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1.
Vestn Otorinolaringol ; 87(6): 72-75, 2022.
Artículo en Ruso | MEDLINE | ID: mdl-36580513

RESUMEN

One of the brilliant representatives of medicine of the XX century is Yuri Nikolaevich Volkov. His results of scientific and practical activities are impressive in their scale. They are represented in numerous printed works devoted to the most important theoretical and practical aspects of otorhinolaryngology. Yuri Nikolaevich Volkov also created some inventions. His works are included in a four-volume guide to otorhinolaryngology and textbooks for medical students.


Asunto(s)
Otolaringología , Humanos , Historia del Siglo XX , Invenciones
2.
Cancer Treat Res Commun ; 31: 100524, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35101831

RESUMEN

The aim of our trial was to evaluate the prognostic significance of qualitative ctDNA analysis on different stages of EGFR mutated non-small cell lung cancer (NSCLC) treatment. We included 99 patients amendable for the first line treatment with either gefitinib/erlotinib (n = 87), afatinib (n = 10) or osimertinib (n = 2). Sequential qualitative analysis of ctDNA with cobas® EGFR Mutation Test v2 were performed before first dose, after 2 and 4 months of treatment, and on progression. Our analysis showed clinically significant heterogeneity of EGFR-mutated NSCLC treated with 1st line tyrosine kinase inhibitors (TKIs) in terms of progression-free and overall survival. When treated with conventional approach, i.e. monotherapy with TKIs, the patients falls into three subgroups based on ctDNA analysis before and after 2 months of treatment. Patients without detectable ctDNA at baseline (N = 32) possess the best prognosis on duration of treatment (PFS: 24.07 [16.8-31.3] and OS: 56.2 [21.8-90.7] months). Those who achieve clearance after two months of TKI (N = 42) have indistinguishably good PFS (19.0 [13.7 - 24.2]). Individuals who retain ctDNA after 2 months (N = 25) have the worst prognosis (PFS: 10.3 [7.0 - 13.5], p = 0.000). 9/25 patients did not develop ctDNA clearance at 4 months with no statistical difference in PFS from those without clearance at 2 months. Prognostic heterogeneity of EGFR-mutated NSCLC should be taken into consideration in planning further clinical trials and optimizing the outcome of patients.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas , ADN Tumoral Circulante , Neoplasias Pulmonares , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Carcinoma de Pulmón de Células no Pequeñas/genética , ADN Tumoral Circulante/genética , Receptores ErbB/genética , Humanos , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/genética , Inhibidores de Proteínas Quinasas/farmacología , Inhibidores de Proteínas Quinasas/uso terapéutico , Resultado del Tratamiento
3.
Rev Sci Instrum ; 90(5): 053204, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31153262

RESUMEN

With the advent of optical clocks featuring fractional frequency uncertainties on the order of 10-17 and below, new applications such as chronometric leveling with few-centimeter height resolution emerge. We are developing a transportable optical clock based on a single trapped aluminum ion, which is interrogated via quantum logic spectroscopy. We employ singly charged calcium as the logic ion for sympathetic cooling, state preparation, and readout. Here, we present a simple and compact physics and laser package for manipulation of 40Ca+. Important features are a segmented multilayer trap with separate loading and probing zones, a compact titanium vacuum chamber, a near-diffraction-limited imaging system with high numerical aperture based on a single biaspheric lens, and an all-in-fiber 40Ca+ repump laser system. We present preliminary estimates of the trap-induced frequency shifts on 27Al+, derived from measurements with a single calcium ion. The micromotion-induced second-order Doppler shift for 27Al+ has been determined to be δνEMMν=-0.4-0.3 +0.4×10-18 and the black-body radiation shift is δνBBR/ν = (-4.0 ± 0.4) × 10-18. Moreover, heating rates of 30 (7) quanta per second at trap frequencies of ωrad,Ca+ ≈ 2π × 2.5 MHz (ωax,Ca+ ≈ 2π × 1.5 MHz) in radial (axial) direction have been measured, enabling interrogation times of a few hundreds of milliseconds.

