Proactive Treatment Research Articles

Vitamin D Deficiency in Chronic Childhood Disorders: Importance of Screening and Prevention.

Vitamin D plays a vital role in regulating calcium and phosphate metabolism and maintaining bone health. A state of prolonged or profound vitamin D deficiency (VDD) can result in rickets in children and osteomalacia in children and adults. Recent studies have demonstrated the pleiotropic action of vitamin D and identified its effects on multiple biological processes in addition to bone health. VDD is more prevalent in chronic childhood conditions such as long-standing systemic illnesses affecting the renal, liver, gastrointestinal, skin, neurologic and musculoskeletal systems. VDD superimposed on the underlying disease process and treatments that can adversely affect bone turnover can all add to the disease burden in these groups of children. The current review outlines the causes and mechanisms underlying poor bone health in certain groups of children and young people with chronic diseases with an emphasis on the proactive screening and treatment of VDD.

Decision-making and challenges within the evolving treatment algorithm in spinal muscular atrophy: a clinical perspective

ABSTRACT Introduction The clinical application of disease modifying therapies has dramatically changed the paradigm of the management of people with spinal muscular atrophy (SMA), from sole reliance on symptomatic care directed toward the downstream consequences of muscle weakness, to proactive intervention and even preventative care. Areas covered In this perspective, the authors evaluate the contemporary therapeutic landscape of SMA and discuss the evolution of novel phenotypes and the treatment algorithm, including the key factors that define individual treatment choice and treatment response. The benefits achieved by early diagnosis and treatment through newborn screening are highlighted, alongside an appraisal of emerging prognostic methods and classification frameworks to inform clinicians, patients, and families about disease course, manage expectations, and improve care planning. A future perspective of unmet needs and challenges is provided, emphasizing the key role of research. Expert opinion SMN-augmenting therapies have improved health outcomes for people with SMA and powered the practice of personalized medicine. Within this new proactive diagnostic and treatment paradigm, new phenotypes and different disease trajectories are emerging. Ongoing collaborative research efforts to understand the biology of SMA and define optimal response are critical to refining future approaches.

Optimización del manejo de la degeneración macular asociada a la edad neovascular en España: evolución hacia modelos proactivos de tratamiento

Introduction and objectiveHealthcare resources optimization is crucial to assume the growing demand of neovascular age-related macular degeneration (nAMD). This work provides guidelines and support so that each hospital can lead its change management. MethodsThe OPTIMUS project (n=10 hospitals) was based on face-to-face interviews with the key staff of the ophthalmology services, and alignment with the main responsible for each centre (nominal group) to identify potential needs for improving nAMD. The OPTIMUS nominal group was expanded to 12 centres (eVOLUTION). Through different remote work sessions, different guides and tools were defined and developed to implement proactive treatment strategies, one-step treatment administration and potential for remote visits (eConsult) in nAMD. ResultsThe information collected from the OPTIMUS interviews and working groups (n=10 centres) defined roadmaps to promote the development of protocols and proactive treatment strategies, including healthcare workload optimization and one-stop treatment administration in nAMD. With eVOLUTION, processes and tools were developed to promote eConsult: (i) healthcare burden calculator; (ii) definition of potential patients for telematic management; (iii) definition of nAMD management archetypes; (iv) definition of processes for implementation of eConsult by archetype; and (v) key performance indicators for changing evaluation. ConclusionsManaging change is an internal task that requires an adequate diagnosis of processes and feasible implementation roadmaps. OPTIMUS and eVOLUTION provide the basic tools for an autonomous advance of hospitals in the optimization of AMD management, with the available resources.

Comparison of proactive and conventional treatment of anastomotic leakage in rectal cancer surgery: a multicentre retrospective cohort series

