Late Treatment Group Research Articles

Isolated favorable compound mandibular body fractures: A retrospective review of two cohorts of patients based on the timing of treatment.

Treatment delays in the management of mandible fractures are often unavoidable and, as a result, the timing of treatment of mandibular fractures has remained a contentious issue in clinical practice as the optimal treatment delay for minimizing complications remains unknown. The aim of this study was to determine the rate and types of complications between two cohorts of patients designated as early and late treatment groups and estimate an optimal time threshold for treatment delay after closed reduction and maxillomandibular fixation. Demographic and clinical data were collected retrospectively about patients who were treated for isolated, unilateral, favorable, and compound mandibular body fractures between 1999 and 2019 to answer the question of whether treatment delay is an independent variable impacting post-operative mandible body fracture complications. Descriptive and bivariate statistics were computed. One hundred and seventy subjects were evaluated (n=87 in the control/early group and n=83 in the study/late group). The mean time lapses from injury to treatment were: early (5.8 ± 0.4 days) and late (10.3 ± 0.7 days). The overall complication rate was 14.1%. However, the complication rates of the early and late groups were 13.8% and 14.5%, respectively, with no significant difference (p=0.89). There was no difference between early and late treatment groups. Treatment delay was not an independent variable impacting post-operative mandible body fracture complications if treatment is done between 3 and 12 days after the injury.

The effect of early vs. late CT-guided stereotactic hematoma aspiration on neurological function recovery in patients with hypertensive cerebral hemorrhage in the basal ganglia: a retrospective comparative cohort study.

Surgery plays a major role in treating hypertensive cerebral hemorrhage in the basal ganglia; however, some patients suffer from neurological impairment after surgery. Studies have confirmed that stereotactic hematoma aspiration guided by computed tomography (CT) has significant value for patients with hypertensive intracerebral hemorrhage in the basal ganglia, but little is known about the optimal timing for the operation. This study sought to explore the effect of CT-guided stereotactic hematoma aspiration timing on the recovery of neurological function in patients with hypertensive cerebral hemorrhage in the basal ganglia. The data of 110 patients with hypertensive cerebral hemorrhage in the basal ganglia admitted to the Union Hospital Tongji Medical College Huazhong University of Science and Technology from January 2021 to December 2021 were retrospectively collected. Based on the timing of their operations, the patients were allocated to the early treatment group (within 24 hours, n=50) and late treatment group (after 24 hours, n=60). The postoperative recovery of the 2 groups was compared. There were no significant differences in terms of age, gender, amount of cerebral hemorrhage, hemorrhage ruptured into ventricle rate, Glasgow Coma Scale score, hypertension grade, hyperlipidemia, diabetes, and operation duration between the 2 groups (P>0.05). Additionally, there was no difference in the preoperative National Institute of Health Stroke Scale scores of the patients in the 2 groups (22.50±4.90 vs. 23.83±5.35, P=0.179). Compared to the late treatment group, the National Institute of Health Stroke Scale score of the patients in the early treatment group was significantly lower 3 and 6 months after the operation (5.90±4.02 vs. 9.23±3.47, P<0.001; 4.54±2.56 vs. 6.50±3.07, P<0.001, respectively). The Glasgow Outcome Scale score of patients in the early treatment group was significantly better than that of patients in the late treatment group (P=0.035). No significant difference was found in the incidence of postoperative pulmonary infection, intracranial infection, rebleeding, and lower extremity deep venous thrombosis between the 2 groups (P>0.05). Early CT-guided stereotactic hematoma aspiration may improve the postoperative neurological function of patients with hypertensive cerebral hemorrhage in the basal ganglia.

