What are Clinical and Diagnostic Features of Perioperative Hypersensitivity to Sugammadex?

Recent study analyzed the clinical and diagnostic features of perioperative hypersensitivity to sugammadex, as well as the estimated incidence of sugammadex hypersensitivity in Australia. The researchers retrospectively examined cases of hypersensitivity to sugammadex diagnosed by positive intradermal testing (IDT) or skin prick testing (SPT) at specialist perioperative allergy clinics in South-East Queensland and Northern New South Wales, Australia.

Incidence and Grading of Sugammadex Hypersensitivity

The study identified 30 cases of sugammadex hypersensitivity, with 10% classified as Grade 1, 40% as Grade 2, 40% as Grade 3, and 10% as Grade 4. No cases of mortality (Grade 5) were identified. The most common clinical signs were hypotension (83.3%) and flushing/erythema (70%), with 83.3% of patients displaying both cardiovascular and cutaneous signs. Respiratory signs, such as bronchospasm, occurred in 30% of patients, with a higher prevalence in those with life-threatening reactions.

Timing of Presentation and Clinical Management

Regarding the timing of presentation, 36.7% of reactions were recognized after the patient had left the operating theater, with a median time to clinical recognition of 5 minutes. Epinephrine was administered to 76.7% of patients, and 73.3% required unplanned ICU admission.

Serum Tryptase Levels and Mechanism of Hypersensitivity

Serum tryptase was measured in 93.3% of patients, with positive tryptase reported in 100% of life-threatening cases and 69.2% of non-life-threatening cases. The combination of positive serum tryptase and positive skin tests suggests a possible IgE-mediated mechanism of sugammadex hypersensitivity.

Estimated Incidence of Sugammadex Hypersensitivity

The estimated incidence of sugammadex hypersensitivity in the Australian cohort was 1:23,934 (0.004%), which is lower than earlier reports but likely underestimated. The estimated incidence of life-threatening cases was 1:59,835 (0.0017%). The authors note that the true incidence is likely higher than their estimate, as the study was subject to limitations, such as reliance on initial recognition and referral of reactions, as well as uncertainty around the true number of sugammadex administrations.

Conclusions and Recommendations

Overall, this study provides valuable insights into the clinical and diagnostic features of sugammadex hypersensitivity, as well as an estimate of its incidence in a large Australian cohort. The findings underscore the need for vigilance in recognizing and managing this rare but potentially life-threatening adverse event.

Key Points

1. Incidence and Grading of Sugammadex Hypersensitivity: – The study identified 30 cases of sugammadex hypersensitivity. – 10% were classified as Grade 1, 40% as Grade 2, 40% as Grade 3, and 10% as Grade 4. No cases of mortality (Grade 5) were identified. – The most common clinical signs were hypotension (83.3%) and flushing/erythema (70%), with 83.3% of patients displaying both cardiovascular and cutaneous signs. Respiratory signs, such as bronchospasm, occurred in 30% of patients, with a higher prevalence in those with life-threatening reactions.

2. Timing of Presentation and Clinical Management: – 36.7% of reactions were recognized after the patient had left the operating theater, with a median time to clinical recognition of 5 minutes. – Epinephrine was administered to 76.7% of patients, and 73.3% required unplanned ICU admission.

3. Serum Tryptase Levels and Mechanism of Hypersensitivity: – Serum tryptase was measured in 93.3% of patients, with positive tryptase reported in 100% of life-threatening cases and 69.2% of non-life-threatening cases. – The combination of positive serum tryptase and positive skin tests suggests a possible IgE-mediated mechanism of sugammadex hypersensitivity.

4. Estimated Incidence of Sugammadex Hypersensitivity: – The estimated incidence of sugammadex hypersensitivity in the Australian cohort was 1:23,934 (0.004%), which is lower than earlier reports but likely underestimated. – The estimated incidence of life-threatening cases was 1:59,835 (0.0017%). – The true incidence is likely higher than the estimate, as the study was subject to limitations, such as reliance on initial recognition and referral of reactions, as well as uncertainty around the true number of sugammadex administrations.

5. Conclusions and Recommendations: – This study provides valuable insights into the clinical and diagnostic features of sugammadex hypersensitivity, as well as an estimate of its incidence in a large Australian cohort. – The findings underscore the need for vigilance in recognizing and managing this rare but potentially life-threatening adverse event.

Reference –

Danielle Crimmins et al. (2024). Sugammadex Hypersensitivity: A Multicentre Retrospective Analysis Of A Large Australian Cohort.. *British Journal Of Anaesthesia*. https://doi.org/10.1016/j.bja.2024.07.042.

