Total Treatment Course Research Articles

989. Isavuconazonium Sulfate Treatment of Blastomycosis: A Case Series

Abstract Background Blastomyces fungi, endemic to the Ohio and Mississippi River Valleys, cause pneumonia and disseminated disease in both immunocompetent and immunocompromised patients. Prolonged antifungal therapy is commonly complicated by hepatic toxicity, QT prolongation, and drug interactions. Isavuconazonium sulfate is dosed once daily, does not prolong the QT interval, and has fewer drug interactions, but there is a paucity of data for its use in blastomycosis. Methods This case series of blastomycosis treated with isavuconazonium sulfate at the University of Wisconsin Hospital and Clinics from 2015 to December 2019 focuses on long term outcomes. Inclusion criteria were adults, that received at least one day of isavuconazole. Exclusion criteria was no blastomycosis diagnosis. Results Of 14 cases, median age was 53 years, 6/14 were female, 11/14 White, 2/14 Black, 1/14 Hmong, 6/14 had a solid organ transplant (4 renal, 1 heart, 1 bilateral lung), 1/14 on a TNF-alpha inhibitor (infliximab). Most cases, 9/14 had moderate severity illness requiring inpatient care, 2/14 required ICU level care, and 3/14 were outpatient. Most cases, 11/14, were initially treated with Liposomal Amphotericin B (LAMB) for a median duration of 14 days, 9/14 cases received itraconazole, 8/14 voriconazole, 1/14 posaconazole. Isavuconazonium sulfate was started after adverse drug effects with other azoles in 10/14 cases, prolonged QT interval in 3/14, drug interactions in 2/14, subtherapeutic azole levels in 2/14. Isavuconazonium sulfate was well tolerated and used for median duration of 255 (average 68% total treatment course). 3/14 cases had adverse reactions to isavuconazonium sulfate: nausea, rash, elevated liver enzymes. There was only one death during therapy from a fatal hemorrhagic stroke, and 2/14 cases were still on therapy at end of data collection. 11/14 were cured after treatment course. Conclusion This is the largest case series treating Blastomycosis with isavuconazonium sulfate, and it adds to the evidence that isavuconazonium sulfate can be safely used to treat pulmonary and disseminated blastomycosis. Prospective data is needed to compare isavuconazonium sulfate to other antifungals for the treatment of Blastomycosis. Disclosures All Authors: No reported disclosures

Resecting the Lesion Combined with Local Flap Repairing for the Treatment of Infected Congenital Preauricular Fistula.

PurposeEvaluating the treatment of infected preauricular fistulas by resecting the lesion combining with local flap repairing.Patients and MethodsThis clinical study was implemented in Ningbo No. 1 Hospital and Wuhan No. 1 Hospital of China. We included 100 cases who were diagnosed with infected preauricular fistulas and needed further surgery treatment. Among them, 50 patients experienced the conventional treatment including a fully infection control following with a surgery to remove preauricular fistulas (conventional treatment group). Other 50 patients only took some simple pre-operation treatment for about 1–7 days, and then preauricular fistulas resection combining local flap repairing were performed regardless of the infection (local flap repairing group). The duration of total treatment procedure, healing index, and total cost were observed.ResultsAll patients were discharged at about 7 days after surgery, the duration of the post-operative period had no significant difference between groups. The total duration of treatment (from any first treatment time point to patient discharge) was only 13.98±2.14 days in the local flap treatment group compared with that of 43.06±8.24 days in the conventional treatment group. Further, the total cost of treatment per patient in the local flap repairing treatment group was about 47.1% of that in the conventional treatment group.ConclusionFor the treatment of infected preauricular fistula, performing a lesion removing surgery combining a local flap repairing can shorten the total treatment course, relieve patient’s suffering, reduce treatment cost, and achieve a better clinical prognosis.

Lack of in-brace x-rays in compliant AIS patients wearing full-time TLSO braces associates with failure

