1
|
Kümpfel T, Giglhuber K, Aktas O, Ayzenberg I, Bellmann-Strobl J, Häußler V, Havla J, Hellwig K, Hümmert MW, Jarius S, Kleiter I, Klotz L, Krumbholz M, Paul F, Ringelstein M, Ruprecht K, Senel M, Stellmann JP, Bergh FT, Trebst C, Tumani H, Warnke C, Wildemann B, Berthele A. Update on the diagnosis and treatment of neuromyelitis optica spectrum disorders (NMOSD) - revised recommendations of the Neuromyelitis Optica Study Group (NEMOS). Part II: Attack therapy and long-term management. J Neurol 2024; 271:141-176. [PMID: 37676297 PMCID: PMC10770020 DOI: 10.1007/s00415-023-11910-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 09/08/2023]
Abstract
This manuscript presents practical recommendations for managing acute attacks and implementing preventive immunotherapies for neuromyelitis optica spectrum disorders (NMOSD), a rare autoimmune disease that causes severe inflammation in the central nervous system (CNS), primarily affecting the optic nerves, spinal cord, and brainstem. The pillars of NMOSD therapy are attack treatment and attack prevention to minimize the accrual of neurological disability. Aquaporin-4 immunoglobulin G antibodies (AQP4-IgG) are a diagnostic marker of the disease and play a significant role in its pathogenicity. Recent advances in understanding NMOSD have led to the development of new therapies and the completion of randomized controlled trials. Four preventive immunotherapies have now been approved for AQP4-IgG-positive NMOSD in many regions of the world: eculizumab, ravulizumab - most recently-, inebilizumab, and satralizumab. These new drugs may potentially substitute rituximab and classical immunosuppressive therapies, which were as yet the mainstay of treatment for both, AQP4-IgG-positive and -negative NMOSD. Here, the Neuromyelitis Optica Study Group (NEMOS) provides an overview of the current state of knowledge on NMOSD treatments and offers statements and practical recommendations on the therapy management and use of all available immunotherapies for this disease. Unmet needs and AQP4-IgG-negative NMOSD are also discussed. The recommendations were developed using a Delphi-based consensus method among the core author group and at expert discussions at NEMOS meetings.
Collapse
Affiliation(s)
- Tania Kümpfel
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.
| | - Katrin Giglhuber
- Department of Neurology, School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Ilya Ayzenberg
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Judith Bellmann-Strobl
- Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité-Universitätsmedizin Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, and Berlin Institute of Health, and Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Vivien Häußler
- Department of Neurology and Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Kerstin Hellwig
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Martin W Hümmert
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Ingo Kleiter
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany
| | - Luisa Klotz
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Markus Krumbholz
- Department of Neurology and Pain Treatment, Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
- Department of Neurology & Stroke, University Hospital of Tübingen, Tübingen, Germany
| | - Friedemann Paul
- Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité-Universitätsmedizin Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, and Berlin Institute of Health, and Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Marius Ringelstein
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Neurology, Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Klemens Ruprecht
- Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Makbule Senel
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Jan-Patrick Stellmann
- Department of Neurology and Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- APHM, Hopital de la Timone, CEMEREM, Marseille, France
- Aix Marseille University, CNRS, CRMBM, Marseille, France
| | | | - Corinna Trebst
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | | | - Clemens Warnke
- Department of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Brigitte Wildemann
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany
| | - Achim Berthele
- Department of Neurology, School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Munich, Germany.
| |
Collapse
|
2
|
Zheng Y, Guo R, Tian Q, Du Y, Wang L, Zhu Z, Yu E, Sun J, Yi X, Xu C. The efficacy of GnRH-a followed by SanJieZhenTong capsules in long-term management of endometriosis: Study protocol for a multicenter, double-blinded, double-dummy randomized clinical trial. Contemp Clin Trials Commun 2023; 34:101179. [PMID: 37409188 PMCID: PMC10319207 DOI: 10.1016/j.conctc.2023.101179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 07/07/2023] Open
Abstract
Background Endometriosis is a common benign gynecological disorder with high risk of recurrence and adverse impact on fertility-sparing. This study aims to evaluate the effectiveness and safety of SanJieZhenTong Capsules, a traditional Chinese medicine, in the long-term management of endometriosis postoperatively. Methods and analysis: A prospective, double-blinded, double-dummy parallel-group randomized controlled trial will be conducted at three university-based medical centers in China. A total of 600 patients with rAFS III-IV endometriosis diagnosed by laparoscopy will be enrolled. After fundamental treatment (gonadotropin-releasing hormone agonists injection starts on the first day of menstruation postoperatively, and repeats 3 times every 28 days), participants will be randomly allocated to the oral contraceptive group (oral contraceptive + dummy A) or SanJieZhenTong Capsules group (SanJieZhenTong Capsules + dummy B) in a 1:1 ratio. All participants will be treated and followed up for 52 weeks. The primary outcome is a recurrence rate based on endometriosis-related symptoms, physical examination, and/or ultrasound/MRI findings. The secondary outcome includes changes in quality of life and organic function outcome via the 36-item Short-Form scores and gastrointestinal function score. Conclusion The current trial could provide rigorous evidence on SanJieZhenTong Capsules application in the long-term management of advanced-stage endometriosis.
