Background
In Europe cardiovascular disease (CVD) is responsible for 3.9 million deaths (45% of deaths), being ischaemic heart disease, stroke, hypertension (leading to heart failure) the major cause ...of these CVD related deaths. Periodontitis is also a chronic non‐communicable disease (NCD) with a high prevalence, being severe periodontitis, affecting 11.2% of the world's population, the sixth most common human disease.
Material and Methods
There is now a significant body of evidence to support independent associations between severe periodontitis and several NCDs, in particular CVD. In 2012 a joint workshop was held between the European Federation of Periodontology (EFP) and the American Academy of Periodontology to review the literature relating periodontitis and systemic diseases, including CVD. In the last five years important new scientific information has emerged providing important emerging evidence to support these associations
Results and Conclusions
The present review reports the proceedings of the workshop jointly organised by the EFP and the World Heart Federation (WHF), which has updated the existing epidemiological evidence for significant associations between periodontitis and CVD, the mechanistic links and the impact of periodontal therapy on cardiovascular and surrogate outcomes. This review has also focused on the potential risk and complications of periodontal therapy in patients on anti thrombotic therapy and has made recommendations for dentists, physicians and for patients visiting both the dental and medical practices.
ABSTRACT
BACKGROUND & AIMS
Elimination of HCV by 2030, as defined by the World Health Organization (WHO), is attainable with the availability of highly efficacious therapies. This study reports ...progress made in the timing of HCV elimination in 45 high‐income countries between 2017 and 2019.
METHODS
Disease progression models of HCV infection for each country were updated with latest data on chronic HCV prevalence, and annual diagnosis and treatment levels, assumed to remain constant in the future. Modelled outcomes were analysed to determine the year in which each country would meet the WHO 2030 elimination targets.
RESULTS
Of the 45 countries studied, 11 (Australia, Canada, France, Germany, Iceland, Italy, Japan, Spain, Sweden, Switzerland, and United Kingdom) are on track to meet WHO's elimination targets by 2030; five (Austria, Malta, Netherlands, New Zealand, and South Korea) by 2040; and two (Saudi Arabia and Taiwan) by 2050. The remaining 27 countries are not expected to achieve elimination before 2050. Compared to progress in 2017, South Korea is no longer on track to eliminate HCV by 2030, three (Canada, Germany, and Sweden) are now on track, and most countries (30) saw no change.
CONCLUSIONS
Assuming high‐income countries will maintain current levels of diagnosis and treatment, only 24% are on track to eliminate HCV by 2030, and 60% are off track by at least 20 years. If current levels of diagnosis and treatment continue falling, achieving WHO's 2030 targets will be more challenging. With less than ten years remaining, screening and treatment expansion is crucial to meet WHO's HCV elimination targets.
Background and Aim
Therapeutic endoscopy has recently evolved into the treatment of complex gastrointestinal (GI) postoperative leakage, especially with over‐the‐scope clips (OTSC). We describe our ...2‐year experience of 30 patients treated for digestive fistulas using the OTSC device.
Methods
This was a retrospective study conducted on patients referred for GI fistulas in two French hospitals. Technical aspects, clinical outcomes and closure rates were recorded.
Results
Thirty patients were treated for GI leaks: 19 (63%) had a gastric fistula after laparoscopic sleeve gastrectomy (LSG); the others had rectovaginal, urethrorectal, rectovesical, gastrogastric, gastrocutaneous, esophagojejunal fistulas and colorectal anastomotic leak. Average follow up was 10.4 months. Eighteen (60%) had undergone previous endoscopic or surgical treatment. Orifice size was 3–20 mm (average 7.2 mm). Successful OTSC placement was achieved in 30 out of 34 attempts. There were four intraoperative undesired events (13.3%) but these were successfully managed. Overall success rate was 71.4% and 16 patients (53%) recovered with primary efficacy. Six patients (20%) required a subsequent endoscopic treatment. Eight patients (26.7%) required surgery for failure. In nine cases, we used one or more additional endoscopic procedures concomitantly with the OTSC combining self‐expandable metal stents, standard clips and glue injection. Healing rate after LSG fistula was 88.9%, which was significantly higher than the overall rate (P = 0.01).
