SOSTIENICI
Pubblicazioni recenti - cardiovascular risk
-
Cost of primary care approaches for hypertension management and risk-based cardiovascular disease prevention in Bangladesh: a HEARTS costing tool application.
BMJ Open2022 Jun;12(6):e061467. doi: 10.1136/bmjopen-2022-061467.
Husain Muhammad Jami, Haider Mohammad Sabbir, Tarannum Renesa, Jubayer Shamim, Bhuiyan Mahfuzur Rahman, Kostova Deliana, Moran Andrew E, Choudhury Sohel Reza,
Abstract
OBJECTIVE:
To estimate the costs of scaling up the HEARTS pilot project for hypertension management and risk-based cardiovascular disease (CVD) prevention at the full population level in the four subdistricts (upazilas) in Bangladesh.
SETTINGS:
Two intervention scenarios in subdistrict health complexes: hypertension management only, and risk-based integrated hypertension, diabetes, and cholesterol management.
DESIGN:
Data obtained during July-August 2020 from subdistrict health complexes on the cost of medications, diagnostic materials, staff salaries and other programme components.
METHODS:
Programme costs were assessed using the HEARTS costing tool, an Excel-based instrument to collect, track and evaluate the incremental annual costs of implementing the HEARTS programme from the health system perspective.
PRIMARY AND SECONDARY OUTCOME MEASURES:
Programme cost, provider time.
RESULTS:
The total annual cost for the hypertension control programme was estimated at US$3.2?million, equivalent to US$2.8 per capita or US$8.9 per eligible patient. The largest cost share (US$1.35?million; 43%) was attributed to the cost of medications, followed by the cost of provider time to administer treatment (38%). The total annual cost of the risk-based integrated management programme was projected at US$14.4?million, entailing US$12.9 per capita or US$40.2 per eligible patient. The estimated annual costs per patient treated with medications for hypertension, diabetes and cholesterol were US$18, US$29 and US$37, respectively.
CONCLUSION:
Expanding the HEARTS hypertension management and CVD prevention programme to provide services to the entire eligible population in the catchment area may face constraints in physician capacity. A task-sharing model involving shifting of select tasks from doctors to nurses and local community health workers would be essential for the eventual scale-up of primary care services to prevent CVD in Bangladesh.
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Guarda su PubMed
-
Examining anti-inflammatory therapies in the prevention of cardiovascular events: protocol for a systematic review and network meta-analysis of randomised controlled trials.
BMJ Open2022 Jun;12(6):e062702. doi: 10.1136/bmjopen-2022-062702.
Boczar Kevin Emery, Shin Sheojung, Bezzina Kathryn A, Geejo Aishwarya, Pearson Alexander Liam, Shahab Saba, Fehlmann Christophe A, Visintini Sarah, Beanlands Rob, Wells George A,
Abstract
INTRODUCTION:
Inflammation is emerging as an important risk factor for atherosclerotic cardiovascular disease and has been a recent target for many novel therapeutic agents. However, comparative evidence regarding efficacy of these anti-inflammatory treatment options is currently lacking.
METHODS AND ANALYSIS:
This systematic review will include randomised controlled trials evaluating the effect of anti-inflammatory agents on cardiovascular outcomes in patients with known cardiovascular disease. Studies will be retrieved from Medline, Embase, the Cochrane Central Register of Controlled Trials, as well as clinical trial registry websites, Europe PMC and conference abstract handsearching. No publication date or language restrictions will be imposed. Eligible interventions must have some component of anti-inflammatory agent. These include (but are not limited to): non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, prednisone, methotrexate, canakinumab, pexelizumab, anakinra, succinobucol, losmapimod, inclacumab, atreleuton, LP-PLA (darapladib) and sPLA (varespladib). The primary outcomes will include major adverse cardiac events (MACE), and each individual component of MACE (myocardial infarction, stroke and cardiovascular death). Key secondary outcomes will include unstable angina, heart failure, all-cause mortality, cardiac arrest and revascularisation. Screening, inclusion, data extraction and quality assessment will be performed independently by two reviewers. Network meta-analysis based on the random effects model will be conducted to compare treatment effects both directly and indirectly. The quality of the evidence will be assessed with appropriate tools including the Grading of Recommendations, Assessment, Development and Evaluation profiler or Confidence in Network Meta-Analysis tool.
ETHICS AND DISSEMINATION:
Ethics approval is not required for this systematic review. The findings will be disseminated through a peer-reviewed journal.
PROSPERO REGISTRATION NUMBER:
CRD42022303289.
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Guarda su PubMed
-
Abdominal aortic aneurysm in heart transplant recipients: new insights from a 30-year experience at a single center.
Ann Vasc Surg2022 Jun;():. doi: S0890-5096(22)00311-9.
Tchana-Sato Vincent, Koch Jean-Noël, Ancion Arnaud, Adelin Albert, Minga Lowampa Elie, Burelli Mara, Defraigne Jean-Olivier, Sakalihasan Natzi,
Abstract
OBJECTIVE:
The improvement in survival rates for heart transplant recipients (HTRs) has increased their risk of developing extracardiac diseases such as abdominal aortic aneurysms (AAAs). The purposes of this study were to evaluate the prevalence and to describe the clinical features and natural history of AAA in HTRs.
