Good Therapeutic Results Research Articles

Application of the mesh bridging technique in the excision of abdominal endometriosis lesions: Case report and literature review.

Abdominal wall scar endometriosis (AWE) is a rare endometriosis that usually occurs after gynecological or obstetric surgery and for which surgical resection is the standard treatment. For large tissue defects after resection, abdominal wall reconstruction is needed. Here, we describe a mesh bridging technique using biological and polypropylene meshes for abdominal wall reconstruction. A 34-year-old woman visited the center with complaints of low abdominal wall pain during menstruation for more than 5 years. Her surgical history included undergoing a cesarean section delivery twice. A mass measuring 6 cm × 5 cm × 3 cm was found above the symphysis pubis in the lower part of the abdominal incision. Endometriosis lesion was considered based on abdominal ultrasound and magnetic resonance imaging findings. After a multidisciplinary discussion that included surgical experts and gynecologists, the decision was made to perform abdominal endometrial focus excision plus abdominal wall reconstruction. Two kinds of mesh were skillfully used in the operation of this patient. Biological mesh was used close to the peritoneal side and covered with polypropylene mesh to reduce the stimulation by the polypropylene mesh of the peritoneum, enhance the strength of the biological mesh, and reduce the incidence of abdominal wall hernia. Our case demonstrates that accurate diagnosis of AWE followed by complete resection and reconstruction of the abdominal wall using a combination of biological and polypropylene mesh bridging can achieve good therapeutic results and patient satisfaction.

Thoracic giant cell tumor after two total en bloc spondylectomies including one emergency surgery: A case report

BACKGROUND For patients with acute paraplegia caused by spinal giant cell tumor (GCT) who require emergency decompressive surgery, there is still a lack of relevant reports on surgical options. This study is the first to present the case of an acute paraplegic patient with a thoracic spinal GCT who underwent an emergency total en bloc spondylectomy (TES). Despite tumor recurrence, three-level TES was repeated after denosumab therapy. CASE SUMMARY A 27-year-old female patient who underwent single-level TES in an emergency presented with sudden severe back pain and acute paraplegia due to a thoracic spinal tumor. After emergency TES, the patient's spinal cord function recovered, and permanent paralysis was avoided. The postoperative histopathological examination revealed that the excised neoplasm was a rare GCT. Unfortunately, the tumor recurred 9 months after the first surgery. After 12 months of denosumab therapy, the tumor size was reduced, and tumor calcification. To prevent recurrent tumor progression and provide a possible cure, a three-level TES was performed again. The patient returned to an active lifestyle 1 month after the second surgery, and no recurrence of GCT was found at the last follow-up. CONCLUSION This patient with acute paraplegia underwent TES twice, including once in an emergency, and achieved good therapeutic results. TES in emergency surgery is feasible and safe when conditions permit; however, it may increase the risk of tumor recurrence.

Otogenic brain abscess as a complication of acute otitis media in an adult female patient – a case report and literature review

<b>Introduction:</b>Ear abscess of the brain occurs in 0.3–1.3/100,000 of the population per year, and about 30% of abscesses are accompanied by other intracranial complications. Such complications can occur in the course of both chronic and acute otitis media, but the latter is extremely rare.<b>Aim:</b> To present a case of temporal lobe abscess in the course of acute otitis media (AOM) in an adult.<b>Case study: </b> The patient was admitted to the Hospital Emergency Department (ED) with symptoms of AOM with purulentleakage from the right ear and disturbance of consciousness. In addition to inflammatory changes in the middle ear, a CTscan showed zones of swelling in the right temporal lobe with suspicion of a forming temporal lobe abscess on the rightside. The treatment administered included urgent anthromastoidectomy and right-sided tympanostomy, as well as empiricalantibiotic therapy. Six days after admission, a follow-up magnetic resonance imaging (MRI) scan of the brain showedprogression of the lesions, complete formation of the abscess, and thrombotic changes in the cerebral venous sinuses werealso described. Further treatment included drainage of the temporal lobe abscess. A significant improvement in generaland neurological condition was achieved. Conservative treatment was continued and regression of the right temporal lobeabscess was achieved, and a follow-up RM study confirmed stable thrombotic lesions in the right transverse sinus.<b>Conclusions:</b> The occurrence of intracranial complications in the course of AOM in adults is extremely rare. Deterioration of the general condition and the appearance of consciousness disturbances in the course of AOM may indicate developing intracranial complications. Implementation of multidisciplinary diagnostic and therapeutic management makes it possible to achieve good therapeutic results.

