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Sample records for capecitabine initially concomitant

  1. Capecitabine

    Science.gov (United States)

    ... Capecitabine is also used to treat colon or rectal cancer (cancer that begins in the large intestine) ... of reach of children. Store it at room temperature and away from excess heat and moisture (not ...

  2. Oxaliplatin and capecitabine concomitant with neoadjuvant radiotherapy and extended to the resting period in high risk locally advanced rectal cancer

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    Gao, Y.H.; Zeng, Z.F. [State Key Laboratory of Oncology in South China, Guangzhou (China); Sun Yat-sen University Cancer Center, Departments of Radiation Oncology, Guangzhou (China); Zhang, X. [State Key Laboratory of Oncology in South China, Guangzhou (China); Sun Yat-sen University Cancer Center, Departments of Thoracic Surgery, Guangzhou (China); An, X. [State Key Laboratory of Oncology in South China, Guangzhou (China); Sun Yat-sen University Cancer Center, Departments of Medical Oncology, Guangzhou (China); Cai, M.Y. [State Key Laboratory of Oncology in South China, Guangzhou (China); Sun Yat-sen University Cancer Center, Departments of Pathology, Guangzhou (China); Chen, G.; Kong, L.H.; Lin, J.Z.; Wan, D.S.; Pan, Z.Z.; Ding, P.R. [State Key Laboratory of Oncology in South China, Guangzhou (China); Sun Yat-sen University Cancer Center, Departments of Colorectal Surgery, Guangzhou (China)

    2014-02-15

    Conventional neoadjuvant chemoradiotherapy (CRT) is suboptimal for systemic control in locally advanced rectal cancer (LARC). To improve systemic control, we developed an alternative approach in which an intensified oxaliplatin and capecitabine (XELOX) chemotherapy regimen was administered concomitantly with radiation and extended to the resting period (consolidation chemotherapy) for high-risk LARC. The aim of the current study was to evaluate the short-term efficacy and toxicity of this strategy. Patients with high-risk LARC were treated with CRT. Two cycles of XELOX were administered concomitantly with radiation. Thereafter, an additional cycle of the same regimen was administered during the resting period after completion of CRT. Tumor response, toxicities and surgical complications were recorded. This study includes 36 patients treated with the above strategy. All patients completed the planned concurrent CRT. Because of grade 3 toxicities, 2 patients were unable to complete the additional chemotherapy. Grade 3 toxicities were leucopenia (2.8 %), diarrhea (2.8 %) and radiodermatitis (2.8 %). All patients underwent optimal surgery with total mesorectal excision (TME) and a sphincter-saving procedure was performed in 27 patients (75 %). There was no perioperative mortality. Postoperative complications developed in 7 patients (19.4 %). Pathologic complete regression (pCR),''nearly pCR'' (major regression), and moderate or minimal regression were achieved in 13 (36.1 %), 16 (44.4 %), and 7 patients (19.5 %), respectively. The preliminary results suggest that a XELOX regimen initially administered concomitantly with radiotherapy and then extended to the resting period in high-risk LARC patients is well tolerated. The strategy is highly effective in terms of pCR and nearly pCR rates, and thus warrants further investigation. (orig.)

  3. Proton therapy with concomitant capecitabine for pancreatic and ampullary cancers is associated with a low incidence of gastrointestinal toxicity

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    Nichols, R. Charles Jr.; Huh, Soon; Ho, Meng Wei; Mendenhall, Nancy P.; Morris, Christopher G.; Hoppe, Bradford S. [Univ. of Florida Proton Therapy Inst., Jacksonville (United States)], e-mail: rnichols@floridaproton.org; George, Thomas J.; Zaiden, Robert A. Jr. [Dept. of Hematology and Medical Oncology, Univ. of Florida, Gainesville and Jacksonville (United States); Awad, Ziad T. [Dept. of Surgery, Univ. of Florida, Jacksonville (United States); Asbun, Horacio J. [Dept. of Surgery, Mayo Clinic, Jacksonville (United States)

    2013-04-15

    Background: To review treatment toxicity for patients with pancreatic and ampullary cancer treated with proton therapy at our institution. Material and methods: From March 2009 through April 2012, 22 patients were treated with proton therapy and concomitant capecitabine (1000 mg PO twice daily) for resected (n = 5); marginally resectable (n = 5); and unresectable/inoperable (n = 12) biopsy-proven pancreatic and ampullary adenocarcinoma. Two patients with unresectable disease were excluded from the analysis for reasons unrelated to treatment. Proton doses ranged from 50.40 cobalt gray equivalent (CGE) to 59.40 CGE. Results: Median follow-up for all patients was 11 (range 5-36) months. No patient demonstrated any grade 3 toxicity during treatment or during the follow-up period. Grade 2 gastrointestinal toxicities occurred in three patients, consisting of vomiting (n = 3); and diarrhea (n = 2). Median weight loss during treatment was 1.3 kg (1.75% of body weight). Chemotherapy was well-tolerated with a median 99% of the prescribed doses delivered. Percentage weight loss was reduced (p = 0.0390) and grade 2 gastrointestinal toxicity was eliminated (p = 0.0009) in patients treated with plans that avoided anterior and left lateral fields which were associated with reduced small bowel and gastric exposure. Discussion: Proton therapy may allow for significant sparing of the small bowel and stomach and is associated with a low rate of gastrointestinal toxicity. Although long-term follow-up will be needed to assess efficacy, we believe that the favorable toxicity profile associated with proton therapy may allow for radiotherapy dose escalation, chemotherapy intensification, and possibly increased acceptance of preoperative radiotherapy for patients with resectable or marginally resectable disease.

  4. Simultaneous Integrated Boost–Intensity Modulated Radiation Therapy With Concomitant Capecitabine and Mitomycin C for Locally Advanced Anal Carcinoma: A Phase 1 Study

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    Deenen, Maarten J. [Division of Clinical Pharmacology, Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam (Netherlands); Dewit, Luc [Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam (Netherlands); Boot, Henk [Division of Gastroenterology and Hepatology, Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam (Netherlands); Beijnen, Jos H. [Department of Pharmacy and Pharmacology, Slotervaart Hospital, Amsterdam (Netherlands); Faculty of Science, Department of Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, Utrecht (Netherlands); Schellens, Jan H.M. [Division of Clinical Pharmacology, Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam (Netherlands); Faculty of Science, Department of Pharmaceutical Sciences, Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht University, Utrecht (Netherlands); Cats, Annemieke, E-mail: a.cats@nki.nl [Division of Gastroenterology and Hepatology, Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam (Netherlands)

    2013-04-01

    Purpose: Newer radiation techniques, and the application of continuous 5-FU exposure during radiation therapy using oral capecitabine may improve the treatment of anal cancer. This phase 1, dose-finding study assessed the feasibility and efficacy of simultaneous integrated boost–intensity modulated radiation therapy (SIB-IMRT) with concomitant capecitabine and mitomycin C in locally advanced anal cancer, including pharmacokinetic and pharmacogenetic analyses. Methods and Materials: Patients with locally advanced anal carcinoma were treated with SIB-IMRT in 33 daily fractions of 1.8 Gy to the primary tumor and macroscopically involved lymph nodes and 33 fractions of 1.5 Gy electively to the bilateral iliac and inguinal lymph node areas. Patients received a sequential radiation boost dose of 3 × 1.8 Gy on macroscopic residual tumor if this was still present in week 5 of treatment. Mitomycin C 10 mg/m{sup 2} (maximum 15 mg) was administered intravenously on day 1, and capecitabine was given orally in a dose-escalated fashion (500-825 mg/m{sup 2} b.i.d.) on irradiation days, until dose-limiting toxicity emerged in ≥2 of maximally 6 patients. An additional 8 patients were treated at the maximum tolerated dose (MTD). Results: A total of 18 patients were included. The MTD of capecitabine was determined to be 825 mg/m{sup 2} b.i.d. The predominant acute grade ≥3 toxicities included radiation dermatitis (50%), fatigue (22%), and pain (6%). Fifteen patients (83% [95%-CI: 66%-101%]) achieved a complete response, and 3 (17%) patients a partial response. With a median follow-up of 28 months, none of the complete responders, and 2 partial responders had relapsed. Conclusions: SIB-IMRT with concomitant single dose mitomycin C and capecitabine 825 mg/m{sup 2} b.i.d. on irradiation days resulted in an acceptable safety profile, and proved to be a tolerable and effective treatment regimen for locally advanced anal cancer.

  5. Hypofractionated Image-Guided IMRT in Advanced Pancreatic Cancer With Simultaneous Integrated Boost to Infiltrated Vessels Concomitant With Capecitabine: A Phase I Study

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    Passoni, Paolo, E-mail: passoni.paolo@hsr.it [Department of Radiation Oncology, San Raffaele Scientific Institute, Milan (Italy); Reni, Michele [Department of Medical Oncology, San Raffaele Scientific Institute, Milan (Italy); Cattaneo, Giovanni M. [Department of Medical Physics, San Raffaele Scientific Institute, Milan (Italy); Slim, Najla [Department of Radiation Oncology, San Raffaele Scientific Institute, Milan (Italy); Cereda, Stefano [Department of Medical Oncology, San Raffaele Scientific Institute, Milan (Italy); Balzano, Gianpaolo; Castoldi, Renato [Department of Surgery, San Raffaele Scientific Institute, Milan (Italy); Longobardi, Barbara [Department of Medical Physics, San Raffaele Scientific Institute, Milan (Italy); Bettinardi, Valentino; Gianolli, Luigi [Department of Nuclear Medicine, San Raffaele Scientific Institute, Milan (Italy); Gusmini, Simone [Department of Radiology, San Raffaele Scientific Institute, Milan (Italy); Staudacher, Carlo [Department of Surgery, San Raffaele Scientific Institute, Milan (Italy); Calandrino, Riccardo [Department of Medical Physics, San Raffaele Scientific Institute, Milan (Italy); Di Muzio, Nadia [Department of Radiation Oncology, San Raffaele Scientific Institute, Milan (Italy)

    2013-12-01

    Purpose: To determine the maximum tolerated radiation dose (MTD) of an integrated boost to the tumor subvolume infiltrating vessels, delivered simultaneously with radical dose to the whole tumor and concomitant capecitabine in patients with pretreated advanced pancreatic adenocarcinoma. Methods and Materials: Patients with stage III or IV pancreatic adenocarcinoma without progressive disease after induction chemotherapy were eligible. Patients underwent simulated contrast-enhanced four-dimensional computed tomography and fluorodeoxyglucose-labeled positron emission tomography. Gross tumor volume 1 (GTV1), the tumor, and GTV2, the tumor subvolume 1 cm around the infiltrated vessels, were contoured. GTVs were fused to generate Internal Target Volume (ITV)1 and ITV2. Biological tumor volume (BTV) was fused with ITV1 to create the BTV+Internal Target Volume (ITV) 1. A margin of 5/5/7 mm (7 mm in cranium-caudal) was added to BTV+ITV1 and to ITV2 to create Planning Target Volume (PTV) 1 and PTV2, respectively. Radiation therapy was delivered with tomotherapy. PTV1 received a fixed dose of 44.25 Gy in 15 fractions, and PTV2 received a dose escalation from 48 to 58 Gy as simultaneous integrated boost (SIB) in consecutive groups of at least 3 patients. Concomitant chemotherapy was capecitabine, 1250 mg/m{sup 2} daily. Dose-limiting toxicity (DLT) was defined as any treatment-related G3 nonhematological or G4 hematological toxicity occurring during the treatment or within 90 days from its completion. Results: From June 2005 to February 2010, 25 patients were enrolled. The dose escalation on the SIB was stopped at 58 Gy without reaching the MTD. One patient in the 2{sup nd} dose level (50 Gy) had a DLT: G3 acute gastric ulcer. Three patients had G3 late adverse effects associated with gastric and/or duodenal mucosal damage. All patients received the planned dose of radiation. Conclusions: A dose of 44.25 Gy in 15 fractions to the whole tumor with an SIB of 58 Gy to small

  6. A randomised study evaluating the use of pyridoxine to avoid capecitabine dose modifications

    OpenAIRE

    2012-01-01

    Background: Pyridoxine is frequently used to treat capecitabine-induced hand–foot syndrome (HFS), although the evidence of benefit is lacking. We performed a randomised placebo-controlled trial to determine whether pyridoxine could avoid the need for capecitabine dose modifications and improve outcomes. Methods: A total of 106 patients planned for palliative single-agent capecitabine (53 in each arm, 65%/ 35% colorectal/breast cancer) were randomised to receive either concomitant pyridoxine (...

  7. Capecitabine treatment patterns in patients with gastroesophageal cancer in the United States

    Institute of Scientific and Technical Information of China (English)

    Muhammad Wasif Saif; Nianwen Shi; Susan Zelt

    2009-01-01

    AIM: To assess the use of capecitabine-based therapy and associated complication rates in patients with gastroesophageal cancer (GEC) in a real-world treatment setting.METHODS: Patients with claims between 2004 and 2005 were identified from the Thomson Reuters Mar-ketScan?databases. Capecitabine regimens were compared with 5-fluorouracil (5-FU) and other chemotherapy regimens, and were stratified by treatment setting.RESULTS: We identified 1013 patients with GEC: approximately half had treatment initiated with a 5-FU regimen, whereas 11% had therapy initiated with a capecitabine regimen. The mean capecitabine dose overall was 2382 ?118 mg/d, and capecitabine was used as monotherapy more often than in combination. Overall, 5-FU regimens were the most common treatment option in neoadjuvant and adjuvant settings, while other non-capecitabine regimens were used more widely in first- and second-line settings. The overall unadjusted complication rate for capecitabine regimens was about half of that seen with 5-FU regimens. In multivariate analyses, capecitabine recipients had a 51% (95% CI: 26%-81%) lower risk of developing any complication than 5-FU recipients did. The risk of developing bone marrow, constitutional, gastrointestinal tract, infectious, or skin complications was lowerwith capecitabine therapy than with 5-FU.CONCLUSION: Capecitabine appeared to have a favorable side effect profile compared with 5-FU, which indicates that it may be a treatment option for GEC.

  8. Preoperative treatment with capecitabine, cetuximab and radiotherapy for primary locally advanced rectal cancer : A phase II clinical trial

    NARCIS (Netherlands)

    Eisterer, Wolfgang; de Vries, Alexander; Öfner, Dietmar; Rabl, Hans; Koplmüller, Renate; Greil, Richard; Tschmelitsch, Jöerg; Schmid, Rainer; Kapp, Karin; Lukas, Peter; Sedlmayer, Felix; Höfler, Gerald; Gnant, Michael; Thaler, Josef; Widder, Joachim

    2014-01-01

    BACKGROUND/AIM: To investigate the feasibility and safety of preoperative capecitabine, cetuximab and radiation in patients with MRI-defined locally advanced rectal cancer (LARC, cT3/T4). PATIENTS AND METHODS: 31 patients with LARC were treated with cetuximab and capecitabine concomitantly with 45 G

  9. Capecitabine-Induced Coronary Vasospasm

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    Danish Henry

    2016-10-01

    Full Text Available Capecitabine, an oral prodrug of 5-fluorouracil (5-FU, is approved for early-stage and advanced colorectal cancer and metastatic breast cancer. Cardiotoxicity of 5-FU is well described in the literature. However, cardiac adverse effects of capecitabine are poorly described. We report a case of coronary vasospasm induced by capecitabine. A 41-year-old female with metastatic breast cancer presented with chest pain 3 days after starting capecitabine. The chest pain was relieved by rest and exacerbated by exertion. Her physical examination was unremarkable except for a rapid heart rate of 100 bpm. Electrocardiogram test showed no acute ischemic changes. Troponin tests were negative. CT angiography of the chest was negative for acute pulmonary embolism. An echocardiogram showed a left ventricular ejection fraction of 60% without any wall motion abnormalities. The chest pain resolved with aspirin and analgesic use. She was discharged following an inconclusive cardiac workup. Further use of capecitabine was discontinued.

