Neutrophil-to-lymphocyte ratio (NLR) variations in relationship with childhood maltreatment in patients with anorexia nervosa: a retrospective cohort study

PURPOSE

Anorexia nervosa (AN) is a serious mental illness. It is frequently accompanied by a history of childhood maltreatment (CM) that may constitute a specific ecophenotype in patients with eating disorders necessitating special assessment and management. This retrospective study tested whether in patients with AN, CM-related chronic stress may manifest through low-grade inflammation reflected by an increase in white blood cell ratios (neutrophil-to-lymphocyte ratio, NLR, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio).

METHODS

Participants (N = 206) were enrolled at an eating disorder daycare unit in Montpellier, France, from March 2013 and January 2020. CM was assessed using the childhood trauma questionnaire (CTQ). The Eating Disorder Examination Questionnaire (EDE-Q) and the MINI were used to assess AN severity and the other clinical characteristics, respectively.

RESULTS

NLR was higher in patients with AN and history of CM (p = 0.029) and in patients with AN and history of emotional abuse (p = 0.021), compared with patients with AN without history of CM. In multivariate analysis, emotional abuse (β = 0.17; p = 0.027) contributed significantly to NLR variability.

CONCLUSION

In patients with AN, NLR is a low-grade inflammation marker that is influenced by various sociodemographic, clinical and biological factors. It is more directly affected by some CM types, especially emotional abuse, than by the presence/absence of CM history. Future studies should focus on mediators between CM and increased inflammation, such as interoceptive awareness, emotional dysregulation, food addiction, and stress sensitization.

LEVEL OF EVIDENCE

III. Evidence obtained from well-designed cohort or case-control analytic studies.

Increasing COVID-19 Vaccination in the United States: Projected Impact on Cases, Hospitalizations, and Deaths by Age and Racial Group

Objectives

Minority populations in the United States face a disproportionate burden of illness from COVID-19 infection and have lower vaccination rates compared with other groups. This study estimated the equity implications of increased COVID-19 vaccination in the United States, with a focus on the number of cases, hospitalizations, and deaths avoided.

Study design

This was an observational real-world modeling study.

Methods

Data from the Centers for Disease Control and Prevention (CDC) were used to identify the remaining unvaccinated US population by county, age, and race as of October 22, 2021. The number of COVID-19 cases, hospitalizations, and deaths avoided were calculated based on case incidence and death data from the CDC, along with data on race- and age-specific hospitalization multipliers, under a scenario in which half of the remaining unvaccinated population per county, race, and age group obtained a full vaccine regimen.

Results

Vaccinating half of the remaining unvaccinated population in each age and race subgroup within counties would result in an estimated 22.09 million COVID-19 cases avoided, 1.38 million hospitalizations avoided, and 150,000 deaths avoided over 12 months. Some minority groups, particularly Black and Hispanic/Latino populations, were projected to experience substantial benefits from increased vaccination rates as they face both lower vaccination rates and worse outcomes if infected with COVID-19.

Conclusions

Increasing COVID-19 vaccination in the United States not only benefits the population as a whole but also serves as a potentially useful lever to reduce the disproportionate burden of COVID-19 illness among minority populations.

Impact de l’épidémie de COVID-19 sur la couverture vaccinale antigrippale du personnel hospitalier

Introduction

La couverture vaccinale (CV) antigrippale des soignants hospitaliers en France est faible et très inférieure aux objectifs de l’OMS (≥ 75 %). Afin de réduire le potentiel impact cumulé d’une épidémie de grippe concomitante de celle de COVID-19, la HAS a réaffirmé la nécessité d’augmenter la CV antigrippale auprès des professionnels de santé. Nous avons cherché à évaluer l’impact de l’épidémie de COVID-19 sur la CV antigrippale du personnel hospitalier pour la saison 2020-2021.

Matériels et méthodes

Nous avons réalisé un questionnaire informatique diffusé dans six centres hospitaliers du 12 janvier au 28 février 2021. La diffusion s’est faite via la messagerie électronique des salariés de l’hôpital et des étudiants des 2^e et 3^e cycles de médecine ainsi que par une affiche contenant un QR-code renvoyant au questionnaire en ligne et disposé dans certains services.

