The “incidental anesthetic” — an opportunity for the endoscopic correction of vesicoureteral reflux in children

Introduction: The endoscopic management of vesicoureteral reflux(VUR) with subureteric injection (STING) has become more popular.The low morbidity associated with the STING procedure hasled to some authors advocating its use as a first-line therapy. Manyparents are uncomfortable with this procedure being performedin children because of the potential morbidity associated with generalanesthesia. We present an alternative without added anestheticmorbidity: offering the parents a STING when their childis undergoing an anesthetic for another surgical indication.Methods: We reviewed the records of 10 children who underwentincidental dextranomer/hyaluronic acid copolymer (DHA) injectionover a 2-year period.Results: We considered the treatment outcome after a single STINGprocedure to be successful in 8 (80%) patients and a failure in 2(20%). Distribution of VUR grade, according to the highest gradeper patient, was high in 5 (50%) patients, moderate in 3 (30%)and low in 2 (20%). We observed no complications.Conclusion: The idea of performing STING in children under incidentalanesthetic introduces yet another possibility in the paradigmof VUR care. Though the long-term efficacy of DHA remains to bedetermined, this option reduces the potential morbidity of DHA asfirst-line therapy while favourably altering the cost benefit.Introduction : L'injection sub-urétérale endoscopique est uneméthode de plus en plus utilisée pour la prise en charge d'un refluxvésico-urétéral (RVU). La faible morbidité associée à cette techniquea amené certains auteurs à recommander son emploi entraitement de première ligne. Bien des parents ne sont pas à l'aiseavec cette suggestion en raison du risque de morbidité lié àl'anesthésie générale. Nous présentons ici une solution de rechangequi n'augmente pas la morbidité liée à l'anesthésie, soit le recoursà l'injection sub-urétérale endoscopique pendant que l'enfantest déjà sous anesthésie pour une autre intervention chirurgicale.Méthodes : Les dossiers de 10 enfants ayant subi une injectionde copolymère de dextranomère / acide hyaluronique (DxAH) aucours d'une période de 2 ans ont été passés en revue.Résultats : Après une seule injection sub-urétérale, l'issue du traitement a été jugée excellente chez 8 patients (80 %) et un écheca été constaté chez 2 patients (20 %). La distribution des stadesde RVU en fonction du stade le plus élevé noté chez chaque patientétait la suivante : grade élevé, 50 %, modéré, 30 % et faible, 20 %.Aucune complication n'a été observée.Conclusion : L'idée de recourir à une injection sub-urétérale pendantune autre intervention nécessitant une anesthésie ajoute uneoption dans l'algorithme de traitement du RVU. Même si l'efficacitéà long terme du DxAH reste à établir, cette option a l'avantagede réduire le risque de morbidité lié au DxAH comme traitementde première ligne tout en modifiant pour le mieux l'équationcoûts-avantages.

Download Full-text

Not BCL2 mutation but dominant mutation conversation contributed to acquired venetoclax resistance in acute myeloid leukemia

Biomarker Research ◽

10.1186/s40364-021-00288-7 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Xiang Zhang ◽

Jiejing Qian ◽

Huafeng Wang ◽

Yungui Wang ◽

Yi Zhang ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

Myeloid Leukemia ◽

Underlying Mechanism ◽

Lymphocytic Leukemia ◽

First Line ◽

Dominant Mutation ◽

First Line Therapy ◽

Line Therapy ◽

Acute Myeloid

AbstractVenetoclax (VEN) plus azacitidine has become the first-line therapy for elderly patients with acute myeloid leukemia (AML), and has a complete remission (CR) plus CR with incomplete recovery of hemogram rate of ≥70%. However, the 3-year survival rate of these patients is < 40% due to relapse caused by acquired VEN resistance, and this remains the greatest obstacle for the maintenance of long-term remission in VEN-sensitive patients. The underlying mechanism of acquired VEN resistance in AML remains largely unknown. Therefore, in the current study, nine AML patients with acquired VEN resistance were retrospectively analyzed. Our results showed that the known VEN resistance-associated BCL2 mutation was not present in our cohort, indicating that, in contrast to chronic lymphocytic leukemia, this BCL2 mutation is dispensable for acquired VEN resistance in AML. Instead, we found that reconstructed existing mutations, especially dominant mutation conversion (e.g., expanded FLT3-ITD), rather than newly emerged mutations (e.g., TP53 mutation), mainly contributed to VEN resistance in AML. According to our results, the combination of precise mutational monitoring and advanced interventions with targeted therapy or chemotherapy are potential strategies to prevent and even overcome acquired VEN resistance in AML.

