Efficacy Of Different Treatments Research Articles

34649 Racial/ethnic differences in treatment efficacy and safety for moderate-to-severe plaque-psoriasis: A systematic review

Background: Psoriasis is a chronic inflammatory skin condition and is one of the most commonly diagnosed dermatologic disorders within skin of color. There remains uncertainty in which biologics provide maximum efficacy based on race/ethnicity.

Nab-Paclitaxel for Previously Treated Advanced Non–Small Cell Lung Cancer: Analysis of Safety and Efficacy for Patients With Renal Impairment

BackgroundRenal impairment can affect treatment tolerability and outcome in individuals with cancer. We aimed to assess the safety and efficacy of nab-paclitaxel for previously treated patients with advanced non–small cell lung cancer (NSCLC) and renal impairment enrolled in a phase 3 trial of nab-paclitaxel vs. docetaxel. Patients and MethodsPreviously treated NSCLC patients were randomly allocated (1:1) to receive docetaxel (60 mg/m²) on day 1 or nab-paclitaxel (100 mg/m²) on days 1, 8, and 15 of a 21-day cycle. Safety and efficacy outcomes of treatment were evaluated according to renal function. ResultsAmong the 503 patients enrolled in the phase 3 trial, 17.3% had moderate renal impairment (creatinine clearance of ≤50 mL/min, n = 49 for docetaxel and n = 38 for nab-paclitaxel) and 53.1% had mild renal impairment (creatinine clearance of >50 to ≤80 mL/min, n = 133 for docetaxel and n = 134 for nab-paclitaxel). For patients with renal impairment, the incidence of febrile neutropenia was lower in the nab-paclitaxel group than in the docetaxel group. The difference in treatment efficacy for nab-paclitaxel vs. docetaxel among patients with moderate or mild renal impairment was similar to that among the overall study population. ConclusionNab-paclitaxel was found to be tolerable and beneficial for previously treated patients with advanced NSCLC and mild or moderate renal impairment.

Developmental and epileptic encephalopathies: from genetic heterogeneity to phenotypic continuum.

Developmental and epileptic encephalopathies (DEEs) are a heterogeneous group of disorders characterized by early-onset, often severe epileptic seizures and EEG abnormalities on a background of developmental impairment that tends to worsen as a consequence of epilepsy. DEEs may result from both nongenetic and genetic etiologies. Genetic DEEs have been associated with mutations in many genes involved in different functions including cell migration, proliferation, and organization, neuronal excitability, and synapse transmission and plasticity. Functional studies performed in different animal models and clinical trials on patients have contributed to elucidate pathophysiological mechanisms underlying many DEEs and have explored the efficacy of different treatments. Here, we provide an extensive review of the phenotypic spectrum included in the DEEs and of the genetic determinants and pathophysiological mechanisms underlying these conditions. We also provide a brief overview of the most effective treatment now available and of the emerging therapeutic approaches.

Study of Plasmodiophora brassicae's Virulence and its Management on Cauliflower

Club root disease is one of the most serious diseases affecting the production and the quality of cruciferous vegetables. The main aim of the study was to identify virulence of Plasmodiophora brassicae's pathotypes and assessment of efficacy of different treatments against clubroot disease. A field survey was conducted on 10 cauliflower's sample from Dhading, Makawanpur, Kavrepalanchowk, Lalitpur, Bhaktapur and Kathmandu, similarly laboratory experiment were conducted to assess the efficacy of different treatments. Disease inoculum was inoculated in 7 days old healthy seedlings of cauliflower and transplanted in the potting mixture with treatments applied. The virulence of each isolates and effectiveness of treatments along with differential hosts against clubroot was evaluated for disease incidence and severity. Isolates collected from Kavre (Panauti), Makawanpur (Palung) and Dhading (Benighat) showed highest disease incidence and severity. Similarly, Boron and Lime showed the least disease incidence and severity percentage, of 44.45% and 33.33% respectively followed by Trichoderma and Lime treatment with 48.14% and 37.03% disease incidence and severity respectively. Similarly, differential reaction among cole crops, cauliflower had highest incidence (100%) and severity (45%) followed by broccoli. While efficacy results of different treatments are derived from pot experiment so, it is needed to further validate by testing in disease infested fields.

