9 research outputs found
Transurethral Resection of Non-Muscle Invasive Bladder Tumors Combined with Fluorescence Diagnosis and Photodynamic Therapy with Chlorin e6-Type Photosensitizers
Bladder cancer is a common disease with a high recurrence rate. In order to improve the treatment of superficial bladder tumors, we evaluated the efficacy and safety of transurethral resection (TURB) followed by fluorescence diagnosis (FD) and photodynamic therapy (PDT) with chlorin e6 photosensitizers (PSs), viz. “Fotoran e6” and “Fotoditazin”. It was found that both PSs generated singlet oxygen and revealed moderate affinity toward the lipid-like compartment. Between November 2018 and October 2020, 12 patients with verified non-muscle invasive bladder cancer (NMIBC) were treated by TURB combined with FD and PDT. Eight patients received “Fotoran e6” intravenously, while four patients received intravesical PSs. The patient ages were between 31 and 79 years, with a median age of 64.5 years (mean 61.3 ± 14.2). The total light dose was 150 J/cm2 for the local irradiation of the tumor bed with a red light at the λ = 660 nm wavelength, and 10–25 J/cm2 were additionally delivered for diffuse irradiation of the entire bladder mucosa. At the median follow-up period of 24 months (mean 24.5 ± 5.4 months, range 16–35 months), 11 patients remained tumor-free. One 79-year-old patient developed a recurrence without progression to the muscle layer. This pilot study shows that the TURB + FD + PDT technique is an effective and safe option for the first-line treatment of superficial bladder tumors
Amended STRONG-HF study design
International audienceNo abstract availabl
Safety, Tolerability and efficacy of Rapid Optimization, helped by NT-proBNP and GDF-15, of Heart Failure therapies (STRONG-HF): rationale and design for a multicentre, randomized, parallel-group study
Aims
Patients admitted for acute heart failure (HF) are at high risk of readmission and death, especially in the 90âdays following discharge. We aimed to assess the safety and efficacy of early optimization of oral HF therapy with betaâblockers (BB), angiotensinâconverting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) or angiotensin receptorâneprilysin inhibitors (ARNi), and mineralocorticoid receptor antagonists (MRA) on 90âday clinical outcomes in patients admitted for acute HF.
Methods
In a multicentre, randomized, openâlabel, parallelâgroup study, a total of 900 patients will be randomized in a 1:1 ratio to either âusual careâ or âhighâintensity careâ. Patients enrolled in the usual care arm will be discharged and managed according to usual clinical practice at the site. In the highâintensity care arm, doses of oral HF medications â including a BB, ACEi or ARB, and MRA â will be upâtitrated to 50% of recommended doses before discharge and to 100% of recommended doses within 2 weeks of discharge. Upâtitration will be delayed if the patients develop worsening
symptoms and signs of congestion, hyperkalaemia, hypotension, bradycardia, worsening of renal function or significant increase in Nâterminal proâBâtype natriuretic peptide between visits. The primary endpoint is 90âday allâcause mortality or HF readmission.
Conclusions
STRONGâHF is the first study to assess whether rapid upâtitration of evidenceâbased guidelineârecommended therapies with close followâup in a large cohort of patients discharged from an acute HF admission is safe and can affect adverse outcomes during the first 90âdays after discharge