Symptom Improvement Rate Research Articles

Posterior vertebral column resection for recurrent tethered cord syndrome: a 10-year case series.

Tethered cord syndrome (TCS) is a significant cause of debilitation in patients with spinal dysraphisms or tumors. Management of TCS has historically centered on intradural detethering surgery, which is associated with a substantial risk of retethering, symptom recurrence, and repeat surgery. Vertebral column resection (VCR) has recently gained popularity as a treatment option via spinal shortening, but the literature on long-term outcomes is sparse. The objective of this study was to explore long-term clinical outcomes in a series of patients undergoing VCR for recurrent TCS. A retrospective review was conducted of all consecutive patients undergoing VCR for recurrent TCS at a single center between 2014 and 2024. Demographic and radiological characteristics were recorded, including spinal column height reduction as well as symptom improvement rates regarding sensorimotor dysfunction, pain, and incontinence at the latest follow-up. Intra- and postoperative complications were noted, and pre- and postoperative symptomology was compared using McNemar's test at a significance level of p < 0.05 to identify improvements. Twenty surgeries in 19 patients (median age 19 years) involving 10 males (52.6%) were assessed. The most common etiology of TCS was lipomyelomeningocele (n = 7, 36.8%), followed by lipoma (n = 6, 31.6%). Patients underwent a mean of 3.4 previous detethering procedures. Osteotomy was most commonly performed at the L1 level (n = 11, 55.0%), and the mean spinal column height reduction was 16.5 mm. At a mean follow-up of 43.1 (range 12-101) months, resolution of symptoms was observed in 10 patients with back pain (71.4%; p = 0.043), 10 patients with leg pain (66.7%; p = 0.004), 9 patients with lower extremity weakness (75.0%; p = 0.008), 4 patients with urinary incontinence (44.4%; p = 0.371), and 1 patient with fecal incontinence (33.3%; p > 0.99). Complications included a CSF leak in 1 patient and repeat VCR in 1 patient. These results suggest that in select patients with recurrent TCS, VCR represents a treatment option with high rates of symptomatic improvement and a relatively low risk of retethering as observed over several years of follow-up. These results add to the body of literature supporting VCR and provide a compelling basis for future prospectively designed studies.

An Adapted Friendship Bench Counseling Intervention (FB) to Improve Mental Health and HIV Care Engagement Outcomes Among People Living with HIV (PWH) Who Inject Drugs in Hanoi, Vietnam: Results from the VITAL Pilot Randomized Controlled Trial.

Common mental disorders (CMDs) are prevalent among people living with HIV (PWH) and cause morbidity, jeopardize HIV care engagement, and worsen HIV outcomes. In Vietnam, PWH who inject drugs are at high risk for poor HIV and CMD outcomes. However, few evidence-based interventions are available to address this population. We conducted a three-arm individually randomized pilot trial assigning 75 PWH with opiate use disorder and a CMD from methadone maintenance treatment clinics to either FB by a professional counselor, FB by a peer counselor, or enhanced usual care. Primary outcomes were feasibility, acceptability, and fidelity of FB; we also assessed preliminary indicators of CMD improvement and HIV care engagement. Feasibility was high, with 99% retention at 6weeks and 96% retention at 6months. 100% of patients receiving FB attended all 6 weekly sessions. Acceptability of FB was high for participants in both the professional and peer counselor groups. Providers were highly satisfied with the FB experience. Fidelity was adequate: 72% of professional counselors met or exceeded fidelity expectations, while 44% of peer counselors did. Preliminary indicators of effectiveness for CMDs were promising. Participants in the professional counselor arm had the greatest improvement as measured by CMD symptom improvement and CMD response rates at most follow-up visits. The adapted FB intervention should be scaled up and evaluated in a larger, fully powered randomized controlled trial to evaluate its efficacy in improving CMDs and HIV engagement for PWH and CMDs at greatest risk of poor HIV and CMD outcomes.Clinical Trial Number: NCT04790201 registered 3/10/2021.

