AudioAbstracts

Vedolizumab as Induction and Maintenance Therapy for Crohn's Disease in Patients Naïve to or Who Have Failed Tumor Necrosis Factor Antagonist Therapy.

Sands BE1, Sandborn WJ, Van Assche G, Lukas M, Xu J, James A, Abhyankar B, Lasch K.

BACKGROUND:

Vedolizumab is a gut-selective α4β7 integrin antagonist for the treatment of moderately to severely active Crohn's disease (CD). Aims of this study were to characterize the efficacy and safety of vedolizumab induction and maintenance therapy in patients who were naïve to tumor necrosis factor-alpha (TNF-α) antagonist therapy (TNF-naïve) or who had discontinued TNF-α antagonist therapy because of inadequate response (i.e., primary nonresponse), loss of response, or intolerance (collectively classified as the TNF-failure population).

METHODS:

Post hoc analyses of the efficacy data for 516 TNF-naïve and 960 TNF-failure patients from the GEMINI 2 and GEMINI 3 trials were evaluated at weeks 6, 10, and 52 and included clinical remission (CD Activity Index [CDAI] score ≤150), enhanced clinical response (≥100-point decrease from baseline in CDAI score), durable clinical remission (remission at ≥80% of visits), and corticosteroid-free remission. Adverse events were summarized for the TNF-naïve and TNF-failure subgroups by treatment received.

RESULTS:

Among patients who responded to vedolizumab induction at week 6, 48.9% …

Predictors of Emergency Department Use by Persons with Inflammatory Bowel Diseases: A Population-based Study

Nugent, Zoann PhD; Singh, Harminder MD, MPH; Targownik, Laura E. MD; Strome, Trevor MS; Snider, Carolyn MD, MPH; Bernstein, Charles N. MD

Background: To describe the patterns and predictors of emergency department (ED) attendance and post-ED hospitalization by persons with inflammatory bowel disease (IBD).

Methods: We linked the University of Manitoba IBD Epidemiology Database with the Emergency Department Information System of the Winnipeg Regional Health Authority to determine the rates of presentation to the ED by persons with IBD from January 01, 2009 to March 31, 2012. Incident cases were diagnosed during the study period and all others were considered prevalent cases. Multivariate logistic regression was used to determine predictors of attendance in the ED and for hospitalization within 2 days of ED attendance.

Results: The study population included 300 incident and 3394 prevalent IBD cases, of whom 76% and 49%, respectively, attended the ED at least once during the study period. Incident cases with Crohn's disease or with a history of opioid use were more likely to attend the ED. Those …

A Cohort Study of Cervical Screening Using Partial HPV Typing and Cytology Triage Mark Schiffman, Noorie Hyun, Tina R. Raine-Bennett, Hormuzd Katki, Barbara Fetterman, Julia C. Gage, Li C. Cheung, Brian Befano, Nancy Poitras, Thomas Lorey, Philip E. Castle and Nicolas Wentzensen Int J Cancer. 2016 Dec 1;139(11):2606-15. doi: 10.1002/ijc.30375. Epub 2016 Aug 26. Abstract HPV testing is more sensitive than cytology for cervical screening. However, to incorporate HPV tests into screening, risk-stratification ("triage") of HPV-positive women is needed to avoid excessive colposcopy and overtreatment. We prospectively evaluated combinations of partial HPV typing (Onclarity, BD) and cytology triage, and explored whether management could be simplified, based on grouping combinations yielding similar 3-year or 18-month CIN3+ risks. We typed ∼9,000 archived specimens, taken at enrollment (2007-2011) into the NCI-Kaiser Permanente Northern California (KPNC) HPV Persistence and Progression (PaP) cohort. Stratified sampling, with reweighting in the statistical analysis, permitted risk estimation of HPV/cytology combinations for the 700,000+-woman KPNC screening population. Based on 3-year CIN3+ risks, Onclarity results could be combined into five groups (HPV16, else HPV18/45, else HPV31/33/58/52, else HPV51/35/39/68/56/66/68, else HPV negative); cytology results fell into three risk groups ("high-grade," ASC-US/LSIL, NILM). For the resultant 15 HPV group-cytology combinations, 3-year CIN3+ ...

