Pretreatment Period Research Articles

Relation of whole-body metabolic tumor volume and total lesion glycolysis on fluorodeoxyglucose PET/computed tomography with clinical and laboratory parameters in newly diagnosed multiple myeloma.

This study aims to evaluate the relationships of metabolic fluorodeoxyglucose PET/computed tomography (FDG PET/CT) parameters such as whole-body metabolic tumor volume (WB MTV), WB-total lesion glycolysis (TLG), and bone marrow (BM)-mean standard uptake value (SUVmean) with clinical stage and other prognostic biomarkers in newly diagnosed multiple myeloma (MM) patients. Patients who underwent pretreatment PET/CT with the diagnosis of MM were evaluated retrospectively. The number of focal lesions, WB MTV, WB TLG, and BM SUVmean values were measured on FDG PET/CT images. Clinical stages and prognostic laboratory parameters were recorded the pretreatment period. WB MTV and WB TLG values were significantly higher in patients with more than three focal lesions on FDG PET/CT scan (all P < 0.001). According to the Revised International Staging System (R-ISS), all WB MTV, WB TLG, and BM SUVmean values are significantly higher in patients with stage 3 disease than in stages 1-2 ( P = 0.027, P = 0.019, P = 0.001, respectively). Serum creatinine level is positively correlated with WB MTV, WB TLG, and BM SUVmean values ( P = 0.020, P = 0.004, P < 0.001, respectively). In addition, the β2 microglobulin level, an essential biochemical prognostic parameter, was positively correlated with the BM SUVmean value ( P = 0.013). The BM SUVmean, WB MTV, and WB TLG values, which reflect FDG avid WB tumor burden, are associated with prognostic biomarkers and R-ISS stage in newly diagnosed MM patients. It contributes to the identification of high-risk patients at the pretreatment staging.

Quality-of-Life Assessment after Head and Neck Oncological Surgery for Advanced-Stage Tumours.

Squamous cell carcinoma of the head and neck (HNSCC) is a common malignancy often diagnosed in the advanced stage with a complex negative influence on the patient’s quality of life (QoL). Given its multi-modal treatment, the first step is to adequately balance the needs of the patient, and the second step includes the consultations, interventions, and care provided by the medical team, with the purpose of improving the overall management of the HNSCC. Current attempts to develop and validate quality-of-life instruments specific to cancers of the head and neck have been reported, and certain questionnaires are now available. We performed a retrospective study in a tertiary centre, involving 89 patients who survived 3 years after HNSCC surgery. A patient-related outcome measurement was made using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-H&N35 instruments to assess QoL at admission and 3 years after treatment. The 3-year survivors reported an overall improvement in QoL compared with those in the pre-treatment period. The unique details of head and neck cancer treatments outline the importance of considering the characteristics of the patient population in quality-of-life research and also identify how quality-of-life data can contribute to the care provided by the multi-disciplinary team involved in a patient’s follow-up.

Modulatory effect of two regimens of magnesium sulfate on the systemic inflammatory response in pregnant women with imminent eclampsia.

This study compared the modulatory effect of two intravenous magnesium sulfate (MgSO4) regimens on the systemic inflammatory response in pregnant women diagnosed with imminent eclampsia. In a single-blind cross-sectional study, 33 women were allocated according to the Zuspan (n=16) and Sibai (n=17) MgSO4 regimens, and treated for 24h. Blood samples were collected pre-administration of the loading dose, at 24h of the maintenance dose of MgSO4, and at 48h, when patients were without treatment. Plasma was used to determine interleukin (IL)-1 beta (IL-1β), IL-6, IL-10, tumor necrosis factor-alpha (TNF-α), heat shock protein (Hsp70), and heme oxygenase-1 (HO-1) by ELISA. The treatment with the Zuspan's regimen didn't change plasma concentrations of TNF-α, IL-10, and Hsp70 in the three-time points studied. However, it decreased IL-1β at 24h and 48h and IL-6 at 48h, and increased HO-1 concentration at 48h. On the other hand, compared to the pre-treatment period, Sibai's regimen induced a significant decrease in TNF-α, IL-1β, IL-6, and Hsp70, while increased HO-1 levels both at 24h and 48h and, IL-10 concentration at 48h. Sibai's regimen determined an early and efficient immunoregulatory effect on systemic inflammatory response in preeclampsia, suggesting that the maintenance dose of two grams of MgSO4 was better than one gram in the treatment of imminent eclampsia.

