Post-treatment Period Research Articles

Нутритивный статус и факторы, влияющие на него, у детей с опухолями центральной нервной системы, закончившими противоопухолевое лечение: ретроспективный анализ

Objective. To study the prevalence of nutritional status (NS) disorders and possible factors affecting these processes in children with central nervous system (CNS) tumors who underwent anti-tumor therapy. Patients and methods. A retrospective analysis of data from 109 patients aged 8 to 17 years (42.2% of boys) was performed, of whom 57.8% had malignant tumors (MT) of the CNS and 42.2% had benign tumors (BT). The post-treatment period was 1 to 58 months. The body mass index (BMI), fat mass index (FMI), fat-free mass index (FFMI), dietary composition, and endocrine disorders (growth hormone (GH) deficiency and hypothyroidism) were examined. Results. BMI was within the reference range in 54.1% of children, normal body composition was revealed in 29.4%. GH deficiency was found in 27.5% of children, and excess body fat in 43.1%. BMI (p = 0.009) and FFMI (p = 0.011) were lower in children with MT than in children with BT. In children with the post-treatment period of 2 to 5 years, BMI was higher (p = 0.041). Patients with MT were more likely to have GH deficiency (p = 0.016), the frequency of hypothyroidism did not differ in children with MT and BT. A direct association was found between the frequency of intake of dairy, fermented dairy, combination of dairy and meat dishes and the value of FFMI, pasta combined with meat or sausage products and FMI, and an inverse association between FFMI and intake of sugar products. Conclusions. In children with CNS tumors, nutritional disorders are common after anti-tumor therapy that do not tend to improve over time. Measuring BMI alone is not sufficient to assess nutritional status. Dietary disturbances in a significant proportion of patients provide grounds for dietary correction in practice. Key words: children, brain tumors, long-term outcomes, nutritional status, body composition, nutrition

A Novel Inflammatory Marker in the Follow-up of Moderate-to-Severe Acne Vulgaris Administered Isotretinoin: Systemic Immune-Inflammation Index (SII).

Background: Systemic immune-inflammation index (SII) is calculated by multiplying the neutrophil-lymphocyte ratio (NLR) and the platelet count. In this study, we aimed to investigate the difference of SII and other inflammatory markers in patients with acne vulgaris compared to healthy controls and themselves after Oral isotretinoin (ISO) treatment. Materials and methods: In this study 190 patients with severe acne vulgaris who received at least 3 months of ISO treatment (0.5-1mg/kg/day) and 66 healthy individuals were evaluated. Hemoglobin, neutrophil, lymphocyte, monocyte, and platelet counts, mean platelet volume (MPV), Plateletcrit (PCT), NLR, platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), and SII were analyzed. Results: Before ISO treatment, patients with moderate-to-severe acne vulgaris had significantly higher neutrophil counts and SII levels than healthy controls (p=0.036, p=0.028; respectively). In the third month of ISO treatment, both neutrophil count and SII level were similar to healthy control (p=0.376, p=0.379; respectively). In the follow-up of patients using ISO, a significant decrease was observed especially in SII levels (p=0.037). Although the lymphocyte count was not significantly different from the control group before treatment, it increased significantly after ISO and was significantly higher than both the control and pretreatment period (p=0.134, P=0.026, p=0.017; respectively). Although NLR was not different from control in the pre- and post-treatment period, the change in neutrophil and lymphocyte counts after treatment caused a statistically significant decrease in NLR (p=0.682, p=0.289, p=0.043; respectively). Conclusions: We believe that SII is a more useful parameter as an indicator of the anti-inflammatory effect of isotretinoin.

A Culturally Adapted Cognitive Behavioral Therapy Group: A Randomized Controlled Trial

Objective This study aimed to evaluate a culturally adapted cognitive behavior therapy (CBT) group for Chinese people with depression that aimed to alter participants’ negative beliefs of themselves, which were influenced by traditional Chinese cultural values. Method In this randomized controlled trial, 43 participants diagnosed with depression were randomly allocated to a 10-session culturally adapted CBT group or treatment as usual (TAU). A research assistant, who was blinded to the group allocation process, used the Chinese Beck Depression Inventory-II to assess participants’ depressive symptoms during the pre-treatment and post-treatment periods. Results The results of the mixed linear model for repeated measures showed that the CBT group had significantly greater improvement in depressive symptoms than treatment as usual, with a medium effect size. Conclusion This study supports the efficacy and effectiveness of the culturally adapted CBT group in facilitating clinically significant improvement in Chinese people with depression.

