Asporin Promising Protective Target in Pulmonary Arterial Hypertension Identifies New Multiomics Study

USA: A recent study published in the journal Circulation has revealed that the asporin gene could be a promising therapeutic target for patients with pulmonary arterial hypertension (PAH).

Recent research employing integrative multiomics techniques has illuminated the potential of asporin as a protective factor in PAH. The study, which combined genomic, transcriptomic, proteomic, and metabolomic data, offers new insights into the mechanisms underlying PAH and highlights the promising role of asporin in combating this severe condition.

The researchers identified two gene network modules linked to vascular cells, with asporin emerging as a central hub gene. Asporin was observed to be upregulated in the lungs and plasma of PAH patients and was associated with reduced disease severity.

Pulmonary arterial hypertension is a progressive disease characterized by elevated blood pressure in the pulmonary arteries, leading to heart failure and reduced exercise capacity. Despite advances in treatment, managing PAH remains challenging due to its complex pathophysiology and the need for more targeted therapies.

Integrative multiomics can help us understand pulmonary arterial hypertension better, but getting human lung samples from PAH patients is quite rare. Considering this, Jason Hong, Division of Pulmonary and Critical Care Medicine, University of California, Los Angeles, and colleagues used integrative multiomics to investigate the pathobiology of PAH through transcriptomic profiling and deep phenotyping of the largest multicenter PAH lung biobank.

The researchers utilized transcriptomic profiling and extensive phenotyping from the largest multicenter PAH lung biobank to date, which included 96 PAH samples and 52 control samples. This was integrated with clinicopathologic data, genome-wide association studies, Bayesian regulatory networks, single-cell transcriptomics, and pharmacotranscriptomics.

The study revealed the following findings:

  • Two potentially protective gene network modules associated with vascular cells were identified, and ASPN was validated, coding for asporin, as a key hub gene that is upregulated as a compensatory response to counteract PAH.
  • Asporin is upregulated in the lungs and plasma of multiple independent PAH cohorts and correlates with reduced PAH severity.
  • Asporin inhibits proliferation and transforming growth factor–β/phosphorylated SMAD2/3 signaling in pulmonary artery smooth muscle cells from PAH lungs.
  • In Sugen-hypoxia rats, ASPN knockdown exacerbated PAH, while recombinant asporin attenuated the condition.

“The integrative systems biology approach used to analyze the PAH lung transcriptome revealed asporin as a new potential therapeutic target with protective effects in pulmonary arterial hypertension,” the researchers concluded.

Reference:

Hong J, Medzikovic L, Sun W, Wong B, Ruffenach G, Rhodes CJ, Brownstein A, Liang LL, Aryan L, Li M, Vadgama A, Kurt Z, Schwantes-An TH, Mickler EA, Gräf S, Eyries M, Lutz KA, Pauciulo MW, Trembath RC, Perros F, Montani D, Morrell NW, Soubrier F, Wilkins MR, Nichols WC, Aldred MA, Desai AA, Trégouët DA, Umar S, Saggar R, Channick R, Tuder RM, Geraci MW, Stearman RS, Yang X, Eghbali M. Integrative Multiomics in the Lung Reveals a Protective Role of Asporin in Pulmonary Arterial Hypertension. Circulation. 2024 Aug 21. doi: 10.1161/CIRCULATIONAHA.124.069864. Epub ahead of print. PMID: 39167456.

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Exclusive breastfeeding tied to greater weight loss in women with high BMI compared to women with normal weight: Study

A KK Women’s and Children’s Hospital (KKH) study on breastfeeding practices revealed that among the women who exclusively breastfed, those with high body mass index (BMI) before pregnancy lost more weight than women with a healthy BMI pre-pregnancy.

Women with high BMI who exclusively breastfed, in addition to losing their pregnancy weight, lost an extra 200 grammes on average, 12 months after childbirth. Women with normal BMI who exclusively breastfed lost weight but continued to retain about 1,330 grammes of their postnatal weight during the same period.

