Medi Seminar

Research has shown that retinal changes are a precursor to Parkinson’s disease. Using this, it is possible to predict the possibility of onset seven years in advance when tissue changes are observed with retinal optical coherence tomography (OCT).

The results of a study on the possibility of diagnosing Parkinson’s disease using OCT conducted by researchers including Siegfried Karl Wagner, London Eye Institute, University College London, UK, were published in the international journal Neurology on the 21st (doi.org/10.1212/WNL.0000000000207727).

A cohort analysis showed that retinal changes were a precursor to Parkinson’s disease.

Although there have been previous studies that showed neurodegeneration and other morphological abnormalities in the retina of patients with Parkinson’s disease (PD), it was unclear whether imaging such as OCT could reliably diagnose them.

The research team set out to investigate the actual relevance by examining the anatomical retinal changes measured using OCT in patients with Parkinson’s disease and evaluating the association using a prospective study cohort.

Data from both studies were used in the analysis. To detect retinal markers in patients with Parkinson’s disease, we used data from AlzEye, a cohort of 154,830 patients over the age of 40 who attended an eye hospital in London, UK, between 2008 and 2018.

They then used a UK Biobank cohort of retinal scans of 67,311 people between the ages of 40 and 69 between 2006 and 2010 to evaluate retinal markers in patients with Parkinson’s disease.

Macular retinal nerve fiber layer (mRNFL), ganglion cell inner plexiform layer (GCTUL) and inner nuclear layer (INL) thicknesses were extracted from the fovea.

Within the AlzEye cohort, 700 patients with Parkinson’s disease and 105,770 controls were screened to investigate the association between diagnosis of Parkinson’s disease and retinal thickness.

After adjusting for age, gender, ethnicity, hypertension, and diabetes, those with Parkinson’s disease had significantly thinner GCUL and reduced INL thickness.

A total of 53 people were diagnosed with Parkinson’s disease during the study period.

The Biobank cohort also found an association between new diagnoses and reduced thickness of GCLECT and INL. The association persisted even in those who developed clinical symptoms within 2 years of retinal scans.

“The cohort analysis showed that people with Parkinson’s disease had reduced retinal INL and GICUL thickness,” said the researchers. added.

2023-09-04 03:10:28

#Retinal #diagnosed #Parkinsons #disease #precursor #retinal #OCT

Studies have shown that statin, a representative treatment for dyslipidemia, reduces the risk of ischemic stroke in patients with cerebral hemorrhage.

Recently, as studies that show that statins reduce the risk of stroke are continuously accumulating, there is a possibility that they will be established as a new treatment option.

The results of a study on the association between statin use and the risk of stroke recurrence after intracerebral hemorrhage conducted by researchers including David Geist of the Department of Neurology at Odense University Hospital in Denmark were published in the international journal Neurology on the 30th (doi.org/10.1212/WNL.0000000000207792).

Studies have shown that statins, a treatment for dyslipidemia, reduce the risk of ischemic stroke recurrence.

Statins, which lower LDL-C and triglycerides, which are referred to as bad cholesterol, are administered to prevent major cardiovascular diseases such as coronary artery disease.

Risk factors for stroke include hypertension, diabetes, heart disease, transient ischemia as well as dyslipidemia.

The researchers entered a cohort analysis to determine whether statin treatment of survivors of cerebral hemorrhage (ICH) had an impact on future hemorrhagic and ischemic stroke (IS).

To determine whether the incidence of stroke, IS, or recurrent ICH differs by statin use or not in 15,151 people who were diagnosed with first ICH between January 2003 and December 2021 and survived 30 days or longer enrolled in the Danish Stroke Registry. The average follow-up was 3.3 years.

Of these, 1959 patients with stroke were matched with 7400 controls, 1073 IS patients were matched with 4035 controls, and 984 patients with recurrent ICH were matched with 3755 controls.

When the incidence of all strokes, IS, and recurrent ICH related to statin exposure was calculated using conditional logistic regression analysis, the incidence of all types of stroke in the statin exposure group was 38.6%, which was lower than that of the control group (41.1%) (aOR 0.88).

Subsequently, a risk reduction of about 21% was observed with the incidence of IS at 39.8% and the control group at 41.8%, but no risk reduction was observed for recurrent ICH (39.1% vs. 40.8%).

The research team said, “It was confirmed that administering statins to patients who suffered cerebral hemorrhage mainly lowered the risk of IS. concluded.

