scholarly journals Age Related Non-Type 2 Inflammation and its Association with Treatment Outcome in Patients with Chronic Rhinosinusitis with Nasal Polyp in Korea

2021 ◽  
Author(s):  
Jeong-Whum Kim ◽  
Tae-Bin Won ◽  
Hyunjun Woo ◽  
Seung Koo Yang ◽  
Chayakoen Phannikul ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Chronic Rhinosinusitis ◽  
Nasal Polyp ◽  
Older Patients ◽  
Clinical Characteristics ◽  
Blood Eosinophil ◽  
Younger Patients ◽  
Tissue Eosinophilia ◽  
Type 2 Inflammation

Abstract This study aimed to investigate the effect of age in patients with chronic rhinosinusitis with nasal polyp (CRSwNP). 296 patients were divided into eosinophilic and non-eosinophilic groups based on tissue eosinophilia, defined by eosinophils accounting for more than 20% of the total inflammatory cells. Patients were then further divided into younger and older groups based on the age of 35 years. Clinical characteristics including blood eosinophil, Lund Mackay score, and modified Lund-Kennedy(mLK) scores were compared. Levels of 14 cytokines from nasal tissues of an additional 58 patients were analyzed. Tissue eosinophilia was significantly associated with age, and the proportion of non-eosinophilic CRSwNP was significantly higher in younger patients as compared to older patients (79.2% vs 56.6%). There was no difference in clinical characteristics and cytokine levels between the younger and older patients with eosinophilic CRSwNP. In contrast, younger patients had significantly lower preoperative blood eosinophils and higher mLK scores at three and six months, postoperatively, compared to older patients in patients with non-eosinophilic CRSwNP. Alpha-1 antitrypsin and IL-5 levels were significantly lower in younger patients than in older patients in non-eosinophilic CRSwNP. This study suggests a potential association between age, non-type 2 inflammation and treatment outcome in CRSwNP.

Patient characteristics, biomarkers, and exacerbation risk in severe, uncontrolled asthma

2021 ◽  
pp. 2100413
Author(s):  
Monica Kraft ◽  
Guy Brusselle ◽  
J. Mark FitzGerald ◽  
Ian D. Pavord ◽  
Matthew Keith ◽  
...  
Keyword(s):  
Asthma Exacerbation ◽  
Clinical Characteristics ◽  
Nasal Polyposis ◽  
Blood Eosinophil ◽  
Uncontrolled Asthma ◽  
Asian Race ◽  
Exacerbation Risk ◽  
Type 2 Inflammation ◽  
Eosinophil Counts

BackgroundGreater precision in asthma exacerbation risk prediction may improve outcomes. We sought to identify clinical characteristics and biomarkers associated with elevated exacerbation risk in patients with severe, uncontrolled asthma.MethodsData were pooled from seven similarly designed Phase II and III randomized controlled clinical trials of biologic therapies for the treatment of severe, uncontrolled asthma that enrolled comparable patient populations. Annualized asthma exacerbation rates (AAERs) for patients randomized to placebo were assessed by baseline clinical characteristics and by biomarker concentrations at baseline and over the study duration.ResultsThe AAER for the 2016 patients in the combined placebo group was 0.91 (95% CI 0.84‒0.98). Baseline characteristics associated with greater AAER were frequent or severe exacerbations within the prior 12 months, nasal polyposis, maintenance oral corticosteroid use, Asian race, and Asian or Western European region. AAER increased with baseline blood eosinophil counts and fractional exhaled nitric oxide (FeNO) concentration, with the greatest AAER occurring for patients with eosinophils ≥300 cells·μL−1 and FeNO ≥50 ppb. No relationship was observed between baseline serum immunoglobulin E concentration and AAER. Combining type 2 inflammation criteria for eosinophils and FeNO had greater prognostic value than either biomarker alone. Persistent eosinophil and FeNO elevations throughout the study period were associated with greater AAER.ConclusionsExacerbation history, maintenance corticosteroid use, nasal polyposis, Asian race, geographic region, and elevations in blood eosinophil counts and FeNO concentrations (particularly when combined and/or persistently achieving type 2 inflammation criteria) were associated with increased exacerbation risk in patients with severe, uncontrolled asthma.

scholarly journals Clinical Characteristics and Prognostic Factors of Early-Onset Pancreatic Neuroendocrine Tumors

2021 ◽  
Vol 28 ◽  
pp. 107327482098682
Author(s):  
Min Shi ◽  
Biao Zhou
Keyword(s):  
Prognostic Factors ◽  
Neuroendocrine Tumors ◽  
Early Onset ◽  
Older Patients ◽  
Clinical Characteristics ◽  
Clinicopathological Characteristics ◽  
Pancreatic Neuroendocrine Tumors ◽  
Chi Square ◽  
Younger Patients ◽  
Significant Difference

