Tufts Medical School
Tufts Medical School
News Article | May 24, 2017
ATS 2017, WASHINGTON, DC -- In a new study presented at the 2017 American Thoracic Society International Conference, adult asthma patients treated with bronchial thermoplasty (BT) had fewer severe exacerbations and were able to reduce their ER visits and hospitalizations in the two years following treatment. Approved by the FDA in 2010, BT is a new device-based therapy that uses a series of three radio-frequency treatments to open the airways of adults with severe, persistent asthma whose symptoms are not adequately controlled by inhaled corticosteroids or long-acting beta-agonists. To date, more than 6,800 patients in 33 countries have been treated with BT. The "Post-FDA Approval Clinical Trial Evaluating BT in Severe Persistent Asthma" (PAS2 study), which involves hundreds of patients at dozens of research centers, looks at the long-term effects and safety of BT. "The results of the PAS2 study suggest that after a single series of BT procedures, patients experience long-term improvement in their asthma control," said lead author Geoffrey Chupp, MD, from Yale School of Medicine. "These results indicate that BT works across the spectrum of severe asthma patients. We believe BT should be more widely considered as a treatment option in patients with poorly controlled severe asthma." Two-hundred eighty four patients were enrolled in the study at 27 centers in the U.S. and Canada. Two-hundred seventy-nine study subjects had at least one BT procedure, and 271 had all three procedures. In the 12 months prior to the first BT procedure, 78 percent of subjects had at least one severe exacerbation, 16 percent required hospitalization and 29 percent had ER visits. In the first year follow up, 50.6 percent had severe exacerbations; 45.4 percent had exacerbations in the second year follow up. Asthma-related hospitalizations and ER visits also saw significant, continuing reductions: 14.4 percent and 12.7 percent of subjects had hospitalizations, respectively, in the first and second year, and 18.3 percent and 13.5 percent made ER visits in the first and second year post-treatment. "On average, patients also reduced their inhaled corticosteroid dose and a significant number were able to discontinue maintenance oral corticosteroids," said Dr. Chupp. "BT offers an alternative approach for patients who are inadequately controlled with medications designed to improve the control of their asthma." Authors: G. Chupp1, J. Kline2, S.B. Khatri3, C. McEvoy4, G.A. Silvestri5, A. Shifren6, S. Bansal7, M. McClelland8, M. Dransfield9, R. Olivenstein10, E. Lawson11, M. Simoff12, M.M. Wahidi13, C.R. Lamb14, S. Ferguson15, A. Haas16, K. Hogarth17, R. Tejedor18, J. Toth19, A. Majid20, S. Rafeq21, J.M. Fitzgerald22, K. Enfield23, G.M. Grubb24, E. McMullen24, M. Laviolette25; 1Yale University - New Haven, CT/US, 2University of Iowa Hospitals and Clinics - Iowa City, IA/US, 3Cleveland Clinic Respiratory Institute - Cleveland, OH/US, 4Regions Hospital - St. Paul, MN/US, 5Medical University of South Carolina - Charleston, SC/US, 6Washington University School of Medicine - St. Louis, MO/US, 7Dubois Regional Medical Center - DuBois, PA/US, 8Spectrum Health Hospitals - Grand Rapids, MI/US, 9University of Alabama - Birmingham, AL/US, 10Montreal Chest Institute, McGill University - Montreal, QC/CA, 11Surrey Memorial Hospital - Surrey, BC/CA, 12Henry Ford Hospital - Detroit, MI/US, 13Duke University Medical Center - Durham, NC/US, 14Lahey Hospital and Medical Center - Burlington, MA/US, 15University of Wisconsin Madison - Madison, WI/US, 16University of Pennsylvania - Philadelphia, PA/US, 17University of Chicago - Chicago, IL/US, 18LSU Health Science Center - New Orleans, LA/US, 19Penn State University - Hershey, PA/US, 20Beth Israel Deaconess Medical Center - Boston, MA/US, 21St. Elizabeth's Medical Center, Tufts Medical School - Boston, MA/US, 22University of British Columbia - Vancouver, BC/CA, 23University of Virginia Health System - Charlottesville, VA/US, 24Boston Scientific - Marlborough, MA/US, 25Laval University - Québec, QC/CA Rationale: Bronchial thermoplasty (BT) is a non-pharmacologic, device-based treatment for subjects ?18 years with severe persistent asthma not well controlled with