Traditional Treatment Options Research Articles

Effect of Graphene Oxide and Silver Nanoparticle Hybrid Composite on Acinetobacter baumannii Strains, Regarding Antibiotic Resistance and Prevalence of AMP-C Production.

Background and Objectives: Growing antibiotic resistance among bacteria is a global issue that is becoming harder and more expensive to solve. Traditional treatment options are becoming less effective, causing more fatal outcomes of nosocomial infections. Since the development of new antibiotics has stagnated in the last decade, a novel approach is needed. Materials and Methods: Graphene-based materials are being developed and tested for various applications, and the medical field is no exception. We tested 98 clinical A. baumannii strains for antibiotic resistance, AMP-C production and the effectiveness of a graphene oxide and silver nanoparticle hybrid nanocomposite. The disc diffusion method was used to determine antibiotic susceptibility results. Antibiotic discs containing cefotaxime, cloxacillin and clavulanate were used to detect AMP-C production. The effectiveness of the GO-Ag hybrid nanocomposite was determined by counting colony forming units (CFUs) after a suspension of A. baumannii and the GO-Ag hybrid nanocomposite was plated on MH agar and incubated overnight to grow colonies. Results: In our research, we found that A. baumannii strains are resistant to the majority of commonly used antibiotics. Antibiotic resistance levels and AMP-C production can be factors, indicating the better effectiveness of the graphene oxide and silver nanoparticle hybrid nanocomposite. Conclusions: In this study, a GO-Ag hybrid nanocomposite was shown to have the potential to fight even the most problematic bacteria like A. baumannii.

The Impact of Modern Dietary Practices on Cancer Risk and Progression: A Systematic Review.

Cancer is a leading cause of mortality around the world, despite continued advancements in the management of cancer. Recent research efforts have shifted to evaluating the role that modifiable risk factors play in cancer risk and development, as diet and nutrition have been found to play a significant role in the onset and progression of cancer. As a result, there has been an increasing focus on the impact of dietary modifications on preventing the onset, progression, and reoccurrence of cancer. In this systematic review, data were collected on three common diets, the Mediterranean diet (MD), ketogenic diet (KD), and plant-based diet, to gain insight into the application of these three dietary modification approaches for risk prevention and limitation of cancer burden.Initially, 4,397 articles were identified from three databases (Ovid, Web of Science, and CINHAL). After removing studies based on the exclusion criteria, only 23 studies were eligible to be included in the systematic reviewof which 15 evaluated the MD, four assessed the ketogenic diet, and four evaluated the plant-based diet. Each article was considered for its methods, procedures, and findings. The findings indicate that dietary interventions may effectively reduce the odds of cancer development and the advancement of diagnosed cancers. With the introduction of the MD, KD, and plant-based diets, significant improvements in lowering cancer development, recurrence-free status, and limiting tumor growth were noted across numerous cancer types. Currently, the MD has been extensively studied in the literature, and amongst the widest variety of cancer types. Additional information and evaluation are required on the ketogenic and plant-based diets to fully understand their impact on the cancer burden across a wider subset of cancers. Clinicians should evaluate and recommend nutritional adaptations to their patients to limit the development of specific cancers and as an adjunctive therapy to traditional pharmacological treatment options for patients with diagnosed cancers.

Tumor-selective Blockade of CD47 Signaling with CD47 Antibody for Enhanced Anti-tumor Activity in Malignant Meningioma.