Thermal accelerated urease-driven hyaluronan-targeted melanin nano-missile for bio-radar detection and chemodrug-free phototherapy

Polymer-based nanomotors are attracting increasing interest in the biomedical field due to their microscopic size and kinematic properties which support overcoming biological barriers, completing cellular uptake and targeted blasting in limited spaces. However, their applications are limited by the complex viscous physiological environment and lack of sufficient biocompatibility. This manuscript firstly reports a natural melanin nano-missile of MNP@HA-EDA@Urease@AIE PS (MHUA) based on photothermally accelerated urease-driven to achieve chemodrug-free phototherapy. Compared to conventional nano-missiles that only provide driving force, this photothermally accelerated urease-driven nanomotor is independent of chemodrug to maximise biocompatibility, and achieve ideal therapeutic effect through targeted PTT/PDT. In particular, the thermal effect can not only boost the catalytic activity of urease but also achieve ideally anti-tumor effect. In addition, guided by and AIE PS, the nanomotor can generate 1O2 to achieve PDT and be traced in real time serving as an effective fluorescent bio-radar for intracellular self-reporting during cancer treatment. Finally, the targeting ability of MUHA is provided by hyaluronan. Taken together, this MHUA platform provides a simple and effective strategy for target/fluorescence radar detective-guided PTT/PDT combination, and achieves good therapeutic results without chemodrug under thermal accelerated strategy, providing a new idea for the construction of chemodrug-free nanomotor-therapy system.

Using single atom substitution strategy for constructing a novel Se-substituted hemicyanine dye with hydroxyl group as an ideal activatable photosensitizer dye scaffold

Photodynamic therapy (PDT) is an effective method to treat diseases, especially for tumor treatment, with remarkable characteristics including good therapeutic results and low drug resistance, which has attracted the attention of researchers. The performances of photosensitizer dye largely determine the tumor treatment results. However, most of the reported photosensitive dyes belong to the “always-on” photosensitive property, which cannot avoid the photodamage caused to normal tissues during tumor PDT. By contrast, activatable photosensitizers possess the desirable characteristic of controllable phototoxicity, ensuring tumor safety treatment. Until now, ideal photosensitizer dye scaffold is still lacking. Therefore, constructing a universal photosensitive dye scaffold is a vital issue to be solved urgently. In this work, inspired by the single atom substitution strategy, the oxygen atom in classical hemicyanine dye has been replaced by selenium (Se) atom to obtain a novel Se-substituted hemicyanine dye with hydroxy group, HCySe-OH, as a novel dye platform for constructing activatable photosensitizers. We found that HCySe-OH had high singlet oxygen (1O2) generation ability and longer absorption and emission in contrast to the classical O-substituted hemicyanine, endowing its better biomedical application. Additionally, HCySe-OH was successfully utilized to kill cancer cells and bacteria under 760 nm laser irradiation. More importantly, we believe that numerous smart activatable photosensitizers will be developed based on this platform, HCySe-OH.

Frontal site surgery for chronic migraine therapy.

According to the most current theories, chronic inflammation of some cranial nerves give rise to an inflammatory chain that would result in migraines. As for frontally located attacks, the nerves involved are two (on each side): the supraorbital and the supratrochlear. Surgical treatment includes complete neurolysis of both of these nerves. In this work, we describe our experience with this type of surgery. From 2011 to 2022, we treated 98 cases suffering from chronic migraine not responsive to drugs with frontal localization. The results were evaluated through a specific questionnaire three months and one year after surgery. After three months post-surgery, we observed a success rate (reduction of monthly attacks equivalent to or greater than 50%) in 87% of patients (32% complete recovery). These results were essentially confirmed one year after surgery. The rare complications (mainly paresthesias and dysesthesias of the frontal area) have always resolved spontaneously within a few months. The surgical approach allowed to obtain good therapeutic results with a low rate of complications.

