Anastrozole shows greater carryover effects compared with tamoxifen and resolution of fracture risk post-treatment – data from ATAC at 100 months' median follow-up

Abstract Background Patients with cardiovascular diseases (CVD) are treated over a long period of time by physicians and therapists from various institutions collaborating within a multidisciplinary team. Usually, medical records detailing the diagnoses and treatment regimens are long and extensive. Brief overviews of relevant diagnostic and treatment data in the form of a patient passport are currently missing in routine care for patients with CVD. This study aimed to develop and evaluate a patient passport (the Kardio-Pass) based on the needs of patients who had undergone cardiac rehabilitation, and of healthcare professionals. Methods A mixed method design was adopted consisting of an explorative qualitative phase followed by a quantitative evaluation phase. Interviews with patients and experts were conducted to develop the Kardio-Pass. CVD rehabilitees (N = 150) were asked to evaluate the passport using a semi-standardized written questionnaire. Results Patients and experts who were interviewed in the qualitative study phase considered the following passport contents to be particularly important: documentation of findings and diagnoses, cardiac diagnostics and intervention, medication plan, risk factors for heart disease, signs of a heart attack and what to do in an emergency. During the evaluation phase, 93 rehabilitees (response rate: 62%) completed the questionnaire. The Kardio-Pass achieved high overall approval: All respondents considered the information contained in the passport to be trustworthy. The professionalism and the design of the passport were rated very highly by 93 and 92% of participants, respectively. Use of the Kardio-Pass prompted 53% of participants to regularly attend follow-up appointments. The most common reasons for non-use were a lack of support from the attending doctor, failure by the patient to make entries in the passport, and loss of the passport. Conclusions By documenting the course of cardiac diseases, the patient passport pools all medical data–from diagnosis to treatment and aftercare–in a concise manner. Rehabilitees who used the cardiac passport rated it as a helpful tool for documenting follow-up data. However, with regard to this explorative study there is a need for further research, particularly on whether the patient passport can improve heart patient care.

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349 Cognitive Behavioral Therapy for Insomnia in Patients with Chronic Pain - A Systematic Review and Meta-Analysis

SLEEP ◽

10.1093/sleep/zsab072.348 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A139-A140

Author(s):

Janannii Selvanathan ◽

Chi Pham ◽

Mahesh Nagappa ◽

Philip Peng ◽

Marina Englesakis ◽

...

Keyword(s):

Systematic Review ◽

Cognitive Behavioral Therapy ◽

Cancer Pain ◽

Behavioral Therapy ◽

Meta Analysis ◽

Post Treatment ◽

Cognitive Behavioral ◽

Comorbid Insomnia ◽

Patient Reported

Abstract Introduction Patients with chronic non-cancer pain often report insomnia as a significant comorbidity. Cognitive behavioral therapy for insomnia (CBT-I) is recommended as the first line of treatment for insomnia, and several randomized controlled trials (RCTs) have examined the efficacy of CBT-I on various health outcomes in patients with comorbid insomnia and chronic non-cancer pain. We conducted a systematic review and meta-analysis on the effectiveness of CBT-I on sleep, pain, depression, anxiety and fatigue in adults with comorbid insomnia and chronic non-cancer pain. Methods A systematic search was conducted using ten electronic databases. The duration of the search was set between database inception to April 2020. Included studies must be RCTs assessing the effects of CBT-I on at least patient-reported sleep outcomes in adults with chronic non-cancer pain. Quality of the studies was assessed using the Cochrane risk of bias assessment and Yates quality rating scale. Continuous data were extracted and summarized using standard mean difference (SMD) with 95% confidence intervals (CIs). Results The literature search resulted in 7,772 articles, of which 14 RCTs met the inclusion criteria. Twelve of these articles were included in the meta-analysis. The meta-analysis comprised 762 participants. CBT-I demonstrated a large significant effect on patient-reported sleep (SMD = 0.87, 95% CI [0.55–1.20], p < 0.00001) at post-treatment and final follow-up (up to 9 months) (0.59 [0.31–0.86], p < 0.0001); and moderate effects on pain (SMD = 0.20 [0.06, 0.34], p = 0.006) and depression (0.44 [0.09–0.79], p= 0.01) at post-treatment. The probability of improving sleep and pain following CBT-I at post-treatment was 81% and 58%, respectively. The probability of improving sleep and pain at final follow-up was 73% and 57%, respectively. There were no statistically significant effects on anxiety and fatigue. Conclusion This systematic review and meta-analysis showed that CBT-I is effective for improving sleep in adults with comorbid insomnia and chronic non-cancer pain. Further, CBT-I may lead to short-term moderate improvements in pain and depression. However, there is a need for further RCTs with adequate power, longer follow-up periods, CBT for both insomnia and pain, and consistent scoring systems for assessing patient outcomes. Support (if any):