Conclusion
OTSC placement seems to be safe and effective for the treatment of GI fistulas. Better results were seen in leaks after LSG.
The COPD Patient Management European Trial (COMET) investigated the efficacy and safety of a home-based COPD disease management intervention for severe COPD patients.The study was an international ...open-design clinical trial in COPD patients (forced expiratory volume in 1 s <50% of predicted value) randomised 1:1 to the disease management intervention or to the usual management practices at the study centre. The disease management intervention included a self-management programme, home telemonitoring, care coordination and medical management. The primary end-point was the number of unplanned all-cause hospitalisation days in the intention-to-treat (ITT) population. Secondary end-points included acute care hospitalisation days, BODE (body mass index, airflow obstruction, dyspnoea and exercise) index and exacerbations. Safety end-points included adverse events and deaths.For the 157 (disease management) and 162 (usual management) patients eligible for ITT analyses, all-cause hospitalisation days per year (mean±sd) were 17.4±35.4 and 22.6±41.8, respectively (mean difference -5.3, 95% CI -13.7 to -3.1; p=0.16). The disease management group had fewer per-protocol acute care hospitalisation days per year (p=0.047), a lower BODE index (p=0.01) and a lower mortality rate (1.9%
14.2%; p<0.001), with no difference in exacerbation frequency. Patient profiles and hospitalisation practices varied substantially across countries.The COMET disease management intervention did not significantly reduce unplanned all-cause hospitalisation days, but reduced acute care hospitalisation days and mortality in severe COPD patients.
This study investigated the temporal variability and changes in snow cover duration and the average snow depth from December to April in the Pyrenees at 1,500 and 2,100 m a.s.l. for the period ...1958–2017. This is the first such analysis for the entire mountain range using SAFRAN‐Crocus simulations run for this specific purpose. The SAFRAN‐Crocus simulations were evaluated for the period 1980–2016 using 28 in situ snow depth data time series, and for the period 2000–2017 using MODIS observations of the snow cover duration. Following confirmation that the simulated snow series satisfactorily reproduced the observed evolution of the snowpack, the Mann–Kendall test showed that snow cover duration and average depth decreased during the full study period, but this was only statistically significant at 2,100 m a.s.l. The temporal evolution in the snow series indicated marked differences among massifs, elevations, and snow variables. In general, the most western massifs of the French Pyrenees underwent a greater decrease in the snowpack, while in some eastern massifs the snowpack did not decrease, and in some cases increased at 1,500 m a.s.l. The results suggest that the trends were consistent over time, as they were little affected by the start and end year of the study period, except if trends are computed only starting after 1980, when no significant trends were apparent. Most of the observed negative trends were not correlated with changes in the atmospheric circulation patterns during the snow season. This suggests that the continuous warming in the Pyrenees since the beginning of the industrial period, and particularly the sharp increase since 1955, is a major driver explaining the snow cover decline in the Pyrenees.
Snow duration and accumulation have shown decreasing trend during the study period. Statistically significance of trends increases at higher elevations because warming affects mainly spring time. Most of trends in snowpack seem to be non‐related with changes in atmospheric circulation.
Downstream microvascular thrombosis (DMT) is known to be a contributing factor to incomplete reperfusion in acute ischemic stroke. The aim of this study was to determine the timing of DMT with ...intravital imaging and to test the hypothesis that intravenous alteplase infusion could reduce DMT in a transient middle cerebral artery occlusion (MCAO) rat stroke model.
Rats were subjected to 60-minute transient MCAO. Alteplase (10 mg/kg) was administered 30 minutes after the beginning of MCAO. Real-time intravital fluorescence microscopy through a dura-sparing craniotomy was used to visualize circulating blood cells and fibrinogen. Cerebral microvessel patency was quantitatively evaluated by fluorescein isothiocyanate-dextran perfusion.
