Recommended Treatment Strategy Research Articles

Surgeon Factors Rather than Patient Factors Account for Variation in Recommended Treatment Strategy for Patients with Multi-ligament Knee Injury

Objectives: To seek the factors associated with timing, staging, and type of surgery in the management of multi-ligament knee injuries. Design: Cross-sectional scenario-based experiment. Setting: 15 fictional patient scenarios with randomized elements. Participants: Fracture surgeons of the Science of Variation Group, an international collaborative of musculoskeletal surgeons that studies variation in care, were invited to participate. Surgeons with limited experience treating multi-ligament knee injuries were asked to self-exclude. Outcome measures and comparisons: Surgeon recommendations for operative treatment, timing of surgery, and use of open surgery in addition to arthroscopy were measured. Patient factors (age, time from injury, contralateral fracture, knee dislocation, combinations of ruptured ligaments, pre-existing osteoarthritis) and surgeon factors (gender, practice location, years of experience, supervision of trainees) associated with surgeon recommendations were assessed. Results: Eighty-five surgeons participated, of which most were men (89%) and practiced in the United States (44%) or Europe (38%). Operative treatment was less likely among older patients (OR=0.051) and pre-existing osteoarthritis (OR=0.32), and more likely in knee dislocation (OR=1.9) and disruption of anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and lateral collateral ligament (LCL) with or without medial collateral ligament (MCL; OR=5.1 and OR=3.1, respectively). Disruption of ACL, PCL, and MCL was associated with shorter time to surgery (β=-11). Longer time to surgery was associated with contralateral fracture (β=9.2), and surgeons supervising trainees (β=23) and practicing in Europe (β=13). Surgeon factors accounted for more variation in timing than patient and injury factors (5.1% vs 1.4%, respectively). Open surgery was more likely in patients with LCL injury (OR=2.9 to 3.3). Conclusion: The observation that surgeons were more likely to operate in younger patients with more severe injury has face validity, while the finding that surgeon factors accounted for more variation in timing of surgery than patient or injury factors suggests that treatment variation is based on opinion more so than evidence. Level of Evidence: Level III. See Instructions for Authors for a complete description of levels of evidence.

Dolichoectatic Posterior Inferior Cerebellar Artery Aneurysm Treated With Excision and Posterior Inferior Cerebellar Artery Double Reimplantation Bypass: 2-Dimensional Operative Video.

Posterior inferior cerebellar artery (PICA) aneurysms account for 0.3% of all intracranial aneurysms, and they commonly present with a complex fusiform morphology that necessitates unique bypass strategies.1-5 An adolescent boy with a familial predisposition to aneurysmal subarachnoid hemorrhage was identified as harboring a fusiform aneurysm of the right distal PICA, characterized by 2 outflow branches. Our recommended treatment strategy involved a right far lateral craniotomy, followed by P1 PICA reanastomosis and P2 PICA reimplantation. Informed written consent was obtained. On exposure, the aneurysm was trapped, and the inflow and 2 outflow PICA branches were excised. Revascularization was established through a P1 PICA end-to-end reanastomosis using running continuous suturing techniques, followed by P2 PICA end-to-side reimplantation into a more distal portion of PICA. Subsequent indocyanine green videoangiography confirmed patency of the P2 PICA reimplantation; however, the initial P1 PICA reanastomosis was noted to be thrombosed. After several unsuccessful attempts to dissolve the thrombus, the decision was made to proceed with a P2 PICA side-to-side in situ reimplantation into the V4 segment of the vertebral artery. Indocyanine green videoangiography and postoperative digital subtraction angiography confirmed patency of the PICA double reimplantation bypass. The patient tolerated the procedure well and was discharged home at his neurological baseline. This video showcases the microsurgical treatment of a complex dolichoectatic, distal PICA aneurysm using a double reimplantation technique, in addition to highlighting bypass decision-making processes for managing complex PICA aneurysms.

