Chemotherapy-free cancer treatment - not for everyone yet.

Childhood-onset systemic lupus erythematosus (cSLE) often presents with aggressive manifestations that may not respond to standard immunosuppressive therapy. We describe two paediatric cSLE cases with severe life-threatening complications-autoimmune hemolytic anemia in one patient and macrophage activation syndrome with acute respiratory distress syndrome in the other-successfully managed with Eculizumab as adjunctive treatment. Both patients demonstrated rapid stabilization after Eculizumab initiation and showed favorable outcomes at their latest follow-up. These cases highlight the potential role of complement inhibition in select cSLE complications and suggest that Eculizumab may serve as a rescue therapy beyond its established use in thrombotic microangiopathy. Further studies are needed to better define its optimal use and target patient population.

End-of-life care decisions for terminal cancer patients remain a clinical and ethical challenge, particularly regarding the use of aggressive interventions. This retrospective observational study aimed to evaluate the impact of different treatment schemes on survival time in terminal cancer patients. A total of 1266 patients were categorized into 4 groups: Group A received mechanical assistance and other rescue measures in the intensive care unit (ICU); Group B received drug rescue with cardiopulmonary resuscitation in the general ward; Group C received drug rescue only; and Group D received no rescue treatment. Overall survival was estimated using Kaplan–Meier analysis, and between-group differences were assessed with stratified log-rank tests. The median survival times were: Group A: 138.0 hours (95% confidence interval [CI]: 109.1–166.8), Group B: 54.5 hours (95% CI: 42.8–66.3), Group C: 60.0 hours (95% CI: 51.7–68.3), and Group D: 60.4 hours (95% CI: 53.9–66.8). Group A showed significantly longer survival than Groups B, C, and D (P < .05), whereas no significant difference was observed among Groups B, C, and D (P > .05). ICU-based resuscitation may provide modest survival benefit for terminal cancer patients, whereas drug-based rescue and cardiopulmonary resuscitation outside the ICU do not appear to extend survival. These findings support individualized, evidence-based decision-making for end-of-life interventions.

Aneurysmal subarachnoid haemorrhage (SAH) is a life-threatening condition with high morbidity. Delayed cerebral ischaemia (DCI) significantly contributes to secondary injury and poor outcomes. While perfusion CT (CTP) aids DCI detection, multimodal neuromonitoring-including brain tissue oxygenation (PtiO2) and cerebral microdialysis-offers superior temporal resolution. Its value in guiding treatment remains underexplored. This prospective cohort study included SAH patients monitored with multimodal neuromonitoring at RWTH Aachen University Hospital (2014-2020). DCI was diagnosed with neuromonitoring abnormalities and confirmed by CTP. First-line treatment involved induced hypertension, with endovascular rescue treatment for refractory cases. Physiological data were time-aligned to treatment onset and aggregated into hourly summaries. Binomial logistic regression identified predictors of favourable 1-year outcome (modified Rankin Scale 0-3). Of 56 patients with confirmed DCI, correctly placed probes and available outcome data, 22 (39.3%) achieved favourable outcome. These patients showed greater post-treatment reductions in pressure reactivity index (PRx) and lactate-to-pyruvate ratio (LPR). In multivariable analysis, greater PRx reduction was significantly associated with favourable outcome (OR 0.023, 95% CI 0.001 to 0.394, p=0.009), translating to a 46.5% increase in odds per 0.1-unit decrease. Greater LPR reductions were also predictive (OR 0.950, 95% CI 0.904 to 0.998, p=0.042), with a 5-unit drop linked to a 29.3% increase in odds. Although PtiO2₂ improved post-treatment, it was not associated with outcome. PRx and LPR reflect meaningful physiological responses to DCI treatment and are associated with 1-year outcomes. Multimodal neuromonitoring may support not only diagnosis but also treatment monitoring and decision-making in unconscious SAH patients. German Clinical Trial Registry (DRKS00030505).

The Bruton tyrosine kinase inhibitor acalabrutinib aborts ongoing acute food-induced anaphylactic reactions in humanized mice.

