Arnon D. Cohen

Bio: Arnon D. Cohen is an academic researcher from Clalit Health Services. The author has contributed to research in topics: Population & Odds ratio. The author has an hindex of 41, co-authored 374 publications receiving 7913 citations. Previous affiliations of Arnon D. Cohen include University of Milan & University of Connecticut.

Biosimilars for Psoriasis—Experience from Europe

Abstract: Over the last several years, major changes have occurred in Europe regarding the use of biosimilars. Some countries such as Norway, Denmark, and the United Kingdom (UK) have a relatively high market penetration of biosimilars, whereas in other European countries, biosimilar uptake is low. The objectives of this review are to describe the use of biosimilars in selected European countries, using “real-life” information from members of the International Psoriasis Council (IPC) who are key opinion leaders in dermatology. The use of biosimilars for patients with psoriasis is continuously discussed and reviewed by the IPC, through in-person meetings by members of the Biosimilar Working Group (BSWG). In preparation for this paper, we surveyed the use of biosimilars for patients with psoriasis through European BSWG members, who were asked to describe the situation in their countries. The survey collected information from each IPC councilor regarding the use of biosimilars currently on the market, guidelines for interchangeability, traceability, and naming of these agents. In addition, information regarding pricing, access, and physician/patient education was obtained. The status of biosimilars was discussed at an IPC biosimilar working group roundtable event which was held in Stockholm on June 28th, 2018. With increased use of biosimilars likely in the future, the IPC will continue to provide leadership, education, and guidance for dermatologists to maximize the challenges presented by the adoption of biosimilars into clinical practice and improve the choice of biologic treatment for patients with moderate-severe psoriasis.

The Risk of Pulmonary Embolism in Patients With Pemphigus: A Population-Based Large-Scale Longitudinal Study.

Abstract: Growing evidence suggests that inflammation may pose an atypical risk factor for pulmonary embolism (PE), as it drives venous thrombosis via several pathways. The increased risk of PE in several autoimmune diseases has lent weight to this concept. However, the relative risk of PE among patients with pemphigus has not yet been established. We aimed to examine the risk of PE in patients with pemphigus. A large-scale population-based longitudinal cohort study was conducted to evaluate the relative risk (RR) of PE among 1,985 patients with pemphigus relative to 9,874 age-, sex-, and ethnicity-matched control subjects. A multivariate Cox regression model was utilized. The incidence of PE was 3.0 (95% CI, 2.2-4.0) and 1.2 (95% CI, 1.0-1.5) per 1,000 person-years among patients with pemphigus and controls, respectively. The period prevalence of PE corresponding to the study period was 2.2% (95% CI, 1.6-2.9%) among cases and 0.9% (95% CI, 0.7-1.1%) among controls. Patients with pemphigus were twice as likely to develop PE as compared to control subjects (adjusted RR, 1.98; 95% confidence interval [CI], 1.29-3.04). The highest PE risk was observed during the 1st year following the diagnosis of pemphigus (adjusted RR, 3.55; 95% CI, 1.78-7.09) and decreased over time. The increased risk was robust to a sensitivity analysis that included only cases managed by pemphigus-related systemic medications (adjusted RR, 1.82; 95% CI, 1.11-2.98). In conclusion, pemphigus is associated with an increased risk of PE, particularly during the 1st year of the disease. An awareness of this risk should be increased, additional precipitating factors for PE should be avoided, and thromboprophylaxis may be evaluated in high-risk patients. Further research is required to establish this risk.

Anxiety and depression predispose individuals to an autoimmune bullous diseases- bullous pemphigoid: A large-scale population-based cohort study

Abstract: The association of bullous pemphigoid (BP) with anxiety and anxiety-depression comorbidity is yet to be established. We aimed to evaluate the bidirectional association of BP with anxiety, depression, and anxiety-depression comorbidity, and to delineate the epidemiological features of patients with BP and the aforementioned psychiatric comorbidities. A population-based cohort study was performed to assess the risk of anxiety, depression, and anxiety-depression comorbidity among patients with BP (n = 3924) relative to age-, sex- and ethnicity-matched control subjects (n = 19,280). A case-control design was additionally adopted to estimate the odds of BP in individuals with a preexisting diagnosis of these three psychiatric conditions. Adjusted hazard ratios (HRs) and adjusted odds ratios (ORs) were estimated by Cox regression and logistic regression, respectively. A history of anxiety (OR, 1.17; 95% CI, 1.04–1.31), depression (OR, 1.26; 95% CI, 1.15–1.38), and anxiety-depression comorbidity (OR, 1.19; 95% CI, 1.04–1.35) was associated with subsequent development of BP. In the cohort study design, patients with BP were found to be at an increased overall risk of depression (HR, 1.17; 95% CI, 1.01–1.35), while female BP patients had an increased risk of depression (HR, 1.19; 95% CI, 1.00–1.42) and anxiety (HR, 1.29; 95% CI, 1.00–1.67). Patients with comorbid BP and depression exhibited a 19% increased all-cause mortality rate (HR, 1.19; 95% CI, 1.08–1.31), whereas patients with BP and anxiety-depression comorbidity were less adherent to long-term topical corticosteroid treatment and less frequently managed by adjuvant agents. In conclusion, a history of anxiety, depression, and anxiety-depression comorbidity predisposes individuals to BP, whereas patients with BP are at an increased risk of depression. Clinicians managing patients with anxiety and depression should take the increased risk of BP into consideration, and patients with BP should be monitored for depression.

