Therapeutic Complications Research Articles

Medical Treatment of Pediatric Low-Grade Glioma.

Low-grade glioma (LGG) is the most common brain tumor in children and has excellent long-term survival. With an excellent survival rate, the choice of treatment involves careful consideration of minimizing late toxicity from surgery, radiation, and chemotherapy. Surgery, radiation therapy, and chemotherapy can be used as monotherapy or in combination, providing different therapeutic ratios and complications. As a result, establishing the selection of ideal therapies has been a controversial area, presenting challenges. Recent advances in understanding molecular characteristics of pediatric LGG affect classification and treatment approaches. This review aims to overview recent developments in medical treatment in pediatric LGG.

Radiomics in Nasopharyngeal Carcinoma.

Nasopharyngeal carcinoma (NPC) is one of the most common head and neck malignancies, and the primary treatment methods are radiotherapy and chemotherapy. Radiotherapy alone, concurrent chemoradiotherapy, and induction chemotherapy combined with concurrent chemoradiotherapy can be used according to different grades. Treatment options and prognoses vary greatly depending on the grade of disease in the patients. Accurate grading and risk assessment are required. Recently, radiomics has combined a large amount of invisible high-dimensional information extracted from computed tomography, magnetic resonance imaging, or positron emission tomography with powerful computing capabilities of machine-learning algorithms, providing the possibility to achieve an accurate diagnosis and individualized treatment for cancer patients. As an effective tumor biomarker of NPC, the radiomic signature has been widely used in grading, differential diagnosis, prediction of prognosis, evaluation of treatment response, and early identification of therapeutic complications. The process of radiomic research includes image segmentation, feature extraction, feature selection, model establishment, and evaluation. Many open-source or commercial tools can be used to achieve these procedures. The development of machine-learning algorithms provides more possibilities for radiomics research. This review aimed to summarize the application of radiomics in NPC and introduce the basic process of radiomics research.

Extracorporeal membrane oxygenation in the forensic setting: A series of 19 forensic cases.

Extracorporeal membrane oxygenation (ECMO) employs vascular cannulation and a gas exchange circuit to provide support to patients with severely compromised cardiopulmonary function. ECMO is often the last intervention taken before death and thus presents a unique challenge to medical examiners. This study describes the characteristics of decedents on ECMO at the time of death, including clinical indications, types of circuit configurations, causes and manners of death, gross findings at autopsy, and therapeutic complications. Files of a regional medical examiner office within an academic medical center were searched for the period between 2013 and 2019. Nineteen cases were identified with a median age of 36years. The circumstances surrounding the initial presentation included: sudden death, trauma, substance abuse, homicide, therapeutic complication, work-related injury, drowning, and hypothermia. The underlying causes of death included injury-related, as well as respiratory and cardiac-related natural diseases. The time spent on ECMO varied from less than 1h to 10months. Complications encountered due to ECMO included cannulation site bleeding, pneumohemopericardium, retroperitoneal hematoma, limb ischemia, clotting, and cannula dislodgement. The patient population likely to receive ECMO has significant overlap with death circumstances likely to be reported to the medical examiner. As ECMO therapy has become increasingly available, it is of importance for medical examiners and death investigators to be familiar with the procedure as well as its limitations. Familiarity with ECMO and its sequelae allows for the proper documentation of postmortem findings and fosters an informed determination of the cause and manner of death.