inhaled corticosteroids (ICS) and long-acting beta-agonists (LABA). The "Post-FDA Approval Clinical Trial Evaluating BT in Severe Persistent Asthma" (PAS2 study) collects real-world data on subjects undergoing BT treatment with the Alair BT System. We report for the first time baseline and follow-up results for the primary and secondary endpoints to 2 years. Methods: The PAS2 study is a prospective, open-label, observational, multi-center trial at US and Canadian centers. Subjects 18-65 years taking ICS ?1000μg/day (beclomethasone or equivalent) and LABA ?80μg/day (salmeterol or equivalent) were enrolled. Additional inclusion criteria were: pre-bronchodilator FEV1 ?60% predicted, non-smoker for ?1 year ( Results: Two-hundred eighty-four subjects were enrolled at 27 centers; 279 subjects had at least 1 of 3 BT procedures; 271 subjects had all 3 BT procedures. Subjects had mean age 45.7 years with 64.5% female and mean BMI 32.2kg/m2. Mean ICS dose was 2269μg/day, LABA dose was 74μg/day, and SABA dose was 2.35μg/day at baseline. Baseline mean AQLQ was 4.03 with a mean of 25.2 years since asthma diagnosis. In the 12 months prior to first BT procedure, 78% of subjects had at least one severe exacerbation (mean 1.6/subject), 16% had hospitalizations, and 29% had ER visits. In the first and second year of follow-up, 50.6% and 45.4% of subjects had severe exacerbations, respectively. Similarly, 14.4% and 12.7% of subjects had hospitalizations in the first and second year of follow-up, and 18.3% and 13.5% of subjects had ER visits in the first and second year of follow-up. Conclusion: The PAS2 study shows that compared to the year prior to BT treatment, in the 2 years after BT treatment study subjects experienced improved asthma control with respect to severe exacerbations, hospitalizations and ER visits. Short-Acting Beta Agonists (SABA) used per day for asthma symptoms (μg/day) How long has the subject been diagnosed with asthma (years) Session: A7043 Novel Therapeutic Targets in Obstructive Lung Disease Abstract Presentation Time: Wednesday, May 24, 2017, 9:15-9:30 a.m. ET Location: Marquis Ballroom 6 (Level M2), Marriott Marquis Washington
News Article | April 26, 2017
Nadia Waheed, M.D., MPH, Associate Professor für Ophthalmologie an der Tufts Medical School und Direktorin des Boston Image Reading Center, sagte: „Die verbesserte Dichte von AngioVueHD liefert eine hohe Auflösung, die der von 3-x-3-Millimeter-Scans gleicht – der Größe, die wir bislang verwendet haben, um höchste Bildqualität zu erzielen, dies allerdings in einem größeren Format von 6 x 6 Millimetern. So erzielen wir eine weit höhere Bildauflösung beim 6-x-6-Millimeter-Sichtfeld, was eine genauere Untersuchung von Pathologien ermöglicht, die von großen oder verdeckten Läsionen gekennzeichnet sind.“ Das Unternehmen veröffentlichte darüber hinaus AngioVueHD Montage für eine automatische Kombination von zwei Bildern mit hoher Dichte. Das eine zeigt den zentralen Makulabereich (der Teil der Netzhaut, der für zentrales, hochauflösendes Farbsehen in gutem Licht zuständig ist), und das andere die Mitte des Sehnervenkopfs (der Eintrittspunkt für die wichtigsten Blutgefäße, die die Netzhaut versorgen) – in einem Sichtfeld von 10 x 6 Millimetern. Die Möglichkeit einer automatischen Erstellung der Montage ist nützlich für die Bildgebung des Gefäßsystems bei potenziellen Pathologien, die sich in die Peripherie der Bildgebungsebene erstrecken. Optovue, Inc. ist ein Privatunternehmen für medizinische Geräte, das 2003 gegründet wurde. Das Unternehmen hat seinen Hauptsitz in Fremont, Kalifornien, und hat sich die Weiterentwicklung und Vermarktung von Hochgeschwindigkeits-OCT- und -OCTA-Technologien zur Aufgabe gemacht. Sie finden Einsatz bei der Diagnose und Behandlung von Augenerkrankungen, von denen viele zu dauerhafter Erblindung führen können. Optovue ist das erste Unternehmen, das die wegweisende OCTA-Technologie entwickelt und vermarktet hat. Bis heute wurden über 225 referierte Publikationen, in denen die AngioVue-Bildgebung und die klinischen Anwendungsbereiche ausführlich beschrieben werden, veröffentlicht. Das Unternehmen hat bereits über 11.000 Produkte weltweit installiert und beschäftigt mehr als 170 Mitarbeiter. Weitere Informationen finden Sie unter www.optovue.com.