Patients with WHO grade III meningioma have a poor prognosis with a median survival of less than two years and a high risk of recurrence. However, traditional treatment options have failed to improve prognosis. Therefore, development of novel immunotherapy targets is urgently needed. CD47 acting as a "don't eat me" signal to macrophages can trigger tumor immune escape. However, the role of CD47 in malignant meningioma is not well understood. We collected 190 clinical meningioma samples and detected the expression of CD47 and immune infiltration in WHO grade I-III by immunohistochemistry, western blot, qPCR. We also examined the functional effects of anti-CD47 on cell proliferation, migration and invasion, macrophagemediated phagocytosis and tumorigenicity both in vitro and in vivo. We found that the expression of CD47 was increased in malignant meningioma along with a decreased number of T cells and an increase in CD68+ macrophages. Blocking CD47 with anti-CD47 antibody (B6H12) suppressed tumor cell growth, motility and promoted macrophage-mediated phagocytosis in IOMM-Lee cells in vitro. In vivo experiments showed that anti-CD47 antibody (B6H12 or MIAP301) significantly inhibited the tumor growth and this effect was partly blocked by the depletion of macrophages. Finally, p-ERK and EGFR showed higher expression in malignant meningioma with high expression of CD47, which was verified by western blot. Our results demonstrated that CD47 maybe involved in the meningioma progression and prognosis and offered a novel therapeutic option by targeting CD47 in malignant meningioma.

Neuro-regenerative behavior of adipose-derived stem cells in aligned collagen I hydrogels.

Peripheral nerve injuries persist as a major clinical issue facing the US population and can be caused by stretch, laceration, or crush injuries. Small nerve gaps are simple to treat, and the nerve stumps can be reattached with sutures. In longer nerve gaps, traditional treatment options consist of autografts, hollow nerve guidance conduits, and, more recently, manufactured fibrous scaffolds. These manufactured scaffolds often incorporate stem cells, growth factors, and/or extracellular matrix (ECM) proteins to better mimic the native environment but can have issues with homogenous cell distribution or uniformly oriented neurite outgrowth in scaffolds without fibrous alignment. Here, we utilize a custom device to fabricate collagen I hydrogels with aligned fibers and encapsulated adipose-derived mesenchymal stem cells (ASCs) for potential use as a peripheral nerve repair graft. Initial results of our scaffold system revealed significantly less cell viability in higher collagen gel concentrations; 3mg/mL gels showed 84.8±7.3% viable cells, compared to 6mg/mL gels viability of 76.7±9.5%. Mechanical testing of the 3mg/mL gels showed a Young's modulus of 6.5±0.8kPa nearly matching 7.45kPa known to support Schwann cell migration. Further analysis of scaffolds coupled with stretching in vitro revealed heightened angiogenic and factor secretion, ECM deposition, fiber alignment, and dorsal root ganglia (DRG) neurite outgrowth along the axis of fiber alignment. Our platform serves as an in vitro testbed to assess neuro-regenerative potential of ASCs in aligned collagen fiber scaffolds and may provide guidance on next-generation nerve repair scaffold design.

Drug Repositioning for Treatment of Head and Neck Cancers

Head and neck cancer (HNC) is a complex disease that poses significant therapeutic challenges. Traditional treatment options such as surgery, radiation, and chemotherapy have limited efficacy and often result in significant side effects. In recent years, drug repositioning has emerged as a promising strategy to identify new therapeutic options for HNC. Drug repositioning involves repurposing existing drugs, already approved for other indications, for the treatment of HNC. This approach takes advantage of existing knowledge about drug safety and efficacy, reducing the time and cost needed to develop new drugs. By leveraging the known safety profiles, pharmacokinetic, and pharmacodynamic properties of these drugs, drug repositioning can accelerate the drug development process and reduce costs. In this review, the current status of drug repositioning efforts for HNC and the challenges and opportunities associated with this approach are discussed. We also highlight some of the most promising drug candidates that have emerged from recent studies and clinical trials. Overall, drug repositioning has the potential to significantly improve the treatment landscape for HNC and offer new hope for patients with this challenging disease.

Update on Endovascular Therapy for Fibroids and Adenomyosis.

