The International Journal Of Risk & Safety In Medicine[JOURNAL]
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200 papers
Effectiveness of a reduced dose of ready-to-use therapeutic food in community-based management of severe acute malnutrition: A non-inferiority randomized controlled trial in the Democratic Republic of Congo.
Ntaongo Alendi J, Salpeteur C, Botomba S … +11 more , Argaw A, Nikièma V, Mayavanga JB, Guesdon B, Petry M, Sebinwa U, Bruneau S, Mupuala Masaya A, Mbiya Muadi F, Mampunza Ma Miezi S, Muyer MC
PLoS Med · 2025 May · PMID 40378371 · Full text
INTRODUCTION: The reduced Ready-to-use Therapeutic Food (RUTF) dose strategy was demonstrated effective in recovering children with Severe Acute Malnutrition (SAM) in ideal conditions and in a context of food security. T...
INTRODUCTION: The reduced Ready-to-use Therapeutic Food (RUTF) dose strategy was demonstrated effective in recovering children with Severe Acute Malnutrition (SAM) in ideal conditions and in a context of food security. The present study was conducted to provide further evidence on the effectiveness of reduced RUTF dose in a context of high food insecurity and post conflict humanitarian crisis, and with routine health staff. METHODS AND FINDINGS: An individually randomized non-inferiority trial was conducted in 968 children aged 6-59 months suffering from SAM without medical complications in 14 health centers in the Bonzola and Nzaba health zones of Kasaï Oriental, Democratic Republic of Congo (DRC). Children were randomly assigned to either a control group receiving the standard WHO (World Health Organization) RUTF dose at the time or an intervention group receiving a reduced RUTF dose starting from the third week of treatment. The primary outcome was weight gain velocity from admission to discharge from treatment, while secondary outcomes included anthropometry measurements, programmatic outcomes and relapse. Mixed effects linear and logistic regression models with the health center as random intercept were used to compare differences between the two study groups. Close to 94% of the children were from severely food insecure households. There was no difference in weight gain velocity between the two groups (4.88 ± 2.36 g/kg/d reduced dose group versus 5.09 ± 2.28 g/kg/d standard dose group; difference -0.09 g/kg/d (95% CI [-0.33, 0.15]; p = 0.46). Programmatic outcomes were also similar between the two groups: recovery rate (64.3% versus 67.0%), loss to follow-up (4.69% versus 5.23%), defaulter rate (2.65% and 1.88%), relapse rate over 3 months (2.86% versus 2.40%) and mean length of stay (42 versus 43 days). Nevertheless, the rate of mid-upper arm circumference (MUAC) gain from the third week onwards was lower in the reduced-dose group than in the standard-dose group, with a mean difference of -0.13 mm/week (95% CI [-0.25, -0.01]; p = 0.04). There was no difference in terms of serious adverse events, in the reduced versus standard dose: weight loss (2.24% versus 1.26%), weight stagnation (14.9% versus 17.0%), and medical complications (4.08% versus 3.77%). Important effect modifiers identified were: child sex, child age, season of admission and missed treatment visits. CONCLUSIONS: The strategy of a reduced RUTF dose starting from the third week of treatment is as effective as the standard dose strategy on weight gain velocity and programmatic outcomes in a context of severe food insecurity. However, MUAC gain velocity was lower in the reduced dose group. Future studies should investigate the effectiveness of a reduced dose strategy among sub group of children with high risk factors. Trial registration: International Standard Randomized Controlled Trial Network (ISRCTN15258669).
Risk of hypothyroidism in meat-eaters, fish-eaters, and vegetarians: a population-based prospective study.
Candussi CJ, Bell W, Thompson AS … +8 more , Knüppel S, Gaggl M, Světnička M, Gojda J, Cassidy A, Weikert C, Córdova R, Kühn T
BMC Med · 2025 May · PMID 40336074 · Full text
BACKGROUND: Plant-based diets are gaining popularity due to their well-documented cardiometabolic benefits and environmental sustainability. However, these diets are often lower in specific micronutrients such as iodine,...
BACKGROUND: Plant-based diets are gaining popularity due to their well-documented cardiometabolic benefits and environmental sustainability. However, these diets are often lower in specific micronutrients such as iodine, raising concerns about their potential impact on thyroid health. Therefore, we examined the associations between plant-based diets and the risk of hypothyroidism. METHODS: We analysed data from the UK (United Kingdom) Biobank cohort. Multivariable Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for incident hypothyroidism across vegans, vegetarians, pescatarians, poultry-eaters, low meat-eaters, and high meat-eaters aged 40-69 years. Ancillary to this, we carried out logistic regression analyses to evaluate associations between the diet groups and prevalent hypothyroidism according to International Classification of Diseases (ICD) codes at baseline. RESULTS: We included 466,362 individuals from the UK Biobank, of which 220,514 followed a high meat, 221,554 a low meat, 5242 a poultry-based, 10,598 a pescatarian, 8057 a vegetarian, and 397 a vegan diet. During a median SD (Standard Deviation) follow-up of 12.7 (± 3.2) years, 10,831 participants developed hypothyroidism. In multivariable Cox regression models without adjustment for body mass index (BMI), none of the diets were significantly associated with the risk of hypothyroidism. However, there was a tendency for a higher risk of hypothyroidism among vegetarians compared to people following a high meat diet (HR = 1.13, 95% CI 0.98-1.30). After controlling for BMI, a potential collider, the association for vegetarians (HR = 1.23, 95% CI 1.07-1.42) became stronger and statistically significant. Furthermore, we observed a positive association between low meat-eaters (OR = 1.05, 95% CI 1.03-1.08), poultry-eaters (OR = 1.15, 95% CI 1.04-1.28), pescatarians (OR = 1.10, 95% CI 1.01-1.19) and vegetarian (OR = 1.26, 95% CI 1.15-1.38) with hypothyroidism prevalence. CONCLUSIONS: In the present study, we found a moderately higher risk of hypothyroidism among vegetarians, after controlling for BMI, a potential collider. This slightly higher risk of hypothyroidism among vegetarians requires further investigation, taking iodine status and thyroid hormone levels into account.
Circulating linoleic acid and its interplay with gut microbiota during pregnancy for gestational diabetes mellitus.