BackgroundIn-brace correction and brace compliance with thoraco-lumbo-sacral orthotic (TLSO) braces are associated with successful treatment of adolescent idiopathic scoliosis (AIS). This paper compares patients who had consistent radiographic documentation of in-brace correction to those who did not.MethodsAll skeletally immature (Risser 0-2) patients were treated for AIS (25-45°) with full-time TLSO braces that had compliance temperature monitors. All patients wore their braces at least 12 h a day. Brace failure was defined as curve progression to a surgical magnitude (≥ 50°). All patients were followed until brace discontinuation.ResultsNinety patients (F 82, M 8) with an average age of 12.1 (10.1-15.0) years, Risser grade 0 (0-2), BMI percentile 48.5 (0.0-98.8), and daily brace wear of 16.5 (12.1-21.6) h/day were treated for 24.3 (8.0-66.6) months. Patients went through 1.7 (1-4) braces on average. Forty-two out of 90 (46.7%) patients had some amount of brace time with an unknown in-brace correction, which, on average, was 66.1% of their total treatment course (11.5-100). On univariate analysis, patients that did not have a repeat in-brace x-ray with major brace adjustments or new brace fabrication tended to be more skeletally immature (Risser 0 and tri-radiate open, p = 0.028), wear more braces throughout their treatment (2.0 vs 1.4, p < 0.001), were treated for a longer period of time (27 vs 22 months, p = 0.022), and failed bracing more often (47.6% vs 22.9%, p = 0.014).ConclusionsPatients who did not have new in-brace x-rays with major brace adjustments and/or new brace fabrication were 3.1 (95% CI 1.2-7.6) times more likely to fail bracing than patients who were re-checked with new in-brace x-rays.Trial registrationClinicalTrials.gov—NCT02412137, initial registration date April 2015Level of evidenceIII

COVID-19: Diagnosis, Management and Response

Background: COVID infection 2019 (COVID-19) is identified as a disease caused by Corona virus formally known as severe acute respiratory syndrome (SARS-CoV-2), which was first detected in Wuhan City, Hubei Province, China, amidst of an outbreak of respiratory sickness cases.&#x0D; Summary: As there is no affirmed total course of treatment for the Novel Coronavirus, the best way to handle it is by playing it safe, its administration and early reaction. Segregation and disinfection go inseparably with regards to dealing with a COVID positive patient. In any case, the predetermined number of clinical office accessible is blocking the cycle of control and anticipation for a particularly number of infected patients.&#x0D; Conclusion: As the pandemic is advancing, more examinations and exploration is needed to effectively deal with the spread of the novel Corona virus. Foundation improvement and arrangement of clinical office and gear is the preeminent prerequisite for early reaction and treatment.

Duration of antibiotic therapy in systemic lupus erythematosus patients with hospital-acquired bacterial pneumonia in eastern China.

To investigate the duration of antibiotic therapy and its influencing factors in treating systemic lupus erythematosus (SLE) patients with hospital-acquired bacterial pneumonia (HABP). Clinical data of SLE patients with HABP from January 2015 to December 2019 were collected. Duration of antibiotic treatment and its correlations with the severity of pneumonia, status of SLE and the time to clinical stability (TCS) were analysed. A logistic regression model was performed to screen the risk factors influencing the total antibiotic treatment course >7 days. Three hundred and forty-four patients were finally enrolled in the study and the mean duration of total antibiotic therapy was 9.5 days. The TCS was related to the duration of antibiotic therapy (R2 =0.76, P<0.0001). More patients with multidrug-resistant pathogen infection and Candida colonization were found in the total duration >7 days group. SLE disease activity index (SLEDAI) [odds ratio (OR) =5.52, 95% confidence interval (CI): 3.59-7.28], taking immunosuppressants during HABP treatment (OR =5.29, 95% CI: 3.93-7.09) and multidrug-resistant pathogen infection (OR =4.91, 95% CI: 1.45-6.87) were greatly impacted risk factors (P<0.05, respectively). The duration of antibiotic therapy in SLE patients with HABP was longer than the course recommended by practice guidelines. The severity of the disease and the host's immune status might influence the duration of treatment.

Effect of Argatroban Injection on Clinical Efficacy in Patients with Acute Cerebral Infarction: Preliminary Findings

Objective: The aim is to observe the effects of argatroban injection and butylphthalide injection on blood flow rheology, clinical efficacy, and safety in patients with acute cerebral infarction. Methods: 344 patients with acute cerebral infarction within 48 h after admission were divided into treatment group and control group, with 172 cases in each group. The control group received routine treatment. The treatment group received argatroban injection 60 mg on the basis of the control group, intravenously guttae (ivgtt) was used for 2 days and then changed to argatroban injection 10 mg, ivgtt bid for 5 days, and the total course of treatment was 7 days. The neurological changes, activities of daily living, and the rheology indicators (fibrinogen [Fib], platelet aggregation rate [Pag], whole blood high shear viscosity [Whsv], hematocrit [Hct]) were compared between the 2 groups, clinical efficacy and adverse drug reactions. Results: After treatment, the total effective rates of the treatment group and the control group were 90.70% (156 /172 cases) and 74.41% (128 and 172 cases), respectively, and the difference was statistically significant (p < 0.05). After treatment, the National Institutes of Health Stroke Scale scores of the treatment group and the control group were (7.05 ± 1.97) and (8.30 ± 1.79), respectively, and the Barthel index was (68.02 ± 11.07) and (62.32 ± 11.46), respectively. The difference was statistically significant (p < 0.05). After treatment, the treatment group and the control group were (2.66 ± 0.22) g/L and (3.50 ± 0.22) g/L, respectively, and Pag were (0.68 ± 0.06)% and (0.81 ± 0.09)%, respectively, and Whsv was (6.44 ± 0.76) mPs/s and (6.87 ± 0.91) mPs/s, Hct were (8.19 ± 1.21)% and (10.44 ± 1.04)%, respectively, and the differences were statistically significant (p < 0.05). The incidence of adverse reactions in the treatment group and the control group was 6.97 and 5.81%, respectively, and the difference was not statistically significant (p > 0.05). Conclusion: Argatroban injection is effective in the treatment of acute cerebral infarction, which can significantly improve the hemorheology of patients with good safety.