Uterine fibroids and adenomyosis are prevalent benign neoplasms that can lead to serious deleterious health effects including life-threatening anemia, prolonged menses, and pelvic pain; however, up to 40% of women remain undiagnosed. Traditional treatment options such as myomectomy or hysterectomy can effectively manage symptoms but may entail longer hospital stays and hinder future fertility. Endovascular treatment, such as uterine artery embolization (UAE), is a minimally invasive procedure that has emerged as a well-validated alternative to surgical options while preserving the uterus and offering shorter hospital stays. Careful patient selection and appropriate techniques are crucial to achieving optimal outcomes. There have been advancements in recent times that encompass pre- and postprocedural care aimed at enhancing results and alleviating discomfort prior to, during, and after UAE. Furthermore, success and reintervention rates may also depend on the size and location of the fibroids. This article reviews the current state of endovascular treatments of uterine fibroids and adenomyosis.

Single-stage Palatal Lengthening Using Modified Buccinator Myomucosal and Buccal Fat Flaps.

Surgical treatment of velopharyngeal insufficiency (VPI) after primary palatoplasty poses a difficult challenge in cleft care management. Traditional treatment options have shown improved speech outcomes but oftentimes lead to airway obstruction by constriction of the posterior pharynx. The buccinator myomucosal flap is an alternative flap used for VPI correction that re-establishes palatal length and velar sling anatomy by recruiting tissue from the buccal mucosa and buccinator muscle. We present innovative modifications to the original buccinator myomucosal flap by performing the procedure in one stage without a mucosal bridge, incorporating full-thickness buccinator muscle during flap elevation, and placement of bilateral buccal fat flaps. These refinements facilitate wound healing by providing a tension-free closure with both a well-vascularized myomucosal flap and interposed buccal fat flap to prevent scar contracture. Furthermore, no additional surgery is necessary for pedicle division.

Recreational Therapists and the Duty of Care

Background: A variety of residential and experiential therapeutic programs exist for youth who experience emotional, behavioral, or substance abuse problems that are not adequately responsive to traditional treatment options. While evaluations of programs are available in the literature, investigation of the experiences of professionals who undergird these programs and oversee reentry of youth back into their communities is lacking. Purpose: The research reported here aimed to explicate the experiences of recreational therapists. Methodology/Approach: Qualitative design was used to collect and analyze data. Semistructured interviews were employed, and data were analyzed by content analysis. Findings/Conclusions: Findings indicated recreational therapists were optimistic, intrinsically motivated to spend time outdoors, became personally invested in their work and experienced personal growth from their work. They required additional systems of support and guidance to effectively counter compassion fatigue and associated burnout. Measures for organizations to effectively counter compassion fatigue through enhancement of peer support systems and self-care guidance are needed. Implications: The results provided insight into the characteristics, needs, and experiences of recreational therapists who work with high-promise youth. Further, the work provided a proposed change to current models of compassion satisfaction and compassion fatigue subscale interactions in this population.

Episodic Migraine and Psychiatric Comorbidity: A Narrative Review of the Literature.

We evaluate the evolving evidence of psychiatric comorbidities associated with episodic migraine. Utilizing recent research publications, we aim to assess traditional treatment option considerations and discuss recent and evolving non-pharmacologic treatment progress for episodic migraine and related psychiatric conditions. Recent findings indicate that episodic migraine is strongly linked to comorbid depression, anxiety, posttraumatic stress disorder, and sleep disorders. Not only do patients with episodic migraine have higher rates of psychiatric comorbidity, but a higher number of headache days reported is also strongly linked to an increased risk of developing a psychiatric disorder, indicating there may be a link between frequency and psychiatric comorbidity and that patients with high-frequency episodic migraine should be assessed for psychiatric comorbidity. Few migraine preventive medications have examined the effect of the medication on both migraine and psychiatric comorbidity though we discuss what has been reported in the literature. Non-pharmacologic-based treatments including behavioral therapies and mind-body interventions previously developed for psychiatric conditions, e.g., mindfulness-based CBT (MBCT), acceptance and commitment therapy (ACT), and mindfulness-based stress reduction (MBSR) therapy, have promising results for patients diagnosed with episodic migraine and may therefore be useful in treating migraine and comorbid psychiatric conditions. Psychiatric comorbidity may affect the efficacy of the treatment of episodic migraine. Thus, we must assess for psychiatric comorbidities to inform better treatment plans for patients. Providing patients with episodic migraine with alternate modalities of treatment may help to improve patient-centered care and increase patients' sense of self-efficacy.