Résultats

Parmi les 1930 réponses analysées, 74,6 % étaient celles de femmes (n = 1440) et la moyenne d’âge était de 40 ans. Il y avait 1492 professionnels de santé (77,3 %) : 457 médecins, 205 internes, 63 sages-femmes (SF), 314 infirmiers, 106 cadres, 89 aides-soignants (AS), 81 pharmaciens ou préparateurs en pharmacie et 177 personnes exerçant une autre profession paramédicale. Il y avait 148 étudiants (7,7%) et 290 personnes exerçant une profession non médicale (15,0 %). La CV antigrippale du personnel hospitalier répondant était de 65,1% (n = 1257) contre 41,3% (n = 798) l’année précédente soit une augmentation de 57,5% de la CV. Les hommes étaient plus vaccinés (74,9 %) que les femmes (61,8 %). Les personnes de 50 ans et plus étaient vaccinées à 72,6 % (n = 373) contre 62,4% (n = 884) pour les moins de 50 ans. La CV des professionnels de santé était de 68,1% (n = 1016), contre 44,6 % l’année passée (n = 666). Les médecins et internes étaient vaccinés respectivement à 81,8 % (n = 374) et 80,0 % (n = 164), les SF à 60,3 % (n = 38), les infirmiers à 55,1 % (n = 173), les AS à 43,8 % (n = 39) et les cadres à 76,4 % (n = 81). Les pharmaciens et préparateurs en pharmacie étaient vaccinés à 66,7% (n = 54), les étudiants à 64,9 % (n = 96), le personnel exerçant une autre profession paramédicale à 52,5 % (n = 93) et ceux exerçant une profession non médicale à 50,0 % (n = 145). Les trois principales motivations à la vaccination antigrippale étaient de se protéger (90,1 % [n = 1133]), de protéger ses proches (88,7 % [n = 1115]) et de protéger les patients (86,7 % [n = 1090]). Parmi les 535 personnes vaccinées cette année mais non vaccinées l’année dernière, 58,9% (n = 315) ont estimé que l’épidémie de COVID-19 les avait incités à se faire vacciner.

Conclusion

Nous constatons une forte augmentation de la CV antigrippale quels que soient la classe d’âge, le genre et la profession. Les médecins sont les professionnels qui se vaccinent le plus, atteignant même l’objectif de CV établit par l’OMS. Il semble que l’épidémie de COVID-19 et les mesures d’incitation vaccinale antigrippale associées aient contribué à cette augmentation.

PI3K functions as a hub in mechanotransduction

Mammalian cells integrate different types of stimuli that govern their fate. These stimuli encompass biochemical as well as biomechanical cues (shear, tensile, and compressive stresses) that are usually studied separately. The phosphatidylinositol 3-kinase (PI3K) enzymes, producing signaling phosphoinositides at plasma and intracellular membranes, are key in intracellular signaling and vesicular trafficking pathways. Recent evidence in cancer research demonstrates that these enzymes are essential in mechanotransduction. Despite this, the importance of the integration of biomechanical cues and PI3K-driven biochemical signals is underestimated. In this opinion article, we make the hypothesis that modeling of biomechanical cues is critical to understand PI3K oncogenicity. We also identify known/missing knowledge in terms of isoform specificity and molecular pathways of activation, knowledge that is needed for clinical applications.

[Alcohol consumption and head and neck cancer]

Alcohol is often considered as a simple co-factor, potentiating the carcinogenic effect of tobacco, in head and neck cancer. However, its own effect is less clear. It has been recognized by the International Agency for Research on Cancer (IARC) as a risk factor for head and neck cancer for many years. It seems that the risk is a function of the importance of consumption, with certain genetic predispositions. This risk can also decrease if consumption stops, with a prolonged interruption. In addition, alcohol consumption may have a negative influence on the prognosis of patients with this type of cancer. A preventive action is therefore essential, among other things via information to the patient provided by health providers.

Impact of bipolar disorder on eating disorders severity in real-life settings

BACKGROUND

Comorbidity of bipolar disorder (BD) and eating disorders (ED) is common and increases the course and severity of BD. However, the impact of comorbid BD on the clinical profile of ED patients remains unclear. Most studies have focused on patients primarily assessed for BD and data on patients with a primary diagnosis of ED are sparse. We investigated the association between a dual diagnosis and severity in terms of clinical, neuropsychological dimensions and daily functioning.

METHOD

Two hundred and sixty-one patients with ED were consecutively recruited. BD was screened with the MINI and further confirmed in the French expert centre network. The severity of ED symptoms was assessed with the EDE-Q and EDI-2, daily functioning with the FAST. The neurocognitive assessment targeted attention, set-shifting and decision-making.

RESULTS

Forty-nine patients screened positive for BD, but diagnosis was confirmed in only thirty patients (11.5% of the cohort). After multiple adjustments, comorbidity was associated with greater severity on the total score and three subscales of the EDE-Q and on four of the ten dimensions of the EDI-2. Comorbid BD was associated with lower daily functioning but not with lower neuropsychological performance.

LIMITATIONS

Sample referred to specialist clinics not large enough to authorize an analysis by subtype and cross-sectional evaluation.

CONCLUSION

The association between ED and BD increases ED severity for most of these core features. It negatively impacts daily functioning. The results also highlight issues about the validity of screening tools to detect BD in patients with ED.

[Platypnea, orthodeoxia… A report of two cases]

The plathypnea orthodeoxia syndrome is a rare condition that is characterized by dyspnea and hypoxia that occurs in the upright position and improves with recumbency. The diagnostic is often made tardively and requires the combination of two components: a mechanical one (for example a patent foramen ovale) and a kinetic one (for example COPD). This combination contributes to the blood flow through the communication. The treatment consists of closing the veno-arterial communication (in the case of a patent foramen ovale, the closing of the inter-atrial septum) (Knapper et al, 2014). In the present article, we describe two severe hypoxemic patients suffering from this syndrome. Both cases were associated with an acute pulmonary disease. A review of the literature is performed.