4.
Aliment Pharmacol Ther ; 47(2): 259-267, 2018 01.
Artículo en Inglés | MEDLINE | ID: mdl-29181842

RESUMEN

BACKGROUND: Chronic hepatitis C infection leads to impairment of patient-reported outcomes (PROs). Treatment with direct-acting antiviral regimens results in short- and long-term improvement of these outcomes. AIM: To assess PROs in patients treated with a newly developed direct-acting antiviral, a fixed-dose combination of sofosbuvir/velpatasvir (SOF/VEL) with/without voxilaprevir (VOX). METHODS: The PRO data were collected from participants of POLARIS-2 and POLARIS-3 clinical trials (DAA-naïve, all HCV genotypes). Participants self-administered SF-36v2, FACIT-F, CLDQ-HCV and WPAI:SHP instruments at baseline, during treatment, and in follow-up. RESULTS: Of 1160 patients, 611 received SOF/VEL/VOX and 549 received SOF/VEL (52.8 ± 11.0 years, 55.9% male, 75.4% treatment-naïve, 33.9% cirrhotic). The sustained viral response at 12 weeks (SVR12) rates were 95%-98%. During treatment, improvements in most PRO scores were significant (all but one P < .01) and ranged from, on average, +2.3 to +15.0 points (on a 0-100 scale) by the end of treatment. These improvements were similar between SOF/VEL/VOX and SOF/VEL arms (all P > .05). After treatment discontinuation, patients treated with both regimens achieved significant and clinically meaningful PRO gains (+2.7 to +16.7 by post-treatment week 12, +3.9 to +20.1 by post-treatment week 24; all but one P < .001). Multivariate analysis showed that depression, anxiety and cirrhosis were the most consistent independent predictors of PRO impairment while no association of PROs with the treatment regimen choice was found (all P > .05). CONCLUSIONS: The pan-genotypic regimens with SOF/VEL with or without VOX not only have excellent efficacy and safety, but also significantly positively impact patients' experience both during treatment and after achieving sustained virologic response in DAA-naïve patients with HCV.


Asunto(s)
Antivirales/administración & dosificación , Carbamatos/administración & dosificación , Hepatitis C Crónica/tratamiento farmacológico , Compuestos Heterocíclicos de 4 o más Anillos/administración & dosificación , Compuestos Macrocíclicos/administración & dosificación , Sofosbuvir/administración & dosificación , Sulfonamidas/administración & dosificación , Adulto , Ácidos Aminoisobutíricos , Antivirales/efectos adversos , Carbamatos/efectos adversos , Ensayos Clínicos Fase III como Asunto , Ciclopropanos , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Genotipo , Hepatitis C Crónica/genética , Hepatitis C Crónica/virología , Compuestos Heterocíclicos de 4 o más Anillos/efectos adversos , Humanos , Lactamas Macrocíclicas , Leucina/análogos & derivados , Cirrosis Hepática/tratamiento farmacológico , Cirrosis Hepática/genética , Cirrosis Hepática/virología , Compuestos Macrocíclicos/efectos adversos , Masculino , Persona de Mediana Edad , Estudios Multicéntricos como Asunto , Medición de Resultados Informados por el Paciente , Prolina/análogos & derivados , Quinoxalinas , Ensayos Clínicos Controlados Aleatorios como Asunto , Autoinforme , Sofosbuvir/efectos adversos , Sulfonamidas/efectos adversos , Respuesta Virológica Sostenida , Resultado del Tratamiento
5.
J Viral Hepat ; 25(4): 354-362, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-29193603

RESUMEN

Chronic HCV infection has been associated with impairment of HRQL in both adults and paediatric patients. Our aim was to assess the HRQL of HCV-positive children treated with SOF + RBV. The data for this post hoc analysis were collected in a phase 2 open-label multinational study that evaluated safety and efficacy of SOF (400 mg/day) plus RBV (weight-based up to 1400 mg/day) for 12 or 24 weeks in adolescents with chronic HCV (GS-US-334-1112). Patients and their parents/guardians completed the PedsQL-4.0-SF-15 questionnaire at baseline, at the end of treatment and in post-treatment follow-up. We included 50 adolescents with HCV genotype 2 and 3 without cirrhosis (14.8 ± 1.9 years; male: 58%; treatment-naïve: 82%; vertically transmitted HCV: 70%). After treatment, 100% of patients with HCV genotype 2 and 95% with genotype 3 achieved SVR-12. During treatment with SOF + RBV, there were no significant decrements in any of patients' self-reported or parent-proxy-reported PRO scores regardless of treatment duration (all P > .05). After treatment cessation, we recorded a statistically significant improvement in patients' self-reported Social Functioning score by post-treatment week 12: on average, +4.8 points on a 0-100 scale (P = .02). By post-treatment week 24, parent-proxy-reported School Functioning score increased by, on average, +13.0 points (P = .0065). In multivariate analysis, history of abdominal pain and psychiatric disorders were predictive of impaired HRQL in adolescents with HCV (P < .05). Adolescents with HCV do not seem to experience any HRQL decrement during treatment with SOF + RBV and experience some improvement of their HRQL scores after achieving SVR.