Anti-CD20 monoclonal antibodies are gaining clinical relevance in the nephrology community due to their demonstrated efficacy and favorable safety profiles across short-, medium-, and long-term use. Initially developed for hematologic malignancies and multiple sclerosis, B-cell depletion therapies are now being investigated across a broader spectrum of autoimmune diseases, including glomerulopathies, both with and without associated podocytopathy. Recent advances have led to the development of novel anti-CD20 agents that are being used not only as potential alternatives to corticosteroids but also as adjunctive therapies in complex clinical settings. However, their efficacy is not uniform across all conditions, whether used for induction therapy, relapse management, or as rescue treatment following first-line therapy failure. A thorough understanding of their mechanisms of action, along with the potential for resistance and therapeutic failure, is essential for advancing precision medicine in this field. This review provides a molecular and clinical overview, incorporating pharmacokinetic and pharmacodynamic insights into the most widely used and emerging anti-CD20 monoclonal antibodies in nephrology. It serves as a practical guide to understand how these agents' function, why they may fail, and what alternative strategies should be considered in cases of adverse reactions or inadequate response. Finally, it highlights their evolving role in precision therapy, both as monotherapy in podocytopathies and as part of a multi-targeted treatment approach for glomerular diseases with systemic involvement.

Comparative efficacy of immunomodulators, biologics, and advanced therapies for steroid-refractory acute severe ulcerative colitis: A network meta-analysis and time-to-event analysis.

Design of RESOLVE Lung, a multinational Phase 2, randomized, placebo-controlled trial of the anti-GM-CSF monoclonal antibody namilumab in patients with chronic pulmonary sarcoidosis.

BackgroundIntensive care unit (ICU) is a professional and special ward for the treatment of various critical and severe diseases in clinical medical institutions, which is an important embodiment of the strength of critical and severe treatment in a hospital. Acute leukemia (AL) is one of the most common hematological malignancies with the most serious condition and poor prognosis. Different from other hematological malignancies, AL kills many young patients every year, although the treatment for AL has been perfected and put into clinical treatment for many years, however, due to the severity and rapid progression of AL, it is still necessary to strengthen the ability of nursing and medical treatment. Careful analysis and discussion of the rescue treatment and nursing of AL patients transferred to ICU is particularly necessary to improve the rescue ability of malignant hematological tumors in the critical stage and improve the rescue success rate of AL.ObjectiveThe purpose of this paper is to discuss and analyze the clinical features, diagnosis, treatment and prognosis of AL patients transferred to ICU, so as to provide suggestions for improving the ability to treat malignant hematological tumors in critical stage and improve the rescue measures for AL. More importantly, our aim was to provide evidence-based insights for early warning systems and multidisciplinary approaches in managing critically ill patients with hematological malignancies, investigate the clinical characteristics and prognostic factors of AL patients requiring ICU admission, providing valuable insights for improving diagnosis, nursing, prognosis assessment, and palliative care in hematology and critical care medicine.MethodsClinical data were retrospectively collected and systematically organized for AL patients transferred to the ICU from the First Affiliated Hospital of Gannan Medical University, Fujian Medical University Union Hospital, the Affiliated Hospital of Putian University, and the Affiliated Hospital of Guangdong Medical University during January 2014 to January 2025. The collected data included general patient characteristics, age at onset, treatment regimens, routine hematological indicators, cytogenetic and molecular biological abnormalities, extramedullary organ infiltration, and acute physiology and chronic health evaluation scores (APACHE II score), ICU duration and outcomes, reasons for ICU admission, treatment courses during ICU stays, and relevant laboratory and imaging findings. This study aimed to analyze and discuss the clinical features, diagnostic and therapeutic approaches, and prognosis of leukemia patients admitted to the ICU.ResultsA total of 357 AL patients, aged 16.5 ~ 77 years, were included in this study, comprising 216 males and 141 females. The time interval from AL diagnosis to ICU admission ranged from 0.03 to 144 months, with a median of 1 month. The length of ICU stay varied between 1 and 30 days. From the perspective of the unique molecular biology and cytogenetics of AL, we found FLTS-ITD was independent risk factors for mortality of AML, while E2A-PBX1 and DNMT3A were independent risk factors for mortality of ALL. Regardless of whether the subtype of AL patients included in this study was AML or ALL, patients with complex karyotypes accounted for the largest proportion. Meanwhile, age, leukemia type, heart failure, APACHE II score, WBC, PLT, LDH, PCT, APTT significantly affected the time from diagnosis to transfer to the ICU in AL patients (p < 0.05), accompanied by the gene mutation of WT1, FLT3-ITD, and TP53 significantly affected the time from diagnosis to transfer to the ICU in AML patients (p < 0.05), and FLT3-ITD, E2A-PBX1, DNMT3A, HOX11, RUNX1 significantly affected the time from diagnosis to transfer to the ICU in ALL patients (p < 0.05). Univariate analysis revealed that heart failure, sepsis, continuous renal replacement therapy (CRRT), administration of two or more treatments simultaneously, APACHE II score ≥20, and procalcitonin (PCT) levels were significantly associated with prognosis. Multivariate analysis indicated that heart failure, CRRT, and APACHE II score ≥20 were independent risk factors for mortality. COX univariate analysis suggested that heart failure, vasopressor use, and APACHE II score were influencing factors for overall survival (OS), while multivariate analysis confirmed that vasopressor use was an independent risk factor for OS.ConclusionThe prognosis and outcomes for AL patients transferred to the ICU were generally poor. Some molecular biological and cytogenetic indicators can be used as early warning indicators for AL patients’ transfer to the ICU or short-term death. Acute respiratory failure, sepsis, and severe infections were the primary reasons for ICU admission. Heart failure, CRRT, and APACHE II score ≥20 were identified as independent risk factors for mortality, while vasopressor use was an independent risk factor for OS.

