Ultimate Goal Of Treatment Research Articles

Electrospinned bioactive glass/nano hydroxyapatite reinforced polycaprolactone GTR/GBR membranes in periodontics- A review

Periodontitis, a chronic inflammatory infectious disease triggered by an interaction between microbial biofilm and host response leading to gingival bleeding, connective tissue destruction , alveolar bone loss and finally causing tooth loss. Periodontal regeneration or restoration is the ultimate goal of any periodontal treatment. This can be achieved by GTR/GBR [Guided Tissue Regeneration/Guided Bone Regeneration] membranes along with bone replacement grafts. With the evolution of Tissue engineering and different generation of GTR/GBR nanofibrous membranes, periodontal restoration or regeneration can be easily and rapidly achieved . Nanofibrous GTR/GBR Membranes can be fabricated using natural or synthetic polymers by different techniques such as Phase separation, Self assembly and Electrospinning [E-spinning]. Of these, E-spinning is the most widely studied technique and also seems to exhibit the most promising results for Tissue Engineering[TE] applications . This review addresses the Electrospinning method of GTR/GBR membrane fabrication using Bioactive Glass [BG]/Nano Hydroxyapatite[nHAP] reinforced polycaprolactone polymer and its advantages and disadvantages. Keywords: Electrospinning, Guided Tissue Regeneration, Periodontal Regeneration

Root canal medicaments

The ultimate goals of endodontic treatment are complete removal of bacteria, their byproducts and pulpal remnants from infected root canals and the complete seal of disinfected root canals. Intracanal medicaments have been thought an essential step in killing the bacteria in root canals; however, in modern endodontics, shaping and cleaning may be assuming greater importance than intracanal medicaments as a means of disinfecting root canals. Until recently, formocresol and its relatives were frequently used as intracanal medicaments, but it was pointed out that such bactericidal chemicals dressed in the canal distributed to the whole body from the root apex and so might induce various harmful effects including allergies. Furthermore, as these medicaments are potent carcinogenic agents, there is no indication for these chemicals in modern endodontic treatment. Today, biocompatibility and stability are essential properties for intracanal medicaments. The more modern meaning of intracanal dressing is for a blockade against coronal leakage from the gap between filling materials and cavity wall. Calcium hydroxide has been determined as suitable for use as an intracanal medicament as it is stable for long periods, harmless to the body, and bactericidal in a limited area. It also induces hard tissue formation and is effective for stopping inflammatory exudates. Single-visit endodontics, where intracanal medicaments are not used, is generally not now contraindicated and various reports have shown that the clinical outcomes between single- and multiple- visit endodontics are similar. There is no reason to counsel against single-visit endodontics: however, if multiple-visit endodontics is chosen, calcium hydroxide is recommended to be used as an intracanal medicament.

Glucose-Responsive Gold Nanocluster-Loaded Microneedle Patch for Type 1 Diabetes Therapy.

Responsive blood glucose control in a convenient and noninvasive manner is the ultimate goal in diabetes treatment. In this study, we developed a closed-loop microneedle (MN)-array patch for transdermal and responsive insulin delivery in type 1 diabetes therapy. We prepared alginate-based MN-array patches integrated with glucose-responsive gold nanoclusters (GNCs) using a two-step casting and centrifuging process. From both theoretical calculation and experimental study, we found that the integration of GNCs into MNs significantly improved the mechanical strength of alginate-based MN-array patches. The GNCs facilitated the MNs to penetrate the skin of mice, and the glucose-responsive GNCs in MNs allowed the closed-loop insulin release both in vitro in glucose solutions and in vivo in type 1 diabetic mice. With transdermal application only once on the skin of mice, the MN-array patches regulated the blood glucose levels of mice in normoglycemic ranges for up to 2.8 days and decreased the diabetic symptoms of the mice. Our study proved the successful application of glucose-responsive GNC-loaded MN-array patches for minimally invasive and responsive insulin delivery, providing a promising alternative for type 1 diabetes therapy.

