Thermal infrared radiances from the Tropospheric Emission Spectrometer (TES) between 10 and 15 μm contain significant carbon dioxide (CO2) information, however the CO2 signal must be separated from ...radiative interference from temperature, surface and cloud parameters, water, and other trace gases. Validation requires data sources spanning the range of TES CO2 sensitivity, which is approximately 2.5 to 12 km with peak sensitivity at about 5 km and the range of TES observations in latitude (40° S to 40° N) and time (2005–2011). We therefore characterize Tropospheric Emission Spectrometer (TES) CO2 version 5 biases and errors through comparisons to ocean and land-based aircraft profiles and to the CarbonTracker assimilation system. We compare to ocean profiles from the first three Hiaper Pole-to-Pole Observations (HIPPO) campaigns between 40° S and 40° N with measurements between the surface and 14 km and find that TES CO2 estimates capture the seasonal and latitudinal gradients observed by HIPPO CO2 measurements. Actual errors range from 0.8–1.8 ppm, depending on the campaign and pressure level, and are approximately 1.6–2 times larger than the predicted errors. The bias of TES versus HIPPO is within 1 ppm for all pressures and datasets; however, several of the sub-tropical TES CO2 estimates are lower than expected based on the calculated errors. Comparisons to land aircraft profiles from the United States Southern Great Plains (SGP) Atmospheric Radiation Measurement (ARM) between 2005 and 2011 measured from the surface to 5 km to TES CO2 show good agreement with an overall bias of −0.3 ppm to 0.1 ppm and standard deviations of 0.8 to 1.0 ppm at different pressure levels. Extending the SGP aircraft profiles above 5 km using AIRS or CONTRAIL measurements improves comparisons with TES. Comparisons to CarbonTracker (version CT2011) show a persistent spatially dependent bias pattern and comparisons to SGP show a time-dependent bias of −0.2 ppm yr−1. We also find that the predicted sensitivity of the TES CO2 estimates is too high, which results from using a multi-step retrieval for CO2 and temperature. We find that the averaging kernel in the TES product corrected by a pressure-dependent factor accurately reflects the sensitivity of the TES CO2 product.
We present volume mixing ratio profiles of NO, NO2, HNO3, HNO4, N2O5, and ClNO3 and their composite budget (NOy), from 20 to 39 km, measured remotely in solar occultation by the Jet Propulsion ...Laboratory MkIV Interferometer during a balloon flight from Fort Sumner, New Mexico (35°N), on September 25, 1993. In general, observed profiles agree well with values calculated using a photochemical steady state model constrained by simultaneous MkIV observations of long‐lived precursors and aerosol surface area from the Stratospheric Aerosol and Gas Experiment II. The measured variation of concentrations of NOx (= NO + NO2) and N2O5 between sunrise and sunset reveals the expected ∼2:1 stoichiometry at all altitudes. Despite relatively good agreement between theory and observation for profiles of NO and HNO3 the observed concentration of NO2 becomes progressively higher than model values below 30 km, with the discrepancy reaching ∼30% at 22 km. This suggests an incomplete understanding of factors that regulate the NO/NO2 and NO2/HNO3 ratios below 30 km. Observations obtained during September 1990, prior to the June 1991 eruption of Mount Pinatubo, as well as during April 1993 and September 1993 provide a test of our understanding of the affect of aerosol surface area on the NOx/NOy ratio at midlatitudes. The observations reveal a decrease in the NOx/NOy ratio for increasing aerosol surface area that is consistent with the heterogeneous hydrolysis of N2O5 being the dominant sink of between altitudes of 18 and 24 km for the conditions encountered (e.g., surface areas as high as 14 μm2 cm−3 and temperatures from 209 to 219 K).
This study was designed to evaluate the total costs associated with repair of laparoscopic cholecystectomy (LC)-related bile duct injuries.
