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1دورية أكاديمية
المؤلفون: Karlsberg, Ronald, Gupta, Himanshu, Sullenberger, Lance, Quesada, Carlos, Rahban, Habib, Woods, Kevin, Uzzilia, Jeffrey, Purga, Scott, Aquino, Melissa, Hoffmann, Udo, Min, James, Earls, James, Choi, Andrew, Nurmohamed, Nick, Cole, Jason, Budoff, Matthew
المصدر: European Heart Journal - Cardiovascular Imaging. 25(6)
مصطلحات موضوعية: AI-QCT, CCTA, artificial intelligence, atherosclerosis imaging-quantitative computed tomography, coronary CT angiography, multi-centre, Humans, Male, Female, Middle Aged, Coronary Artery Disease, Computed Tomography Angiography, Coronary Angiography, Prospective Studies, Aged, Cross-Over Studies, Myocardial Revascularization, Tomography, X-Ray Computed
الوصف: AIMS: The incremental impact of atherosclerosis imaging-quantitative computed tomography (AI-QCT) on diagnostic certainty and downstream patient management is not yet known. The aim of this study was to compare the clinical utility of the routine implementation of AI-QCT versus conventional visual coronary CT angiography (CCTA) interpretation. METHODS AND RESULTS: In this multi-centre cross-over study in 5 expert CCTA sites, 750 consecutive adult patients referred for CCTA were prospectively recruited. Blinded to the AI-QCT analysis, site physicians established patient diagnoses and plans for downstream non-invasive testing, coronary intervention, and medication management based on the conventional site assessment. Next, physicians were asked to repeat their assessments based upon AI-QCT results. The included patients had an age of 63.8 ± 12.2 years; 433 (57.7%) were male. Compared with the conventional site CCTA evaluation, AI-QCT analysis improved physicians confidence two- to five-fold at every step of the care pathway and was associated with change in diagnosis or management in the majority of patients (428; 57.1%; P < 0.001), including for measures such as Coronary Artery Disease-Reporting and Data System (CAD-RADS) (295; 39.3%; P < 0.001) and plaque burden (197; 26.3%; P < 0.001). After AI-QCT including ischaemia assessment, the need for downstream non-invasive and invasive testing was reduced by 37.1% (P < 0.001), compared with the conventional site CCTA evaluation. Incremental to the site CCTA evaluation alone, AI-QCT resulted in statin initiation/increase an aspirin initiation in an additional 28.1% (P < 0.001) and 23.0% (P < 0.001) of patients, respectively. CONCLUSION: The use of AI-QCT improves diagnostic certainty and may result in reduced downstream need for non-invasive testing and increased rates of preventive medical therapy.
وصف الملف: application/pdf
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2دورية أكاديمية
المؤلفون: Rivas, Victor N, Crofton, Amanda E, Jauregui, Carina E, Wouters, Jalena R, Yang, Betty S, Wittenburg, Luke A, Kaplan, Joanna L, Hwee, Darren T, Murphy, Anne N, Morgan, Bradley P, Malik, Fady I, Harris, Samantha P, Stern, Joshua A
المصدر: Scientific Reports. 14(1)