PurposeComparative studies on efficacy of treatment strategies for anastomotic leakage (AL) after low anterior resection (LAR) are almost non-existent. This study aimed to compare different proactive and conservative treatment approaches for AL after LAR.MethodsThis retrospective cohort study included all patients with AL after LAR in three university hospitals. Different treatment approaches were compared, including a pairwise comparison of conventional treatment and endoscopic vacuum-assisted surgical closure (EVASC). Primary outcomes were healed and functional anastomosis rates at end of follow-up.ResultsOverall, 103 patients were included, of which 59 underwent conventional treatment and 23 EVASC. Median number of reinterventions was 1 after conventional treatment, compared to 7 after EVASC (p < 0.01). Median follow-up was 39 and 25 months, respectively. Healed anastomosis rate was 61% after conventional treatment, compared to 78% after EVASC (p = 0.139). Functional anastomosis rate was higher after EVASC, compared to conventional treatment (78% vs. 54%, p = 0.045). Early initiation of EVASC in the first week after primary surgery resulted in better functional anastomosis rate compared to later initiation (100% vs. 55%, p = 0.008).ConclusionProactive treatment of AL consisting of EVASC resulted in improved healed and functional anastomosis rates for AL after LAR for rectal cancer, compared to conventional treatment. If EVASC was initiated within the first week after index surgery, a 100% functional anastomosis rate was achievable.

Alternative clinical approaches to the treatment of pruritus related with canine atopic dermatitis

Canine atopic dermatitis (CAD) is a genetically inheritable, inflammatory and pruritic skin disease with characteristic clinical features, most commonly associated with IgE antibodies to environmental allergens. Itching is the most prominent clinical finding. Depending on the allergens involved, seasonal or non-seasonal pruritus may occur. &#x0D; In the first active phase of pruritus treatment, which consists of two stages, acute exacerbations should be controlled by drugs with active ingredients such as corticosteroids, oclacitinib, lokivetmab, etc. In the proactive pruritus treatment, it is aimed to prevent exacerbations and prolong the pruritus-free period with maintenance treatment. For this purpose, in addition to active phase of the therapy, different treatment options such as cyclosporine, tacrolimus, antihistamines, essential fatty acids, Palmitoylethanolamide (PEA), topical drugs and shampoos can be used to repair the skin barrier.&#x0D; Due to the side effects and costs of the drugs used in the treatment of pruritus in atopic dermatitis, researches on alternative treatment methods are still continuing. Applications such as mesenchymal stem cell therapy, recombinant canine gamma-interferon, luteolin, vitamin D, vitamin E, lactoferricin/verbascoside, mastinib, cannabidiol (CBD), probiotics and vaccination against IL-31 are the alternative treatment options for atopic dermatitis in dogs. However, more studies are needed before their inclusion in our routine clinical practices and added to the guidelines. In this review, it is aimed to provide information about new treatments used for pruritus in CAD and to encourage their use in routine veterinary clinical practice.

SPINAL MUSCULAR ATROPHY CLINICAL FEATURES, CLASSIFICATION, NATURAL HISTORY, GENETICS, DIAGNOSIS, COMPLICATIONS AND TREATMENT OF THE DISEASE

Introduction: Spinal muscular atrophy (SMA) is a complex neuromuscular disorder, it is the most usual autosomal recessively inherited lethal neuromuscular disease in pediatrics, it presents a defective alteration in the survival motor neuron 1 (SMN1) gene. Spinal muscular atrophy clinically shows progressive weakness of skeletal and respiratory muscles. In recent years, drugs with encouraging results from phase II and III clinical trials have been presented. Objective: to detail current information related to spinal muscular atrophy, clinical features, classification, natural history, genetics, diagnosis, complications and treatment of the disease. Methodology: a total of 40 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 31 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: spinal muscular atrophy, Spinal Muscular Atrophy, spinal muscular atrophy and spinal muscular atrophy. Results: About 95 % of the occurrences of spinal muscular atrophy are generated by homozygous deletions. Individuals with 5q mutation make up 95% of cases of spinal muscular atrophy and the remaining 5% are generated by mutations in 5q1-5. Targeted treatments may prevent or delay the progression of some symptoms of spinal muscular atrophy. Conclusions: Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disease characterized by muscle atrophy and weakness resulting from irreversible loss and progressive degeneration of the brainstem nuclei and anterior horn cells in the spinal cord (lower motor neurons). Clinically it presents with symmetrical proximal limb weakness that also impacts the axial muscles, intercostal and bulbar musculature and is progressive, and the classification protocol is important in genetics, as well as providing prognostic and clinical information. The natural history of the disease is variable and complicated. It is made by demonstrating a history of proximal muscle weakness, motor difficulties or regression, diminished or absent deep tendon reflexes. Among the most frequent complications in unsupported individuals are those previously mentioned such as poor weight gain with growth retardation, scoliosis, restrictive lung disease, joint contractures and sleep difficulties. In terms of treatment, several different compounds have been investigated in recent years, focused on increasing muscle strength and function. Proactive supportive treatment involving a multidisciplinary team is paramount to decrease the severity of symptoms. KEY WORDS: muscle atrophy, spine, spinal, spinal cord, motor neuron.

