Significant Difference In Efficacy Research Articles

Comparative evaluation of root canal disinfection efficacy of three different endodontic irrigants using EndoVac: An in vitro bioluminescence-assisted study

Abstract Aim: To compare and evaluate root canal disinfection efficacy of three different endodontic irrigants 2.5% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX), and 2% alexidine (ALX) using negative pressure irrigation (NPI) system with EndoVac and syringe irrigation (SI) against Enterococcus faecalis. Materials and Methods: Seventy single-rooted mandibular premolars were decoronated, enlarged up to F4, autoclaved, and inoculated with E. faecalis for 21 days. The samples were divided into seven groups (n = 10) according to the protocol of disinfection: G1: 2.5% NaOCl + NPI, G2: 2.5% NaOCl + SI, G3: 2% CHX + NPI, G4: 2% CHX + SI, G5: 2% ALX + NPI, G6: 2% ALX + SI, and G7: no irrigation (positive control group). Adenosine triphosphate Assay was performed using luminometer for relative luminescence units (RLU) before and after the irrigation protocol. Statistical Analysis: One-way ANOVA test followed by Dunn’s post hoc and Wilcoxon Signed-Rank Test analysis was performed (P < 0.05). Results and Conclusion: G1 (7.90 ± 6.03) and G2 (2.90 ± 1.79) exhibited the least mean RLU values with no significant difference among them. It was noted that G5 (32.30 ± 7.92) performed better than G6 (14.20 ± 4.05) significantly (P < 0.008). G3 (27.70 ± 7.85) and G4 (28.50 ± 6.62) irrespective of irrigation protocols did not show significant differences in disinfection efficacy. Irrespective of irrigation protocol used, all the 3 irrigants exhibited a decrease in RLU values. In our study, EndoVac irrigation system did not improve the disinfection efficacy of the irrgiants.

Updated survival results of ZL-IRIAN: Irinotecan plus anlotinib or in combination with penpulimab as second-line treatment of metastatic colorectal cancer.

167 Background: The irinotecan based chemotherapy in combination with bevacizumab had become the standard second-line treatment for metastatic colorectal cancer (mCRC), but the efficacy was limited. Anlotinib, an oral anti-angiogenic tyrosine kinase inhibitor, had initially shown promising clinical effects when combined with chemotherapy in the first-line treatment of mCRC. Whether anlotinib could bring clinical benefit in the second line treatment warrants further exploration. The PD-1 antibody might have partial effects when combined with anti-angiogenic agents with or without chemotherapy in first- and third-line treatment for proficient mismatch repair (pMMR)/microsatellite stable (MSS) mCRC. Our study was to explore the rationality of anlotinib plus chemotherapy or further combined with a novel anti-PD-1 IgG1 antibody—penpulimab in the second line treatment of mCRC. Methods: This study was an open label, non-randomized, multi-cohorts, phase II prospective clinical trial that included pts with pMMR/MSS mCRC who were eligible for the second-line systemic treatment. Two cohorts were established as follows: Cohort A consisted of anlotinib(10mg daily, d1-10, q2w) + irinotecan (180mg/m d6, q2w) (n = 23); Cohort B consisted of anlotinib (8mg daily, d1-10, q2w)+irinotecan (180mg/m d6, q2w) + penpulimab (200mg, d6, q2w) (n = 23). The primary endpoint was ORR. Secondary endpoints included progress free survival (PFS), overall survival (OS), duration of response (DoR), disease control rate (DCR) and safety. The ORR was reported at 2024 ASCO, and PFS and OS have been updated in this report. Results: At the cutoff date on August 2024, a total of 23 Pts were enrolled in A cohort, and 23 pts were enrolled B cohort but 21 pts received at least one dose of treatment. The median PFS was 7.87 months (95% CI 5.52-10.22) in A cohort, compared to 7.4 months (95% CI 3.17-11.63) in B cohort, p=0.141. The 6-month, 12-month and 18-month PFS rates in A cohort and B cohort were 69.3% vs 80.7%, 27.5% vs 40.3% and 5.5% vs 22.4%, respectively. The median OS of A cohort was 21.73 months (95% CI 9.43-34.03), compared to 19.17 months (95% CI 11.44-26.90 months) in B cohort, p=0.987. The 12-month and 24-month OS rates in A cohort and B cohort were 64.7% vs 73.1% and 20.2% vs 54.8%, respectively. Safety profile indicated that 65.2% (15/23) and 66.7% (14/21) experienced grade≥3 adverse events in A cohort and B cohort, respectively. Common grade ≥ 3 adverse reactions (≥ 20%) mainly include hypertension (4.35% vs 14.29%), diarrhea (13.04% vs 9.52%), neutrophilopenia (39.13% vs 33.33%), and leukopenia (26.09% vs 9.52%). Conclusions: There was no statistically significant difference in overall efficacy between the two cohorts, but the long-term PFS and OS rates were higher in group B cohort, indicating that immunotherapy may bring long-term survival benefits to certain patients. Clinical trial information: NCT05229003 .

