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J Card Surg ; 37(5): 1161-1167, 2022 May.
Article En | MEDLINE | ID: mdl-35218243

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has been and will continue to be a challenge to the healthcare system worldwide. In this context, we aimed to discuss the impact of the COVID-19 pandemic on the diagnosis, timing, and prognosis of surgical treatment for active infective endocarditis (IE) during the pandemic and share our coping strategy. METHODS: A total of 39 patients were admitted for active IE in the year 2020. The number of the same period last year was 50. Medical information of these two groups was extracted from our surgical database. Data were compared between the two groups and differences with or without statistical significance were discussed. RESULTS: In the pandemic year, we admitted fewer transferred patients (64.1% vs. 80%, p = .094). Timespan for diagnosis were prolonged (60 vs. 34.5 days, p = .081). More patients were admitted in emergency (41% vs. 20%, p = .030) More patients had heart failure (74.4% vs. 40%, p = .001), sepsis (69.2% vs. 42.0%, p = .018), or cardiogenic shock (25.6% vs. 8.0%, p = .038). Overall surgical risk (EuroSCORE II) was higher (4.15% vs. 3.24%, p = .019) and more commando surgery was performed (7.7% vs. 2.0%, p = .441). However, we did not see more postoperative complications, and early mortality was not worse either (0 vs. 4%, p = .502). CONCLUSIONS: The negative impact of the COVID-19 pandemic on the clinical practice of surgical treatment for active IE was multifaceted. However, with the preservation of the effectiveness of multidisciplinary IE surgical team, the early outcomes were comparable with those in the normal years.

COVID-19 , Endocarditis, Bacterial , Endocarditis , Endocarditis/surgery , Endocarditis, Bacterial/surgery , Humans , Pandemics , Postoperative Complications/epidemiology , Retrospective Studies , Treatment Outcome
Dermatol Ther ; 35(2): e15231, 2022 02.
Article En | MEDLINE | ID: mdl-34820971

Data on the effectiveness and safety of a drug in real-world clinical practice complement the evidence from clinical trials, which are carried out in a different setting. Little has been published on the effectiveness and safety of guselkumab in the treatment of psoriasis in clinical practice. The ojective of this study was to assess the effectiveness and safety of guselkumab at 24 weeks in patients with moderate to severe plaque psoriasis in routine clinical practice. A retrospective, multicentre study of adult patients with moderate to severe plaque psoriasis treated with guselkumab for at least 24 weeks was carried out in Spain. We studied 343 patients, 249 of whom were followed for 24 weeks. By week 24, the mean (SD) psoriasis area severity index (PASI) had decreased from 11.1 (7.3) to 1.7 (2.8) (-9.3; [-10.2;-8.4]), 85.9% of the patients had achieved PASI score of 4 or less and 77.9% a PASI score of 2 or less. In terms of relative PASI response, 59.4% of the patients achieved a PASI-90 response and 49.0% a PASI-100 response. On multivariate analysis, two factors reduced the probability of a PASI of 2 or less at 24 weeks: a BMI ≥30 (OR, 0.44; 95% CI, 0.22-0.88) and a greater previous exposure to biologic therapy (OR, 0.69; 95% CI, [0.56-0.84]). Adverse events were rare (9.9%) and led to withdrawal from treatment in only nine patients (2.6%) by the end of the follow-up period. The results of this study confirm the high efficacy and safety of guselkumab indicated by the clinical trial data. In clinical practice, the absolute PASI score appears to be a better marker of response to treatment than the relative value.

Psoriasis , Adult , Antibodies, Monoclonal, Humanized , Humans , Psoriasis/diagnosis , Psoriasis/drug therapy , Retrospective Studies , Severity of Illness Index , Treatment Outcome
Dermatol Ther ; 35(2): e15229, 2022 02.
Article En | MEDLINE | ID: mdl-34820974

Carboxytherapy has been used in the treatment of autoimmune skin diseases such as psoriasis and morphea. Carboxytherapy has antioxidant effects, and leads to better tissue oxygenation, and release of growth factors. In this article, we decided to evaluate efficacy of combined carboxytherapy and narrowband-ultraviolet B (NB-UVB) compared to NB-UVB alone in the treatment of vitiligo. This is a prospective, split-body double-blind comparative study performed in patients with generalized stable vitiligo in acral areas and extremities referred to dermatology clinic of Afzalipour hospital in Kerman University of Medical Sciences. NB-UVB was performed three times a week in non-consecutive days for 4 months. In each patient, one lesion was randomly treated with carboxytherapy (weekly sessions for total of 16 sessions). Efficacy of treatment was evaluated by percentage of repigmentation of the lesions. Chi-square test and analysis of variance test (ANOVA) were used to compare efficacy of treatment based on demographic features of the patients and clinical features of the lesions, respectively. Twenty-eight patients with mean age of 32.35 ± 7.37 years old completed the study. At the end of the treatment, 37% of the patients in combination therapy group demonstrated more than 75% improvement compared to 0% in the monotherapy group (p = 0.001). There was no significant difference between either demographic features of the patients (age, sex, and skin phototypes) or duration of disease with efficacy of the treatment in both groups. Combination of carboxytherapy with NB-UVB leads to higher percentage of repigmentation and patients' satisfaction compared to monotherapy with NB-UVB.

