Usual Treatment Research Articles

Acute Declines in Estimated GFR in Blood Pressure Target Trials and Risk of Adverse Outcomes

Acute decreases in glomerular filtration rate (GFR) occur commonly during intensive blood pressure (BP) lowering. Our objective was to determine the relationship between acute decreases in estimated GFR and patient outcomes. Retrospective observational study. Participants from 4 randomized controlled trials of intensive BP lowering in chronic kidney disease (Modification of Diet in Renal Disease study, African American Study of Kidney Disease and Hypertension, Systolic Blood Pressure Intervention Trial, and Action to Control Cardiovascular Risk in Diabetes trial). A 4-category exposure defined by the level of acute decrease in estimated GFR (defined as>15% vs≤15% between baseline and month 4) and the randomization to intensive versus usual BP control. Risk of kidney replacement therapy (primary outcome), defined as the need for dialysis or transplant except in the Action to Control Cardiovascular Risk in Diabetes trial, which defined its kidney outcome as a composite occurrence of serum creatinine concentration>3.3mg/dL, kidney failure, or kidney replacement therapy. Multivariable Cox models. We included 4,473 individuals randomly assigned to intensive versus usual BP control who had a total of 351 kidney outcomes and 304 deaths during median follow-up durations of 22 and 24 months, respectively. Approximately 14% of participants exhibited an acute decrease in eGFR, 11.0% in the usual BP treatment arm and 17.8% in the intensive BP treatment arm. In adjusted models, compared with a≤15% eGFR decrease in the usual BP arm, a≤15% eGFR decrease in the intensive BP control arm was associated with lower risk of the kidney outcome (HR, 0.75; 95% CI, 0.57-0.98). In contrast, a>15% decrease in eGFR was associated with a higher risk of the kidney outcome in the usual (HR, 2.47; 95% CI, 1.80-3.38) and intensive BP treatment arms (HR, 1.99; 95% CI, 1.45-2.73) compared with a≤15% decrease in the usual BP arm. Observational study, residual confounding. Decreases in eGFR of>15% in the usual and intensive BP treatment arms were associated with a higher risk of kidney outcomes compared with a≤15% decrease in the usual BP arm and may be a harbinger of adverse outcomes.

The Effect of ISBT-Bowen Therapy in the Treatment of Myofascial Neck Pain-a Randomized, Single-Blinded Clinical Trial.

Myofascial pain syndrome (MPS) is the most common diagnosis in patient presenting with chronic non-specific neck pain. It affects people's work performance, productivity, and quality of life. To date, there is little research evaluating the effectiveness of non-invasive techniques, such as ISBT-Bowen Therapy in managing neck MPS. To investigate the effectiveness of Bowen therapy in managing myofascial pain syndrome with symptoms lasting for more than six weeks. The study will also examine the long-term effect of ISBT-Bowen Therapy on functional enhancement, quality of life, and physical and mental well-being. This is a prospective, single-blinded randomized controlled trial (RCT). A total of 90 myofascial neck pain patients were recruited and randomized to receive 8 sessions of ISBT-Bowen Therapy over a 12-week period (n = 45) or to continue their usual conventional treatment (n = 45). Pressure pain threshold (PPT), cervical range of motion (CROM), numerical rating pain scores, Neck Disability Index (NDI), SF-12 Health Survey (SF-12) Version 2, Generalized Anxiety Disorder 7-item (GAD7), and Patient Health Questionnaire (PHQ9) were measured at baseline, 12 weeks, and 24 weeks after baseline. When compared with the control group, PPT significantly increased after ISBT-Bowen Therapy at 12 and 24 weeks. CROM on flexion, lateral flexion, and rotation were greatly improved at 12 weeks after Bowen therapy, and maintained at 24 weeks, except left lateral flexion. NDI, GAD7, and PHQ9 were all reduced after Bowen Therapy at both 12 and 24 weeks. Both Physical and Mental Component Summary scores of SF-12 were improved after Bowen therapy at 12 and 24 weeks. This study confirmed the efficacy of ISBT-Bowen Therapy for patients with MPS. It alleviates pain, improves functional outcomes, enhances quality of life, and relieves mood symptoms.

