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Late-Onset Reactions after Hyaluronic Acid Dermal Fillers: A Consensus Recommendation on Etiology, Prevention and Management

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DERMATOLOGY AND THERAPY 2024年第7期14卷 1767-1785页

作者： Baranska-Rybak, Wioletta Lajo-Plaza, Jose V. Walker, Lee Alizadeh, Navid Med Univ Gdansk Dept Dermatol Venereol & Allergol Ul Smoluchowskiego 17 PL-80214 Gdansk Poland Ctr Med Lajo Plaza Madrid Spain BCity Clin Liverpool England Care Geneva Aesthet Geneva Switzerland

Hyaluronic acid (HA) dermal fillers, generally considered low-risk, can lead to rare late-onset reactions (LORs) manifesting between 3 and 4 months postinjection, occasionally even as early as 24 h postinjection. The Complication Assessment and Risk Evaluation (CARE) board was established to review these reactions. In this publication, the authors aims to explore the etiological hypotheses underlying LORs, associated risk factors, prevention, and management approaches suggested by the CARE board. The CARE board identified three etiological hypotheses contributing to LORs. Firstly, the physicochemical structure of the filler, particularly low molecular weight HA, which may trigger an immune response. Secondly, infection, potentially introduced during injection or by dormant biofilm activation. Lastly, an imbalance in the host immune system, caused by factors like autoimmune diseases or viral infections, may lead to extended foreign body reactions, delayed type IV hypersensitivity, or adjuvant-based reactions. Based on these hypotheses, the board categorized various risk factors as patient-related (e.g., recent dental treatment, current medical status, active autoimmune disease), product-related (e.g., molecular weight), and procedure-related (e.g., aseptic technique and trauma). To reduce the risk of LORs, the CARE board recommends diligent patient selection, including comprehensive medical history assessment and informed consent. Practitioners should maintain an effective aseptic technique, and choose an appropriate product and injection depth for the anatomical location. Post-procedure, patients should receive education on proper filler care. Management of LORs depends on the suspected etiology, and the CARE board has proposed an algorithm to determine the most appropriate treatment. Hyaluronidase is recommended for noninflammatory reactions in the absence of active infection, while watchful waiting and/or steroid treatment may be preferred for inflammatory reactio

关键词： Expert opinion Delayed onset reactions Inflammation Infection treatment algorithm

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treatment of Septic Arthritis of the Hip Joint Using Repeated Aspirations: When Should We Operate?

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INDIAN JOURNAL OF ORTHOPAEDICS 2022年第6期56卷 1090-1095页

作者： Rotem, Gilad Zur-Aviran, Noa Sherr-Lurie, Nir Weltsch, Daniel Schindler, Amos Tenenbaum, Shay Givon, Uri Tel Aviv Univ Sheba Med Ctr Sackler Sch Med Hand Surg DeptOrthoped Div IL-5262100 Ramat Gan Israel Safra Hosp Children Sackler Sch Med Sheba Med Ctr Pediat Orthoped Unit Ramat Gan Israel Sheba Med Ctr Sackler Sch Med Orthoped Div Ramat Gan Israel

Background The well-accepted treatment of septic arthritis of the hip joint (SAHJ) is surgical drainage of the joint, but repeated aspirations of the hip joint under sonography, have been used for over twenty years with significant success in some centers, including ours. In recent years, we identified some children who did not respond to aspirations and had to undergo arthrotomies. We were concerned that some children may have reached the operating room after a longer than ideal time. Objective Identification of the characteristics of patients who did not respond to repeated aspirations and development of a treatment algorithm that expedites decision-making regarding the necessity of surgery. Methods This is a single-center retrospective cohort analysis. All the patients diagnosed with SAHJ between 2007 and 2019 were identified. Patients who responded to repeated aspirations were compared to those who did not improve and required surgery. Demographic and clinical data and laboratory results were obtained from the patients' electronic medical records. Results Forty-eight children (88.9%) were treated successfully with repeated aspirations and six children (11.1%) did not improve after aspirations and underwent hip arthrotomies. Five out of 48 children from the aspiration group (10.4%) and 4 out of 6 from the arthrotomy group (66.7%) had chronic comorbidities (p = 0.0051). The mean duration of fever over 38.5 degrees centigrade and the length of stay were higher in the arthrotomy group (p = 0.0040, p = 0.0301, respectively). When we examined the change in C-reactive protein (CRP) levels before and after the first aspiration (Delta CRP), we found a decrease in the aspiration group and an increase in the arthrotomy group (p = 0.0044). Conclusion The new algorithm which we present allows an expeditious assessment of the patient's response to the repeated aspiration method and thus prevents unnecessary surgeries for the treatment of SAHJ. Patients with chronic comorbidit