News Article | April 26, 2017
FREMONT, Californie--(BUSINESS WIRE)--Optovue, le leader mondial dans le développement de la tomographie par cohérence optique (OCT, Optical Coherence Tomography) et de l'angiographie OCT (OCTA, OCT Angiography ), est la première entreprise à proposer des images OCTA de densité supérieure qui apportent des améliorations significatives dans la résolution et la visualisation périphérique de la circulation vasculaire de l'œil. L'imagerie AngioVueHD, qui est distribuée commercialement par Optovue aujourd'hui, produit des angiographies OCTA présentant 73 % de points d'échantillonnage* en plus et améliore la résolution d'image d'environ 33 % par rapport au champ de vision existant, permettant ainsi aux médecins d'évaluer plus étroitement le réseau capillaire fin de l'œil pour observer des variations qui signaleraient une maladie oculaire. Selon Nadia Waheed, M.D., MPH, professeur agrégé d'ophtalmologie à la Tufts Medical School et directrice du Centre de lecture d'images Boston Image Reading Center, « La densité améliorée d'AngioVueHD assure une résolution élevée rappelant celle des balayages de 3 x 3 millimètres, soit la taille que nous utilisions auparavant pour obtenir la qualité d'image la plus élevée, dans un format pourtant plus large de 6 x 6 millimètres. Nous disposons de ce fait d'une résolution d'image beaucoup plus importante dans le champ de vision de 6 x 6 millimètres, permettant ainsi une meilleure évaluation des pathologies caractérisées par des lésions larges ou obliques. » L'entreprise a également lancé sur le marché AngioVueHD Montage, qui associe automatiquement deux images haute densité, l'une au niveau de la région maculaire centrale (la partie de la rétine responsable de la vision des couleurs centrale et haute résolution, possible sous un bon éclairage) et l'autre centrée au niveau du disque optique (le point d'entrée des vaisseaux sanguins majeurs qui irriguent la rétine), dans un champ de vision de 10 x 6 millimètres. Il est utile de pouvoir créer automatiquement le montage pour obtenir les images de la circulation vasculaire de certaines pathologies qui pourraient s'étendre dans la périphérie du plan d'imagerie. « AngioVueHD deviendra la nouvelle référence absolue de l'angiographie OCTA et transformera la façon dont les médecins utilisent cette technologie pour soigner leurs patients » a déclaré Jay Wei, fondateur et PDG d'Optovue. « Notre plate-forme AngioVue assure déjà aux professionnels des soins ophtalmologiques une technique d'imagerie non invasive plus rapide produisant une qualité d'image supérieure de la circulation rétinienne et choroïdienne. Avec une nouvelle résolution d'image de plus forte densité dans un champ de vision élargi, nous avons haussé la barre de l'angiographie OCTA. » Optovue, Inc. est une entreprise privée opérant dans le secteur des dispositifs médicaux et fondée en 2003. L'entreprise qui a son siège à Fremont en Californie, se consacre à la progression et à la commercialisation des technologies d'angiographie OCTA et de balayage OCT à grande vitesse qui sont utilisées pour faciliter le diagnostic et la gestion des maladies oculaires, dont nombre d'entre elles peuvent aboutir à une cécité permanente. Optovue est la première entreprise à développer et à commercialiser la technologie OCTA révolutionnaire. On compte à ce jour plus de 225 publications revues par un comité de lecture détaillant les applications cliniques et la technologie d'imagerie AngioVue. L'entreprise a installé plus de 11 000 produits dans le monde et emploie plus de 170 personnes. Pour de plus amples informations, visitez www.optovue.com.