Digital technology for early identification of exacerbations in people with cystic fibrosis.

Cystic fibrosis (CF) is a life-limiting genetic condition affecting various organ systems including the gastrointestinal tract, endocrine system and especially the respiratory tract. Pulmonary exacerbations in CF result in increased symptoms, an acceleration in the rate of lung decline and an increased need for treatment. Early detection of infections or clinical worsening provides an opportunity for proactive treatment that may affect clinical outcomes. To evaluate whether digital technology can effectively predict pulmonary exacerbations to allow earlier intervention and improved health outcomes without increasing the burden of treatment in people with CF. We used standard, extensive Cochrane search methods. We searched the Cochrane Cystic Fibrosis Trials Register and the reference lists of relevant articles and reviews on 13 October 2022. We searched Embase and the clinical trial registries on 3 January 2023. We included randomised controlled trials (RCTs) or quasi-RCTs in people with CF looking at whether digital technology can effectively predict pulmonary exacerbations to allow earlier intervention and improved health outcomes without increasing the burden of treatment. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were 1. pulmonary exacerbations and 2. quality of life (QoL). Our secondary outcomes were 3. lung function, 4. hospitalisations, 5. intravenous (IV) antibiotics, 6. microbiology, 7. cost-effectiveness and 8. We used GRADE to assess certainty of evidence. We included three studies (415 participants) in people with CF aged 15 to 41 years over a 12-month period. One was a multicentre RCT, whilst two were single-centre RCTs. The three studies were mostly similar in their risk of bias, having low or unclear risk of selection bias but a high risk of detection bias, due to the unblinded design of these studies. The studies used a variety of digital technologies to monitor symptoms such as a digital symptom diary either with or without home spirometry monitoring. As the trials only included adults and older children, we are not certain that the results would apply to younger children. One of our primary outcomes was to assess time to detection of pulmonary exacerbation and number of pulmonary exacerbations identified between the intervention and routine care groups. We were largely unable to pool results in a meta-analysis due to the variety of methodologies and ways of reporting data. Two studies noted a shorter time to detection of exacerbations in the intervention group and one of these also reported that the intervention group had a shorter time to first exacerbation (hazard ratio for time to first exacerbation 1.45, 95% confidence interval (CI) 1.09 to 1.93), whilst a further study reported a shorter time to detection of exacerbations in the intervention group requiring oral or IV antibiotics compared to the control group (median: 70 (interquartile range (IQR) 123) days with intervention versus 141 (IQR 140) days with control; P = 0.02). However, all three studies were concordant in finding no probable effect on spirometry in the intervention groups when compared with their routine care groups over a 12-month period. We found that there is probably no difference between groups with regard to QoL scores across most domains except for Weight and Body Image, which favoured the usual care group. There is also probably no difference in the number of days of additional IV antibiotics needed or newly detected pathogens. No studies reported serious adverse events directly linked to the intervention and one study reported their smartphone application was generally well received. Pulmonary exacerbations are universally accepted to be detrimental to progression of CF-related lung disease, therefore, it is intuitive that early detection and intervention would help to improve outcomes. Digital technology provides an opportunity to detect physiological and symptomatic changes to identify exacerbations early. Our review found that digital technologies based on recording physiological change (spirometry) and symptoms probably allow earlier identification of exacerbations as a group. However, this may not reduce the number of exacerbations warranting IV antibiotics and there is probably no effect on lung function. This may be partly due to inconsistent definitions of pulmonary exacerbations and discrepancy in the management strategies for pulmonary exacerbations. Overall, the intervention may make little or no difference to QoL scores. The adherence to and uptake of digital technologies, especially those which include physiological measurements, are not well sustained and the costs of these need to be balanced against the clinical efficacy.

The promotion of sleep wellness: Resilience as a protective factor.

