Predictors of adherence to follow-up and treatment success in childhood obesity.

INTRODUCTION: Management of childhood obesity, based upon behavioural, physical activity and dietary guidance, usually achieves limited success and is hindered by a high attrition rate. The identification of potential predictors of either weight loss or early weight management attrition could help develop personalised management plans in order to improve patient outcomes. PATIENTS AND METHODS: We conducted a retrospective study in a cohort of 1300 patients with obesity managed in speciality clinics for up to 5 years with outpatient conservative treatment. We studied the family background and personal characteristics (demographic, behavioural, psychosocial, anthropometric and metabolic) of patients who dropped out before completing the first year of the programme and patients who achieved significant weight loss, with a separate analysis of patients who achieved substantial reductions in weight compared to the rest of the cohort. RESULTS: The mean age of the patients in the cohort was 10.46 years (SD, 3.48) the mean BMI z-score 4.01 (SD, 1.49); 52.8% of the patients were male, 53.3% were prepubertal, 75.8% were Caucasian and 19% Latin. We found a higher proportion of Latinla ethnicity and compulsive eating in the group of patients with early attrition from the weight management follow-up. In the group of patients with substantial weight loss, a greater proportion were male, there was a higher frequency of dietary intake control at home and obesity was more severe, and the latter factor was consistently observed in patients who achieved substantial weight loss at any point of the follow-up. CONCLUSIONS: Some family and personal characteristics in childhood obesity are associated with an increased risk of early withdrawal from follow-up or a greater probability of successful outcomes; however, the predictive value of these variables is limited.

Emollients in dermatological creams: Early evaluation for tailoring formulation and therapeutic performance.

The targeted choice of the emollient of a cream determines its physicochemical properties and clinical effectiveness. This work researched the effects of emollient properties on the final characteristics and potential performance of oil-in-water dermatological creams. Seven emollients with different chemical characteristics and structures (alkane, triglyceride, ether, silicone, vegetable oils, and mineral oil) were tested in a model formulation. Early stability, pH, droplet size distribution, rheology, tackiness, adhesivity, spreadability, tribology, and release profile of a lipophilic substance model (in Franz cells, through a synthetic membrane, for six hours) were assessed. The creams had acid epicutaneous pH and a "shear-thinning" "solid-like" viscoelastic behavior. Among the seven emollients' properties, polarity, density, and viscosity were the most influential. Droplet parameters were the most impacted, pH and release were moderately affected, and the textural properties were lowly to moderately impacted. The emollient substitution in the model formulation affected the experimental parameters differently, allowing formulation optimization and tailoring its potential therapeutic performance regarding drug release, coadjutant effects, and dwell time on the skin. By looking at the creams' characteristics, it was possible to select the best-suited emollients for releasing a lipophilic drug, applying on painful skin, and formulation in wash-off products or leave-on protective barrier creams.

Long-term outcomes of therapeutic corneal transplants performed in a tertiary eye care hospital in South India.

Purpose: This study aimed to review the demographics, clinical characteristics, and long-term outcomes of therapeutic penetrating keratoplasty (TPK) performed in a tertiary eye care hospital. Methods: Case records of 149 therapeutic transplants (135 patients) that were performed during the calendar year 2016 were retrospectively analyzed, and outcomes were measured until 3 years of follow-up. Information on demographics, presentation characteristics, keratoplasty indications, offending microbe, and secondary surgical interventions was studied. The final outcome was classified in terms of therapeutic, anatomical, and functional outcomes. Results: The median age of the recipients was 55 years with 61% men. The most common indications for TPK were perforated infectious ulcer (45.9%), nonhealing ulcers (29.9%), and graft infections (17.4%). Fungal etiology was noted in 61.2% and bacterial etiology in 17.4% of the eyes. Therapeutic success was achieved in 130 eyes (89%) at the end of 1 month. Anatomical success was achieved in 130 (98.5%) and 88 patients (86.3%) at the end of 1 and 6 months, respectively. At the 6-month time point, 78 patients (76.5%) attained functional success with vision better than light perception. Three-year follow-up data were available for 23.7% of recipients, of which only 12 patients (37.5%) retained a clear graft either after a primary therapeutic or secondary optical keratoplasty. Conclusion: Therapeutic keratoplasty is highly effective in eradicating infection and providing anatomical integrity. However, timely intervention can aid in achieving the best functional outcome.

