Evaluation Of Different Treatment Modalities Research Articles

Evaluation of different treatment modalities for vital pulp of immature permanent molars: a randomized clinical trial

The study aimed to assess the efficacy of hydroxypropyl guar (HP) formulation (Systane) to protect tear film parameters under desiccating environment using protection and relief treatment modalities. The subjects were exposed to adverse environmental conditions using a Controlled Environment Chamber (CEC) where the relative humidity (RH) was 5% and the ambient temperature was 21 °C and screened for Tear break-up time (TBUT), Tear film evaporation rate (TFER) and lipid layer thickness (LLT) using the HIRCAL grid, Servomed EP3 Evaporimeter and Keeler’s TearScope-Plus respectively. Significant improvement in LLT was noticed in the protection modality. The mean tear film evaporation rate doubled after exposure to the humidity of 5% to a value of 105.37 g/m2/h (0.29 µl/min). All subjects displayed a significant reduction in non-invasive tear break-up time (NITBUT) with a mean NITBUT of 7.7 s after exposure to a desiccating environment for 15 min. A significant increase in NITBUT after the instillation of the drops was recorded in both methods. The results obtained from this study showed that a solution containing HP-Guar significantly improves tear film parameters under a desiccating environment. Apart from the tear evaporation rate, all tear parameters showed improvement after the use of HP-Guar eye drops. It is evident that tear film parameters respond differently to the management modalities and using CEC has the potential to provide researchers with a readily available method to evaluate the efficiency of tear supplementation.

To provide perspectives on preoperative diagnosis and conservative treatment for diffuse uterine leiomyomatosis (DUL). The clinical characteristics, management, and outcome of the five cases diagnosed with DUL receiving surgical treatment at Peking Union Medical College Hospital between January 2010 and December 2021 were retrospectively analyzed. DUL is a diagnosis based on histopathology. It is a subtype of uterine leiomyoma, characterized by innumerable, poorly circumscribed hypercellular nodules of bland smooth muscle cells with no cytologic atypia diffusely involving the myometrium. Clinical manifestations, including menorrhagia, anemia, and infertility, are similar to those of typical uterine leiomyomas, making a definitive preoperative diagnosis difficult. Magnetic resonance imaging plays an important role in the pre-treatment mapping. Conservative surgery can reduce the uterine volume and improve the contour of the uterine cavity, thereby relieving symptoms of menorrhagia and improving the chance of conception. Gonadotropin-releasing hormone (GnRH) agonist therapy is of great significance for controlling vaginal bleeding, reducing uterine volume, and delaying postoperative recurrence, and can be used alone or as postoperative adjuvant therapy for conservative surgery. The treatment goal for DUL patients with fertility-sparing request should not aim at complete fibroid removal. A successful pregnancy can be achieved following conservative surgery and/or GnRH agonist therapy.

POSB153 Health Economic Evaluation of Different Treatment Modalities for Extracorporeal Photopheresis: Can New Alternatives Generate Health Economic Value?

Simple bone cysts (SBCs) occur most frequently in the proximal aspect of the humerus and femur in growing age and are associated with intercurrent pathological fractures in up to 87%. Therapeutic management of SBCs remains controversial. The aim of this study was to examine the outcome of conservative and various surgical treatment modalities considering the specific anatomic location and integrity of the SBC.In this retrospective study, we analyzed 68 cases of SBCs who underwent a conservative or surgical treatment between 2009 and 2020 with a mean follow-up of 30.1 months. The epidemiological characteristics, complications, clinical, and radiographic outcome after conservative or surgical treatment were assessed.The study includes 50 male (73.5%) and 18 female (26.5%) patients with a mean age of 9.1 years. The most common locations were the proximal humerus (69.2%, n = 47) and femur (16.2%, n = 11). In 43 cases (63.2%; upper limb n = 40, lower limb n = 3) a pathological fracture occurred. Fifty patients (73.5%; upper limb n = 40, lower limb n = 10) underwent a conservative treatment. In 11 cases (16.2.1%; upper limb n = 4, lower limb n = 7) an intralesional curettage and defect reconstruction with bone substitute without stabilization were performed. Five patients (7.3%; upper limb n = 4, lower limb n = 1) received an osteosynthesis, in two cases (2.9%; upper limb 1; lower limb 1) combined with an intralesional curettage and defect reconstruction with bone substitute. All 32 pathological fractures treated conservatively (upper limb n = 31, lower limb n = 1) healed within 6 weeks; 17/43 patients (39.5%) suffered at least one second fracture. After intralesional curettage and defect reconstruction with bone substitute local recurrence was observed in 5/13 cases (38.5%). Spontaneous consolidation, at least partially, was observed in three cases (4.4%) following conservative treatment after fracture. No relevant secondary angular or torsional deformity was observed after treatment.The majority of SBCs can be treated conservatively, especially in the upper extremity. However, if a fracture is completely dislocated, joint affecting, unstable or open, surgical treatment is necessary. Load-dependent pain or the inability to mobilize timely after fracture can necessitate surgical treatment in SBCs affecting the lower extremity. Spontaneous resolution, especially after fracture, can be seen in rare cases.

