Effectiveness Of Treatment Research Articles

Effectiveness of treatment with budesonide orodispersible tablets in 76 patients with eosinophilic oesophagitis – real-life experience from the population-based DanEoE cohort

Background Eosinophilic oesophagitis (EoE) is a chronic immune-mediated disease. In Denmark, the budesonide orodispersible tablet (BOT) is recommended as a second-line treatment for proton pump inhibitor-refractory EoE patients. Aims To evaluate the effectiveness of treatment with BOT in adult EoE patients in a population-based setting in Denmark. Methods This was a retrospective, registry-based, DanEoE cohort study of all 76 adult EoE patients treated with BOT and diagnosed between 2007 and 2021 in the North Denmark Region. After medical record revision, the EoE diagnosis was defined according to the AGREE consensus. Symptomatic response was based on the information found in the patients’ medical reports and histologic remission was defined as <15 eosinophils per high-power field (eos/hpf). Results Histologic remission was achieved in 89% of the patients treated with BOT who underwent histologic evaluation. Clinicohistologic remission was achieved in 71% of the patients who underwent both symptomatic and histologic evaluation. Despite histologic remission, 18% of patients still experienced symptoms. Non-responders were found in 7% of the patients. Complications were rare, with dilation of strictures performed in 7% and food bolus obstruction (FBO) occurring in 3%. Discontinuation of the treatment due to unacceptable side effects was observed in 11% of the treated patients. Conclusions Treatment with BOT effectively induced histologic remission in most of the EoE patients. Despite achieving histologic remission, approximately 1/5 of the patients were still symptomatic. Complications were rare. In non-responders and those with unacceptable side effects, alternative treatment options such as biologic agents might be needed.

A - 27 Case Study Approach to Initial Exploration of Adaptations of Cognitive Behavioral Therapy (CBT) for Non-Epileptic Seizures (NES) in the Context of Cognitive Impairment

Abstract Objective The following case study seeks to review implementation of CBT for NES, discuss psychotherapeutic adaptations and outcomes while balancing treatment fidelity, and offer preliminary recommendations for expansion of psychotherapeutic modalities for individuals with cognitive impairment. Methods 49-year-old Hispanic male with a history of mixed epileptic (non-lesional frontal lobe medically refractory) and non-epileptic events. Neurological workup included video EEG, which captured seven events without EEG correlate and an unremarkable brain MRI. Neuropsychological evaluation indicated mild cognitive impairment due to epilepsy with deficits in processing speed, executive functioning, and confrontation naming with borderline to low average core visual and verbal abilities. The patient participated in manualized CBT for PNES. Results Treatment adaptations included extending treatment sessions from 12–19 sessions and including the patient’s sister. They read the chapters together and practiced strategies outside of session. She participated in helping him notice patterns of manifestations of fear and anger and their influence on somatic symptoms. Omission of treatment elements with higher cognitive demand (i.e., thought chart). Outcomes included increased awareness of emotions, triggers, and warnings but not episode reduction in the context of increased epileptic seizures. Conclusions Feasibility of treatment may be limited for individuals with mixed epileptic and NES episodes, particularly if there is cognitive impairment and difficulty differentiating between the two. Psychotherapeutic techniques that are concrete and behaviorally based will = be beneficial for individuals with cognitive impairment. Episode reduction in isolation is likely reductionistic when considering treatment effectiveness. Ability to self-manage episodes, quality of life, functional status, and self-efficacy are valuable markers of improvement.

Patient-to-patient value co-creation in online health communities: a systematic literature review and research agenda