Outcomes and Predictors of Rapid Antiretroviral Therapy Initiation for People With Newly Diagnosed HIV in an Integrated Health Care System.

Rapid antiretroviral therapy (ART) is the recommended treatment strategy for patients newly diagnosed with HIV, but the literature supporting this strategy has focused on short-term outcomes. We examined both long-term outcomes and predictors of rapid ART among patients newly diagnosed with HIV within an integrated health care system in Northern California. This observational cohort study included adults newly diagnosed with HIV between January 2015 and December 2020 at Kaiser Permanente Northern California. Rapid ART was defined as ART initiation within 7 days of HIV diagnosis. We collected demographic and clinical data to determine short-term and long-term outcomes, including viral suppression, care retention, medication adherence, and cumulative viral burden. Logistic regression models were used to identify predictors of rapid ART initiation. We enrolled 1409 adults; 34.1% initiated rapid ART. The rapid ART group achieved viral suppression faster (48 vs 77 days; P < .001) and experienced lower cumulative viral burden (log10 viremia copy-years, 3.63 vs 3.82; P < .01) but had slightly reduced medication adherence (74.8% vs 75.2%; P < .01). There was no improvement in long-term viral suppression and care retention in the rapid group during follow-up. Patients were more likely to initiate rapid ART after 2017 and were less likely if they required an interpreter. Patients who received rapid ART had an improved cumulative HIV burden but no long-term improvement in care retention and viral suppression. Our findings suggest that rapid ART should be offered but additional interventions may be needed for patients newly diagnosed with HIV.

Systemic Treatment for Advanced and Metastatic Non-Clear Cell Renal Cell Carcinoma: Examining Modern Therapeutic Strategies for a Notoriously Challenging Malignancy.

Non-clear cell renal cell carcinoma (nccRCC) is a heterogeneous group of malignancies that represents 25% of renal cell carcinoma (RCC) cases. Treatment for non-clear cell histologies is mostly based on evidence from small phase II clinical trials or extrapolated from successful therapies in clear cell RCC because of the low incidence of non-clear cell pathology. Advances in genomic profiling have improved clinicians' understanding of molecular targets for nccRCC, such as altered mesenchymal epithelial transition (MET) gene status and fumarate hydratase (FH) gene inactivation, but patient outcomes remain poor and optimal management of this disease remains unclear. This review assesses outcomes by histologic subtype from 27 prospective and 13 ongoing clinical trials to identify therapeutic strategies for advanced or metastatic nccRCC. Vascular endothelial growth factor tyrosine kinase inhibitors (TKI), such as sunitinib, and mammalian target of rapamycin (mTOR) inhibitors, such as everolimus, have demonstrated efficacy and remain viable treatment options, with a preference for sunitinib. However, everolimus is preferred in patients with chromophobe RCC because folliculin (FLCN) gene mutations upregulate the mTOR pathway. Novel TKIs, such as cabozantinib, show improved outcomes in patients with papillary RCC because of targeted MET inhibition. Platinum-based chemotherapy continues to be the recommended treatment strategy for collecting duct and medullary RCC. Clinically meaningful antitumor activity has been observed across all non-clear cell histologies for immune checkpoint inhibitors, such as nivolumab, pembrolizumab, and ipilimumab. Ongoing trials are evaluating novel tyrosine kinase inhibitor and immunotherapy combination regimens, with an emphasis on the promising MET-inhibitor cabozantinib and pembrolizumab plus lenvatinib.

Clarification of the "pain neuroscience education" concept in the management of patients with persistent low back pain: A scoping review.

