Effectiveness Of Different Treatment Strategies Research Articles

The effect of different treatment strategies on glycolipid metabolism disorders and cardiovascular events in primary aldosteronism.

Recent studies have explored the association between primary aldosteronism and cardiovascular disease incidence. The association between specific primary aldosteronism treatments and differential improvement in cardiovascular event rates is yet to be established. This study was designed to compare the relative effects of spironolactone therapy and surgical intervention on cardiovascular outcomes among primary aldosteronism patients. This retrospective observational study included 853 primary aldosteronism patients from the First Affiliated Hospital of China Medical University between 2014 and 2022. Patients who had completed abdominal computed tomography (CT) examinations with similar metabolic characteristics and 6-month follow-up analyses were included in this study. These patients were separated into a surgical treatment group (n = 33) and a spironolactone treatment group (n = 51). Demographic data, biochemical analysis results, liver/spleen (L/S) X-ray attenuation ratio, hospitalization frequency, and cardiovascular events were compared between the two groups. The spironolactone group demonstrated significantly improved metabolic characteristics compared to the surgical group, shown by lower BMI, blood pressure, total cholesterol (TC), insulin resistance index (IRI), and reduced non-alcoholic fatty liver disease prevalence. Metabolic parameters did not differ significantly within the surgical treatment group when comparing pre- and postoperative values. The incidence of cardiovascular events was lower in the spironolactone group compared to the surgery group (23/33 vs. 20/51, P < 0.001) despite higher hospitalization rates(37/31 vs. 61/53, P < 0.001). In patients with primary aldosteronism, spironolactone treatment is more effective than surgical intervention in remediating abnormal lipid and glucose metabolism while improving cardiovascular outcomes. Chinese clinical trial registry registration number: ChiCTR2300074574.

ResDeepSurv: A Survival Model for Deep Neural Networks Based on Residual Blocks and Self-attention Mechanism.

Survival analysis, as a widely used method for analyzing and predicting the timing of event occurrence, plays a crucial role in the medicine field. Medical professionals utilize survival models to gain insight into the effects of patient covariates on the disease, and the correlation with the effectiveness of different treatment strategies. This knowledge is essential for the development of treatment plans and the enhancement of treatment approaches. Conventional survival models, such as the Cox proportional hazards model, require a significant amount of feature engineering or prior knowledge to facilitate personalized modeling. To address these limitations, we propose a novel residual-based self-attention deep neural network for survival modeling, called ResDeepSurv, which combines the benefits of neural networks and the Cox proportional hazards regression model. The model proposed in our study simulates the distribution of survival time and the correlation between covariates and outcomes, but does not impose strict assumptions on the basic distribution of survival data. This approach effectively accounts for both linear and nonlinear risk functions in survival data analysis. The performance of our model in analyzing survival data with various risk functions is on par with or even superior to that of other existing survival analysis methods. Furthermore, we validate the superior performance of our model in comparison to currently existing methods by evaluating multiple publicly available clinical datasets. Through this study, we prove the effectiveness of our proposed model in survival analysis, providing a promising alternative to traditional approaches. The application of deep learning techniques and the ability to capture complex relationships between covariates and survival outcomes without relying on extensive feature engineering make our model a valuable tool for personalized medicine and decision-making in clinical practice.

Strategies to increase the coverage of influenza and pneumonia vaccination in older adults: a systematic review and network meta-analysis.

It is urgent to implement interventions to increase vaccination rates of influenza/pneumonia vaccines in older adults, yet the effectiveness of different intervention strategies has not been thoroughly evaluated. We aimed to assess the effectiveness of intervention strategies for increasing the coverage of influenza/pneumonia vaccination in older adults. PubMed, Web of Science, Cochrane Library, Embase, China Biology Medicine disc, China National Knowledge Infrastructure and Wanfang were searched from 1 January 2000 to 1 October 2022. RCTs that assessed any intervention strategies for increasing influenza/pneumonia vaccination coverage or willingness in older adults were included. A series of random-effects network meta-analysis was conducted by using frequentist frameworks. Twenty-two RCTs involving 385,182 older participants were eligible for further analysis. Eight types of intervention strategies were evaluated. Compared with routine notification, health education (odds ratio [OR], 1.85 [95%CI, 1.19 to 2.88]), centralised reminder (OR, 1.63 [95%CI, 1.07 to 2.47]), health education + onsite vaccination (OR, 2.89 [95%CI, 1.30 to 6.39]), and health education + centralised reminder + onsite vaccination (OR, 20.76 [95%CI, 7.33 to 58.74]) could effectively improve the vaccination rate. The evidence grade was low or very low due to the substantial heterogeneity among studies. Our findings suggest that health education + centralised reminder + onsite vaccination may potentially be an effective strategy regardless of cost, but the evidence level was low. More rigorous trials are needed to identify the association between strategies and vaccination rates among older adults and to integrate such evidence into clinical care to improve vaccination rates.

