Relationship between Adherence Level to Statins, Clinical Issues and Health-Care Costs in Real-Life Clinical Setting

AbstractObjectiveStatins have been shown to reduce the risk of major cardiovascular disease. We recognize that there is a major gap between the use of statins in actual practice and treatment guidelines for dyslipidemia. Low adherence to statins may have a significant impact on clinical issues and health-care costs. The objective is to evaluate the impact of low adherence to statins on clinical issues and direct health-care costs.MethodsA cohort of 55,134 patients newly treated with statins was reconstructed from the Régie de l'Assurance Maladie du Québec and Med-Echo databases. Subjects included were aged between 45 and 85, initially free of cardiovascular disease, newly treated with statins between 1999 and 2002, and followed-up for a minimum of 3 years. Adherence to statins was measured in terms of the proportion of days' supply of medication dispensed over a defined period, and categorized as ≥80% or <80%. The adjusted odds ratio (OR) of cardiovascular events between the two adherence groups was estimated using a polytomous logistic analysis. The mean costs of direct health-care services were evaluated. A two-part model was applied for hospitalization costs.ResultsThe mean high adherence level to statins was around to 96% during follow-up; and this value was at 42% for the low adherence level. The patients with low adherence to statins were more likely to have coronary artery disease (OR 1.07; 95% confidence interval [CI], 1.01–1.13), cerebrovascular disease (OR 1.13; 95% CI 1.03–1.25), and chronic heart failure within 3-year period of follow-up (OR 1.13; 95% CI 1.01–1.26). Low adherence to statins was also associated with an increased risk of hospitalization by 4% (OR 1.04; 95% CI 1.01–1.09). Among patients who were hospitalized, low adherence to statins was significantly associated with increase of hospitalization costs by approximately $1060/patient for a 3-year period.ConclusionLow adherence to statins was correlated with a higher risk of cardiovascular disease, hospitalization rate, and hospitalization costs. An increased level of adherence to statins agents should provide a better health status for individuals and a net economic gain

Enhancing genetic mapping of complex genomes through the design of highly-multiplexed SNP arrays: application to the large and unsequenced genomes of white spruce and black spruce

<p>Abstract</p> <p>Background</p> <p>To explore the potential value of high-throughput genotyping assays in the analysis of large and complex genomes, we designed two highly multiplexed Illumina bead arrays using the GoldenGate SNP assay for gene mapping in white spruce (<it>Picea glauca </it>[Moench] Voss) and black spruce (<it>Picea mariana </it>[Mill.] B.S.P.).</p> <p>Results</p> <p>Each array included 768 SNPs, identified by resequencing genomic DNA from parents of each mapping population. For white spruce and black spruce, respectively, 69.2% and 77.1% of genotyped SNPs had valid GoldenGate assay scores and segregated in the mapping populations. For each of these successful SNPs, on average, valid genotyping scores were obtained for over 99% of progeny. SNP data were integrated to pre-existing ALFP, ESTP, and SSR markers to construct two individual linkage maps and a composite map for white spruce and black spruce genomes. The white spruce composite map contained 821 markers including 348 gene loci. Also, 835 markers including 328 gene loci were positioned on the black spruce composite map. In total, 215 anchor markers (mostly gene markers) were shared between the two species. Considering lineage divergence at least 10 Myr ago between the two spruces, interspecific comparison of homoeologous linkage groups revealed remarkable synteny and marker colinearity.</p> <p>Conclusion</p> <p>The design of customized highly multiplexed Illumina SNP arrays appears as an efficient procedure to enhance the mapping of expressed genes and make linkage maps more informative and powerful in such species with poorly known genomes. This genotyping approach will open new avenues for co-localizing candidate genes and QTLs, partial genome sequencing, and comparative mapping across conifers.</p

Braces optimized with computer-assisted design and simulations are lighter, more comfortable, and more efficient than plaster-cast braces for the treatment of adolescent idiopathic scoliosis

Study Design Feasibility study to compare the effectiveness of 2 brace design and fabrication methods for treatment of adolescent idiopathic scoliosis: a standard plaster-cast method and a computational method combining computer-aided design and fabrication and finite element simulation. Objectives To improve brace design using a new brace design method. Summary of Background Data Initial in-brace correction and patient's compliance to treatment are important factors for brace efficiency. Negative cosmetic appearance and functional discomfort resulting from pressure points, humidity, and restriction of movement can cause poor compliance with the prescribed wearing schedule. Methods A total of 15 consecutive patients with brace prescription were recruited. Two braces were designed and fabricated for each patient: a standard thoracolumbo-sacral orthosis brace fabricated using plaster-cast method and an improved brace for comfort (NewBrace) fabricated using a computational method combining computer-aided design and fabrication software (Rodin4D) and a simulation platform. Three-dimensional reconstructions of the torso and the trunk skeleton were used to create a personalized finite element model, which was used for brace design and predict correction. Simulated pressures on the torso and distance between the brace and patient's skin were used to remove ineffective brace material situated at more than 6 mm from the patient's skin. Biplanar radiographs of the patient wearing each brace were taken to compare their effectiveness. Patients filled out a questionnaire to compare their comfort. Results NewBraces were 61% thinner and had 32% less material than standard braces with equivalent correction. NewBraces were more comfortable (11 of 15 patients) or equivalent to (4 of 15 cases) standard braces. Simulated correction was simulated within 5° compared with in-brace results. Conclusions This study demonstrates the feasibility of designing lighter and more comfortable braces with correction equivalent to standard braces. This design platform has the potential to further improve brace correction efficiency and its compliance