Euphorbia hirta nanoextract as a piezoelectric ultrasonic scaler coolant in gingivitis treatment in a Wistar rat model

ObjectivesThis research was aimed at investigating the effects of various concentrations of Euphorbia hirta nanoextract as a piezoelectric scaler coolant on gingivitis healing in a Wistar rat model. MethodsA piezoelectric ultrasonic scaler coolant was made from E. hirta nanoextract through ionic gelation. Experiments were conducted in 45 adult male Wistar rats divided into three groups treated with E. hirta nanoextract coolant (25%, 30%, and 35% concentrations), and negative and positive control groups. A silk ligature was used to trap debris and induce gingivitis in the maxillary incisors of the rats. Scaling was conducted with a piezoelectric ultrasonic scaler after the respective treatment for each group. Data were collected on days 3, 5, 7, 14, and 21 after treatment. Observations were collected with an Optilab® camera at 400× magnification. Angiogenesis and neutrophil data were analyzed with two-way analysis of variance (ANOVA) and post hoc Duncan tests at a 95% significance level. ResultsUse of E. hirta nanoextract as a piezoelectric ultrasonic coolant accelerated gingivitis healing in Wistar rats, particularly at a 25% concentration. Two-way ANOVA indicated a significant difference in angiogenesis and neutrophil counts between the control group and each treatment group (p < 0.05). Duncan's post-hoc test showed significant differences in mean neutrophil numbers and angiogenesis among groups on days 3, 5, 7, 14, and 21. The group treated with 25% nanoextract concentration showed no significant differences with respect to the positive control group. ConclusionsUse of E. hirta nanoextract as a piezoelectric ultrasonic coolant had good therapeutic results in promoting gingivitis healing. E. hirta nanoextract may potentially resolve inflammation in gingivitis by modulating neutrophils and angiogenesis.

Time-Dependent Changes in the Bladder Muscle Metabolome After Traumatic Spinal Cord Injury in Rats Using Metabolomics.

The main treatment options of neurogenic bladder remains catheterization and long-term oral medications. Metabolic interventions have shown good therapeutic results in many diseases. To date, no studies have characterized the metabolites of the detrusor muscle during neurogenic bladder. Using metabolomics, new muscle metabolomic signatures were identified to reveal the temporal metabolic profile of muscle during disease progression. We used 42 Sprague-Dawley rats (200±20 g, males) for T10 segmental spinal cord injury modeling and collected detrusor tissue and performed nontargeted metabolomics after sham surgery, 30-minute, 6-hour, 12-hour, 24-hour, 5-day, and 2-week postmodelling, to identify the dysregulated metabolic pathways and key metabolites. By comparing mzCloud, mzVault, MassList, we identified a total of 1,271 metabolites and enriched a total of 12 metabolism-related pathways with significant differences (P<0.05) based on Kyoto Encyclopedia of Genes and Genomes analysis. Metabolites in several differential metabolic pathways such as ascorbate and aldarate metabolism, Steroid hormone biosynthesis, and carbon metabolism are altered in a regular manner before and after ridge shock. Our study is the first time-based metabolomic study of rat forced urinary muscle after traumatic spinal cord injury, and we identified multiple differential metabolic pathways during injury that may improve long-term management strategies for neurogenic bladder and reduce costs in long-term treatment.

Microbiota-gut-brain axis and related therapeutics in Alzheimer's disease: prospects for multitherapy and inflammation control.