METHODS:
A retrospective review of all patients (375) who underwent heart transplantation (HT) at our center over a 32-year period (1983-2015) was carried out.
RESULTS:
We identified 20 patients (5.3%) with AAA. All but one patient were male (95%), and most of them (80%) had a history of ischemic heart disease (IHD) prior to transplantation. The mean age of the patients with AAA at transplant was 57.2±7.3 years (range: 42-62 years). Seven of the 20 patients with AAA already had an AAA (30 to 55 mm) prior to transplantation. The average aneurysm size at the time of diagnosis was 40.9±9.6 mm, and the average patient age at the time of diagnosis was 62.2±8.3 years. The mean linear expansion rate was 10.6±2.12 mm/y, and the exponential expansion rate was 0.220±0.040 year respectively. The median follow-up time was 5.4 years (range 0.1-27.4 years). The median survival was 143 months (95% confidence interval (CI) 65 to 180 months) for the 20 HTRs with AAA and 68.8 months (95% CI 46 to 88 months) for the other HTRs.
CONCLUSIONS:
The natural history of AAA in HTR is characterized by an increased expansion rate. Male HTR with end-stage IHD are particularly at risk and should be closely followed-up after HT.
Copyright © 2022 Elsevier Inc. All rights reserved.
Guarda su PubMed
-
The effect of balloon-assisted pharmacomechanical catheter-directed thrombolysis on the patency and post-thrombotic syndrome in patients with acute iliofemoral deep vein thrombosis: Is it really necessary or not?
Ann Vasc Surg2022 Jun;():. doi: S0890-5096(22)00305-3.
Gumus Fatih, Arslanturk Oguz,
Abstract
OBJECTIVES:
The objective of this study was to describe the contribution and advantage of balloon-dilatation of iliac and femoral veins following pharmacomechanical catheter-directed thrombolysis (PCDT) on the development of post-thrombotic syndrome (PTS).
METHODS:
From October 2018 and January 2022, 85 patients with acute total occlusion of the iliac and femoral veins were treated with PCDT. The cohort was divided into two groups depending on the utilization of concomitant balloon dilatation of iliac and femoral veins (Group 1, n=34, 40.0%) or not (Group 2, n=51, 60.0%) during the PCDT. All patients underwent duplex ultrasound scanning for evaluating the patency of iliac veins and recanalization rates at 3, 6, and 12 months postoperatively. the Villalta score was used to score the severity of PTS at 12 months postoperatively.
RESULTS:
Patients who underwent balloon-assisted PCDT (group 1) exhibited significantly higher primary patency rates in CIV (recanalization 84.3 ± 14.6%, p = 0.003) , EIV (recanalization 82.8 ± 17.2, p = 0.003) and CFV (recanalization 88.1 ± 12.1%, p = 0.038) compared with the group 2 at the end of 12 months follow-up. Only 2 patients underwent venous stenting in follow-up due to severe venous claudication, however, 13 patients were required iliac vein stenting due to severe PTS proved with a high Villalta score at 12-month follow-up. The d-dimer level at 1-year follow-up had also significantly lower in Group 1 due to higher rates of patency and lower thrombosis burden. The most common bleeding events were hematuria (n =4) or oozing in the puncture site (n = 4).
CONCLUSIONS:
This study showed that balloon-assisted PCDT reduces the risk of PTS, is more successful in common iliac vein recanalization, reduces the need for the venous stent, and even lowers the D-dimer levels of the patients compared to routine PCDT alone.
Copyright © 2022. Published by Elsevier Inc.
Guarda su PubMed
-
Safety and Efficacy of Ultra Short-Duration Dual Antiplatelet Therapy After Percutaneous Coronary Interventions: A Meta analysis of Randomized Controlled Trials.
Curr Probl Cardiol2022 Jun;():101295. doi: S0146-2806(22)00192-X.
Abusnina Waiel, Baral Nischit, Seri Amith, Ben-Dor Itsik, Alkhouli Mohamad, Monteleone Peter, Haddad Elias, Goldsweig Andrew M, Paul Timir K,
Abstract
INTRODUCTION:
Dual antiplatelet therapy (DAPT) is required after percutaneous coronary intervention (PCI) to reduce stent thrombosis, but DAPT increases bleeding risks. The optimal duration of DAPT that provides the maximum protective ischemic effect along with the minimum bleeding risk is unclear. This is the first meta-analysis comparing outcomes for 1-month versus longer DAPT strategies following PCI.
METHODS:
We searched PubMed, Cochrane, and ClinicalTrials.gov databases (from inception to October 2021) for randomized controlled trials (RCTs) that compared 1-month duration versus > 1-month duration of DAPT following PCI. We used a random-effects model to calculate risk ratio (RR) with 95% confidence interval (CI). The co-primary outcomes for study selection were all-cause mortality, major bleeding, and stent thrombosis. Secondary outcomes included myocardial infarction (MI), cardiovascular mortality, ischemic stroke and target vessel revascularization.
