Objective:To share a single institutional experience with clinical research on COVID-related olfactory dysfunction(OD).Data Source/Method:Narrative review of published original data and ongoing clinical trials on COVI...Objective:To share a single institutional experience with clinical research on COVID-related olfactory dysfunction(OD).Data Source/Method:Narrative review of published original data and ongoing clinical trials on COVID-related OD at Washington University from 2020 to 2023.Results:There were three new diagnostic-/patient-reported outcome measures developed and tested.We report five clinical trials of interventions for COVID-related olfactory disorders:combined Visual-Olfactory Training(VOLT)with patient-preferred scents versus standard olfactory training(VOLT trial),oral gabapentin versus placebo(Gabapentin for the Relief of Acquired Chemosensory Experience trial),nasal theophylline irrigations versus placebo(Smell Changes and Efficacy of Nasal Theophylline trial),stellate ganglion block(single-arm),and mindfulness-based stress reduction(MBSR)versus lifestyle intervention(MBSR trial).Conclusions:Initial intervention trials for COVID-related OD have shown potential for improving subjective and objective olfactory outcomes.However,there remains no gold standard treatment that definitively outperforms placebo in controlled trials.Therefore,continued investigation of novel therapeutic strategies for COVID-related OD is necessary to maximize olfactory outcomes for affected patients.展开更多
To assess the merits of currently available treatment options in the management of patients with low rectal cancer, a review of the medical literature pertaining to the operative and non-operative management of low re...To assess the merits of currently available treatment options in the management of patients with low rectal cancer, a review of the medical literature pertaining to the operative and non-operative management of low rectal cancer was performed, with particular emphasis on sphincter preservation, oncological outcome, functional outcome, morbidity, quality of life, and patient preference. Low anterior resection (AR) is technically feasible in an increasing proportion of patients with low rectal cancer. The cost of sphincter preservation is the risk of morbidity and poor functional outcome in a significant proportion of patients. Transanal and endoscopic surgery are attractive options in selected patients that can provide satisfactory oncological outcomes while avoiding the morbidity and functional sequelae of open total mesorectal excision. In complete responders to neo-adjuvant chemoradiotherapy, a non-operative approach may prove to be an option. Abdominoperineal excision (APE) imposes a permanent stoma and is associated with significant incidence of perineal morbidity but avoids the risk of poor functional outcome following AR. Quality of life following AR and APE is comparable. Given the choice, most patients will choose AR over APE, however patients following APE positively appraise this option. In striving toward sphincter preservation the challenge is not only to achieve the best possible oncological outcome, but also to ensure that patients with low rectal cancer have realistic and accurate expectations of their treatment choice so that the best possible overall outcome can be obtained by each individual.展开更多
Coronary artery disease(CAD) screening and diagnosis are core cardiac specialty services.From symptoms,autopsy correlations supported reductions in coronary blood flow and dynamic epicardial and microcirculatory coron...Coronary artery disease(CAD) screening and diagnosis are core cardiac specialty services.From symptoms,autopsy correlations supported reductions in coronary blood flow and dynamic epicardial and microcirculatory coronaries artery disease as etiologies.While angina remains a clinical diagnosis,most cases require correlation with a diagnostic modality.At the onset of the evidence building process much research,now factored into guidelines were conducted among population and demographics that were homogenous and often prior to newer technologies being available.Today we see a more diverse multi-ethnic population whose characteristics and risks may not consistently match the populations from which guideline evidence is derived.While it would seem veryunlikely that for the majority,scientific arguments against guidelines would differ,however from a translational perspective,there will be populations who differ and importantly there are cost-efficacy questions,e.g.,the most suitable first-line tests or what parameters equate to an adequate test.This article reviews non-invasive diagnosis of CAD within the context of multi-ethnic patient populations.展开更多
Background:Dual antiplatelet therapy(DAPT)is key for preventing ischaemic events post-percutaneous coronary intervention(PCI).Various DAPT modifications like the shortened duration or P2Y12 inhibitor(P2Y12i)de-escalat...Background:Dual antiplatelet therapy(DAPT)is key for preventing ischaemic events post-percutaneous coronary intervention(PCI).Various DAPT modifications like the shortened duration or P2Y12 inhibitor(P2Y12i)de-escalation are implemented to reduce bleeding risk.However,these strategies lack direct comparative studies.This study aimed to assess the efficacy and safety of such DAPT strategies,including de-escalated and short DAPT,in patients undergoing PCI.Methods:We searched PubMed,Embase,Cochrane Central Register of Controlled Trials,and ClinicalTrials.gov databases for relevant randomized controlled trials(RCTs).We performed a network meta-analysis(NMA)to estimate risk ratios(RRs)and 95%confidence intervals(CIs).The primary efficacy endpoint was major adverse cardiac events(MACEs),and the primary safety endpoint was major bleeding.Secondary endpoints included individual components of MACEs and net adverse clinical events(NACEs).Results:A total of 17 RCTs comprising 53,156 patients(median age,62.0 years,24.8%female)were included.NMA suggested that de-escalation DAPT was associated with a significantly lower risk of MACEs(risk ratio[RR]=0.79,95%confidence interval[CI]=0.64-0.98),bleeding(RR=0.63,95%CI=0.49-0.82),and NACEs(RR=0.69,95%CI=0.60-0.79)compared with standard DAPT.Short DAPT followed by P2Y12i monotherapy exhibited a significantly decreased risk of major bleeding(RR=0.63,95%CI=0.46-0.86)compared with standard DAPT.Conclusions:De-escalation DAPT was the most effective strategy for preventing the risk of MACEs without increasing bleeding events,while short DAPT followed by P2Y12i monotherapy was the most effective strategy for reducing the risk of bleeding among patients undergoing PCI.展开更多
基金National Institute on Deafness and Other Communication Disorders,Grant/Award Number:T32DC000022。
文摘Objective:To share a single institutional experience with clinical research on COVID-related olfactory dysfunction(OD).Data Source/Method:Narrative review of published original data and ongoing clinical trials on COVID-related OD at Washington University from 2020 to 2023.Results:There were three new diagnostic-/patient-reported outcome measures developed and tested.We report five clinical trials of interventions for COVID-related olfactory disorders:combined Visual-Olfactory Training(VOLT)with patient-preferred scents versus standard olfactory training(VOLT trial),oral gabapentin versus placebo(Gabapentin for the Relief of Acquired Chemosensory Experience trial),nasal theophylline irrigations versus placebo(Smell Changes and Efficacy of Nasal Theophylline trial),stellate ganglion block(single-arm),and mindfulness-based stress reduction(MBSR)versus lifestyle intervention(MBSR trial).Conclusions:Initial intervention trials for COVID-related OD have shown potential for improving subjective and objective olfactory outcomes.However,there remains no gold standard treatment that definitively outperforms placebo in controlled trials.Therefore,continued investigation of novel therapeutic strategies for COVID-related OD is necessary to maximize olfactory outcomes for affected patients.