Purpose The idea of value co-creation involves the benefit actors gain from integrating resources through activities and interactions within a service network, with the environment enabling high-quality collaboration. This paradigm highlights customers’ ability to co-create value with service providers and other customers. This idea is gaining traction in health care. These days, patients are no longer passive recipients of health-care services; rather they have started taking proactive roles in their self-health management. This study aims to understand the phenomenon of value co-creation among patients within online health communities (OHCs). Design/methodology/approach A systematic literature review of papers published from 2003 to 2024 in Web of Science-indexed journals was conducted. The review highlights theories, contexts, characteristics and methodologies in this area, synthesizing insights from previous research and presenting a future research agenda for underexplored and unexplored contexts using emerging theoretical perspectives and analytical methodologies. Findings The review illuminates theoretical and empirical studies on value co-creation among patients in OHCs. Previous research shows that value co-creation among patients leads to cognitive, affective and physical benefits such as reduced anxiety and stress, increased assurance and self-confidence, improved quality of life, enhanced patient empowerment, acceptance of disease and treatment effectiveness and a sense of self-worth and well-being. Originality/value This review synthesizes insights from previous works and outlines a research agenda for future studies in underexplored and unexplored contexts using new theoretical perspectives and methodologies. Considering the role social media plays in an individual’s life, this work will help in deep diving into the role of such online communities in the health-care sector.

Nanoengineered Injectable Hydrogel: An Advanced Radioprotective Barrier with Magnetic Hyperthermia Synergy.

Despite its effectiveness in eradicating cancer cells, current tumor radiotherapy often causes irreversible damage to the surrounding healthy tissues. To address this issue and enhance therapeutic outcomes, we developed a multifunctional injectable hydrogel that integrates electromagnetic shielding and magnetothermal effects. This innovation aims to improve the efficacy of brachytherapy while protecting adjacent normal tissues. Recognizing the limitations of existing hydrogel materials in terms of stretchability, durability, and single functionality, we engineered a composite hydrogel by self-assembling nickel nanoparticles on the surface of liquid metal particles and embedding them into an injectable hydrogel matrix. The resulting composite material demonstrates superior electromagnetic interference shielding performance (74.89 dB) and a rapid magnetothermal heating rate (10.9 °C/min), significantly enhancing its in vivo applicability. The experimental results confirm that this innovative nanocomposite hydrogel effectively attenuates electromagnetic waves during brachytherapy, thereby protecting normal tissues surrounding the tumor and enhancing radiotherapy efficacy through magnetothermal therapy. This study advances the safety and effectiveness of cancer treatments and provides new insights into the development of multifunctional biomedical materials, promoting the innovative application of nanotechnology in the medical field.

Exploring the Intersection of Body Dysmorphic Disorder (BDD) and Dermatological Conditions: A Narrative Review.

This narrative literature review examined the intricate relationship between body dysmorphic disorder (BDD) and dermatological conditions, with a brief focus on those characterized by conspicuous skin irregularities such as acne vulgaris, psoriasis, and vitiligo. Highlighting the significant prevalence of BDD among individuals afflicted with dermatological issues, our analysis illuminated the profound psychological repercussions stemming from an exaggerated preoccupation with perceived skin imperfections. Through an exploration of the underlying BDD symptoms, we analyzed the complex dynamics between skin health and mental well-being, emphasizing the disorder's impact on patients' psychological and social functioning. This narrative review further investigated the consequential effects of BDD on essential aspects of dermatological treatment, including patient adherence to therapeutic regimens, overall quality of life (QOL), and the effectiveness of available treatments. In addition to presenting current therapeutic approaches, we advocate for the integration of psycho-dermatological interventions tailored to mitigate the dual burden of skin conditions and psychological distress. Future research directions proposed include longitudinal studies to assess the long-term effects of BDD on skin disease prognosis and psychosocial well-being, which aim to refine and optimize treatment modalities to contribute to a more holistic understanding of BDD within dermatological practice.

Mn‐functionalized ZIF‐67 for Sensitive Colorimetric Detection of Artemisinin and Ascorbic Acid

AbstractArtemisinin (Art) is the first‐choice medicine for treating malaria. It also shows good therapeutic effects in antibacterial and antitumor treatment. Therefore, a simple and efficient method for detecting Art is of great significance. Mn‐functionalized ZIF‐67 (Mn@ZIF‐67) hybrid materials were synthesized using a post‐synthesis modification method. Due to the introduction of Mn2+, Mn@ZIF‐67 possesses higher peroxidase/oxidase like dual‐mimic enzymes activity than ZIF‐67, which can catalyze Art and generate peroxyl radicals. Based on this fact, Mn@ZIF‐67 was used to detect Art in the presence of TMB. A good linear relationship between absorption intensities at 652 nm and Art concentrations was obtained in the range of 0–22 μM with a detection limit of 200 nM. Ascorbic acid (AA), due to its reducibility, can inhibit peroxidase/oxidase mimetics activity of Mn@ZIF‐67 and the blue Mn@ZIF‐67‐TMB solution fades gradually with the addition of AA. Mn@ZIF‐67‐TMB acting as a colorimetric sensor, AA can be sensitively detected ranging from 0–30 μM, and the detection limit is 50 nM. Coexisting substances don't interfere with the detection of Art or AA. This sensing platform provides a highly sensitive and selective colorimetric method for monitoring AA and Art in serum, thereby demonstrating remarkable practicality.