Regardless of BMI, all women practising exclusively breastfeeding tended to retain less weight than those who practised mixed feeding or exclusively formula feeding. Most women with normal BMI gain an average of 11 to 16 kilogrammes during pregnancy.

Lead author of the study, Dr Loy See Ling, Department of Reproductive Medicine, KKH, said, “In this year-long study, we made an interesting discovery – an additional benefit for women with high BMI. Due to hormonal factors, there is a re-distribution and management of their body fat to the extent that there is an opportunity for them to lose more than the postnatal weight gain.

“This is of particular interest in Singapore where we are facing a rising obesity rate at 10.5 per cent in a year. Encouraging exclusive breastfeeding alongside targeted lifestyle changes may serve as an effective intervention for enhancing the metabolic health of young mothers and their families after childbirth especially if they have high BMI, thus decreasing the likelihood of mother and child developing obesity, diabetes and cardiovascular diseases in the later years.”

Exclusive breastfeeding benefits all mothers

Supported by Tanoto Foundation, the KKH study is the first such study tracking and linking breastfeeding practices with weight loss in an Asian, multi-ethnic population. The study tracked 379 first-time mothers for 12 months after childbirth, and their feeding practices – where the mothers exclusively breastfed, practiced a mix of breast feeding and formula feed, or excusively formula fed.

The study revealed that six months after giving birth, women of all BMI who exclusively breastfed retained the least amount of the postnatal weight at approximately 910 grammes. In contrast, women who practiced a mix of breast feeding and formula feeding retained 3,280 grammes, while those who exclusively formula fed retained the most at 4,150 grammes.

These patterns remained consistent at 12 months after childbirth – women of all BMI who exclusively breastfed retained approximately 960 grammes of their postnatal weight, much lower than women who mixed fed their babies (2,800 grammes), and those who exclusively formula fed (3,740 grammes). 

Implications of postnatal weight retention in women

Asians are found to have a higher tendency to accumulate abdominal or visceral fat as compared to other populations. This can have a profound impact on the Asian mother’s lifelong health, including metabolic and cardiovascular disease, as well as on subsequent pregnancies and the future health of her child.

Dr Loy said, “Postnatal weight retention can also lead to concerns such as stress, anxiety, and depression, especially in Singapore’s culture where there is an emphasis on a rapid return to pre-pregnancy weight. In women with multiple pregnancies, each instance of retained weight can accumulate, resulting in a significant long-term weight increase that can impact pregnancy outcomes and long-term health, thereby increasing the risk of obesity, diabetes and heart diseases for both mother and child.”

Building a Healthier SG with breastfeeding

This study exemplifies the life-course principle of the KKH-led SingHealth Duke-NUS Maternal and Child Health Research Institute (MCHRI), underscoring the benefits of exclusive breastfeeding and its role in optimising health of mothers and children in setting the foundation that will last beyond infancy, through childhood, adolescence into adulthood.

This is the first published study under the Community-enabled Readiness for first 1,000 days Learning Ecosystem (CRADLE) programme funded by Tanoto Foundation. One of the key programmes under the KKH-led MCHRI, CRADLE aims to create a self-learning eco-community that spans from pregnancy to early childhood, to enhance parenting self-efficacy among first-time parents. Started in 2020, the programme involves KKH participants who were randomly assigned to receive (1) standard routine care; (2) behavioural nudges (text messages) along with the use of a social media platform; or (3) midwife-led continuity care involving individualised teleconferencing sessions, during pregnancy and post-delivery.

In the next phase, CRADLE will provide an innovative, sustainable, scientifically-based strategy to help first-time parents enhance their skills in promoting positive child development and behaviours. This will assist to equip children with the right skills and behaviours for preschool.

Reference:

Loy SL, Chan HG, Teo JX, Chua MC, Chay OM, Ng KC. Breastfeeding Practices and Postpartum Weight Retention in an Asian Cohort. Nutrients. 2024; 16(13):2172. https://doi.org/10.3390/nu16132172.

