Study of the safety and efficacy of minimally invasive percutaneous nephrolithotomy in the management of large and complex renal stone

Background: Nephrolithiasis is highly prevalent across all demographic groups in the india and beyond, and its incidence rates are rising. In addition to the morbidity of the acute event, stone disease often becomes a lifelong problem that requires preventative therapy to diminish ongoing morbidity. Objective of this study to evaluate the safety and efficacy of minimally invasive percutaneous nephrolithotomy (PCNL) in the management of large and complex renal stone.Methods: This retrospective study includes 75 renal calculi patients with 100 renal units with large and complicated stone >20 mm. Stones were classified into simple (isolated renal pelvis or isolated calyceal stones) or complex (partial or complete stag horn stones, renal pelvis stones with accompanying calyceal stones). Then various parameter like decrease haemoglobin, surgical complication, creatinine level, duration of surgery etc were compared between simple and complex stones patients by calculation p value using online student t test calculator. P value less than 0.01 considered as a difference of significance.Results: The mean stone size was 35.5±20.37 mm and mean operative duration was 60±35.3 min. In all, cases 60 (80%) were stone-free after the first procedure and another 10 needed an auxiliary procedure (5 second-look PCNL, 3 extracorporeal shockwave lithotripsy-ESWL, 2 ureterorenoscopy, and) to become stone-free, resulting in a 93.33% stone-free rate. Complications occurred in 9 procedures (12%).Conclusions: From this study, it would be concluded that Minimally invasive PCNL provided significantly higher stone-free rate and efficiency quotient for management of urinary calculi. Overall complications are usually observed in patients having intraoperative hypotension and increased intra operative time.

Efficacy and safety of a combination of hydrodissection and radiofrequency ablation therapy for benign thyroid nodules larger than 2 cm: A retrospective study

Background: Radiofrequency ablation (RFA) is a safe, highly effective, and novel method used to treat benign thyroid nodules. This study aimed to evaluate the efficacy and safety of a combination of RFA and hydrodissection for treating benign thyroid nodules larger than 2 cm. Materials and Methods: The data of 137 patients with at least one thyroid nodule ≥2 cm who underwent RFA combined with hydrodissection at our medical center from November 2014 to October 2016 were analyzed. Ultrasound-guided RFA was applied to 532 nodules, including 139 nodules ≥2 cm and 393 nodes <2 cm. Results: The volumes of thyroid nodules, complications, and changes in thyroid function were analyzed. Ablation treatments were successfully performed without intraoperative skin burns, serious bleeding, or serious thyroid storm. A positive correlation was observed between ablation time and nodule size (R2 = 0.674). Only one patient (0.7%) experienced laryngeal nerve injury after operation. Moreover, the results of thyroid function tests (free triiodothyronine, free thyroxine, and thyroid-stimulating hormone) remained within normal ranges both before and after ablation. The complete ablation rate was 99.06%. The volumes of both nodules ≥2 cm and <2 cm significantly decreased after ablation. Six months after ablation, the average volume of nodules ≥2 cm had decreased to 1.02 ± 2.42 mL, and the volume reduction ratio was 83.11%. Conclusion: The combination of ultrasound-guided RFA with hydrodissection very effectively treats benign thyroid nodules while reducing damage to the surrounding tissues. This method is safe and effective for treating benign thyroid nodules

Comparative clinical evaluation of safety and efficacy of commonly used drug-eluting stents in coronary artery disease patients after angioplasty in South India: A retro-prospective multi-center study

