Πέμπτη 20 Οκτωβρίου 2022

Risk factors for high‐dose methotrexate associated toxicities in patients with primary central nervous system lymphoma

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Risk factors for high-dose methotrexate associated toxicities in patients with primary central nervous system lymphoma

In this study, including 54 PCNSL patients with 175 HD-MTX-based chemotherapy courses, the rate of AKI and myelosuppression increased significantly in patients treated with HD-MTX co-administered with VDS. We also found a significant correlation between MTX pharmacokinetics, eGFR before MTX infusion, and toxicity.


Abstract

What is Known and Objective

Methotrexate (MTX) is an antimetabolic antitumor drug with high individual differences and may lead to severe toxicities in a considerable number of patients. This study aimed to explore the factors influencing major adverse events in patients with primary central nervous system lymphoma treated with high-dose MTX (HD-MTX), which could be useful in clinical practice.

Methods

Fifty-four patients who received 175 courses of MTX at 3–8 g/m2 between January 2015 and December 2016 were enrolled in this study. We assessed the association between clinical characteristics, MTX pharmacokinetics, MTX delayed elimination, and adverse events, including hepatotoxicity, acute kidney injury (AKI), and myelosuppression.

Results and Discussion

A total of 124 adverse events occurred after MTX infusion. Using independent sample t-tests, we found that patients with myelosuppression had higher MTX area under the concentration-time curve up to 48 h after infusion (AUC0-48h) (p = 0.001) and MTX peak concentration (Cmax) (p = 0.002). MTX concentrations at 48 and 72 h were higher in patients with AKI than in those without (p = 0.034 and p = 0.041, respectively). Using chi-square tests, we found that AKI was correlated with MTX elimination at either 48 h or 72 h (22.1% vs. 8.2%, p = 0.010). By multivariate logistic regression model, our results showed that baseline level of ALT and WBC had a significant effect on hepatotoxicity (OR = 1.079, 95% CI 1.044–1.116, p = 6.9 × 10−6; OR = 0.808, 95% CI 0.711–0.917, p = 0.001, respectiv ely). Patient's age, eGFR before MTX infusion, and co-administration of vindesine had a significant effect on AKI (OR = 0.960, 95% CI 0.935–0.986, p = 0.003; OR = 1.009, 95% CI 1.001–1.017, p = 0.034; OR = 5.463, 95% CI 1.793–16.646, p = 0.003, respectively). LDH and Co-administration of vindesine had a significant effect on myelosuppression (OR = 0.985, 95% CI 0.972–0.998, p = 0.025; OR = 3.070, 95% CI 1.032–9.133, p = 0.044).

What is New and Conclusion

Our study demonstrated that co-administration of VDS, eGFR before MTX infusion, and the baseline index of laboratory examinations including ALT, WBC, LDH may be useful biomarkers for predicting MTX-induced toxicities.
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The development of the Standardized Tool for the Assessment of Bruxism (STAB): An international road map

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Abstract

This paper summarizes the background reasoning and work that led to the selection of the items included in the Standardized Tool for the Assessment of Bruxism (STAB), also introducing the list of items. The instrument is currently being tested for face validity and on-field comprehension.

The underlying premise is that the different motor activities included in the bruxism spectrum (e.g., clenching versus grinding, with or without teeth contact) potentially need to be discriminated from each other, based on their purportedly different etiology, comorbidities, and potential consequences. Focus should be on a valid impression of the activities' frequency, intensity, and duration.

The methods that can be used for the above purposes can be grouped into strategies that collect information from the patient's history (subject-based), from the clinical assessment performed by an examiner (clinically based), or from the use of instruments to measure certain outcomes (instrumentally based). The three strategies can apply to all aspects of bruxism (i.e., status, comorbid conditions, etiology, and consequences).

The STAB will help gathering information on many aspects, factors, and conditions that are currently poorly investigated in the field of bruxism. To this purpose, it is divided into two axes. Axis A includes the self-reported information on bruxism status and potential consequences (subject-based report) together with the clinical (examiner report) and instrumental assessment (technology report). Axis B includes the self-reported information (subject-based report) on factors and conditions that may have an etiological or comorbid role for bruxism. This comprehensive multidimensional assessment system will allow building predictive model for clinical and research purposes.
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Prolonged Dexamethasone Exposure Enhances Zebrafish Lateral-Line Regeneration But Disrupts Mitochondrial Homeostasis and Hair Cell Function

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AbstractThe synthetic glucocorticoid dexamethasone is commonly used to treat inner ear disorders. Previous work in larval zebrafish has shown that dexamethasone treatment enhances hair cell regeneration, yet dexamethasone has also been shown to inhibit regeneration of peripheral nerves after lesion. We therefore used the zebrafish model to determine the impact of dexamethasone treatment on lateral-line hair cells and primary afferents. To explore dexamethasone in the context of regeneration, we used copper sulfate (CuSO4) to induce hair cell loss and retraction of nerve terminals, and then allowed animals to recover in dexamethasone for 48  h. Consistent with previous work, we observed significantly more regenerated hair cells in dexamethasone-treated larvae. Importantly, we found that th...
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