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Tirofiban Boosts Reperfusion Success and Reduces Disability in Stroke Patients, RESCUE BT Trial Finds

China: The RESCUE BT trial found that intravenous (IV) tirofiban administered before endovascular thrombectomy significantly improved first-pass successful reperfusion (FPSR) rates in patients with acute ischemic stroke caused by large-vessel occlusion. The findings were published online in the Journal of the American Heart Association on November 4, 2024.

“Among 948 patients, FPSR was achieved in 30.5% of those treated with tirofiban, compared to 23.5% in the placebo group. This enhanced reperfusion was associated with better functional outcomes at 90 days,” the researchers reported.

First-pass successful reperfusion (FPSR), which refers to achieving complete and successful reperfusion after a single thrombectomy pass, is a strong predictor of favorable outcomes in patients with acute ischemic stroke due to large-vessel occlusion. Based on this, Junjie Yuan, Department of Critical Care Medicine General Hospital of Southern Theatre Command, PLA Guangzhou China, and colleagues aimed to assess whether intravenous tirofiban could increase the rate of FPSR in patients with acute anterior large-vessel occlusion stroke.

For this purpose, the researchers analyzed data from patients with acute large-vessel occlusion stroke who presented within 24 hours and underwent endovascular thrombectomy as part of the RESCUE BT (Intravenous Tirofiban for Patients With Large Vessel Occlusion Stroke) clinical trial. While the main analysis of the trial was neutral, it randomized patients to receive either intravenous tirofiban or a placebo before thrombectomy.

The primary endpoint was FPSR, defined as successful reperfusion (using the extended thrombolysis in cerebral infarction scale of 2b50, 2c, or 3) achieved after the first thrombectomy attempt. A modified Poisson regression analysis was conducted to assess the association between intravenous tirofiban treatment and FPSR. Among the 948 enrolled patients, 463 were randomized to receive tirofiban and 485 to the placebo group. The mean age of participants was 67 years, and 41.0% of the patients were women.

The findings from the study can be summarized as follows:

  • First-pass successful reperfusion (FPSR):
    • FPSR was achieved more frequently in the tirofiban group compared to the placebo group (30.5% versus 23.5%).
    • The adjusted risk ratio for FPSR in the tirofiban group was 1.24, with statistical significance.
  • Functional Outcomes at 90 Days:
    • FPSR was associated with a favorable shift to lower modified Rankin Scale (mRS) disability levels at 90 days.
    • The common odds ratio for a favorable shift in disability was 1.42, with statistical significance.

In the post hoc analysis of the RESCUE BT randomized clinical trial, intravenous tirofiban administration before endovascular thrombectomy was found to facilitate the achievement of FPSR in patients with acute ischemic stroke due to large-vessel occlusion. Achieving FPSR, in turn, was linked to lower levels of global disability at 90 days.

“These findings suggest that tirofiban may serve as an effective periprocedural adjunct to enhance FPSR rates during endovascular thrombectomy. However, further confirmation through future trials is needed to validate these results,” the researchers concluded.

Reference:

https://doi.org/10.1161/JAHA.124.03635

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High Disease Activity Linked to Lower Cervical Cancer Screening Rates in Women with SLE, Study Finds

USA: A recent study has highlighted significant barriers to cervical cancer screening among women with systemic lupus erythematosus (SLE), emphasizing that higher disease activity is linked to lower screening rates.

The study, published in Arthritis Care & Research, revealed that women with SLE who experience high disease activity are less likely to undergo cervical cancer screening compared to those with lower disease activity. Additionally, perceived barriers to screening are moderately associated with reduced screening rates.

“These findings underscore the importance of developing targeted strategies to enhance cervical cancer screening in this high-risk group,” the researchers wrote. 

