Artificial Intelligence could help cure loneliness, say experts

Artificial Intelligence (AI) technology could offer companionship to lonely people amid an international epidemic of loneliness, says a robotics expert.

Tony Prescott, a professor of cognitive robotics at the University of Sheffield, argues in his new book The Psychology of Artificial Intelligence that ‘relationships with AIs could support people’ with forms of social interaction..

Loneliness has been found to seriously impair human health, and Professor Prescott makes a case that advances in AI technology could offer a partial solution.

He argues that people can spiral into loneliness, becoming increasingly disconnected as their confidence plummets, and that AI might help people to ‘break the cycle’ by giving them a way to practice and improve their social skills.

The impact of loneliness

Loneliness-or social disconnection-is more harmful to human health than obesity, according to a 2023 report. It can increase the risk of premature death by 26% and is associated with a greater risk of cardiovascular disease, dementia, stroke, depression and anxiety. The extent of the problem is striking: in the UK 3.8 million people are experiencing chronic loneliness. A Harvard study in the US found that 36% of US adults – and 61% of young adults – experience serious loneliness.

Professor Prescott says: “In an age when many people describe their lives as lonely, there may be value in having AI companionship as a form of reciprocal social interaction that is stimulating and personalized. Human loneliness is often characterised by a downward spiral in which isolation leads to lower self-esteem which discourages further interaction with people.

“There may be ways in which AI companionship could help break this cycle by scaffolding feelings of self-worth and helping maintain or improve social skills. If so, relationships with AIs could support people to find companionship with both human and artificial others.”

He does suggest this is not without risk, however, as it could be ‘designed to encourage users to interact for longer and longer periods and to keep them coming back’, and suggests regulation may be needed.

AI and the human brain

Prescott is a leading expert on the relationship between the human brain and AI, combining expertise in robotics and AI with psychology and philosophy. He contributes to the scientific understanding of the human condition by researching the re-creation of perception, memory, and emotion in synthetic entities.

As well as researching and teaching cognitive robotics at the University of Sheffield, Prescott is also the co-founder of Sheffield Robotics, which is a hub for robotics research.

In The Psychology of Artificial Intelligence, Prescott explores the nature of the human mind and its cognitive processes and compares and contrasts this with the way AI is developing.

The book explores questions including:

• Are computers really like brains?

• Will AI surpass humans?

• Does AI have the ability to be creative?

• Would giving AI a robotic body enable it to create new types of intelligence?

• Could AI help us tackle climate change?

• And could humans ‘piggyback’ on AI to extend their own intelligence?

He concludes: “As psychology and AI proceed, this partnership should unlock further insights into both natural and artificial intelligence. This could help answer some key questions about what it means to be human and for humans to live alongside AI.”

Reference:

Prescott, T. (2024). The Psychology of Artificial Intelligence (1st ed.). Routledge. https://doi.org/10.4324/9781003088660.

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Bisoprolol fails to improve outcomes in COPD patients at high risk of exacerbations: BICS trial

UK: In a landmark advancement in managing chronic obstructive pulmonary disease (COPD), the findings of the BICS (Bisoprolol in COPD Study) randomized clinical trial have brought attention to the role of bisoprolol in patients at high risk of exacerbation.

COPD, a progressive respiratory condition characterized by airflow limitation, poses significant challenges in treatment, particularly in preventing exacerbations that often lead to hospitalizations and a decline in quality of life.

The results of the BICS trial, published in the Journal of the American Medical Association (JAMA), showed that treatment with the β1-selective β-blocker bisoprolol did not reduce the number of self-reported COPD exacerbations requiring treatment with antibiotics, oral corticosteroids, or both among patients with COPD.

“These findings will help physicians and patients with COPD assess the risks and benefits of using bisoprolol to treat cardiovascular disease,” the researchers wrote.

Chronic obstructive pulmonary disease is a leading cause of mortality and morbidity worldwide. Observational studies report that β-blocker use may be associated with lowered risk of COPD exacerbations. However, a recent trial reported that metoprolol did not reduce COPD exacerbations and increased COPD exacerbations requiring hospital admission. Graham Devereux, Liverpool School of Tropical Medicine, Liverpool, United Kingdom, and colleagues tested whether bisoprolol decreased COPD exacerbations in patients with a high risk of exacerbations.