Two-Year Evaluation of the German Clinical Amyloidosis Registry

Introduction Currently there are no sufficient epidemiology data on systemic amyloidosis in Germany. Our aim was to collect epidemiological data on amyloidosis diseases to determine incidence and distribution of amyloidosis types in Germany. In addition, data on diagnosic pathways, demographic, clinical and biological factors, quality of life (Qol) and overall survival (OS) have been collected.Methods: The actual registry population consists of the first n=1000 reported cases of newly diagnosed amyloidosis patients between 4.1.18 - 21.11.19. Data cutoff of the analysis was June 30, 2021. Patients were included in the registry by two main ways: personal presentation at the amyloidosis outpatient clinic or phone contact of the attending physician to the Amyloidosis Center. Inclusion criteria were either a Congo Red positive tissue sample or unequivocal findings in bone scintigraphy (ATTR amyloidosis). Patients were contacted every 6 months to obtain QoL data using EORTC QLQ-C30, EQ-5D-5L and SF36-v2 questionnaires. This registry was financially supported by Prothena.Results: During this time period 963 of the first 1000 reported newly diagnosed patients (37 pts. did not fulfil inclusion criteria and were excluded) were evaluated mainly through the amyloidosis outpatient clinic (n=581, 60.3%). Seventy-three percent of cases were male (n=706). The median age at diagnosis was 71 years and differed between the AL pts.(65,5 years) and ATTRwt (78 years) patients. The subgroup distribution was as follows: 438 (45,5%) AL pts., 318 (33%) ATTRwt pts., 35 (3,6%) ATTRv pts, 60 (6,2%) ATTR of unknwon subtype, 66 (6,8%) local amyloidosis, 30 (3,1%) AA amyloidosis, 12 (1,2%) others and 4 (0,4%) not typed. Diagnosis was confirmed by biopsy in 88% and in 12% by bone scintigraphy. The most commonly involved organs were heart (n=733, 76,1%) and kidney (n=305, 31,7%). Cardiac staging systems were used for systemic AL (Kumar et al., 2014) with heart involvement and ATTR amyloidosis (Gillmore et al., 2018). Data on survival were available in all cases (median follow-up 27 months). During the observation time 249 patients died (60 ATTRwt and 153 AL pts., 36 other, figure). The most frequent cause of death was amyloidosis itself (n=191, 76,7%). Seven (2,8%) patients died due to therapeutic complications. Compared to ATTRwt patients with cardiac AL amyloidosis had a higher hazard to die, 1 year survival was 78.96% (95% CI 75.23% - 82.88%) compared to 94.30% (95% CI 91.80% - 96.90%), respectively. In multivariate analysis (including age, cardiac staging systems and time from symptoms to diagnosis) factors associated with worse OS were increasing age for AL pts. (HR 1.04, p<0,001 for AL, and highest cardiac stage (HR 2.33, p=0,001 for AL and 5.69, p<0,001 for ATTRwt).Conclusion: The first 2 years of the German clinical amyloidosis registry have been successful to generate valuable clinial data for all types of amyloidosis from newly diagnosed patients. Subtyping the amyloid precursor protein was successful in nearly all patients. The most common form is AL followed by ATTRwt amyloidosis. Heart involvment was very common and pts. were mostly in advanced cardiac stage. Main cause of death was amyloidosis related. In 2020 we have started an extended registry (financially supported by Janssen) including anonymized biopsy reports from reference pathologists. With this approach we will probably obtain more precise data on incidence in Germany. [Display omitted] DisclosuresHegenbart: Alnylam: Honoraria; Akcea: Honoraria; Pfizer: Consultancy, Honoraria; Janssen: Consultancy, Research Funding; Prothena: Research Funding. Carpinteiro: Janssen: Honoraria; BMS: Honoraria; GSK: Honoraria; Amgen: Honoraria; Takeda: Honoraria. Müller-Tidow: Pfizer: Research Funding; Bioline: Research Funding; Janssen: Consultancy, Research Funding. Schönland: Janssen: Honoraria, Other: Travel grants, Research Funding; Prothena: Honoraria, Other: Travel grants; Pfizer: Honoraria; Takeda: Honoraria, Other: Travel grants; Sanofi: Research Funding.

Effects of Pulmonary Surfactant Combined with Noninvasive Positive Pressure Ventilation on KRT-14 and ET-1 Levels in Peripheral Blood and Therapeutic Effects in Neonates with Respiratory Distress Syndrome.