Cannabidiol for neuropsychiatric symptoms in Alzheimer’s dementia

AbstractBackgroundBehavioural and Psychological Symptoms of Dementia (BPSD) in people with Alzheimer’s disease (AD) is particularly distressing to patients and carers. There are currently no licensed medications for BPSD, and the current available treatments have limited benefits and greater risk for side effects. There is therefore a considerable unmet clinical need for interventions that are safe, well‐tolerated and effective for treating BPSD in AD. Cannabidiol (CBD), a non‐addictive substance present in cannabis shows promise for treating psychotic and anxiety symptoms in people without dementia and is generally safe and well‐tolerated in elderly. However, its efficacy, safety and tolerability need to be systematically tested in elderly with dementia. We aimed to evaluate acceptability and tolerability of CBD as treatment for BPSD in patients with AD.MethodsWe are conducting a double‐blind, parallel group, placebo‐controlled pragmatic randomized controlled feasibility trial (EudraCT Number ‐ 2019‐002106‐52) and recruiting AD patients with BPSD within Mental Health for Older Adults services, South London and Maudsley NHS trust, United Kingdom. Half of the participants receive 600 mg of CBD orally once a day over 6 weeks and the other half receive a placebo, in addition to their usual treatment for 6 weeks. Clinical data collected includes measures of cognition, Clinical Dementia Rating for staging, behaviour symptoms on Neuropsychiatric Inventory (NPI), global functioning, Quality of Life for patients and carer’s burden. Tolerability is assessed by self‐report of side‐effects, and side‐effect rating scale.ResultsOf the participants recruited and randomised so far, there have been no withdrawals or serious adverse events. The study is ongoing and due for completion at the end of April 2022, following which we will have the data to analyse and present the findings at the July 2022 conference.ConclusionsCBD has been generally acceptable and safe for people with AD with BPSD. The final analysis and findings related to adverse events, and changes in clinical measures for the groups (CBD treatment versus placebo) including BPSD, cognition etc. will be presented at the conference.

ID: 210631 Case Report: Peripheral Nerve Stimulation of the Pudendal Nerve for Pudendal Neuralgia

Pudendal neuralgia is an incapacitating condition that causes pelvic pain, disability and dysfunction along the pudendal nerve and can be difficult to treat. Usual treatment includes pelvic floor physical therapy, neuropathic and pain medications, biofeedback and cognitive behavioral therapy, nerve blocks, sympathetic blocks, and spinal cord or DRG stimulation.

THE EFFECT OF TEXT MESSAGES BY CELL PHONE IN THE CONTROL OF HYPERTENSION: A RANDOMIZED CLINICAL TRIAL

Objective: To compare the effects of texting by cell phone plus standard usual guidance for hypertension versus standard usual guidance alone, on blood pressure control, among hypertensive patients undergoing outpatient treatment. Design and method: Randomized controlled clinical trial, composed of two groups: Intervention Group, who received SMS text messages twice a week for 10 weeks; and Comparison Group, who received the usual care. Both groups received an educational pamphlet about the hypertension. The primary outcome was BP control by office blood pressure measurement (OBPM; <140/90 mmHg) or by daytime Ambulatory Blood Pressure Monitoring (ABPM; <135/85 mmHg). Adherence to treatment was assessed indirectly using the 4 item Morisky Medication Adherence Scale and, directly, by assessing antihypertensive drugs in the urine, using a high-performance liquid chromatography technique associated with mass spectrometry. The significance level was 5%. Results: In the study, 178 patients were randomized, (90 in the Intervention Group and 88 in the Comparison Group). The sample was 60 (10) years old, women (63.8%), non-white (58.9%) and married (54.6%). The hypertensive patients were classified as having high cardiovascular risk (77.3%). The result of the intervention effect showed that there was no difference between the Intervention Group and Comparison Group (RR = 1.05; 95%CI = 0.75-1.47, and RR = 1.23; 95%CI = 0.87-1.74, respectively) in the control of OBPM, or by the daytime ABPM. However, in the Intervention Group and Comparison Group, respectively, there was a mean reduction in BP (-8.6 and -7.3 mmHg in systolic OBPM and -2.19 mmHg and -2.09 mmHg in systolic daytime ABPM); and increase in the BP control by the OBPM (19.8% to 36.0% and 19.7% to 38.2%) and daytime ABPM (38.6% to 42.5% and 41.3% to 52.2%); and in the assessment of adherence indirectly (45.3% to 69.4% and 57.1% to 59.2%). In the assessment of adherence directly, there was little difference between the groups and the two moments evaluated. Conclusions: The effect of texting by cell phone was similar to usual treatment for hypertension on BP control. On the other hand, both groups improved BP control and increased adherence to treatment.

