Success Rate Of Therapy Research Articles

Limited Efficacy of Thrombolytics for Pump Thrombosis in Durable Left Ventricular Assist Devices

This study reports a single-center experience with thrombolytics for left ventricular assist device (LVAD) pump thrombosis. Adults undergoing continuous-flow LVAD implantation between 2004 and 2018 at a single center were reviewed and those with pump thrombosis were identified. Primary outcomes included 1-year survival and success rates of thrombolytic therapy. Secondary outcomes included posttreatment adverse events, freedom from major bleeding at 1 year, and freedom from stroke at 1-year follow-up. A total of 341 patients underwent LVAD implantation and 10.8% (n= 37) developed pump thrombosis. Of those 37, 26 received initial thrombolytic therapy (70.2%), 5 underwent direct pump exchange (13.5%), and 6 received only intravenous heparin owing to presentation with acute stroke or severe multiorgan failure (16.2%). Successful treatment was achieved in 11.5% of patients receiving thrombolytics (n= 3). Early adverse events after thrombolytic therapy included major bleeding in 11.5% (n= 3) and new stroke in 7.7% (n= 2). Most patients undergoing thrombolytic therapy underwent subsequent device exchange (69.2%; n= 18). Overall survival in patients with pump thrombosis after treatment was 96.8% at 30 days, 78.9% at 90 days, and 63.1% at 1 year. Freedom from major bleeding and stroke at 1 year was 74.2% and 87.2%, respectively. In this single-center experience of thrombolytics for pump thrombosis in LVAD patients, there was limited efficacy; most patients required subsequent pump exchange. Combined with the risk for major bleeding or stroke with thrombolysis, this underscores the importance of further refining patient selection for direct pump exchange in those presenting with pump thrombosis.

Patient reported long-term outcome after endovascular therapy of indirect dural carotid cavernous fistulas.

PurposePatient-reported long-term follow-up after endovascular treatment of indirect carotid cavernous fistulas is important, but rarely addressed in literature. We report on this issue with a special focus on the patient’s view and its impact on the indication evaluation process.MethodsWe retrospectively reviewed the records of all patients (n = 33) with a minimum follow-up interval of at least 36 and up to 166 months after endovascular treatment of an indirect carotid cavernous fistula (Barrow B-D) at our institution (treated from 01/2003 to 06/2015). We determined treatment details including primary therapy success and complication rate and quote the patient’s subjective perception of the long-term treatment success using a standardized interview form.ResultsAs a primary result the fistula was completely occluded in 25/33 cases (76%), while a downgrading was achieved in 8/33 (24%) of the cases. Secondary occlusion was observed in three out of eight patients (38%). In the long-term interview (response rate: 91%, median follow-up interval: 114 months) 87% of the patients reported high satisfaction with the long-term therapy result. Endovascular treatment achieved a sustainable relief from all eye-related symptoms in 89% and from pulsatile tinnitus in 57% of the cases.ConclusionsIn addition to good results in terms of angiographic and clinical cure, endovascular treatment is also perceived as beneficial by most of the patients. This is another important argument in favor of an endovascular treatment.

The success rate of radioactive iodine therapy for Graves’ disease in iodine-replete area and affecting factors: a single-center study