Collapse
Affiliation(s)
- Yunxi Zheng
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
- Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, 200011, China
- Department of Gynecology, Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, 200011, China
| | - Ruoyi Guo
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
- Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, 200011, China
- Department of Gynecology, Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, 200011, China
- Department of Integrated Traditional & Western Medicine, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
| | - Qi Tian
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
- Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, 200011, China
- Department of Gynecology, Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, 200011, China
| | - Yan Du
- Office of Clinical Epidemiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Li Wang
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
- Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, 200011, China
- Department of Gynecology, Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, 200011, China
- Department of Integrated Traditional & Western Medicine, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
| | - Zhiling Zhu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
- Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, 200011, China
- Department of Gynecology, Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, 200011, China
- Department of Integrated Traditional & Western Medicine, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
| | - Erkai Yu
- Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200011, PR China
| | - Jing Sun
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, Shanghai, 200011, PR China
| | - Xiaofang Yi
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
- Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, 200011, China
- Department of Gynecology, Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, 200011, China
| | - Congjian Xu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
- Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, 200011, China
- Department of Gynecology, Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, 200011, China
| |
Collapse
|
3
|
Niimi A, Fukunaga K, Taniguchi M, Nakamura Y, Tagaya E, Horiguchi T, Yokoyama A, Yamaguchi M, Nagata M. Executive summary: Japanese guidelines for adult asthma (JGL) 2021. Allergol Int 2023; 72:207-226. [PMID: 36959028 DOI: 10.1016/j.alit.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/17/2023] [Indexed: 03/25/2023] Open
Abstract
Asthma is characterized by chronic airway inflammation, variable airway narrowing, and sensory nerve irritation, which manifest as wheezing, dyspnea, chest tightness, and cough. Longstanding asthma may result in airway remodeling and become intractable. Despite the increased prevalence of asthma in adults, asthma-associated deaths have decreased in Japan (0.94 per 100,000 people in 2020). The goals of asthma treatment include the control of symptoms and reduction of future risks. A functional partnership between physicians and patients is indispensable for achieving these goals. Long-term management with medications and the elimination of triggers and risk factors are fundamental to asthma treatment. Asthma is managed via four steps of pharmacotherapy ("controllers"), ranging from mild to intensive treatments, depending on disease severity; each step involves daily administration of an inhaled corticosteroid, which varies from low to high dosage. Long-acting β2 agonists, leukotriene receptor antagonists, sustained-release theophylline, and long-acting muscarinic antagonists are recommended as add-on drugs. Allergen immunotherapy is a new option that is employed as a controller treatment. Further, as of 2021, anti-IgE antibody, anti-IL-5 and anti-IL-5 receptor α-chain antibodies, and anti-IL-4 receptor α-chain antibodies are available for the treatment of severe asthma. Bronchial thermoplasty can be performed for asthma treatment, and its long-term efficacy has been reported. Algorithms for their usage have been revised. Comorbidities, such as allergic rhinitis, chronic rhinosinusitis, chronic obstructive pulmonary disease, and aspirin-exacerbated respiratory disease, should also be considered during the treatment of chronic asthma. Depending on the severity of episodes, inhaled short-acting β2 agonists, systemic corticosteroids, short-acting muscarinic antagonists, oxygen therapy, and other approaches are used as needed ("relievers") during exacerbation.
