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Funding
Open Access funding enabled and organized by Projekt DEAL. Application for funding by the German Research Foundation (DFG) is ongoing.
PMC9949689
Availability of data and materials
It is possible to make the full protocol, participant-level dataset and statistical code available on the basis of a reasonable request.Patient and public involvement: There was no public or patient involvement in the design of the protocol.
PMC9949689
Declarations
PMC9949689
Ethics approval and consent to participate
This study was approved by the Ethics Committee of the Medical Faculty of the Ludwig-Maximilians University of Munich (project number 020–798). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with ...
PMC9949689
Consent for publication
All authors gave final approval and agreed to be accountable for all aspects of the work. All authors contributed equally to the project conception, the development of the study design and the writing of the manuscript.
PMC9949689
Competing interests
The authors declare that they have no competing interests.
PMC9949689
References
PMC9949689
1. Introduction
fracture, fractures, Fractures
ADVERSE EVENTS
Background and Objectives: Fractures of the proximal humerus are common, particularly in elderly populations. Anatomical locking plates target stabilization with a multitude of screws spanning into the humeral head. Sound implant placement and screw length determination are key for a successful clinical outcome but are...
PMC10055017
2. Materials and Methods
PMC10055017
2.1. Xin1 System
The Xin1 technology is a generic, X-ray-based tracking and navigation concept, designed to assist implant positioning in various orthopedic applications. The underlying principle is based on feature extraction from projections of cylindrical holes in X-ray images for determining the spatial alignment of the implant and...
PMC10055017
2.2. In Vitro Study
CORTEX
For performance assessment, the Xin1 system was compared to the conventional free-hand method in 12 intact, non-fractured shoulders from 6 formalin-embalmed, full-body specimens (3 male and 3 female), which were pre-used for medical student courses. The experiment was performed at the Department of Anatomy of the Medic...
PMC10055017
2.3. Clinical Handling Test
fracture
Eleven patients undergoing plate fixation osteosynthesis with PHILOS were enrolled in a focused registry at a single medical center (UZ Leuven, Leuven, Belgium). The clinical trial was approved by the local ethical committee and the Federal Agency for Medicines and Health Products Belgium (FAMHP, AFMPS/SE/80M0661) and ...
PMC10055017
3. Results
PMC10055017
3.1. In Vitro Study
perforations
The mean procedure time for the conventional technique was 35:03 ± 6:11 min (mean ± SD), compared to 21:41 ± 4:31 min for the Xin1 technique. This total time reduction of 38% when using Xin1 was statistically significant (The number of fluoroscopic images was on average 30.3 ± 5.7 (mean ± SD) with the conventional tech...
PMC10055017
3.2. Clinical Handling Test
proximal humerus fractures, Fracture
ADVERSE EVENTS
Eleven proximal humerus fractures (eight left, three right shoulders) from eight female and three male patients were operated by five different surgeons. The average age of patients at surgery was 67 years and ranged between 47 and 84 years. Fracture types (AO classification) were: 1× 11A2, 1× 11A3, 3× 11B1, 1× 11B2, 4...
PMC10055017
4. Discussion
fracture, fractures
ADVERSE EVENTS, STILL
The Xin1 implant positioning system, as introduced in [Anatomical locking plates such as the PHILOS system stabilize proximal humerus fractures by spanning a multitude of screws in the often-osteoporotic head segment. It is aimed to anchor the screw tips in the subchondral bone region, close to the cartilage layer. The...
PMC10055017
5. Conclusions
fracture, fractures
This study demonstrated the potential of a newly proposed assistance technology for implant positioning in proximal humerus plating using conventional X-ray projections. In an in vitro setting, the system significantly improved surgical precision, reduced X-ray exposure and shortened surgery time. In a clinical handlin...
PMC10055017
Author Contributions
D.K., S.N.
Conceptualization, M.W.; methodology, M.W. and J.B.; software, M.W.; formal analysis, M.W. and J.B.; investigation, M.W., D.K., S.N. and A.S.; writing—original draft preparation, M.W. and J.B.; writing—review and editing, R.G.R., D.K. and M.B.; visualization, M.W. and J.B.; supervision, M.B. and R.G.R.; project adminis...
