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Kaur P, Sakthivel M, Venkatasamy V, Jogewar P, Gill SS, Kunwar A, Sharma M, Pathni AK, Durgad K, Sahoo SK, Wankhede A, Kumar N, Bharadwaj V, Das B, Chavan T, Khedkar S, Sarode L, Bangar SD, Krishna A, Shivashankar R, Ganeshkumar P, Pragya P, Bhargava B. India Hypertension Control Initiative: Blood Pressure Control Using Drug and Dose-Specific Standard Treatment Protocol at Scale in Punjab and Maharashtra, India, 2022. Glob Heart 2024; 19:30. [PMID: 38524909 PMCID: PMC10959138 DOI: 10.5334/gh.1305] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 02/05/2024] [Indexed: 03/26/2024] Open
Abstract
Background Hypertension treatment coverage is low in India. A stepwise simple treatment protocol is one of the strategies to improve hypertension treatment in primary care. We estimated the effectiveness of various protocol steps to achieve blood pressure (BP) control in public sector health facilities in Punjab and Maharashtra, India, where the India Hypertension Control Initiative (IHCI) was implemented. Methods We analyzed the records of people enrolled for hypertension treatment and follow-up under IHCI between January 2018 and December 2021 in public sector primary and secondary care facilities across 23 districts from two states. Each state followed a different treatment protocol. We calculated the proportion with controlled BP at each step of the protocol. We also estimated the mean decline in BP pre- and post-treatment. Results Of 281,209 patients initiated on amlodipine 5 mg, 159,292 continued on protocol drugs and came for a follow-up visit during the first quarter of 2022. Of 33,450 individuals who came for the follow-up in Punjab and 125,842 in Maharashtra, 70% and 76% had controlled BP, respectively, at the first step with amlodipine 5 mg. In Punjab, at the second step with amlodipine 10 mg, the cumulative BP control increased to 75%. A similar 5% (76%-81%) increase was seen in the second step after adding telmisartan 40 mg in Maharashtra. Overall, the mean (SD) systolic blood pressure (SBP) decreased by 16 mmHg from 148 (15) mmHg at the baseline in Punjab. In Maharashtra, the decline in the mean (SD) SBP was about 15 mmHg from the 144 (18) mmHg baseline. Conclusion Simple drug- and dose-specific protocols helped achieve a high control rate among patients retained in care under program conditions. We recommend treatment protocols starting with a single low-cost drug and escalating with the same or another antihypertensive drug depending on the cost and availability.
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Affiliation(s)
- Prabhdeep Kaur
- ICMR - National Institute of Epidemiology Author Institution is Unverified Chennai, IN
| | | | | | - Padmaja Jogewar
- State NCD Cell, Directorate of Health and Family Welfare, Government of Maharashtra, Mumbai, IN
| | - Sandeep S. Gill
- State NCD Cell, Directorate of Health and Family Welfare, Government of Punjab, Chandigarh, IN
| | - Abhishek Kunwar
- Division of Noncommunicable Diseases, WHO Country Office for India, New Delhi, IN
| | - Meenakshi Sharma
- Division of Noncommunicable Diseases, Indian Council of Medical Research (ICMR), New Delhi, IN
| | | | - Kiran Durgad
- IHCI project, WHO Country Office for India, New Delhi, IN
| | | | - Amol Wankhede
- IHCI project, WHO Country Office for India, New Delhi, IN
| | - Navneet Kumar
- IHCI project, State NCD Cell, Chandigarh (Punjab), WHO, IN
| | | | - Bidisha Das
- IHCI project, District NCD Cell, Bhatinda (Punjab), WHO, IN
| | | | - Suhas Khedkar
- IHCI project, District NCD Cell, Satara (Maharashtra), WHO, IN
| | - Lalit Sarode
- IHCI project, District NCD Cell, Nashik (Maharashtra), WHO, IN
| | - Sampada D. Bangar
- Division of Epidemiology and biostatistics, ICMR-National AIDS Research Institute, Pune, IN
| | | | - Roopa Shivashankar
- Division of Noncommunicable Diseases, Indian Council of Medical Research (ICMR), New Delhi, IN
| | | | - Pragati Pragya
- Division of Noncommunicable Diseases, Indian Council of Medical Research (ICMR), New Delhi, IN
| | - Balram Bhargava
- Department of Health Research, MoHFW, Indian Council of Medical Research (ICMR), New Delhi, IN
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DeMerle KM, Kennedy JN, Chang CCH, Delucchi K, Huang DT, Kravitz MS, Shapiro NI, Yealy DM, Angus DC, Calfee CS, Seymour CW. Identification of a hyperinflammatory sepsis phenotype using protein biomarker and clinical data in the ProCESS randomized trial. Sci Rep 2024; 14:6234. [PMID: 38485953 PMCID: PMC10940677 DOI: 10.1038/s41598-024-55667-5] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/26/2024] [Indexed: 03/18/2024] Open
Abstract
Sepsis is a heterogeneous syndrome and phenotypes have been proposed using clinical data. Less is known about the contribution of protein biomarkers to clinical sepsis phenotypes and their importance for treatment effects in randomized trials of resuscitation. The objective is to use both clinical and biomarker data in the Protocol-Based Care for Early Septic Shock (ProCESS) randomized trial to determine sepsis phenotypes and to test for heterogeneity of treatment effect by phenotype comparing usual care to protocolized early, goal-directed therapy(EGDT). In this secondary analysis of a subset of patients with biomarker sampling in the ProCESS trial (n = 543), we identified sepsis phenotypes prior to randomization using latent class analysis of 20 clinical and biomarker variables. Logistic regression was used to test for interaction between phenotype and treatment arm for 60-day inpatient mortality. Among 543 patients with severe sepsis or septic shock in the ProCESS trial, a 2-class model best fit the data (p = 0.01). Phenotype 1 (n = 66, 12%) had increased IL-6, ICAM, and total bilirubin and decreased platelets compared to phenotype 2 (n = 477, 88%, p < 0.01 for all). Phenotype 1 had greater 60-day inpatient mortality compared to Phenotype 2 (41% vs 16%; p < 0.01). Treatment with EGDT was associated with worse 60-day inpatient mortality compared to usual care (58% vs. 23%) in Phenotype 1 only (p-value for interaction = 0.05). The 60-day inpatient mortality was similar comparing EGDT to usual care in Phenotype 2 (16% vs. 17%). We identified 2 sepsis phenotypes using latent class analysis of clinical and protein biomarker data at randomization in the ProCESS trial. Phenotype 1 had increased inflammation, organ dysfunction and worse clinical outcomes compared to phenotype 2. Response to EGDT versus usual care differed by phenotype.
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Affiliation(s)
- Kimberley M DeMerle
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Pittsburgh, PA, USA
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jason N Kennedy
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Pittsburgh, PA, USA
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chung-Chou H Chang
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kevin Delucchi
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - David T Huang
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Pittsburgh, PA, USA
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Multidisciplinary Acute Care Research Organization (MACRO), Pittsburgh, PA, USA
| | - Max S Kravitz
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Donald M Yealy
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Derek C Angus
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Pittsburgh, PA, USA
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carolyn S Calfee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine and Anesthesia, University of California San Francisco, San Francisco, CA, USA
| | - Christopher W Seymour
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Pittsburgh, PA, USA.
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, 3459 Fifth Avenue, NW628, Pittsburgh, PA, 15213, USA.
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Mueller C, Adams M, Abrajano C, Yousefi R, Dalusag KS, Hui T, Su W, Fuchs J, Chiu B. A standardized treatment protocol for pilonidal disease can influence the health mindset of adolescents. Langenbecks Arch Surg 2024; 409:93. [PMID: 38467936 DOI: 10.1007/s00423-024-03282-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 03/06/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE Pilonidal disease (PD) significantly impacts patients' quality of life and requires regular maintenance behaviors to achieve cure. Health mindset is a psychological construct which can influence health behaviors and outcomes, with a growth mindset being associated with better outcomes than a fixed. We propose that participation in a standardized treatment protocol can affect the health mindset for adolescents with pilonidal disease. METHODS PD patients' demographics, recurrence, and comorbidities were prospectively collected from 2019 to 2022. We assessed patients' mindset score at initial presentation using the validated Three-Item Mindset Scale (1-6) then reassessed during follow-up. t-test was used to compare baseline and follow-up mindset scores and stratified by recurrence or comorbidities. p ≤ 0.05 was considered significant. RESULTS A total of 207 PD patients (108 males, 99 females) with mean age 18.2 ± 3.7 years were followed for 351 ± 327 days. Mean baseline mindset score (4.76 ± 1.27) was significantly lower than mean follow-up mindset score (5.03 ± 1.18, p = 0.049). Baseline mindset score was significantly lower among patients with PD recurrence (4.00 ± 0.66) compared to those without recurrence (4.8 ± 1.29, p = 0.05). Among patients with PD recurrence, mean baseline mindset score (4.00 ± 0.66) was significantly lower than mean follow-up mindset score (5.27 ± 0.93, p = 0.0038). Patient comorbidity did not affect the baseline or follow-up mindset score. CONCLUSIONS Participation in a standardized treatment protocol is associated with the development of a stronger growth mindset over time for patients with PD. Furthermore, a growth mindset was linked to lower recurrence rate than a fixed mindset. Further investigations into how treatment approaches can work in concert with health mindset are proposed.
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Affiliation(s)
- Claudia Mueller
- Department of Surgery, Stanford University, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA
| | - Madeline Adams
- Department of Surgery, Stanford University, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA
| | - Claire Abrajano
- Department of Surgery, Stanford University, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA
| | - Razie Yousefi
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX, USA
| | - Kyla Santos Dalusag
- Department of Surgery, Stanford University, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA
| | - Thomas Hui
- Department of Surgery, Stanford University, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA
| | - Wendy Su
- Department of Surgery, Stanford University, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA
| | - Julie Fuchs
- Department of Surgery, Stanford University, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA
| | - Bill Chiu
- Department of Surgery, Stanford University, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA.
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Rantamo A, Gallé C, Numminen J, Virta J, Tanskanen P, Lindroos AC, Resendiz-Nieves J, Lehecka M, Niemelä M, Haeren R, Raj R. Flow diversion of ruptured intracranial aneurysms: a single-center study with a standardized antithrombotic treatment protocol. Acta Neurochir (Wien) 2024; 166:130. [PMID: 38467916 PMCID: PMC10927838 DOI: 10.1007/s00701-024-06029-7] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 02/28/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND The use of antithrombotic medication following acute flow diversion for a ruptured intracranial aneurysm (IA) is challenging with no current guidelines. We investigated the incidence of treatment-related complications and patient outcomes after flow diversion for a ruptured IA before and after the implementation of a standardized antithrombotic medication protocol. METHODS We conducted a single-center retrospective study including consecutive patients treated for acutely ruptured IAs with flow diversion during 2015-2023. We divided the patients into two groups: those treated before the implementation of the protocol (pre-protocol) and those treated after the implementation of the protocol (post-protocol). The primary outcomes were hemorrhagic and ischemic complications. A secondary outcome was clinical outcome using the modified Ranking Scale (mRS). RESULTS Totally 39 patients with 40 ruptured IAs were treated with flow diversion (69% pre-protocol, 31% post-protocol). The patient mean age was 55 years, 62% were female, 63% of aneurysms were in the posterior circulation, 92% of aneurysms were non-saccular, and 44% were in poor grade on admission. Treatment differences included the use of glycoprotein IIb/IIIa inhibitors (pre-group 48% vs. post-group 100%), and the use of early dual antiplatelets (pre-group 44% vs. 92% post-group). The incidence of ischemic complications was 37% and 42% and the incidence of hemorrhagic complications was 30% and 33% in the pre- and post-groups, respectively, with no between-group differences. There were three (11%) aneurysm re-ruptures in the pre-group and none in the post-group. There were no differences in mortality or mRS 0-2 between the groups at 6 months. CONCLUSION We found no major differences in the incidence of ischemic or hemorrhagic complications after the implementation of a standardized antithrombotic protocol for acute flow diversion for ruptured IAs. There is an urgent need for more evidence-based guidelines to optimize antithrombotic treatment after flow diversion in the setting of subarachnoid hemorrhage.
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Affiliation(s)
- Anni Rantamo
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, Po Box 320, 00029 HUS, Helsinki, Finland.
| | - Camille Gallé
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, Po Box 320, 00029 HUS, Helsinki, Finland
- Department of Neurosurgery, Maastricht University Medical Center, PO box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Jussi Numminen
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, Po Box 320, 00029 HUS, Helsinki, Finland
| | - Jyri Virta
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, Po Box 320, 00029 HUS, Helsinki, Finland
| | - Päivi Tanskanen
- Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Ann-Christine Lindroos
- Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Julio Resendiz-Nieves
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, Po Box 320, 00029 HUS, Helsinki, Finland
| | - Martin Lehecka
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, Po Box 320, 00029 HUS, Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, Po Box 320, 00029 HUS, Helsinki, Finland
| | - Roel Haeren
- Department of Neurosurgery, Maastricht University Medical Center, PO box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Rahul Raj
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, Po Box 320, 00029 HUS, Helsinki, Finland
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Hassan NE, El-Masry SA, El Shebini SM, Ahmed NH, Mohamed T F, Mostafa MI, Afify MAS, Kamal AN, Badie MM, Hashish A, Alian K. Gut dysbiosis is linked to metabolic syndrome in obese Egyptian women: potential treatment by probiotics and high fiber diets regimen. Sci Rep 2024; 14:5464. [PMID: 38443406 PMCID: PMC10914807 DOI: 10.1038/s41598-024-54285-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 02/10/2024] [Indexed: 03/07/2024] Open
Abstract
Metabolic syndrome (MetS) is defined as a cluster of glucose intolerance, hypertension, dyslipidemia, and central obesity with insulin resistance. The role of gut microbiota in metabolic disorders is increasingly considered. To investigate the effects of probiotic supplements and hypocaloric high fiber regimen on MetS in obese Egyptian women. A longitudinal follow-up intervention study included 58 obese Egyptian women, with a mean age of 41.62 ± 10.70 years. They were grouped according to the criteria of MetS into 2 groups; 23 obese women with MetS and 35 ones without MetS. They followed a hypocaloric high fiber regimen weight loss program, light physical exercise, and received a probiotic supplement daily for 3 months. For each participating woman, blood pressure, anthropometric measurements, basal metabolic rate (BMR), dietary recalls, laboratory investigations, and microbiota analysis were acquired before and after 3 months of follow-up. After intervention by the probiotic and hypocaloric high fiber regimen and light exercise, reduction ranged from numerical to significant difference in the anthropometric parameters, blood pressure, and BMR was reported. All the biochemical parameters characterized by MetS decreased significantly at p ≤ 0.05-0.01. Before the intervention, results revealed abundant of Bacteroidetes bacteria over Firmicutes with a low Firmicutes/Bacteroidetes ratio. After the intervention, Log Lactobacillus, Log Bifidobacteria, and Log Bacteroidetes increased significantly in both groups, while Log Firmicutes and the Firmicutes/Bacteroidetes Ratio revealed a significant decrease. In conclusion, this study's results highlight a positive trend of probiotics supplementation with hypocaloric high-fiber diets in amelioration of the criteria of the Mets in obese Egyptian women.
