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Ventilator-Associated Pneumonia in COVID-19 Patients Admitted in Intensive Care Units: Relapse, Therapeutic Failure and Attributable Mortality-A Multicentric Observational Study from the OutcomeRea Network. J Clin Med 2023; 12:jcm12041298. [PMID: 36835834 PMCID: PMC9961155 DOI: 10.3390/jcm12041298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/24/2023] [Accepted: 02/02/2023] [Indexed: 02/10/2023] Open
Abstract
Introduction: Ventilator-associated pneumonia (VAP) incidence is high among critically ill COVID-19 patients. Its attributable mortality remains underestimated, especially for unresolved episodes. Indeed, the impact of therapeutic failures and the determinants that potentially affect mortality are poorly evaluated. We assessed the prognosis of VAP in severe COVID-19 cases and the impact of relapse, superinfection, and treatment failure on 60-day mortality. Methods: We evaluated the incidence of VAP in a multicenter prospective cohort that included adult patients with severe COVID-19, who required mechanical ventilation for ≥48 h between March 2020 and June 2021. We investigated the risk factors for 30-day and 60-day mortality, and the factors associated with relapse, superinfection, and treatment failure. Results: Among 1424 patients admitted to eleven centers, 540 were invasively ventilated for 48 h or more, and 231 had VAP episodes, which were caused by Enterobacterales (49.8%), P. aeruginosa (24.8%), and S. aureus (22%). The VAP incidence rate was 45.6/1000 ventilator days, and the cumulative incidence at Day 30 was 60%. VAP increased the duration of mechanical ventilation without modifying the crude 60-day death rate (47.6% vs. 44.7% without VAP) and resulted in a 36% increase in death hazard. Late-onset pneumonia represented 179 episodes (78.2%) and was responsible for a 56% increase in death hazard. The cumulative incidence rates of relapse and superinfection were 45% and 39.5%, respectively, but did not impact death hazard. Superinfection was more frequently related to ECMO and first episode of VAP caused by non-fermenting bacteria. The risk factors for treatment failure were an absence of highly susceptible microorganisms and vasopressor need at VAP onset. Conclusions: The incidence of VAP, mainly late-onset episodes, is high in COVID-19 patients and associated with an increased risk of death, similar to that observed in other mechanically ventilated patients. The high rate of VAP due to difficult-to-treat microorganisms, pharmacokinetic alterations induced by renal replacement therapy, shock, and ECMO likely explains the high cumulative risk of relapse, superinfection, and treatment failure.
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Van Nieuwenhuysen JP, D'Hoore W, Leprince JG. What ultimately matters in root canal treatment success and tooth preservation: A 25-year cohort study. Int Endod J 2023; 56:544-557. [PMID: 36683563 DOI: 10.1111/iej.13895] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/24/2023]
Abstract
AIM There are currently no prospective studies evaluating the long-term outcomes of non-surgical root canal treatments beyond 5 years, both in terms of treatment success and tooth preservation, and identifying factors predictive of treatment outcome. The aim of the present work was therefore to fill this gap by assessing these outcomes over time and identifying predictive variables based on systematic data collection over a 25-year period. METHODOLOGY Data concerning the treatments (N = 2500) were systematically collected since 1990. Information was recorded among clinical, technical, radiographic and patient-related characteristics, i.e., approximately 150 variables for each treatment. The data were analysed regarding both treatment success and tooth preservation by multivariable Cox proportional hazards model, and survival curves were generated. The statistical significance level was set at 0.0125. RESULTS In total, 56.4% of the treatments could be followed over time (0-25 years, mean = 6.5 years, median = 5 years). Survival probability decreased almost linearly for treatment success, with about 85% after 5 years and 60% after 20 years, and for tooth preservation, with about 90% at 5 years and 50% at 20 years. The variables significantly associated with treatment failure were: pre-operative pain (Hazard Ratio-HR = 1.56 [95% CI 1.23-1.97]), persistent pain (HR = 2.63 [95% CI 1.44-4.80]), good operator rating of treatment prognosis (HR = 0.46 [95% CI 0.36-0.58]), size of periapical bone radiolucency (HR = 1.88 [95% CI 1.67-2.11]), and tooth type (p = .0006). For tooth extraction, they were: combined endodontic-periodontal lesion (HR = 3.37 [95% CI 1.88-6.05]), pre-existing complication before treatment (HR = 1.67 [95% CI 1.26-2.21]), good operator rating of treatment prognosis (HR = 0.45 [95% CI 0.33-0.60]), clinical failure of root canal treatment (HR = 2.78 [95% CI 1.98-3.89]) and tooth type (p = .0012). CONCLUSION Root canal treatment success and tooth preservation on the arch are not static outcomes, but evolve with time. Among a substantial set of potential predictors, only a small proportion was significantly predictive of treatment success and tooth preservation, most of them being disease and patient characteristics, and not technical aspects, except pre-existing complications. These observations challenge the importance frequently given to byzantine considerations related to the numerous technical details of endodontic procedures, as opposed to general concepts of good clinical practice.
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Flaten D. Risk of Treatment Failure for Prosthetic Joint Infections: Retrospective Chart Review in an Outpatient Parenteral Antimicrobial Therapy Program. Can J Hosp Pharm 2023; 76:14-22. [PMID: 36683659 PMCID: PMC9817224 DOI: 10.4212/cjhp.3264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background Prosthetic joint infections (PJIs) are a major complication of total joint replacement surgeries. Treatment includes surgical intervention with prolonged courses of IV antibiotics in outpatient parenteral antimicrobial therapy (OPAT) programs. The risk of PJI treatment failure is high and may be associated with various clinical factors. Objectives To determine the rate of PJI treatment failure and to identify potential risk factors for failure in patients admitted to an OPAT program. Methods A retrospective chart review was conducted for adult patients with PJI admitted to an OPAT program between July 1, 2013, and July 1, 2019. Treatment courses were deemed to have failed according to predetermined criteria. χ2 tests and multiple linear regression were used to examine associations of comorbidities, pathogens, and antimicrobial regimens with treatment failure. Results In total, 100 patients associated with 137 PJI treatment courses in the OPAT program were included. Of these, 28 patients accounted for 65 of the treatment courses. Methicillin-susceptible Staphylococcus aureus was the most frequently isolated pathogen (31/137 or 22.6% of treatment courses). Patient comorbidities included body mass index of at least 30 kg/m2 (58% of patients) and diabetes (41% of patients). The overall rate of treatment failure was 56.2% (77/137 treatment courses). Selected risk factors associated with treatment failure or success were diabetes (50.9% versus 29.8%; odds ratio [OR] 4.03, 95% confidence interval [CI] 1.38-12.88, p = 0.013) and depression (32.1% versus 14.9%; OR 5.02, 95% CI 1.30-22.89, p = 0.025). Conclusions The overall rate of PJI treatment failure in the study population was high. Patients with diabetes and depression experienced higher incidences of failure. Future investigations of comprehensive PJI management should be considered to ensure successful treatment and to minimize excessive use of health care resources.
