Therapeutics and Clinical Risk Management最新文献

{"title":"Safety of Early Discharge Among Low-Risk Patients After Primary Percutaneous Coronary Intervention: An Updated Systematic Review and Meta-Analysis","authors":"Firman Sugiharto, Yanny Trisyani, Aan Nuraeni, Praneed Songwathana","doi":"10.2147/tcrm.s451598","DOIUrl":"https://doi.org/10.2147/tcrm.s451598","url":null,"abstract":"<strong>Background:</strong> Guidelines for early discharge (ED) strategies after primary percutaneous coronary intervention (PPCI) in low-risk patients still need to be informed. Previous meta-analysis evidence is considered to have limitations, from the level of heterogeneity, which is still relatively high, and the sample size still needed to be more significant.<br/><strong>Purpose:</strong> This study aims to identify the safety of early discharge after PPCI in low-risk patients<br/><strong>Methods:</strong> The literature search used five primary databases: CINAHL, PubMed, ScienceDirect, Scopus, Taylor and Francis, and one search engine: Google Scholar. Two reviewers independently screened and critically appraised studies using JBI’s and Cochrane’s Risk of Bias tool. Fixed and random effects model were applied to collect standardized mean differences and risk differences. Statistical analysis was performed using Review Manager 5.3 and JAMOVI version 2.4.8.0.<br/><strong>Results:</strong> Seven RCTs consisting of 1.780 patients and seven cohort studies consisting of 46.710 patients were included in the quantitative analysis. The results of the RCT analysis showed no significant differences in all-cause readmission (RD − 0.01; 95% CI: − 0.04 to 0.01; Z=1.20; <em>p</em>=0.23; I²=0%) and mortality (RD 0.00; 95% CI: − 0.01 to 0.01; Z=0.01; <em>p</em>=0.99; I²=0%) and also significant in reducing LOS in hour (SMD − 2.32; 95% CI: − 3.13 to − 1.51; Z=5.64; <em>p</em>&lt; 0.001; I²=93%) and day (SMD − 0.58; 95% CI: - 1.00 to − 0.17; Z=2.76; <em>p</em>=0.006; I²=84%). In addition, analysis of cohort studies showed that ED strategy was associated with all-cause readmission (RD − 0.00; 95% CI: − 0.01 to − 0.00; Z =2.18; <em>p</em>=0.03; I²=0%) and mortality (RD − 0.01; 95% CI: − 0.02 to − 0.00; Z=2.04; <em>p</em>=0.04; I²=94%).<br/><strong>Conclusion:</strong> ED strategies in low-risk patients after PPCI can be completely safe. This is proven by the absence of significant differences in readmission and mortality rates as well as reduce the length of stay.<br/><br/>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140044270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors of Chylothorax After Congenital Heart Surgery in Infants: A Single-Centre Retrospective Study","authors":"Rui-Gui Zhang, Yu-Mei Liu, Zhi-Ye Yao, Jing-Xuan Fang, Yuan Li, Man-Li Zheng, Xin Sun, Shu-Sheng Wen, Xi-Meng Wang, Jian Zhuang, Dan-Dong Luo, Shao-Ru He","doi":"10.2147/tcrm.s436991","DOIUrl":"https://doi.org/10.2147/tcrm.s436991","url":null,"abstract":"<strong>Background:</strong> Studies of chylothorax after congenital heart disease in infants are rare. Chylothorax has a higher incidence in infancy, but its risk factors are not well understood.<br/><strong>Objective:</strong> The purpose of this study is to investigate the risk factors of chylothorax after congenital heart surgery in infants.<br/><strong>Methods:</strong> This retrospective study included 176 infants who underwent congenital heart disease surgery at the Guangdong Cardiovascular Institute, China, between 2016 and 2020. According to the occurrence of chylothorax, the patients were divided into a control group (n = 88) and a case group (n = 88). Univariate and multivariate logistic regression were performed to analyse the incidence and influencing factors of chylothorax after congenital heart surgery in infants.<br/><strong>Results:</strong> Between 2016 and 2020, the annual incidence rate fluctuated between 1.55% and 3.17%, and the total incidence of chylothorax was 2.02%. Multivariate logistic regression analysis showed that postoperative albumin (<em>p</em> = 0.041; odds ratio [OR] = 0.095), preoperative mechanical ventilation (<em>p</em> = 0.001; OR = 1.053) and preterm birth (<em>p</em> = 0.002; OR = 5.783) were risk factors for postoperative chylothorax in infants with congenital heart disease.