Treatment of Refractory Uveitis with Adalimumab: A Prospective Multicenter Study of 131 Patients

Objective: To evaluate adalimumab therapy in refractory uveitis. Design: Prospective case series. Participants: A total of 131 patients with refractory uveitis and intolerance or failure to respond to prednisone and at least 1 other systemic immunosuppressive drug participated. Intervention: Patients received a 40 mg adalimumab subcutaneous injection every other week for 6 months. The associated immunosuppressants were tapered after administering 3 adalimumab injections (week 6). Main outcome measures: Degree of anterior and posterior chamber inflammation (Standardization of Uveitis Nomenclature Working Group criteria), immunosuppression load (as defined by Nussenblatt et al), visual acuity (logarithm of the minimal angle of resolution [logMAR]), and macular thickness (optical coherence tomography). Results: There were 61 men and 70 women (mean age, 27.3 years). The most common causes were juvenile idiopathic arthritis in 39 patients, pars planitis in 16 patients, and Behçet's disease in 13 patients. Twenty-seven patients had uveitis of idiopathic origin. Inflammation in the anterior chamber was present in 82% of patients and in the vitreous cavity in 59% of patients. Anterior chamber inflammation and vitreous inflammation decreased significantly (P < 0.001) from a mean of 1.51 and 1.03 at baseline to 0.25 and 0.14, respectively, at 6 months. Macular thickness was 296 (102) μ at baseline versus 240 (36) μ at the 6-month visit (P < 0.001). Visual acuity improved by -0.3 logMAR in 32 of 150 eyes (21.3%) and worsened by +0.3 logMAR (-15 letters) in 5 eyes (3.3%). The dose of corticosteroids also decreased from 0.74 (3.50) to 0.20 (0.57) mg/kg/day (P < 0.001). Cystoid macular edema, which was present in 40 eyes at baseline, showed complete resolution in 28 eyes at 6 months. The mean suppression load decreased significantly (8.81 [5.05] vs 5.40 [4.43]; P < 0.001). Six months after the initiation of the study, 111 patients (85%) were able to reduce at least 50% of their baseline immunosuppression load. Only 9 patients (6.9%) had severe relapses during the 6 months of follow-up. Conclusions: Adalimumab seems to be well tolerated and helpful in decreasing inflammatory activity in refractory uveitis and may reduce steroid requirement. Further controlled studies of adalimumab for uveitis are warranted.Medicin

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DecanatoFac. de VeterinariaFALSEsubmitte

Surgical outcomes of gallbladder cancer: the OMEGA retrospective, multicentre, international cohort study

Background Gallbladder cancer (GBC) is rare but aggressive. The extent of surgical intervention for different GBC stages is non-uniform, ranging from cholecystectomy alone to extended resections including major hepatectomy, resection of adjacent organs and routine extrahepatic bile duct resection (EBDR). Robust evidence here is lacking, however, and survival benefit poorly defined. This study assesses factors associated with recurrence-free survival (RFS), overall survival (OS) and morbidity and mortality following GBC surgery in high income countries (HIC) and low and middle income countries (LMIC).Methods The multicentre, retrospective Operative Management of Gallbladder Cancer (OMEGA) cohort study included all patients who underwent GBC resection across 133 centres between 1st January 2010 and 31st December 2020. Regression analyses assessed factors associated with OS, RFS and morbidity.Findings On multivariable analysis of all 3676 patients, wedge resection and segment IVb/V resection failed to improve RFS (HR 1.04 [0.84-1.29], p = 0.711 and HR 1.18 [0.95-1.46], p = 0.13 respectively) or OS (HR 0.96 [0.79-1.17], p = 0.67 and HR 1.48 [1.16-1.88], p = 0.49 respectively), while major hepatectomy was associated with worse RFS (HR 1.33 [1.02-1.74], p = 0.037) and OS (HR 1.26 [1.03-1.53], p = 0.022). Furthermore, EBDR (OR 2.86 [2.3-3.52], p &lt; 0.0010), resection of additional organs (OR 2.22 [1.62-3.02], p &lt; 0.0010) and major hepatectomy (OR 3.81 [2.55-5.73], p &lt; 0.0010) were all associated with increased morbidity and mortality. Compared to LMIC, patients in HIC were associated with poorer RFS (HR 1.18 [1.02-1.37], p = 0.031) but not OS (HR 1.05 [0.91-1.22], p = 0.48). Adjuvant and neoadjuvant treatments were infrequently used.Interpretation In this large, multicentre analysis of GBC surgical outcomes, liver resection was not conclusively associated with improved survival, and extended resections were associated with greater morbidity and mortality without oncological benefit. Aggressive upfront resections do not benefit higher stage GBC, and international col-laborations are needed to develop evidence-based neoadjuvant and adjuvant treatment strategies to minimise surgical morbidity and prioritise prognostic benefit.Funding Cambridge Hepatopancreatobiliary Department Research Fund.Copyright &amp; COPY; 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care

Search for new physics with emerging jets in proton-proton collisions at s\sqrt{s} = 13 TeV