Comparison of Direct Oral Anticoagulants for Treatment of Cerebral Venous Thrombosis - A Retrospective Cohort Study.

Limited available evidence comparing DOACs with warfarin suggests efficacy and safety of DOACs for CVT. We aimed to evaluate whether a specific DOAC is preferred for the treatment of CVT. This retrospective cohort study included adult patients with CVTs between September 2018 and September 2022 treated with a DOAC. The primary outcome was rate of partial or complete recanalization. Secondary outcomes included rate of recurrent VTE, CVT extension, major or clinically relevant non-major bleeding, and death within 180 days after DOAC initiation. Of 31 patients with CVT, 21 received apixaban, 7 received rivaroxaban, and 3 received dabigatran. Among those with repeat imaging, the primary composite outcome occurred in 100%, 80%, and 100% for each group, respectively (P = 0.34). One patient had extension of CVT while on apixaban and one patient had increased midline shift while on rivaroxaban. No other secondary outcomes were observed. There do not appear to be significant efficacy or safety differences between DOACs when used for CVT treatment, though larger studies are needed to validate these findings.

Treatment of café-au-lait macules with picosecond and nanosecond 1064-nm nd: YAG laser: a retrospective study.

To investigate the efficacy and safety of picosecond (PS) and nanosecond (NS) 1064-nm neodymium-doped yttrium aluminum garnet (Nd: YAG) laser in treating Café-au-lait macules (CALMs). We retrospectively analyzed the medical records of patients with CALMs, who were treated with PS or NS 1064-nm lasers from January 2020 to January 2022. The efficacy was determined based on the before and after pictures by two independent investigators. The incidence of adverse events and recurrence were explored after treatments. A total of 116 patients (83 in the PS group and 33 in the NS group) were recruited. For subjects in the PS group, after 1-9 sessions, the lesion clearance was poor in 15 patients (18.1%), fair in 29 (34.9%), good in 14 (16.9%), and excellent in 25 (30.1%). In the NS group, after 1-7 sessions, the lesion clearance was poor, fair, good, and excellent in 7 (21.2%), 8 (24.2%), 13 (39.4%), and 5 (15.2%) patients, respectively. There was no statistically significant difference in efficacy between the two lasers (p > 0.05). The incidence of complications (hyperpigmentation, hypopigmentation) in the PS group (16.9%) was numerically lower than in the NS group (24.2%) (p = 0.136). Among patients who responded well to the treatment, 10.3% of patients in the PS group experienced relapse, compared with 22.2% in the NS group (p = 0.926). The PS 1064-nm laser provided comparable efficacy and potentially fewer complications compared with the NS laser in treating CALMs.

Deep learning and machine learning in CT-based COPD diagnosis: Systematic review and meta-analysis.

With advancements in medical technology and science, chronic obstructive pulmonary disease (COPD), one of the world's three major chronic diseases, has seen numerous remarkable outcomes when combined with artificial intelligence, particularly in disease diagnosis. However, the diagnostic performance of these AI models still lacks comprehensive evidence. Therefore, this study quantitatively analyzed the diagnostic performance of AI models in CT images of COPD patients, aiming to promote the development of related research in the future. PubMed, Cochrane Library, Web of Science, and Embase were retrieved up to September 1, 2024. The QUADAS-2 evaluation tool was used to assess the quality of the included studies. Meta-analysis of the included researches was performed using Stata18, RevMan 5.4, and Meta-Disc 1.4 software to merge sensitivity, specificity and plot a summary receiver operating characteristic curve (SROC). Heterogeneity was assessed using the Q statistic, and sources of inter-study heterogeneity were explored through meta-regression analysis. Twenty-two of 3280 identified studies were eligible. Meta-analysis was performed on 15 of these studies, encompassing a total of 22,817 patients for which statistical metrics were reported or could be calculated. Seven studies were based on deep learning (DL) model, three on machine learning (ML) model, and five on DL model with multiple-instance learning (MIL) mechanisms. One study evaluated both DL and ML models. The meta-analysis results showed that the pooled sensitivity of all DL and ML models was 86% (95%CI 78-91%), specificity was 87% (95%CI 83-91%), and area under the curve was 93% (95%CI 90-95%). Subgroup analyses revealed no significant difference in diagnostic sensitivity and specificity between DL and ML models (sensitivity 82% (95%CI 76-87%), 93% (95%CI 85-97%); specificity 87% (95%CI 79-91%), 84% (95%CI 79-88%), and the DL model with MIL (sensitivity 87% (95%CI 61-96%); specificity 89% (95%CI 78-95%) improved the performance of DL model, but this improvement was not statistically significant (p>0.05). Both DL and ML models for diagnosing COPD using CT images exhibited high accuracy. There was no significant difference in diagnostic efficacy between the two types of AI models, and the addition of the MIL mechanism may enhance the performance of the DL model.