Gamma knife radiosurgery for cavernous malformations: a comprehensive study on symptom relief, hemorrhage rates, and histopathological changes

This study aims to demonstrate the effect of gamma knife radiosurgery (GKRS) on symptoms, hemorrhage rates, and histopathological changes in patients with cavernous malformations (CMs), regardless of whether the symptomatic lesions are hemorrhagic. This single-center retrospective study evaluated symptomatic patients with single CMs treated with GKRS between 2016 and 2023. The patients’ demographic data, presenting symptoms, GKRS radiation dose, complications developed during follow-up (hemorrhage, radiotoxicity), the rate of symptom improvement, and histopathological changes of surgically removed CMs were recorded. Our study included 134 symptomatic patients, of whom 55 were male (41%) and 79 were female (59%). Among the patients, 80 (59.7%) had CMs in the lobar region, 23 (17.1%) in the cerebellum, 16 (12%) in the brainstem, and 15 (11.2%) in the basal nuclei/thalamus. The mean target volume was 0.64 ± 1.23 cm3, and the mean tumor margin dose was 14.89 ± 1.90 Gy. Symptoms were completely recovered in 95 patients (70.9%), while 18 (13.4%) experienced partial recovery. The annual hemorrhage rate (AHR) reduced from 6.26 to 1.01 following GKRS. Adverse radiation effects (ARE) were encountered in ten patients (7.46%) of cases, with only three patients (2.2%) being permanent. The mean follow-up period was 35.57 ± 23.54 months (2–83 months). Two patients without hemorrhage underwent surgical removal of CM due to symptomatic deterioration after GKRS. Histopathological examination demonstrated numerous vascular structures with luminal narrowing due to hyalinization and fibrinoid necrosis caused after GKRS. Our findings suggest that GKRS may help reduce hemorrhage rates and potentially relieve symptoms in patients with symptomatic CMs, although further long-term studies are necessary to confirm these observations and to fully assess potential risks. Since there is no radiological method to evaluate the impact of GKRS on CMs, our study examines the histopathological changes that occurred following the GKRS. The histopathological changes prove that GKRS alters the morphology of the CMs and thus can relieve symptoms and reduce hemorrhage rates associated with CMs.

Efficacy and Safety of Dual Delayed-Release Formulation of Esomeprazole in Patients with Gastroesophageal Reflux Disease: A Multicenter, Prospective, Observational Study

Gastroesophageal reflux disease (GERD) is a chronic and recurrent condition requiring constant dietary management and medication. This study evaluated the efficacy and safety of HIP1601, a dual delayed-release formulation of esomeprazole, in patients with GERD in a clinical setting. This prospective, multicenter, observational study was conducted at 309 medical institutions in Korea between June 2021 and March 2023. HIP1601 was administered at daily doses of 40 mg or 20 mg to 5,407 patients requiring treatment or prevention of erosive esophagitis. The primary outcome was the improvement rate of GERD symptoms at four weeks. GERD-related symptoms and treatment-emergent adverse events were also analyzed. This study included 5,282 patients in the safety analysis set and 5,232 in the full analysis set. At four weeks, the improvement rate of GERD symptoms was 92.1% (95% confidence interval [CI]: 91.3-92.8%). By eight weeks, the improvement rate increased to 94.6% (95% CI: 94.0-95.3%). After HIP1601 administration, the severity scores for all four GERD symptoms decreased to less than 1, with statistically significant changes in the scores (p<0.001). HIP1601 was well-tolerated, with minimal adverse events reported (0.17%), and the treatment-emergent adverse events were mild to moderate in severity. HIP1601 showed strong efficacy and safety in managing GERD symptoms, with high rates of symptom relief at four and eight weeks. Its extended action and improved symptom control make it a promising therapeutic option for GERD patients.

Oral medications for the treatment of postural orthostatic tachycardia syndrome; a systematic review of studies before and during the COVID-19 pandemic.

