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Background Recurrent respiratory papillomatosis (RRP) is a human papillomavirus (HPV)-driven disorder that causes substantial morbidity and can lead to fatal distal airway obstruction and post-obstructive pneumonias. Patients require frequent surgical debridement of disease, and no approved systemic adjuvant therapies exist. Methods A phase II study was conducted to investigate the clinical activity and safety of programmed death-ligand 1 (PD-L1) blockade with avelumab in patients with RRP. Results Twelve patients were treated. All patients with laryngeal RRP displayed improvement in disease burden, and 5 of 9 (56%) displayed partial responses. None of 4 patients with pulmonary RRP displayed a response. Using each patient’s surgical history as their own control, patients required fewer surgical interventions after avelumab treatment ( p = 0.008). A subset of partial responders developed HPV-specific reactivity in papilloma-infiltrating T-cells that correlated with reduced HPV viral load and an increased Tissue Inflammation Signature. Conclusions Avelumab demonstrated safety and clinical activity in patients with laryngeal RRP. Further study of immune checkpoint blockade for RRP, possibly with longer treatment duration or in combination with other immunotherapies aimed at activating antiviral immunity, is warranted. Trial registration NCT, number NCT02859454 , registered August 9, 2016. Electronic supplementary material The online version of this article (10.1186/s40425-019-0603-3) contains supplementary material, which is available to authorized users.

BackgroundCurrently, many clinical trials have shown that inulin-type fructans (ITF) supplementation is associated with glycemic control; nevertheless, the results are inconclusive. The aim of this meta-analysis of randomized controlled trials was to assess the effects of ITF supplementation on glycemic control.MethodsPubMed, EMBASE and the Cochrane Library were searched for eligible articles up to March 6, 2019. A random-effects model was used to analyze the pooled results, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was applied to assess the quality of evidence. The dose–response model was used to recommend the daily dose and duration for ITF supplementation.ResultsThirty-three trials involving 1346 participants were included. Overall, ITF supplementation could significantly reduce concentrations of fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), fasting insulin (FINS) and homeostasis model assessment-insulin resistance (HOMA-IR). In the prediabetes and type 2 diabetes (T2DM) population, a more significant reduction in FBG [weighted mean difference (WMD): − 0.60 mmol/l; 95% CI − 0.71, − 0.48 mmol/l; high rate], HbA1c (WMD: − 0.58%; 95% CI − 0.83, − 0.32%; high rate), FINS (WMD: − 1.75 µU/ml; 95% CI − 2.87, − 0.63 µU/ml; low rate), and HOMA-IR (WMD: − 0.69; 95% CI − 1.10, − 0.28; low rate) were observed, and ITF supplementation with a daily dose of 10 g for a duration of 6 weeks and longer was recommended. Moreover, subgroup analyses suggested that the effects of glycemic control were significantly influenced by the sex of the subjects and the type and the method of intake of ITF.ConclusionsOur analyses confirmed that these four main glycemic indicators were significantly reduced by ITF supplementation, particularly in the prediabetes and T2DM population. Evidence supports that reasonable administration of ITF supplementation may have potential clinical value as an adjuvant therapy for prediabetes and T2DM management.Trial registration The trial was registered at PROSPERO as CRD42018115875 on November 23, 2018.

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Objective: The purpose of this study was to evaluate the efficacy of ultrasonography-guided percutaneous A1 pulley release with the needle knife for trigger finger. Methods: The prospective study included 21 patients (21 fingers) who underwent blind release with the needle knife and 20 patients (20 fingers) who underwent ultrasonography-guided release with the needle knife. The thickness and width of A1 pulley, clinical grade before and after release, complications, and operation time were compared between the groups. Results: The results showed that the ultrasonography-guided group had significantly better grade postoperatively and reached to 100% complete release in one time compared to the blind group ( p < 0.05). Moreover, no any complications had been happened in the ultrasonography-guided group. A relatively longer operation time of the ultrasonography-guided group was observed compared to the time of the blind group. Conclusions: The needle knife is a very good tool for release of triggering fingers. Ultrasound provides a direct and precise visualization of the thickness, width and location of A1 pulley lesion. The combined use of ultrasound and the needle knife can achieve the best result for trigger finger. Moreover, the combination changes the traditional opinion and operator-dependent mode that were once widely adopted in the hospital of Chinese Medicine.