Modeling the Efficacy of Phosphine on Eggs of Major Stored-Product Insect Species: Investigating Strains with Varying Susceptibility Levels

Phosphine is a widely utilized fumigant insecticide in stored-product facilities; however, its excessive application and improper usage have contributed to the emergence of resistance in insect populations. Although phosphine resistance is globally recognized, limited studies address its effects across different developmental stages. This research investigates the efficacy of phosphine on the eggs of major stored-product pests, including Oryzaephilus surinamensis (L.) (Coleoptera: Silvanidae), Rhyzopertha dominica (F.) (Coleoptera: Bostrichidae), Tribolium castaneum, and T. confusum (Coleoptera: Tenebrionidae), focusing on strains with varying levels of phosphine susceptibility. Egg hatching rates were analyzed following exposure to phosphine concentrations ranging from 50 to 1000 ppm for durations of 1 to 7 days. Predictive models were constructed to correlate phosphine concentration and exposure time, facilitating the determination of optimal pest control strategies. The findings reveal significant differences in efficacy among species and strains, with eggs from susceptible strains experiencing complete hatch failure at 50 ppm, while resistant strains showed higher tolerance. Lethal time (LT50 and LT99) values were determined, with LT99 ranging from 6.91 to 12.95 days at 50 ppm, highlighting species-specific and age-related differences in phosphine susceptibility. Lethal concentration (LC50 and LC99) values could only be estimated for T. castaneum, with LC99 for 1-day-old eggs ranging from 773.67 ppm to 923.03 ppm after 2.5 days of exposure. Furthermore, egg age influenced susceptibility, with 2-day-old eggs exhibiting greater mortality compared to 1-day-old eggs. This study underscores the critical role of phosphine concentration, exposure duration, and developmental stage in resistance management, providing valuable insights for enhancing fumigation protocols and improving the control of stored-product pests.

Updated Bayesian network meta-analysis on the efficacy and safety of PD−1 versus PD−L1 inhibitors in first−line treatment with chemotherapy for extensive−stage small-cell lung cancer

ObjectiveTo compare the efficacy and safety of programmed cell death 1 inhibitors plus chemotherapy (PD-1 + Chemo) and programmed cell death ligand 1 inhibitors plus chemotherapy (PD-L1 + Chemo) for the treatment of extensive-stage small-cell lung cancer (ES-SCLC).MethodsWe performed a meta-analysis of relevant data using R software, considering overall survival (OS), progression-free survival (PFS), and grade ≥ 3 treatment-related adverse events (TRAES).ResultsPD-1 + Chemo (OS: hazard ratio [HR] 0.71; PFS: HR 0.59) and PD-L1 + Chemo (OS: HR 0.72; PFS: HR 0.73) significantly prolonged survival and did not increase the incidence of grade ≥3 TRAEs compared with chemotherapy. Indirect comparisons showed no significant difference in clinical efficacy (OS: HR 0.99, 95% CI: 0.86–1.1; PFS: HR 0.80, 95% CI: 0.61–1.0) or safety (HR 1.0, 95% CI: 0.93–1.1) between PD-1 + Chemo and PD-L1 + Chemo. Non-cumulative probability ranking plot ranking results showed that PD-1 + Chemo ranked first in OS and PFS. Patients with PD-L1 expression levels < 1%, PD-1 + Chemo showed a trend of disadvantage (OS: HR 1.3; PFS: HR 1.2), whereas for patients with PD-L1 expression levels ≥ 1%, PD-1 + Chemo showed a trend of advantage (OS: HR 0.85; PFS: HR 0.85).ConclusionsPD-1 + Chemo and PD-L1 + Chemo significantly prolonged OS and PFS in patients with ES-SCLC and did not significantly increase the incidence of grade ≥ 3 TRAES. The efficacy and safety profiles of PD-1 + Chemo and PD-L1 + Chemo appear to be similar.

Stem cell-derived exosome treatment for acute spinal cord injury: a systematic review and meta-analysis based on preclinical evidence