Korean Sports Violence from a Philosophical Perspective: Exploration and Critique

This study utilizes critical theory to understand the phenomenon of sports violence in South Korea, specifically examining the tragic case of Choi Sook-hyun. The incident is not viewed as an isolated act, but rather a reflection of power dynamics, societal expectations, and cultural norms. The analysis reveals that such violence results from the abuse of power within sports organizations and a cultural environment that places competition and obedience above athletes’ well-being. It proposes that interventions should focus on restructuring power relations in sports and driving sociocultural shifts through public education and legislations. This comprehensive approach can aid in the prevention of sports violence and promote a culture of respect and fairness. Further research is suggested to examine sports violence in various social and cultural contexts and to evaluate the effectiveness of different intervention strategies.

Study on prognosis of acutely ruptured intracranial aneurysms (SPARTA): a protocol for a multicentre prospective cohort study

BackgroundRuptured intracranial aneurysms resulting in subarachnoid haemorrhage can be treated by open surgical or endovascular treatment. Despite multiple previous studies, uncertainties on the optimal treatment practice still exists. The resulting treatment variation may result in a variable, potentially worse, patient outcome. To better inform future treatment strategies, this study aims to identify the effectiveness of different treatment strategies in patients with ruptured intracranial aneurysms by investigating long-term functional outcome, complications and cost-effectiveness. An explorative analysis of the diagnostic and prognostic value of radiological imaging will also be performed.MethodsThis multi-centre observational prospective cohort study will have a follow-up of 10 years. A total of 880 adult patients with a subarachnoid haemorrhage caused by a ruptured intracranial aneurysm will be included. Calculation of sample size (N = 880) was performed to show non-inferiority of clip-reconstruction compared to endovascular treatment on 1 year outcome, assessed by using the ordinal modified Rankin Scale. The primary endpoint is the modified Rankin Scale score and mortality at 1 year after the initial subarachnoid haemorrhage. Patients will receive ‘non-experimental’ regular care during their hospital stay. For this study, health questionnaires and functional outcome will be assessed at baseline, before discharge and at follow-up visits.DiscussionDespite the major healthcare and societal burden, the optimal treatment strategy for patients with subarachnoid haemorrhage caused by ruptured intracranial aneurysms is yet to be determined. Findings of this comparative effectiveness study, in which in-between centre variation in practice and patient outcome are investigated, will provide evidence on the effectiveness of treatment strategies, hopefully contributing to future high value treatment standardisation.Trial registration numberNCT05851989Date of registrationMay 10th, 2023

Two protocols using fluralaner for Rhipicephalus microplus strategic control on taurine cattle in a tropical region

