Effect Of Treatment Modification Research Articles

Risk Factors for Emergency Room Visits in Patients with Digestive Bleeding Associated with Direct-Acting Anticoagulants

Gastrointestinal bleeding is the main cause of admission to the emergency services of patients taking direct-acting oral anticoagulants (DOACs). Little is known about the effects of treatment modification on the risk of readmission, especially in elderly patients. This retrospective observational study included elderly patients with atrial fibrillation who were on DOACs and who were admitted to the emergency department due to gastrointestinal bleeding from 2018 to 2023. To evaluate the risk factors for readmission 90 days after discharge, a multivariate analysis was conducted, which included patient comorbidities, concomitant treatment, changes in anticoagulant treatment, and the prescription of DOACs at discharge. One hundred and thirty-nine patients were included. At discharge, anticoagulant therapy was modified in 44 (31.6%) patients, 16 (36.3%) patients were switched from one DOAC to another, 23 (52.2%) to heparins, and 5 (11.3%) to vitamin K antagonists. A total of 21 (15.1%) patients returned to the emergency department within 90 days after discharge due to new bleeding events. No significant differences were observed depending on the modification of treatment at discharge. The presence of cognitive impairment was the only factor associated with readmission at 90 days. Patients who undergo treatment with DOACs and have gastrointestinal bleeding at discharge are at risk of readmission to the emergency room due to new bleeding events. No benefit was observed in modifying anticoagulant treatment at discharge.

Investigating the Effect of Smoke Treatment on Hygroscopic Characteristics of Bamboo by FTIR and Raman Spectroscopy.

Treatment modification to improve the durability of bamboo against biotic and abiotic factors often results in adverse effects to its mechanical properties due to changes in hygroscopic characteristics. This study aims at exploring in more detail, the effect of treatment modification, in particular smoke treatment, on the hygroscopic nature of bamboo. In the first part of this study, changes to its chemical structure were investigated by Raman and Fourier-transform infrared (FTIR) spectroscopic techniques. From Raman analysis, specific bands attributed to lignin component in bamboo, namely at 1600 cm−1 and 1632 cm−1, which varied in intensities among treated and untreated specimens, could be considered to assess the extent of treatment modification. Besides, FTIR results showed that the chemical constituents of bamboo inner and outermost surfaces vary extensively with distinctive changes during treatment modification. The steam component in smoke treatment is assumed to cause a slight increase in the moisture content in the outermost surface of smoked bamboo as evidenced by FTIR results. In addition, the hydrophobic surface of smoked bamboo, which was affected during smoke treatment modification due to superior mean roughness parameter in its outermost surface, impacted its water-repelling ability. From FTIR results, an increase in lignin in bamboo was confirmed at peak 1114 cm−1, which occurred as a result of thermal effect above a temperature of 100 °C leading to poly-condensation reactions. The increase in lignin is assumed to cause an overall increase in hardness of smoked bamboo which was found to be two-fold higher when compared with the untreated ones. The approach of this research investigation, which has shown the benefit of using spectroscopic techniques to monitor and understand the changes in the hygroscopic nature of bamboo surfaces, can likewise be considered to predict the corresponding effects of treatment modification or degradation on the mechanical properties of natural materials.

Gimema Registry of Conception/Pregnancy in Adult Italian Patients Diagnosed with Chronic Myeloid Leukemia (CML): Report on 166 Outcomes

