Articles: treatment.
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The use of inhaled antibiotics for treating pneumonia in invasively ventilated patients offers a direct approach, allowing for high local concentrations of the drug in the lower respiratory tract while simultaneously reducing systemic toxicity. However, the real efficacy and safety of nebulized antibiotics remain unclear. The aim of the present is to assess among critically adult patients with pneumonia and invasive ventilation, whether receiving adjuvant inhaled antibiotics improves the rate of microbiological eradication. ⋯ In conclusion, compared to the sole intravenous therapy, the use of adjuvant inhaled antibiotics for treatment of pneumonia in invasively ventilated critically ill patients was associated with a greater incidence of microbiological eradication (low GRADE and high risk of publication bias), but not with clinical recovery and survival.
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As a common clinical disease, lumbar spinal stenosis (LSS) is currently the preferred surgical treatment, and there are various opinions. We conducted a study on whether fusion should be performed simultaneously with decompression for lumbar spinal stenosis caused by low-grade degenerative lumbar spondylolisthesis and compared the efficacy and safety of the two surgeries. ⋯ In this article, decompression alone has shorter surgical and hospitalization time, and less intraoperative bleeding compared to decompression plus fusion. And there was no significant difference in pain score and disability index between the two surgeries during follow-up. Therefore, we can say that for patients with lumbar spinal stenosis caused by low-grade lumbar spondylolisthesis, decompression alone is not inferior to decompression plus fusion.
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Biologics approved by the US Food and Drug Administration (FDA) receive 12 years of guaranteed protection from biosimilar competition compared with 5 years of protection from generic competition for new small-molecule drugs. Under the 2022 Inflation Reduction Act, biologics are exempt from selection for Medicare price negotiation for 11 years compared with 7 years for small-molecule drugs. Congress codified these differing legal protections on the premise that biologics require more time and resources to develop and have weaker patent protection, necessitating additional protections for manufacturers to recoup their development costs and generate adequate returns on investment. ⋯ There is little evidence to support biologics having longer periods of market exclusivity or protection from negotiation. As a result of differential treatment, US law appears to overly reward the development of biologics relative to small-molecule drugs.
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Transvenous coil embolization (TVCE) is a common and effective treatment for cavernous sinus dural arteriovenous fistulas (CSDAVFs). However, some patients may experience residual fistulas or worsening visual symptoms after the procedure. This study aimed to compare the effectiveness of transvenous coil and Onyx embolization (TVCOE) with TVCE in treating CSDAVFs. ⋯ The use of a small volume of Onyx as an adjunctive embolic material in TVCOE resulted in reduced coil use and improved immediate CO. This technique is viable for patients with PVR. Aside from the transient hemodynamic instability, periprocedural complications and follow-up angiographic outcomes did not show significant differences between the two groups.