Compromise Treatment Outcomes Research Articles

O-174 Marginal gains: can small actions in the ART lab improve the environmental impact of medically assisted reproduction?

Abstract Marginal gains can small actions in the ART laboratory improve the environmental impact of medically assisted reproduction? (Invitation) Study question Is it possible to reduce the environmental impact of assisted reproductive technology (ART) laboratories while maintaining quality and safety? Summary answer While individual interventions may yield modest results, their cumulative effect on a wider scale can lead to substantial reductions in resource consumption and emissions over time without compromising treatment outcomes or patient/staff safety. What is known already According to the World Health Organisation (WHO) the change in global climate is one of the gravest threats facing humanity, with pregnant women, new-born and child health considered highly vulnerable. In recent years growing evidence has linked climate change, air pollution, pollutant exposure and microplastics to compromised male and female reproductive health and even spontaneous and in vitro fertilisation (IVF) outcomes. Ironically, the healthcare industry is a major contributor of greenhouse gas emissions, and the rapidly increasing utilisation of ART has raised concerns regarding its environmental footprint. A field primarily driven by highly specialised, energy-intensive laboratory processes, continuous monitoring of hormone testing, single-use consumables and large amounts of waste; the quest for bringing awareness to sustainable practices within ART laboratories is critical, not just for the planet, but for our patients and future generations. Study design, size, duration Alongside a comprehensive review of existing literature, a panel of international professionals and enthusiasts within reproductive medicine, law and environmental science convened in a green conferencing format to discuss key environmental challenges associated with ART and explored potential avenues for enhancing sustainability in the laboratory. A survey and interviews with stakeholders also took place to understand current attitudes and provide real-time social, economic and environmental examples of sustainability in ART laboratories. Main Results I will present a roadmap for sustainability in the IVF laboratory so far. A selection of actions which result in marginal gains within the ART laboratory include but are not limited to: Participate in a ‘green certification’ programme specifically tailored to the IVF laboratory and consider forming a ‘green team’ Aim for energy efficiency, renewable energy, preventive maintenance and consider plug load of non-essential equipment for cost savings. Consider widening operating ranges for temperature and humidity, air circulation changes and HVAC design where possible for energy savings of 15–30% Correct waste management can result in > 30% reduction in clinical waste alongside €11,600 annual savings, with focus on prevention of unnecessary consumables (dishes, media), reducing use of plastics and other single-use items to the extent that is possible and safe, and reusing where appropriate (e.g., training vitrification straws). Adopt electronic platforms for consents/laboratory paperwork; avoiding the use of > 40 pages per cycle in the UK. Reuse packaging materials (cold gel packs, bubble wrap) or form partnerships with local businesses who can reuse. Manage inventory carefully, asking for products with longer expiry dates, and consolidate purchase order to minimise frequency. Minimise liquid nitrogen loss during routine activities and consider batching samples for cryo-transport to minimise frequency of shipments. Limitations Every country, region and laboratory is different and will have their own myriad of regulatory constraints and industry standards to adhere to. This may present barriers to the adoption of certain sustainability measures in ART laboratories and is therefore imperative to seek local guidance first. Wider implications of the findings The carbon footprint of ART extends beyond the laboratory and into the supply chain, encompassing transportation, pharmaceutical production, and waste disposal processes. In this way a holistic approach is necessary, with the need for partnerships between fertility clinics, manufacturers, and regulatory bodies continuously working together to drive the development and adoption of sustainable practices and technologies across the entire ART field.

Adjuvant Chemotherapy for Breast Cancer in Older Adult Patients.

Decision-making regarding adjuvant chemotherapy for older adults with breast cancer is a challenge because older adult patients often have poor physical health, frailty, and age-related comorbidities, which can compromise treatment outcome. Due to these considerations, doctors tend to use less chemotherapy for breast cancer in older adults. However, older patients in good general health could still benefit from chemotherapy. Careful benefit-risk assessment is essential to provide best care for each older adult patient. Due to a rapidly aging population, breast cancer in older adults is becoming a serious public health issue in China. In this mini review, we discuss the need, means, and tools to assess the benefits and risks of adjuvant chemotherapy in older adults with breast cancer. The contents of this review may drive decision-making with regard to the use and selection of adjuvant chemotherapy for older adult patients in China who are fit for the treatment.

