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Pediatric Surgery International Jun 2022We aimed to evaluate a complicated appendicitis clinical practice guideline at our institution.
PURPOSE
We aimed to evaluate a complicated appendicitis clinical practice guideline at our institution.
METHODS
Records were compared before and after protocol implementation. We standardized an ED consult pathway, antibiotic use and need for early appendectomy (EA) versus interval appendectomy (IA). We evaluated demographics, clinical characteristics, and outcomes. Subgroup analysis was performed to compare patients with small abscess treated with IA pre-protocol versus similar patients treated by EA post-protocol.
RESULTS
In total 246 patients were reviewed (Pre-protocol = 152, Post-protocol = 94). Pre-protocol early appendectomy rate was 51% versus 82% on post-protocol patients. There were no differences in demographics. Post-protocol the use of preoperative imaging significantly decreased (Pre 92% vs. 56%, p = 0.0001), as well as the use of discharge antibiotics (Pre 93% vs. Post 27%, p = 0.0001) with no change in abscess rate. Overall, post-protocol patients had fewer total CT scans performed (Pre 40% vs. Post 28%, p = 0.03) and decreased total length of stay (Pre 7.7 vs. Post 6.5 days, p = 0.049). On subgroup analysis, post-protocol EA with no or small abscess had lower median number of admissions, decreased total LOS (Pre IA 9 days vs. Post EA 5 days, p = 0.00001) and fewer complications (Pre IA 42% vs. EA 22%, p = 0.022).
CONCLUSION
The establishment of a standardized pediatric complicated appendicitis protocol may lead to improved outcomes and resource utilization. Patients presenting with no or small abscess may be the least likely to benefit from interval appendectomy.
LEVEL OF EVIDENCE
Level III.
Topics: Abscess; Anti-Bacterial Agents; Appendectomy; Appendicitis; Child; Humans; Length of Stay; Retrospective Studies
PubMed: 35396951
DOI: 10.1007/s00383-022-05124-z -
IEEE Transactions on Neural Networks... Dec 2023This article proposes a novel deep-reinforcement learning-based medium access control (DL-MAC) protocol for underwater acoustic networks (UANs) where one agent node...
This article proposes a novel deep-reinforcement learning-based medium access control (DL-MAC) protocol for underwater acoustic networks (UANs) where one agent node employing the proposed DL-MAC protocol coexists with other nodes employing traditional protocols, such as time division multiple access (TDMA) or q -Aloha. The DL-MAC agent learns to exploit the large propagation delays inherent in underwater acoustic communications to improve system throughput by either a synchronous or an asynchronous transmission mode. In the sync-DL-MAC protocol, the agent action space is transmission or no transmission, while in the async-DL-MAC, the agent can also vary the start time in each transmission time slot to further exploit the spatiotemporal uncertainty of the UANs. The deep Q -learning algorithm is applied to both sync-DL-MAC and async-DL-MAC agents to learn the optimal policies. A theoretical analysis and computer simulations demonstrate the performance gain obtained by both DL-MAC protocols. The async-DL-MAC protocol outperforms the sync-DL-MAC protocol significantly in sum throughput and packet success rate by adjusting the transmission start time and reducing the length of time slot.
PubMed: 35580103
DOI: 10.1109/TNNLS.2022.3170050 -
Trials Mar 2016With the aging of the global population, an increasing number of elderly are diagnosed with advanced non-small cell lung cancer. Although systematic chemotherapy has... (Randomized Controlled Trial)
Randomized Controlled Trial
A multicenter randomized controlled open-label trial to assess the efficacy of compound kushen injection in combination with single-agent chemotherapy in treatment of elderly patients with advanced non-small cell lung cancer: study protocol for a randomized controlled trial.
BACKGROUND
With the aging of the global population, an increasing number of elderly are diagnosed with advanced non-small cell lung cancer. Although systematic chemotherapy has been one of the primary treatments for advanced non-small cell lung cancer worldwide, the elderly cannot always tolerate standard platinum-based doublet chemotherapy, thus resulting in treatment failure. To reduce toxicity, single-agent chemotherapy is often used to treat the elderly with non-small cell lung cancer; however, this may increase the risk of treatment failure due to an inadequate dose. It has been shown that compound kushen injection in combination with chemotherapy can enhance the efficacy and reduce the toxicity. The aim of this trial is to assess the clinical effectiveness and safety of compound kushen injection in combination with single-agent chemotherapy versus platinum-based doublet chemotherapy in the treatment of elderly patients with advanced non-small cell lung cancer.