Systemic lupus erythematosus is a chronic autoimmune disease that can significantly impact overall health and complicate the management of other medical conditions. Women with SLE are at an increased risk for several health issues, including cervical cancer, making regular screening essential. Sebastian Bruera, Baylor College of Medicine, Houston, Texas, and colleagues aimed to determine cervical cancer screening rates and factors associated with reduced cervical cancer screening in women with SLE.

For this purpose, the researchers conducted a cross-sectional study involving consecutive women aged 21 to 64 with SLE. They gathered data on demographics, clinical characteristics, and Health Beliefs Model (HBM) components, including susceptibility, severity, barriers, benefits, cues to action, and self-efficacy. Self-reported cervical cancer screening data, which were verified with electronic medical records, were also collected.

The primary outcome was adherence to cervical cancer screening as per current guidelines. Multivariable logistic regression models were employed to analyze the relationship between SLE disease activity and cervical cancer screening and to explore the mediation effects of HBM constructs.

The following were the key findings of the study:

  • One hundred thirty women with SLE were enrolled. The median age was 42 years.
  • The cervical cancer screening adherence rate was 61.5%.
  • Women with high SLE disease activity were less likely to have cervical cancer screening versus those with low disease activity (odds ratio 0.59), which remained statistically significant after adjusting for baseline demographics and drug therapy in a multivariable model (odds ratio 0.25).
  • Regarding the HBM constructs, increased perceived barriers to cervical cancer screening (r = −0.30) and decreased self-efficacy (r = −0.21) correlated with decreased cervical cancer screening.

The findings reveal that women with high disease activity are less likely to undergo cervical cancer screening compared to those with lower disease activity.

In summary, the study sheds light on the factors influencing cervical cancer screening adherence among women with systemic lupus erythematosus and calls for targeted interventions to improve screening rates in this high-risk group.

Reference:

Bruera, S., Bowman, S., Huang, Y., Suarez-Almazor, M. E., Lo, G. H., Lopez-Olivo, M., Chiao, E., Kramer, J. R., Pereira, F. A., & Agarwal, S. K. (2024). Factors Associated With Adherence of Cervical Cancer Screening in Women With Systemic Lupus Erythematosus. Arthritis Care & Research, 76(9), 1224-1231. https://doi.org/10.1002/acr.25355

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PCOS in Mothers Linked to Reduced Growth in Newborns, With BMI Playing Key Role, finds study

Norway: Recent research has highlighted a concerning trend in the growth patterns of infants born to mothers with Polycystic Ovary Syndrome (PCOS). According to the study, babies born to these mothers tend to have smaller anthropometric measurements compared to those born to mothers without PCOS, indicating a possible link between the maternal condition and restricted fetal growth.

In the cohort of mother-infant pairs, maternal PCOS status was linked to shorter birth length, reduced birth weight, and smaller head circumference in the infants.

“The observed growth restrictions became more pronounced when accounting for maternal BMI, offering deeper insight into the relationship between PCOS and body mass index. This study enhances our understanding of how PCOS impacts fetal growth and development,” the researchers wrote in JAMA Network Open.

PCOS is a common endocrine disorder affecting women of reproductive age, characterized by irregular menstrual cycles, elevated androgen levels, and polycystic ovaries. The condition influences metabolic and reproductive aspects of women’s health. However, its impact on offspring growth has been less studied until now. To fill this knowledge gap, Maren Sophie Aaserud Talmo, Norwegian University of Science and Technology, Trondheim, Norway, and colleagues aimed to investigate the association between maternal PCOS and newborn anthropometrics and the modifying effects of maternal body mass index (BMI), PCOS phenotype, and gestational diabetes.

The cohort study tracked women from the early stages of pregnancy through to birth, integrating data from three clinical trials involving pregnant women with PCOS and a reference population from the Norwegian Mother, Father, and Child Cohort (MoBa) Study, along with the Medical Birth Registry of Norway. The clinical trials were conducted from October 1, 2000, to August 31, 2017, while the MoBa data covered the period from July 1, 1999, to December 31, 2008. The study included women with singleton pregnancies and live-born children, with data analysis between January 1 and June 15, 2023.

