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Objective To explore the therapeutic effect of picosecond alexandrite lattice laser combined with tranexamic acid in the treatment of seborrheic keratosis and its effect on sex hormones. Methods From March 2017 to January 2019, 238 patients with seborrheic keratosis admitted to department of dermatology were randomly divided into control group and observation group, 119 patients in each group. The control group was treated by ultra-pulse carbon dioxide laser. The observation group was treated by picosecond alexandrite lattice laser combined with tranexamic acid. Each group was treated by appropriate energy according to the location and properties of the lesion. All patients were followed up at 3 months after the treatment finished. Dermatology life quality index (DLQI), sex hormones level (E2, FSH, LH) and adverse reactions between 2 groups were recorded. Results The effective rate of the control group was 72.3% and the cure rate was 29.4%. The effective rate of the observation group was 78.2% and the cure rate was 58.0%. The cure rate of the observation group after one treatment was significantly better than that of the control group(P<0.001). There was no significant difference in the effective rate(P>0.05). The level of E2, FSH and LH of the observation group was lower than those before the treatment (P<0.05). The DLQI scores of both groups were lower than those before the treatment (P<0.05). There was no significant difference between two groups (P>0.05). No serious adverse reactions occurred. Conclusion Picosecond alexandrite lattice laser combined with tranexamic acid had a good therapeutic effect on seborrheic keratosis patients. This method could help to improve the level of sex hormones. [ABSTRACT FROM AUTHOR]

Background: Community-onset pneumonia (COP) is a combined concept of community acquired pneumonia and the previous classification of healthcare-associated pneumonia. Although ceftriaxone (CRO) is one of the treatment choices for COP, it is unclear whether 1 or 2 g CRO daily has better efficacy. We compared the effectiveness of 1 g with 2 g of CRO for COP treatment. We hypothesized that 1 g CRO would show non-inferiority over 2 g CRO.Methods: This study was an analysis of prospectively registered data of the patients with COP from four Japanese hospitals (the Adult Pneumonia Study Group-Japan: APSG-J). We included subjects who were initially treated solely with 1 or 2 g of CRO. The propensity score was estimated from the 33 pre-treatment variables, including age, sex, weight, pre-existing comorbidities, prescribed drugs, risk factors for aspiration pneumonia, vital signs, laboratory data, and a finding from chest xrays. The primary endpoint was the cure rate, for which a non-inferiority analysis was performed with a margin of 0.05. In addition, we performed three sensitivity analyses; using data limited to the group in which CRO solely was used until the completion of treatment, using data limited to inpatient cases, and performing a generalized linear mixed-effect logistic regression analysis to assess the primary outcome after adjusting for random hospital effects.Results: Of the 3817 adult subjects with pneumonia who were registered in the APSG-J study, 290 and 216 were initially treated solely with 1 or 2 g of CRO, respectively. Propensity score matching was used to extract 175 subjects in each group. The cure rate was 94.6 and 93.1% in the 1 and 2 g CRO groups, respectively (risk difference 1.5%; 95% confidence interval - 3.1 to 6.0; p = 0.009 for non-inferiority). The results of the sensitivity analyses were consistent with the primary result.Conclusions: The propensity score-matched analysis of multicenter cohort data from Japan revealed that the cure rate for COP patients treated with 1 g daily CRO was non-inferior to that of patients treated with 2 g daily CRO. [ABSTRACT FROM AUTHOR]

Background: Sub-Saharan Africa carries most of the global burden of schistosomiasis. To optimize disease control and reduce morbidity, precise data are needed for control measures adapted to the local epidemiological situation. The objective of this study is to provide baseline information on schistosomiasis dynamics, including praziquantel (PZQ) treatment outcome in children and young adults living in the vicinity of Lambaréné, Gabon. Methods: Eligible volunteers were included into a prospective longitudinal study. Urine filtration technique was used to detect eggs in urine for schistosomiasis diagnosis. Subjects were treated with 60 mg of PZQ once per month for three consecutive months, and the outcome was assessed by cure rate (CR) and egg reduction rate (ERR). Results: A total of 328 volunteers were enrolled in the study with a mean (± SD) age of 12.2 ± 4.7 years-old. The female-to-male ratio was 0.99. Out of 258 participants in total, 45% had schistosomiasis during the survey and 43% presented with heavy infections. The incidences of haematuria and schistosomiasis were 0.11 and 0.17 person-years, respectively. After the first and third dose of PZQ, overall ERR of 93% and 95% were found, respectively; while the CR were 78% and 88%, respectively. Both ERR (100 vs 88%) and CR (90 vs 68%) were higher among females than males after the first dose. The CR increased for both groups after the third dose to 95% and 80%, respectively. After the first PZQ dose, ERR was higher for heavy compared to light infections (94 vs 89%), while the CR was higher for light than for heavy infections (87 vs 59%). After the third PZQ dose, ERR increased only for light infections to 99%, while CR increased to 98% and 75% for light and for heavy infections, respectively. The reinfection rate assessed at a mean of 44.6 weeks post-treatment was 25%. Conclusions: The prevalence of schistosomiasis is moderate in communities living in the vicinity of Lambaréné, where a subpopulation with a high risk of reinfection bears most of the burden of the disease. To improve schistosomiasis control in this scenario, we suggest education of these high-risk groups to seek themselves a one-year PZQ treatment. Trial registration clinicaltrials.gov Identifier NCT 02769103. Registered 11 May 2016, retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT02769013 [ABSTRACT FROM AUTHOR]