Therapy outcome measures in temporomandibular disorder: a scoping review

ObjectivesTherapy outcome measures (TOMs) in temporomandibular disorders (TMDs) have not been systematically evaluated. We systematically explored the main TOM assessment methods for TMD TOMs used in previous studies.DesignScoping review.Data sourcesAccording...

Comparing analgesic efficacy of different interventions after arthroscopic shoulder surgery: a reply

Comparing analgesic efficacy of different interventions after arthroscopic shoulder surgery: a reply

Assessing the Efficacy of Alkylating Agent Regimens in the Treatment of Infantile Malignant Osteopetrosis: Cyclophosphamide, Busulfan, or Thiotepa.

Infantile malignant osteopetrosis is a debilitating disease that requires total bone marrow irradiation and transplant procedures for patients to survive. The major complication of this procedure is graft vs host disease (GVHD), followed by infections and end organ toxicity. Therefore, current research efforts into treatment mainly aim to reduce GVHD while limiting infections and organ toxicity. Different regimens of alkylating agents have been used to try to reduce GVHD. The most common regimen is cyclophosphamide (Cy) with busulfan (Bu), followed by Cy with Bu and thiotepa (Thio). This meta-analysis aimed to evaluate the efficacy of different treatments by comparing mortality and morbidity causes and rates across groups. The mean one-year survival rate for the Cy, Bu, Thio regimen studies in the human leukocyte antigen (HLA) unmatched group (45.01%) was statistically lower than the one-year survival rate for the studies using just a Cy, Bu regimen (70.8%) in the HLA unmatched studies (p<0.00142). The one-year survival in the studies which had HLA-matched donors was 80.56%, which is statistically higher (p<0.001) than the one-year survival in the HLA-unmatched studies (53.96%), indicating a benefit of finding HLA-matched donors. It seems that price and availability could be a factor in the widespread use of Cy.

Usefulness of combined handheld ultrasound and fluoroscopy-guided injection in adhesive capsulitis of the shoulder: A prospective, randomized single blind-pilot study.

BACKGROUND: Ultrasound is increasingly being utilized in the diagnosis and treatment of adhesive capsulitis.OBJECTIVE: To compare the therapeutic effects and advantages of combined handheld ultrasound and fluoroscopy-guided intra-articular corticosteroid injection with those of conventional ultrasound-guided corticosteroid injection in adhesive capsulitis of the shoulder.METHODS: A total of 39 patients diagnosed with adhesive capsulitis of the shoulder were randomly assigned into two groups. Group A patients ( 19) underwent combined handheld ultrasound and fluoroscopy-guided corticosteroid injection and group B patients ( 20) underwent conventional ultrasound-guided corticosteroid injection to the intra-articular space of the shoulder twice. Treatment efficacy was assessed at 2 and 6 weeks after the final injection, based on the verbal numeric pain scale, Shoulder Pain and Disability Index, and range of motion. Secondary outcome measures were the accuracy and procedure time.RESULTS: Both injection methods were effective in the treatment of adhesive capsulitis. No significant differences in treatment efficacy and injection accuracy were observed between the two groups ( 0.05).CONCLUSIONS: This study showed no statistical differences in treatment efficacy between 2 groups. However, the combined use of ultrasound and fluoroscopy can increase the accuracy of injection compared with conventional ultrasound alone.

Telemedicine in headache care: A systematic review.

Telemedicine is defined as video-based consultations with synchronous video and sound. This systematic review investigated the use of telemedicine for headache patients. The primary outcomes of interest were treatment efficacy, feasibility, safety, convenience, compliance, and patient satisfaction. A systematic literature search was performed using PubMed and Embase. Thirteen articles met the eligibility criteria and were included in the review. A systematic review protocol was registered on the International Prospective Register of Systematic Reviews, registration number CRD42021265875. There were no significant differences in treatment efficacy, patient satisfaction, compliance or safety using telemedicine when compared to traditional consultations. Telemedicine was found to be convenient due to being less time-consuming and expensive, especially for patients with limited access to health care. Despite the frequent occurrence of technical errors, telemedicine was found to be feasible. Telemedicine consultations are similar in quality to traditional in-office headache consultations and can be a more convenient solution for eligible headache patients.