Guest: Caroline Mitchell, MD, MPH

The Burden of Bacterial Vaginosis: Women’s Experience of the Physical, Emotional, Sexual and Social Impact of Living with Recurrent Bacterial Vaginosis Jade E. Bilardi, Sandra Walker, Meredith Temple-Smith, Ruth McNair, Julie Mooney-Somers, Clare Bellhouse, Christopher K. Fairley, Marcus Y. Chen, Catriona Bradshaw

Bilardi JE, Walker S, Temple-Smith M, McNair R, Mooney-Somers J, et al. (2013) The Burden of Bacterial Vaginosis: Women’s Experience of the Physical, Emotional, Sexual and Social Impact of Living with Recurrent Bacterial Vaginosis. PLoS ONE 8(9): e74378. doi:10.1371/journal.pone.0074378

Abstract

Background
Bacterial vaginosis is a common vaginal infection, causing an abnormal vaginal discharge and/or odour in up to 50% of sufferers. Recurrence is common following recommended treatment. There are limited data on women’s experience of bacterial vaginosis, and the impact on their self-esteem, sexual relationships and quality of life. The aim of this study was to explore the experiences and impact of recurrent bacterial vaginosis on women.

Methods
A social constructionist approach was chosen as the framework for the study. Thirty-five women with male and/or female partners participated in semi-structured interviews face-to-face or by telephone about their experience of recurrentbacterial vaginosis.

Results
Recurrent bacterial vaginosis impacted on women to varying degrees, with some women ...

Noninvasive prenatal screening for fetal aneuploidy, 2016 update: a position statement of the American College of Medical Genetics and Genomics Anthony R. Gregg, MD, MBA, Brian G. Skotko, MD, MPP, Judith L. Benkendorf, MS, Kristin G. Monaghan, PhD, Komal Bajaj, MD, Robert G. Best, PhD, Susan Klugman, MD and Michael S. Watson, MS, PhD Gregg, AR et al. Noninvasive prenatal screening for fetal aneuploidy: 2016 update Abstract Noninvasive prenatal screening using cell-free DNA (NIPS) has been rapidly integrated into prenatal care since the initial American College of Medical Genetics and Genomics (ACMG) statement in 2013. New evidence strongly suggests that NIPS can replace conventional screening for Patau, Edwards, and Down syndromes across the maternal age spectrum, for a continuum of gestational age beginning at 9–10 weeks, and for patients who are not significantly obese. This statement sets forth a new framework for NIPS that is supported by information from validation and clinical utility studies. Pretest counseling for NIPS remains crucial; however, it needs to go beyond discussions of Patau, Edwards, and Down syndromes. The use of NIPS to include sex chromosome aneuploidy screening and screening for selected copy-number variants (CNVs) is becoming commonplace because there are no other screening options ...

Impact of Specialized Inpatient IBD Care on Outcomes of IBD Hospitalizations: A Cohort Study

Law, Cindy C. Y. MD; Sasidharan, Saranya MD; Rodrigues, Rodrigo MD; Nguyen, Deanna D. MD; Sauk, Jenny MD; Garber, John MD; Giallourakis, Cosmas MD; Xavier, Ramnik MD, PhD; Khalili, Hamed MD, MPH; Yajnik, Vijay MD, PhD; Ananthakrishnan, Ashwin N. MD, MPH

Host: Dr. Manish Singla, Gastroenterology Division, Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, MD

Background: The management of inflammatory bowel diseases (IBDs; Crohn's disease, ulcerative colitis) is increasingly complex. Specialized care has been associated with improved ambulatory IBD outcomes.

Aims: To examine if the implementation of specialized inpatient IBD care modified short-term and long-term clinical outcomes in IBD-related hospitalizations.

Methods: This retrospective cohort study included IBD patients hospitalized between July 2013 and April 2015 at a single tertiary referral center where a specialized inpatient IBD care model was implemented in July 2014. In-hospital medical and surgical outcomes as well as postdischarge outcomes at 30 and 90 days were analyzed along with measures …

Host: David L. Bell, MD, MPH

Human Papillomavirus Vaccine Uptake in Adolescent Boys: An Evidence Review Voss DS1, Wofford LG2. Worldviews Evid Based Nurs. 2016 Jul 26. doi: 10.1111/wvn.12172. [Epub ahead of print] Abstract BACKGROUND:Despite evidence-based guidelines recommending routine vaccination against human papillomavirus (HPV) for adolescent boys, ages 11-12 years, vaccine uptake among this population remains low. AIMS:To examine reasons for low HPV quadrivalent vaccine uptake and methods available to increase vaccine uptake among adolescent males, ages 11-12 years. METHODS AND RESULTS:Of 341 identified studies, 30 were included from three databases. The 30 studies were grouped into six categories: population-specific, problem-specific, educational interventions, theory-specific, political implications, and foundational guidelines and Websites. DISCUSSION:Among eight studies, low vaccine uptake was attributed to lack of parental, adolescent, and physician knowledge of HPV4 vaccine availability and recommendations. HPV4 vaccine educational interventions for parents and adolescents were the most effective for promoting vaccine uptake. Theory applications and gain-framed messages were shown to be effective for assessing HPV vaccine attitudes and perceptions. Political implication studies reveal the need for political and financial measures to encourage HPV vaccine acceptability among the population. IMPLICATIONS FOR CLINICIANS:To promote HPV vaccine uptake among adolescent males, providers must remain current with HPV vaccine recommendations and offer parental ...

