Objective-Promising results were obtained in an earlier pilot study of a preventive intervention based on the principles of interpersonal psychotherapy to reduce the risk of postpartum major depressive disorder. In this study, the authors examined whether the intervention would reduce the risk of postpartum major depressive disorder in a larger sample of pregnant women.Method-Ninety-nine pregnant women on public assistance who were assessed to be at risk for postpartum depression were randomly assigned to receive standard antenatal care plus the intervention or standard antenatal care only. Diagnostic interviews were administered 3 months after delivery to assess for major depressive disorder.Results-Within 3 months after delivery, eight (20%) of the women in the standard antenatal care condition had developed postpartum major depressive disorder, compared with two (4%) in the intervention condition.Conclusions-This study provides further evidence for the efficacy of a brief intervention to reduce the occurrence of major depressive disorder among financially disadvantaged women during a postpartum period of 3 months.Postpartum major depressive disorder is a common illness with a high degree of morbidity, especially among low-income women (1). Several experts on this disorder have advocated for preventive interventions beginning in pregnancy (2, 3). In an earlier pilot study (4), we found that an intervention based primarily on the principles of interpersonal therapy appeared to be successful in preventing the occurrence of postpartum depression within 3 months after delivery among pregnant women on public assistance with at least one risk factor for postpartum depression. To date, ours is the only study on interventions aiming to reduce postpartum depression in at-risk pregnant women that has reported empirical support for an intervention. The lack of effect in other intervention studies is difficult to interpret because of methodological limitations, such as high attrition rate, lack of a standardized intervention, and an insufficiently high risk of postpartum depression among study subjects (5).Address correspondence to Dr. Zlotnick, Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906; caron_zlotnick@brown.edu. HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptThe primary aim of this study was to examine whether participation in a program based primarily on interpersonal therapy could reduce the risk of postpartum depression during the first 3 months after delivery in a larger sample of pregnant women who were on public assistance and were at risk for postpartum depression. The ROSE Program (Reach Out, Stand strong, Essentials for new mothers) was designed to help mothers-to-be in an ethnically diverse population improve their close interpersonal relationships and change their expectations about them, build and use their social support networks, and master their role transition to motherhood. An emphasis on social relationships is especially relevant for l...
Key Points Question What is the association of uric acid–lowering therapy with the development of new onset chronic kidney disease (CKD)? Findings In this cohort study of 269 651 patients with estimated glomerular filtration rate of at least 60 mL/min/1.73 m 2 and no albuminuria, there was no beneficial association between initiating uric acid–lowering therapy and the incidence of CKD. Uric acid lowering–therapy was associated with a significantly higher risk of new-onset CKD. Meaning These findings do not support the initiation of uric acid–lowering therapy as a means to prevent the development of CKD.
In summary, we describe three children with ADHD who manifested hallucinations as a side effect of MPH at low therapeutic doses. These children were seen in our clinic during a 5-year period during which~2,000 children with ADHD were diagnosed and treated. The prevalence of hallucinations in conjunction with MPH is rare, probably Ͻ0.2%. 1 However, the comorbidities in our patients may have rendered them more vulnerable to hallucinatory phenomena. Because MPH is a widely used, well-studied, and safe pharmacologic agent, 1 physicians who prescribe MPH should be aware of even rare adverse manifestations occurring at therapeutic doses. References1. Wilens T, Pelham W, Stein M, et al. ADHD treatment with once-daily OROS methylphenidate: interim 12-month results from a long-term open-label study. J Am Acad Child Adolesc Psychiatry 2003;42:424 -433. 2. Young JG. Methylphenidate-induced hallucinosis: case histories and possible mechanisms of action. J Dev Behav Pediatr 1981;2:35-38. 3. Klein-Schwartz W, McGrath J. Poison centers' experience with methylphenidate abuse in pre-teens and adolescents. J Am Acad Child Adolesc Psychiatry 2003;42:288 -294. 4. Martinez D, Slifstein M, Broft A, et al. Imaging human mesolimbic dopamine transmission with positron emission tomography. Part II: amphetamine-induced dopamine release in the functional subdivisions of the striatum. J Cereb Blood Flow Metab 2003;23:285-300. 5. Hall W, Hando J, Darke S, Ross J. Psychological morbidity and route of administration among amphetamine users in Sydney, Australia. Addiction 1996;91:81-87. 6. McGowan S, Lawrence AD, Sales T, Quested D, Grasby P. Presynaptic dopaminergic dysfunction in schizophrenia: a positron emission tomographic [18F]fluorodopa study.
