Impact of focal zone size on treatment outcomes and renal injury subsequent to extracorporeal shockwave lithotripsy for renal calculi

A recent study showed that the standard narrow focal zone (FZ) demonstrates similar safety and superior treatment efficacy when compared to the extended FZ during extracorporeal shockwave lithotripsy (SWL) for renal stones. This study’s findings were published in Journal of Endourology.

In this prospective randomized study, 276 patients diagnosed with renal stones were assigned to receive SWL using either standard or extended FZ. The treatment was administered using a Modulith SLX-F2 lithotripter, delivering a maximum of 3000 shocks at a frequency of 1.5 Hz. The primary outcome of the study assessed the success of the treatment 12 weeks after a single SWL session, which was determined by the absence of a stone or stone fragment smaller than 4 mm on computed tomography. Secondary outcomes included the incidence of the stone-free rate (SFR), perinephric hematoma, and changes in the levels of acute renal injury markers in the urine.

Similar baseline parameters were observed in both groups. The standard FZ group achieved a significantly higher treatment success rate (74.3%) than the extended FZ group (59.3%). Additionally, standard FZ exhibited a significantly better SFR (Grade-A, 36.8% vs. 23.0%,) and lower post-treatment pain levels. Both groups had comparable rates of perinephric hematoma formation, changes in urinary acute renal injury markers, and unplanned hospital admissions.

The above results demonstrated that the standard narrow FZ shows comparable safety and improved treatment efficacy in comparison to the extended FZ in extracorporeal SWL for renal stones.

Evaluation of Pollinex Quattro (PQ) Grass allergen-specific immunotherapy induced immunomodulatory mechanisms for treating seasonal allergic rhinitis

A recent study found that Pollinex Quattro (PQ) Grass exhibited a superior extended regimen with a mechanistic efficacy profile compared to the conventional PQ regimen. This study was published in the journal, Clinical and Experimental Allergy.

This study included 119 subjects suffering from grass pollen seasonal allergic rhinitis (SAR) who were randomized in a 2:2:1:1 ratio. These patients received a cumulative dose of PQ Grass either as an extended pre-seasonal or conventional regimen, placebo, or placebo with MicroCrystalline Tyrosine. An exploratory endpoint, gene expression analysis, was assessed in a subgroup of 30 individuals chosen at random from each of the four treatment arms. Baseline samples and those obtained before the start and end of the grass pollen season were analyzed.

At the end of the study, transcriptome analysis showed most significant changes in the gene expression for the main Th1 candidate molecules (IL-12A, IFNγ) upregulated as well as the Th2 signature cytokines downregulated (IL-4, IL-13, IL-9). Based on the absolute value of the activation z-score, the canonical pathways analysis showed that Th1, Th2, Th17, and IL-17 were the most significantly enriched pathways. Pronounced inhibition of pro-inflammatory allergic molecules, IgE, IL-17A, IL-17F, IL-25 and activation of pro-tolerogenic molecules, IL-12A, IL-27, IL-35 was shown by upstream regulator analysis.

Based on the above results, it can be concluded that peripheral blood mononuclear cells showed an inhibition of pro-inflammatory allergic responses (Th2, Th17) while exhibiting an immune deviation towards Th1 responses. Thus, PQ Grass extended regimen may show a superior mechanistic efficacy profile compared to the conventional PQ regimen.

Risk factors for thromboembolic events in individuals with dialysis-dependent chronic kidney disease

A recent study has shown that it is reasonable to avoid sudden fluctuations in hemoglobin levels and maintain transferrin saturation (TSAT) levels at or above 30%, rather than escalating the dosage of roxadustat. The findings of the study were published in the journal Advances in Therapy.

Thromboembolic events in patients receiving roxadustat were investigated through a combined analysis of four phase 3 trials, including PYRENEES, HIMALAYAS, SIERRAS, and ROCKIES, both prior to and following the twelfth week. Cox regression analyses were used to explore the baseline risk factors for thromboembolic events. The association between thromboembolic events and laboratory parameters that were last known before the event was explored through nested case-control studies using matched case-control pairs.