Qiu J, Hu P, Li F … +22 more , Huang Y, Yang Y, Sun F, Wu P, Lai Y, Wang Y, He X, Dong Y, Zhang P, Zhang S, Wu N, Wang T, Yang S, Li S, Yuan J, Liu X, Liu G, Hu Y, Wu JHY, Chen D, Pan A, Pan XF
BMC Med · 2025 Apr · PMID 40289092 · Full text
BACKGROUND: Circulating linoleic acid (LA) levels have been reported to be associated with various metabolic outcomes. However, the role of LA and its interplay with gut microbiota in gestational diabetes mellitus (GDM)...
BACKGROUND: Circulating linoleic acid (LA) levels have been reported to be associated with various metabolic outcomes. However, the role of LA and its interplay with gut microbiota in gestational diabetes mellitus (GDM) remains unclear. This study aimed to investigate the longitudinal association between circulating LA levels during pregnancy and the risk of GDM, and the potential role of gut microbiota. METHODS: A nested case-control study was conducted within the ongoing Tongji-Huaxi-Shuangliu Birth Cohort in Chengdu, China. Blood and fecal samples were collected during early and middle pregnancy from 807 participants. GDM was diagnosed in middle pregnancy using the International Association of Diabetes and Pregnancy Study Groups criteria. Plasma LA levels were measured using gas chromatography-mass spectrometry, and gut microbiota was analyzed through 16S rRNA gene sequencing and shotgun metagenomic sequencing. A two-sample Mendelian randomization study was conducted using data from the IEU OpenGWAS database and the FinnGen consortium. RESULTS: Elevated plasma LA levels were associated with a lower risk of GDM in both early (P for trend = 0.002) and middle pregnancy (P for trend = 0.02). Consistently, Mendelian randomization analysis revealed that each unit increase in LA was associated with a 16% reduction in GDM risk (odds ratio: 0.84, 95% confidence interval: 0.72, 0.95). In early pregnancy, higher plasma LA levels were correlated with higher adiponectin levels (P < 0.001) and lower levels of triglycerides (P < 0.001), HbA1c (P = 0.04), and C-peptide (P = 0.04). The LA-accociated microbiota mediated the relationship between LA and C-peptide (P = 0.01). Additionally, the inverse association between LA and GDM was modified by Bilophila (P for interaction = 0.03), with a stronger association observed in participants with lower Bilophila levels in early pregnancy. Metagenomic analyses further showed that the LA-associated pathway (D-galacturonate degradation I) and its key enzyme (EC 4.2.1.7) were associated with metabolic traits. CONCLUSIONS: Our study provides evidence for an inverse causal association between plasma LA levels during pregnancy and GDM risk, which is both mediated and modified by gut microbiota.
Paclitaxel-coated balloon catheter versus paclitaxel-eluting stent for the treatment of coronary in-stent restenosis: A GRADE-assessed systematic review and meta-analysis of randomized controlled trials.
Ahmed S, Ahmad E, Ahmed M … +6 more , Ul Ain H, Ahmed R, Jain H, Harikrishna A, Ali Ashraf D, Ahmad S
Medicine (Baltimore) · 2025 Apr · PMID 40228264 · Full text
BACKGROUND: Paclitaxel is an antimicrotubular agent and is used to coat balloons and stents used in percutaneous coronary intervention. This study aims to provide a pooled comparison of paclitaxel-coated balloons (PCB) a...
BACKGROUND: Paclitaxel is an antimicrotubular agent and is used to coat balloons and stents used in percutaneous coronary intervention. This study aims to provide a pooled comparison of paclitaxel-coated balloons (PCB) and paclitaxel-eluting stents (PES) in terms of their efficacy in treating restenosis and their associated safety outcomes. METHODS: We systematically searched PubMed, Scopus, Science Direct, and Clinicaltrials.gov from inception until August 2024 to evaluate the outcomes between PCB and PES for treating coronary in-stent restenosis. Studies were deemed eligible if they compared PCB with PES in patients with coronary in-stent restenosis. Pooled data were reported using risk ratio (RR) for dichotomous outcomes and mean difference for continuous outcomes, along with 95% confidence intervals (CI). This systematic review and meta-analysis was registered with International Prospective Register of Systematic Reviews (CRD42024543509). RESULTS: 734 patients across 4 trials were included in this analysis. Descriptive analysis showed high device success in both groups (99.6% for PCB vs 97.9% for PES), while restenosis occurred in 20.6% of PCB patients and 23.7% of PES patients. Myocardial infarction rates were 1.9% for PCB and 3.0% for PES, while mortality was observed in 1.6% and 3.6% of patients, respectively. No significant differences between PCB and PES were revealed in terms of recurrent binary restenosis rates (RR: 0.76; 95% CI: 0.19 to 2.99) or late lumen loss (mean difference: -0.02; 95% CI: -0.25 to 0.22). Device success rates (RR: 1.01; 95% CI: 0.91 to 1.13), the incidence of myocardial infarction (RR: 0.64; 95% CI: 0.24 to 1.69), and the incidence of death (RR: 0.48; 95% CI: 0.16 to 1.41) were also comparable between the 2 groups. CONCLUSION: PCB provides a viable stent-free alternative to PES with comparable outcomes. Further studies, especially those focused on assessing patient-specific factors and lesion characteristics are required to guide optimal treatment selection.
Food additive mixtures and type 2 diabetes incidence: Results from the NutriNet-Santé prospective cohort.
Payen de la Garanderie M, Hasenbohler A, Dechamp N … +20 more , Javaux G, Szabo de Edelenyi F, Agaësse C, De Sa A, Bourhis L, Porcher R, Pierre F, Coumoul X, Kesse-Guyot E, Allès B, Fezeu LK, Cosson E, Tatulashvili S, Huybrechts I, Hercberg S, Deschasaux-Tanguy M, Chassaing B, Rytter H, Srour B, Touvier M
PLoS Med · 2025 Apr · PMID 40198579 · Full text
BACKGROUND: Mixtures of food additives are daily consumed worldwide by billions of people. So far, safety assessments have been performed substance by substance due to lack of data on the effect of multiexposure to combi...
