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2021 ◽  
Vol 124 ◽  
pp. 108326
Rui Zhong ◽  
Qingling Chen ◽  
Mengmeng Li ◽  
Yingxue Lu ◽  
Qian Zhao ◽  

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Yoshiki Arakawa ◽  
Keita Sasaki ◽  
Yohei Mineharu ◽  
Megumi Uto ◽  
Takashi Mizowaki ◽  

Abstract Background The current standard treatment for elderly patients with newly diagnosed glioblastoma is surgery followed by short-course radiotherapy with temozolomide. In recent studies, 40 Gy in 15 fractions vs. 60 Gy in 30 fractions, 34 Gy in 10 fractions vs. 60 Gy in 30 fractions, and 40 Gy in 15 fractions vs. 25 Gy in 5 fractions have been reported as non-inferior. The addition of temozolomide increased the survival benefit of radiotherapy with 40 Gy in 15 fractions. However, the optimal regimen for radiotherapy plus concomitant temozolomide remains unresolved. Methods This multi-institutional randomized phase III trial was commenced to confirm the non-inferiority of radiotherapy comprising 25 Gy in 5 fractions with concomitant (150 mg/m2/day, 5 days) and adjuvant temozolomide over 40 Gy in 15 fractions with concomitant (75 mg/m2/day, every day from first to last day of radiation) and adjuvant temozolomide in terms of overall survival (OS) in elderly patients with newly diagnosed glioblastoma. A total of 270 patients will be accrued from 51 Japanese institutions in 4 years and follow-up will last 2 years. Patients 71 years of age or older, or 71–75 years old with resection of less than 90% of the contrast-enhanced region, will be registered and randomly assigned to each group with 1:1 allocation. The primary endpoint is OS, and the secondary endpoints are progression-free survival, frequency of adverse events, proportion of Karnofsky performance status preservation, and proportion of health-related quality of life preservation. The Japan Clinical Oncology Group Protocol Review Committee approved this study protocol in April 2020. Ethics approval was granted by the National Cancer Center Hospital Certified Review Board. Patient enrollment began in August 2020. Discussion If the primary endpoint is met, short-course radiotherapy comprising 25 Gy in 5 fractions with concomitant and adjuvant temozolomide will be a standard of care for elderly patients with newly diagnosed glioblastoma. Trial registration Registry number: jRCTs031200099. Date of Registration: 27/Aug/2020. Date of First Participant Enrollment: 4/Sep/2020.

2021 ◽  
Vol 13 (1) ◽  
pp. 11-17
Mamadou Saliou Sow ◽  
Alioune Camara ◽  
Sidikiba Sidibé ◽  
Ibrahima Kaba ◽  
Nestor Niouma Leno ◽  

Introduction: The aim was to assess weight gain during tuberculosis treatment in patients co-infected with tuberculosis and HIV. Methods: Tuberculosis patients co-infected with HIV and undergoing tuberculosis treatment in the pneumophtisiology and infectious and tropical diseases departments of the CHU in Conakry were included. Results: 562 patients were included, with a mean age of 35.6±11.3 years, and 52.5% were women. The average Body Mass Index [BMI] at baseline was 17.8 3.3 kg/m2. 71.5% of patients had a favorable result and 28.5% had an unfavorable result [death, abandonment]. Healed and lost patients gained an average of 2.6 kg and 0.1 kg respectively. Deceased patients lost an average of 3.6 kg. The weight variations of the cured patients were different from those of the deceased [p < 0.001]. A weight gain of 5% after 6 months of treatment was associated with the treatment site [OR=3.81; 95% CI 1.08 to 13.45], alcohol consumption [OR=10.33; 95% CI 1.20 to 89.16], malnutrition before treatment [OR=2.72; 95% CI 1.43 to 5.17] and the form of tuberculosis [OR=3.27; 95% CI 1.15 to 9.33]. Conclusion: Newly diagnosed patients co-infected with TB-HIV at Conakry's CHU are often malnourished. Weight gain during treatment seems to be a reliable indicator of the overall response to treatment.

2021 ◽  
pp. 00293-2021
Leena E. Tuomisto ◽  
Pinja Ilmarinen ◽  
Lauri Lehtimäki ◽  
Onni Niemelä ◽  
Minna Tommola ◽  

Spirometry and testing for bronchodilator response have been recommended to detect asthma, and a bronchodilator response (BDR) of ≥12% and ≥200 mL has been suggested to confirm asthma. However, the clinical value of bronchodilation tests in newly diagnosed steroid-naïve adult patients with asthma remains unknown. We evaluated the sensitivity of BDR in FEV1 as a diagnostic test for asthma in a real-life cohort of participants in the Seinäjoki Adult Asthma Study (SAAS). In the diagnostic phase, 369 spirometry tests with bronchodilation were performed for 219 steroid-naïve patients. The fulfilment of each test threshold was assessed. According to the algorithm of the National Institute for Health and Care Excellence, we divided the patients into obstructive (FEV11/FVC<0.70) and non-obstructive (FEV1/FVC≥0.70) groups. Of the overall cohort, 35.6% fulfilled ΔFEV1≥12% and ≥200mL for the initial FEV1, 18.3% fulfilled ΔFEV1≥15% and ≥400 mL for the initial FEV1 and 36.1% fulfilled ΔFEV1≥9% of predicted FEV1 at least once. One-third (31%) of these steroid-naïve patients was obstructive (pre-bronchodilator FEV1/FVC<0.7). Of the obstructive patients, 55.9%, 26.5% and 48.5%, respectively, met the same thresholds. In multivariate logistic regression analysis, different thresholds recognized different kinds of asthma patients. In steroid-naïve adult patients, the current BDR threshold (ΔFEV1≥12% and ≥200 mL) has low diagnostic sensitivity (36%) for asthma. In obstructive patients, sensitivity is somewhat higher (56%) but far from optimal. If the first spirometry test with bronchodilation is not diagnostic but asthma is suspected, spirometry should be repeated, and other lung function tests should be used to confirm the diagnosis.