RESULTS:
A total of five RCTs were included [n=29,355; 1-month DAPT(n=14,662) vs > 1-month DAPT (n=14,693)]. There was no statistically significant difference between the two groups in terms of all-cause mortality (RR 0.89; 95% CI 0.78-1.03; p?=?0.12) and stent thrombosis (RR 1.07; 95% CI 0.80-1.43; p?=?0.65). Similarly, there were no significant differences in MI, cardiovascular mortality, ischemic stroke, and target vessel revascularization. The rate of major bleeding was significantly lower in the group treated with DAPT for 1-month (RR 0.74; 95% CI 0.56-0.99, p?=?0.04).
CONCLUSION:
There is no difference in all-cause mortality, cardiovascular mortality, MI, stent thrombosis, ischemic stroke and target vessel revascularization with 1-month of DAPT following PCI with contemporary drug eluting stents compared to longer DAPT duration.
Copyright © 2022 Elsevier Ltd. All rights reserved.
Guarda su PubMed
-
Assessment of drinking water safety in the Netherlands using nationwide exposure and mortality data.
Environ Int2022 Jun;166():107356. doi: S0160-4120(22)00283-5.
Houthuijs Danny, Breugelmans Oscar R P, Baken Kirsten A, Sjerps Rosa M A, Schipper Maarten, van der Aa Monique, van Wezel Annemarie P,
Abstract
BACKGROUND:
Although drinking water in the Netherlands is generally accepted as safe, public concern about health risks of long-term intake still exist.
OBJECTIVE:
The aim was to explore associations between drinking water quality for nitrate, water hardness, calcium and magnesium and causes-of-death as related to cardiovascular diseases amongst which coronary heart disease and colorectal cancer.
METHODS:
We used national administrative databases on cause-specific mortality, personal characteristics, residential history, social economic indicators, air quality and drinking water quality for parameters specified by the EU Drinking Water Directive. We put together a cohort of 6,998,623 persons who were at least 30 years old on January 1, 2008 and lived for at least five years on the same address. The average drinking water concentration over 2000-2010 at the production stations were used as exposure indicators. We applied age stratified Cox proportional hazards models.
RESULTS:
Magnesium was associated with a reduced risk for mortality due to coronary heart diseases: HR of 0.95 (95% CI: 0.90, 0.99) per 10 mg/L increase. For mortality due to cardiovascular diseases, a 100 mg/L increase in calcium was associated with a HR of 1.08 (95% CI: 1.03, 1.13) and an increase of 2.5 mmol/L of water hardness with a HR of 1.06 (95% CI: 1.01, 1.10). The results show an elevated risk for coronary heart disease mortality at calcium concentrations below 30 mg/L, but over the whole exposure range no exposure response relation was observed. For other combinations of drinking water quality parameters and cause-specific mortality studied, no statistical significant associations were identified.
CONCLUSION:
We identified in this explorative study a protective effect of magnesium for the risk of mortality to coronary heart disease. Also we found an increased risk of mortality due to cardiovascular disease associated with the concentration of calcium and the water hardness in drinking water.
Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.
Guarda su PubMed
-
High R wave as a risk factor for cardivoascular and all-cause mortality. A 45-year follow-up of 13 cohorts of the Seven Countries Study.
J Electrocardiol2022 Jun;73():103-107. doi: S0022-0736(22)00085-1.
Menotti Alessandro, Puddu Paolo Emilio, Tolonen Hanna, Kafatos Anthony, Adachi Hisashi,
Abstract
OBJECTIVES:
To study the role of high R waves predicting cardiovascular (CVD) and all-cause mortality in a male middle-aged population followed-up 45 years.
MATERIAL AND METHODS:
A total of 7985 CVD-free men aged 40-59 years were enrolled in 13 cohorts in seven countries (USA, Finland, the Netherlands, Italy, Serbia, Greece, Japan) and high R waves were classified by Minnesota Code 3.1 (as a dichotomous variable) from baseline resting otherwise normal ECG at entry examination together with other personal characteristics. Cox models were solved to detect the possible predictive role of high R waves for CVD and all-cause mortality.
RESULTS:
In Cox models high R waves were predictive of 45-year major CVD deaths with a hazard ratio of 1.17 (95% confidence intervals of 1.03-1.33) after adjustment for 6 major CVD risk factors (age, systolic blood pressure, serum cholesterol, cigarette smoking, physical activity and body mass index). The predictive role of high R wave was less evident for 45-year all-cause mortality and after adjustment for the 6 covariates the HR of high R wave lost its significance. A multiple logistic model indicated that body mass index, serum cholesterol, systolic blood pressure and mainly vigorous physical activity were directly related to high R wave prevalence while heart rate, subscapular skinfold, laterality index and shoulder pelvis shape did so in an inverse way.
CONCLUSION:
High R waves seem associated with an excess CVD mortality in a 45-year follow-up of middle-aged men, while their role is diluted when the end-point is all-cause mortality.
Copyright © 2022. Published by Elsevier Inc.
Guarda su PubMed
-
Risk factors of clinically significant complications in transbronchial lung cryobiopsy: A prospective multi-center study.
Respir Med2022 Jun;200():106922. doi: S0954-6111(22)00187-1.
