Favorable Clinical Outcomes In Patients Research Articles

Use of Neutralizing Monoclonal Antibodies and Its Outcome Measures in COVID-19 Patients

Neutralizing monoclonal antibodies (mAbs) can stimulate protective immunity. Hence their rapid identification and characterization are incorporated into clinical practice to provide effective treatment and prophylaxis during the COVID-19 pandemic. Previously, mAbs have been effectively used in several other viral infections, including Ebola, influenza, HIV, RSV, Zika virus, and MERS-CoV. Currently, the utilization of mAbs appears to have favorable clinical outcomes in patients with mild-moderate SARS-CoV-2 infection, particularly individuals at high risk of hospitalization and progression to severe COVID-19. However, most of the interim results on anti-SARS-CoV-2 mAbs are based on ongoing clinical trial data; thereby, several questions revolve around this novel therapy, including its long-term implication, application, and feasibility. Although, the use of neutralizing mAbs may assist in alleviating the critical burden on healthcare settings and minimizing hospital stay due to severe progression of the COVID-19 symptoms especially among those with poor immune responses to vaccination, elderly, and/or vaccine-refractory individuals. Nonetheless, there is a broader need to explore these novel therapies for their effective use in clinical practice and to improve patient-related outcomes.

Resection of Cervical Dumbbell-Shaped Schwannoma Using Posterior Unilateral Approach: Impact on Postoperative Cervical Function and Clinical Outcomes.

A retrospective comparative study. This study aimed to evaluate the radiographical changes in cervical sagittal alignment (CSA) and clinical outcomes after tumor resection using a posterior unilateral approach without spinal fixation for patients with cervical dumbbell-shaped schwannoma (DS). Seventy-three patients with DS who were followed up for at least 2years were included. The Eden classification was used to designate the types of DS. The CSA and range of motion (ROM) were analyzed using radiographs. The clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA) score and JOA cervical myelopathy questionnaire. The CSA in the neutral, flexion, and extension position and cervical ROM were not significantly reduced in the follow-up period. The JOA scores showed significant improvement after surgery. The postoperative radiographic parameters and clinical outcomes of Eden type II or III DS, which needed facetectomy for the resection, did not show any statistically significant difference compared with those of Eden type I tumor, which was resected without facetectomy. Fifty-two cases (71.2%) achieved gross total resection, whereas 21 cases (28.8%) remained in partial resection (PR). One case underwent reoperation due to the regrowth of the remnant tumor whose margin was at the entrance of the intervertebral foramen. Tumor resection using the posterior unilateral approach preserved CSA and resulted in favorable clinical outcomes in patients with DS. When the resection ends in PR, the proximal margin of the remnant tumor should be located distally away from the entrance of the foramen to prevent regrowth.

Intrinsic suppression of type I interferon production underlies the therapeutic efficacy of IL-15-producing natural killer cells in B-cell acute lymphoblastic leukemia

BackgroundType I interferons (IFN-Is), secreted by hematopoietic cells, drive immune surveillance of solid tumors. However, the mechanisms of suppression of IFN-I-driven immune responses in hematopoietic malignancies including B-cell acute lymphoblastic...

The epidemiology of concurrent infection in patients with pyogenic spine infection and its association with early mortality: A nationwide cohort study based on 10,695 patients