Background: The incidence of pancreatic neuroendocrine tumors (PNETs) has increased significantly. The purpose of this study was to analyze the clinical characteristics and prognosis of patients under 50 years old. Methods: Patients with PNETs recorded in the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2015 were analyzed. The clinical characteristics were analyzed by Chi-square test. The Kaplan-Meier method was used to estimate overall survival (OS). Multivariate Cox proportional risk regression analysis was used to determine independent prognostic factors. Results: 2,303 patients included, of which 547 (23.8%) patients were younger than 50 years old. The number of younger patients has increased steadily, while the proportion in total PNETs decreased recently. Compared with older group, the proportion of the Black, grade I/II, and surgery were higher in early-onset PNETs. Liver was the most frequent metastatic site. There was no significant difference in the incidence of different metastatic sites between younger and older PNETs patients, while younger patients had better OS (P < 0.05). Grade, N stage, M stage, and surgery were independent prognostic factors for OS in early-onset PNETs. Conclusions: Younger patients have unique clinicopathological characteristics compared with older patients in PNETs. Better OS was observed in younger patients which might due to the higher proportion of well-differentiated tumor and surgery than older patients.

scholarly journals Multiparametric Analysis of Factors Associated With Eosinophilic Chronic Rhinosinusitis With Nasal Polyps

2020 ◽  
pp. 014556132096035
Author(s):  
Gian Luca Fadda ◽  
Andrea Galizia ◽  
Giuseppe Galizia ◽  
Paolo Castelnuovo ◽  
Maurizio Bignami ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Nasal Polyps ◽  
Predictive Biomarker ◽  
Blood Eosinophil ◽  
High Power Field ◽  
Diverse Range ◽  
Blood Eosinophilia ◽  
Tissue Eosinophilia ◽  
Eosinophilic Chronic Rhinosinusitis ◽  
Clinical Records

Introduction: Previous studies have reported a diverse range of threshold values for blood eosinophilia. In addition, a single predictive biomarker for eosinophilic chronic rhinosinusitis (CRS) with nasal polyps (ECRSwNP) has not yet been identified. Objectives: The aim of this study is to compare the clinical characteristics of ECRSwNP and non-ECRSwNP to evaluate the preoperative risk of tissue eosinophilia of chronic rhinosinusitis with nasal polyps (CRSwNP) through a multiparametric statistical analysis. Methods: One hundred ten patients with evidence of chronic polypoid rhinosinusitis were included in this study and clinical records were retrospectively reviewed. Eosinophilic CRSwNP was diagnosed based on the presence of at least 10 eosinophils per high-power field. The demographic and clinical features of ECRSwNP and non-ECRSwNP are described. The values of blood eosinophilia as predictors of tissue eosinophilia have been identified using receiver operating characteristic curves. As the predictive value of the identified cutoff through regression analysis was low, we evaluated whether other risk factors could be statistically associated with ECRSwNP, and from this, a new predictive model was proposed for the identification of eosinophilic nasal polyps before surgery. Results: We found that the best method for predicting ECRSwNP is based on a model having asthma, blood eosinophil percentage, posterior ethmoid value in Lund-Mackay score, and modified Lund-Kennedy score as explanatory variables. Conclusions: This study provides new data for a better understanding of the polypoid CRS endotypes, and the proposed model allows the endotype to be identified preoperatively.

P505 DUPILUMAB EFFECT ON TYPE 2 INFLAMMATION BIOMARKERS IN CHRONIC RHINOSINUSITIS WITH NASAL POLYPS AND NSAID-ERD

2020 ◽  
Vol 125 (5) ◽  
pp. S48
Author(s):  
A. White ◽  
S. Fujieda ◽  
T. Takabayashi ◽  
N. Daizadeh ◽  
Y. Deniz ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Nasal Polyps ◽  
Type 2 Inflammation

scholarly journals Dupilumab: new opportunities for the treatment of asthma and chronic rhinosinusitis with nasal polyps

2021 ◽  
Vol 18 (1) ◽  
pp. 18-31
Author(s):  
Miramgul E. Dyneva ◽  
Gulyumkhan E. Aminova ◽  
Oksana Kurbacheva ◽  
Natalya I. Il'ina
Keyword(s):  
Chronic Rhinosinusitis ◽  
Nasal Polyps ◽  
Human Monoclonal Antibody ◽  
High Rate ◽  
Cytokine Signaling ◽  
Main Task ◽  
Receptor Complexes ◽  
Target Individual ◽  
Type 2 Inflammation

Airway inflammation plays a key role in asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). The inflammatory process can vary in intensity thus affecting the clinical picture of the disease and, most importantly, the effectiveness of therapy. Today, there is still a high rate of growth in the incidence of asthma and CRSwNP and dissatisfaction with the effectiveness of existing therapy for severe forms of asthma, especially when asthma is associated with CRSwNP, so the main task is to find new approaches to diagnosis and therapy. The development of biologics is a promising step forward in achieving control of severe and poorly controlled asthma and recurrent CRSwNP that target individual and specific components of inflammation. One of the latest monoclonal antibodies is Dupilumab that has shown significant success in the treatment of asthma and CRSwNP. Dupilumab is a fully human monoclonal antibody directed against the -subunit of the Il-4 interleukin receptor (IL-4R), common to both IL-4 and IL-4/IL-13 receptor complexes. This contributes to the suppression of type 2 cytokine signaling (IL-4 and IL-13), since the IL-4/IL-13/STAT6 signaling pathway plays a crucial role in type 2-inflammation. Currently, Dupilumab is approved for the treatment of severe asthma and CRSwNP, so this article summarizes the main information about Dupilumab and its effectiveness in these diseases, as well as presents the results of clinical observation.