Mononen Minna, Saari Eeva, Hasala Hannele, Kettunen Hannu-Pekka, Suoranta Sanna, Nurmi Hanna, Randell Jukka, Laurikka Jari, Uibu Toomas, Koskela Heikki, Kaarteenaho Riitta, Purokivi Minna,
Abstract
BACKGROUND:
The use of a transbronchial lung cryobiopsy (TBLC) is increasing as a diagnostic method of interstitial lung diseases (ILD). This study aimed to evaluate risk factors associated with clinically significant complications of TBLC in ILD patients.
METHODS:
Patients referred to Kuopio or Tampere university hospitals, in Finland, for a suspected ILD were included. The TBLC was performed in an outpatient setting for 100 patients. Patients were mechanically ventilated in general anesthesia. Fluoroscopy guidance and prophylactic bronchial balloon were used. Complications, such as bleeding, pneumothorax, infections, and mortality were recorded. Moderate or serious bleeding, pneumothorax, or death ?90 days were defined as clinically significant complications. A multivariable model was created to assess clinically significant complications.
RESULTS:
The extent of traction bronchiectasis (Odds ratio [OR] 1.30, Confidence interval [CI] 1.03-1.65, p = 0.027) and young age (OR 7.96, CI 2.32-27.3, p = 0.001) were associated with the risk of clinically significant complications whereas the use of oral corticosteroids ?30 days before the TBLC (OR 3.65, CI 0.911-14.6, p = 0.068) did not quite reach statistical significance. A history of serious cough was associated with the risk of pneumothorax (OR 4.18, CI 1.10-16.0, p = 0.036). Procedure associated mortality ?90 days was 1%.
CONCLUSION:
The extent of traction bronchiectasis on HRCT and young age were associated with the risk of clinically significant complications whereas oral corticosteroid use did not quite reach statistical significance. A history of serious cough was associated with the risk of clinically significant pneumothorax.
Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.
Guarda su PubMed
-
Anti-hyperglycemic, anti-hyperlipidemic, and anti-inflammatory effect of the drug Guggulutiktaka ghrita on high-fat diet-induced obese rats.
J Ayurveda Integr Med2022 Jun;13(3):100583. doi: S0975-9476(22)00042-0.
Sheik Samreen M, Bakthavatchalam Pugazhandhi, Shenoy Revathi P, Hadapad Basavaraj S, Nayak M Deepak, Biswas Monalisa, Bolar Suryakanth Varashree,
Abstract
BACKGROUND:
Ayurveda is a holistic system of medicine and describes a vast array of herbs and herbal mixtures that are been demonstrated to possess efficacy in research investigations. Guggulutikthaka gritha (GTG) is one such drug evaluated for its role in skin and bone diseases.
OBJECTIVE:
In the current study, the hypoglycemic, hypolipidemic, and anti-inflammatory effect of the drug GTG was studied with the scope to treat dyslipidemia and thereby reduce the risk of cardiovascular disease.
MATERIALS AND METHOD:
The animals (Wistar rats) were fed a high-fat diet and dyslipidemia was induced. The control group was provided with a normal chow diet and had free access to water. The treatment with the drug GTG was given for 21 days after confirming dyslipidemia. The blood glucose was measured immediately using a glucometer. The serum was analyzed for lipid profile and Vascular Cell Adhesion Molecule - 1(VCAM 1) by ELISA method before and after treatment. The histopathology of the heart and liver was also performed.
RESULTS:
The abnormal change in lipid profile, blood glucose, and inflammatory marker along with the accumulation of intracellular fats in the arteries of the heart and liver confirmed dyslipidemia. A significant reduction in serum lipid profile (p
CONCLUSION:
The study provides scientific validation on the drug GTG being effective in hyperglycemia, hyperlipidemia, and inflammation in dyslipidemia.
Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.
Guarda su PubMed
-
Omega-3 fatty acids, subclinical atherosclerosis, and cardiovascular events: Implications for primary prevention.
Atherosclerosis2022 Jun;353():11-19. doi: S0021-9150(22)01316-8.
Alfaddagh Abdulhamied, Kapoor Karan, Dardari Zeina A, Bhatt Deepak L, Budoff Matthew J, Nasir Khurram, Miller Michael, Welty Francine K, Miedema Michael D, Shapiro Michael D, Tsai Michael Y, Blumenthal Roger S, Blaha Michael J,
Abstract
BACKGROUND AND AIMS:
High-dose eicosapentaenoic acid (EPA) therapy was beneficial in high-risk patients without clinical cardiovascular disease (CVD). Whether higher plasma levels of EPA and docosahexaenoic acid (DHA) have similar benefits in those without subclinical CVD is unclear. We aim to evaluate the interplay between plasma omega-3 fatty acids and coronary artery calcium (CAC) in relation to CVD events.
METHODS:
We examined 6568 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) with plasma EPA and DHA levels and CAC measured at baseline. The primary outcome was incident CVD events (myocardial infarction, angina, cardiac arrest, stroke, CVD death). Hazard ratios for the primary outcome were adjusted for potential confounder using Cox regression.