Asunto(s)
Antivirales/uso terapéutico , Hepatitis C Crónica/tratamiento farmacológico , Hepatitis C Crónica/psicología , Calidad de Vida/psicología , Ribavirina/uso terapéutico , Sofosbuvir/uso terapéutico , Adolescente , Niño , Quimioterapia Combinada , Femenino , Humanos , Masculino , Encuestas y Cuestionarios , Resultado del Tratamiento
6.
Artículo en Ruso | MEDLINE | ID: mdl-28617385

RESUMEN

Cerebral autosomal dominant arteriopathy with subcortical infarctions and leucoencephalopathy (CADASIL) is an inherited CNS disease, which is caused by mutations in the NOTCH3 gene. Selective disorders of small vessels underlie the disease pathogenesis. Clinically CADASIL is characterized by headaches, multiple stroke-like disorders (in most cases transient ischemic attacks and lacunar strokes), and different focal neurological symptoms and dementia. There are specific MRI signs of the disease: multiple lacunar infarctions located in the basal ganglia, brain steam and cerebellum, focal lesions of temporal poles, capsula externa, periventricular and subcortical areas; diffuse white matter changes and leukoaraiosis can be observed as well. The differential diagnosis of CADASIL is made with many diseases, which are manifested by multiple brain matter lesions, including demyelinating disorders. It should be taken into account that CADASIL is characterized by headaches as one of the initial symptoms, multiple lacunar and diffuse brain matter lesions based on MRI data with an absence of atherosclerosis and arterial hypertension. Family history and autosomal dominant mode of inheritance is also typical of CADASIL. Detection of the NOTCH3 gene mutation is necessary for the definite diagnosis of CADASIL.


Asunto(s)
Encéfalo , CADASIL , Encéfalo/diagnóstico por imagen , CADASIL/diagnóstico , Diagnóstico Diferencial , Humanos , Imagen por Resonancia Magnética , Mutación , Receptor Notch3/genética
7.
Gig Sanit ; 96(2): 158-61, 2017.
Artículo en Ruso | MEDLINE | ID: mdl-29446603

RESUMEN

In the article there are considered current requirements for the design of the architectural environment of preschool institutions. These requirements provide conditions ofpreservation and promotion of health ofpreschool children. Among them are: the association of rooms according to a functional purpose; division of children collectives according to the age; rational placement of main rooms for the prevention ofpenetration of noise and pollution; ensuring convenientfunctional connections between different premises and group rooms and the parcel ofpreschool institutions; optimal solution of the light mode; rational air and thermal mode. There are made proposals for the expansion of the list of hygienic principles of the design of buildings of kindergartens: provision of conditions for realization of physical activity of children, the safe use of electronic educational equipment, and the creation of the barrier-free environment. There was established the insufficiency of areas of group rooms for the realization of voluntary motor activity of children in modern kindergartens and the need of the revision of the standard of the area of the group room per one child.


Asunto(s)
Arquitectura y Construcción de Instituciones de Salud , Escuelas de Párvulos , Códigos de Edificación , Salud Infantil/normas , Preescolar , Arquitectura y Construcción de Instituciones de Salud/métodos , Arquitectura y Construcción de Instituciones de Salud/normas , Humanos , Higiene/normas , Federación de Rusia , Escuelas de Párvulos/organización & administración , Escuelas de Párvulos/normas
8.
Mol Biosyst ; 13(1): 165-182, 2016 Dec 20.
Artículo en Inglés | MEDLINE | ID: mdl-27844078