Autologous Hematopoietic Stem-Cell Transplantation in Multiple Sclerosis: A Systematic Review and Meta-Analysis.

IntroductionIn 1995, the use of autologous hematopoietic stem-cell transplantation (AHSCT), which was previously used to treat hematological tumors, was introduced for severe autoimmune diseases such as multiple sclerosis (MS). AHSCT has proven its safety over the past few years due to technical advances and careful patient selection in transplant centers. While most studies have reported that AHSCT led to decreased Expanded Disability Status Scale (EDSS) scores, some patients reported increased EDSS scores following the procedure. Given the contradictory results, we aimed to conduct a comprehensive systematic review and meta-analysis to investigate the efficacy and safety of AHSCT.MethodsPubMed, Web of Science, and Scopus were searched in March 2022 using a predefined search strategy. We included cohort studies, clinical trials, case–control studies, and case series that investigated the efficacy or safety of AHSCT in patients with MS. PICO in the present study was defined as follows: problem or study population (P): patients with MS; intervention (I): AHSCT; comparison (C): none; outcome (O): efficacy and safety.ResultsAfter a two-step review process, 50 studies with a total of 4831 patients with MS were included in our study. Our analysis showed a significant decrease in EDSS score after treatment (standardized mean difference [SMD]: −0.48, 95% CI −0.75, −0.22). Moreover, the annualized relapse rate was also significantly reduced after AHSCT compared to the pretreatment period (SMD: −1.58, 95% CI −2.34, −0.78). The pooled estimate of progression-free survival after treatment was 73% (95% CI 69%, 77). Furthermore, 81% of patients with MS who received AHSCT remained relapse-free (95% CI 76%, 86%). Investigating event-free survival, which reflects the absence of any disease-related event, showed a pooled estimate of 63% (95% CI 54%, 73%). Also, the MRI activity-free survival was 89% (95% CI 84%) among included studies with low heterogeneity. New MRI lesions seem to appear in nearly 8% of patients who underwent AHSCT (95% CI 4%, 12%). Our meta-analysis showed that 68% of patients with MS experience no evidence of disease activity (NEDA) after AHSCT (95% CI 59%, 77). The overall survival after transplantation was 94% (95% CI 91%, 96%). In addition, 4% of patients died from transplant-related causes (95% CI 2%, 6%).ConclusionCurrent data encourages a broader application of AHSCT for treating patients with MS while still considering proper patient selection and transplant methods. In addition, with increasing knowledge and expertise in the field of stem-cell therapy, AHSCT has become a safer treatment approach for MS.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40120-022-00389-x.

The effect of personality traits and parental attitudes on treatment in children and adolescents: a 6-month follow-up study

Objectives: This study aims to examine the effects of personality traits and parental attitudes on the change of emotional and behavioral problems in children and adolescents with mental disorders receiving outpatient treatment during the six months. Methods: In the study, 233 individuals between the ages of 7-17 who applied to the Child Psychiatry Outpatient Clinic of a private hospital in Istanbul between September 2015 and September 2017 and who had psychiatric disorders regarding DSM-V diagnostic criteria were evaluated before treatment with the Sociodemographic Data Form, Strengths and Difficulties Questionnaire (SDQ), Quick Big Five Personality Test (QBFPT), and Parental Attitude Scale (PAS). Emotional and behavioral problems of children and adolescents who were followed up for psychiatric treatment were evaluated by SDQ at the first, third, and sixth months. Results: According to the Pearson Correlation Analysis, it was found that the SDQ total scores of children and adolescents in the pre-treatment period were statistically significantly positively correlated with the Democratic Attitude subscale scores (r = 0.129, p = 0.049). Considering the QBFPT and PAS sub-dimension scores in ANCOVA analyzes, the change in the SDQ total scores before and after treatment was statistically significant (p &amp;lt; 0.05), and Democratic Attitude subscale scores (F = 2.70, p = 0.048) and Emotional Stability subscale scores (F = 3.27, p = 0.023) had statistically significant effects on this change. Conclusions: In children and adolescents with mental disorders, focusing on democratic attitudes and personality traits associated with emotional stability may help reduce emotional and behavioral problems during treatment.