Postural Orthostatic Tachycardia Syndrome (POTS) is a complex form of dysautonomia that presents with abnormal autonomic reflexes upon standing, leading to symptoms such as lightheadedness, tachycardia, fatigue, and cognitive impairment. The COVID-19 pandemic has brought renewed attention to POTS due to its overlap with post-acute sequelae of COVID-19 (PASC). Studies have found that a substantial percentage of COVID-19 survivors exhibit symptoms resembling POTS, elevating POTS diagnoses to previously unseen levels. We systematically reviewed the literature for existing high-quality evidence on potential interventions. A systematic review of the literature was performed to identify studies of oral medications for the management of POTS. We searched for published manuscripts on the medical management of POTS through 6 April 2024 which met pre-specified inclusion criteria. We conducted quality appraisal and assessed risk of bias before extracting the data and performing synthesis to determine the current state of the evidence; particularly in the context of PASC. The study search and selection process identified 32 studies that met inclusion criteria, comprising randomized controlled trials, observational studies, and systematic reviews. Most included studies were judged to be of moderate to high quality, with largely low risk of bias. The most frequently studied medications were beta-blockers, ivabradine, and midodrine. Ivabradine and midodrine demonstrated the highest rate of symptomatic improvement, while beta-blockers showed the largest reduction in heart rate variability. Limited evidence was available for PASC-associated POTS, but findings suggest that treatments may have similar efficacy in both PASC and non-PASC cases. Ivabradine, midodrine, and beta-blockers currently appear to be reasonable front-line choices in pharmacologic management of POTS (PASC associated and otherwise). Further RCTs that evaluate long term outcomes of medications are needed to further establish evidence based pharmacologic treatment approaches for POTS. Particular areas of inquiry include differential efficacy of recommended therapies based on POTS subtypes, and a need for treatments directly targeting the underlying autonomic nervous system dysfunction. PROSPERO, identifier CRD42024505967, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=505967.

Efficacy and safety of chemotherapy combined with iodine-125 seed brachytherapy for intermediate and advanced oncogenic driver gene-negative non-small cell lung cancer

To compare the effectiveness and safety of CT-guided iodine-125 seed brachytherapy in conjunction with chemotherapy against chemotherapy alone for the management of intermediate and advanced non-small cell lung cancer (NSCLC) lacking oncogenic driving genes. Retrospective analysis was conducted on clinical data from 128 patients diagnosed with intermediate and advanced non-small cell lung cancer who received iodine-125 combined with chemotherapy or chemotherapy alone due to the absence of oncogenic driver gene mutations. The patients in two groups were compared at 6-month follow-up for objective remission rate (ORR), Disease control rate (DCR), local progression-free survival (LPFS), overall survival (OS), clinical symptom improvement, and adverse events. A median of 47 (range, 16-100) iodine-125 seeds were implanted. The median D90 was 139.4 Gy. In patients with stage III NSCLC, the 6-month ORR were 40.0% and 8.0% in two groups, while those with stage IV NSCLC had rates of 20.9% and 4.0%. No significant issues arose during the 5-58 months follow-up period. OS did not significantly differ between stage III and IV NSCLC patients. The LPFS for stage III patients was 14 months and 9 months, compared to 8 months and 7 months for stage IV patients. Symptom improvement rates, including cough, chest discomfort, hemoptysis, and chest constriction, were 87.2% versus 20.4%, 77.8% versus 33.3%, and 77.8% versus 26.1%, respectively. CT-guided iodine-125 seed implantation with chemotherapy failed to improve OS in stages III and IV NSCLC. However, it did extend the LPFS of stage III NSCLC. Furthermore, the ORR was much higher than that of the chemotherapy-only group, and lung cancer clinical symptoms were significantly reduced, improving patient quality of life.

Umbilical needling therapy for neck pain during pregnancy: A case report.