Initial treatment options for Graves' disease include antithyroid drugs, radioactive iodine (RAI), and surgery. Because of similar effects of three modalities, initial treatment preferences differ by country to country. In Korea, iodine-replete area, RAI was used as a second-line option. For these reasons, the RAI success rate in Korea might differ from other countries. A total of 247 patients were enrolled. The primary outcome was cumulative success rate in the first year, and the secondary outcome was factors that affected the success. Delayed response, which included patients who attained successful RAI during the follow-up, after the first year without further RAI, and factors that affected the delayed response were reviewed. The cumulative success rate in the first year was 62.8%. Higher RAI activity [odds ratio (OR) 2.56, P = 0.02], longer disease duration (OR 0.43, P = 0.01), larger goiter (OR 0.31, P = 0.01), and higher post-RAI fT4 (fT4 between upper normal limit (UNL) to 1.5 × UNL; OR 0.24; P < 0.01, 1.5 × UNL<; OR 0.08; P < 0.01) were associated with RAI success. Twenty-seven patients showed delayed response, and goiter size (P < 0.05), pre-RAI TSH receptor Ab (TRAb) level (P < 0.01) and post-RAI fT4 (P < 0.01) were associated. The success rate of the first RAI in Korea was lower than that in other countries. Delayed response was observed in patients with smaller goiter, low pre-RAI TRAb, and low post-RAI fT4. In these patients, clinical follow-up with monitoring could be an option, and decision of optimal timing of first RAI is crucial.

Is “Dilator Use” More Effective Than “Finger Use” in Exposure Therapy in Vaginismus Treatment?

Vaginismus is the persistence of difficulties in allowing the vaginal entry of a penis, a finger or a gynecologic examination. This study aimed to compare the success rates of vaginismus therapy with exposure therapy treatment using a finger or a dilator. The finger training group (FTG) (n = 30) and the dilator training group (DTG) (n = 30) were established. Groups were trained about dilatation and desensitization. The Female Sexual Function Index (FSFI) was applied. From the baseline measurement to the post-treatment measurement, the average change in FSFI scores for both groups was statistically significant (p < 0.001). There was a significant difference between two groups in terms of patient drop-out numbers (p = 0.016); the DTG was more successful in continuing treatment than the FTG. This research revealed that DTG is more successful in treatment continuity and show more improvement in sexual functions.

Antibiotic therapy success rate in pulmonary Mycobacterium avium complex: a systematic review and meta-analysis

ABSTRACT Objectives The incidence of Mycobacterium avium complex (MAC) pulmonary disease is increasing worldwide. We conducted a systematic review and meta-analysis to determine the treatment success rate of antibiotic therapy in MAC pulmonary disease and evaluate the effectiveness of aminoglycoside-containing regimens. Methods We searched literature between 1 January 1980 to 19 June 2019. Studies with diagnosis criteria based on the current guidelines that reported treatment outcomes were included. We defined treatment success as the achievement of culture conversion and completion of the planned treatment without relapse while on treatment. Results We retrieved 45 studies including 3862 patients. The estimated pooled treatment success rate was 68.1% [95% confidence interval (CI) 64.7–71.4%]. Based on the Cochrane tool, the included studies had a low risk of bias. Forty-two studies reported macrolide-containing regimens, while 6 studies included aminoglycoside-containing regimens. Macrolide-containing regimens led to better treatment success rates comparing to non-macrolide-containing regimens; 69% vs 58.5%, respectively. Treatment duration of 12 months or more showed better results. Conclusion Poor treatment success rate of MAC pulmonary disease calls for more randomized clinical trials designed based on consensus definitions of the disease diagnosis and treatment. New drugs with a better adherence rate need to be developed. Systematic Review Registration PROSPERO (pending registration ID: 151674).

Regenerative medicine and injection therapies in stress urinary incontinence

Stress urinary incontinence (SUI) is a common and bothersome condition. Anti-incontinence surgery has high cure rates, but concerns about mesh tapes have resulted in the resurgence of surgical procedures that involve increased abdominopelvic dissection and morbidity. Injection therapy with urethral bulking agents or stem cell formulations have been developed as minimally invasive alternatives. Many synthetic and biological bulking agents havebeen trialled, but several have been discontinued owing to safety concerns. The use of Macroplastique and Contigen has the largest evidence base, but, overall, success rates seem to be similar between the various agents and positive outcomes are poorly sustained for more than 6 months. Furthermore, subjective cure rates, although initially high, also deteriorate over time. The available data consistently demonstrate manifestly poorer outcomes for injection therapies than for surgery. Stem cell treatments are thought to functionally regenerate the urethral sphincter in patients with suspected intrinsic sphincter deficiency. Autologous adipose and muscle-derived stem cells seem to be the intuitive cell source, as they are comparatively abundant, can be harvested and cause minimal donor site morbidity. To date, only a few small clinical studies have been reported and most data are derived from animal models. The success rates of stem cell injection therapies seem to be comparable with those of bulking agents.