scholarly journals The epidemiology of diabetes in the Waikato region: an analysis of primary care data

2021 ◽  
Vol 13 (1) ◽  
pp. 44
Author(s):  
Lynne Chepulis ◽  
Brittany Morison ◽  
Rawiri Keenan ◽  
Ryan Paul ◽  
Chunhuan Lao ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Primary Care ◽  
Clinical Characteristics ◽  
Glycated Haemoglobin ◽  
Annual Review ◽  
Available N ◽  
Younger Patients ◽  
General Practices ◽  
Prevalence Of Diabetes Mellitus

ABSTRACT INTRODUCTIONDiabetes mellitus is common in primary care, yet little has been reported of its primary care prevalence or the clinical characteristics of patients with Type 2 diabetes mellitus (T2DM). AIMTo determine the prevalence of diabetes mellitus and clinical characteristics of diabetes patients in primary care in the Waikato region. METHODSPrimary care data were extracted from the electronic records of 15 general practices for patients aged &gt;20 years with current diabetes mellitus at 20 June 2017. Diabetes mellitus was defined as having a glycated haemoglobin (HbA1c) of ≥50mmol/mol (6.7%) or having being dispensed two or more anti-diabetic medications in the previous 12 months. Additional data collected included patients’ ethnicity, age, sex and years since diagnosis. RESULTSThe overall prevalence of diabetes mellitus was 5.7% and was higher for Māori (8.6%), Asian (7.0%) and Pacific peoples (9.1%) than Europeans (5.0%; all P&lt;0.001). For patients with T2DM for whom current diabetes annual review data were available (n=2227) the mean body mass index (BMI) was 32.8±0.2kg/m2, but BMI was higher in Māori, younger patients, females and patients diagnosed &lt;2 years previously (all P&lt;0.001). Similarly, HbA1c levels were highest in Māori and younger patients (both P&lt;0.001), with 40% of patients overall having a HbA1c of ≤53mmol/mol (7.0%). Approximately 70% of all patients had at least one measure of hypertension (systolic ≥130 or diastolic ≥80mmHg), or dyslipidaemia. More than 85% of patients had completed a recent retinal screen and foot check. DISCUSSIONWe found that management of T2DM was suboptimal, with measures for many patients not meeting clinical targets. Support should be provided to improve weight and glycaemic management, particularly for Māori, females and younger patients.

scholarly journals Clinical characteristics and comparison of the outcome in young versus older patients with upper gastrointestinal carcinoma

2020 ◽  
Vol 146 (12) ◽  
pp. 3313-3322
Author(s):  
Hannah Christina Puhr ◽  
Alexander Karner ◽  
Hossein Taghizadeh ◽  
Gerd Jomrich ◽  
Sebastian Friedrich Schoppmann ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Older Patients ◽  
Clinical Characteristics ◽  
Young Patients ◽  
Screening Methods ◽  
Gastrointestinal Carcinoma ◽  
Younger Patients ◽  
Metastatic Setting ◽  
Initial Onset ◽  
Tumour Location

Abstract Background The clinical behaviour and outcome of young patients with gastroesophageal tumours (GET) is surmised to differ from older patients, yet data on the comparison of these two patient subgroups is scarce. This study focuses on the investigation of the clinical characteristics and survival outcome of younger-age people with GET, when compared to older patients. Methods Patients diagnosed with GET at the Medical University of Vienna between 2004 and 2016 were included in this study. Clinical parameters and the overall survival (OS) were compared between young (≤ 45 years) and elderly (≥ 65 years) patients. Results Among 796 patients, who were eligible for this analysis, fifty-eight patients (7%) were ≤ 45 years at the initial onset of the disease. These 58 young patients were then matched to elderly patients based on the gender, tumour stage, histology and tumour location. The number of metastatic lesions was significantly higher among young patients (p < 0.05). In a non-metastatic setting younger patients showed a significant longer OS than older patients (median 1226 versus 801 days, p = 0.028). Furthermore, young patients with extensive metastatic disease (2 or more metastatic site) had a significantly poorer OS than elderly patients (median 450 versus 646 days, p = 0.033). Conclusion These results indicate that young patients might be diagnosed very late, which might lead to the development of a more aggressive disease compared to older patients, but a relatively long OS when diagnosed and treated in a non-metastatic setting. Thus, screening methods for younger patients might be considerable to enhance the outcome of young patients with GET.

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