Therapy Treatment Research Articles

Factors associated with electroconvulsive therapy treatment for adults with serious psychiatric conditions in Australia.

To identify factors associated with receiving electroconvulsive therapy (ECT) for serious psychiatric conditions. Retrospective observational study using hospital administrative data linked with death registrations and outpatient mental health data in New South Wales (NSW), Australia. The cohort included patients admitted with a primary psychiatric diagnosis between 2013 and 2022. The outcome measure was receipt of ECT. Of 94,950 patients, 3465 (3.6%) received ECT. The likelihood of receiving ECT was higher in older (hazard ratio [HR] = 1.03), female (HR = 1.24) patients. Compared to depression, patients with schizophrenia/schizoaffective disorder (HR = 0.79), schizophrenia-related disorders (HR = 0.37), mania (HR = 0.64) and other mood disorders (HR = 0.45) had lower odds of receiving ECT. Patients with depression and one other serious psychiatric condition had higher odds of receiving ECT than depression alone. Bipolar disorder likelihood of ECT did not differ from depression. A higher number of mental health outpatient visits in the prior year and an involuntary index admission with depression were also associated with receiving ECT. Likelihood of receiving ECT increased with year of admission (HR = 1.32), private patient status (HR = 2.06), higher socioeconomic status (HR = 1.09) and being married (HR = 1.25). ECT use for depression and bipolar disorder in NSW aligns with clinical national guidelines. Patients with schizophrenia/schizoaffective, schizophrenia-related disorders, mania and other mood disorders had lower likelihood of ECT than depression, despite ECT being recommended by clinical guidelines for these diagnoses. Variations in ECT were strongly associated with healthcare access, with private patients twice as likely to receive ECT than their public counterparts, suggesting a need to explore ECT accessibility.

Current Practices for Severe Alpha-1 Antitrypsin Deficiency Associated COPD and Emphysema

Alpha-1 antitrypsin deficiency is a genetic disorder that can lead to chronic obstructive pulmonary disease and emphysema. Although it is the most well-studied genetic risk factor for emphysema, data is still scarce. Traditionally, medical therapy is similar to standard chronic obstructive pulmonary disease patients. Over the past several decades, enzyme augmentation therapy has emerged as a highly utilized alpha-1 antitrypsin-specific therapy. It has become the standard of care for severe alpha-1 antitrypsin deficiency despite unclear effects on a multitude of clinical outcomes. Significant data supports interventional therapies, including lung volume reduction surgery and bronchoscopic lung volume reduction, for chronic obstructive pulmonary disease patients without alpha-1 antitrypsin deficiency. These interventions have less robust data in the treatment of alpha-1 antitrypsin-induced chronic obstructive pulmonary disease. This review will explore the data regarding various treatment options for severe alpha-1 antitrypsin deficiency associated with chronic obstructive pulmonary disease and emphysema.

Rehabilitation Frequency for Pediatric Patients With Burns in Acute Care.

It is known that rehabilitation provides beneficial outcomes postburns. However, the frequency of therapy interventions is inconsistent, especially in the hospital setting. Our objective is to identify the frequency of rehabilitation interventions for pediatric patients with burns in acute care. Manuscripts were included if they addressed rehabilitation burn interventions for the pediatric population and reported intervention frequencies. Studies were excluded if they included adults and/or were beyond the acute care setting. We searched 6 databases for published literature, in the English language, from 2010 to April 2023. A total of 140 articles were found; however, only 8 met the inclusion criteria. Five studies met criteria for high-quality evidence, 3 for low quality. Frequency of rehabilitative therapy in the acute care setting was found to be variable, ranging from 1 day per week to 2 times per day. More research is needed to support optimum frequency.