Alexandre Roux ◽  
Hichem Ammar ◽  
Alessandro Moiraghi ◽  
Sophie Peeters ◽  
Marwan Baroud ◽  

2021 ◽  
Vol 1 (10) ◽  
Reimbursement Team

CADTH reimbursement reviews are comprehensive assessments of the clinical effectiveness and cost-effectiveness, as well as patient and clinician perspectives, of a drug or drug class. The assessments inform non-binding recommendations that help guide the reimbursement decisions of Canada's federal, provincial, and territorial governments, with the exception of Quebec. This review assesses venetoclax (Venclexta), 10 mg, 50 mg, and 100 mg oral tablets. Indication: In combination with azacitidine or low-dose cytarabine for the treatment of patients with newly diagnosed AML who are 75 years or older, or who have comorbidities that preclude the use of intensive induction chemotherapy.

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318258
E Madelief J Marsman ◽  
Pieter G Postema ◽  
Carol Ann Remme

Brugada syndrome (BrS) is an inherited cardiac disorder, characterised by a typical ECG pattern and an increased risk of arrhythmias and sudden cardiac death (SCD). BrS is a challenging entity, in regard to diagnosis as well as arrhythmia risk prediction and management. Nowadays, asymptomatic patients represent the majority of newly diagnosed patients with BrS, and its incidence is expected to rise due to (genetic) family screening. Progress in our understanding of the genetic and molecular pathophysiology is limited by the absence of a true gold standard, with consensus on its clinical definition changing over time. Nevertheless, novel insights continue to arise from detailed and in-depth studies, including the complex genetic and molecular basis. This includes the increasingly recognised relevance of an underlying structural substrate. Risk stratification in patients with BrS remains challenging, particularly in those who are asymptomatic, but recent studies have demonstrated the potential usefulness of risk scores to identify patients at high risk of arrhythmia and SCD. Development and validation of a model that incorporates clinical and genetic factors, comorbidities, age and gender, and environmental aspects may facilitate improved prediction of disease expressivity and arrhythmia/SCD risk, and potentially guide patient management and therapy. This review provides an update of the diagnosis, pathophysiology and management of BrS, and discusses its future perspectives.

2021 ◽  
Vol 11 ◽  
Ying-Cheng Chiang ◽  
Po-Han Lin ◽  
Wen-Fang Cheng

Epithelial ovarian cancer (EOC) patients are generally diagnosed at an advanced stage, usually relapse after initial treatments, which include debulking surgery and adjuvant platinum-based chemotherapy, and eventually have poor 5-year survival of less than 50%. In recent years, promising survival benefits from maintenance therapy with poly(ADP-ribose) polymerase (PARP) inhibitor (PARPi) has changed the management of EOC in newly diagnosed and recurrent disease. Identification of BRCA mutations and/or homologous recombination deficiency (HRD) is critical for selecting patients for PARPi treatment. However, the currently available HRD assays are not perfect predictors of the clinical response to PARPis in EOC patients. In this review, we introduce the concept of synthetic lethality, the rationale of using PARPi when HRD is present in tumor cells, the clinical trials of PARPi incorporating the HRD assays for EOC, the current HRD assays, and other HRD assays in development.

2021 ◽  
Vol 8 ◽  
Jeehyun Kim ◽  
Kwan Hong ◽  
Raquel Elizabeth Gómez Gómez ◽  
Soojin Kim ◽  
Byung Chul Chun

Background: Concerns about alopecia areata (AA) in coronavirus disease 2019 (COVID-19) patients have emerged among dermatologists. However, most of the extant kinds of literature have limited implications by relying on cross-sectional studies with restricted study subjects without the control group.Objective: Our study aims to investigate the risk of developing AA among COVID-19 patients in South Korea using national representative data.Methods: We used the National Health Insurance Service COVID-19 cohort database, comprising COVID-19 patients and the control group, all of whom were diagnosed from January 1, 2020, to June 4, 2020. Patients were defined as individuals who were confirmed as COVID-19 positive, regardless of disease severity. Controls were defined as those who were confirmed as COVID-19 negatives. People with a history of AA during the period 2015–2019 were excluded. The primary endpoint was a new diagnosis of AA (ICD-10-Code: L63). The adjusted incidence rate ratio (IRR) of developing AA was estimated using a log-link Poisson regression model based on incidence density. The model adjusted for (1) age and sex and (2) demographic variables (age, sex, place of residence, and income level).Results: A total of 226,737 individuals (7,958 [3.5%] cases and 218,779 [96.5%] controls) were included in the final analysis. The ratio of newly diagnosed AA was 18/7,958 (0.2%) in cases and 195/218,779 (0.1%) in controls. IRRs of COVID-19 patients having newly diagnosed AA compared to controls were 0.78 (95% CI: 0.48–1.27) when age and sex were adjusted for and 0.60 (95% CI: 0.35–1.03) when all demographic variables were adjusted for.Conclusion: Diagnosis of COVID-19 was not significantly associated with the development of AA even after appropriately adjusting for covariates.

2021 ◽  
pp. 1-11
Shuling Li ◽  
Yuanyuan Ji ◽  
Yi Peng ◽  
Vamsi Kota ◽  
Christopher Kim

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