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Relevant bibliographies by topics / 621.389 28 / Journal articles
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Author: Grafiati
Published: 4 June 2021
Last updated: 12 February 2022
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1
Komrokji,RamiS., AmyE.DeZern, Katrina Zell, NajlaH.AlAli, Christopher Estling, Cassie Zimmerman, Wesley Hand, et al. "Validation of International Working Group (IWG) Response Criteria in Higher-Risk Myelodysplastic Syndromes (MDS): A Report on Behalf of the MDS Clinical Research Consortium (MDS CRC)." Blood 126, no.23 (December3, 2015): 909. http://dx.doi.org/10.1182/blood.v126.23.909.909.
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Introduction The primary goal for treatment of higher-risk MDS patients (pts) is to improve overall survival (OS) and delay acute myeloid leukemia (AML) evolution. The IWG 2006 response criteria are used in clinical trials and in clinical practice for assessing efficacy of MDS therapies. These criteria were originally proposed by an international group of experts based on available data and consensus. In an ad hoc landmark analysis of the AZA-001 study using the 2006 IWG criteria, pts who achieved hematological improvement (HI), complete response (CR), marrow CR (mCR), or partial response (PR) demonstrated improved OS. The aim of this study is to validate the IWG 2006 response criteria among a large cohort of higher-risk MDS pts. Methods Pts with higher-risk MDS (intermediate-2 (Int-2) or High Risk by International Prognostic Scoring System (IPSS)) who had received treatment and for whom details of response and outcome were available were included from the MDS CRC database. Pts were also classified per IPSS-R. The best response to treatment was categorized per the published IWG 2006 response criteria as CR, PR, mCR, HI, stable disease (SD) or progressive disease (PD). The primary endpoint was OS. Results We identified 646 treated higher-risk MDS pts. Table-1 summarizes baseline characteristics. The first line treatment was hypomethylating agent-based therapy (HMA) in 470 pts (74%). The median duration of follow up was 23.2 months (mo) (95% CI: (19.9, 26.5). Median OS from diagnosis was significantly longer for pts with int-2 IPSS risk disease IPSS (26.2 mo (21.5, 29.7)) compared to those who were High Risk (18.8 mo (15.9, 23.6); (p = 0.026). Median OS from diagnosis also differed by IPSS-R category (p < 0.001): for pts with Low risk (n = 6) it was not reached; Intermediate risk it was 41.7 mo (31.8, NR); High Risk it was 28.4 mo (24.1, 33.2); and for pts with Very High it was 16.5 mo (15.3, 19.1). The best IWG 2006 response rate for first line therapy among evaluable pts (n=597) was CR in 93 pts (16%), mCR in 10 (2%), PR in 57(10%), HI in 60 (10%), SD in 233 (39%), and PD in 144 (24%). The median OS based on IWG 2006 best response for first line therapy was 41 mo for CR, 12 mo for mCR, 26 mo for PR, 13 mo for HI, 14 mo for SD and 7 mo for PD. (p <0.001). CR was associated with better outcome compared to all other response groups. Pts with PR, HI, and SD had better outcome compared to PD, and similar outcome among the 3 groups. There was no difference in rate of AML transformation among response groups except in PD pts compared to others. For pts who were treated with HMA as first line therapy, the best response rates by IWG 2006 criteria were CR in 15%, mCR in 2%, PR in 10%, HI in 12%, SD in 40% and PD in 21%. Median OS in mo from time of HMA therapy based on response was: CR 19 (16.3, NR), mCR: 9 (7.1, NR), PR: 13 (8.8, NR), HI: 11 (7.7, 19.0), SD: 11.0 (8.5, 12.6), and PD: 3 (2.3, 3.9). (p <0.001) The best response by IWG 2006 criteria remained predictive of OS after adjusting for IPSS-R risk group. HR 0.30 (95% CI 0.2-0.4) for CR, and 0.57 (95% CI 0.45-0.7) for mCR/PR/HI compared to PD, (p <0.001) Conclusions: The best response by IWG 2006 criteria to first line therapy in higher-risk MDS correlates with OS. Pts who achieved CR had the best OS, while pts who achieved SD or better response had improved outcome compared to PD, with mCR having an OS equivalent to SD. The CR by IWG 2006 response criteria can be used as a surrogate endpoint for OS in higher-risk MDS pts in randomized Phase II studies determining comparison arms of Phase III trials, and for regulatory purposes. Table 1. Baseline characteristics Variable Total n=646 Age Median 68 Gender Male 399/645(62%) Race White 566/633 (89%) t-MDS Yes 161/545/514 (30%) WHO RA RARS RCMD RAEB-I RAEB-II MDS-U MDS/MPN CMML 5/527 (1%) 7/527 (1%) 69/527 (13%) 1153/527 (29%) 284/527 (54%) 3/527 (1%) 5/527 (1%) 1/527 (1%) IPSS Intermediate-II High 468/646 (72%) 178/646 (28%) R-IPSS Very low Low Intermediate High Very High 0 6/621 (1%) 74/621 (12%) 211/621 (34%) 330/621 (53%) IPSS karyotype Good Intermediate Poor 135/642 (21%) 118/642 (18%) 389 /642 (61%) IPSS-R karyotype Very good Good Intermediate Poor Very poor 7/642 (1%) 137/642 (21%) 134/642 (21%) 118/642 (18%) 246/642 (38%) Allogeneic transplant Yes 158/554 (29%) First line therapy HMA Chemotherapy IMiDClinical trial other 470/634 (74%) 57/634 (9%) 43/634 (7%) 25/634 (4%) 38/634 (6%) Lab (mean) Hgb (n=514) Platelets (n=514) ANC (n=514) Bone marrow blasts (n=639) 9.2 94 1.6 10% Disclosures Komrokji: Novartis: Research Funding, Speakers Bureau; Incyte: Consultancy; Pharmacylics: Speakers Bureau; Celgene: Consultancy, Research Funding. Steensma:Incyte: Consultancy; Amgen: Consultancy; Celgene: Consultancy; Onconova: Consultancy. Sekeres:TetraLogic: Membership on an entity's Board of Directors or advisory committees; Celgene Corporation: Membership on an entity's Board of Directors or advisory committees; Amgen: Membership on an entity's Board of Directors or advisory committees.
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Sutoro, NFN, and NFN Hadiatmi. "Perbanyakan Bibit Stek Umbi dan Uji Adaptabilitas Plasma Nutfah Garut (Marantha arundinaceae L.)." Buletin Plasma Nutfah 17, no.1 (October11, 2016): 1. http://dx.doi.org/10.21082/blpn.v17n1.2011.p1-11.
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<p>Multiplication of Propagated Tuber and Adaptability Test of Arrowroot Germplasm. Increasing arrowroot production needs technology production and variety suitable to the plant environment. Production constraints for arrowroot are seedling (stolon and tuber) limitation of cultivars adapted to the production area. Experiment had been carried out by using two factors (seedling source and variety) planted under randomized complete block design, three replications to study their germination capability. Three parts of seedlings source (tip, middle and basal part of tuber, 2 buds each) as first factor, and 10 varieties as second factor. Effect of seedling (stolon and tuber) of arrowroot and variety (10 accessions) were tested to study their adaptability had been done in 3 locations (Bogor, Cianjur and Serang). Seedling were planted at 50 cm x 40 cm, one row for each treatment. Tip-part and base-part of tuber showed better germination than middle-part of arrowroot tuber. There were effect of genotypic and environment interaction to tuber and starch yield. Accession No. 27 (Tasikmalaya), No. 28 (Gunung Kidul), No. 29 (Garut), No. 58 (Karawang), No. 387 (Banjarnegara), No. 403 (Banyumas), No. 478 (Brebes), dan No. 625 (Cilacap) could be categorized as stabil, while No. 626 (Cilacap) was more responsive while No. 627 (Malang) less responsive to environment changes.</p><p> </p><p><strong>Abstrak</strong></p><p>Peningkatan produksi garut memerlukan teknik budi daya dan varietas yang sesuai dengan lingkungan tumbuh tanaman. Salah satu kendala dalam peningkatan produksi garut adalah sulitnya mendapatkan bibit dalam jumlah relatif banyak dan terbatasnya varietas yang cocok di daerah pengembangan. Percobaan telah dilakukan dengan menggunakan rancangan acak kelompok lengkap dengan perlakuan dua faktor, dengan tiga ulangan. Faktor pertama adalah stek umbi dengan dua mata tunas pada bagian ujung, tengah, dan pangkal. Faktor kedua adalah 10 aksesi garut. Penelitian bertujuan untuk mengetahui adaptabilitas 10 aksesi plasma nutfah garut, dilaksanakan di tiga lokasi, yaitu di Bogor, Pacet, dan Serang. Bibit ditanam dengan jarak 60 cm x 40 cm, satu baris tanaman tiap perlakuan. Hasil percobaan menunjukkan bahwa persentase stek umbi yang tumbuh pada bahan pangkal dan ujung lebih tinggi daripada stek umbi bagian tengah. Aksesi No. 27 (Tasikmalaya), No. 28 (Gunung Kidul), No. 29 (Garut), No. 58 (Karawang), No. 387 (Banjarnegara), No. 403 (Banyumas), No. 478 (Brebes), dan No. 625 (Cilacap) dapat dikategorikan stabil, sedangkan aksesi No. 626 (Cilacap) lebih responsif, dan aksesi No. 627 (Malang) kurang responsif terhadap perubahan lingkungan.</p>
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Okumu, Mitchel, Minal Patel, Foram Bhogayata, Irene Olweny, Francis Ochola, and Joshua Onono. "Acute Poisonings at a Regional Referral Hospital in Western Kenya." Tropical Medicine and Infectious Disease 3, no.3 (September3, 2018): 96. http://dx.doi.org/10.3390/tropicalmed3030096.
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The emergency department (ED) of the Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) handles many cases of poisoning. However, there is scant information on the factors, agents, and outcomes of poisoning at the hospital. The aim of this work was to determine the factors, agents, and outcomes of poisoning at JOOTRH. Records of patients who presented to JOOTRH with symptoms of poisoning between January 2011 and December 2016 were retrieved. Data on age, gender, offending agents, time, and season of exposure were collected. Information on the route of exposure, motive, and clinical symptoms of poisoning was also included. Other information included the laboratory evaluation, first aid measures, period of hospitalization, and outcome of poisoning. Mean, standard deviation, frequencies and bar graphs were used to describe the demographic factors of the study population. Multivariate logistic regression was used to determine the strength of association between risk factors and outcome of poisoning among patients. The level of significance for inferential analysis was set at 5%. There were 385 cases of poisoning: 57.9% (223/385) were male, 31.9% (123/385) were 13–24 years of age, and 83.9% (323/385) of exposures were in Kisumu County. The peak time of exposure was 6:00–00:00, and 23.6% (91/385) presented 1–4 h after exposure. About 62.9% (242/385) of the cases were due to accidental poisoning. Snakebites and organophosphates (OPPs) contributed to 33.0% (127/385) and 22.1% (85/385) of all cases, respectively. About 62.1% (239/385) of exposures were oral, and 63.9% (246/385) of all cases occurred in the rainy season. Additionally, 49.2% (60/122) of intentional poisoning was due to family disputes, and 16.1% (10/62) of pre-hospital first aid involved the use of tourniquets and herbal medicine. About 28.6% (110/385) of the victims were subjected to laboratory evaluation and 83.9% (323/385) were hospitalized for between 1–5 days. Other results indicated that 80.0% (308/385) responded well to therapy, while 7.3% (28/385) died, 68% (19/28) of whom were male. Furthermore, 39.3% (11/28) of the deaths were related to OPPs. Our findings suggest that the earlier the victims of poisoning get to the hospital, the more likely they are to survive after treatment is initiated. Similarly, victims of poisoning due to parental negligence are more likely to survive after treatment compared to other causes of poisoning, including family disputes, love affairs, snakebites, and psychiatric disorders. The management of JOOTRH should consider allocating resources to support the development of poison management and control.
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Zaid,HarrasB., David Yang, MatthewK.Tollefson, Igor Frank, WilliamP.Parker, Robert Houston Thompson, R.JeffreyKarnes, and StephenA.Boorjian. "Safety and efficacy of extended-duration thromboembolic prophylaxis following radical cystectomy." Journal of Clinical Oncology 34, no.2_suppl (January10, 2016): 389. http://dx.doi.org/10.1200/jco.2016.34.2_suppl.389.
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389 Background: Venous thromboembolism (VTE) has been reported in approximately 5-7% of patients undergoing radical cystectomy (RC). While extended-duration pharmacologic prophylaxis (EDPP) has been investigated following surgery for a variety of malignancies, limited data exist in bladder cancer. Herein, we evaluated the efficacy and safety of EDPP after RC. Methods: We instituted a change in our clinical practice beginning in May 2014 such that patients undergoing RC were prescribed 30 days of enoxaparin at discharge. We recorded symptomatic VTE and lymphocele rates within 30 days of RC among patients treated from 5/14-6/15, and compared these outcomes to the cohort of all patients who underwent RC at our institution in the year prior to EDPP implementation. Patients in both groups received subcutaneous unfractionated heparin and mechanical prophylaxis during hospitalization. Patients with a history of VTE prior to surgery (n = 24) were excluded from study. Unadjusted descriptive statistics and univariate analyses were performed using the Pearson or Fisher chi-square test for categorical variables and Wilcoxon rank-sum test for continuous variables. Results: In total, 58 patients who received EDPP and 82 patients who had not received EDPP after RC were included for analysis. Baseline clinicopathologic demographics were similar between the cohorts. We found that only 1 patient (1.9%) discharged with EDPP was diagnosed with a VTE within 30 days of RC, compared to 5 (6.1%) who had not received EDPP. Mean time to VTE was 18.0 days after RC (range 9-28 days). Events consisted of DVT alone (n = 2), DVT and PE (n = 2), and PE alone (n = 2). The odds ratio for VTE in the absence of EDPP was 3.31 (95% CI 0.38, 29.2). Overall, 3 patients developed a symptomatic lymphocele within 30 days of RC: 1 (1.9%) who received EDPP and 2 (2.4%) who had not (p = 0.84). No patient in either cohort was rehospitalized for bleeding complications. Conclusions: Our initial experience suggests that EDPP was associated with a lower rate of VTE following RC, and does not increase the risks of bleeding or symptomatic lymphocele. Future evaluation in a larger-scale prospective clinical trial setting is needed to confirm the benefit of EDPP in RC patients.
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Zensen, Sebastian, Sumitha Selvaretnam, Marcel Opitz, Denise Bos, Johannes Haubold, Jens Theysohn, Michael Forsting, Nika Guberina, and Axel Wetter. "Differences in Radiation Exposure of CT-Guided Percutaneous Manual and Powered Drill Bone Biopsy." CardioVascular and Interventional Radiology 44, no.9 (May11, 2021): 1430–38. http://dx.doi.org/10.1007/s00270-021-02851-z.
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Abstract Purpose Apart from the commonly applied manual needle biopsy, CT-guided percutaneous biopsies of bone lesions can be performed with battery-powered drill biopsy systems. Due to assumably different radiation doses and procedural durations, the aim of this study is to examine radiation exposure and establish local diagnostic reference levels (DRLs) of CT-guided bone biopsies of different anatomical regions. Methods In this retrospective study, dose data of 187 patients who underwent CT-guided bone biopsy with a manual or powered drill biopsy system performed at one of three different multi-slice CT were analyzed. Between January 2012 and November 2019, a total of 27 femur (A), 74 ilium (B), 27 sacrum (C), 28 thoracic vertebrae (D) and 31 lumbar vertebrae (E) biopsies were included. Radiation exposure was reported for volume-weighted CT dose index (CTDIvol) and dose–length product (DLP). Results CTDIvol and DLP of manual versus powered drill biopsy were (median, IQR): A: 56.9(41.4–128.5)/66.7(37.6–76.2)mGy, 410(203–683)/303(128–403)mGy·cm, B: 83.5(62.1–128.5)/59.4(46.2–79.8)mGy, 489(322–472)/400(329–695)mGy·cm, C: 97.5(71.6–149.2)/63.1(49.1–83.7)mGy, 627(496–740)/404(316–515)mGy·cm, D: 67.0(40.3–86.6)/39.7(29.9–89.0)mGy, 392(267–596)/207(166–402)mGy·cm and E: 100.1(66.5–162.6)/62.5(48.0–90.0)mGy, 521(385–619)/315(240–452)mGy·cm. Radiation exposure with powered drill was significantly lower for ilium and sacrum, while procedural duration was not increased for any anatomical location. Local DRLs could be depicted as follows (CTDIvol/DLP): A: 91 mGy/522 mGy·cm, B: 90 mGy/530 mGy·cm, C: 116 mGy/740 mGy·cm, D: 87 mGy/578 mGy·cm and E: 115 mGy/546 mGy·cm. The diagnostic yield was 82.4% for manual and 89.4% for powered drill biopsies. Conclusion Use of powered drill bone biopsy systems for CT-guided percutaneous bone biopsies can significantly reduce the radiation burden compared to manual biopsy for specific anatomical locations such as ilium and sacrum and does not increase radiation dose or procedural duration for any of the investigated locations. Level of Evidence Level 3.