RESUMEN

Aggregation of amyloid ß (Aß) peptide is implicated in fatal Alzheimer's disease, for which no cure is available. Understanding the mechanisms responsible for this aggregation is required in order for therapies to be developed. In an effort to better understand the molecular mechanisms involved in spontaneous aggregation of Aß peptide, extensive molecular dynamics simulations are reported, and the results are analyzed through a combination of structural biology tools and a novel essential collective dynamics method. Several model systems composed of ten or twelve Aß17-42 chains in water are investigated, and the influence of metal ions is probed. The results suggest that Aß monomers tend to aggregate into stable globular-like oligomers with 13-23% of ß-sheet content. Two stages of oligomer formation have been identified: quick collapse within the first 40 ns of the simulation, characterized by a decrease in inter-chain separation and build-up of ß-sheets, and the subsequent slow relaxation of the oligomer structure. The resulting oligomers comprise a stable, coherently moving sub-aggregate of 6-9 strongly inter-correlated chains. Cu2+ and Fe2+ ions have been found to develop coordination bonds with carboxylate groups of E22, D23 and A42, which remain stable during 200 ns simulations. The presence of Fe2+, and particularly Cu2+ ions, in negatively charged cavities has been found to cause significant changes in the structure and dynamics of the oligomers. The results indicate, in particular, that formation of non-fibrillar oligomers might be involved in early template-free aggregation of Aß17-42 monomers, with charged species such as Cu2+ or Fe2+ ions playing an important role.


Asunto(s)
Péptidos beta-Amiloides/química , Simulación de Dinámica Molecular , Agregado de Proteínas , Agregación Patológica de Proteínas , Multimerización de Proteína , Secuencia de Aminoácidos , Péptidos beta-Amiloides/metabolismo , Interacciones Hidrofóbicas e Hidrofílicas , Iones/química , Metales/química , Fragmentos de Péptidos/química , Conformación Proteica , Dominios y Motivos de Interacción de Proteínas , Estructura Secundaria de Proteína , Estructura Terciaria de Proteína
10.
Gig Sanit ; 95(4): 387-91, 2016.
Artículo en Ruso | MEDLINE | ID: mdl-27430073

RESUMEN

In the article there are presented the results ofphysiological and hygienic evaluation of studies in kindergarten with the use of educational games on an electronic PC tablet. The study involved 44 foster-children. In one of the groups children in the classroom used the interactive game software on electronic PC tablets "Samsung", the same time while working with the PC tablet did not exceed 10 minutes, in the other--the classes were held traditionally. There were investigated the state of health, psychosomatic and psycho-emotional state of children, determined their functional readiness for systematic training in school, mental performance, the functional state of the central nervous system (CNS) by simple visual-motor reaction (SVMR) and reactions to a moving object (RDO). Developing ofgame sessions with the use of electronic PC tablets for 10 minutes were established to contribute to the activation of the central nervous system and increase in children resistance to the development of fatigue.


Asunto(s)
Capacitación de Usuario de Computador , Computadoras de Mano/normas , Niño , Capacitación de Usuario de Computador/métodos , Capacitación de Usuario de Computador/normas , Evaluación Educacional/métodos , Femenino , Humanos , Masculino , Técnicas Proyectivas , Desempeño Psicomotor , Materiales de Enseñanza/normas
11.
J Chromatogr B Analyt Technol Biomed Life Sci ; 1029-1030: 198-204, 2016 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-27433985

RESUMEN

The series of macroporous monolithic molecularly imprinted monoliths differed by pore size, column length (volume) and amount of template used for imprinting was synthesized using methacrylic acid and glycerol dimethacrylate as co-monomers and antibiotic ciprofloxacin as a template. The prepared monoliths were characterized regarding to their permeability, pore size, porosity, and resistance to the flow of a mobile phase. The surface morphology was also analyzed. The slight dependence of imprinting factor on flow rate, as well as its independence on pore size of macroporous molecularly imprinted monolithic media was observed. The column obtained at different conditions exhibited different affinity of ciprofloxacin to the imprinted sites that was characterized with Kdiss values in the range of 10(-5)-10(-4)M. The solid-phase extraction of ciprofloxacin from such biological liquids as human blood serum, human urine and cow milk serum was performed using the developed monolithic columns. In all cases, the extraction was found to be 95.0-98.6%. Additionally, the comparison of extraction of three fluoroqinolone analogues, e.g. ciprofloxacin, levofloxacin and moxifloxacin, from human blood plasma was carried out. Contrary to ciprofloxacin extracted with more than 95%, this parameter did not exceed 40% for its analogues.


