A recent study suggests that appropriate dose modifications in selinexor in response to adverse events (AEs) were associated with improved efficacy, reduced AE rates and improved quality of life (QoL) in patients with relapsed/refractory multiple myeloma. The study’s findings were published in the journal, Clinical Lymphoma, Myeloma & Leukemia. 
The BOSTON study, a phase III, open label, randomized, controlled trial included 195 patients with relapsed/refractory multiple myeloma. They were randomized either to once-weekly (QW) 100 mg of selinexor, QW subcutaneous bortezomib (1.3 mg/m2), QW with 20 mg of twice-weekly dexamethasone or to a standard subcutaneous bortezomib and dexamethasone twice-weekly. Primary endpoint was progression-free survival (PFS). Secondary endpoints included Overall response rate (ORR), ≥ very good partial response (VGPR) rate, overall survival (OS), duration of response (DoR), time to next treatment (TTNT), and time to response (TTR) 
Of the total 195 patients enrolled, 126 patients had selinexor dose reductions. The median progression-free survival for patients who received dose reductions was 16.6 months (95% CI 12.9 – NR), while it was 9.2 months (95% CI 6.8, 15.5) for those who did not with a hazard ratio of 0.57 (95% CI 0.36, 0.89). The ORR was 81.7% (95% CI 73.9%, 88.1%) vs 66.7% (95% CI 54.3%, 77.6%) for patients with dose reductions vs in those without dose reductions, respectively. DOR was not reached (95% CI 13.8, NE) in the dose reduction group and was 12.0 months (95% CI 8.3, NE) in the group without reduction (HR = 0.59 [95% CI 0.34, 1.04]). TTNT was 22.6 months (95% CI 14.6, NE) for patients who received selinexor dose reductions, whereas it was 10.5 months (95% CI 6.3, 18.2) for patients who did not receive dose reductions.  
On the EORTC QLQ-C30 Global Health Status/QoL scale, the mean best change from baseline was 10.0 ± 20.5 (95% CI 6.3, 13.7) in the dose reduction group as opposed to 4.0 ± 20.9 (95% CI −1.4, 9.3) in those without dose reduction. After selinexor dose reduction, AE rates that were lower included thrombocytopenia (62.5% before vs. 47.6% after), fatigue (28.1% before vs. 9.9% after), nausea (31.6% before vs. 7.3% after), anemia (17.9% before vs. 10.3% after), diarrhea (12.9% before vs. 5.2% after), and diarrhea (21.5% before vs. 6.4% after).
Based on the above results, it can be concluded that appropriate dose reductions of 100 mg selinexor starting dose may be associated with improved efficacy, reduced AE rates and improved QoL

This split-mouth, randomized, double-blind clinical trial evaluated the efficacy of transcutaneous electrical nerve stimulation (TENS) in managing pain, edema, and trismus following the surgical removal of impacted mandibular third molars. 
Thirty-seven patients with bilaterally impacted third molars received TENS on one side immediately after surgery (50 Hz, 100-µs pulse, 15 minutes for 6 days), while the contralateral side received a placebo treatment. Pain scores, the primary outcome, were recorded for 7 days postoperatively, while edema and trismus were assessed on days 2, 4, and 7.
Results indicated that the TENS group experienced significantly lower pain scores compared to the placebo group (P<0.05), with reduced analgesic consumption during the first three days post-surgery (P<0.001). Although postoperative edema was lower in the TENS group, this reduction was not statistically significant (P>0.05). Trismus, measured by inter-incisal distance, showed no significant difference on day 2 but was significantly improved in the TENS group thereafter (P<0.001).
TENS proved effective in reducing postoperative pain and trismus following impacted third molar surgery, supporting its use as a non-pharmaceutical intervention to alleviate postoperative symptoms and enhance recovery.
 

According to a recent study, the administration of fifty mg of Vibegron once daily for twelve weeks exhibited significant improvement in bladder storage symptoms related to overactive bladder (OAB) following laser vaporization of the prostate for symptomatic benign prostatic hyperplasia when compared to the untreated follow-up period. The findings of this study were published in the journal, Lower Urinary Tract Symptoms.Split into two groups: one group received Vibegron 50 mg once daily, while the other group had no treatment and were only followed up for 12 weeks.The median age (interquartile range) was 75.5 (72.5-78.5) years for the Vibegron group, while it was 76.5 (71.0-81.0) years for the control group. At twelve weeks post-randomization, the intergroup difference in the mean change (95% CI) in twenty-four hour urinary frequency was -3.66 (-4.99, -2.33) with a significant decrease in the Vibegron group. Significant improvements were noted in the International Prostate Symptom Score, Overactive Bladder Questionnaire score, Overactive Bladder Symptom Score, and IPSS storage score for the Vibegron group. Additionally, in the Vibegron group the voided volume per micturition increased.
Therefore, the treatment with fifty mg of Vibegron once a day for a duration of twelve weeks resulted in notable enhancement in bladder storage symptoms associated with overactive OAB after laser vaporization of the prostate for symptomatic benign prostatic hyperplasia when compared to the untreated follow-up period.
 

This double-blind, randomized, controlled trial examined the impact of vitamin D supplementation on anemia management in hemodialysis (HD) patients with end-stage renal disease (ESRD) and vitamin D deficiency. 
One hundred anemic HD patients with vitamin D deficiency were randomly assigned to receive either monthly vitamin D (50,000 IU) or a placebo for six months. Serum 25-hydroxyvitamin D (25(OH)D) levels were measured at baseline and after six months, while hemoglobin (Hb) concentrations were monitored monthly.
Results demonstrated that vitamin D supplementation significantly increased 25(OH)D levels in the treatment group compared to the placebo group (p > 0.001). While serum ferritin, serum iron, and transferrin saturation did not differ significantly between the groups, Hb concentrations in the vitamin D group rose significantly more than in the placebo group throughout the study period. 
Additionally, erythropoietin (EPO) dosage requirements were notably lower in the vitamin D group compared to the placebo group (p > 0.001).
These findings indicate that vitamin D supplementation is a safe and effective approach to improving anemia in HD patients with vitamin D deficiency, reducing the need for EPO therapy, and enhancing overall anemia management in this vulnerable population.