<br/><strong>Conclusion:</strong> The total incidence of chylothorax was 2.02% and the annual incidence rate fluctuated between 1.55% and 3.17% between 2016 and 2020. Premature infants, longer preoperative mechanical ventilation and lower albumin after congenital heart surgery may be risk factors for chylothorax. In addition, infants with chylothorax are inclined to be infected, need more respiratory support, use a chest drainage tube for longer and remain longer in hospital.<br/><br/>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140036912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Pharmacokinetic Effects of Herbal Medicines on Escitalopram","authors":"Yun Seob Jung, Byung Hak Jin, Ju Eun Choi, Min Soo Park, Young-Woo Kim, Hyung Won Kang, Sunyoung Cho, Choon Ok Kim","doi":"10.2147/tcrm.s448090","DOIUrl":"https://doi.org/10.2147/tcrm.s448090","url":null,"abstract":"<strong>Purpose:</strong> Herbal medicines are occasionally used in combination with conventional antidepressants to mitigate various depression-associated symptoms. However, there is limited information on herb–antidepressant interactions. In this study, we investigated the pharmacokinetic (PK) effects of four herbal medicines (Gami-soyosan, Banhasasim-tang, Ojeok-san, and Bojungikgi-tang) on escitalopram, a commonly used antidepressant.<br/><strong>Patients and Methods:</strong> In this open-label, fixed-sequence, three-period, crossover study, 18 participants were enrolled and divided into two groups. Each group received a 10 mg oral dose of escitalopram in period 1. Participants took escitalopram once daily and their assigned herbal medicines thrice a day for 7 d in periods 2 (group 1: Gami-soyosan, group 2: Ojeok-san) and 3 (group 1: Banhasasim-tang; group 2: Bojungikgi-tang). The primary endpoints were C_max,ss and AUC_tau,ss of escitalopram. C_max,ss and AUC_tau,ss in period 1 were obtained using nonparametric superposition from single-dose data. The PK endpoints were classified according to the CYP2C19 phenotype.<br/><strong>Results:</strong> Of 18 participants, 16 completed the study. Systemic exposure to escitalopram resulted in a minor increase in the presence of each herbal medicine. The geometric mean ratios (GMRs, combination with herbal medicines/escitalopram monotherapy) and their 90% confidence intervals (CIs) for C_max,ss and AUC_tau,ss were as follows: Gamisoyosan– 1.1454 (0.9201, 1.4258) and 1.0749 (0.8084, 1.4291), Banhasasim-tang– 1.0470 (0.7779, 1.4092) and 1.0465 (0.7035, 1.5568), Ojeok-san– 1.1204 (0.8744, 1.4357) and 1.1267 (0.8466, 1.4996), and Bojungikgi-tang– 1.1264 (0.8594, 1.4762) and 1.1400 (0.8515, 1.5261), respectively. Furthermore, no significant differences in the GMRs of C_max,ss and AUC_tau,ss were observed across different CYP2C19 phenotypes in any of the groups.<br/><strong>Conclusion:</strong> The co-administration of escitalopram with Gami-soyosan, Banhasasim-tang, Ojeok-san, or Bojungikgi-tang did not exert significant PK effects on escitalopram. These findings provide valuable insights into the safe use of herbal medicines along with escitalopram.<br/><br/><strong>Keywords:</strong> CYP2C19 phenotype, herb–drug interaction, antidepressant, geometric mean ratio<br/>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139969524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Classification and Regression Tree Predictive Model for Acute Kidney Injury in Traumatic Brain Injury Patients","authors":"Ruoran Wang, Jing Zhang, Min He, Jianguo Xu","doi":"10.2147/tcrm.s435281","DOIUrl":"https://doi.org/10.2147/tcrm.s435281","url":null,"abstract":"<strong>Background:</strong> Acute kidney injury (AKI) is prevalent in hospitalized patients with traumatic brain injury (TBI), and increases the risk of poor outcomes. We designed this study to develop a visual and convenient decision-tree-based model for predicting AKI in TBI patients.