Effects of moisture and density-dependent interactions on tropical tree diversity.

Tropical tree diversity increases with rainfall1,2. Direct physiological effects of moisture availability and indirect effects mediated by biotic interactions are hypothesized to contribute to this pantropical increase in diversity with rainfall2-6. Previous studies have demonstrated direct physiological effects of variation in moisture availability on tree survival and diversity5,7-10, but the indirect effects of variation in moisture availability on diversity mediated by biotic interactions have not been shown11. Here we evaluate the relationships between interannual variation in moisture availability, the strength of density-dependent interactions, and seedling diversity in central Panama. Diversity increased with soil moisture over the first year of life across 20 annual cohorts. These first-year changes in diversity persisted for at least 15 years. Differential survival of moisture-sensitive species did not contribute to the observed changes in diversity. Rather, negative density-dependent interactions among conspecifics were stronger and increased diversity in wetter years. This suggests that moisture availability enhances diversity indirectly through moisture-sensitive, density-dependent conspecific interactions. Pathogens and phytophagous insects mediate interactions among seedlings in tropical forests12-18, and many of these plant enemies are themselves moisture-sensitive19-27. Changes in moisture availability caused by climate change and habitat degradation may alter these interactions and tropical tree diversity.

Estimation of daylight spectral power distribution from uncalibrated hyperspectral radiance images.

This paper introduces a novel framework for estimating the spectral power distribution of daylight illuminants in uncalibrated hyperspectral images, particularly beneficial for drone-based applications in agriculture and forestry. The proposed method uniquely combines image-dependent plausible spectra with a database of physically possible spectra, utilizing an image-independent principal component space (PCS) for estimations. This approach effectively narrows the search space in the spectral domain and employs a random walk methodology to generate spectral candidates, which are then intersected with a pre-trained PCS to predict the illuminant. We demonstrate superior performance compared to existing statistics-based methods across various metrics, validating the framework's efficacy in accurately estimating illuminants and recovering reflectance values from radiance data. The method is validated within the spectral range of 382-1002 nm and shows potential for extension to broader spectral ranges.

Effect of earthquake sequences on risk-based catastrophe bond pricing.

Catastrophe bonds (cat bond in short) are an alternative risk-transfer instrument used to transfer peril-specific financial risk from governments, financial institutions, or (re)insurers, to the capital market. Current approaches for cat bond pricing are calibrated on seismic mainshocks, and thus do not account for potential effects induced by earthquake sequences. This simplifying assumption implies that damage arises from mainshocks only, while aftershocks yield no damage. Postearthquake field surveys reveal that this assumption is inaccurate. For example, in the 2011 Christchurch Earthquake sequence and 2016-2017 Central Italy Earthquake sequence, aftershocks were responsible for higher economic losses when compared to those caused by mainshocks. This article proposes a time-dependent aggregate loss model that takes into account seismicity clustering and damage accumulation effects in the computation of damage. The model is calibrated on the seismic events recorded during the recent 2016-2017 Central Italy Earthquake sequence. Furthermore, the effects of earthquake sequence on cat bond pricing is explored by implementing the proposed model on five Italian municipalities. The investigation showed that neglecting time-dependency may lead to higher difference (up to 45%) in the cat bond price when compared to standard approaches.

BID expression determines the apoptotic fate of cancer cells after abrogation of the spindle assembly checkpoint by AURKB or TTK inhibitors.

