Increasing Treatment Duration Research Articles

Assessing the Impact of Oral Isotretinoin on the Menstrual Cycle: A Prospective Study on Predictors of Menstrual Irregularities.

Background and Objectives: This study aims to evaluate the association between the use of oral isotretinoin and menstrual irregularities in acne patients with previously regular menstrual cycles. Materials and Methods: A prospective observational study was conducted on 58,599 female patients aged 14 to 36 at King Abdullah University Hospital in Irbid, Jordan. The patients were followed for a period of 4.5 to 8 months during treatment and for 2 months post-treatment. Menstrual cycle changes were documented, and statistical analysis was performed to identify any significant associations. Results: A total of 111 (37.1%) patients, who were previously known to have regular menstrual cycles, complained of menstrual changes while using oral isotretinoin. Ninety-nine of those patients who complained of menstrual changes had their cycles back to normal post-treatment. There is a significant difference in the total accumulative dose between those with changes in menses and those without; p-value [0.008]. The most common change that occurred was amenorrhea (p < 0.001), followed by oligomenorrhea and menorrhagia (p < 0.001 and p = 0.050, respectively). The duration of treatment was a significant predictor of menstrual irregularities, with an odds ratio (OR) of 5.106 (95% CI: 1.371-19.020, p = 0.015), indicating a higher likelihood of menstrual changes with increased treatment duration. The total accumulative dose was also significantly associated with menstrual irregularities (OR = 0.964; 95% CI: 0.939-0.990; p = 0.006). Additionally, a family history of PCOS significantly increased the odds of menstrual irregularities (OR = 3.783; 95% CI: 1.314-10.892; p = 0.014). Conclusions: The study identified that 37.1% of the participants experienced changes in their menstrual cycles while undergoing isotretinoin therapy, with the vast majority (89.2%) returning to normal within two months post-treatment. Our logistic regression analysis pinpointed the duration of isotretinoin treatment, the total accumulative dose, and a family history of PCOS as significant predictors of menstrual irregularities.

Associations of cumulative voriconazole dose, treatment duration, and alkaline phosphatase with voriconazole-induced periostitis.

To investigate the associations of cumulative voriconazole dose, treatment duration, and alkaline phosphatase with voriconazole-induced periostitis. One hundred and thirty-one patients with voriconazole use were identified using a clinical informatics tool. Health record data including age, sex, immune status, alkaline phosphatase, voriconazole levels, voriconazole dose, frequency, and treatment duration were collected. Imaging studies during the duration of treatment were reviewed by two radiology trainees and imaging features of voriconazole-induced periostitis were confirmed by a board-certified musculoskeletal radiologist. The length, location in the body, location in the bone, type, and morphology of periostitis lesions were recorded. Incident voriconazole-induced periostitis was defined as new periostitis on imaging after 28days or more of voriconazole treatment in the absence of an alternative diagnosis. Univariate Firth's logistic regression models were performed using cumulative voriconazole dose, treatment duration, and average ALP as predictors and incident VIP as the outcome. There were nine patients with voriconazole-induced periostitis and 122 patients without voriconazole-induced periostitis. The most common lesion location in the body was the ribs (37%) and morphology was solid (44%). A 31.5-g increase in cumulative voriconazole dose was associated with 8% higher odds of incident periostitis. Increased treatment duration (63days) and higher average alkaline phosphatase (50IU/L) were associated with 7% higher odds of periostitis and 34% higher odds of periostitis, respectively. Increased cumulative voriconazole dose, treatment duration, and average alkaline phosphatase were associated with higher odds of voriconazole-induced periostitis.

Treatment duration by morphology and location of impacted maxillary canines: A cone-beam computed tomography investigation