The main objective of this manuscript is to study the dynamical behaviour and numerical solution of a HIV/AIDS dynamics model with fusion effect and cure rate. Local and global asymptotic stability of the model is established by Routh-Hurwitz criterion and Lyapunov functional method for infection-free equilibrium point. The numerical solutions of the model has also examined for support of analysis, through Mathematica software. [ABSTRACT FROM AUTHOR]

Summary: An important research topic in survival analysis is related to the modelling and estimation of the cure rate, i.e. the proportion of subjects who will never experience the event of interest. However, most estimation methods proposed so far in the literature do not handle the case of insufficient follow‐up, i.e. when the right end point of the support of the censoring time is strictly less than that of the survival time of the susceptible subjects, and consequently these estimators overestimate the cure rate in that case. We fill this gap by proposing a new estimator of the cure rate that makes use of extrapolation techniques from the area of extreme value theory. We establish the asymptotic normality of the estimator proposed and show how the estimator works for small samples by means of a simulation study. We also illustrate its practical applicability through the analysis of data on the survival of breast cancer patients. [ABSTRACT FROM AUTHOR]

Introduction: One of the most serious problems in TB control is non‐adherence to treatment leading to the risk of drug resistance and subsequent treatment failure. Objectives: To assess the impact of an educational strategy intervention and remote supervision on the post‐discharge management of new cases of TB diagnosed in hospital on TB cure rate. Secondarily, to assess the impact of this intervention on default rate. Methods: Randomized control trial conducted at a general, tertiary care, university affiliated hospital. New cases of TB diagnosed in hospital were included. The primary outcome was cure rate and secondary outcome was default rate. Analysis was carried out by modified intention to treat. Results: A total of 169 new tuberculosis patients were enrolled. Among them, 80 were assigned to intervention group and 89 to control group. The cure rate was 71.3% in the intervention group and 58.4% in the control group. In the multivariate binary logistic regression model to evaluate the effect of the intervention, controlled by age, sex, current smoking status and directly observed treatment short, intervention was independently associated with cure rate (OR = 0.47; 95% CI: 0.24‐0.94; P = 0.033).There was a significant difference in the default rate between the control and intervention groups (18.0% vs 5.0%, respectively, P = 0.039). Conclusion: An educational strategy intervention and remote supervision on the post‐discharge management of new cases of TB with in‐hospital diagnosis had a positive effect of small magnitude on cure rate. Secondarily, the treatment default rate has been significantly decreased with the intervention. [ABSTRACT FROM AUTHOR]

In this work, we proposed the semi-parametric cure rate models with independent and dependent spatial frailties. These models extend the proportional odds cure models and allow for spatial correlations by including spatial frailty for the interval censored data setting. Moreover, since these cure models are obtained by considering the occurrence of an event of interest is caused by the presence of any nonobserved risks, we also study the complementary cure model, that is, the cure models are obtained by assuming the occurrence of an event of interest is caused when all of the nonobserved risks are activated. The MCMC method is used in a Bayesian approach for inferential purposes. We conduct an influence diagnostic through the diagnostic measures in order to detect possible influential or extreme observations that can cause distortions on the results of the analysis. Finally, the proposed models are applied to the analysis of a real data set. [ABSTRACT FROM AUTHOR]

Voids or porosities have been one of the biggest headaches in composite fabricators and are still a challenging issue. In this study, void behavior in a low pressurized area of the laminate during cure is identified and analyzed. And, the influence of material's cure rate difference on laminate inner quality is evaluated and verified through material evaluation and test article fabrication with subsequent non-destructive and destructive inspection. When there is a surface film on outer layer of the laminate, it is confirmed that surface film acts as barrier layer to prevent void evacuation and keep voids locked in laminate during cure. And, under the same fabrication condition and process variables, except for a layer of surface film, trapped void have been properly evacuated and test article exhibited good inner quality. [ABSTRACT FROM AUTHOR]