BackgroundThe present study aimed to evaluate the effects of different treatment strategies using a new commercial formulation containing pour-on fluralaner on Rhipicephalus microplus infestation in cattle and in pastures in a tropical climate region where up to five generations of this tick species can occur per year.MethodsForty-five naturally infested cattle were divided into three experimental groups: T01, treated with fluralaner (2.5 mg/kg) pour-on every 42 days; T02, the cattle received the first treatment with fluralaner on Day 0 but the next treatment involved a weekly visual evaluation; T03, control, received palliative treatment with a spray formulation when the group mean was ≥ 30 ticks. Counts of female R. microplus were performed weekly until day 343, and larval counts on pasture were performed on Days 0, 30, and 60 and every 30 days until Day 330.ResultsUsing fluralaner, six applications were performed in Group T01, and four were performed in Group T02. In the control group (T03), it was necessary to perform eight palliative acaricide treatments with the spray formulation. The animals in T01 and T02 showed lower mean tick counts (p ≤ 0.05) than the control group (T03) on 28 and 27 of the 49 evaluated dates, respectively. In the paddock where the animals were kept as controls, the R. microplus larvae counts increased to 1458. In the paddocks where the animals were treated with fluralaner, the number was ≤ 19 per paddock during the study.ConclusionsThe different strategic treatment protocols performed with pour-on fluralaner (2.5 mg/kg) over a year in taurine cattle in a tropical region with a history of up to five annual generations of cattle ticks were effective, maintaining levels of R. microplus infestations in animals and in pastures close to zero in most of the study. Depending on the retreatment criterion adopted, the number of applications per year may be lower, resulting in a reduction in the mean cost of acaricide treatment per year and lower exposure of R. microplus populations to the active ingredient, resulting in lower resistance and selection pressure.Graphical

Sick leave length and the costs of operatively and conservatively treated distal radius fractures in the working age population: a retrospective cohort study

BackgroundAmong the working population, a transient loss of working ability due to distal radius fracture (DRF) has a societal impact in terms of sick leave. Non-operative cast immobilization is the most common treatment option for DRF. However, these fractures are increasingly treated operatively. This retrospective cohort study of patients aged 20–64 with DRF compares the effects of different treatment strategies on sick leave length and overall cost of treatment.MethodsMultivariable regression analysis was used with treatment modality as an exposure and sick leave length as an outcome. Sick leave data were obtained from a national register. Costs were evaluated by adding the direct cost of the treatment modality to the mean cost of sick leave per patient in different treatment groups.ResultsOf 614 working-age patients with a DRF who were treated at a tertiary hospital in Finland between January 2013 and December 2014, 521 were primarily treated non-operatively with cast immobilization and 93 were primarily operated. Of the primarily non-operatively treated patients, 48 were operated during follow-up. The mean follow-up was 5 years. The median time lost from work after DRF was 55 days (7.9 weeks), and the separated medians by treatment modality were 49 (7 weeks) and 70 days (10 weeks) for conservative and operative treatment, respectively. Multivariable linear regression analyses were performed for those patients who had sick leave (n = 292). Regression analysis also showed that operative treatment correlates with longer sick leave.ConclusionsOperative treatment of distal radius fracture led more often to longer time lost from work than conservative treatment. Moreover, due to longer sick leave and the costs of the operation itself, operative treatment is over two times more expensive than conservative treatment.Trial registrationretrospectively registered.

Knowledge support for optimising antibiotic prescribing for common infections in general practices: evaluation of the effectiveness of periodic feedback, decision support during consultations and peer comparisons in a cluster randomised trial (BRIT2) – study protocol

IntroductionThis project applies a Learning Healthcare System (LHS) approach to antibiotic prescribing for common infections in primary care. The approach involves iterations of data analysis, feedback to clinicians and implementation...

Changing students’ explicit and implicit attitudes toward peers with disabilities: Effects of a curriculum-based intervention programme

AbstractNegative peer attitudes are a significant barrier to social participation of students with disabilities in inclusive classrooms. Although many intervention studies have demonstrated the effectiveness of interaction or disability awareness programmes in promoting positive peer attitudes, reliance on students’ self-reported attitudes is prone to social desirability bias and is unable to capture implicit prejudice. The present study examined changes in students’ explicit and implicit attitudes toward peers with disabilities after a curriculum-based intervention programme (“Prinzip Vielfalt”), which aims to promote an open-minded attitude toward human diversity. Teachers in 12 primary school classes in the experimental group (n = 195 students) used the programme for eight weeks, whereas a control group of 12 classes (n = 191 students) used no intervention. Students’ pre- and post-intervention attitudes were assessed using an adapted version of the Chedoke–McMaster Attitudes Towards Children with Handicaps Scale and a disability Implicit Association Test for children. Post-intervention analyses revealed a significant relative improvement in explicit attitudes toward peers with disabilities in the experimental group compared to the control group (b = 0.20, 95% CI = [0.03; 0.37]) but no change in implicit attitudes (b = -0.03, 95% CI = [-0.10; 0.03]). Thus, while the intervention positively affected self-reported attitudes, implicit negative associations were unchanged. Using explicit and implicit measures of attitudes and attitude changes among children can provide valuable insights into the mechanisms and effectiveness of different intervention strategies.

