Association between immune checkpoint inhibitors and vascular endothelial growth factor targeted therapy with cardiovascular events

Background

The use of immune checkpoint inhibitors (ICI) has been associated with a 3-fold higher risk for cardiovascular events as compared to cancer patients who did not receive ICI. Therapies targeting vascular endothelial growth factor (VEGF) have also been associated with a wide range of cardiovascular events. The combination use of ICIs and VEGF inhibitors is currently approved as a treatment for patients with renal-cell carcinoma, hepatocellular carcinoma, non-small cell lung cancer, and endometrial cancer. Data are lacking whether the combination of ICIs and VEGF-targeted therapy is associated with an additional increase in cardiovascular events.

Purpose

To evaluate whether the combination use of ICI and VEGF targeted therapies are associated with a higher risk of cardiovascular events as compared to ICI therapy alone, we performed a retrospective matched case-control study.

Methods

Cases received both ICI and VEGF-targeted therapy (n=157), and control patients (n=157) only received ICI therapy. The primary outcome was a composite of cardiovascular events (myocardial infarction, coronary revascularization, ischemic stroke, deep venous thrombosis, and pulmonary embolism). Patients were censored at time of first event or at last date of follow up. Cox proportional hazard regression analysis was performed to calculate hazard ratio (HR) with 95% confidence interval (CI), counting only the first cardiovascular event.

Results

Baseline characteristics for the cases and controls are shown in Table 1. Overall cases (combination ICI and VEGF inhibitor) and controls (ICI alone) were not different with respect to age, type of cancer, and a prior history of any cardiovascular event. Cases received more ICI cycles as compared to controls (median of 7 [4–17] cycles vs. 4 [2–10] cycles, P<0.001). Cases also had a longer follow-up time (334 [127–663] days vs. 201 [60–564] days, P=0.008) as compared to the control group. As compared to ICI alone, a similar risk for a composite cardiovascular event was observed in those who received both ICI and VEGF-targeted therapy (HR, 0.70 [95% CI, 0.39–1.25]; P=0.23, Table 1). In total, 21/157 patients had a composite cardiovascular event among the cases, who received the combination of ICI and VEGF inhibitor (9 DVT, one MI, 9 PE, two ischemic strokes) as compared to 25/157 among the controls, who received ICI alone (14 DVT, 3 MI, 7 PE, one ischemic stroke). The median time to event was not different between the two groups (126 [98–260] days vs. 145 [28–205] days, P=0.47).

Conclusion

We found that among 157 patients who received a combination of ICI and VEGF-targeted therapy and 157 matched control patients who only received ICI therapy, the risk for cardiovascular events was not different between the two groups.

Funding Acknowledgement

Type of funding sources: Public grant(s) – EU funding.

Survey on Diagnosing CORONA VIRUS from Radiography Chest X-ray Images Using Convolutional Neural Networks

Corona Virus continues to harms its effects on the people lives across the globe. The screening of infected persons has to be identified is a vital step because it is a fast and low-cost way. Certain above mentioned things can be recognized by chest X-ray images that plays a significant role and also used for examining in detection of CORONA VIRUS(COVID-19). Here radiological chest X-rays are easily available with low cost only. In this survey paper, Convolutional Neural Network(CNN) based solution that will benefit in detection of the Covid-19 positive patients using radiography chest X-Ray images. To test the efficiency of the solution, using data sets of publicly available X-Ray images of Corona virus positive cases and negative cases. Images of positive Corona Virus patients and pictures of healthy person images are divided into testing images and trainable images. The solution which are providing the good results with classification accuracy within the test set-up. Then GUI based application supports for medical examination areas. This GUI application can be used on any computer and performed by any medical examiner or technician to determine Corona Virus positive patients using radiography X-ray images. The result will be precisely obtaining the Covid-19 Patient analysis through the chest X-ray images and also results may be retrieve within a few seconds.

Study of dung, urine, and milk of selected grazing animals as bioindicators in environmental geoscience--a case study from Mangampeta barite mining area, Kadapa District, Andhra Pradesh, India

