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To compare the effectiveness of progressive tendon-loading exercises (PTLE) with eccentric exercise therapy (EET) in patients with patellar tendinopathy (PT).
In a stratified, investigator-blinded, block-randomised trial, 76 patients with clinically diagnosed and ultrasound-confirmed PT were randomly assigned in a 11 ratio to receive either PTLE or EET. The primary end point was clinical outcome after 24 weeks following an intention-to-treat analysis, as assessed with the validated Victorian Institute of Sports Assessment for patellar tendons (VISA-P) questionnaire measuring pain, function and ability to play sports. Secondary outcomes included the return to sports rate, subjective patient satisfaction and exercise adherence.
Patients were randomised between January 2017 and July 2019. The intention-to-treat population (mean age, 24 years, SD 4); 58 (76%) male) consisted of patients with mostly chronic PT (median symptom duration 2 years). Most patients (82%) underwent prior treatment for PT but failed to recover fully. 38 patients were randomised to the PTLE group and 38 patients to the EET group. The improvement in VISA-P score was significantly better for PTLE than for EET after 24 weeks (28 vs 18 points, adjusted mean between-group difference, 9 (95% CI 1 to 16); p=0.023). There was a trend towards a higher return to sports rate in the PTLE group (43% vs 27%, p=0.13). No significant between-group difference was found for subjective patient satisfaction (81% vs 83%, p=0.54) and exercise adherence between the PTLE group and EET group after 24 weeks (40% vs 49%, p=0.33).
In patients with PT, PTLE resulted in a significantly better clinical outcome after 24 weeks than EET. PTLE are superior to EET and are therefore recommended as initial conservative treatment for PT.
In patients with PT, PTLE resulted in a significantly better clinical outcome after 24 weeks than EET. PTLE are superior to EET and are therefore recommended as initial conservative treatment for PT.
Talimogene laherparepvec (TVEC) is an oncolytic herpes simplex 1 virus approved for treatment of melanoma. We hypothesized intratumoral TVEC may enhance response to neoadjuvant chemotherapy (NAC). This article reports the results of a trial combining NAC with TVEC for triple-negative breast cancer (TNBC).
Patients with stage II-III TNBC enrolled in a 3+3 phase I trial (NCT02779855) of two TVEC dose levels [DL; DL 1 = 10
plaque-forming units (PFU) × 5 doses; DL 2 = 10
PFUs first dose, then 10
PFUs × 4 doses] on weeks 1, 4, 6, 8, and 10 plus weekly paclitaxel (80 mg/m
) for 12 weeks, followed by doxorubicin/cyclophosphamide (60/600 mg/m
) every 2 weeks for 8 weeks. Postoperative response assessment using residual cancer burden (RCB) was performed. Primary endpoints were safety and MTD. selleck chemical Secondary endpoints were RCB0 rate and immune correlates. Dose-limiting toxicity (DLT) rule was grade 3-5 adverse events due to TVEC during first 5 weeks.
Nine patients [DL 1 (
= 3); DL 2 (
= 6)] were enrolled. Six had stage II disease, and 3 had stage III (6 clinically N
). No DLTs occurred, and MTD was DL 2. Most common toxicities with TVEC were fever (
= 8), chills (
= 3), hematomas (
= 3), and injection site pain (
= 3). Thromboembolic events (
= 2) and bradycardia (
= 1) occurred during or after NAC. Five patients (55%) achieved RCB0, 2 had RCB1 (22%), and 2 had RCB2 (22%).
The addition of TVEC to NAC was feasible at the approved dose, with manageable toxicity. The complete response rate was 55%.
The addition of TVEC to NAC was feasible at the approved dose, with manageable toxicity. The complete response rate was 55%.
To examine the associations between dietary patterns in midlife and likelihood of future healthy ageing in Chinese older adults.
Prospective population-based study.
We included 14,159 participants aged 45-74years who were free from cancer, cardiovascular disease, or diabetes at baseline (1993-1998) from the Singapore Chinese Health Study.
Dietary intakes in midlife were assessed by a validated food frequency questionnaire at baseline. Diet quality was scored according to the alternate Mediterranean diet (aMED), the Dietary Approaches to Stop Hypertension (DASH) diet, the alternative Healthy Eating Index (AHEI)-2010, overall plant-based diet index (PDI), and healthful plant-based diet index (hPDI). Healthy ageing was assessed at the third follow-up visit (2014-2016), which occurred about 20years after the baseline visit, and was defined as the absence of 10 chronic diseases, no impairment of cognitive function, no limitations in instrumental activities of daily living, no clinical depression at screenierence to various healthy dietary patterns at midlife is associated with higher likelihood of healthy ageing at later life.Iron ore tailings (IOT) represent a major problem in the mining industry worldwide due to large volumes of waste disposed in mine sites. IOT are exposed to the environment and subjected to wind and water dispersion, even under non-catastrophic scenarios as dam collapses, and the effects of these particles to the biota are still mostly unknown. This work aimed to prepare and to characterize a suspension containing the finest (micro/nano range) particles of IOT and to evaluate its effects on development and behavior of zebrafish (Danio rerio), at both embryonic and larval stages. IOT suspension comprised 37 mg L-1 of a multi-mineral material mainly composed by hematite and quartz, in a size-range of 33-1400 nm. Regarding in vivo toxicological assays, no robust alterations were recorded in functional, morphological and behavioral end-points analyzed, although a significant adhesion of IOT particles on zebrafish chorion was observed, without a prejudice of embryo hatching. Under applied conditions, iron ore particles did not present harmful effects to the initial stages of zebrafish development, and the particle size range and potential interactions with SiO2 content might be behind such effect.