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Acupuncture Shows Effective Results in the Treatment of Primary Osteoporosis, reveals research

Acupuncture has emerged as a promising treatment for primary osteoporosis (POP), according to a new meta-analysis involving 40 clinical studies and over 2,600 participants. The findings published in the Journal of Orthopaedic Surgery and Research highlight the potential of acupuncture in improving bone health and reducing pain for individuals with this debilitating condition.

The meta-analysis compared acupuncture treatments against conventional medical therapies and placebo interventions. This research assessed key health indicators, including bone mineral density (BMD), pain levels, clinical effectiveness rates, estradiol (E2) levels, and disability indices.

The results revealed that acupuncture significantly increased BMD by an average mean difference (MD) of 0.04 units. This improvement indicates a notable improvement in bone strength for patients treated with acupuncture. Also, the therapy was associated with a 24% higher clinical efficacy rate when compared to conventional treatments, signifying overall better health outcomes.

One of the most striking findings was the substantial reduction in pain reported by participants who were undergoing acupuncture treatments. The visual analogue scale (VAS) scores showed a significant drop, with an average standardized mean difference (SMD) of -1.79 points. This highlighted the potential of acupuncture as an effective pain management strategy for POP patients.

Hormonal improvements were also evident where the levels of estradiol (E2) showed a moderate but meaningful increase (SMD 0.30). However, data on disability index (ODI) and serum alkaline phosphatase (ALP) levels were insufficient to draw conclusive results. All participants were from China, which has raised concerns about sample diversity. This also has emphasized the need for high-quality, multicenter studies conducted across different countries to validate the results and ensure broader applicability.

The study concludes that acupuncture can be an effective physical intervention for patients with POP, complementing conventional treatments. This research underlines the growing interest in integrating traditional therapies with modern medicine for better health outcomes. Overall, acupuncture may offer a natural, non-invasive solution to help patients improve their bone health and overall quality of life as osteoporosis continues to impact the lives of millions globally.

Source:

Ma, T., Zhang, T., Zhang, L., Zhao, H., Liu, K., Kuang, J., & Ou, L. (2025). Efficacy of acupuncture for primary osteoporosis: a systematic review and meta-analysis of randomized controlled trials. Journal of Orthopaedic Surgery and Research, 20(1). https://doi.org/10.1186/s13018-025-05513-9

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Research assesses how infertility treatments can affect family and work relationships, reveals study

Infertility is a problem that affects between 8% and 12% of couples of reproductive age worldwide – for some of them, the problem interrupts a life project, which is the desire to have children and build a family. Advances in technology and medicine have made assisted reproductive treatments possible, but they can be physically and psychologically draining for the couples involved, especially because of expectations of results that may not be achieved.

The emotional impact of treatment is well documented in the scientific literature. Frustration with negative results has an impact on the psychological and social well-being of the couple, who may develop symptoms such as depression, anxiety, anger and stressstress, thus worsening their quality of life. Now, for the first time, a study supported by FAPESP and carried out at the ABC Medical School (FM-ABC) in Santo André, a municipality in the Metropolitan Region of São Paulo (MRSP), in Brazil, has examined work-family conflicts in these patients, which can be associated with frequent absences due to medical appointments or tests, for example.

The results, published in the journal Psychology, Health & Medicine, indicate that levels of work-family conflict are higher among men, while stress affects women more.

A total of 242 couples undergoing assisted reproductive treatment at the Ideia Fértil Institute, linked to the FM-ABC, in the MRSP, were studied. Among the participants, the median age was 37 years; 60% were women; 67% had a university degree; 37% had been married for more than ten years, 26% for between five and ten years, and 37% for five years or less.

In most cases, assisted reproductive treatments require time and large financial investments, which can be stressful for working patients. However, the scientific literature lacks data on the impact of this procedure on work-family conflicts.

“Infertile patients undergoing treatment can risk losing their jobs due to frequent absences for medical appointments and tests. For example, it’s common for a woman to ask for a medical certificate without the clinic’s logo so that her employer doesn’t know she’s trying to get pregnant,” says Victor Zaia, professor in the Postgraduate Program in Health Sciences at the FM-ABC and lead author of the study.

In addition, these patients may also experience reduced productivity, difficulty concentrating, challenges in managing medication side effects, and difficulties with time management. “Work-family conflict occurs when these individuals experience tension as they try to fulfill their professional and personal responsibilities. Many experience stress, fatigue, emotional exhaustion, sleep disturbances, dissatisfaction, marital problems, and decreased productivity. The result can be conflicts between these roles, with physical and psychological consequences.”