Ultraviolet Therapy , Vitiligo , Adult , Combined Modality Therapy , Humans , Prospective Studies , Skin/pathology , Treatment Outcome , Ultraviolet Therapy/adverse effects , Vitiligo/diagnosis , Vitiligo/drug therapy , Vitiligo/radiotherapy , Young Adult
Acta Derm Venereol ; 102: adv00683, 2022 Mar 28.
Article En | MEDLINE | ID: mdl-35191512

Brodalumab is approved for treatment of moderate-to-severe plaque psoriasis. Here, we assess the safety profile of brodalumab using pooled safety data from 5 phase II/III trials of brodalumab 140 mg or 210 mg. In total, 4,464 patients received brodalumab, representing 8,891.6 patient-years of exposure. During the placebo-controlled 12-week induction period, rates of serious adverse events per 100 patient-years were 10.8 and 9.6 (brodalumab 140 mg and 210 mg, respectively) vs 4.3 and 6.5 (ustekinumab and placebo, respectively); infections were the most frequent serious adverse event. Rates of serious adverse events during the comparator-controlled 52-week period were 14.4, 10.2 and 8.3 per 100 patient-years for brodalumab 210 mg, brodalumab 140 mg, and ustekinumab, respectively. Brodalumab was not associated with increased risks of malignancy, major adverse cardiac events, suicidal ideation and behaviour, or fatal events. Overall, brodalumab demonstrated an acceptable safety profile in short- and long-term treatment.

Antibodies, Monoclonal, Humanized , Psoriasis , Antibodies, Monoclonal, Humanized/adverse effects , Clinical Trials as Topic , Humans , Psoriasis/drug therapy , Severity of Illness Index , Treatment Outcome
BMC Musculoskelet Disord ; 23(1): 308, 2022 Mar 31.
Article En | MEDLINE | ID: mdl-35361169

BACKGROUND: Calcific tendinitis of the shoulder (CT) is a common disorder with a large disease burden. The initial treatment is with conservative measures. However, when this fails the next step treatment remains unclear. Minimal invasive treatment modalities have emerged. Needle aspiration of the calcific deposits (NACD) and extracorporeal shock wave therapy (ESWT) have both shown good clinical results. Nonetheless, in the current orthopedic literature there are not any studies available that compare both the effectiveness and cost-effectiveness of those two treatment modalities. Therefore, our primary objective is to compare the effectiveness of NACD to ESWT. A secondary objective is to compare the cost-effectiveness of both treatment modalities and workability. METHODS: Following a power calculation using the minimal clinical important difference of our primary outcome (Constant-Murley score, CMS) 140 patients will be included in the study. Enrolment is based upon strict inclusion/ exclusion criteria outlined in the Methods section. Participants will be randomized by computer in two groups (e.g. 70 patients will receive NACD and 70 patients will receive ESWT). The NACD treatment will consist of a sonographically guided removal of the calcific deposits and the ESWT treatment will be a focused ESWT. Both treatments will be conducted according to a standardized protocol, as part of care as usual in our hospital. The primary outcome will be the between group differences in functional outcome (measured with the CMS) between baseline and after 12 months follow-up. Secondary outcomes will be questionnaires regarding the clinical outcome (SST) and quality of life (EQ-5D-5L). Furthermore, NRS pain and cost related questionnaires (iPCQ and ProDisQ) will be collected during follow-up after two months, six months and at final follow-up after 12 months. DISCUSSION: This study will provide more insight regarding treatment for conservative therapy resistant calcific tendinitis of the shoulder by comparing NACD to focused ESWT, which will aid the physician and patient in determining the appropriate treatment plan. TRIAL REGISTRATION: Dutch trial register: NTR7093 registered on 11 March 2018.