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Relationship between metamorphopsia and inner retinal microstructure following intravitreal ranibizumab injection for branch retinal vein occlusion

Scientific Reports ◽

10.1038/s41598-021-84038-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yoshimi Sugiura ◽

Fumiki Okamoto ◽

Tomoya Murakami ◽

Shohei Morikawa ◽

Takahiro Hiraoka ◽

...

Keyword(s):

Macular Edema ◽

Retinal Vein Occlusion ◽

Branch Retinal Vein Occlusion ◽

Post Treatment ◽

Intravitreal Ranibizumab ◽

Vein Occlusion ◽

Treatment Naïve ◽

Pre Treatment ◽

Number Of Injections

AbstractTo evaluate the effects of intravitreal ranibizumab injection (IVR) on metamorphopsia in patients with branch retinal vein occlusion (BRVO), and to assess the relationship between metamorphopsia and inner retinal microstructure and other factors. Thirty-three treatment-naïve eyes of 33 patients with macular edema caused by BRVO with at least 12 months of follow-up were included. The degree of metamorphopsia was quantified using the M-CHARTS. Retinal microstructure was assessed with spectral-domain optical coherence tomography. Disorganization of the retinal inner layers (DRIL) at the first month after resolution of the macular edema (early DRIL) and at 12 months after treatment (after DRIL) was studied. Central retinal thickness (CRT), and status of the external limiting membrane as well as ellipsoid zone were also evaluated. IVR treatment significantly improved best-corrected visual acuity (BCVA) and CRT, but the mean metamorphopsia score did not improve even after 12 months. Post-treatment metamorphopsia scores showed a significant correlation with pre-treatment metamorphopsia scores (P < 0.005), the extent of early DRIL (P < 0.05) and after DRIL (P < 0.05), and the number of injections (P < 0.05). Multivariate analysis revealed that the post-treatment mean metamorphopsia score was significantly correlated with the pre-treatment mean metamorphopsia score (P < 0.05). IVR treatment significantly improved BCVA and CRT, but not metamorphopsia. Post-treatment metamorphopsia scores were significantly associated with pre-treatment metamorphopsia scores, the extent of DRIL, and the number of injections. Prognostic factor of metamorphopsia was the degree of pre-treatment metamorphopsia.

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MDCT-Based Finite Element Analyses: Are Measurements at the Lumbar Spine Associated with the Biomechanical Strength of Functional Spinal Units of Incidental Osteoporotic Fractures along the Thoracolumbar Spine?

Diagnostics ◽

10.3390/diagnostics11030455 ◽

2021 ◽

Vol 11 (3) ◽

pp. 455

Author(s):

Nico Sollmann ◽

Nithin Manohar Rayudu ◽

Long Yu Yeung ◽

Anjany Sekuboyina ◽

Egon Burian ◽

...