Grebely J.,University of New South Wales |
Page K.,University of California at San Francisco |
Sacks-Davis R.,Burnet Institute |
Sacks-Davis R.,Monash University |
And 20 more authors.
Hepatology | Year: 2014
Although 20%-40% of persons with acute hepatitis C virus (HCV) infection demonstrate spontaneous clearance, the time course and factors associated with clearance remain poorly understood. We investigated the time to spontaneous clearance and predictors among participants with acute HCV using Cox proportional hazards analyses. Data for this analysis were drawn from an international collaboration of nine prospective cohorts evaluating outcomes after acute HCV infection. Among 632 participants with acute HCV, 35% were female, 82% were Caucasian, 49% had interleukin-28 (IL28)B CC genotype (rs12979860), 96% had injected drugs ever, 47% were infected with HCV genotype 1, and 7% had human immunodeficiency virus (HIV) coinfection. Twenty-eight percent were HCV antibody negative/RNA positive at the time of acute HCV detection (early acute HCV). During follow-up, spontaneous clearance occurred in 173 of 632, and at 1 year after infection, 25% (95% confidence interval [CI]: 21, 29) had cleared virus. Among those with clearance, the median time to clearance was 16.5 weeks (IQR: 10.5, 33.4), with 34%, 67%, and 83% demonstrating clearance at 3, 6, and 12 months. Adjusting for age, factors independently associated with time to spontaneous clearance included female sex (adjusted hazards ratio [AHR]: 2.16; 95% CI: 1.48, 3.18), IL28B CC genotype (versus CT/TT; AHR, 2.26; 95% CI: 1.52, 3.34), and HCV genotype 1 (versus non-genotype 1; AHR: 1.56; 95% CI: 1.06, 2.30). The effect of IL28B genotype and HCV genotype on spontaneous clearance was greater among females, compared to males. Conclusions: Female sex, favorable IL28B genotype, and HCV genotype 1 are independent predictors of spontaneous clearance. Further research is required to elucidate the observed sex-based differences in HCV control. © 2013 by the American Association for the Study of Liver Diseases.
Lapane K.L.,Virginia Commonwealth University |
Sands M.R.,Brown University |
Sands M.R.,Memorial Hospital of Rhode Island |
Yang S.,Virginia Commonwealth University |
And 3 more authors.
Osteoarthritis and Cartilage | Year: 2012
Objective: To examine use of complementary and alternative medicine (CAM) among individuals with radiographic-confirmed osteoarthritis (OA) of the knee. Methods: We included 2679 participants of the Osteoarthritis Initiative with radiographic tibiofemoral knee OA in at least one knee at baseline. Trained interviewers asked a series of specific questions relating to current OA treatments including CAM therapies (seven categories - alternative medical systems, mind-body interventions, manipulation and body-based methods, energy therapies, and three types of biologically based therapies) and conventional medications. Participants were classified as: (1)conventional medication users only, (2) CAM users only; (3) users of both; and (4) users of neither. Polytomous logistic regression identified correlates of treatment approaches including sociodemographics and clinical/functional correlates. Results: CAM use was prevalent (47%), with 24% reporting use of both CAM and conventional medication approaches. Multi-joint OA was correlated with all treatments (adjusted odds ratios (aOR) conventional medications only: 1.62; CAM only: 1.37 and both: 2.16). X-ray evidence of severe narrowing (OARSI grade 3) was associated with use of glucosamine/chondroitin (aOR: 2.20) and use of both (aOR: 1.98). The Western Ontario and McMaster Universities (WOMAC)-Pain Score was correlated with conventional medication use, either alone (aOR: 1.28) or in combination with CAM (aOR: 1.41 per one standard deviation change). Knee Outcomes in Osteoarthritis Survey (KOOS)-Quality of Life (QOL) and Short Form (SF)-12 Physical Scale scores were inversely related to all treatments. Conclusion: CAM is commonly used to treat joint and arthritis pain among persons with knee OA. The extent to which these treatments are effective in managing symptoms and slowing disease progression remains to be proven. © 2011 Osteoarthritis Research Society International.