Mucosal microbiota and gene expression are associated with long-term remission after discontinuation of adalimumab in ulcerative colitis

Given that sustained remission is the ultimate treatment goal in the management of patients with ulcerative colitis (UC), the decision to stop anti-tumor necrosis factor (anti-TNF) treatment in UC patients is difficult. The aim of this study was to evaluate mucosal microbiota and gene expression profiles associated with long-term remission after discontinuation of anti-TNF therapy. In nine UC patients who received anti-TNF therapy for 6 months, microbiota isolated from uninflamed mucosae and gene expression in inflamed and uninflamed mucosae were investigated at week 0 and at week 24. At treatment initiation, Fusobacterium sp. and Veillonella dispar were over-represented in the relapse group compared with the non-relapse group. After treatment, Dorea sp. and Lachnospira sp. were over-represented in the non-relapse group. In the relapse group only, a significant shift in gut bacterial community composition was found between week 0 and week 24. Gene expression of ALIX (PDCD6IP) and SLC9A3 was significantly higher in the non-relapse group than in the relapse group. Lastly, we used machine learning methods to identify relevant gene signatures associated with sustained remission. Statistical analyses of microbiota and expression profiles revealed differences between UC patients who did or did not keep remission after the discontinuation of TNF inhibitors.Trial registration: UMIN000020785: Evaluation of adalimumab therapy in mesalazine-resistant or -intolerant ulcerative colitis; an observational study (EARLY study).

TREATMENT OF GINGIVAL RECESSION DEFECT USING MESENCHYMAL STEM CELLS CULTURED PCL BASED BONE REGENERATING SCAFFOLD: A RANDOMIZED CONTROLLED CLINICAL STUDY

Gingival recession defects generally give rise to functional as well as aesthetic problems. Basic periodontal treatment could only get rid of plaque and calculus to control inflammation, while the ultimate goal of periodontal treatment is to repair and reconstruct the periodontal lining using a gum grafting periodontal plastic surgery. So far, use of stem cells has proven to be effective for in vivo periodontal regeneration and repair of structural defects in case of Miller’s classification class I. However, class II and class III required serious bone grafting to repair the defect.
 In the present study, a patient of multiple gingival recession (Miller’s class II) was treated using human Umbilical Cord Wharton’s jelly derived mesenchymal stem cells (hUCMSCs) in combination with bone regeneration poly ε-caprolactone (PCL)-graphene oxide (GO)-Cissus quadrangularis(CQ)(PCL-GO-CQ) scaffold. The study was concluded with reference to clinical parameters including root coverage that was recorded at baseline, and at 2 months postoperative. The final analysis revealed significant reduction of gingival recession with over 70% of root coverage. Thus, the study proved the efficacy of bone regenerating scaffold to regenerate multiple tissue defects, when seeded with human Umbilical cord Wharton’s jelly derived mesenchymal stem cells.

Early-onset scoliosis: challenges and current management options

Early-onset scoliosis is one of the most challenging conditions facing spinal and paediatric surgeons and clinicians. The ultimate goal of treatment is to improve the children's quality of life and to give them the best chance to develop to independent adults. However, the road to these goals is not an easy one. There are obstacles to be overcome, risks to be encountered; and difficult decisions to be inevitably made. The young age of the patients means they have significant growth potential. Managing the growing child means not only controlling and correcting the spinal deformity; but also preserving the motion and development of the spine, chest cavity and the cardiopulmonary system. Different treatment modalities exist to help these ambitions. These include observation, casting, bracing and surgery. However, nothing is more worthy of emphasis than the importance of a multi-team approach; with the involvement of surgeons, physicians, neurologists, nutritionists and physiotherapists. In this review we aim to shed some light on different management strategies; examining the principles behind them, their advantages and drawbacks; and some of the results reported in the literature. We will also explore some currently promising advances that might play a future role in managing early-onset scoliosis.

Effects of Phonomotor Therapy and Semantic Feature Analysis on Discourse Production.

Background Anomia treatments typically focus on single word retrieval, although the ultimate goal of treatment is to improve functional communication at the level of discourse in daily situations. Aims The focus of this study was to investigate the impact of two effective anomia treatments on discourse production as measured by a story retell task. Method and Procedure Fifty-seven people with aphasia were randomized to receive either a phoneme-based treatment, Phonomotor Therapy (PMT; 28 participants), or a lexical-semantic treatment, Semantic Feature Analysis (SFA; 29 participants). Groups were matched for age, aphasia severity, education, and years post onset. All received 56-60 hr of treatment in a massed treatment schedule. Therapy was delivered for a total of 8-10 hr/week over the course of 6-7 weeks. All participants completed testing 1 week prior to treatment (A1), immediately following treatment (A2), and again 3 months later (A3). Discourse was analyzed through the percentage of correct information units at each time point. Outcomes and Results Both groups showed nonsignificant improvements from pretreatment to immediately posttreatment. The PMT group showed significant improvement 3 months posttreatment, while the SFA group returned to near-baseline levels. Conclusion These results add to our understanding of the effects of both PMT and SFA. Future research should address understanding variability in discourse outcomes across studies and the effects of aphasia severity and individual participant and treatment factors on treatment outcomes for both of these approaches.