Improving infection prevention behaviours in schools: Feasibility study to measure the impact of educational resources

Background: Evidence indicates that tailored educational resources such as e-Bug in schools can improve students’ knowledge of infection prevention. This study aimed to (1) understand the feasibility of using soap use data as a proxy for measuring student handwashing behaviours and (2) refine a study method that could be implemented by local authorities and schools to assess impact as a result of the implementation of e-Bug. Design: A stepped-wedge design was employed, and 10 primary schools were randomly assigned to groups where teachers were trained to use e-Bug, either in July 2019 (early intervention group) or in January 2020 (late intervention group). Pre/post student knowledge-retention questionnaire data and soap use measurements were collected from all schools before and after the early group teachers used e-Bug. The sample included 16 soap use measures, 561 students in the early group and 601 students in the late group. Statistical analysis involved single/multivariable mixed-effects linear and logistic regression. Setting: A local authority in England. Results: In 15–18 questions, there was a significant relationship between training and students answering questions about microbes, hand/respiratory hygiene and antibiotic use/resistance correctly (degree of change varied). There was not enough power to comment on the relationship between the intervention and soap use. Conclusion: This study informs the feasibility of cluster, randomised, controlled trials in educational settings to measure the impact of educational resources. It can be used to inform future studies and highlights the need to ensure adequate sample size to estimate soap use and improve the measurement accuracy of data collection tools.

Fatigue and cognitive impairment in neuroborreliosis patients posttreatment-A neuropsychological retrospective cohort study.

BackgroundThe aim of this study was to determine the prevalence of fatigue and cognitive impairment in patients with neuroborreliosis (NB) posttreatment and to determine whether delayed treatment initiation led to higher levels of fatigue and cognitive impairment.MethodsThe study population consisted of 88 patients with NB included between October 10, 2014, and August 21, 2020, at the Clinical Center for Emerging and Vector‐borne Infections at Odense University Hospital, Denmark. The Symbol Digit Modalities Test (SDMT) was used as a cognitive screening test, and the Modified Fatigue Impact Scale (MFIS) was used to assess the patients’ level of fatigue over the course of a year.ResultsOverall, 14.3% of patients had an SDMT score indicative of cognitive impairment, and 38.8% of patients reported experiencing fatigue 12 months posttreatment. We found no statistically significant differences in fatigue or cognitive impairment when comparing the patients who had a treatment delay of ≤14 days and those with a treatment delay of >14 days (p > .05) 12 months posttreatment. A random effects regression model showed a significant positive correlation between longer treatment delay and higher MFIS scores, indicating higher levels of fatigue.ConclusionsThe results of this study show that both the early and late treatment groups improved significantly over a 12‐month period in terms of both cognitive symptoms and fatigue. However, it also showed that a substantial subgroup of patients with NB still suffer from fatigue and cognitive impairment 12 months posttreatment.

Analysis of the efficacy of different timing of vestibular rehabilitation interventions in the acute phase of vestibular neuritis

Objective:To investigate the impact of time interval from symptoms onset to vestibular rehabilitation on the recovery of patients in the acute phase of vestibular neuritis. Methods:Thirty-one patients with vestibular neuritis treated in outpatient and inpatient settings from December 2019 to July 2021 were selected and randomly divided into vestibular rehabilitation group and general treatment group. The vestibular rehabilitation group was subdivided into early-intervention group （1-week after symptom onset） and late-intervention group （2-week after symptom onset） according to the interval from the onset to vestibular rehabilitation. The differences in DP, UW, VOR, DHI, BBS and SAS values at 1 month and 3 months after treatment were compared among early-intervention group（11 cases）, late-intervention group （10 cases） and general treatment group（10 cases）. Results:For patients in the vestibular rehabilitation group and the general treatment group, DP, UW, VOR gain, DHI score and SAS score were significantly different after treatment （ P<0.05） and no significant difference was found in BBS score （P>0.05 ）. Pairwise comparisons between early-intervention and late-intervention group showed that the DP, UW and VOR gain were significantly different （P<0.05）, while the score of DHI and SAS were not significantly different （P>0.05）. Conclusion:Vestibular rehabilitation therapy can accelerate vestibular compensation, relieve vertigo symptoms and anxiety symptoms in patients with vestibular neuritis. It is better to be carried out within 1 week after symptom onset.