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van der Meer PB, Maschio M, Dirven L, Taphoorn MJB, Koekkoek JAF, Coppola A, Maialetti A, Pietrella A, Rigamonti A, Zarabla A, Frigeni B, Salis B, Di. Bonaventura C, Marras CE, Palestini C, Ferlazzo E, Venturelli E, Dainese F, Martella F, Paladin F, Villani F, Capizzi G, Napoleoni L, Stanzani L, Stragapede L, Zummo L, Balducci M, Eoli M, Rizzi M, Vernaleone M, Messina R, Vittorini R, Gasparini S, Ius T, Cianci V, Manfioli V, Mariani V, Capovilla G. First-line levetiracetam versus enzyme-inducing antiseizure medication in glioma patients with epilepsy. Epilepsia 2023; 64:162-169. [PMID: 36380710 PMCID: PMC10100008 DOI: 10.1111/epi.17464] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/08/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study aimed to directly compare the effectiveness of first-line monotherapy levetiracetam (LEV) versus enzyme-inducing antiseizure medications (EIASMs) in glioma patients. METHODS In this nationwide retrospective observational cohort study, Grade 2-4 glioma patients were included, with a maximum duration of follow-up of 36 months. Primary outcome was antiseizure medication (ASM) treatment failure for any reason, and secondary outcomes were treatment failure due to uncontrolled seizures and due to adverse effects. For estimation of the association between ASM treatment and ASM treatment failure, multivariate cause-specific cox proportional hazard models were estimated, adjusting for potential confounders. RESULTS In the original cohort, a total of 808 brain tumor patients with epilepsy were included, of whom 109 glioma patients were prescribed first-line LEV and 183 glioma patients first-line EIASMs. The EIASM group had a significantly higher risk of treatment failure for any reason compared to LEV (adjusted hazard ratio [aHR] = 1.82, 95% confidence interval [CI] = 1.20-2.75, p = .005). Treatment failure due to uncontrolled seizures did not differ significantly between EIASMs and LEV (aHR = 1.32, 95% CI = .78-2.25, p = .300), but treatment failure due to adverse effects differed significantly (aHR = 4.87, 95% CI = 1.89-12.55, p = .001). SIGNIFICANCE In this study, it was demonstrated that LEV had a significantly better effectiveness (i.e., less ASM treatment failure for any reason or due to adverse effects) compared to EIASMs, supporting the current neuro-oncology guideline recommendations to avoid EIASMs in glioma patients.
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Graham DY. Implications of the paradigm shift in management of Helicobacter pylori infections. Therap Adv Gastroenterol 2023; 16:17562848231160858. [PMID: 36950252 PMCID: PMC10026128 DOI: 10.1177/17562848231160858] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/12/2023] [Indexed: 03/24/2023] Open
Abstract
The recent availability of susceptibility testing for Helicobacter pylori infections in the United Sates has resulted in paradigm shifts in the diagnosis, therapy, and follow-up of H. pylori infections. Here, we reviewed the English literature concerning changes in H. pylori diagnosis and therapy with an emphasis on the last 3 years. We focus on the new methods that offer rapid and convenient susceptibility testing using either invasive (endoscopic) or noninvasive (stool) methods of obtaining test material. We also discuss the implications of this availability on therapy and follow-up after therapy. The approach to therapy was categorized into four groups: (1) therapies that can be used empirically, (2) therapies that should be restricted to those that are susceptibility-based, (3) potentially effective therapies that have yet to be optimized for local use, and (4), therapies that contain unneeded antibiotics that should not be prescribed. The most convenient and efficient method of susceptibility testing is by using reflexive stool testing in which if the sample is positive, it is automatically also used for determination of susceptibility. Reflexive testing can also be done via reflexive ordering (e.g., for all positive urea breath tests). The post therapy test-of-cure has emerged as a critical component of therapy as it not only provides feedback regarding treatment success but when combined with susceptibility testing also provide evidence regarding the cause of failure (e.g., poor adherence versus emergence of resistance during therapy. Susceptibility testing has made even the most current H. pylori guidelines for diagnosis and therapy generally obsolete. Clarithromycin, metronidazole, and levofloxacin triple therapies should only be administered as susceptibility-based therapy. Regimens containing unneeded antibiotics should not be given. We provide recommendations regarding the details and indications for all current therapies.
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Wang Y, Huang X, Zhou G, Han J, Xie Z, Zhang M, Li X, Wu QR, Li L, Ye Z, Chen M, Qiu Y, Zhang S. A Novel Nomogram Combining Mucus Barrier Index for Predicting Treatment Failures in Ulcerative Colitis. J Inflamm Res 2023; 16:1879-1894. [PMID: 37152865 PMCID: PMC10162100 DOI: 10.2147/jir.s410057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 04/21/2023] [Indexed: 05/09/2023] Open
Abstract
Background Treatment failures (TFs) generally exist in the course of ulcerative colitis (UC), while early reliable predictors of TFs are still lacking. We aimed to generate nomograms for the prediction of TFs. Methods In this retrospective case-control study, the endpoint was the occurrence of TFs, which included medically associated treatment failures and surgery-associated treatment failures (colectomy). Clinical features and mucus integrity evident by goblet cells (GCs) number, expression levels of MUC2 and SLC26A3 were enrolled in the univariate analysis. Nomogram performance was evaluated by discrimination and calibration. Results We identified 256 UC patients at our center from January 2010 to June 2022. Fourteen variables for TFs and 9 for colectomy were identified by univariate analysis. Five baseline indices were incorporated into the nomogram for the prediction of TFs: area of GCs, age at diagnosis, disease duration, hemoglobin, and Mayo score. The model was presented with decent discrimination (C index of 0.822) and well calibration. In addition, the colectomy predictive nomogram was built using MUC2 intensity, age at onset, and Mayo score with a good discrimination (C index of 0.92). Conclusion Nomograms based on comprehensive factors including mucus barrier function were developed to predict TFs in UC patients with great discrimination, which may serve as practical tools aiming to identify high-risk subgroups warrant timely intervention.