Background: Over the past decade, immune checkpoint inhibitors (ICIs) have increasingly become the standard of care for various advanced malignancies, including metastatic clear cell renal cell carcinoma (mccRCC). Most ICIs currently used in clinical practice inhibit the interaction between the programmed cell death protein-1 (PD-1) and programmed death ligand-1 (PD-L1) complex. A deeper understanding of this interaction and PD-L1 expression in tumors has led to more effective therapies in the treatment of advanced cancers, but the debate regarding the utility of PD-L1 as a biomarker continues. Objective: We aimed to systematically evaluate the role of PD-L1 in mccRCC in terms of expression and treatment implications. Methods: Following PRISMA guidelines, we performed a systematic literature search using PubMed and Embase through August 31, 2020. Titles and abstracts were screened to identify articles for full-text review. A hand search was also performed using Google Scholar and the bibliography to relevant studies. Results: A total of 26 articles were identified, and relevant data were extracted and organized. The available information regarding PD-L1 expression in mccRCC from both prospective clinical trials and retrospective studies were summarized. We discussed the utility of PD-L1 as a predictive and prognostic biomarker in mccRCC, its association with other potential biomarkers, and the pattern and level of expression of PD-L1 in primary versus metastatic tumors. Conclusions: Although significant progress has been made, much more remains to be learned regarding the differences between PD-L1+ and PD-L1- ccRCC tumors, in terms of both the underlying biology and clinical responses to immunotherapy and other agents.
344 Background: IROC is an expanding multi-institution collaborative database which includes socioeconomic, genomic, pathologic, clinical and laboratory data in metastatic RCC patients (pts), primarily in the modern setting. Elevated baseline NLR is now an established poor prognostic factor in renal cell carcinoma (RCC) but currently has limited practical use. We hypothesized that an increase in NLR of 3 or more (NLR Failure) at 2 months on therapy could be a predictor of eventual treatment failure and shorter overall survival and thus augment the utility of this marker. Methods: Patients with complete data on NLR at time = 0 and +2 months of therapy were analyzed. Information on comorbidities, previous therapy, demographics were collected for adjusted analysis. NLR failure was defined as an increase of 3 or more compared to baseline NLR. Cox proportional hazard models were used to analyze the risk of progression and death with NLR failure at 2 months (+/- 2 weeks). Kaplan Meier graphs were constructed to trace survival functions for PFS and OS by NLR. Results: Among 165 pts; 121 were eligible (Table). NLR failure at 2 months was associated with a highly statistically significant increase in the risk of death in < 1 year (HR 6.82, 95% CI [3.16-14.70], p<0.001). In a model adjusted for NLR change, the value of baseline NLR to predict OS <1 year was non-significant (HR 1.02, p = 0.65). Similarly, NLR failure increased the risk of treatment failure in less than 6 months (HR 4.83 95% CI [ 2.29-10 .19], p<0.001), while baseline NLR did not predict it (HR 1.03, p = 0.34). These findings were unaffected by immunotherapy vs TKI therapy. NLR failure at 2 months had a 78% (11/14) positive predictive value for survival <1 year and 86% (12/14) [p=.0001] for treatment failure in 6 months. Conclusions: In this multi-institutional cohort of RCC pts; an increase in NLR of 3 or more at 2 months following therapy start predicts for an increasing risk of death and impending treatment failure with a high PPV. The prognostic value of baseline NLR is non-significant when adjusting for NLR change. NLR failure should be validated in prospective studies and could have clinical utility in management of RCC pts. [Table: see text]
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