Asunto(s)
Antibacterianos/aislamiento & purificación , Ciprofloxacina/aislamiento & purificación , Impresión Molecular/métodos , Extracción en Fase Sólida/métodos , Animales , Antibacterianos/sangre , Antibacterianos/orina , Bovinos , Ciprofloxacina/sangre , Ciprofloxacina/orina , Humanos , Metacrilatos/química , Leche/química , Porosidad
12.
J Viral Hepat ; 23(11): 857-865, 2016 11.
Artículo en Inglés | MEDLINE | ID: mdl-27291391

RESUMEN

A fixed-dose combination of ledipasvir and sofosbuvir (LDV/SOF) has been approved for treatment of HCV patients. We assessed the effect of LDV/SOF on patient-reported outcomes (PROs) in HIV-HCV-co-infected patients. Patient-reported outcomes data from HIV-HCV-co-infected patients who were treated with LDV/SOF for 12 weeks were collected as a part of a clinical trial (ION-4). Historical controls were HIV-HCV-co-infected patients treated with SOF and ribavirin (RBV) in PHOTON-1. We included 335 HIV-HCV-co-infected patients (SVR-12 in HCV genotype 1 was 96%) who received LDV/SOF, while 223 patients (SVR-12 in HCV genotype 1 was 76.3%) received SOF/RBV. During treatment, patients receiving LDV/SOF showed improvement in all of their PRO scores (+6.0% in activity/energy of CLDQ-HCV, +5.0% in fatigue score of FACIT-F, +6.8% in physical component of SF-36; all P < 0.0001) while those receiving SOF+RBV showed moderate decline in some of their PRO scores (-4.8% in physical functioning of SF-36, -4.4% in fatigue score of FACIT-F, both P < 0.001). Patients who achieved sustained virologic response with LDV/SOF also showed improvement of PROs (average +5.1%) while those treated with SOF/RBV showed less or no improvement (average +1.4%). In a multivariate analysis, in addition to depression and fatigue, receiving SOF+RBV (vs LDV/SOF) was independently associated with more PRO impairment during treatment (beta -6.1 to -12.1%, P < 0.001). Hence, HIV-HCV patients treated with LDV/SOF show significant improvement of their health-related quality of life and other patient-reported outcomes during treatment and after treatment cessation.


Asunto(s)
Antivirales/uso terapéutico , Bencimidazoles/uso terapéutico , Fluorenos/uso terapéutico , Infecciones por VIH/complicaciones , Hepatitis C Crónica/complicaciones , Hepatitis C Crónica/tratamiento farmacológico , Sofosbuvir/uso terapéutico , Adulto , Eficiencia , Fatiga/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Resultado del Tratamiento
13.
Aliment Pharmacol Ther ; 44(3): 271-8, 2016 08.
Artículo en Inglés | MEDLINE | ID: mdl-27279496

RESUMEN

BACKGROUND: Chronic hepatitis C patients in need of a lung transplant are often considered ineligible due to their infection. AIM: To assess the association of hepatitis C virus (HCV) infection with long-term outcomes of lung transplants. METHODS: From the Scientific Registry of Transplant Recipients (1995-2011), we selected all adults with and without HCV infection who underwent lung transplantation. RESULTS: A total of 17 762 lung transplant recipients were included (55.5% bilateral). Of those, 319 (1.83%) had positive HCV serology. The HCV-positive recipients were 1.6 years younger, less Caucasian and more African-American, and had a significantly higher rate of co-infection with hepatitis B virus (all P < 0.001). Post-transplant patients were discharged alive at similar rates regardless of HCV status: 88.4% in HCV+ vs. 90.3% in HCV- (P = 0.25). The mortality rates were also similar at 1 and 2 years after transplantation (20.7% in HCV+ vs. 19.2% in HCV- and 31.6% in HCV+ vs. 28.9% in HCV-, respectively; both P > 0.05), but at post-transplant year 3 year, mortality rate in HCV+ became significantly higher (42.5% vs. 36.4%, P = 0.04) and remained higher for the duration of the follow-up (mean 9.1 years, max 18.4 years). In multivariate survival analysis, after adjustment for confounders, being HCV+ was associated with higher mortality: adjusted hazard ratio 1.24 (1.04-1.46), P = 0.01. No association of HCV infection with time to graft loss was found (P = 0.92). CONCLUSIONS: Chronic HCV infection is associated with a moderate increase in post-lung transplant mortality. Treatment of HCV in lung transplant recipients may, therefore, result in improvement of post-transplant outcomes.