BackgroundGenerally, a sufficient duration of relevant antibiotics based on an appropriate culture combined with proper surgical treatment guarantees a favorable clinical outcome in patients with pyogenic spine infections. However, a patient’s condition often deteriorates as concurrent infections occur in other organs, leading to mortality. Therefore, this study aimed to investigate the epidemiology of concurrent infections in patients with a pyogenic spine infection and estimate the rates and risks of early mortality. MethodsPatients with a pyogenic spine infection were identified using a national claims database that includes the entire population. The epidemiology of the six types of concurrent infections was investigated, and the corresponding early mortality rates and risks were estimated. The results were validated internally by bootstrapping and externally by defining two additional cohorts for sensitivity analysis. ResultsAmong 10,695 patients with a pyogenic spine infection, the prevalence of the six types of concurrent infections was 11.3 % for urinary tract infections, 9.4 % for intra-abdominal infections, 8.5 % for pneumonia, 4.6 % for septic arthritis or osteomyelitis of the extremities, 0.7 % for central nervous system infections, and 0.5 % for cardiac infections. Patients with a concurrent infection had approximately 4-fold greater mortality than those without (3.3 % vs. 0.8 %). The early mortality rates were particularly higher in patients with multiple or specific types of concurrent infections, including central nervous system infections, cardiac infections, and pneumonia. In addition, the mortality trends differed significantly according to the number and type of concurrent infections. ConclusionsThese data on six types of concurrent infection among patients with pyogenic spinal infection can be used as a source of reference by clinicians.

Early Tumor Shrinkage as a Predictor of Favorable Treatment Outcomes in Patients With Extensive-Stage SCLC Who Received Programmed Cell Death-Ligand 1 Inhibitor Plus Platinum-Etoposide Chemotherapy: A Prospective Observational Study

IntroductionIn recent years, programmed cell death-ligand 1 (PD-L1) inhibitor plus platinum-etoposide chemotherapy was found to have favorable clinical outcomes in patients with extensive-stage SCLC (ES-SCLC). The usefulness of early tumor shrinkage (ETS) has been reported in various types of cancers. Nevertheless, there have been few reports evaluating ETS in ES-SCLC. Therefore, this study aimed to evaluate the role of ETS in the clinical outcomes of patients with ES-SCLC receiving chemoimmunotherapy. MethodsWe prospectively identified 46 patients with ES-SCLC who received PD-L1 inhibitor plus platinum-etoposide chemotherapy at 10 institutions in Japan between September 2019 and October 2021. Of them, 35 patients were selected for analyses. ResultsThe responders (progression-free survival [PFS] ≥ 6.0 mo) had significantly greater tumor shrinkage at the first evaluation than the nonresponders (PFS < 6.0 mo) (65.0% versus 53.7%, p = 0.03). We defined the cutoff value for ETS as a 57% change from the baseline on the basis of the receiver operating characteristic results to determine the optimal tumor shrinkage rate at the first evaluation for identifying responders. The patients with ES-SCLC who achieved ETS had longer PFS and overall survival than those who did not achieve ETS (5.6 versus 4.0 mo, log-rank test p = 0.001 and 15.0 versus 8.3 mo, log-rank test p = 0.02). In the multivariate analyses, ETS was significantly associated with PFS and overall survival (hazard ratio = 0.27, 95% confidence interval: 0.12–0.63, p = 0.002 and hazard ratio = 0.34, 95% confidence interval: 0.13–0.85, p = 0.02). ConclusionsOur prospective observational study indicated that ETS was related to favorable clinical outcomes for patients with ES-SCLC receiving PD-L1 inhibitor plus platinum-etoposide chemotherapy.

BCL11B Mutations Are Associated with Higher CD8+ T-Cell Percentage and Favorable Clinical Outcomes in Patients with T-Cell Acute Lymphoblastic Leukemia.

BCL11B Mutations Are Associated with Higher CD8+ T-Cell Percentage and Favorable Clinical Outcomes in Patients with T-Cell Acute Lymphoblastic Leukemia.