Comparison of Clindamycin with Other Anti-staphylococcal Antibiotics for the Treatment of Pediatric Staphylococcal Skin-Scaled Syndrome

Background: Staphylococcal scalded skin syndrome (4S) is caused by Staphylococcus aureus exfoliative toxin and is characterized by the separation of the surface layers of skin. Given the existence of conflicting treatment strategies and differences in antibiotic resistance patterns, this study aimed to compare the effectiveness of clindamycin, clindamycin with another anti-staph agent, and antibiotic regimen without clindamycin in the management of pediatric 4S. Objectives: To compare the effectiveness of different treatment strategies in the management of pediatric 4S. Methods: In this cross-sectional study, children with 4S (based on the final documented clinical diagnosis) admitted to the 17th-Shahrivar Hospital of Rasht, Iran, from 2005 to 2021 were enrolled. Exclusion criteria comprised being a neonate, having chronic skin diseases or immunodeficiencies, and incomplete data files. The variables gathered included age, sex, type of antibiotic received, time of fever cessation (if fever existed), recovery time, duration of hospitalization, and complications. The data were entered into SPSS v.24 software and analyzed. Results: This study was conducted on 73 patients with the final diagnosis of 4S. The mean age of the patients was 17.70 ± 15.85 months, and 47.9% of them experienced fever during hospitalization. The mean duration of hospital stay was 6.52 ± 1.90 days. Also, the average duration of recovery in these children was 4.90 ± 1.73 days. There were no differences in terms of sex (P-value = 0.245), age (P-value = 0.383), and duration of fever (P-value = 0.568) between the three groups receiving different antibiotic regimens. Meanwhile, the durations of recovery (P-value = 0.018) and hospitalization (P-value = 0.020) were significantly longer in children who did not receive clindamycin. Moreover, the duration of hospitalization was significantly shorter in the patients who received clindamycin alone compared to those treated with clindamycin plus another antibiotic (P-value = 0.044). There was no significant difference in the occurrence of disease/drug complications between the three groups, and the most common complication in all patients was scaling. Conclusions: Clindamycin (alone or in combination with other anti-staphylococcal agents) could shorten the recovery period, and hospital stay in children with 4S. Besides, it did not have any adverse impact on the occurrence of complications. The patients who received clindamycin alone had a shorter hospital stay than patients who were treated with clindamycin plus another antibiotic. Considering the lower complications, lower costs, and shorter length of hospital stay associated with monotherapy, we recommend using clindamycin alone for treating 4S patients.

Myocardial Perfusion in ST-Segment Elevation Myocardial Infarction Patients After Percutaneous CoronaryIntervention:Influencing Factors and Intervention Strategies.