The exposure of interest was maternal PCOS status. Key outcomes measured included newborn birth weight, birth length, head circumference (both as continuous variables and z scores), ponderal index (calculated as birth weight in grams multiplied by 100 and divided by birth length in centimeters cubed), placenta weight, and the ratio of birth weight to placenta weight (BWPW).

The study led to the following findings:

  • The cohort included 390 pregnant women with PCOS (mean age, 29.6 years) and 68 708 women in the reference group (mean age, 30.4 years).
  • The offspring in the PCOS group had lower birth weight, birth length, and head circumference than in the reference group.
  • The estimated mean differences in z scores were −0.26 for birth weight, −0.19 for birth length, and −0.13 for head circumference.
  • The PCOS group also had a lower ponderal index (−0.04 g × 100/cm3) and placenta weight (−24 g), and a higher BWPW ratio (0.4).
  • The association between growth restriction and PCOS was more apparent when additionally adjusting for body mass index.
  • Neither PCOS phenotype nor gestational diabetes diagnosis was associated with neonatal anthropometry in women with PCOS.

The key discovery of the cohort study is that neonates born to mothers with PCOS show signs of growth restriction, including lower birth weight, shorter birth length, and smaller head circumference. This growth restriction was more evident when adjusting for BMI, particularly among women with overweight or obesity, though the impact of maternal BMI requires further investigation.

“Additionally, the study observed a smaller placenta and a higher BWPW ratio, indicating a potentially stressed but efficient placenta,” the researchers added.

“This may help explain the increased perinatal mortality associated with PCOS. Further research is necessary to explore these findings in greater depth,” they concluded.

Reference:

Talmo MSA, Fløysand IS, Nilsen GØ, et al. Growth Restriction in the Offspring of Mothers With Polycystic Ovary Syndrome. JAMA Netw Open. 2024;7(8):e2430543. doi:10.1001/jamanetworkopen.2024.30543

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Counseling Interventions for Walking reduce risk of CV Events in Peripheral Artery Disease, finds study

New research revealed that counseling interventions to increase walking and physical activity have reduced the risk of major adverse cardiovascular events (MACE) and cardiovascular deaths in individuals with peripheral artery disease. The trial which is a post hoc analysis published the results in the journal JAMA Surgery. 

Peripheral artery disease (PAD) is a condition where blood flow to the limbs is reduced due to narrowing of the arteries. This results in walking impairment and increased risk of cardiovascular events. It is a global disease-causing increased risk of heart diseases and stroke. Structured exercise programs significantly improve walking ability and quality of life (QOL) in individuals with peripheral artery disease (PAD). However, access to these programs is often limited, and many patients struggle to maintain the walking improvements over time. Research has shown that short-term benefits are achievable through structured exercise and long-term walking improvements often diminish once formal programs end. Effective long-term strategies could not only enhance mobility but also improve overall cardiovascular health and reduce the risk of adverse events in this population. Hence, Brief Behavioral Intervention by Allied Health Professionals to Promote Physical Activity Interventions for PAD is a randomized clinical trial that was conducted in Australia to offer new hope for patients suffering from PAD. 

Also Read: Study Reveals Potential Causal Link Between Depression and Peripheral Artery Disease

The trial is a parallel, multicenter randomized clinical trial that examined a counseling intervention. It was conducted between January 2015 and August 2023 involving 200 participants from vascular departments in Brisbane, Sydney, and Townsville. Participants who experienced walking difficulties due to PAD were randomly assigned to either a counseling intervention group or a control group. The counseling group were given four brief sessions designed to help them overcome challenges related to increasing physical activity, specifically walking. The primary outcome of the trial was to measure the difference in MACE risk between the two groups.