The popularity of LC with both patients and surgeons is ...such that this procedure now exceeds open cholecystectomy by a ratio of approximately 4 to 10:1. However, costs associated with LC-related injuries, particularly regarding treatment patterns, have up to now not been explored fully.
The complete hospital and interventional radiology (IR) billing records for 49 patients who have completed treatment for laparoscopic cholecystectomy-related bile duct injuries were divided into 8 categories. These records were totaled for comparison of costs between patient groups that experienced different injuries and treatment patterns.
Patients with LC-related bile duct injuries were billed a mean of $51,411 for all care related to repair of their bile duct injury. Patients incurred an average of 32 days of inpatient hospitalization and 10 outpatient care days. Postoperative treatment included long-term chronic biliary intubation averaging 378 days. Two patients (4%) died as a result of their LC-related complications. Patients with bile duct injuries that were recognized immediately at the time of the initial surgery ultimately experienced a total cost for their repair and hospitalization of 43% to 83% less than for patients in whom recognition of the injury was delayed (p < 0.019 to 0.070). In addition, the total hospitalization and outpatient care days was reduced by as much as 76% with early recognition of an iatrogenic injury.
Repair of cholecystectomy-related bile duct injuries can run 4.5 to 26.0 times the cost of the uncomplicated procedure and carries a significant mortality rate. Intraoperative recognition of such an injury with immediate conversion to an open procedure for definitive repair can result in significant cost savings and relates directly to a decreased morbidity, mortality, length of hospitalization, and number of outpatient care days.
To compare the outcomes of hemodialysis catheters placed by interventional radiologists with those placed by surgeons.
The outcomes were retrospectively analyzed of 237 hemodialysis catheters placed ...in 140 patients by a radiology service from January 1991 through December 1992. Follow-up data were available for 222 catheters (94%). Catheter secondary patency and freedom from infection were analyzed statistically and by means of life-table analysis.
Pneumothorax occurred after the placement of six catheters (2.5%); in two patients, a chest tube was required for decompression. Other short-term complications included air embolism with no clinical sequelae (two procedures) and prolonged oozing from the tunnel (two procedures). Long-term complications included infection and catheter failure. Infection occurred in 26 patients (18%) with 32 catheters (14%) and resulted in removal of 25 catheters. Ninety-three catheters (42%) failed, and 63 catheters (28%) were removed because of failure.
Hemodialysis catheters placed by radiologists do not have a higher rate of complications or failure than catheters placed by surgeons.
Abstract
Background
With the emergence of oral small molecule therapies for ulcerative colitis (UC), there is a need for identification of favourable safety and efficacy profiles for these therapies. ...The Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency reassessed the benefit–risk of Janus kinase inhibitor (JAKi) use based upon data showing increased risk of major adverse cardiovascular (CV) events (MACE) and cancer with tofacitinib. Accordingly, the PRAC identified criteria for which a JAKi should be used only if no alternatives are available or used with caution. This analysis of the phase 3 True North (TN) study (NCT02435992) evaluated the safety and efficacy of ozanimod (OZA) by the presence of JAKi PRAC criteria in patients with moderately to severely active UC.
Methods
Analyses were performed in TN patients comparing those with ≥1 vs no JAKi PRAC criteria at TN baseline (BL). The criteria included age ≥65 y, history of major CV problems, history of CV risk factors (eg, hypertension, high-density lipoprotein cholesterol <40 mg/dl, diabetes mellitus), current or former smoker, and history of cancer. Safety was monitored through Week (W) 52 and efficacy endpoints were assessed at W10 and W52 in patients receiving OZA or placebo (PBO).