Analysis of the concentration of selected serological parameters in patients undergoing antibiotic treatment of Lyme disease and assessment of their potential application in the control of the therapy effectiveness - pilot study.

The aim of the study was to analyze the concentrations of some serological parameters in patients undergoing antibiotic therapy for LD, and to assess the potential use of IgG anti-C6VlsE in the assessment of treatment effectiveness. The study involved 21 patients diagnosed with LD. To determine the levels of anti-C6VlsE IgG, metalloproteinases and cytokines, blood was collected three times: before treatment, immediately after treatment, and 3-4 months after treatment. Immediately after the antibiotic therapy, all the patients in the study group declared improvement in their health. At 3-4 months post-treatment, 50% of patients reported recurrence of the disease symptoms. The anti-C6VlsE IgG concentrations at the analyzed time points exhibited varied dynamics: in 15% of patients, a decrease in the concentration of anti-C6VlsE was observed in the three consecutive serum samples; an increase of anti-C6VlsE IgG was detected in 35% of cases; in 15% of the subjects, the concentration of anti-C6VlsE IgG increased immediately after the antibiotic therapy and declined after 3-4 months, whereas a reverse situation was noted in 10% of the patients. The presence of high concentrations of anti-C6VlsE IgG is associated with appearance of response to Borreliella spp. infection, which suggests that the parameter can be used in the diagnosis of the active form of borreliosis. However, from a practical point of view, a marker of successful elimination of infection should indicate the effectiveness or failure of antibiotic therapy within a relatively short post-treatment period. The anti-C6VlsE IgG antibodies do not seem to satisfy this provision.

Efficacy and Safety of Chuanxiong Qingnao Granule in Patients with Migraine: A Randomized, Double-Blind, Placebo-Controlled Trial.

Objective To evaluate the efficacy and safety of Chuanxiong Qingnao Granule (CQG) to treat migraine. Method This study was a randomized, double-blind, placebo-controlled trial. All migraineurs were recruited and randomly assigned into a treatment group treated with CQG and a control group treated with a placebo. The whole research process included a 4-week baseline, 12-week intervention, and 12-week follow-up. The primary outcome was responder rate, defined as the percentage of migraineurs with 50% or more reduction in the frequency of migraine attack during treatment and posttreatment period compared with the baseline. The secondary outcomes were the number of migraine days, migraine attack frequency, visual analogue scale (VAS), Fatigue Severity Scale (FSS), Hamilton Depression Scale (HAMD), and Migraine Disability Assessment (MIDAS). Results A total of 346 migraineurs completed the research and were included in the intention-treatment analyses. The response rates differed significantly between the treatment group and the control group (71.5% vs. 12.1% at week 12 and 83.1% vs. 3.4% at week 24). Attack frequency, days of headache attack, VAS, FSS, HAMD, and MIDAS decreased at week 12 in both groups with more reduction in the treatment group (P < 0.001). No severe adverse events were observed in this trial. Conclusion Chuanxiong Qingnao Granule can significantly improve headache symptoms in patients with migraine while improving disability, fatigue, and depression with a good safety profile.

An Ayurvedic Critical Review on Nutritional Deficiency Disorders in Children

Ayurveda has two basic aims i.e., first preventive aspect rather than curative method. Aahara (food) plays very important role to maintain health of a person as it is one of the three sub pillars (Tri-upastambha) of Ayurveda. Aahara is the main source of energy and nutrition, also with therapeutic value and most important during post treatment period to regain the strength of body. Aahara not only nourishes the body but also nurtures the mind and soul, hence it is called as Poornabramha and Aahara-sevana (eating food) considered as a ritual in Ayurveda. Nutrition is always a basic and essential part for mankind. It has also positive effect on growth and development with cognitive function in children. Various health problems can be prevented through nutritious diet.&#x0D; Malnutrition generally refers both to under nutrition and over nutrition diseases. Nutritional deficiency disorders are described in various Ayurvedic texts which can be correlated with Apatarpanajanya Vyadhis. Various Acharya of Ayurveda described diseases such as Phakka, Parigarbhika, Balashosha, Karshya etc in different Samhitas can also correlated to nutritional deficiency disorders. A critical review of these disorders provides different aspects of malnutrition and proper understanding of pathogenesis in terms of Dosha - Dushya which will give a valuable key for their effective management. This paper highlights the Ayurvedic review of nutritional deficiency related disorders in children

Three-Month Follow-Up Results of a Double-Blind, Randomized Placebo-Controlled Trial of 8-Week Self-Administered At-Home Behavioral Skills-Based Virtual Reality (VR) for Chronic Low Back Pain