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Kakubu MAM, Frans K, Gibutai N, Katoto PDMC. A case report of clinical implications of a delayed antiretroviral therapy switch in a patient with multiple treatment interruptions. SAGE Open Med Case Rep 2022; 10:2050313X221144209. [PMID: 36569036 PMCID: PMC9772926 DOI: 10.1177/2050313x221144209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
The Namibia national antiretroviral therapy guidelines recommend that patients living with HIV who interrupt antiretrovirals and in the process disengage from care be restarted on their usual antiretroviral therapy regimen upon return. We introduce a 39-year-old male patient on first-line antiretroviral therapy, namely, tenofovir disoproxil fumarate, lamivudine and efavirenz, from 2015 to 2019 (4 years), who returned to care after the fourth episode of interrupting his treatment, though his adherence to antiretroviral therapy was deemed poor. Thus, he presented with severe immunosuppression and an AIDS-defining condition. Hence, he was switched to second-line antiretroviral therapy, treated with fluconazole for oesophageal candidiasis and reinitiated on cotrimoxazole prophylaxis. The client is currently clinically stable with a suppressed viral load. Medical and drug history taking with an emphasis on the previous history of treatment failure in patients returning to care are paramount in guiding the choice of future prescriptions of antiretrovirals. The multiple antiretroviral therapy interruptions from the patient and the delay in decision-making on the side of the clinician to switch treatments contributed to the emergence of an AIDS-defining condition.
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Sandau C, Hansen EF, Pedersen L, Jensen JUS. Hypoxemia and not hyperoxemia predicts worse outcome in severe COPD exacerbations - an observational study. Eur Clin Respir J 2022; 10:2153644. [PMID: 36505897 PMCID: PMC9731582 DOI: 10.1080/20018525.2022.2153644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objectives For patients admitted with an acute exacerbation of COPD (AECOPD) and a need for supplementary oxygen therapy, to determine if peripheral oxygen saturation < 88% (hypoxemia) or >92% (hyperoxemia), within first 24 hours of admission, is associated with 'treatment failure' or fewer days alive and out of hospital within 14 days after admission. Design A retrospective multicenter observational study, reviewing consecutive data on SpO2, oxygen, and drug administration at three predefined time points, on adverse events in patients admitted with COPD between December 2019 and June 2020. Multivariable logistic regression analysis, Mann Whitney U- and Chi-square-test were used. Setting Acute hospital setting, across four different hospitals in the capital region of Denmark. Participants Patients with a confirmed diagnosis of COPD admitted with an acute exacerbation and an oxygen need within the first 24 hours admission. Results In total 289 COPD patients were included. The median age was 74.8 years [interquartile range (IQR):69.6 to 81.8], 191 were female and 132 patients experienced 'treatment failure'. A minimum of one episode of hypoxemia (SpO2 < 88%) within first 24 hours was associated with having a low number (≤4) of days alive and out of hospital within 14 days after admission: OR 2.4 (95%CI 1.2 to 4.8), p = 0.02, absolute risk 44% vs. 26% p = 0.01, Chi-square. Comparable results were observed after 30 days of follow-up: OR 2.6 (95% CI 1.0 to7.1), p = 0.05. A minimum of one measurement of hyperoxemia (SpO2 > 92%), within first 24 hours of admission was not associated with low number of days alive and out of hospital within 14 days OR 1.0 (95% CI 0.5 to 2.1) nor at 30 days. Conclusion For admitted patients with AECOPD, being hypoxemic ever within the first 24 hours after admission is associated with a substantially increased risk of a poor prognosis.
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Gesche J, Beier CP. Drug resistance in idiopathic generalized epilepsies: Evidence and concepts. Epilepsia 2022; 63:3007-3019. [PMID: 36102351 PMCID: PMC10092586 DOI: 10.1111/epi.17410] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/05/2022] [Accepted: 09/12/2022] [Indexed: 01/11/2023]
Abstract
Although approximately 10%-15% of patients with idiopathic generalized epilepsy (IGE)/genetic generalized epilepsy remain drug-resistant, there is no consensus or established concept regarding the underlying mechanisms and prevalence. This review summarizes the recent data and the current hypotheses on mechanisms that may contribute to drug-resistant IGE. A literature search was conducted in PubMed and Embase for studies on mechanisms of drug resistance published since 1980. The literature shows neither consensus on the definition nor a widely accepted model to explain drug resistance in IGE or one of its subsyndromes. Large-scale genetic studies have failed to identify distinct genetic causes or affected genes involved in pharmacokinetics. We found clinical and experimental evidence in support of four hypotheses: (1) "network hypothesis"-the degree of drug resistance in IGE reflects the severity of cortical network alterations, (2) "minor focal lesion in a predisposed brain hypothesis"-minor cortical lesions are important for drug resistance, (3) "interneuron hypothesis"-impaired functioning of γ-aminobutyric acidergic interneurons contributes to drug resistance, and (4) "changes in drug kinetics"-genetically impaired kinetics of antiseizure medication (ASM) reduce the effectiveness of available ASMs. In summary, the exact definition and cause of drug resistance in IGE is unknown. However, published evidence suggests four different mechanisms that may warrant further investigation.
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Muacevic A, Adler JR, Mujahid OM, Borthakur MP, Panda CK, Kalbande JV. The Relationship of Respiratory Rate-Oxygenation (ROX) and Modified ROX Index With High-Flow Nasal Cannula Oxygen Therapy in COVID-19 Patients: An Observational Pilot Study. Cureus 2022; 14:e32900. [PMID: 36699780 PMCID: PMC9869921 DOI: 10.7759/cureus.32900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2022] [Indexed: 12/25/2022] Open
Abstract
Background and aim Respiratory Rate-Oxygenation (ROX) and modified ROX (mROX) indexes have been proposed to detect early high-flow nasal cannula (HFNC) therapy failure. We evaluated the utility and relationship of ROX and mROX indexes in COVID-19 patients started on HFNC oxygen therapy. Methods This pilot study collected data from adult COVID-19 patients requiring HFNC oxygenation from 29 Jan - 29 Jun 2021. The patients were divided into two cohorts based on HFNC therapy success. ROX and mROX were compared using statistical diagnostic testing, including receiver operating characteristics and area under the curve (AUC) using online Epitools (https://epitools.ausvet.com.au/) and MedCalc software (MedCalc Software Ltd, Ostend, Belgium, https://www.medcalc.org/); p<0.05 was considered significant. Results Twenty-seven patients fulfilled the inclusion criteria; 48.15% of therapy failed. The cohort's mean ± standard deviation age was 53.93 ± 10.67 years; 74.1% were male. The accuracy of predicting failure for mean ROX versus mROX at baseline and six-hour values was 59.81 versus 70.68 and 67.42 versus 74.88, respectively (all p>0.05). The AUC for ROX and mROX at baseline and at six hours were statistically indifferent. Only an mROX of 4.05 (mean value) and 3.34 (Youden's J cut-off) had a sensitivity plus specificity at 156% and 163%, respectively. Conclusion Both ROX and mROX at baseline and six hours had fair-to-good accuracies and AUC; the differences were insignificant. Both ROX and mROX had better accuracies at six hours. However, only mROX < 4.05 at six hours fulfilled the sensitivity plus specificity criteria to be a clinically valuable screener.
