JAK-inhibitors and risk on serious viral infection, venous thromboembolism and cardiac events in patients with rheumatoid arthritis:A protocol for a prevalent new-user cohort study using the Danish nationwide DANBIO register

Janus Kinase inhibitors (JAKis) are targeted synthetic disease-modifying antirheumatic drugs and represent an important alternative to treat patients with moderate to high rheumatoid arthritis (RA) disease activity. Safety concerns associated with increased risk for venous thromboembolism (VTE), serious viral infection, and, more recently, major adverse cardiovascular events (MACE) in JAKi users have emerged worldwide. However, as the exact mechanisms to explain these safety concerns remain unclear, the increased risk of VTE, MACE, and serious viral infection in JAKi users is heavily debated. In light of the need to enrich the safety profile of JAKis in real-world data, we aim to quantify the incidence and risk of MACE, VTE, and serious viral infections in RA patients registered in the Danish DANBIO registry, a nationwide registry of biological therapies used in rheumatology. Therefore, we will conduct a population-based cohort study using a prevalent new-user design. We will identify all RA patients in the DANBIO, ≥ 18 years old, receiving a JAKi or a tumor necrosis factor α inhibitor (TNF-αi) from January 2017 to December 2022. Prevalent and new users of JAKis will be matched to TNF-αi comparators with similar exposure history using time-conditional propensity scores (TCPS). We will describe the cumulative incidence of the outcomes (VTE, MACE, serious viral infection) in each exposure group (JAKi users; TNF-αi users), stratified by outcome type. Additionally, the Aalen-Johansen method will be used to estimate the time-to-event survival function stratified by outcome type. We will also estimate the hazard ratio (HR) with 95% confidence interval (CI) of each outcome in both exposure groups using the time-dependent Cox proportional hazards model. Results will enrich the safety profile of JAKis in real-world data

Importance of Vanadium-Catalyzed Oxidation of SO2 to SO3 in Two-Stroke Marine Diesel Engines

Low-speed marine diesel engines are mostly operated on heavy fuel oils, which have a high content of sulfur and ash, including trace amounts of vanadium, nickel, and aluminum. In particular, vanadium oxides could catalyze in-cylinder oxidation of SO2 to SO3, promoting the formation of sulfuric acid and enhancing problems of corrosion. In the present work, the kinetics of the catalyzed oxidation was studied in a fixed-bed reactor at atmospheric pressure. Vanadium oxide nanoparticles were synthesized by spray flame pyrolysis, i.e., by a mechanism similar to the mechanism leading to the formation of the catalytic species within the engine. Experiments with different particle compositions (vanadium/sodium ratio) and temperatures (300–800 °C) show that both the temperature and sodium content have a major impact on the oxidation rate. Kinetic parameters for the catalyzed reaction are determined, and the proposed kinetic model fits well with the experimental data. The impact of the catalytic reaction is studied with a phenomenological zero-dimensional (0D) engine model, where fuel oxidation and SOx formation is modeled with a comprehensive gas-phase reaction mechanism. Results indicate that the oxidation of SO2 to SO3 in the cylinder is dominated by gas-phase reactions and that the vanadium-catalyzed reaction is at most a very minor pathway

Incidence of COVID-19 hospitalisation in patients with systemic lupus erythematosus:A nationwide cohort study from Denmark

Background: Patients with systemic lupus erythematosus (SLE) have an increased risk of infections due to impaired immune functions, disease activity, and treatment. This study investigated the impact of having SLE on the incidence of hospitalisation with COVID-19 infection. Methods: This was a nationwide cohort study from Denmark between 1 March 2020 to 2 February 2021, based on the linkage of several nationwide registers. The adjusted incidence of COVID-19 hospitalisation was estimated for patients with SLE compared with the general population in Cox-regression models. Among SLE patients, the hazard ratio (HR) for hospitalisation was analysed as nested case-control study. Results: Sixteen of the 2533 SLE patients were hospitalised with COVID-19 infection. The age-sex adjusted rate per 1000 person years was 6.16 (95% CI 3.76–10.08) in SLE patients, and the corresponding hazard ratio was 2.54 (95% CI 1.55–4.16) compared with the matched general population group after adjustment for comorbidities. Among SLE patients, hydroxychloroquine treatment was associated with a HR for hospitalisation of 0.61 (95% CI 0.19–1.88), and 1.06 (95% CI 0.3–3.72) for glucocorticoid treatment. Conclusion: Patients with SLE were at increased risk of hospitalisation with COVID-19

Intake of marine n-3 polyunsaturated fatty acids and the risk of rheumatoid arthritis:Protocol for a cohort study using data from the Danish Diet, Cancer and Health cohort and Danish health registers