Involvement of Pinus taeda MYB1 and MYB8 in phenylpropanoid metabolism and secondary cell wall biogenesis: a comparative in planta analysis

The involvement of two R2R3-MYB genes from Pinus taeda L., PtMYB1 and PtMYB8, in phenylpropanoid metabolism and secondary cell wall biogenesis was investigated in planta. These pine MYBs were constitutively overexpressed (OE) in Picea glauca (Moench) Voss, used as a heterologous conifer expression system. Morphological, histological, chemical (lignin and soluble phenols), and transcriptional analyses, i.e. microarray and reverse transcription quantitative PCR (RT-qPCR) were used for extensive phenotyping of MYB-overexpressing spruce plantlets. Upon germination of somatic embryos, root growth was reduced in both transgenics. Enhanced lignin deposition was also a common feature but ectopic secondary cell wall deposition was more strongly associated with PtMYB8-OE. Microarray and RT-qPCR data showed that overexpression of each MYB led to an overlapping up-regulation of many genes encoding phenylpropanoid enzymes involved in lignin monomer synthesis, while misregulation of several cell wall-related genes and other MYB transcription factors was specifically associated with PtMYB8-OE. Together, the results suggest that MYB1 and MYB8 may be part of a conserved transcriptional network involved in secondary cell wall deposition in conifers

Régulation de l'expression des facteurs de transcriptions C/EBP et FOS/JUN lors du dévelopement de l'instestin murin

Le développement de l'intestin murin est caractérisé par l'établissement d'un gradient d'expression génétique le long de l'axe crypte-villosité et le long de l'axe céphalocaudal. Les médiateurs qui dirigent l'expression génétique des cellules épithéliales de façon spatiale et temporelle sont toujours inconnus. Nous avons étudié l'expression des facteurs de transcription C/EBP et fos/iun lors du développement de l'intestin grêle et du côlon murin afin d'évaluer leur potentiel comme régulateurs moléculaires de la différenciation intestinale. Les études par Northern et Western montrent la modulation de l'expression des ARNm et des protéines C/EBPs lors du développement intestinal, le long de l'axe céphalocaudal. L'immunolocalisation des protéines par immunofluorescence indirecte indique que dans l'intestin proximal des souris non-sevrées, C/EBPa est surtout cytoplasmique dans les cellules prolifératives des cryptes et surtout nucléaire dans l'épithélium différencié des villosités. Après le sevrage, C/EBPa est surtout cytoplasmique le long de l'axe crypte villosité. Dans le côlon, l'expression de C/EBPa est limitée à l'épithélium différencié. Les protéines C/EBPB et S sont exprimées dans les noyaux de la majorité des cellules intestinales. L'étude de la liaison des protéines à l'ADN révèle que cette activité diminue dans le côlon des souris adultes. Finalement, C/EBPS est induit rapidement et transitoirement par les glucocorticoïdes. Nos résultats montrent aussi que les ARNm de c-fos. fosB et iunB sont induits dans l'intestin proximal et dans le côlon au sevrage des souris. De plus, c-fos est induit rapidement et transitoirement par les glucocorticoïdes. Ces observations suggèrent un rôle pour les facteurs de ranscription C/EBPs et fos/iun dans la régulation de la prolifération et de la différenciation des cellules épithéliales intestinales. Le développement de l'intestin murin est caractérisé par l'établissement d'un gradient d'expression génétique le long de l'axe crypte-villosité et le long de l'axe céphalocaudal. Les médiateurs qui dirigent l'expression génétique des cellules épithéliales de façon spatiale et temporelle sont toujours inconnus. Nous avons étudié l'expression des facteurs de transcription C/EBP et fos/iun lors du développement de l'intestin grêle et du côlon murin afin d'évaluer leur potentiel comme régulateurs moléculaires de la différenciation intestinale. Les études par Northern et Western montrent la modulation de l'expression des ARNm et des protéines C/EBPs lors du développement intestinal, le long de l'axe céphalocaudal. L'immunolocalisation des protéines par immunofluorescence indirecte indique que dans l'intestin proximal des souris non-sevrées, C/EBPa est surtout cytoplasmique dans les cellules prolifératives des cryptes et surtout nucléaire dans l'épithélium différencié des villosités. Après le sevrage, C/EBPa est surtout cytoplasmique le long de l'axe crypte villosité. Dans le côlon, l'expression de C/EBPa est limitée à l'épithélium différencié. Les protéines C/EBPB et S sont exprimées dans les noyaux de la majorité des cellules intestinales. L'étude de la liaison des protéines à l'ADN révèle que cette activité diminue dans le côlon des souris adultes. Finalement, C/EBPS est induit rapidement et transitoirement par les glucocorticoïdes. Nos résultats montrent aussi que les ARNm de c-fos. fosB et iunB sont induits dans l'intestin proximal et dans le côlon au sevrage des souris. De plus, c-fos est induit rapidement et transitoirement par les glucocorticoïdes.. Ces observations suggèrent un rôle pour les facteurs de ranscription C/EBPs et fos/iun dans la régulation de la prolifération et de la différenciation des cellules épithéliales intestinales