First Experience in the Control of the Venous Side of the Brain AVM

Background and purpose: Brain arteriovenous malformations (AVM) are increasingly curable with endovascular embolization. This study examines the preliminary experience with a novel double-sided hybrid approach in the treatment of cerebral arteriovenous malformations (AVM) versus a purely single-sided intra-arterial approach. Materials and methods: The single-center study cohort included 18 patients with brain AVMs (Spetzler–Martin Grade 2 or 3) having stand-alone endovascular treatment with either the arterial-side-only pressure cooker technique (aPCT) (group 1; n = 9) or a double-sided hybrid intra-arterial and transvenous approach (HIPRENE) (group 2; n = 9). Results: Patients belonging to group 2 had lower rates of intra-procedural hemorrhaging (66.7% vs. 33.3%, p = 0.169) and needed fewer treatment sessions to achieve nidus occlusion (1.7 vs. 1.2, p = 0.136). The HIPRENE treatment regime led to higher nidus occlusion rates after the initial treatment compared to aPCT (77.7% vs. 44.4%, p = 0.167). Group 2 patients had a lower rate of neuromonitoring events (22.2% vs. 44.4%, p = 0.310) and fewer accounts of blood flow obstruction in post-operative MRIs (33.3% vs. 55.6%, p = 0.319). Conclusion: A double-sided hybrid intra-arterial and transvenous approach might have benefits for curative endovascular brain AVM treatment in patients with Spetzler–Martin Grade 2 or 3. In our small study cohort, the HIPRENE treatment regime had higher nidus occlusion rates after the first treatment, which reduces the number of treatment sessions and lowers intra- and post-operative complication rates. Further randomized controlled studies are awaited to corroborate our preliminary outcomes.

AYURVEDA MEDICINE INTERVENTION IN THE MANAGEMENT OF KITIBHA KUSHTHA (PSORIASIS): A CASE STUDY

ABSTRACT Kitibha kushtha is one of the common forms of disorder which can be correlated with psoriasis in modern medicine. According to Ayurveda classics, the disease arise mainly due to vitiation of Tridosha (Vata, Pitta, Kapha) and Rasa, Rakta, Mamsa, Medas and Kleda dhatu. This disease primarily characterized by Syava (silvery scaly lesions), Kinakara sparsha (Hard), and Parusha (rough to touch). It is observed that many Ayurveda treatment regimes have been used to treat Kitibha kushtha. Therefore, this study was accomplished to evaluate the Ayurvedic treatment regime for Kitibha kushtha. A fourteen year old female patient was referred to Ayurvedic Teaching Hospital, Borella, Sri Lanka with two years history of Kitibha kushtha, presented with symptoms of Syava (silvery scaly lesions), Kinakara sparsha (Hard), Parusha (rough to touch and Kandu (severe itching) of the affected area of skin. These existing clinical features were graded and marked using a standard performa. Treatment regime conducted for nine weeks continuously and results were recorded through subsequent visits every week. At the end of the treatment period the patient was entirely relief (100%) from clinical features of the disease Kitibha kushtha. Key words: Kitibha kushtha, Treatment regime, Psoriasis, Ayurveda

LEVEL OF COMPLIANCE WITH TREATMENT REGIME OF TYPE 2 DIABETES MELLITUS ON OUTPATIENTS

Objectives: To evaluate the compliance of patients with treatment regime of type 2 diabetes on outpatients at Dong Thap Regional General Hospital. Objects and methods: Retrospective descriptive study on 240 patients diagnosed with type 2 diabetes and outpatient treatment at Dong Thap General Hospital. Results: The percentage of patients who always adhered to the treatment regime was not high: 38.40% of patients always limited the use of fast hyperglycemic foods; 30.28% of patients always limited the intake of high-fat foods; The rate of patients who always ate washy foods was 27.68%, the rate of patients who always limited drinking beer and alcohol was 28.12%, 31.45% of patients always consumed fiber foods. The rate of patients complying with exercise regimes was an average level: 53.48% patients had the regular adherence to exercise regimes. The rate of good compliance of using drugs was an average level of 60.43%, still having 11.30% of patients were poor drug compliance. Conclusion: The proportion of patients who always adhered to the treatment regime was not high. The percentage of patients adhering to the exercise regimen was moderate. The proportion of patients who complied with good drug administration was moderate.