Long-term obstructive sleep apnea therapy: a 10-year follow-up of mandibular advancement device and continuous positive airway pressure

Obstructive sleep apnea (OSA) is a sleep-related breathing disorder, commonly managed by either continuous positive airway pressure (CPAP) or a mandibular advancement device (MAD). Long-term follow-up and comparison regarding efficacy of these therapies is scarce. In this study the results of treatment, patient adherence, and satisfaction over a 10-year follow-up of these therapies are reported. This is a longitudinal follow-up study taken from a subset of patients initially enrolled in a randomized controlled clinical trial of 103 patients with OSA (51 and 52 patients randomized for MAD and CPAP, respectively). After a 10-year follow-up period, 14 patients using MAD and 17 patients using CPAP could be evaluated for this longitudinal follow-up study. Data were analyzed at baseline, after 3 months and at 1-, 2-, and 10-year follow-up. All 31 patients with OSA underwent polysomnography and self-reported measurements. Polysomnography results showed a favorable outcome of both therapies at 10-year follow-up. At baseline, included patients in both groups did not significantly differ in apnea-hypopnea index (AHI) values. At 10-year follow-up, both the MAD and CPAP groups showed a significant reduction in AHI. At baseline the mean AHI in the MAD group was 31.7 ± 20.6 events/h whereas in the CPAP group it was 49.2 ± 26.1 events/h. At 10-year follow-up the mean AHI in the MAD group was 9.9 ± 10.3 events/h and in the CPAP group it was 3.4 ± 5.4 events/h. Both therapies resulted in a substantial improvement in self-reported neurobehavioral outcomes at 10-year follow-up. Both CPAP and MAD therapy demonstrate good and stable treatment effects after a 10-year follow-up period. Therefore, when indicated, both therapies are appropriate modalities for the long-term management of OSA. Registry: Netherlands Trial Register; Name: Management of the Obstructive Sleep Apnea-Hypopnea Syndrome: Oral Appliance versus Continuous Positive Airway Pressure Therapy; Identifier: NL75; URL: https://www.trialregister.nl/trial/75.

A REVIEW ON STEM CELLSTHERAPYIS A NEW ERA IN TYPE 2 DIABETES

Diabetes is one of the most leading cause of death worldwide. Around 40 million diabetics are reported in India. Stem cell therapy is a branch of medicine that involves introducing stem cells into a diseased tissue which triggers the body’s ability to heal itself. Stem cell therapy is a latest technique which can be used to treat diabetes mellitus. In India the success rate of stem cell therapy in diabetes mellitus is approximately 70 - 80 %. As this stem cells may be harvested from the bone marrow, umbilical cord and matured adult. In the present review we are discussing about the use of stem cell therapy in type 2 diabetes and how it works. Type 2 diabetes mellitus results from combination of insulin resistance and dysfunction of insulin producing beta cells which cannot be reversed by existing therapeutic strategies, transplantation of stem cells which are differentiating into insulin producing cells is one of the most promising strategy for treating type 2 diabetes.