<br/><strong>Methods:</strong> A total of 376 patients admitted to the emergency department of the West China Hospital for TBI between January 2015 and June 2019 were included. Demographic information, vital signs on admission, laboratory test results, radiological signs, surgical options, and medications were recorded as variables. AKI was confirmed since the second day after admission, based on the Kidney Disease Improving Global Outcomes criteria. We constructed two predictive models for AKI using least absolute shrinkage and selection operator (LASSO) regression and classification and regression tree (CART), respectively. Receiver operating characteristic (ROC) curves of these two predictive models were drawn, and the area under the ROC curve (AUC) was calculated to compare their predictive accuracy.<br/><strong>Results:</strong> The incidence of AKI on the second day after admission was 10.4% among patients with TBI. Lasso regression identified five potent predictive factors for AKI: glucose, serum creatinine, cystatin C, serum uric acid, and fresh frozen plasma transfusions. The CART analysis showed that glucose, serum uric acid, and cystatin C ranked among the top three in terms of the feature importance of the decision tree model. The AUC value of the decision-tree predictive model was 0.892, which was higher than the 0.854 of the LASSO regression model, although the difference was not statistically significant.<br/><strong>Conclusion:</strong> The decision tree model is valuable for predicting AKI among patients with TBI. This tree-based flowchart is convenient for physicians to identify patients with TBI who are at high risk of AKI and prompts them to develop suitable therapeutic strategies.<br/><br/>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139926862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Descemetic Deep Anterior Lamellar Keratoplasty versus Penetrating Keratoplasty in Advanced Keratoconus: Comparison of Visual and Refractive Outcomes","authors":"Leopoldo Spadea, Lucia Di Genova, Edoardo Trovato Battagliola, Stefano Scordari","doi":"10.2147/tcrm.s441577","DOIUrl":"https://doi.org/10.2147/tcrm.s441577","url":null,"abstract":"<strong>Purpose:</strong> To assess and contrast the visual and refractive results of Descemetic deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) in the treatment of advanced keratoconus.<br/><strong>Design:</strong> Retrospective, comparative, interventional study.<br/><strong>Methods:</strong> This study enrolled eyes affected by keratoconus with preoperative mean keratometry ≥ 60 diopters (D) that were treated with either Descemetic DALK (30 eyes) or PK (29 eyes) by using always the same corneal diameters (8.00mm recipient; 8.25mm donor cornea) and the same suture technique (10– 0 nylon double-running 12-bites continuous suture). The outcome measures were postoperative uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (CDVA), subjective refractive astigmatism (SRAst), and keratometric astigmatism at 3mm area (SimK), spherical equivalent (SEq).<br/><strong>Results:</strong> Postoperative visual acuity significantly improved in both groups. Mean CDVA was higher in the DALK group 3 months (DALK 0.61, PK 0.42, p&lt; 0.05), 6 months (DALK 0.69, PK 0.44, p&lt; 0.05), and 12 months (DALK 0.72, PK 0.45, p&lt; 0.05) postoperatively. However, 6 months after suture removal, CDVA was not statistically different between the two groups (DALK 0.71, PK 0.75, p&gt; 0.05). Final SRAst and SimK also were comparable between the two groups (respectively DALK 2.97, PK:2.81, p&gt; 0.05; DALK 3.91, PK 2.37, p&gt; 0.05). No significant statistical differences were noted for UCVA and SEq data during the entire follow-up period between the two groups.<br/><strong>Conclusion:</strong> Both methods of corneal transplantation resulted in a notable enhancement of visual and refractive outcomes in eyes afflicted by advanced keratoconus. Descemetic DALK demonstrated superior visual acuity before suture removal, whereas DALK and PK exhibited comparable results in terms of visual acuity, refractive correction, and keratometric astigmatism after suture removal.