Effectiveness and Persistency of Ustekinumab Treatment for Ulcerative Colitis: A Phoenix retrospective Cohort Study

Background

Real-world data regarding ustekinumab (UST) for ulcerative colitis (UC) particularly in biologics-naïve patients is currently limited. This study aimed to elucidate the real-world effectiveness and safety of UST for UC.

Methods

Overall, 150 patients with UC treated with UST from March 2020 to January 2023 were enrolled across 7 referral hospitals. To assess the clinical efficacy and persistence of UST, retrospective analyses were conducted from weeks 8 to 56. Predictive factors concerning the response and persistence of UST were examined through univariate and multivariate analyses.

Results

Of the 150 patients, 125 received UST for remission induction, including 36% biologics-naïve. The response and remission rates were 72.8% and 56.0% at week 8 and 73.2% and 63.4% at week 56, respectively. Biologics-naïve patients represented higher response and remission rates at week 8 (84.4% and 73.3%) than those with biologics exposure (66.2% and 46.2%). Patients with prior antitumor necrosis factor (anti-TNF) and vedolizumab (VDZ) exposure had relatively lower response and remission rates (34.5% and 24.1%, respectively). The 1-year cumulative persistence rate was 84.0%. Multivariate analysis revealed that the chronic continuous type and prior anti-TNF and VDZ exposure were negative predictive factors for week 8 responsiveness. Clinical response at week 8 was a predictor of 1-year persistence. Adverse event incidence remained notably low at 6.4%.

Conclusions

This study highlights the safety and effectiveness of UST as an induction and maintenance therapy for UC. Chronic continuous type and previous anti-TNF and VDZ exposure negatively contributed to short-term effectiveness, whereas short-term effectiveness provided good persistency.

Modeling daily yields of milk, fat, protein, and lactose of New Zealand dairy goats undergoing standard and extended lactations

This study aimed to assess the milk production data for New Zealand dairy goats in either a standard lactation (SL; ≤305 d in milk [DIM]) or extended lactation (EL; >305 and ≤670 DIM) using a random regression (RR) with third- and fifth-order Legendre polynomials, respectively. Persistency of EL was defined as (B/A) × 100, where A was the accumulated yield from d 1 to 305, and B was the accumulated yield from d 366 to 670. On average, goats in SL produced 1,183 kg of milk, 37 kg of fat, 37 kg of protein, and 54 kg of lactose. The average production of milk, fat, protein, and lactose in EL were 2,473 kg, 78 kg, 79 kg, and 112 kg, respectively. The average persistences for milk, fat, protein, and lactose yields during EL were 98%, 98%, 102%, and 96%, respectively. The relative prediction errors were close to 10% and the concordance correlation coefficients >0.92, indicating that the RR model with Legendre polynomials is adequate for modeling lactation curves for both SL and EL. Total yields and persistency were analyzed with a mixed model that included the fixed effects (year, month of kidding, parity, and proportion of Saanen) as covariates and the random effects of animal and residual errors. Effects of year, month of kidding, and parity were significant on the total yields of milk, fat, protein, and lactose for both SL and EL. The total milk yield of first-parity goats with SL was 946 kg and the total milk yield of second-parity goats with SL was 1,284 kg, making a total of 2,230 kg over 2 years. The total milk yield of a first-parity goat with EL was 2,140 kg. Thus, on average, a goat with SL for the first and second parity produced 90 kg more milk than a first-parity goat subjected to EL. However, a second-parity goat subjected to EL produced 43 kg more milk (2,639 kg) than a goat with SL following the second and third parity (1,284 kg + 1,312 kg). These data, along with the various other benefits of EL (e.g., fewer offspring born and reduced risk of mastitis, lameness, and metabolic problems in early lactation), indicate that EL as a management strategy holds the potential to improve dairy goat longevity and lifetime efficiency without compromising milk production.

Genetic parameters and genome-wide association studies for mozzarella and milk production traits, lactation length, and lactation persistency in Murrah buffaloes

Genetic and genomic analyses of longitudinal traits related to milk production efficiency are paramount for optimizing water buffaloes breeding schemes. Therefore, this study aimed to (1) compare single-trait random regression models under a single-step genomic BLUP setting based on alternative covariance functions (i.e., Wood, Wilmink, and Ali and Schaeffer) to describe milk (MY), fat (FY), protein (PY), and mozzarella (MZY) yields, fat-to-protein ratio (FPR), somatic cell score (SCS), lactation length (LL), and lactation persistency (LP) in Murrah dairy buffaloes (Bubalus bubalis); (2) combine the best functions for each trait under a multiple-trait framework; (3) estimate time-dependent SNP effects for all the studied longitudinal traits; and (4) identify the most likely candidate genes associated with the traits. A total of 323,140 test-day records from the first lactation of 4,588 Murrah buffaloes were made available for the study. The model included the average curve of the population nested within herd-year-season of calving, systematic effects of number of milkings per day, and age at first calving as linear and quadratic covariates, and additive genetic, permanent environment, and residual as random effects. The Wood model had the best goodness of fit based on the deviance information criterion and posterior model probabilities for all traits. Moderate heritabilities were estimated over time for most traits (0.30 ± 0.02 for MY; 0.26 ± 0.03 for FY; 0.45 ± 0.04 for PY; 0.28 ± 0.05 for MZY; 0.13 ± 0.02 for FPR; and 0.15 ± 0.03 for SCS). The heritability estimates for LP ranged from 0.38 ± 0.02 to 0.65 ± 0.03 depending on the trait definition used. Similarly, heritabilities estimated for LL ranged from 0.10 ± 0.01 to 0.14 ± 0.03. The genetic correlation estimates across days in milk (DIM) for all traits ranged from -0.06 (186-215 DIM for MY-SCS) to 0.78 (66-95 DIM for PY-MZY). The SNP effects calculated for the random regression model coefficients were used to estimate the SNP effects throughout the lactation curve (from 5 to 305 d). Numerous relevant genomic regions and candidate genes were identified for all traits, confirming their polygenic nature. The candidate genes identified contribute to a better understanding of the genetic background of milk-related traits in Murrah buffaloes and reinforce the value of incorporating genomic information in their breeding programs.