Comparative data on safety and efficacy of new generation drug-eluting stents (DESs) are still lacking, theobjective of this study is to compare the safety and efficacy of commonly used DESs in patients with coronaryartery disease (CAD). Individual data of 146 consecutive patients (119 male and 27 female) stented with differentDESs such as Sirolimus (SESs), Everolimus (EESs), or Zotarolimus (ZESs) eluting stents were randomly collectedfrom various hospitals in South India. Pooled data were retro-prospectively analyzed, the primary end-point ofthis study was determination of major adverse cardiovascular events (MACE) and individual events, which is acomposite of cardiac death, target vessel related myocardial infarction (TV-MI), target lesion revascularization(TLR), target vessel revascularization (TVR), stent thrombosis (ST), and in-stent restenosis (ISR) at the end ofclinical follow-up which was scheduled at 3 months once up to 1 year after angioplasty. Baseline clinical andcardiac characteristics, angiographic and stent procedural characteristics, efficacy and suspected adverse reactionswere compared. Our study results indicate that SESs (a first-generation DES) were found to be non-inferior toEESs and ZESs in reducing risks and remains safe and effective at the end of 1-year clinical follow-up period inCAD patients after angioplasty.

Comparative clinical evaluation of safety and efficacy of commonly used drug-eluting stents in coronary artery disease patients after angioplasty in South India: A retro-prospective multi-center study

Comparative data on safety and efficacy of new generation drug-eluting stents (DESs) are still lacking, theobjective of this study is to compare the safety and efficacy of commonly used DESs in patients with coronaryartery disease (CAD). Individual data of 146 consecutive patients (119 male and 27 female) stented with differentDESs such as Sirolimus (SESs), Everolimus (EESs), or Zotarolimus (ZESs) eluting stents were randomly collectedfrom various hospitals in South India. Pooled data were retro-prospectively analyzed, the primary end-point ofthis study was determination of major adverse cardiovascular events (MACE) and individual events, which is acomposite of cardiac death, target vessel related myocardial infarction (TV-MI), target lesion revascularization(TLR), target vessel revascularization (TVR), stent thrombosis (ST), and in-stent restenosis (ISR) at the end ofclinical follow-up which was scheduled at 3 months once up to 1 year after angioplasty. Baseline clinical andcardiac characteristics, angiographic and stent procedural characteristics, efficacy and suspected adverse reactionswere compared. Our study results indicate that SESs (a first-generation DES) were found to be non-inferior toEESs and ZESs in reducing risks and remains safe and effective at the end of 1-year clinical follow-up period inCAD patients after angioplasty

Safety Profile and Therapeutic Efficacy of One Cycle of Lu177-PSMA in End-Stage Metastatic Castration-Resistant Prostate Cancer Patients with Low Performance Status / 대한핵의학회잡지

PURPOSE: The aim of this study was to evaluate safety and therapeutic efficacy of lutetium 177 prostate-specific membrane antigen (Lu-177-PSMA) in metastatic castration-resistant prostate cancer (mCRPC) patients with low performance status.METHODS: Twenty-two patients already treated with anti-androgens and docetaxel were enrolled for one cycle of Lu-177-PSMA therapy. Haemoglobin, total leukocyte counts, platelets and serum creatinine for toxicity profile while prostate specific antigen (PSA), Eastern Cooperative Oncology Group (ECOG) performance status, visual analogue scale (VAS) and analgesic quantification scale (AQS) for therapeutic efficacy were recorded pre and 8 weeks post therapy. Wilcoxon signed-rank and ANOVA tests were used for statistical analysis.RESULTS: Partial response (PR), stable disease (SD) and progressive disease (PD) for PSAwere seen in 5 (22.7%), 13 (59.1%) and 4 (18.2%) patients respectively treated with mean 6.88 GBq dose of Lu-177-PSMA. 8/22 (36.4%) patients showed ≥ 30% drop in PSA. Grade 3 haemoglobin toxicity was seen in 5/22 (22.7%) patients. No patient developed grade 4 haemoglobin toxicity. No patients had grade 3 or 4 leukocytopenia or thrombocytopenia. Wilcoxon signed-rank test showed statistical significant (P < 0.05) difference in pre and post treatment ECOG, VAS, and AQS scores. The ANOVA test showed statistically significant difference in mean doses of Lu-177-PSMA used in three PSA response groups while difference was non-significant for other variables.CONCLUSION: We concluded that Lu-177-PSMA therapy has adequate pain palliation in end-stage mCRPC patients with low performance status and it has a potential to become effective therapeutic option in properly selected patients.

