Correlation of mixed lymphocyte culture with chronic graft-versus-host disease following allogeneic stem cell transplantation

The purpose of the present study was to evaluate the mixed lymphocyte culture as a predictive assay of acute and chronic graft-versus-host disease (GVHD). We studied 153 patients who received a first bone marrow transplantation from human leukocyte antigen-identical siblings. Acute GVHD was observed in 26 of 128 (20.3%) patients evaluated and chronic GVHD occurred in 60 of 114 (52.6%). One-way mixed lymphocyte culture (MLC) assays were performed by the standard method. MLC results are reported as the relative response (RR) from donor against patient cells. The responses ranged from -47.0 to 40.7%, with a median of 0.5%. The Kaplan-Meier probability of developing GVHD was determined for patients with positive and negative MLC. There was no significant difference in incidence of acute GVHD between the groups studied. However, the incidence of chronic GVHD was higher in recipients with RR >4.5% than in those with RR 4.5%), 2.9 for those who received peripheral blood progenitor cells as a graft, and 2.2 for patients who developed previous acute GVHD. MLC was not useful for predicting acute GVHD, but MLC with RR >4.5% associated with other risk factors could predict the development of chronic GVHD, being of help for the prevention and/or treatment of this late complication.56757

Opioid prescriptions are associated with hepatic encephalopathy in a national cohort of patients with compensated cirrhosis

Background: Opioids are often prescribed for pain in cirrhosis and may increase the risk of hepatic encephalopathy (HE). Aim: To assess the association between opioids and HE in patients with well-compensated cirrhosis. Methods: We used the IQVIA PharMetrics (Durham, NC) database to identify patients aged 18-64 years with cirrhosis. We excluded patients with any decompensation event from 1 year before cirrhosis diagnosis to 6 months after cirrhosis diagnosis. Over the 6 months after cirrhosis diagnosis, we determined the duration of continuous opioid use and classified use into short term (1-89 days) and chronic (90-180 days). We assessed whether patients developed HE over the subsequent year (ie 6-18 months after cirrhosis diagnosis). We used a landmark analysis and performed multivariable Cox proportional hazards regression to assess associations between opioid use and HE, adjusting for relevant confounders. Results: The cohort included 6451 patients with compensated cirrhosis, of whom 23.3% and 4.7% had short-term and chronic opioid prescriptions respectively. Over the subsequent year, HE occurred in 6.3% patients with chronic opioid prescriptions, 5.0% with short-term opioid prescriptions and 3.3% with no opioid prescriptions. In the multivariable model, an increased risk of HE was observed with short-term (adjusted hazard ratio, HR 1.44, 95% CI 1.07-1.94) and chronic opioid prescriptions (adjusted HR 1.83, 95% CI 1.07-3.12) compared to no opioid prescriptions. Conclusion: In this national cohort of privately insured patients with cirrhosis, opioid prescriptions were associated with the risk of incident HE. Opioid use should be minimised in those with cirrhosis and, when required, limited to short duration

Complications Associated With Anesthesia Services in Endoscopic Procedures Among Patients With Cirrhosis

Background and Aims: Anesthesia services for endoscopic procedures have proliferated with the promise of increased comfort and safety. Cirrhosis patients are higher risk for sedation, yet limited data are available describing anesthesia complications in this population. Approach and Results: This cross-sectional study utilized the National Anesthesia Clinical Outcomes Registry, a multicenter quality-improvement database from 2010 to 2015. Patients with cirrhosis undergoing an endoscopy were identified by International Classification of Diseases, Ninth Revision (ICD-9)/Current Procedures Terminology (CPT) codes. The outcome of interest was serious anesthesia-related complication defined as cardiovascular, respiratory, neurological, drug related, patient injury, death, or unexpected admission. A mixed-effects multivariate logistic regression model determined odds ratios (ORs) between variables and serious complications, adjusting for potential confounders. In total, 9,007 endoscopic procedures were performed among patients with cirrhosis; 92% were esophagogastroduodenoscopies. The majority (81%) were American Society of Anesthesiologists (ASA) class ≥3, and 72% had a history of hepatic encephalopathy, ascites, varices, hepatorenal syndrome, or spontaneous bacterial peritonitis identified by ICD-9/CPT codes. In total, 87 complications were reported, 33 of which were serious. Frequency of serious complications was 0.4% or 378.6 per 100,000 procedures (95% confidence interval [CI], 260.8, 531.3). The majority of serious complications were cardiovascular (21 of 33), including 15 cardiac arrests. Serious complications were significantly associated with ASA 4/5 (OR, 3.84; 95% CI, 1.09, 13.57) and general anesthesia (OR, 4.71; 95% CI, 1.20, 18.50), adjusting for age, sex, ASA class, anesthesia type, inpatient status, portal hypertension history, and variable complication reporting practices. Conclusions: Anesthesia complications among endoscopic procedures in cirrhosis are rare overall. Serious complications were predominantly cardiac and associated with sicker patients undergoing general anesthesia. The complexity of end-stage liver disease may warrant more intensive care during endoscopic procedures, including anesthesia monitoring