Cardiac Amyloidosis Imaging, Part 1: Amyloidosis Etiology and Image Acquisition.

Cardiac amyloidosis is a systemic form of amyloidosis in which protein-based infiltrates are deposited in myocardial extracellular space. The accumulation of amyloid fibrils causes the myocardium to thicken and stiffen, leading to diastolic dysfunction and, eventually, heart failure. Until recently, cardiac amyloidosis was considered rare. However, the recent adoption of noninvasive diagnostic testing, including 99mTc-pyrophosphate imaging, has revealed a previously undiagnosed sizable disease prevalence. Light-chain amyloidosis (AL) and transthyretin amyloidosis (ATTR), the 2 primary types, account for 95% of cardiac amyloidosis diagnoses. AL results from plasma cell dyscrasia and has a very poor prognosis. The usual treatment for cardiac AL is chemotherapy and immunotherapy. Cardiac ATTR is more chronic, usually resulting from age-related instability and misfolding of the transthyretin protein. ATTR is treated by managing heart failure and using new pharmacotherapeutic drugs. 99mTc-pyrophosphate imaging can efficiently and effectively distinguish between ATTR and cardiac AL. Although the exact mechanism of myocardial 99mTc-pyrophosphate uptake is unknown, it is believed to bind to amyloid plaque microcalcifications. 99mTc-pyrophosphate imaging has a 97% sensitivity and nearly 100% sensitivity for identifying cardiac ATTR when the AL form of the disease is ruled out through serum free light-chain and serum and urine protein electrophoresis with immunofixation testing. Although there are no published 99mTc-pyrophosphate cardiac amyloidosis imaging guidelines, the American Society of Nuclear Cardiology, Society of Nuclear Medicine and Molecular Imaging, and others have published consensus recommendations to standardize test performance and interpretation. This article, part 1 of a 3-part series in this issue of the Journal of Nuclear Medicine Technology, describes amyloidosis etiology and cardiac amyloidosis characteristics, including the types, prevalence, signs and symptoms, and disease course. It further explains the scan acquisition protocol. Part 2 of the series focuses on image/data quantification and technical considerations. Finally, part 3 describes scan interpretation, along with the diagnosis and treatment of cardiac amyloidosis.

Liver steatosis in patients with rheumatoid arthritis treated with methotrexate is associated with body mass index.

Methotrexate (MTX) is the usual first-line treatment for rheumatoid arthritis (RA). Long-term use of MTX has been associated with liver steatosis (LS) and liver fibrosis (LF). To determine if LS in patients treated with MTX for RA is associated with MTX cumulative dose (MTX-CD), metabolic syndrome (MtS), body mass index (BMI), the male sex, or LF. A single-center, prospective study of patients receiving MTX for RA was performed from February 2019 to February 2020. The inclusion criteria were patients aged 18 years or older diagnosed with RA by a rheumatologist and being treated with MTX (without limitation on the duration of treatment). The exclusion criteria were previous diagnosis of liver disease (hepatitis B or C virus infection, known nonalcoholic fatty liver disease), alcohol consumption greater than 60 g/d in males or 40 g/d in females, human immunodeficiency virus infection on antiretroviral therapy, diabetes mellitus, chronic renal failure, congestive heart failure, or BMI greater than 30 kg/m². Patients receiving leflunomide in the 3 years prior to the study were also excluded. Transient elastography (FibroScan, Echosens®, Paris, France) was used for fibrosis determination (LF > 7 KpA) and computer attenuation parameter (CAP) for LS (CAP > 248 dB/m). Demographic variables, laboratory data, MTX-CD (> 4000 mg), MtS criteria, BMI (> 25), transient elastography, and CAP scores were collected from all patients. Fifty-nine patients were included. Forty-three were female (72.88%), and the mean age was 61.52 years (standard deviation: 11.73). When we compared MTX-CD ≤ 4000 mg (26 patients; 14 with LS and 12 without) with > 4000 mg (33 patients; 12 with LS and 21 without), no statistical differences were found (P = 0.179). We compared CAP scores stratified by MtS, BMI, sex, and LF. There were no significant differences in CAP scores based on the presence of MtS [CAP/MtS: 50 no MtS (84.75%); 9 MtS (15.25%); P = 0.138], the male sex (CAP/sex: 8 male/18 female LS; 8 male/25 female no LS; P = 0.576), or LF [CAP/fibrosis: 53 no LF (89.83%); 6 LF (10.17%); P = 0.239]. LS determined by CAP was significantly associated with BMI > 25 (CAP/BMI: 22 BMI ≤ 25 (37.29%); 37 BMI > 25 (62.71%); P = 0.002]. LS in patients with RA treated with MTX was not associated with MTX-CD, LF, the male sex, or MtS. However, BMI was significantly related to LS in these patients.