This study is aimed at exploring the effect of pulmonary surfactant (PS) combined with noninvasive positive pressure ventilation on the levels of Keratin-14 (KRT-14) and Endothelin-1 (ET-1) in peripheral blood and the therapeutic effect of neonatal respiratory distress syndrome (NRDS). Altogether 137 cases of neonates with respiratory distress syndrome treated in our hospital from April 2016 to July 2018 were collected. Among them, 64 cases treated with noninvasive positive pressure ventilation were considered as the control group, and 73 cases treated with PS combined with noninvasive positive pressure ventilation were considered as the observation group. The expression of KRT-14 and ET-1 in the two groups was compared. The therapeutic effect, death, complications, and blood gas indexes PaO2, PaCO2, and PaO2/FiO2 in the two groups were compared. Receiver operating characteristic curve (ROC) was applied to analyze the diagnostic value of KRT-14 and ET-1 in the therapeutic effect of NRDS. The effective rate of the observation group was higher than that of the control group. After treatment, PaO2 and PaO2/FiO2 in both groups were notably higher than that before treatment, while PaCO2 was notably lower than that before treatment. And after treatment, the levels of PaO2 and PaO2/FiO2 in the observation group were remarkably higher than that in the control group; PaCO2 was notably lower than that in the control group. After treatment, the levels of KRT-14 and ET-1 in the two groups were remarkably lower than those before treatment, and the levels of KRT-14 and ET-1 in the observation group were considerably lower than those in the control group after treatment. ROC curve showed that the area under the curve (AUC) of KRT-14 was 0.791, and the AUC of ET-1 was 0.816. PS combined with noninvasive positive pressure ventilation can notably improve the therapeutic effect of NRDS. KRT-14 and ET-1 levels may be potential therapeutic diagnostic indicators.

Фітопрепарати в комплексному лікуванні запальних захворювань пародонту

In this article the review of foreign and domestic literary sources, which are devoted to the actual problem of modern dentistry – the treatment of inflammatory diseases of periodontal tissues: gingivitis and periodontitis are presented. The complex approach to their treatment involves the appointment of a significant amount of pharmacotherapeutic drugs. Therapeutic failures and iatrogenic complications have led to the fact that today the interests of doctors and population to medicinal products significantly increased. The purpose of the study is to analyze the data of scientific literature on the use of plant-based medicinal products for the treatment of periodontal inflammatory diseases over the past 10 years. Materials and methods. Comprehensive and systematic analysis of literature. Review and discussion. The analysis of information sources on the use of plant-based medicinal products in dentistry both independently and in the composition of medical and prophylactic means has established that the modern assortment of plant-based preparations in the pharmaceutical market of Ukraine to a certain extent is limited. The emergence of new plant-based species that have been tested in conditions of experimental pathology and require an evidence-based clinical base is noted. The composition of plant-based preparations used for the treatment of inflammatory periodontal diseases include vitamins, biologically active substances, glycosides, alkaloids, in connection with a wide range of action: antiseptic, anti-inflammatory, regenerating, hemostatic, antioxidative. The data on plant-based preparations that are most often used such as chamomile extracts, calendula, hypericum, plantain, kalanchoe, aloe, eucalyptus, milfoil, nettle, calamus and plant-based species are summarized. The medicinal agents considered are mainly recommended for local treatment of periodontal diseases in the form of dental care means, mouth rinse, gel, chewing gum, herbal liquer. It is known that the complex treatment of periodontal diseases includes a general influence on the body. The properties of green tea with its wide range of actions are investigated. With antioxidant properties, it can be a healthy alternative for controlling destructive changes in periodontal diseases. Attention is drawn to the proposed unique natural complex “Resverazin” due to a wide range of pharmacological action, low toxicity and relative safety. The drug produces antioxidant, anti-inflammatory, immune stimulating, vasodilative, neuroprotective action. Conclusion. Based on the literature analysis, it can be concluded that the accumulated experimental and clinical data on the therapeutic properties of plants prove perspective of their use in the complex treatment of inflammatory periodontal diseases. Future studies are mandatory for further confirmation of the effectiveness of these medicinal plants

Effects of I-125 seeds combined with anlotinib on tumor growth and bone metabolism in A549 tumor-bearing mice