A prospective, randomised, controlled, double blinded, cross-over study on the effect of a single session of pulsed electromagnetic field therapy on signs of hip osteoarthritis in dogs

BackgroundCanine coxofemoral joint osteoarthritis is a common, painful and debilitating condition. The objective of this study was to evaluate if any measurable changes in pain or lameness occurred in this patient group immediately after a single treatment with pulsed electromagnetic field therapy. Eight dogs with coxofemoral joint osteoarthritis presenting with signs of pain and lameness were prospectively recruited to this randomised, controlled, double blinded, cross-over study. Subjects attended the research facility on two occasions for one active and one placebo treatment with pulsed electromagnetic field therapy. The immediate effect of one pulsed electromagnetic field therapy treatment on pain and lameness was measured subjectively with the Helsinki Chronic Pain Index and Visual Analogue Scale and objectively using a pressure sensitive walkway.ResultsA statistically significant difference (P = 0.03) for change in stride length in the affected limb was recorded for subjects between the active and placebo treatments with pulsed electromagnetic field therapy. Within the active treatment results, there was a statistically significant change in the measurement for reach (P = 0.04) and stride length (P = 0.047) which got shorter in the affected limb post treatment. For the subjective outcome measures, there was no statistically significant difference between the active and placebo treatments for the evening of the treatment day or the next morning from pre-treatment values. Within the placebo treatment results a statistically significant change (improvement) was detected in Visual Analogue Score (P = 0.03) between pre-treatment and the next morning values.ConclusionsThe findings of this study do not show demonstrable improvement in owner assessed pain levels or temporospatial performance in dogs with coxofemoral joint osteoarthritis immediately after a single application of pulsed electromagnetic field therapy.

Comprehensive review of the heart failure management guidelines presented by the American College of Cardiology and the current supporting evidence.

Heart failure (HF) is a chronic condition that affects the heart's functional capacity, resulting in symptoms such as fatigue, edema, and dyspnea. It affects millions of adults in the United States and presents challenges in optimizing treatment and coordinating care among clinicians. Additionally, the various classifications for HF and limited research on treatment outcomes in heart failure with midrange ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF) further complicate the pharmacological management of patients with this disease. The objectives of this article are to review the pharmacotherapy guidelines for HF provided by the American College of Cardiology (ACC) and offer an update on the current trials conducted on these agents. The paper includes a post hoc analysis of established randomized controlled trials (RCTs), current RCTs, analysis of HF registries, and the guidelines published by the ACC. The gathering of research began in June 2023 and completed in August 2023. PubMed was utilized with the following search items: "treatment for HFrEF" (heart failure with reduced ejection fraction), "treatment for HFmrEF," and "treatment for HFpEF." The screening process was completed by one author. The automation tools utilized were "clinical trials," "randomized control trials," and "five years". Meta-analyses, systematic reviews, and case reports were excluded from the screening process. This review does not include research regarding medical devices, interventional therapies, and lifestyle modifications. Finally, research regarding additional comorbidities, nonpharmacological focused research, and agents not recommended by the ACC are not included in this paper. The search began with 6,561 records identified from PubMed, with 407 records screened after automation tools were utilized to filter for "clinical trials," "randomized control trials," "one year," and "five years". A total of 22 duplicates were reviewed, 318 were sought for screening after trials from 2019 were removed, and 31 studies were ultimately included in the review. A detailed summary of the most recent recommendations by the ACC are provided. The discussion includes indications, mechanisms of action, side effects, and contraindications for the selected agents. Additionally, recent clinical trials are included to provide evidence on the efficacy of the recommended classes of drugs. The current guidelines for managing HFrEF have been consistent, but there is limited consensus on treating HFmrEF and HFpEF. Large RCTs have provided compelling evidence supporting the use of the recommended pharmacological agents. However, despite the new effective treatment protocols, slow clinical inertia and underoptimization of HF management persist. Thus, it is crucial to synchronize care among clinicians involved in managing patients with this disease.