Alzheimer's disease (AD) is the most common type of dementia in the elderly and causes neurodegeneration, leading to memory loss, behavioral disorder, and psychiatric impairment. One potential mechanism contributing to the pathogenesis of AD may be the imbalance in gut microbiota, local and systemic inflammation, and dysregulation of the microbiota-gut-brain axis (MGBA). Most of the AD drugs approved for clinical use today are symptomatic treatments that do notimprove AD pathologic changes. As a result, researchers are exploring novel therapeutic modalities. Treatments involving the MGBA include antibiotics, probiotics, transplantation of fecal microbiota, botanical products, and others. However, single-treatment modalities are not as effective as expected, and a combination therapy is gaining momentum. The purpose ofthis review is to summarize recent advances in MGBA-related pathological mechanisms and treatment modalities in AD and to propose a new concept of combination therapy. "MGBA-based multitherapy" is an emerging view of treatment in which classic symptomatic treatments and MGBA-based therapeutic modalities are used in combination. Donepezil and memantine are two commonly used drugs in AD treatment. On the basis of the single/combined use of these two drugs, two/more additional drugs and treatment modalities that target the MGBA are chosen based on the characteristics of the patient's condition as an adjuvant treatment, as well as the maintenance of good lifestyle habits. "MGBA-based multitherapy" offers new insights for the treatment of cognitive impairment in AD patients and is expected to show good therapeutic results.

Oral mucosa diseases in seafarers during long voyages, their treatment and prevention : prospective study

OBJECTIVE: To detect oral mucous membrane disease of the mouth, lips and tongue in seafarers on long voyage, to evaluate preventive measures and treatment effectiveness. MATERIALS AND METHODS: There was a dental examination of 169 men, aged 22-52 on long voyage, who got full treatment and preventive measures of oral rehabilitation in the pre-deployment period in a time manner. The seafarers were divided into 2 groups. The 1st group included 57 seamen, who were part of the crew. The 2nd group consisted of 112 men, who were training and had the first long voyage. The oral mucosa diagnosis was based on a clinic examination. When identifying pathology, treatment was provided and there were anti-relapse measures after its completion, which were possible given the people on board on long voyage. RESULTS: It was found that the structure of oral mucosa is quite different among people of the 1st and 2nd groups. The pathology among the crew occurred more often due to the autoimmune component of pathogenesis in 5,26% and 0,9% cases respectively, while the people in the 2nd group, being on long voyage as part of their training, experienced infectious oral mucosa pathology (12,28% and 15,32% respectively) significantly more often, and also lesions of the lips due to meteorological factors in 8,77% and 10,81% cases accordingly. DISCUSSION: The article discusses the treatment of meteorological cheilitis, the fracture of the vermilion border of the lip, Vincent disease, herpetic fever and chronic recurrent aphthous stomatitis with the use of domestic medicine for topical application. CONCLUSION: On long voyage 26,04% seafarers had cases of oral mucosa, among which most frequently diagnosed ones were infectious diseases, pathology due to meteorological factors, and also diseases with the autoimmune component of pathogenesis. In all cases domestic medicine for topical application was used to reveal pathology of oral mucosa, and further, to prevent its recurrence that allowed to achieve a good therapeutic result and to avoid recurrence of oral mucosa disease, typical for seafarers during a 9-month voyage.

Impact of comorbidity scores and lifestyle factors in curative radiotherapy in laryngeal cancer.

The principal goal of treatment of laryngeal cancer is to eliminate atumour while preserving laryngeal function with radio(chemo)therapy being the mainstay of treatment. The aim of this report is to present the influence of comorbidities and lifestyle factors on treatment outcomes in our cohort of patients. During the period 2009-2018, curative radio(chemo)therapy for laryngeal cancer was performed on 189patients. The median OS was 50.8months, with amean PFS of 96.5months, mean LC of 101.4months and amedian follow-up of 38.1months. Acute and late treatment toxicity grade 3-4 was observed in 39.2% patients and 10.1% patients, respectively. Asignificant effect on overall survival was confirmed for the baseline PS (performance status), severity of weight loss, baseline haemoglobin values, history of alcohol abuse, marital status and comorbidities according to the Charlson Comorbidity Index, as well as the ACE-27 and ASA scores. In our cohort of patients treated with radio(chemo)therapy for laryngeal cancer, we found good therapeutic results and an acceptable side-effect profile. Statistically significant predictors of overall survival were the baseline PS, weight loss, anaemia, associated comorbidities, history of alcohol abuse and marital status.