Abstract Backgroud This study compares the outcome of parathyroidectomy for primary hyperparathyroidism (PHPT) in patients whose adenomas' weights were at the extremes of the distribution curve. As the size of parathyroid adenomas influences the success rate of localization studies for PHPT, it is possible that a difference in cure rate could be observed between subgroups of patients. Materials and methods Data were retrieved from a prospective database maintained in a large university hospital. Results From a cohort of 519 patients who underwent parathyroidectomy for PHPT, two subgroups of patients were identified based on the extreme 10% of the distribution curve for adenomas' weight: adenomas <300 mg ("dwarfs", n = 100, median 200 mg) and >3000 mg ("giants", n = 56, median 4300 mg). In comparison with giant adenomas, dwarf adenomas were associated with less severe hypercalcemia (median 2.84 versus 3.00 mmol/L, P < 0.001) and lower PTH (median 11.7 versus 25.6 pmol/L, P < 0.001). The occurrence of dwarf adenomas showed no trend during the study period (23/173 [13%] in 2000-2004 versus 36/217 [17%] in 2007-2011). Scan-directed parathyroidectomy was feasible in more patients with giant adenomas (59% versus 38%). Persistent disease was diagnosed in three patients with dwarf adenomas. Patients with giant adenomas had no recurrence during a follow-up of 40 mo even though eight patients had histological features suggestive of atypical/malignant tumors. Conclusions Preoperative biochemistry is a poor predictor of adenomas' size even at the extremes of the distribution curve. Cure can be achieved in all patients with "dwarf" adenomas. Even in the presence of suspicious histological features, "giant" adenomas did not show malignant behavior. [ABSTRACT FROM AUTHOR]

Zero-inflated nonnegative continuous (or semicontinuous) data arise frequently in biomedical, economical, and ecological studies. Examples include substance abuse, medical costs, medical care utilization, biomarkers (e.g., CD4 cell counts, coronary artery calcium scores), single cell gene expression rates, and (relative) abundance of microbiome. Such data are often characterized by the presence of a large portion of zero values and positive continuous values that are skewed to the right and heteroscedastic. Both of these features suggest that no simple parametric distribution may be suitable for modeling such type of outcomes. In this paper, we review statistical methods for analyzing zero-inflated nonnegative outcome data. We will start with the cross-sectional setting, discussing ways to separate zero and positive values and introducing flexible models to characterize right skewness and heteroscedasticity in the positive values. We will then present models of correlated zero-inflated nonnegative continuous data, using random effects to tackle the correlation on repeated measures from the same subject and that across different parts of the model. We will also discuss expansion to related topics, for example, zero-inflated count and survival data, nonlinear covariate effects, and joint models of longitudinal zero-inflated nonnegative continuous data and survival. Finally, we will present applications to three real datasets (i.e., microbiome, medical costs, and alcohol drinking) to illustrate these methods. Example code will be provided to facilitate applications of these methods. [ABSTRACT FROM AUTHOR]

Abstract Background TB and HIV are the most prevalent communicable diseases of major public health importance in the populations of sub-Saharan African countries, and an estimated 30 % of HIV infected persons have dual infection with TB. TB is the leading cause of death in HIV infected individuals, and HIV co-infected TB patients have multiple individual, disease specific and treatment related factors that can adversely affect their treatment outcomes. There is lack of evidence on the individual patient outcomes of HIV co-infected TB patients who receive anti-TB treatment. It is relevant to understand the differential patient outcomes of HIV co-infected TB patients and identify the factors that are associated with these outcomes. Methods A comparative analysis was done on the data from a random sample of 575 TB patients who were enrolled for TB treatment from January 2013 to December 2013 at eight health facilities in Ethiopia. A descriptive analysis was done on the data, and chi-square test and logistic regression analysis was conducted to compare TB treatment outcomes based on HIV status and to identify factors associated with these outcomes. Results Out of a total of 575 TB patients enrolled into the study, 360 (62.6 %) were non-HIV infected, 169 (29.4 %) were HIV co-infected, and 46 (8 %) had no documented HIV status. The overall treatment success rate was 91.5 % for all the study participants. HIV co-infected TB patients have a treatment success rate of 88.2 % compared with 93.6 % for non-HIV infected study participants (P = 0.03). HIV co-infected TB patients had a significantly higher rate (11.8 % versus 6.4 %, P = 0.03) of unfavourable outcomes. The cure rate was significantly lower (10.1 % versus 24.2 %, P = 0.001) and the death rate higher in HIV co-infected TB patients (8.3 % versus 2.5 %, P = 0.014). Age and TB classification were significantly associated with treatment outcome. No association was found with starting ART, Cotrimoxazole prophylactic treatment or enrolment in HIV care. Conclusions There is high TB treatment success rate among patients who have been treated for TB, but the treatment success rate and the cure rate in HIV co-infected TB patients is lower than that observed in non-HIV infected patients. Patients with advanced age and those with smear positive pulmonary TB have unfavourable treatment outcomes.