Aim We aim to explore the factors influencing myocardial perfusion in patients with acute ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI)and evaluate the effects of different intervention strategies on myocardial perfusion improvement. Methods A retrospective analysis was conducted on 300 patients withSTEMIwho underwent primary percutaneous coronary intervention (PPCI) at our hospital between January 2020 and December 2022. Based on post-procedural coronary angiography results using the thrombolysis in myocardial infarction (TIMI) blood flow grade and myocardial blush grade (MBG), patients were categorized into two groups: the normal perfusion group (TIMI grade 3 or MBG 2-3, n=180) and the impaired perfusion group (TIMI grades 0-2 or MBG 0-1, n=120). The impaired perfusion group was further divided using a random number table into the thrombus aspiration-only group (control group, n=60) and the thrombus aspiration combined with nicorandil group (nicorandil group, n=60). A 1:1 propensity score matching method was employed to adjust for baseline characteristics between the groups. Clinical characteristics, hematological parameters, coronary lesion features, and percutaneous coronary intervention (PCI) technical parameters were compared between the matched groups. Additionally, a multivariate logistic regression analysis was performed to identify independent risk factors influencing myocardial perfusion. Furthermore, the post-procedural myocardial perfusion, cardiac function, and clinical prognosis were compared between the control and nicorandil groups. Results After matching, the baseline characteristics of the two groups were compared. The impaired perfusion group had older age, higher proportion of male patients, higher rates of diabetes and hypertension, longer time from symptom onset to balloon dilation, higher peak cardiac troponin I (cTnI) levels, higher proportion of left main or multivessel involvement, heavier coronary lesion burden, and lower balloon inflation pressure (P<0.05). Multivariate logistic regression analysis revealed that age of ≥65 years (odds ratio {OR}=2.34, 95% confidence interval {CI}=1.23-4.46, P<0.01), time from symptom onset to balloon dilation of ≥6 hours (OR=3.12, 95% CI=1.67-5.83, P<0.01), peak cTnI level of ≥100 ng/mL (OR=4.27, 95% CI=2.18-8.36, P<0.01), left main or multivessel involvement (OR=2.86, 95% CI=1.51-5.41, P<0.01), and balloon inflation pressure of <8 atm (OR=3.45, 95% CI=1.79-6.65, P<0.01) were independent risk factors affecting myocardial perfusion. In the intervention analysis, the nicorandil group showed superior post-procedural TIMI blood flow grade, MBG, left ventricular ejection fraction (LVEF), and New York Heart Association (NYHA) functional classification compared to the control group (P<0.05). During a six-month follow-up, the nicorandil group had a lower incidence of major adverse cardiovascular events (MACE) compared to the control group (P<0.05). Conclusion Age, time from symptom onset to balloon dilation, peak cTnI level, extent of coronary artery lesions, and balloon inflation pressure were identified as independent risk factors affecting myocardial perfusion in STEMI patients after PCI. Compared to simple thrombus aspiration, thrombus aspiration combined with nicorandil demonstrated better improvement in myocardial perfusion, cardiac function, and clinical outcomes for patients with impaired perfusion.

Application of HIPEC simulations for optimizing treatment delivery strategies

Introduction Hyperthermic IntraPEritoneal Chemotherapy (HIPEC) aims to treat microscopic disease left after CytoReductive Surgery (CRS). Thermal enhancement depends on the temperatures achieved. Since the location of microscopic disease is unknown, a homogeneous treatment is required to completely eradicate the disease while limiting side effects. To ensure homogeneous delivery, treatment planning software has been developed. This study compares simulation results with clinical data and evaluates the impact of nine treatment strategies on thermal and drug distributions. Methods For comparison with clinical data, three treatment strategies were simulated with different flow rates (1600-1800mL/min) and inflow temperatures (41.6–43.6 °C). Six additional treatment strategies were simulated, varying the number of inflow catheters, flow direction, and using step-up and step-down heating strategies. Thermal homogeneity and the risk of thermal injury were evaluated. Results Simulated temperature distributions, core body temperatures, and systemic chemotherapeutic concentrations compared well with literature values. Treatment strategy was found to have a strong influence on the distributions. Additional inflow catheters could improve thermal distributions, provided flow rates are kept sufficiently high (>500 mL/min) for each catheter. High flow rates (1800 mL/min) combined with high inflow temperatures (43.6 °C) could lead to thermal damage, with CEM 43 10 values of up to 27 min. Step-up and step-down heating strategies allow for high temperatures with reduced risk of thermal damage. Conclusion The planning software provides valuable insight into the effects of different treatment strategies on peritoneal distributions. These strategies are designed to provide homogeneous treatment delivery while limiting thermal injury to normal tissue, thereby optimizing the effectiveness of HIPEC.

Experiences of Street Harassment and the Active Engagement of Bystanders: Insights From a Swiss Sample of Respondents.

In this article, we analyze data from a survey conducted in the Swiss city of Fribourg to investigate the correlation between bystanders' experiences of street harassment and their likelihood of active engagement and strategies used to stop the harasser or assist and support targets of street harassment. Results reveal that, among bystanders, lifetime experiences of street harassment correlate positively with their ability to recognize street harassment conduct and the likelihood of intervention, support of the survivors, and reporting emergencies, even more significantly when the bystander endured physical abuse. In addition, behavioral differences among bystanders reflect different forms of resistance to the sexist culture that fuels street harassment. In light of these findings, we emphasize the need to integrate the narratives of the bystanders into awareness programs and campaigns, the importance of designing tools and policies to improve feelings of safety and limit street harassment conducts, including forms of benevolent sexism, and support further studies to assess the effectiveness of different intervention strategies in support of victims, including the need to research the use of digital media and its impact as a deterrent to street harassment or in increasing police reporting.