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Campos FG, Cavalari-Mancuzo D, Bustamante-Lopez LA, Morais PGM, Martinez CAR. IS IT POSSIBLE TO OPTIMIZE STAPLED HEMORRHOIDOPEXY OUTCOMES BY ENLARGING OPERATIVE CRITERIA INDICATIONS? RESULTS OF A TAILORED PROCEDURE WITH ASSOCIATED RESECTION IN A COMPARATIVE PERSONAL SERIES. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2022; 35:e1696. [PMID: 36449865 PMCID: PMC9704851 DOI: 10.1590/0102-672020220002e1696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/28/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Since its introduction, stapled hemorrhoidopexy has been increasingly indicated in the management of hemorrhoidal disease. AIM Our primary end point was to evaluate the incidence of recurrent disease requiring another surgical intervention. On a secondary analysis, we also compared pain, complications, and patient's satisfaction after a tailored surgery. METHODS We retrospectively reviewed 196 patients (103 males and 93 females) with a median age of 47.9 years (range, 17-78) who were undergoing stapled hemorrhoidopexy alone (STG; n=65) or combined surgery (CSG; n=131, stapled hemorrhoidopexy associated with resection). RESULTS Complications were detected in 11 (5.6%) patients (4.6% for STG vs. 6.1% for CSG; p=0.95). At the same time, symptoms recurrence (13.8% vs. 8.4%; p=034), reoperation rate for complications (3.1% vs. 3.0%; p=1.0), and reoperation rate for recurrence (6.1% vs. 4.6%; p=1.0) were not different among groups. Grade IV patients were more commonly managed with simultaneous stapling and resection (63% vs. 49.5%), but none of them presented symptoms recurrence nor need reoperation due to recurrence. Median pain score during the first week was higher in CSG patients (0.8 vs. 1.7). After a follow-up of 24.9 months, satisfaction scores were similar (8.6; p=0.8). CONCLUSION Recurrent symptoms were observed in 10% of patients, requiring surgery in approximately half of them. Even though the association of techniques may raise pain scores, a tailored approach based on amplified indication criteria and combined techniques seems to be an effective and safe alternative, with decreased relapse rates in patients suffering from more advanced hemorrhoidal disease. Satisfaction scores after hemorrhoidopexy are high.
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Tanigawa K, Misono S, Mizuno K, Asai S, Suetsugu T, Uchida A, Kawano M, Inoue H, Seki N. MicroRNA signature of small-cell lung cancer after treatment failure: impact on oncogenic targets by miR-30a-3p control. Mol Oncol 2022; 17:328-343. [PMID: 36345848 PMCID: PMC9892828 DOI: 10.1002/1878-0261.13339] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 10/10/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
Small-cell lung cancer (SCLC) is associated with a high mortality rate and limited treatment efficacy. We created a microRNA (miRNA) expression signature by RNA sequencing using specimens from patients with SCLC who had failed treatment. Forty-nine miRNAs were downregulated in SCLC tissues and were candidate tumor-suppressive miRNAs. In this signature, both guide and passenger strands were downregulated for five miRNAs (miR-30a, miR-34b, miR-34c, miR-223, and miR-4529). Recent studies have revealed that passenger strands of miRNAs are involved in the molecular pathogenesis of human cancer. Although miR-30a-5p (the guide strand) has been shown to be a tumor-suppressive miRNA in various types of cancers, miR-30a-3p (the passenger strand) function is not well characterized in SCLC cells. We investigated the functional significance of miR-30a-3p and oncogenic genes regulated by miR-30a-3p in SCLC cells. Ectopic expression assays showed that miR-30a-3p expression inhibited cell proliferation and induced cell cycle arrest and apoptosis in two SCLC cell lines. Furthermore, in silico database searches and gene expression assays identified 25 genes as putative targets of miR-30a-3p in SCLC cells. Luciferase reporter assays revealed that downstream neighbor of SON (DONSON) was directly regulated by miR-30a-3p in SCLC cells. Knockdown of DONSON induced cell cycle arrest in SCLC cells and DONSON overexpression were detected in SCLC clinical samples. Analyzing the regulatory networks of tumor-suppressive miRNAs may lead to the identification of therapeutic targets in SCLC.
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Cao S, Tang Z, Wang C, Huang P, Zhang C, Huang J, Wang X, Ma X. Dynamic Reach Deficit Is a Predictive Factor of Inferior Outcomes After Modified Broström Procedure for Lateral Ankle Instability. Foot Ankle Int 2022; 43:1460-1464. [PMID: 36000205 DOI: 10.1177/10711007221115716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Only a few studies have analyzed functional predictive factors for inferior outcomes after modified Broström procedure (MBP). The aim of the current study is to identify the influence of the preoperative dynamic reach deficit on the surgical outcomes of MBP. METHODS Sixty-one patients with lateral ankle instability who underwent MBP were included in the current study and followed up for a median of 24 months. The Karlsson scores and the reaches of the Star Excursion Balance Test (SEBT) were evaluated before surgery and during the last follow-up. A total of 19 prognostic factors were analyzed. The relationship between the variables and inferior outcomes (Karlsson score < 90) in the bivariate analysis was tested through the Mann-Whitney U test or the Fisher exact test. A multivariate logistic regression model was developed to investigate the influence of the selected factors on inferior outcomes. RESULTS Thirty-two of the patients had superior outcomes, and the rest had inferior outcomes. The age, gender, and body mass index of the groups with superior and inferior outcomes did not differ. Preoperative dynamic reach deficit (P = .032), osteochondral lesion of the talus (P = .004), and decreased preoperative Karlsson score (P = .004) were independent predictors of inferior outcomes. CONCLUSION Patients with preoperative dynamic reach deficit, osteochondral lesion of the talus, or decreased preoperative Karlsson score have inferior outcomes after MBP. LEVEL OF EVIDENCE Level III, case-control study.