Is Serum Serotonin Involved in the Bone Loss of Young Females with Anorexia Nervosa?

Recent experimental data suggest that circulating serotonin interacts with bone metabolism, although this is less clear in humans. This study investigated whether serum serotonin interferes with bone metabolism in young women with anorexia nervosa (AN), a clinical model of energy deprivation. Serum serotonin, markers of bone turnover [osteocalcin (OC), procollagen type I N-terminal propeptide (PINP), type I-C telopeptide breakdown products (CTX)], leptin, soluble leptin receptor (sOB-R), and insulin-like growth factor-1 (IGF-1) and its binding protein (IGFBP-3) were assessed. Whole body, spine, hip, and radius areal bone mineral density BMD (aBMD) were assessed by dual-energy X-ray absorptiometry in 21 patients with AN and 19 age-matched controls. Serum serotonin, leptin, IGF-1, IGFBP-3, OC, PINP, and aBMD at all sites, radius excepted, were significantly reduced in AN whereas CTX and sOB-R were increased compared with controls. Serum serotonin levels were positively correlated with weight, body mass index, whole body fat mass, leptin, and IGF-1, and negatively with CTX for the entire population. Low serum serotonin levels are observed in patients with AN. Although no direct link between low serum serotonin levels and bone mass was identified in these patients, the negative relationship between serotonin and markers of bone resorption found in all population nevertheless suggests the implication of serotonin in bone metabolism. Impact of low serum serotonin on bone in AN warrants further studies.

Evidence of a link between resting energy expenditure and bone remodelling, glucose homeostasis and adipokine variations in adolescent girls with anorexia nervosa

Low bone mass is a consequence of anorexia nervosa (AN). This study assessed the effects of energy deficiency on various bone and hormonal parameters. The interrelationships between energy deficiency and bone remodelling, glucose homeostasis and adipokines underscore the importance of preventing energy deficiency to limit demineralisation and hormonal alterations in AN patients.

INTRODUCTION

Low areal bone mineral density (aBMD) is a well-known consequence of AN. However, the impact of reduced energy expenditure on bone metabolism is unknown. This study assessed the effects of energy deficiency on bone remodelling and its potential interactions with glucose homeostasis and adipose tissue-derived hormones in AN, a clinical model for reduced energy expenditure.

METHODS

Fifty women with AN and 50 age-matched controls (mean age 18.1 ± 2.7 and 18.0 ± 2.1 years, respectively) were enrolled. aBMD was determined with DXA. Resting energy expenditure (REEm), a marker of energy status, was indirectly assessed by calorimetry. Bone turnover markers, undercarboxylated osteocalcin (ucOC), parameters of glucose homeostasis, adipokines and growth factors were concomitantly evaluated.

RESULTS

AN patients presented low aBMD at all bone sites. REEm, bone formation markers, ucOC, glucose, insulin, HOMA-IR, leptin and IGF-1 were significantly reduced, whereas the bone resorption marker, leptin receptor (sOB-R) and adiponectin were elevated in AN compared with CON. In AN patients, REEm was positively correlated with weight, BMI, whole body (WB) fat mass, WB fat-free soft tissue, markers of bone formation, glucose, insulin, HOMA-IR, leptin and IGF-1 and negatively correlated with the bone resorption marker and sOB-R. Biological parameters, aBMD excepted, appeared more affected by the weight variation in the last 6 months than by the disease duration.

CONCLUSIONS

The strong interrelationships between REEm and bone remodelling, glucose homeostasis and adipokines underscore the importance of preventing energy deficiency to limit short- and long-term bone demineralisation and hormonal alterations in AN patients.

Transport of indirect excitons in ZnO quantum wells

We report on spatially- and time-resolved emission measurements and observation of transport of indirect excitons in ZnO/MgZnO wide single quantum wells.

The neuron-derived orphan receptor 1 (NOR1) is induced upon human alternative macrophage polarization and stimulates the expression of markers of the M2 phenotype

BACKGROUND

Atherosclerosis is an inflammatory disease in which macrophages play a crucial role. Macrophages are present in different phenotypes, with at the extremes of the spectrum the classical M1 pro-inflammatory and the alternative M2 anti-inflammatory macrophages. The neuron-derived orphan receptor 1 (NOR1), together with Nur77 and Nurr1, are members of the NR4A orphan nuclear receptor family, expressed in human atherosclerotic lesion macrophages. However, the role of NOR1 in human macrophages has not been studied yet.

OBJECTIVES

To determine the expression and the functions of NOR1 in human alternative macrophages.

METHODS AND RESULTS

In vitro IL-4 polarization of primary monocytes into alternative M2 macrophages enhances NOR1 expression in human but not in mouse macrophages. Moreover, NOR1 expression is most abundant in CD68+MR+ alternative macrophage-enriched areas of human atherosclerotic plaques in vivo. Silencing NOR1 in human alternative macrophages decreases the expression of several M2 markers such as the Mannose Receptor (MR), Interleukin-1 Receptor antagonist (IL-1Ra), CD200 Receptor (CD200R), coagulation factor XIII A1 polypeptide (F13A1), Interleukin 10 (IL-10) and the Peroxisome Proliferator-Activated Receptor (PPAR)γ. Bioinformatical analysis identified F13A1, IL-1Ra, IL-10 and the Matrix Metalloproteinase-9 (MMP9) as potential target genes of NOR1 in human alternative macrophages. Moreover, expression and enzymatic activity of MMP9 are induced by silencing and repressed by NOR1 overexpression in M2 macrophages.