Elimination of Simulium neavei-Transmitted Onchocerciasis in Wambabya-Rwamarongo Focus of Western Uganda.

.Wambabya–Rwamarongo onchocerciasis focus is one of the eight foci Uganda verified using the WHO verification guidelines. The approach for elimination was twice yearly treatment with ivermectin for every round, treating at least 90% of all the eligible population. This was in combination with vector elimination using Abate® (BASF SE, Limburgerhof, Germany) since elimination nationwide policy was launched. From 2008 to 2013, the program distributed ivermectin with a mean treatment coverage of the ultimate treatment goal (UTG) or eligible population of 91.2%, with a range of 85–96%. In 2009, vector elimination based on ground larviciding had a dramatic impact on the Simulium vectors, as the last fly was observed in October 2009. No more Simulium vectors were observed during a period of at least 7 years, including the 3-year posttreatment surveillance (PTS) until the focus was reclassified as eliminated in August 2017. During the PTS period, none of the 10,578 trapped crabs were found infested with the aquatic stages of the vector. The last infested crab was observed in March 2010, and for at least 7 years, no infested crabs were observed. Serological surveys showed that of 2,978 young children examined in 2013, only one was OV16 positive (0.0%; 95% CI: 0–0.21). In 2017, after the PTS period, all 3,079 young children examined were negative for OV16 (95% CI: 0–0.16). Therefore, entomological and serological results provided evidence that resulted in the reclassification of Wambabya–Rwamarongo focus from “transmission interrupted” to “transmission eliminated” with no possibility of recrudescence.

2281-PUB: Quality of Life in Japanese Patients with Type 2 Diabetes Mellitus

Introduction: The ultimate goal of antihyperglycemic treatment for people with diabetes is to have a similar longevity and quality of life (QOL) as those without diabetes. No study has specifically aimed at assessing the association between glycemic control and QOL in general type 2 diabetes patients in Japan. We therefore wanted to evaluate QOL in Japanese type 2 diabetes (T2DM) patients using a validated diabetes treatment related-QOL (DTR-QOL) questionnaire. The aim of this study was to investigate the association between glycemic controls and QOL among Japanese patients with T2DM. We presented its interim report on 77th scientific session in June, 2017. We will finally submit our final report this time. Methods: We conducted a large-scale multi-centered, cross-sectional study and analyzed a total of 3,259 type 2 diabetes patients who provided valid answers to the DTR-QOL questionnaire. Results: Among 3,259 patients, 61% were male and 39% were female. The mean age was 63.0 ± 11.8 years, the mean BMI was 25.3 ± 4.8 kg/m2, and the mean HbA1c was 7.5 ± 1.6%. There was a significant negative correlation between the total DTR-QOL score and HbA1c (ρ =-0.325, p<0.0001). The total DTR-QOL score increased with increasing age (p < 0.0001) and decreased with increased BMI (p < 0.0001) and increased HbA1c levels (p < 0.0001). In multiple regression analysis, adjusted for age, sex and BMI, HbA1c (β=-0.229, p<0.0001), neuropathy (β=0.082, p<0.0001), macroangiopathy (β=0.050, p=0.0027), and insulin injection (β=0.196, p<0.0001) were found to be independent factors with significant effects on DTR-QOL. Conclusions: Our results show that poor blood glucose control, diabetic neuropathy, macroangiopathy, and insulin injections are factors that lead to reduced QOL in type 2 diabetes patients. In routine practice, healthcare professionals should not forget to evaluate the patient’s QOL in addition to assessing blood glucose control status and other factors. Disclosure K. Takahashi: None. Y. Terauchi: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo, Eli Lilly Japan K.K., Novo Nordisk A/S, Sanofi. Consultant; Self; Astellas Pharma Inc. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo, Eli Lilly Japan K.K., Merck Sharp & Dohme Corp., Novartis Pharmaceuticals Corporation, Novo Nordisk A/S, Ono Pharmaceutical Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited. Speaker’s Bureau; Self; Astellas Pharma Inc., AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo, Eli Lilly Japan K.K., Kowa Company, Ltd., Medscape, Medtronic, Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Novartis Pharmaceuticals Corporation, Novo Nordisk A/S, Ono Pharmaceutical Co., Ltd., Sanofi, Sanwa Kagaku Kenkyusho, Sumitomo Dainippon Pharma Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Terumo Medical Corporation. T. Yamakawa: None.