Prior work established post-treatment efficacy for an 8-week home-based therapeutic virtual reality (VR) program in a double-blind, parallel arm, randomized placebo-controlled study. Participants were randomized 1:1 to 1 of 2 56-day VR programs: 1) a therapeutic immersive pain relief skills VR program; or 2) a Sham VR program within an identical commercial VR headset. Immediate post-treatment results demonstrated clinically meaningful and superior reduction for therapeutic VR compared to Sham VR for average pain intensity, indices of pain-related interference (activity, mood, stress but not sleep), physical function, and sleep disturbance. The objective of the current report was to quantify treatment effects to post-treatment month 3 and describe durability of effects. Intention-to-treat analyses revealed sustained benefits for both groups and superiority for therapeutic VR for pain intensity and multiple indices of pain-related interference (activity, stress, and newly for sleep; effect sizes ranged from drm = .56–.88) and physical function from pre-treatment to post-treatment month 3. The between-group difference for sleep disturbance was non-significant and pain-interference with mood did not survive multiplicity correction at 3 months. For most primary and secondary outcomes, treatment effects for therapeutic VR showed durability, and maintained superiority to Sham VR in the 3-month post-treatment period. PerspectiveWe present 3-month follow-up results for 8-week self-administered therapeutic virtual reality (VR) compared to Sham VR in adults with chronic low back pain. Across multiple pain indices, therapeutic VR had clinically meaningful benefits, and superiority over Sham VR. Home-based, behavioral skills VR yielded enduring analgesic benefits; longer follow-up is needed.

A micrometeorological flux perspective on brush management in a shrub-encroached Sonoran Desert grassland

Woody plant encroachment typically limits the forage productivity of managed rangelands and alters a panoply of semiarid ecosystem processes and services. Intervention strategies to reduce woody plant abundance, collectively termed “brush management”, often lack observations to quantify and interpret changes in ecosystem processes. Furthermore, comparative studies between treated and untreated areas should account for heterogeneity since plant composition, microclimate, topoedaphic factors, and historical land use can substantially vary over short distances in drylands. Here, we quantify ecosystem responses to brush management after a single aerial herbicide application on an 18 hectare shrub-encroached grassland (savanna) in southern Arizona, USA. We conducted a pre- and post-treatment comparison of a flux tower site in the treated area with that of a tower in a nearby control site. The comparison, spanning a seven year period, included: (1) ground, airborne, and satellite-based measurements of vegetation structure, and (2) eddy covariance measurements. The herbicide treatment defoliated the dominant shrub (velvet mesquite, Prosopis velutina) and led to a temporary reduction in summer greening, but full foliar recovery occurred within two years. Contrary to expectations, perennial grass cover decreased and bare soil cover increased on the treated site. Relative amounts of evapotranspiration were reduced, while carbon uptake increased during the 2 year post-treatment period at the treated site due to a higher water use efficiency in the following spring. During mesquite recovery, carbon uptake was enhanced by higher gross primary productivity and accompanied by a decrease in ecosystem respiration relative to the untreated site. Mesquite recovery was facilitated by access to deep soil water, carbohydrate reserves in rooting systems, and a lower competition from reduced perennial grass cover.

The Desmopressin melt therapy in children with non-monosymptomatic nocturnal enuresis: a prospective study

Objective: The negative consequences of enuresis in children can be far reaching and an understanding of the impact of these is essential for effective treatment by the clinician. Enuresis can be categorized into monosymptomatic nocturnal enuresis (MNE) and non-monosymptomatic nocturnal enuresis (NMNE). There have been several studies in treatment of MNE with lyophilizate desmopressin melt but very limited research into the efficacy of desmopressin melt in treating NMME. The objectives of this study were to measure the efficacy and side effects of desmopressin melt in treating children with NMNE. Materials and Methods: Children aged 6 to 18 years with NMNE who visited the outpatient department of pediatric urology were included in this prospective study. Any underlying diseases and lower urinary tract symptoms were corrected then their enuresis was treated with 120-240 mcg of desmopressin melt for 6-8 weeks. Outcomes were defined as complete response, partial response, and no-response as defined by the International Children’s Continence Society guidelines. Results: A total of 25 children with NMNE were included in the study. The results showed 44% complete response, 20% partial response, and 36% no-response. The mean volume of nocturnal enuresis decreased from 159.96 to 115.30 ml in the pre and post treatment periods, respectively (p = 0.012). The mean frequency of enuresis decreased from 4.36 to 2.84 days per week in pre and post treatment periods, respectively (p &lt; 0.001). The mean whole night urine volume decreased from 373.39 to 292.37 ml in pre and post treatment periods (p = 0.061). There were no major side effects in the study. Conclusion: Desmopressin melt is effective and safe in treating NMNE in children. However, to add weight to the findings of this study further research with a larger number of patients should be considered in the near future.