Download Full-text

Long‐term outcome comparing histological grades of follicular lymphoma patients treated with immunochemotherapy as first‐line therapy: A retrospective analysis from two institutions

European Journal Of Haematology ◽

10.1111/ejh.13359 ◽

2019 ◽

Vol 104 (3) ◽

pp. 198-206

Author(s):

Santiago Mercadal ◽

Juan‐Manuel Sancho ◽

Fina Climent ◽

Gustavo Tapia ◽

Helena Pomares ◽

...

Keyword(s):

Follicular Lymphoma ◽

Retrospective Analysis ◽

First Line ◽

Term Outcome ◽

Long Term Outcome ◽

First Line Therapy ◽

Line Therapy

Download Full-text

LONG-TERM RESULTS OF THE ENDOSCOPIC CORRECTION OF VESICOURETERAL REFLUX IN CHILDREN USING AUTOLOGOUS CHONDROCYTES

The Journal of Urology ◽

10.1016/s0022-5347(05)66170-8 ◽

2001 ◽

Vol 165 (6 Part 2) ◽

pp. 2224-2227 ◽

Cited By ~ 58

Author(s):

ANTHONY A. CALDAMONE ◽

DAVID A. DIAMOND

Keyword(s):

Vesicoureteral Reflux ◽

Long Term Results ◽

Endoscopic Correction

Download Full-text

Cost-Effectiveness of Pembrolizumab Plus Chemotherapy Versus Pembrolizumab Monotherapy in Metastatic Non-Squamous and Squamous NSCLC Patients With PD-L1 Expression ≥ 50%

Frontiers in Pharmacology ◽

10.3389/fphar.2021.803626 ◽

2022 ◽

Vol 12 ◽

Author(s):

Qiao Liu ◽

Zhen Zhou ◽

Xia Luo ◽

Lidan Yi ◽

Liubao Peng ◽

...

Keyword(s):

Cost Effectiveness ◽

Life Expectancy ◽

Cost Effective ◽

Base Case ◽

First Line ◽

Term Survival ◽

First Line Therapy ◽

Line Therapy ◽

Nsclc Patients

Objective To compare the cost-effectiveness of the combination of pembrolizumab and chemotherapy (Pembro+Chemo) versus pembrolizumab monotherapy (Pembro) as the first-line treatment for metastatic non-squamous and squamous non-small-cell lung cancer (NSCLC) with PD-L1expression ≥50%, respectively, from a US health care perspective.Material and Methods A comprehensive Makrov model were designed to compare the health costs and outcomes associated with first-line Pembro+Chemo and first-line Pembro over a 20-years time horizon. Health states consisted of three main states: progression-free survival (PFS), progressive disease (PD) and death, among which the PFS health state was divided into two substates: PFS while receiving first-line therapy and PFS with discontinued first-line therapy. Two scenario analyses were performed to explore satisfactory long-term survival modeling.Results In base case analysis, for non-squamous NSCLC patients, Pembro+Chemo was associated with a significantly longer life expectancy [3.24 vs 2.16 quality-adjusted life-years (QALYs)] and a substantially greater healthcare cost ($341,237 vs $159,055) compared with Pembro, resulting in an ICER of $169,335/QALY; for squamous NSCLC patients, Pembro+Chemo was associated with a slightly extended life expectancy of 0.22 QALYs and a marginal incremental cost of $3,449 compared with Pembro, resulting in an ICER of $15,613/QALY. Our results were particularly sensitive to parameters that determine QALYs. The first scenario analysis yielded lower ICERs than our base case results. The second scenario analysis founded Pembro+Chemo was dominated by Pembro.Conclusion For metastatic non-squamous NSCLC patients with PD-L1 expression ≥50%, first-line Pembro+Chemo was not cost-effective when compared with first-line Pembro. In contrast, for the squamous NSCLC patient population, our results supported the first-line Pembro+Chemo as a cost-effective treatment. Although there are multiple approaches that are used for extrapolating long-term survival, the optimal method has yet to be determined.

Download Full-text