Intratunical injection of rat-derived bone marrow mesenchymal stem cells prevents fibrosis and is associated with increased Smad7 expression in a rat model of Peyronie’s disease

ObjectivePeyronie’s disease (PD) is a fibrotic disorder of the penis, but effective treatments are lacking. Here, we observed the effects of rat-derived bone marrow mesenchymal stem cells (BMSCs) injection in the active phase and chronic phase in a rat model of PD, and the possible mechanism was analysed with fibroblasts derived from rat penile tunica albuginea (TA).MethodsThirty-two male Sprague-Dawley rats were divided into four groups. In sham group, the rats were injected with 50 µL of vehicle. In the PD group, the rats were injected with 50 µg TGF-β1. In the PD + BMSCs early treatment group, the rats were injected with 50 µg TGF-β1 and injected with 1 × 106 BMSCs after 1 day. In the PD + BMSCs late treatment group, the rats were injected with 50 µg TGF-β1 and injected with 1 × 106 BMSCs after 28 days. Twenty-seven days after the last injection, the erectile function of the rats was measured, and then, penile fibrosis was analysed by histology and western blot. In vitro, fibroblasts derived from rat penile TA were used to identify a possible antifibrotic mechanism of BMSCs, and a Smad7 expression vector was used as a positive control. Fibroblasts were pretreated with the Smad7 expression vector or BMSCs for 48 h and then activated with 10 ng/mL TGF-β1 for 24 h. Cells viability was assessed, and Smad7, collagen 3, elastase-2B and osteopontin expression levels were analysed by immunofluorescence and western blot. Furthermore, fibroblasts were transfected with Smad7 siRNA or scramble control to observe whether the effects of BMSCs could be offset.ResultsErectile function obviously improved, and fibrosis of penile TA was prevented after BMSCs treatment compared with that in the rats with PD. Furthermore, the effects of BMSCs treatment in the active phase were better than those in the chronic phase. After cocultured with BMSCs, cell viability was not affected, Smad7 expression was upregulated, and collagen 3, elastase-2B and osteopontin levels were decreased in the TGF-β1-treated fibroblasts. After transfection with Smad7 siRNA, the antifibrotic effects of BMSCs were offset.ConclusionsThe antifibrotic effects of BMSCs treatment in the active phase of the PD rat model were better than those in the chronic phase. A possible mechanism of BMSCs treatment was related to increased Smad7 expression, suggesting a possible effective and safe procedure for the treatment of PD.

Comparison of the outcomes between early and late anti-tumor necrosis factor therapy in patients with enthesitis-related subcategory of juvenile idiopathic arthritis: a multi-center study in Southeast Asia

ABSTRACT Background Little is known about the impact of delayed initiation of anti-tumor necrosis factor (TNF) therapy in patients with enthesitis-related arthritis (ERA). Here, we compared the impact of delayed treatment on disease outcomes of ERA patients in Southeast Asia. Research design and methods This retrospective study enrolled 149 ERA patients from Thailand and Singapore. Early (e-aTNF) and late (l-aTNF) treatment groups received anti-TNF therapy starting at ≤6 months and >6 months, respectively, after diagnosis. Outcomes included mean differences in disease activity parameters, Juvenile Spondyloarthritis Disease Activity (JSpADA) score, Juvenile Arthritis Diseases Activity (JADAS)-10 score, and American College of Rheumatology Pediatric (ACR Pedi) criteria, and the frequency of clinically inactive disease and first flare event. Results The mean changes in JSpADA (p = 0.002) and JADAS-10 (p < 0.001) scores over time were significantly higher in the e-aTNF group than in the l-aTNF group. A significantly higher proportion of patients in the e-aTNF group than l-aTNF group satisfied ACR Pedi 100 criteria at 2 years (p = 0.042). All other long-term outcomes were not significantly different between the groups. Conclusions Although early anti-TNF treatment improved disease activity parameters somewhat better than delayed anti-TNF therapy, there was no significant difference in long-term outcomes.

Effectiveness of Early Favipiravir Therapy in Hospitalised COVID-19 Patients.