Background. The availability of multiple tyrosine kinase inhibitors (TKIs) and precise molecular monitoring has dramatically changed the prognosis in CML patients. With proper medical management, the planning of a pregnancy in both male (M) and female (F) patients is now possible. Towards this goal, the GIMEMA CML working party initiated a retrospective and prospective study to describe all male conceptions/female pregnancy outcomes in the CML Italian population from January 2013.Aims. The specific aims of this study were to analyze conceptions and pregnancies in male and female patients with regard to 3 general issues: 1) Illness issues, including CML treatment prior to conception/during/after pregnancy, transcript kinetics, the recovery of a lost response after therapy cessation, and the effects of treatment modifications (e.g., resistance, switching); 2) Conception/pregnancy issues, including planned, unplanned, spontaneous and medically assisted pregnancies (MAP), spontaneous/elective abortions, pregnancy progression, delivery, and breast feeding; and , 3) Post-natal health issues from birth to walking including speaking and academic performance.Patients and methods. Patients included in the study had to meet the following criteria A) Age >18 yrs; B) Confirmed CML diagnosis; C) Conception or pregnancy; D) TKI treatment before, during and/or after pregnancy; and E) Signed, IRB-approved written informed consent form. Of the 143 enrollees, data were obtained from 135 patients (83M and 52F). A total number of 166 cases were analyzable. Male conceptions were 106, and female pregnancies 60.Results 1) At time of conception 34 patients had no treatment (TF), 8 received interferon-a (IFN), and the remaining were treated with a TKI (Table 1). Considering only female patients, all stopped TKI treatment when pregnancy was discovered at 3-6 weeks (w). After placental maturation (>20w) 13 patients were treated with IFN (10), 2 with Imatinib, and 1 with Nilotinib (N). In this latter patient N concentration was tested in maternal plasma and cord blood at delivery and showed no transfer to the baby. Kinetics of rise was calculated in a subgroup of 17 patients. Doubling time [DT = duration x log(2) /log (final ratio)-log (initial ratio)] exhibits a bimodal trend, very short for some patients (5.8 days mean, range 4.5-8.2) and much longer for others (182 days mean, range 59.2-328.4), This result does not correlate with molecular status pre TF. Furthermore 76.5% of patients will not lose Major Molecular Response during pregnancy, while in TF, that is more than expected when compared to non pregnant controls (TFR). No cases of CML progression or resistance to re-treatment were observed. CML transcript ratios during pregnancy are shown in Fig.1.2) The majority of pregnancies were planned. MAPs were reported in 5M and 3F. Two spontaneous conceptions occurred in 2M after allogeneic transplant. Eleven abortions before 12 w (2 M ,induced; 9F, 5 induced) were reported (not included in the 166 cases). Pregnancies in all cases progressed normally. In F there were 2 pre-eclampsia, 2 oligohydramnios, 1 abruption placenta. In 8M and 8 F babies were born pre term and 1M and 2F were small at birth with no further consequences. Forty-two F (70%) delivered spontaneously. Babies were born at a mean 40 w (34-44) in M, 39 w (33-42) in F. Breast feeding information was collected for 45F of which18 (29%) breast feed for at least one month (range 1-28 mo).3) Post-natal information showed normal child development and growth. One respiratory arrest was noted at birth with rapid recovery and 1 macrocephaly was described with no further consequences. Of the 56 children >3 yrs old attending school (44M,12F), 2M presented with language problems and in one case autism was diagnosed. Other reported outcomes include 1 child diagnosed as having rheumatoid arthritis at 2 yr (F), and 1 diagnosed with celiac disease (M).Conclusions TKI therapy has allowed CML patients to pursue a normal life including planning/managing a family. Males do not need to stop therapy to conceive due to the therapy's non-genotoxic nature, in contrast to females who must cease therapy due to the teratogenic nature of TKIs. Kinetics of regrowth of the CML residual disease during pregnancy in female patients is different than in TFR patients. To our knowledge this is the largest multicentric study regarding CML and reproduction. Results and practical management will be presented. [Display omitted] DisclosuresAbruzzese:Novartis: Research Funding; Pfizer: Consultancy; Ariad: Consultancy; BMS: Consultancy. Castagnetti:Incyte: Consultancy, Honoraria; Bristol Myers Squibb: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; Pfizer: Consultancy, Honoraria. Gambacorti-Passerini:Pfizer: Consultancy, Honoraria, Research Funding; BMS: Consultancy. Rambaldi:Pfizer: Consultancy; Novartis: Consultancy; Italfarmaco: Consultancy; Omeros: Consultancy; Roche: Consultancy; Celgene: Consultancy; Amgen Inc.: Consultancy. Gaidano:Roche: Consultancy, Honoraria; Morphosys: Honoraria; AbbVie: Consultancy, Honoraria; Gilead: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; Amgen: Consultancy, Honoraria.

Overview of HIV-related lipodystrophy

Lipodystrophy is a well-recognised adverse effect of HIV and antiretroviral therapy, with certain antiretrovirals, specifically thymidine analogues, implicated in the aetiology and pathogenesis. Lipodystrophy is often accompanied by metabolic complications, such as hyperlipidaemia and insulin resistance, which increase risk for cardiovascular disease. There are limited data on the effect of treatment modification, pharmacological interventions and surgical management on this condition. Here we summarise the latest data on lipodystrophy, with the aim of facilitating informed decision-making in managing this condition. In light of the absence of cost-effective measures to treat lipoatrophy and lipohypertrophy, prevention remains the best option; we recommend targeted annual screening. Healthcare workers should be sensitised to early detection in patients on thymidine-based regimens, and affected patients should be switched to an appropriate regimen as soon as feasible. There is no evidence to support the use of new-generation ARVs, except in patients with significant hypercholesterolaemia, where atazanavir and raltegravir may present better options. S Afr J HIV Med 2013;14(1):29-33. DOI:10.7196/SAJHIVMED.871

Overview of HIV-related lipodystrophy

Lipodystrophy is a well-recognised adverse effect of HIV and antiretroviral therapy, with certain antiretrovirals, specifically thymidine analogues, implicated in the aetiology and pathogenesis. Lipodystrophy is often accompanied by metabolic complications, such as hyperlipidaemia and insulin resistance, which increase risk for cardiovascular disease. There are limited data on the effect of treatment modification, pharmacological interventions and surgical management on this condition. 
 Here we summarise the latest data on lipodystrophy, with the aim of facilitating informed decision-making in managing this condition. In light of the absence of cost-effective measures to treat lipoatrophy and lipohypertrophy, prevention remains the best option; we recommend targeted annual screening. Healthcare workers should be sensitised to early detection in patients on thymidine-based regimens, and affected patients should be switched to an appropriate regimen as soon as feasible. There is no evidence to support the use of new-generation ARVs, except in patients with significant hypercholesterolaemia, where atazanavir and raltegravir may present better options.
 