Asunto(s)
Hepatitis C Crónica/epidemiología , Trasplante de Pulmón/mortalidad , Trasplante de Pulmón/estadística & datos numéricos , Receptores de Trasplantes/estadística & datos numéricos , Adulto , Anciano , Coinfección , Femenino , Supervivencia de Injerto , Hepatitis C/complicaciones , Hepatitis C/epidemiología , Hepatitis C Crónica/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Sistema de Registros , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del Tratamiento , Estados Unidos/epidemiología
14.
J Viral Hepat ; 23(8): 623-30, 2016 08.
Artículo en Inglés | MEDLINE | ID: mdl-26988765

RESUMEN

Patients with HCV infection have reduced work productivity (WP), in terms of both presenteeism (impairment in work productivity while working) and absenteeism (productivity loss due to absence from work). The aim of this study was to identify clinical and patient-reported factors that are predictive of WP in HCV-infected patients. HCV-infected patients enrolled in clinical trials completed 3 PRO questionnaires (CLDQ-HCV, SF-36 and FACIT-F) and one work productivity (WPAI:SHP) questionnaire. In employed subjects, work productivity and its absenteeism and presenteeism components were calculated using WPAI:SHP instrument. Of 4121 HCV-infected patients with work productivity data, 2480 (60.2%) reported to be employed, and of those, 2190 had completed all PRO questionnaires before treatment initiation. Of the study cohort, 519/2190 (23.7%) had severe work impairment. In multiple linear regression analysis, work productivity was predicted by lower scores in activity/energy domain of CLDQ-HCV, physical well-being domain of FACIT-F, worry domain of CLDQ-HCV and role physical domain of SF-36 (all P < 0.0005). Furthermore, presenteeism was independently predicted by the activity/energy of CLDQ-HCV, physical well-being of FACIT-F, worry domain of CLDQ-HCV, role physical scale of SF-36 and fatigue scale of FACIT-F (P < 0.002). Finally, absenteeism was independently predicted by physical well-being scale of FACIT-F and role physical scale of SF-36 (all P < 0.002). Clinically, work productivity impairment was predicted by the presence of cirrhosis, anxiety, depression and clinically overt fatigue (P < 0.01). Thus, the most important drivers of WP in HCV are impairment of physical aspects of PROs and clinical history of depression, anxiety, fatigue and cirrhosis.


Asunto(s)
Eficiencia , Hepatitis C Crónica/patología , Hepatitis C Crónica/psicología , Absentismo , Adulto , Anciano , Ensayos Clínicos como Asunto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Presentismo , Encuestas y Cuestionarios
16.
J Viral Hepat ; 23(3): 217-26, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26482680

RESUMEN

CH-C negatively affects work productivity (WP), creating a large economic burden. The aim of this study was to model the impact of sustained virologic response (SVR) on WP in CHC genotype 1 (GT1) patients in five European countries (EU5). Work Productivity and Activity Index-Specific Health Problem questionnaire was administered to patients across the ION clinical trials (n = 629 European patients). The analysis modelled a population of GT1 CHC patients over one year, who had been either not treated or treated with LDV/SOF. Sensitivity analyses assessed the possibility that CHC patients' labour costs were lower than the general population's and presented results by fibrosis stage. Before initiation of treatment, EU patients with CHC GT1 exhibited absenteeism and presenteeism impairments of 3.54% and 9.12%, respectively. About 91.8% of EU patients in the ION trials achieved SVR and improved absenteeism and presenteeism impairments by 16.3% and 19.5%, respectively. Monetizing these data, treatment with LDV/SOF resulted in an annual productivity gain of €435 million and a weighted average per-employed patient (PEP) gain of €900 in the EU5. PEP gains from treatment are projected to be higher in cirrhotic than in noncirrhotic patients. If CHC patients are assumed to earn 20% less than the general population, gains of €348 million (€720 PEP) annually are projected. CHC results in a significant economic burden to European society. Due to improvements in WP, SVR with treatment could provide substantial economic gains, partly offsetting the direct costs related to its widespread use.


Asunto(s)
Antivirales/uso terapéutico , Erradicación de la Enfermedad , Eficiencia , Hepatitis C Crónica/tratamiento farmacológico , Modelos Económicos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Bencimidazoles/uso terapéutico , Europa (Continente) , Femenino , Fluorenos/uso terapéutico , Genotipo , Hepacivirus/genética , Hepacivirus/aislamiento & purificación , Hepatitis C Crónica/virología , Humanos , Masculino , Persona de Mediana Edad , Sofosbuvir/uso terapéutico , Encuestas y Cuestionarios , Adulto Joven
17.
J Viral Hepat ; 23(1): 53-61, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26289820