Collapse
Affiliation(s)
- Akio Niimi
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
| | - Koichi Fukunaga
- Pulmonary Division, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Masami Taniguchi
- Center for Immunology and Allergology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Yoichi Nakamura
- Medical Center for Allergic and Immune Diseases, Yokohama City Minato Red Cross Hospital, Yokohama, Japan
| | - Etsuko Tagaya
- Department of Respiratory Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Takahiko Horiguchi
- Department of Respiratory Medicine, Toyota Regional Medical Center, Toyota, Japan
| | - Akihito Yokoyama
- Department of Respiratory Medicine and Allergology, Kochi Medical School, Kochi University, Kochi, Japan
| | - Masao Yamaguchi
- Division of Respiratory Medicine, Third Department of Medicine, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Makoto Nagata
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan; Allergy Center, Saitama Medical University Hospital, Saitama Medical University, Saitama, Japan
| |
Collapse
|
4
|
Nagashima N, Hirata T, Arakawa T, Neriishi K, Sun H, Harada M, Hirota Y, Koga K, Wada-Hiraike O, Osuga Y. Long-term conservative management of symptomatic bladder endometriosis: A case series of 17 patients. Taiwan J Obstet Gynecol 2022; 61:606-611. [PMID: 35779908 DOI: 10.1016/j.tjog.2022.02.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate the course of long-term conservative management of bladder endometriosis (BE). MATERIALS AND METHODS We retrospectively reviewed 17 cases of BE conservatively managed without surgery in our facility. The following factors were analyzed: age, medical history, lesion size, symptoms, hormonal treatment, and follow-up outcomes. RESULTS In this study, 15 patients received hormonal therapy and 2 did not. Oral contraceptive (OC), dienogest (DNG), and gonadotropin-releasing hormone agonist (GnRHa) were administered as the first regimen in 7, 5, and 3 patients, respectively. Of the 7 patients, OC administration was effective in alleviating urinary symptoms in all but 2 patients. Of 3 patients who received GnRHa, 2 switched to OC and then DNG, and 1 patient discontinued the treatment because of adverse effects. Of 5 patients who received DNG, all experienced symptom relief. DNG, OC, and GnRHa administration were effective and tolerable in 9 of 10 patients (90.0%), in 5 of 9 patients (55.6%), and in 2 of 3 patients (66.7%), respectively. In particular, 3 patients completed DNG treatment until menopause. The size of the BE lesion significantly decreased after 3 months of DNG administration, and the reduction effect was maintained until 48 months thereafter. CONCLUSION This study proposed that hormonal therapy for BE is an effective option for those who are not planning to conceive or to undergo surgery. Specifically, DNG may be suitable for patients refusing surgery, considering the effectiveness and tolerance for long-term use.
Collapse
Affiliation(s)
- Natsuki Nagashima
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan
| | - Tetsuya Hirata
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan; Department of Obstetrics and Gynecology, Doai Kinen Hospital, Japan.
| | - Tomoko Arakawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan
| | - Kazuaki Neriishi
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan
| | - Hui Sun
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan
| | - Miyuki Harada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan
| | - Yasushi Hirota
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan
| | - Kaori Koga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan
| | - Osamu Wada-Hiraike
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan
| |
Collapse
|
5
|
Kaendler S, Ritter M, Sander D, Elstner M, Schwarzbach C, Wagner M, Meisel A. [Position paper on stroke aftercare of the German Stroke Society-Part 1: long-term care after stroke: status quo of the reality and deficits of care in Germany]. Nervenarzt 2022; 93:368-376. [PMID: 34978578 PMCID: PMC9010384 DOI: 10.1007/s00115-021-01231-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 11/03/2022]
Abstract
Die Akutversorgung des Schlaganfalls in Deutschland hat ein sehr hohes Niveau, dargestellt durch die Stroke-Units. Die Erkrankung Schlaganfall hat eine Akutphase, gefolgt von einer chronischen Phase mit einem hohen und qualifizierten multi- und interprofessionellen Versorgungsbedarf. Die Deutsche Schlaganfall-Gesellschaft (DSG) hat 2020 eine Nachsorgekommission gegründet, mit dem Ziel der Darstellung der aktuellen Versorgungssituation und zur Erarbeitung von Vorschlägen für eine Verbesserung der Versorgung nach der Akutphase. In dieser Arbeit wird der Status quo ermittelt und Defizite benannt. Analysiert wurden Beiträge unterschiedlicher Beteiligter im deutschen Gesundheitswesen, dargestellt werden unterschiedliche Projekte einer Nachsorge. In Deutschland existiert kein anerkanntes strukturiertes Nachsorgekonzept für Patienten nach einem Schlaganfall. Die bestehende hausarztbasierte Versorgung ohne eine zukünftig stärkere und abgestimmte Integration der Neurologen erschwert eine leitlinien- und qualitätsgesteuerte Nachsorge. Aufgabenverteilungen sowie notwendige Ausbildungsstandards für ihre leitliniengerechte Erfüllung durch die Fachgruppen liegen nicht vor. Zu selten werden neben den medizinischen Domänen die physischen, sozialen und emotionalen Domänen durch ein multiprofessionelles Versorgungsteam beachtet. Zu diskutieren ist eine Weiterentwicklung eines regionalen Care-Management-Konzeptes. Evaluiert werden müssen die Ergebnisse und die Kosten eines Nachsorgekonzeptes vor einer breiten Anwendung.