Evaluation scales

To arrive at the results, the researchers used online questionnaires to assess the couples. They answered questions from four internationally validated scales: Infertility-Related Stress Scale-Brazil (IRSS); Connor-Davidson Resilience Scale 10 (CD-RISC 10); Perceived Social Support Scale (PSSS); and Work-Family Conflict Scale.

On the Infertility-Related Stress Scale, the volunteers answered 12 questions about interpersonal stress (how infertility situations would disrupt the person’s daily life with friends, family, spouse) and questions about intrapersonal stress (how much the infertility problem affects their physical and emotional well-being).

On the Resilience Scale, the participants answered ten questions about their ability to adapt to life’s changes; about overcoming difficulties after illness or other problems; and about being able to think clearly when under pressure, among others.

The difference in this case, Zaia explains, is that the research focused on something that was happening at the time – the assisted reproductive treatment – whereas many studies on resilience ask about something that has already happened in the past, looking for memories. “In our study, people were starting reproductive treatment. So the impact, the risky situation, was being experienced in the now.”

The third tool used in the survey was the Perceived Social Support Scale, which, as its name suggests, is a 29-question scale designed to understand whether the participant receives and perceives any type of emotional or practical support from their spouse, family, and friends.

Finally, the researchers applied the Work-Family Conflict Scale – the most important in the study. It aims to assess the interference between the family and work environments within two sub-scales: Work Interference in the Family and Family Interference in Work.

In the analyses, the male participants showed greater resilience and lower levels of stress, both intrapersonal and interpersonal, compared to the women undergoing infertility treatment. However, the male patients reported higher levels of work interference in the family. In addition, there were significant differences in work-family conflict based on the couple’s income: those with higher incomes reported more interference.

On the other hand, the study found that women undergoing infertility treatment had lower levels of resilience and higher levels of stress, which the authors suggest may be explained by societal expectations about motherhood, which is considered a central role for women. The researchers also found significant correlations between resilience and emotional support, intrapersonal stress, and interpersonal stress.

“Stress alone doesn’t explain work-family conflict. But we concluded that if a person has more stress, little social support and less resilience, they’ll most likely have higher levels of conflict. And if they can’t manage those conflicts, they’ll probably have more stress, leading to a kind of vicious circle,” Zaia explains.

From a clinical practice standpoint, Zaia says, these findings can guide health professionals in working with couples to reinforce strategies to improve and strengthen aspects of resilience and emotional support. “All the issues are important. This couple is suffering. We need to improve communication and support, as well as working on stress management strategies so that they can better adapt to treatment,” the researcher explained.

According to Zaia, there are two ways to try to overcome these conflicts: resilience (which is the ability to adapt to significant changes in life) and social support. Resilience is considered a protective factor because it can moderate the relationship between stress and quality of life, reducing the possible negative effects of stress related to infertility. And social support, in turn, helps because being surrounded by people who provide emotional and practical support can reduce the affective burden of infertility and possibly ease the challenges of treatment.

Assisted reproduction

Infertility is defined as the inability to get pregnant after at least one year of regular unprotected intercourse. Assisted reproductive treatments are available, but they are time-consuming and costly. There are few services in the Sistema Único de Saúde (SUS, Brazil’s national public health network) that offer this treatment – and they are very restrictive (imposing age limits, for example).

A report by the United Nations Population Fund (UNFPA) in Brazil, published in March 2024, points out that Brazil has 192 assisted reproduction clinics, of which only 11 are public (6%). In 2023, the cost of a complete IVF cycle varied between BRL 15,000 and BRL 100,000, depending on the number of attempts, the procedure used and the location of the clinic. The clinic involved in the study is a social organization and the patients treated there pay only the cost of the treatments, which start at BRL 3,000.

Reference:

Alves-Leite, N., Montagna, E., Hokama, E., Barbosa, C. P., & Zaia, V. (2024). Relationships between work-family conflict, infertility-related stress, resilience and social support in patients undergoing infertility treatment. Psychology, Health & Medicine, 1–14. https://doi.org/10.1080/13548506.2024.2418437

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Study shows urine test for prostate cancer could be used at home

Researchers at Vanderbilt and the University of Michigan have shown that a simple at-home urine test for prostate cancer screening is highly accurate. The exciting new results, published in The Journal of Urology, build upon a prior Vanderbilt study of prostate cancer screening that required a digital rectal exam.

The results are important because this could enable at-home testing and increased access to testing for patients undergoing telehealth care or living in remote areas.

Traditional prostate cancer screening with PSA testing and biopsy has been shown to lead to unnecessary procedures and overdiagnosis of low-grade cancers, according to lead author Jeffrey Tosoian, MD, MPH, assistant professor of Urology and director of Translational Cancer Research at Vanderbilt University Medical Center.