Contemporary National Incidence and Outcomes of Acute Limb Ischemia

Acute Limb Ischemia (ALI) is a morbid and deadly diagnosis. However, existing epidemiologic studies describing ALI predate the introduction of the Affordable Care Act in 2010 and direct oral anticoagulants in 2011. Thus, we synergized the National Inpatient Sample (NIS) and United States (U.S.) Census to define contemporary trends in the incidence, treatment, and outcomes of ALI in the US. We included emergent admissions of adults with primary diagnosis of lower extremity ALI in survey-weighted NIS data (2005-2020). Mann-Kendal trend test evaluated ALI incidence (primary outcome), anticoagulation usage, insurance coverage, revascularization type, and in-hospital amputation/death. Multivariable logistic regression quantified covariate associations with in-hospital amputation/death. Of 582,322,862 estimated hospitalizations in the NIS, 227,440 met inclusion criteria (mean age 68.80 years, 49.94% women, 76.66% White). ALI incidence peaked in 2006 (7.16/100,000 person-years) but has declined since 2015 to 4.16/100,000 person-years in 2020 (ptrend=.008). Endovascular revascularization, anticoagulation, and Medicaid coverage increased, while self-pay insurance decreased (ptrend<.05). Amputation rates significantly decreased from 8.04% to 6.54% (ptrend=.01) while death rate remained at 5.59% (ptrend=.16) over the study period. Pre-hospitalization anticoagulation was associated with decreased amputation (aOR=0.74 [95%CI 0.65-0.84]) and death (aOR=0.50 [95%CI 0.43-0.57]). When controlling for covariates, women had a higher risk of death (aOR=1.17 [95%CI 1.07-1.27], p<.0001), while Black patients had a higher risk of amputation (aOR=1.24 [95%CI 1.10-1.41], p<.0001). Our U.S. population based epidemiological study demonstrates that ALI incidence and in-hospital amputation rates are decreasing, while mortality remains unchanged. We further highlight the ongoing need for ALI investigation specifically as it relates to access to care, antithrombotic therapy use, treatment strategy, and strategies to combat gender and racial disparities.

Change in Depression Severity Among Depressed Older Crime Victims.

The crime rates in urban centers are rising. The psychological impact of crime can range from distress to longstanding mental health impairment. Despite the rising crime rates and psychological impact on victims, little research has been conducted on older adult crime victims' mental health. In this manuscript we describe the profile of older adult crime victims in New York City referred for mental health services, their rates of depression, and the preliminary outcome data from a brief therapy intervention (PROTECT) targeting depression among victims. Building on prior research demonstrating the efficacy of PROTECT for depressive symptom reduction in elder abuse victims, the present study hypothesized elder crime victims who completed PROTECT therapy would demonstrate clinically meaningful depression symptom reduction as measured by the Patient Health Questionnaire-9 (PHQ-9). Additionally, it was hypothesized that these clinically significant depression symptom reductions would be demonstrated regardless of sex, gender, victimization type, victimization frequency, or living status. The results demonstrate that 67.7% (21/31) of participants had a clinically significant reduction in PHQ-9 scores (≥5 points) upon completion of PROTECT. There were no significant group differences in clinically significant depression symptom reduction, suggesting that PROTECT is an effective intervention for a diverse sample of elder crime victims. Future research should focus on the mental health impact of crime against older adults and explore reductions in anxiety and PTSD symptoms among crime victims. Through our partnerships we aim to bridge the divide between victim service providers, and mental health service providers to assist victims to recover, heal, and thrive.

Mood Disorders in Schizotypal Disorder with Leading Syndrome of Eating Disorders

Background: сoverage of the problem of mood disorders in patients with schizotypal disorder with leading eating disorders (EDs), in childhood and adolescence is relevant. However, concomitant disorders in eating disorder in childhood and adolescence and their dynamics have not been sufficiently studied. The aim: to study the clinical and psychopathological structure of mood disorders in patients with schizotypal disorder and eating disorders leading in the clinical picture. Patients and methods: the study included 50 patients (9 boys, 41 girls), aged 7 to 16 years. Inclusion criteria: 1) schizotypal disorder; 2) eating disorders; 3) mood disorders. Research methods: clinical-psychopathological, psychometric (HDRS, PANSS), follow-up, somatic observation. Results: in patients with schizotypal and mood disorders, the following variants of eating disorder were observed: anorexia nervosa (AN — first type), anorexia nervosa with dominance of bulimia (ANB — second type), anorexia nervosa with dominance of bulimia and vomitomania (ANB + B — third type). Mood disorders in the first type of eating disorder were characterized by a pronounced depressive triad, suicidal thoughts and stupor at the cachectic stage of the disease. Mood disorders in the second type of eating disorder were characterized by a mixed affective state: short unproductive mania, ideas of dysmorphophobia, ideas of attitude, followed by a prolonged depressive state with senesto-hypochondriacal disorders, asthenia, and an increase in cognitive impairment. Mood disorders in the third type of eating disorder were characterized by the presence, of pronounced delusional and dysmorphophobic disorders and ideas of attitude, psychopathic behavior, depersonalization-derealization disorders, asthenia and cognitive impairment. Affective pathology in schizotypal disorder with eating disorder, as well as body dysmorphic syndrome, persisted for a long time. The most severe course was observed in the third group of patients (NANB + B), which was due to a significant proportion of psychotic disorders in the structure of the syndrome and somatic complications due to vomiting behavior. Conclusions: patients with schizotypal disorder with leading symptoms of eating disorder and mood disorders require an integrated approach to therapy, including somatic and psychopharmacological treatment.