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BAILEY,J.S., N.J.STERN, P.FEDORKA-CRAY, S.E.CRAVEN, N.A.COX, D.E.COSBY, S.LADELY, and M.T.MUSGROVE. "Sources and Movement of Salmonella through Integrated Poultry Operations: A Multistate Epidemiological Investigation." Journal of Food Protection 64, no.11 (November1, 2001): 1690–97. http://dx.doi.org/10.4315/0362-028x-64.11.1690.
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The prevalence of Salmonella from numerous sources in 32 integrated broiler operations of high- and low-performing broiler houses was characterized from four states across four seasons. Previous studies of Salmonella in broilers have been limited in scope, offering only a snapshot of pathogen prevalence as seen on a small number of individual farms. Twenty-six different sample types were collected from the hatchery to the end of processing, and Salmonella was found in all sample types. A total of 10,740 samples were analyzed for Salmonella, and 973 (9.1%) of these samples, including 49 of 798 (6.1%) carcass rinse samples, were Salmonella positive. Hatchery transport pads (389 of 765, 50.8%), flies (28 of 150, 18.7%), drag swabs (57 of 402, 14.2%), and boot swabs (20 of 167, 12%) were samples from which Salmonella was most frequently isolated. Thirty-six different serotypes were identified, and the most frequently encountered serotypes were Salmonella Senftenberg, Salmonella Thompson, and Salmonella Montevideo. Determining critical contaminating sources and following the movement of Salmonella through integrated poultry operations will help researchers and the industry develop practical intervention strategies.
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Wreghitt,T.G., J.Whipp, C.Redpath, and W.Hollingworth. "An analysis of infection control of varicella-zoster virus infections in Addenbrooke's Hospital Cambridge over a 5-year period, 1987–92." Epidemiology and Infection 117, no.1 (August 1996): 165–71. http://dx.doi.org/10.1017/s0950268800001278.
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SummaryThis prospective study analyses infections with varicella-zoster virus (VZV) in Addenbrooke's Hospital, Cambridge during 1987–92 and examines the spread of infection. In total, 93 patients and staff experienced VZV infection. Twenty-one patients had varicella and 49 experienced zoster. None of 101 patients and 1 of 625 staff members in contact with varicella cases acquired infection. By contrast, 2 of 227 patients, and 5 of 1039 staff in contact with zoster cases acquired varicella. One out of 28 (3·6%) VZV antibody-negative patients and staff in contact with varicella acquired infection, compared with 5 out of 29 (17·2%) VZV antibody-negative patients and staff in contact with zoster. Thus, zoster was found to be a more frequent cause of nosocomial infection than varicella. Fourteen members of staff had VZV infection during the study period. One of 99 patients and none of 389 staff members in contact with these cases developed varicella. The cost of dealing with infection control for VZV infections in our hospital is estimated to be £714 per patient case and a total of £13204 per year.
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Pinar, Halit, Merielle Stephens, DonB.Singer, TheoniaK.Boyd, SolveigM.V.Pflueger, DavidL.Gang, DrucillaJ.Roberts, and C.JamesSung. "Triplet Placentas: Reference Values for Weights." Pediatric and Developmental Pathology 5, no.5 (September 2002): 495–98. http://dx.doi.org/10.1007/s10024-002-0014-0.
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The occurrence of twins, triplets, and other multiple births increased significantly between 1970 and 2000 in the United States and other industrialized countries. The number of triplet placentas submitted for examination as pathologic specimens has also markedly increased, but no reference values are published for triplet weights. We examined 196 normal triplet placentas. Specimens with associated conditions known to affect the weights of the placentas were excluded. The gestational ages ranged between 20 and 38 weeks. Mean weights for different gestational ages are summarized as follows: 253 g for 20 weeks, 319 g for 22 weeks, 406 g for 24 weeks, 509 g for 26 weeks, 621 g for 28 weeks, 738 g for 30 weeks, 855 g for 32 weeks, 965 g for 34 weeks, 1065 g for 36 weeks, and 1147 g for 38 weeks. Weight gain of triplet placentas appears to parallel that of twin placentas. The mean values of placental weights for triplets at each gestational age are less than triple those of singleton weights for the same duration of gestation. The placental weights in multiple gestations do not increase proportionately with the number of fetuses.
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Sazhin,A.F., N.D.Romanova, A.I.Kopylov, and E.A.Zabotkina. "Bacteria and viruses in Arctic Sea ice." Океанология 59, no.3 (June26, 2019): 373–82. http://dx.doi.org/10.31857/s0030-1574593373-382.
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We studied vertical distribution of bacteria and viruses in different layers of the Arctic sea ice drilled at the North Pole. The sampled multi-year ice was characterized by uneven vertical distribution of bacterial abundance. This characteristic varied within the range of 8±1.2×103 to 95±2.6×103 cells ml-1. The layers with the maximal bacterial abundance were located in the intermediate and lower layers of the ice cores. Bacterial biomass varied from 0.5 to 5 mg C m-3 with the mean value 1.57±0.2 mg C m-3. The ratio of viral to bacterial abundance varied from 0.6 to 28, with the mean value 12.5. The average total number of phages attached to bacteria was 6.2×103 viral particles ml-1. The number of viral particles located within bacterial cells varied from 2 to 21 particles per a bacterial cell. The frequency of visibly infected bacterial cells (FVIC) calculated for the upper, intermediate and lower layers of the ice was 0.92, 1.23 and 0.8% of the total bacterial abundance, respectively. The overall frequency of infected cells (FIC) calculated for the same layers was 6.3, 8.4 and 0.8% of bacteria numbers, respectively, while the viral-mediated mortality of bacteria (VMB) was 7.1, 9.8 and 6.1 %, respectively. Our data show that during the study period the rate of viral infection of bacterial cells and the viral-mediated mortality of bacterial cells in the multy-year ice of the North Pole were relatively low.
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Turpie, Alexander GG, RussellD.Hull, SebastianM.Schellong, VictorF.Tapson, Manuel Monreal, Meyer Michel Samama, and RogerD.Yusen. "Venous Thromboembolism Risk in Stroke Patients Receiving Extended-Duration Enoxaparin Prophylaxis: Sub-Analysis of the EXCLAIM Study." Blood 112, no.11 (November16, 2008): 433. http://dx.doi.org/10.1182/blood.v112.11.433.433.
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Abstract Background: Venous thromboembolism (VTE) is a common complication after acute ischemic stroke. Short-term (10 ± 4 days) prophylaxis reduces the risk of VTE in ischemic stroke patients (Lancet2007; 369:1347–1355), but the efficacy and safety of extended VTE prophylaxis in patients with stroke remains unknown. The EXCLAIM study demonstrated that extended-duration enoxaparin prophylaxis (28 ±4 days) reduced the risk for VTE compared with placebo (2.5% vs 4.0%, respectively: absolute difference − 1.5%, 95.8% confidence interval −2.5 to −0.5%; p= 0.002), in acutely ill medical patients with recent reduced mobility who had already received a short-term 10 ± 4 days prophylaxis regimen (J Thromb Haemost2007;5:Supp.1:O-S-001). In this analysis of the EXCLAIM study, we evaluated the benefit-to-risk ratio of extended-duration enoxaparin in a population of ischemic stroke patients at high risk for VTE. Methods: Acutely ill medical patients enrolled in EXCLAIM were aged ≥40 years and had recently reduced mobility (≤3 days). Of the 7500 patients enrolled, 7415 received enoxaparin 40mg subcutaneous (SC) once-daily for 10 ± 4 days. Of these, 6085 patients were randomized to receive double-blind therapy (enoxaparin 40mg SC once-daily or placebo) for a further 28 ± 4 days. The primary efficacy endpoint, VTE, defined as the composite of symptomatic or asymptomatic deep-vein thrombosis, symptomatic pulmonary embolism (PE), or fatal PE, was assessed at completion of the randomized treatment. The primary safety endpoint, major bleeding, was assessed through 48 hours after the last dose of randomized treatment. Secondary endpoints included symptomatic VTE and major and total (major plus minor) bleeding. Results: Of the 5,963 randomized patients who received at least 1 dose of study treatment, 389 (6.5%) had acute ischemic stroke. Of these, 198 received extended-duration enoxaparin prophylaxis and 191 received placebo. Key demographic variables were comparable in both groups. The VTE rate in the placebo group was higher in ischemic stroke patients, compared with those without (8.0% vs 3.7%). The incidence of VTE was significantly reduced in patients receiving extended-duration enoxaparin prophylaxis vs placebo (p<0.05). Major bleeding was increased in patients receiving extended-duration enoxaparin prophylaxis vs patients receiving placebo, however this difference was not statistically significant (Table). Conclusion: Our findings support that acute ischemic stroke patients are at increased risk for VTE, compared with the general medical population. Acutely ill patients with ischemic stroke receiving extended-duration enoxaparin experienced a significantly reduced risk of VTE and a non-statistically significant increase in major bleeding compared with patients receiving placebo, after all patients completed a short-term 10 ± 4 days enoxaparin regimen. These findings warrant further studies of extended-duration VTE prophylaxis in patients with acute ischemic stroke. Table. Efficacy and safety outcomes in stroke patients receiving extended-duration enoxaparin prophylaxis vs placebo. Stroke patients, n=389 Parameter Extended-duration enoxaparin, n (%) Placebo, n (%) Relative risk (95.8% CI) P-value †Efficacy endpoints were assessed in all randomized patients who received at least 1 dose of study drug and had an evaluable ultrasound. ‡Safety endpoints were assessed in all randomized patients who received at least 1 dose of study drug. Efficacy † N=166 N=150 VTE 4 (2.4) 12 (8.0) 0.30 (0.10–0.91) 0.0236 Symptomatic VTE 0 (0.0) 2 (1.3) 0.1356 Safety ‡ N=198 N=191 Major bleeding 3 (1.5) 0 (0.0) 0.0881 Major and minor bleeding 12 (6.1) 5 (2.6) 2.32 (0.83–6.45) 0.0972
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Kugatov,P.V., B.S.Zhirnov, and A.E.Eremenko. "Study of Dependence of Softening Point on Mesophase Content of Petroleum Pitches from Heavy Pyrolysis Resin and Decantoil." Chemistry and Technology of Fuels and Oils 625, no.3 (2021): 28–31. http://dx.doi.org/10.32935/0023-1169-2021-625-3-28-31.
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Samples of petroleum pitches were obtained from heavy pyrolysis resin and decantoil (heavy gas-oil of catalytic cracking) by thermal polycondensation at atmospheric pressure, temperatures of 380–400 and 410–440°С (for resin and decantoil, respectively) and isothermal holding time of 30–480 min. Analysis of the dependence of the softening point on the mesophase content for the obtained samples showed that at the same mesophase content, decantoil pitches exhibit a lower softening point compared to pyrolysis resin pitches, for which, even at 30 % mesophase, the softening point approaches 300°C. This suggests that it is impossible to obtain pitch from pyrolysis resin with high mesophase content without preliminary preparation (for example, by hydrogenation). On the other hand, it has been shown that for pitches from decantoil, it is possible to isolate the mesophase up to 65% or more with a softening point not higher than 250°C.
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Ignjatovic,D., V.Zivanovic, G.Vasic, and I.Ilic. "Meta-analysis on minimally invasive surgical therapy of sigmoid diverticulitis." Acta chirurgica Iugoslavica 51, no.3 (2004): 25–28. http://dx.doi.org/10.2298/aci0403025i.
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The bowel diverticulitis is a complication of diverticulosis, occuring in 35% patients in 20 years after diagnosis. The study purpose was analysis of the results published in world literature. Method: double blind electronic search of several databases using key words: diverticulitis, laparoscopy. Results: 11 studies with 415 patients that satisfy the criteria were selected. Age: 62,7 + 14.2. Hinchey stadiums: I, IIa i IIb of these 44% I and 28 % IIa i Iib each. Operative time: 197.4+ 49.6 min. Conversions: 11.7+10,1 (0-38,9%). Protective stoma: 5,5%. Bowel sounds: 2,3 - 3,2 postoperative day. Oral feeding: 2,6-5 postoperative day. Hospitalization: 6.1 2.1 dana. Anastomotic dehiscence: 2,8%, wound infection: 7,3%, iatrogen rectum perforation with stapler: 3,3%, bleeding: 3,5%, ileus: 4,4%, reoperation rate: 4,7%. Conclusion: Sigmoid resection with or without a protective "loop" ileostomy is technically feasable by minimally invasive surgical technique, with an acceptable ratio of benefits and complications.
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Condo, Dominique, Maria Makrides, Sheila Skeaff, and ShaoJ.Zhou. "Development and validation of an iodine-specific FFQ to estimate iodine intake in Australian pregnant women." British Journal of Nutrition 113, no.6 (March6, 2015): 944–52. http://dx.doi.org/10.1017/s0007114515000197.
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Adequate iodine is important during pregnancy to ensure optimal growth and development of the offspring. We validated an iodine-specific FFQ (I-FFQ) for use in Australian pregnant women. A forty-four-item I-FFQ was developed to assess iodine intake from food and was administered to 122 pregnant women at 28 weeks gestation. Iodine supplement use was captured separately at 28 weeks gestation. Correlation between iodine intake from food estimated using the I-FFQ and a 4 d weighed food record as well as correlation between total iodine intake and 24 h urinary iodine excretion (UIE), 24 h urinary iodine concentration (UIC), spot UIC and thyroid function were assessed at 28 weeks gestation. A moderate correlation between the two dietary methods was shown (r0·349,P< 0·001), and it was strengthened with the addition of iodine supplements (r0·876,P< 0·001). There was a fair agreement (k= 0·28,P< 0·001) between the two dietary measures in the classification of women as receiving adequate ( ≥ 160 μg/d) or inadequate ( < 160 μg/d) iodine intake from food, but the limits of agreement from the Bland–Altman plot were large. Total iodine intake was associated with 24 h UIE (β = 0·488,P< 0·001) but not with spot UIC. Iodine intake from food using the I-FFQ was assessed at study entry ( < 20 weeks gestation) in addition to 28 weeks gestation, and there was a strong correlation in iodine intake at the two time points (r0·622,P< 0·001), which indicated good reproducibility. In conclusion, the I-FFQ provides a valid tool for estimating iodine intake in pregnant women and can be used to screen women who are at risk of inadequate intake.
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Khoury, Jad, Marilyn Jones, Autumn Grim, Wm Michael Dunne, and Vicky Fraser. "Eradication of Methicillin-ResistantStaphylococcus AureusFrom a Neonatal Intensive Care Unit by Active Surveillance and Aggressive Infection Control Measures." Infection Control & Hospital Epidemiology 26, no.7 (July 2005): 616–21. http://dx.doi.org/10.1086/502590.
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AbstractObjectives:To describe an outbreak of hospital-acquired MRSA in a NICU and to identify the risk factors for, outcomes of, and interventions that eliminated it.Setting:An 18-bed, level III-IV NICU in a community hospital.Methods:Interventions to control MRSA included active surveillance, aggressive contact isolation, and cohorting and decolonization of infants and HCWs with MRSA. A case–control study was performed to compare infants with and without MRSA.Results:A cluster of 6 cases of MRSA infection between September and October 2001 represented an increased attack rate of 21.2% compared with 5.3% in the previous months. Active surveillance identified unsuspected MRSA colonization in 6 (21.4%) of 28 patients and 6 (5.5%) of 110 HCWs screened. They were all successfully decolonized. There was an increased risk of MRSA colonization and infection among infants with low birth weight or younger gestational age. Multiple gestation was associated with an increased risk of colonization (OR, 37.5; CI95, 3.9–363.1) and infection (OR, 5.36; CI95, 1.37–20.96). Gavage feeding (OR, 10.33; CI95, 1.28–83.37) and intubation (OR, 5.97; CI95, 1.22–29.31) were associated with increased risk of infection. Infants with MRSA infection had a significantly longer hospital stay than infants without MRSA (51.83 vs 21.46 days;P= .003). Rep-PCR withmectyping and PVL analysis confirmed the presence of a single common strain of hospital-acquired MRSA.Conclusion:Active surveillance, aggressive implementation of contact isolation, cohorting, and decolonization effectively eradicated MRSA from the NICU for 2½ years following the outbreak. (Infect Control Hosp Epidemiol 2005;26:616-621)
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Zavadilová, Ludmila, Eva Kašná, Zuzana Krupová, and Michaela Brzáková. "Genetic parameters for clinical mastitis in Czech Holstein cattle." Czech Journal of Animal Science 65, No.12 (December21, 2020): 463–72. http://dx.doi.org/10.17221/151/2020-cjas.
