Therapeutic Advances in Chronic Disease最新文献

{"title":"Comparative short-term risks of infection and serious infection in patients receiving biologic and small-molecule therapies for psoriasis and psoriatic arthritis: a systemic review and network meta-analysis of randomized controlled trials.","authors":"Hsien-Yi Chiu,&nbsp;Yi-Teng Hung,&nbsp;Yu-Huei Huang","doi":"10.1177/20406223231206225","DOIUrl":"https://doi.org/10.1177/20406223231206225","url":null,"abstract":"<p><strong>Background: </strong>Infection events are a major concern for patients and physicians when making psoriasis treatment decisions.</p><p><strong>Objective: </strong>To estimate the relative short-term risks of infection and serious infection for biologic and small molecule therapies in the treatment of moderate-to-severe plaque psoriasis (PsO) and psoriatic arthritis (PsA).</p><p><strong>Data sources and methods: </strong>A systematic literature search of the PubMed, EMBASE, and Web of Science databases was conducted on 17 June 2022. We included phase II, III, or IV randomized controlled trials (RCTs) of biologic and small-molecule therapies that are licensed or likely to gain approval soon for PsO and PsA, as well as infection data reports. Two investigators independently extracted the data based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Network meta-analysis (NMA) was performed to estimate the pooled relative risks (RRs) and corresponding 95% confidence intervals of total infections and serious infections for treatments during placebo-controlled phases of RCTs. The surface under the cumulative ranking area (SUCRA) was calculated to rank the infection risk for each treatment.</p><p><strong>Results: </strong>A total of 94 RCTs with a total of 19 treatment arms involving 54,369 participants were analyzed. For patients with PsO, bimekizumab, secukizumab, risankizumab, ustekinumab, apremilast, guselkumab, and adalimumab were associated with significantly higher risks of infection than placebo; SUCRA ranked infliximab, deucravacitinib, and bimekizumab with the highest risks of infection. For patients with PsA, bimekizumab, apremilast, and upadacitinib (30 mg daily) were associated with higher risks of infection; SUCRA ranked bimekizumab with the highest risk of infection. No treatments, except for upadacitinib (30 mg daily), were associated with a higher risk of serious infection than placebo in PsA.</p><p><strong>Conclusion: </strong>This NMA provides a comprehensive assessment of the comparative short-term risks of infection, which could help physicians and patients to select individualized treatments for psoriasis.</p><p><strong>Registration: </strong>CRD42022359873.</p>","PeriodicalId":22960,"journal":{"name":"Therapeutic Advances in Chronic Disease","volume":"14 ","pages":"20406223231206225"},"PeriodicalIF":3.5,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10612457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71413980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A new dual function dorsal root ganglion stimulation in pain management: a technical note and case report.","authors":"Qiao Wang,&nbsp;Rui Han,&nbsp;Rong Hu,&nbsp;Qianxi Liu,&nbsp;Dong Huang,&nbsp;Haocheng Zhou","doi":"10.1177/20406223231206224","DOIUrl":"https://doi.org/10.1177/20406223231206224","url":null,"abstract":"<p><p>Sensitization of dorsal horn ganglion sensory neuron plays a crucial role in the maintenance of chronic pain disorder. Multiple interventions targeting dorsal horn ganglion can provide considerable relief of pain, including selective nerve root block, pulsed radiofrequency, and electrical nerve stimulation technique. It remains controversial about the superiority of neuromodulation mentioned above due to distinct pattern of analgesic mechanism. Here, we reported one 71-year-old male presenting at our pain clinic with severe, unilateral lower limb pain caused by postherpetic neuralgia. An implantable stimulator with dual neuromodulation mode, combining pulsed radiofrequency with electrical nerve stimulation, was then placed into the lateral epidural space adjacent to dorsal root ganglion at L4 level. Standard stimulation programing was performed with technicians to achieve satisfactory control of pain, with numerical rating scale decreasing from 8 to 2 postoperatively. This novel dual function neuromodulation strategy may provide an alternative option for pain management for those with intractable neuropathic pain.