This study investigates the association between corporate social responsibility (CSR) performance and cross-listing. In a clean setting where a change in CSR performance can be attributed to the ...cross-listing, we find a statistically significant and economically meaningful increase in CSR performance for the cross-listed firms. Moreover, such an increase comes mostly in technical CSR, which targets the firms’ primary stakeholders. We also find that the positive association between cross-listing and CSR improvements is more pronounced for firms with weak corporate governance. The results hold under a variety of different robustness checks.
Several commercial and academic autologous chimeric antigen receptor T-cell (CAR-T) products targeting CD19 have been approved in Europe for relapsed/refractory B-cell acute lymphoblastic leukemia, ...high-grade B-cell lymphoma and mantle cell lymphoma. Products for other diseases such as multiple myeloma and follicular lymphoma are likely to be approved by the European Medicines Agency in the near future.
The European Society for Blood and Marrow Transplantation (EBMT)-Joint Accreditation Committee of ISCT and EBMT (JACIE) and the European Haematology Association collaborated to draft best practice recommendations based on the current literature to support health care professionals in delivering consistent, high-quality care in this rapidly moving field.
Thirty-six CAR-T experts (medical, nursing, pharmacy/laboratory) assembled to draft recommendations to cover all aspects of CAR-T patient care and supply chain management, from patient selection to long-term follow-up, post-authorisation safety surveillance and regulatory issues.
We provide practical, clinically relevant recommendations on the use of these high-cost, logistically complex therapies for haematologists/oncologists, nurses and other stakeholders including pharmacists and health sector administrators involved in the delivery of CAR-T in the clinic.
Most Zr conversion coatings are prepared on Al alloys, with Al3+ from the substrate contributing significantly to the film growth process. Thus, the effect of Al3+ on the electrochemical ...characteristics, surface microstructure and film-formation mechanism of Zr-based conversion coatings on old- rolled steel (CRS) substrates was investigated by growing the coatings with and without Al3+ as an additive. Electrochemical tests indicated that the anticorrosion performance of the Zr-Al coatings prepared in the presence of Al3+ was greatly superior to that of Zr conversion coatings obtained in the absence of Al3+. Field-emission scanning electron microscopy and X-ray photoelectron spectroscopy analysis indicated that adding of Al3+ in the conversion bath changed the surface microstructure of the Zr coating, greatly promoted the deposition of Zr and F on the CRS substrate and increased the film thickness and density. Both coatings were embedded into the etched CRS substrates. The presence of Al3+ additive induced the formation of different coating components. The Zr coating mainly consisted of ZrO2 and some FeFx, whereas the Zr-Al coatings comprised of ZrO2, ZrOxFy, Al2O3, AlFx and some FeFx. The present study results confirm the key role of Al3+ as an additive in the film formation and growth process of Zr coatings and its effect on enhancing the anticorrosion performance of CRS substrates in NaCl solutions.
Background
This review is one of a suite of six Cochrane reviews looking at the primary medical management options for patients with chronic rhinosinusitis.
Chronic rhinosinusitis is a common ...condition involving inflammation of the lining of the nose and paranasal sinuses. It is characterised by nasal blockage and nasal discharge, facial pressure/pain and loss of sense of smell. The condition can occur with or without nasal polyps. Oral corticosteroids are used to control the inflammatory response and improve symptoms.
Objectives
To assess the effects of oral corticosteroids compared with placebo/no intervention or other pharmacological interventions (intranasal corticosteroids, antibiotics, antifungals) for chronic rhinosinusitis.
Search methods
The Cochrane ENT Information Specialist searched the ENT Trials Register; Central Register of Controlled Trials (CENTRAL 2015, Issue 7); MEDLINE; EMBASE; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 11 August 2015.
Selection criteria
Randomised controlled trials (RCTs) comparing a short course (up to 21 days) of oral corticosteroids with placebo or no treatment or compared with other pharmacological interventions.
Data collection and analysis
We used the standard methodological procedures expected by Cochrane. Our primary outcomes were disease‐specific health‐related quality of life (HRQL), patient‐reported disease severity, and the adverse event of mood or behavioural disturbances. Secondary outcomes included general HRQL, endoscopic nasal polyp score, computerised tomography (CT) scan score and the adverse events of insomnia, gastrointestinal disturbances and osteoporosis. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics.