655. Combination Eravacycline Therapy for Carbapenem-Resistant Acinetobacter baumannii Pneumonia

Abstract Background Acinetobacter baumannii typically causes infections in debilitated, hospitalized patients and is difficult to treat due to multiple virulence factors and the presence of intrinsic and acquired antibiotic resistance mechanisms leading to frequent isolation of multi-drug resistant (MDR) phenotypes. Due to problematic pharmacokinetics and/or dose-limiting toxicities of salvage agents, combination therapy with aminoglycosides, ampicillin/sulbactam, polymyxins, minocycline, or tigecycline, is often used. Eravacycline has demonstrated greater in-vitro potency against A. baumannii compared to other tetracycline derivatives making it potentially the more appealing option. However, its utility is hindered by a lack of data supporting pharmacodynamic targets and adequate dosing strategies for CRAB. The goal of this case series was to describe our experience with the use of combination eravacycline therapy for the treatment of CRAB pneumonia. Methods This case series included all patients ≥ 18 years of age, diagnosed with SARS-CoV-2, ≥ 1 sputum culture positive for CRAB and a clinical diagnosis of new bacterial pneumonia, who received at least one dose of eravacycline between April 1st and October 1st, 2020. The primary outcome was clinical resolution of CRAB pneumonia. Secondary outcomes evaluated microbiological resolution, need for extended durations of therapy, and frequency of re-starting CRAB therapy within 48 hours of completion. Results In total, 25 patients were included in this case series. The median duration of combination therapy was 10 days. Most patients (96%) received eravacycline + ampicillin/sulbactam, with 7 of those patients also receiving inhaled colistin (Table 2). In total, 17 (68%) patients achieved clinical resolution of CRAB pneumonia. Post-treatment sputum cultures were collected in 18 patients, of which 13 (72%) achieved microbiological resolution. One patient received &amp;gt; 14 days of therapy and no patients re-initiated therapy within 48 hours of eravacycline completion. Table 1:Baseline CharacteristicsTable 2:Study Outcomes Conclusion In this small case series, eravacycline showed favorable clinical outcomes in patients with CRAB pneumonia. In light of limited treatment options, this agent can be considered for CRAB pneumonia salvage therapy. Disclosures All Authors: No reported disclosures.

Prognostic nutritional index of early post-pembrolizumab therapy predicts long-term survival in patients with advanced urothelial carcinoma.

Pembrolizumab has been widely used to treat advanced urothelial carcinoma that has progressed after first-line platinum-based chemotherapy. Because its clinical benefits are limited, biomarkers that can predict a good response to pembrolizumab are required. The prognostic nutritional index (PNI), calculated using the serum albumin level and peripheral lymphocyte count, has been evaluated as a predictive biomarker in cancer immunotherapy. The present study investigated the application of PNI as a predictive biomarker for pembrolizumab response in patients with advanced urothelial cancer. A retrospective study was conducted on 34 patients treated with pembrolizumab at Shiga University of Medical Science Hospital between January 2018 and July 2022. The posttreatment PNI (post-PNI) was calculated within 2 months of starting pembrolizumab. The present study investigated the association between post-PNI and objective response, overall survival (OS) and progression-free survival (PFS). The patient cohort was stratified into two categories, high and low post-PNI groups, with a cutoff value of post-PNI at 40. The higher post-PNI group demonstrated a better disease control rate than the lower post-PNI group (complete response + partial response + stable disease, 75 vs. 21%, P=0.004). Regarding median OS, the higher post-PNI group exhibited a significantly longer survival time than the lower post-PNI group (23.1 vs. 2.9 months, P<0.001). Similarly, the higher post-PNI group exhibited a significantly longer PFS than the lower post-PNI group (10.2 vs.1.9 months, P<0.001). Multivariate analysis showed that a higher post-PNI value was an independent predictor for OS (hazard ratio, 0.04; 95% confidence interval, 0.01-0.14; P<0.001) and PFS (hazard ratio, 0.12; 95% confidence interval, 0.04-0.35; P<0.001). The present study indicated that the post-PNI was a predictor of favorable clinical outcomes in patients treated with pembrolizumab for advanced urothelial carcinoma.

Disability in perioperative activities of daily living is associated with worse survival outcomes following hepatic resection in patients with intrahepatic cholangiocarcinoma.