Collapse
Affiliation(s)
- Stephen Kaendler
- Praxis Kaendler & Wurtz, Praxis für Nervenheilkunde, Kaiserstraße 75, 63065, Offenbach, Deutschland.
| | | | - Dirk Sander
- Neurozentrum Tutzing-Feldafing, Benedictus-Krankenhaus, Tutzing, Deutschland
| | - Matthias Elstner
- Klinik für Neurologie, Klinikum Ansbach, Ansbach, Deutschland.,TUM, München, Deutschland
| | | | - Markus Wagner
- Stiftung Deutsche Schlaganfall-Hilfe, Gütersloh, Deutschland
| | - Andreas Meisel
- Centrum für Schlaganfallforschung Berlin und Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Deutschland
| | | |
Collapse
|
6
|
Dribin TE, Castells M. Anaphylaxis: Data Gaps and Research Needs. Immunol Allergy Clin North Am 2021; 42:187-200. [PMID: 34823747 DOI: 10.1016/j.iac.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There are significant anaphylaxis data and knowledge gaps that result in suboptimal patient care and outcomes. To address these gaps there is need for collaborative, multidisciplinary research networks to strategically design practice changing research specific to the following anaphylaxis themes: Population Science, Basic and Translational Sciences, Acute Management, and Long-Term Management. Top priorities are to refine anaphylaxis diagnostic criteria, identify accurate diagnostic and predictive anaphylaxis biomarkers, standardize postanaphylaxis care (observation periods, hospitalization criteria), and determine immunotherapy best practices. Addressing these gaps will result in improved, optimal care and clinical outcomes for patients with or at risk of anaphylaxis.
Collapse
Affiliation(s)
- Timothy E Dribin
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, 3244 Burnet Avenue, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Mariana Castells
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Hale BTM Building Room 5002N, 60 Fenwood Road, Boston, MA 02115, USA
| |
Collapse
|
7
|
Sclafani M, Arcari L, Russo D, Tini G, Limite LR, Cacciotti L, Volpe M, Autore C, Musumeci MB. Long-term management of Takotsubo syndrome: a not-so-benign condition. Rev Cardiovasc Med 2021; 22:597-611. [PMID: 34565063 DOI: 10.31083/j.rcm2203071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 11/06/2022] Open
Abstract
Takotsubo syndrome (TTS) is an intriguing clinical entity, characterized by usually transient and reversible abnormalities of the left ventricular systolic function, mimicking the myocardial infarction with non-obstructive coronary arteries. TTS was initially regarded as a benign condition, however recent studies have unveiled adverse outcomes in the short- and long-term, with rates of morbidity and mortality comparable to those experienced after an acute myocardial infarction. Given the usual transient nature of TTS, this is an unexpected finding. Moreover, long-term mortality seems to be mainly driven by non-cardiovascular causes. The uncertain long-term prognosis of TTS warrants a comprehensive outpatient follow-up after the acute event, although there are currently no robust data indicating its modality and timing. The aim of the present review is to summarize recent available evidence regarding long-term prognosis in TTS. Moreover methods, timing and findings of the long-term management of TTS will be discussed.