  10. Concomitant chemoradiotherapy with CDDP and 5FU for nasopharyngeal carcinoma. The initial evaluation and side effects

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    Takeuchi, Yousuke; Suzuki, Haruhiko; Shigehara, Takeo; Omura, Ken; Shimada, Fumiyuki; Hatano, Kazuo; Sekiya, Yuichi; Togawa, Takashi [Chiba Cancer Center Hospital (Japan)

    1998-03-01

    Concomitant chemoradiotherapy with CDDP and 5FU was given to 18 patients with nasopharyngeal carcinoma during January 1994-October 1996. One and 17 were in Stages III-IV respectively. None had distant metastasis. The median duration of follow-up of all patients was 23.5 months (6-45). Objective response (CR+PR) of the primary lesion and the regional nodes was 18/18 (100%), whereas CR was 2/18 (11%). CR+PR and CR at the primary lesion were 18/18 (100%) and 5/18 (28%) respectively. Two patients died of disease at T site. One patient was alive with disease. The remaining 15 (83%) patients were relapse free alive. There were 2 relapses, 1 at T+M, and 1 at T+N sites. Side effects, especially myelosuppression and mucositis, were severe. Leukopenia and mucositis in grade 3-4 were 78% and 89% respectively. In conclusion, this regimen has been effective in short term follow-up. However, because of severe side effects, further modifications are required. Long term follow-up are required to define final effectiveness of this regimen. (author)

  11. Toxic encephalopathy induced by capecitabine.

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    Niemann, B; Rochlitz, C; Herrmann, R; Pless, M

    2004-01-01

    Toxic encephalopathy is a rarely described side effect of 5-fluorouracil which usually presents with cerebellar, neuropsychiatric, and focal neurological symptoms. Magnetic resonance imaging findings are described as patchy white matter alterations. We report the 1st case of capecitabine-induced toxic encephalopathy with epilepsy-like symptoms and diffuse white matter alterations on magnetic resonance imaging.

  12. Capecitabine-induced lichenoid drug eruption: a case report.

    Science.gov (United States)

    Gehlhausen, Jeff R; Strausburg, Matthew B; Aouthmany, Mouhammad; Katona, Terrence M; Turner, Matthew J

    2017-02-15

    Capecitabine is a 5-fluorouracil basedchemotherapeutic drug widely used in the treatmentof solid tumors, especially colorectal and breast. Someof the most common side effects of capecitabine arecutaneous in nature, including hand-foot syndrome(palmar-plantar erythrodysesthesia). Several reports inthe literature link capecitabine use with photosensitivelichenoid eruptions. Herein, we present a case ofcapecitabine-induced lichenoid eruption in an elderlyfemale with metastatic breast cancer and discuss ourfindings in relationship to previously reported cases ofthis and other capecitabine-induced skin pathologies.

  13. Adverse Interaction between Capecitabine and Warfarin Resulting in Altered Coagulation Parameters: A Review of the Literature Starting from a Case Report

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    Giovanni Giunta

    2010-01-01

    Full Text Available Capecitabine is an orally active prodrug of fluorouracil and is extensively used as an antineoplastic agent. It is converted to 5-Fluorouracil in the liver and tumor tissues. Warfarin is an anticoagulant agent for preventing and treating venous and arterial thrombosis and embolism and is metabolized by cytochrome P450 isoenzymes in the liver. Preclinical in vitro studies using human liver microsomes report no inhibitory effects between capecitabine and substrates of cytochrome P. However, the concomitant administration of capecitabine and warfarin resulted in INR elevation in the cases previously reported in the literature. The exact mechanism of this interaction is unknown but may be related to downregulation of cytochrome P450 2C9 by capecitabine or its metabolites. We report on the possible adverse interaction between capecitabine and warfarin in a patient with metastatic breast cancer and critically review the existing literature on this topic. Physicians should be aware of adverse reactions arising from the combined use of capecitabine and warfarin. In the light of the current data, INR levels should be closely monitored in patients using these drugs together.

  14. Incidence and risk factors for capecitabine-induced symptomatic cardiotoxicity

    DEFF Research Database (Denmark)

    Polk, Anne; Shahmarvand, Nahid; Vistisen, Kirsten

    2016-01-01

    OBJECTIVES: Case reports of capecitabine cardiotoxicity resemble those seen with intravenous 5-fluorouracil (5-FU) with chest pain as the predominant manifestation, but few studies of capecitabine cardiotoxicity are available. We aimed to determine the incidence of symptomatic cardiotoxicity from.......020) were risk factors of cardiotoxicity. CONCLUSIONS: The incidence of cardiotoxicity from capecitabine resembles that of intravenous 5-FU (≈5%). Cardiac comorbidity, hypercholesterolaemia and current smoking were associated with development of cardiotoxicity....

  15. Capecitabine based postoperative accelerated chemoradiation of pancreatic carcinoma. A dose-escalation study

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    Morganti, Alessio G.; Picardi, Vincenzo; Ippolito, Edy; Massaccesi, Mariangela; Macchia, Gabriella; Deodato, Francesco (Radiotherapy Unit, Dept. of Oncology, ' John Paul II' Center for High Technology Research and Education in Biomedical Sciences, Catholic Univ., Campobasso (Italy)), E-mail: gmacchia@rm.unicatt.it; Caravatta, Luciana; Tambaro, Rosa; Mignogna, Samantha (Palliative Therapies Unit, Dept. of Oncology, ' John Paul II' Center for High Technology Research and Education in Biomedical Sciences, Catholic Univ., Campobasso (Italy)); Cellini, Numa; Valentini, Vincenzo; Mattiucci, Gian Carlo (Dept. of Radiotherapy, Policlinico Universitario ' A. Gemelli' , Catholic Univ., Rome (Italy)); Di Lullo, Liberato (Dept. of Oncology, ' F. Veneziale' General Hospital, Isernia (Italy)); Giglio, Gianfranco (Dept. of Oncology, ' A. Cardarelli' General Hospital Campobasso (Italy)); Caprino, Paola; Sofo, Luigi (Surgery Unit, Dept. of Oncology, ' John Paul II' Center for High Technology Research and Education in Biomedical Sciences, Catholic Univ., Campobasso (Italy)); Ingrosso, Marcello (Endoscopy Unit, Dept. of Oncology, ' John Paul II' Center for High Technology Research and Education in Biomedical Sciences, Catholic Univ., Campobasso (Italy))

    2010-05-15

    The objective of this study was to evaluate the safety of escalating up to 55 Gy within five weeks, the dose of external beam radiotherapy to the previous tumor site concurrently with a fixed daily dose of capecitabine, in patients with resected pancreatic cancer. Material and methods. Patients with resected pancreatic carcinoma were eligible for this study. Capecitabine was administered at a daily dose of 1600 mg/m2. Regional lymph nodes received a total radiation dose of 45 Gy with 1.8 Gy per fractions. The starting radiation dose to the tumor bed was 50.0 Gy (2.0 Gy/fraction, 25 fractions). Escalation was achieved up to a total dose of 55.0 Gy by increasing the fraction size by 0.2 Gy (2.2 Gy/fraction), while keeping the duration of radiotherapy to five weeks (25 fractions). A concomitant boost technique was used. Dose limiting toxicity (DLT) was defined as any grade>3 hematologic toxicity, grade>2 liver, renal, neurologic, gastrointestinal, or skin toxicity, by RTOG criteria, or any toxicity producing prolonged (> 10 days) radiotherapy interruption. Results and discussion. Twelve patients entered the study (median age: 64 years). In the first cohort (six patients), no patient experienced DLT. Similarly in the second cohort, no DLT occurred. All 12 patients completed the planned regimen of therapy. Nine patients experienced grade 1-2 nausea and/or vomiting. Grade 2 hematological toxicity occurred in four patients. The results of our study indicate that a total radiation dose up to 55.0 Gy/5 weeks can be safely administered to the tumor bed, concurrently with capecitabine (1600 mg/m2) in patients with resected pancreatic carcinoma.

  16. Use of capecitabine in management of early colon cancer

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    Cassidy J

    2011-08-01

    Full Text Available H Hameed, J CassidyBeatson West of Scotland Cancer Centre, Glasgow, Scotland, UKAbstract: Capecitabine (Xeloda®, Roche, Basel, Switzerland is a pro-drug of 5-fluorouracil (5-FU, and it is converted to 5-FU in the cancer cell by enzymatic degradation. The role of capecitabine in colorectal cancer has evolved in the last 15 years. In early trials in the metastatic setting, capecitabine has shown superior response rates compared with those achieved with 5-FU (Mayo Clinic regimen (26% vs 17%, with equivalent progression-free survival and overall survival. In the adjuvant setting, the Xeloda in Adjuvant Colon Cancer Therapy (X-ACT trial demonstrated that capecitabine as a single agent led to improvement in relapse-free survival (hazard ratio: 0.86, 95% confidence interval: 0.74–0.99, P = 0.04 and was associated with significantly fewer adverse events than 5-FU plus leucovorin (LV, folinic acid. On the basis of the X-ACT trial, capecitabine was approved by the United States Food and Drug Administration, the National Institute for Clinical Excellence, and the Scottish Medicines Consortium as monotherapy for the adjuvant treatment of stage III colon cancer. The next step was to incorporate capecitabine into combination therapy. The XELOXA trial studied the combination of capecitabine and oxaliplatin (XELOX vs 5-FU/LV and demonstrated 5-year disease-free survival of 66% for XELOX, compared with 60% for 5-FU/LV. The toxicity profile was also quite comparable in the two arms. So both the single agent use of capecitabine as well as in combination with oxaliplatin can be considered as part of the standard of care in management of early colon cancer in appropriately selected patient groups.Keywords: 5-fluorouracil, 5-FU, leucovorin, folinic acid, LV, XELOX, oxaliplatin, FOLFOX

  17. Targeting cancers in the gastrointestinal tract: role of capecitabine

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    Muhammad Wasif Saif

    2009-03-01

    Full Text Available Muhammad Wasif SaifYale Cancer Center, Yale University School of Medicine, New Haven, CT, USAAbstract: Capecitabine is currently the only novel, orally home-administered fluorouracil prodrug. It offers patients more freedom from hospital visits and less inconvenience and complications associated with infusion devices. The drug has been extensively studied in large clinical trials in many solid tumors, including breast cancer, colorectal cancer, gastric cancer, and many others. Furthermore, the drug compares favorably with fluorouracil in patients with such cancers, with a safe toxicity profile, consisting mainly of gastrointestinal and dermatologic adverse effects. Whereas gastrointestinal events and hand-foot syndrome occur often with capecitabine, the tolerability profile is comparatively favorable. Prompt recognition of severe adverse effects is the key to successful management of capecitabine. Ongoing and future clinical trials will continue to examine, and likely expand, the role of capecitabine as a single agent and/or in combination with other anticancer agents for the treatment of gastrointestinal as well as other solid tumors, both in the advanced palliative and adjuvant settings. The author summarizes the current data on the role of capecitabine in the management of gastrointestinal cancers. Keywords: 5-fluorouracil, capecitabine, chemotherapy, adjuvant, advanced, colon cancer, gastric cancer, hepatocellular cancer, pancreatic cancer, cholangiocarcinoma, rectal cancer, anal cancer

  18. Hand and foot syndrome secondary to capecitabine

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    Hina Shaikh Lal

    2014-01-01

    Full Text Available A 55-year-old woman on treatment with capecitabine and paclitaxel for breast carcinoma presented with history of a tingling sensation in her hands and feet with a progressive burning sensation. She also noted discomfort, minimal pain and stiffness while holding objects. On examination, there was patchy hyperpigmentation of both the palms and soles, and the dorsa of hands and feet. This was accompanied by a thickening of the skin more over the knuckles and toes. In addition there was a moist desquamation around the toes and over the palmar creases and a bluish discoloration of the lunulae of both thumbnails. She was diagnosed with hand and foot syndrome and started on pyridoxine and emollients. The finding of keratoderma noted in our patient is not seen commonly in hand and foot syndrome.

  19. Capecitabine caused cardiogenic shock through induction of global takotsubo syndrome

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    Y-Hassan, Shams, E-mail: shams.younis-hassan@karolinska.se; Tornvall, Per; Törnerud, Mattias; Henareh, Loghman

    2013-01-15

    5-Fluorouracil (5-FU) and its oral pro-drug capecitabine are widely used in oncology for the treatment of various solid tumours, including colorectal cancers. Cardiotoxicity to these drugs is not an uncommon adverse effect and has been reported in 1%–18% of patients. Capecitabine has been reported to trigger mid-apical Takotsubo syndrome (TS). We describe here the case of a 55-year-old man who presented with cardiogenic shock and ECG signs of ST-elevation myocardial infarction. The symptoms began 28 h after the commencement of capecitabine adjuvant therapy, following a radical right-sided hemicolectomy for low-differentiated adenocarcinoma of the caecum. Echocardiography showed severe global left ventricular dysfunction. Cardiac magnetic resonance imaging showed no signs of late gadolinium enhancement. These clinical, cardiac image study findings and the course of the disease with full recovery within one week were consistent with global TS triggered by the adjuvant therapy capecitabine and presenting with a life-threatening cardiogenic shock. Moreover, we have demonstrated the speedy dynamic of the left ventricular wall motion abnormality with global TS at presentation and basal (inverted) TS findings 4 days later on.

  20. Preparation and Characterization of a Gastric Floating Dosage Form of Capecitabine

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    Ehsan Taghizadeh Davoudi

    2013-01-01

    Full Text Available Gastrointestinal disturbances, such as nausea and vomiting, are considered amongst the main adverse effects associated with oral anticancer drugs due to their fast release in the gastrointestinal tract (GIT. Sustained release formulations with proper release profiles can overcome some side effects of conventional formulations. The current study was designed to prepare sustained release tablets of Capecitabine, which is approved by the Food and Drug Administration (FDA for the treatment of advanced breast cancer, using hydroxypropyl methylcellulose (HPMC, carbomer934P, sodium alginate, and sodium bicarbonate. Tablets were prepared using the wet granulation method and characterized such that floating lag time, total floating time, hardness, friability, drug content, weight uniformity, and in vitro drug release were investigated. The sustained release tablets showed good hardness and passed the friability test. The tablets’ floating lag time was determined to be 30–200 seconds, and it floated more than 24 hours and released the drug for 24 hours. Then, the stability test was done and compared with the initial samples. In conclusion, by adjusting the right ratios of the excipients including release-retarding gel-forming polymers like HPMC K4M, Na alginate, carbomer934P, and sodium bicarbonate, sustained release Capecitabine floating tablet was formulated.

  1. Preparation and Characterization of a Gastric Floating Dosage Form of Capecitabine

    Science.gov (United States)

    Taghizadeh Davoudi, Ehsan; Ibrahim Noordin, Mohamed; Kadivar, Ali; Kamalidehghan, Behnam; Farjam, Abdoreza Soleimani; Akbari Javar, Hamid

    2013-01-01

    Gastrointestinal disturbances, such as nausea and vomiting, are considered amongst the main adverse effects associated with oral anticancer drugs due to their fast release in the gastrointestinal tract (GIT). Sustained release formulations with proper release profiles can overcome some side effects of conventional formulations. The current study was designed to prepare sustained release tablets of Capecitabine, which is approved by the Food and Drug Administration (FDA) for the treatment of advanced breast cancer, using hydroxypropyl methylcellulose (HPMC), carbomer934P, sodium alginate, and sodium bicarbonate. Tablets were prepared using the wet granulation method and characterized such that floating lag time, total floating time, hardness, friability, drug content, weight uniformity, and in vitro drug release were investigated. The sustained release tablets showed good hardness and passed the friability test. The tablets' floating lag time was determined to be 30–200 seconds, and it floated more than 24 hours and released the drug for 24 hours. Then, the stability test was done and compared with the initial samples. In conclusion, by adjusting the right ratios of the excipients including release-retarding gel-forming polymers like HPMC K4M, Na alginate, carbomer934P, and sodium bicarbonate, sustained release Capecitabine floating tablet was formulated. PMID:24288681

  2. Development of an oral dosage form of capecitabine with modified release characteristics

    NARCIS (Netherlands)

    Meulenaar, J

    2013-01-01

    Capecitabine is an orally-administered chemotherapeutic agent used in the treatment of a.o. metastatic breast, gastric and colorectal cancer and is commercially available as an immediate release tablet (Xeloda®, Roche). Capecitabine is a pre-pro-drug that is enzymatically converted into 5-fluorourac

  3. Phase I study of short-time oxaliplatin, capecitabine and epirubicin (EXE) as first line therapy in patients with non-resectable gastric cancer

    DEFF Research Database (Denmark)

    Dupont, Jeanette; Jensen, Helle A; Jensen, Benny V

    2007-01-01

    A phase I trial of short-time oxaliplatin (E), capecitabine (X) and epirubicin (E) for patients with metastatic gastric cancer was initiated to establish the recommended dose for further therapy with short-time EXE. Patients received out-patient therapy with a fixed dose of epirubicin 50 mg/m2 day......-8), median survival was 9.2 months and median TTP was 7.5 months. A combination of epirubicin 50 mg/m2 day 1, capecitabine 1,000 mg/m2 continuously and oxaliplatin 130 mg/m2 day 1 each 3 weeks is an easily administered and well tolerated out-patient regimen for patients with non-resectable gastric cancer....

