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Towards personalised medicine in autoimmune hepatitis: Measurement of thiopurine metabolites results in higher biochemical response rates compared to standard weight-based dosing of thiopurine therapy.

J Hepatol 2021 Apr 16. Epub 2021 Apr 16.

Institute of Liver Studies, King's College Hospital, London, SE5 9RS, UK; School of Transplantation, Immunology and Mucosal Biology, Faculty of Life Sciences and Medicine, King's College London, London, UK; European Reference Network - Hepatological Diseases (ERN RARE-LIVER).

Background: Patients with autoimmune hepatitis (AIH) usually receive maintenance therapy with thiopurines, such as azathioprine (AZA) or mercaptopurine (MP). Genetic polymorphisms in AZA metabolism can lead to variations in thioguanine nucleotide (TGN) and 6-methylmercaptopurine (MMP), both of which can cause adverse drug reactions (ADR). In inflammatory bowel disease (IBD), a therapeutic TGN range (225-450 pmol/8x10 erythrocytes) has been identified to optimise effectiveness. Read More

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A Practical Approach to Hospital Visitation During a Pandemic: Responding With Compassion to Unjustified Restrictions.

Am J Crit Care 2021 Apr 19:e1-e10. Epub 2021 Apr 19.

Daniel Garros is a clinical professor, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, and a member of the Ethics Committee and senior attending physician in the pediatric intensive care unit, Stollery Children's Hospital, Edmonton, Alberta, Canada.

During the COVID-19 pandemic, evidence-based resources have been sought to support decision-making and strategically inform hospitals' policies, procedures, and practices. While greatly emphasizing protection, most guiding documents have neglected to support and protect the psychosocial needs of frontline health care workers and patients and their families during provision of palliative and end-of-life care. Consequently, the stage has been set for increased anxiety, moral distress, and moral injury and extreme moral hazard. Read More

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Determining the Appropriate Treatment for T-Cell Acute Lymphoblastic Leukemia With Fusion: Perspectives From a Case Report and Literature Review.

Front Oncol 2021 26;11:651494. Epub 2021 Mar 26.

Department of Hematology, The First Affiliated Hospital of China Medical University, Shenyang, China.

fusion is a recurrent event most commonly seen in T-cell acute lymphoblastic leukemia (T-ALL). It is related to resistance to glucocorticoids and chemotherapy; however, the reported prognosis of T-ALL with fusion is diverse, and the optimal treatment option remains undetermined. Here, we present the treatment process of an illuminating case of T-ALL with fusion. Read More

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Recommendations by the European Network of Paediatric Research at the European Medicines Agency (Enpr-EMA) Working Group on preparedness of clinical trials about paediatric medicines process.

Arch Dis Child 2021 Apr 15. Epub 2021 Apr 15.

Institute if Life Course and Medical Sciences, Liverpool Health Partners, University of Liverpool, Liverpool, UK

Conduct of clinical trials in babies, children and young people is often hindered by issues that could have been foreseen before the trial opened; that is, some clinical trials are often underprepared. In order to identify a good approach to trial preparedness, the European Network of Paediatric Research at the European Medicines Agency formed a working group. The Working Group included representation from regulators, industry, academics, paediatric clinical research networks and parents. Read More

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Estrogen profile- and pharmacogenetics-based lamotrigine dosing regimen optimization: recommendations for pregnant women with epilepsy.

Pharmacol Res 2021 Apr 12:105610. Epub 2021 Apr 12.

Department of Pharmacy, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China. Electronic address:

During pregnancy, various physiological changes occur that can alter the pharmacokinetics of antiepileptic drugs, such as lamotrigine (LTG). Anticipating the change in LTG dose required to achieve a pre-pregnancy target concentration is challenging. This study aimed to develop a refined population pharmacokinetic (PopPK) model of LTG in pregnant women with epilepsy (WWE) to identify factors explaining the variability in pharmacokinetics and to establish a model-informed individualized dosing regimen. Read More

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Nonmyeloablative Conditioning Regimen Including Low-Dose Total Marrow/Lymphoid Irradiation Before Haploidentical Transplantation with Post-Transplantation Cyclophosphamide in Patients with Advanced Lymphoproliferative Diseases.