Autologous ovarian platelet rich plasma treatment improves oocyte and embryo quality: a before-after prospective study

Platelet-rich plasma (PRP) is used for successful regeneration of female reproductive tissues. However, little is known about the effect of ovarian PRP treatment on oocyte and embryo quality. The objective of our study was to assess the role of autologous ovarian PRP treatment on ovarian reserve and number and quality of oocytes and embryos in women with poor ovarian response (POR) undergoing in-vitro fertilization cycles. A total of 66 women with POR were treated with ovarian PRP injection in two subsequent menstrual cycles. The antral follicle counts, serum anti-Mullerian hormone, follicle-stimulating hormone levels, fertilization rate, number and quality of oocytes, and embryos were assessed and compared between the cycle before and after PRP treatment. Ovarian PRP treatment resulted in insignificantly lower follicle-stimulating hormone levels, significantly higher antral follicle count, anti-Mullerian hormone, number of retrieved oocytes, and insignificantly higher fertilization rate. However, the mean number of Day 5 embryos (2.19 ± 1.45 vs. 1.58 ± 1.30, p = 0.01), the percentage of high-quality oocytes (45.29% ± 42.40% vs. 15.21% ± 30.24%, p < 0.01) and the percentage of grade-I blastocysts (52.10% ± 37.94% vs. 12.86% ± 22.97%, p < 0.01) were significantly higher after PRP treatment in comparison to the pretreatment period. Moreover, the mean MII oocyte quality (1.60 ± 0.54 vs. 2.31 ± 0.63, p < 0.01) and mean blastocyst quality (1.53 ± 0.45 vs. 2.42 ± 0.63, p < 0.01) were significantly improved in the post-treatment period. In conclusion, the applied autologous ovarian PRP treatment in poor responders may significantly improve oocyte and embryo quality.

Pretreatment and During-Treatment Weight Trajectories in Black and White Women

Black participants often lose less weight than White participants in response to behavioral weight-loss interventions. Many participants experience significant pretreatment weight fluctuations (between baseline measurement and treatment initiation), which have been associated with treatment outcomes. Pretreatment weight gain has been shown to be more prevalent among Black participants and may contribute to racial differences in treatment responses. The purpose of this study was to (1) examine the associations between pretreatment weight change and treatment outcomes and (2) examine racial differences in pretreatment weight change and weight loss among Black and White participants. Participants were Black and White women (n=153, 60% Black) enrolled in a 4-month weight loss program. Weight changes occurring during the pretreatment period (41 ± 14 days) were categorized as weight stable (±1.15% of baseline weight), weight gain (≥+1.15%), or weight loss (≤-1.15%). Recruitment and data collection occurred from 2011 to 2015; statistical analyses were performed in 2021. During the pretreatment period, most participants (56%) remained weight stable. Pretreatment weight trajectories did not differ by race (p=0.481). At 4-months, those who lost weight before treatment experienced 2.63% greater weight loss than those who were weight stable (p<0.005), whereas those who gained weight before treatment experienced 1.91% less weight loss (p<0.01). Pretreatment weight changes can impact weight outcomes after initial treatment, although no differences between Black and White participants were observed. Future studies should consider the influence of pretreatment weight change on long-term outcomes (e.g., weight loss maintenance) along with potential racial differences in these associations. This study is registered (retrospectively registered) at ClinicalTrials.gov (NCT02487121) on June 26, 2015.

The Influence of Pinochet on the Chilean Miracle

AbstractThis article analyzes the impact of Augusto Pinochet’s autocracy on the Chilean economy. The study compares outcomes under Pinochet’s leadership with those in a synthetic counterfactual made of a weighted average of countries with similar characteristics. It finds that, relative to the control, Chilean income per capita greatly underperformed for at least the first fifteen years after Pinochet’s coup. The results are robust to extending the pool of donor countries and expanding the pretreatment period by switching data sets to capture potential heterogeneity of effects. The evidence suggests that Chile’s remarkable economic growth during the period 1985–1997 did not depend on Pinochet’s autocracy. These results further bring into question the effectiveness of the regime to enhance economic growth and the narrative of the Chilean miracle.

First-in-human phase 1/2 study of autologous T cells engineered using the Sleeping Beauty System transposon/transposase to express T-cell receptors (TCRs) reactive against cancer-specific mutations in patients with advanced solid tumors.