Findings:

  • The median age of the participants was 70 years, with 28% being female.
  • Over the average follow-up period of 3.5 years, a total of 31 individuals experienced a MACE, including 19 heart attacks, 4 strokes, and 8 cardiovascular-related deaths.
  • The study showed promising results.
  • Participants who received counseling were significantly less likely to experience a MACE compared to those in the control group (9.8% vs. 21.4%).
  • There was a 57% reduction in the risk of cardiovascular events in Intervention group (hazard ratio [HR], 0.43; 95% CI, 0.20-0.91; P = .03).
  • Further analysis suggested that improvements in disease-specific quality of life (QOL) were a key factor in reducing MACE risk.
  • The likelihood of MACE was reduced with higher scores on the Intermittent Claudication Questionnaire (ICQ) and the PAD Quality of Life (PADQOL) survey at four and twelve months. 
  • However, no statistically significant results were seen between counseling and cardiovascular events when the analysis was adjusted for the QOL improvements. 
Also Read: People in their 50s are at higher amputation risk than older people after leg surgery, reveals research

The trial results highlight the potential benefits of counseling interventions aimed at increasing physical activity in PAD patients, possibly due to their positive impact on quality of life. While more research is needed, this trial suggests a promising strategy for reducing cardiovascular risk in a vulnerable population. 

Further reading:

Golledge J, Venn A, Yip L, et al. Counseling Intervention and Cardiovascular Events in People With Peripheral Artery Disease: A Post Hoc Analysis of the BIP Randomized Clinical Trial. JAMA Surg. Published online August 21, 2024. doi:10.1001/jamasurg.2024.3083

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Early-onset asthma worsens memory and executive function in children: JAMA

A recent cohort study published in the Journal of American Medical Association revealed significant insights into how childhood asthma affects cognitive development, particularly memory and executive functions. Approximately 5 million children in the US live with this chronic respiratory condition, but its potential influence on cognitive growth has remained largely unexplored. Thus, this comprehensive, multisite longitudinal research project that started in 2015 to highlight the lesser-known neurological impact of asthma.

The study involved nearly 11,800 children aged 9 to 10 at baseline, with follow-up assessments conducted 1 and 2 years later. The participants were grouped based on their asthma status. For the longitudinal analysis, the children were divided into 3 categories, where one group had those with asthma since baseline (earlier childhood onset), the other with those who developed asthma by the 2-year follow-up (later onset), and another being the control group without asthma. For the cross-sectional analysis, the children were grouped based on whether they had asthma at any time during the study or never had asthma.

Asthma status was established through parent reports, while primary outcomes focused on episodic memory. Secondary outcomes assessed processing speed, attention, and inhibition abilities, which are crucial components of executive function. In the longitudinal analysis involved 474 children, the ones with earlier-onset asthma expressed significantly slower progress in memory development when compared to their peers without asthma. Also, the data indicated that these children had a lower rate of memory improvement over time (β = −0.17, P = .01). The group breakdown showed diverse racial representation, with 56% of the earlier-onset group being male and notable proportions identifying as Black, Hispanic, or White.

The cross-sectional analysis included 2,062 children which reinforced these findings. Children with asthma (n = 1,031) scored lower on episodic memory (β = −0.09, P = .04), processing speed (β = −0.13, P = .01), and executive functions related to inhibition and attention (β = −0.11, P = .02). Demographics revealed that the asthma group had a higher male ratio (57%) and a balanced racial distribution.

Overall, this comprehensive study underlined the potential cognitive toll that asthma may exert on children, particularly the ones with an early onset. These findings point to the importance of early cognitive assessments and targeted interventions for children with asthma to support better educational and developmental outcomes.