Transplant Cell Ther 2021 Mar 15. Epub 2021 Mar 15.

BMT Unit, Humanitas Clinical and Research Center-IRCCS, Humanitas Cancer Center, Milan, Italy. Electronic address:

Low-dose total body irradiation (TBI) has long been used in nonmyeloablative conditioning (NMAC) regimens before allogeneic stem cell transplantation from haploidentical donors (haplo-SCT). More recently, the use of total marrow lymphoid irradiation (TMLI) instead of TBI in conditioning is increasing. This study aimed to evaluate outcomes in a cohort of patients treated with low-dose TMLI in terms of engraftment, full donor chimerism status, graft-versus-host disease (GVHD), and extrahematologic toxicities, and to compare these outcomes with those in a cohort of patients receiving conventional TBI-containing conditioning. Read More

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Clinical Presentation, Management, and Outcomes of Patients With Brain Abscess due to Species.

Open Forum Infect Dis 2021 Apr 7;8(4):ofab067. Epub 2021 Apr 7.

Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA.

Background: Nocardial brain abscesses are rare, and published literature describing brain abscesses due to species is limited to individual case reports or small series. We report one of the largest contemporary retrospective studies describing risk factors, diagnostic evaluation, management, and outcomes of nocardial brain abscess.

Methods: Retrospective review of all adults with brain abscess due to culture-confirmed species at our institution between January 1, 2009, and June 30, 2020. Read More

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Predictors of adherence to option B+ approach for the prevention of mother to child transmission of human immunodeficiency virus in Abuja, 2017.

Pan Afr Med J 2021 18;38:54. Epub 2021 Jan 18.

Nigeria Field Epidemiology and Laboratory Training Program Abuja, Abuja, Nigeria.

Introduction: option B+ ART is a lifelong regimen of ART using a combination of 3 ARVs and adherence to this regimen can reduce risk of MTCT to 1-2% as against 15-40% without treatment. To achieve an undetectable viral load and prevent the development of drug resistance, a person on ARV drugs need to take at least 95% of prescribed doses on time. This study assessed the level of adherence to Option B+ PMTCT program and its predictors among HIV+ Pregnant women accessing antenatal care in health facilities Abuja. Read More

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January 2021

Comparison of Different Intensity Modes of Neuromuscular Electrical Stimulation in the Rehabilitation of Elderly Patients with Decompensated Chronic Heart Failure.

Kardiologiia 2021 Mar 30;61(3):23-29. Epub 2021 Mar 30.

I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow.

Aim        To compare effects of neuromuscular electrostimulation (NMES) with various intensity of induced muscle contractions on its tolerance and effect on physical work ability in elderly patients admitted for chronic heart failure (CHF).Material and methods        The study included 22 patients older than 60 years admitted for decompensated CHF. NMES was performed from the 2nd or 3d day of stay in the hospital to the discharge from the hospital. Read More

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Deep learning-based ECG-free Cardiac Navigation for Multi-Dimensional and Motion-Resolved Continuous Magnetic Resonance Imaging.

IEEE Trans Med Imaging 2021 Apr 13;PP. Epub 2021 Apr 13.

For the clinical assessment of cardiac vitality, time-continuous tomographic imaging of the heart is used. To further detect e.g. Read More

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Hypertension in Kidney Transplant Recipients: Where Are We Today?

Curr Hypertens Rep 2021 Apr 13;23(4):21. Epub 2021 Apr 13.

Department of Nephrology, Hospital Universitario de Badajoz, and Cardiovascular Risk Chair, University of Salamanca School of Medicine, Salamanca, Spain.