关键词： Hip arthrotomy Septic arthritis Hip aspiration treatment algorithm Ultrasonography guided Risk factors

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Guidance on Dravet syndrome from infant to adult care: Road map for treatment planning in Europe

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EPILEPSIA OPEN 2022年第1期7卷 11-26页

作者： Cardenal-Munoz, Elena Auvin, Stephane Villanueva, Vicente Cross, J. Helen Zuberi, Sameer M. Lagae, Lieven Aibar, Jose Angel Dravet Syndrome Fdn Spain Madrid Spain EpiCARE ePAG Grp Madrid Spain Hop Robert Debre AP HP Serv Neurol Pediat Paris France Univ Paris INSERM NeuroDiderot Paris France Inst Univ France IUF Paris France Hosp Univ & Politecn La Fe Refractory Epilepsy Unit Valencia Spain ERN EpiCARE Valencia Spain UCL NIHR BRC Great Ormond St Inst Child Hlth Dept Dev Neurosci London England Great Ormond St Hosp Sick Children Dept Neurol London England ERN EpiCARE London England Royal Hosp Children Paediat Neurosci Res Grp Glasgow Lanark Scotland ERN EpiCARE Glasgow Lanark Scotland Univ Glasgow Inst Hlth & Wellbeing Glasgow Lanark Scotland Katholieke Univ Leuven Dept Dev & Regenerat Herestr 49 B-3000 Leuven Belgium ERN EpiCARE Leuven Belgium

Dravet syndrome (DS) is a severe, rare, and complex developmental and epileptic encephalopathy affecting 1 in 16 000 live births and characterized by a drug-resistant epilepsy, cognitive, psychomotor, and language impairment, and behavioral disorders. Evidence suggests that optimal treatment of seizures in DS may improve outcomes, even though neurodevelopmental impairments are the likely result of both the underlying genetic variant and the epilepsy. We present an updated guideline for DS diagnosis and treatment, taking into consideration care of the adult patient and nonpharmaceutical therapeutic options for this disease. This up-to-date guideline, which is based on an extensive review of the literature and culminates with a new treatment algorithm for DS, is a European consensus developed through a survey involving 29 European clinical experts in DS. This guideline will serve professionals in their clinical practice and, as a consequence, will benefit DS patients and their families.

关键词： antiseizure medication comorbidities epilepsy genetic diagnosis treatment algorithm

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Last, But Not Least TricValve Implantation Reduces Heart Failure Burden in Severe Tricuspid Regurgitation

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JACC-CARDIOVASCULAR INTERVENTIONS 2024年第1期17卷 73-75页

作者： Stocker, Thomas J. Ludwig Maximilians Univ Munchen LMU Univ Hosp Dept Cardiol Dept Med 1 Munich Germany German Ctr Cardiovasc Res DZHK Partner Site Munich Heart Alliance Munich Germany LMU Univ Hosp Dept Cardiol Dept Med 1 Marchioninistr 15 D-81377 Munich Germany

Corresponding Author

关键词： heart failure heterotopic tricuspid valve replacement quality of life transcatheter tricuspid intervention treatment algorithm tricuspid regurgitation

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Non-unions of the upper extremities

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CHIRURGIE 2024年第8期95卷 671-682页

