The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Major surgery in a minor way

Poster presentationBackground: Hysterectomy is one of the most common gynaecology operations performed in the UK and is often the chosen management in benign conditions that has not responded to conservative or medical treatment . This is commonly the case in the treatment of large uterine fibroids where the size of the fibroid uterus is a major factor for consideration in the determination of hysterectomy technique. Objective: The aim of this study is to evaluate the relevance of laparoscopic subtotal hysterectomy (LSH) in the treatment of large uterine fibroids as a safe alternative to total laparoscopic (TLH) and abdominal hysterectomy (AH). Method: A retrospective collection of all patients who underwent a LSH under one surgeon between 2009 and 2011 was analysed. Patients with a uterus which clinically measured as ‡16 weeks and a uterus weight of ‡240 g also confirmed on histology were included. Data was collected for intra-operative complications, operation duration, estimated blood loss and length of hospital stay, which includes the time the patient is admitted to the time she is discharged. Results: Fifty-three patients were included, 52 patients had successful LSH and one patient was converted to AH due to a large broad ligament fibroid (775 g). Mean weight of the uterus was 467 g (%) [245–410 g: 28 (53%), 450–649 g: 13 (25%), 650–849 g: 7 (13%), 850–1400 g: 5 (9%)]. Mean operation time was 83.83 min (40–117 min). There were no significant major intra-operative complications recorded. Fifty-two (98.1%) patients had insignificant blood loss and 1 (1.8%) had significant blood loss requiring blood transfusion. Mean hospital stay was 1.45 days [1 day: 36 (67.9%), 2 days (22.6%): 12, 3 days: 3 (5.6%), 4 days: 2 (3.8%)]. Conclusion: In the case of large uterine fibroids, LSH provide a safe and better alternative to TLH and A

Ethanol and its metabolites impair the maturation and function of monocyte-derived dendritic cells obtained from alcoholics and healthy subjects

Azione dell'alcol sull'immunità in vitro e in vivo

Is the multidisciplinary support effective in preventing alcohol relapse after liver transplantation?

Introduction: Alcoholic liver disease (ALD) is one of the main indications for liver transplantation (LT) reaching about 30% in Europe and the United States. One of the most important burden in patients transplanted for ALD is alcohol relapse. In fact, according to the literature, the 20–50% of patients experience alcohol relapse in the first 5 years after LT. With this in mind, a program of program of multidisciplinary support to alcohol misuse (MSAM) was started up at the Transplant Unit of University of Rome “Sapienza” in 2004 involving a team of alcohol disorder specialists to help patients undergoing LD for ALD to cope with their alcohol use disorder. Aim: We aimed at analyze the relapse rate, risk factors for relapse and survival in patients involved in MSAM. The relapse rate was also compared with that of a historical group of transplanted patients. Material and methods: Consecutive patients with ALD transplanted from 2004 were included. The most important demographic, psychosocial and clinical characteristics known to be associated with alcohol relapse were registered. Patients transplanted for ALD before from 2000 to 2004, with no access to MSAM, were considered as historical control group. Results: Sixty-nine patients underwent MSAM. 8.7% presented alcohol relapse. Relapse risk factors were female gender (p = 0.004), history of alcohol-withdrawal-syndrome (p = 0.01), a short follow-up before LT (p = 0.004), few sessions for support to alcohol misuse (p = 0.003) and a short time of abstinence before LT (p = 0.0007). The alcohol relapse rate was significantly lower in the MSAM group vs the historical group (8.7% vs 27.7%; p = 0.02) despite similar demographic, clinical and psychological characteristics and a similar transplant follow-up protocol. Five-year survival was higher than that of the historical group (p = 0.008). Conclusion: This study shows that aMSAM program contributes to alcohol relapse prevention after LT in patients transplanted for ALD

The multidisciplinary support in preventing alcohol relapse after liver transplantation: A single centre experience