HEmoRhoidal disease management with Band ligation versus polidocanol Sclerotherapy: a systematic review and meta-analysis (the HerBS Review).

PURPOSE: Symptomatic internal hemorrhoids affect up to 40% of people in Western society. Patients with grade I-III hemorrhoids, who fail lifestyle and medical management, may benefit from office-based procedures. As per the American Society of Colon and Rectum Surgeons (ASCRS), rubber band ligation (RBL) is the first-line office-based treatment. Polidocanol sclerotherapy is a relatively new approach for these patients. The aim of this systematic review is to compare the efficacy of RBL and polidocanol sclerotherapy with the treatment of symptomatic grade I-III internal hemorrhoids. METHODS: The systematic review was completed by searching MEDLINE, Embase, and CENTRAL databases from inception to August 2022 for prospective studies comparing RBL and polidocanol sclerotherapy or evaluating the efficacy of polidocanol sclerotherapy alone for adult (> 18 years) patients with grade I-III internal hemorrhoids. Treatments were evaluated for therapeutic success and post-procedure morbidity. RESULTS: Of 155 citations obtained, 10 studies (3 comparative and 7 single-arm studies) and 4 abstracts (2 comparative and 2 single arm) were included in the study. The patients undergoing sclerotherapy had a 93% (151/163) therapeutic success rate compared to 75% (68/91) in the RBL group (OR 3.39, 95% CI 1.48-7.74, p < 0.01). The post-procedure morbidity was 8% (17/200) in the sclerotherapy group and 18% (23/128) in the RBL group (OR 0.53, 95% CI 0.15-1.82, p = 0.31). CONCLUSION: This study highlights that polidocanol sclerotherapy may be associated with higher therapeutic success in patients with symptomatic grade I-III internal hemorrhoids. Further evaluations in the form of randomized trials are required to evaluate patient populations, which may benefit more from sclerotherapy.

Early intervention in psoriasis: Where do we go from here?

Patients with psoriasis often have comorbidities and are at increased risk of developing several complications compared with the general population. Knowledge on the role of immune mediators and systemic inflammation in psoriasis has led to the hypothesis that early intervention with systemic therapy has the potential to modify the course of the disease and reduce the risk of long-term adverse outcomes. In this article, we address some potential issues that need to be considered before early intervention can be implemented routinely. The first is determining what constitutes "early" intervention for psoriasis. A second point is whether the intervention should be considered for patients with early disease or for selected subsets based on risk stratification. A third important consideration is defining success for early intervention. Finally, adoption of early and effective intervention should be based on high-level evidence. Ideally, randomized trials would be the best strategy to compare early vs. late systemic treatment in patients with psoriasis, probably using the frequency of long-term outcomes as primary endpoint, with cutaneous and pharmacoeconomic outcomes assessed secondarily.

A New Perspective for Predicting the Therapeutic Success of RFA in Solid BTNs: Quantitative Initial RFA Ratio by Contrast-Enhanced Ultrasound.

Objective: The short-term therapeutic success of radiofrequency ablation (RFA) in solid benign thyroid nodules is of great concern. The aim of this study was to investigate a new method, initial radiofrequency ablative ratio (IRAR) using contrast-enhanced ultrasound (CEUS), for predicting therapeutic success of RFA in solid benign thyroid nodules (BTNs) immediately and effectively after RFA. Methods: A total of 813 nodules in 776 patients with benign thyroid nodules were treated with RFA from January 2014 to August 2018, among which 120 patients (M:F=41:79) with 120 solid BTNs (small: ≤10ml, n=57; medium: 10-30ml, n=42; large: >30ml, n=21) were enrolled in our study according to the inclusion criteria. The IRAR was defined as the ablative volume ratio immediately after RFA displayed by CEUS. The therapeutic success was evaluated at the 6-month follow-up. The relationship between the IRAR and volume reduction ratio (VRR) at 6-month was analyzed. The marginal regrowth of solid BTNs was also examined by CEUS at the 6 and 12 months of follow-up. Results: In medium and large nodules, the IRAR was significantly and positively correlated with VRR (r= 0.69, P < 0.001) at 6 months after RFA. There was a tendency to achieve therapeutic success (50% VRR: 55/63, 87.3%) when the IRAR exceeded 75%, and marginal regrowth was also relatively slow within 12 months after a single session treatment. No significant correlation between IRAR and VRR of small nodules was found. In conclusion, IRAR is significantly and positively correlated with VRR, which may indicate therapeutic success when it exceeds 75%. Conclusions: CEUS can be used to accurately quantify the IRAR, which is positively correlated with the VRR. Moreover, the IRAR may be used as a parameter to predict the short-term therapeutic success of RFA in solid BTNs.