METHODS
This multicenter study will be an open-label, randomized controlled trial. Three hundred seventy elderly patients with advanced non-small cell lung cancer will be randomly divided into experimental (n = 185) and control groups (n = 185) to receive compound kushen injection in combination with single-agent chemotherapy or standard platinum-based doublet chemotherapy for two cycles. After two cycles, the disease control rate, objective response rate, clinical symptoms, quality of life, Karnofsky Performance Status, and side effects will be assessed. Follow-up evaluations will be performed every 8 weeks to evaluate the progression-free and overall survival.
DISCUSSION
Before the trial was designed, compound kushen injection was shown to be effective for lung cancer through basic experiments and clinical trials. This study will determine whether or not the efficacy of compound kushen injection in combination with single-agent chemotherapy is comparable to that of platinum-based doublet chemotherapy, and whether or not the toxicity of compound kushen injection in combination with single-agent chemotherapy is lower than that of platinum-based doublet chemotherapy.
TRIAL REGISTRATION
ChiCTR-IPR-14005484 (16 November 2014).
Topics: Age Factors; Aged; Antineoplastic Agents, Phytogenic; Antineoplastic Combined Chemotherapy Protocols; Carboplatin; Carcinoma, Non-Small-Cell Lung; Cisplatin; Clinical Protocols; Deoxycytidine; Disease-Free Survival; Docetaxel; Drugs, Chinese Herbal; Female; Humans; Kaplan-Meier Estimate; Karnofsky Performance Status; Lung Neoplasms; Male; Paclitaxel; Proportional Hazards Models; Quality of Life; Research Design; Taxoids; Time Factors; Treatment Outcome; Gemcitabine
PubMed: 26956875
DOI: 10.1186/s13063-016-1231-6 -
Gan To Kagaku Ryoho. Cancer &... Dec 1992In advanced pancreatic cancer, chemotherapy has no curative potential, and the goal is to palliate symptoms or delay their onset so as to improve the quality of life of... (Review)
Review
In advanced pancreatic cancer, chemotherapy has no curative potential, and the goal is to palliate symptoms or delay their onset so as to improve the quality of life of patients. There is no standard chemotherapeutic regimen with a clear advantage in survival prolongation or response rate, over any other regimen. Moreover, difficulties in determining the chemotherapeutic response have made accurate determination of the response rate virtually impossible for each trial. 5-FU and MMC are two main drugs so far in single-agent chemotherapy, but streptozotocin, doxorubicin, ifosfamide, epirubicin and CDDP are also investigated. FAM and SMF are the representative regimen of combination chemotherapy, but recently FP or biochemical modulation have been under close scruting. For greater improvement of chemotherapy, a new drug or combined modality approach is awaited.
Topics: Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Carboplatin; Cisplatin; Cyclophosphamide; Doxorubicin; Drug Evaluation; Fluorouracil; Humans; Mitomycin; Mitomycins; Pancreatic Neoplasms; Streptozocin
PubMed: 1463339
DOI: No ID Found -
Journal of Clinical Oncology : Official... Mar 1996We reviewed the published literature of clinical studies in malignant pleural mesothelioma, including phase II trials of the newer antifolates and plant derivatives, as... (Review)
Review
PURPOSE AND DESIGN
We reviewed the published literature of clinical studies in malignant pleural mesothelioma, including phase II trials of the newer antifolates and plant derivatives, as well as older single-agent and combination chemotherapy trials. We excluded trials with less than 15 patients, although we have mentioned smaller trials in the text to make a specific point, as well as ones that show promise. We have also included confidence intervals when cited in the original reports, or calculated them when absent.
RESULTS
No drugs have consistently induced a response greater than 20%. Higher response rates have been reported with detorubicin, high-dose methotrexate, and edatrexate at 26%, 37%, and 25%, respectively, but these have yet to be confirmed. Agents that produce response rates in 10% to 20% of patients include doxorubicin, epirubicin, mitomycin, cyclophosphamide, ifosfamide, cisplatin, and carboplatin. Combination chemotherapy trials do not demonstrate a consistently greater response rate than single-agent trials. However, the combination of doxorubicin, cisplatin, bleomycin, and mitomycin demonstrated a response rate of 44% (95% confidence interval, 27% to 63%), but this remains unconfirmed. Intrapleural therapy using interferon gamma, particularly for small-volume disease, shows promise.