PMC10055017
Institutional Review Board Statement
The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Federal Agency for Medicines and Health Products Belgium (FAMHP, AFMPS/SE/80M0661, 6 March 2017).
PMC10055017
Informed Consent Statement
Informed consent was obtained from all subjects involved in the study.
PMC10055017
Data Availability Statement
Not applicable.
PMC10055017
Conflicts of Interest
The authors declare no conflict of interest.
PMC10055017
References
Postmortem experiment. (User interface of the Xin1 software for proximal humeral plating showing the semi-automatically selected humeral head (red circle) and the resulting virtual screw trajectories (green lines). All screw lengths are shown on the left side of the graphical user interface. Left image shows screw leng...
PMC10055017
Introduction
Ravulizumab demonstrated efficacy and an acceptable safety profile versus placebo in the randomized controlled period (RCP) of the phase 3 CHAMPION MG trial in patients with anti-acetylcholine receptor antibody-positive generalized myasthenia gravis. We report an interim analysis of the ongoing open-label extension (OL...
PMC10134722
Methods
Myasthenia Gravis
MYASTHENIA GRAVIS
Following completion of the 26-week RCP, patients could enter the OLE; patients who received ravulizumab in the RCP continued the drug; patients who previously received placebo switched to ravulizumab. Patients receive body-weight-based maintenance dosing of ravulizumab every 8 weeks. Efficacy endpoints up to 60 weeks ...
PMC10134722
Results
EVENTS, MENINGOCOCCAL INFECTIONS
Long-term efficacy and safety in the OLE were analyzed in 161 and 169 patients, respectively. Improvements in all scores were maintained through 60 weeks in patients who received ravulizumab during the RCP; LS mean change from RCP baseline in MG-ADL score was − 4.0 (95% CI: − 4.8, − 3.1; p < 0.0001). Rapid (within 2 we...
PMC10134722
Conclusion
Findings support the sustained efficacy and long-term safety of ravulizumab, administered every 8 weeks, in adults with anti-acetylcholine receptor antibody-positive generalized myasthenia gravis.ClinicalTrials.gov identifier: NCT03920293; EudraCT: 2018-003243-39.
PMC10134722
Supplementary Information
The online version contains supplementary material available at 10.1007/s00415-023-11699-x.
PMC10134722
Keywords
Open Access funding enabled and organized by Projekt DEAL.
PMC10134722
Introduction
anti-AChR
Myasthenia gravis (MG) is a rare, chronic, autoimmune condition that affects the neuromuscular junction [Approximately 85% of patients with gMG have autoantibodies directed against the acetylcholine receptor (AChR) [Traditional therapies for MG include oral cholinesterase inhibitors and long-term immune therapies, such...
PMC10134722
Methods
PMC10134722
Study design and patients
anti-AChR, Myasthenia Gravis
MENINGOCOCCAL INFECTION, DISEASE, MYASTHENIA GRAVIS
The CHAMPION MG study consists of a 26-week, double-blind, randomized, placebo-controlled period (RCP), followed by an ongoing OLE of up to 4 years (Fig. Study design. IV, intravenous. From NEJM Evidence, Vu T, et al, Terminal complement inhibitor ravulizumab in generalized myasthenia gravis, 1, EvidDoa2100066. Copyrig...
PMC10134722
Treatments
During the RCP, patients were randomized 1:1 to intravenous ravulizumab or matching placebo. Ravulizumab dosing during the study was based on patients’ body weight. In the RCP, patients received an initial loading dose of 2400, 2700, or 3000 mg on Day 1, followed by a maintenance dose of 3000, 3300, or 3600 mg starting...
PMC10134722
Study endpoints
weakness, Neuro-QoL Fatigue, fatigue
NEUROLOGIC DISORDERS, ADVERSE EVENTS, DOUBLE VISION, ADVERSE EVENT, EYELID DROOP
Efficacy was evaluated using the following validated measures: the MG-ADL score [The MG-ADL scale is an 8-item survey of patient-reported MG symptom severity with a total score range of 0–24. The QMG is a 13-item clinician assessment of strength with a total score range of 0–39. The MG-QOL15r is a 15-item questionnaire...