Phytofabrication, characterization of silver nanoparticles using Hippophae rhamnoides berries extract and their biological activities.

Fabrication of plant-based metal nanoparticles has yielded promising results, establishing this approach as viable, sustainable, and non-toxic in the biomedical sector for targeted drug delivery, diagnostic imaging, biosensing, cancer therapy, and antimicrobial treatments. The present work demonstrates the suitability of Hippophae rhamnoides berries for the instant green synthesis of silver nanoparticles to check their antioxidant, lipid peroxidation, and antimicrobial potential. The preliminary characterization of Hippophae rhamnoides-mediated AgNPs was validated by monitoring the color shift in the solution from pale yellow to reddish brown, which was further confirmed by UV-vis spectroscopy and the plasmon peaks were observed at 450 nm. Field Emission Scanning Electron Microscopy (FESEM) and X-ray diffraction (XRD) were used to evaluate the surface topography and structure of AgNPs. Herein, the antioxidant potential of synthesized AgNPs was investigated using DPPH free radical assay and the antimicrobial efficacy of similar was checked against E. coli and S. aureus by following MIC (minimum inhibitory concentration) and MBC (Minimum bactericidal concentration) assay. Along with the inhibitory percentage of lipid peroxidation was analysed by following TBARS (Thiobarbituric acid reactive species) assay. The results revealed that the AgNPs were spherical in shape with an average size distribution within the range of 23.5-28 nm and a crystalline structure. Negative zeta potential (-19.7 mV) revealed the physical stability of synthesized AgNPs as the repulsive force to prevent immediate aggregation. The bioactive functional moieties involved in reducing bulk AgNO3 into AgNPs were further validated by FTIR. TBARS was adapted to test lipid peroxidation, and Hippophae rhamnoides-mediated AgNPs showed a 79% inhibition in lipid peroxidation compared to Hippophae rhamnoides berries extract as 65%. Furthermore, the antibacterial tests showed 37 ± 0.01 mm and 35 ± 0.0132 mm, zones of inhibition against E. coli MTCC 1698 and S. aureus MTCC 3160 with MIC and MBC values of 1 mg/mL, respectively.

Exploring the impact of early-stage dementia on everyday activities

Introduction: This paper explores the impact that early-stage dementia has on everyday activities from the perspective of people living with dementia, their supporters and occupational therapy practitioners. Method: People living with dementia and their supporters ( n = 10), and occupational therapy practitioners ( n = 21) took part in semi-structured interviews, with transcripts analysed thematically. Findings: Six primary themes were identified across participants, namely: (1) ‘Everybody seems to be different, [but] they are similar’; (2) An awareness of change: ‘Something’s not quite right’; (3) ‘ Changes’ and ‘ difficulties’ associated with complex and unfamiliar activities; (4) Social withdrawal and exclusion: ‘I’ve felt like I was a leper’; (5) Post-diagnostic mental health: ‘. . . a dark place’; and (6) A process of adaptation: ‘I’m still who I am, I can still do things. . .’ Conclusion: Findings indicate that occupational therapy intervention programmes for people living with early-stage dementia should target difficulties associated with a broad range of activity types, and include components that target mental health and motivational needs. The study adds to existing knowledge about the need to personally tailor interventions to ensure that they meet individual needs, experiences, and circumstances. Findings will inform the development of an occupational therapy intervention programme theory (theory of change) for early-stage dementia.