International audienceA search for ``emerging jets'' produced in proton-proton collisions at a center-of-mass energy of 13 TeV is performed using data collected by the CMS experiment corresponding to an integrated luminosity of 138 fb$^{-1}$. This search examines a hypothetical dark quantum chromodynamics (QCD) sector that couples to the standard model (SM) through a scalar mediator. The scalar mediator decays into an SM quark and a dark sector quark. As the dark sector quark showers and hadronizes, it produces long-lived dark mesons that subsequently decay into SM particles, resulting in a jet, known as an emerging jet, with multiple displaced vertices. This search looks for pair production of the scalar mediator at the LHC, which yields events with two SM jets and two emerging jets at leading order. The results are interpreted using two dark sector models with different flavor structures, and exclude mediator masses up to 1950 (1850) GeV for an unflavored (flavor-aligned) dark QCD model. The unflavored results surpass a previous search for emerging jets by setting the most stringent mediator mass exclusion limits to date, while the flavor-aligned results provide the first direct mediator mass exclusion limits to date

Search for new physics with emerging jets in proton-proton collisions at s\sqrt{s} = 13 TeV

International audienceA search for ``emerging jets'' produced in proton-proton collisions at a center-of-mass energy of 13 TeV is performed using data collected by the CMS experiment corresponding to an integrated luminosity of 138 fb$^{-1}$. This search examines a hypothetical dark quantum chromodynamics (QCD) sector that couples to the standard model (SM) through a scalar mediator. The scalar mediator decays into an SM quark and a dark sector quark. As the dark sector quark showers and hadronizes, it produces long-lived dark mesons that subsequently decay into SM particles, resulting in a jet, known as an emerging jet, with multiple displaced vertices. This search looks for pair production of the scalar mediator at the LHC, which yields events with two SM jets and two emerging jets at leading order. The results are interpreted using two dark sector models with different flavor structures, and exclude mediator masses up to 1950 (1850) GeV for an unflavored (flavor-aligned) dark QCD model. The unflavored results surpass a previous search for emerging jets by setting the most stringent mediator mass exclusion limits to date, while the flavor-aligned results provide the first direct mediator mass exclusion limits to date

Search for new physics with emerging jets in proton-proton collisions at s\sqrt{s} = 13 TeV

International audienceA search for ``emerging jets'' produced in proton-proton collisions at a center-of-mass energy of 13 TeV is performed using data collected by the CMS experiment corresponding to an integrated luminosity of 138 fb$^{-1}$. This search examines a hypothetical dark quantum chromodynamics (QCD) sector that couples to the standard model (SM) through a scalar mediator. The scalar mediator decays into an SM quark and a dark sector quark. As the dark sector quark showers and hadronizes, it produces long-lived dark mesons that subsequently decay into SM particles, resulting in a jet, known as an emerging jet, with multiple displaced vertices. This search looks for pair production of the scalar mediator at the LHC, which yields events with two SM jets and two emerging jets at leading order. The results are interpreted using two dark sector models with different flavor structures, and exclude mediator masses up to 1950 (1850) GeV for an unflavored (flavor-aligned) dark QCD model. The unflavored results surpass a previous search for emerging jets by setting the most stringent mediator mass exclusion limits to date, while the flavor-aligned results provide the first direct mediator mass exclusion limits to date

Search for new physics with emerging jets in proton-proton collisions at s= \sqrt{s} = 13 TeV

A search for ``emerging jets'' produced in proton-proton collisions at a center-of-mass energy of 13 TeV is performed using data collected by the CMS experiment corresponding to an integrated luminosity of 138 fb$^{-1}$. This search examines a hypothetical dark quantum chromodynamics (QCD) sector that couples to the standard model (SM) through a scalar mediator. The scalar mediator decays into an SM quark and a dark sector quark. As the dark sector quark showers and hadronizes, it produces long-lived dark mesons that subsequently decay into SM particles, resulting in a jet, known as an emerging jet, with multiple displaced vertices. This search looks for pair production of the scalar mediator at the LHC, which yields events with two SM jets and two emerging jets at leading order. The results are interpreted using two dark sector models with different flavor structures, and exclude mediator masses up to 1950 (1850) GeV for an unflavored (flavor-aligned) dark QCD model. The unflavored results surpass a previous search for emerging jets by setting the most stringent mediator mass exclusion limits to date, while the flavor-aligned results provide the first direct mediator mass exclusion limits to date.A search for ``emerging jets'' produced in proton-proton collisions at a center-of-mass energy of 13 TeV is performed using data collected by the CMS experiment corresponding to an integrated luminosity of 138 fb$^{-1}$. This search examines a hypothetical dark quantum chromodynamics (QCD) sector that couples to the standard model (SM) through a scalar mediator. The scalar mediator decays into an SM quark and a dark sector quark. As the dark sector quark showers and hadronizes, it produces long-lived dark mesons that subsequently decay into SM particles, resulting in a jet, known as an emerging jet, with multiple displaced vertices. This search looks for pair production of the scalar mediator at the LHC, which yields events with two SM jets and two emerging jets at leading order. The results are interpreted using two dark sector models with different flavor structures, and exclude mediator masses up to 1950 (1850) GeV for an unflavored (flavor-aligned) dark QCD model. The unflavored results surpass a previous search for emerging jets by setting the most stringent mediator mass exclusion limits to date, while the flavor-aligned results provide the first direct mediator mass exclusion limits to date