Patient education is a recommended treatment strategy for persistent low back pain (PLBP). Pain neuroscience education (PNE) is an emerging concept with boundaries still unclear. To clarify the PNE concept and identify its key characteristics in PLBP management. A systematic search was conducted using the following databases: Pubmed, ScienceDirect, Google Scholar, Cochrane, and Pedro. publications in English or French on pain neuroscience education and chronic low back pain, educational books cited in white literature. Three reviewers independently selected eligible studies for final inclusion. Numerical analysis and narrative synthesis were carried out from the extracted data. From 919 identified publications, 54 were selected. Ten educational resources were added. PNE refers to a theoretical framework, a specific educational intervention, and an overall care approach. It is characterized by the intention to help the patient reconceptualize their PLBP from a tissue injury marker to a protective, neurobiological perspective, and then to increase adherence to biopsychosocial rehabilitation and normalize cognitive-behavioral responses. Pain sciences concepts are presented with an optimization of learning strategies. PNE stands out from other educational and cognitive behavioral approaches through its objective of changing the pain concept.

Intermittent fasting improves hepatic end points in nonalcoholic fatty liver disease: A systematic review and meta-analysis.

Despite NAFLD being the most prevalent liver disease globally, currently there are no FDA-approved treatments, and weight loss through caloric restriction and enhanced physical activity is the recommended treatment strategy. Intermittent fasting (IF) has been proposed as an alternative strategy with additional cardiometabolic benefits. In this systematic review and meta-analysis, we evaluated the anthropometric, biochemical, and hepatic impacts of IF in patients with NAFLD. MEDLINE, EMBASE, Cochrane Central, and conference abstracts were searched for IF interventions in adults with NAFLD until April 2, 2023. Meta-analysis with a random effects model was used to compare pre-intervention and post-intervention changes in anthropometric, biochemical, and hepatic end points in the IF intervention group with the control group. Publication bias was assessed using Egger's test. Fourteen studies were included in the systematic review and ten in the meta-analysis (n = 840 participants, 44.64% male). Studies varied in modalities for NAFLD diagnosis, duration of IF (4-52weeks), and type of IF (5:2 diet, modern alternate-day fasting, time-restricted eating, or religious fasting). Body weight, body mass index, and waist to hip ratio all significantly improved following fasting intervention (p< 0.05). Adults with NAFLD showed an improvement in serum alanine transaminase, aspartate aminotransferase, hepatic steatosis (controlled attenuation parameter measured by vibration-controlled transient elastography), and hepatic stiffness (measured by vibration-controlled transient elastography) after fasting intervention (p < 0.05). There is limited, but moderate- to high-quality evidence to suggest that IF can improve hepatic end points and promote weight loss in adults with NAFLD. Larger randomized controlled studies with extended duration are needed to further validate our findings.

Synergistic Antitumor Effect of Combined Radiotherapy and Engineered Salmonella typhimurium in an Intracranial Sarcoma Mouse Model.

Intracranial sarcoma is an uncommon aggressive cancer with a poor prognosis and a high recurrence rate. Although postoperative adjuvant radiotherapy (RT) is the most recommended treatment strategy, it does not significantly improve survival rates. In this study, we used an attenuated Salmonella typhimurium strain engineered to secrete Vibrio vulnificus flagellin B (SLpFlaB) as an immunotherapy to assist with the antitumor effects of RT on intracranial sarcoma. In vitro, the expression of γH2AX and cleaved caspase-3 was analyzed by Western blot. In vivo detection of SLpFlaB colonization time in tumors was measured using an in vivo imaging system (IVIS). Tumor growth delay and elimination were demonstrated in an intracranial mouse model, and the distribution of macrophages, M1 macrophages, and CD8+ cells after treatment was measured using FACS analysis. Our findings in vitro suggest that combination therapy increases S-180 radiosensitivity, the expression of DNA double-strand breaks, and programmed cell death. In vivo, combination treatment causes intracranial sarcoma to be eliminated without tumor recurrence and redistribution of immune cells in the brain, with data showing the enhanced migration and infiltration of CD8+ T cells and macrophages, and an increased proportion of M1 macrophage polarization. Compared to RT alone, the combination therapy enhanced the radiosensitivity of S-180 cells, promoted the recruitment of immune cells at the tumor site, and prevented tumor recurrence. This combination therapy may provide a new strategy for treating intracranial sarcomas.