Calcinosis , Extracorporeal Shockwave Therapy , Tendinopathy , Calcinosis/complications , Calcinosis/diagnostic imaging , Calcinosis/therapy , Conservative Treatment , Humans , Quality of Life , Randomized Controlled Trials as Topic , Shoulder , Tendinopathy/complications , Tendinopathy/diagnostic imaging , Tendinopathy/therapy , Treatment Outcome
BJOG ; 129(5): 805-811, 2022 Apr.
Article En | MEDLINE | ID: mdl-34545675

OBJECTIVE: Pregnant women may develop disseminated intravascular coagulation (DIC), possibly resulting in massive maternal haemorrhage and perinatal death. The Japan guideline recommends use of antithrombin III (ATIII) for DIC in obstetrics; however, its effect remains uncertain. The present study aimed to investigate the effect of ATIII for DIC in obstetrics, using a national inpatient database in Japan. DESIGN: Nationwide observational study. SETTING: Japan. POPULATION: We used the Diagnosis Procedure Combination inpatient database to identify patients who delivered at hospital and were diagnosed with DIC from July 2010 to March 2018. METHODS: Propensity score matching analyses were performed to compare in-hospital maternal mortality and hysterectomy during hospitalisation between users and non-users of ATIII on the day of delivery. MAIN OUTCOME MEASURES: In-hospital mortality, hysterectomy. RESULTS: A total of 9920 patients were enrolled, including 4329 patients (44%) who used ATIII and 5511 patients (56%) who did not use ATIII. One-to-one propensity score matching created 3290 pairs. In-hospital maternal mortality did not differ significantly between the propensity-matched groups (0.3% in the ATIII group versus 0.5% in the control group; odds ratio 0.73; 95% CI 0.35-1.54). A significantly lower proportion of patients in the ATIII group, compared with those in the control group, underwent hysterectomy during hospitalisation (5.3% versus 8.7%; absolute risk difference -2.9%; 95% CI -4.2 to -1.6%). CONCLUSIONS: Although the present study did not show a mortality-reducing effect of ATIII for patients with DIC in obstetrics, it may have clinical benefit in terms of reducing the number of patients undergoing hysterectomy. TWEETABLE ABSTRACT: This study did not show mortality-reducing effect of antithrombin III for patients with DIC in obstetrics.

Disseminated Intravascular Coagulation , Obstetrics , Antithrombin III/therapeutic use , Disseminated Intravascular Coagulation/diagnosis , Disseminated Intravascular Coagulation/drug therapy , Female , Humans , Japan/epidemiology , Pregnancy , Propensity Score , Treatment Outcome
J Interv Cardiol ; 2022: 3932912, 2022.
Article En | MEDLINE | ID: mdl-35360092

Background: The combined procedure of left atrial appendage closure (LAAC) and catheter ablation (CA) is a safe and feasible therapy to treat patients with atrial fibrillation (AF). However, the effect of the combined procedure on cardiac function remains unclear. This study aimed to investigate the changes in endocrine and mechanical function of the heart following the combined procedure. Methods: This retrospective study included 62 consecutive patients who underwent the combined procedure of AF ablation and WATCHMAN LAAC and 62 sex and age-matched patients who only received AF ablation. During follow-up, patients were examined for brain natriuretic peptide (BNP) levels to represent endocrine cardiac function. Mechanical cardiac function was assessed during echocardiographic examination by means of the LA ejection fraction, LA strain (Ƹ), and LA strain rate (SR). Results: (1) The BNP levels decreased acutely after the procedure, rose at day 3 postoperation, but trended downwards at 3 months postoperation in both groups. No significant difference was observed between the two groups. (2) LA ejection fraction, LA Ƹ, and SR exhibited a continuous upward trend over a 3-month follow-up in both groups. There was no significant difference in LA ejection fractions, SRe (the parameter of LA conduit function), and SRa (the parameter of LA booster pump function) between the two groups. However, the Ƹ and SRs (the parameters of LA reservoir function) improved in patients treated with CA alone. Conclusions: The combined procedure of LAAC and CA significantly improved the endocrine and mechanical function of the heart. Compared to simple CA, based on CA with LAAC intervention, it does not significantly change LA endocrine function but may lead to a decline in the LA reservoir function.

Atrial Appendage , Atrial Fibrillation , Catheter Ablation , Atrial Appendage/diagnostic imaging , Atrial Appendage/surgery , Atrial Fibrillation/diagnosis , Atrial Fibrillation/surgery , Catheter Ablation/methods , Humans , Retrospective Studies , Treatment Outcome
J Cardiovasc Electrophysiol ; 33(4): 731-737, 2022 Apr.
Article En | MEDLINE | ID: mdl-35138039