To evaluate the association between resilience, sleep quality, and health. This cross-sectional study included 190 patients (Mean age = 51, SD = 15.57) recruited from the Johns Hopkins Center for Sleep and Wellness. Patients completed a modified version of the brief resilience scale (BRS) to assess characteristics of resilience and questions to assess aspects of mental health, physical health, sleep quality, and daytime functioning. Participants' average score on the BRS was 4.67 (SD = 1.32, range = 1.17-7), reflecting a high level of resilience. There was a significant gender difference in resilience levels for men (Mean = 5.04, SD = 1.14) and women (Mean = 4.30, SD = 1.38), such that men reported significantly higher levels of resilience compared to women (t (188) = 4.02, p < 0.001) [lower levels of resilience were significantly associated with higher levels of (current) fatigue and tiredness after adjusting for demographic, physical, and mental covariates. In those reporting between one and three mental health symptoms, high levels of resilience minimized the negative influence that these symptoms had on sleep quality. This minimizing effect was no longer evident in those experiencing >3 mental health symptoms, who also reported significantly higher symptoms of fatigue despite their high resilience scores. This study emphasizes how resilience may affect the relationship between mental health and sleep quality in sleep patients. Resilience may further our understanding of the inter-relationships between sleep and the manifestation of physical health symptoms, a relationship that will likely heighten in relevance during personal and global crisis. An awareness of this interaction could be used as a proactive prevention and treatment strategy. In other words, incorporating methods to evaluate resilience in patients with mental illnesses regularly can be useful for predicting the potential manifestation and severity of sleep disturbance. Therefore, strategies that focus on promoting resilience could improve health and wellness.

Saccharomyces cerevisiae surface display of endolysin LysKB317 for control of bacterial contamination in corn ethanol fermentations.

Control of bacterial contamination in bioethanol fermentation facilities has traditionally relied on chemical-based products such as hop acids and use of antibiotics. Recent emphasis on antibiotic stewardship has prompted new research into the development of alternative approaches to microbial remediation strategies. We recently described a recombinant peptidoglycan hydrolase, endolysin LysKB317, which inhibited Limosilactobacillus fermentum strains in corn mash fermentation. Here, Saccharomyces cerevisiae EBY100 was used to anchor recombinant LysKB317 using cell surface display with the a-agglutinin proteins Aga1p-Aga2p. Immunostaining and confocal fluorescence were used for localization of the extracellular interface of the cells. Yeast surface-expressed endolysin demonstrated an 83.8% decrease in bacterial cell counts compared to a 9.5% decrease in control yeast. Recombinant S. cerevisiae expressing LysKB317 used for small-scale corn mash fermentation, when infected with L. fermentum, could proactively control bacterial infection for 72h with at least 1-log fold reduction. Analysis of fermentation products showed improved ethanol concentrations from 3.4% to at least 5.9% compared to the infection-only control and reduced levels of lactic and acetic acid from 34.7mM to 13.8mM and 25.5mM to 18.1mM, respectively. In an optimized yeast surface display system, proactive treatment of bacterial contaminants by endolysin LysKB317 can improve fermentation efficiency in the presence of L. fermentum contamination.

Spectrum of Liver: GI Disorders in Pregnancy.

Pregnant women are affected by gastrointestinal and liver disorders. These may or may not be related to pregnancy. Unrelated conditions are pre-existent or coincidental during pregnancy. Pregnancy may promote symptoms/alter course of new or pre-existing disease resulting in complications only during pregnancy. This in turn can have adverse effect on clinical course affecting mother and fetus. The management remains same but its effect on mother and fetus needs to be kept in mind with pro-active treatment. Severe liver diseases though rare during pregnancy can occasionally be life threatening. Pregnancy after bariatric surgery/liver transplant is possible but with thorough counseling and needs multidisciplinary approach. Endoscopy for GI problems, if required can be carried out by gastroenterologist with special attention. Hence, this article, for quick reference to tackle GI and liver disorders in pregnancy.

Intestinal Permeability Targeted Rectal Enema Nutraceutical Intervention in Dogs with Cutaneous Adverse Food Reactions: Gut-Brain-Skin Axis Directed Pro-active Treatment

Intestinal Permeability Targeted Rectal Enema Nutraceutical Intervention in Dogs with Cutaneous Adverse Food Reactions: Gut-Brain-Skin Axis Directed Pro-active Treatment

Impact of additional genetic abnormalities at diagnosis of chronic myeloid leukemia for first-line imatinib-treated patients receiving proactive treatment intervention.