Lactation curves of Montbéliarde-sired and Viking Red-sired crossbred cows and their Holstein herdmates in commercial dairies

Lactation curves were estimated for Montbéliarde (MO) × Holstein (HO) and Viking Red (VR) × HO 2-breed crossbred cows and for MO × VR/HO and VR × MO/HO 3-breed crossbred cows and their HO herdmates from test-day observations in 7 high-performance herds that participated in a designed study. Cows calved from 2010 to 2017. Test-day observations from milk recording were used to fit the lactation curves of cows in their first 3 lactations. Lactations of cows were required to have at least 250 d in milk (DIM) and to have at least 6 test days ≤265 DIM. Lactation curves from random regression (RR) were compared for 305-d production (kg), peak production (kg), peak d of production, and production from 4 to 103 DIM (kg), from 104 to 205 DIM (kg), and from 206 to 305 DIM (kg) for milk, fat, and protein. Also, the persistency of production was compared. First-lactation versus second and third lactation cows were analyzed separately for both the 2-breed and 3-breed crossbred cows and their respective HO herdmates. Legendre polynomial RR had the best goodness of fit for the lactation curves compared with Ali-Schaeffer and Wilmink RR from the test-day observations of milk, fat, and protein production. For fluid milk production of first-lactation cows, the MO × HO 2-breed crossbreds were not different from their HO herdmates for any of the lactation curve characteristics, except persistency. However, the VR × HO 2-breed crossbreds had less fluid milk production compared with their HO herdmates. For first lactation, the MO × HO 2-breed crossbreds had more persistency of milk, fat, and protein production compared with their HO herdmates. The first-lactation MO × VR/HO 3-breed crossbreds had more persistency of fluid milk production compared with their HO herdmates. For second and third lactations, both the MO × HO and the VR × HO 2-breed crossbreds had higher fat production compared with their HO herdmates. Furthermore, the MO × HO 2-breed crossbreds had more protein production (kg) in all 3 periods of lactation compared with their HO herdmates. Crossbred cows may have advantages over HO cows for persistency of production in high-performance herds.

The Persistency Index: a novel screening tool for identifying myofascial pelvic floor dysfunction in patients seeking care for lower urinary tract symptoms

BACKGROUND

Patients with myofascial pelvic floor dysfunction often present with lower urinary tract symptoms, such as urinary frequency, urgency, and bladder pressure. Often confused with other lower urinary tract disorders, this constellation of symptoms, recently termed myofascial urinary frequency syndrome, is distinct from other lower urinary tract symptoms and optimally responds to pelvic floor physical therapy. A detailed pelvic floor myofascial examination performed by a skilled provider is currently the only method to identify myofascial urinary frequency syndrome. Despite a high influence on quality of life, low awareness of this condition combined with no objective diagnostic testing leads to the frequent misdiagnosis or underdiagnosis of myofascial urinary frequency syndrome.

OBJECTIVE

This study aimed to develop a screening measure to identify patients with myofascial urinary frequency syndrome (bothersome lower urinary tract symptoms secondary to myofascial pelvic floor dysfunction) from patient-reported symptoms.

STUDY DESIGN

A population of patients with isolated myofascial urinary frequency syndrome was identified by provider diagnosis from a tertiary urology practice and verified by standardized pelvic floor myofascial examination and perineal surface pelvic floor electromyography. Least Angle Shrinkage and Selection Operator was used to identify candidate features from the Overactive Bladder Questionnaire, Female Genitourinary Pain Index, and Pelvic Floor Distress Index predictive of myofascial urinary frequency syndrome in a pooled population also containing subjects with overactive bladder (n=42), interstitial cystitis/bladder pain syndrome (n=51), and asymptomatic controls (n=54) (derivation cohort). A simple, summated score of the most discriminatory questions using the original scaling of the Pelvic Floor Distress Index 5 (0-4) and Genitourinary Pain Index 5 (0-5) and modified scaling of Female Genitourinary Pain Index 2b (0-3) had an area under the curve of 0.75. As myofascial urinary frequency syndrome was more prevalent in younger subjects, the inclusion of an age penalty (3 points added if under the age of 50 years) improved the area under the curve to 0.8. This score was defined as the Persistency Index (possible score of 0-15). The Youden Index was used to identify the optimal cut point Persistency Index score for maximizing sensitivity and specificity.

RESULTS

Using a development cohort of 215 subjects, the severity (Pelvic Floor Distress Index 5) and persistent nature (Female Genitourinary Pain Index 5) of the sensation of incomplete bladder emptying and dyspareunia (Female Genitourinary Pain Index 2b) were the most discriminatory characteristics of the myofascial urinary frequency syndrome group, which were combined with age to create the Persistency Index. The Persistency Index performed well in a validation cohort of 719 patients with various lower urinary tract symptoms, including overactive bladder (n=285), interstitial cystitis/bladder pain syndrome (n=53), myofascial urinary frequency syndrome (n=111), controls (n=209), and unknown diagnoses (n=61), exhibiting an area under the curve of 0.74. A Persistency Index score ≥7 accurately identified patients with myofascial urinary frequency syndrome from an unselected population of individuals with lower urinary tract symptoms with 80% sensitivity and 61% specificity. A combination of the Persistency Index with the previously defined Bladder Pain Composite Index and Urge Incontinence Composite Index separated a population of women seeking care for lower urinary tract symptoms into groups consistent with overactive bladder, interstitial cystitis/bladder pain syndrome, and myofascial urinary frequency syndrome phenotypes with an overall diagnostic accuracy of 82%.

CONCLUSION

Our study recommends a novel screening method for patients presenting with lower urinary tract symptoms to identify patients with myofascial urinary frequency syndrome. As telemedicine becomes more common, this index provides a way of screening for myofascial urinary frequency syndrome and initiating pelvic floor physical therapy even before a confirmatory pelvic examination.

Prediction of persistency for day 305 of lactation at the moment of the insemination decision

When deciding on the voluntary waiting period of an individual cow, it might be useful to have insight into the persistency for the remainder of that lactation at the moment of the insemination decision, especially for farmers who consider persistency in their reproduction management. Currently, breeding values for persistency are calculated for dairy cows but, to our knowledge, prediction models to accurately predict persistency at different moments of insemination are lacking. This study aimed to predict lactation persistency for DIM 305 at different insemination moments (DIM 50, 75, 100, and 125). Available cow and herd level data from 2005 to 2022 were collected for a total of 20,508 cows from 85 herds located in the Netherlands and Belgium. Lactation curve characteristics were estimated for every daily record using the data up to and including that day. Persistency was defined as the number of days it takes for the milk production to decrease by half during the declining stage of lactation, and calculated from the estimated lactation curve characteristic 'decay'. Four linear regression models for each of the selected insemination moment were built separately to predict decay at DIM 305 (decay-305). Independent variables included the lactation curve characteristics at the selected insemination moment, daily milk yield, age, calving season, parity group and other herd variables. The average decay-305 of primiparous cows was lower than that of multiparous cows (1.55 *10-3 vs. 2.41*10-3, equivalent to a persistency of 447 vs. 288 days, respectively). Results showed that our models had limitations in accurately predicting persistency, although predictions improved slightly at later insemination moments, with R2 values ranging between 0.27 and 0.41. It can thus be concluded that, based only on cow and herd milk production information, accurate prediction of persistency for DIM 305 is not feasible.