Letter: are opioid prescriptions associated with hepatic encephalopathy in patients with compensated cirrhosis? Authors' reply

EDITORS, We appreciate the letter from Li et al about our recently pub-lished article on the association between opioids and hepatic en-cephalopathy (HE). The letter raises interesting points deserving additional clarification

Polypharmacy Among The Elderly In The City Of São Paulo, Brazil - Sabe Study [polifarmácia Entre Idosos Do Município De São Paulo - Estudo Sabe]

Polypharmacy for the elderly and associated factors were assessed. A cross-sectional study was conducted using data from the SABE Study (Health, Well-being and Aging), 2006. 1,115 individuals representing 422,377 elderly aged 65 or more, living in São Paulo City, were interviewed. Polypharmacy was defined as the use of five or more medications. A multivariate regression logistics was used. Polypharmacy prevalence was 36%. Female (OR = 1.7; IC 95%: 1.0; 2.9), age over 75 years (OR = 1.9; CI 95%: 1.3; 2.7), higher income (OR = 1.8; CI 95%: 1.2; 2.8), working (OR = 1.8; CI 95%: 1.1; 2.9), regular self assessed health (OR = 1.6; CI 95%: 1.1; 2.3) or poor (OR = 2.6; CI 95%: 1.4; 4.9), hypertension (OR = 2.0; CI 95%: 1.4; 2.9), diabetes (OR = 4.1; CI 95%: 2.2; 7.5), rheumatic diseases (OR = 2.3; CI 95%: 1.5; 3.6) and cardiac problems (OR = 2.9; CI 95%: 1.9; 4.5) were associated positively with polypharmacy. Using only the public health system (OR = 0.5, 95% CI: 0.3; 0.7) was inversely associated with polypharmacy. Medicines for the cardiovascular system and for the alimentary tract and metabolism were the most used. The knowledge of factors associated with polypharmacy, such as those identified in this study, may be useful to alert health professionals about the importance of identifying and monitoring the elderly groups most vulnerable to polypharmacy.154817827Ramos, L.R., Fatores determinantes do envelhecimento saudável em idosos residentes em centro urbano: Projeto Epidoso, São Paulo (2003) Cad Saúde Pública, 19, pp. 793-798(2002) Active Ageing. A Policy Framework, , http://whqlibdoc.who.int/hq/2002/WHO_NMH_NPH_02.8.pdf, World Health Organization, Geneva: WHO;,. Disponível em, [Acessado em 20 de fevereiro de 2006]Coelho Filho, J.M., Marcopito, L.F., Castelo, A., Medication use patterns among elderly people in urban area in Northeastern Brazil (2004) Rev Saude Publica, 38, pp. 557-564Qato, D.M., Alexander, G.C., Conti, R.M., Johnson, M., Schumm, P., Lindau, S.T., Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States (2008) JAMA, 300, pp. 2867-2878Ribeiro, A.Q., Rozenfeld, S., Klein, C.H., César, C.C., Acurcio Fde, A., Survey on medicine use by elderly retirees in Belo Horizonte, Southeastern Brazil (2008) Rev Saúde Pública, 42, pp. 724-732Flores, L.M., Mengue, S.S., Uso de medicamentos por idosos em região do sul do Brasil (2005) Rev Saúde Pública, 39, pp. 924-929Kaufman, D.W., Kelly, J.P., Rosenberg, L., Anderson, T.E., Michell, A.A., Recent patterns of medication use in the ambulatory adult population of the United States (2002) JAMA, 287, pp. 337-344Safran, D.G., Neuman, P., Schoen, C., Kitchman, M.S., Wilson, I.B., Cooper, B., Prescription drug coverage and seniors: Findings from a 2003 national survey (2005) Health Aff, , (Millwood),Suppl Web Exclusives: W5-152-W5-166Prybys, K.M., Melville, K., Hanna, J., Gee, A., Chyka, P., Polypharmacy in the elderly: Clinical challenges in emergency practice: Part 1 overview, etiology, and drug interactions (2002) Emerg Med Rep, 23, pp. 145-153Rozenfeld, S., Fonseca, M.J.M., Acurcio, F.A., Drug