Association of Oral Corticosteroid Bursts With Severe Adverse Events in Children

To examine the association between exposure to oral corticosteroid bursts with severe adverse medical events.A retrospective cohort was derived from the National Health Insurance Research Database in Taiwan of children (<18 years old) from 2013–2017.By using a national database of medical claims and prescription data, a self-controlled case series was used to compare risks in a pretreatment period before corticosteroid exposure (5–90 days) and 2 posttreatment periods (5–30 days and 31–90 days). The primary outcomes were the incidence rate ratios per 1000 person-years for gastrointestinal bleeding, sepsis, pneumonia, and glaucoma after oral corticosteroid burst exposure among children who did or did not receive the oral corticosteroid bursts. Exposure to corticosteroid burst was defined as a prescription record of oral corticosteroids for ≤14 days. A conditional fixed-effect Poisson regression model was used.The study sample included 4 542 623 children of which 42% received at least 1 oral corticosteroid burst, and the mean age was 9.7 (SD: 5.8) years. The most common reason for corticosteroid use was acute upper respiratory infection (34%) and allergic diseases (31%), including urticaria (11.0% to 11.9%), contact dermatitis or eczema (9.1% to 10.3%), asthma (5.2% to 7.1%), and allergic rhinitis (3.2% to 3.4%). Corticosteroid bursts were associated significantly with a 1.4- to 2.2-fold increase of gastrointestinal bleed, sepsis, and pneumonia.The risks with long-term use of corticosteroids are well described, but the risks of oral corticosteroid bursts, commonly prescribed for pediatric conditions like asthma and other allergic conditions, are not well known. The findings from this national, longitudinal, population-based analyses revealed that oral corticosteroid bursts were significantly associated with rare but severe medical events for children.With the study, the authors reframe how the use of short-term oral corticosteroids are not without potential harm and should guide clinicians in their practice, especially monitoring in the first month after corticosteroid use.

"You either sink or you swim, and you're better off swimming": A qualitative study exploring the self-management experiences of soft tissue sarcoma survivors.

To qualitatively explore the consequences of soft tissue sarcoma and its treatment experienced by survivors, the self-management strategies they use to deal with these consequences, and any factors that may act as barriers or facilitators to their self-management. Semi-structured interviews were conducted with seven soft tissue sarcoma survivors who had completed their primary treatment. Interviews were audio-recorded, transcribed and thematically analysed. Physical, psychological and social consequences of soft tissue sarcoma and its treatment were identified, with side-effects, physical restrictions, body image issues, fear of recurrence, feeling depressed, familial relationships and sexual activity being the most frequently reported. Nine different types of self-management strategy encompassing eighteen specific strategies were identified, including cognitive strategies, lifestyle changes and utilisation of resources. Personal, social and environmental facilitators of self-management were identified; being in a relationship, being at an appropriate life stage, and having support from family, friends and medical staff were most commonly reported. Finally, personal and environmental barriers to self-management included the adaptation period, ongoing complications, rareness of sarcoma and poor patient-healthcare provider communication. The findings of this study suggest that soft tissue sarcoma survivors, especially those who are younger and experience physical limitations, may find the immediate post-treatment period particularly challenging and may benefit from nurse-led self-management support.

Stakeholder-Identified Interventions to Address Cancer Survivors' Psychosocial Needs after Completing Treatment.

The interventions used in cancer-survivorship care do not always address outcomes important to survivors. This study sought to understand stakeholders’ views on the key concerns of cancer survivors after treatment and the interventions needed to meet survivors’ and families’ psychosocial needs after completing cancer treatment. We conducted a descriptive qualitative study using semi-structured interviews with stakeholders (survivors, family/friend caregivers, oncology providers, primary care providers, and cancer system decision-/policy-makers) from across Canada. For the data analysis, we used techniques commonly employed in descriptive qualitative research, such as coding, grouping, detailing, and comparing the data. There were 44 study participants: 11 survivors, seven family/friend caregivers, 18 health care providers, and eight decision-/policy-makers. Stakeholder-relevant interventions to address survivors’ psychosocial needs were categorized into five groups, as follows: information provision, peer support, navigation, knowledge translation interventions, and caregiver-specific supports. These findings, particularly interventions that deliver timely and relevant information about the post-treatment period and knowledge translation interventions that strive to integrate effective tools and programs into survivorship care, have implications for future research and practice.