For this purpose, the researchers conducted a double-blind, placebo-controlled RCT in 76 UK sites. It enrolled patients with COPD having at least moderate airflow obstruction on spirometry and at least 2 COPD exacerbations treated with oral corticosteroids, antibiotics, or both in the prior 12 months from 2018 to 2022. At least moderate airflow obstruction on spirometry was defined as the ratio of forced expiratory volume in the first second of expiration [FEV1] to forced vital capacity <0.7; FEV1 <80% predicted.

Patients were randomly assigned to bisoprolol (n = 261) or placebo (n = 258). Bisoprolol was started at 1.25 mg orally daily and was titrated as tolerated during four sessions to a maximum dose of 5 mg/d.

The primary clinical outcome was the number of patient-reported COPD exacerbations treated with antibiotics, oral corticosteroids, or both during the 1-year treatment period. Safety outcomes included adverse reactions and serious adverse events.

The following were the key findings of the study:

  • Although the trial planned to enroll 1574 patients, recruitment was suspended due to the COVID-19 pandemic from March 16, 2020, to July 31, 2021. Two patients in each group were excluded postrandomization.
  • Among the 515 patients (mean age, 68 years; 53% men; mean FEV1, 50.1%), primary outcome data were available for 99.8% of patients, and 72.0% continued taking the study drug.
  • The primary outcome of patient-reported COPD exacerbations treated with oral corticosteroids, antibiotics, or both was 526 in the bisoprolol group, with a mean exacerbation rate of 2.03/y, vs 513 exacerbations in the placebo group, with a mean exacerbation rate of 2.01/y.
  • The adjusted incidence rate ratio was 0.97.
  • Serious adverse events occurred in 14.5% of patients in the bisoprolol group vs 14.3% in the placebo group (relative risk, 1.01).

The findings showed that treatment with bisoprolol did not reduce the number of self-reported COPD exacerbations requiring treatment with oral corticosteroids, antibiotics, or both among people with COPD at high risk of exacerbation.

Reference:

Devereux G, Cotton S, Nath M, et al. Bisoprolol in Patients With Chronic Obstructive Pulmonary Disease at High Risk of Exacerbation: The BICS Randomized Clinical Trial. JAMA. Published online May 19, 2024. doi:10.1001/jama.2024.8771

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High-dose etanercept helps children with juvenile idiopathic arthritis achieve remission and reduce disease activity: Study

Researchers have found that high-dose etanercept could help children with juvenile idiopathic arthritis (JIA) reduce disease activity and achieve remission, according to a new analysis. This stems from a post-hoc analysis of the BeSt for Kids trials, which provides insights into the effects of off-label dose escalation with etanercept and its potential risks compared to the recommended dose. The study was published in the Pediatric Rheumatology Online Journal by Van Dijk and colleagues.

Etanercept, a TNF inhibitor, was first approved by the US Food and Drug Administration in 1998 for rheumatoid arthritis and later for other conditions, including polyarticular JIA. Despite its broad use, the standard dosing in clinical trials has sometimes proven inadequate for achieving desired clinical responses in JIA patients. Consequently, off-label use at elevated doses occurs in real-world settings. The current study aimed to analyze data from the BeSt for Kids trial to evaluate the clinical outcomes of JIA patients who received high-dose etanercept versus those who did not escalate their dose despite eligibility.

Launched in 2008, the BeSt for Kids trial assessed treat-to-target approaches for JIA using different therapy combinations, including methotrexate with etanercept. Among 92 patients with oligoarticular JIA, RF-negative polyarticular JIA, or juvenile psoriatic arthritis, 32 patients received high-dose etanercept, defined as escalating up to 1.6 mg/kg per week, with a maximum of 50 mg per week. The comparator group included patients who did not escalate to high-dose etanercept despite meeting eligibility criteria.

  • In the high-dose group, the median age was 6 years (IQR, 4-10), and 69% were girls. In the comparator group, the median age was 8 years (IQR, 6-9), with 73% being girls.