In vitro reduction of Escherichia coli biofilm mass by platelet-rich plasma lysate (PRP-L)

Placentitis-induced, pre-term fetal loss has caused hardships and financial losses to the equine breeding industry for decades. While traditional multi-modal treatments including a combination of gentamicin, penicillin, altrenogest, firocoxib, and pentoxifylline can sometimes prolong gestation and neonatal survival, treatment failures still occur and antibiotic therapy can be quite lengthy. Understanding potential biofilms in these reproductive infections uncovers a pitfall to the success of traditional treatment options: antimicrobials are ineffective at penetrating and killing biofilms in vitro and in vivo. Platelet-rich plasma lysate (PRP-L) is increasingly accepted as an adjunctive treatment option for biofilm associated infections across species. The aim of this study was to evaluate the reduction in biofilm formation of 10 isolates of Escherichia coli collected from the equine uterus. Isolates were stored in glycerol at -80°C; each isolate including a positive (ATCC 25922) and negative (ATCC BAA 2469) strain, was cultured for 18-24 h at 33-37°Cin ambient air until bacterial colonies were visible. A suspension of each isolate, adjusted to a 0.5 McFarland value, was used to inoculate a tissue culture treated, round-bottom 96-well microtiter plate incubated under microaerophilic orbital shaking conditions for 18-24 h at 33-37°C. Following incubation, with or without PRP-L, the supernatant was removed, wells were stained with 0.03% crystal violet for 15 minutes at room temperature with orbital shaking, rinsed to remove excess stain, solubilized with ethanol, and absorbance optical density (OD570) read with a plate reader. The range in reduction of biofilm mass with PRP-L treatment was 48 – 84%, with an average of 60%. In conclusion, the results suggest that comparison of a traditional multi-modal therapy for placentitis with a multi-modal therapy augmented with PRP-L has the potential to finally improve placentitis outcomes and reduce the length of antibiotic treatment, but further in vivo evaluation of this approach is required.

The Current State of Osteoarthritis Treatment Options Using Stem Cells for Regenerative Therapy: A Review.

Articular cartilage has very low metabolic activity. While minor injuries may be spontaneously repaired within the joint by chondrocytes, there is very little chance of a severely impaired joint regenerating itself when damaged. Therefore, any significant joint injury has little chance of spontaneously healing without some type of therapy. This article is a review that will examine the causes of osteoarthritis, both acute and chronic, and how it may be treated using traditional methods as well as with the latest stem cell technology. The latest regenerative therapy is discussed, including the use and potential risks of mesenchymal stem cells for tissue regeneration and implantation. Applications are then discussed for the treatment of OA in humans after using canine animal models. Since the most successful research models of OA were dogs, the first applications for treatment were veterinary. However, the treatment options have now advanced to the point where patients suffering from osteoarthritis may be treated with this technology. A survey of the literature was performed in order to determine the current state of stem cell technology being used in the treatment of osteoarthritis. Then, the stem cell technology was compared with traditional treatment options.

Coccidioidomycosis and Host Microbiome Interactions: What We Know and What We Can Infer from Other Respiratory Infections.

Between 70 and 80% of Valley fever patients receive one or more rounds of antibiotic treatment prior to accurate diagnosis with coccidioidomycosis. Antibiotic treatment and infection (bacterial, viral, fungal, parasitic) often have negative implications on host microbial dysbiosis, immunological responses, and disease outcome. These perturbations have focused on the impact of gut dysbiosis on pulmonary disease instead of the implications of direct lung dysbiosis. However, recent work highlights a need to establish the direct effects of the lung microbiota on infection outcome. Cystic fibrosis, chronic obstructive pulmonary disease, COVID-19, and M. tuberculosis studies suggest that surveying the lung microbiota composition can serve as a predictive factor of disease severity and could inform treatment options. In addition to traditional treatment options, probiotics can reverse perturbation-induced repercussions on disease outcomes. The purpose of this review is to speculate on the effects perturbations of the host microbiome can have on coccidioidomycosis progression. To do this, parallels are drawn to aa compilation of other host microbiome infection studies.

