Severe Asthma Standard-of-Care Background Medication Reduction With Benralizumab: ANDHI in Practice Substudy

Background: The phase IIIb, randomized, parallel-group, placebo-controlled ANDHI double-blind (DB) study extended understanding of the efficacy of benralizumab for patients with severe eosinophilic asthma. Patients from ANDHI DB could join the 56-week ANDHI in Practice (IP) single-arm, open-label extension substudy. Objective: Assess potential for standard-of-care background medication reductions while maintaining asthma control with benralizumab. Methods: Following ANDHI DB completion, eligible adults were enrolled in ANDHI IP. After an 8-week run-in with benralizumab, there were 5 visits to potentially reduce background asthma medications for patients achieving and maintaining protocol-defined asthma control with benralizumab. Main outcome measures for non-oral corticosteroid (OCS)-dependent patients were the proportions with at least 1 background medication reduction (ie, lower inhaled corticosteroid dose, background medication discontinuation) and the number of adapted Global Initiative for Asthma (GINA) step reductions at end of treatment (EOT). Main outcomes for OCS-dependent patients were reductions in daily OCS dosage and proportion achieving OCS dosage of 5 mg or lower at EOT. Results: For non-OCS-dependent patients, 53.3% (n = 208 of 390) achieved at least 1 background medication reduction, increasing to 72.6% (n = 130 of 179) for patients who maintained protocol-defined asthma control at EOT. A total of 41.9% (n = 163 of 389) achieved at least 1 adapted GINA step reduction, increasing to 61.8% (n = 110 of 178) for patients with protocol-defined EOT asthma control. At ANDHI IP baseline, OCS dosages were 5 mg or lower for 40.4% (n = 40 of 99) of OCS-dependent patients. Of OCS-dependent patients, 50.5% (n = 50 of 99) eliminated OCS and 74.7% (n = 74 of 99) achieved dosages of 5 mg or lower at EOT. Conclusions: These findings demonstrate benralizumab's ability to improve asthma control, thereby allowing background medication reduction

withdrawn 2017 hrs ehra ecas aphrs solaece expert consensus statement on catheter and surgical ablation of atrial fibrillation

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Exploiting the potential of 2-((5-(4-(diphenylamino)phenyl)thiophen-2-yl)methylene)malononitrile as an efficient donor molecule in vacuum-processed bulk-heterojunction organic solar cells

International audienceA comprehensive experimental study is reported on the optical and electrical characteristics of 2-((5-(4-(diphenylamino)phenyl)thiophen-2-yl)methylene)malononitrile (DPTMM) when used as molecular donor in an organic solar cell (OSC) device structure. A major property of this new donor-type material is an unusually deep highest-occupied molecular orbital (HOMO) level that leads to a high open-circuit voltage (Voc). A reasonably high hole-mobility was also observed in a hole-injection diode configuration. These are both promising factors for high-performance OSCs. In order to fully explore the potential of DPTMM in bulk-heterojunction-based OSCs, a step-wise experimental strategy was applied to optimize film composition and cell architecture. By co-evaporating the DPTMM with C60 to promote exciton dissociation by maximizing the heterojunction area power conversion efficiency (PCE) of 3.0% was achieved. Finally, inserting a buffer layer and a spatial gradient of the donor/acceptor ratio was found to provide better conduction paths for charge carriers. The maximum obtained PCE was 4.0%, which compares favorably with the state-of-the-art of high-performance OSCs. All optimized devices show quite unusual high Voc values up to 1 V

Circulating tumour cells as a potential screening tool for lung cancer (the AIR study): protocol of a prospective multicentre cohort study in France

International audienceLung cancer (LC) is the leading cause of death from cancer. Early diagnosis of LC is of paramount importance in terms of prognosis. The health authorities of most countries do not accept screening programmes based on low-dose chest CT (LDCT), especially in Europe, because they are flawed by a high rate of false-positive results, leading to a large number of invasive diagnostic procedures. These authorities advocated further research, including companion biological tests that could enhance the effectiveness of LC screening. The present project aims to validate early diagnosis of LC by detection and characterisation of circulating tumour cells (CTCs) in a peripheral blood sample taken from a prospective cohort of persons at high-risk of LC

Two-year follow-up after endobronchial coil treatment in emphysema: results from the REVOLENS study

International audienceSevere emphysema is a difficult to treat condition with limited efficacy of currently available treatments. Endobronchial coil treatment (ECT) is a minimally invasive endobronchial treatment which consists of placing shape-memory nitinol coils in emphysematous lobes to enhance lung recoil and reduce lung hyperinflation at rest and during exercise [1, 2]. Randomised studies demonstrated an improvement in exercise capacity, lung function and quality of life, and showed an acceptable safety profile at 1 year [3–6]. However, to our best knowledge, longer term safety and effectiveness results beyond 1 year have not been reported thus far.REVOLENS (Réduction volumique endobronchique par spirales) (NCT01822795) is a 1:1 randomised controlled study of 100 patients (50 patients treated with coils and optimal medical management and 50 patients treated with optimal medical management only) in 10 centres across France. Patients treated with optimal medical management only were offered coil treatment after 1 year. The study protocol [7] and 1-year results [5] of the REVOLENS study have been previously described, demonstrating a decrease in lung hyperinflation and improvement in quality of life. In the present study, we analysed efficacy and safety data at 2 years in the 50 patients randomised to the ECT group