The ancient scientific Sanskrit texts of Ayurveda (science of longevity) deal with waters, plants, and animals in relation to human health. Based on the studies mentioned in Ayurveda and modern literature, biological responses of grazing animals in Mangampeta barite mining area in Kadapa District, Andhra Pradesh, were studied. A non-mineralized Tirupati area in Chittoor District, Andhra Pradesh, was selected for the purpose of comparison. In these areas, certain animal products of selected grazing animals were studied if they could be used as tools in mineral exploration. Samples of dung, urine, and milk from cow, bullock, she-buffalo, he-buffalo, sheep, and goat were collected from these two areas during winter and summer seasons. Goat dung was found to have lowest moisture content and highest organic matter while goat urine contained highest amounts of organic matter and ash content. All these animal products were analyzed for 11 trace elements. The concentration of trace elements released through dung, urine, and milk widely varied in different animal species with seasonal variations. The elemental concentration was higher in dung and lower in urine, when compared to that of milk. The concentration of all elements in dung, urine, and milk of all animals, in both the areas, was higher in winter than that in summer. Dung represents the metabolic process of the whole animal and reflects the dietary conditions whether fed on natural or inorganic supplement. It can be inferred that dung, urine, and milk of any animal can be used as tools in mineral exploration during winter, while during summer, only dung can be useful. The dung of goat when compared to that of the other cattle serves as a better tool in environmental studies as goat depends almost entirely on natural vegetation without human interference.

Distribution of trace elements in certain ecological components and animal products in a dairy farm at Tirupati, Chittoor District, Andhra Pradesh, India

Biogeochemical characteristics of the cattle are dealt based on the observations made in Ayurveda in the light of modern scientific developments in applied environmental geochemistry. The biogeochemical characteristics of certain important ecological components and animal products of the stall-fed animals were studied. For this purpose, a dairy farm of Tirumala-Tirupati Devasthanams, a religious organization in Tirupati, Chittoor District, Andhra Pradesh was selected. This study is intended to trace out the trace element interactions in the ecological components (soil, water, fodder, feed) of the stall-fed animals and their output components viz. dung, urine and milk. Physical, physico-chemical properties and certain trace elements were determined for composite samples of ecological components and dung, urine, and milk of stall-fed animals. The variations in the distribution of pH and EC of urine and milk reflect the variations in their physico-chemical or hydro-chemical properties. As mentioned in Ayurveda, not only the properties of milk but also the properties of dung and urine reflect their diet and conditions of their habitat. Even though the diet is the same, the cows of different breeds yield milk of variable physical, physico-chemical properties and trace element composition which can be attributed to their body colour, substantiating Ayurveda.

Volumetric analysis of root canal fillings in primary teeth using spiral computed tomography: an in vitro study

PURPOSE

The purpose of this study was to volumetrically analyze the efficacy of root canal fillings in primary teeth using spiral computed tomography (CT).

METHODS

Root canals in 30 primary maxillary and mandibular molars were instrumented with K files to size 30, and the volumes of the canals were then measured using spiral CT. The teeth were randomly divided into 3 groups of 10 each, and 18 of the canals in each group were evaluated with spiral CT after obturation with zinc oxide eugenol paste, Metapex and Vitapex. The filled volume in each canal was mea- sured using spiral CT, and the percentage of obturated volume (POV) was calculated. The pre- and post-mean canal volume values within each group and the POV of the 3 groups were statistically analyzed using one-way analysis of variance and paired t tests.

RESULTS

Filler voids were seen in all groups, but there was a statistically significant difference (P <.001) in the calculated POV. Vitapex showed 95% POV compared to Metapex (88%) and ZOE (84%).

CONCLUSION

Voids were seen in all 3 filling materials. Vitapex showed the maximum percentage of obturated volume among the 3 groups.

Utility of check dams in dilution of fluoride concentration in ground water and the resultant analysis of blood serum and urine of villagers, Anantapur District, Andhra Pradesh, India

High levels of fluoride (beyond 1.5 ppm) in ground water as source of drinking water are common in many parts of Andhra Pradesh, India, causing fluorosis. The study carried out in endemic Nalgonda District, Andhra Pradesh, has indicated that the fluoride-rich ground water present in the wells located down stream and close to the surface water bodies is getting diluted by the low-fluoride surface water. Encouraged by this result, check dams were constructed upstream of the identified marginally high fluoride bearing ground water zones in Anantapur District to reduce fluoride levels as an alternate solution for safe drinking water. In this paper, an attempt is made to study the utility and effect of these check dams in dilution of fluoride concentration in drinking water and its resultant impact on the health aspects of certain villagers of Anantapur District through the analysis of their blood serum and urine. Ground water samples from three fluoride-affected villages, blood and urine of males and females from the same villages were collected and analyzed for fluoride using ion selective electrode method. The results indicated that the fluoride levels in blood serum and urine of males in the age group of 5-11 years are found to be the highest. The concentration of fluoride in ground water is directly proportional to the concentration of fluoride in blood serum and urine. The concentration of fluoride in ground water with depth of the aquifer is a function of lithology, amount and duration of rainfall, rate of infiltration, level of ground water exploitation in the area etc. The construction of check dams upstream of the identified marginally high fluoride waters will not only cause additional recharge of ground water but also reduces the fluoride concentration eventually improving the health of the villagers.