Neck pain during pregnancy is a common disease during pregnancy. It is urgent to find a safe and effective method without side effects. Acupuncture therapy including umbilical needling has been widely used in many diseases. But there is no report in such cases. We report a case of umbilical needling therapy for neck pain during pregnancy and explore its possible mechanism of action. A 35-year-old Chinese woman was pregnant for more than 7 months and had neck pain for 1 week. Neck pain was diagnosed in Western medicine, and neck arthralgia in traditional Chinese medicine. The syndrome differentiation was wind-cold arthralgia. One patient with neck pain during pregnancy was treated with umbilical needling. According to the 12 branches and the 8 trigrams in the umbilicus, the umbilical needling Zhuque 3 acupuncture and di Tiantai guayi acupuncture were used to treat neck pain during pregnancy. The clinical improvement was evaluated by the changes in clinical symptoms and signs and the improvement rate of the Visual Analogue Scale score. After 7 times umbilical needling treatments, the improvement rate of neck pain symptoms and Visual Analogue Scale score of pregnant women reached 100%. These results show that umbilical needling therapy can effectively improve the clinical symptoms of neck pain during pregnancy without affecting the fetus. Umbilical needling in neck pain treatment during pregnancy should be further investigated.

Factors for Treatment Failure After Fecal Microbiota Transplantation in Clostridioides difficile Infection.

Recently, fecal microbiota transplantation (FMT) has been introduced as an effective treatment option for Clostridioides difficile infection (CDI). However, the risk factors associated with FMT treatment failure have not been well demonstrated. Therefore, we aimed to investigate the risk factors of treatment failure or recurrence after FMT for CDI. This retrospective study included 124 patients with CDI who underwent FMT at Inha University Hospital between November 2017 and August 2021 and were followed up for 8 weeks after FMT for symptoms of CDI. FMT failure was defined as diarrhea recurrence or a positive stool test. We assessed the risk factors for treatment failure, including comorbidities, antibiotic use pre- and post-FMT, and the number of CDI episodes before FMT. Ninety-three patients (75%) experienced symptom improvement <7 days after FMT, while treatment failure occurred in 40 patients (32.3%). Multivariate analysis revealed that males had a lower symptom improvement rate <7 days after FMT (p = 0.049). Patients using antibiotics after FMT showed a higher rate of recurrence or treatment failure in <8 weeks (p = 0.032). Patients requiring antibiotics after FMT should be considered at higher risk of treatment failure. Careful antibiotic stewardship, particularly minimizing non-essential antibiotic use before and after FMT, may significantly enhance treatment outcomes. Further large-scale prospective studies are warranted to confirm these findings and develop targeted antibiotic management protocols for improving the efficacy of FMT in CDI treatment.

Arcuate eminence distance to temporal bone outer table in the middle fossa repair of superior canal dehiscence.

To investigate the influence of arcuate eminence's distance to temporal bone outer table (AE-OT) on surgical outcomes following the middle fossa repair of superior canal dehiscence (SCD). We conducted a cohort study of consecutive repairs at a center between 2011 and 2022. AE-OT was measured on temporal bone CT imaging. Surgical outcomes were assessed with established metrics including Symptom Resolution Score (SRS), rate of Overall Symptom Improvement (OSI), and change in low-frequency air-bone gap (ΔLF-ABG) from pre- to post-surgery. Multivariable regression models assessing surgical outcomes were constructed with AE-OT as the primary predictor. Models adjusted for patient demographics, medical and surgical history, and follow-up duration. A total of 402 repairs were included. Mean AE-OT was 27.1mm (SD 2.1, range 20.8-33.9). Every mm increase in AE-OT was independently associated with a 14% reduction in odds of OSI (aOR 0.86, 95% C.I. [0.75, 0.98]) and a 4-point decrease in SRS (adj. β - 4.0 [- 6.9, - 1.1]) among frank dehiscences. AE-OT was also not associated with operative duration and ΔLF-ABG among both frank dehiscences and near dehiscences. Longer AE-OT predicted poorer symptomatic response but similar operative duration and audiometric improvementamong frank SCDcases.