This study aimed to identify whether patients with impacted maxillary canines take longer to treat than orthodontic patients without an impacted canine. We also sought to identify factors that are predictive of increased treatment duration in patients with impacted maxillary canines and treated by surgical exposure. A retrospective investigation of 37 patients with an impacted maxillary canine, treated by surgical exposure and fixed appliance therapy, was undertaken. In addition, an age- and sex-matched control group of 39 patients (without impacted canines) was also collected. Patient age, sex, and total treatment duration were recorded. For patients with an impacted canine, patient records and pretreatment cone-beam computed tomography datasets were assessed. Point coordinates identifying relevant landmarks were recorded, and a geometric method was used to calculate variables describing canine location, orientation, and apical morphology. Controlling for age and sex, linear regression identified a statistically significant increase in treatment duration of 46.7 and 41.5 weeks for palatal and labial/midalveolar impacted canines, respectively, vs controls (P<0.002). Age and sex of patients with impacted canines collectively affected treatment duration (P= 0.04), with females of increased age being treated faster than younger males. Rotation of the impacted canine crown had a highly significant effect on treatment duration, with every degree of rotation increasing treatment duration by 0.32 weeks (P<0.001). There was a significant degree of multicollinearity between the other radiographic variables. Collectively, radiographic variables describing canine displacement significantly prolonged treatment duration (P<0.001) and explained 29.8% of the variability in total treatment time. The apical morphology of impacted maxillary canines was significantly associated with increased treatment duration (P= 0.01) and explained 11.3% of the overall treatment variability (P= 0.01). Increased total treatment duration of surgically exposed impacted maxillary canines is associated with increasing mesiopalatal canine crown rotation, worsening displacement, and hooked apical morphology.

P134 Developing a potential composite pharmacodynamic serum marker of skin severity in systemic sclerosis

Abstract Background/Aims Previously, through multilevel and high dimensional analysis, we derived a composite biomarker for modified Rodnan Skin Score (mRSS) in systemic sclerosis (SSc) patients using a derivation cohort (BIOPSY). This identified 4 blood proteins (COMP, COL4A1, TNC and SPON1) that independently correlated with mRSS and also with skin gene and dermal blister expression at a separate 12-month timepoint. These proteins likely reflect overlapping aspects of SSc skin pathobiology that are not overly influenced by other disease compartments. In the present study, we undertake technical and biological validation of this novel composite marker in well characterised SSc patients. Methods COMP (DCMP0, R&amp;D Systems), COL4A1 (CSB-EL005741HU, Cusabio), TNC (ab213831, Abcam) and SPON1 (CSB-EL022599HU, Cusabio) were examined in serum samples from diffuse cutaneous SSc (dcSSc) cases in two independent cohorts of patients, BIOPSY (n = 33) and MODERNISE (n = 37). The BIOPSY cohort was previously used to derive the composite marker and MODERNISE was a novel validation cohort. Later, early dcSSc patients from both cohorts were combined into a third analysis group (n = 36). Multiple regression analysis derived a formula for a composite biomarker score which predicted mRSS based on serum ELISA results. Results Serum concentration positively correlated with mRSS for COMP and TNC, particularly in early dcSSc patients (COMP, r = 0.10, p = 0.05; TNC, r = 0.13, p = 0.03). No significant correlation was observed for COL4A1 (r = 0.03, p = 0.34). Interpretable data could not be obtained for SPON1 due to technical limitations of the ELISA. Confirming previous results multiple regression analysis derived a formula for the prediction of mRSS using the three remaining serum proteins (r = 0.15, p = 0.009). mRSS = 9.896 + 0.01719(COMP) - 0.006481(COL4A1) - 0.002318(TNC). Patients receiving mycophenolate mofetil showed numerically lower serum concentrations of COMP (p = 0.16), COL4A1 (p = 0.32), TNC (p = 0.15) and a lower composite biomarker score (p = 0.22) with increasing treatment duration in early dcSSc cases (Table 1). Conclusion Our results confirm this novel three-protein composite serum marker predicts skin severity in SSc better than each individual analyte. After further validation, this blood-based approach may help evaluate treatment response to standard immunosuppression. Further work will establish utility of this composite measure as a predictive or prognostic biomarker. Disclosure E. Roblin: None. K.E.N. Clark: None. C. Beesley: None. V.H. Ong: None. C.P. Denton: Consultancies; C.P.D. has received consulting fees from Arxx Therapeutics, Roche, Janssen, GlaxoSmithKline, Bayer, Sanofi, Galapagos, Boehringer Ingelheim, CSL Behring and Acceleron. Honoraria; C.P.D. has received honoraria from Janssen, Boehringer Ingelheim, and Corbus. Grants/research support; C.P.D. has received research grants to the institution from Servier, Horizon, Arxx Therapeutics and GlaxoSmithKline.

Optimising oncology drug expenditure in Ireland.