Novel approach of prophylactic radiation to reduce toxicities comparing 2-step 40 Gy with 56 Gy simultaneous integrated boost intensity-modulated radiation therapy for locally advanced squamous cell carcinoma of the head and neck: A phase III trial (JCOG1912, NEW BRIDGE).

TPS6121 Background: Chemoradiotherapy (CRT) with concurrent cisplatin is the standard of care as a nonsurgical definitive treatment for patients with locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). However, CRT is associated with increased severe late adverse events, including swallowing dysfunction, xerostomia, ototoxicity, and hypothyroidism. Few strategies aimed at less invasive CRT without compromising treatment outcomes have been successful. The purpose of this study is to confirm the non-inferiority of reduced dose prophylactic radiation with 40 Gy compared to standard dose prophylactic radiation with 56 Gy in terms of the time to treatment failure (TTF) among patients with clinical stage III-IVB LA-SCCHN. Methods: This study is a multicenter, two-arm, open-label, randomized phase III trial. The main inclusion criteria are as follows: (i) Primary lesions are located in the oropharynx, hypopharynx, or larynx. (ii) Histologically proven SCC on biopsy specimens of the primary lesion. Immunohistochemistry reveals p16 negativity in patients with oropharyngeal cancer. (iii) Clinical stage of III, IVA, or IVB (excluding N3a) based on the 8th UICC-TNM classification. Patients are randomized to the standard arm or experimental arm. A total dose of 70 Gy for tumors with concurrent cisplatin at 100 mg/m2 are administered in both arms. For prophylactic field, patients in the standard arm receive a total dose of 56 Gy in 35 fractions for 7 weeks using simultaneous integrated boost (SIB56) and those in the experimental arm receive 40 Gy in 20 fractions using two-step methods for 4 weeks (2-step40). A total of 400 patients will be enrolled from 52 Japanese institutions within 5 years. The primary endpoint is TTF, and the secondary endpoints are overall survival, complete response rate, progression-free survival, locoregional relapse-free survival, acute and late adverse events, quality of life score, and swallowing function score.Patient accrual was started in May 2021 and the study is now open for accrual. A total of 186 patients have been enrolled as of January 2024. This trial has been registered in the Japan Registry of Clinical Trials as jRCTs031210100. Clinical trial information: jRCTs031210100 .

BET Inhibitor JQ1 Selectively Reduce Tregs by Upregulating STAT3 and Suppressing PD-1 Expression in Patients with Multiple Myeloma.

Multiple myeloma (MM) stands as a prevalent hematological malignancy, primarily incurable, originating from plasma cell clones. MM's progression encompasses genetic abnormalities and disruptions in the bone marrow microenvironment, leading to tumor proliferation, immune dysfunction, and compromised treatment outcomes. Emerging evidence highlights the critical role of regulatory T cells (Tregs) in MM progression, suggesting that targeting Tregs could enhance immune functionality and treatment efficacy. In this study, a notable increase in Treg proportions within MM patients' bone marrow (BM) compared to healthy individuals is observed. Additionally, it is found that the bromodomain and extraterminal domain (BET) inhibitor JQ1 selectively diminishes Treg percentages in MM patients' BM and reduces TGF-β1-induced Tregs. This reduction occurs via inhibiting cell viability and promoting apoptosis. RNA sequencing further indicates that JQ1's inhibitory impact on Tregs likely involves upregulating STAT3 and suppressing PD-1 expression. Collectively, these findings suggest JQ1's potential to modulate Tregs, bolstering the immune response in MM and introducing a promising avenue for MM immunotherapy.

Minimally Invasive Management of Complicated and Re-operative Crohn's Disease

AbstractMinimally invasive techniques for the surgical management of Crohn's disease have become the recommended approach for initial surgical intervention in noncomplicated patients as there is lower morbidity for patients without compromising treatment outcomes. There has been a push to expand minimally invasive approaches to complex and recurrent diseases, trying to benefit these difficult patients. However, until recently there have been little data to support the adoption of minimally invasive surgery (MIS) in these scenarios. This article aims to build on the 2019 Clinics in Colon and Rectal Surgery article on complex Crohn's and MIS by introducing new data in support of these approaches. Decisions for technique should be based on patient characteristics, but minimally invasive techniques have emerged as valid and possibly superior for complex and recurrent disease.