Experts’ views on the implementation of digital interventions for eating disorders: a Delphi study

BackgroundEating disorders (EDs) constitute a considerable burden for individuals and society, but adequate and timely professional treatment is rare. Evidence-based Digital Mental Health Interventions (DMHIs) have the potential both to reduce this treatment gap and to increase treatment effectiveness. However, their integration into routine care is lacking. Understanding practitioners’ attitudes towards DMHIs for EDs is crucial for their effective use.AimsTo investigate the consensus among German ED treatment experts on the relevance of different influencing factors for DMHI use in EDs.MethodsThis Delphi study consisted of two rounds and was conducted online with an initial sample of N = 24 ED experts (Mage=41.96, SDage=9.92, n = 22 female). Prior to the Delphi rounds, semi-structured qualitative telephone interviews were performed to explore participants’ attitudes, experiences, and expectations towards DMHIs. In order to construct the Delphi survey, content analysis was applied to a subset of ten interviews. A total of 63 influencing factors were identified and grouped into three main categories: contextual conditions, design, and content of DMHIs. In both Delphi rounds, the interview participants were subsequently invited to rate each of the factors with regard to their importance on 10-point scales. Group percentages and individual ratings of the first round (n = 23) were presented in the second round (n = 21). Consensus was calculated for each item (defined as IQR ≤ 2).ResultsImportance ratings were high across items (M = 7.88, SD = 2.07, Mdn = 8). In the first round, 48% of the items reached consensus, with its most important (Mdn = 10) factors referring to data security, evidence base, technical requirements, usability, and specific DMHI content (psychoeducation, crisis intervention). In the second Delphi round, a consensus was reached on 73% of the items. No consensus was reached on 17 items.ConclusionsThe findings on practitioners’ attitudes and priorities have relevant implications for subsequent DMHI development, dissemination, and implementation strategies, indicating that the highest-rated factors should be highlighted in the process.

Development of an external system for monitoring the couch speed in radiotherapy using continuous bed movement.

Total body irradiation before bone marrow transplantation for hematological malignancies using Radixact, a high-precision radiotherapy machine, can potentially reduce side effects and the risk of secondary malignancies. However, stable control of couch speed is critical, and direct assessment methods outlined in quality assurance guidelines are lacking. This study aims to develop a real-time couch speed verification system for the Radixact. The developed system used a linear encoder to measure couch speed directly. Accuracy was verified via a linear stage, comparing measurements with a laser distance sensor. After placing a phantom simulating the human body on the Radixact couch, the couch speed was verified using predefined speed plans. Operating the linear stage at 0.1, 0.5, and 1.0mm/s revealed that the maximum position error of the developed verification system compared to the laser distance sensor was nearly equivalent to the distance resolution of the system (0.05mm/pulse), with negligible average speed error. When the Radixact couch operated at 0.1, 0.5, and 1.0mm/s, the values obtained by the verification system agreed with the theoretical values within the sampling period (0.01s) and distance resolution (0.05mm). The verification system developed provides real-time monitoring of the speed of the Radixact table, ensuring treatment effectiveness and patient safety. It would guarantee the couch speed's soundness and contribute to the "visualization" of safety.

Application of the upcycling trend using ultrafiltrate of water from the production of collagen from fish skin in hair care cosmetics.