‘This is hardcore’: a qualitative study exploring service users’ experiences of Heroin-Assisted Treatment (HAT) in Middlesbrough, England

BackgroundHeroin-Assisted Treatment (HAT) is well evidenced internationally to improve health and social outcomes for people dependent on opioids who have not been helped by traditional treatment options. Despite this evidence base, England has been slow to implement HAT. The first service outside of a trial setting opened in 2019, providing twice-daily supervised injections of medical-grade heroin (diamorphine) to a select sample of high-risk heroin users in Middlesbrough. This paper explores their experiences, including the negotiation of the strict regularly controls required of a novel intervention in the UK context.MethodsWe conducted in-depth interviews with service providers and users of the Middlesbrough HAT service between September and November 2021. Data from each group were thematically analysed and reported separately. This paper details the experiences of the twelve heroin dependent men and women accessing HAT.ResultsParticipants’ accounts of HAT treatment evidenced a tension between the regulatory constraints and uncertainty of treatment provision, and the positive outcomes experienced through supportive service provision and an injectable treatment option. Limited confidence was held in treatment efficacy, longevity of funding, and personal capacity for treatment success. This was counteracted by a strong motivation to cease engagement with the illicit drug market. While attendance requirements placed restrictions on daily activities, participants also experienced benefits from strong, supportive bonds built with the service providers through their continued engagement.ConclusionsThe Middlesbrough HAT programme provided benefits to a high-risk population of opioid dependent people who were unable or disinclined to participate in conventional opioid substitution treatments. The findings in this paper highlight the potential for service modifications to further enhance engagement. The closure of this programme in 2022 prohibits this opportunity for the Middlesbrough community, but holds potential to inform advocacy and innovation for future HAT interventions in England.

Multipotent Mesenchymal Stem Cell-Based Therapies for Spinal Cord Injury: Current Progress and Future Prospects.

Spinal cord injury (SCI) represents a significant medical challenge, often resulting in permanent disability and severely impacting the quality of life for affected individuals. Traditional treatment options remain limited, underscoring the need for novel therapeutic approaches. In recent years, multipotent mesenchymal stem cells (MSCs) have emerged as a promising candidate for SCI treatment due to their multifaceted regenerative capabilities. This comprehensive review synthesizes the current understanding of the molecular mechanisms underlying MSC-mediated tissue repair in SCI. Key mechanisms discussed include neuroprotection through the secretion of growth factors and cytokines, promotion of neuronal regeneration via MSC differentiation into neural cell types, angiogenesis through the release of pro-angiogenic factors, immunomodulation by modulating immune cell activity, axonal regeneration driven by neurotrophic factors, and glial scar reduction via modulation of extracellular matrix components. Additionally, the review examines the various clinical applications of MSCs in SCI treatment, such as direct cell transplantation into the injured spinal cord, tissue engineering using biomaterial scaffolds that support MSC survival and integration, and innovative cell-based therapies like MSC-derived exosomes, which possess regenerative and neuroprotective properties. As the field progresses, it is crucial to address the challenges associated with MSC-based therapies, including determining optimal sources, intervention timing, and delivery methods, as well as developing standardized protocols for MSC isolation, expansion, and characterization. Overcoming these challenges will facilitate the translation of preclinical findings into clinical practice, providing new hope and improved treatment options for individuals living with the devastating consequences of SCI.

Innovations in the Treatment of Gastric Outlet Obstruction: Is This the Era of Endoscopic Ultrasonography-Guided Gastroenterostomy?