A combination of improvements in patient survival, increasing treatment duration, and the development of more expensive agents has led to a doubling of per-capita spending on cancer medicines in Ireland (2008-2018). Despite this, access to new drugs is poor in comparison to other EU countries. We examine methods to optimise oncology drug spending to facilitate access to newer anticancer agents. Key targets for spending optimisation (biosimilar use, clinical trials and expanded access programs, waste reduction, avoidance of futile treatment, and altered drug scheduling) were identified through an exploratory analysis. A structured literature search was performed, with a focus on articles relevant to the Irish Healthcare system, supplemented by reports from statutory bodies. At the present time, EMA-approved agents are available once approved by the NCPE. Optimising drug costs occurs through guideline-based practice and biosimilar integration, the latter provides €80 million in cost savings annually. Access to novel therapies can occur via over 50 clinical trials and 28 currently available expanded access programmes. Additional strategies include reversion to weight-based immunotherapy dosing, potentially saving €400,000 per year in our centre alone, vial sharing, and optimisation of treatment schedules. A variety of techniques are being employed by oncologists to optimise costs and increase access to innovation for patients. Use of biosimilars, drug wastage, and prescribing at end of life should be audited as key performance indicators, which may lead to reflective practice on treatment planning. Such measures could further optimise oncology drug expenditure nationally facilitating approval of new agents.

A key parametric study of ultrasonic exfoliation of 2D TiB2 using DI water as a unique medium

Liquid Phase Exfoliation (LPE) is a very effective technique for the synthesis of few layered two dimensional (2D) nanosheets. There is a surge to find environment friendly solvents for efficient exfoliation of layered materials to produce 2D nanosheets. TiB2 is an important layered material with very little reported work on its 2D nanosheets. The present work is about successful LPE of TiB2 using deionized (DI) water as a clean, green and low cost dispersion medium to make TiB2 nanosheets. The impact of ultrasonication conditions i.e. input power and treatment duration for efficient synthesis of few layered 2D nanosheets in DI water is studied by Atomic Force Microscopy (AFM), X-Ray Diffraction (XRD) and Scanning Electron Microscopy (SEM). It is found that by increasing input power, the layer thickness is reduced from bulk to 34 nm with lateral dimensions as huge as up to 5 μm. The increased treatment duration has further reduced the layer thickness to 21 nm associated with a decrease in lateral dimensions to about 1 μm. The mechanism of variation in the aspect ratio of the 2D nanosheets with ultrasonication power and treatment duration is explained. The optimum conditions for the fabrication of high aspect ratio 2D nanosheets of TiB2 owe to a greater acoustic cavitation intensity, an optimum treatment duration and a homogenous distribution of the cavitation events while using an appropriate size of the sonotrode in the sonicated volume during ultrasonication.

Impact of irregular appointment interval on Orthodontic treatment amid COVID-19 Pandemic- A Cross sectional Observational Study.

Introduction: The COVID-19 pandemic situation has affected all professions including orthodontics. The present study proposed determination of impact of irregular appointments on Orthodontic treatment amid COVID-19 pandemic. Materials and Methods: The cross-sectional observational study design enrolled 134 patients over period of 2 weeks were recorded such as treatment start date, total number of appointments scheduled and frequency of missed appointments after 24 March 2020, Stage of Orthodontic treatment on or before 24 March 2020 i.e., Alignment &amp; levelling b) Space closure c) Finishing and Detailing d) Retention. Results: The distribution of malocclusion based on Angle Molar criteria showed prevalence of 53.73 % Class I, 37.32 % Class II and 8.95% Class III. The malocclusions were treated predominantly by extraction in 57.46 % and non-extraction in 42.44 % patients. The total treatment duration revealed that more than 51 % patients’ treatment lasted beyond 24 months but finished before 36 months. Similarly, 35.82 % patients’ treatment duration was less than 12 months. It was found that more than 47 % were in Stage I, 28.36 % were in stage II, 18.66 % in stage III and lastly 5.97 % were in stage IV. Conclusion: Orthodontic emergencies and un-schedule appointments had prevalence of Class I, followed by Class II and Class III with extraction treatment therapy. Majority patients treated with fixed mechanotherapy followed by Clear aligners and Retainers. More than half of the patients had increased treatment duration due to irregular follow up. Keywords: COVID-19, Corona Virus Disease, Orthodontic Appointment, Orthodontic Appliances.

