Term Therapy Research Articles

Arthroscopic capsular release is more effective in pain relief than conservative treatment in patients with frozen shoulder

BackgroundFrozen shoulder is a common medical condition, but the ideal therapeutic method is yet to be determined. Our aim was to analyze the pain-relieving effect of different treatment options used for the management of this disease.MethodsMedical records of 59 patients (22 male, 37 female, average age: 55.5 years ±9.9) with early stage primary frozen shoulder were evaluated, their demographic data, physical examination, concomitant diseases and treatment specific data were registered. Life quality and the level of pain were assessed using the Oxford Shoulder Score (OSS) and Numeric Rating Scale (NRS). Different treatment modalities and their effect on pain relief were recorded. Any existing correlation between life quality, pain and demographic data, concomitant diseases or the therapeutic method used was investigated.ResultsThe level of pain measured on NRS improved from 7.9 ± 1.6 to 1.9 ± 2.2. The most effective therapeutic method in terms of pain relief was surgery, followed by physiotherapy and intraarticular steroid injection (NRS score after treatment: 2 - p < 0.0001; 3.3 - p < 0.0001; 4.9 - p < 0.0001, respectively). Non-steroidal anti-inflammatory drugs (NSAIDs) did not reduce pain significantly. OSS improved from 24 to 43.6 and was not affected by the investigated variables, time to recovery was not influenced by the demographic data, the type of treatment or concomitant diseases.ConclusionsArthroscopic capsular release, physiotherapy and intraarticular steroid injection outperformed physical therapy and NSAID treatment in terms of pain relief. Despite of slight but persistent post-therapeutic pain found in half of the cases, treatment was considered satisfactory by the patients. Nor patient specific neither therapy specific data had a significant effect on the course of the disease.

Goal-directed fluid therapy guided by plethysmographic variability index versus conventional liberal fluid therapy in neonates undergoing abdominal surgery: A prospective randomized controlled trial.

Intraoperative fluid therapy maintains normovolemia, normal tissue perfusion, normal metabolic function, normal electrolytes, and acid-base status. Plethysmographic variability index has been shown to predict fluid responsiveness but its role in guiding intraoperative fluid therapy is still elusive. The aim of the present study was to compare intraoperative goal-directed fluid therapy based on plethysmographic variability index with liberal fluid therapy in term neonates undergoing abdominal surgeries. A prospective randomized controlled study was conducted in a tertiary care centre, over a period of 18 months. A total of 30 neonates completed the study out of 132 neonates screened. Neonates with tracheoesophageal fistula, congenital diaphragmatic hernia, congenital heart disease, respiratory disorders, creatinine clearance <90 mL/min and who were hemodynamically unstable were excluded. Neonates were randomized to goal-directed fluid therapy group where the plethysmographic variability index was targeted at <18 or liberal fluid therapy group. Primary outcome was comparison of total amount of fluid infused intraoperatively in both the groups. Secondary outcomes included intraoperative and postoperative arterial blood gas parameters, biochemical parameters, use of vasopressors, number of fluid boluses, complications and duration of hospital stay. There was no significant difference in total intraoperative fluid infused [90 (84-117.5 mL) in goal-directed fluid therapy and 105 (85.5-144.5 mL) in liberal fluid therapy group (p = .406)], median difference (95% CI) -15 (-49.1 to 19.1). There was a decrease in serum lactate levels in both groups from preoperative to postoperative 24 h. The amount of fluid infused before dopamine administration was significantly higher in liberal fluid therapy group (58 [50.25-65 mL]) compared to goal-directed fluid therapy group (36 [22-44 mL], p = .008), median difference (95% CI) -22 (-46 to 2). In postoperative period, the total amount of fluid intake over 24 h was comparable in two groups (222 [204-253 mL] in goal-directed fluid therapy group and 224 [179.5-289.5 mL] in liberal fluid therapy group, p = .917) median difference (95% CI) cutoff -2 (-65.3 to 61.2). Intraoperative plethysmographic variability index-guided goal-directed fluid therapy was comparable to liberal fluid therapy in terms of total volume of fluid infused in neonates during perioperative period. More randomized controlled trials with higher sample size are required. Central Trial Registry of India (CTRI/2020/02/023561).