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Holm MKA, Jørgensen KM, Bagge K, Worning P, Pedersen M, Westh H, Monk JM, Bartels MD. Estimated Roles of the Carrier and the Bacterial Strain When Methicillin-Resistant Staphylococcus aureus Decolonization Fails: a Case-Control Study. Microbiol Spectr 2022; 10:e0129622. [PMID: 36000891 PMCID: PMC9602359 DOI: 10.1128/spectrum.01296-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/06/2022] [Indexed: 12/30/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a common bacterial pathogen that frequently colonizes healthy individuals, with potential to cause invasive infection. In Denmark, to keep the prevalence low, MRSA carriers are recommended to undergo decolonization treatments, but achieving decolonization is challenging. Knowledge about the factors contributing to decolonization is scarce. We aimed to identify bacterial genome and clinical factors influencing MRSA decolonization. We identified all new MRSA patients above 2 years of age within the Hvidovre catchment area, Copenhagen, Denmark, in 2017 and 2018. Carriers were defined as chronic carriers (cases) if they were MRSA positive after two or more treatments and as nonchronic carriers (controls) if they were MRSA free after the first or second treatment. Using whole-genome sequencing (WGS), we constructed a pangenome of bacterial strains. With the incorporation of bacterial genome and clinical patient data, machine learning and multivariate analyses were performed to determine the factors associated with decolonization. A total of 477 MRSA carriers were included. An age of ≥13 years was significantly associated with nonchronic carriage. We identified 278 bacterial genetic features that were statistically significantly associated with chronic carriage (P < 0.05 by Fisher's exact test). Chronic MRSA carriage was predicted with 68% accuracy using a combination of bacterial genome data and patient clinical data. Decolonization success is multifactorial. Apart from the 68% predicted accuracy found in this study, we estimate that the remaining 32% is a result of host factors and microbiome composition. IMPORTANCE Carriage of methicillin-resistant Staphylococcus aureus (MRSA) and other multiresistant bacteria is a prerequisite for infection and transmission. Successful decolonization treatment removes these risks. We aimed to identify bacterial genome and host clinical factors that influence MRSA decolonization to estimate the roles of the carrier and the bacterial strain, respectively, when decolonization fails. The long-term goal, beyond this study, is to optimize decolonization success, minimize MRSA transmission, and, ultimately, improve the quality of life of MRSA carriers.
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Mascarenhas J, Nguyen H, Saunders A, Oliver L, Tomkinson H, Perry R, McBride A. MPN-036 Treatment Failure and Transition to Next-Line Therapy in Myelofibrosis: A Modified Delphi Panel Approach. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22 Suppl 2:S323. [PMID: 36163980 DOI: 10.1016/s2152-2650(22)01431-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Ruxolitinib (RUX) is a first-line treatment for intermediate or high-risk myelofibrosis (MF) and was shown to improve splenomegaly and MF symptoms; however, patients experience loss of response and discontinuation rates are high (40%-70%). New treatment options have emerged for patients who are intolerant to or progress on RUX. The aim of the study was to establish how treatment failure can be defined in real-world practice and develop parameters to guide appropriate transition to next-line therapy. METHODS A 3-round modified Delphi panel was conducted with 14 hematologist-oncologists who had been a principal investigator on ≥1 clinical trial or involved in NCCN Guidelines for Myeloproliferative Neoplasms around the USA. Two survey rounds were completed via online questionnaires and scored using 9-point Likert scales, followed by a consensus meeting to resolve conflicting statements. Agreement was defined as ≥80% of respondents scoring 7-9 and disagreement 1-3. RESULTS Eighty-four statements were agreed upon to define RUX failure. Consensus was reached for primary refractory treatment failure, defined as patients with no spleen/symptom response within ≥3 months while receiving a maximally tolerated dose. Loss of spleen/symptom response within ≥1 month following initial response or progressive disease, including to blast phase, were agreed upon as indicative of RUX failure. Intolerance can indicate RUX failure, presenting as treatment-emergent toxicities deemed unacceptable to the patient after ≥4 weeks of treatment. Additional consensus statements suggest that patient-reported symptoms of fatigue, poor concentration, inactivity, and bone pain were too general to define RUX failure versus other specific MF symptoms, i.e., night sweats. Following RUX failure, consensus recommendations suggest that next-line treatment should be guided by patient characteristics to mitigate risk of withdrawal and should start as soon as clinically appropriate. CONCLUSIONS This research provides expert consensus on recognizing RUX failure in those with no treatment response or progression based on spleen and symptom control and intolerance. These definitions can be utilized to add guidance to future clinical guidelines or help providers recognize RUX failure in real-world practice. The study was supported by Bristol Myers Squibb. This work was previously presented at the 27th National Comprehensive Cancer Network (NCCN) Annual Conference, 2022.