Comparison of fluoxetine with other selective serotonin reuptake inhibitors in the treatment of premature ejaculation: A systematic review and meta-analysis.

The primary goal of this systematic review and meta-analysis was to compare the efficacy and safety of fluoxetine with other oral pharmaceuticals in the treatment of premature ejaculation (PE). We searched through databases including CNKI, PubMed, EMBASE and Cochrane to find research published up to 31 March 2022. PROSPERO was used to pre-register this meta-analysis (registration number CRD42022315459). Two separate writers extracted relevant details from all of the papers included in the study. To analyse the quality of literature publishing, we used the Cochrane risk of bias tool. The severity of premature ejaculation was determined using intravaginal ejaculatory latency time (IELT), and the effectiveness and safety of pharmacological interventions were determined using standardized mean difference (SMD) and risk ratio (RR) values with matching 95% confidence level intervals (95% CIs). Our meta-analysis includes a total of ten trials to investigate into the differences in treatment efficacy and safety between fluoxetine and other medicines. The findings revealed that fluoxetine was more effective than placebo in treating PE, whereas sertraline and paroxetine were more effective than fluoxetine (p < 0.05). The side effects of the medications were not significantly different, and they were all acceptable. The results of the sensitivity analysis were unaffected by the removal of any of the articles. There was no evidence of bias in the media. This meta-analysis examined the differences in efficacy and safety between fluoxetine and other oral medications and can be used by clinicians in the treatment of PE.

Does previous use of tumour necrosis inhibitors change the therapeutic effect of interleukin (IL)-17 or IL-12/23 inhibitors on psoriasis and psoriatic arthritis? Results of a systematic review.

Tumour necrosis factor inhibitors (TNFi) were the first biologics approved for the treatment of psoriasis (PsO) and psoriatic arthritis (PsA). However, some patients are intolerant of or unresponsive to TNFi. To investigate the therapeutic effect of interleukin (IL)-17 and IL-12/23 inhibitors in patients with PsO or psoriatic arthritis PsA who were intolerant of or had responded inadequately to TNFi therapy (TNFi-experienced patients). A systematic review of randomized controlled trials searched from the PubMed, Cochrane Library and Embase databases was conducted on 17 May 2021. Responses of 75% and 90% improvement on Psoriasis Area and Severity Index (PASI75, PASI90), 20%, 50% and 70% improvement on the American College of Rheumatology response criteria (ACR20, ACR50, ACR70), and full resolution of dactylitis/enthesitis were used to assess the treatment efficacy. In total, 7 studies with a total of 3398 patients with PsA were included, 1330 of whom were intolerant of or had responded inadequately to TNFi. All studies were categorized as having low risk of bias. For IL-17A inhibitors, there were significantly higher achievements in all of the endpoints compared with placebo, but the proportions of patients achieving these endpoints were lower in TNFi-experienced patients compared with TNFi-naïve patients. However, the differences between TNFi-experienced and TNFi-naïve patients were significant only for ACR responses and for full resolution of enthesitis. For IL-12/23 inhibitors, only the results for ACR20 response were reported. Significantly more TNFi-experienced patients achieved ACR20 response compared with patients receiving placebo, and the differences in treatment efficacy between TNFi-experienced and TFNi-naïve patients was not significant. IL-17A and IL-12/23 inhibitors still had efficacy for patients with PsO or PsA had failed or were intolerant to TNFi therapy; however, the efficacy was lower than that in TNFi-naïve patients. Further studies to confirm these findings are warranted.

Describing and Characterizing the Literature Regarding Umbilical Health in Intensively Raised Cattle: A Scoping Review.