  • The median follow-up was 24.6 months. The number of actively inflamed joints at inclusion was higher in the high-dose group (median, 11; IQR, 8-18) compared to the comparator group (median, 7; IQR, 5-11; P=0.022).

Clinical Improvements: Significant clinical improvements within three months of dose escalation were observed:

  • Median JADAS10 score reduced from 7.2 to 2.8 (P=0.008).

  • VAS-physician score decreased from 12 to 4 (P=0.022).

  • VAS-patient/parent score dropped from 38.5 to 13 (P=0.003).

  • Number of active joints fell from 2 to 0.5 (P=0.12).

  • VAS-pain score improved from 35.5 to 15 (P=0.030).

  • Functional impairments, measured by the CHAQ score, improved gradually from 0.63 to 0.50 (P=0.047), while erythrocyte sedimentation rates remained stable (6 to 6; P=0.32).

  • No severe adverse events were reported post-escalation. Non-severe adverse events were recorded in 81% of the high-dose group and 55% of the comparator group.

The analysis suggests that high-dose etanercept can lead to meaningful clinical improvements in children with JIA, as evidenced by significant reductions in disease activity scores and improvements in physician and patient/parent assessments. However, similar improvements were observed in the comparator group, highlighting the need for further research to establish the definitive benefits and safety of high-dose etanercept.

Researchers have found that escalating to high-dose etanercept in JIA patients can result in significant clinical improvement, although similar outcomes were observed in those who did not escalate. The study underscores the necessity for additional research to fully understand the efficacy and safety of high-dose etanercept in this patient population.

Reference:

van Dijk BT, Bergstra SA, van den Berg JM, et al. Increasing the etanercept dose in a treat-to-target approach in juvenile idiopathic arthritis: does it help to reach the target? A post-hoc analysis of the BeSt for Kids randomised clinical trial. Pediatr Rheumatol Online J. 2024;22(1):53. Published 2024 May 10. doi:10.1186/s12969-024-00989-x

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Comparative analysis of intubating conditions using channeled and non-channeled video laryngoscopes in supine and 25° back-up positions

When administering general anesthesia, tracheal intubation is crucial for maintaining patency of the airway. The ideal head and neck posture for direct laryngoscopy has long been considered to be the “sniffing” position. Endotracheal intubation using video laryngoscopes (VLSs) has become more common due to its ability to reduce the stress response while simultaneously improving laryngeal exposure. But there is still a dearth of information in the literature on the proper head and neck positioning for video-laryngoscopy. The clinical practice makes use of a variety of postures, including the 25° backup position and the supine (neutral or sniffing) position.

Recently published study aimed to compare intubating conditions in the supine (sniffing) and 25° back-up positions using King Vision and McGrath video laryngoscopes. The primary objective was to compare intubating conditions in terms of the modified Intubation Difficulty Scale (mIDS), with secondary comparisons of intubation time, number of attempts, vital parameters, and airway complications in both positions.

Study Procedure and Patient Enrollment The study, conducted at a tertiary healthcare center, enrolled 100 adult patients and randomized them into two groups using computer-generated random numbers. The patients were intubated using either King Vision or McGrath VLS in the supine (sniffing) or 25° back-up positions. The primary outcome measured was the ease of intubation using mIDS, while secondary outcomes included intubation time, number of attempts, vital parameters, and complications.

Study Findings The study found that the 25° back-up position resulted in significantly lower mIDS compared to the supine position when using both King Vision and McGrath VLS. Intubation time was also shorter in the 25° back-up position for both VLSs. Additionally, fewer patients required ancillary maneuvers during intubation in the 25° back-up position compared to the supine position. The study concluded that the 25° back-up position provided easier intubation using both channelled and non-channelled VLS, with less requirement for ancillary maneuvers and shorter intubation time, without complications. The authors also noted that the results cannot be generalized to patients with difficult airways, obese and pregnant patients, or those requiring emergency surgeries, and cautioned that the same results cannot be extrapolated to VLSs other than King Vision and McGrath. They also offered to share de-identified data upon request and confirmed no conflicts of interest. In summary, the study demonstrated the advantages of the 25° back-up position over the supine position for intubating conditions, providing valuable insights for anesthesiologists and researchers in the field.

