SAN DIEGO—Vitamin D levels may be associated with brain imaging measures in patients with progressive multiple sclerosis (MS), according to an analysis presented at the ACTRIMS 2018 Forum. The association appears to be similar in primary progressive MS and secondary progressive MS and may reflect vitamin D’s protective effect on myelin in gray matter.

Research has identified vitamin D deficiency as a risk factor for MS. Low levels of the vitamin are associated with increased risk of brain lesions, relapses, and early progression of disability. Much of the literature focuses on relapsing-remitting MS. Less is known about the part that vitamin D plays in progressive MS, particularly with respect to clinical and imaging findings.

An Analysis of Phase II Data

Justin Abbatemarco, MD, a neurologist at Cleveland Clinic, and colleagues studied results from the phase II clinical trial of ibudilast to examine the association between vitamin D levels and clinical and MRI features in progressive MS. In the trial, investigators measured participants’ serum 25 OH vitamin D levels. At baseline, they collected demographic information such as age, gender, race, disease duration, duration of progression, prior treatment history, Expanded Disability Status Scale score, MS Functional Composite, and neurocognitive testing. Baseline MRI information included brain parenchymal fraction, diffusion tensor imaging (DTI), and magnetization transfer ratio (MTR).

Dr. Abbatemarco and colleagues used Spearman correlation to evaluate the associations between total vitamin D and vitamin D3 levels and clinical or imaging characteristics. They created a linear regression model to predict clinical and imaging outcome variables.

Vitamin D Was Associated With Whole Brain MTR

The analysis included 267 patients (47.2% male) with a mean age of 55.6. In all, 137 participants had primary progressive MS, and 130 participants had secondary progressive MS. Mean disease duration was 16.4 years. The population’s mean vitamin D3 level was 40.7 ng/mL, and mean total vitamin D level was 43.8 ng/mL. Mean brain parenchymal fraction was 0.8, mean T2 lesion volume was 10.3 mL, and mean whole brain MTR was 0.1.

The investigators did not observe a significant difference in mean vitamin D levels between patients with secondary progressive MS (44.7 ng/mL) and those with primary progressive MS (42.9 ng/mL). They did find positive associations between vitamin D3 and whole brain MTR, normal appearing brain tissue MTR, and normal appearing gray matter MTR. Dr. Abbatemarco’s group found no significant associations between vitamin D levels and brain parenchymal fraction, T1 or T2 lesion volume, or DTI metrics. The associations between vitamin D3 and MRI features were similar in patients with primary progressive MS and those with secondary progressive MS.

In a multivariate analysis that controlled for age, gender, disease duration, the time that vitamin D level was obtained, and latitude of study site, associations between vitamin D3 level and whole brain MTR remained significant. Every 10-ng/mL increase in vitamin D3 was associated with a 2.1% unit increase in whole brain MTR. The investigators found no association between vitamin D3 and brain parenchymal fraction, T2 lesion volume, T1 lesion volume, and clinical scores.

Dr. Abbatemarco and colleagues plan to test the effect of longitudinal changes on clinical and MRI measures once data become available.

—Erik Greb

Suggested Reading

Smolders J, Menheere P, Kessels A, et al. Association of vitamin D metabolite levels with relapse rate and disability in multiple sclerosis. Mult Scler. 2008;14(9):1220-1224.

SAN DIEGO—Vitamin D levels may be associated with brain imaging measures in patients with progressive multiple sclerosis (MS), according to an analysis presented at the ACTRIMS 2018 Forum. The association appears to be similar in primary progressive MS and secondary progressive MS and may reflect vitamin D’s protective effect on myelin in gray matter.

Research has identified vitamin D deficiency as a risk factor for MS. Low levels of the vitamin are associated with increased risk of brain lesions, relapses, and early progression of disability. Much of the literature focuses on relapsing-remitting MS. Less is known about the part that vitamin D plays in progressive MS, particularly with respect to clinical and imaging findings.

An Analysis of Phase II Data

Justin Abbatemarco, MD, a neurologist at Cleveland Clinic, and colleagues studied results from the phase II clinical trial of ibudilast to examine the association between vitamin D levels and clinical and MRI features in progressive MS. In the trial, investigators measured participants’ serum 25 OH vitamin D levels. At baseline, they collected demographic information such as age, gender, race, disease duration, duration of progression, prior treatment history, Expanded Disability Status Scale score, MS Functional Composite, and neurocognitive testing. Baseline MRI information included brain parenchymal fraction, diffusion tensor imaging (DTI), and magnetization transfer ratio (MTR).

Dr. Abbatemarco and colleagues used Spearman correlation to evaluate the associations between total vitamin D and vitamin D3 levels and clinical or imaging characteristics. They created a linear regression model to predict clinical and imaging outcome variables.

Vitamin D Was Associated With Whole Brain MTR

The analysis included 267 patients (47.2% male) with a mean age of 55.6. In all, 137 participants had primary progressive MS, and 130 participants had secondary progressive MS. Mean disease duration was 16.4 years. The population’s mean vitamin D3 level was 40.7 ng/mL, and mean total vitamin D level was 43.8 ng/mL. Mean brain parenchymal fraction was 0.8, mean T2 lesion volume was 10.3 mL, and mean whole brain MTR was 0.1.

The investigators did not observe a significant difference in mean vitamin D levels between patients with secondary progressive MS (44.7 ng/mL) and those with primary progressive MS (42.9 ng/mL). They did find positive associations between vitamin D3 and whole brain MTR, normal appearing brain tissue MTR, and normal appearing gray matter MTR. Dr. Abbatemarco’s group found no significant associations between vitamin D levels and brain parenchymal fraction, T1 or T2 lesion volume, or DTI metrics. The associations between vitamin D3 and MRI features were similar in patients with primary progressive MS and those with secondary progressive MS.