CONCLUSIONS

These data identify NOR1 as a transcription factor induced during alternative differentiation of human macrophages and demonstrate that NOR1 modifies the alternative macrophage phenotype.

Light-emitting-diodes based on ordered InGaN nanocolumns emitting in the blue, green and yellow spectral range

The growth of ordered arrays of InGaN/GaN nanocolumnar light emitting diodes by molecular beam epitaxy, emitting in the blue (441 nm), green (502 nm), and yellow (568 nm) spectral range is reported. The device active region, consisting of a nanocolumnar InGaN section of nominally constant composition and 250 to 500 nm length, is free of extended defects, which is in strong contrast to InGaN (planar) layers of similar composition and thickness. Electroluminescence spectra show a very small blue shift with increasing current (almost negligible in the yellow device) and line widths slightly broader than those of state-of-the-art InGaN quantum wells.

VIS-UV ZnCdO/ZnO multiple quantum well nanowires and the quantification of Cd diffusion

We report on the growth and microstructure analysis of high Cd content ZnCdO/ZnO multiple quantum wells (MQW) within a nanowire. Heterostructures consisting of ten wells with widths from 0.7 to 10 nm are demonstrated, and show photoluminescence emissions ranging from 3.03 to 1.97 eV. The wells with thicknesses ≦̸2 nm have high radiative efficiencies compared to the thickest ones, consistent with the presence of quantum confinement. However, a nanometric analysis of the Cd profile along the heterostructures shows the presence of Cd diffusion from the ZnCdO well to the ZnO barrier. This phenomenon modifies the band structure and the optical properties of the heterostructure, and is considered in order to correctly identify quantum effects in the ZnCdO/ZnO MQWs.

[Swallowing in disorders of consciousness]

INTRODUCTION

Interest in studying swallowing disorders in patients with altered consciousness has increased over the past decade. Swallowing deficit is frequently encountered in severe brain-injured patients.

STATE OF ART

Results of studies have highlighted different factors such as the delay between the injury and the treatment and the level of consciousness of these patients, as well as the presence or not of tracheotomy, which will determine the feasibility of resuming oral feeding. Nowadays, very few valid and sensitive scales can be used to assess swallowing deficit in patients with disorders of consciousness. The Facial Oral Tract Therapy (FOTT) scale is an inter-professional multidisciplinary approach offering a structured way to evaluate and treat patients with swallowing disorders. In contrast with other scales, patients do not have to follow verbal instructions for the FOTT.

PERSPECTIVES

This paper presents a review of existing literature on the assessment and management of swallowing disorders in patients with altered state of consciousness, and a description of the FOTT method.

CONCLUSION

The FOTT seems to be an interesting assessment and rehabilitation tool for patients with disorders of consciousness. However, clinical studies are needed to confirm the validity and sensitivity of this technique.

Micro Epitaxial lateral overgrowth of GaN/sapphire by Metal Organic Vapour Phase Epitaxy

GaN/sapphire layers have been grown by Metal Organic Vapour Phase Epitaxy (MOVPE). An amorphous silicon nitride layer is deposited using a SiH4/NH3 mixture prior to the growth of the low temperature GaN buffer layer. Such a process induces a 3D nucleation at the early beginning of the growth, resulting in a kind of maskless ELO process with random opening sizes. This produces a significant decrease of the threading dislocation (TD) density compared to the best GaN/sapphire templates. Ultra Low Dislocation density (ULD) GaN layers were obtained with TD density as low as 7×107cm−2 as measured by atomic force microscopy (AFM), cathodoluminescence and transmission electron microscopy (TEM). Time-resolved photoluminescence experiments show that the lifetime of the A free exciton is principally limited by capture onto residual donors, similar to the situation for nearly dislocation-free homoepitaxial layers.

Exciton dynamics in thick GaN MOVPE epilayers deposited on sapphire

Time-resolved photoluminescence spectra have been recorded on three GaN epitaxial layers of thickness 2.5 μm, 7 μm and 16 μm, at various temperatures ranging from 8K to 300K. The layers were deposited by MOVPE on (0001) sapphire substrates with standard AlN buffer layers. To achieve good homogeneities, the growth was in-situ monitored by laser reflectometry. All GaN layers showed sharp excitonic peaks in cw PL and three excitonic contributions were seen by reflectivity. The recombination dynamics of excitons depends strongly upon the layer thickness. For the thinnest layer, exponential decays with τ ~ 35 ps have been measured for both XA and XB free excitons. For the thickest layer, the decay becomes biexponential with τ1 ~ 80 ps and τ2 ~ 250 ps. These values are preserved up to room temperature. By solving coupled rate equations in a four-level model, this evolution is interpreted in terms of the reduction of density of both shallow impurities and deep traps, versus layer thickness, roughly following a L−1 law.