S67. TREATMENT-RESISTANCE AFFECTS LONG-TERM COGNITIVE TRAJECTORIES IN SCHIZOPHRENIA: A LONGITUDINAL STUDY

BackgroundSchizophrenia is a highly heterogeneous disorder, and despite extensive research progress approximately 30% of patients with schizophrenia show poor response to first-line antipsychotics, denoted as treatment-resistant schizophrenia (TRS). Meta-analytic evidence showed that clozapine is the most effective antipsychotic for TRS, although 40% of TRS patients do not respond even to clozapine (ultra-treatment-resistant schizophrenia -UTR). Recent studies indicated that TRS is neurobiologically and categorically distinct from treatment-responsive schizophrenia, being associated with elevated glutamate levels in the anterior cingulate cortex and unaltered striatal dopamine synthesis. Moreover, the striking majority of TRS patients do not respond to first-line antipsychotic therapy since disease onset and present more severe cognitive deficits since first episode of psychosis, further suggesting the presence of a distinct and more disrupted neurobiological substrate. It is widely known that cognitive impairment is a core feature of schizophrenia and determines a significant detrimental impact on long-term functional outcome, which represents the ultimate treatment goal. However, despite the central role of cognition in schizophrenia, to date no study has investigated longitudinal cognitive outcome among TRS patients.Based on these evidences, the aim of this study is to evaluate longitudinal cognitive trajectories in a sample of clinically stabilized patients with schizophrenia, stratified according to antipsychotic response. We hypothesized that treatment-resistance is associated with a more severe long-term cognitive decline.MethodsWe enrolled 93 patients with schizophrenia (DSM-V), stratified as follows: 32 first-line responders (FLR), 42 TRS and 19 UTR. Cognition was longitudinally assessed at baseline and at least after 6 years of follow-up (mean: 9.3±2.8 years) using the Brief Assessment of Cognition in Schizophrenia (BACS). From BACS subscores we calculated for each patient a Cognitive Index, as a measure of overall cognitive functioning. In order to quantify global cognitive functioning changes during the course of illness, we estimated effect size score for Cognitive Index using Cohen’s d. Finally, General linear Models (GLM) were performed with overall cognitive index effect size as dependent variable, treatment (FLR/TRS/UTR) as categorical variable and age, duration of illness and education as covariates.ResultsThe first GLM (FLR vs TRS+UTR) showed a significant main effect of treatment (F=7.34, p=0.01), with worse cognitive outcome between resistant patients. Consistently, the second GLM (FLR/TRS/UTR) resulted significant as well (F=17.90, p<0.001), with UTR group showing worse cognitive trajectory (Fisher’s post-hoc: p<0.001, UTR Cognitive Index effect size = -0.7).DiscussionThis is the first study to longitudinally evaluate cognitive trajectories of patients with schizophrenia according to their antipsychotic response. We showed that treatment resistance is associated with a more severe cognitive decline, with worse outcome among UTR patients. These data suggest that greater severity of treatment resistance in schizophrenia is associated with greater cognitive impairment, possibly due to the presence of a distinct and more disrupted neurobiological substrate that affects both cognition and antipsychotic response. These findings further highlight the necessity of early individuation and tailored pharmacological treatment for TRS patients, in order to improve long-term clinical, cognitive and functional outcome.