In a multivariate analysis that controlled for age, gender, disease duration, the time that vitamin D level was obtained, and latitude of study site, associations between vitamin D3 level and whole brain MTR remained significant. Every 10-ng/mL increase in vitamin D3 was associated with a 2.1% unit increase in whole brain MTR. The investigators found no association between vitamin D3 and brain parenchymal fraction, T2 lesion volume, T1 lesion volume, and clinical scores.

Dr. Abbatemarco and colleagues plan to test the effect of longitudinal changes on clinical and MRI measures once data become available.

—Erik Greb

Suggested Reading

Smolders J, Menheere P, Kessels A, et al. Association of vitamin D metabolite levels with relapse rate and disability in multiple sclerosis. Mult Scler. 2008;14(9):1220-1224.

SAN DIEGO—Vitamin D levels may be associated with brain imaging measures in patients with progressive multiple sclerosis (MS), according to an analysis presented at the ACTRIMS 2018 Forum. The association appears to be similar in primary progressive MS and secondary progressive MS and may reflect vitamin D’s protective effect on myelin in gray matter.

Research has identified vitamin D deficiency as a risk factor for MS. Low levels of the vitamin are associated with increased risk of brain lesions, relapses, and early progression of disability. Much of the literature focuses on relapsing-remitting MS. Less is known about the part that vitamin D plays in progressive MS, particularly with respect to clinical and imaging findings.

An Analysis of Phase II Data

Justin Abbatemarco, MD, a neurologist at Cleveland Clinic, and colleagues studied results from the phase II clinical trial of ibudilast to examine the association between vitamin D levels and clinical and MRI features in progressive MS. In the trial, investigators measured participants’ serum 25 OH vitamin D levels. At baseline, they collected demographic information such as age, gender, race, disease duration, duration of progression, prior treatment history, Expanded Disability Status Scale score, MS Functional Composite, and neurocognitive testing. Baseline MRI information included brain parenchymal fraction, diffusion tensor imaging (DTI), and magnetization transfer ratio (MTR).

Dr. Abbatemarco and colleagues used Spearman correlation to evaluate the associations between total vitamin D and vitamin D3 levels and clinical or imaging characteristics. They created a linear regression model to predict clinical and imaging outcome variables.

Vitamin D Was Associated With Whole Brain MTR

The analysis included 267 patients (47.2% male) with a mean age of 55.6. In all, 137 participants had primary progressive MS, and 130 participants had secondary progressive MS. Mean disease duration was 16.4 years. The population’s mean vitamin D3 level was 40.7 ng/mL, and mean total vitamin D level was 43.8 ng/mL. Mean brain parenchymal fraction was 0.8, mean T2 lesion volume was 10.3 mL, and mean whole brain MTR was 0.1.

The investigators did not observe a significant difference in mean vitamin D levels between patients with secondary progressive MS (44.7 ng/mL) and those with primary progressive MS (42.9 ng/mL). They did find positive associations between vitamin D3 and whole brain MTR, normal appearing brain tissue MTR, and normal appearing gray matter MTR. Dr. Abbatemarco’s group found no significant associations between vitamin D levels and brain parenchymal fraction, T1 or T2 lesion volume, or DTI metrics. The associations between vitamin D3 and MRI features were similar in patients with primary progressive MS and those with secondary progressive MS.

In a multivariate analysis that controlled for age, gender, disease duration, the time that vitamin D level was obtained, and latitude of study site, associations between vitamin D3 level and whole brain MTR remained significant. Every 10-ng/mL increase in vitamin D3 was associated with a 2.1% unit increase in whole brain MTR. The investigators found no association between vitamin D3 and brain parenchymal fraction, T2 lesion volume, T1 lesion volume, and clinical scores.

Dr. Abbatemarco and colleagues plan to test the effect of longitudinal changes on clinical and MRI measures once data become available.

—Erik Greb

Suggested Reading

Smolders J, Menheere P, Kessels A, et al. Association of vitamin D metabolite levels with relapse rate and disability in multiple sclerosis. Mult Scler. 2008;14(9):1220-1224.

Think of it as a biological nuclear export ban: A combination of the nuclear export protein inhibitor selinexor and dexamethasone was associated with relatively good objective response rates and clinical benefit rates among some patients with relapsed or refractory multiple myeloma (MM).

In the dose-expansion portion of a phase 1 dose-finding trial, the objective response rate (ORR) among 12 patients treated with selinexor 45 mg/m² and 20 mg dexamethasone twice weekly was 50%, and the clinical benefit rate – a composite of complete responses, very good partial responses, partial responses and minimal responses – was 58%, reported Christine Chen, MD, of Princess Margaret Cancer Centre in Toronto, and her colleagues.

“Selinexor is an oral agent with a completely novel mechanism of action and anti-MM activity in combination with dexamethasone that could provide a new option for patients suffering from this incurable disease,” wrote Dr. Chen and her colleagues. The report was published in Blood.

Selinexor is a selective oral inhibitor of the cellular nuclear export protein exportin 1 (XPO1). Inhibition of this protein causes tumor suppressor proteins to accumulate in the nuclei of malignant cells, leading to programmed cell death (apoptosis) of malignant cells, but with minimal effects on normal cells.

In the safety analysis, which included all patients who received at least one dose of selinexor, the most common grade 3 or 4 adverse events included thrombocytopenia in 45% of patients, hyponatremia in 26% of patients, and anemia and neutropenia in 23% each.