OVARIAN CANCER BURDEN IN GEORGIA

Goal 1. To determine the incidence and death rates and features of ovarian cancer in the female population of Georgia in 2015-2019 using standardized rates and to create epidemiological maps. 2. To study the risks of cancer progression, recurrence and metastasis in oncogynecologic patients in the posttreatment period. 3. Study of 3-year survival rates of ovarian cancer. 4. To determine the burden of gynecologic cancer in the female population . 5. To develop preventive recommendations for oncogynecology patient advocacy. METHODS The following gross and standardized rates were calculated: Crude Morbidity and Mortality Rate (CrudeRate); AgeSpecific Rate (Age-Specific Rate); Age-Standardized Rate (ASR); 95% confidence interval of Age-standardized Rate (95% CI ASR); Truncated Age Standardized Rate (TASR); 95% confidence interval of Truncated Age Standardized Rate (95% CI TASR); Age-Adjusted Rate (AAR); 95% confidence interval of age-adjusted rate (95% CI AAR); Standardized Rate Ratio (SRR); 95% confidence interval of standardized ratio ratios (95% CI SRR); Cumulative risk indicator (Cumulative Risk-CR , CR ,); 95% confidence interval of cumulative risk indicator (95% CI CR); Proportional Incidence 64 74 Ratio (PIR); 95% confidence interval of proportional incidence ratios (95% CI PIR); Standardized Incidence Ratio (SIR); 95% confidence interval of standardized incidence ratio (95% CI SIR). 3-year survival rates for ovarian cancer were studied using SPSS, Kaplan-Maier curves, and Cox multifactorial analysis were used. Disability-adjusted life years (DALYs) in patients with gynecologic cancer were studied. RESULTS 1. In the overall structure of cancer incidence in women, according to age standardized (ASR) rates per 100 000 women, in 2015-2019, the third most common site for gynecologic cancer in Georgia was cervical cancer (ASR = 13,4; 95% CI ASR = 12,8-14,1) , the fourth – uterine cancer (ASR = 11,3; 95% CI ASR = 10,8-11,9), and sixth - ovarian (ASR = 9,8; 95% CI ASR = 9,3-10.3) cancer. 2. In the overall structure of cancer incidence in women, by age-adjusted (AAR) rates per 100 000 women (Georgian Standard 2014), in 2015-2019, the fourth most common gynecologic cancer in Georgia was cervical cancer (AAR = 18,6; 95% CI AAR = 18,0-19,3), uterine cancer was the fifth (AAR = 18,5; 95% CI AAR = 18,0-19,1), and ovarian cancer the sixth (AAR = 15,1; 95% CI AAR = 14,6 -15 6). 3. In Georgia, the risks of recurrence and/or development of metastases and disease progression after the period of treatment and remission of cervical and uterine cancer are not statistically significantly different from each other (OR = 1,0, 95% CI OR = 0,7-1,4), while compared to the cervical and uterine cancer, the risk of ovarian cancer progression is 2,9 times higher (OR = 2,9, 95% CI OR = 2,1-3,9).The risk of recurrence and / or development of metastases and disease progression post-therapy and remission is 2,3 times higher for uterine cancer compared to cervical cancer in Tbilisi (OR = 2,3, 95% CI OR = 1,4-3,9). At the same time, compared to cervical and uterine cancers, the risk of ovarian cancer progression is 4,1 times and 1,8 times higher, respectively (OR = 4,1, 95% CI OR = 2,4-6,8; OR = 1 , 8, 95% CI OR = 1 2-2 7). 4. In Tbilisi (the capital city of Georgia), the 3-year survival rate of gynecologic cancer with Kaplan-Meyer curves averaged 70,5%. Better 3-year survival rates among gynecologic cancer localizations were observed in cases of uterine cancer (78,7%) and cervical cancer (75,2%). The 3-year survival rate for ovarian cancer was 55,2%. 5. According to the DALYs index of gynecologic cancer in Georgia and Tbilisi, 39 459,1 women/year were lost due to gynecologic cancer in Georgia in 2015-2019, each patient lost an average of 7,3 years, and in Tbilisi, respectively 11 521,3 women/year is lost, each patient lost an average of 5,8 years.