The aim of the research problem of the article was to try to popularize the upcycling trend in the production of sustainable cosmetics and to confirm their effectiveness. The development of recycled raw materials is a new discovery in the chemical industry. Manufacturers emphasize the production of more environmentally friendly raw materials. Conscious consumers choose cosmetics whose production is based on sustainable development. Instead of throwing away waste from various industries, let us use it to produce active substances used in hair cosmetics. The production of the collagen series was created in accordance with the principles of upcycling, which involves obtaining collagen water, which is waste generated during the production of supplements. The main goal of the work was to learn cosmetic recipes for styling, washing and conditioning hair based on collagen waste, as well as to compare the results of people using the product in question. The aim of the study was also to demonstrate the effectiveness of the treatment in preventing split ends and hair breakage, usually caused by mechanical stress (brushing), as well as to confirm the effectiveness of other tests. The article presents procedures and parameters confirming the effectiveness of treatment with the tested hair products. The following tests were carried out: hair thickness and density, colour uniformity, shine factor and scalp hydration. All parameters numerically confirmed the beneficial effects of products containing collagen water used in hair care.

Consensus on a Patient-Centered Definition of Atopic Dermatitis Flare

Flare is a term commonly used in atopic dermatitis (AD) care settings and clinical research, but little consensus exists on what it means. Meanwhile, flare management is an important unmet research and treatment need. Understanding how various therapies might comparatively improve AD flares as a measure of treatment effectiveness may facilitate shared decision-making and enable assessment of effectiveness within and outside clinical settings. To identify patient-reported attributes associated with an AD flare to develop a patient-centered, consensus-based working definition. This consensus survey study used a modified eDelphi method involving consensus-building focus groups and a survey conducted from January 10 through October 24, 2023. Focus groups were conducted virtually, and the online survey was advertised to National Eczema Association members. US adults aged 18 years or older with AD were recruited via convenience sampling. Lived experience of AD. The main outcome was consensus on which attributes of AD to include in a patient-centric definition of flare. Using a rating scale (range, 1-9), consensus for the modified eDelphi statement rating was defined as at least 70% of participants rating a statement as 7 to 9 (critical to a flare definition) and less than 15% rating it as 1 to 3 (not important). Twenty-six participants with AD who completed focus group activities (24 aged 18-44 years [92.3%] and 2 aged 45-64 years [7.7%]; 18 women [69.2%]) and 631 participants with AD (mean [SD] age, 45.5 [18.1] years; 533 women [84.5%]) who completed the survey were included in the analysis. Fifteen statements reached consensus from the focus groups, and of those, 12 reached consensus from survey participants. More than half (334 of 631 [52.9%]) of survey participants reported alignment with their health care practitioner on what a flare is, and most (478 of 616 [77.6%]) reported that a patient-centered definition would be useful when communicating with their health care practitioner about their condition. In this study, participants with AD reached consensus on what an AD flare means from the patient perspective. This understanding may improve research and care by addressing this key patient-centered aspect of evaluating treatment effectiveness.

Green synthesis of polyethylene glycol coated, ciprofloxacin loaded CuO nanoparticles and its antibacterial activity against Staphylococcus aureus

Antibacterial resistance requires an advanced strategy to increase the efficacy of current therapeutics in addition to the synthesis of new generations of antibiotics. In this study, copper oxide nanoparticles (CuO-NPs) were green synthesized using Moringa oleifera root extract. CuO-NPs fabricated into a form of aspartic acid-ciprofloxacin-polyethylene glycol coated copper oxide-nanotherapeutics (CIP-PEG-CuO) to improve the antibacterial activity of NPs and the efficacy of the drug with controlled cytotoxicity. These NPs were charachterized by Fourier transform infrared spectroscopy (FTIR), x-rays diffraction spectroscopy (XRD), scanning electron microscopy (SEM) and energy-dispersive spectroscopy (EDS). Antibacterial screening and bacterial chemotaxis investigations demonstrated that CIP-PEG-CuO NPs show enhanced antibacterial potential against Gram-positive and Gram-negative clinically isolated pathogenic bacterial strains as compared to CuO-NPs. In ex-vivo cytotoxicity CIP-PEG-CuO-nano-formulates revealed 88% viability of Baby Hamster Kidney 21 cell lines and 90% RBCs remained intact with nano-formulations during hemolysis assay. An in-vivo studies on animal models show that Staphylococcus aureus were eradicated by this newly developed formulate from the infected skin and showed wound-healing properties. By using specially designed nanoparticles that are engineered to precisely transport antimicrobial agents, these efficient nano-drug delivery systems can target localized infections, ensure targeted delivery, enhance efficacy through increased drug penetration through physical barriers, and reduce systemic side effects for more effective treatment.