BACKGROUND: Mixtures of food additives are daily consumed worldwide by billions of people. So far, safety assessments have been performed substance by substance due to lack of data on the effect of multiexposure to combinations of additives. Our objective was to identify most common food additive mixtures, and investigate their associations with type 2 diabetes incidence in a large prospective cohort. METHODS AND FINDINGS: Participants (n = 108,643, mean follow-up = 7.7 years (standard deviation (SD) = 4.6), age = 42.5 years (SD = 14.6), 79.2% women) were adults from the French NutriNet-Santé cohort (2009-2023). Dietary intakes were assessed using repeated 24h-dietary records, including industrial food brands. Exposure to food additives was evaluated through multiple food composition databases and laboratory assays. Mixtures were identified through nonnegative matrix factorization (NMF), and associations with type 2 diabetes incidence were assessed using Cox models adjusted for potential socio-demographic, anthropometric, lifestyle and dietary confounders. A total of 1,131 participants were diagnosed with type 2 diabetes. Two out of the five identified food additive mixtures were associated with higher type 2 diabetes incidence: the first mixture included modified starches, pectin, guar gum, carrageenan, polyphosphates, potassium sorbates, curcumin, and xanthan gum (hazard ratio (HR)per an increment of 1SD of the NMF mixture score = 1.08 [1.02, 1.15], p = 0.006), and the other mixture included citric acid, sodium citrates, phosphoric acid, sulphite ammonia caramel, acesulfame-K, aspartame, sucralose, arabic gum, malic acid, carnauba wax, paprika extract, anthocyanins, guar gum, and pectin (HR = 1.13 [1.08,1.18], p < 0.001). No association was detected for the three remaining mixtures: HR = 0.98 [0.91, 1.06], p = 0.67; HR = 1.02 [0.94, 1.10], p = 0.68; and HR = 0.99 [0.92, 1.07], p = 0.78. Several synergistic and antagonist interactions between food additives were detected in exploratory analyses. Residual confounding as well as exposure or outcome misclassifications cannot be entirely ruled out and causality cannot be established based on this single observational study. CONCLUSIONS: This study revealed positive associations between exposure to two widely consumed food additive mixtures and higher type 2 diabetes incidence. Further experimental research is needed to depict underlying mechanisms, including potential synergistic/antagonist effects. These findings suggest that a combination of food additives may be of interest to consider in safety assessments, and they support public health recommendations to limit nonessential additives. TRIAL REGISTRATION: The NutriNet-Santé cohort is registered at clinicaltrials.gov (NCT03335644). https://clinicaltrials.gov/study/NCT03335644.
Increased vision impairment reports linked to semaglutide: analysis of FDA adverse event data.
Massy M, Marti S, Hammer H … +1 more , Hoepner R
BMC Med · 2025 Apr · PMID 40189538 · Full text
BACKGROUND: Semaglutide, a GLP-1 receptor agonist widely prescribed for type 2 diabetes and obesity, has recently raised concerns about its ocular safety. This study aimed to investigate the association between semagluti...
BACKGROUND: Semaglutide, a GLP-1 receptor agonist widely prescribed for type 2 diabetes and obesity, has recently raised concerns about its ocular safety. This study aimed to investigate the association between semaglutide use and vision impairment using data from the FDA Adverse Event Reporting System (FAERS). METHODS: We conducted an analysis of FAERS data, comparing reports of vision impairment associated with semaglutide to those associated with other antidiabetic and weight loss medications. The main outcome measure was the reporting odds ratio (rOR) for vision impairment linked to semaglutide use compared to other medications. RESULTS: Semaglutide showed significantly higher reporting of vision impairment compared to other GLP-1 receptor agonists (rOR 1.95, 95% CI 1.75-2.17, p < 0.0001), DPP-4 inhibitors (rOR 2.46, 95% CI 2.12-2.86, p < 0.0001), SGLT2 inhibitors (rOR 3.89, 95% CI 3.35-4.51, p < 0.0001), and metformin (rOR 2.23, 95% CI 1.90-2.62, p < 0.0001). Similar findings were observed when compared to phentermine (rOR 1.57, 95% CI 1.07-2.31, p = 0.026) and orlistat (rOR 3.77, 95% CI 2.96-4.81, p < 0.0001). Topiramate was the sole exception, showing higher vision impairment reporting than semaglutide (rOR 0.30, 95% CI 0.20-0.45, p < 0.0001). CONCLUSIONS: These findings suggest a potentially elevated risk of vision impairment with semaglutide use compared to other diabetes and weight loss medications, warranting further investigation and vigilant post-marketing surveillance. Future studies should assess the clinical impact of this potential increased risk on an absolute scale to better inform treatment decisions.
Efficacy and safety of herbal medicine treatment on postsurgical recovery in gastric cancer patients: A systematic review and meta-analysis.
Kim SD, Pyo SJ, Kim DH … +2 more , Yoo HS, Park SJ
Medicine (Baltimore) · 2025 Jan · PMID 40184097 · Full text
BACKGROUND: Gastric cancer (GC) is the second most prevalent cancer in Korea, and is associated with significant morbidity and mortality. Although advancements in early detection and treatment have improved survival rate...
BACKGROUND: Gastric cancer (GC) is the second most prevalent cancer in Korea, and is associated with significant morbidity and mortality. Although advancements in early detection and treatment have improved survival rates, management of postsurgical recovery remains vital. Herbal medicine (HM) has emerged as a potential adjunct therapy for enhancing the recovery and quality of life (QoL) of patients post-GC surgery. METHODS: This systematic review and meta-analysis evaluated the efficacy and safety of HM in the postsurgical recovery of patients with GC. We searched both Korean and international databases and identified 16 randomized controlled trials that met our inclusion criteria. We assessed the study quality using the Cochrane Risk of Bias tool and analyzed the data using the Review Manager Software (RevMan). RESULTS: Our analysis included 1546 patients from selected studies, demonstrating that HM significantly improved gastrointestinal recovery times, including the time to first flatus, bowel movement, and return of bowel sounds. Significant improvements were also observed in nutritional markers, such as albumin and prealbumin, along with beneficial effects on immune markers, such as CD3+ and CD4+ levels. QoL assessments using the WHOQOL-BREF and QLQ-C30 indicated substantial improvements. HM had a favorable safety profile, showing a reduced incidence of adverse effects compared to the controls. CONCLUSION: The findings suggest that HM can significantly enhance recovery and improve quality of life following GC surgery, with a favorable safety profile. However, due to the considerable heterogeneity in study results, extended clinical trials and rigorous follow-ups are recommended to comprehensively assess long-term effects and side effects.
The effect of prenatal balanced energy and protein supplementation on gestational weight gain: An individual participant data meta-analysis in low- and middle-income countries.