Association of cellular HIV-1 DNA and virological success of antiretroviral treatment in HIV-infected sub-Saharan African adults.

BACKGROUND: HIV-1 DNA persists in infected cells, forming viral reservoirs. Pre-antiretroviral treatment (ART) HIV-1 DNA load was reported to predict ART success in European severely immunocompromised patients. The aim of this study was to determine whether HIV-1 DNA levels are associated with virological success in less severely immunocompromised patients who receive early ART in sub-Saharan Africa. METHODS: The association between pre-ART HIV-1 DNA and the virological response after 30 months on ART was studied in multivariate logistic regression in patients randomised to immediate ART groups in the Temprano trial, which assessed the benefits of early ART in HIV-infected adults in Côte d'Ivoire. HIV-1 DNA was quantified in peripheral blood mononuclear cell (PBMC) using real-time PCR. RESULTS: HIV-1 DNA levels were measured in 1013 patients. Their medians [IQR] of pre-ART CD4 count, HIV-1 RNA and HIV-1 DNA levels were 465 [379-578]/mm3, 4.7 [4.0-5.3] log10 copies/ml and 2.9 [2.5-3.2] log10 copies/million PBMC, respectively. Pre-ART HIV-1 DNA was significantly correlated with pre-ART HIV-1 RNA (R = 0.59, p < 0.0001). In multivariate analysis, HIV-1 DNA < 3 log10 copies/million PBMC was significantly associated with virological success at M30 after adjustment for other key variables (ART regimen, IPT, sex, age, WHO clinical stage, CD4 and HIV-1 RNA; aOR 1.57; 95% CI 1.08-2.30; p = 0.02). CONCLUSION: Low HIV-1 DNA was statistically associated with virological success in this population of sub-Saharan African adults who started treatment with a median pre-ART CD4 count at 465/mm3. HIV-1 DNA could become a useful tool for guiding some therapeutic decisions in the test-and-treat era. Trial registration TEMPRANO ANRS 12136 ClinicalTrials.gov, number NCT00495651, date of registration 03/07/2007.

Identifying individual predictive factors for treatment efficacy.

Given the heterogeneous responses to therapy and the high cost of treatments, there is an increasing interest in identifying pretreatment predictors of therapeutic effect. Clearly, the success of such an endeavor will depend on the amount of information that the patient-specific variables convey about the individual causal treatment effect on the response of interest. In the present work, using causal inference and information theory, a strategy is proposed to evaluate individual predictive factors for cancer immunotherapy efficacy. In a first step, the methodology proposes a causal inference model to describe the joint distribution of the pretreatment predictors and the individual causal treatment effect. Further, in a second step, the so-called predictive causal information (PCI), a metric that quantifies the amount of information the pretreatment predictors convey on the individual causal treatment effects, is introduced and its properties are studied. The methodology is applied to identify predictors of therapeutic success for a therapeutic vaccine in advanced lung cancer. A user-friendly R library EffectTreat is provided to carry out the necessary calculations.

Perspectives on Nanodelivery to the Brain: Prerequisites for Successful Brain Treatment.

Nanocarriers (NCs) are promising tools to improve drug delivery across the blood-brain barrier (BBB) for more effective treatment of brain disorders, although there is a scarcity of clinical translation of brain-directed NCs. In order to drive the development of brain-oriented NCs toward clinical success, it is essential to understand the prerequisites for nanodelivery to be successful in brain treatment. In this Perspective, we present how pharmacokinetic/pharmacodynamic (PK/PD), formulation and nanotoxicity factors impact the therapeutic success of brain-specific nanodelivery. Properties including high loading efficiency, slow in vivo drug release, long systemic circulation, an increase in unbound brain-to-plasma concentration/exposure ratio (Kp,uu,brain), high drug potency, and minimal nanotoxicity are prerequisites that should preferably be combined to maximize the therapeutic potential of a brain-targeted NC. The PK of brain-directed NCs needs to be evaluated in a more therapeutically relevant manner, focusing on the released, unbound drug. It is more crucial to increase the Kp,uu,brain than to improve the ability of the NC to cross the BBB in its intact form. Brain-targeted NCs, which are mostly developed for treating brain tumors, including metastases, should aim to enhance drug delivery not just to tumor regions with disrupted BBB, but equally important to regions with intact BBB where the drugs themselves have problems reaching. This article provides critical insights into how a brain-targeted nanoformulation needs to be designed and optimized to achieve therapeutic success in the brain.