Intrahepatic cholangiocarcinoma (ICC) is a rare disease; however, its incidence and mortality are increasing worldwide. The rapid aging of populations around the world is leading to an increased number of patients with cancer who develop disability in activities of daily living (ADL). This study was conducted to investigate the associations of perioperative ADL with patient survival after hepatic resection for ICC. We included 70 consecutive patients who underwent hepatectomy for ICC from 2010 to 2021 in the current study. Preoperative and postoperative ADL were evaluated based on the Barthel index, which yields a score of 0-100points, with higher scores indicating greater independence. A preoperative or postoperative Barthel index score of <100 was defined as disability in perioperative ADL. Cox proportional hazards regression was used to calculate hazard ratios after adjusting for potential confounders. Among the 70 patients, seven (10%) had a preoperative Barthel index score of <100, and 23 (33%) showed a postoperative Barthel index score of <100. Multivariate analyses revealed that disability in perioperative ADL was associated with shorter recurrence-free survival (multivariable hazard ratios 2.38, 95% confidence interval 1.22-4.57; p=0.011) and overall survival (multivariable hazard ratio 2.49, 95% confidence interval 1.09-5.70; p=0.031). Disability in perioperative ADL is associated with shorter recurrence-free and overall survival after hepatic resection for ICC. Upon validation, perioperative measurement of ADL may improve risk assessment, and improvement of perioperative ADL may lead to favorable clinical outcomes in patients with ICC.

Identification and Validation of Proteasome Subunit Alpha Type-7 (PSMA7) as a Therapeutically Vulnerable Target in GBM

<h3>Purpose/Objective(s)</h3> A neomorphic gain-of-function mutation of isocitrate dehydrogenase (IDH1/2) is significantly associated with favorable clinical outcome of patients with glioblastoma (GBM; WHO grade IV) compared with ones with wildtype IDH(1/2). The current standard treatment for GBM consists of maximal safe surgical tumor resection followed by radiation treatment (RT) and concomitant and adjuvant temozolomide (TMZ) (Stupp protocol). Despite the standard treatment, the five-year survival rate remains dismal, only 5%. Therefore, there is an urgent need to identify druggable, therapeutically vulnerable targets in GBM. In this study we identified PSMA7, an alpha-type subunit of the 20S proteasome core particle that is involved in the regulated degradation of proteins in cells via the ubiquitin-proteasome system. PSMA7 has been shown to be frequently upregulated in multiple cancer types and blocking PSMA7 inhibits cell proliferation in cervical, colorectal, and gastric cancer. Although the connection between PSMA7 and tumor progression has been studied in several tumor models, little is known about the role of PSMA7 in GBM biology and treatment response where its expression is significantly upregulated. <h3>Materials/Methods</h3> PSMA7 was identified from publicly available mRNA profiling data of primary glioma patients in two patient cohorts from the Chinese Glioma Genome Atlas (CGGA) database. PSMA7 was functionally validated <i>in vitro</i> using RNAi-mediated knockdown approaches. Stable cell lines with shRNA-mediated knockdown of PSMA7 were generated by puromycin selection. Protein expression was quantified by Western blot analysis. mRNA expression from <i>in vitro</i> studies was determined by qRT-PCR. Cell viability and cell proliferation were assessed by MTS or ATP assays. A biological irradiator was used to treat cells with ionizing radiation for evaluating RT response. <h3>Results</h3> Primary glioma patients with high PSMA7 mRNA levels (median split) were found to have worse overall survival than patients with low mRNA levels in two primary glioma cohorts. Moreover, PSMA7 was significantly upregulated in IDH1/2 wildtype (IDHwt) primary gliomas compared to IDH1/2 mutant (IDHmut) primary gliomas in these two cohorts. We confirmed PSMA7 mRNA and protein expression to be significantly higher in U87MG-IDHwt GBM cells compared to U87MG-IDHmut cells <i>in vitro</i>. RNAi-mediated knockdown of PSMA7 in PDX GBM cell lines decreased cell viability and increased sensitivity to ionizing radiation <i>in vitro</i>. We observed that PSMA7 knockdown in a PDX GBM cell line prolonged mouse overall survival in an <i>in vivo</i> orthotopic xenograft mouse model. <h3>Conclusion</h3> Our data indicate that PSMA7 is a potentially vulnerable therapeutic target in GBM as PSMA7 knockdown slowed GBM cell proliferation, sensitized GBM cells to ionizing radiation, and prolonged overall survival in an orthotopic xenograft mouse model.