Reference –

Desai, Devyani; Sompura, Riddhi; Yadav, Sudarshan. Comparison of intubating conditions in supine (sniffing) and 25° back-up position using channelled and non-channelled video laryngoscopes – A randomised controlled study. Indian Journal of Anaesthesia 67(12):p 1090-1095, December 2023. | DOI: 10.4103/ija.ija_662_23

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Half-dose photodynamic therapy clinically useful therapy for chronic central serous chorioretinopathy, suggests study

Researchers have found that half-dose photodynamic therapy (PDT) results in faster and more effective resolution of subretinal fluid (SRF) in patients with chronic central serous chorioretinopathy (CSCR) compared to subthreshold micropulse laser therapy (SMLT). The recent study was published in Ophthalmology Retina journal by Marten E. and colleagues. This prospective, double-masked, randomized, controlled clinical trial aimed to compare the anatomic and functional outcomes of these two treatments in patients diagnosed with chronic CSCR.

Chronic CSCR is a condition characterized by the accumulation of SRF under the retina, leading to vision impairment. Current treatments include PDT and SMLT, but their comparative efficacy has not been conclusively determined. This study, conducted between April 2017 and October 2020, sought to fill this knowledge gap by evaluating the effectiveness of half-dose PDT versus SMLT.

Eligible patients were randomly assigned to receive either half-dose PDT or SMLT. The treatments were repeated if persistent SRF was observed. Evaluations were conducted one month after treatment and every three months thereafter until the 12-month endpoint. The primary outcome measure was the complete resolution of SRF on OCT scan at 12 months. Secondary outcomes included changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), retinal sensitivity, and vision-related quality of life.

  • A total of 68 patients were enrolled in the study. At the 1-month mark, SRF resolved in 24.2% of patients receiving SMLT and 58.8% of patients receiving half-dose PDT.

  • By 12 months, SRF resolution was observed in 82.1% of the SMLT group and 90.9% of the half-dose PDT group.

  • Kaplan-Meier survival curves indicated significantly faster SRF resolution in the half-dose PDT group compared to the SMLT group (P = 0.016).

  • Both treatment groups showed significant improvements in BCVA, CMT, and retinal sensitivity at 12 months.

  • Specifically, BCVA improved by −0.12 ± 0.21 in the SMLT group and −0.13 ± 0.12 in the half-dose PDT group.

  • CMT decreased by −154.2 ± 105.6 in the SMLT group and −140.8 ± 94.0 in the half-dose PDT group.

  • Retinal sensitivity increased by 5.70 ± 5.02 in the SMLT group and 6.05 ± 3.83 in the half-dose PDT group.

  • There were no significant differences between the two groups at each time point in terms of BCVA, CMT, and retinal sensitivity, except for BCVA at 3 months (P = 0.03).

The findings indicate that both half-dose PDT and SMLT are viable treatment options for chronic CSCR. However, half-dose PDT provides faster anatomic success and functional improvement, making it a potentially more effective treatment option for this condition. The study highlights the importance of personalized treatment plans for patients with chronic CSCR, taking into consideration the speed of recovery and overall efficacy of the therapy.

This study demonstrates that half-dose PDT achieves faster resolution of SRF and functional improvement in chronic CSCR patients compared to SMLT. Both treatments are effective, but half-dose PDT offers a quicker pathway to anatomic success, suggesting it may be the preferred option in managing chronic CSCR.

Reference:

Brelen, M. E., Ho, M., Li, S., Ng, D. S. C., Yip, Y. W. Y., Lee, W. S., Chen, L. J., Young, A. L., Tham, C. C., & Pang, C. P. (2024). Comparing half-dose photodynamic therapy with subthreshold micropulse laser for the treatment of central serous chorioretinopathy. Ophthalmology Retina, 8(5), 490–498. https://doi.org/10.1016/j.oret.2023.10.024

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Combined aerobic and resistance exercise may reduce cardiovascular disease risks: Study

USA: Aerobic exercise alone or resistance plus aerobic exercise, but not resistance exercise alone, improved composite cardiovascular disease (CVD) risk profile in adults with obesity or overweight compared with the control, a recent study published in the European Heart Journal has revealed. 