First-line dual immune checkpoint inhibitor therapies versus combination therapies comprising immune checkpoint inhibitors and tyrosine kinase inhibitors for advanced renal cell carcinoma: a comparative analysis of the effectiveness using real-world data.

There are few comparative studies on dual immune checkpoint inhibitors (ICIs) (i.e., IO-IO) and combination therapies comprising ICIs plus tyrosine kinase inhibitors (TKIs) (i.e., IO-TKI) for advanced renal cell carcinoma (RCC), especially in real-world settings. We retrospectively evaluated data of 175 patients with IMDC intermediate-risk or poor-risk RCC; as first-line therapy, 103 received IO-IO, and 72 received IO-TKI. An inverse probability of treatment weighting (IPTW) analysis was conducted to balance patients' backgrounds in the IO-IO and IO-TKI groups. Based on the IPTW analysis, progression-free survival (PFS) was longer in the IO-TKI group than in the IO-IO group (median: 15.6 vs. 8.3months; p = 0.0386). In contrast, overall survival was not different between groups (median: 46.7 vs. 49.0months; p = 0.465). Although the IPTW-adjusted objective response rate was not significantly different (51.2% vs. 43.9%; p = 0.359), the progressive disease rate as the best overall response was lower in the IO-TKI group than in the IO-IO group (3.3% vs. 27.4%; p < 0.0001). Regarding the safety profile, the treatment interruption rate was higher in the IO-TKI group than in the IO-IO group (70.3% vs. 49.2%; p = 0.005). In contrast, the IO-IO group had a higher corticosteroid administration rate (43.3% vs. 20.3%; p = 0.001). IO-TKI therapy exhibited superior effectiveness over IO-IO therapy in terms of PFS improvement and immediate disease progression prevention and was associated with a higher risk of treatment interruption and a lower risk of needing corticosteroids.

The Effect of Ethambutol Therapy in terms of Visual Evoked Potential, Color Vision Test, and Contrast Sensitivity Test at the Subclinical Level

Abstract&#x0D; Introduction &amp; Objectives : Ethambutol is one of the first-line drugs in the treatment of tuberculosis and known to induce optic neuropathy. However, there are unknown protocols for detecting subclinical level of toxicity. The aim of this study was to assess the difference in amplitude and latency of visual evoked potential (VEP), color vision, and contrast sensitivity in tuberculosis patients before and after taking ethambutol for 1 and 2 months.&#x0D; Methods : This was a prospective observational cohort study of 38 eyes of 19 newly diagnosed patients with category-1 tuberculosis being treated with ethambutol. All patients were given ethambutol for 2 months at a dose of 15 - 20 mg/kg body weight/day. The participants underwent complete eye and visual function examination including pattern-reversal VEP, color vision with Farnsworth Munsell D-15 test, and contrast sensitivity with LEA Low Contrast Flip Chart before and after 1 and 2 months of treatment. Wilcoxon test was employed for data analysis.&#x0D; Results : During the study, no changes in visual acuity was observed. The results showed that the latencies of VEP after 1 month (p = 0.000) and 2 months (p = 0.000) of treatment were significantly delayed. There was a significant difference in contrast sensitivity after 2 months (p = 0.014) of treatment. However, no significant difference was found in color vision and amplitude of VEP.&#x0D; Conclusion : Latency of VEP and contrast sensitivity test could prove useful in detecting subclinical and hence very useful for monitoring patients under ethambutol therapy for ocular toxicity.

Inhibition of PTPN3 Expressed in Activated Lymphocytes Enhances the Antitumor Effects of Anti-PD-1 Therapy in Head and Neck Cancer, Especially in Hypoxic Environments.