COVID-19 is a disease caused by a novel coronavirus with no specific, standard treatment. We investigated the clinical data of COVID-19 patients admitted to King Fahad Specialist Hospital (KFSH) in Buraydah by comparing the patients who were treated early with favipiravir (within 3 days of admission) to patients who were treated after three days of admission or not treated. 165 patients were confirmed with PCR tests and admitted to KFSH for treatment. Comorbidities contributed significantly to increasing the length of stay in hospital at 11.4 ± 0.8 days compared to patients with no comorbidities at 8.6 ± 0.9 days (p=0.041). A total of 103 patients were treated with favipiravir, and we found that early treatment with favipiravir (within 3 days) reduced the length of stay in hospital significantly (8.8 ± 1.4 days) compared to patients who were treated after 3 days (13.3 ± 4.6 days) (p=0.0015). Moreover, patients with comorbidities in both early and late treatment groups had significantly higher average lengths of stay in hospital (11.2 ± 0.9 days) compared to patients with no comorbidities (7.9 ± 0.7 days) (p=0.017). Interestingly, patients treated early with favipiravir (with comorbidities and without) stayed fewer days in hospital compared to those with late treatment (p=0.021; a difference of 4.5 ± 1.9 days; and p=0.018; a difference of 4.2 ± 1.7 days, respectively). In conclusion, our analysis indicates that early treatment with favipiravir can reduce the length of stay in hospital and improve clinical manifestations of COVID-19 patients.

Effect of early or late nutritional intervention with psychological support on symptoms associated with Anorexia Nervosa: a comparative study

Introduction: Anorexia nervosa (AN) is a disease with increasing incidence and prevalence, favored by biological, psychological, familial, and social factors. Management must be interdisciplinary, involving the intervention of nutritionists and psychologists. Additionally, it is important to evaluate the effect of an early or a late onset of the intervention. Objective: To determine if early nutrition-based intervention along with psychological support leads to a decrease in the symptoms associated with Anorexia Nervosa, when compared with late intervention. Methods: To evaluate the above parameters, an exploratory study was proposed with a design of non-randomized clinical trial and a non-probability purposive sampling of n = 17 women with AN between 12 and 25 years of age (x̄ = 16.8 ± 3.6). According to the moment of the nutritional intervention with psychological support, the 17 women were divided into two groups: Group 1 (n = 10) start the intervention in the first six months after the onset of the disease while Group 2 (n = 7) started 3 years after the disease. The nutritional and psychological carried out consisted of three phases: individualized nutritional assessment, design of the meal plan according to the metabolic needs of each patient and nutritional indications, and an individualized psychological intervention. Both interventions were carried out once a week for six months, for a total of 24 psychological and nutritional sessions. The physical variables of body mass index (BMI) and arm muscle area (AMA) were measured. To assess emotional changes, the body image dissatisfaction subscale of the Eating Disorder Inventory (EDI) was used. Results: Six months after follow-up, the results showed statistically significant changes in the BMI (p &lt;,0.01), AMA (p &lt;,0.01) and body image dissatisfaction (p &lt;,0.01) after the intervention. It was found that the early-intervention group presented lower values in BMI and AMA as compared to the late-intervention patients while both groups showed a marked reduction in body image dissatisfaction values. The late-intervention group presented the sharpest reduction. There was no significant difference in the variables BMI and AMA in the intragroup comparisons. Conclusion: The early-onset nutritional intervention with psychological support decreased the physical and emotional symptoms associated with AN.

Timing of Initiation of Methylprednisolone Pulse Therapy in Patients with COVID-19

High-dose methylprednisolone pulse therapy is widely used in patients with severe COVID-19. This therapy is known to have sufficient clinical effectiveness, but the optimal administration method is not known. In this study, we assessed the deterioration of oxygenation after methylprednisolone pulse therapy in patients with COVID-19 according to disease severity (oxygen requirement) at initiation of therapy. Ninety-nine patients with COVID-19 who received methylprednisolone pulse therapy at Saitama Medical University Hospital in Japan between October 2020 and October 2021 were retrospectively reviewed. Clinical outcomes were compared according to the fraction of inspired oxygen as a measure of disease severity at initiation of methylprednisolone pulse therapy. Based on the FIO2 level at initiation of methylprednisolone pulse therapy, patients were classified into an early treatment group (FIO2 ≤ 0.39; n = 21), a middle treatment group (FIO2 0.40–0.69; n = 38), and a late treatment group (FIO2 ≥ 0.70; n = 40). The frequency of administration of mechanical ventilation and the days of oxygen therapy in the middle group were lower than in the other groups. The frequency of adverse events was also lower in the middle group. Both late and early methylprednisolone pulse therapy may lead to further deterioration of COVID-19 and an increase in adverse events.