Collapse
Affiliation(s)
- Matteo Sclafani
- Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Luca Arcari
- Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy.,Institute of Cardiology, Madre Giuseppina Vannini Hospital, 00100 Rome, Italy
| | - Domitilla Russo
- Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Giacomo Tini
- Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Luca Rosario Limite
- Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Luca Cacciotti
- Institute of Cardiology, Madre Giuseppina Vannini Hospital, 00100 Rome, Italy
| | - Massimo Volpe
- Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Camillo Autore
- Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Maria Beatrice Musumeci
- Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| |
Collapse
|
8
|
Porcelli T, Luongo C, Sessa F, Klain M, Masone S, Troncone G, Bellevicine C, Schlumberger M, Salvatore D. Long-term management of lenvatinib-treated thyroid cancer patients: a real-life experience at a single institution. Endocrine 2021; 73:358-366. [PMID: 33537956 DOI: 10.1007/s12020-021-02634-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/18/2021] [Indexed: 01/30/2023]
Abstract
PURPOSE The efficacy of lenvatinib for advanced and progressive radioactive iodine refractory differentiated thyroid cancer is well established. Herein, we retrospectively evaluated the long-term safety and efficacy of lenvatinib in 23 patients treated at a single Institution. METHODS Clinical data of all patients treated for a differentiated thyroid cancer with lenvatinib from April 2015 to September 2020 were retrospectively analyzed. RESULTS A total of 23 patients were included. In all, 21 patients received lenvatinib as first-line systemic therapy. Median age at initiation of lenvatinib treatment was 68 (44-90) years. Median duration of the study from initiation of lenvatinib to study end was 23 (2-65) months. The indication for lenvatinib treatment was documented progression of distant metastases in 20 patients and of locally advanced disease in the other 3 and median duration of lenvatinib therapy was 15 (2-64) months. Best treatment responses were: partial response in 6 patients, stable disease in 14, progressive disease in 1, and not evaluable in 2. Median progression-free survival was 25 months (95% CI: 12-40) and median overall survival was 46 months (95% CI: 28-65). Three patients had to discontinue lenvatinib treatment due to serious adverse events and no drug-related death was observed. Ten patients continued lenvatinib for more than 24 months and the only newly registered adverse event after this period of time was one case of G2 proteinuria. Six patients continued lenvatinib treatment beyond documented tumor progression due to oligoprogression or slowly progressive disease (median time 18.5 months, 8-42 months). A total of 14 patients were alive at the end of the study: 11 showed partial response/stable disease on lenvatinib, including 3 who had a stable disease after local ablative therapy for oligoprogressive metastases; 3 had to change treatment, including 2 for lenvatinib-related serious adverse events and 1 for progressive disease. CONCLUSIONS Long-term lenvatinib treatment is safe and some patients may experience persistent long-term control of the disease. Late treatment-related AEs rarely occurred. Oligoprogressive and slowly progressive disease can be managed without treatment withdrawal as long as there are some clinical benefits.
Collapse
Affiliation(s)
- Tommaso Porcelli
- Department of Public Health, University of Naples "Federico II", 80131, Naples, Italy.
| | - Cristina Luongo
- Department of Public Health, University of Naples "Federico II", 80131, Naples, Italy
| | - Francesca Sessa
- Department of Public Health, University of Naples "Federico II", 80131, Naples, Italy
| | - Michele Klain
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Stefania Masone
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Giancarlo Troncone
- Department of Public Health, University of Naples "Federico II", 80131, Naples, Italy
| | - Claudio Bellevicine
- Department of Public Health, University of Naples "Federico II", 80131, Naples, Italy
| | - Martin Schlumberger
- Department of Endocrine Oncology, Gustave Roussy and University Paris-Saclay, 94805, Villejuif, France
| | - Domenico Salvatore
- Department of Public Health, University of Naples "Federico II", 80131, Naples, Italy
| |
Collapse
|
9
|
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory disease, characterized by abscess formation and mutilating scar formation in the body folds. The burden of disease is high for both patient and treating physician. In dermatological daily practice, proper patient education and formation of a trustful physician-patient relationship are of highest importance. HS patients are treated both conservatively and surgically mostly by dermatologists, which requires extensive knowledge of the pathogenesis, trigger factors, comorbidities and treatment options. Interdisciplinary collaboration with other disciplines is still underdeveloped. New physical treatments (laser, radiofrequency, intense pulsed light [IPL]), topical and systemic therapies enable good ambulatory long-term management for all HS stages.