Purpose Of Review: Cardiovascular disease is the leading cause of death and allograft loss among kidney transplant recipients, and hypertension is an independent risk factor for cardiovascular morbidity of this patient population. The etiology of hypertension is multifactorial, including pre-transplant volume overload, post-transplant recipient and donor-associated variables, and transplant-specific causes (immunosuppressive medications, allograft dysfunction and surgical complications such as transplant artery stenosis).

Recent Findings: No randomized controlled trials have assessed the optimal blood pressure targets and explored the best antihypertensive regimen for kidney transplant recipients. Read More

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MANual vs. automatIC local activation time annotation for guiding Premature Ventricular Complex ablation procedures (MANIaC-PVC study).

Europace 2021 Apr 13. Epub 2021 Apr 13.

Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain.

Aims: To assess potential benefits of a local activation time (LAT) automatic acquisition protocol using wavefront annotation plus an ECG pattern matching algorithm [automatic (AUT)-arm] during premature ventricular complex (PVC) ablation procedures.

Methods And Results: Prospective, randomized, controlled, and international multicentre study (NCT03340922). One hundred consecutive patients with indication for PVC ablation were enrolled and randomized to AUT (n = 50) or manual (MAN, n = 50) annotation protocols using the CARTO3 navigation system. Read More

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Enhancing recovery: Joining the Improving Surgical Care and Recovery programme to decrease colorectal surgical site infections.

J Perioper Pract 2021 Apr 12:1750458920962029. Epub 2021 Apr 12.

21666Baltimore Washington Medical Center, Glen Burnie, MD, USA.

Aim: Surgical site infections after colorectal surgery are a clinical and financial challenge in healthcare. The purpose of this project was to decrease the rate of surgical site infections in colorectal surgical patients in a community hospital with an academic cancer centre in the United States of America.

Method: The Quality Improvement Department obtained data to measure the hospital's performance with colorectal surgical patients. Read More

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Importance of Anatomical Efficacy for Disease Control in Neovascular AMD: An Expert Opinion.

Ophthalmol Ther 2021 Apr 10. Epub 2021 Apr 10.

Wolverhampton Eye Infirmary, The Royal Wolverhampton NHS Trust, Wolverhampton, UK.

Background: Neovascular age-related macular degeneration (nAMD) presents a significant treatment burden for patients, carers and medical retina services. However, significant debate remains regarding how best to manage nAMD when assessing disease activity by optical coherence tomography (OCT), and particularly the significance of different types of fluid and how the understanding of anatomical efficacy can influence treatment strategies. This article provides opinion on the practical implications of anatomical efficacy and significance of fluid in the management of nAMD and proposes recommendations for healthcare professionals (HCPs) to improve understanding and promote best practice to achieve disease control. Read More

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Feasibility and Effectiveness of Norepinephrine Outside the Intensive Care Setting for Treatment of Hepatorenal Syndrome.

Liver Transpl 2021 Apr 10. Epub 2021 Apr 10.

Stanford University, Division of Nephrology.

Background & Aims: Vasoconstrictors are the treatment of choice for hepatorenal syndrome (HRS), a potentially lethal complication of end-stage liver disease. We evaluate the real-life effectiveness of a sequential vasoconstrictor regimen of midodrine-octreotide followed by norepinephrine in a non-ICU setting in the United States, where terlipressin is not available.

Approach & Results: Adult patients diagnosed with HRS were treated with oral midodrine and subcutaneous octreotide in conjunction with albumin. Read More

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Reinduction chemotherapy regimen involved decitabine and cladribine improves the prognosis of patients with relapsed or refractory acute myeloid leukemia: a preliminary study.

Int J Cancer 2021 Apr 9. Epub 2021 Apr 9.

Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.