Antibiotic Treatment Shapes the Antigenic Environment During Chronic TB Infection, Offering Novel Targets for Therapeutic Vaccination

The lengthy and complicated current regimen required to treat drug-susceptible tuberculosis (TB) reflects the ability of Mycobacterium tuberculosis (Mtb) to persist in host tissues. The stringent response pathway, governed by the dual (p)ppGpp synthetase/hydrolase, RelMtb, is a major mechanism underlying Mtb persistence and antibiotic tolerance. In the current study, we addressed the hypothesis that RelMtb is a “persistence antigen” presented during TB chemotherapy and that enhanced immunity to RelMtb can enhance the tuberculocidal activity of the first-line anti-TB drug, isoniazid, which has reduced efficacy against Mtb persisters. C57BL/6 mice and Hartley guinea pigs were aerosol-infected with M. tuberculosis (Mtb) and, 4 weeks later, received either human-equivalent daily doses of isoniazid alone, or isoniazid in combination with a DNA vaccine targeting relMtb. After isoniazid treatment, there was a significant reduction in dominant antigen ESAT6-reactive CD4+ or TB10.4-reactive CD8+ T cells in the lungs and spleens of mice. However, the total number of RelMtb-reactive CD4+ T cells remained stable in mouse lungs and spleens, as did the number of RelMtb-reactive CD8+T cells. Therapeutic vaccination with relMtb DNA vaccine enhanced the activity of isoniazid in Mtb-infected C57BL/6 mice and guinea pigs. When treatment with isoniazid was discontinued, mice immunized with the relMtb DNA vaccine showed a lower mean lung bacterial burden at relapse compared to the control group. Our work shows that antitubercular treatment shapes the antigenic environment, and that therapeutic vaccination targeting the Mtb stringent response may represent a novel approach to enhance immunity against Mtb persisters, with the ultimate goal of shortening curative TB treatment.

Journey of Platelet Concentrates: A Review

Indroduction Periodontal repair and regeneration is the ultimate goal in treatment of Periodontal defects. Various biomaterials, natural as well as synthetic have been tried since many years to accelerate wound healing of both soft and hard tissue. Naturally occurring materials also known as “a

Do We Have Another Option to Treat Bleeding Hemorrhoids? The Emborrhoid Technique: Experience in 16 Patients.

Hemorrhoidal disease is very common in western countries and rectal bleeding is the main symptom complained by patients. Nowadays the ultimate goal of treatment is to block the bleeding with minimally-invasive techniques to minimize post-procedural pain. The aim of this study is to assess the preliminary results of the emborrhoid technique (embolization of the superior rectal arteries branches) as a new tool for the proctologist to treat severe bleeding hemorrhoids causing anemia. Many categories of patients might benefit from this treatment, such as patients not eligible for conventional surgery, patients not responding to conventional treatment and fit patients with severe bleeding who refused endorectal surgical therapy. From May 2017 to November 2018 a total of 16 patients with chronic rectal bleeding due to hemorrhoids underwent super-selective embolization of the superior rectal arteries at the department of General Surgery in La Spezia, S. Andrea Hospital, Italy. Median age was 59 years. 14 patients were males (87.5%). No post-procedural and short-term complications were observed at maximum follow up (12 months). The reduction of rectal bleeding with improvement of the quality of life was obtained in 14 patients (87.5%). Our study, although small in number, demonstrates that embolization of superior rectal arteries with coils to treat severe bleeding due to hemorrhoids is safe and effective and does not lead to immediate complications.

Efficacy and Limitations of Lenvatinib Therapy for Radioiodine-Refractory Differentiated Thyroid Cancer: Real-World Experiences.

Background: The ultimate clinical goal of advanced cancer treatment is improvement of survival. Tyrosine kinase inhibitors (TKIs) were recently approved for radioiodine-refractory differentiated thyroid carcinoma (RR-DTC) that is resistant to conventional therapies since they have significant potential to improve survival in patients who previously had no more treatment strategies available. However, eligible patients are limited in clinical practice, making it difficult to accurately determine the efficacy of TKIs. Patients and Methods: We retrospectively analyzed the efficacy of lenvatinib at a single institution, enrolling 42 RR-DTC patients. Results: The best overall response was partial remission in 26 (62%) patients, stable disease in 10 (24%) patients, and progressive disease (PD) in 6 (14%) patients. The results indicated three-year overall survival (OS) and progression-free survival rates of 51.0% and 32.4%, respectively. Twenty-three (55%) patients had backgrounds that did not match the inclusion criteria of the Study of (E7080) Lenvatinib in Differentiated Cancer of the Thyroid (SELECT) trial. Furthermore, PD-experienced patients individually decided whether to continue lenvatinib, and 17 (41%) made the decision themselves; these patients had a three-year OS of 43.0% and postprogression survival (PPS) of 13.3 [95% confidence interval 6.1-not reached] months. Conclusions: Our real-world investigation revealed that patients have wide-ranging background characteristics, and the decision regarding continuation of therapy after PD is based on the patient's general condition. Our management protocol resulted in good PPS. Furthermore, our results indicated equivalent efficacy of lenvatinib as in the SELECT trial. In conclusion, lenvatinib proved effective for RR-DTC patients in a real-world setting.