Wang D, Partap U, Liu E … +39 more , Costa JC, Cliffer IR, Wang M, Nookala SK, Subramoney V, Briggs B, Ahmed I, Argaw A, Ariff S, Bhandari N, Chowdhury R, Erchick D, García-Guerra A, Ghaffarpour M, Hanley-Cook G, Huybregts L, Jehan F, Kaseb F, Krebs NF, Lachat C, Lama TP, Manandhar DS, McClure EM, Moore SE, Muhammad A, Neufeld LM, Prentice AM, Quezada-Sánchez AD, Roberfroid D, Saville NM, Shafiq Y, Shrestha BP, Sonko B, Soofi S, Taneja S, Tielsch JM, Toe LC, Valaei N, Fawzi WW
PLoS Med · 2025 Feb · PMID 39899474 · Full text
BACKGROUND: Understanding the effects of balanced energy and protein (BEP) supplements on gestational weight gain (GWG) and how the effects differ depending on maternal characteristics and the nutritional composition of...
BACKGROUND: Understanding the effects of balanced energy and protein (BEP) supplements on gestational weight gain (GWG) and how the effects differ depending on maternal characteristics and the nutritional composition of the supplements will inform the implementation of prenatal BEP interventions. METHODS AND FINDINGS: Individual participant data from 11 randomized controlled trials of prenatal BEP supplements (N = 12,549, with 5,693 in the BEP arm and 6,856 in the comparison arm) in low- and middle-income countries were used. The primary outcomes included GWG adequacy (%) and the estimated total GWG at delivery as continuous outcomes, and severely inadequate (<70% adequacy), inadequate GWG (<90% adequacy), and excessive GWG (>125% adequacy) as binary outcomes; all variables were calculated based on the Institute of Medicine recommendations. Linear and log-binomial models were used to estimate study-specific mean differences or risk ratios (RRs), respectively, with 95% confidence intervals (CIs) of the effects of prenatal BEP on the GWG outcomes. The study-specific estimates were pooled using meta-analyses. Subgroup analyses were conducted by individual characteristics. Subgroup analyses and meta-regression were conducted for study-level characteristics. Compared to the comparison group, prenatal BEP led to a 6% greater GWG percent adequacy (95% CI: 2.18, 9.56; p = 0.002), a 0.59 kg greater estimated total GWG at delivery (95% CI, 0.12, 1.05; p = 0.014), a 10% lower risk of severely inadequate GWG (RR: 0.90; 95% CI: 0.83, 0.99; p = 0.025), and a 7% lower risk of inadequate GWG (RR: 0.93; 95% CI: 0.89, 0.97; p = 0.001). The effects of prenatal BEP on GWG outcomes were stronger in studies with a targeted approach, where BEP supplements were provided to participants in the intervention arm under specific criteria such as low body mass index or low GWG, compared to studies with an untargeted approach, where BEP supplements were provided to all participants allocated to the intervention arm. CONCLUSIONS: Prenatal BEP supplements are effective in increasing GWG and reducing the risk of inadequate weight gain during pregnancy. BEP supplementation targeted toward pregnant women with undernutrition may be a promising approach to delivering the supplements.
"If that would have lessened my symptoms, that would have been great...": a qualitative study about the acceptability of tecovirimat as treatment for mpox.
Paparini S, Hayes R, Weil B … +5 more , Nutland W, Maatouk I, Wi T, Orkin CM, Lewis R
BMC Med · 2025 Jan · PMID 39838404 · Full text
BACKGROUND: Tecovirimat, an antiviral treatment for smallpox, was approved as a treatment for mpox by the European Medicines Agency in January 2022. Approval was granted under "exceptional circumstances" based on effecti...
BACKGROUND: Tecovirimat, an antiviral treatment for smallpox, was approved as a treatment for mpox by the European Medicines Agency in January 2022. Approval was granted under "exceptional circumstances" based on effectiveness found in pre-clinical challenge studies in animals and safety studies in humans showing minimal side effects. As clinical efficacy studies are still ongoing, there is currently limited information with regard to the acceptability of tecovirimat to treat mpox. The aim of this study is to understand prospective acceptability of use of tecovirimat as treatment for mpox. METHODS: A co-produced, qualitative, focus group study design was conducted with a theoretically informed sample of people from communities at higher risk and with experience of mpox illness. Thirteen participants took part: all self-identified as cisgender male, 1 self-identified as Black British, 1 as British Asian, 5 as White, 3 as White British, 3 as White Other. Inclusion criteria were as follows: experience of mpox illness; age 18 and over; living in the United Kingdom (UK); living in the UK during 2022 mpox outbreak. Focus groups were recorded, transcribed and thematically analysed using a combination inductive and deductive coding informed by the Treatment Acceptability Framework. RESULTS: Very few participants were aware of tecovirimat as a treatment option and none were offered it during their mpox illness. Key factors influencing acceptability found in this study were as follows: levels of trust in medicine; level of information; provider communication approach; quality of experience of mpox care. Marginalised communities at highest risk of mpox may have prior experience of structural discrimination which can greatly influence treatment acceptability. CONCLUSIONS: This exploratory study suggest that offering tecovirimat (or comparable emergency-licensed treatments) to people with mpox is acceptable, although uptake will depend on knowledge of mpox treatment options, trust in medicine and medical professionals and provision of relevant information and choice. To increase acceptability of such treatments, clinicians should ensure patients are aware of mpox symptom management options, including pain relief; acknowledge and address patient concerns upfront and within the context of non-stigmatising care; and communicate offers in a consistent and supportive manner in line with locally approved eligibility criteria and protocols at the time.
Efficacy and safety of ivermectin-albendazole combination versus ivermectin or albendazole monotherapy in soil-transmitted helminthiasis: A systematic review and meta-analysis.
Malik H, Din MFU, Faizan MA … +10 more , Rehman T, Hudaib M, Shah SMA, Khan AA, Amir SF, Fraz M, Khalid M, Anjum MU, Larik MO, Bhattarai P
Medicine (Baltimore) · 2025 Jan · PMID 39833059 · Full text
BACKGROUND: Soil-transmitted helminthiasis remains a daunting challenge to global health, exerting its greatest toll on resource-limited regions of the world. A dual drug approach using the co-administration of ivermecti...
