Among patients with unstable angina or myocardial infarction without ST-segment elevation, prasugrel did not significantly reduce the frequency of the primary end point, as compared with clopidogrel, and similar risks of bleeding were observed. (Funded by Eli Lilly and Daiichi Sankyo; TRILOGY ACS ClinicalTrials.gov number, NCT00699998.).

A new category of autoantibodies--antipolymerized albumin antibodies (AAA)--was discovered in 1974. Studies performed from 1974 to 1976 showed their diagnosis and prognostic values in hepatic diseases; the AAA tests [immunodiffusion (ID) and hemagglutination (HS)] made possible a good estimation of the total liver cell function. Without being specific for a viral hepatitis B infection, highly significant linear correlations were found for AAA precipitin and agglutinin positivities with presence of HBsAg. High titre of AAA agglutinins unaccompanied by a positive ID test, characterise the "healthy carrier" of the HBsAg, while the isolated AAA positivity in ID is met in more severe, long-standing hepatic diseases.

This study explores clinical and radiologic outcomes of PD-1 inhibitor use in patients with ILD, who have traditionally been excluded from PD-1 inhibitor safety and efficacy trials. We included 41 patients with radiographic evidence of ILD in the study. Our findings suggest that PD-1 inhibitors for oncologic indications should not be uniformly withheld in patients with underlying ILD. Background: Immune checkpoint inhibitors (ICIs), such as programmed cell death 1 (PD-1) inhibitors, are used to treat multiple cancers. Limited data exist as to the use of ICIs in patients with coexistent interstitial lung disease (ILD). We conducted a retrospective case series to assess clinical and radiologic outcomes of patients with ILD treated with PD-1 inhibitors. Methods: Eligible patients were 18 years of age or older, treated with pembrolizumab or nivolumab for oncologic indications, and had evidence of ILD on chest computed tomography scan not attributable to radiotherapy before initiation of ICI therapy. Outcomes of interest included mortality, hospitalizations for respiratory-related causes, development of pneumonitis, and radiologic change in ILD over a 1-year follow-up period. Results: We included 41 patients in the analysis. At 1 year, 17 patients (41.5%) were alive, 23 had died (56.1%), and 1 (2.4%) was lost to follow-up. Of 23 deaths, 16 (69.6%) were due to cancer, 4 (17.4%) to causes excluding cancer and ILD, and 3 (13.0%) to hypoxemic respiratory failure from ILD-or ICI-induced pneumonitis. Three patients (7.3%) required hospitalization owing to ILD, including drug-induced pneumonitis, and 3 (7.3%) developed pneumonitis attributable to anti-PD-1 therapy. On follow-up computed tomography scans, 32 patients (78.0%) had stable or improved ILD and 9 (22.0%) had progression. Conclusion:Patients with ILD receiving PD-1 inhibitors more frequently died of cancer-related causes than from ILD. Further research is needed to determine the safety of ICIs in patients with ILD and if ILD subtype may help to refine ICI-associated risks.

Patients with interstitial lung disease (ILD), especially those with pulmonary fibrosis, are at increased risk of developing lung cancer. Management of lung cancer in patients with ILD is particularly challenging. Diagnosis can be complicated by difficulty differentiating lung nodules from areas of focal fibrosis, and percutaneous biopsy approaches confer an increased risk of complications in those with pulmonary fibrosis. Lung cancer treatment in these patients pose several specific considerations. The degree of lung function impairment may preclude lobectomy or surgical resection of any type. Surgical resection can trigger an acute exacerbation of the underlying ILD. The presence of ILD confers an increased risk of pneumonitis with radiotherapy, and many of the systemic therapies also carry an increased risk of pneumonitis in this population. The safety of immunotherapy in the setting of ILD remains to be fully elucidated and concerns remain as to triggering pneumonitis. The purpose of this review is to summarize the evidence regarding consideration for tissue diagnosis, chemotherapy and immunotherapy, radiotherapy, and surgery, in this patient population and discuss emerging areas of research. We also propose a multidisciplinary approach and practical considerations for monitoring for ILD progression during lung cancer treatment.

The presence and titers of anti-albumin antibodies (AAA)--ie, precipitins (AA-IP) and agglutinins (AA-Aggl)--and the serum concentrations of immunoglobulins and albumin were determined in 210 asymptomatic carriers of HBsAg grouped according to HBsAg titer and subtype. A different immunologic pattern was observed in the HBsAg/ad and HBsAg/ay carriers, the results suggesting an increased aggressivity for the HBsAg/ay subtype which was evident in subjects with lower HBs antigenemia and characterized by higher concentrations of IgG and IgM and rises in AA-P titers. A positive linear correlation was found between HBsAg and AA-Aggl titers; the carriage of HBsAg/ad was associated with significant higher values of AA-Aggl than of HBsAg/ay. These subtle correlations between HBsAg titer and subtype and AAA suggest that the human serum albumin (HSA) known to exist on the HBsAg particles may be similar in a modified form, to that representing AAA specificity.