Acute appendicitis (AA) is the leading cause of surgical acute abdomen worldwide, with a prevalence of approximately 7% of the population. The present study was conducted to compare different treatment modalities of acute appendicitis. 102 cases of acute appendicitis undergoing appendectomy were divided into 2 groups of 51 each. Group I patients were managed with laparoscopy appendectomy and Group II patients were managed with open appendectomy. Symptoms and parameter such as requirement of oral feed started postoperatively, average hospital stay, wound abscess and wound infection were recorded. Group I had 31 males and 20 females and group II had 35 males and 16 females. Symptoms were fever in 22 in group I and 14 in group II, abdominal pain 48 in group I and 44 in group II and nausea/vomiting 31 in group I and 30 in group II. The mean hospital stay was 5.2 days in group I and 4.3 days in group II, wound abscess was seen in 2 in group I and 5 in group II and wound infection 3 in group I and 7 in group II and oral feed started postoperatively at mean of 5.4 days in group I and 3.2 days in group II. The difference was significant (P< 0.05). There were less complications and better outcome in laparoscopic appendectomy as compared to open appendectomy.

Focus Area: Supporting Behavioral ChangeRigorous quality improvement and outcome reporting within interdisciplinary academic integrative health centers (IHCs) is a realm requiring significant focus in an era of skyrocketing healthcare costs, especially in management of complex chronic illness. In one southeastern US academic IHC seeing primarily (>80%) patients with chronic pain, treatment modalities include yoga, physical therapy (PT), cognitive-based therapy (CBT), acupuncture, and group therapy. A random sample of returning patients at this IHC completed a paper survey querying the following: treatment length and modalities used as a patient at this IHC; current pain, fatigue, and anxiety levels (0–10); change in pain, fatigue, anxiety, and quality of life (−5, “much worse,” to 5, “much better”) since first visit to this IHC. Seventy-seven responses were collected. Mean and median scores were calculated for current pain (m=3.9, SD=2.6, M=4), fatigue (m=4.7, SD=3.0, M=4), anxiety (m=3.5, SD=2.7, M=3), as well as changes in QOL (m=2.8, SD=1.7, M=3), pain (m=2.4, SD=1.9, M=3), anxiety (m=2.4, SD=1.7, M=3), and fatigue (m=1.8, SD=1.7, M=3). Increasing time following treatment was associated with improved QOL (P=.045, r=0.232) as was an increasing number of services utilized (P=.021, r=0.263). Associated with these QOL changes were improved pain (P<.01, r=0.561), fatigue (P<.01, r=0.604), and anxiety (P<0.01, r=0.495) while more severe current pain (P=.002, r=−.347) and fatigue (P=.015, r=−0.277) upon survey completion inversely predicted QOL change. A two-tailed t-test revealed that patients finding PT useful reported improved QOL (P=.008), anxiety (P=.008), fatigue (P=.006), and pain (P=.003) compared to those not. Patients reporting acupuncture useful enjoyed lower anxiety (P=.016) and improved pain (P=.037) while those finding yoga useful reported improved anxiety (P=.005). Together, these data suggest the potential value of implementing a more robust, EMR-based, and consistent evaluation of different treatment modalities and QOL improvement housed within this interdisciplinary academic IHC for quality improvement of personalized, internally coordinated care.

Deceased Organ Donor Research: The Last Research Frontier?