Time-resolved photoluminescence studies of InGaN/GaN multiple quantum wells

We report both cw and time resolved optical investigations performed on an InGaN/GaN multiple quantum well grown by MOVPE on <0001>-oriented sapphire substrate. At low temperature we find a strong “blue” luminescence band, of which energy position corresponds well with the wavelength of stimulated emission when excited with a nitrogen laser. We show that this PL band appears systematically red-shifted with respect to the QWs features, which supports a standard picture of fluctuations of the indium composition. Coming to the time-resolved data, we find at low temperature at least two “blue” band components which are both associated with long decay times (up to 4-5 ns at 8K). The decay time is temperature dependent and, when rising the temperature, the recombination rate increases. At room temperature, we reach typical values in the range ~100 to 500 ps.

Risk factors associated with myocardial infarction in venous thromboembolism patients

BACKGROUND

Although risk factors for MI have been described in the general population, there is a lack of data on the assessment of risk factors associated with MI in venous thromboembolism (VTE) patients.

OBJECTIVE

The purpose of this study was to identify risk factors associated with MI in VTE patients.

PATIENTS AND METHODS

Health insurance claims between January 2004 and September 2008 from the Ingenix IMPACT database were analyzed. Patients aged ≥18 years were identified as of the date of their first VTE diagnosis with ≥1 year of continuous insurance coverage before the index VTE. The risk of MI for VTE patients with 1, 2, and ≥3 major risk factors as identified by published guidelines was calculated. Multivariate Cox proportional hazard models were conducted to identify the most predictive risk factors associated with MI.

RESULTS

A total of 177,885 VTE patients were identified; 4412 (2.5%) developed an MI during a mean follow-up period of 1.3 years. Previous MI, age (≥65 years), and coronary artery disease were the most predictive risk factors of MI with adjusted hazard ratios (HRs; 95% CI) of 5.47 (5.01-5.97), 1.78 (1.66-1.91), and 1.60 (1.48-1.74), respectively. Adjusted HRs (95% CI) for VTE patients with 1, 2, and ≥3 major risk factors relative to no major risk factor were 2.34 (1.94-2.81), 3.21 (2.67-3.85), and 6.93 (5.85-8.22), respectively.

LIMITATIONS

These included possible inaccuracies or omissions in diagnoses, classification bias such as the identification of false-positive MI events, and the likely undercoding of some risk factors such as social issues.

CONCLUSIONS

Traditional major cardiovascular risk factors are also predictive of MI in VTE patients. Having multiple major risk factors significantly increases the probability of developing MI events in VTE patients.

In-hospital risk of venous thromboembolism and bleeding and associated costs for patients undergoing total hip or knee arthroplasty

OBJECTIVE

Benefits of anti-coagulation for venous thromboembolism (VTE) prevention in total hip and knee arthroplasty (THA/TKA) may be offset by increased risk of bleeding. The aim was to assess in-hospital risk of VTE and bleeding after THA/TKA and quantify any increased costs.

METHODS

Healthcare claims from the Premier Perspective(TM) Comparative Hospital Database (January 2000-September 2008) were selected for subjects ≥ 18 years with ≥ 1 diagnosis code for THA/TKA. VTE was defined as ≥ 1 code for deep vein thrombosis or pulmonary embolism. Bleeding was classified as major/non-major. Incremental in-hospital costs associated with VTE and bleeding were calculated as cost differences between inpatients with VTE or bleeding matched 1:1 with inpatients without VTE or bleeding.

RESULTS

A total of 820,197 inpatient stays were identified: 8042 had a VTE event and 7401 a bleeding event (2740 major bleeding). The risks of VTE, any bleeding, and major bleeding were 0.98, 0.90, and 0.33/100 inpatient stays, respectively. Mean incremental in-hospital costs per inpatient were $2663 for VTE, $2028 for bleeding, and $3198 for major bleeding.

LIMITATIONS

These included possible inaccuracies or omissions in procedures, diagnoses, or costs of claims data; no information on the amount of blood transfused or decreases in the hemoglobin level to evaluate bleeding event severity; and potential biases due to the observational design of the study.

CONCLUSIONS

In-hospital risk and incremental all-cause costs with THA/TKA were higher for VTE than for bleeding. Despite higher costs, major bleeding occurred less frequently than VTE, suggesting a favorable benefit/risk profile for VTE prophylaxis in THA/TKA.

Recombination Dynamics in Nitride Quantum Boxes and Quantum Wells for Colors Ranging from the UV to the Red

Time-resolved photoluminescence experiments at varying temperature are performed on a series of InxGa1−xN/GaN quantum well and quantum box samples of similar compositions (0.15 < x < 0.20). The results are analyzed by using envelope-function calculations of transition energies and oscillator strengths, accounting for internal electric fields. The respective influences of localization and electric fields on radiative and nonradiative lifetimes and on the Stokes shift are deduced. The results indicate that the spatial extension of localization centers is much smaller than the size of the quantum boxes (∼10 × 3 nm, typically). The room-temperature radiative efficiency of both quantum well and quantum box samples is enhanced by replacing the topmost GaN barrier by an AlGaN one.