“The test is highly accurate for ruling out the presence of clinically significant prostate cancers – those that merit treatment – so that patients with a negative test result can confidently avoid having to undergo MRI or biopsy,” Tosoian said.

“In the current study, this non-invasive urine test would have allowed patients with an elevated PSA to avoid 34-53% of unnecessary biopsies.”

MyProstateScore 2.0 (MPS2) urine test is a non-invasive test used to help identify high-grade prostate cancers that need early detection and treatment by analyzing 18 genes associated with prostate cancer.

In a 2024 study, Tosoian and colleagues developed and validated the test in urine collected after a digital rectal exam, but the new study re-validated the test in urine obtained without the exam and the accuracy was very similar.

The test is used to rule out the presence of clinically significant prostate cancer, meaning those that merit treatment, with high accuracy in men being evaluated for prostate cancer due to elevated serum PSA (PSA >3 ng/ml).

“Rectal exams are no fun,” Tosoian said. “These findings will increase the impact of the test, as it can now be used for at-home testing.”

Tosoian said next steps will be to demonstrate the use of MPS2 in patients undergoing active surveillance for low-grade prostate cancer. If proven to be similarly accurate in this setting, use of MPS2 could eliminate or reduce the need for prostate biopsies during active surveillance, enabling reliable non-invasive monitoring of low-grade cancers.

Reference:

Tosoian JJ, Zhang Y, Meyers JI, Heaton S, Siddiqui J, Xiao L, Assani KD, Barocas DA, Ross AE, Chopra Z, Herron GC, Edelson JA, Graham NJ, Singhal U, Salami SS, Morgan TM, Palapattu GS, Wei JT, Chinnaiyan AM. Clinical Validation of MyProstateScore 2.0 Testing Using First-Catch, Non-Digital Rectal Examination Urine. J Urol. 2025 Jan 21:101097JU0000000000004421. doi: 10.1097/JU.0000000000004421. 

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Use of Semaglutide and tirzepatide use linked to ophthalmic complications, finds study

Almost 2% of the U.S. population received prescriptions for the weight-loss and diabetes drugs semaglutide and tirzepatide in 2023. These medications, best known by brand names like Ozempic and Mounjaro, have gained popularity for their effectiveness in managing Type 2 diabetes and obesity. However, this recent study published in the Journal of American Medical Association raised concerns about potential ophthalmic complications associated with these drugs.

This retrospective case series was conducted in a community setting, where 9 patients (average age 57.4 years, ranging from 37 to 77 years) were identified as having experienced significant eye health issues while taking either semaglutide or tirzepatide. Among them, 5 were women, and 4 were men.

The most frequently reported complication was nonarteritic ischemic anterior optic neuropathy (NAION) that can lead to sudden and sometimes permanent vision loss, affecting 7 of the 9 patients. One patient presented with bilateral papillitis, a rare inflammation of the optic nerve, while another suffered from paracentral acute middle maculopathy, which is marked by impaired blood flow to the retina, potentially affecting central vision.

What made these cases particularly atypical were features such as sequential ischemic optic neuropathy (occurring in both eyes at different times), persistent bilateral disc swelling, and progressive vision loss even after initial presentation. This study stressed that their findings do not conclusively establish a causal link between the medications and the reported vision problems.

However, one hypothesis suggests that the rapid correction of blood sugar levels caused by these medications, rather than a toxic drug effect, may trigger these complications. Sudden improvements in glucose levels could potentially affect blood flow to the optic nerve or other structures in the eye, leading to the complications observed. While these cases remain relatively rare given the vast number of prescriptions filled, the outcomes emphasize the importance of further investigation.

Ophthalmologists and physicians are encouraged to monitor patients taking semaglutide or tirzepatide for any signs of vision changes. The patients experiencing sudden vision loss, blurred vision, or other visual disturbances while on these medications should seek immediate medical attention. Early detection and intervention could be critical in preventing permanent damage. As research continues, clinicians will likely weigh these potential risks against the well-documented benefits of semaglutide and tirzepatide in managing diabetes and obesity.

Source:

Katz, B. J., Lee, M. S., Lincoff, N. S., Abel, A. S., Chowdhary, S., Ellis, B. D., Najafi, A., Nguyen, J., Seay, M. D., & Warner, J. E. A. (2025). Ophthalmic complications associated with the antidiabetic drugs semaglutide and tirzepatide. JAMA Ophthalmology. https://doi.org/10.1001/jamaophthalmol.2024.6058

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Study Links Overactive Bladder to Cognitive Decline in Seniors, Depression as Key Mediator

China: A recent study exploring the association between overactive bladder (OAB) and cognitive decline in elderly adults has uncovered compelling findings that suggest depression plays a key role in mediating this relationship. Using a weighted analysis from the National Health and Nutrition Examination Survey (NHANES), the study revealed that OAB in older adults (aged ≥60) has been significantly linked to reduced cognitive function, with depression accounting for more than a third of this association.