1356. Ribavirin Use in Hospitalized Children

BackgroundRespiratory syncytial virus (RSV) infection is a significant cause of morbidity and mortality in immunocompromised children. Aerosolized ribavirin is approved for treatment of RSV lower respiratory tract infections. However, due to high cost, challenges to administration and uncertainty about benefit, use is limited. Recent studies in adult patients have reported similar outcomes between patients treated with aerosolized and oral ribavirin. We sought to characterize trends in use of ribavirin for hospitalized children.MethodsWe used the Pediatric Health Information System (PHIS), an administrative database which contains resource utilization data from 52 children’s hospitals, to perform a retrospective analysis of children hospitalized between January 1, 2010 through December 31, 2019 who were billed for ribavirin treatment. Data related to ribavirin use (number of courses, route of administration) and clinical characteristics were abstracted. International Classification of Diseases, 9th Revision (ICD-9) or 10th Revision (ICD-10) codes and All Patients Refined Diagnosis Related Groups (APR DRG) classifications were used to define underlying clinical conditions and illness severity. Summary statistics were used to describe patient characteristics and the use of ribavirin.ResultsThirty-eight hospitals reported ribavirin use; 1 hospital was excluded due to inaccuracies in charge coding. We identified 837 children who received 937 courses of ribavirin (Table 1). The overall frequency of ribavirin use was unchanged over the study period, and the number of ribavirin treatment courses per hospital ranged from 1 to 228 (Figure 1). The most frequent routes of administration were inhalation (603/937, 64%) and oral (322/937, 34%). There was a decrease in the use of aerosolized ribavirin over time, with a corresponding increase in the use of oral ribavirin (Figure 2).Table 1: Patient demographics (N=837) Figure 1: Total ribavirin treatment courses over the study period (a) by year and (b) by treating hospital Figure 2: (a) Route of administration (inhalation versus oral), by year during the study period and (b) use of oral ribavirin over time during the study period ConclusionAlthough overall prescribing rates of ribavirin in hospitalized children have remained stable, use varies widely across centers and the proportion of oral ribavirin use has increased over time. Comparative effectiveness studies are needed in the pediatric population to evaluate outcomes of children treated with aerosolized vs. oral ribavirin.Disclosures All Authors: No reported disclosures

Clinical study of sequential glucocorticoids in the treatment of acute mercury poisoning complicated with interstitial pneumonia

Objective: To study the clinical efficacy of sequential glucocorticoids in the treatment of acute mercury poisoning complicated with interstitial pneumonia. Methods: Retrospective analysis of 37 patients with acute mercury poisoning complicated with interstitial pneumonia admitted from January 2009 to April 2019, including the sequential treatment group (15 cases) and the conventional treatment group (22 cases) , all patients were treated with sodium dimercaptopropane sulfonate, and given anti-inflammatory, liver-protecting and other drugs for symptomatic treatment. The conventional treatment group was given methylprednisolone 1mg/kg once a day for 5-7 days. The sequential treatment group was given 1 mg/kg of methylprednisolone once a day for 5-7 days, then gradually reduced to 20 mg, and the total course of treatment was 14-21 days. To observe the changes of clinical symptoms, signs, lung function including forced vital capacity (FVC) , forced expiratory volume in the first second (FEV(1)) and ratio of forced expiratory volume in the first second to forced vital capacity (FEV(1)/FVC) , and chest CT indexes before and after treatment in the two groups. Results: The clinical symptoms and signs of the two groups were significantly improved compared with those before treatment, and there was no significant difference between the apparent efficiency and the total effective rate of the two groups (P>0.05) . The FVC, FEV(1), and FEV(1)/FVC of the two groups were significantly higher than those before treatment. After treatment, the indexes of the sequential treatment group were significantly higher than that of the conventional treatment group, and the difference was statistically significant (P<0.05) . The apparent efficiency (93.3%, 14/15) of CT lesions in the sequential treatment group was significantly higher than those of the conventional treatment group (59.1%, 13/22) , and the difference was statistically significant (P< 0.05) . Conclusion: Sequential glucocorticoid treatment of acute mercury poisoning complicated with interstitial pneumonia could improve the effect of clinical signs and symptoms which is equal to conventional treatment, but it could better promote the recovery of lung function and the absorption of lung lesions.