Newly developed artificial intelligence algorithm for COVID-19 pneumonia: utility of quantitative CT texture analysis for prediction of favipiravir treatment effect

PurposeUsing CT findings from a prospective, randomized, open-label multicenter trial of favipiravir treatment of COVID-19 patients, the purpose of this study was to compare the utility of machine learning (ML)-based algorithm with that of CT-determined disease severity score and time from disease onset to CT (i.e., time until CT) in this setting.Materials and methodsFrom March to May 2020, 32 COVID-19 patients underwent initial chest CT before enrollment were evaluated in this study. Eighteen patients were randomized to start favipiravir on day 1 (early treatment group), and 14 patients on day 6 of study participation (late treatment group). In this study, percentages of ground-glass opacity (GGO), reticulation, consolidation, emphysema, honeycomb, and nodular lesion volumes were calculated as quantitative indexes by means of the software, while CT-determined disease severity was also visually scored. Next, univariate and stepwise regression analyses were performed to determine relationships between quantitative indexes and time until CT. Moreover, patient outcomes determined as viral clearance in the first 6 days and duration of fever were compared for those who started therapy within 4, 5, or 6 days as time until CT and those who started later by means of the Kaplan–Meier method followed by Wilcoxon’s signed-rank test.Results% GGO and % consolidation showed significant correlations with time until CT (p < 0.05), and stepwise regression analyses identified both indexes as significant descriptors for time until CT (p < 0.05). When divided all patients between time until CT of 4 days and that of more than 4 days, accuracy of the combined quantitative method (87.5%) was significantly higher than that of the CT disease severity score (62.5%, p = 0.008).ConclusionML-based CT texture analysis is equally or more useful for predicting time until CT for favipiravir treatment on COVID-19 patients than CT disease severity score.

Effectiveness of Comanagement Model: Geriatric Medicine and Vascular Surgery.

Older surgical patients frequently develop postoperative complications due to their frailty and multiple comorbidities. Geriatric medicine consultation helps to optimize risk factors and improve outcomes in patients with hip fracture. This study aimed to evaluate patient outcomes before and after comanagement model implementation between geriatric medicine (Geriatric Surgical Service) and vascular surgery services. This was a case-control study involving emergency vascular surgical patients who were comanaged by vascular surgery, geriatric medicine, and geriatric nursing services. This study was conducted in a tertiary hospital in Singapore from 2015 to 2018 with acute vascular surgical patients aged older than 65years. A retrospective cohort of 135 patients from 2013 to 2014 (control group) who fulfilled the criteria for the comanagement model was compared with a prospective cohort of 348 patients who were comanaged by a geriatric surgical service from 2015 to 2018, and a further subgroup analysis of patients between 2015 and 2016 (n= 150) (early intervention group) and between 2017 and 2018 (n= 198) (late intervention group) was performed. Comanaged patients had a significantly shorter length of hospital stay (11.6 vs 20.8days, P=.001), reduced nosocomial infections (3% vs 12% for urinary tract infection, P= .003) and decreased 30-day readmission rates (22% vs 34%, P= .011). A trend of a decreased incidence of fluid overload was noted in patients comanaged with the geriatric surgical service (3% vs 7%, P= .073). Subgroup analysis showed progressive reductions in the length of stay (15.4 vs 11.6days, P= .001), 30-day readmission rate (35% vs 22%, P= .01), and nosocomial urinary tract infection (8% vs 3%, P= .003) between the early intervention group and the late intervention group. Although they were not statistically significant, reductions were also observed in the delirium rate (13% vs 11%) and other postoperative medical complications in the early intervention group and the late intervention group. Despite having increasing comorbidities, older vascular surgical inpatients had a significantly shorter length of stay, reduced nosocomial infections, and decreased 30-day readmission rates through a comanagement model with vascular surgery and geriatric medicine services. Improvements in outcomes were observed over time as the model of care evolved. Geriatric medicine intervention in the perioperative period improves the outcomes of older acute vascular surgical patients.