Purpose This study aimed to investigate the therapeutic potential of tumor suppression and mechanism for different implantation modes of iodine-125 (I-125) seeds irradiation in a mice xenograft model, and its skeletal complications. Materials and methods A total of 24 mice carrying A549 lung tumor-derived xenografts were randomly assigned to four groups, including non-radioactive (sham) seeds implantation, I-125 seeds fractional implantation, I-125 seeds single implantation and I-125 seeds single implantation combined with anlotinib. Ki67 immunohistochemistry, TUNEL immunofluorescence and CD31 morphometric analysis were used to determine the proliferation index, rate of apoptotic cells and microvessel density, respectively. Additionally, the side effects on the skeletal system in mice treated with I-125 seeds implantation were evaluated by histomorphometric staining with tartrate-resistant acid phosphate (TRAP) and alkaline phosphatase (ALP) expression in femur, tartrate-resistant acid phosphatase 5b (TRACP-5b) and procollagen type I N-terminal propeptide (PINP) levels in serum were evaluated by enzyme-linked immunosorbent assay (ELISA). Results The I-125 seeds single and fractionated implantation had similar therapeutic effects and complications when the total number of I-125 seeds was the same. A single implantation of I-125 seeds with or without anlotinib could analogously inhibit the tumor growth in xenografts mice, while the single implantation combined with anlotinib had more effective in tumor inhibition. The results of Ki67, TUNEL and CD31 staining confirmed an evident reduction in tumor cell proliferation and angiogenesis, as well as an increase in apoptosis. A relatively integrated bone metabolism was indicated after I-125 seeds single implantation with or without anlotinib, and the results were similar in I-125 seeds fractional implantation, including a reduction in the number of TRAP-positive cells and an increase in ALP expression level. Additionally, the serum TRACP-5b activity was decreased and the serum PINP concentration was increased following I-125 seeds implantation. Conclusions Single and fractionated implantation pattern of I-125 radioactive seeds had similar therapeutic efficacy against tumor growth, while brachytherapy with I-125 seeds implantation may be an effective and safe treatment strategy for its potential protection against cancer treatment-induced bone loss.

Successful Endoscopic Sclerotherapy Using Lauromacrogol Injection for Laryngopharyngeal Hemangioma.

Objectives: This study aims to investigate the efficacy and safety of local lauromacrogol injection in the treatment of hypopharyngeal hemangioma. Methods: From Aug 2015 to May 2021, 13 consecutive patients suffering from hypopharyngeal hemangioma underwent local lauromacrogol injection assisted by endoscope in this prospective clinical series. All patients were followed up regularly and the therapeutic effects and complications were observed. Results: A total 13 of patients were enrolled, including 11 men and 2 women, with an average age of 48.5 years (range 25-76 years). The sizes of the hemangioma ranged from 0.5 × 1.0cm to 3.5 × 3.5cm. After 1 to 40months of follow-up, 12 patients were cured and 1 was significantly effective after 1 to 4 (mean 1.8) injections. All patients suffered varying degrees of postoperative pain or foreign body sensation. 3 patients were significantly affected by local swelling of the injection site, 2 of which underwent prophylactic tracheostomy postoperatively and 1 patient returned to the ward with endotracheal intubation postoperatively. No complications such as mucosal ulceration, fever, and allergies occurred. Conclusions: Lauromacrogol injection is a safe and effective method to treat hypopharyngeal hemangioma.

Short-term Outcomes and Prognostic Factors of Cataract-combined Surgery with iStent versus iStent Inject

Purpose: To analyze the therapeutic effects, prognostic factors, and complications that occurred after iStent&lt;sup&gt;®&lt;/sup&gt; or iStent inject&lt;sup&gt;®&lt;/sup&gt; implantation in South Korean glaucoma patients. Methods: We retrospectively analyzed 42 eyes of South Korean glaucoma patients, who were followed-up for more than 6 months after iStent&lt;sup&gt;®&lt;/sup&gt; or iStent inject&lt;sup&gt;®&lt;/sup&gt; implantation alone or combined with cataract surgery. Surgical success was defined as an intraocular pressure (IOP) ≤21 mmHg and an IOP reduction ≥20% from preoperative IOP levels. Results: The cumulative success rate at 6 months after surgery was 45.3 ± 8.1% for iStent inject&lt;sup&gt;®&lt;/sup&gt; alone (group A), 28.6 ± 13.1% for iStent&lt;sup&gt;®&lt;/sup&gt; alone (group B), 81.2 ± 6.8% for iStent inject&lt;sup&gt;®&lt;/sup&gt; combined with cataract surgery (group A-1), and 27.3 ± 21.8% for iStent&lt;sup&gt;®&lt;/sup&gt; combined with cataract surgery (group B-1). Group A-1 showed a higher success rate than group B-1 (&lt;i&gt;p&lt;/i&gt; = 0.007); the difference in success rates between groups A and B was not statistically significant (&lt;i&gt;p&lt;/i&gt; = 0.579). When the success prognostic factors were analyzed by Cox regression analysis, the results showed that a higher preoperative IOP was associated with a higher surgical success rate (hazard ratio 0.80, &lt;i&gt;p&lt;/i&gt; = 0.02). Conclusions: In our patient group, iStent inject&lt;sup&gt;®&lt;/sup&gt; was more effective than iStent&lt;sup&gt;®&lt;/sup&gt; in combination with cataract surgery. The higher the preoperative IOP, the higher the surgical success rate; the results were significant.