High Blood Concentration of Leukocyte-Derived Extracellular Vesicles Is Predictive of Favorable Clinical Outcomes in Patients with Pancreatic Cancer: Results from a Multicenter Prospective Study.

Simple SummaryBlood-circulating extracellular vesicles (EVs) are emerging as key players to develop novel liquid biopsy-based approaches in cancer, including pancreatic cancer. In this study, we aimed to explore the prognostic and predictive value of blood-circulating extracellular vesicles released by immune cells in patients with pancreatic cancer. A recently patented flow cytometry protocol was applied for the identification and phenotypical characterization of blood-circulating EVs in a cohort of 56 patients with pancreatic cancer (PC) and in a group of 48 healthy controls. We observed an increased blood concentration of leukocyte-derived EVs (CD45+) and PD-L1+ EVs in patients with PC as compared to healthy controls. Intriguingly, a high blood concentration of leukocyte-derived EVs identified PC patients with a good prognosis and improved clinical outcomes. This study revealed the promising role of EVs released by immune cells as a source of candidate biomarkers in patients with pancreatic cancer.Pancreatic cancer (PC) is one of the leading causes of cancer-related death worldwide. Identification of novel tumor biomarkers is highly advocated in PC to optimize personalized treatment algorithms. Blood-circulating extracellular vesicles hold promise for liquid biopsy application in cancer. We used an optimized flow cytometry protocol to study leukocyte-derived EVs (CD45+) and PD-L1+ EVs in blood from 56 pancreatic cancer patients and 48 healthy controls (HCs). Our results show that PC patients presented higher blood levels of total EVs (p = 0.0003), leukocyte-derived EVs (LEVs) (p = 0.001) and PD-L1+ EVs (p = 0.01), as compared with HCs. Interestingly, a blood concentration of LEVs at baseline was independently associated with improved overall survival in patients with borderline resectable or primary unresectable PC (HR = 0.17; 95% CI 0.04–0.79; p = 0.02). Additionally, increased blood-based LEVs were independently correlated with prolonged progression-free survival (HR = 0.10; 95% CI 0.01–0.82; p = 0.03) and significantly associated with higher disease control rate (p = 0.02) in patients with advanced PC receiving standard chemotherapy. Notably, a strong correlation between a decrease in blood LEVs concentration during chemotherapy and disease control was observed (p = 0.005). These intriguing findings point to the potential of LEVs as novel blood-based EV biomarkers for improved personalized medicine in patients affected by PC.

Mechanical thrombectomy in a Chilean public hospital. Experience in 149 patients

Mechanical thrombectomy is the accepted treatment for acute ischemic stroke in Large Vessel Occlusion. The Barros Luco Trudeau hospital developed endovenous thrombolysis in 2010, and since 2012, implemented endovascular management, becoming the neurovascular center in the southern area of the metropolitan region. To describe endovascular management of acute ischemic stroke in a Chilean public hospital. Analysis of patients with acute ischemic stroke that were treated with mechanical throm-bectomy from 2012 to 2019 in the Barros Luco Hospital. In the study period, a mechanical thrombectomy was carried out in 149 patients aged 61 ± 15 years (46% females). The average National institute of Health Stroke Scale (NIHSS) at presentation was 19 ± 4-5. Anterior or posterior circulation involvement was present in 89.9 and 10.1 % of patients. Twenty-five percent of patients were referred from other public centers. The mean lapse between onset of symptoms and thrombectomy was 266 ± 178 in. Ninety days after the procedure, 58% of patients had minimal or absent disability (Modified Ranson score of 0-2), and 19,2% died. Mechanical thrombectomy, according to this experience, has favorable clinical outcomes in patients with high NIHSS scores at entry.