TPS2679 Background: In 2022 approximately 1.7 million Americans will die from solid cancers. Recently there have been significant advances in the genetic engineering of T lymphocytes to recognize neoantigens on tumors in vivo, resulting in remarkable cases of tumor regression and remission. Cancer cells frequently harbor KRAS, TP53, and EGFR somatic hotspot mutations that can be processed and presented by tumor HLA as neoantigens to T cells through their T-cell receptor (TCR). These neoantigens are not present in the normal tissues; thus, they are attractive targets for adoptive T cell therapy. Given the number and complexity of different neoantigen/HLA combinations on solid tumors, a TCR library approach is warranted. Therefore, we have developed a library of TCR-T cell therapies including those targeting shared KRAS, TP53 and EGFR mutations. Methods: Patients for whom a TCR matching the subject’s somatic mutation(s) and HLA type is available in our TCR library, and have progressive or recurrent disease following standard therapy are eligible for enrollment on this protocol. Patients with the following tumor types will be enrolled: ovarian, endometrial, colorectal, pancreatic, cholangiocarcinoma, and non-small cell lung cancer. This first-in-human study includes Screening, Pre-Treatment, Treatment and Follow-up Periods. During the Pre-Treatment Period, subjects will undergo apheresis for PBMCs isolation. The PBMCs will be transposed using the Sleeping Beauty system to express the subject’s mutation specific TCR. Bridging therapy after apheresis is allowed once the apheresis product has been accepted. During the Treatment Period, patients will undergo lymphodepletion with cyclophosphamide and fludarabine. After which, the TCR-T cell drug product will be administered to the subject by infusion at the assigned dose level. The starting dose level of Arm A (monotherapy) will be DL1 (5 x10 9 TCR+ Cells) administered on Day 0. Dose escalation will continue utilizing the accelerated BOIN design (planned escalation dose levels: 5 x10 9, 4 x10 10 and 1 x10 11 TCR+ Cells). In Arm B, if initiated by protocol, subjects will also receive aldesleukin (interleukin-2) infusion starting on Day 0 (within 24 hours of TCR-T cell product infusion) at 720K IU/kg, every eight hours for up to 4 days. The Follow-up Period will begin after the subject completes their Day 28 visit. Clinical and radiologic response will be assessed at 6 and 12 weeks after TCR-T cell drug product infusion and every 12 weeks thereafter until up to 2 years or study discontinuation (e.g., disease progression, initiation of new anti-cancer therapy, consent withdrawn), whichever occurs first. All subjects will continue to be followed in the Long-Term Follow-up Protocol for up to 15 years post-TCR-T cell drug product infusion. Clinical trial information: NCT05194735.

Altered Arginine/Nitric Oxide Pathway in Children Diagnosed Attention Deficit Hyperactivity Disorder, and the Effect of 10 Weeks Methylphenidate Treatment.

ObjectiveIn this study, we investigated the levels of arginine, nitric oxide (NO), asymmetric dimethylarginine (ADMA), and adrenomedullin that are presumed to play a role in attention deficit hyperactivity disorder (ADHD) etiology, and to compare the findings with healthy controls.MethodsThirty ADHD patients and thirty healthy control subjects aged 6−12 years were included in the study. Sociodemographic data form, Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version; Conners’ Parent/Teacher Rating Scale-Revised Long Form; Children’s Depression Inventory; and The State-Trait Anxiety Inventory for Children were applied to all cases. All participants included in the study were evaluated in terms of their serum arginine, NO, ADMA, and adrenomedullin levels. Subsequently, methylphenidate treatment was started in ADHD patients and blood parameters were tested again in the tenth week of treatment.ResultsAt the start of the study, arginine and ADMA levels were significantly higher and NO and adrenomedullin levels were significantly lower in the ADHD group compared to the control group. Post-treatment arginine and ADMA levels were found to be significantly lower than in the pre-treatment period. There were no significant differences in NO and adrenomedullin levels before and after treatment. There was no correlation between scale scores and blood parameters.ConclusionThese variations in the blood parameters of the ADHD group seem to be worth further investigation. Studies to be conducted with larger sample groups after longer-term treatment may provide new information about the alterations in neurobiological processes related to ADHD etiology and treatment.

Use the Complete Blood Counts and Esr as Biomarkers Prognostic Tool in Breast Cancer Patients Attending Surgery Department at Esut Teaching Hospital, Parklane Enugu Nigeria