BACKGROUND: Drugs targeting the spindle assembly checkpoint (SAC), such as inhibitors of Aurora kinase B (AURKB) and dual specific protein kinase TTK, are in different stages of clinical development. However, cell response to SAC abrogation is poorly understood and there are no markers for patient selection. METHODS: A panel of 53 tumor cell lines of different origins was used. The effects of drugs were analyzed by MTT and flow cytometry. Copy number status was determined by FISH and Q-PCR; mRNA expression by nCounter and RT-Q-PCR and protein expression by Western blotting. CRISPR-Cas9 technology was used for gene knock-out (KO) and a doxycycline-inducible pTRIPZ vector for ectopic expression. Finally, in vivo experiments were performed by implanting cultured cells or fragments of tumors into immunodeficient mice. RESULTS: Tumor cells and patient-derived xenografts (PDXs) sensitive to AURKB and TTK inhibitors consistently showed high expression levels of BH3-interacting domain death agonist (BID), while cell lines and PDXs with low BID were uniformly resistant. Gene silencing rendered BID-overexpressing cells insensitive to SAC abrogation while ectopic BID expression in BID-low cells significantly increased sensitivity. SAC abrogation induced activation of CASP-2, leading to cleavage of CASP-3 and extensive cell death only in presence of high levels of BID. Finally, a prevalence study revealed high BID mRNA in 6% of human solid tumors. CONCLUSIONS: The fate of tumor cells after SAC abrogation is driven by an AURKB/ CASP-2 signaling mechanism, regulated by BID levels. Our results pave the way to clinically explore SAC-targeting drugs in tumors with high BID expression.

Spent coffee grounds and its antioxidant dietary fiber promote different colonic microbiome signatures: Benefits for subjects with chronodisruption.

Chronodisruption, commonly displayed by people living with obesity (PLO), is linked to colonic microbiota dysbiosis, and may increase the risk of many chronic non-communicable diseases, whereas dietary interventions-called chrononutrition may mitigate it. We evaluated the in vitro effects of spent coffee grounds (SCG), and their antioxidant dietary fiber (SCG-DF) on the colonic microbiota of an obese donor displaying dysbiosis and chronodisruption. Basal microbiota pattern was associated with an increased risk of non-communicable chronic diseases. Both samples decrease species richness and increase microbiota diversity (p < 0.05; Chao and Shannon index, respectively), positively enhancing Firmicutes/Bacteroidetes index (SCG, p < 0.04; SCG-DF, p < 0.02). SCG and SCG-DF modulated the microbiota, but SCG-DF induced greater changes, significantly increasing. p_Actonobacterias (SCG p < 0.04; SCG-DF, p < 0.02), and reducing g_Alistipes; s_putredinis, g_Prevotella;s_copri. The highest increase was displayed by p_Proteobacteria (f_Desulfovibrionaceae and f_Alcanigenaceae, p < 0.05), while g_Haemophilus; s_parainfluenzae decreased (p < 0.05). However, neither SCG nor SCG-DF modulated g_Alistipes (evening-type colonic microbial marker) beneficially. SCG and SCG-DF reduced (p < 0.05) g_Lachnospira, a microbial evening-type marker, among other microbial populations, of an obese donor displaying chronodisruption and dysbiosis. SCG and SCG-DF displayed a prebiotic effect with the potential to mitigate diseases linked to chronodisruption.

Chalcogen-Bond Catalysis: Telluronium-Catalyzed [4+2]-Cyclocondensation of (in situ Generated) Aryl Imines with Alkenes.

In the chalcogen series, tellurium species exhibit the strongest chalcogen bonding (ChB) interaction with electron-rich atom. This property explains the renewed interested toward tellurium-based derivatives and their use in different applications, such as organocatalysis. In this context, the catalytic activity of telluronium salts in the Povarov reaction is presented herein. Different dienophiles, as well as imines of variable electronic nature, efficiently react in the presence of catalytic amount of either diarylmethyltelluronium or triaryltelluronium salts. Both catalysts could also readily perform the three-component Povarov reaction starting from aldehyde, aniline and dihydrofuran. The reactivity of telluroniums towards imines and aldehydes was confirmed in the solid state by the ability of Te atom to interact through ChB with the oxygen carbonyl of acetone, and in solution with significant shift variations of the imine proton and of the tellurium atom in 1 H and 125 Te NMR spectroscopy. For the most active telluronium catalysts bearing CF3 groups, association constants (K) with N-phenyl phenylmethanimine in the range 22-38 M-1 were measured in dichloromethane.

