazepines.
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A brief view of known landmarks reorientates path integration in hamsters. THE SCIENCE OF NATURE - NATURWISSENSCHAFTEN 2000; 87:494-8. [PMID: 11151669 DOI: 10.1007/s001140050766] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In darkness, hamsters commute between their nest and a feeding site through path integration only, and therefore show cumulative errors in the return direction to the nest. We examined whether a brief presentation of familiar room cues could reset the path integrator. The hamsters could see the room cues either during, or at the end of, the outward journey to the food place, in a conflict situation where motion cues and visual information were set at variance. In both conditions, the animals used mainly visual information to return home. Thus, hamsters can determine their azimuth, and possibly their location, through a visual fix, and can reset their path integrator through the fix. This allows them to update their position during further locomotion in the dark and thus to compute a correct homing vector with respect to a visually induced reference frame. Taking episodic positional fixes may greatly enhance the functional value of path integration.
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In situ localization of transforming growth factor beta and S-phase cells in patients with acute myeloid leukemia and myelodysplastic syndrome. Anticancer Res 1992; 12:403-7. [PMID: 1580558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In situ localization of transforming growth factor beta (TGF-B) was accomplished in 16 acute myeloid leukemia (AML) and 11 myelodysplastic syndrome (MDS) cases. A modified and greatly shortened procedure for immunohistochemical localization of TGF-B using a monoclonal antibody was undertaken in plastic embedded bone marrow biopsy sections that demonstrated excellent preservation of morphologic detail. In addition, a double-label procedure was developed for the simultaneous detection of TGF-B and cells actively engaged in DNA-synthesis which were labeled in vivo by infusing thymidine analogues. Marked variation in intensity of TGF-B staining in interstitial areas of biopsies was noted among different patients. TGF-B was also conspicuously present in the basement membrane of blood vessel endothelial cells and the cytoplasm of megakaryocytes. Double-labeling revealed that S-phase cells in a number of MDS cases appeared clustered together and that megakaryocytes in S-phase were completely devoid of TGF-B.
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Biological significance of cell cycle kinetics in 128 standard risk newly diagnosed patients with acute myelocytic leukemia. Br J Haematol 1991; 79:33-9. [PMID: 1911386 DOI: 10.1111/j.1365-2141.1991.tb08003.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Bromodeoxyuridine (BrdU) was administered to 128 newly diagnosed patients with standard risk acute myelocytic leukaemia (AML) for cell cycle measurements. Labelling indices (LI) were obtained from both the bone marrow aspirate (BMasp) and biopsies (bx) and durations of S-phase (Ts) and total cell cycle time (Tc) were measured by double-labelling the S-phase cells in vitro with tritiated thymidine. Median LI BMasp was 8% and from BMbx was 25%. The median Ts was 12 h (range 3.1-35 h) and Tc was 48 h (range 11.5-211 h). All patients received induction therapy with a combination of cytosine arabinoside and an anthracycline. Outcome of therapy or FAB type were not related to cell cycle characteristics. Patients with above median LI BMasp, however, had longer remission durations (P = 0.03) as did patients with above median Ts (P = 0.03) and Tc (P = 0.03). Upon longer follow-ups, even some of the patients with slowly cycling myeloblasts have relapsed (log rank P = 0.453 and 0.203 for Ts and Tc respectively). We conclude that patients with rapidly cycling cells tend to relapse faster; however, slowly cycling nature of myeloblasts is not associated with curability.
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