Abstract Background Intestinal schistosomiasis is one of the neglected tropical parasitic diseases caused by Schistosoma mansoni. Currently, the control measures for the disease are mainly based on mass drug administration (MDA) with praziquantel (PZQ) targeting the school-age children. In Ethiopia, the potential foci for schistosomiasis and therapeutic efficacy of PZQ among school-age children remain poorly explored. Therefore, we determined both the prevalence and intensity of S. mansoni infection and the therapeutic efficacy of PZQ among school children in the Manna District (new foci for S. mansoni), Jimma Zone, southwest Ethiopia. Methods A cross-sectional study was conducted among the school children aged between 6 and 18 years in three primary schools in Manna district from March to April 2014. For diagnosis of S. mansoni, a single stool sample was obtained from each child and processed using single Kato Katz and examined under light microscopy. A questionnaire was used to collect demographic information of the school children participated in the study. School children excreting eggs of S. mansoni were administered with 40 mg/kg of PZQ and re-examined after three weeks post-treatment. The therapeutic efficacy of PZQ against S. mansoni was evaluated by means of cure rate and egg reduction rate. Results The overall prevalence of S. mansoni among the school children in the three primary schools in Manna District was 24.0 %. Higher prevalence was recorded for males 25.6 % (61/238) than for females 22.5 % (59/262). Majority (27.5 %) of infection intensity was light with mean faecal egg count (FEC) of 202 eggs per gram (EPG). The therapeutic efficacy of PZQ at a dose of 40 mg/kg was highly efficient (cure rate of 99.1 % and egg reduction rate of 99.9 %) among the school children in the three primary schools in Manna District. Conclusions The school children in the three primary schools of Manna District, Jimma Zone were at moderate risk of the morbidity caused by S. mansoni (prevalence > 10 % and

Abstract We propose a Bayesian spatial model for time-to-event data in which we allow the censoring mechanism to depend on covariates and have a spatial structure. The survival model incorporates a cure rate fraction and assumes that the time-to-event follows a Weibull distribution, with covariates such as race, stage, grade, marital status and age at diagnosis being linked to its scale parameter. With right censoring being a primary concern, we consider a joint logistic regression model for the death versus censoring indicator, allowing dependence on covariates and including a spatial structure via the use of random effects. We apply the models to examine prostate cancer data from the Surveillance, Epidemiology, and End Results (SEER) registry, which displays marked spatial variation. [ABSTRACT FROM AUTHOR]

In this paper, we develop a general Bayesian clinical trial design methodology, tailored for time-to-event trials with a cured fraction in scenarios where a previously completed clinical trial is available to inform the design and analysis of the new trial. Our methodology provides a conceptually appealing and computationally feasible framework that allows one to construct a fixed, maximally informative prior a priori while simultaneously identifying the minimum sample size required for the new trial so that the design has high power and reasonable type I error control from a Bayesian perspective. This strategy is particularly well suited for scenarios where adaptive borrowing approaches are not practical due to the nature of the trial, complexity of the model, or the source of the prior information. Control of a Bayesian type I error rate offers a sensible balance between wanting to use high-quality information in the design and analysis of future trials while still controlling type I errors in an equitable way. Moreover, sample size determination based on our Bayesian view of power can lead to a more adequately sized trial by virtue of taking into account all the uncertainty in the treatment effect. We demonstrate our methodology by designing a cancer clinical trial in high-risk melanoma. [ABSTRACT FROM AUTHOR]

Survival models deal with the time until the occurrence of an event of interest. However, in some situations the event may not occur in part of the studied population. The fraction of the population that will never experience the event of interest is generally called cure rate. Models that consider this fact (cure rate models) have been extensively studied in the literature. Hypothesis testing on the parameters of these models can be performed based on likelihood ratio, gradient, score or Wald statistics. Critical values of these tests are obtained through approximations that are valid in large samples and may result in size distortion in small or moderate sample sizes. In this sense, this paper proposes bootstrap corrections to the four mentioned tests and bootstrap Bartlett correction for the likelihood ratio statistic in the Weibull promotion time model. Besides, we present an algorithm for bootstrap resampling when the data presents cure fraction and right censoring time (random and non-informative). Simulation studies are conducted to compare the finite sample performances of the corrected tests. The numerical evidence favours the corrected tests we propose. We also present an application in an actual data set. [ABSTRACT FROM AUTHOR]