Real-world clinical resource utilization of metastatic prostate cancer patients in the United States: Results from two large claims databases

204

Background: In metastatic prostate cancer (MPC) patients, treatment options include hormonal therapies, chemotherapy, and radiotherapy. This study quantifies the real-world healthcare resource utilization of MPC patients.

Methods: Health insurance claims from 40 self-insured companies across the US (Employer [E]; 01/1999-02/2009), and from the Medicare 5% ([M]; 1999-2008) databases were analyzed. Patients with a metastasis diagnosis (ICD-9: 196-199) following 2 prostate cancer diagnoses (ICD-9: 185, V10.46) within 365 days were identified. Patients with other malignant diagnoses at baseline, defined as 365 days prior to metastasis diagnosis (index date), were excluded. Patients were evaluated for baseline medical history and for chemotherapy, hormonal agents, radiation, and corticosteroids utilization during both baseline and observation periods. Hospitalization rates and prostate cancer-related procedures post index date were also reported.

Results: The study population comprised 11,725 patients (E: 3,227; M: 8,498). Mean age (SD) was 72.8 (10.2) in Employer and 78.1 (7.7) in Medicare. Mean observation period (SD) was 803 (753) days in Employer and 9.2 (8.2) quarters in Medicare. During the baseline period, chemotherapy, hormonal agents, radiation therapy, and corticosteroids were administered to 5%, 52%, 9%, and 21% of Employer, and 2%, 45%, 8%, and 12% of Medicare patients respectively, whereas these interventions increased to 22%, 55%, 39%, and 46% for Employer, and to 21%, 50%, 33%, and 29% for Medicare during the observation period. A total of 66% Employer and 79% Medicare patients were hospitalized post index date. Most patients (E: 92%; M: 98%) had prostate cancer-related procedures, including prostate specific-antigen testing (E: 39%; M: 80%), computerized axial tomography scan (E: 72%; M: 81%), prostate biopsy (E: 47%; M: 54%), X-ray (E: 11%; M: 64%), bone scan (E: 56%; M: 60%), and magnetic resonance imaging scan (E: 35%; M: 37%).

Conclusions: This observational study describes real-world utilization patterns in patients with advanced prostate cancer.

[Table: see text]

Rhinomanometry and acoustic rhinometry in rhinoplasty

Acoustic rhinometry (AR) and rhinomanometry (RMM) study two different parameters of nasal ventilation: respiratory function and the anatomy of nasal cavities. This article looks at their usefulness, in particular in the surgical field. We list the normal values for these tests. Nasal obstruction is a symptom of multifactorial origin. Nasal patency is only one factor influencing the sensation of nasal ventilation. Despite the range of divergent opinions in both the literature and among rhinological clinicians, the objective assessment of nasal patency in functional rhinoplasty or septorhinoplasty seems to be advisable. The roles of AR and RMM still have to be established.

Evaluation of Cardiac Comorbidities in Patients with Metastatic Breast Cancer Receiving Doxorubicin-Based and Non-Doxorubicin-Based Chemotherapy

Background: Some metastatic breast cancer (MBC) treatments are associated with cardiac toxicity. Real-world data regarding baseline cardiac comorbidities in patients with MBC prior to chemotherapy initiation are scarce. Such information would be useful in guiding treatment decisions. This study aims to describe the cardiac comorbidity profile of patients with MBC initiating doxorubicin-based (DOX) versus non-doxorubicin-based (Non-DOX) chemotherapy regimens from a managed-care perspective.Methods: Medical claims from the Ingenix Impact National Managed Care Database between 07/2002 and 06/2008 were analyzed. Patients included were aged ≥ 18 years, and had ≥ 2 diagnoses for breast cancer as well as ≥ 1 diagnosis for metastatic site within 12 months of chemotherapy initiation. Cardiac comorbidities [hypertension (HTN), cardiac arrhythmia (CAr), coronary artery disease (CAD), congestive heart failure (CHF), and myocardial infarction (MI)] were evaluated within 6 months prior to chemotherapy initiation. Patients were categorized based on receipt of DOX vs. Non-DOX-based chemotherapy.Results: A total of 12,345 patients (Non-DOX: 7,023, DOX: 5,322) formed the study population. Compared with the DOX group, the Non-DOX group was slightly older. Both groups reported a significant proportion of patients with cardiac comorbidities prior to chemotherapy, with significantly greater proportions reported in the Non-DOX group. Mean age (SD)HTNCArCADCHFMINon-DOX (n=7,023)56.9 (10.6)35.7%11.8%5.5%3.5%1.3%DOX (n=5,322)52.1 (9.1)30.8%8.1%3.3%2.0%0.5%P-value&lt;.001&lt;.001&lt;.001&lt;.001&lt;.001&lt;.001 Conclusions: Cardiac comorbidities were commonly reported in women with MBC prior to chemotherapy, with significantly greater proportions reported in the Non-DOX group. Such information is useful to healthcare professionals when considering potential interventions for patients with MBC.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2078.