Coccygectomy: Therapeutic Results of 12 Cases of Posttraumatic Coccygodynia

Abstract Introduction Coccygodynia is pain localized in the coccygeal region. Symptoms can be relieved after conservative treatment. In refractory cases, surgical treatment gives good clinical results. We report 12 cases of posttraumatic coccygodynia refractory to conservative treatment managed surgically. Materials and Methods This was a retrospective analysis including the records of all patients operated on in the neurosurgery departments and units of the Conakry University Hospital and the Sino-Guinean Friendship Hospital for posttraumatic coccygodynia refractory to conservative treatment over a 4-year period from January 2019 to December 2022 with a minimum postoperative follow-up of 12 months. Results Twelve cases were identified over a 4-year period with a mean age of 36 years and a male predominance (7 males/5 females). Coccygodynia was the main complaint and was present in all patients. The mean visual analog scale was 8.7 and the mean body mass index was 24.1. Sacrococcygeal computed tomography scans were performed in all patients. The indication for surgery was given after failure of conservative treatment. Three patients underwent partial resection of the coccyx and nine underwent total resection. All patients underwent postoperative sacrococcygeal radiography. Progress was favorable in 75% of patients. Morbidity included two cases of surgical site infection and zero mortalities. Conclusion Although the number of cases in this study was small, our positive results in terms of symptom improvement and satisfaction rates suggest that coccygectomy is a relatively safe and effective means of treating traumatic coccygodynia when nonsurgical methods have failed.

Ten years of experience with ruxolitinib since approval for polycythemia vera: A review of clinical efficacy and safety.

The oral Janus kinase (JAK) 1/JAK2 inhibitor ruxolitinib was approved by the US Food and Drug Administration in 2014 for treatment of patients with polycythemia vera (PV) who have an inadequate response to or intolerance of hydroxyurea (HU). PV is a chronic myeloproliferative neoplasm defined by primary absolute erythrocytosis, bone marrow hypercellularity, and JAK mutations such as JAK2V617F. Patients with PV experience burdensome symptoms and are at risk of thromboembolic events, in particular those with resistance to or intolerance of initial treatments such as HU. Other risks for patients with PV include progression of disease to more aggressive forms with worse prognoses, such as myelofibrosis or blast-phase myeloproliferative neoplasms. This review summarizes the efficacy and safety of ruxolitinib from key phase 2 and 3 trials (MAJIC-PV, RESPONSE, RESPONSE-2, RELIEF, and Ruxo-BEAT), large real-world studies, and a decade of postmarketing surveillance safety data. The authors focus on improved blood count control, rates of thromboembolic events, symptom improvement, and markers of disease modification such as reduction of JAK2V617F allele burden in patients treated with ruxolitinib. They also discuss the well-characterized safety profile of ruxolitinib regarding hematologic and other adverse events of interest. In the 10 years since its approval, ruxolitinib remains a safe and effective standard-of-care treatment for PV. As the treatment landscape for PV continues to evolve in the coming years, the efficacy and safety profiles of ruxolitinib suggest it will remain a preferred treatment as monotherapy and as a potential backbone of future combination regimens.

Traditional Chinese medicine application and evidence analysis of 1426 cases of long COVID: A retrospective study

BackgroundIn recent years, with the increase in COVID-19 infection cases, the focus of treatment and rehabilitation has shifted to symptoms and complications that arise during the recovery period. Traditional Chinese medicine (TCM) has certain advantages in treatment and rehabilitation, but there is currently a lack of systematic clinical research. ObjectiveTo preliminarily evaluate the clinical efficacy of integrated Chinese and Western medical treatment plans and to describe the characteristics of "long COVID'' syndromes. MethodsEligible "long COVID'' patients diagnosed between December 2022 and June 2023 at the Third Affiliated Hospital of Zhejiang Chinese Medical University were identified through electronic medical records. Baseline demographic information was collected, and patients were divided into a TCM group and a Western medicine group based on their treatment methods. The primary outcome for efficacy evaluation was TCM syndrome scores and symptom improvement time, with secondary outcomes including symptom improvement rates. Survival curve analysis was used to assess symptom improvement time, and a Cox regression model was employed to identify potential risk factors affecting symptom prognosis. Chi-square tests were used to compare binary data between or among groups. The Jaccard method was applied for systematic clustering of TCM syndromes, and clinical characteristics at the start and end of treatment were reported. ResultsAnalysis showed that younger patients, those with underweight, and those receiving TCM treatment had shorter recovery times (P < 0.0001). Systematic clustering of the main symptom elements (33 elements with a frequency ≥ 5 %) identified six core combinations. The main symptoms of long COVID included cough, excessive sputum, nasal congestion, chest tightness, sore throat, and fatigue. Notably, symptoms such as fatigue, shortness of breath, and loss of appetite, classified as deficiency syndromes in TCM, had longer recovery times. ConclusionElderly, obesity, underlying diseases, and exclusive Western medicine treatment were associated with poorer prognosis. The early recovery period is characterized by a mix of deficiency and excess syndromes, whereas the later period is dominated by deficiency syndromes. TCM treatment can effectively improve clinical symptoms and shorten symptom duration, but further research is needed.