<br/><br/><strong>Keywords:</strong> astigmatism, corneal topography, descemetic dalk, keratoconus, PK<br/>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139760024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in the Early Diagnosis and Treatment of Chronic Inflammatory Demyelinating Polyradiculoneuropathy in Adults: Current Perspectives","authors":"Iris N van Doorn, Filip Eftimov, Luuk Wieske, Ivo N van Schaik, Camiel Verhamme","doi":"10.2147/tcrm.s360249","DOIUrl":"https://doi.org/10.2147/tcrm.s360249","url":null,"abstract":"<strong>Abstract:</strong> Diagnosing Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) poses numerous challenges. The heterogeneous presentations of CIDP variants, its mimics, and the complexity of interpreting electrodiagnostic criteria are just a few of the many reasons for misdiagnoses. Early recognition and treatment are important to reduce the risk of irreversible axonal damage, which may lead to permanent disability. The diagnosis of CIDP is based on a combination of clinical symptoms, nerve conduction study findings that indicate demyelination, and other supportive criteria. In 2021, the European Academy of Neurology (EAN) and the Peripheral Nerve Society (PNS) published a revision on the most widely adopted guideline on the diagnosis and treatment of CIDP. This updated guideline now includes clinical and electrodiagnostic criteria for CIDP variants (previously termed atypical CIDP), updated supportive criteria, and sensory criteria as an integral part of the electrodiagnostic criteria. Due to its many rules and exceptions, this guideline is complex and misinterpretation of nerve conduction study findings remain common. CIDP is treatable with intravenous immunoglobulins, corticosteroids, and plasma exchange. The choice of therapy should be tailored to the individual patient’s situation, taking into account the severity of symptoms, potential side effects, patient autonomy, and past treatments. Treatment responses should be evaluated as objectively as possible using disability and impairment scales. Applying these outcome measures consistently in clinical practice aids in recognizing the effectiveness (or lack thereof) of a treatment and facilitates timely consideration of alternative diagnoses or treatments. This review provides an overview of the current perspectives on the diagnostic process and first-line treatments for managing the disease.<br/><br/><strong>Keywords:</strong> CIDP, treatment, diagnosis, NCS, imaging<br/>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139759956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectivity of Virtual Reality to Improve Balance, Motor Function, Activities of Daily Living, and Upper Limb Function in Children with Cerebral Palsy: A Systematic Review and Meta-Analysis","authors":"Maria Komariah, Shakira Amirah, Muhammad Fahd Abdurrahman, Mohammad Farrel Shaquille Handimulya, Hesti Platini, Sidik Maulana, Annisa Dewi Nugrahani, Aep Maulid Mulyana, Shurouq Ghalib Qadous, Henny Suzana Mediani, Arpit Mago","doi":"10.2147/tcrm.s432249","DOIUrl":"https://doi.org/10.2147/tcrm.s432249","url":null,"abstract":"<strong>Background:</strong> Cerebral palsy (CP) is the most common motor disorder in childhood. CP limits movement, which can interfere with children’s daily activities. As a technology that provides intensive mass practice to children, virtual reality (VR) can create an interactive and motivating environment. With the intensity set by the therapist and feedback that can be used to produce individualized therapy, VR has great potential to improve CP patients’ quality of life, especially in a safe, enjoyable, and playful environment.<br/><strong>Purpose:</strong> This systematic review and meta-analysis sought to determine the effectiveness of VR for children with CP.<br/><strong>Methods:</strong> We conducted a comprehensive literature search based on the PRISMA guidelines through PubMed, Scopus, Embase, Wiley, and ProQuest to assess the efficacy of VR in managing children with CP up to 15 September 2022. Risk assessment of bias was performed using Cochrane RoB 2.