Abstract Background and aim: Alcoholic liver disease (ALD) represents a frequent indication for liver transplantation (LT). Since 2004, we have adopted a program of multidisciplinary support(MS) to assist patients undergoing LT for ALD. We aimed at analyzingthe relapse rate and the risk factors for relapse. The relapse rate was also compared with that of a historical group of patients who underwent transplantation. Their survival rate was also analyzed.Patients and methods: Consecutive patients with ALD transplanted from 2004 were included. The most important demographic, psychosocial, and clinical characteristics known to be associated with alcohol relapse were recorded. Results: Sixty-nine patients underwent MS: 8.7% presented alcohol relapse. At multivariate analysis female gender (sHR 9.02, 95% CI 1.71-47.56,P = .009), alcohol withdrawal syndrome (sHR 5.89, 95% CI 1.42-24.46, P = .015) and a shorter time of MSprogram before LT (sHR 0.928 per month, 95% CI 0.870-0.988, P = .021) were identified as independent risk factors for relapse. The rate of alcohol relapse was significantly lower than that of the historical group who did not undergo MS (sHR 0.21, 95% CI: 0.06-0.68; P = .009).Conclusion: This study shows that a MS program may contribute to alcohol relapse prevention after LT in ALD patients. However, the relevance of this support needs to be confirmed by clinical trials. K EYWORDS alcohol abuse, alcohol dependence, alcohol relapse after liver transplantatio

Screening Of An Endothelial Cdna Library Identifies Several Potential Autoantigens In Chronic Alcoholics With Atherosclerotic PLAQ11E

Chronic alcoholism is associated with atherosclerotic cardiovascular events. Atherosclerosis is an immune-mediated inflammatory disorder involving autoimmune reactions. The humoral immune response to endothelium has a pivotal role in thè development of atherosclerosis. Autoimmune reactions are also associated with atherosclerotic alcohol-related damages but thè mecha-nisms responsible are largely unknown. Excessive ethanol consumptìon may result directly in increased oxidative stress and inflammatìon, and indirectly by thè development of autoantibodies against oxidized low density lipoprotein (ox-LDL) and phospholipids. Ali these mechanisrns may contribute to alcohol-induced injuries. Aim of this study ìs thè identificaù'on of autoantigens involved in thè pathogenesis of atherosclerotic disorders in chronic alcoholic patients. Screening of a cDNA library from human umbilical arterv endothelial cells (HUAEC) was performed with sera from two chronic alcoholic patients with carotid atherosclerosis ascertained by colour eco-doppler. Four positive strongly reactive clones were identified. The nucleotide sequence of thè cloned cDNA insertion revealed: (i) zinc finger protein 92, (ii) recombining binding protein suppressor of hairless, (iii) SWAP-70 protein. and (iv) excision repair protein. Further studies are needed to clarify thè linkage between serum antibodies to these proteins and thè atherosclerotic manifestations in chronic alcoholism. Having these recombinant antìgens might help in defming thè pre¬cise role that specific autoantibodies play in thè autoimmune mechanisms underlying atherosclerosis in chronic alcoholists

Chronic and acute alcohol exposure prevents monocyte-derived dendritic cells from differentiating and maturing

Increasing evidence suggests that alcohol abuse may be linked to adverse immunomodulatory effects on immune responses. Our study was undertaken to clarify the immunological consequences of chronic and acute alcohol exposure on differentiation and maturation of human dendritic cells (DCs). Using immunochemical and cytofluorimetric analysis we determined the phenotype and functions of monocyte-derived DCs from alcoholics and healthy subjects and analyzed their ability to respond to lipopolysaccharide (LPS) in the presence or absence of ethanol (EtOH) exposure. Our results showed that alcoholics' monocytes differentiated to immature DCs with altered phenotype and functions (alciDCs). Alc-iDCs showed fewer CD1a+ cells, weaker CD86 expression and higher HLA-DR expression associated with lower endocytosis and allostimulatory functions than iDCs from healthy subjects (control-iDCs). Despite these impairments, alc-iDCs produced TNF-α and IL-6 in large amounts. LPS stimulation failed to induce full phenotypical and functional alc-iDC maturation. In vitro acute EtOH exposure also prevented alc-iDCs and control-iDCs from maturing in response to LPS. T-cell priming experiments showed that EtOH treatment prevented LPS-stimulated control-iDCs from priming and polarizing naïve allogeneic T cells into Th1 cells, thus favouring a predominant Th2 environment. Collectively, our results provide evidence that chronic and acute alcohol exposure prevents DCs from differentiating and maturing in response to a microbial stimulus. Copyright © by BIOLIFE, s.a.s