Effect of Different Doses of 17 Α -Methyltestosterone on Masculinization, Pre-Post Treatment Growth Parameters and Condition Factor of Sarotherodon Melanotheron in Pond System

Over-population and stunted growth had been major challenges in the culture of tilapia. The use of synthetic androgen 17- α Methyl Testosterone (MT) was a breakthrough. However, its optimum level towards effective masculinization and growth is a concern. The aim of this research was to ascertain the optimum level of MT towards effective all-male population production and growth of Black-Chinned tilapia. In the present study, the effect of different dose rates of synthetic androgen 17-α Methyl Testosterone (MT) i.e., 0, 30, 60, and 120 mg of the hormone per kg of feed on sex, growth, and condition of Black-Chinned tilapia was evaluated. MT was administered orally by using powdered dry starter feed (Crude Protein 40 %) and Ethanol. The fry was fed for 30 days in the experimental tanks. At the end of the experiment, the sex ratios were determined by examining the operculum coloration as a means of sex identification. Growth performance was monitored by measuring and recording the morphometric characteristics. Bodyweight and total length of the fish on the start of feeding, end of feeding (one month sex reversal period), and two months after feeding were measured. The results of the present study showed that all MT receiving treatment showed a significantly higher male proportion than the control (0 mg MT/kg feed individuals). In all MT treatments groups, the control expects the 30 mg MT/kg in feed individuals’ deviate significantly from the normal 1:1 sex ratio (Chi-square analysis). The dose rate of 120 mg MT /kg feed resulted in the maximum male population (92.7%). Hence, for an effective high percentage of all-male population production in Black-Chinned tilapia, 120 mg MT /kg in feed is recommended. In terms of growth and condition factor, all the individual treatments, as well as the control, showed no significant difference. All the treated individuals showed similar condition factors during the pre and post-treatment, however, the individuals treated with 30 mg MT /kg feed exhibited better condition during the pre-treatment than the post-treatment period. Temperature, pH and dissolved oxygen recorded in this study were within the desirable limit for tilapia.

Trajectories of resilience and related factors in primary caregivers of patients with advanced head and neck cancer: Alongitudinal cohort study.

Primary caregivers (PC) of patients with advanced head and neck cancer (HNC) report stress during caregiving time post-treatment. We sought to identify the trajectories of resilience from initial completion of treatment to 1-year post-treatment in PC of patients with advanced HNC and to determine the factors associated with trajectories of resilience. In this prospective cohort study with convenience sampling, patient-PC dyads were recruited from a medical center in northern Taiwan between August 2015 and July 2020. We recruited 120 patient-PC dyads and followed up at treatment completion and 1, 6, and 12months post-treatment. Generalized estimating equation analysis was performed to identified factors related to resilience. PCs' overall resilience increased from initial completion of treatment to peak at 1-year post-treatment. Patient factors associated with greater overall resilience included older age, higher performance status, and shorter time since cancer diagnosis; PC factors included reporting more social support, better physical health, and better mental health. PC mental health was the most important factor in the resilience trajectory of patients with advanced HNC cancer. Quantifying the relevant factors of trajectoriesof resilience will help to identify vulnerable PCs and guide survivorship care in the early stages of the post-treatment period.

The Use of Automated Traps to Assess the Efficacy of Insecticide Barrier Treatments Against Abundant Mosquitoes in Remote Environments.

Commercially available 'smart' trap technology has not yet been widely used to evaluate interventions against mosquitoes despite potential benefits. These benefits include the ability to capture data continuously at fine temporal scales without the human resources usually required for conventional trap deployment. Here, we used a commercially available smart trap (BG-Counter, Biogents) to assess the efficacy of an insecticide barrier treatment (BiFlex AquaMax) in reducing mosquito nuisance in a logistically challenging coastal environment in Queensland, Australia. Adoption of smart trap technology permitted us to conduct a uniquely detailed assessment of barrier treatments, ultimately allowing us to demonstrate significant reductions in mosquito collections from treated properties over all temporal scales. On average, daily mosquito collections from treated properties were reduced by 74.6% for the duration of the post-treatment period (56 d). This observation was supported by similar reductions (73.3%) in mosquito collections across all hours of the day. It was further found that underlying mosquito population dynamics were comparable across all study sites as evidenced by the high congruence in daily collection patterns among traps (Pearson r = 0.64). Despite limitations related to trap costs and replication, the results demonstrate that smart traps offer new precision tools for the assessment of barrier treatments and other mosquito control interventions.