Clinical outcomes in patients with solid tumors living in rural and urban areas followed via telemedicine: experience in a highly complex latin american hospital.

BACKGROUND: Difficulties in cancer services access increase the burden of disease and mortality in rural areas, and telehealth can be a useful tool to address these inequalities. OBJECTIVE: We aimed to describe the outcomes of patients in rural and urban areas with solid tumors managed by oncologists through telemedicine. METHODS: We conducted a retrospective cohort study of patients with solid tumors from March to December 2020. A total of 1270 subjects with solid tumors were included, 704 living in urban areas and 566 in rural areas. RESULTS: The most frequent tumors were breast (51.8%) and prostate (12.4%). The trend of telemedicine care was similar for both populations; in-person care was more frequent in the urban population. There were no differences in referral to the emergency room, need for hospitalization, and mortality for both groups. CONCLUSION: Telemedicine is a care modality that reduces barriers in the care of patients with solid tumors, evidencing similar outcomes regardless of living in rural or urban areas.

Acute kidney injury decreases pulmonary vascular growth and alveolarization in neonatal rat pups.

BACKGROUND: Acute kidney injury (AKI) is common in sick neonates and associated with poor pulmonary outcomes, however, the mechanisms responsible remain unknown. We present two novel neonatal rodent models of AKI to investigate the pulmonary effects of AKI. METHODS: In rat pups, AKI was induced surgically via bilateral ischemia-reperfusion injury (bIRI) or pharmacologically using aristolochic acid (AA). AKI was confirmed with plasma blood urea nitrogen and creatinine measurements and kidney injury molecule-1 staining on renal immunohistochemistry. Lung morphometrics were quantified with radial alveolar count and mean linear intercept, and angiogenesis investigated by pulmonary vessel density (PVD) and vascular endothelial growth factor (VEGF) protein expression. For the surgical model, bIRI, sham, and non-surgical pups were compared. For the pharmacologic model, AA pups were compared to vehicle controls. RESULTS: AKI occurred in bIRI and AA pups, and they demonstrated decreased alveolarization, PVD, and VEGF protein expression compared controls. Sham pups did not experience AKI, however, demonstrated decreased alveolarization, PVD, and VEGF protein expression compared to controls. CONCLUSION: Pharmacologic AKI and surgery in neonatal rat pups, with or without AKI, decreased alveolarization and angiogenesis, producing a bronchopulmonary dysplasia phenotype. These models provide a framework for elucidating the relationship between AKI and adverse pulmonary outcomes. IMPACT: There are no published neonatal rodent models investigating the pulmonary effects after neonatal acute kidney injury, despite known clinical associations. We present two novel neonatal rodent models of acute kidney injury to study the impact of acute kidney injury on the developing lung. We demonstrate the pulmonary effects of both ischemia-reperfusion injury and nephrotoxin-induced AKI on the developing lung, with decreased alveolarization and angiogenesis, mimicking the lung phenotype of bronchopulmonary dysplasia. Neonatal rodent models of acute kidney injury provide opportunities to study mechanisms of kidney-lung crosstalk and novel therapeutics in the context of acute kidney injury in a premature infant.

Comparison between dedicated MRI and symphyseal fluoroscopic guided contrast agent injection in the diagnosis of cleft sign in athletic groin pain and association with pelvic ring instability.