Relapsed/refractory acute myeloid leukemia (R/R-AML) is characterized by a high incidence, short survival and poor prognosis. Presently, no unified effective reinduction chemotherapy regimen has been developed. Therefore, the use of reinduction chemotherapy regimens before allogeneic hematopoietic stem cell transplantation (allo-HSCT) is controversial. Read More

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An Immune Recovery-Based Revaccination Protocol for Pediatric Hematopoietic Stem Cell Transplant Recipients: Revaccination Outcomes Following Pediatric HSCT.

Transplant Cell Ther 2021 Apr 28;27(4):317-326. Epub 2021 Jan 28.

Division of Pediatric Infectious Diseases, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado.

Following hematopoietic stem cell transplant (HSCT), patients are at increased risk of vaccine-preventable diseases (VPDs) and experience worse outcomes of VPDs compared to immunocompetent patients. Therefore, patients are routinely vaccinated post-HSCT to restore VPD immunity. Published guidelines recommend revaccination based on time post-HSCT, although optimal revaccination timing and the value of using other clinical and laboratory variables to guide revaccination remain unclear. Read More

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Guidelines for Adult Patient Selection and Conditioning Regimens in Cord Blood Transplant Recipients with Hematologic Malignancies and Aplastic Anemia.

Transplant Cell Ther 2021 Apr;27(4):286-291

Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota.

For cord blood transplantation (CBT), appropriate patient and conditioning regimen selection is necessary to achieve long-term disease-free survival. This review aims to provide comprehensive guidelines on these issues using evidence from the literature and experience at dedicated CBT centers. Topics include patient and disease characteristics that make CBT a good or poor choice and a review of outcomes in commonly used conditioning regimens in CBT. Read More

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Evaluation of clinical outcomes and efficacy of palonosetron and granisetron in combination with dexamethasone in Egyptian patients receiving highly emetogenic chemotherapy.

Cancer Chemother Pharmacol 2021 Apr 9. Epub 2021 Apr 9.

Medical Oncology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.

Background: Chemotherapy-induced nausea and vomiting (CINV) is considered one of the most serious adverse events affecting chemotherapy-receiving cancer patients. It dramatically affects their food intake, nutritional status and more importantly their quality of life. We can observe CINV in highly emetogenic chemotherapy (HEC) such as adriamycin-cyclophosphamide combination (AC) in breast cancer patients and cisplatin-based regimens in other cancer types. Read More

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[Identification of TCF3-ZNF384 fusion by transcriptome sequencing in B cell acute lymphoblastic leukemia and its laboratory and clinical characteristics].

Zhonghua Yi Xue Yi Chuan Xue Za Zhi 2021 Apr;38(4):351-354

Department of Pathology and Laboratory Medicine, Beijing Ludaopei Hospital, Beijing 100176, China.

Objective: To detect fusion gene with pathological significance in a patient with refractory and relapsed acute B cell lymphoblastic leukemia (B-ALL) and to explore its laboratory and clinical characteristics.

Methods: Transcriptome sequencing was used to detect potential fusion transcripts. Other laboratory results and clinical data of the patient were also analyzed. Read More

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Controlling the Drug Resistant TB Epidemic in India: Challenges & Implications.

Epidemiol Health 2021 Apr 7:e2021022. Epub 2021 Apr 7.

Research Centre, Dr G.M. Taori Central India Institute of Medical Sciences (CIIMS), Nagpur (Maharashtra), India.

India is highest Tuberculosis (TB) burden country accounting for an estimated one-fourth of the global burden. Drug resistant TB (DR-TB) represents major public health problem in India. Patients with DR-TB may often require profound changes in their drug regimen which are invariably linked to poor adherence and sub-optimal treatment outcomes compared to drug sensitive TB. Read More

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Diabetes and Frailty: An Expert Consensus Statement on the Management of Older Adults with Type 2 Diabetes.

Diabetes Ther 2021 Apr 8. Epub 2021 Apr 8.

The Foundation for Diabetes Research in Older People (fDROP) and King's College, London, UK.