MEDICINAL BIOMAGNETISMO IN THE TREATMENT OF PROSTATE CANCER

Prostate cancer (PC) is reported as an important neoplasm worldwide, caused by the uncontrolled multiplication of cells in the prostate. The main risk factors are age over 50 years, family history, genetic susceptibility, hormonal disorders, obesity and environmental factors. Active surveillance of low-risk PC defers aggressive treatment until disease progression and is an increasingly recommended treatment strategy. This strategy aims to reduce costs and decrease treatment-related morbidity without affecting survival. Medicinal Biomagnetism (BM) is based on the distortion of the limit of homeostasis towards hyperacidity and hyperalkalinity of two specific points for each pathogenic microorganism or glandular dysfunction. The induction of loads that are in a vibrational and energetic relationship, by means of medium intensity magnets, greater than 1000 Gauss, corrects or prevents the distortion of the pH of the organs or tissues of the human body. In this way, the neutralization of pathogenic bioenergetic distortions promotes health. The aim of this study was to evaluate the effect of BM in the treatment of prostatic adenocarcinoma, prognostic group 1. After three sessions of BM, the levels of prostate-specific antigen (PSA) decreased and the prostate adenocarcinoma regressed to discrete chronic inflammation. This study represents the first in the evaluation of BM for the treatment of CP and may stimulate further studies in this field that are likely to yield important discoveries.&#x0D;

Refractory Choledocholithiasis Causing Endogenous Endophthalmitis: A Case Report.

BACKGROUND Endogenous bacterial endophthalmitis is caused by a breach of the blood-ocular barrier by pathogens originating from distant infective foci. Here, we report a case of endogenous endophthalmitis due to cholangitis complicated by common bile duct stones, which is a rare source of infection. CASE REPORT A 73-year-old man with type II diabetes mellitus underwent endoscopic choledocholithotripsy 20 years ago and laparoscopic cholecystectomy 18 years ago. He had choledocholith-related cholangitis 6, 5, and 1 years previously and 4 times in the last year and underwent endoscopic choledocholithotripsy each time. Three days after the last surgery, the patient developed right endogenous endophthalmitis and vitrectomy was performed. Four months later, the patient relapsed with cholangitis and required surgery for recurrent endophthalmitis. Roux-en-Y choledochojejunostomy was performed with curative intent, and the patient was followed up for 5 years without recurrence of choledocholith, cholangitis, or endophthalmitis. CONCLUSIONS The recommended treatment strategy for patients diagnosed with common bile duct stones or choledocholithiasis is stone extraction. Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic intervention is a widely accepted procedure. However, in cases of recurrent choledocholithiasis, the rate of recurrence increases and the interval between ERCP becomes shorter in proportion to the number of recurrences. In such intractable cases requiring numerous sessions of endoscopic stone removal, bypass Roux-en-Y choledochojejunostomy should be performed to prevent possible rare complications such as endogenous bacterial endophthalmitis.

Treatment strategy for spontaneous coronary artery dissection based on anatomical characteristics