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Genetic parameters were estimated for clinical mastitis in Czech Holstein cattle. The datasets included 14 329 cows with 28 626 lactations. Clinical mastitis was defined as 0/1 occurrence per lactation. Single- or multi-trait repeatability linear animal models were employed for estimation of (co)variances and prediction of conventional or genomic breeding values. The inclusion of the random herd-year-month effect in the model was analysed. The estimated heritability for clinical mastitis ranged from 2.10% to 2.72%, while permanent environmental variance ratios or random herd-year-month effect ratios were twice higher than heritability. In the multi-trait models, udder type traits, such as fore udder attachment, rear udder attachment, rear udder width, front teat placement and udder depth, were employed. The highest genetic correlations of clinical mastitis occurred with rear udder width (0.41) and the lowest with front teat placement (–0.10). Both the multi-trait model and the genomic model provided breeding value estimates with higher reliability. In contrast, the model with random herd-year-season effects provided breeding values with lower accuracy.
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Felisia, Wynda, Asril Aminullah, and Sudigdo Sastroasmoro. "Nilai APGAR, Trauma Lahir Mekanik dan Mortalitas Neonatal Dini pada Bayi Lahir dengan Presentasi Bokong Di RSUPN Cipto Mangunkusumo." Sari Pediatri 9, no.6 (November30, 2016): 412. http://dx.doi.org/10.14238/sp9.6.2008.412-6.
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Latar belakang. Presentasi bokong merupakan bentuk malpresentasi tersering yang ditemukan pada kehamilancukup bulan, sekitar 3%-4% kelahiran. Fasilitas dan pelayanan kebidanan telah banyak mencatat kemajuan,namun mortalitas dan morbiditas bayi presentasi bokong 2-3 kali lebih tinggi dibanding presentasi kepala.Tujuan. Mengetahui gambaran nilai APGAR, trauma lahir mekanik dan mortalitas neonatal dini padabayi presentasi bokong.Metode. Penelitian retrospektif pada bayi yang lahir dengan presentasi bokong di RSUPN CiptoMangunkusumo pada 1 Januari 2004 sampai dengan 31 Desember 2005. Kriteria inklusi adalah bayipresentasi bokong yang lahir hidup, usia gestasi >28 minggu. Kriteria eksklusi apabila dijumpai lahir matidan malformasi kongenital berat.Hasil. Terdapat 386 bayi lahir dengan presentasi bokong yang memenuhi kriteria inklusi penelitian. Mortalitasneonatal dini lebih sering terjadi pada persalinan pervaginam dibanding bedah kaisar (12,2% vs 2,8%). NilaiApgar menit ke-5 <7 lebih sering pada persalinan pervaginam dibanding bedah kaisar (12,9% vs 4,0%). Traumalahir mekanik lebih sering pada persalinan pervaginam dibanding bedah kaisar (14/139, 10,1% vs 15/247, 6,1%)Kesimpulan. Mortalitas neonatal dini, nilai Apgar rendah dan trauma lahir mekanik pada bayi presentasibokong lebih sering terjadi pada persalinan pervaginam
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Minashina,I.N., and N.L.Naumova. "Safety of vegetable raw materials used in the production of flour products in order to increase their mineral value." Innovations and Food Safety, no.2 (March21, 2021): 22–27. http://dx.doi.org/10.31677/2311-0651-2020-28-2-22-27.
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Wheat high-grade flour used in the technology of flour products is poor in respect of certain minerals (iron, calcium, etc.), so their mineral value is increased by using non-traditional raw materials for production, in particular flax flour and red mountain ash fruits, in the recipe of bread, muffins, muffins, gingerbread, cookies, etc. the Purpose of research is to study the mineral composition of wheat, flax and mountain ash raw materials in a comparative aspect to establish its safety and effectiveness usage. The objects of tests were: wheat flour baking of the first grade (JSC “Shadrinsky combine of bread products”, Kurgan region, Shadrinsk), flax flour (LLC NPO “Compass of health”, Novosibirsk), red mountain ash fruit (LLC “Staroslav”, Novosibirsk region, Berdsk). Physical and chemical parameters and mineral composition of raw materials were studied. The superiority of Flaxseed flour over wheat in the amount of potassium (33.3 times more), calcium (27.2 times more), magnesium (16.2 times more), iron (8.5 times more), copper (6.1 times more), phosphorus and zinc (4.8-4.9 times more), and manganese (4.3 times more); Rowan fruit - by the content of manganese (12.5 times) and iron (3.9 times). The upper limit was exceeded in both types of flour by the amount of lead, which is a violation of the regulated requirements of TR CU 021/2011. The effectiveness of the use of red Rowan fruit in replacing wheat flour in order to increase the level of dietary fiber, manganese and iron in ready-made flour products was shown.
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De Swart, Louise, Chloé Reiniers, Tim Bagguley, Corine van Marrewijk, David Bowen, Jaroslav Cermak, Eva Hellström-Lindberg, et al. "Hepcidin and GDF15 Levels during the First 2 Years Follow-up in Patients with Low and Int-1 Risk Myelodysplastic Syndromes (MDS) from the European Leukemianet MDS Registry." Blood 124, no.21 (December6, 2014): 3267. http://dx.doi.org/10.1182/blood.v124.21.3267.3267.
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Abstract Background: The EUMDS registry is a prospective observational registry to collect data on lower risk MDS. 17 Countries and 133 centers are participating. We analyzed serum from 101 patients for ferritin, hepcidin, growth differentiation factor 15 (GDF15) and C-reactive protein (CRP) at six-month intervals in order to evaluate temporal changes in iron metabolism. Objective: To explore hepcidin and GDF15 levels over time in lower risk MDS patients and their relation with WHO2001 subtype, transfusion history and conventional iron parameters. Results: The median age of the study population was 73 years (range 44-95 years). The majority was male: 64%. Distribution according to WHO2001 MDS subtype was RCMD (41%), RARS (25%), RA (14%), RAEB (11%), 5q-syndrome (6%) and RCMD-RS (3%). Table 1 shows iron parameters at registration, 1 year and 2 years follow-up both in transfusion-dependent (TD) and transfusion-independent (TI) patients and stratified according to MDS subtypes: RS (RARS/RCMD-RS) or MDS Other (RA/RCMD/RAEB/5q-syndrome). Serum ferritin was increased in TD patients with a median concentration at registration of 550µg/L and at 2 years 818µg/L, compared to TI patients (median <250µg/L, all time points). During follow-up ferritin was most elevated in patients who received >10 red blood cell (RBC) units: median at registration 1482µg/L - 2 years 1970µg/L. Ferritin correlated significantly with hepcidin (r=0.57; p<0.001) as well as CRP: r=0.27, p<0.001. Median CRP was within reference range (<10mg/L) for both TD and TI patients at registration and during follow-up, but mainly TD patients had elevated CRP levels >50mg/L. Median serum hepcidin levels were elevated in TD patients at registration and remained elevated during follow-up, especially in patients with >10 RBC units transfused (median 27.4nmol/l at registration, 12.8nmol/l at 2 years). Remarkable fluctuation in hepcidin levels occurred in patients with elevated hepcidin during follow-up. Even in the longitudinal cohorts hepcidin fluctuated considerably, maybe due to the interval between the previous transfusion and the measurement of hepcidin or due to diurnal fluctuation. Hepcidin was lowest in MDS RS TI patients and showed a tendency to decrease over time from a median level of 4.4nmol/l at registration to 2.4nmol/l after 2 years, associated with ineffective erythropoiesis. This is supported by the high median GDF15 in these patients. Lowest GDF15 was found in TD patients with ‘MDS Other’ associated with transfusional load. The number of transfused RBC units did not affect the median GDF15 levels. Conclusions: Hepcidin levels were influenced by RBC transfusion history, but hepcidin levels appear to decrease over time in the RS subtype only. Interestingly, increase in hepcidin after transfusions was already visible early in follow-up, depending on the transfusional load and erythropoietic activity of the bone marrow. GDF15 concentration appeared to be most related to MDS subtype, functioning as a marker of ineffective erythropoiesis. Table1: ferritin, hepcidin and GDF15 during-follow-up Registration 1 yr follow-up 2 yrs follow-up N Median (p25-p75) N Median (p25-p75) N Median (p25-p75) Ferritin (µg/L) 101 286 (138 - 558) 83 287 (149 - 845) 66 347 (191 - 818) MDS Other: TI 53 205 (87 - 389) 31 148 (78 - 288) 25 202 (71 - 319) MDS Other: TD 20 479 (279 - 877) 29 845 (481 - 1538) 22 841 (323 - 2387) RARS/RCMD-RS: TI 25 268 (195 - 558) 19 233 (170 - 323) 10 319 (222 - 379) RARS/RCMD-RS: TD 3 610 (108 - 1382) 4 1909 (1206 - 2935) 9 712 (590 - 1222) Hepcidin (nmol/L) 100 5.2 (3.0 - 9.9) 83 5.8 (2.7 - 14.0) 66 5.2 (2.5 - 9.9) MDS Other: TI 53 4.6 (2.8 - 8.4) 31 4.4 (2.3 - 8.1) 25 4.2 (2.5 - 6.8) MDS Other: TD 20 11.1 (4.9 - 21.0) 29 17.2 (9.2 - 22.3) 22 9.6 (4.5 - 17.1) RARS/RCMD-RS: TI 24 4.2 (2.1 - 6.1) 19 3.5 (1.6 - 5.1) 10 2.4 (1.6 - 3.9) RARS/RCMD-RS: TD 3 9.8 (6.0 - 11.1) 4 9.3 (7.3 - 12.1) 9 5.2 (2.9 - 9.3) TI: 0 RBC units 81 4.5 (2.8 - 8.4) 51 4.0 (2.0 - 7.5) 37 3.1 (2.1 - 6.7) TD: ≤10 RBC units 17 10.6 (4.7 - 14.9) 14 9.2 (5.3 - 17.2) 14 4.3 (2.4 - 8.7) TD: >10 RBC units 2 27.4 (15.7 - 39.1) 18 18.1 (12.7 - 24.5) 15 12.8 (9.3 - 21.3) GDF15 (ng/L) 101 1945 (1207 - 3611) 82 2467 (1659 - 4318) 66 2582 (1519- 5332) MDS Other: TI 53 1831 (1100 - 3176) 31 1902 (1076 - 2698) 25 1702 (1136 - 3564) MDS Other: TD 20 1452 (1169 - 2789) 28 2583 (1937 - 4493) 22 2556 (1661 - 4050) RARS/RCMD-RS: TI 25 3532 (2124 - 4211) 19 3148 (2195 - 4560) 10 3661 (1986 - 5524) RARS/RCMD-RS: TD 3 2196 (1869 - 2893) 4 2996 (1806 - 5141) 9 5555 (3204 - 7488) Disclosures Hellström-Lindberg: Celgene: Research Funding. Symeonidis:Celgene: Research Funding; Novartis Oncology: Research Funding; Amgen: Research Funding; Novartis Oncology: Consultancy; Amgen: Consultancy. de Witte:Novartis: Research Funding; Novartis: Honoraria; Celgene: Consultancy; Novartis: Consultancy.
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Strangfeld,A., B.Manger, M.Worsch, T.Schmeiser, A.Zink, and M.Schaefer. "OP0116 ELDERLY PATIENTS ARE NOT AT INCREASED RISK OF SERIOUS INFECTIONS WHEN RECEIVING BDMARDS OR JAK INHIBITORS COMPARED TO CSDMARD TREATMENT." Annals of the Rheumatic Diseases 80, Suppl 1 (May19, 2021): 64.2–65. http://dx.doi.org/10.1136/annrheumdis-2021-eular.763.
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Background:Elderly rheumatoid arthritis (RA) patients are generally at increased risk of serious infections (SI). At the same time, treatment with bDMARDs has been associated with a higher SI risk than treatment with csDMARDs (1). However, long-term use of bDMARDs did not increase the risk of SI in a small group of elderly patients over 65 (2). The extent to which elderly patients are exposed to a higher SI risk when treated with JAK inhibitors (JAKi) is an open question.Objectives:To assess the effects of bDMARDs and specifically JAKi on the risk of SI in elderly patients with RA.Methods:The German register RABBIT is a prospective, longitudinally followed cohort of RA patients enrolled with a new start of a DMARD after at least one csDMARD failure. This analysis comprises patients over 70 years of age who were enrolled between 01/2007 and 04/2020 and had at least one follow-up.Results:Of 13,491 patients followed-up in RABBIT, 2274 with an age > 70 years were included in the analysis. 626 SI were observed in 425 of these patients. Baseline characteristics at start of the respective DMARD are shown in Table 1. In most characteristics, patients on JAKi were more comparable to patients under bDMARDs than to those on csDMARDs. JAKi patients received glucocorticoids (GC) less frequently than patients on other treatments. The HR for SI was lower than 1 in patients receiving bDMARDs or JAKi compared to csDMARDs, but without statistical significance (Figure 1). GC use (HR 1.6, 95% CI: 1.2 – 2.2 for ≤ 10 mg/d), higher DAS28-ESR values (HR 1.1, 95% CI: 1.0 – 1.2 per 1 point increase), COPD or pulmonary fibrosis (HR 1. 8, 95% CI: 1.3 – 2.4), chronic kidney disease (HR 1.5, 95% CI: 1.2 – 1.9) and diabetes mellitus (HR 1.3, 95% CI: 1.0 – 1.7) were associated with an increased risk of SI. Better physical capacity was associated with a decreased risk of SI (HR 0.9, 95% CI: 0.88 – 0.98 for a 10 point increase).Table 1.Patient characteristics by treatment at baselineParametercsDMARDsTNFiRTXABAIL-6iJAKiN=758N=840N=209N=147N=212N=108Age (years)75.9 (3.9)75.5 (3.6)74.8 (3.6)76.1 (3.9)75.9 (3.7)76.7 (3.7)Male sex184 (24.3)220 (26.2)50 (23.9)36 (24.5)46 (21.7)28 (25.9)Ever smoker249 (32.8)287 (34.2)77 (36.8)50 (34)73 (34.4)39 (36.1)Disease duration (years)7.9 (8.8)12.3 (11.4)17 (11.1)12.8 (10)13.8 (11.7)11.9 (10.9)Seropositivity487 (64.3)671 (79.9)201 (96.2)126 (85.4)182 (85.8)79 (73.5)Number of previous DMARDs1.4 (0.7)2.5 (1.3)4.2 (1.8)3.6 (1.9)3.3 (1.8)2.6 (1.5)DAS28-ESR4.6 (1.2)5.1 (1.2)5.4 (1.3)5.3 (1.3)5.3 (1.3)5 (1.2)Proportion of full physical function64.8 (23.1)57.1 (23.6)50.4 (23.7)52.9 (23.5)55.3 (24.1)55.2 (23.7)Number of comorbidities3.1 (2.5)3.8 (2.6)4.2 (2.6)4.6 (2.9)3.6 (2.4)3.8 (2.2)No comorbidity52 (6.9)29 (3.5)4 (1.9)4 (2.7)9 (4.2)5 (4.6)Three and more comorbidities385 (50.8)528 (62.9)147 (70.3)107 (72.8)131 (61.8)76 (70.4)COPD or pulmonary fibrosis69 (9.1)89 (10.6)29 (13.9)26 (17.7)12 (5.7)11 (10.2)Chronic kidney disease94 (12.4)151 (18)28 (13.4)21 (14.3)39 (18.4)22 (20.4)Diabetes mellitus151 (19.9)172 (20.5)31 (14.8)23 (15.6)42 (19.8)25 (23.1)GCs (last 6 months)347 (45.8)526 (62.6)143 (68.8)82 (56.2)127 (59.9)44 (40.7)GCs (<5mg)447 (58.9)384 (45.7)101 (48.2)88 (60)118 (55.8)72 (66.7)GCs (5-9mg)252 (33.3)375 (44.6)81 (38.7)43 (29)72 (34.2)27 (25.1)GCs (>=10mg)59 (7.8)82 (9.8)274 (13.1)16 (11)21 (10)9 (8.2)Results are presented as mean ± SD for continuous variables and number (percentage) for discrete variables.Figure 1.Hazard ratios for serious infections with 95% confidence intervalsConclusion:Treatment with JAKi as well as treatment with bDMARDs was not associated with an increased risk of SI in elderly patients above 70 years of age. Key comorbidities such as diabetes mellitus, chronic pulmonary and kidney diseases were associated with increased risk, as was concomitant GC use and higher disease activity.References:[1] Listing J et al., Rheumatology 2013; 52 (1): 53-61.[2] Kawashima H. et al., Rheum. Intern. 2017; 37: 369-376.Acknowledgements:RABBIT is supported by a joint, unconditional grant from AbbVie, Amgen, BMS, Celltrion, Fresenius-Kabi, Gilead, Hexal, Lilly, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi-Aventis, UCB, and Viatris.Disclosure of Interests:None declared
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Aditya,Y., and D.R.K.Reddy. "Locally rotationally symmetric Bianchi type-I string cosmological models in f(R) theory of gravity." International Journal of Geometric Methods in Modern Physics 15, no.09 (August8, 2018): 1850156. http://dx.doi.org/10.1142/s0219887818501566.
