Techniques – Mini incision and plication (MIP) cure hydrocele: A minimally invasive surgical variation

Idiopathic hydroceles are the commonest cause of chronic benign scrotal swelling, affecting 1% of adult men. Larger idiopathic hydroceles can become symptomatic and affect quality of life. The popular Jaboulay technique described in 1902 is curative and remains the standard for most surgeons. However, it is associated with significant morbidity and has a reported recurrence rate of 5%. Various minimally invasive approaches have been described with fewer reported complications but are of limited efficacy and unacceptable recurrence rates requiring multiple treatments. In this single-surgeon case series of 92 men, we present the mini incision and plication (MIP) cure hydrocele technique for the treatment of idiopathic hydrocele. This minimally invasive open surgical variant achieves the desired eversion and plication with minimal hydrocele manipulation, providing excellent results independent of hydrocele size, with fewer complications and a recurrence rate of <1%.

Comparing Efficacy of Punctum-incised Surgery versus Punctum- Sparing Surgery in Primary Canaliculitis Patients

Purpose: This study aims to describe the characteristics of canaliculitis patients and compare the operative outcomes between punctum-sparing canaliculotomy and traditional punctum-incised canaliculotomy.Methods: The medical records of 58 patients who were diagnosed with canaliculitis were reviewed from March 1, 2010, to December 31, 2020. The demographic characteristics, symptoms, time to disease onset, location of involvement, operation information, and prognosis were recorded and analyzed.Results: Canaliculitis showed a female (67%) predominance. Epiphora with discharge was the most common symptom which happened in 56 (97%) patients. The recurrence rates of the punctum-incised group and the punctum-sparing group were 5% and 9% respectively, and there was no significant difference between the two groups. (p=0.514)Conclusion: The recurrence rate of the punctum-sparing group showed no significant difference with punctum-incised group. Patients with recurrence finally recovered after multiple treatments. Squeezing by tweezers was a good way to locate the infected lacrimal duct. Punctum-incised surgery can be the first-line therapy for canaliculitis.

Anti-Drug Antibodies in Pigtailed Macaques Receiving HIV Broadly Neutralising Antibody PGT121

Broadly neutralising antibodies (bNAbs) may play an important role in future strategies for HIV control. The development of anti-drug antibody (ADA) responses can reduce the efficacy of passively transferred bNAbs but the impact of ADA is imperfectly understood. We previously showed that therapeutic administration of the anti-HIV bNAb PGT121 (either WT or LALA version) controlled viraemia in pigtailed macaques with ongoing SHIV infection. We now report on 23 macaques that had multiple treatments with PGT121. We found that an increasing number of intravenous doses of PGT121 or human IgG1 isotype control antibodies (2-4 doses) results in anti-PGT121 ADA induction and low plasma concentrations of PGT121. ADA was associated with poor or absent suppression of SHIV viremia. Notably, ADA within macaque plasma recognised another human bNAb 10E8 but did not bind to the variable domains of PGT121, suggesting that ADA were primarily directed against the constant regions of the human antibodies. These findings have implications for the development of preclinical studies examining multiple infusions of human bNAbs.

Automated Interpretable Discovery of Heterogeneous Treatment Effectiveness: A Covid-19 Case Study

Testing multiple treatments for heterogeneous (varying) effectiveness with respect to many underlying risk factors requires many pairwise tests; we would like to instead automatically discover and visualize patient archetypes and predictors of treatment effectiveness using multitask machine learning. In this paper, we present a method to estimate these heterogeneous treatment effects with an interpretable hierarchical framework that uses additive models to visualize expected treatment benefits as a function of patient factors (identifying personalized treatment benefits) and concurrent treatments (identifying combinatorial treatment benefits). This method achieves state-of-the-art predictive power for Covid-19 in-hospital mortality and interpretable identification of heterogeneous treatment benefits. We first validate this method on the large public MIMIC-IV dataset of ICU patients to test recovery of heterogeneous treatment effects. Next we apply this method to a proprietary dataset of over 3000 patients hospitalized for Covid-19, and find evidence of heterogeneous treatment effectiveness predicted largely by indicators of inflammation and thrombosis risk: patients with few indicators of thrombosis risk benefit most from treatments against inflammation, while patients with few indicators of inflammation risk benefit most from treatments against thrombosis. This approach provides an automated methodology to discover heterogeneous and individualized effectiveness of treatments.

The Togolese Medicinal Recipe, Diabeto-Dolvo® Exerted Antidiabetic Effects in Wistar Rats

Objective: this study was to evaluate the toxicity of a herbal recipe Diabeto-Dolvo® (DD) and its efficacy in streptozotocin-induced diabetic Wistar rats. Methodology and results: The toxicity test was performed by oral administration of the extract to rats while diabetes was induced with streptozotocin, the 250, and 500 mg / kg body weight. The results of the toxicity tests revealed no evidence of mortality or morbidity suggesting an LD50 greater than 5000 mg / kg. Similarly, the biochemical and haematological parameters remained unchanged. In antidiabetic tests, there was a progressive decrease followed by a normalization of the glucose level of the treated rats. Overall, the extract at 250 and 500 mg / kg body weight resulted in a significant reduction in glycated haemoglobin, amylase, lipase, G6PD and serum lipids. Conclusion and application of results: This study revealed that, the treatment with the recipe might repair oxidative damages, hyperglycaemia and hyperlipidaemia in diabetic rats in the same way as the treatment with glibenclamide. This study is a contribution to the experimental validation of the DD recipe. In research and development application, the DD recipe will be used in the treatment of cases of diabetes mellitus. A natural product, it will support the multiple treatments of so-called conventional medicine, relatively expensive for the population. Key words: Diabeto-Dolvo®; blood glucose; oxidative damage; streptozotocin; diabetes mellitus; Togo.

Predictive P-score for treatment ranking in Bayesian network meta-analysis

Background Network meta-analysis (NMA) is a widely used tool to compare multiple treatments by synthesizing different sources of evidence. Measures such as the surface under the cumulative ranking curve (SUCRA) and the P-score are increasingly used to quantify treatment ranking. They provide summary scores of treatments among the existing studies in an NMA. Clinicians are frequently interested in applying such evidence from the NMA to decision-making in the future. This prediction process needs to account for the heterogeneity between the existing studies in the NMA and a future study. Methods This article introduces the predictive P-score for informing treatment ranking in a future study via Bayesian models. Two NMAs were used to illustrate the proposed measure; the first assessed 4 treatment strategies for smoking cessation, and the second assessed treatments for all-grade treatment-related adverse events. For all treatments in both NMAs, we obtained their conventional frequentist P-scores, Bayesian P-scores, and predictive P-scores. Results In the two examples, the Bayesian P-scores were nearly identical to the corresponding frequentist P-scores for most treatments, while noticeable differences existed for some treatments, likely owing to the different assumptions made by the frequentist and Bayesian NMA models. Compared with the P-scores, the predictive P-scores generally had a trend to converge toward a common value of 0.5 due to the heterogeneity. The predictive P-scores’ numerical estimates and the associated plots of posterior distributions provided an intuitive way for clinicians to appraise treatments for new patients in a future study. Conclusions The proposed approach adapts the existing frequentist P-score to the Bayesian framework. The predictive P-score can help inform medical decision-making in future studies.