BACKGROUND: Soil-transmitted helminthiasis remains a daunting challenge to global health, exerting its greatest toll on resource-limited regions of the world. A dual drug approach using the co-administration of ivermectin and albendazole has shown promising results in comparison to the traditional monotherapy strategy. In light of this, a systematic review and meta-analysis of randomized controlled trials was conducted. METHODS: Several electronic databases including PubMed, Cochrane Central, Google Scholar, and Embase were explored to search for relevant studies from inception to September 2023. The Cochrane Risk of Bias Tool for Randomized Controlled Studies was utilized to evaluate the quality of studies. RESULTS: A total of 8 randomized controlled trials, reporting 10 patient populations, were included. The treatment of trichuriasis significantly favored the dual therapy regimen of ivermectin-albendazole over albendazole-only monotherapy (risk ratio [RR]: 2.86; 95% confidence interval [CI]: 1.66-4.93; P = .0002), with no significant differences observed for ascariasis and hookworm. The treatment of trichuriasis and hookworm significantly favored the dual therapy regimen of ivermectin-albendazole over ivermectin-only monotherapy (RR: 1.86; 95% CI: 1.56-2.21; P < .00001 and RR: 2.31; 95% CI: 1.23-4.31; P = .009, respectively). There were no statistically significant differences between dual therapy and monotherapy in terms of adverse effects. CONCLUSION: These findings highlight the nuanced effectiveness of combined therapy specific to certain helminth types, in addition to their comparable safety profiles, thereby providing pivotal insights that contribute to the evolving landscape of soil-transmitted helminth treatment strategies.
Advancements in sacroiliac joint reduction for enhancing lumbosacral pain relief and achieving balanced gait: A literature review.
Zheng J, Duan C, Ma C
Medicine (Baltimore) · 2024 Dec · PMID 39686504 · Full text
This article provides a comprehensive review of recent research advancements in sacroiliac joint reduction therapy for addressing lumbosacral pain and gait balance issues, delving into its application efficacy, future ou...
This article provides a comprehensive review of recent research advancements in sacroiliac joint reduction therapy for addressing lumbosacral pain and gait balance issues, delving into its application efficacy, future outlook, and existing challenges. Current literatures were searched on sacroiliac joint reduction therapy, lumbosacral pain and gait balance disorders using the databases PubMed and Cochrane. There were no restrictions when conducting the literature search with regard to publication date, study language, or study type. Research indicates notable enhancements in various gait parameters, including stride length, gait speed, and cycle uniformity, among patients undergoing sacroiliac joint reduction therapy. These improvements translate into augmented walking stability and a reduced risk of falls. Despite its clinical efficacy, this therapeutic modality encounters several challenges in practical implementation. One major hurdle is the absence of standardized international diagnostic criteria for sacroiliac joint dysfunction, hindering the widespread adoption and standardization of this treatment approach. Further clinical investigations and longitudinal data are imperative to ascertain the long-term efficacy and potential risks associated with this therapy. Future research avenues should prioritize the development of precise diagnostic tools and standardized treatment protocols to enhance the efficacy and safety of sacroiliac joint reduction therapy. Moreover, interdisciplinary collaboration is paramount, leveraging the expertise of physical therapists, rehabilitation specialists, and spine surgeons to offer comprehensive treatment solutions. Sacroiliac joint reduction therapy emerges as a compelling therapeutic option for individuals grappling with lumbosacral pain and gait instability, showcasing significant clinical potential and promising future prospects.
rVSV-ZEBOV vaccination in people with pre-existing immunity to Ebolavirus: an open-label safety and immunogenicity study in Guinean communities affected by Ebola virus disease (l'essai proches).
Watson CH, Gsell PS, Hall Y … +34 more , Camacho A, Riveros X, Enwere G, Vicari A, Nadlaou SD, Toure A, Sani IM, Diallo A, Kolie C, Duraffour S, Ifono K, Maomou A, Dore K, Djidonou HA, Bagayoko A, Damey PP, Camara MN, Diallo FB, Oumar FT, Toure K, Diaby ML, Sylla L, Conde D, Kaba IL, Tipton T, Eggo RM, Marks M, Roberts CH, Strecker T, Günther S, Keita S, Edmunds WJ, Carroll MW, Henao-Restrepo AM
BMC Med · 2024 Nov · PMID 39511527 · Full text
BACKGROUND: Zaire Ebolavirus disease (EVD) outbreaks can be controlled using rVSV-ZEBOV vaccination and other public health measures. People in high-risk areas may have pre-existing antibodies from asymptomatic Ebolaviru...
BACKGROUND: Zaire Ebolavirus disease (EVD) outbreaks can be controlled using rVSV-ZEBOV vaccination and other public health measures. People in high-risk areas may have pre-existing antibodies from asymptomatic Ebolavirus exposure that might affect response to rVSV-ZEBOV. Therefore, we assessed the impact pre-existing immunity had on post-vaccination IgG titre, virus neutralisation, and reactogenicity following vaccination. METHODS: In this prospective cohort study, 2115 consenting close contacts ("proches") of EVD survivors were recruited. Proches were vaccinated with rVSV-ZEBOV and followed up for 28 days for safety and immunogenicity. Anti-GP IgG titre at baseline and day 28 was assessed by ELISA. Samples from a representative subset were evaluated using live virus neutralisation. RESULTS: Ten percent were seropositive at baseline. At day 28, IgG in baseline seronegative (GMT 0.106 IU/ml, 95% CI: 0.100 to 0.113) and seropositive (GMT 0.237 IU/ml, 0.210 to 0.267) participants significantly increased from baseline (both p < 0.0001). There was strong correlation between antibody titres and virus neutralisation in day 28 samples (Spearman's rho 0.75). Vaccinees with baseline IgG antibodies against Zaire Ebolavirus had similar safety profiles to those without detectable antibodies (63.6% vs 66.1% adults experienced any adverse event; 49.1% vs 60.9% in children), with almost all adverse events graded as mild. No serious adverse events were attributed to vaccination. No EVD survivors tested positive for Ebolavirus by RT-PCR. CONCLUSIONS: These data add further evidence of rVSV-ZEBOV safety and immunogenicity, including in people with pre-existing antibodies from suspected natural ZEBOV infection whose state does not blunt rVSV-ZEBOV immune response. Pre-vaccination serological screening is not required.
Risk of Herpes Simplex virus type 1 (HSV-1) among patients with insomnia: A retrospective cohort study.