文摘To assess the merits of currently available treatment options in the management of patients with low rectal cancer, a review of the medical literature pertaining to the operative and non-operative management of low rectal cancer was performed, with particular emphasis on sphincter preservation, oncological outcome, functional outcome, morbidity, quality of life, and patient preference. Low anterior resection (AR) is technically feasible in an increasing proportion of patients with low rectal cancer. The cost of sphincter preservation is the risk of morbidity and poor functional outcome in a significant proportion of patients. Transanal and endoscopic surgery are attractive options in selected patients that can provide satisfactory oncological outcomes while avoiding the morbidity and functional sequelae of open total mesorectal excision. In complete responders to neo-adjuvant chemoradiotherapy, a non-operative approach may prove to be an option. Abdominoperineal excision (APE) imposes a permanent stoma and is associated with significant incidence of perineal morbidity but avoids the risk of poor functional outcome following AR. Quality of life following AR and APE is comparable. Given the choice, most patients will choose AR over APE, however patients following APE positively appraise this option. In striving toward sphincter preservation the challenge is not only to achieve the best possible oncological outcome, but also to ensure that patients with low rectal cancer have realistic and accurate expectations of their treatment choice so that the best possible overall outcome can be obtained by each individual.
文摘Coronary artery disease(CAD) screening and diagnosis are core cardiac specialty services.From symptoms,autopsy correlations supported reductions in coronary blood flow and dynamic epicardial and microcirculatory coronaries artery disease as etiologies.While angina remains a clinical diagnosis,most cases require correlation with a diagnostic modality.At the onset of the evidence building process much research,now factored into guidelines were conducted among population and demographics that were homogenous and often prior to newer technologies being available.Today we see a more diverse multi-ethnic population whose characteristics and risks may not consistently match the populations from which guideline evidence is derived.While it would seem veryunlikely that for the majority,scientific arguments against guidelines would differ,however from a translational perspective,there will be populations who differ and importantly there are cost-efficacy questions,e.g.,the most suitable first-line tests or what parameters equate to an adequate test.This article reviews non-invasive diagnosis of CAD within the context of multi-ethnic patient populations.
基金Thailand Science Research and Innovation fundUniversityof Phayao,Grant/Award Numbers:UoE66003,FF65-RIM100Unit of Excellence on Clinical Outcomes Research and IntegratioN(UNICORN)。
文摘Background:Dual antiplatelet therapy(DAPT)is key for preventing ischaemic events post-percutaneous coronary intervention(PCI).Various DAPT modifications like the shortened duration or P2Y12 inhibitor(P2Y12i)de-escalation are implemented to reduce bleeding risk.However,these strategies lack direct comparative studies.This study aimed to assess the efficacy and safety of such DAPT strategies,including de-escalated and short DAPT,in patients undergoing PCI.Methods:We searched PubMed,Embase,Cochrane Central Register of Controlled Trials,and ClinicalTrials.gov databases for relevant randomized controlled trials(RCTs).We performed a network meta-analysis(NMA)to estimate risk ratios(RRs)and 95%confidence intervals(CIs).The primary efficacy endpoint was major adverse cardiac events(MACEs),and the primary safety endpoint was major bleeding.Secondary endpoints included individual components of MACEs and net adverse clinical events(NACEs).Results:A total of 17 RCTs comprising 53,156 patients(median age,62.0 years,24.8%female)were included.NMA suggested that de-escalation DAPT was associated with a significantly lower risk of MACEs(risk ratio[RR]=0.79,95%confidence interval[CI]=0.64-0.98),bleeding(RR=0.63,95%CI=0.49-0.82),and NACEs(RR=0.69,95%CI=0.60-0.79)compared with standard DAPT.Short DAPT followed by P2Y12i monotherapy exhibited a significantly decreased risk of major bleeding(RR=0.63,95%CI=0.46-0.86)compared with standard DAPT.Conclusions:De-escalation DAPT was the most effective strategy for preventing the risk of MACEs without increasing bleeding events,while short DAPT followed by P2Y12i monotherapy was the most effective strategy for reducing the risk of bleeding among patients undergoing PCI.
