A recent retrospective cohort study examined the impact of initiating anemia treatment at different hemoglobin levels on renal and cardiovascular outcomes in patients with nondialysis-dependent chronic kidney disease (NDD-CKD). 
Using data from two large Japanese databases, the study evaluated patients treated with long-acting erythropoiesis-stimulating agents (ESAs), dividing them into early treatment (hemoglobin ≥9.0 g/dl) and delayed treatment (<9.0 g/dl) groups. 
The primary outcome was a renal composite, including renal replacement therapy, significant reduction in estimated glomerular filtration rate (eGFR), and all-cause mortality. Secondary outcomes focused on cardiovascular events such as heart failure, stroke, and cardiovascular death. 
After propensity score matching, results from 1472 (MDV) and 1264 (RWD) patients revealed that delayed treatment did not significantly raise the risk of renal events (MDV HR: 1.15; RWD HR: 1.08). However, delayed anemia treatment was associated with a substantial increase in cardiovascular risks, including heart failure (MDV HR: 1.50; RWD HR: 1.53), as well as higher all-cause mortality (MDV HR: 1.83; RWD HR: 1.64).
The findings suggest that while renal outcomes may remain unaffected, delaying anemia treatment in NDD-CKD patients can significantly increase cardiovascular risks and mortality, highlighting the importance of early intervention before hemoglobin drops below 9.0 g/dl.
 

A recent study revealed that the size of apical preparation had a significant impact on postoperative pain levels. The results of this study were published in the journal BMC Oral Health. 
In this study, fifty teeth belonging to twenty-five individuals were separated into two equal groups, with twenty-five teeth in each group using E3 Azure rotary files. Group A was expanded by two sizes in relation to the Initial Binding File (IBF), extending to 40#/0.04 for the distal canals and 35#/0.04 for the mesial canals. Group B, on the other hand, was expanded by three sizes larger than the IBF: 45#/0.04 for the distal canals and 40#/0.04 for mesial canals. Patients were asked to rate their pain levels on a modified VAS form and describe their pain intensity at twelve, twenty-four, and seventy-two hours, as well as after a week. VAS data were analyzed using Freidman's test, Nemenyi post hoc test for intragroup comparisons and signed-rank test for intergroup comparisons.
The outcomes revealed that irrespective of the timing of the measurement, an enlargement of the apical preparation was significantly linked to increased pain scores (p value < 0.001). In both groups, there was a significant decline in reported pain scores over time, with scores at twelve-and twenty-four hours post-treatment significantly higher than those at other intervals (p value < 0.001). Additionally, pain scores at three days post-treatment were significantly higher than those at one week (p value < 0.001).
Thus, it can be concluded that apical preparation size significantly influenced postoperative pain levels.
 

Linaclotide, a guanylate cyclase C agonist approved for chronic idiopathic constipation and irritable bowel syndrome with constipation in adults, was evaluated for its efficacy and safety in children aged 6-17 with functional constipation. 
This phase 3, randomized, double-blind, placebo-controlled trial was conducted across 64 sites in seven countries. A total of 330 participants meeting modified Rome III criteria were randomly assigned to receive linaclotide 72 μg or placebo once daily for 12 weeks. The primary outcome was the change in spontaneous bowel movement (SBM) frequency, and the secondary outcome was stool consistency over the treatment period.
Out of 330 enrolled patients, 328 were analyzed (164 per group). Baseline SBM rates were 1.28 per week for placebo and 1.16 for linaclotide, increasing to 2.29 and 3.41 SBMs per week, respectively. Linaclotide significantly improved SBM frequency compared to placebo (LSM change: 2.22 vs. 1.05 SBMs per week; difference: 1.17; 95% CI: 0.65-1.69; p < 0.0001) and stool consistency (LSM change: 1.11 vs. 0.69; difference: 0.42; 95% CI: 0.21-0.64; p = 0.0001). 
The most common adverse event was diarrhea, reported in 4% of the linaclotide group compared to 2% of placebo. One case of severe diarrhea led to hospitalization but resolved without complications. No deaths occurred. 
Linaclotide demonstrated efficacy and tolerability in treating pediatric functional constipation and is now approved by the FDA for this indication.
 

A recent study suggests that dosing rituximab for B cell repopulation results in decreased clinical relapses during the maintenance of remission for ANCA vasculitis, in comparison to dosing based on an increase in ANCA level. This study’s findings were published in the Annals of the rheumatic diseases. 
This single-centre, open-label, randomised control trial enrolled 115 patients with ANCA vasculitis in remission after receiving at least 2 years of fixed-schedule rituximab. Rituximab was reinfused upon B cell repopulation in the B cell group, whereas rituximab was reinfused upon a significant increase in ANCA level in the ANCA group. Evaluations were conducted every 3 months, with the primary endpoint being clinical relapse, defined as a modified BVAS/WG >0 by 36 months. Secondary endpoints of the study included rituximab exposure and serious adverse events (SAEs). 
The median follow-up time of the study was 4.1 years (IQR 2.5 - 5.0). Utilizing Kaplan-Meier analysis, it was found that at the 3-year mark after study entry, 4.1% (95% CI 1.0 to 15.6) of patients in the B cell arm experienced a clinical relapse, while 20.5% (95% CI 11.9 to 34.1) of patients in the ANCA arm had a relapse. There were no significant differences in the total number of SAEs, including infectious SAEs and deaths, between the two arms. Patients in the B cell group received an average of 3.6 infusions (3.6 g) per person over the 4.1-year median follow-up period, compared to only 0.5 infusions (0.5 g) per patient in the ANCA group.
Therefore, it can be concluded that rituximab dosed for B cell repopulation may reduce the number of clinical relapses in comparison to when dosed to raise ANCA levels in the maintenance of remission for ANCA vasculitis.
 