The most common nonhematologic adverse events – primarily grade 1 or 2 – included nausea, fatigue, anorexia, vomiting, and weight loss and diarrhea.

The combination of selinexor and dexamethasone is currently being investigated in the phase 2 Selinexor Treatment of Refractory Myeloma study, in combination with standard multiple myeloma therapies in the STOMP trial (Selinexor and Backbone Treatments of Multiple Myeloma Patients), and with bortezomib in the BOSTON trial (Bortezomib, Selinexor and Dexamethasone in Patients with Multiple Myeloma).

Dr. Chen reported no conflicts of interest. Her coauthors reported financial ties to Karyopharm Therapeutics, which funded the study.

[email protected]

SOURCE: Chen C et al. Blood. 2018;131(8):855-63.

Think of it as a biological nuclear export ban: A combination of the nuclear export protein inhibitor selinexor and dexamethasone was associated with relatively good objective response rates and clinical benefit rates among some patients with relapsed or refractory multiple myeloma (MM).

In the dose-expansion portion of a phase 1 dose-finding trial, the objective response rate (ORR) among 12 patients treated with selinexor 45 mg/m² and 20 mg dexamethasone twice weekly was 50%, and the clinical benefit rate – a composite of complete responses, very good partial responses, partial responses and minimal responses – was 58%, reported Christine Chen, MD, of Princess Margaret Cancer Centre in Toronto, and her colleagues.

“Selinexor is an oral agent with a completely novel mechanism of action and anti-MM activity in combination with dexamethasone that could provide a new option for patients suffering from this incurable disease,” wrote Dr. Chen and her colleagues. The report was published in Blood.

Selinexor is a selective oral inhibitor of the cellular nuclear export protein exportin 1 (XPO1). Inhibition of this protein causes tumor suppressor proteins to accumulate in the nuclei of malignant cells, leading to programmed cell death (apoptosis) of malignant cells, but with minimal effects on normal cells.

In the safety analysis, which included all patients who received at least one dose of selinexor, the most common grade 3 or 4 adverse events included thrombocytopenia in 45% of patients, hyponatremia in 26% of patients, and anemia and neutropenia in 23% each.

The most common nonhematologic adverse events – primarily grade 1 or 2 – included nausea, fatigue, anorexia, vomiting, and weight loss and diarrhea.

The combination of selinexor and dexamethasone is currently being investigated in the phase 2 Selinexor Treatment of Refractory Myeloma study, in combination with standard multiple myeloma therapies in the STOMP trial (Selinexor and Backbone Treatments of Multiple Myeloma Patients), and with bortezomib in the BOSTON trial (Bortezomib, Selinexor and Dexamethasone in Patients with Multiple Myeloma).

Dr. Chen reported no conflicts of interest. Her coauthors reported financial ties to Karyopharm Therapeutics, which funded the study.

[email protected]

SOURCE: Chen C et al. Blood. 2018;131(8):855-63.

Think of it as a biological nuclear export ban: A combination of the nuclear export protein inhibitor selinexor and dexamethasone was associated with relatively good objective response rates and clinical benefit rates among some patients with relapsed or refractory multiple myeloma (MM).

In the dose-expansion portion of a phase 1 dose-finding trial, the objective response rate (ORR) among 12 patients treated with selinexor 45 mg/m² and 20 mg dexamethasone twice weekly was 50%, and the clinical benefit rate – a composite of complete responses, very good partial responses, partial responses and minimal responses – was 58%, reported Christine Chen, MD, of Princess Margaret Cancer Centre in Toronto, and her colleagues.

“Selinexor is an oral agent with a completely novel mechanism of action and anti-MM activity in combination with dexamethasone that could provide a new option for patients suffering from this incurable disease,” wrote Dr. Chen and her colleagues. The report was published in Blood.

Selinexor is a selective oral inhibitor of the cellular nuclear export protein exportin 1 (XPO1). Inhibition of this protein causes tumor suppressor proteins to accumulate in the nuclei of malignant cells, leading to programmed cell death (apoptosis) of malignant cells, but with minimal effects on normal cells.

In the safety analysis, which included all patients who received at least one dose of selinexor, the most common grade 3 or 4 adverse events included thrombocytopenia in 45% of patients, hyponatremia in 26% of patients, and anemia and neutropenia in 23% each.

The most common nonhematologic adverse events – primarily grade 1 or 2 – included nausea, fatigue, anorexia, vomiting, and weight loss and diarrhea.

The combination of selinexor and dexamethasone is currently being investigated in the phase 2 Selinexor Treatment of Refractory Myeloma study, in combination with standard multiple myeloma therapies in the STOMP trial (Selinexor and Backbone Treatments of Multiple Myeloma Patients), and with bortezomib in the BOSTON trial (Bortezomib, Selinexor and Dexamethasone in Patients with Multiple Myeloma).

Dr. Chen reported no conflicts of interest. Her coauthors reported financial ties to Karyopharm Therapeutics, which funded the study.

[email protected]

SOURCE: Chen C et al. Blood. 2018;131(8):855-63.

The coming months will provide us a welcome relief from health care politics as we turn our attention to the science of medicine. Digestive Disease Week® (DDW) will occur from June 2 to 5 in Washington, DC. Major themes already are emerging and implications for our clinical practices are exciting. In this month’s issue of GI & Hepatology News, we summarize a presentation about the IBD medication pipeline given by Dr. Bill Sandborn (UCSD) at the Crohn’s & Colitis Congress^TM (a partnership between the Crohn’s & Colitis Foundation and AGA, in Las Vegas). The number of medications that will enter clinical practice is impressive and so is the variety of antigen targets. Over the last several decades, we have defined multiple inflammatory pathways that can lead to IBD and developed medications that modify abnormal immune responses. We are entering an era of precision medicine never before seen in our specialty. Most of these biological medications can be given orally or subcutaneously, precluding the need for infusion centers. I anticipate an enormous offering of IBD-related science at DDW^®.