مصطلحات موضوعية: Veterinary Sciences, Agricultural, Veterinary and Food Sciences, Biomedical and Clinical Sciences, Heart Disease, Cardiovascular, Pediatric, Pediatric Cardiomyopathy, Clinical Trials and Supportive Activities, Orphan Drug, Clinical Research, Rare Diseases, 5.1 Pharmaceuticals, Evaluation of treatments and therapeutic interventions, Development of treatments and therapeutic interventions, 6.1 Pharmaceuticals, Animals, Cats, Cardiomyopathy, Hypertrophic, Cardiac Myosins, Cat Diseases, Male, Female, Ventricular Outflow Obstruction, Systole, Echocardiography, Cross-Over Studies, Cat, Left ventricular outflow tract obstruction, Myosin-inhibitor, Obstructive hypertrophic cardiomyopathy, Pharmacodynamics
الوصف: Hypertrophic cardiomyopathy (HCM) remains the most common cardiomyopathy in humans and cats with few preclinical pharmacologic interventional studies. Small-molecule sarcomere inhibitors are promising novel therapeutics for the management of obstructive HCM (oHCM) patients and have shown efficacy in left ventricular outflow tract obstruction (LVOTO) relief. The objective of this study was to explore the 6-, 24-, and 48-hour (h) pharmacodynamic effects of the cardiac myosin inhibitor, CK-586, in six purpose-bred cats with naturally occurring oHCM. A blinded, randomized, five-treatment group, crossover preclinical trial was conducted to assess the pharmacodynamic effects of CK-586 in this oHCM model. Dose assessments and select echocardiographic variables were assessed five times over a 48-h period. Treatment with oral CK-586 safely ameliorated LVOTO in oHCM cats. CK-586 treatment dose-dependently eliminated obstruction (reduced LVOTOmaxPG), increased measures of systolic chamber size (LVIDs Sx), and decreased select measures of heart function (LV FS% and LV EF%) in the absence of impact on heart rate. At all tested doses, a single oral CK-586 dose resulted in improved or resolved LVOTO with well-tolerated, dose-dependent, reductions in LV systolic function. The results from this study pave the way for the potential use of CK-586 in both the veterinary and human clinical setting.
وصف الملف: application/pdf
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3دورية أكاديمية
المؤلفون: Landry, Matthew J, Ward, Catherine P, Cunanan, Kristen M, Fielding-Singh, Priya, Crimarco, Anthony, Gardner, Christopher D
المصدر: Scientific Reports. 14(1)
مصطلحات موضوعية: Biomedical and Clinical Sciences, Nutrition and Dietetics, Clinical Research, Prevention, Clinical Trials and Supportive Activities, Nutrition, Obesity, Humans, Weight Loss, Male, Female, Cross-Over Studies, Adult, Middle Aged, Diet, Carbohydrate-Restricted, Diet, Reducing, Diet, Fat-Restricted
الوصف: Weight change trajectory from diet and lifestyle interventions typically involves rapid weight loss followed by a weight plateau after approximately 6 months. Changing from one weight-loss diet to another at the time of the plateau could instigate renewed weight loss. Therefore, our secondary analysis aimed to assess trajectory of weight loss in a 12-month, randomized, cross-over study. Forty-two adults were randomized to eat a healthy low-fat or healthy low-carbohydrate diet for 6 months then switched to the opposite diet for an additional 6 months. Regardless of diet assignment, participants experienced rapid initial weight loss, which slowed between 3 to 6 months. After switching diets at 6 months, weight modestly decreased until 9 months, but at a rate slower than the initial 3 months and slower than the rate from 3 to 6 months. This suggests that the weight loss plateau typically seen at 6 months is physiological and cannot be overcome by simply switching to a different weight-loss diet.