CONCLUSION
The successful treatment of unresectable pleural mesothelioma awaits the discovery of active drugs. Recent trials of high-dose methotrexate and other antifolates are encouraging. Newer agents, including suramin, should be evaluated in phase II trials. Off-protocol combination therapy cannot be recommended over single-agent therapy, but studies that use combinations of the newer agents should be conducted.
Topics: Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Clinical Trials as Topic; Clinical Trials, Phase II as Topic; Forecasting; Humans; Mesothelioma; Pleural Neoplasms
PubMed: 8622005
DOI: 10.1200/JCO.1996.14.3.1007 -
Journal of Clinical Oncology : Official... Sep 2005Mantle-cell lymphoma (MCL) is now recognized as a distinct clinicopathologic subtype of B-cell non-Hodgkin's lymphoma. Patients with MCL are typically older adults with... (Comparative Study)
Comparative Study Review
Mantle-cell lymphoma (MCL) is now recognized as a distinct clinicopathologic subtype of B-cell non-Hodgkin's lymphoma. Patients with MCL are typically older adults with a male predominance and usually present with stage IV disease. The cells are characterized as CD20+ CD5+ CD23- with a t(11;14)(q13;q32) and cyclin D1 overexpression on immunohistochemistry. Response to chemotherapy usually results in a tumor response but unmaintained remissions are short and the median survival is 3 to 4 years. The treatment approach to newly diagnosed patients with MCL depends on the patient's eligibility for stem cell transplantation (SCT). Those who are eligible are usually treated with either rituximab-CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) followed by SCT or rituximab-HyperCVAD (cyclophosphamide, vincristine, doxorubicin, decadron, cytarabine, and methotrexate) followed by observation. The purine nucleoside analogues also have activity as single agents and with rituximab. Unfortunately none of these approaches can definitively cure patients with MCL, and new agents are needed. Recent studies in patients with relapsed MCL have shown substantial antitumor activity of single-agent bortezomib, single-agent temsirolimus, and the combination of thalidomide and rituximab. Studies integrating these novel agents earlier in the disease course or in combination with each other will hopefully produce more durable responses with less toxicity.
Topics: Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Cyclophosphamide; Dose-Response Relationship, Drug; Doxorubicin; Drug Administration Schedule; Female; Hematopoietic Stem Cell Transplantation; Humans; Lymphoma, Mantle-Cell; Male; Patient Selection; Prednisolone; Prognosis; Randomized Controlled Trials as Topic; Severity of Illness Index; Survival Analysis; Treatment Outcome; Vincristine
PubMed: 16155027
DOI: 10.1200/JCO.2005.55.017 -
Physiology International Mar 2020Viruses have caused many epidemics throughout human history. The novel coronavirus [10] is just the latest example. A new viral outbreak can be unpredictable, and...
MOTIVATION
Viruses have caused many epidemics throughout human history. The novel coronavirus [10] is just the latest example. A new viral outbreak can be unpredictable, and development of specific defense tools and countermeasures against the new virus remains time-consuming even in today's era of modern medical science and technology. In the lack of effective and specific medication or vaccination, it would be desirable to have a nonspecific protocol or substance to render the virus inactive, a substance/protocol, which could be applied whenever a new viral outbreak occurs. This is especially important in cases when the emerging new virus is as infectious as SARS-CoV-2 [4].
AIMS AND STRUCTURE OF THE PRESENT COMMUNICATION
In this editorial, we propose to consider the possibility of developing and implementing antiviral protocols by applying high purity aqueous chlorine dioxide (ClO2) solutions. The aim of this proposal is to initiate research that could lead to the introduction of practical and effective antiviral protocols. To this end, we first discuss some important properties of the ClO2 molecule, which make it an advantageous antiviral agent, then some earlier results of ClO2 gas application against viruses will be reviewed. Finally, we hypothesize on methods to control the spread of viral infections using aqueous ClO2 solutions.