RESULTS:
Mean ± SD age was 62.1 ± 10.2 years and 52.9% were females. The median follow-up time was 15.6 years. Higher log(EPA) (adjusted hazard ratio, aHR = 0.83; 95% CI, 0.74-0.94) and log(DHA) (aHR = 0.79; 95% CI, 0.66-0.96) were independently associated with fewer CVD events. The difference in absolute CVD event rates between lowest vs. highest EPA tertile increased at higher CAC levels. The adjusted HR for highest vs. lowest EPA tertile within CAC = 0 was 1.02 (95% CI, 0.72-1.46), CAC = 1-99 was 0.71 (95% CI, 0.51-0.99), and CAC?100 was 0.67 (95% CI, 0.52-0.84). A similar association was seen in tertiles of DHA by CAC category.
CONCLUSIONS:
In an ethnically diverse population free of clinical CVD, higher plasma omega-3 fatty acid levels were associated with fewer long-term CVD events. The absolute decrease in CVD events with higher omega-3 fatty acid levels was more apparent at higher CAC scores.
Copyright © 2022 Elsevier B.V. All rights reserved.
Guarda su PubMed
-
[Metabolic profile and concentration of ghrelin and obestatin in children and adolescents with obesity].
Rev Med Inst Mex Seguro Soc2022 May;60(3):268-274.
García-González Claudia Lizett, Romero-Velarde Enrique, Gurrola-Díaz Carmen Magdalena, Sánchez-Muñoz Martha Patricia, Soto-Luna Guadalupe Irma Catalina,
Abstract
Background:
It has been pointed out that ghrelin and obestatin could have an impact on the genesis of obesity, since they estimulate and inhibit apetite and, therefore, food consumption.
Objective:
To compare the metabolic profile, lipid profile and the concentrations of ghrelin and obestatin in children with normal weight or obesity.
Material and methods:
Cross-sectional design with 97 normal weight or obese children, 6 to 18 years of age, who did not present systemic diseases. The serum concentrations of glucose, insulin, total cholesterol, triglycerides, high (HDL), low (LDL) and very low density (VLDL) lipoproteins, aspartate aminotransferase (AST), alanine aminotransferase (ALT), ghrelin and obestatin were determined. Descriptive statistics were performed. Student's t test was used to compare groups, and correlation coefficients of ghrelin and obestatin values with biochemical and anthropometric variables. A p value of ? 0.05 was significant.
Results:
55 children with normal weight and 42 with obesity were included; mean age was 10.7 years. Triglycerides, LDL, VLDL, ALT and insulin were higher, and HDL lower in obese children (p
Conclusions:
The lower concentration of ghrelin in obese children may indicate a negative feedback to regulate energy consumption. Children and adolescents with obesity show metabolic and lipid profile alterations that place them at risk of early development of cardiovascular risk factors.
© 2022 Revista Medica del Instituto Mexicano del Seguro Social.
Guarda su PubMed
-
[Clinical characteristics related to mortality by COVID-19 in intensive care].
Rev Med Inst Mex Seguro Soc2022 May;60(3):249-257.
López-Valdés Josué Israel, Ponce-Mendoza Rubén Alejandro, Solís-Barraza Miguel, Trevizo-Díaz Juan Luis, Nevarez-Campos Jesús Roberto,
Abstract
Background:
The COVID-19 pandemic caused hospital reconversion throughout Mexico and it was scarce information about its development in second-level intensive care units (ICU).
Objective:
To determine the clinical characteristics related to COVID-19 mortality in a second-level ICU.
Material and methods:
Observational, cohort, retrospective, and analytical study. Demographic variables, medical history, as well as clinical, ventilatory and laboratory characteristics, and complications of patients admitted to ICU from March to November 2020 due to acute respiratory failure were recorded. Patients were divided into two groups: improvement or death. Lost data were imputed by normal multivariated regression. Descriptive statistics and inferencial analysis were made to determine the risk of significant variables against the death outcome with Cox regression.
Results:
60% of patients were male. In-hospital mortality was 55%. An older age (44.4 ± 12.1 vs. 50.7 ± 12.1, p = 0.01), higher APACHE II score (8 (10-13) vs. 15 (11-21), p
Conclusions:
A higher age, more days from beginning of symptoms to hospital admission, and lower oxygenation at admission were pre-admission determining factors for risk of death, while cardiovascular, renal complications and hyperglycemia were the in-hospital determinants.
© 2022 Revista Medica del Instituto Mexicano del Seguro Social.
Guarda su PubMed
-
Atezolizumab for Pretreated Non-Small Cell Lung Cancer with Idiopathic Interstitial Pneumonia: Final Analysis of Phase II AMBITIOUS Study.
Oncologist2022 Jun;():. doi: oyac118.
Ikeda Satoshi, Kato Terufumi, Kenmotsu Hirotsugu, Ogura Takashi, Sato Yuki, Hino Aoi, Harada Toshiyuki, Kubota Kaoru, Tokito Takaaki, Okamoto Isamu, Furuya Naoki, Yokoyama Toshihide, Hosokawa Shinobu, Iwasawa Tae, Kasajima Rika, Miyagi Yohei, Misumi Toshihiro, Okamoto Hiroaki,
Abstract
BACKGROUND:
Interstitial pneumonia (IP) is a poor prognostic comorbidity in patients with non-small cell lung cancer (NSCLC) and is also a risk factor for pneumonitis. The TORG1936/AMBITIOUS trial, the first known phase II study of atezolizumab in patients with NSCLC with comorbid IP, was terminated early because of the high incidence of severe pneumonitis.