“Cognitive test scores were lower in individuals with OAB, and the rate of depression was more than twice as high compared to those without OAB (15% versus 6.05%). Additionally, individuals with OAB experienced a 14% greater decline in cognitive health z-scores than those without the condition,” Ling Liu, University of International Business and Economics, Chaoyang District, Beijing, P. R. China, wrote in Scientific Reports.

Overactive bladder is a common condition among older adults and may be associated with cognitive health. The study examined the relationship between OAB and cognitive function in U.S. adults aged 60 and older, utilizing data from the NHANES 2011–2014.

For this purpose, Ling Liu conducted a cross-sectional analysis using a nationally representative sample of 2,324 adults (45.95% male, 54.05% female), with 755 individuals diagnosed with overactive bladder (OAB). Cognitive health was assessed through the Consortium to Establish a Registry for Alzheimer’s Disease-Word Learning (CERAD W-L), Animal Fluency Test (AFT), and Digit Symbol Substitution Test (DSST). OAB was defined by a score greater than three on the Overactive Bladder Syndrome Symptom Score (OABSS).

The study also recorded depression incidence. Weighted linear regression models, adjusted for demographic, behavioral, and comorbid factors such as diabetes and kidney disease, were used to examine the independent association between cognitive health and OAB.

The study revealed the following findings:

  • Cognitive scores were significantly lower in the OAB group than the non-OAB group across all cognitive tests.
  • The incidence of depression was notably higher in the OAB group (15%) compared to the non-OAB group (6.05%).
  • Regression analysis showed a 14% decrease in cognitive health z-scores in patients with OAB.
  • Depression was found to mediate 34.56% of the association between OAB and cognitive health.
  • This negative association remained consistent across subgroups based on demographics, behavioral factors, and comorbidities.

The findings of this study establish a strong link between overactive bladder and cognitive health, with depression identified as a significant mediator in this association among older adults.

“However, further research is required to fully understand the complex mechanisms underlying the relationship between OAB and cognitive decline. Additionally, healthcare providers, particularly psychiatrists, should pay greater attention to the interconnectedness of urinary health, depression, and cognitive dysfunction in older adults. Early detection and management of OAB are essential for preventing further cognitive decline in this population,” Dr. Ling Liu concluded.

Reference:

Liu, L. (2025). Exploring the Association Between Overactive Bladder (OAB) and Cognitive decline: Mediation by depression in elderly adults, a NHANES weighted analysis. Scientific Reports, 15(1), 1-11. https://doi.org/10.1038/s41598-025-86267-6

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Blood test could guide use of celecoxib to reduce risk of colon cancer recurrence: Study

A data analysis from a randomized clinical trial for stage 3 colon cancer patients by investigators at Dana-Farber Brigham Cancer Center found that patients with evidence of residual cancer in their blood after surgery to remove the cancer, may benefit from adding of celecoxib, to post surgery treatment. The analysis showed that patients with positive blood tests for circulating tumor DNA (ctDNA) had worse outcomes in general, but those who were treated with celecoxib, a non-steroidal anti-inflammatory drug, experienced significantly improved disease-free survival.

“This is one of the first studies to show that ctDNA status has predictive utility in terms of selecting patients that respond better to a drug,” says Jonathan Nowak, MD, PhD, a pathologist at Dana-Farber Cancer Institute and Brigham and Women’s Hospital who presents the study at the American Society of Clinical Oncology Gastrointestinal Cancers Symposium on Jan. 25, 2025, in San Francisco, Calif.

“These results add to our earlier findings that celecoxib improves survival for PIK3CA mutated colon cancer,” says Jeffrey Meyerhardt, MD, MPH, senior author and co-director of the Colon and Rectal Cancer Center at Dana-Farber Cancer Institute. “These findings will help develop a personalized approach to additional therapy for patients with early-stage colon cancer.”

Patients with stage 3 colon cancer are initially treated with surgery to remove the cancer in the colon and nearby lymph nodes. After this treatment, they typically receive adjuvant chemotherapy intended to reduce their risk of the cancer coming back. In a subset of these patients, however, the cancer returns, potentially rendering them incurable. A key research focus at Dana-Farber is finding ways to improve adjuvant therapies and stave off recurrence.