Prognosis and appropriate treatment goals for older adults with diabetes vary greatly according to frailty. It is now recognised that changes may be needed to diabetes management in some older people. Whilst there is clear guidance on the evaluation of frailty and subsequent target setting for people living with frailty, there remains a lack of formal guidance for healthcare professionals in how to achieve these targets. Read More

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Comparison of the effects of butorphanol-midazolam-medetomidine and butorphanol-azaperone-medetomidine in wild common palm civets (Paradoxurus musangus).

Vet Anaesth Analg 2021 Mar 5. Epub 2021 Mar 5.

Universiti Putra Malaysia, Malaysia.

Objective: To assess the efficacy of butorphanol-azaperone-medetomidine (BAM) and butorphanol-midazolam-medetomidine (BMM) protocols for immobilization of wild common palm civets (Paradoxurus musangus) with subsequent antagonization with atipamezole.

Study Design: Prospective, randomized, blinded clinical trial.

Animals: A total of 40 adult wild common palm civets, 24 female and 16 male, weighing 1. Read More

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Excellent Outcome for Pediatric Patients With High-Risk Hodgkin Lymphoma Treated With Brentuximab Vedotin and Risk-Adapted Residual Node Radiation.

J Clin Oncol 2021 Apr 7:JCO2003286. Epub 2021 Apr 7.

Department of Radiation Oncology, St Jude Children's Research Hospital, Memphis, TN.

Purpose: Brentuximab vedotin, an effective anti-CD30 antibody-drug conjugate approved for use in adults with classical Hodgkin lymphoma (HL), was introduced in this frontline trial to reduce prescribed radiation in children and adolescents with classical HL.

Methods: Open-label, single-arm, multicenter trial for patients (age ≤ 18 years) with stage IIB, IIIB, or IV classical HL was conducted. Brentuximab vedotin replaced each vincristine in the OEPA/COPDac (vincristine, etoposide, prednisone, and doxorubicin/cyclophosphamide, vincristine, prednisone, and dacarbazine) regimen according to GPOH-HD2002 treatment group 3 (TG3); two cycles of AEPA and four cycles of CAPDac. Read More

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Pharmacokinetics of Levornidazole Tablet in Healthy Chinese Subjects and Proposed Dosing Regimen Based on Pharmacokinetic/Pharmacodynamic Analysis.

Infect Dis Ther 2021 Apr 7. Epub 2021 Apr 7.

Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, 200040, China.

Introduction: Levornidazole is a novel nitroimidazole antimicrobial agent active against anaerobes. We aimed to investigate the pharmacokinetic (PK) profile of levornidazole after single and multiple oral doses of levornidazole tablets in healthy Chinese subjects and propose the dosing regimen based on pharmacokinetic/pharmacodynamic (PK/PD) analysis.

Methods: A single-center, randomized, double-blind, placebo-controlled study was conducted with a single ascending dose (250, 500, 1000, and 1500 mg) and multiple doses of 500 mg levornidazole q12h for 7 days. Read More

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Myeloablative Busulfan/Melphalan Consolidation following Induction Chemotherapy for Patients with Newly Diagnosed High-Risk Neuroblastoma: Children's Oncology Group Trial ANBL12P1.

Transplant Cell Ther 2021 Mar 6. Epub 2021 Mar 6.

Department of Pediatrics, University of Michigan Medical Center, Ann Arbor, Michigan.

Consolidation using high-dose chemotherapy with autologous stem cell transplantation (ASCT) is an important component of frontline therapy for children with high-risk neuroblastoma. The optimal preparative regimen is uncertain, although recent data support a role for busulfan/melphalan (BuMel). The Children's Oncology Group (COG) conducted a trial (ANBL12P1) to assess the tolerability and feasibility of BuMel ASCT following a COG induction. Read More

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DOSAGE INDIVIDUALIZATION OF LINEZOLID: PRECISION DOSING OF LINEZOLID TO OPTIMISE EFFICACY AND MINIMISE TOXICITY.

Antimicrob Agents Chemother 2021 Apr 5. Epub 2021 Apr 5.