John I. Allen, MD, MBA, AGAF

Editor in Chief

The coming months will provide us a welcome relief from health care politics as we turn our attention to the science of medicine. Digestive Disease Week® (DDW) will occur from June 2 to 5 in Washington, DC. Major themes already are emerging and implications for our clinical practices are exciting. In this month’s issue of GI & Hepatology News, we summarize a presentation about the IBD medication pipeline given by Dr. Bill Sandborn (UCSD) at the Crohn’s & Colitis Congress^TM (a partnership between the Crohn’s & Colitis Foundation and AGA, in Las Vegas). The number of medications that will enter clinical practice is impressive and so is the variety of antigen targets. Over the last several decades, we have defined multiple inflammatory pathways that can lead to IBD and developed medications that modify abnormal immune responses. We are entering an era of precision medicine never before seen in our specialty. Most of these biological medications can be given orally or subcutaneously, precluding the need for infusion centers. I anticipate an enormous offering of IBD-related science at DDW^®.

John I. Allen, MD, MBA, AGAF

Editor in Chief

The coming months will provide us a welcome relief from health care politics as we turn our attention to the science of medicine. Digestive Disease Week® (DDW) will occur from June 2 to 5 in Washington, DC. Major themes already are emerging and implications for our clinical practices are exciting. In this month’s issue of GI & Hepatology News, we summarize a presentation about the IBD medication pipeline given by Dr. Bill Sandborn (UCSD) at the Crohn’s & Colitis Congress^TM (a partnership between the Crohn’s & Colitis Foundation and AGA, in Las Vegas). The number of medications that will enter clinical practice is impressive and so is the variety of antigen targets. Over the last several decades, we have defined multiple inflammatory pathways that can lead to IBD and developed medications that modify abnormal immune responses. We are entering an era of precision medicine never before seen in our specialty. Most of these biological medications can be given orally or subcutaneously, precluding the need for infusion centers. I anticipate an enormous offering of IBD-related science at DDW^®.

John I. Allen, MD, MBA, AGAF

Editor in Chief

A mathematical formula may help determine the variability in the frequency of patients’ seizures, according to researchers from the National Institutes of Health, Beth Israel Deaconess Medical Center, and other institutions.

• Because clinicians and researchers have yet to develop a reliable way to predict the range of each patient’s seizure counts, investigators analyzed 3 independent seizure diary databases to look for patterns.
• The databases included 3106 entries in Seizure Tracker, 93 from the Human Epilepsy Project, and 15 from NeuroVista.
• The analysis looked at the relationship between mean seizure frequency and the standard deviation of seizure frequency.
• The analysis revealed that the logarithm of the mean seizure count had a linear relationship with the log of the standard deviation (R² >0.83).
• Using this mathematical relationship, researchers were able to predict variability in seizure frequency with a 94% accuracy rate, compared to only 77% using traditional prediction methods.

Goldenholz DM, Goldenholz SR, Moss R, et al. Is seizure frequency variance a predictable quantity? Ann Clin Transl Neurol. 2018;5(2):201-207.

A mathematical formula may help determine the variability in the frequency of patients’ seizures, according to researchers from the National Institutes of Health, Beth Israel Deaconess Medical Center, and other institutions.

• Because clinicians and researchers have yet to develop a reliable way to predict the range of each patient’s seizure counts, investigators analyzed 3 independent seizure diary databases to look for patterns.
• The databases included 3106 entries in Seizure Tracker, 93 from the Human Epilepsy Project, and 15 from NeuroVista.
• The analysis looked at the relationship between mean seizure frequency and the standard deviation of seizure frequency.
• The analysis revealed that the logarithm of the mean seizure count had a linear relationship with the log of the standard deviation (R² >0.83).
• Using this mathematical relationship, researchers were able to predict variability in seizure frequency with a 94% accuracy rate, compared to only 77% using traditional prediction methods.

Goldenholz DM, Goldenholz SR, Moss R, et al. Is seizure frequency variance a predictable quantity? Ann Clin Transl Neurol. 2018;5(2):201-207.

A mathematical formula may help determine the variability in the frequency of patients’ seizures, according to researchers from the National Institutes of Health, Beth Israel Deaconess Medical Center, and other institutions.

• Because clinicians and researchers have yet to develop a reliable way to predict the range of each patient’s seizure counts, investigators analyzed 3 independent seizure diary databases to look for patterns.
• The databases included 3106 entries in Seizure Tracker, 93 from the Human Epilepsy Project, and 15 from NeuroVista.
• The analysis looked at the relationship between mean seizure frequency and the standard deviation of seizure frequency.
• The analysis revealed that the logarithm of the mean seizure count had a linear relationship with the log of the standard deviation (R² >0.83).
• Using this mathematical relationship, researchers were able to predict variability in seizure frequency with a 94% accuracy rate, compared to only 77% using traditional prediction methods.

Goldenholz DM, Goldenholz SR, Moss R, et al. Is seizure frequency variance a predictable quantity? Ann Clin Transl Neurol. 2018;5(2):201-207.

Amygdalohippocampectomy may offer hope for select patients with intractable temporal lobe epilepsy according to a review published in Brain Sciences by Warren Boling, MD, a neurosurgeon at Loma Linda University Health.