The objective of this scoping review was to describe and characterize the existing literature regarding umbilical health and identify gaps in knowledge. Six databases were searched for studies examining umbilical health in an intensively raised cattle population. There were 4249 articles initially identified; from these, 723 full text articles were then screened, with 150 articles included in the review. Studies were conducted in the USA (n = 41), Brazil (n = 24), Canada (n = 13), UK (n = 10), and 37 additional countries. Seventeen were classified as descriptive, 24 were clinical trials, and 109 were analytical observational studies. Umbilical outcomes evaluated in descriptive studies were infection (n = 11), parasitic infection (n = 5), and hernias (n = 2). Of the clinical trials, only one examined treatment of navel infections; the remainder evaluated preventative management factors for navel health outcomes (including infections (n = 17), myiasis (n = 3), measurements (n = 5), hernias (n = 1), and edema (n = 1)). Analytical observational studies examined risk factors for umbilical health (n = 60) and umbilical health as a risk factor (n = 60). Studies examining risk factors for umbilical health included navel health outcomes of infections (n = 28; 11 of which were not further defined), hernias (n = 8), scoring the navel sheath/flap size (n = 16), myiasis (n = 2), and measurements (n = 6). Studies examining umbilical health as a risk factor defined these risk factors as infection (n = 39; of which 13 were not further defined), hernias (n = 8; of which 4 were not further defined), navel dipping (n = 12), navel/sheath scores as part of conformation classification for breeding (n = 2), measurements (n = 3), and umbilical cord drying times (n = 2). This review highlights the areas in need of future umbilical health research such as clinical trials evaluating the efficacy of different treatments for umbilical infection. It also emphasizes the importance for future studies to clearly define umbilical health outcomes of interest, and consider standardization of these measures, including time at risk.

Does race-ethnicity affect upper airway stimulation adherence and treatment outcome of obstructive sleep apnea?

Untreated obstructive sleep apnea (OSA) is associated with excessive daytime sleepiness, decreased quality of life, and cardiovascular disease. Positive airway pressure is the first-line therapy for OSA; however, adherence is difficult. Upper airway stimulation is a Food and Drug Administration-approved treatment of OSA. The objective of this study was to evaluate for a difference in treatment efficacy and adherence of upper airway stimulation therapy for OSA between individuals who are White and non-White using data from the ADHERE registry. ADHERE registry is a multicenter prospective study of real-world experience of upper airway stimulation for treatment of OSA in the United States and Europe. Propensity score matching was used to create a balanced dataset between the White and non-White groups. t-Tests at a significance level of 5% were used to compare numeric values between groups. There were 2,755 participants of the ADHERE registry: 27 were excluded due to not having a race identified, 125 participants identified as non-White, 2,603 identify as White, and 27 did not provide race information. Propensity score matching was used to select 110 participants, with 55 White and 55 non-White for the noninferiority analysis. We did not find a difference in adherence, treatment apnea-hypopnea index, changes in Epworth Sleepiness Scale score, or clinical global impression after intervention score between White and non-White individuals. Our study found that there was no statistically significant difference in adherence or efficacy with upper airway stimulation therapy between White and non-White individuals. However, the percent of non-White people implanted is low, which suggests a need to expand access to this therapy for non-White populations with OSA who cannot tolerate positive airway pressure therapy. Khan M, Stone A, Soose RJ, etal. Does race-ethnicity affect upper airway stimulation adherence and treatment outcome of obstructive sleep apnea? J Clin Sleep Med. 2022;18(9):2167-2172.

The efficacy of different treatments for type 2 cesarean scar pregnancy

To study the efficacy of 3 treatment options for type 2 cesarean scar pregnancy (CSP) and establish an optimal treatment strategy for type 2 CSP. Retrospective cohort study. A tertiary hospital. The study examined 160 women with type 2 CSP. Ultrasound-guided vacuum aspiration after local injection of lauromacrogol, ultrasound-guided vacuum aspiration after uterine artery embolization (UAE), and transabdominal resection or hysteroscopy combined with laparoscopic resection. The success rates, duration of hospitalization, hospitalization cost, amount of blood loss, recovery time, and menstruation resuming after recovery. The success rates of the UAE, lauromacrogol, and surgical groups were 87.1%, 92.5%, and 95.5%, respectively, with no significant differences. The cost and duration of hospitalization in the lauromacrogol group were significantly lower than those in the UAE and surgical groups. Analysis of the causes of treatment failure revealed a significant difference in the gestational age. The area under the receiver operating characteristic curve was 0.660 (95% confidence interval, 0.533-0.788). When the gestational age was 48.5 days, Youden index was the highest. Furthermore, when the diagnostic thresholds were selected as 49, 56, and 63 days of pregnancy, the corresponding areas under the receiver operating characteristic curve were 0.652, 0.541, and 0.510, respectively. Ultrasound-guided vacuum aspiration after local injection of lauromacrogol is recommended for patients with type 2 CSP at <49 days of gestation. Laparotomy or laparoscopy combined with hysteroscopy is suitable for patients with gestation of >49 days, especially for those with >56 days of gestation.