Main results
We included eight RCTs (474 randomised participants), which compared oral corticosteroids with placebo or no intervention. All trials only recruited adults with chronic rhinosinusitis with nasal polyps. All trials reported outcomes at two to three weeks, at the end of the short‐course oral steroid treatment period. Three trials additionally reported outcomes at three to six months. Two of these studies prescribed intranasal steroids to patients in both arms of the trial at the end of the oral steroid treatment period.
Oral steroids versus placebo or no intervention
Disease‐specific health‐related quality of life was reported by one study. This study reported improved quality of life after treatment (two to three weeks) in the group receiving oral steroids compared with the group who received placebo (standardised mean difference (SMD) ‐1.24, 95% confidence interval (CI) ‐1.92 to ‐0.56, 40 participants, modified RSOM‐31), which corresponds to a large effect size. We assessed the evidence to be low quality (we are uncertain about the effect estimate; the true effect may be substantially different from the estimate of the effect).
Disease severity
as measured by patient‐reported symptom scores was reported by two studies, which allowed the four key symptoms used to define chronic rhinosinusitis (nasal blockage, nasal discharge, facial pressure, hyposmia) to be combined into one score. The results at the end of treatment (two to three weeks) showed an improvement in patients receiving oral steroids compared to placebo, both when presented as a mean final value (SMD ‐2.84, 95% CI ‐4.09 to ‐1.59, 22 participants) and as a change from baseline (SMD ‐2.28, 95% CI ‐2.76 to ‐1.80, 114 participants). These correspond to large effect sizes but we assessed the evidence to be low quality.
One study (114 participants) followed patients for 10 weeks after the two‐week treatment period. All patients in both arms received intranasal steroids at the end of the oral steroid treatment period. The results showed that the initial results after treatment were not sustained (SMD ‐0.22, 95% CI ‐0.59 to 0.15, 114 participants, percentage improvement from baseline). This corresponds to a small effect size and we assessed the evidence to be low quality.
There was an increase in adverse events in people receiving orals steroids compared with placebo for gastrointestinal disturbances (risk ratio (RR) 3.45, 95% CI 1.11 to 10.78; 187 participants; three studies) and insomnia (RR 3.63, 95% CI 1.10 to 11.95; 187 participants; three studies). There was no significant impact of oral steroids on mood disturbances at the dosage used in the included study (risk ratio (RR) 2.50, 95% CI 0.55 to 11.41; 40 participants; one study). We assessed the evidence to be low quality due to the lack of definitions of the adverse events and the small number of events or sample size, or both).
Other comparisons
No studies that compared short‐course oral steroids with other treatment for chronic rhinosinusitis met the inclusion criteria.
Authors' conclusions
At the end of the treatment course (two to three weeks) there is an improvement in health‐related quality of life and symptom severity in patients with chronic rhinosinusitis with nasal polyps taking oral corticosteroids compared with placebo or no treatment. The quality of the evidence supporting this finding is low. At three to six months after the end of the oral steroid treatment period, there is little or no improvement in health‐related quality of life or symptom severity for patients taking an initial course of oral steroids compared with placebo or no treatment.
The data on the adverse effects associated with short courses of oral corticosteroids indicate that there may be an increase in insomnia and gastrointestinal disturbances but it is not clear whether there is an increase in mood disturbances. All of the adverse events results are based on low quality evidence.
More research in this area, particularly research evaluating patients with chronic rhinosinusitis without nasal polyps, longer‐term outcomes and adverse effects, is required.
There is no evidence for oral steroids compared with other treatments.
Cytoreductive surgery with HIPEC has shown promising results in the interval setting of advanced epithelial ovarian cancer. Its role in upfront setting has not yet been established. All eligible ...patients underwent CRS-HIPEC as per institution protocol. Relevant data was collected prospectively in institutional HIPEC registry and analyzed retrospectively for the study period from February 2014 to February 2020. Out of 190 patients, 80 underwent CRS-HIPEC in upfront setting and 110 in interval setting. The median age was 54 ± 7.45 years, upfront group had higher PCI (14.1 ± 8.75 vs. 9.6 ± 5.2. 2), and required longer duration of surgery (10.6 ± 1.73 vs. 8.4 ± 1.71 h) had more blood loss (1025 ± 668.76 vs. 680 ± 302.23 ml). The upfront group required more diaphragmatic resections, bowel resections, and multivisceral resections. The overall G3-G4 morbidity was comparable (25.4% vs. 27.3%), upfront group had more surgical morbidity (20% vs. 9.1%) whereas interval group had more medical morbidity, i.e., electrolyte imbalance and hematological. After a median follow-up of 43 months, median DFS was 33 months in the upfront vs. 30 months in the interval group,
p
= 0.75, median OS was 46 months interval group and was not yet achieved in upfront group.(
p
= 0.13). Four-year OS was 85% vs. 60%. In patients of advanced EOC upfront CRS HIPEC showed promising outcomes and trend towards better survival with similar morbidity and mortality. The upfront group had more surgical morbidity whereas interval group had more medical morbidity. Multiinstitutional randomized studies are needed to define patient selection and study morbidity patterns and compare the outcomes between CRS-HIPEC in the upfront and interval setting for advanced epithelial ovarian cancer.