<br/><strong>Results:</strong> Nineteen randomized controlled trials with 467 and 427 patients with CP were included in the intervention and control groups in qualitative and quantitative analyses. Participants consisted of cerebral palsy with hemiplegia (n=7), diplegia (n=2), a combination of both (n=4), and undefined (n=13). From all studies conducted, VR showed significant results where VR could improve balance (MD: 2.71[1.95, 3.48]; p &lt; 0.00001), motor function (MD: 3.73 [1.67, 5.79]; p = 0.0004), and activity daily living (MD: 10.05 [2.89, 17.22]. However, VR showed not effective in improving upper limb function.<br/><strong>Conclusion:</strong> With its advantages and excellent effectiveness, VR may improve functional mobility and the quality of life of children with CP.<br/><br/>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139759963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acthar Gel in African Americans versus Non-African Americans with Symptomatic Sarcoidosis: Physician Assessment of Patient Medical Records.","authors":"Jas Bindra, Ishveen Chopra, Kyle Hayes, John Niewoehner, Mary Prince Panaccio, George J Wan","doi":"10.2147/TCRM.S438174","DOIUrl":"10.2147/TCRM.S438174","url":null,"abstract":"<p><strong>Introduction: </strong>Sarcoidosis is common among African Americans in the United States. Acthar^® Gel is a viable option for the treatment of advanced symptomatic sarcoidosis. This study examined patient characteristics, Acthar Gel utilization, co-medication use, and treatment response based on physicians' assessments among African Americans versus non-African Americans with advanced symptomatic sarcoidosis.</p><p><strong>Methods: </strong>Data from the medical charts of patients were used. During data collection, patients had either completed ≥1 course or received treatment with Acthar Gel for ≥6 months.</p><p><strong>Results: </strong>This study comprised 168 African Americans and 104 non-African Americans. On average, the time since the first diagnosis of sarcoidosis was slightly longer among African Americans than non-African Americans (5.2 versus 4.3 years). Skin, heart, eyes, and joints were the most common extrapulmonary sites involved among both race groups. Shortness of breath, fatigue, bone and joint pain, and wheezing/coughing were the most frequent symptoms among both race groups. A higher proportion of African Americans versus non-African Americans were first-time Acthar Gel users and had not completed treatment during data collection. Patients in both race groups with higher starting doses of Acthar Gel therapy had a shorter treatment duration and vice-versa. A significantly lower proportion of patients among both race groups were on any co-medication after Acthar Gel initiation (p<0.0001). Further, a higher proportion of African Americans versus non-African Americans had a reduction in any co-medication use after Acthar Gel initiation. The mean daily dose of prednisone decreased among African Americans (18.5 to 10.1 mg) and non-African Americans (17.6 to 10.0 mg) after Acthar Gel initiation. Improvement in patient health status and overall symptoms was similar for both race groups.</p><p><strong>Conclusion: </strong>Findings suggest that Acthar Gel improves health outcomes for patients with sarcoidosis, which could help to alleviate health disparities among African Americans, who are disproportionately affected by this disease.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10863497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139730534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally Invasive Treatment of Chyle Leak After Thyroidectomy and Cervical Lymph Node Dissection in Patients with Thyroid Carcinoma: Results of a Study Involving 36 Patients.","authors":"Nguyen Ngoc Cuong, Le Hoan, Thieu Thi Tra My, Doan Tien Luu, Le Tuan Linh, Pham Hong Canh, Trieu Quoc Tinh, Tran Nguyen Khanh Chi, Nguyen Quang Trung, Tran Quoc Hoa","doi":"10.2147/TCRM.S446113","DOIUrl":"10.2147/TCRM.S446113","url":null,"abstract":"<p><strong>Objective: </strong>Chyle leak (CL) after head and neck surgery is a rare but well-known complication. In patients with high-output leakage, the treatment can be complicated. This study aims to report on a recent innovation in lymphatic intervention for treating such patients.