Among the 2354 patients studied, 1026 thromboembolic events were observed in 568 patients. Baseline risk factors identified included hemodialysis versus peritoneal dialysis, race, high high-sensitivity C-reactive protein, advanced age ≥ 65 years, a history of thromboembolism, cardiovascular disease, or diabetes. Univariate case-control analyses indicated that a high hemoglobin rate of rise (≥ 0.5 g/dL/week; OR 2.09; 95% CI 0.98-4.46) showed a potential increase in the risk of thromboembolic events before week twelve, while a high rate of hemoglobin decline was linked to events after week 12 (< - 0.5 g/dL/week; OR 3.73; 95% CI 1.68-8.27) in comparison to steady levels of hemoglobin (ranging from ≥ - 0.1– < 0.1 g/dL/week).

Multivariate case-control analyses demonstrated that a low last known hemoglobin level (< 10 g/dL: adjusted OR 1.91; 95% CI 1.04-3.50; versus ≥ 12 g/dL) and low last known transferrin saturation (TSAT < 10%: adjusted OR 3.78; 95% CI 1.71-8.39; versus ≥ 30%) before event onset were associated with events after week twelve. An increased dose of roxadustat was correlated with thromboembolic events in patients whose last known transferrin saturation was less than 30%, while no correlation was observed in patients with transferrin saturation of 30% or higher.

The above study demonstrated that among several risk factors associated with thromboembolic events, it is suitable to avoid abrupt changes in hemoglobin levels and keep TSAT levels at or above 30% instead of increasing the dosage of roxadustat.

Evaluation of pain after utilizing various single-file glide path systems

In a recent study, the WaveOne Gold Glider (WOGG) glide-path file system demonstrated a lower incidence of postoperative pain compared to alternative systems. The ProGlider (PG) group exhibited elevated rates of abscess formation and analgesic consumption in contrast to the other groups. Women were found to experience greater postoperative pain than men. These study findings were published in the Journal of Endodontics.

This randomized clinical trial included a total of 78 patients with asymptomatic apical periodontitis in their maxillary and mandibular molars. These patients were then randomly allocated into three groups: control group (n = 26), PG group (n = 26), and WOGG group (n = 26). Postoperative pain levels were monitored using a numerical rating scale at specific time intervals (6, 12, 18, 24, 48, and 72 hours), while the use of analgesics and abscess formation were also documented. Statistical analyses were conducted using the Mann-Whitney U, Bonferroni Dunn, Chi-square, Friedman, and Fisher exact tests.

The WOGG group demonstrated lower levels of postoperative pain at 12 and 18 hours compared to the other groups (P < .05). Women experienced higher postoperative pain scores at 6 and 24 hours in comparison to men (P < .05). Notably, the most intense postoperative pain scores were recorded at 6 hours (P < .05).

It can be concluded that the WOGG glide-path file system was linked to a reduced occurrence of postoperative pain when compared to alternative systems. In contrast to the other groups, the PG group displayed higher rates of abscess formation and analgesic consumption and women experienced greater postoperative pain than men.

Management of the breathlessness-cough-fatigue symptom cluster in lung cancer through respiratory distress symptom intervention

A recent study showed that the use of respiratory distress symptom intervention (RDSI) has shown to be an effective and low-risk intervention in aiding the management of the respiratory distress symptom cluster in individuals diagnosed with lung cancer. This study’s findings were published in the journal, BMJ Supportive & Palliative Care.

A total of 263 patients diagnosed with lung cancer were enrolled in this clinical trial, with 132 patients assigned to receive RDSI and 131 patients assigned to receive standard care. To be eligible for the trial, participants had to self-report experiencing adverse effects in their daily lives from at least two out of the three symptoms, in any combination. The outcomes measured were the changes in each symptom within the cluster, namely Dyspnoea-12 (D-12), Functional Assessment of Chronic Illness-Fatigue, and Manchester Cough in Lung Cancer (MCLC) at the 12-week mark.

Nearly 60% of the participants reported experiencing all three symptoms at the baseline. By the end of the trial, there was a total attrition of 109 participants (41.4%). When compared to the control group, the RDSI group demonstrated a statistically significant improvement in D-12 (p=0.007) and MCLC (p<0.001). Each outcome reached the minimal clinically important difference (MCID): MCLC -5.49 (MCID >3), D-12 -4.13 (MCID >3), and FACIT-F 4.91 (MCID >4).

Thus, RDSI has proven its effectiveness and safety in supporting the management of the respiratory distress symptom cluster in patients with lung cancer. However, it is important to consider the significant attrition observed in the study while interpreting these findings.