Electric shock causes a fleeing-like persistent behavioral response in the nematode Caenorhabditis elegans

Behavioral persistency reflects internal brain states, which are the foundations of multiple brain functions. However, experimental paradigms enabling genetic analyses of behavioral persistency and its associated brain functions have been limited. Here, we report novel persistent behavioral responses caused by electric stimuli in the nematode Caenorhabditis elegans. When the animals on bacterial food are stimulated by alternating current, their movement speed suddenly increases 2- to 3-fold, persisting for more than 1 minute even after a 5-second stimulation. Genetic analyses reveal that voltage-gated channels in the neurons are required for the response, possibly as the sensors, and neuropeptide signaling regulates the duration of the persistent response. Additional behavioral analyses implicate that the animal's response to electric shock is scalable and has a negative valence. These properties, along with persistence, have been recently regarded as essential features of emotion, suggesting that C. elegans response to electric shock may reflect a form of emotion, akin to fear.

Modeling three-dimensional T-cell motility using clustering and hidden Markov models

Recent advances in imaging technologies now allow for real-time tracking of fast-moving immune cells as they search for targets such as pathogens and tumor cells through complex three-dimensional tissues. Cytotoxic T cells are specialized immune cells that continually scan tissues for such targets to engage and kill, and have emerged as the principle mediators of breakthrough immunotherapies against cancers. Modeling the way these T cells move is of great value in furthering our understanding of their collective search efficiency. T-cell motility is characterized by heterogeneity at two levels: (a) Individual cells display different distributions of translational speeds and turning angles, and (b) each cell can during a given track, its motility, switch between local search and directional motion. Despite a likely considerable influence on a motile population's search performance, statistical models that accurately capture both such heterogeneities in a distinguishing manner are lacking. Here, we model three-dimensional T-cell trajectories through a spherical representation of their incremental steps and compare model outputs to real-world motility data from primary T cells navigating physiological environments. T cells in a population are clustered based on their directional persistence and characteristic "step lengths" therein capturing between-cell heterogeneity. The motility dynamics of cells within each cluster are individually modeled through hidden Markov model to capture within-cell transitions between local and more extensive search patterns. We explore the importance of explicitly capturing altered motility patterns when cells lie in close proximity to one another, through a non-homogenous hidden Markov model.

Myofascial Frequency Syndrome: A novel syndrome of bothersome lower urinary tract symptoms associated with myofascial pelvic floor dysfunction

Background

Patients presenting with lower urinary tract symptoms (LUTS) are historically classified to several symptom clusters, primarily overactive bladder (OAB) and interstitial cystitis/bladder pain syndrome (IC/BPS). Accurate diagnosis, however, is challenging due to overlapping symptomatic features, and many patients do not readily fit into these categories. To enhance diagnostic accuracy, we previously described an algorithm differentiating OAB from IC/BPS. Herein, we sought to validate the utility of this algorithm for identifying and classifying a real-world population of individuals presenting with OAB and IC/BPS and characterize patient subgroups outside the traditional LUTS diagnostic paradigm.

Methods

An Exploratory cohort of 551 consecutive female subjects with LUTS evaluated in 2017 were administered 5 validated genitourinary symptom questionnaires. Application of the LUTS diagnostic algorithm classified subjects into controls, IC/BPS, and OAB, with identification of a novel group of highly bothered subjects lacking pain or incontinence. Symptomatic features of this group were characterized by statistically significant differences from the OAB, IC/BPS and control groups on questionnaires, comprehensive review of discriminate pelvic exam, and thematic analysis of patient histories. In a Reassessment cohort of 215 subjects with known etiologies of their symptoms (OAB, IC/BPS, asymptomatic microscopic hematuria, or myofascial dysfunction confirmed with electromyography), significant associations with myofascial dysfunction were identified in a multivariable regression model. Pre-referral and specialist diagnoses for subjects with myofascial dysfunction were catalogued.

Findings

Application of a diagnostic algorithm to an unselected group of 551subjects presenting for urologic care identified OAB and IC/BPS in 137 and 96 subjects, respectively. An additional 110 patients (20%) with bothersome urinary symptoms lacked either bladder pain or urgency characteristic of IC/BPS and OAB, respectively. In addition to urinary frequency, this population exhibited a distinctive symptom constellation suggestive of myofascial dysfunction characterized as "persistency": bothersome urinary frequency resulting from bladder discomfort/pelvic pressure conveying a sensation of bladder fullness and a desire to urinate. On examination, 97% of persistency patients demonstrated pelvic floor hypertonicity with either global tenderness or myofascial trigger points, and 92% displayed evidence of impaired muscular relaxation, hallmarks of myofascial dysfunction. We therefore classified this symptom complex "myofascial frequency syndrome". To confirm this symptom pattern was attributable to the pelvic floor, we confirmed the presence of "persistency" in 68 patients established to have pelvic floor myofascial dysfunction through comprehensive evaluation corroborated by symptom improvement with pelvic floor myofascial release. These symptoms distinguish subjects with myofascial dysfunction from subjects with OAB, IC/BPS, and asymptomatic controls, confirming that myofascial frequency syndrome is a distinct LUTS symptom complex.

Interpretation

This study describes a novel, distinct phenotype of LUTS we classified as myofascial frequency syndrome in approximately one-third of individuals with urinary frequency. Common symptomatic features encompass elements in other urinary syndromes, such as bladder discomfort, urinary frequency and urge, pelvic pressure, and a sensation of incomplete emptying, causing significant diagnostic confusion for providers. Inadequate recognition of myofascial frequency syndrome may partially explain suboptimal overall treatment outcomes for women with LUTS. Recognition of the distinct symptom features of MFS (persistency) should prompt referral to pelvic floor physical therapy. To improve our understanding and management of this as-yet understudied condition, future studies will need to develop consensus diagnostic criteria and objective tools to assess pelvic floor muscle fitness, ultimately leading to corresponding diagnostic codes.

Funding

This work was supported by the AUGS/Duke UrogynCREST Program (R25HD094667 (NICHD)) and by NIDDK K08 DK118176 and Department of Defense PRMRP PR200027, and NIA R03 AG067993.