作者： Vogel, Carolina Reumann, Marie K. Menger, Maximilian M. Herath, Steven C. Rollmann, Mika F. R. Lauer, Henrik Histing, Tina Braun, Benedikt J. Eberhard Karls Univ Tubingen Klin Unfall & Wiederherstellungschirurg BG Klin Tubingen Schnarrenbergstr 95 D-72076 Tubingen Germany Eberhard Karls Univ Tubingen Klin Hand Plast Rekonstrukt & Verbrennungschirurg BG Klin Tubingen Tubingen Germany

The diagnosis and treatment of non-unions still represents an interdisciplinary challenge. Therefore, prevention, early detection and specific treatment are of great importance. Non-unions of the upper extremities, although less common than that of the lower extremities, requires special attention for successful treatment due to the central role of the shoulder girdle and arm in day to day activities. Successful treatment of non-unions requires a comprehensive evaluation of the patient's medical history, a thorough clinical examination and in particular radiological imaging. In order to effectively treat the pseudarthrosis it is crucial to distinguish between pseudarthroses that are suspected to be due to infections and those that are not. This article presents a treatment algorithm for managing both pseudarthrosis due to infection and pseudarthrosis without infection in the upper extremities.

关键词： Fracture healing treatment algorithm Infection management Previous medical history Radiological imaging

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Nanocrystalline silver for the treatment of otitis externa

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INDIAN JOURNAL OF OTOLARYNGOLOGY AND HEAD & NECK SURGERY 2023年第4期75卷 3497-3500页

作者： Ingale, Mayur Shinde, Vinod Chavan, Paresh Suresh, Anvitha Dr DY Patil Vidyapeeth Dr DY Patil Med Coll Hosp & Res Ctr Dept ENT Pune 411018 India

ObjectiveTo study the efficacy of nanocrystalline silver in treating otitis *** is a retrospective study constituting 50 patients of 18 to 60 years, studied from July 2022 to February 2023, conducted in the outpatient clinic of a tertiary healthcare centre. Clinically diagnosed otitis externa patients were treated with fragmented gel foam coated with nanocrystalline silver gel and the response to this treatment was *** study analysed a total of 50 cases of otitis externa in which the majority of patients fell between the age group of 30 to 45 years. Of the 50 patients included in the study, 30 were male and 20 were female. Pseudomonas aeruginosa was isolated in 50% of the patients followed by staphylococcus aureus in 36% of the patients. Among the 50 patients, 32 responded early to treatment (early responders), 15 were partial responders, and 3 did not respond to treatment (non-responders).ConclusionOut of 50 patients, 32 responded early to treatment, 15 were partial responders, and 3 did not respond to treatment. The antimicrobial and anti-inflammatory properties of silver, particularly when used in the nanocrystalline form, have been shown to be highly effective in managing this condition. Further research is warranted to fully explore the potential of nanocrystalline silver in treating otitis externa and other related conditions.

关键词： Nanocrystalline silver treatment algorithm Otorhinolaryngology Otitis Externa

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Current systemic treatment options and new developments in palliative first-line treatment of head and neck squamous cell carcinoma

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MEMO-MAGAZINE OF EUROPEAN MEDICAL ONCOLOGY 2023年第3期16卷 176-179页

作者： Kocher, Florian Seeber, Andreas Med Univ Innsbruck Comprehens Canc Ctr Innsbruck Dept Internal Med Hematol & Oncol 5 Anichstr 35 A-6020 Innsbruck Austria

This short review gives an overview of current treatment concepts, recently published trials, and novel developments in relapsed or metastatic head and neck squamous cell carcinoma (HNSCC) not amendable for local curative treatment. Trials with potential future clinical implications and relevant updates of landmark trials are provided as well.

关键词： Head and neck squamous cell carcinoma (HNSCC) Palliative first-line tratment Recent trials treatment algorithm

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Pharmacotherapy of obesity-Competition to bariatric surgery or a meaningful supplement?