• Patients with mesial temporal lobe epilepsy that does not respond to medical therapy may experience freedom from their seizures by means of resection surgery.
• Two surgical approaches worth considering in this patient population are standard anterior temporal removal and selective amygdalohippocampectomy.
• The advantage of selective amygdalohippocampectomy is the potential to remove the seizure focal point, thus avoiding the removal of portions of the temporary lobe that are not actually part of the epileptogenic zone.
• Selective amygdalohippocampectomy (SAH), if performed using a minimally access approach, also has the advantage of allowing patients to recover more quickly.
• Evidence also suggests that SAH may provide cognitive benefits that standard temporal resections do not.

Boling WW. Surgical Considerations of Intractable Mesial Temporal Lobe Epilepsy. Brain Sciences. 2018;8:35.  doi:10.3390/brainsci8020035.

Amygdalohippocampectomy may offer hope for select patients with intractable temporal lobe epilepsy according to a review published in Brain Sciences by Warren Boling, MD, a neurosurgeon at Loma Linda University Health.

• Patients with mesial temporal lobe epilepsy that does not respond to medical therapy may experience freedom from their seizures by means of resection surgery.
• Two surgical approaches worth considering in this patient population are standard anterior temporal removal and selective amygdalohippocampectomy.
• The advantage of selective amygdalohippocampectomy is the potential to remove the seizure focal point, thus avoiding the removal of portions of the temporary lobe that are not actually part of the epileptogenic zone.
• Selective amygdalohippocampectomy (SAH), if performed using a minimally access approach, also has the advantage of allowing patients to recover more quickly.
• Evidence also suggests that SAH may provide cognitive benefits that standard temporal resections do not.

Boling WW. Surgical Considerations of Intractable Mesial Temporal Lobe Epilepsy. Brain Sciences. 2018;8:35.  doi:10.3390/brainsci8020035.

Amygdalohippocampectomy may offer hope for select patients with intractable temporal lobe epilepsy according to a review published in Brain Sciences by Warren Boling, MD, a neurosurgeon at Loma Linda University Health.

• Patients with mesial temporal lobe epilepsy that does not respond to medical therapy may experience freedom from their seizures by means of resection surgery.
• Two surgical approaches worth considering in this patient population are standard anterior temporal removal and selective amygdalohippocampectomy.
• The advantage of selective amygdalohippocampectomy is the potential to remove the seizure focal point, thus avoiding the removal of portions of the temporary lobe that are not actually part of the epileptogenic zone.
• Selective amygdalohippocampectomy (SAH), if performed using a minimally access approach, also has the advantage of allowing patients to recover more quickly.
• Evidence also suggests that SAH may provide cognitive benefits that standard temporal resections do not.

Boling WW. Surgical Considerations of Intractable Mesial Temporal Lobe Epilepsy. Brain Sciences. 2018;8:35.  doi:10.3390/brainsci8020035.

SAN ANTONIO – Intermittent administration of sedation and analgesia significantly reduced mechanical ventilation time among surgical patients requiring ventilation, according to a preliminary analysis of a randomized trial.

Additionally, the researchers found that much lower amounts of sedation and analgesia were given to patients who underwent intermittent dosing, compared with patients who received a continuous infusion.

monkeybusinessimages/Thinkstock

SOURCE: Sich N et al. CCC47, Abstract 18.

SAN ANTONIO – Intermittent administration of sedation and analgesia significantly reduced mechanical ventilation time among surgical patients requiring ventilation, according to a preliminary analysis of a randomized trial.

Additionally, the researchers found that much lower amounts of sedation and analgesia were given to patients who underwent intermittent dosing, compared with patients who received a continuous infusion.

monkeybusinessimages/Thinkstock

SOURCE: Sich N et al. CCC47, Abstract 18.

SAN ANTONIO – Intermittent administration of sedation and analgesia significantly reduced mechanical ventilation time among surgical patients requiring ventilation, according to a preliminary analysis of a randomized trial.

Additionally, the researchers found that much lower amounts of sedation and analgesia were given to patients who underwent intermittent dosing, compared with patients who received a continuous infusion.

monkeybusinessimages/Thinkstock

SOURCE: Sich N et al. CCC47, Abstract 18.

Young children with autism spectrum disorder seem to experience less severe symptomology if they have a history of seizures according to a recent study published in Developmental Neurorehabilitation.

• To reach that conclusion, investigators reviewed patient records with the help of a licensed clinical psychologist.
• The study looked at the severity of autism symptoms and developmental functioning in young children, comparing children with and without a history of seizures and comparing those with autism to those who had atypical development.
• Among children with autism spectrum disorders whose parents reported a history of seizures, symptoms of autism were less severe, when compared to children without seizures.
• On the other hand, among children with atypical development, the direction of the correlation was the opposite, with those children with atypical development experiencing more severe symptoms if they had a history of seizures.

Burns CO, Matson JL. An investigation of the association between seizures, autism symptomology, and developmental functioning in young children. [Published online ahead of print February 20, 2018] Dev Neurorehabil. doi: 10.1080/17518423.2018.1437842.

Young children with autism spectrum disorder seem to experience less severe symptomology if they have a history of seizures according to a recent study published in Developmental Neurorehabilitation.

• To reach that conclusion, investigators reviewed patient records with the help of a licensed clinical psychologist.
• The study looked at the severity of autism symptoms and developmental functioning in young children, comparing children with and without a history of seizures and comparing those with autism to those who had atypical development.
• Among children with autism spectrum disorders whose parents reported a history of seizures, symptoms of autism were less severe, when compared to children without seizures.
• On the other hand, among children with atypical development, the direction of the correlation was the opposite, with those children with atypical development experiencing more severe symptoms if they had a history of seizures.