Background: Full blood count is a prerequisite investigation requested from all breast cancer patients before and during treatment.Poor parameters adversely influence the outcome of cancers.&#x0D; Objective: This study investigated the use of Complete Blood Count (CBC) and Erythrocyte Sedimentation Rate (ESR) as biomarker prognostic tool in breast cancer subjects.&#x0D; Methods: The sample size comprised of 110 female subjects and controls with ages between 21-70 years. A longitudinal study method was used. The samples were collected from apparently healthy individuals as control, pre-treatment at diagnosis and the treatment samples at different stages of the treatment. Questionnaire used obtained other demographic information. The data was analyzed with IBM SPSS PC. Version 20.0; SPSS Inc., Chicago, III., USA.&#x0D; Results: Results showed that increased Neutrophil/Lymphocyte Ratio (NLR) and decreased Lymphocyte / Monocyte Ratio (LMR) were significantly associated with increased hazard ratio (HR) and decreased OS at p&lt;0.05 while Platelet/Lymphocyte Ratio ( PLR) had no significant difference at P&gt;0.05 in Breast Cancer. In CBC and ESR, control, pre-treatment and treatment period, red blood cell (RBC) parameters and total white blood cell (TWBC) parameters decreased significantly at p&lt;0.05 in treatment results compared to the pre-treatment and control results while others showed no significant increase at p&lt;0.05 in treatment results compared to pre-treatment results. Treatment red cell distribution width (RDW) and mean platelet volume (MPV) observed a significant increase (p&lt;0.05) compared to the control and pre-treatment results. Age group 21-30 years showed more susceptibility than other age groups with lowest mean±SD in CBC and ESR but with no significant difference at p&gt;0.05.&#x0D; Conclusion: This study supports the concept that biomarkers such as CBC and ESR can be used as a prognostic tool in early detection, treatment and monitoring of the disease progression in these subjects

Association between Pemafibrate Therapy and Triglyceride to HDL-Cholesterol Ratio.

Background: Pemafibrate is a novel selective peroxisome proliferator-activated receptor-α modulator, which was demonstrated to reduce serum triglyceride level with few drug-related adverse events in phase II and III clinical trials. However, its clinical implication in real-world practice remains unknown. Triglyceride/HDL-cholesterol ratio is a surrogate of small dense LDL-cholesterol, which is a newly proposed cardiovascular risk factor independent of LDL-cholesterol levels. Methods: Consecutive patients who received pemafibrate between April 2020 and September 2021 and continued therapy for at least 3 months were included in this retrospective analysis. The primary outcome was the trend in triglyceride/HDL-cholesterol ratio during the 3-month treatment period. The change in cardiovascular event rate between the one-year pre-treatment period and the on-treatment period was also analyzed. Results: A total of 19 patients (median age 63 years, 74% men) were included and continued pemafibrate therapy for 3 months without any drug-related adverse events. Sixteen were add-on and three were conversions from other fibrates. Triglyceride/HDL-cholesterol ratio decreased significantly from 5.85 (4.19, 16.1) to 3.14 (2.39, 4.62) (p < 0.001). The cardiovascular event rate decreased significantly from 0.632 events/year to 0.080 events/year (p < 0.001). Conclusions: Pemafibrate therapy might have the potential to lower triglyceride/HDL-cholesterol ratio and decrease cardiovascular events.

Investigation of the Role of Pituitary Adenylate Cyclase-Activating Peptide (PACAP) and Its Type 1 (PAC1) Receptor in Uterine Contractility during Endometritis in Pigs.

Uterine inflammation is a common pathology in animals, leading to disturbances in reproductive processes and reduced production profitability. Pituitary adenylate cyclase-activating peptide (PACAP) effects at the uterine level during inflammation are not known. In the current study, we analyzed the relative PACAP type 1 receptor (PAC1R) mRNA transcript and protein abundances in the myometrium (MYO), as well s PACAP and PAC1R involvement in the contractile function of inflamed pig uterus. To that end, E. coli suspension (E. coli group) or saline (SAL group) was injected into the uterine horns or laparotomy was performed (CON group). Eight days after the bacteria injections, severe acute endometritis and a reduced relative abundance of PAC1R protein in the MYO were observed. Compared to the period before PACAP in vitro administration, PACAP (10−7 M) in the CON and SAL groups decreased in amplitude in the MYO and endometrium (ENDO)/MYO, whereas in the E. coli group, increased amplitude in the MYO and reduced amplitude in the ENDO/MYO were observed. In the E. coli group, PACAP enhanced the amplitude in the MYO (10−7 M) and decreased the amplitude in the ENDO/MYO (10−8 M) compared with other groups. PACAP (10−7 M) increased the frequency of both kinds of strips in the CON and SAL groups compared with the pretreatment period. PACAP (both doses) did not significantly change the frequency in the E. coli group, whereas in response to PACAP (10−7 M), the frequency was reduced compared to other groups. In the MYO, PAC1R antagonist decreased the amplitude reduction (CON and SAL groups) and reversed a rise in PACAP (10−7 M)-evoked amplitude (E. coli group). PAC1R blocking reversed (MYO) and abolished (ENDO/MYO) the stimulatory effect of PACAP (10−7 M) on the frequency (CON and SAL groups). PAC1R antagonist and PACAP (10−7 M) evoked the appearance of frequency depression in both kinds of strips (E. coli group). In summary, in pigs, severe acute endometritis reduces the relative abundance of PAC1R protein in the MYO, and PAC1R mediates the influence of PACAP on inflamed uterus contractility.