Transhepatic Percutaneous Sustained Dilation with Multiple Catheters for the Management of Hepaticojejunostomy Benign Stricture.

Background: Benign biliary strictures (BBS) befall in ∼7%-23% after hepaticojejunostomy and in 0.3%-0.6% after cholecystectomies. Their treatment options include surgical, endoscopic, and percutaneous management. The percutaneous approach is an excellent mini-invasive option including balloon dilation, biodegradable stents, and sustained dilation, a procedure born endoscopically. However, when the endoscopic approach fails or it is not available, it is possible to perform it percutaneously. Aim: To estimate the technical and clinical success of sustained percutaneous dilation with multiple catheters (SPDMC) in hepaticojejunostomy strictures and the percentage of complications and recurrence. Materials and Methods: We conducted a retrospective study, from a prospective database from January 2010 to March 2019, of 17 patients with postoperative BBS who failed to percutaneous pneumatic balloon dilation and underwent SPDMC with a mean follow-up of 2 years. Results: Seventeen patients between 28 and 71 years of age underwent SPMDC with technical success of 100%; the average number of catheters used was 5.59 (95% confidence interval [CI] 5.12-6.06) achieving a dilatation diameter of 16.15 mm (95% CI 14.71-17.60), and the therapeutic success rate was 71%, with recurrences of stricture and complications of 29% and 18%, respectively. The mean time with SPMDC was 7.06 months (95% CI 5.56-8.56). The median follow-up after dilation was 16 months, with an average of 27.75 months (95% CI 14.15-41.34). Conclusion: SPMDC is a feasible technique with a high technical success rate, therapeutic success rate, and low morbidity and mortality.

Patients' Satisfaction With the Therapeutic Relationship and Therapeutic Outcome Is Related to Suicidal Ideation in the Attempted Suicide Short Intervention Program (ASSIP).

Background: The therapeutic alliance may be a moderating factor of outcome in the Attempted Suicide Short Intervention Program (ASSIP). Aims: This study investigates the two components of the therapeutic alliance, patients' satisfaction with the therapeutic relationship and therapeutic outcome and their associations with suicidal ideation over time. Method: A total of 120 patients (55% female; mean age = 36 years) with a history of attempted suicide were randomly allocated to either the intervention group (N = 60) or the control group (N = 60). Patients' satisfaction with the therapeutic relationship and outcome were measured with the two subscales of the Helping Alliance Questionnaire. The Beck Scale of Suicide Ideation was used to measure suicidal ideation in this 24-month follow-up study. Results: The ASSIP group showed that patients' satisfaction with therapeutic relationship and outcome increased significantly from the first to the third session. Higher satisfaction with therapeutic outcome correlated significantly with lower suicidal ideation at follow-up. Conversely, the control group showed no significant results. Limitations: The collaborative approach adopted in the initial clinical interview of the control group could possibly have influenced the results of both scales. Conclusion: In particular, the component satisfaction with therapeutic outcome seems crucial to the subjectively perceived satisfaction of treatment and is associated with lower suicidal ideation over time. Thus, an enhanced understanding of components of the therapeutic alliance plays an important role in the development of interventions for suicidal patients.

Caracterização dos estudos sobre ambivalência em Psicoterapia: uma revisão de literatura / Characterization of ambivalence studies in Psychotherapy: a literature review