In the tumor microenvironment, wherein cytotoxic lymphocytes interact with cancer cells, lymphocyte exhaustion, an immune checkpoint inhibitor target, is promoted. However, the efficacy of these inhibitors is limited, and improving response rates remains challenging. We previously reported that protein tyrosine phosphatase nonreceptor type (PTPN) 3 is a potential immune checkpoint molecule for activated lymphocytes and that PTPN3 inhibition should be a focus area for cancer immunotherapy development. Therefore, in this study, we focused on PTPN3-suppressive therapy in terms of lymphocyte exhaustion under hypoxic conditions, which are a cancer microenvironment, and investigated measures for improving the response to anti-programmed death receptor (PD)-1 antibody drugs. We found that PTPN3 expression was upregulated in activated lymphocytes under hypoxic conditions, similar to the findings for other immune checkpoint molecules, such as PD-1, T cell immunoglobulin mucin-3, and lymphocyte-activation gene-3; furthermore, it functioned as a lymphocyte exhaustion marker. In addition, PTPN3-suppressed activated lymphocytes promoted the mammalian target of rapamycin (mTOR)-Akt signaling pathway activation and enhanced proliferation, migration, and cytotoxic activities under hypoxic conditions. Furthermore, PTPN3 suppression in activated lymphocytes increased PD-1 expression and enhanced the antitumor effects of anti-PD-1 antibody drugs against head and neck cancer in vitro and in vivo. These results suggest that the suppression of PTPN3 expression in activated lymphocytes enhances the therapeutic effect of anti-PD-1 antibody drugs in head and neck cancer, especially under hypoxic conditions that cause lymphocyte exhaustion.

Adjuvant Chemotherapy With UFT/LV Versus UFT/LV Plus PSK in Stage II/III Colorectal Cancer.

Uracil-tegafur+leucovorin (UFT/LV), an oral adjuvant therapy for stage II/III colorectal cancer, is non-inferior to standard weekly fluorouracil and folinate. Although polysaccharide K (PSK) has been evaluated as a postoperative adjuvant colorectal cancer drug, its efficacy remains unclear. This randomized phase II trial compared UFT/LV+PSK with UFT/LV as adjuvant chemotherapy. Between April 2011 and August 2016, 186 patients who underwent radical resection randomly received 6 months of UFT/LV (Group A: 300 mg/m2/day UFT and 75 mg/day LV, every 35 days for five cycles), 6 months of UFT/LV+PSK (Group B: standard UFT/LV regimen and daily administration of 3 g/day of PSK), or 12 months of UFT/LV+PSK (Group C). The primary endpoint was the 3-year disease-free survival. Groups A, B, and C consisted of 37, 75, and 74 patients, of which treatment was completed by 33 (89.2%), 63 (84.9%), and 53 (70.4%) patients, respectively (p=0.0279). Adverse event incidence for all grades were 59.5%, 52.1%, and 59.2%, and for grade ≥3 were 13.5%, 9.6%, and 9.9%, respectively. The 3-year disease-free survival rates were 72.5%, 82.2%, and 74.2%, respectively, with no significant differences. The preoperative lymphocyte ratio did not significantly differ between groups. UFT/LV+PSK is comparable to UFT/LV therapy in terms of prognostic efficacy and reduced adverse effects. Thus, UFT/LV+PSK is a useful adjuvant chemotherapy option for patients with high-risk stage II/III colorectal cancer.

Prognostic factors in an individualised approach to non-pharmacological therapy of COVID-19: from oxygen and mechanical ventilation to extracorporeal membrane oxygenation

Our centre followed a stepwise approach in the nonpharmacological treatment of respiratory failure in COVID-19 in accordance with German national guidelines, escalating non-invasive measures before invasive mechanical ventilation (IMV) or extracorporeal membrane oxygenation (ECMO). The aim of this study was to analyse this individualized approach to non-pharmacologic therapy in terms of patient characteristics and clinical features that may help predict more severe disease, particularly the need for intensive care. This retrospective single-centre study of COVID-19 inpatients between March 2020 and December 2021 analysed anthropometric data, non-pharmacological maximum therapy and survival status via a manual medical file review. Of 1052 COVID-19-related admissions, 835 patients were included in the analysis cohort (54% male, median 58 years); 34% (n=284) received no therapy, 40% (n=337) conventional oxygen therapy (COT), 3% (n=22) high flow nasal cannula (NHFC), 9% (n=73) continuous positive airway pressure (CPAP), 7% (n=56) non-invasive ventilation (NIV), 4% (n=34) intermittent mandatory ventilation (IMV), and 3% (n=29) extracorporeal membrane oxygenation (ECMO). Of 551 patients treated with at least COT, 12.3% required intubation. A total of 183 patients required ICU treatment, and 106 (13%) died. 25 (74%) IMV patients and 23 (79%) ECMO patients died. Arterial hypertension, diabetes and dyslipidemia was more prevalent in non-survivors. Binary logistic analysis revealed the following risk factors for increased mortality: an oxygen supplementation of ≥2 L/min at baseline (OR 6.96 [4.01-12.08]), age (OR 1.09 [1.05-1.14]), and male sex (OR 2.23 [0.79-6.31]). The physician's immediate clinical decision to provide oxygen therapy, along with other recognized risk factors, plays an important role in predicting the severity of the disease course and thus aiding in the management of COVID-19.