وصف الملف: application/pdf
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4دورية أكاديمية
المؤلفون: Bergeman, Auke, Lieve, Krystien, Kallas, Dania, Bos, J, Rosés I Noguer, Ferran, Denjoy, Isabelle, Zorio, Esther, Kammeraad, Janneke, Peltenburg, Puck, Tobert, Katie, Aiba, Takeshi, Atallah, Joseph, Drago, Fabrizio, Batra, Anjan, Brugada, Ramon, Borggrefe, Martin, Clur, Sally-Ann, Cox, Moniek, Davis, Andrew, Dhillon, Santokh, Etheridge, Susan, Fischbach, Peter, Franciosi, Sonia, Haugaa, Kristina, Horie, Minoru, Johnsrude, Christopher, Kane, Austin, Krause, Ulrich, Kwok, Sit-Yee, LaPage, Martin, Ohno, Seiko, Probst, Vincent, Roberts, Jason, Robyns, Tomas, Sacher, Frederic, Semsarian, Christopher, Skinner, Jonathan, Swan, Heikki, Tavacova, Terezia, Tisma-Dupanovic, Svjetlana, Tfelt-Hansen, Jacob, Yap, Sing-Chien, Kannankeril, Prince, Leenhardt, Antoine, Till, Janice, Sanatani, Shubhayan, Tanck, Michael, Ackerman, Michael, Wilde, Arthur, van der Werf, Christian
المصدر: Circulation. 148(25)
مصطلحات موضوعية: catecholaminergic polymorphic ventricular tachycardia, sudden cardiac death, ventricular arrhythmias, Female, Humans, Adolescent, Male, Flecainide, Incidence, Cross-Over Studies, Tachycardia, Ventricular, Adrenergic beta-Antagonists, Defibrillators, Implantable, Death, Sudden, Cardiac
الوصف: BACKGROUND: In severely affected patients with catecholaminergic polymorphic ventricular tachycardia, beta-blockers are often insufficiently protective. The purpose of this study was to evaluate whether flecainide is associated with a lower incidence of arrhythmic events (AEs) when added to beta-blockers in a large cohort of patients with catecholaminergic polymorphic ventricular tachycardia. METHODS: From 2 international registries, this multicenter case cross-over study included patients with a clinical or genetic diagnosis of catecholaminergic polymorphic ventricular tachycardia in whom flecainide was added to beta-blocker therapy. The study period was defined as the period in which background therapy (ie, beta-blocker type [beta1-selective or nonselective]), left cardiac sympathetic denervation, and implantable cardioverter defibrillator treatment status, remained unchanged within individual patients and was divided into pre-flecainide and on-flecainide periods. The primary end point was AEs, defined as sudden cardiac death, sudden cardiac arrest, appropriate implantable cardioverter defibrillator shock, and arrhythmic syncope. The association of flecainide with AE rates was assessed using a generalized linear mixed model assuming negative binomial distribution and random effects for patients. RESULTS: A total of 247 patients (123 [50%] females; median age at start of flecainide, 18 years [interquartile range, 14-29]; median flecainide dose, 2.2 mg/kg per day [interquartile range, 1.7-3.1]) were included. At baseline, all patients used a beta-blocker, 70 (28%) had an implantable cardioverter defibrillator, and 21 (9%) had a left cardiac sympathetic denervation. During a median pre-flecainide follow-up of 2.1 years (interquartile range, 0.4-7.2), 41 patients (17%) experienced 58 AEs (annual event rate, 5.6%). During a median on-flecainide follow-up of 2.9 years (interquartile range, 1.0-6.0), 23 patients (9%) experienced 38 AEs (annual event rate, 4.0%). There were significantly fewer AEs after initiation of flecainide (incidence rate ratio, 0.55 [95% CI, 0.38-0.83]; P=0.007). Among patients who were symptomatic before diagnosis or during the pre-flecainide period (n=167), flecainide was associated with significantly fewer AEs (incidence rate ratio, 0.49 [95% CI, 0.31-0.77]; P=0.002). Among patients with ≥1 AE on beta-blocker therapy (n=41), adding flecainide was also associated with significantly fewer AEs (incidence rate ratio, 0.25 [95% CI, 0.14-0.45]; P
وصف الملف: application/pdf
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5دورية أكاديمية
المؤلفون: Marcus, Gregory M, Rosenthal, David G, Nah, Gregory, Vittinghoff, Eric, Fang, Christina, Ogomori, Kelsey, Joyce, Sean, Yilmaz, Defne, Yang, Vivian, Kessedjian, Tara, Wilson, Emily, Yang, Michelle, Chang, Kathleen, Wall, Grace, Olgin, Jeffrey E