</p>","PeriodicalId":22960,"journal":{"name":"Therapeutic Advances in Chronic Disease","volume":"14 ","pages":"20406223231206224"},"PeriodicalIF":3.5,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ca/cd/10.1177_20406223231206224.PMC10580718.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49682583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complementary and alternative medicine for long COVID: a systematic review of randomized controlled trials.","authors":"Juan Yang, Kia Hui Lim, Kia Teng Lim, Jeffrey T Woods, Arya B Mohabbat, Dietlind L Wahner-Roedler, Ravindra Ganesh, Brent A Bauer","doi":"10.1177/20406223231204727","DOIUrl":"10.1177/20406223231204727","url":null,"abstract":"<p><strong>Background: </strong>Complementary and alternative medicine (CAM) interventions are growing in popularity as possible treatments for long COVID symptoms. However, comprehensive analysis of current evidence in this setting is still lacking.</p><p><strong>Objective: </strong>This study aims to review existing published studies on the use of CAM interventions for patients experiencing long COVID through a systematic review.</p><p><strong>Design: </strong>Systematic review of randomized controlled trials (RCTs).</p><p><strong>Methods: </strong>A comprehensive electronic literature search was performed in multiple databases and clinical trial registries from September 2019 to January 2023. RCTs evaluating efficacy and safety of CAM for long COVID were included. Methodological quality of each included trial was appraised with the Cochrane 'risk of bias' tool. A qualitative analysis was conducted due to heterogeneity of included studies.</p><p><strong>Results: </strong>A total of 14 RCTs with 1195 participants were included in this review. Study findings demonstrated that CAM interventions could benefit patients with long COVID, especially those suffering from neuropsychiatric disorders, olfactory dysfunction, cognitive impairment, fatigue, breathlessness, and mild-to-moderate lung fibrosis. The main interventions reported were self-administered transcutaneous auricular vagus nerve stimulation, neuro-meditation, dietary supplements, olfactory training, aromatherapy, inspiratory muscle training, concurrent training, and an online breathing and well-being program.</p><p><strong>Conclusion: </strong>CAM interventions may be effective, safe, and acceptable to patients with symptoms of long COVID. However, the findings from this systematic review should be interpreted with caution due to various methodological limitations. More rigorous trials focused on CAM for long COVID are warranted in the future.</p>","PeriodicalId":22960,"journal":{"name":"Therapeutic Advances in Chronic Disease","volume":"14 ","pages":"20406223231204727"},"PeriodicalIF":3.5,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b2/97/10.1177_20406223231204727.PMC10571674.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41238624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the profiles of first-line PD-1/PD-L1 inhibitors for advanced NSCLC lacking driver gene mutations: a systematic review and Bayesian network meta-analysis.","authors":"Fu Wenfan,&nbsp;Xu Manman,&nbsp;Shi Xingyuan,&nbsp;Jiang Zeyong,&nbsp;Zhao Jian,&nbsp;Dai Lu","doi":"10.1177/20406223231189224","DOIUrl":"10.1177/20406223231189224","url":null,"abstract":"<p><strong>Background: </strong>Numerous first-line immune checkpoint inhibitors (ICI) were developed for patients with advanced non-small cell lung cancer (NSCLC) lacking driver gene mutations. However, this group consists of a heterogeneous patient population, for whom the optimal therapeutic choice is yet to be confirmed.</p><p><strong>Objective: </strong>To identify the best first-line immunotherapy regimen for overall advanced NSCLC patients and different subgroups.</p><p><strong>Design: </strong>Systematic review and Bayesian network meta-analysis (NMA).</p><p><strong>Methods: </strong>We searched several databases to retrieve relevant literature. We performed Bayesian NMA for the overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and treatment-related adverse events (tr-AEs) with a grade equal or more than 3 (grade ⩾ 3 tr-AEs). Subgroup analysis was conducted according to programed death ligand 1 (PD-L1) levels, histologic type, central nervous system (CNS) metastases and tobacco use history.