INTRODUCTION: The aim of this study was to assess the safety and efficacy of the TightRail™ sheath for pacemaker/defibrillator transvenous lead extraction (TLE). METHODS: Multicenter observational study including patients who underwent a TLE with the TightRail™ sheath in five French university hospitals from September 2014 to January 2020. RESULTS: Two hundred and twenty-five patients (76% males, 71 ± 12 years) underwent a TLE procedure with the TightRail™. A total of 438 leads were extracted using the TightRail™, and the mean age of the extracted leads was 128 ± 85 months; of these, 344 (79%) were pacing leads and 94 (21%) were implantable cardioverter defibrillator leads. The overall clinical success of the extraction procedures was 93%. Overall, 410 of the 438 leads (95%) were extracted (complete or incomplete removal). After multilevel mixed-effects logistic regression model, we found that lead age (odds ratio [OR], 95% confidence interval [CI] for a 1 year increase: 1.11 [1.07-1.15], p < .001) and number of leads extracted (OR, 95% CI: 2.09 [1.50-2.96], p < .001) were the two independent factors associated with complete lead removal failure. Finally, there were 7 (3%) cases of major complications but no per-procedural death. CONCLUSION: This is the first large-scale survey assessing the efficacy and safety profile of the Tightrail™ mechanical sheath. The clinical success rate was 93%, and the lead removal failure was dependent on the age and number of leads. We show a satisfactory safety profile in this cohort of patients from primarily low-volume centers with older leads.

Defibrillators, Implantable , Pacemaker, Artificial , Device Removal/adverse effects , Female , Humans , Male , Retrospective Studies , Treatment Outcome
Female Pelvic Med Reconstr Surg ; 28(5): 287-292, 2022 May 01.
Article En | MEDLINE | ID: mdl-35536667

OBJECTIVE: The eCoin (Valencia Technologies Corporation, Valencia, CA) is a battery-powered, nickel-sized and shaped neuromodulation device for the treatment of overactive bladder, and it is implanted in the lower leg in a short office or outpatient procedure under local anesthesia. A follow-on trial was conducted to evaluate the feasibility, safety, and efficacy of eCoin reimplantation. METHODS: This was a prospective, single-arm, open-label study, including 23 participants with refractory urgency urinary incontinence (UUI) who were previously participants in the eCoin clinical feasibility trial. This follow-on study was conducted at 7 sites in the United States and New Zealand. Participants were reimplanted with a new eCoin device and activated after 4 weeks. Bladder diary data and validated quality-of-life instruments, collected at 12 weeks and 24 weeks postactivation, were compared with baseline. RESULTS: Participants of the study were considered responders if they reported a ≥ 50% reduction from baseline in episodes of UUI on a 3-day voiding diary. At 12 weeks of treatment, 74% (95% confidence interval [CI], 52%-90%) of participants were considered responders. At 24 weeks of treatment, 82% (95% CI, 60%-95%) of participants were considered responders with 36% (95% CI, 20%-57%) of participants achieving complete continence. There were no device-related serious adverse events reported during the study. CONCLUSIONS: The reimplantation of eCoin was both safe and effective in treating UUI associated with overactive bladder syndrome. The demonstrated significant reduction or resolution of symptoms with no serious safety concern suggests that eCoin is a convenient and maintainable therapeutic device.

Urinary Bladder, Overactive , Urinary Incontinence , Female , Humans , Male , Prospective Studies , Quality of Life , Replantation , Tibial Nerve , Treatment Outcome , Urinary Bladder, Overactive/therapy , Urinary Incontinence, Urge/drug therapy
Can J Surg ; 65(3): E296-E302, 2022.
Article En | MEDLINE | ID: mdl-35504661

BACKGROUND: Young men with osteoarthritis of the hip are a growing segment of the population requiring arthroplasty, and there is compelling evidence that the Birmingham Hip Resurfacing (BHR) system provides good functional outcomes and durability in young, active men. We reviewed the survivorship and clinical outcomes of patients who underwent BHR with a minimum follow-up of 10 years. METHODS: We analyzed survivorship using the Kaplan-Meier method. Functional scoring was performed using the Harris Hip Score (HHS), the University of California, Los Angeles (UCLA) Activity Score, and a visual analogue scale (VAS). RESULTS: In total, 211 patients (243 hips) were included in the study. Of these, 107 patients (127 hips) were available for long-term clinical follow-up, with a mean duration of 12.4 ± 1.4 years. The proportion of male participants with BHRs surviving past 13 years was 93.8% (95% confidence interval [CI] 87.9%-100%) compared with 87% (95% CI 77.8%-97.3%) of female patients. Eleven patients (11 hips) underwent BHR revision. Upon final follow-up, the median HHS was 93.9 in males and 93.6 in females (p = 0.27); median UCLA Activity Score was 8.2 in males and 7.2 in females (p < 0.001), and the median VAS score was 81.9 in males and 81.3 in females (p = 0.35). The median acetabular component inclination was 45.5° ± 6.0° (range 34.6°-57.2°) in males and 44.6° ± 5.9° (range 29°-58.9°) in females. The most common femoral head size was 50 mm with a 56 mm or 58 mm cup (36.3%). CONCLUSION: This study confirms that BHR provides good to excellent functional outcomes, lasting functional improvements, and acceptable durability beyond 10 years in men. Survivorship following BHR is inferior in women; however, HHS and VAS scores were similar in women and men.