Approximately one in three deaths in the U.S. is caused by cardiovascular disease, according to the U.S. Centers for Disease Control and Prevention. A robust body of evidence shows aerobic exercise can reduce risks, especially for people who are overweight or obese. However, few studies have compared results with resistance exercise known as strength or weight training or with workout regimens that are half aerobic and half resistance. Researchers at Iowa State University led one of the longest and largest supervised exercise trials to help fill this gap.

Their results indicate that splitting the recommended amount of physical activity between aerobic and resistance exercise reduces cardiovascular disease risks as much as aerobic-only regimens. Resistance exercise on its own for the same amount of time did not provide the same heart health benefits when compared to the control group.

“If you’re bored with aerobic exercise and want variety or you have joint pain that makes running long distances difficult, our study shows you can replace half of your aerobic workout with strength training to get the same cardiovascular benefits. The combined workout also offers some other unique health benefits, like improving your muscles,” says Duck-chul Lee, lead author and professor of kinesiology at Iowa State.

Performing a certain number of sets and repetitions with weight machines, free weights, elastic bands or your own body weight through push-ups or lunges, all fall under resistance exercise.

“One of the most common reasons why people don’t exercise is because they have limited time. The combined exercise with both cardio and strength training we’re suggesting is not more time consuming,” Lee underscores.

Co-authors from Iowa State include Angelique Brellenthin, associate professor of kinesiology; Lorraine Lanningham-Foster,department chair and associate professor of food science and human and nutrition; Marian Kohut, the Barbara E. Forker Professor in kinesiology. Yehua Li, professor of statistics at the University of California Riverside, also contributed.

In the paper, they wrote: “These findings may help develop clinical and public health practices and recommendations for the approximately 2 billion adults with overweight or obesity worldwide who are at increased risk of [cardiovascular disease.]”

One of the longest, largest exercise trials

Four hundred and six participants between 35 and 70 years of age enrolled in the one-year randomized controlled exercise trial. All met the threshold for being overweight or obese with body mass indexes between 25-40 kg/m2 and had elevated blood pressure.

The researchers randomly assigned participants to one of four groups: no exercise, aerobic only, resistance only, or aerobic plus resistance. Those who were in one of the three exercise groups worked out under supervision for one hour, three times a week for one year.

Every participant in one of the exercise groups received a tailored workout routine based on their individual fitness levels, health conditions and progression. Those assigned to resistance training were given a certain number of sets, repetitions and weights for weight-lifting machines. With aerobic exercises, participants wore a heart rate monitor and inserted a unique exercise program key into a treadmill or stationary bike. Sensing the participant’s heart rate, the machine automatically adjusted the speed and grade to match the prescribed intensity.

Researchers collected physical activity and diet data outside the lab, as well. All participants, including those in the no exercise group, wore pedometers to measure daily steps. They met every three months with registered dietitians at Iowa State for “Dietary Approaches to Stop Hypertension” education, which is promoted by the National Institutes of Health. On three random days per month, participants were asked to record what they had consumed in the last 24 hours with an online dietary assessment tool developed by the U.S. National Cancer Institute.

At the start of the year-long clinical trial, six months in and at the end, the researchers measured each participant’s systolic blood pressure, low-density lipoprotein cholesterol, fasting glucose and body fat percentage. All are well-established cardiovascular disease risk factors.

“Many previous studies only looked at one of these four factors, but it’s really multiple factors combined that increase cardiovascular disease risk,” explains Lee.

The researchers used a composite score to fairly quantify changes across all four factors since each uses a different unit of measurement. A lower composite score indicates less risk for developing cardiovascular disease.

Main findings

At the end of the year-long trial, the percentage of body fat in all three exercise groups had decreased significantly compared to the no-exercise control group. The authors write in the paper that “every -1% body fat reduction is associated with -3%, -4%, and -8% lower risks of developing [cardiovascular disease] risk factors of hypertension, hypercholesterolemia, and metabolic syndrome.”

However, taking all four cardiovascular disease risk factors into account, the aerobic and combined exercise groups had lower composite scores than the control group. The results were consistent across gender and age.