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Chanchlani N, Lin S, Auth MK, Lee CL, Robbins H, Looi S, Murugesan SV, Riley T, Preston C, Stephenson S, Cardozo W, Sonwalkar SA, Allah‐Ditta M, Mansfield L, Durai D, Baker M, London I, London E, Gupta S, Di Mambro A, Murphy A, Gaynor E, Jones KDJ, Claridge A, Sebastian S, Ramachandran S, Selinger CP, Borg‐Bartolo SP, Knight P, Sprakes MB, Burton J, Kane P, Lupton S, Fletcher A, Gaya DR, Colbert R, Seenan JP, MacDonald J, Lynch L, McLachlan I, Shields S, Hansen R, Gervais L, Jere M, Akhtar M, Black K, Henderson P, Russell RK, Lees CW, Derikx LAAP, Lockett M, Betteridge F, De Silva A, Hussenbux A, Beckly J, Bendall O, Hart JW, Thomas A, Hamilton B, Gordon C, Chee D, McDonald TJ, Nice R, Parkinson M, Gardner‐Thorpe H, Butterworth JR, Javed A, Al‐Shakhshir S, Yadagiri R, Maher S, Pollok RCG, Ng T, Appiahene P, Donovan F, Lok J, Chandy R, Jagdish R, Baig D, Mahmood Z, Marsh L, Moss A, Abdulgader A, Kitchin A, Walker GJ, George B, Lim Y, Gulliver J, Bloom S, Theaker H, Carlson S, Cummings JRF, Livingstone R, Beale A, Carter JO, Bell A, Coulter A, Snook J, Stone H, Kennedy NA, Goodhand JR, Ahmad T. Implications for sequencing of biologic therapy and choice of second anti-TNF in patients with inflammatory bowel disease: results from the IMmunogenicity to Second Anti-TNF therapy (IMSAT) therapeutic drug monitoring study. Aliment Pharmacol Ther 2022; 56:1250-1263. [PMID: 36039036 PMCID: PMC9804266 DOI: 10.1111/apt.17170] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/05/2022] [Accepted: 07/19/2022] [Indexed: 01/30/2023]
Abstract
BACKGROUND Anti-drug antibodies are associated with treatment failure to anti-TNF agents in patients with inflammatory bowel disease (IBD). AIM To assess whether immunogenicity to a patient's first anti-TNF agent would be associated with immunogenicity to the second, irrespective of drug sequence METHODS: We conducted a UK-wide, multicentre, retrospective cohort study to report rates of immunogenicity and treatment failure of second anti-TNF therapies in 1058 patients with IBD who underwent therapeutic drug monitoring for both infliximab and adalimumab. The primary outcome was immunogenicity to the second anti-TNF agent, defined at any timepoint as an anti-TNF antibody concentration ≥9 AU/ml for infliximab and ≥6 AU/ml for adalimumab. RESULTS In patients treated with infliximab and then adalimumab, those who developed antibodies to infliximab were more likely to develop antibodies to adalimumab, than patients who did not develop antibodies to infliximab (OR 1.99, 95%CI 1.27-3.20, p = 0.002). Similarly, in patients treated with adalimumab and then infliximab, immunogenicity to adalimumab was associated with subsequent immunogenicity to infliximab (OR 2.63, 95%CI 1.46-4.80, p < 0.001). For each 10-fold increase in anti-infliximab and anti-adalimumab antibody concentration, the odds of subsequently developing antibodies to adalimumab and infliximab increased by 1.73 (95% CI 1.38-2.17, p < 0.001) and 1.99 (95%CI 1.34-2.99, p < 0.001), respectively. Patients who developed immunogenicity with undetectable drug levels to infliximab were more likely to develop immunogenicity with undetectable drug levels to adalimumab (OR 2.37, 95% CI 1.39-4.19, p < 0.001). Commencing an immunomodulator at the time of switching to the second anti-TNF was associated with improved drug persistence in patients with immunogenic, but not pharmacodynamic failure. CONCLUSION Irrespective of drug sequence, immunogenicity to the first anti-TNF agent was associated with immunogenicity to the second, which was mitigated by the introduction of an immunomodulator in patients with immunogenic, but not pharmacodynamic treatment failure.
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Muacevic A, Adler JR. Prediction of Noninvasive Ventilation Failure in COVID-19 Patients: When Shall We Stop? Cureus 2022; 14:e30599. [PMID: 36420242 PMCID: PMC9679987 DOI: 10.7759/cureus.30599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION In coronavirus disease 2019 (COVID-19), there are no tools available for the difficult task of recognizing which patients do not benefit from maintaining respiratory support, such as noninvasive ventilation (NIV). Identifying treatment failure is crucial to provide the best possible care and optimizing resources. Therefore, this study aimed to build a model that predicts NIV failure in patients who did not progress to invasive mechanical ventilation (IMV). METHODS This retrospective observational study included critical COVID-19 patients treated with NIV who did not progress to IMV. Patients were admitted to a Portuguese tertiary hospital between October 1, 2020, and March 31, 2021. The outcome of interest was NIV failure, defined as COVID-19-related in-hospital death. A binary logistic regression was performed, where the outcome (mortality) was the dependent variable. Using the independent variables of the logistic regression a decision-tree classification model was implemented. RESULTS The study sample, composed of 103 patients, had a mean age of 66.3 years (SD=14.9), of which 38.8% (40 patients) were female. Most patients (82.5%) were autonomous for basic activities of daily living. The prediction model was statistically significant with an area under the curve of 0.994 and a precision of 0.950. Higher age, a higher number of days with increases in the fraction of inspired oxygen (FiO2), a higher number of days of maximum expiratory positive airway pressure, a lower number of days on NIV, and a lower number of days from disease onset to hospital admission were, with statistical significance, associated with increased odds of death. A decision-tree classification model was then obtained to achieve the best combination of variables to predict the outcome of interest. CONCLUSIONS This study presents a model to predict death in COVID-19 patients treated with NIV in patients who did not progress to IMV, based on easily applicable variables that mainly reflect patients' evolution during hospitalization. Along with the decision-tree classification model, these original findings may help clinicians define the best therapeutical approach to each patient, prioritizing life-comforting measures when adequate, and optimizing resources, which is crucial within limited or overloaded healthcare systems. Further research is needed on this subject of treatment failure, not only to understand if these results are reproducible but also, in a broader sense, helping to fill this gap in modern medicine guidelines.
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Wu Y, Zheng S, Zhang Z, Chen G, Chen X, Zheng T, Guo X, Chen H, Wang M, Xie X, Zhang B. Hepatic Arterial Infusion Chemotherapy with Oxaliplatin Plus Raltitrexed as an Alternative Option in Advanced Hepatocellular Carcinoma Patients with Failure of, or Unsuitability for, Transarterial Chemoembolization. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101343. [PMID: 36295504 PMCID: PMC9607605 DOI: 10.3390/medicina58101343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 12/24/2022]
Abstract
Background and Objectives: To assess the efficacy and safety of hepatic arterial infusion chemotherapy (HAIC) with oxaliplatin plus raltitrexed (HAICROX) as an alternative treatment option for advanced hepatocellular carcinoma (HCC) patients who are ineligible for, or failed, the transarterial chemoembolization (TACE) treatment. Materials and Methods: From July 2020 to November 2021, a total of 35 HCC patients were enrolled and received HAIC with oxaliplatin plus raltitrexed. The overall survival (OS) and time to progression (TTP) were primary and secondary endpoints, respectively. The tumor response was assessed by the modified response evaluation criteria in solid tumors (mRECIST), and the adverse events were investigated using the common terminology criteria for adverse events version 5.0 (CTCAE 5.0). Results: The median OS and TTP were 10 months (95% confidence interval (CI): 5.5-14.6) and 3.5 months (95% CI: 2.3-4.7), respectively. By means of multivariate analysis, anti-programmed cell death protein 1 (anti-PD-1) immunotherapy was found to be an independent prognostic factor for better survival. No patients experienced toxicity-related death. Thrombocytopenia, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) elevation were the most common toxicities. No grade 3 or higher adverse events related to HAICROX were observed. Conclusion: HAICROX showed valuable efficacy and tolerable toxicity in advanced HCC patients who progressed on TACE or were ineligible for TACE. HAICROX is a promising treatment for advanced-stage HCC patients with TACE failure or ineligibility.