Source:

Christopher-Hayes, N. J., Haynes, S. C., Kenyon, N. J., Merchant, V. D., Schweitzer, J. B., & Ghetti, S. (2024). Asthma and Memory Function in Children. In JAMA Network Open (Vol. 7, Issue 11, p. e2442803). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2024.42803

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AI finds undiagnosed liver disease in early stages, suggests study

SAN DIEGO: Liver disease, which is treatable when discovered early, often goes undetected until late stages, but a new study revealed that an algorithm fueled by artificial intelligence can accurately detect early-stage metabolic-associated steatotic liver disease (MASLD) by using electronic health records. The study was scheduled for presentation today at The Liver Meeting, hosted by the American Association for the Study of Liver Diseases.
“A significant proportion of patients who meet criteria for MASLD go undiagnosed,” said Ariana Stuart MD, a resident at University of Washington Internal Medicine Residency Program and lead author of the study. “This is concerning because delays in early diagnosis increase the likelihood of progression to advanced liver disease.”
Researchers used an AI algorithm to analyze imaging findings in electronic health records from three sites within the University of Washington Medical System to identify patients who met the criteria for MASLD, the most common form of liver disease, affecting 4.5 million adults in the United States. While 834 patients met the criteria, only 137 actually had an official MASLD-associated diagnosis in their record. This left 83% of patients undiagnosed even when data in their electronic health record showed they met the criteria for MASLD.
“People should not interpret our findings as a lack of primary care training or management,” Stuart said. “Instead, our study shows how AI can complement physician workflow to address the limitations of traditional clinical practice.”
MASLD occurs when fat isn’t managed properly in the liver and is often associated with other common diseases such as obesity, Type-2 diabetes, and abnormal cholesterol levels. Early diagnosis of MASLD is key because it can quickly progress to more severe forms of liver disease, but many individuals in this early stage are asymptomatic, making diagnosis challenging.
Ariana Stuart, MD, will present the study, “Artificial Intelligence for Early MASLD Identification in the Electronic Medical Record,” abstract 2360, on Saturday, Nov. 16 at 8 a.m. PST.

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Intravitreal Aflibercept and Faricimab decreases ocular blood flow to optic nerve head and peripapillary retinal vessels: Study

Diabetic retinopathy (DR) is the primary cause of visual
impairment among working-age populations in industrialized nations. Vision loss
may result from various mechanisms, but the most prevalent cause is diabetic
macular edema (DME). The treatment landscape for DME has advanced significantly
over the past decade. Currently, the most frequently employed therapeutic approach
involves intravitreal administration of anti-vascular endothelial growth factor
(VEGF) agents, and the prognosis of patients with DME has markedly improved.
There are various commercially available anti-VEGF agents. Older options
include monoclonal antibodies such as ranibizumab and bevacizumab. While
ranibizumab and bevacizumab alone inhibit VEGF-A, aflibercept, a recombinant
fusion protein, inhibits VEGF-A, VEGF-B, and placental growth factor (Plgf),
and faricimab, a bispecific antibody, inhibits both VEGF-A and angiopoietin-2
(Ang-2).

Laser speckle flowgraphy (LSFG) facilitates two-dimensional,
non-invasive measurements of perfusion at the optic nerve head (ONH), retina,
and choroid by utilizing the laser speckle phenomenon and has proven instrumental
in quantifying ocular blood flow in patients with DR, retinal vein occlusion,
age-related macular degeneration, or central serous chorioretinopathy. In this
study, authors aimed to evaluate and compare the effects of intravitreal
aflibercept (IVA) versus intravitreal faricimab (IVF) on blood flow in the
optic nerve head and retinal vessels of the peripapillary region using LSFG in
patients with DME. This was the first study to investigate the effect of
intravitreal faricimab on ocular perfusion and compare the effects of different
anti-VEGF agents on ocular blood flow one month after injection.

This study included 20 eyes of 18 patients treated with IVA
and 15 eyes of 11 patients treated with IVF for DME. The mean blur rate (MBR)
of the ONH and retinal artery and vein of the peripapillary region were
measured using LSFG at baseline and 1 month after injection. Central retinal
thickness (CRT) and best-corrected visual acuity (BCVA) were measured for all
patients.