Secondary findings

For the 12-month study, those in the aerobic-only group continued to improve with the VO2max test, which is the maximum rate of oxygen consumption attainable during a maximal treadmill test. The resistance-only group stayed relatively flat. The inverse was true for the maximal bench and leg press tests for muscular strength; the resistance-only group continued to improve while the aerobic-only group did not.

However, the combination exercise group improved both aerobic fitness and muscular strength.

Finding the right dose

The authors say their findings support “physical activity guidelines recommending both resistance and aerobic exercise by the U.S., [World Health Organization] and European Society of Cardiology, specifically for individuals with obesity.” Currently, it’s at least 150 minutes each week of moderate intensity aerobic exercise and two sessions per week of resistance training.

“But these guidelines don’t specify how long those strength training sessions should be to get the health benefits,” says Lee.

With a newly awarded grant from the National Heart, Lung and Blood Institute, Lee wants to find “the right dose” of resistance exercise among adults who are overweight or obese. He plans to conduct another randomized controlled resistance exercise trial, this time with 240 participants. The study will compare results from 0-, 15-, 30- and 60-minute resistance sessions, twice per week for six months in a supervised exercise lab. Participants in all four groups also will be asked to do 30-minute sessions of moderate-intensity aerobic exercise, twice per week, per the physical activity guidelines.

During the second six-month phase, participants will receive a free health club membership and be asked to continue their assigned regimen, unsupervised. Lee explains this will help identify which dose of resistance exercise is both effective and feasible outside experimental trials.

Reference:

Duck-chul Lee, Angelique G Brellenthin, Lorraine M Lanningham-Foster, Marian L Kohut, Yehua Li, Aerobic, resistance, or combined exercise training and cardiovascular risk profile in overweight or obese adults: the CardioRACE trial, European Heart Journal, 2024;, ehad827,https://doi.org/10.1093/eurheartj/ehad827.

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TASTE trial results support use of tenecteplase for acute ischaemic stroke within 4.5 hours based on perfusion imaging

In the international TASTE trial, the intention-to- treat analysis narrowly failed to demonstrate non-inferiority of tenecteplase compared to alteplase in patients with acute ischaemic stroke within 4.5 hours of symptom onset selected by perfusion imaging. Non-inferiority was demonstrated in the per- protocol analysis, supporting the growing body of evidence for the use of tenecteplase in acute ischaemic stroke.

Over the past two years, several clinical trials have demonstrated non-inferiority of intravenous tenecteplase as compared to alteplase for acute ischaemic stroke. The Tenecteplase versus Alteplase for Stroke Thrombolysis Evaluation with Perfusion Imaging Selection within 4·5 hours of Onset (TASTE) trial, presented today at the European Stroke Organisation Conference (ESOC) 2024, lends considerable weight to this series of studies.

The trial design of TASTE differed to the prior trials, in that all patients in TASTE had modern brain imaging including measurement of salvageable tissue (‘target mismatch’) on brain perfusion imaging. TASTE was a multicentre, randomised, controlled phase III non-inferiority trial conducted in 35 hospitals in 8 countries. Patients were randomly assigned to intravenous tenecteplase (0.25mg/kg) or alteplase (0.90mg/kg). The primary outcome was the proportion of patients without disability (modified Rankin Scale 0-1) at 3-months. Safety outcomes were all-cause mortality and symptomatic intracranial haemorrhage.

The trial was stopped early following the results of previous tenecteplase trials. 680 patients were randomised. In intention-to-treat analysis, the primary outcome occurred in a numerically higher proportion of patients allocated to tenecteplase (57.0%) as compared to those allocated to alteplase (55.3%). This translated into a standardised risk difference of 0.03 (95% confidence interval: -0.033;0.10), which narrowly missed the pre-defined non- inferiority criteria of a lower boundary of -0.03. In the per-protocol analysis, non-inferiority was demonstrated and safety outcomes were comparable between groups.

Although the primary endpoint was not met, the results of TASTE are in line with those from previous trials of tenecteplase for acute ischaemic stroke. When the TASTE results are added to a meta-analysis of the previous trials tenecteplase was, for the first time, demonstrated to be superior to alteplase for excellent recovery at 3 months after stroke. This means that for every 25 patients treated with tenecteplase (rather than alteplase), one more patient will have full recovery at 3 months.