Rates and Predictors of Visits to Primary Care Physicians during and after Treatment of Childhood Acute Lymphoblastic Leukemia: A Population-Based Cohort Study

Introduction: Though ideal models of survivorship care are not definitively established, it has been suggested that childhood acute lymphoblastic leukemia (ALL) survivors can be cared for by properly informed primary care physicians (PCP - e.g. family physicians, community pediatricians) given low risks of late effects. PCP-driven models of care are dependent on the willingness of families to re-engage with their PCPs after a prolonged period of treatment delivered by pediatric oncologists during which PCP involvement may be minimal. We thus aimed to identify rates and predictors of PCP visits both during and after treatment among a population-based cohort of children with ALL.Methods: We identified all children <18 years at diagnosis of ALL at a pediatric center in Ontario, Canada between 2002-2012. Patients were linked to healthcare data and matched to population-controls by age, sex, and geography (1:5 ratio). PCP physicians at the time of diagnosis were identified through validated algorithms using primary care billing codes and patient rosters. PCP visit rates during treatment were determined and compared between cases and controls, with cases censored at the time of relapse, stem cell transplant, or death. Post-treatment PCP visit rates were calculated among those completing frontline therapy until relapse, death, or the end of the study period. Predictors included demographic- (e.g. age, sex, socioeconomic status, distance from treatment center), disease-related (e.g. risk status, lineage), and PCP-related variables (e.g. pediatrician vs. non-pediatrician).Results: Of 801 children with ALL, 751 (93.8%) had an identified PCP at the time of diagnosis. Excluding a further 8 (1.0%) patients who did not have treatment information available resulted in 743 cases and 3,112 controls. The median age of children with ALL was 4.0 years [interquartile range (IQR) 3.0-8.0], 409 (55%) of whom were male. Nearly half of patients (361, 48.6%) did not visit their PCP during treatment. The rate of PCP visits during treatment was 0.64 per person per year (PPPY) compared to 1.4 PPPY among controls. Adjusting for age, sex, and socioeconomic status resulted in an adjusted rate ratio (aRR) of 0.47 [95th confidence interval (95CI) 0.40-0.54; p<0.0001]. In multivariable analyses, no disease-related factors were associated with PCP visit rates. Infants had lower PCP visit rates during treatment (RR 0.09 vs. age 1-4 years, 95CI 0.01-0.6, p=0.01) while patients living at greatest distance from their treatment centre had higher rates (RR 1.6, 95CI 1.1-2.3, p=0.01). PCP type (pediatrician vs. other) did not have an impact on visit rates during treatment.Excluding 32 (4.3%) patients who relapsed, died, or underwent stem cell transplant prior to completing frontline therapy yielded 711 cases (survivors) and 2,973 controls available for analyses of post-treatment PCP visits. The median time of follow up after the end of treatment among survivors was 6.0 years (IQR 4.0-8.5). Though 287 (40.4%) of survivors did not visit their PCP during the post-treatment period, survivors overall still experienced greater post-treatment PCP visit rates compared to controls (aRR 1.4, 95CI 1.2-1.6; p<0.0001). This was true throughout the post treatment period, with the greatest increase in visit rates compared to controls seen 10 years from the end of treatment and beyond (aRR 3.6, 95CI 1.7-7.5, p=0.0007). In multivariable analyses, survivors who had seen their PCP during active treatment had post-treatment visit rates twice as high as those who had not (aRR 2.0, 95CI 1.6-2.5; p<0.0001). Survivors with pediatricians as PCPs also had higher post-treatment visit rates compared to survivors who did not (aRR 1.4, 95CI 1.1-1.8; p=0.003).Conclusions: Only a portion of children with ALL see their PCPs during treatment and return to PCP care following the completion of leukemia treatment, indicating that PCP-led survivorship care is feasible only for a subset of this population. The rate of PCP visits among survivors however continues to increase relative to general-population controls beyond 10 years after end of treatment. Post-treatment engagement with PCPs may be improved by PCP involvement during treatment, as well as in some cases the involvement of community pediatricians. DisclosuresGupta: Jazz Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees.

Microsurgical resection versus stereotactic radiosurgery for low-grade intracranial arteriovenous malformations: A 27-year institutional experience

The role of microsurgery and radiosurgery in the management of low-grade (Spetzler-Martin grade 1 and 2) arteriovenous malformations (AVMs) remains controversial. We aimed to compare outcomes of low-grade AVMs following microsurgery and radiosurgery using a database of AVM patients presenting between 1990 and 2017. Procedure-related complications, obliteration, and functional status at last follow-up were compared between groups. Hemorrhage-free survival was compared using Kaplan-Meier analysis with subgroup analyses by rupture status on presentation. The study involved 233 patients, of which 113 and 120 were treated with microsurgery and radiosurgery, respectively. The complication rates were statistically comparable between both treatment modalities. Mean follow-up time was 5.1 ± 5.2 years. In the complete cohort, there was no significant difference in hemorrhage-free survival between microsurgery and radiosurgery (log-rank p = 0.676, Breslow p = 0.493). When excluding procedure-related hemorrhage and partial resection, hemorrhage-free survival was significantly higher in the surgically treated cohort (log-rank = 0.094, Breslow p = 0.034). The obliteration rate was significantly higher in the surgical cohort (96% vs. 57%, p < 0.001), while functional status was similar. Microsurgery may offer superior hemorrhage-free survival in the early post-treatment period and demonstrates equivalent long-term hemorrhage control and functional outcome at 5 years compared to radiosurgery with nearly complete obliteration rates. Persistent neurologic deficits following microsurgery and symptomatic cerebral edema represent important treatment risks despite low SM grading. Appropriate patient selection even when dealing with low-grade AVMs is advised, as judicious patient selection and emphasis on technical success can minimize procedure-related hemorrhage and the incidence of subtotal resection.