Abstract Purpose of review Gastric outlet obstruction is a syndrome that is caused by several benign and malignant diseases. Endoscopic ultrasonography-guided gastroenterostomy (EUS-GE) is a novel treatment that seems to combine the advantages of the two traditional treatments: enteral stent placement (ES) and surgical gastrojejunostomy (SGJ). This review aims to determine the current position of EUS-GE amidst the two traditional treatment options. Recent findings Different approaches can be adopted to facilitate EUS-GE. Direct gastroenterostomy seems to have the shortest procedure time. All methods possess high technical success rates. Several retrospective analyses have compared EUS-GE to ES and SGJ. EUS-GE seems to have better stent patency compared to ES and a lower adverse event rate compared to SGJ. Recently, randomized trials have been initiated which compare EUS-GE with ES or SGJ. Summary Although the currently published literature unequivocally shows the great promises of EUS-GE, properly powered and controlled studies are warranted to ascertain the definitive position of EUS-GE within the treatment repertoire of GOO. Until reliable data has been collected, EUS-GE can be considered a safe and effective alternative to ES and SGJ.

Integrating Non-Targeted Ecosystem Services into Assessment of Natural Stormwater Treatment Systems

Natural stormwater treatment systems (NTS) are built ecosystems designed to capture and treat stormwater runoff via natural processes. Although NTS design typically targets water services, the biological communities associated with NTS (i.e., plants, animals, and microbes) can provide non-targeted functions that can result in ecosystem services, such as biodiversity, pollination, and climate regulation, or in some cases disservices. Additional co-benefits of NTS include recreation, education and outreach opportunities, and aesthetic value. A review of NTS ecosystem services and co-benefits is provided with specific examples from Los Angeles County, highlighting the need for ecosystem services indicators, standard measurements, and monitoring. As NTS become globally widespread, best practices must include the ability to holistically assess NTS performance in ways that extend beyond water treatment services. Three models are presented that can be used to evaluate NTS performance. Such information can be important in advancing NTS design, choosing spatial placement, and making choices between NTS and more traditional stormwater treatment options.

Abstract 3277: In vivo CRISPR screening identifies PTDSS1 as a potential combinatorial target to improve immune checkpoint therapy response

Abstract Immune checkpoint therapy (ICT) has recently revolutionized the treatment paradigm for various types of cancer. However, despite the unprecedented safety and efficacy profile compared to traditional treatment options, many patients do not respond to ICT, highlighting the urgent need for novel strategies to improve ICT efficacy. Here, we used a pooled in vivo CRISPR knockout screening in a mouse bladder cancer model treated with immune checkpoint inhibitor to discover targets that may improve immunotherapy response. Our data identified Ptdss1, which encodes phosphatidylserine synthase 1, as a potential regulator of anti-PD-1 response. Depletion of Ptdss1 not only increased tumor cell immunogenicity and response to interferon gamma, but also facilitated development of an anti-tumor microenvironment. Ptdss1 depletion in tumor cells increased effector CD8+ T cells cytolytic function, decreased regulatory T cells activation and inhibitory function, increased frequency of iNOS+ myeloid cells and induced macrophage M2-to-M1 polarization. Ptdss1 knockdown induced changes in the tumor microenvironment were further amplified when combined with anti-PD-1 treatment, which translates into better tumor control and prolonged animal survival in mouse bladder cancer model. Together, our results provide insights on a new therapeutic strategy for overcoming resistance to immune checkpoint therapy through combination of PTDSS1 inhibition and PD-1 blockade. Citation Format: Jielin Liu, Swetha Anandhan, Sreyashi Basu, Yulong Chen, Sangeeta Goswami, Ashwat Nagarajan, Shelley Herbrich, Liangwen Xiong, Baoxiang Guan, Padmanee Sharma. In vivo CRISPR screening identifies PTDSS1 as a potential combinatorial target to improve immune checkpoint therapy response [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3277.

Potential Alternative Therapeutic Modalities for Management Head and Neck Squamous Cell Carcinoma: A Review.