Effects of Hydrolysable Tannin Supplementation on Nutrient Intake, Milk Production and Milk Somatic Cell Count in On-farm Dairy Cows

This study examined the effects of hydrolysable tannin (HT) supplementation on nutrient intake, milk production and milk somatic cell count in on-farm dairy cows. Fifty-four Holstein Friesian crossbred cows weighing 450 to 500 kg and were subjected to an experiment for 49 days. Dairy cows were divided into 3 groups, which were 1) the control group without HT supplementation and the HT supplementation groups, which received HT products (15 g/day), 2) one contains 3.15 g/day of HT and 3) another contains 6.30 g/day of HT. Hydrolysable tannin was extracted from sweet chestnut wood (Castanea Sativa Mill.). Dairy cows received HT products on the top of concentrate (22 % CP) in the morning after milking. Total mixed ration (TMR), pangola grass (Digitaria eriantha) hay and concentrate were offered according to animal nutrient requirements. The results showed that supplementation of HT has no influence (p &gt; 0.05) on the nutrient intake, milk yield and milk composition when compared to the control group. In addition, the increased levels of HT caused quadratic increases in fat:protein at pre-treatment and treatment periods (p &lt; 0.05; p = 0.06, respectively), while differential somatic cell count (DSCC) at treatment and post-treatment periods showed a quadratic decrease (p &lt; 0.05; p &lt; 0.05, respectively), with supplementation of HT product containing 6.30 g HT/day (p &lt; 0.05) being the lowest. Therefore, it can be concluded that supplementation with HT product does not affect nutrient intake, milk yield, however, it could reduce DSCC and probably improve udder health in on-farm dairy cows.&#x0D; HIGHLIGHTS&#x0D; &#x0D; A quantitative performance comparison of Radio over Free Space Optical links&#x0D; WDM increases the capacity while the MIMO links help to maintain the transmission range&#x0D; A combination of WDM and MIMO RoFSO links is identified to be the best&#x0D;

Geometric morphometric analysis of the pharyngeal airway during treatment of Class III malocclusion

The pharyngeal airway is important during diagnosis and treatment planning in orthodontics. This study aimed to compare the changes in the shape of the pharyngeal airway in patients with Class III malocclusion treated with a facemask (FM) with a removable maxillary appliance and modified tandem traction bow appliance (MTTBA). This study consisted of pretreatment and posttreatment lateral cephalograms of 35 subjects with skeletal and dental Class III malocclusion. In the first group, 20 patients (12 males, 8 females; mean age, 10.2 years) were treated with MTTBA. The mean treatment time was 12 months. In the second group, 15 patients (10 males, 5 females; mean age, 10.3 years) were treated with FM. The mean treatment time was 11.7 months. Nineteen pharyngeal landmarks were considered from the image corresponding to the midsagittal plane and marked using tpsDig software (version 2.04; Stony Brook, NY). Pharyngeal airway shape difference between the groups was assessed by performing a Generalized Procrustes analysis. The shape deformation of the pharyngeal airway from the pre- to posttreatment periods was evaluated using the thin-plate spline method. There were no differences between MTTBA and FM groups according to airway shape for pretreatment and posttreatment periods. However, there were some deformities using the enlargement of the nasopharyngeal area in the FM group and oropharyngeal area in the MTTBA group according to pretreatment periods. There were no differences between the groups according to the mean pharyngeal airway shapes when the posttreatment periods of the FM and MTTBA groups were examined.

