Summary
Background
Irritable bowel syndrome is a widespread disorder with a marked socioeconomic burden. Previous studies support the proposal that a subset of patients with features compatible with ...diarrhoea‐predominant IBS (IBS‐D) have bile acid malabsorption (BAM).
Aim
To perform a systematic review and meta‐analysis to assess the prevalence of BAM in patients meeting the accepted criteria for IBS‐D.
Methods
MEDLINE and EMBASE were searched up to March 2015. Studies recruiting adults with IBS‐D, defined by the Manning, Kruis, Rome I, II or III criteria and which used 23‐seleno‐25‐homotaurocholic acid (SeHCAT) testing for the assessment of BAM were included. BAM was defined as 7 day SeHCAT retention of <10%. We calculated the rate of BAM and 95% confidence intervals (CI) using a random effects model. The methodological quality of included studies was evaluated using the Quality Assessment for Diagnostic Accuracy Studies (QUADAS‐2).
Results
The search strategy identified six relevant studies comprising 908 individuals. The rate of BAM ranged from 16.9% to 35.3%. The pooled rate was 28.1% (95% CI: 22.6–34%). There was significant heterogeneity in effect sizes (Q‐test χ2 = 17.9, P < 0.004; I2 = 72.1%). The type of diagnostic criteria used or study country did not significantly modify the effect.
Conclusions
These data provide evidence that in excess of one quarter of patients meeting accepted criteria for IBS‐D have bile acid malabsorption. This distinction has implications for the interpretation of previous studies, as well as contemporaneous clinical practice and future guideline development.
Objective: To report the use of risperidone long‐acting injection (RLAI) in a UK psychiatric service.
Method: Retrospective case note review of all patients prescribed RLAI over a 35‐month period. ...In the mirror‐image analysis patients initiated on RLAI as in‐patients had the index admission attributed to previous treatment.
Results: Patients prescribed RLAI had significantly higher baseline rates of drug misuse, alcohol misuse, unemployment and forensic markers than control patients prescribed oral antipsychotics. Most patients started RLAI because of poor compliance with oral antipsychotics. Inefficacy accounted for more discontinuations than intolerability. Fifty‐eight percent (39/67) of patients were continuing RLAI 12 months after initiation. Mirror‐image analysis (n = 74) showed that RLAI was associated with a reduction in the number of admissions (65 vs. 33, P < 0.005) and in total in‐patient days (4550 vs. 2188 days, P < 0.005). The mean reduction in in‐patient care was 29 days per patient‐year of treatment, equivalent to a net financial saving over the acquisition and administration costs of RLAI of £1172.
Conclusion: Risperidone long‐acting injection was associated with reduced in‐patient care and was cost‐effective.
Introduction. Aortic graft infection (AGI) is a rare complication following AAA repair and is associated with high morbidity and mortality. Management is variable, and there are no evidence-based ...guidelines. The aim of this study was to systematically review and analyse management options for AGI. Methods. Data was collected between July and August 2018. A full HDAS search was conducted on the following databases: MEDLINE, EMBASE, CINAHL, and PUBMED. Meta-analysis was conducted using RevMan 5 software. Results. 1,365 patient outcomes were assessed (10 cohort studies and 12 comparative studies). The most common treatment was in situ replacement of the graft (ISR) followed by extra-anatomical replacement (EAR). Various grafts were used for ISR, such as fresh/cryopreserved allograft, venous graft, and prosthetic grafts. No graft material was shown to be superior. Axillobifemoral graft was the commonest type of EAR used. In the majority of cohort studies, ISR was the main treatment for AGI. There was no significant difference in the overall mortality rate (ISR n=70/176 vs. EAR n=47/126, OR 0.93 95% CI 0.36-2.36, P=0.87). Graft occlusion rate was significantly lower in the ISR group vs. the EAR group (n=14/115 vs. n=29/60 OR 0.16 95% CI 0.07-0.36, P<0.001). There was no significant difference in the amputation rate between the surgical treatments (ISR n=9/141 vs. EAR n=8/82, OR 0.75 95% CI 0.07-8.39, P=0.82). Discussion. In situ replacement is the preferred method of treatment as it had lower rates of occlusion. Further strong evidence is required, such as a multicentre trial to establish a management pathway for the condition.