utilization and polypharmacy among the elderly: A survey in Rio de Janeiro City, Brazil (2008) Pan Am J Public Health, 23, pp. 34-43Lebrão, M.L., Duarte, Y.A.O., (2003) SABE-Saúde, Bem Estar e envelhecimento-O projeto SABE no município de São Paulo:Uma abordagem inicial [livro na internet], , http://www.opas.org.br/sistema/arquivos/l_saber.pdf, Brasília: Athalaia Bureau;,. Disponível em, [Acessado em 20 de fevereiro de 2006](2006) Anatomical therapeutic chemical (ATC) classification index with defined daily doses (DDDs), , http://www.whocc.no/atcddd/index, World Health Organization, [homepage na Internet]. Genevac2007. Disponível em, [atualizado em 16 de dezembro de, e acessado em 16 de março de 2007]Rao, J.N.K., Scott, A.J., On chi-squared tests for multiway contingency tables with cell proportions estimated from survey data (1984) Annals of Statistics, 12, pp. 46-60(2009) Stata Statistical Software: Release 11, , StataCorp, College Station. Texas: StataCorp LPRollason, V., Vogt, N., Reduction of polypharmacy in the elderly. A systematic review of the role of the pharmacist (2003) Drugs Aging, 20, pp. 817-832Rochon, P.A., Gurwitz, J.H., Optimising drug treatment for elderly people: The prescribing cascade (1997) BMJ, 315, pp. 1096-1099Gurwitz, J.H., Polypharmacy: A new paradigm for quality drug therapy in the elderly? (2004) Arch Int Med, 164, pp. 1957-1959Loyola Filho, A.I., Uchoa, E., Lima-Costa, M.F., A population-based study on use of medication by the elderly in Greater Metropolitan Belo Horizonte, Minas Gerais, Brazil (2006) Cad Saude Publica, 22, pp. 2657-2667Linjakumpu, T., Hartikainen, S., Klaukka, T., Veijola, J., Kivelä, S.L., Isoaho, R., Use of medications and polypharmacy are increasing among the elderly (2002) J Clin Epidemiol, 55, pp. 809-817Jörgensen, T., Johansson, S., Kennerfalk, A., Wallander, M.A., Svärdsudd, K., Prescription drug use, diagnoses, and healthcare utilization among the elderly (2001) Ann Pharmacother, 35, pp. 1004-1009Loyola Filho, A.I., Uchoa, E., Firmo, J.O., Lima-Costa, M.F., A population-based study on use of medications by elderly Brazilians: The Bambuí Health and Aging Study (BHAS) (2005) Cad Saúde Pública, 21, pp. 545-553Loyola Filho, A.I., Uchoa, E., Firmo, J.O., Lima-Costa, M.F., Influence of income on the association between cognitive impairment and polypharmacy: Bambuí Project (2008) Rev Saúde Pública, 42, pp. 89-99Rosholm, J.U., Christensen, K., Relationship between drug use and self-reported health in elderly Danes (1997) Eur J Clin Pharmacol, 53, pp. 179-183Parente, F., Cucino, C., Gallus, S., Bargiggia, S., Greco, S., Pastore, L., Bianchi Porro, G., Hospital use of acid-suppressive medications and its fall-out on prescribing in general practice: A 1-month survey (2003) Aliment Pharmacol Ther, 17, pp. 1503-1506Alves, L.C., Rodrigues, R.N., Determinantes da autopercepção de saúde entre idosos do Município de São Paulo, Brasil (2005) Rev Panam Salud Publica, 17 (5-6), pp. 333-341Woodward, M.C., Deprescribing: Achieving better health outcomes for older people through reducing medications (2003) J Pharm Pract Res, 33, pp. 323-328Stein, C., Moritz, I., (1999) A life course perspective of maintaining independence in older age, , http://whqlibdoc.who.int/hq/1999/WHO_HSC_AHE_99.2_life.pdf, Geneva: WHO.,. Disponível em, [Acessado em 20 de fevereiro de 2006](2006) Dispõe sobre o salário mínimo a partir de 1o de abril de, , http://www010.dataprev.gov.br/sislex/paginas/42/2006/11321.htm, BRASIL, Lei no 11.321, de 7 de julho de 2006, Disponível em, [Acessado em 23 de outubro de 2011