Efficacy and Safety of Single-Session Radiofrequency Ablation in Treating Benign Thyroid Nodules: A Short-Term Prospective Cohort Study.

Objective The aims of this study are to evaluate the safety and efficacy of RFA in the treatment of benign thyroid nodule(s) and to find independent factors related to the volume reduction rate of the nodule(s). Materials and Methods This short-term prospective study from a single medical center was conducted on 93 benign thyroid nodules in 93 patients treated with RFA. Two basic techniques were used: the trans-isthmic approach and moving-shot technique. Clinical and ultrasonography examinations were performed at 1- and 3-month follow-up after the treatment session. Primary outcomes included volume reduction ratio (VRR) at 1-month and 3-month follow-ups; secondary outcomes were therapeutic success rate and complications. Multiple linear regression analysis was used to determine independent factors associated with VRR. Results A final sample of 78 patients with 78 nodules, given participant rate 83.8% (including 60 solid nodules, 16 predominantly cystic nodules, and 2 thyroid cysts), was followed up for 3 months. The mean volume reduction ratio was 41.47% and 64.72% after 1-month and 3-month follow-ups, respectively. The therapeutic success rate was 30.8% at 1-month and 84.6% at 3-month follow-ups. Symptom score and cosmetic score improved significantly. There was no change in thyroid function tests. Two minor complications (transient voice change) were found. The multiple linear regression analysis showed that the internal component of the nodules significantly related to the VRR during the 3-month follow-up (β = 23.00; 95%CI (7.59–38.45)). Conclusion RFA was demonstrated as a safe and effective option for benign thyroid nodules treatment. It can be used as an alternative treatment with encouraging results.

Interactions of adenoviruses with platelets and coagulation and the vaccine-induced immune thrombotic thrombocytopenia syndrome.

The COVID-19 pandemic has had a heavy impact on global health and economy and vaccination remains the primary way of controlling the infection. During the ongoing vaccination campaign some unexpected thrombotic events have emerged in subjects who had recently received the AstraZeneca (Vaxzevria) vaccine or the Johnson&Johnson (Janssen) vaccine, two adenovirus vector-based vaccines. Epidemiological studies confirm that the observed/expected ratio of these unusual thromboses is abnormally increased, especially in women in fertile age. The characteristics of this complication, with venous thromboses at unusual sites, most frequently in the cerebral vein sinuses but also in splanchnic vessels, often with multiple associated thromboses, thrombocytopenia, and sometimes disseminated intravascular coagulation, are unique and the time course and tumultuous evolution are suggestive of an acute immunological reaction. Indeed, plateletactivating anti-PF4 antibodies have been detected in a large proportion of the affected patients. Several data suggest that adenoviruses may interact with platelets, the endothelium and the blood coagulation system. Here we review interactions between adenoviral vectors and the hemostatic system that are of possible relevance in vaccine-associated thrombotic thrombocytopenia syndrome. We systematically analyze the clinical data on the reported thrombotic complications of adenovirus-based therapeutics and discuss all the current hypotheses on the mechanisms triggering this novel syndrome. Although, considering current evidence, the benefit of vaccination clearly outweighs the potential risks, it is of paramount importance to fully unravel the mechanisms leading to vaccineassociated thrombotic thrombocytopenia syndrome and to identify prognostic factors through further research.

Adequacy of information provided in the informed consent to patients undergoing surgery at a tertiary care hospital

