Ефективність рофлуміласту у хворих на хронічне обструктивне захворювання легень із ожирінням

Хронічне обструктивне захворювання легень (ХОЗЛ) – проблема, актуальність якої в усьому світі стрімко зростає. ХОЗЛ є четвертою провідною причиною смерті в світі, являє собою важливу проблему охорони здоров'я [19]. Розуміння проблеми ХОЗЛ значно змінилося за останнє десятиліття. Зараз це не просто обмеження швидкості повітряного потоку, а складний і гетерогенний стан зі значними позалегеневими проявами, які включають в себе хвороби серцево-судинної системи, дисфункцію скелетних м'язів, і діабет [27]. Особливої актуальності набуває проблема асоціації ХОЗЛ та ожиріння, яке є складовою метаболічного синдрому (МС) і стало проблемою нашого часу. Зв'язок між МС та ХОЗЛ спостерігається в декількох довготривалих і одномоментних дослідженнях, а також синдром був визначений як незалежний фактор ризику для погіршення респіраторних симптомів, збільшення порушення функції легень, легеневої гіпертензії та бронхіальної астми [3]. 50% пацієнтів з ХОЗЛ мають один або декілька компонентів МС [2]. Одним із актуальних аспектів проблеми поєднання ХОЗЛ та МС є розроблення обґрунтованої патогенетичної терапії. Залишається відкритим питання про лікування ХОЗЛ на тлі МС (глюкокортикостероїдні гормони сприяють підвищенню артеріального тиску та рівня глюкози в крові) [16, 44]. Є дані про сприятливу дію на рівень глюкози інгібітору фосфодіестерази-4 [ФДЕ-4] — рофлуміласту [9]. Встановлено, що даний препарат зменшує вираженість порушення толерантності до глюкози [34]. На тлі лікування рофлуміластом, відзначається зниження маси тіла у пацієнтів з ожирінням, поліпшення глікемічного профілю у хворих на цукровий діабет 2-го типу [70]. За даними подвійного сліпого, рандомізованого дослідження [17] лікування рофлуміластом призводило до значного зниження ваги (-2.0 кг з рофлуміластом, проти 0,1 кг з плацебо), індексу маси тіла (ІМТ) (-0,73 кг/м² з рофлуміластом, проти 0,03 кг/м² з плацебо). Застосування рофлуміласту покращує показники oб’єму фoрсoванoгo видиху за першу секунду (ОФВ1) та позитивно впливає на інші показники функції легень у порівнянні з плацебо [7]. Позитивна дія рофлуміласту на функцію легень пов'язана зі значним зменшенням ваги пацієнтів, в першу чергу за рахунок втрати жирової маси [6]. Мета нашої роботи дослідити ефективність рофлуміласту у хворих на хронічне обструктивне захворювання легень із ожирінням

Global landscape review of serotype-specific invasive pneumococcal disease surveillance among countries using PCV10/13: The pneumococcal serotype replacement and distribution estimation (PSERENADE) project

Serotype-specific surveillance for invasive pneumococcal disease (IPD) is essential for assessing the impact of 10- and 13-valent pneumococcal conjugate vaccines (PCV10/13). The Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) project aimed to evaluate the global evidence to estimate the impact of PCV10/13 by age, product, schedule, and syndrome. Here we systematically characterize and summarize the global landscape of routine serotype-specific IPD surveillance in PCV10/13-using countries and describe the subset that are included in PSERENADE. Of 138 countries using PCV10/13 as of 2018, we identified 109 with IPD surveillance systems, 76 of which met PSERENADE data collection eligibility criteria. PSERENADE received data from most (n = 63, 82.9%), yielding 240,639 post-PCV10/13 introduction IPD cases. Pediatric and adult surveillance was represented from all geographic regions but was limited from lower income and high-burden countries. In PSERENADE, 18 sites evaluated PCV10, 42 PCV13, and 17 both; 17 sites used a 3 + 0 schedule, 38 used 2 + 1, 13 used 3 + 1, and 9 used mixed schedules. With such a sizeable and generally representative dataset, PSERENADE will be able to conduct robust analyses to estimate PCV impact and inform policy at national and global levels regarding adult immunization, schedule, and product choice, including for higher valency PCVs on the horizon

Serotype distribution of remaining pneumococcal meningitis in the mature PCV10/13 period: Findings from the PSERENADE Project