Anti-lymphangiogenesis for boosting drug accumulation in tumors

The inadequate tumor accumulation of anti-cancer agents is a major shortcoming of current therapeutic drugs and remains an even more significant concern in the clinical prospects for nanomedicines. Various strategies aiming at regulating the intratumoral permeability of therapeutic drugs have been explored in preclinical studies, with a primary focus on vascular regulation and stromal reduction. However, these methods may trigger or facilitate tumor metastasis as a tradeoff. Therefore, there is an urgent need for innovative strategies that boost intratumoral drug accumulation without compromising treatment outcomes. As another important factor affecting drug tumor accumulation besides vasculature and stroma, the impact of tumor-associated lymphatic vessels (LVs) has not been widely considered. In the current research, we verified that anlotinib, a tyrosine kinase inhibitor with anti-lymphangiogenesis activity, and SAR131675, a selective VEGFR-3 inhibitor, effectively decreased the density of tumor lymphatic vessels in mouse cancer models, further enhancing drug accumulation in tumor tissue. By combining anlotinib with therapeutic drugs, including doxorubicin (Dox), liposomal doxorubicin (Lip-Dox), and anti-PD-L1 antibody, we observed improved anti-tumor efficacy in comparison with monotherapy regimens. Meanwhile, this strategy significantly reduced tumor metastasis and elicited stronger anti-tumor immune responses. Our work describes a new, clinically transferrable approach to augmenting intratumoral drug accumulation, which shows great potential to address the current, unsatisfactory efficacies of therapeutic drugs without introducing metastatic risk.

Supportive periodontal care in dental practice: Part 2 - perceptions of locally referring UK general dental practitioners.

Background Supportive periodontal care (SPC) is important in maintaining periodontal treatment outcomes. Hospital services provide specialist periodontal care at high costs. On completion of treatment, patients are discharged back to the general dental practitioner (GDP) to provide SPC. This project aimed to evaluate the change in GDPs' understanding of SPC over more than 20 years.Method A validated questionnaire about SPC was sent to GDPs during 1996 (397) and 2020 (300), with a response rate of 74% and 52%, respectively. The anonymous data were entered on a Microsoft Excel spreadsheet for analysis.Results In total, 98.5% of the GDPs in 1996 and 97% in 2020 perceived SPC to be highly important. Additionally, 49% in 2020 had a better understanding of SPC when compared to 1996 (42%). Finally, 70-74% (1996, 2020) of the GDPs indicated that they were responsible for SPC; however, 13-16% said that they were not.Conclusion and clinical relevance Notwithstanding the lower response rate in 2020, there has been an improvement in understanding and awareness of responsibility of SPC among GDPs. Reported challenges of provision were related to education and funding. If GDPs are to effectively deliver SPC, education and current funding should be addressed to prevent compromised treatment outcomes for patients.

Impact of War on the Drug Supply for Cancer Patients in Sudan

This review investigates the ramifications of conflict on chemotherapy drug accessibility for cancer patients in Sudan. For this review article, the data was collected from file records Port Sudan Oncology Center, Port Sudan, Sudan. Through a comprehensive analysis of drug supply frequencies during distinct conflict periods, the study reveals fluctuating availability and challenges in sustaining the supply chain. Grouping chemotherapy drugs according to their availability patterns elucidates the varying degrees of accessibility during conflict, ranging from consistent supplies to complete absence. The impact of these shortages on cancer patients is profound, resulting in compromised treatment outcomes, increased morbidity and mortality rates, and substantial socioeconomic burdens. Real-life patient accounts underscore the emotional, physical, and financial toll imposed by interrupted access to vital medications. Despite efforts by healthcare institutions, NGOs, and governmental bodies, persistent challenges hinder effective mitigation strategies during conflict, including logistical constraints, inadequate funding, and political instability. The socioeconomic and psychological implications of drug shortages are significant, pushing patients deeper into poverty and exacerbating psychological distress. Addressing these challenges necessitates sustained efforts to fortify drug supply chains, enhance infrastructure, and foster multi-stakeholder cooperation. The study emphasises the critical need for sustained interventions to ensure continuous access to chemotherapy drugs in Sudan and conflict zones globally. Immediate actions are imperative to alleviate the burdens faced by cancer patients and fortify healthcare systems to withstand the challenges of conflict-induced drug scarcity.