Detection of prostate cancer recurrence using an ultrasensitive nanoparticle-based PSA assay

e16146

Approximately 400,000 men are diagnosed each year with prostate cancer worldwide, and many of those patients undergo radical prostatectomy in an attempt to cure the disease. Although prostatectomy is effective for a majority of patients, approximately 15 to 40 % will experience prostate cancer recurrence within 5 years, and a majority of those patients will die from the disease (JAMA. 2008;299:2760-2769). Currently, prostate cancer recurrence is determined by monitoring prostate specific antigen (PSA) levels in patients following treatment, and those patients whose PSA levels rise above the clinical cutoff of 200 pg/mL PSA are defined as having recurrent prostate cancer. For those that do recur and have high PSA doubling times, early salvage radiotherapy confers a significant increase in prostate cancer specific survival (1). We have developed an ultrasensitive assay that measures PSA levels with a limit of detection of 0.5 pg/mL PSA with a CV of less than 20 % at 2 pg/mL. This assay utilizes functionalized gold nanoparticles to label PSA targets captured onto antibody coated glass substrates. The amount of PSA is quantified through silver enhancement of the functionalized gold. In this presentation, we describe the application of this technology in monitoring PSA levels in patients that are approximately 400 fold below the current clinical cutoff as a means of diagnosing prostate cancer recurrence at a much earlier timepoint than current assays.

[Table: see text]

Comparison of epoetin alfa (EPO) and darbepoetin alfa (DARB) utilization in cancer chemotherapy patients treated in a hospital outpatient setting

e17524

Background: With recent changes in erythropoiesis-stimulating agent (ESA) labeling and coverage limitations by the Centers for Medicare and Medicaid Services, it is important to examine the evolution of EPO and DARB real-world utilization in cancer patients receiving chemotherapy in a hospital outpatient setting. Methods: Electronic outpatient records (2006–2007) from >500 hospitals in the Premier Perspective Comparative Hospital Database were analyzed. Subjects were ≥18 years, had ≥1 cancer diagnosis, received chemo during newly initiated ESA therapy, and ≥2 doses during the treatment episode (classified by quarter of ESA initiation). Mean cumulative dose and dose ratio of EPO:DARB were calculated. 2% of patients with extreme doses were excluded. Results: 7,259 outpatient treatment episodes were identified (EPO 3,568;DARB 3,691). EPO patients were slightly younger (years; EPO 62.7;DARB 64.0, p<.0001), had lower proportion of women (EPO 62.2%;DARB 65.4%, p=0.0044), and had slightly longer mean treatment duration (EPO 3.1 months; DARB 2.9 months, p=0.0009) compared to DARB patients. Mean cumulative dose (SD) per treatment episode was EPO 263,582 (210,167) Units and DARB 1,005 (678) mcg, corresponding to a dose ratio of 262:1 (Units EPO: mcg DARB). Over time, mean cumulative dose, mean treatment duration, and dose ratio reflected a downward trend for both groups ( Table ). Conclusions: This analysis reported a mean dose ratio of 262:1 (Units EPO: mcg DARB) in cancer chemotherapy patients from a hospital outpatient setting. Recent changes in ESA prescribing information and coverage appear to have decreased ESA utilization and the EPO: DARB dose ratio over time.

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An atypical case of Whipple's disease: case report and review of the literature

We report the case of a 57-year-old man, presenting with bilateral panuveitis, bilateral sacroiliitis, intermittent pyrexia and a pulmonary nodule. The patient had been under immunosuppressive treatment for 2 years for Behçet's disease. However, he did not fulfill the diagnostic criteria of Behçet's disease. Blood analysis showed a very high C reactive protein (CRP at 34 mg/dl). In view of severe intra-ocular inflammation, the anterior chamber was punctured. Polymerase chain reaction (PCR) on the aqueous humour and on the blood revealed the presence of Tropheryma whippelii DNA, an agent responsible for Whipple's disease. The patient was treated with ceftriaxone followed by trimethoprim-sulfamethoxazol for 1 year with good clinical and biological evolution. This case illustrates the difficulty to diagnose an atypical Whipple's disease. In cases of uveitis with atypical signs and/or not responding to the treatment, the internist must consider to perform an analysis of the ocular fluids.