Random regression models to estimate genetic parameters for milk yield, fat, and protein contents in Tunisian Holsteins

This study aimed to find the parsimonious random regression model (RRM) to evaluate the genetic potential for milk yield (MY), fat content (FC), and protein content (PC) in Tunisian Holstein cows. For this purpose, 551,139; 331,654; and 302,396 test day records for MY, FC, and PC were analysed using various RRMs with different Legendre polynomials (LP) orders on additive genetic (AG) and permanent environmental (PE) effects, and different types of residual variances (RV). The statistical analysis was performed in a Bayesian framework with Gibbs sampling, and the model performances were assessed, mainly, on the predictive ability criteria. The study found that the optimal model for evaluating these traits was an RRM with a third LP order and nine classes of heterogeneous RV. In addition, the study found that heritability estimates for MY, FC, and PC ranged from 0.11 to 0.22, 0.11 to 0.17, and 0.12 to 0.18, respectively, indicating that genetic improvement should be accompanied by improvements in the production environment. The study also suggested that new selection rules could be used to modify lactation curves by exploiting the canonical transformation of the random coefficient covariance (RC) matrix or by using the combination of slopes of individual lactation curves and expected daily breeding values.

Dynamic visualization of ultraviolet dose on skin with sunscreen applied using minimum erythema dose

BACKGROUND

Visualizing the ultraviolet (UV) dose on skin serve as an intuitive approach to ensure appropriate sunscreen usage and reduce the risk of erythema. UV dose is determined by a number of external factors, such as properties of sunscreens, weather, and type of outdoor activity. We propose a framework for visualizing UV doses that considers various external factors.

MATERIALS AND METHODS

First, the skin of a three-dimensional human model was represented using triangular meshes, and various static postures and dynamic motions were simulated to express outdoor activities. Then, we evaluated the persistency and insufficiency properties of sunscreen, which are time dependent and directly affect the effectiveness of the sunscreen skin protection factor (SPF) during UV exposure. Finally, to calculate the UV dose in real time, we tracked the trajectory of the sun and motion of the skin while considering the time-dependent properties of sunscreen.

RESULTS

An S/W system was implemented based on the proposed framework to visualize the distribution of UV doses through dynamic color changes in exposed skin areas. The color types include true colors, which represent the minimum erythema dose (MED), and pseudo colors representing states before 1 MED is reached. We devised various examples to discuss the usability of the proposed framework.

CONCLUSION

The system conveniently displays the MED according to an individual's skin phototype. When the properties of a wide range of commercial sunscreens are added to the system database, it is expected that the rate of appropriate sunscreen usage by customers will increase.

Long COVID: current status in Japan and knowledge about its molecular background

Even after recovering from coronavirus disease 2019 (COVID-19), patients can experience prolonged complaints, referred to as "long COVID". Similar to reports in Caucasians, a follow-up study in Japan revealed that fatigue, dyspnea, cough, anosmia/dysgeusia, and dyssomnia are common symptoms. Although the precise mode of long COVID remains elusive, multiple etiologies such as direct organ damage by infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), autoimmunity, prolonged inflammatory reactions, and psychiatric impairment seem to be involved. Notably, SARS-CoV-2 is neurotropic, and viral RNA and proteins are continuously detectable in multiple organs, including the brain. Viral proteins exert a number of different toxic effects on cells, suggesting that persistent infection is a key element for understanding long COVID. Here, we first reviewed the current status of long COVID in Japan, and then summarized literature that help us understand the molecular background of the symptoms. Finally, we discuss the feasibility of vaccination as a treatment for patients with long COVID.

Persistent Object Search and Surveillance Control With Safety Certificates for Drone Networks Based on Control Barrier Functions

In this paper, we address a persistent object search and surveillance mission for drone networks equipped with onboard cameras, and present a safe control strategy based on control barrier functions The mission for the object search and surveillance in this paper is defined with two subtasks, persistent search and object surveillance, which should be flexibly switched depending on the situation. Besides, to ensure actual persistency of the mission, we incorporate two additional specifications, safety (collision avoidance) and energy persistency (battery charging), into the mission. To rigorously describe the subtask of persistent search, we present a novel notion of γ-level persistent search and the performance certificate function as a candidate of a time-varying Control Barrier Function. We then design a constraint-based controller by combining the performance certificate function with other CBFs that individually reflect other specifications. In order to manage conflicts among the specifications, the present controller prioritizes individual specifications in the order of safety, energy persistency, and persistent search/object surveillance. The present controller is finally demonstrated through simulation and experiments on a testbed.

Associations between feed efficiency and aspects of lactation curves in primiparous Holstein dairy cattle

Genetic selection for improved feed efficiency in dairy cattle has received renewed attention over the last decade to address the needs of a growing global population. As milk yield is a critical component of feed efficiency metrics in dairy animals, our objective was to evaluate the associations between feed efficiency in primiparous Holstein cattle and parameters of a mathematical model describing individual lactation curves. The Dijkstra lactation curve model was fit to individual lactation records from 34 Holstein heifers with previously estimated measures of feed efficiency. We found that the optimal fit of the Dijkstra model was achieved using daily milk yield records up to 21 d in milk to capture the rise to peak milk yield and using monthly dairy herd improvement records for the remainder of lactation to accurately characterize lactation persistency. In the period of lactation before peak milk yield, improved feed efficiency was associated with a faster increase in daily milk yield over a shorter period of time at the expense of increased mobilization of body reserves; this serves to reinforce the concept that dairy cattle are primarily capital breeders versus income breeders. Feed efficiency in the period following peak lactation, as measured by gross feed efficiency, return over feed costs, and net energy efficiency of lactation, was positively associated with higher peak milk yield. The findings in early lactation suggest that estimates of feed efficiency could be improved by evaluating feed efficiency relative to conception, rather than parturition and lactation, to better account for the energy stored and released from body reserves in capital breeding.

Identification and Persistence of 5,6-Dihydro-2H-pyran-3-carboxaldehyde in Aged Aqueous Acrolein Media

Acrolein hydrolysis byproducts are a part of good industrial stewardship practice. Aqueous acrolein is used worldwide as an industrial raw material, an herbicide, an oilfield biocide, a hydrogen sulfide scavenger, and a molluscicide. Industrial acrolein is obtained by the catalytic oxidation of propylene followed by aqueous absorption and then by distillations. Generally, the fate of aqueous acrolein is described as occurring by hydrolysis, evaporation, absorption into the ground, and its consumption by the intended application purposes and conditions. Measurements of acrolein in water are normally confined to its loss. However, its byproducts are rarely discussed. In this study, an aged acrolein solution has been found to contain byproduct aldehydes, including the major soluble 5,6-dihydro-2H-pyran-3-carboxaldehyde. Despite acrolein's facile hydrolysis degradation, this byproduct is surprisingly stable in aqueous media for at least 25 years at ambient temperatures. The presence of this byproduct has been established by ¹H and ¹³C NMR, using DEPT, COSY, and HMBC, and UV spectroscopy at λ_max 229 nm in natural water systems.