Trigeminal neuralgia management after microvascular decompression surgery: two case reports

Trigeminal neuralgia (TN) involves chronic neuropathic pain, characterized by attacks of repeating short episodes of unilateral shock-like pain, which are abrupt in onset and termination. Anticonvulsants, such as carbamazepine, are the gold standard first-line drugs for pharmacological treatment. Microvascular decompression (MVD) surgery is often the course of action if pharmacological management with anticonvulsants is unsuccessful. MVD surgery is an effective therapy in approximately 83% of cases. However, persistent neuropathic pain after MVD surgery may require reintroduction of pharmacotherapy. This case report presents two patients with persistent pain after MVD requiring reintroduction of pharmacological therapy. Although MVD is successful for patients with failed pharmacological management, it is an invasive procedure and requires hospitalization of the patient. About one-third of patients suffer from recurrent TN after MVD. Often, alternative treatment protocols, including the reintroduction of medications, may be necessary to achieve improvement. This case report presents two cases of post-MVD recurrent pain. Further research is lacking on the success rates of subsequent medication therapy after MVD has proven less effective in managing TN.

Determination of success rate of root canal therapy performed by dentistry students in the Department of Endodontics at Birjand University of Medical Sciences, Birjand, Iran, during 2014-2017

IntroductionRoot canal treatment, including pulp removal, mechanical and chemical cleaning, and canal filling is an important part of a dentist's job. This study aimed to evaluate the quality and success rate of root canal therapy performed by dentistry students in the Department of Endodontics, School of Dentistry, Birjand University of Medical Sciences, Birjand, Iran.MethodsThis retrospective study was conducted from 2014 to 2017. In total, 62 students were randomly divided into two equal groups of males and females. For each tooth, four radiographs, including the periapical images of the initial radiograph, master apical file, master cone, and final obturation radiographs, were reviewed under the supervision of an endodontist. The investigated technical errors included transport, ledge, perforation, underfilling, overfilling, and presence of void and broken instrument. Data were analyzed in SPSS software (Version 22). A P-value less than 0.05 was considered statistically significant.ResultsAccording to the results, only 79.3% of the students committed at least one type of root healing error, and there was no significant difference between males and females regarding the overall prevalence of error (P=0.12). However, errors, such as underfill, broken instrument, and transport were more common among males; moreover, void and perforation errors were slightly more prevalent among females. It should be noted that this difference was not statistically significant.ConclusionsThe results of the present study can help identify the weaknesses of treatment in order to improve the quality of root canal treatment, especially regarding student gender in the School of Dentistry affiliated to Birjand University of Medical Sciences, Birjand, Iran.

Antimicrobial and Anti-Biofilm Effect of an Electrolyzed Superoxidized Solution at Neutral-pH against Helicobacter pylori.

The presence of Helicobacter pylori in the oral cavity has been associated to the failure of antimicrobial therapy in patients with gastrointestinal infection and the development of oral diseases. However, it has been reported that the maintenance of good oral hygiene can improve the therapeutic success rates, where the use of mouthwashes with anti-Helicobacter activity would help to achieve it. The aim was to evaluate the antimicrobial activity of OxOral® mouthwash against H. pylori and its effect on biofilm formation. The minimum inhibitory concentration (MIC) of OxOral® (pH = 6.4–7.5, ORP = 650–900 mV) against H. pylori was calculated testing serial dilutions 0.117–15 ppm against 1 × 108 CFU/mL of H. pylori (ATCC® 700824™) by broth microdilution method using 96‐well plates. The H. pylori biofilm formation was determined by the optical density measurement at 600 nm from coverslips stained with 0.1% crystal violet. The gene expression of ureA, luxS, flaA, omp18, and lpxD were analyzed by RT‐qPCR. OxOral® cytotoxicity was evaluated in a human gingival fibroblast cell line by MTT assay. MIC was of 3.75 ppm, with 99.7 ± 7.7% bacterial growth inhibition. In the negative control, the biofilm formation was observed, whereas when bacteria were treated with OxOral® at 0.234, 0.469, and 0.938 ppm, an inhibition of 35.5 ± 0.9%, 89.1 ± 1.2%, and 99.9 ± 5.5% were obtained, respectively. The gene expression analysis showed that flaA, omp18, and lpxD genes were down‐regulated with OxOral® compared with control (p < 0.05). Low cytotoxicity of 16.5 ± 7.6% was observed at the highest dose (15 ppm); no significant differences were observed from 15 to 0.469 ppm compared to the control of untreated cells (p > 0.05). Our results reveal an important anti-Helicobacter activity of OxOral® and open the possibility of its therapeutic use new studies, which would increase the success rate of conventional therapies against H. pylori.