The efficacy and safety of high‐dose amoxicillin‐bismuth‐potassium competitive acid blocker therapy for <i>Helicobacter pylori</i> infection—A pilot study

Timing of surgical intervention for chronic subdural hematoma in patients undergoing middle meningeal artery embolization: A retrospective propensity score matched study.

Eltrombopag, a thrombopoietin receptor agonist, is approved by the US Food and Drug Administration for children with chronic immune thrombocytopenia. Efficacy of eltrombopag during the newly diagnosed phase of pediatric immune thrombocytopenia is unknown. To determine if the proportion of patients with a platelet response is significantly greater in patients with newly diagnosed immune thrombocytopenia treated with eltrombopag than in those treated with standard therapy (first-line treatments). This phase 3, randomized clinical trial enrolled patients (aged 1-<18 years) with newly diagnosed primary immune thrombocytopenia (platelet count <30 × 109/L who required pharmacological treatment but did not have severe bleeding or need a rapid increase in platelet count) from May 7, 2019, to January 25, 2024, at 23 centers participating in the Pediatric ITP Consortium of North America. Final follow-up occurred on February 26, 2025. Eltrombopag was administered orally based on a standard dosing schedule (n = 78) vs standard therapy (investigator choice of glucocorticoids, intravenous immunoglobulin, or anti-D immunoglobulin) (n = 40). The primary outcome was a sustained platelet response defined as 3 or more of 4 platelet counts greater than 50 × 109/L during weeks 6 to 12 without rescue treatment. The secondary outcomes included bleeding scores, change in health-related quality of life, and serious adverse events. Of 118 pediatric patients (median age, 8 years [IQR, 4-12 years]; 49% were male), 63% experienced an initial treatment failure after observation or medical therapy. Enrollment ended after a planned interim analysis met a prespecified threshold for efficacy. Of 71 patients in the eltrombopag group, 46 (65% [95% CI, 54%-76%]) had a sustained platelet response compared with 13 of 37 patients (35% [95% CI, 20%-51%]) in the standard therapy group (between-group difference, 30% [95% CI, 11%-49%]; P = .002), which crossed the monitoring boundary for efficacy. Overall, there was no between-group difference in the number and type of adverse events. In pediatric patients with newly diagnosed immune thrombocytopenia requiring pharmacological treatment, eltrombopag resulted in a higher rate of sustained platelet response compared with standard therapy. Eltrombopag may be an effective option for pediatric patients with newly diagnosed immune thrombocytopenia with nonsevere bleeding who warrant medical intervention. ClinicalTrials.gov Identifier: NCT03939637.