Burns CO, Matson JL. An investigation of the association between seizures, autism symptomology, and developmental functioning in young children. [Published online ahead of print February 20, 2018] Dev Neurorehabil. doi: 10.1080/17518423.2018.1437842.

Young children with autism spectrum disorder seem to experience less severe symptomology if they have a history of seizures according to a recent study published in Developmental Neurorehabilitation.

• To reach that conclusion, investigators reviewed patient records with the help of a licensed clinical psychologist.
• The study looked at the severity of autism symptoms and developmental functioning in young children, comparing children with and without a history of seizures and comparing those with autism to those who had atypical development.
• Among children with autism spectrum disorders whose parents reported a history of seizures, symptoms of autism were less severe, when compared to children without seizures.
• On the other hand, among children with atypical development, the direction of the correlation was the opposite, with those children with atypical development experiencing more severe symptoms if they had a history of seizures.

Burns CO, Matson JL. An investigation of the association between seizures, autism symptomology, and developmental functioning in young children. [Published online ahead of print February 20, 2018] Dev Neurorehabil. doi: 10.1080/17518423.2018.1437842.

SAN DIEGO – Early results of the novel human endogenous retrovirus-W antagonist GNbAC1 in a phase 2 trial of patients with relapsing-remitting multiple sclerosis demonstrated evidence of remyelination at week 24 among high-dose users, but it did not meet its primary endpoint of active lesions seen on MRI.

In an interview at ACTRIMS Forum 2018, held by the Americas Committee for Treatment and Research in Multiple Sclerosis, study author Robert Glanzman, MD, said that GNbAC1 is a monoclonal antibody that targets and blocks the envelope protein pHER-W ENV, a potent agonist of Toll-like receptor 4. It thereby inhibits TLR4-mediated pathogenicity, which includes activation of macrophages and microglia into proinflammatory phenotypes and direct inhibition of remyelination via TLR4.

Doug Brunk/Frontline Medical News

[email protected]

SOURCE: Glanzman R et al. Abstract P034.

SAN DIEGO – Early results of the novel human endogenous retrovirus-W antagonist GNbAC1 in a phase 2 trial of patients with relapsing-remitting multiple sclerosis demonstrated evidence of remyelination at week 24 among high-dose users, but it did not meet its primary endpoint of active lesions seen on MRI.

In an interview at ACTRIMS Forum 2018, held by the Americas Committee for Treatment and Research in Multiple Sclerosis, study author Robert Glanzman, MD, said that GNbAC1 is a monoclonal antibody that targets and blocks the envelope protein pHER-W ENV, a potent agonist of Toll-like receptor 4. It thereby inhibits TLR4-mediated pathogenicity, which includes activation of macrophages and microglia into proinflammatory phenotypes and direct inhibition of remyelination via TLR4.

Doug Brunk/Frontline Medical News

[email protected]

SOURCE: Glanzman R et al. Abstract P034.

SAN DIEGO – Early results of the novel human endogenous retrovirus-W antagonist GNbAC1 in a phase 2 trial of patients with relapsing-remitting multiple sclerosis demonstrated evidence of remyelination at week 24 among high-dose users, but it did not meet its primary endpoint of active lesions seen on MRI.

In an interview at ACTRIMS Forum 2018, held by the Americas Committee for Treatment and Research in Multiple Sclerosis, study author Robert Glanzman, MD, said that GNbAC1 is a monoclonal antibody that targets and blocks the envelope protein pHER-W ENV, a potent agonist of Toll-like receptor 4. It thereby inhibits TLR4-mediated pathogenicity, which includes activation of macrophages and microglia into proinflammatory phenotypes and direct inhibition of remyelination via TLR4.

Doug Brunk/Frontline Medical News

[email protected]

SOURCE: Glanzman R et al. Abstract P034.

Racial and regional disparities in liver transplant allocation persist despite multiple allocation schemes as identified in a large dataset spanning at least 30 years, according to a study.

The Model for End-Stage Liver Disease (MELD) score was put forth in 1998 by the Organ Procurement and Transplantation Network under the guidance of the Centers for Medicare & Medicaid Services and the Department of Health & Human Services, to indicate that organs should be allocated to the sickest patients as interpreted by the MELD score. Since then, four separate liver allocation systems are being followed across the country owing to disagreements over a universal allocation scheme. These include MELD score, the initial three-tier UNOS (United Network for Organ Sharing) Status, Share 35, and now MELD Na.

VILevi/Thinkstock

Unfavorable supply and demand ratios for liver allograft allocation persist across the country with differential and limited access to care, which leads to decreased wellness, lower life expectancies, and higher baseline morbidity and mortality rates in some areas. Furthermore, a short cold storage capacity of liver allografts limits greater allocation and distribution schema.

Dominique J. Monlezun, MD, PhD, MPH, and his colleagues at the Tulane Transplant Institute at Tulane University, New Orleans, evaluated the effect of MELD and other allocation schemes on the incidence of racial and regional disparities in a study published in Surgery. They performed fixed-effects multivariate logistic regression augmented by modified forward and backward stepwise-regression of transplanted patients from the United Network for Organ Sharing Standard Transplant Analysis and Research database (1985-2016) to assess causal inference of such disparities.