BackgroundThe study aims were to systematically review and analyze preclinical research on the efficacy of exosomes derived from various mesenchymal stem cell sources (MSC-exos) for the treatment of spinal cord contusion injury (SCI) in small animal models.MethodsWe conducted a systematic search of PubMed, Embase and Google Scholar databases from their inception through February 29, 2024, to identify eligible English-language studies based on predefined inclusion and exclusion criteria. Two independent investigators performed literature screening, data extraction and bias assessment.ResultsA total of 235 rats were used to assess locomotor recovery at the initial assessment, and exhibited significant improvement in hind limb movement in those treated with exosomes, as indicated by a statistically significant increase in Basso-Beattie-Bresnahan (BBB) scores (MD: 1.26, 95% CI: 1.14–1.38, p < 0.01) compared to the controls. This trend persisted in final assessment data across 21 studies, with pooled analysis confirming similar results (MD: 1.56, 95% CI: 1.43–1.68, p < 0.01). Funnel plot analysis indicated asymmetry in the pooled BBB scores at both baseline and endpoint assessments, suggesting potential publication bias. Exosomes were derived from bone marrow, adipose tissue, umbilical cord or human placental MSCs. Meta-analysis results showed no statistically significant differences in therapeutic efficacy among these MSC-exos sources at various treatment time points.ConclusionMSC-exos demonstrated considerable promise in improving motor function in SCI-affected rats, with bone marrow MSC-derived exosomes having particularly notable effectiveness.

P0641 Efficacy of Vedolizumab and Ustekinumab Following Cyclosporine Induction in Acute Severe Ulcerative Colitis: A Retrospective Cohort Study

Abstract Background In corticosteroid-resistant acute severe ulcerative colitis (ASUC), second-line treatment involves infliximab or cyclosporine (CYCLO). With increasing antiTNFα exposed patients, CYCLO is often chosen to prevent emergency colectomy but is limited to the induction phase due to tolerability, serving as a bridge until effective maintenance therapy. In this setting, limited data on vedolizumab (VDZ) and ustekinumab (UST) as maintenance make the choice of an optimal bridge strategy challenging. This study aimed to compare the efficacy of VDZ and UST after CYCLO induction in corticosteroid-resistant ASUC. Methods This single-center retrospective cohort included all patients hospitalized for ASUC, responding to CYCLO induction, and starting VDZ or UST maintenance. ASUC was defined by modified Truelove and Witts criteria, with response to CYCLO defined by a Lichtiger score reduction to <10 points for 2 consecutive days, with a minimum 3-point decrease by day 7. The primary outcome was colectomy-free survival; secondary outcomes were treatment persistence and safety. Results From 2014-2024, 72 ASUC patients received CYCLO. Fourteen were excluded (non-response, tofacitinib [n=6], infliximab [n=3], and/or emergency colectomy [n=11]), leaving 58 CYCLO-responsive ASUC patients (median age 39, IQR 30-58, 60% female), with 46 on VDZ (79%) and 12 on UST (21%). ASUC was related to ulcerative colitis in 81% (68% pancolitis) and Crohn’s in 19%. Disease duration was 7 years (IQR 2-15), with 91% prior biologic exposure, primarily antiTNF. Presentation included Lichtiger score 10 (IQR 10-12), CRP 40 mg/L (22-79), albumin 29 g/L (27-30), fecal calprotectin 874 µg/g (450-1800), UCEIS 7 (5-8), and Mayo endoscopic score 3 (3-3). Colectomy-free survival was 75% at M12 and 69% at M24 with VDZ and 57% at M12 and M24 with UST (p=0.38, figure 1). Treatment persistence was 48% at M12 and 37% at M24 with VDZ, and 42% at M12 and M24 with UST (p=0.51, figure 2). After adjusting for maintenance therapy, disease type, and severity, colectomy risk factors included albumin <27 g/L (HR=3.4; 95%CI:1.2-9.8) and prior tofacitinib exposure (HR=4.3; 95%CI:1.2-15.8). Over a median 37-month follow-up (95%CI:35-40), 34% of patients experienced adverse events, with 19% severe (mainly CYCLO-related), including 2 deep vein thromboses in the VDZ group and 1 infection in the UST group. No deaths occurred. Conclusion In this large cohort of biologic-exposed, corticosteroid-resistant ASUC patients, a CYCLO bridge strategy with VDZ or UST avoided colectomy in two-thirds of patients, with almost 50% treatment persistence at 12 months. There was no significant difference in efficacy, persistence, or safety between strategies.

Comparative Efficacy of Lenvatinib Plus Immunotherapy and Regorafenib Plus Immunotherapy After Lenvatinib Failure for Advanced Hepatocellular Carcinoma: A Retrospective Study.