Overall Survival Outcome In Patients With New Treatment Approaches For Glioblastoma Multiforme In Randomized Controlled Trials (P3-13.004)

<h3>Objective:</h3> ○ Analyze and compare <b>the current standard treatment</b> for <b>glioblastoma multiforme</b> with <b>new treatment approaches</b> with an emphasis on overall survival in <b>randomized controlled trials</b>. <h3>Background:</h3> ○ <b>Glioblastoma multiforme</b> is the most common malignant brain tumor in adults, accounting for approximately 16% of all CNS neoplasms. The <b>current standard treatment</b> for glioblastoma consists of maximal surgical resection, radiotherapy and concomitant or adjuvant chemotherapy with temozolomide. While overall mortality remains high, the understanding of gene mutations and molecular mechanisms combined with clinical trials are opening new ways to approach this disease. <h3>Design/Methods:</h3> The search in <b>PUBMED/MEDLINE</b> included the keywords: “<b>Glioblastoma</b>”, “ <b>Temozolomide</b>”, resulting in 2,618 articles, the filter of the last 5 years was applied as well as randomized clinical trials, this yielded 37 results. A reading of the abstract and title was made. Referenced articles were also used. Finally, 12 articles were used. Subsequent analysis was performed with <b>PRISMA</b>. <h3>Results:</h3> Among the new treatment approaches, the use of Tumor – treating fields <b>(TTFields)</b> plus <b>temozolomide</b> increases progression free survival and overall survival compared to standard of care, while therapies such as <b>ipilimumab</b> plus <b>temozolomide</b> and <b>velipaprib</b> did not show significant differences in overall survival, progression free survival rate did not improve compared to the use of <b>radiotherapy</b> and <b>concomitant or adjuvant chemotherapia</b> with <b>temozolomide</b>. <h3>Conclusions:</h3> To summarize up due to the high mortality associated with glioblastoma, a search for efficacy of alternative treatments is necessary. The effect of different treatment strategies on survival and other health outcomes remains largely unknown, although in treating fields (TTFields) there was a statistically significant increase in survival, it is an efficient and safe treatment that will increase the overall survival in this disease where recurrence and lethality are high and where the quality and lengthening of life become the central axis. <b>Disclosure:</b> Ms. Castillo Vaca has nothing to disclose. Dr. Arreola Flores has nothing to disclose. Dr. Bermudez-Faz has received publishing royalties from a publication relating to health care. Dr. Chavez has nothing to disclose. Dr. Chavez has nothing to disclose. Mr. Carrillo Rodríguez has nothing to disclose. Ms. Estrada Posadas has nothing to disclose. Miss Estrada Ortega has nothing to disclose. Miss Rojas Martínez has nothing to disclose. Mr. Zamorano has nothing to disclose.

Developmental and/or epileptic encephalopathy with spike-and-wave activation in sleep in Saudi Arabia: Electroclinical, etiologic, genetic, and outcome multicenter study