Arthroplasty, Replacement, Hip , Hip Prosthesis , Osteoarthritis, Hip , Arthroplasty, Replacement, Hip/adverse effects , Canada , Female , Follow-Up Studies , Humans , Male , Osteoarthritis, Hip/etiology , Osteoarthritis, Hip/surgery , Reoperation , Retrospective Studies , Treatment Outcome
Transl Vis Sci Technol ; 11(5): 8, 2022 May 02.
Article En | MEDLINE | ID: mdl-35536720

Purpose: To explore the safety and feasibility of robot-assisted orbital fat decompression surgery. Methods: Ten prospectively enrolled patients (18 eyes) with Graves' ophthalmopathy underwent robot-assisted orbital fat decompression surgery with the da Vinci Xi surgical system. Intraoperative blood loss, operative time, and complications were recorded. For every patient, the exophthalmos of the operated eyes and Graves' orbitopathy quality of life (GO-QoL) were measured both preoperatively and 3 months postoperatively to assess the surgical effect. Results: All surgical procedures were successfully performed. The mean duration to complete the whole procedure was 124.3 ± 33.2 minutes (range, 60-188). The mean intraoperative blood loss was 17.8 ± 6.2 mL (range, 7.5-28). There were neither complications nor unexpected events in terms of either orbital decompression surgery or robot-assisted procedures. The mean exophthalmos was 20.2 ± 1.8 mm before surgery and 17.9 ± 1.4 mm postoperatively (P < 0.0001). The preoperative and postoperative GO-QoL on the visual function arm was 84.38 ± 20.04 and 93.75 ± 9.32, respectively. The preoperative and postoperative GO-QoL on the appearance arm was 42.50 ± 14.97 and 64.38 ± 21.46, respectively (P = 0.027). Conclusions: The da Vinci Xi surgical system provided the stability, dexterity, and good visualization necessary for orbital fat decompression surgery, indicating the safety and feasibility of robot-assisted orbital fat decompression surgery. Translational Relevance: Based on a literature search using EMBASE and MEDLINE databases, we believe that this study reports the first in-human results of the safety and effectiveness of da Vinci robot-assisted orbital fat decompression surgery.

Exophthalmos , Graves Ophthalmopathy , Robotics , Blood Loss, Surgical , Decompression, Surgical/methods , Exophthalmos/complications , Exophthalmos/surgery , Graves Ophthalmopathy/complications , Graves Ophthalmopathy/surgery , Humans , Quality of Life , Treatment Outcome
Comput Math Methods Med ; 2022: 4217270, 2022.
Article En | MEDLINE | ID: mdl-35529262

Background: Acute myocardial infarction (AMI) refers to the acute necrosis of part of the myocardium caused by persistent and severe myocardial ischemia. This study is aimed at investigating the efficacy of tirofiban combined with ticagrelor in AMI patients after percutaneous coronary intervention (PCI) and its effects on plasma activated partial thromboplastin time (APTT), fibrinogen (FIB), D-dimer (D-D) levels, myocardial injury markers, and inflammatory factors. Methods: 68 AMI patients with AMI who received PCI were divided into control group and observation group (n =34) according to postoperative treatment methods. Both groups received ticagrelor tablets (90 mg). The observation group was additionally given tirofiban (10 µg/kg). APTT, FIB, D-D, serum myoglobin (MB), cardiac troponin I (cTnI), serum C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and IL-6, myeloperoxidase (MPO) levels and the peak time in both groups were detected. The incidence of cardiovascular events and drug safety were compared. Results: After treatment, APTT was increased, and FIB and D-D levels were decreased in both groups. After treatment, the APTT in the observation group was longer, and FIB and D-D levels were lower than those in the control group. The peak time of serum MB and cTnI in the observation group was earlier than that in the control group. The levels of serum MB and cTnI in the observation group were lower than those in the control group. After treatment, serum CRP, TNF-α, IL-6, and MPO levels were decreased. And the incidence of cardiovascular events was reduced. Conclusion: Tirofiban combined with ticagrelor can improve coagulation function, protect myocardium, relieve inflammation, and reduce the risk of cardiovascular events in patients with AMI after PCI.