المصدر: New England Journal of Medicine. 388(12)
مصطلحات موضوعية: Biomedical and Clinical Sciences, Public Health, Health Sciences, Clinical Research, Prevention, Clinical Trials and Supportive Activities, 6.1 Pharmaceuticals, Evaluation of treatments and therapeutic interventions, Cardiovascular, Good Health and Well Being, Adult, Female, Humans, Male, Middle Aged, Atrial Premature Complexes, Caffeine, Coffee, Glucose, Prospective Studies, Drinking, Cross-Over Studies, Blood Glucose, Walking, Sleep Duration, Accelerometry, Electrocardiography, Ambulatory, Blood Glucose Self-Monitoring, Mobile Applications, Text Messaging, Ventricular Premature Complexes, Medical and Health Sciences, General & Internal Medicine, Biomedical and clinical sciences, Health sciences
الوصف: BackgroundCoffee is one of the most commonly consumed beverages in the world, but the acute health effects of coffee consumption remain uncertain.MethodsWe conducted a prospective, randomized, case-crossover trial to examine the effects of caffeinated coffee on cardiac ectopy and arrhythmias, daily step counts, sleep minutes, and serum glucose levels. A total of 100 adults were fitted with a continuously recording electrocardiogram device, a wrist-worn accelerometer, and a continuous glucose monitor. Participants downloaded a smartphone application to collect geolocation data. We used daily text messages, sent over a period of 14 days, to randomly instruct participants to consume caffeinated coffee or avoid caffeine. The primary outcome was the mean number of daily premature atrial contractions. Adherence to the randomization assignment was assessed with the use of real-time indicators recorded by the participants, daily surveys, reimbursements for date-stamped receipts for coffee purchases, and virtual monitoring (geofencing) of coffee-shop visits.ResultsThe mean (±SD) age of the participants was 39±13 years; 51% were women, and 51% were non-Hispanic White. Adherence to the random assignments was assessed to be high. The consumption of caffeinated coffee was associated with 58 daily premature atrial contractions as compared with 53 daily events on days when caffeine was avoided (rate ratio, 1.09; 95% confidence interval [CI], 0.98 to 1.20; P = 0.10). The consumption of caffeinated coffee as compared with no caffeine consumption was associated with 154 and 102 daily premature ventricular contractions, respectively (rate ratio, 1.51; 95% CI, 1.18 to 1.94); 10,646 and 9665 daily steps (mean difference, 1058; 95% CI, 441 to 1675); 397 and 432 minutes of nightly sleep (mean difference, 36; 95% CI, 25 to 47); and serum glucose levels of 95 mg per deciliter and 96 mg per deciliter (mean difference, -0.41; 95% CI, -5.42 to 4.60).ConclusionsIn this randomized trial, the consumption of caffeinated coffee did not result in significantly more daily premature atrial contractions than the avoidance of caffeine. (Funded by the University of California, San Francisco, and the National Institutes of Health; CRAVE ClinicalTrials.gov number, NCT03671759.).
وصف الملف: application/pdf
الوصول الحر: https://escholarship.org/uc/item/4mp6x23zTest
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6دورية أكاديمية
المؤلفون: Marcin, James P, Sauers-Ford, Hadley S, Mouzoon, Jamie L, Haynes, Sarah C, Dayal, Parul, Sigal, Ilana, Tancredi, Daniel, Lieng, Monica K, Kuppermann, Nathan
المصدر: JAMA network open. 6(2)
مصطلحات موضوعية: Humans, Retrospective Studies, Cross-Over Studies, Telemedicine, Child, Child, Preschool, Rural Health Services, Referral and Consultation, Male, Health Services, Emergency Care, Prevention, Rural Health, Clinical Research, Pediatric, Clinical Trials and Supportive Activities, Generic health relevance, Good Health and Well Being