Associations of Antithrombotic Timing and Regimen with Ischemic Stroke and Bleeding Complications in Blunt Cerebrovascular Injury

Background: Blunt cerebrovascular injuries (BCVIs) are associated with long-term neurological effects. The first-line treatment for BCVIs is antithrombotics, but consensus on the optimal choice and timing of treatment is lacking. Methods: This was a retrospective study on patients aged at least 18 years admitted to 6 level 1 trauma centers between 1/1/2014 and 12/31/2017 with grade 1-4 BCVI and treated with antithrombotics. Differences in treatment practices were examined across the 6 centers. The primary outcome was ischemic stroke, and secondary outcomes were related to bleeding complications: blood transfusion and intracranial hemorrhage (ICH). Treatment characteristics examined were time to diagnosis and first computerized tomography angiography, time of total treatment course, time on each antithrombotic (anticoagulants, antiplatelets, combination), time from hospital arrival to antithrombotic initiation, and treatment interruption, i.e., treatment halted for a surgical procedure and restarted postoperatively. Chi-square, Fisher exact, Spearman's rank-order correlation, Wilcoxon rank-sum, Kruskal-Wallis, and Cox proportional hazards models with time-varying covariates were used to evaluate associations with the outcomes. Results: A total of 189 patients with BCVI were included. The median (IQR) time from arrival to antithrombotic initiation was 27 (8-61) hours, and 28% of patients had treatment interrupted. The ischemic stroke rate was 7.5% (n = 14), with most strokes (64%, n = 9) occurring between arrival and treatment initiation. Treatment interruption was associated with ischemic stroke (75% of patients with stroke had an interruption versus 24% of patients with no stroke; P < .01). Time on anticoagulants was not associated with ischemic stroke (P = .78), transfusion (P = .43), or ICH (P = .96). Similarly, time on antiplatelets (P = .54, P = .65, P = .60) and time on combination therapy (P = .96, P = .38, P = .57) were not associated with these outcomes. Conclusions: The timing and consistency of antithrombotic administration are critical in preventing adverse outcomes in patients with BCVI. Most ischemic strokes in this study population occurred between arrival and antithrombotic initiation, representing events that may potentially be intervened upon by earlier treatment. Future studies should examine the safety of continuing treatment through surgical procedures.

Therapeutic effect of subcutaneous injection of low dose recombinant human granulocyte-macrophage colony-stimulating factor on pulmonary alveolar proteinosis

ObjectiveTo observe the efficacy of recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) for pulmonary alveolar proteinosis (PAP).Materials and methodsA total of 55 patients with PAP were screened at Shanghai Pulmonary Hospital between May 2014 and May 2018. Among these, 42 were diagnosed with idiopathic PAP, 24 were included in this study, 20 were treated for 6 months, and 17 were followed up for additional 6 months. All patients received a subcutaneous injection of 75μg/d GM-CSF qd for 1 month. The therapeutic dose was adjusted according to the changes in the lesions of chest CT. If the lesions were absorbed, subcutaneous injections of 75μg/d GM- CSF qd and 75μg/d GM-CSF qod were given for 2 and 3 months, otherwise, the dose was increased to 150μg/d GM-CSF qd and 150μg/d qod for 2 and 3 months, respectively. All cases were treated once a day in the first 3 months and once every other day in the last 3 months. The total course of treatment was 6 months. After withdrawal, the patients were followed up for another 6 months. The deadline of follow up was September 30, 2019.ResultsTwenty patients completed the treatment and efficacy evaluation. One patient was completely cured, 16 cases improved, three cases were noneffective. After 1-month evaluation, 12 patients received an increased dose (150μg) from the second month of treatment. Seventeen patients completed the 12-month follow-up, among which fourteen improved. CT showed the lesions were slightly increased in three cases. Economic burden was the following: RMB 7324–15,190 Yuan were required for the 6-month treatment course, which is significantly lower compared to other treatment methods.ConclusionSubcutaneous injection of rhGM-CSF at low dose (75μg-150μg /d) is effective treatment for patients with idiopathic PAP.Trial registrationNCT01983657. Registered 16 April 2013.