PMC10134722
Statistical analysis
REGRESSION, EVENTS, EVENT
Sample-size calculations for the RCP have been described previously [A mixed model for repeated measures (MMRM) was used to analyze changes from baseline, with the assumption that missing data were missing at random. Missing data were not imputed. Data are shown as least-squares (LS) mean change from baseline with 95% ...
PMC10134722
Discussion
anti-AChR, fatigue
EVENT
The interim results of this long-term extension of the CHAMPION MG study demonstrate that the benefits of ravulizumab are sustained through 60 weeks in patients with anti-AChR antibody-positive gMG. In patients who received ravulizumab during the RCP, improvements in activities of daily living, muscle strength, fatigue...
PMC10134722
Supplementary Information
Below is the link to the electronic supplementary material.Supplementary file1 (PDF 236 KB)
PMC10134722
Acknowledgements
RARE DISEASE
We thank the patients who took part in the study and their families, as well as the CHAMPION MG principal investigators, sub-investigators, and study coordinators. We also thank Sivani Paskaradevan (Alexion, AstraZeneca Rare Disease) for critical review of the manuscript; Kathleen Beasley (Alexion, AstraZeneca Rare Dis...
PMC10134722
Authors’ contribution
RA
AM, DA, TV, RM, MK, JFH Jr contributed to study data acquisition. GF and LG contributed to study design and/or execution. RA provided statistical analyses. All authors contributed to data interpretation and to the critical revision of the manuscript.
PMC10134722
Funding
RARE DISEASE
Open Access funding enabled and organized by Projekt DEAL. This study and all costs associated with development of this publication were funded by Alexion, AstraZeneca Rare Disease.
PMC10134722
Data availability
RARE DISEASE
Alexion, AstraZeneca Rare Disease will consider requests for disclosure of clinical study participant-level data provided that participant privacy is assured through methods like data de-identification, pseudonymization, or anonymization (as required by applicable law), and if such disclosure was included in the releva...
PMC10134722
Declarations
PMC10134722
Conflict of interest
Stroke, Muscular Dystrophy, Arthritis, Musculoskeletal, Myasthenia Gravis, Neurological Disorders
RARE DISEASE, MUSCULAR DYSTROPHY, STROKE, ARTHRITIS, SKIN DISEASES, MYASTHENIA GRAVIS, DISEASE, NEUROLOGICAL DISORDERS
Andreas Meisel has received speaker honoraria, consulting fees, or financial research support (paid to institution) from Alexion, AstraZeneca Rare Disease, Argenx, Axunio, Grifols, Hormosan, Janssen, Merck, Octapharma, and UCB. He serves as chairman of the medical advisory board of the German Myasthenia Gravis Society....
PMC10134722
Ethics approval
The trial protocol was approved by the independent ethics committee or institutional review board at each participating institution. The trial was conducted in accordance with the provisions of the World Medical Association Declaration of Helsinki, the International Conference on Harmonisation E6 Guidelines for Good Cl...
PMC10134722
Consent to participate
Informed consent was obtained from all individual participants included in the study.
PMC10134722
References
PMC10134722
Background
endoloops
Polymeric clips are easy to apply, but whether they present more advantages than endoloops is unclear. This single-center, open-label, randomized controlled trial study was conducted to compare the advantages of using a polymeric clip versus an endoloop in terms of the surgical time.
PMC10311724
Methods
perforation, acute appendicitis
SECONDARY, COMPLICATIONS, ACUTE APPENDICITIS
Adult patients who were diagnosed with acute appendicitis without perforation on preoperative abdominal computed tomography and underwent laparoscopic appendectomy between August 6, 2019, and December 26, 2022, were included. Single-blinded randomization was performed in a 1:1 ratio between the endoloop and polymeric c...
PMC10311724
Results
The completed trial included 104 and 103 patients in the polymeric clip and endoloop groups, respectively. The median surgery time with a polymeric clip was shorter than that with an endoloop; however, the difference was not significant (18 min 56 s vs 19 min 49 s,
PMC10311724
Keywords
PMC10311724
Background
COMPLICATED APPENDICITIS
When performing a laparoscopic appendectomy, an endoloop, an endostapler, or a polymeric clip can be used to ligate and resect the appendiceal stump [During the process of ligating the appendiceal base, an endoloop is relatively difficult to handle, whereas a polymeric clip has the advantage of being easy to apply [The...