ObjectivesTo compare the clinical and angiographic characteristics of high-risk and low-risk spontaneous coronary artery dissection (SCAD) patients to determine the optimal treatment strategy.BackgroundSCAD is a rare and emerging cause of acute coronary syndrome and sudden cardiac death, especially in young female patients. However, the indication of percutaneous coronary intervention (PCI) in patients with SCAD remains elusive.MethodsWe evaluated the clinical and angiographic characteristics of all SCAD patients admitted to our center from 2012 to 2020. The outcomes of the high-risk and low-risk SCAD patients according to the location of the lesion segment with dissection or intramural hematoma were compared. Further analyses were performed to evaluate the vessel healing or residual dissection in the patients receiving the follow-up angiography.ResultsA total of 81 SCAD patients were enrolled in the present study, in which 38 patients were categorized as high-risk group, defined as involvement of the left main artery or proximal segment of any main coronary artery. PCI was the more common treatment approach in the high-risk group (68.4%), while conservative treatment was more common in the low-risk group (62.8%). The incidence of major adverse cardiac events, defined as cardiac death, myocardial infarction, unstable angina pectoris, severe arrhythmias, or heat failure, within 1 year follow-up was similar between the two groups. 57 patients (70.4%) received the follow-up angiography after 1 year. The high- and low-risk groups had a similar rate of vessel healing among the PCI treatment patients. However, more patients achieved spontaneous healing in the low-risk group than the high-risk group among the conservative treatment patients (86.4% vs. 33.3%, p < 0.05).ConclusionsConservative management remains the recommended treatment strategy for the low-risk SCAD patients. PCI could be considered in high-risk SCAD patients with favorable clinical outcomes and vessel healing. Characterization of lesion anatomy may be an important indicator for treatment decision.

Convenient Decision Criteria for Surgery in Elderly Patients with Oral Squamous Cell Carcinoma.

Elderly patients with oral squamous cell carcinoma (OSCC) have difficulty undergoing curative surgical treatment due to various factors besides age. The purpose of the present study was to study the factors determining surgery in elderly patients with OSCC. We designed and implemented a retrospective cohort study. The study sample included elderly patients aged ≥ 70 years with OSCC and they were statistically compared between the surgery and non-surgery groups. The primary outcome variable was selecting surgery as the treatment plan, while the secondary outcome was the prognosis of each group. The sample comprised 76 patients aged ≥ 70 years with OSCC, of whom 52 treated with surgery and 24 patients treated with non-surgery. As decision factors, performance status (PS), clinical stage, serum Alb level, body mass index (BMI), and Geriatric Nutritional Risk Index (GNRI) were significantly associated with the selection of surgery. Logistic multivariate analysis identified three independent predictive factors for selecting surgery: Alb (≥3.5 vs. &lt;3.5), PS (0, 1, 2, 3), and clinical stage. According to the decision tree analysis, curative surgery is the recommended treatment strategy for elderly patients with Alb ≥ 3.5 g/dL, PS 0, and stage I, II. In conclusion, Alb, PS, and clinical stage may be the criteria for selecting surgery in elderly patients.

Systemic therapy‐based split‐course stereotactic body radiation therapy

AbstractPurposeGiven the therapeutic toxicity of concurrent chemoradiotherapy, the dose of chemotherapy is always limited. Hence, the question of how to administer adequate chemotherapy to synchronize stereotactic body radiation therapy (SBRT) treatment strategy for maximizing the benefits of neoadjuvant therapy to improve prognosis is a challenging and debatable issue.MethodsWe summarized the major clinical trials and preclinical studies of split‐course CRT and split‐course SBRT and explored the feasibility and theoretical advantages of implementing split‐course SBRT and systemic therapy simultaneously.ResultsSplit‐course radiotherapy is a strategy mainly proposed with the aim of further reducing the toxicity of radiotherapy and improving the patient's treatment tolerance, with added features of the extended interval between the fractions instead of daily irradiation. In the past, split‐course radiotherapy was not a recommended treatment strategy in terms of local tumor control rates, late response rates, and survival without significant improvement relative to continuous radiotherapy. Split‐course SBRT has different biological effects compared to split‐course conventional radiotherapy (CRT). The current findings suggest that the split‐course SBRT model has good treatment tolerance and facilitates the implementation of adaptive radiotherapy.ConclusionThis treatment strategy facilitates the upgrading of radiotherapy doses and the combination with systemic therapy, especially with vascular targeting agents and immunotherapy, thus avoiding the disadvantages of split‐course CRT, such as reduced local control rate, increased treatment time and economic cost, and has the potential to achieve better tumor suppression.