Immediately after MCAO, platelet and leukocyte accumulation were observed mostly in the venous compartment. Within 30 minutes after MCAO, microthrombi and parietal fibrin deposits were detected in postcapillary microvessels. Alteplase treatment significantly (P=0.006) reduced infarct volume and increased the percentage of perfused vessels during MCAO (P=0.02) compared with saline. Plasma levels of fibrinogen from alteplase-treated rats showed a rapid and profound hypofibrinogenemia. In vitro platelet aggregation demonstrated that alteplase reduced platelet aggregation (P=0.0001) and facilitated platelet disaggregation (P=0.001). These effects were reversible in the presence of exogenous fibrinogen.
Our data demonstrate that DMT is an early phenomenon initiated before recanalization. We further show that alteplase-dependent maintenance of downstream perfusion during MCAO improves acute ischemic stroke outcome through a fibrinogen-dependent platelet aggregation reduction. Our results indicate that early targeting of DMT represents a therapeutic strategy to improve the benefit of large artery recanalization in acute ischemic stroke.
The use of laparoscopic fundoplication (LF) to treat refractory GERD may induce refractory dysphagia (5%-10%). The management is complex, and peroral endoscopic myotomy (POEM) including valve ...incision is a new therapeutic option.
This retrospective study involved patients with postfundoplication refractory dysphagia treated by POEM associated with complete wrap incision. Patients were evaluated with Eckardt and dysphagia scores. Study objectives were to evaluate clinical and technical outcomes, adverse events, and GERD recurrence.
Twenty-six patients, with a mean age of 57.3 ± 15.6 years, were included. Mean follow-up was 25.3 ± 17.6 months. The technical and clinical success rates were 96% and 84.6%, respectively. Among failures, 1 patient underwent Lewis-Santy, 2 required dilations, and 1 was lost to follow-up. Three late recurrences occurred and were endoscopically managed. Five patients (19%) had GERD recurrence that was mainly improved by proton pump inhibitors.
POEM with fundoplication is a serious therapeutic option for managing persistent dysphagia after LF, with a low risk of GERD recurrence.
Objectives
A single‐use duodenoscope (SUD) has been recently developed to overcome issues with endoscopic retrograde cholangiopancreatography (ERCP)‐related cross‐infections. The aim was to evaluate ...SUD safety and performance in a prospective multi‐centre study.
Methods
All consecutive patients undergoing ERCP in six French centers were prospectively enrolled. All procedures were performed with the SUD; in case of ERCP failure, operators switched to a reusable duodenoscope. Study outcomes were the successful completion of the procedure with SUD, safety and operators’ satisfaction based on a VAS 0–10 and on 22 qualitative items. The study protocol was approved by French authorities and registered (ID‐RCB: 2020‐A00346‐33). External companies collected the database and performed statistical analysis.
Results
Sixty patients (34 females, median age 65.5 years old) were enrolled. Main indications were bile duct stones (41.7%) and malignant biliary obstruction (26.7%). Most ERCP were considered ASGE grade 2 (58.3%) or 3 (35.0%). Fifty‐seven (95.0%) procedures were completed using the SUD. Failures were unrelated to SUD (one duodenal stricture, one ampullary infiltration, and one tight biliary stricture) and could not be completed with reusable duodenoscopes. Median operators’ satisfaction was 9 (7–9). Qualitative assessments were considered clinically satisfactory in a median of 100% of items and comparable to a reusable duodenoscope in 97.9% of items. Three patients (5%) reported an adverse event. None was SUD‐related.
Conclusions
The use of a SUD allows ERCP to be performed with an optimal successful rate. Our data show that SUD could be used for several ERCP indications and levels of complexity.
The mouse model of laser-induced choroidal neovascularization (CNV) has been used extensively in studies of the exudative form of age-related macular degeneration (AMD). This experimental in vivo ...model relies on laser injury to perforate Bruch's membrane, resulting in subretinal blood vessel recruitment from the choroid. By recapitulating the main features of the exudative form of human AMD, this assay has served as the backbone for testing antiangiogenic therapies. This standardized protocol can be applied to transgenic mice and can include treatments with drugs, recombinant proteins, antibodies, adenoviruses and pre-microRNAs to aid in the search for new molecular regulators and the identification of novel targets for innovative treatments. This robust assay requires 7-14 d to complete, depending on the treatment applied and whether immunostaining is performed. This protocol includes details of how to induce CNV, including laser induction, lesion excision, processing and different approaches to quantify neoformed vasculature.
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