Can pressurised intraperitoneal aerosol chemotherapy with oxaliplatin (PIPAC-O+) be added to standard treatment for resectable high-risk gastric cancer patients? a study protocol

Objectives Gastric cancer remains one of the most fatal cancers, despite an intensive treatment regime of chemotherapy–surgery–chemotherapy. Peritoneal metastatic disease is commonly diagnosed post treatment regime and once established, patients are likely to die in 3–9 months. Systemic chemotherapy does not increase survival for these patients due to the poor vascularisation of this area. We are proposing the addition of pressurised intraperitoneal aerosol chemotherapy (PIPAC) to the treatment regime for curative patients as a preventive measure to reduce the risk of peritoneal metastases occurring. Methods This is a prospective, single centre, non-randomised, open-label pilot trial evaluating the addition of PIPAC to the standard multimodal treatment pathway. Patients will undergo standard neoadjuvant chemotherapy with four cycles of fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT), then PIPAC, followed by gastrectomy. Four cycles of FLOT will be administered post-surgery. Primary outcome is safety and feasibility, assessed by perioperative morbidity and possible interruptions of the standard multimodal treatment pathway.

Evaluation of the standard procedure for treatment of periprosthetic joint infections of total knee and hip arthroplasty: a comparison of the 2015 and 2020 census in total joint replacement centres in Germany

Background There are different procedures for both, the diagnosis and the therapy of a periprosthetic joint infection (PJI), however, national or international guidelines for a standardised treatment regime are still lacking. The present paper evaluates the use of the predominant treatment protocols for PJI in certified total joint replacement centres (EPZ) in Germany based on an EndoCert questionnaire. Materials and methods The questionnaire was developed in cooperation with the EndoCert Certification Commission to survey the treatment protocols for septic revision arthroplasties in EPZ. Questions targeted the various treatment options including prosthesis preserving procedures (DAIR - Debridement, antibiotics, irrigation, and retention of the prosthesis), one-stage revision, two-stage revision, removal of the endoprosthesis and diagnostic sampling prior to re-implantation. All certified EPZ participated (n = 504) and the results from the current survey in 2020 were compared to data from a previous analysis in 2015. Results The number of centres that performed DAIR up to a maximum of 4 weeks and more than 10 weeks after index surgery decreased since 2015, while the number of centres that provided a one-stage revision as a treatment option increased (hip: + 6.3%; knee: + 6.6%). The majority of the centres (73.2%) indicated a 4–8 week period as the preferred interval between prosthesis removal and re-implantation in two-stage revision in hip as well as knee revisions. Centres with a higher number of revision surgeries (> 200 revisions/year), opted even more often for the 4–8 week period (92.3%). In two-stage revision the use of metal-based spacers with/without reinforcement with antibiotic-containing cement as an interim placeholder was significantly reduced in 2020 compared to 2015. There was also a clear preference for cemented anchoring in two-stage revision arthroplasty in the knee in 2020, whereas the majority of hip replacements was cementless. Additionally, in 2020 the number of samples for microbiological testing during the removal of the infected endoprosthesis increased and 72% of the centres took five or more samples. Overall, the number of EPZ with a standardised protocol for the procedure expanded from 2015 to 2020. Conclusion While there was a trend towards standardised therapeutic algorithms for PJI with more uniform choices among the centres in 2020 compared to 2015, the treatment often remains an individual decision. However, since a consistent treatment regime is of vital importance with an expected rise of total numbers of revision arthroplasties, uniform definitions with regard to comparability and standardisation are necessary for the further development of the EndoCert system.

Molecular Manipulation of the MiR396/GRF Expression Module Alters the Salt Stress Response of Arabidopsis thaliana

We previously demonstrated that microRNA396 (miR396) abundance is altered in 15-day-old Arabidopsis thaliana (Arabidopsis) whole seedlings following their exposure to a 7-day salt stress treatment regime. We, therefore, used a molecular modification approach to generate two new Arabidopsis transformant populations with reduced (MIM396 plants) and elevated (MIR396 plants) miR396 abundance. The exposure of 8-day-old wild-type Arabidopsis whole seedlings and a representative plant line of the MIM396 and MIR396 transformant populations to a 7-day salt stress treatment regime revealed unique phenotypic and physiological responses to the imposed stress by unmodified wild-type Arabidopsis plants and the MIM396 and MIR396 transformat lines. A quantitative reverse transcriptase polymerase chain reaction (RT-qPCR) approach was, therefore, applied to demonstrate that the plant line specific responses to salt stress likely stemmed from the unique molecular profile of each of the GROWTH REGULATING FACTOR (GRF) transcription factor gene family members which form posttranscriptional targets of miR396-directed expression regulation. RT-qPCR additionally revealed that, in 15-day-old Arabidopsis whole seedlings, the three previously identified putative target genes of miR396 belonging to the NEUTRAL/ALKALINE NONLYSOSOMAL CERAMIDASE-LIKE (NCER) gene family, including NCER1, NCER2, and NCER3, do not form targets of miR396-directed expression regulation at the posttranscriptional level. Taken together, the phenotypic and molecular analyses presented here demonstrate that alteration of the miR396/GRF expression module is central to the molecular response of Arabidopsis to salt stress.