Survey of confidence and knowledge to manage patellofemoral pain in readers versus nonreaders of the physical therapy clinical practice guideline

ObjectivesTo compare beliefs of physical therapists (PTs) who read the clinical practice guideline (CPG) for the management of individuals with patellofemoral pain (PFP) to those who have not read the CPG. DesignCross-sectional study. SettingOnline survey. Participants494 currently licensed/registered PTs or physiotherapists. Main outcome measuresRespondents answered Likert-based or open-ended questions regarding the diagnosis, prognosis, risk factors, and management of individuals with PFP, as well as confidence for managing individuals with PFP, especially the ability to identify beneficial and non-beneficial interventions. We dichotomized responses into participants who read (READERS) and did not read (NonREADERS) the CPG. ResultsMost respondents held inaccurate beliefs about risk factors and prognosis; however, READERS’ beliefs better aligned with the CPG than NonREADERS (P < 0.01). Most respondents correctly agreed that hip and knee exercise was the recommended treatment strategy; yet NonREADERS believed in implementing unsupported passive treatments (P < 0.01). READERS reported greater confidence in managing individuals with PFP, delivering evidence-based interventions, identifying less beneficial treatments, and locating evidence-based resources than NonREADERS (P < 0.01). ConclusionWhile READERS and NonREADERS held accurate beliefs for exercise-based treatment for PFP, greater knowledge translation is needed to counter inaccurate beliefs regarding risk factors, prognostic factors, and passive treatments.

Prospective evaluation of a clinical decision support system in psychological therapy.

Thus far, most applications in precision mental health have not been evaluated prospectively. This article presents the results of a prospective randomized-controlled trial investigating the effects of a digital decision support and feedback system, which includes two components of patient-specific recommendations: (a) a clinical strategy recommendation and (b) adaptive recommendations for patients at risk for treatment failure. Therapist-patient dyads (N = 538) in a cognitive behavioral therapy outpatient clinic were randomized to either having access to a decision support system (intervention group; n = 335) or not (treatment as usual; n = 203). First, treatment strategy recommendations (problem-solving, motivation-oriented, or a mix of both strategies) for the first 10 sessions were evaluated. Second, the effect of psychometric feedback enhanced with clinical problem-solving tools on treatment outcome was investigated. The prospective evaluation showed a differential effect size of about 0.3 when therapists followed the recommended treatment strategy in the first 10 sessions. Moreover, the linear mixed models revealed therapist symptom awareness and therapist attitude and confidence as significant predictors of an outcome as well as therapist-rated usefulness of feedback as a significant moderator of the feedback-outcome and the not on track-outcome associations. However, no main effects were found for feedback. The results demonstrate the importance of prospective studies and the high-quality implementation of digital decision support tools in clinical practice. Therapists seem to be able to learn from such systems and incorporate them into their clinical practice to enhance patient outcomes, but only when implementation is successful. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Non-parametric hypothesis testing to model some cancers based on goodness of fit

&lt;abstract&gt; &lt;p&gt;By observing the failure behavior of the recorded survival data, we aim to compare the different processing approaches or the effectiveness of the devices or systems applied in this non-parametric statistical test. We'll apply the proposed strategy of used better than aged in Laplace (UBAL) transform order, which assumes that the data used in the test will either behave as UBAL Property or exponential behavior. If the survival data is UBAL, it means that the suggested treatment strategy is effective, whereas if the data is exponential, the recommended treatment strategy has no negative or positive effect on patients, as indicated in the application section. To guarantee the test's validity, we calculated the suggested test's power in both censored and uncensored data, as well as its efficiency, compared the results to other tests, and then applied the test to a variety of real data.&lt;/p&gt; &lt;/abstract&gt;