Effect of the use of low power laser in the treatment of chronic wounds: an integrative review

Objective: The objective was to identify the effects of low-power laser on the healing of chronic wounds. Method: This is an integrative literature review, carried out in the Medline / Pubmed, Cochrane Library and Virtual Health Library (VHL) databases, limited to Randomized Clinical Trials, in which 68 articles were identified, of which 19 were pre-selected and seven were included in the final sample, after checking the eligibility criteria. Results: Most articles (n = 05) included patients with injuries resulting from diabetes mellitus located in the regions of the feet and two studies addressed venous ulcers. Most of the selected studies showed that the use of low-level laser therapy was able to accelerate the tissue repair process, with a significant reduction in the wound area, showing effectiveness in promoting healing, when compared to the treatments presented in the different studies. The significant reduction in pain in the laser-treated group was also an important effect reported in some studies. The wavelength in nanometers (nm) used for laser application varied from 632.8 to 830 nm and the doses in joules (J) were from 3 to 7J / cm2. The duration of laser therapy treatment averaged 4 weeks. Conclusion: The low-power laser can be an alternative therapy in the treatment of chronic wounds in clinical practice to optimize and enhance the healing process.

Supportive care of female hormones in brain health: what and how?

Female hormones, functioning as neuroactive steroids, are utilized beyond menopausal hormone therapy. The rapid onset of allopregnanolone analogs, such as brexanolone and zuranolone, in treating depression, and the effectiveness of megestrol acetate in addressing appetite and weight gain, prompted the Food and Drug Administration to authorize the use of progesterone for treating postpartum depression and cancer-related cachexia. Progesterone has also been found to alleviate neuropathic pain in animal studies. These off-label applications offer a promising option for patients with advanced cancer who often experience various mood disorders such as depression, persistent pain, social isolation, and physical complications like cachexia. These patients have shown low tolerance to opioids and mood-regulating medications. However, the potential risks and uncertainties associated with hormone therapy treatment modalities can be daunting for both patients and medical professionals. This review aims to offer a comprehensive understanding of the non-reproductive functions and mechanisms of female hormones in brain health.

Lactobacillus acidophilus protects against Corynebacterium pseudotuberculosis infection by regulating the autophagy of macrophages and maintaining gut microbiota homeostasis in C57BL/6 mice.

Corynebacterium pseudotuberculosis (C. p) is known to induce a range of chronic diseases in both animals and humans. Currently, clinical treatment for C. p infection mainly relies on antibiotic therapy or surgical intervention. However, excessive use of antibiotics may increase the risk of drug-resistant strains, and the effectiveness of treatment remains unsatisfactory. Furthermore, surgical procedures do not completely eradicate pathogens and can easily cause environmental pollution. Probiotic interventions are receiving increasing attention for improving the body's immune system and maintaining health. In this study, we established a C. p infection model in C57BL/6 mice to explore the impact of Lactobacillus acidophilus during C. p infection. Our results showed that L. acidophilus effectively protected against C. p infection by regulating the autophagy of macrophages and maintaining intestinal microbiota homeostasis. This study may provide a new strategy for the prevention of C. p infection.

An efficient and successful outcome after haematopoietic stem cell transplantation in a patient with an LPS-responsive beige-like anchor gene mutation.

Lipopolysaccharide (LPS)-responsive beige ankyrin (LRBA) gene mutations were first reported as the cause of immunodeficiency syndromes and autoimmunity in 2012. The majority of LRBA patients have multiple organ system involvement and a complex clinical phenotype. Herein we present a comprehensive account on the disease progression and transplantation procedure in a patient with LRBA deficiency who exhibited progressive autoimmune disease symptoms along with recurrent pulmonary infections since the age of 6 years old. Despite receiving abatacept therapy and immunoglobulin replacement treatments to manage the symptoms, but the symptoms still progressed. Therefore, nine years after disease onset, patients were treated with allogeneic haematopoietic stem cell transplantation (allo-HSCT). The patient experienced acute and chronic graft-versus-host disease (GVHD) and recurrent infections after transplantation. During one and a half years of follow-up, we found that allogeneic haematopoietic stem cell transplantation can relieve the symptoms of autoimmune disease in patients with LRBA deficiency, and marked clinical improvement and recovery of immune function were observed following stem cell transplantation.

Comparative evaluation of cognitive behavioural therapy versus standard treatment in temporomandibular disorders: Asystematic review.