Pneumococcal conjugate vaccine (PCV) introduction has reduced pneumococcal meningitis incidence. The Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) project described the serotype distribution of remaining pneumococcal meningitis in countries using PCV10/13 for least 5-7 years with primary series uptake above 70%. The distribution was estimated using a multinomial Dirichlet regression model, stratified by PCV product and age. In PCV10-using sites (N = 8; cases = 1141), PCV10 types caused 5% of cases <5 years of age and 15% among ≥5 years; the top serotypes were 19A, 6C, and 3, together causing 42% of cases <5 years and 37% ≥5 years. In PCV13-using sites (N = 32; cases = 4503), PCV13 types caused 14% in <5 and 26% in ≥5 years; 4% and 13%, respectively, were serotype 3. Among the top serotypes are five (15BC, 8, 12F, 10A, and 22F) included in higher-valency PCVs under evaluation. Other top serotypes (24F, 23B, and 23A) are not in any known investigational product. In countries with mature vaccination programs, the proportion of pneumococcal meningitis caused by vaccine-in-use serotypes is lower (≤26% across all ages) than pre-PCV (≥70% in children). Higher-valency PCVs under evaluation target over half of remaining pneumococcal meningitis cases, but questions remain regarding generalizability to the African meningitis belt where additional data are needed

Effects of environmental Bisphenol A exposures on germ cell development and Leydig cell function in the human fetal testis

<div><p>Background</p><p>Using an organotypic culture system termed human Fetal Testis Assay (hFeTA) we previously showed that 0.01 μM BPA decreases basal, but not LH-stimulated, testosterone secreted by the first trimester human fetal testis. The present study was conducted to determine the potential for a long-term antiandrogenic effect of BPA using a xenograft model, and also to study the effect of BPA on germ cell development using both the hFETA and xenograft models.</p><p>Methods</p><p>Using the hFeTA system, first trimester testes were cultured for 3 days with 0.01 to 10 μM BPA. For xenografts, adult castrate male nude mice were injected with hCG and grafted with first trimester testes. Host mice received 10 μM BPA (~ 500 μg/kg/day) in their drinking water for 5 weeks. Plasma levels of total and unconjugated BPA were 0.10 μM and 0.038 μM respectively. Mice grafted with second trimester testes received 0.5 and 50 μg/kg/day BPA by oral gavage for 5 weeks.</p><p>Results</p><p>With first trimester human testes, using the hFeTA model, 10 μM BPA increased germ cell apoptosis. In xenografts, germ cell density was also reduced by BPA exposure. Importantly, BPA exposure significantly decreased the percentage of germ cells expressing the pluripotency marker AP-2γ, whilst the percentage of those expressing the pre-spermatogonial marker MAGE-A4 significantly increased. BPA exposure did not affect hCG-stimulated androgen production in first and second trimester xenografts as evaluated by both plasma testosterone level and seminal vesicle weight in host mice.</p><p>Conclusions</p><p>Exposure to BPA at environmentally relevant concentrations impairs germ cell development in first trimester human fetal testis, whilst gonadotrophin-stimulated testosterone production was unaffected in both first and second trimester testis. Studies using first trimester human fetal testis demonstrate the complementarity of the FeTA and xenograft models for determining the respective short-term and long term effects of environmental exposures.</p></div

A prospective survey in European Society of Cardiology member countries of atrial fibrillation management: baseline results of EURO bservational Research Programme Atrial Fibrillation (EORP-AF) Pilot General Registry

Aims: Given the advances in atrial fibrillation (AF) management and the availability of new European Society of Cardiology (ESC) guidelines, there is a need for the systematic collection of contemporary data regarding the management and treatment of AF in ESC member countries. Methods and results: We conducted a registry of consecutive in- and outpatients with AF presenting to cardiologists in nine participating ESC countries. All patients with an ECG-documented diagnosis of AF confirmed in the year prior to enrolment were eligible. We enroled a total of 3119 patients from February 2012 to March 2013, with full data on clinical subtype available for 3049 patients (40.4% female; mean age 68.8 years). Common comorbidities were hypertension, coronary disease, and heart failure. Lone AF was present in only 3.9% (122 patients). Asymptomatic AF was common, particularly among those with permanent AF. Amiodarone was the most common antiarrhythmic agent used (~20%), while beta-blockers and digoxin were the most used rate control drugs. Oral anticoagulants (OACs) were used in 80% overall, most often vitamin K antagonists (71.6%), with novel OACs being used in 8.4%. Other antithrombotics (mostly antiplatelet therapy, especially aspirin) were still used in one-third of the patients, and no antithrombotic treatment in only 4.8%. Oral anticoagulants were used in 56.4% of CHA 2DS2-VASc = 0, with 26.3% having no antithrombotic therapy. A high HAS-BLED score was not used to exclude OAC use, but there was a trend towards more aspirin use in the presence of a high HAS-BLED score. Conclusion: The EURObservational Research Programme Atrial Fibrillation (EORP-AF) Pilot Registry has provided systematic collection of contemporary data regarding the management and treatment of AF by cardiologists in ESC member countries. Oral anticoagulant use has increased, but novel OAC use was still low. Compliance with the treatment guidelines for patients with the lowest and higher stroke risk scores remains suboptimal. © The Author 2013