The combination of regorafenib and immune checkpoint inhibitor (ICI) has been the most popular second-line systemic therapy for advanced hepatocellular carcinoma (HCC). However, considering the good anti-tumor performance of lenvatinib, combined immunotherapy on the basis of lenvatinib after first-line lenvatinib failure is also popular in clinical practice. This study aimed to compare the efficacy and safety of regorafenib plus ICI (TACE-R-I) versus lenvatinib plus ICI (TACE-L-I) in patients with advanced HCC after lenvatinib failure. In this single-center retrospective study, 164 patients with advanced HCC were enrolled from January 2019 to March 2024 in China. All patients were aged ≥18 years, clinically or pathologically diagnosed with HCC. All patients received trans-arterial chemoembolization (TACE) as local treatment. Overall survival (OS), progression-free survival (PFS), and treatment-related adverse events (TRAEs) were compared between groups. The Cox regression model was used to analyze the factors associated with OS and PFS. We compared 77 patients from each group after propensity score matching (PSM). There was no significant difference in the OS (p=0.255) or PFS (p=0.387) between groups. However, in the subgroup (distant metastases, Barcelona Clinic Liver Cancer (BCLC) stage C or tumor thrombus), the TACE-R-I group showed better survival benefit than the TACE-L-I group. The multivariable Cox regression model suggested that BCLC stage and alpha-fetoprotein (AFP) were independently associated with OS. Distant metastases, tumor thrombus and Child-Pugh were independent associated factors for PFS (p<0.05). The frequency of grade ≥3 TRAEs was not significantly different between groups (p≥0.05). Our study demonstrated that in patients with greater tumor burden, the TACE-R-I group showed better OS and PFS benefits than the TACE-L-I group. However, in the overall population of HCC patients, there was no significant difference in efficacy and safety between the groups.

The Effect of Visual Feedback on Plaque Control: An RCT Comparing Toothbrushing Methods in Periodontitis Patients.

Background/Objectives: As gingivitis prevalence is closely related to plaque accumulation, effective oral hygiene is mandatory for maintaining healthy gingival tissues. The aim of this study was to evaluate the impact of different toothbrushing methods (a manual toothbrush (group 1 = MTB, the control); an electric toothbrush (group 2 = ETB); and an electric toothbrush with daily visual feedback (group 3 = ETBV)) on the plaque levels and periodontal health in patients after receiving initial periodontal treatment. Methods: A total of 67 patients were initially screened in this study, and 60 patients were randomly allocated into 1 of the 3 groups, with 53 patients completing this study. At baseline, the average probing depth across all groups was 3.60 mm, with an average bleeding on probing (BoP) score of 69,15%. Clinical parameters were assessed at multiple time points over 12 weeks. Results: The plaque levels reduced significantly in all groups: MTB decreased from 65,57% to 33.26%, ETB from 64,17% to 31.49%, and ETBV from 63,04% to 26.25% (p < 0.001 for all groups). Furthermore, a significant improvement for BoP was recorded across all groups: BoP decreased to 25.68% (MTB), 22.32% (ETB), and 23.14% (ETBV) (p < 0.001 for all groups). However, no significant difference in the plaque removal efficacy was observed between manual and electric toothbrushes, irrespective of visual feedback (p > 0.190). A linear mixed model analysis showed a significant overall group effect on the periodontal health parameters (p = 0.041) but no interaction with time (p = 0.965). Conclusions: These findings emphasize the importance of consistent oral hygiene in reducing periodontal disease. Further research is necessary to explore effective strategies for enhancing patient adherence and optimizing health outcomes.

Laboratory Exploration of Several Potential Biocontrol Methods Against the Ambrosia Beetle, Euwallacea interjectus.

The ambrosia beetle Euwallacea interjectus Blandford (Coleoptera: Curculionidae: Scolytinae) has recently emerged as a pest in Chinese poplar plantations, causing significant economic losses through damage to host trees in association with its mutualistic fungus Fusarium populicola. This study evaluated the biocontrol potential of Beauveria bassiana strain B-BB-1, Serratia marcescens strain B-SM-1, its metabolite prodigiosin, and two ectoparasitic mites, Pyemotes moseri and Pyemotes zhonghuajia. B. bassiana exhibited significant lethality toward adult female E. interjectus, reduced offspring production, and inhibited F. populicola growth. S. marcescens and prodigiosin had certain lethal effects on larvae and inhibited the growth of F. populicola. Both mites effectively parasitized beetle pupae and larvae, with no significant differences in efficacy between the two species. These agents demonstrate promise for the biological control of E. interjectus, offering insights for managing ambrosia beetle infestations.

Evaulation of varicocelectomy efficacy in primary and secondary infertile men

Introduction. Varicocele is one of the main causes of subfertility in men with primary and secondary infertility. Objective. In this study, we compared the initial semen parameters and the effectiveness of varicocelectomy in men with primary and secondary infertility. Materials &amp; methods. 100 men suffering from primary infertility (PI) and secondary infertility (SI) and having varicocelectomy were recruited. Patients were divided into 2 groups. Group 1 included 58 men with PI and the group 2 42 men with SI. Preoperative clinical characteristics and semen parameters before and after varicocelectomy were analyzed and compared between groups. Results. Analysis revealed that the mean age of patients of the group 1 was significantly lower (p &lt; 0,001) and duration of infertility was accurately shorter (p &lt; 0,01) than those of group 2. Main semen parameters increased significantly in group I (e. g., sperm concentration increased by 50 %, from 62,2 ± 8,7 to 93,5 ± 10,0 M/ml and total motile sperm count increased by 113 %, from 76,7 ± 17,1 to 163,4 ± 27,8 M p &lt; 0,05), while in group 2 only % of progressive motile sperm increased significantly (by 107 %, from 13,5 ± 2,6 to 28,0 ± 5,2 % p &lt; 0,05). We identified significant difference in varicocelectomy efficacy between group 1 and group 2 in change of total motile sperm count (by 113 % vs. 74 % respectively, p &lt; 0,01). We also revealed discrepancy between groups in correlation ratio (r) between initial and post-surgical percentage of progressive motile sperm. Conclusions. Patients with SI were older and had longer infertility period. Varicocelectomy resulted in significant semen parameters improvement in patients with PI. In patients with SI only a percent of progressively motile sperm improved significantly. It shows that male age and infertility duration may negatively affect varicocelectomy outcomes in male subfertility treatment.