Effects of Thermo-Mechanical Processing on the Microstructure and Mechanical Properties of β -Type Titanium Alloys

This study investigates the microstructural evolution and mechanical behavior of severe cold-rolled β-type Ti-29Nb-13Ta-4.6Zr (TNTZ) alloys under systematic solution heat treatments (ST) at 1063 K for durations ranging from 5 to 60 minutes. This comprehensive analysis provides valuable insights into the microstructural and mechanical characteristics of TNTZ alloys under varying solution heat treatment durations, offering a foundational understanding for optimizing their application in engineering contexts. Microstructural analysis reveals that both solution-treated (ST) and cold-rolled (CR) samples exhibit a predominant single body-centered cubic (BCC) β phase, while cold-rolled and solution-treated (CST-Q) samples display a combination of β and martensite orthorhombic α'' phases. ST samples demonstrate equiaxed grains with an average diameter of ~72 μm, albeit with limited clarity. In contrast, CST-Q samples treated for over 10 minutes exhibit finer equiaxed grains within the 7-14 μm range. Hardness values increase with prolonged solution heat treatment, reaching approximately ~183 HV for ST and ~234 HV for CR. Moreover, hardness continues to rise with increasing treatment duration, reaching ~204 HV for CST10Q, ~229 HV for CST30Q, and ~242 HV for CST60Q. Mechanical properties, including tensile strength, yield strength, and elongation, vary across samples. ST shows values of ~710 MPa, ~610 MPa, and ~25%, CR with ~1305 MPa, ~395 MPa, and ~17.5%, CST5Q with ~1042 MPa, ~440 MPa, and 17.5%, CST10Q with ~1010 MPa, ~650 MPa, and 21%, and CST60Q with ~930 MPa, ~660 MPa, and ~21%. Fracture surfaces of all samples exhibit dimple structures and microvoid nucleation, indicative of ductile failure.

Racial Disparities in Clozapine Prescription Patterns Among Patients With Schizophrenia.

Previous research has suggested that demographic factors affect the likelihood of a patient with schizophrenia receiving a clozapine prescription. The authors aimed to determine the impact of race, social determinants of health, gender, rurality, and care patterns on clozapine prescription rates. This cross-sectional observational study used structured electronic health records data from 3,160 adult patients diagnosed as having schizophrenia between October 1, 2015, and November 30, 2021, in a multifacility health system. The social vulnerability index (SVI) was used to quantify social determinants of health. Descriptive data analysis, logistic regression, and sensitivity analysis were conducted to identify differences between patients with schizophrenia who received a clozapine prescription and those who received antipsychotic medications other than clozapine. Overall, 401 patients with schizophrenia were given a clozapine prescription during the study period, and 2,456 received antipsychotics other than clozapine. Results of the logistic regression indicated that White race (OR=1.71, compared with Black race), community minority status and language SVI score (OR=2.97), and increased treatment duration (OR=1.36) were significantly associated with a higher likelihood of clozapine prescription; gender, rurality, age at first diagnosis, and ethnicity did not influence the likelihood of receiving clozapine. Black patients with schizophrenia had a lower likelihood of receiving a clozapine prescription compared with White patients, even after analyses accounted for demographic variables, social determinants of health, and care access patterns. Given the effectiveness of clozapine in managing treatment-resistant schizophrenia, it is crucial for future research to better understand the factors contributing to this treatment disparity.

Assessment of the protective effects of pomegranate peel extract and N-acetyl cysteine alone or in combination with Ornipural® against Cadmium-induced bone toxicity in rat

Aim: The present study was conducted to determine the effects of pomegranate peel extract (PPE) and N-acetyl Cysteine (NAC) alone or in their treatment combinations with commercial preparation Ornipural® (ORN) on bone metabolism against experimentally cadmium (Cd)-induced toxicity in rats. Materials and Methods: Totally 36 animals were used in the study including 6 Wistar Albino rats in each group. The animals were assigned to control, Cd, Cd+PPE, Cd+NAC, Cd+PPE+ORN and Cd+NAC+ORN groups. The animals in the groups were euthanized after their blood samples were taken at the end of the 8th week. The bones were subjected to maceration for morphometric and histopathological examinations after euthanasia. Results: The statistically significant differences were determined between the treatment groups and Cd group in terms of histopathological changes (osteoporotic alterations and changes in red bone marrow) and biomarkers (Ca, P and Mg) (P&lt;0.05). Conclusion: Although PPE, NAC and treatment combinations with ORN applied against experimentally induced cadmium toxicity were determined to have positive effects on bone metabolism, it has been thought that carrying out trials by increasing treatment duration and dose would be beneficial to determine definite efficacy of the applied treatment protocols.

Contemporary Management and Outcomes of Veterans Hospitalized With Alcohol Withdrawal: A Multicenter Retrospective Cohort Study.