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Affiliation(s)
- Nayera E Hassan
- Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre, 33 El-Buhouth St., Dokki, Giza, 12622, Egypt
| | - Sahar A El-Masry
- Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre, 33 El-Buhouth St., Dokki, Giza, 12622, Egypt.
| | - Salwa M El Shebini
- Nutrition and Food Science Department, Food and Industries and Nutrition Research Institute, National Research Centre, Giza, Egypt
| | - Nihad H Ahmed
- Nutrition and Food Science Department, Food and Industries and Nutrition Research Institute, National Research Centre, Giza, Egypt
| | - Fouad Mohamed T
- Food and Dairy Microbiology Department, Food and Industries and Nutrition Research Institute, National Research Centre, Giza, Egypt
| | - Mohammed I Mostafa
- Clinical Pathology Department, Medical Research and Clinical Studies Institute, National Research Centre, Giza, Egypt
| | - Mahmoud A S Afify
- Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre, 33 El-Buhouth St., Dokki, Giza, 12622, Egypt
| | - Ayat N Kamal
- Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre, 33 El-Buhouth St., Dokki, Giza, 12622, Egypt
| | - Mai M Badie
- Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre, 33 El-Buhouth St., Dokki, Giza, 12622, Egypt
| | - Adel Hashish
- Children With Special Needs Department, Medical Research and Clinical Studies Institute, National Research Centre, Giza, Egypt
| | - Khadija Alian
- Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre, 33 El-Buhouth St., Dokki, Giza, 12622, Egypt
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Karamon E, Czermańska A, Kerob D, Demessant AL, Le Dantec G, le Floc'h C, Tan J. Benefits of a dermocosmetic regimen in the management of local side effects triggered by a topical retinoid-based acne treatment. J Cosmet Dermatol 2024; 23:1091-1093. [PMID: 37985407 DOI: 10.1111/jocd.16055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/08/2023] [Accepted: 10/17/2023] [Indexed: 11/22/2023]
Affiliation(s)
- Ewa Karamon
- Studio Dermatologia i Kosmetyka, Malbork, Poland
| | | | - Delphine Kerob
- International Scientific Direction, La Roche-Posay Laboratoire Dermatologique, Levallois-Perret, France
| | - Ann' Laure Demessant
- International Scientific Direction, La Roche-Posay Laboratoire Dermatologique, Levallois-Perret, France
| | - Guénaëlle Le Dantec
- International Scientific Direction, La Roche-Posay Laboratoire Dermatologique, Levallois-Perret, France
| | - Caroline le Floc'h
- International Scientific Direction, La Roche-Posay Laboratoire Dermatologique, Levallois-Perret, France
| | - Jerry Tan
- Department of Medicine and Windsor Clinical Research Inc, Western University, Windsor, Ontario, Canada
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Marotta BM, Sugaya NN, Hanna R, Gallo CDB. Efficacy of 660 nm Photobiomodulation in Burning Mouth Syndrome Management: A Single-Blind Quasi-Experimental Controlled Clinical Trial. Photobiomodul Photomed Laser Surg 2024; 42:225-229. [PMID: 38407832 DOI: 10.1089/photob.2023.0158] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
Background: Burning mouth syndrome (BMS) is characterized by a burning sensation of the oral mucosa without any evidence of clinical signs or underlining condition. Several treatment modalities have been utilized with various results and levels of evidence. Lately, photobiomodulation (PBM) has emerged as a noninvasive effective therapy due to its anti-inflammatory and biostimulatory effects, especially the low-power laser setting of red wavelength. Objective: This single-blind quasi-experimental controlled clinical trial aimed to evaluate the PBM effectiveness at a low level of red laser light in patients with BMS compared with sham control. Materials and methods: Thirty patients diagnosed with BMS were consecutively assigned to intervention (PBM therapy) and control (sham) groups. The protocol for PBM dosimetry was as follows: laser 660 nm; spot size: 0.04 cm2; power output: 100 mW; emission mode: continuous wave; power density: 6 J/cm2; irradiation time: 10 sec per point within 1 cm2 surface area of the symptomatic area. The treatment protocol was based on once a week for a total of 10 sessions. Results: Our results showed no statistically significant difference in reduction of pain intensity between the two groups at all the evaluated timepoints during the course of treatment. However, in both groups, we observed a statistically significant reduction of maximum pain intensity of 50% compared with patient-self reporting before the treatment. Conclusions: Further randomized clinical trials to validate our positive results with a large sample size with a long-term follow-up and understanding further the sham placebo effect are warranted.
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Affiliation(s)
- Bruno Munhoz Marotta
- Department of Stomatology, School of Dentistry of the Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Norberto Nobuo Sugaya
- Department of Stomatology, School of Dentistry of the Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Reem Hanna
- Department of Oral Surgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
- Department of Dental Sciences, UCL-Eastman Dental Institute, University College London, London, United Kingdom
| | - Camila de Barros Gallo
- Department of Stomatology, School of Dentistry of the Universidade de Sao Paulo, Sao Paulo, Brazil
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Zeng L, Chen S, Zeng R, Hu H, Yang Q, Cui K, Chen Q, Fu H, Pu X. CLOSE protocol versus lower ablation index value for paroxysmal atrial fibrillation: A randomized noninferior clinical trial. J Cardiovasc Electrophysiol 2024; 35:469-477. [PMID: 38282257 DOI: 10.1111/jce.16194] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/02/2024] [Accepted: 01/14/2024] [Indexed: 01/30/2024]
Abstract
INTRODUCTION The optimized ablation index (AI) value for catheter ablation of atrial fibrillation (AF) remains to be defined. We aimed to compare the efficacy and safety of CLOSE protocol and lower AI protocol in paroxysmal AF. METHODS AND RESULTS Patients with symptomatic, drug-resistant paroxysmal AF for first ablation were prospectively enrolled from September 2020 to January 2022. The patients were randomly divided into CLOSE group (AI ≥ 550 for anterior/roof segments and ≥400 for posterior/inferior segments) and lower AI group (AI ≥ 450 for anterior/roof segments and ≥350 for posterior/inferior segments). First-pass isolation, acute pulmonary vein (PV) reconnections, 1-year arrhythmia recurrence, and major complications were assessed. Of the 270 enrolled patients, 238 completed 1-year follow-up (118 in CLOSE group and 120 in lower AI group). First-pass isolation in left PVs was higher in CLOSE group (71.2% vs. 53.3%, p = .005). Acute PV reconnections were comparable between groups (9.3% vs. 14.2%, p = .246). At 1 year, 86.4% in CLOSE group versus 81.7% in lower AI group were free from atrial arrhythmia (log rank p = .334). The proportion difference was -4.8% (95% CI: -14.1% to 4.6%), and p = .475 for noninferiority. Stroke occurred in four patients of lower AI group, and no cardiac tamponade, atrioesophageal fistula, major bleeding or death occurred post procedure. CONCLUSION For patients with paroxysmal AF and treated by AI-guided PV ablation, lower AI is not noninferior to CLOSE protocol.
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Affiliation(s)
- Lijun Zeng
- Laboratory of Heart Valve Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Shi Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Rui Zeng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hongde Hu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qing Yang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Kaijun Cui
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qingyong Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hua Fu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaobo Pu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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LaGrone LN, Stein D, Cribari C, Kaups K, Harris C, Miller AN, Smith B, Dutton R, Bulger E, Napolitano LM. American Association for the Surgery of Trauma/American College of Surgeons Committee on Trauma: Clinical protocol for damage-control resuscitation for the adult trauma patient. J Trauma Acute Care Surg 2024; 96:510-520. [PMID: 37697470 DOI: 10.1097/ta.0000000000004088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
ABSTRACT Damage-control resuscitation in the care of critically injured trauma patients aims to limit blood loss and prevent and treat coagulopathy by combining early definitive hemorrhage control, hypotensive resuscitation, and early and balanced use of blood products (hemostatic resuscitation) and the use of other hemostatic agents. This clinical protocol has been developed to provide evidence-based recommendations for optimal damage-control resuscitation in the care of trauma patients with hemorrhage.
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Affiliation(s)
- Lacey N LaGrone
- From the Department of Surgery (D.S.), University of Maryland, Baltimore, Maryland; Department of Surgery (L.N.L., C.C.), UCHealth, Loveland, Colorado; Department of Surgery (K.K), University of California San Francisco Fresno, San Francisco, California; Department of Surgery (C.H.), Tulane University, New Orleans, Louisiana; Orthopedic Surgery (A.N.M.), Washington University in St. Louis, St. Louis, Missouri; Department of Surgery (B.S.), University of Pennsylvania, Philadelphia, Pennsylvania; American Society of Anesthesiologists (R.D.), Anesthesia, Waco, Texas; Department of Surgery (E.B.), University of Washington, Seattle, Washington; and Department of Surgery (L.M.N.), University of Michigan, Ann Arbor, Michigan
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Park BH, Kim YN, Shin HS, Jung Y, Rim H. Current use of antithymoglobulin as induction regimen in kidney transplantation: A review. Medicine (Baltimore) 2024; 103:e37242. [PMID: 38428847 PMCID: PMC10906612 DOI: 10.1097/md.0000000000037242] [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] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/22/2024] [Indexed: 03/03/2024] Open
Abstract
Currently, various immunosuppressive drugs are used in organ transplantation. In particular, antithymoglobulin is a widely used drug in kidney transplantation in Korea, accounting for 20% of all induction therapy. According to existing studies, antithymoglobulin induction therapy has several advantages and disadvantages compared with other immunotherapies depending on the kidney transplant situation (dead donor, living donor, low-risk recipient, and high-risk recipient) or antithymoglobulin dose. In this review, we summarize the research conducted so far on antithymoglobulin and hope that antithymoglobulin research on kidney transplantation will be actively conducted in the future.
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Affiliation(s)
- Byung Hwa Park
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
- Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
| | - Ye Na Kim
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
- Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
| | - Ho Sik Shin
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
- Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
| | - Yeonsoon Jung
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
- Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
| | - Hark Rim
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
- Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
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Abreu SA, Laursen SA, Perrin KL, Tahas SA, Bertelsen MF. COMPARISON OF THREE MIDAZOLAM-BASED SEDATION PROTOCOLS IN BUDGERIGARS ( MELOPSITTACUS UNDULATUS) AND BLACK-CHEEKED LOVEBIRDS ( AGAPORNIS NIGRIGENIS). J Zoo Wildl Med 2024; 55:111-124. [PMID: 38453494 DOI: 10.1638/2022-0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 03/09/2024] Open
Abstract
This randomized, crossover study evaluated three sedation protocols administered subcutaneously in nine budgerigars (Melopsittacus undulatus) and nine black-cheeked lovebirds (Agapornis nigrigenis). All protocols included midazolam (5 mg/kg), combined with butorphanol (5 mg/kg) (BM), medetomidine (20 lg/kg) (MM), or alfaxalone (13 mg/kg) (AM). Mortalities from suspected cardiorespiratory arrest were observed when AM was used in lovebirds, even after reduction of alfaxalone dosage to 3 mg/kg, and therefore this protocol was excluded from further use in this species. Induction and recovery times were recorded and their quality assessed. Sedation depth and heart and respiratory rates were measured every 5 min and radiographic positioning was attempted at 10 and 20 min. At 30 min, midazolam and medetomidine were reversed with flumazenil (0.05 mg/kg, SC), and atipamezole (0.2 mg/kg, SC), respectively. MM consistently provided deep sedation in both species, with successful radiographic positioning at every attempt. As expected, heart rate was often lower with MM than with other protocols, but no associated complications were noted. In budgerigars, BM had the lowest radiographic positioning success rate (10 min: 5/9, 20 min: 3/9), whereas in lovebirds it provided significantly deeper sedation (P < 0.001), allowing radiographic positioning in all subjects. In both species, BM provided the shortest recovery times. AM resulted in reliable radiographic positioning of all budgerigars at 10 min, but not at 20 min (5/ 9), and provided consistently poor recoveries. This study highlights how differently two psittacine species of similar size may react to the same sedation protocols. AM sedation cannot be fully reversed and produced significant undesirable effects, several of which have been previously reported with alfaxalone administration to avian species. The authors therefore caution against using alfaxalone-midazolam combinations in budgerigars and black-cheeked lovebirds. Both BM and MM provided reliable sedation in these species, and appear to be suitable alternatives to AM.
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Affiliation(s)
- Sara A Abreu
- Center for Zoo and Wild Animal Health, Copenhagen Zoo, Frederiksberg, 2000, Denmark,
| | - Sophie A Laursen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, 1870, Denmark
| | - Kathryn L Perrin
- Center for Zoo and Wild Animal Health, Copenhagen Zoo, Frederiksberg, 2000, Denmark
| | - Stamatios A Tahas
- Center for Zoo and Wild Animal Health, Copenhagen Zoo, Frederiksberg, 2000, Denmark
| | - Mads F Bertelsen
- Center for Zoo and Wild Animal Health, Copenhagen Zoo, Frederiksberg, 2000, Denmark
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Devendra A, Patra SK, Velmurugesan P, Zackariya M, Ramesh P, Arun Kamal C, Dheenadhayalan J, Rajasekaran S. Results of a simple treatment protocol for aseptic femoral shaft nonunion in 330 patients. Injury 2024; 55:111412. [PMID: 38341997 DOI: 10.1016/j.injury.2024.111412] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/21/2024] [Accepted: 01/27/2024] [Indexed: 02/13/2024]
Abstract
INTRODUCTION Our primary aim of the study was to assess the results of a treatment protocol for aseptic femoral shaft nonunion treated by three techniques - Exchange Nailing (EN), Plate Augmentation (PA), and Exchange Nailing combined with Plate augmentation (NP). The secondary objective was to assess the radiological outcome, duration of surgery (DOS) and need for blood transfusion (BT) in all the three groups. MATERIALS AND METHODS We analyzed 330 patients treated for AFNU between Jan 2007 and Dec 2019. Using a simple treatment algorithm, EN, PA and NP were performed in 24,183 and 123 patients respectively. Patients in all the three groups were assessed for radiological-union (union rate and time to union), DOS and BT. RESULTS Of these 330 patients, 327 (99 %) patients achieved radiological union at a mean duration of 6.07 months. Union rate is highest with NP followed by PA and EN. The union rate in patients with NP, PA and EN were 100 %, 99.5 % and 91.7 % respectively (p < 0.01). Time to union was lowest for NP followed by PA and EN (p < 0.001).The mean time to union for NP, PA and EN were 3.76, 7.2and 9.21 months respectively (p < 0.001). The mean DOS in minutes for NP, EN and PA was 107, 94 and 82 respectively (p < 0.01). The mean need for BT in the form of packed red blood cells for NP, PA and EN were 1.95, 1.87 and 1.38 units respectively (p < 0.01). CONCLUSION Following a simple algorithm to decide treatment protocol on a case-to case basis helps to achieve good results in an optimal time period. When compared with EN and PA, NP is associated with 100 % union rate with least time to union making NP a reasonably effective procedure with a very high success rate. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Agraharam Devendra
- Department of Orthopaedics and Trauma, Ganga Medical Centre & Hospitals Pvt Ltd, Tamil Nadu, India.