Professor Mark Parsons, the principal investigator of the trial, commented, “TASTE is the largest clinical trial ever in stroke to use modern brain perfusion imaging selection in all patients. Although there were other tenecteplase trials completed before us, we were the only phase 3 clinical trial of tenecteplase that exclusively included patients with a proven tissue target for reperfusion treatment. Thus, the TASTE results increase confidence that tenecteplase is actually a superior agent for stroke thrombolysis.”

Intravenous alteplase has been the predominant thrombolytic agent used for acute ischaemic stroke for more than two decades. Currently, the stroke community is facing a transition towards tenecteplase becoming the first choice for intravenous thrombolysis in clinical practice. The results of TASTE will further push forward this movement.

Reference:

TENECTEPLASE VERSUS ALTEPLASE FOR STROKE THROMBOLYSIS EVALUATION (TASTE): A MULTICENTRE RANDOMISED CONTROLLED PHASE III TRIAL. Presented at the European Stroke Organisation Conference; 15 May 2024; Basel, Switzerland.

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Bariatric Surgery Linked to Reduced Breast Cancer Risk in Women with Obesity: Study

Researchers have long suspected a link between obesity, insulin levels, and breast cancer risk in women. While retrospective studies suggest that bariatric surgery may lower the risk of breast cancer, there is a lack of long-term prospective data to confirm these findings and understand the role of baseline insulin levels. Obesity and insulin levels have been implicated as risk factors for breast cancer. Bariatric surgery is known to be effective in reducing obesity-related complications, but its impact on breast cancer risk has not been well-established.

This study was published in the journal of JAMA Surgery by Felipe M. and colleagues.

  • The study, conducted as part of the Swedish Obese Subjects (SOS) study, included 2867 women aged 37 to 60 years with a body mass index (BMI) of 38 or greater.

  • Over a median follow-up period of 23.9 years, 154 breast cancer events were recorded, with 66 in the surgery group and 88 in the usual care group.

  • Women who underwent bariatric surgery had a decreased risk of breast cancer compared to those receiving usual obesity care (adjusted hazard ratio [HR] 0.72; 95% confidence interval [CI], 0.52-1.01; P = .06).

  • The reduction in breast cancer risk after bariatric surgery was more pronounced in women with baseline insulin levels above the median (adjusted HR, 0.55; 95% CI, 0.35-0.86; P = .008) compared to those with lower insulin levels.

The findings of this study suggest that bariatric surgery may lower the risk of breast cancer in women with obesity. Furthermore, the reduction in breast cancer risk appears to be more significant in individuals with higher baseline insulin levels, indicating a potential role for insulin in breast cancer development.

In conclusion, this prospective clinical trial provides evidence that bariatric surgery is associated with a reduced risk of breast cancer in women with obesity. Moreover, the study highlights the importance of considering baseline insulin levels in assessing breast cancer risk reduction following bariatric surgery.

Reference:

Kristensson, F. M., Andersson-Assarsson, J. C., Peltonen, M., Jacobson, P., Ahlin, S., Svensson, P.-A., Sjöholm, K., Carlsson, L. M. S., & Taube, M. (2024). Breast cancer risk after bariatric surgery and influence of insulin levels: A nonrandomized controlled trial. JAMA Surgery. https://doi.org/10.1001/jamasurg.2024.1169

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Flapless surgical approach viable surgical treatment alternative for the management of peri-implantitis: Study

The flapless surgical approach viable surgical treatment alternative for management of peri-implantitis suggests a study published in the Journal of Clinical Periodontology.