Myocardial Infarction , Percutaneous Coronary Intervention , Biomarkers , C-Reactive Protein/analysis , Humans , Interleukin-6 , Myocardial Infarction/drug therapy , Percutaneous Coronary Intervention/adverse effects , Ticagrelor/therapeutic use , Tirofiban/therapeutic use , Treatment Outcome , Tumor Necrosis Factor-alpha
Neural Plast ; 2022: 7055697, 2022.
Article En | MEDLINE | ID: mdl-35529453

Background: Postherpetic neuralgia (PHN) is the most common and severe complication after varicella-zoster infection, especially in elderly patients. PHN is always refractory to treatment. Both pulsed radiofrequency (PRF) and short-term spinal cord stimulation (stSCS) have been used as effective analgesia methods in clinic. However, which technique could provide better pain relief remains unknown. Objectives: This study is aimed at evaluating the efficacy and safety of PRF and stSCS in elderly patients with PHN. Study Design. A prospective, randomized-controlled study. Setting. Department of Pain Management, the Second Affiliated Hospital of Guangzhou Medical University. Methods: A total of 70 elderly patients with PHN were equally randomized to the PRF group or stSCS group. Patients in the PRF group received PRF treatment, while patients in the stSCS group received stSCS treatment. The primary outcome was the effective rate. The secondary outcomes included the Visual Analogue Scale (VAS), the 36-Item Short Form Health Survey Questionnaire (SF-36), and the pregabalin dosage. All outcomes were evaluated at baseline and at different postoperative time points. Results: At 12 months after surgery, the effective rate reached 79.3% in stSCS group, while 42.1% in PRF group. The effective rate was significantly higher in the stSCS group than in the PRF group at 3, 6, and 12 months after surgery. VAS scores decreased significantly at each postoperative time point in both groups (P < 0.001). The VAS scores were significantly lower in the stSCS group than in the PRF group at 3, 6, and 12 months after surgery. SF-36 scores (bodily pain and the physical role) were significantly improved at each postoperative time point in both groups (P < 0.001). The SF-36 scores were significantly higher in the stSCS group than in the PRF group at some postoperative time points. The pregabalin dosage was significantly lower in the stSCS group than in the PRF group at 3, 6, and 12 months after surgery. Limitations. A single-center study with a relatively small sample size. Conclusions: Both PRF and stSCS are effective and safe neuromodulation techniques for elderly patients with PHN. However, stSCS could provide better and longer-lasting analgesic effect compared to PRF.

Neuralgia, Postherpetic , Pulsed Radiofrequency Treatment , Spinal Cord Stimulation , Aged , Humans , Neuralgia, Postherpetic/etiology , Neuralgia, Postherpetic/therapy , Pregabalin/therapeutic use , Prospective Studies , Pulsed Radiofrequency Treatment/adverse effects , Pulsed Radiofrequency Treatment/methods , Spinal Cord Stimulation/adverse effects , Spinal Cord Stimulation/methods , Treatment Outcome
Transpl Int ; 35: 10044, 2022.
Article En | MEDLINE | ID: mdl-35529595

Background: This study evaluated endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD) as interventions for patients with anastomotic biliary complications (ABC) after living donor liver transplantation (LDLT). Methods: Prospectively collected data of patients who were diagnosed with ABC after LDLT between January 2013 and June 2017 were retrospectively reviewed. Results: There were 57 patients who underwent LDLT with a right liver graft using duct-to-duct biliary reconstruction and experienced ABC. Among the patients with RAD involvement, there were no significant differences in the intervention success (p = 0.271) and patency rates (p = 0.267) between ERCP and PTBD. Similarly, among the patients with RPD involvement, there were no significant differences in the intervention success (p = 0.148) and patency rates (p = 0.754) between the two procedures. Graft bile duct variation (p = 0.013) and a large angle between the recipient and graft bile duct (R-G angle) (p = 0.012) significantly increased the likelihood of failure of ERCP in the RAD. When the R-G angle was greater than 47.5°, the likelihood of ERCP failure increased. Conclusion: We recommend PTBD when graft bile duct variation is presented in patients with RAD involvement and/or when the R-G angle is greater than 47.5°.

Liver Transplantation , Living Donors , Anastomosis, Surgical/adverse effects , Bile Ducts/surgery , Drainage/methods , Humans , Liver/surgery , Liver Transplantation/adverse effects , Liver Transplantation/methods , Postoperative Complications/diagnosis , Retrospective Studies , Treatment Outcome
Transpl Int ; 35: 10333, 2022.
Article En | MEDLINE | ID: mdl-35529597