The BCR::ABL1 gene fusion initiates chronic myeloid leukemia (CML); however, evidence has accumulated from studies of highly selected cohorts that variants in other cancer-related genes are associated with treatment failure. Nevertheless, the true incidence and impact of additional genetic abnormalities (AGA) at diagnosis of chronic phase (CP)-CML is unknown. We sought to determine whether AGA at diagnosis in a consecutive imatinib-treated cohort of 210 patients enrolled in the TIDEL-II trial influenced outcome despite a highly proactive treatment intervention strategy. Survival outcomes including overall survival, progression-free survival, failure-free survival, and BCR::ABL1 kinase domain mutation acquisition were evaluated. Molecular outcomes were measured at a central laboratory and included major molecular response (MMR, BCR::ABL1 ≤0.1%IS), MR4 (BCR::ABL1 ≤0.01%IS), and MR4.5 (BCR::ABL1 ≤0.0032%IS). AGA included variants in known cancer genes and novel rearrangements involving the formation of the Philadelphia chromosome. Clinical outcomes and molecular response were assessed based on the patient's genetic profile and other baseline factors. AGA were identified in 31% of patients. Potentially pathogenic variants in cancer-related genes were detected in 16% of patients at diagnosis (including gene fusions and deletions) and structural rearrangements involving the Philadelphia chromosome (Ph-associated rearrangements) were detected in 18%. Multivariable analysis demonstrated that the combined genetic abnormalities plus the EUTOS long-term survival clinical risk score were independent predictors of lower molecular response rates and higher treatment failure. Despite a highly proactive treatment intervention strategy, first-line imatinib-treated patients with AGA had poorer response rates. These data provide evidence for the incorporation of genomically-based risk assessment for CML.

Enhanced early skin treatment for atopic dermatitis in infants reduces food allergy

Early-onset atopic dermatitis is a strong risk factor for food allergy, suggesting that early effective treatment may prevent transcutaneous sensitization. This study tested whether enhanced treatment of atopic dermatitis to clinically affected and unaffected skin is more effective in preventing hen's egg allergy than reactive treatment to clinically affected skin only. This was a multicenter, parallel-group, open-label, assessor-blind, randomized controlled trial (PACI [Prevention of Allergy via Cutaneous Intervention] study). This study enrolled infants 7-13 weeks old with atopic dermatitis and randomly assigned infants in a 1:1 ratio to enhanced early skin treatment or conventional reactive treatment using topical corticosteroids (TCSs). The primary outcome was the proportion of immediate hen's egg allergy confirmed by oral food challenge at 28 weeks of age. This study enrolled 650 infants and analyzed 640 infants (enhanced [n= 318] or conventional [n= 322] treatment). Enhanced treatment significantly reduced hen's egg allergy compared with the conventional treatment (31.4% vs 41.9%, P= .0028; risk difference: -10.5%, upper bound of a 1-sided CI: -3.0%), while it lowered body weight (mean difference: -422 g, 95% CI: -553 to -292 g) and height (mean difference: -0.8 cm, 95% CI: -1.22 to -0.33 cm) at 28 weeks of age. This study highlighted the potential of well-controlled atopic dermatitis management as a component of a hen's egg allergy prevention strategy. The enhanced treatment protocol of this trial should be modified before it can be considered as an approach to prevent hen's egg allergy in daily practice to avoid the adverse effects of TCSs. After remission induction by TCSs, maintenance therapy with lower potency TCSs or other topical therapies might be considered as alternative proactive treatments to overcome the safety concerns of TCSs.

Machine learning-based prediction of intraoperative hypoxemia for pediatric patients.

Reducing the duration of intraoperative hypoxemia in pediatric patients by means of rapid detection and early intervention is considered crucial by clinicians. We aimed to develop and validate a machine learning model that can predict intraoperative hypoxemia events 1 min ahead in children undergoing general anesthesia. This retrospective study used prospectively collected intraoperative vital signs and parameters from the anesthesia ventilator machine extracted every 2 s in pediatric patients undergoing surgery under general anesthesia between January 2019 and October 2020 in a tertiary academic hospital. Intraoperative hypoxemia was defined as oxygen saturation <95% at any point during surgery. Three common machine learning techniques were employed to develop models using the training dataset: gradient-boosting machine (GBM), long short-term memory (LSTM), and transformer. The performances of the models were compared using the area under the receiver operating characteristics curve using randomly assigned internal testing dataset. We also validated the developed models using temporal holdout dataset. Pediatric patient surgery cases between November 2020 and January 2021 were used. The performances of the models were compared using the area under the receiver operating characteristic curve (AUROC). In total, 1,540 (11.73%) patients with intraoperative hypoxemia out of 13,130 patients' records with 2,367 episodes were included for developing the model dataset. After model development, 200 (13.25%) of the 1,510 patients' records with 289 episodes were used for holdout validation. Among the models developed, the GBM had the highest AUROC of 0.904 (95% confidence interval [CI] 0.902 to 0.906), which was significantly higher than that of the LSTM (0.843, 95% CI 0.840 to 0.846 P < .001) and the transformer model (0.885, 95% CI, 0.882-0.887, P < .001). In holdout validation, GBM also demonstrated best performance with an AUROC of 0.939 (95% CI 0.936 to 0.941) which was better than LSTM (0.904, 95% CI 0.900 to 0.907, P < .001) and the transformer model (0.929, 95% CI 0.926 to 0.932, P < .001). Machine learning models can be used to predict upcoming intraoperative hypoxemia in real-time based on the biosignals acquired by patient monitors, which can be useful for clinicians for prediction and proactive treatment of hypoxemia in an intraoperative setting.

