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.

Efficacy of a universal dentin adhesive containing mesoporous bioactive glass in alleviating dentin hypersensitivity

According to a recent study, the universal adhesive with mesoporous bioactive glass (MBG) provided relief from dentin hypersensitivity, with effectiveness that is identical with or even superior to that of specific desensitizing agents. It can be utilized as an efficient in-office treatment for dentin hypersensitivity relief. This study’s findings were published in the journal, Scientific Reports.

This randomized study included 225 teeth from 39 patients to evaluate the effectiveness of a desensitizing agent with oxalate/resin polymer and a universal adhesive containing MBG for relieving dentin hypersensitivity. The assessment of efficacy was done using Schiff sensitivity score (SSS) and visual analog scale (VAS). The teeth with dentin hypersensitivity in split quadrants were treated with either MS Coat ONE or Hi-Bond Universal with MBG as the functional additive. Standardized stimulus protocols including air, cold, and acid were used for assessments at baseline, immediately after application, and at 1- and 2-week follow-ups. The primary outcome of the study was the SSS difference, whereas the VAS difference was the secondary outcome.

An instant decrease in DH was observed following exposure to air stimuli, showing a significant reduction in Group HB compared to Group MS (p = 0.017). The reduction in response to cold stimuli showed a gradual cumulative effect, consistently resulting in larger reductions in Group HB than in Group MS (p ≤ 0.037). Both groups effectively handled acidic stimuli, with no significant variances (p > 0.05). The VAS scores gradually decreased throughout the follow-up duration (p < 0.0001).

The above study showed that dentin hypersensitivity was successfully relieved by the mesoporous bioactive glass containing universal adhesive.

Impact of folic acid and vitamin B12 supplementation on arsenic methylation

A recent study demonstrated that folic acid (FA) and vitamin B12 (B12) supplementation improved arsenic methylation in children, leading to a decrease in monomethyl- (MMAs) and an increase in dimethyl- (DMAs) in both blood and urine. Implementing nutritional interventions could enhance arsenic methylation and elimination in children, thereby reducing arsenic toxicity and improving their nutritional status. This study’s results were published in the Environment International journal.

This double-blind, placebo-controlled trial involved 240 participants aged 8-11 years, who were consuming water from wells with arsenic levels exceeding 50 μg/L. They were advised to switch to wells with lower arsenic levels and were randomly assigned to receive either 400 μg FA + 5 μg B12 or a placebo daily for a period of 12 weeks. Samples of urine and blood were taken at the baseline, week 1 (urine only), and week 12. Generalized estimated equation (GEE) models were utilized to evaluate the impact of the treatment on arsenic levels in both blood and urine.

At the baseline, the mean ± SD total urinary and blood arsenic levels were measured as 91.2 ± 89.5 μg/L and 5.3 ± 2.9 μg/L, respectively. After the follow-up period, there was an overall decrease of 11.7% in total blood arsenic and 17.6% in urinary arsenic. In comparison to the placebo group, the supplementation group showed a notable increase in blood DMAs concentration by of 14.0% and blood secondary methylation index (DMAs/MMAs) by 0.19 at 12 weeks. Additionally, the supplementation group had a significantly higher urinary %DMAs (1.62%) and a significantly lower urinary %MMAs (-1.10%) compared to the placebo group after 1 week. The effects of the treatment were stronger in individuals with higher baseline blood arsenic levels. These results remained consistent across both males and females, as well as participants with varying folate and B12 status at baseline.

Thus, it can be concluded that FA and B12 supplementation resulted in improved arsenic methylation in children, resulting in a reduction in MMAs and an elevation in DMAs in both blood and urine.

Efficacy of fluoride varnish for the treatment of dentin hypersensitivity

According to a recent study, Single Bond Universal, Xeno V+ (seventh-generation dentin bonding agents), and Bifluorid 12 exhibit equal effectiveness in reducing dentin hypersensitivity (DH), with no clear superiority observed over a one-month period. These findings underscore the potential of fluoride varnishes as a cost-effective and less technique-sensitive treatment option for DH. This study’s results were published in the BMC Oral Health.

In this parallel-group, single-center, double-blind, controlled randomized clinical trial, a total of 105 patients with DH were included. The patients were divided into three groups: one group received Single Bond Universal by 3 M ESPE, another group received Xeno-V+ by Dentsply, and the control group received fluoride varnish (Bifluorid 12 by Voco). This study assessed the Discomfort Interval Scale scores and Schiff Cold Air Sensitivity Scale scores at baseline, immediately after the treatment, after 1 week, and after 1 month.

Treatment with all the materials demonstrated a significant reduction in discomfort and sensitivity (DIS scores p-value 0.01) observed immediately after one week and sustained over one month compared to baseline scores. None of the materials showed superiority during the one-month observation period. The study also provided insights into dental hygiene practices, indicating that the majority of participants used a toothbrush. Cold stimuli were identified as the most prevalent cause of sensitivity.

The above study demonstrated that Single Bond Universal, Xeno V+, and Bifluorid 12 are equally effective in reducing dentin hypersensitivity for one month. These results underscore the potential of fluoride varnishes as a cost-effective and less technique-sensitive treatment option for DH.