Influence of antibiotic treatment duration on the development of antibiotic resistance

Avoidance of unnecessary antimicrobial administration is a key point of antimicrobial stewardship; knowing the optimal duration of therapy obviates over-treatment. In this article we have highlighted the results of modern research on the influence of the duration of antibiotic use on the success of treatment and the development of resistance of microorganisms. Foreign literary sources and the results of scientific research by experts in this field are analyzed. Based on the research results, the following conclusions were made. The results of modern studies on the duration of antibiotic use show that short-course antibiotic therapy is superior to usual long-course antimicrobial treatment. A short course of antibiotic therapy usually leads to the same positive clinical outcomes, a lower rate of antibiotic resistance and the number of clinical relapses. The two most important potential complications associated with the duration of antibiotic therapy are incomplete treatment and the emergence of antibiotic resistance. The time points used for antibiotic treatment (clinical or bacteriological cure, relapses, etc.) are subjective, complex and unreliable. The effectiveness of procalcitonin or other blood parameters for use in monitoring antibiotic treatment requires more focused studies. Despite the high relevance and publicity of various aspects of antibiotic therapy in the practice of human and animal healthcare, research on the efficacy and consequences of short-term antibiotic therapy in veterinary medicine is limited. More attention should be paid to this issue, especially in the field of animal husbandry. Key words: antibiotic resistance, antibiotic, microorganisms, treatment scheme, animals, duration of antibiotic therapy, clinical result, relapses.

Effects of Semisupervised Exercise Training on Health Outcomes in People With Lung or Head and Neck Cancer: Protocol for a Randomized Controlled Trial.

Lung or head and neck cancers are known for their high prevalence and mortality rates. Chemotherapy and radiotherapy are usually recommended as cancer treatment for these malignancies; however, they can negatively impact both the physical and mental status of patients. Hence, it is reasonable to consider resistance and aerobic exercise training to prevent these negative health outcomes. Further, several factors prevent patients from attending outpatient exercise training programs, and, therefore, a semisupervised home-based exercise training program may be seen as a well-accepted alternative. The aim of this study will be to investigate the effects of a semisupervised home-based exercise training program on physical performance, body composition, and self-reported outcomes; changes in the initial cancer treatment dose prescribed; number of hospitalizations at 3, 6, and 9 months; and 12-month survival in people with primary lung or head and neck cancer. Participants will be randomly allocated to the training group (TG) or control group (CG). The TG will undergo semisupervised home-based resistance and aerobic exercise training throughout their cancer treatment. The resistance training will be performed using elastic bands (TheraBand) twice a week. The aerobic training (ie, brisk walk) will be performed for at least 20 minutes per day outdoors. The equipment and tools used during the training sessions will be provided. This intervention will start the week before treatment commencement, will be performed throughout the duration of the treatment, and will continue for 2 weeks after treatment completion. The CG will undergo usual care (ie, cancer treatment with no formal exercise prescription). Assessments will take place 2 weeks before the beginning of the usual cancer treatment and 2 weeks after treatment completion. The measures of physical function (peripheral muscle strength, functional exercise capacity, and physical activity), body composition, and self-reported outcomes (symptoms of anxiety and depression, health-related quality of life, and symptoms related to the disease and treatment) will be collected. We will report on any change in the initial cancer treatment dose prescribed; number of hospitalizations at 3, 6, and 9 months; and 12-month survival. In February 2021, the clinical trial registration was approved. Recruitment and data collection for the trial are ongoing (as of April 2023, 20 participants had already been randomized), and findings of this study are likely to be published late in 2024. This exercise training as a complementary treatment for patients with cancer is likely to promote positive effects on the health outcomes assessed, over and above any change in the CG, and prevent the reduction of initial cancer treatment dose prescribed. If these positive effects are shown, they will likely impact long-term outcomes such as hospitalizations and 12-month survival. Brazilian Clinical Trials Registry (ReBEC) RBR-5cyvzh9; https://ensaiosclinicos.gov.br/rg/RBR-5cyvzh9. PRR1-10.2196/43547.