Mine closures and local diversification: Job diversity for coal-mining areas in a post-coal economy

This paper tries to shed light in the research that relates mining activities and regional diversification by studying how a group of local economies heavily specialized in mining diversified its economy after the ending of public subsidies that supported coal extraction. The case of study are the mining municipalities located in the center of Asturias (an autonomous region in Northern Spain), which constituted one the most important coal basins in the country. Although the extraction of coal was one of the main driving forces of the economic activity of the region, the mine pits were located in just a few municipalities across the territory. The economy of this area experienced the most severe effects produced by this policy, which started to be implemented in the early nineties and that gradually led to the cease of coal extraction in 2018. According to recent literature (see Fitjar and Timmermans, 2019), this shift in the public mining policy should have produced a greater diversification in the local economies previously specialized in mining activities, but a proper measurement of this effect can be problematic. Traditional methods, as difference-in-differences, are precluded due to the small number of spatial units directly affected by the treatment. This paper applies the estimation strategy proposed in Abadie and Gardeazabal (2003) of the Synthetic Control Method (SCM) to overcome this problem. The application of the SCM generates a weighted average of the untreated units (non-mining municipalities) that closely matches the treated unit over the pre-treatment period. Outcomes for this synthetic control are then projected into the post-treatment period using the weights identified from the pre-treatment comparison. This projection is used as the counterfactual for the treated unit. This methodology will be exploited together with rich historical data on local employment classified by industry, available for all the municipalities of the region for the period 1978-2018. The level of diversification on each area is quantified by calculating a Herfindahl-Hirschman Index (HHI), being this indicator the variable of interest. Taking the initial years of the 1990 decade as the break-point (when the policies of public support to coal extraction started to end), the application of this technique shows how this sped-up the diversification of the mining area, producing significant differences on the HHI with the counterfactual synthetic unit and indicating that the level of concentration of the economic activity is significantly lower than it would be if the mining activity had prolonged over time.

Neutrophil to Lymphocyte ratio is significantly reduced after Sodium glucose cotransporter-2 inhibitor treatment in patients with type 2 diabetes mellitus

Background. Sodium glucose cotransporter-2 inhibitors (SGLT2i) are novel therapeutic agents that became available in the treatment of type 2 diabetes mellitus (T2DM). This group of antidiabetic agents are associated with reduced glycated hemoglobin (HbA1c), fasting glucose, body weight and body mass index (BMI) in diabetic patients. All those beneficial effects may also be associated with a reduction in inflammatory burden. The purpose of the study is to compare neutrophil to lymphocyte ratio (NLR), a novel inflammatory marker derived from hemogram, before and 6 months after SGLT2i treatment in diabetic subjects. We also aimed to compare fasting glucose, HbA1c and other metabolic parameters as well as anthropometric measures (weight, BMI) before and 6 month after initiation of SGLT2i therapy. Materials and methods. The subjects with type T2DM that show up in internal medicine outpatient clinics of Abant Izzet Baysal University Hospital between January 2021 and December 2021 were enrolled to the study. Pretreatment and posttreatment NLR and other parameters were compared. We also obtained pretreatment and posttreatment laboratory data including urea, creatinine, fasting glucose, HbA1c, glomerular filtration rate, aspartate and alanine transaminases, plasma sodium and potassium. Results. Fasting glucose was reduced from 195±72 mg/dl in pretreatment period to 146±53 mg/dl in posttreatment period (p&lt;0.001). HbA1c was reduced from 9.1±1.7% in pretreatment period to 7.7±1.7% in posttreatment period (p&lt;0.001). The NLR before treatment was 2.6±1.2% before SGLT2i treatment and was reduced to 2.2±0.6% in 6th month of SGLT2i therapy. NLR was significantly decreased after treatment (p=0.003). Conclusions. We suggest that NLR levels could be a marker of reduced inflammatory burden in T2DM subjects receiving SGLT2i treatment.

Radiosurgery in Treatment of Ventricular Tachycardia – Initial Experience Within the Polish SMART-VT Trial

BackgroundStereotactic Arrhythmia Radioablation (STAR) is an emerging treatment modality for patients with sustained ventricular tachycardia (VT) and refractory to treatment with drugs and radiofrequency catheter ablation (RFA). It is believed that up to 12–17% of patients experience recurrence of VT within 1 year of follow-up; thus, novel therapeutic options are needed. The aim of this article is to present initial experience within a novel treatment modality for VT.Case SummaryTwo patients with a medical history of coronary artery disease and heart failure with reduced left ventricle (LV) ejection fraction, after implantation of cardioverter-defibrillator (ICD) and previous unsuccessful RFAs owing to sustained VT were admitted to the cardiology department due to recurrence of sustained VT episodes. With electroanatomical mapping (EAM), the VT substrate in LV has been confirmed and specified. In order to determine the target volume for radioablation, contrast-enhanced computed tomography was performed and the arrhythmia substrate was contoured using EAM data. Using the Volumetric Modulated Arc Therapy technique and three 6 MeV flattening filter-free photon beam fields, a single dose of 25 Gy was delivered to the target volume structure located in the apex and anterior apical segments of LV in the first patient and in the apex, anterolateral and inferior apical segments of the second patient. In both cases, volumes of the target structures were comparable. Interrogation of the implanted ICD at follow-up visits throughout 6 months after the treatment revealed no VT episodes in the first patient and sudden periprocedural increase in VT burden with a subsequent gradual decrease of ventricular arrhythmia to only two non-sustained episodes at the end of the follow-up period in case of the second patient. A significant reduction in premature ventricular contractions burden was observed compared to the pre-treatment period. No noticeable deterioration in LV function was noted, nor any adverse effects of radiosurgery associated with the implanted device.ConclusionThe early response to STAR can be unpredictable and probably does not reflect the final outcome of irradiation. Close monitoring of patients, especially in the early period after irradiation is crucial to properly handle potentially harmful early reactions to STAR.