METHODS:
This study included patients with idiopathic chronic fibrotic IP, with a predicted forced vital capacity (%FVC) of >70%, with or without honeycomb lung, who had previously been treated for NSCLC. The patients received atezolizumab every 3 weeks. The primary endpoint was the 1-year survival rate.
RESULTS:
A total of 17 patients were registered; the median %FVC was 85.4%, and 41.2% had honeycomb lungs. The 1-year survival rate was 53.3% (95% CI, 25.9-74.6). The median overall and progression-free survival times were 15.3 months (95% CI, 3.1-not reached) and 3.2 months (95% CI, 1.2-7.4), respectively. The incidence of pneumonitis was 29.4% for all grades, and 23.5% for grade ?3. Tumor mutational burden and any of the detected somatic mutations were not associated with efficacy or risk of pneumonitis.
CONCLUSION:
Atezolizumab may be one of the treatment options for patients with NSCLC with comorbid IP, despite the high risk of developing pneumonitis. This clinical trial was retrospectively registered in the Japan Registry of Clinical Trials on August 26, 2019, (registry number: jRCTs031190084, https://jrct.niph.go.jp/en-latest-detail/jRCTs031190084).
© The Author(s) 2022. Published by Oxford University Press.
Guarda su PubMed
-
Skin cancer risk factors among Black South Africans-The Johannesburg Cancer Study, 1995-2016.
Immun Inflamm Dis2022 Jul;10(7):e623. doi: 10.1002/iid3.623.
Ndlovu Babongile C, Sengayi-Muchengeti Mazvita, Wright Caradee Y, Chen Wenlong C, Kuonza Lazarus, Singh Elvira,
Abstract
BACKGROUND:
The Black population has lower skin cancer incidence compared to White, Indian/Asian, and Mixed-race populations in South Africa; however, skin cancer still exists in the Black population. The aim of this study is to identify risk factors associated with skin cancer among Black South Africans.
MATERIALS AND METHODS:
A case-control study was conducted. Cases were patients with keratinocyte cancers (KCs) and/or melanoma skin cancers (MSCs) and controls were cardiovascular patients. Sociodemographic exposures, environmental health variables, smoking, and HIV status were assessed. Stepwise logistic regression was used to identify risk factors associated with KCs and MSCs.
RESULTS:
The KCs histological subtypes showed that there were more squamous cell carcinomas (SCCs) (78/160 in females, and 72/160 in males) than basal cell carcinomas (BCCs). The SCC lesions were mostly found on the skin of the head and neck in males (51%, 38/72) and on the trunk in females (46%, 36/78). MSC was shown to affect the skin of the lower limbs in both males (68%, 27/40) and females (59%, 36/61). Using females as a reference group, when age, current place of residency, type of cooking fuel used, smoking, and HIV status were adjusted for, males had an odds ratio (OR) of 2.04 for developing KCs (confidence interval [CI]: 1.08-3.84, p?=?.028). Similarly, when age, current place of residency, and place of cooking (indoors or outdoors) were adjusted for, males had an OR of 2.26 for developing MSC (CI: 1.19-4.29, p?=?.012).
CONCLUSIONS:
Differences in the anatomical distribution of KCs by sex suggest different risk factors between sexes. There is a positive association between being male, smoking, rural dwelling, and a positive HIV status with KCs and being male and rural dwelling with MSC. The rural dwelling was a newly found association with skin cancer and warrants further investigation.
© 2022 The Authors. Immunity, Inflammation and Disease published by John Wiley & Sons Ltd.
Guarda su PubMed
-
An alternative way of SARS-COV-2 to induce cell stress and elevated DNA damage risk in cardiomyocytes without direct infection.
Immun Inflamm Dis2022 Jul;10(7):e638. doi: 10.1002/iid3.638.
Zhou Houqing, Ren Xiaohu, Yang Yang, Xu Benhong, Li Yichong, Feng Yin, Shisong Fang, Liu Jianjun,
Abstract
BACKGROUND:
The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) in 2020 has led to millions of deaths worldwide. Case reports suggested that infection of SARS-CoV-2 is potentially associated with occurrences of cardiovascular pathology. However, the mode of action and mechanisms of SARS-CoV-2 influencing cardiomyocytes still remain largely unclear.
AIMS:
To explore the mechanisms underlying cardiomyocytes damage induced by SARS-CoV-2 infection.
MATERIALS & METHODS:
the serum markers of cardiovascular injury were analyzed by ELISA. The isolated SARS-CoV-2 virus were co-cultured with human cardiomyocytes (AC16) and immunofluorescence assay was used evaluate the invasion of virus. Moreover, serum obtained from acute stage of SARS-CoV-2 infected patients and healthy controls were used to incubate with AC16 cells, then indicators associated with cell stress and DNA damage were analyzed by Western-blot.