Major controversy exists regarding the preferred treatment option for acute kidney injury (AKI). The purpose of this study was to assess the incremental cost-effectiveness of continuous renal replacement therapy (CRRT) versus intermittent renal replacement therapy (IRRT) and conservative (CONS) AKI treatment in Belgium. An area-under-the-curve model based on survival analysis was used to estimate costs and health outcomes using a 2-year time horizon. Input data were derived from the multi-centre Stuivenberg Hospital Acute Renal Failure 4 study. Analyses indicated that in-hospital mortality, hospitalization costs and hospital length of stay differed significantly between treatment modes. Follow-up mortality rates and follow-up cost per day showed no significant difference between the treatment modes. Utility values, which improved gradually after admission to the hospital, revealed no significant differences between the three treatment strategies. CONS treatment was associated with a 2-year cost of 33,802€ and 0.54 quality-adjusted life years (QALYs). The CRRT was the most expensive therapy with a cost of 51,365€ leading to 0.57 QALYs. The cost and QALYs associated with IRRT were 43,445€ and 0.50, respectively. One-way sensitivity analyses indicated the 'in-hospital mortality' as the variable with the greatest influence on the results. Probabilistic sensitivity analysis resulted in a significant difference in treatment costs but no significant difference in QALY gain. This study has indicated that the most expensive treatment (CRRT) associated with an incremental cost of approximately €7920 generates only a minor non-significant increase in QALYs of 0.07 compared with IRRT. Additionally, the results revealed that the RRTs did not result in a significant increase in QALYs despite their higher cost compared with the CONS treatment. From a health economic perspective, the latter seems to be the preferred treatment strategy.

Current vitiligo treatments are not always satisfactory for both patients and dermatologists. Recently, combination therapies have been introduced in order to obtain better results and reduce risks in the management of the disease. Novel efficacious products are needed to improve the therapeutic possibilities of dermatologists in the respect of safety for the patients. The objective of the present study was to evaluate the effects of a novel topical in a gel formulation containing phenylalanine, cucumis melo extract, and acetyl cysteine in vitiligo. The present study used an open observational study to evaluate the efficacy and safety of the investigated product, given alone or in combination with 311-nm narrow band microphototherapy. Results were compared with those obtained treating a matched patient population with microphototherapy alone and with clobetasol propionate 0.05% ointment alone. One hundred forty-nine patients suffering from symmetrical vitiligo affecting less than 10% of the skin surface were evaluated. Patients affected by acral vitiligo only were excluded from the analysis. Treatment duration was scheduled for 12 weeks. Excellent repigmentation (>75%) was achieved by 38-73% of patients, depending on the treatment regimen. Mild to moderate side effects were observed only in patients treated with clobetasol 0.05% ointment. The tested gel formulation showed a good efficacy in improving vitiligo repigmentation. No side effects were observed.

A comparative evaluation of different treatment modalities for parasymphysis fractures: a pilot study

Oro-antral communication is a common occurrence following removal of maxillary premolars and molars because of anatomic proximity of root apices of these teeth and maxillary antrum. Various methods have been described in literature for closure of these communications which vary from simple local methods like buccal advancement flap to complex distal flaps and grafts. Out of these plethora of the treatment modalities available for the treatment of oro antral fistula, the most simple and commonly used ones are either the buccal flap or the buccal pad of fat. In our study we compared the results, advantages and disadvantages of using buccal advancement technique and buccal fat pad individually and also in combination. With this paper, we aim to shed light on the efficacy of buccal pad of fat and the buccal flap, either alone or together, for the closure of OAF of various regions. We also aim to provide a systematic and rational approach for repair of oro-antral communications.

Laparoscopic surgery has been the most significant advancement in our surgical practice in recent years. The essential attribute of laparoscopic surgery is the reduction of the surgical trauma of access [6]. Therefore, laparoscopic surgery is less invasive, less disabling and less disfiguring, allowing shorter hospital stay and faster recuperation [7]. However, true to the principle that “all operations carry some risk of complications,” laparoscopic surgery has its fair share of problems. An effective treatment modality always has benefits outweighing the risks. A comparative evaluation of different treatment modalities establishes the one with best benefit: risk profile as the favoured method. In light of this, I wish to critically evaluate the statement that “laparoscopic surgery is said to carry increased risk” by examining its role in present-day surgical practice. I shall also discuss how these risks can be reduced further and how to communicate the risks to our patients. Diagnostic laparoscopy has a definitive role in the investigations of chronic pelvic pain [39], endometriosis, suspected ectopic pregnancy and infertility, as it offers the advantage of visual inspection of the abdominal and pelvic organs over imaging techniques. The notion that “laparoscopy carries increased risk” has not been proved true in the case of laparoscopic sterilisation, which is the most common laparoscopic surgery performed worldwide. A systematic review evaluating the risks and benefits of laparoscopic sterilisation compared to mini-laparotomy [19] confirmed that the minor morbidity is significantly less following laparoscopic sterilisation and that there is no significant difference in the incidence of major morbidity associated with either method. For the surgical treatment of ectopic pregnancy, significant advantages with the laparoscopic approach have been demonstrated in many studies [22, 27, 40] and it is the preferred option over laparotomy in haemodynamically stable patients [30]. Laparoscopy has also become an increasingly preferred approach for adenexal surgery, such as the removal of benign ovarian tumours and prophylactic bilateral salpingo-oophorectomy (BSO). A systematic review of six randomised controlled trials (RCT) confirms that, in women undergoing surgery for benign ovarian tumours, the laparoscopic approach results in less post-operative complications, including pain, pyrexia, urinary tract infection, hospital stay and total cost compared to laparotomy [25]. Patients with polycystic ovarian syndrome (PCOS), who are resistant to ovulation induction with clomiphene, show no difference in live birth and miscarriage rates compared to gonadotrophin therapy when treated with laparoscopic ovarian drilling (LOD) using diathermy or laser. LOD has a significantly lower multiple pregnancy rate and is an attractive treatment option for ovulation induction for this condition [9]. Laparoscopy remains the gold standard for the diagnosis of endometriosis [29]. Laparoscopic treatment is effective for pain relief in minimal to moderate endometriosis [14] and for minimal and mild endometriosis to improve fertility [15]. For advanced and deeply infiltrative endometriosis, radical laparoscopic excision of all diseased areas results in improvements in pain score and the quality of life [12]. The risks of surgery are proportional to its extent and complexity. There are concerns in this area as laparoscopic hysterectomy (LH) takes longer to perform and has a higher incidence of intra-operative injury to the bladder and ureter Gynecol Surg (2006) 3:315–319 DOI 10.1007/s10397-006-0256-3