To investigate the use of celecoxib on disease-free survival in patients with stage 3 colon cancer, Meyerhardt and colleagues initiated a randomized clinical trial, the CALGB (Alliance)/SWOG 80702 trial, in 2010 with the Alliance for Clinical Trial in Oncology and the National Cancer Institute. The trial enrolled 2,526 patients between 2010 and 2015. After treatment, patients were randomized to receive adjuvant chemotherapy with fluorouracil, leucovorin, and oxaliplatin (FOLFOX) for three or six months with or without daily celecoxib for three years. Those taking celecoxib showed a moderate benefit, but the results, which were published in 2021, were not statistically significant.

Evidence has since emerged suggesting that anti-inflammatory drugs might benefit some patients with colon cancer, but not others. One possibility for this is that patients who have a blood test soon after surgery showing evidence of ctDNA have a higher risk to relapse and may benefit from additional therapies beyond standard chemotherapy. In this new study, investigators wanted to explore whether anti-inflammatory drugs might help stave off relapse in patients whose ctDNA test was positive soon after surgery.

When the original prospective celecoxib clinical trial was designed a decade ago, patients were assessed before and after surgery using imaging, which reveals where cancer cells have clustered, but has limited resolution. The ctDNA tests available today provide a more sensitive read on whether cancer remains after surgery by detecting microscopic fragments of tumor DNA in the blood.

The study team identified 1,011 of 2,526 patients who had participated in the original trial and had agreed to have blood drawn for research purposes that was available for analysis. They performed ctDNA tests on blood samples taken after surgery. This analysis revealed that patients with positive ctDNA generally had worse outcomes. However, those with positive ctDNA tests who had been prescribed celecoxib in addition to standard chemotherapy had significantly improved disease-free survival compared to those who received only standard chemotherapy. For those who had negative ctDNA tests, there was no significant difference between those taking celecoxib versus placebo.

“Based on this analysis, the benefits of celecoxib with chemotherapy look promising for early-stage colon cancer patients with positive ctDNA after primary treatment,” say the investigators. “This evidence plus results from other ongoing studies will help determine which patients may benefit from celecoxib in addition to other standard treatments.”

Reference:

Blood test could guide use of anti-inflammatory drug celecoxib to reduce risk of colon cancer recurrence, Dana-Farber Cancer Institute, Meeting: ASCO GI.

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Autologous Platelet-Rich Concentrates Show Potential in Periodontal Therapy, but Evidence Remains Inconclusive: Meta-Analysis

Malaysia: A recent systematic review and meta-analysis of randomized controlled trials (RCTs) evaluated the effectiveness of autologous platelet-rich concentrates (APC) as an adjunct to nonsurgical periodontal therapy (NSPT). The findings were published online in Evidence-Based Dentistry. 

After reviewing the available studies, the authors found that the use of APC alongside NSPT showed potential benefits in improving clinical parameters, such as probing depth, clinical attachment level, and bleeding on probing. However, the strength of the evidence was limited. A significant number of studies involved small sample sizes, which reduced the generalizability of the results. Additionally, the quality of the trials was compromised by moderate to high risk of bias in most of the studies, primarily due to issues with randomization, blinding, and the handling of data.

Platelet-rich concentrates, derived from a patient’s own blood, are believed to promote tissue healing and regeneration. Previous studies have explored the potential of APC in periodontal therapy, with promising results, particularly in accelerating healing and reducing inflammation. However, the overall evidence remained inconclusive due to inconsistencies across studies and the quality of the research.

To fill this knowledge gap, Nazurah Nik Eezammuddeen, Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh, Malaysia, and colleagues aimed to assess the effectiveness of autologous platelet concentrates in improving periodontal outcomes in patients undergoing nonsurgical therapy for periodontitis.

For this purpose, the researchers conducted an electronic search through Web of Science, MEDLINE via PubMed, Scopus, and Cochrane CENTRAL registry, along with a manual search from June to July 2024 for relevant publications. Studies were included if they reported on periodontal outcomes after adjunctive APC in NSPT and excluded if unpublished or not in English. Two independent reviewers assessed the articles, and the risk of bias was evaluated using the Cochrane risk-of-bias tool (RoB 2). A fixed-effect meta-analysis was performed to measure changes in periodontal pocket depth (PPD) and clinical attachment level (CAL), with statistical heterogeneity assessed using the I2 test.

Key Findings:

  • A total of 607 records were identified from four electronic databases.
  • After removing duplicates and conducting initial title screening, 16 full-text articles from the electronic search and seven articles from the manual search were assessed.
  • Ultimately, 13 studies were included in the systematic review.
  • Most studies had a moderate to high risk of bias.
  • The fixed-effect meta-analysis showed that adjunctive APC use in nonsurgical periodontal therapy favored positive outcomes but with high heterogeneity between studies, particularly for CAL.

