Hepatitis C Virus Clearance and Diffusing Capacity for Carbon Monoxide in Women With and Without Human Immunodeficiency Virus

Hepatitis C virus (HCV) infection is associated with extrahepatic effects, including reduced diffusing capacity of the lungs. It is unknown whether clearance of HCV infection is associated with improved diffusing capacity. In this sample of women with and without human immunodeficiency virus, there was no association between HCV clearance and diffusing capacity.

Two-Year Outcomes of Valoctocogene Roxaparvovec Therapy for Hemophilia A

BACKGROUND

Valoctocogene roxaparvovec delivers a B-domain-deleted factor VIII coding sequence with an adeno-associated virus vector to prevent bleeding in persons with severe hemophilia A. The findings of a phase 3 study of the efficacy and safety of valoctocogene roxaparvovec therapy evaluated after 52 weeks in men with severe hemophilia A have been published previously.

METHODS

We conducted an open-label, single-group, multicenter, phase 3 trial in which 134 men with severe hemophilia A who were receiving factor VIII prophylaxis received a single infusion of 6×10¹³ vector genomes of valoctocogene roxaparvovec per kilogram of body weight. The primary end point was the change from baseline in the annualized rate of treated bleeding events at week 104 after receipt of the infusion. The pharmacokinetics of valoctocogene roxaparvovec were modeled to estimate the bleeding risk relative to the activity of transgene-derived factor VIII.

RESULTS

At week 104, a total of 132 participants, including 112 with data that were prospectively collected at baseline, remained in the study. The mean annualized treated bleeding rate decreased by 84.5% from baseline (P<0.001) among the participants. From week 76 onward, the trajectory of the transgene-derived factor VIII activity showed first-order elimination kinetics; the model-estimated typical half-life of the transgene-derived factor VIII production system was 123 weeks (95% confidence interval, 84 to 232). The risk of joint bleeding was estimated among the trial participants; at a transgene-derived factor VIII level of 5 IU per deciliter measured with chromogenic assay, we expected that participants would have 1.0 episode of joint bleeding per year. At 2 years postinfusion, no new safety signals had emerged and no new serious adverse events related to treatment had occurred.

CONCLUSIONS

The study data show the durability of factor VIII activity and bleeding reduction and the safety profile of valoctocogene roxaparvovec at least 2 years after the gene transfer. Models of the risk of joint bleeding suggest that the relationship between transgene-derived factor VIII activity and bleeding episodes is similar to that reported with the use of epidemiologic data for persons with mild-to-moderate hemophilia A. (Funded by BioMarin Pharmaceutical; GENEr8-1 ClinicalTrials.gov number, NCT03370913.).

Magnetic resonance imaging (MRI) in evaluation of left atrial masses: an in vitro and in vivo study

Thirty patients, 15 each of suspected of left atrial myxoma and clot were studied in a prospective study to assess the role of magnetic resonance imaging (MRI) in evaluation of left atrial masses. Upon clinical and echocardiographic suspicion of a left atrial mass, patients were subjected to ECG-gated MRI (in vivo study) and subsequently all of them underwent surgery for the removal of mass and/or mitral valve replacement/repair. Within 6 hours of its removal the mass was subjected to in vitro MRI study and subsequently to histopathological examination. During the study T1, T2 gated images were obtained and tissue characterization was done. A magnetic dye Gd-DTPA was used for contrast enhancement. Cine-display of the images was obtained to demonstrate dynamic movement of the mass across the mitral valve. MRI was found to be highly useful in delineating the exact anatomical details of left atrial masses. Results of MRI diagnosis with illustrations are discussed.

Dimensions of potential arterial grafts for coronary artery bypass grafting in Indians--an autopsy evaluation study

Total revascularization of the heart using as many arterial grafts as possible is the trend of the day. We have chosen two commonly used arterial grafts to evaluate their efficiency in myocardial revascularization in Indian subjects. An autopsy study was conducted in 25 cases. Both internal mammary arteries with their branches and the right gastroepiploic artery were harvested. These arteries were distended with heated Gelatin, deep frozen and their diameters were measured. In 56% of subjects diameter of internal mammary artery was 1.5 to 2.0 mm (n = 14). However 36% of subjects had diameter above 2.0 mm (n = 9). Musculo-phrenic and superior epigastric arteries had 1.85 and 1.65 mm internal diameters respectively. The mean internal diameter of right gastro-epiploic artery was 2.3 mm. When these diameters were indexed to the body surface area, they were comparable with similar figures from western subjects.

The importance of pesticides in Indian food production

A brief background of Indian agriculture, climate, crops and cropping patterns will help in understanding the problems of pests and diseases and their magnitude. The geographical area of India is 326-9 million hectares and about 78-45 million hectares are under forests and about 14 million hectares are under permanent pasture and grazing lands. The total cropped area is 156-7 million hectares, out of which 20-5 million hectares are sown more than once, leaving a net cultivated area of 136-2 million hectares. In addition, about 4-6 million hectares are put to miscellaneous tree crops and orchards.