OBJECTIVE: To compare dedicated MRI with targeted fluoroscopic guided symphyseal contrast agent injection regarding the assessment of symphyseal cleft signs in men with athletic groin pain and assessment of radiographic pelvic ring instability. METHODS: Sixty-six athletic men were prospectively included after an initial clinical examination by an experienced surgeon using a standardized procedure. Diagnostic fluoroscopic symphyseal injection of a contrast agent was performed. Additionally, standing single-leg stance radiography and dedicated 3-Tesla MRI protocol were employed. The presence of cleft injuries (superior, secondary, combined, atypical) and osteitis pubis was recorded. RESULTS: Symphyseal bone marrow edema (BME) was present in 50 patients, bilaterally in 41 patients and in 28 with an asymmetrical distribution. Comparison of MRI and symphysography was as followed: no clefts: 14 cases (MRI) vs. 24 cases (symphysography), isolated superior cleft sign: 13 vs. 10, isolated secondary cleft sign: 15 vs. 21 cases and combined injuries: 18 vs. 11 cases. In 7 cases a combined cleft sign was observed in MRI but only an isolated secondary cleft sign was visible in symphysography. Anterior pelvic ring instability was observed in 25 patients and was linked to a cleft sign in 23 cases (7 superior cleft sign, 8 secondary cleft signs, 6 combined clefts, 2 atypical cleft injuries). Additional BME could be diagnosed in 18 of those 23. CONCLUSION: Dedicated 3-Tesla MRI outmatches symphysography for purely diagnostic purposes of cleft injuries. Microtearing at the prepubic aponeurotic complex and the presence of BME is a prerequisite for the development of anterior pelvic ring instability. CLINICAL RELEVANCE STATEMENT: For diagnostic of symphyseal cleft injuries dedicated 3-T MRI protocols outmatch fluoroscopic symphysography. Prior specific clinical examination is highly beneficial and additional flamingo view x-rays are recommended for assessment of pelvic ring instability in these patients. KEY POINTS: • Assessment of symphyseal cleft injuries is more accurate by use of dedicated MRI as compared to fluoroscopic symphysography. • Additional fluoroscopy may be important for therapeutic injections. • The presence of cleft injury might be a prerequisite for the development of pelvic ring instability.

Hairy Cell Leukemia: Where Are We in 2023?

PURPOSE OF REVIEW: This article summarizes the current state of knowledge of hairy cell leukemia (HCL) regarding presentation, diagnosis, therapy, and monitoring, including perspectives on emergent therapies. RECENT FINDINGS: Over the past decade, there has been enormous progress in the understanding of the biology of HCL which has led to the development of novel therapeutic strategies. The maturation of data regarding existing management strategies has also lent considerable insight into therapeutic outcomes and prognosis of patients treated with chemo- or chemoimmunotherapy. Purine nucleoside analogs remain the cornerstone of treatment, and the addition of rituximab has deepened and prolonged responses in the upfront and relapsed setting. Targeted therapies now have a more defined role in the management of HCL, with BRAF inhibitors now having a potential in the first-line setting in selected cases as well as in relapse. Next-generation sequencing for the identification of targetable mutations, evaluation of measurable residual disease, and risk stratification continue to be areas of active investigation. Recent advances in HCL have led to more effective therapeutics in the upfront and relapsed setting. Future efforts will focus on identifying patients with high-risk disease who require intensified regimens. Multicenter collaborations are the key to improving overall survival and quality of life in this rare disease.

Factors affecting the benefit of glasses alone in treating childhood amblyopia: an analysis of PEDIG data.

BACKGROUND: To evaluate factors associated with better outcomes from optical treatment alone in amblyopic children from 3 up to 7 years. METHODS: Data extracted from two studies with similar protocols, Amblyopic Treatment Studies 5 (n = 152) and 13 (n = 128) from the Pediatric Eye Disease Investigator Group database, were used to determine by regression analysis the factors associated with improvements in visual acuity in the amblyopic eye, inter-ocular visual acuity difference and stereoacuity. Input variables were aetiology of amblyopia (anisometropic, strabismic and combined-mechanism amblyopia), treatment compliance, visual acuity, interocular visual acuity difference, stereoacuity, tropia size at distance and near, age and refractive error at baseline. RESULTS: Despite the range of clinical factors considered, our models explain only a modest proportion of the variance in optical treatment outcomes. The better predictors of the degree of optical treatment success in amblyopic children are visual acuity of the amblyopic eye, interocular visual acuity difference, stereoacuity, treatment compliance and the amblyopic eye spherical-equivalent refractive error. While the aetiology of the amblyopia does not exert a major influence upon treatment outcome, combined-mechanism amblyopes experience the smallest improvement in visual acuity, tropia and stereoacuity and may need longer optical treatment periods. CONCLUSIONS: While results identify the factors influencing optical treatment outcome in amblyopic children, clinicians will be unable to predict accurately the benefits of optical treatment in individual patients. Whether this is because relevant clinical or non-clinical factors (e.g. nature and volume of daily activities undertaken) influences the outcomes from optical treatment has not yet been identified and remains to be discovered.