Review of the Application of Nanovesicles and the Human Interstitial Fluid in Gastrointestinal Premalignant Lesion Detection, Diagnosis, Prognosis and Therapy.

Premalignant lesions arise from cells that abnormally proliferate and have a tendency to become cancerous. Developing methods to specifically target and remove these premalignant lesions is imperative to the prevention of malignant progression into gastrointestinal (GI) tumors. However, accurate detection and diagnosis of GI precancerous lesions is challenging, as these lesions show little or no structural change. Thus, this prevents early intervention and reduces the success rate of therapy. In this review, we performed a systematic analysis of the technological advancements in the combined application of nanovesicles (NVs) and the human interstitial fluid (HIF) to specifically target GI premalignant lesions. NVs, which include quantum dots (QDs), are small membranous vehicles of a nanometer diameter that are widely used as drug delivery vectors, therapeutic effectors and diagnostic sensors. HIF is the fluid that is present in human interstitial tissues (HITs) in which signaling molecules and agents travel and can be found throughout the body. HIF is exploited by tumor cells for their invasion, migration and spread. Because the HITs span the entire submucosa of the gastrointestinal tract, they have been increasingly targeted in GI tumor therapy. The challenges involved in the combined application of NVs and HIF in the detection, diagnosis, prognosis and therapy of GI premalignant lesions are also discussed.

Does biofeedback therapy improve quality of life in children with lower urinary tract dysfunction: parents' perspective

Lower urinary tract dysfunction (LUTD) is a situation that often disrupts the quality of life (QoL) of both the child and the family with daytime and nighttime incontinence. Although the first-line treatment option for children with LUTD is standard urotherapy, biofeedback therapy can be performed in children in which standard urotherapy failed. We studied the biofeedback success in children with LUTD according to parents' expressions. We retrospectively analyzed our hospital records of children who were diagnosed with LUTD between 2005 and 2017. In total, 281 patients, refractory to standard urotherapy were included into the study and directed to biofeedback treatment. Their parents completed the dysfunctional voiding symptom scores (DVSS) before and after biofeedback therapy. At the end of the six-month follow-up period, all voiding disorders and voiding patterns were evaluated. According to DVSS, QoL tools before biofeedback treatment 48 (17%) parents appraised that LUTD caused no effect in their children's daily life, 104 (37.8%) expressed little effect, 89 (31%) moderate effect, and 40 (14.2%) serious effect. And, 120 (43%) parents expressed no effect, 95 (34%) little effect, 51 (18%) moderate effect, and 15 (5%) serious effect (P=0.001) after biofeedback therapy. Biofeedback therapy affected positively the daily life of LUTD's family. The less serious the effect of LUTD on these children's family, the more success rate of biofeedback therapy. The effect of biofeedback therapy was less successful in moderated and serious affected families. Biofeedback treatment is a non-invasive and effective treatment modality for improving the QoL for LUTDfamilies who were less suffered from LUTD.

Etiology, drug sensitivity profiles and clinical outcome of bloodstream infections: A retrospective study of 784 pediatric patients with hematological and neoplastic diseases