2023-08-31 02:58:38

#Effects #statins #patients #cerebral #hemorrhage #Ischemic #stroke #recurrence

Subcutaneous ICD (S-ICD), which overcomes the disadvantages of transvenous-ICD (TV-ICD), which requires electrode wires to be inserted into the blood vessels and heart, is establishing itself as a next-generation runner.

With the accumulation of Rewall World Data (RWD) following comparative clinical trials with various TV-ICDs, evidence is being established that it is no inferior to ‘standard status’.

Even in the largest post-approval study in which 1637 patients were enrolled, it received a passing score in terms of the incidence of complications and the shock effect of eliminating ventricular fibrillation over a period of 5 years.

The clinical results of S-ICD PAS, which observed the complications of S-ICD and the efficacy of electric shock for 5 years, were published in the August issue of the Journal of the American College of Cardiology (JCC) (doi.org/10.1016/j.jacc.2023.05.034).

TV-ICD has been the defibrillator standard for 40 years. The problem is that due to the nature of electrode wires being inserted into blood vessels and the heart, they are not free from side effects such as infection or electrode wire defects when they remain in the blood vessels for a long time.

The currently commercialized S-ICD is the only emblem developed by Boston Scientific.

On the other hand, S-ICD overcomes the disadvantages of existing ICDs by adopting a method in which electrode lines are located outside the heart to avoid direct contact with the heart and blood vessels.

Since S-ICD is a relatively new technology, various verifications in the medical world are continuing.

Clinical studies such as PRAETORIAN, ATLAS, and EFFORTLESS focused on ‘comparison’ of the incidence rate of complications and incidence of inappropriate electric shock between the two groups of S-ICD and TV-ICD, while recent studies are ‘comparison’ that examines long-term clinical efficacy and safety in the field after commercialization. RWD rationale’ is focused on.

Both the EHRA 22 clinical trial published in 2021 and the ELISIR clinical trial published in 2022 analyzed the actual effects of S-ICD in heart failure patients. The S-ICD PAS clinical trial, which was released this month, was followed up for five years on efficacy and safety, including shock efficacy and complications and complications related to the transplant procedure, at 86 medical institutions in the United States.

In an analysis of a total of 1643 patients, the mean shock efficacy for individual occurrences of ventricular tachycardia or ventricular fibrillation was 98.4%, which remained similar during the follow-up period.

The rates without S-ICD-related complications and electrode-related complications were 93.4% and 99.3%, respectively.

Only 1.6% of patients had their device replaced with a TV-ICD as needed, with a cumulative all-cause mortality rate of 21.7% and an inappropriate shock rate of 15.8%, similar shock rates to TV-ICD.

“This study is the largest in terms of scale among prospective studies on S-ICD that have been conducted so far,” said Michael R. Gold of the University of South Carolina Medical School, USA. It proves safety and efficacy.”

As S-ICD entered the insurance benefit right in Korea in 2019, efforts to upgrade the recommended grade in the guidelines and calculate RWD are currently in progress.

Professor A of Cardiovascular Internal Medicine at Seoul National University Hospital said, “Since the S-ICD insertion was performed, we have been monitoring patients in the hospital.” Complications definitely tend to be less,” he said.

As the international guidelines recommend the use of S-ICD for high-risk patients such as infections and chronic diseases, the Korean Heart Failure Society also added a new implantable cardioversion defibrillator item last year and said, “subcutaneous cardioversion defibrillators are difficult to access to blood vessels or have previously been It is useful in patients who have had an infection from a defibrillator.”

2023-08-21 20:30:00

#Implantable #defibrillator #RWD #verified #anotherIs #generational #change #accelerating

To minimize the fracture side effects of corticosteroids, a study has found that focus should be placed on duration rather than dose.

In the case of short and thick one-time use, the risk of fracture increased and the frequency of taking osteoporosis drugs increased compared to those who were consistently prescribed a similar cumulative dose.

The results of a study on the risk of fracture by corticosteroid use and dose, conducted by researchers including Julian Matthewman of the London School of Hygiene and Tropical Medicine, UK, were published in the international journal JAMA on the 9th (doi:10.1001/jamadermatol.2023.2495). ).

As a result of cohort analysis of the London School of Hygiene and Tropical Medicine in the UK, the duration of steroid administration has an effect on the risk of fracture.