Impact of the COVID-19 pandemic on patients with chronic rheumatic diseases: A study in 15 Arab countries

AIM

To evaluate the impact of the coronavirus disease 2019 pandemic (COVID-19) on the access to rheumatology care for patients with chronic rheumatic diseases (CRD) in the Arab countries.

METHOD

A web-based cross-sectional survey was designed by the Arab Adult Arthritis Awareness group (AAAA) consisting of 16 rheumatologists representing countries from the Arab League of Associations for Rheumatology (ArLAR) and was validated by the ArLAR scientific committee. The survey was disseminated online through social media and patients' association channels between May 8 and May 22, 2020. The steering committee developed recommendations to improve the care of patients with CRD during the COVID-19 pandemic.

RESULTS

A total of 2163 patients were included in the analysis; 72% were female; mean age was 40 years (SD 11.9). The Levant, the Gulf, and North Africa contributed almost equally to the sample. The pandemic had a significant negative impact on rheumatology visits in 82% of cases, access to hydroxychloroquine (47%), and chronic medication persistency (28%). The negative impact on rheumatology visits was associated with female gender, country, medication non-persistency, isolation due to COVID-19, and impact on mental health. Sixty-one patients (2.8%) stated that they had COVID-19, 5% said that a close contact was infected, and 47% were in isolation because of COVID-19.

CONCLUSION

The current study highlights the deleterious consequences of the COVID-19 pandemic on the continuity of rheumatology care. Therefore, an action plan, including establishing a telemedicine platform, securing drug availability, and promoting medication persistence through the appropriate communication channels, is strongly recommended.

Variance components using genomic information for 2 functional traits in Italian Simmental cattle: Calving interval and lactation persistency

Functional traits, such as fertility and lactation persistency, are becoming relevant breeding goals for dairy cattle. Fertility is a key element for herd profitability and animal welfare; in particular, calving interval (CIN) is an indicator of female fertility that can be easily recorded. Lactation persistency (LPE; i.e., the ability of a cow to maintain a high milk yield after the lactation peak) is economically important and is related to several other traits, such as feed efficiency, health, and reproduction. The selection of these functional traits is constrained by their low heritability. In this study, variance components for CIN and LPE in the Italian Simmental cattle breed were estimated using genomic and pedigree information under the single-step genomic framework. A data set of 594,257 CIN records (from 275,399 cows) and 285,213 LPE records (from 1563,389 cows) was considered. Phenotypes were limited up to the third parity. The pedigree contained about 2 million animals, and 7,246 genotypes were available. Lactation persistency was estimated using principal component analysis on test day records, with higher values of the second extracted principal component (PC2) values associated with lower LPE, and lower PC2 values associated with higher LPE. Heritability of CIN and LPE were estimated using single-trait repeatability models. A multiple-trait analysis using CIN and production traits (milk, fat, and protein yields) was performed to estimate genetic correlations among these traits. Heritability for CIN in the single-trait model was low (0.06 ± 0.002). Unfavorable genetic correlations were found between CIN and production traits. A measure of LPE was derived using principal component analysis on test day records. The heritability and repeatability of LPE were 0.11 ± 0.004 and 0.20 ± 0.02, respectively. Genetic correlation between CIN and LPE was weak but had a favorable direction. Despite the low heritability estimates, results of the present work suggest the possibility of including these traits in the Italian Simmental breeding program. The use of a single-step approach may provide better results for young genotyped animals without their own phenotypes.

Estimation of genetic parameters for dairy traits and somatic cell score in the first 3 parities using a random regression test-day model in French Alpine goats

Lactation curve shape can affect an animal's health, feed requirements, and milk production throughout the year. We implemented a random regression model for the genetic evaluation of lactation curve shapes of dairy traits in French Alpine goats for their first 3 parities. Milk, fat, and protein yields, fat and protein contents, somatic cell score, and fat/protein ratio were considered. The data consisted of test-day records from 49,849 first lactation Alpine goats during their first 3 lactations. The reference model used a Legendre polynomial of order 2 for each parity to describe the genetic and permanent environmental effects, and was compared with a model that combined the second and third parities. A rank reduction of the variance-covariance matrix was also performed using an eigenvalue decomposition for each parity from the 2 models. Genetic parameters were consistent between the models tested. With a reduction to rank 2 and combining the second and third parities, the first 2 principal components correctly summarized the genetic variability of milk yield level and persistency, with a near-nil correlation between the 2, and with a much shorter computation time than the reference model. A favorable correlation of +0.43 between milk yield persistency and fat/protein ratio persistency at the beginning of the lactation was found from buck estimated breeding values.

Persistency of Thyroid Dysfunction from Early to Late Pregnancy

Background: Subclinical thyroid disease occurs in approximately 5-8% of all pregnancies and is associated with a higher risk of adverse outcomes such as miscarriage, preterm birth, and suboptimal child neurodevelopment. It is generally assumed that subclinical thyroid disease that persists from early to late pregnancy is associated with a higher risk of adverse outcomes than transient disease. However, it is unknown as to what percentage of women with subclinical disease during early pregnancy have persistent disease in the third trimester. Methods: This study comprised 42,492 mothers for whom early and late pregnancy thyrotropin (TSH), free thyroxine (fT4), triiodothyronine (T3), or TPOAbs were available and who did not receive thyroid treatment before or during pregnancy. We adjusted for potential confounders, including maternal age, parity, anthropometrics, and β-hCG concentrations. Results: Subclinical hypothyroidism and hypothyroxinemia persisted in 24.8% and 17.7% of cases. Overt hyperthyroidism persisted in 8.4% of cases while subclinical hyperthyroidism persisted in 20.9% of cases. Low T3 persisted in 43.4% of cases while elevated T3 persisted in 15.7% of cases. TPOAb positivity persisted in 84.0% of cases. In women with subclinical hypothyroidism, a TSH below ∼5 mU/L at the time of diagnosis was associated with an up to 50% lower risk of persistency. The fT4 concentration at diagnosis predicted hyperthyroidism persistency and TPOAb positivity predicted persistency of all disease entities. Conclusions: Early pregnancy thyroid disease only persists until the third trimester in 8.4-24.8% of cases when left untreated. The main predictor for persistency is TPOAb positivity, with TPOAb-positive women having a lower risk that subclinical hypothyroidism or hypothyroxinemia persists, but a higher risk that (subclinical) hyperthyroidism persists.