Bariatric surgery, particularly laparoscopic sleeve gastrectomy, is an effective and pivotal treatment for obesity. Patients undergoing laparoscopic sleeve gastrectomy commonly experience moderate pain in the immediate postoperative period. Therefore, optimal pain management is crucial. The aim of this review was to update the recommendations for pain management following laparoscopic sleeve gastrectomy, building upon the 2019 guidelines. A systematic review was conducted using the PROSPECT methodology. Randomised controlled clinical trials (RCTs) and systematic reviews concerning analgesic, anaesthetic and operative interventions, focusing on pain management for patients undergoing laparoscopic sleeve gastrectomy, were identified through searches in MEDLINE, EMBASE and Cochrane Databases from September 2018 until February 2024. Primary outcome included pain scores. We used the Rob 2 tool as our method to assess the risk of bias in the included studies. The previous review included data from 18 RCTs. Since then, 188 eligible studies were identified, of which 39 RCTs and two meta-analyses met our inclusion criteria. In addition to paracetamol and NSAIDs or cyclooxygenase (COX)-2 specific inhibitors, ultrasound or laparoscopic-guided bilateral transversus abdominis plane (TAP) blocks and port-site local anaesthetic infiltration are recommended. In addition, intra-operative intravenous dexamethasone is recommended for analgesia and prevention of postoperative nausea and vomiting. Opioids are reserved for rescue treatment. This systematic review identified an evidence-based analgesic regimen for laparoscopic sleeve gastrectomy. Our current recommendations differ from the previous ones in that a TAP block is now recommended, and gabapentinoids are no longer advised. CRD42023487108.

Ulcerative colitis (UC) is a chronic inflammatory condition affecting the large intestine that can progress to colorectal cancer if left untreated. Different therapeutic approaches are used for its treatment and cyclosporine is one of them. It has been investigated as a rescue treatment option in cases when patients are unresponsive to steroidal therapy. However, its efficacy and safety remain uncertain. This study aims to conduct a comprehensive analysis of clinical evidence on cyclosporine safety and efficacy for the treatment of UC. Electronic databases, Cochrane Library, and PubMed were searched from 1998 till December 2024 to screen the relevant studies. A systematic approach was followed to pool and analyze the studies following the PICOS framework (population, intervention, comparison, outcome, and study design). Data was extracted systematically and analyzed using Comprehensive Meta-analysis software (CMA version 3), with the risk of bias evaluated using the RoB-2 tool, heterogeneity measured using I2 statistic, and Publication bias was evaluated using funnel plots and Egger's test. Out of 27 studies initially identified, 6 studies meeting the eligibility criteria were included in the final analysis. The risk of bias was high in four studies for all the outcomes except for colectomy rates. Heterogeneity between studies was not significant for all outcomes. Analysis results demonstrated that there was no statistically significant difference between the clinical response (OR = 1.290, 95%CI 0.552-3.012, P = 0.557), colectomy rates (OR = 1.171, 95%CI 0.776-1.767, P = 0.452), and serious adverse events (OR = 0.592, 95%CI 0.313-1.120, P = 0.107) of cyclosporine in comparison with control group. There is no statistically significant difference between cyclosporine compared to the control group in improving clinical outcomes for patients with ulcerative colitis. Future studies with larger sample sizes can explore its role with combination therapy in targeted patient sub-groups.

The aim of this study was to compare outcomes in cancer patients treated with middle meningeal artery embolization (MMAE) versus surgical treatment for chronic subdural hematomas (cSDHs), with outcome measures of requirement of rescue treatment and time to resumption of previously held systemic cancer therapy. A retrospective cohort study was conducted that included a review of medical records of cancer patients with cSDH treated with MMAE or surgical drainage. Patients without adequate follow-up including radiological follow-up and patients who underwent dual therapy (i.e., MMAE plus surgery) were excluded. The primary outcome was the requirement for rescue treatment within 180 days, defined as surgical reintervention or repeat embolization due to hematoma progression or symptom recurrence. Secondary outcomes included the time to resumption of previously held systemic cancer therapy. Inverse probability of treatment weighting using covariate balancing propensity scores was used to adjust for baseline differences. A total of 110 patients were included. Of these patients, 54 received MMAE and 56 were treated with surgical drainage. No significant differences were found regarding baseline demographic features. Although patients in the surgery group had a higher incidence of headaches and dizziness preoperatively, no difference in preoperative motor deficits was found. The MMAE group had a higher incidence of clotting disturbances and thrombocytopenia. Within 180 days, 5.6% of the patients who underwent MMAE required rescue treatment, all performed through surgical drainage. In contrast, 30.4% of the surgically treated patients required rescue treatment that included surgery, MMAE, or a combination of both. A Poisson regression analysis for rescue treatment within 180 days demonstrated that patients treated with MMAE had an 87.5% lower incidence rate of rescue treatment compared with those who underwent surgical drainage (p = 0.001). Additionally, the surgery group received significantly more postoperative platelet transfusions (median of 6 units) when compared with 0 units in the MMAE group. Time to restart previously held chemotherapy was significantly shorter in the MMAE group (p = 0.005). MMAE as a primary therapy for cSDH in cancer patients was associated with lower recurrence rates, earlier resumption of cancer therapy, reduction in platelet transfusion, and shorter hospitalizations compared with surgical drainage. These findings suggest that MMAE alone is safe and effective, and facilitates earlier resumption of chemotherapy in the oncology population.