PMC10311724
Methods
This was a single-center, open-label, RCT. This study was approved by the Institutional Review Board (IRB) of the Catholic University of Korea and performed in accordance with the guidelines and regulations of the IRB. Informed consent was obtained from all the included patients. The study was conducted after registrat...
PMC10311724
Patients
periappendiceal abscess, perforation, acute appendicitis
INFLAMMATION, APPENDICITIS, ACUTE APPENDICITIS
Nonpregnant adult patients aged 19–70 years who were diagnosed with acute appendicitis without perforation on preoperative abdominal computed tomography (CT) were eligible. Consecutive patients who underwent surgery between August 6, 2019, and December 26, 2022, in Uijeongbu St. Mary’s Hospital were included, and the f...
PMC10311724
Sample size calculation
The sample size calculation was based on the results of a previous study that compared the use of polymeric clips with that of endoloops [
PMC10311724
Randomization and blinding
Using SAS ver 9.4 (SAS Institute Inc., NC, Cary, USA) for Microsoft Windows, random assignment numbers were generated, and a random assignment envelope was created. Before a polymeric clip or an endoloop was applied, the envelope was opened, and the patients were assigned to either the intervention (polymeric clip) or ...
PMC10311724
Primary and secondary endpoints
SECONDARY, COMPLICATIONS
The primary endpoint was the difference in surgical time between the polymeric clip and endoloop groups. The secondary endpoints were differences in the time from the introduction of each instrument to appendiceal base cutting, operation and anesthesia fees, as well as the frequency of complications.
PMC10311724
Procedure
COMPLICATIONS, POSTOPERATIVE COMPLICATIONS
The amount of time from the initiation of skin incision to the completion of skin suturing was defined as the total surgical time. To minimize bias in surgical timepoints, the surgical time was subdivided into skin incision, mesoappendiceal dissection (from start to completion time), polymeric clip or endoloop applicat...
PMC10311724
Statistical analysis
Continuous variables are presented as mean and standard deviation in cases of normal distribution, as well as median and interquartile range (IQR) values in cases of non-normal distribution. Categorical variables are presented as frequencies and percentages. To evaluate the difference between the two groups in continuo...
PMC10311724
Discussion
intra-abdominal, inflammation, 33,260
INFLAMMATION, COMPLICATED APPENDICITIS, COMPLICATIONS, POSTOPERATIVE COMPLICATIONS
In this study, we were unable to verify the superiority of the polymeric clip over the endoloop in laparoscopic appendectomy for uncomplicated appendicitis in terms of shortening the operative time. However, it was confirmed that the application time of the polymeric clip was shorter than that of the endoloop, and no d...
PMC10311724
Conclusion
INFLAMMATION, COMPLICATED APPENDICITIS
The use of a polymeric clip is easier and more comfortable than the use of an endoloop in patients with uncomplicated appendicitis in the absence of appendiceal base inflammation. Even if the application of the polymeric clip fails, it can be compensated for using an endoloop or endostapler. Therefore, we suggest consi...
PMC10311724
Acknowledgements
We express our gratitude to GEMSKOREA for providing no-fault compensation for the clinical trials and volunteer insurance.
PMC10311724
Author contributions
KYL and JIL designed the study. KYL collected the data. KYL, YYP, and JIL performed the statistical analysis. KYL, YYP, JIL, and STO interpreted the results of the analysis and prepared the manuscript. All authors contributed extensively to the work presented.
PMC10311724
Funding
No funding was received for this study.
PMC10311724
Declarations
PMC10311724
Competing interests
The authors declare no competing interests.
PMC10311724
Ethics approval and consent to participate
This study was approved by the Institutional Review Board (IRB) of the Catholic University of Korea and performed in accordance with the guidelines and regulations of the IRB. Informed consent was obtained from all the included patients.
PMC10311724
Consent for publication
Not applicable.