Arrhythmias in congenital heart disease: a position paper of the European Heart Rhythm Association (EHRA), Association for European Paediatric and Congenital Cardiology (AEPC), and the European Society of Cardiology (ESC) Working Group on Grown-up Congenital Heart Disease, endorsed by HRS, PACES, APHRS, and SOLAECE

The population of patients with congenital heart disease (CHD) is continuously increasing with more and more patients reaching adulthood. A significant portion of these young adults will suffer from arrhythmias due to the underlying congenital heart defect itself or as a sequela of interventional or surgical treatment. The medical community will encounter an increasing challenge as even most of the individuals with complex congenital heart defects nowadays become young adults. Within the past 20 years, management of patients with arrhythmias has gained remarkable progress including pharmacological treatment, catheter ablation, and device therapy. Catheter ablation in patients with CHD has paralleled the advances of this technology in pediatric and adult patients with structurally normal hearts. Growing experience and introduction of new techniques like the 3D mapping systems into clinical practice have been particularly beneficial for this growing population of patients with abnormal cardiac anatomy and physiology. Finally, device therapies allowing maintanence of chronotropic competence and AV conduction, improving haemodynamics by cardiac resynchronization, and preventing sudden death are increasingly used. For pharmacological therapy, ablation procedures, and device therapy decision making requires a deep understanding of the individual pathological anatomy and physiology as well as detailed knowledge on natural history and long-term prognosis of our patients. Composing expert opinions from cardiology and paediatric cardiology as well as from non-invasive and invasive electrophysiology this position paper was designed to state the art in management of young individuals with congenital heart defects and arrhythmias

Niakhar, mémoires et perspectives

Fondé en 1962 en zone rurale à 150 km de Dakar, en pays Sereer, l'observatoire de Niakhar est le plus ancien observatoire de population en Afrique encore en activité. Au cœur d'une histoire scientifique et humaine originale, il a permis d'assurer, depuis sa création, le suivi sanitaire, démographique, social, économique et environnemental de plus de deux générations. Les résultats de recherche de Niakhar, avec des indicateurs suivis dans le temps long, ont éclairé et accompagné les politiques nationales et internationales en matière de santé, notamment pour la prévention du paludisme. En revisitant 50 années de recherche sur le site de Niakhar, cet ouvrage décrit et analyse la construction de cette plate-forme d'observation prospective pluridisciplinaire. Il illustre l'intérêt de l'approche sur le long terme dans les différents domaines de recherche et ouvre une réflexion sur les enjeux éthiques particuliers à cet instrument de collecte. Enfin, il propose des pistes d'évolution méthodologique et de gouvernance pour la recherche. Cette première synthèse sur l'observatoire de Niakhar permettra à l'État sénégalais et aux décideurs ouest-africains, avec les institutions internationales et les scientifiques, de disposer de bases concrètes pour optimiser ces plates-formes de recherche et les mobiliser dans la perspective des objectifs de développement durable

Circulating tumour cells as a potential biomarker for lung cancer screening: a prospective cohort study

International audienceBackground Lung cancer screening with low-dose chest CT (LDCT) reduces the mortality of eligible individuals. Bloodsignatures might act as a standalone screening tool, refine the selection of patients at risk, or help to classifyundetermined nodules detected on LDCT. We previously showed that circulating tumour cells (CTCs) could bedetected, using the isolation by size of epithelial tumour cell technique (ISET), long before the cancer was diagnosedradiologically. We aimed to test whether CTCs could be used as a biomarker for lung cancer screening.Methods We did a prospective, multicentre, cohort study in 21 French university centres. Participants had to beeligible for lung cancer screening as per National Lung Screening Trial criteria and have chronic obstructivepulmonary disease with a fixed airflow limitation defined as post-bronchodilator FEV1/FVC ratio of less than 0∙7.Any cancer, other than basocellular skin carcinomas, detected within the previous 5 years was the main exclusioncriterion. Participants had three screening rounds at 1-year intervals (T0 [baseline], T1, and T2), which involved LDCT,clinical examination, and a blood test for CTCs detection. Participants and investigators were masked to the results ofCTC detection, and cytopathologists were masked to clinical and radiological findings. Our primary objective was totest the diagnostic performance of CTC detection using the ISET technique in lung cancer screening, compared withcancers diagnosed by final pathology, or follow up if pathology was unavailable as the gold standard. This studyis registered with ClinicalTrials.gov identifier, number NCT02500693.Findings Between Oct 30, 2015, and Feb 2, 2017, we enrolled 614 participants, predominantly men (437 [71%]), aged65∙1 years (SD 6∙5), and heavy smokers (52∙7 pack-years [SD 21∙5]). 81 (13%) participants dropped out betweenbaseline and T1, and 56 (11%) did between T1 and T2. Nodules were detected on 178 (29%) of 614 baseline LDCTs.19 participants (3%) were diagnosed with a prevalent lung cancer at T0 and 19 were diagnosed with incident lungcancer (15 (3%) of 533 at T1 and four (1%) of 477 at T2). Extrapulmonary cancers were diagnosed in 27 (4%) ofparticipants. Overall 28 (2%) of 1187 blood samples were not analysable. At baseline, the sensitivity of CTC detectionfor lung cancer detection was 26∙3% (95% CI 11∙8–48∙8). ISET was unable to predict lung cancer or extrapulmonarycancer development