Vδ2 T cells are associated with favorable clinical outcomes in patients with bladder cancer and their tumor reactivity can be boosted by BCG and zoledronate treatments

Vδ2 T cells are associated with favorable clinical outcomes in patients with bladder cancer and their tumor reactivity can be boosted by BCG and zoledronate treatments

Machine learning-guided covariate selection for time-to-event models developed from a small sample of real-world patients receiving bevacizumab treatment.

Therapeutic outcomes in patients with metastatic colorectal cancer (mCRC) receiving bevacizumab treatment are highly variable, and a reliable predictive factor is not available. Progression‐free survival (PFS) and overall survival (OS) were recorded from an observational, prospective study after 5 years of follow‐up, including 46 patients with mCRC receiving bevacizumab treatment. Three vascular endothelial growth factor (VEGF)‐A and two intercellular adhesion molecule‐1 genes polymorphisms, age, gender, weight, dosing scheme, and co‐treatments were collected. Given the relatively small number of events (37 [80%] for the PFS and 26 [57%] for the OS), to study the effect of these covariates on PFS and OS, a covariate analysis was performed using statistical and supervised machine learning techniques, including Cox regression, penalized Cox regression techniques (least absolute shrinkage and selection operator [LASSO], ridge regression, and elastic net), survival trees, and survival forest. The predictive performance of each method was evaluated in bootstrapped samples, using prediction error curves and the area under the curve of the receiver operating characteristic. The LASSO penalized Cox‐regression model showed the best overall performance. Nonlinear mixed effects (NLME) models were developed, and a conventional stepwise covariate search was performed. Then, covariates identified as important by the LASSO model were included in the base NLME models developed for PFS and OS, resulting in improved models as compared to those obtained with the stepwise covariate search. It was shown that having gene polymorphisms in VEGFA (rs699947 and rs1570360) and ICAM1 (rs1799969) are associated with a favorable clinical outcome in patients with mCRC receiving bevacizumab treatment.

Vδ2 T cells are associated with favorable clinical outcomes in patients with bladder cancer and their tumor reactivity can be boosted by BCG and zoledronate treatments

Background Bladder cancer is an important public health concern due to its prevalence, high risk of recurrence and associated cost of management. Although BCG instillation for urothelial cancer treatment is...

Phage Therapy of Mycobacterium Infections: Compassionate Use of Phages in 20 Patients With Drug-Resistant Mycobacterial Disease.

Nontuberculous Mycobacterium infections, particularly Mycobacterium abscessus, are increasingly common among patients with cystic fibrosis and chronic bronchiectatic lung diseases. Treatment is challenging due to intrinsic antibiotic resistance. Bacteriophage therapy represents a potentially novel approach. Relatively few active lytic phages are available and there is great variation in phage susceptibilities among M. abscessus isolates, requiring personalized phage identification. Mycobacterium isolates from 200 culture-positive patients with symptomatic disease were screened for phage susceptibilities. One or more lytic phages were identified for 55 isolates. Phages were administered intravenously, by aerosolization, or both to 20 patients on a compassionate use basis and patients were monitored for adverse reactions, clinical and microbiologic responses, the emergence of phage resistance, and phage neutralization in serum, sputum, or bronchoalveolar lavage fluid. No adverse reactions attributed to therapy were seen in any patient regardless of the pathogen, phages administered, or the route of delivery. Favorable clinical or microbiological responses were observed in 11 patients. Neutralizing antibodies were identified in serum after initiation of phage delivery intravenously in 8 patients, potentially contributing to lack of treatment response in 4 cases, but were not consistently associated with unfavorable responses in others. Eleven patients were treated with only a single phage, and no phage resistance was observed in any of these. Phage treatment of Mycobacterium infections is challenging due to the limited repertoire of therapeutically useful phages, but favorable clinical outcomes in patients lacking any other treatment options support continued development of adjunctive phage therapy for some mycobacterial infections.