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Elvstam O, Malmborn K, Elén S, Marrone G, García F, Zazzi M, Sönnerborg A, Böhm M, Seguin-Devaux C, Björkman P. Virologic Failure Following Low-level Viremia and Viral Blips During Antiretroviral Therapy: Results From a European Multicenter Cohort. Clin Infect Dis 2022; 76:25-31. [PMID: 36100984 PMCID: PMC9825828 DOI: 10.1093/cid/ciac762] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/24/2022] [Accepted: 09/08/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND It is unclear whether low-level viremia (LLV), defined as repeatedly detectable viral load (VL) of <200 copies/mL, and/or transient viremic episodes (blips) during antiretroviral therapy (ART), predict future virologic failure. We investigated the association between LLV, blips, and virologic failure (VF) in a multicenter European cohort. METHODS People with HIV-1 who started ART in 2005 or later were identified from the EuResist Integrated Database. We analyzed the incidence of VF (≥200 copies/mL) depending on viremia exposure, starting 12 months after ART initiation (grouped as suppression [≤50 copies/mL], blips [isolated VL of 51-999 copies/mL], and LLV [repeated VLs of 51-199 copies/mL]) using Cox proportional hazard models adjusted for age, sex, injecting drug use, pre-ART VL, CD4 count, HIV-1 subtype, type of ART, and treatment experience. We queried the database for drug-resistance mutations (DRM) related to episodes of LLV and VF and compared those with baseline resistance data. RESULTS During 81 837 person-years of follow-up, we observed 1424 events of VF in 22 523 participants. Both blips (adjusted subhazard ratio [aHR], 1.7; 95% confidence interval [CI], 1.3-2.2) and LLV (aHR, 2.2; 95% CI, 1.6-3.0) were associated with VF, compared with virologic suppression. These associations remained statistically significant in subanalyses restricted to people with VL <200 copies/mL and those starting ART 2014 or later. Among people with LLV and genotype data available within 90 days following LLV, 49/140 (35%) had at least 1 DRM. CONCLUSIONS Both blips and LLV during ART are associated with increased risk of subsequent VF.
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Jiang H, Zhu C, Qin L, Wu X, Yin J, Guo Y, Ma H, Jia J, Huo F, Xue Y, Gao M, Li W. Case report: A 9-year systematic treatment failure of a pulmonary tuberculosis patient. Front Public Health 2022; 10:966891. [PMID: 36148360 PMCID: PMC9487995 DOI: 10.3389/fpubh.2022.966891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/17/2022] [Indexed: 01/24/2023] Open
Abstract
Objective To explore the reasons of failure in a case of pulmonary tuberculosis (PTB) after 9 years systematic treatment. Methods We extracted the patients' treatment history, drug susceptibility testing (DST), Computed tomography (CT) images, and sequenced the isolated strains by whole gene sequencing (WGS). Results Although most results of the phenotypical DSTs were consistent with the genotype DST, the occurrence of gene resistance to amikacin (AMK), capreomycin (CAP), moxifloxacin (MFX) was earlier than the phenotypical DST. Based on the continuously reversed results of phenotypical DSTs, CT images in different stages and WGS, it can be confirmed that the patient was infected with two different strains of Mycobacterium tuberculosis (M.TB). Moreover, severe cavities may be another factor leading to treatment failure. Conclusion Given the suggestive effect of genotype DST is earlier than the phenotypical DST, so genotype DST can play a better guiding role in patients with MDR-TB. Additionally, for patients who have not been cured for a long time, medication should be more cautious and the role of WGS in drug resistance surveillance should be fully utilized.
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Lan J, Huang G, Chen S, Zhou W, Yang H. Retroperitoneal laparoscopic renorrhaphy for post-percutaneous nephrolithotomy hemorrhage: a case report. J Int Med Res 2022; 50:3000605221123392. [PMID: 36113038 PMCID: PMC9478727 DOI: 10.1177/03000605221123392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Percutaneous nephrolithotomy is the preferred treatment for large renal calculi; however,
postoperative hemorrhage is a dangerous complication. The three main causes of hemorrhage
after percutaneous nephrolithotomy are pseudoaneurysms, arteriovenous fistulas, and
arterial lacerations. The preferred treatment for acute hemorrhage is superselective
angioembolization. However, in a few cases, angiography reveals no abnormal findings
pertaining to hemorrhage. We herein present a clinical case of a 48-year-old man who
presented with multiple complex right renal calculi and was managed with percutaneous
nephrolithotomy in the prone position. Massive hemorrhage occurred 6 days postoperatively,
and renal angiography was immediately performed. However, while the bleeding was still
occurring, no extravasation was observed on renal angiography. We performed
retroperitoneal laparoscopic renorrhaphy, which successfully stopped the bleeding and
consequently preserved the kidney. We suggest that retroperitoneal laparoscopic
renorrhaphy can be effective in patients who have undergone failed renal arterial
embolization or are reluctant to undergo renal arterial embolization.
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Prognostic Factors and Primary Healing on Root Perforation Repaired with MTA: A 14-year Longitudinal Study. J Endod 2022; 48:1092-1099. [PMID: 35714727 DOI: 10.1016/j.joen.2022.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/07/2022] [Accepted: 06/07/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Few data are available on the long-term efficacy of mineral trioxide aggregate (MTA) in treating root canal perforations. This prospective cohort study builds on a previously reported trial to determine the outcome for teeth with root perforations treated with orthograde MTA after longer follow-up and identify potential prognostic factors. METHODS A prospective cohort study was performed, enrolling (1999-2009) patients with a single dental perforation treated with MTA. Preoperative, intraoperative, and postoperative information was evaluated, and the outcomes were dichotomized as healed or nonhealing. Patients were followed up yearly until 2018 for a maximum of 17 years after treatment, with controls carried out until 14 years. Clinical and radiographic outcomes were evaluated using standardized follow-up protocols. RESULTS Of the 124 entrolled patients (median age = 36.5 years, 53.2% male), 115 were healed at the first (n = 110, 89%) or second (n = 5, 4%) annual posttreatment checkup, while 9 subjects (7%, 4 females, 18-65 years old) did not heal. Characteristics significantly associated with nonhealing were gender, positive probing, size, and perforation site. Perforations recurred in 48 teeth during the follow-up with the estimated probability of reversal at 5, 10, and 14 years of 6% (95% confidence interval [CI], 2%-10%), 30% (95% CI, 20%-38%), and 62% (95% CI, 46%-73%), respectively. Positive probing had a higher reversal risk (hazard ratio = 3.3, P ≤ .001), and perforations >3 mm were more likely to have a reversal (hazard ratio = 4.1, P < .001). CONCLUSIONS The risk of reversal for healed MTA-treated root canal perforations, initially relatively low, vastly increases over time.