الوصف: ImportancePediatric referral centers are increasingly using telemedicine to provide consultations to help care for acutely ill children presenting to rural and community emergency departments (EDs). These pediatric telemedicine consultations may help improve physician decision-making and may reduce the frequency of overtriage and interfacility transfers.ObjectiveTo examine the use of pediatric critical care telemedicine vs telephone consultations associated with risk-adjusted transfer rates of acutely ill children from community and rural EDs.Design, setting, and participantsA cluster-randomized crossover trial was conducted between November 18, 2015, and March 26, 2018. Analyses were conducted from January 19, 2018, to July 23, 2022, 2022. Participants included acutely ill children aged 14 years and younger presenting to a participating ED in 15 rural and community EDs in northern California.InterventionsParticipating EDs were randomized to use telemedicine or telephone for consultations with pediatric critical care physicians according to 1 of 4 unbalanced (3 telemedicine:1 telephone) crossover treatment assignment sequences.Main outcomes and measuresIntention-to-treat, treatment-received, and per-protocol analyses were performed to determine the risk of transfer using mixed effects Poisson regression analyses with random intercepts for presenting EDs to account for hospital-level clustering.ResultsA total of 696 children (392 boys [56.3%]; mean [SD] age, 4.2 [4.6] years) were enrolled. Of the 537 children (77.2%) assigned to telemedicine, 251 (46.7%) received the intervention. In the intention-to-treat analysis, patients assigned to the telemedicine arm were less likely to be transferred compared with patients assigned to the telephone arm after adjusting for patient age, severity of illness, and hospital study period (risk rate [RR], 0.93; 95% CI, 0.88-0.99). The adjusted risk of transfer was significantly lower in the telemedicine arm compared with the telephone arm in both the treatment-received analysis (RR, 0.81; 95% CI, 0.71-0.94) and the per-protocol analysis (RR, 0.79; 95% CI, 0.68-0.92).Conclusions and relevanceIn this randomized trial, the use of telemedicine to conduct consultations for acutely ill children in rural and community EDs resulted in less frequent overall interfacility transfers than consultations done by telephone.Trial registrationClinicalTrials.gov Identifier: NCT02877810.
وصف الملف: application/pdf
الوصول الحر: https://escholarship.org/uc/item/5cc3n113Test
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7دورية أكاديمية
المؤلفون: Williams Louie, Elizabeth, Nieto, Jorge, Wensley, Fiona, Finno, Carrie, Berryhill, Emily, Morgan, Jessica
المصدر: Journal of Veterinary Internal Medicine. 37(6)
مصطلحات موضوعية: EGUS, colic, squamous, stomach, vitamin E, Animals, Humans, Male, alpha-Tocopherol, Dietary Supplements, Horse Diseases, Horses, Omeprazole, Prospective Studies, Stomach Ulcer, Ulcer, Cross-Over Studies
الوصف: BACKGROUND: Omega-3 fatty acid and alpha-tocopherol supplementation reduces gastric ulcer formation in humans and rodents; however, efficacy of prevention in horses is unknown. Equine Omega Complete (EOC) is an oral supplement containing omega-3 fatty acids and alpha-tocopherol. HYPOTHESIS/OBJECTIVE: Determine if EOC supplementation prevents gastric ulcers and increases serum alpha-tocopherol concentrations in healthy horses. ANIMALS: Nine thoroughbred geldings; 5-13 years old. METHODS: Prospective randomized block design, repeated in crossover model. Horses were administered EOC, omeprazole, or water PO for 28 days. Horses underwent an established gastric ulcer induction protocol from days 21-28 via intermittent feed deprivation. Gastroscopies were performed on days 0, 21, and 28. Serum alpha-tocopherol concentrations were measured on days 0 and 28. The effects of treatment and time on ulcer grades were assessed with ordinal logistic regression, with significance at P-value
وصف الملف: application/pdf
الوصول الحر: https://escholarship.org/uc/item/2b86z20mTest
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8دورية أكاديمية
المؤلفون: Richardson, Christine E, Tovar, Ashley P, Davis, Brian A, Van Loan, Marta D, Keim, Nancy L, Casazza, Gretchen A