EXPERIMENTAL EVALUATION OF VAJIKARANA KARMA OF TILAGOKSHURA SIDDA DUGDA WITH SPECIAL REFERENCE TO APHRODISIAC ACTIVITY

Infertility is a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse. Estimates suggest that approximately one in every six people of reproductive age worldwide experience infertility in their lifetime. Conventional management need long term therapy and are not devoid of ADR’s. Vajikarana is one among Astanga Ayurveda that deals with the preservation and amplification of sexual potency of a healthy man and conception of healthy progeny. Vajikarana yogas helpful in management of Shukra dusti and Vandytava were documented in the classics. ‘TilaGokshura Sidda Dugdha’ is one such formulation explained by Chakradatta in Vajikarana chapter indicat-ed in Shandatva (Impotency). The ingredients of yoga are Tila and Gokshura processed in Aja ksheera (Gaot milk) which are having Shukrala and Vrishya karma. Thus, yoga was selected to evaluate the Vajikarana karma. Also, an additional attempt is made to evaluate the same yoga by changing the processing agent as Go-Dugda(Cow milk) in another group. MATERIAL AND METHODS : Wister rats were grouped in to 5 groups of 6 animals each. Experimental period was 28 days study. Oligospermia was induced by administrating Metroni-dazole for initial 14 days. Group one as Normal, Group 2 as Disease control, Group 3 was treated with Clomi-phene citrate, Group 4 and Group 5 were treated with Tila Gokshura Sidda Dugda (Aja Dugda Saditha) and Tila Gokshura Sidda Dug-da (Go-Dugda Saditha) respectively for next 14 days. Sexual Behaviour Pattern, Sperm count, Serum parameters, Tissue parameters and Histopathological changes in testis tissue were Observed. DIS-CUSSIONS AND CONCLUSION : Tila Gokshura Sidda Dugda (Aja Dugda Saditha) showed effective Vajika-rana karma in experimental rats when compared to standard drug. RESULTS : The results of the experimental study reveal that TilaGokshura Sidda Dugda has significant Vajikarana karma when compared with standard drug.

Does Genotype-Specific Phenotype in Patients with Multiple Endocrine Neoplasia Type 2 Occur as Current Guidelines Predict?

The clinical manifestation of multiple endocrine neoplasia type 2 (MEN2) in terms of developing medullary thyroid cancer (MTC), pheochromocytoma (PCC), and/or primary hyperparathyroidism (PHPT) is related to the respective pathogenic variant of the RET proto-oncogene. The aim of this study is to retrospectively analyze the individual, genotype-dependent clinical manifestations of a large cohort of MEN2 patients. By comparing their clinical profile with currently existing evidence-based knowledge, an optimal therapy and prevention strategy in terms of prophylactic thyroidectomy and clinical follow-up could be ensured. This is a retrospective single-center study of 158 MEN2 patients who were diagnosed and/or surgically treated at a tertiary referral care center between 1990 and 2022. All participants were categorized according to their pathogenic variant of the RET proto-oncogene. Subsequently, the clinical manifestation of the disease and its time of occurrence was documented. Our analysis showed results in line with existing studies, except for a considerably lower-than-predicted occurrence of PCC in patients with V804M/L mutations. This study supports the current recommendation regarding the pathogenic variant-dependent management of this rare cancer-associated syndrome.