Comparative analysis of treatment protocols and clinical outcomes in the management of acute urticaria and angioedema in the emergency department

Objective: The purpose of the study was to identify clinical differences in patients with acute urticaria and/or angioedema receiving various treatment regimes in the emergency department of Lady Reading Hospital, Peshawar. Particularly, it compared modern antihistamine therapy with corticosteroids as an analogue to routine antihistamines with regard to the rate of symptom improvement, relapse, and hospitalisation. Methods: This was a cross-sectional descriptive study involving 542 patients with acute urticaria and/or angioedema. Patients were categorised into two groups: Group A, receiving a combination of antihistamines and corticosteroids (280); and Group B, receiving only antihistamines (262). Thus, the primary end points considered include time to resolution of symptoms, recurrence within 48 hours, and hospitalisation need. Data was analysed using the statistical package of social sciences (SPSS), while a p-value of &lt; 0.05 formed the basis of significance. Results: The overall improvement time for symptoms was 3.6 hours in Group A and 5.1 hours in Group B (p &lt; 0.001). The rates of recurrence were also lower in Group A (15%) than in Group B (29.8%, p &lt; 0.01). Meanwhile, patients who were in Group A had 10% that needed inpatient admission as an intervention compared to 19.1% in Group B; p &lt; 0.05. Side effects were few and were comparable between the two groups; therefore, patients in both groups had reactions such as drowsiness and gastrointestinal disturbances. Conclusion: Together, antihistamines plus corticosteroids were superior to antihistamines only in the treatment of acute urticarial and angioedema in patients in the emergency department. Patients reported symptoms resolved sooner, the rate of relapse was shorter, and hospitalisation was reduced. Based on this observation, corticosteroids should be considered as part of the usual care of patients presenting with moderate to severe symptoms in the emergency department. Future research should aim at sorting out various recommendations of treatment value for the purpose of achieving even better results of the therapy.

Unveiling the efficacy of paroxetine and gabapentin in ulcerative colitis patients in remission with co-existing IBS-like symptoms: a single-blinded randomized clinical trial.

This clinical trial is designed to explore the efficacy of paroxetine and gabapentin in alleviating functional gastrointestinal symptoms, anxiety, depression, and quality of life in patients with ulcerative colitis during the remission stage. The study enrolled 97 patients with ulcerative colitis in remission who had reported functional gastrointestinal symptoms. Patients were measured in terms of quality of life, anxiety, depression, and IBS severity. One group received paroxetine at a dosage of 20 mg/day, and the other group received gabapentin at a dosage of 100 mg/day in the first month and 300 mg/day in the second and third months. The patients were followed up for 3 months. Anxiety (p < 0.001), depression (p = 0.012), and severity score levels (p = 0.045) among patients in the paroxetine group were significantly lower compared to the gabapentin group following the intervention. Paired evaluation in each treatment group revealed a significant reduction in the paroxetine group, while changes in the gabapentin group were not significant. Quality-of-life scores among patients in the paroxetine group were significantly higher compared to the gabapentin group following the intervention (p < 0.001). The rate of improvement in gastrointestinal functional symptoms, anxiety, depression, and quality of life is significantly superior with paroxetine compared to gabapentin. https://irct.behdasht.gov.ir/trial/69397, identifier RCT20220417054557N1.

Impact of nurse-led palliative care on symptom management and life quality outcomes in elderly cancer patients: A retrospective study.