Temporomandibular disorders (TMDs) are musculoskeletal and neuromuscular conditions affecting the temporomandibular joint and associated structures. Cognitive-behavioural therapy (CBT) has emerged as a potential intervention for TMDs, but its comparative effectiveness against standard treatments remains unclear. This systematic review aimed to evaluate and compare the efficacy of CBT versus standard treatment interventions in managing TMDs. A comprehensive search was conducted across multiple databases using MeSH keywords and Boolean operators. Inclusion criteria encompassed clinical trials comparing CBT/CBT in combination with standard treatment interventions or a control group in individuals with TMDs. The primary outcome measured was pain. Secondary outcomes such as disability, depression and jaw function were also looked into. Two reviewers independently assessed for the eligibility of the articles and conducted data extraction. Quality assessments were performed using RoB 2.0 for randomised clinical trials. The initial search identified 623 articles, of which a total of eight clinical studies met the inclusion criteria and were included in the systematic review. Seven out of eight studies demonstrated improvements in outcomes related to TMD. Pain was significantly decreased in studies that showed a positive outcome. Jaw function, quality of life and psychological well-being were superior among individuals receiving CBT alone or in combination with conventional modalities, as well as hypnotic therapy coupled with CBT-based interventions. The quality of studies assessed showed all articles to be of good quality as per RoB-2 evaluation. This systematic review highlights the potential benefits of CBT in managing TMDs, suggesting its effectiveness in improving pain outcomes and enhancing overall well-being. The findings indicate that CBT may be a valuable adjunct or alternative to standard treatment interventions for individuals with TMDs. However, further research with larger sample sizes and standardised outcome measures is warranted to establish definitive conclusions regarding the comparative efficacy of CBT versus standard treatments in TMD management.

Locoregional interventional therapy for hepatocellular carcinoma: radiologic and clinical factors predictive of untreatable progression and time to untreatable progression.

In this retrospective cohort study, independent risk factors that influence untreatable progression (UP) and time to UP (TTUP) in patients with hepatocellular carcinoma (HCC) after locoregional interventional therapy were examined. The effects of initial response and best response on UP occurrence and TTUP after locoregional interventional therapy were evaluated. Data were collected from HCC patients who were initially treated with the drug-eluting beads-transcatheter arterial chemoembolization (DEB-TACE) procedure at our hospital from January 2017 to December 2022. Modified response evaluation criteria in solid tumors (m-RECIST) was used to evaluate the radiologic response of tumors. Logistic regression analysis was used to analyze the risk factors for UP in patients, and Cox regression analysis was used to discover independent variables that influenced TTUP. A total of 93 patients who initially underwent the DEB-TACE procedure were included. Subsequent to initial treatment, 50 patients continued with DEB-TACE treatment, while 43 received DEB-TACE and sequential thermal ablation treatment. The probability of developing UP was 82.8% (n = 77). Furthermore, 49 (52.7%) patients achieved an initial response, and 70 (75.3%) achieved the best response. Multivariate logistic regression analysis confirmed three independent risk factors of UP, namely, age (odds ratio [OR]: 0.950, p = 0.044); initial response (OR: 0.177, p = 0.020); and treatment regimen (OR: 7.133, p = 0.007). Multivariate Cox regression found that total bilirubin (hazard ratio [HR]: 1.029, p = 0.002), tumor distribution (HR: 1.752, p = 0.034), Subjective Angiographic Chemoembolization Endpoint (SACE) classification (HR: 0.668, p = 0.043), number of tumors (HR: 1.130, p = 0.004), initial response (HR: 0.539, p = 0.019), and treatment regimen (HR: 4.615, p < 0.001) were independent variables that influenced TTUP. Age, initial response, and treatment regimen significantly affected the occurrence of UP in HCC patients. Initial response, SACE classification, treatment regimen, total bilirubin, number of tumors, and tumor distribution were significantly correlated with TTUP. The initial response following locoregional interventional therapy had greater effects on UP occurrence and TTUP than the best response.

SARS-CoV-2 surveillance testing and isolation management of immunocompromised patients: Survey results from 13 health care centers in the United States

As a newly emerging pathogen, infection prevention and isolation management response for SARS-CoV-2 varied greatly by individual health care center. Specific patient population needs, especially those of severely immunocompromised oncologic patients, potentially intensified the response.A survey was distributed to academic healthcare centers to ascertain surveillance testing frequency, patient placement, and isolation management for patients undergoing cell therapy treatments.