PMC10311724
References
PMC10311724
ABSTRACT
coronavirus disease 2019
CHRONIC PANCREATITIS, CORONAVIRUS DISEASE 2019
The authors declare no conflict of interest.Although several antiviral agents have become available for coronavirus disease 2019 (COVID-19) treatment, oral drugs are still limited. Camostat mesylate, an orally bioavailable serine protease inhibitor, has been used to treat chronic pancreatitis in South Korea, and it has...
PMC9872678
KEYWORDS
PMC9872678
INTRODUCTION
deaths, coronavirus disease 2019
CORONAVIRUS DISEASE 2019
Since its emergence in December 2019, coronavirus disease 2019 (COVID-19) has spread worldwide. As of 9 February 2022, the cumulative number of COVID-19 cases was over 399 million, including more than 5.8 million deaths (Camostat mesylate (DWJ1248, Foistar) is an orally bioavailable synthetic serine protease inhibitor ...
PMC9872678
RESULTS
obesity, sore throat, cardiovascular disease, TEAEs, cough, migraine, diabetes
OBESITY, SORE THROAT, VIRUS, CARDIOVASCULAR DISEASE, ADVERSE EVENTS, ADVERSE DRUG REACTIONS, EVENT, CHRONIC RESPIRATORY DISEASE, MAY, PLAQUE, REGRESSION, HIGH BLOOD PRESSURE, MIGRAINE, DIABETES
A total of 365 patients from 21 institutions in South Korea were assessed between February and May 2021, and 342 patients were enrolled in the study (Enrollment and randomization.Of the 342 randomized patients, a total of 323 patients (161 in the camostat group and 162 in the placebo group), excluding 15 who did not re...
PMC9872678
DISCUSSION
ADVERSE REACTIONS, DISEASE PROGRESSION, POSITIVE, ADVERSE EVENTS, CHRONIC PANCREATITIS, SECONDARY, ADVERSE DRUG REACTIONS
In this phase 2 clinical trial, we assessed the clinical benefit and safety of camostat mesylate in the treatment of mild to moderate COVID-19. No primary or secondary endpoint was statistically significant, according to the A recent randomized, placebo-controlled clinical trial showed that camostat mesylate was not ef...
PMC9872678
MATERIALS AND METHODS
PMC9872678
Study design.
MAY, INFECTIOUS, CORONAVIRUS
This study was a double-blind, randomized, placebo-controlled, multicenter, phase 2 clinical trial in patients with mild to moderate COVID-19. Enrollment of participants began in February 2021 and ended in May 2021. There were 21 study sites, all in South Korea. This clinical trial was planned and recruited COVID-19 pa...
PMC9872678
Patients.
pneumonia, (RT-PCR)-confirmed SARS-CoV-2 infection
PNEUMONIA
Participants who gave informed consent were assessed for eligibility. The inclusion criteria were age 19 years or older, real-time reverse transcription-PCR (RT-PCR)-confirmed SARS-CoV-2 infection, mild to moderate COVID-19, and one or more COVID-19 symptoms. Patients with mild COVID-19 had symptoms of COVID-19 but did...
PMC9872678
Outcome measures.
obesity, cardiovascular disease, diabetes
OBESITY, VIRUS, CARDIOVASCULAR DISEASE, DISEASE, CHRONIC RESPIRATORY DISEASE, SECONDARY, REGRESSION, HIGH BLOOD PRESSURE, DIABETES
The primary endpoint was time (days) to clinical improvement of subjective symptoms within 14 days. A four-point scale (0, none; 1, mild; 2, moderate; and 3, severe) was utilized for subjective symptom assessment (The secondary endpoints were time (days) to clinical improvement of subjective symptoms within 28 days, ch...
PMC9872678
Randomization.
obesity, cardiovascular disease, diabetes
OBESITY, CARDIOVASCULAR DISEASE, CHRONIC RESPIRATORY DISEASE, HYPERTENSION, DIABETES
A stratified block randomization with age (<60 years versus ≥60 years) and the presence of risk factors (any versus none of cardiovascular disease, chronic respiratory disease, hypertension, diabetes, obesity, or smoking) as the stratification factors was used. Subject randomization codes were generated by an independe...
PMC9872678
Statistical analysis.