HMM phoneme recognition with supervised training and Viterbi algorithm

Abstract: An HMM continuous Hebrew phoneme recognition system, that requires no manual segmentation for its training was developed. A relatively small Hebrew data base was acquired for training and recognition of phonemes in continuous speech. One of the main problems in phoneme recognition, that of manual segmentation of the training data base, was overcome by a special training algorithm. The Viterbi algorithm was used in the recognition stage, and the evaluation of the results was done with the Levenshtein distance measure. Initial recognition results of Hebrew phonemes for speaker independent, text dependent cases were 69.4% correct phoneme recognition.

Hidradenitis suppurativa and pemphigus: a cross-sectional study.

Abstract: A recent study of comorbidities in hospitalized pemphigus patients in the United States has demonstrated a significant association of hidradenitis suppurativa (HS) and pemphigus, but this association has not been firmly established in other populations. A retrospective, cross-sectional study was undertaken to determine the prevalence of HS in patients with pemphigus and compare with control subjects. Regression analysis was performed to obtain ORs, and 95% CIs, to evaluate the prevalence between pemphigus patients and controls matched by age, sex, and ethnicity. Among the patients included in the study, 1985 patients had pemphigus and 9874 were control subjects. The average age of presentation of pemphigus was 72.1 ± 18.5 and the group was comprised of 59.8% females. Overall, the pemphigus group had lower rates of smoking (25.7% vs. 27.9%; P = 0.045). The prevalence of HS was greater in patients with pemphigus than in control subjects (OR 4.98; 95% CI 1.01–24.69; P < 0.001), with an even more prominent association among patients who have been prescribed “pemphigus-related treatments” (OR 6.30; 95% CI 1.27–31.22; P < 0.001). The study detected a significant association between HS and pemphigus in an Israeli population. Future prospective studies are needed to establish a temporal order of appearance and the mechanistic relationship between these entities.

Harrison's Principles of Internal Medicine

Abstract: The 11th edition of Harrison's Principles of Internal Medicine welcomes Anthony Fauci to its editorial staff, in addition to more than 85 new contributors. While the organization of the book is similar to previous editions, major emphasis has been placed on disorders that affect multiple organ systems. Important advances in genetics, immunology, and oncology are emphasized. Many chapters of the book have been rewritten and describe major advances in internal medicine. Subjects that received only a paragraph or two of attention in previous editions are now covered in entire chapters. Among the chapters that have been extensively revised are the chapters on infections in the compromised host, on skin rashes in infections, on many of the viral infections, including cytomegalovirus and Epstein-Barr virus, on sexually transmitted diseases, on diabetes mellitus, on disorders of bone and mineral metabolism, and on lymphadenopathy and splenomegaly. The major revisions in these chapters and many

The Self-Organizing Map

Abstract: An overview of the self-organizing map algorithm, on which the papers in this issue are based, is presented in this article.

The Geometry of Algorithms with Orthogonality Constraints

Abstract: In this paper we develop new Newton and conjugate gradient algorithms on the Grassmann and Stiefel manifolds. These manifolds represent the constraints that arise in such areas as the symmetric eigenvalue problem, nonlinear eigenvalue problems, electronic structures computations, and signal processing. In addition to the new algorithms, we show how the geometrical framework gives penetrating new insights allowing us to create, understand, and compare algorithms. The theory proposed here provides a taxonomy for numerical linear algebra algorithms that provide a top level mathematical view of previously unrelated algorithms. It is our hope that developers of new algorithms and perturbation theories will benefit from the theory, methods, and examples in this paper.

Sarcoidosis

Abstract: 结节病易误诊,据王洪武等~([1])收集国内18篇关于此病误诊的文献,误诊率高达63.2%,当然有误诊就会有误治,如孙永昌等~([2])报道26例结节病在影像学检查诊断的第一印象中拟诊结核5例,其中就有2例完成规范的抗结核治疗,为此应引起临床对本病诊治的重视。

Type 2 diabetes mellitus.

Abstract: Type 2 diabetes mellitus (T2DM) is an expanding global health problem, closely linked to the epidemic of obesity. Individuals with T2DM are at high risk for both microvascular complications (including retinopathy, nephropathy and neuropathy) and macrovascular complications (such as cardiovascular comorbidities), owing to hyperglycaemia and individual components of the insulin resistance (metabolic) syndrome. Environmental factors (for example, obesity, an unhealthy diet and physical inactivity) and genetic factors contribute to the multiple pathophysiological disturbances that are responsible for impaired glucose homeostasis in T2DM. Insulin resistance and impaired insulin secretion remain the core defects in T2DM, but at least six other pathophysiological abnormalities contribute to the dysregulation of glucose metabolism. The multiple pathogenetic disturbances present in T2DM dictate that multiple antidiabetic agents, used in combination, will be required to maintain normoglycaemia. The treatment must not only be effective and safe but also improve the quality of life. Several novel medications are in development, but the greatest need is for agents that enhance insulin sensitivity, halt the progressive pancreatic β-cell failure that is characteristic of T2DM and prevent or reverse the microvascular complications. For an illustrated summary of this Primer, visit: http://go.nature.com/V2eGfN.