RESUMEN

Hepatocellular carcinoma (HCC) is the most common complication of HCV infection leading to liver transplantation. We evaluated the impact of aetiology of liver disease on patient and graft survival following liver transplantation for HCC. From the Scientific Registry of Transplant Recipients (2002-2011), all adults who underwent liver transplantation for HCC were retrospectively included. Aetiology of liver disease was grouped into HCV, HBV, HCV-HBV co-infection and nonviral liver disease. Of 8,733 liver transplant recipients with HCC, 5507 had HCV, 631 had HBV, 163 were co-infected, and 2432 had nonviral causes of liver disease. In follow-up (48 ± 32 months), 8.2% had graft failure and 29.5% died. The mean rates of graft failure were 9.5%, 4.7%, 6.1% and 6.4% in HCV, HBV, HCV-HBV co-infection and nonviral liver disease, respectively (P < 0.0001). Post-transplant mortality rate in patients with HBV was 20.2%, HCV 31.0%, HCV-HBV 28.5% and nonviral 28.5% (P < 0.0001). This difference was significant starting one year post-transplant and became even more prominent later in follow-up. Five-year post-transplant survival was 64.7% in HCV, 77.7% in HBV, 71.0% in HCV-HBV and 69.1% in nonviral HCC (P < 0.0001). A diagnosis of HCV in patients with HCC was also independently associated with an increased risk of both graft failure (adjusted hazard ratio = 1.84 (1.46-2.33), P < 0.0001) and mortality (1.35 (1.21-1.50), P < 0.0001) in multivariate analysis. Patients with HCV-related HCC are at higher risk of adverse post-transplant outcomes. These patients should be considered for preemptive interferon-free antiviral therapy prior to or immediately following liver transplantation.


Asunto(s)
Carcinoma Hepatocelular/cirugía , Hepatitis C Crónica/cirugía , Neoplasias Hepáticas/cirugía , Trasplante de Hígado/mortalidad , Antivirales/uso terapéutico , Carcinoma Hepatocelular/mortalidad , Carcinoma Hepatocelular/virología , Coinfección/patología , Coinfección/virología , Femenino , Supervivencia de Injerto , Hepatitis B Crónica/tratamiento farmacológico , Hepatitis B Crónica/patología , Hepatitis B Crónica/virología , Hepatitis C Crónica/tratamiento farmacológico , Hepatitis C Crónica/patología , Hepatitis C Crónica/virología , Humanos , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/virología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Receptores de Trasplantes/estadística & datos numéricos
18.
J Viral Hepat ; 22(12): 977-82, 2015 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-26280786

RESUMEN

The interaction of lipoproteins with hepatitis C virus (HCV) has pathogenic and therapeutic implications. Our aim was to evaluate changes in the apolipoprotein profile of patients with chronic hepatitis C during and after successful cure with ledipasvir and sofosbuvir (LDV/SOF) with and without ribavirin (RBV). One hundred HCV genotype 1 patients who had achieved SVR-12 after treatment with 12 weeks of LDV/SOF ± RBV were selected from the ION-1 clinical trial. Frozen serum samples from baseline, end of treatment and week 4 of follow-up were used to assay apolipoproteins (apoAI, apoAII, apoB, apoCII, apoCIII, apoE) using the Multiplex platform to assess for changes in the apolipoprotein levels. At the end of treatment compared to baseline, a significant reduction in apoAII levels (-14.97 ± 63.44 µg/mL, P = 0.0067) and apoE levels (-4.38 ± 12.19 µg/mL, P < 0.001) was noted. These declines from baseline in apoAII (-16.59 ±66.15 µg/mL, P = 0.0075) and apoE (-2.66 ± 12.64 µg/mL, P = 0.015) persisted at 4 weeks of post-treatment follow-up. In multivariate analysis, treatment with LDV/SOF + RBV was independently associated with reduction in apoE (beta = 5.31 µg/mL, P = 0.002) (compared to RBV-free LDV/SOF) (P < 0.05). In contrast, apoCII levels overall increased from baseline to end of treatment (+2.74 ±11.76 µg/mL, P = 0.03) and persisted at 4 weeks of follow-up (+4.46 ± 12.81 µg/mL from baseline, P = 0.0005). Subgroup analysis revealed an increase in apoCII during treatment only in patients receiving LDV/SOF without RBV (+5.52 ± 11.92 µg/mL, P = 0.0007) but not in patients receiving LDV/SOF + RBV (P = 0.638). Treatment with LDV/SOF ± RBV is associated with a persistent reduction in the apolipoprotein AII and E after achieving cure. These data suggest that treatment with LDV/SOF ± RBV may be associated with alterations in serum apolipoproteins which could potentially impact viral eradication.