Spinal Versus General Anesthesia for Cesarean Delivery in Pregnant Women With Moyamoya Disease: A Retrospective Observational Study

(Anesth Analg. 2022;135:617–624) Moyamoya disease (MMD), a rare cerebrovascular disease causing the vascular network at the brain’s base to be fragile, requiring careful blood pressure control and proactive medical treatment to prevent life-threatening hemorrhage and/or ischemic events. The exact risks pregnancy, labor, and delivery for MMD patients is unknown. The aim of this study was to determine if the choice of spinal anesthesia versus general anesthesia would have a significant effect on the intraoperative mean arterial pressure in MMP patients undergoing cesarean section.

A Systematic Review of IoT Integration on Health Monitoring System

The Internet of Things (IoT) has had a significant impact on many fields, including the healthcare industry. It has, in particular, resulted in the development of devices that can collect and transmit data, allowing for better patient monitoring. IoT has enabled remote patient monitoring and telemedicine, which has significantly improved care. IoT wearable devices can collect and transmit data on patients' blood pressure, heart rates, and blood glucose levels. IoT could also help monitor hand hygiene compliance and track patients' moods and depression. Significantly, monitoring the symptoms of Parkinson's disease patients via IoT aids in disease management. These IoT applications have had significant implications in healthcare. IoT applications reduce healthcare costs while also improving treatment. The diagnosis becomes timely, allowing timely interventions to be implemented. IoT also enables proactive treatment and ensures the effective use and management of drug-related equipment. The main challenges are data security and the high initial implementation cost. In general, implementing IoT has had an impact on care delivery and resulted in better patient outcomes. Keywords— Internet of Things, patient monitoring, heart rates, blood glucose, Parkinson's disease

Real-World Outcomes of Ranibizumab Treatment in French Patients with Visual Impairment due to Macular Edema Secondary to Retinal Vein Occlusion: 24-Month Results from the BOREAL-RVO Study

Introduction: Information about real-world ranibizumab use is needed to optimize treatment of macular edema secondary to retinal vein occlusion (RVO). The BOREAL-RVO study assessed treatment use, effectiveness, and safety of 24-month treatment with ranibizumab 0.5 mg in patients with visual impairment due to macular edema secondary to RVO in a real-world setting. Methods: This was a multicenter, post-authorization, observational study in France, including patients starting ranibizumab for RVO. Primary endpoint was mean change from baseline in best-corrected visual acuity (BCVA) at month 6. Secondary endpoints were mean changes from baseline in BCVA at month 24 and central retinal thickness (CRT) at months 6 and 24, and treatment use in real-world setting. Results: 226 branch RVO (BRVO) and 196 central RVO (CRVO) patients were enrolled; 71.7% and 70.9% completed the 24-month follow-up, respectively. In BRVO, mean (SD) baseline BCVA was 55.2 (18.7) letters, with gains of 14.3 (13.7), 14.1 (16.5), 13.0 (17.5), and 11.4 (20.1) letters at months 3, 6, 12, and 24, respectively. In CRVO, mean (SD) baseline BCVA was 40.4 (25.6) letters, with gains of 16.0 (21.2), 9.5 (25.4), 9.2 (27.7), and 8.3 (23.8) letters at months 3, 6, 12, and 24, respectively. At month 24, 52% of BRVO and 41% of CRVO patients had gains of 15 or more letters. In BRVO, mean (SD) CRT values at baseline and months 3, 6, 12, and 24 were 550 (175), 315 (104), 343 (122), 335 (137), and 340 (105) μm. In CRVO, mean (SD) CRT values at baseline and months 3, 6, 12, and 24 were 643 (217), 327 (152), 400 (203), 379 (175), and 348 (161) μm. On average, BRVO patients had 3.8 injections for 6.9 visits by month 6, and 7.2 injections for 19.7 visits by month 24. CRVO patients had 2.7 injections for 4.2 visits by month 6 and 7.1 injections for 21.1 visits by month 24. Factors predictive of better BCVA gain at month 6 were age under 60 at baseline, lower baseline BCVA and BCVA gain at month 3. There were no new safety findings. Conclusion: Major improvements in BCVA and CRT were observed at month 3 after the induction phase and then were sustained up to month 24, with a slight decrease, probably due to under-treatment. This study demonstrated ranibizumab to be a safe and effective treatment for BRVO and CRVO in the real-world setting, although more regular or proactive treatment could further improve outcomes.