  4. A prospective, non-randomized phase II trial of Trastuzumab and Capecitabine in patients with HER2 expressing metastasized pancreatic cancer

    Directory of Open Access Journals (Sweden)

    Endlicher Esther

    2009-01-01

    Full Text Available Abstract Background Pancreatic cancer is the fourth most common cause of cancer related death in Western countries. Advantages in surgical techniques, radiation and chemotherapy had almost no impact on the long term survival of affected patients. Therefore, the need for better treatment strategies is urgent. HER2, a receptor tyrosine kinase of the EGFR family, involved in signal transduction pathways leading to cell growth and differentiation is overexpressed in a number of cancers, including breast and pancreatic cancer. While in breast cancer HER2 has already been successfully used as a treatment target, there are only limited data evaluating the effects of inhibiting HER2 tyrosine kinases in patients with pancreatic cancer. Methods Here we report the design of a prospective, non-randomized multi-centered Phase II clinical study evaluating the effects of the Fluoropyrimidine-carbamate Capecitabine (Xeloda ® and the monoclonal anti-HER2 antibody Trastuzumab (Herceptin® in patients with non-resectable, HER2 overexpressing pancreatic cancer. Patients eligible for the study will receive Trastuzumab infusions on day 1, 8 and 15 concomitant to the oral intake of Capecitabine from day 1 to day 14 of each three week cylce. Cycles will be repeated until tumor progression. A total of 37 patients will be enrolled with an interim analysis after 23 patients. Discussion Primary end point of the study is to determine the progression free survival after 12 weeks of bimodal treatment with the chemotherapeutic agent Capecitabine and the anti-HER2 antibody Trastuzumab. Secondary end points include patient's survival, toxicity analysis, quality of life, the correlation of HER2 overexpression and clinical response to Trastuzumab treatment and, finally, the correlation of CA19-9 plasma levels and progression free intervals.

  5. Randomized Phase III Trial of Ixabepilone Plus Capecitabine Versus Capecitabine in Patients With Metastatic Breast Cancer Previously Treated With an Anthracycline and a Taxane

    Science.gov (United States)

    Sparano, Joseph A.; Vrdoljak, Eduard; Rixe, Oliver; Xu, Binghe; Manikhas, Alexey; Medina, Carlos; Ventilari Da Costa, Susanne Crocamo; Ro, Jungsil; Rubio, Gonzalo; Rondinon, Monica; Perez Manga, Gumersindo; Peck, Ronald; Poulart, Valerie; Conte, Pierfranco

    2010-01-01

    Purpose We sought to determine whether the combination of ixabepilone plus capecitabine improved overall survival (OS) compared with capecitabine alone in patients with metastatic breast cancer (MBC) previously treated with anthracyclines and taxanes. Patients and Methods A total of 1,221 patients with MBC previously treated with anthracycline and taxanes were randomly assigned to ixabepilone (40 mg/m2 intravenously on day 1) plus capecitabine (2,000 mg/m2 orally on days 1 through 14) or capecitabine alone (2,500 mg/m2 on the same schedule) given every 21 days. The trial was powered to detect a 20% reduction in the hazard ratio (HR) for death. Results There was no significant difference in OS between the combination and capecitabine monotherapy arm, the primary end point (median, 16.4 v 15.6 months; HR = 0.9; 95% CI, 078 to 1.03; P = .1162). The arms were well balanced with the exception of a higher prevalence of impaired performance status (Karnofsky performance status 70% to 80%) in the combination arm (32% v 25%). In a secondary Cox regression analysis adjusted for performance status and other prognostic factors, OS was improved for the combination (HR = 0.85; 95% CI, 0.75 to 0.98; P = .0231). In 79% of patients with measurable disease, the combination significantly improved progression-free survival (PFS; median, 6.2 v 4.2 months; HR = 0.79; P = .0005) and response rate (43% v 29%; P < .0001). Grade 3 to 4 neuropathy occurred in 24% treated with the combination, but was reversible. Conclusion This study confirmed a previous trial demonstrating improved PFS and response for the ixabepilone-capecitabine combination compared with capecitabine alone, although this did not result in improved survival. PMID:20530276

  6. Acute myocardial infarction after capecitabine treatment: not always vasospasm is responsible

    Institute of Scientific and Technical Information of China (English)

    Tolga Sinan G(ü)venc; Emel Celiker; Kazlm Serhan (O)zcan; Erkan (I)lhan; Mehmet Eren

    2012-01-01

    Capecitabine is an orally available chemotherapeutic agent that is converted to 5-fluorouracil (5-FU) after absorbtion.Capecitabine and its active metabolite,5-FU,have cardiotoxic effects with reported instances of acute coronary syndromes caused due to coronary vasospasm.However,these agents exert toxic effects on cardiovascular system and beyond vasospasm provacation.We report a 46-year-old patient diagnosed as acute inferior infarction who is treated with capecitabine for 3 months due to metastatic breast carcinoma,in whom thrombotic coronary occlusion was observed in angiography.This case demonstrates that apart from vasospasm,coronary thrombosis could be observed after capecitabine treatment,with a possible direct effect of this drug.

  7. Evaluation of Nanocarrier Targeted Drug Delivery of Capecitabine-PAMAM Dendrimer Complex in a Mice Colorectal Cancer Model

    Directory of Open Access Journals (Sweden)

    Fatemeh Nabavizadeh

    2016-09-01

    Full Text Available Capecitabine, an effective anticancer drug in colorectal cancer chemotherapy, may create adverse side effects on healthy tissues. In the present study, we first induced colon adenocarcinoma with azoxymethane, a carcinogen agent, and then investigated the potentiality of polyamidoamine (PAMAM dendrimer to improve capecitabine therapeutic index and decrease its adverse side effects on healthy tissues like liver and bone marrow. Other variables such as nanoparticle concentrations have also been investigated. Drug loading concentration (DLC and encapsulation efficiency (EE were calculated for capecitabine/dendrimer complex. Experimental results showed an increase in DLC percentage resulted from elevated capecitabine/dendrimer ratio. Capecitabine/dendrimer complex could reduce tumor size and adverse side effects in comparison with free capecitabine form.

  8. Capecitabine versus 5-fluorouracil in colorectal cancer: where are we now?

    OpenAIRE

    Lakshmi Chintala; Susmitha Vaka; Joaquina Baranda; Williamson, Stephen K.

    2011-01-01

    Fluorouracil (5-FU) remains the most widely used agent for colorectal cancer. Capecitabine is a rationally designed 5-FU pro-drug developed to mimic the continuous infusion of 5-FU while avoiding complications and inconvenience of intravenous administration. Capecitabine is absorbed intact from the gastrointestinal tract, converted enzymatically to active 5-FU, and released directly into the tumor. Capecitabine’s efficacy and safety are shown in multiple phase III trials across different dise...

  9. Capecitabine Induced Multifocal Leukoencephalopathy: Do We Have Always to Switch off the Chemotherapy?

    Directory of Open Access Journals (Sweden)

    Anastasia Bougea

    2016-01-01

    Full Text Available Capecitabine is a well tolerated and safe 5-fluorouracil agent for adjuvant, neoadjuvant chemotherapy or metastatic cases. Neurological side effects require discontinuation of chemotherapy. We report this unique case of a 50-year-old female, who presented an isolated episode of dysarthria and ataxia under bevacizumab, capecitabine, and oxaliplatin treatment due to reversible multifocal leukoencephalopathy that did not recur after readministration of chemotherapy.

  10. Role of capecitabine in treating metastatic colorectal cancer in Chinese patients

    Directory of Open Access Journals (Sweden)

    Wang F

    2014-04-01

    Full Text Available Feng Wang,* Feng-Hua Wang,* Long Bai, Rui-Hua XuDepartment of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China *These authors contributed equally to this workAbstract: The China Food and Drug Administration approved the use of capecitabine in patients with metastatic colorectal cancer (mCRC in 2004. This paper reviews the available information of capecitabine in Chinese patients with mCRC, focusing on its effectiveness and safety against mCRC. Identification of all eligible studies was made by searching the PubMed and Wanfang database from 2000 to 2013. Published data examining various aspects of clinical response and tolerability with capecitabine alone or in combination with other chemotherapeutic or biological agents for first- and second-line mCRC were examined. Capecitabine and its combination displayed high efficacy in Chinese patients with mCRC. Toxicities are generally manageable, and elderly patients can tolerate capecitabine well.Keywords: capecitabine, metastatic colorectal cancer, Chinese

  11. Randomised phase III trial of S-1 versus capecitabine in the first-line treatment of metastatic colorectal cancer: SALTO study by the Dutch Colorectal Cancer Group.

    Science.gov (United States)

    Kwakman, J J M; Simkens, L H J; van Rooijen, J M; van de Wouw, A J; Ten Tije, A J; Creemers, G J M; Hendriks, M P; Los, M; van Alphen, R J; Polée, M B; Muller, E W; van der Velden, A M T; van Voorthuizen, T; Koopman, M; Mol, L; van Werkhoven, E; Punt, C J A

    2017-04-05

    Hand-foot syndrome (HFS) is a common side effect of capecitabine. S-1 is an oral fluoropyrimidine with comparable efficacy to capecitabine in gastrointestinal cancers but associated with a lower incidence of HFS in Asian patients. This study compares the incidence of HFS between S-1 and capecitabine as first-line treatment in Western metastatic colorectal cancer (mCRC) patients.

  12. Neoadjuvant Sandwich Treatment With Oxaliplatin and Capecitabine Administered Prior to, Concurrently With, and Following Radiation Therapy in Locally Advanced Rectal Cancer: A Prospective Phase 2 Trial

    Energy Technology Data Exchange (ETDEWEB)

    Gao, Yuan-Hong [State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou (China); Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou (China); Lin, Jun-Zhong [State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou (China); Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou (China); An, Xin [State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou (China); Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou (China); Luo, Jie-Lin [State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou (China); Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou (China); Cai, Mu-Yan [State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou (China); Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou (China); Cai, Pei-Qiang [State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou (China); Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou (China); Kong, Ling-Heng; Liu, Guo-Chen; Tang, Jing-Hua; Chen, Gong; Pan, Zhi-Zhong [State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou (China); Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou (China); Ding, Pei-Rong, E-mail: dingpr@mail.sysu.edu.cn [State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou (China); Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou (China)

    2014-12-01

    Purpose: Systemic failure remains the major challenge in management of locally advanced rectal cancer (LARC). To optimize the timing of neoadjuvant treatment and enhance systemic control, we initiated a phase 2 trial to evaluate a new strategy of neoadjuvant sandwich treatment, integrating induction chemotherapy, concurrent chemoradiation therapy, and consolidation chemotherapy. Here, we present preliminary results of this trial, reporting the tumor response, toxicities, and surgical complications. Methods and Materials: Fifty-one patients with LARC were enrolled, among which were two patients who were ineligible because of distant metastases before treatment. Patients were treated first with one cycle of induction chemotherapy consisting of oxaliplatin, 130 mg/m² on day 1, with capecitabine, 1000 mg/m² twice daily for 14 days every 3 weeks (the XELOX regimen), followed by chemoradiation therapy, 50 Gy over 5 weeks, with the modified XELOX regimen (oxaliplatin 100 mg/m²), and then with another cycle of consolidation chemotherapy with the XELOX regimen. Surgery was performed 6 to 8 weeks after completion of radiation therapy. Tumor responses, toxicities, and surgical complications were recorded. Results: All but one patent completed the planned schedule of neoadjuvant sandwich treatment. Neither life-threatening blood count decrease nor febrile neutropenia were observed. Forty-five patents underwent optimal surgery with total mesorectal excision (TME). Four patients refused surgery because of clinically complete response. There was no perioperative mortality in this cohort. Five patients (11.1%) developed postoperative complications. Among the 45 patients who underwent TME, pathologic complete response (pCR), pCR or major regression, and at least moderate regression were achieved in 19 (42.2%), 37 (82.2%), and 44 patients (97.8%), respectively. Conclusions: Preliminary results suggest that the strategy of neoadjuvant sandwich treatment using XELOX regimen

  13. Clinical Efficacy of Capecitabine and Cyclophosphamide (XC in Patients with Metastatic Breast Cancer

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    Shien,Tadahiko

    2011-08-01

    Full Text Available Combined low-dose therapy of oral capecitabine (Xeloda and cyclophosphamide (XC has been demonstrated to be useful for long-term control of lesions in patients with metastatic breast cancer (MBC and is aimed at symptomatic alleviation and prolongation of survival. Here, a retrospective review was conducted of MBC patients administered XC at the Okayama University Hospital (OUH, to evaluate responses to XC, adverse events and time to progression (TTP. Twenty patients with MBC received XC between 2006 and 2009. With the exception of 2 elderly patients who were over the age of 70 at the initial examination, all of the patients had received prior treatment with an anthracycline and/or a taxane. No complete response (CR cases were observed, but partial response (PR was achieved in 6 patients (30% and SD in 9 (45%, of whom 5 (20% sustained SD status for >12 months. The median TTP was 6 months (range:3-27 mo.. Three patients developed Grade 3 adverse events (diarrhea, nausea and stomatitis, but no other patients developed adverse reactions causing interruption of the therapy. XC was safe even in previously treated and elderly MBC patients;moreover, it yielded remarkable clinical responses.

  14. Clinical efficacy of capecitabine and cyclophosphamide (XC) in patients with metastatic breast cancer.

    Science.gov (United States)

    Shien, Tadahiko; Doihara, Hiroyoshi; Nishiyama, Keiko; Masuda, Hiroko; Nogami, Tomohiro; Ikeda, Hirokuni; Taira, Naruto

    2011-08-01

    Combined low-dose therapy of oral capecitabine (Xeloda) and cyclophosphamide (XC) has been demonstrated to be useful for long-term control of lesions in patients with metastatic breast cancer (MBC) and is aimed at symptomatic alleviation and prolongation of survival. Here, a retrospective review was conducted of MBC patients administered XC at the Okayama University Hospital (OUH), to evaluate responses to XC, adverse events and time to progression (TTP). Twenty patients with MBC received XC between 2006 and 2009. With the exception of 2 elderly patients who were over the age of 70 at the initial examination, all of the patients had received prior treatment with an anthracycline and/or a taxane. No complete response (CR) cases were observed, but partial response (PR) was achieved in 6 patients (30%) and SD in 9 (45%), of whom 5 (20%) sustained SD status for >12 months. The median TTP was 6 months (range:3-27 mo.). Three patients developed Grade 3 adverse events (diarrhea, nausea and stomatitis), but no other patients developed adverse reactions causing interruption of the therapy. XC was safe even in previously treated and elderly MBC patients;moreover, it yielded remarkable clinical responses.