Comparative effectiveness of budesonide inhalation suspension and montelukast in children with mild asthma in Korea

Objective: The comparative effectiveness of low-dose budesonide inhalation suspension (BIS) versus oral montelukast (MON) in managing asthma control among children with mild asthma was assessed in Korea.Methods: Claims from Korea's national health insurance database for children (2-17 years) with mild asthma (GINA 1 or 2) who initiated BIS or MON during 2015 were retrospectively analyzed. Pre- and post-index windows were 1 year each. Adherence, persistency, asthma control, asthma-related health-care resource utilization, and costs were evaluated using unadjusted descriptive statistics and propensity score-matched regression analyses.Results: The number of children identified was 26,052 for unmatched (n = 1,221 BIS; n = 24,831 MON) and 2,290 for matched populations (n = 1,145 per cohort). Medication adherence, measured by proportion of days covered, was low for both cohorts but significantly higher for MON versus BIS (13.8% vs. 4.5%; p < .001). Time to loss of persistency was longer for MON versus BIS (82.3 vs. 78.4 days, respectively; p < .001). Mean number of post-index asthma-related office visits was 6.6 for BIS versus 8.3 for MON (p < .001). However, a greater proportion of patients in the BIS cohort had an asthma exacerbation-related office visit than the MON cohort (78.3% vs. 56.1%; p < .001). Asthma-related total health-care costs were higher with MON versus BIS (₩ 190,185 vs. ₩ 167,432, respectively; p < .001), likely driven by higher pharmaceutical costs associated with MON (₩ 69,113 vs. ₩ 49,225; p < .001).Conclusions: Montelukast patients had better adherence, a longer time to loss of persistency, and were less likely to experience an exacerbation-related office visit in the post-index period than BIS patients.

Short communication: Selection for persistency by changing the shape of lactation curves with geometric morphometrics

The objective was to simulate the response to selection by modifying the shape of the lactation curve to improve persistency in Israeli first-parity Holstein cattle using geometric morphometrics and multivariate quantitative genetics. The 2-dimensional Cartesian coordinates representing the shape of the lactation curve were characterized using geometric morphometrics. Genetic parameters of daily milk yield were estimated for the individual animal model using REML. Results of selection were simulated using the multivariate breeders' equation. We defined 6 selection regimens: (1) decrease in the third month in milk (MIM), (2) increase in the ninth MIM, (3) decrease in the third MIM and increase in the ninth MIM, (4) decrease in the first MIM, (5) decrease in the second MIM, and (6) decrease in the fourth MIM. The first 3 selection criteria targeted changes in the MIM of previous measurements of persistency in the Israeli Holstein population, and the last 3 targeted the months with the highest variability. All selection regimens attempted to modify the shape of the lactation curve while keeping total milk yield constant. The first 3 selection regimens showed greater total responses, with the highest response for decrease in the third MIM and increase in the ninth MIM. Magnitudes of correlated responses consistently surpassed direct responses in all selection criteria, suggesting that selection on specific parts of the lactation curve would produce correlated responses in other parts. Predicted responses to selections were depicted as shape changes from the mean shape in the data set. Most predicted responses demonstrated a fairly similar shape compared with the lactation curve. The predicted responses of lactation shapes of the last 3 selection regimens were overall lower in the first 3 MIM and decreased less in the last MIM, demonstrating a much flatter shape and thus improved persistency.

Organochlorine Pesticides in Honey and Pollen Samples from Managed Colonies of the Honey Bee Apis mellifera Linnaeus and the Stingless Bee Scaptotrigona mexicana Guérin from Southern, Mexico

In this paper, we show the results of investigating the presence of organochlorine pesticides in honey and pollen samples from managed colonies of the honey bee, Apis mellifera L. and of the stingless bee Scaptotrigona mexicana Guérin. Three colonies of each species were moved into each of two sites. Three samples of pollen and three samples of honey were collected from each colony: the first collection occurred at the beginning of the study and the following ones at every six months during a year. Thus the total number of samples collected was 36 for honey (18 for A. mellifera and 18 for S. mexicana) and 36 for pollen (18 for A. mellifera and 18 for S. mexicana). We found that 88.44% and 93.33% of honey samples, and 22.22% and 100% of pollen samples of S. mexicana and A. mellifera, respectively, resulted positive to at least one organochlorine. The most abundant pesticides were Heptaclor (44% of the samples), γ-HCH (36%), DDT (19%), Endrin (18%) and DDE (11%). Despite the short foraging range of S. mexicana, the number of pesticides quantified in the honey samples was similar to that of A. mellifera. Paradoxically we found a small number of organochlorines in pollen samples of S. mexicana in comparison to A. mellifera, perhaps indicating a low abundance of pollen sources within the foraging range of this species.

Predictors of Persistent Medically Unexplained Physical Symptoms: Findings From a General Population Study

Objective: To explore the persistency of Medically Unexplained Symptoms (MUS) and its prognostic factors in the general adult population. Knowledge of prognostic factors of MUS may indicate possible avenues for intervention development. Methods: Data were derived from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a nationally representative face-to-face cohort study among the Dutch general population aged 18-64 years. We selected subjects with MUS at baseline and who participated at follow-up (N = 324) and reassessed those subjects for having MUS at 3 year follow-up. Logistic regression analyses were used to determine risk factors for persistency of MUS. Results: 36.4% of the subjects had persistent MUS at follow-up. In logistic regression analyses adjusted for sex and age, persistency of MUS was predicted by the number of comorbid chronic medical disorder(s), lower education, female sex, not having a paid job, parental psychopathology as well as lower functioning. In the logistic regression analysis in which all significant variables adjusted for sex and age were entered simultaneously, three variables predicted persistent MUS: parental psychopathology, the number of comorbid chronic medical disorder(s) and physical functioning, with odds ratios of 2.01 (1.20-3.38), 1.19 (1.01-1.40), and 0.99 (0.97-1.00), respectively. Conclusion: In the adult general population, MUS were persistent in over one third of the subjects with MUS at baseline. Persistency was significantly predicted by parental psychopathology, number of comorbid chronic medical disorders, and physical functioning. These findings warrant further research into early intervention and treatment options for persons with an increased risk of persistent MUS.