Multiform-based Baduanjin exercise prevention and treatment for idiopathic pulmonary fibrosis: study protocol for a randomized controlled trial

IntroductionIn this study, we will combine the traditional Baduanjin with Yijin Jing and Wuqinxi to create an optimized Baduanjin exercise program with three different forms (vertical, sitting, and horizontal) to adapt to idiopathic pulmonary fibrosis (IPF) patients in vairous stages of the disease. The purpose of this study is to explore and compare the therapeutic effects of this multi-form Baduanjin, traditional Baduanjin, and resistance training on lung function and limb motor function in IPF patients. The goal of this study is to prove a novel optimal exercise prescription strategy of Baduanjin exercise for improving and protecting lung function in IPF patients.Methods/designA single-blind and randomized controlled trial is used to conduct this study, while the randomization list will be generated using a computerized random number generator and opaque sealed envelopes with group allocation will be prepared. It will be strictly followed to blind the outcome assessors. and until the experiment’s conclusion, participants won’t know which group they are enrolled in. Patients between the ages of 35 and 80 who have stable diseases and have not regularly practiced Baduanjin exercise in the past will be included. They are divvied up into the following five groups at random: (1) The conventional care group (control group, CG), (2) The traditional Baduanjin exercise group (TG), (3) The modified Baduanjin exercise group (IG), (4) The resistance exercise group (RG) (5) The modified Baduanjin exercise combined with resistance exercise group (IRG). Those CG participants only received the usual treatment, while TC, IG, and RG participants exercised 1 h twice a day for 3 months. MRG participants will have a 3-month intervention with 1 h of Modified Baduanjin Exercise and 1 H of Resistance Training for each day. Every week, all groups underwent will supervis one-day training, with the exception of the control group. The Pulmonary Function Testing (PFT), HRCT, and 6MWT are the main outcome variables. The St. George Respiratory Questionnaire and mMRC are used as secondary outcome measures.DiscussionThis study may produce a new Baduanjin exercise prescription that is user-friendly, simple to execute, more targeted, and adaptable. Because it consists of three forms, including vertical, sitting, and horizontal, it is more adaptable to the various disease stages and actual situations of IPF patients and may compensate for the shortcomings of conventional pulmonary rehabilitation and traditional Baduanjin.Trial registrationChinese Clinical Trial Registry, ChiCTR2200055559. Registered on 12 January 2022.

The Effect of Cannabidiol 3% on Neuropsychiatric Symptoms in Dementia – Six-Month Follow-Up

ABSTRACT Objectives To investigate the beneficial outcomes of giving cannabidiol (CBD) 3% over a six-month period in the BPSD, the management of which is a crucial issue for everyday clinical praxis and to compare the progress in BPSD of patients who receive Cannabidiol 3% with those who follow usual medical treatment (UMT) in everyday clinical praxis. Methods A total of 20 PwD with severe BPSD were recruited from the database of Alzheimer Hellas with NPI score >30. Ten of them were assigned to UMT, while ten were assigned to a six-month treatment with CBD drops. The follow-up assessment was performed with NPI, both clinically and by structured telephone interview. Results The follow-up assessment with NPI showed significant improvement of the BPSD in all our patients who received CBD, and no or limited improvement in the second group, regardless of the underlying neuropathology of dementia. Conclusions We suggest that CBD may be a more effective and safe choice for managing BPSD than the typical intervention. Future large randomized clinical trials are needed to re-assure these findings. Clinical Implications Healthcare professionals should consider incorporating CBD 3% into their practices to reduce BPSD in PwD. Regular assessments are necessary to ensure long-term effectiveness.

‘It Helped Me to Disconnect My Mind from the Problems’: The Subjective Experiences of People with Schizophrenia Taking Part in a Concurrent Exercise Program

The aim of this study was to investigate the subjective experiences of a concurrent exercise program designed to improve both physical and mental health, through participation, for people with schizophrenia. Participants diagnosed with schizophrenia (n = 35, 41.6 ± 10.3 years) received an intensive concurrent exercise program for a 5-month duration, three times a week, at out-of-hospital facilities. Qualitative data was collected via individual, semi-structured interviews, organized, and analyzed with thematic analysis. The findings highlight the participants’ perspective in supporting an out-of-hospital exercise program as an acceptable and beneficial adjunct to usual treatment in people with schizophrenia for holistic health improvements.