Few studies describe contemporary alcohol withdrawal management in hospitalized settings or review current practices considering the guidelines by the American Society of Addiction Medicine (ASAM). We conducted a retrospective cohort study of patients hospitalized with alcohol withdrawal on medical or surgical wards in 19 Veteran Health Administration (VHA) hospitals between October 1, 2018, and September 30, 2019. Demographic and comorbidity data were obtained from the Veteran Health Administration Corporate Data Warehouse. Inpatient management and hospital outcomes were obtained by chart review. Factors associated with treatment duration and complicated withdrawal were examined. Of the 594 patients included in this study, 51% were managed with symptom-triggered therapy alone, 26% with fixed dose plus symptom-triggered therapy, 10% with front loading regimens plus symptom-triggered therapy, and 3% with fixed dose alone. The most common medication given was lorazepam (87%) followed by chlordiazepoxide (33%), diazepam (14%), and phenobarbital (6%). Symptom-triggered therapy alone (relative risk [RR], 0.68; 95% confidence interval [CI], 0.57-0.80) and front loading with symptom-triggered therapy (RR, 0.75; 95% CI, 0.62-0.92) were associated with reduced treatment duration. Lorazepam (RR, 1.20; 95% CI, 1.02-1.41) and phenobarbital (RR, 1.28; 95% CI, 1.06-1.54) were associated with increased treatment duration. Lorazepam (adjusted odds ratio, 4.30; 95% CI, 1.05-17.63) and phenobarbital (adjusted odds ratio, 6.51; 95% CI, 2.08-20.40) were also associated with complicated withdrawal. Overall, our results support guidelines by the ASAM to manage patients with long-acting benzodiazepines using symptom-triggered therapy. Health care systems that are using shorter acting benzodiazepines and fixed-dose regimens should consider updating alcohol withdrawal management pathways to follow ASAM recommendations.

Impact of a Best Practices Program in Patients with Relapsed/Refractory Multiple Myeloma Receiving Selinexor.

Best practice (BP) in cancer care consists of a multifaceted approach comprising individualized treatment plans, evidence-based medicine, the optimal use of supportive care and patient education. We investigated the impact of a BP program in patients with relapsed/refractory multiple myeloma (RRMM) receiving selinexor. Features of the BP program that were specific to selinexor were initiating selinexor at doses ≤80 mg once weekly and the upfront use of standardized antiemetics. Study endpoints included time to treatment failure (TTF), duration of therapy, dose limiting toxicities and overall survival. Comparative analysis on TTF and duration of therapy was conducted using a log-rank test and multivariate Cox proportional hazard regression. Over the ensuing 12-month post-BP period, 41 patients received selinexor-based therapy compared to 68 patients who received selinexor-based therapy pre-BP implementation. Patients treated in the post-BP period had reductions in TTF (hazard ratio [HR] = 0.50; 95% CI: 0.27 to 0.92). Patients in the pre-BP period were four times more likely to stop therapy than those in the post-period (odds ratio [OR] = 4.0, 95% CI: 1.75 to 9.3). The findings suggest a BP program tailored to selinexor could increase the time to treatment failure, increase treatment duration and lower the incidence of drug limiting toxicities.

The second molar dilemma in orthodontics: to bond or not to bond?

To compare orthodontic treatment (OT) outcome in adolescents undergoing nonextraction fixed OT with or without bonding of second molars using the score of the American Board of Orthodontics Cast Radiograph Evaluation (C-R-Eval). This study included healthy adolescents with skeletal Class I or mild Class II/Class III malocclusion, normal or deep overbite (OB), and mild-to-moderate dental crowding (<5 mm) who underwent nonextraction fixed OT with ("bonded" group) or without ("not-bonded" group) bonding of second molars. Patient treatment records, pre- and posttreatment digital models, lateral cephalograms, and orthopantomograms were assessed. The evaluated outcomes included leveling of the curve of Spee (COS), OB, control of incisor mandibular plane angle (IMPA), number of emergency visits (related to poking wires and/or bracket failure of the terminal molar tubes), treatment duration, and C-R-Eval. Treatment variables were compared across time points and among groups. The sample included 30 patients (mean age 16.07 ± 1.80 years) in the bonded group and 32 patients (mean age 15.69 ± 1.86 years) in the not-bonded group. The mean overall C-R-Eval score was significantly higher (P < .001) in the not-bonded group (25.25 ± 3.98) than in the bonded group (17.70 ± 2.97). There were no significant differences in mean changes of COS, OB, IMPA, or treatment duration among groups. The mean number of emergency visits was significantly higher in the bonded (3.3 ± 0.6) than the not-bonded group (1.9 ± 0.4) (P < .001). Bonding of second molars enhances the outcome of nonextraction fixed OT as demonstrated by the C-R-Eval without increasing treatment duration, irrespective of more emergency visits.