A randomized controlled trial of the dissemination of an mHealth intervention for improving health outcomes: the WiseApp for Spanish-speakers living with HIV study protocol

BackgroundWhile there is no cure for HIV, adherence to antiretroviral therapy can extend the lifespan and improve the quality of life of people with HIV. Despite the global reduction of HIV infection rates in recent years, New York City and La Romana, Dominican Republic, continue to report high infection rates among Latino populations. Many people with HIV remain virally unsuppressed in these geographic hotspots, suggesting a need for additional interventions to overcome medication adherence barriers. Tailored and culturally appropriate mobile health (mHealth) technology can be an engaging way to improve adherence. The primary objective of this trial is to test the effectiveness of an mHealth tool to improve HIV medication adherence among Spanish-speaking people living in New York City and the Dominican Republic.MethodsThe WiseApp study is a two-arm randomized controlled trial among 248 people with HIV across the New York and Dominican Republic sites over the course of 12 months. Participants are randomly assigned to either receive a CleverCap pill bottle that is linked to the WiseApp (intervention) or standard of care (control). All participants complete surveys at baseline, 3-month, 6-month, and 12-month follow-up visits and the study team obtains HIV-1 viral load and CD4 count results through blood draw at each study timepoint.DiscussionThe use of mHealth technologies to improve medication adherence among people with HIV has been implemented in recent years. Although some studies have found improvement in adherence to antiretroviral therapy in the short term, there is limited information about how these interventions improve adherence among Spanish-speaking populations. Disproportionate rates of HIV infection among Latinos in New York City suggest an existing inequitable approach in reaching and treating this population. Due to a lack of mHealth studies with Latino populations, and apps tailored to Spanish-speakers, the WiseApp study will not only demonstrate the effectiveness of this particular mHealth app but will also contribute to the mHealth research community as a whole.Trial registrationThis trial was registered with Clinicaltrials.gov (NCT05398185) on 5/31/2022.

Palliative urologic surgery for metastatic prostate cancer: what needs to be considered in the future?

Androgen deprivation in combination with novel hormonal agents, docetaxel or the combination of abiraterone/prednisone plus docetaxel or darolutamide plus docetaxel represent the standard therapeutic approach in metastatic hormone-sensitive prostate cancer (mHSPC). Patients with low-risk prostate cancer also benefit from additional radiation therapy or radical prostatectomy in terms of progression-free and overall survival. Despite favourable response rates, basically all patients will develop castration-resistant prostate cancer (CRPC) within 2.5 to 4 years. Systemic chemotherapy, second-line hormonal treatment or systemic application of radionuclides such as Radium-223 or 177Lu-PSMA represent salvage management options. As the new medical treatment options have led to an improved oncological outcome with significantly prolonged survival times, about 50% to 65% of patients will develop symptoms due to local progression of prostate cancer. The management of such symptomatic local progression will become more important in upcoming years, which means that all uro-oncologists need to be aware of the various surgical management options. If complications of the lower urogenital tract occur, for example repetitive gross haematuria with or without bladder clotting and with the necessity for red blood cell transfusions, subvesical obstruction, acute urinary retention or rectourethral or rectovesical fistulas, these may be managed by palliative surgery such as palliative TURP, radical cystectomy, radical cystoprostatectomy with urinary diversion, and pelvic exenteration. Symptomatic or asymptomatic obstruction of the upper urinary tract can be managed by endoluminal or percutaneous urinary diversion, ureteral reimplantation, ileal ureter replacement, or implantation of a Detour system. However, an individualised and risk-adapted treatment strategy needs to be developed for each single patient to achieve an optimal therapeutic outcome with improvement of both symptoms and quality of life. In specific clinical situations, best supportive care may be an adequate option.

Endovascular Therapy for Basilar Artery Occlusion in Sudden Onset to Maximal Deficit Ischemic Events.