Typhoon and agricultural production portfolioEmpirical evidence for a developing economy

This paper investigates whether and how households adjust their agricultural practices, such as cultivation and livestock, to adapt to a severe typhoon. We, therefore, make use of a natural experiment coming from Typhoon Ketsana in 2009. We combine micro-data on the household level and spatial data of Ketsana to construct a 4-year panel dataset with 2733 observations. Our empirical results derived from the difference-in-differences approach suggest that households altered their agricultural activities in response to the shock. While they decreased the area planted for staple crops, i.e., rice and cassava, they tended to purchase more livestock, i.e., pigs, in 2011 and 2013 (1.5 and 3.5 years succeeding the typhoon). On average, the decrease in the area planted in 2011 corresponds to 51% of the average area planted of affected households in the pre-treatment period 2008. The increase in the number of purchased pigs in 2011 corresponds to 173% of the average number of pigs bought by treated households in 2008. Our paper indicates the adjustment to the crop-livestock system as a livelihood adaptation strategy to a severe typhoon. The empirical results also support the shifting trend from crop planting to livestock raising in the aftermath of an extreme weather event observed in other developing countries.

Reno-protective Effect Of Mineralocorticoid Receptor Antagonist Esaxerenone

Background The implications of mineralocorticoid receptor antagonists, including a newly-introduced esaxerenone, on renal function remains uncertain. Methods We retrospectively included the patients who received esaxerenone for resistant hypertension between Nov 2019 and Jun 2020. The trends of estimated glomerular filtration ratio (eGFR) were compared between the six-month pre-treatment period (without esaxerenone) and the six-month treatment period (on esaxerenone). Results Twenty-six patients (70 [51, 73] years old, 15 men, systolic blood pressure 146 [139, 156] mmHg) were included and completed 6-month esaxerenone therapy without any adverse events. eGFR decreased significantly during the pre-treatment period (from 66.6 down to 59.5 mL/min/1.73m2, p = 0.003), whereas eGFR remained unchanged during the treatment period (from 59.5 to 61.8 mL/min/1.73m2, p = 0.15; Figure 1A). A median change in eGFR was significantly higher in the treatment period compared to the pre-treatment period (3.8 [-4.2, 6.8] versus -6.1 [-11.1, 1.8] mL/min/1.73m2, p = 0.008; Figure 1B). Conclusions Esaxerenone may have reno-protective effect when administered to treat hypertension. Further studies are needed to understand which patient populations may see greater reno-protective benefits. The implications of mineralocorticoid receptor antagonists, including a newly-introduced esaxerenone, on renal function remains uncertain. We retrospectively included the patients who received esaxerenone for resistant hypertension between Nov 2019 and Jun 2020. The trends of estimated glomerular filtration ratio (eGFR) were compared between the six-month pre-treatment period (without esaxerenone) and the six-month treatment period (on esaxerenone). Twenty-six patients (70 [51, 73] years old, 15 men, systolic blood pressure 146 [139, 156] mmHg) were included and completed 6-month esaxerenone therapy without any adverse events. eGFR decreased significantly during the pre-treatment period (from 66.6 down to 59.5 mL/min/1.73m2, p = 0.003), whereas eGFR remained unchanged during the treatment period (from 59.5 to 61.8 mL/min/1.73m2, p = 0.15; Figure 1A). A median change in eGFR was significantly higher in the treatment period compared to the pre-treatment period (3.8 [-4.2, 6.8] versus -6.1 [-11.1, 1.8] mL/min/1.73m2, p = 0.008; Figure 1B). Esaxerenone may have reno-protective effect when administered to treat hypertension. Further studies are needed to understand which patient populations may see greater reno-protective benefits.