BACKGROUND Peripartum cardiomyopathy (PPCM) remains a major cause of maternal morbidity and mortality. OBJECTIVES This study sought to prospectively evaluate recovery of the left ventricular ejection fraction (LVEF) and clinical outcomes in the multicenter IPAC (Investigations of Pregnancy Associated Cardiomyopathy) study. METHODS We enrolled and followed 100 women with PPCM through 1 year post-partum. The LVEF was assessed by echocardiography at baseline and at 2, 6, and 12 months post-partum. Survival free from major cardiovascular events (death, transplantation, or left ventricular [LV] assist device) was determined. Predictors of outcome, particularly race, parameters of LV dysfunction (LVEF), and remodeling (left ventricular end-diastolic diameter [LVEDD]) at presentation, were assessed by univariate and multivariate analyses. RESULTS The cohort was 30% black, 65% white, 5% other; the mean patient age was 30 ± 6 years; and 88% were receiving beta-blockers and 81% angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. The LVEF at study entry was 0.35 ± 0.10, 0.51 ± 0.11 at 6 months, and 0.53 ± 0.10 at 12 months. By 1 year, 13% had experienced major events or had persistent severe cardiomyopathy with an LVEF <0.35, and 72% achieved an LVEF ≥0.50. An initial LVEF <0.30 (p = 0.001), an LVEDD ≥6.0 cm (p < 0.001), black race (p = 0.001), and presentation after 6 weeks postpartum (p = 0.02) were associated with a lower LVEF at 12 months. No subjects with both a baseline LVEF <0.30 and an LVEDD ≥6.0 cm recovered by 1 year post-partum, whereas 91% with both a baseline LVEF ≥0.30 and an LVEDD <6.0 cm recovered (p < 0.00001). CONCLUSIONS In a prospective cohort with PPCM, most women recovered; however, 13% had major events or persistent severe cardiomyopathy. Black women had more LV dysfunction at presentation and at 6 and 12 months post-partum. Severe LV dysfunction and greater remodeling at study entry were associated with less recovery. (Investigations of Pregnancy Associated Cardiomyopathy [IPAC]; NCT01085955)

Purpose Autophagy is a cell survival mechanism that plays a critical role in pancreatic carcinogenesis. Murine studies have previously demonstrated that treatment with the late-autophagy inhibitor chloroquine in combination with chemotherapy limited tumor growth. Methods In this Phase I/II trial we examined treatment with hydroxychloroquine (HCQ) with gemcitabine for patients with pancreatic adenocarcinoma. The primary endpoints were the safety and tolerability, evaluated with Storer's dose escalation design. Secondary endpoints were CA 19-9 biomarker response, R0 resection rates, survival and correlative studies of autophagy. Results Thirty-five patients were enrolled. There were no dose-limiting toxicities and no Grade 4/5 events related to treatment. 19 patients (61%) had a decrease in CA19-9 following treatment. 29 patients (94%) underwent surgical resection as scheduled with a 77% R0 resection rate. Median overall survival was 34.8 months (95% CI: (11.57 months, not reached)). Patients who had more than a 51% increase in the autophagy marker LC3-II in circulating peripheral blood mononuclear cells had improvement in disease-free (15.03 vs. 6.9 months, p<0.05) and overall survival (34.83 vs. 10.83 months, p<0.05). No outcome differences were demonstrated in the 81% of patients with abnormal p53 expression assessed by immunohistochemistry in the resected specimens. Conclusion Pre-operative autophagy inhibition with HCQ plus gemcitabine is safe and well-tolerated. Surrogate biomarker responses (CA19-9) and surgical oncologic outcomes were enouraging. p53 status was not associated with adverse outcomes.

Background and AimsThe fatty liver index (FLI) is an algorithm involving the waist circumference, body mass index, and serum levels of triglyceride and gamma-glutamyl transferase to identify fatty liver. Although some studies have attempted to validate the FLI, few studies have been conducted for external validation among Asians. We attempted to validate FLI to predict ultrasonographic fatty liver in Taiwanese subjects.MethodsWe enrolled consecutive subjects who received health check-up services at the Taipei Veterans General Hospital from 2002 to 2009. Ultrasonography was applied to diagnose fatty liver. The ability of the FLI to detect ultrasonographic fatty liver was assessed by analyzing the area under the receiver operating characteristic (AUROC) curve.ResultsAmong the 29,797 subjects enrolled in this study, fatty liver was diagnosed in 44.5% of the population. Subjects with ultrasonographic fatty liver had a significantly higher FLI than those without fatty liver by multivariate analysis (odds ratio 1.045; 95% confidence interval, CI 1.044–1.047, p< 0.001). Moreover, FLI had the best discriminative ability to identify patients with ultrasonographic fatty liver (AUROC: 0.827, 95% confidence interval, 0.822–0.831). An FLI < 25 (negative likelihood ratio (LR−) 0.32) for males and <10 (LR− 0.26) for females rule out ultrasonographic fatty liver. Moreover, an FLI ≥ 35 (positive likelihood ratio (LR+) 3.12) for males and ≥ 20 (LR+ 4.43) for females rule in ultrasonographic fatty liver.ConclusionsFLI could accurately identify ultrasonographic fatty liver in a large-scale population in Taiwan but with lower cut-off value than the Western population. Meanwhile the cut-off value was lower in females than in males.

The authors conducted a worldwide survey to explore the experiences of higher education faculty who converted classes to distance learning during the COVID-19 pandemic. Most respondents experienced much higher workloads and stress than in face-to-face classes. Previous experience with Online Distance Learning (ODL) predicted positive faculty response. Less than half used a school-provided LMS, instead using a wide range of other technologies. Respondents said they learned the need for adaptability and good planning, emphasizing doing what it takes to serve their students. There was high variability in most answers, indicating that the experiences of individual teachers ranged widely between positive and negative. The researchers provide recommendations based on the findings, including the need for better ODL instructional design training as part of long-term professional development for faculty and remembering the importance of all student higher education experiences, many of which are beyond the scope of the actual classes.