</p><p><strong>Materials and methods: </strong>A retrospective review of 36 patients with chyle leak after neck surgery for thyroid cancer was conducted to assess the efficacy of percutaneous lymphatic embolization and thoracic duct (TD) disruption.</p><p><strong>Results: </strong>Antegrade catheterization of the thoracic duct was achieved in 31 of 36 patients (86.1%). Therefore, embolization of the thoracic duct and thoracic duct branches was performed in 26 and 5 patients, respectively. In 5 cases of unsuccessful antegrade catheterization into the thoracic duct, transcervical access embolization was performed in 2 patients, and TD disruption (TDD) was performed in 3 patients. The pooled overall technical success rate of lymphatic embolization was 33/36 patients (91.7%). One patient who underwent thoracic duct embolization (TDE) with technical success (1/33 patients) but clinical failure had additional treatment directly sclerosing the TD under computed tomography scan. Cervical fluid collection sclerotherapy was done in 7 patients as an additional treatment. Resolution of the chyle leak after procedures was observed in all patients (100%). The mean time to resolution was 3 days (1-7 days). There was no complication intra and after procedures.</p><p><strong>Conclusion: </strong>TDE, selective TD branches embolization and TDD are safe and effective minimally invasive treatments for CL post-surgery for thyroid carcinoma. Sclerosing cervical fluid collection contributes to clinical success.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10863455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139730535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment Patterns and <i>FLT3</i> Mutation Testing Among Patients with Acute Myeloid Leukemia in China: A Retrospective Observational Study.","authors":"Benfa Gong, Li-Jen Cheng, Christopher H Young, Prabhuram Krishnan, Ying Wang, Hui Wei, Chunlin Zhou, Shuning Wei, Yan Li, Qiuyun Fang, Jia Zhong, Eric Q Wu, Yingchang Mi, Jianxiang Wang","doi":"10.2147/TCRM.S434556","DOIUrl":"10.2147/TCRM.S434556","url":null,"abstract":"<p><strong>Introduction: </strong>For acute myeloid leukemia (AML), prognosis is particularly poor in patients harboring FMS-like tyrosine kinase 3 (<i>FLT3</i>) gene mutations, though routine screening for these mutations at diagnosis has been shown to be insufficient. The understanding of the impact of <i>FLT3</i> mutations on treatment decisions is limited.</p><p><strong>Methods: </strong>In this retrospective, observational study, we investigated the key epidemiological characteristics, treatment patterns and responses among adult patients with newly diagnosed (ND) AML in China, who initiated treatment from January 1, 2015, to December 31, 2019, or progressed to relapsed/refractory (R/R) AML by December 31, 2020.</p><p><strong>Results: </strong>Of the 853 ND AML patients included, 63.4% were screened for <i>FLT3</i> status, and 20.1% tested positive (<i>FLT3</i>^MUT) at initial diagnosis. Of 289 patients who progressed to R/R AML during the study period, 24.9% were screened at the diagnosis of R/R AML, and 19.4% tested positive; 20.5% of screened patients changed <i>FLT3</i> status at first diagnosis of R/R AML. Initial treatment regimens or treatment responses did not seem to differ in patients with ND AML by <i>FLT3</i> mutation status. In patients with R/R AML, there was an apparent difference in second-line treatment choices by <i>FLT3</i> mutation status; however, the number of <i>FLT3</i>-mutated patients were limited to demonstrate any meaningful distinction. <i>FLT3</i>-mutated R/R AML was associated with shorter relapse time.</p><p><strong>Conclusion: </strong>Study findings showed that there was a lack of routine testing for <i>FLT3</i> mutations at first diagnosis of R/R AML, and initial treatment decisions did not differ by <i>FLT3</i> mutation status. Given the clinical burden of <i>FLT3</i>^MUT, likelihood of <i>FLT3</i> status changes, and emerging FLT3 inhibitors, further routine <i>FLT3</i> screening is needed to optimize treatment of R/R AML.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10861151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}