Advances in Nanomaterials and Composites Based on Mesoporous Materials as Antimicrobial Agents: Relevant Applications in Human Health.

Nanotechnology has emerged as a cornerstone in contemporary research, marked by the advent of advanced technologies aimed at nanoengineering materials with diverse applications, particularly to address challenges in human health. Among these challenges, antimicrobial resistance (AMR) has risen as a significant and pressing threat to public health, creating obstacles in preventing and treating persistent diseases. Despite efforts in recent decades to combat AMR, global trends indicate an ongoing and concerning increase in AMR. The primary contributors to the escalation of AMR are the misuse and overuse of various antimicrobial agents in healthcare settings. This has led to severe consequences not only in terms of compromised treatment outcomes but also in terms of substantial financial burdens. The economic impact of AMR is reflected in skyrocketing healthcare costs attributed to heightened hospital admissions and increased drug usage. To address this critical issue, it is imperative to implement effective strategies for antimicrobial therapies. This comprehensive review will explore the latest scientific breakthroughs within the metal-organic frameworks and the use of mesoporous metallic oxide derivates as antimicrobial agents. We will explore their biomedical applications in human health, shedding light on promising avenues for combating AMR. Finally, we will conclude the current state of research and offer perspectives on the future development of these nanomaterials in the ongoing battle against AMR.

EVALUATING THE MANAGEMENT AND MAINTENANCE PRACTICES OF LINEAR ACCELERATOR AND COBALT-60 CANCER TREATMENT MACHINES IN NIGERIA: A COMPREHENSIVE ASSESSMENT

This research paper investigated the state of radiotherapy machines and their management in cancer treatment centers in Nigeria. The study aimed to identify the challenges faced by these centers and propose strategies for improvement. Through a comprehensive analysis of data collected from surveys and questionnaires, critical issues impacting the availability, reliability, and effectiveness of radiotherapy machines were highlighted. The findings revealed a significant shortage of radiotherapy machines across the nation, with Nigeria having less than 6% of the required number of linacs. This scarcity led to a high workload on the existing machines, resulting in long waiting lists and compromised treatment outcomes. Management challenges, such as the absence of preventive maintenance policies, inadequate personnel training, delayed spare parts delivery, and limited engagement of maintenance contractors, were identified. The research emphasized the need for supportive cancer treatment machines, including orthovoltage and superficial machines, to alleviate the burden on existing radiotherapy machines. However, most centers lacked these supportive machines, limiting their ability to provide comprehensive care to patients. Financial sustainability also emerged as a significant concern, as internal funds proved insufficient for maintenance and operations. The involvement of the government and the establishment of independent regulatory bodies were proposed to address these challenges. In conclusion, this study called for urgent action to address the gaps and challenges in radiotherapy machine management in Nigeria. It highlighted the importance of increasing the number of machines, implementing preventive maintenance policies, enhancing staff training, and securing adequate funding. By doing so, the quality of cancer care could be significantly improved, leading to better patient outcomes and a more robust healthcare system in Nigeria.

Novel approach of prophylactic radiation to reduce toxicities comparing 2-step40 with 56-Gy simultaneous integrated boost intensity-modulated radiation therapy for locally advanced squamous cell carcinoma of the head and neck, an intergroup phase III trial (JCOG1912, NEW BRIDGE)