Effectiveness of Genotype-Specific Tricyclic Antidepressant Dosing in Patients With Major Depressive Disorder

Evidence of the clinical benefit of pharmacogenetics-informed treatment (PIT) with antidepressants is still limited. Especially for tricyclic antidepressants (TCAs), pharmacogenetics may be of interest because therapeutic plasma concentrations are well defined, identification of optimal dosing can be time consuming, and treatment is frequently accompanied by adverse effects. To determine whether PIT results in faster attainment of therapeutic TCA plasma concentrations compared with usual treatment in patients with unipolar major depressive disorder (MDD). This randomized clinical trial compared PIT with usual treatment among 111 patients at 4 centers in the Netherlands. Patients were treated with the TCAs nortriptyline, clomipramine, or imipramine, with clinical follow-up of 7 weeks. Patients were enrolled from June 1, 2018, to January 1, 2022. At inclusion, patients had unipolar nonpsychotic MDD (with a score of ≥19 on the 17-item Hamilton Rating Scale for Depression [HAMD-17]), were aged 18 to 65 years, and were eligible for TCA treatment. Main exclusion criteria were a bipolar or psychotic disorder, substance use disorder, pregnancy, interacting comedications, and concurrent use of psychotropic medications. In the PIT group, the initial TCA dosage was based on CYP2D6 and CYP2C19 genotypes. The control group received usual treatment, which comprised the standard initial TCA dosage. The primary outcome was days until attainment of a therapeutic TCA plasma concentration. Secondary outcomes were severity of depressive symptoms (measured by HAMD-17 scores) and frequency and severity of adverse effects (measured by Frequency, Intensity, and Burden of Side Effects Rating scores). Of 125 patients randomized, 111 (mean [SD] age, 41.7 [13.3] years; 69 [62.2%] female) were included in the analysis; of those, 56 were in the PIT group and 55 were in the control group. The PIT group reached therapeutic concentrations faster than the control group (mean [SD], 17.3 [11.2] vs 22.0 [10.2] days; Kaplan-Meier χ21 = 4.30; P = .04). No significant difference in reduction of depressive symptoms was observed. Linear mixed-model analyses showed that the interaction between group and time differed for the frequency (F6,125 = 4.03; P = .001), severity (F6,114 = 3.10; P = .008), and burden (F6,112 = 2.56; P = .02) of adverse effects, suggesting that adverse effects decreased relatively more for those receiving PIT. In this randomized clinical trial, PIT resulted in faster attainment of therapeutic TCA concentrations, with potentially fewer and less severe adverse effects. No effect on depressive symptoms was observed. These findings indicate that pharmacogenetics-informed dosing of TCAs can be safely applied and may be useful in personalizing treatment for patients with MDD. ClinicalTrials.gov Identifier: NCT03548675.

High dose tirofiban versus standard therapy in primary PCI for ST-segment elevation myocardial infarction (STEMI)

Background: The goal of this randomized controlled study was to evaluate the safety and efficacy of high-dose tirofiban compared to standard care in patients undergoing primary PCI for ST-segment elevation myocardial infarction (STEMI). Methods: This study was carried out at the Tertiary care hospital Rawalpindi (Pakistan) from June 2021 to December 2022. The administration of high-dose tirofiban or usual treatment was randomly assigned to a total of 600 individuals. The main outcome was the 30-day composite of major adverse cardiovascular events (MACE), that involved stroke, target vessel revascularization, repeat myocardial infarction, and all-cause mortality. Aside from problems related to bleeding, stent thrombosis was one of the secondary outcomes. Results: When compared to the group receiving conventional medication, the rate of the main endpoint was significantly reduced in the tirofiban group (5.7% vs. 10.3%, p=0.03). This was principally caused by a decline in target vessel revascularization and recurring myocardial infarction in the tirofiban category. In terms of stent thrombosis or hemorrhage problems, there wasn't no discernible difference among both groups. Conclusion: In patients receiving primary PCI for STEMI, high-dose tirofiban added to conventional treatment lowers the risk of MACE at 30 days.

Outcomes of Linear Circumferential Skin Closure for Congenital Constriction Ring Syndrome.