Pharmacy Department. Hospital del Mar, Parc de Salut Mar, Passeig Marítim 25-29, E-08003 Barcelona, Spain.

High interindividual variability in the pharmacokinetics (PK) of linezolid has been described, which results in an unacceptably high proportion of patients with either suboptimal or potentially toxic concentrations following the administration of a fixed regimen. The aim of this study was to develop a population pharmacokinetic model of linezolid and use this to build and validate alogorithms for individualised dosing.A retrospective pharmacokinetic analysis was performed using data from 338 hospitalized patients (65. Read More

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Effects of Different Exposure Days to Gonadotropin-Releasing Hormone Agonist (GnRH-a) on Live Birth Rates in the Depot GnRH-a Protocol: A Retrospective Analysis of 7007 Cycles.

Med Sci Monit 2021 Apr 5;27:e929854. Epub 2021 Apr 5.

Reproductive Medicine Center, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland).

BACKGROUND In controlled ovarian hyperstimulation protocols worldwide, depot gonadotropin-releasing hormone agonist (GnRH-a) pretreatment is generally used for pituitary desensitization. The delay between the GnRH-a administration and starting gonadotropin treatment varies greatly, from 25 to 60 days. However, the association between exposure days to GnRH-a before the onset of gonadotropin administration and the clinical outcomes remains unknown. Read More

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Late presentation for HIV impairs immunological but not virological response to antiretroviral treatment.

AIDS 2021 Mar 31. Epub 2021 Mar 31.

Unit AIDS Research Network Cohort (CoRIS). National Center of Epidemiology (CNE). Health Institute Carlos III (ISCIII). Madrid. Spain Hospital Universitario 12 de Octubre. Facultad de Medicina. Universidad Complutense de Madrid, Spain Hospital Universitario de Canarias,, Universidad de La Laguna, Canary Islands, Spain Infectious Diseases Unit, Complejo Hospitalario de Navarra - IdiSNA, Pamplona, Spain Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain HIV Unit, Hospital Clínico San Carlos, Madrid, Spain Department of Infectious Diseases, Hospital Universitario Valle de Hebrón, Barcelona, Spain Research Unit on Digital Health. Health Institute Carlos III (ISCIII). Madrid. Spain Department of Infectious Diseases, University Hospital, IIS Biodonostia, San Sebastián, SPAIN Ramón y Cajal University Hospital, Madrid, Spain.

Objectives: To study the impact of late presentation (CD4 <350 cells/μL or an AIDS-defining event) on effectiveness and safety of initial ART and to evaluate whether treatment response depends on first-line ART regimen in late presenters (LP).

Design: ART-naïve adults from the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) starting triple ART between 2010 and 2018.

Methods: We used multivariable models to assess differences in viral suppression (VS, viral load <50 copies/mL), immunological response (IR, change in CD4 count, CD4% (>29%) and CD4/CD8 normalization (>0. Read More

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[Evaluation of the Clinical Efficacy and Prognosis of Long-Term Maintenance Lenalidomide Therapy in Patients with Multiple Myeloma].

Zhongguo Shi Yan Xue Ye Xue Za Zhi 2021 Apr;29(2):540-546

Department of Oncology, Shunde Hospital, Guangzhou University of Chinese Medicine, Shunde 528333, Guangdong Province,

Objective: To investigate the clinical efficacy and prognosis of patients with multiple myeloma (MM) treated by long-term maintenance lenalidomide treatment.

Methods: A total of 97 patients diagnosed as MM in the Department of Hematology of First Affiliated Hospital of Guangzhou University of Chinese Medicine from 2012 to 2019 were selected, and the basic clinical characteristics and laboratory indicators of the patients were tested and evaluated. After long-term maintenance lenalidomide treatment for patients with MM, the short-term and long-term clinical efficacy and the incidence of adverse reactions were evaluated, and factors affecting the prognosis of the patients were analyzed. Read More

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