Evaluation of Different Treatment Modalities for Vulvar Intraepithelial Neoplasia (VIN): CO2 Laser Vaporization, Photodynamic Therapy, Excision and Vulvectomy

Evaluation of different treatment modalities for vulvar intraepithelial neoplasia (VIN): CO 2 laser vaporization, photodynamic therapy, excision and vulvectomy

In 1997, the Pediatric Eye Disease Investigator Group (PEDIG) was formed to conduct clinical research in eye disorders that affect children.1,2 The primary focus of PEDIG involves studies that can be conducted through simple protocols with limited data collection and implemented by both university-based and community-based pediatric eye care practitioners as part of their routine practice. As of October 1, 2003, 135 investigators at 97 sites in North America have participated in at least 1 PEDIG study. A major focus of PEDIG has been the evaluation of different treatment modalities for amblyopia (the Amblyopia Treatment Study). Amblyopia was selected for study because it is the most common cause of monocular visual impairment in children and young and middle-aged adults,3,4 and opinions vary on the appropriate treatment regimens. Three randomized trials have been completed thus far, and 3 trials and 2 observational studies are currently in progress. The first PEDIG amblyopia trial compared patching of the sound eye versus instillation of atropine drops in the sound eye as treatments for moderate amblyopia (20/40 to 20/100) in children 3 to 7 years old.5–9 Amblyopia was due to unequal refractive error, strabismus, or both. Atropine blurs the vision in the sound eye through its cycloplegic effect that can last, at least partially, for up to 14 days. The group of children randomized to atropine treatment received 1 drop of 1% atropine in the sound eye daily; if by 4 months acuity had not reached 20/30 or improved from baseline by ≥3 lines, then any far-sighted correction in the spectacle lens of the sound eye was removed to augment the effect of the atropine. The patching group was initially prescribed daily patching for a minimum of 6 hours up to all waking hours at investigator … Address correspondence to Graham E. Quinn, MD, MSCE, Division of Pediatric Ophthalmology, Children’s Hospital of Philadelphia, One Children’s Center, Philadelphia, PA 19104. E-mail: quinn{at}email.chop.edu

To investigate the attitude of Belgian pediatricians toward the management and treatment of children with suspected acute pyelonephritis, a short letter was sent to all Belgian pediatricians (1,200). It contained a brief description of a clinical case strongly suggestive of acute pyelonephritis followed by a series of questions centered on complementary examinations to be performed, need of hospitalization and treatment. A total of 583 responses were received (49%). In the acute phase, 99% of pediatricians perform urine cultures, 87% blood examinations, and 76% renal ultrasound. Dimercaptosuccinate (DMSA) scintigraphy is performed during the acute phase by 37% and during follow-up by 32% of all pediatricians. A voiding cystogram is requested by 71%. Ambulatory treatment is considered by 30% of responders. Amoxicillin/clavulanic acid (44%) and trimethoprim/sulfonamide (22%) are the most frequently used oral antibiotics. Private pediatricians perform fewer examinations and more frequently consider ambulatory treatment of acute pyelonephritis, compared to pediatricians working in hospitals. Among Belgian pediatricians, attitudes toward the diagnosis and treatment of acute pyelonephritis are heterogeneous. This survey underlines the need for properly documented prospective studies for the evaluation of different treatment modalities in childhood acute pyelonephritis.

Fertility in Cryptorchidism: An Experimental Model