</p><p><strong>Results: </strong>For the PD-L1 non-selective patients, sintilimab plus chemotherapy (sinti-chemo) provided the best OS [hazard ratio (HR) = 0.59, 95% confidence interval (CI):0.42-0.83]. Nivolumab plus bevacizumab plus chemotherapy (nivo-bev-chemo) was comparable to atezolizumab plus bevacizumab plus chemotherapy (atezo-bev-chemo) in prolonging PFS (HR = 0.99, 95% CI: 0.51-1.91). Atezo-bev-chemo remarkably elevated the ORR than chemotherapy (OR = 3.13, 95% CI: 1.51-6.59). Subgroup analysis showed pembrolizumab plus chemotherapy (pembro-chemo) ranked first in OS in subgroups of PD-L1 < 1%, non-squamous, no CNS metastases, with or without smoking history, and ranked second in OS in subgroups of PD-L1 ⩾ 1% and PD-L1 1-49%. Cemiplimab and sugemalimab plus chemotherapy ranked first in OS and PFS for squamous subgroup, respectively. For patients with CNS metastases, nivolumab plus ipilimumab plus chemotherapy (nivo-ipili-chemo) and camrelizumab plus chemotherapy provided the best OS and PFS, respectively.</p><p><strong>Conclusions: </strong>Sinti-chemo and nivo-bev-chemo were two effective first-line regimens ranked first in OS and PFS for overall patients, respectively. Pembro-chemo was favorable for patients in subgroups of PD-L1 < 1%, PD-L1 ⩾ 1%, PD-L1 1-49%, non-squamous, no CNS metastases, with or without smoking history. Addition of bevacizumab consistently provided with favorable PFS results in patients of all PD-L1 levels. Cemiplimab was the best option in squamous subgroup and nivo-ipili-chemo in CNS metastases subgroup due to their advantages in OS.</p>","PeriodicalId":22960,"journal":{"name":"Therapeutic Advances in Chronic Disease","volume":"14 ","pages":"20406223231189224"},"PeriodicalIF":3.5,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/02/81/10.1177_20406223231189224.PMC10568994.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41238623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medication adherence in Medicare-enrolled older adults with asthma and chronic obstructive pulmonary disease before and during COVID-19 pandemic.","authors":"Ligang Liu,&nbsp;Armando Silva Almodóvar,&nbsp;Milap C Nahata","doi":"10.1177/20406223231205796","DOIUrl":"10.1177/20406223231205796","url":null,"abstract":"<p><strong>Background: </strong>Medication adherence in Medicare-enrolled older adults with asthma and chronic obstructive pulmonary disease (COPD) before and during the coronavirus disease 2019 (COVID-19) pandemic is unknown.</p><p><strong>Objectives: </strong>To evaluate medication adherence and determinants of high adherence before and during the COVID-19 pandemic in this population.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>The proportion of days covered (PDC) reflected medication adherence from January to July 2019 and from January to July 2020. Patients <65 years of age, with COPD or asthma alone, or with cystic fibrosis were excluded. Paired <i>t</i> tests were used to assess adherence changes. Logistic regression explored association of age, sex, diagnosis of depression, number of medications, medication-related problems, prescribers, pharmacies, controller medication classes, albuterol rescue inhaler fills, oral corticosteroid fills, and having a 90-day supply with high adherence (PDC ⩾ 80%).</p><p><strong>Results: </strong>This analysis included 989 patients. In this cohort, 61.2% of patients received oral corticosteroids. Over 60% of patients had ⩾3 rescue fills in both 2019 and 2020. Medication adherence to controller medications significantly decreased for all controller medications (<i>p</i> < 0.001) in 2020. In 2019 and 2020, number of controller medication classes and having a 90-day supply were associated with high adherence (<i>p</i> < 0.001). In 2019, variables associated with high adherence also included number of medication-related problems and having ⩾3 albuterol rescue inhalers (<i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Medication adherence to controllers significantly decreased during the pandemic among older adults with asthma and COPD. Patients with multiple controller classes and a 90-day supply were more likely to be highly adherent. A 90-day supply of medications should be used to facilitate access to medication during the pandemic. Healthcare professionals should assess medication adherence, resolve the barriers of adherence and medication-related problems to achieve desired clinical outcomes among older adults with both asthma and COPD.