10. Complex regional pain syndrome.

Complex regional pain syndrome (CRPS) is a clinical disorder that can develop following surgery or trauma. Based on the most prominent underlying pathophysiological mechanisms, CRPS can be classified into different subtypes, namely inflammatory, nociplastic/neuropathic, vasomotor, and motor. Depending on the subtype, personalized treatment can be applied. If conservative treatments are insufficient or ineffective, more invasive treatments may be recommended. This article provides an overview of the most recent insights into CRPS and discusses the most common invasive treatments. The literature regarding interventional treatments for CRPS has been systematically reviewed and summarized. Bisphosphonates are effective in treating the inflammatory subtype, while ketamine can provide pain relief for the nociplastic/neuropathic subtype. Sympathetic blocks are effective in addressing vasomotor disturbances. For patients with refractory symptoms, neurostimulation is a viable option due to its multimechanistic properties for all subtypes. End-of-line motor disturbances may benefit from intrathecal baclofen. CRPS is a debilitating condition with an unpredictable course. The effectiveness of treatment varies from patient to patient. When conservative approaches prove insufficient, gradual progression to invasive treatments based on the underlying subtype is recommended.

Cladribine use trend in Latin America: the changes in patient profile impact in the drug effectiveness.

Cladribine was approved for Multiple Sclerosis (MS) inour country in 2018. A previous study by our group showed that its use among high efficacy therapiesoptions has been increasing along the years. to analyze the cladribineuse trend across time since its approval. A retrospective cohort study was performed. People withMS (pwMS) treated with cladribinewere included. Two periods were defined: P1 = 2018 - 2020 and P2 = 2021 - 2023. A comparative analysis was carry outbetween P1and P2 to assessthe trend of use, clinical/demographic characteristics, and effectiveness. One hundred ninety- seven people with MS (pwMS) were included, mean EDSS: 2.2 ± 3.08, 72.6% female, mean age: 35.2 ± 9years, mean disease duration: 6.6 ± 5.6years, mean time lapse under cladribine: 26.1 ± 12.4months. Regarding patient profile, we found significant differences between P1 and P2 in the MS evolution (p = 0.001) and EDSS (p = 0.018) prior to initiation of cladribine.In the individualized analysis by year, we found a decrease in relapse number in the year prior to starting cladribine (p = 0.02). Ahigher proportion of No Evidence of Disease Activity (NEDA) was found in patients treated at P2 compared to those treated at P1 (p < 0.001). An earlier use of cladribineachieved a significant increase in reaching NEDA. This learning curve in the use of cladribine allows a better identification of the candidate patient and influences the treatment effectiveness.

Low temperature conditioning and nitric oxide treatment reduced chilling injury and altered fatty acid metabolism of flat peaches

Low-temperature conditioning is a recognized method for alleviating chilling injuries in flat peaches. However, long-term low-temperature storage can mitigate volatile organic compounds, thereby limiting fruit availability. To improve the supply of flat peaches, we investigated the combined effects of low-temperature conditioning and nitric oxide treatment on various parameters including physiological quality, volatile organic compounds, fatty acids, associated enzymes, and genes involved in the fatty acid pathway with the transcriptome sequencing analysis. The results indicated that low-temperature conditioning coordinated with 10 µL L−1 nitric oxide treatment possessed higher firmness and vitamin C content and restricted the content of malonaldehyde and relative electrical conductivity, thus maintaining the overall quality of flat peaches. In the study, 10 µL L−1 nitric oxide was employed for subsequent experiments. Moreover, higher contents of volatile organic compounds were supported by increased contents of palmitic acid, stearic acid, oleic acid, linoleic acid, linolenic acid, alcohol dehydrogenase, hydroperoxide lyase, and up-regulated genes of LOX2, LOX3, LOX6, ADH2, and ADH3. In summary, nitric oxide treatment effectively facilitated the recovery of volatile organic compounds in flat peaches during cold storage. Therefore, low-temperature conditioning and nitric oxide treatment can be a promising strategy to prevent the loss of volatile organic compounds by modulating the fatty acid pathway and associated genes.