Lin CP, Lin CL, Wu HC … +2 more , Chung CH, Chien WC
Medicine (Baltimore) · 2024 Aug · PMID 39093735 · Full text
The aim of this study was to explore the risk of Simplex virus type 1 (HSV-1) in patients with insomnia. This study applied a population-based retrospective cohort design. A total of 50,210 patients aged ≥ 20 years who h...
The aim of this study was to explore the risk of Simplex virus type 1 (HSV-1) in patients with insomnia. This study applied a population-based retrospective cohort design. A total of 50,210 patients aged ≥ 20 years who had received a diagnosis of insomnia between 2000 and 2015. They were identified according to the corresponding International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code. The control cohort comprised 100,420 age-matched and sex-matched patients. Data from the Taiwan National Health Insurance Research Database were employed from 2000 to 2015. The overall incidence of HSV-1 in the insomnia cohort was significantly higher than that in the comparison cohort (3.10 vs 0.33 per 1000 person-years). Patients with insomnia had a higher risk of HSV-1 infection, compared with the comparisons (hazard ratio (HR) = 4.33, 95% confidence interval (CI) 2.18-5.58). For individuals divided into 3 age groups (≤40, 41-65, and >65 years old), the HSV-1 infection risk of the insomnia cohort was significantly greater than that of the comparisons. As the duration of insomnia increases, the risk of HSV-1 occurrence decreases.
Hearing loss in Australian First Nations children at 6-monthly assessments from age 12 to 36 months: Secondary outcomes from randomised controlled trials of novel pneumococcal conjugate vaccine schedules.
Leach AJ, Wilson N, Arrowsmith B … +19 more , Beissbarth J, Mulholland K, Santosham M, Torzillo PJ, McIntyre P, Smith-Vaughan H, Skull SA, Oguoma VM, Chatfield MD, Lehmann D, Brennan-Jones CG, Binks MJ, Licciardi PV, Andrews RM, Snelling T, Krause V, Carapetis J, Chang AB, Morris PS
PLoS Med · 2024 Jun · PMID 38829821 · Full text
BACKGROUND: In Australian remote communities, First Nations children with otitis media (OM)-related hearing loss are disproportionately at risk of developmental delay and poor school performance, compared to those with n...
BACKGROUND: In Australian remote communities, First Nations children with otitis media (OM)-related hearing loss are disproportionately at risk of developmental delay and poor school performance, compared to those with normal hearing. Our objective was to compare OM-related hearing loss in children randomised to one of 2 pneumococcal conjugate vaccine (PCV) formulations. METHODS AND FINDINGS: In 2 sequential parallel, open-label, randomised controlled trials (the PREVIX trials), eligible infants were first allocated 1:1:1 at age 28 to 38 days to standard or mixed PCV schedules, then at age 12 months to PCV13 (13-valent pneumococcal conjugate vaccine, +P) or PHiD-CV10 (10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine, +S) (1:1). Here, we report prevalence and level of hearing loss outcomes in the +P and +S groups at 6-monthly scheduled assessments from age 12 to 36 months. From March 2013 to September 2018, 261 infants were enrolled and 461 hearing assessments were performed. Prevalence of hearing loss was 78% (25/32) in the +P group and 71% (20/28) in the +S group at baseline, declining to 52% (28/54) in the +P groups and 56% (33/59) in the +S group at age 36 months. At primary endpoint age 18 months, prevalence of moderate (disabling) hearing loss was 21% (9/42) in the +P group and 41% (20/49) in the +S group (difference -19%; (95% confidence interval (CI) [-38, -1], p = 0.07) and prevalence of no hearing loss was 36% (15/42) in the +P group and 16% (8/49) in the +S group (difference 19%; (95% CI [2, 37], p = 0.05). At subsequent time points, prevalence of moderate hearing loss remained lower in the +P group: differences -3%; (95% CI [-23, 18], p = 1.00 at age 24 months), -12%; (95% CI [-30, 6], p = 0.29 at age 30 months), and -9%; (95% CI [-23, 5], p = 0.25 at age 36 months). A major limitation was the small sample size, hence low power to reach statistical significance, thereby reducing confidence in the effect size. CONCLUSIONS: In this study, we observed a high prevalence and persistence of moderate (disabling) hearing loss throughout early childhood. We found a lower prevalence of moderate hearing loss and correspondingly higher prevalence of no hearing loss in the +P group, which may have substantial benefits for high-risk children, their families, and society, but warrant further investigation. TRIAL REGISTRATION: ClinicalTrials.gov NCT01735084 and NCT01174849.
Efficacy and safety of electroacupuncture for benign prostatic hyperplasia: A systematic review and meta-analysis.
Chen R, Huang H, Zhan S … +3 more , Yi L, Huang L, Yue Z
Medicine (Baltimore) · 2024 Feb · PMID 38394501 · Full text
BACKGROUND: This study aimed to evaluate the efficacy and safety of electroacupuncture (EA) in the treatment of benign prostatic hyperplasia. METHODS: Seven databases were searched from the inception of each database to...
BACKGROUND: This study aimed to evaluate the efficacy and safety of electroacupuncture (EA) in the treatment of benign prostatic hyperplasia. METHODS: Seven databases were searched from the inception of each database to March 31, 2023, including PubMed, Web of Science, Cochrane, Embase, China National Knowledge Infrastructure, Wanfang, and China Biology Medicine. The modified Jadad scale was used to assess literature quality, and literature inclusion and exclusion were conducted in strict accordance with the criteria of a score of ≥4. The risk of bias was evaluated using the Cochrane risk of bias tool. The pooled effect size of the binary data was measured by odds ratio (OR) and 95% confidence interval (CI), and the pooled effect size of the continuous data was presented as weighted mean difference (WMD) and 95% CI. If I² was larger than 50%, a random effects model was adopted, and otherwise, a fixed effects model was used. Additionally, publication bias assessment and sensitivity analysis were conducted. RESULTS: A total of 325 records were retrieved, and finally 9 randomized controlled trial studies were included, involving 1045 patients. Meta-analysis revealed that the EA group had better improvement than the control group in terms of clinical effective rate (odds ratio = 3.92, 95% CI = 2.38 to 6.47, I² = 0%, P < .001), International Prostate Symptom Score (WMD = -4.99, 95% CI = -6.15 to -3.84, I² = 76.9%, P < .001), maximum urinary flow rate (WMD = -4.99, 95% CI = -6.15 to -3.84, I² = 87.4%, P < .001), and post-void residual volume (WMD = -17.12, 95% CI = -29.49 to -4.75, I² = 89.1%, P < .01). There was no statistical significance in prostate volume and adverse events between the EA group and the control group (P > .05). CONCLUSION: EA is effective in the treatment of benign prostatic hyperplasia with acceptable overall safety.