| | - Sudipta Kumar Patra
- Department of Orthopaedics and Trauma, Ganga Medical Centre & Hospitals Pvt Ltd, Tamil Nadu, India
| | - P Velmurugesan
- Department of Orthopaedics and Trauma, Ganga Medical Centre & Hospitals Pvt Ltd, Tamil Nadu, India
| | - Mohd Zackariya
- Department of Orthopaedics and Trauma, Ganga Medical Centre & Hospitals Pvt Ltd, Tamil Nadu, India
| | - P Ramesh
- Department of Orthopaedics and Trauma, Ganga Medical Centre & Hospitals Pvt Ltd, Tamil Nadu, India
| | - Chandramohan Arun Kamal
- Department of Orthopaedics and Trauma, Ganga Medical Centre & Hospitals Pvt Ltd, Tamil Nadu, India
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Bieler D, Franke A, Völlmecke M, Hentsch S, Markewitz A, Kollig E. [Treatment regimen for deep sternal wound infections after cardiac surgical interventions in an interdisciplinary approach]. Unfallchirurgie (Heidelb) 2024; 127:211-220. [PMID: 38085276 PMCID: PMC10891204 DOI: 10.1007/s00113-023-01394-x] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 02/24/2024]
Abstract
The aim of this article is to present the importance of a structured and situation-adapted approach based on the diagnostic and therapeutic strategy in the interdisciplinary treatment of 54 patients with deep sternal wound infections (DSWI) after cardiac surgical interventions and the results achieved. The patients were 41 men and 13 women with an average age of 65.1 years, who developed a DSWI after a cardiac surgical intervention during the period 2003-2016. The treatment strategy included a thorough debridement including the removal of indwelling foreign material, the reconstruction with a stable re-osteosynthesis after overcoming the infection and if necessary, situation-related surgical flaps for a defect coverage with a good blood supply and mandatory avoidance of dead spaces. A total of 146 operations were necessary (average 2.7 operations/patient, range 1-7 operations). In 24.1 % of the cases a one-stage approach could be carried out. In 41 patients negative pressure wound therapy (NPWT) with programmed sponge changing was used for wound conditioning (mean 5 changes, standard deviation, SD± 5.6 changes over 22 days, SD± 23.9 days, change interval every 3-4 days in 40.7% of the cases). In 33 patients a bilateral myocutaneous pectoralis major flap was used, in 4 patients a vertical rectus abdominis myocutaneous (VRAM) flap and in 7 patients both were carried out. A total of 43 osteosynthesis procedures were carried out on the sternum with fixed-angle titanium plates. Of the patients 7 died during intensive care unit treatment (total mortality 13 %, n = 5, 9.3 % ≤ 30 days) or in the later course. Of the patients 47 (87.1 %) could be discharged with a cleansed infection. In 2 patients the implant was removed after 2 years due to loosening.
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Affiliation(s)
- D Bieler
- Klinik für Unfallchirurgie und Orthopädie, Wiederherstellungs- und Handchirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacherstraße 170, 56072, Koblenz, Deutschland.
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland.
| | - A Franke
- Klinik für Unfallchirurgie und Orthopädie, Wiederherstellungs- und Handchirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacherstraße 170, 56072, Koblenz, Deutschland
| | - M Völlmecke
- Klinik für Unfallchirurgie und Orthopädie, Wiederherstellungs- und Handchirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacherstraße 170, 56072, Koblenz, Deutschland
| | - S Hentsch
- Klinik für Unfallchirurgie und Orthopädie, Wiederherstellungs- und Handchirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacherstraße 170, 56072, Koblenz, Deutschland
| | | | - E Kollig
- Klinik für Unfallchirurgie und Orthopädie, Wiederherstellungs- und Handchirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Rübenacherstraße 170, 56072, Koblenz, Deutschland
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Lee SM, Marmo M. Intentional Replantation: No Longer a Last Resort for Saving a Natural Tooth. Compend Contin Educ Dent 2024; 45:152-156. [PMID: 38460140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/11/2024]
Abstract
Intentional replantation (IR) is the intentional extraction of a tooth followed by its replacement back into its socket for the purpose of performing a root-end surgery or other necessary repairs. The procedure may be considered a favorable alternative to conventional microsurgery, especially when surgical access is restricted due to specific anatomical challenges. With advancements in magnification, bioceramics, and instrumentation, IR has become a well-established, scientifically supported treatment modality and is cost-effective when compared to single-implant placement. This article discusses the rationale and indications for IR, describes treatment protocols, and reports on its outcomes.
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Affiliation(s)
- Su-Min Lee
- Assistant Professor of Endodontics and Director of Endodontic Clinic, Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Diplomate, American Board of Endodontics
| | - Michael Marmo
- Clinical Associate Professor of Endodontics, Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Private Practice in Endodontics, Newtown, Pennsylvania; Diplomate, American Board of Endodontics
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Kikushima W, Sakurada Y, Fukuda Y, Matsubara M, Yoneyama S, Shijo T, Sugiyama A, Kotoda Y, Kashiwagi K. INCIDENCE AND CHARACTERISTICS OF NEOVASCULAR AGE-RELATED MACULAR WITH OVER A 12-MONTH REMISSION AFTER THREE MONTHLY AFLIBERCEPT ADMINISTRATION: 60 Months Results of a Pro Re Nata Regimen. Retina 2024; 44:498-505. [PMID: 38376852 DOI: 10.1097/iae.0000000000003994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
PURPOSE To investigate the characteristics of patients with over a 12-month remission after 3 monthly intravitreal aflibercept injections followed by a pro re nata regimen for exudative age-related macular degeneration (AMD). METHODS One hundred forty-four eyes with exudative AMD were included. All patients received 3 monthly intravitreal aflibercept injections as a loading dose, followed by an as-needed regimen for 60 months. Patients were classified into the remission and recurrence groups depending on the presence or absence of a 12-month remission. ARMS2 A69S and CFH I62V were genotyped in all cases. RESULTS During the study, 82 eyes (56.9%) showed 12 months or more remission at least once. The cumulative incidence rate of a 12-month remission showed a plateau pattern and converged to 60% (y = -166.26x-2.172 + 0.6, R2 = 0.8168). Patients in the remission group were younger than those in the recurrence group (P < 0.001) and had less risk allele frequency of the ARMS2 gene than the recurrence group (P < 0.001). The longer the remission interval was prolonged, the better visual acuity was achieved at the 60-month visit (P < 0.001). CONCLUSION Fifty-seven percent of patients showed a 12-month remission or more at least once during a 60-month follow-up, suggesting that patients with no reactivation can prolong the treatment interval.
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Affiliation(s)
- Wataru Kikushima
- Department of Ophthalmology, University of Yamanashi, Yamanashi, Japan
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Zeng J, Zhu D, Zhang H, Lin T, Song T. IGRA-based INH regimen for prevention of active tuberculosis after kidney transplantation: A single-centre retrospective study. Int J Antimicrob Agents 2024; 63:107093. [PMID: 38244813 DOI: 10.1016/j.ijantimicag.2024.107093] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 09/22/2023] [Accepted: 01/12/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVES To evaluate the effectiveness and safety of Interferon-gamma release Assay (IGRA)-based isoniazid (INH) prophylaxis strategy to prevent tuberculosis (TB) infection in kidney transplantation (KT) with a risk of TB occurrence. METHODS Adult KT recipients (KTRs) between June 2014 and July 2021 were retrospectively enrolled. The development of active TB after KT was evaluated. RESULTS Of 925 KTRs, 111 (12.0%) developed active TB. Among the 501 KTRs at a risk of TB occurrence, 70 (14.0%) patients developed active TB, while 41 (9.7%) of 424 patients without risk factors developed active TB (P = 0.05). Two hundred thirty-nine KTRs received IGRA test with 62 (25.9%) were positive. None of IGRA positive patients (0/40) receiving INH prophylaxis developed active TB, whereas 8 out of 22 patients who had positive IGRA results without INH prophylaxis developed active TB (0 vs. 36.4%, P < 0.01). Of note, for those in risk group but with negative IGRA result, no active TB was found even without INH prophylaxis. Although alanine aminotransferase and aspartate aminotransferase in INH prevention group were higher than those before treatment, they did not exceed three-fold of limit of reference range. CONCLUSIONS IGRA-based INH treatment is an effective and safe protocol to prevent the development of active TB in KTRs.
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Affiliation(s)
- Jun Zeng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Daiwen Zhu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Haohan Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tao Lin
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Turun Song
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Dumbuya H, Podimatis K, Kerob D, Draelos ZD. INDIVIDUAL ARTICLE: Efficacy of a Prebiotic Skincare Regimen on Improving Mild Atopic Dermatitis and Severe Xerosis in Diverse Ethnically Patients. J Drugs Dermatol 2024; 23:SF395747s12-SF395747s22. [PMID: 38443135 DOI: 10.36849/jdd.sf395747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Atopic Dermatitis (AD) is a chronic relapsing inflammatory skin disease associated with a significant patient burden on quality-of-life. Given skin barrier including skin microbiome changes are linked to AD pathogenesis, prebiotic emollients are shown to improve disease symptoms and maintain skin barrier integrity, normalizing skin microbiota. In this study, we evaluated the efficacy and safety of a prebiotic skincare routine in improving AD and xerosis, and ultimately quality-of-life in ethnically diverse patients. A total of 140 subjects from different racial/ethnic backgrounds, aged 3-80 years old with skin phototypes I-VI, and presenting with mild-AD or severe xerosis completed study. Expert grading, instrumentation, self-assessment questionnaires, plus clinical imaging demonstrated that a prebiotic cleanser and moisturizer routine significantly reduced skin conditions severity, strengthened skin barrier properties in both lesional and normal skin, and improved patients' quality-of-life while providing itch relief as soon as 4 weeks. The results of this research indicate that a prebiotic cleanser and moisturizer regimen offers benefits for diverse patient’s daily skincare routine by effectively managing AD and xerosis severity and symptoms, normalizing skin microbiota, plus preserving skin barrier integrity to prevent long-term sequelae. J Drugs Dermatol. 2024;23:3(Suppl 2):s12-22.
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Thorlund K, Duffield S, Popat S, Ramagopalan S, Gupta A, Hsu G, Arora P, Subbiah V. Quantitative bias analysis for external control arms using real-world data in clinical trials: a primer for clinical researchers. J Comp Eff Res 2024; 13:e230147. [PMID: 38205741 PMCID: PMC10945419 DOI: 10.57264/cer-2023-0147] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
Development of medicines in rare oncologic patient populations are growing, but well-powered randomized controlled trials are typically extremely challenging or unethical to conduct in such settings. External control arms using real-world data are increasingly used to supplement clinical trial evidence where no or little control arm data exists. The construction of an external control arm should always aim to match the population, treatment settings and outcome measurements of the corresponding treatment arm. Yet, external real-world data is typically fraught with limitations including missing data, measurement error and the potential for unmeasured confounding given a nonrandomized comparison. Quantitative bias analysis (QBA) comprises a collection of approaches for modelling the magnitude of systematic errors in data which cannot be addressed with conventional statistical adjustment. Their applications can range from simple deterministic equations to complex hierarchical models. QBA applied to external control arm represent an opportunity for evaluating the validity of the corresponding comparative efficacy estimates. We provide a brief overview of available QBA approaches and explore their application in practice. Using a motivating example of a comparison between pralsetinib single-arm trial data versus pembrolizumab alone or combined with chemotherapy real-world data for RET fusion-positive advanced non-small cell lung cancer (aNSCLC) patients (1-2% among all NSCLC), we illustrate how QBA can be applied to external control arms. We illustrate how QBA is used to ascertain robustness of results despite a large proportion of missing data on baseline ECOG performance status and suspicion of unknown confounding. The robustness of findings is illustrated by showing that no meaningful change to the comparative effect was observed across several 'tipping-point' scenario analyses, and by showing that suspicion of unknown confounding was ruled out by use of E-values. Full R code is also provided.
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Affiliation(s)
- Kristian Thorlund
- Dept. Health Research Methods, Evidence, & Impact, McMaster University, ON, Canada
| | | | - Sanjay Popat
- Royal Marsden Hospital, Imperial College, London, UK
| | | | | | | | - Paul Arora
- Dalla Lana School of Public Health, University of Toronto, ON, Canada
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Walker EF, Flook M, Rodger AJ, Fielding KL, Stagg HR. Quantifying non-adherence to anti-tuberculosis treatment due to early discontinuation: a systematic literature review of timings to loss to follow-up. BMJ Open Respir Res 2024; 11:e001894. [PMID: 38359965 PMCID: PMC10875541 DOI: 10.1136/bmjresp-2023-001894] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 12/15/2023] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND The burden of non-adherence to anti-tuberculosis (TB) treatment is poorly understood. One type is early discontinuation, that is, stopping treatment early. Given the implications of early discontinuation for treatment outcomes, we undertook a systematic review to estimate its burden, using the timing of loss to follow-up (LFU) as a proxy measure. METHODS Web of Science, Embase and Medline were searched up to 14 January 2021 using terms covering LFU, TB and treatment. Studies of adults (≥ 18 years) on the standard regimen for drug-sensitive TB reporting the timing of LFU (WHO definition) were included. A narrative synthesis was conducted and quality assessment undertaken using an adapted version of Downs and Black. Papers were grouped by the percentage of those who were ultimately LFU who were LFU by 2 months. Three groups were created: <28.3% LFU by 2 months, ≥28.3-<38.3%, ≥38.3%). The percentage of dose-months missed due to early discontinuation among (1) those LFU, and (2) all patients was calculated. RESULTS We found 40 relevant studies from 21 countries. The timing of LFU was variable within and between countries. 36/40 papers (90.0%) reported the percentage of patients LFU by the end of 2 months. 31/36 studies (86.1%) reported a higher than or as expected percentage of patients becoming LFU by 2 months. The percentage of dose-months missed by patients who became LFU ranged between 37% and 77% (equivalent to 2.2-4.6 months). Among all patients, the percentage of dose-months missed ranged between 1% and 22% (equivalent to 0.1-1.3 months). CONCLUSIONS A larger than expected percentage of patients became LFU within the first 2 months of treatment. These patients missed high percentages of dose months of treatment due to early discontinuation. Interventions to promote adherence and retain patients in care must not neglect the early months of treatment. PROSPERO REGISTRATION NUMBER CRD42021218636.