Em psicoterapia, a ambivalência é definida como posições opostas, do paciente, em relação à mudança e tem sido apontada como uma variável de forte interferência nos resultados terapêuticos. Devido à importância e influência desse fenômeno para o desenvolvimento e resultado da terapia, e à escassez de pesquisas que tenham essa temática como objeto de estudo, objetiva-se apresentar uma revisão de literatura englobando artigos que definam a ambivalência, apresentem sua relação com o sucesso terapêutico, avaliem instrumentos e abordem teorias que embasam o fenômeno. Foram utilizados os descritores "Ambivalence", "Psychotherapy" e "Motivation for change" nas bases de dados PubMed, PsychoINFO e Web of Science. Inicialmente foram encontrados 2178 artigos, dos quais 13 foram incluídos por preencherem os seguintes critérios: estudos em português, inglês ou espanhol, que tinham como objetivo principal relacionar a ambivalência com resultados terapêuticos, definir a ambivalência, avaliar instrumentos de identificação e mensuração da ambivalência ou apresentar a ambivalência a partir de alguma teoria. Os critérios de exclusão foram: teses, dissertações, livros e capítulos de livros, ou estudos realizados há mais de 10 anos. Através dessa revisão de literatura, a Entrevista Motivacional e a teoria dos Momentos de Inovação se apresentaram como principais bases teóricas do fenômeno e diversos estudos evidenciaram a relação da ambivalência com o sucesso terapêutico, indicando a necessidade de que as pesquisas futuras apliquem esforços na construção de melhores definições para esse constructo, no aprofundamento em suas bases teóricas, e principalmente na construção e avaliação de formas de mensuração da ambivalência no contexto da psicoterapia.(AU)

In psychotherapy, ambivalence is defined as the patient's opposite positions in relation to change and has been pointed as a variable of strong interference in therapeutic outcomes. Due to the importance and influence of this phenomenon for the development and outome of the therapy, and the scarcity of research that have this theme as object of study, we aim to present a literature review encompassing articles that define ambivalence, present their relationship with therapeutic success, assess the instruments and address theories underlying the phenomenon. The descriptors "Ambivalence", "Psychotherapy" and "Motivation for change" were used in the PubMed, PsychoINFO and Web of Science databases. Initially, 2178 articles were found, of which 13 were included because they met the following criteria: studies in Portuguese, English or Spanish, whose main objective was to relate ambivalence to therapeutic outcomes, define ambivalence, evaluate instruments for identification and measurement of ambivalence or present ambivalence from some theory. Exclusion criteria were: theses, dissertations, books and book chapters, or studies conducted more than 10 years ago. Through this literature review, the Motivational Interview and the Moments of Innovation theory werepresented as the main theoretical basis of the phenomenon and several studies have shown the relation between ambivalence and therapeutic success, indicating the need for future research to apply efforts in the construction of better definitions for this construct, deepening its theoretical bases, and especially in the construction and evaluation of ways of measuring ambivalence in the context of psychotherapy.(AU)

En psicoterapia, la ambivalencia se define como las posiciones opuestas del paciente en relación con el cambio y se ha señalado como una variable de fuerte interferencia en los resultados terapéuticos. Debido a la importancia e influencia de ese fenómeno para el desarrollo y resultado de la terapia, y la escasez de investigaciones que tienen este tema como objeto de estudio, nuestro objetivo es presentar una revisión de literatura que engloba artículos que definan la ambivalencia, presenten su relación con el éxito terapéutico, evalúen instrumentos y aborden teorías que fundamentan el fenómeno. Se utilizaron los descriptores "Ambivalence", "Psychotherapy" y "Motivation for change" en las bases de datos PubMed, PsychoINFO y Web of Science. Inicialmente, se encontraron 2178 artículos, de los cuales 13 se incluyeron porque cumplían con los siguientes criterios: estudios en portugués, inglés o español, cuyo objetivo principal era relacionar la ambivalencia con los resultados terapéuticos, definir la ambivalencia, evaluar los instrumentos para la identificación y medición de la ambivalencia o la ambivalencia actual de algunos teoría Los criterios de exclusión fueron: tesis, disertaciones, libros y capítulos de libros, o estudios realizados hace más de 10 años. A través de esta revisión de literatura, la Entrevista Motivacional y la teoría de los Momentos de Innovación se presentaron como principales bases teóricas del fenómeno y diversos estudios evidenciaron la relación de la ambivalencia con el éxito terapéutico, indicando la necesidad de que las investigaciones futuras apliquen esfuerzos en la construcción de las mejores definiciones para ese constructo, en la profundización en sus bases teóricas, y principalmente en la construcción y evaluación de formas de medición de la ambivalencia en el contexto de la psicoterapia.(AU)

[Impact on success rates among drugdependent men and women treated in separate therapeutic groups.] / Impacto en el éxito terapéutico de hombres y mujeres drogodependientes en grupos separados.