Most studies involving cure fraction models in survival analysis relate the probability of cure and possible prognostic factors considering a logistic link function. As is well known, the logistic density function is symmetric, preventing the possibility of asymmetry in the relationship between the cure probability and the covariates. The main purpose of this paper is to predict the chance (or probability) of cure for future patients, considering other links between the covariates with the cure fraction. Some links extensively considered in the literature for modeling the cure probabilities are the probit and the complementary loglog links (c-loglog). We evaluate the use of asymmetric links when the main goal is the estimation of survival probabilities. In addition, the patients are considered to be grouped in clinics and, for a given clinic, there may be a non-null association among the survival times, thus affecting the survival probabilities. An EM-type algorithm conjugated with REML estimation procedure in the M-step is considered for parameter estimation. Model comparisons are implemented using the cAIC and cBIC scores. A simulation study suggests that the proposed estimation procedure behaves well for moderate and large sample sizes. A real data illustration reveals also the good performance of the proposed model and estimation approach. [ABSTRACT FROM AUTHOR]

A cancer clinical trial with an immunotherapy often has 2 special features, which are patients being potentially cured from the cancer and the immunotherapy starting to take clinical effect after a certain delay time. Existing testing methods may be inadequate for immunotherapy clinical trials, because they do not appropriately take the 2 features into consideration at the same time, hence have low power to detect the true treatment effect. In this paper, we proposed a piece‐wise proportional hazards cure rate model with a random delay time to fit data, and a new weighted log‐rank test to detect the treatment effect of an immunotherapy over a chemotherapy control. We showed that the proposed weight was nearly optimal under mild conditions. Our simulation study showed a substantial gain of power in the proposed test over the existing tests and robustness of the test with misspecified weight. We also introduced a sample size calculation formula to design the immunotherapy clinical trials using the proposed weighted log‐rank test. [ABSTRACT FROM AUTHOR]

Many quantities of interest in survival analysis are smooth, closed-form functionals of the law of the observations. For instance, the conditional law of a lifetime of interest under random right censoring, and the conditional probability of being cured. In such cases, one can easily derive nonparametric estimators for the quantities of interest by plugging-into the functional the nonparametric estimators of the law of the observations. However, with multivariate covariates, the nonparametric estimation suffers from the curse of dimensionality. Here, a new dimension reduction approach for survival analysis is proposed and investigated in the right-censored lifetime case. First, we consider a single-index hypothesis on the conditional law of the observations and propose a n-asymptotically normal semiparametric estimator. Next, we apply the smooth functionals to this estimator. This results in semiparametric estimators of the quantities of interest that avoid the curse of dimensionality. Confidence regions for the index and the functional of interest are built by bootstrap. The new methodology allows to test the dimension reduction assumption, can be extended to other dimension reduction methods and can be applied to closed-form functionals of more general censoring mechanisms. [ABSTRACT FROM AUTHOR]

The Cox proportional hazards (PH) model is a common statistical technique used for analyzing time-to-event data. The assumption of PH, however, is not always appropriate in real applications. In cases where the assumption is not tenable, threshold regression (TR) and other survival methods, which do not require the PH assumption, are available and widely used. These alternative methods generally assume that the study data constitute simple random samples. In particular, TR has not been studied in the setting of complex surveys that involve (1) differential selection probabilities of study subjects and (2) intracluster correlations induced by multistage cluster sampling. In this paper, we extend TR procedures to account for complex sampling designs. The pseudo-maximum likelihood estimation technique is applied to estimate the TR model parameters. Computationally efficient Taylor linearization variance estimators that consider both the intracluster correlation and the differential selection probabilities are developed. The proposed methods are evaluated by using simulation experiments with various complex designs and illustrated empirically by using mortality-linked Third National Health and Nutrition Examination Survey Phase II genetic data. [ABSTRACT FROM AUTHOR]

An editorial is presented that discusses the drawbacks of traditional techniques of comparing medication therapies and treatment tactics, which do not give full information regarding medical results from the customer's viewpoint. It introduces the Desirability of Outcome Ranking (DOOR) as a novel approach to evaluating outcomes.