REGRESSION, EVENTS, SECONDARY
A total of 189 events across both groups was required, which would provide ≥89% power and a two-sided significance level of 5% if the hazard ratio (HR) comparing the camostat mesylate group to the placebo group was ≥1.6. Assuming a 70% probability of events within 28 days across both groups and a dropout rate of 20%, a...
PMC9872678
ACKNOWLEDGMENTS
INFECTIOUS DISEASES
We thank the South Korean government, including the Ministry of Food and Drug Safety, Ministry of Health and Welfare, Center for Infectious Diseases Research of KNIH, Ministry of Science and ICT, and Pan-Government Support Committee for COVID-19 Treatment and Vaccine Development for their support to progress the clinic...
PMC9872678
REFERENCES
PMC9872678
Supplementary Information
The use of virtual reality for simulations plays an important role in the initial training for robotic surgery. This randomized controlled trial aimed to investigate the impact of educational video on the performance of robotic simulation. Participants were randomized into the intervention (video) group that received a...
PMC10374749
Keywords
Open access funding provided by Okayama University.
PMC10374749
Introduction
An increasing number of procedures are being performed as robotic surgery in the fields of gastroenterology, urology, and gynecology [This study aimed to investigate the impact of educational video on performance of robotic simulation training, called the
PMC10374749
Methods
PMC10374749
Trial design
We performed a randomized controlled trial with two parallel training groups; one group received an educational video and robotic simulation training (video group), while the other received simulation training alone (control group). The study protocol was approved by the institutional ethics committee of (No: 2108–017)...
PMC10374749
Participants
MAY
Robotic surgery trainees in our department were recruited between September 2021 and May 2022. The participants included experienced surgeons and surgical trainees who had no experience with robotic simulation training.
PMC10374749
Robotic simulation training
This study was performed using a
PMC10374749
Intervention
Educational videos on the tips and tricks of each drill were created by the principal investigator (KT) (Supplementary Table 1). The participants in both groups received robotic simulation training. However, the video group received an additional educational video training for a few hours prior to starting the robotic ...
PMC10374749
Primary and secondary endpoints
SECONDARY
Assessment outcomes for each drill included overall, efficiency, and penalty scores. Efficiency scores were calculated by evaluating the time to completion, economy of motion, or master workspace range. Penalty scores consisted of excessive force use, instruments out of view, drops, instrument and cone collisions, inco...
PMC10374749
Sample size and randomization
The sample size was calculated based on the primary end point. Assuming a difference in the mean overall scores between the groups of 15 with a standard deviation of 10 according to our unpublished data, this study required a total sample size of 20 participants (10 participants for each group) to achieve a power of 90...
PMC10374749
Statistical analysis
Statistical analysis and sample size calculation were performed using the JMP 11.2.0 software (SAS Institute, Cary, NC, USA). First, the overall, efficiency, and penalty scores of all drills in cycles 1–10 were compared between the video and control groups. Subsequently, the overall, efficiency, and penalty scores in e...
PMC10374749
Results
PMC10374749
Discussion
This is the first randomized controlled trial to investigate the impact of educational videos on the performance of robotic simulation training. We found that educational video training improved the performance in robotic simulation. Moreover, CUSUM analysis confirmed the positive effect of the educational video on sho...
PMC10374749
Author contributions
K.T. wrote the main manuscript. K.T., N.H., and J.K. prepared figures. All authors contributed to this study, and reviewed the manuscript.
PMC10374749
Funding
Open access funding provided by Okayama University. Financial support was received from Japan Society for the Promotion of Science (grant number 21K16447) and the Okayama Medical Foundation.
PMC10374749
Declarations
PMC10374749
Conflict of interest
Tomokazu
NOMA
Kosei Takagi, Nanako Hata, Jiro Kimura, Satoru Kikuchi, Kazuhiro Noma, Kazuya Yasui, Tomokazu Fuji, Ryuichi Yoshida, Yuzo Umeda, Takahito Yagi, and Toshiyoshi Fujiwara have no conflicts of interest or financial ties to disclose.
PMC10374749
References
PMC10374749
Purpose
OHCA, cardiac arrest, comatose
CARDIAC ARREST, COMATOSE
This study aimed to assess the effect of different blood pressure levels on global cerebral metabolism in comatose patients resuscitated from out-of-hospital cardiac arrest (OHCA).
PMC9951410