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This study deals with spatially homogeneous and anisotropic locally rotationally symmetric (LRS) Bianchi type-I universe with cosmic string source in the framework of [Formula: see text] theory of gravity [S. Capozziello, S. Carloni and A. Troisi, Quintessence without scalar fields, Recent Res. Dev. Astron. Astrophys. 1 (2003), 625; S. Nojiri and S. D. Odintsov, Modified gravity with negative and positive powers of curvature: Unification of inflation and cosmic acceleration, Phys. Rev. D 68 (2003) 123512]. Solving the field equations using (i) relation between metric potentials, (ii) power law relation between [Formula: see text] and average scale factor [Formula: see text] and (iii) equations of state for string models we have presented Takabayasi [T. Takabayasi, Quantum Mechanics Determinism, Causality, and Particles (Springer, Berlin, 1976)], Nambu [P. S. Letelier, String cosmologies, Phys. Rev. D 28 (1983) 2414–2419] and Reddy [D. R. K. Reddy, A string cosmological model in a scalar–Tensor theory of gravitation, Astrophys. Space Sci. 286 (2003) 359–363] string cosmological models. The dynamical parameters of our models are determined and their physical behavior is discussed. The most interesting result about the models is that the anisotropic effects are wiped out at late times.
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Romand,J.A., M.R.Pinsky, L.Firestone, H.A.Zar, and J.R.Lancaster. "Effect of inhaled nitric oxide on pulmonary hemodynamics after acute lung injury in dogs." Journal of Applied Physiology 76, no.3 (March1, 1994): 1356–62. http://dx.doi.org/10.1152/jappl.1994.76.3.1356.
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Increased pulmonary vascular resistance (PVR) and mismatch in ventilation-to-perfusion ratio characterize acute lung injury (ALI). Pulmonary arterial pressure (Ppa) decreases when nitric oxide (NO) is inhaled during hypoxic pulmonary vasoconstriction (HPV); thus NO inhalation may reduce PVR and improve gas exchange in ALI. We studied the hemodynamic and gas exchange effects of NO inhalation during HPV and then ALI in eight anesthetized open-chest mechanically ventilated dogs. Right atrial pressure, Ppa, and left ventricular and arterial pressures were measured, and cardiac output was estimated by an aortic flow probe. Shunt and dead space were also estimated. The effect of 5-min exposures to 0, 17, 28, 47, and 0 ppm inhaled NO was recorded during hyperoxia, hypoxia, and oleic acid-induced ALI. During ALI, partial beta-adrenergic blockade (propranolol, 0.15 mg/kg i.v.) was induced and 74 ppm NO was inhaled. Nitrosylhemoglobin (NO-Hb) and methemoglobin (MetHb) levels were measured. During hyperoxia, NO inhalation had no measurable effects. Hypoxia increased Ppa (from 19.8 +/- 6.1 to 28.3 +/- 8.7 mmHg, P < 0.01) and calculated PVR (from 437 +/- 139 to 720 +/- 264 dyn.s.cm-5, P < 0.01), both of which decreased with 17 ppm NO. ALI decreased arterial PO2 and increased airway pressure, shunt, and dead space ventilation. Ppa (19.8 +/- 6.1 vs. 23.4 +/- 7.7 mmHg) and PVR (437 +/- 139 vs. 695 +/- 359 dyn.s.cm-5, P < 0.05) were greater during ALI than during hyperoxia. No inhalation had no measureable effect during ALI before or after beta-adrenergic blockade. MetHb remained low, and NO-Hb was unmeasurable. Bolus infusion of nitroglycerin (15 micrograms) induced an immediate decrease in Ppa and PVR during ALI.(ABSTRACT TRUNCATED AT 250 WORDS)
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Oliver,VincentO., George Otieno, Roman Gvetadze, MiteshA.Desai, Mumbi Makanga, Victor Akelo, DeborahA.Gust, Beatrice Nyagol, and Eleanor McLellan-Lemal. "High prevalence of sexually transmitted infections among women screened for a contraceptive intravaginal ring study, Kisumu, Kenya, 2014." International Journal of STD & AIDS 29, no.14 (August2, 2018): 1390–99. http://dx.doi.org/10.1177/0956462418782810.
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We assessed prevalence and correlates of bacterial vaginosis (BV) and sexually transmitted infections (STIs) including herpes simplex virus type 2 (HSV-2), gonorrhoea (GC), syphilis (SYP), Chlamydia (CT) and HIV among Kenyan women aged 18–34 years who were screened for a contraceptive intravaginal ring study. Women provided demographic, behavioural and medical information, and underwent medical evaluation, including a pelvic exam. We computed crude and adjusted prevalence ratio (aPR) and 95% confidence interval (CI) using log-binomial regression. Of 463 women screened, 457 provided laboratory specimens and were included in the analysis. The median age was 25 years, interquartile range (21–28), and 68.5% had completed primary or lower education. Overall, 72.2% tested positive for any STI or BV. Point prevalence was 55.6, 38.5, 3.9, 2.0, 4.6, and 14.7% for HSV-2, BV, GC, SYP, CT, and HIV, respectively. Co-infection with HSV-2, BV, and HIV occurred in 28 (6.1%) participants. Having ≥1 STI/BV was associated with younger age at first sex (≤13 versus 17–19 years, aPR=1.27, 95% CI 1.07–1.51), history of exchange sex (aPR = 2.05, 95% CI 1.07–3.92), sexual intercourse in the past seven days (aPR = 1.17, 95% CI 1.01–1.36), and older age (30–34 versus 18–24 years, aPR = 1.26, 95% CI 1.06–1.48). STI/BV diagnosis was less likely for women reporting one lifetime sexual partner compared to women with ≥4 lifetime sexual partners (aPR = 0.70, 95% CI 0.54–0.92). Combination prevention approaches (biomedical, behavioural, social, and structural) tailored to women with diverse risk profiles may help mitigate STI/BV prevalence in this setting.
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Dorreh, Fatemeh, Mohammad Hasan Esmaili, Parsa Yousefhajian, Mahdieh Naziri, Aziz Eghbali, and Bahador Bagheri. "Efficacy of Montelukast for Prevention of Upper Respiratory Tract Infection in Children: A Randomized, Placebo-Controlled Trial." Pharmaceutical Sciences 26, no.2 (June27, 2020): 193–97. http://dx.doi.org/10.34172/ps.2020.7.
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Background: Upper Respiratory tract infection (URTI) or common cold is very prevalent in children particularly in young children. Leukotriene receptor antagonists (LTRAs) like montelukast are effective drugs in asthma and some other respiratory diseases. Our purpose was to study preventive effects of montelukast on pediatric URTI. Methods: This randomized, placebo-controlled, and double blind trial was performed on 450 healthy children aged 1-5 year in Amir Kabir Hospital, Arak, Iran. Children were randomized 1:1 to placebo group or montelukast group for 12 weeks. Number of URTI episodes and duration were the primary end points and were compared at baseline and after termination of treatment. Results: Mean age was 28 ± 12.3 months. Mean of URTI episodes was 0.7 ± 0.57 in children treated with montelukast and 1.27 ± 0.72 in children treated with placebo, respectively. Differences were statistically significant (P =0.01). A significant difference was seen in URTI duration between two study groups (6.3 ± 6.1 vs 4.1 ± 3.9, P = 0.05). In addition, duration of fever was shorter in children receiving montelukast (P=0.001). Conclusion: Our study indicates that 3 month treatment with montelukast is effective for reducing the incidence of URTI in young children. This treatment has an acceptable safety without any serious concern.
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Pratiwi, Diah, Tri Rima Setyawati, and Ari Hepi Yanti. "Food Habit of Seluang Batu (Paracrossochilus vittatus Boulenger 1894) in Mentuka River Sekadau Districts West Kalimantan Province." Jurnal ILMU DASAR 21, no.1 (January21, 2020): 11. http://dx.doi.org/10.19184/jid.v21i1.8703.
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Seluang batu (Paracrossochilus vittatus) is one of the Borneo endemic fish from Cyprinidae Family that live in high stream water. The aim of this study was to know the food habit and niche breadth of seluang batu in Mentuka River. This study was conducted 3 months from November 2016 to January 2017. The sampling method used in this research was purposive random sampling. Seluang batu was taken from three stations in the Mentuka River using trap nets. The fish was measured in length and weight, then dissected to find out the type of food in the stomach. Food analysis was determined using index of preponderance and the niche breadth using Smith’s index. The results showed that seluang batu in Mentuka River including herbivore because they eat microalgae, namely Synedra was main food. Nice breadth of seluang batu for peryphiton was 0.71 meanwhile plankton was 0.20. Most of peryphiton and plankton in Mentuka River are Bacillariophyceae. The Mentuka River environtment supported the life of seluang batu and their natural food, namely the temperature about 26-28 ̊C, current speed was about 1-2,6 m/s, pH was about 6,8-7,3, dissolved oxygen was about 6,1-7 mg/L and free CO2 was 3,9-5,0 mg/L. Keywords: food habit, Paracrossochilus vittatus, periphyton, plankton.
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Nakamae, Toshio, Yoshinori Fujimoto, Kiyotaka Yamada, Takashi Hashimoto, and Kjell Olmarker. "Efficacy of Percutaneous Vertebroplasty in the Treatment of Osteoporotic Vertebral Compression Fractures with Intravertebral Cleft." Open Orthopaedics Journal 9, no.1 (May15, 2015): 107–13. http://dx.doi.org/10.2174/1874325001509010107.
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Intravertebral cleft (IVC) is frequently observed in patients with painful osteoporotic vertebral compression fracture (OVCF). Some studies reported the usefulness of percutaneous vertebroplasty (PVP) for treating OVCF with IVC. However, systematic studies are scarce, and their results are conflicting. The purpose of this study was to evaluate the clinical and radiographic results of PVP in the treatment of painful OVCF with IVC. Two hundred ninety-one patients with OVCF with IVC underwent PVP. Back pain was measured using a visual analog scale (VAS), and physical disability was assessed using the Oswestry Disability Index (ODI). Three radiological parameters were assessed: the local kyphotic angle, percentage spinal canal cross-sectional area of compromise, and intravertebral instability of the affected vertebra. The mean follow-up period was 28 months. The mean values for the VAS and ODI were 8.4 and 60.0%, respectively, before PVP, versus 3.9 and 35.4%, respectively, at the final follow-up. The average local kyphotic angle, percentage spinal canal cross-sectional area of compromise, and intravertebral instability were 10.5°, 17.9% and 6.1°, respectively, before PVP and 8.1°, 15.2%, and 0.8°, respectively, at the final follow-up. There were no neurological or systemic complications due to cement leakage. PVP is an effective and safe intervention for treating OVCF with IVC.
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Luo, Shengyuan, Josef Coresh, Adrienne Tin, CaseyM.Rebholz, LawrenceJ.Appel, Jingsha Chen, RamachandranS.Vasan, et al. "Serum Metabolomic Alterations Associated with Proteinuria in CKD." Clinical Journal of the American Society of Nephrology 14, no.3 (February7, 2019): 342–53. http://dx.doi.org/10.2215/cjn.10010818.
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Background and objectivesData are scarce on blood metabolite associations with proteinuria, a strong risk factor for adverse kidney outcomes. We sought to investigate associations of proteinuria with serum metabolites identified using untargeted profiling in populations with CKD.Design, setting, participants, & measurementsUsing stored serum samples from the African American Study of Kidney Disease and Hypertension (AASK; n=962) and the Modification of Diet in Renal Disease (MDRD) study (n=620), two rigorously conducted clinical trials with per-protocol measures of 24-hour proteinuria and GFR, we evaluated cross-sectional associations between urine protein-to-creatinine ratio and 637 known, nondrug metabolites, adjusting for key clinical covariables. Metabolites significantly associated with proteinuria were tested for associations with CKD progression.ResultsIn the AASK and the MDRD study, respectively, the median urine protein-to-creatinine ratio was 80 (interquartile range [IQR], 28–359) and 188 (IQR, 54–894) mg/g, mean age was 56 and 52 years, 39% and 38% were women, 100% and 7% were black, and median measured GFR was 48 (IQR, 35–57) and 28 (IQR, 18–39) ml/min per 1.73 m2. Linear regression identified 66 serum metabolites associated with proteinuria in one or both studies after Bonferroni correction (P<7.8×10−5), 58 of which were statistically significant in a meta-analysis (P<7.8×10−4). The metabolites with the lowest P values (P<10−27) were 4-hydroxychlorthalonil and 1,5-anhydroglucitol; all six quantified metabolites in the phosphatidylethanolamine pathway were also significant. Of the 58 metabolites associated with proteinuria, four were associated with ESKD in both the AASK and the MDRD study.ConclusionsWe identified 58 serum metabolites with cross-sectional associations with proteinuria, some of which were also associated with CKD progression.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2019_02_07_CJASNPodcast_19_03_.mp3
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DiPaolo,J., C.Paumier, C.Pollet, N.Duc, and E.Augeraud. "Programme d’éducation thérapeutique ARSIMED® : première évaluation du module destiné aux familles." European Psychiatry 30, S2 (November 2015): S152—S153. http://dx.doi.org/10.1016/j.eurpsy.2015.09.307.
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Le programme d’éducation thérapeutique ARSIMED® est indiqué pour les patients souffrant de troubles psychotiques. Il comprend un module destiné aux Familles de ces patients, visant à leur faire acquérir trois habiletés : une connaissance de la maladie et des traitements, une meilleure communication avec leur proche (utilisation d’une méthode basée sur l’écoute et l’empathie), une meilleure gestion de leurs propres pensées et émotions (utilisation d’une méthode basée sur la Pleine Conscience). Depuis 2012, ce module a été suivi par cinq groupes de familles, soit 40 participants. L’objectif est de réaliser une première évaluation de son efficacité en analysant les résultats de questionnaires individuels effectués avant et après avoir suivi la totalité du module (10 séances). Trois outils d’évaluation ont été utilisés : Questionnaire de santé GHQ-28, Questionnaire des facultés de communication inspiré du questionnaire de Cungi, Echelle d’acceptation de la maladie et des traitements (auto-évaluation, score de 0 à 10). Les scores des questionnaires GHQ-28 réalisés après les séances ont été statistiquement supérieurs aux scores initiaux (n = 40, t-Student = 1,88, p < 0,05, test unilatéral), même si l’écart moyen est faible (5 points). Il n’y a pas de différence significative concernant les questionnaires de communication. Selon les familles, l’acceptation de la maladie par leur proche a augmenté entre le début (score moyen : 3,9) et la fin (score moyen : 6,1) du programme (n = 31, t-Student = 4,61, p < 0,05, test unilatéral). Une réévaluation des différents questionnaires sera réalisée à distance des séances pour tous les participants ; en effet, des bénéfices supérieurs pourraient être attendus sur un plus long terme car du temps est nécessaire pour l’acquisition des habiletés. D’autre part, les questionnaires seront modifiés afin de mesurer le ressenti des participants sur leur évolution avant et après le programme.
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Lakshman, Arjun, JithmaP.Abeykoon, Shaji Kumar, S.VincentRajkumar, Taxiarchis Kourelis, Francis Buadi, David Dingli, et al. "Daratumumab-based combination therapies (DCT) in heavily-pretreated patients (pts) with relapsed and/or refractory multiple myeloma (RRMM)." Journal of Clinical Oncology 35, no.15_suppl (May20, 2017): 8038. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.8038.
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8038 Background: Daratumumab-based Combination Therapies (DCT) with bortezomib (V)/ lenalidomide (R)/ pomalidomide (P) and dexamethasone (d) showed exceptional activity in RRMM in trials. Experience outside of trials since the approval of Daratumumab (D) in 2015 is limited. Methods: RRMM pts seen at Mayo Clinic, MN from 12/2015 -12/2016 were reviewed. Pts who received ≥ 1cycle of DCT were included. Time-to-event analyses were done from date of starting DCT. Common terminology criteria for adverse events v4.0 were used to grade toxicities. Results: Of 130 pts, 59% were males and median age at DCT initiation was 67 (43-93) years, ECOG performance score was ≥2 in 29%. Pts were classified as mSMART high (22%), intermediate (22%) or standard (56%) risk. Median time from diagnosis to initiation of DCT was 51.3 (5-156) months (m), and median number of prior therapies was 4 (1-14). 14% of pts were refractory to prior D monotherapy. Fifty-three (41%), 34 (26%) and 25 (19%) received DPd, DRd and DVd respectively. Eighteen (14%) pts received ‘other’ DCT. Median time to first response (≥ PR) was 3.1 m (95% CI 2.1-4.6). Overall response rate was 46%, [CR-2%, VGPR-18%, PR-26%]. Minimal response was seen in 17%, with clinical benefit rate of 62%. Median estimated follow up from initiation of DCT was 5.5 m (CI 4.2-6.1). The median duration of response was 6.1 m [CI 5.1- not reached (NR)]. Median progression free survival (PFS) was 5.5 m (CI 4.1-7.8) and median time to next therapy (TTNT) was 5.9 m (CI 4.6-9.4). Median PFS for DPd, DRd, DVd and other DCTs were 4.6 (CI 2.7-NR), 7.8 (CI 5-NR), 3.9 (CI 2.1-NR) and 3.9 (CI 2.8-8.2) m, respectively (p = 0.3). Median PFS for quadruple refractory (n = 28) MM was 2.8 m (CI 2.2-5.3) vs 5.9 m (CI 4.9-NR) for the rest (p < 0.01). Median overall survival (OS) from DCT was NR (CI 11.4-NR). Grade 3 or higher hematological toxicities were seen in 42% of pts. Other toxicities included infections (37%), fatigue (31%), infusion reactions (16%) and diarrhea (10%). Conclusions: DCT are effective in RRMM, but the PFS remains short particularly in quadruple refractory pts, reflecting the challenges encountered in managing heavily-pretreated, and often less fit patients, in routine practice.