Recurrent event data often arise in longitudinal studies. In many applications, subjects may experience two different types of events alternatively over time or a pair of subjects may experience recurrent events of the same type. Medical advances have made it possible for some patients to be cured such that the disease of interest does not recur. In this article, we consider non parametric analysis of bivariate recurrent event data with cure fraction. Using the inverse-probability weighted (IPW) approach, we propose non parametric estimators for the proportion of cured patients and for the joint distribution functions of bivariate recurrence times of the uncured ones. The asymptotic properties of the proposed estimators are established. Simulation study indicates that the proposed estimators perform well in finite samples. [ABSTRACT FROM AUTHOR]

Study Objective: To evaluate the effectiveness and safety of the MiniArc single-incision sling in the treatment of urodynamic stress incontinence (USI) through 5 years.Design: Retrospective observational study (Canadian Task Force classification II-2).Setting: Tertiary referral center.Patients: Eighty-five patients with USI without needing concurrent procedures who underwent anti-incontinence surgery using the MiniArc SIMS from February 2010 to December 2011.Interventions: Anti-incontinence surgery.Measurements and Main Results: Objective cure was defined as no demonstrable leakage of urine on the cough stress test and 1-hour pad test weight <2 g. Subjective cure was based on negative response to Urinary Distress Inventory question 3, no leakage on coughing, sneezing, or laughing. Most patients were postmenopausal, overweight, and multiparous. Postoperative USI significantly improved (p < .001) through 3 years, and the 1-hour pad test showed significant improvement through 5 years (p < .001). Although 13 patients had recurrence of USI, no repeat surgery was done. The cumulative cure rates may show a declining trend of cure, yet subjective cure was 80.0% and objective cure 84.7%, with age as a significant risk factor for sling failure.Conclusion: MiniArc maintains its effectiveness and safety in treatment of USI through 5 years with high objective and subjective cure rates and low incidence of complications. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To systematically review the effectiveness of Xuefuzhuyu preparation in treatment of cyclomastopathy, so as to provide evidence-based references for the rational application ol this kind of preparations. METHODS: CBM, VIP, Wanfang database, CNKI, Em base and MedLine were retrieved to collect randomized controlled trials between Xuefuzhuyu preparation (decoction, capsule and oral liquid) combined with other treatment (observation group) and other drugs combined with some therapeutic options or follow up (control group). On the basis of quality evaluation and literature extraction, the RevMan 5.3 was adopted to conduct Meta analysis. RESULTS: 7 studies were involved, including 871 patients. Results of Mela analysis indicated the total effective rale (OR =4. 62, 95%Cl = 3.08-6.93, P <0.000 01) and cure rate [OR=2.83,95% Cl=1.94-4.13,P <0.000 01 (6 studies); OR =2.32,95% Cl = 1.54-3.49, P <0.000 1 (5 studies after excluding heterogeneity)] of observation group were significantly higher than those of the control group, with statistically significance differences. CONCLUSIONS: The efficacy of Xuefuzhuyu preparation combined with other therapeutic options in treatment cyclomastopathy is belter than that of drugs combined with other treatment methods. [ABSTRACT FROM AUTHOR]

Objective To evaluate the efficiency of radiotherapy (RT) only and chemotherapy plus radiotherapy (CRT) strategy in the treatment of pure intracranial germinoma. Methods We searched PUBMED, EMBASE, Medline and Cochrane library up to May 2016 for studies that enrolled patients with pure intracranial germinoma receiving either RT only or CRT treatment as their first-line treatment. The meta-analysis was conducted on the overall survival rate (OS) and disease free survival (DFS) at 3 years and 5 years. The outcomes were pooled using a random-effect model. Results The final search included 15 studies with 310 patients. The pooled 3-year OS (97% vs. 94%, p = .000) and 3-year DFS (96% vs. 93%, p = 0.043) of CRT group was significantly higher than that of RT only group. However, at 5 years, the OS was 94% in RT only group and 92% in the combined group ( p = 0.29) . For DFS, the RT only group was higher than the combined group (94% vs.89%, p = .000). Conclusions Both RT and CRT for intracranial pure germinoma gain satisfying outcomes, and the CRT strategy has a higher overall survival rate and disease free survival rate at 3 years than RT regimen. At 5 years in the postoperative period, the advantage of survival rates for CRT is eliminated or even reversed. For patients with pure intracranial germinoma, especially those with acute and severer condition and poorer prognosis, CRT strategy would be a better choice. [ABSTRACT FROM AUTHOR]