Color vision deficiencies and camouflage: a comparative study between normal and CVD observers.

There is a belief that observers with color vision deficiencies (CVD) perform better in detecting camouflaged objects than normal observers. Some studies have concluded contradictory findings when studying the performance of normal and CVD observers in the camouflage detection tasks in different conditions. This work presents a literature review on this topic, dividing it into three different and contradictory types of results: better performance for CVD, for normal observers, or same performance. Besides, two psychophysical experiments have been designed and carried out in a calibrated computer monitor on both normal and CVD human observers to measure the searching times of the different types of observers needed to find camouflaged stimuli in two different types of stimuli. Results show the trend that, in our experimental conditions, normal observers need shorter searching times than CVD observers in finding camouflaged stimuli both in images of natural scenes and in images with synthetic stimuli.

Long-term effects of blue-blocking spectacle lenses on color perception.

The use of blue-blocking filters is increasing in spectacle lens users. Despite the low absorption in the blue range, some users complain about these filters because they affect their color perception. In a pilot study we have evaluated how the long-term use of 8 different blue-blocking filters impact the color perception during more than 2 weeks on a group of 18 normal color vision observers, compared with a control group of 10 observers. The evaluation was done using the FM100, the Color Assessment and Diagnosis (CAD) and an achromatic point measurement. Our results show that there is a trend to worsen with the filters on.

CVD-MET: an image difference metric designed for analysis of color vision deficiency aids.

Color vision deficiency (CVD) has gained in relevance in the last decade, with a surge of proposals for aid systems that aim to improve the color discrimination capabilities of CVD subjects. This paper focuses on the proposal of a new metric called CVD-MET, that can evaluate the efficiency and naturalness of these systems through a set of images using a simulation of the subject's vision. In the simulation, the effect of chromatic adaptation is introduced via CIECAM02, which is relevant for the evaluation of passive aids (color filters). To demonstrate the potential of the CVD-MET, an evaluation of a representative set of passive and active aids is carried out both with conventional image quality metrics and with CVD-MET. The results suggest that the active aids (recoloration algorithms) are in general more efficient and produce more natural images, although the changes that are introduced do not shift the CVD's perception of the scene towards the normal observer's perception.

MR-proADM as marker of endotheliitis predicts COVID-19 severity.

BACKGROUND: Early identification of patients at high risk of progression to severe COVID-19 constituted an unsolved challenge. Although growing evidence demonstrates a direct association between endotheliitis and severe COVID-19, the role of endothelial damage biomarkers has been scarcely studied. We investigated the relationship between circulating mid-regional proadrenomedullin (MR-proADM) levels, a biomarker of endothelial dysfunction, and prognosis of SARS-CoV-2-infected patients. METHODS: Prospective observational study enrolling adult patients with confirmed COVID-19. On admission to emergency department, a blood sample was drawn for laboratory test analysis. Primary and secondary endpoints were 28-day all-cause mortality and severe COVID-19 progression. Area under the curve (AUC) and multivariate regression analysis were employed to assess the association of the biomarker with the established endpoints. RESULTS: A total of 99 patients were enrolled. During hospitalization, 25 (25.3%) cases progressed to severe disease and the 28-day mortality rate was of 14.1%. MR-proADM showed the highest AUC to predict 28-day mortality (0.905; [CI] 95%: 0.829-0.955; P < .001) and progression to severe disease (0.829; [CI] 95%: 0.740-0.897; P < .001), respectively. MR-proADM plasma levels above optimal cut-off (1.01 nmol/L) showed the strongest independent association with 28-day mortality risk (hazard ratio [HR]: 10.470, 95% CI: 2.066-53.049; P < .005) and with progression to severe disease (HR: 6.803, 95% CI: 1.458-31.750; P = .015). CONCLUSION: Mid-regional proadrenomedullin was the biomarker with highest performance for prognosis of death and progression to severe disease in COVID-19 patients and represents a promising predictor for both outcomes, which might constitute a potential tool in the assessment of prognosis in early stages of this disease.