Periodontal diseases of seafarers, their prevention and treatment during long voyages: prospective study

INTRODUCTION: For seafarers are characteristic a number of ecopathic factors that might provoke the emergence and progression of periodontal disease. Pre-voyage oral rehabilitation is an important component, aimed at timely detection, treatment and recurrence prevention of periodontal disease on long voyage.OBJECTIVES: The study focused on detecting periodontal disease among seafarers, determining the cause, contributing to its emergence and progression, assessment of preventive health care measures and treatment effectiveness on long voyage.MATERIALS AND METHODS: There was the study of periodontal tissues, occurrence and intensity of the periodontal pathology course, also oral hygiene and conditions of items for individual dental care among 169 men, aged 22–52 on long voyage. The first group included 57 seamen, who were part of the crew. The second group included 112 people, who were studying and a long voyage was the first one for them. While detecting periodontal pathology, treatment was carried out, and after its completion there were relapse-prevention measures, that were consistent given the people on the ship on long voyage. Informed consent was obtained from each patient. The study was approved by the Ethics Committee of the International Academy of Ecological Science, Human and Nature Security (protocol № 3 of 10.05.2022). Statistics. Parametric Student’s criterion under normal distribution law and Mann-Whitney non-parametric criterion as distinct from normal indicator distribution were used for the evaluation of reliability of differences compared averages.RESULTS: Found that pre-voyage rehabilitation of the oral cavity among seafarers is not always properly carried out as there were 26,3–31,3% cases of periodontal disease, identified on long voyage. Despite adequate individual oral hygiene in 24,6–27,7% seafarers, there were inappropriate oral care items that provoked inadequate individual oral hygiene.DISCUSSION: The most frequent kinds of periodontal disease were catarrhal gingivitis and localized periodontitis of mild severity. Issues of periodontal disease treatment in seafarers on long voyage are being discussed.CONCLUSION: To improve dental health in seafarers, it is necessary to treat periodontal diseases before voyage. On long voyage seamen should use only the items, habitable for individual oral hygiene, and make their timely replacement. In all cases of periodontal disease treatment it was possible to achieve directly good therapeutic results and to avoid the relapse of inflammatory periodontal pathology, typical for seafarers, during 9-month voyage.

Recent developments in natural biopolymer based drug delivery systems.

Targeted delivery of drug molecules to diseased sites is a great challenge in pharmaceutical and biomedical sciences. Fabrication of drug delivery systems (DDS) to target and/or diagnose sick cells is an effective means to achieve good therapeutic results along with a minimal toxicological impact on healthy cells. Biopolymers are becoming an important class of materials owing to their biodegradability, good compatibility, non-toxicity, non-immunogenicity, and long blood circulation time and high drug loading ratio for both macros as well as micro-sized drug molecules. This review summarizes the recent trends in biopolymer-based DDS, forecasting their broad future clinical applications. Cellulose chitosan, starch, silk fibroins, collagen, albumin, gelatin, alginate, agar, proteins and peptides have shown potential applications in DDS. A range of synthetic techniques have been reported to design the DDS and are discussed in the current study which is being successfully employed in ocular, dental, transdermal and intranasal delivery systems. Different formulations of DDS are also overviewed in this review article along with synthesis techniques employed for designing the DDS. The possibility of these biopolymer applications points to a new route for creating unique DDS with enhanced therapeutic qualities for scaling up creative formulations up to the clinical level.

Bee Sting-Inspired Inflammation-Responsive Microneedles for Periodontal Disease Treatment.

Periodontal lesions are common and frustrating diseases that impact life quality. Efforts in this aspect aim at developing local drug delivery systems with better efficacy and less toxicity. Herein, inspired by the sting separation behavior of bees, we conduct novel reactive oxygen species (ROS)-responsive detachable microneedles (MNs) that carry antibiotic metronidazole (Met) for controllable periodontal drug delivery and periodontitis treatment. Benefiting from the needle-base separation ability, such MNs can penetrate through the healthy gingival to reach the gingival sulcus's bottom while offering minimal impact to oral function. Besides, as the drug-encapsulated cores were protected by poly (lactic-co-glycolic acid) (PLGA) shells in MNs, the surrounding normal gingival tissue is not affected by Met, resulting in excellent local biosafety. Additionally, with the ROS-responsive PLGA-thioketal-polyethylene glycol MN tips, they can be unlocked to release Met directly around the pathogen under the high ROS in the periodontitis sulcus, bringing about improved therapeutic effects. Based on these characteristics, the proposed bioinspired MNs show good therapeutic results in treating a rat model with periodontitis, implying their potential in periodontal disease.