Introduction: Informed consent gives patient assurance and faith by providing information on diagnostic and therapeutic methods, risks, cost, complications, and alternative treatment options. This study aims to determine the adequacy of information provided in preoperative informed consent in everyday practice.&#x0D; Method: A cross sectional study was conducted among 388 patients undergoing surgery at Patan Hospital from November, 2016 to April, 2017. Respondents’ characteristics with Adequacy of information scale (AOI scale) were evaluated. Frequency, percentage, mean and standard deviation were calculated for descriptive study while Student t-test and ANOVA test was applied for assessing association between categorical variables. P value less than 0.05 was considered statistically significant. &#x0D; Result: Among participants 52.6% were females and 47.4% males with mean age of 40.69 years. Most of the patients were literate and with higher education. Male patients, exhibit a statistically significant higher AOI scale (p value &lt;0.001) then females. Illiterates and people with higher education had statistically significant lower mean AOI scales (p value &lt;0.001) compared to literates. A high mean AOI scale was associated with active involvement of both the surgeon and the patient in the decision-making process (p value &lt;0.0001). Even among patients satisfied with consent process mean AOI scale was low (4.30=53.75%). The mean AOI scale did not differ significantly amongst patients of different ages, marital status, religion or caste.&#x0D; Conclusion: There is a need of improving the preoperative informed consent process as adequacy of information provided is still lacking.&#x0D; Keywords: Adequacy of information scale (AOI scale), informed consent, Patan Hospital, patient satisfaction

Intercellular and inter-organ crosstalk in browning of white adipose tissue: molecular mechanism and therapeutic complications.

Adipose tissue (AT) is highly plastic and heterogeneous in response to environmental and nutritional changes. The development of heat-dissipating beige adipocytes in white AT (WAT) through a process known as browning (or beiging) has garnered much attention as a promising therapeutic strategy for obesity and its related metabolic complications. This is due to its inducibility in response to thermogenic stimulation and its association with improved metabolic health. WAT consists of adipocytes, nerves, vascular endothelial cells, various types of immune cells, adipocyte progenitor cells, and fibroblasts. These cells contribute to the formation of beige adipocytes through the release of protein factors that significantly influence browning capacity. In addition, inter-organ crosstalk is also important for beige adipocyte biogenesis. Here, we summarize recent findings on fat depot-specific differences, secretory factors participating in intercellular and inter-organ communications that regulate the recruitment of thermogenic beige adipocytes, as well as challenges in targeting beige adipocytes as a potential anti-obese therapy.

Eight years experience with botulinum toxin A and eyelid surgery in the treatment of hemifacial spasm

AIM: To report the therapeutic outcomes of botulinum toxin A (Botox) and eyelid surgery in patients with hemifacial spasm (HFS). METHODS: Patients’ images and medical notes were retrospectively reviewed with subsequent analysis of both the therapeutic outcomes and complications of Botox injections. RESULTS: The information of 76 patients (female=58) with HFS who received a minimum of 4 Botox injections were included. The mean follow-up interval was 83±50 (20-112)mo with an average of 16±10 (4-34) injections. The peak incidence was between 55 and 64 years and the average age of onset was 66±11 (32-85)y. Up to 23% of patients with HFS had aberrant vascular structures (right=8, left=7) in close relationship to the facial nerve (MRI=14, CT=1), where the vertebral artery (n=6) was the most involved vessel followed by the anterior inferior cerebellum artery (n=5). Patients with primary HFS had a shorter effective duration (2.5 vs 3.1mo, P&lt;0.05), a longer onset time (4.1 vs 3.8d, P=0.739) and a lower Subjective Spasm Alleviation score (SSAs; 1.7 vs 1.9, P=0.179) than those with secondary HFS. Twelve of the 19 patients with preexisting eyelid diseases underwent surgical correction including upper blepharoplasty (n=12), limited myectomy (n=7), browplasty (n=7) and advancement of levator aponeurosis (n=5). Five (41.7%) of those with surgical correction and suboptimal response to Botox showed improvement 6mo after surgery [onset time (P=0.0256), effective duration (P=0.374) and SSAs (P=0.0161)]. Those 12 patients with eyelid surgery had a lower complication rate than those without eyelid surgery (23% vs 42%, P≤0.05). CONCLUSION: Botox is an effective and safe treatment for HFS. Patients with primary HFS had a less favorable therapeutic outcome with Botox than those with secondary HFS. Eyelid surgery for patients with concurrent eyelid diseases can augment the effect of subsequent Botox injections by improving patient satisfaction and reducing complication rate.