The objective was to explore impacts of nurse-led palliative care interventions on elderly cancer patients in terms of symptom management and life quality outcomes. This retrospective study examined 150 cancer patients from January 2021 to September 2023, divided into 2 groups based on nurse-led palliative care receipt. The observation group (n = 90) received nurse-led palliative care while the control group (n = 60) received routine nursing frequency was 3 times per week for 6 months. The treatment-related symptoms (therapy-related symptoms checklist, TRSC) was used to evaluate the symptom improvement rate of patients, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) was used to evaluate the improvement of patients' quality of life, and Chinese version of the Brief Pain Inventory (BPI-C) and Chinese version of the Brief Fatigue Inventory (BFI-C) were used to access the improvement of pain and fatigue respectively. Following the intervention, symptom improvement rate in the observation group exhibited markedly superior compared to the control group (100% vs 91.67%, P < .05) and a significant improvement in the patient's health-related quality of life was observed in the observation group at 1, 3, and 5 months postintervention (P < .05). In additional, the observation group displayed notably lower scores on both BPI-C and the BFI-C in contrast to the control group (P < .05). Nurse-led palliative care interventions can effectively improve symptom management and quality of life in elderly cancer patients compared to routine nursing care.

Outcomes after endovascular revascularization for chronic limb-threatening ischemia from the only Vascular Quality Initiative (VQI) center in Asia

ObjectiveThis study compares chronic limb-threatening ischemia disease characteristics and endovascular revascularization outcomes in a multi-ethnic Asian cohort vs their North American counterparts. MethodsThe Society for Vascular Surgery Vascular Quality Initiative (VQI) registry database from the first and currently the only VQI center in Asia was reviewed to identify patients with chronic limb-threatening ischemia who underwent endovascular revascularization between July 2019 and April 2024. Standardized VQI reporting variables were compared against benchmarks derived from all participating centers in North America. ResultsA total of 2862 endovascular revascularization procedures from our center were benchmarked against 129,347 procedures from 406 North American centers. Our cohort had a higher burden of comorbidities (diabetes mellitus, end-stage renal disease, cardiac disease) and presented with more advanced Wound, Ischemia, and foot Infection stages. Our patients had more heavily calcified and longer (14.8 cm vs 6.0 cm) diseased vessels with higher prevalence of multi-level (87% vs 54.6%), infrapopliteal (52.6% vs 38.9%), and inframalleolar (9.6% vs 2.4%) disease. Rates of technical success (92.7% vs 93%) and symptom improvement (39.1% vs 40.4%) were comparable between cohorts. However, 1-year mortality rates (28.9% vs 25.1%) and major amputation rates (13.3% vs 7.8%) were significantly higher. ConclusionsShort-term outcomes of technical success and symptom relief in our center were comparable to benchmarked North American outcomes despite having a cohort with more diseased vessels, higher Wound, Ischemia, and foot Infection stages, and more comorbidities. However, this cohort fared worse in longer term outcomes of 1-year mortality and major amputation rates. Further studies are required to elucidate the causes to improve these outcomes.

S559 Heartburn Frequency and Symptom Improvement Rates of Treated Episodes when Switching From Daily to On-Demand Vonoprazan Treatment for Non-erosive Reflux Disease

S559 Heartburn Frequency and Symptom Improvement Rates of Treated Episodes when Switching From Daily to On-Demand Vonoprazan Treatment for Non-erosive Reflux Disease

Posterior Cranial Vault Distractor Osteogenesis for the Treatment of Chiari Malformation Type 1: A Systematic Review of the Literature.