The Prognostic Effect Of The NPM1 Mutation And The FLT3-ITD Genes In Acute Promyelocytic Leukemia

Background: The Nucleophosmin 1 gene mutation (NPM1mut) is considered a favorable clinical outcome in patients with acute myeloid leukemia (AML) with normal chromosome, and this outcome may be reduced with the presence of an internal tandem repeat of the Fms-like tyrosine kinase 3 gene (FLT3-ITD). However, the effect of NPM1mut on patients with acute promyelocytic leukemia (APL) remains unclear. Our objective was to analyze the prognostic effect of the NPM1mut gene and the FLT3-ITD gene in patients with APL. Methods: Sixty patients with new APL diagnoses underwent RT-PCR detection of the NPM1mut and FLT3-ITD genes, and accepted treatment with ATRA and chemotherapy. The presence and combinations of genotypes were compared in association with overall survival (OS) and progression- free survival (PFS) outcome. Results: Twenty- eight patients had positive FLT3-ITD with a rate of 46.7%, nine had positive NPM1mut with a rate of 15%. Patients with FLT3-ITD positive have worse OS and PFS compared to FLT3-ITD negative (p=0.027; 0.008, respectively), but there were no statistically significant differences in OS, PFS between the groups: NPM1mut positive and NPM1mut negative (p=0.209; 0.352, respectively), NPM1mut positive/FLT3-ITD positive and NPM1mut negative/FLT3-ITD positive (p=0.235; 0.444, respectively), NPM1mut positive/FLT3-ITD negative and NPM1mut negative/FLT3-ITD negative (p=0.376; 0.324, respectively). Conclusions: The FLT3-ITD gene confers a poor prognosis in patients with acute promyelocytic leukemia, but the NPM1mut gene had no effect on efficacy and did no change the prognostic value of FLT3- ITD.

Improvement in Medication Adherence after Pharmacist Intervention Is Associated with Favorable Clinical Outcomes in Patients with Ulcerative Colitis.

Background/AimsAlthough pharmacist intervention for patients with chronic diseases has been shown to improve medication adherence, few studies have evaluated its effects on the objective clinical outcomes. We investigated the impact of pharmacist intervention on medication adherence and clinical outcomes in patients with ulcerative colitis (UC).MethodsPatients with UC and low medication adherence were divided into two groups, based on pharmacist intervention. Their medication possession ratio and nonadherence rate for 6 months before and after the baseline were investigated. The partial Mayo score, flare-up incidence, and factors influencing flare-up events for 1 year after the baseline were analyzed.ResultsOf 99 patients, 33 and 66 were included in the intervention and control groups, respectively. The nonadherence rate significantly declined in the intervention group 6 months after the baseline (60.6% before vs 30.3% after; p=0.013). The groups showed a significant difference regarding time-related partial Mayo scores (p=0.002). Intervention was significantly negatively correlated with time and the partial Mayo score (r2=0.035, p=0.013). A significant difference was observed in the flare-up incidence (33.3% in the intervention group vs 54.6% in the control group; p=0.046). Multivariate logistic regression indicated that pharmacist intervention (adjusted odds ratio, 0.370; 95% confidence interval, 0.145 to 0.945; p=0.038) independently reduced the flare-up risk.ConclusionsPharmacist intervention significantly decreased the nonadherence rate, improved the partial Mayo score, and reduced the flare-up incidence compared with the control group in a cohort of UC patients identified to have low medication adherence.