Dapagliflozin — a key pawn on the new guidelines chessboard

Treatment of patients with heart failure and reduced left ventricular ejection fraction (HFrEF) aims to reduce mortality, prevent rehospitalizations due to heart failure (HF) exacerbation, and improve the clinical status, functional capacity, and quality of life. All these goals were achieved in the DAPA-HF trial. In this trial, the reduction in the primary outcome, defined as a composite of worsening of HF or cardiovascular death, was achieved in patients receiving dapagliflozin [hazard ratio (HR) 0.74; 95% confidence interval (CI) 0.65–0.85; p &lt; 0.001) as compared with placebo. In addition, the beneficial effect of dapagliflozin on the primary outcome was generally consistent across prespecified subgroups regardless of baseline treatment, diagnosis of diabetes, or left ventricular ejection fraction (LVEF). Data from multiple countries was obtained in the CVD-REAL study. The use of different sodium-glucose co-transporter 2 (SGLT2) inhibitors, versus other glucose-lowering drugs, was associated with lower rates of hospitalization for HF (HR 0.61; 95% CI 0.51–0.73; p &lt; 0.001) and death (HR 0.49; 95% CI 0.41–0.57; p &lt; 0.001). These findings were confirmed in the CVD-REAL-2 study. The exceptional clinical benefits of SGLT2 inhibitors applied on top of the previously guideline recommended treatment in patients with chronic HFrEF led to fundamental changes in the recommended treatment strategy proposed in the 2016 European Society of Cardiology (ESC) guidelines for the diagnosis and treatment of acute and chronic HF. To conclude, the new treatment algorithm for HFrEF is based on the findings of many groundbreaking trials. However, it is the results of trials with SGLT2 inhibitors, applied in patients with HFrEF on top of the optimal treatment including an implantable cardioverter-defibrillator and/or cardiac resynchronization therapy, that have fundamentally changed the strategy of treatment.

COMPARATIVE THEORETICAL ANALYSIS ON RESPIRATORY TRACT INFECTION CAUSED BY DIFFERENT MICROORGANISMS WITH REFERENCE TO COVID-19

Respiratory Tract Infection (RTI) may be caused by different microorganisms and resulting deadly diseases such as novel coronavirus (Covid-19), severe acute respiratory syndrome (SARS), Middle East Respiratory Syndrome (MERS), influenza and other viral infection, tuberculosis, pneumonia 8 other Bacterial RTI etc. Till now there is no recommended treatment strategy for COVID-19, as for this no specific pharmacologically proved drug till invented or identified. To identify/find out any new drug to treat particularly Covid-19 demands detailed attention in the characteristics of virus, so that the specific chemical approach in a short time can solve the health problem arouse worldwide. This paper is highlighting the comparative theoretical analysis of RTI caused by different microorganisms for the purpose of designing antiviral drugs to combat Covid-19.

The Clinical Efficacy and Safety of 11 Commonly Used Treatment Strategies Improving Arrhythmia of CHD in China: A Network Meta-Analysis

Purpose: Arrhythmia which as a common complication of CHD, has a high incidence. At present, more and more anti-arrhythmic drugs are used in clinical practice. However, which drug has the best efficacy and high safety is still unknown. Therefore, we decided to use NMA to solve this problem.Method: We searched CNKI, Wanfang database, VIP database, Pubmed, Embase and Cochrane libraries, and collected all RCTs of arrhythmia of CHD, and used RevMan (5.3) and Stata (13.0) to carry out this NMA. The primary outcome indicator of this study is efficiency; the secondary outcome indicator is the incidence of adverse reactions.Result: A total of 134 RCTs, 13,951 patients, and 11 treatment strategies were included in this NMA. The results show that all treatment strategies can effectively improve the arrhythmia of patients. Among them, PMA+AM, AM+AT, AM+WG have higher effective rates, and PMA+AM, WG+ME, SC+ME have better safety. The effectiveness and safety of the treatment strategies which combined TCM and chemical drugs, are significantly better than that of using chemical drugs alone.Conclusion: The treatment strategy of combination of multiple drugs usually has higher efficiency and safety. PMA+AM seems to be the most recommended treatment strategy. In addition, the rational combination of TCM and chemical drugs may provide potential benefit.Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42021229693.