المصدر: Nutrients. 15(4)
مصطلحات موضوعية: Biomedical and Clinical Sciences, Public Health, Health Sciences, Sports Science and Exercise, Clinical Sciences, Nutrition and Dietetics, Clinical Research, Clinical Trials and Supportive Activities, Nutrition, Prevention, Obesity, Metabolic and endocrine, Cardiovascular, Stroke, Humans, Male, Body Composition, Cardiometabolic Risk Factors, Cardiovascular Diseases, Cross-Over Studies, Lipids, Athletes, Intermittent Fasting, Running, resting energy expenditure, insulin, glucose, blood pressure, body composition, fat mass, cholesterol, lipoproteins, intermittent fasting, Food Sciences, Clinical sciences, Nutrition and dietetics, Public health
الوصف: Timing of nutrient intake for athletes may affect exercise performance and cardiometabolic factors. Our objective was to examine the effect of time-restricted eating (TRE) on cardiometabolic health. Using a cross-over study design, 15 endurance-trained male runners were randomized to either a normal dietary pattern (ND) first (12 h eating/fasting times) followed by time-restricted eating (TRE) pattern (16 h fast; 8 h eating) or the reverse, with a 4-week washout period between interventions. Body composition, resting energy expenditure, blood pressure and serum insulin, glucose and lipids were measured using standard laboratory methods. Exercise training and dietary intake (calories and macronutrients) were similar across interventions. No significant differences were observed in resting energy expenditure, markers of insulin resistance, serum lipids or blood pressure. Body composition did change significantly (p < 0.05) with whole body fat mass (-0.8 ± 1.3 kg with TRE vs. +0.1 ± 4.3 kg with ND), leg fat mass (-0.3 ± 0.5 kg with TRE vs. +0.1 ± 0.4 kg with ND), and percent body fat (-1.0 ± 1.5% with TRE vs. +0.1 ± 1.3% with ND) declining more in the TRE intervention, with no change in fat-free mass. This study is one of a few to investigate the effects of an isocaloric 16/8 TRE eating pattern in trained endurance athletes and confirms no change in cardiometabolic risk factors. In conclusion, TRE is not detrimental to cardiometabolic health in endurance-trained male runners but could be beneficial on exercise performance by reducing fat mass.
وصف الملف: application/pdf
الوصول الحر: https://escholarship.org/uc/item/2q95p24tTest
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9دورية أكاديمية
المؤلفون: Pelham, William E, Altszuler, Amy R, Merrill, Brittany M, Raiker, Joseph S, Macphee, Fiona L, Ramos, Marcela, Gnagy, Elizabeth M, Greiner, Andrew R, Coles, Erika K, Connor, Carol M, Lonigan, Christopher J, Burger, Lisa, Morrow, Anne S, Zhao, Xin, Swanson, James M, Waxmonsky, James G
المصدر: Journal of Consulting and Clinical Psychology. 90(5)
مصطلحات موضوعية: Psychology, Clinical and Health Psychology, Social and Personality Psychology, Applied and Developmental Psychology, Brain Disorders, Pediatric, Attention Deficit Hyperactivity Disorder (ADHD), Clinical Trials and Supportive Activities, Mental Health, Clinical Research, Behavioral and Social Science, 6.1 Pharmaceuticals, Evaluation of treatments and therapeutic interventions, Mental health, Attention Deficit Disorder with Hyperactivity, Central Nervous System Stimulants, Child, Cross-Over Studies, Curriculum, Double-Blind Method, Female, Humans, Male, Methylphenidate, Treatment Outcome, ADHD, methylphenidate, learning, Clinical Psychology, Applied and developmental psychology, Clinical and health psychology, Social and personality psychology