“Significant disparities in the odds of receiving a liver were found: African Americans, odds ratio, 1.12 (95% confidence interval, 1.08-1.17); Asians, 1.12 (95% CI, 1.07-1.18); females, 0.80 (95% CI, 0.78-0.83); and malignancy 1.18 (95% CI, 1.13-1.22). Significant racial disparities by region were identified using Caucasian Region 7 (Ill., Minn., N.D., S.D., and Wisc.) as the reference: Hispanic Region 9 (N.Y., West Vt.) 1.22 (1.02-1.45), Hispanic Region 1 (New England) 1.26 (1.01-1.57), Hispanic Region 4 (Ok., Tex.) 1.23 (1.05-1.43), and Asian Region 4 (Ok., Tex.) 1.35 (1.05-1.73).” Since the transplantation rate in Region 7 closely approximated the sex and race-matched rate of the national post–Share 35 average, it was used as a reference in the study.

“Although traditional disparities as with African Americans and [whites] have been improved during the past 30 years, new disparities as with Hispanics and Asians have developed in certain regions,” stated the authors.

They acknowledged the limitations in the observational nature of the study and those of the statistical analyses, which could only approximate, rather than perfectly replicate, a randomized trial. Big Data tools such as artificial intelligence–based machine learning can provide real-time analysis of large heterogeneous datasets for patients across different regions.

The authors reported no conflicts of interest.

SOURCE: Monlezun DJ et al. Surgery. 2018 doi: 10.1016/j.surg.2017.10.009.

Racial and regional disparities in liver transplant allocation persist despite multiple allocation schemes as identified in a large dataset spanning at least 30 years, according to a study.

The Model for End-Stage Liver Disease (MELD) score was put forth in 1998 by the Organ Procurement and Transplantation Network under the guidance of the Centers for Medicare & Medicaid Services and the Department of Health & Human Services, to indicate that organs should be allocated to the sickest patients as interpreted by the MELD score. Since then, four separate liver allocation systems are being followed across the country owing to disagreements over a universal allocation scheme. These include MELD score, the initial three-tier UNOS (United Network for Organ Sharing) Status, Share 35, and now MELD Na.

VILevi/Thinkstock

Unfavorable supply and demand ratios for liver allograft allocation persist across the country with differential and limited access to care, which leads to decreased wellness, lower life expectancies, and higher baseline morbidity and mortality rates in some areas. Furthermore, a short cold storage capacity of liver allografts limits greater allocation and distribution schema.

Dominique J. Monlezun, MD, PhD, MPH, and his colleagues at the Tulane Transplant Institute at Tulane University, New Orleans, evaluated the effect of MELD and other allocation schemes on the incidence of racial and regional disparities in a study published in Surgery. They performed fixed-effects multivariate logistic regression augmented by modified forward and backward stepwise-regression of transplanted patients from the United Network for Organ Sharing Standard Transplant Analysis and Research database (1985-2016) to assess causal inference of such disparities.

“Significant disparities in the odds of receiving a liver were found: African Americans, odds ratio, 1.12 (95% confidence interval, 1.08-1.17); Asians, 1.12 (95% CI, 1.07-1.18); females, 0.80 (95% CI, 0.78-0.83); and malignancy 1.18 (95% CI, 1.13-1.22). Significant racial disparities by region were identified using Caucasian Region 7 (Ill., Minn., N.D., S.D., and Wisc.) as the reference: Hispanic Region 9 (N.Y., West Vt.) 1.22 (1.02-1.45), Hispanic Region 1 (New England) 1.26 (1.01-1.57), Hispanic Region 4 (Ok., Tex.) 1.23 (1.05-1.43), and Asian Region 4 (Ok., Tex.) 1.35 (1.05-1.73).” Since the transplantation rate in Region 7 closely approximated the sex and race-matched rate of the national post–Share 35 average, it was used as a reference in the study.

“Although traditional disparities as with African Americans and [whites] have been improved during the past 30 years, new disparities as with Hispanics and Asians have developed in certain regions,” stated the authors.

They acknowledged the limitations in the observational nature of the study and those of the statistical analyses, which could only approximate, rather than perfectly replicate, a randomized trial. Big Data tools such as artificial intelligence–based machine learning can provide real-time analysis of large heterogeneous datasets for patients across different regions.

The authors reported no conflicts of interest.

SOURCE: Monlezun DJ et al. Surgery. 2018 doi: 10.1016/j.surg.2017.10.009.

Racial and regional disparities in liver transplant allocation persist despite multiple allocation schemes as identified in a large dataset spanning at least 30 years, according to a study.

The Model for End-Stage Liver Disease (MELD) score was put forth in 1998 by the Organ Procurement and Transplantation Network under the guidance of the Centers for Medicare & Medicaid Services and the Department of Health & Human Services, to indicate that organs should be allocated to the sickest patients as interpreted by the MELD score. Since then, four separate liver allocation systems are being followed across the country owing to disagreements over a universal allocation scheme. These include MELD score, the initial three-tier UNOS (United Network for Organ Sharing) Status, Share 35, and now MELD Na.

VILevi/Thinkstock

Unfavorable supply and demand ratios for liver allograft allocation persist across the country with differential and limited access to care, which leads to decreased wellness, lower life expectancies, and higher baseline morbidity and mortality rates in some areas. Furthermore, a short cold storage capacity of liver allografts limits greater allocation and distribution schema.

Dominique J. Monlezun, MD, PhD, MPH, and his colleagues at the Tulane Transplant Institute at Tulane University, New Orleans, evaluated the effect of MELD and other allocation schemes on the incidence of racial and regional disparities in a study published in Surgery. They performed fixed-effects multivariate logistic regression augmented by modified forward and backward stepwise-regression of transplanted patients from the United Network for Organ Sharing Standard Transplant Analysis and Research database (1985-2016) to assess causal inference of such disparities.