  15. Neoadjuvant capecitabine combined with standard radiotherapy in patients with locally advanced rectal cancer. Mature results of a phase II trial

    Energy Technology Data Exchange (ETDEWEB)

    Dunst, J. [Dept. of Radiotherapy, Univ. of Luebeck (Germany); Debus, J. [Univ. of Heidelberg (Germany); Rudat, V. [Univ. of Hamburg (Germany); Wulf, J. [Univ. of Wuerzburg (Germany); Budach, W. [Univ. of Tuebingen (Germany); Hoelscher, T. [Technical Univ., Dresden (Germany); Reese, T. [Martin Luther Univ., Halle (Germany); Mose, S.; Roedel, C. [Univ. of Frankfurt (Germany); Zuehlke, H. [Paul Gerhard Hospital, Wittenberg (Germany); Hinke, A. [WiSP GmbH, Langenfeld (Germany)

    2008-09-15

    Purpose: the objective of this expanded phase II trial was to confirm the safety results of the preceding phase I study and establish the efficacy of neoadjuvant radiochemotherapy with capecitabine in rectal cancer in a multicenter setting. Patients and methods: 96 patients (63% male, age 34-81 years) with advanced rectal cancer (cT3-4 or cN+) from seven university centers in Germany were recruited. All were to receive a total irradiation dose of 50.4-55.8 Gy with conventional fractions. Capecitabine was given at an oral dosage of 825 mg/m{sup 2} bid on each day of the radiotherapy period with the first daily dose applied 2 h before irradiation, followed by surgery 6 weeks later. Results: most of the patients suffered from an advanced primary tumor (cT3: 57%, cT4: 40%) with lymph node involvement in 60%. After neoadjuvant treatment, with a mean of 99% of the scheduled radiation dose actually delivered, a clinical response rate of 68% (95% confidence interval: 57-78%) was observed. Out of 87 evaluable patients undergoing surgery, a sphincter-preserving procedure could be performed in 51% and RO resection in 94%. A pathologically complete response was achieved in six patients (7%, 95% confidence interval: 3-14%). The comparison of initial diagnosis and pathologic findings showed a downstaging in 61%. Acute toxicity with > 5% incidence of NCI (National Cancer Institute) grade {>=} 3 included lymphopenia (12%), leukopenia (6%), and diarrhea (7%). Mild to moderate hand-foot syndrome occurred in 12% only. After a median follow-up of 48 months, the 5-year overall survival and tumor control data were, with regard to patient selection, in the expected range with an overall survival of 65%, a relapse-free survival of 47%, and a local recurrence rate after 5 years of 17%. Conclusion: the data clearly confirm that capecitabine is an adequate substitute for 5-fluorouracil in preoperative chemoradiation of rectal cancer with a favorable safety profile. (orig.)

  16. Treatment with capecitabine + bevacizumab following induction treatment with FOLFIRI + bevacizumab in metastatic colorectal carcinoma

    Science.gov (United States)

    Tatlı, Ali Murat; Coşkun, Hasan Şenol; Uysal, Mükremin; Arslan, Deniz; Sezgin Göksu, Sema; Güenay Gündüz, Şeyda; Çakal, Selda; Bozcuk, Hakan Şat; Savaş, Burhan

    2014-01-01

    Bevacizumab is a humanized monoclonal antibody that inhibits vascular endothelial growth factor, and it has been found to increase both progression-free survival and overall survival when it is combined with chemotherapeutic agents in the first-line and subsequent treatment of metastatic colorectal carcinoma. The objective of this study was to show the efficacy of maintenance treatment with capecitabine plus bevacizumab in patients with metastatic colorectal cancer who responded to treatment with FOLFIRI plus bevacizumab. The study included patients with metastatic colorectal cancer who received FOLFIRI plus bevacizumab as a first-line treatment. Patients who had objective response with FOLFIRI plus bevacizumab treatment after an average period of 6 months received a maintenance treatment with capecitabine plus bevacizumab (capecitabine 2 x 1000 mg/m2, 1 - 14 days, every 21 days, bevacizumab 7.5 mg/m2, every 21 days) until disease progression or toxicity. The time to progression on bevacizumab treatment was evaluated. A total of 29 patients (15 male, 14 female) were included. The mean age was 62 years. The mean number of cycles for maintenance treatment with capecitabine plus bevacizumab was 12. The median PFS was 16 ± 3 months, and OS was 42 ± 11 months. PFS and OS were remarkably higher in patients with a complete or near complete response to induction treatment. Fourteen patients (48%) experienced hand-foot syndrome associated with capecitabine plus bevacizumab treatment, without any severe toxicity. Inselected patients with metastatic colorectal carcinoma who had a remarkable objective response to FOLFIRI plus bevacizumab treatment, a maintenance treatment with capecitabine plus bevacizumab following FOLFIRI plus bevacizumab until disease progression may be a suitable, effective and tolerable regimen, which requires further studies. PMID:25232406

  17. Phenytoin toxicity due to fluoropyrimidines (5FU/capecitabine): three case reports.

    Science.gov (United States)

    Brickell, K; Porter, D; Thompson, P

    2003-08-18

    Interactions between phenytoin and the fluoropyrimidine derivatives, 5 fluorouracil (5FU) and capecitabine, are not commonly documented or widely recognised. As more people with significant medical comorbidities are now being considered for chemotherapy, it is increasingly likely that people receiving phenytoin will be prescribed treatment with fluoropyrimidines. We present two cases of clinical phenytoin toxicity occurring after starting treatment with 5-fluorouracil/folinic acid (5FU/FA) and a third who developed clinical phenytoin toxicity after starting capecitabine (an orally administered prodrug of fluorouracil).

  18. Predictive value of MSH2 gene expression in colorectal cancer treated with capecitabine

    DEFF Research Database (Denmark)

    Jensen, Lars H; Danenberg, Kathleen D; Danenberg, Peter V;

    2007-01-01

    was associated with a hazard ratio of 0.5 (95% confidence interval, 0.23-1.11; P = 0.083) in survival analysis. CONCLUSION: The higher gene expression of MSH2 in responders and the trend for predicting overall survival indicates a predictive value of this marker in the treatment of advanced CRC with capecitabine.......PURPOSE: The objective of the present study was to evaluate the gene expression of the DNA mismatch repair gene MSH2 as a predictive marker in advanced colorectal cancer (CRC) treated with first-line capecitabine. PATIENTS AND METHODS: Microdissection of paraffin-embedded tumor tissue, RNA...

  19. The use of capecitabine in daily practice: a study on adherence and patients' experiences

    Directory of Open Access Journals (Sweden)

    Timmers L

    2012-10-01

    Full Text Available Lonneke Timmers,1 Eleonora L Swart,1 Christel CLM Boons,1 Dirk Mangnus,1 Peter M van de Ven,2 Godefridus J Peters,3 Epie Boven,3 Jacqueline G Hugtenburg11Department of Clinical Pharmacology and Pharmacy, 2Department of Epidemiology and Biostatistics, 3Department of Medical Oncology, VU University Medical Center, Amsterdam, The NetherlandsBackground: Adherence to pharmacological therapy is a complex and multifactorial issue that can substantially alter the outcome of treatment. Especially when using long-term medication, cancer patients have adherence rates similar to those of patients with other diseases. The consequences of poor adherence are poor health outcomes and increased health care costs. Only few studies have focused on the use of oral anticancer agents in daily practice. Information about the reasons for nonadherence is essential for the development of interventions that may improve adherence. This report presents the CAPER-capecitabine protocol, which is designed to study the adherence to capecitabine and the influence of patient attitudes towards medication and self-reported side effects. Furthermore, the relationships between patient characteristics, disease characteristics, side effects, quality of life, patient beliefs and attitudes towards disease and medication, dose adjustments, reasons for discontinuation, and plasma concentration of three of the main metabolites, including the active compound 5-fluorouracil, will be explored.Methods: In this multicenter, prospective, observational cohort study, 90 patients aged 18 years or older starting treatment with capecitabine will be included and followed for a period up to five cycles. The main study parameters are adherence, patient attitudes towards medication, and the number and grade of patient-reported side effects. At baseline and during week 2 of cycles 1, 3 and 5, patients will be asked to donate blood and fill out a questionnaire. Blood samples will be analyzed for plasma

  20. Variants in CDA and ABCB1 are predictors of capecitabine-related adverse reactions in colorectal cancer

    Science.gov (United States)

    García, María I.; García-Alfonso, Pilar; Robles, Luis; Grávalos, Cristina; González-Haba, Eva; Marta, Pellicer; Sanjurjo, María; López-Fernández, Luis A.

    2015-01-01

    Adverse reactions to capecitabine-based chemotherapy limit full administration of cytotoxic agents. Likewise, genetic variations associated with capecitabine-related adverse reactions are associated with controversial results and a low predictive value. Thus, more evidence on the role of these variations is needed. We evaluated the association between nine polymorphisms in MTHFR, CDA, TYMS, ABCB1, and ENOSF1 and adverse reactions, dose reductions, treatment delays, and overall toxicity in 239 colorectal cancer patients treated with capecitabine-based regimens. The ABCB1*1 haplotype was associated with a high risk of delay in administration or reduction in the dose of capecitabine, diarrhea, and overall toxicity. CDA rs2072671 A was associated with a high risk of overall toxicity. TYMS rs45445694 was associated with a high risk of delay in administration or reduction in the dose of capecitabine, HFS >1 and HFS >2. Finally, ENOSF1 rs2612091 was associated with HFS >1, but was a poorer predictor than TYMS rs45445694. A score based on ABCB1-CDA polymorphisms efficiently predicts patients at high risk of severe overall toxicity (PPV, 54%; sensitivity, 43%) in colorectal cancer patients treated with regimens containing capecitabine. Polymorphisms in ABCB1, CDA, ENOSF1,and TYMS could help to predict specific and overall severe adverse reactions to capecitabine. PMID:25691056

  1. A Phase I Study of EKB-569 in Combination with Capecitabine in Patients with Advanced Colorectal Cancer

    Science.gov (United States)

    Laheru, Dan; Croghan, Gary; Bukowski, Ronald; Rudek, Michelle; Messersmith, Wells; Erlichman, Charles; Pelley, Robert; Jimeno, Antonio; Donehower, Ross; Boni, Joseph; Abbas, Richat; Martins, Patricia; Zacharchuk, Charles; Hidalgo, Manuel

    2011-01-01

    Purpose To determine the maximum tolerated dose (MTD), characterize the principal toxicities, and assess the pharmacokinetics of EKB-569, an oral selective irreversible inhibitor of the epidermal growth factor receptor tyrosine kinase, in combination with capecitabine in patients with advanced colorectal cancer. Experimental Design Patients were treated with EKB-569 daily for 21days and capecitabine twice daily for14 days of a 21-day cycle. The dose levels of EKB-569 (mg/day) and capecitabine (mg/m2 twice daily) assessed were 25/750, 50/750, 50/1,000 and 75/1,000. An expanded cohort was enrolled at the MTD to better study toxicity and efficacy. Samples of plasma were collected to characterize the pharmacokinetics of the agents. Treatment efficacy was assessed every other cycle. Results A total of 37 patients, the majority of whom had prior chemotherapy, received a total of 163 cycles of treatment. Twenty patients were treated at the MTD, 50 mg EKB-569, daily and 1,000 mg/m2 capecitabine twice daily. Dose-limiting toxicities were diarrhea and rash. No patients had complete or partial responses but 48% had stable disease. The conversion of capecitabine to 5-fluorouracil was higher for the combination of EKB-569 and capecitabine (321 ± 151 ng*h/mL) than for capecitabine alone (176 ± 62 ng*hours/mL; P = 0.0037). Conclusion In advanced colorectal cancer, 50 mg EKB-569 daily can be safely combined with 1,000 mg/m2 capecitabine twice a day. A statistically significant increase in plasma levels of 5-fluorouracil for the combination of EKB-569 and capecitabine may be due to the single-dose versus multiple-dose exposure difference, variability in exposure or a potential drug interaction. PMID:18765554

  2. Long-Term Survival on Capecitabine in Two Gemcitabine Refractory Pancreatic Cancer Patients. Is there a Pharmacogenetic Explanation?

    Directory of Open Access Journals (Sweden)

    Muhammad Wasif Saif

    2007-11-01

    Full Text Available Context Capecitabine has shown efficacy in treatment of metastatic pancreatic cancer. Several researchers have identified thymidine phosphorylase, dihydropyrimidine dehydrogenase, or their ratio as indicators of response to capecitabine in various cancers. Case report We report two patients with metastatic pancreatic carcinoma who had long-term survivals on capecitabine after gemcitabine failure. These two cases prompted us to measure thymidine phosphorylase and dihydropyrimidine dehydrogenase levels to facilitate discourses regarding their relationship with efficacy of capecitabine. We also describe a novel method of measuring thymidine phosphorylase level from serum without an invasive tissue biopsy. One patient is alive as of today, with improved performance status, 50 months after capecitabine was started. CA 19-9 and CT scans remained stable during 57 cycles. Her thymidine phosphorylase level was 1.77 compared to a control level of 1.00. Dihydropyrimidine dehydrogenase level was 4.14 compared to a control level of 1.00. Their ratio was 0.43. The other patient was alive on capecitabine for 24 months. His performance status, bilirubin, AST, and ALT improved on capecitabine. CT scans and CA 19-9 remained stable during this period. He had thymidine phosphorylase level of 5.56, dihydropyrimidine dehydrogenase level of 2.74, and their ratio of 2.03. Conclusion Capecitabine resulted in long term survivals in two patients with metastatic pancreatic cancer after gemcitabine failure. The use of capecitabine as second-line treatment in metastatic pancreatic cancer should be further explored along with the role of thymidine phosphorylase and dihydropyrimidine dehydrogenase levels in its activity. A non-invasive method of thymidine phosphorylase measurement we described should be validated in larger trials.

  3. Capecitabine and bevacizumab in heavily pre-treated patients with advanced colorectal cancer

    DEFF Research Database (Denmark)

    Larsen, Finn Ole; Boisen, Mogens Karsbøl; Fromm, Anne-Lene Gunge

    2012-01-01

    No standard treatment exists for patients with metastatic colorectal cancer who have progressed after treatment with 5-fluorouracil (5-FU), oxaliplatin, irinotecan and an anti-EGFR antibody. The efficacy and safety of bevacizumab and capecitabine in heavily pre-treated patients with metastatic...

  4. DPD is a molecular determinant of capecitabine efficacy in colorectal cancer

    DEFF Research Database (Denmark)

    Vallböhmer, Daniel; Yang, Dong Yun; Kuramochi, Hidekazu

    2007-01-01

    Capecitabine is a fluoropyrimidine-based drug that offers physicians a more convenient treatment for advanced colorectal cancer (CRC), with manageable toxicity and antitumor activity comparable to that of continuous-infusion therapies with 5-fluorouracil (5-FU). However, there are no validated...

  5. 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

    2015-01-01

    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.

  6. Capecitabine and Oxaliplatin Before, During, and After Radiotherapy for High-Risk Rectal Cancer

    DEFF Research Database (Denmark)

    Larsen, Finn Ole; Markussen, Alice; Jensen, Benny V

    2016-01-01

    PURPOSE: To evaluate the effect of capecitabine and oxaliplatin before, during, and after radiotherapy for high-risk rectal cancer. PATIENTS AND METHODS: Patients with rectum cancer T4 or T3 involving the mesorectal fascia was included in a prospective phase 2 trial. Liver or lung metastases were...

  7. Capecitabine and oxaliplatin as second-line treatment in patients with carcinoma of unknown primary site

    DEFF Research Database (Denmark)

    Møller, Anne Kirstine Hundahl; Pedersen, Karen Damgaard; Abildgaard, Julie Rafn;

    2010-01-01

    tumours may be overrepresented. These patients could be candidates for GI tract-directed therapy. We here report the results obtained with oxaliplatin and capecitabine as second-line therapy in 25 recurrent/refractory CUP patients following first-line treatment with paclitaxel, cisplatin and gemcitabine....

  8. Clinical pharmacokinetic/pharmacodynamic and physiologically based pharmacokinetic modeling in new drug development: the capecitabine experience.

    Science.gov (United States)

    Blesch, Karen S; Gieschke, Ronald; Tsukamoto, Yuko; Reigner, Bruno G; Burger, Hans U; Steimer, Jean-Louis

    2003-05-01

    Preclinical studies, along with Phase I, II, and III clinical trials demonstrate the pharmacokinetics, pharmacodynamics, safety and efficacy of a new drug under well controlled circumstances in relatively homogeneous populations. However, these types of studies generally do not answer important questions about variability in specific factors that predict pharmacokinetic and pharmacodynamic (PKPD) activity, in turn affecting safety and efficacy. Semi-physiological and clinical PKPD modeling and simulation offer the possibility of utilizing data obtained in the laboratory and the clinic to make accurate characterizations and predictions of PKPD activity in the target population, based on variability in predictive factors. Capecitabine is an orally administered pro-drug of 5-fluorouracil (5-FU), designed to exploit tissue-specific differences in metabolic enzyme activities in order to enhance efficacy and safety. It undergoes extensive metabolism in multiple physiologic compartments, and presents particular challenges for predicting pharmacokinetic and pharmacodynamic activity in humans. Clinical and physiologically based pharmacokinetic (PBPK) and pharmacodynamic models were developed to characterize the activity of capecitabine and its metabolites, and the clinical consequences under varying physiological conditions such as creatinine clearance or activity of key metabolic enzymes. The results of the modeling investigations were consistent with capecitabine's rational design as a triple pro-drug of 5-FU. This paper reviews and discusses the PKPD and PBPK modeling approaches used in capecitabine development to provide a more thorough understanding of what the key predictors of its PBPK activity are, and how variability in these predictors may affect its PKPD, and ultimately, clinical outcomes.

  9. Phase I Study of Capecitabine, Oxaliplatin, Bevacizumab, and Everolimus in Advanced Solid Tumors

    Science.gov (United States)

    Rangwala, F.; Bendell, J.; Kozloff, M.; Arrowood, C.; Dellinger, A.; Meadows, J.; Tourt-Uhlig, S.; Murphy, J.; Meadows, K.L.; Starr, A.; Broderick, S.; Brady, J.C.; Cushman, S. M.; Morse, M.; Uronis, H.; Hsu, S.D.; Zafar, S.Y.; Wallace, J.; Starodub, A.; Strickler, J.; Pang, H.; Nixon, A.B.; Hurwitz, H.

    2014-01-01

    Purpose To define maximum tolerated dose (MTD), toxicities, and pharmacodynamics of capecitabine, oxaliplatin, bevacizumab, and everolimus in advanced solid tumor patients. Design This was a standard “3+3” dose-escalation trial. All subjects received bevacizumab 7.5mg/kg on day one of each cycle. Doses for capecitabine, oxaliplatin and everolimus were modified per dose limiting toxicity (DLT). Baseline and on-treatment plasma biomarkers were analyzed. Archived tumor mRNA levels were evaluated for NRP1, NRP2 and VEGF-A isoforms. Results Twenty-nine patients were evaluable for toxicity and 30 for efficacy. Two DLTs were observed in cohort 1 and one DLT each was observed in cohort -1 and -1b. Grade ≥3 toxicities included neutropenia, hypertension, perforation/fistula/hemorrhage, hypertriglyceridemia, diarrhea, and thromboembolism. Twelve subjects experienced partial response (PR); 12 had stable disease as best response. Three of seven chemorefractory metastatic colorectal cancer (mCRC) subjects experienced PR; eight of 15 chemonaive mCRC subjects experienced PR. Plasma TβRIII and IL-6 increased on treatment but without correlation to outcome. Increased VEGF165 levels significantly correlated with longer progression free survival. Conclusions Everolimus with full dose capecitabine, oxaliplatin, and bevacizumab had unacceptable toxicity. MTD was: everolimus 5mg daily; capecitabine 680mg/m2 BID days 1-14; oxaliplatin 100mg/m2 and bevacizumab 7.5mg/kg, day one. Activity was noted in mCRC. PMID:24711126

  10. Metronomic capecitabine in gastroenteropancreatic neuroendrocrine tumors: a suitable regimen and review of the literature

    Directory of Open Access Journals (Sweden)

    Bongiovanni A

    2014-10-01

    Full Text Available Alberto Bongiovanni,1 Nada Riva,1 Sebastiano Calpona,1 Marianna Ricci,1 Erica Gunelli,1 Chiara Liverani,1 Federico La Manna,1 Alessandro De Vita,1 Manuela Monti,1 Stefano Severi,2 Federica Pieri,3 Elena Amadori,1 Riccardo Galassi,1 Davide Cavaliere,4 Alberto Zaccaroni,5 Andreas Tartaglia,6 Veronica Lunedei,7 Andrea Gardini,8 Laura Mercatali,1 Dino Amadori,1 Toni Ibrahim11Osteoncology and Rare Tumors Center, 2Nuclear Medicine Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST IRCCS, Meldola, 3Pathology Unit, 4Unit of Oncological Surgery and Advanced Therapies, 5Endocrine Surgery Unit, 6Endocrinology Unit, 7Gastroenterology and Digestive Endoscopy Unit, 8Department of General Surgery, Morgagni-Pierantoni Hospital, Forlì, ItalyBackground: We present a retrospective analysis of metronomic capecitabine in metastatic gastroenteropancreatic neuroendrocrine tumors (GEP-NETs. A review of the literature is also presented.Methods: From January 2007 to December 2013, ten patients with metastatic GEP-NETs (four pancreatic and six ileal who progressed after treatment with somatostatin analogs and other cytotoxic agents received oral capecitabine 1,500 mg/day continuously. The median patient age was 68 (range 29–82 years. The median treatment duration was 8 months.Results: Five (50% patients achieved a partial radiographic response, four (40% showed stable disease, and one (10% progressed. Median overall survival was 56 months. Three of the four pancreatic patients achieved a partial radiographic response that lasted for a median of 15.5 months; overall survival and progression-free survival in this subgroup was 58 and 6 months, respectively.Conclusion: Data in the literature show that capecitabine has only occasionally been used as a single agent, with increased toxicity. Only one study using single-agent capecitabine reported a progression-free survival of 9.9 months and overall survival of 36.5 months, without an objective

  11. Are capecitabine and the active metabolite 5-Fu CNS penetrable to treat breast cancer brain metastasis?

    Science.gov (United States)

    Zhang, Jinqiang; Zhang, Lingli; Yan, Yumei; Li, Shaorong; Xie, Liang; Zhong, Wei; Lv, Jing; Zhang, Xiuhua; Bai, Yu; Cheng, Ziqiang

    2015-03-01

    Brain metastasis (BM) is increasingly diagnosed in Her2 positive breast cancer (BC) patients. Lack of effective treatment to breast cancer brain metastases (BCBMs) is probably due to inability of the current therapeutic agents to cross the blood-brain barrier. The central nervous system (CNS) response rate in BCBM patients was reported to improve from 2.6%-6% (lapatinib) to 20%-65% (lapatinib in combination with capecitabine). Lapatinib is a poor brain penetrant. In this study, we evaluated the CNS penetration of capecitabine and hoped to interpret the mechanism of the improved CNS response from the pharmacokinetic (PK) perspective. Capecitabine does not have antiproliferative activity and 5-fluorouracil (5-FU) is the active metabolite. Capecitabine was orally administered to mouse returning an unbound brain-to-blood ratio (Kp,uu,brain) at 0.13 and cerebrospinal fluid (CSF)-to-unbound blood ratio (Kp,uu,CSF) at 0.29 for 5-FU. Neither free brain nor CSF concentration of 5-FU can achieve antiproliferative concentration for 50% of maximal inhibition of cell proliferation of 4.57 µM. BCBM mice were treated with capecitabine monotherapy or in combination with lapatinib. The Kp,uu,brain value of 5-FU increased to 0.17 in the brain tumor in the presence of lapatinib, which is still far below unity. The calculated free concentration of 5-FU and lapatinib in the brain tumor did not reach the antiproliferative potency and neither treatment showed antitumor activity in the BCBM mice. The CNS penetration of 5-FU in human was predicted based on the penetration in preclinical brain tumor, CSF, and human PK and the predicted free CNS concentration was below the antiproliferative potency. These results suggest that CNS penetration of 5-FU and lapatinib are not desirable and development of a true CNS penetrable therapeutic agent will further improve the response rate for BCBM.

  12. Intrahepatic and systemic therapy with oxaliplatin combined with capecitabine in patients with hepatic metastases from breast cancer

    DEFF Research Database (Denmark)

    Nielsen, D L; Nørgaard, H; Weber Vestermark, Lene;

    2012-01-01

    The aim was to evaluate activity and toxicity of hepatic arterial infusion of oxaliplatin in combination with capecitabine in patients with metastatic breast cancer with liver metastases and limited extrahepatic disease....

  13. Contribution of capecitabine for therapy of patients with gastroesophageal cancer: an update of recent phase III results

    Directory of Open Access Journals (Sweden)

    Putao Cen

    2008-03-01

    Full Text Available Putao Cen, Eric D Tetzlaff, Jaffer A AjaniDepartment of Gastrointestinal Medical Oncology in the Division of Cancer Medicine at the University of Texas MD Anderson Cancer Center, Houston, TX, USABackground: Capecitabine, an orally administered fluoropyrimidines, is widely used in the treatment of multiple malignancies. It has been extensively evaluated in patients with gastroesophageal carcinoma. Since recent reviews have discussed phase I/II trials (Cancer 107:221–231, 2006; Drugs 67:601–610, 2007, we focus on the impact of the results of the most current phase III trials using capectiabine in the treatment of advanced gastroesophageal cancers, primarily in the first-line setting.Methods: To find published phase III trials, Medline was searched for English-language clinical trials published from 1996 through June 2007 along with relevant abstracts presented at the American Society of Clinical Oncology, and meetings of the European Cancer Conference and European Society of Medical Oncology. Only representative trials were chosen for this manuscript.Results: The most frequently investigated combinations are capecitabine with taxanes, platinols, and camptothecins. Recent results of a large phase III trial (REAL-2 in untreated patients with gastroesophageal cancer suggest that capecitabine is a non-inferior substitute for intravenous 5-fluorouracil. These results of REAL-2 trial are substantiated by a smaller phase III trial. Previous analysis of multiple trials had suggested that capecitabine, when combined in doses lower than 1250 mg/m2 twice daily, consistently resulted in lower frequency of Grade 3 or 4 toxic effects.Conclusions: Capecitabine provides much needed convenience to patients with gastroesophageal cancer. The recent data derived from two phase III trials confirm that capecitabine is a suitable substitute for intravenous 5-fluorouracil in patients whose swallowing is not greatly affected. Capecitabine remains a subject of further

  14. Preliminary results of capecitabine metronomic chemotherapy in operable triple-negative breast cancer after standard adjuvant therapy – A single-arm phase II study

    Directory of Open Access Journals (Sweden)

    Hanan Shawky

    2014-12-01

    Conclusion: One year of capecitabine metronomic therapy preceded by standard adjuvant chemotherapy, is active and well-tolerated in TNBC patients previously treated with standard adjuvant chemotherapy.

  15. Profile of capecitabine/temozolomide combination in the treatment of well-differentiated neuroendocrine tumors

    Science.gov (United States)

    Kotteas, Elias A; Syrigos, Konstantinos N; Saif, Muhammad Wasif

    2016-01-01

    Neuroendocrine tumors are a rare and heterogeneous group of tumors with a variety of primary origins and variable aggressiveness. Platinum-based chemotherapy has been the cornerstone of treatment for the poorly differentiated tumors. However, well-differentiated neuroendocrine tumors are quite chemoresistant and therapy options are limited. Octreotide analogs and tyrosine kinase inhibitors are widely acceptable treatments due to substantial efficacy and tolerable toxicity. On the contrary, monotherapy or combinations of the only approved cytotoxic agent streptozocin with other drugs have been almost abandoned because of excessive toxic events. In recent years, the combination of capecitabine and temozolomide has emerged as the most promising and efficacious treatment. The oral route of administration and the substantial improvement in the outcomes with manageable toxicity are the major advantages. We reviewed the current literature and presented the profile of the capecitabine/temozolomide combination in the management of well-differentiated neuroendocrine tumors. PMID:26929640

  16. Preparation and Characterization of a Gastric Floating Dosage Form of Capecitabine

    OpenAIRE

    Taghizadeh Davoudi, Ehsan; Ibrahim Noordin,Mohamed; Ali KADIVAR; Kamalidehghan, Behnam; Farjam, Abdoreza Soleimani; Akbari Javar, Hamid

    2013-01-01

    Gastrointestinal disturbances, such as nausea and vomiting, are considered amongst the main adverse effects associated with oral anticancer drugs due to their fast release in the gastrointestinal tract (GIT). Sustained release formulations with proper release profiles can overcome some side effects of conventional formulations. The current study was designed to prepare sustained release tablets of Capecitabine, which is approved by the Food and Drug Administration (FDA) for the treatment of a...

  17. Capecitabine Maintenance Therapy after First-Line Chemotherapy in Patients with Metastatic Colorectal Cancer

    Institute of Scientific and Technical Information of China (English)

    Yan Li; Jing Li; Ming Lu; Xi-cheng Wang; Lin Shen

    2010-01-01

    Objective:To evaluate the efficacy and toxicity of capecitabine maintenance therapy in metastatic colorectal cancer(mCRC)patients.Methods:From June 2001 to November 2006,after they had achieved clinical response from first-line chemotherapy,patients with mCRC in our hospital received two different treatment strategies.Thirty-three patients non-maintenance group did not receive any further chemotherapy.Results:Patients in maintenance group and non-maintenance group both received FOLFOX,FOLFIRI and XELOX as first-line therapy.The median chemotherapy cycles the two groups received were the same(6 vs 6).The response rates of first-line chemotherapy were 33.3% in maintenance group and 32.7% in non-maintenance group.Patients in maintenance group received 3-9 cycles of capecitabine therapy(median cycle 4).29/33(87.9%)patients in maintenance group and 47/52(90.4%)in non-maintenance group received following second-line chemotherapy,and no patients underwent targeted therapy.The median survival time and TTP were 40.4 months(95%CI:24.2-56.6)and 9.0 months(95%CI:6.7-11.3)in maintenance group,as compared with 21.5 months(95%CI:14.9-28.0,P=0.015)and 6.5 months(95%CI:4.4-8.5,P=0.007)in non-maintenance group.No severe adverse event was observed in the capecitabine maintenance group.Conclusion:mCRC patients could benefit from capecitabine maintenance therapy by prolonging survival time and TTP.

  18. Preoperative Radiation Therapy With Concurrent Capecitabine, Bevacizumab, and Erlotinib for Rectal Cancer: A Phase 1 Trial

    Energy Technology Data Exchange (ETDEWEB)

    Das, Prajnan, E-mail: PrajDas@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Eng, Cathy [Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Rodriguez-Bigas, Miguel A.; Chang, George J.; Skibber, John M.; You, Y. Nancy [Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Maru, Dipen M. [Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Munsell, Mark F. [Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Clemons, Marilyn V. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Kopetz, Scott E.; Garrett, Christopher R.; Shureiqi, Imad [Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Delclos, Marc E.; Krishnan, Sunil; Crane, Christopher H. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2014-02-01

    Purpose: The goal of this phase 1 trial was to determine the maximum tolerated dose (MTD) of concurrent capecitabine, bevacizumab, and erlotinib with preoperative radiation therapy for rectal cancer. Methods and Materials: Patients with clinical stage II to III rectal adenocarcinoma, within 12 cm from the anal verge, were treated in 4 escalating dose levels, using the continual reassessment method. Patients received preoperative radiation therapy with concurrent bevacizumab (5 mg/kg intravenously every 2 weeks), erlotinib, and capecitabine. Capecitabine dose was increased from 650 mg/m{sup 2} to 825 mg/m{sup 2} orally twice daily on the days of radiation therapy; erlotinib dose was increased from 50 mg orally daily in weeks 1 to 3, to 50 mg daily in weeks 1 to 6, to 100 mg daily in weeks 1 to 6. Patients underwent surgery at least 9 weeks after the last dose of bevacizumab. Results: A total of 19 patients were enrolled, and 18 patients were considered evaluable. No patient had grade 4 acute toxicity, and 1 patient had grade 3 acute toxicity (hypertension). The MTD was not reached. All 18 evaluable patients underwent surgery, with low anterior resection in 7 (39%), proctectomy with coloanal anastomosis in 4 patients (22%), posterior pelvic exenteration in 1 (6%), and abdominoperineal resection in 6 (33%). Of the 18 patients, 8 (44%) had pathologic complete response, and 1 had complete response of the primary tumor with positive nodes. Three patients (17%) had grade 3 postoperative complications (ileus, small bowel obstruction, and infection). With a median follow-up of 34 months, 1 patient developed distant metastasis, and no patient had local recurrence or died. The 3-year disease-free survival was 94%. Conclusions: The combination of preoperative radiation therapy with concurrent capecitabine, bevacizumab, and erlotinib was well tolerated. The pathologic complete response rate appears promising and may warrant further investigation.

  19. In vivo monitoring of capecitabine metabolism in human liver by 19fluorine magnetic resonance spectroscopy at 1.5 and 3 Tesla field strength.

    NARCIS (Netherlands)

    Laarhoven, H.W.M. van; Klomp, D.W.J.; Kamm, Y.J.L.; Punt, C.J.A.; Heerschap, A.

    2003-01-01

    In metastatic colorectal cancer the oral 5-fluorouracil (5FU) prodrug capecitabine is used with increasing frequency as an alternative to i.v. 5FU administration. The rate of conversion of capecitabine into 5'deoxy-5-fluorouridine has been related to tumor response, and 5FU catabolites have been ass

  20. Safety, pharmacokinetics, and pharmacodynamics of the DR5 antibody LBY135 alone and in combination with capecitabine in patients with advanced solid tumors

    NARCIS (Netherlands)

    Sharma, Sunil; de Vries, Elisabeth G. E.; Infante, Jeffrey R.; Oldenhuis, Corina N.; Gietema, Jourik A.; Yang, Lin; Bilic, Sanela; Parker, Katie; Goldbrunner, Michael; Scott, Jeffrey W.; Burris, Howard A.

    2014-01-01

    Purpose We evaluated the safety, maximum tolerated dose (MTD), pharmacokinetics, pharmacodynamics, biologic activity, and antitumor efficacy of the DR5 antibody, LBY135 +/- capecitabine. Experimental design Escalating LBY135 was administered every 21 days, alone (Arm1) or with capecitabine (Arm2), t

  1. Capecitabine, alone and in combination, in the management of patients with colorectal cancer: a review of the evidence.

    Science.gov (United States)

    Comella, Pasquale; Casaretti, Rossana; Sandomenico, Claudia; Avallone, Antonio; Franco, Luca

    2008-01-01

    Capecitabine, an oral prodrug of fluorouracil (5FU), has shown efficacy in terms of progression-free and overall survival at least equivalent to standard folinic acid (leucovorin)-modulated intravenous 5FU bolus regimens in patients with metastatic colorectal cancer. Moreover, capecitabine has demonstrated a better tolerability profile, producing a significantly lower occurrence of severe stomatitis than 5FU plus folinic acid regimens, making this drug particularly attractive for treating elderly patients. In addition, capecitabine can be combined with other active drugs such as irinotecan or oxaliplatin. Indeed, the combination of capecitabine plus oxaliplatin (XELOX regimen) now represents a new standard of care for the metastatic disease and is also under evaluation in the adjuvant setting. The combination of new biological drugs, such as bevacizumab, with the XELOX regimen was shown to further prolong the time to progression of metastatic disease, and might reduce the risk of recurrence for those with resected colon cancer with poor risk factors. Cost-effectiveness analyses have demonstrated that, despite higher acquisition costs, capecitabine appears to be more cost effective than standard treatments for the management of colorectal cancer patients.

  2. A GINECO randomized phase II trial of two capecitabine and weekly paclitaxel schedules in metastatic breast cancer.

    Science.gov (United States)

    Lortholary, Alain; Hardy-Bessard, Anne-Claire; Bachelot, Thomas; de Rauglaudre, Gaëtan; Alexandre, Jérôme; Bourgeois, Hugues; Jaubert, Dominique; Paraiso, Désiré; Largillier, Rémy

    2012-01-01

    To determine whether capecitabine schedule adaptation improves the tolerability of capecitabine-paclitaxel combination therapy for metastatic breast cancer (MBC), patients with anthracycline-pretreated HER2-negative MBC were randomized to either arm A (21-day cycles: capecitabine 1,000 mg/m(2) twice daily, days 1-14; paclitaxel 60 mg/m(2), days 1, 8, and 15) or arm B (28-day cycles: capecitabine 1,000 mg/m(2) twice daily, days 1-5, 8-12, and 15-19; paclitaxel 80 mg/m(2), days 1, 8, and 15). The primary endpoint was the incidence of dose reductions or delays >1 week for grade 3/4 toxicity. Secondary endpoints were efficacy and safety. All 130 randomized patients were evaluable for safety. Dose reduction or delay for grade 3/4 toxicity occurred in 39% of patients in arm A and 34% in arm B during cycles 1-6. In arm A, there were significantly more toxicity-related dose reductions (cycles 1-6: 82 vs. 67%, respectively; P = 0.05) and discontinuations (29 vs. 8%, respectively). Grade 3 diarrhea occurred in 12 and 0%, respectively, and grade 3 hand-foot syndrome in 12 versus 9%, respectively (grade 4 not applicable). There were no detectable differences in efficacy. Weekday capecitabine dosing with weekly paclitaxel may improve tolerability without a detrimental effect on efficacy, and merits further evaluation in patients suited to combination chemotherapy.

  3. Efficacy Endpoints of Radiation Therapy Group Protocol 0247: A Randomized, Phase 2 Study of Neoadjuvant Radiation Therapy Plus Concurrent Capecitabine and Irinotecan or Capecitabine and Oxaliplatin for Patients With Locally Advanced Rectal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Wong, Stuart J. [Medical College of Wisconsin, Madison, Wisconsin (United States); Moughan, Jennifer [Radiation Therapy Oncology Group Statistical Center, Philadelphia, Pennsylvania (United States); Meropol, Neal J., E-mail: Neal.Meropol@case.edu [University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio (United States); Anne, Pramila Rani [Department of Radiation Oncology and Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (United States); Kachnic, Lisa A. [Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts (United States); Rashid, Asif [Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Watson, James C. [Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (United States); Mitchell, Edith P. [Department of Radiation Oncology and Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (United States); Pollock, Jondavid [The Schiffler Cancer Center, Wheeling, West Virginia (United States); Lee, R. Jeffrey [Intermountain Medical Center, Murray, Utah (United States); Haddock, Michael [Division of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Erickson, Beth A. [Medical College of Wisconsin, Madison, Wisconsin (United States); Willett, Christopher G. [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States)

    2015-01-01

    Purpose: To report secondary efficacy endpoints of Radiation Therapy Oncology Group protocol 0247, primary endpoint analysis of which demonstrated that preoperative radiation therapy (RT) with capecitabine plus oxaliplatin achieved a pathologic complete remission prespecified threshold (21%) to merit further study, whereas RT with capecitabine plus irinotecan did not (10%). Methods and Materials: A randomized, phase 2 trial evaluated preoperative RT (50.4 Gy in 1.8-Gy fractions) with 2 concurrent chemotherapy regimens: (1) capecitabine (1200 mg/m{sup 2}/d Monday-Friday) plus irinotecan (50 mg/m{sup 2}/wk × 4); and (2) capecitabine (1650 mg/m{sup 2}/d Monday-Friday) plus oxaliplatin (50 mg/m{sup 2}/wk × 5) for clinical T3 or T4 rectal cancer. Surgery was performed 4 to 8 weeks after chemoradiation, then 4 to 6 weeks later, adjuvant chemotherapy (oxaliplatin 85 mg/m{sup 2}; leucovorin 400 mg/m{sup 2}; 5-fluorouracil 400 mg/m{sup 2}; 5-fluorouracil 2400 mg/m{sup 2}) every 2 weeks × 9. Disease-free survival (DFS) and overall survival (OS) were estimated univariately by the Kaplan-Meier method. Local–regional failure (LRF), distant failure (DF), and second primary failure (SP) were estimated by the cumulative incidence method. No statistical comparisons were made between arms because each was evaluated individually. Results: A total of 104 patients (median age, 57 years) were treated; characteristics were similar for both arms. Median follow-up for RT with capecitabine/irinotecan arm was 3.77 years and for RT with capecitabine/oxaliplatin arm was 3.97 years. Four-year DFS, OS, LRF, DF, and SP estimates for capecitabine/irinotecan arm were 68%, 85%, 16%, 24%, and 2%, respectively. The 4-year DFS, OS, LRF, DF, and SP failure estimates for capecitabine/oxaliplatin arm were 62%, 75%, 18%, 30%, and 6%, respectively. Conclusions: Efficacy results for both arms are similar to other reported studies but suggest that pathologic complete remission is an

  4. An unusual case of capecitabine hyperpigmentation: Is hyperpigmentation a part of hand-foot syndrome or a separate entity?

    Directory of Open Access Journals (Sweden)

    Vasudevan Biju

    2010-01-01

    Full Text Available A 59-year-old man with adenocarcinoma of stomach was prescribed capecitabine as adjuvant chemotherapy. After two cycles of therapy, patient developed hyperpigmentation on hands and feet. Examination revealed a peculiar distribution of hyperpigmentation on hands and feet and in addition, hyperpigmented spots on the dorsum of tongue. Although hand-foot syndrome (HFS to capecitabine solely manifesting as palmoplantar hyperpigmentation has been described earlier, this is probably the first instance wherein oral pigmentation has also been found in association. In addition, this finding lends support to the growing argument of hyperpigmentation being a separate entity: different from HFS, both therefore being separate adverse effects of the same drug.

  5. Combined treatment of oxaliplatin and capecitabine in patients with metastatic esophageal squamous cell cancer

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    Tian-Jie Qin; Gai-Li An; Xin-Han Zhao; Fang Tian; Xiao-Hua Li; Juan-Wen Lian; Bo-Rong Pan; Shan-Zhi Gu

    2009-01-01

    AIM: To investigate the efficacy and side effects of the combined therapy of oxaliplatin and capecitabine in patients with metastatic esophageal squamous cell cancer (ESCC) and the survival of the patients. METHODS: Sixty-four patients (median age of 63 years) with histological or cytological confirmation of ESCC received oxaliplatin 120 mg/m2 intravenously on day 1 and capecitabine 1000 mg/m2 orally twice daily on days 1 to 14 in a 21-d treatment cycle as palliative chemotherapy. Each patient received at least two cycles of treatment. The efficacy, side effects and patient survival were evaluated. RESULTS: The partial response (PR) rate was 43.8% (28/64). Stable disease (SD) rate was 47.9% (26/64), and disease progression rate was 15.6% (10/64). The clinical benefit rate (PR + SD) was 84.4%. The main toxicities were leukopenia (50.0%), nausea and vomiting (51.6%), diarrhea (50.0%), stomatitis (39.1%), polyneuropathy (37.5%) and hand-foot syndrome (37.5%). No grade 4 event in the entire cohort was found. The median progression-free survival was 4 mo, median overall survival was 10 mo (95% CI: 8.3-11.7 mo), and the 1- and 2-year survival rates were 38.1% and 8.2%, respectively. High Karnofsky index, single metastatic lesion and response to the regimen indicated respectively good prognosis. CONCLUSION: Oxaliplatin plus capecitabine regimen is effective and tolerable in metastatic ESCC patients. The regimen has improved the survival moderately and merits further studies.

  6. Clinical efficacy of including capecitabine in neoadjuvant chemotherapy for breast cancer: a systematic review and meta-analysis of randomized controlled trials.

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    Qiuyun Li

    Full Text Available BACKGROUND: Capecitabine has proven effective as a chemotherapy for metastatic breast cancer. Though several Phase II/III studies of capecitabine as neoadjuvant chemotherapy have been conducted, the results still remain inconsistent. Therefore, we performed a meta-analysis to obtain more precise understanding of the role of capecitabine in neoadjuvant chemotherapy for breast cancer patients. METHODS: The electronic database PubMed and online abstracts from ASCO and SABCS were searched to identify randomized clinical trials comparing neoadjuvant chemotherapy with or without capecitabine in early/operable breast cancer patients without distant metastasis. Risk ratios were used to estimate the association between capecitabine in neoadjuvant chemotherapy and various efficacy outcomes. Fixed- or random-effect models were adopted to pool data in RevMan 5.1. RESULTS: Five studies were included in the meta-analysis. Neoadjuvant use of capecitabine with anthracycline and/or taxane based therapy was not associated with significant improvement in clinical outcomes including: pathologic complete response in breast (pCR; RR = 1.10, 95% CI 0.87-1.40, p = 0.43, pCR in breast tumor and nodes (tnpCR RR = 0.99, 95% CI 0.83-1.18, p = 0.90, overall response rate (ORR; RR = 1.00, 95% CI 0.94-1.07, p = 0.93, or breast-conserving surgery (BCS; RR = 0.98, 95% CI 0.93-1.04, p = 0.49. CONCLUSIONS: Neoadjuvant treatment of breast cancer involving capecitabine did not significantly improve pCR, tnpCR, BCS or ORR. Thus adding capecitabine to neoadjuvant chemotherapy regimes is unlikely to improve outcomes in breast cancer patients without distant metastasis. Further research is required to establish the condition that capecitabine may be useful in breast cancer neoadjuvant chemotherapy.

  7. Capecitabine with radiation is an effective adjuvant therapy in gastric cancers

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    Chee; Kian; Tham; Su; Pin; Choo; Donald; Yew; Hee; Poon; Han; Chong; Toh; Simon; Yew; Kuang; Ong; Sze; Huey; Tan; Michael; Lian; Chek; Wang; Kian; Fong; Foo

    2010-01-01

    AIM:To analyze the outcome of patients who received concurrent capecitabine(Xeloda) and radiation(XRT) compared to the established concurrent 5-fluorouracil(5-FU) with radiation(5FU-RT) and fluoropyrimidine-based chemotherapy alone as adjuvant treatment in gastric cancers.METHODS:All patients with gastric cancers who received adjuvant treatment at the National Cancer Centre Singapore between 1996 and 2006 were reviewed.Treatment outcomes of patients who received XRT were compared with those who had 5FU-RT o...