Public Preference for Off-Label Use of Drugs for Cancer Treatment and Relative Importance of Associated Adverse Events: A Discrete Choice Experiment and Best-Worst Scaling.

Patients may get more treatment options with off-label use of drugs while exposed to unknown risks of adverse events. Little is known about the public or demand-side perspective on off-label drug use, which is important to understand how to use off-label treatment and devise financial assistance. This study aimed to quantify public preference for off-label cancer treatment outcomes, process, and costs, and perceived importance of associated adverse events. A discrete choice experiment and a best-worst scaling were conducted in Hong Kong in December 2022. Quota sampling was used to randomly select the study sample from a territory-wide panel of working-age adults. Preferences and willingness to pay (WTP) for treatment effectiveness, risk of adverse events, mode of drug administration, and availability of off-label treatment guidelines were estimated using a random parameter logit model and latent class model. The relative importance of different adverse events was elicited using Case 1 best-worst scaling. A total of 435 respondents provided valid responses. In the discrete choice experiment, the respondents indicated that extra overall survival as treatment effectiveness (WTP: HK$448,000/US$57,400 for 12-month vs 3-month extra survival) was the most important attribute for off-label drugs, followed by the risk of adverse events (WTP: HK$318,000/US$40,800 for 10% chance to have adverse event vs 55%), mode of drug administration (WTP: HK$42,000/US$5300 for oral intake vs injection), and availability of guidelines (WTP: HK$31,000/US$4000 for available versus not available). Four groups with distinct preferences were identified, including effectiveness oriented, off-label use refusal, oral intake oriented, and adverse event risk aversion. In the best-worse scaling, hypothyroidism, nausea/vomiting, and arthralgia/joint pain were the three most important adverse events based on the perceptions of respondents. Risk-averse respondents, who were identified from the discrete choice experiment, had different perceived importance of the adverse events compared with those with other preferences. Knowing the preference and WTP for cancer treatment-related characteristics from a societal perspective facilitates doctors' communications with patients on decision making and treatment goal-setting for off-label treatment, and enables devising financial assistance for related treatments. This study also provides important insight to inform evaluations of public acceptance and information dissemination in drug development as well as future economic evaluations.

Common and differential EEG microstate of major depressive disorder patients with and without response to rTMS treatment

ObjectiveRepetitive transcranial magnetic stimulation (rTMS) has recently emerged as a novel treatment option for patients with major depressive disorder (MDD), but clinical observations reveal variability in patient's responses to rTMS. Therefore, it is clinically significant to investigate the baseline neuroimaging differences between patients with (Responder) and without (NonResponder) response to rTMS treatment and predict rTMS treatment outcomes based on baseline neuroimaging data. MethodBaseline resting-state EEG data and Beck Depression Inventory (BDI) were collected from 74 rTMS Responder, 43 NonResponder, and 47 matched healthy controls (HC). EEG microstate analysis was applied to analyze common and differential microstate characteristics of Responder and NonResponder. In addition, the microstate temporal parameters were sent to four machine learning models to classify Responder from NonResponder. ResultThere exists some common and differential EEG microstate characteristics for Responder and NonResponder. Specifically, compared to the HC group, both Responder and NonResponder exhibited a significant increase in the occurrence of microstate A. Only Responder showed an increase in the coverage of microstate A, occurrence of microstate D, transition probability (TP) from A to D, D to A, and C to A, and a decrease in the duration of microstates B and E, TP from A to B and C to B compared to HC. Only NonResponder exhibited a significant decrease in the duration of microstate D, TP from C to D, and an increase in the occurrence of microstate E, TP from C to E compared to HC. The primary differences between the Responder and NonResponder are that Responder had higher parameters for microstate D, TP from other microstates to D, and lower parameters for microstate E, TP from other microstates to E compared to NonResponder. Baseline parameters of microstate D showed significant correlation with Beck Depression Inventory (BDI) reduction rate. Additionally, these microstate features were sent to four machine learning models to predict rTMS treatment response and classification results indicate that an excellent predicting performance (accuracy = 97.35 %, precision = 96.31 %, recall = 100 %, F1 score = 98.06 %) was obtained when using AdaBoost model. These results suggest that baseline resting-state EEG microstate parameters could serve as robust indicators for predicting the effectiveness of rTMS treatment. ConclusionThis study reveals significant baseline EEG microstate differences between rTMS Responder, NonResponder, and healthy controls. Microstates D and E in baseline EEG can serve as potential biomarkers for predicting rTMS treatment outcomes in MDD patients. These findings may aid in identifying patients likely to respond to rTMS, optimizing treatment plans and reducing trial-and-error approaches in therapy selection.

