Outcomes Following Subclavian and Axillary Artery Access for Transcatheter Aortic Valve Replacement: Society of the Thoracic Surgeons/American College of Cardiology TVT Registry Report

Objectives

The aim of this study was to analyze the frequency and outcomes of patients who underwent transsubclavian or transaxillary (TAx) transcatheter aortic valve replacement (TAVR) using the balloon-expandable SAPIEN 3 prosthesis compared with traditional alternative access, transapical (TA) and transaortic (TAo).

Antinuclear antibodies in the oldest-old women and men

The aim of this study was to compare the prevalence of antinuclear antibodies (ANA) in very old individuals (>or=86 years of age) with healthy younger (18-68 years) blood donors (n=200) regarding gender, health status, ratio of circulating CD4/CD8 cells and cytomegalovirus (CMV) serology. Frozen plasma was used for ANA detection in two study groups, i.e. 'OCTO' (97 persons aged 86-92 years, 65% women) and 'NONA' (136 persons aged 86-95 years, 70% women). OCTO participants were recruited on the basis that they were healthy or moderately healthy according to a selection protocol. No exclusion criteria regarding health status were applied in the NONA sample. The prevalence of ANA was significantly higher in the oldest-old samples compared to blood donors. There was no association between health status and the presence of ANA in the oldest-old. The difference across age was most pronounced in men, with low levels at younger age, whereas the prevalence among the oldest-old men reached similar levels as in women. There were no associations between the presence of ANA and CD4/CD8 ratio or with CMV status in the oldest-old. Our findings confirm an increased prevalence of ANA in the oldest-old, and emphasize the importance of taking gender and age into consideration when evaluating ANA.     

Antibodies against deamidated gliadin peptides identify adult coeliac disease patients negative for antibodies against endomysium and tissue transglutaminase

Aliment Pharmacol Ther 2010; 32: 254–260

Summary

Background This study was done to evaluate the diagnostic utility of antibodies against deamidated gliadin peptides compared to traditional markers for coeliac disease. Aim To evaluate diagnostic utility of antibodies against deamidated gliadin peptide (DGP). Methods Sera from 176 adults, referred for endoscopy without previous analysis of antibodies against tissue transglutaminase (tTG) or endomysium (EmA), were retrospectively analysed by ELISAs detecting IgA/IgG antibodies against DGP or a mixture of DGP and tTG, and compared with IgA‐tTG and EmA. Seventy‐nine individuals were diagnosed with coeliac disease. Results Receiver operating characteristic analyses verified the manufacturers’ cut‐off limits except for IgA/IgG‐DGP/tTG. In sera without IgA deficiency, the sensitivity was higher for IgA/IgG‐DGP (0.85–0.87) compared with IgA‐tTg (0.76) and EmA (0.61). All tests showed high specificity (0.95–1.00). Eighteen coeliac disease‐sera were negative regarding IgA‐tTG, nine of which were positive for IgA/IgG‐DGP. Sera from coeliac disease‐patients >70 years were more often negative for IgA‐tTG (50%) and IgA/IgG‐DGP (36%) than younger patients (15% and 8% respectively) (P < 0.01). Three of the four IgA‐deficient patients were positive in the IgA/IgG‐DGP assay. Conclusions In this study of patients unselected regarding IgA‐tTg/EmA, thus unbiased in this respect, IgA/IgG‐DGP identified adult coeliac disease patients negative for antibodies against endomysium and tissue transglutaminase. Serology is often negative in elderly patients with coeliac disease; a small bowel biopsy should therefore be performed generously before coeliac disease is excluded.     

Activation of the liver X receptor protects against hepatic injury in endotoxemia by suppressing Kupffer cell activation