“Significant disparities in the odds of receiving a liver were found: African Americans, odds ratio, 1.12 (95% confidence interval, 1.08-1.17); Asians, 1.12 (95% CI, 1.07-1.18); females, 0.80 (95% CI, 0.78-0.83); and malignancy 1.18 (95% CI, 1.13-1.22). Significant racial disparities by region were identified using Caucasian Region 7 (Ill., Minn., N.D., S.D., and Wisc.) as the reference: Hispanic Region 9 (N.Y., West Vt.) 1.22 (1.02-1.45), Hispanic Region 1 (New England) 1.26 (1.01-1.57), Hispanic Region 4 (Ok., Tex.) 1.23 (1.05-1.43), and Asian Region 4 (Ok., Tex.) 1.35 (1.05-1.73).” Since the transplantation rate in Region 7 closely approximated the sex and race-matched rate of the national post–Share 35 average, it was used as a reference in the study.

“Although traditional disparities as with African Americans and [whites] have been improved during the past 30 years, new disparities as with Hispanics and Asians have developed in certain regions,” stated the authors.

They acknowledged the limitations in the observational nature of the study and those of the statistical analyses, which could only approximate, rather than perfectly replicate, a randomized trial. Big Data tools such as artificial intelligence–based machine learning can provide real-time analysis of large heterogeneous datasets for patients across different regions.

The authors reported no conflicts of interest.

SOURCE: Monlezun DJ et al. Surgery. 2018 doi: 10.1016/j.surg.2017.10.009.

Despite the rhetorical winds blowing out of Washington, 92% of Americans believe that they have the right to affordable health care, according to a recent survey by the Commonwealth Fund.

Political affiliation, it turns out, does not appear to determine support for such a right. Democrats aged 19-64 years voiced their support to the tune of 99% in favor of a right to affordable care, compared with 82% of Republicans and 92% of independents, the Commonwealth Fund said in a survey brief released March 1.

The survey showed that 36% of those who have health care insurance through the Affordable Care Act marketplaces are pessimistic about their chances of keeping that coverage, compared with 27% of those with Medicaid and 9% of adults with employer-sponsored health benefits.

Among those who lacked confidence about maintaining their coverage, the largest proportion (32%) of respondents believe that they will lose it because the “Trump administration will not carry out the law” and 19% think that they won’t be able to afford it in the future, they said.

“Signals of support for this coverage from both [the executive and legislative] branches of government would reassure consumers about their access to health care. Such a shift also would provide a more stable regulatory environment for insurers participating in both the marketplaces and Medicaid,” according to the report.

The Commonwealth Fund’s sixth Affordable Care Act Tracking Survey was conducted by the research firm SSRS between Nov. 2 and Dec. 27, 2017, with responses from 2,410 adults aged 19-64 years. The overall margin of error was ±2.7 percentage points at the 95% confidence level.

[email protected]

Despite the rhetorical winds blowing out of Washington, 92% of Americans believe that they have the right to affordable health care, according to a recent survey by the Commonwealth Fund.

Political affiliation, it turns out, does not appear to determine support for such a right. Democrats aged 19-64 years voiced their support to the tune of 99% in favor of a right to affordable care, compared with 82% of Republicans and 92% of independents, the Commonwealth Fund said in a survey brief released March 1.

The survey showed that 36% of those who have health care insurance through the Affordable Care Act marketplaces are pessimistic about their chances of keeping that coverage, compared with 27% of those with Medicaid and 9% of adults with employer-sponsored health benefits.

Among those who lacked confidence about maintaining their coverage, the largest proportion (32%) of respondents believe that they will lose it because the “Trump administration will not carry out the law” and 19% think that they won’t be able to afford it in the future, they said.

“Signals of support for this coverage from both [the executive and legislative] branches of government would reassure consumers about their access to health care. Such a shift also would provide a more stable regulatory environment for insurers participating in both the marketplaces and Medicaid,” according to the report.

The Commonwealth Fund’s sixth Affordable Care Act Tracking Survey was conducted by the research firm SSRS between Nov. 2 and Dec. 27, 2017, with responses from 2,410 adults aged 19-64 years. The overall margin of error was ±2.7 percentage points at the 95% confidence level.

[email protected]

Despite the rhetorical winds blowing out of Washington, 92% of Americans believe that they have the right to affordable health care, according to a recent survey by the Commonwealth Fund.

Political affiliation, it turns out, does not appear to determine support for such a right. Democrats aged 19-64 years voiced their support to the tune of 99% in favor of a right to affordable care, compared with 82% of Republicans and 92% of independents, the Commonwealth Fund said in a survey brief released March 1.

The survey showed that 36% of those who have health care insurance through the Affordable Care Act marketplaces are pessimistic about their chances of keeping that coverage, compared with 27% of those with Medicaid and 9% of adults with employer-sponsored health benefits.

Among those who lacked confidence about maintaining their coverage, the largest proportion (32%) of respondents believe that they will lose it because the “Trump administration will not carry out the law” and 19% think that they won’t be able to afford it in the future, they said.

“Signals of support for this coverage from both [the executive and legislative] branches of government would reassure consumers about their access to health care. Such a shift also would provide a more stable regulatory environment for insurers participating in both the marketplaces and Medicaid,” according to the report.

The Commonwealth Fund’s sixth Affordable Care Act Tracking Survey was conducted by the research firm SSRS between Nov. 2 and Dec. 27, 2017, with responses from 2,410 adults aged 19-64 years. The overall margin of error was ±2.7 percentage points at the 95% confidence level.

[email protected]