Total IgE as a biomarker of omalizumab response in chronic spontaneous urticaria: A meta-analysis.

Background: Omalizumab is approved for the treatment of chronic spontaneous urticaria (CSU) that is refractory to antihistamines. Total immunoglobulin E (IgE) levels have emerged as a possible biomarker to predict response to omalizumab. However, the existing literature is heterogenous, with conflicting conclusions with regard to the role of total IgE levels. Objective: We sought to clarify the role of evaluating total IgE levels in patients with CSU by performing a meta-analysis on the existing literature to determine if meaningful changes exist between responders and nonresponders to omalizumab. Methods: A total of 68 unique citations were returned and screened by two independent reviewers. Editorials, reviews, and case reports were excluded, and a total of 33 original articles were identified and underwent secondary evaluation. Studies that present mean ± standard deviation total IgE levels and/or 95% confidence intervals (CI) were included, whereas studies with < 25 subjects were excluded. Three studies ultimately met these criteria. Results: We found a mean difference in total IgE levels between those who responded to omalizumab versus those without a response of 49.76 (95% CI, 7.13-92.38; p = 0.02), which demonstrated higher mean IgE values in responders compared with nonresponders. Conclusion: This study presents additional evidence that supports evaluation of total IgE levels as it pertains to response to omalizumab therapy in CSU. When considering the current evidence, it seems reasonable to consider the baseline total IgE level as a biomarker to predict the treatment response to omalizumab. Based on the existing literature, we cannot conclude at what threshold nonresponse is more likely to occur.

The role of metal patch testing in evaluating patients for metallic prosthetic joint failure.

BACKGROUND: Metal allergy may be an uncommon cause of prosthetic joint failure. There exist little data on patch testing to metals in this context and its impact on outcomes of joint revision in these patients. OBJECTIVE: To explore the use and indications for metal patch testing in the evaluation of patients suspected of having metal allergy as a cause of failed joint replacements and to clarify the outcomes of patients revised with alternative metallic joints because of positive patch testing result. METHODS: A retrospective analysis from January 2016 to April 2020 was completed on a patient cohort referred for evaluation of metal hypersensitivity. Charts were reviewed for age, biological sex, referring specialty, patch testing results, joint, revision status, and outcome measures. Biostatistical analysis and descriptive statistics were performed to determine patch testing performance and functional outcome trends among this patient cohort. RESULTS: The sensitivity and specificity of patch testing, in general, are limited when evaluating patients with metallic joint replacements. However, the predictive value of testing seemed to improve with strongly positive patch testing results. Functional outcomes in patients when positive results were used to guide revision prosthesis revealed clinical improvement. CONCLUSION: The attribution of metal allergy or hypersensitivity as a cause of failure in metal prosthetic joint replacement remains unproven. Some patients with positive histories and patch testing results that were used to modify the implanted prosthesis had improved functional outcomes. These results suggest that patch testing may be useful in patients with history of metal sensitivity and prosthetic failure.

Relativistic correction scheme for core-level binding energies from GW.

We present a relativistic correction scheme to improve the accuracy of 1s core-level binding energies calculated from Green's function theory in the GW approximation, which does not add computational overhead. An element-specific corrective term is derived as the difference between the 1s eigenvalues obtained from the self-consistent solutions to the non- or scalar-relativistic Kohn-Sham equations and the four-component Dirac-Kohn-Sham equations for a free neutral atom. We examine the dependence of this corrective term on the molecular environment and the amount of exact exchange in hybrid exchange-correlation functionals. This corrective term is then added as a perturbation to the quasiparticle energies from partially self-consistent and single-shot GW calculations. We show that this element-specific relativistic correction, when applied to a previously reported benchmark set of 65 core-state excitations [D. Golze et al., J. Phys. Chem. Lett. 11, 1840-1847 (2020)], reduces the mean absolute error (MAE) with respect to the experiment from 0.55 eV to 0.30 eV and eliminates the species dependence of the MAE, which otherwise increases with the atomic number. The relativistic corrections also reduce the species dependence for the optimal amount of exact exchange in the hybrid functional used as a starting point for the single-shot G0W0 calculations. Our correction scheme can be transferred to other methods, which we demonstrate for the delta self-consistent field (ΔSCF) approach based on density functional theory.

Accurate Absolute and Relative Core-Level Binding Energies from GW.

We present an accurate approach to compute X-ray photoelectron spectra based on the GW Green's function method that overcomes the shortcomings of common density functional theory approaches. GW has become a popular tool to compute valence excitations for a wide range of materials. However, core-level spectroscopy is thus far almost uncharted in GW. We show that single-shot perturbation calculations in the G0W0 approximation, which are routinely used for valence states, cannot be applied for core levels and suffer from an extreme, erroneous transfer of spectral weight to the satellite spectrum. The correct behavior can be restored by partial self-consistent GW schemes or by using hybrid functionals with almost 50% of exact exchange as a starting point for G0W0. We also include relativistic corrections and present a benchmark study for 65 molecular 1s excitations. Our absolute and relative GW core-level binding energies agree within 0.3 and 0.2 eV with experiment, respectively.