Based on the findings, the researchers concluded that the evidence supporting the use of APC as an adjunct in NSPT is limited due to the small number of studies, the moderate to high risk of bias in most studies, and significant heterogeneity in the results.

Reference:

Nik Eezammuddeen, N., Johari, N. N., Demius, O., & Hussain, F. (2024). The effectiveness of autologous platelet-rich concentrates as an adjunct during nonsurgical periodontal therapy: A systematic review and meta-analysis of randomized controlled trials. Evidence-Based Dentistry, 1-8. https://doi.org/10.1038/s41432-024-01060-0

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Obesity Paradox: Better Survival in Obese Lung Cancer Patients with Strong Muscle Health, Study Finds

Korea: A recent study published in the Radiology Journal has highlighted the significant role of obesity and skeletal muscle mass in influencing postoperative survival in patients with non-small cell lung cancer (NSCLC) who undergo curative resection. Researchers found that obesity was linked to better overall survival (OS) following curative resection in NSCLC patients, especially among those who did not exhibit low skeletal muscle mass (LSMM) or myosteatosis.

“In a study of more than 7,000 patients, those classified as obese (body mass index [BMI] ≥25) had a 21% lower risk of death compared to those without obesity (HR 0.79). This association was particularly strong among patients without low skeletal muscle mass or myosteatosis (HR 0.77),” the researchers reported.

The researchers note that a thorough evaluation of skeletal muscle health is essential to understanding the link between improved clinical outcomes and obesity, as defined by body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), in lung cancer. However, there have been few studies exploring this relationship. To address this gap, Ji Hyun Lee, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea, and colleagues aimed to investigate the association between BMI-defined obesity and survival in patients with non-small cell lung cancer who underwent curative resection, with particular emphasis on skeletal muscle status assessed through CT imaging.

For this purpose, the researchers conducted a retrospective study on Korean non-small cell lung cancer patients who underwent curative resection between 2008 and 2019. Patients were categorized into nonobese (BMI <25) and obese (BMI ≥25) groups. Skeletal muscle status was assessed via CT scans at the level of the third lumbar vertebrae, with low skeletal muscle mass defined as the sex-specific lowest quartile. Cox regression analysis was performed to assess the associations between BMI, muscle status, and overall survival.

The research unveiled the following findings:

  • The study included 7,076 patients, with a mean age of 62.5 years, of whom 4,081 were male. Of these, 35.5% had a BMI of 25 or greater, classifying them as obese.
  • In patients without low skeletal muscle mass and myosteatosis, the obese group had longer overall survival compared to the nonobese group (HR 0.77).
  • The association between obesity and lower mortality was observed only in male patients (HR 0.72).
  • There was a lower mortality risk in patients who had ever smoked (HR 0.71) and had no LSMM or myosteatosis.
  • The effect varied according to sex and smoking status, with P values ranging from <.001 to .02 for interaction.

The study identified a link between BMI–defined obesity and improved overall survival in patients with non–small cell lung cancer who underwent curative resection, provided that their CT-measured skeletal muscle mass and radiodensity were within normal ranges. The researchers suggest that while BMI is a useful and practical tool for initial assessment, it should be supplemented with detailed body composition measurements to deeply understand the obesity paradox in non–small cell lung cancer.

“The findings underscore the significance of the quantity and quality of skeletal muscle in explaining the relationship between obesity and improved survival. Further research exploring the biological mechanisms connecting preserved skeletal muscle status with better survival in individuals with obesity, particularly focusing on metabolic health, is essential,” the researchers concluded.

Reference:

Lee JH, Kang D, Lee J, Jeon YJ, Park SY, Cho JH, Choi YS, Kim J, Shim YM, Kong S, Kim HK, Cho J. Association of Obesity and Skeletal Muscle with Postoperative Survival in Non-Small Cell Lung Cancer. Radiology. 2025 Jan;314(1):e241507. doi: 10.1148/radiol.241507. PMID: 39873605.

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Blood test may detect stroke type before hospital arrival, allowing faster treatment, unravels study

A blood test may rapidly distinguish brain bleeds from clot-caused strokes, even before people with stroke symptoms reach the emergency room, according to a preliminary study to be presented at the American Stroke Association’s International Stroke Conference 2025. The meeting is in Los Angeles, Feb. 5-7, 2025 and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

The more time that elapses before a stroke is diagnosed and treated, the more brain tissue is irreparably damaged, and the worse the outcome for the individual. However, even when symptoms point to a stroke, it is crucial to distinguish between a hemorrhagic (bleeding) or ischemic (clot-caused) stroke before giving treatment. That’s usually done through imaging, which can be delayed for hours while a patient is stabilized, brought to the emergency room and then on to radiology for a brain scan – all the while brain cells are dying.