Five-year follow-up of sustained virological response with hepatitis C infection after direct-acting antiviral therapy: A single-center retrospective study.
Li M, Li Y, Zhang Y … +2 more , Wang X, Lin C
Medicine (Baltimore) · 2024 Feb · PMID 38363923 · Full text
In recent years, direct-acting antivirals (DAAs) have dramatically improved the sustained virological response (SVR) rates in chronic hepatitis C (CHC) patients with their favorable safety and efficacy. However, there is...
In recent years, direct-acting antivirals (DAAs) have dramatically improved the sustained virological response (SVR) rates in chronic hepatitis C (CHC) patients with their favorable safety and efficacy. However, there is a lack of data on the long-term prognosis of DAA therapy for CHC patients after achieving SVR in the real world. The aim of this study was to evaluate the long-term clinical prognosis of patients with chronic hepatitis C treated by DAA after achieving SVR. This study was a single-center, retrospective, observational study that included 243 CHC patients who reached SVR after DAA treatment in the Third Affiliated Hospital of Sun Yat-sen University from January 2017 to December 2021, with a median follow-up period (FUP) of 24 months, to assess the long-term prognosis and clinical outcomes of CHC patients who reached SVR by DAA treatment. A total of 243 patients were enrolled in this study, 151 patients were male, the mean age of this study was 46.7 ± 12.3 years old, and 23.0% (n = 56) patients were cirrhosis in the baseline. At the end of follow-up, 9 patients (3.7%) progressed to hepatocellular carcinoma (HCC), and patients with cirrhosis at baseline (n = 5) had a significantly higher risk of HCC compared with noncirrhotic patients (n = 4; OR = 4.485, 95% CI: 1.162-17.318, P = .029); 2.9% patients (n = 7) relapsed at the median FUP of 12 months, and patients with genotype 3b had a significantly higher risk of relapsing than those without genotype 3b (OR = 18.48, P = .002, 95% CI: 2.866-119.169). ALT, AST, and ALB all showed improvement at the end of treatment compared with the baseline, remaining at normal levels during FUP meanwhile. The DAA-induced SVR was durable, with conspicuous improvement in clinical outcomes. Nevertheless, patients, especially patients with cirrhosis, still exist the risk of appearance of HCC after reaching SVR. Therefore, regular surveillance and monitoring is necessary even after patients reached SVR.
Parental genetically predicted liability for coronary heart disease and risk of adverse pregnancy outcomes: a cohort study.
Hernáez Á, Skåra KH, Page CM … +13 more , Mitter VR, Hernández MH, Magnus P, Njølstad PR, Andreassen OA, Corfield EC, Havdahl A, Næss Ø, Brumpton B, Åsvold BO, Lawlor DA, Fraser A, Magnus MC
BMC Med · 2024 Jan · PMID 38273336 · Full text
BACKGROUND: Adverse pregnancy outcomes (APO) may unmask or exacerbate a woman's underlying risk for coronary heart disease (CHD). We estimated associations of maternal and paternal genetically predicted liability for CHD...
BACKGROUND: Adverse pregnancy outcomes (APO) may unmask or exacerbate a woman's underlying risk for coronary heart disease (CHD). We estimated associations of maternal and paternal genetically predicted liability for CHD with lifelong risk of APOs. We hypothesized that associations would be found for women, but not their male partners (negative controls). METHODS: We studied up to 83,969 women (and up to 55,568 male partners) from the Norwegian Mother, Father and Child Cohort Study or the Trøndelag Health Study with genotyping data and lifetime history of any APO in their pregnancies (1967-2019) in the Medical Birth Registry of Norway (miscarriage, stillbirth, hypertensive disorders of pregnancy, gestational diabetes, small for gestational age, large for gestational age, and spontaneous preterm birth). Maternal and paternal genetic risk scores (GRS) for CHD were generated using 148 gene variants (p-value < 5 × 10, not in linkage disequilibrium). Associations between GRS for CHD and each APO were determined using logistic regression, adjusting for genomic principal components, in each cohort separately, and combined using fixed effects meta-analysis. RESULTS: One standard deviation higher GRS for CHD in women was related to increased risk of any hypertensive disorders of pregnancy (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.05-1.10), pre-eclampsia (OR 1.08, 95% CI 1.05-1.11), and small for gestational age (OR 1.04, 95% CI 1.01-1.06). Imprecise associations with lower odds of large for gestational age (OR 0.98, 95% CI 0.96-1.00) and higher odds of stillbirth (OR 1.04, 95% CI 0.98-1.11) were suggested. These findings remained consistent after adjusting for number of total pregnancies and the male partners' GRS and restricting analyses to stable couples. Associations for other APOs were close to the null. There was weak evidence of an association of paternal genetically predicted liability for CHD with spontaneous preterm birth in female partners (OR 1.02, 95% CI 0.99-1.05), but not with other APOs. CONCLUSIONS: Hypertensive disorders of pregnancy, small for gestational age, and stillbirth may unmask women with a genetically predicted propensity for CHD. The association of paternal genetically predicted CHD risk with spontaneous preterm birth in female partners needs further exploration.
Impact of occupational heat exposure on selected haematological parameters of bakery workers: A comprehensive study in Ilorin, Kwara State.
Anyiam AF, Arinze-Anyiam OC, Oyindamola AM … +1 more , Obeagu EI
Medicine (Baltimore) · 2024 Jan · PMID 38215138 · Full text
The Occupational Health and Safety Administration has identified indoor industries at risk of experiencing heat-related illnesses due to the presence of heat-generating appliances; these include bakeries, kitchens, laund...