Prostate-specific membrane antigen (PSMA) is a cell membrane glycoprotein that is selectively expressed in prostate cells, with expression levels increasing dramatically in prostatic adenocarcinoma. ...PSMA-based radioligand therapy (RLT) has emerged as a viable therapeutic modality for the treatment of progressive metastatic prostate cancer. One commonly employed combination involves lutetium-177 conjugated to the ligand PSMA-617 (177Lu-PSMA-617). In this meta-analysis, we examine therapeutic responses in patients with metastatic disease who have received 177Lu-PSMA-617 therapy. We conducted a literature search with the following inclusion criteria: clinical trials involving more than 10 patients and solely utilizing 177Lu-PSMA-617. Seventeen studies were included in the final analysis. Variables documented included the number of patients, the total therapeutic dose administered, the percentage of any prostate-specific antigen (PSA) decline, the percentage with PSA decline exceeding 50% baseline, and toxicities. Overall, a majority of patients responded to therapy, and in the prospective studies, survival was found to be upwards of one year. Significant toxicities included cytopenias, which were infrequent. Patients who had PSA declines in response to therapy had longer survival. Performance status and tumor grade were also key predictors of outcome.
Shahid Zamiruddin Ahmed Niaz, S Niaz, O Niaz, F Niaz, Q
BMJ (Online),
04/2013, Letnik:
346, Številka:
apr17 2
Journal Article
Recenzirano
When he was a youngster, the family would annually visit their holiday home in Allahabad, fond memories of which he carried throughout his life. Family life was central to him, and he was proud to ...pass his family values on to his children.
Cancer cells can be selectively targeted by identifying and developing antibodies to specific antigens present on the cancer cell surface. Cytotoxic agents can be conjugated to these antibodies that ...bind to these cell surface antigens in order to significantly increase the therapeutic index of whichever cytotoxic agent is utilized. This approach of conjugating the cytotoxic drugs to antibodies to target specific surface antigens enhances the anti-tumor activity of antibodies and improves the tumor-to-normal tissue selectivity of chemotherapy. Critical parameters in the development of these antibody-drug conjugates include: 1) selection of most appropriate antigen, 2) the ability of an antibody to be internalized after binding to the antigen, 3) cytotoxic drug potency and 4) stability of the antibody-drug conjugate. For prostate cancer, prostate-specific membrane antigen (PSMA, also known as folate hydrolase-1) is the most validated theragnostic target to date. PSMA is overexpressed on the prostate cancer cell surface, which makes it an even better target for selective drug delivery through conjugated antibodies. Here, we review the PSMA-based antibody-drug conjugates for metastatic castration-resistance prostate cancer (mCRPC).
Prostate cancer is the most common non-cutaneous cancer in men in the United States and is the second most common cause of cancer deaths after lung cancer in men. Despite all advances in the field of ...prostate cancer imaging and treatment, currently, it is sub-optimally responsive to all available treatment options. Radioimmunotherapy with a monoclonal antibody (mAb), J591, has shown promising results in the treatment of prostate cancer. J591 is a deimmunized mAb that targets the extracellular domain of prostate-specific membrane antigen (PSMA), a surface-bound and internalizing glycoprotein that is upregulated in prostate cancer. Phase I/II clinical trials have shown accurate tumor targeting, biochemical and radiographic responses, and increased overall survival in patients with mCRPC with tolerable, predictable, and reversible myelotoxicity. Ongoing studies focus on improving the therapeutic index of radiolabeled J591. Herein, the literature on published clinical trials involving therapeutic J591 conjugated to b-emitter, lutetium-177 for mCRPC, is sequentially reviewed.
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