BackgroundChemoradiotherapy (CRT) with concurrent cisplatin is the standard of care as a nonsurgical definitive treatment for patients with locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). However, CRT is associated with increased severe late adverse events, including swallowing dysfunction, xerostomia, ototoxicity, and hypothyroidism. Few strategies aimed at less invasive CRT without compromising treatment outcomes have been successful. The purpose of this study is to confirm the non-inferiority of reduced dose prophylactic radiation with 40 Gy compared to standard dose prophylactic radiation with 56 Gy in terms of the time to treatment failure (TTF) among patients with clinical stage III-IVB LA-SCCHN.MethodsThis study is a multicenter, two-arm, open-label, randomized phase III trial. Patients with LA-SCCHN excluding p16 positive oropharynx cancer are randomized to the standard arm or experimental arm. A total dose of 70 Gy for tumors with concurrent cisplatin at 100 mg/m2 are administered in both arms. For prophylactic field, patients in the standard arm receive a total dose of 56 Gy in 35 fractions for 7 weeks using simultaneous integrated boost (SIB56) and those in the experimental arm receive 40 Gy in 20 fractions using two-step methods for 4 weeks (2-step40). A total of 400 patients will be enrolled from 52 Japanese institutions within 5 years. The primary endpoint is TTF, and the secondary endpoints are overall survival, complete response rate, progression-free survival, locoregional relapse-free survival, acute and late adverse events, quality of life score, and swallowing function score.DiscussionIf the experimental arm is non-inferior to the standard arm in terms of TTF and superior on the safety endpoints, the 2-step40 procedure is the more useful treatment than SIB56 for definitive CRT.Trial registrationThis trial has been registered in the Japan Registry of Clinical Trials as jRCTs031210100 (https://jrct.niph.go.jp/latest-detail/jRCTs031210100). Date of Registration: May 2021.

Fabrication of Biogenic Titanium Nanoparticles and Investigating Their Biological Properties for Dental Applications.

Oral inflammation, often triggered by infections, injuries, or immune responses, can compromise treatment outcomes, delay healing, and contribute to patient discomfort. The development of green nanoparticle synthesis methods is receiving attention due to their potential advantages over existing approaches. These procedures use commonly available, affordable, and environmentally friendly natural plant extracts. Due to their numerous uses in various industries, titanium oxide nanoparticles (TiO2NPs) have attracted the most attention among the nanoparticles. In this study, we present the green synthesis of Myristica fragrans (mace) extract as a reductant and stabilizer for the production of curcumin-functionalized TiO2NPs (CTN). We additionally evaluated the effectiveness of these nanoparticles as anti-inflammatory agents. In this study, we aim to develop biogenic TiO2NPs using Myristica fragrans as a natural capping agent and functionalized with curcumin for effectively managing oral inflammation in dental applications. The nanoparticles were synthesized using the green synthesis method and characterized using various characterization techniques. Biocompatibility was evaluated using hemolytic assays, and the bioactivity of the nanoparticles was assessed using anti-inflammatory assays. Curcumin-coated M-TiO2NPs (MCTN) were successfully synthesized and characterized by various techniques, confirming their morphology, crystallinity, functionalization, elemental composition, size, and stability. In vitro bioactivity studies revealed that MCTN exhibited significant anti-inflammatory activity, as evidenced by the inhibition of protein denaturation with minimal hemolytic potential. These findings highlight the potential of MCTN as a promising candidate for anti-inflammatory applications. Our results suggest that MCTN exhibits promising anti-inflammatory and anti-hemolytic properties. However, further in-depth in vivo analysis is required to fully understand their efficacy and toxicity.

CGRP-loaded Porous Microspheres Protect BMSCs for Alveolar Bone Regeneration in The Periodontitis Microenvironment.

Periodontitis is a prevalent dental disease marked by progressive destruction of tooth-supporting tissues, and the recovery of bone defects after periodontitis remains challenging. Although stem cell-based therapy is a promising treatment for periodontal tissue regeneration, the function of mesenchymal stem cells is constantly impaired by the inflammatory microenvironment, leading to compromised treatment outcomes. Herein, calcitonin gene-related peptide (CGRP)-loaded porous microspheres (PMs) are prepared to protect bone marrow mesenchymal stem cells (BMSCs) against inflammatory mediators in periodontitis. The released CGRP could effectively ameliorate the inflammation-induced dysfunction of BMSCs, which may involve suppressing the ROS (reactive oxygen species)/NLRP3 (NOD-, LRR- and pyrin domain-containing protein 3)/Caspase-1 pathway. Moreover, the porous architecture of PMs provides effective cell-carrying capacity and physical protection for BMSCs during transplantation. In vivo experiments demonstrate that CGRP/BMSC-loaded PMs could effectively inhibit inflammation and improve osteogenic activity, resulting in better periodontal bone regeneration. This study focuses on the protection of stem cell function in the inflammatory microenvironment, which is important for stem cell-mediated tissue regeneration and repair under inflammatory conditions. This article is protected by copyright. All rights reserved.