Results
At TN BL, 491 patients had ≥1 JAKi PRAC criteria and 521 had no JAKi PRAC criteria. BL patient characteristics were generally similar across groups, but the ≥1 JAKi PRAC criteria group was older (46-48 y vs 36-37 y), with more male patients (62-72% vs 52-61%) and longer UC disease duration (7-9 y vs 6-7 y) vs the no JAKi PRAC criteria group. Treatment-emergent adverse events (TEAEs) occurring during the induction and maintenance periods are shown in Table 1. Overall, TEAE rates were slightly higher in patients with ≥1 vs no JAKi PRAC criteria; however, rates of serious TEAEs and TEAEs leading to treatment discontinuation were similar. Bradycardia and hypertension rates were slightly higher in patients with ≥1 vs no JAKi PRAC criteria; rates of other CV and thromboembolic events and cancer were similar between groups. At W10, OZA was more effective than PBO for clinical remission and response, with slightly greater treatment differences in patients with ≥1 vs no JAKi PRAC criteria (Figure 1A). At W52, more OZA/OZA pts achieved all endpoints vs OZA/PBO pts, with slightly greater treatment differences in patients with ≥1 vs no JAKi PRAC criteria (Figure 1B).
Conclusion
In patients with UC, JAKi PRAC criteria were not associated with greater rates of MACE or cancer with OZA for up to 52 wk, nor did they affect OZA efficacy, suggesting that OZA is a safe and tolerable oral small molecule treatment option for such patients.
The Far Ultraviolet Spectroscopic Explorer satellite observes light in the far-ultraviolet spectral region, 905-1187 Å, with a high spectral resolution. The instrument consists of four co-aligned ...prime-focus telescopes and Rowland spectrographs with microchannel plate detectors. Two of the telescope channels use Al:LiF coatings for optimum reflectivity between approximately 1000 and 1187 Å, and the other two channels use SiC coatings for optimized throughput between 905 and 1105 Å. The gratings are holographically ruled to correct largely for astigmatism and to minimize scattered light. The microchannel plate detectors have KBr photocathodes and use photon counting to achieve good quantum efficiency with low background signal. The sensitivity is sufficient to examine reddened lines of sight within the Milky Way and also sufficient to use as active galactic nuclei and QSOs for absorption-line studies of both Milky Way and extragalactic gas clouds. This spectral region contains a number of key scientific diagnostics, including O VI, H I, D I, and the strong electronic transitions of H2 and HD.
To evaluate percutaneous declotting of dialysis access grafts with available catheters without urokinase.
Thirty-four clotted grafts were treated in 24 patients. Clot was macerated and pushed into ...the central circulation with balloon catheters.
Successful mechanical declotting was performed in all but two patients (94%). The procedure was abandoned after successful declotting in four patients with poor venous outflow, resulting in a 24-hour success rate of 82%. Mean total procedure time was 116 minutes. Eight grafts clotted within 1 week. Using successful dialysis beyond 1 week as the measure of clinical success, the authors report a 59% clinical success rate with mean primary patency of 126 days (range, 16-322 days). Two complications, both emboli to the brachial artery, were successfully treated with urokinase. No symptomatic pulmonary emboli occurred.
Mechanical thrombolysis of clotted grafts with currently available catheters yields results similar to those reported with mechanical devices and urokinase. The procedure is relatively inexpensive, safe, and well tolerated.
Abstract
Background
Ozanimod is approved in multiple countries for the treatment of adults with moderately to severely active ulcerative colitis (UC). A previous post hoc analysis of individual ...outcomes in the phase 3 True North trial (NCT02435992) identified 5 groups of patient-response trajectories to ozanimod using group-based trajectory modeling (GBTM) and found that populations with fast response had higher rates of disease control, including patient-reported intestinal symptoms and objective measures of disease activity. This analysis of the True North open-label extension study (OLE; NCT02531126) evaluated the durability of ozanimod in the 5 groups for up to 3 years in the OLE (Week W 142).
Methods
In patients who entered the OLE from the 5 patient groups (Group 1 super-response, Group 2 sustained improvement, Group 3 partial improvement, Group 4 fast rebound, and Group 5 slow rebound), symptomatic endpoints were evaluated throughout the OLE until W142. Clinical and mucosal endpoints were evaluated at OLE W46, W94 and W142. Efficacy endpoints were evaluated using nonresponder imputation analysis.