Thermoset and thermoplastic elastomeric chain comparative strength: An in vitro study

Aim: Technology in the field of orthodontic has experienced many developments in the last two decades. The ultimate goal of orthodontic treatment is to provide continuous light pressure to get orthodontic tooth movement with minimum side effects. Elastomeric chains are commonly used materials for moving teeth and closing space. The strength of elastomeric chain results in a tendency for better elastomer selection. Some factories make elastomeric chains with thermoplastic and thermoset materials with thermoset material claims having strength resistance for longer periods of time. The aim of the study was to compare the degradation strength between thermoplastic and thermoset elastomeric chain. Materials and Methods: This was a true-experimental laboratory study (in vitro study). The sample comprised open-type elastomeric chains (power chain) with clear transparent color thermoplastic material, which include original power chain, plastic chain and thermoset material generation II, and memory chain. The samples were divided into four groups (n = 5): 24h, 7, 14, and 21 days. Independent samples t tests and analysis of variance (ANOVA) were performed to analyze the data. Results: There was significant dissimilarity between thermoplastic and thermoset elastomeric chain material in strength. Thermoplastic elastomeric chains decreased by 60.84%–65.51% and thermoset elastomeric chain reached 36.28%–58.80% within 21 days in artificial saliva solution. Conclusion: There was dissimilarity between the thermoplastic and thermoset elastomeric chain materials in force decay due to excessive early withdrawal forces in the elastomeric chains of thermoplastic materials with a more rigid material than the thermoset elastomeric chains of the thermoset material.

Blood rheology biomarkers in sickle cell disease.

Sickle cell disease (SCD) is the most common inherited blood disorder, affecting approximately 100,000 patients in the U.S. and millions more worldwide. Patients with SCD experience a wide range of clinical complications, including frequent pain crises, stroke, and early mortality, all originating from a single-point mutation in the β-globin subunit. The RBC changes resulting from the sickle mutation lead to a host of rheological abnormalities that diminish microvascular blood flow, and produce severe anemia due to RBC hemolysis, and ischemia from vaso-occlusion initiated by sticky, rigid sickle RBCs. While the pathophysiology and mechanisms of SCD have been investigated for many years, therapies to treat the disease are limited. In addition to RBC transfusion, there are only two US Food and Drug Administration (FDA)-approved drugs to ameliorate SCD complications: hydroxyurea (HU) and L-glutamine (Endari™). The only curative therapy currently available is allogeneic hematopoietic stem cell transplantation (HSCT), which is generally reserved for individuals with a matched related donor, comprising only 10–15% of the total SCD population. Potentially curative advanced gene therapy approaches for SCD are under investigation in ongoing clinical trials. The ultimate goal of any curative treatment should be to repair the hemorheological abnormalities caused by SCD, and thus normalize blood flow and prevent clinical complications. Our mini-review highlights a set of key hemorheological biomarkers (and the current and emerging technologies used to measure them) that may be used to guide the development of novel curative and palliative therapies for SCD, and functionally assess outcomes.Impact statementSevere impairment of blood rheology is the hallmark of SCD pathophysiology, and one of the key factors predisposing SCD patients to pain crises, organ damage, and early mortality. As novel therapies emerge to treat or cure SCD, it is crucial that these treatments are functionally evaluated for their effect on blood rheology. This review describes a comprehensive panel of rheological biomarkers, their clinical uses, and the technologies used to obtain them. The described technologies can produce highly sensitive measurements of the ability of current treatments to improve blood rheology of SCD patients. The goal of curative therapies should be to achieve blood rheology biomarkers measurements in the range of sickle cell trait individuals (HbAS). The use of the panel of rheological biomarkers proposed in this review could significantly accelerate the development, optimization, and clinical translation of novel therapies for SCD.