0676 Sleep medication prescribing among patients receiving opioid use disorder treatment with comorbid insomnia

Abstract Introduction People initiating treatment for opioid use disorder (OUD) report insomnia to be a high priority, and insomnia is associated with compromised OUD treatment outcomes. However, insomnia treatments have yet to be investigated in the OUD clinical setting. Knowledge of prescribing patterns for sleep medications among OUD treatment patients is an essential first step to advance therapeutic development at the insomnia-OUD comorbidity. This retrospective cohort study used administrative claims data from IBM MarketScan Commercial and Multi-State Medicaid databases (2006-2016) to investigate the prevalence of insomnia medication prescriptions among patients in OUD treatment with buprenorphine. In doing so, we assess sex differences in prescription receipt within this unique patient population, given the known sex-based disparities in insomnia among other adult populations. Methods We included people aged 12-64 years with diagnoses of insomnia and OUD initiating buprenorphine during the study timeframe. The primary outcome was receipt of insomnia medication prescription within 60 days of buprenorphine start, encompassing benzodiazepines, Z-drugs, or non-sedative/hypnotic insomnia medications (e.g., hydroxyzine, trazodone, and mirtazapine). Descriptive analyses present prescription prevalence for the total sample as well as separately for males and females. Lastly, associations between sex and insomnia medication prescription receipt were estimated using Poisson regression models. Results Our sample included 9,510 individuals (female n=4,637; male n=4,873) initiating buprenorphine for OUD who also had insomnia, of whom 6,569 (69.1%) received benzodiazepines, 3,891 (40.9%) Z-drugs, and 8,441 (88.8%) non-sedative/hypnotic medications. Poisson regression models, adjusting for sex differences in psychiatric comorbidities, found female sex to be associated with a slightly increased likelihood of prescription receipt: benzodiazepines (risk ratio [RR], RR=1.17 [1.11-1.23]), Z-drugs (RR=1.26 [1.18-1.34]), and non-sedative/hypnotic insomnia medication (RR=1.07, [1.02-1.12]). Conclusion Sleep medications are commonly being prescribed to individuals with insomnia in OUD treatment, especially females. These findings juxtapose the known increased overdose risk with benzodiazepine use and lack of efficacy data for these pharmacologic insomnia treatments in this growing patient population in the opioid crisis. Support (if any) National institute of Drug Abuse: K23 DA053507 (CEM), UG1DA050207 (FGM). National Institutes of Health: R25 MH112473-01 (HP), T32 DA015035 (KYX), R21 DA044744 (RAG and LJB). National Center for Advancing Translational Sciences: UL1 TR002345 (Washington University), UL1TR002649 (Virginia Commonwealth University)

Effect of non-pharmacological treatment on the full recovery of social functioning in patients with attention deficit hyperactivity disorder

Long-term treatment of attention deficit/hyperactivity disorder (ADHD) is associated with adverse events, such as nausea and vomiting, dizziness, and sleep disturbances, and poor maintenance of late ADHD medication compromises treatment outcomes and prolongs the recovery of patients' social functioning. To evaluate the effect of non-pharmacological treatment on the full recovery of social functioning in patients with ADHD. A total of 90 patients diagnosed with ADHD between May 2019 and August 2020 were included in the study and randomly assigned to either the pharmacological group (methylphenidate hydrochloride and tomoxetine hydrochloride) or the non-pharmacological group (parental training, behavior modification, sensory integration therapy, and sand tray therapy), with 45 cases in each group. Outcome measures included treatment compliance, Swanson, Nolan, and Pelham, Version IV (SNAP-IV) scores, Conners Parent Symptom Questionnaire (PSQ) scores, and Weiss Functional Impairment Rating Scale (WFIRS) scores. The non-pharmacological interventions resulted in significantly higher compliance in patients (95.56%) compared with medication (71.11%) (P < 0.05). However, no significant differences in SNAP-IV and PSQ scores, in addition to the learning/school, social activities, and adventure activities of the WFIRS scores were observed between the two groups (P > 0.05). Patients with non-pharmacological interventions showed higher WFIRS scores for family, daily life skills, and self-concept than those in the pharmacological group (P < 0.05). Non-pharmacological interventions, in contrast to the potential risks of adverse events after long-term medication, improve patient treatment compliance, alleviate patients' behavioral symptoms of attention, impulsivity, and hyperactivity, and improve their cognitive ability, thereby improving family relationships and patient self-evaluation.