Stevens R.G.,University of Connecticut Health Center |
Brainard G.C.,Thomas College |
Blask D.E.,Tulane University |
Lockley S.W.,Harvard University |
Motta M.E.,Tufts Medical School
CA Cancer Journal for Clinicians | Year: 2014
Breast cancer is the leading cause of cancer death among women worldwide, and there is only a limited explanation of why. Risk is highest in the most industrialized countries but also is rising rapidly in the developing world. Known risk factors account for only a portion of the incidence in the high-risk populations, and there has been considerable speculation and many false leads on other possibly major determinants of risk, such as dietary fat. A hallmark of industrialization is the increasing use of electricity to light the night, both within the home and without. It has only recently become clear that this evolutionarily new and, thereby, unnatural exposure can disrupt human circadian rhythmicity, of which three salient features are melatonin production, sleep, and the circadian clock. A convergence of research in cells, rodents, and humans suggests that the health consequences of circadian disruption may be substantial. An innovative experimental model has shown that light at night markedly increases the growth of human breast cancer xenografts in rats. In humans, the theory that light exposure at night increases breast cancer risk leads to specific predictions that are being tested epidemiologically: evidence has accumulated on risk in shift workers, risk in blind women, and the impact of sleep duration on risk. If electric light at night does explain a portion of the breast cancer burden, then there are practical interventions that can be implemented, including more selective use of light and the adoption of recent advances in lighting technology and application. CA Cancer J Clin 2014;64:207-218. © 2013 American Cancer Society. © 2013 American Cancer Society, Inc.
Letendre S.L.,University of California at San Diego |
Zheng J.C.,University of Nebraska Medical Center |
Kaul M.,Sanford Burnham Institute for Medical Research |
Yiannoutsos C.T.,Indiana University |
And 4 more authors.
Journal of NeuroVirology | Year: 2011
Chemokines influence HIV neuropathogenesis by affecting the HIV life cycle, trafficking of macrophages into the nervous system, glial activation, and neuronal signaling and repair processes; however, knowledge of their relationship to in vivo measures of cerebral injury is limited. The primary objective of this study was to determine the relationship between a panel of chemokines in cerebrospinal fluid (CSF) and cerebral metabolites measured by proton magnetic resonance spectroscopy (MRS) in a cohort of HIV-infected individuals. One hundred seventy-one stored CSF specimens were assayed from HIV-infected individuals who were enrolled in two ACTG studies that evaluated the relationship between neuropsychological performance and cerebral metabolites. Concentrations of six chemokines (fractalkine, IL-8, IP-10, MCP-1, MIP-1β, and SDF-1) were measured and compared with cerebral metabolites individually and as composite neuronal, basal ganglia, and inflammatory patterns. IP-10 and MCP-1 were the chemokines most strongly associated with individual cerebral metabolites. Specifically, (1) higher IP-10 levels correlated with lower N-acetyl aspartate (NAA)/creatine (Cr) ratios in the frontal white matter and higher MI/Cr ratios in all three brain regions considered and (2) higher MCP-1 levels correlated with lower NAA/Cr ratios in frontal white matter and the parietal cortex. IP-10, MCP-1, and IL-8 had the strongest associations with patterns of cerebral metabolites. In particular, higher levels of IP-10 correlated with lower neuronal pattern scores and higher basal ganglia and inflammatory pattern scores, the same pattern which has been associated with HIV-associated neurocognitive disorders (HAND). Subgroup analysis indicated that the effects of IP-10 and IL-8 were influenced by effective antiretroviral therapy and that memantine treatment may mitigate the neuronal effects of IP-10. This study supports the role of chemokines in HAND and the validity of MRS as an assessment tool. In particular, the findings identify relationships between the immune response - particularly an interferon-inducible chemokine, IP-10 - and cerebral metabolites and suggest that antiretroviral therapy and memantine modify the impact of the immune response on neurons. © The Author(s) 2011.