 S Afr J HIV Med 2013;14(1):29-33. DOI:10.7196/SAJHIVMED.871

Effect of Treatment Modification by the Initial Response in Patients with High-Risk Childhood Acute Lymphoblastic Leukemia

Background: The bone marrow (BM) findingd on day 7 of induction chemotherapy is one of major prognostic factors for patients with acute lymphoblastic leukemia (ALL). M3 marrow (blast ＞25% on BM examination) on day 7 is associated with lower survival rates, compared with the M1 (blast ＜5%) or M2 (blast 5∼25%) marrow. Herein, we analyzed the effect of augmented post-induction chemotherapy in patients who have high-risk ALL with M3 marrow on the day 7 BM examination. Methods: We analyzed the patients who were diagnosed with high-risk ALL and they received modified Children's Cancer Group (CCG)-1882 induction chemotherapy between January 1996 and October 2005 at Seoul National University Children’s Hospital. The patients with M1 or M2 marrow on day 7 were treated with modified CCG-1882A/B chemotherapy from consolidation, and the patients with M3 marrow were treated with modified CCG-1882C chemotherapy. Results: A total of 44 patients (29 with modified CCG-1882A/B and 15 with modified CCG-1882C) were analyzed. The overall survival (OS) and 5-year event-free survival (EFS) were 86.2% and 81.9%, respectively. The OS of the patients who were treated with the modified CCG-1882A/B protocol (88.9%) was not different from that of the patients who were treated with the modified CCG-1882C protocol (80.0%) (P=0.3256). Also, there was no statistical difference in the 5-year EFS of both groups (85.4% vs 72.7%, respectively, P=0.2117).Conclusions: There was no difference of survival between the patients with M1/M2 marrow on the day 7 BM examination and those with M3 marrow after augmented post-induction chemotherapy for the pa-tient with high-risk ALL. We suggest that the poor prognosis of high-risk ALL patients with a poor initial response could be overcome by augmented post-induction chemotherapy. (Korean J Hematol 2008;43:238-246.)

The Effects of Altering Seagrass Canopy Height on Small, Motile Invertebrates of Shallow Mediterranean Embayments

Abstract. The height of seagrass canopy was manipulated in experimental plots in meadows of the fine‐leaves seagrass Cymodocea nodosa at two sites in the Mediterranean Sea, la Lagune du Brusc, Iles des Embiez near Toulon, and I'Etang de Diana on Corsica. Epifauna (small motile invertebrates associated with the seagrass canopy or sediment surface), was collected at night at both sites, and during the day at Diana only, from three treatments: full seagrass canopy, reduced canopy, and canopy removed entirely. Although epifaunal assemblages from the two sites were different, treatment modification had the same effect at both sites when analysed using multivariate ordinations. Abundance and biomass of total epifauna and of key taxa were all reduced in line with decreasing seagrass cover at both sites at night. The effects of treatment modification on epifauna during the day showed the same trend but were of greater magnitude, both for assemblages and for total abundance and biomass. At both sites and at both times, the fauna of plots from which seagrass had been cut tended to be dominated by animals of higher biomass than the fauna of plots with full canopy. Epifauna form the major dietary component of small fish inhabiting shallow, sheltered embayments. These results are therefore consistent with a model in which reduced abundance of fish associated with reduced seagrass canopy is explained by a reduction in food availability.

The X-Ray Diffraction Measurement of Residual Stresses in Aluminum Alloys

AbstractThis paper presents the theoretical and practical aspects of measuring residual stresses by X-ray diffraction with emphasis on the analysis of aluminum alloys. The theoretical considerations of radiation) beam geometry, and peak location will be discussed in regard to establishing optimum analysis techniques. The precision and reproducibility of this technique have been investigated so that results can be applied accurately. The approach, however, is basically a practical one, with the intent of studying residual stress systems as they affect engineering applications. Residual stress systems produced by thermal and mechanical treatments have been determined and the effect of treatment modifications and variations on the resultant stress system have been analyzed. The effect of operational variables such as time and temperature on the developed stress system are shown. From this, the merits of a particular treatment can be determined with respect to its intended application.Analysis of solution heat-treated and quenched 2014 aluminum has shown a significant effect of the quench temperature on the resultant residual stress system. The results obtained from shot-peening this alloy are presented, as well as the effect of time and temperature on the shot-peened stress gradient.