Steroids are widely prescribed as effective anti-inflammatory agents in chronic inflammatory diseases. Steroids begin to lose bone within a few weeks of administration, increasing the risk of fracture, so short-term prescription is recommended for eczema, asthma, and COPD, except for rheumatoid arthritis.

It has been known that the cumulative steroid dose is the largest factor in the decrease in bone density and the risk of fracture, but it has not been confirmed whether the total number of days of administration affects the risk.

Focusing on the fact that the elderly are vulnerable to the risk of steroid-induced fractures, the research team focused on cumulative administration of 450 mg of Prednisolone for a short period of time (high-intensity group), and when 5 mg or more daily was administered over a relatively long time or divided into several times (low-intensity group). We analyzed whether there was a change in fracture risk.

A total of 93,869 patients with eczema, asthma, or COPD (UK cohort 65,195, Canada cohort 28,674) aged 66 years or older who took cumulative oral prednisolone ≥ 450 mg within 6 months for fracture prevention according to increased fracture risk Prescription medications and rates of major osteoporotic fractures were compared.

As a result of risk analysis using a Cox proportional hazards regression model, the risk of receiving fracture prevention treatment was up to twice as high in the high-intensity group who received short-term oral corticosteroids once (UK cohort HR 2.34, Canadian cohort 1.49).

However, the rates of major osteoporotic fractures in both the high- and low-intensity groups were similar (UK HR 1.07, Canada 0.87).

“Previous studies have looked at the association between oral corticosteroid prescribing patterns and fracture risk, but no study has investigated the association with cumulative doses,” the researchers said. Compared to the high-intensity group, the risk of receiving fracture prevention treatment was reduced by half.”

2023-08-21 03:19:00

#Strategies #preventing #steroid #fractures #changed #short #thick #wrong

A study has found that removal of the thymus gland increases the risk of death and cancer.

Although it is involved in the development of immune function, it gradually degenerates with the maturation of the human body, and unlike in adults, where it was considered safe to remove it because its function was unclear, thymectomy in adults resulted in a worsening prognosis.

The results of a study on the correlation between thymus removal and health in adults, in which Professor Cameron A. Kooshesh of the Center for Regenerative Medicine at Massachusetts General Hospital in the U.S. participated, was published in the international journal NEJM on the 3rd (DOI: 10.1056/NEJ Moa2302892).

Located behind the breastbone and in front of the heart and aorta, the thymus gland is an organ that makes immune cells. It started to develop in newborns, reached its largest size during puberty, then degenerated, and changed to small adipose tissue in adults, after which its function was thought to be unclear.

A study has found that removing the degenerated thymus gland after adulthood increases the risk of cancer and death.

In particular, as it is known that thymectomy is effective in the treatment of myasthenia gravis, thymus removal is being performed in various surgical procedures including myasthenia gravis.

The researchers hypothesized that even in adults, the thymus gland is required to maintain immunity and overall health, and in a cohort comparing mortality, cancer and autoimmune disease rates in adult patients who underwent thymectomy with a control group who underwent similar thoracic surgery without thymectomy. embarked on

Registry-enrolled 1420 patients who underwent thymectomy and 6021 controls were included in the study, and 1146 of the patients who underwent thymectomy had a demographically matched control group.

As a result of the analysis, the all-cause mortality rate at 5 years after surgery was 8.1% in the resection group and 2.8% in the control group.

There was no significant difference in the risk of autoimmune disease among the groups in the entire cohort, but when patients with preoperative infection, cancer, or autoimmune disease were excluded from the analysis, the autoimmune disease rate was higher in the resection group at 12.3% versus 7.9%.

The results were similar when the follow-up period was extended to more than 5 years.

All-cause mortality was higher in the thymectomy group than in the general population (9.0% vs. 5.2%), and mortality from cancer was higher (2.3% vs. 1.5%).

A subgroup of patients (22 thymectomy patients, 19 control patients) for whom T cell production and plasma cytokine levels were measured was followed up for an average of 14.2 years after surgery. wrote

This means that the thymus is mostly replaced by fat in adulthood and degenerates, but it is still in charge of ‘functions’ such as generating T cells.

“This study confirmed that all-cause mortality and cancer risk were higher in patients who underwent thymectomy,” said the researchers. When excluded from the analysis, it was found to be associated with an increased risk of autoimmune disease.”

2023-08-03 02:53:16

#thymus #useless #organ.. #Increased #risk #death #cancer #resection