Efficacy of plasma exchange on top of standard immunosuppressive therapy in adult autoimmune inflammatory rheumatic diseases-associated macrophage activation syndrome, a single center real-world analysis

BackgroundThere is a lack of documented real-world evidence about the efficacy of current therapeutics for autoimmune inflammatory rheumatic diseases (AIIRD)-associated adult macrophage activation syndrome (MAS). ObjectiveTo analyze the efficacy of different treatments, especially plasma exchange (PE), in AIIRD-associated MAS. MethodsAmong 5775 patients with AIIRD in Tongji Hospital from 2014 to 2020, 62 AIIRD-associated MAS cases were collected. Unadjusted logistic regression, least absolute shrinkage and selection operator (LASSO), and inverse probability of treatment weight (IPTW) analyses were used to characterize the clinical features and potential factors related to the prognosis. Paired t-test was used to compared the changes of inflammatory indicators before and after PE treatment. ResultsThe baseline data was defined as the data collected at the onset of MAS, and all of the 62 patients were diagnosed as AIIRD before MAS onset. The prevalance rate of MAS in AIIRD was 1.1%, and the most common types of AIIRD were systemic lupus erythematosus (45.2%) and adult-onset Still's disease (33.9%). All 62 MAS patients received glucocorticoids, 87.1% patients used at least one immunosuppressive agent, and 54.8% received PE. LASSO regression indicates a positive effect of PE on the basis of variables. After PE treatment, serum levels of multiple inflammatory cytokines were rapidly reduced, accompanied by improvements in clinical symptoms and laboratory indecies including ferritin, lactate dehydrogenase, and C-reactive protein. LASSO regression indicates that PE treatment was associated with a marked reduction of mortality (from 53.6% to 11.8%), with a hazard ratio (HR) of 0.148 (p < 0.001) after adjustment for confounding factors using IPTW analysis. ConclusionWith the background therapy of glucocorticoids and immunosuppressive agents, PE is an effective approach to rapidly clear inflammatory cytokines and reduce mortality of AIIRD-associated MAS. Clinical implicationThis study provided real-world information on the efficacy of PE in AIIRD-associated MAS.

Enhanced immune activation within the tumor microenvironment and circulation of female high-risk melanoma patients and improved survival with adjuvant CTLA4 blockade compared to males

BackgroundWe hypothesized that a gender difference in clinical response may exist to adjuvant CTLA4 blockade with ipilimumab versus high-dose IFNα (HDI). We investigated differences in candidate immune biomarkers in the circulation and tumor microenvironment (TME).Patients and methodsThis gender-based analysis was nested within the E1609 trial that tested adjuvant therapy with ipilimumab 3 mg/kg (ipi3) and 10 mg/kg (ipi10) versus HDI in high risk resected melanoma. We investigated gender differences in treatment efficacy with ipi3 and ipi10 versus HDI while adjusting for age, stage, ECOG performance (PS), ulceration, primary tumor status and lymph node number. Forest plots were created to compare overall survival (OS) and relapse free survival (RFS) between ipi and HDI. Gene expression profiling (GEP) was performed on tumors of 718 (454 male, 264 female) patients. Similarly, serum and peripheral blood mononuclear cells (PBMC) samples were tested for soluble and cellular biomarkers (N = 321 patients; 109 female and 212 male).ResultsThe subgroups of female, stage IIIC, PS = 1, ulcerated primary, in-transit metastasis demonstrated significant improvement in RFS and/or OS with ipi3 versus HDI. Female gender was significant for both OS and RFS and was further explored. In the RFS comparison, a multivariate Cox regression model including significant variables indicated a significant interaction between gender and treatment (P = 0.024). In peripheral blood, percentages of CD3+ T cells (P = 0.024) and CD3+ CD4+ helper T cells (P = 0.0001) were higher in females compared to males. Trends toward higher circulating levels of IL1β (P = 0.07) and IL6 (P = 0.06) were also found in females. Males had higher percentages of monocytes (P = 0.03) with trends toward higher percentages of regulatory T cells (T-reg). Tumor GEP analysis supported enhanced infiltration with immune cells including gammadelta T cells (P = 0.005), NK cells (P = 0.01), dendritic cells (P = 0.01), CD4+ T cells (P = 0.03), CD8+ T cells (P = 0.03) and T-reg (P = 0.008) in the tumors of females compared to males and a higher T-effector and IFNγ gene signature score (P = 0.0244).ConclusionFemale gender was associated with adjuvant CTLA4 blockade clinical benefits and female patients were more likely to have evidence of type1 immune activation within the TME and the circulation.Trial registration ClinicalTrials.gov NCT01274338. Registered 11 January 2011, https://www.clinicaltrials.gov/ct2/show/NCT01274338