Dosimetric comparison in sparing normal tissue dosage by using auto-SBRT planning in oligo liver tumors.

The study aimed to compare the dosimetric distribution of VMAT plans by increasing the number of half arcs in liver SBRT and investigate the effect by using automatic plan software in plan optimization. Thirty-one patients with oligo liver tumors were randomly selected. VMAT treatment plans with different numbers of coplanar half arcs were generated. Adding arcs significantly increased the PTV, D2%, D50%, and CI, but sacrificed the plan homogeneity. It also decreased the maximum dose of normal tissues such as the stomach, duodenum, and spinal cord and reduced Dmean, D500cc, and D700cc for the liver. Nevertheless, the diminishing effect gradually decayed into three arcs. Meanwhile, the addition of arcs substantially extended the beam-on time. In the context of SBRT for oligo liver tumors, increasing the number of coplanar half arcs will improve PTV conformity and offer better protection for OARs, albeit at the expense of increased treatment duration. Considering the trade-off between plan quality and treatment efficiency, a three-arc plan may be more suitable for clinical implementation.

Extraction vs nonextraction orthodontic treatment: a systematic review and meta-analysis.

To compare four first premolar extraction and nonextraction treatment effects on intra-arch width, profile, treatment duration, occlusal outcomes, smile aesthetics and stability. An electronic search of the literature to June 2, 2023 was conducted using health science databases, with additional search of gray literature, unpublished material, and hand searching, for studies reporting nonsurgical patients with fixed appliances regarding sixteen sub-outcomes. Data extraction used customized forms, quality assessed with ROBINS-I (Risk Of Bias In Non-randomized Studies-of Interventions) and Cochrane RoB 2 (risk-of-bias) tool. GRADE (Grading of Recommendations Assessment, Development and Evaluation) assessed certainty of evidence. Thirty (29 retrospective studies, 1 randomized controlled trial) studies were included. Random-effect meta-analysis (95% CI) demonstrated maxillary (MD: -2.03 mm; [-2.97, -1.09]; P < .0001) and mandibular inter-first molar width decrease (MD: -2.00 mm; [-2.71, -1.30]; P < .00001) with four first premolar extraction; mandibular intercanine width increase (MD: 0.68 mm; [0.36, 0.99]; P < .0001) and shorter treatment duration (MD: 0.36 years; [0.10, 0.62]; P = .007) in the nonextraction group. Narrative synthesis included three and five studies for upper and lower lip-E plane, respectively. For American Board of Orthodontics Objective Grading System and maxillary/mandibular anterior alignment (Little's irregularity index), each included two studies with inconclusive evidence. There were no eligible studies for UK Peer Assessment Rating (PAR) score. Class I subgroup/sensitivity analyses favored the same results. Prediction interval indicated no significant difference for all outcomes. Four first premolar extraction results in maxillary and mandibular inter-first molar width decrease and retraction of upper/lower lips. Nonextraction treatment results in mandibular intercanine width increase and shorter treatment duration. There was no significant difference between the two groups regarding maxillary intercanine width, US PAR score, and posttreatment smile esthetics. Further high-quality focused research is recommended.

Study of Brewer's Spent Grain Environmentally Friendly Processing Ways.