Bioresorbable Vascular Scaffold: A Focused Review on Development and Preclinical Studies / 中国医疗器械杂志

Bioresorbable vascular scaffolds(BVS) are new treatment strategies of percutaneous coronary intervention. They have been introduced to overcome limitations of bare metal stents (BMS) and drug-eluting stents(DES), since they provide temporary scaffolding and then disappear, liberate the treated vessel from cage. In this article, we review the current status and problems of BVS, various tests required before gaining regulatory approval for clinical use.

Guidelines for Transcatheter Aortic Valve Replacement in Korea: Past Obstacles and Future Perspectives

BACKGROUND: Analyses of the efficacy and safety of transcatheter aortic valve replacement (TAVR) in most countries have been based on outcomes obtained in accordance with national practice guidelines and monitoring protocols. The purpose of this study is to share our experience regarding the process for establishing guidelines and monitoring protocols for the use of TAVR in Korea, in the hopes that it may be helpful to others undergoing a similar process in their own country. METHODS: The Korean guidelines for TAVR were established on June 1, 2015 in through a tri-party agreement involving the Department of Health and Welfare, the Korean Society of Thoracic and Cardiovascular Surgery and the Korean Society of Cardiology. We agreed to monitor the guidelines transparently and to exchange opinions regarding amendments or continuation of its contents after 3 years of monitoring. RESULTS: The monitoring meetings were not held as regularly as agreed, and monitoring was also made difficult by insufficient and incomplete data. Nevertheless, during the meetings, measures to improve the monitoring process were discussed, and accordingly, an agreement was made to continue the monitoring process, with the aim of completing data collection by 2018. CONCLUSION: Compliance with guidelines is critical for assessing the efficacy and safety of TAVR. Moreover, the TAVR monitoring process must be properly conducted for an accurate evaluation to be made. Any country planning to introduce TAVR may encounter difficulties with regards to the optimal initiation strategy and subsequent monitoring. Nevertheless, continued efforts should be made to persuade the government and the corresponding medical societies to facilitate the optimal application of TAVR.

Complementary and alternative medicine therapies for chronic pain / 中国结合医学杂志

Pain afflflicts over 50 million people in the US, with 30.7% US adults suffering with chronic pain. Despite advances in therapies, many patients will continue to deal with ongoing symptoms that are not fully addressed by the best conventional medicine has to offer them. The patients frequently turn to therapies outside the usual purview of conventional medicine (herbs, acupuncture, meditation, etc.) called complementary and alternative medicine (CAM). Academic and governmental groups are also starting to incorporate CAM recommendations into chronic pain management strategies. Thus, for any physician who care for patients with chronic pain, having some familiarity with these therapies-including risks and benefits-will be key to helping guide patients in making evidence-based, well informed decisions about whether or not to use such therapies. On the other hand, if a CAM therapy has evidence of both safety and efficacy then not making it available to a patient who is suffering does not meet the need of the patient. We summarize the current evidence of a wide variety of CAM modalities that have potential for helping patients with chronic pain in this article. The triad of chronic pain symptoms, ready access to information on the internet, and growing patient empowerment suggest that CAM therapies will remain a consistent part of the healthcare of patients dealing with chronic pain.

Clinical Research - Past, Present & Future.

Clinical pharmacology/research has a very interesting history. It started in the 40's of the 20th century through the pioneering work of Harry Gold at Cornell University, New York. Clinical research is an integral part of drug development. Drug development can be hastened by a number of new techniques with reduction in cost. In addition reverse pharmacology approaches for drug discovery have come to occupy a special place. 85% of the neutral antagonists act as inverse agonists. Inverse agonists have a distinct effect on receptor regulation as opposed to neutral antagonists. Orphan receptors constitute about 50% of the GPCRs. It is estimated that now there are nearly 175 orphan receptors after 125 having been deorphanised. Targeting these orphan receptors can lead to about the same number of ligands and antagonists thereof. Polymorphism of cytochrome P450 provides the basis for the use of predictive pharmacogenomics to yield drug therapies that are more efficient and safer. It is estimated that such personalized P450 gene-based treatment would be relevant for 10- 20% of all drug therapy.