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Affiliation(s)
| | - Mary Flook
- Faculty of Life and Health Sciences, University of Liverpool, Liverpool, UK
| | - Alison J Rodger
- Institute for Global Health, University College London, London, UK
| | - Katherine L Fielding
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- School of Public Health, University of the Witwatersrand- Johannesburg, Johannesburg, South Africa
| | - Helen R Stagg
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Chambliss AB, Devaraj S, Hinson JS, Katz SE, Kerbel RB, Ledeboer NA. New Sepsis Diagnostics and Their Impacts on Clinical Decision-Making and Treatment Protocols. Clin Chem 2024; 70:361-367. [PMID: 38170198 DOI: 10.1093/clinchem/hvad211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/16/2023] [Indexed: 01/05/2024]
Affiliation(s)
- Allison B Chambliss
- Associate Professor, Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Sridevi Devaraj
- Professor, Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, United States
| | - Jeremiah S Hinson
- Associate Professor, Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Sophie E Katz
- Assistant Professor, Department of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Russell B Kerbel
- Associate Professor, Department of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Nathan A Ledeboer
- Professor, Department of Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
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Lyles E, Ismail S, Ramaswamy M, Drame A, Leidman E, Doocy S. Simplified treatment protocols improve recovery of children with severe acute malnutrition in South Sudan: results from a mixed methods study. J Health Popul Nutr 2024; 43:21. [PMID: 38308364 PMCID: PMC10835937 DOI: 10.1186/s41043-024-00518-2] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/30/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND As part of COVID-19 mitigation strategies, emergency nutrition program adaptations were implemented, but evidence of the effects is limited. Compared to the standard protocol, the full adapted protocol included adapted admissions criteria, simplified dosing, and reduced visit frequency; partially adapted protocols consisting of only some of these modifications were also implemented. To enable evidence-based nutrition program modifications as the context evolved, this study was conducted to characterize how protocol adaptations in South Sudan affected Outpatient Therapeutic Feeding Program outcomes. METHODS A mixed methods approach consisting of secondary analysis of individual-level nutrition program data and key informant interviews was used. Analyses focused on program implementation and severe acute malnutrition treatment outcomes under the standard, full COVID-19 adapted, and partially adapted treatment protocols from 2019 through 2021. Analyses compared characteristics and outcomes by different admission types under the standard protocol and across four different treatment protocols. Regression models evaluated the odds of recovery and mean length of stay (LoS) under the four protocols. RESULTS Very few (1.6%; n = 156) children admitted based on low weight-for-height alone under the standard protocol would not have been eligible for admission under the adapted protocol. Compared to the full standard protocol, the partially adapted (admission only) and partially adapted (admission and dosing) protocols had lower LoS of 28.4 days (CI - 30.2, - 26.5) and 5.1 days (CI - 6.2, - 4.0); the full adapted protocol had a decrease of 3.0 (CI - 5.1, - 1.0) days. All adapted protocols had significantly increased adjusted odds ratios (AOR) for recovery compared to the full standard protocol: partially adapted (admission only) AOR = 2.56 (CI 2.18-3.01); partially adapted (admission + dosing) AOR = 1.78 (CI 1.45-2.19); and fully adapted protocol AOR = 2.41 (CI 1.69-3.45). CONCLUSIONS This study provides evidence that few children were excluded when weight-for-height criteria were suspended. LoS was shortest when only MUAC was used for entry/exit but dosing and visit frequency were unchanged. Significantly shorter LoS with simplified dosing and visit frequency vs. under the standard protocol indicate that protocol adaptations may lead to shorter recovery and program enrollment times. Findings also suggest that good recovery is achievable with reduced visit frequency and simplified dosing.
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Affiliation(s)
- Emily Lyles
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Suite E8132, Baltimore, MD, 21205, USA
| | - Sule Ismail
- Integral Global Consulting, Atlanta, GA, USA
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maya Ramaswamy
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Aly Drame
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eva Leidman
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shannon Doocy
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Suite E8132, Baltimore, MD, 21205, USA.
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Salvio AG, Stringasci MD, Requena MB, Fregolenti BA, Medeiro MMDC, Santos RG, Bagnato VS. Long-term follow-up results of a pilot study for nodular basal cell carcinoma with PDT using partial home treatment protocol. Photodiagnosis Photodyn Ther 2024; 45:103930. [PMID: 38103584 DOI: 10.1016/j.pdpdt.2023.103930] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/08/2023] [Accepted: 12/08/2023] [Indexed: 12/19/2023]
Abstract
SIGNIFICANCE Evaluate a photodynamic therapy (PDT) protocol for low-risk basal cell carcinoma (BCC) treatment that requires less time spent at the hospital and is less painful. APPROACH Eight BCCs were selected, debulked, and received 20 % methyl aminolevulinate cream. After 3 h, the first irradiation was performed at the hospital (20 min, 150 J/cm2). Then, the cream was re-applied, and a portable irradiation prototype was fixed to the skin around the lesion. After 1.5 h, the patients turned on the prototype for irradiation at home (for 2 h, totalizing 312 J/cm2). Disease-free survival rate and pain score during irradiations were evaluated. RESULTS The clearance at 30 days after PDT was 87.5 % by histological analysis. The mean follow-up was 21.5 months and the recurrence-free survival at 22 months was 75 %. The pain score was significantly lower at home. CONCLUSIONS A potentially less painful and more comfortable PDT treatment protocol with proven long-term efficiency is presented. A randomized clinical trial has been conducted to confirm these results.
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Affiliation(s)
- Ana Gabriela Salvio
- Skin Department of Amaral Carvalho Hospital, Jaú, Brazil; Sao Carlos Institute of Physics, University of Sao Paulo, Sao Carlos, Brazil.
| | - Mirian D Stringasci
- Sao Carlos Institute of Physics, University of Sao Paulo, Sao Carlos, Brazil
| | - Michelle B Requena
- Sao Carlos Institute of Physics, University of Sao Paulo, Sao Carlos, Brazil
| | | | | | | | - Vanderlei Salvador Bagnato
- Sao Carlos Institute of Physics, University of Sao Paulo, Sao Carlos, Brazil; Department of Biomedical Engineering, Texas A&M University, TX, USA
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23
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Aiuto R, Dioguardi M, Angiero F, Peñarrocha-Diago M, Peñarrocha-Diago M, Crippa R. A clinical protocol for immediate dental implant placement in post-extraction-infected sites decontaminated with Er,Cr:YSGG laser. Minerva Dent Oral Sci 2024; 73:53-60. [PMID: 37255309 DOI: 10.23736/s2724-6329.23.04406-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Placement of dental implants into fresh extraction sockets offers some advantages, such as reduced treatment times and enhanced patient comfort. The Er,Cr:YSGG (Erbium, Chromium-doped: Yttrium, Scandium, Gallium, and Garnet) laser can significantly reduce bacterial concentration after the extraction of a compromised tooth. The aim of this article is to provide a clinical protocol for the management of implants placed in infected extraction sites decontaminated with Er,Cr:YSGG laser. METHODS A compromised tooth, which was an abutment for a fixed bridge, with clinical and radiological signs of infection was extracted. The infected site was treated and decontaminated with an Er,Cr:YSGG laser device (Biolase iPlus®) and two implants (Straumann®) were placed in the same surgery, in order to rehabilitate the edentulous area. The intervention was completed by tissue regeneration with biomaterials. RESULTS Prosthetic rehabilitation after the surgical phase allowed us to provide correct function and satisfactory esthetics. In the follow-up visit, clinicians found good tissue healing and did not observe any complications, such as implant loss or peri-implantitis. The technique used in our study is repeatable and predictable, but patient selection is very important for this type of protocol as the presence of contraindications can lead to failure. The photoacoustic effect exerted by this type of laser has been proven to be effective against many pathogens. Several authors have previously demonstrated the effectiveness of this technique. CONCLUSIONS Immediate implantation in infected sites decontaminated with Er,Cr:YSGG laser does not seem to contribute to an increased risk of failure; however, it is necessary to follow a certain set of protocols and procedures to prevent peri-implantitis and other complications.
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Affiliation(s)
- Riccardo Aiuto
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain -
| | - Mario Dioguardi
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Francesca Angiero
- Department of Medical Sciences and Diagnostic Integrated, S. Martino Hospital, University of Genoa, Genoa, Italy
| | - María Peñarrocha-Diago
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Miguel Peñarrocha-Diago
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Rolando Crippa
- Department of Medical Sciences and Diagnostic Integrated, S. Martino Hospital, University of Genoa, Genoa, Italy
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İbis MA, Ozkaya F, Tokatli Z, Akpinar C, Yaman O. Efficacy of low-intensity shockwave therapy with different tadalafil regimens in patients with PDE5 inhibitor-resistant erectile dysfunction: a retrospective cohort study. Int Urol Nephrol 2024; 56:407-413. [PMID: 37751053 DOI: 10.1007/s11255-023-03769-w] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/23/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE Currently, there is a lack of research comparing tadalafil treatment protocols recommended during low-intensity shock wave therapy (LI-SWT) for patients with erectile dysfunction (ED) who are unresponsive to phosphodiesterase type 5 inhibitors (PDE5i). The objective of this study is to compare the efficacy of only LI-SWT versus LI-SWT plus 5 mg tadalafil daily versus LI-SWT plus 20 mg tadalafil alternate-day in PDE5i -resistant ED. MATERıALS AND METHODS: In this study, a cohort of 105 patients with PDE5i-resistant ED was recruited and divided into three groups labeled as A (only LI-SWT), B (LI-SWT plus 5 mg tadalafil daily), and C (LI-SWT plus 20 mg tadalafil alternate-day), comprising 27, 42, and 36 patients, respectively. The patients' International Index of Erectile Function-5 (IIEF-5) scores and the Erection Hardness Score (EHS) were evaluated at the baseline, three months and six months following the treatment. RESULTS After three months post-treatment, the IIEF-5 scores in group A, B, and C increased by 4.1 ± 0.6, 7.3 ± 0.6, and 8.2 ± 0.6, respectively. These improvements were maintained at six months with IIEF-5 scores increasing by 3.7 ± 0.6, 7.3 ± 0.6, and 8.5 ± 0.7 in groups A, B, and C, respectively. At 3 and 6 months post-treatment, groups B and C showed significant improvement in IIEF-5 scores and EHS values compared to group A (p < 0.001). The rate of patients with EHS ≥ 3 and IIEF-5 ≥ 17 was significantly higher in groups B and C compared to group A, while there was no significantly different between groups B and C. CONCLUSıON: In patients with PDE5i-resistant ED, PDE5i combined with LI-SWT is superior to LI-SWT monotherapy. The statistical analysis failed to demonstrate any difference between two distinct tadalafil regimens when administered with LI-SWT treatment.
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Affiliation(s)
- Muhammed Arif İbis
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
| | - Fatih Ozkaya
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Zafer Tokatli
- Department of Urology, Private Cankaya Yasam Hospital, Ankara, Turkey
| | - Cagri Akpinar
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Onder Yaman
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
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Fu Q, Zheng C, Zhou GW, Xu X, Lai LY, Sun XE, Zhang LX, Wu Q, Ding HF, Yang Y, Fu HJ, Chen ML. Percutaneous Intra-arterial Hyaluronidase Injection for Hyaluronic Acid Filler Embolism Threatening Skin Barrier Integrity: Implementation of a Stepwise Treatment Protocol. Aesthetic Plast Surg 2024; 48:747-751. [PMID: 37775575 DOI: 10.1007/s00266-023-03640-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 08/20/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Hyaluronic acid (HA) filler-induced vascular embolism that threatens skin integrity is an urgent situation. There is increasing evidence that percutaneous intra-arterial hyaluronidase injection is an effective therapeutic technique for it. However, until now, there is a lack of a unifying protocol about the technique. OBJECTIVES This study aims to provide a conclusion of percutaneous intra-arterial hyaluronidase injection along with adjunctive measures on the treatment of occlusions precipitated by HA-based filler and develop a stepwise treatment protocol. METHODS We searched PubMed for peer-reviewed studies, consensus statements, case series, and case reports using a variety of keywords. RESULTS High-dose, pulsed hyaluronidase is the mainstay for the treatment of HA filler-induced embolism, but percutaneous intra-arterial hyaluronidase injection is a more effective technique. Until now, hyaluronidase is injected into three arteries percutaneously, including facial artery, supratrochlear artery, and superficial temporal artery. Furthermore, the adjunctive measures that may optimize clearance of an occlusion and/or skin barrier repair such as the use of image guidance and CGF should be considered. CONCLUSION Vascular occlusions that threaten skin integrity are an urgent matter which requires accurate diagnosis and effective intervention. Percutaneous intra-arterial hyaluronidase injection along with adjunctive measures performed in a stepwise manner is key to an optimal outcome. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Qiang Fu
- Plastic and Reconstructive Surgery Unit, Department of Burns and Plastic Surgery, Fourth Medical Center, PLA General Hospital, 51 Fucheng Rd., Beijing, 100048, People's Republic of China
| | - Can Zheng
- Plastic and Reconstructive Surgery Unit, Department of Burns and Plastic Surgery, Fourth Medical Center, PLA General Hospital, 51 Fucheng Rd., Beijing, 100048, People's Republic of China
| | - Gui-Wen Zhou
- Plastic and Reconstructive Surgery Unit, Department of Burns and Plastic Surgery, Fourth Medical Center, PLA General Hospital, 51 Fucheng Rd., Beijing, 100048, People's Republic of China
| | - Xiao Xu
- Department of Ophthalmology, The Third Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Lin-Ying Lai
- Zhifu Medical Beauty Clinic, Beijing, People's Republic of China
| | - Xu-Er Sun
- Medical School of Chinese PLA, Beijing, People's Republic of China
| | - Li-Xia Zhang
- Medical School of Chinese PLA, Beijing, People's Republic of China
| | - Qian Wu
- Medical School of Chinese PLA, Beijing, People's Republic of China
| | - Hong-Fan Ding
- Medical School of Chinese PLA, Beijing, People's Republic of China
| | - Yi Yang
- Medical School of Chinese PLA, Beijing, People's Republic of China
| | - Hui-Juan Fu
- Medical School of Chinese PLA, Beijing, People's Republic of China
| | - Min-Liang Chen
- Plastic and Reconstructive Surgery Unit, Department of Burns and Plastic Surgery, Fourth Medical Center, PLA General Hospital, 51 Fucheng Rd., Beijing, 100048, People's Republic of China.
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D'Hooghe TM. Preface: Health economics and outcomes research in reproductive medicine: Methods and comparative effectiveness of treatment protocols. Best Pract Res Clin Obstet Gynaecol 2024; 92:102424. [PMID: 37952324 DOI: 10.1016/j.bpobgyn.2023.102424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
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27
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Carreño F, Karatza E, Mehta R, Collins J, Austin D, Swift B. Population Dose-Response-Time Analysis of Itch Reduction and Patient-Reported Tolerability Supports Phase III Dose Selection for Linerixibat. Clin Pharmacol Ther 2024; 115:288-298. [PMID: 37953500 DOI: 10.1002/cpt.3103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/31/2023] [Indexed: 11/14/2023]
Abstract
Increase in serum bile acids (BAs) in patients with primary biliary cholangitis (PBC) may play a causal role in cholestatic pruritus (itch). Linerixibat is a selective small molecule inhibitor of the ileal bile acid transporter, which blocks re-absorption of BAs in the gastrointestinal tract thereby lowering BAs in the systemic circulation and reducing itch. One consequence is excess BAs in the colon, leading to diarrhea and abdominal pain. GLIMMER (NCT02966834) was a placebo-controlled phase IIb dose-ranging trial of linerixibat once (q.d.) or twice daily (b.i.d.) in adults with moderate to severe pruritus and PBC. To determine the optimal dose for maximum itch reduction while minimizing diarrhea, a kinetic-pharmacodynamic (k-PD) model was developed using data from GLIMMER. The PD end point modeled was worst daily itch, derived from itch score reported by patients b.i.d. A proportional odds model was developed post hoc to indicate the probability of diarrhea occurrence, a patient-reported outcome (GI-5) recorded weekly. The final k-PD model successfully described the effects of linerixibat and placebo on itch. Model simulations were consistent with the observed dose-dependent increase in the average number of itch responders (patients with a ≥ 2-point improvement in itch). This was paralleled by a dose-dependent increase in the probability of higher diarrhea frequency scores. The b.i.d. dosing regimens led to a modest increase in the number of itch responders as compared with q.d. dosing. This quantitative framework highlights the trade-off between benefit and tolerability and supported the selection of 40 mg b.i.d. in the phase III GLISTEN trial (NCT04950127).