Aims Intrinsic sphincter deficiency (ISD) is a known risk factor for therapy failure after tension-free vaginal tape (TVT) insertion. The purpose of this study was to investigate if the severity of ISD alone or other factors such as urethral mobility and tape localization influence outcomes. Methods One hundred and nine women with urodynamically determined ISD, a TVT insertion, and a 6-month follow-up visit were included. Urethral length, mobility, and tape localization were evaluated by pelvic floor sonography. Patients were classified into three urethral mobility groups (hypomobile, normomobile, hypermobile). Surgical outcome was assessed by a combination of objective and subjective criteria. Results Therapeutic success rate after TVT insertion was 81.6%. The severity of ISD did not associate with therapy failure. But urethral mobility ( P < 0.0001), relative tape position ( P = 0.0003), and tape-urethra distance ( P < 0.0001) differed between cured and not cured patient groups. Patients with a relative tape position toward 1/2 of urethral length had a higher cure rate. Significantly different cure rates ( P = 0.0003) were found for hypomobile (67%), normomobile (76%), and hypermobile (100%) urethras. For ISD patients with a hypomobile urethra, highest cure rates were obtained for tape-urethra distances between 2.5 and 3.5 mm. Conclusions The reduced cure rate for ISD patients was due to the subgroup with a hypomobile urethra. A prospective study is needed to confirm that slightly shorter tape-urethra distances and a relative tape position more toward the mid-urethra will lead to better outcomes for this patient group. [ABSTRACT FROM AUTHOR]

The main objective of this study was to compare the common treatment methods of clinical endometritis (CE) including injection of PGF2a and intrauterine infusion of cephapirin benzathine (CB) with intrauterine infusion of 50% dextrose solution (DEX) and intrauterine infusion of liquid paraffin (LP) in dairy cows. To this end, 188 lactating Holstein cows with clinical signs of endometritis were randomly assigned into five treatment groups and cytological smear was prepared. In group 1 ( n = 37), cows were treated with intrauterine infusion of CB. In the second group ( n = 53), the treatment protocol included intramuscular injection of 500-mg cloprostenol sodium in cows with corpus luteum (CL) in their ovaries. In group 3 ( n = 43), cows were treated with intrauterine infusion of DEX solution. In group 4 ( n = 35), cows were treated with intrauterine infusion of LP solution and 20 untreated cows were assigned into a control group (group 5). Clinical treatment rates were 62.2, 66, 60.5, 54.3, and 50% in CB, PG, DEX, LP, and control groups, respectively ( P ≥ 0.05). In the cytological assessment, there was no significant difference in reduction in the neutrophil's number in the second examination after treatment ( P ≥ 0.05). Percentage of cows with clean vaginal discharge in the second examination is higher in cows with CL than cows without CL in all five groups, but this difference was not significant ( P ≥ 0.05). According to the result of this study, future large studies are required for assessment of DEX and LP as alternative therapies for the treatment of CE instead of antibiotics. [ABSTRACT FROM AUTHOR]

Background:- DOTS program has been adopted by WHO as hopeful strategy for treatment of TB since early nineties, and it is widely accepted as an essential strategy for achieving (TB) control . Iraqi health authorities started DOTS program implementation since 2001 in Baghdad, Iraq. Objectives:- This study aimed to evaluate DOTS program implementation in Al-Anbar Governorate from 2008- 2012, and to assess the treatment outcomes of this program . Patients and Methods:- This Cross -Sectional Descriptive Study was conducted in consultation clinic in Ramadi city, Al-Anbar Governorate for the period of October 1, 2012 to March 31,2013 . Records of (1680) TB patients were studied retrospectively for the years 2008 to 2012 .Data regarding pulmonary cases for positive and negative smears, extra-pulmonary and relapse cases, treatment failure and chronic cases, in addition to Socio - demographic features were obtained .Statistical package for social sciences (SPSS)version 17, and chi- square test were used, while P values of less than 0.05 considered statistically significant . Results:- A total of 1680 TB patients records reviewed, (919) were males, and (761) were females . Male to female ratio was 1.2:1 .The total of new sputum smear positive( SS+) cases were 541(32.2%),sputum smear negative(SS- ) were 413(24.5%), and extra pulmonary( EP) cases were 726(43.2%) .The Cure rate for TB patients for the period (2008- 2012) was 84.7%, 86.8%, 82.7%, 85.6%, and 91.4% respectively. The treatment success rate of DOTS program for the period from 2008 to -2012 were 89%, 85.6%, 85.6%, 85.8%, 87.7% respectively .The higher death rate was at 2010 (4.5%), treatment failure rate was higher at 2012(2.6%), while defaulter rate was higher at 2009(10.5%),and transfer out rate was higher at 2010 (1.9%) . Conclusions:- DOTS program is still an important role in improving registration and curing TB cases, and widely accepted for achieving TB control strategy in AL-Anbar Governorate .Although many results were close to WHO targets, the case detection rate was very low and faraway from its goals . [ABSTRACT FROM AUTHOR]