Early vs. late treatment initiation in multiple sclerosis and its impact on cost of illness: A register-based prospective cohort study in Sweden

BackgroundEarly treatment with disease modifying therapies (DMTs) for multiple sclerosis (MS) has been associated with lower disability progression; the aim was to explore its association with cost of illness (COI) in MS.MethodsAll people with relapsing-remitting MS in the Swedish MS register, aged 20–57 years and receiving their first MS DMT in 2006–2009, were followed in nationwide registers for 8 years. Healthcare costs (in- and outpatient healthcare, DMTs and other prescribed drugs), and productivity losses (sickness absence and disability pension) of individuals receiving therapy in ≤6 months after diagnosis (early treatment group) were compared to those receiving therapy >6 months (late treatment group). Using Poisson regressions, the mean COI per patient per year, and per group, was estimated, adjusted for disability progression.ResultsThe early treatment group comprised 74% of the 1562 individuals included in the study. The early treatment group had lower productivity losses over time. Both groups had similar healthcare costs, which first increased and then decreased over time.ConclusionsEarly DMT in MS could result in lower productivity losses possibly through maintained work capacity. COI serves as an objective measure showing the advantage of early vs. late treatment initiation in MS.

Glucosamine regulates macrophage function in heart failure.

Glucosamine regulates macrophage function in heart failure.

Neurological Outcome of Early versus Late Surgery Following Cervical Spinal Cord Injury

Background There are numerous retrospective studies and a few prospective studies to determine the neurologic outcome after early versus late surgical treatment for cervical spinal cord injury.&#x0D; Objective To compare the neurological outcome between early (within 72 hours after injury) and delayed (≥ 72 hours after injury) surgery in patients with cervical spinal injury.&#x0D; Method This is a retrospective analysis of the neurological outcome of early versus late surgery following cervical spinal cord trauma. Patients meeting appropriate inclusion criteria were divided into an early or a late surgical treatment group. The neurologic outcomes and other complications were recorded up to six months of follow-up.&#x0D; Result Overall, there was a significant difference in neurological status at presentation and at follow-up (p &lt; 0.001). However, there was no statistically significant difference between the early versus late surgery groups (p-value 0.261) in terms of neurological outcome. Complications were found to be higher among those undergoing posterior surgical approach (OR = 23.75; 95% CI 2.65, 212.98) than those with anterior or combined approach (p=0.005). However, multivariate analysis of these variables failed to show any statistically significant difference between the two groups.&#x0D; Conclusion The timing of surgery does not alter the neurological outcomes and the development of complications significantly. The American Spinal Cord Injury Association (ASIA) status at the time of presentation is found to be the single most important factor correlating with the neurological outcome.

Clinical effects of maxillary protraction in different stages of dentition in skeletal class III children: A systematic review and meta-analysis.

This systematic review and meta-analysis aimed to evaluate the effectiveness of using maxillary protraction during different stages of the dentition by assessing changes in the jaws and inclination of incisors. MEDLINE (PubMed), Embase, Cochrane, Web Of Science, China National Knowledge Infrastructure and Wanfang Databases were searched without time limitations up to 15 January 2022. Google Scholar was used to search grey literature. We included cohort studies that compared the effect of maxillary protraction by analysing primary outcomes and were grouped in age-related conditions. Mean differences and 95% confidence intervals were used for statistical analysis, followed by Grading of Recommendations Assessment, Development and Evaluation analysis. Six studies were finally included. The heterogeneity test showed P≥.1 and I2 ≤50%, and a fixed-effect model was applied. Patients in the early treatment group (ETG) were mainly in the early-mixed dentition stage, while patients in the late treatment group (LTG) were in the late-mixed and early-permanent dentition stage. Meta-analysis showed that there were no statistical differences (P>.05) between the ETG and LTG groups in terms of SNA (the angle composed by point Sella-Nasion-Subspinale), SNB (the angle composed by point Sella-Nasion-Supramentale), ANB (the angle composed by point Subspinale-Nasion-Supramentale), Wits, U1/SN (the angle composed by the axis of upper incisors and Sella-Nasion plane) and L1/MP (the angle composed by the axis of lower incisors and the mandibular plane). Our analysis showed that maxillary protraction applied in the late-mixed or early-permanent dentition stage did not cause different effects on the maxillary growth, the correction of the intermaxillary relationship, the inhibition of mandibular growth and dental tipping of skeletal class III patients when compared to that in the early-mixed dentition stage. Collectively, these data provide a theoretical basis for widening the applicable age period of maxillary protraction and choosing the best treatment opportunity for children patients after a comprehensive assessment.