The presence of sudden onset to maximal deficit (SOTMD) in patients with acute basilar artery occlusion often results in more severe outcomes. However, the effect of endovascular therapy on SOTMD and whether the outcome is affected by onset-to-puncture time remain unclear. This retrospective analysis was conducted using data from the prospective BASILAR (Endovascular Treatment for Acute Basilar Artery Occlusion Study Registry). Consecutive patients with basilar artery occlusion receiving endovascular therapy were dichotomized into SOTMD and non-SOTMD cohorts. The primary outcomes included a favorable outcome (modified Rankin scale 0-3), recanalization, and mortality at 90 days. The outcomes of patients with SOTMD were analyzed using multivariable logistic regression. In the multivariate analysis, a favorable outcome was similar between the two cohorts (odds ratio [OR], 0.88 [95% CI, 0.58-1.34]; P=0.5), although the mortality of patients with SOTMD was higher than that of patients with non-SOTMD (OR, 1.67 [95% CI, 1.14-2.44]; P=0.008). The probability of mortality increased from 40.0% at 1 hour to 70.0% at 6 hours in the SOTMD cohort, and favorable outcomes of patients with non-SOTMD declined from 38.0% at 1 hour to 18.0% at 8 hours. No significant difference was observed in favorable outcomes between the SOTMD and non-SOTMD groups, although mortality was higher in the SOTMD cohort. The patients with SOTMD had a stronger time dependence for endovascular therapy in terms of mortality, while the time dependency regarding favorable outcome in the NSOTMD group was even higher. URL: https://www.chictr.org.cn; Unique identifier: ChiCTR1800014759.

Is cognitive behavioral therapy more effective than pharmacotherapy for binge spectrum disorders? A systematic review and meta-analysis.

Binge spectrum disorders are prevalent worldwide. Psychiatric and medical comorbidities are common, and societal costs are significant. Evidence-based treatment remains underutilized. Cognitive behavioral therapy is the recommended first-line treatment, but pharmacotherapy may be easier to access. Meta-analytic evidence directly comparing cognitive behavioral therapy with pharmacotherapy is lacking. We aimed to compare the effects of cognitive behavioral therapy interventions with any pharmacological treatment for binge spectrum disorders. We searched PubMed, Embase, CENTRAL, ClinicalTrials.gov and reference lists for randomized controlled trials comparing cognitive behavioral therapy with any pharmacotherapy for bulimia nervosa/binge eating disorder and performed pairwise meta-analytic evaluations. Primary outcomes are remission and frequency of binges. Secondary outcomes are frequency of purges, response, eating disorder psychopathology, weight/body mass index, depression, anxiety, quality of life and dropouts. Eleven randomized controlled trials comparing cognitive behavioral therapy with fluoxetine/imipramine/desipramine/methylphenidate/sibutramine were identified (N = 531). Cognitive behavioral therapy was superior to antidepressants in terms of remission, frequency of binges and eating disorder psychopathology. There were no statistically significant differences for any of the individual cognitive behavioral therapy vs drug comparisons in terms of response/depression/anxiety/weight/quality of life/dropouts. Cognitive behavioral therapy was not superior to sibutramine/methylphenidate for the primary outcomes. Data are scarce, comparisons underpowered and, considering the inherent methodological limitations of psychotherapy trials, questions arise regarding the presumed superiority of cognitive behavioral therapy. Further research is needed.

Immunohistochemical analysis of epidermal growth factor receptor as a predictive biomarker in lung adenocarcinoma – A cross-sectional study of 33 cases on computed tomography-guided core needle biopsy specimens

Background: Lung cancer is the second most common cause of cancer in all ages and both genders and is the leading cause of cancer death. Two major groups of lung cancers are – small cell lung carcinoma (SCLC) and non-SCLC (NSCLC). Due to discovery of driver mutation such as epidermal growth factor receptor (EGFR) mutation in NSCLC, the paradigm of lung cancer therapy has shifted from cytotoxic platinum based therapy to tyrosine kinase inhibitor (TKI) therapy. In this study, we have analyzed EGFR expression in NSCLC by immunohistochemistry (IHC) and studied the response to TKI therapy in terms of progression free survival (PFS) and overall survival (OS). Aims and Objectives: In this study, we have retrospectively analyzed the EGFR overexpression in adenocarcinoma of lung in core needle biopsy (CNB) specimen by IHC analysis and correlated with the therapeutic response and survival rate (OS and PFS) in lung carcinoma patients. Materials and Methods: We have analyzed retrospectively EGFR expression in lung adenocarcinoma cases (computed tomography-guided CNB specimen) by IHC. In our study, we have used monoclonal primary antibodies against two most common EGFR mutations, that is, L858R point mutation and E 746–A 750 deletion. Results: Out of 33 cases, EGFR expression was seen in 28 cases. For EGFR expression assessment by IHC, both cytoplasmic and/or membranous staining taken into consideration. EGFR positivity was interpreted only when &gt;10% tumor cells having 2+ or more intensely staining pattern. The response to TKI therapy in terms of PFS and OS was also studied. Conclusion: IHC analysis of EGFR mutation using specific antibodies has extremely high specificity with good sensitivity. Use of targeted therapy in the form of TKI in EGFR positive lung adenocarcinoma has high response rate and long duration of survival (PFS and OS) with acceptable toxicity profile in contrast to the conventional therapy.