Consequences of dietary energy source and energy level on energy balance, lactogenic hormones, and lactation curve characteristics of cows after a short or omitted dry period

Omitting the dry period (DP) generally reduces milk production in the subsequent lactation. The aim of this study was to evaluate the effect of dietary energy source-glucogenic (G) or lipogenic (L)-and energy level-standard (std) or low-on milk production; energy balance (EB); lactogenic hormones insulin, insulin-like growth factor 1 (IGF-1), and growth hormone (GH); and lactation curve characteristics between wk 1 and 44 postpartum in cows after a 0-d or 30-d DP. Cows (n = 110) were assigned randomly to 3 transition treatments: a 30-d DP with a standard energy level required for expected milk yield [30-d DP(std)], a 0-d DP with the same energy level as cows with a 30-d DP [0-d DP(std)], and a 0-d DP with a low energy level [0-d DP(low)]. In wk 1 to 7, cows were fed the same basal ration but the level of concentrate increased to 6.7 kg/d for cows fed the low energy level and to 8.5 kg/d for cows fed the standard energy level in wk 4. From wk 8 postpartum onward, cows received a G ration (mainly consisting of corn silage and grass silage) or an L ration (mainly consisting of grass silage and sugar beet pulp) with the same energy level contrast (low or std) as in early lactation. Cows fed the G ration had greater milk, lactose, and protein yields, lower milk fat percentage, greater dry matter and energy intakes, and greater plasma IGF-1 concentration compared with cows fed the L ration. Dietary energy source did not affect EB or lactation curve characteristics. In cows with a 0-d DP, the reduced energy level decreased energy intake, EB, and weekly body weight gain, but did not affect milk production or lactation curve characteristics. A 30-d DP resulted in a greater total predicted lactation yield, initial milk yield after calving, peak milk yield, energy intake, energy output in milk, days to conception [only when compared with 0-d DP(low)], plasma GH concentration [only when compared with 0-d DP(std)], and decreased weekly body weight gain compared with a 0-d DP. A 30-d DP decreased both the increasing and the declining slope parameters of the lactation curve and the relative rate of decline in milk yield (indicating greater lactation persistency) compared with a 0-d DP, and decreased plasma insulin and IGF-1 concentration, and EB. In conclusion, feeding a G ration after wk 7 in milk improved energy intake and milk production, but did not affect EB compared with an L ration. For cows without a DP, a reduced dietary energy level did not affect milk production and lactation curve characteristics, but did decrease EB and weekly body weight gain. A 30-d DP increased milk yield and lactation persistency, but decreased milk fat and protein content, EB, and plasma insulin and IGF-1, compared with a 0-d DP.

Measures of Dogs' Inhibitory Control Abilities Do Not Correlate across Tasks

Inhibitory control, the ability to overcome prepotent but ineffective behaviors, has been studied extensively across species, revealing the involvement of this ability in many different aspects of life. While various different paradigms have been created in order to measure inhibitory control, only a limited number of studies have investigated whether such measurements indeed evaluate the same underlying mechanism, especially in non-human animals. In humans, inhibitory control is a complex construct composed of distinct behavioral processes rather than of a single unified measure. In the current study, we aimed to investigate the validity of inhibitory control paradigms in dogs. Sixty-seven dogs were tested in a battery consisting of frequently used inhibitory control tests. Additionally, dog owners were asked to complete an impulsivity questionnaire about their dog. No correlation of dogs' performance across tasks was found. In order to understand whether there are some underlying behavioral aspects explaining dogs' performance across tests, we performed principle component analyses. Results revealed that three components (persistency, compulsivity and decision speed) explained the variation across tasks. The questionnaire and dogs' individual characteristics (i.e., age and sex) provided only limited information for the derived components. Overall, results suggest that no unique measurement for inhibitory control exists in dogs, but tests rather measure different aspects of this ability. Considering the context-specificity of inhibitory control in dogs and most probably also in other non-human animals, extreme caution is needed when making conclusions about inhibitory control abilities based on a single test.

Brominated flame retardant: environmental and exposed individuals' health impact

Since Antiquity, men have used chemicals to protect their goods against fire. Effective and easy to use, brominated flame retardants are used since decades massively in plastic industry. Such like other organohalogenated compounds, brominated flame retardants are very persistent in the environment and able to accumulate along the food chain. Many authors highlight their presence in the environment, in many animal species and in the human serum. Worryingly, man is exposed as soon as the pregnancy and then by the breastfeeding. This exposition may have consequence on our health. Many studies (in vitro, in vivo or epidemiologic) highlight brominated flame retardant negative effects on the endocrine system, mainly on the thyroid function but also on the reproduction, the neurodevelopment in the children and on the metabolism with increasing diabetes risk. If authorities and some big enterprises are aware about the problematic, new studies are needed to confirm previous results, elucidate endocrine disrupting mechanisms and highlight hypothetical synergies with other pollutants such like PCBs.

Persistency of Cannabis Use Predicts Violence following Acute Psychiatric Discharge

BACKGROUND

Violence is a major concern and is prevalent across several mental disorders. The use of substances has been associated with an exacerbation of psychiatric symptoms as well as with violence. Compared to other substances such as alcohol and cocaine, existing literature on the cannabis-violence relationship has been more limited, with most studies being conducted in the general population, and has shown controversial results. Evidence has suggested a stronger relationship when examining the effects of the persistency of cannabis use on future violent behaviors. Though, while cannabis use is highly prevalent amid psychiatric patients, far less literature on the subject has been conducted in this population. Hence, the present prospective study aims to investigate the persistency of cannabis use in psychiatric patients.

METHOD

The sample comprised of 1,136 recently discharged psychiatric patients provided by the MacArthur Risk Assessment Study. A multi-wave (five-assessment) follow-up design was employed to allow temporal sequencing between substance use and violent behaviors. Generalized estimating equations (GEE) were used to examine the effect of persistency of cannabis use on violence, while controlling for potential confounding factors. Potential bidirectional association was also investigated using the same statistical approach.

RESULTS

Our results suggest a unidirectional association between cannabis use and violence. GEE model revealed that the continuity of cannabis use across more than one time wave was associated with increased risks of future violent behavior. Patients who reported having used cannabis at each follow-up periods were 2.44 times more likely to display violent behaviors (OR = 2.44, 95% CI: 1.06-5.63, p < 0.05).

CONCLUSION

These findings are particularly relevant as they suggest that the longer individuals report having used cannabis after a psychiatric discharge, the more likely they are of being violent in the following time waves. These results add to our understanding of the negative consequences of chronic cannabis use amid psychiatric patients.