Background: Congenital constriction ring syndrome (CCRS) is a rare condition diagnosed at birth characterised by deformation due to a constriction ring. The usual treatment for CCRS involves excision of the constriction ring and suture of the skin incorporating a Z-plasty to prevent scar contracture. A Z-plasty often results in an unsightly scar. In order to avoid this, we performed linear circumferential skin closure (LCSC). The aim of this paper is to report the outcomes of LCSC for CCRS. Methods: We retrospectively investigated all patients with CCRS who underwent LCSC between 2002 and 2020. Two linear incisions were placed proximal and distal to the constriction ring in parallel, and the constriction ring was excised carefully so as not to damage nerves or vessels. The deep subcutaneous and dermis layers were sutured. The skin was closed using adhesive tape. Two-stage surgery was performed in two patients with severe CCRS of the lower leg to avoid problems with distal circulation. Patients were followed up for at least 1 year and assessed for complications and quality of scar. Results: We performed LCSC for 31 sites in 19 patients, including one forearm, 14 fingers, 10 lower legs and six toes. The median age at the operation was 16 months (range: 4-175). The median follow-up period after surgery was 5.8 years (range: 1.9-16.0). The linear surgical scar had healed well in all patients and there were no complications. There was no recurrence of the constriction ring and no scar hypertrophy, though we did not perform fat mobilisation in all cases. None of the patients required additional surgery and the aesthetic outcome of the linear circumferential surgical scar was maintained at the final observation. Conclusions: Treatment for CCRS using LCSC resulted in no complications, no recurrence of constriction and an excellent aesthetic outcome. Level of Evidence: Level IV (Therapeutic).

Geriatrician-led multidisciplinary team management improving polypharmacy among older inpatients in China.

Background/Aim: Polypharmacy is prevalent among older inpatients and associated with adverse outcomes. To determine whether a geriatrician-led multidisciplinary team (MDT) management mode could reduce medications use among older inpatients. Methods: A retrospective cohort study was conducted in a geriatric department of a tertiary hospital in China with 369 older inpatients, including 190 patients received MDT management (MDT cohort), and 179 patients received usual treatment (non-MDT cohort). The primary outcome was to compare the changes of the amount of medications before and after hospitalization in two cohorts. Results: We reported that MDT management significantly reduced the number of medications used in older inpatients at discharge (at home: n = 7 [IQR: 4, 11] vs at discharge: n = 6 [IQR: 4, 8], p < 0.05). Hospitalization with the MDT management had a significant effect on the change in the amount of medications (F = 7.813, partial-η2 = 0.011, p = 0.005). The discontinuance of medications was associated with polypharmacy at home (OR: 96.52 [95% CI: 12.53-743.48], p < 0.001), and the addition of medications was associated with a diagnosis of chronic obstructive pulmonary disease (COPD) (OR: 2.36 [95% CI: 1.02-5.49], p = 0.046). Conclusion: The results indicated that the geriatrician-led MDT mode during hospitalization could reduce the number of medications used by older patients. The patients with polypharmacy were more likely to "deprescription" after MDT management, while the patients with COPD were more likely to be under-prescription at home, polypharmacy which could be made up for after MDT management.

The Tryptophan Metabolite Indole-3-Carboxaldehyde Alleviates Mice with DSS-Induced Ulcerative Colitis by Balancing Amino Acid Metabolism, Inhibiting Intestinal Inflammation, and Improving Intestinal Barrier Function.

Ulcerative colitis (UC) has attracted much attention for its negative influence on quality of life and increased risk of colorectal cancer. Chemical and biological drugs are currently the usual treatment for UC. These drugs always induce severe side effects, or patients might become resistant to these therapies. Therefore, new therapeutic options for UC are urgently needed. In this study, we discovered the inhibitory activity of the intestinal tryptophan metabolite indole-3-carboxaldehyde (3-IAld) in dextran sulfate sodium salt (DSS)-induced UC mice by targeting the TLR4/NF-κB/p38 signaling pathway. This compound effectively protected against colon length shortening and damage induced by DSS in the colon, notably reducing the severity of inflammation. The production of inflammatory factors of TNF-α, IL-6, and IL-1β was significantly attenuated when treating with 3-IAld in vivo and vitro. This might be attributed to inhibition of the TLR4/NF-kB/p38 signaling pathway. Moreover, 3-IAld could up-regulate the expression of ZO-1 and Occludin in vivo and vitro. Meanwhile, liquid chromatography mass spectrometry (LC-MS) results showed that 3-IAld could balance the aspartate and glutamate metabolism and the lysine degradation metabolism in the serum of DSS-induced colitis mice. In conclusion, 3-IAld ameliorated the intestinal barrier dysfunction and inflammatory response in DSS-induced UC mice, balanced amino acid metabolism, and inhibited the activation of the TLR4/NF-kB/p38 signaling pathway, thereby protecting mice with colitis.