Previous efforts to examine differences in adverse childhood experiences (ACEs) exposure by geography have yielded mixed results, and have not distinguished between urban, suburban, and rural areas. Additionally, few studies to date have considered the potentially moderating role of geography on the relationship between ACEs and health outcomes.
To examine differences in exposure to ACEs by geography, and determine whether geography moderates the relationship between ACE exposure and health outcomes (overall health, asthma, attention deficit hyperactivity disorder (ADHD), and special health care needs).
The cross-sectional 2017-18 National Survey of Children's Health (NSCH).
Distributions of individual and cumulative ACEs by geography (urban, suburban, rural) were compared using chi-squared tests. Logistic regression was used to determine the association between geography and exposure to 4 + ACEs, and to explore whether the relationship between ACEs and health outcomes varied by geography, adjusting for sociodemographic covariates.
Adjusting for covariates, rural residency was associated with 1.29 times increased odds of exposure to 4 + ACEs (95 % CI 1.00, 1.66) compared to suburban residency. Statistically significant evidence for an interaction between geography and ACE exposure on overall health was not observed, but urban status was observed to increase the association between ACEs and asthma.
This analysis demonstrates a higher ACE burden in rural compared to suburban children. These findings underscore the importance of ACE screening and suggest investment of healthcare resources in the historically underserved rural population.
This analysis demonstrates a higher ACE burden in rural compared to suburban children. These findings underscore the importance of ACE screening and suggest investment of healthcare resources in the historically underserved rural population.Carotid endarterectomy remains the reference standard procedure for carotid revascularization in patients with significant carotid artery stenosis. However, carotid artery stenting was established as a minimally invasive procedure for patients who are not candidates for open surgery due to medical or anatomic high-risk factors. However, despite years of technical refinement and significant improvement in proper patient selection and aggressive medical management, carotid artery stenting via the transfemoral approach has been scrutinized due to a higher risk of stroke or death in the perioperative period compared with carotid endarterectomy. The higher risk of stroke after carotid artery stenting was attributed to manipulation of the diseased aortic arch and the carotid lesion before placement of distal embolic protection devices, as well as failure of these devices to provide adequate neuroprotection. These limitations led to the development of transcarotid artery revascularization, which avoids the need to cross the aortic arch through direct access to the common carotid artery and utilizes a robust neuroprotection mechanism through clamping the proximal carotid artery and establishing active reversal of cerebral blood flow to clear embolic debris. Earlier studies have demonstrated favorable outcomes after transcarotid artery revascularization in high-risk patients. In this study, we aimed to compare the in-hospital outcomes of transcarotid artery revascularization with those of carotid endarterectomy in patients with symptomatic and asymptomatic carotid artery stenosis.
To investigate the effect of replacing canes with an elasticated orthotic-garment on balance and gait-function in chronic stroke survivors.
Experimental, N-of-1 series with a replicated, ABC design with randomised phase duration in a home setting.
Four cane using chronic stroke survivors (P1-4).
Phase A (9-12 weeks) cane-walking "as usual" to establish baseline values; Phase B (9-16 weeks) intervention orthotic-garment worn throughout the day with maximal cane-use reduction; Phase C (9-10 weeks) participant-determined follow-up either no walking-aid, orthotic-garment or cane.
Primary Functional-Gait-Assessment (FGA), Secondary Trunk-sway during walking measured as Total-Angle-Area (TAA°
) in frontal and sagittal-planes, both measured weekly.
Visual and statistical analysis of results showed significant improvements in FGA from phase A to B in all participants. Improvement continued in phase C in P2, stabilized in P1 and P4 and deteriorated in P3. A Minimal-Clinical-Important-Difference of 6 points-change was achieved in P2 & P4. Trunk-sway reduced during walking, indicating increased stability, in two participants from phase A to B and in three participants from A to C but no TAA changes were statistically significant. In phase C participant-selected walking-aids were P1 cane-usage reduced by 25%, P2 independent-walking with no assistive-device, S3 usual cane-usage, P4 orthotic-garment with reduced cane-usage 2-3 days-a-week, usual cane-usage 4-5 days.
Although walking ability is multifactorial these results indicate that the choice of walking-aids can have a specific and clinically relevant impact on gait following stroke. "Hands-free" assistive-devices may be more effective than canes in improving gait-function in some patients. CLINICALTRIALS.
NCT03642444.
NCT03642444.