Background and Aims: Morphometric features such as the Milan criteria serve as standard criteria for liver transplantation (LT) in patients with hepatocellular carcinoma (HCC). Since it has been recognized that these criteria are too restrictive and do not adequately display the tumor biology, additional selection parameters are emerging. Methods: Concise review of the current literature on patient selection for downstaging and LT for HCC outside the Milan criteria. Results: The major task in patients outside the Milan criteria is the need for higher granularity with patient selection, since the benefit through LT is not uniform. The recent literature clearly shows that beneath tumor size and number, additional selection parameters are useful in the process of patient selection for and during downstaging. For initial patient selection, the alpha fetoprotein (AFP) level adds additional information to the size and number of HCC nodules concerning the chance of successful downstaging and LT. This effect is quantifiable using newer selection tools like the WE (West-Eastern) downstaging criteria or the Metroticket 2.0 criteria. Also an initial PET-scan and/or tumor biopsy can be helpful, especially in the high risk group of patients outside the University of California San Francisco (UCSF) criteria. After this entry selection, the clinical course during downstaging procedures concerning the tumor and the AFP response is of paramount importance and serves as an additional final selection tool. Conclusion: Selection criteria for liver transplantation in HCC patients are becoming more and more sophisticated, but are still imperfect. The implementation of molecular knowledge will hopefully support a more specific risk prediction for HCC patients in the future, but do not provide a profound basis for clinical decision-making at present.

Carcinoma, Hepatocellular , Liver Neoplasms , Liver Transplantation , Carcinoma, Hepatocellular/pathology , Carcinoma, Hepatocellular/surgery , Humans , Liver Neoplasms/pathology , Liver Neoplasms/surgery , Liver Transplantation/adverse effects , Neoplasm Recurrence, Local , Neoplasm Staging , Patient Selection , Retrospective Studies , Treatment Outcome , alpha-Fetoproteins
Can J Gastroenterol Hepatol ; 2022: 7395506, 2022.
Article En | MEDLINE | ID: mdl-35531123

Objective: To assess the geographic distribution of HCV genotypes, effectiveness, and safety of DAA treatment for HCV-infected patients in North and Northeast China. Methods: The geographic distribution of HCV genotypes was analyzed in 2162 patients recruited from April 2018 to February 2021. Sustained virologic response rates at 12 (SVR12) or 24 (SVR24) weeks posttreatment and safety were analyzed in 405 patients who completed DAA treatment according to patient baseline characteristics and treatment. Results: Four genotypes and six subtypes were identified as follows: 1b (1187, 54.90%), 2a (790, 36.54%), 3a/b (134, 6.20%), 6a/n (44, 2.04%), mixed genotypes (2a-6a or 2a-3a) (7, 0.32%). Overall, 99.01% patients achieved SVR12, while 98.43% achieved SVR24. All patients treated with elbasvir/grazoprevir (EBR/GZR), sofosbuvir/velpatasvir ± ribavirin (SOF/VEL ± RBV), and SOF/ledipasvir (LDV) achieved SVR12 or SVR24; 92.86% SVR12 and 95.83% SVR24 were observed in patients using SOF + RBV. SVR12 was higher in noncirrhosis versus compensated cirrhosis patients (100% vs. 97.09%, p=0.022). No severe drug-related adverse event was observed. Conclusions: Genotypes 1b and 2a were dominant subtypes in North and Northeast China. The approved drug regimens EBR/GZR and SOF/LDV for subtype 1b and SOF/VEL for nongenotype 1b are the optimal effective and safety profile.

Antiviral Agents , Hepatitis C, Chronic , Antiviral Agents/adverse effects , Drug Therapy, Combination , Genotype , Hepacivirus/genetics , Hepatitis C, Chronic/drug therapy , Humans , Ribavirin/therapeutic use , Sofosbuvir/therapeutic use , Sustained Virologic Response , Treatment Outcome
Rom J Ophthalmol ; 66(1): 49-54, 2022.
Article En | MEDLINE | ID: mdl-35531458

Objective: Complex congenital nasolacrimal duct obstruction (CNLDO) is caused by pathologies other than the typical incomplete perforation of the thin membrane in the distal end of the nasolacrimal duct (NLD). Our purpose was to determine the success of silicone tube insertion for such complex CNLDO cases. Methods: Children who met the defined criteria for complex CNLDO and underwent monocanalicular silicone tube insertion between April 2016 and December 2020 were included. The tube was retained for 6-8 weeks and the final outcome was measured 3-4 months after tube removal. If the patients were totally symptom free, the outcome was recorded as complete success. Acceptable outcome was defined as Munk score ≤ 1 (requiring less than twice daily dabbing) and others were classified as failed. Results: Initially, 147 eyes of 132 patients underwent NLD intubation. However, after exclusion of the 11 cases with spontaneous tube extrusion (7.48%), 136 eyes of 121 patients entered the final analysis. The mean age was 23.9 ± 13.0 months (range 8-73 months). The outcome was complete success in 100 eyes (73.5%), acceptable in 16 (11.8%), and failure in 20 eyes (14.7%). The differences in the outcome of the procedure for the eyes based on history of previous probing and age was not statistically significant. Conclusions: NLD intubation with monocanalicular stent is effective in the resolution of complex CNLDO in 85% of cases. This procedure is associated with infrequent complications, like tube loss. The success is not negatively affected by older age and previously failed probing history. Abbreviations: CNLDO = congenital nasolacrimal duct obstruction, NLD = nasolacrimal duct.