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Finch,R., D.Schürmann, O.Collins, R.Kubin, J.McGivern, H.Bobbaers, J.L.Izquierdo, et al. "Randomized Controlled Trial of Sequential Intravenous (i.v.) and Oral Moxifloxacin Compared with Sequential i.v. and Oral Co-Amoxiclav with or without Clarithromycin in Patients with Community-Acquired Pneumonia Requiring Initial Parenteral Treatment." Antimicrobial Agents and Chemotherapy 46, no.6 (June 2002): 1746–54. http://dx.doi.org/10.1128/aac.46.6.1746-1754.2002.
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ABSTRACT The objective of the present trial was to compare the efficacy, safety, and tolerability of moxifloxacin (400 mg) given intravenously (i.v.) once daily followed by oral moxifloxacin (400 mg) for 7 to 14 days with the efficacy, safety, and tolerability of co-amoxiclav (1.2 g) administered by i.v. infusion three times a day followed by oral co-amoxiclav (625 mg) three times a day, with or without clarithromycin (500 mg) twice daily (i.v. or orally), for 7 to 14 days in adult patients with community-acquired pneumonia requiring initial parenteral therapy. A total of 628 patients were enrolled and assessed by evaluation of their clinical and bacteriological responses 5 to 7 days and 21 to 28 days after administration of the last dose of study medication. Although the trial was designed, on the basis of predefined outcomes, to demonstrate the equivalence of the two regimens, the results showed statistically significant higher clinical success rates (for moxifloxacin, 93.4%, and for comparator regimen, 85.4%; difference [Δ], 8.05%; 95% confidence interval [CI], 2.91 to 13.19%; P = 0.004) and bacteriological success rates (for moxifloxacin, 93.7%, and for comparator regimen, 81.7%; Δ, 12.06%; 95% CI, 1.21 to 22.91%) for patients treated with moxifloxacin. This superiority was seen irrespective of the severity of the pneumonia and whether or not the combination therapy included a macrolide. The time to resolution of fever was also statistically significantly faster for patients who received moxifloxacin (median time, 2 versus 3 days), and the duration of hospital admission was approximately 1 day less for patients who received moxifloxacin. The treatment was converted to oral therapy immediately after the initial mandatory 3-day period of i.v. administration for a larger proportion of patients in the moxifloxacin group than patients in the comparator group (151 [50.2%] versus 57 [17.8%] patients). There were fewer deaths (9 [3.0%] versus 17 [5.3%]) and fewer serious adverse events (38 [12.6%] versus 53 [16.5%]) in the moxifloxacin group than in the comparator group. The rates of drug-related adverse events were comparable in both groups (38.9% in each treatment group). The overall incidence of laboratory abnormalities was similar in both groups. Thus, it is concluded that monotherapy with moxifloxacin is superior to that with a standard combination regimen of a β-lactam and a β-lactamase inhibitor, co-amoxiclav, with or without a macrolide, clarithromycin, in the treatment of patients with community-acquired pneumonia admitted to a hospital.
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Rissam,H.S., S.Kishore, M.L.Bhatia, and N.Trehan. "Trans-telephonic electrocardiographic monitoring—experience in India." Journal of Telemedicine and Telecare 4, no.1_suppl (March 1998): 8–11. http://dx.doi.org/10.1258/1357633981931641.
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A centre for trans-telephonic electrocardiographic monitoring (TTEM) was established at the Escorts Heart Institute in May 1996. We have reviewed our experience in the first 398 patients. There were 321 males (81%) and 77 females (19%); their age range was 1 month to 95 years. Sixty-five per cent of patients were from New Delhi, while the remainder were from other cities in India and abroad. As well as follow-up of patients after discharge, the system was used for the evaluation of chest pain, palpitation, chronic angina, arrhythmias, and pacemaker implants. Out of 664 symptomatic transmissions, 510 (77%) were for cardiac symptoms like chest pain (309), palpitation (90), uneasiness (61), dizziness (28) and breathlessness (22); the other 154(23) were for non-cardiac symptoms like stitch pain and backache(51), typical chest pain(39), weakness and fever (45), and sweating(19). The majority of patients with chest pain (84%), palpitation (78%) and dizziness (75%) transmitted their electrocardiograms within one hour of the onset of the symptoms. Out of 664 symptomatic transmissions, 531 required either reassurance or drug-dose adjustment by telephone and 97 were called to the outpatient department on an elective basis. Immediate hospitalization was advised for 36 patients, for acute management of their symptoms. TTEM was useful in avoiding 628 unnecessary visits to the hospital, while 36 patients were immediately hospitalized for acute care.
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Holland,ThomasL., HelenW.Boucher, Issam Raad, DeverickJ.Anderson, SaraE.Cosgrove, Suzanne Aycock, JohnW.Baddley, et al. "Doing the Same with Less: A Randomized, Multinational, Open-Label, Adjudicator-Blinded Trial of an Algorithm vs. Standard of Care to Determine Treatment Duration for Staphylococcal Bacteremia." Open Forum Infectious Diseases 4, suppl_1 (2017): S29. http://dx.doi.org/10.1093/ofid/ofx162.072.
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Abstract Background The appropriate duration of antibiotics for staphylococcal bloodstream infection (BSI) is unknown. An algorithm to identify patients with staphylococcal BSI who can be safely treated with shorter courses of therapy would improve care and reduce total antibiotic use. Methods Adult patients with staphylococcal BSI were randomized to treatment based on algorithm-based therapy (ABT) or to standard of care (SOC). Co-primary outcomes were clinical success, as determined by a blinded Adjudication Committee, and serious adverse event (SAE) rates. The prespecified secondary outcome measure was antibiotic days by treatment group, among patients without complicated BSI. Prespecified durations of therapy in ABT were: S. aureus BSI (SAB): uncomplicated: 14 days; complicated: 4–6 weeks. Coagulase-negative staphylococci BSI (CoNSB): simple (1 positive blood culture) (0–3 days), uncomplicated (>1 positive blood culture) (5 days), complicated (7–28 days). Outcomes were compared using intention-to-treat principles. The target sample size was 500 patients, to ensure 90% power for establishing noninferiority within a margin of 15%. Results Between April 2011 and March 2017, 509 adults with suspected staphylococcal BSI at 16 sites in the US and Spain were randomized to ABT (N = 255) or SOC (N = 254). There were 116 patients with SAB (23%) and 385 (76%) with CoNSB (Figure 1). Overall success rate in the ABT group was 82.0% vs. 81.5% in the SOC group, difference 0.5%, 95% CI −5.2% to 6.1%. SAEs were reported in 32.9% of ABT vs. 28.3% of SOC patients (OR 1.2, 95% CI 0.9 to 1.8). Among evaluable patients without complicated BSI, mean duration of therapy was 4.4 days in the ABT group vs. 6.4 days in the SOC group (difference −2.0 days, 95% CI −3.3 to −-0.7, P = 0.003). Among patients with uncomplicated SAB, treatment durations were similar (15.3 days in ABT vs. 16.3 days in SOC, difference −1 day, 95% CI −3.89 to 1.91, P = 0.497), whereas for uncomplicated CoNSB, duration was shorter in the ABT group (5.3 days in ABT vs. 8.4 days in SOC, difference −3 days, 95% CI −4.87 to −1.34, P < 0.001). Conclusion The use of a treatment algorithm for staphylococcal BSI was associated with significant reductions in duration of antibiotic therapy in patients without complicated BSI, without significant differences in overall success or SAEs. Disclosures V. Fowler Jr., NIH: Investigator, Contract HHSN272200900023C
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Saura, Cristina, Mafalda Oliveira, Yin-Hsun Feng, Ming-Shen Dai, Shang-Wen Chen, SaraA.Hurvitz, Sung-Bae Kim, et al. "Neratinib Plus Capecitabine Versus Lapatinib Plus Capecitabine in HER2-Positive Metastatic Breast Cancer Previously Treated With ≥ 2 HER2-Directed Regimens: Phase III NALA Trial." Journal of Clinical Oncology 38, no.27 (September20, 2020): 3138–49. http://dx.doi.org/10.1200/jco.20.00147.
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PURPOSE NALA (ClinicalTrials.gov identifier: NCT01808573 ) is a randomized, active-controlled, phase III trial comparing neratinib, an irreversible pan-HER tyrosine kinase inhibitor (TKI), plus capecitabine (N+C) against lapatinib, a reversible dual TKI, plus capecitabine (L+C) in patients with centrally confirmed HER2-positive, metastatic breast cancer (MBC) with ≥ 2 previous HER2-directed MBC regimens. METHODS Patients, including those with stable, asymptomatic CNS disease, were randomly assigned 1:1 to neratinib (240 mg once every day) plus capecitabine (750 mg/m2 twice a day 14 d/21 d) with loperamide prophylaxis, or to lapatinib (1,250 mg once every day) plus capecitabine (1,000 mg/m2 twice a day 14 d/21 d). Coprimary end points were centrally confirmed progression-free survival (PFS) and overall survival (OS). NALA was considered positive if either primary end point was met (α split between end points). Secondary end points were time to CNS disease intervention, investigator-assessed PFS, objective response rate (ORR), duration of response (DoR), clinical benefit rate, safety, and health-related quality of life (HRQoL). RESULTS A total of 621 patients from 28 countries were randomly assigned (N+C, n = 307; L+C, n = 314). Centrally reviewed PFS was improved with N+C (hazard ratio [HR], 0.76; 95% CI, 0.63 to 0.93; stratified log-rank P = .0059). The OS HR was 0.88 (95% CI, 0.72 to 1.07; P = .2098). Fewer interventions for CNS disease occurred with N+C versus L+C (cumulative incidence, 22.8% v 29.2%; P = .043). ORRs were N+C 32.8% (95% CI, 27.1 to 38.9) and L+C 26.7% (95% CI, 21.5 to 32.4; P = .1201); median DoR was 8.5 versus 5.6 months, respectively (HR, 0.50; 95% CI, 0.33 to 0.74; P = .0004). The most common all-grade adverse events were diarrhea (N+C 83% v L+C 66%) and nausea (53% v 42%). Discontinuation rates and HRQoL were similar between groups. CONCLUSION N+C significantly improved PFS and time to intervention for CNS disease versus L+C. No new N+C safety signals were observed.
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Retuerto-Guerrero,M., E.Trujillo, C.Valero, C.Fernandez-Espartero, C.Y.Soleto, A.García-Valle, E.Aurrecoechea, et al. "FRI0132 EFFICACY AND SAFETY OF SWITCHING JAKINIBS IN RHEUMATOID ARTHRITIS." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 648–49. http://dx.doi.org/10.1136/annrheumdis-2020-eular.6284.
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Background:Different Jakinibs (JAKi) have shown efficacy in rheumatoid arthritis (RA) but in an important proportion of patients, insufficient response leads to therapy withdrawal. The different JAKi show variable selectivity for the four Jak isoforms (Jak1,2,3 y Tyk2) but there are no clinical trials analyzing the response to a JAKi after the suspension of another JAKi and therefore, observational data may be useful in this regard.Objectives:To describe efficacy and safety of the second JAKi in patients with suspension of the first due to failure or side effects.Methods:Spanish observational multicentric study. Data were retrospectively obtained from medical records of 28 patients with RA sequentially treated with baricitinib o tofacitinib in any order.Results:We identified 28 patients with RA treated with baricitinib and tofacitinib. Patient´s characteristics are summarized in Table 1. Half of the patients received tofacitinib first, and the other half baricitinib as the first JAKi. Mean survival for the first JAKi was 7,6 ± 6,1 months. The reason for withdrawal was inefficacy in 17 cases (61%) and adverse effects in 11 (39%). Mean follow-up after starting on the second JAKi was 9,6 ± 5,6 [3-19] months. Disease activity data along follow-up are depicted in Table 2. Survival on the second JAKi was 82% at 3, 76% at 6, and 62% at 12 months when 13 of the 21 patients maintained the therapy. In all 8 patients who discontinued the second JAKi, the reason was inefficacy. The treatment suspension rate was similar among patients discontinuing the first JAKi for inefficacy (n=5, 29,4%) or for adverse effects (n=3; 27,3%).Table 1.Baseline Charateristics.N 28Clinical characteristicsFemale24 (86%)Age*61.2 ± 13.2ACPA (+)19 (67,9%)Erosions13 (46,4%)Extra-articular manifestations8 (28,6%)TJC*10,8 ± 5,4SJC *7,4 ± 4,6DAS28-CPR*5,4 ± 0,91 High disease activity71,5% Moderate disease activity23,8% Low disease activity4,7%Previous treatmentbDMARD24 (86%)N° of previous bDMARDs *3,9±2,2 iTNF75% No-iTNF67,9%(*) Mean ± SDTabla 2.Treatment results during the follow-up period.Baseline (n 28)3 m (n 28)6 m (n 25)12 m (n 21)TJC10,8±5,43,8±3,34,23±2,51,9±1,5SJC7,2±4,61,8±1,71,7±20,7±1CPR mg/dL1±0,60,54±0,480,64±0,90,33±0,24DAS28CPR5,4±0,913,29±0,973,15±1,22,15±0,6Prednisone mg7,2±4,26,8±3,55,3±2,53,1±2,1Conclusion:Our data show that therapy with a second JAKi is a safe and efficacious option after discontinuation of the first JAKi due to either inefficacy or side effects. The response rate to the second JAKi is similar in patients with inefficacy or side effects which suggests that failure to the first does not reduce the chance of response to the second.Acknowledgments:M. Retuerto was recipient of a training grant from Sociedad Española de Reumatología (SER).Disclosure of Interests:None declared
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C., Kathirvelu, AyyasamyR., and KarthikeyanM. "Preliminary checklist of moths (Lepidoptera: Glossata) of Annamalai Nagar, Tamil Nadu." Journal of Applied and Natural Science 11, no.2 (June10, 2019): 404–9. http://dx.doi.org/10.31018/jans.v11i2.2063.
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The present research was carried out to document the moth fauna of Annamalai Nagar during December, 2015 to November, 2016 comprising four seasons for a period of one year, from agriculture and horticulture ecosystems using light traps and host rearing methods. The sheet method was used to record moth insects individually without any damage. Any moths that alight on the screen were recorded in jars just after sunset between 18.00 – 23.00 hr. A total of 2,679 moths were recorded using all the three types of methods employed in the study. Out of which, light trap was found with maximum of 2,253 moths followed by manual collection (369) and host rearing (57) from four different sites of observation. Among the sites, light trapping of moths were observed maximum (656) in Orchard followed by Experimental farm with 629 numbers. The diversity of moths was observed in the study area of Annamalai Nagar indicated the presence of 70 genera and 56 species identified under nine superfamilies of Clades viz., Obtectomera (Pyraloidea and Thyridoidea) Macroheterocera (Noctuoidea, Bombycoidea, Geometroidea, Lasiocampoidea) Apoditrysia (Pterophoroidea and Cossoidea) Ditrysia (Tineoidea). The families namely Crambidae, Erebidae, Noctuidae, Sphingidae, Bombycidae, Uraniidae, Thyrididae, Eupterotidae, Geometridae, Pterophoridae, Lasiocampidae, Cossidae and Psychidae were observed in the study area. Out of which, the family Erebidae alone had 28 genera and 25 species and found to be the superior family. From the results, it was clear that light trapping was superior in collection of moths during night times.
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Sururin,S. "PETA PERINGKAT AKREDITASI PERGURUAN TINGGI KEAGAMAAN ISLAM Sebuah Kajian Awal." At-Taqaddum 9, no.1 (July31, 2017): 95. http://dx.doi.org/10.21580/at.v9i1.1783.