Bloodstream infections (BSI) represent one of the most serious complications in patients in the hematology-oncology unit. In this study, the prevalence, distribution, drug sensitivity profiles, and clinical outcome of BSI were analyzed in pediatric patients with hematological malignancies. Patients admitted to the pediatric hematology-oncology unit at Shenzhen Children's Hospital (Shenzen, China) between January 2016 and December 2017 were enrolled. Their medical records, including gender, age, primary diseases, and microbiology results of all clinical specimens, were reviewed. The incidence of BSI, microbiology characteristics,and effectiveness of antimicrobial therapy were analyzed. A total of 125 BSI cases in 108 patients (mean age, 5.5 years) were recorded, of which 69 (55.2%) were nosocomial BSI cases. The overall rate of BSI was 18.8% in the hematology-oncology unit, of which 75 (75.2%) episodes were neutropenic patients. Patients with nosocomial BSIs and the neutropenic group were older (p#.02, p#.03). HSCTs and AML were more often observed in nosocomial BSIs, while solid tumors were more found in nonnosocomial and non-neutropenic BSIs. BSIs were dominated by Gram-negative pathogens (49.6%) in the hematology-oncology unit compared with Gram-positive pathogens (39.2%). The most common pathogens were coagulase-negative Staphylococcus (24.2%) followed by Klebsiella pneumonia (15.2%), Escherichia coli (12.5%), viridans streptococci (8.2%), and Candida species (7.8%). The antibiotic therapy success rate in patients was 93.5%. Based on our center's experience, Gram-negative pathogens were commonly observed among pediatric hematology-oncology patients with BSI. Coagulase-negative Staphylococcus and K. pneumoniae predominated and antibiotic therapy was effective in these patients.

PIH1 RELATIONSHIP BETWEEN INFERTILITY RELATED DISTRESS AND PRE-TREATMENT MODERATE TO VIGOROUS PHYSICAL ACTIVITY IN FEMALE PATIENTS

Physical activity (PA) may have positive effects on perceived distress during such sensitive life events like fertility treatments.Our aim was to study the association between PA and infertility-related stress, because of increasing incidence of infertility but remaining levels of success rate of assisted reproductive therapies (ART). A cross-sectional cohort study was carried out involving 50 female patients with infertility diagnosis during December 2018 – April 2019 in a university hospital-based fertility centre in South-Hungary. Respondents wear Actigraph GT3X accelerometers for a 7-days and completed the International Physical Activity Questionnaire Hungarian Short version (IPAQ-SFH) and the Global Physical Activity Questionnaire (GPAQ-H). Distress was measured with Beck Depression Inventory (BDI-13) and Fertility Problem Inventory (FPI-H). Spearman’s rank correlation was used to compared the different methods by SPSS 22.0 where the level of significance was set at p<0.05. Near to normal value of general stress (BDI-13: 5.13±5.22) but very high infertility-related stress in sexual (38.77±7.98) and relationship (47.63±10.52) domain (FPI-H) were self-reported. Higher level of performed moderate to vigorous physical activity (MVPA) with GPAQ-H (360.00±279.3 min/week) and lower with IPAQ-SFH (165.08±226.26 min/week, p≤0.01) and ActiGraph (159.07±92.01) was found. IPAQ-SFH MVPA correlates positively with FPI Relationship Concern (R=0.321, p=0.049) and negatively with FPI Rejection Concern (R=-0.399, p=0.012). Significant difference between active and inactive group was described for FPI Relationship Concern (Z=-2.534, p=0.011) and reaching the recommended 150 min/week MVPA for FPI Need for Parenthood Concern (Z=-2.124, p= 0.034). However, some partially counteracting relationship between PA and infertility-related stress was found, using only MVPA does not have sufficient evidence. For more impressive results, by domains and intensity detailed PA description, increased number of participants, and further examinations are needed.

Gender Differences in Arrhythmias: Focused on Atrial Fibrillation.

There are significant differences in clinical presentation and treatment of atrial fibrillation (AF) between women and men. The primary goal of AF management is to restore sinus rhythm and to prevent various complications, including stroke and heart failure. In many areas of AF, such as prevalence, clinical manifestations, morbidity, risk factors, pathophysiology, treatment strategies, and complications, gender-specific variability is observed and needs to be further addressed by large-scale population researches or randomized clinical trials, which help to promote the customization of AF treatment programs, hence to maximize the success rate of AF therapy in both sexes. This review highlights our current understanding of these gender differences in AF and how these differences affect treatment decisions on AF.