Risk of Mortality among Patients with Gastrointestinal Bleeding with Early and Late Treatment with Tranexamic Acid: A Population-Based Cohort Study.

Tranexamic acid (TXA) is an antifibrinolytic pharmacological agent, but its use in gastrointestinal bleeding remains contentious. Moreover, studies on the timing of TXA administration are limited. We examined whether early TXA administration reduced the risk of mortality in patients with gastrointestinal bleeding in a Taiwanese population. We used the National Health Insurance Research Database to identify patients diagnosed with gastrointestinal bleeding with early and late TXA treatment. We defined early treatment as initial TXA treatment in an emergency department and late treatment as initial TXA treatment after hospitalization. Mortality within 52 weeks was the primary outcome. A multivariable analysis using a multiple Cox regression model was applied for data analysis. Propensity score matching (PSM) was performed to reduce the potential for bias caused by measured confounding variables. Of the 52,949 selected patients with gastrointestinal bleeding, 5127 were assigned to either an early or late TXA treatment group after PSM. The incidence of mortality was significantly decreased during the first and fourth weeks (adjusted HR (aHR): 0.65, 95% CI: 0.56–0.75). A Kaplan–Meier curve revealed a significant decrease in cumulative incidence of mortality in the early TXA treatment group (log-rank test: p < 0.0001). Multiple Cox regression analysis revealed significantly lower mortality in the early TXA treatment group compared with the late treatment group (aHR: 0.64, 95% CI: 0.57–0.73). Thromboembolic events were not significantly associated with early or late TXA treatment (aHR: 1.03, 95% CI: 0.94–1.12). A Kaplan–Meier curve also revealed no significant difference in either venous or arterial events (log-rank test: p = 0.3654 and 0.0975, respectively). In conclusion, early TXA treatment was associated with a reduced risk of mortality in patients with gastrointestinal bleeding compared with late treatment, without an increase in thromboembolic events. The risk of rebleeding and need for urgent endoscopic intervention require further randomized clinical trials.

An evaluation of safety and survival for patients with locally advanced pancreatic cancer treated with irreversible electroporation combined with chemotherapy: a retrospectively observational study

Abstract Objective: Irreversible electroporation (IRE) is emerging as a new therapy for locally advanced pancreatic cancer (LAPC). We aimed to conduct survival and safety analyses in LAPC patients after treatment with IRE combined with chemotherapy. Methods: A total of 64 patients with LAPC who had received IRE and chemotherapy were retrospectively collected from August 2015 to March 2019 at Sun Yat-sen University Cancer Center. Overall survival (OS) and progression-free survival (PFS) were evaluated using Kaplan-Meier method and compared by the log-rank test. A multivariate Cox regression model was used to determine the prognostic factors of survival. The perioperative complications of IRE were also evaluated. The study was approved by the Institutional Review Board of Sun Yat-sen University Cancer Center (approval No. C2021-003). Results: The median survival of all included patients were 24.63 (95% confidence interval: 21.78–27.49) for overall survival and 13.00 (95% confidence interval: 8.81–17.19) months for progression-free survival, with 96.8%, 51.9%, 18.3%; and 52.3%, 21.5%, 7.9% as the 1-, 2- and 3-year OS and PFS rates, respectively. Tumor size [OS, hazard ratio (HR)=1.768, P = 0.048; PFS, HR = 0.304, P = 0.010], neoadjuvant chemotherapy (OS, HR = 0.338, P = 0.030; PFS, HR = 0.358, P = 0.034), carbohydrate antigen 19-9 variation after IRE (OS, HR = 19.320, P = 0.003; PFS, HR = 14.591, P = 0.021) and tumor response after neoadjuvant chemotherapy (OS, HR = 8.779, P = 0.033; PFS, HR = 5.562, P = 0.008) were predictive factors of survival in patients with LAPC after IRE. Complications were observed in 20.3% of patients. Grade B pancreatic fistula was the most common complication. The complication rates of the late treatment group (6.1%) were significantly lower than those of the first 15 patients after IRE treatment (66.7%). The median length of hospital stay of late treatment group was 8.6 days, which was also shorter than that of the early treatment group (10.0 days). Conclusions: IRE combined with chemotherapy could improve survival of LAPC patients with acceptable complication rates. Therefore, it may be a suitable method for LAPC but should be validated in prospective randomized trials.