Understanding Public Perceptions of COVID-19 Contact Tracing Apps: Artificial Intelligence-Enabled Social Media Analysis.

BACKGROUND: The emergence of SARS-CoV-2 in late 2019 and its subsequent spread worldwide continues to be a global health crisis. Many governments consider contact tracing of citizens through apps installed on mobile phones as a key mechanism to contain the spread of SARS-CoV-2. OBJECTIVE: In this study, we sought to explore the suitability of artificial intelligence (AI)-enabled social media analyses using Facebook and Twitter to understand public perceptions of COVID-19 contact tracing apps in the United Kingdom. METHODS: We extracted and analyzed over 10,000 relevant social media posts across an 8-month period, from March 1 to October 31, 2020. We used an initial filter with COVID-19-related keywords, which were predefined as part of an open Twitter-based COVID-19 dataset. We then applied a second filter using contract tracing app-related keywords and a geographical filter. We developed and utilized a hybrid, rule-based ensemble model, combining state-of-the-art lexicon rule-based and deep learning-based approaches. RESULTS: Overall, we observed 76% positive and 12% negative sentiments, with the majority of negative sentiments reported in the North of England. These sentiments varied over time, likely influenced by ongoing public debates around implementing app-based contact tracing by using a centralized model where data would be shared with the health service, compared with decentralized contact-tracing technology. CONCLUSIONS: Variations in sentiments corroborate with ongoing debates surrounding the information governance of health-related information. AI-enabled social media analysis of public attitudes in health care can help facilitate the implementation of effective public health campaigns.

Band Selection for Dehazing Algorithms Applied to Hyperspectral Images in the Visible Range.

Images captured under bad weather conditions (e.g., fog, haze, mist, dust, etc.), suffer from poor contrast and visibility, and color distortions. The severity of this degradation depends on the distance, the density of the atmospheric particles and the wavelength. We analyzed eight single image dehazing algorithms representative of different strategies and originally developed for RGB images, over a database of hazy spectral images in the visible range. We carried out a brute force search to find the optimum three wavelengths according to a new combined image quality metric. The optimal triplet of monochromatic bands depends on the dehazing algorithm used and, in most cases, the different bands are quite close to each other. According to our proposed combined metric, the best method is the artificial multiple exposure image fusion (AMEF). If all wavelengths within the range 450-720 nm are used to build a sRGB renderization of the imagaes, the two best-performing methods are AMEF and the contrast limited adaptive histogram equalization (CLAHE), with very similar quality of the dehazed images. Our results show that the performance of the algorithms critically depends on the signal balance and the information present in the three channels of the input image. The capture time can be considerably shortened, and the capture device simplified by using a triplet of bands instead of the full wavelength range for dehazing purposes, although the selection of the bands must be performed specifically for a given algorithm.

Metasurface-based contact lenses for color vision deficiency: comment.

Recently Karepov and Ellenbogen [Opt. Lett.45, 1379 (2020)OPLEDP0146-959210.1364/OL.384970] claimed that a new metasurface-based contact lens is able to correct deuteranomaly. Unfortunately, their results are not supported by psychophysical experiments, and some key assumptions in their simulations were misinterpreted. All of this has led to wrong conclusions providing false expectations to the color vision deficiency community.