Effect of different regional anaesthesia techniques on postoperative analgesia following percutaneous nephrolithotomy: A systematic review and network meta-analysis

Background and Aims: The optimal analgesia for percutaneous nephrolithotomy (PCNL) remains uncertain. This study aims to conduct a systematic review and network meta-analysis to compare the efficacy of various analgesic strategies for PCNL. Methods: We searched PubMed, ScienceDirect, ClinicalTrials.gov, MEDLINE, Web of Science, Ovid and EMBASE to identify all relevant randomised controlled trials published up to January 2024. Our review was prospectively registered with PROSPERO (ID: CRD42024504578). The identified methods included erector spinae plane block (ESPB), paravertebral block (PVB), intercostal nerve block (ICNB), quadratus lumborum block (QLB) and local infiltration. Our primary outcomes consisted of 24-h cumulative opioid consumption and the time to first use of opioid medication postoperatively. Secondary outcomes encompassed pain scores at 2, 6, 12 and 24 h postoperatively, as well as occurrences of postoperative nausea and vomiting. Results: Overall, 27 trials met our inclusion criteria. QLB, PVB and ESPB demonstrated significant advantages in reducing 24-h postoperative opioid consumption and providing effective analgesia at all measured postoperative time points within 24 h, compared to the placebo group. However, there was no statistical difference between the three interventions. Similarly, there were no statistical differences in all outcomes between the ICNB and infiltration groups compared to the placebo group. Conclusions: ESPB, PVB and QLB offer significant analgesic benefits for PCNL compared to placebo, with no significant differences in efficacy among them. Due to limited evidence, ICNB and local infiltration were found not to be more effective than placebo.

Cardiovascular Therapy Benefits of Novel Antidiabetic Drugs in Patients With Type 2 Diabetes Mellitus Complicated With Cardiovascular Disease: A Network Meta-Analysis.

Provide an evidence-based basis for the selection of cardiovascular benefit drugs in Type 2 diabetes mellitus (T2DM) patients with cardiovascular disease (CVD). Conduct a comprehensive search of all relevant literature from PubMed, Embase, Web of Science, Cochrane Library, and Clinical Trials.gov from their establishment until December 13, 2023, and select randomized controlled trials (RCTs) that meet the pre-established inclusion and exclusion criteria. Use the Cochrane bias risk assessment tool to evaluate the quality of the included literature. Use R 4.3.2 software to conduct network meta-analysis for drug category comparison. A total of 24 large-scale randomized controlled trials (RCTs) were included, including 19 intervention measures, and 172 803 patients participated in the study. The results of the network meta-analysis show that: GLP1RA (OR 0.89, 95% CI 0.81-0.97) and SGLT2i (OR 0.91, 95% CI 0.83-0.99) can reduce the occurrence of major adverse cardiovascular events (MACE), GLP1RA (OR 0.88, 95% CI 0.79-0.97) and SGLT2i (OR 0.89, 95% CI 0.81-0.99) reduced the risk of cardiovascular death. SGLT2i (OR 0.68, 95% CI 0.62-0.75) reduced the occurrence of hospitalization for heart failure, GLP1RA (OR 0.88, 95% CI 0.81-0.97) and SGLT2i (OR 0.89, 95% CI 0.80-0.97) reduced the occurrence of all-cause death. In the comparison of new hypoglycemic drug classes, GLP1RA and SGLT2i reduced MACE, cardiovascular mortality and all-cause mortality in T2DM patients with CVD, with no significant difference in efficacy, and DPP4i was noninferior to placebo. Only GLP1RA reduced the risk of nonfatal stroke, and only SGLT2i reduced the risk of HHF.