Asunto(s)
Antivirales/uso terapéutico , Apolipoproteínas/sangre , Bencimidazoles/uso terapéutico , Fluorenos/uso terapéutico , Hepatitis C Crónica/tratamiento farmacológico , Sofosbuvir/uso terapéutico , Quimioterapia Combinada , Femenino , Hepacivirus/efectos de los fármacos , Hepacivirus/metabolismo , Hepatitis C Crónica/virología , Humanos , Masculino , Persona de Mediana Edad , Ribavirina/uso terapéutico
19.
Aliment Pharmacol Ther ; 42(3): 286-95, 2015 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-26059536

RESUMEN

BACKGROUND: Interferon and ribavirin negatively impact health-related quality of life (HRQL) during treatment. AIM: To compare the impact of interferon and/or ribavirin-containing regimens on HRQL to interferon- and ribavirin-free regimens. METHODS: HRQL data from nine multinational phase 3 clinical trials of sofosbuvir (SOF)-based regimens with and without ledipasvir (LDV), pegylated interferon (IFN) or ribavirin (RBV) were used. The Short Form-36 (SF-36) HRQL questionnaire was administered to subjects prospectively at baseline, during treatment, and 12 and 24 weeks after treatment cessation. RESULTS: A total of 3460 CH-C with SF-36 data were included (52.2 ± 10.3 years, 62.6% male, 73.6% treatment-naïve, 15.0% cirrhotic, 68.2% HCV genotype 1 and 20.1% genotype 3). Compared to baseline HRQL, at the end of treatment, severe HRQL decrements were noted in IFN + RBV ± SOF regimens (on average, -3.8 to -24.3 on a 0-100 scale for different HRQL domains), while moderate decrements were noted in SOF + RBV ± LDV (-2.8 to -8.6). In contrast, in SOF/LDV without RBV, HRQL improvements were noted during treatment (+2.3 to +5.2). By 12 weeks post-treatment, HRQL returned to baseline in IFN + RBV ± SOF (P > 0.05) and improved in all IFN-free arms (+2.6 to +7.8). In multivariate analysis, a lower end of treatment HRQL was associated with IFN + RBV + SOF and a higher end of treatment HRQL was associated with SOF/LDV. By post-treatment-12, SOF/LDV was additionally associated with higher mental health scores. These improvements in HRQL scores were maintained 24 weeks post-treatment. CONCLUSIONS: Removing interferon and ribavirin has led to substantial improvement of health-related quality of life during treatment. This may result in better patient experience and higher adherence to treatment regimen.


Asunto(s)
Antivirales/uso terapéutico , Hepatitis C Crónica/tratamiento farmacológico , Interferones/uso terapéutico , Ribavirina/uso terapéutico , Adulto , Ensayos Clínicos Fase III como Asunto , Quimioterapia Combinada , Femenino , Genotipo , Hepacivirus/genética , Humanos , Masculino , Salud Mental , Persona de Mediana Edad , Estudios Prospectivos , Calidad de Vida , Sofosbuvir/uso terapéutico , Encuestas y Cuestionarios , Privación de Tratamiento
20.
J Sep Sci ; 38(16): 2763-71, 2015 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-26033867

RESUMEN

The synthesis of macroporous molecularly imprinted monoliths was performed using the monomers system 2-hydroxyethyl methacrylate-ethylene glycol dimethacrylate and erythromycin as a template. The copolymerization was carried out in situ inside 50 mm × 4.6 mm i.d. stainless-steel tubing. The morphology of the monoliths was examined with scanning electron microscopy. The porous characteristics were determined both from the data of hydrodynamic permeability of monoliths and by means of mercury intrusion porosimetry. The retention parameters of target substance (erythromycin), values of calculated imprinting factors and apparent dynamic dissociation constants were obtained for monoliths prepared with the application of different amount of template (4, 8 and 12 mol%). The separations of the mixtures azithromycin/erythromycin and ciprofloxacin/erythromycin were demonstrated. Additionally, the possibility of erythromycin quantification in human blood plasma was shown.


Asunto(s)
Eritromicina/aislamiento & purificación , Polímeros/química , Adsorción , Cromatografía Líquida de Alta Presión/instrumentación , Eritromicina/sangre , Impresión Molecular , Polimerizacion , Polímeros/síntesis química , Porosidad
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