Healthcare Disparities in the Management of Acute Cholecystitis: Impact of Race, Gender, and Socioeconomic Factors on Cholecystectomy vs Percutaneous Cholecystostomy

BackgroundWhile percutaneous cholecystostomy (PC) is a recommended treatment strategy in lieu of cholecystectomy (CCY) for acute cholecystitis among patients who may not be considered good surgical candidates, reports on disparities in treatment utilization remain limited. The aim of this study was to investigate the role of demographic, clinical, and socioeconomic factors in treatment of acute cholecystitis. MethodsPatients with a diagnosis of acute cholecystitis who underwent CCY versus PC were reviewed from the U.S. Nationwide Inpatient Sample (NIS) database between 2008-2014. Measured variables including age, race/ethnicity, Charlson comorbidity index (CCI), hospital type/region, insurance payer, household income, length of stay (LOS), hospital cost, and mortality were compared using chi-square and ANOVA. Multivariable logistic regression was performed to identify specific predictors of cholecystitis treatment. ResultsA total of 1,492,877 patients (CCY:n=1,435,255 versus PC:n=57,622) were analyzed. The majority of patients that received PC were at urban teaching hospitals (65.2%). LOS was significantly longer with higher associated costs for PC [(11.1±11.0 versus 4.5±5.3 days; P<0.001) and ($99577±138850 versus $48399±58330; P<0.001)]. Mortality was also increased for patients that received PC compared to CCY (8.8% versus 0.6%; P<0.001). Multivariable regression demonstrated multiple socioeconomic and healthcare-related factors influencing the utilization of PC including male gender, Black or Asian race/ethnicity, Medicare payer status, urban hospital location, and household income (all P<0.001). ConclusionAlthough patients receiving PC had higher CCI scores, multiple socioeconomic and healthcare related factors appeared to also influence this treatment decision. Additional studies to investigate these disparities are indicated to improve outcomes for all individuals with this condition.

Staging 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Changes Treatment Recommendation in Invasive Bladder Cancer

Given the high risk of systemic relapse following initial therapy for muscle-invasive bladder cancer (MIBC), improved pretreatment staging is needed. We evaluated the incremental value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) after standard conventional staging, in the largest cohort of MIBC patients to date. This is a retrospective analysis of 711 consecutive patients with invasive urothelial bladder cancer who underwent staging contrast-enhanced CT (chest and abdomen) and FDG-PET/CT in a tertiary referral center between 2011 and 2020. We recorded the clinical stage before and after FDG-PET/CT and treatment recommendation based on the stage before and after FDG-PET/CT. Clinical stage changed after FDG-PET/CT in 184/711 (26%) patients. Consequently, the recommended treatment strategy based on imaging changed in 127/711 (18%) patients. In 65/711 (9.1%) patients, potential curative treatment changed to palliative treatment because of the detection of distant metastases by FDG-PET/CT. Fifty (7.0%) patients were selected for neoadjuvant/induction chemotherapy based on FDG-PET/CT. Moreover, FDG-PET/CT detected lesions suspicious for second primary tumors in 15%; a second primary malignancy was confirmed in 28/711 (3.9%), leading to treatment change in ten (1.4%) patients. Contrarily 57/711 (8.1%) had false positive secondary findings. In conclusion, FDG-PET/CT provides important incremental staging information, which potentially influences clinical management in 18% of MIBC patients, but leads to false positive results as well. Patient summaryIn this report, we investigated the impact of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scanning on treatment of bladder cancer patients. We found that FDG-PET/CT potentially influences the treatment of almost one-fifth of patients. We therefore suggest performing FDG-PET/CT as part of bladder cancer staging.