Comparison of hepatitis C treatment outcomes between telehepatology and specialty care clinics in the era of direct-acting antivirals

Introduction Telehealth technologies for rural patients are increasingly being used to deliver care within the Department of Veterans Affairs (VA), and treatment of hepatitis C virus (HCV) is no exception. However, data evaluating outcomes with telehealth compared with specialty clinics in the era of direct-acting antiviral (DAA) agents is sparse. Methods In a retrospective analysis, we compared treatment outcomes for patients receiving DAAs followed solely in a telehepatology clinic (telehealth) versus an in-person specialty care clinic (standard of care) at the VA Eastern Colorado Health Care System. Patients with decompensated cirrhosis (CTP-B or CTP-C) were excluded from the study as they were exclusively followed via standard of care. Provider overlap occurred between clinics and consisted of physician specialists (hepatology and infectious diseases), physician assistants and clinical pharmacists. Results From 1 January 2014 to 31 December 2017, we treated 764 veterans for HCV infection. Standard of care was provided to 629 patients representing 654 treatment courses, and telehealth was provided to 135 patients representing 138 treatment courses. Sustained virologic response rates were not significantly different between the two clinics when looking at total treatment courses (93% telehepatology vs 89% specialty care, p = 0.203) and individual patients treated (95% telehepatology vs 93% specialty care, p = 0.377). Discussion Hepatitis C treatment utilizing telehealth technologies to improve access to care does not negatively impact treatment outcomes when compared with specialty care clinics in the era of DAAs.

A Case Study on the Ayurvedic Managment of Spastic Cerebral Palsy Due to Birth Asphyxia

Background: Cerebral palsy is a disorder of motor control due to a static lesion of the developing brain. It was described almost 150 years ago. Global incidence of Cerebral Palsy is 2 to 2.5/1000 children but in Indian scenario, incidence is 03.8% of population. In India about twenty-five Lakh children are suffering from cerebral palsy. Most common type of cerebral palsy is spastic which cover 70% to 75% of overall. There is no exact correlation found for cerebral palsy in Ayurvedic literature but may be the result of Shiromarmabhighata (injury to brain) and can be considered as Vata Vikara or Vata Vyadhi (neurological disorders). Aim: To assess the effect of certain oral medication with Purvakarma (preparatory procedures) and Panchakarma procedures (Five-fold measures of Bio-cleansing) in the management of Cerebral Palsy (CP). Material and Method: In this case study, one case of Spastic cerebral palsy was registered and treated with multiple Ayurvedic treatment modalities. Total period of treatment was 93 days in which 5 days of Abhyanga (Massage) with Nadi swedana (steam kettle Sudation), 5 days of Abhyanga (Massage) with Shashti Shali Pinda Swedana (a type of Sudation) and then 7 days of Matra Vasti (Enema by Medicated oil in small dose) by Ksheera Bala Taila; this schedule of treatment was given three times with a gap of 14 days. Vacha mula (Root of Acorus calamus ) and Samvardhana Ghrita was given as internal medication during the total course of treatment. Results were assessed by progress in delayed milestone, anthropometrical measurement, modified Ashworth scale, muscle power grading and Manual Ability Classification System (MACS) scale. Result: Treatment protocol of oral medication with Panchkarma delivered better result in CP patient, especially improving anthropometric data (weight, height, chest circumference), delaying milestone (walking and language), reducing spasticity and improved Quality of Life (QOL). Conclusion: Cerebral palsy is a disorder of motor function. The cause originates from the brain sometime during its developmental period. Internal medication along with Purvakarma (preparatory procedures) and Panchakarma (Five-fold measures of Bio-cleansing) give significant improvement in all the facets of spastic CP.

Outcomes Using Narrow Band UVB Phototherapy for Acute Skin Graft Versus Host Disease (GVHD) in Pediatric Allogeneic Hematopoietic Stem Cell Transplant Recipients