Clinical characteristics, treatment and clinical outcomes of leiomyosarcoma: A retrospective study from single center.

e23536 Background: Leiomyosarcomas are genetically heterogeneous tumors with highly variable survival. The clinical efficacy of different treatments has not been determined. This retrospective study analyzed the clinical pathological features, treatments and outcomes of leiomyosarcoma patients. Methods: A retrospective review was performed of leiomyosarcoma patients between 2000 to 2021. 214 patients were initially investigated, 102 patients were excluded owing to a lack of follow-up or loss of data., and 112 patients were finally analyzed. Treatment outcomes were measured using overall survival (OS), disease-free survival (DFS) and progression-free survival (PFS). Optimal responses of first-line chemotherapies were also investigated under RECIST criteria. Results: Mean age of patients was 52.63 years, and male to female ratio was 1/2.2. Tumors mainly located in head and neck (2.68%), trunk and extremities (35.71%), abdomen and thoracic organs (16.07%), retroperitoneum (17.86%) and pelvis (27.68%). Patients with ⅠA, ⅠB, II, IIIA, IIIB and IV stage was 15.18%, 23.21%, 9.82%, 12.50%, 7.14% and 9.82% respectively. 2 patients received only chemotherapy after diagnosis, and 109 patients underwent surgery, among them 33.04% (37 cases) of patients had further radiation or chemotherapy. The median OS (mOS) of all patients was 42.65 months (95% CI 33.77-50.43). Adjuvant therapy had no significant influence on median DFS (mDFS) (28.63 months vs 30.33 months, P= 0.888). Significantly, R0 resection prolonged mDFS (33.30 months vs 7.37 months, P = 0.019) and mOS (102.5 months vs 35.83 months, P= 0.001). 32 patients occurred recurrence and all had surgery. 28 patients occurred metastases and 6 of them received surgery alone, 11 patients had systemic treatment, 6 patients received both treatments, 5 of them were untreated. In patients with metastases, the median PFS of systemic treatment (15.33 months) was shorter than median DFS of local treatment (48.83 months), while systemic treatment achieved similar survival time as surgery (78.03 months vs 79.27 months, P= 0.651). The disease control rate (DCR) of anthracycline-based regimens, ifosfamide (IFO), gemcitabine-based regimens and targeted therapy was 52.94%, 33.33%, 33.33%, 50% respectively. Conclusions: Surgery with R0 margin improved survival significantly of leiomyosarcoma patients. For survival time of patients with metastases, systemic treatment was not inferior to surgery, and anthracycline-based regimens had a higher disease control rate.

The role of retinal focal photosensitivity in micropulse treatment of vascular genesis focal macular edema

Introduction. Vascular macular edema (ME) is the most common in diabetic retinopathy and retinal vein occlusion. To assess the efficacy and safety of ongoing treatment the dynamics of the best-corrected visual acuity is always taken into account, however, taking into consideration the subjectivity of this indicator, objective methods of assessing the morphofunctional state of the retina should be performed. These include optical coherence tomography and microperimetry.The aim of the study is to evaluate the role of focal retinal photosensitivity (FRP) in assessing the efficacy of micropulse treatment of macular edema of vascular genesis.Material and methods. The study group consisted of 110 patients (110 eyes) including 74 patients (74 eyes) with diabetic macular edema (DME) up to 500 μm and 36 patients (36 eyes) with ME up to 500 μm caused by branch retinal vein occlusion. The patients were divided into two groups randomly: in the first group micropulse was performed using a green laser (λ = 532 nm), in the second group – a yellow laser (λ = 577 nm).Results. In both groups ME decreased significantly to 342 ± 11 µm (M ± σ), maximum corrected visual acuity and FRP increased to 0.59 ± 0.07 and 23.9 ± 1.7 dB (M ± σ), accordingly. Statistically significant difference in treatment efficacy depending on laser length wasn’t detected.Conclusion. FRP in the area of edema of neuroepithelium (NE) has a direct correlation with NE thickness and is an important indicator of the retinal functional state and can be used to develop a personalized approach to patient treatment and assess the effectiveness of ME treatment. Application of micropulse for treatment of vascular genesis focal ME with height up to 500 μm is effective and safe, as it allows to decrease reliably the thickness of NE in the edema zone and improve clinical and functional indices, reliably increase FRP.