Effectiveness of mobile smoking cessation treatment with 1-week nicotine replacement therapy sampling at outdoor smoking hotspots: A cluster randomized controlled trial.

To evaluate the effectiveness of mobile smoking cessation (SC) treatment with 1-week nicotine replacement therapy (NRT) sampling on recruitment and quitting outcomes. Two-arm cluster RCT (1:1 ratio), single-blinded, at 244 recruitment sessions in Hong Kong outdoor smoking hotspots from October 2018-December 2019. Participant were recruited by ambassadors and treated at the mobile SC truck. 834 adult (≥18 years, male 81.3%) daily smokers, Chinese-speaking, non-NRT users in the past month, consented after nurse-led intervention in mobile SC truck were randomized to the experimental (n = 482 male 79.5%) and the control group (n = 352, male 83.8%). The experimental group received a 1-week free NRT sample, an NRT instruction card, and mobile SC treatment including onsite nurse-led brief medication advice (about 15 minutes) and referral to SC clinics. The control group received the same mobile SC treatment. Primary outcome was self-reported quit attempts at 1-month follow-up. Secondary outcomes included SC service use at 1month, and biochemically validated abstinence (exhaled carbon monoxide < 4ppm; or saliva cotinine < 10ng/ml) at 6-month follow-up. Additionally, a post-hoc cost analysis was conducted. By intention-to-treat, the two groups showed similar prevalence of quit attempts (44·4% versus 43·5%, risk ratio (RR) = 1·04, 95% confidence interval (CI) = 0·79-1·37, P = 0·79). Compared with the control group, the experimental group showed lower SC service use at clinics (32·4% versus 44·9%, RR = 0·72, 95%CI = 0·57-0·91, P = 0·006), but no significant difference in validated abstinence (4·6% versus 2·8%, RR = 1·64, 95%CI = 0·76-3·50, P = 0·21). The experimental recruitment sessions recruited more smokers for onsite medication advice than the control session (mean 6·7 vs 5·0, adjusted incident rate ratio = 1·30, 95%CI = 1·08-1·56, P = 0·005). Mobile smoking cessation treatment with 1-week nicotine replacement therapy sampling did not increase quit attempts or abstinence outcomes among recruited daily smokers in Hong Kong. The intervention increased smokers' uptake of onsite medication advice but reduced subsequent smoking cessation service use at clinics.

Hormonal Treatments and Vaginal Moisturizers for Genitourinary Syndrome of Menopause : A Systematic Review.

Postmenopausal women commonly experience vulvovaginal, urinary, and sexual symptoms associated with genitourinary syndrome of menopause (GSM). To evaluate effectiveness and harms of vaginal estrogen, nonestrogen hormone therapies, and vaginal moisturizers for treatment of GSM symptoms. Medline, Embase, and CINAHL through 11 December 2023. Randomized controlled trials (RCTs) of at least 8 weeks' duration enrolling postmenopausal women with at least 1 GSM symptom and reporting effectiveness or harms of hormonal interventions or vaginal moisturizers. Risk of bias and data extraction were performed by one reviewer and verified by a second reviewer. Certainty of evidence (COE) was assessed by one reviewer and verified by consensus. From 11 993 citations, 46 RCTs evaluating vaginal estrogen (k = 22), nonestrogen hormones (k = 16), vaginal moisturizers (k = 4), or multiple interventions (k = 4) were identified. Variation in populations, interventions, comparators, and outcomes precluded meta-analysis. Compared with placebo or no treatment, vaginal estrogen may improve vulvovaginal dryness, dyspareunia, most bothersome symptom, and treatment satisfaction. Compared with placebo, vaginal dehydroepiandrosterone (DHEA) may improve dryness, dyspareunia, and distress, bother, or interference from genitourinary symptoms; oral ospemifene may improve dryness, dyspareunia, and treatment satisfaction; and vaginal moisturizers may improve dryness (all low COE). Vaginal testosterone, systemic DHEA, vaginal oxytocin, and oral raloxifene or bazedoxifene may provide no benefit (low COE) or had uncertain effects (very low COE). Although studies did not report frequent serious harms, reporting was limited by short-duration studies that were insufficiently powered to evaluate infrequent serious harms. Most studies were 12 weeks or less in duration and used heterogeneous GSM diagnostic criteria and outcome measures. Few studies enrolled women with a history of cancer. Vaginal estrogen, vaginal DHEA, oral ospemifene, and vaginal moisturizers may improve some GSM symptoms in the short term. Few long-term data exist on efficacy, comparative effectiveness, tolerability, and safety of GSM treatments. Agency for Healthcare Research and Quality and Patient-Centered Outcomes Research Institute. (PROSPERO: CRD42023400684).