Orofacial findings and orthodontic treatment conditions in patients with down syndrome – a retrospective investigation

IntroductionThe most common chromosomal anomaly is Down syndrome/Trisomy 21, which can be associated with varying degrees of intellectual disability and physical malformation. Specific orofacial characteristics regarding orthodontic treatment options and features are described on the basis of a patient collective from the Witten/Herdecke University, Germany.MethodsData of 20 patients (14 boys and 6 girls, mean age: 11.69 ± 3.94 years) who underwent orthodontic treatment between July 2011 and May 2022 were analyzed. Baseline skeletal and dental conditions were assessed, as well as the presence of hypodontia, displacements, and treatment-related root resorptions. The treatment need was evaluated based on the main findings according to the German KIG classification. In addition, treatment success was determined in relation to patient compliance.ResultsThe patient group was characterized predominantly by a class III relationship (ΔANB: −2.07 ± 3.90°; ΔWITS: −3.91 ± 4.33 mm) and a brachyfacial cranial configuration (ΔML-NL: −4.38 ± 7.05°, ΔArGoMe: − 8.45 ± 10.06°). The transversal discrepancy of the dental arch width from maxilla to mandible was −0.91 ± 3.44 mm anteriorly and −4.4 ± 4.12 mm posteriorly. Considering the orthodontic indication groups, the most frequent initial finding and treatment indication represented hypodontia (85%), followed by frontal (75%) and unilateral lateral (35%) crossbite. In 55% of the cases, the teeth had a regular shape, but in 35% a generalized and in 15% an isolated hypoplasia. Only 25% of the patients could be treated with a fixed multiband appliance due to sufficient cooperation. In each of these patients, varying degrees of root resorptions were detected during treatment, and 45% of all treatments had to be terminated prematurely due to a lack of cooperation by patients or parents.ConclusionThe extent of dental and skeletal malformations and the high rate of findings requiring treatment in patients with Down syndrome represent a significant indication for orthodontic therapy, which can be well illustrated by the KIG classification. However, this is in contrast to the eventually increased risk of root resorption, with significantly reduced patient cooperation. A compromised treatment outcome and process must be expected. Consequently, the orthodontic treatment must be simple and realistic to achieve fast and therapeutically satisfactory treatment result.

Patient-Related Characteristics Associated with Treatment Modifications and Suboptimal Relative Dose Intensity of Neoadjuvant Chemotherapy in Patients with Breast Cancer-A Retrospective Study.

Reduced relative dose intensity (RDI) of neoadjuvant chemotherapy (NACT) in patients with breast cancer may compromise treatment outcome and survival. We examined patient-related characteristics associated with treatment modifications and suboptimal RDI and tumour response in patients with breast cancer. In this observational study, electronic medical records were reviewed retrospectively for female patients with breast cancer scheduled for NACT at a university hospital in Denmark between 2017 and 2019. The RDI (ratio of delivered dose intensity in relation to standard dose intensity) was calculated. Multivariate logistic regression analyses examined associations of sociodemographics, general health and clinical cancer characteristics with dose reductions, dose delays, discontinuation of NACT and suboptimal RDI < 85%. Among 122 included patients, 43%, 42% and 28% experienced dose reductions, dose delays ≥3 days and discontinuation, respectively. A total of 25% received an RDI < 85%. Comorbidity, taking long-term medications and being overweight were statistically significantly associated with treatment modifications, while age ≥ 65 years and comorbidity were associated with RDI < 85%. Around one third of all patients had radiologic (36%) or pathologic (35%) complete tumour response, with no statistically significant differences by RDI < or ≥85% irrespective of breast cancer subtype. While most patients had RDI ≥85%, still one out of four patients received an RDI < 85%. Further investigations of possible supportive care initiatives to improve patients' treatment tolerability are needed, particularly among subgroups of older age or with comorbidity.