</p>","PeriodicalId":22960,"journal":{"name":"Therapeutic Advances in Chronic Disease","volume":"14 ","pages":"20406223231205796"},"PeriodicalIF":3.5,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/76/51/10.1177_20406223231205796.PMC10563468.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41213622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A narrative review of neuro-ophthalmologic disease in African Americans and Hispanics with multiple sclerosis.","authors":"Lauren Tardo,&nbsp;Amber Salter,&nbsp;Melanie Truong-Le,&nbsp;Lindsay Horton,&nbsp;Kyle M Blackburn,&nbsp;Peter V Sguigna","doi":"10.1177/20406223231202645","DOIUrl":"https://doi.org/10.1177/20406223231202645","url":null,"abstract":"<p><p>Multiple sclerosis (MS) is the most common non-traumatic cause of disability in young people, with vision loss in the disease representing the second largest contributor to disability. In particular, African-American patients with MS are noted to have lower vision than their Caucasian counterparts. In this review, we examine the disparities in eye diseases in the MS population with our gaps in knowledge and discuss the underlying nature of pathological disparities.</p>","PeriodicalId":22960,"journal":{"name":"Therapeutic Advances in Chronic Disease","volume":"14 ","pages":"20406223231202645"},"PeriodicalIF":3.5,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10542320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41166168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between vascular access and angulation of vena cava filter at placement and retrieval: a multicenter retrospective cohort study.","authors":"Maofeng Gong,&nbsp;Rui Jiang,&nbsp;Boxiang Zhao,&nbsp;Jie Kong,&nbsp;Zhengli Liu,&nbsp;Cheng Qian,&nbsp;Xu He,&nbsp;Jianping Gu","doi":"10.1177/20406223231200254","DOIUrl":"https://doi.org/10.1177/20406223231200254","url":null,"abstract":"<p><strong>Background: </strong>Inferior vena cava (IVC) filters are commonly used intravascular devices designed to prevent fatal pulmonary embolism (PE), maintaining the IVC filter as centered as possible is fundamental for achieving its filtration function.</p><p><strong>Objective: </strong>This study aimed to characterize the tilt angles of IVC filter between the vascular access of internal jugular vein (IJV) and femoral vein (FV), as well as to identify factors associated with increased or decreased tilt angles between placement and retrieval.</p><p><strong>Design: </strong>This is a multicenter retrospective study.</p><p><strong>Methods: </strong>A multicenter retrospective study was conducted from October 2017 to March 2019. The primary outcome was the change in filter tilt between placement and retrieval. The secondary outcome was the identifications of factors associated with increased or decreased tilt angle. Relevant variables were analyzed using <i>t-</i>tests, <i>Chi-square</i> tests, <i>Fisher's</i> exact tests, while multivariate logistic regression analysis was used to determine risk factors.</p><p><strong>Results: </strong>A total of 184 eligible patients were included in this study. The IJV group had a lower likelihood of tilt angle over 10° at the time of placement compared to the FVs group (0% <i>versus</i> 12.5%, <i>p</i> = 0.040). Among the 171 patients with a mean dwell time of 22.1 days, the IJV group had a higher likelihood of tilt angle over 10° than the FVs group (10.3% <i>versus</i> 2.3%, <i>p</i> = 0.080). The use of FVs access at placement was associated with a higher difference between placement and retrieval filter tilt angles (<i>p</i> < 0.01). Multivariate logistic regression analysis showed that hypertension [odds ratio (OR) 0.668; 95% confidence interval (CI) 0.328-1.358, <i>p</i> = 0.265], cardiologic artery disease (OR 0.537; 95% CI 0.136-2.130, <i>p</i> = 0.377), cerebral venous disease (OR 0.555; 95% CI 0.186-1.651, <i>p</i> = 0.290), filter types (OR 1.624; 95% CI 0.851-3.096, <i>p</i> = 0.141), and IVC filter thrombosis (OR 1.634; 95% CI 0.804-3.323, <i>p</i> = 0.175) were not associated with increased filter tilt angle. Right side (OR 0.434; 95% CI 0.202-0.930, <i>p</i> = 0.032) or bilateral lower extremity deep vein thrombosis (LEDVT) (OR 0.383; 95% CI 0.148-0.995, <i>p</i> = 0.049) were identified as protective factors.