Editorial: Advances in SIBO Treatment: The Synergistic Role of Rifaximin and Probiotics

A study conducted by Abu-Hammour et al. Published in the December 2024 issue of the Jordan Medical Journal (1) explored the effectiveness of combining rifaximin with probiotics in treating Small Intestinal Bacterial Overgrowth (SIBO). Participants were divided into two groups based on the timing of probiotic administration: concurrent (Group A) and sequential (Group B). Both treatment approaches have shown significant effectiveness, with 69.8% of patients in Group A and 74.8% in Group B achieving a negative lactulose hydrogen breath test (LHBT) after treatment. Additionally, the overall clinical response rates were also remarkable, exceeding 86% in both groups. Interestingly, no side effects were reported, highlighting the safety of rifaximin and probiotics as a therapeutic combination. Furthermore, the study found no statistically significant difference between the two regimens, indicating that whether probiotics are administered concurrently or sequentially, the outcomes remain favorable. However, the sequential regimen did show a more prolonged clinical response, which could offer additional therapeutic benefits, especially for patients who may require longer-term management. These results contribute to a growing body of evidence supporting the synergistic effects of rifaximin and probiotics in treating SIBO (2). The addition of probiotics, whether started simultaneously with rifaximin or in a staggered manner, enhances treatment outcomes by not only eradicating harmful bacteria but also promoting the restoration of the gut's beneficial microbiota. This dual approach is particularly relevant given the complex pathophysiology of SIBO, which involves both bacterial overgrowth and disturbances in the gut's microbiome. It is essential to highlight the diagnostic challenges in SIBO which have been linked to several gastrointestinal and extraintestinal diseases. While small bowel aspiration and culture is the accepted gold standard for diagnosis, breath testing (GBT) is widely used in the routine clinical setting including lactulose and glucose hydrogen breath tests, which often result in varying levels of sensitivity and specificity (3). Despite these challenges, the use of non-invasive methods like the lactulose hydrogen breath test remains a cornerstone of SIBO diagnosis, with some studies suggesting that it may offer better sensitivity compared to glucose-based tests, particularly in cases of distal SIBO. The study by Abu-Hammour and colleagues is an important step toward refining SIBO treatment protocols. It underscores the need for personalized treatment strategies that consider both the microbiological and clinical aspects of the disease. Furthermore, it opens the door for future research to explore the optimal duration and timing of probiotic administration, as well as the potential benefits of combining rifaximin with other novel therapeutic agents. In conclusion, the addition of probiotics to rifaximin therapy offers a promising, well-tolerated approach to treating SIBO, with no significant differences in efficacy between concurrent and sequential use. This study reinforces the importance of addressing both bacterial overgrowth and microbiome imbalance in the management of SIBO, providing a potential model for future therapeutic strategies in this prevalent and often debilitating condition.

Comparison between Lavender and Chamomile Essential Oils for Pain and Anxiety Reduction during Amniocentesis in Second Trimester Pregnancy: A Randomized Controlled Trial

Objective: To investigate the effectiveness of aromatherapy using lavender and chamomile essential oils, to alleviate pain and reduce anxiety during the amniocentesis procedure in second trimester pregnancy. Materials and Methods: The present was a randomized controlled trial approved by the Human Research Ethics Committee of Thammasat University (MTU-EC-OB-1-023/66) and registered in the Thai Clinical Trials Registry on June 29, 2023 (TCTR20230629001). The present study was conducted at the Maternal and Fetal Medicine Unit, Thammasat University Hospital, Pathum Thani, Thailand between July and November 2023. The participants were pregnant women undergoing amniocentesis. Participants were randomly assigned into three groups, lavender, chamomile, and normal saline, which was the control group. Participants in each group were instructed to inhale the assigned scent, lavender, chamomile, or normal saline, for 15 minutes prior to the amniocentesis procedure. For each participant, a cotton swab containing four drops of the assigned scent was held 10 centimeters from the participant’s nose. Pain and anxiety were recorded using visual analog scale (VAS) and visual facial anxiety scale (VFAS). Expected pain and anxiety were recorded before amniocentesis (Te), immediate after procedure (T0), and at 15 and 30 minutes after the procedure (T15 and T30). Results: One hundred fifty participants were allocated into three groups. To ensure comparability, demographic characteristics were matched across the three groups. The present study revealed that both lavender and chamomile lowered pain more than the control at 15 minutes after amniocentesis (T15), and only lavender can reduce pain during the procedure (T0). Both lavender and chamomile reduced anxiety more than the control 15 minutes after amniocentesis (T15), and only chamomile continued to reduce anxiety 30 minutes post procedure (T30). Thus, lavender proved to be more effective in managing pain during the amniocentesis procedure, whereas chamomile offers a prolonged effect in reducing anxiety, lasting up to 30 minutes post-procedure. Conclusion: Aromatherapy effectively reduces pain and anxiety associated with amniocentesis. In the present study. Both lavender and chamomile reduced pain at 15 minutes after the procedure, but only lavender has efficacy in pain reduction during the procedure. Both lavender and chamomile reduced anxiety 15 minutes after the procedure, but only chamomile continued to reduce anxiety 30 minutes post procedure. However, when comparing lavender and chamomile, there was no statistically significant difference in efficacy of pain or anxiety reduction. Keywords: Lavender; Chamomile; Aromatherapy; Essential oil; Amniocentesis; Pain; Anxiety

Comparative Study of Safety and Efficacy of α-n-Butyl-2-cyanoacrylate Glue versus Traditional Embolization Materials in the Treatment of Acute Renal Hemorrhage.