ObjectivesTo investigate the clinical features of developmental and/or epileptic encephalopathy with spike-and-wave activation in sleep (D/EE-SWAS), its electrographic characteristics, and etiology and to compare the effects of different treatment strategies on the outcomes using a Saudi Arabian database. MethodsThis multicenter study included children with D/EE-SWAS who were evaluated between 2010 and 2020 at 11 tertiary centers. Data were collected on their baseline clinical features, etiologies, and treatment modalities. Seizure reduction, spike-wave index, and cognitive state were examined as potential therapeutic outcomes. ResultsNinety-one children were diagnosed with D/EE-SWAS, with a median age of 7 years (IQR: 3–5) and an almost equal sex distribution. The average age at which epilepsy was diagnosed was 3 years (IQR: 5–2). A genetic/metabolic etiology was found in 35.1% of the patients, and a structural etiology was found in 27.4%. Children with underlying genetic/metabolic diseases exhibited an earlier seizure onset (P = 0.001) than children with other etiologies. Benzodiazepines (76.6%) were the most common treatment, followed by steroids (51.9%). Sodium valproate (75%) was the most frequently used antiseizure medication, followed by levetiracetam (64.9%). Children with a later seizure onset were more likely to have better clinical responses (P = 0.046), EEG responses (P = 0.012), and cognitive outcomes (P = 0.006) than children with an earlier onset. Moreover, better seizure response and electrographic response were seen in patients with bilateral interictal discharges on the EEG than otherwise. Children had a higher likelihood of both clinical and electrographic improvement with combination therapy of benzodiazepines (P = 0.001) and steroids (P = 0.001) than with other therapies. SignificanceThis study shows a higher prevalence of genetic/metabolic causes and suggests the superior efficacy of combination therapy with steroids and benzodiazepines in D/EE-SWAS. Prospective studies that strictly assess the treatment protocols and outcomes are needed.

Rethinking on the management strategy of malignant phyllodes tumor of the breast: An analysis based on the SEER database.

Malignant phyllodes tumor of the breast (MPTB) is a rare breast neoplasm that has a high recurrence rate and its optimal treatment strategies remain controversial. Our study used the most up-to-date database to determine prognostic factors that predict cancer-specific survival (CSS) and to evaluate the effects of different treatment strategies for MPTB. We performed a retrospective cohort study using the National Cancer Institute's Surveillance, Epidemiology, and End Results database. Women who were diagnosed with MPTB from 2000 to 2019 were included. Kaplan-Meier method and Cox proportional hazards regressions were used to evaluate the prognostic power of variables on CSS. A total of 1902 women with MPTB were included in the study, with a median follow-up duration of 87.5 months. Age was found not to independently predict CSS in patients with tumors larger than 10 cm (P = .235). Mastectomy was performed on a total of 898 (47.2%) patients including 210 women (23.4%) undergoing radiotherapy after surgery. Mastectomy showed worse CSS when compared with breast-conserving surgery in patients with tumors smaller than 10 cm. Patients undergoing radiotherapy were not inferior to non-radiotherapy patients on CSS when patients were stratified by tumor size. Breast-conserving surgery showed survival benefits for patients with small tumors (T1 and T2). Patients with radiotherapy were not inferior to non-radiotherapy patients on CSS. Treatment of patients with MPTB should be carefully selected based on different tumor sizes.

Simulation of COVID-19 Outbreak in Nanjing Lukou Airport Based on Complex Dynamical Networks

The Corona Virus Disease 2019 (COVID-19) pandemic is still imposing a devastating impact on public health, the economy, and society. Predicting the development of epidemics and exploring the effects of various mitigation strategies have been a research focus in recent years. However, the spread simulation of COVID-19 in the dynamic social system is relatively unexplored. To address this issue, considering the outbreak of COVID-19 at Nanjing Lukou Airport in 2021, we constructed an artificial society of Nanjing Lukou Airport based on the Artificial societies, Computational experiments, and Parallel execution (ACP) approach. Specifically, the artificial society includes an environmental model, population model, contact networks model, disease spread model, and intervention strategy model. To reveal the dynamic variation of individuals in the airport, we first modeled the movement of passengers and designed an algorithm to generate the moving traces. Then, the mobile contact networks were constructed and aggregated with the static networks of staff and passengers. Finally, the complex dynamical network of contacts between individuals was generated. Based on the artificial society, we conducted large-scale computational experiments to study the spread characteristics of COVID-19 in an airport and to investigate the effects of different intervention strategies. Learned from the reproduction of the outbreak, it is found that the increase in cumulative incidence exhibits a linear growth mode, different from that (an exponential growth mode) in a static network. In terms of mitigation measures, promoting unmanned security checks and boarding in an airport is recommended, as to reduce contact behaviors between individuals and staff.

A comparison of concurrent chemoradiotherapy and radical surgery in patients with specific locally advanced cervical cancer (stage IB3, IIA2, IIICr): trial protocol for a randomized controlled study (C-CRAL trial).