The Effect of Non-Invasive Mechanical Ventilation on Respiratory and Inflammatory Parameters in Patients with Chronic Obstructive Pulmonary Disease

Background: Chronic Obstructive Pulmonary Disease (COPD) is an airway obstructive disease that is often caused by smoking. The disease is currently the third leading cause of death worldwide. The current therapeutic approach is based on Non-Invasive Ventilation (NIV) therapy, which can reduce mortality, the need for hospitalization in the intensive care unit, and to some extent therapeutic complications. Therefore, this study was performed to determine the effect of non-invasive ventilation along with routine treatments on respiratory markers, inflammation, and clinical status of patients with COPD. Methods: A total of 30 patients with COPD referred to Masih Daneshvari Hospital were divided into control and intervention groups. In the intervention group, 15 patients underwent non-invasive ventilation in addition to the usual treatments, and in the control group, the patients underwent only the usual treatments. After completing the mMRC (Modified Medical Research Council) questionnaire and evaluating FEV1 (Forced Expiratory Value in one score), 5 ml of blood samples were taken from these patients at the beginning of the study, on the seventh to tenth day, and also in the third month, and the results of this evaluation were compared between the two groups. Results: Based on the results of this study, the mMRC score of the intervention group was significantly lower than the control group in the first week (p=0.043) and three months after treatment (p=0.049). However, indices such as FEV1, and IL-8(Interleukin-8) did not change significantly in both groups. Conclusion: The use of non-invasive mechanical ventilation along with standard treatments can play a relative role in improving patient outcomes.

Bleomycin sclerotherapy for large diffuse microcystic lymphatic malformations.

Microcystic lymphatic malformations (LMs) are congenital lesions with the diameter of the majority of cysts <1 cm. Bleomycin sclerotherapy has been shown to yield beneficial results for macrocystic LMs. This study aims to evaluate the safety and efficacy of consecutive bleomycin sclerotherapy for large diffuse microcystic LMs. The location and size of the lesions were detected by ultrasound for the 46 patients included in this study. Bleomycin lavage was performed in larger cysts and intradermal injection for the superficial lesion. The outcome and complications were assessed for its efficacy and safety. The large diffuse microcystic LMs mainly located in the neck, abdominal wall and axilla/lateral chest wall. The average lesion size was 10.6 cm × 7.2 cm. The mean number of treatment sessions was 4.5 with 7.3 mg bleomycin for per session averagely. Excellent (69.6%) and moderate (23.9%) responses were obtained. There was no recurrence for the 6 patients (13%) who received a long follow-up. Obvious local swelling, slight intralesional hemorrhage and low-grade fever were the most commonly occurred complications. No lung fibrosis was identified for the patients who received more than 6 sessions. Local lavage combined with intradermal injection of bleomycin is effective and safe for large diffuse microcystic LMs with good therapeutic effect and low complication rates, and can be regarded as the mainstay of therapy for microcystic LMs.

Complications Associated With Intravenous Antibiotic Treatment for Cutibacterium acnes Periprosthetic Shoulder Infection.

Whether positive Cutibacterium acnes cultures during revision shoulder arthroplasty represent true periprosthetic joint infection (PJI), deep tissue inoculant, or laboratory contaminant is a point of substantial controversy. The purpose of this study was to review complications of intravenous antibiotics used for treatment of presumed C acnes shoulder PJI. A study population of 26 patients treated for C acnes PJI with a minimum follow-up of 2 years after operative treatment was established. Complication occurrence and severity were obtained through chart review and phone survey. Sixteen (61.5%) patients experienced a therapeutic complication. Twelve (46.2%) patients experienced a total of 47 antibiotic-associated adverse effects and 10 (38.5%) patients experienced 11 total peripherally inserted central catheter line-associated complications. Female sex carried an increased risk for severe complications (relative risk, 3.3; 95% CI, 1.2-9.5; P=.024). Treatment duration of greater than 6 weeks was a significant predictor for the total number of complications experienced [F(1,23)=5.361; P=.030; adjusted R2=0.189]. Age older than 65 years, treatment duration greater than 6 weeks, and female sex were significant predictors for the number of severe complications [F(3,21)=3.249; P=.042; adjusted R2=0.219]. Treating C acnes infection with intravenous antibiotics carries a substantial risk of adverse events, highlighting the importance of accurate diagnosis of shoulder PJI. Further investigations into the efficacy and safety profile of oral antibiotics for shoulder PJI are necessary. [Orthopedics. 2021;44(3):e422-e426.].