Collapse
|
10
|
Banham-Hall E, Allison A, Santarsieri A, Gohel M, Crowley MP, Sheares K, Thomas W. An international survey of clinicians regarding their management of venous thromboembolism following the initial 3-6 months of anticoagulation. J Thromb Thrombolysis 2021; 51:17-24. [PMID: 32592081 DOI: 10.1007/s11239-020-02193-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
After an initial treatment period for venous thromboembolism (VTE), indefinite anticoagulation may be considered, depending upon individual risks. The aim of the study was to determine if there is consensus amongst clinicians that manage VTE regarding which patients require 3-6 months versus indefinite anticoagulation. The importance of VTE site and severity in decision making was also evaluated. An international survey of clinicians involved in VTE management was undertaken. Respondents were asked about long-term treatment of six patients that had completed 3-6 months initial anticoagulation. These included four cases of VTE not associated with a major reversible risk factor and two control cases; one unprovoked VTE and one VTE associated with a major reversible risk factor. For consensus, there was a pre-defined equivalence boundary whereby at least 70% of clinicians had to decide either to stop or consider indefinite anticoagulation for each case. 351 responses were collected. In the control cases, there was a ≥ 95% consensus on long-term management (stop versus indefinite anticoagulation). In three of the four test cases, there was no consensus about duration of anticoagulation. In case 3, 78% (99% confidence interval 73-84%) would stop anticoagulation after 3-6 months. When analysed by grade or specialty of doctor, a lack of consensus remained. Opinion on whether site or severity of VTE influenced decision making was variable. For patients with unprovoked VTE or VTE associated with a major transient risk factor there is treatment consensus. For the remainder, there is a lack consensus regarding the need for indefinite anticoagulation.
Collapse
|
11
|
Cai Z, Zhang J, Li H. Two Birds with One Stone: Regular Use of PDE5 Inhibitors for Treating Male Patients with Erectile Dysfunction and Cardiovascular Diseases. Cardiovasc Drugs Ther 2019; 33:119-28. [PMID: 30675707 DOI: 10.1007/s10557-019-06851-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Patients with cardiovascular disease (CVD) frequently have erectile dysfunction (ED) because the two conditions have similar risk factors and potential mechanisms. The therapeutic effect of CVD is strongly dependent upon long-term management of the condition. Patients with CVD tend to have poor medication compliance, and the coexistence of ED often discourages patients with CVD from continuing their long-term CVD management, thus worsening CVD treatment compliance. The two major reasons for poor compliance are that (i) the adverse effects of cardiovascular medications on erectile function drive people to reduce the prescribed dosage or even stop taking the medications to obtain satisfactory sexual arousal and (ii) a worsening mental state due to ED reduces medication compliance. The regular administration of phosphodiesterase-5 inhibitors (PDE5is) guarantees that the prescribed medication dosages are easy to comply with and that they improve the mental status of patients by enhancing their erectile function, resulting in improved long-term management of CVD through medication compliance. PDE5is themselves also play a role in reducing cardiovascular events and improving the prognosis. We recommend prescribing PDE5is for ED and suggest that PDE5i administration is a promising strategy to improve the long-term management of patients with both ED and CVD.
Collapse
|
12
|
Marin-Oto M, Vicente EE, Marin JM. Long term management of obstructive sleep apnea and its comorbidities. Multidiscip Respir Med 2019; 14:21. [PMID: 31312448 PMCID: PMC6609382 DOI: 10.1186/s40248-019-0186-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/08/2019] [Indexed: 12/24/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a worldwide highly prevalent disease associated with systemic consequences, including excessive sleepiness, impairment of neurocognitive function and daytime performance, including driving ability. The long-term sequelae of OSA include and increase risk for cardiovascular, cerebrovascular and metabolic syndrome disorders that ultimately lead to premature death if untreated. To ensure optimal long-term outcomes, the assessment and management of OSA should be personalized with the involvement of the appropriate specialist. Most studies have demonstrated inmediate improvement in daytime somnolence and quality of life with CPAP and other therapies, but the effect of long-term treatment on mortality is still under debate. Currently, the long-term management of OSA should be based on a) identifying physiological or structural abnormalities that are treatable at the time of patient evaluation and b) comprehensive lifestyle interventions, especially weight-loss interventions, which are associated with improvements in OSA severity, cardiometabolic comorbidities, and quality of life. In long-term management, attention should be paid to the clinical changes related to a potential reoccurrence of OSA symptoms and it is also necessary to monitor throughout the follow up how the main associated comorbidities evolve.