In this paper, we extensively explore the electronic, magnetic, and optical properties of CrS, a 3D bulk which cleaved into a 2D monolayer structure. Using density functional theory, we found that ...both configurations have half-metallic properties, where the spin-up is metallic while the spin-down channel is a semiconductor with a band gap of 3.77, and 3.09 eV in the 3D and 2D structures, respectively. These structures have (100 %) spin polarization of electrons near of Fermi level. However, the magnetic moments offer that both structures are ferromagnetic with a total magnetic moment of 4 μB, calculated according to the Slater-Pauling rule total magnetic moment = valance electrons −8. The spin-down has a good band gap so we test the optical properties for 3D and 2D structures, a comprehensive examination of the alloy’s optical properties was conducted within the energy range of 0–15 eV, encompassing the real and imaginary components of the dielectric function, as well as the absorption coefficient.
Rubella Infection In Pregnancy Serudji, Joserizal
Journal of Midwifery (Online),
07/2022, Letnik:
7, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Rubella is a systemic viral disease that is mild, non-specific, rarely diagnosed, and easily transmitted. Rubella virus easily crosses the placenta, so infection in pregnancy, especially in the first ...trimester, has the risk of transmitting to the fetus and potentially causing abortion, fetal death, and congenital rubella syndrome (CRS). CRS includes auditory, sensorineural, cardiac, and ocular abnormalities, and is an irreversible congenital disorder. Rubella can be prevented by the administration of antirubella vaccination.Serology tests are still the most reliable diagnostic test today, although these immune reactions appear later than the appearance of the rash. Analysis of serology test results can provide information on whether you are in acute infection, infected, and are still active, or chronic infection and are currently active or inactive.Management of rubella infection in pregnancy is symptomatic, nothing can be done for CRS in pregnancy. Postpartum CRS management is multidisciplinary and supportive
Chronic rhinosinusitis (CRS) is a complex and heterogeneous disorder whose etiopathogenetic picture is not yet completely known and is classically divided into CRS with (CRSwNP) and without nasal ...polyps (CRSsNP). But today the distinction is made with type 2 and nontype 2 variants. A rational and defined pathway for the diagnosis of chronic rhinosinusitis is an indispensable means to be able to arrive at a correct identification of the patient. This typing is essential to be able to arrive at the correct course of treatment, which turns out to be different for different types of patients. For this reason, the realization of a diagnostic therapeutic pathway represents a fundamental way for the otolaryngologist specialist but not only, since today diagnostics has a multidisciplinary framework. In the present work, precise indications have been developed to arrive at a correct diagnosis. The various diagnostic pathways and processes to arrive at a correct therapeutic framing have been highlighted. Therapy ranging from medical therapy to surgical therapy without neglecting the new biological therapies. It does not represent a guideline but a diagnostic method that can be adapted to all the various territorial realities.
Background
This review is one of six looking at the primary medical management options for patients with chronic rhinosinusitis.
Chronic rhinosinusitis is common and is characterised by inflammation ...of the lining of the nose and paranasal sinuses leading to nasal blockage, rhinorrhoea, facial pressure/pain and loss of sense of smell. The condition can occur with or without nasal polyps. The use of topical (intranasal) corticosteroids has been widely advocated for the treatment of chronic rhinosinusitis given the belief that inflammation is a major component of this condition.
Objectives
To assess the effects of intranasal corticosteroids in people with chronic rhinosinusitis.
Search methods
The Cochrane ENT Information Specialist searched the Cochrane ENT Trials Register; Central Register of Controlled Trials (CENTRAL 2015, Issue 8); MEDLINE; EMBASE; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 11 August 2015.