INTRODUCTION: Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory joint disease with multifactorial aetiology. Smoking is a well-established lifestyle risk factor, but diet may also have an impact on the risk of RA. Intake of the major marine n-3 polyunsaturated fatty acids in particular eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have been hypothesised to lower the risk of RA due to their anti-inflammatory effects, although based on limited knowledge. Therefore, we aim to investigate the associations between dietary intake of EPA and DHA and the risk of incident RA. METHODS AND ANALYSIS: A cohort study. The follow-up design will be based on data from the Danish Diet, Cancer and Health cohort, which was established between 1993 and 1997. The participants will be followed through record linkage using nationwide registers including the Danish Civil Registration System, the Danish National Patient Registry and the Danish National Prescription Registry using the unique Civil Personal Registration number. Time-to-event analyses will be conducted with RA as the outcome of interest. The participants will be followed from inclusion until date of RA diagnosis, death, emigration or end of follow-up. HRs with 95% CIs obtained using Cox proportional hazard regression models, with age as underlying time scale and adjustment for established and potential risk factors, will be used as measures of association. ETHICS AND DISSEMINATION: The study has been approved by the Data Protection Committee of Northern Jutland, Denmark (2019-87) and the North Denmark Region Committee on Health Research Ethics (N-20190031). Study results will be disseminated through peer-reviewed journals and presentations at international conferences

Polyautoimmunity in patients with cutaneous lupus erythematosus:A nationwide sex- and age-matched cohort study from Denmark

BACKGROUND: Polyautoimmunity is defined as having 2 or more autoimmune diseases. Little is known about polyautoimmunity in patients with cutaneous lupus erythematosus (CLE).OBJECTIVES: To estimate prevalence and 5-year incidence of non-lupus erythematosus (LE) autoimmune diseases in patients with CLE.METHODS: Patients with CLE were identified In the Danish National Patient Registry and each patient was age- and sex-matched with 10 general population controls. Outcome information on non-LE autoimmune diseases was obtained by register-linkage between Danish National Patient Registry and the National Prescription Register. The risk ratio (RR) for prevalent non-LE autoimmune disease at time of CLE diagnosis was calculated in modified Poisson regression; and hazard ratios (HRs) for incident non-LE autoimmune disease were estimated in Cox regression analyses.RESULTS: Overall, 1674 patients with CLE had a higher prevalence of a non-LE autoimmune disease than the comparators (18.5 vs 7.9%; RR 2.4; 95% CI, 2.1 to 2.6). Correspondingly, the cumulative incidence of a non-LE autoimmune disease during 5 years of follow-up was increased for the patients with CLE: HR 3.5 (95% CI, 3.0 to 4.0).LIMITATIONS: Risk of detection and misclassification bias, mainly pertaining to the CLE group.CONCLUSION: Patients with CLE had higher prevalence and 5-year cumulative incidence of a non-LE autoimmune disease than the general population.</p

Use of plastic adhesive drapes during surgery for preventing surgical site infection (Review)

Background: Surgical site infection has been estimated to occur in about 15% of clean surgery and 30% of contaminated surgery cases. Using plastic adhesive drapes to protect the wound from organisms that may be present on the surrounding skin during surgery is one strategy used to prevent surgical site infection. Results from non-randomised studies have produced conflicting results about the efficacy of this approach, but no systematic review has been conducted to date to guide clinical practice. Objectives: To assess the effect of adhesive drapes used during surgery on surgical site infection, cost, mortality and morbidity. Search methods: For this third update we searched the Cochrane Wounds Group Specialised Register (searched 19 July 2012); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 7); Ovid MEDLINE (1946 to July Week 2, 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, July 18, 2012); Ovid EMBASE (1974 to Week 28, 2012); and EBSCO CINAHL (1982 to July 6, 2012). Selection criteria: Randomised controlled trials comparing any plastic adhesive drape with no plastic adhesive drape, used alone or in combination with woven (material) drapes or disposable (paper) drapes, in patients undergoing any type of surgery. Data collection and analysis: Two review authors independently selected and assessed studies for trial quality and both independently extracted data. We contacted study authors for additional information. Main results: We identified no new studies for this third update. The review includes five studies involving 3082 participants comparing plastic adhesive drapes with no drapes and two studies involving 1113 participants comparing iodine-impregnated adhesive drapes with no drapes. A significantly higher proportion of patients in the adhesive drape group developed a surgical site infection when compared with no drapes (risk ratio (RR) 1.23, 95% confidence interval (CI) 1.02 to 1.48, P = 0.03). Iodine-impregnated adhesive drapes had no effect on the surgical site infection rate (RR 1.03, 95% CI 0.06 to 1.66, P = 0.89). Length of hospital stay was similar in the adhesive drape and non-adhesive drape groups. Authors' conclusions: There was no evidence from the seven trials that plastic adhesive drapes reduce surgical site infection rates, and some evidence that they increase infection rates. Further trials may be justified, using blinded outcome assessment to examine the effect of adhesive drapes on surgical site infection, based on different wound classifications