Results
The percentage of patients who continued into the OLE was similar among the 5 trajectory groups, but higher proportions of patients in Groups 1–3 completed W52 before entering the OLE (Group 1 84.2%, Group 2 85.9%, Group 3 86.7%, Group 4 32.0%, and Group 5 28.6%). Notably, more patients from Groups 1 (60.6%), 2 (62.3%), and 3 (60.0%) completed OLE W142 than those in Groups 4 (20.0%) and 5 (26.3%). More patients in Groups 1–3, with the highest rates in Group 1, retained symptomatic response and remission through OLE W142 with continuous ozanimod treatment compared with those in Groups 4 and 5 (Figure). Higher proportions of patients in Groups 1–3 achieved and sustained response in all clinical and mucosal outcomes at OLE W46, W94, and W142 compared with Groups 4 and 5 (Table).
Conclusion
This analysis showed that personalized patient trajectory response-based modeling distinguished patients in terms of long-term outcomes. Specifically, patients with more robust patterns of response (Groups 1–3, especially Group 1) had higher sustained rates of symptomatic, clinical, and mucosal efficacy for up to 3 years of ozanimod treatment in the OLE than patients with less robust response patterns (Groups 4 and 5).
Abstract
Background
Ozanimod (OZA) is approved for the treatment of adults with moderately to severely active ulcerative colitis (UC). A previous post hoc analysis of the phase 3 True North (TN) ...trial identified 5 discrete groups of patient (pt)-response trajectories to OZA using group-based trajectory modelling (GBTM). The current analysis further evaluated symptomatic, clinical, and mucosal outcomes in these groups.
Methods
Five trajectory groups were previously identified by GBTM using change from baseline (BL) in partial Mayo score in pts on continuous OZA treatment until W52 (OZA/OZA; N=229): super-response (Group 1; n=38), sustained improvement (Group 2; n=85), partial improvement (Group 3; n=60), fast rebound (Group 4; n=25), and slow rebound (Group 5; n=21) (Schreiber et al. Am J Gastroenterol. 2023;118:S671–2). In each of these groups, symptomatic remission and response were evaluated through W52, and results were compared with placebo (PBO). Clinical and mucosal EPs were evaluated at W10 and/or W52 using nonresponder imputation analysis.
Results
Significantly more pts in Group 1 vs PBO achieved early symptomatic response on Day (D) 5 (34.2% vs 11.1%; P=0.0002) and remission on D6 (10.5% vs 2.8%; P=0.0264). Symptomatic EPs were sustained for 52 wk in Groups 1–3, whereas Groups 4 and 5 started losing symptomatic efficacy by W18 (Figure 1). The highest proportions of symptomatic remission at W10 were achieved by pts in Groups 1 and 2 (97.4% and 75.3%) and were sustained until W52 (73.7% and 64.7%) (Figure 1A); similarly ~100% of pts in Groups 1 and 2 achieved symptomatic response by W10 and it was sustained in >80% of pts until W52 (Figure 1B). Generally, Groups 1>2>3 had sustained or increased rates of clinical and mucosal EPs from W10 to W52, whereas Groups 4 and 5 had decreased rates of clinical and mucosal EPs at W52 (Table). Corticosteroid (CS)-free remission at W52 was greatest in Groups 1>2>3. Analysis of BL parameters showed that Group 1 had the least prior CS (60.5%), immunomodulator (26.3%), and anti–tumor necrosis factor (TNF) use (23.7%).
Conclusion
This analysis shows 3 distinctly different OZA populations within the responders, with the super-response Group 1 achieving symptomatic response as early as D5. Early response was related to long-term benefits, with Group 1 (and to a lesser extent with Groups 2 and 3) being more likely to achieve disease control at W52 with OZA. These findings demonstrate the utility of personalized medicine to direct therapeutic choice but need to be confirmed in future prospective cohorts.
PDF