Autologous Matrix-Induced Chondrogenesis (AMIC) with Lateral Ligament Stabilization for Osteochondral Lesions of the Talus in Patients with Ankle Instability

Category:Ankle; Hindfoot; SportsIntroduction/Purpose:Autologous matrix-induced chondrogenesis (AMIC) has shown to result in favorable clinical outcome in patients with osteochondral lesions of the talus (OLT). Yet, the influence of ankle instability on cartilage repair of the ankle has still to be determined. This study sought to compare the clinical and radiographic outcome in patients with and without concomitant lateral ligament stabilization (LLS) undergoing AMIC for the treatment of OLT.Methods:This study evaluated AMIC that were implanted in patients for the treatment of symptomatic OLT with and without concomitant ankle instability. Postoperative MRI, Tegner, AOFAS and Cumberland Ankle Instability Tool (CAIT) were obtained at a minimum follow-up of 2 years. A musculoskeletal radiologist scored all grafts according to the MOCART 1 and 2.0 scores.Patients were stratified into two groups based on whether they underwent concomitant LLS for ankle instability. Patients without LLS served as controls. Patients were matched 1:1 for BMI, lesion size, follow-up and age.Results:Twenty-six patients that underwent AMIC with a mean follow-up of 4.2 +- 1.5 years were enrolled in this study (13 with and 13 without concomitant ankle instability). Patients' mean age was 33.4 +- 12.7 years with a BMI averaging 26.2 +- 3.7. Patients with concomitant LLS showed worse clinical outcome measured by AOFAS (85.1 +- 14.4 vs. 96.3 +- 5.8, p=0.034) and Tegner (3.8 +- 1.1 vs. 4.4 +- 2.3, p=0.012). No difference was seen between both groups regarding MOCART 1 and 2.0 scores (p=0.714 and p=0.371, respectively). Additionally, postoperative CAIT and AOFAS significantly correlated in patients that underwent concomitant LLS (r=0.766, p=0.002) with a CAIT score of > 24 (stable ankle joint) resulting in AOFAS scores comparable to scores in patients with isolated AMIC (90.1 +- 11.6 vs. 95.3 +- 6.6; p=0.442).Conclusion:The results of this study suggest a negative influence of ankle instability on the clinical outcome of cartilage repair with AMIC for the treatment of OLT. If postoperative ankle stability is achieved in patients with LLS, however, comparable outcome as seen after isolated AMIC can be expected.

Left bundle branch area pacing versus right ventricular pacing in patients with persistent atrial fibrillation requiring ventricular pacing.

This study aims to assess whether left bundle branch area pacing (LBBAP) can result in favorable clinical and echocardiographic outcomes among patients with persistent atrial fibrillation (PeAF). We prospectively enrolled consecutive patients with PeAF if they required ventricular pacing and had left ventricular ejection fraction (LVEF)>35%. During the same period, two experienced operators performed LBBAP and right ventricular pacing (RVP). All-cause death and heart failure hospitalization (HFH) were routinely followed after procedure. The primary outcome was the composite endpoints of all-cause death or HFH. LBBAP was successful in 49 of 52 patients (94.2%), whereas 44 patients received RVP. During a mean follow-up of 13.9±7.0 months, LBBAP group presented with higher ventricular pacing percentage (80% vs. 50.9%, p=.04) and narrower paced QRS duration (117.2±18.8ms vs. 151.8±13.7ms, p<.001) than RVP group. The primary endpoint was slightly reduced in LBBAP group than RVP without reaching statistical significance (7.7% vs. 11.4%, p=.48). Compared with baseline, we observed significant changes in LVEF (+0.7% vs. -2.2%, p=.007) and left atrial diameter (-1.63mm vs. +1.23mm, p=.011) between LBBAP and RVP. Our results indicate possible effect of LBBAP on reverse remodeling of left atrium and a trend towards favorable clinical outcomes in patients with PeAF requiring high burden of ventricular pacing when compared with RVP.