RESULTS:
we found that high-sensitivity troponin T (hsTnT), an indicator of cardiovascular disease, was higher in the acute stage of COVID-19. Additionally, in vitro coculture of SARS-CoV-2 and AC16 cells showed almost no infectious ability of SARS-CoV-2 to directly infect AC16 cells. Results of serum treatment suggested that serum from infected subjects induced cell stress (upregulation of p53 and HSP70) and elevation of DNA damage risk (increased ?H2Ax and H3K79me2) in AC16.
DISCUSSION:
our observations indicated a hard way for SARS-CoV-2 to infect cardiomyocytes directly. However, infection-induced immune storm in serum could bring stress and elevated DNA damage risks to cardiovascular system.
CONCLUSION:
These findings indicated the possibilities of SARS-CoV-2 inducing stress and elevating DNA damage risk to cardiomyocytes without direct infection.
© 2022 The Authors. Immunity, Inflammation and Disease published by John Wiley Sons Ltd.
Guarda su PubMed
-
LINC01013 Is a Determinant of Fibroblast Activation and Encodes a Novel Fibroblast-Activating Micropeptide.
J Cardiovasc Transl Res2022 Jun;():. doi: 10.1007/s12265-022-10288-z.
Quaife N M, Chothani S, Schulz J F, Lindberg E L, Vanezis K, Adami E, O'Fee K, Greiner J, Litvi?uková M, van Heesch S, Whiffin N, Hubner N, Schafer S, Rackham O, Cook S A, Barton P J R,
Abstract
Myocardial fibrosis confers an almost threefold mortality risk in heart disease. There are no prognostic therapies and novel therapeutic targets are needed. Many thousands of unannotated small open reading frames (smORFs) have been identified across the genome with potential to produce micropeptides (100 amino acids). We sought to investigate the role of smORFs in myocardial fibroblast activation.Analysis of human cardiac atrial fibroblasts (HCFs) stimulated with profibrotic TGF?1 using RNA sequencing (RNA-Seq) and ribosome profiling (Ribo-Seq) identified long intergenic non-coding RNA LINC01013 as TGF?1 responsive and containing an actively translated smORF. Knockdown of LINC01013 using siRNA reduced expression of profibrotic markers at baseline and blunted their response to TGF?1. In contrast, overexpression of a codon-optimised smORF invoked a profibrotic response comparable to that seen with TGF?1 treatment, whilst FLAG-tagged peptide associated with the mitochondria.Together, these data support a novel LINC01013 smORF micropeptide-mediated mechanism of fibroblast activation.
© 2022. The Author(s).
Guarda su PubMed
-
Cholesterol-Lowering Therapy in Patients at Low-to-Moderate Cardiovascular Risk.
High Blood Press Cardiovasc Prev2022 Jun;():. doi: 10.1007/s40292-022-00529-2.
Figorilli Filippo, Mannarino Massimo R, Bianconi Vanessa, Pirro Matteo,
Abstract
Elevated low-density lipoprotein cholesterol (LDL-C) is unanimously recognized as a major modifiable risk factor related to the development of atherosclerotic cardiovascular disease (ASCVD). Consistent evidence confirms that reducing LDL-C is associated with reduction of major adverse cardiovascular events (MACEs), with benefits proportionally related to initial individual CV risk and absolute reduction of LDL-C levels. The recent European guidelines on cardiovascular prevention have proposed a revised approach in cardiovascular risk evaluation, taking into account a renewed consideration of the interaction between risk factors and possible confounding factors (e.g., age). Although for patients considered to be at high and very high cardiovascular risk the need for stringent risk factors treatment is clearly stated, for those who are at low-to-moderate cardiovascular risk the issue is more debated. For those latter subjects, current guidelines indicate that risk factor treatment is generally not necessary, unless the impact of CV risk modifiers, lifetime CV risk and treatment benefit may be substantial. In addition, despite the estimated low-to-moderate short-term CV risk, the early appearance of even mild LDL-C level elevations may contribute to impair long-term CV prognosis. Therefore, encouraging the achievement of desired LDL-C goals through tailored conservative lifestyle changes and, if necessary, pharmacologic strategies should not be excluded categorically in all low-to-moderate risk individuals. In this review, we summarize the most recent evidence that may influence the choice to treat or not to treat LDL-C elevations in subjects at low-to-moderate risk and the suggested therapeutic tools aimed at achieving the recommended LDL-C goals.
© 2022. The Author(s).
Guarda su PubMed
-
A systematic review and meta-analysis comparing radiofrequency catheter ablation with medical therapy for ventricular tachycardia in patients with ischemic and non-ischemic cardiomyopathies.
J Interv Card Electrophysiol2022 Jun;():. doi: 10.1007/s10840-022-01287-w.
Ravi Venkatesh, Poudyal Abhushan, Khanal Smriti, Khalil Charl, Vij Aviral, Sanders David, Larsen Timothy, Trohman Richard G, Aksu Tolga, Tung Roderick, Santangeli Pasquale, Winterfield Jeffrey, Sharma Parikshit S, Huang Henry D,
Abstract
BACKGROUND:
In patients with cardiomyopathy, radiofrequency catheter ablation (CA) for ventricular tachycardia (VT) is an adjunctive and alternative treatment option to long-term anti-arrhythmic drug therapy. We sought to compare CA with medical therapy for the management of VT in patients with ischemic and non-ischemic cardiomyopathies.