Search for boosted diphoton resonances in the 10 to 70 GeV mass range using 138 fb−1 of 13 TeV pp collisions with the ATLAS detector

A search for diphoton resonances in the mass range between 10 and 70 GeV with the ATLAS experiment at the Large Hadron Collider (LHC) is presented. The analysis is based on pp collision data corresponding to an integrated luminosity of 138 fb−1 at a centre-of-mass energy of 13 TeV recorded from 2015 to 2018. Previous searches for diphoton resonances at the LHC have explored masses down to 65 GeV, finding no evidence of new particles. This search exploits the particular kinematics of events with pairs of closely spaced photons reconstructed in the detector, allowing examination of invariant masses down to 10 GeV. The presented strategy covers a region previously unexplored at hadron colliders because of the experimental challenges of recording low-energy photons and estimating the backgrounds. No significant excess is observed and the reported limits provide the strongest bound on promptly decaying axion-like particles coupling to gluons and photons for masses between 10 and 70 GeV

Evidence for the charge asymmetry in pp → tt¯ production at s√ = 13 TeV with the ATLAS detector

Inclusive and differential measurements of the top–antitop (tt¯) charge asymmetry Att¯C and the leptonic asymmetry Aℓℓ¯C are presented in proton–proton collisions at s√ = 13 TeV recorded by the ATLAS experiment at the CERN Large Hadron Collider. The measurement uses the complete Run 2 dataset, corresponding to an integrated luminosity of 139 fb−1, combines data in the single-lepton and dilepton channels, and employs reconstruction techniques adapted to both the resolved and boosted topologies. A Bayesian unfolding procedure is performed to correct for detector resolution and acceptance effects. The combined inclusive tt¯ charge asymmetry is measured to be Att¯C = 0.0068 ± 0.0015, which differs from zero by 4.7 standard deviations. Differential measurements are performed as a function of the invariant mass, transverse momentum and longitudinal boost of the tt¯ system. Both the inclusive and differential measurements are found to be compatible with the Standard Model predictions, at next-to-next-to-leading order in quantum chromodynamics perturbation theory with next-to-leading-order electroweak corrections. The measurements are interpreted in the framework of the Standard Model effective field theory, placing competitive bounds on several Wilson coefficients

Search for the Zγ decay mode of new high-mass resonances in pp collisions at √s = 13 TeV with the ATLAS detector

This letter presents a search for narrow, high-mass resonances in the Zγ final state with the Z boson decaying into a pair of electrons or muons. The √s = 13 TeV pp collision data were recorded by the ATLAS detector at the CERN Large Hadron Collider and have an integrated luminosity of 140 fb−1. The data are found to be in agreement with the Standard Model background expectation. Upper limits are set on the resonance production cross section times the decay branching ratio into Zγ. For spin-0 resonances produced via gluon–gluon fusion, the observed limits at 95% confidence level vary between 65.5 fb and 0.6 fb, while for spin-2 resonances produced via gluon–gluon fusion (or quark–antiquark initial states) limits vary between 77.4 (76.1) fb and 0.6 (0.5) fb, for the mass range from 220 GeV to 3400 GeV

Search for heavy resonances decaying into a Z or W boson and a Higgs boson in final states with leptons and b-jets in 139 fb−1 of pp collisions at s√ = 13 TeV with the ATLAS detector

This article presents a search for new resonances decaying into a Z or W boson and a 125 GeV Higgs boson h, and it targets the νν¯¯¯bb¯¯, ℓ+ℓ−bb¯¯, or ℓ±νbb¯¯ final states, where ℓ = e or μ, in proton-proton collisions at s√ = 13 TeV. The data used correspond to a total integrated luminosity of 139 fb−1 collected by the ATLAS detector during Run 2 of the LHC at CERN. The search is conducted by examining the reconstructed invariant or transverse mass distributions of Zh or Wh candidates for evidence of a localised excess in the mass range from 220 GeV to 5 TeV. No significant excess is observed and 95% confidence-level upper limits between 1.3 pb and 0.3 fb are placed on the production cross section times branching fraction of neutral and charged spin-1 resonances and CP-odd scalar bosons. These limits are converted into constraints on the parameter space of the Heavy Vector Triplet model and the two-Higgs-doublet model