Aims/Background This study aims to evaluate the safety and efficacy of α-n-butyl-2-cyanoacrylate (NBCA) glue in comparison with traditional embolization materials for the treatment of acute renal hemorrhage. Methods A total of 105 patients with the acute renal hemorrhage who underwent superselective renal artery embolization were enrolled. The patients were divided into two groups based on the embolization materials used: the traditional group (43 cases, control group) and the medical glue group (62 cases, observation group). Demographic characteristics, medical history, preoperative and postoperative 24-hour blood counts, renal function, and other clinical data were collected. The safety and efficacy of the two treatment methods were then compared between the groups. Results No significant difference in efficacy was observed between the traditional group and the medical glue group (p > 0.05). However, significant differences were found between the two groups in terms of embolization vessel grade, systemic immune-inflammation index (SII) difference, estimated glomerular filtration rate (eGFR) difference, and combined eGFR difference (p < 0.05). The traditional group exhibited a higher postoperative inflammatory response and greater renal function damage compared to the medical glue group. The degree of vascular embolization also influenced the extent of postoperative inflammatory response and renal function damage in patients with acute renal hemorrhage. Conclusion Compared to traditional embolization materials, NBCA glue demonstrates a clear hemostatic effect in the treatment of patients with acute renal hemorrhage, while also leading to reduced postoperative inflammatory response and renal function damage. NBCA adhesive is both safe and effective for treating acute renal hemorrhage.

Efficacy of reminiscence therapy in improving cognitive decline: a systematic review and meta-analysis.

‌ Reminiscence therapy(RT) is used in the care of people with dementia to help improve their quality of life, but the efficacy of RT in various cognitive decline populations is unclear, and long-term effects are not sufficiently evidenced.This systematic review and meta-analysis aims to determine the efficacy of RT in improving cognitive decline and provide evidence for its implementation in care. A comprehensive search strategy utilizing MeSH terms and free-text keywords was employed to systematically search the Embase, PubMed, and Cochrane databases up to January 24, 2024. Randomized controlled trials(RCTs) investigating RT monotherapy for improving cognitive decline were included. The primary outcomes of interest were the standard Mini-Mental State Examination (MMSE) scores. Additionally, all data analyses will be performed using RevMan5.4 software. ‌ We identified 612 studies, and 24 studies met the inclusion criteria, involving 2650 participants. This meta-analysis shows that RT significantly improves immediate and long-term cognitive decline with Standardized Mean Difference(SMD) and 95% CI of 0.55 [0.37, 0.73] and 0.50 [0.11, 0.88], respectively. However, there is no significant difference in efficacy between subgroups (P > 0.05). ‌ Our findings suggestS that RT significantly improves cognitive decline, with no significant differences between subgroups. This suggests that RT is universal in improving cognition and that the way RT is implemented has no significant effect on outcomes. These findings supportS the use of RT as a reliable non-pharmacological treatment option to enhance cognitive function.

Comparative Evaluation of Antimicrobial Effect of Different Irrigating Solution Against Enterococcus Faecalis - An In-Vitro Study

BACKGROUND The invasion of microorganisms into the root canal system poses a significant challenge in endodontic infections, especially in primary teeth. Enterococcus faecalis is a common culprit in such infections, necessitating effective antimicrobial strategies. This study aims to assess various irrigating solutions' antimicrobial efficacy against E. faecalis. Aim: The aim of this study was to evaluate the antimicrobial efficacy of different irrigating solutions against E. faecalis. METHODS Six experimental groups, including lemon extract, chlorine dioxide solution, apple cider vinegar, Echinacea angustifolia, sodium hypochlorite, and a control group (normal saline), were evaluated. The antimicrobial activity was assessed using the agar-well diffusion method, and MIC (Minimum Inhibitory Concentration) and MBC (Minimum Bactericidal Concentration) were determined. RESULTS Lemon extract and apple cider vinegar exhibited higher zones of inhibition compared to sodium hypochlorite, chlorine dioxide, and Echinacea angustifolia. Statistical analysis confirmed significant differences in antimicrobial efficacy between various groups. Lemon extract and apple cider vinegar demonstrated the lowest MIC and MBC values, indicating potent antimicrobial activity against E. faecalis. CONCLUSIONS This study highlights the antimicrobial efficacy of lemon extract and apple cider vinegar against E. faecalis, suggesting their potential as alternative irrigating solutions in endodontic practice. Further research is warranted to explore their clinical applicability and long-term effects on treatment outcomes.