BRAFV600E 変異を認めたエナメル上皮癌の1例

The usual treatment for ameloblastic carcinoma is surgical resection. The effectiveness of radiotherapy and chemotherapy for the disease has not been determined, and few effective treatments are available for local recurrence and distant metastasis. Recently, molecular targeting using BRAFV600E inhibitors has attracted interest as a treatment for ameloblastoma and ameloblastic carcinoma.

The effects of combination treatment with LT4 and LT3 on diastolic functions and atrial conduction time in LT4-treated women with low T3: a short term follow-up study.

To investigate the effects of combination treatment with levothyroxine (LT4) and l- triiodothyronine (LT3) on left atrial volume (LAV), diastolic functions, and atrial electro-mechanical delays in LT4-treated women with low triiodothyronine (T3) levels. This prospective study consisted of 47 female patients between 18 and 65 years old treated at an Endocrinology and Metabolism outpatient clinic between February and April 2022 due to primary hypothyroidism. The study included patients with persistently low T3 levels in at least three measurements, despite LT4 treatment (1.6-1.8 mcg/kg/m2) for 23.13 ± 6.28 months with normal thyrotropin (TSH) and free tetraiodothyronine (fT4) levels. The combination therapy dose was as follows: the fixed LT4 dose (25 mcg) was removed from patients' usual LT4 treatment [100 mcg (min-max, 75-150)], and a fixed LT3 dose (12.5 mcg) was added. Biochemical samples were taken, and an echocardiographic assessment was performed for patients upon their first admission, and after 195.5 ± 12.8 days of receiving LT3 (12.5 mcg) treatment. There was a statistically significant reduction at left ventricle (LV) end-systolic diameter (27.69 ± 3.14, 27.13 ± 2.89, p = 0.035), left atrial (LA) maximum volume (14.73 ± 3.22, 13.94 ± 3.15, p = 0.009), LA minimum volume (7.84 ± 2.45, 6.84 ± 2.30, p < 0.001), LA vertical diameter (44.08 ± 6.92, 34.60 ± 4.31, <0.001), LA horizontal diameter (45.65 ± 6.88, 33.43 ± 4.51, p < 0.001), LAVI (50.73 ± 18.62, 41.0 ± 13.02, p < 0.001), total conduction time (103.69 ± 12.70, 79.82 ± 18.40, p < 0.001) after LT3 replacement (respectively pre-post- treatment and p value). In conclusion, the findings of this study suggest that the addition of LT3 to LT4 treatment may lead to improvements in LAVI and atrial conduction times in patients with low T3. However, further research with larger patient groups and exploration of different LT4 + LT3 dose combinations is needed to better understand the effects of combined hypothyroidism treatment on cardiac functions.

Impact of clinical pharmacist interventions in a bone and joint infection orthoseptic surgery unit

To assess the impact of interventions of a clinical pharmacist in a unit of orthopedic surgery specialized in bone and joint infections. Daily, in routine, a clinical pharmacist analyzed medication prescribed to inpatients via a computerized physician order entry (CPOE) (Phedra software). His attention was particularly focused on the impact of antibiotics on other medications. For this study, all of the pharmacist interventions (PI) have been retrospectively collected, then anonymized, and assessed over a two-month period. Thirty-eight patients were hospitalized during the study period, with a mean age of 63 years old. Forty-five interventions were identified which represents a mean of 1.18 pharmaceutical interventions per patient. Most of them concerned lack of follow-up (24%) and drug-drug interactions (22%) and widely non-anti-infectious medication (35 interventions) with levothyroxine (10 interventions) as the most involved non-anti-infectious molecule. Among antibiotics, with respectively 9 and 8 interventions, rifampicin and fluoroquinolones (6 interventions for moxifloxacin) were the most concerned notably for drug-drug interactions with usual treatment. In this observational retrospective study, 1.18 pharmacist interventions (PI) per patient were observed. Most of them are lack of follow-up and drug-drug interactions especially with usual treatment of patients. Moxifloxacin and rifampicin were the most antibiotics involved. Patients' characteristics (older, polypharmacy), long-term hospitalization and surgery are known to be predictive factors of medication errors and this study highlights the importance of the presence of clinical pharmacist in orthopedic surgery wards.