Collapse
Affiliation(s)
- Marta Marin-Oto
- 1Department of Respiratory Medicine, Clinica Universitaria de Navarra, University of Navarra, Pamplona, Spain
| | - Eugenio E Vicente
- 2Otorhinolaryngology Service, Hospital Universitario Miguel Servet, Zaragoza, Spain.,4Traslational Respiratory Research Unit, IISAragon, Zaragoza and CIBER Enfermedades Respiratorias, Instituto Salud Carlos III, Madrid, Spain
| | - Jose M Marin
- 3Respiratory Service, Hospital Universitario Miguel Servet, and Department of Medicine, University of Zaragoza, Avda. Isabel la Católica, 1-3, 50009 Zaragoza, Spain.,4Traslational Respiratory Research Unit, IISAragon, Zaragoza and CIBER Enfermedades Respiratorias, Instituto Salud Carlos III, Madrid, Spain
| |
Collapse
|
13
|
Guo Z, Brusseau ML, Fogg GE. Determining the long-term operational performance of pump and treat and the possibility of closure for a large TCE plume. J Hazard Mater 2019; 365:796-803. [PMID: 30476803 PMCID: PMC6320714 DOI: 10.1016/j.jhazmat.2018.11.057] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 10/20/2018] [Accepted: 11/15/2018] [Indexed: 05/11/2023]
Abstract
The purpose of this study is to evaluate the impact of heterogeneity on the long-term performance of a large pump-and-treat (PAT) system that has been in operation for 30 years at a site located in Tucson, AZ. A 3D numerical model was developed. Three different concentrations were examined: composite concentration in the influent to the treatment plant, resident concentration in the aquifer, and concentration for downgradient boundary discharge. The time scales needed for concentrations measured in these ways to reach the Maximum Contaminant Levels (MCLs) are significantly different, with ∼125 years required for treatment-plant influent compared to ∼225 years for downgradient boundary discharge and >>227 years (total simulated time) for the resident concentration in the aquifer. These large time scales, compared to 36 years for a hypothetical homogeneous system, demonstrate the significant impacts of permeability heterogeneity on remediation at this site. The possibility of closure of the site was investigated by examining the mass discharge from the site boundary and the concentration rebound after simulating shutdown of the PAT system. The results of this study provide insight on evaluation of closure potential for large, complex contamination sites and a reference on selecting performance metrics for site management.
Collapse
Affiliation(s)
- Zhilin Guo
- Land, Air, and Water Resources, University of California, Davis, 1 Shields Ave, Davis, CA, 95616, United States.
| | - Mark L Brusseau
- Soil, Water and Environmental Science Department, University of Arizona, 429 Shantz Bldg., Tucson, AZ, 85721, United States
| | - Graham E Fogg
- Land, Air, and Water Resources, University of California, Davis, 1 Shields Ave, Davis, CA, 95616, United States
| |
Collapse
|
14
|
Abstract
Anaphylaxis is an acute, potentially fatal systemic allergic reaction with varied mechanisms and clinical presentations. Although prompt recognition and treatment of anaphylaxis are imperative, both patients and healthcare professionals often fail to recognize and diagnose early signs and symptoms of the condition. Clinical manifestations vary widely; however, the most common signs are cutaneous symptoms, including urticaria, angioedema, erythema and pruritus. Immediate intramuscular administration of epinephrine into the anterolateral thigh is first-line therapy, even if the diagnosis is uncertain. The mainstays of long-term management include specialist assessment, avoidance measures, and the provision of an epinephrine auto-injector and an individualized anaphylaxis action plan. This article provides an overview of the causes, clinical features, diagnosis and acute and long-term management of this serious allergic reaction.
Collapse
Affiliation(s)
| | | | | | - Harold Kim
- 1Western University, London, ON Canada.,4McMaster University, Hamilton, ON Canada
| |
Collapse
|
15
|
Arakawa H, Hamasaki Y, Kohno Y, Ebisawa M, Kondo N, Nishima S, Nishimuta T, Morikawa A. Japanese guidelines for childhood asthma 2017. Allergol Int 2017; 66:190-204. [PMID: 28108245 DOI: 10.1016/j.alit.2016.11.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Indexed: 10/20/2022] Open
Abstract
The Japanese Guideline for the Diagnosis and Treatment of Allergic Diseases 2017 (JAGL 2017) includes a minor revision of the Japanese Pediatric Guideline for the Treatment and Management of Asthma 2012 (JPGL 2012) by the Japanese Society of Pediatric Allergy and Clinical Immunology. The section on child asthma in JAGL 2017 provides information on how to diagnose asthma between infancy and adolescence (0-15 years of age). It makes recommendations for best practices in the management of childhood asthma, including management of acute exacerbations and non-pharmacological and pharmacological management. This guideline will be of interest to non-specialist physicians involved in the care of children with asthma. JAGL differs from the Global Initiative for Asthma Guideline in that JAGL emphasizes diagnosis and early intervention of children with asthma at <2 years or 2-5 years of age. The first choice of treatment depends on the severity and frequency of symptoms. Pharmacological management, including step-up or step-down of drugs used for long-term management based on the status of asthma control levels, is easy to understand; thus, this guideline is suitable for the routine medical care of children with asthma. JAGL also recommends using a control test in children, so that the physician aims for complete control by avoiding exacerbating factors and appropriately using anti-inflammatory drugs (for example, inhaled corticosteroids and leukotriene receptor antagonists).