Keyword(s):

Finite Element ◽

Lumbar Spine ◽

Fracture Risk ◽

Thoracolumbar Spine ◽

Areal Bone Mineral Density ◽

Mineral Density ◽

Osteoporotic Vertebral Fractures ◽

The Mean ◽

Biomechanical Strength

Assessment of osteoporosis-associated fracture risk during clinical routine is based on the evaluation of clinical risk factors and T-scores, as derived from measurements of areal bone mineral density (aBMD). However, these parameters are limited in their ability to identify patients at high fracture risk. Finite element models (FEMs) have shown to improve bone strength prediction beyond aBMD. This study aims to investigate whether FEM measurements at the lumbar spine can predict the biomechanical strength of functional spinal units (FSUs) with incidental osteoporotic vertebral fractures (VFs) along the thoracolumbar spine. Multi-detector computed tomography (MDCT) data of 11 patients (5 females and 6 males, median age: 67 years) who underwent MDCT twice (median interval between baseline and follow-up MDCT: 18 months) and sustained an incidental osteoporotic VF between baseline and follow-up scanning were used. Based on baseline MDCT data, two FSUs consisting of vertebral bodies and intervertebral discs (IVDs) were modeled: one standardly capturing L1-IVD–L2-IVD–L3 (FSU_L1–L3) and one modeling the incidentally fractured vertebral body at the center of the FSU (FSU_F). Furthermore, volumetric BMD (vBMD) derived from MDCT, FEM-based displacement, and FEM-based load of the single vertebrae L1 to L3 were determined. Statistically significant correlations (adjusted for a BMD ratio of fracture/L1–L3 segments) were revealed between the FSU_F and mean load of L1 to L3 (r = 0.814, p = 0.004) and the mean vBMD of L1 to L3 (r = 0.745, p = 0.013), whereas there was no statistically significant association between the FSU_F and FSU_L1–L3 or between FSU_F and the mean displacement of L1 to L3 (p > 0.05). In conclusion, FEM measurements of single vertebrae at the lumbar spine may be able to predict the biomechanical strength of incidentally fractured vertebral segments along the thoracolumbar spine, while FSUs seem to predict only segment-specific fracture risk.

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Translating Virtual Reality Cue Exposure Therapy for Binge Eating into a Real-World Setting: An Uncontrolled Pilot Study

Journal of Clinical Medicine ◽

10.3390/jcm10071511 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1511

Author(s):

Katherine Nameth ◽

Theresa Brown ◽

Kim Bullock ◽

Sarah Adler ◽

Giuseppe Riva ◽

...

Keyword(s):

Virtual Reality ◽

Eating Disorder ◽

Binge Eating ◽

Real World ◽

Exposure Therapy ◽

Post Treatment ◽

Cue Exposure ◽

Treatment Gains ◽

Intent To Treat

Binge-eating disorder (BED) and bulimia nervosa (BN) have adverse psychological and medical consequences. Innovative interventions, like the integration of virtual reality (VR) with cue-exposure therapy (VR-CET), enhance outcomes for refractory patients compared to cognitive behavior therapy (CBT). Little is known about the feasibility and acceptability of translating VR-CET into real-world settings. To investigate this question, adults previously treated for BED or BN with at least one objective or subjective binge episode/week were recruited from an outpatient university eating disorder clinic to receive up to eight weekly one-hour VR-CET sessions. Eleven of 16 (68.8%) eligible patients were enrolled; nine (82%) completed treatment; and 82% (9/11) provided follow-up data 7.1 (SD = 2.12) months post-treatment. Overall, participant and therapist acceptability of VR-CET was high. Intent-to-treat objective binge episodes (OBEs) decreased significantly from 3.3 to 0.9/week (p < 0.001). Post-treatment OBE 7-day abstinence rate for completers was 56%, with 22% abstinent for 28 days at follow-up. Among participants purging at baseline, episodes decreased from a mean of one to zero/week, with 100% abstinence maintained at follow-up. The adoption of VR-CET into real-world clinic settings appears feasible and acceptable, with a preliminary signal of effectiveness. Findings, including some loss of treatment gains during follow-up may inform future treatment development.

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Evaluation of microscopy, serology, circulating anodic antigen (CAA), and eosinophil counts for the follow-up of migrants with chronic schistosomiasis: a prospective cohort study

Parasites & Vectors ◽

10.1186/s13071-021-04655-z ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Francesca Tamarozzi ◽

Tamara Ursini ◽

Pytsje T. Hoekstra ◽

Ronaldo Silva ◽

Cecilia Costa ◽

...