Selection criteria
Randomised controlled trials (RCTs) with a follow‐up period of at least three months comparing intranasal corticosteroids (e.g. beclomethasone dipropionate, triamcinolone acetonide, flunisolide, budesonide) against placebo or no treatment in patients with chronic rhinosinusitis.
Data collection and analysis
We used the standard methodological procedures expected by Cochrane. Our primary outcomes were disease‐specific health‐related quality of life (HRQL), patient‐reported disease severity and the commonest adverse event ‐ epistaxis. Secondary outcomes included general HRQL, endoscopic nasal polyp score, computerised tomography (CT) scan score and the adverse events of local irritation or other systemic adverse events. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics.
Main results
We included 18 RCTs with a total of 2738 participants. Fourteen studies had participants with nasal polyps and four studies had participants without nasal polyps. Only one study was conducted in children.
Intranasal corticosteroids versus placebo or no intervention
Only one study (20 adult participants without polyps) measured our primary outcome disease‐specific HRQL using the Rhinosinusitis Outcome Measures‐31 (RSOM‐31). They reported no significant difference (numerical data not available) (very low quality evidence).
Our second primary outcome, disease severity , was measured using the Chronic Sinusitis Survey in a second study (134 participants without polyps), which found no important difference (mean difference (MD) 2.84, 95% confidence interval (CI) ‐5.02 to 10.70; scale 0 to 100). Another study (chronic rhinosinusitis with nasal polyps) reported an increased chance of improvement in the intranasal corticosteroids group (RR 2.78, 95% CI 1.76 to 4.40; 109 participants). The quality of the evidence was low.
Six studies provided data on at least two of the individualsymptoms used in the EPOS 2012 criteria to define chronic rhinosinusitis (nasal blockage, rhinorrhoea, loss of sense of smell and facial pain/pressure). When all four symptoms in the EPOS criteria were available on a scale of 0 to 3 (higher = more severe symptoms), the average MD in change from baseline was ‐0.26 (95% CI ‐0.37 to ‐0.15; 243 participants; two studies; low quality evidence). Although there were more studies and participants when only nasal blockage and rhinorrhoea were considered (MD ‐0.31, 95% CI ‐0.38 to ‐0.24; 1702 participants; six studies), the MD was almost identical to when loss of sense of smell was also considered (1345 participants, four studies; moderate quality evidence).
When considering the results for the individual symptoms, benefit was shown in the intranasal corticosteroids group. The effect size was larger for nasal blockage (MD ‐0.40, 95% CI ‐0.52 to ‐0.29; 1702 participants; six studies) than for rhinorrhoea (MD ‐0.25, 95% CI ‐0.33 to ‐0.17; 1702 participants; six studies) or loss of sense of smell (MD ‐0.19, 95% CI ‐0.28 to ‐0.11; 1345 participants; four studies). There was heterogeneity in the analysis for facial pain/pressure (MD ‐0.27, 95% CI ‐0.56 to 0.02; 243 participants; two studies). The quality of the evidence was moderate for nasal blockage, rhinorrhoea and loss of sense of smell, but low for facial pain/pressure.
There was an increased risk of epistaxis with intranasal corticosteroids (risk ratio (RR) 2.74, 95% CI 1.88 to 4.00; 2508 participants; 13 studies; high quality evidence).
Considering our secondary outcome, general HRQL, one study (134 participants without polyps) measured this using the SF‐36 and reported a statistically significant benefit only on the general health subscale. The quality of the evidence was very low.
It is unclear whether there is a difference in the risk of local irritation (RR 0.94, 95% CI 0.53 to 1.64; 2124 participants; 11 studies) (low quality evidence).
None of the studies treated or followed up patients long enough to provide meaningful data on the risk of osteoporosis or stunted growth (children).
Other comparisons
We identified no other studies that compared intranasal corticosteroids plus co‐intervention A versus placebo plus co‐intervention A.
Authors' conclusions
Most of the evidence available was from studies in patients with chronic rhinosinusitis with nasal polyps. There is little information about quality of life (very low quality evidence). For disease severity, there seems to be improvement for all symptoms (low quality evidence), a moderate‐sized benefit for nasal blockage and a small benefit for rhinorrhoea (moderate quality evidence). The risk of epistaxis is increased (high quality evidence), but these data included all levels of severity; small streaks of blood may not be a major concern for patients. It is unclear whether there is a difference in the risk of local irritation (low quality evidence).