The Efficacy and Safety of a Novel Protective Complex Combined With 50% Glycolic Acid Peel: A Double-Blinded, Split Face, Controlled Study.

Glycolic acid (GA) is a commonly used superficial peel with higher concentrations and lower pH levels leading to a stronger effect despite a higher risk of adverse effects (AE), which include burning, pain, itching, erythema, and edema. This study aimed to evaluate the potential of a novel protective complex (NPC) to reduce facial AEs following a GA chemical peel treatment. Twenty volunteers were selected for the study. A pair of numbered kits were supplied by and randomly assigned to be applied to each side of a patient&rsquo;s face with either a 50% GA peel plus NPC or a control formulation with only a 50% GA peel. AEs, patient photographs, and standard and red filtered VISIA scans were evaluated by three independent dermatologists. The average post-treatment pain and itching were significantly higher in the control half as compared to the study half. Recovery time appeared to be significantly shorter in the treated side compared to the control side. The addition of the NPC to GA 50% peel is a highly effective, safe modality in the reduction of erythema, pain, and itching after peel application, and it provides an advantage in the post-treatment healing period. J Drugs Dermatol. 2021;20(12):1336-1339. doi:10.36849/JDD.5939.

Associative polymers for disproportionate permeability reduction – Formation wettability effects

Core-based laboratory experiments were performed on water- and chemically-treated-oil-wet Berea sandstone long-core samples to investigate the disproportionate permeability reduction (DPR) potential of a low-molecular weight associative polymer. The impact of single- and two-phase DPR treatments were considered at 60 °C. In the experiments conducted, real-time electrical resistivity measurements were obtained during the coreflood tests to serve as (a) a valuable tool for fluids saturation monitoring and (b) improved core fluids saturation evaluation in flooded porous media. Results from DPR treatments in water-wet cores showed high initial oil residual resistance factors, RRFo (≈20), followed by relatively long clean-up times; stabilized RRFo was achieved at relatively high PVs of oil injection (≈25). For the range of the post-treatment pressure gradients applied in the laboratory experiment, no DPR effects were observed for the water-wet core samples. However, the different shear-dependent behavior for the oil and water phases in the treated zone suggests that a positive DPR effect is possible at extrapolated low post-treatment applied pressure gradients; this could also be translated as higher clean-up times. For the two-phase DPR treatments in water-wet cores, RRFo can be significantly reduced to approximately 8, while RRFw stabilized at the relatively high value of 40. However, the required significantly long clean-up period during oil flow through the treated zone may question the efficiency of the achieved DPR effect. For the two-phase DPR treatment in oil-wet cores, stabilized RRFo were achieved at considerably lower injected oil PVs, i.e., shorter post-treatment clean-up periods were required. In addition, distinguishably smaller RRFo values were achieved for the oil-wet cores compared to the water-wet ones with a substantial separation from the achieved RRFw values (i.e., faster attainment of low values ranging between 6 and 4 for 15 to 40 injected PVs clean-up duration). These results indicate greater potential for effective positive DPR treatment for oil-wet medium treated through two-phase injection methods. Multi-rate tests conducted during polymer injection showed that the mobility reduction (resistance factor, RF) during DPR treatments, for both single- and two-phase methods, are shear dependent. In addition, post-treatment water and oil injection (production) showed different behavior regarding permeability reduction (RRF). In both core wettability cases, water flow experienced a noticeable power-law dependency to the applied differential pressure. On the other hand, the oil flow behavior in the two wettability cases was different; slightly shear-thinning for the water-wet cases and weakly shear-thickening for the oil-wet cores. In both cases the shear dependency of oil flow was much less pronounced than that of the water flow. Finally, the production water cut can be decreased to a noticeable amount using associative polymer DPR treatments. However, one must note that the water cut reduction (economic gain) is associated with a reduced total (oil) production rate (time loss); therefore, implementation of an associative polymer DPR treatment should be considered carefully.