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Affiliation(s)
- Fernando Carreño
- UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- GSK, Collegeville, Pennsylvania, USA
| | - Eleni Karatza
- UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- GSK, Durham, North Carolina, USA
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28
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Moreno-Martinez A, Blanco-Marchite C, Copete S. Influence of prior treatment protocol on intravitreal dexamethasone implant behavior in patients with diabetic macular edema in real-world practice. Expert Opin Drug Saf 2024; 23:199-205. [PMID: 38234187 DOI: 10.1080/14740338.2024.2305361] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/15/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND AND OBJECTIVE Intravitreal dexamethasone implant (DEXI) has been placed as an effective option to treat diabetic macular edema (DME). However, there is no consensus on the best time to introduce it. We conducted a study to evaluate anatomical and functional behavior after the first DEXI according to previous treatment. RESEARCH DESIGN AND METHODS This retrospective, real-world study between 2013 and 2020 investigated changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT at months 2 and 6 after the first DEXI in DME. Patients were divided into naive, early switch (≤3 anti-VEGF injections), or late switch (>3 anti-VEGF injections) groups. RESULTS Among 112 consecutive eyes, mean BCVA and CMT improved significantly in all groups at month 2, with no difference between them. However, this improvement was not maintained at 6 months. The Naíve group presented better BCVA all over the study period. The previously treated groups, which started with worse initial visual acuity, showed more visual gain without reaching the BCVA of the naive group. CMT performance was similar between groups. CONCLUSIONS There was similar anatomical and functional behavior in all groups. Poorer visual acuity at baseline was associated with worse functional outcome despite good anatomic response.
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Affiliation(s)
| | | | - Sergio Copete
- Department of Ophthalmology, Albacete University Hospital Complex, Albacete, Spain
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29
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Zang Y, Thall PF, Yuan Y. A generalized phase 1-2-3 design integrating dose optimization with confirmatory treatment comparison. Biometrics 2024; 80:ujad022. [PMID: 38364811 PMCID: PMC10873567 DOI: 10.1093/biomtc/ujad022] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/10/2023] [Accepted: 12/06/2023] [Indexed: 02/18/2024]
Abstract
A generalized phase 1-2-3 design, Gen 1-2-3, that includes all phases of clinical treatment evaluation is proposed. The design extends and modifies the design of Chapple and Thall (2019), denoted by CT. Both designs begin with a phase 1-2 trial including dose acceptability and optimality criteria, and both select an optimal dose for phase 3. The Gen 1-2-3 design has the following key differences. In stage 1, it uses phase 1-2 criteria to identify a set of candidate doses rather than 1 dose. In stage 2, which is intermediate between phase 1-2 and phase 3, it randomizes additional patients fairly among the candidate doses and an active control treatment arm and uses survival time data from both stage 1 and stage 2 patients to select an optimal dose. It then makes a Go/No Go decision of whether or not to conduct phase 3 based on the predictive probability that the selected optimal dose will provide a specified substantive improvement in survival time over the control. A simulation study shows that the Gen 1-2-3 design has desirable operating characteristics compared to the CT design and 2 conventional designs.
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Affiliation(s)
- Yong Zang
- Department of Biostatistics and Health Data Science; Center for Computational Biology and Bioinformatics, School of Medicine, Indiana University, Indianapolis, IN 46202, United States
| | - Peter F Thall
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Ying Yuan
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
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Lotia Farrukh I, Lachenal N, Adenov MM, Ahmed S, Algozhin Y, Coutisson S, Garavito ES, Hewison C, Holtzman D, Huerga H, Janmohamed A, Khan PY, Jacques GL, Lomtadze N, Melikyan N, Mitnick CD, Mussabekova G, Osso E, Perea S, Putri FA, Rashidov M, Rich ML, Sakhabutdinova Y, Seung KJ, Stambekova A, Vásquez DV, Franke MF, Khan U. Pregnancy and Birth Outcomes in Patients With Multidrug-Resistant Tuberculosis Treated With Regimens That Include New and Repurposed Drugs. Clin Infect Dis 2024; 78:144-148. [PMID: 37606512 PMCID: PMC10810705 DOI: 10.1093/cid/ciad445] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Indexed: 08/23/2023] Open
Abstract
Among 43 pregnant women receiving multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) treatment with bedaquiline and/or delamanid, 98% had favorable treatment outcomes. Of 31 continued pregnancies, 81% had live births with no reported malformations, and 68% of neonates had normal birth weights. Effective MDR/RR-TB treatment during pregnancy can improve maternal outcomes without harming neonates.
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Affiliation(s)
| | - Nathalie Lachenal
- Pharmacovigilance Unit, Médecins Sans Frontières, Geneva, Switzerland
| | - Malik M Adenov
- National Scientific Center of Phthisiopulmonology, Ministry of Health, Republic of Kazakhstan, Almaty, Kazakhstan
| | - Saman Ahmed
- Interactive Research and Development Pakistan, Karachi, Pakistan
| | | | - Sylvine Coutisson
- Pharmacovigilance Unit, Médecins Sans Frontières, Geneva, Switzerland
| | | | | | | | - Helena Huerga
- Field Epidemiology Department, Epicentre, Paris, France
| | | | - Palwasha Y Khan
- Interactive Research and Development Pakistan, Karachi, Pakistan
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Nino Lomtadze
- Surveillance and Strategic Planning, Ministry of Health, Tbilisi, Georgia
| | - Nara Melikyan
- Field Epidemiology Department, Epicentre, Yerevan, Armenia
| | - Carole D Mitnick
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
| | - Gulnaz Mussabekova
- National Scientific Center of Phthisiopulmonology, Ministry of Health, Republic of Kazakhstan, Almaty, Kazakhstan
| | - Elna Osso
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Sara Perea
- Socios En Salud Sucursal Peru, Lima, Peru
| | | | | | - Michael L Rich
- Partners In Health, Boston, Massachusetts, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Kwonjune J Seung
- Partners In Health, Boston, Massachusetts, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Uzma Khan
- Interactive Research and Development Pakistan, Karachi, Pakistan
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El Zein S, Berbari EF, Passerini M, Petri F, Maamari J, Murad MH, Sendi P, Tande AJ. Rifampin Based Therapy for Patients With Staphylococcus aureus Native Vertebral Osteomyelitis: A Systematic Review and Meta-analysis. Clin Infect Dis 2024; 78:40-47. [PMID: 37721158 DOI: 10.1093/cid/ciad560] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/01/2023] [Accepted: 09/15/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Native vertebral osteomyelitis (NVO) caused by Staphylococcus aureus is associated with high risk of treatment failure and increased morbidity. The role of rifampin-based therapy for the treatment of this condition is controversial. The goal of this systematic review and meta-analysis is to explore the efficacy and safety of rifampin-based therapy for the treatment of S. aureus NVO. METHODS We searched Cochrane, Embase, Medline, Scopus, and Web of Science databases for studies published up to May 2023, focusing on adults with NVO treated with or without rifampin-containing regimens. A random-effects model meta-analysis estimated relative risks and risk difference with 95% confidence intervals (CI). RESULTS Thirteen studies (2 randomized controlled trials and 11 comparative cohort studies), comprising 244 patients with S. aureus NVO who received rifampin and 435 who did not, were analyzed. Meta-analysis showed that rifampin-based regimens were associated with lower risk of clinical failure (risk difference, -14%; 95% CI, -19% to -8%; P < .001; I2 = 0%; relative risk, 0.58; 95% CI, .37-.92, P = .02, I2 = 21%). Only 1 study reported on adverse events. All studies had a high or uncertain risk of bias, and the certainty of evidence was rated as very low. CONCLUSIONS Adjunctive rifampin therapy might be associated with lower risk of S. aureus NVO treatment failure; however, the low certainty of evidence precludes drawing definitive conclusions that would alter clinical practice. A randomized trial is necessary to corroborate these findings.
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Affiliation(s)
- Said El Zein
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Elie F Berbari
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Matteo Passerini
- Department of Infectious Disease, ASST FBF SACCO Fatebenefratelli, Milano, Lombardia, Italy
| | - Francesco Petri
- Department of Infectious Disease, ASST FBF SACCO Fatebenefratelli, Milano, Lombardia, Italy
| | - Julian Maamari
- St. Elizabeth's Medical Center, A Boston University Teaching Hospital, Brighton, Massachusetts, USA
| | - M Hassan Murad
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Parham Sendi
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Aaron J Tande
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Pavlos R, Bhuiyan MU, Jones M, Oakes D, O'Brien S, Borland ML, Doyle S, Richmond P, Martin AC, Snelling TL, Blyth CC. Pragmatic Adaptive Trial for Respiratory Infection in Children (PATRIC) Clinical Registry protocol. BMJ Open 2024; 14:e074308. [PMID: 38272557 PMCID: PMC10824052 DOI: 10.1136/bmjopen-2023-074308] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION Acute respiratory infections (ARI) are the most common cause of paediatric hospitalisation. There is an urgent need to address ongoing critical knowledge gaps in ARI management. The Pragmatic Adaptive Trial for Respiratory Infections in Children (PATRIC) Clinical Registry will evaluate current treatments and outcomes for ARI in a variety of paediatric patient groups. The registry will provide a platform and data to inform a number of PATRIC clinical trials, testing various interventions in ARI treatment and management to optimise paediatric ARI care. METHODS AND ANALYSIS The PATRIC Clinical Registry is a single-centre, prospective observational registry recruiting from a tertiary paediatric Emergency Department in Western Australia. Through characterising demographic, clinical, treatment and outcome data, the PATRIC Clinical Registry will improve our understanding of antibiotic utilisation and ARI outcomes in children. ETHICS AND DISSEMINATION The PATRIC Clinical Registry is conducted in accordance with the Declaration of Helsinki, and the International Council for Harmonisation (ICH) Guidelines for Good Clinical Practice (CPMP/ICH/13595) July 1996. Approval is provided by the Child and Adolescent Health Service Human Research Ethics Committee (HREC). Study results will be communicated by presentation and publication (HREC: RGS0000003078.) TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12619000903189. UTN: U1111-1231-3365.
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Affiliation(s)
- Rebecca Pavlos
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Mejbah U Bhuiyan
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Mark Jones
- School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Daniel Oakes
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Sharon O'Brien
- Emergency Department, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Nedlands, Western Australia, Australia
- School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Sarah Doyle
- What the Doctor Said, North Perth, Western Australia, Australia
| | - Peter Richmond
- School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Andrew C Martin
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Thomas L Snelling
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Sydney Children's Hospitals Network Randwick, Randwick, New South Wales, Australia
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia
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Alhalabi M, Almokdad R. Efficacy of a 2-week therapy with levofloxacin concomitant versus a levofloxacin sequential regimen for Helicobacter pylori infection in the Syrian population: a study protocol for randomized controlled trial. Trials 2024; 25:55. [PMID: 38225650 PMCID: PMC10789050 DOI: 10.1186/s13063-024-07906-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 01/02/2024] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Treating Helicobacter pylori is becoming increasingly difficult with the development of bacterial resistance to many established treatment regimens. As a result, researchers are constantly looking for novel and effective treatments. This trial aims to establish the efficacy of levofloxacin-based sequential treatment regimen and concomitant levofloxacin-based regimen as empirical first-line therapy in the Syrian population. METHOD This is an open-label, prospective, single-center, parallel, active-controlled, superiority, randomized clinical trial. The recruitment will target Helicobacter pylori-positive males and females between the ages of 18 and 65 to evaluate the efficacy of empirical first-line therapy in the Syrian population. We are planning to recruit up to 300 patients which is twice the required sample size. One hundred fifty individuals will be randomly assigned to undergo either a sequential levofloxacin-based treatment regimen or a concomitant levofloxacin-based regimen. High-dose dual therapy (proton-pump inhibitor and amoxicillin) will be the rescue therapy in the event of first-line failure. The first-line eradication rate in both groups is the primary outcome, and one of the secondary outcomes is the overall eradication rate of high-dose dual therapy in the event of first-line treatment protocol failure. Intention-to-treat analysis and per-protocol analysis will be used to evaluate the eradication rates of Helicobacter pylori for first-line treatment protocols. DISCUSSION For the first time in the Syrian population, this randomized controlled trial will provide objective and accurate evidence about the efficacy of a sequential levofloxacin-based treatment regimen. TRIAL REGISTRATION ClinicalTrials.gov NCT06065267 . Registered on October 3, 2023. Prospective registered. Enrollment of the first participant has not started yet.
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Affiliation(s)
- Marouf Alhalabi
- Gastroenterology Department, Damascus Hospital, Almujtahed Street, Damascus, Syria.
| | - Rasha Almokdad
- Gastroenterology Department, Damascus Hospital, Almujtahed Street, Damascus, Syria
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Fietz AK, Onken M, Padberg S, Schaefer C, Dathe K. Impact of maternal first trimester treatment regimen on the outcome of valproate exposed pregnancies: an observational Embryotox cohort study. Sci Rep 2024; 14:674. [PMID: 38182639 PMCID: PMC10770162 DOI: 10.1038/s41598-023-50669-1] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 12/22/2023] [Indexed: 01/07/2024] Open
Abstract
Effects of valproate (VPA) dose and treatment discontinuation during the first trimester of pregnancy on the risks of spontaneous abortions (SAB) and major birth defects were analyzed. Pregnancies with first trimester VPA exposure (n = 484) prospectively recorded by the German Embryotox center in 1997-2016 were compared with a randomly selected, non-exposed cohort (n = 1446). The SAB risk was not significantly increased in the VPA cohort [HRadj 1.31 (95% CI 0.85-2.02)] but major birth defects were significantly more frequent [8.7% vs. 3.4%; ORadj 2.61 (95% CI 1.51-4.50)]. Risk was even higher in pregnancies with no VPA discontinuation in first trimester [ORadj 3.66 (95% CI 2.04-6.54)]. Significant ORs were found for nervous system defects in general [ORadj 5.69 (95% CI 1.73-18.78)], severe microcephaly [ORadj 6.65 (95% CI 1.17-37.68)], hypospadias [ORadj 19.49 (95% CI 1.80-211)] and urinary system defects [ORadj 6.51 (95% CI 1.48-28.67)]. VPA dose had a stronger effect than antiepileptic poly- versus monotherapy; for VPA dose ≥ 1500 mg/day the ORadj was 5.41 (95% CI 2.32-12.66)]. A daily dose increase of 100 mg was calculated to raise the risk for major birth defects by 15% [OR 1.15 (95% CI 1.08-1.23)]. Overall, maternal first trimester treatment regimen had a relevant impact on birth defect risk.
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Affiliation(s)
- Anne-Katrin Fietz
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Clinical Pharmacology and Toxicology, Embryotox Center of Clinical Teratology and Drug Safety in Pregnancy, Augustenburger Platz 1, 13353, Berlin, Germany.