METHODS:
MEDLINE, Cochrane, and ClinicalTrials.gov databases were evaluated for relevant studies.
RESULTS:
Eleven studies with 2126 adult patients were included (711 in CA, 1415 in medical therapy). In the randomized controlled trial (RCT) analysis, CA reduced risk of recurrent VT (risk ratio (RR) 0.79 [95% CI 0.67 to 0.93], p?=?0.005), ICD shocks (RR 0.64 [95% CI 0.45 to 0.89] p?=?0.008), and cardiac hospitalizations (RR 0.76 [95% CI 0.63 to 0.92] p?=?0.005). There was no difference in all-cause mortality (RR 0.94, p?=?0.71). In combined RCT and observational study analysis, there was a trend for reduction in all-cause mortality (RR 0.75 [95% CI 0.55 to 1.02] p?=?0.07). In subgroup analysis of studies with mean left ventricular ejection fraction (LVEF)?35%, CA demonstrated reduction in mortality (RR 0.71, p?=?0.004), ICD shocks (RR 0.63, p?=?0.03), VT recurrence (RR 0.76, p?=?0.004), and cardiac hospitalizations (RR 0.75, p?=?0.02). The subgroup of early CA prior to ICD shocks demonstrated reduction in ICD shocks (RR 0.57, p?0.001) and VT recurrence (RR 0.74, p?=?0.01).
CONCLUSIONS:
CA for VT demonstrated a lower risk of VT recurrence, ICD shocks, and hospitalization in comparison to medical therapy. The subgroups of early CA and LVEF?35% demonstrated better outcomes.
© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Guarda su PubMed
-
Diagnosis of heart failure in the elderly: current status and future perspectives for echocardiographic diagnostic systems.
J Med Ultrason (2001)2022 Jun;():. doi: 10.1007/s10396-022-01223-5.
Seo Yoshihiro,
Abstract
Since Japan is experiencing a super-aged society, the number of heart failure patients (HF) is increasing remarkably. In particular, the increase in heart failure with preserved ejection fraction (HFpEF), which is common in the elderly, has characterized the last decade. The diagnosis of HFpEF by assessment of left ventricular (LV) diastolic dysfunction, which is also referred to as diastolic heart failure, is an important role assigned to echocardiography. The Doppler echocardiographic algorithm for the evaluation of LV diastolic function from the American Society of Echocardiography (ASE) and the European Association of Cardiovascular Imaging (EACVI) has been widely used to diagnose HFpEF. This article will focus on the HFpEF diagnostic algorithm proposed in 2018 by the Heart Failure Association of the European Society of Cardiology (HFA-PEFF score) based on autologous elderly cases. We compared the usefulness of the HFA-PEFF score with the ASE/EACVI algorithm. By comparing HFpEF patients with healthy elderly subjects and hypertensive patients with no history of HF, this paper will identify the usefulness and challenges of the HFA-PEFF score in the assessment of the elderly. The echocardiographic findings in at-risk or early-stage elderly patients with HFpEF will also be summarized. In addition, this review will describe future prospects for echocardiographic diagnostic systems for the prevention of HF onset and HF progression in the elderly and propose the concept of "early HFpEF".
© 2022. The Author(s), under exclusive licence to The Japan Society of Ultrasonics in Medicine.
Guarda su PubMed
-
Thromboembolic complications of recreational nitrous oxide (ab)use: a systematic review.
J Thromb Thrombolysis2022 Jun;():. doi: 10.1007/s11239-022-02673-x.
Oulkadi Sanad, Peters Benjamin, Vliegen Anne-Sophie,
Abstract
The recreatinal use of nitrous oxide has become more common in recent years, especially in adolescents and young adults. It has been mainly associated with medical conditions like megaloblastic anemia and (myelo)neuropathy. We report on the thromboembolic complications, a less known side effect, associated with recreational inhalation of nitrous oxide. An extensive literature search was performed for publications reporting on the thromboembolic complications associated with recreational nitrous oxide abuse. Data about sex, age, location of thrombosis, laboratory findings, therapy and outcome were collected. A total of 13 case reports or case series were identified comprising a total of 14 patients. The reported thromboembolic side effects included deep venous thrombosis, pulmonary embolism, mesenterial-, portal and splenic vein thrombosis, cerebral sinus thrombosis, cortical vein thrombosis, stroke, acute myocardial infarction and peripheral artery thromboembolism. These side effects are possibly mediated by the interaction of nitrous oxide with vitamin B12, a cofactor of the methionine synthase complex, which eventually results in elevation of plasma levels of homocysteine. Despite being a known risk factor for cardiovascular disease, the exact pathophysiological mechanism remains unclear. Cessation of nitrous oxide inhalation is necessary to prevent recurrent thrombosis. Nitrous oxide abuse may thus result in a wide spectrum of thromboembolic complications. One should be aware of this etiology, especially in a young person with no obvious risk factors for cardiovascular disease. Spreading awareness is important to inform people about the potentially serious side effects associated with nitrous oxide inhalation.
© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Guarda su PubMed