Genotype-Phenotype Relationship and Follow-up Analysis of a Chinese Cohort With Osteogenesis Imperfecta

ObjectiveTo evaluate the genotype-phenotype relationship and the effect of treatment on the clinical course of osteogenesis imperfecta (OI). MethodsWe established a Chinese hospitalized cohort with OI and followed them up for an average of 6 years. All patients were confirmed as having OI using whole-exome sequencing. We analyzed the genotype-phenotype relationship based on different types, pathogenic mechanisms, and gene inheritance patterns of OI. Additionally, we assessed whether there was a difference in treatment efficacy based on genotype. ResultsOne hundred sixteen mutations in 6 pathogenic genes (COL1A1, COL1A2, IFITM5, SERPINF1, FKBP10, and WNT1) were identified in 116 patients with type I, III, IV, V, VI, XI, or XV OI. Compared with patients with COL1A1 mutations, patients with COL1A2 mutations were younger at the time of the first fracture, whereas other phenotypes were similar. When 3 groups (helical, haploinsufficiency, and non-collagen I gene mutations) were compared, patients with helical mutations were the shortest and most prone to dentinogenesis imperfecta. Patients with haploinsufficiency mutations were the oldest at the time of the first fracture. Moreover, patients with non-collagen I gene mutations were least susceptible to blue sclerae and had the highest fracture frequency. Furthermore, there were some minor phenotypic differences among non-collagen I gene mutations. Interestingly, pamidronate achieved excellent results in the treatment of patients with OI, and the treatment effect appeared to be unrelated to their genotypes. ConclusionOur findings indicated a genotype-phenotype relationship and a similar effect of pamidronate treatment in patients with OI, which could provide a basis for guiding clinical treatment and predicting OI prognosis.

Locoregional recurrence after nephrectomy for localized renal cell carcinoma: Feasibility and outcomes of different treatment modalities.

Locoregional recurrence after nephrectomy for localized renal cell carcinoma (RCC) is rare with diverse manifestations. The selection criteria and efficacy of different treatments are unanswered. The objective was to compare different treatment modalities and present data on stereotactic body radiotherapy (SBRT) for recurrent RCC. Patients with locoregional recurrence after nephrectomy without distant metastasis were identified from institutional big data intelligence platform between 2001 and 2020. Patients receiving local therapy (surgery or SBRT) or systemic therapy alone (targeted therapy or PD-1 inhibitors) were divided into two groups. Progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier method, Cox regression model. Patients were matched with propensity score matching. Among 106 patients, 33 (31.1%) received systemic therapy alone and 73 (68.9%) received local therapy. Local therapy was surgery in 34 patients (32.1%) and SBRT in 39 (36.8%) patients. Patients treated with systemic therapy alone had more non-clear cell type (p=0.044), more advanced T stage (p=0.006), higher number (p=0.043) but smaller size of lesions (p=0.042). Patients receiving local therapy had significantly longer PFS than systemic therapy (19.7 vs. 7.5months, p=0.001). After matching, the PFS in the local therapy group remained higher (23.9 vs. 7.5months, p=0.001). The 2-year OS of the local therapy group and systemic therapy group was 91.6% and 71.8%, respectively (p=0.084). Local therapy was associated with better PFS (HR 0.37; p=0.0003) and OS (HR 0.23; p=0.002) in multivariate analysis. Grade 2 or higher toxicities related to local therapy occurred in nine patients. Local therapy could delay disease progression compared with systemic therapy alone. SBRT is safe and effective for locally recurrent RCC.