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, Berlin, Germany.
| | - Marlies Onken
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Clinical Pharmacology and Toxicology, Embryotox Center of Clinical Teratology and Drug Safety in Pregnancy, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Stephanie Padberg
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Clinical Pharmacology and Toxicology, Embryotox Center of Clinical Teratology and Drug Safety in Pregnancy, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Christof Schaefer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Clinical Pharmacology and Toxicology, Embryotox Center of Clinical Teratology and Drug Safety in Pregnancy, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Katarina Dathe
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Clinical Pharmacology and Toxicology, Embryotox Center of Clinical Teratology and Drug Safety in Pregnancy, Augustenburger Platz 1, 13353, Berlin, Germany
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Huang W, Wang C, Shen Y, Chen Q, Huang Z, Liu J, Lin X, Wang L, Wu F, Chen X, Li N, Hong Y, Chen M, Li J, Huang C. A real-world study of the effectiveness and safety of apatinib-based regimens in metastatic triple-negative breast cancer. BMC Cancer 2024; 24:39. [PMID: 38182995 PMCID: PMC10768098 DOI: 10.1186/s12885-023-11790-6] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/22/2023] [Indexed: 01/07/2024] Open
Abstract
PURPOSE This investigation sought to examine the efficacy and safety of low-dose apatinib used alongside chemotherapy in the clinical management of patients with metastatic triple-negative breast cancer (TNBC) within a real-world setting, whilst comparing the outcomes with those treated solely with chemotherapy. METHODS This case series study analyzed clinical data and treatment outcomes of 163 patients with metastatic TNBC who underwent rescue treatment at the Medical Oncology Department of Clinical Oncology, Fujian Cancer Hospital, School of Fujian Medical University, China, between October 2011 and January 2023. All the patients underwent rescue treatment with either chemotherapy alone or apatinib (250 mg/day) combined with chemotherapy. The study's primary outcome was progression-free survival (PFS), whereas the secondary outcomes included overall survival (OS), objective response rate (ORR), disease control rate (DCR), and safety profiles. RESULTS The study was designed to compare two groups [1]. Out of the 163 TNBC patients who participated in the study, 107 individuals (65.6%) received treatment based on chemotherapy, whereas 56 patients (34.4%) were given treatment based on a combination of low-dose apatinib (250 mg/day) and other treatments, including chemotherapy. After propensity score matching (PSM), the objective response rate (ORR) and disease control rate (DCR) of patients with advanced triple-negative breast cancer (TNBC) who received apatinib-based treatment were 50.0 and 90.0%, respectively, while they were 6.7 and 20.0%, respectively, for the chemotherapy-based group (P < 0.001). The group that received apatinib-based treatment showed superior results in both PFS and OS compared to the group that received chemotherapy. The median PFS and OS for the apatinib-based group were 7.8 and 20.3 months, respectively, while they were only 2.2 months and 9.0 months, respectively, for the chemotherapy-based group (P < 0.001) [2]. Patients who were administered combo therapies, including PD-1 inhibitors, were excluded. In total, 97 patients received chemotherapy alone, while 34 patients were treated with apatinib in combination with chemotherapy. After propensity score matching (PSM), the ORR and DCR for the total group who received combo therapies were 44.4 and 81.5%, respectively, while they were 11.1 and 22.2%, respectively, for the chemotherapy alone group (P < 0.001). The group receiving both apatinib and chemotherapy displayed notable advantages over the group solely receiving chemotherapy in regards to PFS and OS for the entirety of the population. The PFS was found to be 7.8 months in comparison to 2.1 months (P < 0.001) and the OS was 21.1 months in contrast to 9.0 months (P < 0.001). Apatinib combined with chemotherapy induced grade 3/4 hematological toxicities, including neutropenia (8.8%) and thrombocytopenia (2.9%). Additionally, non-hematological toxicities were commonly observed, such as Hand-foot syndrome (35.3%), proteinuria (26.5%), hypertension (61.8%), higher alanine aminotransferase levels (26.5%), and fatigue (35.3%). The most frequent non-hematological grade 3/4 toxicities were Hand-foot syndrome (2.9%) and hypertension (5.9%). The study did not report any fatal adverse effects. CONCLUSIONS The combination of low-dose apatinib with chemotherapy has proven to be more effective than chemotherapy alone in treating metastatic triple-negative breast cancer (TNBC). Additionally, the occurrence of grade 3/4 non-hematologic toxicities was significantly lower compared to the recommended dose of apatinib.
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Affiliation(s)
- Weiwei Huang
- Department of Medical Oncology, Fujian Medical University Union Hospital, No.29, Xinquan Road, Gulou District, Fuzhou, Fujian province, 350001, China
- Department of Medical Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, No.91, Fuma Road, Jin'an District, Fuzhou, Fujian province, 350014, China
- Fujian Key Laboratory of Translational Cancer Medicine, Fujian Cancer Hospotial, No.91, Fuma Road, Jin'an District, Fuzhou, Fujian province, 350014, China
| | - Chenxi Wang
- Fujian Key Laboratory of Innate Immune Biology, Biomedical Research Center of South China, Fujian Normal University Qishan Campus, College Town, Fuzhou, Fujian Province, 350117, PR China
| | - Yangkun Shen
- Fujian Key Laboratory of Innate Immune Biology, Biomedical Research Center of South China, Fujian Normal University Qishan Campus, College Town, Fuzhou, Fujian Province, 350117, PR China
| | - Qi Chen
- Fujian Key Laboratory of Innate Immune Biology, Biomedical Research Center of South China, Fujian Normal University Qishan Campus, College Town, Fuzhou, Fujian Province, 350117, PR China
| | - Zhijian Huang
- Department of Breast Surgical Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, No. 91, Fuma Road, Jin'an District, Fuzhou, Fujian province, 350014, China
| | - Jian Liu
- Department of Medical Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, No.91, Fuma Road, Jin'an District, Fuzhou, Fujian province, 350014, China
| | - Xiaoyan Lin
- Department of Medical Oncology, Fujian Medical University Union Hospital, No.29, Xinquan Road, Gulou District, Fuzhou, Fujian province, 350001, China.
- Fujian Key Laboratory of Translational Cancer Medicine, Fujian Cancer Hospotial, No.91, Fuma Road, Jin'an District, Fuzhou, Fujian province, 350014, China.
| | - Lili Wang
- Department of Medical Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, No.91, Fuma Road, Jin'an District, Fuzhou, Fujian province, 350014, China
| | - Fan Wu
- Department of Medical Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, No.91, Fuma Road, Jin'an District, Fuzhou, Fujian province, 350014, China
| | - Xinhua Chen
- Department of Medical Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, No.91, Fuma Road, Jin'an District, Fuzhou, Fujian province, 350014, China
| | - Nani Li
- Department of Medical Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, No.91, Fuma Road, Jin'an District, Fuzhou, Fujian province, 350014, China
| | - Yi Hong
- Department of Medical Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, No.91, Fuma Road, Jin'an District, Fuzhou, Fujian province, 350014, China
| | - Mulan Chen
- Department of Medical Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, No.91, Fuma Road, Jin'an District, Fuzhou, Fujian province, 350014, China
| | - Jieyu Li
- Laboratory of Immuno-Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, No.91, Fuma Road, Jin'an District, Fuzhou, Fujian province, 350014, China
| | - Chuanzhong Huang
- Laboratory of Immuno-Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, No.91, Fuma Road, Jin'an District, Fuzhou, Fujian province, 350014, China
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Gupta A, Juneja S, Babawale V, Rustam Majidovich N, Ndjeka N, Thi Mai Nguyen P, Nargiza Nusratovna P, Robert Omanito D, Tiara Pakasi T, Terleeva Y, Toktogonova A, Waheed Y, Myint Z, Yanlin Z, Sahu S. Global adoption of 6-month drug-resistant TB regimens: Projected uptake by 2026. PLoS One 2024; 19:e0296448. [PMID: 38180980 PMCID: PMC10769048 DOI: 10.1371/journal.pone.0296448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/13/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND The WHO has issued a call to action urging countries to accelerate the rollout of new WHO-recommended shorter all-oral treatment regimens for drug-resistant TB (DR-TB), which remains a public-health crisis. The all-oral, 6-month BPaL/M regimen comprises 3-4 drugs: pretomanid used in combination with bedaquiline and linezolid, with or without moxifloxacin. This regimen has been recommended by the WHO for use in DR-TB patients instead of ≥9-month (up to 24-month) regimens. This study aims to project this regimen's use, along with its components bedaquiline, pretomanid and linezolid, and other treatments for DR-TB globally through 2026. It is intended to guide global health stakeholders in planning and budgeting for DR-TB interventions. Projected usage could help estimate cost of the individual components of DR-TB regimens over time. METHODS Semi-structured interviews were conducted with national TB programme participants in key countries to gather intelligence on established plans and targets for use of various DR-TB treatment regimens from 2023 to 2026. These data informed development of projections for the global use of regimens and drugs. RESULTS Consistent global growth in the use of shorter regimens in DR-TB treatment was shown: BPaLM reaching 126,792 patients, BPaL reaching 43,716 patients, and the 9-11-month all-oral bedaquiline-based regimen reaching 13,119 patients by 2026. By 2026, the longer all-oral regimen is projected to be used by 19,262 patients, and individualised treatment regimens by 15,344 patients. CONCLUSION The study shows BPaL/M will be used in majority of DR-TB patients by 2024, reaching 78% by 2026. However, national efforts to scale-up, case-finding, monitoring, drug-susceptibility testing, and implementation of new treatments will be essential for ensuring they are accessible to all eligible patients in the coming years and goals for ending TB are met. There is an urgent need to engage communities in capacity building and demand generation.
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Affiliation(s)
- Aastha Gupta
- TB Alliance, New York, NY, United States of America
| | | | - Victor Babawale
- National Tuberculosis and Leprosy Control Programme, Abuja, Nigeria
| | | | | | | | | | - David Robert Omanito
- Disease Prevention and Control Bureau, Philippine Department of Health, Manila, Philippines
| | | | | | | | - Yasir Waheed
- National TB Control Programme, Islamabad, Pakistan
| | - Zaw Myint
- National TB Programme, Naypyidaw, Myanmar
| | - Zhao Yanlin
- National Center for TB Control and Prevention, National Tuberculosis Reference Laboratory of China, Chinese Center for Disease Control and Prevention, Beijing, China
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Lo AC, Liu A, Liu Q, Yasui Y, Castellino SM, Kelly KM, Hererra AF, Friedberg JW, Friedman DL, Schwartz CL, Pei Q, Kessel S, Bergeron-Gravel S, Dama H, Roberts K, Constine LS, Hodgson DC. Late Cardiac Toxic Effects Associated With Treatment Protocols for Hodgkin Lymphoma in Children. JAMA Netw Open 2024; 7:e2351062. [PMID: 38241048 PMCID: PMC10799264 DOI: 10.1001/jamanetworkopen.2023.51062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/20/2023] [Indexed: 01/22/2024] Open
Abstract
Importance Contemporary North American trials for children with Hodgkin lymphoma (HL) have decreased radiation therapy (RT) use and increased pharmacologic cardioprotection but also increased the cumulative doxorubicin dose, making overall treatment consequences for late cardiac toxic effects uncertain. Objective To estimate the risk of cardiac toxic effects associated with treatments used in modern pediatric HL clinical trials. Design, Setting, and Participants For this cohort study, Fine and Gray models were fitted using survivors in the Childhood Cancer Survivor Study who were diagnosed with HL between January 1, 1970, and December 31, 1999, and were followed for a median of 23.5 (range, 5.0-46.3) years. These models were applied to the exposures in the study population to estimate the 30-year cumulative incidence of cardiac disease. The study population comprised patients with intermediate-risk or high-risk HL treated in 4 consecutive Children's Oncology Group clinical trials from September 2002 to October 2022: AHOD0031, AHOD0831, AHOD1331, and S1826. Data analysis was performed from April 2020 to February 2023. Exposures All patients received chemotherapy including doxorubicin, and some patients received mediastinal RT, dexrazoxane, or mediastinal RT and dexrazoxane. Main Outcomes and Measures Estimated 30-year cumulative incidence of grade 3 to 5 cardiac disease. Results The study cohort comprised 2563 patients, with a median age at diagnosis of 15 (range, 1-22) years. More than half of the patients were male (1357 [52.9%]). All 2563 patients received doxorubicin, 1362 patients (53.1%) received mediastinal RT, and 307 patients (12.0%) received dexrazoxane. Radiation therapy use and the median mean heart dose among patients receiving RT decreased, whereas the planned cumulative dose of doxorubicin and use of dexrazoxane cardioprotection increased. For patients treated at age 15 years, the estimated 30-year cumulative incidence of severe or fatal cardiac disease was 9.6% (95% CI, 4.2%-16.4%) in the AHOD0031 standard treatment group (enrolled 2002-2009), 8.6% (95% CI, 3.8%-14.9%) in the AHOD0831 trial (enrolled 2009-2012), 8.2% (95% CI, 3.6%-14.3%) in the AHOD1331 trial (enrolled 2015-2019), and 6.2% (95% CI, 2.7%-10.9%) in the S1826 trial (enrolled 2019-2022), whereas the expected rate in an untreated population was 5.0% (95% CI, 2.1%-9.3%). Despite the estimated reduction in late cardiac morbidity, the frequency of recommended echocardiographic screening among survivors will increase based on current guidelines. Conclusions and Relevance In this cohort study of sequential HL trials, reductions in the proportion of children receiving mediastinal RT and increases in dexrazoxane use were estimated to offset the increased doxorubicin dose and produce a net reduction in late cardiac disease. Further studies on dexrazoxane are warranted to confirm whether its role in reducing cardiac toxic effects is maintained long term. These findings suggest that survivorship follow-up guidelines should be refined to align with the risks associated with treatment.
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Affiliation(s)
- Andrea C Lo
- Department of Radiation Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amy Liu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Qi Liu
- Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Yutaka Yasui
- Epidemiology and Cancer Control Department, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Sharon M Castellino
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Kara M Kelly
- Department of Pediatric Oncology, Roswell Park Cancer Institute and Oishei Children's Hospital, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Alex F Hererra
- Department of Hematology, City of Hope, Duarte, California
| | | | - Debra L Friedman
- Division of Pediatric Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cindy L Schwartz
- Department of Pediatrics, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee
| | - Qinglin Pei
- Children's Oncology Group, Statistics and Data Center, Department of Biostatistics, University of Florida, Gainesville
| | - Sandy Kessel
- Imaging and Radiation Oncology Core, Lincoln, Rhode Island
| | | | - Hitesh Dama
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Kenneth Roberts
- Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Louis S Constine
- Department of Radiation Oncology, Wilmot Cancer Institute, University of Rochester, Rochester, New York
| | - David C Hodgson
- Department of Radiation Oncology, Princess Margaret Cancer Centre-University Health Network, Toronto, Ontario, Canada
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Felicita AS, Khader SA. Comparison of two treatment protocols for intrusion and retraction of maxillary anterior teeth using mini-implants : A prospective clinical trial. J Orofac Orthop 2024; 85:13-29. [PMID: 35482028 DOI: 10.1007/s00056-022-00394-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/03/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The primary objective of this study was to compare the magnitude of incisor intrusion and retraction between two different treatment protocols and the secondary objective was to evaluate overall treatment effects. MATERIALS AND METHODS Thirty-four patients with proclined upper anterior teeth, increased overbite, and incisal show were randomly assigned to two treatment groups (G1 and G2). Upper first premolar extractions were performed in all cases. In G1, space closure was performed with conventional straight-wire friction mechanics with NiTi (nickel titanium) coil springs placed on 0.019″ × 0.025″ stainless steel wires in a 0.022 slot system with an additional intrusive force via a midline mini-implant. In G2, NiTi coil springs were placed from buccal mini-implants placed onto 0.016″ × 0.022″ SS wires in a 0.022 slot system bilaterally. Lateral cephalograms and study models taken at the beginning and at the end of 6 months of treatment were assessed. RESULTS Both groups showed a statistically significant mild maxillary incisor intrusion, reduction in overjet, overbite, incisal show and a reduction in lower anterior facial height. There was a mild intrusion of the maxillary first permanent molar in G2 (not significant). Mesial movement of the maxillary first permanent molar was noted in G1 but distal movement occurred in G2. Constriction of the entire maxillary arch was noted in G1, whereas constriction was seen in the molar region only in G2. Root resorption was noticed in both groups. CONCLUSION Both groups produced comparable results. Except for molar control, all the results obtained were comparable between the two mechanics. Application of an intrusive force in the midline may be beneficial in patients treated with conventional straight-wire mechanics to treat increased overbite when anchorage requirement is not high.