ANALOGUE SAMPLES IN AN EUROPEAN SAMPLE CURATION FACILITY - THE EURO-CARES PROJECT.

The objective of the H2020-funded EURO-CARES project (grant agreement n° 640190) was to create a roadmap for the implementation of a European Extraterrestrial Sample Curation Facility (ESCF) that would be suitable for the curation of samples from all possible return missions likely over the next few decades, i.e. from the Moon, asteroids and Mars. The return of extraterrestrial samples brought to Earth will require specific storage conditions and handling procedures, in particular for those coming from Mars. For practical reasons and sterility concerns it might be necessary for such a facility to have its own collection of analogue samples permitting the testing of storage conditions, and to develop protocols for sample prepartion and analyses. Within the framework of the EURO-CARES project, we havecreated a list of the different types of samples that would be relevant for such a curation facility. The facility will be used for receiving and opening of the returned sample canisters, as well as for handling and preparation of the returned samples. Furthermore, it will provide some analysis of the returned samples, i.e. early sample characterisation, and is expected to provide longterm storage of the returned samples. Each of these basic functions requires special equipment. Equipment, handling protocols and long-term storage conditions will strongly depend on the characteristics of the materials, and on whether returned samples are from the Moon, Mars or an asteroidal body. Therefore the different types and aspects of analogue samples one need to be considered, i.e. the nature of the materials, which analogues are needed for what purpose, what mass is needed, and how should the analogue samples be stored within the facility. We distinguished five different types of anologue samples: analogue (s.s.), witness plate, voucher specimen, reference sample, and standard. Analogues are materials that have one or more physical or chemical properties similar to Earth-returned extraterrestrial samples. Reference samples are well-characterised materials with known physical and chemical properties used for testing. They may not necessarily be the same materials as the analogues defined above. Standards are internationally recognised, homogeneous materials with known physical and chemical properties that are used for calibration. They can also be used as reference samples in certain circumstances. They may be made of natural materials but are often produced artificially. A voucher specimen is a duplicate of materials used at any stage during sample acquisition, storage, transport, treatment etc., e.g. spacecraft materials (including solar panels), lubricants, glues, gloves, saws, drills, and others. In addition, Earth landing site samples (from the touch down site) would be necessary in case of doubtful analysis, even if normally this type of contamination is not expected. Finally, a witness plate is defined as material left in an area where work is being done to detect any biological, particulate, chemical, and/or organic contamination. It is a spatial and temporal document of what happens in the work area. Analogue materials could be solids (including ices), liquids or gases. These could contain biological (extant and/or exinct) and/or organic components. They could be natural materials, e.g. rocks or minerals, or could be manufactured, such as mixtures of different components, which may be biologically and/or organically doped. Analogues with appropriate sample size and nature will be well-suited for testing and training of sample handling procedures, and for transport protocols. The training of science and curation teams also requires reference samples and standards. Long-term storage needs special witness plates and voucher specimes. Developing and testing sample preparation protocols needs all sample types

Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry

Background: Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. Methods: We utilised the ESC-EHRA EORP-AF Long-Term General Registry. Outcomes were analysed according to renal function by CKD-EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all-cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission. Results: A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p&nbsp;&lt;.001. Over 24&nbsp;months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01–1.14] per 10&nbsp;ml/min/1.73&nbsp;m2 decrease), that was most notable in patients with eGFR &lt;30&nbsp;ml/min/1.73&nbsp;m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90&nbsp;ml/min/1.73&nbsp;m2). Conclusion: A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all-cause death in patients with AF

Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

Background: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods: From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results: Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions: An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients

Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P &lt;.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes