Sample records for advanced clinical usefulness

  1. The Use of Computers for Clinical Care: A Case Series of Advanced U.S. Sites (United States)

    Doolan, David F.; Bates, David W.; James, Brent C.


    Objective: To describe advanced clinical information systems in the context in which they have been implemented and are being used. Design: Case series of five U.S. hospitals, including inpatient, ambulatory and emergency units. Descriptive study with data collected from interviews, observations, and document analysis. Measurements: The use of computerized results, notes, orders, and event monitors and the type of decision support; data capture mechanisms and data form; impact on clinician satisfaction and clinical processes and outcomes; and the organizational factors associated with successful implementation. Results: All sites have implemented a wide range of clinical information systems with extensive decision support. The systems had been well accepted by clinicians and have improved clinical processes. Successful implementation required leadership and long-term commitment, a focus on improving clinical processes, and gaining clinician involvement and maintaining productivity. Conclusion: Despite differences in approach there are many similarities between sites in the clinical information systems in use and the factors important to successful implementation. The experience of these sites may provide a valuable guide for others who are yet to start, or are just beginning, the implementation of clinical information systems. PMID:12509360

  2. Advancing clinical decision support using lessons from outside of healthcare: an interdisciplinary systematic review

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    Wu Helen W


    Full Text Available Abstract Background Greater use of computerized decision support (DS systems could address continuing safety and quality problems in healthcare, but the healthcare field has struggled to implement DS technology. This study surveys DS experience across multiple non-healthcare disciplines for new insights that are generalizable to healthcare provider decisions. In particular, it sought design principles and lessons learned from the other disciplines that could inform efforts to accelerate the adoption of clinical decision support (CDS. Methods Our systematic review drew broadly from non-healthcare databases in the basic sciences, social sciences, humanities, engineering, business, and defense: PsychINFO, BusinessSource Premier, Social Sciences Abstracts, Web of Science, and Defense Technical Information Center. Because our interest was in DS that could apply to clinical decisions, we selected articles that (1 provided a review, overview, discussion of lessons learned, or an evaluation of design or implementation aspects of DS within a non-healthcare discipline and (2 involved an element of human judgment at the individual level, as opposed to decisions that can be fully automated or that are made at the organizational level. Results Clinical decisions share some similarities with decisions made by military commanders, business managers, and other leaders: they involve assessing new situations and choosing courses of action with major consequences, under time pressure, and with incomplete information. We identified seven high-level DS system design features from the non-healthcare literature that could be applied to CDS: providing broad, system-level perspectives; customizing interfaces to specific users and roles; making the DS reasoning transparent; presenting data effectively; generating multiple scenarios covering disparate outcomes (e.g., effective; effective with side effects; ineffective; allowing for contingent adaptations; and facilitating

  3. Next-generation sequencing in patients with advanced cancer: are we ready for widespread clinical use? A single institute's experience. (United States)

    Grenader, Tal; Tauber, Rachel; Shavit, Linda


    The next-generation sequencing (NGS) assay targeting cancer-relevant genes has been adopted widely for use in patients with advanced cancer. The primary aim of this study was to assess the clinical utility of commercially available NGS. We retrospectively collected demographic and clinicopathologic data, recommended therapy, and clinical outcomes of 30 patients with a variety of advanced solid tumors referred to Foundation Medicine NGS. The initial pathologic examination was performed at the pathology department of the referring hospital. The comprehensive clinical NSG assay was performed on paraffin-embedded tumor samples using the Clinical Laboratory Improvement Amendments-certified FoundationOne platform. The median number of genomic alterations was 3 (0-19). The median number of therapies with potential benefit was 2 (0-8). In 12 cases, a comprehensive clinical NGS assay did not indicate any therapy with potential benefit according to the genomic profile. Ten of the 30 patients received treatments recommended by genomic profile results. In six of the 10 cases, disease progressed within 2 months and four patients died within 3 months of treatment initiation. Three of the 30 patients benefited from a comprehensive clinical NGS assay and the subsequent recommended therapy. The median PFS was 12 weeks (95% confidence interval 10-57) in patients treated with molecularly targeted agents chosen on the basis of tumor genomic profiling versus 48 weeks (95% confidence interval 8-38) in the control group treated with physician choice therapy (P=0.12). Our study suggests that NGS can detect additional treatment targets in individual patients, but prospective medical research and appropriate clinical guidelines for proper clinical use are vital. PMID:27384593

  4. Advances in inducing adaptive immunity using cell-based cancer vaccines: Clinical applications in pancreatic cancer. (United States)

    Kajihara, Mikio; Takakura, Kazuki; Kanai, Tomoya; Ito, Zensho; Matsumoto, Yoshihiro; Shimodaira, Shigetaka; Okamoto, Masato; Ohkusa, Toshifumi; Koido, Shigeo


    The incidence of pancreatic ductal adenocarcinoma (PDA) is on the rise, and the prognosis is extremely poor because PDA is highly aggressive and notoriously difficult to treat. Although gemcitabine- or 5-fluorouracil-based chemotherapy is typically offered as a standard of care, most patients do not survive longer than 1 year. Therefore, the development of alternative therapeutic approaches for patients with PDA is imperative. As PDA cells express numerous tumor-associated antigens that are suitable vaccine targets, one promising treatment approach is cancer vaccines. During the last few decades, cell-based cancer vaccines have offered encouraging results in preclinical studies. Cell-based cancer vaccines are mainly generated by presenting whole tumor cells or dendritic cells to cells of the immune system. In particular, several clinical trials have explored cell-based cancer vaccines as a promising therapeutic approach for patients with PDA. Moreover, chemotherapy and cancer vaccines can synergize to result in increased efficacies in patients with PDA. In this review, we will discuss both the effect of cell-based cancer vaccines and advances in terms of future strategies of cancer vaccines for the treatment of PDA patients. PMID:27182156

  5. Advances in the Use of Stem Cells in Veterinary Medicine: From Basic Research to Clinical Practice (United States)


    Today, several veterinary diseases may be treated with the administration of stem cells. This is possible because these cells present a high therapeutic potential and may be injected as autologous or allogenic, freshly isolated, or previously cultured. The literature supports that the process is safe and brings considerable benefits to animal health. Knowledge about how adult stem cells modulate the molecular signals to activate cell homing has also been increasingly determined, evidencing the mechanisms which enable cells to repair and regenerate injured tissues. Preclinical studies were designed for many animal models and they have contributed to the translation to the human clinic. This review shows the most commonly used stem cell types, with emphasis on mesenchymal stem cells and their mechanistic potential to repair, as well as the experimental protocols, studied diseases, and species with the highest amount of studies and applications. The relationship between stem cell protocols utilized on clinics, molecular mechanisms, and the physiological responses may offer subsidies to new studies and therefore improve the therapeutic outcome for both humans and animals. PMID:27379197

  6. Advances in the Use of Stem Cells in Veterinary Medicine: From Basic Research to Clinical Practice

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    Melissa Medeiros Markoski


    Full Text Available Today, several veterinary diseases may be treated with the administration of stem cells. This is possible because these cells present a high therapeutic potential and may be injected as autologous or allogenic, freshly isolated, or previously cultured. The literature supports that the process is safe and brings considerable benefits to animal health. Knowledge about how adult stem cells modulate the molecular signals to activate cell homing has also been increasingly determined, evidencing the mechanisms which enable cells to repair and regenerate injured tissues. Preclinical studies were designed for many animal models and they have contributed to the translation to the human clinic. This review shows the most commonly used stem cell types, with emphasis on mesenchymal stem cells and their mechanistic potential to repair, as well as the experimental protocols, studied diseases, and species with the highest amount of studies and applications. The relationship between stem cell protocols utilized on clinics, molecular mechanisms, and the physiological responses may offer subsidies to new studies and therefore improve the therapeutic outcome for both humans and animals.

  7. Advances in the Use of Stem Cells in Veterinary Medicine: From Basic Research to Clinical Practice. (United States)

    Markoski, Melissa Medeiros


    Today, several veterinary diseases may be treated with the administration of stem cells. This is possible because these cells present a high therapeutic potential and may be injected as autologous or allogenic, freshly isolated, or previously cultured. The literature supports that the process is safe and brings considerable benefits to animal health. Knowledge about how adult stem cells modulate the molecular signals to activate cell homing has also been increasingly determined, evidencing the mechanisms which enable cells to repair and regenerate injured tissues. Preclinical studies were designed for many animal models and they have contributed to the translation to the human clinic. This review shows the most commonly used stem cell types, with emphasis on mesenchymal stem cells and their mechanistic potential to repair, as well as the experimental protocols, studied diseases, and species with the highest amount of studies and applications. The relationship between stem cell protocols utilized on clinics, molecular mechanisms, and the physiological responses may offer subsidies to new studies and therefore improve the therapeutic outcome for both humans and animals. PMID:27379197

  8. Advances in the Use of Stem Cells in Veterinary Medicine: From Basic Research to Clinical Practice. (United States)

    Markoski, Melissa Medeiros


    Today, several veterinary diseases may be treated with the administration of stem cells. This is possible because these cells present a high therapeutic potential and may be injected as autologous or allogenic, freshly isolated, or previously cultured. The literature supports that the process is safe and brings considerable benefits to animal health. Knowledge about how adult stem cells modulate the molecular signals to activate cell homing has also been increasingly determined, evidencing the mechanisms which enable cells to repair and regenerate injured tissues. Preclinical studies were designed for many animal models and they have contributed to the translation to the human clinic. This review shows the most commonly used stem cell types, with emphasis on mesenchymal stem cells and their mechanistic potential to repair, as well as the experimental protocols, studied diseases, and species with the highest amount of studies and applications. The relationship between stem cell protocols utilized on clinics, molecular mechanisms, and the physiological responses may offer subsidies to new studies and therefore improve the therapeutic outcome for both humans and animals.

  9. Consequences of Advanced Glycation End Products Accumulation in Chronic Kidney Disease and Clinical Usefulness of Their Assessment Using a Non-invasive Technique - Skin Autofluorescence. (United States)

    Oleniuc, Mihaela; Secara, Irina; Onofriescu, Mihai; Hogas, Simona; Voroneanu, Luminita; Siriopol, Dimitrie; Covic, Adrian


    . The Autofluorescence Reader may be useful as a clinical tool for rapid assessment of risk for advanced glycation end-products related long-term complications, not only in diabetes, but in other conditions associated with advanced glycation end-products accumulation as well.

  10. Clinical use of cabozantinib in the treatment of advanced kidney cancer: efficacy, safety, and patient selection

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    Yu SS


    Full Text Available Steven S Yu, David I Quinn, Tanya B Dorff Division of Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA Abstract: Clear cell (cc renal cell carcinoma (RCC is the most common type of cancer found in the kidney accounting for ~90% of all kidney cancers. In 2012, there were ~337,000 new cases of RCC diagnosed worldwide with an estimated 143,000 deaths, with the highest incidence and mortality in Western countries. Despite improvements in cancer control achieved with VEGF- and mTOR-targeted therapy for RCC, progression remains virtually universal and additional therapies are needed. The pivotal results of the METEOR trial led to cabozantinib’s designation as a breakthrough drug by the US Food and Drug Administration and its approval for treatment of advanced RCC in 2016. Subsequent data from the CABOSUN trial, where caboxantinib is compared with sunitinib, will provide information on the relative activity of cabozantinib as first-line therapy for ccRCC. We review the development of cabozantinib in advanced RCC and its role in the treatment landscape for advanced RCC. Keywords: cabozantinib, renal cell carcinoma, kidney cancer, clear cell carcinoma, tyrosine kinase inhibitor

  11. [Clinical trials with advanced therapy medicinal products]. (United States)

    Schüssler-Lenz, M; Schneider, C K


    For advanced therapies, the same basic principles for assessment apply as for any other biotechnological medicinal product. Nevertheless, the extent of data for quality, safety, and efficacy can be highly specific. Until recently, advanced therapies were not uniformly regulated across Europe, e.g., tissue engineered products were regulated either as medicinal products or medical devices. Thus, for some products no data from clinical studies are available, e.g., for autologous chondrocyte products. The draft guideline on Good Clinical Practice for clinical trials with advanced therapies describes specific additional requirements, e.g., ensuring traceability. Most clinical studies with advanced therapies in Germany are still in early phase I or II trials with highly divergent types of products and clinical indications. The Committee for Advanced Therapies (CAT) at the European Medicines Agency (EMEA) has been established to meet the scientific and regulatory challenges with advanced therapies.

  12. Consequences of Advanced Glycation End Products Accumulation in Chronic Kidney Disease and Clinical Usefulness of Their Assessment Using a Non-invasive Technique - Skin Autofluorescence. (United States)

    Oleniuc, Mihaela; Secara, Irina; Onofriescu, Mihai; Hogas, Simona; Voroneanu, Luminita; Siriopol, Dimitrie; Covic, Adrian


    . The Autofluorescence Reader may be useful as a clinical tool for rapid assessment of risk for advanced glycation end-products related long-term complications, not only in diabetes, but in other conditions associated with advanced glycation end-products accumulation as well. PMID:22879845

  13. Advanced Clinical Usefulness of Ultrasonography for Diseases in Oral and Maxillofacial Regions

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    Nao Wakasugi-Sato


    Full Text Available Various kinds of diseases may be found in the oral and maxillofacial regions and various modalities may be applied for their diagnosis, including intra-oral radiography, panoramic radiography, ultrasonography, computed tomography, magnetic resonance imaging, and nuclear medicine methods such as positron emission tomography. Of these modalities, ultrasound imaging is easy to use for the detection of noninvasive and soft tissue-related diseases. Doppler ultrasound images taken in the B-mode can provide vascular information associated with the morphology of soft tissues. Thus, ultrasound imaging plays an important role in confirming the diagnosis of many kinds of diseases in such oral and maxillofacial regions as the tongue, lymph nodes, salivary glands, and masticatory muscles. In the present article, we introduce three new applications of ultrasonography: guided fine-needle aspiration, measurement of tongue cancer thickness, and diagnosis of metastasis to cervical lymph nodes.

  14. The ex vivo purge of cancer cells using oncolytic viruses: recent advances and clinical implications

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    Tsang JJ


    Full Text Available Jovian J Tsang,1,2 Harold L Atkins2,3 1Department of Biochemistry, University of Ottawa, 2Cancer Therapeutics, Ottawa Hospital Research Institute, 3Blood and Marrow Transplant Program, The Ottawa Hospital, Ottawa, ON, Canada Abstract: Hematological malignancies are treated with intensive high-dose chemotherapy, with or without radiation. This is followed by hematopoietic stem cell (HSC transplantation (HSCT to rescue or reconstitute hematopoiesis damaged by the anticancer therapy. Autologous HSC grafts may contain cancer cells and purging could further improve treatment outcomes. Similarly, allogeneic HSCT may be improved by selectively purging alloreactive effector cells from the graft rather than wholesale immune cell depletion. Viral agents that selectively replicate in specific cell populations are being studied in experimental models of cancer and immunological diseases and have potential applications in the context of HSC graft engineering. This review describes preclinical studies involving oncolytic virus strains of adenovirus, herpes simplex virus type 1, myxoma virus, and reovirus as ex vivo purging agents for HSC grafts, as well as in vitro and in vivo experimental studies using oncolytic coxsackievirus, measles virus, parvovirus, vaccinia virus, and vesicular stomatitis virus to eradicate hematopoietic malignancies. Alternative ex vivo oncolytic virus strategies are also outlined that aim to reduce the risk of relapse following autologous HSCT and mitigate morbidity and mortality due to graft-versus-host disease in allogeneic HSCT. Keywords: hematopoietic stem cells, oncolytic virus, hematopoietic stem cell transplantation, stem cell graft purging, hematopoietic malignancy, graft vs host disease

  15. Towards advanced OCT clinical applications (United States)

    Kirillin, Mikhail; Panteleeva, Olga; Agrba, Pavel; Pasukhin, Mikhail; Sergeeva, Ekaterina; Plankina, Elena; Dudenkova, Varvara; Gubarkova, Ekaterina; Kiseleva, Elena; Gladkova, Natalia; Shakhova, Natalia; Vitkin, Alex


    In this paper we report on our recent achievement in application of conventional and cross-polarization OCT (CP OCT) modalities for in vivo clinical diagnostics in different medical areas including gynecology, dermatology, and stomatology. In gynecology, CP OCT was employed for diagnosing fallopian tubes and cervix; in dermatology OCT for monitoring of treatment of psoriasis, scleroderma and atopic dermatitis; and in stomatology for diagnosis of oral diseases. For all considered application, we propose and develop different image processing methods which enhance the diagnostic value of the technique. In particular, we use histogram analysis, Fourier analysis and neural networks, thus calculating different tissue characteristics as revealed by OCT's polarization evolution. These approaches enable improved OCT image quantification and increase its resultant diagnostic accuracy.

  16. Mutation Profiling of Clinically Advanced Cancers Using Next-Generation Sequencing for Targeted Therapy: A Lifespan Experience. (United States)

    Friedman, Kenneth; Resnick, Murray B; Safran, Howard


    The application of modern molecular tests such as next-generation sequencing (NGS) to human malignancies has led to better understanding of tumor biology and the design of targeted molecular therapies. In the research setting, important genomic alterations in tumors have been discovered with potential therapeutic implications but data regarding the impact of this technology in a real world oncology practice is limited. As a result, we decided to review the results of NGS in 144 advanced-stage cancer patients referred to the oncology practices of Lifespan-affiliated centers in Rhode Island. Most cancers revealed genomic alterations in genes commonly mutated in cancer. However, several unexpected genomic alterations were discovered in certain cancers with potential therapeutic intervention. Most cancers contained "actionable" genomic alterations despite being of advanced stage. Our experience demonstrates that application of NGS in the clinical setting contributes both to increasing the therapeutic armamentarium as well as our understanding of tumor biology.

  17. Mutation Profiling of Clinically Advanced Cancers Using Next-Generation Sequencing for Targeted Therapy: A Lifespan Experience. (United States)

    Friedman, Kenneth; Resnick, Murray B; Safran, Howard


    The application of modern molecular tests such as next-generation sequencing (NGS) to human malignancies has led to better understanding of tumor biology and the design of targeted molecular therapies. In the research setting, important genomic alterations in tumors have been discovered with potential therapeutic implications but data regarding the impact of this technology in a real world oncology practice is limited. As a result, we decided to review the results of NGS in 144 advanced-stage cancer patients referred to the oncology practices of Lifespan-affiliated centers in Rhode Island. Most cancers revealed genomic alterations in genes commonly mutated in cancer. However, several unexpected genomic alterations were discovered in certain cancers with potential therapeutic intervention. Most cancers contained "actionable" genomic alterations despite being of advanced stage. Our experience demonstrates that application of NGS in the clinical setting contributes both to increasing the therapeutic armamentarium as well as our understanding of tumor biology. PMID:26422540

  18. Clinical trial of combination therapy using systemic interleukin-2 infusion and low-dose tumor irradiation for advanced hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Although recent progress in surgical techniques and interventional radiology enables patients with hepatocellular carcinoma (HCC) to survive longer, there are still many who cannot receive them due to disease progression. We are currently investigating the therapeutic efficacy of the combination of systemic recombinant interleukin-2 (IL-2) administration and local tumor irradiation for HCC patients in the advanced stage. First, the results of the basic experiment to analyze the optimal dose and timing of IL-2 infusion were demonstrated. Intensive administration of high-dose IL-2 caused acute death, whereas intermittent low-dose IL-2 administration resulted in complete tumor regression followed by the acquisition of tumor-specific immunity. Our data suggested that the tumor-bearing state increased the responsiveness to IL-2 treatment, and that an excessively high-dose regimen is not prerequisite for the optimal IL-2 treatment. With regard to the effectiveness of radiotherapy for HCC, human hepatoma cells exhibited apoptotic death when hepatoma cells were cocultured with LAK cells, or were irradiated in vitro with relatively low-dose irradiation. These results suggested the possible synergistic effect of killer cells and low-dose irradiation. Finally, we presented six eligible cases of advanced HCC treated by combination therapy of IL-2 infusion and local low-dose tumor irradiation. Direct anti-tumor effects were one CR, one MR, two NC, and two PD. One CR case and a NC case have survived now for longer than 40 months. In all cases, NK cell activity increased prominently, and side effects wee mild flu-like symptoms except macroscopic hematuria and moderate VLS-like symptoms in two cases in which therapy was continued for longer than 2 years. Hepatic reserve function like prothrombin time or hepaplastic time improved. The apparent clinical effectiveness of the combination therapy presented here might give promising hints for a new therapeutic strategy for HCC. (author)

  19. Clinical significance of geographic miss when using conventional four field radiotherapy technique in treatment of locally advanced carcinoma cervix

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    A Gulia


    Full Text Available Background: Although conventional four- field radiotherapy based on bony landmarks has been traditionally used, areas of geographical miss due to individual variation in pelvic anatomy have been identified with advanced imaging techniques. AIMS: The primary aim of this study is to evaluate the geographical miss in patientswhen using the conventional four-field planningplanning and to find out the impact of 3-D conformal CT based in patients with locally advanced carcinoma cervix.Materials and Methods: In 50 patients, target volume delineation was done on planning computed tomography (CT scans, according to guidelines by Taylor et al. Patients were treated with modified four field plan, except for the superior, where field border was kept at L4-L5 interspace A dosimetric comparison was done between the conventional four-field based on bony landmarks and the target volume delineated on computed tomography. The disease free survival, pelvic and para aortic nodal free survival, distant failures free survival were calculated using Kaplan Meir Product Limit Method. Results: Patients were followed-up for a median period of 11 months. The median V95 for conventional and modified extended four field plans were 89.4% and 91.3% respectively. Patients with V95 for modified extended pelvic fields less than 91.3% had a trend toward inferior disease free survival (mean DFS 9.8 vs. 13.9 months though the difference was not statistically significant log rank test.Conclusions: Our preliminary data shows trend toward lower DFS in patients with inadequate target volume coverage. We recommend routine use of CT based planning for four field technique.

  20. Clinical implications of advances in liver regeneration


    Kwon, Yong Jin; Lee, Kyeong Geun; Choi, Dongho


    Remarkable advances have been made recently in the area of liver regeneration. Even though liver regeneration after liver resection has been widely researched, new clinical applications have provided a better understanding of the process. Hepatic damage induces a process of regeneration that rarely occurs in normal undamaged liver. Many studies have concentrated on the mechanism of hepatocyte regeneration following liver damage. High mortality is usual in patients with terminal liver failure....

  1. Pre-Operative Prediction of Advanced Prostatic Cancer Using Clinical Decision Support Systems: Accuracy Comparison between Support Vector Machine and Artificial Neural Network

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    Kim, Sang Youn; Moon, Sung Kyoung; Hwang, Sung Il; Sung, Chang Kyu; Cho, Jeong Yeon; Kim, Seung Hyup; Lee, Hak Jong [Seoul National University College of Medicine, Seoul (Korea, Republic of); Jung, Dae Chul [National Cancer Center, Ilsan (Korea, Republic of); Lee, Ji Won [Kangwon National University College of Medicine, Chuncheon (Korea, Republic of)


    The purpose of the current study was to develop support vector machine (SVM) and artificial neural network (ANN) models for the pre-operative prediction of advanced prostate cancer by using the parameters acquired from transrectal ultrasound (TRUS)-guided prostate biopsies, and to compare the accuracies between the two models. Five hundred thirty-two consecutive patients who underwent prostate biopsies and prostatectomies for prostate cancer were divided into the training and test groups (n = 300 versus n 232). From the data in the training group, two clinical decision support systems (CDSSs-[SVM and ANN]) were constructed with input (age, prostate specific antigen level, digital rectal examination, and five biopsy parameters) and output data (the probability for advanced prostate cancer [> pT3a]). From the data of the test group, the accuracy of output data was evaluated. The areas under the receiver operating characteristic (ROC) curve (AUC) were calculated to summarize the overall performances, and a comparison of the ROC curves was performed (p < 0.05). The AUC of SVM and ANN is 0.805 and 0.719, respectively (p = 0.020), in the pre-operative prediction of advanced prostate cancer. Te performance of SVM is superior to ANN in the pre-operative prediction of advanced prostate cancer.

  2. Construction of databases: advances and significance in clinical research. (United States)

    Long, Erping; Huang, Bingjie; Wang, Liming; Lin, Xiaoyu; Lin, Haotian


    Widely used in clinical research, the database is a new type of data management automation technology and the most efficient tool for data management. In this article, we first explain some basic concepts, such as the definition, classification, and establishment of databases. Afterward, the workflow for establishing databases, inputting data, verifying data, and managing databases is presented. Meanwhile, by discussing the application of databases in clinical research, we illuminate the important role of databases in clinical research practice. Lastly, we introduce the reanalysis of randomized controlled trials (RCTs) and cloud computing techniques, showing the most recent advancements of databases in clinical research. PMID:27215009

  3. Treatment of liver cancer of middle and advanced stages using ultrasound-guided percutaneous ethanol injection combined with radiofrequency ablation: A clinical analysis (United States)



    Liver cancer is a malignancy of the digestive system and has a high morbidity and mortality rate. Local intervention has become a viable option in identifying liver treatment. The aim of the present study was to analyze the clinical effects of treating liver cancer in middle and advanced stages using ultrasound-guided percutaneous ethanol injection (PEI) in tumors combined with radiofrequency ablation (RFA). A total of 100 patients with stage III–IV liver cancers were selected to participate in the study. Patients were divided into groups. In group A, treatment was initiated with PEI and after 1–2 weeks RFA was applied while in group B treatment was initiated with RFA and after 1–2 weeks PEI was applied. Patients in group C received PEI and RFA simultaneously. The clinical effects in the 3 groups were compared after 6-month follow ups. The volume of tumor ablation necrosis in group A was significantly greater than that in the groups B and C, while the size was significantly smaller compared to groups B and C after ablation. For group A, the complete ablation rate was significantly higher than that in groups B and C, and the differences were statistically significant (P<0.05). Liver damage indices, including raising levels of glutamic-pyruvic transaminase and total bilirubin, were significantly decreased in group A (P<0.05). The survival rate in group A was also significantly higher than in groups B and C (P<0.05). In conclusion, for patients with liver cancer in middle and advanced stages, the treatment method using PEI followed by RFA was more beneficial in terms of improving the tumor ablation rate, alleviating liver damages and increasing survival rates. PMID:26998128

  4. Advanced and controlled drug delivery systems in clinical disease management

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    Brouwers, JRBJ


    Advanced and controlled drug delivery systems are important for clinical disease management. In this review the most important new systems which have reached clinical application are highlighted. Microbiologically controlled drug delivery is important for gastrointestinal diseases like ulcerative co

  5. Technological advances in perioperative monitoring: Current concepts and clinical perspectives. (United States)

    Chilkoti, Geetanjali; Wadhwa, Rachna; Saxena, Ashok Kumar


    Minimal mandatory monitoring in the perioperative period recommended by Association of Anesthetists of Great Britain and Ireland and American Society of Anesthesiologists are universally acknowledged and has become an integral part of the anesthesia practice. The technologies in perioperative monitoring have advanced, and the availability and clinical applications have multiplied exponentially. Newer monitoring techniques include depth of anesthesia monitoring, goal-directed fluid therapy, transesophageal echocardiography, advanced neurological monitoring, improved alarm system and technological advancement in objective pain assessment. Various factors that need to be considered with the use of improved monitoring techniques are their validation data, patient outcome, safety profile, cost-effectiveness, awareness of the possible adverse events, knowledge of technical principle and ability of the convenient routine handling. In this review, we will discuss the new monitoring techniques in anesthesia, their advantages, deficiencies, limitations, their comparison to the conventional methods and their effect on patient outcome, if any.

  6. TU-C-12A-09: Modeling Pathologic Response of Locally Advanced Esophageal Cancer to Chemo-Radiotherapy Using Quantitative PET/CT Features, Clinical Parameters and Demographics

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    Zhang, H; Chen, W; Kligerman, S; D’Souza, W; Suntharalingam, M; Lu, W [University of Maryland School of Medicine, Baltimore, MD (United States); Tan, S [Huazhong University of Science and Technology, Wuhan (China); Kim, G [Duke University, High Point, NC (United States)


    Purpose: To develop predictive models using quantitative PET/CT features for the evaluation of tumor response to neoadjuvant chemo-radiotherapy (CRT) in patients with locally advanced esophageal cancer. Methods: This study included 20 patients who underwent tri-modality therapy (CRT + surgery) and had {sup 18}F-FDG PET/CT scans before initiation of CRT and 4-6 weeks after completion of CRT but prior to surgery. Four groups of tumor features were examined: (1) conventional PET/CT response measures (SUVmax, tumor diameter, etc.); (2) clinical parameters (TNM stage, histology, etc.) and demographics; (3) spatial-temporal PET features, which characterize tumor SUV intensity distribution, spatial patterns, geometry, and associated changes resulting from CRT; and (4) all features combined. An optimal feature set was identified with recursive feature selection and cross-validations. Support vector machine (SVM) and logistic regression (LR) models were constructed for prediction of pathologic tumor response to CRT, using cross-validations to avoid model over-fitting. Prediction accuracy was assessed via area under the receiver operating characteristic curve (AUC), and precision was evaluated via confidence intervals (CIs) of AUC. Results: When applied to the 4 groups of tumor features, the LR model achieved AUCs (95% CI) of 0.57 (0.10), 0.73 (0.07), 0.90 (0.06), and 0.90 (0.06). The SVM model achieved AUCs (95% CI) of 0.56 (0.07), 0.60 (0.06), 0.94 (0.02), and 1.00 (no misclassifications). Using spatial-temporal PET features combined with conventional PET/CT measures and clinical parameters, the SVM model achieved very high accuracy (AUC 1.00) and precision (no misclassifications), significantly better than using conventional PET/CT measures or clinical parameters and demographics alone. For groups with a large number of tumor features (groups 3 and 4), the SVM model achieved significantly higher accuracy than the LR model. Conclusion: The SVM model using all features

  7. Clinical Usefulness of {sup 18}F-Fluorodeoxyglucose-Positron Emission Tomography in Patients With Locally Advanced Pancreatic Cancer Planned to Undergo Concurrent Chemoradiation Therapy

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    Chang, Jee Suk; Choi, Seo Hee; Lee, Youngin; Kim, Kyung Hwan [Department of Radiation Oncology, Yonsei University College of Medicine, Seoul (Korea, Republic of); Park, Jeong Youp; Song, Si Young [Department of Internal Medicine, Yonsei University College of Medicine, Seoul (Korea, Republic of); Cho, Arthur; Yun, Mijin; Lee, Jong Doo [Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul (Korea, Republic of); Seong, Jinsil, E-mail: [Department of Radiation Oncology, Yonsei University College of Medicine, Seoul (Korea, Republic of)


    Purpose: To assess the role of coregistered {sup 18}F-fluorodeoxyglucose positron emission tomography (FDG-PET) in detecting radiographically occult distant metastasis (DM) at staging in patients with locally advanced pancreatic cancer (LAPC) and to study whether FDG-PET parameters can predict relatively long-term survival in patients who are more likely to benefit from chemoradiation therapy (CRT). Methods and Materials: From our institutional database, we identified 388 LAPC patients with M0 on conventional computed tomography (CT) who were planned to undergo CRT. Coregistered FDG-PET staging was offered to all patients, and follow-up FDG-PET was used at the clinical discretion of the physician. Results: FDG-PET detected unsuspected CT-occult DM in 33% of all 388 patients and allowed them to receive systemic therapy immediately. The remaining 260 patients (PET-M0) underwent CRT selectively as an initial treatment. Early DM arose in 13.1% of 260 patients, and the 1-year estimated locoregional recurrence rate was 5.4%. Median overall survival (OS) and progression-free survival (PFS) were 14.6 and 9.3 months, respectively, at a median follow-up time of 32.3 months (range, 10-99.1 months). Patients with a baseline standardized uptake value (SUV) <3.5 and/or SUV decline ≥60% had significantly better OS and PFS than those having none, even after adjustment for all potential confounding variables (all P<.001). Conclusions: FDG-PET can detect radiographically occult DM at staging in one-third of patients and spare them from the potentially toxic therapy. Additionally, FDG-PET parameters including baseline SUV and SUV changes may serve as useful clinical markers for predicting the prognosis in LAPC patients.

  8. Mentoring for retention and advancement in the multigenerational clinical laboratory. (United States)

    Laudicina, R J


    Retention of recent graduates and other laboratory practitioners in the workplace will play a key role in addressing current and projected shortages of clinical laboratory scientists (CLS) and technicians (CLT). In addition, with overrepresentation of the aging Baby Boomer generation in laboratory supervisory and management positions, it is crucial not only to retain younger practitioners, but to prepare them for assuming these important functions in the future. Mentoring, a practice commonly employed in other professions, is widely considered to be useful in employee retention and career advancement. Mentoring has probably been used in the clinical laboratory profession, but has not been well documented. In the clinical laboratory environment, potential mentors are in the Veteran and Baby Boomer generations, and new practitioners who could benefit from mentoring are in Generation X. Generational differences among these groups may present challenges to the use of mentoring. This article will attempt to provide a better understanding of generational differences and show how mentoring can be applied in the setting of the clinical laboratory in order to increase retention and promote career advancement of younger practitioners. A panel of five laboratory managers provided examples of mentoring strategies. Definitions, benefits, and examples of mentoring are addressed in the accompanying article, "Passing the Torch: Mentoring the Next Generation of Laboratory Professionals". PMID:15633495

  9. Advancing cell wall inhibitors towards clinical applications. (United States)

    Maffioli, Sonia I; Cruz, João C S; Monciardini, Paolo; Sosio, Margherita; Donadio, Stefano


    Natural products represent a major source of approved drugs and still play an important role in supplying chemical diversity. Consistently, 2014 has seen new, natural product-derived antibiotics approved for human use by the US Food and Drug Administration. One of the recently approved second-generation glycopeptides is dalbavancin, a semi-synthetic derivative of the natural product A40,926. This compound inhibits bacterial growth by binding to lipid intermediate II (Lipid II), a key intermediate in peptidoglycan biosynthesis. Like other recently approved antibiotics, dalbavancin has a complex history of preclinical and clinical development, with several companies contributing to different steps in different years. While our work on dalbavancin development stopped at the previous company, intriguingly our current pipeline includes two more Lipid II-binding natural products or derivatives thereof. In particular, we will focus on the properties of NAI-107 and related lantibiotics, which originated from recent screening and characterization efforts. PMID:26515981

  10. Advances take stage - Office of Cancer Clinical Proteomics Research (United States)

    Regulatory advances in proteomics will be taking center stage at a Symposia scheduled to occur at the 2011 American Association for Clinical Chemistry (AACC) Annual Meeting. The symposium entitled "Enabling Translational Proteomics with NCI's Clinical Proteomic Technologies for Cancer" is scheduled for July 25, 2011 at AACC's annual Meeting.

  11. Autosomal dominant polycystic kidney disease: recent advances in clinical management. (United States)

    Mao, Zhiguo; Chong, Jiehan; Ong, Albert C M


    The first clinical descriptions of autosomal dominant polycystic kidney disease (ADPKD) go back at least 500 years to the late 16 (th) century. Advances in understanding disease presentation and pathophysiology have mirrored the progress of clinical medicine in anatomy, pathology, physiology, cell biology, and genetics. The identification of PKD1 and PKD2, the major genes mutated in ADPKD, has stimulated major advances, which in turn have led to the first approved drug for this disorder and a fresh reassessment of patient management in the 21 (st) century. In this commentary, we consider how clinical management is likely to change in the coming decade. PMID:27594986

  12. Basic principles and clinical advancements of muscle electrotransfer

    DEFF Research Database (Denmark)

    Hojman, Pernille


    clinical potential within DNA vaccination, systemic delivery of therapeutic proteins and correction of gene defects in muscles. In the recent years, DNA electrotransfer to muscle tissue has reached clinical advancement with 8 on-going clinical trials. In the present review, I will draw on the experiences...... obtained from the clinical studies, in understanding the mechanistic and practical advantages and limits of muscle electrotransfer. The effect of applying electric pulses to muscle tissue will be described in details, while present and future clinical applications are reviewed....

  13. Recent advances in dengue pathogenesis and clinical management. (United States)

    Simmons, Cameron P; McPherson, Kirsty; Van Vinh Chau, Nguyen; Hoai Tam, D T; Young, Paul; Mackenzie, Jason; Wills, Bridget


    This review describes and commentates on recent advances in the understanding of dengue pathogenesis and immunity, plus clinical research on vaccines and therapeutics. We expand specifically on the role of the dermis in dengue virus infection, the contribution of cellular and humoral immune responses to pathogenesis and immunity, NS1 and mechanisms of virus immune evasion. Additionally we review a series of therapeutic intervention trials for dengue, as well as recent clinical research aimed at improving clinical diagnosis, risk prediction and disease classification.

  14. Advances and applications of molecular cloning in clinical microbiology. (United States)

    Sharma, Kamal; Mishra, Ajay Kumar; Mehraj, Vikram; Duraisamy, Ganesh Selvaraj


    Molecular cloning is based on isolation of a DNA sequence of interest to obtain multiple copies of it in vitro. Application of this technique has become an increasingly important tool in clinical microbiology due to its simplicity, cost effectiveness, rapidity, and reliability. This review entails the recent advances in molecular cloning and its application in the clinical microbiology in the context of polymicrobial infections, recombinant antigens, recombinant vaccines, diagnostic probes, antimicrobial peptides, and recombinant cytokines. Culture-based methods in polymicrobial infection have many limitation, which has been overcome by cloning techniques and provide gold standard technique. Recombinant antigens produced by cloning technique are now being used for screening of HIV, HCV, HBV, CMV, Treponema pallidum, and other clinical infectious agents. Recombinant vaccines for hepatitis B, cholera, influenza A, and other diseases also use recombinant antigens which have replaced the use of live vaccines and thus reduce the risk for adverse effects. Gene probes developed by gene cloning have many applications including in early diagnosis of hereditary diseases, forensic investigations, and routine diagnosis. Industrial application of this technology produces new antibiotics in the form of antimicrobial peptides and recombinant cytokines that can be used as therapeutic agents. PMID:25023463

  15. Advances in functional magnetic resonance imaging: technology and clinical applications. (United States)

    Dickerson, Bradford C


    Functional MRI (fMRI) is a valuable method for use by clinical investigators to study task-related brain activation in patients with neurological or neuropsychiatric illness. Despite the relative infancy of the field, the rapid adoption of this functional neuroimaging technology has resulted from, among other factors, its ready availability, its relatively high spatial and temporal resolution, and its safety as a noninvasive imaging tool that enables multiple repeated scans over the course of a longitudinal study, and thus may lend itself well as a measure in clinical drug trials. Investigators have used fMRI to identify abnormal functional brain activity during task performance in a variety of patient populations, including those with neurodegenerative, demyelinating, cerebrovascular, and other neurological disorders that highlight the potential utility of fMRI in both basic and clinical spheres of research. In addition, fMRI studies reveal processes related to neuroplasticity, including compensatory hyperactivation, which may be a universally-occurring, adaptive neural response to insult. Functional MRI is being used to study the modulatory effects of genetic risk factors for neurological disease on brain activation; it is being applied to differential diagnosis, as a predictive biomarker of disease course, and as a means to identify neural correlates of neurotherapeutic interventions. Technological advances are rapidly occurring that should provide new applications for fMRI, including improved spatial resolution, which promises to reveal novel insights into the function of fine-scale neural circuitry of the human brain in health and disease.

  16. Student Pharmacists’ Clinical Interventions in Advanced Pharmacy Practice Experiences at a Community Nonteaching Hospital


    Shogbon, Angela O.; Lundquist, Lisa M.


    Objective. To assess student pharmacists’ clinical interventions in advanced pharmacy practice experiences (APPEs) at a community nonteaching hospital and evaluate completed interventions based on the type of documentation method used.

  17. Pharmacovigilance using Clinical Text. (United States)

    Lependu, Paea; Iyer, Srinivasan V; Bauer-Mehren, Anna; Harpaz, Rave; Ghebremariam, Yohannes T; Cooke, John P; Shah, Nigam H


    The current state of the art in post-marketing drug surveillance utilizes voluntarily submitted reports of suspected adverse drug reactions. We present data mining methods that transform unstructured patient notes taken by doctors, nurses and other clinicians into a de-identified, temporally ordered, patient-feature matrix using standardized medical terminologies. We demonstrate how to use the resulting high-throughput data to monitor for adverse drug events based on the clinical notes in the EHR. PMID:24303315

  18. Building the Clinical Bridge to Advance Education, Research, and Practice Excellence

    Directory of Open Access Journals (Sweden)

    Marilyn Svejda


    Full Text Available The University of Michigan School of Nursing and the Health System partnered to develop an undergraduate clinical education model as part of a larger project to advance clinical education, practice, and scholarship with education serving as the clinical bridge that anchors all three areas. The clinical model includes clusters of clinical units as the clinical home for four years of a student's education, clinical instruction through team mentorship, clinical immersion, special skills preparation, and student portfolio. The model was examined during a one-year pilot with junior students. Stakeholders were largely positive. Findings showed that Clinical Faculty engaged in more role modeling of teaching strategies as Mentors assumed more direct teaching used more clinical reasoning strategies. Students reported increased confidence and competence in clinical care by being integrated into the team and the Mentor's assignment. Two new full time faculty roles in the Health System support education, practice, and research.

  19. Nurse cannulation: introducing an advanced clinical skill.

    LENUS (Irish Health Repository)

    Hoctor, Bridget


    Many patients admitted to emergency departments (EDs) require therapy delivered by cannula. Mid-Western Regional Hospital, Tipperary, used to run a system in which many patients had to endure two invasive procedures: on arrival their blood was taken by nurses and later they were cannulated by doctors. To reduce the number of procedures, ED nurses initiated a project to extend their skills to include cannulation. The new system of nurse cannulation at triage has also helped reduce waiting times.

  20. Clinical Applications of Procalcitonin in Pediatrics: An Advanced Biomarker for Inflammation and Infection—Can It Also Be Used in Trauma?


    Koutroulis, Ioannis; Loscalzo, Steven M.; Kratimenos, Panagiotis; Singh, Sabina; Weiner, Evan; Syriopoulou, Vassiliki; Theocharis, Stamatios; Chrousos, Georgios


    Background. Procalcitonin is a small molecular peptide that has gained increased support as an adjunct diagnostic marker of infection in the adult population; the concordant body of evidence for the use of procalcitonin in pediatric populations is far less complete. Objectives. Our objective is to review the current evidence supporting the utilization of procalcitonin in children in a variety of clinical scenarios including SIRS, sepsis, burns, and trauma and to identify existing knowledge ga...

  1. Introducing Advanced Clinical Reasoning to an Adult Learning Disability Service (United States)

    Stansfield, Jois; Matthews, Alison


    The advanced clinical reasoning approach is widely adopted in speech and language therapy practice. This article reports on the introduction of the approach across a multidisciplinary adult learning disability service and staff reports on the impact of this initiative. Staff and team managers reported that the training had a positive impact on…

  2. Breast cancer stem cells: current advances and clinical implications. (United States)

    Luo, Ming; Clouthier, Shawn G; Deol, Yadwinder; Liu, Suling; Nagrath, Sunitha; Azizi, Ebrahim; Wicha, Max S


    There is substantial evidence that many cancers, including breast cancer, are driven by a population of cells that display stem cell properties. These cells, termed cancer stem cells (CSCs) or tumor initiating cells, not only drive tumor initiation and growth but also mediate tumor metastasis and therapeutic resistance. In this chapter, we summarize current advances in CSC research with a major focus on breast CSCs (BCSCs). We review the prevailing methods to isolate and characterize BCSCs and recent evidence documenting their cellular origins and phenotypic plasticity that enables them to transition between mesenchymal and epithelial-like states. We describe in vitro and clinical evidence that these cells mediate metastasis and treatment resistance in breast cancer, the development of novel strategies to isolate circulating tumor cells (CTCs) that contain CSCs and the use of patient-derived xenograft (PDX) models in preclinical breast cancer research. Lastly, we highlight several signaling pathways that regulate BCSC self-renewal and describe clinical implications of targeting these cells for breast cancer treatment. The development of strategies to effectively target BCSCs has the potential to significantly improve the outcomes for patients with breast cancer.

  3. Can EGFR-TKIs be used in first line treatment for advanced non-small cell lung cancer based on selection according to clinical factors ? -- A literature-based meta-analysis

    Directory of Open Access Journals (Sweden)

    Xu Chongrui


    Full Text Available Abstract Background In the first line treatment of non-small cell lung cancer (NSCLC, several clinical trials have shown that not all NSCLC patients can benefit from treatment with tyrosine kinase inhibitors (TKIs than receiving chemotherapy. Some trials treated patients with TKI according to their clinical characteristics. A few studies only chose patients with an epidermal grouth factor receptor (EGFR mutation for TKI therapy. We aimed to determine whether patients could be treated with TKIs based on clinical factors in the first-line setting. Methods We performed a meta-analysis of randomized trials involving patients with advanced NSCLC treated with chemotherapy or TKIs by different selections. Efficacy outcomes of interest were the objective response rate (ORR, progression-free survival (PFS and the overall survival (OS of each treatment arm. Results Four trials enrolled unselected patients, and two trials selected East Asian patients using the clinical factors of gender and smoking history. Five trials chose patients with an EGFR mutation who were randomized for treatment with TKI or chemotherapy. For unselected patients, the risk ratio (RR of the ORR was 3.52, the hazard ratio (HR of the PFS was 1.29 and the HR of the OS was 1.35. For the clinically selected patients, the RR of the ORR was 0.64. The HRs of the PFS and OS were 0.83 and 0.92, respectively. The ORR and PFS were better for TKIs than for chemotherapy in patients with an EGFR mutation. The ORR was 0.47, and the HRs of the PFS and OS were 0.36 and 1.00, respectively. Conclusions Advanced NSCLC patients with an EGFR mutation benefit most from TKIs. EGFR-TKI treatment is justified for patients with unknown EGFR status,and those who cannot tolerate chemotherapy owing to age, poor performance status (PS or other medical conditions, when selected according to clinical factors in the first-line setting.

  4. Risk of discontinuation of Advanced Therapy Medicinal Products clinical trials (United States)

    Hanna, Eve; Rémuzat, Cecile; Auquier, Pascal; Toumi, Mondher


    Objective Advanced therapy medicinal products (ATMPs) constitute a class of innovative products that encompasses gene therapy, somatic cell therapy, and tissue-engineered products (TEP). There is an increased investment of commercial and non-commercial sponsors in this field and a growing number of ATMPs randomized clinical trials (RCT) and patients enrolled in such trials. RCT generate data to prove the efficacy of a new therapy, but the discontinuation of RCTs wastes scarce resources. Our objective is to identify the number and characteristics of discontinued ATMPs trials in order to evaluate the rate of discontinuation. Methods We searched for ATMPs trials conducted between 1999 to June 2015 using three databases, which are, the International Clinical Trials Registry Platform (ICTRP), and the EU Drug Regulating Authorities Clinical Trials (EudraCT). We selected the ATMPs trials after elimination of the duplicates. We identified the disease areas and the sponsors as commercial or non-commercial organizations. We classified ATMPs by type and trial status, that is, ongoing, completed, terminated, discontinued, and prematurely ended. Then, we calculated the rate of discontinuation. Results Between 1999 and June 2015, 143 withdrawn, terminated, or prematurely ended ATMPs clinical trials were identified. Between 1999 and June 2013, 474 ongoing and completed clinical trials were identified. Therefore, the rate of discontinuation of ATMPs trials is 23.18%, similar to that for non-ATMPs drugs in development. The probability of discontinuation is, respectively, 27.35, 16.28, and 16.34% for cell therapies, gene therapies, and TEP. The highest discontinuation rate is for oncology (43%), followed by cardiology (19.2%). It is almost the same for commercial and non-commercial sponsors; therefore, the discontinuation reason may not be financially driven. Conclusion No failure risk rate per development phase is available for ATMPs. The discontinuation rate may

  5. Advanced Nursing Directives: Integrating Validated Clinical Scoring Systems into Nursing Care in the Pediatric Emergency Department

    Directory of Open Access Journals (Sweden)

    Erin Kate deForest


    Full Text Available In an effort to improve the quality and flow of care provided to children presenting to the emergency department the implementation of nurse-initiated protocols is on the rise. We review the current literature on nurse-initiated protocols, validated emergency department clinical scoring systems, and the merging of the two to create Advanced Nursing Directives (ANDs. The process of developing a clinical pathway for children presenting to our pediatric emergency department (PED with suspected appendicitis will be used to demonstrate the successful integration of validated clinical scoring systems into practice through the use of Advanced Nursing Directives. Finally, examples of 2 other Advanced Nursing Directives for common clinical PED presentations will be provided.

  6. Introducing Advances in Bioscience and Clinical Medicine (ABCmed)


    Samad EJ Golzari; Kamyar Ghabili


    We are pleased to announce the launch of the Advances in Bioscience and Clinical Medicine (ABCmed), aninternational open-access, and peer-reviewed journal. Mostly intended to cover all areas of bioscience and medicine, theJournal would provide a unique venue for the scientists from all over the world to publish their scientific works. One ofthe advantages of publishing with us is the rapid yet rigorous review process which is mostly performed by ourdistinguished Editorial and Review Board mem...

  7. Clinical Trial Results Vary Widely, But Always Advance Research | NIH MedlinePlus the Magazine (United States)

    ... of this page please turn Javascript on. Feature: Clinical Trials Clinical Trial Results Vary Widely, But Always Advance Research Past ... very emotional." Should You Be Interested in a Clinical Trial People volunteer to take part in clinical trials ...

  8. Coronary Stents: The Impact of Technological Advances on Clinical Outcomes. (United States)

    Mennuni, Marco G; Pagnotta, Paolo A; Stefanini, Giulio G


    Percutaneous coronary interventions (PCI) were proposed in the late 1970s as an alternative to surgical coronary artery bypass grafting for the treatment of coronary artery disease. Important technological progress has been made since. Balloon angioplasty was replaced by bare metal stents, which allowed to permanently scaffold the coronary vessel avoiding acute recoil and abrupt occlusion. Thereafter, the introduction of early generation drug-eluting stents (DES) has significantly improved clinical outcomes, primarily by markedly reducing the risk of restenosis. New generation DES with thinner stent struts, novel durable or biodegradable polymer coatings, and new limus antiproliferative agents, have further improved upon the safety and efficacy profile of early generation DES. The present article aims to review the impact of technological advances on clinical outcomes in the field of PCI with coronary stents, and to provide a brief overview on clinical margins of improvement and unmet needs of available DES.

  9. Advance in clinical use of dexmedetomidine during perioperative period%右美托咪啶在围术期临床应用的研究进展

    Institute of Scientific and Technical Information of China (English)

    徐枫; 杨承祥; 邓硕曾


    Background Dexmedetomidine (DEX) is a highly selective α2 adrenoreceptor agonist, which was first marketedin March, 2000 in America. DEX has an α2∶α1 adrenoreceptor affinity ratio of approximately 1 620∶1 ( eight times higher than that of clonidine). The half-life of DEX is shorter than clonidine. The elimination half-life of DEX is 2 h and the distribution half-life of DEX is 6 min. The short half-life of DEX makes it an ideal drug for intravenous titration. DEX has been shown to have sedative, anxiolytic and analgesic effects. It has also been shown to anti sympathetic, restrain stress reaction, stabilize hemodynamic responses and reduce anesthetic requirements without relevant respiratory depression.Objective This review aims to summarize the clinical application of DEX and provide the best evidence for its clinical medication. Content This review will present the pharmacological properties and perioperative use of DEX. Trend DEX will be utilized clinicallymuch more safely, perfectly and widely during perioperative period in future.%背景右美托咪啶(dexmedetomidine,DEX)是一种高选择性的α2肾上腺素受体(α2 adrenoreceptor,α2AR)激动剂,于2000年3月在美国首次上市,它与α2、α1肾上腺素受体结合的比例是1 620∶1(比可乐定高8倍).它的半衰期比可乐定短,消除半衰期为2 h,分布半衰期为6 min,其较短的分布半衰期使其成为一种理想的静脉注射药.DEX具有镇静、抗焦虑和镇痛作用,还有抗交感、抑制应激反应、稳定血流动力学和减少麻醉剂用量的作用,且无呼吸抑制.目的 概述DEX的临床应用,为临床用药提供参考.内容对DEX的药理学特点和同术期临床应用进展进行介绍.趋向 DEX将更加安全、正确、广泛的应用于临床.


    Directory of Open Access Journals (Sweden)



    Full Text Available BACKGROUND : In India it is observed that most of the patients of breast cancer clinically present in late stage due to their ignorance of disease despite so much advancement in its detection and management. Locally advanced breast cancer (LABC accounts for 30 - 35% of all cases of breast cancers in India. This study aims to evaluate C linical features, Investigations, various Treatment modalities and the Clinico - pathological correlation & outcome of various treatment modalities of LABC, with special emphasis on Neo - adjuvant chemotherapy (NACT in Indian setting. MATERIAL AND METHOD : This was a non - randomised prospective observational study. We analyzed 57 patients of LABC Stage IIIB & IIIC presenting at Government Medical College, Nagpur, Maharashtra, a tertiary care C entre from September 2012 to November 2014. RESULTS : Stage IIIB comprised 84.21% patients while remaining 15.79% were having Stage IIIC disease. Skin involvement was observed in 91.23% patients. 15.79% showed supraclavicular lymph node involvement. 32 patients received NACT (2 to 6 cycles. Out of these 32, complete clinical response (cCR was 12.5%, partial response (cPR was 68.75% and pathological CR (pCR was 6.25% with Total Objective response (cCR+cPR 81.25%. Feasibility of Breast Conserving Surgery (BCS was observed in 12.5% patients. 25 patients underwent primary surgery followed by adjuvant chemotherapy. Modified Radical Mastectomy was performed in 89.48% patients. CONCLUSIONS : With overall clinical response of 81.25%, n eoadjuvant chemotherapy is the best treatment option for patients with Locally Advanced Breast Cancer with added advantage of in vivo testing the sensitivity of chemotherapeutic agents, early management of micrometastasis and down staging the primary tumour with feasibility of BCS. Patients presenting LABC constitute a diverse group for whic h a variety of treatment modalities should be instituted with co o rdinated treatment planning among surgeons

  11. Clinical and Experimental Advances in Regeneration of Spinal Cord Injury


    Jung Keun Hyun; Hae-Won Kim


    Spinal cord injury (SCI) is one of the major disabilities dealt with in clinical rehabilitation settings and is multifactorial in that the patients suffer from motor and sensory impairments as well as many other complications throughout their lifetimes. Many clinical trials have been documented during the last two decades to restore damaged spinal cords. However, only a few pharmacological therapies used in clinical settings which still have only limited effects on the regeneration, recovery ...

  12. How we used a patient visit tracker tool to advance experiential learning in systems-based practice and quality improvement in a medical student clinic. (United States)

    Chen, Chen Amy; Park, Ryan J; Hegde, John V; Jun, Tomi; Christman, Mitalee P; Yoo, Sun M; Yamasaki, Alisa; Berhanu, Aaron; Vohra-Khullar, Pamela; Remus, Kristin; Schwartzstein, Richard M; Weinstein, Amy R


    Poorly designed healthcare systems increase costs and preventable medical errors. To address these issues, systems-based practice (SBP) education provides future physicians with the tools to identify systemic errors and implement quality improvement (QI) initiatives to enhance the delivery of cost-effective, safe and multi-disciplinary care. Although SBP education is being implemented in residency programs and is mandated by the Accreditation Council for Graduate Medical Education (ACGME) as one of its core competencies, it has largely not been integrated into undergraduate medical education. We propose that Medical Student-Faculty Collaborative Clinics (MSFCCs) may be the ideal environment in which to train medical students in SBPs and QI initiatives, as they allow students to play pivotal roles in project development, administration, and management. Here we describe a process of experiential learning that was developed within a newly established MSFCC, which challenged students to identify inefficiencies, implement interventions, and track the results. After identifying bottlenecks in clinic operations, our students designed a patient visit tracker tool to monitor clinic flow and implemented solutions to decrease patient visit times. Our model allowed students to drive their own active learning in a practical clinical setting, providing early and unique training in crucial QI skills.

  13. Advance directives: prerequisites and usefulness. (United States)

    van Asselt, D


    Advance directives allow competent persons to extend their right of self-determination into the future, by recording choices that are intended to influence their future care should they become unable to make choices. They are considered tools to facilitate end-of-life decision making. Advance directives are a form of anticipatory decision-making. This article will focus on instruction directives against a certain treatment, so-called advance refusals. The most important legal requirement is the acknowledgement of patient autonomy. This condition is met in all European countries. The legal uncertainties surrounding advance refusals are focused on practical modalities rather than on the validity of the general principle. According to leading ethics the underlying moral rule of advanced directives is that all truly autonomous refusals of treatment must be respected, no matter what the consequences. Physicians find it hard to adhere to the wishes and choices of patients as expressed in directives. They find the text ambiguous. Another weakness is that directives give little information about what in the patient's view constitutes a good quality of life. Some health professionals lack the willingness to step outside their own value systems and fully embrace that of the patient. Empathic skills are required. Very few persons create an advance directive. Furthermore, of the created directives only some are accessible when patients are admitted to hospital. However, when directives are available they usually influence medical treatment decisions.

  14. Polymeric nanotherapeutics: clinical development and advances in stealth functionalization strategies (United States)

    Hu, Che-Ming J.; Fang, Ronnie H.; Luk, Brian T.; Zhang, Liangfang


    Long-circulating polymeric nanotherapeutics have garnered increasing interest in research and in the clinic owing to their ability to improve the solubility and pharmacokinetics of therapeutic cargoes. Modulation of carrier properties promises more effective drug localization at the disease sites and can lead to enhanced drug safety and efficacy. In the present review, we highlight the current development of polymeric nanotherapeutics in the clinic. In light of the importance of stealth properties in therapeutic nanoparticles, we also review the advances in stealth functionalization strategies and examine the performance of different stealth polymers in the literature. In addition, we discuss the recent development of biologically inspired ``self'' nanoparticles, which present a differing stealth concept from conventional approaches.

  15. Advance in clinical research of radiation-induced heart disease

    International Nuclear Information System (INIS)

    Radiation-induced heart disease (RIHD) is one of common late side effects derived by thoracic radiotherapy. RIHD is often subclinical and there is an extremely long clinical latent period between radiation therapy and the first clinical presentation of radiation injury, and it did not cause clinical attention for a long time. Until the 1990s, epidemiologic investigations demonstrate that thoracic cancer radiotherapy increased rates of cardiac mortality, RIHD has partly offset the survival benefit provided by adjuvant RT. Radiotherapy techniques has undergone many improvements over the last decades, these improvements decreased both the volume and dose of radiation delivered to the heart, seem to have decreased the incidence of RIHD. Nonetheless, recent studies indicate that the problem of RIHD may persist. For instance, patients with Hodgkin's Disease, lung cancer, and esophageal may still receive either a high dose of radiation to a small part of the heart or a lower dose to the whole heart in radiotherapy. Therefore, long-term cardiac followup of these patients is essential. This article briefly review the clinical presentations, influence factors, prevention and managements, diagnosis and study advances of RIHD. (authors)

  16. Photodynamic therapy for locally advanced pancreatic cancer: early clinical results (United States)

    Sandanayake, N. S.; Huggett, M. T.; Bown, S. G.; Pogue, B. W.; Hasan, T.; Pereira, S. P.


    Pancreatic adenocarcinoma ranks as the fourth most common cause of cancer death in the USA. Patients usually present late with advanced disease, limiting attempted curative surgery to 10% of cases. Overall prognosis is poor with one-year survival rates of less than 10% with palliative chemotherapy and/or radiotherapy. Given these dismal results, a minimally invasive treatment capable of local destruction of tumor tissue with low morbidity may have a place in the treatment of this disease. In this paper we review the preclinical photodynamic therapy (PDT) studies which have shown that it is possible to achieve a zone of necrosis in normal pancreas and implanted tumour tissue. Side effects of treatment and evidence of a potential survival advantage are discussed. We describe the only published clinical study of pancreatic interstitial PDT, which was carried out by our group (Bown et al Gut 2002), in 16 patients with unresectable locally advanced pancreatic adenocarcinoma. All patients had evidence of tumor necrosis on follow-up imaging, with a median survival from diagnosis of 12.5 months. Finally, we outline a phase I dose-escalation study of verteporfin single fibre PDT followed by standard gemcitabine chemotherapy which our group is currently undertaking in patients with locally advanced pancreatic cancer. Randomized controlled studies are also planned.

  17. What clinical activities do advanced-practice registered dietitian nutritionists perform? Results of a Delphi study. (United States)

    Brody, Rebecca A; Byham-Gray, Laura; Touger-Decker, Riva; Passannante, Marian R; Rothpletz Puglia, Pamela; O'Sullivan Maillet, Julie


    Activities performed by advanced-practice registered dietitian nutritionists (RDNs) have yet to be clearly elucidated. The study aimed to gain consensus on the practice activities of advanced-practice RDNs who provide direct clinical nutrition care. A three-round Delphi study was conducted. Purposive sampling identified 117 RDN experts working as clinicians and/or managers in direct care settings that met inclusion criteria for advanced-level practice. In Round 1, 85 experts provided open-ended advanced-level practice activities linked to the Nutrition Care Process sections. Using content analysis, the responses were coded into activity statements. In Round 2, experts rated the essentiality of these activities. In Round 3, experts re-rated statements not reaching consensus while viewing their previous rating, the group median, and comments. Median ratings of 1.0 to 3.0 were defined as essential, 4.0 were neither essential nor nonessential, and 5.0 to 7.0 were nonessential. Consensus was reached when the interquartile range of responses to each question was <2.0. Seventy-six (89.4%) experts completed all rounds. From 770 comments, 129 activity statements were generated. All statements reached consensus: 97.7% as essential; 0.8% as nonessential; and 1.5% as neither. Of essential activities, 67.5% were highly essential with limited variability (median=1.0; interquartile range≤2.0). Advanced-practice RDNs' tasks are patient-centered and reflect complex care; involve a comprehensive and discriminating approach; are grounded in advanced knowledge and expertise in clinical nutrition; include use of advanced interviewing, education, and counseling strategies; and require communication with patient, families, and the health care team. The high-level of consensus from experts suggest advanced-level clinical nutrition practice exists and can be defined.

  18. Using Quality of Life Measures in a Phase I Clinical Trial of Noni in Patients with Advanced Cancer to Select a Phase II Dose (United States)

    Issell, Brian F.; Gotay, Carolyn C.; Pagano, Ian; Franke, A. Adrian


    Purpose We conducted a Phase I study of noni in patients with advanced cancer. Quality of life measures were examined as an alternate way to select a Phase II dose of this popular dietary supplement. Patients and Methods Starting at two capsules twice daily (2 grams), the dose suggested for marketed products, dose levels were escalated by 2 grams daily in cohorts of at least five patients until a maximum tolerated dose was found. Patients completed QLQ-C30 Quality of Life, and the Brief Fatigue Inventory (BFI), questionnaires at baseline and at four week intervals. Scopoletin was measured in blood and urine collected at baseline and at approximately four week intervals. Results Fifty-one patients were enrolled at seven dose levels. Seven capsules four times daily (14 grams) was the maximum tolerated dose. No dose limiting toxicity was found but four of eight patients at this level withdrew from the study due to the challenges of ingesting so many capsules. There was a dose response for self reported physical functioning and the control of pain and fatigue. Patients taking four capsules four times daily experienced less fatigue than patients taking lower or higher doses. A relationship between noni dose and blood and urinary scopoletin concentrations was found. Conclusion Measuring quality of life to determine a dose for subsequent Phase II testing is feasible. A noni dose of four capsules four times daily (8 grams) is recommended for Phase II testing where controlling fatigue and maintaining physical function is the efficacy of interest. Scopoletin is a measurable noni ingredient for pharmacokinetic studies in patients with cancer. PMID:22435516

  19. Clinical Use and Advances of ω-3 Fish Oil Emulsion in Abdominal Surgery%ω-3鱼油脂肪乳对腹部手术患者的临床应用及进展

    Institute of Scientific and Technical Information of China (English)



    Patients undergoing abdominal surgery are prone to systemic inflammatory response syndrome and further multiple organ dysfunction syndrome, due to surgical stress, massive release of inflammatory factors, and initiation of inflammatory response. ω-3 polyunsaturated fatty acids are regulatory in inflammation and immunity and able to improve the postsurgical early inflammatory response and immunity.The clinical use and potential of ω-3 have been increasingly recognized. This article reviews the clinical use and advances of ω-3 fish oil emulsion in patients undergoing abdominal surgeries.%腹部手术后患者因为手术应激打击、炎性因子大量释放、启动炎性反应,引起全身炎性反应综合征,进一步可导致多器官功能不全综合征.ω-3多不饱和脂肪酸具有调节炎症和免疫功能的作用,它能够改善术后早期患者的炎性反应和免疫功能,它的临床应用价值和潜力逐渐得到人们的认识.在此就目前国内外ω-3鱼油脂肪乳对腹部手术后患者的临床应用及进展予以综述.

  20. Anti-EGFR Therapy: Mechanism and Advances in Clinical Efficacy in Breast Cancer

    Directory of Open Access Journals (Sweden)

    John F. Flynn


    Full Text Available This review will focus on recent advances in the application of antiepidermal growth factor receptor (anti-EGFR for the treatment of breast cancer. The choice of EGFR, a member of the ErbB tyrosine kinase receptor family, stems from evidence pinpointing its role in various anti-EGFR therapies. Therefore, an increase in our understanding of EGFR mechanism and signaling might reveal novel targets amenable to intervention in the clinic. This knowledge base might also improve existing medical treatment options and identify research gaps in the design of new therapeutic agents. While the approved use of drugs like the dual kinase inhibitor Lapatinib represents significant advances in the clinical management of breast cancer, confirmatory studies must be considered to foster the use of anti-EGFR therapies including safety, pharmacokinetics, and clinical efficacy.

  1. Identifying components of advanced-level clinical nutrition practice: a Delphi study. (United States)

    Brody, Rebecca A; Byham-Gray, Laura; Touger-Decker, Riva; Passannante, Marian R; O'Sullivan Maillet, Julie


    The dietetics profession lacks a comprehensive definition of advanced-level practice. Using a three-round Delphi study with mailed surveys, expert consensus on four dimensions of advanced-level practice that define advanced practice registered dietitians (RDs) in clinical nutrition was explored. Purposive sampling identified 117 RDs who met advanced-level practice criteria. In round 1, experts rated the essentiality of statements on a 7-point ordinal scale and generated open-ended practice activity statements regarding the following four dimensions of advanced-level practice: professional knowledge, abilities and skills, approaches to practice, roles and relationships, and practice behaviors. Median ratings of 1.0 to 3.0 were defined as essential, 4.0 was neutral, and 5.0 to 7.0 were nonessential. In rounds 2 and 3, experts re-rated statements not reaching consensus by evaluating their previous responses, group median rating, and comments. Consensus was reached when the interquartile range of responses to a statement was ≤2.0. Eighty-five experts enrolled (72.6%); 76 (89.4%) completed all rounds. In total, 233 statements were rated, with 100% achieving consensus; 211 (90.6%) were essential to advanced practice RD clinical practice. Having a master's degree; completing an advanced practice residency; research coursework; and advanced continuing education were essential, as were having 8 years of experience; clinical nutrition knowledge/expertise; specialization; participation in research activities; and skills in technology and communication. Highly essential approaches to practice were systematic yet adaptable and used critical thinking and intuition and highly essential values encompassed professional growth and service to patients. Roles emphasized patient care and leadership. Essential practice activities within the nutrition care process included provision of complex patient-centered nutrition care using application of advanced knowledge/expertise and

  2. Identifying components of advanced-level clinical nutrition practice: a Delphi study. (United States)

    Brody, Rebecca A; Byham-Gray, Laura; Touger-Decker, Riva; Passannante, Marian R; O'Sullivan Maillet, Julie


    The dietetics profession lacks a comprehensive definition of advanced-level practice. Using a three-round Delphi study with mailed surveys, expert consensus on four dimensions of advanced-level practice that define advanced practice registered dietitians (RDs) in clinical nutrition was explored. Purposive sampling identified 117 RDs who met advanced-level practice criteria. In round 1, experts rated the essentiality of statements on a 7-point ordinal scale and generated open-ended practice activity statements regarding the following four dimensions of advanced-level practice: professional knowledge, abilities and skills, approaches to practice, roles and relationships, and practice behaviors. Median ratings of 1.0 to 3.0 were defined as essential, 4.0 was neutral, and 5.0 to 7.0 were nonessential. In rounds 2 and 3, experts re-rated statements not reaching consensus by evaluating their previous responses, group median rating, and comments. Consensus was reached when the interquartile range of responses to a statement was ≤2.0. Eighty-five experts enrolled (72.6%); 76 (89.4%) completed all rounds. In total, 233 statements were rated, with 100% achieving consensus; 211 (90.6%) were essential to advanced practice RD clinical practice. Having a master's degree; completing an advanced practice residency; research coursework; and advanced continuing education were essential, as were having 8 years of experience; clinical nutrition knowledge/expertise; specialization; participation in research activities; and skills in technology and communication. Highly essential approaches to practice were systematic yet adaptable and used critical thinking and intuition and highly essential values encompassed professional growth and service to patients. Roles emphasized patient care and leadership. Essential practice activities within the nutrition care process included provision of complex patient-centered nutrition care using application of advanced knowledge/expertise and

  3. Clinical relevance of advanced glycation endproducts for vascular surgery. (United States)

    Meerwaldt, R; van der Vaart, M G; van Dam, G M; Tio, R A; Hillebrands, J-L; Smit, A J; Zeebregts, C J


    Atherosclerosis is the main contributor to cardiovascular disease and leads to intimal plaque formation, which may progress to plaque rupture with subsequent thromboembolic events and/or occlusion of the arterial lumen. There is increasing evidence that the development or progression of atherosclerosis is associated with advanced glycation endproducts (AGEs). AGEs are a heterogeneous group of compounds formed by the non-enzymatic reaction of reducing sugars with proteins, lipids, and nucleic acids. An increased understanding of the mechanisms of formation and interaction of AGEs has allowed the development of several potential anti-AGE strategies. This review summarizes AGE formation and biochemistry, the pathogeneic role of AGEs in cardiovascular disease, anti-AGE therapies and clinical relevance to vascular surgery.

  4. Integrating first-line treatment options into clinical practice: what's new in advanced melanoma? (United States)

    Dummer, Reinhard; Schadendorf, Dirk; Ascierto, Paolo A; Larkin, James; Lebbé, Celeste; Hauschild, Axel


    Melanoma remains a serious form of skin cancer in Europe and worldwide. Localized, early-stage melanomas can usually be treated with surgical excision. However, the prognosis is poorer for patients with advanced disease. Before 2011, treatment for advanced melanoma included palliative surgery and/or radiotherapy, and chemotherapy with or without immunotherapy, such as interleukin-2. As none of these treatments had shown survival benefits in patients with advanced melanoma, European guidelines had recommended that patients be entered into clinical trials. The lack of approved first-line options and varying access to clinical trials meant that European clinicians relied on experimental regimens and chemotherapy-based treatments when no other options were available. Since 2011, ipilimumab, an immuno-oncology therapy, and vemurafenib and dabrafenib, targeted agents that inhibit mutant BRAF, have been approved by the European Medicines Agency for the treatment of advanced melanoma. More recently, the MEK inhibitor, trametinib, received European marketing authorization for use in patients with BRAF mutation-positive advanced melanoma. In 2014, the anti-PD-1 antibody nivolumab was approved as a first-line therapy in Japan. Whereas nivolumab and another anti-PD-1 antibody, pembrolizumab, were approved as second-line therapies in the USA, their recent approval in Europe are for first-line use based on new clinical trial data in this setting. Together these agents are changing clinical practice and making therapeutic decisions more complex. Here, we discuss current and emerging therapeutic options for the first-line treatment of advanced melanoma, and how these therapies can be optimized to provide the best possible outcomes for patients. PMID:26426764

  5. A clinical study of radiotherapy with CHFU for advanced and recurrent breast cancer

    International Nuclear Information System (INIS)

    We have investigated the usefulness of combination therapy with radiation and CHFU for advanced and recurrent breast cancer according to a clinical cotrolled multicenter trial from 1982 to 1984. One hundred cases were registered and 82 of them were availabe. Treatment sites were the lymph nodes, skin, bone and lung, and the overall response rate was 58% in CR and 19% in PR, while the duration of remission was 18 weeks in CR. Side effects were found in 10% of the patients. Combination therapy with radiation and HCFU may be useful in multimodal tretment for advanced recurrent breast cancer. (author)

  6. Recent technological advances in computed tomography and the clinical impact therein. (United States)

    Runge, Val M; Marquez, Herman; Andreisek, Gustav; Valavanis, Anton; Alkadhi, Hatem


    Current technological advances in CT, specifically those with a major impact on clinical imaging, are discussed. The intent was to provide for both medical physicists and practicing radiologists a summary of the clinical impact of each advance, offering guidance in terms of utility and day-to-day clinical implementation, with specific attention to radiation dose reduction.

  7. Test Review: Advanced Clinical Solutions for WAIS-IV and WMS-IV (United States)

    Chu, Yiting; Lai, Mark H. C.; Xu, Yining; Zhou, Yuanyuan


    The authors review the "Advanced Clinical Solutions for WAIS-IV and WMS-IV". The "Advanced Clinical Solutions (ACS) for the Wechsler Adult Intelligence Scale-Fourth Edition" (WAIS-IV; Wechsler, 2008) and the "Wechsler Memory Scale-Fourth Edition" (WMS-IV; Wechsler, 2009) was published by Pearson in 2009. It is a clinical tool for extending the…

  8. Clinical implications of hepatitis B virus mutations: recent advances. (United States)

    Lazarevic, Ivana


    Hepatitis B virus (HBV) infection is a major cause of acute and chronic hepatitis, and of its long-term complications. It is the most variable among DNA viruses, mostly because of its unique life cycle which includes the activity of error-prone enzyme, reverse transcriptase, and the very high virion production per day. In last two decades, numerous research studies have shown that the speed of disease progression, reliability of diagnostic methods and the success of antiviral therapy and immunization are all influenced by genetic variability of this virus. It was shown that mutations in specific regions of HBV genome could be responsible for unwanted clinical outcomes or evasion of detection by diagnostic tools, thus making the monitoring for these mutations a necessity in proper evaluation of patients. The success of the vaccination programs has now been challenged by the discovery of mutant viruses showing amino acid substitutions in hepatitis B surface antigen (HBsAg), which may lead to evasion of vaccine-induced immunity. However, the emergence of these mutations has not yet raised concern since it was shown that they develop slowly. Investigations of HBV genetic variability and clinical implications of specific mutations have resulted in significant advances over the past decade, particularly in regard to management of resistance to antiviral drugs. In the era of drugs with high genetic barrier for resistance, on-going monitoring for possible resistance is still essential since prolonged therapy is often necessary. Understanding the frequencies and clinical implications of viral mutations may contribute to improvement of diagnostic procedures, more proper planning of immunization programs and creating the most efficient therapeutic protocols. PMID:24976703

  9. Cancer Pharmacogenomics: Integrating Discoveries in Basic, Clinical and Population Sciences to Advance Predictive Cancer Care (United States)

    Cancer Pharmacogenomics: Integrating Discoveries in Basic, Clinical and Population Sciences to Advance Predictive Cancer Care, a 2010 workshop sponsored by the Epidemiology and Genomics Research Program.

  10. Quality assurance issues in conducting multi-institutional advanced technology clinical trials. (United States)

    Purdy, James A


    The National Cancer Institute-sponsored Advanced Technology Quality Assurance (QA) Consortium, which consisted of the Image-Guided Therapy QA Center, Radiation Therapy Oncology Group, Radiological Physics Center, Quality Assurance Review Center, and Resource Center for Emerging Technologies, has pioneered the development of an infrastructure and QA method for advanced technology clinical trials that requires volumetric digital data submission of a protocol patient's treatment plan and verification data. In particular, the Image-Guided Therapy QA Center has nearly 15 years experience in facilitating QA review for Radiation Therapy Oncology Group advanced technology clinical trials. This QA process includes (1) a data integrity review for completeness of protocol required elements, the format of data, and possible data corruption, and recalculation of dose-volume histograms; (2) a review of compliance with target volume and organ-at-risk contours by study chairs; and (3) a review of dose prescription and dose heterogeneity compliance by the Radiation Therapy Oncology Group Headquarters Dosimetry Group or the Radiological Physics Center dosimetrists (for brachytherapy protocols). This report reviews the lessons learned and the QA challenges presented by the use of advanced treatment modalities in clinical trials requiring volumetric digital data submission. PMID:18406941

  11. Clinical cancer advances 2007: major research advances in cancer treatment, prevention, and screening--a report from the American Society of Clinical Oncology. (United States)

    Gralow, Julie; Ozols, Robert F; Bajorin, Dean F; Cheson, Bruce D; Sandler, Howard M; Winer, Eric P; Bonner, James; Demetri, George D; Curran, Walter; Ganz, Patricia A; Kramer, Barnett S; Kris, Mark G; Markman, Maurie; Mayer, Robert J; Raghavan, Derek; Ramsey, Scott; Reaman, Gregory H; Sawaya, Raymond; Schuchter, Lynn M; Sweetenham, John W; Vahdat, Linda T; Davidson, Nancy E; Schilsky, Richard L; Lichter, Allen S


    A MESSAGE FROM ASCO'S PRESIDENT: For the third year, the American Society of Clinical Oncology (ASCO) is publishing Clinical Cancer Advances: Major Research Advances in Cancer Treatment, Prevention, and Screening, an annual review of the most significant cancer research presented or published over the past year. ASCO publishes this report to demonstrate the important progress being made on the front lines of clinical cancer research today. The report is intended to give all those with an interest in cancer care-the general public, cancer patients and organizations, policymakers, oncologists, and other medical professionals-an accessible summary of the year's most important cancer research advances. These pages report on the use of magnetic resonance imaging for breast cancer screening, the association between hormone replacement therapy and breast cancer incidence, the link between human papillomavirus and head and neck cancers, and the use of radiation therapy to prevent lung cancer from spreading. They also report on effective new targeted therapies for cancers that have been historically difficult to treat, such as liver cancer and kidney cancer, among many others. A total of 24 advances are featured in this year's report. These advances and many more over the past several years show that the nation's long-term investment in cancer research is paying off. But there are disturbing signs that progress could slow. We are now in the midst of the longest sustained period of flat government funding for cancer research in history. The budgets for the National Institutes of Health and the National Cancer Institute (NCI) have been unchanged for four years. When adjusted for inflation, cancer research funding has actually declined 12% since 2004. These budget constraints limit the NCI's ability to fund promising cancer research. In the past several years the number of grants that the NCI has been able to fund has significantly decreased; this year, in response to just the

  12. Advanced Carbon Fiber Nears Broad Automotive Use

    Institute of Scientific and Technical Information of China (English)


    General Motors and Teijin Limited, a leader in the carbon fiber and composites industry, will co-develop advanced carbon fiber composite technologies for potential high-volume use globally in GM cars, trucks and crossovers.

  13. Comparison of allogeneic stem cell transplantation and non-transplant approaches in elderly patients with advanced myelodysplastic syndrome: optimal statistical approaches and a critical appraisal of clinical results using non-randomized data.

    Directory of Open Access Journals (Sweden)

    Ronald Brand

    Full Text Available Allogeneic stem cell transplantation (ASCT from related or unrelated donors may cure patients with myelodysplastic syndromes (MDS, a heterogeneous group of clonal stem cell disorders. We analysed 384 elderly patients (55-69 years with advanced MDS who received either ASCT (n=247 and were reported to The European Group for Blood and Marrow Transplantation (EBMT or a non -transplant approach (n=137 reported to the Düsseldorf registry. Besides an attempt to answer the question of "comparison", the purpose of this work is to explain the difficulties in comparing a non-transplant with a transplant cohort, when death before transplant is likely but unknown and the selection of patients for transplant is based on assumptions. It shows which methods are almost always biased and that even the most sophisticated approaches crucially rely on clinical assumptions. Using the most appropriate model for our data, we derive an overall univariate non-significant survival disadvantage for the transplant cohort (HR: 1.29, p = 0.11. We show that such an "average" hazard ratio is however misleading due to non-proportionality of the hazards reflecting early treatment related mortality, the occurring of which is logically correlated with the interval between diagnosis and transplant creating a disproportional drop in the (reconstructed survival curve of the transplanted patients. Also in multivariate analysis (correcting for age > 60 (HR: 1.4, p = 0.02 and abnormal cytogenetics (HR: 1.46, p = 0.01, transplantation seems to be worse (HR: 1.39, p = 0.05 but only in the (incorrect but commonly applied model without time varying covariates. The long term (time depending hazard ratio is shown to be virtually 1 and overall survival is virtually identical in both groups. Nonetheless no conclusion can be reached from a clinical point of view without assumptions which are by their very nature untestable unless all patients would be followed from diagnosis.

  14. A Bright Future for Precision Medicine: Advances in Fluorescent Chemical Probe Design and Their Clinical Application. (United States)

    Garland, Megan; Yim, Joshua J; Bogyo, Matthew


    The Precision Medicine Initiative aims to use advances in basic and clinical research to develop therapeutics that selectively target and kill cancer cells. Under the same doctrine of precision medicine, there is an equally important need to visualize these diseased cells to enable diagnosis, facilitate surgical resection, and monitor therapeutic response. Therefore, there is a great opportunity for chemists to develop chemically tractable probes that can image cancer in vivo. This review focuses on recent advances in the development of optical probes, as well as their current and future applications in the clinical management of cancer. The progress in probe development described here suggests that optical imaging is an important and rapidly developing field of study that encourages continued collaboration among chemists, biologists, and clinicians to further refine these tools for interventional surgical imaging, as well as for diagnostic and therapeutic applications. PMID:26933740

  15. Introducing Advances in Bioscience and Clinical Medicine (ABCmed

    Directory of Open Access Journals (Sweden)

    Samad EJ Golzari


    Full Text Available We are pleased to announce the launch of the Advances in Bioscience and Clinical Medicine (ABCmed, aninternational open-access, and peer-reviewed journal. Mostly intended to cover all areas of bioscience and medicine, theJournal would provide a unique venue for the scientists from all over the world to publish their scientific works. One ofthe advantages of publishing with us is the rapid yet rigorous review process which is mostly performed by ourdistinguished Editorial and Review Board members; this obviously hard-to-achieve goal would not be realized withouttheir continuous support and advice.Another distinguishing characteristic of ABCmed is the diversity of published items in each issue. The editorial team ofthe Journal has devoted separate sections to rather unknown yet interesting fields of the science for instance hypotheses,history of medicine, etc. In the first issue of ABCmed, the readers might refer to the two published hypotheseshighlighting the possible role of chamomile in the treatment of rheumatoid arthritis, and also the preventive effects oftadalafil together with nimodipine in subarachnoid hemorrhage-induced cerebral vasospasm.Letters to the Editor are one of the major sectors in the ABCmed providing not only further on the already publisheddata in the Journal, but also personal comments on the major public health concerns and medical issues. In the firstissue of the Journal, a very important cancer surgery complication is debated, introducing different strategies in the painmanagement of breast cancer patients.We hope that ABCmed will provide a basis to bring together the scientists from all over the globe with the same goal ofpromoting science.

  16. Advances in endodontics: Potential applications in clinical practice


    Anil Kishen; Peters, Ove A.; Matthias Zehnder; Anibal R Diogenes; Nair, Madhu K.


    Contemporary endodontics has seen an unprecedented advance in technology and materials. This article aimed to review some of the challenges and advances in the following sections: (1) endodontic imaging, (2) root canal preparation, (3) root canal disinfection, (4) root canal filling, and (4) regenerative endodontic procedures (REPs). Jointly, these advances are aimed at improving the state of the art and science of root canal treatment.

  17. Clinical significance of preoperative regional intra-arterial infusion chemotherapy for advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Cheng-Wu Zhang; Shou-Chun Zou; Dun Shi; Da-Jian Zhao


    AIM: Preoperative intra-arterial infusion chemotherapy could increase the radical resection rate of advanced gastric cancer, but its effect on the long-term survival has not been assessed. This study was designed to evaluate the clinical significance of preoperative intra-arterial infusion chemotherapy for advanced gastric cancer.METHODS: Clinicopathological data of 91 patients who underwent curative resection for advanced gastric cancer were collected. Among them, 37 patients undertaken preoperative intra-arterial infusion chemotherapy were used as the interventional chemotherapy group, and the remaining 54 patients as the control group. Eleven factors including clinicopathological variables, treatment procedures and molecular biological makers that might contribute to the long-term survival rate were analyzed using Cox multivariate regression analysis.RESULTS: The 5-year survival rate was 52.5% and 39.8%,respectively, for the interventional group and the control group (P<0.05). Cox multivariate regression analysis revealed that the TNM stage (P<0.001), preoperative intraarterial infusion chemotherapy (P = 0.029) and growth pattern (P = 0.042) were the independent factors for the long-term survival of patients with advanced gastric cancer.CONCLUSION: Preoperative intra-arterial infusion chemotherapy plays an important role in improving the prognosis of advanced gastric cancer.

  18. Clinical Holistic Health: Advanced Tools for Holistic Medicine

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt


    Full Text Available According to holistic medical theory, the patient will heal when old painful moments, the traumatic events of life that are often called “gestalts”, are integrated in the present “now”. The advanced holistic physician’s expanded toolbox has many different tools to induce this healing, some that are more dangerous and potentially traumatic than others. The more intense the therapeutic technique, the more emotional energy will be released and contained in the session, but the higher also is the risk for the therapist to lose control of the session and lose the patient to his or her own dark side. To avoid harming the patient must be the highest priority in holistic existential therapy, making sufficient education and training an issue of highest importance. The concept of “stepping up” the therapy by using more and more “dramatic” methods to get access to repressed emotions and events has led us to a “therapeutic staircase” with ten steps: (1 establishing the relationship; (2 establishing intimacy, trust, and confidentiality; (3 giving support and holding; (4 taking the patient into the process of physical, emotional, and mental healing; (5 social healing of being in the family; (6 spiritual healing — returning to the abstract wholeness of the soul; (7 healing the informational layer of the body; (8 healing the three fundamental dimensions of existence: love, power, and sexuality in a direct way using, among other techniques, “controlled violence” and “acupressure through the vagina”; (9 mind-expanding and consciousness-transformative techniques like psychotropic drugs; and (10 techniques transgressing the patient's borders and, therefore, often traumatizing (for instance, the use of force against the will of the patient.We believe that the systematic use of the staircase will greatly improve the power and efficiency of holistic medicine for the patient and we invite a broad cooperation in scientifically testing the

  19. Alzheimer's disease: Cerebrovascular dysfunction, oxidative stress, and advanced clinical therapies

    NARCIS (Netherlands)

    M.W. Marlatt; P.J. Lucassen; G. Perry; M.A. Smith; X. Zhu


    Many lines of independent research have provided convergent evidence regarding oxidative stress, cerebrovascular disease, dementia, and Alzheimer's disease (AD). Clinical studies spurred by these findings engage basic and clinical communities with tangible results regarding molecular targets and pat

  20. Clinical evaluation of endodotic therapy on periodontal tissue healing in chronic advanced periodontitis

    Directory of Open Access Journals (Sweden)

    Sadeghi R.


    Full Text Available Statement of Problem: There is a controversy about the relationship between pulpal and periodontal diseases. The interrelationship between pulp and periodontium could have an important effect on the treatment plan of the tooth. Purpose: The aim of the present research is to evaluate root canal therapy effects on periodontal healing of teeth with chronic advanced periodontitis. Materials and Methods: In this randomized controlled clinical trial 32 single rooted teeth which had necrotic pulp or irreversible pulpitis in 7 patients with chronic advanced periodontitis were selected based on specific criteria. Using a split mouth design, teeth were randomly put in two groups of test and control. In the test group root canal therapy ,scaling & root planing were done.In the control group, only scaling & root planing were performed. Clinical parameters including Pocket Depth (PD, Clinical Attachment Level (CAL, mobility, pattern of bone destruction and plaque index (PI were evaluated in two groups at base line, 1 and 3 months after treatment. Appropriate tests such as paired Wilcoxon and Mann-Whitney were performed. Results: Statistically significant reductions were found in the test group when comparing baseline and one-month post treatment values for Clinical Attachment level (CAL but not after 3-months. In the control group the CAL reductions were not statistically significant between baseline and one month post-treatment, but a increase were observed between one month and three months after treatment. There was a statstically significant difference between the test and the control groups. Other parameters didn’t show any significant differences in each group and between two groups. Conclusion: Since clinical attachment level was the most important parameter we found it can high lighted the role of pathogene with pulpal origin in progression of periodeontal disease and it is concluded that beside periodontal treatment in some advanced periodontal

  1. Developing more open and equitable relationships with industry to improve advancements in clinical research in dermatology. (United States)

    Campa, M; Ryan, C; Menter, A


    Relationships between physicians, scientists, and the pharmaceutical industry can be complicated by conflicts of interest. Honest and equitable relationships, however, are essential to the advancement of dermatologic clinical research. Several factors can increase transparency in clinical trials including preregistration of clinical trials, reporting of all data produced from clinical trials, non-industry ownership of clinical trial data, clarity of statistical methods and publication of both positive and negative results. Through collaborative, scientifically rigorous studies, physicians and industry can achieve significant advances in dermatologic care. PMID:27317287

  2. Advanced circuit simulation using Multisim workbench

    CERN Document Server

    Báez-López, David; Cervantes-Villagómez, Ofelia Delfina


    Multisim is now the de facto standard for circuit simulation. It is a SPICE-based circuit simulator which combines analog, discrete-time, and mixed-mode circuits. In addition, it is the only simulator which incorporates microcontroller simulation in the same environment. It also includes a tool for printed circuit board design.Advanced Circuit Simulation Using Multisim Workbench is a companion book to Circuit Analysis Using Multisim, published by Morgan & Claypool in 2011. This new book covers advanced analyses and the creation of models and subcircuits. It also includes coverage of transmissi

  3. Recent advances towards the clinical application of DNA vaccines. (United States)

    Bins, A D; van den Berg, J H; Oosterhuis, K; Haanen, J B A G


    DNA vaccination is an attractive method for therapeutic vaccination against intracellular pathogens and cancer. This review provides an introduction into the DNA vaccination field and discusses the pre-clinical successes and most interesting clinical achievements thus far. Furthermore, general attributes, mechanism of action and safety of DNA vaccination will be discussed. Since clinical results with DNA vaccination so far show room for improvement, possibilities to improve the delivery and immunogenicity of DNA vaccines are reviewed. In the coming years, these new developments should show whether DNA vaccination is able to induce clinically relevant responses in patients.

  4. Advancing Medication Reconciliation in an Outpatient Internal Medicine Clinic through a Pharmacist-Led Educational Initiative


    Sarah M. Westberg, Pharm.D.; Kathrine Beeksma, R.N.


    Objectives: To develop and deliver an effective pharmacist-led educational initiative to clinic staff to advance medication reconciliation in the electronic medical record of an outpatient internal medicine clinic.Methods: An educational initiative designed to improve the ability of nursing staff in medication reconciliation was launched in the outpatient internal medicine clinic of a regional healthcare system. The education was provided by the pharmacist to clinic nursing staff, includ...

  5. Advancing description and explanation in clinical linguistics: a legacy of Martin J. Ball. (United States)

    Damico, Jack S; Damico, Holly L; Nelson, Ryan L


    This article asserts the importance of explication of order and disorder in language as a privileged objective of clinical linguistics and service delivery and reviews the contributions of Martin Ball in advancing this agenda.

  6. Using Local Data To Advance Quantitative Literacy

    Directory of Open Access Journals (Sweden)

    Stephen Sweet


    Full Text Available In this article we consider the application of local data as a means of advancing quantitative literacy. We illustrate the use of three different sources of local data: institutional data, Census data, and the National College Health Assessment survey. Our learning modules are applied in courses in sociology and communication, but the strategy of using local data can be integrated beyond these disciplinary boundaries. We demonstrate how these data can be used to stimulate student interests in class discussion, advance analytic skills, as well as develop capacities in written and verbal communication. We conclude by considering concerns that may influence the types of local data used and the challenges of integrating these data in a course in which quantitative analysis is not typically part of the curriculum.

  7. Clinical Application of Total Knee Arthroplasty on Patients with Advanced Knee Osteoarthritis


    WU Zhi-sen; ZHENG Chen-xiao; Qi, Liang; CHANG Shang-yi


    Objective: To investigate the clinical value of total knee arthroplasty (TKA) on patients with advanced knee osteoarthritis. Methods: The clinical data and efficacy of 26 patients with advanced knee osteoarthritis (26 knees) who were given TKA in our department from June 2012 to May 2013 were retrospectively observed and analyzed. The knee function scores before operation and after follow up were evaluated according to American HSS scoring standard. Results: At the end of follow up, of...


    Directory of Open Access Journals (Sweden)

    Gh. Bălan


    Full Text Available Background: During 2000-2007 we have selected and supervised a lot of 279 cases operated for colorectal cancer in Clinic no.1 Surgery from “St. Spiridon” Hospital. The sex repartition during the entire study period shows the preponderance of male cases (61.29% in comparison to the female cases of 38.7 %. In our study the operated colorectal carcinomas have a higher incidence at patients over 60 years old, 71.67%. There is as well a higher percent for the age group 60-70 years old and 70-80 years old which percent reaches 34.76% respectively 32.97% out of the total number of cases. When comparing the average age of the two analyzed lots there we can notice that the average age of the female patients does not differ significantly from the age of the male patients. The average age of the female patients was of 64,3±8,58 with minimum values of 51 years and maximum of 78 years and the average age of male patients was of 67,9±10,5 with minim of 44 years and maximum of 86 years. The on segments distribution of the colorectal cancer is presented as follows: rectum 108 cases (38,7%, sigmoid 96 cases (34,40%, descendent 19 cases (6,81%, hepatic angle 17 cases (6.09%, transverse 17 cases (6.09%, ascending 12 cases (4,3% % the rest of the localizations being in a smaller number. In the case of males the colorectal cancer is met most often at the level of the rectum (32.74% and the case of females at the level of the sigmoid (41.66%. Regarding the microscopic results they were: well differentiated adenocarcinoma 45.83%, moderate differentiated 43.75% and weak differentiated 10.42%. The Chi-square analysis shows that there is no association between the macroscopic aspects of the tumours and their histological aspect. Analyzing the microscopic aspect according to the location of the tumour there is observed that 86.95% of the tumours that were located at the level of the rectum have a vegetative aspect. There was not observed any link between the gender

  9. Recent developments in choledochoscopy: technical and clinical advances


    Xu MM; Kahaleh M


    Ming-Ming Xu, Michel Kahaleh Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, NY, USA Abstract: Peroral cholangioscopy has become an important tool in the diagnosis and treatment of a variety of biliary diseases, ranging from indeterminate biliary strictures to bile duct stones. Although the first cholangioscopy was performed in the 1970s, recent technological advances have provided us with cholangioscopes that yield high-resolution im...

  10. Clinical skills assessment of procedural and advanced communication skills: performance expectations of residency program directors

    Directory of Open Access Journals (Sweden)

    Erik E. Langenau


    Full Text Available Background: High stakes medical licensing programs are planning to augment and adapt current examinations to be relevant for a two-decision point model for licensure: entry into supervised practice and entry into unsupervised practice. Therefore, identifying which skills should be assessed at each decision point is critical for informing examination development, and gathering input from residency program directors is important. Methods: Using data from previously developed surveys and expert panels, a web-delivered survey was distributed to 3,443 residency program directors. For each of the 28 procedural and 18 advanced communication skills, program directors were asked which clinical skills should be assessed, by whom, when, and how. Descriptive statistics were collected, and Intraclass Correlations (ICC were conducted to determine consistency across different specialties. Results: Among 347 respondents, program directors reported that all advanced communication and some procedural tasks are important to assess. The following procedures were considered ‘important’ or ‘extremely important’ to assess: sterile technique (93.8%, advanced cardiovascular life support (ACLS (91.1%, basic life support (BLS (90.0%, interpretation of electrocardiogram (89.4% and blood gas (88.7%. Program directors reported that most clinical skills should be assessed at the end of the first year of residency (or later and not before graduation from medical school. A minority were considered important to assess prior to the start of residency training: demonstration of respectfulness (64%, sterile technique (67.2%, BLS (68.9%, ACLS (65.9% and phlebotomy (63.5%. Discussion: Results from this study support that assessing procedural skills such as cardiac resuscitation, sterile technique, and phlebotomy would be amenable to assessment at the end of medical school, but most procedural and advanced communications skills would be amenable to assessment at the end of the

  11. Major clinical research advances in gynecologic cancer in 2015 (United States)


    In 2015, fourteen topics were selected as major research advances in gynecologic oncology. For ovarian cancer, high-level evidence for annual screening with multimodal strategy which could reduce ovarian cancer deaths was reported. The best preventive strategies with current status of evidence level were also summarized. Final report of chemotherapy or upfront surgery (CHORUS) trial of neoadjuvant chemotherapy in advanced stage ovarian cancer and individualized therapy based on gene characteristics followed. There was no sign of abating in great interest in immunotherapy as well as targeted therapies in various gynecologic cancers. The fifth Ovarian Cancer Consensus Conference which was held in November 7–9 in Tokyo was briefly introduced. For cervical cancer, update of human papillomavirus vaccines regarding two-dose regimen, 9-valent vaccine, and therapeutic vaccine was reviewed. For corpus cancer, the safety concern of power morcellation in presumed fibroids was explored again with regard to age and prevalence of corpus malignancy. Hormone therapy and endometrial cancer risk, trabectedin as an option for leiomyosarcoma, endometrial cancer and Lynch syndrome, and the radiation therapy guidelines were also discussed. In addition, adjuvant therapy in vulvar cancer and the updated of targeted therapy in gynecologic cancer were addressed. For breast cancer, palbociclib in hormone-receptor-positive advanced disease, oncotype DX Recurrence Score in low-risk patients, regional nodal irradiation to internal mammary, supraclavicular, and axillary lymph nodes, and cavity shave margins were summarized as the last topics covered in this review. PMID:27775259

  12. Urological diagnosis using clinical PACS (United States)

    Mills, Stephen F.; Spetz, Kevin S.; Dwyer, Samuel J., III


    Urological diagnosis using fluoroscopy images has traditionally been performed using radiographic films. Images are generally acquired in conjunction with the application of a contrast agent, processed to create analog films, and inspected to ensure satisfactory image quality prior to being provided to a radiologist for reading. In the case of errors the entire process must be repeated. In addition, the radiologist must then often go to a particular reading room, possibly in a remote part of the healthcare facility, to read the images. The integration of digital fluoroscopy modalities with clinical PACS has the potential to significantly improve the urological diagnosis process by providing high-speed access to images at a variety of locations within a healthcare facility without costly film processing. The PACS additionally provides a cost-effective and reliable means of long-term storage and allows several medical users to simultaneously view the same images at different locations. The installation of a digital data interface between the existing clinically operational PACS at the University of Virginia Health Sciences Center and a digital urology fluoroscope is described. Preliminary user interviews that have been conducted to determine the clinical effectiveness of PACS workstations for urological diagnosis are discussed. The specific suitability of the workstation medium is discussed, as are overall advantages and disadvantages of the hardcopy and softcopy media in terms of efficiency, timeliness and cost. Throughput metrics and some specific parameters of gray-scale viewing stations and the expected system impacts resulting from the integration of a urology fluoroscope with PACS are also discussed.

  13. Artificial Sight Basic Research, Biomedical Engineering, and Clinical Advances

    CERN Document Server

    Humayun, Mark S; Chader, Gerald; Greenbaum, Elias


    Artificial sight is a frontier area of modern ophthalmology combining the multidisciplinary skills of surgical ophthalmology, biomedical engineering, biological physics, and psychophysical testing. Many scientific, engineering, and surgical challenges must be surmounted before widespread practical applications can be realized. The goal of Artificial Sight is to summarize the state-of-the-art research in this exciting area, and to describe some of the current approaches and initiatives that may help patients in a clinical setting. The Editors are active researchers in the fields of artificial sight, biomedical engineering and biological physics. They have received numerous professional awards and recognition for their work. The artificial sight team at the Doheny Eye Institute, led by Dr. Mark Humayun, is a world leader in this area of biomedical engineering and clinical research. Key Features Introduces and assesses the state of the art for a broad audience of biomedical engineers, biophysicists, and clinical...


    Directory of Open Access Journals (Sweden)



    Full Text Available The water has an essential role in the functioning of ecosystems by integrating the complex physical, chemical, and biological processes that sustain life. Water is a key factor in determining the productivity of ecosystems, biodiversity and species composition. Water is also essential for humanity: water supply systems for population, agriculture, fisheries, industries, and hydroelectric power depend on water supplies. The modelling of hydrological processes is an important activity for water resources management, especially now, when the climate change is one of the major challenges of our century, with strong influence on hydrological processes dynamics. Climate change and needs for more knowledge in water resources require the use of advanced hydroinformatic tools in hydrological processes modelling. The rationale and purpose of advanced hydroinformatic tools is to develop a new relationship between the stakeholders and the users and suppliers of the systems: to offer the basis (systems which supply useable results, the validity of which cannot be put in reasonable doubt by any of the stakeholders involved. For a successful modelling of hydrological processes also need specialists well trained and able to use advanced hydro-informatics tools. Results of modelling can be a useful tool for decision makers to taking efficient measures in social, economical and ecological domain regarding water resources, for an integrated water resources management.

  15. Advances in data exchange for the clinical laboratory. (United States)

    Dolin, R H


    The focus of the article is on the nuts and bolts of those standards relevant to the exchange of data between a clinical laboratory and an electronic health record. These include: Health Level 7 (HL7), Logical Observation Identifier Names and Codes (LOINC), Systematized Nomenclature of Human and Veterinary Medicine (SNOMED), and, most recently, the Extensible Markup Language (XML). PMID:10421962

  16. Preliminary Data from an Advanced Dementia Consult Service: Integrating Research, Education, and Clinical Expertise (United States)

    Catic, Angela G.; Mitchell, Susan L.


    Hospitalized patients with advanced dementia often receive care that is of limited clinical benefit and inconsistent with preferences. We designed an Advanced Dementia Consult Service and conducted a pre and post pilot study to evaluate it in a Boston hospital. Consults were conducted by geriatricians and palliative care nurse practitioner. They consisted of structured consultation, counseling and provision of an information booklet to the family, and post-discharge follow-up with the family and primary care providers. Patients > 65 admitted with advanced dementia were identified and consults were solicited using pop-ups programmed into the computerized provider order entry (POE) system. In the initial 3-month period, patients received usual care (N=24). In the subsequent 3-month period, consults were provided to patients for whom it was requested (N=5). Data were obtained from the electronic medical record and proxies interviews (admission, 1-month post-discharge). The patients’ mean age in the combined sample (N=29) was 85.4, 58.6% were from nursing homes, and 86.2% of their proxies stated comfort was the goal of care. Nonetheless, their hospitalizations were characterized by high rates of intravenous antibiotics (86.2%), > 5 venipunctures (44.8%), and radiological exams (96.6%). Acknowledging the small sample size, there were trends towards better outcomes in the intervention group including: higher proxy knowledge of the disease, greater communication between proxies and providers, more advance care planning, lower re-hospitalization rates, and fewer feeding tube insertions after discharge. Targeted consultation for advanced dementia is feasible and may promote greater engagement of proxies and goal-directed care for patients after discharge. PMID:24219202

  17. Autosomal dominant polycystic kidney disease: recent advances in clinical management [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Zhiguo Mao


    Full Text Available The first clinical descriptions of autosomal dominant polycystic kidney disease (ADPKD go back at least 500 years to the late 16th century. Advances in understanding disease presentation and pathophysiology have mirrored the progress of clinical medicine in anatomy, pathology, physiology, cell biology, and genetics. The identification of PKD1 and PKD2, the major genes mutated in ADPKD, has stimulated major advances, which in turn have led to the first approved drug for this disorder and a fresh reassessment of patient management in the 21st century. In this commentary, we consider how clinical management is likely to change in the coming decade.

  18. Clinical use of glutamine supplementation. (United States)

    Wernerman, Jan


    Endogenous production of glutamine may become insufficient during critical illness. The shortage of glutamine is reflected as a decrease in plasma concentration, which is a prognostic factor for poor outcome in sepsis. Because glutamine is a precursor for nucleotide synthesis, rapidly dividing cells are most likely to suffer from a shortage. Therefore, exogenous glutamine supplementation is necessary. In particular, when i.v. nutrition is given, extra glutamine supplementation becomes critical, because most present formulations for i.v. use do not contain any glutamine for technical reasons. The major part of endogenously produced glutamine comes from skeletal muscle. For patients staying a long time in the intensive care unit (ICU), the muscle mass decreases rapidly, which leaves a tissue of diminishing size to maintain the export of glutamine. The metabolic and nutritional adaptation in long-staying ICU patients is poorly studied and is one of the fields that needs more scientific evidence for clinical recommendations. To date, there is evidence to support the clinical use of glutamine supplementation in critically ill patients, in hematology patients, and in oncology patients. Strong evidence is presently available for i.v. glutamine supplementation to critically ill patients on parenteral nutrition. This must be regarded as the standard of care. For patients on enteral nutrition, more evidence is needed. To guide administration of glutamine, there are good arguments to use measurement of plasma glutamine concentration for guidance. This will give an indication for treatment as well as proper dosing. Most patients will have a normalized plasma glutamine concentration by adding 20-25 g/24 h. Furthermore, there are no reported adverse or negative effects attributable to glutamine supplementation.

  19. Recent advances in understanding xenotransplantation: implications for the clinic. (United States)

    Cooper, David Kc; Bottino, Rita


    The results of organ and cell allotransplantation continue to improve, but the field remains limited by a lack of deceased donor organs. Xenotransplantation, for example, between pig and human, offers unlimited organs and cells for clinical transplantation. The immune barriers include a strong innate immune response in addition to the adaptive T-cell response. The innate response has largely been overcome by the transplantation of organs from pigs with genetic modifications that protect their tissues from this response. T-cell-mediated rejection can be controlled by immunosuppressive agents that inhibit costimulation. Coagulation dysfunction between the pig and primate remains problematic but is being overcome by the transplantation of organs from pigs that express human coagulation-regulatory proteins. The remaining barriers will be resolved by the introduction of novel genetically-engineered pigs. Limited clinical trials of pig islet and corneal transplantation are already underway. PMID:26548357

  20. Thermochemoradiotherapy for advanced or recurrent head and neck cancer. Analysis of clinical results and background variables

    Energy Technology Data Exchange (ETDEWEB)

    Hoshina, Hideyuki; Takagi, Ritsuo; Nagashima, Katsuhiro; Fujita, Hajime; Miyamoto, Takeshi; Sohma, Yoh; Fukuda, Jun-ichi; Imai, Nobuyuki; Nagata, Masaki [Niigata Univ. (Japan). Faculty of Dentistry


    Eighteen patients with 25 unresectable advanced or recurrent head and neck cancers (squamous cell carcinomas) received thermochemotherapy in combination with radiotherapy. The total radiation dose ranged from 50 to 82 Gy (mean, 65.6 Gy). Patients received thermochemotherapy twice a week, for a total number of 8.8 sessions, on average. The temperature in the tumor, as a result of the hyperthermia, was over 42 deg C in 185 (84.5%) of the 219 treatments. Three kinds of heating systems were used: a 13.56-MHz radiofrequency system, a 2450-MHz microwave system, and a radiofrequency interstitial system. The total amount of administered CDDP ranged from 40 to 300 mg (mean, 110 mg), combined with PEP and/or 5FU. Background factors (tumor factors and treatment factors) were investigated in detail, and the clinical results (tumor response and the 5-year cumulative focal control rate) were evaluated. The relationship between these two results was then analyzed using univariate and multivariate statistics. The clinical results of patients with a WHO histological classification of grade 3 were poor compared with patients with a classification of grade 1 or 2. The difference between these two results was significant when analyzed using univariate statistics, but not significant when analyzed using multivariate statistics. The clinical results of patients with primary lesions surrounded by bony tissues were slightly poor compared with those of patients whose lesions were surrounded by soft tissues, but the difference between these two results was not significant. Successful treatment of refractory recurrent tumors, large tumor masses, and diffuse invasive carcinomas was not affected by the treatment factors (heating systems, heating sessions, radiation dose, and CDDP dose and drug combination). These results suggest that refractory recurrence, proximity to bony tissues, tumor size, and histological malignancy might not be prognostic variables for thermochemoradiotherapy strategy

  1. Prognostic significance of clinical and pathological stages on locally advanced rectal carcinoma after neoadjuvant chemoradiotherapy

    International Nuclear Information System (INIS)

    To investigate prognostic significance of clinical and pathological stages in patients with locally advanced rectal carcinoma treated with neoadjuvant chemoradiotherapy (neo-CRT) and total mesorectal excision. 210 patients with locally advanced rectal carcinoma (cT3-4 or cN+) treated with neo-CRT followed by total mesorectal excision. Treatment outcomes were compared according to clinical and pathological stage. Overall survival (OS), disease free survival (DFS) among patients with different clinical stage and pathological stage after neo-CRT. The median follow-up time was 47 months (range, 14–98 months). Clinical T stage was associated with 5 year OS (p = 0.042) and 5 year DFS (p = 0.014) while clinical N stage was not associated with 5 year OS (p = 0.440), 5 year DFS (p = 0.711). Pathological T stage was associate with 5 year OS (p = 0.001) and 5 year DFS (p = 0.046); and N stage was associated with 5 year OS (p = 0.001), 5 year DFS (p = 0.002). The pathological stage was further classified into three groups: ypT0–2N0 in 91 patients (43.3 %), ypT3–4N0 in 69 patients (32.9 %) and ypT0–4N+ in 50 patients (23.8 %). While pathological stage (ypT0–2 vs ypT3–4N0 vs ypT0–4N+) was associated with 5 year OS (87.9 %, 75.5 %, 56.7 %, p = 0.000), 5 year DFS (74.5 %, 77.4 %, 50.5 %, p = 0.003). Multivariate analysis showed that ypN stage was an independent prognostic factor for patients 5 year DFS. Pathological stage is strongly associated with treatment outcomes in patients with locally advanced rectal carcinoma treated with neo-CRT followed by total mesorectal excision, which may be used as guidance for further individualized treatment

  2. Opioid growth factor improves clinical benefit and survival in patients with advanced pancreatic cancer

    Directory of Open Access Journals (Sweden)

    Jill P Smith


    Full Text Available Jill P Smith1, Sandra I Bingaman1, David T Mauger2, Harold H Harvey1, Laurence M Demers3, Ian S Zagon41Departments of Medicine, 2Public Health Sciences, 3Pathology, and 4Neurosciences and Anatomy, Pennsylvania State University, College of Medicine, Hershey Medical Center, Hershey, PA, USABackground: Advanced pancreatic cancer carries the poorest prognosis of all gastrointestinal malignancies. Once the tumor has spread beyond the margins of the pancreas, chemotherapy is the major treatment modality offered to patients; however, chemotherapy does not significantly improve survival.Objective: Opioid growth factor (OGF; [Met5]-enkephalin is a natural peptide that has been shown to inhibit growth of pancreatic cancer in cell culture and in nude mice. The purpose of this study was to evaluate the effects of OGF biotherapy on subjects with advanced pancreatic cancer who failed chemotherapy.Methods: In a prospective phase II open-labeled clinical trial, 24 subjects who failed standard chemotherapy for advanced pancreatic cancer were treated weekly with OGF 250 μg/kg intravenously. Outcomes measured included clinical benefit, tumor response by radiographic imaging, quality of life, and survival.Results: Clinical benefit response was experienced by 53% of OGF-treated patients compared to historical controls of 23.8% and 4.8% for gemcitabine and 5-fluorouracil (5-FU, respectively. Of the subjects surviving more than eight weeks, 62% showed either a decrease or stabilization in tumor size by computed tomography. The median survival time for OGF-treated patients was three times that of untreated patients (65.5 versus 21 days, p < 0.001. No adverse effects on hematologic or chemistry parameters were noted, and quality of life surveys suggested improvement with OGF. Limitations: Measurements other than survival were not allowed in control patients, and clinical benefit comparisons were made to historical controls.Conclusion: OGF biotherapy improves the

  3. Development of Advanced Alloys using Fullerenes (United States)

    Sims, J.; Wasz, M.; O'Brien, J.; Callahan, D. L.; Barrera, E. V.


    Development of advanced alloys using fullerenes is currently underway to produce materials for use in the extravehicular mobility unit (EMU). These materials will be directed toward commercial usages as they are continually developed. Fullerenes (of which the most common is C(sub 60)) are lightweight, nanometer size, hollow molecules of carbon which can be dispersed in conventional alloy systems to enhance strength and reduce weight. In this research, fullerene interaction with aluminum is investigated and a fullerene-reinforced aluminum alloy is being developed for possible use on the EMU. The samples were manufactured using standard commercial approaches including powder metallurgy and casting. Alloys have been processed having 1.3, 4.0 and 8.0 volume fractions of fullerenes. It has been observed that fullerene dispersion is related to the processing approach and that they are stable for the processing conditions used in this research. Emphasis will be given to differential thermal analysis and wavelength dispersive analysis of the processed alloys. These two techniques are particularly useful in determining the condition of the fullerenes during and after processing. Some discussion will be given as to electrical properties of fullerene-reinforced materials. Although the aluminum and other advanced alloys with fullerenes are being developed for NASA and the EMU, the properties of these materials will be of interest for commercial applications where specific Dual-Use will be given.

  4. Advanced Optics Experiments Using Nonuniform Aperture Functions

    CERN Document Server

    Wood, Lowell T


    A method to create instructive, nonuniform aperture functions using spatial frequency filtering is described. The diffraction from a single slit in the Fresnel limit and the interference from a double slit in the Fraunhofer limit are spatially filtered to create electric field distributions across an aperture to produce apodization, inverse apodization or super-resolution, and apertures with phase shifts across their widths. The diffraction effects from these aperture functions are measured and calculated. The excellent agreement between the experimental results and the calculated results makes the experiment ideal for use in an advanced undergraduate or graduate optics laboratory to illustrate experimentally several effects in Fourier optics.

  5. Clinical utility of nivolumab in the treatment of advanced melanoma

    Directory of Open Access Journals (Sweden)

    Asmar R


    Full Text Available Ramsey Asmar,1 Jessica Yang,1 Richard D Carvajal1,2 1Department of Medicine, College of Physicians and Surgeons, 2Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA Abstract: Melanomas are highly immunogenic tumors that evade the immune system by exploiting innate checkpoint pathways, rendering effector T-cells anergic. The immunotherapeutic approach of checkpoint inhibition can restore and invigorate endogenous antitumor T-cell responses and has become an important treatment option for patients with advanced melanoma. The CTLA-4 inhibitor ipilimumab and the PD-1 inhibitors nivolumab and pembrolizumab have been shown to induce durable responses and improve overall survival in metastatic, refractory melanoma. Optimization and validation of pretreatment biomarkers to predict response to these agents is a crucial area of ongoing research. Combination immunotherapy has recently demonstrated superior response rates compared to monotherapy; further investigation is needed to refine combinatorial strategies. Keywords: nivolumab, immune checkpoint inhibitors, PD-1, melanoma

  6. Regulation of Clinical Trials with Advanced Therapy Medicinal Products in Germany. (United States)

    Renner, Matthias; Anliker, Brigitte; Sanzenbacher, Ralf; Schuele, Silke


    In the European Union, clinical trials for Advanced Therapy Medicinal Products are regulated at the national level, in contrast to the situation for a Marketing Authorisation Application, in which a centralised procedure is foreseen for these medicinal products. Although based on a common understanding regarding the regulatory requirement to be fulfilled before conduct of a clinical trial with an Advanced Therapy Investigational Medicinal Product, the procedures and partly the scientific requirements for approval of a clinical trial application differ between the European Union Member States. This chapter will thus give an overview about the path to be followed for a clinical trial application and the subsequent approval process for an Advanced Therapy Investigational Medicinal Product in Germany and will describe the role of the stakeholders that are involved. In addition, important aspects of manufacturing, quality control and non-clinical testing of Advanced Therapy Medicinal Products in the clinical development phase are discussed. Finally, current and future approaches for harmonisation of clinical trial authorisation between European Union Member States are summarised.

  7. Advanced Pre-clinical Research Approaches and Models to Studying Pediatric Anesthetic Neurotoxicity

    Directory of Open Access Journals (Sweden)

    Cheng eWang


    Full Text Available Advances in pediatric and obstetric surgery have resulted in an increase in the duration and complexity of anesthetic procedures. A great deal of concern has recently arisen regarding the safety of anesthesia in infants and children. Because of obvious limitations, it is not possible to thoroughly explore the effects of anesthetic agents on neurons in vivo in human infants or children. However, the availability of some advanced pre-clinical research approaches and models, such as imaging technology both in vitro and in vivo, stem cell and nonhuman primate experimental models, have provided potentially invaluable tools for examining the developmental effects of anesthetic agents. This review discusses the potential application of some sophisticaled research approaches, e.g., calcium imaging, in stem cell-derived in vitro models, especially human embryonic neural stem cells, along with their capacity for proliferation and their potential for differentiation, to dissect relevant mechanisms underlying the etiology of the neurotoxicity associated with developmental exposures to anesthetic agents. Also, this review attempts to discuss several advantages for using the developing rhesus monkey models (in vivo, when combined with dynamic molecular imaging approaches, in addressing critical issues related to the topic of pediatric sedation/anesthesia. These include the relationships between anesthetic-induced neurotoxicity, dose response, time-course and developmental stage at time of exposure (in vivo studies, serving to provide the most expeditious platform toward decreasing the uncertainty in extrapolating pre-clinical data to the human condition.

  8. [Dapoxetine for premature ejaculation: Advances in clinical studies]. (United States)

    Zhou, Ting-you; Li, Yan-feng


    Premature ejaculation (PE) is a most common sexual dysfunction, for which dapoxetine, a novel selective serotonin (5-HT) re-uptake inhibitor (SSRI), is the only licensed oral medicine at present. With the advantages of fast absorption, rapid action, on-demand medication, and short half-life time, dapoxetine has been proved by clinical trials to be effective in prolonging the intravaginal ejaculation latency time (IELT) and improving the overall condition of PE patients in various areas and populations. Compared with the traditional SSRIs, dapoxetine has a better safety and tolerability. The most frequently reported dapoxetine-related adverse events include nausea, diarrhea, headache and dizziness, but with very few severe or serious cases. PMID:26665685

  9. [Research advance on clinical blood transfusion and tumor therapy]. (United States)

    Jiang, Xue-Bing; Zhang, Li-Ping; Wang, Yan-Ju; Ma, Cong


    Clinical blood transfusion is one of the most important supportive therapy for patients with tumor. The blood transfusion has dual effects for patients with tumor. First, blood transfusion can rectify anemia and improve oxygen saturation, accelerate oxidation and necrosis for tumor cells; the second, blood transfusion can induce immunosuppression, tumor recurrence and postoperative infection for tumor patients. Filtering white blood cells (WBC) before blood transfusion can decrease the incidence of the adverse reactions. The rational perioperative autotransfusion for patients with tumors is focus to which the world medical sciences pay close attention. In this article, the support effect of blood transfusion for treatment of tumor patients, blood transfusion and immunosuppression, blood transfusion and postoperative infection and relapse of tumor patients, depleted leukocyte blood transfusion and autologous transfusion of tumor patients are reviewed.

  10. Recent Advances in the Clinical Management of Lead Poisoning.

    Directory of Open Access Journals (Sweden)

    Sina Kianoush


    Full Text Available Lead poisoning is a historic universal disease. Acute or chronic lead exposure may cause reversible or even permanent damages in human beings. Environmental lead exposure is a global health concern in children. Occupational lead poisoning is still a health issue, particularly in developing countries. During the last decades, new methods and medications have been advocated for the prevention and treatment of lead poisoning. This review deals mainly with recent developments in the management of lead poisoning. Sources of lead exposure are introduced, and methods for the primary prevention of lead poisoning are discussed. Details for the screening of adults and children are also explained to serve as a practical guideline for the secondary prevention. Standard chelation therapy in different groups and up-to-date less toxic new medications for the treatment of lead poisoning are finally discussed. Our published clinical research on the therapeutic effects of garlic tablets in mild to moderate occupational lead poisoning will also be discussed.

  11. Why Most Clinical Research Is Not Useful. (United States)

    Ioannidis, John P A


    John Ioannidis argues that problem base, context placement, information gain, pragmatism, patient centeredness, value for money, feasibility, and transparency define useful clinical research. He suggests most clinical research is not useful and reform is overdue. PMID:27328301

  12. Advanced monolithic pixel sensors using SOI technology (United States)

    Miyoshi, Toshinobu; Arai, Yasuo; Asano, Mari; Fujita, Yowichi; Hamasaki, Ryutaro; Hara, Kazuhiko; Honda, Shunsuke; Ikegami, Yoichi; Kurachi, Ikuo; Mitsui, Shingo; Nishimura, Ryutaro; Tauchi, Kazuya; Tobita, Naoshi; Tsuboyama, Toru; Yamada, Miho


    We are developing advanced pixel sensors using silicon-on-insulator (SOI) technology. A SOI wafer is used; top silicon is used for electric circuit and bottom silicon is used as a sensor. Target applications are high-energy physics, X-ray astronomy, material science, non-destructive inspection, medical application and so on. We have developed two integration-type pixel sensors, FPIXb and INTPIX7. These sensors were processed on single SOI wafers with various substrates in n- or p-type and double SOI wafers. The development status of double SOI sensors and some up-to-date test results of n-type and p-type SOI sensors are shown.

  13. Advanced clinical practice for radiographers in Great Britain: professional roles, accountability and the educational provision

    International Nuclear Information System (INIS)

    A change in British health care has resulted in a broadening of roles and responsibilities beyond 'traditional boundaries' for a range of health care professionals. This has occurred because of staff shortages (particularly within the medical profession) and the recognition that many 'non-doctor' health care staff can make safe, competent and effective contributions outside their 'normal' sphere of responsibilities. In the context of advanced clinical practice, this paper will explain the current arrangements for radiographers' roles and responsibilities, their accountability and the educational provision that underpins the development of competencies at these higher clinical levels. Some advanced roles that British radiographers perform, within their current normal responsibilities, will be identified and some British legislation and professional body guidance that make role advancement possible will be outlined. The article will conclude with an indication of the educational level at which the advanced competencies are learned and assessed. (author)

  14. Clinical Application of Total Knee Arthroplasty on Patients with Advanced Knee Osteoarthritis

    Institute of Scientific and Technical Information of China (English)

    WU Zhi-sen; ZHENG Chen-xiao; QI Liang; CHANG Shang-yi


    Objective:To investigate the clinical value of total knee arthroplasty (TKA) on patients with advanced knee osteoarthritis. Methods:The clinical data and efficacy of 26 patients with advanced knee osteoarthritis (26 knees) who were given TKA in our department from June 2012 to May 2013 were retrospectively observed and analyzed. The knee function scores before operation and after follow up were evaluated according to American HSS scoring standard. Results:At the end of follow up, of the 26 patients, 18 were excellent, 6 were good and 2 were not bad in knee function and mobility without sense of pain, which was regarded to be associated with the poor enthusiasm in knee function training, and the total rate of excellent and good was 92.3%. Conclusion:TKA has signiifcant clinical value and favorable efifcacy on patients with advanced knee osteoarthritis.

  15. Vision 20/20: Automation and advanced computing in clinical radiation oncology

    Energy Technology Data Exchange (ETDEWEB)

    Moore, Kevin L., E-mail:; Moiseenko, Vitali [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California 92093 (United States); Kagadis, George C. [Department of Medical Physics, School of Medicine, University of Patras, Rion, GR 26504 (Greece); McNutt, Todd R. [Department of Radiation Oncology and Molecular Radiation Science, School of Medicine, Johns Hopkins University, Baltimore, Maryland 21231 (United States); Mutic, Sasa [Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri 63110 (United States)


    This Vision 20/20 paper considers what computational advances are likely to be implemented in clinical radiation oncology in the coming years and how the adoption of these changes might alter the practice of radiotherapy. Four main areas of likely advancement are explored: cloud computing, aggregate data analyses, parallel computation, and automation. As these developments promise both new opportunities and new risks to clinicians and patients alike, the potential benefits are weighed against the hazards associated with each advance, with special considerations regarding patient safety under new computational platforms and methodologies. While the concerns of patient safety are legitimate, the authors contend that progress toward next-generation clinical informatics systems will bring about extremely valuable developments in quality improvement initiatives, clinical efficiency, outcomes analyses, data sharing, and adaptive radiotherapy.

  16. Biodegradable polymers in clinical use and clinical development

    CERN Document Server

    Domb, Abraham J


    The definitive guide to biodegradable polymer science-where we are and what's to come The most comprehensive review of biodegradable polymers already utilized or under development for clinical use, Biodegradable Polymers in Clinical Use and Clinical Development looks at the state of biodegradable polymers now and over the next five years. Implantable molecules that break down within the body over a predetermined period of time, biodegradable polymers have been employed as drug carriers, orthopedic fixation devices, and absorbable sutures. Yet while hundreds of such polymers have been deve

  17. Clinical and radiographic evaluation of maxillary central incisors exposure in patients undergoing maxillary advancement

    Directory of Open Access Journals (Sweden)

    Guilherme dos Santos Trento


    Full Text Available Abstract Introduction: Patients with dentofacial deformities may undergo orthodontic or orthodontic-surgical treatment. Both modalities can affect esthetics. Objective: This study aims to evaluate clinical and radiographic changes in exposure of maxillary central incisors occurring after orthognathic surgery for maxillary advancement. Methods: A total of 17 patients who underwent orthognathic surgery for maxillary advancement between September, 2010 and July, 2011 were selected. Exposure of maxillary central incisors was evaluated clinically and by lateral cephalograms. Measurements were taken one week before and three months after surgery. Data were paired in terms of sex, age, nasolabial angle, height and thickness of the upper lip, the amount of maxillary advancement, clinical exposure and inclination of maxillary central incisor by statistical tests (CI 95%. Results: After maxillary advancement, incisor clinical exposure had increased even with relaxed lips and under forced smile. Moreover, there was a mean increase of 23.33% revealed by lateral cephalograms. There was an inverse correlation between upper lip thickness and incisors postsurgical exposure revealed by radiographic images (p = 0.002. Conclusions: Significant changes in the exposure of maxillary central incisors occur after maxillary advancement, under the influence of some factors, especially lip thickness.

  18. Advances in basic and clinical immunology in 2014. (United States)

    Chinen, Javier; Notarangelo, Luigi D; Shearer, William T


    Genetic identification of immunodeficiency syndromes has become more efficient with the availability of whole-exome sequencing, expediting the identification of relevant genes and complementing traditional linkage analysis and homozygosity mapping. New genes defects causing immunodeficiency include phophoglucomutase 3 (PGM3), cytidine 5' triphosphate synthase 1 (CTPS1), nuclear factor κB-inducing kinase (NIK), cytotoxic T lymphocyte-associated antigen 4 (CTLA4), B-cell chronic lymphocytic leukemia/lymphoma 10 (BCL10), phosphoinositide-3 kinase regulatory subunit 1 (PIK3R1), IL21, and Jagunal homolog 1 (JAGN1). New case reports expanded the clinical spectrum of gene defects. For example, a specific recombination-activating gene 1 variant protein with partial recombinant activity might produce Omenn syndrome or a common variable immunodeficiency phenotype. Central and peripheral B-cell tolerance was investigated in patients with several primary immunodeficiencies, including common variable immunodeficiency and Wiskott-Aldrich syndrome, to explain the occurrence of autoimmunity and inflammatory disorders. The role of IL-12 and IL-15 in the enhancement of natural killer cell activity was reported. Newborn screening for T-cell deficiency is being implemented in more states and is achieving its goal of defining the true incidence of severe combined immunodeficiency and providing early treatment that offers the highest survival for these patients. Definitive treatment of severe immunodeficiency with both hematopoietic stem cell transplantation and gene therapy was reported to be successful, with increasing definition of conditions needed for optimal outcomes. Progress in HIV infection is directed toward the development of an effective vaccine and the eradication of hidden latent virus reservoirs.

  19. Recent clinical and translational advances in pediatric hypertension. (United States)

    Falkner, Bonita


    Epidemiological reports describe a child population increase in BP level and an increase in prevalence of hypertension, that is largely, but not entirely, driven by a concurrent increase in childhood obesity. Given current estimates, ≈10% of adolescents have hypertension or prehypertension. In addition to obesity, dietary salt intake and waist circumference, a marker of visceral obesity, are found to be independently associated with the rise in BP among children and adolescents. Dietary salt intake in urban children is well above recommended levels largely because of consumption of processed and fast foods. Childhood exposures, such as stress,52 salt, and fructose, as well as lifestyles, including food sources, sleep patterns, and reductions in physical activity may have a role in obesity-high BP associations. In addition, clinical and translational evidence is mounting that intrauterine exposures alter can effect changes in fetal development that have an enduring effect on cardiovascular and metabolic function later in life. These effects can be detected even in children who are products of a term otherwise normal pregnancy. Hypertension in childhood has been defined statistically (BP ≥ 95th percentile) because of lack of outcome data that links a BP level with heightened risk for future cardiovascular events. Therefore, primary hypertension had been considered a risk factor for later hypertension in adulthood. Intermediate markers of TOD, including cardiac hypertrophy, vascular stiffness, and increases in cIMT, are detectable in adolescents with primary hypertension. Evidence that vascular injury is present in the early phase of hypertension and even in prehypertension warrants consideration on the current definition of pediatric hypertension. With further studies on TOD and other risk factors in addition to high BP, it may be possible to shift from a statistical definition to a definition of childhood hypertension that is evidence based. Preventing or

  20. Recent advances in computational methods and clinical applications for spine imaging

    CERN Document Server

    Glocker, Ben; Klinder, Tobias; Li, Shuo


    This book contains the full papers presented at the MICCAI 2014 workshop on Computational Methods and Clinical Applications for Spine Imaging. The workshop brought together scientists and clinicians in the field of computational spine imaging. The chapters included in this book present and discuss the new advances and challenges in these fields, using several methods and techniques in order to address more efficiently different and timely applications involving signal and image acquisition, image processing and analysis, image segmentation, image registration and fusion, computer simulation, image based modeling, simulation and surgical planning, image guided robot assisted surgical and image based diagnosis. The book also includes papers and reports from the first challenge on vertebra segmentation held at the workshop.

  1. Evaluating advanced LMR reactivity feedbacks using SSC

    International Nuclear Information System (INIS)

    Analyses of the PRISM and SAFR liquid metal reactor transients, using SSC, are discussed. These two advanced reactors incorporate innovative approaches to safety, utilizing passive rather than active engineered safety systems. A key feature of these designs is their reliance on the inherent negative reactivity feedbacks of the metal fuel to accommodate unscrammed events passively. These feedbacks include Doppler, sodium density, and thermal expansion of the reactor and the control rod drive lines. Each of these feedbacks is discussed, as is the modeling implemented into the SSC code. These calculations provide an independent evaluation of the proposed reactors, and show how the reactivity feedbacks can provide an inherent shutdown in response to key anticipated events. The results from the SSC calculations support the contention that the inherent reactivity feedbacks can provide an extra degree of safety for the proposed liquid metal reactors

  2. ALADIN - Advanced Laue Diffraction Instruments using Neutrons

    International Nuclear Information System (INIS)

    Laue diffraction techniques have proven to be very attractive to a broad user community interested in obtaining detailed structural information on very small single-crystal samples or needing data collection speeds comparable to those available with the powder diffraction technique. However our experience has clearly demonstrated the negative effect of up-stream monochromatic instruments on the quality of Laue data. In order to obtain Laue diffraction data with a statistical accuracy similar to that achieved on a monochromatic instrument (neutron or X-rays), the project ALADIN (for Advanced Laue Diffraction Instruments using Neutrons) aims to: -) construct a Laue-dedicated thermal neutron guide, with m=2 super-mirror coating, providing access to the desirable wavelength bandwidth; -) installation of one of the ILL Laue diffractometers (VIVALDI or CYCLOPS) on this new guide. (authors)

  3. Using Disguised Clinical Case Material (United States)

    Kantrowitz, Judy L.


    When, why, and how clinicians decide to write about clients are ethical concerns. There are risks and potential clinical ramifications as well as responsibilities for how these decisions are made. On the basis of 141 interviews with psychoanalysts who have published in 3 major national and international psychoanalytic journals, the author explores…

  4. Myositis registries and biorepositories: powerful tools to advance clinical, epidemiologic and pathogenic research (United States)

    Rider, Lisa G.; Dankó, Katalin; Miller, Frederick W.


    Purpose of review Clinical registries and biorepositories have proven extremely useful in many studies of diseases, especially rare diseases. Given their rarity and diversity, the idiopathic inflammatory myopathies, or myositis syndromes, have benefited from individual researchers’ collections of cohorts of patients. Major efforts are being made to establish large registries and biorepositories that will allow many additional studies to be performed that were not possible before. Here we describe the registries developed by investigators and patient support groups that are currently available for collaborative research purposes. Recent findings We have identified 46 myositis research registries, including many with biorepositories, which have been developed for a wide variety of purposes and have resulted in great advances in understanding the range of phenotypes, clinical presentations, risk factors, pathogenic mechanisms, outcome assessment, therapeutic responses, and prognoses. These are now available for collaborative use to undertake additional studies. Two myositis patient registries have been developed for research, and myositis patient support groups maintain demographic registries with large numbers of patients available to be contacted for potential research participation. Summary Investigator-initiated myositis research registries and biorepositories have proven extremely useful in understanding many aspects of these rare and diverse autoimmune diseases. These registries and biorepositories, in addition to those developed by myositis patient support groups, deserve continued support to maintain the momentum in this field as they offer major opportunities to improve understanding of the pathogenesis and treatment of these diseases in cost-effective ways. PMID:25225838

  5. Current Molecular Targeted Therapy in Advanced Gastric Cancer: A Comprehensive Review of Therapeutic Mechanism, Clinical Trials, and Practical Application

    Directory of Open Access Journals (Sweden)

    Kaichun Li


    Full Text Available Despite the great progress in the treatment of gastric cancer, it is still the third leading cause of cancer death worldwide. Patients often miss the opportunity for a surgical cure, because the cancer has already developed into advanced cancer when identified. Compared to best supportive care, chemotherapy can improve quality of life and prolong survival time, but the overall survival is often short. Due to the molecular study of gastric cancer, new molecular targeted drugs have entered the clinical use. Trastuzumab, an antibody targeting human epidermal growth factor receptor 2 (HER2, can significantly improve survival in advanced gastric cancer patients with HER2 overexpression. Second-line treatment of advanced gastric cancer with ramucirumab, an antibody targeting VEGFR-2, alone or in combination with paclitaxel, has been proved to provide a beneficial effect. The VEGFR-2 tyrosine kinase inhibitor, apatinib, can improve the survival of advanced gastric cancer patients after second-line chemotherapy failure. Unfortunately, none of the EGFR targeting antibodies (cetuximab or panitumumab, VEGF targeting monoclonal antibodies (bevacizumab, mTOR inhibitor (everolimus, or HGF/MET pathway targeting drugs has a significant survival benefit. Many other clinical trials based on molecular markers are underway. This review will summarize targeted therapies for advanced gastric cancer.

  6. Clinical Study of Endostar Combined with DP Protocol in Treatment of Advanced Esophageal Cancer

    Directory of Open Access Journals (Sweden)

    Wen-ying DENG


    Full Text Available Objective: To observe the clinical outcomes of Endostar combined with DP regimen for treating advanced esophageal cancer.Methods: A total of 62 patients with advanced esophageal cancer admitted from May, 2011 to May, 2013 were enrolled for a prospective, randomized controlled trial and 2 cases were excluded from the study because of Ⅳ degree of digestive tract reaction and myelosuppression. Therefore, 60 cases could be evaluated, and then divided into combined group (given Endostar+DP plan and single chemotherapy group, 30 cases in each group. The level of VEGF, tumor size and CT perfusion (CTP parameters, including blood flow (BF, blood volume (BV, mean transit time (MTT, and permeability surface (PS before and after treatment were determined for comparison. Kaplan-Merier method was used to analyze the overall survival (OS of 2 groups.Results: The efficacy of combined group was superior to single chemotherapy group. The level of vascular endothelial growth factor (VEGF in combined group was obviously lower than that in single chemotherapy group after treatment (P<0.01. Compared with treatment before in combined group, BF, BV and PS decreased while MTT increased after treatment (P<0.05. However, there were no significant differences in single chemotherapygroup before and after treatment (P>0.05. The median OS was 30 months (95%CI: 20.935-39.065 for combined group and 21 months (95%CI: 15.109-26.591 for single chemotherapy group, respectively (P=0.048. The 1-, 2- and 3-year survival rates were 86.2%, 59.3% and 36.6% in combined group, and 70.8%, 32.1% and 17.8% in single chemotherapy group, respectively.Conclusion: Endostar can down-regulate the expression of VEGF, improve the state of hypertransfusion and high permeability of tumor vessels, has better curative effect without slighter adverse reactions, and prolong the survival time of patients with advanced esophageal cancer when combined with chemotherapy.

  7. Clinical Study of Endostar Combined with DP Protocol in Treatment of Advanced Esophageal Cancer

    Institute of Scientific and Technical Information of China (English)

    DENG Wen-ying; LI Ning; LUO Su-xia


    Objective: To observe the clinical outcomes of Endostar combined with DP regimen for treating advanced esophageal cancer. Methods: A total of 62 patients with advanced esophageal cancer admitted from May, 2011 to May, 2013 were enrolled for a prospective, randomized controlled trial and 2 cases were excluded from the study because ofⅣ degree of digestive tract reaction and myelosuppression. Therefore, 60 cases could be evaluated, and then divided into combined group (given Endostar+DP plan) and single chemotherapy group, 30 cases in each group. The level of VEGF, tumor size and CT perfusion (CTP) parameters, including blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability surface (PS) before and after treatment were determined for comparison. Kaplan-Merier method was used to analyze the overall survival (OS) of 2 groups. Results:The efifcacy of combined group was superior to single chemotherapy group. The level of vascular endothelial growth factor (VEGF) in combined group was obviously lower than that in single chemotherapy group after treatment (P0.05). The median OS was 30 months (95%CI: 20.935-39.065) for combined group and 21 months (95%CI: 15.109-26.591) for single chemotherapy group, respectively (P=0.048). The 1-, 2- and 3-year survival rates were 86.2%, 59.3% and 36.6% in combined group, and 70.8%, 32.1% and 17.8% in single chemotherapy group, respectively. Conclusion: Endostar can down-regulate the expression of VEGF, improve the state of hypertransfusion and high permeability of tumor vessels, has better curative effect without slighter adverse reactions, and prolong the survival time of patients with advanced esophageal cancer when combined with chemotherapy.

  8. Molecular Biology of Pancreatic Cancer: How Useful Is It in Clinical Practice?


    Sakorafas, George H; Vasileios Smyrniotis


    Context During the recent two decades dramatic advances of molecular biology allowed an in-depth understanding of pancreatic carcinogenesis. It is currently accepted that pancreatic cancer has a genetic component. The real challenge is now how these impressive advances could be used in clinical practice. Objective To critically present currently available data regarding clinical application of molecular biology in pancreatic cancer. Methods Reports about clinical implications of molecular bio...

  9. Advanced optic fabrication using ultrafast laser radiation (United States)

    Taylor, Lauren L.; Qiao, Jun; Qiao, Jie


    Advanced fabrication and finishing techniques are desired for freeform optics and integrated photonics. Methods including grinding, polishing and magnetorheological finishing used for final figuring and polishing of such optics are time consuming, expensive, and may be unsuitable for complex surface features while common photonics fabrication techniques often limit devices to planar geometries. Laser processing has been investigated as an alternative method for optic forming, surface polishing, structure writing, and welding, as direct tuning of laser parameters and flexible beam delivery are advantageous for complex freeform or photonics elements and material-specific processing. Continuous wave and pulsed laser radiation down to the nanosecond regime have been implemented to achieve nanoscale surface finishes through localized material melting, but the temporal extent of the laser-material interaction often results in the formation of a sub-surface heat affected zone. The temporal brevity of ultrafast laser radiation can allow for the direct vaporization of rough surface asperities with minimal melting, offering the potential for smooth, final surface quality with negligible heat affected material. High intensities achieved in focused ultrafast laser radiation can easily induce phase changes in the bulk of materials for processing applications. We have experimentally tested the effectiveness of ultrafast laser radiation as an alternative laser source for surface processing of monocrystalline silicon. Simulation of material heating associated with ultrafast laser-material interaction has been performed and used to investigate optimized processing parameters including repetition rate. The parameter optimization process and results of experimental processing will be presented.

  10. The Clinical Impact of Recent Advances in LC-MS for Cancer Biomarker Discovery and Verification

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Hui; Shi, Tujin; Qian, Weijun; Liu, Tao; Kagan, Jacob; Srivastava, Sudhir; Smith, Richard D.; Rodland, Karin D.; Camp, David G.


    Mass spectrometry-based proteomics has become an indispensable tool in biomedical research with broad applications ranging from fundamental biology, systems biology, and biomarker discovery. Recent advances in LC-MS have made it become a major technology in clinical applications, especially in cancer biomarker discovery and verification. To overcome the challenges associated with the analysis of clinical samples, such as extremely wide dynamic range of protein concentrations in biofluids and the need to perform high throughput and accurate quantification, significant efforts have been devoted to improve the overall performance of LC-MS bases clinical proteomics. In this review, we summarize the recent advances in LC-MS in the aspect of cancer biomarker discovery and quantification, and discuss its potentials, limitations, and future perspectives.


    Directory of Open Access Journals (Sweden)

    Oleksandr Luppo


    Full Text Available Purpose: Concept of Flexible Use of Airspace (FUA allows to eliminate many problems on the basis of civil-military coordination, but there are still a lot of areas for improvement. These improvements will be implemented in the Advanced Flexible Use of Airspace (AFUA concept. Methods: We examine the airspace structure in the frames of AFUA concept, which includes variable profile areas, temporary reserved and temporary segregated areas, danger or restricted areas. Mission Trajectory in AFUA which allows designing ad-hoc structures delineation at short notice is also examined. Regarding the performance enhancements of AFUA we compare these with FUA concept. Examination of AFUA structure gives us better view of the functions and opportunities of this concept. Result: AFUA concept provides many advantages for the civil aviation stakeholders and includes many other positive sides. Variable Profile Areas provide more flexibility, particularly in a high density traffic area and any combination of basic volume possible. Collaborative decision-making will increase the situational awareness of both parties and help to decrease the transit between airbases and training areas, allows military to use larger airspaces for missions on an absolute time-limited basis. As a result of mission trajectory implementation in AFUA concept general air traffic crossing are possible in all type of airspace structures, after coordination or under specific permanent agreements. The use of Centralized AFUA Services will allow the central collection, integration and provision of ASM data in support of continuous collaborative network processes, in such a way improving operational performance during the planning and execution phases (predictability, flexibility, better use of capacity, enhanced flight efficiency, real time sharing of information, better management of available airspace. Discussion: Given the important contribution that AFUA brings into air traffic management

  12. Application of next-generation sequencing in clinical oncology to advance personalized treatment of cancer

    Institute of Scientific and Technical Information of China (English)

    Yan-Fang Guan; Gai-Rui Li; Rong-Jiao Wang; Yu-Ting Yi; Ling Yang; Dan Jiang; Xiao-Ping Zhang; Yin Peng


    With the development and improvement of new sequencing technology,next-generation sequencing (NGS) has been applied increasingly in cancer genomics research over the past decade.More recently,NGS has been adopted in clinical oncology to advance personalized treatment of cancer.NGS is used to identify novel and rare cancer mutations,detect familial cancer mutation carriers,and provide molecular rationale for appropriate targeted therapy.Compared to traditional sequencing,NGS holds many advantages,such as the ability to fully sequence all types of mutations for a large number of genes (hundreds to thousands) in a single test at a relatively low cost.However,significant challenges,particularly with respect to the requirement for simpler assays,more flexible throughput,shorter turnaround time,and most importantly,easier data analysis and interpretation,will have to be overcome to translate NGS to the bedside of cancer patients.Overall,continuous dedication to apply NGS in clinical oncology practice will enable us to be one step closer to personalized medicine.

  13. Research advances in drug resistance mechanisms of Enterobacter cloacae against clinical commonly used antibiotics%阴沟肠杆菌对临床常用抗菌药物耐药机制的研究进展

    Institute of Scientific and Technical Information of China (English)

    王凤霞; 宿振国


    Enterobacter cloacae is a common clinical conditioned pathogen,which could cause a variety of hospital infections when body immunity decreases.It is very difficult to achieve a successful clinical anti-infective therapy against multiple drug resistant and even pan-drug resistant Enterobacter cloacae infection.This review is mainly about drug resistance mechanisms of Enterobacter cloacae,including the production of aminoglycoside-modifying enzymes(AMEs) and various of enzymes to inactivate antibiotics,the formation of biofilm and the mobile gene elements,so as to provide evidences for rational drug use and new drug discovery.%阴沟肠杆菌是临床常见的一种条件致病菌,在机体体抗力下降时可引起各种医院感染,其多重耐药甚至泛耐药给临床抗感染治疗带来极大困难.此文就阴沟肠杆菌的主要耐药机制作一综述,包括产生氨基糖苷修饰酶及灭活抗生素的各种酶、生物被膜的形成及可移动基因元件等参与的耐药,为临床合理用药及新药开发提供依据.

  14. Serum levels of MMP-11 correlate with clinical outcome in Chinese patients with advanced gastric adenocarcinoma

    International Nuclear Information System (INIS)

    The aim of the present study was to investigate the association between serum levels of matrix metalloproteinase 11 (MMP-11) and responses to front-line chemotherapy and prognosis in advanced unresectable gastric adenocarcinoma. Clinical data concerning 86 patients with advanced gastric adenocarcinoma (stages III c to IV), treated in Beijing Chao-Yang Hospital from 2005 to 2009, were reviewed retrospectively. Adenocarcinoma was confirmed by pathology and patients received 5-fluorouracil-based front-line combination chemotherapy with third generation chemotherapeutic agents including paclitaxel, docetaxel and oxaliplatin. The regimen was repeated every two to three weeks, and the first evaluation was carried out after three cycles. The median cycle of chemotherapy was 6 (ranging from three to twelve cycles). Serum MMP-11 protein from the 86 patients was examined using enzyme-linked-immunosorbent-assay (ELISA) prior to chemotherapy and after three cycles of chemotherapy. Serum samples from healthy individuals were used as controls. The response rate (RR, complete response plus partial response) to chemotherapy in the 86 patients was 44.2% (38/86). The median TTP (time to progression) and overall survival (OS) in patients who responded to chemotherapy were 6.0 and 10.0 months, respectively. The response rate to chemotherapy in patients with high levels of serum MMP-11 (42.9%; 9/21) was similar to that in patients with low levels (44.6%; 29/65) (P = 0.935). Patients with low serum levels of MMP-11 had a higher median survival time and 1-year survival rate than those with high levels (11 months vs. 8 months, 50.2% vs. 21.7%, P = 0.017), although the TTP was comparable in all patients, irrespective of serum MMP-11 level (P = 0.178). Serum MMP-11 levels were correlated with lymph node metastasis (P = 0.006). Cox multivariate regression analysis demonstrated that the serum level of MMP-11 was an independent prognostic factor for patients presenting with advanced gastric

  15. The impact of smoking on the clinical outcome of locoregionally advanced nasopharyngeal carcinoma after chemoradiotherapy

    International Nuclear Information System (INIS)

    Cigarette smoking is a common risk factor for developing nasopharyngeal carcinoma. However, the relationship between smoking and clinical outcomes remains uncertain. The patients who participated in this study were drawn from a randomized clinical trial, for which the purpose was to compare the efficacy of induction chemotherapy plus concurrent chemoradiotherapy with that of induction chemotherapy plus radiotherapy in patients with locoregionally advanced nasopharyngeal carcinoma. The patients who ever smoked were divided into the following categories of cumulative smoking exposure based on the duration of smoking and the quantity of cigarettes smoked: light, short-term smokers; light, long-term smokers; heavy, short-term smokers; and heavy, long-term smokers. A log-rank test and Cox models were used to assess the association between smoking and the clinical outcomes of overall survival (OS), failure-free survival (FFS), locoregional recurrence failure-free survival (LRFFS) and distant failure-free survival (DFFS). We found that ever-smokers experienced significantly shorter LRFFS times than never-smokers (5-year LRFFS rates: 85.8% vs. 88.5%, P = 0.022). The amount of smoking was significantly associated with FFS (P = 0.046) and LRFFS (P = 0.001) in the different ever-smoker groups. The amount of smoking was associated with LRFFS [P = 0.002, HR = 2.069 (95% confident interval (CI), 1.298-3.299)] even after a multivariable adjustment. Smoking increases the risk of locoregional recurrence. Furthermore, the amount of smoking influences the prognosis of smokers, and these effects are dose-dependent

  16. Current technological advances in magnetic resonance with critical impact for clinical diagnosis and therapy. (United States)

    Runge, Val M


    The last 5 years of technological advances with major impact on clinical magnetic resonance (MR) are discussed, with greater emphasis on those that are most recent. These developments have already had a critical positive effect on clinical diagnosis and therapy and presage continued rapid improvements for the next 5 years. This review begins with a discussion of 2 topics that encompass the breadth of MR, in terms of anatomic applications, contrast media, and MR angiography. Subsequently, innovations are discussed by anatomic category, picking the areas with the greatest development, starting with the brain, moving forward to the liver and kidney, and concluding with the musculoskeletal system, breast, and prostate. Two final topics are then considered, which will likely, with time, become independent major fields in their own right, interventional MR and MR positron emission tomography (PET).The next decade will bring a new generation of MR contrast media, with research focused on substantial improvements (>100-fold) in relaxivity (contrast effect), thus providing greater efficacy, safety, and tissue targeting. Magnetic resonance angiography will see major advances because of the use of compressed sensing, in terms of spatial and temporal resolution, with movement away from nondynamic imaging. The breadth of available techniques and tissue contrast has greatly expanded in brain imaging, benefiting both from the introduction of new basic categories of imaging techniques, such as readout-segmented echo planar imaging and 3D fast spin echo imaging with variable flip angles, and from new refinements specific to anatomic areas, such as double inversion recovery and MP2RAGE. Liver imaging has benefited from the development of techniques to easily and rapidly assess lipid, and will see, overall, a marked improvement in the next 5 years from new techniques on the verge of clinical introduction, such as controlled aliasing in parallel imaging results in higher acceleration

  17. Clinical Decision Support Systems: A Useful Tool in Clinical Practice

    Directory of Open Access Journals (Sweden)

    Kolostoumpis G.


    Full Text Available The possibility of supporting in decision – making shows an increase in recent years. Based on mathematic simulation tools, knowledge databases, processing methods, medical data and methods, artificial intelligence for coding of the available knowledge and for resolving complex problems arising into clinical practice. Aim: the aim of this review is to present the development of new methods and modern services, in clinical practice and the emergence in their implementation. Data and methods: the methodology that was followed included research of articles that referred to health sector and modern technologies, at the electronic data bases “pubmed” and “medline”. Results: Is a useful tool for medical experts using characteristics and medical data used by the doctors. Constitute innovation for the medical community, and ensure the support of clinical decisions with an overall way by providing a comprehensive solution in the light of the integration of computational decision support systems into clinical practice. Conclusions: Decision Support Systems contribute to improving the quality of health services with simultaneous impoundment of costs (i.e. avoid medical errors

  18. Recurrent miscarriage is a useful and valid clinical concept

    DEFF Research Database (Denmark)

    Christiansen, Ole B


    favorable. Believers of the latter hypothesis think that treatments aimed at the woman may improve pregnancy outcome, but that testing of such treatments in randomized controlled trials is needed. In this article in favor of RM being a specific and useful clinical concept, arguments are advanced......Although epidemiological, clinical and biochemical risk factors are known for recurrent miscarriage (RM), the etiology is mainly unknown. Two main hypotheses dominate: that RM is mainly caused by aneuploid conceptions and other conception errors and that the recurrence rate is explained...

  19. Gold Nanoparticles and Nanocomposites in Clinical Diagnostics Using Electrochemical Methods

    Directory of Open Access Journals (Sweden)

    Pranjal Chandra


    Full Text Available Progress and development in clinical diagnostics certainly focus upon the advances in the nanomaterials, particularly gold nanoparticles (AuNPs that offer promise to solve the biocompatible and sensitive detection systems. This paper focuses on the recent application of AuNPs in clinical diagnosis. Various important methods of AuNPs synthesis and their application in clinical detection of various biomolecules using electrochemical detection methods have been described. AuNPs alone and in various composites are also described based on the various biosensors design recently published for the detection of cancer biomarkers, proteins, bacteria, and cancer cells. The effect of AuNPs type and size in clinical detection has also been briefly illustrated.

  20. Standardizing clinical laboratory data for secondary use


    Abhyankar, Swapna; Demner-Fushman, Dina; McDonald, Clement J.


    Clinical databases provide a rich source of data for answering clinical research questions. However, the variables recorded in clinical data systems are often identified by local, idiosyncratic, and sometimes redundant and/or ambiguous names (or codes) rather than unique, well-organized codes from standard code systems. This reality discourages research use of such databases, because researchers must invest considerable time in cleaning up the data before they can ask their first research que...

  1. Clinical Effects for Patients with Recurrent Advanced Non-small Cell Lung Cancer Treated with Icotinib Hydrochloride

    Directory of Open Access Journals (Sweden)

    Jingying NONG


    Full Text Available Background and objective Icotinib hydrochloride is the third single target EGFR-TKI used in clinical treatment of advanced non-small cell lung cancer (NSCLC. Clinical research reports on its efficacy and survival in patients with Recurrent Advanced NSCLC are still little.The aim of this study is to evaluate the efficacy and survival of Icotinib hydrochloride for patients with advanced non-small cell lung cancer who failed to previous chemotherapy and explore the association of clinical features with the efficacy and survival. Methods The clinical data of 60 NSCLC patients referred to the Beijing Chest Hospital, Capital Medical University from March 2009 to July 2012 were retrospectively analyzed. Results The overall response rate (ORR was 45.0% and the disease control rate (DCR was 80.0%. The median progression-free survival (PFS time was 6.7 months. RR and PFS in female were superior to male (P=0.014, 0.013, respectively. RR, DCR in 2nd-line subgroup were superior to ≥3rd-line subgroup (P=0.020, 0.024, respectively. RR, DCR and PFS in EGFR mutation carriers were significantly superior to wild-type patients (P=0.006, <0.001, 0.002, respectively . There was no statistical difference in RR and PFS between those age <65 and ≥65 or PS<2 and PS≥2. There was no statistical difference in RR and DCR between exon 19 deletion and exon 21 mutations, while the former had much longer PFS (P=0.020. EGFR mutation and exon 19 deletion are the independent prognostic factors to significantly improve the PFS (P=0.009, 0.012, respectively. The side effects were generally mild and consisted of rash and diarrhea. Conclusion Icotinib hydrochloride is effective especially in EGFR mutation carriers and well tolerated in patients with recurrent advanced non-small-cell lung cancer.

  2. Weather Prediction Improvement Using Advanced Satellite Technology (United States)

    Einaudi, Franco; Uccellini, L.; Purdom, J.; Rogers, D.; Gelaro, R.; Dodge, J.; Atlas, R.; Lord, S.


    We discuss in this paper some of the problems that exist today in the fall utilization of satellite data to improve weather forecasts and we propose specific recommendations to solve them. This discussion can be viewed as an aspect of the general debate on how best to organize the transition from research to operational satellites and how to evaluate the impact of a research instrument on numerical weather predictions. A method for providing this transition is offered by the National Polar-Orbiting Operational Environmental Satellite System (NPOESS) Preparatory Project (NPP). This mission will bridge the time between the present NOAA and Department of Defense (DOD) polar orbiting missions and the initiation of the converged NPOESS series and will evaluate some of the Earth Observing System (EOS) instruments as appropriate for operational missions. Thus, this mission can be viewed as an effort to meet the operational requirements of NOAA and DOD and the research requirements of NASA. More generally, however, it can be said that the process of going from the conception of new, more advanced instruments to their operational implementation and full utilization by the weather forecast communities is not optimal. Instruments developed for research purposes may have insufficient funding to explore their potential operational capabilities. Furthermore, instrument development programs designed for operational satellites typically have insufficient funding for assimilation algorithms needed to transform the satellite observations into data that can be used by sophisticated global weather forecast models. As a result, years often go by before satellite data are efficiently used for operational forecasts. NASA and NOAA each have unique expertise in the design of satellite instruments, their use for basic and applied research and their utilization in weather and climate research. At a time of limited resources, the two agencies must combine their efforts to work toward common

  3. Clinical Research of Crizotinib in Advanced Non-small Cell Lung Cancer

    Directory of Open Access Journals (Sweden)

    Haibo ZHU


    Full Text Available At present, in the treatment of non-small cell lung cancer (NSCLC, targeted therapy has an important status. After epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKIs, crizotinib targeted at EML4-ALK fusion gene becomes a significant drug of molecular targeted therapy in NSCLC. Phase I and II clinical trials prove that crizotinib is effective for treatment of activating EML4-ALK mutation in advanced NSCLC patients, little side-effect, and well tolerated. Recently, crizotinib can inhibit ROS1 receptor tyrosine kinase and show extraordinary significant antitumor activity in ROS1-rearranged NSCLC. Drug resistance also exists in crizotinib. The mechanism of drug resistance needs further research. In this study, a review is performed in the mechanism and pharmacokinetics of crizotinib, and the clinical progress of treatment in advanced NSCLC.

  4. High intensity focused ultrasound treatment of small renal masses: Clinical effectiveness and technological advances


    Nabi, G; Goodman, C; Melzer, A.


    The review summarises the technological advances in the application of high-intensity focused ultrasound for small renal masses presumed to be cancer including the systematic review of its clinical application. Current progress in the area of magnetic resonance image guided ultrasound ablation is also appraised. Specifically, organ tracking and real time monitoring of temperature changes during the treatment are discussed. Finally, areas of future research interest are outlined.

  5. Using Clinical Cases to Teach General Chemistry (United States)

    Dewprashad, Brahmadeo; Kosky, Charles; Vaz, Geraldine S.; Martin, Charlotte L.


    A clinical study was designed and used to show the relationship of health and medicine, in a typical clinical scenario, where many chemical principles are involved and that an integrated knowledge of chemistry and biology is essential to the understanding, diagnosing and treating of illnesses. A case study would be a positive learning experience…

  6. A Method for Increasing Elders' Use of Advance Directives. (United States)

    Luptak, Marilyn K.; Boult, Chad


    Studied effectiveness of intervention to help frail elders to record advance directives (ADs). In collaboration with physicians and lay volunteer, social worker provided information/counseling to elderly subjects, families, and proxies in series of visits to geriatric evaluation and management clinic. Seventy-one percent of subjects recorded ADs.…

  7. Multiple Pathogen Detection Using Biosensors: Advancements and Challenges (United States)

    Advancements in biosensor research have considerably impacted clinical diagnostics for human health. Efforts in capitalizing on the sensitivity of biosensors for food pathogen detection are evident in the food safety/security research community. For practical application with foods that normally h...

  8. The clinical observation of neoadjuvant chemotherapy in locally advanced breast cancer with DX regimen

    Institute of Scientific and Technical Information of China (English)

    Miao Zhang; Jianing Qiu; Shuxian Qu; Yaling Han; Zhaozhe Liu; Xiaodong Xie


    Objective:The recent clinical curative ef ect and adverse events of docetaxel and capecitabine (DX) of neo-adjuvant chemotherapy in patients with local y advanced breast cancer was discussed. Methods:The data of 72 cases of neoadjuvant chemotherapy (DX) in local y advanced breast cancer after 4 cycles were retrospectively analyzed. Docetaxel 75 mg/m2 by infusion 1 h on d1, capecitabine 2000 mg/m2 by oral for twice daily on d1–14, 21 days was a cycle. Results:Al 72 patients were assessed for ef icacy and adverse events. The total ef ective rate was 80.5%(58/72), including pathological complete response (pCR) was 7 (9.7%), clinical complete remission (cCR) was 15(20.8%), clinical partial response (PR) was 43 (59.7%), stable disease (SD) was 8 (11.1%) and progressive disease (PD) was 6 (8.3%). The main adverse events were gastrointestinal reactions and bone marrow suppression. The 3 to 4 degrees of adverse reactions including granulocytopenia in 7 patients (20.6%), hand-foot syndrome in 6 patients (15.2%). Conclusion:The DX regimen provide a favorable ef icacy and safety profile in patients with local y advanced breast cancer for neoadjuvant chemotherapy.

  9. Traumatic brain injury: advanced multimodal neuromonitoring from theory to clinical practice. (United States)

    Cecil, Sandy; Chen, Patrick M; Callaway, Sarah E; Rowland, Susan M; Adler, David E; Chen, Jefferson W


    Traumatic brain injury accounts for nearly 1.4 million injuries and 52 000 deaths annually in the United States. Intensive bedside neuromonitoring is critical in preventing secondary ischemic and hypoxic injury common to patients with traumatic brain injury in the days following trauma. Advancements in multimodal neuromonitoring have allowed the evaluation of changes in markers of brain metabolism (eg, glucose, lactate, pyruvate, and glycerol) and other physiological parameters such as intracranial pressure, cerebral perfusion pressure, cerebral blood flow, partial pressure of oxygen in brain tissue, blood pressure, and brain temperature. This article highlights the use of multimodal monitoring in the intensive care unit at a level I trauma center in the Pacific Northwest. The trends in and significance of metabolic, physiological, and hemodynamic factors in traumatic brain injury are reviewed, the technical aspects of the specific equipment used to monitor these parameters are described, and how multimodal monitoring may guide therapy is demonstrated. As a clinical practice, multimodal neuromonitoring shows great promise in improving bedside therapy in patients with traumatic brain injury, ultimately leading to improved neurological outcomes. PMID:20592189

  10. The Clinical Significance of Cathepsin D and p53 Expression in Locally Advanced Rectal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jun-Sang; Lee, Sheng-Jin; Kim, Jin-Man; Cho, Moon-June [Chungnam National University, Daejeon (Korea, Republic of)


    Cathepsin D (CD) is a lysosomal acid proteinase that is related to malignant progression, invasion, and a poor prognosis in several tumors. The aim of this study was to evaluate the prognostic clinical significance of CD and p53 expression in pretreatment biopsy specimens from patients with locally advanced rectal cancer who were treated with preoperative chemoradiation. Eighty-nine patients with locally advanced rectal cancer (cT3/T4 or N+) were included in this study. Preoperative chemoradiation consisted of a dose of 50.4 Gy of pelvic radiation and two concurrent cycles of administration of 5-fluorouracil and leucovorin. Surgery was performed six weeks after chemoradiation. CD and p53 expression in pretreatment formalin-fixed paraffin-embedded tumor biopsy specimens were assessed by immunohistochemical staining using a CD and p53 monoclonal antibodies. The threshold value for a positive stain in tumor tissue and stromal cells was 1+ intensity in 10% of the tumors or stromal cells, respectively. Positive CD expression was found in 57 (64%) of the tumors and 32 (35%) of the stromal cell specimens. There was no association with CD expression of the tumor or stromal cells and patient characteristics. There was a correlation between tumor CD expression with stromal cell CD expression (p=0.01). Overexpression of p53 was not a significant prognostic factor. The 5-year overall survival (OS) and disease-free survival (DFS) rates were not different between tumor CD-negative and positive patient biopsy samples (69% vs. 65%, 60% vs. 61%, respectively). The 5-year OS rates in the tumor-negative/stromal cell-negative, tumor-negative/stromal cell-positive, tumor-positive/stromal cell-negative and tumor-positive/ stromal cell-positive biopsy samples were 75%, 28%, 62%, and 73%, respectively. Stromal cell staining only without positive tumor staining demonstrated the worst overall survival prognosis for patients (p=0.013). Overexpression of p53 in rectal biopsy tissue was not

  11. Residency training in advance care planning: can it be done in the outpatient clinic? (United States)

    Alderman, Jeffrey S; Nair, Baishali; Fox, Mark D


    Resident physicians are expected to assist their outpatients to understand and complete advance directives, but their efficacy in doing so remains uncertain. After receiving educational training, internal medicine residents identified at-risk patients and solicited them about advance directives. Residents completed pretest and posttest questionnaires that assessed their knowledge, skills, attitude, and comfort with advance directives. Patients were also surveyed about their attitudes regarding advance directives. Ten internal medicine residents and 88 patients participated. Residents' self-assessed knowledge rose from 6.0 to 9.2 on a 10-point Likert scale. Skills using advance directives increased from 4.0 to 7.9, attitudes improved from 6.0 to 8.4, and comfort rose from 5.4 to 8.9. Eighty-four percent of patients expressed interest in completing advance directives, and 16% actually completed documents. An educational intervention improved knowledge, skills, attitudes, and comfort with advance directives among internal medicine residents practicing in the outpatient setting. Meanwhile, patients demonstrated a strong interest in completing advance directives.

  12. Professional excellence and career advancement in nursing: a conceptual framework for clinical leadership development. (United States)

    Adeniran, Rita Kudirat; Bhattacharya, Anand; Adeniran, Anthony A


    Increasingly, stakeholders in the health care community are recognizing nursing as key to solving the nation's health care issues. This acknowledgment provides a unique opportunity for nursing to demonstrate leadership by developing clinical nurse leaders to collaborate with the multidisciplinary care team in driving evidence-based, safe quality, cost-effective health care services. One approach for nursing success is standardizing the entry-level education for nurses and developing a uniform professional development and career advancement trajectory with appropriate incentives to encourage participation. A framework to guide and provide scientific evidence of how frontline nurses can be engaged will be paramount. The model for professional excellence and career advancement provides a framework that offers a clear path for researchers to examine variables influencing nurses' professional development and career advancement in a systematic manner. Professional Excellence and Career Advancement in Nursing underscores professional preparedness of a registered nurse as central to leadership development. It also describes the elements that influence nurses' participation in professional development and career advancement under 4 main categories emphasizing mentorship and self-efficacy as essential variables.

  13. Recent advances and clinical application of erythropoietin and erythropoiesis-stimulating agents. (United States)

    Tanaka, Tetsuhiro; Nangaku, Masaomi


    Erythropoietin (EPO) is an essential glycoprotein that facilitates red blood cell maturation from erythroid progenitors and mediates erythropoiesis. The use of recombinant human EPO (rhEPO) dramatically changed management of anemic patients with chronic kidney disease and improved their quality of life. EPO is mainly produced in the fetal liver and the postnatal kidney, although the molecular determinants for tissue-specific expression are elusive. Meanwhile, recent advances established a role of hypoxia-inducible factors (HIF) in transcriptionally upregulating EPO in hypoxia. Out of three HIF- isoforms, HIF-2 appears to play a central role. Prolyl hydroxylase domain-containing protein (PHD), a key regulator connecting oxygen availability and HIF-α expression, is also involved in hypoxic induction of EPO mRNA and the precise roles of PHD paralogs in erythropoiesis are now beginning to be uncovered. On the other hand, widespread expression of EPO receptors (EPOR) beyond erythroid progenitors led to the discovery of non-hematopoietic, pleiotropic roles of EPO in the brain, the heart and the kidney. The precise signal transduction pathways of pleiotropic EPO remain unclear, but carbamylated EPO, which fails to bind to the canonical EPOR homodimers or transduce the JAK2-STAT5 signaling, conferred organ protection through multimeric receptors composed of EPO-R and the common β subunit (βCR). The clinical benefit of normalization of anemia in pre-dialysis CKD by EPO therapy is controversial and recent large-scale, randomized-controlled trials do not favor normalization of anemia by EPO in improving cardiovascular as well as renal outcomes. The optimal EPO therapy should be determined based on the clinical context of individual patients. PMID:22414872

  14. Advanced regenerator testing in the Raytheon dual-use cryocoolerr

    Energy Technology Data Exchange (ETDEWEB)

    Schaefer, B. R.; Bellis, L.; Ellis, M. J.; Conrad, T. J. [Raytheon Space and Airborne Systems 2000 E. El Segundo Blvd., El Segundo, CA 90245 (United States)


    Significant progress has been made on the Raytheon low cost space cryocooler called the Dual-Use Cryocooler (DUC). Most notably, the DUC has been integrated and tested with an advanced regenerator. The advanced regenerator is a drop-in replacement for stainless steel screens and has shown significant thermodynamic performance improvements. This paper will compare the performance of two different regenerators and explain the benefits of the advanced regenerator.

  15. Clinical research of genetically modified dendritic cells in combination with cytokine-induced killer cell treatment in advanced renal cancer

    International Nuclear Information System (INIS)

    Renal cell carcinoma (RCC) is a malignant disease that demonstrates resistance to standard chemotherapeutic agents. Yet Active immunization using genetically modified dendritic cells holds promise for the adjuvant treatment of malignancies to eradicate or control residual disease. Cytokine-induced killer (CIK) cells are a heterogeneous population of effector CD8+ T cells with diverse TCR specificities, possessing non-MHC-restricted cytolytic activities against tumor cells. Clinical studies have confirmed benefit and safety of CIK cell-based therapy for patients with malignancies. This clinical trial was conducted to evaluate efficacy and safety of genetically modified dendritic cells in combination with Cytokine-Induced Killer Cell (gmDCs-CIK) treatment of patients with RCC. 28 patients with advanced renal cancer were admitted to Affiliated Hospital of Academy of Military Medical Sciences from December 2010 to March 2012 and treated by gmDCs-CIK. Clinical efficacy and safety between pre- and post-treatment were compared. This analysis showed an objective response rate (ORR) of 39% and a disease control rate (DCR) of as 75%. There is no significant relationship between clinical efficacy and whether metastasis occurred or not (P > 0.05). There is no significant relationship between ORR and cycles of treatment (P > 0.05), but DCR was significantly related with cycles of treatment (P < 0.05). No clinically significant side effects were observed. There were no significant changes of T cell subsets including CD3+, CD4+, CD8+, CD4+ CD25+ Treg cells except Th1 in peripheral blood between day 30 after immunotherapy and 1 day before immunotherapy in 11 patients. DC-CIK is feasible and effective in treating advanced renal cancer and thus provides a new approach. Identifier: Registration date: August 14, 2013

  16. Clinical observation of capecitabine monotherapy in elderly patients with advanced breast cancer

    Institute of Scientific and Technical Information of China (English)

    Miao Zhang; Zhaozhe Liu Co-first author; Zhendong Zheng; Tao Han; Yaling Han; Min Song; Xiaodong Xie


    Objective The aim of the study was to evaluate the safety and ef icacy of capecitabine mono-chemo-therapy in elderly patients with advanced breast cancer. Methods The data from 36 cases of capecitabine monotherapy in elderly patients with advanced breast cancer were retrospectively analyzed. Oral administration of capecitabine 2000 mg/m2 twice daily (D1–14) for 21 days constituted a cycle. The ef ect of the disease and main adverse reactions were evaluated every 2 cycles. Results The data from 36 elderly patients were studied. The median number of chemotherapy cycles was 4. The total ef ective rate was 30.6% (11/36) and the disease control rate was 72.2% (26/36). The number of patients with clinical complete remission was 2, clinical partial response was 9, stable disease was 15, and progressive disease was 10. Where treatment was ef ective, the median time to progression was 6 months and the median overal survival was 9.5 months. The main adverse events were gastroin-testinal reactions, bone marrow suppression, and oral mucositis; most of the reactions were grade 1 to 2. Grade 3 to 4 adverse reactions included granulocytopenia in 2 patients (12.5%) and hand-foot syndrome in 1 patient (6.7%). Conclusion Capecitabine monotherapy was ef ective in control ing disease progression, and adverse reactions were tolerated by elderly patients with advanced breast cancer.

  17. Mechanical Design Optimization Using Advanced Optimization Techniques

    CERN Document Server

    Rao, R Venkata


    Mechanical design includes an optimization process in which designers always consider objectives such as strength, deflection, weight, wear, corrosion, etc. depending on the requirements. However, design optimization for a complete mechanical assembly leads to a complicated objective function with a large number of design variables. It is a good practice to apply optimization techniques for individual components or intermediate assemblies than a complete assembly. Analytical or numerical methods for calculating the extreme values of a function may perform well in many practical cases, but may fail in more complex design situations. In real design problems, the number of design parameters can be very large and their influence on the value to be optimized (the goal function) can be very complicated, having nonlinear character. In these complex cases, advanced optimization algorithms offer solutions to the problems, because they find a solution near to the global optimum within reasonable time and computational ...

  18. Clinical outcomes of anti-androgen withdrawal and subsequent alternative anti-androgen therapy for advanced prostate cancer following failure of initial maximum androgen blockade


    MOMOZONO, HIROYUKI; Miyake, Hideaki; TEI, HIROMOTO; Harada, Ken-ichi; Fujisawa, Masato


    The present study aimed to investigate the significance of anti-androgen withdrawal and/or subsequent alternative anti-androgen therapy in patients with advanced prostate cancer (PC) who relapsed after initial maximum androgen blockade (MAB). The present study evaluated the clinical outcomes of 272 consecutive advanced PC patients undergoing anti-androgen withdrawal and/or subsequent alternative anti-androgen therapy with flutamide following the failure of initial MAB using bicalutamide. With...

  19. Evaluation of two preoparative chemotherapy regimens for complete operability of advanced gastric adenocarcinoma: a clinical trial

    Directory of Open Access Journals (Sweden)

    S. Sedighi


    Full Text Available Background: This prospective phase III study was designed to compare the activity of two combinations chemotherapy drugs in advanced gastric adenocarcinoma Methods: In a double blinded clinical trial, From Jan. 2002 to Jan. 2005, ninety patients with advanced gastric adenocarcinoma were randomly assigned to 1 Cisplatin and continuous infusion of 5FU and Epirubicin (ECF, and 2 Cisplatin and continuous infusion of 5FU with Docetaxel (TCF. Reduction in tumor mass, overall survival (OS, time to progression (TTP, and safety were measured outcome. Results: About 90% of patients had stage III or IV disease and the most common sites of tumor spread were peritoneal surfaces, liver and Paraaortic lymph nodes in either group. The objective clinical response rate (more than 50% decreases in tumor mass was 38% and 43% in ECF and TCF group respectively. Global quality of life increased (p=0 002 and symptoms of pain and insomnia decreased after chemotherapy. Patients in TCF had more grade one or two skin reactions, neuropathy and diarrhea. Fourteen patients underwent surgery. Complete microscopic (R0 resection had done in two of ECF and six of TCF tumors (p=0.015. Two cases in TCF group showed complete pathologic response. Median TTP was nine months and 10 months in ECF and TCF group respectively. Median OS was 12 months in both groups. Conclusion: Although there wasn’t statistically significant difference regarded to clinical response or survival between two groups, TCF showed more complete pathologic response.

  20. Managing Dyspnea in Patients with Advanced Chronic Obstructive Pulmonary Disease: A Canadian Thoracic Society Clinical Practice Guideline

    Directory of Open Access Journals (Sweden)

    Darcy D Marciniuk


    Full Text Available Dyspnea is a cardinal symptom of chronic obstructive pulmonary disease (COPD, and its severity and magnitude increases as the disease progresses, leading to significant disability and a negative effect on quality of life. Refractory dyspnea is a common and difficult symptom to treat in patients with advanced COPD. There are many questions concerning optimal management and, specifically, whether various therapies are effective in this setting. The present document was compiled to address these important clinical issues using an evidence-based systematic review process led by a representative interprofessional panel of experts.

  1. The role of animal models in advancing amyloid-beta immunotherapy to the clinic


    Games, Dora; Seubert, Peter


    The amyloid-beta (Aβ) hypothesis of Alzheimer's disease (AD) causality is now well into its third decade and is finally entering a phase of rigorous clinical testing in numerous late stage clinical trials. The use of Aβ-based animal models of AD has been essential to the discovery and/or preclinical validation of many of these therapeutic approaches. While several neuropathologically based results from preclinical studies have translated nicely into AD patients, the full clinical value of Aβ-...

  2. The clinical relevance of assessing advanced glycation endproducts accumulation in diabetes. (United States)

    Meerwaldt, Robbert; Links, Thera; Zeebregts, Clark; Tio, Rene; Hillebrands, Jan-Luuk; Smit, Andries


    Cardiovascular disease is the major cause of morbidity and mortality associated with diabetes. There is increasing evidence that advanced glycation endproducts (AGEs) play a pivotal role in atherosclerosis, in particular in diabetes. AGE accumulation is a measure of cumulative metabolic and oxidative stress, and may so represent the "metabolic memory". Furthermore, increased AGE accumulation is closely related to the development of cardiovascular complications in diabetes. This review article will focus on the clinical relevance of measuring AGE accumulation in diabetic patients by focusing on AGE formation, AGEs as predictors of long-term complications, and interventions against AGEs.

  3. The clinical relevance of assessing advanced glycation endproducts accumulation in diabetes

    Directory of Open Access Journals (Sweden)

    Hillebrands Jan-Luuk


    Full Text Available Abstract Cardiovascular disease is the major cause of morbidity and mortality associated with diabetes. There is increasing evidence that advanced glycation endproducts (AGEs play a pivotal role in atherosclerosis, in particular in diabetes. AGE accumulation is a measure of cumulative metabolic and oxidative stress, and may so represent the "metabolic memory". Furthermore, increased AGE accumulation is closely related to the development of cardiovascular complications in diabetes. This review article will focus on the clinical relevance of measuring AGE accumulation in diabetic patients by focusing on AGE formation, AGEs as predictors of long-term complications, and interventions against AGEs.

  4. Advances with the Chinese anthelminthic drug tribendimidine in clinical trials and laboratory investigations. (United States)

    Xiao, Shu-Hua; Utzinger, Jürg; Tanner, Marcel; Keiser, Jennifer; Xue, Jian


    The anthelminthic drug tribendimidine has been approved by Chinese authorities for human use in 2004, and a first comprehensive review was published in Acta Tropica in 2005. Here, we summarise further advances made through additional clinical trials and laboratory investigations. Two phase IV trials have been conducted in the People's Republic of China, the first one enrolling 1292 adolescents and adults aged 15-70 years and the second one conducted with 899 children aged 4-14 years who were infected with one or multiple species of soil-transmitted helminths. Oral tribendimidine (single 400mg enteric-coated tablet given to adolescents/adults and 200mg to children) showed high cure rates against Ascaris lumbricoides (90.1-95.0%) and moderate-to-high cure rates against hookworm (82.0-88.4%). Another trial done in school-aged children using a rigorous diagnostic approach found a cure rate against hookworm of 76.5%. A single oral dose of tribendimidine showed only low cure rates against Trichuris trichiura (23.9-36.8%) confirming previous results. Tribendimidine administered to children infected with Enterobius vermicularis (two doses of 200mg each on consecutive days) resulted in a high cure rate (97.1%). Importantly, a series of randomised, exploratory trials revealed that tribendimidine shows interesting activity against the liver flukes Opisthorchis viverrini and Clonorchis sinensis, the tapeworm Taenia spp. and the threadworm Strongyloides stercoralis with respective cure rates of 70.0%, 40.0%, 53.3% and 36.4%. Pharmacokinetic studies in healthy Chinese volunteers indicated that after oral administration of tribendimidine, no parent drug was detected in plasma, but its primary metabolite, p-(1-dimethylamino ethylimino) aniline (aminoamidine, deacylated amidantel) (dADT), was found in plasma. dADT is then further metabolised to acetylated dADT (AdADT). dADT exhibits activity against several species of hookworm and C. sinensis in experimental studies, similar to

  5. Using e-technologies in clinical trials. (United States)

    Rosa, Carmen; Campbell, Aimee N C; Miele, Gloria M; Brunner, Meg; Winstanley, Erin L


    Clinical trials have been slow to incorporate e-technology (digital and electronic technology that utilizes mobile devices or the Internet) into the design and execution of studies. In the meantime, individuals and corporations are relying more on electronic platforms and most have incorporated such technology into their daily lives. This paper provides a general overview of the use of e-technologies in clinical trials research, specifically within the last decade, marked by rapid growth of mobile and Internet-based tools. Benefits of and challenges to the use of e-technologies in data collection, recruitment and retention, delivery of interventions, and dissemination are provided, as well as a description of the current status of regulatory oversight of e-technologies in clinical trials research. As an example of ways in which e-technologies can be used for intervention delivery, a summary of e-technologies for treatment of substance use disorders is presented. Using e-technologies to design and implement clinical trials has the potential to reach a wide audience, making trials more efficient while also reducing costs; however, researchers should be cautious when adopting these tools given the many challenges in using new technologies, as well as threats to participant privacy/confidentiality. Challenges of using e-technologies can be overcome with careful planning, useful partnerships, and forethought. The role of web- and smartphone-based applications is expanding, and the increasing use of those platforms by scientists and the public alike make them tools that cannot be ignored.

  6. Clinical Studies in the Second Line Setting of Advanced Pancreatic Cancer: Are We Making Any Progress?

    Directory of Open Access Journals (Sweden)

    Vassilios S Ramfidis


    Full Text Available Despite the enormous advances in clinical research in oncology, the prognosis of pancreatic carcinoma remains poor. Thetherapeutic options in this type of cancer are very limited, with modest results at present. In the 2012 American Society of Clinical Oncology (ASCO Annual Meeting, four interesting trials on the second line treatment of pancreatic cancer were presented. The first study (Abstract #4017 with a phase II design suggested that maintenance therapy with sunitinib, after a complete course of standard first line treatment, was feasible and effective while the second phase I/II study (Abstract #4034 evaluated the role of trabedersen, an agent that inhibits TGF-β2 expression. Finally, the efficacy and toxicity of lapatinib combined with either FOLFOX (Abstract #e14533 or capecitabine (Abstract #e14569 were examined in the second line setting of pancreatic cancer.

  7. Can “early” and “late”18F-FDG PET–CT be used as prognostic factors for the clinical outcome of patients with locally advanced head and neck cancer treated with radio-chemotherapy?

    International Nuclear Information System (INIS)

    Purpose: To evaluate the prognostic value of “early” and “late” Fluorine-18-Fluorodeoxyglucose (18F-FDG) positron emission tomography–computed tomography (PET–CT) in patients with head and neck squamous cell carcinoma (HNSCC) treated with radio-chemotherapy (RTCT). Materials and methods: Twenty-six patients treated with RTCT for HNSCC were included. All patients underwent 18F-FDG PET–CT at baseline (“staging” PET–CT), after 2 weeks of treatment (“early” PET–CT) and 8–12 weeks after treatment (“late” PET–CT). Changes in FDG uptake in the primary tumor (T) and lymph nodes (N) were correlated with local and regional control, respectively; overall metabolic response was correlated with relapse free survival (RFS) and disease specific survival (DSS). Results: After a median follow-up of 29.2 months, 19/26 patients were living and 17/19 had no evidence of disease. When comparing “staging”, “early” and “late” PET results, a significant decrease of FDG SUVmax in T and N was documented. When correlating changes in FDG uptake in T and N with local and regional control, a statistically significant correlation only with the “late” reduction was found. Statistical analysis failed to demonstrate any correlation between the “early” metabolic response and the patient clinical outcome while the “late” metabolic response revealed a strong correlation with RFS (p = 0.01) and DSS (p = 0.009). Conclusions: In patients with HNSCC, PET–CT performed after RTCT predicts the clinical outcome, since it strongly correlates with RFS and DSS. On the other hand, the predictive role of “early” metabolic response was not confirmed by this study.

  8. The use of combinations of monoclonal antibodies in clinical oncology. (United States)

    Henricks, Linda M; Schellens, Jan H M; Huitema, Alwin D R; Beijnen, Jos H


    Treatment with monoclonal antibodies is becoming increasingly important in clinical oncology. These antibodies specifically inhibit signaling pathways in tumor growth and/or induce immunological responses against tumor cells. By combining monoclonal antibodies several pathways may be targeted simultaneously, potentially leading to additive or synergistic effects. Theoretically, antibodies are very suitable for use in combination therapy, because of limited overlapping toxicity and lack of pharmacokinetic interactions. In this article an overview is given of preclinical and clinical data on twenty-five different combinations of antibodies in oncology. Some of these combinations have proven clinical benefit, for example the combination of trastuzumab and pertuzumab in HER2-positive breast cancer, which exemplifies an additive or synergistic effect on antitumor activity in clinical studies and the combination of nivolumab and ipilimumab, which results in significant increases in progression-free and overall survival in patients with advanced melanoma. However, other combinations may lead to unfavorable results, such as bevacizumab with cetuximab or panitumumab in advanced colorectal cancer. These combinations result in shorter progression-free survival and increased toxicity compared to therapy with a single antibody. In summary, the different published studies showed widely varying results, depending on the combination of antibodies, indication and patient population. More preclinical and clinical studies are necessary to unravel the mechanisms behind synergistic or antagonistic effects of combining monoclonal antibodies. Most research on combination therapies is still in an early stage, but it is expected that for several tumor types the use of combination therapy of antibodies will become standard of care in the near future.

  9. Potential uses of probiotics in clinical practice. (United States)

    Reid, Gregor; Jass, Jana; Sebulsky, M Tom; McCormick, John K


    Probiotics are defined as live microorganisms that, when administered in adequate amounts, confer a health benefit on the host. There is now mounting evidence that selected probiotic strains can provide health benefits to their human hosts. Numerous clinical trials show that certain strains can improve the outcome of intestinal infections by reducing the duration of diarrhea. Further investigations have shown benefits in reducing the recurrence of urogenital infections in women, while promising studies in cancer and allergies require research into the mechanisms of activity for particular strains and better-designed trials. At present, only a small percentage of physicians either know of probiotics or understand their potential applicability to patient care. Thus, probiotics are not yet part of the clinical arsenal for prevention and treatment of disease or maintenance of health. The establishment of accepted standards and guidelines, proposed by the Food and Agriculture Organization of the United Nations and the World Health Organization, represents a key step in ensuring that reliable products with suitable, informative health claims become available. Based upon the evidence to date, future advances with single- and multiple-strain therapies are on the horizon for the management of a number of debilitating and even fatal conditions. PMID:14557292

  10. 21 CFR 862.2700 - Nephelometer for clinical use. (United States)


    ... (CONTINUED) MEDICAL DEVICES CLINICAL CHEMISTRY AND CLINICAL TOXICOLOGY DEVICES Clinical Laboratory Instruments § 862.2700 Nephelometer for clinical use. (a) Identification. A nephelometer for clinical use is a... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nephelometer for clinical use. 862.2700...

  11. 21 CFR 862.2680 - Microtitrator for clinical use. (United States)


    ... (CONTINUED) MEDICAL DEVICES CLINICAL CHEMISTRY AND CLINICAL TOXICOLOGY DEVICES Clinical Laboratory Instruments § 862.2680 Microtitrator for clinical use. (a) Identification. A microtitrator for clinical use is... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Microtitrator for clinical use. 862.2680...

  12. 21 CFR 862.2560 - Fluorometer for clinical use. (United States)


    ...) MEDICAL DEVICES CLINICAL CHEMISTRY AND CLINICAL TOXICOLOGY DEVICES Clinical Laboratory Instruments § 862.2560 Fluorometer for clinical use. (a) Identification. A fluorometer for clinical use is a device... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Fluorometer for clinical use. 862.2560 Section...

  13. Recent advances in bone regeneration using adult stem cells. (United States)

    Zigdon-Giladi, Hadar; Rudich, Utai; Michaeli Geller, Gal; Evron, Ayelet


    Bone is a highly vascularized tissue reliant on the close spatial and temporal association between blood vessels and bone cells. Therefore, cells that participate in vasculogenesis and osteogenesis play a pivotal role in bone formation during prenatal and postnatal periods. Nevertheless, spontaneous healing of bone fracture is occasionally impaired due to insufficient blood and cellular supply to the site of injury. In these cases, bone regeneration process is interrupted, which might result in delayed union or even nonunion of the fracture. Nonunion fracture is difficult to treat and have a high financial impact. In the last decade, numerous technological advancements in bone tissue engineering and cell-therapy opened new horizon in the field of bone regeneration. This review starts with presentation of the biological processes involved in bone development, bone remodeling, fracture healing process and the microenvironment at bone healing sites. Then, we discuss the rationale for using adult stem cells and listed the characteristics of the available cells for bone regeneration. The mechanism of action and epigenetic regulations for osteogenic differentiation are also described. Finally, we review the literature for translational and clinical trials that investigated the use of adult stem cells (mesenchymal stem cells, endothelial progenitor cells and CD34(+) blood progenitors) for bone regeneration.

  14. A new recombinant factor VIII: from genetics to clinical use. (United States)

    Santagostino, Elena


    Advances in recombinant technology and knowledge about coagulation factor VIII (FVIII) are building a platform for new therapeutic options in patients with hemophilia A. The development of turoctocog alfa, a novel, high-purity, third-generation, B-domain truncated recombinant FVIII, has been produced and formulated without the use of animal-derived or human serum-derived components, in the wake of understanding of the new biochemical characteristics of FVIII, namely its protein structure, and glycosylation and sulfating patterns. Culture conditions and a five-step purification process have been developed to optimize the safety of turoctocog alfa. The results of two pilot clinical trials using turoctocog alfa confirmed high safety levels, with no patient developing inhibitors during the period of observation. The purpose of this review is to describe briefly the molecular and biological properties of turoctocog alfa, together with details of its clinical development, with emphasis on the needs of patients with hemophilia A. PMID:25548513

  15. Le fort I maxillary advancement using distraction osteogenesis. (United States)

    Combs, Patrick D; Harshbarger, Raymond J


    Treatment of maxillary hypoplasia has traditionally involved conventional Le Fort I osteotomies and advancement. Advancements of greater than 10 mm risk significant relapse. This risk is greater in the cleft lip and palate population, whose anatomy and soft tissue scarring from prior procedures contributes to instability of conventional maxillary advancement. Le Fort I advancement with distraction osteogenesis has emerged as viable, stable treatment modality correction of severe maxillary hypoplasia in cleft, syndromic, and noncleft patients. In this article, the authors provide a review of current data and recommendations concerning Le Fort I advancement with distraction osteogenesis. In addition, they outline their technique for treating severe maxillary hypoplasia with distraction osteogenesis using internal devices.


    Institute of Scientific and Technical Information of China (English)

    DING Jing; SHI Xue-min


    In the present paper, the authors review recent advances in clinical and experimental studies on acupuncture treatment of cerebral hemorrhage(CH). Regarding clinical studies, the resuscitation-inducing needling maneuver, and main points of Shuigou(水沟GV 26),Baihui(百会 GV 20) and scalp-points Motor Area(MS 6), Sensory Area(MS 7), etc. are often involved. Concerning experimental studies, the underlying mechanisms of acupuncture of GV-26+"Neiguan"(内关 PC 6), GV-20,GV-26+GV-20, etc. in improving acute CH are introduced. In a word, acupuncture therapy works well in improving clinical symptoms and signs of CH patients, and acupuncture stimulation induced ameilioration of cerebral blood flow, favorable modulation of some bioactive substances as excitatory and inhibitory amino acids, endothelin, CGRP, heat shock protein 70, etc. and neuro-endocrine-immune network may contribute to the effect of acupuncture on CH. In addition, acupuncture combined with medicine and earlier application of acupuncture therapy in the acute stage of CH are recommended in clinical practice.

  17. Advances in clinical determinants and neurological manifestations of B vitamin deficiency in adults. (United States)

    Sechi, GianPietro; Sechi, Elia; Fois, Chiara; Kumar, Neeraj


    B vitamin deficiency is a leading cause of neurological impairment and disability throughout the world. Multiple B vitamin deficiencies often coexist, and thus an understanding of the complex relationships between the different biochemical pathways regulated in the brain by these vitamins may facilitate prompter diagnosis and improved treatment. Particular populations at risk for multiple B vitamin deficiencies include the elderly, people with alcoholism, patients with heart failure, patients with recent obesity surgery, and vegetarians/vegans. Recently, new clinical settings that predispose individuals to B vitamin deficiency have been highlighted. Moreover, other data indicate a possible pathogenetic role of subclinical chronic B vitamin deficiency in neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, and amyotrophic lateral sclerosis. In light of these findings, this review examines the clinical manifestations of B vitamin deficiency and the effect of B vitamin deficiency on the adult nervous system. The interrelationships of multiple B vitamin deficiencies are emphasized, along with the clinical phenotypes related to B vitamin deficiencies. Recent advances in the clinical determinants and diagnostic clues of B vitamin deficiency, as well as the suggested therapies for B vitamin disorders, are described. PMID:27034475

  18. Breast Cancer Clinical Trials: Past Half Century Moving Forward Advancing Patient Outcomes. (United States)

    Kuerer, Henry M; van la Parra, Raquel F D


    Clinical trials in breast cancer have contributed immensely to the advancements of modern multimodal breast cancer treatment. Due to improved screening methods and more effective biologic-based tailored systemic therapies, the extent of surgery necessary for local and systemic control of disease is decreasing. Sequential trials for ductal carcinoma in situ (DCIS) have changed the management of this disease and are culminating in randomized active surveillance studies in an effort potentially to prevent overtreatment of low- and intermediate-grade disease. For patients with initial node-positive disease, clipping and marking of the biopsy-proven nodal metastases before the start of neoadjuvant chemotherapy can allow for selective node dissection based on the axillary response. With the current advances in primary systemic therapy, feasibility trials are beginning to investigate the potential of nonoperative therapy for invasive cancers with percutaneously documented pathologic complete response. This article presents a review and update on landmark clinical trials related to DCIS, the extent of axillary surgery in node-positive disease, and the integration of systemic therapy with local therapy. PMID:27364503

  19. Special issue of clinical pharmacology: advances and applications in new protein therapeutics modulating tumor immunity

    Directory of Open Access Journals (Sweden)

    Frankel AE


    Full Text Available Arthur E Frankel Department of Internal Medicine, Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, TX, USA Until recent decades, the role of the immune system in harnessing tumor growth was based on anecdotal observations of increased cancers in immune-compromised patients, the benefits of graft-versus-leukemia in allogeneic stem cell transplants, and the limited but reproducible anticancer activity of several lymphokines, including interferon and interleukin (IL-2. Vaccine studies and infusions of "activated" lymphocytes yielded variable clinical responses and disease control. An improved understanding of the molecular and cell mechanisms of the innate and adaptive immune system in cancer-bearing animals and the discovery of an immune-suppressive tumor microenvironment then led to development and testing of a battery of new drug and cell-based approaches to trigger antitumor immunity. This issue of Clinical Pharmacology: Advances and Applications highlights some of the new protein-based compounds that are radically changing the cancer therapeutic landscape. The purpose of this collection of reviews is to inform the readership regarding the importance of the seismic change in cancer therapeutics and stimulate efforts to find novel niches and combinations of agents similar to recent advances in the application of cancer pathway inhibitors.

  20. Clinical observation on docetaxel plus S1 in the treatment of advanced metastatic breast cancer

    Institute of Scientific and Technical Information of China (English)

    Jian Cao; Ping Sun


    Objective: The aim of our study was to observe the efficacy and adverse reactions of docetaxel plus S1 in patients with advanced metastatic breast cancer. Methods: Twenty-seven patients with advanced metastatic breast cancer receiving docetaxel plus S1 in our hospital were analyzed. The efficacy and safety were evaluated according to RECIST and NCI CTC 3.0. Results: The clinical efficacy and toxicity were evaluated in all the 27 patients, including 1 case of CR, 12 of PR, 6 of SD, and 8 of PD (ORR = 48.1%, CBR = 70.3%). The median time to tumor progression (mTTP) was 7.3 months. No IV degree of adverse reaction was observed in the observation group. Most adverse reactions were degrees I and II, the most common reactions were neutropenia (59.3%), abnormal liver function (33.3%), gastrointestinal adverse events (29.6 %) and stomatitis (7.4%). Conclusion: With good efficacy and low toxicity, docetaxel plus S1 could be administered in the treatment of advanced metastatic breast cancer.

  1. Integrating Academic and Clinical Learning Using a Clinical Swallowing Assessment (United States)

    Phillips, Daniel E.


    This article describes an experiential learning activity designed to integrate classroom knowledge and a clinical swallowing assessment. Twenty master's-level graduate students in a dysphagia course conducted a clinical swallowing assessment with a resident of an independent retirement community. The exercise was designed to allow students an…

  2. Advanced Aqueous Phase Catalyst Development using Combinatorial Methods Project (United States)

    National Aeronautics and Space Administration — The use of combinatorial methods is proposed to rapidly screen catalyst formulations for the advanced development of aqueous phase oxidation catalysts with greater...

  3. Research and development of advanced materials using ion beam

    Energy Technology Data Exchange (ETDEWEB)

    Namba, Susumu [Nagasaki Inst. of Applied Science, Nagasaki (Japan)


    A wide range of research and development activities of advanced material synthesis using ion beams will be discussed, including ion beam applications to the state-of-the-art electronics from giant to nano electronics. (author)

  4. Recent advances in bone regeneration using adult stemcells

    Institute of Scientific and Technical Information of China (English)

    Hadar Zigdon-Giladi; Utai Rudich; Gal Michaeli Geller; Ayelet Evron


    Bone is a highly vascularized tissue reliant on theclose spatial and temporal association between bloodvessels and bone cells. Therefore, cells that participatein vasculogenesis and osteogenesis play a pivotalrole in bone formation during prenatal and postnatalperiods. Nevertheless, spontaneous healing of bonefracture is occasionally impaired due to insufficientblood and cellular supply to the site of injury. In thesecases, bone regeneration process is interrupted, whichmight result in delayed union or even nonunion ofthe fracture. Nonunion fracture is difficult to treatand have a high financial impact. In the last decade,numerous technological advancements in bone tissueengineering and cell-therapy opened new horizon inthe field of bone regeneration. This review starts withpresentation of the biological processes involved inbone development, bone remodeling, fracture healingprocess and the microenvironment at bone healingsites. Then, we discuss the rationale for using adultstem cells and listed the characteristics of the availablecells for bone regeneration. The mechanism of actionand epigenetic regulations for osteogenic differentiationare also described. Finally, we review the literature fortranslational and clinical trials that investigated the useof adult stem cells (mesenchymal stem cells, endothelialprogenitor cells and CD34+ blood progenitors) for boneregeneration.

  5. Recent advances in gastrointestinal oncology - updates and insights from the 2009 annual meeting of the American Society of Clinical Oncology

    Directory of Open Access Journals (Sweden)

    Hsueh Chung-Tsen


    Full Text Available Abstract We have reviewed the pivotal presentations related to gastrointestinal malignancies from 2009 annual meeting of the American Society of Clinical Oncology with the theme of "personalizing cancer care". We have discussed the scientific findings and the impact on practice guidelines and ongoing clinical trials. Adding trastuzumab to chemotherapy improved the survival of patients with advanced gastric cancer overexpressing human epidermal growth factor receptor 2. Gemcitabine plus cisplatin has become a new standard for first-line treatment of advanced biliary cancer. Octreotide LAR significantly lengthened median time to tumor progression compared with placebo in patients with metastatic neuroendocrine tumors of the midgut. Addition of oxaliplatin to fluoropyrimidines for preoperative chemoradiotherapy in patients with stage II or III rectal cancer did not improve local tumor response but increased toxicities. Bevacizumab did not provide additional benefit to chemotherapy in adjuvant chemotherapy for stage II or III colon cancer. In patients with resected stage II colon cancer, recurrence score estimated by multigene RT-PCR assay has been shown to provide additional risk stratification. In stage IV colorectal cancer, data have supported the routine use of prophylactic skin treatment in patients receiving antibody against epidermal growth factor receptor, and the use of upfront chemotherapy as initial management in patients with synchronous metastasis without obstruction or bleeding from the primary site.

  6. Personality Assessment Use by Clinical Neuropsychologists (United States)

    Smith, Steven R.; Gorske, Tad T.; Wiggins, Chauntel; Little, Jessica A.


    The present study is an exploration of the personality assessment practices of clinical neuropsychologists. Professional members of the National Academy of Neuropsychology and the International Neuropsychological Society (N = 404) were surveyed to examine use of several forms of personality, behavior, and emotional function measures. Results…

  7. Clinical observation of raltitrexed/bevacizumab combined with irinotecan or oxaliplation for advanced colorectal cancer

    Institute of Scientific and Technical Information of China (English)

    Jianwei Yang; Wei Gao; Jinyuan Lin; Yan Meng; Shuzhen Zhang; Tong Wang


    Objective: The aim of the study was to investigate the ef icacy and safety of raltitrexed/bevacizumab in combina-tion with irinotecan or oxaliplation for advanced colorectal cancer as the second-line and second-line above treatments. Meth-ods: Fifteen cases of advanced colorectal cancer were enrol ed to receive regimens including raltitrexed/bevacizumab com-bined with irinotecan or oxaliplation. Two cases were treated with raltitrexed + bavacizumab regimen, 9 cases with raltitrexed+ bavacizumab + irinotecan regimen, and 4 cases with raltitrexed + bevacizumab + oxaliplation regimen. The doses of the drugs were as fol ows: bevacizumab 5 mg/kg ivgtt, d1; raltitrexed 2.0 mg/m2 ivgtt 15 min, d2; irinotecan 180 mg/m2 ivgtt 1 h, d2; and oxaliplatin 85 mg/m2 ivgtt 2 h, d2. Two weeks was a cycle for each regimen. Results: The ef icacy of the 15 patients could be evaluated. Two cases were in PR ,10 cases in SD, 3 cases in PD, the response rate was 13.3%, and the disease control rate was 80.0%. The median progress-free survival was 5.1 months (95% CI: 3.404-6.813 months), and the median overal survival was 11.5 months (95% CI: 8.985-13.930 months). The adverse ef ects included anorexia, nausea/vomit-ing, fatigue, leucopenia, thrombocytopenia, etc, and the main 3-4 grades adverse ef ects were anorexia, nausea/vomiting, fatigue, and thrombocytopenia. Conclusion: Raltitrexed/bevacizumab combined with irinotecan or oxaliplatin as the second-line and second-line above treatments for advanced colorectal cancer has high disease control rates, and the adverse ef ect is wel tolerated. The combined regimen can be recommended as a phase III clinical research and second-line and second-lines above treatments for advanced colorectal cancer.

  8. Strengthening of structure using advanced composites


    Recuero, A.; Miravete, A.


    [EN] Restoration, strengthening and rehabilitation of buildings becomes one of the more interesting aspects of the use of composites. Construction industry has not yet accepted the wide structural use of these new materials because it does not know the advantages of composites in comparison with traditional materials, such as concrete or steel. Proffesionals involved in design and construction are conservative and resist to changes. They require codes and specifications, ...

  9. Using Advanced Fuel Bundles in CANDU Reactors

    International Nuclear Information System (INIS)

    Improving the exit fuel burnup in CANDU reactors was a long-time challenge for both bundle designers and performance analysts. Therefore, the 43-element design together with several fuel compositions was studied, in the aim of assessing new reliable, economic and proliferation-resistant solutions. Recovered Uranium (RU) fuel is intended to be used in CANDU reactors, given the important amount of slightly enriched Uranium (~0.96% w/o U235) that might be provided by the spent LWR fuel recovery plants. Though this fuel has a far too small U235 enrichment to be used in LWR's, it can be still used to fuel CANDU reactors. Plutonium based mixtures are also considered, with both natural and depleted Uranium, either for peacefully using the military grade dispositioned Plutonium or for better using Plutonium from LWR reprocessing plants. The proposed Thorium-LEU mixtures are intended to reduce the Uranium consumption per produced MW. The positive void reactivity is a major concern of any CANDU safety assessment, therefore reducing it was also a task for the present analysis. Using the 43-element bundle with a certain amount of burnable poison (e.g. Dysprosium) dissolved in the 8 innermost elements may lead to significantly reducing the void reactivity. The expected outcomes of these design improvements are: higher exit burnup, smooth/uniform radial bundle power distribution and reduced void reactivity. Since the improved fuel bundles are intended to be loaded in existing CANDU reactors, we found interesting to estimate the local reactivity effects of a mechanical control absorber (MCA) on the surrounding fuel cells. Cell parameters and neutron flux distributions, as well as macroscopic cross-sections were estimated using the transport code DRAGON and a 172-group updated nuclear data library. (author)

  10. From orphan drugs to adopted therapies: Advancing C3-targeted intervention to the clinical stage. (United States)

    Mastellos, Dimitrios C; Reis, Edimara S; Yancopoulou, Despina; Hajishengallis, George; Ricklin, Daniel; Lambris, John D


    Complement dysregulation is increasingly recognized as an important pathogenic driver in a number of clinical disorders. Complement-triggered pathways intertwine with key inflammatory and tissue destructive processes that can either increase the risk of disease or exacerbate pathology in acute or chronic conditions. The launch of the first complement-targeted drugs in the clinic has undeniably stirred the field of complement therapeutic design, providing new insights into complement's contribution to disease pathogenesis and also helping to leverage a more personalized, comprehensive approach to patient management. In this regard, a rapidly expanding toolbox of complement therapeutics is being developed to address unmet clinical needs in several immune-mediated and inflammatory diseases. Elegant approaches employing both surface-directed and fluid-phase inhibitors have exploited diverse components of the complement cascade as putative points of therapeutic intervention. Targeting C3, the central hub of the system, has proven to be a promising strategy for developing biologics as well as small-molecule inhibitors with clinical potential. Complement modulation at the level of C3 has recently shown promise in preclinical primate models, opening up new avenues for therapeutic intervention in both acute and chronic indications fueled by uncontrolled C3 turnover. This review highlights recent developments in the field of complement therapeutics, focusing on C3-directed inhibitors and alternative pathway (AP) regulator-based approaches. Translational perspectives and considerations are discussed, particularly with regard to the structure-guided drug optimization and clinical advancement of a new generation of C3-targeted peptidic inhibitors. PMID:27353192

  11. Treatment outcome of advanced pancreatic cancer patients who are ineligible for a clinical trial

    Directory of Open Access Journals (Sweden)

    Ueda A


    Full Text Available Akira Ueda, Ayumu Hosokawa, Kohei Ogawa, Hiroki Yoshita, Takayuki Ando, Shinya Kajiura, Haruka Fujinami, Kengo Kawai, Jun Nishikawa, Kazuto Tajiri, Masami Minemura, Toshiro SugiyamaDepartment of Gastroenterology and Hematology, Faculty of Medicine, University of Toyama, Toyama, JapanObjective: The aim of this study was to evaluate the outcome of patients with advanced pancreatic cancer in clinical practice, and assess whether chemotherapy provided a clinical benefit for patients who did not meet the eligibility criteria of the clinical trial.Methods: We retrospectively analyzed the medical records of 75 patients who received first-line chemotherapy for pancreatic cancer between April 2006 and September 2011. Patients were treated with gemcitabine (GEM alone, S-1 (tegafur, gimeracil, and oteracil potassium alone, or GEM plus S-1. Patients were divided into the clinical trial eligible group (arm eligible or the ineligible group (arm ineligible. We evaluated the efficacy and the safety of the chemotherapy.Results: A total of 23 patients out of 75 (31% belonged to the ineligible group, for the following reasons: 20 patients had poor performance status, eight had massive ascites, one had synchronous malignancy, and one had icterus. The median progression-free survival (PFS was 3.5 months, and the median overall survival (OS was 6.7 months in all patients. In arm eligible, median PFS was 4.5 months, and median OS was 10.5 months. In arm ineligible, median PFS was 1.1 months, and median OS was 2.9 months.Conclusion: The outcome of the patients who did not meet the eligibility criteria was very poor. It is important to select the patients that could benefit from either chemotherapy or optimal supportive care.Keywords: gemcitabine, S-1, clinical practice

  12. Efficacy of mandibular advancement device in the treatment of obstructive sleep apnea syndrome: A randomized controlled crossover clinical trial (United States)

    Crovetto-Martínez, Rafael; Alkhraisat, Mohammad-Hamdan; Crovetto, Miguel; Municio, Antonio; Kutz, Ramón; Aizpuru, Felipe; Miranda, Erika; Anitua, Eduardo


    Background Evaluation of the efficacy and safety of a mandibular advancement device (MAD) (KlearwayTM) in the treatment of mild-to-moderate obstructive sleep apnea and chronic roncopathy. Material and Methods A randomized, placebo-controlled, double blinded, and crossover clinical trial was conducted. Placebo device (PD) defined as a splint in the centric occlusion that did not induce a mandibular advancement served as a control. The mandible was advanced to the maximum tolerable distance or to a minimum of 65% of the maximum protrusion. After each sequence of treatment, patients were assessed by questionnaires, conventional polysomnography, and objective measurement of snoring at the patient’s own home. Results Forty two patients participated in the study and 38 completed the study. Patients mean age was 46 ±9 years and the 79% were males. The mean mandibular advancement was 8.6 ±2.8 mm. Patients used the MAD and the PD for 6.4 +2.4 hours and 6.2 +2.0 hours, respectively. Secondary effects (mostly mild) occurred in the 85.7% and the 86.8% of the users of MAD and PD, respectively. The MAD induced a decrease in the apnea-hypopnea index (AHI) from 15.3 +10.2 to 11.9 +15.5. The 50% reduction in the AHI was achieved in the 46.2% and the 18.4% of the patients treated with MAD and PD, respectively. The use of the MAD induced a reduction in the AHI by 3.4 +15.9 while the PD induced an increase by 10.6 +26.1. The subjective evaluation of the roncopathy indicated an improvement by the MAD and an increase in the perceptive quality of sleep. However, the objective evaluation of the roncopathy did not show significant improvements. Conclusions The use of MAD is efficient to reduce the AHI and improve subjectively the roncopathy. MAD could be considered in the treatment of mild-to-moderate OSA and chronic roncopathy. Key words:Obstructive sleep apnea (OSA), mandibular advance device, treatment, efficacy, clinical assay. PMID:26241460

  13. Methodological Advances in Uses and Gratifications Research. (United States)

    Becker, Lee B.

    One of the most difficult problems facing scholars interested in conducting empirical research concerning the gratification that audience members seek or receive from the media is measurement of gratification itself. This paper outlines the strategies commonly used by researchers and describes some of the limitations of each. Particular attention…

  14. Intrusion Detection System Using Advanced Honeypots

    CERN Document Server

    Singh, Ram Kumar


    The exponential growth of Internet traffic has made public servers increasingly vulnerable to unauthorized accesses and intrusions. In addition to maintaining low latency for the client, filtering unauthorized accesses has become one of the major concerns of a server maintainer. This implementation of an Intrusion Detection System distinguishes between the traffic coming from clients and the traffic originated from the attackers, in an attempt to simultaneously mitigate the problems of both latency and security. We then present the results of a series of stress and scalability tests, and suggest a number of potential uses for such a system. As computer attacks are becoming more and more difficult to identify the need for better and more efficient intrusion detection systems increases. The main problem with current intrusion detection systems is high rate of false alarms. Using honeypots provides effective solution to increase the security.

  15. Recent advances in innovative therapeutic approaches for Duchenne muscular dystrophy: from discovery to clinical trials (United States)

    Shimizu-Motohashi, Yuko; Miyatake, Shouta; Komaki, Hirofumi; Takeda, Shin’ichi; Aoki, Yoshitsugu


    Duchenne muscular dystrophy (DMD) is an X-linked progressive degenerative muscle disorder caused by the absence of dystrophin. There is no curative therapy, although innovative therapeutic approaches have been aggressively investigated over recent years. Currently, the international clinical trial registry platform for this disease has been constructed and clinical trials for innovative therapeutic approaches are underway. Among these, exon skipping and read-through of nonsense mutations are in the most advanced stages, with exon skipping theoretically applicable to a larger number of patients. To date, exon skipping that targets exons 51, 44, 45, and 53 is being globally investigated including in USA, EU, and Japan. The latest announcement from Japan was made, demonstrating successful dystrophin production in muscles of patients with DMD after treating with exon 53 skipping antisense oligonucleotides (ASOs). However, the innovative therapeutic approaches have demonstrated limited efficacy. To address this issue in exon skipping, studies to unveil the mechanism underlying gymnotic delivery of ASO uptake in living cells have been conducted in an effort to improve in vivo delivery. Further, establishing the infrastructures to integrate multi-institutional clinical trials are needed to facilitate the development of successful therapies for DMD, which ultimately is applicable to other myopathies and neurodegenerative diseases, including spinal muscular atrophy and motor neuron diseases. PMID:27398133



    Amit kumar; parmod kumar; Tarun gupta; Vinod shehrawat


    Energy is essence of life. Now days we see that all the activities performed by mankind are being optimized in terms of use of resources. The list of resources being optimized is long, few are very general in nature of their application for example manpower, investment&nb...

  17. Advance reservoir evaluation by using NMR logging

    International Nuclear Information System (INIS)

    Based on brief explanation of the measurement principle for nuclear magnetic resonance (NMR) logging, this paper illustrates the importance of NMR logging in reservoir evaluation through typical case examples. These case examples include: Reservoir characterization and productivity evaluation by using NMR logging, determination of reservoir porosity in complex lithology, identification of oil, water and gas zones under complex reservoir conditions where resistivity log data give poor indication, guiding the implementation of completion and drilling programs, etc. Excellent application results indicate that NMR logging has its special features and advantages in comparison with conventional logging techniques. It is a very practical and very promising logging technology

  18. The use of biomarkers in clinical osteoporosis. (United States)

    Cabral, Hebert Wilson Santos; Andolphi, Bruna Ferreira Galone; Ferreira, Brunna Vila Coutinho; Alves, Danielle Cristina Filgueira; Morelato, Renato Lírio; Chambo, Antônio; Borges, Lizânia Spinassé


    Osteoporosis is a disease of ascending character in the world population; in this context, bone biomarkers are being increasingly studied in order to aid in the diagnosis and monitoring of these patients. The main objective of this study was a literature review of articles whose main theme was the use of biomarkers for bone formation and degradation, and to evaluate their possible applicability in clinical practice. Literature review was performed through articles indexed and published in the last five years in the PubMed database. The findings of this study showed that most of the previously selected articles were published in the last two years, and the most cited markers were bone resorption, C-terminal collagen telopeptide (CTX), showing the highest correlation with the dynamics of bone, and the biomarker of bone formation, bone-specific alkaline phosphatase (BAP), which is increased in the event of fracture or may suggest another bone disease. There was an increase in published articles, associating different bone biomarkers and their clinical applicability, especially for treatment control. Our findings suggest that in recent years there has been significant increase in publications evaluating the use of bone turnover biomarkers for bone formation and resorption and their possible clinical applicability, especially in the monitoring of treatment. Still, we believe that further studies need to be conducted to confirm these findings, given the advantages that bone biomarkers can deliver in the clinical management of the disease.

  19. Clinical usefulness of wave intensity analysis. (United States)

    Sugawara, Motoaki; Niki, Kiyomi; Ohte, Nobuyuki; Okada, Takashi; Harada, Akimitsu


    Wave intensity (WI) is a hemodynamic index, which can evaluate the working condition of the heart interacting with the arterial system. It can be defined at any site in the circulatory system and provides a great deal of information. However, we need simultaneous measurements of blood pressure and velocity to obtain wave intensity, which has limited the clinical application of wave intensity, in spite of its potential. To expand the application of wave intensity in the clinical setting, we developed a real-time non-invasive measurement system for wave intensity based on a combined color Doppler and echo-tracking system. We measured carotid arterial WI in normal subjects and patients with various cardiovascular diseases. In the coronary artery disease group, the magnitude of the first peak of carotid arterial WI (W (1)) increased with LV max. dP/dt (r = 0.74, P WI can be obtained non-invasively using an echo-Doppler system in the clinical setting. This method will increase the clinical usefulness of wave intensity.

  20. Control of Smart Building Using Advanced SCADA (United States)

    Samuel, Vivin Thomas

    For complete control of the building, a proper SCADA implementation and the optimization strategy has to be build. For better communication and efficiency a proper channel between the Communication protocol and SCADA has to be designed. This paper concentrate mainly between the communication protocol, and the SCADA implementation, for a better optimization and energy savings is derived to large scale industrial buildings. The communication channel used in order to completely control the building remotely from a distant place. For an efficient result we consider the temperature values and the power ratings of the equipment so that while controlling the equipment, we are setting a threshold values for FDD technique implementation. Building management system became a vital source for any building to maintain it and for safety purpose. Smart buildings, refers to various distinct features, where the complete automation system, office building controls, data center controls. ELC's are used to communicate the load values of the building to the remote server from a far location with the help of an Ethernet communication channel. Based on the demand fluctuation and the peak voltage, the loads operate differently increasing the consumption rate thus results in the increase in the annual consumption bill. In modern days, saving energy and reducing the consumption bill is most essential for any building for a better and long operation. The equipment - monitored regularly and optimization strategy is implemented for cost reduction automation system. Thus results in the reduction of annual cost reduction and load lifetime increase.

  1. Soil aquifer treatment using advanced primary effluent

    KAUST Repository

    Sharma, Saroj K.


    Soil aquifer treatment (SAT) using primary effluent (PE) is an attractive option for wastewater treatment and reuse in many developing countries with no or minimal wastewater treatment. One of the main limitations of SAT of PE is rapid clogging of the infiltration basin due to high suspended solid concentrations. Some pre-treatment of PE before infiltration is likely to reduce this limitation, improve performance of SAT and help to implement this technology effectively. The effects of three pre-treatment options namely sedimentation (SED), coagulation (COAG) and horizontal roughing filtration (HRF) on SAT were analyzed by conducting laboratory-scale batch and soil column experiments. The sedimentation and coagulation pre-treatments led to less head loss development and reduction of clogging effect. The head loss development in soil column using PE + COAG and PE + SED was reduced by 85 and 72%, respectively, compared to PE alone without any pretreatment. The overall dissolved organic carbon (DOC) removal of pre-treatments and soil column collectively were 34, 44, 51 and 43.5% for PE without any pre-treatment, PE + SED, PE+ COAG and PE + HRF, respectively. Coagulation pre-treatment of PE was found to be the most effective option in terms of suspended solids, DOC and nitrogen removal. Sedimentation pre-treatment of PE could be attractive where land is relatively less expensive for the construction of sedimentation basins. © IWA Publishing 2011.

  2. Standardizing clinical laboratory data for secondary use. (United States)

    Abhyankar, Swapna; Demner-Fushman, Dina; McDonald, Clement J


    Clinical databases provide a rich source of data for answering clinical research questions. However, the variables recorded in clinical data systems are often identified by local, idiosyncratic, and sometimes redundant and/or ambiguous names (or codes) rather than unique, well-organized codes from standard code systems. This reality discourages research use of such databases, because researchers must invest considerable time in cleaning up the data before they can ask their first research question. Researchers at MIT developed MIMIC-II, a nearly complete collection of clinical data about intensive care patients. Because its data are drawn from existing clinical systems, it has many of the problems described above. In collaboration with the MIT researchers, we have begun a process of cleaning up the data and mapping the variable names and codes to LOINC codes. Our first step, which we describe here, was to map all of the laboratory test observations to LOINC codes. We were able to map 87% of the unique laboratory tests that cover 94% of the total number of laboratory tests results. Of the 13% of tests that we could not map, nearly 60% were due to test names whose real meaning could not be discerned and 29% represented tests that were not yet included in the LOINC table. These results suggest that LOINC codes cover most of laboratory tests used in critical care. We have delivered this work to the MIMIC-II researchers, who have included it in their standard MIMIC-II database release so that researchers who use this database in the future will not have to do this work. PMID:22561944

  3. Transonic wing analysis using advanced computational methods (United States)

    Henne, P. A.; Hicks, R. M.


    This paper discusses the application of three-dimensional computational transonic flow methods to several different types of transport wing designs. The purpose of these applications is to evaluate the basic accuracy and limitations associated with such numerical methods. The use of such computational methods for practical engineering problems can only be justified after favorable evaluations are completed. The paper summarizes a study of both the small-disturbance and the full potential technique for computing three-dimensional transonic flows. Computed three-dimensional results are compared to both experimental measurements and theoretical results. Comparisons are made not only of pressure distributions but also of lift and drag forces. Transonic drag rise characteristics are compared. Three-dimensional pressure distributions and aerodynamic forces, computed from the full potential solution, compare reasonably well with experimental results for a wide range of configurations and flow conditions.

  4. Advances in MAD-X using PTC

    CERN Document Server

    Skowronski, P K; Forest, E


    For the last few years the MAD-X program makes use of the Polymorphic Tracking Code (PTC) to perform calculations related to beamdynamics in the nonlinear regime. An important new feature is the extension of the matching module to allow fitting of non-linear parameters to any order. Moreover, calculations can now be performed with parameter dependence defined in the MAD-X input. In addition, the user can access the PTC routines for the placement of a magnet with arbitrary position and orientation. This facilitates the design of non-standard lattices, in particular since a 3D visualization of a lattice is now available. For the LHC studies during commissioning it is of special interest that one has access to within the thick PTC elements which allows e.g. to find PTC Twiss parameters at any point in the ring.

  5. Advanced Steganography Algorithm using Encrypted secret message

    Directory of Open Access Journals (Sweden)

    Joyshree Nath


    Full Text Available In the present work the authors have introduced a new method for hiding any encrypted secret message inside a cover file. For encrypting secret message the authors have used new algorithm proposed by Nath et al(1. For hiding secret message we have used a method proposed by Nath et al(2. In MSA(1 method we have modified the idea of Play fair method into a new platform where we can encrypt or decrypt any file. We have introduced a new randomization method for generating the randomized key matrix to encrypt plain text file and to decrypt cipher text file. We have also introduced a new algorithm for encrypting the plain text multiple times. Our method is totally dependent on the random text_key which is to be supplied by the user. The maximum length of the text_key can be of 16 characters long and it may contain any character(ASCII code 0 to 255. We have developed an algorithm to calculate the randomization number and the encryption number from the given text_key. The size of the encryption key matrix is 16x16 and the total number of matrices can be formed from 16 x 16 is 256! which is quite large and hence if someone applies the brute force method then he/she has to give trail for 256! times which is quite absurd. Moreover the multiple encryption method makes the system further secured. For hiding secret message in the cover file we have inserted the 8 bits of each character of encrypted message file in 8 consecutive bytes of the cover file. We have introduced password for hiding data in the cover file. We propose that our new method could be most appropriate for hiding any file in any standard cover file such as image, audio, video files. Because the hidden message is encrypted hence it will be almost impossible for the intruder to unhide the actual secret message from the embedded cover file. This method may be the most secured method in digital water marking.

  6. Serum cytokine levels in patients with advanced non-small cell lung cancer: correlation with clinical outcome of erlotinib treatment

    Institute of Scientific and Technical Information of China (English)

    WANG Yong-sheng; MIAO Li-yun; LIU Lu; CAI Hou-rong; DING Jing-jing; REN Sheng-xiang; ZHOU Cai-cun


    Background Serum expression of cytokines may provide information about the clinical outcome of advanced non-small cell lung cancer (NSCLC) patients.This study aimed to investigate the relationship between serum cytokine levels and the clinical outcome of erlotinib treatment in a second or third line setting in patients with advanced NSCLC.Methods A total of 162 patients with advanced NSCLC who received erlotinib as either second or third line therapy were enrolled in this study.Blood samples were collected before the initiation of erlotinib treatment,and the levels of IL-1,IL-2R,IL-6,and tumor necrosis factor (TNF)-α were assessed by enzyme-linked immunosorbent assay (ELISA).Cutoff points were defined as the median levels of IL-1 (low (≤26.5 pg/ml) and high (>26.5 pg/ml)),IL-2R (low (≤115 pmol/L) and high (>15 pmol/L)),IL-6 (low (≤49.5 pg/ml) and high (>49.5 pg/ml)),and TNF-α (low (≤48.5 pg/ml) and high (>48.5 pg/ ml)).Kaplan-Meier analysis was used to estimate the survival time,and Cox regression analyses were used to correlate cytokines and baseline clinical characteristics with clinical outcomes,including time to progression (TTP) and overall survival (OS).Results Between January 2007 and May 2011,162 patients were enrolled.Their median age was 58 years.In this group,109 were males and 53 were females,74 were former or current smokers and 88 were non-smokers.A total of 122 patients had adenocarcinoma,27 had squamous cell carcinoma,and 13 had tumors with other types of histology.And 139 patients had an Eastern cooperative oncology group (ECOG) performance status of 0-1,while 23 scored at 2-3.Expression of IL-1,IL-2R,and IL-6 was not significantly associated with age,gender,ECOG performance status,smoking status,or histology and stage of tumor.Only TNF-α was associated with smoking status (P=0.045).Survival analysis showed that patients with low levels of either IL-6 or TNF-α had a statistically longer TTp and OS than patients with high

  7. The consequences of using advanced physical assessment skills in medical and surgical nursing: A hermeneutic pragmatic study (United States)

    Zambas, Shelaine I.; Smythe, Elizabeth A.; Koziol-Mclain, Jane


    Aims and objectives The aim of this study was to explore the consequences of the nurse's use of advanced assessment skills on medical and surgical wards. Background Appropriate, accurate, and timely assessment by nurses is the cornerstone of maintaining patient safety in hospitals. The inclusion of “advanced” physical assessment skills such as auscultation, palpation, and percussion is thought to better prepare nurses for complex patient presentations within a wide range of clinical situations. Design This qualitative study used a hermeneutic pragmatic approach. Method Unstructured interviews were conducted with five experienced medical and surgical nurses to obtain 13 detailed narratives of assessment practice. Narratives were analyzed using Van Manen's six-step approach to identify the consequences of the nurse's use of advanced assessment skills. Results The consequences of using advanced assessment skills include looking for more, challenging interpretations, and perseverance. The use of advanced assessment skills directs what the nurse looks for, what she sees, interpretation of the findings, and her response. It is the interpretation of what is seen, heard, or felt within the full context of the patient situation, which is the advanced skill. Conclusion Advanced assessment skill is the means to an accurate interpretation of the clinical situation and contributes to appropriate diagnosis and medical management in complex patient situations. Relevance to clinical practice The nurse's use of advanced assessment skills enables her to contribute to diagnostic reasoning within the acute medical and surgical setting. PMID:27607193

  8. Optimal use of MRI in clinical trials, clinical care and clinical registries of patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Østergaard, Mikkel; Møller-Bisgaard, Signe


    with rheumatoid arthritis (RA). The question is when and how MRI should be used. The present article reviews our knowledge about, and provides suggestions for, the use of MRI in clinical trials, clinical care and clinical registries. In clinical trials, the OMERACT RA MRI scoring system (RAMRIS) is a thoroughly...

  9. Advancing evidence-based practice in primary care physiotherapy : Guideline implementation, clinical practice, and patient preferences


    Bernhardsson, Susanne


    Research on physiotherapy treatment interventions has increased dramatically in the past 25 years and it is a challenge to transfer research findings into clinical practice, so that patients benefit from effective treatment. Development of clinical practice guidelines is a potentially useful strategy to implement research evidence into practice. However, the impact of guideline implementation in Swedish primary care physiotherapy is unknown. To achieve evidence-based practice (EBP), research ...

  10. Preservation of Bone Marrow for Clinical Use

    International Nuclear Information System (INIS)

    The author describes the results of many years' research into the problems of obtaining and preserving bone marrow in the quantities required for clinical use. Particular attention is paid to the preservation and long-term storage of bone marrow at ultra- low temperatures (-196°C), its separation from the protective medium and methods of determining whether the biological functions of thawed bone marrow have been impaired. (author)

  11. Cryotherapy combined with chemoembolization for the treatment of advanced hepatic carcinoma: a clinical study

    International Nuclear Information System (INIS)

    Objective: To discuss the technique, efficacy and clinical significance of cryoablation combined with transcatheter arterial chemoembolization(TACE) for the treatment of advanced hepatic carcinoma. Methods: One hundred and ninety-two patients, who accorded with the selected criterion, were divided into TACE group (n=100) and combination group (cryotherapy combined with TACE, n=92). Pre-and post-treatment AFP level, recurrence rate and life span between two groups were compared. Results: The complete necrosis rate of the tumor and the recurrence rate in TACE group were 29% and 42%, which were 88.04% and 24% in combination group, respectively. The serum AFP level was significantly decreased after treatment in both groups (P<0.05), and the reduction in AFP level was significantly greater in combination group than that in TACE group (P<0.05). During a follow-up of 30 months the survival rate at each evaluation period of combination group was higher than that of TACE group without exception. Conclusion: As an effective and safe technique, cryoablation combined with chemoembolization is far superior to simple TACE in treating advanced hepatic carcinoma. (authors)

  12. Clinical outcome of hyperthermo-radio-chemotherapy combined with surgery for patients with advanced breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kobayashi, Kokuriki; Fujimoto, Shigeru; Takahashi, Makoto; Nemoto, Kazuhisa; Mutou, Takaaki; Toyosawa, Tadashi [Social Insurance Funabashi Central Hospital, Chiba (Japan)


    For the patients with breast cancer that are locally advanced or metastatic, treatment to control not only local disease but also distant metastasis is desirable. Hyperthermo-radio-chemotherapy (HRC) combined with surgery was performed for 16 patients with stage III or stage IV breast cancer and the clinical outcomes of this multimodal treatment were analyzed. The size of the primary tumor was significantly reduced after preoperative HRC with the CR rate of 18.8% (3/16) and PR rate of 81.3% (13/16). Three- and 5-year overall survival rates for the stage III patients were 100% and 87.5%, respectively; their 3- and 5- year disease free rates were 78.8% and 52.5%, respectively. One- and 3-year survival rates for the stage IV patients were 80.0% and 20.0%, respectively. No loco-regional recurrence was observed. HRC combined with surgery for advanced breast cancer patients was effective for down-staging of the primary tumor and maintaining local control. (author)

  13. A Clinical Tissue Oximeter Using NIR Time-Resolved Spectroscopy. (United States)

    Fujisaka, Shin-ichi; Ozaki, Takeo; Suzuki, Tsuyoshi; Kamada, Tsuyoshi; Kitazawa, Ken; Nishizawa, Mitsunori; Takahashi, Akira; Suzuki, Susumu


    The tNIRS-1, a new clinical tissue oximeter using NIR time-resolved spectroscopy (TRS), has been developed. The tNIRS-1 measures oxygenated, deoxygenated and total hemoglobin and oxygen saturation in living tissues. Two-channel TRS measurements are obtained using pulsed laser diodes (LD) at three wavelengths, multi-pixel photon counters (MPPC) for light detection, and time-to-digital converters (TDC) for time-of-flight photon measurements. Incorporating advanced semiconductor devices helped to make the design of this small-size, low-cost and low-power TRS instrument possible. In order to evaluate the correctness and reproducibility of measurement data obtained with the tNIRS-1, a study using blood phantoms and healthy volunteers was conducted to compare data obtained from a conventional SRS device and data from an earlier TRS system designed for research purposes. The results of the study confirmed the correctness and reproducibility of measurement data obtained with the tNIRS-1. Clinical evaluations conducted in several hospitals demonstrated a high level of usability in clinical situations and confirmed the efficacy of measurement data obtained with the tNIRS-1. PMID:26782242

  14. A Clinical Tissue Oximeter Using NIR Time-Resolved Spectroscopy. (United States)

    Fujisaka, Shin-ichi; Ozaki, Takeo; Suzuki, Tsuyoshi; Kamada, Tsuyoshi; Kitazawa, Ken; Nishizawa, Mitsunori; Takahashi, Akira; Suzuki, Susumu


    The tNIRS-1, a new clinical tissue oximeter using NIR time-resolved spectroscopy (TRS), has been developed. The tNIRS-1 measures oxygenated, deoxygenated and total hemoglobin and oxygen saturation in living tissues. Two-channel TRS measurements are obtained using pulsed laser diodes (LD) at three wavelengths, multi-pixel photon counters (MPPC) for light detection, and time-to-digital converters (TDC) for time-of-flight photon measurements. Incorporating advanced semiconductor devices helped to make the design of this small-size, low-cost and low-power TRS instrument possible. In order to evaluate the correctness and reproducibility of measurement data obtained with the tNIRS-1, a study using blood phantoms and healthy volunteers was conducted to compare data obtained from a conventional SRS device and data from an earlier TRS system designed for research purposes. The results of the study confirmed the correctness and reproducibility of measurement data obtained with the tNIRS-1. Clinical evaluations conducted in several hospitals demonstrated a high level of usability in clinical situations and confirmed the efficacy of measurement data obtained with the tNIRS-1.

  15. Clinical evaluation of the effect of platelet rich plasma on the coronally advanced flap root coverage procedure

    Directory of Open Access Journals (Sweden)

    Sharashchandra Madhavarao Biradar


    Full Text Available Background: Coronally advanced flap (CAF has been shown to effectively treat gingival recession. Platelet rich plasma (PRP, containing autologous growth factors, has been shown to promote soft tissue healing. The aim of this clinical study was to determine whether the addition of an autologous PRP to a CAF when compared to a CAF alone would improve the clinical outcome for treatment of multiple gingival recessions. Materials and Methods: Thirty patients with Miller′s class I and class II buccal recession defect were randomly assigned to control (CAF alone or test (CAF with PRP groups. Recession depth (RD, recession width (RW, probing depth (PD, clinical attachment level (CAL, width of keratinized tissue, wound healing index, percentage of root coverage was assessed. Patients were followed at 2, 4, 12 and 16 weeks post-surgery. Statistical analysis for intra and inter group comparisons was done using Wilcoxon sign rank and Wilcoxon rank sum tests respectively. P < 0.05 denoted statistical significance. Results: The differences between the test and control groups were not significant with respect to all the clinical variables. The RD at 16 weeks was significantly reduced from 2.88 ± 0.69 to 0.76 ± 0.24 mm in control group (P < 0.05 and from 2.95 ± 0.43 to 0.76 ± 0.35 mm in the test group (P < 0.05. The mean percentage of root coverage was 73.1 ± 7.3 in the control group and 75.0 ± 8.3 in test group (P < 0.05. The CAL gain was 3.17 ± 0.84 mm within the control group and 3.17 ± 0.79 mm within test group. Conclusion: Within the limitations of this study, PRP with CAF can provide an early healing of soft tissues, but does not provide clinically measurable improvement in the final therapeutics outcome in CAF.

  16. Advancing clinical development pathways for new CFTR modulators in cystic fibrosis. (United States)

    Mayer-Hamblett, Nicole; Boyle, Michael; VanDevanter, Donald


    Cystic fibrosis (CF) is a life-shortening genetic disease affecting approximately 70,000 individuals worldwide. Until recently, drug development efforts have emphasised therapies treating downstream signs and symptoms resulting from the underlying CF biological defect: reduced function of the CF transmembrane conductance regulator (CFTR) protein. The current CF drug development landscape has expanded to include therapies that enhance CFTR function by either restoring wild-type CFTR protein expression or increasing (modulating) the function of mutant CFTR proteins in cells. To date, two systemic small-molecule CFTR modulators have been evaluated in pivotal clinical trials in individuals with CF and specific mutant CFTR genotypes that have led to regulatory review and/or approval. Advances in the discovery of CFTR modulators as a promising new class of therapies have been impressive, yet work remains to develop highly effective, disease-modifying modulators for individuals of all CF genotypes. The objectives of this review are to outline the challenges and opportunities in drug development created by systemic genotype-specific CFTR modulators, highlight the advantages of sweat chloride as an established biomarker of CFTR activity to streamline early-phase development and summarise options for later phase clinical trial designs that respond to the adoption of approved genotype-specific modulators into standard of care. An optimal development framework will be needed to move the most promising therapies efficiently through the drug development pipeline and ultimately deliver efficacious and safe therapies to all individuals with CF.

  17. Clinical Relevance of the Advanced Microbiologic and Biochemical Investigations in Periodontal Diagnosis: A Critical Analysis

    Directory of Open Access Journals (Sweden)

    Vishakha Grover


    Full Text Available New approaches to periodontal diagnosis, including advanced microbiologic, biochemical, and genetic tests, have been shown to provide the clinician with the information not available by traditional means. The purpose of a diagnostic test is to confirm, exclude, classify, or monitor disease to guide treatment. Their clinical value depends on whether the information they provide leads to improved patient outcomes. This can be assessed by randomized trials, which compare patient outcomes from the new diagnostic test versus the old test strategy. Being nonmandatory for marketing approval, such trials are not always feasible because of large sample sizes requirements. So, many diagnostic tests enter the practice without being critically analysed for any additional benefits. Effective diagnosis is just as essential as the selection of effective treatments for the success of periodontal therapy. So, the current paper aims to focus on the practical utility of this rapidly emerging plethora of periodontal diagnostic tools, emphasizing the critical issues surrounding the clinical application of microbiologic and biochemical investigations, employed for periodontal diagnosis.

  18. Photodynamic therapy of locally advanced pancreatic cancer (VERTPAC study): final clinical results (United States)

    Huggett, M. T.; Jermyn, M.; Gillams, A.; Mosse, S.; Kent, E.; Bown, S. G.; Hasan, T.; Pogue, B. W.; Pereira, S. P.


    We undertook a phase I dose-escalation study of verteporfin photodynamic therapy (PDT) in 15 patients with locally advanced pancreatic cancer. Needle placement and laser delivery were technically successful in all patients. Thirteen patients were treated with a single laser fibre. Three treatments were carried out each at 5, 10 and 20 J/cm2; and 5 treatments (4 patients) at 40 J/cm2. A further 2 patients were treated with 2 or 3 laser fibres at 40 J/cm2. Tumour necrosis was measured on CT (computed tomography) by two radiologists 5 days after treatment. There was a clear dosedependent increase in necrosis with a median area of 20 x 16 mm (range 18 x 16 to 35 x 30 mm) at 40 J/cm2. In the 2 patients treated with multiple fibres, necrosis was 40 x 36 mm and 30 x 28 mm, respectively. There were no early complications in patients treated with a single fibre. Both patients treated with multiple fibres had evidence on CT of inflammatory change occurring anterior to the pancreas but without clinical deterioration. These results suggest that single fibre verteporfin PDT is safe in a clinical setting up to 40J/cm2 and produces a dose-dependent area of pancreatic necrosis.

  19. Clinical advances on Cardiac Insuffiency Avances clínicos en insuficiencia cardiaca

    Directory of Open Access Journals (Sweden)

    Gerardo Rivero González


    Full Text Available Cardiac insuffiency is a complex clinical syndrome which constitutes a common final path to get in by the majority of the cardiac diseases. Studies based on the communitarian surveys shows that from 30 to 40 % of the patients decease within the first year of the diagnosis. The rest of the patients (from 60 to 70 % die within the 5 years after being diagnosed. For this reason it has been called as the ¨cancer of cardiology¨. The objective of this article is to update the advances reached in the clinical and therapeutic aspects of this important syndrome.

    La insuficiencia cardiaca es un síndrome clínico complejo que constituye una vía final común a la que van a llegar la mayoría de las enfermedades cardiacas. Los estudios basados en encuestas comunitarias muestran que entre el 30 – 40 % de los pacientes mueren dentro del primer año del diagnóstico y el 60 – 70 % dentro de los 5 años, por lo que ha sido denominada, como el ¨cáncer de la cardiología¨. El objetivo de este artículo consiste en actualizar los avances alcanzados en los aspectos clínicos y terapéuticos de este importante síndrome.

  20. Current clinical advances and future perspectives in the psychiatry/mental health field of Latin America. (United States)

    Cía, Alfredo H; Rojas, Rodrigo Córdoba; Adad, Miguel Abib


    The history of Mental Health in Latin America is relatively young. It dates back to the mid nineteenth century and widely developed during the twentieth century, with formidable scientific, social, political, and ethical challenges. Latin American psychiatry has contributed in the fields of epidemiology, phenomenology, social psychiatry, psychiatric and epistemological research, and clinical genetics as well. More recent advances can also be seen in clinical psychotherapy and psychopharmacology. Now, there is a formal and informal recognition of various areas of expertise, such as children and adolescents, addictions, anxiety disorders, among others. However, we need to solve the health problems resulting from mental illnesses as well as the disorders related to the social, environmental, political, and economic factors of a continent marked by the precariousness of underdevelopment, which have a high impact on population health. Therefore, considering and trying to minimize the impact of those factors, contributing to the destigmatization of mental illnesses and their consequences, together with the growing number of non-governmental organizations (NGOs), human rights defenders, public figures, etc., and collaborating in building a society that guarantees the right to mental health and adequate treatment and rehabilitation are part of our present challenges in Latin America. PMID:20874063

  1. Uses of internet technology in clinical practice

    International Nuclear Information System (INIS)

    The practice of medicine has extended itself to vast areas and requires active clinicians to systematize and organize their workload through the use of the most up-to-date digital and computer communication technologies. Computerization and worldwide accessibility of information has especially provided great assistance in this regard. The explosive growth of medical information increases the need for the use of these new methods of organizing and accessing data. This article briefly summarizes a few of the vital tools that internet technology has provided clinical practice, with the aid of basic concepts of internet, database systems, hospital systems and data security and reliability. (author)

  2. Clinical Outcome of Palliative Radiotherapy for Locally Advanced Symptomatic Gastric Cancer in the Modern Era


    Tey, Jeremy; Choo, Bok Ai; Leong, Cheng Nang; Loy, En Yun; Wong, Lea Choung; Lim, Keith; Lu, Jiade Jay; Koh, Wee Yao


    Abstract The purpose of this study was to report the outcomes of patients with symptomatic locally advanced/recurrent gastric cancer treated with radiotherapy (RT) using modern 3-dimensional conformal techniques. We retrospectively reviewed patients who had palliative RT for index symptoms of gastric bleeding, pain, and obstruction. Study endpoints included symptom response, median survival, and treatment toxicity. Of 115 patients with median age of 77 years, 78 (67.8%) patients had metastati...

  3. Production of Construction Materials Using Advanced Recycling Technologies


    ECT Team, Purdue


    Waste reduction, material reuse, and use of recycle-content products can be focused on the management system somewhat. In contrast, material recycling is the technical issue how to create new materials using wastes. Thus, three advanced recycling technologies; 1) Synthetic Lightweight Aggregate technology (SLA), 2) Clean Coal Technology (CCT), and 3) RP-1 Polymer Identification System are introduced.

  4. Emerging uses of patient generated health data in clinical research. (United States)

    Wood, William A; Bennett, Antonia V; Basch, Ethan


    Recent advancements in consumer directed personal computing technology have led to the generation of biomedically-relevant data streams with potential health applications. This has catalyzed international interest in Patient Generated Health Data (PGHD), defined as "health-related data - including health history, symptoms, biometric data, treatment history, lifestyle choices, and other information-created, recorded, gathered, or inferred by or from patients or their designees (i.e. care partners or those who assist them) to help address a health concern."(Shapiro et al., 2012) PGHD offers several opportunities to improve the efficiency and output of clinical trials, particularly within oncology. These range from using PGHD to understand mechanisms of action of therapeutic strategies, to understanding and predicting treatment-related toxicity, to designing interventions to improve adherence and clinical outcomes. To facilitate the optimal use of PGHD, methodological research around considerations related to feasibility, validation, measure selection, and modeling of PGHD streams is needed. With successful integration, PGHD can catalyze the application of "big data" to cancer clinical research, creating both "n of 1" and population-level observations, and generating new insights into the nature of health and disease. PMID:25248998

  5. Gene therapy for cardiovascular disease: advances in vector development, targeting, and delivery for clinical translation. (United States)

    Rincon, Melvin Y; VandenDriessche, Thierry; Chuah, Marinee K


    Gene therapy is a promising modality for the treatment of inherited and acquired cardiovascular diseases. The identification of the molecular pathways involved in the pathophysiology of heart failure and other associated cardiac diseases led to encouraging preclinical gene therapy studies in small and large animal models. However, the initial clinical results yielded only modest or no improvement in clinical endpoints. The presence of neutralizing antibodies and cellular immune responses directed against the viral vector and/or the gene-modified cells, the insufficient gene expression levels, and the limited gene transduction efficiencies accounted for the overall limited clinical improvements. Nevertheless, further improvements of the gene delivery technology and a better understanding of the underlying biology fostered renewed interest in gene therapy for heart failure. In particular, improved vectors based on emerging cardiotropic serotypes of the adeno-associated viral vector (AAV) are particularly well suited to coax expression of therapeutic genes in the heart. This led to new clinical trials based on the delivery of the sarcoplasmic reticulum Ca(2+)-ATPase protein (SERCA2a). Though the first clinical results were encouraging, a recent Phase IIb trial did not confirm the beneficial clinical outcomes that were initially reported. New approaches based on S100A1 and adenylate cyclase 6 are also being considered for clinical applications. Emerging paradigms based on the use of miRNA regulation or CRISPR/Cas9-based genome engineering open new therapeutic perspectives for treating cardiovascular diseases by gene therapy. Nevertheless, the continuous improvement of cardiac gene delivery is needed to allow the use of safer and more effective vector doses, ultimately bringing gene therapy for heart failure one step closer to reality.

  6. Assessment of advanced glycated end product accumulation in skin using auto fluorescence multispectral imaging


    Larsson, Marcus; Favilla, Riccardo; Strömberg, Tomas


    Several studies have shown that advanced glycation end products (AGE) play a role in both the microvascular and macrovascular complications of diabetes and are closely linked to inflammation and atherosclerosis. AGEs accumulate in skin and can be detected using their auto fluorescence (AF).A significant correlation exists between AGE AF and the levels of AGEs as obtained from skin biopsies. A commercial device, the AGE Reader, has become available to assess skin AF for clinical purposes but, ...

  7. A myofeedback instrument for clinical use. (United States)

    McCarthy, C F; De Luca, C J


    As a result of a collaborative effort by engineers, physical therapists, and patients, a myofeedback device called Myochirp was designed and constructed. This device was field-tested in six busy medical centers to determine its acceptance and usefulness to clinicians in the daily activities of their environments. As a result of this field evaluation, a second-generation device was constructed incorporating the suggested improvements. The second-generation Myochirp was accepted by physical therapists as a compact, portable, and lightweight device that was convenient and easy to use. The salient feature of the device which rendered it so useful in clinical environments was the dry electrode used to detect the electromyographic signals. Its usefulness as a myofeedback instrument was determined by the variety of its applications to treatment needs and by its ability to obtain immediate and quantifiable data that could be documented.

  8. Using the Internet to search for cancer clinical trials: a comparative audit of clinical trial search tools. (United States)

    Atkinson, Nancy L; Saperstein, Sandra L; Massett, Holly A; Leonard, Colleen Ryan; Grama, Lakshmi; Manrow, Rick


    Advancing the clinical trial research process to improve cancer treatment necessitates helping people with cancer identify and enroll in studies, and researchers are using the power of the Internet to facilitate this process. This study used a content analysis of online cancer clinical trial search tools to understand what people with cancer might encounter. The content analysis revealed that clinical trial search tools were easy to identify using a popular search engine, but their functionality and content varied greatly. Most required that users be fairly knowledgeable about their medical condition and sophisticated in their web navigation skills. The ability to search by a specific health condition or type of cancer was the most common search strategy. The more complex tools required that users input detailed information about their personal medical history and have knowledge of specific clinical trial terminology. Search tools, however, only occasionally advised users to consult their doctors regarding clinical trial decision-making. This, along with the complexity of the tools suggests that online search tools may not adequately facilitate the clinical trial recruitment process. Findings from this analysis can be used as a framework from which to systematically examine actual consumer experience with online clinical trial search tools.

  9. Comprehensive clinical study of concurrent chemotherapy breathing IMRT middle part of locally advanced esophageal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Jae Hong; Moon, Seong Kwon [Dept. of Radiation Oncology, College of Medicine, Soonchunhyang University , Asan (Korea, Republic of); Kim, Seung Chul [Dept. of Radiology, Songho College, Hoengseong (Korea, Republic of)


    The standard treatment of locally advanced type of mid-esophageal cancer is concurrent chemoradiation therapy (CRT). We evaluated the feasibility of chemotherapy with adding docetaxel to the classical basic regimens of cisplatin plus 5-fluorouracil (5-FU) and radiotherapy up to 70.2 Gy using dose escalations for esophageal cancer. It was possible to escalate radiation treatment dose up to 70.2 Gy by the respiratory-gated intensity- modulated radiotherapy (gated-IMRT) based on the 4DCT-simulation, with improving target coverage and normal tissue (ex., lung, heart, and spinal cord) sparing. This study suggested that the definitive chemo-radiotherapy with docetaxel, cisplatin, and 5-fluorouracil (i.e., DCF-R) and gating IMRT is tolerable and active in patients with locally advanced mid-esophageal cancer (AEC)

  10. Clinical Use of PPARγ Ligands in Cancer

    Directory of Open Access Journals (Sweden)

    Jennifer L. Hatton


    Full Text Available The role of PPARγ in adipocyte differentiation has fueled intense interest in the function of this steroid nuclear receptor for regulation of malignant cell growth and differentiation. Given the antiproliferative and differentiating effects of PPARγ ligands on liposarcoma cells, investigation of PPARγ expression and ligand activation in other solid tumors such as breast, colon, and prostate cancers ensued. The anticancer effects of PPARγ ligands in cell culture and rodent models of a multitude of tumor types suggest broad applicability of these agents to cancer therapy. This review focuses on the clinical use of PPARγ ligands, specifically the thiazolidinediones, for the treatment and prevention of cancer.

  11. Using Video Ethnography in Clinical Nurse Education

    DEFF Research Database (Denmark)

    Kjær, Malene; Sørensen, Erik Elgaard; Raudaskoski, Pirkko Liisa


    Training to become a nurse involves education in the clinical practice in hospital wards. It is a multifaceted and complex arena in which the student nurses not only have to learn about medical encounters but also how to interact with colleagues as well as patients and their families. By using...... video ethnography and interaction analysis the authors show how the participants involved understand and act within the everyday encounters and situations in the hospital. The micro ethnographic analysis in this article shows how interaction between participants involved in the complex setting takes...

  12. Advanced vehicles: Costs, energy use, and macroeconomic impacts (United States)

    Wang, Guihua

    Advanced vehicles and alternative fuels could play an important role in reducing oil use and changing the economy structure. We developed the Costs for Advanced Vehicles and Energy (CAVE) model to investigate a vehicle portfolio scenario in California during 2010-2030. Then we employed a computable general equilibrium model to estimate macroeconomic impacts of the advanced vehicle scenario on the economy of California. Results indicate that, due to slow fleet turnover, conventional vehicles are expected to continue to dominate the on-road fleet and gasoline is the major transportation fuel over the next two decades. However, alternative fuels could play an increasingly important role in gasoline displacement. Advanced vehicle costs are expected to decrease dramatically with production volume and technological progress; e.g., incremental costs for fuel cell vehicles and hydrogen could break even with gasoline savings in 2028. Overall, the vehicle portfolio scenario is estimated to have a slightly negative influence on California's economy, because advanced vehicles are very costly and, therefore, the resulting gasoline savings generally cannot offset the high incremental expenditure on vehicles and alternative fuels. Sensitivity analysis shows that an increase in gasoline price or a drop in alternative fuel prices could offset a portion of the negative impact.

  13. Advances on the clinical applications of the image fusion techniques in coronary heart disease

    International Nuclear Information System (INIS)

    The diagnosis of coronary heart disease increasingly depends on referring and combining the information from a variety of imaging techniques. The fusion imaging of the anatomy and function provides a convenient 'one stop' examination which improves the existing imaging examination process. The development of the image fusion techniques, such as SPECT/coronary angiography, SPECT/CT, especially PET/CT, has shown a larger value in the diagnosis, risk stratification, clinical treatment guidance and efficacy prognosis of coronary heart disease than a single imaging examination, while the more complete data of the image and the quantitative analysis provide more useful information for the clinic. (authors)

  14. Advanced hepatocellular carcinoma and sorafenib:Diagnosis, indications, clinical and radiological follow-up

    Institute of Scientific and Technical Information of China (English)


    Advanced stage hepatocellular carcinoma (HCC) is acategory of disease defined by radiological, clinical andhepatic function parameters, comprehending a widerange of patients with different general conditions. Themain therapeutic option is represented by sorafenibtreatment, a multi-kinase inhibitor with anti-proliferativeand anti-angiogenic effect. Trans-arterial Radio Embolizationalso represents a promising new approach tointermediate/advanced HCC. Post-marketing clinicalstudies showed that only a portion of patients actuallybenefits from sorafenib treatment, and an even smallerpercentage of patients treated shows partial/completeresponse on follow-up examinations, up against relevantcosts and an incidence of drug related adverse effects.Although the treatment with sorafenib has shown asignificant increase in mean overall survival in differentstudies, only a part of patients actually shows realbenefits, while the incidence of drug related significantadverse effects and the economic costs are relativelyhigh. Moreover, only a small percentage of patientsalso shows a response in terms of lesion dimensionsreduction. Being able to properly differentiate patientswho are responding to the therapy from non-respondersas early as possible is then still difficult and couldbe a pivotal challenge for the future; in fact it couldspare several patients a therapy often difficult to bear,directing them to other second line treatments (many ofwhich are at the moment still under investigation). Forthis reason, some supplemental criteria to be added tothe standard modified Response Evaluation Criteriain Solid Tumors evaluation are being searched for. Inparticular, finding some parameters (cellular density,perfusion grade and enhancement rate) able to predictthe sensitivity of the lesions to anti-angiogenic agentscould help in stratifying patients in terms of treatmentresponsiveness before the beginning of the therapyitself, or in the first weeks of sorafenib treatment

  15. Simulation of advanced ultrasound systems using Field II

    DEFF Research Database (Denmark)

    Jensen, Jørgen Arendt


    impulse responses is explained. A simulation example for a synthetic aperture spread spectrum flow systems is described. It is shown how the advanced coded excitation can be set up, and how the simulation can be parallelized to reduce the simulation time from 17 months to 391 hours using a 32 CPU Linux...

  16. The use of advanced computer simulation in structural design

    Energy Technology Data Exchange (ETDEWEB)

    Field, C.J.; Mole, A. [Arup, San Fransisco, CA (United States); Arkinstall, M. [Arup, Sydney (Australia)


    The benefits that can be gained from the application of advanced numerical simulation in building design were discussed. A review of current practices in structural engineering was presented along with an illustration of a range of international project case studies. Structural engineers use analytical methods to evaluate both static and dynamic loads. Structural design is prescribed by a range of building codes, depending on location, building type and loading, but often, buildings do not fit well within the codes, particularly if one wants to take advantage of new technologies and developments in design that are not covered by the code. Advanced simulation refers to the use of mathematical modeling to complex problems to allow a wider consideration of building types and conditions that can be designed reliably using standard practices. Advanced simulation is used to address virtual testing and prototyping, verifying innovative design ideas, forensic engineering, and design optimization. The benefits of advanced simulation include enhanced creativity, improved performance, cost savings, risk management, sustainable design solutions, and better communication. The following 5 case studies illustrated the value gained by using advanced simulation as an integral part of the design process: the earthquake resistant Maison Hermes in Tokyo; the seismic resistant braces known as the Unbonded Brace for use in the United States; a simulation of the existing Disney Museum to evaluate its capacity to resist earthquakes; simulation of the MIT Brain and Cognitive Science Project to evaluate the effect of different foundation types on the vibration entering the building; and, the Beijing Aquatic Center whose design was streamlined by optimized structural analysis. It was suggested that industry should encourage the transfer of technology from other professions and should try to collaborate towards a global building model to construct buildings in a more efficient manner. 7 refs

  17. Advancing the High Throughput Identification of Liver Fibrosis Protein Signatures Using Multiplexed Ion Mobility Spectrometry

    Energy Technology Data Exchange (ETDEWEB)

    Baker, Erin Shammel; Burnum-Johnson, Kristin E.; Jacobs, Jon M.; Diamond, Deborah L.; Brown, Roslyn N.; Ibrahim, Yehia M.; Orton, Daniel J.; Piehowski, Paul D.; Purdy, David E.; Moore, Ronald J.; Danielson, William F.; Monroe, Matthew E.; Crowell, Kevin L.; Slysz, Gordon W.; Gritsenko, Marina A.; Sandoval, John D.; Lamarche, Brian L.; Matzke, Melissa M.; Webb-Robertson, Bobbie-Jo M.; Simons, Brenna C.; McMahon, Brian J.; Bhattacharya, Renuka; Perkins, James D.; Carithers, Robert L.; Strom, Susan; Self, Steven; Katze, Michael G.; Anderson, Gordon A.; Smith, Richard D.


    Rapid diagnosis of disease states using less invasive, safer, and more clinically acceptable approaches than presently employed is an imperative goal for the field of medicine. While mass spectrometry (MS)-based proteomics approaches have attempted to meet these objectives, challenges such as the enormous dynamic range of protein concentrations in clinically relevant biofluid samples coupled with the need to address human biodiversity have slowed their employment. Herein, we report on the use of a new platform that addresses these challenges by coupling technical advances in rapid gas phase multiplexed ion mobility spectrometry (IMS) separations [1, 2] with liquid chromatography (LC) and MS to dramatically increase measurement sensitivity and throughput, further enabling future MS-based clinical applications. An initial application of the LC-IMS-MS platform for the analysis of blood serum samples from stratified post-liver transplant patients with recurrent fibrosis progression illustrates its potential utility for disease characterization and use in personalized medicine [3, 4].

  18. Ambulance officers' use of online clinical evidence

    Directory of Open Access Journals (Sweden)

    Westbrook Mary T


    Full Text Available Abstract Background Hospital-based clinicians have been shown to use and attain benefits from online evidence systems. To our knowledge there have been no studies investigating whether and how ambulance officers use online evidence systems if provided. We surveyed ambulance officers to examine their knowledge and use of the Clinical Information Access Program (CIAP, an online evidence system providing 24-hour access to information to support evidence-based practice. Methods A questionnaire was completed by 278 ambulance officers in New South Wales, Australia. Comparisons were made between those who used CIAP and officers who had heard of, but not used CIAP. Results Half the sample (48.6% knew of, and 28.8% had used CIAP. Users were more likely to have heard of CIAP from a CIAP representative/presentation, non-users from written information. Compared to ambulance officers who had heard of but had not used CIAP, users were more likely to report better computer skills and that their supervisors regarded use of CIAP as a legitimate part of ambulance officers' clinical role. The main reasons for non-use were lack of access(49.0% and training(31.4%. Of users, 51.3% rated their skills at finding information as good/very good, 67.5% found the information sought all/most of the time, 87.3% believed CIAP had the potential to improve patient care and 28.2% had directly experienced this. Most access to CIAP occurred at home. The databases frequently accessed were MIMS (A medicines information database (73.8% and MEDLINE(67.5%. The major journals accessed were Journal of Emergency Nursing(37.5%, American Journal of Medicine(30.0% and JAMA(27.5%. Conclusion Over half of ambulance officers had not heard of CIAP. The proportion who knew about and used CIAP was also low. Reasons for this appear to be a work culture not convinced of CIAP's relevance to pre-hospital patient care and lack of access to CIAP at work. Ambulance officers who used CIAP accessed it

  19. Patient-controlled encrypted genomic data: an approach to advance clinical genomics

    Directory of Open Access Journals (Sweden)

    Trakadis Yannis J


    Full Text Available Abstract Background The revolution in DNA sequencing technologies over the past decade has made it feasible to sequence an individual’s whole genome at a relatively low cost. The potential value of the information generated by genomic technologies for medicine and society is enormous. However, in order for exome sequencing, and eventually whole genome sequencing, to be implemented clinically, a number of major challenges need to be overcome. For instance, obtaining meaningful informed-consent, managing incidental findings and the great volume of data generated (including multiple findings with uncertain clinical significance, re-interpreting the genomic data and providing additional counselling to patients as genetic knowledge evolves are issues that need to be addressed. It appears that medical genetics is shifting from the present “phenotype-first” medical model to a “data-first” model which leads to multiple complexities. Discussion This manuscript discusses the different challenges associated with integrating genomic technologies into clinical practice and describes a “phenotype-first” approach, namely, “Individualized Mutation-weighed Phenotype Search”, and its benefits. The proposed approach allows for a more efficient prioritization of the genes to be tested in a clinical lab based on both the patient’s phenotype and his/her entire genomic data. It simplifies “informed-consent” for clinical use of genomic technologies and helps to protect the patient’s autonomy and privacy. Overall, this approach could potentially render widespread use of genomic technologies, in the immediate future, practical, ethical and clinically useful. Summary The “Individualized Mutation-weighed Phenotype Search” approach allows for an incremental integration of genomic technologies into clinical practice. It ensures that we do not over-medicalize genomic data but, rather, continue our current medical model which is based on serving

  20. Lost in Translation: The Gap in Scientific Advancements and Clinical Application. (United States)

    Fernandez-Moure, Joseph S


    The evolution of medicine and medical technology hinges on the successful translation of basic science research from the bench to clinical implementation at the bedside. Out of the increasing need to facilitate the transfer of scientific knowledge to patients, translational research has emerged. Significant leaps in improving global health, such as antibiotics, vaccinations, and cancer therapies, have all seen successes under this paradigm, yet today, it has become increasingly difficult to realize this ideal scenario. As hospital revenue demand increases, and financial support declines, clinician-protected research time has been limited. Researchers, likewise, have been forced to abandon time- and resource-consuming translational research to focus on publication-generating work to maintain funding and professional advancement. Compared to the surge in scientific innovation and new fields of science, realization of transformational scientific findings in device development and materials sciences has significantly lagged behind. Herein, we describe: how the current scientific paradigm struggles in the new health-care landscape; the obstacles met by translational researchers; and solutions, both public and private, to overcoming those obstacles. We must rethink the old dogma of academia and reinvent the traditional pathways of research in order to truly impact the health-care arena and ultimately those that matter most: the patient. PMID:27376058

  1. Advanced age and the clinical outcomes of transcatheter aortic valve implan-tation

    Institute of Scientific and Technical Information of China (English)

    Osama Alsara; Ahmad Alsarah; Heather Laird-Fick


    Aortic valve stenosis (AS) is common in the elderly. Although surgical replacement of the valve has been the gold standard of management, many patients have been excluded from surgery because they were very old, frail, or had co-morbidities that increased operative risks. In the last decade, transcatheter aortic valve implantation (TAVI) has emerged as a new treatment option suitable for these patients. This article reviews the available literature on the role of TAVI in elderly patients with severe aortic stenosis. Published studies showed that elderly individuals who underwent TAVI experienced better in-hospital recovery, and similar short and mid-term mortality compared to those underwent surgical treatment of AS. However, long-term outcomes of TAVI in elderly patients are still unknown. The available data in the literature on the ef-fect of advanced age on clinical outcomes of TAVI are limited, but the data that are available suggest that TAVI is a beneficial and tolerable procedure in very old patients. Some of the expected complications after TAVI are reported more in the oldest patients such as vascular in-jures. Other complications were comparable in TAVI patients regardless of their age group. However, very old patients may need closer monitoring to avoid further morbidities and mortality.

  2. Clinical management of advanced gastric cancer: The role of new molecular drugs (United States)

    De Vita, Ferdinando; Di Martino, Natale; Fabozzi, Alessio; Laterza, Maria Maddalena; Ventriglia, Jole; Savastano, Beatrice; Petrillo, Angelica; Gambardella, Valentina; Sforza, Vincenzo; Marano, Luigi; Auricchio, Annamaria; Galizia, Gennaro; Ciardiello, Fortunato; Orditura, Michele


    Gastric cancer is the fourth most common malignant neoplasm and the second leading cause of death for cancer in Western countries with more than 20000 new cases yearly diagnosed in the United States. Surgery represents the main approach for this disease but, notwithstanding the advances in surgical techniques, we observed a minimal improvement in terms of overall survival with a significant increasing of relapsing disease rates. Despite the development of new drugs has significantly improved the effectiveness of chemotherapy, the prognosis of patients with unresectable or metastatic gastric adenocarcinoma remains poor. Recently, several molecular target agents have been investigated; in particular, trastuzumab represents the first target molecule showing improvements in overall survival in human epithelial growth factor 2-positive gastric cancer patients. New molecules targeting vascular epithelial growth factor, mammalian target of rapamycin, and anti hepatocyte growth factor-c-Met pathway are also under investigation, with interesting results. Anyway, it seems necessary to select more accurately the population to treat with new agents by the identification of new biomarkers in order to optimize the results. In this paper we review the actual “scenario” of targeted treatments, also focusing on the new agents in development for gastric cancer and gastro-esophageal carcinoma, discussing their efficacy and potential applications in clinical practice. PMID:25356019

  3. Lost in Translation: The Gap in Scientific Advancements and Clinical Application

    Directory of Open Access Journals (Sweden)

    Joseph eFernandez-Moure


    Full Text Available The evolution of medicine and medical technology hinges on the successful translation of basic science research from the bench to clinical implementation at the bedside. Born out of the increasing need to facilitate the transfer of scientific knowledge to patients, translational research has emerged. Significant leaps in improving global health such as antibiotics, vaccinations, and cancer therapies have all seen successes under this paradigm yet today it has become increasingly difficult to realize this ideal scenario. As hospital revenue demand increase, and financial support declines, clinician protected research time has been limited. Researchers, likewise, have been forced to abandon time and resource consuming translational research to focus on publication generating work to maintain funding and professional advancement. Compared to the surge in scientific innovation and new fields of science have surged, realization of transformational scientific findings in device development and materials sciences has significantly lagged behind. Herein, we describe: how the current scientific paradigm struggles in the new health-care landscape; the obstacles met by translational researchers; and solutions, both public and private, to overcoming those obstacles. We must rethink the old dogma of academia and reinvent the traditional pathways of research in order to truly impact the health-care arena and ultimately those that matter most: the patient.

  4. Uses of coercion in addiction treatment: clinical aspects. (United States)

    Sullivan, Maria A; Birkmayer, Florian; Boyarsky, Beth K; Frances, Richard J; Fromson, John A; Galanter, Marc; Levin, Frances R; Lewis, Collins; Nace, Edgar P; Suchinsky, Richard T; Tamerin, John S; Tolliver, Bryan; Westermeyer, Joseph


    Coerced or involuntary treatment comprises an integral, often positive component of treatment for addictive disorders. By the same token, coercion in health care raises numerous ethical, clinical, legal, political, cultural, and philosophical issues. In order to apply coerced care effectively, health care professionals should appreciate the indications, methods, advantages, and liabilities associated with this important clinical modality. An expert panel, consisting of the Addiction Committee of the Group for the Advancement of Psychiatry, listed the issues to be considered by clinicians in considering coerced treatment. In undertaking this task, they searched the literature using Pubmed from 1985 to 2005 using the following search terms: addiction, alcohol, coercion, compulsory, involuntary, substance, and treatment. In addition, they utilized relevant literature from published reports. In the treatment of addictions, coercive techniques can be effective and may be warranted in some circumstances. Various dimensions of coercive treatment are reviewed, including interventions to initiate treatment; contingency contracting and urine testing in the context of psychotherapy; and pharmacological methods of coercion such as disulfiram, naltrexone, and the use of a cocaine vaccine. The philosophical, historical, and societal aspects of coerced treatment are considered.

  5. Clinical usefulness of hemoencephalography beyond the neurofeedback

    Directory of Open Access Journals (Sweden)

    Serra-Sala M


    Full Text Available Mireia Serra-Sala,1–3 Carme Timoneda-Gallart,1–3 Frederic Pérez-Álvarez1,2,4 1Fundació Carme Vidal NeuroPsicoPedagogia, 2Institut Recerca Qualitat de Vida Universitat de Girona, 3Facultat Educació Psychology University of Girona, 4Pediatric and Behavioral Neurology, University Hospital Doctor Josep Trueta, Girona, Spain Aim: Hemoencephalography (HEG is an emerging procedure for clinical application in attention-deficit hyperactivity disorder and other disorders, regardless of age. It is available to any research group for its relative simplicity and low cost and is a useful tool for assessing prefrontal-dependent functions. Older teenagers pose peculiarities in the prefrontal maturation, and we aim to establish HEG patterns that might have clinical applicability. Methods: The HEG patterns of 70 university students (56 women and 14 men, 21–48 years old, mean 31.84, SD 10.65, standard error of mean 0.31 were compared with those of 59 adolescents – 13–14-year-old secondary education students, 28 females and 31 males. The HEG patterns were obtained in response to the observation of shocking, unpleasant, and pleasant pictures. We use one-way and two-way analysis of variance to disentangle the differences between groups. All effects were analyzed with F-tests. Results: In all cases, university students and adolescents showed a decrease in prefrontal activity, indicative of differences in the emotional inner networks between groups, which are responsible for security–insecurity processing. Compared with university students, adolescents showed statistically significant differences in decreased activity in very unpleasant (shocking tests that demand increased security–insecurity processing. Adolescents showed lower decrease. In addition, adolescents, compared with university subjects, did not show statistically significantly decreased HEG activity compared with the baseline in very unpleasant tests. Conclusion: Teens showed


    Energy Technology Data Exchange (ETDEWEB)

    David Liscinsky


    A multidisciplined team led by the United Technologies Research Center (UTRC) and consisting of Pratt & Whitney Power Systems (PWPS), the University of North Dakota Energy & Environmental Research Center (EERC), KraftWork Systems, Inc. (kWS), and the Connecticut Resource Recovery Authority (CRRA) has evaluated a variety of gasified biomass fuels, integrated into advanced gas turbine-based power systems. The team has concluded that a biomass integrated gasification combined-cycle (BIGCC) plant with an overall integrated system efficiency of 45% (HHV) at emission levels of less than half of New Source Performance Standards (NSPS) is technically and economically feasible. The higher process efficiency in itself reduces consumption of premium fuels currently used for power generation including those from foreign sources. In addition, the advanced gasification process can be used to generate fuels and chemicals, such as low-cost hydrogen and syngas for chemical synthesis, as well as baseload power. The conceptual design of the plant consists of an air-blown circulating fluidized-bed Advanced Transport Gasifier and a PWPS FT8 TwinPac{trademark} aeroderivative gas turbine operated in combined cycle to produce {approx}80 MWe. This system uses advanced technology commercial products in combination with components in advanced development or demonstration stages, thereby maximizing the opportunity for early implementation. The biofueled power system was found to have a levelized cost of electricity competitive with other new power system alternatives including larger scale natural gas combined cycles. The key elements are: (1) An Advanced Transport Gasifier (ATG) circulating fluid-bed gasifier having wide fuel flexibility and high gasification efficiency; (2) An FT8 TwinPac{trademark}-based combined cycle of approximately 80 MWe; (3) Sustainable biomass primary fuel source at low cost and potentially widespread availability-refuse-derived fuel (RDF); (4) An overall integrated

  7. Advanced MR methods at ultra-high field (7 Tesla) for clinical musculoskeletal applications

    Energy Technology Data Exchange (ETDEWEB)

    Trattnig, Siegfried [Medical University of Vienna/Vienna General Hospital, MR Centre - High Field MR, Department of Radiology, Vienna (Austria); Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Austrian Cluster for Tissue Regeneration, Vienna (Austria); Zbyn, Stefan; Schmitt, Benjamin; Friedrich, Klaus; Bogner, Wolfgang [Medical University of Vienna/Vienna General Hospital, MR Centre - High Field MR, Department of Radiology, Vienna (Austria); Juras, Vladimir; Szomolanyi, Pavol [Medical University of Vienna/Vienna General Hospital, MR Centre - High Field MR, Department of Radiology, Vienna (Austria); Slovak Academy of Sciences, Department of Imaging Methods, Institute of Measurement Science, Bratislava (Slovakia)


    This article provides an overview of the initial clinical results of musculoskeletal studies performed at 7 Tesla, with special focus on sodium imaging, new techniques such as chemical exchange saturation transfer (CEST) and T2* imaging, and multinuclear MR spectroscopy. Sodium imaging was clinically used at 7 T in the evaluation of patients after cartilage repair procedures because it enables the GAG content to be monitored over time. Sodium imaging and T2* mapping allow insights into the ultra-structural composition of the Achilles tendon and help detect early disease. Chemical exchange saturation transfer was, for the first time, successfully applied in the clinical set-up at 7 T in patients after cartilage repair surgery. The potential of phosphorus MR spectroscopy in muscle was demonstrated in a comparison study between 3 and 7 T, with higher spectral resolution and significantly shorter data acquisition times at 7 T. These initial clinical studies demonstrate the potential of ultra-high field MR at 7 T, with the advantage of significantly improved sensitivity for other nuclei, such as {sup 23}Na (sodium) and {sup 31}P (phosphorus). The application of non-proton imaging and spectroscopy provides new insights into normal and abnormal physiology of musculoskeletal tissues, particularly cartilage, tendons, and muscles. (orig.)

  8. Coronally Advanced Flap with Different Designs in the Treatment of Gingival Recession: A Comparative Controlled Randomized Clinical Trial. (United States)

    Zucchelli, Giovanni; Stefanini, M; Ganz, S; Mazzotti, Claudio; Mounssif, Ilham; Marzadori, Matteo


    The aim of this parallel double-blind randomized controlled clinical trial was to describe a modified approach using the coronally advanced flap (CAF) with triangular design and to compare its efficacy, in terms of root coverage and esthetics, with a trapezoidal type of CAF. A sample of 50 isolated Miller Class I and II gingival recessions with at least 1 mm of keratinized tissue apical to the defects were treated with CAF. Of these recessions, 25 were randomly treated with trapezoidal CAF (control group) while the other 25 (test group) were treated with a modified triangular CAF. The clinical and esthetic evaluations, made by the patient and an independent periodontist, were performed 3 months, 6 months, and 1 year after the surgery. No statistically significant difference was demonstrated between the two CAF groups in terms of recession reduction, complete root coverage, or 6-month and 1-year patient esthetic scores. Better 3-month patient esthetic evaluations and better periodontist root coverage, color match, and contiguity assessments were reported after triangular CAF. Trapezoidal CAF was associated with greater incidence of keloid formation. Single-type gingival recessions can be successfully covered with both types of CAF. The triangular CAF should be preferred for esthetically demanding patients. PMID:27100801

  9. Topical corticosteroids: clinical pharmacology and therapeutic use. (United States)

    Miller, J A; Munro, D D


    The development of topical corticosteroids has enabled many dermatoses to be more effectively treated than previously, but there is also no doubt that misuse of these preparations can lead to troublesome local effects and potentially serious systemic problems. The most effective assay for comparing different compounds has been their vasoconstrictive activity, and this on the whole correlates well with clinical effect. To be effective, corticosteroid must be absorbed and the importance of concentration, occlusion, the type of vehicle, added penetrants such as urea and the anatomical site, on the amount of absorption and therefore on clinical activity has been demonstrated. Ointments have been shown to be more effective than creams but because of the considerable choice of potencies now available most dermatologists tend to prescribe the different formulations according to the wishes of the patient. For the same reason, dilution of the commercially marketed preparations is now not generally recommended. The main therapeutic activity of topical corticosteroids is their nonspecific anti-inflammatory effect, thought to be primarily a result of their action on the chemical mediators of inflammation. They have also been shown to be antimitotic which may well be relevant not only to the treatment of scaling dermatoses but also to their dermal thinning effect resulting from inhibition of fibroblasts. Combinations of corticosteroids with antibacterial and antifungal agents have been shown to be very effective in flexural eruptions and secondarily infected dermatoses. As a general rule, the use of topical corticosteroids in outpatients, unless badly misused, is not associated with any significant risk of adrenal axis suppression, but care must be exercised as to the amount prescribed, especially if large areas of the body are to be treated with highly potent preparations. Certain groups such as young children and patients with liver failure, and certain anatomical sites such

  10. PET/SPECT molecular imaging in clinical neuroscience: recent advances in the investigation of CNS diseases


    Lu, Feng-Mei; Yuan, Zhen


    Molecular imaging is an attractive technology widely used in clinical practice that greatly enhances our understanding of the pathophysiology and treatment in central nervous system (CNS) diseases. It is a novel multidisciplinary technique that can be defined as real-time visualization, in vivo characterization and qualification of biological processes at the molecular and cellular level. It involves the imaging modalities and the corresponding imaging agents. Nowadays, molecular imaging in n...

  11. Beyond research: a primer for considerations on using viral metagenomics in the field and clinic

    NARCIS (Netherlands)

    Hall, Richard J; Draper, Jenny L; Nielsen, Fiona G G; Dutilh, Bas E


    Powered by recent advances in next-generation sequencing technologies, metagenomics has already unveiled vast microbial biodiversity in a range of environments, and is increasingly being applied in clinics for difficult-to-diagnose cases. It can be tempting to suggest that metagenomics could be used

  12. Clinical Uses of Melatonin in Pediatrics

    Directory of Open Access Journals (Sweden)

    Emilio J. Sánchez-Barceló


    Full Text Available This study analyzes the results of clinical trials of treatments with melatonin conducted in children, mostly focused on sleep disorders of different origin. Melatonin is beneficial not only in the treatment of dyssomnias, especially delayed sleep phase syndrome, but also on sleep disorders present in children with attention-deficit hyperactivity, autism spectrum disorders, and, in general, in all sleep disturbances associated with mental, neurologic, or other medical disorders. Sedative properties of melatonin have been used in diagnostic situations requiring sedation or as a premedicant in children undergoing anesthetic procedures. Epilepsy and febrile seizures are also susceptible to treatment with melatonin, alone or associated with conventional antiepileptic drugs. Melatonin has been also used to prevent the progression in some cases of adolescent idiopathic scoliosis. In newborns, and particularly those delivered preterm, melatonin has been used to reduce oxidative stress associated with sepsis, asphyxia, respiratory distress, or surgical stress. Finally, the administration of melatonin, melatonin analogues, or melatonin precursors to the infants through the breast-feeding, or by milk formula adapted for day and night, improves their nocturnal sleep. Side effects of melatonin treatments in children have not been reported. Although the above-described results are promising, specific studies to resolve the problem of dosage, formulations, and length of treatment are necessary.

  13. Advanced Heat Map and Clustering Analysis Using Heatmap3


    Shilin Zhao; Yan Guo; Quanhu Sheng; Yu Shyr


    Heat maps and clustering are used frequently in expression analysis studies for data visualization and quality control. Simple clustering and heat maps can be produced from the “heatmap” function in R. However, the “heatmap” function lacks certain functionalities and customizability, preventing it from generating advanced heat maps and dendrograms. To tackle the limitations of the “heatmap” function, we have developed an R package “heatmap3” which significantly improves the original “heatmap”...

  14. Recent Advances in Disease Modeling and Drug Discovery for Diabetes Mellitus Using Induced Pluripotent Stem Cells

    Directory of Open Access Journals (Sweden)

    Mohammed Kawser Hossain


    Full Text Available Diabetes mellitus (DM is a widespread metabolic disease with a progressive incidence of morbidity and mortality worldwide. Despite extensive research, treatment options for diabetic patients remains limited. Although significant challenges remain, induced pluripotent stem cells (iPSCs have the capacity to differentiate into any cell type, including insulin-secreting pancreatic β cells, highlighting its potential as a treatment option for DM. Several iPSC lines have recently been derived from both diabetic and healthy donors. Using different reprogramming techniques, iPSCs were differentiated into insulin-secreting pancreatic βcells. Furthermore, diabetes patient-derived iPSCs (DiPSCs are increasingly being used as a platform to perform cell-based drug screening in order to develop DiPSC-based cell therapies against DM. Toxicity and teratogenicity assays based on iPSC-derived cells can also provide additional information on safety before advancing drugs to clinical trials. In this review, we summarize recent advances in the development of techniques for differentiation of iPSCs or DiPSCs into insulin-secreting pancreatic β cells, their applications in drug screening, and their role in complementing and replacing animal testing in clinical use. Advances in iPSC technologies will provide new knowledge needed to develop patient-specific iPSC-based diabetic therapies.

  15. Recent Advances in Disease Modeling and Drug Discovery for Diabetes Mellitus Using Induced Pluripotent Stem Cells. (United States)

    Kawser Hossain, Mohammed; Abdal Dayem, Ahmed; Han, Jihae; Kumar Saha, Subbroto; Yang, Gwang-Mo; Choi, Hye Yeon; Cho, Ssang-Goo


    Diabetes mellitus (DM) is a widespread metabolic disease with a progressive incidence of morbidity and mortality worldwide. Despite extensive research, treatment options for diabetic patients remains limited. Although significant challenges remain, induced pluripotent stem cells (iPSCs) have the capacity to differentiate into any cell type, including insulin-secreting pancreatic β cells, highlighting its potential as a treatment option for DM. Several iPSC lines have recently been derived from both diabetic and healthy donors. Using different reprogramming techniques, iPSCs were differentiated into insulin-secreting pancreatic βcells. Furthermore, diabetes patient-derived iPSCs (DiPSCs) are increasingly being used as a platform to perform cell-based drug screening in order to develop DiPSC-based cell therapies against DM. Toxicity and teratogenicity assays based on iPSC-derived cells can also provide additional information on safety before advancing drugs to clinical trials. In this review, we summarize recent advances in the development of techniques for differentiation of iPSCs or DiPSCs into insulin-secreting pancreatic β cells, their applications in drug screening, and their role in complementing and replacing animal testing in clinical use. Advances in iPSC technologies will provide new knowledge needed to develop patient-specific iPSC-based diabetic therapies.

  16. 21 CFR 888.4210 - Cement mixer for clinical use. (United States)


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cement mixer for clinical use. 888.4210 Section... (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Surgical Devices § 888.4210 Cement mixer for clinical use. (a) Identification. A cement mixer for clinical use is a device consisting of a container intended for use in...

  17. Role of mammography in evaluating residual cancer of locally advanced breast carcinoma after neo-adjuvant chemotherapy : compared with clinical examination

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Byoung Wook; Kim, Eun Kyung; Oh, Ki Keun; Cho, Jae Min; Chung, Hyun Cheol; Lee, Byung Chan; Lee, Kyong Sik; Lee, Yong Hee [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)


    To compare the usefulness of mammography and clinical examination in the evaluation of residual cancer of locally-advanced breast carcinoma treated with neoadjuvant chemotherapy. Among 67 patients with locally advanced breast carcinoma who were treated with neoadjuvant chemotherapy, 18, aged 35-67 (mean, 48) years, underwent mammography before and after this therapy. The 18 sets of mammographs were analyzed retrospectively and compared with the results of clinical examination based on histologic diagnosis. On histologic examinations, 16 of 18 patients (89%) were found to have residual cancer, but in one of these 16, mammography did not show this same result. On mammography, residual cancer was found in 16 patients, but in one of this group, histologic examination did not reveal the same finding. Clinically, a complete response was shown by four patients, and a partial response by 11 ; three showed no response. On histolgogic examination, three of the four patients with complete clinical response were found to have residual cancer. Post-treatment mammographic findings showed that 11 patients had measurable mass ; all of these had residual cancer (positive predictive value : 100%). However, five of seven patients in whom no measurable mass was evident also had residual cancer. Seven of 8 patients in whom microcalcifications were seen on mammography were found to have residual cancer (positive predictive value : 88%). The sensitivity of mammography in predicting residual cancer was greater than that of clinical examination (94% vs 81%), even when microscopic residual cancer was considered as a complete response (92% vs 77%). The specificity of mammography was the same as that of clinical examination(50% vs 50%, 20% vs 20%). In evaluating residual cancer of locally-advanced breast carcinoma after neoadjuvant chemotheragy, mammography is more accurate and informative than clincal examination. In predicting residual cancer, however, it is not accurate enough to replace

  18. Multiple Gingival Recession Defects Treated with Coronally Advanced Flap and Either the VISTA Technique Enhanced with GEM 21S or Periosteal Pedicle Graft: A 9-Month Clinical Study. (United States)

    Dandu, Shruti Raju; Murthy, K Raja


    The objective of this study was to clinically evaluate and compare the efficacy of the vestibular incision subperiosteal tunnel access (VISTA) technique using Bio-Gide (Geistlich) membrane enhanced with GEM 21S (Osteohealth) with periosteal pedicle graft (PPG) using a coronally advanced flap. Multiple gingival recession sites in 15 individuals were randomly assigned either to experimental site A (VISTA) or experimental site B (PPG) in a split-mouth design. The clinical parameters were recorded at baseline and 9 months postoperatively. Repeated measures analysis of variance with post hoc Bonferroni correction and paired t test were used to assess statistical significance (P technique was less invasive and required minimal time and clinical maneuvering. It also resulted in a superior esthetic outcome. PMID:26901301

  19. Recent advances in iterative reconstruction for clinical SPECT/PET and CT

    Energy Technology Data Exchange (ETDEWEB)

    Hutton, Brian F. (Inst. of Nuclear Medicine, Univ. College London, London (United Kingdom)), e-mail:


    Statistical iterative reconstruction is now widely used in clinical practice and has contributed to significant improvement in image quality in recent years. Although primarily used for reconstruction in emission tomography (both single photon emission computed tomography (SPECT) and positron emission tomography (PET)) there is increasing interest in also applying similar algorithms to x-ray computed tomography (CT). There is increasing complexity in the factors that are included in the reconstruction, a demonstration of the versatility of the approach. Research continues with exploration of methods for further improving reconstruction quality with effective correction for various sources of artefact

  20. Adjuvant radiotherapy for pathologically advanced prostate cancer a randomized clinical trial

    Energy Technology Data Exchange (ETDEWEB)

    Ian, M.; Thompson, J.R.; Catherine, M.; Tangen, P.H.; Paradelo, J.; Scott Lucia, M.; Miller, G.; Troyer, D.; Messing, E.; Forman, J.; Chin, J.; Swanson, G.; Canby-Hagino, E.; Crawford, E.D


    Context - Despite a stage-shift to earlier cancer stages and lower tumor volumes for prostate cancer, pathologically advanced disease is detected at radical prostatectomy in 38% to 52% of patients. However, the optimal management of these patients after radical prostatectomy is unknown. Objective - To determine whether adjuvant radiotherapy improves metastasis-free survival in patients with stage pT3 NO MO prostate cancer. Design, Setting, and Patients - Randomized, prospective, multi-institutional, US clinical trial with enrollment between August 15, 1988, and January 1, 1997 (with database frozen for statistical analysis on September 21, 2005). Patients were 425 men with pathologically advanced prostate cancer who had undergone radical prostatectomy. Intervention - Men were randomly assigned to receive 60 to 64 Gy of external beam radiotherapy delivered to the prostatic fossa (n = 214) or usual care plus observation (n = 211). Main Outcome Measures - Primary outcome was metastasis-free survival, defined as time to first occurrence of metastatic disease or death due to any cause. Secondary outcomes included prostate-specific antigen (PSA) relapse, recurrence-free survival, overall survival, freedom from hormonal therapy, and postoperative complications. Results - Among the 425 men, median follow-up was 10.6 years (inter-quartile range, 9.2-12.7 years). For metastasis-free survival,76 (35.5%) of 214 men in the adjuvant radiotherapy group were diagnosed with metastatic disease or died (median metastasis-free estimate, 14.7 years), compared with 91 (43.1%) of 211 (median metastasis-free estimate, 13.2 years) of those in the observation group (hazard ratio [HR], 0.75; 95% CI, 0.55-1.02; P = .06). There were no significant between-group differences for overall survival (71 deaths, median survival of 14.7 years for radiotherapy vs 83 deaths, median survival of 13.8 years for observation; HR, 0.80; 95% Cl, 0.58-1.09; P =.16). PSA relapse (median PSA relapse-free survival

  1. Use of online clinical videos for clinical skills training for medical students: benefits and challenges


    Jang, Hye Won; Kim, Kyong-Jee


    Background Multimedia learning has been shown effective in clinical skills training. Yet, use of technology presents both opportunities and challenges to learners. The present study investigated student use and perceptions of online clinical videos for learning clinical skills and in preparing for OSCE (Objective Structured Clinical Examination). This study aims to inform us how to make more effective us of these resources. Methods A mixed-methods study was conducted for this study. A 30-item...

  2. IMRT for locally advanced anal cancer: clinical experience of the Montpellier Cancer Center

    International Nuclear Information System (INIS)

    To assess outcomes of patients with carcinoma of the anal canal (CAC) treated with intensity-modulated radiation therapy (IMRT). From August 2007 to January 2011, seventy-two patients suffering from CAC were treated with IMRT. Concurrent chemotherapy was added in case of locally advanced tumors. Radiation course consisted in delivering an initial plan to the PTV1 defined as the primary tumor and the risk area including pelvic and inguinal nodes. Forty-five Gy in daily 1.8 Gy-daily fractions were delivered five days a week. A second plan of 14.4-20 Gy to the primary tumor (PTV2) was administered in 1.8-2 Gy-daily fractions, 5 days a week. We present here the results of dosimetry, toxicities, and clinical outcome of the first 39 patients with a median follow-up of 24 months. Thirty-one women and eight men were included in the present analysis. Tumors were classified as stages I, II, III and IV in 2, 7, 27 and 2 patients, respectively. Median age was 59 years (range, 38-85). Radiotherapy alone (RT) or combined with chemotherapy (RCT) were delivered in 6 (15%) and 33 (85%) patients, respectively. Six patients (15%) required a treatment break ≥ 3 days, and median time for treatment break was 8 days (range, 3-14 days). Acute grade 3 gastrointestinal (GI) and genitourinary (GU) toxicities were seen in 10 and 5% of patients, respectively. Grade 4 toxicity was only hematologic and occurred in 12% patients receiving RCT. With a median follow-up of 24 months, no patient experienced any late grade 4 toxicity. The 2-year overall survival rate was 89%, the 2-year local relapse free survival was 77% and the 2-year colostomy-free survival rate was 85%. IMRT is well tolerated with acceptable treatment interruption allowing dose escalation

  3. Advance of Cellular Immunotherapy in Clinical and Translational Medicine of Lung Cancer

    Institute of Scientific and Technical Information of China (English)

    YAN Fei; YU Shao-rong; FENG Ji-feng


    Lung cancer is one of the most common cancers and ranks the ifrst in the mortality worldwide. The core of immunotherapy, especially cellular immunotherapy, is to activate the T cell-mediated tumor-killing effect in patients with tumors, so as to increase their anti-tumor effect. Surgery and radio- and chemotherapy cannot radically eliminate cancerous cells, but immunotherapy is an important supplementary method in killing tumor stem cells and non-proliferating cells. Cellular immunotherapy contains dendritic cells (DC), cytokine-induced killer (CIK), DC-CIK, natural killer T cells (NKT) and γδ T cells, which provides new techniques for the comprehensive treatment of lung cancer. Using CIK combined with DC, radiochemotherapy, radiofrequency ablation and monomers of Chinese medicine to induce CIK cells that directionally migrate to cancerous nest can increase tumor-killing ability and immunoregulatory ability of CIK cells, reduce adverse and toxic reactions and increase patients’ quality of life, and NKT cell and γδ T cell therapies have also been gradually perfected and promoted in clinical translation. This study mainly introduced the clinical translation of DC vaccines, CIK cells and DC-CIK treatment for lung cancer, hoping to provide new pathways and reference for the clinical treatment of lung cancer.

  4. Advanced thermal hydraulic method using 3x3 pin modeling

    International Nuclear Information System (INIS)

    Advanced thermal hydraulic methods are being developed as part of the US DOE sponsored Nuclear Hub program called CASL (Consortium for Advanced Simulation of LWRs). One of the key objectives of the Hub program is to develop a multi-physics tool which evaluates neutronic, thermal hydraulic, structural mechanics and nuclear fuel rod performance in rod bundles to support power uprates, increased burnup/cycle length and life extension for US nuclear plants. Current design analysis tools are separate and applied in series using simplistic models and conservatisms in the analysis. In order to achieve key Nuclear Hub objectives a higher fidelity, multi-physics tool is needed to address the challenge problems that limit current reactor performance. This paper summarizes the preliminary development of a multi-physics tool by performing 3x3 pin modeling and making comparisons to available data. (author)

  5. Clinical Education, the lessons learned from practical applications - Albanian issues, East Europe and the advanced international practices on Clinical Education

    Directory of Open Access Journals (Sweden)

    Alban Koci


    In legal clinics, students perform various tasks just as an attorney would do in the same job position, such as doing legal research, drafting briefs and other legal documents, and interviewing clients. Many jurisdictions even allow students to appear in court on behalf of clients, even in criminal defense. Legal clinics is part of the academic law program in the most of the law faculties all over the world and it has a great impact in the community’s life. Throughout legal clinics students not only get the opportunity to be part of an important experience, but also they can be effective and help the people in need with their work. This paper aims to bring attention to the importance of clinical education in the formation of young lawyers and how one can learn from experience. There will be discussed important issues about legal clinic, the objectives and its mission, how to apply it and the benefits legal clinic brings not only for the academic area but also for the society.

  6. Nuclear magnetic resonance based metabolomics and liver diseases: Recent advances and future clinical applications. (United States)

    Amathieu, Roland; Triba, Mohamed Nawfal; Goossens, Corentine; Bouchemal, Nadia; Nahon, Pierre; Savarin, Philippe; Le Moyec, Laurence


    Metabolomics is defined as the quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modification. It is an "omics" technique that is situated downstream of genomics, transcriptomics and proteomics. Metabolomics is recognized as a promising technique in the field of systems biology for the evaluation of global metabolic changes. During the last decade, metabolomics approaches have become widely used in the study of liver diseases for the detection of early biomarkers and altered metabolic pathways. It is a powerful technique to improve our pathophysiological knowledge of various liver diseases. It can be a useful tool to help clinicians in the diagnostic process especially to distinguish malignant and non-malignant liver disease as well as to determine the etiology or severity of the liver disease. It can also assess therapeutic response or predict drug induced liver injury. Nevertheless, the usefulness of metabolomics is often not understood by clinicians, especially the concept of metabolomics profiling or fingerprinting. In the present work, after a concise description of the different techniques and processes used in metabolomics, we will review the main research on this subject by focusing specifically on in vitro proton nuclear magnetic resonance spectroscopy based metabolomics approaches in human studies. We will first consider the clinical point of view enlighten physicians on this new approach and emphasis its future use in clinical "routine".

  7. Electrochemical behavior of dental implant system before andafter clinical use

    Institute of Scientific and Technical Information of China (English)

    Chae-Heon CHUNG; Hee-Jung KIM; Yong-Tae JEONG; Mee-Kyoung SON; Yong-Hoon JEONG; Han-Cheol CHOE


    Electrochemical behavior of dental implant system before and after clinical use (in vivo and in vitro) was researched by using abutment and titanium fixture. To simulate an oral environment, the samples of clinically used and non-used implant systems as a working electrode were exposed to artificial saliva at (36.5±1) ℃. Electrochemical tests were carried out using a potentiostat. After electrochemical test, the corrosion morphology of each sample was investigated by FE-SEM and EDS. The corrosion potential and pitting potential of clinically used implant system are lower than those of non-used implant system, and clinically used implant system exhibits a lower range of passivation, indicating a less degree of inherent resistance against chloride ion. The polarization resistance decreases in the case of clinically used implant system, whereas, Rp for clinically non-used implant system increases compared with clinically used implant system.

  8. Using socioeconomic evidence in clinical practice guidelines


    Aldrich, Rosemary; Kemp, Lynn; Williams, Jenny Stewart; Harris, Elizabeth; Simpson, Sarah; Wilson, Amanda; McGill, Katie; Byles, Julie; Lowe, Julia; Jackson, Terri


    The effects of socioeconomic position on health have been largely ignored in clinical guidelines. Australia's National Health and Medical Research Council has produced a framework to ensure that they are taken into account

  9. Clinical challenges in HIV/AIDS: Hints for advancing prevention and patient management strategies. (United States)

    Sued, Omar; Figueroa, María Inés; Cahn, Pedro


    Acquired immune deficiency syndrome has been one of the most devastating epidemics of the last century. The current estimate for people living with the HIV is 36.9 million. Today, despite availability of potent and safe drugs for effective treatment, lifelong therapy is required for preventing HIV re-emergence from a pool of latently infected cells. However, recent evidence show the importance to expand HIV testing, to offer antiretroviral treatment to all infected individuals, and to ensure retention through all the cascade of care. In addition, circumcision, pre-exposure prophylaxis, and other biomedical tools are now available for included in a comprehensive preventive package. Use of all the available tools might allow cutting the HIV transmission in 2030. In this article, we review the status of the epidemic, the latest advances in prevention and treatment, the concept of treatment as prevention and the challenges and opportunities for the HIV cure agenda. PMID:27117711

  10. 21 CFR 862.2920 - Plasma viscometer for clinical use. (United States)


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Plasma viscometer for clinical use. 862.2920... Instruments § 862.2920 Plasma viscometer for clinical use. (a) Identification. A plasma viscometer for clinical use is a device intended to measure the viscosity of plasma by determining the time...

  11. 21 CFR 862.2720 - Plasma oncometer for clinical use. (United States)


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Plasma oncometer for clinical use. 862.2720... Instruments § 862.2720 Plasma oncometer for clinical use. (a) Identification. A plasma oncometer for clinical use is a device intended to measure plasma oncotic pressure, which is that portion of the total...

  12. 21 CFR 862.2500 - Enzyme analyzer for clinical use. (United States)


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Enzyme analyzer for clinical use. 862.2500 Section... Instruments § 862.2500 Enzyme analyzer for clinical use. (a) Identification. An enzyme analyzer for clinical use is a device intended to measure enzymes in plasma or serum by nonkinetic or kinetic measurement...

  13. Detecting exacerbations using the Clinical COPD Questionnaire

    Directory of Open Access Journals (Sweden)

    Trappenburg Jaap CA


    Full Text Available Abstract Background Early treatment of COPD exacerbations has shown to be important. Despite a non-negligible negative impact on health related quality of life, a large proportion of these episodes is not reported (no change in treatment. Little is known whether (low burden strategies are able to capture these unreported exacerbations. Methods The Clinical COPD Questionnaire (CCQ is a short questionnaire with great evaluative properties in measuring health status. The current explorative study evaluates the discriminative properties of weekly CCQ assessment in detecting exacerbations. Results In a multicentre prospective cohort study, 121 patients, age 67.4 ± 10.5 years, FEV1 47.7 ± 18.5% pred were followed for 6 weeks by daily diary card recording and weekly CCQ assessment. Weeks were retrospectively labeled as stable or exacerbation (onset weeks using the Anthonisen symptom diary-card algorithm. Change in CCQ total scores are significantly higher in exacerbation-onset weeks, 0.35 ± 0.69 compared to -0.04 ± 0.37 in stable weeks (p Conclusions Weekly CCQ assessment is a promising, low burden method to detect unreported exacerbations. Further research is needed to validate discriminative performance and practical implications of the CCQ in detecting exacerbations in daily care.

  14. Clinical use of radioprotector amifostine (YM-08310)

    Energy Technology Data Exchange (ETDEWEB)

    Takahashi, Iku; Mitsuhashi, Norio; Itoh, Jun (Gunma Univ., Maebashi (Japan). School of Medicine)


    Radiotherapy was conducted at the Department of Radiology, Gunma University Hospital using amifostine (YM-08310) as a radioprotective agent. The subjects were patients suffering malignant tumors between 1978 and 1980, and comprised 52 with tumors in the head and neck region, 39 in the abdomino-pelvic region and 16 miscellaneous, totalling 107 in all. Amifostine was administered intravenously in a dose on principle, of 100 mg, 30 minutes prior to irradiation; the radioprotection provided by amifostine against reaction of the dermatomucosa caused by irradiation of head and neck region and against diarrhea caused by irradiation of the abdomino-pelvic region was investigated. 1. Side effects were observed in 10%, but there were no cases in which radiotherapy was interrupted for that reason. Most side effects were manifested as digestive organ symptoms and were most frequently observed in cases with drop infusion. 2. Clinical efficacy was evaluated at 80% or higher in cases with irradiation of the head and neck region, and deterioration in balanced diet content, which is an index of mucositis, was curbed in 70%. In the group administered amifostine thoses cases which required parenteral alimentation were significantly lower than the control group at 30 Gy or higher. 3. Control of diarrhea was feasible in 60% of patients irradiated in the abdomino-pelvic region. Moreover, despite the occurrence of diarrhea, the administration is considered to have adequate efficacy.

  15. Outcome Modeling Using Clinical DVH Data

    CERN Document Server

    Gordon, JJ


    Purpose: To quantify the ability of correlation and regression analysis to extract the normal lung dose-response function from dose volume histogram (DVH) data. Methods: A local injury model is adopted, in which radiation-induced damage (functional loss) G is the integral of the DVH with function R(D). RP risk is H(G) where H() is the sigmoid cumulative distribution of functional reserve. RP incidence is a Bernoulli function of risk. A homogeneous patient cohort is assumed, allowing non-dose-related factors to be ignored. Clinically realistic DVHs are combined with the injury model to simulate RP data. Results: Correlation analysis is often used to identify predictor variables that are correlated with outcome, for inclusion in a predictive model. In the local injury model, all DVH metrics VD contribute to damage. Correlation analysis therefore has limited value. The subset of VD significantly correlated with incidence varies randomly from trial to trial due to random variations in the DVH set, and does not ne...

  16. Optical diagnosis of mammary ductal carcinoma using advanced optical technology (United States)

    Wu, Yan; Fu, Fangmeng; Lian, Yuane; Nie, Yuting; Zhuo, Shuangmu; Wang, Chuan; Chen, Jianxin


    Clinical imaging techniques for diagnosing breast cancer mainly include X-ray mammography, ultrasound, and magnetic resonance imaging (MRI), which have respective drawbacks. Multiphoton microscopy (MPM) has become a potentially attractive optical technique to bridge the current gap in clinical utility. In this paper, MPM was used to image normal and ductal cancerous breast tissues, based on two-photon excited fluorescence (TPEF) and second harmonic generation (SHG). Our results showed that MPM has the ability to exhibit the microstructure of normal breast tissue, ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC) lesions at the molecular level comparable to histopathology. These findings indicate that, with integration of MPM into currently accepted clinical imaging system, it has the potential to make a real-time histological diagnosis of mammary ductal carcinoma in vivo.

  17. GMP facilities for manufacturing of advanced therapy medicinal products for clinical trials: an overview for clinical researchers. (United States)

    Alici, Evren; Blomberg, Pontus


    To be able to produce advanced therapy medicinal products, compliance with regulatory standards while maintaining flexibility is mandatory. For this purpose, careful planning is vital in the design or upgrade of a facility. Similarly, extensive foresight is elemental to anticipate upcoming needs and requirements. Failing this may lead to the facility's in-ability to meet the demands. In this chapter we aimed to outline the current issues with regards to the European Union Directives (EUD) and the proposal for Advanced Therapies, which are of importance to cellular and gene therapy facilities in Europe. This chapter is an attempt to elucidate what the minimum requirements for GMP facilities for cell and gene therapy products are and what is considered necessary to comply with the regulations in Europe.

  18. In vitro fertilization (IVF): a review of 3 decades of clinical innovation and technological advancement. (United States)

    Wang, Jeff; Sauer, Mark V


    In vitro fertilization, popularly referred to as IVF, has captured the attention of the public since its sensational introduction in 1978. Today assisted reproductive technology is available throughout most of the civilized world, and the practice is largely different from that used during the early days. Refinements in laboratory technology and clinical practice have allowed IVF to evolve into a medical procedure that is efficient, safe, readily accessible, and relatively affordable. More than 2 million IVF children have been born to date, and it is likely that continued enhancements will widen its appeal and applicability.

  19. Long-term survival in advanced melanoma patients using repeated therapies: successive immunomodulation improving the odds?

    Directory of Open Access Journals (Sweden)

    Coventry BJ


    Full Text Available Brendon J Coventry, Dominique Baume, Carrie Lilly Discipline of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia Background: Patients with advanced metastatic melanoma are often confronted with little prospect of medium- to longer-term survival by any currently available therapeutic means. However, most clinicians are aware of exceptional cases where survival defies the notion of futility. Prolonged survival from immunotherapies, including interleukin-2, vaccines and antibodies to cytotoxic lymphocyte antigen-4, and programmed death-1 receptor inhibitory monoclonal antibody, implies a role for immune system modulation. We aimed to identify cases where exceptional survival from advanced melanoma occurred prior to recent novel therapies to facilitate better understanding of this phenomenon. Methods: Cases of long-term survival of ≥3 years' duration (from diagnosis of metastatic disease were identified from the database of one clinician; these cases were treated before the availability of newer immunotherapies, and they were documented and examined. A literature search for reported outcome measures from published studies using older and recent therapies for advanced melanoma was conducted to enable the comparison of data. Results: Eighteen cases were identified that identified survival of ≥3 years' duration from metastatic disease (12 American Joint Committee on Cancer [AJCC] Stage IV cases; six AJCC III cases diagnosis. These were assessed and reported to detail the clinical course. Standard clinical prognostication methods predicted high risk of early mortality in those patients. No identifiable differences could be detected between these and other patients with similar patterns of disease. At evaluation, 17 patients (94% had survived ≥5 years, and eleven patients (61% had survived ≥10 years (range: 3–15 years. The median survival duration with metastatic disease was 11 years; 15 remained alive and three

  20. Use of advanced commercial ICs (COTS) for space application

    International Nuclear Information System (INIS)

    A product line of space-qualified radiation-tolerant ICs based on a high-volume commercial-off-the-shelf (COTS) silicon has been developed. The basic results from over 300 lots of COTS silicon, assembled and screened to Class B and Class S requirements will be presented. Intelligent use of commercial ICs engineered to improve radiation performance, is effective in introducing advanced technology to new satellite systems. Space Electronics has introduced over 125 space-qualified microelectronics standard products, that are used on over 90 space projects. (authors)

  1. Advances in the management of multiple sclerosis spasticity: experiences from recent studies and everyday clinical practice. (United States)

    Pozzilli, Carlo


    Although spasticity of varying severity affects up to 80% of patients with multiple sclerosis (MS) during the course of their disease, the symptom is often overlooked and undertreated. Despite the availability of oral antispasticity treatments (baclofen, tizanidine and others), approximately one-third of MS patients in Europe and the USA experience moderate or severe nonfocalized spasticity. At present, a thorough clinical evaluation of MS-related spasticity that takes into account the patient's own perception of spasms, spasticity-related pain and other associated symptoms is not common in daily neurological practice. Some of the usual spasticity scales, such as the Ashworth and modified Ashworth scales, reflect the observer's measurement of spasticity at a particular point in time. Herbal (smoked) cannabis has long been recognized as a possible option for relief of spasticity and neuropathic pain, but pertinent concerns about psychoactive effects and addiction risk have prevented its common use. An innovative method of benefiting from the mode of action of cannabinoids while limiting their drawbacks is to reduce peak plasma levels of 9-delta-tetrahydrocannabinol and counteract psychoactivity with higher than naturally occurring proportions of a second cannabinoid, cannabidiol. Sativex® oromucosal spray (1:1 ratio of 9-delta-tetrahydrocannabinol/cannabidiol) has recently been approved in a number of EU countries and elsewhere for use in patients with MS-related spasticity who are resistant to treatment with other antispasticity medications. In clinical trials, Sativex provided initial relief of spasticity symptoms within the first 4 weeks of treatment (trial period) in up to about half of patients resistant to other available oral antispasticity medications and demonstrated clinically significant improvement in spasticity (30% or higher reduction from baseline) in three-quarters of the initial responders. Adverse events were limited mainly to mild or moderate

  2. Clinical review: surgical management of locally advanced and recurrent colorectal cancer.

    LENUS (Irish Health Repository)

    Courtney, D


    Recurrent and locally advanced colorectal cancers frequently require en bloc resection of involved organs to achieve negative margins. The aim of this review is to evaluate the most current literature related to the surgical management of locally advanced and recurrent colorectal cancer.

  3. Clinical experience of intrapleural administration of fibrin glue for secondary pneumothorax with advanced lung cancer

    International Nuclear Information System (INIS)

    Secondary pneumothorax with advanced lung cancer is an intractable and serious pathosis, which directly aggravates patients' Quality of Life (QOL) and prognosis. We first select the intrapleural administration of fibrin glue for secondary pneumothorax with advanced lung cancer. From April 2009 to May 2012, we encountered 5 patients who developed secondary pneumothorax during treatment for advanced lung cancer. Their average age was 60.8 years old, and 4 of them had squamous cell carcinoma, 1 had adenocarcinoma, and all had unresectable advanced lung cancer. In 4 of them, the point of air leakage could be detected by pleurography, and leakage could be stopped by the intrapleural administration of fibrin glue. All of them could receive chemotherapy or radiotherapy after treatment for secondary pneumothorax. The intrapleural administration of fibrin glue may be an effective and valid treatment for intractable secondary pneumothorax with advanced lung cancer. (author)

  4. Pulmonary hyperpolarized noble gas MRI: Recent advances and perspectives in clinical application

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Zaiyi [Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women' s Hospital, Harvard Medical School, Boston (United States); Department of Radiology, Guangdong General Hospital Guangdong Academy of Medical Sciences (China); Araki, Tetsuro, E-mail: [Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women' s Hospital, Harvard Medical School, Boston (United States); Okajima, Yuka [Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women' s Hospital, Harvard Medical School, Boston (United States); Albert, Mitchell [Hyperpolarized Gas MRI Laboratory, Thunder Bay Regional Research Institute, Lakehead University (Canada); Hatabu, Hiroto [Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women' s Hospital, Harvard Medical School, Boston (United States)


    The invention of hyperpolarized (HP) noble gas MRI using helium-3 ({sup 3}He) or xenon-129 ({sup 129}Xe) has provided a new method to evaluate lung function. Using HP {sup 3}He or {sup 129}Xe for inhalation into the lung air spaces as an MRI contrast agent significantly increases MR signal and makes pulmonary ventilation imaging feasible. This review focuses on important aspects of pulmonary HP noble gas MRI, including the following: (1) functional imaging types, (2) applications for major pulmonary diseases, (3) safety considerations, and (4) future directions. Although it is still challenging to use pulmonary HP noble gas MRI clinically, the technology offers promise for the investigation of the microstructure and function of the lungs.

  5. Estimation of BCL-2 protein in carcinoma of the breast and its clinical correlation in locally advanced breast cancer

    Directory of Open Access Journals (Sweden)

    Aggarwal Himanshu


    Full Text Available The change in expression of apoptotic markers (Bcl-2 and Bax proteins brought about by various chemotherapeutic regimens is being used for its predictive value for assessing response to neoadjuvant chemotherapy (NACT in locally advanced breast carcinoma (LABC. Aims: (1 Estimation of Bcl 2 expression in LABC, (2 Any change in Bcl 2 expression following chemotherapy in LABC, (3 Any relation of Bcl 2 estimation to changes in size of tumor, nodal status, age, and menopausal status. Settings and Design: This was a prospective study of 120 cases of LABC. Materials and Methods: All cases were subjected to biopsy and the tissue was evaluated immunohistochemically for apoptotic marker Bcl-2 family protein. Three cycles of NACT were given at three-weekly intervals. Modified radical mastectomy was performed and the specimens were re-evaluated for any change in the Bcl-2 family protein. The clinical response and immunohistochemical response were correlated and compared. Statistical Analysis: Coefficient of correlation was calculated by Pearson correlation coefficient (P-value. Results: Clinical response, as measured by reduction in the tumor size, was observed in 81 (67.5% patients while immunohistochemical response was observed in 67 (55.8% patients. Correlation between immunohistochemical and clinical response was found to be statistically significant (P = 0.02. Nodal response was seen in 72 (60% patients. There were no patients in the N o group; 22 (53.7% of the N 1 patients were down-staged to N o , while 19 (46.3% remained N 1 . In patients with N 2 disease, 11 (13.9% were down-staged to N o status, 39 (49.4% were down-staged to N 1 status, and 29 (36.7% did not show any response. Immunohistochemical response was observed in 67 (55.8% patients. Correlation between immunohistochemical and nodal responses was also found to be statistically significant (P = 0.03. Conclusions: This significant positive correlation between clinical and immunohistochemical

  6. Explaining clinical behaviors using multiple theoretical models

    Directory of Open Access Journals (Sweden)

    Eccles Martin P


    Full Text Available Abstract Background In the field of implementation research, there is an increased interest in use of theory when designing implementation research studies involving behavior change. In 2003, we initiated a series of five studies to establish a scientific rationale for interventions to translate research findings into clinical practice by exploring the performance of a number of different, commonly used, overlapping behavioral theories and models. We reflect on the strengths and weaknesses of the methods, the performance of the theories, and consider where these methods sit alongside the range of methods for studying healthcare professional behavior change. Methods These were five studies of the theory-based cognitions and clinical behaviors (taking dental radiographs, performing dental restorations, placing fissure sealants, managing upper respiratory tract infections without prescribing antibiotics, managing low back pain without ordering lumbar spine x-rays of random samples of primary care dentists and physicians. Measures were derived for the explanatory theoretical constructs in the Theory of Planned Behavior (TPB, Social Cognitive Theory (SCT, and Illness Representations specified by the Common Sense Self Regulation Model (CSSRM. We constructed self-report measures of two constructs from Learning Theory (LT, a measure of Implementation Intentions (II, and the Precaution Adoption Process. We collected data on theory-based cognitions (explanatory measures and two interim outcome measures (stated behavioral intention and simulated behavior by postal questionnaire survey during the 12-month period to which objective measures of behavior (collected from routine administrative sources were related. Planned analyses explored the predictive value of theories in explaining variance in intention, behavioral simulation and behavior. Results Response rates across the five surveys ranged from 21% to 48%; we achieved the target sample size for three of

  7. Advanced Burnup Method using Inductively Coupled Plasma Mass Spectrometry

    Energy Technology Data Exchange (ETDEWEB)

    Hilton, Bruce A. [Idaho Natonal Laboratory, P.O. Box 1625, Idaho Falls, ID 83415-6188 (United States); Glagolenko, Irina; Giglio, Jeffrey J.; Cummings, Daniel G


    Nuclear fuel burnup is a key parameter used to assess irradiated fuel performance, to characterize the dependence of property changes due to irradiation, and to perform nuclear materials accountability. For advanced transmutation fuels and high burnup LWR fuels that have multiple fission sources, the existing Nd-148 ASTM burnup determination practice requires input of calculated fission fractions (identifying the specific fission source isotope and neutron energy that yielded fission, e.g., U-235 from thermal neutron, U-238 from fast neutron) from computational neutronics analysis in addition to the measured concentration of a single fission product isotope. We report a novel methodology of nuclear fuel burnup determination, which is completely independent of model predictions and reactor types. The proposed method leverages the capability of Inductively Coupled Plasma Mass Spectrometry (ICP-MS) to quantify multiple fission products and actinides and uses these data to develop a system of burnup equations whose solution is the fission fractions. The fission fractions are substituted back in the equations to determine burnup. This technique requires high fidelity fission yield data, which is not uniformly available for all fission products. We discuss different means that can potentially assist in indirect determination, verification and improvement (refinement) of the ambiguously known fission yields. A variety of irradiated fuel samples are characterized by ICP-MS and the results used to test the advanced burnup method. The samples include metallic alloy fuel irradiated in fast spectrum reactor (EBRII) and metallic alloy in a tailored spectrum and dispersion fuel in the thermal spectrum of the Advanced Test Reactor (ATR). The derived fission fractions and measured burnups are compared with calculated values predicted by neutronics models. (authors)

  8. Using Simulated Sessions to Enhance Clinical Social Work Education (United States)

    Mooradian, John K.


    This article evaluates a learning method that used theatre students as family clients in an advanced social work practice course. Data from 47 advanced graduate students showed that observing peers conduct simulated sessions can be an effective and valued learning experience. Quantitative findings indicated that simulations are perceived to be…

  9. Recent Advances in Genome Editing Using CRISPR/Cas9


    Ding, Yuduan; Li, Hong; Chen, Ling-Ling; Xie, Kabin


    The CRISPR (clustered regularly interspaced short palindromic repeat)-Cas9 (CRISPR-associated nuclease 9) system is a versatile tool for genome engineering that uses a guide RNA (gRNA) to target Cas9 to a specific sequence. This simple RNA-guided genome-editing technology has become a revolutionary tool in biology and has many innovative applications in different fields. In this review, we briefly introduce the Cas9-mediated genome-editing method, summarize the recent advances in CRISPR/Cas9 ...

  10. Cogeneration power plant concepts using advanced gas turbines

    Energy Technology Data Exchange (ETDEWEB)

    Huettenhofer, K.; Lezuo, A. [Siemens Power Generation, Erlangen (Germany)


    Cogeneration of heat and power (CHP) is undeniably the environmentally most favourable way of making efficient use of energy in the power generation industry. Cogeneration is also particularly appreciated by political decision makers because of its high yield from primary energy sources, and thus its contribution to the protection of the environment and the conservation of resources. Advanced gas turbines, along with an intelligent power plant design consisting of pre-engineered, modular power plant items, will help cogeneration to play an important role in future energy markets also from an economic point of view. (orig.)

  11. Thymostimulin versus placebo for palliative treatment of locally advanced or metastasised hepatocellular carcinoma: a phase III clinical trial

    Directory of Open Access Journals (Sweden)

    Dollinger Matthias M


    Full Text Available Abstract Background Thymostimulin is a thymic peptide fraction with immune-mediated cytotoxicity against hepatocellular carcinoma (HCC in vitro and palliative efficacy in advanced HCC in two independent phase II trials. The aim of this study was to assess the efficacy of thymostimulin in a phase III trial. Methods The study was designed as a prospective randomised, placebo-controlled, double-blind, multicenter clinical phase III trial. Between 10/2002 and 03/2005, 135 patients with locally advanced or metastasised HCC (Karnofsky ≥60%/Child-Pugh ≤ 12 were randomised to receive thymostimulin 75 mg s.c. 5×/week or placebo stratified according to liver function. Primary endpoint was twelve-month survival, secondary endpoints overall survival (OS, time to progression (TTP, tumor response, safety and quality of life. A subgroup analysis according to liver function, KPS and tumor stage (Okuda, CLIP and BCLC formed part of the protocol. Results Twelve-month survival was 28% [95%CI 17-41; treatment] and 32% [95%CI 19-44; control] with no significant differences in median OS (5.0 [95% CI 3.7-6.3] vs. 5.2 [95% CI 3.5-6.9] months; p = 0.87, HR = 1.04 [95% CI 0.7-1.6] or TTP (5.3 [95%CI 2.0-8.6] vs. 2.9 [95%CI 2.6-3.1] months; p = 0.60, HR = 1.13 [95% CI 0.7-1.8]. Adjustment for liver function, Karnofsky status or tumor stage did not affect results. While quality of life was similar in both groups, fewer patients on thymostimulin suffered from accumulating ascites and renal failure. Conclusions In our phase III trial, we found no evidence of any benefit to thymostimulin in the treatment of advanced HCC and there is therefore no justification for its use as single-agent treatment. The effect of thymostimulin on hepato-renal function requires further confirmation. Trial Registration Current Controlled Trials ISRCTN64487365.

  12. A novel dentifrice technology for advanced oral health protection: A review of technical and clinical data. (United States)

    Baig, Arif; He, Tao


    Throughout the world, dentifrices have played a key role in the practice of good oral hygiene and promotion of better oral health. In addition to providing general dental cleaning, toothpastes also have served as an excellent vehicle for the introduction of new agents that deliver therapeutic and cosmetic benefits. Key examples of using dentifrices to provide added benefits include the introduction in 1955 of the first fluoridated toothpaste clinically proven to fight caries (Crest Cavity Protection) and the launch of the first tartar-control dentifrice (Crest Tartar Control) in the mid-1980s. To continue expanding the health and esthetic benefits offered by a single dentifrice, a multitude of agents have been investigated over the past 3 decades. The focus of these investigations has been in the multibenefit segment, the most widely used among US consumers.

  13. Recent advances of liquid chromatography-(tandem) mass spectrometry in clinical and forensic toxicology - An update. (United States)

    Remane, Daniela; Wissenbach, Dirk K; Peters, Frank T


    Liquid chromatography (LC) coupled to mass spectrometry (MS) or tandem mass spectrometry (MS/MS) is a well-established and widely used technique in clinical and forensic toxicology as well as doping control especially for quantitative analysis. In recent years, many applications for so-called multi-target screening and/or quantification of drugs, poisons, and or their metabolites in biological matrices have been developed. Such methods have proven particularly useful for analysis of so-called new psychoactive substances that have appeared on recreational drug markets throughout the world. Moreover, the evolvement of high resolution MS techniques and the development of data-independent detection modes have opened new possibilities for applications of LC-(MS/MS) in systematic toxicological screening analysis in the so called general unknown setting. The present paper will provide an overview and discuss these recent developments focusing on the literature published after 2010.

  14. Use of advanced technologies across the wound care spectrum: prologue. (United States)

    Kirsner, Robert S; Romanelli, Marco


    The growing trends of ageing populations and increasing prevalence of diabetes have given rise to an expanding number of problematic acute and chronic wounds. Over the past two decades, the use of negative pressure wound therapy (NPWT) with and without instillation of topical wound solutions has expanded to include treatment of a large variety of wounds. Additionally, the use of NPWT specifically designed for use over closed surgical incisions has been associated with favourable results. The recent introduction of an automated epidermal harvesting system, which neither creates a donor site wound nor requires the use of a surgeon, operating room or anaesthesia, has facilitated the use of epidermal grafting. This supplement highlights some of the advanced wound approaches that have been developed to address challenging wounds and the growing burden of wound care affecting both the patient and the health care system. PMID:27547957

  15. Advance care planning - a multi-centre cluster randomised clinical trial

    DEFF Research Database (Denmark)

    Rietjens, Judith A C; Korfage, Ida J; Dunleavy, Lesley;


    BACKGROUND: Awareness of preferences regarding medical care should be a central component of the care of patients with advanced cancer. Open communication can facilitate this but can occur in an ad hoc or variable manner. Advance care planning (ACP) is a formalized process of communication between......, and improve their quality of life. METHODS/DESIGN: We will study the effects of the ACP program Respecting Choices on the quality of life of patients with advanced lung or colorectal cancer. In a phase III multicenter cluster randomised controlled trial, 22 hospitals in 6 countries will be randomised...

  16. FBXW7 mutations in patients with advanced cancers: clinical and molecular characteristics and outcomes with mTOR inhibitors.

    Directory of Open Access Journals (Sweden)

    Denis L Jardim

    Full Text Available PURPOSE: FBXW7 is a tumor suppressor gene responsible for the degradation of several proto-oncogenes. Preclinical data suggest that FBXW7 mutations sensitize cells to mTOR inhibitors. Clinicopathologic characteristics of cancer patients with FBXW7 mutations and their responses to mTOR inhibitors remain unknown. METHODS: Using multiplex gene panels we evaluated how the FBXW7 mutation affected the cancer phenotype of patients referred to a phase I clinic starting January 2012. Whenever possible patients positive for FBXW7 mutation were treated with regimens containing an mTOR inhibitors and their outcomes were reviewed. RESULTS: FBXW7 mutations were detected in 17 of 418 patients (4.0%. Among tumor types with more than 10 patients tested, FBXW7 mutations occurred in colorectal cancer (7/49; 14.3%, squamous cell cancer of head and neck (2/18; 11.1%, liver (1/13; 7.7%, and ovarian cancers (1/40; 2.5%. No one clinical, pathological or demographic feature was characteristic of the FBXW7-mutated patient population. The mutation occurred in isolation in only 2/17 (12% patients, and KRAS was frequently found as a concomitant mutation, especially in patients with colorectal cancer (6/7; 86%. Ten patients were treated on a protocol containing an mTOR inhibitor, with a median time to treatment failure of 2.8 months (range, 1.3-6.8. One patient with liver cancer (fibrolamellar subtype continues to have a prolonged stable disease for 6.8+ months. CONCLUSION: In patients with advanced cancers, somatic mutations in FBXW7 usually occur with other simultaneous molecular aberrations, which can contribute to limited therapeutic efficacy of mTOR inhibitors.

  17. Directions for advanced use of nuclear power in century XXI

    Energy Technology Data Exchange (ETDEWEB)

    Walter, C E


    Nuclear power can provide a significant contribution to electricity generation and meet other needs of the world and the US during the next century provided that certain directions are taken to achieve its public acceptance. These directions include formulation of projections of population, energy consumption, and energy resources over a responsible period of time. These projections will allow assessment of cumulative effects on the environment and on fixed resources. Use of fossil energy resources in a century of growing demand for energy must be considered in the context of long-term environmental damage and resource depletion. Although some question the validity of these consequences, they can be mitigated by use of advanced fast reactor technology. It must be demonstrated that nuclear power technology is safe, resistant to material diversion for weapon use, and economical. An unbiased examination of all the issues related to energy use, especially of electricity, is an essential direction to take.

  18. Study of nanoscale structural biology using advanced particle beam microscopy (United States)

    Boseman, Adam J.

    This work investigates developmental and structural biology at the nanoscale using current advancements in particle beam microscopy. Typically the examination of micro- and nanoscale features is performed using scanning electron microscopy (SEM), but in order to decrease surface charging, and increase resolution, an obscuring conductive layer is applied to the sample surface. As magnification increases, this layer begins to limit the ability to identify nanoscale surface structures. A new technology, Helium Ion Microscopy (HIM), is used to examine uncoated surface structures on the cuticle of wild type and mutant fruit flies. Corneal nanostructures observed with HIM are further investigated by FIB/SEM to provide detailed three dimensional information about internal events occurring during early structural development. These techniques are also used to reconstruct a mosquito germarium in order to characterize unknown events in early oogenesis. Findings from these studies, and many more like them, will soon unravel many of the mysteries surrounding the world of developmental biology.

  19. In utero stem cell transplantation and gene therapy: rationale, history, and recent advances toward clinical application


    Almeida-Porada, Graça; Atala, Anthony; Porada, Christopher D


    Recent advances in high-throughput molecular testing have made it possible to diagnose most genetic disorders relatively early in gestation with minimal risk to the fetus. These advances should soon allow widespread prenatal screening for the majority of human genetic diseases, opening the door to the possibility of treatment/correction prior to birth. In addition to the obvious psychological and financial benefits of curing a disease in utero, and thereby enabling the birth of a healthy infa...

  20. Advanced Genetic Testing Comes to the Pain Clinic to Make a Diagnosis of Paroxysmal Extreme Pain Disorder

    Directory of Open Access Journals (Sweden)

    Ashley Cannon


    Full Text Available Objective. To describe the use of an advanced genetic testing technique, whole exome sequencing, to diagnose a patient and their family with a SCN9A channelopathy. Setting. Academic tertiary care center. Design. Case report. Case Report. A 61-year-old female with a history of acute facial pain, chronic pain, fibromyalgia, and constipation was found to have a gain of function SCN9A mutation by whole exome sequencing. This mutation resulted in an SCN9A channelopathy that is most consistent with a diagnosis of paroxysmal extreme pain disorder. In addition to the patient being diagnosed, four siblings have a clinical diagnosis of SCN9A channelopathy as they have consistent symptoms and a sister with a known mutation. For treatment, gabapentin was ineffective and carbamazepine was not tolerated. Nontraditional therapies improved symptoms and constipation resolved with pelvic floor retraining with biofeedback. Conclusion. Patients with a personal and family history of chronic pain may benefit from a referral to Medical Genetics. Pelvic floor retraining with biofeedback should be considered for patients with a SCN9A channelopathy and constipation.

  1. Considerations for using research data to verify clinical data accuracy. (United States)

    Fort, Daniel; Weng, Chunhua; Bakken, Suzanne; Wilcox, Adam B


    Collected to support clinical decisions and processes, clinical data may be subject to validity issues when used for research. The objective of this study is to examine methods and issues in summarizing and evaluating the accuracy of clinical data as compared to primary research data. We hypothesized that research survey data on a patient cohort could serve as a reference standard for uncovering potential biases in clinical data. We compared the summary statistics between clinical and research datasets. Seven clinical variables, i.e., height, weight, gender, ethnicity, systolic and diastolic blood pressure, and diabetes status, were included in the study. Our results show that the clinical data and research data had similar summary statistical profiles, but there are detectable differences in definitions and measurements for individual variables such as height, diastolic blood pressure, and diabetes status. We discuss the implications of these results and confirm the important considerations for using research data to verify clinical data accuracy. PMID:25717415

  2. Recent Advances in Magnetoseismology Using Network Observations by Ground Magnetometers (United States)

    Chi, P. J.; Russell, C. T.


    The rise of modern, synchronized networks of ground magnetometers in recent years has inspired and advanced research and development in magnetoseismology. Like the practice in other geophysical disciplines, magnetoseismology can infer the structure of the magnetosphere from the observations of normal-mode frequencies of the magnetic field. It can also time and locate impulsive events by measuring the signal arrival time at multiple ground stations. We highlight recent advances in using network observations by ground magnetometers for both types of magnetoseismic research. In the area of normal-mode magnetoseismology the increase in ground magnetometers has enabled ever more station pairs suitable for the gradient analysis. We demonstrate progress in automatic detection of field line resonance frequencies and the results that reveal longitudinal structure of the plasmasphere. As a relatively young research topic, travel-time magnetoseismology has shown its capability to time and locate sudden impulses and substorm onsets by using ground-based magnetometer observations. These initial successes in turn motivated detailed examination of MHD wave propagation in the magnetosphere. In the end we discuss how these magnetoseismic studies shed light on the regions in the world where future establishment of ground magnetometers is desirable.

  3. Positron Emission Tomography: Current Challenges and Opportunities for Technological Advances in Clinical and Preclinical Imaging Systems. (United States)

    Vaquero, Juan José; Kinahan, Paul


    Positron emission tomography (PET) imaging is based on detecting two time-coincident high-energy photons from the emission of a positron-emitting radioisotope. The physics of the emission, and the detection of the coincident photons, give PET imaging unique capabilities for both very high sensitivity and accurate estimation of the in vivo concentration of the radiotracer. PET imaging has been widely adopted as an important clinical modality for oncological, cardiovascular, and neurological applications. PET imaging has also become an important tool in preclinical studies, particularly for investigating murine models of disease and other small-animal models. However, there are several challenges to using PET imaging systems. These include the fundamental trade-offs between resolution and noise, the quantitative accuracy of the measurements, and integration with X-ray computed tomography and magnetic resonance imaging. In this article, we review how researchers and industry are addressing these challenges.

  4. Preoperative chemoradiation using oral capecitabine in locally advanced rectal cancer

    International Nuclear Information System (INIS)

    Purpose: Capecitabine (Xeloda) is a new orally administered fluoropyrimidine carbamate that was rationally designed to exert its effect by tumor-selective activation. We attempted to evaluate the efficacy and toxicity of preoperative chemoradiation using capecitabine in locally advanced rectal cancer. Methods and Materials: Between July 1999 and March 2001, 45 patients with locally advanced rectal cancer (cT3/T4 or N+) were treated with preoperative chemoradiation. Radiation of 45 Gy/25 fractions was delivered to the pelvis, followed by a 5.4 Gy/3 fractions boost to the primary tumor. Chemotherapy was administered concurrent with radiotherapy and consisted of 2 cycles of 14-day oral capecitabine (1650 mg/m2/day) and leucovorin (20 mg/m2/day), each of which was followed by a 7-day rest period. Surgery was performed 6 weeks after the completion of chemoradiation. Results: Thirty-eight patients received definitive surgery. Primary tumor and node downstaging occurred in 63% and 90% of patients, respectively. The overall downstaging rate, including both primary tumor and nodes, was 84%. A pathologic complete response was achieved in 31% of patients. Twenty-one patients had tumors located initially 5 cm or less from the anal verge; among the 18 treated with surgery, 72% received sphincter-preserving surgery. No Grade 3 or 4 hematologic toxicities developed. Other Grade 3 toxicities were as follows: hand-foot syndrome (7%), fatigue (4%), diarrhea (4%), and radiation dermatitis (2%). Conclusion: These preliminary results suggest that preoperative chemoradiation with capecitabine is a safe, well-tolerated, and effective neoadjuvant treatment modality for locally advanced rectal cancer. In addition, this preoperative treatment has a considerable downstaging effect on the tumor and can increase the possibility of sphincter preservation in distal rectal cancer

  5. Using business intelligence to monitor clinical quality metrics. (United States)

    Resetar, Ervina; Noirot, Laura A; Reichley, Richard M; Storey, Patricia; Skiles, Ann M; Traynor, Patrick; Dunagan, W Claiborne; Bailey, Thomas C


    BJC HealthCare (BJC) uses a number of industry standard indicators to monitor the quality of services provided by each of its hospitals. By establishing an enterprise data warehouse as a central repository of clinical quality information, BJC is able to monitor clinical quality performance in a timely manner and improve clinical outcomes.

  6. Clinical observation of transcatheter arterial chemoembolization combined with sorafenib on intermediate-advanced hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Objective: To evaluate the treatment effect and security of transcatheter arterial chemoembolization (TACE) combined with sorafenib for intermediate-advanced hepatocellular carcinoma. Methods: From July 2008 to November 2010,the treatment effects of two groups of patients with advanced hepatocellular carcinoma were retrospectively analyzed and compared, including 44 patients treated by sorafenib combined with TACE (test group) and the other 44 patients treated only with TACE (control group). To assess the treatment effect based on mRECIST, the time for patients' tumor progression (TTP), overall survival (OS) time and adverse events were recorded. Survival rate were analyzed using Kaplan-Meier method and Log-rank analysis in SPSS 18.0. Results: Till January 2011, 24 patients (54.5%) survived and 20 patients (include patients lost to visit) died (45.5%) among the test group, 13 patients survived (29.5 %) and 31 patients (include patients lost to visit) died (70.5 %) among the control group. No complete remission condition was observed in all patients. Among the test group, 1 patient got partial remission, 24 ones remain stable and 19 patients got progression. While among the control group, conditions remained stable in 21 patients and progressed in rest 23 ones. The disease control rate (DCR) in the test group and control group were 56.8% (25/44) and 47.7% (21/44) respectively, with no statistical significance (χ2=0.729, P=0.393). The median overall survival time (mOS) of test group and control group were 21.0 (95% CI: 14.9-27.1)months and 10.0 (95% CI: 6.4-13.6) months respectively, and the difference reached statistical significance (χ2=7.436, P=0.006). The median time to tumor progression (mTTP) of test group and control group was 11.0 (95% CI: 8.7-13.3) and 6.0 (95% CI: 3.9-8.1) months respectively, and the difference had statistical significance (χ2=10.437, P=0.001). The adverse events of test group mainly included hand-foot skin reaction, loss of

  7. Advances in umbilical cord blood stem cell expansion and clinical translation. (United States)

    Pineault, Nicolas; Abu-Khader, Ahmad


    Umbilical cord blood (CB) is a rich source of hematopoietic stem cells (HSCs) with important applications in allogeneic stem cell transplantation. However, the low numbers of hematopoietic stem and progenitor cells (HSPCs) in banked units remain a major limitation. Protocols developed for HSPC expansion ex vivo or to improve HSPC homing to the marrow represent solutions to overcome this shortcoming. In recent decades, wide arrays of functionally divergent approaches were developed for the amplification of HSPCs. These include optimization of cytokine cocktails, coculture systems, small molecules, and delivery systems for HSPC-expansion genes. Herein, we review past and current strategies, focusing on studies that characterize the contribution of expanded CB HSPC to short- and long-term engraftment in transplantation models or in clinical trials. Also discussed are homing effectors used to promote engraftment. In summary, these studies underscore that early-acting cytokines alone can expand HSPC with short-term engraftment activity, but that robust expansion of HSPCs with long-term engraftment necessitates the synergistic action of multiple HSC-expansion agonists. In support of this, early clinical trials based on cytokine-driven HSPC-expansion protocols delivered disappointing results, whereas recent trials based on the synergistic action of cytokines and HSPC-expansion agonists reported significant improvements in engraftment and therapeutic outcomes. Conversely, molecules that enhance homing of HSPC may represent a complementary approach to improve and perhaps accelerate engraftment. Optimization of the next generation of HSPC-expansion and priming strategies should support a paradigm shift in CB transplantation in which smaller, better matched units may preferentially be used.

  8. Potential Uses of Probiotics in Clinical Practice


    Reid, Gregor; Jass , Jana; Sebulsky, M. Tom; McCormick, John K.


    Probiotics are defined as live microorganisms that, when administered in adequate amounts, confer a health benefit on the host. There is now mounting evidence that selected probiotic strains can provide health benefits to their human hosts. Numerous clinical trials show that certain strains can improve the outcome of intestinal infections by reducing the duration of diarrhea. Further investigations have shown benefits in reducing the recurrence of urogenital infections in women, while promisi...

  9. Advanced hyperspectral video imaging system using Amici prism. (United States)

    Feng, Jiao; Fang, Xiaojing; Cao, Xun; Ma, Chenguang; Dai, Qionghai; Zhu, Hongbo; Wang, Yongjin


    In this paper, we propose an advanced hyperspectral video imaging system (AHVIS), which consists of an objective lens, an occlusion mask, a relay lens, an Amici prism and two cameras. An RGB camera is used for spatial reading and a gray scale camera is used for measuring the scene with spectral information. The objective lens collects more light energy from the observed scene and images the scene on an occlusion mask, which subsamples the image of the observed scene. Then, the subsampled image is sent to the gray scale camera through the relay lens and the Amici prism. The Amici prism that is used to realize spectral dispersion along the optical path reduces optical distortions and offers direct view of the scene. The main advantages of the proposed system are improved light throughput and less optical distortion. Furthermore, the presented configuration is more compact, robust and practicable. PMID:25321019

  10. Advanced methods of microscope control using μManager software

    Directory of Open Access Journals (Sweden)

    Arthur D Edelstein


    Full Text Available µManager is an open-source, cross-platform desktop application, to control a wide variety of motorized microscopes, scientific cameras, stages, illuminators, and other microscope accessories. Since its inception in 2005, µManager has grown to support a wide range of microscopy hardware and is now used by thousands of researchers around the world. The application provides a mature graphical user interface and offers open programming interfaces to facilitate plugins and scripts. Here, we present a guide to using some of the recently added advanced µManager features, including hardware synchronization, simultaneous use of multiple cameras, projection of patterned light onto a specimen, live slide mapping, imaging with multi-well plates, particle localization and tracking, and high-speed imaging.

  11. Anthropometric, biochemical and clinical assessment of malnutrition in Malaysian patients with advanced cirrhosis

    Directory of Open Access Journals (Sweden)

    Rampal Sanjay


    Full Text Available Abstract Background There is limited data on the nutritional status of Asian patients with various aetiologies of cirrhosis. This study aimed to determine the prevalence of malnutrition and to compare nutritional differences between various aetiologies. Methodology A cross-sectional study of adult patients with decompensated cirrhosis was conducted. Nutritional status was assessed using standard anthropometry, serum visceral proteins and subjective global assessment (SGA. Results Thirty six patients (mean age 59.8 ± 12.8 years; 66.7% males; 41.6% viral hepatitis; Child-Pugh C 55.6% with decompensated cirrhosis were recruited. Malnutrition was prevalent in 18 (50% patients and the mean caloric intake was low at 15.2 kcal/kg/day. SGA grade C, as compared to SGA grade B, demonstrated significantly lower anthropometric values in males (BMI 18.1 ± 1.6 vs 26.3 ± 3.5 kg/m2, p Conclusion Significant malnutrition in Malaysian patients with advanced cirrhosis is common. Alcoholic cirrhosis may have more malnutrition compared to other aetiologies of cirrhosis.

  12. A regulatory perspective of clinical trial applications for biological products with particular emphasis on Advanced Therapy Medicinal Products (ATMPs). (United States)

    Jones, David R; McBlane, James W; McNaughton, Graham; Rajakumaraswamy, Nishanthan; Wydenbach, Kirsty


    The safety of trial subjects is the tenet that guides the regulatory assessment of a Clinical Trial Authorization application and applies equally to trials involving small molecules and those with biological/biotechnological products, including Advanced Therapy Medicinal Products. The objective of a regulator is to ensure that the potential risk faced by a trial subject is outweighed by the potential benefit to them from taking part in the trial. The focus of the application review is to assess whether risks have been identified and appropriate steps taken to alleviate these as much as possible. Other factors are also taken into account during a review, such as regulatory requirements, and emerging non-clinical and clinical data from other trials on the same or similar products. This paper examines the regulatory review process of a Clinical Trial Authorization application from the perspectives of Quality, Non-Clinical and Clinical Regulatory Assessors at the Medicines and Healthcare products Regulatory Agency. It should be noted that each perspective has highlighted specific issues from their individual competence and that these can be different between the disciplines.

  13. Clinical Study of MR Perfusion Imaging of Locally Advanced Breast Cancer to Neoadjuvant Chemotherapy using Magnetic%局部进展期乳腺癌新辅助化疗应用磁共振灌注成像的临床疗效研究

    Institute of Scientific and Technical Information of China (English)



    Objective To explore the clinical application of magnetic resonance imaging neoadjuvant chemotherapy of locally advanced breast cancer, and analyze the feasibility of the method as a predictor of response to chemotherapy. Methods 12 cases of patients with breast cancer after neoadjuvant chemotherapy on tumor volume change into effect group and ineffective group, the rate of change in tumor volume loss, maximum signal comparison before and after chemotherapy and chemotherapy before the maximum signal loss rate from a correlation between the rate and tumor. Results The effect of chemotherapy group, the average tumor volume of (2.89±1.03) cm3, significantly lower than that before chemotherapy and after chemotherapy the tumor volume of invalid should group, the difference was statistically significant (P<0.05);group effect in patients receiving neoadjuvant chemotherapy, the maximum signal loss rate was (13±11.2)%, significantly below before chemotherapy and after chemotherapy should be related to invalid index group. Neoadjuvant chemotherapy after a period of treatment, loss rate change perfusion maximum signal between two groups was statistically significant (P>0.05). There was a positive correlation between the shrinking rate of mean values of maximum signal loss rate and tumor volume (r=0.313, P=0.44). Conclusion Neoadjuvant chemotherapy of locally advanced breast cancer can be early evaluation of the application of magnetic resonance imaging technology, but need further study to prove whether it can be used as a predictor of response to chemotherapy.%目的:探究局部进展期乳腺癌新辅助化疗中应用磁共振灌注成像的疗效,并分析该方法作为化疗反应预测因子的可行性。方法12例乳腺癌患者依据新辅助化疗后肿瘤体积的改变分为效应组和无效应组,比较化疗前后最大信号丢失率、肿瘤体积的变化以及化疗前最大信号丢失率与肿瘤退缩率之间的相关性。结果化疗后,

  14. Advancing medicine one research note at a time: the educational value in clinical case reports


    Cabán-Martinez Alberto J; Beltrán Wilfredo F


    Abstract A case report—a brief written note that describes unique aspects of a clinical case—provides a significant function in medicine given its rapid, succinct, and educational contributions to scientific literature and clinical practice. Despite the growth of, and emphasis on, randomized clinical trials and evidenced-based medicine, case reports continue to provide novel and exceptional knowledge in medical education. The journal BMC Research Notes introduces a new “case reports” section ...

  15. Retrospective Analysis of Implant Overdenture Treatment in the Advanced Prosthodontic Clinic at the University of Illinois at Chicago. (United States)

    Marinis, Aristotelis; Afshari, Fatemeh S; Yuan, Judy Chia-Chun; Lee, Damian J; Syros, George; Knoernschild, Kent L; Campbell, Stephen D; Sukotjo, Cortino


    The aim of the present retrospective study was to evaluate the clinical outcomes of implant-supported overdenture treatment provided by prosthodontic specialty residents. Twenty-three patients with 25 implant-supported overdentures (IODs) participated in the study. Seventy-four implants were placed by periodontic, prosthodontics, or oral and maxillofacial surgery students. All prostheses were fabricated in the advanced prosthodontics clinic at University of Illinois at Chicago. The condition of the peri-implant soft tissue, implants, and prostheses were evaluated. Complications and any maintenance were documented. Patients completed an oral health impact profile-14 and semantic differential scale questionnaires. Statistical analyses were performed using SPSS statistical software. Twenty mandibular and 5 maxillary IODs were evaluated. Ninety-seven percent of the attachments were locators (Zest Anchors) and 3% ball attachments. None of the implants had lost osseointegration, but 14 implants (19%) had developed marginal bone loss in one-third of the implant length or more. Fourteen (19%) implants had developed dehiscence, which ranged from 1 to 4 mm. A variation in the width of the keratinized tissue, gingival, plaque, and calculus index was observed. There was a statistically significant relationship between the presence of plaque and the bleeding on probing on the buccal aspect of implants (P = .012). The incidence of dehiscence was significantly higher on the midfacial when the keratinized tissue was less than 2 mm (P < .0001). The majority of the complications were prosthetic in nature, such as broken denture teeth (74%) and worn or loose matrices (35%). Debris was observed in 19% of the locator abutments, and 36% of the overdentures were not stable in application of anterior force. Patients were compliant with oral hygiene protocols and their chewing ability was high (mean = 8.0). The overall experience was pleasant (mean = 7.5); the treatment provided good

  16. Recent Advances on the Technologies to Increase Fertilizer Use Efficiency

    Institute of Scientific and Technical Information of China (English)

    YAN Xiang; JIN Ji-yun; HE Ping; LIANG Ming-zao


    To increase fertilizer use efficiency (FUE) and to minimize its negative impact on environment have been the focal points in the world for a long time. It is very important to increase FUE in China for its relatively low FUE and serious losses of nutrients. Recent advances of the technologies to increase FUE are reviewed in this article. These include site-specific and real-time nitrogen management, non-destructive quick test of the nitrogen status of plants, new types of slow release and controlled release fertilizers, site-specific nutrient management, and use of urease inhibitor and nitrification inhibitor to decrease nitrogen losses. Future outlook in technologies related to FUE improvement is also discussed.


    Directory of Open Access Journals (Sweden)

    Zoltan KATO


    Full Text Available By purchasing a plane ticket or a cargo service, the passenger or the customer signs a contract with the airline company. From that moment on the airline company is responsible for all aspects of air travel, including the passenger' luggage (recording, handling to / from the aircraft etc.. Safe transport of passengers' luggage or cargo packages on airlines raises numerous problems for airlines and requires flexible, efficient solutions, appropriate to the specific requirements of each client. Annually millions of luggages get lost in airports around the world. This causes inconvenience to passengers and loss of resources and additional costs for the airlines. The aim of this paper is to examine how RFID(Radio Frequency Identification technology could be useful for advanced shipment tracking (Track and Trace in the airlines industry, by using rewritable passive RFID tags.

  18. Recent advances in the use of gelatin in biomedical research. (United States)

    Su, Kai; Wang, Chunming


    The biomacromolecule, gelatin, has increasingly been used in biomedicine-beyond its traditional use in food and cosmetics. The appealing advantages of gelatin, such as its cell-adhesive structure, low cost, off-the-shelf availability, high biocompatibility, biodegradability and low immunogenicity, among others, have made it a desirable candidate for the development of biomaterials for tissue engineering and drug delivery. Gelatin can be formulated in the form of nanoparticles, employed as size-controllable porogen, adopted as surface coating agent and mixed with synthetic or natural biopolymers forming composite scaffolds. In this article, we review recent advances in the versatile applications of gelatin within biomedical context and attempt to draw upon its advantages and potential challenges. PMID:26160110

  19. Beyond research: a primer for considerations on using viral metagenomics in the field and clinic


    Hall, Richard J.; Draper, Jenny L.; Nielsen, Fiona G.G.; Dutilh, Bas E.


    Powered by recent advances in next-generation sequencing technologies, metagenomics has already unveiled vast microbial biodiversity in a range of environments, and is increasingly being applied in clinics for difficult-to-diagnose cases. It can be tempting to suggest that metagenomics could be used as a “universal test” for all pathogens without the need to conduct lengthy serial testing using specific assays. While this is an exciting prospect, there are issues that need to be addressed bef...

  20. Advanced Online Survival Analysis Tool for Predictive Modelling in Clinical Data Science. (United States)

    Montes-Torres, Julio; Subirats, José Luis; Ribelles, Nuria; Urda, Daniel; Franco, Leonardo; Alba, Emilio; Jerez, José Manuel


    One of the prevailing applications of machine learning is the use of predictive modelling in clinical survival analysis. In this work, we present our view of the current situation of computer tools for survival analysis, stressing the need of transferring the latest results in the field of machine learning to biomedical researchers. We propose a web based software for survival analysis called OSA (Online Survival Analysis), which has been developed as an open access and user friendly option to obtain discrete time, predictive survival models at individual level using machine learning techniques, and to perform standard survival analysis. OSA employs an Artificial Neural Network (ANN) based method to produce the predictive survival models. Additionally, the software can easily generate survival and hazard curves with multiple options to personalise the plots, obtain contingency tables from the uploaded data to perform different tests, and fit a Cox regression model from a number of predictor variables. In the Materials and Methods section, we depict the general architecture of the application and introduce the mathematical background of each of the implemented methods. The study concludes with examples of use showing the results obtained with public datasets. PMID:27532883

  1. Advancing the use of checklists for evaluating performance in health care. (United States)

    Rosen, Michael A; Pronovost, Peter J


    Patients frequently do not receive recommended therapies because performance expectations are often unclear. Clinical guidelines provide exhaustive details and recommendations, but this information is not formatted in a way that supports decision making or bedside translation of therapies. When performance expectations are unclear, it is difficult for clinicians to assess their own or others' competence. Checklists offer hope because they codify interventions, remove ambiguity, and increase reliability of care processes. Schmutz and colleagues developed a robust methodology to create a checklist for evaluating clinical performance, which is described in this issue of Academic Medicine.In this commentary, the authors offer several points to consider as checklists become more prevalent in medical education and clinical practice. First, culture is a much larger part of the equation than the checklist; understanding what all stakeholders expect to gain will help engage checklist use. Second, the construction, validation, and maintenance of checklist evaluation tools is labor intensive, requiring innovative dissemination approaches to ensure maximum access and use of checklists. Third, integrated systems that evaluate technically specified and adaptive performance are needed because some aspects of clinical performance cannot be captured on a checklist. Fourth, checklists provide an opportunity to evaluate and improve an individual's performance concurrently with the context in which it is delivered. A tighter connection between education and training activities and process improvement strategies will accelerate improvements in safety and quality. Schmutz and colleagues have provided advancements in performance evaluation that will help health care achieve higher-quality and safer care. PMID:24826861

  2. Developing novel 3D antennas using advanced additive manufacturing technology (United States)

    Mirzaee, Milad

    In today's world of wireless communication systems, antenna engineering is rapidly advancing as the wireless services continue to expand in support of emerging commercial applications. Antennas play a key role in the performance of advanced transceiver systems where they serve to convert electric power to electromagnetic waves and vice versa. Researchers have held significant interest in developing this crucial component for wireless communication systems by employing a variety of design techniques. In the past few years, demands for electrically small antennas continues to increase, particularly among portable and mobile wireless devices, medical electronics and aerospace systems. This trend toward smaller electronic devices makes the three dimensional (3D) antennas very appealing, since they can be designed in a way to use every available space inside the devise. Additive Manufacturing (AM) method could help to find great solutions for the antennas design for next generation of wireless communication systems. In this thesis, the design and fabrication of 3D printed antennas using AM technology is studied. To demonstrate this application of AM, different types of antennas structures have been designed and fabricated using various manufacturing processes. This thesis studies, for the first time, embedded conductive 3D printed antennas using PolyLactic Acid (PLA) and Acrylonitrile Butadiene Styrene (ABS) for substrate parts and high temperature carbon paste for conductive parts which can be a good candidate to overcome the limitations of direct printing on 3D surfaces that is the most popular method to fabricate conductive parts of the antennas. This thesis also studies, for the first time, the fabrication of antennas with 3D printed conductive parts which can contribute to the new generation of 3D printed antennas.

  3. Clinical Observation of Icotinib Hydrochloride for Advanced Non-small Cell Lung Cancer Patients with EGFR Status Identified

    Directory of Open Access Journals (Sweden)

    Xi LI


    Full Text Available Background and objective Icotinib is the first self-developed small molecular drug in China for targeted therapy of lung cancer. Compared to the other two commercially available epidermal growth factor receptor (EGFR tyrosine kinase inhibitors, gefitinib and erlotinib, icotinib is similar to them in chemical structure, mechanism of activity and therapeutic effects. To explore the efficacy and side effects of icotinib hydrochloride in the treatment of the advanced non-small cell lung cancer (NSCLC patients with EGFR mutation and wild-type. Methods Patients with advanced NSCLC who were treated with icotinib hydrochloride in Beijing Chest Hospital were retrospective analyzed from March 2009 to December 2014. Results The clinical data of 124 patients (99 with EGFR mutation and 25 with wild type with advanced NSCLC were enrolled in this study. The patients’ overall objective response rate (ORR was 51.6 % and the disease control rate (DCR was 79.8%; The patients with EGFR mutation, ORR was 63.6%, DCR was 93.9%. The ORR was 4.0% and the DCR was 24.0% in the wild-type patients. Median progression-free survival (PFS with icotinib treatment in EGFR mutation patients was 10.5 months and 1.0 month in wild-type patients. The major adverse events were mild skin rash (30.6% and diarrhea (16.1%. Conclusion Monotherapy with icotinib hydrochloride is effective and tolerable for the advanced NSCLC EGFR mutation patients.

  4. Advanced Aqueous Phase Catalyst Development using Combinatorial Methods Project (United States)

    National Aeronautics and Space Administration — Combinatorial methods are proposed to develop advanced Aqueous Oxidation Catalysts (AOCs) with the capability to mineralize organic contaminants present in...

  5. Practical Guidance on How to Handle Levodopa/Carbidopa Intestinal Gel Therapy of Advanced PD in a Movement Disorder Clinic

    DEFF Research Database (Denmark)

    Pedersen, Stephen Wørlich; Clausen, Jesper Bøje; Gregerslund, Mie Manon


    Continuous dopaminergic delivery is recognized for the capacity to ameliorate symptoms in Parkinson's disease (PD). In advanced PD the short comings of orally administered Levodopa/Carbidopa include fluctuations resulting in unstable effect and dyskinesia. Levodopa/Carbidopa intestinal gel, LCIG......, (Duodopa®, Abbott Laboratories) is delivered continuously through a percutaneous endoscopic gastrostomy with the inner tube placed in the duodenum by means of a device (CADD legacy Duodopa pump (CE 0473)). The therapy implies continuous dopaminergic delivery directly to the duodenum and is therefore...... unaffected by gastric emptying and represents a major adjuvant in the treatment of advanced PD with significant improvement in motor and non-motor symptoms. The aim of this paper is to suggest the prerequisites for a LCIG clinic and propose a feasible set-up and lean organization of a movement disorder...

  6. Infusing Swanson's Theory of caring into an advanced practice nursing model for an infectious diseases anal dysplasia clinic. (United States)

    Ahern, Richard L; Corless, Inge B; Davis, Sheila M; Kwong, Jeffrey J


    The incidence of anal cancer is increasing among HIV-infected men and women. The process of screening for anal dysplasia and the management of abnormal findings are currently and most often based on a medical model. The needs of these patients, however, go well beyond medical care. A more comprehensive and holistic approach to health care is, therefore, required. Given the scope of practice of advanced practice nurses who are involved in the diagnosis and treatment of patients with anal dysplasia, it is appropriate for them to assume leadership roles in addressing the needs of these patients. This article describes the application of a theory of caring to create an advanced practice nursing model of care for HIV-infected men and women in infectious diseases anal dysplasia clinics. PMID:22035527

  7. Advanced Authentication Scheme Using a Predefined Keystroke Structure

    Directory of Open Access Journals (Sweden)

    Abdulameer K. Hussain


    Full Text Available This paper presents an advanced keystroke authenticatio n model improving users’ validation strength. The proposed system is based on defining a keystroke structure for each authorized user, to be used in t he user login attempts. This structure is composed based on two components; the user’s typing time deviati on thresholds; and a unique user secret code which is distributed between password's characters based on time distances. The strength of the proposed method depends primarily on the amount of information distributed among typing time, and on reducing the d eviation of these times. During the preliminary evaluation, it was confirmed that the proposed system has achieved an improved authentication level, and the system model was highly accepted between participating us

  8. Water quality management of aquifer recharge using advanced tools. (United States)

    Lazarova, Valentina; Emsellem, Yves; Paille, Julie; Glucina, Karl; Gislette, Philippe


    Managed aquifer recharge (MAR) with recycled water or other alternative resources is one of the most rapidly growing techniques that is viewed as a necessity in water-short areas. In order to better control health and environmental effects of MAR, this paper presents two case studies demonstrating how to improve water quality, enable reliable tracing of injected water and better control and manage MAR operation in the case of indirect and direct aquifer recharge. Two water quality management strategies are illustrated on two full-scale case studies, including the results of the combination of non conventional and advanced technologies for water quality improvement, comprehensive sampling and monitoring programs including emerging pollutants, tracer studies using boron isotopes and integrative aquifer 3D GIS hydraulic and hydrodispersive modelling.

  9. Channel Estimation using Adaptive Filtering for LTE-Advanced

    Directory of Open Access Journals (Sweden)

    Saqib Saleem


    Full Text Available For demand of high data rates, enhanced system capacity and coverage, ITU made proposal for the standardization of next generation wireless communication systems, known as IMT-Advanced. To achieve these targets, a priori knowledge of the channel is required at the transmitter side. In this paper, three adaptive channel estimation techniques: Least Mean Square (LMS, Recursive Least Square (RLS and Kalman-Filtering Based, are compared in terms of performance and complexity. For performance, Mean Square Error (MSE and Symbol Error Rate (SER while for complexity, computational time is measured for variable channel impulse response (CIR lengths and channel taps. MATLAB Monte-Carlo Simulations are used to evaluate these techniques.

  10. [Clinical practice using colon capsule endoscopy]. (United States)

    Kakugawa, Yasuo; Matsumoto, Minori; Saito, Yutaka


    PillCam COLON capsule endoscopy(CCE) (Given Imaging Ltd., Yoqneam, Israel) is one of the most recent diagnostic technologies designed to explore the colorectum. The first generation of CCE was released onto the market in 2006, and the second generation (PillCam COLON 2 : CCE-2), with increased sensitivity, was released in 2009. The CCE-2 has 2 imagers with a much wider angle of view that has been increased to 172 degrees per imager, allowing nearly 360 degrees coverage of the colon by two. The most unique feature of the CCE-2 is its adaptive frame rate (AFR). This new technology allows the CCE-2 to capture 35 images per second when in motion and 4 images per second when virtually stationary. The per-patient CCE-2 sensitivity for detecting polyps > or = 6 mm has been reported as 84%-91%. These recent advancements in this modality might offer physicians the option to screen for colorectal lesions noninvasively. PMID:24597367

  11. Lapatinib : clinical benefit in patients with HER2-positive advanced breast cancer

    NARCIS (Netherlands)

    Kroep, J. R.; Linn, S. C.; Boven, E.; Bloemendal, H. J.; Baas, J.; Mandjes, I. A. M.; Smit, W. M.; de Graaf, H.; Schroder, C. P.; Vermeulen, G. J.; Hop, W. C. J.; Nortier, J. W. R.


    Background: Lapatinib, a tyrosine kinase inhibitor of human epidermal growth factor receptor 2 (HER2), has shown activity in combination with capecitabine in patients with HER2-positive advanced breast cancer progressive on standard treatment regimens. We present results on preapproval drug access f

  12. Clinical use of an enterprise data warehouse. (United States)

    Evans, R Scott; Lloyd, James F; Pierce, Lee A


    The enormous amount of data being collected by electronic medical records (EMR) has found additional value when integrated and stored in data warehouses. The enterprise data warehouse (EDW) allows all data from an organization with numerous inpatient and outpatient facilities to be integrated and analyzed. We have found the EDW at Intermountain Healthcare to not only be an essential tool for management and strategic decision making, but also for patient specific clinical decision support. This paper presents the structure and two case studies of a framework that has provided us the ability to create a number of decision support applications that are dependent on the integration of previous enterprise-wide data in addition to a patient's current information in the EMR.

  13. Clinical Analysis of Icotinib on Beneficiary of 
Advanced Non-small Cell Lung Cancer with EGFR Common Mutation

    Directory of Open Access Journals (Sweden)

    Xiaowen JIANG


    Full Text Available Background and objective Targeted therapy has become an indispensable therapy method in advanced non-small cell lung cancer (NSCLC treatment. Epithelial growth factor receptor (EGFR tyrosine kinase inhibitor (TKI can significantly prolong the survival of patients harboring EGFR gene mutation. Icotinb is China's first EGFR-TKI with independent intellectual property rights. The aim of this study is to investigate the clinical characteristics about the beneficiary of advanced NSCLC patients with EGFR Common mutation who were treated with Icotinib. Retrospectively collect the data about beneficiary [progression-free survival (PFS≥6 months] and analysis of the related risk factors for prognosis. Methods From September 1, 2011 to September 30, 2015, 231 cases of advanced NSCLC beneficiary with EGFR common mutation were enrolled for treatment with icotinib in Zhejiang Cancer Hospital. Results The one year benefit rate was 67.9% in the group treated with Icotinib as first line, and in the groupas second line or above was 53.6%, which is statisticallysignificant. The two years benefit rate was 18.7% and 9.3%, respectively. The median PFS of first line group and the second line or above was 16.7 and 12.4 months, respectively. The presence of brain metastasis (P=0.010, Prior chemotherapy (P=0.001, Eastern Cooperative Oncology Group (ECOG score (P=0.001 were the main factors influencing the prognosis. The most common adverse were skin rashes (51 cases, 22.1% and diarrhea (27 cases, 11.7%. Conclusion Icotinib offers long-term clinical benefit and good tolerance for advanced NSCLC harboring EGFR gene mutation. Its advantage groups in addition to the patients with brain metastases and better ECOG score, the curative effect of patients with the first-line treatment is superior to second or further line.

  14. Advances in Research on Contingency Management for Adolescent Substance Use. (United States)

    Stanger, Catherine; Lansing, Amy Hughes; Budney, Alan J


    Multiple interventions for treating adolescents with substance use disorders have demonstrated efficacy, but a majority of teens do not show an enduring positive response to these treatments. Contingency management (CM)-based strategies provide a promising alternative, and clinical research focused on the development and testing of innovative CM models continues to grow. This article provides an updated review on the progress made in this area. It is important to continue to search for more effective models, focus on post-treatment maintenance (reduce relapse), and strive for high levels of integrity and fidelity during dissemination efforts to optimize outcomes. PMID:27613343

  15. Clinical Significance of Serum Cytokeratin 19 Fragment in the Prediction of Chemotherapy Efficacy and Prognosis in Patients with Advanced Non-small Cell Lung Cancer


    Chong'an XU; Liu, Jiali; Xing, Lili; Liu, Shu


    Background and objective RECIST (Response Evaluation Criteria in Solid Tumors) criteria could not be used to detect viable tumor tissue and is not an accurate tool for evaluation of objective response (OR) in non-small cell lung cancer (NSCLC) patients without measurable lesions. The aim of this study is to detect the pre- and post-chemotherapy serum cytokeratin 19 fragment (CYFRA21-1) expression levels in advanced NSCLC patients to evaluate the clinical value of CYFRA21-1 in the prediction o...

  16. Advanced probabilistic risk analysis using RAVEN and RELAP-7

    Energy Technology Data Exchange (ETDEWEB)

    Rabiti, Cristian [Idaho National Lab. (INL), Idaho Falls, ID (United States); Alfonsi, Andrea [Idaho National Lab. (INL), Idaho Falls, ID (United States); Mandelli, Diego [Idaho National Lab. (INL), Idaho Falls, ID (United States); Cogliati, Joshua [Idaho National Lab. (INL), Idaho Falls, ID (United States); Kinoshita, Robert [Idaho National Lab. (INL), Idaho Falls, ID (United States)


    RAVEN, under the support of the Nuclear Energy Advanced Modeling and Simulation (NEAMS) program [1], is advancing its capability to perform statistical analyses of stochastic dynamic systems. This is aligned with its mission to provide the tools needed by the Risk Informed Safety Margin Characterization (RISMC) path-lead [2] under the Department Of Energy (DOE) Light Water Reactor Sustainability program [3]. In particular this task is focused on the synergetic development with the RELAP-7 [4] code to advance the state of the art on the safety analysis of nuclear power plants (NPP). The investigation of the probabilistic evolution of accident scenarios for a complex system such as a nuclear power plant is not a trivial challenge. The complexity of the system to be modeled leads to demanding computational requirements even to simulate one of the many possible evolutions of an accident scenario (tens of CPU/hour). At the same time, the probabilistic analysis requires thousands of runs to investigate outcomes characterized by low probability and severe consequence (tail problem). The milestone reported in June of 2013 [5] described the capability of RAVEN to implement complex control logic and provide an adequate support for the exploration of the probabilistic space using a Monte Carlo sampling strategy. Unfortunately the Monte Carlo approach is ineffective with a problem of this complexity. In the following year of development, the RAVEN code has been extended with more sophisticated sampling strategies (grids, Latin Hypercube, and adaptive sampling). This milestone report illustrates the effectiveness of those methodologies in performing the assessment of the probability of core damage following the onset of a Station Black Out (SBO) situation in a boiling water reactor (BWR). The first part of the report provides an overview of the available probabilistic analysis capabilities, ranging from the different types of distributions available, possible sampling

  17. Metabolic Control of Dendritic Cell Activation and Function: Recent Advances and Clinical Implications

    Directory of Open Access Journals (Sweden)

    Bart eEverts


    Full Text Available Dendritic cells (DCs are key regulators of both immunity and tolerance by controlling activation and polarization of effector T helper cell and regulatory T cell responses. Therefore, there is a major focus on developing approaches to manipulate DC function for immunotherapy. It is well known that changes in cellular activation are coupled to profound changes in cellular metabolism. Over the past decade there is a growing appreciation that these metabolic changes also underlie the capacity of immune cells to perform particular functions. This has led to the concept that the manipulation of cellular metabolism can be used to shape innate and adaptive immune responses. While most of our understanding in this area has been gained from studies with T cells and macrophages, evidence is emerging that the activation and function of DCs are also dictated by the type of metabolism these cells commit to. We here discuss these new insights and explore whether targeting of metabolic pathways in DCs could hold promise as a novel approach to manipulate the functional properties of DCs for clinical purposes.

  18. The Ease of Language Understanding (ELU model: theoretical, empirical, and clinical advances

    Directory of Open Access Journals (Sweden)

    Jerker eRönnberg


    Full Text Available Working memory is important for online language processing during conversation. We use it to maintain relevant information, to inhibit or ignore irrelevant information, and to attend to conversation selectively. Working memory helps us to keep track of and actively participate in conversation, including taking turns and following the gist. This paper examines the Ease of Language Understanding model (i.e., the ELU model, Rönnberg, 2003; Rönnberg et al., 2008 in light of new behavioral and neural findings concerning the role of working memory capacity (WMC in uni-modal and bimodal language processing. The new ELU model is a meaning prediction system that depends on phonological and semantic interactions in rapid implicit and slower explicit processing mechanisms that both depend on WMC albeit in different ways. A revised ELU model is proposed based on findings that address the relationship between WMC and (a early attention processes in listening to speech, (b signal processing in hearing aids and its effects on short-term memory, (c inhibition of speech maskers and its effect on episodic long-term memory, (d the effects of hearing impairment on episodic and semantic long-term memory, and finally, (e listening effort. New predictions and clinical implications are outlined. Comparisons with other WMC and speech perception models are made.

  19. Corticosteroid-Binding Globulin: A Review of Basic and Clinical Advances. (United States)

    Meyer, E J; Nenke, M A; Rankin, W; Lewis, J G; Torpy, D J


    Corticosteroid-binding globulin (CBG, transcortin) is the primary cortisol binding protein. It is a non-inhibitory serine protease inhibitor, capable of conformational change from a high cortisol-binding affinity form to a low affinity form upon cleavage of its reactive centre loop by various proteases, such as neutrophil elastase. The burgeoning inflammatory role of CBG applies to acute, severe inflammation where depletion is associated with mortality, and to chronic inflammation where defects in cortisol delivery may perpetuate inflammation. Naturally occurring human mutations influence a wide range of CBG properties and point toward a role in hitherto unexplained chronic musculoskeletal pain and fatigue disorders as well as potentially affecting fertility outcomes including offspring gender. In vitro and knock-out animal models of CBG propose a role for CBG in cortisol transport to the brain, providing a foundation for understanding the human observations in those with CBG mutations and sex differences in stress-related mood and behaviour. Finally, CBG measurement has a practical role in the estimation of free cortisol, useful in clinical circumstances where CBG levels or cortisol binding affinity is reduced. Taken together, novel data suggest a role for cortisol in targeted cortisol delivery, with implications in acute and chronic inflammation, as well as roles in metabolism and neurocognitive function, implying that CBG is a multifaceted component in the mechanisms of hypothalamic-pituitary-adrenal axis related homeostasis. PMID:27214312

  20. Clinical advances in the management of chronic myelogenous leukemia: focus on bosutinib and patient considerations

    Directory of Open Access Journals (Sweden)

    Sweet K


    Full Text Available Kendra Sweet,1 Javier Pinilla-Ibarz,1 Ling Zhang21Malignant Hematology, 2Hematopathology, H Lee Moffitt Cancer Center, Tampa, FL, USAAbstract: The treatment for chronic myeloid leukemia has changed significantly over the past 15 years, and as of now, there are five BCR-ABL1 (breakpoint cluster region-Abelson murine leukemia viral oncogene homolog 1 tyrosine kinase inhibitors that have gained approval for treatment of this disease. All five are very effective drugs, and the decision surrounding which to use in specific patients is based on numerous factors. Bosutinib is one of the newer tyrosine kinase inhibitors to gain approval, and has been studied in the first-line setting as well as after failure of other tyrosine kinase inhibitors. It is an SRC-ABL1 (steroid receptor co-activator-ABL1 inhibitor that works in the presence of most kinase domain mutations. The primary side effects of bosutinib are gastrointestinal upsets. In the appropriate clinical setting, bosutinib can be considered a valuable addition to the armamentarium of treatments available for chronic myeloid leukemia.Keywords: chronic myeloid leukemia, bosutinib, treatment options

  1. Effect of integrated Chinese medical treatment on the survival time of patients with advanced non-small-cell lung cancer: a clinical study

    Institute of Scientific and Technical Information of China (English)



    Objective To observe clinical effect of integrated Chinese medical(CM)treatment(as maintenance therapy)on the progression-free survival(PFS)and overall survival(OS)in patients with advanced non-small-cell lung cancer(NSCLC)after first-line chemotherapy.Methods The study was a prospective,randomized,controlled clinical trial.Totally 69 non-progressive advanced NSCLC patients treated with first-line chemotherapy were

  2. Using L1 in Teaching English to Advanced Students

    Directory of Open Access Journals (Sweden)

    Khalid Al Hariri


    Full Text Available Using L1 in the English classroom has long been considered as an unforgivable wrongdoing. Many English teachers who use L1 in the classroom feel guilty about it and in many cases do not admit it. Recent researchers started to question the validity of this claim suggesting contexts and situations in which using L1 can be very helpful in ELT and refuting, on the other hand, the claims upon which the idea of using L2 solely were built.  My paper will examine the attitudes of advanced English language learners toward using L1 in the class of English where the students and the teacher speak the same first language and will also examine the attitudes of a group of EFL and ESL teachers toward the same practice. The same questionnaire given to the students will be redesigned and given to a number of teachers so that the study will look at the viewpoints from both perspectives.Keywords:  L1, Code Switching, Interference of L1, ELT, TESOL

  3. Clinical Impact of Education Provision on Determining Advance Care Planning Decisions among End Stage Renal Disease Patients Receiving Regular Hemodialysis in University Malaya Medical Centre (United States)

    Hing (Wong), Albert; Chin, Loh Ee; Ping, Tan Li; Peng, Ng Kok; Kun, Lim Soo


    Introduction: Advance care planning (ACP) is a process of shared decision-making about future health-care plans between patients, health care providers, and family members, should patients becomes incapable of participating in medical treatment decisions. ACP discussions enhance patient's autonomy, focus on patient's values and treatment preferences, and promote patient-centered care. ACP is integrated as part of clinical practice in Singapore and the United States. Aim: To assess the clinical impact of education provision on determining ACP decisions among end-stage renal disease patients on regular hemodialysis at University Malaya Medical Centre (UMMC). To study the knowledge and attitude of patients toward ACP and end-of-life issues. Materials and Methods: Fifty-six patients were recruited from UMMC. About 43 questions pretest survey adapted from Lyon's ACP survey and Moss's cardiopulmonary resuscitation (CPR) attitude survey was given to patients to answer. An educational brochure is then introduced to these patients, and a posttest survey carried out after that. The results were analyzed using SPSS version 22.0. Results: Opinion on ACP, including CPR decisions, showed an upward trend on the importance percentage after the educational brochure exposure, but this was statistically not significant. Seventy-five percent of participants had never heard of ACP before, and only 3.6% had actually prepared a written advanced directive. Conclusion: The ACP educational brochure clinically impacts patients’ preferences and decisions toward end-of-life care; however, this is statistically not significant. Majority of patients have poor knowledge on ACP. This study lays the foundation for execution of future larger scale clinical trials, and ultimately, the incorporation of ACP into clinical practice in Malaysia.

  4. A pilot study using next-generation sequencing in advanced cancers: feasibility and challenges.

    Directory of Open Access Journals (Sweden)

    Glen J Weiss

    Full Text Available PURPOSE: New anticancer agents that target a single cell surface receptor, up-regulated or amplified gene product, or mutated gene, have met with some success in treating advanced cancers. However, patients' tumors still eventually progress on these therapies. If it were possible to identify a larger number of targetable vulnerabilities in an individual's tumor, multiple targets could be exploited with the use of specific therapeutic agents, thus possibly giving the patient viable therapeutic alternatives. EXPERIMENTAL DESIGN: In this exploratory study, we used next-generation sequencing technologies (NGS including whole genome sequencing (WGS, and where feasible, whole transcriptome sequencing (WTS to identify genomic events and associated expression changes in advanced cancer patients. RESULTS: WGS on paired tumor and normal samples from nine advanced cancer patients and WTS on six of these patients' tumors was completed. One patient's treatment was based on targets and pathways identified by NGS and the patient had a short-lived PET/CT response with a significant reduction in his tumor-related pain. To design treatment plans based on information garnered from NGS, several challenges were encountered: NGS reporting delays, communication of results to out-of-state participants and their treating oncologists, and chain of custody handling for fresh biopsy samples for Clinical Laboratory Improvement Amendments (CLIA target validation. CONCLUSION: While the initial effort was a slower process than anticipated due to a variety of issues, we demonstrate the feasibility of using NGS in advanced cancer patients so that treatments for patients with progressing tumors may be improved.

  5. Using advanced electron microscopy for the characterization of catalytic materials (United States)

    Pyrz, William D.

    Catalysis will continue to be vitally important to the advancement and sustainability of industrialized societies. Unfortunately, the petroleum-based resources that currently fuel the energy and consumer product needs of an advancing society are becoming increasingly difficult and expensive to extract as supplies diminish and the quality of sources degrade. Therefore, the development of sustainable energy sources and the improvement of the carbon efficiency of existing chemical processes are critical. Further challenges require that these initiatives are accomplished in an environmentally friendly fashion since the effects of carbon-based emissions are proving to be a serious threat to global climate stability. In this dissertation, materials being developed for sustainable energy and process improvement initiatives are studied. Our approach is to use materials characterization, namely advanced electron microscopy, to analyze the targeted systems at the nano- or Angstrom-scale with the goal of developing useful relationships between structure, composition, crystalline order, morphology, and catalytic performance. One area of interest is the complex Mo-V-M-O (M=Te, Sb, Ta, Nb) oxide system currently being developed for the selective oxidation/ammoxidation of propane to acrylic acid or acrylonitrile, respectively. Currently, the production of acrylic acid and acrylonitrile rely on propylene-based processes, yet significant cost savings could be realized if the olefin-based feeds could be replaced by paraffin-based ones. The major challenge preventing this feedstock replacement is the development of a suitable paraffin-activating catalyst. Currently, the best candidate is the Mo-V-Nb-Te-O complex oxide catalyst that is composed of two majority phases that are commonly referred to as M1 and M2. However, there is a limited understanding of the roles of each component with respect to how they contribute to catalyst stability and the reaction mechanism. Aberration

  6. Portfolio use as a tool to demonstrate professional development in advanced nursing practice. (United States)

    Hespenheide, Molly; Cottingham, Talisha; Mueller, Gail


    A concrete way of recognizing and rewarding clinical leadership, excellence in practice, and personal and professional development of the advanced practice registered nurse (APRN) is lacking in the literature and healthcare institutions in the United States. This article presents the process of developing and evaluating a professional development program designed to address this gap. The program uses APRN Professional Performance Standards, Relationship-Based Care, and the Magnet Forces as a guide and theoretical base. A key tenet of the program is the creation of a professional portfolio. Narrative reflections are included that illustrate the convergence of theories. A crosswalk supports this structure, guides portfolio development, and operationalizes the convergence of theories as they specifically relate to professional development in advanced practice. Implementation of the program has proven to be challenging and rewarding. Feedback from APRNs involved in the program supports program participation as a meaningful method to recognize excellence in advanced practice and a clear means to foster ongoing professional growth and development. PMID:22016019

  7. Symptomatic treatment of multiple sclerosis using cannabinoids: recent advances. (United States)

    Smith, Paul F


    Recent years have seen a dramatic increase in the number of clinical trials investigating the potential efficacy of medicinal cannabinoids for the symptomatic treatment of chronic pain and spasticity in multiple sclerosis (MS). A number of different cannabinoids have been used, including: delta9-tetrahydrocannabinol (THC) itself; the synthetic delta9-THC, dronabinol; a 1:1 ratio of delta9-THC:cannabidiol (Sativex); and the synthetic delta9-THC metabolites CT-3 and nabilone. Other Cannabis extracts have also been tested. While 2-3 years ago there was little consensus in the literature, now the majority of studies are beginning to suggest that cannabinoids are useful in the treatment of MS in at least a subset of individuals. Their adverse side-effect profile has generally been mild compared with other drugs used for pain and spasticity; nonetheless, there is still concern about potential long-term side effects, particularly psychiatric side effects and effects on fetal development. PMID:17868014

  8. Recent Advances in Fungal Hydrophobin Towards Using in Industry. (United States)

    Khalesi, Mohammadreza; Gebruers, Kurt; Derdelinckx, Guy


    Fungal hydrophobin is a family of low molecular weight proteins consisting of four disulfide bridges and an extraordinary hydrophobic patch. The hydrophobic patch of hydrophobins and the molecules of gaseous CO2 may interact together and form the stable CO2-nanobubbles covered by an elastic membrane in carbonated beverages. The nanobubbles provide the required energy to provoke primary gushing. Due to the hydrophobicity of hydrophobin, this protein is used as a biosurfactant, foaming agent or encapsulating agent in food products and medicine formulations. Increasing demands for using of hydrophobins led to a challenge regarding production and purification of this product. However, the main issue to use hydrophobin in the industry is the regulatory affairs: yet there is no approved legislation for using hydrophobin in food and beverages. To comply with the legislation, establishing a consistent method for obtaining pure hydrophobins is necessary. Currently, few research teams in Europe are focusing on different aspects of hydrophobins. In this paper, an up-to-date collection of highlights from those special groups about the bio-chemical and physicochemical characteristics of hydrophobins have been studied. The recent advances of those groups concerning the production and purification, positive applications and negative function of hydrophobin are also summarised.

  9. Use of the experience sampling method in the context of clinical trials (United States)

    Verhagen, Simone J W; Hasmi, Laila; Drukker, Marjan; van Os, J; Delespaul, Philippe A E G


    Objective The experience sampling method (ESM) is a structured diary technique to appraise subjective experiences in daily life. It is applied in psychiatric patients, as well as in patients with somatic illness. Despite the potential of ESM assessment, the improved logistics and its increased administration in research, its use in clinical trials remains limited. This paper introduces ESM for clinical trials in psychiatry and beyond. Methods ESM is an ecologically valid method that yields a comprehensive view of an individual's daily life. It allows the assessment of various constructs (eg, quality of life, psychopathology) and psychological mechanisms (eg, stress-sensitivity, coping). These constructs are difficult to assess using cross-sectional questionnaires. ESM can be applied in treatment monitoring, as an ecological momentary intervention, in clinical trials, or in single case clinical trials. Technological advances (eg, smartphone applications) make its implementation easier. Results Advantages of ESM are highlighted and disadvantages are discussed. Furthermore, the ecological nature of ESM data and its consequences are explored, including the potential pitfalls of ambiguously formulated research questions and the specificities of ESM in statistical analyses. The last section focuses on ESM in relation to clinical trials and discusses its future use in optimising clinical decision-making. Conclusions ESM can be a valuable asset in clinical trial research and should be used more often to study the benefits of treatment in psychiatry and somatic health. PMID:27443678

  10. Characteristics of student preparedness for clinical learning: clinical educator perspectives using the Delphi approach

    Directory of Open Access Journals (Sweden)

    Chipchase Lucinda S


    Full Text Available Abstract Background During clinical placements, clinical educators facilitate student learning. Previous research has defined the skills, attitudes and practices that pertain to an ideal clinical educator. However, less attention has been paid to the role of student readiness in terms of foundational knowledge and attitudes at the commencement of practice education. Therefore, the aim of this study was to ascertain clinical educators’ views on the characteristics that they perceive demonstrate that a student is well prepared for clinical learning. Methods A two round on-line Delphi study was conducted. The first questionnaire was emailed to a total of 636 expert clinical educators from the disciplines of occupational therapy, physiotherapy and speech pathology. Expert clinical educators were asked to describe the key characteristics that indicate a student is prepared for a clinical placement and ready to learn. Open-ended responses received from the first round were subject to a thematic analysis and resulted in six themes with 62 characteristics. In the second round, participants were asked to rate each characteristic on a 7 point Likert Scale. Results A total of 258 (40.56% responded to the first round of the Delphi survey while 161 clinical educators completed the second (62.40% retention rate. Consensus was reached on 57 characteristics (six themes using a cut off of greater than 70% positive respondents and an interquartile deviation IQD of equal or less than 1. Conclusions This study identified 57 characteristics (six themes perceived by clinical educators as indicators of a student who is prepared and ready for clinical learning. A list of characteristics relating to behaviours has been compiled and could be provided to students to aid their preparation for clinical learning and to universities to incorporate within curricula. In addition, the list provides a platform for discussions by professional bodies about the role of placement

  11. Clinical evaluation of radiotherapy for advanced esophageal cancer after metallic stent placement

    Institute of Scientific and Technical Information of China (English)

    You-Tao Yu; Guang Yang; Yan Liu; Bao-Zhong Shen


    AIM: To evaluate the therapeutic effect of radiotherapy for esophageal cancer after expandable metallic stent placement.METHODS: Ten cases of advanced esophageal cancer were evaluated, 7 having complete obstruction and 3 with digestive-respiratory fistula. Ten nitinol stents were placed at the site of stenosis. Patients were treated with a total dose of 1 200 cGy divided into 3 fractions of 400 cGy 4-7 d after stents placement.RESULTS: All the 10 stents were placed successfully at one time. After radiotherapy for advanced esophageal cancer, the survival period of the cases ranged from 14 to 22 mo, with a mean survival of 17 mo. No re-stenosis occurred among all the 10 cases.CONCLUSION: Stent placement combined with radiotherapy for esophageal cancer is helpful to prolong patients' survival and reduce occurrence of re-stenosis.

  12. Default options in advance directives: study protocol for a randomised clinical trial


    Gabler, Nicole B.; Cooney, Elizabeth; Small, Dylan S.; Troxel, Andrea B.; Arnold, Robert M.; White, Douglas B.; Angus, Derek C.; Loewenstein, George; Volpp, Kevin G; Bryce, Cindy L.; Halpern, Scott D.


    Introduction Although most seriously ill Americans wish to avoid burdensome and aggressive care at the end of life, such care is often provided unless patients or family members specifically request otherwise. Advance directives (ADs) were created to provide opportunities to set limits on aggressive care near life's end. This study tests the hypothesis that redesigning ADs such that comfort-oriented care is provided as the default, rather than requiring patients to actively choose it, will pr...

  13. [A device for mandibular advancement in respiratory disorders of sleep. Clinical study]. (United States)

    Bacon, W; Tschill, P; Sforza, E; Krieger, J


    This study describes the technical steps for the making of a mandibular advancement device for sleep disordered patients (apnea index mandibule forward (SNB angle increases by 1.7 degrees) and downward (mandibular plane angle increases by 3 degrees, which can be related to the 7.4 mm anterior vertical height increase). The hyoid bone adopted a more distant position from the cervical vertebrae. Important individual variations were seen among the patients for the optimal repositioning of the mandible.

  14. Barrett's esophagus and cancer risk: how research advances can impact clinical practice. (United States)

    di Pietro, Massimiliano; Alzoubaidi, Durayd; Fitzgerald, Rebecca C


    Barrett's esophagus (BE) is the only known precursor to esophageal adenocarcinoma (EAC), whose incidence has increased sharply in the last 4 decades. The annual conversion rate of BE to cancer is significant, but small. The identification of patients at a higher risk of cancer therefore poses a clinical conundrum. Currently, endoscopic surveillance is recommended in BE patients, with the aim of diagnosing either dysplasia or cancer at early stages, both of which are curable with minimally invasive endoscopic techniques. There is a large variation in clinical practice for endoscopic surveillance, and dysplasia as a marker of increased risk is affected by sampling error and high interobserver variability. Screening programs have not yet been formally accepted, mainly due to the economic burden that would be generated by upper gastrointestinal endoscopy. Screening programs have not yet been formally accepted, mainly due to the economic burden that would be generated by widespread indication to upper gastrointestinal endoscopy. In fact, it is currently difficult to formulate an accurate algorithm to confidently target the population at risk, based on the known clinical risk factors for BE and EAC. This review will focus on the clinical and molecular factors that are involved in the development of BE and its conversion to cancer and on how increased knowledge in these areas can improve the clinical management of the disease. PMID:25071900

  15. 21 CFR 862.2860 - Mass spectrometer for clinical use. (United States)


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Mass spectrometer for clinical use. 862.2860... Instruments § 862.2860 Mass spectrometer for clinical use. (a) Identification. A mass spectrometer for... by means of an electrical and magnetic field according to their mass. (b) Classification. Class...

  16. Phase I clinical trial of fibronectin CH296-stimulated T cell therapy in patients with advanced cancer.

    Directory of Open Access Journals (Sweden)

    Takeshi Ishikawa

    Full Text Available BACKGROUND: Previous studies have demonstrated that less-differentiated T cells are ideal for adoptive T cell transfer therapy (ACT and that fibronectin CH296 (FN-CH296 together with anti-CD3 resulted in cultured cells that contain higher amounts of less-differentiated T cells. In this phase I clinical trial, we build on these prior results by assessing the safety and efficacy of FN-CH296 stimulated T cell therapy in patients with advanced cancer. METHODS: Patients underwent fibronectin CH296-stimulated T cell therapy up to six times every two weeks and the safety and antitumor activity of the ACT were assessed. In order to determine immune function, whole blood cytokine levels and the number of peripheral regulatory T cells were analyzed prior to ACT and during the follow up. RESULTS: Transferred cells contained numerous less-differentiated T cells greatly represented by CD27+CD45RA+ or CD28+CD45RA+ cell, which accounted for approximately 65% and 70% of the total, respectively. No ACT related severe or unexpected toxicities were observed. The response rate among patients was 22.2% and the disease control rate was 66.7%. CONCLUSIONS: The results obtained in this phase I trial, indicate that FN-CH296 stimulated T cell therapy was very well tolerated with a level of efficacy that is quite promising. We also surmise that expanding T cell using CH296 is a method that can be applied to other T- cell-based therapies. TRIAL REGISTRATION: UMIN UMIN000001835.

  17. Advanced Reservoir Imaging Using Frequency-Dependent Seismic Attributes

    Energy Technology Data Exchange (ETDEWEB)

    Fred Hilterman; Tad Patzek; Gennady Goloshubin; Dmitriy Silin; Charlotte Sullivan; Valeri Korneev


    Our report concerning advanced imaging and interpretation technology includes the development of theory, the implementation of laboratory experiments and the verification of results using field data. We investigated a reflectivity model for porous fluid-saturated reservoirs and demonstrated that the frequency-dependent component of the reflection coefficient is asymptotically proportional to the reservoir fluid mobility. We also analyzed seismic data using different azimuths and offsets over physical models of fractures filled with air and water. By comparing our physical model synthetics to numerical data we have identified several diagnostic indicators for quantifying the fractures. Finally, we developed reflectivity transforms for predicting pore fluid and lithology using rock-property statistics from 500 reservoirs in both the shelf and deep-water Gulf of Mexico. With these transforms and seismic AVO gathers across the prospect and its down-dip water-equivalent reservoir, fluid saturation can be estimated without a calibration well that ties the seismic. Our research provides the important additional mechanisms to recognize, delineate, and validate new hydrocarbon reserves and assist in the development of producing fields.

  18. Advanced trans-tibial socket fabrication using selective laser sintering. (United States)

    Rogers, Bill; Bosker, Gordon W; Crawford, Richard H; Faustini, Mario C; Neptune, Richard R; Walden, Gail; Gitter, Andrew J


    There have been a variety of efforts demonstrating the use of solid freeform fabrication (SFF) for prosthetic socket fabrication though there has been little effort in leveraging the strengths of the technology. SFF encompasses a class of technologies that can create three dimensional objects directly from a geometric database without specific tooling or human intervention. A real strength of SFF is that cost of fabrication is related to the volume of the part, not the part's complexity. For prosthetic socket fabrication this means that a sophisticated socket can be fabricated at essentially the same cost as a simple socket. Adding new features to a socket design becomes a function of software. The work at The University of Texas Health Science Center at San Antonio (UTHSCSA) and University of Texas at Austin (UTA) has concentrated on developing advanced sockets that incorporate structural features to increase comfort as well as built in fixtures to accommodate industry standard hardware. Selective laser sintering (SLS) was chosen as the SFF technology to use for socket fabrication as it was capable of fabricating sockets using materials appropriate for prosthetics. This paper details the development of SLS prosthetic socket fabrication techniques at UTHSCSA/UTA over a six-year period.

  19. Removing baseline flame's spectrum by using advanced recovering spectrum techniques. (United States)

    Arias, Luis; Sbarbaro, Daniel; Torres, Sergio


    In this paper, a novel automated algorithm to estimate and remove the continuous baseline from measured flame spectra is proposed. The algorithm estimates the continuous background based on previous information obtained from a learning database of continuous flame spectra. Then, the discontinuous flame emission is calculated by subtracting the estimated continuous baseline from the measured spectrum. The key issue subtending the learning database is that the continuous flame emissions are predominant in the sooty regions, in absence of discontinuous radiation. The proposed algorithm was tested using natural gas and bio-oil flames spectra at different combustion conditions, and the goodness-of-fit coefficient (GFC) quality metric was used to quantify the performance in the estimation process. Additionally, the commonly used first derivative method (FDM) for baseline removing was applied to the same testing spectra in order to compare and to evaluate the proposed technique. The achieved results show that the proposed method is a very attractive tool for designing advanced combustion monitoring strategies of discontinuous emissions. PMID:22945158

  20. Clinical efficacy of CT-guided 125I seed implantation therapy for advanced pancreatic cancer

    International Nuclear Information System (INIS)

    Objective: To discuss the clinical efficacy of CT-guided radioactive 125I seed implantation treatment for unresectable pancreatic cancer. Methods: Forty patients with inoperable pancreatic cancer were enrolled in this study, including 25 males and 15 females with an median age of 69 years (38-89 years). Treatment planning system (TPS) was used to reconstruct 3-dimensional images of pancreatic tumor and to define the quantity and distribution of 125I seeds. The radioactivity of 125I seeds was 0.5 - 0.8 mCi / seed. The seeds were implanted into pancreatic tumor under CT guidance at intervals of 1 cm and were kept away from vessels, pancreatic duct and other adjacent important organs. The tumor matched peripheral dose (MPD) was 60-140 Gy. The median amount of implanted 125I seeds was 36 (18-68) in number. CT scan was performed immediately after the procedure to check the quality of the seeds. In addition, 10 patients received concurrent chemotherapy with arterial infusion of gemcitabin and 5-fluororacil (5-Fu) for 3 to 4 therapeutic courses. Results: The median diameter of the tumors was 4.9 cm. The follow-up period was 2 to 28 months. After the treatment the refractory pain was significantly relieved (P 125I seed implantation is a safe, effective and minimally-invasive brachytherapy for unresectable pancreatic cancer with reliable short-term efficacy. It has an excellent anti-pain effect. The curative results can be further improved when chemotherapy is employed together. However, its long-term efficacy needs to be observed. (authors)

  1. Recent advances using immunomodulators for inflammatory bowel disease

    DEFF Research Database (Denmark)

    Nielsen, Ole Haagen; Bjerrum, Jacob Tveiten; Herfarth, Hans;


    Use of the immunomodulators thiopurines and methotrexate (MTX) in the treatment of inflammatory bowel disease (IBD), i.e., Crohn's disease and ulcerative colitis (UC), is considered to be good clinical practice. However, despite being administered to a considerable number of IBD patients over...... to define the subgroup of IBD patients in need of immunomodulators, including those in need of combination therapy with biologic agents, especially because some side effects may be rather severe. Second, colorectal cancer is observed more often in IBD patients than in the background population. However...... on pharmacokinetics, pharmacogenetics, and therapeutic blood testing, as well as the occurrence of adverse events, when using AZA, 6-MP, and MTX in an attempt to determine a more up-to-date and rational treatment regimen in IBD....

  2. Advanced smile diagnostics using CAD/CAM mock-ups. (United States)

    Sancho-Puchades, Manuel; Fehmer, Vincent; Hämmerle, Christoph; Sailer, Irena


    Diagnostics are essential for predictable restorative dentistry. Both patient and clinician must agree on a treatment goal before the final restorations are delivered to avoid future disappointments. However, fully understanding the patient's desires is difficult. A useful tool to overcome this problem is the diagnostic wax-up and mock-up. A potential treatment outcome is modeled in wax prior to treatment and transferred into the patient's mouth using silicon indexes and autopolymerizing resin to obtain the patient's approval. Yet, this time-consuming procedure only produces a single version of the possible treatment outcome, which can be unsatisfactory for both the patient and the restorative team. Contemporary digital technologies may provide advantageous features to aid in this diagnostic treatment step. This article reviews opportunities digital technologies offer in the diagnostic phase, and presents clinical cases to illustrate the procedures. PMID:26171442

  3. [Clinical probability of PE: should we use a clinical prediction rule?]. (United States)

    Le Gal, G; Righini, M; Perrier, A


    The determination of the clinical pretest probability using clinical prediction models is an important step in the assessment of patients with suspected pulmonary embolism (PE). It helps establish which test or sequence of tests can effectively corroborate or safely rule out PE. For example, it has been demonstrated that it is safe to withhold anticoagulant therapy in patients with negative d-dimer results and low pretest probability at initial presentation. Clinical probability will also increase the diagnostic yield of ventilation perfusion lung scan. Compared with clinical gestalt, clinical prediction rules provide a standardized and more reproducible estimate of a patient's probability of having a PE. Clinical prediction models combine aspects of the history and physical examination to categorize a patient's probability of having a disease. The models classify patients as having a low, moderate, or high likelihood of having PE. Clinical prediction models have been validated and are well established for the diagnosis of PE in symptomatic patients. They allow all physicians, whatever their expertise, to reliably determine the clinical pretest probability of PE, and thus safely manage their patients using diagnostic and therapeutic algorithms. PMID:19084205

  4. Environmental Monitoring Networks Optimization Using Advanced Active Learning Algorithms (United States)

    Kanevski, Mikhail; Volpi, Michele; Copa, Loris


    The problem of environmental monitoring networks optimization (MNO) belongs to one of the basic and fundamental tasks in spatio-temporal data collection, analysis, and modeling. There are several approaches to this problem, which can be considered as a design or redesign of monitoring network by applying some optimization criteria. The most developed and widespread methods are based on geostatistics (family of kriging models, conditional stochastic simulations). In geostatistics the variance is mainly used as an optimization criterion which has some advantages and drawbacks. In the present research we study an application of advanced techniques following from the statistical learning theory (SLT) - support vector machines (SVM) and the optimization of monitoring networks when dealing with a classification problem (data are discrete values/classes: hydrogeological units, soil types, pollution decision levels, etc.) is considered. SVM is a universal nonlinear modeling tool for classification problems in high dimensional spaces. The SVM solution is maximizing the decision boundary between classes and has a good generalization property for noisy data. The sparse solution of SVM is based on support vectors - data which contribute to the solution with nonzero weights. Fundamentally the MNO for classification problems can be considered as a task of selecting new measurement points which increase the quality of spatial classification and reduce the testing error (error on new independent measurements). In SLT this is a typical problem of active learning - a selection of the new unlabelled points which efficiently reduce the testing error. A classical approach (margin sampling) to active learning is to sample the points closest to the classification boundary. This solution is suboptimal when points (or generally the dataset) are redundant for the same class. In the present research we propose and study two new advanced methods of active learning adapted to the solution of

  5. Clinical use of Skype: a review of the evidence base. (United States)

    Armfield, Nigel R; Gray, Leonard C; Smith, Anthony C


    Skype is a popular and free software application that allows PCs and mobile devices to be used for video communication over the Internet. We reviewed the literature to determine whether the clinical use of Skype is supported by evidence. One small (n = 7) controlled clinical trial had assessed the effect of nursing communication using Skype on elderly patients with dementia and their carers. However, we were unable to identify any large, well-designed studies which had formally evaluated the safety, clinical effectiveness, security and privacy of Skype for the routine delivery of patient care. While there were many case reports and small studies, no firm evidence either in favour of, or against the use of Skype for clinical telehealth was found. The risks and benefits of using Skype for clinical purposes are not known. PMID:22362829

  6. Recent advances of ventilation-perfusion scintigraphy in clinical diagnosis and interventional treatment of pulmonary embolism

    International Nuclear Information System (INIS)

    Ventilation-perfusion scintigraphy can reflect the pulmonary function of ventilation and perfusion, then, indirectly assess the distribution of embolism. This technique is especially valuable in evaluating hemodynamic stability in patients with suspected pulmonary embolism. Ventilation-perfusion scintigraphy is superior to other imaging means in clinical practice as it is non-invasive and carries high specificity in detecting sub-segmental embolism. Furthermore, the advantages of interventional therapy are of significant clinical value in treating pulmonary embolism. This paper aims to make a comprehensive review for the ventilation-perfusion scintigraphy diagnosis, as well as the interventional treatment, of pulmonary embolism. (authors)

  7. Bench to bedside: integrating advances in basic science into daily clinical practice. (United States)

    McGoldrick, Rory B; Hui, Kenneth; Chang, James


    This article focuses on the initial steps of commercial development of a patentable scientific discovery from an academic center through to marketing a clinical product. The basics of partnering with a technology transfer office (TTO) and the complex process of patenting are addressed, followed by a discussion on marketing and licensing the patent to a company in addition to starting a company. Finally, the authors address the basic principles of obtaining clearance from the Food and Drugs Administration, production in a good manufacturing practice (GMP) facility, and bringing the product to clinical trial. PMID:25066849

  8. Clinical and immunological evaluation of anti-apoptosis protein, survivin-derived peptide vaccine in phase I clinical study for patients with advanced or recurrent breast cancer

    Directory of Open Access Journals (Sweden)

    Asanuma Hiroko


    Full Text Available Abstract Background We previously reported that survivin-2B, a splicing variant of survivin, was expressed in various types of tumors and that survivin-2B peptide might serve as a potent immunogenic cancer vaccine. The objective of this study was to examine the toxicity of and to clinically and immunologically evaluate survivin-2B peptide in a phase I clinical study for patients with advanced or recurrent breast cancer. Methods We set up two protocols. In the first protocol, 10 patients were vaccinated with escalating doses (0.1–1.0 mg of survivin-2B peptide alone 4 times every 2 weeks. In the second protocol, 4 patients were vaccinated with the peptide at a dose of 1.0 mg mixed with IFA 4 times every 2 weeks. Results In the first protocol, no adverse events were observed during or after vaccination. In the second protocol, two patients had induration at the injection site. One patient had general malaise (grade 1, and another had general malaise (grade 1 and fever (grade 1. Peptide vaccination was well tolerated in all patients. In the first protocol, tumor marker levels increased in 8 patients, slightly decreased in 1 patient and were within the normal range during this clinical trial in 1 patient. With regard to tumor size, two patients were considered to have stable disease (SD. Immunologically, in 3 of the 10 patients (30%, an increase of the peptide-specific CTL frequency was detected. In the second protocol, an increase of the peptide-specific CTL frequency was detected in all 4 patients (100%, although there were no significant beneficial clinical responses. ELISPOT assay showed peptide-specific IFN-γ responses in 2 patients in whom the peptide-specific CTL frequency in tetramer staining also was increased in both protocols. Conclusion This phase I clinical study revealed that survivin-2B peptide vaccination was well tolerated. The vaccination with survivin-2B peptide mixed with IFA increased the frequency of peptide-specific CTL more

  9. The committee for advanced therapies' of the European Medicines Agency reflection paper on management of clinical risks deriving from insertional mutagenesis. (United States)

    Aiuti, Alessandro; Cossu, Giulio; de Felipe, Pablo; Galli, Maria Cristina; Narayanan, Gopalan; Renner, Matthias; Stahlbom, Axel; Schneider, Christian K; Voltz-Girolt, Caroline


    In the European Union, the Committee for Advanced Therapies of the European Medicines Agency takes the lead in the scientific assessment for marketing authorization applications for advanced therapy medicinal products, which include gene therapy medicinal products, somatic cell therapy medicinal products, and tissue-engineered products. The Committee for Advanced Therapies also takes the lead in defining the scientific framework for the quality, nonclinical and clinical development of such products. This reflection paper represents the Committee's current thinking on management of clinical risks deriving from insertional mutagenesis. A multidisciplinary approach to insertional mutagenesis is provided. This reflection paper has been adopted by the committee in its April 2013 meeting.

  10. Technology advancement: a factor in increasing resource use (United States)

    Wilburn, David R.; Goonan, Thomas G.; Bleiwas, Donald I.


    The specter of mineral resource scarcity has been repeatedly raised as a concern because ever-growing populations with seemingly insatiable appetites for minerals place claims against a finite resource endowment. This report analyzes how technology has helped to ease resource constraints, and uses case studies of aluminum, copper, potash, and sulfur minerals to identify the effects of technology on resource supply. In spite of heightened demand for and increased loss of resources to environmental policy and urbanization, mineral producers historically have been able to continually expand production and lower costs. Specific production increases for the years 1900-98 were: aluminum (3,250 percent), copper (2,465 percent), potash (3,770 percent), and sulfur (6,000 percent). For the same period, constant-dollar (1998) prices decreased: aluminum (90 percent), copper (75 percent), potash (94 percent), and sulfur (89 percent). The application of technology has made available mineral deposits that were previously overlooked or considered non-viable. Using technology, producers can meet the demand for stronger, energy-efficient, more environmentally safe products with less physical material. Technologies have been developed to increase the amount of materials recycled and remanufactured. Technology development can occur in breakthroughs, but most often advances incrementally. Technological development is driven by the profit motive.

  11. Burnout prediction using advance image analysis coal characterization techniques

    Energy Technology Data Exchange (ETDEWEB)

    Edward Lester; Dave Watts; Michael Cloke [University of Nottingham, Nottingham (United Kingdom). School of Chemical Environmental and Mining Engineering


    The link between petrographic composition and burnout has been investigated previously by the authors. However, these predictions were based on 'bulk' properties of the coal, including the proportion of each maceral or the reflectance of the macerals in the whole sample. Combustion studies relating burnout with microlithotype analysis, or similar, remain less common partly because the technique is more complex than maceral analysis. Despite this, it is likely that any burnout prediction based on petrographic characteristics will become more accurate if it includes information about the maceral associations and the size of each particle. Chars from 13 coals, 106-125 micron size fractions, were prepared using a Drop Tube Furnace (DTF) at 1300{degree}C and 200 millisecond and 1% Oxygen. These chars were then refired in the DTF at 1300{degree}C 5% oxygen and residence times of 200, 400 and 600 milliseconds. The progressive burnout of each char was compared with the characteristics of the initial coals. This paper presents an extension of previous studies in that it relates combustion behaviour to coals that have been characterized on a particle by particle basis using advanced image analysis techniques. 13 refs., 7 figs.

  12. Destruction of estrogenic activity in water using UV advanced oxidation

    Energy Technology Data Exchange (ETDEWEB)

    Rosenfeldt, Erik J. [Department of Civil and Environmental Engineering, Duke University, Durham, NC 27708 (United States); Chen, P.J. [Department of Civil and Environmental Engineering, and Integrated Toxicology Program, Nicolas School of Environment and Earth Science, Duke University (United States); Integrated Toxicology Program, Nicolas School of Environment and Earth Science, Duke University (United States); Kullman, Seth [Integrated Toxicology Program, Nicolas School of Environment and Earth Science, Duke University (United States); Linden, Karl G. [Department of Civil and Environmental Engineering, Duke University, Box 90287, 121 Hudson Hall Engineering Building, Durham, NC 27708-0287 (United States)]. E-mail:


    The transformation of the steroidal Endocrine Disrupting Compounds (EDCs), 17-{beta}-estradiol (E2) and 17-{alpha}-ethinyl estradiol (EE2) by direct UV photolysis and UV/H{sub 2}O{sub 2} advanced oxidation was studied from the perspective of the removal of estrogenic activity associated with the compounds. First, experiments were performed to link the oxidation of E2 and EE2 with subsequent reduction in estrogenic activity. No statistically significant difference between removal rates was observed, implying that the oxidation products of E2 and EE2 are not as estrogenic (measured by the Yeast Estrogen Screen (YES)) as the parent compounds. Utilizing the YES, 90% removal of estrogenic activity of E2 and EE2 at environmentally relevant concentrations ({approx} 3 {mu}g L{sup -1}) was achieved using a combination of 5 mg L{sup -1} H{sub 2}O{sub 2} and a UV fluence of less than 350 mJ cm{sup -2}. Thus, these compounds, when considered at environmentally relevant levels, are significantly degraded at much lower UV fluences than previously thought. A steady state OH radical model was used to predict oxidation of EE2 in laboratory and natural waters.

  13. Recent Advances and Uses of Grape Flavonoids as Nutraceuticals

    Directory of Open Access Journals (Sweden)

    Vasil Georgiev


    Full Text Available Grape is one of the oldest fruit crops domesticated by humans. The numerous uses of grape in making wine, beverages, jelly, and other products, has made it one of the most economically important plants worldwide. The complex phytochemistry of the berry is characterized by a wide variety of compounds, most of which have been demonstrated to have therapeutic or health promoting properties. Among them, flavonoids are the most abundant and widely studied, and have enjoyed greater attention among grape researchers in the last century. Recent studies have shown that the beneficial health effects promoted by consumption of grape and grape products are attributed to the unique mix of polyphenolic compounds. As the largest group of grape polyphenols, flavonoids are the main candidates considered to have biological properties, including but not limited to antioxidant, anti-inflammatory, anti-cancer, antimicrobial, antiviral, cardioprotective, neuroprotective, and hepatoprotective activities. Here, we discuss the recent scientific advances supporting the beneficial health qualities of grape and grape-derived products, mechanisms of their biological activity, bioavailability, and their uses as nutraceuticals. The advantages of modern plant cell based biotechnology as an alternative method for production of grape nutraceuticals and improvement of their health qualities are also discussed.

  14. A Clinical Study on Global TCM Therapy in Treating Senile Advanced Non-small Cell Lung Cancer

    Institute of Scientific and Technical Information of China (English)


    Objective:To assess the clinical efficacy of global traditional Chinese medicine(TCM)therapy in treating senile advanced non-small cell lung cancer(NSCLC),with the aim of seeking a standardized,rational and economical way to treat advanced NSCLC in old patients.Methods:A retrospective analysis and comparison was carried out in 86 patients with senile advanced NSCLC,44 treated by global TCM(TCM group)and 42 by chemotherapy(control group)through dynamical observation on related indexes including tumor size,quality of life and the survival time,as well as on the fee for medical service at various time points in the course of the treatment.Results:The changes of tumor size,score of clinical main symptoms and behavior condition(by ZPS scoring),as well as survival rates in the two groups at corresponding time points,were not different significantly(P>0.05).The mean survival time in the TCM group was 13.20±1.52 months and that in the chemotherapy group was 13.45±1.94 months,showing insignificant difference between them.However,the median survival time in the TCM group(12 months)was actually longer than that in the chemotherapy group (9 months,P<0.05).The mean daily expense and the mean expense(RMB yuan)for each patient in the TCM group were significantly lower than that in the control group,which was 180.73±93.21 vs 825.84±329.63 for the mean daily expense and 34 077.21±14 638.04 vs 58 516.59±45 429.76 for the mean expense for each patient(both P<0.01).Conclusion:Treatment of senile advanced NSCLC with TCM alone has its apparent superiority in stabilizing tumor focus,improving clinical symptoms,elevating quality of life and prolonging the survival time.TCM is also less expensive,making it a good alternative therapeutic approach for this specific group of people.

  15. Effect of advanced chronic kidney disease in clinical and echocardiographic outcomes of patients treated with MitraClip system

    DEFF Research Database (Denmark)

    Estévez-Loureiro, Rodrigo; Settergren, Magnus; Pighi, Michele;


    BACKGROUND: Data regarding the influence of different levels of renal dysfunction on clinical and echocardiographic results of MitraClip therapy are scarce. We aimed to evaluate the impact of baseline advance renal failure in the outcomes of a cohort of patients treated with MitraClip. METHODS...... AND RESULTS: We analyzed data from a multicenter registry of 173 patients treated with MitraClip between 2009 and 2012. Patients were classified as advanced chronic kidney disease (CKD, creatinine clearance [CrCl] ... function (CrCl >60 ml/min, group 3, n=75). Twenty patients (11.5%) presented advanced CKD. Procedural success was equal in the 3 groups (95.0% group 1, 100% in group 2 and 96.0% in group 3, p=0.180). Post-procedural MR and NYHA class at 1 month (MR ≥ 3+5.0% vs. 0% vs. 4.0% p=0.190 and NYHA>II 40.0% vs. 21...

  16. Using Simulated Debates to Teach History of Engineering Advances (United States)

    Reynolds, Terry S.


    Described is a technique for utilizing debates of past engineering controversies in the classroom as a means of teaching the history of engineering advances. Included is a bibliography for three debate topics relating to important controversies. (SL)

  17. [Written advance directives in dementia: useful and relevant]. (United States)

    Widdershoven, Guy A M; Nieuwenhuijzen Kruseman, Arie C; van Wijmen, Frans C B


    According to the Dutch euthanasia law, the current wishes of the patient can be replaced by an advance directive if the patient is unable to give consent. However, Dutch physicians say they have difficulty responding to advance directives in people with dementia. A crucial issue is how to establish whether the patient actually suffers in a specific situation. We argue that the patient's wishes, views and decisions should be discussed in a timely manner, and laid down both in patient directives and in the doctor's files. We also ask for regular discussion, updating and reaffirmation of the advance directive so that the patient can trust the doctor knowing the patient's wishes and what constitutes unbearable suffering for that patient. Through frequent discussion and reaffirmation, the advance directive can play the role intended by the law on euthanasia. PMID:25424631

  18. Early clinical investigation of sulofenur with a daily schedule in advanced solid tumours

    DEFF Research Database (Denmark)

    Krarup-Hansen, A; Pedersen, H; Andersen, E;


    Sulofenur, a sulfonylurea, has demonstrated antitumour effect in preclinical studies. A phase I trial was initiated to study the clinical aspects. Sulofenur was given p.o. daily for a period of 28 days in 5-week courses. The initial dosage was 250 mg/m2 escalating to 700 mg/m2 daily with no dose ...

  19. Clinical and neurobiological advances in promoting regeneration of the ventral root avulsion lesion

    NARCIS (Netherlands)

    Eggers, R.; Tannemaat, Martijn R; De Winter, F.; Malessy, Martijn J A; Verhaagen, J.


    Root avulsions due to traction to the brachial plexus causes complete and permanent loss of function. Until fairly recent, such lesions were considered impossible to repair. Here we review clinical repair strategies and current progress in experimental ventral root avulsion lesions. The current gold

  20. Clinical application of brain MRI in parkinsonism. From basic to advanced imaging

    NARCIS (Netherlands)

    Meijer, F.J.A.


    Parkinson’s disease is a neurodegenerative disorder with increased prevalence at raising age, and the most frequent cause of parkinsonism. In clinical practice, differentiating Parkinson’s disease from the various forms of neurodegenerative atypical parkinsonism can be difficult, especially in the e

  1. Positive Porn: Educational, Medical, and Clinical Uses (United States)

    Watson, Mary Ann; Smith, Randyl D.


    Despite its widespread use, pornography has been vilified as a symptom of personal and cultural depravity and as a cause of rape, aggression, devaluation of women, and marital dissolution. Yet in some cases there may be personal, relational, and social value to the use of sexually explicit material. In this paper, we briefly review the literature,…

  2. Study on advancement of in vivo counting using mathematical simulation

    Energy Technology Data Exchange (ETDEWEB)

    Kinase, Sakae [Japan Atomic Energy Research Inst., Tokai, Ibaraki (Japan). Tokai Research Establishment


    To obtain an assessment of the committed effective dose, individual monitoring for the estimation of intakes of radionuclides is required. For individual monitoring of exposure to intakes of radionuclides, direct measurement of radionuclides in the body - in vivo counting- is very useful. To advance in a precision in vivo counting which fulfills the requirements of ICRP 1990 recommendations, some problems, such as the investigation of uncertainties in estimates of body burdens by in vivo counting, and the selection of the way to improve the precision, have been studied. In the present study, a calibration technique for in vivo counting application using Monte Carlo simulation was developed. The advantage of the technique is that counting efficiency can be obtained for various shapes and sizes that are very difficult to change for phantoms. To validate the calibration technique, the response functions and counting efficiencies of a whole-body counter installed in JAERI were evaluated using the simulation and measurements. Consequently, the calculations are in good agreement with the measurements. The method for the determination of counting efficiency curves as a function of energy was developed using the present technique and a physiques correction equation was derived from the relationship between parameters of correction factor and counting efficiencies of the JAERI whole-body counter. The uncertainties in body burdens of {sup 137}Cs estimated with the JAERI whole-body counter were also investigated using the Monte Carlo simulation and measurements. It was found that the uncertainties of body burdens estimated with the whole-body counter are strongly dependent on various sources of uncertainty such as radioactivity distribution within the body and counting statistics. Furthermore, the evaluation method of the peak efficiencies of a Ge semi-conductor detector was developed by Monte Carlo simulation for optimum arrangement of Ge semi-conductor detectors for

  3. Advanced defect detection algorithm using clustering in ultrasonic NDE (United States)

    Gongzhang, Rui; Gachagan, Anthony


    A range of materials used in industry exhibit scattering properties which limits ultrasonic NDE. Many algorithms have been proposed to enhance defect detection ability, such as the well-known Split Spectrum Processing (SSP) technique. Scattering noise usually cannot be fully removed and the remaining noise can be easily confused with real feature signals, hence becoming artefacts during the image interpretation stage. This paper presents an advanced algorithm to further reduce the influence of artefacts remaining in A-scan data after processing using a conventional defect detection algorithm. The raw A-scan data can be acquired from either traditional single transducer or phased array configurations. The proposed algorithm uses the concept of unsupervised machine learning to cluster segmental defect signals from pre-processed A-scans into different classes. The distinction and similarity between each class and the ensemble of randomly selected noise segments can be observed by applying a classification algorithm. Each class will then be labelled as `legitimate reflector' or `artefacts' based on this observation and the expected probability of defection (PoD) and probability of false alarm (PFA) determined. To facilitate data collection and validate the proposed algorithm, a 5MHz linear array transducer is used to collect A-scans from both austenitic steel and Inconel samples. Each pulse-echo A-scan is pre-processed using SSP and the subsequent application of the proposed clustering algorithm has provided an additional reduction to PFA while maintaining PoD for both samples compared with SSP results alone.

  4. Cell therapy for intervertebral disc repair: advancing cell therapy from bench to clinics

    Directory of Open Access Journals (Sweden)

    LM Benneker


    Full Text Available Intervertebral disc (IVD degeneration is a major cause of pain and disability; yet therapeutic options are limited and treatment often remains unsatisfactory. In recent years, research activities have intensified in tissue engineering and regenerative medicine, and pre-clinical studies have demonstrated encouraging results. Nonetheless, the translation of new biological therapies into clinical practice faces substantial barriers. During the symposium "Where Science meets Clinics", sponsored by the AO Foundation and held in Davos, Switzerland, from September 5-7, 2013, hurdles for translation were outlined, and ways to overcome them were discussed. With respect to cell therapy for IVD repair, it is obvious that regenerative treatment is indicated at early stages of disc degeneration, before structural changes have occurred. It is envisaged that in the near future, screening techniques and non-invasive imaging methods will be available to detect early degenerative changes. The promises of cell therapy include a sustained effect on matrix synthesis, inflammation control, and prevention of angio- and neuro-genesis. Discogenic pain, originating from "black discs" or annular injury, prevention of adjacent segment disease, and prevention of post-discectomy syndrome were identified as prospective indications for cell therapy. Before such therapy can safely and effectively be introduced into clinics, the identification of the patient population and proper standardisation of diagnostic parameters and outcome measurements are indispensable. Furthermore, open questions regarding the optimal cell type and delivery method need to be resolved in order to overcome the safety concerns implied with certain procedures. Finally, appropriate large animal models and well-designed clinical studies will be required, particularly addressing safety aspects.

  5. Use of "big data" in drug discovery and clinical trials. (United States)

    Taglang, Guillaume; Jackson, David B


    Oncology is undergoing a data-driven metamorphosis. Armed with new and ever more efficient molecular and information technologies, we have entered an era where data is helping us spearhead the fight against cancer. This technology driven data explosion, often referred to as "big data", is not only expediting biomedical discovery, but it is also rapidly transforming the practice of oncology into an information science. This evolution is critical, as results to-date have revealed the immense complexity and genetic heterogeneity of patients and their tumors, a sobering reminder of the challenge facing every patient and their oncologist. This can only be addressed through development of clinico-molecular data analytics that provide a deeper understanding of the mechanisms controlling the biological and clinical response to available therapeutic options. Beyond the exciting implications for improved patient care, such advancements in predictive and evidence-based analytics stand to profoundly affect the processes of cancer drug discovery and associated clinical trials.

  6. Treatment of Childhood Acute Lymphoblastic Leukemia: Prognostic Factors and Clinical Advances. (United States)

    Vrooman, Lynda M; Silverman, Lewis B


    While the majority of children and adolescents with newly diagnosed childhood acute lymphoblastic leukemia (ALL) will be cured, as many as 20 % of patients will experience relapse. On current treatment regimens, the intensity of upfront treatment is stratified based upon prognostic factors with the aim of improving cure rates (for those at the highest risk of relapse) and minimizing treatment-related morbidity (for lower-risk patients). Here we review advances in the understanding of prognostic factors and their application. We also highlight novel treatment approaches aimed at improving outcomes in childhood ALL.

  7. Identifying clinical course patterns in SMS data using cluster analysis

    DEFF Research Database (Denmark)

    Kent, Peter; Kongsted, Alice


    ABSTRACT: BACKGROUND: Recently, there has been interest in using the short message service (SMS or text messaging), to gather frequent information on the clinical course of individual patients. One possible role for identifying clinical course patterns is to assist in exploring clinically important...... clinically interpretable and different from those of the whole group. Similar patterns were obtained when the number of SMS time points was reduced to monthly. The advantages and disadvantages of this method were contrasted to that of first transforming SMS data by spline analysis. CONCLUSIONS: This study...

  8. 21 CFR 872.6660 - Porcelain powder for clinical use. (United States)


    ... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Miscellaneous Devices § 872.6660 Porcelain powder for clinical use... removable dentures, of jacket crowns, facings, and veneers. The device is used in prosthetic dentistry...

  9. Recent advances in environmental monitoring using commercial microwave links (United States)

    Alpert, Pinhas; Guez, Oded; Messer, Hagit; David, Noam; Harel, Oz; Eshel, Adam; Cohen, Ori


    Recent advances in environmental monitoring using commercial microwave links Pinhas Alpert, H. Messer, N. David, O. Guez, O. Cohen, O. Harel, A. Eshel Tel Aviv University, Israel The propagation of electromagnetic radiation in the lower atmosphere, at centimeter wavelengths, is impaired by atmospheric conditions. Absorption and scattering of the radiation, at frequencies of tens of GHz, are directly related to the atmospheric phenomena, primarily precipitation, oxygen, mist, fog and water vapor. As was recently shown, wireless communication networks supply high resolution precipitation measurements at ground level while often being situated in flood prone areas, covering large parts of these hazardous regions. On the other hand, at present, there are no satisfactory real time flash flood warning facilities found to cope well with this phenomenon. I will exemplify the flash flood warning potential of the commercial wireless communication system for semi-arid region cases when floods occurred in the Judean desert in Israel with comparison to hydrological measurements in the Dead Sea area. In addition, I will review our recent improvements in monitoring rainfall as well as other-than-rain phenomena like, fog, dew, atmospheric moisture. References: N. David, P. Alpert, and H. Messer, "Technical Note: Novel method for water vapor monitoring using wireless communication networks measurements", Atmos. Chem. Phys., 9, 2413-2418, 2009. A. Rayitsfeld, R. Samuels, A. Zinevich, U. Hadar and P. Alpert,"Comparison of two methodologies for long term rainfall monitoring using a commercial microwave communication system", Atmospheric Research 104-105, 119-127, 2012. N. David, O. Sendik, H. Messer and P. Alpert, "Cellular network infrastructure-the future of fog monitoring?" BAMS (Oct. issue), 1687-1698, 2015. O. Harel, David, N., Alpert, P. and Messer, H., "The potential of microwave communication networks to detect dew using the GLRT- experimental study", IEEE Journal of Selected

  10. Comparison of prone versus supine 18F-FDG-PET of locally advanced breast cancer: Phantom and preliminary clinical studies

    Energy Technology Data Exchange (ETDEWEB)

    Williams, Jason M.; Rani, Sudheer D.; Li, Xia; Whisenant, Jennifer G.; Abramson, Richard G. [Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee 37232 and Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee 37232 (United States); Arlinghaus, Lori R. [Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee 37232 (United States); Lee, Tzu-Cheng [Department of Bioengineering, University of Washington, Seattle, Washington 98195 (United States); MacDonald, Lawrence R.; Partridge, Savannah C. [Department of Radiology, University of Washington, Seattle, Washington 98195 (United States); Kang, Hakmook [Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee 37232 and Department of Biostatistics, Vanderbilt University, Nashville, Tennessee 37232 (United States); Linden, Hannah M. [Department of Medical Oncology, University of Washington, Seattle, Washington 98195 (United States); Kinahan, Paul E. [Department of Radiology, University of Washington, Seattle, Washington 98195 (United States); Department of Bioengineering, University of Washington, Seattle, Washington 98195 (United States); Department of Physics, University of Washington, Seattle, Washington 98195 (United States); Department of Electrical Engineering, University of Washington, Seattle, Washington 98195 (United States); Yankeelov, Thomas E., E-mail: [Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee 37232 (United States); Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee 37232 (United States); Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee 37232 (United States); Department of Physics, Vanderbilt University, Nashville, Tennessee 37232 (United States); Department of Cancer Biology, Vanderbilt University, Nashville, Tennessee 37232 (United States)


    Purpose: Previous studies have demonstrated how imaging of the breast with patients lying prone using a supportive positioning device markedly facilitates longitudinal and/or multimodal image registration. In this contribution, the authors’ primary objective was to determine if there are differences in the standardized uptake value (SUV) derived from [{sup 18}F]fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) in breast tumors imaged in the standard supine position and in the prone position using a specialized positioning device. Methods: A custom positioning device was constructed to allow for breast scanning in the prone position. Rigid and nonrigid phantom studies evaluated differences in prone and supine PET. Clinical studies comprised 18F-FDG-PET of 34 patients with locally advanced breast cancer imaged in the prone position (with the custom support) followed by imaging in the supine position (without the support). Mean and maximum values (SUV{sub peak} and SUV{sub max}, respectively) were obtained from tumor regions-of-interest for both positions. Prone and supine SUV were linearly corrected to account for the differences in 18F-FDG uptake time. Correlation, Bland–Altman, and nonparametric analyses were performed on uptake time-corrected and uncorrected data. Results: SUV from the rigid PET breast phantom imaged in the prone position with the support device was 1.9% lower than without the support device. In the nonrigid PET breast phantom, prone SUV with the support device was 5.0% lower than supine SUV without the support device. In patients, the median (range) difference in uptake time between prone and supine scans was 16.4 min (13.4–30.9 min), which was significantly—but not completely—reduced by the linear correction method. SUV{sub peak} and SUV{sub max} from prone versus supine scans were highly correlated, with concordance correlation coefficients of 0.91 and 0.90, respectively. Prone SUV{sub peak} and SUV{sub max} were

  11. Advances in the use of open-source information

    International Nuclear Information System (INIS)

    Great advances have been made in the application of open-source information for Safeguards. However, the open-source 'ecosystem' is rapidly evolving. Recently, the combination of powerful smart-phones and the World Wide Web have led to novel developments for mapping the impact of natural and man-made disasters. Researchers are learning to harness online volunteers as citizen scientists. Online social media such as Facebook, LinkedIn, and Twitter are becoming accepted channels of credible information. Geo-spatially-aware applications (augmented reality applications) are capable of overlaying data upon a smart-phone's view screen. The authors review available open-source tools and technologies. These and other developments will have a significant effect on the collection, evaluation, structuring, analysis, and dissemination of safeguards-relevant information. In addition, the modern, open Internet is posing new security threats.not just viruses and their ilk, but threats based on digital traces left by browsing the open Web. The authors present a case study of the disastrous toxic flood near Devecser, Hungary in October 2010 for which we get 621,000 results for everything related to search terms, 68,000 blog posts on the topic, 43,300 images available and then give recommendations for the future use of open-source information and software tools. (authors)

  12. Recent advances in Rydberg physics using alkaline-earth atoms (United States)

    Dunning, F. B.; Killian, T. C.; Yoshida, S.; Burgdörfer, J.


    In this brief review, the opportunities that the alkaline-earth elements offer for studying new aspects of Rydberg physics are discussed. For example, the bosonic alkaline-earth isotopes have zero nuclear spin which eliminates many of the complexities present in alkali Rydberg atoms, permitting simpler and more direct comparison between theory and experiment. The presence of two valence electrons allows the production of singlet and triplet Rydberg states that can exhibit a variety of attractive or repulsive interactions. The availability of weak intercombination lines is advantageous for laser cooling and for applications such as Rydberg dressing. Excitation of one electron to a Rydberg state leaves behind an optically active core ion allowing, for high-L states, the optical imaging of Rydberg atoms and their (spatial) manipulation using light scattering. The second valence electron offers the possibility of engineering long-lived doubly excited states such as planetary atoms. Recent advances in both theory and experiment are highlighted together with a number of possible directions for the future.

  13. Advances in the use of intravenous techniques in ambulatory anesthesia

    Directory of Open Access Journals (Sweden)

    Eng MR


    Full Text Available Matthew R Eng,1 Paul F White1,2 1Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; 2White Mountain Institute, The Sea Ranch, CA, USA Summary statement: Advances in the use of intravenous techniques in ambulatory anesthesia has become important for the anesthesiologist as the key perioperative physician in outpatient surgery. Key techniques and choices of anesthetics are important in accomplishing fast track goals of ambulatory surgery. Purpose of review: The anesthesiologist in the outpatient environment must focus on improving perioperative efficiency and reducing recovery times while accounting for patients' well-being and safety. This review article focuses on recent intravenous anesthetic techniques to accomplish these goals. Recent findings: This review is an overview of techniques in intravenous anesthesia for ambulatory anesthesia. Intravenous techniques may be tailored to accomplish outpatient surgery goals for the type of surgical procedure and individual patient needs. Careful anesthetic planning and the application of the plans are critical to an anesthesiologist's success with fast-track ambulatory surgery. Conclusion: Careful planning and application of intravenous techniques are critical to an anesthesiologist's success with fast-track ambulatory surgery. Keywords: intravenous anesthesia, outpatient anesthesia, fast-track surgery

  14. Immobilization biological activated carbon used in advanced drinking water treatment

    Institute of Scientific and Technical Information of China (English)


    Bacteria separated from a mature filter bed of groundwater treatment plants were incubated in a culture media containing iron and manganese. A consortium of 5 strains of bacteria removing iron and manganese were obtained by repeated enrichment culturing. It was shown from the experiments of effect factors that ironmanganese removal bacteria in the culture media containing both Fe and Mn grew better than in that containing only Fe, however, they were unable to grow in the culture media containing only Mn. When comparing the bacteria biomass in the case ofρ (DO) =2.8 mg/L andρ (DO) =9.0 mg/L, no significant difference was found.The engineering bacteria removing the organic and the bacteria removing iron and manganese were simultaneously inoculated into activated carbon reactor to treat the effluent of distribution network. The experimental results showed that by using IBAC ( Immobilization Biological Activated Carbon) treatment, the removal efficiency of iron, manganese and permanganate index was more than 98% , 96% and 55% , respectively. After the influent with turbidity of 1.5 NTU, color of 25 degree and offensive odor was treated, the turbidity and color of effluence were less than 0.5 NTU and 15 degree, respectively, and it was odorless. It is determined that the cooperation function of engineering bacteria and activated carbon achieved advanced drinking water treatment.

  15. Clinical anatomy of the canine brain using magnetic resonance imaging. (United States)

    Leigh, Edmund J; Mackillop, Edward; Robertson, Ian D; Hudson, Lola C


    The purpose of this study was to produce an magnetic resonsnce (MR) image atlas of clinically relevant brain anatomy and to relate this neuroanatomy to clinical signs. The brain of a large mixed breed dog was imaged in transverse, sagittal, and dorsal planes using a 1.5 T MR unit and the following pulse sequences: Turbo (fast) spin echo (TSE) T2, T1, and T2- weighted spatial and chemical shift-encoded excitation sequence. Relevant neuroanatomic structures were identified using anatomic texts, sectioned cadaver heads, and previously published atlases. Major subdivisions of the brain were mapped and the neurologic signs of lesions in these divisions were described. TSE T2-weighted images were found to be the most useful for identifying clinically relevant neuroanatomy. Relating clinical signs to morphology as seen on MR will assist veterinarians to better understand clinically relevant neuroanatomy in MR images. PMID:18418990

  16. Enhancing endothelial progenitor cell for clinical use

    Institute of Scientific and Technical Information of China (English)


    Circulating endothelial progenitor cells (EPCs) havebeen demonstrated to correlate negatively with vascularendothelial dysfunction and cardiovascular risk factors.However, translation of basic research into the clinicalpractice has been limited by the lack of unambiguousand consistent definitions of EPCs and reduced EPCcell number and function in subjects requiring them forclinical use. This article critically reviews the definitionof EPCs based on commonly used protocols, their valueas a biomarker of cardiovascular risk factor in subjectswith cardiovascular disease, and strategies to enhanceEPCs for treatment of ischemic diseases.

  17. Clinical Analysis of Bisphosphonates Treatment on Bone Metastases and Hypercalcemia of Malignancy in Advanced Solid Tumor

    Institute of Scientific and Technical Information of China (English)

    MING Shu-hong; SUN Tie-ying


    Objective: To evaluate the efficacy and toleration of bisphosphonates therapy in patients with bone metastases and hypercalcemia of malignancy in advanced solid tumor. Methods: Patients with histologically or cytologically confirmed cancer and hypercalcemia with bone metastases were designed to open treatment with either 4mg zoledronic acid or 90mg pamidronate. The primary efficacy parameters were pain scores(NRS), Corrected serum calcium(CSC) and CSC effective rate. The vital signs, biochemical and hematological parameters were determined. Results: Twenty patients were enrolled in this study, twelve patients in zoledronic acid group and eight in pamidronate group. Zoledronic acid and pamidronate significantly palliated pain. Pain scores were significantly lower at end-point after Zoledronic acid or pamidronate infusion(5.92 vs 3.25,P<0.01;6.13 vs 4.38, P<0.01, respectively). The mean CSC level decreased significantly after Zoledronic acid or pamidronate infusion from 12.86 to 10.28mg/dl and 13.19 to 10.36mg/dl respectively. The CSC effective rate was about 90% at 14 days after infusion in two groups. There was no statistical significance for all primary efficacy parameters in zoledronic acid group compared with pamidronate group. An adverse reaction was mild fever after pamidronate infusion and then completely reversible. Conclusion: Zoledronic acid and pamidronate disodium were well tolerated and effective for bone metastases and hypercalcemia of malignancy in advanced solid tumor.

  18. A new NEDO research project towards hospital based accelerator BNCT using advanced DDS system

    International Nuclear Information System (INIS)

    A new national project of developing a hospital based accelerator for boron neutron capture therapy (BNCT) with advanced drug delivery system (DDS) has been started in 2005. In this paper, the outline of the new project will be introduced. The project includes two main topics: 1) a hospital based accelerator for BNCT will be developed by a research consortium of Universities and companies. A fixed field alternating gradient (FFAG) type of accelerator with internal target is planned. 2) New boronated DDS using different methods including porphyrins, virus envelope vector, and liposome are planned. BNCT may become a first line charged particle therapy if the hospital based accelerator become feasible due to broadening the opportunity to use the neutron source. Due to such clinical convenience, there will be also possibility to spread the indication of BNCT for the diseases (cancer and other diseases) which has not been the candidate for BNCT in the nuclear-reactor era. (author)

  19. Advanced reconstruction of attenuation maps using SPECT emission data only (United States)

    Salomon, André; Goedicke, Andreas; Aach, Til


    Today, attenuation corrected SPECT, typically performed using CT or Gadolinium line source based transmission scans, is more and more becoming standard in many medical applications. Moreover, the information about the material density distribution provided by these scans is key for other artifact compensation approaches in advanced SPECT reconstruction. Major drawbacks of these approaches are the additional patient radiation and hardware/maintenance costs as well as the additional workflow effort, e.g. if the CT scans are not performed on a hybrid scanner. It has been investigated in the past, whether it is possible to recover this structural information solely from the SPECT scan data. However, the investigated methods often result in noticeable image artifacts due to cross-dependences between attenuation and activity distribution estimation. With the simultaneous reconstruction method presented in this paper, we aim to effectively prevent these typical cross-talk artifacts using a-priori known atlas information of a human body. At first, an initial 3D shape model is coarsely registered to the SPECT data using anatomical landmarks and each organ structure within the model is identified with its typical attenuation coefficient. During the iterative reconstruction based on a modified ML-EM scheme, the algorithm simultaneously adapts both, the local activity estimation and the 3D shape model in order to improve the overall consistency between measured and estimated sinogram data. By explicitly avoiding topology modifications resulting in a non-anatomical state, we ensure that the estimated attenuation map remains realistic. Several tests with simulated as well as real patient SPECT data were performed to test the proposed algorithm, which demonstrated reliable convergence behaviour in both cases. Comparing the achieved results with available reference data, an overall good agreement for both cold as well as hot activity regions could be observed (mean deviation: -5.98%).

  20. Recent Advances in Genome Editing Using CRISPR/Cas9

    Directory of Open Access Journals (Sweden)

    Yuduan eDing


    Full Text Available AbstractThe CRISPR (clustered regularly interspaced short palindromic repeat-Cas9 (CRISPR-associated nuclease 9 system is a versatile tool for genome engineering that uses a guide RNA (gRNA to target Cas9 to a specific sequence. This simple RNA-guided genome-editing technology has become a revolutionary tool in biology and has many innovative applications in different fields. In this review, we briefly introduce the Cas9-mediated genome-editing method, summarize the recent advances in CRISPR/Cas9 technology, and discuss their implications for plant research. To date, targeted gene knockout using the Cas9/gRNA system has been established in many plant species, and the targeting efficiency and capacity of Cas9 has been improved by optimizing its expression and that of its gRNA. The CRISPR/Cas9 system can also be used for sequence-specific mutagenesis/integration and transcriptional control of target genes. We also discuss off-target effects and the constraint that the protospacer-adjacent motif (PAM puts on CRISPR/Cas9 genome engineering. To address these problems, a number of bioinformatic tools are available to help design specific gRNAs, and new Cas9 variants and orthologs with high fidelity and alternative PAM specificities have been engineered. Owing to these recent efforts, the CRISPR/Cas9 system is becoming a revolutionary and flexible tool for genome engineering. Adoption of the CRISPR/Cas9 technology in plant research would enable the investigation of plant biology at an unprecedented depth and create innovative applications in precise crop breeding.

  1. Targeting Notch signaling pathway in cancer: Clinical development advances and challenges


    Takebe, Naoko; Nguyen, Dat; Yang, Sherry X


    Notch signaling plays an important role in development and cell fate determination, and it is deregulated in human hematologic malignancies and solid tumors. This review includes a brief introduction of the relevant pathophysiology of Notch signaling pathway and primarily focuses on the clinical development of promising agents that either obstruct Notch receptor cleavages such as γ-secretase inhibitors (GSIs) or interfere with the Notch ligand–receptor interaction by monoclonal antibodies (mA...

  2. Barrett’s Esophagus and Cancer Risk: How Research Advances Can Impact Clinical Practice


    di Pietro, Massimiliano; Alzoubaidi, Durayd; Fitzgerald, Rebecca C.


    Barrett’s esophagus (BE) is the only known precursor to esophageal adenocarcinoma (EAC), whose incidence has increased sharply in the last 4 decades. The annual conversion rate of BE to cancer is significant, but small. The identification of patients at a higher risk of cancer therefore poses a clinical conundrum. Currently, endoscopic surveillance is recommended in BE patients, with the aim of diagnosing either dysplasia or cancer at early stages, both of which are curable with minimally inv...

  3. Lost in Translation: The Gap in Scientific Advancements and Clinical Application


    Fernandez-Moure, Joseph S.


    The evolution of medicine and medical technology hinges on the successful translation of basic science research from the bench to clinical implementation at the bedside. Out of the increasing need to facilitate the transfer of scientific knowledge to patients, translational research has emerged. Significant leaps in improving global health, such as antibiotics, vaccinations, and cancer therapies, have all seen successes under this paradigm, yet today, it has become increasingly difficult to r...

  4. Lost in Translation: The Gap in Scientific Advancements and Clinical Application


    Joseph eFernandez-Moure


    The evolution of medicine and medical technology hinges on the successful translation of basic science research from the bench to clinical implementation at the bedside. Born out of the increasing need to facilitate the transfer of scientific knowledge to patients, translational research has emerged. Significant leaps in improving global health such as antibiotics, vaccinations, and cancer therapies have all seen successes under this paradigm yet today it has become increasingly difficult to ...


    Benneker, L.M.; Andersson, G.; Iatridis, J.C.; Sakai, D.; Härtl, R.; Ito, K.; Grad, S.


    Intervertebral disc (IVD) degeneration is a major cause of pain and disability; yet therapeutic options are limited and treatment often remains unsatisfactory. In recent years, research activities have intensified in tissue engineering and regenerative medicine, and pre-clinical studies have demonstrated encourageing results. Nonetheless, the translation of new biological therapies into clinical practice faces substantial barriers. During the symposium “Where Science meets Clinics”, sponsored by the AO Foundation and held in Davos, Switzerland, from September 5–7, 2013, hurdles for translation were outlined, and ways to overcome them were discussed. With respect to cell therapy for IVD repair, it is obvious that regenerative treatment is indicated at early stages of disc degeneration, before structural changes have occurred. It is envisaged that in the near future, screening techniques and non-invasive imageing methods will be available to detect early degenerative changes. The promises of cell therapy include a sustained effect on matrix synthesis, inflammation control, and prevention of angio- and neurogenesis. Discogenic pain, originating from “black discs” or annular injury, prevention of adjacent segment disease, and prevention of post-discectomy syndrome were identified as prospective indications for cell therapy. Before such therapy can safely and effectively be introduced into clinics, the identification of the patient population and proper standardisation of diagnostic parameters and outcome measurements are indispensable. Furthermore, open questions regarding the optimal cell type and delivery method need to be resolved in outline order to overcome the safety concerns implied with certain procedures. Finally, appropriate large animal models and well-designed clinical studies will be required, particularly addressing safety aspects. PMID:24802611

  6. Clinical consequences of nonnarcotic analgesic use. (United States)

    Matzke, G R


    The accuracy of the economic analysis of the selected adverse events evaluated by McGoldrick and Bailie is questionable. The quantitative perspective on the economics of the adverse events associated with nonnarcotic analgesic use proposed by these authors is limited by the fact that they have combined data on over 30 different NSAIDs into a single value for comparison with two single-entity agents: acetaminophen and aspirin. The relative prevalence of major organ system toxicities varies markedly among the NSAIDs, and this variance invalidates the use of a class conclusion approach. Their conservative incidence estimates, the lack of data in some areas (i.e., hepatic injury), and the exclusion of combination analgesics further limit the utility of their conclusions. However, it is difficult to argue authoritatively that the relative costs of toxicities associated with the three analgesic classes they reviewed are not representative. The ultimate question is, "What is the optimal analgesic for a given patient?" This question can be addressed only if one considers the underlying cause of pain, its chronicity/acuity, the patient's concurrent disease states, if any, and the potential for drug interactions with the patient's concomitant medications. McGoldrick and Bailie concluded on an economic basis that acetaminophen is the analgesic of choice for most patients, including those with impaired renal function. This recommendation is in agreement with those of the Analgesics and the Kidney Ad Hoc Committee of the National Kidney Foundation. It also would seem prudent to use acetaminophen as the first-line agent for those patients in whom aspirin and NSAID use should be avoided or used only with caution along with frequent monitoring of renal function, blood pressure, electrolytes, and/or coagulation status. Thus, there is little to no controversy in their recommendation to initiate treatment with acetaminophen. The authors, however, also suggested that switching

  7. Advances in Danon Disease Clinical Research%Danon病临床研究进展

    Institute of Scientific and Technical Information of China (English)



    Danon病是一种X连锁显性遗传性溶酶体病,以肥厚型心肌病、骨骼肌病和智力障碍三联征为主要临床表现,其引起的心肌病变与典型的肥厚型心肌病相似.Ⅱ型溶酶体相关膜蛋白是一种高度糖基化的蛋白质,是溶酶体膜的重要组成成份,编码Ⅱ型溶酶体相关膜蛋白的基因突变是导致Danon病的重要病因.现对Danon病的发病机制及其临床特点作一综述.%Danon disease, an X-linked lysosome disease caused by the mutations of genes encoding lysosome-associated membrane protein-2 which is a highly glycosylated protein and an important constituent of the lysosomal membrane, is characterized clinically by the triad of cardiomyopathy, myopathy, and mental retardation. Danon disease produces a cardiomyopathy that clinically mimics hypertrophic car-diomyopathy due to sarcomere protein mutations. This article reviews the pathogenesis and clinical profile of Danon disease.

  8. Quantitative clinical uptake measurements using conjugate counting

    International Nuclear Information System (INIS)

    While the use of conjugate counting for determination of organ uptake in human subjects has been extensively described, in the present study the determination of the organ uptake of ortho-iodohippurate presented several opportunities for validation of the in vivo counting data. Ortho-iodohippurate is distributed in the extracellular space, is largely extracted on each pass through the kidneys, and is not significantly deiodinated in vivo. Thus, the kidney uptake rate should be proportional to the blood level, the appearance rate of activity in the bladder is equal to the disappearance rate from the kidneys, and direct measurement of activity in the urine after voiding provides an internal standard for imaging measurements of bladder activity. Since the activity levels in the kidneys, bladder, and remainder of the body changed fairly rapidly, especially in the first 20 to 30 minutes following injection, posterior images of the trunk including kidneys and bladder were obtained continuously using a gamma camera fitted with a diverging collimator for 30 minutes and then at intervals for several hours. Simultaneous conjugate counting determinations were made using a whole body scanning system previously described at these meetings. Imaging data corrected for decay and adjacent background were fitted by least squares methods to curves representing a sum of exponentials, and the curves were normalized to the conjugate uptake measurements. The uptake curves of the kidneys and bladder matched well with the direct measurements of the urinary excretion. Data were collected in 16 normal subjects, and the estimated absorbed dose was calculated for the kidneys, the bladder and the remainder of the body for seven radioisotopes of iodine. 4 references, 6 figures, 2 tables

  9. Advancement of 31P Magnetic Resonance Spectroscopy Using GRAPPA Reconstruction on a 3D Volume (United States)

    Clevenger, Tony

    The overall objective of this research is to improve currently available metabolic imaging techniques for clinical use in monitoring and predicting treatment response to radiation therapy in liver cancer. Liver metabolism correlates with inflammatory and neoplastic liver diseases, which alter the intracellular concentration of phosphorus- 31 (31P) metabolites [1]. It is assumed that such metabolic changes occur prior to physical changes of the tissue. Therefore, information on regional changes of 31P metabolites in the liver, obtained by Magnetic Resonance Spectroscopic Imaging (MRSI) [1,2], can help in diagnosis and follow-up of various liver diseases. Specifically, there appears to be an immediate need of this technology for both the assessment of tumor response in patients with Hepatocellular Carcinoma (HCC) treated with Stereotactic Body Radiation Therapy (SBRT) [3--5], as well as assessment of radiation toxicity, which can result in worsening liver dysfunction [6]. Pilot data from our lab has shown that 31P MRSI has the potential to identify treatment response five months sooner than conventional methods [7], and to assess the biological response of liver tissue to radiation 24 hours post radiation therapy [8]. While this data is very promising, commonly occurring drawbacks for 31P MRSI are patient discomfort due to long scan times and prone positioning within the scanner, as well as reduced data quality due to patient motion and respiration. To further advance the full potential of 31P MRSI as a clinical diagnostic tool in the management of liver cancer, this PhD research project had the following aims: I) Reduce the long acquisition time of 3D 31P MRS by formulating and imple- menting an appropriate GRAPPA undersampling scheme and reconstruction on a clinical MRI scanner II) Testing and quantitative validation of GRAPPA reconstruction on 3D 31P MRSI on developmental phantoms and healthy volunteers At completion, this work should considerably advance 31P MRSI

  10. Beauty Clinic Services and Using of Cosmetic for Beauty Clinic Attendees at Jakarta, Indonesia


    raharni budiarto


    Cosmetic is one of pharmaceuticals preparation, with the vigorous cosmetic advertising in print media, electronic media or internet, communities are faced with cosmetics advertising, in which mostly are offering for skin care, especially women to get the skin whiter and brighter. Cosmetic advertising based on Ministry of Health regulation no. 386/Menkes/SK/1994. The objective of this study was to know the beauty clinic services and using of cosmetic for beauty clinic attendees and affecting f...

  11. Clinical use of pharmacogenomic tests in 2009. (United States)

    Sheffield, Leslie J; Phillimore, Hazel E


    Pharmacogenomics is a new field where testing an individual can define either a risk status for an adverse event, or the rate of metabolism of a drug. This is achieved by the categorisation of the enzyme activity or documenting genetic polymorphisms of a metabolising enzyme. The best example of risk status assessment is the recent finding that HLA-B typing a person can predict whether they are at risk of a severe skin reaction from the drug abacavir. Those patients showing HLA-B*5701, who are being considered for abacavir therapy, can be prevented from developing potentially toxic epidermal necrosis (TEN) or Stevens-Johnson Syndrome by avoiding abacavir. The evidence for HLA-B typing for allopurinol and carbamazepine has also been described. Most other pharmacogenomic tests are of drug metabolising enzymes, which can either be assessed using "probe" drugs and measuring a ratio of parent drug to metabolite, or, by genetic testing for polymorphisms of the genes. In practice, testing is usually done by molecular testing, but this typically does not detect all polymorphisms. This article briefly reviews the evidence for the utilisation of pharmacogenomics for antidepressant drugs, tamoxifen, codeine, warfarin, azathioprine, clopidogrel, omeprazole, tacrolimus and irinotecan. There are few pharmacogenomics tests being carried out in practice, as there has not been a wide appreciation of their use, and only limited evidence exists for many individual drugs. It is expected that utilisation will increase as more evidence becomes available and there is a wider understanding of the existing evidence by the medical profession. PMID:19565025

  12. Clinical responses in patients with advanced colorectal cancer to a dendritic cell based vaccine

    DEFF Research Database (Denmark)

    Burgdorf, Stefan K; Fischer, Anders; Myschetzky, Peter S;


    -testis antigens. Vaccines were biweekly administered intradermally with a total of 10 vaccines per patient. CT scans were performed and responses were graded according to the RECIST criteria. Quality of life was monitored with the SF-36 questionnaire. Toxicity and adverse events were graded according...... with this DC-based cancer vaccine was safe and non-toxic. Stable disease was found in 24% (4/17) of the patients. The quality of life remained for most categories high and stable throughout the study period.......Patients with disseminated colorectal cancer have a poor prognosis. Preliminary studies have shown encouraging results from vaccines based on dendritic cells. The aim of this phase II study was to evaluate the effect of treating patients with advanced colorectal cancer with a cancer vaccine based...

  13. Ergonomics of virtual environments for clinical use. (United States)

    Spagnolli, Anna; Gamberini, Luciano; Cottone, Paolo; Mantovani, Giuseppe


    Usability is defined by the International Standards Organization as "the effectiveness, efficiency and satisfaction with which a certain user may achieve a specific objective in a particular environment" (ISO DIS 9241-11). This definition highlights the need for considering the specific destination of a certain technology and reflects the current trends in Human-Computer Interaction (HCI). In compliance with these remarks, the evaluation will be described here of a Virtual Environment (VE) for the treatment of male sexual dysfunctions; the common assumption will be avoided according to which a VE is a space separated from its "real" surroundings [6, 7] and the full environment where the Virtual session takes place will be addressed instead. After a description of the conceptual framework adopted, the paper will dwell on one method among those deployed for the evaluation, namely the analysis of "situated actions". Four aspects will be dealt with: (a) the interplay of various concurrent settings during the virtual session; (b) the users' comprehension of the symbols used in the VE; (c) the structure of the relationship between users and guide; (d) the breakdowns during the human-VE interaction. The goals and the intended meanings of the simulation as set by the designers became the main parameters for the evaluation. PMID:15295153

  14. Posaconazole: An Update of Its Clinical Use

    Directory of Open Access Journals (Sweden)

    Simon Leung


    Full Text Available Posaconazole (PCZ is a relatively new addition to the azole antifungals. It has fungicidal activities against Aspergillus fumigatus, Blastomyces dermatitidis, selected Candida species, Crytopcoccus neoformans, and Trichosporon. PCZ also has fungistatic activities against Candida, Coccidioides, selected Fusarium spp., Histoplasma, Scedosporium and Zygomycetes. In addition, combining the drug with caspofungin or amphotericin B results in a synergistic interaction against A. fumigatus, C. glabrata and C. neoformans. The absorption of PCZ suspension is enhanced when given with food, nutritional supplements, and carbonated beverages. Oral administration of PCZ in divided doses also increases its bioavailability. PCZ has a large volume of distribution and is highly protein bound (>95%. The main elimination route of PCZ is fecal. PCZ is an inhibitor of the CYP3A4 enzyme; therefore, monitoring for drug-drug interactions is warranted with other CYP3A4 substrates/inhibitors/inducers. The most common adverse effects include headache, fatigue, nausea, vomiting and elevated hepatic enzymes. PCZ, with its unique antifungal activities, expands the azole class of antifungal agents. Because of its limit in formulation, PCZ oral suspension is recommended in immunocompromised patients with functional gastrointestinaltracts who fail conventional antifungal therapies or who are suspected to have a breakthrough fungal infection. However, a delayed-release tablet formulation and intravenous (IV injection became available in 2014, expanding the use of PCZ in other patient populations, including individuals who are unable to take oral formulations.

  15. Molecular Biology of Pancreatic Cancer: How Useful Is It in Clinical Practice?

    Directory of Open Access Journals (Sweden)

    George H Sakorafas


    Full Text Available Context During the recent two decades dramatic advances of molecular biology allowed an in-depth understanding of pancreatic carcinogenesis. It is currently accepted that pancreatic cancer has a genetic component. The real challenge is now how these impressive advances could be used in clinical practice. Objective To critically present currently available data regarding clinical application of molecular biology in pancreatic cancer. Methods Reports about clinical implications of molecular biology in patients with pancreatic cancer were retrieved from PubMed. These reports were selected on the basis of their clinical relevance, and the data of their publication (preferentially within the last 5 years. Emphasis was placed on reports investigating diagnostic, prognostic, and therapeutic implications. Results Molecular biology can be used to identify individuals at high-risk for pancreatic cancer development. Intensive surveillance is indicated in these patients to detect pancreatic neoplasia ideally at a preinvasive stage, when curative resection is still possible. Molecular biology can also be used in the diagnosis of pancreatic cancer, with molecular analysis on samples of biologic material, such as serum or plasma, duodenal fluid or preferentially pure pancreatic juice, pancreatic cells or tissue, and stools. Molecular indices have also prognostic significance. Finally, molecular biology may have therapeutic implications by using various therapeutic approaches, such as antiangiogenic factors, purine synthesis inhibitors, matrix metalloproteinase inhibitors, factors modulating tumor-stroma interaction, inactivation of the hedgehog pathway, gene therapy, oncolytic viral therapy, immunotherapy (both passive as well as active etc. Conclusion Molecular biology may have important clinical implications in patients with pancreatic cancer and represents one of the most active areas on cancer research. Hopefully clinical applications of molecular biology

  16. Evaluation of Resin Dissolution Using an Advanced Oxidation Process - 13241

    Energy Technology Data Exchange (ETDEWEB)

    Goulart de Araujo, Leandro; Vicente de Padua Ferreira, Rafael; Takehiro Marumo, Julio [Nuclear and Energy Research Institute, Av. Lineu Prestes, 2242., Sao Paulo, SP. (Brazil); Passos Piveli, Roque; Campos, Fabio [The Polytechnic School of the University of Sao Paulo, Av. Prof. Almeida Prado, 83, trav.2. Sao Paulo, SP (Brazil)


    The ion-exchange resin is widely used in nuclear reactors, in cooling water purification and removing radioactive elements. Because of the long periods of time inside the reactor system, the resin becomes radioactive. When the useful life of them is over, its re-utilization becomes inappropriate, and for this reason, the resin is considered radioactive waste. The most common method of treatment is the immobilization of spent ion exchange resin in cement in order to form a solid monolithic matrix, which reduces the radionuclides release into the environment. However, the characteristic of contraction and expansion of the resin limits its incorporation in 10%, resulting in high cost in its direct immobilization. Therefore, it is recommended the utilization of a pre-treatment, capable of reducing the volume and degrading the resin, which would increase the load capacity in the immobilization. This work aims to develop a method of degradation of ion spent resins from the nuclear research reactor of Nuclear and Energy Research Institute (IPEN/CNEN-SP), Brazil, using the Advanced Oxidative Process (AOP) with Fenton's reagent (hydrogen peroxide and ferrous sulphate as catalyst). The resin evaluated was a mixture of cationic (IR 120P) and anionic (IRA 410) resins. The reactions were conducted by varying the concentration of the catalyst (25, 50, 100 e 150 mM) and the volume of the hydrogen peroxide, at three different temperatures, 50, 60 and 70 deg. C. The time of reaction was three hours. Total organic carbon content was determined periodically in order to evaluate the degradation as a function of time. The concentration of 50 mM of catalyst was the most effective in degrading approximately 99%, using up to 330 mL of hydrogen peroxide. The most effective temperature was about 60 deg. C, because of the decomposition of hydrogen peroxide in higher temperatures. TOC content was influenced by the concentration of the catalyst, interfering in the beginning of the

  17. Radiolabelled Autologous Cells: Methods and Standardization for Clinical Use

    International Nuclear Information System (INIS)

    This publication serves as a useful resource for nuclear medicine physicians, radiologists, radiopharmacists, pharmacologists and other researchers engaged with radiolabelling of autologous products for clinical application. It provides practical guidelines towards clinical work with radiolabelled autologous products and aims to streamline the variety of strategies that have evolved, for example, in the handling of radiolabelled red and white blood cells. The publication highlights the importance of the quality of radiolabelling services, provides advice on safety issues, and also addresses the use of other radiolabelled autologous products and their translation into the clinical environment

  18. Use of crowdsourcing for cancer clinical trial development. (United States)

    Leiter, Amanda; Sablinski, Tomasz; Diefenbach, Michael; Foster, Marc; Greenberg, Alex; Holland, John; Oh, William K; Galsky, Matthew D


    Patient and physician awareness and acceptance of trials and patient ineligibility are major cancer clinical trial accrual barriers. Yet, trials are typically conceived and designed by small teams of researchers with limited patient input. We hypothesized that through crowdsourcing, the intellectual and creative capacity of a large number of researchers, clinicians, and patients could be harnessed to improve the clinical trial design process. In this study, we evaluated the feasibility and utility of using an internet-based crowdsourcing platform to inform the design of a clinical trial exploring an antidiabetic drug, metformin, in prostate cancer. Over a six-week period, crowd-sourced input was collected from 60 physicians/researchers and 42 patients/advocates leading to several major (eg, eligibility) and minor modifications to the clinical trial protocol as originally designed. Crowdsourcing clinical trial design is feasible, adds value to the protocol development process, and may ultimately improve the efficiency of trial conduct.

  19. The use of online discussions for post-clinical conference. (United States)

    Berkstresser, Kristie


    Nurse educators, at every level of pre-licensure nursing education, are charged with developing critical thinking skills within their students. Post-clinical conference is one teaching strategy that nurse educators can employ to help promote the development of critical thinking skills in pre-licensure nursing students. However, traditional face-to-face post-clinical conference is marred with issues and concerns, as identified in the nursing education literature. An alternative to face-to-face post-clinical conference, asynchronous online learning environment, mitigates the issues and concerns associated with traditional post-clinical conference. Adult learning theory supports the use of asynchronous online learning environment because the asynchronous online learning environment promotes student-centered teaching strategy in place of teacher-centered learning, which by its nature traditional face-to-face post-clinical conference tends to support. PMID:26159285

  20. Design of advanced industrial furnaces using numerical modeling method


    Dong, Wei


    This doctoral thesis describes the fundamentals ofmathematical modeling for the industrial furnaces and boilersand presents the results from the numerical simulations of sometypical applications in advanced industrial furnaces andboilers. The main objective of this thesis work is to employcomputational fluid dynamics (CFD) technology as an effectivecomputer simulation tool to study and develop the newcombustion concepts, phenomena and processes in advancedindustrial furnaces and boilers. The ...

  1. Low dose dynamic myocardial CT perfusion using advanced iterative reconstruction (United States)

    Eck, Brendan L.; Fahmi, Rachid; Fuqua, Christopher; Vembar, Mani; Dhanantwari, Amar; Bezerra, Hiram G.; Wilson, David L.


    Dynamic myocardial CT perfusion (CTP) can provide quantitative functional information for the assessment of coronary artery disease. However, x-ray dose in dynamic CTP is high, typically from 10mSv to >20mSv. We compared the dose reduction potential of advanced iterative reconstruction, Iterative Model Reconstruction (IMR, Philips Healthcare, Cleveland, Ohio) to hybrid iterative reconstruction (iDose4) and filtered back projection (FBP). Dynamic CTP scans were obtained using a porcine model with balloon-induced ischemia in the left anterior descending coronary artery to prescribed fractional flow reserve values. High dose dynamic CTP scans were acquired at 100kVp/100mAs with effective dose of 23mSv. Low dose scans at 75mAs, 50mAs, and 25mAs were simulated by adding x-ray quantum noise and detector electronic noise to the projection space data. Images were reconstructed with FBP, iDose4, and IMR at each dose level. Image quality in static CTP images was assessed by SNR and CNR. Blood flow was obtained using a dynamic CTP analysis pipeline and blood flow image quality was assessed using flow-SNR and flow-CNR. IMR showed highest static image quality according to SNR and CNR. Blood flow in FBP was increasingly over-estimated at reduced dose. Flow was more consistent for iDose4 from 100mAs to 50mAs, but was over-estimated at 25mAs. IMR was most consistent from 100mAs to 25mAs. Static images and flow maps for 100mAs FBP, 50mAs iDose4, and 25mAs IMR showed comparable, clear ischemia, CNR, and flow-CNR values. These results suggest that IMR can enable dynamic CTP at significantly reduced dose, at 5.8mSv or 25% of the comparable 23mSv FBP protocol.

  2. Clinical usefulness of the Vaughan Williams classification system. (United States)

    Cobbe, S M


    The clinical usefulness of the Vaughan Williams classification scheme is limited by the complexity of the mechanisms of arrhythmia formation in man, which offer multiple potential sites for intervention. The properties of antiarrhythmic drugs may be considerably altered in abnormal myocardium. Despite these limitations, however, the classification provides a valuable conceptual framework for the understanding of the clinical electrophysiological properties of antiarrhythmic drugs and for their use.

  3. Comparative study of clinical pulmonary surfactants using atomic force microscopy


    Zhang, Hong; Fan, Qihui; Wang, Yi E.; Neal, Charles R.; Zuo, Yi Y.


    Clinical pulmonary surfactant is routinely used to treat premature newborns with respiratory distress syndrome, and has shown great potential in alleviating a number of neonatal and adult respiratory diseases. Despite extensive study of chemical composition, surface activity, and clinical performance of various surfactant preparations, a direct comparison of surfactant films is still lacking. In this study, we use atomic force microscopy to characterize and compare four animal-derived clinica...

  4. Efficacy and clinical/molecular predictors of erlotinib monotherapy for Chinese advanced non-small cell lung cancer

    Institute of Scientific and Technical Information of China (English)

    ZHU Yu-jia; XIA Ying; REN Guan-jun; WANG Meng-zhao; ZENG Xuan; ZHANG Li


    Background A retrospective analysis of clinical data were conducted reviewing patients who were given erlotinib at Peking Union Medical College (PUMC) Hospital from May 2005 to December 2009. Relationships between clinical factors, epidermal growth factor receptor (EGFR) mRNA expression, EGFR gene mutations, KRAS gene mutations and clinical outcomes were investigated in Chinese patients with advanced non-small cell lung cancer (NSCLC). Methods Patients with stage ⅢB/Ⅳ NSCLC who had not previously participated in erlotinib related clinical trials were enrolled into this study. All patients were given oral erlotinib 150 mg per day. Tumor samples of some patients were accessed with mutant-enriched polymerase chain reaction assay (EGFR, KRAS gene mutations) and multiplex branched DNA assay (EGFR mRNA expression).Results Seventy-nine patients were enrolled in this study, 23 patients had a partial response (PR), 36 patients had a stable disease (SD), 20 patients had a PD, with an objective response rate of 29.1%, and a disease control rate of 74.7%.Females (P=0.023), non-smokers (P=0.013), patients with a skin rash (P=0.047), and with highly differentiated tumors (P=0.037) were significantly correlated with the objective response rate. Patients with a lower ECOG PS (P=0.002),highly differentiated tumors (P=0.014), non-smokers (P=0.002), and patients with a skin rash (P <0.001) were significantly correlated with the disease control rate. The median progression-free survival was 35 weeks (95% CI: 13-57 weeks) and 1-year survival was 72.3%. Highly-differentiated tumors (P=0.027) and patients with a skin rash (P <0.001)were significantly correlated with PFS. Seventeen patients were tested for EGFR/KRAS gene mutations and EGFR mRNA expression. Progression-free survival (PFS) of patients with EGFR exon 19/21 mutations was 66 weeks, longer than patients with wild type EGFR exon 19/21 (P=0.018). No significant relationships were found between EGFR mRNA expression, EGFR

  5. The Effect of“Metacognitive Strategy”on the Use of“Advance Organizer”

    Institute of Scientific and Technical Information of China (English)



    Advance organizer”is a practical teaching strategy proposed by American modern educational psychologist Ausubel in 1960. This research considers learners’use of metacognitive strategy in the teaching activities of“advance organizer”, trying to explore the effects of metacognitive strategy in the“advance organizer”teaching practices and testing whether“advance organiz⁃er”can effectively help students understand and retain reading materials. Further researches should be focused on how to conduct learners’“metacognitive strategy”training and employ learners’metacognitive strategies into“advance organizer”teaching activ⁃ities.

  6. Advanced clinical interpretation of the WAIS-IV and WMS-IV: prevalence of low scores varies by level of intelligence and years of education. (United States)

    Brooks, Brian L; Holdnack, James A; Iverson, Grant L


    Clinicians can use the base rates of low scores in healthy people to reduce the likelihood of misdiagnosing cognitive impairment. In the present study, base rates were developed for the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) and Wechsler Memory Scale-Fourth Edition (WMS-IV) using 900 healthy adults and validated on 28 patients with moderate or severe traumatic brain injuries (TBIs). Results indicated that healthy people obtain some low scores on the WAIS-IV/WMS-IV, with prevalence rates increasing with fewer years of education and lower predicted intelligence. When applying the base rates information to the clinical sample, the TBI patients were 13 times more likely to be identified as having a low cognitive profile compared with the controls. Using the base rates information is a psychometrically advanced method for establishing criteria to determine low cognitive abilities on the WAIS-IV/WMS-IV.

  7. Phase Ⅱ clinical study on the modified DCF regimen for treatment of advanced gastric carcinoma

    Institute of Scientific and Technical Information of China (English)

    Yihebali Chi; REN Jian-hong; YANG Lin; CUI Cheng-xu; LI Jun-ling; WANG Jin-wan


    Background A phase Ⅲ trial involving docetaxel, cisplatin, and fluorouracil (DCF) in the treatment of advanced gastric cancer was shown to have superior efficacy compared to cisplatin and fluorouracil alone, but with a high rate of hematologic toxicity. To reduce toxicity while maintaining the efficacy of DCF, we reduced the doses of docetaxel (D) and cis-platinum (CDDP), and administered 5-fluorouracil (5-FU) via a continuous intravenous (CIV) infusion.Methods Chemotherapy-naive patients with gastric adenocarcinomas received D (60 mg/m2 1 hour on day 1), CDDP (30 mg/m2on days 1 and 2), and 5-FU (1500 mg·m-2·24 h-1 CIV on days 1 and 8 every 3 weeks). The primary endpoint was the response rate.Results Fourteen patients were enrolled. Based on the efficacy evaluation following at least 2 cycles of treatment, there was 7.1% complete remission (CR), 71% partial remission (PR), 14% stable disease (NC/SD), and 7.1% progressive disease (PD). The median survival time was 13 months. Nine patients (64%) had grade Ⅲ-Ⅳ neutropenia, and 4 patients (29%) had grade Ⅳ neutropenia, among whom 1 had grade Ⅳ neutropenia with grade Ⅲ nausea and vomiting.Conclusion The modified DCF regimen is highly active and has a favorable toxicity profile in Chinese patients with gastric cancer.

  8. [Sequential Chemoradiotherapy for Advanced Head and Neck Cancer: A Clinical Study with 33 Cases]. (United States)

    Takahashi, Katsumasa; Nakajima, Kyoko; Murata, Takaaki; Shino, Masato; Nikkuni, Osamu; Toyoda, Minoru; Takayasu, Yukihiro; Chikamatsu, Kazuaki


    A total of 33 patients with advanced head and neck cancer (AHNC) treated with sequential chemoradiotherapy (SCRT) were retrospectively evaluated at Gunma University Hospital between 2009 and 2011. The regimen of SCRT was docetaxel, cisplatin, and fluorouracil (TPF)-based induction chemotherapy (ICT), accompanied by docetaxel and cisplatin-based concurrent chemoradiotherapy (CCRT), and oral administration of TS-1 after that. The response rate was 61%, the 3-year overall survival rate was 42%, the non-tumor-bearing survival rate was 27%, and the tumor-bearing survival rate was 15%. Fourteen of 33 patients were tumor-free, and their 3-year overall survival rate was surprisingly 86%. On the other hand, 3-year overall survival rate in the remaining 19 patients was significantly low. To select good response cases for ICT was important. In such cases, TPF should be applied repeatedly, which achieved a 61% response rate even in AHNC. A long-term TS-1 oral medication suppressed cancer regrowth and contributed to long-term survival. PMID:27459819

  9. Clinical utility of vandetanib in the treatment of patients with advanced medullary thyroid cancer

    Directory of Open Access Journals (Sweden)

    Deshpande H


    Full Text Available Hari Deshpande1,3, Vicky Marler3, Julie Ann Sosa2,31Department of Medicine, 2Department of Surgery, Yale University School of Medicine, 3Yale Cancer Center, New Haven, CT, USAAbstract: Vandetanib (ZD6474 became the first systemic agent to be approved for the treatment of metastatic or locally advanced medullary thyroid cancer. It was a proof of principle, because it is an orally bioavailable medication that targets the growth factors felt to be important in the pathogenesis of this disease, ie, the rearranged during transfection proto-oncogene and vascular endothelial growth factor receptor. It was tested initially in two Phase II studies at doses of 100 mg and 300 mg daily. Although activity was seen at both doses, the higher dose was chosen for a randomized, placebo-controlled Phase II study. This trial, which accrued more than 300 patients, showed a statistically significant benefit for the group taking vandetanib compared with those taking placebo medication. Progression-free survival for the vandetanib arm has not been reached, compared with 19 months for the placebo arm. The main toxicity appears to be diarrhea, although some patients experienced significant side effects, including torsades de pointes and sudden cardiac death. Therefore, it is now necessary for practitioners to enroll in a Risk Evaluation Mitigation Strategy before being allowed to prescribe this medication, to reduce the risk of serious side effects occurring.Keywords: ZD6474, medullary thyroid cancer, vandetanib

  10. Advances in diagnosis, clinical care, research, and treatment in retinopathy of prematurity

    Directory of Open Access Journals (Sweden)

    Hartnett ME


    Full Text Available M Elizabeth Hartnett,1–3 Antonio Capone Jr4,5 1Vitreoretinal Surgery, John A. Moran Eye Center, 2Department of Ophthalmology, 3Department of Neurobiology and Anatomy, and Pediatrics, University of Utah, Salt Lake City, UT, 4Associated Retina Consultants, Royal Oak, 5Department of Ophthalmology, Oakland University William Beaumont Hospital School of Medicine, Auburn Hills, MI, USAThe appearance of retinopathy of prematurity (ROP has changed throughout the world and since the first description of “retrolental fibroplasia” in 1942. However, despite advances in neonatal care and the abilities to improve the survival of ever younger and smaller premature infants, ROP remains a leading cause of childhood blindness worldwide. We know that ROP is complex in that it is influenced by genetic predisposition, epigenetic regulation, and environmental risks. It is strongly associated with extreme degrees of prematurity, and the “phenotype” of ROP depends on resources available to support premature infants with adequate nutrition and regulation of oxygen, as examples. New studies also suggest that what is seen in the preterm infant retina may portend later neurodevelopmental outcomes. Therefore, we believe this is a needed time to revisit ROP and provide a thematic issue focused on ROP from several perspectives.

  11. Stress and coping research. Methodological challenges, theoretical advances, and clinical applications. (United States)

    Somerfield, M R; McCrae, R R


    Coping is among the most widely studied topics in contemporary psychology. However, the explosion of interest in coping has yielded little and the field is in crisis. This section offers a survey of the state of the art in theory and research on stress and adaptational processes. The four core articles in the section take up, respectively, problems in research design, the neglect of unconscious reactions to stress, the selection of adaptational outcomes, and the link between research on adaptational processes and clinical practice. The final article by Richard S. Lazarus offers a commentary. The present introduction provides the historical backdrop for the section. Then, after a brief overview of research on adaptational processes, the authors summarize the scope and yield of coping research and preview the four core articles in the section. The strengths and limits of individual coping efforts and the need for realistic expectations and redoubled efforts are discussed.

  12. Recent advances in Gilles de la Tourette syndrome: implications for clinical practice and future research. (United States)

    Leckman, J F; Cohen, D J


    The clinical presentation and natural history of Gilles de la Tourette syndrome (TS) are reviewed. The waxing and waning of symptoms, the rostrocaudal progression of areas of motor involvement, complex stereotypies, and the familial aggregation of TS and chronic multiple tics are suggestions of underlying neurochemical disturbance; whereas attentional problems, impulsivity and obsessive-compulsive behaviors create interesting links with other disorders. The most robust metabolic findings are the lowered CSF HVA in many TS patients, and the positive response of symptoms to dopamine blockers and clonidine particularly, which would be consistent with dopamine receptor hypersensitivity and possible noradrenergic-dopaminergic interactions in TS. However, no definitive account of patho-physiology or genetic contributions to the disorder is yet available.

  13. Enhancing Patient Safety Using Clinical Nursing Data: A Pilot Study. (United States)

    Choi, Jeeyae; Choi, Jeungok E


    To enhance patient safety from falls, many hospital information systems have been implemented to collect clinical data from the bedside and have used the information to improve fall prevention care. However, most of them use administrative data not clinical nursing data. This necessitated the development of a web-based Nursing Practice and Research Information Management System (NPRIMS) that processes clinical nursing data to measure nurses' delivery of fall prevention care and its impact on patient outcomes. This pilot study developed computer algorithms based on a falls prevention protocol and programmed the prototype NPRIMS. It successfully measured the performance of nursing care delivered and its impact on patient outcomes using clinical nursing data from the study site. Results of the study revealed that NPRIMS has the potential to pinpoint components of nursing processes that are in need of improvement for preventing patient from falls. PMID:27332171

  14. Data management by using R: big data clinical research series. (United States)

    Zhang, Zhongheng


    Electronic medical record (EMR) system has been widely used in clinical practice. Instead of traditional record system by hand writing and recording, the EMR makes big data clinical research feasible. The most important feature of big data research is its real-world setting. Furthermore, big data research can provide all aspects of information related to healthcare. However, big data research requires some skills on data management, which however, is always lacking in the curriculum of medical education. This greatly hinders doctors from testing their clinical hypothesis by using EMR. To make ends meet, a series of articles introducing data management techniques are put forward to guide clinicians to big data clinical research. The present educational article firstly introduces some basic knowledge on R language, followed by some data management skills on creating new variables, recoding variables and renaming variables. These are very basic skills and may be used in every project of big data research.

  15. Smartphone use to answer clinical questions: a descriptive study of APNs. (United States)

    Grabowsky, Adelia


    This study examines the use of smartphones by Alabama Advanced Practice Nurses to find information to address clinical questions and seeks to describe the types of questions answered using smartphones; barriers to information seeking; apps and online resources perceived as most helpful; and training/resource needs. Information collected in this study can be used by libraries that serve nursing students to develop training and resources to assist both nursing students and practicing nurses to become more efficient and effective information seekers. PMID:25927507

  16. Clinical efficacy evaluation of Liujunzi decoction combined with EP chemotherapy regiment for advanced non-small cell lung cancer

    Institute of Scientific and Technical Information of China (English)

    Xin-Jun Xiong; Long-Jun Xiong


    Objective:To analyze the clinical efficacy of Liujunzi decoction combined with EP chemotherapy regiment for advanced non-small cell lung cancer.Methods:A total of 72 cases of patients with non-small cell lung cancer were included in the study, the range of patients’ treatment was from August 2012 to October 2014, and according to different treatment, they were divided into observation group 36 cases and control group 36 cases. Control group received EP chemotherapy, observation group received Liujunzi decoction combined with EP chemotherapy regiment, and then differences in serum tumor marker levels, tumor tissue-related protein levels, PDCD5, Nrf2, HIF-1α and GLUT1 levels, and levels of VEGF, GSTs, TSGF and so on were compared between two groups.Results:Serum CY211, SCC, NSE, CEA and CA199 levels of observation group after treatment were lower than those of control group; TUBB3, ERCC-1, MT and P53 expression levels of observation group after treatment were lower while Mcll and Fbw7 expression levels were higher; PDCD5 level of observation group after treatment was higher than that of control group while Nrf2, HIF-1α and GLUT1 levels were lower than those of control group; CD4+CD25+Foxp3+ Treg/CD4+ T, VEGF, GSTs and TSGF values of observation group after treatment were lower than those of control group. Conclusion:Liujunzi decoction combined with EP chemotherapy regiment for patients with advanced non-small cell lung cancer can effectively inhibit tumor cell proliferation as well as invasion and metastasis, is helpful for disease control and prognosis improvement, and has positive clinical significance.

  17. Clinical study on the D4 lymph nodes excision in advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Bo Jian Jiang; Hong Qiang Wang; Rong Xun Sun; You Fu Gao; Hao Shen


    AIM To study the safety and the traumatic degree of D4 approach by retrospective analysis of the para-operative data from the para-aortic lymph nodes excision in comparison with those from standard radicalresection in advanced gastric cancer (AGC).METHODS Several para-operative data including the resectability, the mortality, the complicatedmorbidity, the amount of transfused blood, and the hospitalized days relating to the operation were analyzedstatistically between D4(n = 30) and D2 lymph nodes excision (n = 34) groups. The data expressed as means±SD was analyzed statistically by Student t test. Percentage of the data was analyzed by x2 test statistically.It was taken as significant difference if P value was less than 0.05.RESULTS The percentage of palliated resection in D4 group was significantly lower than that in D2 group(16.67% vs 47.06%, P<0.05). This D4 radical resection would indeed prolong the drainage time (7.35±0.98 days vs 14.78±2.16 days, P < 0.01). The amount of transfused blood during operation (774.32±112.09mL) and the operative consuming time in D4 group (7.14±0.39h) increased significantly toocompared with those in D2 group (538.67±59.87mL, P < 0.05; 4.12±0.18h, P < 0.05), suggesting that thedraumatic degree of D4 operation was severer than that of D2 operation. But the mortality, the morbidity ofcomplication and the hospitalized time after D4 operation did not increase significantly, indicating that D4lymph nodes excision as a choice of the surgical treatment of AGC was safe and feasible.CONCLUSION D4 lymph nodes excision for AGC is safe, reasonable and feasible.

  18. Clinical Response of Pelvic and Para-aortic Lymphadenopathy to a Radiation Boost in the Definitive Management of Locally Advanced Cervical Cancer

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    Rash, Dominique L. [Department of Radiation Oncology, University of California Davis Medical Center, Sacramento, California (United States); Lee, Yongsook C. [Department of Radiation Oncology, University of Kansas School of Medicine, Kansas City, Kansas (United States); Kashefi, Amir [Division of Nuclear Medicine, Department of Radiology, University of California Davis Medical Center, Sacramento, California (United States); Durbin-Johnson, Blythe [Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Sacramento, California (United States); Mathai, Mathew; Valicenti, Richard [Department of Radiation Oncology, University of California Davis Medical Center, Sacramento, California (United States); Mayadev, Jyoti S., E-mail: [Department of Radiation Oncology, University of California Davis Medical Center, Sacramento, California (United States)


    Purpose: Optimal treatment with radiation for metastatic lymphadenopathy in locally advanced cervical cancer remains controversial. We investigated the clinical dose response threshold for pelvic and para-aortic lymph node boost using radiographic imaging and clinical outcomes. Methods and Materials: Between 2007 and 2011, 68 patients were treated for locally advanced cervical cancer; 40 patients had clinically involved pelvic and/or para-aortic lymph nodes. Computed tomography (CT) or 18F-labeled fluorodeoxyglucose-positron emission tomography scans obtained pre- and postchemoradiation for 18 patients were reviewed to assess therapeutic radiographic response of individual lymph nodes. External beam boost doses to involved nodes were compared to treatment response, assessed by change in size of lymph nodes by short axis and change in standard uptake value (SUV). Patterns of failure, time to recurrence, overall survival (OS), and disease-free survival (DFS) were determined. Results: Sixty-four lymph nodes suspicious for metastatic involvement were identified. Radiation boost doses ranged from 0 to 15 Gy, with a mean total dose of 52.3 Gy. Pelvic lymph nodes were treated with a slightly higher dose than para-aortic lymph nodes: mean 55.3 Gy versus 51.7 Gy, respectively. There was no correlation between dose delivered and change in size of lymph nodes along the short axis. All lymph nodes underwent a decrease in SUV with a complete resolution of abnormal uptake observed in 68%. Decrease in SUV was significantly greater for lymph nodes treated with ≥54 Gy compared to those treated with <54 Gy (P=.006). Median follow-up was 18.7 months. At 2 years, OS and DFS for the entire cohort were 78% and 50%, respectively. Locoregional control at 2 years was 84%. Conclusions: A biologic response, as measured by the change in SUV for metastatic lymph nodes, was observed at a dose threshold of 54 Gy. We recommend that involved lymph nodes be treated to this minimum dose.

  19. EGFR testing and clinical management of advanced NSCLC: a Galician Lung Cancer Group study (GGCP 048-10

    Directory of Open Access Journals (Sweden)

    Vázquez S


    Full Text Available Sergio Vázquez,1 Joaquín Casal,2 Francisco Javier Afonso Afonso,3 José Luis Fírvida,4 Lucía Santomé,5 Francisco Barón,6 Martín Lázaro,7 Carolina Pena,7 Margarita Amenedo,8 Ihab Abdulkader,9 Carmen González-Arenas,10 Laura Fachal,11 Ana Vega11 On behalf of the Galician Lung Cancer Group (GGCP1Medical Oncology Department, Lucus Augusti University Hospital, Lugo, 2Medical Oncology Department, University Hospital Complex of Vigo, Pontevedra, 3Medical Oncology Department, University Hospital Complex of Ferrol, Ferrol, 4Medical Oncology Department, University Hospital Complex of Ourense, Ourense, 5Medical Oncology Department Povisa Hospital, Vigo, 6Medical Oncology Department, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, 7Medical Oncology Department, Hospital Complex of Pontevedra, Pontevedra, 8Medical Oncology Department, Oncology Center of Galicia, A Coruña, 9Anatomical Pathology Department, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, 10AstraZeneca, Madrid, 11Galician Public Foundation of Genomic Medicine-SERGAS, Santiago de Compostela Clinic Hospital, Santiago de Compostela, Spain Purpose: This study aimed to assess the incidence of mutations in the epidermal growth factor receptor (EGFR gene in non-small-cell lung cancer (NSCLC patients in the Galician region of Spain and the clinical management and outcome of patients carrying EGFR mutations. Patients and methods: All newly diagnosed advanced or metastatic NSCLC patients were screened for EGFR mutations in matched tumor samples (tissue or cytology specimens and serum samples. Results: Of 198 patients screened for EGFR mutations in tumor samples, 184 had evaluable data and, of these, 25 (13.6% had EGFR mutations (84% sensitizing mutations. EGFR mutation was found in serum in 14 (8.1% patients (of 174 evaluable. Compared to matched tumor tissue, serum EGFR mutation testing specificity and sensitivity were 99% and 52

  20. Integrated NY-ESO-1 antibody and CD8+ T-cell responses correlate with clinical benefit in advanced melanoma patients treated with ipilimumab. (United States)

    Yuan, Jianda; Adamow, Matthew; Ginsberg, Brian A; Rasalan, Teresa S; Ritter, Erika; Gallardo, Humilidad F; Xu, Yinyan; Pogoriler, Evelina; Terzulli, Stephanie L; Kuk, Deborah; Panageas, Katherine S; Ritter, Gerd; Sznol, Mario; Halaban, Ruth; Jungbluth, Achim A; Allison, James P; Old, Lloyd J; Wolchok, Jedd D; Gnjatic, Sacha


    Ipilimumab, a monoclonal antibody against cytotoxic T lymphocyte antigen 4 (CTLA-4), has been shown to improve survival in patients with advanced metastatic melanoma. It also enhances immunity to NY-ESO-1, a cancer/testis antigen expressed in a subset of patients with melanoma. To characterize the association between immune response and clinical outcome, we first analyzed NY-ESO-1 serum antibody by ELISA in 144 ipilimumab-treated patients with melanoma and found 22 of 140 (16%) seropositive at baseline and 31 of 144 (22%) seropositive following treatment. These NY-ESO-1-seropositive patients had a greater likelihood of experiencing clinical benefit 24 wk after ipilimumab treatment than NY-ESO-1-seronegative patients (P = 0.02, relative risk = 1.8, two-tailed Fisher test). To understand why some patients with NY-ESO-1 antibody failed to experience clinical benefit, we analyzed NY-ESO-1-specific CD4(+) and CD8(+) T-cell responses by intracellular multicytokine staining in 20 NY-ESO-1-seropositive patients and found a surprising dissociation between NY-ESO-1 antibody and CD8 responses in some patients. NY-ESO-1-seropositive patients with associated CD8(+) T cells experienced more frequent clinical benefit (10 of 13; 77%) than those with undetectable CD8(+) T-cell response (one of seven; 14%; P = 0.02; relative risk = 5.4, two-tailed Fisher test), as well as a significant survival advantage (P = 0.01; hazard ratio = 0.2, time-dependent Cox model). Together, our data suggest that integrated NY-ESO-1 immune responses may have predictive value for ipilimumab treatment and argue for prospective studies in patients with established NY-ESO-1 immunity. The current findings provide a strong rationale for the clinical use of modulators of immunosuppression with concurrent approaches to favor tumor antigen-specific immune responses, such as vaccines or adoptive transfer, in patients with cancer.

  1. Clinical and neurobiological advances in promoting regeneration of the ventral root avulsion lesion. (United States)

    Eggers, Ruben; Tannemaat, Martijn R; De Winter, Fred; Malessy, Martijn J A; Verhaagen, Joost


    Root avulsions due to traction to the brachial plexus causes complete and permanent loss of function. Until fairly recent, such lesions were considered impossible to repair. Here we review clinical repair strategies and current progress in experimental ventral root avulsion lesions. The current gold standard in patients with a root avulsion is nerve transfer, whereas reimplantation of the avulsed root into the spinal cord has been performed in a limited number of cases. These neurosurgical repair strategies have significant benefit for the patient but functional recovery remains incomplete. Developing new ways to improve the functional outcome of neurosurgical repair is therefore essential. In the laboratory, the molecular and cellular changes following ventral root avulsion and the efficacy of intervention strategies have been studied at the level of spinal motoneurons, the ventral spinal root and peripheral nerve, and the skeletal muscle. We present an overview of cell-based pharmacological and neurotrophic factor treatment approaches that have been applied in combination with surgical reimplantation. These interventions all demonstrate neuroprotective effects on avulsed motoneurons, often accompanied with various degrees of axonal regeneration. However, effects on survival are usually transient and robust axon regeneration over long distances has as yet not been achieved. Key future areas of research include finding ways to further extend the post-lesion survival period of motoneurons, the identification of neuron-intrinsic factors which can promote persistent and long-distance axon regeneration, and finally prolonging the pro-regenerative state of Schwann cells in the distal nerve.

  2. Recent advances in the pathogenesis and clinical evaluation of pulmonary fibrosis

    Directory of Open Access Journals (Sweden)

    G.A. Margaritopoulos


    Full Text Available Interstitial lung diseases (ILDs are a group of heterogeneous disorders, either idiopathic or associated with injurious or inflammatory causes, in which the major site of damage is the lung interstitium. For a long time, knowledge regarding pathogenesis was trivial and there were difficulties in diagnosing and subsequently treating these diseases. During the past decade, however, there has been an impressive development in the field of ILDs. Idiopathic pulmonary fibrosis, the most common and fatal form of ILD, was initially believed to be due to an inflammatory response to unknown lung injury, whereas nowadays it is believed to be the result of multiple injuries at different sites of the lung followed by aberrant repair. The integration of clinical, radiological and histological data, namely a multidisciplinary team (MDT approach, has provided grounds for a more accurate diagnosis of ILDs, and helped the identification of different entities and development of different therapeutic approaches. However, because of the complexity of ILDs, even this approach may fail to establish a confident diagnosis. How should the clinician behave in this case and what are the pitfalls of the MDT approach? In addition, since diagnosis is the major predictor of prognosis, are there any other tools available to predict prognosis?

  3. Health status measured by the Clinical COPD Questionnaire (CCQ) improves following post-acute pulmonary rehabilitation in patients with advanced COPD: a prospective observational study


    van Dam van Isselt, Eléonore F; Spruit, Monica; Groenewegen-Sipkema, Karin H; Chavannes, Niels H.; Achterberg, Wilco P.


    Aims: To evaluate outcomes of the Clinical Chronic obstructive pulmonary disease (COPD) Questionnaire (CCQ) in patients with advanced COPD admitted for a post-acute pulmonary rehabilitation (PR) programme and to relate (change in) health status to lung function, degree of dyspnoea and (change in) functional capacity. Methods: This is a prospective observational study in patients with advanced COPD admitted for a post-acute PR programme in a skilled nursing facility. Health status (CCQ) and fu...

  4. Using clinical signs to diagnose anaemia in African children.


    Luby, S. P.; Kazembe, P.N.; Redd, S. C.; Ziba, C.; Nwanyanwu, O. C.; Hightower, A. W.; C. Franco; Chitsulo, L.; Wirima, J J; Olivar, M. A.


    Anaemia is a serious and common problem among young children in sub-Saharan Africa. As a first step towards developing guidelines for its recognition and treatment, we conducted a study to evaluate the ability of health workers to use clinical findings to identify children with anaemia. Health care workers examined a total of 1104 children under 5 years of age at two hospital-based outpatient clinics in rural Malawi. Blood samples were taken to determine haemoglobin concentrations. Pallor of ...

  5. Using the objective structured clinical examinations in undergraduate midwifery students


    Delavar, MA; Salmalian, H; M Faramarzi; Pasha, H; A. Bakhtiari; M. Nikpour; Ledari, FM


    The Objective Structured Clinical Examination (OSCE) has been considered a modern type of examination for the assessment of clinical skills within nurse education, but it has been rarely applied in the teaching of midwifery. The aim of the present study was to assess the use of the OSCE as a tool to evaluate the abilities of undergraduate midwifery students and to compare the perspectives of the students regarding the OSCE and traditional examination. Fifty-two midwifery students participated...

  6. Advances in functional and structural imaging of the human lung using proton MRI. (United States)

    Miller, G Wilson; Mugler, John P; Sá, Rui C; Altes, Talissa A; Prisk, G Kim; Hopkins, Susan R


    The field of proton lung MRI is advancing on a variety of fronts. In the realm of functional imaging, it is now possible to use arterial spin labeling (ASL) and oxygen-enhanced imaging techniques to quantify regional perfusion and ventilation, respectively, in standard units of measurement. By combining these techniques into a single scan, it is also possible to quantify the local ventilation-perfusion ratio, which is the most important determinant of gas-exchange efficiency in the lung. To demonstrate potential for accurate and meaningful measurements of lung function, this technique was used to study gravitational gradients of ventilation, perfusion, and ventilation-perfusion ratio in healthy subjects, yielding quantitative results consistent with expected regional variations. Such techniques can also be applied in the time domain, providing new tools for studying temporal dynamics of lung function. Temporal ASL measurements showed increased spatial-temporal heterogeneity of pulmonary blood flow in healthy subjects exposed to hypoxia, suggesting sensitivity to active control mechanisms such as hypoxic pulmonary vasoconstriction, and illustrating that to fully examine the factors that govern lung function it is necessary to consider temporal as well as spatial variability. Further development to increase spatial coverage and improve robustness would enhance the clinical applicability of these new functional imaging tools. In the realm of structural imaging, pulse sequence techniques such as ultrashort echo-time radial k-space acquisition, ultrafast steady-state free precession, and imaging-based diaphragm triggering can be combined to overcome the significant challenges associated with proton MRI in the lung, enabling high-quality three-dimensional imaging of the whole lung in a clinically reasonable scan time. Images of healthy and cystic fibrosis subjects using these techniques demonstrate substantial promise for non-contrast pulmonary angiography and detailed

  7. Recent advances in bariatric/metabolic surgery: appraisal of clinical evidence

    Institute of Scientific and Technical Information of China (English)

    Wei-Jei Lee; Abdullah Almulaifi


    Obesity and associated type 2 diabetes mellitus (T2DM) are becoming a serious medical issue worldwide.Bariatric surgery has been shown to be the most effective and durable therapy for the treatment of morbid obese patients.Increasing data indicates bariatric surgery as metabolic surgery is an effective and novel therapy for not well controlled obese T2DM patients.The review of recent developments in bariatric/metabolic surgery covers 4 major fields.1) Improvement of safety:recent advances in laparoscopic/metabolic surgery has made this minimal invasive surgery more than ten times safer than a decade ago.The safety profile of laparoscopic/metabolic surgery is compatible with that of laparoscopic cholecystectomy now.2) New bariatric/metabolic surgery:laparoscopic sleeve gastrectomy (LSG) is becoming the leading bariatric surgery because of its simplicity and efficacy.Other new procedures,such as gastric plication,banded plication,single anastomosis (mini) gastric bypass and Duodeno-jejunal bypass with sleeve gastrectomy have all been accepted as treatment modalities for bariatric/metabolic surgery.3)Mechanism of bariatric/metabolic surgery:Restriction is the most important mechanism for bariatric surgery.Weight regain after bariatric surgery is usually associated with loss of restriction.Recent studies demonstrated that gut hormone,microbiota and bile acid changes after bariatric surgery may play an important role in durable weight loss as well as in T2DM remission.However,weight loss is still the cornerstone of T2DM remission after metabolic surgery.4) Patient selection:patients who may benefit most from bariatric surgery was found to be patients with insulin resistance.For Asian T2DM patients,the indication of metabolic surgery has been set to those with not well controlled (HbA1c > 7.5%) disease and with their BMI > 27.5 Kg/m2.A novel diabetes surgical score,ABCD score,is a simple system for predicting the success of surgical therapy for T2DM.

  8. Clinical outcomes and immune reconstitution in 103 advanced AIDS patients undergoing 12-month highly active antiretroviral therapy

    Institute of Scientific and Technical Information of China (English)

    DAI Yi; QIU Zhi-feng; LI Tai-sheng; HAN Yang; ZUO Ling-yan; XIE Jing; MA Xiao-jun; LIU Zheng-yin; WANG Ai-xia


    Background Highly active antiretroviral therapy (HAART) roduces profound suppression of HIV replication, substantial increase in CD4+ T cells, and partial reconstitution of the immune system. However, the numbers of subjects were small in previous Chinese studies. This study evaluated the efficacy and side effects of HAART in Chinese advanced AIDS patients.Methods One hundred and three antiretroviral drug naive AIDS patients were enrolled in this study and were divided into two groups by their baseline CD4+ count: <100 cells/ μl or ≥ 100 cells/μl. Clinical, virological and immunological outcomes were monitored at baseline and at 1, 3, 6, 9 and 12 months during the course of treatment with HAART.Results One patient died and another was lost from the follow-up. For the remaining 101 HIV/AIDS patients at the 12th month during the HAART, the plasma viral load (VL) was reduced to (3.2±0.7) lg copies/ml, the CD4+ count increased to (168±51) cells/μl [among which the naive phenotype (CD45RA+CD62L+) increased to (49±27) cells/μl and the memory phenotype (CD45RA ̄) increased to (119±55) cells/μl], and the percentage of CD4+CD28+ cells increased. At the same time, there was a significant reduction of CD8+ T cell activation. In the 69 patients with the baseline CD4+ count <100 cells/μl, 37 had a VL <50 copies/ml; while in the 34 patients with the baseline CD4+ count ≥ 100 cells/μl, 25 had a VL <50 copies/ml, the difference between the two groups was statistically significant. The CD4+ T cell count showed a two-phase increase during HAART and a significant positive correlation was shown between the change of CD4+ count and plasma VL. Over 12 months of HAART,10 patients had gastrointestinal side effects, 13 peripheral neuritis, 7 hepatic lesions, 8 hematological side effects,8 skin rashes, 10 lipodystrophy and 1 renal calculus.Conclusions Immune reconstitution as well as the significantly improved clinical outcomes is observed in Chinese advanced AIDS

  9. Quantitative Clinical Chemistry Proteomics (qCCP) using mass spectrometry: general characteristics and application. (United States)

    Lehmann, Sylvain; Hoofnagle, Andrew; Hochstrasser, Denis; Brede, Cato; Glueckmann, Matthias; Cocho, José A; Ceglarek, Uta; Lenz, Christof; Vialaret, Jérôme; Scherl, Alexander; Hirtz, Christophe


    Proteomics studies typically aim to exhaustively detect peptides/proteins in a given biological sample. Over the past decade, the number of publications using proteomics methodologies has exploded. This was made possible due to the availability of high-quality genomic data and many technological advances in the fields of microfluidics and mass spectrometry. Proteomics in biomedical research was initially used in 'functional' studies for the identification of proteins involved in pathophysiological processes, complexes and networks. Improved sensitivity of instrumentation facilitated the analysis of even more complex sample types, including human biological fluids. It is at that point the field of clinical proteomics was born, and its fundamental aim was the discovery and (ideally) validation of biomarkers for the diagnosis, prognosis, or therapeutic monitoring of disease. Eventually, it was recognized that the technologies used in clinical proteomics studies [particularly liquid chromatography-tandem mass spectrometry (LC-MS/MS)] could represent an alternative to classical immunochemical assays. Prior to deploying MS in the measurement of peptides/proteins in the clinical laboratory, it seems likely that traditional proteomics workflows and data management systems will need to adapt to the clinical environment and meet in vitro diagnostic (IVD) regulatory constraints. This defines a new field, as reviewed in this article, that we have termed quantitative Clinical Chemistry Proteomics (qCCP).

  10. Good Practice for Introducing Radiopharmaceuticals for Clinical Use

    International Nuclear Information System (INIS)

    The use of new radiopharmaceuticals can provide extremely valuable information in the evaluation of cancer, as well as heart and brain diseases. Information that often times cannot be obtained by other means. However, there is a perceived need in many Member States for a useful reference to facilitate and expedite the introduction of radiopharmaceuticals already in clinical use in other countries. This publication intends to provide practical support for the introduction of new radiotracers, including recommendations on the necessary steps needed to facilitate and expedite the introduction of radiopharmaceuticals in clinical use, while ensuring that a safe and high quality product is administered to the patient at all times

  11. Advancing our thinking in presence-only and used-available analysis

    NARCIS (Netherlands)

    Warton, D.; Aarts, G.M.


    1. The problems of analysing used-available data and presence-only data are equivalent, and this paper uses this equivalence as a platform for exploring opportunities for advancing analysis methodology. 2. We suggest some potential methodological advances in used-available analysis, made possible vi

  12. The art of effectively teaching clinical interviewing skills using role-playing: a primer. (United States)

    Barney, Christine; Shea, Shawn Christopher


    Time pressure on trainees and supervisors alike places a premium on efficiency in training students to master clinical skills. Through role-playing, a supervisor can create multiple iterations of the desired skill until competence is obtained. The skill training can be advanced in intensity and complexity until the trainer and trainee are confident that the interviewing skill is accessible on demand and that the trainee is comfortable with its use. This article focuses on practical methods of creating believable roles for role-playing and how to use them to teach specific interviewing skills strategically.

  13. Classification and Regression Tree Analysis of Clinical Patterns to Predict the Survival of Patients with Advanced Non-small Cell Lung Cancer Treated with Erlotinib

    Directory of Open Access Journals (Sweden)

    Yutao LIU


    Full Text Available Background and objective Erlotinib is a targeted therapy drug for non-small cell lung cancer (NSCLC. It has been proven that, there was evidence of various survival benefits derived from erlotinib in patients with different clinical features, but the results are conflicting. The aim of this study is to identify novel predictive factors and explore the interactions between clinical variables as well as their impact on the survival of Chinese patients with advanced NSCLC heavily treated with erlotinib. Methods The clinical and follow-up data of 105 Chinese NSCLC patients referred to the Cancer Hospital and Institute, Chinese Academy of Medical Sciences from September 2006 to September 2009 were analyzed. Multivariate analysis of progressive-free survival (PFS was performed using recursive partitioning referred to as the classification and regression tree (CART analysis. Results The median PFS of 105 eligible consecutive Chinese NSCLC patients was 5.0 months (95%CI: 2.9-7.1. CART analysis was performed for the initial, second, and third split in the lymph node involvement, the time of erlotinib administration, and smoking history. Four terminal subgroups were formed. The longer values for the median PFS were 11.0 months (95%CI: 8.9-13.1 for the subgroup with no lymph node metastasis and 10.0 months (95%CI: 7.9-12.1 for the subgroup with lymph node involvement, but not over the second-line erlotinib treatment with a smoking history ≤35 packs per year. The shorter values for the median PFS were 2.3 months (95%CI: 1.6-3.0 for the subgroup with lymph node metastasis and over the second-line erlotinib treatment, and 1.3 months (95%CI: 0.5-2.1 for the subgroup with lymph node metastasis, but not over the second-line erlotinib treatment with a smoking history >35 packs per year. Conclusion Lymph node metastasis, the time of erlotinib administration, and smoking history are closely correlated with the survival of advanced NSCLC patients with first- to

  14. Using multimodal mining to drive clinical guidelines development. (United States)

    Pasche, Emilie; Gobeill, Julien; Teodoro, Douglas; Vishnyakova, Dina; Gaudinat, Arnaud; Ruch, Patrick; Lovis, Christian


    We present exploratory investigations of multimodal mining to help designing clinical guidelines for antibiotherapy. Our approach is based on the assumption that combining various sources of data, such as the literature, a clinical datawarehouse, as well as information regarding costs will result in better recommendations. Compared to our baseline recommendation system based on a question-answering engine built on top of PubMed, an improvement of +16% is observed when clinical data (i.e. resistance profiles) are injected into the model. In complement to PubMed, an alternative search strategy is reported, which is significantly improved by the use of the combined multimodal approach. These results suggest that combining literature-based discovery with structured data mining can significantly improve effectiveness of decision-support systems for authors of clinical practice guidelines.


    Directory of Open Access Journals (Sweden)

    D. A. Sychev


    Full Text Available Apixaban is a "new" oral anticoagulant, direct Xa factor inhibitor with a good evidence base of the efficacy in the prevention of ischemic stroke in patients with atrial fibrillation. The article is devoted to apixaban use in clinical practice: examination before apixaban administration, clinical situation when laboratory control and monitoring are needed, drugs interactions (at the level of CYP3A4, P-gp, management of patients with bleeding because of apixaban therapy (including antidotes application, perioperative management of patients receiving apixaban.

  16. The Novel Quantitative Technique for Assessment of Gait Symmetry Using Advanced Statistical Learning Algorithm

    Directory of Open Access Journals (Sweden)

    Jianning Wu


    Full Text Available The accurate identification of gait asymmetry is very beneficial to the assessment of at-risk gait in the clinical applications. This paper investigated the application of classification method based on statistical learning algorithm to quantify gait symmetry based on the assumption that the degree of intrinsic change in dynamical system of gait is associated with the different statistical distributions between gait variables from left-right side of lower limbs; that is, the discrimination of small difference of similarity between lower limbs is considered the reorganization of their different probability distribution. The kinetic gait data of 60 participants were recorded using a strain gauge force platform during normal walking. The classification method is designed based on advanced statistical learning algorithm such as support vector machine algorithm for binary classification and is adopted to quantitatively evaluate gait symmetry. The experiment results showed that the proposed method could capture more intrinsic dynamic information hidden in gait variables and recognize the right-left gait patterns with superior generalization performance. Moreover, our proposed techniques could identify the small significant difference between lower limbs when compared to the traditional symmetry index method for gait. The proposed algorithm would become an effective tool for early identification of the elderly gait asymmetry in the clinical diagnosis.

  17. Esophagectomy with gastroplasty in advanced megaesophagus: late results of omeprazole use

    Directory of Open Access Journals (Sweden)

    Celso de Castro Pochini


    Full Text Available Objective: To analyze the late results of advanced Chagasic megaesophagus treatment by esophagectomy associated with the use of proton pump inhibitor (omeprazole as for the incidence of esophagitis and Barrett's esophagus in the remaining stump. Methods : We studied patients with advanced megaesophagus undergoing esophagectomy and transmediastinal esophagogastroplasty. Patients were divided into three groups: A (20 with esophageal replacement by full stomach, without the use of omeprazole; B (20 with esophageal replacement by full stomach, with omeprazole 40 mg/day introduced after the first postoperative endoscopy and maintained for six years; and C (30 with esophageal replacement by gastric tube with use of omeprazole. Dysphagia, weight loss and BMI were clinical parameters we analyzed. Upper gastrointestinal endoscopy was performed in all patients, and determined the height of the anastomosis, the aspect of the mucosa, with special attention to possible injuries arising from gastroesophageal reflux, and the patency of the esophagogastric anastomosis. Results : We studied 50 patients, 28 males (56% and 22 (44% females. All underwent endoscopy every year. In the first endoscopy, erosive esophagitis was present in nine patients (18% and Barrett's esophagus, in four (8%; in the last endoscopy, erosive esophagitis was present in five patients (8% and Barrett's esophagus in one (2%. When comparing groups B and C, there was no evidence that the manufacturing of a gastric tube reduced esophagitis and Barrett's esophagus. However, when comparing groups A and C, omeprazole use was correlated with reduction of reflux complications such as esophagitis and Barrett's esophagus (p <0.005. Conclusion : The use of omeprazole (40 mg/day reduced the onset of erosive esophagitis and Barrett's esophagus during the late postoperative period.

  18. Using systems thinking to support clinical system transformation. (United States)

    Best, Allan; Berland, Alex; Herbert, Carol; Bitz, Jennifer; van Dijk, Marlies W; Krause, Christina; Cochrane, Douglas; Noel, Kevin; Marsden, Julian; McKeown, Shari; Millar, John


    Purpose - The British Columbia Ministry of Health's Clinical Care Management initiative was used as a case study to better understand large-scale change (LSC) within BC's health system. Using a complex system framework, the purpose of this paper is to examine mechanisms that enable and constrain the implementation of clinical guidelines across various clinical settings. Design/methodology/approach - Researchers applied a general model of complex adaptive systems plus two specific conceptual frameworks (realist evaluation and system dynamics mapping) to define and study enablers and constraints. Focus group sessions and interviews with clinicians, executives, managers and board members were validated through an online survey. Findings - The functional themes for managing large-scale clinical change included: creating a context to prepare clinicians for health system transformation initiatives; promoting shared clinical leadership; strengthening knowledge management, strategic communications and opportunities for networking; and clearing pathways through the complexity of a multilevel, dynamic system. Research limitations/implications - The action research methodology was designed to guide continuing improvement of implementation. A sample of initiatives was selected; it was not intended to compare and contrast facilitators and barriers across all initiatives and regions. Similarly, evaluating the results or process of guideline implementation was outside the scope; the methods were designed to enable conversations at multiple levels - policy, management and practice - about how to improve implementation. The study is best seen as a case study of LSC, offering a possible model for replication by others and a tool to shape further dialogue. Practical implications - Recommended action-oriented strategies included engaging local champions; supporting local adaptation for implementation of clinical guidelines; strengthening local teams to guide implementation; reducing

  19. A clinical retrospective study of the detectable ability of the advanced colorectal cancer by plain abdominal multislice CT

    International Nuclear Information System (INIS)

    We evaluated the efficacy of plain CT for diagnosis of advanced colorectal cancer retrospectively. During 2 years between December 1999 and November 2001, 26 patients with advanced colorectal cancer underwent abdominal CT scan (Toshiba ASTEIONMULTI). The patients had received no special preparation for CT scan except for avoiding breakfast. The sensitivity of CT scan in detecting tumors was 76.9%. Moreover, cancers originated in the cecum, ascending colon and descending colon were all detectable by CT. Ninety-two percent of cancers occupying more than 2/3 of circumference of the colonic wall were detectable. These evidences may indicate that plain CT is useful for detecting colorectal cancers with little patients' burden as well as providing information about their extension and metastasis, when colorectal cancer is suspected by patients' symptom. (author)

  20. GliomaPredict: a clinically useful tool for assigning glioma patients to specific molecular subtypes

    Directory of Open Access Journals (Sweden)

    Fine Howard A


    Full Text Available Abstract Background Advances in generating genome-wide gene expression data have accelerated the development of molecular-based tumor classification systems. Tools that allow the translation of such molecular classification schemas from research into clinical applications are still missing in the emerging era of personalized medicine. Results We developed GliomaPredict as a computational tool that allows the fast and reliable classification of glioma patients into one of six previously published stratified subtypes based on sets of extensively validated classifiers derived from hundreds of glioma transcriptomic profiles. Our tool utilizes a principle component analysis (PCA-based approach to generate a visual representation of the analyses, quantifies the confidence of the underlying subtype assessment and presents results as a printable PDF file. GliomaPredict tool is implemented as a plugin application for the widely-used GenePattern framework. Conclusions GliomaPredict provides a user-friendly, clinically applicable novel platform for instantly assigning gene expression-based subtype in patients with gliomas thereby aiding in clinical trial design and therapeutic decision-making. Implemented as a user-friendly diagnostic tool, we expect that in time GliomaPredict, and tools like it, will become routinely used in translational/clinical research and in the clinical care of patients with gliomas.

  1. Preclinical evaluation of intraoperative low-energy photon radiotherapy using sphericalapplicators in locally advanced prostate cancer

    Directory of Open Access Journals (Sweden)

    François eBuge


    Full Text Available Background: Surgery plus adjuvant radiotherapy is standard care for locally advanced prostatecancer (stage pT3R1. Intraoperative low-energy photon radiotherapy offers several advantages overexternal beam radiotherapy, and several systems are now available for its delivery, using sphericalapplicators which require only limited shielding. The aim of this study was to evaluate the feasibilityof this technique for the prostate bed.Materials & Methods: Applicators were assessed using MRI image data and cadavericdissection. In cadavers, targeted tissues, defined as a urethral section, both neurovascular bundlesections, the bladder neck and the beds of the seminal vesicles, were marked with metallic surgicalclips. Distances between clips and applicator were measured using CT. A dosimetric study of theapplication of 12 Gy at 5mm depth was performed using CT images of prostatectomized cadavers.Results: Using MRI images from 34 prostate cancer patients, we showed that the ideal applicatordiameter ranges from 45 to 70 mm. Using applicators of different sizes to encompass the prostate bedin nine cadavers, we showed that the distance between target tissues and applicator was less than 2mm for all target tissues except the upper extremity of the seminal vesicles (19 mm. Dosimetric studyshowed a good dose distribution in all target tissues in contact with the applicator, with a lowprobability of rectum and bladder complication.Conclusions: Intraoperative radiotherapy of the prostate bed is feasible, with good coverage oftargeted tissues. Clinical study of safety and efficacy is now required.

  2. Clinical Use of Laser-Microtextured Abutments: A Case Series. (United States)

    Shapoff, Cary A; Babushkin, Jeffrey A; Wohl, David J


    This article discusses the clinical use of laser-microtextured abutments on dental implant restorations. Four cases are presented, each using one of the four commercially available laser-microtextured abutment styles. Numerous preclinical and clinical studies have shown the positive effects of laser microtexturing on the implant platform in limiting crestal bone loss and benefiting soft tissue stability. Other histologic studies of laser microtexturing on the implant abutment have demonstrated the ability of this specific feature to block epithelial downgrowth and provide a functional connective tissue attachment to the abutment surface. Other abutment designs, styles, and materials have only demonstrated a soft tissue seal with epithelial adhesion and a circular ring of connective tissue fibers around the abutment without direct contact. This article presents clinical and radiographic case examples from a private practice perspective on the longterm successful use of microtextured abutments with respect to crestal bone levels, exceptional soft tissue health, and stability with minimal sulcular depth. PMID:27560683

  3. 21 CFR 862.2800 - Refractometer for clinical use. (United States)


    ... total proteins and urinary total solids. Measurements obtained by this device are used in the diagnosis... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Refractometer for clinical use. 862.2800 Section 862.2800 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN...

  4. Prevention of ventilator-associated pneumonia in the intensive care unit: A review of the clinically relevant recent advancements

    Directory of Open Access Journals (Sweden)

    Holly Keyt


    Full Text Available Ventilator-associated pneumonia (VAP is one of the most commonly encountered hospital-acquired infections in intensive care units and is associated with significant morbidity and high costs of care. The pathophysiology, epidemiology, treatment and prevention of VAP have been extensively studied for decades, but a clear prevention strategy has not yet emerged. In this article we will review recent literature pertaining to evidence-based VAP-prevention strategies that have resulted in clinically relevant outcomes. A multidisciplinary strategy for prevention of VAP is recommended. Those interventions that have been shown to have a clinical impact include the following: (i Non-invasive positive pressure ventilation for able patients, especially in immunocompromised patients, with acute exacerbation of chronic obstructive pulmonary disease or pulmonary oedema, (ii Sedation and weaning protocols for those patients who do require mechanical ventilation, (iii Mechanical ventilation protocols including head of bed elevation above 30 degrees and oral care, and (iv Removal of subglottic secretions. Other interventions, such as selective digestive tract decontamination, selective oropharyngeal decontamination and antimicrobial-coated endotracheal tubes, have been tested in different studies. However, the evidence for the efficacy of these measures to reduce VAP rates is not strong enough to recommend their use in clinical practice. In numerous studies, the implementation of VAP prevention bundles to clinical practice was associated with a significant reduction in VAP rates. Future research that considers clinical outcomes as primary endpoints will hopefully result in more detailed prevention strategies.

  5. Clinical roundtable monograph: a multidisciplinary approach to the use of oncotype DX in clinical practice. (United States)

    Gradishar, William J; Hansen, Nora M; Susnik, Barbara


    Recently, recommendations for the use of the Oncotype DX assay in estrogen receptor-positive node-negative breast cancer patients were incorporated into guidelines from both the American Society of Clinical Oncology and the National Comprehensive Cancer Network. The Oncotype DX assay is a diagnostic test which measures changes in a set of 21 genes in order to predict the likelihood of disease recurrence and also to predict which patients are most likely to respond to chemotherapy. Oncotype DX has been available commercially since January 2004 and has been used for more than 85,000 patients. Drs. William J. Gradishar, Nora M. Hansen, and Barbara Susnik answered questions regarding the incorporation of the Oncotype DX breast cancer assay into routine clinical practice. This expert dialog offers an update and clinical insights into when, how, and why clinicians might incorporate the Oncotype DX assay into the management of their breast cancer patients. Also, the latest research into the benefit of the Oncotype DX assay in node-positive patients is discussed. Finally, sample case studies offer clinically relevant examples of the practical application of the Oncotype DX assay.

  6. Clinical study of tegafur-gimeracil-oteracil potassium capsule (s-1 and oxaliplatin combination chemotherapy in advanced colorectal cancer

    Directory of Open Access Journals (Sweden)

    Huaqun Liu


    Full Text Available Objective: The aim of this study was to evaluate the therapeutic efficacy and toxicity of a combination of tegafur-gimeracil-oteracil potassium capsules (S-1 with oxaliplatin for treatment of advanced or recurrent colorectal cancer. Subjects and Methods: Between October 2009 and October 2011, 70 patients at our hospital with advanced or recurrent colorectal cancer were enrolled into our study and divided randomly into two groups: A treatment group (S-1 combined with oxaliplatin and a control group (Xeloda combined with oxaliplatin. All patients received 130 mg/m 2 oxaliplatin by intravenous infusion on day 1, every three weeks. Patients in the treatment group were treated with oral administration of 30-40 mg/m 2 S-1 twice daily for 14 days. Patients in the control group were treated with oral administration of 1000 mg/m 2 Xeloda twice daily for 14 days. The efficacy and toxicity of the combination therapy were evaluated after two cycles of treatment. Results: The response rates in the treatment and control groups were 54.3% and 42.9%, respectively. The disease control rates of the two groups were 80.0% and 74.3%, respectively. The 1-year and 2-year survival rates were 73.6% and 39.1% in the treatment group, respectively, compared to 73.8% and 37.8% in the control group. No statistical difference between the two groups for any of the parameters, including toxicity, was observed (P > 0.05. Conclusion: The efficacy of the S-1 and oxaliplatin combination regimen in advanced or recurrent colorectal cancer treatment is not inferior to the combination of Xeloda and oxaliplatin and does not result in additional toxicity. Therefore, S-1 could be used to substitute Xeloda in combined chemotherapy with oxaliplatin for the treatment of advanced or recurrent colorectal cancer.

  7. Secondary uses of clinical data in primary care

    Directory of Open Access Journals (Sweden)

    Sheila Teasdale


    Full Text Available This paper, presented as a panel at the American Medical Informatics Association (AMIA Fall Symposium 2006, explores a number of secondary uses of primary care clinical data derived from point-of care systems, and the issues arising from those uses. The authors (from the USA and the UK describe, compare and contrast some secondary uses: pay-for-performance, public disclosure, clinical audit, health resource planning, and clinical system usage; in various environments: national health system, network of small family practice offices, and university teaching centres. In the UK, such data are now being used in pay-for-performance for GPs, and approximately 35% of their salary has been put at risk, which has resulted in close scrutiny. In the USA, pay-for-performance is at an earlier stage but is increasingly prevalent and continues to be hotly debated. Some of the issues that arise from these uses of clinical data _data quality including accuracy, comparability, perverse incentives, effect of secondary uses on care provision, and security and confidentiality among others _were discussed. Finally, options and opportunities for improving secondary uses of data in the light of the issues covered earlier were considered.

  8. Schizoaffective disorder-- the reliability of its clinical diagnostic use

    DEFF Research Database (Denmark)

    Vollmer-Larsen, Anne; Jacobsen, TB; Hemmingsen, R;


    OBJECTIVE: Patients with psychoses often suffer from affective symptoms. The originally broad concept of schizoaffective disorder (SAD) has been significantly narrowed, transformed into a convoluted set of criteria both in the ICD-10 and DSM-IV. We examined the reliability of the clinical use....... Diagnoses were allocated by OPCRIT algorithm and by consensus of two psychiatrists. RESULTS: No patients fulfilled the SAD lifetime diagnosis according to DSM-IV criteria and the raters diagnosed only six patients as possible ICD-10 SAD. CONCLUSION: A moratorium on the clinical use of the SAD diagnosis...

  9. Advances in the management of MS symptoms: recently proposed clinical management algorithms. (United States)

    Vermersch, Patrick


    Guidelines from both the German and Spanish Neurology Societies for managing patients with multiple sclerosis (MS) spasticity emphasize the importance of setting clear objectives and use evidence levels and grades to support their recommendations. Swedish guidelines for MS spasticity also reflect the need to establish treatment aims and recommend use of validated scales to measure symptom changes. Treatment of generalized MS spasticity, beyond physiotherapy, tends to begin with baclofen, tizanidine and/or diazepam, adding Sativex (THC:CBD) oromucosal spray for moderate-to-severe cases. The European Federation of Neurological Societies/European Academy of Neurology Taskforce on Spasticity in Multiple Sclerosis is currently reviewing the literature supporting the pharmacological treatment of MS spasticity and aims to publish recommendations in the near future to guide clinicians in their treatment choices. PMID:26611268

  10. Clinical skills assessment of procedural and advanced communication skills: performance expectations of residency program directors


    Langenau, Erik E.; Zhang, Xiuyuan; Roberts, William L.; Andre F. DeChamplain; Boulet, John R.


    Background: High stakes medical licensing programs are planning to augment and adapt current examinations to be relevant for a two-decision point model for licensure: entry into supervised practice and entry into unsupervised practice. Therefore, identifying which skills should be assessed at each decision point is critical for informing examination development, and gathering input from residency program directors is important.Methods: Using data from previously developed surveys and expert p...

  11. Advanced techniques using the plant as indicator of irrigation management

    Directory of Open Access Journals (Sweden)

    Barbara dos Santos Esteves


    Full Text Available The methodologies which are considered the most promising for irrigation management are those based on the analysis of the water status of the plants themselves. This justifies the study and improvement of indicators based on automatic and continuous measures to enable real-time monitoring data, as indices from sap flow, dendrometry and leaf turgor pressure techniques. The aim of this paper is to analyze such methodologies in order to demonstrate their principles, advantages and challenges. In conclusion, the methodologies analyzed still have many technological advances and challenges before being presented to the final user. The future research should work these tools for elaboration of technical indexes that allow their simplification, on the instrumental point of view, and the interpretation of their results.

  12. Plan of advanced satellite communications experiment using ETS-VI (United States)

    Shiomi, Tadashi


    Communications Research Laboratory (CRL, Ministry of Posts and Telecommunications, Japan) has been engaged in development of three advanced satellite communication payloads aiming at experiments by Japan's 2-ton class Engineering Test Satellite VI (ETS-VI) which is to be launched in H-II rocket by NASDA in August 1992. CRL's three experimental systems are: (1) S-band inter-satellite communications; (2) millimeter-wave inter-satellite and personal-satellite communications; and (3) optical inter-satellite communications. CRL develops experimental optical communication system with telescope of 75 mm diameter which has gimbal mirror beam pointing/tracking mechanism. The onboard system has fundamental optical communication functions with laser diode transmitter of wavelength 0.83 micron, laser beam point-ahead mechanism, receiver of wavelength 0.51 micron, modulation/demodulation subsystem, and so on.

  13. Using the RELAP5-3D advanced systems analysis code with commercial and advanced CFD software

    International Nuclear Information System (INIS)

    The Idaho National Engineering and Environmental Laboratory (INEEL), in conjunction with Fluent Corporation, has developed a new analysis tool by coupling the Fluent computational fluid dynamics (CFD) code to the RELAP5-3D/ATHENA advanced thermal-hydraulic analysis code. This tool enables researchers to perform detailed, three-dimensional analyses using Fluent's CFD capability while the boundary conditions required by the Fluent calculation are provided by the balance-of-system model created using RELAP5-3D/ATHENA. Both steady-state and transient calculations can be performed using many working fluids and also point to three-dimensional neutronics. The Fluent/RELAP5-3D coupled code is intended as a state-of-the-art tool to study the behavior of systems with single-phase working fluids, such as advanced gas-cooled reactors. For systems with two-phase working fluids, particularly during loss-of-coolant accident (LOCA) scenarios where a multitude of flow regimes, heat transfer regimes, and phenomena are present, the Fluent-RELAP5-3D coupling will have less general applicability since Fluent's capabilities to analyze global two-phase problems are limited. Consequently, for two-phase advanced reactor analysis, INEEL plans to employ not only the Fluent-RELAP5-3D coupling, but also to make use of state-of-the-art experimental CFD tools such as CFDLib (available from the Los Alamos National Laboratory). A general description of the techniques used to couple the codes is given. A summary of the process used to checkout the coupled configuration is given. A demonstration calculation is presented. Finally, future tasks and plans are outlined. (author)

  14. Clinical use of CCR5 inhibitors in HIV and beyond

    Directory of Open Access Journals (Sweden)

    Gilliam Bruce


    Full Text Available Abstract Since the discovery of CCR5 as a coreceptor for HIV entry, there has been interest in blockade of the receptor for treatment and prevention of HIV infection. Although several CCR5 antagonists have been evaluated in clinical trials, only maraviroc has been approved for clinical use in the treatment of HIV-infected patients. The efficacy, safety and resistance profile of CCR5 antagonists with a focus on maraviroc are reviewed here along with their usage in special and emerging clinical situations. Despite being approved for use since 2007, the optimal use of maraviroc has yet to be well-defined in HIV and potentially in other diseases. Maraviroc and other CCR5 antagonists have the potential for use in a variety of other clinical situations such as the prevention of HIV transmission, intensification of HIV treatment and prevention of rejection in organ transplantation. The use of CCR5 antagonists may be potentiated by other agents such as rapamycin which downregulate CCR5 receptors thus decreasing CCR5 density. There may even be a role for their use in combination with other entry inhibitors. However, clinical use of CCR5 antagonists may have negative consequences in diseases such as West Nile and Tick-borne encephalitis virus infections. In summary, CCR5 antagonists have great therapeutic potential in the treatment and prevention of HIV as well as future use in novel situations such as organ transplantation. Their optimal use either alone or in combination with other agents will be defined by further investigation.

  15. EHDViz: clinical dashboard development using open-source technologies (United States)

    Badgeley, Marcus A; Shameer, Khader; Glicksberg, Benjamin S; Tomlinson, Max S; Levin, Matthew A; McCormick, Patrick J; Kasarskis, Andrew; Reich, David L; Dudley, Joel T


    Objective To design, develop and prototype clinical dashboards to integrate high-frequency health and wellness data streams using interactive and real-time data visualisation and analytics modalities. Materials and methods We developed a clinical dashboard development framework called electronic healthcare data visualization (EHDViz) toolkit for generating web-based, real-time clinical dashboards for visualising heterogeneous biomedical, healthcare and wellness data. The EHDViz is an extensible toolkit that uses R packages for data management, normalisation and producing high-quality visualisations over the web using R/Shiny web server architecture. We have developed use cases to illustrate utility of EHDViz in different scenarios of clinical and wellness setting as a visualisation aid for improving healthcare delivery. Results Using EHDViz, we prototyped clinical dashboards to demonstrate the contextual versatility of EHDViz toolkit. An outpatient cohort was used to visualise population health management tasks (n=14 221), and an inpatient cohort was used to visualise real-time acuity risk in a clinical unit (n=445), and a quantified-self example using wellness data from a fitness activity monitor worn by a single individual was also discussed (n-of-1). The back-end system retrieves relevant data from data source, populates the main panel of the application and integrates user-defined data features in real-time and renders output using modern web browsers. The visualisation elements can be customised using health features, disease names, procedure names or medical codes to populate the visualisations. The source code of EHDViz and various prototypes developed using EHDViz are available in the public domain at Conclusions Collaborative data visualisations, wellness trend predictions, risk estimation, proactive acuity status monitoring and knowledge of complex disease indicators are essential components of implementing data

  16. Natural Killer Cells: Biology and Clinical Use in Cancer Therapy

    Institute of Scientific and Technical Information of China (English)

    William H. D. Hallett; William J. Murphy


    Natural killer (NK) cells have the ability to mediate both bone marrow rejection and promote engraftment, as well as the ability to elicit potent anti-tumor effects. However the clinical results for these processes are still elusive. Greater understanding of NK cell biology, from activating and inhibitory receptor functions to the role of NK cells in allogeneic transplantation, needs to be appreciated in order to draw out the clinical potential of NK cells. Mechanisms of bone marrow cell (BMC) rejection are known to be dependant on inhibitory receptors specific for major histocompatibility complex (MHC) molecules and on activating receptors that have many potential ligands. The modulation of activating and inhibitory receptors may hold the key to clinical success involving NK cells. Pre-clinical studies in mice have shown that different combinations of activating and inhibitory receptors on NK cells can reduce graft-versus-host disease (GVHD), promote engraftment, and provide superior graft-versus-tumor (GVT) responses. Recent clinical data have shown that the use of KIR-ligand incompatibility produces tremendous graft-versus-leukemia effect in patients with acute myeloid leukemia at high risk of relapse. This review will attempt to be a synthesis of current knowledge concerning NK cells, their involvement in BMT, and their use as an immunotherapy for cancer and other hematologic malignancies. Cellular & Molecular Immunology. 2004;1(1):12-21.

  17. Natural Killer Cells: Biology and Clinical Use in Cancer Therapy

    Institute of Scientific and Technical Information of China (English)

    WilliamH.D.Hallett; WilliamJ.Murphy


    Natural killer (NK) cells have the ability to mediate both bone marrow rejection and promote engraftment, as well as the ability to elicit potent anti-tumor effects. However the clinical results for these processes are still elusive. Greater understanding of NK cell biology, from activating and inhibitory receptor functions to the role of NK cells in allogeneic transplantation, needs to be appreciated in order to draw out the clinical potential of NK cells. Mechanisms of bone marrow cell (BMC) rejection are known to be dependant on inhibitory receptors specific for major histocompatibility complex (MHC) molecules and on activating receptors that have many potential ligands. The modulation of activating and inhibitory receptors may hold the key to clinical success involving NK cells. Pre-clinical studies in mice have shown that different combinations of activating and inhibitory receptors on NK cells can reduce graft-versus-host disease (GVHD), promote engraftment, and provide superior graft-versus-tumor (GVT) responses. Recent clinical data have shown that the use of KIR-ligand incompatibility produces tremendous graft-versus-leukemia effect in patients with acute myeloid leukemia at high risk of relapse. This review will attempt to be a synthesis of current knowledge concerning NK cells, their involvement in BMT, and their use as an immunotherapy for cancer and other hematologic malignancies. Cellular & Molecular Immunology. 2004;1(1):12-21.

  18. Advances in the clinical management of inhibitors in hemophilia A and B. (United States)

    Leissinger, Cindy A


    Inhibitors to factor (F)VIII or FIX are the most serious and challenging complication of hemophilia treatment, increasing morbidity and mortality because bleeds no longer respond to standard clotting factor replacement therapy. For patients with high-titer inhibitors, immune tolerance induction achieved through regular factor exposure is the only proven therapy capable of Inhibitor eradication and is almost always indicated for inhibitors of recent onset. Bypassing therapy is used to treat and prevent bleeding, but neither of the two currently available bypassing agents has the predictable hemostatic efficacy of factor replacement in hemophilia patients without inhibitors. Major research efforts are focused on the development of new, more potent therapies for the management of patients with inhibitors.

  19. First-line treatment with FOLFOXIRI for advanced pancreatic cancer in clinical practice: Patients' outcome and analysis of prognostic factors. (United States)

    Vivaldi, Caterina; Caparello, Chiara; Musettini, Gianna; Pasquini, Giulia; Catanese, Silvia; Fornaro, Lorenzo; Lencioni, Monica; Falcone, Alfredo; Vasile, Enrico


    FOLFIRINOX is a standard first-line treatment for advanced pancreatic cancer (aPC). The Gruppo Oncologico Nord Ovest (GONO) FOLFOXIRI regimen demonstrated efficacy in metastatic colorectal cancer. We aimed to evaluate activity and tolerability of FOLFOXIRI regimen in patients with aPC and to explore putative prognostic factors. One hundred thirty-seven consecutive aPC patients were treated with FOLFOXIRI in our institution between 2008 and 2014. Clinical, laboratory and pathological data were collected and their association with activity, progression free survival (PFS) and overall survival (OS) was investigated. After a median follow up of 30 months, median PFS and OS were 8.0 months (95% CI 6.19-9.81) and 12 months (95% CI 9.75-14.25), respectively. Response rate was 38.6%, while disease-control rate 72.2%. At multivariate analysis liver metastases (p = 0.019; Hazard Ratio, HR, 0.59, 95% Confidence Interval, CI, 0.380.96), Eastern Cooperative Oncology Group (ECOG) performance status (PS) 1 (p = 0.001; HR 2.26, 95%CI 1.42-3.59) and neutrophil-lymphocyte ratio (NLR)> 4 (p= 0.002; HR: 2.42; 95% CI 1.38-4.25) were associated with poorer OS. We categorized 119 pts with complete available data as good-risk (0 factors, 38 pts), intermediate-risk (1 factor, 49 pts) and poor-risk (≥2 factors, 32 pts). Median OS for these three groups were 17.6, 11.1 and 7.4 months, respectively (p factors: our analysis revealed ECOG PS, liver metastases and NLR as the most important predictors of survival. These factors could be helpful for treatment decision and clinical trial design. PMID:27038273

  20. Skin autofluorescence, a novel marker for glycemic and oxidative stress-derived advanced glycation endproducts : An overview of current clinical studies, evidence, and limitations

    NARCIS (Netherlands)

    Mulder, Douwe J.; Van de Water, Tara; Lutgers, Helen L.; Graaff, Reindert; Gans, Rijk O.; Zijlstra, Felix; Smit, Andries J.


    Background: Advanced glycation endproducts (AGES) predict long-term complications in age-related diseases. However, there are no clinically applicable markers for measuring AGES in vivo. Methods: We have recently introduced the AGE-Reader (DiagnOptics B.V., Groningen, The Netherlands) to noninvasive

  1. The frequencies and clinical implications of mutations in 33 kinase-related genes in locally advanced rectal cancer: a pilot study.

    LENUS (Irish Health Repository)

    Abdul-Jalil, Khairun I


    Locally advanced rectal cancer (LARC: T3\\/4 and\\/or node-positive) is treated with preoperative\\/neoadjuvant chemoradiotherapy (CRT), but responses are not uniform. The phosphatidylinositol 3-kinase (PI3K), MAP kinase (MAPK), and related pathways are implicated in rectal cancer tumorigenesis. Here, we investigated the association between genetic mutations in these pathways and LARC clinical outcomes.

  2. High RAB25 expression is associated with good clinical outcome in patients with locally advanced head and neck squamous cell carcinoma. (United States)

    Téllez-Gabriel, Marta; Arroyo-Solera, Irene; León, Xavier; Gallardo, Alberto; López, Montserrat; Céspedes, Maria V; Casanova, Isolda; López-Pousa, Antonio; Quer, Miquel; Mangues, Maria A; Barnadas, Agustí; Mangues, Ramón; Pavón, Miguel A


    Currently there are no molecular markers able to predict clinical outcome in locally advanced head and neck squamous cell carcinoma (HNSCC). In a previous microarray study, RAB25 was identified as a potential prognostic marker. The aim of this study was to analyze the association between RAB25 expression and clinical outcome in patients with locally advanced HNSCC treated with standard therapy. In a retrospective immunohistochemical study (n = 97), we observed that RAB25-negative tumors had lower survival (log-rank, P = 0.01) than patients bearing positive tumors. In an independent prospective mRNA study (n = 117), low RAB25 mRNA expression was associated with poor prognosis. Using classification and regression tree analysis (CART) we established two groups of patients according to their RAB25 mRNA level and their risk of death. Low mRNA level was associated with poor local recurrence-free (log-rank, P = 0.005), progression-free (log-rank, P = 0.002) and cancer-specific (log-rank, P survival. Multivariate Cox model analysis showed that low expression of RAB25 was an independent poor prognostic factor for survival (hazard ratio: 3.84, 95% confidence interval: 1.93-7.62, P Patients whose tumors showed high RAB25 expression had a low probability of death after treatment. We also found lower RAB25 expression in tumors than in normal tissue (Mann-Whitney U, P patients with a high probability of survival after genotoxic treatment. PMID:24403269

  3. Advances in the meta-analysis of heterogeneous clinical trials I: The inverse variance heterogeneity model. (United States)

    Doi, Suhail A R; Barendregt, Jan J; Khan, Shahjahan; Thalib, Lukman; Williams, Gail M


    This article examines an improved alternative to the random effects (RE) model for meta-analysis of heterogeneous studies. It is shown that the known issues of underestimation of the statistical error and spuriously overconfident estimates with the RE model can be resolved by the use of an estimator under the fixed effect model assumption with a quasi-likelihood based variance structure - the IVhet model. Extensive simulations confirm that this estimator retains a correct coverage probability and a lower observed variance than the RE model estimator, regardless of heterogeneity. When the proposed IVhet method is applied to the controversial meta-analysis of intravenous magnesium for the prevention of mortality after myocardial infarction, the pooled OR is 1.01 (95% CI 0.71-1.46) which not only favors the larger studies but also indicates more uncertainty around the point estimate. In comparison, under the RE model the pooled OR is 0.71 (95% CI 0.57-0.89) which, given the simulation results, reflects underestimation of the statistical error. Given the compelling evidence generated, we recommend that the IVhet model replace both the FE and RE models. To facilitate this, it has been implemented into free meta-analysis software called MetaXL which can be downloaded from

  4. Neuroprotective gases--fantasy or reality for clinical use? (United States)

    Deng, Jiao; Lei, Chong; Chen, Yu; Fang, Zongping; Yang, Qianzi; Zhang, Haopeng; Cai, Min; Shi, Likai; Dong, Hailong; Xiong, Lize


    The neuroprotective properties for certain medical gases have been observed for decades, leading to extensive research that has been widely reported and continues to garner interest. Common gases including oxygen, hydrogen, carbon dioxide and nitric oxide, volatile anesthetics such as isoflurane, sevoflurane, halothane, enflurane and desflurane, non-volatile anesthetics such as xenon and nitrous oxide, inert gases such as helium and argon, and even gases classically considered to be toxic (e.g., hydrogen sulfide and carbon monoxide) have all been supported by the evidence alluding to their use as potential neuroprotective agents. A wide range of neural injury types such as ischemic/hemorrhagic, stroke, subarachnoid hemorrhage, traumatic brain injury, perinatal hypoxic-ischemic brain injuries, neurodegenerative disease as well as spinal cord ischemia have been used as platforms for studying the neuroprotective effects of these gases, yet until now, none of the gases has been widely introduced into clinical use specifically for protection against neural injury. Insufficient clinical data together with contradictory paradigms and results further hinders the clinical trials. However, pre-clinical models suggest that despite the various classes of gases and the broad range of injuries to which medical gases confer, protection, several underlying mechanisms for their neuroprotective properties are similar. In this review, we summarize the literature concerning the neuroprotective effect of each gas and its underlying mechanisms, extract common targets reported for the neuroprotective effects of different gases, highlight the conflicting observations from clinical trials and further discuss the possible hindrances impeding clinical applications in order to propose future research perspectives and therapeutic exploitations. PMID:24440817

  5. Use of a respiratory clinical score among different providers. (United States)

    Liu, Lenna L; Gallaher, Margaret M; Davis, Robert L; Rutter, Carolyn M; Lewis, Toby C; Marcuse, Edgar K


    Respiratory assessment of children with asthma or bronchiolitis is problematic because both the components of the assessment and their relative importance vary among care providers. Use of a systematic standard assessment process and clinical score may reduce interobserver variation. Our objective was to determine observer agreement among physicians (MD), nurses (RN), and respiratory therapists (RT), using a standard respiratory clinical score. A clinical score was developed incorporating four physiologic parameters: respiratory rate, retractions, dyspnea, and auscultation. One hundred and sixty-five provider pairs (e.g., MD-MD, RN-RT) independently assessed a total of 55 patients admitted for asthma, bronchiolitis, or wheezing at an urban tertiary-care hospital. A weighted kappa statistic measured agreement beyond chance. Rater pairs had high observed agreement on total score of 82-88% and weighted kappas ranging from 0.52 (MD-RN; 95% CI, 0.19, 0.79) to 0.65 (RN-RN; 95% CI, 0.46, 0.87). Observed agreement on individual components of the score ranged from 58% (auscultation) to 74% (dyspnea), with unweighted kappas of 0.36 (respiratory rate; 95% CI, 0.26, 0.46) to 0.53 (dyspnea; 95% CI, 0.41, 0.65). In conclusion, this respiratory clinical score demonstrates good interobserver agreement between MDs, RNs, and RTs. Future research is needed to examine validity and responsiveness in clinical settings. By standardizing respiratory assessments, use of a clinical score may facilitate care coordination by physicians, nurses, and respiratory therapists and thereby improve care of children hospitalized with asthma and bronchiolitis.

  6. Effects of Narrative Script Advance Organizer Strategies Used to Introduce Video in the Foreign Language Classroom (United States)

    Ambard, Philip D.; Ambard, Linda K.


    The study compared participant comprehension of foreign language video content using two advance organizer (AO) strategies while exploring the benefits of AOs as proficiency increases. Participants were 50 advanced-beginner Spanish college students in three sections. Collaborative reading condition participants read a target language narrative…

  7. Being Mindful about the Use of Mindfulness in Clinical Contexts (United States)

    Dimidjian, Sona; Kleiber, Blair


    Over the last 10 years, interest in the use and investigation of mindfulness-based interventions in clinical settings has expanded greatly. This commentary addresses key questions facing clinicians and researchers in order to undertake future work with rigor and care. We consider, in particular, questions regarding the definition of mindfulness,…

  8. Improving clinical decision support using data mining techniques (United States)

    Burn-Thornton, Kath E.; Thorpe, Simon I.


    Physicians, in their ever-demanding jobs, are looking to decision support systems for aid in clinical diagnosis. However, clinical decision support systems need to be of sufficiently high accuracy that they help, rather than hinder, the physician in his/her diagnosis. Decision support systems with accuracies, of patient state determination, of greater than 80 percent, are generally perceived to be sufficiently accurate to fulfill the role of helping the physician. We have previously shown that data mining techniques have the potential to provide the underpinning technology for clinical decision support systems. In this paper, an extension of the work in reverence 2, we describe how changes in data mining methodologies, for the analysis of 12-lead ECG data, improve the accuracy by which data mining algorithms determine which patients are suffering from heart disease. We show that the accuracy of patient state prediction, for all the algorithms, which we investigated, can be increased by up to 6 percent, using the combination of appropriate test training ratios and 5-fold cross-validation. The use of cross-validation greater than 5-fold, appears to reduce the improvement in algorithm classification accuracy gained by the use of this validation method. The accuracy of 84 percent in patient state predictions, obtained using the algorithm OCI, suggests that this algorithm will be capable of providing the required accuracy for clinical decision support systems.

  9. The Use of Bone Age in Clinical Practice - Part 1

    NARCIS (Netherlands)

    D.D. Martin; J.M. Wit; Z.E. Hochberg; L. Sävendahl; R.R. van Rijn; O. Fricke; N. Cameron; J. Caliebe; T. Hertel; D. Kiepe; K. Albertsson-Wikland; H.H. Thodberg; G. Binder; M.B. Ranke


    This review examines the role of skeletal maturity ('bone age', BA) assessment in clinical practice. BA is mainly used in children with the following conditions: short stature (addressed in part 1 of this review), tall stature, early or late puberty, and congenital adrenal hyperplasia (all addressed

  10. Teaching perceptual skills in clinical diagnostics using digital media

    NARCIS (Netherlands)

    Scheiter, Katharina; Jarodzka, Halszka


    Scheiter, K., & Jarodzka, H. (2011, May). Teaching perceptual skills in clinical diagnostics using digital media. Presentation at the 2nd International Conference “Research in Medical Education”: Shaping diamonds from bench to bedside, Universität Tübingen.

  11. High frame rate photoacoustic imaging using clinical ultrasound system (United States)

    Sivasubramanian, Kathyayini; Pramanik, Manojit


    Photoacoustic tomography (PAT) is a potential hybrid imaging modality which is gaining attention in the field of medical imaging. Typically a Q-switched Nd:YAG laser is used to excite the tissue and generate photoacoustic signals. But, they are not suitable for clinical applications owing to their high cost, large size. Also, their low pulse repetition rate (PRR) of few tens of hertz prevents them from being used in real-time PAT. So, there is a growing need for an imaging system capable of real-time imaging for various clinical applications. In this work, we are using a nanosecond pulsed laser diode as an excitation source and a clinical ultrasound imaging system to obtain the photoacoustic imaging. The excitation laser is ~803 nm in wavelength with energy of ~1.4 mJ per pulse. So far, the reported frame rate for photoacoustic imaging is only a few hundred Hertz. We have demonstrated up to 7000 frames per second framerate in photoacoustic imaging (B-mode) and measured the flow rate of fast moving obje ct. Phantom experiments were performed to test the fast imaging capability and measure the flow rate of ink solution inside a tube. This fast photoacoustic imaging can be used for various clinical applications including cardiac related problems, where the blood flow rate is quite high, or other dynamic studies.

  12. 21 CFR 862.2730 - Osmometer for clinical use. (United States)


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Osmometer for clinical use. 862.2730 Section 862.2730 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... affects its osmotic pressure, freezing point, and other physiochemical properties. Osmometers...

  13. Conocimientos de los alumnos de últimos años de Medicina y residentes sobre indicadores de riesgo epidemiológico utilizados en ensayos clínicos Knowledge of epidemiological risk indicators used in clinical trials among medical students in advanced years and medical residents

    Directory of Open Access Journals (Sweden)

    Alonso Zea-Vera


    Full Text Available Estudio que evaluó el conocimiento de 182 estudiantes de los dos últimos años de medicina y 70 residentes de un hospital nacional de Perú, sobre los indicadores de riesgo utilizados en la presentación de resultados en ensayos clínicos. Se realizó un estudio transversal en el que se aplicó un cuestionario que evaluó la capacidad de reconocer y calcular los indicadores de riesgo epidemiológico más utilizados en la literatura médica. El 19,4% no reconoció ninguno de los indicadores y el 81,4% no logró calcularlos. La reducción de riesgo relativo fue el indicador más reconocido (55,2%, seguida del número necesario a tratar (51,6%; reducción de riesgo absoluto (26,6%, y hazard ratio (9,5%. En conclusión, los alumnos de los dos últimos años de medicina y los residentes, no reconocen ni calculan adecuadamente los indicadores de riesgo utilizados en ensayos clínicos.A cross-sectional study evaluated 182 students in the last two years of medical school and 70 residents of a national hospital in Peru on the risk indicators used for reporting results in clinical trials. A questionnaire was used to assess the ability to recognize and calculate risk indicators most widely used in the epidemiological literature. From the participants, 19.4% did not recognize any of the indicators and 81.4% was not able to calculate them. The relative risk reduction was the most recognized indicator (55.2%, followed by the number needed to treat (51.6%, the absolute risk reduction (26.6%, and the hazard ratio (9.5%. In conclusion, medical students in the last two years of school and medical residents do not recognize or are able to calculate properly the risk indicators used in clinical trials.

  14. MR Neurography: Advances

    Directory of Open Access Journals (Sweden)

    Avneesh Chhabra


    Full Text Available High resolution and high field magnetic resonance neurography (MR neurography, MRN is shown to have excellent anatomic capability. There have been considerable advances in the technology in the last few years leading to various feasibility studies using different structural and functional imaging approaches in both clinical and research settings. This paper is intended to be a useful seminar for readers who want to gain knowledge of the advancements in the MRN pulse sequences currently used in clinical practice as well as learn about the other techniques on the horizon aimed at better depiction of nerve anatomy, pathology, and potential noninvasive evaluation of nerve degeneration or regeneration.

  15. Clinical roundtable monograph: Recent advances in the treatment of mantle cell lymphoma: a post-ASH 2009 discussion. (United States)

    Czuczman, Myron S; Leonard, John P; Williams, Michael E


    Mantle cell lymphoma (MCL) is a rare subtype of non-Hodgkin lymphoma characterized by CD5 expression and a t(11;14) cytogenetic translocation that results in overexpression of the cyclin D1 gene. Currently, there is no standard of care for the treatment of MCL, and patient prognosis is poor. Traditional treatments for MCL rely on conventional chemotherapy agents, including cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). The addition of the immunotherapeutic agent rituximab to this regimen (CHOP-R) has helped to improve patient response to treatment. These treatments often provide good initial responses that are difficult to sustain. Therefore, a number of newer agents and combinations have been investigated to produce more durable benefit. Several of these advances were reported at the 51st American Society of Hematology (ASH) Annual Meeting and Exposition, held December 5-8, 2009 in New Orleans, Louisiana. In this clinical roundtable monograph, new strategies in the treatment of MCL are discussed. Some of the drug classes examined here are proteasome inhibitors, inhibitors of the protein mammalian target of rapamycin (mTOR), the unique alkylating agent bendamustine, and immunomodulatory agents. PMID:20539272

  16. Secondary use of clinical data: the Vanderbilt approach. (United States)

    Danciu, Ioana; Cowan, James D; Basford, Melissa; Wang, Xiaoming; Saip, Alexander; Osgood, Susan; Shirey-Rice, Jana; Kirby, Jacqueline; Harris, Paul A


    The last decade has seen an exponential growth in the quantity of clinical data collected nationwide, triggering an increase in opportunities to reuse the data for biomedical research. The Vanderbilt research data warehouse framework consists of identified and de-identified clinical data repositories, fee-for-service custom services, and tools built atop the data layer to assist researchers across the enterprise. Providing resources dedicated to research initiatives benefits not only the research community, but also clinicians, patients and institutional leadership. This work provides a summary of our approach in the secondary use of clinical data for research domain, including a description of key components and a list of lessons learned, designed to assist others assembling similar services and infrastructure.

  17. Bridging the gap between education and appropriate use of benzodiazepines in psychiatric clinical practice

    Directory of Open Access Journals (Sweden)

    Dell’Osso B


    Public Health, Clinical and Molecular Medicine, Unit of Psychiatry, University of Cagliari, Cagliari, 18Department of Clinical and Experimental Medicine, Psychiatric Division, University of Insubria, Varese, 19Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant’ Andrea Hospital, Sapienza University of Rome, Rome, 20Department of Medical and Surgical Sciences, Bologna University, Bologna, 21Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Verona, Italy *These authors contributed equally as first authors Abstract: More than half a century after their discovery, benzodiazepines (BDZs still represent one of the largest and most widely prescribed groups of psychotropic compounds, not only in clinical psychiatry but also in the entire medical field. Over the last two decades, however, there has been an increased focus on the development of antidepressants and antipsychotics on the part of the pharmaceutical industry, clinicians, and researchers, with a reduced interest in BDZs, in spite of their widespread clinical use. As a consequence, many psychiatric residents, medical students, nurses, and other mental health professionals might receive poor academic teaching and training regarding these agents, and have the false impression that BDZs represent an outdated chapter in clinical psychopharmacology. However, recent advances in the field, including findings concerning epidemiology, addiction risk, and drug interactions, as well as the introduction of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition with related diagnostic changes, strongly encourage an updated appraisal of the use of BDZs in clinical practice. During a recent thematic event convened with the aim of approaching this topic in a critical manner, a group of young Italian psychiatrists attempted to highlight possible flaws in current teaching pathways, identify the main clinical pros and cons

  18. Clinical outcome of advanced and metastatic renal cell carcinoma treated with targeted therapy: is there a difference between young and old patients?

    Directory of Open Access Journals (Sweden)

    Zhang G


    Full Text Available Guiming Zhang,1,2,* Yao Zhu,1,2,* Dahai Dong,3 Weijie Gu,1,2 Hailiang Zhang,1,2 Lijiang Sun,3 Dingwei Ye1,2 1Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; 2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China; 3Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China *These authors contributed equally to this work Background: To assess whether the clinical outcome of advanced and metastatic renal cell carcinoma (mRCC treated with targeted therapy differs between young and old patients. Patients and methods: A total of 327 patients with advanced renal cell carcinoma and mRCC who received targeted therapy in two Chinese clinical centers were analyzed retrospectively. The patients were stratified into three groups: young (aged <45 years, middle-aged (aged 45–64 years, and old (aged ≥65 years. Overall survival (OS and progression-free survival (PFS curves were drawn using the Kaplan–Meier method, and Cox's proportional hazard regression model was used to compare OS and PFS within age groups. Results: There were no significant differences among young, middle-aged, and old groups in terms of OS (P=0.087, whereas PFS in the old group was significantly better than in the young and middle-aged groups (P=0.043. Both OS and PFS in the younger groups (aged <65 years were significantly worse than in the old group (age ≥65 years; median OS, 28.1 vs 28.7 months [P=0.029]; median PFS, 11.4 vs 14 months [P=0.015]. No difference in OS or PFS was found between the young and middle-aged groups. After adjusting for sex, body mass index, smoking status, hypertension, diabetes mellitus, Eastern Cooperative Oncology Group score, history of cytokines, and Fuhrman grade, old age was an independent favorable prognostic factor for OS and PFS compared with younger age (<65 years (OS, hazard ratio, 0.552 [95

  19. The human studies database project: federating human studies design data using the ontology of clinical research. (United States)

    Sim, Ida; Carini, Simona; Tu, Samson; Wynden, Rob; Pollock, Brad H; Mollah, Shamim A; Gabriel, Davera; Hagler, Herbert K; Scheuermann, Richard H; Lehmann, Harold P; Wittkowski, Knut M; Nahm, Meredith; Bakken, Suzanne


    Human studies, encompassing interventional and observational studies, are the most important source of evidence for advancing our understanding of health, disease, and treatment options. To promote discovery, the design and results of these studies should be made machine-readable for large-scale data mining, synthesis, and re-analysis. The Human Studies Database Project aims to define and implement an informatics infrastructure for institutions to share the design of their human studies. We have developed the Ontology of Clinical Research (OCRe) to model study features such as design type, interventions, and outcomes to support scientific query and analysis. We are using OCRe as the reference semantics for federated data sharing of human studies over caGrid, and are piloting this implementation with several Clinical and Translational Science Award (CTSA) institutions. PMID:21347149

  20. Fluvial Morphodynamics: advancing understanding using Multibeam Echo Sounders (MBES) (United States)

    Parsons, D. R.; Best, J. L.


    Accurately and reliably determining riverbed morphology is key to understanding linkages between flow fields, sediment transport and bed roughness in a range of aquatic environments, including large fluvial channels. Modern shallow-water multibeam echo sounder (MBES) systems are now allowing us to acquire bathymetric data at unprecedented resolutions that are millimetric in precision and centimetric in accuracy. Such systems, and the morphological resolution they can supply, are capable of revealing the complex three-dimensional patterns in riverbed morphology that are facilitating a holistic examination of system morphodynamics, at the field scale, that was unimaginable just a few years ago. This paper presents a range of MBES acquired examples to demonstrate how the methodological developments in this technology are leading to advances in our substantive understanding of large river systems. This includes examples that show linkages across scales, and in particular the morphodynamics of superimposed bedforms and bars revealed by such high-resolution data, which have broad implications for a range of applications, including flood prediction, engineering design and reconstructing ancient sedimentary environments.