Acute graft-versus-host-disease (aGVHD) is a significant complication of pediatric allo- BMT. Narrow band UVB (nbUVB) therapy allows targeted treatment without systemic immunosuppression, but data is limited for pediatric patients. We retrospectively reviewed the charts of all pediatric allo-BMT patients from July 1, 2007- July 1, 2018. Seven patients (1 female, 6 male) with a median age of 12.9 years (range 3-20) received nbUVB therapy. Diagnoses included ALL (4), MDS (2), and NHL (1). Preparative regimens were TBI-based (5) or Bu/Cy (2). Donor sources included MSD (1), MUD (1), MMUD (4), and haplo (1). Three of the patients had unrelated female donors. All patients failed topical steroids prior to nbUVB. Treatment with nbUVB was initiated at a median of 48 days (range 44-77) post-BMT, requiring a median of 26 treatments (range 4-36) over a median of 11.5 weeks (range 3 – 17). One patient underwent a second trial of nbUVB due to recurrence. Complete response was noted in 75% of the 8 total nbUVB treatment courses with a mean cumulative dose of 364.5 J•cm−2 (range 234 – 1557). Partial response and no response each occurred in one treatment course (12.5%). Only two patients had aGVHD of other organs prior to nbUVB; however, all seven received IV/PO steroids during a portion of nbUVB treatment. Five patients remain alive without cGVHD at a median of 7 years (range 0.8-10) post-BMT. One patient with a TBI-based preparative regimen developed poikilodermatous radiation dermatitis 4 years post-BMT. No other additional treatment-related skin complications to date. Two patients developed overlap syndrome and cGVHD and died. There is scant published data regarding nbUVB use in pediatric aGVHD treatment. These results suggest that nbUVB is a highly effective second-line therapy for treatment of pediatric cutaneous aGVHD, and further research should be completed to elucidate its efficacy.

Effect of "Tiaoshen Acupuncture" on postpartum low back pain: a randomized controlled trial

To observe the effect of "Tiaoshen Acupuncture" on postpartum low back pain. A total of 98 cases of postpartum low back pain were randomly divided into a control group (45 cases, 4 cases dropping) and a treatment group (47 cases, 2 cases dropping). Conventional acupuncture was treated in the control group, and "Tiaoshen Acupuncture" was added in the treatment group on the basis treatment in the control group, acupuncture was applied at Baihui (GV 20), Neiguan (PC 6), Taichong (LR 3). The treatment was given 30 minutes each time, 5 times a week, 10 times for a total course of treatment. Before and after treatment, pain was assessed by the short-form of McGill pain questionnaire (SF-MPQ), dysfunction was assessed by Oswestry disability index (ODI), and depression was assessed by the Edinburgh postnatal depression scale (EPDS). And the changes of various indexs were observed before and after treatment. After treatment, the pain grade index (PRI) score, visual analog scale (VAS) score and present pain intensity (PPI) score in SF-MPQ of the control group and the treatment group were significantly lower than those before treatment (all P<0.001). The ODI score and EPDS score were also significantly lower than those before treatment (all P<0.001). The decline scores of the treatment group before and after treatment were significantly higher than those in the control group (P<0.001, P<0.01). "Tiaoshen Acupuncture" combined with conventional acupuncture and conventional acupuncture can effectively improve the symptoms of pain, dysfunction and depression in patients with postpartum low back pain, and the former is significantly better than the latter.

The Efficacy and Safety of Super High-Dose Cytarabine Based Strategies in Childhood Acute Myeloid Leukemia Treatment

Objective The aim of this study was to evaluate the effect of super high-dose cytarabine (SHDAC), a regimen first created by the author, on the five-year overall survival (OS) and event-free survival (EFS) of children with AML. Methods From July 2001 to April 2016, a total of 25 pediatric patients with newly diagnosed AML (exclueding secondary AML、APL and Down Syndrome AML) were enrolled. Patients received consolidate chemotherapy with the same regimen of high-dose cytarabine (3g/m2 every 12 hours by continuous infusion for 6 days) after remission induction chemotherapy. Then phase II consolidation therapy (also known as early intensive treatment) was performed according to the regimen of high-dose cytarabine (3g/m2 every 12 hours on days 1, 3, and 5 for four cycles, a total of 108g/m2) in 16 cases, while the other 9 cases received the treatment with another regimen (H3A7, M3A7 and VP16 combined with cytarabine alternately at intervals ranging from 2 to 6 months). The total treatment course spanned about three years, with regular post-treatment follow-up tracking for more than five years. Results Originally 26 cases were enrolled, but 1 case was not relieved after two courses of treatment and quitted therapy, so only 25 cases were enrolled finally. The total remission rate was 96%. There were 12 cases (48%) achieving complete remission within one course, 12 cases (48%) within two consecutive remission course and one case (48%) ,only one case(4%) achieving complete remission within with in five courses. The five-year OS and EFS of these 25 AML patients in this study were 77±0.98% and 77±1.22% respectively. Four patients (16%) died (1 treatment-related (4%), 3 relapse (12%) including 3 marrow relapse and 1 combined with testicular relapse). The average relapse time was 29.6 months and the median time was 14.8 months. Conclusion The application of super high-dose cytarabine (a total of 108g/m2 cytarabine, with a regimen of 3g/m2 every 12 hours by continuous infusion for 6 days as consolidation chemotherapy and 3g/m2 every 12 hours on days 1, 3, and 5 for four cycles as the early intensive treatment) is clinically safe and effective, with minimal hospitalization expense index (HEI). For patients with financial difficulties, especially those in developing countries, super high-dose cytarabine shows landslide advantages and practicality. Therefore, there should be more collaborative clinical applications as well as research upon related mechanisms. DisclosuresNo relevant conflicts of interest to declare.