</p><p><strong>Conclusion: </strong>IJV access was associated with a lower filter tilt angle at the time of placement, while FVs access was linked to a higher difference between placement and retrieval tilt angles. Right side or bilateral LEDVT were identified as protective factors against increased IVC filter tilt angle.</p>","PeriodicalId":22960,"journal":{"name":"Therapeutic Advances in Chronic Disease","volume":"14 ","pages":"20406223231200254"},"PeriodicalIF":3.5,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/63/a6/10.1177_20406223231200254.PMC10515605.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41152180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical scenarios-based guide for tofacitinib in rheumatoid arthritis.","authors":"Mahta Mortezavi, Eduardo F Mysler","doi":"10.1177/20406223231178273","DOIUrl":"10.1177/20406223231178273","url":null,"abstract":"<p><p>Tofacitinib was the first Janus kinase inhibitor to be approved for the treatment of rheumatoid arthritis (RA), and there is a large body of data to inform the efficacy and safety of this drug for patients at different places in their treatment journeys and with diverse demographics and characteristics. Here, we summarize tofacitinib clinical efficacy and safety data from some clinical trials, <i>post hoc</i> analyses, and real-world studies, which provide evidence of the efficacy of tofacitinib in treating patients with RA at various stages of their treatment journeys, and with differentiating baseline characteristics, such as age, gender, race, and body mass index. In addition, we review the safety data available from different patient subpopulations in the tofacitinib clinical development program, real-world data, and findings from the ORAL Surveillance post-marketing safety study that included patients aged ⩾50 years with pre-existing cardiovascular risk factors. The available efficacy and safety data in these subpopulations can enable better discussions between clinicians and patients to guide informed decision-making and individualized patient care.</p>","PeriodicalId":22960,"journal":{"name":"Therapeutic Advances in Chronic Disease","volume":"14 ","pages":"20406223231178273"},"PeriodicalIF":3.3,"publicationDate":"2023-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a2/86/10.1177_20406223231178273.PMC10286162.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10299858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Air pollution and mortality in patients with chronic obstructive pulmonary disease: a cohort study in South Korea.","authors":"Suna Kang, Yun Soo Hong, Jihwan Park, Danbee Kang, Hyunsoo Kim, Jin Lee, Woojin Kim, Sung-Won Kang, Eliseo Guallar, Juhee Cho, Hye Yun Park","doi":"10.1177/20406223231176175","DOIUrl":"10.1177/20406223231176175","url":null,"abstract":"<p><strong>Background: </strong>Evidence on whether long-term exposure to air pollution increases the mortality risk in patients with chronic obstructive pulmonary disease (COPD) is limited.</p><p><strong>Objectives: </strong>We aimed to investigate the associations of long-term exposure to particulate matter with diameter <10 µm (PM₁₀) and nitrogen dioxide (NO₂) with overall and disease-specific mortality in COPD patients.</p><p><strong>Design: </strong>We conducted a nationwide retrospective cohort study of 121,423 adults ⩾40 years diagnosed with COPD during 1 January to 31 December 2009.</p><p><strong>Methods: </strong>Exposure to PM₁₀ and NO₂ was estimated for residential location using the ordinary kriging method. We estimated the risk of overall mortality associated with 1-, 3-, and 5-years average concentrations of PM₁₀ and NO₂ using Cox proportional hazards models and disease-specific mortality using the Fine and Gray method adjusted for age, sex, income, body mass index, smoking, comorbidities, and exacerbation history.