OBJECTIVE: The incorporation of gender variable in drug addiction studies provides information about the presence of differences in the therapeutic success rates between men and women. Is therefore essential to carry out studies to analyse the efficacy of differentiated treatments to improve their success. The objective of this study is to observe differences in success rates among women and men undergoing therapy for drug dependence at an addiction centre during two different periods, before 2005, in which they are treated together and after 2005, in which they are treated in separate groups. METHODS: The method was as follows: profiling of the individuals in treatment, analysis of the relationship between successful therapy and the independent variables, T-tests of independent samples and, finally, a logistic regression analysis of the period after 2005 when women and men were separated. RESULTS: Improved success rates were observed among women after 2005 compared with the previous period (Odds of success in women before 2005=2,00; after 2005=7,08). Success rates among men did not change significantly (Odds of success in men before 2005=2,78; after 2005=2,75). Women's success rates were higher than men's (24,4 times more probable on average) for all types of substance abuse and increased for shorter types of treatment, whereas success rates with longer treatments tended to be similar for both men and women (20,5 more likely). CONCLUSIONS: The study shows improved success rates for drug-dependent women when they are treated separately from men, once the specific problems of drug addiction in women are taken into account.

OBJETIVO: La incorporación de la variable sexo en los estudios sobre drogodependencia ofrece información sobre la existencia de diferencias en el éxito terapéutico entre hombres y mujeres, advirtiéndose la necesidad de realizar estudios que analicen la eficacia de los tratamientos diferenciados para la mejora del éxito de los mismos. El objetivo de este estudio fue observar las diferencias en el éxito terapéutico en mujeres y hombres drogodependientes de un centro en dos períodos diferentes: antes de 2005, cuando son tratados conjuntamente; y a partir de 2005, cuando son tratados separadamente. METODOS: La secuencia de análisis fue la siguiente: elaboración de un perfil de las personas tratadas, análisis de asociación entre éxito terapéutico y variables independientes, realización de pruebas T para muestras independientes y, finalmente, un análisis de regresión logística para el período posterior a 2005 en el que se separan mujeres y hombres. RESULTADOS: Se observaron mejoras del éxito en mujeres a partir de 2005 respecto al éxito en las mismas en el período anterior (Odds de éxito en mujeres antes 2005=2,00; después de 2005=7,08). Las probabilidades de éxito en los hombres no se modificaron sustancialmente (Odds de éxito en hombres antes 2005=2,78; después de 2005=2,75). El éxito en las mujeres respecto al de los hombres fue mayor (24,4 veces más probable de media), independientemente de la sustancia consumida, en los tratamientos más cortos de tiempo, mientras que los tratamientos más largos tendieron a igualar el éxito en hombres y mujeres (20,5 más probable). CONCLUSIONES: El estudio muestra mejoras del éxito en mujeres drogodependientes al presentarse tratamientos separados, una vez atendidas las problemáticas específicas de la drogadicción en las mujeres.

[Core outcome measurements in hand eczema trials : The HECOS initiative]. / Erfassung von Core-Outcomes in Handekzemstudien : Die HECOS(Hand Eczema Core Outcome Set)-Initiative.

BACKGROUND: To enhance the informative value and comparability of hand eczema trials, the consensus of a set of core outcomes is necessary. OBJECTIVES: How is success of therapeutic and preventive interventions currently determined in hand eczema trials? Which standard should apply in the future? MATERIALS AND METHODS: As a first step, a systematic literature review was conducted to describe the status in controlled and randomized-controlled hand eczema trials from 2000-2017 and to identify the applied outcomes. The Hand Eczema Core Outcome Set (HECOS) initiative follows the guidelines of the Cochrane Skin Group Core Outcomes Set Initiative (CS-COUSIN) so that its further process is going to ensure the validity of the proposed measurement instruments and the appropriate inclusion of patients', physicians', and researchers' perspectives. RESULTS: Previous trials predominantly assessed erythema, scaling, fissures, vesicles, or pruritus as clinical signs and symptoms of hand eczema. These variables were often not reported separately but as part of a variety of scores. Only few hand eczema scores were applied in more than one trial-most commonly the Hand Eczema Severity Index (HECSI, in 10% of the trials). Overall skin condition, without mentioning specific signs or symptoms, was assessed in 51% of the trials. CONCLUSIONS: Although certain clinical signs and symptoms were assessed by a majority of hand eczema trials, comparability of results was not ensured because various measurement instruments were applied. HECOS is going to agree on a set of relevant and valid core outcome measurement instruments.