Recent reports have demonstrated that liver X receptors (LXRs) of the nuclear receptor family have anti-inflammatory effects on macrophages. Here we examine whether activation of LXR by the synthetic agonist GW3965 can ameliorate the liver injury/dysfunction caused by endotoxins in the rat. Male Wistar rats received GW3965 (0.3 mg/kg) or vehicle (50% dimethyl sulfoxide) 30 min before coadministration of lipopolysaccharide (LPS, 5 mg/kg i.v.) and peptidoglycan (1 mg/kg i.v.). Treatment with GW3965 attenuated the increase in the plasma levels of alanine aminotransferase and bilirubin (markers of liver injury/dysfunction) as well as the focal hepatocyte necrosis (histology) caused by coadministration of LPS and peptidoglycan. This protective effect of GW3965 treatment was associated with reduced infiltration of mast cells in the liver (histopathology) and reduced gene expression of the chemokines eotaxins 1 and 2, whereas MIP-2 mRNA levels were not affected. Plasma levels of tumor necrosis factor alpha and prostaglandin E2 were significantly attenuated by GW3965, whereas plasma interleukins 6 and 10 were not altered. High expression of LXRalpha mRNA was observed in Kupffer cell cultures, suggesting that Kupffer cells are targets of GW3965. Subsequent in vitro studies in Kupffer cells demonstrated that exposure to GW3965 attenuated the LPS-induced release of tumor necrosis factor alpha and prostaglandin E2 in a dose-dependent manner. In conclusion, this study demonstrates that activation of LXR by GW3965 protects against liver injury and dysfunction in a rat model of endotoxemia, in part by exerting an anti-inflammatory effect on Kupffer cells.     

The Psychiatric Out-Patient Experiences Questionnaire (POPEQ): data quality, reliability and validity in patients attending 90 Norwegian clinics

The aim of this study was to develop and evaluate the Psychiatric Out-Patient Experiences Questionnaire (POPEQ). The instrument was developed following a literature review, patient interviews and pre-testing of questionnaire items. The POPEQ was administered as part of a postal survey of 15,422 adult outpatients attending Norwegian clinics; 6677 (43.3%) patients responded to the questionnaire. Items had low levels of missing data. Factor analysis showed that 11 widely applicable items contribute to a measure of overall experiences. Sub-dimensions include clinician interaction (six items) information (two items) and outcomes (three items). Item-total correlations ranged from 0.5 to 0.8. Cronbach's alpha and test-retest reliability estimates exceeded the criterion of 0.7; the majority were over 0.8 and total scores over 0.9. Construct validity was supported by the results of 128 tests. The POPEQ includes important aspects of patient experience for psychiatric outpatients and has excellent evidence for reliability and construct validity. The instrument is recommended for the measurement of psychiatric outpatient experiences.     

Cisplatin and etoposide regimen is superior to cyclophosphamide, epirubicin, and vincristine regimen in small-cell lung cancer: results from a randomized phase III trial with 5 years' follow-up.

PURPOSE: To investigate whether chemotherapy with etoposide and cisplatin (EP) is superior to cyclophosphamide, epirubicin, and vincristine (CEV) in small-cell lung cancer (SCLC). PATIENTS AND METHODS: A total of 436 eligible patients were randomized to chemotherapy with EP (n = 218) or CEV (n = 218). Patients were stratified according to extent of disease (limited disease [LD], n = 214; extensive disease [ED], n = 222). The EP group received five courses of etoposide 100 mg/m(2) intravenously (IV) and cisplatin 75 mg/m(2) IV on day 1, followed by oral etoposide 200 mg/m(2) daily on days 2 to 4. The CEV group received five courses of epirubicin 50 mg/m(2), cyclophosphamide 1,000 mg/m(2), and vincristine 2 mg, all IV on day 1. In addition, LD patients received thoracic radiotherapy concurrent with chemotherapy cycle 3, and those achieving complete remission during the treatment period received prophylactic cranial irradiation. RESULTS: The treatment groups were well balanced with regard to age, sex, and prognostic factors such as weight loss, and performance status. The 2- and 5-year survival rates in the EP arm (14% and 5%, P =.0004) were significantly higher compared with those in the CEV arm (6% and 2%). Among LD patients, median survival time was 14.5 months versus 9.7 months in the EP and CEV arms, respectively (P =.001). The 2- and 5-year survival rates of 25% and 10% in the EP arm compared with 8% and 3% in the CEV arm (P =.0001). For ED patients, there was no significant survival difference between the treatment arms. Quality-of-life assessments revealed no major differences between the randomized groups. CONCLUSION: EP is superior to CEV in LD-SCLC patients. In ED-SCLC patients, the benefits of EP and CEV chemotherapy seem equivalent, with similar survival time and quality of life.     

Impact of home health care on health care costs and hospitalization frequency in patients with heart failure

This study was undertaken to investigate the costs of delivering home health care services to patients with heart failure and the impact of these services on hospitalization frequency. Results suggest that referring patients with heart failure to home health care is costly and does not necessarily reduce hospitalization frequency.