Topics: Antiviral Agents; Betacoronavirus; COVID-19; Chlorine Compounds; Clinical Protocols; Communicable Diseases, Emerging; Coronavirus Infections; Disease Transmission, Infectious; Disinfectants; Humans; Oxides; Pandemics; Pharmaceutical Solutions; Pneumonia, Viral; Research Design; SARS-CoV-2
PubMed: 32208977
DOI: 10.1556/2060.2020.00015 -
Reumatologia Clinica 2013Treating rheumatoid arthritis (RA) with a goal or «Treat to target» strategy is a therapeutic proposal taken from cardiovascular and endocrine literature. It proposes... (Review)
Review
Treating rheumatoid arthritis (RA) with a goal or «Treat to target» strategy is a therapeutic proposal taken from cardiovascular and endocrine literature. It proposes that the therapeutic target in RA should be a state of remission, or an alternative goal could be a low disease activity. Rheumatologists should measure and register disease activity in every clinical visit and if the goal has not been reached, therapeutic adjustments should be made. Current evidence from clinical trials and a meta-analysis supports the notion that this strategy has important clinical benefits in patients with early RA when compared with routine care. It is also described that using protocolized treatment offers greater benefits. Recent data from Dutch cohorts is presented showing its successful implementation. A discussion is offered on the need of more studies in established RA.
Topics: Antirheumatic Agents; Arthritis, Rheumatoid; Clinical Protocols; Drug Monitoring; Humans; Induction Chemotherapy; Maintenance Chemotherapy; Patient Care Planning; Treatment Outcome
PubMed: 22985804
DOI: 10.1016/j.reuma.2012.04.004 -
Cell and Tissue Banking Dec 2016Cardiovascular allografts are usually disinfected using antibiotics, but protocols vary significantly between tissue banks. It is likely that different disinfection... (Review)
Review
Cardiovascular allografts are usually disinfected using antibiotics, but protocols vary significantly between tissue banks. It is likely that different disinfection protocols will not have the same level of efficacy; they may also have varying effects on the structural integrity of the tissue, which could lead to significant differences in terms of clinical outcome in recipients. Ideally, a disinfection protocol should achieve the greatest bioburden reduction with the lowest possible impact on tissue integrity. We conducted a systematic review of methods applied to disinfect cardiovascular tissues. The use of multiple broad spectrum antibiotics in conjunction with an antifungal agent resulted in the greatest reduction in bioburden. Antibiotic incubation periods were limited to less than 24 h, and most protocols incubated tissues at 4 °C, however one study demonstrated a greater reduction of microbial load at 37 °C. None of the reviewed studies looked at the impact of these disinfection protocols on the risk of infection or any other clinical outcome in recipients.
Topics: Allografts; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cell Culture Techniques; Disinfection; Fungi; Heart Valves; Humans; Mycoses; Sterilization; Tissue Banks; Transplantation, Homologous
PubMed: 27522194
DOI: 10.1007/s10561-016-9570-9 -
Current Opinion in Infectious Diseases Aug 2007The rationale for therapeutic targets in sepsis has arisen from the concept of pathogenesis. This review focuses on recent advances in pathogenesis of sepsis that can... (Review)
Review
PURPOSE OF REVIEW
The rationale for therapeutic targets in sepsis has arisen from the concept of pathogenesis. This review focuses on recent advances in pathogenesis of sepsis that can aid in management of sepsis patients.
RECENT FINDINGS
Cellular survival in sepsis is related to the magnitude of the stimulus, the stage of the cell cycle and the type of microbe. While phenotypic modification of the endothelium (procoagulant and proadhesive properties, increased endothelial permeability, endothelial apoptosis and changes in vasomotor properties) leads to vasoplegia as a direct correlate to septic shock mortality, phenotypic changes in the epithelium cause activation of the virulence of the opportunistic pathogens and loss of mucosal barrier function, the latter causing a vicious circle in severe sepsis. Early identification of sepsis with protocolized screening, triggering evidence-based protocolized care, is anticipated to reduce sepsis morbidity and mortality. Current treatment of sepsis includes early antibiotic therapy, early aggressive goal-directed resuscitation targeting tissue hypoperfusion, steroids (for refractory shock), activated protein C (for high risk of death) and maintaining support of organ systems.
SUMMARY
A better understanding of pathogenesis of sepsis has led to specific proven management tools that are likely to improve clinical outcome once incorporated into protocolized care.
Topics: Anti-Bacterial Agents; Apoptosis; Disease Management; Endothelium, Vascular; Humans; Inflammation; Practice Guidelines as Topic; Protein C; Sepsis; Shock, Septic
PubMed: 17609592
DOI: 10.1097/QCO.0b013e32818be70a