Insulin pump therapy: education and its goals.

Insulin pump therapy represents nowadays the way of insulin administration most similar to the physiological insulin secretion. This form of intensified insulin regime is used mostly (but not exclusively) in type 1 diabetes patients. Insulin pump therapy can be efficiently combined with continuous glucose monitoring. Even there are available insulin pumps which can serve as continuous glucose monitoring signal receiver themselves and are capable to stop automatically basal insulin infusion to prevent hypoglycemia. By this technological combination it is possible to reach near normoglycemia without increasing the risk of severe hypoglycemia. In the Czech Republic this therapy is covered by insurance when defined indication criteria are fulfilled. To reach this therapy full potential the patient as well as the professionals must be trained properly to know all technical aspects of this therapy as well as it is necessary to gain further knowledge. Particularly important is knowledge on food nutrition content and on the glycemic effect of different meals. All these factors are discussed in details in the paper.

Successful radiofrequency ablation strategies for benign thyroid nodules.

PURPOSE: This study aimed to evaluate the effectiveness of ultrasound (US)-guided radiofrequency ablation (RFA) treatment of benign thyroid nodules in consecutive large number series. To find out whether there is any difference according to the nature of the nodules, nodules were subdivided into two groups of predominantly solid vs. predominantly cystic lesions. METHODS: We retrospectively analyzed clinical data of thyroid nodules receiving percutaneous RFA treatment in our institution. We subdivided data into two groups according to the nodule's sonographic characteristics. We defined therapeutic success as a volume reduction rate >50% at 6 months post-RFA. The second ablation was performed in case where <50% VRR was achieved at 6 months. The primary endpoint was to identify factors prognosticating response to RFA treatment. RESULTS: A total of 1000 patients with 1619 thyroid nodules received US-guided RFA treatment. A volume reduction of >50% (therapeutic success) after the first ablation was 78.9% vs. 78.2% (p = 0.439) and 91.4% vs. 93.4% (p = 0.148) after the final ablation for predominantly cystic vs. predominantly solid lesions, respectively, with comparable post-interventional morbidity. RFA sessions were more frequent in the solid group than in the cystic group. Small volume of thyroid nodule (<4 mL) was the only factor significantly associated with therapeutic success in the multivariate analysis (OR 1.848; 95% CI 1.537-2.789, p = 0.030). CONCLUSION: RFA was effective in reducing the volume of benign thyroid nodules volume with non-inferior result in PS group comparing to PC group and can be considered a principal treatment method for treating benign thyroid nodules, including cystic nodules.

Plant essential oils against bacteria isolated from fish: an in vitro screening and in vivo efficacy of Lippia origanoides / Óleos essenciais de plantas contra bactérias isoladas de peixes: uma triagem in vitro e eficácia in vivo de Lippia origanoides

ABSTRACT: The use of natural products, such as essential oils (EOs), is a potential novel approach to treat fish bacterial infections with a lower risk of developing resistance. There has been a number of studies reporting the activity of EOs as those obtained from the species Achyrocline satureioides, Aniba parviflora, Aniba rosaeodora, Anthemis nobilis, Conobea scoparioides, Cupressus sempervirens, Illicium verum, Lippia origanoides, and Melaleuca alternifolia against bacteria. However, there are few studies investigating the effect of these EOs against fish bacteria. Therefore, the aim of this study was to evaluate the in vitro antibacterial activity of EOs against the following fish bacteria, Aeromonas hydrophila, Citrobacter freundii, and Raoultella ornithinolytica. Additionally, the in vivo antibacterial activity of the EO L. origanoides was evaluated against experimentally induced A. hydrophila infection of silver catfish (Rhamdia quelen). The EO of L. origanoides was chosen as it showed the highest in vitro antibacterial activity, with minimum inhibitory concentrations ranging from 0.2 to 0.8 mg mL-1. This EO also presented a therapeutic success of 58.33%, on a 30 day A. hydrophila infection. Therefore, we suggested that the EO of L. origanoides may be a viable alternative as a treatment for A. hydrophila infection.