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CHIRURGIE 2023年第6期94卷 497-505页

作者： Mazaheri, Tina Ansari, Saleem Nallagonda, Madhavi Kollmann, Lars Nickel, Felix Seyfried, Florian Miras, Alexander Dimitri Imperial Coll London Dept Metab Digest & Reprod London England Univ Klinikum Wurzburg Klin Allgemein Viszeral Transplantat Gefass & Kind Wurzburg Germany Univ Klinikum Hamburg Eppendorf Klin Allgemein Viszeral & Thoraxchirurg Hamburg Germany Univ Hosp Wurzburg Ctr Operat Med ZOM Dept Gen Visceral Transplantat Vasc & Pediat Surg Head Upper Gastrointestinal & Bariatr Surg Wurzburg Germany Ulster Univ Sch Med Londonderry Ireland Univ Hosp Wurzburg Ctr Operat Med ZOM Dept Gen Visceral Transplantat Vasc & Pediat Surg Head Upper Gastrointestinal & Bariatr Surg Oberdurrbacherstr 6 D-97080 Wurzburg Germany

Obesity is a complex chronic disease and requires a long-term multimodal approach. The current treatment algorithm for treatment of obesity mainly consists of a stepwise approach, which starts with a lifestyle intervention followed by or combined with medication treatment, whereas bariatric surgery is often reserved for the last option. This article provides an overview of the currently available conservative medicinal treatment regimens and the currently approved medications as well as medications currently undergoing approval studies with respect to the efficacy and possible side effects. Special attention is paid to the importance of combination treatment of pharmacotherapy and surgery in the sense of a multimodal treatment. The data so far show that using a multimodal approach an improvement in the long-term weight loss and metabolic benefits can be achieved for the patients.

关键词： treatment algorithm Combined treatment Efficacy Side effects Long-term weight loss

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Clinical practice guidelines for the diagnosis and management of otitis media with effusion (OME) in children in Japan-2022 update

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AURIS NASUS LARYNX 2023年第5期50卷 655-699页

作者： Hidaka, Hiroshi Ito, Makoto Ikeda, Ryoukichi Kamide, Yosuke Kuroki, Haruo Nakano, Atsuko Yoshida, Haruo Takahashi, Haruo Iino, Yukiko Harabuchi, Yasuaki Kobayashi, Hitome Kansai Med Univ Dept Otorhinolaryngol Head & Neck Surg 2-3-1 Shinmachi Hirakata Osaka 5731191 Japan Jichi Med Univ Jichi Childrens Med Ctr Tochigi Dept Pediat Otolaryngol Shimotsuke Japan Iwate Med Univ Dept Otolaryngol Head & Neck Surg Morioka Japan Kamide Ear Nose & Throat Clin Tokyo Japan Sotobo Childrens Clin Tokyo Japan Chiba Childrens Hosp Div Otorhinolaryngol Chiba Japan Nagasaki Univ Dept Otolaryngol Head & Neck Surg Sch Med Nagasaki Japan Tokyo Kita Med Ctr Dept Otolaryngol Tokyo Japan Asahikawa Med Univ Dept Otolaryngol Head & Neck Surg Asahikawa Japan Showa Univ Dept Otorhinolaryngol Sch Med Tokyo Japan

This is an update of the 2015 Guidelines developed by the Japan Otological Society and Oto-Rhino-Laryngeal Society of Japan defining otitis media with effusion (OME) in children (younger than 12 years old) and describing the disease rate, diagnosis, and method of examination. Rec-ommended therapies that received consensus from the guideline committee were updated in consideration of current therapies used in Japan and based on available ***: Regarding the treatment of OME in children, we developed Clinical Questions (CQs) and retrieved documents on each theme, including the definition, disease state, method of di-agnosis, and medical treatment. In the previous guidelines, no retrieval expression was used to designate a period of time for literature retrieval. Conversely, a literature search of publications from March 2014 to May 2019 has been added to the JOS 2015 Guidelines. For publication of the CQs, we developed and assigned strengths to recommendations based on the collected ***: OME in children was classified into one group lacking the risk of developing chronic or intractable disease and another group at higher risk (e.g., children with Down syndrome, cleft palate), and recommendations for clinical management, including follow-up, is provided. Infor-mation regarding management of children with unilateral OME and intractable cases complicated by adhesive otitis media is also ***: In clinical management of OME in children, the Japanese Clinical Practice Guide-lines recommends management not only of complications of OME itself, such as effusion in the middle ear and pathologic changes in the tympanic membrane, but also pathologic changes in surrounding organs associated with infectious or inflammatory diseases.& COPY;2022 Japanese Society of Otorhinolaryngology-Head and Neck Surgery, Inc. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license ( http://***/licenses/by-nc-nd/