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<p>Akreditasi adalah kegiatan penilaian untuk menentukan kelayakan Program Studi dan Perguruan Tinggi. Sampai saat ini peringkat akreditasi prodi PTKIS mayoritas C (1039 prodi), sebagian B (383 prodi) dan hanya 13 prodi yang memperoleh akreditasi A. Peringkat akreditasi program studi pada PTKIN lebih baik di bandingkan dengan PTKIS, akan tetapi jauh di bawah PTN. Data dari BAN PT per 6 Agustus 2016 menunjukkan 169 prodi terakreditasi A, 718 prodi memproleh nilai B, dan masih terdapat 299 nilai akreditasinya C.</p><p>Sampai saat ini baru 3 institusi yang kerakreditasi A, sebagian besar institusi (28 PTKIN) terakreditasi B, dan terdapat 19 institusi terakreditasi C. Dari seluruh jumlah PTKIN, 5 diantaranya belum diakreditasi. Kondisi tersebut lebih baik, dari pada PTKIS. Belum ada satu pun institusi PTKIS yang terakrediatsi A, baru 7 perguruan tinggi yang mendapatkan nilai B, dan mayoritas, 140 PTKIS mendapatkan peringkat akreditasi C. Menurut data Diktis, terdapat 627 institusi, dan 147 yang terakrediatsi. Berarti terdapat 480 institusi yang belum mengajukan akreditasi. Meurut peraturan yang ada, tahun 2019 seluruh institusi harus sudah terakreditasi agar bisa beroperasi.</p><p>Akreditasi eksternal yang dilakukan oleh BAN PT merupakan cerminan dari mutu pendidikan tinggi. Masih rendahnya akrediatsi program studi dan institusi, khsuusnya PTKIS, dibutuhkan kemauan politik serta kebijakan yang memihak untuk meningkatkan mutu pendidikan tinggi. Perlu strategi khusus untuk mengatasinya. Dua hal yang harus dikuatkan adalah SPMI (Sistem Penjaminan Mutu Internal) dan data PD DIKTI (Pangkalan Data Pendidikan Dikti), oleh karena ke depan akreditasi berbasis pada SPMI dan PD DIKTI.</p>
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Heller,P.R., and R.Walker. "Management of Black Cutworm on Creeping Bentgrass with Experimental Formulations, Tempo 20Wp, and Dursban Pro, 1996." Arthropod Management Tests 22, no.1 (January1, 1997): 348. http://dx.doi.org/10.1093/amt/22.1.348.
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Abstract Treatment plots were 6 X 10 ft, arranged in a RCB design and replicated 4 times at University Park, PA. Liquid formulations were applied by using a CO2 compressed air sprayer with 4 8002VS TeeJet nozzles mounted on a 6 ft boom, operating at 28 psi, and applied in 454 ml of water/60 ft2 or delivering 2.0 gal/1,000 ft2. Treatments were applied on 15 Aug following artificial infestation of research area with 2nd and 3rd instar black cutworms. An average of 16/yd2 cutworm larvae was recorded on 13 Aug prior to treatment. The entire experimental area was covered with bird netting until post-treatment counts were recorded on 17 Aug. At treatment time (15 Aug) the following soil and environmental conditions existed: air temperature, 70°F; soil temperature at 1 inch depth, 64°F; soil temperature at 2 inch depth, 64°F; RH, 93%; amount of thatch, 0.0625 inch; soil textural class, loam; soil particle size analysis; 51.0% sand, 40.6% silt, 8.4% clay; soil moisture (oven dry weight), 23.9%; organic matter, 3.9%; watei pH, 7.0; soil pH, 6.1%; time of application, mid-afternoon; and overcast skies. A total of 2.6 inch of rainfall occurred after treatments had been applied Evaluation was done 2 DAT (17 Aug) and 6 DAT (21 Aug) by counting the number of black cutworm larvae flushed to the surface within a 1.0 yd2 wood frame sampling area using a soap irritant drench of 30 ml Lemon Joy™ dishwashing detergent in 2 gal of water.
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Chauhan, Sandeep, Gaurishankar Ramesh, Nita Saxena, Shiv Kumar Choudhary, Lokendra Kumar, and Arkalgud Sampath Kumar. "Comparison of Normothermic Cardiopulmonary Bypass with Conventional Hypothermic Bypass." Asian Cardiovascular and Thoracic Annals 5, no.4 (December 1997): 199–202. http://dx.doi.org/10.1177/021849239700500403.
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In a prospective randomized study from October to December 1996 at the All India Institute of Medical Sciences, we compared normothermic cardiopulmonary bypass with conventional hypothermic bypass. Sixty patients undergoing open-heart surgery for valvular heart disorders were assigned to undergo either normothermic bypass (35°C to 37°C, n = 30) or moderate hypothermic bypass (28°C, n = 30). Bypass time, pump flow, urine output, need for vasopressors, arterial blood gases on bypass, duration of cardioplegia, need for defibrillation, postoperative blood loss, rewarming time to a peripheral (toe) temperature above 35°C, awakening time, and neurologic outcome were studied. Mean bypass time in the normothermic patients (67.33 ± 23.5 minutes) was 23% less (p < 0.05) than in the hypothermic group (89.6 ± 49.26 minutes). Higher flows were required initially in the normothermic group due to low systemic vascular resistance. Early return of sinus node electrical activity in patients (70%) in the normothermic group required more frequent use of topical ice slush and cardioplegia administration. Postoperative blood loss was similar in both groups but fluid and blood requirements in the normothermic group (514 ± 220 mL·m−2) was significantly less (p < 0.05) than in the hypothermic group (722.3 ± 383 mLm−2). Normothermic patients rewarmed earlier (4.25 ± 1.79 hours) to peripheral (toe) temperatures above 35 °C and awoke earlier compared with the hypothermic group, which took a mean time of 6.1 ± 2.3 hours to rewarm. We concluded that normothermic bypass is more physiologic and significantly reduces bypass time while avoiding the deleterious effects of hypothermia.
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Hamilton, Jonnette Watson. "Cautious Optimism: Fraser v Canada (Attorney General)." Constitutional Forum / Forum constitutionnel 30, no.2 (May12, 2021): 1–14. http://dx.doi.org/10.21991/cf29418.
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Adverse effects discrimination arises when a law that appears to be neutral on its face has a disproportionate and negative impact on members of a group identified by a protected ground.1 The discrimination is usually not as easy to see as it is in cases of direct discrimination, where distinctions are drawn by a law, program, or policy. This may be why Fraser v Canada (Attorney General)2 is only the third adverse effects claim under section 15(1) of the Canadian Charter of Rights and Freedoms3 to succeed since section 15 came into force in 1985.4 Fraser is notable simply because it is the first successful adverse effects claim in twenty-two years.5 1 Jonnette Watson Hamilton & Jennifer Koshan. “Adverse Impact: The Supreme Court’s Approach to Adverse Effects Discrimination under Section 15 of the Charter” (2015) 19:2 Rev Const Stud Studies 191 at 196 [“Adverse Impact”]. 2 2020 SCC 28 [Fraser]. 3 Part I of the Constitution Act, 1982, being Schedule B to the Canada Act 1982 (UK), 1982, c 11 [Charter]. 4 The other two cases in which adverse effects claims were successful were Eldridge v British Columbia, [1997] 3 SCR 624, 151 DLR (4th) 577 [Eldridge cited to SCR] and Vriend v Alberta, [1998] 1 SCR 493, 156 DLR (4th) 385 [Vriend cited to SCR]. 5 At least five adverse effects claims made under section 15 of the Charter failed in the intervening twentytwo years: Health Services and Support — Facilities Subsector Bargaining Assn v British Columbia, 2007 SCC
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Kordelas, Lambros, Aleksandar Radujkovic, Hao Dai, Rashit Bogdanov, DietrichW.Beelen, Carsten Müller-Tidow, Peter Dreger, and Thomas Luft. "High Pre-Transplant Free Interleukin-18 Is Associated with Poor Hematopoietic Recovery after Allogeneic Stem Cell Transplantation." Blood 134, Supplement_1 (November13, 2019): 4507. http://dx.doi.org/10.1182/blood-2019-124278.
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Background: Interleukin-18 (IL-18) is an immune regulatory cytokine that induces interferon-gamma (IFNg) and IL-17A production. The serum activity of IL18 is controlled by an IFNg-inducible inhibitor (IL-18 binding protein, IL18BPa). IL-18 promotes hematopoietic stem cell (HSC) hibernation and aggravates symptoms of sepsis. Here, we investigated whether free IL-18 serum levels measured before and on day 0 of allogeneic stem cell transplantation (alloSCT) inhibit hematologic recovery. Patients and methods: Serum levels of pre-transplant IL-18 and IL18BPa, together with the IFNg-response marker CXCL9, were analyzed in patients from two independent institutions (cohort I n=617 and cohort II n= 605), and in 43 normal subjects. Further, IL-18 and IL18BPa levels were measured also on day 0-3 of alloSCT in 309 patients. Free IL-18 was calculated according to the law of masses. Routine lab parameters were recorded pre-transplant and on days 0, 28 and 100 after alloSCT. These were compared to cytokine serum levels and outcome. Results: Pre-conditioning serum levels of total IL-18 were significantly (approximately threefold) higher in both patient cohorts (cohort I: 629 pg/ml, cohort II: 693 pg/ml) compared to healthy controls (median: 147 pg/ml). Cytokine serum levels further increased by approx. 25% until day 0-3. Pre-transplant IL-18 and free IL-18, but not IL18BPa or CXCL9 were inversely correlated with platelet counts before and on days 28 and 100 after alloSCT in both independent cohorts. This inhibitory effect on platelet recovery was similar for free IL-18 levels measured at the day of transplantation (Figure 1). High free IL18 on day 0-3 and low platelet counts on days 28 and 100 predicted 1-year non-relapse mortality in separate multivariable Cox regression analyses (confounders: age, disease stage, HLA-mismatch, donor and recipient sex, disease, ATG and conditioning strength). Conclusion: Serum levels of free IL-18 were closely associated with platelet recovery after alloSCT. This effect did not depend on the IFNg response markers IL18BPa and CXCL9, suggesting a direct inhibitory effect of IL18 on thrombopoiesis. Strategies reducing IL18 activity should be explored to potentially improve hematopoietic recovery and outcome after alloSCT. Figure 1: ROC curves showing influence of free IL-18 serum levels measured before alloSCT and on day 0-3 on endpoint platelets<50/nl on day+28 Figure 1 Disclosures Bogdanov: Jazz Pharmaceuticals, MSD.: Other: Travel subsidies. Beelen:Medac GmbH Wedel Germany: Consultancy, Honoraria. Dreger:AbbVie, AstraZeneca, Gilead, Janssen, Novartis, Riemser, Roche: Consultancy; AbbVie, Gilead, Novartis, Riemser, Roche: Speakers Bureau; Neovii, Riemser: Research Funding; MSD: Membership on an entity's Board of Directors or advisory committees, Other: Sponsoring of Symposia. Luft:Neovii: Research Funding; JAZZ: Research Funding.
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Kantarjian,HagopM., RichardA.Larson, Francois Guilhot, StephenG.O’Brien, and BrianJ.Druker. "Declining Rates of Adverse Events (AEs), Rare Occurrence of Serious AEs (SAEs), and No Unexpected Long-Term Side Effects at 5 Years in Patients with Newly Diagnosed Chronic Myeloid Leukemia (CML) in Chronic Phase (CP) Initially Treated with Imatinib (IM) in the International Randomized Study of Interferon vs STI571 (IRIS)." Blood 108, no.11 (November1, 2006): 2136. http://dx.doi.org/10.1182/blood.v108.11.2136.2136.
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Abstract The IRIS trial compared interferon alfa + cytarabine (IFN+Ara-C) and imatinib (IM) in patients (pts) with newly diagnosed CML-CP. Among 553 pts randomized to receive 400 mg IM, 157 (28%) discontinued for reasons which included AEs or deaths unrelated to CML and treatment (6%) and unsatisfactory therapeutic effect (11%). Only 2.4% discontinued due to drug-related AEs. The average daily dose was 389±71 mg, suggesting that no major dose modifications were required due to toxicity. In pts still on IM, the average doses was 382±50 mg. Average duration of exposure is 50 mos (median 60 mos). Table 1 summarizes the most frequently reported non-hematologic AEs (regardless of relationship to study drug) in pts who started IM therapy and those who were still on IM at 2 and 4 years (n=456 and 409 respectively). Table 1. AEs (≥ 20%) on First-Line Imatinib Therapy AE All grades N= 551 (%) All grades, after 2 yrs N = 456 (%) All grades, after 4 yrs N = 409 (%) Grades 3/4 N= 551 (%) Fluid retention 61.7 20.2 5.6 2.5 – Superficial edema 59.9 18.2 5.1 1.5 – Other fluid retention events 6.9 2.4 0.7 1.3 Nausea 49.5 15.4 3.4 1.3 Muscle cramps 49.2 22.8 7.3 2.2 Musculoskeletal pain 47.0 20.8 6.1 5.4 Diarrhea 45.4 23.0 5.1 3.3 Rash and related terms 40.1 13.8 2.4 2.9 Fatigue 38.8 11.4 2.9 1.8 Headache 37.0 12.1 3.4 0.5 Abdominal pain 36.5 15.4 3.4 4.2 Joint pain 31.4 9.2 2.0 2.5 Nasopharyngitis 30.5 14.3 3.7 0 Hemorrhage 28.9 14.3 5.1 1.8 Myalgia 24.1 4.6 1.5 1.5 Vomiting 22.5 9.2 3.7 2.0 Upper respiratory tract infection 21.2 11.2 2.7 0.2 Cough 20.0 7.7 3.4 0.2 Hematologic toxicities were the most frequently occurring grade 3/4 AEs (Table 2). Table 2. Grade 3/4 laboratory abnormalities on First-line Imatinib Overall N = 551 (%) After 2 years N= 456 (%) After 4 years N= 409 (%) Hematologic – Neutropenia 16.7 7 1.0 – Thrombocytopenia 8.9 1.5 0.2 – Anemia 4.4 1.8 0.5 Biochemical – ↑ SGOT/SGPT 5.3 0.4 0 – ↑Total bilirubin 1.1 0.4 0.2 The most frequent reported AEs as well as grade 3/4 hematological and biochemical toxicities were observed at decreasing frequencies throughout therapy. After 4 years, 8% of pts experienced an SAE, compared with 14%, 12%, 7.5%, and 9% during year one through four of therapy. Overall, only 6% of pts had SAEs considered related to study drug (1.5% pts after 4 years of IM). Congestive heart failure/cardiac dysfunction (incl. pulmonary edemas) were reported for 3% of pts (<1% grade 3/4) and pleural effusion in 1% (<1% grade 3/4). Despite much shorter average exposure (12 mos), similar % of these AEs were noted for IFN+Ara-C. Although it should be considered that pts more likely to experience grade 3/4 events may have discontinued from the study prematurely, the 5-year data with IM in pts with newly diagnosed CML-CP show declining frequencies of AEs and SAEs over time. Occurrence of SAEs and laboratory abnormalities with long-term follow-up was rare. No unexpected long-term side effects were noted. These results confirm the IM tolerability and safety profile for durations exceeding 4 years.
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Heřmánková,B., M.Špiritović, S.Oreska, H.Štorkánová, H.Smucrova, K.Pavelka, J.Vencovský, L.Šenolt, R.Bečvář, and M.Tomčík. "POS0846 SEXUAL FUNCTION IS IMPAIRED IN WOMEN WITH SYSTEMIC SCLEROSIS COMPARED TO HEALTHY CONTROLS." Annals of the Rheumatic Diseases 80, Suppl 1 (May19, 2021): 677.1–677. http://dx.doi.org/10.1136/annrheumdis-2021-eular.1829.