The effects of left frontal intermittent theta burst stimulation on the efficacy of exposure-based therapy in acrophobia

Abstract Evidence-based treatments for anxiety disorders, as cognitive behavioral and pharmacological therapy achieves good therapeutic results. However, studies have shown that the therapy can be further optimized. Transcranial magnetic stimulation (TMS) may be useful as an adjunct to exposure-based therapy for anxiety disorders, as laboratory studies in healthy subjects have shown (Raij et al., 2018) that extinction learning, as an underlying mechanism in exposure therapy, can be improved using rTMS. The aim of this double-blind, randomized, placebo-controlled clinical trial with 76 patients with acrophobia is to verify whether the stimulation localization (left frontal cortex), shown to be benefical in healthy subjects, can be effectively used to enhance exposure therapy. For this purpose, patients underwent neuronavigational stimulation over the individually defined stimulation localization using the activating intermittent theta burst stimulation (iTBS) protocol before exposure therapy in virtual reality. Clinical symptoms were evaluated via questionnaires and two behavioral approach tests before, after, and for follow-up after 6 months. Furthermore, process variables during the exposure sessions, such as duration of exposure, and maximal anxiety depending on the stimulation groups were investigated. Research Category and Technology and Methods Clinical Research: 10. Transcranial Magnetic Stimulation (TMS) Keywords: rTMS, Anxiety disorders, Psychotherapy

Prognostic and predictive factors of brain meningiomas.

Common primary brain tumors are meningiomas with year incidence 3-8 cases per 100 000 people. Even though we mainly speak about benign disease, with its character and localization, it worsens the life quality to its bearer. The main therapeutic methods are neurosurgery extirpation and stereotactic radiosurgery. Despite reaching very good therapeutic results with both methods, some of the patients suffer with recurrence of the disease requiring other interventions with the risk of creating or worsening a neurological deficit. Small meningiomas without growing tendency and with the absence of symptomatology are observed. On the other hand, we cannot be satisfied with long-term results of the therapy of meningiomas with more aggressive bio-logical behavior. A higher grade is a known risk of meningioma recurrence; however, it is often difficult to identify subgroups that show advantage of a combination of neurosurgery and radiosurgery, respectfully at which it is appropriate to look for ways to treatment escalation, and that is with the risk of side effects. The analysis of hormonal, cytogenetics and epigenetics tumor equipment seems to be the most promising for the development of personalized treatment. The aim of this work is to sum up the facts about epidemiology, treatment algorithms and the prognosis of brain meningiomas and to suggest perspective prognostic and predictive factors for maximally individualized therapy.

Orthogonal excitations of lanthanide nanoparticle up/down conversion emissions via switching NIR lights for in-vivo theranostics

With multiple emissions ranging from NIR-IIb to visible lights, near-infrared light-excited lanthanide nanoparticle (LnNP) is an ideal in-vivo theranostic platform to achieve imaging guided phototherapy. However, current reported LnNPs typically demonstrate simultaneous up and downconversion emissions with fixed single excitation light, which impairs therapeutic efficiency and generates side effect during navigation. Here we develop a lanthanide-based conversion switching nanoparticle (CSNP) with independent activation of 1550 nm NIR-IIb downconversion emission under 808 nm excitation and 345/450 nm upconversion emission under 980 nm excitation. CSNP is modified with Cy-GSH to quench NIR-IIb emission and photosensitizer hypocrellin A. In vivo delivery of CSNP is traced via 808 nm irradiation, and Cy-GSH changes structure in response to glutathione to activate NIR–IIb imaging. This indicates the tumor position and timing to switch for 980 nm irradiation to activate hypocrellin A for photodynamic therapy. Orthogonal activation of CSNP up/down conversion emissions demonstrates high tumor-to-normal tissue ratio in vivo and good therapeutic result, would have promising potential as a theranostics platform.

Therapeutic applications of adipose-derived stromal vascular fractions in osteoarthritis.