Lacrimal Duct Obstruction , Nasolacrimal Duct , Child , Child, Preschool , Humans , Infant , Intubation, Intratracheal , Lacrimal Duct Obstruction/therapy , Nasolacrimal Duct/surgery , Retrospective Studies , Silicones , Treatment Outcome
Front Immunol ; 13: 845417, 2022.
Article En | MEDLINE | ID: mdl-35493516

P-cadherin is a cell-cell adhesion molecule that is overexpressed in several solid tumors. PF-06671008 is a T-cell-redirecting bispecific antibody that engages both P-cadherin on tumors and CD3ϵ on T cells and induces antitumor activity in preclinical models. We conducted a phase 1, open-label, first-in-human, dose-escalation study to characterize the safety and tolerability of PF-06671008, towards determining the recommended phase 2 dose. Adult patients with treatment-refractory solid tumors received PF-06671008 (1.5-400 ng/kg) as a weekly intravenous (IV) infusion on a 21-day/3-week cycle. Parallel cohorts evaluated dosing via subcutaneous injection (SC) or an IV-prime dose. Of the 27 patients enrolled in the study, 24 received PF-06671008 IV in escalating doses, two received SC, and one IV-prime. A dose-limiting toxicity of cytokine release syndrome (CRS) occurred in the 400-ng/kg IV group, prompting evaluation of SC and IV-prime schedules. In all, 25/27 patients who received PF-06671008 reported at least one treatment-related adverse event (TRAE); the most common were CRS (21/27), decreased lymphocyte count (9/27), and hypophosphatemia (8/27). Seven patients permanently discontinued treatment due to adverse events and no treatment-related deaths occurred. Cytokine peak concentrations and CRS grade appeared to positively correlate with Cmax. Although the study was terminated due to limited antitumor activity, it provides important insights into understanding and managing immune-related adverse events resulting from this class of molecules. Clinical Trial Registration: URL:, Identifier: NCT02659631.

Antibodies, Bispecific , Neoplasms , Adult , Antibodies, Bispecific/adverse effects , Cadherins , Humans , Neoplasms/drug therapy , Neoplasms/pathology , Treatment Outcome
Ann Ital Chir ; 93: 235-240, 2022.
Article En | MEDLINE | ID: mdl-35503057

OBJECTIVE: The present study aims to investigate the therapeutic effect and safety of radiofrequency ablation (RFA) of the great saphenous vein in the treatment of varicose veins of the lower extremities. METHODS: Sixty-nine affected limbs of 45 patients were treated with RFA of the great saphenous vein. All patients underwent retrograde puncture of the distal great saphenous vein under the guidance of B-ultrasound. An RFA catheter was introduced 1 cm below the junction of the great saphenous vein and the femoral vein. A tumescent solution was injected around the femoral vein, and the great saphenous vein was ablated section by section from the upper part to the lower part. Twelve months after RFA, color Doppler ultrasound was used to evaluate the closure of great saphenous vein, and changes in the clinical class, etiology, anatomy, pathology (CEAP) classification before and after treatment were compared. The visual analogue score (VAS) was used to evaluate the local pain on the first and third day after operation. The incidence of complications (e.g., phlebitis, thrombosis, infection) was also evaluated. RESULTS: The ablation of the 69 affected limbs in all the 45 patients was successful. Instant B-ultrasound revealed occlusion of the great saphenous vein and the disappearance of blood flow immediately after ablation. There was no reoccurrence in all patients at the 12 month follow-up. The CEAP classification grade after treatment was significantly lower than that before the treatment, and the difference was statistically significant (χ2 = 4.188, P<0.05). The VAS scores on the first and third days after operation were 1.85 ± 0.35 and 0.59 ± 0.21, respectively. Pain was mild, and only two patients required painkillers. No complications were noted, with the exception of five cases of local ecchymosis. CONCLUSION: RFA of the great saphenous vein may represent an effective method for treating varicose veins of the lower extremities. RFA has the advantages of producing less trauma, fewer complications, and a lower incidence of recurrence. KEY WORDS: B-ultrasonography, Pain, Radiofrequency ablation, Varicose veins.

Radiofrequency Ablation , Varicose Veins , Venous Insufficiency , Femoral Vein , Humans , Lower Extremity , Pain/etiology , Radiofrequency Ablation/adverse effects , Saphenous Vein/diagnostic imaging , Saphenous Vein/surgery , Treatment Outcome , Varicose Veins/diagnostic imaging , Varicose Veins/etiology , Varicose Veins/surgery , Venous Insufficiency/surgery