Phonomotor Versus Semantic Feature Analysis Treatment for Anomia in 58 Persons With Aphasia: A Randomized Controlled Trial.

Purpose The ultimate goal of anomia treatment should be to achieve gains in exemplars trained in the therapy session, as well as generalization to untrained exemplars and contexts. The purpose of this study was to test the efficacy of phonomotor treatment, a treatment focusing on enhancement of phonological sequence knowledge, against semantic feature analysis (SFA), a lexical-semantic therapy that focuses on enhancement of semantic knowledge and is well known and commonly used to treat anomia in aphasia. Method In a between-groups randomized controlled trial, 58 persons with aphasia characterized by anomia and phonological dysfunction were randomized to receive 56-60 hr of intensively delivered treatment over 6 weeks with testing pretreatment, posttreatment, and 3 months posttreatment termination. Results There was no significant between-groups difference on the primary outcome measure (untrained nouns phonologically and semantically unrelated to each treatment) at 3 months posttreatment. Significant within-group immediately posttreatment acquisition effects for confrontation naming and response latency were observed for both groups. Treatment-specific generalization effects for confrontation naming were observed for both groups immediately and 3 months posttreatment; a significant decrease in response latency was observed at both time points for the SFA group only. Finally, significant within-group differences on the Comprehensive Aphasia Test-Disability Questionnaire (Swinburn, Porter, & Howard, 2004) were observed both immediately and 3 months posttreatment for the SFA group, and significant within-group differences on the Functional Outcome Questionnaire (Glueckauf et al., 2003) were found for both treatment groups 3 months posttreatment. Discussion Our results are consistent with those of prior studies that have shown that SFA treatment and phonomotor treatment generalize to untrained words that share features (semantic or phonological sequence, respectively) with the training set. However, they show that there is no significant generalization to untrained words that do not share semantic features or phonological sequence features.

Treat to Target: A Valid Concept for Management of Polymyalgia Rheumatica and Giant Cell Arteritis?

Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are common inflammatory diseases of the elderly. They have variable clinical courses and are usually treated with glucocorticoids (GCs). Relapses are frequent in both conditions. Physicians should balance the tradeoff of treatment-related adverse events and risk of relapse. The ultimate goal of treatment is control of the disease while maintaining patient well-being. A treat-to-target approach may achieve the aim of controlling inflammation and preserving patient's functioning and quality of life, and would require pursuit and evaluation of clinical, laboratory, imaging, and structural targets to tackle the different manifestations of GCA and PMR.

Closed reduction in the treatment of neglected mandibular fractures at the Department of Oral and Maxillofacial Surgery, Universitas Airlangga

Background: The mandible is one of the bones most affected by facial fractures commonly resulting from trauma to the face. The ultimate goal of treatment is to re-establish the pre-injury dental occlusion (bite), mandibular anatomy and jaw function of the patient. Treatment approaches range from conservative non-invasive management by ’closed’ reduction and immobilization using intermaxillary fixation (IMF) to the more invasive surgery-based ’open’ reduction incorporating an internal fixation approach. Purpose: The purpose of this case series was to describe the close reduction method as a form of treatment in cases of neglected mandibular fracture. Cases: Four cases of single or multiple mandibular fracture were presented. Case management: All of the cases were managed using a closed reduction method and IMF. Conclusion: A closed reduction method in this case series produced encouraging results and could be considered an alternative in the treatment of neglected mandibular fractures with displacement.

Achieving Mucosal Healing in Inflammatory Bowel Diseases: Which Drug Concentrations Need to Be Targeted?

Biologicals introduced a major shift in the treatment of patients suffering from inflammatory bowel diseases. Despite providing a tight disease control for many patients, a considerable proportion of patients will fail to respond favorably to treatment or will lose response over time. Therapeutic drug monitoring emerged as a valuable tool to guide clinical decision making as serum drug concentrations have been linked to outcomes. Focusing on mucosal healing as the ultimate treatment goal, different drug concentration thresholds to achieve this outcome have been identified in the literature and are summarized in this review. For therapeutic drug monitoring to be successful in guiding clinical decision making, the used assay, the sampling time point, and the outcome that is aimed for should be taken into account when interpreting drug concentration thresholds. Awareness of these essential aspects among clinicians will improve the implementation of therapeutic drug monitoring and aid in making an evidence‐based decision.