Collapse
|
16
|
Devi BR, Syed-Abdul S, Kumar A, Iqbal U, Nguyen PA, Li YCJ, Jian WS. mHealth: An updated systematic review with a focus on HIV/AIDS and tuberculosis long term management using mobile phones. Comput Methods Programs Biomed 2015; 122:257-265. [PMID: 26304621 DOI: 10.1016/j.cmpb.2015.08.003] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/25/2015] [Accepted: 08/03/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To evaluate the utilization of mobile phone technology for treatment adherence, prevention, education, data collection, monitoring long-term management of HIV/AIDS and TB patients. METHODS Articles published in English language from January 2005 until now from PubMed/MEDLINE, EMBASE, Web of Science, WHO databases, and clinical trials were included. Data extraction is based on medication adherence, quality of care, prevention, education, motivation for HIV test, data collection from HIV lab test results and patient monitoring. Articles selected for the analysis cover RCTs and non RCTs related to the use of mobile phones for long-term care and treatment of HIV/AIDS and TB patients. RESULTS Out of 90 articles selected for the analysis, a large number of studies, 44 (49%) were conducted in developing countries, 24 (26%) studies from developed countries, 12 (13%) are systematic reviews and 10 (11%) did not mention study location. Forty seven (52.2%) articles focused on treatment, 11 (12.2%) on quality of care, 8 (9%) on prevention, 13 (14.4%) on education, 6 (6.6%) on data collection, and 5 (5.5%) on patient monitoring. Overall, 66 (73%) articles reported positive effects, 21 (23%) were neutral and 3 (4%) reported negative results. CONCLUSIONS Mobile phone technology is widely reported to be an effective tool for HIV/AIDS and TB long-term care. It can substantially reduce disease burden on health care systems by rendering more efficient prevention, treatment, education, data collection and management support.
Collapse
Affiliation(s)
- Balla Rama Devi
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan
| | - Shabbir Syed-Abdul
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan
| | - Arun Kumar
- Department of Pharmacy Practice, ISF College of Pharmacy, India
| | - Usman Iqbal
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan
| | - Phung-Anh Nguyen
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan
| | - Yu-Chuan Jack Li
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan; Department of Dermatology, Wan Fang Hospital, Taipei, Taiwan
| | - Wen-Shan Jian
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan; Faculty of Health Sciences, Macau University of Science and Technology, Macau, China.
| |
Collapse
|
17
|
Abstract
This review of the long-term management of spasticity addresses some of the clinical dilemmas in the management of patients with chronic disability. It is important for clinicians to have clear objectives in patient treatment and the available treatment strategies. The review reiterates the role of physical treatment in the management, and thereafter the maintenance of patients with spasticity. Spasticity is a physiological consequence of an injury to the nervous system. It is a complex problem which can cause profound disability, alone or in combination with the other features of an upper motor neuron syndrome, and can give rise to significant difficulties in the process of rehabilitation. This can be associated with profound restriction to activity and participation due to pain, weakness, and contractures. Optimum management is dependent on an understanding of its underlying physiology, an awareness of its natural history, an appreciation of the impact on the patient, and a comprehensive approach to minimizing that impact. The aim of this article is to highlight the importance, basic approach, and management options available to the general practitioner in such a complex condition.
Collapse
Affiliation(s)
- Anju Ghai
- Department of Anaesthesiology and Pain Medicine, Rohtak, Haryana, India
| | - Nidhi Garg
- Department of Anaesthesiology and Pain Medicine, Rohtak, Haryana, India
| | - Sarla Hooda
- Department of Anaesthesiology and Pain Medicine, Rohtak, Haryana, India
| | - Tushar Gupta
- Department of Anaesthesiology and Pain Medicine, Rohtak, Haryana, India
| |
Collapse
|