</p><p><strong>Results: </strong>The adjusted hazard ratios (HRs) for overall mortality associated with a 10 µg/m³ increase in 1-year PM₁₀ and NO₂ exposures were 1.004 [95% confidence interval (CI) = 0.985, 1.023] and 0.993 (95% CI = 0.984, 1.002), respectively. The results were similar for 3- and 5-year exposures. For a 10-µg/m³ increase in 1-year PM₁₀ and NO₂ exposures, the adjusted HRs for chronic lower airway disease mortality were 1.068 (95% CI = 1.024, 1.113) and 1.029 (95% CI = 1.009, 1.050), respectively. In stratified analyses, exposures to PM₁₀ and NO₂ were associated with overall mortality in patients who were underweight and had a history of severe exacerbation.</p><p><strong>Conclusion: </strong>In this large population-based study of patients with COPD, long-term PM₁₀ and NO₂ exposures were not associated with overall mortality but were associated with chronic lower airway disease mortality. PM₁₀ and NO₂ exposures were both associated with an increased risk of overall mortality, and with overall mortality in underweight individuals and those with a history of severe exacerbation.</p>","PeriodicalId":22960,"journal":{"name":"Therapeutic Advances in Chronic Disease","volume":"14 ","pages":"20406223231176175"},"PeriodicalIF":3.5,"publicationDate":"2023-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c6/11/10.1177_20406223231176175.PMC10265343.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10351448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Afterload-related cardiac performance is a powerful hemodynamic predictor of mortality in patients with chronic heart failure.","authors":"Yihang Wu, Pengchao Tian, Lin Liang, Yuyi Chen, Jiayu Feng, Boping Huang, Liyan Huang, Xuemei Zhao, Jing Wang, Jingyuan Guan, Xinqing Li, Yuhui Zhang, Jian Zhang","doi":"10.1177/20406223231171554","DOIUrl":"10.1177/20406223231171554","url":null,"abstract":"<p><strong>Background: </strong>Afterload-related cardiac performance (ACP), a diagnostic parameter for septic cardiomyopathy, integrates both cardiac performance and vascular effects and could predict prognosis in septic shock.</p><p><strong>Objectives: </strong>We hypothesized that ACP would also correlate with clinical outcomes in patients with chronic heart failure (HF).</p><p><strong>Design: </strong>A retrospective study.</p><p><strong>Methods: </strong>We retrospectively studied consecutive patients with chronic HF who underwent right heart catheterization and established an expected cardiac output-systemic vascular resistance (CO-SVR) curve model in chronic HF for the first time. ACP was calculated as CO_measured/CO_predicted × 100%. ACP > 80%, 60% < ACP ⩽ 80%, and ACP ⩽ 60% represented less impaired, mildly impaired, and severely impaired cardiovascular function, respectively. The primary outcome was all-cause mortality, and the secondary outcome was event-free survival.</p><p><strong>Results: </strong>A total of 965 individual measurements from 290 eligible patients were used to establish the expected CO-SVR curve model (CO_predicted = 53.468 × SVR ^-0.799). Patients with ACP ⩽ 60% had higher serum NT-proBNP levels (<i>P</i> < 0.001), lower left ventricular ejection fraction (<i>P</i> = 0.001), and required dopamine more frequently (<i>P</i> < 0.001). Complete follow-up data were available in 263 of 290 patients (90.7%). After multivariate adjustment, ACP remained associated with both primary outcome (hazard ratio (HR) 0.956, 95% confidence interval (CI) 0.927-0.987) and secondary outcome (HR 0.977, 95% CI 0.963-0.992). Patients with ACP ⩽ 60% had the worst prognosis (all <i>P</i> < 0.001). ACP was significantly more discriminating (area under the curve of 0.770) than other conventional hemodynamic parameters in predicting mortality (Delong test, all <i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>ACP is a powerful independent hemodynamic predictor of mortality in patients with chronic HF. ACP and the novel CO-SVR two-dimensional graph could be useful in assessing cardiovascular function and making clinical decisions.</p><p><strong>Clinical trial registration: </strong>URL: https://www.clinicaltrials.gov. Unique identifier: NCT02664818.</p>","PeriodicalId":22960,"journal":{"name":"Therapeutic Advances in Chronic Disease","volume":"14 ","pages":"20406223231171554"},"PeriodicalIF":3.3,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8c/3f/10.1177_20406223231171554.PMC10265365.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10301150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}