A protein homeostasis signature in healthy brains recapitulates tissue vulnerability to Alzheimer’s disease

Rosie Freer, Pietro Sormanni, Giulia Vecchi, Prajwal Ciryam, Christopher M. Dobson, and Michele Vendruscolo

Science Advances 10 Aug 2016: Vol. 2, no. 8, e1600947 DOI: 10.1126/sciadv.1600947

Abstract: In Alzheimer’s disease, aggregates of Aβ and tau in amyloid plaques and neurofibrillary tangles spread progressively across brain tissues following a characteristic pattern, implying a tissue-specific vulnerability to the disease. We report a transcriptional analysis of healthy brains and identify an expression signature that predicts—at ages well before the typical onset—the tissue-specific progression of the disease. We obtain this result by finding a quantitative correlation between the histopathological staging of the disease and the expression patterns of the proteins that coaggregate in amyloid plaques and neurofibrillary tangles, together with those of the protein homeostasis components that regulate Aβ and tau. Because this expression signature is evident in healthy brains, our analysis provides an explanatory link between a tissue-specific environmental risk of protein aggregation and a corresponding vulnerability to Alzheimer’s disease.

Effect of Oral Re-esterified Omega-3 Nutritional Supplementation on Dry Eyes

Alice T. Epitropoulos, MD, Eric D. Donnenfeld, MD, Zubin A. Shah, MPH, Edward J. Holland, MD, Michael Gross, MD, William J. Faulkner, MD, Cynthia Matossian, MD, Stephen S. Lane, MD, Melissa Toyos, MD, Frank A. Bucci, Jr, MD, and Henry D. Perry, MD

Cornea Volume 35, Number 9, September 2016

Abstract:

Purpose: To assess the effect of oral re-esterified omega-3 fatty acids on tear osmolarity, matrix metalloproteinase-9 (MMP-9), tear break-up time (TBUT), Ocular Surface Disease Index (OSDI), fluorescein corneal staining, Schirmer score, meibomian gland dysfunction (MGD) stage and omega-3 index in subjects with dry eyes and confirmed MGD.

Methods: This was a multicenter, prospective, interventional, placebo-controlled, double-masked study. Subjects were randomized to receive 4 softgels containing a total of 1680 mg of eicosapentaenoic acid/560 mg of docosahexaenoic acid or a control of 3136 mg of linoleic acid, daily for 12 weeks. Subjects were measured at baseline, week 6, and week 12 for tear osmolarity, TBUT, OSDI, fluorescein corneal staining, and Schirmer test with anesthesia. MMP-9 testing and omega-3 index were done at baseline and at 12 weeks.

Results: One hundred five subjects completed the study. They were ...

Host: Susan J. Wysocki, WHNP, FAANP

Impact and Effectiveness of the Quadrivalent Human Papillomavirus Vaccine: A Systematic Review of 10 Years of Real-world Experience Clinical Infectious Disease 16 Aug 15;63(4):519-27. doi: 10.1093/cid/ciw354. Epub 2016 May 26. Garland SM1, Kjaer SK2, Muñoz N3, Block SL4, Brown DR5, DiNubile MJ6, Lindsay BR6, Kuter BJ6, Perez G7, Dominiak-Felden G8, Saah AJ6,Drury R8, Das R6, Velicer C6. Abstract: Prophylactic human papillomavirus (HPV) vaccination programs constitute major public health initiatives worldwide. We assessed the global effect of quadrivalent HPV (4vHPV) vaccination on HPV infection and disease. PubMed and Embase were systematically searched for peer-reviewed articles from January 2007 through February 2016 to identify observational studies reporting the impact or effectiveness of 4vHPV vaccination on infection, anogenital warts, and cervical cancer or precancerous lesions. Over the last decade, the impact of HPV vaccination in real-world settings has become increasingly evident, especially among girls vaccinated before HPV exposure in countries with high vaccine uptake. Maximal reductions of approximately 90% for HPV 6/11/16/18 infection, approximately 90% for genital warts, approximately 45% for low-grade cytological cervical abnormalities, and approximately 85% for high-grade histologically proven cervical abnormalities have been reported. The full public health potential of HPV vaccination is not yet realized. HPV-related disease remains a ...