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Background:Systemic sclerosis (SSc) is a multisystem, connective tissue disorder characterized by fibrosis of the skin and internal organ involvement, which can influence all aspects of life, including sexual life.Objectives:This study aimed to compare sexual function in patients with SSc to age-/sex-matched healthy controls (HC) and determine the potential impact of clinical features on sexual function.Methods:In total, 90 women with SSc (mean age: 49.1, disease duration: 6.1 years, lcSSc/dcSSc: 62/28, mRSS: 9.3, ESSG activity index: 2.1), who fulfilled the ACR/EULAR 2013 criteria, and 90 healthy controls (mean age: 49.1) without rheumatic diseases filled in 12 well-established and validated questionnaires assessing sexual function (FSFI, BISF-W, SFQ-28, SQoL-F), pelvic floor function (PISQ-12, PFIQ-7), fatigue (FIS, Fatigue Impact Scale), physical activity (HAP, Human Activity Profile), disability (HAQ, Health Assessment Questionnaire), depression (BDI-II, Beck’s Depression Inventory-II) and quality of life (SF-36, Medical outcomes study Short Form 36 – PCS, Physical Component Summary; MCS, Mental Component Summary). A routine laboratory testing was performed. Data are presented as median (IQR).Results:Patients with SSc reported significantly greater prevalence and severity of sexual dysfunction (FSFI, BISF-W, SFQ28 – in all subscales as well as total scores), worse sexual quality of life (SQoL-F) and pelvic floor dysfunction (PISQ-12, PFIQ-7) compared to HC (table 1). The prevalence of sexual dysfunction in patients with SSc according to the FSFI cut-off score was 77%. Worse scores in SSc patients were associated with longer disease duration [BISF-W-total (r=-0.243,p=0.026), FSFI-lubrication (r=-0.229,p=0.035)], higher disease activity [ESSG activity index: BISF-W-total (r=-0.291,p=0.010), FSFI-arousal (r=-0.299,p=0.007)], increased inflammation [CRP: BISF-W-receptivity/initiation (r=-0.301,p=0.007)], more pronounced fatigue [FIS-total: BISF-W-total (r=-0.412,p<0.0001)], more severe depression [BDI-II: FSFI-total (r=-0.506,p<0.0001), SQoL-F (r=-0.369, p<0.0001)], worse functional disability [HAQ: FSFI-total (r=-0.394,p<0.0001)], reduced physical activity [HAP: FSFI-total (r=0.535,p<0.0001)], and decreased overall quality of life [SF-36 PCS: FSFI-total (r=0.428,p<0.0001), SF-36 MCS: SQoL-F (r=0.472, p<0.0001)].Conclusion:Women with SSc reported significantly impaired sexual function and pelvic floor function compared to age-/sex-matched healthy controls. Worse scores in SSc were associated with disease-related features.Table 1.Sexual function and pelvic floor function in women with SSc and healthy controlsQuestionnaire: score range (meaning)SSc (n=90)HC (n=90)p-valueFSFI: Female sexual function index: 2 (worst) - 36 (best)19.4 (3.9-26.8)30.1 (23.1-32.9)p<0.0001BISF-W: Brief Index of Sexual Function for Women: -16 (worst) - 75 (best)14.3 (2.1-35.1)38.2 (19.3-46.2)p<0.0001SQoL-F: Sexual Quality of Life Questionnaire-Female: 0 (worst) - 100 (best)61.1 (34.4-81.1)91.1 (70.0-96.7)p<0.0001PISQ-12: Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form: 0 (best) - 48 (worst)13.0 (9.0-17.0)7.0 (5.0-12.0)p<0.0001PFIQ-7: Pelvic Floor Distress Inventory Questionnaire: 0 (best) - 300 (worst)9.5 (0.0-48.8)0.0 (0.0-8.3)p<0.0001SFQ-28: Sexual Functioning Questionnaire-28 desire: 5 (worst) - 31 (best)17.0 (12.0-20.0)21.0 (17.0-23.0)p<0.0001SFQ-28 arousal sensation: 4 (worst) - 20 (best)10.0 (8.0-13.0)12.0 (9.0-15.0)p=0.0031SFQ-28 arousal lubrication: 2 (worst) - 10 (best)5.0 (4.0-7.0)8.0 (5.2-9.0)p<0.0001SFQ-28 arousal cognitive: 2 (worst) - 10 (best)5.0 (4.0-6.0)7.0 (5.0-8.0)p<0.0001SFQ-28 orgasm: 1 (worst) - 15 (best)10.0 (6.5-12.0)12.0 (10.0-13.0)p<0.0001SFQ-28 pain: 2 (worst) - 15 (best)12.0 (9.5-15.0)15.0 (13.0-15.0)p<0.0001SFQ-28 enjoyment: 6 (worst) - 30 (best)19.0 (12.5-24.0)24.0 (20.0-25.8)p<0.0001SFQ-28 partner: 2 (worst) - 10 (best)9.0 (8.0-10.0)10. (9.0-10.0)p=0.0182Acknowledgements:Supported by MHCR 023728, GA UK 1578119, and SVV 260373.Disclosure of Interests:None declared
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Islam, Md Mahmudul, Khondkar AK Azad, Md Aminul Islam, and Rivu Raj Chakraborty. "Chest Trauma Evaluation and Outcome of Management in a Tertiary Hospital - One Year Experience." Journal of Surgical Sciences 22, no.2 (March22, 2020): 110–17. http://dx.doi.org/10.3329/jss.v22i2.44075.
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Background: Chest trauma is responsible for 50% of deaths due to trauma. This kind of death usually occurs immediately after the trauma has occurred. Various therapeutic options have been reported for management of chest injuries like clinical observation, thoracocentesis, tube thoracostomy and open thoracotomy. Objective: To observe the pattern and outcome of management in chest trauma Methods: This is an observational study carried out in Casualty department of Chittagong Medical College Hospital (CMCH), Chittagong, between April 2015 to March 2016. Our study was included all patients, both sexes, following chest injury at Casualty units of Chittagong Medical College Hospital. All the data were recorded through the preformed data collection sheet and analyzed. Result: The mean age was found 37.7±18.1 years with range from 12 to 80 years. Male female ratio was 11.8:1. The mean time elapsed after trauma was found 6.1±3.1 hours with range from 1 to 72 hours. Almost one third (35.7%) patients was affecting road traffic accident followed by 42(27.3%) assault, 35(22.7%) stab injury, 15(9.7%) fall and 7(4.5%) gun shot . More than three fourth (80.5%) patients were managed by tube thoracostomy followed by 28(18.2%) observation and 2(1.3%) ventilatory support. No thoracotomy was done in emergency department. 42(27.2%) patients was found open pneumothorax followed by 41(26.6%) rib fracture, 31(20.1%) haemopneumothorax, 14(9%) simple pneumothorax, 12(7.8%) haemothorax, 6(3.9%) chest wall injury, 5(3.2%) tension pneumothorax, and 3(1.9%) flail chest. About the side of tube 60(39.0%) patients were given tube on left side followed by 57(37.0%) patients on right side, 9(5.8%) patients on both (left & right) side and 28(18.2%) patients needed no tube. Regarding the complications, 13(30%) patients had persistent haemothorax followed by 12(29%)tubes were placed outside triangle of safety, 6(13.9%) tubes were kinked, 6(13.9%) patients developed port side infection, 2(4.5%)tube was placed too shallow, 2(4.5%) patients developed empyema thoracis and 2(4.5%) patients developed bronchopleural fistula. The mean ICT removal information was found 8.8±3.6 days with range from 4 to 18 days. Reinsertion of ICT was done in 6(4.7%) patients. More than two third (68.2%) patients were recovered well, 43(27.9%) patients developed complication and 6(3.9%)patients died. More than two third (66.9%) patients had length of hospital stay 11-20 days. Conclusion: Most of the patients were in 3rd decade and male predominant. Road traffic accident and tube thoracostomy were more common. Open pneumothorax, rib fracture and haemopneumothorax were commonest injuries. Nearly one third of the patients had developed complications. Re-insertion of ICT needed almost five percent and death almost four percent. Journal of Surgical Sciences (2018) Vol. 22 (2) : 110-117
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Chauhan, Owen, Chris Skedgel, Susan Pleasance, Kara Thompson, and David Anderson. "The Cost Analysis Of Aspirin Versus Low Molecular Weight Heparin For Thromboprophylaxis Following Total Hip Arthroplasty." Blood 122, no.21 (November15, 2013): 1134. http://dx.doi.org/10.1182/blood.v122.21.1134.1134.
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Abstract Background The EPCAT (Extended Prophylaxis Comparing low molecular weight heparin to Aspirin following Total hip arthroplasty) study demonstrated that after patients received an initial 10-day post-operative course of LMWH, extending prophylaxis for an additional 28 days with aspirin was at least as effective and safe as low molecular weight heparin (LMWH) for the prevention of venous thromboembolism (VTE) following elective total hip arthroplasty (Anderson et al Ann Intern Med 2013). However, the cost-effectiveness of aspirin relative to LMWH in this setting is unclear. Based on the EPCAT results, we evaluated the cost-effectiveness of extended aspirin versus LMWH prophylaxis in terms of incremental cost per quality-adjusted life year (QALY) gained. Methods In the EPCAT study, following total hip arthroplasty all patients received 10 days of LMWH (dalteparin 5000 u SQ daily). Patients were then randomized to continue dalteparin or begin aspirin 81 mg daily for an additional 28 days. In the 90-day follow up period after randomization 1 of 380 (0.3%) patients randomized to aspirin compared to 5 of 398 receiving LMWH developed VTE complications (difference 1.0%; 95% CI -0.5 to 2.5%). Clinically significant bleeding occurred in 2 aspirin patients (0.5%) and 5 patients (1.3%) receiving LMWH (difference 0.72; 95% CI -0.83 to 2.3%). A decision tree was constructed to describe the short and long-term health and cost consequences of each regimen, including the presence or absence of VTE or bleeding, the particular type of VTE (deep vein thrombosis (DVT) or pulmonary embolism (PE)) or bleeding (major or clinically important non-major), and whether or not the outcome was fatal. Event probabilities were derived from the EPCAT study. Outpatient treatment protocols were based on expert opinion, with costs from the 2012 Nova Scotia fee schedule and hospital charges. The costs of inpatient management of DVT, PE and clinically significant bleeding were based upon the Ontario Case Costing Initiative (OCCI) estimates of average case costs from 2006/07. Daily drug costs were derived from a pooled sample of prices from 6 retail pharmacies in 3 Canadian provinces. All costs were inflated to 2013 Canadian (CAD) dollars ($) based on the Statistics Canada Consumer Price Index, Health Component. Health state utilities were derived from the literature. Probabilistic sensitivity analysis and one-way threshold analyses were conducted to test the robustness of the results. Results Based on point estimates from the EPCAT study, aspirin was associated with cost savings of CAD442 per patient (95% CI $383 to $628) and a very small gain of 0.9 QALYs per 1000 patients (95% CI 0.3 to 1.6 per 1000 patients) treated relative to LMWH. Aspirin was dominant (more effective and less costly) in >95% of the iterations of the probabilistic sensitivity analysis. The EPCAT study data demonstrated that the relative risk of VTE with aspirin compared to LMWH was 0.21, but threshold analysis showed that aspirin would still be cost-saving relative to LMWH with a relative risk for VTE over 12.0. Similarly, in the EPCAT study, the relative risk of bleeding with aspirin was 0.45, but our analysis indicated it remained cost-saving including a relative risk over 6.0 of clinically important bleeding. Conclusions Extended prophylaxis for 28 days with aspirin was non-inferior to and as safe as LMWH for the prevention of VTE following total hip arthroplasty after patients received LMWH for 10 days. Based on this clinical data, use of aspirin was cost-saving and economically dominant compared to LMWH. Threshold analysis suggested that this conclusion remained robust across large plausible ranges of VTE and bleeding rates. Disclosures: No relevant conflicts of interest to declare.
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Horneff,G., A.Zimmer, K.Minden, T.Hospach, F.Weller-Heinemann, S.Hansmann, J.Kuemmerle-Deschner, et al. "SAT0502 LONG-TERM OBSERVATIONAL SAFETY SURVEILLANCE OF GOLIMUMAB TREATMENT FOR POLYARTICULAR JUVENILE IDIOPATHIC ARTHIRTIS—AN INTERIM ANALYSIS." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1207.1–1207. http://dx.doi.org/10.1136/annrheumdis-2020-eular.3589.
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Background:Golimumab (GOL) is approved for treatment of polyarticular juvenile idiopathic arthritis (pJIA) in patients 2 years and older. Data on long-term safety in this indication are limited.Objectives:Prospective monitoring of long-term safety and effectiveness of GOL in routine care using the German BIKER registry.Methods:In this non-interventional study baseline and safety parameters were compared between patients initiating GOL and contemporary matched control cohorts starting either an alternative TNF inhibitor (TNFi) or methotrexate (MTX) without exposure to a biologic. Efficacy outcomes were JADAS10, JIA ACR scores, joint counts and Childhood Health Assessment Questionnaire disability-index (CHAQ-DI). Safety assessments were based on adverse event (AE) reports.Results:From 2016 to 2019, 55 patients initiating GOL have been recruited and matched to 110 patients starting alternative TNFi and 47 biologic-naïve patients. Patients starting GOL had a longer disease duration (6.8y vs. 4.1 y and 1.0y; p<0.0001) and use of GOL was significantly more often second-line (85% vs 31% and 0%, p<0.0001). Disease activity was lower at baseline compared to MTX patients as indicated by active joint counts, JADAS10 and concomitant steroid use. Otherwise they were comparable with patients treated with other TNFi (Table 1).Table 1Comparison of GOL cohort with (1) other TNFi cohort and (2) MTX cohort.GOLN=55Other TNFiN=110MTXN=47p-value #GOL vs TNFi/MTXGender female, n (%)44 (80)86 (78)34 (72)0.8/0.5Age at baseline, mean (SD), years13.6 (2.8)13.6 (3.0)13.1 (3.4)1.0/0.4Disease duration, mean (SD), years6.8 (4.5)4.1 (3.8)1.0 (1.6)<0.0001RF neg. polyarthritis, n (%)28 (51)53 (48)29 (62)0.7/0.3RF pos. polyarthritis, n (%)6 (11)18 (16.4)11 (23.4)0.5/0.1Extended oligoarthritis, n (%)20 (36.4)37 (33.6)6 (12.8)0.7/0.007Psoriatic arthritis1 (1.8)2 (1.8)1 (2.1)1.0/1.0Pretreatment bDMARD n(%)47 (85.5)34 (30.9)0<0.0001Concomitant steroids, n (%)9 (16.4)26 (23.6)25 (53.2)0.3/0.0001Active joint count, mean (SD)4.6 (4.0)5.4 (6.1)9.7 (6.5)0.4/<0.0001CHAQ DI, mean (SD)0.4 (0.4)0.5 (0.6)0.6 (0.7)0.3/0.07ESR, mm/h, mean (SD)20.4 (27.6)15.4 (18.6)21.4 (18.6)0.2/0.8JADAS10, mean (SD)11.3 (6.0)12.4 (5.8)16.9 (5.4)0.3/<0.0001AE, n (rate/100PY; 95%CI)45 (96; 72-128)106 (114; 94-138)39 (107; 78-146)0.3/0.6SAE, n (rate/100PY; 95%CI)2 (4.2; 1.1-17)5 (5.4; 2-13)1 (2.7; 0.4-19)0.8/0.7Infectious AE, n (rate/100PY; 95%CI)6 (12.8; 5.7-28)11 (11.8; 6.5-21)9 (24.5; 13-47)0.9/0.2Serious infections, n (rate/100PY; 95%CI)02 (2.2; 0.5-8.6)0n.a.Uveitis new manifestation1 (2.1; 0.3-15)2 (2.2; 0.5-8.6)01.0/n.a.In GOL treated patients a marked clinical response was noted at 6 months and beyond demonstrated by a significant decrease of the mean JADAS 10 from 11.3 to 6.4 (p=0.0008), as well as JIA ACR 30/50/70/90 response rates of 56/56/35/21%. JADAS remission and minimal disease activity was observed in 18% and 47% after 6 months and in 29% and 43% of patients after 12 months.Rates of AE, SAE and infectious AE were comparable between the GOL cohort (96, 4.2 and 12.8/100PY), the alternative TNFi cohort (114, 5.4 and 11.8/100PY) and the MTX cohort (107, 2.7 and 24.5/100PY). SAE reported in the GOL cohort were uveitis and JIA flare (each 1). Two serious infections, both influenza, were reported in the alternative TNFi cohort, none in the GOL cohort. No case of pregnancy, malignancy or death was reported.Conclusion:Interim results from this ongoing safety surveillance study indicate acceptable safety and tolerability of GOL in pJIA that is comparable to treatment with alternative TNFi or MTX. The long-term effectiveness data reinforce the established efficacy of GOL in pJIA treatment.Disclosure of Interests:Gerd Horneff Grant/research support from: AbbVie, Chugai, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Speakers bureau: AbbVie, Bayer, Chugai, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Angela Zimmer: None declared, Kirsten Minden Consultant of: GlaxoSmithKline, Sanofi, Speakers bureau: Roche, Toni Hospach: None declared, Frank Weller-Heinemann: None declared, Sandra Hansmann Consultant of: Advisory board Novartis Pharma, Jasmin Kuemmerle-Deschner Grant/research support from: Novartis, Sobi, Consultant of: Novartis, Sobi, Speakers bureau: Novartis, Sobi, Maria Fasshauer Consultant of: Shire, CSL Behring, Nadja Hofmann: None declared, Hans Koessel: None declared, Ivan Foeldvari Consultant of: Novartis, Sonja Mrusek: None declared, Daniel Windschall Speakers bureau: Abbvie, Nils Onken: None declared, Markus Hufnagel: None declared, Dirk Foell Grant/research support from: Novartis, Sobi, Pfizer, Speakers bureau: Novartis, Sobi, Normi Brueck: None declared, Prasad Oommen Consultant of: Novartis, Frank Dressler: None declared, Astrid Helling-Bakki: None declared, Ariane Klein Consultant of: Celgene
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Chambah,S., L.Coupal, and D.Choquette. "AB0752 PSORIATIC ARTHRITIS: OLIGOARTHRITIS AND POLYARTHRITIS PATTERN CHANGES OVER THE INITIAL YEAR OF THE PRESENTATION. A REAL-WORLD EVIDENCE REPORT FROM THE QUEBEC REGISTRY RHUMADATA®." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1672.1–1673. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2848.