CRT decreased significantly in both IVA-treated (p = 0.0003)
and IVF-treated groups (p = 0.0004). Some of the MBR-related parameters of the
ONH, such as MBR of all areas (MA), MBR of vascular areas (MV), and MBR of
tissue areas (MT), decreased significantly 1 month after IVA and IVF compared
to baseline values (MA of IVA, p < 0.0001; MT of IVA, p = 0.0220; MA of IVF,
p = 0.0002; MT of IVF, p = 0.0461). MBR of the retinal artery (MBR-A) and vein
(MBR-V) also decreased significantly 1 month after IVA and IVF compared with
baseline values (MBR-A of IVA, p = 0.0002; MBR-V of IVA, p = 0.0010; MBR-A of
IVF, p = 0.0368). No significant difference in ocular perfusion was observed
between the IVA-treated and IVF-treated groups.

In conclusion, the findings demonstrated that both IVA and
IVF resulted in a decrease in ocular blood flow to the optic nerve head and
peripapillary retinal vessels, as evaluated using the LSFG. This decrease was
associated with a reduction in CRT and improvement in BCVA. No significant
difference was observed in MBR reduction between the IVA-treated and
IVF-treated groups. Study findings warrant further long-term investigations to
reveal differences in ocular circulation modifications between aflibercept and
faricimab.

Source: Mizukami et al; Clinical Ophthalmology 2024:18

https://doi.org/10.2147/OPTH.S476307

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Prostatic urethral lift safe for elderly BHP patients with low prostate volume, finds study

A new study published in the International Journal of Urology found that prostatic urethral lift (PUL) is a safe and successful operation for older patients with comorbidities who have prostate volumes less than 100 mL. A prevalent condition affecting the quality of life (QOL) in older men is benign prostatic hyperplasia (BPH). Lower urinary tract symptoms (LUTS), urine retention, and worsening of bladder function are caused by BPH.

Older males were more likely to have moderate to severe LUTS, which was linked to worse health outcomes and greater difficulty doing everyday tasks. The minimally invasive surgical procedure which is prostate urethral lift (PUL) is less intrusive than traditional prostate surgery. One of the most popular operations for BPH is the PUL procedure with the UroLift® System. The patients with preoperative urine retention who have BPH surgery had a poorer postoperative catheter-free rate than the ones who do not.

Thus, this study used real-world multicenter data to assess the safety and effectiveness of PUL. This study examined the postoperative urinary conditions in patients with preoperative urine retention and the individuals without, as well as prostate volumes of less than 30 mL, 30 mL to 50 mL, and more than 50 mL.

PUL indications were derived from pertinent Japanese standards. Evaluations were made of the preoperative condition, postoperative development at 1 and 3 months, and perioperative complications of the patients. Also, the study examined prostate sizes of less than 30 mL, 30 mL to 50 mL, and more than 50 mL, as well as preoperative urine retention and nonurinary retention individuals.

The research involved a total of160 patients in total. The average prostate volume was 44 mL, and the average age was 75 years. 1 and 3 months after surgery, there was a substantial improvement in the International Prostate Symptom Score, quality of life score, maximal flow rate, and postvoid residual volume as compared to before surgery.

On postoperative days 1, 7, 30, and 90, the preoperative urinary retention group’s catheter-free rates were 58.1%, 72.1%, 83.7%, and 88.4%, respectively. On postoperative days 1, 7, and 14, the catheter-free rates of the the nonurinary retention groups were 94.9%, 98.3%, and 100%, respectively.

Among the 3 groups, there was no difference in the postoperative urine status. But, the group with a prostate volume ≥50 mL required considerably more implants and had a longer operation duration. Overall, as long as the prostate volume is less than 100 mL, PUL has been shown to be both safe and effective for treating BPH in elderly individuals with comorbidities.

Reference:

Anan, G., Minami, H., Fujishima, Y., & Kaga, K. (2024). Efficacy and safety of prostatic urethral lift according to preoperative urinary retention and prostate volume: A Japanese real‐world multicenter data. In International Journal of Urology. Wiley. https://doi.org/10.1111/iju.15621

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