A new way to measure milk yield persistency: a genetic point of view with application to Gyr (Bos indicus) cattle

The objective of this work was to estimate genetic parameters for a measure of persistency of milk yield and to evaluate its association with 305-d cumulative milk yield and lactation length. 12 346 records from 8202 dairy Gyr cows including lactations up to fifth calving were used. The measure of persistency was obtained from one of the parameters of a quadratic model that describes the cumulative yield across lactation as a function of days in milk. A three-trait multivariate analysis was done. Heritability and repeatability for persistency were 0.08 and 0.21, respectively. Deviance Information Criterion provided evidence that the additive genetic covariance between the measure of persistency studied and 305-d cumulative yield is zero. Genetic correlations between persistency and lactation length were 0.50 and 0.27 for first or all lactations, respectively. Milk yield persistency as measured in this study has low heritability. Selection for persistency can increase lactation length. The measure of milk yield persistency studied here is genetically independent of total milk yield and can be included in routine genetic evaluations of dairy cattle.

Predicting persistency of DSM-5 alcohol use disorder and examining drinking patterns of recently remitted individuals: a prospective general population study

AIMS

To establish the 3-year persistency rate of alcohol use disorder (AUD) and its predictors, and to examine drinking patterns of recently remitted individuals.

DESIGN AND SETTING

The Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2) surveyed a nationally representative sample of adults (aged 18-64 years) at baseline (response = 65.1%) and 3-year follow-up (response = 80.4%).

PARTICIPANTS

People with AUD at baseline, as defined by DSM-5 (n = 198).

MEASUREMENTS

AUD, drinking patterns and mental disorders were assessed using the Composite International Diagnostic Interview 3.0. Other predictors were assessed with an additional questionnaire. Predictors of persistency were examined with univariable and multivariable logistic regression analyses.

RESULTS

The AUD persistency rate was 29.5% [95% confidence intervals (CI) = 20.0-39.0]. In the multivariable model, the older (25-34 and 35-44) age groups had lower AUD persistency [odds ratio (OR) = 0.05; 95% CI = 0.00-0.49 and OR = 0.14; 95% CI = 0.02-0.79, respectively] than the youngest age group (18-24). A higher number of weekly drinks and a comorbid anxiety disorder predicted AUD persistency (OR = 1.03; 95% CI = 1.00-1.07 and OR = 4.56; 95% CI = 1.04-20.06, respectively). Furthermore, remission was associated with a reduction of six drinks per week between T0 and T1 . It should be noted, however, that 35.8% (95% CI = 22.4-49.2) of people in diagnostic remission still drank more than the recommended maximum (more than seven/14 drinks weekly for women/men).

CONCLUSIONS

Only a minority of people in the Netherlands with alcohol use disorder as defined by DSM-5 still have the disorder 3 years later. Factors that help to identify people at risk of alcohol use disorder persistence are: younger age, a higher number of weekly drinks and a comorbid anxiety disorder. A substantial number of people recently in diagnostic remission still drink above the maximum recommended level.

Real-world impact of reminder packaging on antihypertensive treatment adherence and persistence

BACKGROUND

Patient medication adherence is multidimensional and poses significant concerns to health care professionals. One aspect of adherence is a patient forgetting to take their prescribed medication, which may be improved with reminder packaging (RP). The objective of this analysis was to assess the impact of RP on patient adherence to antihypertensive therapy.

METHODS

This retrospective, propensity score-matched study evaluated patients switching to a single-pill combination of valsartan-hydrochlorothiazide in RP compared with patients remaining on the combination without reminder packaging (non-RP). Patients receiving combination therapy between April 1, 2009 and July 31, 2010 were eligible for inclusion. Patients were propensity score-matched on baseline adherence and background demographic variables, including comorbidities. Medication possession ratio, proportion of days covered, time to refill, and time to discontinuation were evaluated as primary measures of subsequent adherence and persistence.

RESULTS

In a total of 9266 matched patients (4633 participants in both cohorts), adherence was significantly higher in the RP cohort compared with patients in the non-RP cohort (medication possession ratio, RP 80% versus non-RP 73%; proportion of days covered, RP 76% versus non-RP 63%; both P < 0.001). Refill timing was 10 days for RP patients versus 16 days for non-RP patients (P < 0.001). Similar trends were observed with respect to time to discontinuation (RP 196 days, non-RP 174 days; P < 0.001). A higher proportion of RP patients remained on therapy compared with non-RP patients, with patients in the RP group being 17% less likely to discontinue therapy compared with patients in the non-RP group (hazards ratio 0.833; 95% confidence interval 0.793-0.875).

CONCLUSION

This real-world assessment of differences in adherence and persistence rates demonstrated that patients receiving RP were more adherent and persistent with their treatment regimens.

Treatment persistence and cost-effectiveness of latanoprost/latanoprost-timolol, bimatoprost/bimatoprost-timolol, and travoprost/travoprost-timolol in glaucoma: an analysis based on the United Kingdom general practitioner research database

OBJECTIVE

To compare treatment persistence and costs with 3 glaucoma treatment sequences (first-line/second-line): latanoprost/latanoprost-timolol (LLT), bimatoprost/bimatoprost-timolol (BBT), and travoprost/travoprost-timolol (TTT), derived from the UK General Practitioner Research Database (UK-GPRD).

METHODS

Patient records referring to ocular hypertension, topical glaucoma treatment, surgery, or laser therapy were extracted. Patients prescribed LLT, BBT, or TTT sequences were selected. Treatment failure was inferred from glaucoma prescription change (adding or removing a topical treatment, surgery, or laser therapy). Treatment durations preceding failure were compared by applying Wilcoxon's test to survival curves. Adjustment on confounding variables was performed with a Cox model and a propensity score method. Unit costs were estimated from a UK National Health Service perspective.

RESULTS

A total of 1592 patients received LLT, 110 BBT, and 114 TTT. Their mean age was 68 years and the sex ratio almost 1 male:1 female. No significant demographic or comorbidity differences were observed between treatment sequences. Treatment persistence at 36 months was achieved in 60.0% of LLT, 55.5% of BBT, and 70.3% of TTT patients (P = 0.005). Resources consumed and associated monthly costs were significantly less for the TTT group (£17.74) compared with BBT (£21.30) and LLT (£22.37) groups.

CONCLUSION

Analysis of data obtained from the UK-GPRD suggests that the TTT treatment sequence achieved longer treatment persistence at lower cost than LLT and BBT.