DCNNBT: A NOVEL DEEP CONVOLUTION NEURAL NETWORK-BASED BRAIN TUMOR CLASSIFICATION MODEL

An early brain tumor diagnosis is crucial for effective and proactive treatment, which improves the patient’s survival rate. In this paper, we propose a novel Deep Convolutional Neural Network for Brain Tumor (DCNNBT), which detects and classifies brain tumors. The key differentiators of this paper are dimension scaling for image resolution, depth of layers, and width of channels with rigorous optimization of the hyperparameters. DCNNBT classifies and detects four types of brain tumors: benign, pituitary, glioma, and meningioma based on axial, coronal, and sagittal–coronal views. The DCNNBT was developed and tested on two public MRI datasets with more than 403,064 images containing four modalities for 872 patients. The performance of DCNNBT was evaluated against six well-established pre-trained deep learning (DL) models, including SE-ResNet-101, SE-ResNet-152, SENet-154, ResNet152V2, EfficientNetB0, and EfficientNetB5, through transfer learning. In the comparison, DCNNBT showed high accuracy of 99.18% for brain tumor classification, significantly higher than the other studies based on the same database.

An update on clinical trials for chemoprevention of human skin cancer.

The pathophysiology of skin cancer is complex, with multiple factors contributing to its development. The proactive treatment of skin cancer has been investigated in the form of chemoprevention of cutaneous malignancies in clinical trials. Chemoprevention is the use of natural or pharmacologic agents that prevent or reverse skin cancer development. Multiple trials have arisen over the past decades to explore the efficacy of specific agents to halt the progression of UV radiation damage. This comprehensive review article aims to assess clinical trials performed with chemopreventive agents for melanoma and nonmelanoma skin cancers. The following compounds were most often used in these trials: nicotinamide, retinoids, polyphenolic antioxidants, COX-2 selective inhibitors, non-steroidal anti-inflammatory drugs, difluoromethylornithine, and 5-fluorouracil. Many agents show promise in their ability to prevent nonmelanoma skin cancer formation, with few melanoma trials demonstrating efficacy. The chemoprevention efforts aimed at skin cancer are complex; current and future trials will be instrumental in identifying therapeutic agents that pose efficacy in halting cancer development and assessing whether long-term administration is tolerable.

Neurodevelopmental outcomes of preterm infants.

During the last several decades, the number of preterm infants has increased, and their survival rate has improved owing to advances in perinatal care. As more preterm infants survive, many studies examine their neurodevelopmental outcomes. This study aimed to summarize the neurodevelopmental outcomes of preterm infants according to gestational age at birth using a recently published meta-analysis. The prevalence of neurodevelopmental impairment and behavioral disorders decreased as gestational age and birth weight increased. Recent studies reported that proactive neonatal treatment of periviable preterm infants (gestational age, 22-24 weeks) could improve their prognosis. Moderate and late preterm infants reportedly have less severe disease than very preterm infants; nonetheless, they still experience adverse neurodevelopmental outcomes compared to term infants. Neonatal morbidities such as bronchopulmonary dysplasia and retinopathy of prematurity are associated with poor neurodevelopmental outcomes. Despite improvements in neonatal care, prematurity is still associated with poor neurodevelopmental outcomes. To ensure timely intervention, the establishment of a follow-up system for premature infants is necessary.