970 Thrombolytic Therapy for Acute Non-Malignant Portal Vein Thrombosis: A Systematic Review and Meta-Analysis

INTRODUCTION: Acute portal vein thrombosis (PVT) is a rare diagnosis frequently associated with cirrhosis. Clinical presentation is typically nonspecific with potentially catastrophic short-term complications including sepsis, bowel infarction, and death. Management strategies differ for acute and chronic PVT. Guidelines for treating acute PVT recommend immediate initiation of systemic anticoagulation. Direct and indirect thrombolytic therapy (mechanical thrombectomy and fibrinolytic therapy) may be used in combination with systemic anticoagulation in the setting of bowel ischemia or as an adjunct in patients with a contraindication to systemic anticoagulation. We aimed to assess the success of thrombolytic therapy for non-malignant acute PVT and to compare the success of direct versus indirect thrombolytic therapy. METHODS: This was a systematic review and meta-analysis in which two independent librarians searched the following databases from the date of inception to March 2019: Ovid Medline, Ovid Embase, Scopus and Web of Science. All included studies provided technical and clinical success data, as well as adverse events, and technique(s) used for the intervention of non-malignant acute PVT. RESULTS: The two independent database searches yielded 143 citations, of which 79 duplicates were removed leaving a total of 64 references and 11 were included in our analyses. The overall success rate of thrombolytic therapy using the random effects model was 83% (95%CI: 0.67, 0.92; P = &lt;0.01; I 2 = 61%). The overall clinical improvement rate of thrombolytic therapy using the fixed effects model was 95% (95%CI: 0.88, 0.98; P = 0.73; I 2 = 0%). The overall mortality of thrombolytic therapy using the fixed effects model was 5% (95%CI: 0.03, 0.11; P = 0.92; I 2 = 0%). In the direct and indirect thrombolytic groups, the rate of technical success was 84% and 52%, respectively, with an odds ratio of 3.37 (95%CI (0.96, 7.67), P-value = 0.127). CONCLUSION: Our analysis demonstrates that thrombolytic therapy successfully eliminates non-malignant acute PVTs with low rates of mortality. Direct thrombolysis may produce increased efficacy compared to indirect thrombolytic therapy. Larger prospective randomized trials comparing these interventions are warranted.

In vitro comparison of shear bond strength of a flowable composite resin and a single-component glass-ionomer to three different pulp-capping agents.

Various materials are used for vital pulp capping and the bond strength of restorative materials to these pulp-capping agents significantly affects the success rate of vital pulp therapy. The aim of this study was to determine the shear bond strength of a flowable composite resin and a single-component glass-ionomer to mineral trioxide aggregate (MTA), calcium-enriched mixture (CEM) cement and BiodentineTM as pulp-capping agents. Seventy-two cylindrical acrylic resin blocks, with a central hole 4 mm × 2 mm, were prepared. Mineral trioxide aggregate, CEM cement and Biodentine were placed in the cavities (n = 24 in each group) and incubated for 24 h. The blocks were subdivided into the composite resin and glassionomer subgroups. Cylindrical plastic molds, measuring 3 mm in height and diameter, were used to place the restorative materials on the samples. The shear bond strength test was performed at a strain rate of 1 mm/min in a universal testing machine. The samples were evaluated under a stereomicroscope at ×25 magnification for fracture modes. The data was analyzed with the one-way analysis of variance (ANOVA) and Tukey tests. The maximum and minimum mean shear bond strength values were recorded in the Biodentinecomposite resin (4.77 MPa) and MTA-glass-ionomer (2.20 MPa) groups, respectively. There were significant differences in the mean shear bond strength values of MTA, CEM cement and Biodentine to the composite resin and glass-ionomer (p < 0.001). A composite material may be preferable for definitive filling after pulp capping with Biodentine.