Keyword(s):

Post Treatment ◽

Endemic Country ◽

Active Infection ◽

Positive Serology ◽

Praziquantel Treatment ◽

Positive Urine ◽

Antibody Titers ◽

Eosinophil Counts ◽

Sera Samples

Abstract Background An accurate test for the diagnosis and post-treatment follow-up of patients with schistosomiasis is needed. We assessed the performance of different laboratory parameters, including the up-converting reporter particle technology lateral flow assay to detect circulating anodic antigen (UCP-LF CAA), for the post-treatment follow-up of schistosomiasis in migrants attending a dedicated outpatient clinic in a non-endemic country. Methods Routine anti-Schistosoma serology results and eosinophil counts were obtained of patients with positive urine/stool microscopy and/or PCR (confirmed cases) or only positive serology (possible cases), and at least one follow-up visit at 6 (T6) or 12 (T12) months after praziquantel treatment. All sera samples were tested with the UCP-LF CAA assay. Results Forty-eight patients were included, 23 confirmed and 25 possible cases. The percentage seropositivity and median antibody titers did not change significantly during follow-up. UCP-LF CAA was positive in 86.9% of confirmed and 20% of possible cases. The percentage positivity and median CAA levels decreased significantly post-treatment, with only two patients having positive CAA levels at T12. Conclusions The UCP-LF CAA assay proved useful for the diagnosis of active infection with Schistosoma spp. and highly valuable for post-treatment monitoring in migrants, encouraging the development of a commercial test.

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Outcomes of surgical and/or medical treatment in patients with prolactinomas during long-term follow-up: a retrospective single-centre study

Hormone Molecular Biology and Clinical Investigation ◽

10.1515/hmbci-2020-0077 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Gamze Akkus ◽

Barış Karagun ◽

Hilal Nur Yaldız ◽

Mehtap Evran ◽

Murat Sert ◽

...

Keyword(s):

Medical Treatment ◽

Tumour Size ◽

Optic Chiasm ◽

Initial Therapy ◽

Post Treatment ◽

Surgical Removal ◽

Average Dose ◽

Single Centre Study ◽

Pre Treatment

AbstractObjectivesProlactinoma is the most common cause of pituitary tumours. Current medical guidelines recommend dopamine agonists (cabergoline or bromocriptine) as the initial therapy for prolactinoma. However, surgical removal can also be considered in selected cases, such as patients with macroadenomas with local complications (bleeding or optic chiasm pressure) or those not responding to medical treatment.MethodsThe present retrospective study included patients with prolactinomas (n=43; female, 24; male, 19) who were primarily managed with medical (n=32) or surgical (n=11) treatment.ResultsMacroadenoma (n=29.67%) was commonly detected in both genders (female, 54%; male, 84%). Moreover, the mean pre-treatment prolactin levels were similar in both genders (female, 683.3 ± 1347 ng/mL; male, 685.4 ± 805 ng/mL; p=0.226). Surgically treated patients had a greater reduction in tumour size (27.7 ± 17.9 mm pre-treatment vs. 8.72 ± 14.2 mm post-treatment) than non-surgically treated ones (12.5 ± 7.5 mm pre-treatment vs. 4.1 ± 4.2 mm post-treatment; p=0.00). However, the decrease in prolactin levels was similar between the two patient groups (p=0.108). During the follow-up period (10.6 ± 7.0 years), the average cabergoline dose of the patients was 1.42 ± 1.47 mcg/week.ConclusionsAlthough a surgical approach was considered for selected cases of prolactinoma, the average dose used for medical treatment was highly inadequate for the patients in the present study.

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Post-Treatment Follow-Up Study of Abdominal Cystic Echinococcosis in Tibetan Communities of Northwest Sichuan Province, China

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0001364 ◽

2011 ◽

Vol 5 (10) ◽

pp. e1364 ◽

Cited By ~ 34

Author(s):

Tiaoying Li ◽

Akira Ito ◽

Renqing Pengcuo ◽

Yasuhito Sako ◽

Xingwang Chen ◽

...