  8. Adherence and patients’ experiences with the use of capecitabine in daily practice

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    Lonneke Timmers

    2016-09-01

    Full Text Available Background: Capecitabine is a widely prescribed oral anticancer agent. We studied medication adherence and explored its use in daily practice from a patients’ perspective. Methods: Patients (n=92 starting capecitabine were followed up to five 3-week cycles. Adherence was assessed using a pill count, pharmacy data and dosing information from the patients’ medical file. Self-reported adherence was measured using the Medication Adherence Report Scale (MARS. At baseline and during week 2 of cycles 1, 3 and 5, patients filled out questionnaires about quality of life, symptoms, attitude towards medicines and disease and use in daily practice. Simultaneously, blood samples were taken to determine the area under the curve (AUC of 5’-deoxy-5-fluorouridine (5’-DFUR, 5-fluorouracil (5-FU and α-fluoro-β-alanine (FBAL by a population pharmacokinetic model. Associations between AUCs and patient-reported symptoms were tested for cycles 3 and 5.Results: Most patients (84/92; 91% had an adherence rate of ≥95% and ≤105%. The percentage of patients reporting any non-adherence behaviour measured with MARS increased from 16% at cycle 1 to 29% at cycle 5. Symptoms were reported frequently and the dosing regimen was adjusted by the physician at least once in 62% of patients. In multivariate analysis the probability of an adjustment increased with the number of co-medication (OR 1.19, 95%CI:1.03-1.39 and a stronger emotional response to the disease (OR 1.32, 95%CI:1.10-1.59..The AUC of 5’-DFUR was associated with weight loss (OR 1.10, 95%CI:1.01-1.19, AUC of FBAL with hand-foot syndrome (OR 0.90, 95%CI:0.83-0.99, rhinorrhea (OR 1.21, 95%CI:1.03-1.42 weight loss (OR 1.09, 95%CI:1.00-1.20 and depression (OR 0.90, 95%CI:0.82-0.99. Side effects were reported by one third of patients as the reason to discontinue treatment.Conclusion: Adherence to capecitabine was generally high. Nevertheless, adherence measured with MARS decreased over time Adherence

  9. Q-TWiST analysis of lapatinib combined with capecitabine for the treatment of metastatic breast cancer.

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    Sherrill, B; Amonkar, M M; Stein, S; Walker, M; Geyer, C; Cameron, D

    2008-09-02

    The addition of lapatinib (Tykerb/Tyverb) to capecitabine (Xeloda) delays disease progression more effectively than capecitabine monotherapy in women with previously treated HER2+ metastatic breast cancer (MBC). The quality-adjusted time without symptoms of disease or toxicity of treatment (Q-TWiST) method was used to compare treatments. The area under survival curves was partitioned into health states: toxicity (TOX), time without symptoms of disease progression or toxicity (TWiST), and relapse period until death or end of follow-up (REL). Average times spent in each state, weighted by utility, were derived and comparisons of Q-TWiST between groups performed with varying combinations of the utility weights. Utility weights of 0.5 for both TOX and REL, that is, counting 2 days of TOX or REL as 1 day of TWiST, resulted in a 7-week difference in quality-adjusted survival favouring combination therapy (P=0.0013). The Q-TWiST difference is clinically meaningful and was statistically significant across an entire matrix of possible utility weights. Results were robust in sensitivity analyses. An analysis with utilities based on EQ-5D scores was consistent with the above findings. Combination therapy of lapatinib with capecitabine resulted in greater quality-adjusted survival than capecitabine monotherapy in trastuzumab-refractory MBC patients.

  10. Systemic treatment with capecitabine as maintenance therapy in patients with recurring or metastatic breast cancer: experience in the Oncology Hospital, National Medical Center Siglo XXI, Mexican Social Security Institute.

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    Segura-González, Manuel; Quintana-Quintana, Miguel

    2015-04-01

    Metastatic breast cancer as initial onset represents between 20 and 30 % of cases and is considered an incurable disease. The goal of its treatment is palliative, looking for increasing the survival while reducing the symptoms. Maintenance chemotherapy studies for metastatic breast cancer have demonstrated to prolong the progression-free survival, with unclear results in terms of overall survival. The main objectives of our study were the progression-free survival and overall survival in patients with recurring or metastatic breast cancer treated with capecitabine in the maintenance chemotherapy setting compared with patients not receiving maintenance chemotherapy. As secondary objectives, the frequency of dose-limiting toxicities and response rate were determined. A non-probabilistic sampling was used, through expert selection of patients from the recurring/metastatic breast cancer survey cared within the period from January 1, 2007, to December 21, 2012. A total of 77 patients were included. Clinical data of advanced/recurrent breast cancer patients that were treated with capecitabine were recorded. The study achieved its primary objective, since the progression-free survival was prolonged for the maintenance therapy group: 6.6 versus 18.1 months, p Siglo XXI Oncology Hospital extends the overall survival and progression-free survival with a good toxicity profile.

  11. Capecitabine: an evidence-based review of its effectiveness in the treatment of carcinoma of the pancreas

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    David B. Smith

    2007-11-01

    Full Text Available David B. Smith1, John P. Neoptolemos21Clatterbridge Centre for Oncology, Bebington, Wirral, UK; 2School of Cancer Studies, University of Liverpool, Liverpool, UKIntroduction: More than 90% of patients with pancreatic cancer present either with incurable locally advanced or metastatic disease or relapse following surgery. For these patients systemic therapy offers the only prospect of salvage, but pancreatic cancer is one of the most chemoresistant of tumors; current chemotherapy can only delay progression in a limited proportion of patients and survival rates are poor. There is therefore a pressing need for more effective therapy. Capecitabine is a new oral prodrug of fluorouracil, which has shown activity in pancreatic cancer particularly when used in combination with gemcitabine.Aims: To review the emerging evidence for the clinical effectiveness of capecitabine in the management of carcinoma of the pancreas.Evidence review: There is evidence from phase II testing that capecitabine is active in pancreatic cancer. The Swiss Group for Clinical Cancer Research/Central European Cooperative Oncology Group (SAKK/CECOG phase III trial found that the combination of gemcitabine and capecitabine did not improve overall median survival as compared with gemcitabine alone (8.4 vs 7.3 months, respectively; P=0.314 but subgroup analysis in patients with good performance score [Karnofsky Performance Scores (KPS ³90] revealed a significant survival improvement with the combination arm (10.1 months compared with single-agent gemcitabine (7.5 months; P=0.033. Preliminary data from the GemCap phase III trial indicated significantly improved response rates and survival for the combination of gemcitabine with capecitabine (7.4 months compared with gemcitabine alone (6 months; P=0.026 but analysis of the mature data with adequate follow-up awaits reporting.Clinical potential: The addition of capecitabine to gemcitabine may represent a small step forward in the

  12. Metastatic medullary thyroid cancer: a dramatic response to a systemic chemotherapy (temozolomide and capecitabine regimen

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    Lacin S

    2015-05-01

    Full Text Available Sahin Lacin, Ece Esin, Yusuf Karakas, Suayib Yalcin Department of Medical Oncology, Institute of Cancer, Hacettepe University, Ankara, Turkey Abstract: A 40-year-old male patient presented with increasing serum levels of calcitonin and CEA. He underwent potential curative surgery for medullary thyroid carcinoma, 3 years ago and then 7 months later he had metastasectomy and cervical lymph node dissection for recurrent disease. On admission he had multiple metastatic skin nodules on the chest wall and positron emission tomography–computed tomography revealed multiple visceral metastases as well. The patient had not received any systemic treatment up to that time; therefore, we considered systemic treatment with the new tyrosine kinase inhibitors (vandetanib, cabozantinib, etc. However, since these drugs are only available after cytotoxic chemotherapy, we started temozolomide and capecitabine chemotherapy. After two courses of the treatment all skin nodules disappeared and CEA and calcitonin levels normalized, radiological imaging showed a good partial response. Keywords: medullary thyroid cancer, capecitabine, temozolomide, chemotherapy

  13. Replacing 5-fluorouracil by capecitabine in localised squamous cell carcinoma of the anal canal: systematic review and meta-analysis

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    Souza, Karla T; Pereira, Allan AL; Araujo, Raphael L; Oliveira, Suilane Coelho Ribeiro; Hoff, Paulo M; Riechelmann, Rachel P

    2016-01-01

    Background The standard treatment for localised squamous cell carcinoma of the anal canal (SCCAC) is chemoradiotherapy (CRT) with infusional 5-fluorouracil (5-FU) and mitomycin. Because 5-FU and capecitabine have offered similar efficacy in many phase-III trials of solid tumours, studies have tested capecitabine in this setting of SCCAC. However, these studies are small and have reported variable results. Therefore, a systematic review and meta-analysis was performed. Methods Medline, Scopus and Embase were searched for studies that evaluated the efficacy outcomes of capecitabine used as a substitute of 5-FU in the CRT of localised SCCAC. The primary endpoint was complete response rate (CRR) at 6 months. Metaprop analysis of reported CRR-based on pooled estimates of proportions with corresponding 95% confidence intervals (95%CI) were calculated on the base of the Freeman-Tukey double arcsine transformation. Results We retrieved 300 studies, of which six met our eligibility criteria. The capecitabine dose ranged from 500 mg/m2 to 825 mg/m2 BID for 5 days per week during radiation. With a total of 218 patients, the median follow-up was 21.5 months (14–23). The pooled analysis of three trials (N = 132 patients) reported a CRR at 6 months of 88% (83%–94%), considering all clinical stages. The pooled analysis of overall CRR (N = 218 patients), evaluated at different intervals, showed an overall CRR of 91% (87%–95%). Rates of locoregional relapse varied from 3.2% to 21%. The majority of patients completed the planned radiotherapy dose (93.5%–100%) and any chemotherapy interruption was reported in up to 55.8% of patients. Conclusions Capecitabine is an acceptable and more convenient alternative to infusional 5-FU in the CRT for localised SCCAC, offering similar clinical CRR to those reported by phase-III trials. PMID:28105070

  14. Concomitant vs. Comparative Advantages: Sufficient vs. Necessary Conditions.

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    Flaningam, Carl D.

    1981-01-01

    Discusses the concomitant advantages case in academic debate. Examines the distinction between concomitant and comparative advantages and the implications of this distinction for concomitant advantages as a form of argument. (PD)

  15. Antitumor effects of FP3 in combination with capecitabine on PDTT xenograft models of primary colon carcinoma and related lymphatic and hepatic metastases.

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    Jin, Ketao; Lan, Huanrong; Xie, Bojian; He, Kuifeng; Xu, Zhenzhen; Li, Guangliang; Han, Na; Teng, Lisong; Cao, Feilin

    2012-07-01

    FP3 is an engineered protein which contains the extracellular domain 2 of VEGF receptor 1 (Flt-1) and extracellular domain 3 and 4 of VEGF receptor 2 (Flk-1, KDR) fused to the Fc portion of human immunoglobulin G 1. Previous studies demonstrated its antiangiogenic effects in vitro and in vivo, and its antitumor activity in vivo. In this study, patient-derived tumor tissue (PDTT) xenograft models of primary colon carcinoma and lymphatic and hepatic metastases were established for assessment of the antitumor activity of FP3 in combination with capecitabine. Xenografts were treated with FP3, capecitabine, alone or in combination. After tumor growth was confirmed, volume and microvessel density in tumors were evaluated. Levels of VEGF, and PCNA in the tumor were examined by immunohistonchamical staining, level of thymidine phosphorylase (TP) was examined by ELISA, and levels of related cell signaling pathways proteins expression were examined by western blotting. FP3 in combination with capecitabine showed significant antitumor activity in three xenograft models (primary colon carcinoma, lymphatic metastasis, and hepatic metastasis). The microvessel density in tumor tissues treated with FP3 in combination with capecitabine was lower than that of the control. Antitumor activity of FP3 in combination with capecitabine was significantly higher than that of each agent alone in three xenograft models (primary colon carcinoma, lymphatic metastasis, and hepatic metastasis). This study indicated that addition of FP3 to capecitabine significantly improved tumor growth inhibition in the PDTT xenograft models of primary colon carcinoma and lymphatic and hepatic metastases.

  16. Phase I study of intermittent and chronomodulated oral therapy with capecitabine in patients with advanced and/or metastatic cancer

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    Gasparro Simona

    2006-02-01

    Full Text Available Abstract Background The combination of capecitabine and gemcitabine at Fixed Dose Rate (FDR has been demonstrated to be well tolerated, with apparent efficacy in patients with advanced cancers. FDR gemcitabine infusion leads to enhanced intracellular accumulation of drug and possible augmented clinical effect. The goals of this phase I study were to determine the maximum-tolerated dose (MTD of chronomodulated capecitabine in patients with advanced cancer and to describe the dose-limiting toxicities (DLT, the safety profile of this way of administration. Methods Patients with advanced solid tumours who had failed to response to standard therapy or for whom no standard therapy was available were elegible for this study. Capecitabine was administered orally according to following schedule: 1/4 of dose at 8:00 a.m.; 1/4 of dose at 6:00 p.m. and 1/2 of dose at 11:00 p.m. each day for 14 consecutive days, followed by a 7-day rest period. Results All 27 patients enrolled onto the study were assessable for toxicity. The most common toxicities during the first two cycles of chemotherapy were fatigue, diarrhoea and hand foot syndrome (HFS. Only one out of the nine patients treated at capecitabine dose of 2,750 mg/m2 met protocol-specified DLT criteria (fatigue grade 4. However, at these doses the majority of cycles of therapy were delivered without dose reduction or delay. No other episodes of DLT were observed at the same dose steps and at the lower dose steps of capecitabine (1,500/1,750/2,000/2,250/2,500 mg/m2. The dose of 2,750 mg/m2 is recommended for further study. Tumor responses were observed in patients with metastatic breast and colorectal cancer. Conclusion High doses of chronomodulated capecitabine can be administered with acceptable toxicity. The evidence of antitumor activity deserves further investigation in phase II combination chemotherapy studies.

  17. [Efficiency of the capecitabine in patients with breast cancer with liver metastasis].

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    Gasanzade, D A; Zeĭnalov, R S; Musaev, I N

    2009-01-01

    The main purpose of the present research is to study the efficiency of capecitabine in treatment of patients with breast cancer with liver metastasis. The investigation was carried on 44 patients with breast cancer with liver metastasis. Patients were divided into 2 groups. The first group was composed of patients (n=21) cycles of chemotherapy ( DCapLv) was carried out. The second group (n=23) was composed of patients treated upon the schema of CapLv. Patients had their diagnosis morphologically verified Metastatic involvement of the liver was diagnosed on the base of data of MRI, CT and ultrasonographic research. The obtained results were compared with the results of treatment of patients (n=54), who received the "classical" schema of FAC treatment. The investigation proved high efficiency of chemotherapy treatment schema in patients with breast cancer with liver metastasis. Proposed schema of chemotherapy seems to have had few hepatotoxic effects.

  18. Neoadjuvant Chemotherapy with Capecitabine and Temozolomide for Unresectable Pancreatic Neuroendocrine Tumor

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    Sumana Devata

    2012-11-01

    Full Text Available Pancreatic neuroendocrine tumors (PNETs are relatively rare tumors that arise in the endocrine cells of the pancreas. Historically, somatostatin analogues have been used in this disease primarily for symptom control and, to a limited extent, disease stability. More recently, sunitinib and everolimus have been approved for advanced stage PNETs based on a survival benefit. However, both agents have a <10% actual response rate and cause nontrivial side effect profiles that limit duration of therapy. In locally advanced disease, there is a paucity of data to support an optimal neoadjuvant approach with the expectation of down-staging to allow for curative resection. We describe in this case a young woman who was successfully down-staged using a chemotherapy regimen of capecitabine and temozolomide with minimal toxicity.

  19. Hepatic colorectal cancer metastases showing a distinctive pattern of pathological response after metronomic capecitabine and bevacizumab.

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    Pietrantonio, Filippo; Biondani, Pamela; Pellegrinelli, Alessandro; Marchianò, Alfonso; Dotti, Katia Fiorella; Buzzoni, Roberto; Di Bartolomeo, Maria

    2012-12-01

    A 48-year-old man was referred to our hospital with the diagnosis of colon cancer with multiple hepatic metastases. After right hemicolectomy, the rapid progression of liver disease was treated with metronomic capecitabine and bevacizumab according to a study protocol. A gradual regression of metastatic lesions was observed during a 9-month treatment period. After conversion of liver disease to resectability, the histological examination disclosed the complete necrosis of all lesions, with the exception of small neoplastic foci inside a single nodule. The comparison of this type of histological findings with the classic sclero-hyaline pathological response, as well as its importance as indicator of response to antiangiogenic treatment, is discussed.

  20. First efficacy results of capecitabine with anthracycline- and taxane-based adjuvant therapy in high-risk early breast cancer: a meta-analysis.