A Pilot Prospective Single-Arm Clinical Study on Decitabine Plus CAG or IA Followed with HLA-Mismatched Nonmyeloablative Transplantation (micro transplantation) on De Novo Elderly Acute Myeloid Leukemia and Int-2/High Risk Myelodysplastic Syndrome Patients

Objective: To observe the efficacy and safety of Decitabine plus CAG or IA followed with HLA-mismatched nonmyeloablative transplantation (micro transplantation) on de novo elderly Acute Myeloid Leukemia and Int-2/high risk Myelodysplastic Syndrome patientsMethods: Till submission of this article, 10 patients were enrolled in this prospective clinical study. Patients were admitted from January 2017 to June 2018 to our centre. 6 of whom were elderly AML (≥60 years) and 4 were Int-2/high risk MDS according to IPSS-R scoring system. Induction chemotherapy were decitabine (15 mg/m2) for 5 days followed with CAG (cytarabine 10 mg/m2 q12h; aclarubicin 10 mg/day and G-CSF at 300 μg/day x 6 days for AML and 4 days for MDS), then followed with a transfusion of HLA-mismatched (≤7/10 matched HLA loci) related donor peripheral stem cells (micro transplantation) 24 hours after chemotherapy. Consolidation therapy was another 3 courses of chemotherapies which were decitabine (15 mg/m2) for 5 days with IA (3+7) for AML or CAG (6 days) for MDS, followed by micro transplantation 24 hours after each course. Till now, the total observable treatment courses were 21.Results: The average age of the patients was 63.5 years (range from 55 to 71 years). The average number of transfusion mononuclear cells (MNC) at per course was 3.26 (1.87-5.25) x 108/kg, the average CD34+ cells was 1.12 (0.34-3.16) x 106/kg, and the average of CD3+ T cells was 3.93 (1.87-7.17) x 107/kg. Among them, 5 cases (50%) obtained CR (CR+CRi), 3 cases obtained PR (30%). The ORR was 83.3% for elderly AML patients, 75% for MDS patients and 80% for all patients. The median recovery time of neutrophil (from the end of chemo to neutrophil ≥0.5 x 109) was 9 days and was 8.5 days for platelets (from the end of chemo to platelets ≥20 x 109). 1 patient developed severe aGVHD and died, 1 patient died of heart failure, no other serious adverse events were observed in rest patients. 7 of 10 cases developed peripheral T cell increase after stem cell transfusion, including the total CD3+ T cells, CD4+ and CD8+ T cells, with an average peak at day7. The increased T cells were verified as host origin by short tandem repeat (STR) detection performed on 1 patient. 8 of 10 cases occurred cytokine related fever (CRF) after stem cell transfusion. The fever was usually happened within 24 hours after stem cell transfusion, with an average duration of 5 days and a mean peak temperature at 39.7 ℃. With CRF there was an increase of cytokines with different patterns in different patients but majorly on IL-6, IL-2, IFN-r and TNF-a. Also there was an increase of C-Reactive Protein (CRP) which reached an average peak level as 116.9 mg/L. Patients with CRF had a CR+CRi rate at 62.5%.Conclusion: Our preliminary results of this study indicate that Decitabine plus CAG or IA followed with micro transplantation have an ORR at 80% in de novo elderly Acute Myeloid Leukemia and Int-2/high risk Myelodysplastic Syndrome patients with controllable recover time of neutrophils and platelets. Although the incidence of acute graft versus host disease (aGVHD) in micro transplantation was as low as 1-2% according to reports, it is still possible. How to predict and avoid severe aGVHD is still under investigate. The presence of cytokine related fever may associate with the increase of hosts' T cells, which may relate to the improvement of therapeutic response. Larger cohorts and more investigates need to be done to clarify above findings. DisclosuresNo relevant conflicts of interest to declare.