At present, clinical dilemma remains to be solved in terms of therapy-choices for specific locally advanced cervical cancer (LACC) patients: 1) Although concurrent chemoradiotherapy (CCRT) is recommended as the first choice for them, many patients, influenced by the Chinese culture, prefer to choose radical surgery (RS) as their primary treatment. The difference between the 2 therapies in improving patient prognosis is still unknown. 2) Laparoscopy has been questioned since the noted Laparoscopic Approach to Cervical Cancer trial. Nevertheless, clinical research on laparoscopic surgery under the strict tumor-free principle is still underway globally, therefore whether laparoscopic surgery can be used for specific LACC is also an urgent issue to be explored. A multi-center, randomized controlled study is designed to investigate the effect of different treatment strategies on the prognosis and quality of life (QoL) in patients with specific locally LACC. A total of 402 patients will be enrolled over a period of 3 years. Eligible patients will be randomized (3:1) to either RS group or CCRT group. Patients assigned to RS group will be randomized (1:2) to the abdominal RS group or laparoscopic RS group. All patients will then be followed-up for 5 years. The primary end point is the 2-year progression-free survival (PFS). The secondary end points include 5-year PFS, 2-year overall survival (OS), 5-year OS, adverse events caused by RS or CCRT and QoL. Chinese Clinical Trial Registry Identifier: ChiCTR2000041315.

Commonalities for comorbidity: Overlapping features of the endocannabinoid system in depression and epilepsy.

A wealth of clinical and pre-clinical data supports a bidirectional comorbidity between depression and epilepsy. This suggests commonalities in underlying mechanisms that may serve as targets for more effective treatment strategies. Unfortunately, many patients with this comorbidity are highly refractory to current treatment strategies, while others experience a worsening of one arm of the comorbidity when treating the other arm. This highlights the need for novel pharmaceutical targets that may provide safe and effective relief for both depression and epilepsy symptoms. The endocannabinoid system (ECS) of the brain has become an area of intense interest for possible roles in depression and epilepsy. Several existing literature reviews have provided in-depth analysis of the involvement of various aspects of the ECS in depression or epilepsy separately, while others have addressed the effectiveness of different treatment strategies targeting the ECS in either condition individually. However, there is not currently a review that considers the ECS when both conditions are comorbid. This mini-review will address areas of common overlap between the ECS in depression and in epilepsy, such as commonalities in endocannabinoids themselves, their receptors, and degradative enzymes. These areas of overlap will be discussed alongside their implications for treatment of this challenging comorbidity.

Validation and practical use of Plan2Heat hyperthermia treatment planning for capacitive heating

Background Capacitive devices are used for hyperthermia delivery, initially mainly in Asia, but nowadays also increasingly in Europe. Treatment planning can be very useful to determine the most effective patient-specific treatment set-up. This paper provides a validation of GPU-based simulations using Plan2Heat for capacitive hyperthermia devices. Methods Validation was first performed by comparing simulations with an analytical solution for a spherical object placed inside a uniform electric field. Resolution was 5, 2.5 or 1 mm. Next, simulations for homogeneous and inhomogeneous phantom setups were performed for Thermotron RF8 and Celsius TCS capacitive heating devices at 2.5 mm resolution. Also different combinations of electrode sizes were evaluated. Normalized SAR profiles were compared to phantom measurements from the literature. Possible clinical use of treatment planning was demonstrated for an anal cancer patient, evaluating different treatment set-ups in prone and supine position. Results Numerical and analytical solutions showed excellent agreement. At the center of the sphere, the error was 5.1%, 2.9% and 0.2% for a resolution of 5, 2.5 and 1 mm, respectively. Comparison of measurements and simulations for both Thermotron RF8 and Celsius TCS showed very good agreement within 5% for all phantom set-ups. Simulations were capable of accurately predicting the penetration depth; a very relevant parameter for clinical application. The patient case illustrated that planning can provide insight by comparing effectiveness of different treatment strategies. Conclusion Plan2Heat can rapidly and accurately predict heating patterns generated by capacitive devices. Thus, Plan2Heat is suitable for patient-specific treatment planning for capacitive hyperthermia.