Pleurodesis with an Autologous Blood Patch in the Treatment of Persistent Air Leak after Lung Resection

Objective To evaluate the efficacy and risks of autologous blood patch pleurodesis in patients with persistent air leak(PAL)after lung resection. Methods A total of 97 patients with PAL after lung resection in Beijing Shijitan Hospital from October 2014 to October 2019 were retrospectively reviewed,including 53 treated by autologous blood patch pleurodesis and 44 by the conventional way.The therapeutic effect,adverse reactions and complications were analyzed. Results All the patients with PAL were cured with autologous blood patch pleurodesis.Most air leaks(81.1%)ceased within 48 hours after treatment,and the left 18.9% patients got cured after a repeat.The mean tube retention time and the mean in-hospital stay were 8.4 days and 10.0 days in the autologous blood patch pleurodesis group and 13.5 days and 15.3 days in the conventional treatment group.A prolonged drainage time(P=0.00)and in-hospital stay(P=0.00)were observed in the conventional treatment group.No severe complications were observed except two patients developed slight fever and cutaneous emphysema. Conclusion In our experience,the autologous blood patch pleurodesis is an effective way with low risk of adverse reactions in the treatment of PAL.

Undiagnosed Malignancy and Therapeutic Complications in Oncology Patients.

Despite technologic and medical advancements, autopsies are essential to uncover clinically unsuspected diagnoses, to advance our understanding of disease processes, and to help reduce medical errors. To investigate the percentage of malignancy clinically diagnosed and undiagnosed in a series of hospital autopsies. Secondarily, to explore the therapeutic complications directly contributing to death in cancer patients. A 10-year retrospective study (2008-2018). All nonforensic autopsies performed at the University of Vermont Medical Center during this period were reviewed by 2 pathologists, and data, including antemortem diagnoses of malignancy, and autopsy findings, including therapeutic complications, were collected. A total of 246 cases documented a diagnosis of malignancy. In 34.5% (85 of 246) of cases a tissue diagnosis of malignancy was first documented following postmortem examination. In 41.2% (35 of 85) of cases there was clinical antemortem suspicion of malignancy, whereas in 58.8% (50 of 85) clinically unsuspected malignancy was first diagnosed after postmortem examination. In 16.0% (8 of 50) of cases the undiagnosed malignancy was the primary cause of death. The overall rate of therapeutic complication related to the treatment of oncologic disease in patients that resulted in death was 21.7% (35 of 161). Our study shows the percentage of clinically unsuspected malignancies revealed by postmortem examination to be 5% (50 of 1003) of all autopsy cases. In 16% (8 of 50) of cases, the cause of death was due to the clinically undiagnosed malignancy, and hence not to an incidental finding. Despite advances in medical therapy in the management of oncologic disease, in up to 21.7% (35 of 161) of cases therapeutic complications directly contributed to death.

Clinical utility of antifungal susceptibility testing in patients with fungal rhinosinusitis

PurposeTo determine the association between antifungal susceptibility test (AFST) results and in vivo therapeutic response in Indian patients with fungal rhinosinusitis. MethodsThe clinicoradiological, fungal culture, AFST, histopathology results and outcomes of 48 patients with fungal rhinosinusitis seen between 20132015 were analysed. Minimum inhibitory concentration (MIC) determination was performed for amphotericin B, itraconazole, voriconazole and posaconazole. ResultsForty patients had invasive and 8 had non-invasive fungal sinusitis. Rhizopus and Aspergillus species which comprised 46.9% each of isolates were mostly associated with acute invasive fungal rhinosinusitis and chronic granulomatous fungal rhinosinusitis respectively. All patients with non-invasive fungal rhinosinusitis had Aspergillus isolates.The Geometric Mean (GM) MIC for R. arrhizus of amphotericin B and posaconazole was 0.51 mcg/mL and 3.08 mcg/mL respectively and for A. flavus species for amphotericin B and voriconazole values were 1.41mcg/mL and 0.35 mcg/mL respectively.In patients with Aspergillus infections, while there was no association of MICs for azoles and outcome (p = 1), a strong association was noted between azole therapy and a good outcome (p = 0.003). In patients with Rhizopus infections, no association was found between MICs for amphotericin B and outcome (p = 1) and because of therapeutic complications, no association was found between amphotericin B therapy and outcome (p = 1). ConclusionNo significant association exists between in vitro (AFST) and in vivo responses despite low GM MICs for the drugs used in Aspergillus and Rhizopus infections. Therapeutic complications following conventional amphotericin B therapy confounds analysis. Clinical responses suggest that azoles are the drug of choice for Aspergillus infections.