Endovascular Treatment of Iliac Artery Stenosis Caused by Takayasu Arteritis: A 10-Year Experience

Purpose: To evaluate the safety and efficacy of endovascular treatment for iliac artery stenosis caused by Takayasu arteritis (TA). Methods: Twenty-three consecutive TA patients (mean age 28.6±9.5 years; 17 women) with 30 iliac artery stenoses underwent percutaneous transluminal angioplasty (PTA) and selective stent implantation between January 2007 and December 2016. All had claudication (Rutherford category 2 or 3). The changes in the Rutherford category, ankle-brachial index (ABI), 6-minute walking capacity, and adverse events were assessed. Results: The success rate of endovascular therapy for iliac artery lesions was 93.3% (28/30). Guidewires could not cross either lesion in a patient with bilateral stenoses. Twenty-four lesions were treated by PTA alone and the other 4 lesions with provisional stents. One patient had a puncture site hematoma. Over an average of 4.8±3.3 years, 18 patients remained asymptomatic or had mild intermittent claudication. The other 4 patients developed moderate to severe intermittent claudication due to progression of a previously existing iliac lesion (n=1) or restenosis (n=3); all 4 underwent PTA. At the last follow-up, improvements were seen in the ABI (0.95±0.12 vs 0.51±0.22, p<0.001), 6-minute walking capacity (409.5±46.1 vs 272.6±32.3 m, p<0.001), and the Rutherford category of 22 patients. One patient died of a hemorrhagic stroke at 27 months due to uncontrolled hypertension. Conclusion: Endovascular therapy was safe and effective in treating TA patients with iliac artery stenosis, with good clinical outcomes in the long term.

Benefits of Surgery After Neoadjuvant Intraperitoneal and Systemic Chemotherapy for Gastric Cancer Patients With Peritoneal Metastasis: A Meta-Analysis

BackgroundConversion therapy is intended to allow achieving R0 resection after chemotherapy for tumors initially considered unresectable or partially resectable. Neoadjuvant intraperitoneal and systemic chemotherapy (NIPS) is the current conversion therapy for gastric cancer (GC) patients with peritoneal metastasis. This meta-analysis evaluated the effectiveness and safety of NIPS-combined surgery for GC patients with peritoneal metastasis. MethodsStandard methods were used to select and analyze studies that included GC patients with peritoneal metastasis assigned to two groups, either NIPS-combined surgery or a NIPS-only control. Publications were retrieved from PubMed, EMBASE, Medline, and the Cochrane Central Register. Overall survival, conversion therapy success and R0 resection rates, and adverse events were analyzed using Stata 11.0. ResultsEight of the 14 studies that were evaluated after screening the titles and abstracts of 327 retrieved publications met the selection criteria. The eight retrospective studies included 373 patients with GC and peritoneal metastasis included 265 with NIPS-combined surgery and 109 with NIPS only. Survival was significantly better with NIPS-combined surgery than with NIPS only (hazard ratio = 0.440, 95% confidence interval [CI]: 0.274-0.704; P = 0.0001; odds ratio = 1.960; 95% CI: 1.247-3.083; P = 0.004). Subgroup analysis revealed significantly better survival with S-1 Joint intravenous paclitaxel and intraperitoneal paclitaxel compared with other NIPS regimens. NIPS regimens had a higher conversion rate (effect size [ES] = 0.656; 95% CI: 0.495-0.817; P < 0.05), higher percentage of patients with R0 surgery (ES = 0.633; 95% CI: 0.568-0.699; P < 0.05), less severe adverse reactions to chemotherapy (ES = 0.030; 95% CI: 0.020-0.040; P < 0.05), and fewer postoperative complications (ES = 0.040; 95% CI: 0.020-0.050; P < 0.05). ConclusionsNIPS-combined surgical treatment was effective and safe for treating GC with peritoneal metastasis. Higher quality trials, better patient selection, and multicenter randomized controlled trials are needed to support standard treatment guidelines.