The combination of modified acupuncture needle and melittin hydrogel as a novel therapeutic approach for rheumatoid arthritis treatment

Rheumatoid arthritis (RA) involves chronic joint inflammation. Combining acupuncture and medication for RA treatment faces challenges like spatiotemporal variability, limited drug loading in acupuncture needles, and premature or untargeted drug release. Here, we designed a new type of tubular acupuncture needles, with an etched hollow honeycomb-like structure to enable the high loading of therapeutics, integrating the traditional acupuncture and drug repository into an all-in-one therapeutic platform. In these proof-of-concept experiments, we fabricated injectable hollow honeycomb electroacupuncture needles (HC-EA) loaded with melittin hydrogel (MLT-Gel), enabling the combination treatment of acupuncture stimulation and melittin therapy in a spatiotemporally synchronous manner. Since the RA microenvironment is mildly acidic, the acid-responsive chitosan (CS)/sodium beta-glycerophosphate (β-GP)/ hyaluronic acid (HA) composited hydrogel (CS/GP/HA) was utilized to perform acupuncture stimulation and achieve the targeted release of injected therapeutics into the specific lesion site. Testing our therapeutic platform involved a mouse model of RA and bioinformatics analysis. MLT-Gel@HC-EA treatment restored Th17/Treg-mediated immunity balance, reduced inflammatory factor release (TNF-α, IL-6, IL-1β), and alleviated inflammation at the lesion site. This novel combination of modified acupuncture needle and medication, specifically melittin hydrogel, holds promise as a therapeutic strategy for RA treatment.Graphical abstract

Impact of patient demographics on treatment outcomes in AML: a population-based registry in England, 2013-2020

AbstractWe report 1- and 5-year survival after acute myeloid leukemia (AML) diagnosis, and early mortality within 30 days of systemic anticancer therapy (SACT) treatments, using national cancer registry data in England. Patients aged 18 to 99 years diagnosed between 2013 and 2020 were included. Overall survival (OS) was calculated using Kaplan-Meier methodology, and adjusted hazard ratios (aHRs; adjusted for intensity of treatment, age at diagnosis, gender, ethnicity, socioeconomic deprivation, comorbidity, and year of diagnosis) using Cox proportional hazards regression. Odds of 30-day mortality (adjusted odds ratios [aORs], adjusted for aforementioned characteristics), along with performance status and body mass index, were calculated using logistic regression. Among 17 107 patients identified, older age and comorbidity were associated with worse survival. Asian and Black patients had better survival than White patients: 5-year OS of 34.6%, 29.7%, and 17.8%, respectively; aHR of 0.86; (95% confidence interval [CI], 0.77-0.96) Asian vs White, and 0.84 (95% CI, 0.73-0.96) Black vs White. Socioeconomic deprivation was associated with worse survival. Overall, 7906 (46.2%) patients were documented as having received SACT. Thirty-day mortality was lower for patients receiving intensive rather than nonintensive SACT. After adjustment for cofactors, the risk was higher in those treated intensively (aOR, 0.74; 95% CI, 0.60-0.92). We show that ethnicity and socioeconomic status affects outcomes in AML. Further work is needed to understand how these effects may differ in different health care settings, and whether this because of effects on disease biology, responsiveness to treatment, or drug toxicity. Selection of intensive vs nonintensive treatment should be based on individual patient factors, balancing improved long-term survival against higher early mortality.

Improving treatment fidelity: Factors that predict trauma‐focused cognitive behavioral therapy component use

AbstractThis study examined the utilization of trauma‐focused cognitive behavioral therapy (TF‐CBT) treatment components, as well as factors that predicted therapist TF‐CBT component use. Participants were 264 TF‐CBT‐trained mental health therapists. The most frequently used components, as reported by therapists, were affect regulation, relaxation, and psychoeducation about trauma, while the least frequently used were in vivo exposure, conjoint sessions, and caregiver involvement. Results of a hierarchical linear regression indicated that therapist self‐efficacy and child trauma clinical beliefs (i.e., clinical structure and verbal capacity) positively predicted therapist TF‐CBT component use. Perceived barriers to TF‐CBT use negatively predicted therapist TF‐CBT component use. Implications for counseling practice and future research directions are included.