A study was done to evaluate the effectiveness of a flapless surgical approach in the treatment of peri-implantitis and to explore the factors influencing its outcome. The present retrospective study evaluated patients with at least one implant diagnosed with peri-implantitis and treated with a flapless surgical access, with or without systemic antimicrobials, curettage and, when needed, prostheses modification. Clinical and radiographic parameters were assessed at baseline and at 3 months and at least 12 months. The primary outcome was disease resolution (≤1 bleeding sites, probing depth [PD] ≤5 mm, no bone loss >0.5 mm). Multilevel regression analyses were used to identify predictors influencing the probability of attaining disease resolution. Results: One hundred and seventeen patients with 338 implants were included. Disease resolution was attained in 54.4% of the 338 implants receiving flapless surgical access. At the end of the follow-up period, 111 patients (94.9%) with 295 implants (87.3%) did not require any further treatment, with 81.4% of these implants presenting PD ≤ 5 mm. History of periodontitis and PD at baseline were identified as negative predictors, while compliance with supportive peri-implant care, a machined surface and the adjunctive use of systemic azithromycin or metronidazole were identified as positive predictive factors for disease resolution. A flapless surgical approach led to disease resolution in 54.4% of the implants with peri-implantitis. Several risk/protective predictors for disease resolution were identified.

Reference:

Carrillo de Albornoz, A., Montero, E., Alonso-Español, A., Sanz, M., & Sanz-Sánchez, I. (2024). Treatment of peri-implantitis with a flapless surgical access combined with implant surface decontamination and adjunctive systemic antibiotics: A retrospective case series study. Journal of Clinical Periodontology, 1–13. https://doi.org/10.1111/jcpe.13993

Keywords:

Flapless, surgical, approach, viable, surgical, treatment, alternative, management, peri-implantitis, study, Carrillo de Albornoz, A., Montero, E., Alonso-Español, A., Sanz, M., & Sanz-Sánchez, I

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Antenatal corticosteroid use reduces respiratory morbidity in babies born in the late preterm period: Study

Nigeria: The administration of antenatal corticosteroids (ACS) has long been considered a cornerstone in preterm labor management, aimed at improving neonatal outcomes, particularly respiratory health. However, a recent study published in BMC Pregnancy and Childbirth delves into the efficacy of ACS, specifically in babies born during the late preterm period, shedding light on its impact on respiratory morbidity.

The study found that dexamethasone administration to women at risk for late preterm delivery significantly reduces the rate of neonatal intensive care unit admission, neonatal respiratory complications, and the need for active resuscitation at birth.

Most studies have used dexamethasone or betamethasone as the antenatal steroid. Current research has not shown any significant differences in complication or efficacy of both drugs, hence the choice of dexamethasone in this study. Also, the study was done in a low-resource setting where dexamethasone is significantly cheaper than betamethasone. Considering this, Khadijah A. Shittu, Department of Obstetrics & Gynaecology, Lagos State University Teaching Hospital, Lagos, Nigeria, and colleagues aimed to determine whether antenatal corticosteroids use reduces respiratory morbidity in late preterm babies in the Nigerian population.

For this purpose, the researchers studied two hundred and eighty-six pregnant women at risk of having a late preterm delivery. One hundred and forty-three served as the cases and were given 2 doses of 2 doses of 12 mg intramuscular dexamethasone 12 h apart. In contrast, 143 served as the controls and were given a similar quantity of placebo.

Women were prospectively followed up, and data were collected on the pregnant women and their newborns on a standardized form. The neonates were evaluated for acute respiratory distress syndrome and transient tachypnea of the newborn based on clinical signs, chest x-ray results (when indicated), and symptoms. The primary outcome was the occurrence of neonatal respiratory morbidity.

The study led to the following findings:

· The primary outcome occurred in 3.8% of infants in the dexamethasone group and 25.4% of infants in the placebo group.

· Birth asphyxia, neonatal intensive care admission, and need for active resuscitation at birth also occurred significantly less frequently in the dexamethasone group.

· There were no significant group differences in the incidence of neonatal sepsis, hypoglycemia, neonatal jaundice, and feeding difficulties.

As the medical community continues to grapple with the complexities of preterm birth management, studies like this serve as vital guides, informing clinical practice and guiding the delivery of care to optimize outcomes for newborns born during the late preterm period.

Reference:

Shittu, K.A., Ahmed, B., Rabiu, K.A. et al. Does the use of antenatal corticosteroids reduce respiratory morbidity in babies born in late preterm period?. BMC Pregnancy Childbirth 24, 334 (2024). https://doi.org/10.1186/s12884-024-06304-6

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