Analysis of High-Dose Ascorbate-Induced Cytotoxicity in Human Glioblastoma Cells and the Role of Dehydroascorbic Acid and Iron

Several studies have demonstrated, both in vitro and in animal models, the anti-tumor efficacy of high-dose ascorbate treatment against a variety of tumor entities, including glioblastoma, the most common and aggressive primary malignant brain tumor. The aim of this study was to investigate the effects of high-dose ascorbate as well as dehydroascorbic acid on human glioblastoma cell lines and to evaluate different treatment conditions for the combined administration of ascorbate with magnesium (Mg2+) and iron (Fe3+). Intracellular levels of reactive oxygen species and the induction of cell death following ascorbate treatment were also investigated. We demonstrated high cytotoxicity and antiproliferative efficacy of high-dose ascorbate in human glioblastoma cells, whereas much weaker effects were observed for dehydroascorbic acid. Ascorbate-induced cell death was independent of apoptosis. Both the reduction in cell viability and the ascorbate-induced generation of intracellular reactive oxygen species could be significantly increased by incubating the cells with Fe3+ before ascorbate treatment. This work demonstrates, for the first time, an increase in ascorbate-induced intracellular ROS formation and cytotoxicity in human glioblastoma cells by pre-treatment of the tumor cells with ferric iron, as well as caspase-3 independence of cell death induced by high-dose ascorbate. Instead, the cell death mechanism caused by high-dose ascorbate in glioblastoma cells shows evidence of ferroptosis. The results of the present work provide insights into the efficacy and mode of action of pharmacological ascorbate for the therapy of glioblastoma, as well as indications for possible approaches to increase the effectiveness of ascorbate treatment.

Effectiveness of Systematic Screening and Treatment of Tuberculosis in Prison in Thailand.

The global incidence of tuberculosis (TB) in prison is 5 to 70 times greater than that in the general population. The systematic screening and treatment of TB in prison benefit TB control and treatment outcomes. However, no study has supported this in Thailand. Here, we evaluated the effectiveness of long-term, continuous, systematic screening for TB control. We conducted a retrospective study in Suratthani Central Prison, Thailand, using annual TB screening from 2016 to 2020. A positive TB screening was defined as having any TB symptoms or chest radiography abnormality. We collected sputum smear and Xpert® Mycobacterium tuberculosis/rifampicin (MTB/RIF) results from those inmates with positive screening results. Bacteriologically confirmed TB was defined as a positive sputum smear or M. tuberculosis detected by Xpert assay. Inmates with clinically diagnosed TB were also eligible for this study. Those inmates diagnosed with active TB were sent to an isolation zone in prison and received anti-TB medicine using directly observed therapy and were monitored by pulmonologists during the treatment course via telemedicine. Of 18,965 TB screening events, 175 patients were diagnosed with TB. The 5-year prevalence was 922 per 100,000 inmates. The relative reduction in TB prevalence was 60.5% from 2016 to 2020. Overall, 94.3% of TB patients were successfully treated (sum of patients cured and treatment completed). Three TB patients died during the 5-year study period. All occurred in 2016. The systematic screening and treatment of TB in inmates effectively reduced the prevalence and mortality in Suratthani Central Prison. The success rate of treatment in this prison has been consistently high.