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Park H, Lo-Ciganic WH, Huang J, Wu Y, Henry L, Peter J, Sulkowski M, Nelson DR. Machine learning algorithms for predicting direct-acting antiviral treatment failure in chronic hepatitis C: An HCV-TARGET analysis. Hepatology 2022; 76:483-491. [PMID: 35034373 PMCID: PMC9287493 DOI: 10.1002/hep.32347] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/22/2021] [Accepted: 01/05/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS We aimed to develop and validate machine learning algorithms to predict direct-acting antiviral (DAA) treatment failure among patients with HCV infection. APPROACH AND RESULTS We used HCV-TARGET registry data to identify HCV-infected adults receiving all-oral DAA treatment and having virologic outcome. Potential pretreatment predictors (n = 179) included sociodemographic, clinical characteristics, and virologic data. We applied multivariable logistic regression as well as elastic net, random forest, gradient boosting machine (GBM), and feedforward neural network machine learning algorithms to predict DAA treatment failure. Training (n = 4894) and validation (n = 1631) patient samples had similar sociodemographic and clinical characteristics (mean age, 57 years; 60% male; 66% White; 36% with cirrhosis). Of 6525 HCV-infected adults, 95.3% achieved sustained virologic response, whereas 4.7% experienced DAA treatment failure. In the validation sample, machine learning approaches performed similarly in predicting DAA treatment failure (C statistic [95% CI]: GBM, 0.69 [0.64-0.74]; random forest, 0.68 [0.63-0.73]; feedforward neural network, 0.66 [0.60-0.71]; elastic net, 0.64 [0.59-0.70]), and all four outperformed multivariable logistic regression (0.51 [0.46-0.57]). Using the Youden index to identify the balanced risk score threshold, GBM had 66.2% sensitivity and 65.1% specificity, and 12 individuals were needed to evaluate to identify 1 DAA treatment failure. Over 55% of patients with treatment failure were classified by the GBM in the top three risk decile subgroups (positive predictive value: 6%-14%). The top 10 GBM-identified predictors included albumin, liver enzymes (aspartate aminotransferase, alkaline phosphatase), total bilirubin levels, sex, HCV viral loads, sodium level, HCC, platelet levels, and tobacco use. CONCLUSIONS Machine learning algorithms performed effectively for risk prediction and stratification of DAA treatment failure.
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Lerang F, Holst R, Henriksen M, Wåhlberg H, Jelsness-Jørgensen LP. Antitumour necrosis factor alpha treatment in Crohn's disease: long-term efficacy, side effects and need for surgery. Scand J Gastroenterol 2022; 57:921-929. [PMID: 35188443 DOI: 10.1080/00365521.2022.2042592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To examine the long-term efficacy and side effects of antitumour necrosis factor alpha (anti-TNF) therapy in patients with Crohn's disease (CD), the need for surgery and the clinical outcome after discontinuing anti-TNF therapy. MATERIAL AND METHODS Data were collected from the inflammatory bowel disease (IBD)-TNF register at Østfold Hospital Trust. Clinical and sociodemographic data were recorded for patients initiating anti-TNF therapy from January 2000 until December 2011. Follow-up was conducted until December 2017. RESULTS Complete remission (CR) was achieved in 40/154 (26%) patients at the last follow-up (median follow-up time 10 years). A total of 40 (26%) patients had to discontinue treatment due to serious side effects, and malignancy was recorded in 10 (6.5%) patients. Surgical resection was performed in 55 (36%) patients during follow-up. Patients with Montreal phenotype B2 before anti-TNF therapy were estimated to have a 2.54-fold greater risk of surgery than patients with phenotype B1 (p = .001). Of those with phenotype B1 before anti-TNF therapy, 19 (24%) of them developed stenosis in need of surgical resection ('phenotype migration'). In patients followed up after discontinuing anti-TNF therapy (n = 89, median observational time six years), CR was achieved in most patients. CONCLUSIONS Long-term complete remission was achieved in only one in four patients receiving anti-TNF therapy, and one in four patients had to discontinue therapy due to side effects. Despite anti-TNF therapy, one in four patients with a baseline luminal disease phenotype needed subsequent surgical resection.
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Salvage Radiotherapy Plus Androgen Deprivation Therapy for High-Risk Prostate Cancer with Biochemical Failure after High-Intensity Focused Ultrasound as Primary Treatment. J Clin Med 2022; 11:jcm11154450. [PMID: 35956069 PMCID: PMC9369757 DOI: 10.3390/jcm11154450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/11/2022] [Accepted: 07/28/2022] [Indexed: 11/22/2022] Open
Abstract
We conduct a retrospective analysis of salvage radiotherapy plus androgen deprivation therapy (SRT+ADT) for high-risk prostate cancer patients with biochemical failure after high-intensity focused ultrasound (HIFU) as the primary treatment. A total of 38 patients, who met the criteria of biochemical failure and were consecutively treated with SRT+ADT, were enrolled. All patients received intensity modulated radiotherapy with a median dose of 70 Gy to the clinical target volume. ADT was given before, during or after the course of SRT with the duration of ≦6 months (n = 14), 6−12 months (n = 12) or >12 months (n = 12). The median follow-up was 45.9 months. A total of 10 (26.3%) patients had biochemical failure after SRT+ADT. The cumulative 5-year biochemical progression free survival (b-PFS) and overall survival (OS) rate was 73.0% and 80.3%, respectively. A nadir prostate-specific antigen (nPSA) value 0.02 ng/mL was observed to predict the b-PFS in multivariate analysis. The 5-year b-PFS was 81.6% for those with nPSA < 0.02 compared with 25.0% with nPSA ≧ 0.02. The adverse effects related to SRT+ADT were mild in most cases and only three (8%) patients experienced grade 3 urinary toxicities. For high-risk prostate cancer after HIFU as primary treatment with biochemical failure, our study confirms the feasibility of SRT+ADT with high b-PFS, OS and low toxicity.
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