Nitti V.W.,New York University |
Mourtzinos A.,Tufts Medical School |
Brucker B.M.,Tufts Medical School
Journal of Urology | Year: 2014
Purpose Many investigators have used the number of pads to determine the severity of post-prostatectomy incontinence and yet the accuracy of this tool remains unproven. We determined whether the patient perception of pad use and urine loss reflects actual urine loss. We also identified a quality of life measure that distinguishes patients by severity of incontinence. Materials and Methods We prospectively enrolled 235 men from a total of 18 sites 6 months or more after radical prostatectomy who had incontinence requiring protection. Patients completed a questionnaire on the perception of pad number, size and wetness, a quality of life question, several standardized incontinence questionnaires and a 24-hour pad test that assessed pad number, size and weight. SPSS® was used for statistical analysis. Results Perception of the number of pads used closely agreed with the number of pads collected during a 24-hour pad test. Perceived and actual pad size had excellent concordance (76%, p <0.001). Patients with wet and soaked pads had statistically and clinically significantly different pad weights that were uniquely different from each other and from those of patients who were almost dry and slightly wet. Response to the quality of life question separated the men into 4 statistically significantly different groups based on mean 24-hour pad weight. Conclusions Patients accurately described the number, size and degree of wetness of pads collected during a 24-hour pad test. These values correlated well with actual urine loss. The single question, "To what extent does urine loss affect your quality of life?" separated men into distinct categories. © 2014 by American Urological Association Education and Research, Inc.
Gordon F.D.,Tufts Medical School |
Gordon F.D.,Lahey Clinic Medical Center
Clinics in Liver Disease | Year: 2012
Ascites is the pathologic accumulation of fluid in the peritoneum. It is the most common complication of cirrhosis, with a prevalence of approximately 10%. Over a 10-year period, 50% of patients with previously compensated cirrhosis are expected to develop ascites. As a marker of hepatic decompensation, ascites is associated with a poor prognosis, with only a 56% survival 3 years after onset. In addition, morbidity is increased because of the risk of additional complications, such as spontaneous bacterial peritonitis and hepatorenal syndrome. Understanding the pathophysiology of ascites is essential for its proper management. © 2012 Elsevier Inc.
Gardin J.M.,Hackensack University Medical Center |
Bartz T.M.,University of Washington |
Polak J.F.,Tufts Medical Center |
O'Leary D.H.,Tufts Medical School |
Wong N.D.,University of California at Irvine
Journal of the American Society of Echocardiography | Year: 2014
Background The aim of this study was to evaluate whether the addition of ultrasound carotid intima-media thickness (CIMT) measurements and risk categories of plaque help predict incident stroke and cardiovascular disease (CVD) in older adults. Methods Carotid ultrasound studies were recorded in the multicenter Cardiovascular Health Study. CVD was defined as coronary heart disease plus heart failure plus stroke. Ten-year risk prediction Cox proportional-hazards models for stroke and CVD were calculated using Cardiovascular Health Study-specific coefficients for Framingham risk score factors. Categories of CIMT and CIMT plus plaque were added to Framingham risk score prediction models, and categorical net reclassification improvement (NRI) and Harrell's c-statistic were calculated. Results In 4,384 Cardiovascular Health Study participants (61% women, 14% black; mean baseline age, 72 ± 5 years) without CVD at baseline, higher CIMT category and the presence of plaque were both associated with higher incidence rates for stroke and CVD. The addition of CIMT improved the ability of Framingham risk score-type risk models to discriminate cases from noncases of incident stroke and CVD (NRI = 0.062, P =.015, and NRI = 0.027, P <.001, respectively), with no further improvement by adding plaque. For both outcomes, NRI was driven by down-classifying those without incident disease. Although the addition of plaque to CIMT did not result in a significant NRI for either outcome, it was significant among those without incident disease. Conclusions In older adults, the addition of CIMT modestly improves 10-year risk prediction for stroke and CVD beyond a traditional risk factor model, mainly by down-classifying risk in those without stroke or CVD; the addition of plaque to CIMT adds no statistical benefit in the overall cohort, although there is evidence of down-classification in those without events. © 2014 by the American Society of Echocardiography.