To review the clinical characteristics, antibodies, and response to alternative treatments in a cohort of patients with refractory CIDP.
We reviewed the charts of all CIDP patients seen at the Oregon Health & Science University neuromuscular clinic between 2017 and 2019. We collected demographics, clinical characteristics, antibodies, and response to treatments.
Among 45 CIDP patients studied, 34 (76%) showed improvement with first-line therapy (steroids, IVIG and/or plasmapheresis) and 11 (24%) were considered refractory to first line therapy. Of the latter, 7 of 11 patients (64%) responded to alternative treatment (cyclophosphamide or rituximab). Three were refractory to all treatment. Most patients were ambulatory without aid and a few were in remission. One patient died from complications of alcoholic liver cirrhosis. Thrombosis was seen in three patients receiving IVIG. Six patients (13%) tested positive for Neurofascin (NF) antibodies. Four tested positive for NF155 IgM antibodies only and of those, one responded to IVIG, two partially responded to IVIG and one was refractory. One patient tested positive for NF155 IgG4. Another tested positive for NF155 IgG4 and NF155 IgM. Both patients with IgG4 antibodies were refractory to IVIG, one responded to rituximab and one was refractory to all treatment.
Less than a quarter of our CIDP patients did not respond to steroids, IVIG, and/or plasmapheresis. Most of the refractory patients responded to rituximab or cyclophosphamide. Patients with IgG4 NF antibodies were resistant to IVIG. The majority of refractory CIDP patients were seronegative and disease management relied on clinical judgement.
Less than a quarter of our CIDP patients did not respond to steroids, IVIG, and/or plasmapheresis. Most of the refractory patients responded to rituximab or cyclophosphamide. Patients with IgG4 NF antibodies were resistant to IVIG. The majority of refractory CIDP patients were seronegative and disease management relied on clinical judgement.Research on abundance and composition of fish assemblages surrounding offshore extraction platforms is essential to evaluate their impact as well as to understand relationships between natural and artificial habitats. Also decommissioning practice, which belongs to the lifecycle of these structures, can be encouraged or discouraged if fish school behaviour in the close proximity of the platform is well understood. With thousands of platforms to be decommissioned around the world in coming decades, understanding such dynamic interactions is key to improve spatial management of marine ecosystems. In this context, this study drafts a work plan that can be used to investigate fish presence and abundance, school movement and qualitative species composition around a platform over long time periods. It integrates fishing captures, multibeam echosounder (MBES) investigations, and drop camera shootings to overcome the limitations of the individual methods. Monthly samplings were conducted at a three-leg gas extraction platform placed at ~80 m depth in the central Adriatic Sea, for one year after its installation. MBES completely insonified the studied area, providing data on school shape, volume, surface area and position throughout the water column. Fishing captures were useful for MBES targets' identification by measuring the presence/abundance of nekto-benthic and pelagic species both in the nearby of the structure and in the open sea, while drop camera shootings added evidence of a few species in close proximity to the poles, which were not censused by the other methods. Results underlined the strong attraction exerted by the platform and the significant influence of the explanatory variable distance on the schools' nominal volume.Organisms, such as molluscs, that produce their hard parts from calcium carbonate are expected to show increased difficulties growing and maintaining their skeletons under ocean acidification (OA). Any loss of shell integrity increases vulnerability, as shells provide protection against predation, desiccation, and disease. Not all species show the same responses to OA, which may be due to the composition and microstructural arrangement of their shells. We explore the role of shell composition and microstructure in resisting dissolution caused by decreases in seawater pH using a combination of microCT scans, XRD analysis, and SEM imaging. Two gastropods with different shell compositions and microstructure, Tegula funebralis and Nucella ostrina, were exposed to simulated ocean acidification conditions for six months. Both species showed signs of dissolution on the exterior of their shells, but changes in density were significantly more pronounced in T. funebralis. XRD analysis indicated that the exterior layer of both shell types was made of calcite. T. funebralis may be more prone to dissolution because their outer fibrous calcite layer has more crystal edges and faces exposed, potentially increasing the surface area on which dissolution can occur. These results support a previous study where T. funebralis showed significant decreases in both shell growth and strength, but N. ostrina only showed slight reductions in shell strength, and unaffected growth. We suggest that microstructural arrangement of shell layers in molluscs, more so than their composition alone, is critical for determining the vulnerability of mollusc shells to OA.
Lung to finger circulation time (LFCT) measured from sleep studies may represent a novel physiologic marker for cardiovascular risk in patients with sleep disordered breathing (SDB). We hypothesized that sleep study-derived LFCT would improve risk classification of markers of subclinical cardiovascular disease.
We included participants in the Multi-Ethnic Study of Atherosclerosis (MESA) Sleep cohort with moderate-severe SDB (apnea hypopnea index [AHI]≥15/hr) (N=598).
Those with average LFCT above the median (19.4s) (vs. shorter LFCT) tended to be older, more obese and male. In multivariable analysis, no significant associations were found between average LFCT and subclinical cardiovascular markers including coronary artery calcium, carotid intima-media thickness or left ventricular hypertrophy. However, there was modest improvement in risk classification of coronary artery calcification as compared with AHI alone when average LFCT was added to AHI (C statistics 0.53 vs. click here 0.62, p=0.0066).
In conclusion, LFCT may be a useful addition to conventional SDB metrics to improve cardiovascular risk assessment.click here
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