Although posterior cranial vault distraction osteogenesis (PVDO) is utilized routinely now for the treatment of craniosynostosis, its use as a treatment option for Chiari type 1 malformation (CM1) is limited to case reports and small retrospective case series. The authors conducted a systematic review of the published literature for PVDO as a treatment for CM1. The primary outcomes were reported complications, symptom improvement, and reoperation rates in patients that had PVDO surgery for CM1. The authors further investigated differences between patients with CM1 with an associated genetic syndrome and craniosynostosis. In total, 42 patients with an average age of 41.1 months were used in our analysis. A total of 38.1% of the patients had a diagnosed syndrome, 78.6% of patients had associated craniosynostosis, and 26/42 (61.9%) total patients-reported symptom improvement. Of 26 patients that reported symptom improvement, 20 (76.9%) had associated syndromes and 6 (23.1%) did not (P=0.011). In addition, of these 26 symptom improved patients, 17 (65.4%) were associated with craniosynostosis while 9 (36.4%) did not have craniosynostosis (P=0.008). Posterior cranial vault distraction osteogenesis seems to be a promising new surgical intervention for treatment of CM1. Most patients saw symptom improvement after treatment (61.9%). There was a clinically and statistically significant difference in symptom improvement for patients with syndromic CM1 when compared with nonsyndromic CM1 patients.

A randomised controlled clinical study of standard triple therapy, bismuth-based quadruple therapy and sequential therapy for Helicobacter pylori infection in children

Background and aimBismuth and non-bismuth quadruple therapy are the guideline-recommended first-line therapy in children with Helicobacter pylori infection in areas with high antibiotic resistance. However, their efficacy in children is uncertain and there are few well-designed studies. Here, we evaluated the eradication rates of standard triple therapy, bismuth-based quadruple therapy and sequential therapy in children with H. pylori infection.MethodsA randomised controlled trial was conducted in children infected with H. pylori in West China Second Hospital. They were randomly assigned to 14-day standard triple therapy (omeprazole + amoxicillin + clarithromycin), 14-day bismuth quadruple therapy (bismuth + omeprazole + amoxicillin + clarithromycin) and 10-day sequential therapy (omeprazole + amoxicillin for 5 days followed by omeprazole + clarithromycin + metronidazole for 5 days). The eradication rate was assessed by a 13C-urea breath test 4 to 6 weeks after therapy completion. Symptom improvement and adverse events were compared among the groups.ResultsIn total, 132 patients were enrolled. The eradication rates of 14-day standard triple therapy, 14-day bismuth quadruple therapy and 10-day sequential therapy were 70.0%, 78.9% and 50.0% in per-protocol analysis and 63.6%, 68.2% and 43.2% in intention-to-treat analysis, respectively. Symptom improvement and adverse drug event rates were similar in the three groups.ConclusionThe three therapeutic regimens evaluated in this study are equally not recommendable for H. pylori infection treatment due to unsatisfactory eradication rates. The high prevalence of clarithromycin resistance makes the use of clarithromycin-based quadruple therapy not advisable, even in combination with amoxicillin and bismuth salts.

Endoscopic third ventriculostomy (ETV) for Chiari 1 malformation: a systematic review and meta-analysis.

Meta-analysis and systematic review. To understand the role of endoscopic third ventriculostomy (ETV) for the treatment of concurrent Chiari Malformation Type I (CMI) and hydrocephalus in adults. A literature search on PubMed and Medline with MeSH terms relating to ETV and CMI identified 155 articles between 1988 and 2024. After excluding pediatric cases and other CNS pathologies with associated CMI, 11 articles met inclusion criteria. The Newcastle-Ottawa Scale was identified to assess heterogeneity and risk of bias among the 11 studies analyzed in this systematic-review and meta-analyses compared pre- and post-operative outcomes to examine the use of ETV as a treatment modality for CMI with hydrocephalus. From the 11 included studies, 35 cases of concurrent CMI and hydrocephalus treated with ETV were identified. ETV provided a pooled rate of symptom resolution or improvement of 66%. Additionally, meta-analysis discovered the following pooled rates: a reduction of tonsillar descent in 94% of patients, decreased ventriculomegaly in 94%, and ETV patency in 99%. Syringomyelia, nausea, papilledema and cerebellar dysfunction did not have sufficient numbers for meaningful statistical analyses. However, in each of these categories, more than 85% of the symptoms or radiographic findings improved. This review summarizes the safety and efficacy of ETV for the concurrent management of acquired CMI with hydrocephalus. Specifically, ETV improves radiological outcomes of both ventriculomegaly and tonsillar descent as well as the most prevalent neurological symptom, headaches.