“It is crucial to differentiate these two types of stroke because they need opposite treatments. In ischemic stroke, you need to open the blocked blood vessel with clot-busting drugs or physically remove the clot. In contrast, in a bleeding stroke, you need to lower increased blood pressure and give medication to reverse the effects of certain blood-thinning drugs,” said lead study author Love-Preet Kalra, M.D., a neurology resident at the RKH Hospital Klinikum Ludwigsburg, in Germany.

Researchers studied whether blood levels of glial fibrillary acidic protein (GFAP) could be useful for quickly diagnosing stroke types. GFAP is a protein specific to the brain released into the bloodstream when brain cells are damaged or destroyed. It is already used in assessing traumatic brain injuries.

In a parallel study published in 2024, Kalra and colleagues found that GFAP levels could rapidly distinguish who had a bleeding stroke among unresponsive patients. In this study, researchers evaluated whether levels of GFAP could differentiate between hemorrhagic stroke (caused by bleeding) and ischemic stroke (caused by a blood clot), as well as conditions that mimic a stroke. This assessment was conducted using blood samples collected by the emergency medical services ambulance team before patients arrived at the hospital.

The analysis found that GFAP levels were:

  • almost 7 times higher in patients with bleeding stroke than those with clot-caused stroke (208 picograms per milliliter, or pg/mL, vs. 30 pg/mL);
  • more than 4 times higher in patients with bleeding stroke than those with stroke mimics (208 pg/mL vs. 48 pg/mL);
  • able to rule out bleeding stroke when below 30 pg/mL in patients with moderate to severe neurological deficits;
  • able to predict which patients had a bleeding stroke with 90%-95% accuracy when age-based cut-off points were used. These age-based groups were evenly distributed: below age 72, between age 72 and 83, and above age 83. Notably, the cut-off for the below 72 was very low.
  • higher in bleeding stroke patients taking blood thinners than those not on blood-thinning medications.

“I was personally surprised by the extremely elevated GFAP values in blood thinner-associated bleeding stroke and the fact that, in moderately or severely affected acute stroke patients, bleeding stroke could be excluded in all cases which showed a GFAP lower than 30 pg/mL,” Kalra said.

If larger studies confirm the results, Kalra said early GFAP measurements could change how people with stroke symptoms are treated.

“Treatment to lower blood pressure and reverse blood-thinning medications could be performed in the prehospital setting, leading to a huge change in clinical practice. In the future, even blood thinners or clot-busting treatment might be applied before people reach the hospital,” Kalra said.

A limitation of this test is that a centrifugation step (separates the components of blood) is currently needed. GFAP also increases with age, creating a grey area in which small bleeding strokes might not be identified or mistaken for ischemic strokes in elderly patients.

“This study reveals that levels of GFAP, a marker for brain injury, are higher in patients with brain hemorrhages compared to those who have strokes caused by blood clots. This finding suggests that GFAP could serve as a useful prehospital test for assessing brain injuries. However, the study had a relatively small sample size, and for the test to be effective, both the patient’s blood and the GFAP test must be available as a “point of care” test in the field. Currently, most ambulances and emergency medical services do not have access to this blood test,” said American Heart Association expert volunteer Louise D. McCullough, M.D., P.H.D., FAHA, who is the Roy M. and Phyllis Gough Huffington Distinguished Chair of Neurology at McGovern Medical School; chief of neurology at Memorial Hermann Hospital-Texas Medical Center and co-director of UTHealth Neurosciences, all in Houston. McCullough was not involved in this study.

Study details, background or design:

  • The study included 353 people (average age 75, 47% women) reaching the emergency room within six hours of the onset of stroke symptoms.
  • People were excluded from the analysis if they had previously had a brain tumor or if they had experienced a stroke or traumatic brain injury within the past three months.
  • Blood was drawn before they reached the emergency room at RKH Hospital Ludwigsburg in Ludwigsburg, Germany, where the blood was tested for GFAP levels using a portable blood analyzer.
  • Brain imaging diagnosed intracerebral hemorrhage (bleeding stroke) in 76 people, clot-caused strokes in 258 and conditions mimicking stroke (such as seizure or migraine), in 19 people.
  • GFAP levels were compared between groups based on the diagnosis at hospital discharge.

Reference:

Blood test may detect stroke type before hospital arrival, allowing faster treatment, American Heart Association, Meeting: ASA International Stroke Conference 2025.

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