Long-term core stability training promotes recovery from lumbar disc herniation as evaluated by surface electromyography

Objective To observe the effect of core stability training on lumbar disc herniation using changes in surface-electromyography signals from the core muscles. Methods Sixty patients with lumbar disc herniation were equally divided into an experimental group who were given the core stability training in addition to their regular physical therapy and a control group given the regular physical therapy only. The total course of treatment was 8 weeks. Each patient was assessed before the experiment and after 4 and 8 weeks of the intervention using the numeric rating scales of the Japanese Orthopaedic Association, the Oswestry disability index and integrated electromyogram (iEMG), root mean square (RMS) and medium frequency (MF) of the electromyographic signals from the rectus abdominis, obliqus externus abdominis, erector spinae, lumbar multifidus and gluteus medius muscles. Results No significant differences between the two groups were observed in any of the measurements before or after four weeks of the treatment. After 4 and 8 weeks of treatment, both groups had significant improvements in all of the measurements compared with before the experiment. Between 4 and 8 weeks the experimental group showed significant improvement in all of the measurements which was not matched in the control group. By the end of the treatment, all of the measurements of the experimental group were, on average, significantly better than those of the control group. Conclusions Both core stability training and regular physical therapy have similar effects on patients with lumbar disc herniation in the short term. However, continued core stability training improves the ability of core muscles and relieves pain and dysfunction better than prolonged regular physical therapy. Key words: Lumbar disc herniation; Core muscles; Core stability training; Surface electromyography

Evidence‐based consensus on opportunistic infections in inflammatory bowel disease

Evidence‐based consensus on opportunistic infections in inflammatory bowel disease

Effect of He's Santong Needling Method on Dysphagia after Stroke: A Study Protocol for a Prospective Randomized Controlled Pilot Trial.

Background Dysphagia is a common complication of stroke, affecting up to 78% of stroke patients. The existence of dysphagia after stroke has been associated with an increased risk for pulmonary complications and even mortality. Previous studies have shown that acupuncture could be potential therapeutic method for treatment of dysphagia after stroke. A prospective randomized controlled pilot trial is designed to evaluate the effect of He's Santong needling method on dysphagia after stroke. Methods and Design Sixty eligible participants will be recruited and randomly assigned into treatment group (He's Santong needling method and swallowing rehabilitation training) and control group (swallowing rehabilitation training) in a 1:1 ratio. All treatments will be provided everyday on weekdays with a two-day interval at the weekend, during a total treatment course of four weeks. The Penetration-Aspiration Scale with Fiberoptic Endoscopic Examination of Swallowing will be assessed at baseline and endpoint (Week 4) as primary outcomes. The Saitoh's classification score, Swallowing-Related Quality of Life score, the Modified Mann Assessment of Swallowing Ability score, and Surface Electromyography will be evaluated at baseline and endpoint as secondary outcomes. Ethics and Dissemination The trial protocol has been approved by the Research Ethical Committee of Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University on 9 May 2017 (ethical batch number: 2017BL-013-02). Each participant will be notified regarding the study protocol. Written informed consent will be obtained from each participant. Trial Registration ISRCTN registry: ISRCTN68981054; Registered on 25 September 2017.

Low-intensity Extracorporeal Shock Wave Therapy for Erectile Dysfunction: A Systematic Review and Meta-analysis

To assess the efficacy of low-energy extracorporeal shock wave therapy (LI-ESWT) for erectile dysfunction (ED), a systematic review and meta-analysis was undertaken. A comprehensive search of the PubMed, Cochrane Register, and Embase databases to March 2017 was performed for randomized controlled trials reporting on patients with ED treated with LI-ESWT. The International Index of Erectile Function (IIEF) and the Erection Hardness Score (EHS) were the most commonly used tools to evaluate the therapeutic efficacy of LI-ESWT. There were 9 studies including 637 patients from 2005 to 2017. The meta-analysis revealed that LI-ESWT could significantly improve IIEF (mean difference [MD]: 2.54; 95% confidence interval [CI], 0.83-4.25; P = .004) and EHS (risk difference [RD]: 0.16; 95% CI, 0.03-0.28; P = .01). Therapeutic efficacy could last at least 3 months (MD: 4.15; 95% CI, 1.40-6.90; P = .003). Lower energy density (0.09 mJ/mm2, MD: 4.14; 95% CI, 0.87-7.42; P = .01) increased the number of pulses (3000 pulses per treatment, MD: 5.11; 95% CI, 3.18-7.05, P < .0001) and shorter total treatment courses (<6 weeks, MD: 3.73; 95% CI, 0.54-6.93; P = .02) resulted in better therapeutic efficacy. These studies suggest that LI-ESWT could significantly improve the IIEF and EHS of patients with ED. The publication of robust evidence from additional randomized controlled trials and longer-term follow-up would provide more confidence regarding the use of LI-ESWT for patients with ED.