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Affiliation(s)
- A Sumathi Felicita
- Department of Orthodontics and Dentofacial Orthopedics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, 162, Ponnamallee High Road, 600077, Chennai, Tamil Nadu, India.
| | - Shabeena Abdul Khader
- Department of Orthodontics and Dentofacial Orthopedics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, 162, Ponnamallee High Road, 600077, Chennai, Tamil Nadu, India
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Niccolai E, Martinelli I, Quaranta G, Nannini G, Zucchi E, De Maio F, Gianferrari G, Bibbò S, Cammarota G, Mandrioli J, Masucci L, Amedei A. Fecal Microbiota Transplantation in Amyotrophic Lateral Sclerosis: Clinical Protocol and Evaluation of Microbiota Immunity Axis. Methods Mol Biol 2024; 2761:373-396. [PMID: 38427251 DOI: 10.1007/978-1-0716-3662-6_27] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
The fecal microbial transplantation (FMT) is a therapeutic transplant of fecal microbiota from healthy donors to patients. This practice is aimed at restoring eubiosis and rebalancing the enteric and systemic immune responses, and then eliminating pathogenic triggers of multiple disease, including neurodegenerative diseases. Alterations of gut microbiota (GM) affect the central nervous system (CNS) health, impacting neuro-immune interactions, synaptic plasticity, myelination, and skeletal muscle function. T-regulatory lymphocytes (Treg) are among the most important players in the pathogenesis of amyotrophic lateral sclerosis (ALS), altering the disease course. Along with circulating neuropeptides, other immune cells, and the gut-brain axis, the GM influences immunological tolerance and controls Treg's number and suppressive functions. A double-blind, controlled, multicenter study on FMT in ALS patients has been designed to evaluate if FMT can modulate neuroinflammation, by restoring Treg number, thus modifying disease activity and progression.
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Affiliation(s)
- Elena Niccolai
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Ilaria Martinelli
- Neurology Unit, Department of Neuroscience, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Gianluca Quaranta
- Department of Laboratory and Infectious Sciences, A. Gemelli University Hospital IRCCS, Rome, Italy
| | - Giulia Nannini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Elisabetta Zucchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Flavio De Maio
- Department of Laboratory and Infectious Sciences, A. Gemelli University Hospital IRCCS, Rome, Italy
| | - Giulia Gianferrari
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Bibbò
- Digestive Disease Center, A. Gemelli University Hospital IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Giovanni Cammarota
- Digestive Disease Center, A. Gemelli University Hospital IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Jessica Mandrioli
- Neurology Unit, Department of Neuroscience, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Masucci
- Department of Laboratory and Infectious Sciences, A. Gemelli University Hospital IRCCS, Rome, Italy.
- Department of Basic Biotechnological Sciences, Intensivological and Perioperative Clinics, Catholic University of Sacred Heart, Rome, Italy.
| | - Amedeo Amedei
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
- Internal Interdisciplinary Medicine Unit, Careggi University Hospital, Florence, Italy.
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Chamberlin JH, Baruah D, Smith C, McGuire A, Maisuria D, Kabakus IM. Cardiac Computed Tomography Protocols in Structural Heart Disease: A State-of-the-Art Review. Semin Roentgenol 2024; 59:7-19. [PMID: 38388099 DOI: 10.1053/j.ro.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 11/23/2023] [Accepted: 12/01/2023] [Indexed: 02/24/2024]
Affiliation(s)
- Jordan H Chamberlin
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Dhiraj Baruah
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC.
| | - Carter Smith
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Aaron McGuire
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Dhruw Maisuria
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Ismail M Kabakus
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
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Kocian P, Pazdírek F, Vjaclovský M, Bockova M, Stolz A, Hodyc D. Methodology for implementing early recovery after surgery protocols in colorectal surgery. Rozhl Chir 2024; 102:268-276. [PMID: 38286673 DOI: 10.33699/pis.2023.102.7.268-276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
INTRODUCTION Enhanced recovery after surgery (ERAS) protocols in colorectal surgery leads to improved quality of care and more efficient resource utilization. Despite these positive outcomes, the penetration of ERAS protocols in the Czech Republic is low. The aim of this study is to present a general methodology for implementing an ERAS protocol in colorectal surgery. METHODS The methodology is based on the authors' extensive experience in implementing clinical protocols at various institutions in the Czech Republic, as well as published international experiences. This methodology is described in detail and supplemented with data obtained during implementation of an ERAS program at the author's institution. RESULTS The preparatory phase includes in-depth quality of care audits and preparation of an ERAS protocol. The purpose of the audits is to identify areas of care where standardization or targeted changes in clinical practice are desirable. The implementation phase involves staff training, technical implementation support, protocol dissemination, adherence monitoring, and evaluation of a pilot phase with subsequent protocol adjustments. The evaluation phase involves data collection, maintaining a prospective database, and regular assessments. CONCLUSION The presented methodology describes the individual steps in the process of implementing a clinical protocol into practice. This text can serve as a manual for implementing an ERAS protocol in colorectal surgery at any institution.
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Hsieh J. Synthetization of high-dose images using low-dose CT scans. Med Phys 2024; 51:113-125. [PMID: 37975625 DOI: 10.1002/mp.16833] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 09/05/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Radiation dose reduction has been the focus of many research activities in x-ray CT. Various approaches were taken to minimize the dose to patients, ranging from the optimization of clinical protocols, refinement of the scanner hardware design, and development of advanced reconstruction algorithms. Although significant progress has been made, more advancements in this area are needed to minimize the radiation risks to patients. PURPOSE Reconstruction algorithm-based dose reduction approaches focus mainly on the suppression of noise in the reconstructed images while preserving detailed anatomical structures. Such an approach effectively produces synthesized high-dose images (SHD) from the data acquired with low-dose scans. A representative example is the model-based iterative reconstruction (MBIR). Despite its widespread deployment, its full adoption in a clinical environment is often limited by an undesirable image texture. Recent studies have shown that deep learning image reconstruction (DLIR) can overcome this shortcoming. However, the limited availability of high-quality clinical images for training and validation is often the bottleneck for its development. In this paper, we propose a novel approach to generate SHD with existing low-dose clinical datasets that overcomes both the noise texture issue and the data availability issue. METHODS Our approach is based on the observation that noise in the image can be effectively reduced by performing image processing orthogonal to the imaging plane. This process essentially creates an equivalent thick-slice image (TSI), and the characteristics of TSI depend on the nature of the image processing. An advantage of this approach is its potential to reduce impact on the noise texture. The resulting image, however, is likely corrupted by the anatomical structural degradation due to partial volume effects. Careful examination has shown that the differential signal between the original and the processed image contains sufficient information to identify regions where anatomical structures are modified. The differential signal, unfortunately, contains significant noise and has to be removed. The noise removal can be accomplished by performing iterative noise reduction to preserve structural information. The processed differential signal is subsequently subtracted from TSI to arrive at SHD. RESULTS The algorithm was evaluated extensively with phantom and clinical datasets. For better visual inspection, difference images between the original and SHD were generated and carefully examined. Negligible residual structure could be observed. In addition to the qualitative inspection, quantitative analyses were performed on clinical images in terms of the CT number consistency and the noise reduction characteristics. Results indicate that no CT number bias is introduced by the proposed algorithm. In addition, noise reduction capability is consistent across different patient anatomical regions. Further, simulated water phantom scans were utilized in the generation of the noise power spectrum (NPS) to demonstrate the preservation of the noise-texture. CONCLUSIONS We present a method to generate SHD datasets from regularly acquired low-dose CT scans. Images produced with the proposed approach exhibit excellent noise-reduction with the desired noise-texture. Extensive clinical and phantom studies have demonstrated the efficacy and robustness of our approach. Potential limitations of the current implementation are discussed and further research topics are outlined.
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Affiliation(s)
- Jiang Hsieh
- Independent Consultant, Brookfield, Wisconsin, USA
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Ghahvehchian H, Kashkouli MB, Ghanbari S, Karimi N, Abdolalizadeh P, Abri Aghdam K. Long-Term Results of Oral Propranolol Treatment Protocol for Periocular Infantile Hemangioma: Should There Be Any Contraindication? Ophthalmic Plast Reconstr Surg 2024; 40:61-69. [PMID: 38241619 DOI: 10.1097/iop.0000000000002507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
PURPOSE The authors report long-term results of the oral propranolol treatment protocol for periocular infantile hemangioma regardless of conventional indications. METHODS This is a retrospective study (2008-2018) on children with propranolol treatment protocol for periocular infantile hemangioma and last follow-up (FU) of ≥4 months after treatment and age of >24 months. After systemic evaluation, it was started with 0.5 and increased by 0.5 every 3 days to reach 2 mg/kg/day. If there was no good response, it would be gradually increased up to 3 mg/kg/day. Tapering (0.5 mg/kg/day every 4 weeks) was started when patients were on treatment for ≥6 months and ≥12 months old and there was no change in the infantile hemangioma size for ≥3 months. Rebound growth was based on the parents' report and would be treated by increasing the dose to at least 2 mg/kg/day for 3 months. FU was either in-person or via social media. Change in periocular infantile hemangioma size on the photos was scored by 3 masked observers (visual analog scale) and presented as excellent (≥50% reduction), good (1%-49%), fair (no change), and failure (enlarged). RESULTS Forty-three patients were included. Orbital involvement was in 49%, ptosis in 58%, and risk of amblyopia in 63%. Mean treatment, tapering, and FU duration were 37, 13, and 74 months, respectively. Mean age at presentation, start of propranolol treatment protocol, tapering, stop, and last FU were 1.5, 5, 29, 42, and 78 months, respectively. Twenty-seven patients received 2, seven 2.5, and nine 3 mg/kg/day. Mean visual analog scale significantly increased from 43% (FU1) to 92% (last FU) when 97.6% of patients showed an excellent response. The remaining skin lesions were observed in 35%. No side effect was reported. CONCLUSIONS Long-term results of the propranolol treatment protocol for periocular infantile hemangioma showed an excellent response in 97.6% of patients with no side effects. A residual skin lesion was observed in 1/3 of the patient.
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Affiliation(s)
- Hossein Ghahvehchian
- Department of Ophthalmology, Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Bahmani Kashkouli
- Department of Ophthalmology and Visual Sciences, University of Louisville School of Medicine, Louisville, Kentucky, U.S.A
| | - Shaghayegh Ghanbari
- Department of Ophthalmology, Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Nasser Karimi
- Department of Ophthalmology, Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Parya Abdolalizadeh
- Department of Ophthalmology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Kaveh Abri Aghdam
- Department of Ophthalmology, Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Xu J, Sun W, Wang Y, Jiang H, Ding H, Cheng Q, Bao N, Meng J. Two-Stage Treatment Protocol of Fungal Periprosthetic Hip and Knee Joint Infections: the Clinical Experience from a Single Center Experience. Acta Chir Orthop Traumatol Cech 2024; 91:52-56. [PMID: 38447565 DOI: 10.55095/achot2024/003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
PURPOSE OF THE STUDY To evaluate the clinical results and safety of fungal periprosthetic joint Infections (fPJIs) using two-stage treatment protocol. MATERIAL AND METHODS 8 patients with fPJIs (3 hips and 5 knees) using two-stage revision were reviewed retrospectively and followed up at least 2 years. The preoperative demographic data, two-stage treatment protocol, results of microbiology and histologic workup and postoperative follow-up results (reimplantation success rate and infection free time) were recorded. RESULTS 7 patients got successful reimplantation, with a 75% reimplantation success rate. Two patients got knee arthrodesis eventually. All patients were infection free with a median follow-up of 4.0 ± 2.0 years (range, 2-7 years). Of them, Candida species were found in 7 patients, while non-Candida specimen was only isolated in 1 patient with Aspergillus. Only 2 patients had coexisting bacterial infection (Methicillin-resistant coagulase-negative Staphylococci and Proteus mirabilis respectively). The average interval between the initial surgery and diagnosis of fPJIs was 21.50±34.79 months (range, 4-104 months). The mean time of spacer implantation was 7.75±2.77 months (range, 6-14 months). None serious complication or above knee amputation was found. DISCUSSION fPJIs are very rare and considerable challenge after total hip or knee arthroplasty. The goal of therapy is to eradicate local infection and maintain function. Candida species were the most common pathogen. The duration between spacer placement and staged reimplantation was highly variable, and generally dependent upon the results of joint aspirates and infl ammatory markers. The current study shows that the two-stage treatment protocol is recommended for fungal periprosthetic hip and knee joint infections. CONCLUSIONS The two-stage treatment protocol is recommended for fungal periprosthetic hip and knee joint infections. The safety and effi cacy of biantibiotical impregnated (antifungal + antibiotics) cement spacer is confi rmed. Further evidence-based work is needed to determine the optimal drug dose and reimplantation time. KEY WORDS two-stage treatment protocol, fungal periprosthetic infections, hip spacer, knee spacer.