This article is devoted to the study of the effect of electrochemically activated water (catholyte with pH 9.3) on organic compounds of the plant matrix of brewer's spent grain in order to extract various compounds from it. Brewer's spent grain was obtained from barley malt at a pilot plant by mashing the malt followed by filtration and washing of the grain in water and storing it at (0 ± 2) °C in craft bags. For the organic compound quantitative determination, instrumental methods of analysis (HPLC) were used, and the results were subjected to mathematical analysis. The study results showed that at atmospheric pressure, the alkaline properties of the catholyte showed better results compared to aqueous extraction with respect to β-glucan, sugars, nitrogenous and phenolic compounds, and 120 min was the best period for extraction at 50 °C. The excess pressure conditions used (0.5 ÷ 1 atm) revealed an increase in the accumulation of non-starch polysaccharide and nitrogenous compounds, while the level of sugars, furan and phenolic compounds decreased with increasing treatment duration. The waste grain extract ultrasonic treatment used revealed the effectiveness of catholyte in relation to the extraction of β-glucan and nitrogenous fractions; however, sugars and phenolic compounds did not significantly accumulate. The correlation method made it possible to reveal the regularities in the formation of furan compounds under the conditions of extraction with the catholyte: Syringic acid had the greatest effect on the formation of 5-OH-methylfurfural at atmospheric pressure and 50 °C and vanillic acid under conditions of excess pressure. Regarding furfural and 5-methylfurfural, amino acids had a direct effect at excess pressure. It was shown that the content of all furan compounds depends on amino acids with thiol groups and gallic acid; the formation of 5-hydroxymethylfurfural and 5-methylfurfural is influenced by gallic and vanillic acids; the release of furfural and 5-methylfurfural is determined by amino acids and gallic acid; excess pressure conditions promote the formation of furan compounds under the action of gallic and lilac acids. This study showed that a catholyte allows for efficient extraction of carbohydrate, nitrogenous and monophenolic compounds under pressure conditions, while flavonoids require a reduction in extraction time under pressure conditions.

Cost-effectiveness of Increasing Buprenorphine Treatment Initiation, Duration, and Capacity Among Individuals Who Use Opioids

Buprenorphine is an effective and cost-effective medication to treat opioid use disorder (OUD), but is not readily available to many people with OUD in the US. The current cost-effectiveness literature does not consider interventions that concurrently increase buprenorphine initiation, duration, and capacity. To conduct a cost-effectiveness analysis and compare interventions associated with increased buprenorphine treatment initiation, duration, and capacity. This study modeled the effects of 5 interventions individually and in combination using SOURCE, a recent system dynamics model of prescription opioid and illicit opioid use, treatment, and remission, calibrated to US data from 1999 to 2020. The analysis was run during a 12-year time horizon from 2021 to 2032, with lifetime follow-up. A probabilistic sensitivity analysis on intervention effectiveness and costs was conducted. Analyses were performed from April 2021 through March 2023. Modeled participants included people with opioid misuse and OUD in the US. Interventions included emergency department buprenorphine initiation, contingency management, psychotherapy, telehealth, and expansion of hub-and-spoke narcotic treatment programs, individually and in combination. Total national opioid overdose deaths, quality-adjusted life years (QALYs) gained, and costs from the societal and health care perspective. Projections showed that contingency management expansion would avert 3530 opioid overdose deaths over 12 years, more than any other single-intervention strategy. Interventions that increased buprenorphine treatment duration initially were associated with an increased number of opioid overdose deaths in the absence of expanded treatment capacity. With an incremental cost- effectiveness ratio of $19 381 per QALY gained (2021 USD), the strategy that expanded contingency management, hub-and-spoke training, emergency department initiation, and telehealth was the preferred strategy for any willingness-to-pay threshold from $20 000 to $200 000/QALY gained, as it was associated with increased treatment duration and capacity simultaneously. This modeling analysis simulated the effects of implementing several intervention strategies across the buprenorphine cascade of care and found that strategies that were concurrently associated with increased buprenorphine treatment initiation, duration, and capacity were cost-effective.

132P Neoadjuvant zanidatamab for stage I node-negative HER2- positive breast cancer (BC)