Surgical wound healing quantitative assessment method: the case of dental implant placement using a modified guided bone regeneration technique. Part II

Relevance. The guided bone regeneration (GBR) technique during dental implant treatment, if alveolar bone/part of the jaws is lost, stands out for its effective potential, the main factor of which is the possibility of the necessary bone volume restoration having morphofunctional signs of organotypicity. The prognosis effectiveness of such reconstruction outcome directly depends on the wound process characteristics. The variability of the latter, subject to an unbiased quantitative assessment, can be essential for predictive analysis and prognosis.Aim. The study aimed to develop a technique for quantitative assessment of surgical wound healing (exemplified with an extracted tooth socket), described in the first part of the publication.Materials and methods. The clinical study involved 20 patients of both sexes diagnosed with the condition after dental implantation and reconstruction of the alveolar bone volume using the GBR technique modified by the formation of a situational vicryl framework (SVF). We determined the following parameters: independent and dependent variables, with their indirect mutually dependent influence on a favourable, compromised or unfavourable treatment outcome, based on the wound healing process follow-up and assessment of immediate results in the early, middle and late postoperative period − up to 1 month, and the analysis of delayed – from 1 month to 1 year, and long-term – over one year. These variables are characterized as quantitative indicators – biomarkers, processed by the correlation and regression analysis using the Gretl statistical package.Results. The study revealed a direct correlation regarding all parameters as independent (factor) and dependent (effect) variables necessary for quantifying the wound healing process variability. The created linear regression model confirmed the empirically observed and theoretically substantiated idea of the reciprocal influence of normal and pathological variations of wound healing process on an outcome of dental implantation in the reconstruction of the alveolar bone defect. The correlation and regression analysis for an unbiased quantitative assessment of surgical wound healing demonstrated the statistically explicable behaviour of dependent variables at a 95% le vel.Conclusion. The correlation and regression analysis performed using the presented data indicates a direct correlation between the parameters of a favourable, compromised and unfavourable outcome of dental implantation during the reconstruction of the alveolar bone volume using the GBR technique modified by the formation of SVF and variables expressed by biomarkers, such as the initial complexity of clinical conditions, duration of surgery, mechanical load of the wound, bio-reactive properties of the additional materials required in the w ound.

Treatment adherence in patients with blood system diseases and recipients of allogeneic organs and tissues

Since the middle of the last century, medical communities around the world have begun to attach great importance to the study of adherence to treatment in patients with diseases characterized by long-term and complex therapy, many complications and a potentially high risk of death. Treatment adherence is the single most important modifiable factor compromising treatment outcomes. Poor adherence to treatment remains a worldwide problem regardless of the racial and socio-economic characteristics of the regions. In our review article, we reviewed the relevance of the terms, the history of their occurrence, methods of adherence assessing, and also presented a literary review of studies aimed at adherence to therapy in patients with blood system diseases and recipients of allogeneic organs and tissues.

Effect of Dolutegravir and multi-month dispensing on viral suppression among children with HIV.

Few studies in sub-Saharan Africa have assessed the impact of multi-month dispensing (MMD) of antiretroviral therapy (ART) and dolutegravir (DTG) beyond clinical trials among children with HIV (CWHIV). We assessed the effect of the two interventions on achieving undetectable viral load (VL) among CWHIV 0-15 years in Nigeria. We utilized longitudinal routine records, and cross-sectional survey data from caregivers of a sub-sample of children. VLs were considered suppressed at <1000 copies/ml and undetectable at <50 copies/ml. MMD was defined as ART refill for >84 days. The effect of MMD and DTG on VL levels, and associations between social factors and VL was estimated using generalized linear models, reporting adjusted relative risks (aRR)/prevalence ratios (aPR) and 95% confidence intervals (95%CI). Of 2,490 CWHIV, 52% were male, with a median age of 10 years (IQR: 6-13) and median duration on ART of 4.6 years (IQR: 2.8-7.1). Overall, 73% were on DTG and 55% received MMD. At baseline, 63% were suppressed, while 79% and 56% were suppressed and undetectable in their last VL respectively.We found no differences in undetectable VL between those on MMD and not on MMD (aRR: 1.05 [95%CI: 0.94-1.18]); and between those on DTG and not on DTG (1.07 [0.92-1.25]). In secondary analyses, poor adherence and being in a support group were associated with lower likelihood of undetectable VL (aPR: 0.85 [95%CI: 0.74-0.96], and 0.81 [0.68-0.96] respectively). MMD did not compromise treatment outcomes for CWHIV. Poor adherence however remains a barrier to achieving treatment targets.