Analysis of the Role and Effectiveness of Artificial Intelligence in Art Therapy

Abstract This paper discusses the critical role of art therapy in solving various psychological problems, and introduces an innovative immersive and interactive art therapy mechanism based on artificial intelligence (AI), which combines machine learning and AI algorithms to realize embodied interactions between the learner, the machine, and the environment.The study analyzes the changes of students’ status before and after receiving art therapy in terms of various dimensions, including students’ social avoidance, general well-being, and self-emotions. Using regression modeling, the study validated the positive effects of art therapy on students’ mental health, cognitive abilities, and depression levels. It showed that art therapy had a statistically significant impact on improving students’ mental health, cognition, and reducing depressive symptoms at the 1% level of significance. Students who participated in art therapy had a 0.329 unit increase in mental health scores compared to non-participants, and this study provides a valuable reference and idea for the application of expressive art therapy in mental health education.

Molecular docking analysis of imeglimin and its derivatives with estrogen receptor-alpha.

Estrogen receptor-α (ER- α) is a principal endocrine regulatory protein in breast cancer. The progression of ER-α positive breast cancer is slowed by selective estrogen receptor modulators such as Tamoxifen. But, long term therapy with Tamoxifen leads to resistance. Therefore, it is of interest to document the Molecular docking and pharmacokinetic analysis of imeglimin derivatives with ER-alpha. Among the 166 derivatives of Imeglimin, only five derivatives were shortlisted after toxicity testing. The selected derivatives showed good binding affinity with favorable pharmacokinetic profiles. The selected compounds of Imeglimin were found to possess excellent anticancer potential and could be considered as novel, cost-effective anticancer agents effective against ER positive breast cancer for further investigation.

Zamena bioloških lekova kod psorijaze - izazovi i iskustvo iz malog tercijarnog zdravstvenog centra

Abstract: Objective: Psoriasis, a chronic inflammatory skin disease, significantly impacts patients' quality of life. Over the last decade, therapeutic goals have aimed to complete skin clearance and restore normal patient activities, minimizing the disease's impact on social, family, and work activities. Biologics have emerged as a promising solution to achieve better disease control without organ-specific side effects, helping meet these therapeutic goals. However, it was soon noticed that approximately 30% of patients do not sufficiently react to the therapy in the long term, and the need for switching biologics emerges. Findings: We present our experience with biologic switching over a specific period. Seventeen patients required a switch in biologic agents, with three undergoing a second switch. The cohort predominantly consisted of males (14 out of 17), with an average BMI of 29.81. The primary reasons for switching were secondary failure (loss of initial treatment efficacy), followed by primary failure. Adverse reactions were the least common cause, highlighting the satisfactory safety profile of biologics. One patient underwent dose escalation of secukinumab due to efficacy failure but ultimately ended up switching the biologic. Conclusion: Biologic agents approved for the treatment of psoriasis showed a favorable safety profile without compromising efficacy. The increasing demand for higher efficacy in psoriasis treatment aims to alleviate the disease's multifaceted impact on patients. It is anticipated that biologic switching, primarily due to inadequate therapeutic response and less frequently due to adverse reactions, will become more prevalent in clinical practice. Literature and our clinical experience suggest that constitutional factors influence treatment success. As new agents and targets emerge, the established standards for biologic switching may require ongoing revision.