Outcome of patients (pts) w/ stage I node neg HER2+ treated w/ wkly paclitaxel x 12 doses and trastuzumab x 1yr is excellent (10yr RFS 96%). Therefore, trials to de-escalate chemo and use targeted therapy alone are underway. Zanidatamab is a novel, humanized, bispecific, immunoglobulin G isotype 1-like, monoclonal antibody directed against the juxtamembrane extracellular domain (ECD4) and the dimerization domain (ECD2) of HER2. This results in HER2 clustering that modulates signaling and leads to immune activation. Zanidatamab demonstrated antitumor activity in heavily pre-treated HER2+ metastatic BC with acceptable safety profile. We hypothesized that zanidatamab would be a safe and effective regimen for women w/ node neg stage I HER2+ BC. Pts w/ 1-3cm, clinically node neg HER2+ BC were enrolled in this investigator-initiated clinical trial. Pts had HER2+ BC: HER2 3+ by IHC or IHC 2+ and ISH +. Pts received 2-wkly zani x6 prior to surgery. Pts with ER+ tumors also received neoadjuvant endocrine therapy: postmenopausal pts received letrozole 2.5mg daily, and premenopausal pts received tamoxifen 20mg daily or GNRH and letrozole 2.5mg on treating physician preference. The primary objective was to evaluate efficacy as determined by pathologic complete response (pCR). Secondary objectives included pathologic response by residual cancer burden (RCB), radiological response, and safety profile of zanidatamab. Eleven pts w/ HER2+ BC were enrolled. Median age was 61yrs old (range 30-72). Median tumor size was 2.2cm (range 1-3cm). Four pts were pre-menopausal. Six pts had tumors >2cm tumors. Three received tamoxifen and 3 letrozole. All pts completed 6 cycles of zanidatamab and had Sx. Four (36%) had pCR, 3 RCB1 (28%) and 4 RCB2 (36%). This met the success criterion of Simon’s design (>=3/17 pts with pCR) of targeting a 25% pCR rate against a 5% null rate. Treatment was tolerated well. There were no grade 3 or 4 toxicities. One pt had minor infusion-related reaction and grade 2 acne, and 1 grade 2 diarrhea. Neoadjuvant zanidatamab for 3 months showed significant efficacy, (pCR/RCB-1 64%) w/ acceptable safety profile in pts w/ stage I node neg HER2+ BC. The trial is ongoing and has been modified to increase treatment duration to 5mths (10 cycles).

Mandibular advancement devices used with morning occlusal guides for treating obstructive sleep apnea-changed incisor inclination and its associated factors.

Mandibular advancement devices (MADs) effectively treat patients withobstructive sleep apnea (OSA). Although the use of morning occlusal guides (MOGs) along with MADs is recommended to prevent dental side effects, there is no evidence to support this. The aim of this study was to evaluate the change in incisor inclination in patients withOSA treated with MADs and MOGs, and to identify its predictive factors. Patients with OSA who received MAD and MOG therapy and had a reduction in their apnea-hypopnea index greater than 50% were analyzed. Cephalometric measurements were performed at baseline and at a 1-year follow-up or longerto assess the dentoskeletal side effects of MAD/MOG treatment. Multivariable linear regression analysis was used to assess the association between the change in incisor inclination and the independent variables that may cause the observed side effects. Among 23 patients enrolled in the study, there was significant upper incisor retroclination (U1-SN: 2.83° ± 2.68°, U1-PP: 2.86° ± 2.46°; P < 0.05) and significant lower incisor proclination (L1-SN: 3.04° ± 3.29°, L1-MP: 1.74° ± 3.13°; P < 0.05). However, no significant skeletal changes were observed. Multivariable linear regression revealed that advancement ≥ 95% of the patients' maximal mandibular protrusion was associated with greater upper incisor retroclination. Increased treatment duration was alsoassociated with increased upper incisor retroclination. No \measured variables were associated with the change in lower incisor inclination. Dental side effects occurred in patients who used MADs with MOGs. The amount of mandibular protrusion by MADs and treatment duration were predictive factors associated with upper incisor retroclination.

Orthodontic emergencies and mental health of patients undergoing orthodontic treatment during COVID-19 pandemic: A questionnaire study.

To evaluate the impact of COVID-19 pandemic on orthodontic treatment and mental health of patients undergoing orthodontic treatment and to compare their mental health with the age-matched control group. 484 orthodontic patients (245 males and 239 females) and 200 age-matched control subjects were divided into two age groups. Group 1 had 14-18 years of adolescents (N = 274) and 100 control participants (Group 2) and Group 3 comprised of 19 years above adults (N = 210) and 100 control participants (Group 4). Group 1 and 3 patients filled the 4 sections of the questionnaire related to orthodontic emergencies (Sections 1-3) and mental distress (Kessler Psychological Distress Scale-Section 4), while groups 2 and 4 were asked to fill only Section-4. The comparison of mental distress on high/low Kessler scores was made using the Chi-Square test/Fisher's exact test. The factors which came out to be significant were put to bivariate logistic regression analysis. The percentage of patients with high Kessler scores among Group 1 and Group 3 were 9.9% and 17.2% respectively, and their differences with age-matched control groups were non-significant. The mean differences of Kessler score were significantly higher for Group 3 compared to group 1. The higher Kessler score was associated with age, higher education, a feeling of concern for non-availability of appointments, increased treatment duration, its effect on the quality of treatment, and sabotaging of definitive future plans. The orthodontic treatment and emergencies may not be a significant factor contributing to increased stress among patients during the lockdown.