Keyword(s):

Cystic Echinococcosis ◽

Sichuan Province ◽

Post Treatment ◽

Follow Up Study

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POS0163 INCIDENT FRACTURE RISK PREDICTION USING THE FRAGILITY SCORE CALCULATED BY LUMBAR SPINE RADIOFREQUENCY ECHOGRAPHIC MULTI SPECTROMETRY (REMS) SCANS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2311 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 294.2-294

Author(s):

D. Ciardo ◽

P. Pisani ◽

F. A. Lombardi ◽

R. Franchini ◽

F. Conversano ◽

...

Keyword(s):

Lumbar Spine ◽

Fracture Risk ◽

Fragility Fracture ◽

Osteoporotic Fractures ◽

Fragility Fractures ◽

Bone Fragility ◽

P Value ◽

T Score ◽

Caucasian Women

Background:The main consequence of osteoporosis is the occurrence of fractures due to bone fragility, with important sequelae in terms of disability and mortality. It has been already demonstrated that the information about bone mass density (BMD) alone is not sufficient to predict the risk of fragility fractures, since several fractures occur in patients with normal BMD [1].The Fragility Score is a parameter that allows to estimate skeletal fragility thanks to a trans-abdominal ultrasound scan performed with Radiofrequency Echographic Multi Spectrometry (REMS) technology. It is calculated by comparing the results of the spectral analysis of the patient’s raw ultrasound signals with reference models representative of fragile and non-fragile bones [2]. It is a dimensionless parameter, which can vary from 0 to 100, in proportion to the degree of fragility, independently from BMD.Objectives:This study aims to evaluate the effectiveness of Fragility Score, measured during a bone densitometry exam performed with REMS technology at lumbar spine, in identifying patients at risk of incident osteoporotic fractures at a follow-up period of 5 years.Methods:Caucasian women with age between 30 and 90 were scanned with spinal REMS and DXA. The incidence of osteoporotic fractures was assessed during a follow-up period of 5 years. The ability of the Fragility Score to discriminate between patients with and without incident fragility fractures was subsequently evaluated and compared with the discriminatory ability of the T-score calculated with DXA and with REMS.Results:Overall, 533 women (median age: 60 years; interquartile range [IQR]: 54-66 years) completed the follow-up (median 42 months; IQR: 35-56 months), during which 73 patients had sustained an incident fracture.Both median REMS and DXA measured T-score values were significantly lower in fractured patients than for non-fractured ones, conversely, REMS Fragility Score was significantly higher (Table 1).Table 1.Analysis of T-score values calculated with REMS and DXA and Fragility Score calculated with REMS. Median values and interquartile ranges (IQR) are reported. The p-value is derived from the Mann-Whitney test.Patients without incident fragility fracturePatients with incident fragility fracturep-valueT-score DXA[median (IQR)]-1.9 (-2.7 to -1.0)-2.6 (-3.3 to -1.7)0.0001T-score REMS[median (IQR)]-2.0 (-2.8 to -1.1)-2.7 (-3.5 to -1.9)<0.0001Fragility Score[median (IQR)]29.9 (25.7 to 36.2)53.0 (34.2 to 62.5)<0.0001By evaluating the capability to discriminate patients with/without fragility fractures, the Fragility Score obtained a value of the ROC area under the curve (AUC) of 0.80, higher than the AUC of the REMS T-score (0.66) and of the T-score DXA (0.64), and the difference was statistically significant (Figure 1).Figure 1.ROC curve comparison of Fragility Score, REMS and DXA T-score values in the classification of patients with incident fragility fractures.Furthermore, the correlation between the Fragility Score and the T-score values was low, with Pearson correlation coefficient r=-0.19 between Fragility Score and DXA T-score and -0.18 between the Fragility Score and the REMS T-score.Conclusion:The Fragility Score was found to be an effective tool for the prediction of fracture risk in a population of Caucasian women, with performances superior to those of the T-score values. Therefore, this tool presents a high potential as an effective diagnostic tool for the early identification and subsequent early treatment of bone fragility.References:[1]Diez Perez A et al. Aging Clin Exp Res 2019; 31(10):1375-1389.[2]Pisani P et al. Measurement 2017; 101:243–249.Disclosure of Interests:None declared

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