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Background:Psoriatic Arthritis (PsA) most frequently presents as a polyarthritis or (less often) as an oligoarthritis [1]. Upon reassessment, patients may change category during follow-up [2-3]. Historically, the patients in the original description of Moll and Wight had an oligoarticular presentation [4]. However, other studies have not found the same distribution in all patient populations [5]. Currently, none of the accepted diagnostic or classification criteria set for PsA consider the variation in the number of involved joints in the early phase of PsA.Objectives:To evaluate the change in pattern between oligoarticular and polyarticular psoriatic arthritis, within the first year of follow-up.Methods:Data from RHUMADATA® patients diagnosed with PsA were extracted on December 8th, 2019. In the current analysis, we consider the first year of care patients following their first encounter with clinic staff. Patients with at least two 66/68 joint counts completed during this initial year are the subjects of this analysis. Joint count classification (Oligo vs Poly) was assessed from the first and last available joint counts. Patients were classified as having a polyarticular form of PsA if 5 or more of their joints were assessed as being swollen and/or tender. Subjects with 4 or less swollen and/or tender joints were classified as oligoarticular PsA patients.Results:A total of 287 patients with at least two 66/68 joint counts are used in the present analysis. At baseline, the mean age of patients was 47.8 ± 13.5 with average disease duration of 1.6 ± 5.2 years. 49 % of patients were women. Average joint count at baseline was 7.1 ± 7.2 (swollen) and 7.1 ± 7.5 (tender) joints. Considering only 28 joints, the average was 4.2 ± 5 and 3.9 ± 4.8 for swollen and tender joints respectively. At the first joint count, 115 (40%) patients were assessed as “Oligo” and 172 (60%) as “Poly”, while 159 (55%) and 128 (45%) were similarly assessed at the last assessment. The two assessments agreed for 179 (62%) and disagreed for 108 (38%). Of the 115 patients initially classified as “Oligo”, 32 (28%) were reassessed as “Poly” within the initial year, while 76 (44%) of the 172 patients initially classified as “Poly” were reassessed as “Oligo”. All 172 patients initially classified as “Poly” initiated a DMARD during this period (167 (97%) initiated a csDMARD and 5 (3%) initiated a bDMARS). All patients initially classified as “Oligo” also initiated treatment during this period (98 (85%) and 17 (15%) of the 115 patients initially classified as “Oligo” initiated csDMARDs and bDMARD respectively).Conclusion:These observations suggest that a single assessment of joint count may be misleading in establishing the oligo or polyarticular pattern of PsA. This classification should take treatment into account.References:[1]Gladman DD, Ritchlin C, et al. Clinical manifestations and diagnosis of psoriatic arthritis. Uptodate 2019.[2]Jones SM, Armas JB, Cohen MG, et al. Psoriatic arthritis: outcome of disease subsets and relationship of joint disease to nail and skin disease. Br J Rheumatol 1994; 33:834.[3]McHugh NJ, Balachrishnan C, Jones SM. Progression of peripheral joint disease in psoriatic arthritis: a 5-yr prospective study. Rheumatology (Oxford) 2003; 42:778.[4]Wright V, Moll JM. Psoriatic arthritis. Bull Rheum Dis 1971; 21:627.[5]Gladman DD. Psoriatic arthritis. Baillieres Clin Rheumatol 1995; 9:319.Disclosure of Interests:Sana Chambah: None declared, Louis Coupal: None declared, Denis Choquette Grant/research support from: Rhumadata is supported by grants from Pfizer, Amgen, Abbvie, Gylead, BMS, Novartis, Sandoz, eli Lilly,, Consultant of: Pfizer, Amgen, Abbvie, Gylead, BMS, Novartis, Sandoz, eli Lilly,, Speakers bureau: Pfizer, Amgen, Abbvie, Gylead, BMS, Novartis, Sandoz, eli Lilly,
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vanOosterhout,WillebrordusP.J., GuusG.Schoonman, ErikW.vanZwet, OlafM.Dekkers, GiselaM.Terwindt, Antoinette MaassenVanDenBrink, and MichelD.Ferrari. "Female sex hormones in men with migraine." Neurology 91, no.4 (June27, 2018): e374-e381. http://dx.doi.org/10.1212/wnl.0000000000005855.
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ObjectiveTo assess the role of estradiol and testosterone in men with migraine.MethodsWe measured 17β-estradiol (E2) and calculated free testosterone (Tf) in serum of 17 medication-free men with migraine and 22 men without migraine group-matched for age and body mass index (BMI), targeted at 20 to 28 kg/m2. Blood was sampled on a single, for migraineurs interictal, day at 9 am, 12 pm, 3 pm, and 6 pm. Migraineurs were subsequently measured 3 to 4 times daily until an attack occurred. Clinical androgen deficiency was assessed with the Androgen Deficiency of Ageing Men questionnaire and the Aging Males' Symptoms (AMS) scale. We analyzed interictal data (mean ± standard error) with repeated-measures analysis of covariance and longitudinal data by generalized estimated equations models.ResultsCompared to controls, men with migraine had a lower interictal Tf/E2 ratio (3.9 ± 0.4 vs 5.0 ± 0.3, p = 0.03) due to higher E2 (96.8 ± 6.1 vs 69.1 ± 5.6 pmol/L, p = 0.001) and similar Tf (357.5 ± 21.4 vs 332.6 ± 18.7 pmol/L, p = 0.35) levels. Preictal Tf levels were increased in men with migraine reporting premonitory symptoms (p = 0.03). Men with migraine more frequently reported symptoms of androgen deficiency (11 of 18 [61.1%] vs 6 of 22 [27.3%], p = 0.031), which were also more frequently severe (p = 0.006); their age- and BMI-adjusted AMS scores were higher (27.0 ± 1.2 vs 21.0 ± 1.0, p = 0.002).ConclusionsIn this study, nonobese men with migraine exhibited increased levels of the sex hormone estradiol and showed clinical evidence of relative androgen deficiency. The role of estradiol in modulating migraine susceptibility and activity in men deserves further investigations.
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Halliwill,J.R., J.A.Taylor, T.D.Hartwig, and D.L.Eckberg. "Augmented baroreflex heart rate gain after moderate-intensity, dynamic exercise." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 270, no.2 (February1, 1996): R420—R426. http://dx.doi.org/10.1152/ajpregu.1996.270.2.r420.
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The occurrence of a sustained vasodilation and hypotension after acute, dynamic exercise suggests that exercise may alter arterial baroreflex mechanisms. Therefore, we assessed systemic hemodynamics, baroreflex regulation of heart rate, and cardiac vagal tone after 60 min of cycling at 60% peak oxygen consumption in 12 healthy, untrained men and women (ages 21-28 yr). We derived sigmoidal carotid-cardiac baroreflex relations by measurement of R-R interval changes induced by ramped, stepwise, R-wave-triggered changes in external neck pressure from 40 to -65 mmHg. We estimated tonic cardiac vagal control with power spectral analysis of R-R interval variability in the respiratory frequency band (0.2-0.3 Hz) during frequency- and tidal volume-controlled breathing. Both mean arterial pressure and total peripheral resistance were reduced postexercise [pressure: from 86 +/- 2 (mean +/- SE) to 81 +/- 2 mmHg; resistance: from 23 +/- 2 to 16 +/- 1 units; both P < 0.05]. Cardiac output was increased postexercise (from 3.9 +/- 0.3 to 5.5 +/- 0.5 l/min, P < 0.05). Both slope and range of the carotid-cardiac baroreflex relation were increased postexercise (slope: from 4.7 +/- 0.7 to 6.1 +/- 0.9 ms/mmHg; range: from 186 +/- 23 to 238 +/- 30 ms, P < 0.05). Respiratory R-R interval variability (cardiac vagal tone) was not changed at any time after exercise, whereas heart rate and plasma norepinephrine levels were elevated. Thus moderate-intensity, dynamic exercise increases heart rate and cardiac output, reduces peripheral vascular resistance, and augments baroreflex responsiveness. Our data suggest that augmented baroreflex heart rate gain restrains rather than contributes to postexercise hypotension, which appears to be mediated predominately by vasodilation.
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McCormick, Robert, Juan Estrada, Cynthia Whitney, Mona Hinrichsen, PatrickT.Lee, AdamB.Cohen, Lee Schwamm, and Marcelo Matiello. "Teleneurology Comprehensive Inpatient Consultations Expedite Access to Care and Decreases Hospital Length of Stay." Neurohospitalist 11, no.3 (March11, 2021): 229–34. http://dx.doi.org/10.1177/19418744211000951.
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Background and Purpose: While the successful provision of telestroke care has been well documented in the literature, studies on the impact of comprehensive teleneurology service (TN) to hospital measures are lacking. We evaluated 3 traditional health services metrics of hospital performance: time from consult request to consult completion, inpatient length of stay (LOS), and the rate of patients transferred for tertiary care. Methods: Medical records (n = 899) from 3 community hospitals and our TN consultation database were retrospectively reviewed during the 2 years before (n = 703, 3 hospitals) and 4 months (n = 2 hospitals) to 2 years (n = 1 hospital) after implementation (n = 196) of a TN program for routine and urgent consult requests. Consult order time, consult completion time, total length of stay and discharge disposition were compared across the pre-TN implementation group, which consisted of in-person consultations and the post-TN implementation group, which consisted of TN consultations only. Results: After TN implementation, median length of stay decreased 28% (3.9 vs. 2.8 days, p < 0.0001) and median time from consult order to consult completion decreased by 74% across all diagnoses (5.8 vs. 1.5 hours, p < 0.0001). There were no significant differences in the percentage of patients discharged home (52.3% vs. 56.1%, p = 0.10) or transferred to tertiary care (6.1% to 9.2%, p = 0.10). Conclusions: Implementation of TN program was associated with significant reductions in LOS and time to consultation completion without an increase in shunting of patients to more advanced facilities. Further research is warranted to confirm these findings in independent cohorts and other models of teleneurology delivery.
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Calderón-Goercke,M., J.J.Gaitán-Valdizán, R.Fernández-Ramón, L.Sánchez-Bilbao, R.Demetrio-Pablo, and R.Blanco. "SAT0512 OCULAR INVOLVEMENT AND TREATMENT IN SARCOIDOSIS. STUDY OF 41 PATIENTS OF A SERIES OF 383 PATIENTS FROM A SINGLE UNIVERSITY HOSPITAL." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1212.2–1212. http://dx.doi.org/10.1136/annrheumdis-2020-eular.3757.
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Background:The eye is a common and potential severe complication of sarcoidosis. Topical and systemic corticosteroids are the first-line treatment. Conventional and biological immunosuppressants (IS) are frequently needed(1-5).Objectives:To assess the frequency, clinical and treatment of ocular involvement of sarcoidosis.Methods:Study of a large cohort (n=383) of systemic sarcoidosis from a single university hospital. All consecutive patients diagnosed with sarcoidosis from January 1,1999 to January 1,2019 according the ATS/ERS/WASOG criteria(Eur Respir J 1999;14:735–737) were included.Results:41 (22 women/19 men) of 383 (10.7%) patients had ocular involvement, mean age 44.8±16 years. Uveitis (n=34; 82.9%) was the most common ocular manifestation, especially anterior uveitis (n=18; 52.9%). Ocular surface and eye orbit may also be affected(Table). In addition to topical and systemic corticosteroids, conventional (n=23; 56.1%) and biologic (n=14; 34.1%) IS drugs were required. Adalimumab and Infliximab were the most used biologic treatments(Table).Cystoid macular edema (CME) and Retinal Vasculitis was observed in both cases in 3 (7.3%) patients, 2 of them (66.7%) required biological treatment. Papilitis appeared in 7 (17.1%) cases, biological treatment was needed in 3 (42.9%) patients. The most frequent sequels were cataract (n=9, 21.9%), intraocular hypertension (n=5; 12.2%) and pupil alterations (n=4; 9.7%). The average of the best corrected visual acuity was 0.6±0.3 at diagnosis and 0.7±0.3 after one year follow up.Conclusion:Ocular involvement of sarcoidosis is a relative frequent and potential severe complication, especially if panuveitis is presented.References:[1]Riancho-Zarrabeitia L, et al. Semin Arthritis Rheum. 2015; 45:361-8.[2]Calvo-Río V, et al. Clin Exp Rheumatol. 2014; 32:864-8.[3]Riancho-Zarrabeitia L, et al. Clin Exp Rheumatol. 2014; 32:275-84.[4]Vegas-Revenga N, et al. Am J Ophthalmol. 2019; 200:85-94.[5]Calvo-Río V, et al. Clin Exp Rheumatol. 2014;32(4 Suppl 84): S54-7.Table.Ocular manifestations of sarcoidosis and treatment with corticosteroids, conventional and biological IS.CONVENTIONAL ISBIOLOGICAL ISOCULAR INVOLVEMENTCasesTCSOCSMD of OCSIVMPCISMTXAZACFMMMFBTADAIFXTCZGLMETNSURFACE n(%)3(7.3)2(66.7)2(66.7)2(66.7)2(66.7)2(66.7)2(66.7)1(33.3)0(0)2(66.7)2(66.7)2(66.7)0(0)0(0)0(0)-CG/N, n(%)1(33.3)1(100)0(0)0(0)0(0)0(0)0(0)0(0)0(0)0(0)0(0)0(0)0(0)0(0)0(0)-PUK, n(%)2(66.7)1(50)2(100)602(100)2(100)2(100)2(100)1(50)0(0)2(100)2(100)2(100)0(0)0(0)0(0)UVEITIS n(%)34(82.9)25(73.5)28(82.3)10(29.4)19(55.6)18(52.9)7(20.6)1(2.9)1(2.9)12(35.3)11(32.3)4(11.8)3(8.8)2(5.9)1(2.9)-Anterior uveítis, n(%)18(52.9)11(61.1)13(72.2)301(5.5)5(27.8)5(27.8)1(5.5)0(0)0(0)0(0)0(0)0(0)0(0)0(0)0(0)-Posterior uveítis, n(%)4(11.7)2(50)3(75)601(25)3(75)2(50)2(50)0(0)0(0)2(50)1(25)0(0)0(0)1(25)0(0)-Panuveítis, n(%)12(35.3)12(100)12(100)608(66.7)11(91.7)11(91.7)4(33.3)1(8.3)1(8.3)10(83.3)10(83.3)4(33.3)3(25)1(8.3)1(8.3)EYE ORBIT n(%)4(9.7)2(50)3(75)2(50)2(50)2(50)2(50)0(0)0(0)2(50)1(25)1(25)1(25)0(0)0(0)-Proptosis, n(%)2(50)1(50)1(50)301(50)1(50)1(50)1(50)0(0)0(0)1(50)1(50)0(0)1(50)0(0)0(0)-Strabismus, n(%)2(50)1(50)2(100)601(50)1(50)1(50)1(50)0(0)0(0)1(33.3)0(0)1(33.3)0(0)0(0)0(0)TOTAL, n(%)41(100)29(70.7)33(80.5)50±15.514(34.1)23(56.1)22(53.7)11(26.9)2(4.9)1(2.4)14(34.1)14(34.1)7(17.5)3(7.3)2(4.9)1(2.4)TCS:topical corticosteroids;OCS:oral corticosteroids;MD:maximum dose;IVMP:intravenous methylprednisolone;CIS: conventional immunossupresors;BT:biologic therapy;CG/N:conjunctival granuloma/nodule;PUK:peripheral ulcerative keratitisDisclosure of Interests:Monica Calderón-Goercke: None declared, Jorge Javier Gaitán-Valdizán: None declared, Raúl Fernández-Ramón: None declared, Lara Sánchez-Bilbao: None declared, Rosalía Demetrio-Pablo: None declared, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD
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Riemenschneider, Henna, Sarama Saha, Stephan van den Broucke, Helle Terkildsen Maindal, Gerardine Doyle, Diane Levin-Zamir, Ingrid Muller, et al. "State of Diabetes Self-Management Education in the European Union Member States and Non-EU Countries: The Diabetes Literacy Project." Journal of Diabetes Research 2018 (2018): 1–10. http://dx.doi.org/10.1155/2018/1467171.
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Background. Diabetes self-management education (DSME) is considered essential for improving the prevention and care of diabetes through empowering patients to increase agency in their own health and care processes. However, existing evidence regarding DSME in the EU Member States (EU MS) is insufficient to develop an EU-wide strategy. Objectives. This study presents the state of DSME in the 28 EU MS and contrasts it with 3 non-EU countries with comparable Human Development Index score: Israel, Taiwan, and the USA (ITU). Because type 2 diabetes mellitus (T2DM) disproportionately affects minority and low-income groups, we paid particular attention to health literacy aspects of DSME for vulnerable populations. Methods. Data from multiple stakeholders involved in diabetes care were collected from Feb 2014 to Jan 2015 using an online Diabetes Literacy Survey (DLS). Of the 379 respondents (249 from EU MS and 130 from ITU), most were people with diabetes (33% in the EU MS, 15% in ITU) and care providers (47% and 72%). These data were supplemented by an expert survey (ES) administered to 30 key informants. Results. Access to DSME varies greatly in the EU MS: an average of 29% (range 21% to 50%) of respondents report DSME programs are tailored for people with limited literacy, educational attainment, and language skills versus 63% in ITU. More than half of adult T2DM patients and children/adolescents participate in DSME in EU MS; in ITU, participation of T1DM patients and older people is lower. Prioritization of DSME (6.1 ± 2.8 out of 10) and the level of satisfaction with the current state of DSME (5.0 ± 2.4 out of 10) in the EU MS were comparable with ITU. Conclusion. Variation in availability and organization of DSME in the EU MS presents a clear rationale for developing an EU-wide diabetes strategy to improve treatment and care for people with diabetes.
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