Disorders of gut-brain interaction (DGBI) are common in children and often persist despite conventional treatments, leading families to seek complementary and alternative medicine (CAM). However, evidence for CAM in pediatric DGBI is scarce. This multicenter survey study assessed parents’ and pediatricians’ experiences with and attitudes toward CAM for children with gastrointestinal symptoms. Parents and pediatricians of children (0–18 years) with gastroesophageal reflux disease (GERD) and DGBI (infant colic (IC), functional abdominal pain, and functional constipation) from six Dutch hospitals were included. GERD diagnosis was based on international guidelines, DGBI on Rome IV criteria. Parental surveys addressed child health, medication, (reasons for) CAM use, and attitudes toward CAM research. Pediatricians’ surveys covered experiences and attitudes toward CAM for pediatric DGBI. A total of 677 parents (71
Benign prostatic hyperplasia (BPH) is the main cause of lower urinary tract symptoms (LUTS) in aging men. As the incidence of prostate cancer (PCa) increases with age, coexistence of BPO and PCa is a frequent issue. Radical prostatectomy might be considered as the best option for patients presenting with severe obstructive symptoms, allowing to simultaneously treat both diseases. However, not all patients are eligible or prefer surgery, therefore a large number of patients are referred to receive PCa radiotherapy (RT). Preexisting LUTS represent a well-known risk factor to develop severe genito-urinary (GU) toxicity. While improving urinary function before starting irradiation appears to be crucial, the development of new minimally invasive surgical therapies (MIST) for BPH creates new opportunities for treatment personalization in RT patients with LUTS.
Although early laparoscopic cholecystectomy is the gold standard for acute calculous cholecystitis, its safety in patients presenting more than seven days after symptom onset remains debated. Concerns over increased surgical difficulty and complication rates often results in delaying cholecystectomy, yet evidence supporting this seven-day threshold is lacking. Therefore, this study evaluated the safety of early laparoscopic cholecystectomy in patients operated within versus beyond seven days of symptom onset. This international retrospective cohort included patients who underwent early laparoscopic cholecystectomy for acute calculous cholecystitis at two high-volume centers between 2015 and 2021. Patients were categorized by symptom duration: ≤ 7 days or > 7 days. Multivariable analyses compared major complications (bile duct injury/leakage, bowel injury, bleeding, or postoperative complication Clavien-Dindo grade ≥ 3a), conversions, operative time, and postoperative hospital stay. A total of 1421 patients were included. Of these, 1312 patients (92
The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) recommendations assess radiological change in serial MRI during active surveillance (AS) for prostate cancer. PRECISE 1–2 indicates radiological regression, PRECISE 3 stability, and PRECISE 4–5 progression. Our aim was to test the PRECISE score as a predictive tool for disease progression in a multicentre international setting. This is a retrospective study in which we collected data from 22 international centres from December 2005 to July 2022, applying two entry criteria: (1) at least two scans (baseline and follow-up); (2) at least two biopsies (baseline and follow-up, the latter after the second scan). Local radiologists reported scans according to PRECISE. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) according to different biopsy thresholds and definitions of progression were calculated. A total of 1667 patients were included. Median follow-up was 4 years (IQR: 2.1–6.3). A total of 1248 (75
BACKGROUND:Whether anticoagulation alone is an adequate treatment for acute, intermediate-risk pulmonary embolism is uncertain. METHODS:We conducted a multinational, adaptive-design trial with blinded outcome adjudication. Patients with intermediate-risk pulmonary embolism (with a ratio of right ventricular end-diastolic diameter to left ventricular end-diastolic diameter of ≥1.0 and an elevated troponin level) were eligible if they had at least two indicators of cardiorespiratory distress (systolic blood pressure of ≤110 mm Hg, a heart rate of ≥100 beats per minute, or a respiratory rate of >20 breaths per minute). Patients were randomly assigned to undergo ultrasound-facilitated, catheter-directed fibrinolysis with alteplase plus anticoagulation (the intervention group) or anticoagulation alone (the control group) according to prespecified treatment protocols. The primary outcome was a composite of pulmonary embolism-related death, cardiorespiratory decompensation or collapse, or symptomatic recurrence of pulmonary embolism within 7 days. RESULTS:The intention-to-treat population comprised 544 patients: 273 in the intervention group and 271 in the control group. The mean (±SD) age was 58.2±13.5 years, and 42.6% of the patients were women. A primary-outcome event occurred in 11 patients (4.0%; 95% confidence interval [CI], 2.3 to 7.1) in the intervention group and 28 (10.3%; 95% CI, 7.2 to 14.5) in the control group (relative risk, 0.39; 95% CI, 0.20 to 0.77; P = 0.005). The effect was driven primarily by a lower risk of cardiorespiratory decompensation or collapse in the intervention group. Major bleeding occurred within 7 days after randomization in 11 patients (4.1%) in the intervention group and 6 (2.2%) in the control group (P = 0.32); major bleeding occurred within 30 days in 11 patients (4.1%) and 8 patients (3.0%), respectively (P = 0.64). No substantial between-group differences in the incidence of other serious adverse events were observed up to 30 days after randomization; no intracranial hemorrhage occurred. CONCLUSIONS:In patients with acute, intermediate-risk pulmonary embolism, ultrasound-facilitated, catheter-directed fibrinolysis plus anticoagulation led to a lower risk of the composite of pulmonary embolism-related death, cardiopulmonary decompensation or collapse, or symptomatic recurrence of pulmonary embolism within 7 days than anticoagulation alone. (Funded by Boston Scientific; HI-PEITHO ClinicalTrials.gov number, NCT04790370.).