Objectives: To investigate the changes in the coagulation function and hemodynamic parameters in patients with Hemorrhagic Traumatic Shock (HTS) after restrictive fluid resuscitation., Methods: A total of 139 patients with HTS admitted to our hospital were enrolled, among which 69 HTS patients were divided into the control group and the remaining 70 HTS patients as the observation group. Patients in the control group underwent regular fluid resuscitation, while those in the observation group underwent restrictive fluid resuscitation., Results: During treatment, 70 patients in the observation group had a lower bleeding amount, infusion amount, and blood transfusion volume than those in the control group (p < 0.05). After treatment, patients in the observation group had better hemodynamic parameters and blood coagulation than those in the control group (p < 0.05), and the incidence rate in the observation group was only 12.9%, which was significantly lower than 60.87% in the control group, while the cure rate in the observation group was 100%, which was significantly higher than that in the control group (p < 0.05)., Conclusions: Restrictive fluid resuscitation could remarkably increase the cure rate and reduce the bleeding amount during HTS treatment, thereby benefiting the recovery of the patient's blood coagulation., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2023 HCFMUSP. Published by Elsevier España, S.L.U. All rights reserved.)

Purpose: Sustained cure of acromegaly can only be achieved by surgery. Most growth hormone (GH) secreting pituitary adenomas are macroadenomas (≥ 10 mm) at diagnosis, with reported surgical cure rates of approximately 50%. Long-term data on disease control rates after surgery are limited. Our aim was to estimate short- and long-term rates of biochemical control after pituitary surgery in acromegaly and identify predictive factors., Methods: Patients operated for GH-secreting pituitary adenomas between 2005-2020 were included from the local pituitary registry (n = 178). Disease activity and treatment data were recorded at one-year (short-term) and five-year (long-term) postoperative follow-up. Biochemical control was defined as insulin-like growth factor 1 (IGF-1) ≤ 1.2 × upper limit of normal value. Multivariate regression models were used to identify factors potentially predicting biochemical control., Results: A total of 178 patients with acromegaly (median age at diagnosis 49 (IQR: 38-59) years, 46% women) were operated for a pituitary adenoma. Biochemical control was achieved by surgery in 53% at short-term and 41% at long-term follow-up, without additional treatment for acromegaly. Biochemical control rates by surgery were of same magnitude in paired samples (45% vs. 41%, p = 0.213) for short- and long-term follow-up, respectively. At short-term, 62% of patients with microadenomas and 51% with macroadenomas, achieved biochemical control. At long-term, the biochemical control rate was 58% for microadenomas and 37% for macroadenomas (p = 0.058). With adjunctive treatment, 82% achieved biochemical control at long-term. Baseline IGF-1 levels significantly predicted biochemical control by surgery at short-term (OR: 0.98 (95% CI: 0.96-0.99), p = 0.011), but not at long-term (OR: 0.76 (95% CI: 0.57-1.00), p = 0.053)., Conclusion: In unselected patients with acromegaly, the long-term biochemical control rate remains modest. Our findings indicate a need to identify patients at an earlier stage and improve therapeutic methods and surgical outcomes., (© 2023. The Author(s).)

The objective was to examine the pooled effects of antibiotic-probiotic combinations by examining the cure rate and recurrence rate for bacterial vaginosis (BV). A systematic literature search was conducted from electronic databases. All parallel randomized controlled trials (RCTs) that focused on the effects of antibiotics combined with intravaginal probiotics were included. Cure rate and recurrence rate were the primary and secondary outcomes to be analyzed. Meta-analysis was conducted following the Cochrane handbook for Systematic Reviews of Interventions. As a result, of 923 studies identified, 11 articles involving 1,493 BV patients met the inclusion criteria and nine were available for meta-analysis. A meta-analysis of two studies evaluated the recurrence rate 12-16 weeks after treatment. Results showed a statistically significant difference favoring the antibiotics plus probiotics group vs the antibiotics plus placebo group (relative risk 0.62, 95% confidence interval [CI]: 0.45-0.85). The narrative review in one study indicated that the cure rate was higher in the antibiotics plus probiotics group, giving a significant HR ratio of 0.73 (95% CI 0.54-0.98) ( p = 0.042). In conclusion, vaginal application of Lactobacillus in combination with antibiotics for the treatment of BV could be a promising method for both reducing the recurrence rate and relieving symptoms of BV., Competing Interests: Conflict of interest: The authors report that there is no conflicts of interest in this work., (© 2023 the author(s), published by De Gruyter.)