The Occupational Health and Safety Administration has identified indoor industries at risk of experiencing heat-related illnesses due to the presence of heat-generating appliances; these include bakeries, kitchens, laundries, and furnaces. This study aimed to assess the effects of heat stress on haematological parameters and erythrocyte sedimentation rates (ESR) of bakery workers in Ilorin, Kwara State. It was a cross-sectional study, involving laboratory analysis, which lasted for 3 months. A total of 60 Male and female bakery workers aged between 18 and 65 years with 1 or more years of working experience were recruited for this study. Full blood count estimation was carried out using haematological analyzer (Sysmex-2000) and the ESR was carried out using the Westergren method in the Haematology unit, Kwara State University, Malete. Results were analyzed using SPSS version 20. This study found the bakery workers to have low ESR (2.13 ± 1.28) compared to (10.05 ± 4.95) of the control, the RBC was high (6.708 ± 2.08) compared to (5.46 ± 1.12) of the control group. TWBC was also found to be high (7.425 ± 1.74) compared to (6.95 ± 2.49) of the control population. Findings from this study concluded that working under high temperatures negatively affected the health of bakery workers with reports of heat stress-related symptoms and also affected ESR and haematological parameters. A comprehensive and effective national occupational health and safety program that includes relevant policies, decrees, and proper enforcement is needed to ensure the worker's safety and health both in the formal and the fast-growing informal sectors.
Association of adiposity and its changes over time with COVID-19 risk in older adults with overweight/obesity and metabolic syndrome: a longitudinal evaluation in the PREDIMED-Plus cohort.
Shyam S, García-Gavilán JF, Paz-Graniel I … +49 more , Gaforio JJ, Martínez-González MÁ, Corella D, Martínez JA, Alonso-Gómez ÁM, Wärnberg J, Vioque J, Romaguera D, López-Miranda J, Estruch R, Tinahones FJ, Lapetra J, Serra-Majem JL, Bueno-Cavanillas A, Tur JA, Sánchez VM, Pintó X, Matía-Martín P, Vidal J, Vázquez C, Daimiel L, Ros E, Fernandez-Aranda F, Nishi SK, Garcia-Regata O, Toledo E, Asensio EM, Castañer O, Garcia-Rios A, Torres-Collado L, Gómez-Gracia E, Zulet MA, Ruiz NG, Casas R, Cano-Ibáñez N, Tojal-Sierra L, Gómez-Perez AM, Sorlí JV, Cinza-Sanjurjo S, Martín-Peláez S, Peña-Orihuela PJ, Oncina-Canovas A, Perez-Araluce R, Zomeño MD, Chaplin A, Delgado-Rodríguez M, Babio N, Fitó M, Salas-Salvadó J
BMC Med · 2023 Oct · PMID 37833678 · Full text
BACKGROUND: Cross-sectionally, older age and obesity are associated with increased coronavirus disease-2019 (COVID-19) risk. We assessed the longitudinal associations of baseline and changes in adiposity parameters with...
BACKGROUND: Cross-sectionally, older age and obesity are associated with increased coronavirus disease-2019 (COVID-19) risk. We assessed the longitudinal associations of baseline and changes in adiposity parameters with COVID-19 incidence in older adults at high cardiovascular risk. METHODS: This analysis included 6874 men and women (aged 55-75 years) with overweight/obesity and metabolic syndrome in the PREDIMED-Plus lifestyle intervention trial for cardiovascular risk reduction. Body weight, body-mass-index (BMI), waist circumference, waist-to-height ratio (WHtR), and a body shape index (ABSI) were measured at baseline and annual follow-up visits. COVID-19 was ascertained by an independent Event Committee until 31 December 2021. Cox regression models were fitted to evaluate the risk of COVID-19 incidence based on baseline adiposity parameters measured 5-6 years before the pandemic and their changes at the visit prior to censoring. RESULTS: At the time of censoring, 653 incident COVID-19 cases occurred. Higher baseline body weight, BMI, waist circumference, and WHtR were associated with increased COVID-19 risk. During the follow-up, every unit increase in body weight (HR (95%CI): 1.01 (1.00, 1.03)) and BMI (HR: 1.04 (1.003, 1.08)) was associated with increased COVID-19 risk. CONCLUSIONS: In older adults with overweight/obesity, clinically significant weight loss may protect against COVID-19. TRIAL REGISTRATION: This study is registered at the International Standard Randomized Controlled Trial (ISRCT; http://www.isrctn.com/ISRCTN89898870 ).
A pilot study of stereotactic body radiotherapy combined with pelvic radiotherapy and GTVp boost based on multiparameter magnetic resonance image in patients with high-risk prostate cancer.
Wang F, Yao J, Chen J … +2 more , Zeng H, Wang X
Medicine (Baltimore) · 2023 Sep · PMID 37773877 · Full text
This pilot study aimed to explore the preliminary effects and safety of stereotactic body radiotherapy (SBRT) combined with preventive pelvic radiotherapy and primary gross tumor volumes (GTVp) boost in patients with hig...
This pilot study aimed to explore the preliminary effects and safety of stereotactic body radiotherapy (SBRT) combined with preventive pelvic radiotherapy and primary gross tumor volumes (GTVp) boost in patients with high-risk prostate cancer based on multiparameter magnetic resonance image (mpMRI). Tumors were contoured as GTVp based on mpMRI. The prostate and proximal seminal vesicles were considered as the clinical target volume1. The pelvic lymphatic drainage area constituted clinical target volume 2. Radiation doses were 40Gy or 45Gy/5fractions to planning target volume of primary tumor, 37.5Gy/5f to prostate, seminal vesicle, and positive pelvic lymph nodes, and 25Gy/5f to pelvic synchronously. The treatment was delivered 3 times per week. Volumetric modulated arc radiotherapy and intensity-modulated radiotherapy were used to complete SBRT. The genitourinary (GU) and gastrointestinal (GI) toxicities were evaluated. Quality of life data was also captured. A total of 15 patients were enrolled in this study with a median age of 78 (56-87) from 2017 to 2020. All patients received SBRT. At 3 months after radiotherapy, the proportion of PSA < 0.006 ng/mL was 66.7% (10/15). The 2-year biochemical relapse-free survival was 93.3%. The incidence of grade 1 acute GU side effects was 80% (12/15); the incidence of acute grade 1 GI toxicity was 66.7% (10/15); and no grade 2 or higher acute GU and GI side effects was observed. Two patients presented with temporary late grade 2 GI toxicity. International Prostatic System Score increased rapidly after a transient increase at 1 week (P = .001). There were no significant differences in EORTC quality of life scores in all domains except global health status. In this pilot study, it was revealed that SBRT combined with preventive pelvic radiotherapy and GTVp boost based on mpMRI image was effective and well tolerated for patients with high-risk prostate cancer.
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