关键词： Clinical guidelines Otitis media with effusion (OME) Middle ear (ME) treatment algorithm Tympanostomy tube insertion (TS tube insertion) Clinical Question (CQ)

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Visualizing How to Use Antipsychotics for Agitated Delirium in the Last Days of Life

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JOURNAL OF PAIN AND SYMPTOM MANAGEMENT 2023年第6期65卷 479-489页

作者： Imai, Kengo Morita, Tatsuya Mori, Masanori Kiuchi, Daisuke Yokomichi, Naosuke Miwa, Satoru Okamoto, Soichiro Yamauchi, Toshihiro Naito, Akemi Shirado Matsuda, Yoshinobu Maeda, Isseki Sugano, Koji Ikenaga, Masayuki Inoue, Satoshi Satomi, Eriko Seirei Miyahara Gen Hosp Seirei Hosp Hamamatsu Japan Seirei Miyahara Gen Hosp Div Palliat & Support Care Hamamatsu Japan Natl Canc Ctr Dept Palliat Med Tokyo Japan TEIEIKAI Med Corp Chiba Japan Miyazaki Med Assoc Hosp Dept Palliat Care Miyazaki Japan Natl Hosp Org Kinki Chuo Chest Med Ctr Dept Psychosomat Internal Med Sakai Japan Seri Chuo Hosp Dept Palliat Care Toyonaka Japan Juntendo Univ Grad Sch Med Div Resp Med Fac Med Tokyo Japan Yodogawa Christians Hosp Dept Palliat Med Osaka Japan Seirei Miyahara Gen Hosp Seirei Hosp 3453 Mikatahara ChoKita Ku Hamamatsu Shizuoka 4338558 Japan

Context. How physicians use antipsychotics for agitated delirium in the last days of life varies markedly, which could hamper the quality of ***. To examine adherence to an algorithm-based treatment for terminal agitated delirium, and explore its effective-ness and ***. A single-center, prospective, observational study was conducted in a 27-bed palliative care unit in Japan. All adult cancer patients who developed agitated delirium with a modified Richmond Agitation-Sedation Scale (RASS) of +1 or more were included;the palliative care specialists determined that the etiology was irreversible, the estimated survival was three weeks or less, and the East-ern Cooperative Oncology Group (ECOG) performance status was three or four. Patients were treated with an algorithm to visualize how to use antipsychotics, with the treatment goal defined as no agitation (RASS <= 0) or acceptable agitation for patients and families. We provided all patients nonpharmacological management to alleviate the symptoms of delirium and administered antipsychotic med-ications when the nonpharmacological approach was insufficient. We measured the adherence rate, RASS, Nursing Delirium Screen-ing Scale items 2, 3, 4 (Nu-DESC), and Agitation Distress Scale item 2 (ADS) on days 0, 1, 3, 7, 14, 21, and 24 hours before ***. A total of 164 patients were enrolled. Adherence rates were 99, 94, and 89%, and treatment goals were achieved in 66, 83, and 93% on days one, three, and seven, respectively. The mean RASS decreased from +1.41 to -0.84 on day three;Nu-DESC decreased from 4.19 to 1.83, and ADS decreased from 1.54 to 0.38. There were seven severe adverse events (Common Terminology Criteria for Adverse Events (CTCAE) of 3), including aspiration (n = 3), apnea (n = 2), tremor (n = 1), and muscle rigidity (n = 1) on day ***. The algorithm-based treatment could be feasible, effective, and safe. Visualizing how palliative care specialists provide pharmacolog

关键词： Terminal agitated delirium antipsychotics haloperidol chlorpromazine levomepromazine treatment algorithm

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