RESUMO: O uso de produtos naturais, como óleos essenciais (OEs), é uma nova abordagem potencial para o tratamento de infecções bacterianas em peixes com um baixo risco de desenvolvimento de resistência. Existem estudos reportando a atividade de OEs como aqueles obtidos das espécies Achyrocline satureioides, Aniba parviflora, Aniba rosaeodora, Anthemis nobilis, Conobea scoparioides, Cupressus sempervirens, Illicium verum, Lippia origanoides e Melaleuca alternifolia contra bactérias. Porém, existem poucos estudos investigando o efeito desses OEs supracitados contra bactérias isoladas de peixes. Portanto, o objetivo desse estudo foi avaliar a atividade antibacteriana in vitro desses OEs contra bactérias isoladas de peixes (Aeromonas hydrophila, Citrobacter freundii e Raoultella ornithinolytica). Assim como avaliar a atividade antibacteriana in vivo do OE de L. origanoides contra uma infecção por A. hydrophila experimentalmente induzida em jundiá (Rhamdia quelen). O OE de L. origanoides foi escolhido porque apresentou a melhor atividade antibacteriana in vitro, com concentrações inibitórias mínimas variando de 0,2 a 0,8 mg mL-1. Esse OE apresentou sucesso terapêutico de 58,33% no dia 30 pós-infecção. Portanto, sugerimos que o OE de L. origanoides possa ser uma alternativa viável no tratamento da infecção por A. hydrophila em peixes.

Outcome of therapeutic penetrating keratoplasty in advanced infectious keratitis.

PURPOSE: This study aimed to evaluate the anatomical, therapeutic, and functional outcome of therapeutic penetrating keratoplasty (TPK) in terms of success and failure. METHODS: In this retrospective study 57 eyes of 57 patients were reviewed. They had undergone TPK from December 2012 to June 2017. Data analyzed included the baseline demographic features and characteristics, preoperative diagnosis, and postoperative outcomes. The baseline characteristics included age, gender, laterality, indications of TPK, lens status, size of the recipient, grade of the graft, organisms identified, preoperative best corrected visual acuity (BCVA), secondary procedures, adjunctive surgical procedure, postoperative BCVA at last follow-up, intraocular pressure (IOP), and long-term complications of TPK. The ultimate outcome of TPK was observed in terms of anatomical, therapeutic, and functional outcome which indicated the success and failure. RESULTS: A total of 57 eyes of 57 with an age range of 2-76-year-old patients who underwent TPK were included in the study. Perforated corneal ulcer was a major indication of TPK in 32 (56.1%) cases. Anatomical success was obtained overall in 49 (85.96%) cases. Indications of TPK and preoperative visual acuity, complications of TPK, and ultimate graft clarity showed significant impact on the anatomical outcome (P = 0.03, P = 0.00, P = 0.00, and P = 0.05), respectively. The therapeutic and functional success was observed in 51 (89.47%) and 40 (70.17%) cases, respectively. CONCLUSIONS: Perforated corneal ulcers was the major indication for TPK. Indications and complications significantly affect the anatomical, therapeutic, and functional outcome.

Initial Ablation Ratio: Quantitative Value Predicting the Therapeutic Success of Thyroid Radiofrequency Ablation.

BACKGROUND: The aims of this study were to determine a quantitative index, the initial ablation ratio (IAR), representing the amount of ablation, to predict therapeutic success and to evaluate the correlation between the IAR and volume reduction ratio (VRR). METHODS: Among the patients who underwent radiofrequency ablation (RFA) for the treatment of benign thyroid nodules at the Withsim Clinic between April 2008 and December 2016, 130 patients with 134 nodules were included. The relationship between the IAR and VRR was analyzed at six months, 12 months, and the final follow-up. The relationship between the IAR and final VRR was also analyzed according to the initial nodule volumes. RESULTS: The mean VRR was 78.7 ± 17.5% (range 23.3-100%) at a mean follow-up period of 22.6 ± 20.1 months (range 3-93 months). The mean IAR was 90.0 ± 11.6% (range 39.1-100%). The correlation coefficient between the IAR and final VRR was 0.65, which indicates a positive correlation (p < 0.001). When the IAR exceeded 70%, it tended to achieve 50% VRR in most cases. CONCLUSIONS: The IAR is a quantitative indicator of how well the RFA procedures are performed, and it is highly correlated with the VRR. If the IAR is >70%, VRR of >50% may be expected after RFA.