Spatiotemporal analysis of insecticide-treated net use for children under 5 in relation to socioeconomic gradients in Central and East Africa.

BACKGROUND: Insecticide-treated net (ITN) use is the core intervention among the strategies against malaria in sub-Saharan Africa (SSA) and the percentage of ITN ownership has increased from 47% in 2010 to 72% in 2017 across countries in SSA. Regardless of this massive expansion of ITN distribution, considerable gap between ownership and use of ITNs has been reported. Using data from more than 100,000 households in Central and East Africa (CEA) countries, the main aim of this study was to identify barriers associated with low ITN use and conduct geospatial analyses to estimate numbers and locations of vulnerable children living in areas with high malaria and low ITN use. METHODS: Main sources of data for this study were the Demographic and Health Surveys and Malaria Indicator Surveys conducted in 11 countries in CEA. Logistic regression models for each country were built to assess the association between ITN ownership or ITN use and several socioeconomic and demographic variables. A density map of children under 5 living in areas at high-risk of malaria and low ITN use was generated to estimate the number of children who are living in these high malaria burden areas. RESULTS: Results obtained suggest that factors such as the number of members in the household, total number of children in the household, education and place of residence can be key factors linked to the use of ITN for protecting children against malaria in CEA. Results from the spatiotemporal analyses found that although total rates of ownership and use of ITNs across CEA have increased up to 70% and 48%, respectively, a large proportion of children under 5 (19,780,678; 23% of total number of children) still lives in high-risk malaria areas with low use of ITNs. CONCLUSION: The results indicate that despite substantial progress in the distribution of ITNs in CEA, with about 70% of the households having an ITN, several socioeconomic factors have compromised the effectiveness of this control intervention against malaria, and only about 48% of the households protect their children under 5 with ITNs. Increasing the effective ITN use by targeting these factors and the areas where vulnerable children reside can be a core strategy meant to reducing malaria transmission.

Efficacy of Evolocumab vs low-density lipoprotein cholesterol apheresis in patients with familial hypercholesterolemia and high cardiovascular risk (EVOLAFER01).

Low-density lipoprotein (LDL) apheresis has been considered the last option to treat refractory hyperlipidemia in patients with familiar hypercholesterolemia (FH). Evolocumab is a monoclonal antibody which has shown significant reduction of low-density lipoprotein cholesterol (LDL-C) serum levels and cardiovascular events. The aim of the study was to examine the comparative impact of LDL-apheresis vs Evolocumab vs the combination of both LDL-apheresis and Evolocumab on lipid and lipoprotein parameters, and other metabolic/inflammatory measures. DESIGN OF THE STUDY: Non-randomized open case series study of 10 adult patients diagnosed with FH already on long-term LDL-apheresis therapy. The study was developed in three consecutive phases to compare LDL-apheresis, Evolocumab treatment and the combination of both. Laboratory parameters were collected pre and post LDL-apheresis and before Evolocumab administration. The primary endpoint was the reduction of LDL-C during the three phases. RESULTS: Reduction of LDL-C levels with Evolocumab were 31.4% vs LDL-apheresis from 153 ± 35 mg/dL to 105 ± 56 mg/dL (P < .001). Reduction of Lp(a) was also significantly higher with Evolocumab (45.5%) than LDL-apheresis from 36 (6-119) to 20 (3-41) mg/dL, P = .027. In addition, HDL-C and apo-A increased after Evolocumab treatment, from 41 ± 6 to 46 ± 8 mg/dL (P = .003) and from 124 ± 13 to 144 ± 25 mg/dL (P = .001), respectively. No changes in immunological or inflammatory parameters were observed and no serious adverse events were recorded. CONCLUSION: Evolocumab reduces LDL-C and Lp(a) more effectively than LDL-apheresis and combination of Evolocumab plus LDL-apheresis could be a therapeutic alternative to get lower LDL-C and Lp(a) levels in patients with very high cardiovascular risk.