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Affiliation(s)
- J Xu
- Department of Orthopaedics, Changzhou Traditional Chinese medical hospital, affi liated to Nanjing University of Traditional Chinese Medicine, Changzhou, Jiangsu Province, China
| | - W Sun
- Department of Orthopaedics, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
| | - Y Wang
- Department of Orthopaedics, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
| | - H Jiang
- Department of Orthopaedics, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
| | - H Ding
- Department of Orthopaedics, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
| | - Q Cheng
- Department of Orthopaedics, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
| | - N Bao
- Department of Orthopaedics, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
| | - J Meng
- Department of Orthopaedics, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
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Ugonabo N, Rambhia PH, You J, Ibrahimi OA, Chapas A. Prospective study to assess the efficacy and safety of a noninvasive electro-muscular stimulation for improvement of muscle strength and muscle toning of the extremities. Lasers Surg Med 2024; 56:23-31. [PMID: 37548069 DOI: 10.1002/lsm.23711] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE We sought to evaluate the safety and efficacy of an electrical muscle stimulation (EMS) device in the improvement of muscle strength and toning of the upper extremities. This device, which is FDA-cleared as a two-channel muscle stimulator, provides up to eight electrodes with waveforms inducing muscle stimulation. Although a prior study demonstrated it is safe and effective for use in the abdomen, this system, which has electrodes specifically designed for the extremities, has not previously been evaluated in the upper extremities. METHODS Forty-five subjects enrolled in the study to assess improvement in arm (i.e., bicep and tricep muscle) strength, and appearance following a protocol of treatments with this bioelectric muscle activation (BMA) device. All subjects received four 30-min EMS treatment sessions in Arm mode-twice weekly for 2 weeks and at least 48 h apart. Follow up visits were also scheduled 30- and 90-days after treatment. Strength was measured with a dynamometer device at baseline, at the final treatment session, and at the posttreatment 30- and 90-day assessment. Subject satisfaction was assessed gauging overall comfort of the treatment and satisfaction including willingness to recommend to others. The changes in strength between initial treatment and final treatment, as well as 30 and 90-day assessment were evaluated. Clinical photography at these visits was also assessed for each patient. Patients were instructed to not modify their normal exercise routine while participating in this study. RESULTS All 45 subjects completed the treatment protocol. Most patients showed an improvement in muscle strength from the initial to final treatment (i.e., the fourth treatment). Specifically, the maximum bicep strength increased by a mean of 7.5 lbs (22.83%, p = 0.006), while the average increased by a mean of 8.2 lbs (25.76%, p = 0.001) during this period. Similarly, the maximum tricep strength from initial to final treatment increased by a mean of 10.0 lbs (23.16%, p = 0.000), while the average increased by a mean of 9.6 lbs (27.12%, p = 0.000). Thirty days after the last treatment, the maximum bicep strength increased by a mean of 13.3 lbs (34.13%, p = 0.001) while the average increased by a mean of 13.6 lbs (37.05%, p = 0.000) during this period. Similarly, the maximum tricep strength from initial to 30 days postfinal treatment increased by a mean of 10.9 lbs (24.37%, p = 0.000), while the average increased by a mean of 10.5 lbs (29.37%, p = 0.000). Finally, 90 days after the last treatment, the maximum bicep strength increased by a mean of 19.4 lbs (48.4%, p = 0.000), while the average increased by a mean of 17.4 lbs (46.53%, p = 0.000) during this period. Similarly, the maximum tricep strength from initial to 90 days postfinal treatment increased by a mean of 10.8 lbs (27.12%, p = 0.000), while the average increased by a mean of 10.0 lbs (30.94%, p = 0.001). CONCLUSION This device was well tolerated and resulted in increased strength measurements in the upper extremities, as assessed by a dynamometer, which were sustained at 30 and 90 days.
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Affiliation(s)
| | - Pooja H Rambhia
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, USA
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Rawat S, Kynta RL, Barman B, Sun N, Khandelwal A, Deb P. Retained fragmented needle in intravenous drug users: An institutional experience and treatment protocol. Trop Doct 2024; 54:30-34. [PMID: 37788356 DOI: 10.1177/00494755231204064] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Retained needle fragments can occur in intravenous drug user (IVDU), which can lead to significant morbidity and mortality. The aim of present study is to give an overview of our institutional experience and treatment protocol followed for such patients. IVDU with retained fragment of fractured needle were taken from the patient presenting in Emergency, Medicine and CTVS departments with history of IVDU, from January 2019 to December 2020. Six patients were found with retained broken needles. Detailed history, examination and investigations were done. The needle was removed under local anaesthesia successfully in all patients. IVDU with retained broken needle poses risk for catastrophic complications along with possibility of local complications. A systematic approach in managing such patients is required. These broken needles can be successfully retrieved as day care procedure. Lastly, IVDUs with fractured needles pose threat to the caregivers who should take caution to avoid iatrogenic injury.
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Affiliation(s)
- Sanjib Rawat
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Guwahati, Assam, India
| | - Reuben Lamiaki Kynta
- Department of Cardiothoracic and Vascular Surgery, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Bhupen Barman
- Department of Medicine, All India Institute of Medical Sciences, Guwahati, Assam, India
| | - Neelamjinghba Sun
- Department of Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, Kerala, India
| | - Ankur Khandelwal
- Department of Anaesthesiology, Pain and Critical Medicine, All India Institute of Medical Sciences, Guwahati, Assam, India
| | - Prakash Deb
- Department of Anaesthesiology, Pain and Critical Medicine, All India Institute of Medical Sciences, Guwahati, Assam, India
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Maqbool B, Rego HMC, Santos GC, Ari N, Santos MJMC. Effect of different surface treatment protocols on the bond strength between lithium disilicate and resin cements. Odontology 2024; 112:74-82. [PMID: 37036616 DOI: 10.1007/s10266-023-00809-w] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/24/2023] [Indexed: 04/11/2023]
Abstract
Because the use of hydrofluoric acid (HF) poses health risks if handled improperly, many clinicians prefer to have the ceramic restorations pre-etched in dental laboratories. However, during the try-in procedure, the pre-etched glass-ceramic restorations may be contaminated with saliva resulting in reduced bond strength. This in-vitro study aimed to investigate the effect of different surface treatments on the bond strength of lithium disilicate (LD) glass-ceramic restorations (IPS e.max Press, Ivoclar Vivadent) to two resin cements. One-hundred eighty blocks (4X4X3mm) of LD glass-ceramic were divided into twelve groups (n = 15), of which six received Variolink Esthetic DC (VE) cement and six received RelyX Ultimate (RU) cement, following the surface treatments: G1) Control: Hydrofluoric Acid + Silane (HF + Sil); G2) Hydrofluoric Acid + Saliva + Silane (HF + S + Sil); G3) Hydrofluoric Acid + Saliva + Ivoclean + Silane (HF + S + IC + Sil); G4) Hydrofluoric Acid + Saliva + Phosphoric Acid + Silane (HF + S + P + Sil); G5) Hydrofluoric Acid + Saliva + Monobond Etch & Prime (HF + S + EP); G6) Monobond Etch & Prime (EP). Following treatment, a resin-cement cylinder (2.3 mm diameter) was built on the glass-ceramic surface, photocured (20 s), stored in distilled water (37 °C, 24 h) and submitted to the shear bond strength test. Bond strength data (MPa) were subjected to two-way ANOVA and Tukey (α = 0.01). Cement type and surface treatment had a significant effect on the bond strength (p < 0.001) (Table 4). Single-step Monobond Etch & Prime (EP) significantly improved the bond strength of resin-cements to glass-ceramic with and without saliva contamination.
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Affiliation(s)
- Bilal Maqbool
- Schulich Medicine and Dentistry, Western University, London, ON, Canada
| | - Heleine Maria Chagas Rego
- Department of Restorative Dentistry, Schulich Medicine and Dentistry, Western University, DSB, London, ON, N6A 5C1, Canada
| | - Gildo Coelho Santos
- Department of Restorative Dentistry, Schulich Medicine and Dentistry, Western University, DSB, London, ON, N6A 5C1, Canada
| | - Nilgun Ari
- Department of Restorative Dentistry, Schulich Medicine and Dentistry, Western University, London, ON, Canada
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Nagy A, Duff K, Bauer A, Okonneh F, Rondon JC, Yel L, Li Z. A Phase 1 Open-Label Study to Assess the Tolerability, Safety, and Immunogenicity of Hyaluronidase-Facilitated Subcutaneous Immunoglobulin 20% in Healthy Adults. J Clin Immunol 2023; 44:28. [PMID: 38129731 PMCID: PMC10739571 DOI: 10.1007/s10875-023-01632-2] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE Hyaluronidase-facilitated subcutaneous immunoglobulin (fSCIG) 20% will allow reduced infusion volumes and frequency versus existing subcutaneous therapies such as fSCIG 10% and conventional subcutaneous immunoglobulin 20%, respectively. We assessed the tolerability, safety, and immunogenicity of warmed and unwarmed fSCIG 20%. METHODS This phase 1, single-dose, open-label, three-arm study enrolled healthy adults aged 19-50 years (inclusive) at a single US center (NCT05059977). Post-screening, participants received a single fSCIG 20% dose comprising recombinant human hyaluronidase and varying doses of in-line warmed or unwarmed immunoglobulin G (IgG) during a 4-day treatment period in a sentinel and sequential dosing design (treatment arm 1, warmed IgG 20% 0.4 g/kg; treatment arm 2, warmed IgG 20% 1.0 g/kg; treatment arm 3, unwarmed IgG 20% 1.0 g/kg). Participants were followed for 12 (± 1) weeks post-infusion. The primary endpoint was tolerability ("tolerable" infusions were not interrupted, stopped, or reduced in rate owing to fSCIG 20%-related treatment-emergent adverse events (TEAEs)). Secondary endpoints included occurrence of TEAEs. RESULTS Overall, 24 participants were included, 8 per treatment arm (mean age 39.0 years, 54.2% men). All participants tolerated the infusions. All TEAEs were mild (107 events, in all participants), and all participants experienced fSCIG 20%-related (105 events) and local (102 events) TEAEs. Infusion site erythema and infusion site swelling were most frequently reported. No serious TEAEs occurred, and no participants discontinued the study owing to TEAEs. CONCLUSION fSCIG 20% was well-tolerated with a favorable safety profile in healthy adults. Future studies will evaluate fSCIG 20% in primary immunodeficiency diseases. Trial registration number (ClinicalTrials.gov): NCT05059977 (registered 28 September 2021).
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Affiliation(s)
- Andras Nagy
- Baxalta Innovations GmbH, a Takeda Company, Vienna, Austria
| | - Kimberly Duff
- Takeda Development Center Americas, Inc., Cambridge, MA, USA
| | | | - Fred Okonneh
- Takeda Development Center Americas, Inc., Cambridge, MA, USA
| | - Juan Carlos Rondon
- Clinical Pharmacology of Miami, LLC, an Evolution Research Group portfolio company, Miami, FL, USA
| | - Leman Yel
- Takeda Development Center Americas, Inc., Cambridge, MA, USA
- University of California, Irvine, CA, USA
| | - Zhaoyang Li
- Takeda Development Center Americas, Inc., Cambridge, MA, USA.
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Mei H, Xie J, Qin Y, Li Y. Network and covariate adjusted response-adaptive design for binary response. Stat Med 2023; 42:5369-5388. [PMID: 37750440 DOI: 10.1002/sim.9915] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 08/31/2023] [Accepted: 09/13/2023] [Indexed: 09/27/2023]
Abstract
Randomization is a distinguishing feature of clinical trials for unbiased assessment of treatment efficacy. With a growing demand for more flexible and efficient randomization schemes and motivated by the idea of adaptive design, in this article we propose the network and covariate adjusted response-adaptive (NCARA) design that can concurrently manage three challenges: (1) maximizing benefits of a trial by assigning more patients to the superior treatment group randomly; (2) balancing social network ties across treatment arms to eliminate potential network interference; and (3) ensuring balance of important covariates, such as age, gender, and other potential confounders. We conduct simulation with different network structures and a variety of parameter settings. It is observed that the NCARA design outperforms four alternative randomization designs in solving the above-mentioned problems and has comparable power and type I error for detecting true difference between treatment groups. In addition, we conduct real data analysis to implement the new design in two clinical trials. Compared to equal randomization (the original design utilized in the trials), the NCARA design slightly increases power, largely increases the percentage of patients assigned to the better-performing group, and significantly improves network and covariate balances. It is also noted that the advantages of the NCARA design are augmented when the sample size is small and the level of network interference is high. In summary, the proposed NCARA design assists researchers in conducting clinical trials with high-quality and high-efficiency.
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Affiliation(s)
- Hao Mei
- Center for Applied Statistics, Renmin University of China, Beijing, China
- School of Statistics, Renmin University of China, Beijing, China
| | - Jiaxin Xie
- School of Statistics, Renmin University of China, Beijing, China
| | - Yichen Qin
- Department of Operations, Business Analytics and Information Systems, University of Cincinnati, Cincinnati, Ohio, USA
| | - Yang Li
- Center for Applied Statistics, Renmin University of China, Beijing, China
- School of Statistics, Renmin University of China, Beijing, China
- Statistical Consulting Center, Renmin University of China, Beijing, China
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Rouphael NG, Branche AR, Diemert DJ, Falsey AR, Losada C, Baden LR, Frey SE, Whitaker JA, Little SJ, Kamidani S, Walter EB, Novak RM, Rupp R, Jackson LA, Babu TM, Kottkamp AC, Luetkemeyer AF, Immergluck LC, Presti RM, Bäcker M, Winokur PL, Mahgoub SM, Goepfert PA, Fusco DN, Atmar RL, Posavad CM, Netzl A, Smith DJ, Telu K, Mu J, McQuarrie LJ, Makowski M, Makhene MK, Crandon S, Montefiori DC, Roberts PC, Beigel JH. Immunogenicity of a 2-Dose Regimen of Moderna mRNA Beta/Omicron BA.1 Bivalent Variant Vaccine Boost in a Randomized Clinical Trial. J Infect Dis 2023; 228:1662-1666. [PMID: 37561027 DOI: 10.1093/infdis/jiad323] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 08/08/2023] [Indexed: 08/11/2023] Open
Abstract
We compared the serologic responses of 1 dose versus 2 doses of a variant vaccine (Moderna mRNA-1273 Beta/Omicron BA.1 bivalent vaccine) in adults. A 2-dose boosting regimen with a variant vaccine did not increase the magnitude or the durability of the serological responses compared to a single variant vaccine boost.
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Affiliation(s)
| | - Angela R Branche
- Vaccine and Treatment Evaluation Unit, University of Rochester, New York
| | - David J Diemert
- George Washington Vaccine Research Unit, George Washington University, Washington, District of Columbia
| | - Ann R Falsey
- Vaccine and Treatment Evaluation Unit, University of Rochester, New York
| | | | - Lindsey R Baden
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sharon E Frey
- Center for Vaccine Development, Saint Louis University, Missouri
| | - Jennifer A Whitaker
- Department of Molecular Virology and Microbiology and Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Susan J Little
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla
| | - Satoshi Kamidani
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta
- Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Emmanuel B Walter
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, North Carolina
| | - Richard M Novak
- Project WISH, University of Illinois at Chicago, Chicago, Illinois
| | - Richard Rupp
- Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas
| | - Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Tara M Babu
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington
| | - Angelica C Kottkamp
- Vaccine and Treatment Evaluation Unit, Manhattan Research Clinic, New York University Grossman School of Medicine, New York, New York
| | - Anne F Luetkemeyer
- Department of Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, California
| | - Lilly C Immergluck
- Clinical Research Center, Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, Georgia
| | - Rachel M Presti
- Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Martín Bäcker
- Vaccine and Treatment Evaluation Unit, Long Island Research Clinic, New York University Long Island School of Medicine, Mineola, New York
| | - Patricia L Winokur
- Department of Medicine, University of Iowa College of Medicine, Iowa City, Iowa
| | - Siham M Mahgoub
- Howard University College of Medicine, Howard University Hospital, Washington, District of Columbia
| | - Paul A Goepfert
- Department of Medicine, University of Alabama at Birmingham, Alabama
| | - Dahlene N Fusco
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Robert L Atmar
- Department of Molecular Virology and Microbiology and Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Christine M Posavad
- Infectious Diseases Clinical Research Consortium (IDCRC) Laboratory Operations Unit, Fred Hutchinson Cancer Center, Seattle, Washington
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington
| | - Antonia Netzl
- Centre for Pathogen Evolution, Department of Zoology, University of Cambridge, United Kingdom
| | - Derek J Smith
- Centre for Pathogen Evolution, Department of Zoology, University of Cambridge, United Kingdom
| | | | - Jinjian Mu
- The Emmes Company, LLC, Rockville, Maryland
| | | | | | - Mamodikoe K Makhene
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Sonja Crandon
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | | | - Paul C Roberts
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - John H Beigel
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
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