Head and neck squamous cell carcinoma (HNSCC) includes malignancies of the lip and oral cavity, oropharynx, nasopharynx, larynx, and hypopharynx. It is among the most common malignancy worldwide, affecting nearly 1 million people annually. The traditional treatment options for HNSCC include surgery, radiotherapy, and conventional chemotherapy. However, these treatment options have their specific sequelae, which produce high rates of recurrence and severe treatment-related disabilities. Recent technological advancements have led to tremendous progress in understanding tumor biology, and hence the emergence of several alternative therapeutic modalities for managing cancers (including HNSCC). These treatment options are stem cell targeted therapy, gene therapy, and immunotherapy. Therefore, this review article aims to provide an overview of these alternative treatments of HNSCC.

Robot-assisted simple prostatectomy for prostates greater than 100 g

Efforts are ongoing to treat severe benign prostatic hyperplasia as traditional endoscopic treatment options are often difficult to perform and associated with significant complications. This manuscript highlights our initial experience of robot-assisted simple prostatectomy [RASP] with minimum a year follow-up. We also compared our outcomes with published literature. After an Institution Review Board approval, we gathered data of 50 cases of RASP between Jan 2014 and May 2021. Patients with prostate volume > 100cc [calculated from magnetic resonance imaging (MRI)] and prostate biopsy confirmed benign prostate were candidates for RASP. Patients underwent RASP via transperitoneal route either by suprapubic or trans-vesical approach. Preoperative demographics, peri-operative parameters and post-operative parameters such as hospital stay, catheter removal, urinary continence and uroflow were recorded in standard database and presented as descriptive statistics. Patients presented with a baseline median International Prostate Symptom Score (IPSS) of 23 (inter-quartile range (IQR) 21,25) and a median PSA of 7.7ng/ml (IQR 6.4,8.7). Median preoperative prostate volume was 167ml (IQR, 136,198ml). Median console time was 118min, and median estimated blood loss was 148ml (IQR 130, 167ml). None of our cohort needed intraoperative transfusion, conversion to open surgery or developed any complications. Median time to Foley removal was 10days (IQR 8,12). Significant drop in the IPSS score and improvement in Qmax was noted over the period of follow-up. RASP is associated with considerable improvements in urinary symptoms. However, comparative studies with endoscopic treatment options of large prostatic adenomas are warranted and ideally include cost analysis of different procedures.

Predicting response to CGRP-monoclonal antibodies in patients with migraine in Japan: a single-centre retrospective observational study

BackgroundAnti-calcitonin gene-related peptide monoclonal antibodies (CGRPmAbs) are a favourable option for patients with migraine who experience distressful headache disability and fail to respond to traditional preventive treatment options. However, since CGRPmAb has been available for only 2 years in Japan, the difference between good and poor responders remains unknown. We aimed to investigate the clinical characteristics of patients with migraine in Japan who responded well to CGRPmAb based on real-world data.MethodsWe analysed patients who visited Keio University Hospital, Tokyo, Japan, between the 12th of August 2021 and 31st of August 2022, and were prescribed one of three CGRPmAbs (erenumab, galcanezumab, and fremanezumab) for more than 3 months. We recorded the patients’ basic migraine characteristics, such as pain quality, monthly migraine days (MMD)/monthly headache days (MHD), and the number of prior treatment failures. We defined good responders as patients whose MMDs decreased by more than 50% after 3 months of treatment and other patients as poor responders. We compared the baseline migraine characteristics between the two groups and performed logistic regression analysis based on the items that showed statistically significant differences.ResultsIn total, 101 patients were considered eligible for the responder analysis (galcanezumab: 57 (56%), fremanezumab: 31 (31%), and erenumab: 13 (13%)). After 3 months of treatment, 55 (54%) patients achieved ≥ 50% reduction in MMDs. Comparisons between ≥ 50% responders and non-responders revealed that age was significantly higher (p = 0.003), and MHD and total prior treatment failures were significantly lower (p = 0.027, 0.040, respectively), in responders than in non-responders. Age was a positive predictive factor, and the total number of prior treatment failures and past medical history of immuno-rheumatologic diseases were negative predictive factors of CGRPmAb responsiveness in Japanese patients with migraine.ConclusionsPatients with migraine who are older, with fewer prior treatment failures and no past history of immuno-rheumatologic disease, may respond well to CGRPmAbs.