Cognitive Behavior Therapy as Relapse Prevention for Opioid Use Disorders

Opioid use disorder (OUD) is a prevailing psychiatric illness that provides foundations of morbidity and mortality. Objective: To investigate the effectiveness of Cognitive Behavior Therapy (CBT) in terms of relapse prevention in the treatment of patients with opioid use disorders. Methods: After the period of detoxification, an individualized treatment plan was made based on CBT. To assess the effectiveness of planned and executed CBT sessions, pre and post assessment method was opted. Results: Results specify that CBT worked successfully as relapse prevention in one-on-one sessions. CBT attested to be working in treating patients' lapses as well as relapses by increasing control on cravings and improving assertive behavior. Conclusions: The conclusion can be drawn that CBT is an effective methodology that successfully deals with patients' cravings, and develops assertive behavior thereby preventing relapse.

Possibilities of Preservative-Free Therapy for Primary Open-Angle Glaucoma

Purpose: to evaluate the efficacy and safety of preservative free travoprost generic in primary open-angle glaucoma patients. Patients and methods. 40 patients with compensated primary open-angle glaucoma (POG) and dry eye (DE) were examined: 1st group (20 patients) with the initial stage of POG (travoprost with a preservative monotherapy), 2nd group with an advanced stage of POG (travoprost with a preservative in combination therapy). In all patients, travoprost with a preservative was replaced with preservative free travoprost (Traviolan, 1 time per day, in the evening). Control: 1 — when included in the study; 2 — 4 weeks after replacing travoprost with a preservative for preservative free travoprost. Efficiency criteria: absence of negative dynamics of intraocular pressure (IOP) and MD and PSD perimetric indices (dB; Optos). Safety criteria: absence of OSDI (scores), tear film brake up time (TBUT; Norn’s test, s), lower tear meniscus height (LTMH, µm; OptoVue) and Bijsterveld’s xerosis index (XI, scores) negative dynamics. Results. At the 2nd control point, all observed did not have a statistically significant dynamics of IOP, MD, PSD. In patients of both groups, at the 2nd control point, there was the OSDI and TBUT statistically significant positive dynamics, and in patients of the 1st group — XI statistically significant positive dynamics. The trend towards to XI decreasing in 2nd group patients and the LTMH dynamics in both groups turned out to be statistically insignificant. Conclusion. Preservative free travoprost has shown efficacy comparable to that of travoprost with preservative in both monotherapy and combination therapy. Significant positive dynamics of OSDI and TBUT in patients of both groups and XI in 1st group patients after switching to preservative free travoprost indicates a good “safety profile” of therapy in terms of its effect on the ocular surface state in DE conditions, which, from our point of view, may contribute to maintaining the “quality of life” and patients compliance.

The outcome of integrated motivational interviewing and cognitive-behavioral therapy in Egyptian patients with substance use disorder

ObjectivesThe authors aimed to evaluate the outcome of combined motivational interviewing and cognitive-behavioral therapy (MICBT) for substance use disorder compared to the twelve-step facilitation (TSF) therapy in terms of retention in the treatment program, the number of relapses, and the period of abstinence after discharge, coping with craving, and modification of problematic behaviors.MethodThis randomized controlled trial included 60 individuals with a substance use disorder. Participants were randomly allocated to equal groups. The MICBT group received 20 sessions of approximately 90 min of MICBT group therapy. The NA (control) group was assigned 20 narcotic anonymous (NA)-oriented TSF group therapy sessions. The assessment was conducted 3 and 6 months after the intervention.ResultThe implementation of MICBT in a group setting leads to a significant decline in the number of days of drug use in 3 months of follow-up (P = 0.006) and 6 months of follow-up (P < 0.001), an increase in the number of days of abstinence in 3 months of follow-up (P = 0.008) and 6 months of follow-up (P < 0.001), a longer time to the first lapse (P < 0.001), and a higher percentage of attendance days for treatment (P < 0.001) in comparison to NA groups. MICBT intervention was a significant positive predictor of several urge-specific coping strategies and several general strategies for drugs (P < 0.05).ConclusionUsing MICBT in group settings presents several benefits in clinical contexts.