Treating the anemia of MDS with erythropoietin: Impact of higher dose compared to combination with G/GM-CSF

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Background: Recombinant human erythropoietin (EPO) is extensively used to improve erythropoiesis and reduce transfusions in anemic MDS pts. The addition of G/GM-CSF to EPO alfa or beta has been associated with higher erythroid response (ER) rates vs. EPO alone. Studies suggest higher ER rates could be achieved with EPO monotherapy if higher initiation doses were used. To study this question a meta-analysis was performed on studies of MDS pts treated with EPO alfa or beta + G/GM-CSF. Methods: Data extraction was performed on studies from PubMed, ASCO and ASH proceedings from 1990–2006 in MDS pts treated with EPO (alfa or beta) ± G/GM-CSF. To allow for cross comparisons, only studies including IWG or IWG-like ER criteria were selected for analysis. Pooled estimates of ER rates were calculated using fixed-effect (F-E) meta-analysis methods. Results were stratified by: (i) EPO-alfa at standard doses, (ii) EPO- alfa at high doses, (iii) EPO-alfa + G/GM-CSF, and (iv) EPO-beta + G/GM-CSF. Results: From 39 studies identified, 19 met inclusion criteria. Most pts (>55%) had RA/RARS. Studies using EPO-alfa at standard doses showed comparable ER rates to studies using EPO- alfa + G/GM-CSF (49.0% vs. 50.6%; p=0.731) ( Table ). Among EPO-alfa studies, those using higher EPO doses had higher ER rates vs. studies using standard EPO doses (p<0.001) or EPO + G/GM-CSF combination (p=0.007). Overall ER rates were not available for studies using EPO- beta + G/GM-CSF, however, 52 pts (37.7%) had major ER, similar to that observed in all EPO-alfa monotherapy studies (195/589=33.1%). Conclusions: These findings suggest increasing EPO-alfa dose may have a greater impact on ER than addition of G/GM-CSF. Further validation is warranted.

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Costs associated with intravenous (IV) chemotherapy administration in patients with lung cancer

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Background: The IV method of chemotherapy administration imposes not only a time burden on patients and facilities, but also has cost implications for payers. This study aims to assess the costs associated with the IV administration of chemotherapies for patients with all forms of lung cancer and for a subset of patients with small cell lung cancer (SCLC) in a large employer-payer claims database. Methods: Using medical claims data from 5.5 million beneficiaries between 01/01/1998 and 01/31/2006, we identified 8,605 patients with lung cancer (ICD-9 codes 162.3–162.9, 176.4, or 197.0) receiving IV chemotherapies. We then identified a subset of 942 patients likely to have SCLC by selecting those receiving chemotherapy regimens primarily used to treat SCLC and excluding patients receiving procedures and treatments often associated with NSCLC. Average total costs per day of IV chemotherapy administration (including drug, administration costs, etc.) were computed for all patients and for the SCLC subset based on the actual amount paid. Costs were also computed separately for: IV chemotherapy drugs, IV chemotherapy administration procedures, and other drugs and services such as IV administration of other drugs to treat side effects of chemotherapies, evaluation and management, and laboratory tests. Results: Average total cost per day of IV chemotherapy administration for all patients was $1,112, with $652 (59%) attributable to IV chemotherapy drugs, $85 (8%) to IV chemotherapy administration procedures, and $375 (34%) to other drugs and services. Among patients with SCLC, average total daily cost was $815, with $423 (52%) attributable to IV chemotherapy drugs, $89 (11%) to IV chemotherapy administration, and $303 (37%) to other drugs and services. Conclusions: IV chemotherapy administration procedures and other visit-related services accounted for 42% and 48% of total costs in patients with all forms of lung cancer and those with SCLC, respectively. The increased availability and use of oral chemotherapy drugs in lung cancer should provide savings to payers by avoiding the costs associated with IV administration.

No significant financial relationships to disclose.

Tinnitus: from cochlear to cortical

Tinnitus is presented in view of translational research from research to clinical application.

Ericksonian hypnosis in tinnitus therapy

OBJECTIVE

To evaluate the effect of Ericksonian therapy on tinnitus

STUDY DESIGN

Non-randomised, prospective longitudinal study.

SETTING

Tertiary referral centre.

PATIENTS

A total of 49 patients underwent hypnosis therapy. Fourteen patients failed to finish the therapy (drop-out rate: 35%). Of the 35 patients who completed the therapy, 20 were male and 15 female. The average age was 46.3 years (range 17-78).

INTERVENTION

The treatment is based on the principles and approaches of Ericksonian hypnosis. The first session was mainly dedicated to the evaluation of the impact of tinnitus on the patient's life and to an explanation of hypnosis therapy. The next sessions were "learning sessions" based on relaxation and mental imaging. Exercises were first based on all senses other than hearing. Then they focused on hearing, teaching patients how to modulate sound intensity, and finally how to modulate tinnitus intensity. Patients also learnt self-hypnosis.

MAIN OUTCOME MEASURE(S)

To evaluate the effect of the treatment, tinnitus was assessed with the Tinnitus Handicap Inventory questionnaire before and after the therapy.

RESULTS

After 5 to 10 sessions (mean: 8.09 + -1.92) of Ericksonian hypnosis therapy, the 35 patients were capable of self-hypnosis with the aim of modulating their tinnitus, and the measured THI score fell for all patients. The global score improved significantly from 60:23 before EH therapy to 16.9 at discharge. Within the group, the initial score was distributed as follows: 0% slight, 14% mild, 31% moderate, 31% severe and 23% catastrophic. The t-test for dependent variables revealed significant improvements in all subgroups (p < or = 0.005).

CONCLUSIONS

The results of this clinical trial demonstrate that Ericksonian hypnosis, in particular using self-hypnosis, is a promising technique for treating patients with tinnitus.