الوصف: ObjectiveEvaluate whether stimulant medication improves acquisition of academic material in children with attention deficit hyperactivity disorder (ADHD) receiving small-group, content-area instruction in a classroom setting.MethodParticipants were 173 children between the ages of 7 and 12 years old (77% male, 86% Hispanic) who met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for ADHD and were participating in a therapeutic summer camp. The design was a triple-masked, within-subject, AB/BA crossover trial. Children completed two consecutive phases of daily, 25-min instruction in both (a) subject-area content (science, social studies) and (b) vocabulary. Each phase was a standard instructional unit lasting for 3 weeks. Teachers and aides taught the material to small groups in a summer classroom setting. Each child was randomized to be medicated with daily osmotic-release oral system methylphenidate (OROS-MPH) during either the first or second of the instructional phases, receiving placebo during the other.ResultsMedication had large, salutary, statistically significant effects on children's academic seatwork productivity and classroom behavior on every single day of the instructional period. However, there was no detectable effect of medication on learning the material taught during instruction: Children learned the same amount of subject-area and vocabulary content whether they were taking OROS-MPH or placebo during the instructional period.ConclusionsAcute effects of OROS-MPH on daily academic seatwork productivity and classroom behavior did not translate into improved learning of new academic material taught via small-group, evidence-based instruction. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
وصف الملف: application/pdf
الوصول الحر: https://escholarship.org/uc/item/9br9z1fjTest
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10دورية أكاديمية
المؤلفون: Singh, Dave, Wild, Jim, Saralaya, Dinesh, Lawson, Rod, Marshall, Helen, Goldin, Jonathan, Brown, Matthew, Kostikas, Konstantinos, Belmore, Kristin, Fogel, Robert, Patalano, Francesco, Drollmann, Anton, Machineni, Surendra, Jones, Ieuan, Yates, Denise, Tillmann, Hanns-Christian
المصدر: Respiratory Research. 23(1)
مصطلحات موضوعية: Chronic obstructive pulmonary disease, Hyperpolarized 3He gas magnetic resonance imaging, Indacaterol/glycopyrronium, V/Q index, Ventilation volume and perfusion volume, Ventilation/perfusion ratio, Aged, Bronchoconstriction, Cross-Over Studies, Double-Blind Method, Drug Combinations, Female, Follow-Up Studies, Forced Expiratory Volume, Glycopyrrolate, Humans, Indans, Lung, Male, Middle Aged, Pulmonary Disease, Chronic Obstructive, Quinolones, Respiratory Function Tests, Retrospective Studies, Treatment Outcome, Vital Capacity
الوصف: RATIONALE: The long-acting β2-agonist/long-acting muscarinic antagonist combination indacaterol/glycopyrronium (IND/GLY) elicits bronchodilation, improves symptoms, and reduces exacerbations in COPD. Magnetic resonance imaging (MRI) of the lung with hyperpolarized gas and gadolinium contrast enhancement enables assessment of whole lung functional responses to IND/GLY. OBJECTIVES: The primary objective was assessment of effect of IND/GLY on global ventilated lung volume (%VV) versus placebo in COPD. Lung function, regional ventilation and perfusion in response to IND/GLY were also measured. METHODS: This double-blind, randomized, placebo-controlled, crossover study assessed %VV and pulmonary perfusion in patients with moderate-to-severe COPD after 8 days of once-daily IND/GLY treatment (110/50 µg) followed by 8 days of placebo, or vice versa, using inhaled hyperpolarized 3He gas and gadolinium contrast-enhanced MRI, respectively. Lung function measures including spirometry were performed for each treatment after 8 days. MEASUREMENTS AND MAIN RESULTS: Of 31 patients randomized, 29 completed both treatment periods. IND/GLY increased global %VV versus placebo (61.73% vs. 56.73%, respectively, least squares means treatment difference: 5.00% [90% CI 1.40 to 8.60]; P = 0.025). IND/GLY improved whole lung index of ventilation volume to perfusion volume (V/Q) ratio versus placebo; 94% (90% CI 83 to 105) versus 86% (90% CI 75 to 97; P = 0.047), respectively. IND/GLY showed a trend to improve diffusing capacity for carbon monoxide (DLCO) (+ 0.66 mL/min/mmHg; P = 0.082). By Day 8, forced expiratory volume in 1 s (FEV1) was increased by 0.32 L versus placebo (90% CI 0.26 to 0.38; P
وصف الملف: application/pdf
الوصول الحر: https://escholarship.org/uc/item/6j4051n8Test