Direct comparison of host resistance status and Barbervax vaccination to control parasitism in sheep subjected to a mixed parasite field challenge.

Successful Mechanical Thrombectomy and Balloon Angioplasty in Two Children With Arterial Ischemic Stroke Caused by Focal Cerebral Arteriopathy.

Although steroids are useful antiemetics, various moderate-to-severe chemotherapy-induced adverse events are observed. Although steroid-sparing antiemetic therapy is beneficial for moderate emetic risk, studies on only oxaliplatin-based regimen have not been fully evaluated. Therefore, this prospective observational study aimed to assess the usefulness of steroid-sparing antiemetic therapy for the second and subsequent courses of chemotherapy. Eligible patients who received a moderate emetic risk oxaliplatin-based chemotherapy regimen at Komaki City Hospital between January 2019 and March 2022 were switched to steroid-sparing antiemetic therapy after the second course. Steroid-sparing antiemetic therapy consisted of switching from granisetron to palonosetron on day 1 and discontinuing steroids on days 2-3. Complete response (CR; no emesis and no rescue medication), nausea and vomiting incidence, rescue use, and food intake were recorded by a pharmacist before the next chemotherapy session and compared before and after steroid-sparing antiemetic therapy. In total, 10 patients were included with a median age of 74 years; six were male. CR rate was 70.0% before and 80.0% after steroid-sparing antiemetic therapy, with no significant difference between the two groups. None of the patients experienced worsening nausea or vomiting after steroid-sparing antiemetic therapy. The nausea was transient in all patients with nausea and was managed via abortive rescue treatment with oral administration of metoclopramide. There was no increase in side effects after steroid sparing. Based on the proven efficacy and safety in this patient population, we recommend the implementation of steroid-sparing therapy after the second course.

Botulinum toxin as an effective rescue treatment after failure of anti-CGRP monoclonal antibodies in chronic migraine patients.

Mast cell tumours (MCTs) are common in dogs. Treatment options include surgery, radiation therapy, and cytotoxic chemotherapy; however, in cases of inoperable or metastatic tumours, tyrosine kinase inhibitors (TKIs) can be used. Imatinib mesylate has been used in the treatment of solid tumours in both human and veterinary medicine. Previous studies have shown some efficacy in dogs with MCTs; however, additional data are needed to better define the optimal dosage, toxicity profile, and clinical outcomes associated with its use. Dogs with a cytological or histopathological diagnosis of mucosal, cutaneous or subcutaneous MCTs were included. Medical records from 2017 to 2024 were reviewed for clinical presentation, results of staging procedures, diagnostic tests, and treatment. Inclusion required the presence of macroscopic disease and administration of imatinib, either as a sole treatment or in combination with surgery. Thirty-five cases were included, all receiving medical treatment with or without surgical excision. Imatinib was administered as first-line treatment in 8 dogs (22.8%) and as a rescue treatment in 27 dogs (77.1%), achieving an overall clinical benefit, including complete response, partial response, and stable disease of 77%. Median progression-free survival was 37 days (range 13-770 days), while the overall median survival time (MST) was 270 days (range 83-1396 days). Following imatinib treatment, the MST was 105 days (range 22-1145 days). Gastrointestinal and haematological adverse events were recorded in 2 (5.7%) and 3 (8.6%) dogs, respectively, and were self-limiting. Imatinib treatment was generally well tolerated, with measurable clinical responses observed and only a limited spectrum of toxicities. Further studies are warranted to better characterise its safety and efficacy in dogs with MCTs.