Osteoarthritis (OA) is considered to be a highly heterogeneous disease with progressive cartilage loss, subchondral bone remodeling, and low-grade inflammation. It is one of the world's leading causes of disability. Most conventional clinical treatments for OA are palliative drugs, which cannot fundamentally cure this disease. The stromal vascular fraction (SVF) from adipose tissues is a heterogeneous cell population. According to previous studies, it contains a large number of mesenchymal stem cells, which have been used to treat OA with good therapeutic results. This safe, simple, and effective therapy is expected to be applied and promoted in the future. In this paper, the detailed pathogenesis, diagnosis, and current clinical treatments for OA are introduced. Then, clinical studies and the therapeutic mechanism of SVF for the treatment of OA are summarized.

EFFICACY AND SAFETY OF INITIAL DESMOPRESSIN DOSE OF 50 μg IN ELDERLY MALE PATIENTS WITH NOCTURNAL POLYURIA

(Introduction) Low-dose desmopressin is now available for the treatment of nocturia associated with nocturnal polyuria in men, and its usefulness in a dose-dependent manner has been reported. Since side effects such as hyponatremia have reported frequently, the initial dose has been set at 25 μg in many cases considering age and other factors. In the present study, we investigated the efficacy and safety of an initial dose of 50 μg in elderly patients. (Subjects and methods) At Chikugo city hospital, 45 patients were started on desmopressin at an initial dose of 50 μg for nocturia with nocturnal polyuria. Efficacy and safety after one and four weeks were evaluated based on bladder (micturition) diary. The investigated parameters included frequency of nocturnal urination, nocturnal polyuria index, time to first nocturnal void, first nocturnal urine volume, nocturnal urine volume, International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), and Athens Insomnia Scale. Physical examinations were also carried out, along with blood tests. (Results) The mean age of the patients was 78.3 years, which was higher than that reported in prior studies. After one week of treatment, there was a significant decrease in the frequency of nocturnal urination and nocturnal urine volume, as well as a prolongation of the time to first nocturnal void, improvement in nocturnal polyuria index, and improvement in IPSS, IPSS-QOL, OABSS, and Athens Insomnia Scale. In terms of safety, adverse events were observed in eight patients (17.8%), and hyponatremia was observed in seven patients (15.6%), which was comparable to the findings of prior reports. (Conclusion) Good therapeutic results were obtained in elderly patients at an initial desmopressin dose of 50 μg, indicating that the drug could be safely administered to elderly patients with regular follow-ups and appropriate withdrawal and dose reductions.

A Clinical Pilot Study Showing the Safety and Efficacy of Intramuscular Injection of Atelocollagen for Prevention of Paraspinal Muscle Atrophy after Spine Surgery

Objective: The objective of this study was to assess the safety and efficacy of intramuscular injection of atelocollagen for the prevention of paraspinal muscle atrophy after spine surgery. Atelcollagen has been widely used as an intradermal filler to restore soft tissue defect. Many studies demonstrated that atelocollagen provides good therapeutic results by promoting cell proliferation and enhances the healing effect on injured connective tissues such as tendons and fasciae, while causing few complications. Methods: A total of 118 patients who underwent single level of posterior lumbar interbody fusion (PILF) between December 2017 and April 2019 were retrospectively reviewed. In the study group of 60 patients, 3 mL of gel-type 3% atelocollagen solution was prepared and injected into the multifidus muscle during wound closure. Clinical efficacy was evaluated by the improvement of back pain, elevation of a muscle enzyme, and inflammatory markers. Radiologic efficacy was evaluated with a comparison of density and cross-sectional area (CSA) of multifidus and erector spinae muscle in CT images. Results: Visual analogue scale (VAS) scores for back pain was not significantly lower in the study group postoperatively compared with the control group. The reduction of postoperative paraspinal muscle density and CSA was significantly lower in the study group. The serum level of muscle enzyme and inflammatory markers were significantly lower in the study group. No major procedure-related complications were observed during the follow-up period.Conclusion: Intramuscular injection of atelocollagen is safe and feasible for the prevention of paraspinal muscle atrophy after spine surgery. This novel method seems advantageous for accelerating wound healing without causing inflammation.