A randomized controlled trial has demonstrated that both low-level laser therapy (LLLT) and low-intensity pulsed ultrasound (LIPUS) are effective in reducing pain caused by orthodontic separation. 
The study involved 145 patients, divided into three groups: LLLT, LIPUS, and a control group that received no additional intervention beyond separator placement.
Pain intensity was measured using a Visual Analog Scale (VAS) at multiple time points over four days. The LLLT and LIPUS groups received three treatment doses—immediately after separator placement, and at 24 and 48 hours—applied to the maxillary and mandibular first molars. 
Both therapies significantly reduced pain compared to the control group at all assessment points (P < .001). The highest pain levels were reported 24 hours after separator placement, but patients receiving either LLLT or LIPUS experienced considerable relief.
Interestingly, there was no significant difference in pain reduction between the laser and ultrasound groups, indicating that both modalities are equally effective in managing orthodontic pain. 
This study highlights the potential of these non-invasive therapies in improving patient comfort during orthodontic procedures, offering a promising adjunct to standard treatment protocols for pain management without the need for pharmacological intervention.
 

This multicenter, randomized, open, parallel-controlled clinical study evaluated the effectiveness of the Jianpi Shengxue tablet in treating renal anemia. 
A total of 200 patients with renal anemia were enrolled between December 2020 and December 2022 and randomly assigned to either a control group treated with a polysaccharide-iron complex or an experimental group receiving Jianpi Shengxue tablets. After 8 weeks of continuous treatment, outcomes related to anemia and iron metabolism were compared between the two groups.
Results indicated that the experimental group showed significant improvements in red blood cell count (RBC), hematocrit (HCT), reticulocyte percentage (RET), serum ferritin (SF), serum iron (SI), transferrin saturation (TSAT), and serum albumin (ALB), while clinical symptom scores and total iron binding capacity decreased (P<0.01). 
Notably, improvements in RBC, HCT, RET, SF, SI, TSAT, ALB, and clinical symptoms such as fatigue, anorexia, dull skin complexion, and numbness were significantly greater in the experimental group compared to the control group (P<0.05). The overall effectiveness rate of Jianpi Shengxue tablets was significantly higher than that of the control treatment (P<0.01).
These findings demonstrate that Jianpi Shengxue tablets are effective in managing renal anemia, significantly enhancing iron metabolism, nutritional status, and clinical symptoms, offering a promising alternative for anemia treatment in patients with kidney disease.
 

A recent study demonstrated that low-power YAG VapoEnucleation (ThuVEP) is safe, feasible, and effective, showing results similar to high-power ThuVEP in managing benign prostatic obstruction (BPO). The results of this study were published in the World Journal of Urology.
An analysis was carried out on 80 patients with symptomatic BPO and prostatic enlargement exceeding 80 ml. The patients were randomly split into two groups, each consisting of 40 patients. Group A underwent treatment with low-power ThuVEP, while Group B received high-power ThuVEP. Preoperative and early postoperative evaluations were conducted for all patients, with a follow-up analysis of 12 months. Complications were recorded and categorized based on the modified Clavien classification system.
The average age of patients at the time of surgery was 68 (± 6.1) years. The mean prostate volume was 112 (± 20.1) cc. The groups exhibited no significant variations (p value = 0.457). The average operative time for Group A was 88.4 ± 11.79 minutes, and for Group B it was 93.4 ± 16.34 minutes. Group A had a mean enucleation time of 59.68 ± 7.24 minutes, whereas Group B had a mean enucleation time of 63.13 ± 10.75 minutes. Quality of life (QoL), maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), prostate volume, and postvoiding residual urine (PVR) all showed significant improvement after treatment and were not significantly different between those treated with different energies. Complications were rare and showed no variation between the two groups.
The above study indicates that low-power ThuVEP is safe, feasible, and effective, demonstrating outcomes comparable with high-power ThuVEP in the management of BPO.
 

A randomized controlled trial has shown that a probiotic combination of Bifidobacterium longum and Lactobacillus plantarum (NVP-1703) significantly alleviates symptoms of allergic rhinitis (AR) in children. 
The study included children aged 6 to 19 with perennial AR, who were treated with NVP-1703 or a placebo over a 4-week period.
Results indicated that the total nasal symptom score (TNSS) in the NVP-1703 group decreased significantly compared to the placebo group. Symptom relief was observed both in the morning and evening, with notable improvements in nasal symptom duration and quality of life (QoL), particularly in reducing mouth breathing and itchy nose.
 Additionally, the NVP-1703 group showed reduced levels of inflammatory markers, specifically lower ratios of interleukin (IL)-4 and IL-5 to IL-22, which are associated with allergic responses.
No adverse events were reported, confirming the safety of NVP-1703 in children. These findings suggest that probiotics could offer a safe and effective treatment for managing AR in children, potentially improving both symptom control and overall quality of life. The study adds to the growing body of evidence supporting the role of probiotics in treating allergic conditions.