Outcomes of late open fetal surgery for intrauterine spina bifida repair after 26weeks. Should we extend the Management of Myelomeningocele Study time window?

To evaluate maternal and perinatal outcomes of late open fetal repair for open spina bifida (OSB) between 26+0 -27+6 weeks. A cohort of fetuses with OSB who underwent open surgery in two fetal surgery centers (Argentina and Mexico). Two groups were defined based on the gestational age (GA) at intervention: Management of Myelomeningocele Study (MOMS) time window group: GA 19+0 -25+6 , and late intervention group: GA 26+0 -27+6 . Intrauterine OSB repair was successfully performed in 140 cases, either before (n=57) or after (n=83) 26weeks, at on average 25+0 (22+6 -25+6 ) and 26+5 (26+0 -27+6 ) weeks + days, respectively. There were no significant differences in the rate of premature rupture of membranes, chorioamnionitis, oligohydramnios, preterm delivery, perinatal death and maternal complications. The late intervention group showed a significantly lower surgical times (112.6 vs. 124.2min, p=0.01), lower interval between fetal surgery and delivery (7.9 vs. 9.2weeks, p<0.01) and similar rate of hydrocephalus requiring treatment (30.6% vs. 23.3%, p=0.44) than the MOMS time window group. Late fetal surgery for OSB repair between 26+0 -27+6 weeks is feasible and was associated with similar outcomes than that performed before 26weeks. These findings may allow an extension of the proposed time window for cases with late diagnosis or referral.

Does Early Treatment Improve Clinical Outcome of Class II Patients? A Retrospective Study.

The present study was carried out to evaluate the benefits from one-phase Class II Early Treatment (ET) using extraoral forces and functional appliances but without intermaxillary forces and eventual lower leeway space preservation compared to two-phase Class II Late Treatment (LT) with the need for extractions and full fixed appliances as well as lower incisor proclination. The ET group (n = 239, 115 M, 124 F, mean age 10.6 ± 1.2 years), with first premolars not in contact and the second deciduous lower molars preserved, was compared to the LT group (n = 288, 137 M, 151 F, mean age 12.4 ± 1.5 years). The ET group was first treated with headgears, growth guide appliances, or Teuscher activators and, in borderline crowding cases, with lower space maintenance by a lingual arch, lip bumper, or fixed utility arch. The LT group and the second phase of ET were treated with full fixed appliances including intermaxillary forces such as Class II elastics or noncompliance devices; headgear and a growth guide appliance were also used. Cephalograms and plaster models were taken before (T1) and after treatment (T2) to calculate cephalometric changes and space balance discrepancies. The differences between T1 and T2 were analyzed by a t-test for normally distributed data and by the Mann–Whitney Test for nonnormally distributed data at a level of p < 0.05. The groups were defined as statistically homogeneous at T1. A statistical analysis showed that the ET group (mean treatment time 35.3 ± 13.3 months) was significantly associated with a 22.2% lower extraction rate, 15.9% less need for a full fixed appliance, and more than 5° less incisor proclination in the nonextraction cases compared to the LT group (mean treatment time 25.9 ± 8.1 months); treatment time significantly increased in the ET group compared to the LT group. Early Class II treatment resulted in a significant treatment effort reduction in more than one third of the patients and less lower incisor proclination, even if it clinically increased treatment time.