Background
This review is one of six looking at the primary medical management options for patients with chronic rhinosinusitis.
Chronic rhinosinusitis is common and is characterised by inflammation ...of the lining of the nose and paranasal sinuses leading to nasal blockage, nasal discharge, facial pressure/pain and loss of sense of smell. The condition can occur with or without nasal polyps. Topical (intranasal) corticosteroids are used with the aim of reducing inflammation in the sinonasal mucosa in order to improve patient symptoms.
Objectives
To assess the effects of different types of intranasal steroids in people with chronic rhinosinusitis.
Search methods
The Cochrane ENT Information Specialist searched the ENT Trials Register; Central Register of Controlled Trials (CENTRAL 2015, Issue 7); MEDLINE; EMBASE; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 11 August 2015.
Selection criteria
Randomised controlled trials (RCTs) with a follow‐up period of at least three months comparing first‐generation intranasal corticosteroids (e.g. beclomethasone dipropionate, triamcinolone acetonide, flunisolide, budesonide) with second‐generation intranasal corticosteroids (e.g. ciclesonide, fluticasone furoate, fluticasone propionate, mometasone furoate, betamethasone sodium phosphate), or sprays versus drops, or low‐dose versus high‐dose intranasal corticosteroids.
Data collection and analysis
We used the standard methodological procedures expected by Cochrane. Our primary outcomes were disease‐specific health‐related quality of life (HRQL), patient‐reported disease severity and the commonest adverse event ‐ epistaxis (nosebleed). Secondary outcomes included general HRQL, endoscopic nasal polyp score, computerised tomography (CT) scan score and the adverse event of local irritation. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics.
Main results
We included nine RCTs (911 participants), including four different comparisons. None of the studies evaluated our first primary outcome measure, disease‐specific HRQL.
Fluticasone propionate versus beclomethasone dipropionate
We identified two small studies (56 participants with polyps) that evaluated disease severity and looked at the primary adverse effect: epistaxis , but no other outcomes. We cannot report any numerical data but the study authors reported no difference between the two steroids. The evidence was of very low quality.
Fluticasone propionate versus mometasone furoate
We identified only one study (100 participants with polyps) that evaluated disease severity (nasal symptoms scores), which reported no difference (no numerical data available). The evidence was of very low quality.
High‐dose versus low‐dose steroids
We included five studies (663 participants with nasal polyps), three using mometasone furoate (400 µg versus 200 µg in adults and older children, 200 µg versus 100 µg in younger children) and two using fluticasone propionate drops (800 µg versus 400 µg). We found low quality evidence relating to disease severity and nasal polyps size, with results from the high‐dose and low‐dose groups being similar. Although all studies reported more improvement in polyp score in the high‐dose group, the significance of this is unclear due to the small size of the improvements.
The primary adverse effect, epistaxis , was more common when higher doses were used (risk ratio (RR) 2.06, 95% confidence interval (CI) 1.20 to 3.54, 637 participants, moderate quality evidence). Most of the studies that contributed data to this outcome used a broad definition of epistaxis, which ranged from frank bleeding to bloody nasal discharge to flecks of blood in the mucus.
Aqueous nasal spray versus aerosol spray
We identified only one poorly reported study (unclear number of participants for comparison of interest, 91 between three treatment arms), in which there were significant baseline differences between the participants in the two groups. We were unable to draw meaningful conclusions from the data.
Authors' conclusions
We found insufficient evidence to suggest that one type of intranasal steroid is more effective than another in patients with chronic rhinosinusitis, nor that the effectiveness of a spray differs from an aerosol. We identified no studies that compared drops with spray.
It is unclear if higher doses result in better symptom improvements (low quality evidence), but there was moderate quality evidence of an increased risk of epistaxis as an adverse effect of treatment when higher doses were used. This included all levels of severity of epistaxis and it is likely that the proportion of events that required patients to discontinue usage is low due to the low numbers of withdrawals attributed to it. If epistaxis is limited to streaks of blood in the mucus it may be tolerated by the patient and it may be safe to continue treatment. However, it may be a factor that affects compliance.
There is insufficient evidence to suggest that the different types of corticosteroid molecule or spray versus aerosol have different effects. Lower doses have similar effectiveness but fewer side effects.
Clearly more research in this area is needed, with specific attention given to trial design, disease‐specific health‐related quality of life outcomes and evaluation of longer‐term outcomes and adverse effects.
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