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    Yiwei Jiang

    Full Text Available BACKGROUND: Capecitabine is effective and indicated for the salvage treatment of metastatic breast cancer. Therefore, it is essential to evaluate the efficacy of capecitabine in the adjuvant setting. There have been two large randomized studies to determine whether patients with high-risk early breast cancer benefit from the addition of capecitabine to standard chemotherapy, but they have yielded inconsistent results. We first undertook a meta-analysis to evaluate the efficacy of the addition of capecitabine over standard treatment. METHODS: PubMed, EBSCO, Web of Science, conference proceedings and key trials were searched from 1998 to 2011. The hazard ratio (HR was used to evaluate the efficacy of a taxane-anthracycline regimen and a taxane-anthracycline-capecitabine regimen in early breast cancer. All of the data from each study use either fixed-effects or random-effects by Stata. FINDINGS: We found significant improvement in the additional capecitabine arm versus control in disease-free survival (DFS (HR = 0.83, 95% CI: 0.71-0.98, P = 0.027, overall survival (OS (HR = 0.71, 95% CI: 0.57-0.88, P = 0.002, distant recurrence (HR = 0.79, 95% CI: 0.66-0.94, P = 0.008 and the death from breast cancer only (HR = 0.65, 95% CI: 0.51-0.83, P = 0.001. Meanwhile, the subgroup analysis revealed that capecitabine improved the DFS in triple negative (HR = 0.71, 95% CI: 0.53-0.96, P = 0.028, hormone receptor negative (HR = 0.73, CI: 0.56-0.94, P = 0.017 and HER2 negative (HR = 0.81, CI: 0.67-0.98, P = 0.034 patients. CONCLUSION: Due to the synergistic effect of taxane and capecitabine, taxane-anthracycline-capecitabine regimen may effectively improve the efficacy in the adjuvant setting and may be a novel generation of adjuvant chemotherapy regimen. The results of the current meta-analysis support this hypothesis and indicate that taxane-based regimen with capecitabine may be an effective, convenient

  1. Capecitabine and irinotecan with and without bevacizumab for advanced colorectal cancer patients

    Institute of Scientific and Technical Information of China (English)

    Markus Moehler; Martin F Sprinzl; Murad Abdelfattah; Carl C Schimanski; Bernd Adami; Werner Godderz; Klaus Majer; Dimitri Flieger; Andreas Teufel; Juergen Siebler; Thomas Hoehler; Peter R Galle; Stephan Kanzler

    2009-01-01

    AIM: To investigate the efficacy and safety of capecitabine plus irinotecan ± bevacizumab in advanced or metastatic colorectal cancer patients.METHODS: Forty six patients with previously untreated,locally-advanced or metastatic colorectal cancer (mCRC) were recruited between 2001-2006 in a prospective open-label phase Ⅱ trial, in German community-based outpatient clinics. Patients received a standard capecitabine plus irinotecan (CAPIRI) or CAPIRI plus bevacizumab (CAPIRI-BEV) regimen every 3 wk.Dose reductions were mandatory from the first cycle in cases of > grade 2 toxicity. The treatment choice of bevacizumab was at the discretion of the physician. The primary endpoints were response and toxicity and secondary endpoints included progression-free survival and overall survival.RESULTS: In the CAPIRI group vs the CAPRI-Bev group there were more female than male patients (47%vs 24%), and more patients had colon as the primary tumor site (58.8% vs 48.2%) with fewer patients having sigmoid colon as primary tumor site (5.9% vs20.7%). Grade 3/4 toxicity was higher with CAPIRI than CAPIRI-Bev: 82% vs 58.6%. Partial response rates were 29.4% and 34.5%, and tumor control rates were 70.6% and 75.9%, respectively. No complete responses were observed. The median progression-free survival was 11.4 mo and 12.8 mo for CAPIRI and CAPIRI-Bev, respectively. The median overall survival for CAPIRI was 15 mo (458 d) and for CAPIRI-Bev 24 mo (733 d). These differences were not statistically different.In the CAPIRI-Bev, group, two patients underwenta full secondary tumor resection after treatment,whereas in the CAPIRI group no cases underwent this procedure.CONCLUSION: Both regimens were well tolerated and offered effective tumor growth control in this outpatient setting. Severe gastrointestinal toxicities and thromboembolic events were rare and if observed were never fatal.

  2. Simultaneous Estimation of Gemcitabine Hydrochloride and Capecitabine Hydrochloride in Combined Tablet Dosage Form by RP-HPLC Method

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    V. Rajesh

    2011-01-01

    Full Text Available A new reverse phase high performance liquid chromatography (RP-HPLC method has been developed for the simultaneous estimation of gemcitabine hydrochloride and capecitabine hydrochloride in combined tablet dosage form. An inertsil ODS-3 C-18 column having dimensions of 250×4.6 mm and particle size of 5 µm, with mobile phase containing a mixture of acetonitrile : water : triethyelamine in the ratio of (70 : 28 : 2v/v was used. The pH of mobile phase was adjusted to 4.0 with ortho-phosphoric acid. The flow rate was 1 mL/min and the column effluents were monitored at 260 nm. The retention time for gemcitabine hydrochloride and capecitabine hydrochloride was found to be 2.76 and 2.3 min respectively. The proposed method was validated in terms of linearity, accuracy, precision, limit of detection, limit of quantitation and robustness. The method was found to be linear in the range of 10-50 µg/mL and 4-24 µg/mL for gemcitabine hydrochloride and capecitabine hydrochloride, with regression coefficient r = 0.999 and r = 0.999, respectively.

  3. Anthropophobia: its meaning and concomitant experiences.

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    Zhang, A Y; Yu, L C; Zhang, J; Tang, D; Draguns, J G

    2001-01-01

    This study investigated the essential feature and concomitant experiences of anthropophobia, a culturally specific phobic disorder in China and Japan. One hundred and fifty subjects, including 50 anthropophobic, 50 neurasthenic and 50 normal subjects, were recruited from hospitals and downtown residential areas in Beijing. Measures of anthropophobic symptoms and DSM-III-R depressive and anxiety symptoms were administered to all subjects. Nonparametric analysis of variance, analysis of variance (ANOVA and MANOVA) and Fisher's exact test were performed to examine group differences on each symptomatic item of the three measures. Results indicate that the core anthropophobic symptoms include a fear of making eye contact with others and a fear of being watched by others, which essentially express fears of others' judgement or opinion of oneself. Anxiety and depression are associated features of anthropophobia. However, these concomitants are experienced more cognitively and less somatically in the case of anthropophobia than neurasthenia.

  4. Complete Response of Isolated Para-aortic Lymph Node Recurrence from Rectosigmoid Cancer Treated by Chemoradiation Therapy with Capecitabine/Oxaliplatin plus Bevacizumab: A Case Report.

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    Miyazawa, Tomonori; Ebe, Kazuyu; Koide, Norihiko; Fujita, Nobuhiro

    2012-05-01

    Para-aortic lymph node recurrence is a rare type of metastasis from colorectal cancer, and no treatment has yet been established. Here, we report on a case of isolated para-aortic lymph node metastasis from rectosigmoid cancer that showed complete response to chemoradiation therapy with capecitabine/oxaliplatin plus bevacizumab. A 58-year-old woman underwent high anterior resection for rectosigmoid cancer in 2009. Para-aortic lymph node recurrence occurred in 2011. She underwent radiation therapy (50 Gy) and 8 courses of capecitabine/oxaliplatin plus bevacizumab. Abdominal computed tomography and positron emission tomography with 18-fluorodeoxyglucose did not reveal any para-aortic lymph node recurrence after chemoradiation therapy. Hence, this case was interpreted as a complete response. No recurrence was noted 6 months after the complete response. Chemoradiation therapy with capecitabine/oxaliplatin plus bevacizumab is likely to be effective in treating patients with para-aortic lymph node recurrence.

  5. Complete Response of Isolated Para-aortic Lymph Node Recurrence from Rectosigmoid Cancer Treated by Chemoradiation Therapy with Capecitabine/Oxaliplatin plus Bevacizumab: A Case Report

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    Tomonori Miyazawa

    2012-05-01

    Full Text Available Para-aortic lymph node recurrence is a rare type of metastasis from colorectal cancer, and no treatment has yet been established. Here, we report on a case of isolated para-aortic lymph node metastasis from rectosigmoid cancer that showed complete response to chemoradiation therapy with capecitabine/oxaliplatin plus bevacizumab. A 58-year-old woman underwent high anterior resection for rectosigmoid cancer in 2009. Para-aortic lymph node recurrence occurred in 2011. She underwent radiation therapy (50 Gy and 8 courses of capecitabine/oxaliplatin plus bevacizumab. Abdominal computed tomography and positron emission tomography with 18-fluorodeoxyglucose did not reveal any para-aortic lymph node recurrence after chemoradiation therapy. Hence, this case was interpreted as a complete response. No recurrence was noted 6 months after the complete response. Chemoradiation therapy with capecitabine/oxaliplatin plus bevacizumab is likely to be effective in treating patients with para-aortic lymph node recurrence.

  6. S-1-Based versus capecitabine-based preoperative chemoradiotherapy in the treatment of locally advanced rectal cancer: a matched-pair analysis.

    Directory of Open Access Journals (Sweden)

    Meng Su

    Full Text Available OBJECTIVE: The aim of this paper was to compare the efficacy and safety of S-1-based and capecitabine-based preoperative chemoradiotherapy regimens in patients with locally advanced rectal cancer through a retrospective matched-pair analysis. MATERIALS AND METHODS: Between Jan 2010 and Mar 2014, 24 patients with locally advanced rectal cancer who received preoperative radiotherapy concurrently with S-1 were individually matched with 24 contemporary patients with locally advanced rectal cancer who received preoperative radiotherapy concurrently with capecitabine according to clinical stage (as determined by pelvic magnetic resonance imaging and computed tomography and age (within five years. All these patients performed mesorectal excision 4-8 weeks after the completion of chemoradiotherapy. RESULTS: The tumor volume reduction rates were 55.9±15.1% in the S-1 group and 53.8±16.0% in the capecitabine group (p = 0.619. The overall downstaging, including both T downstaging and N downstaging, occurred in 83.3% of the S-1 group and 70.8% of the capecitabine group (p = 0.508. The significant tumor regression, including regression grade I and II, occurred in 33.3% of S-1 patients and 25.0% of capecitabine patients (p = 0.754. In the two groups, Grade 4 adverse events were not observed and Grade 3 consisted of only two cases of diarrhea, and no patient suffered hematologic adverse event of Grade 2 or higher. However, the incidence of diarrhea (62.5% vs 33.3%, p = 0.014 and hand-foot syndrome (29.2% vs 0%, p = 0.016 were higher in capecitabine group. Other adverse events did not differ significantly between two groups. CONCLUSIONS: The two preoperative chemoradiotherapy regimens were effective and safe for patients of locally advanced rectal cancer, but regimen with S-1 exhibited a lower incidence of adverse events.

  7. Comparison of the efficacy and safety of S-1-based and capecitabine-based regimens in gastrointestinal cancer: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Xunlei Zhang

    Full Text Available PURPOSE: Oral fluoropyrimidine (S-1, capecitabine has been considered as an important part of various regimens. We aimed to evaluate the efficacy and safety of S-1-based therapy versus capecitabine -based therapy in gastrointestinal cancers. METHODS: Eligible studies were identified from Pubmed, EMBASE. Additionally, abstracts presented at American Society of Clinical Oncology (ASCO conferences held between 2000 and 2013 were searched to identify relevant clinical trials. The outcome included overall survival (OS, progression-free survival (PFS, overall response rate (ORR, disease control rate (DCR and advent events. RESULTS: A total of 6 studies (4 RCTs and 2 retrospective analysis studies containing 790 participants were included in this meta-analysis, including 401 patients in the S-1-based group and 389 patients in the capecitabine-based group. Results of our meta-analysis indicated that S-1-based and capecitabine-based regimens showed very similar efficacy in terms of PFS (HR 0.92, 95% CI 0.78-1.09, P = 0.360, OS (HR 1.01, 95% CI 0.84-1.21, P = 0.949, ORR (HR 1.04, 95% CI 0.87-1.25, P = 0.683 and DCR (HR 1.02, 95% CI 0.94-1.10, P = 0.639. There was also no significant difference in toxicity between regimens other than mild more hand-foot syndrome in capecitabine-based regimens. CONCLUSION: Both the S-1-based and capecitabine-based regimens are equally active and well tolerated, and have the potential of backbone chemotherapy regimen in further studies of gastrointestinal cancers.

  8. A CONSANGUINEOUS MATING COUPLE AND THEIR CONCOMITANT ESOTROPIA TWINS

    Institute of Scientific and Technical Information of China (English)

    1991-01-01

    A first cousin marriage couple and their 8-year-old identical twin daughters with concomitant strabismus are described.This family would indicate an autosomal recessive inheritance in concomitant strabismus.

  9. Breast cancer brain metastases responding to lapatinib plus capecitabine as second-line primary systemic therapy.

    Science.gov (United States)

    Bergen, Elisabeth S; Berghoff, Anna S; Rudas, Margaretha; Preusser, Matthias; Bartsch, Rupert

    2015-06-01

    Brain metastases (BM) are diagnosed in up to 40% of HER2-positive breast cancer patients. Standard treatment includes local approaches such as whole-brain radiotherapy (WBRT), radiosurgery, and neurosurgery. The landscape trial established primary systemic therapy as an effective and safe alternative to WBRT in selected patients with Her2-positive BM. We aim to further focus on the role of systemic therapy in oligosymptomatic patients by presenting this case report. We report on a 50-year-old patient diagnosed with multiple BM 5 years after early breast cancer diagnosis. As the patient was asymptomatic and had a favorable diagnosis-specific GPA score, she received primary systemic treatment with T-DM1. She achieved partial remission within the brain for eight treatment cycles and then progressed despite stable extracranial disease. As the patient remained asymptomatic and refused WBRT, we decided upon trastuzumab, lapatinib plus capecitabine as second-line therapy. Another partial remission of BM was observed; to date, she has received 11 treatment cycles without any sign of disease progression. In this case, WBRT was delayed by at least 14 months, again indicating the activity of systemic treatment in BM. Apparently, in selected patients, BM can be controlled with multiple lines of systemic therapy similar to extracranial disease. Further investigation of systemic treatment approaches is therefore warranted.

  10. [Prevention of severe toxicity from capecitabine, 5-fluorouracil and tegafur by screening for DPD-deficiency].

    Science.gov (United States)

    Deenen, Maarten J; Cats, Annemieke; Mandigers, Caroline M P W; Soesan, Marcel; Terpstra, Wim E; Beijnen, Jos H; Schellens, Jan H M

    2012-01-01

    Capecitabine, 5-fluorouracil and tegafur form the group called the fluoropyrimidines, which is one of the most frequently prescribed group of anti-cancer drugs for the treatment of (metastatic) colorectal, gastric and breast cancer. The primary enzyme responsible for the inactivation of the fluoropyrimidines is dihydropyrimidine dehydrogenase (DPD). Consequently, patients with an inborn partial DPD deficiency, induced, for example by the polymorphism DPYD*2A, are highly prone to severe, potentially lethal toxicity following a standard dose of fluoropyrimidines. In this article, based on three representative case reports and our prospective study in patients with cancer, we demonstrate the clinical value of prospective screening for DPD deficiency in patients being treated with fluoropyrimidine-based anti-cancer therapy. The results show that upfront genotyping for DPYD*2A followed by a fluoropyrimidine dose reduction of 50% (on average) in patients heterozygous polymorphic for DPYD*2A, significantly reduces the incidence of severe to potentially lethal toxicity compared to historical control patients given full-dose therapy.

  11. [Treatment of non accomodated concomitant strabismus].

    Science.gov (United States)

    Kikolashvili, M Sh; Shengeliia, D G; Tsomaia, L V

    2011-02-01

    The aim of the study was comparative evaluation of surgical treatment and complex pre and postoperative pleoptic, orthoptic, diploptic treatment of non accommodated concomitant strabismus and identification of the optimum age for surgical treatment of strabismus. The 75 patients (from 2 to 10 years old) with manifested concomitant convergent strabismus were divided into two groups: patients operated at the age from 2 to 4 years old; patients operated at the age of 4-10 years). The 75 of patients operated at the age from 2 to 4 years old, which underwent orthoptic-diploptic treatment pre- and postoperatively got binocular vision showed the full recovery in only 40% of cases of the same age-group undergone the surgical treatment in combination with the direct occlusion. Binocular vision was achieved in 68% of patients operated at the age of 4-10 years with complex treatment, and in 25% in patients of the same age group with surgical treatment plus occlusion. The findings showed the efficacy of complex treatment as well as pre and postoperative pleoptic-orthoptic-diploptic treatment of strabismus and direct occlusion. Thus, the results of this study suggest that the delay of surgical treatment limits the ability to obtain optimal results.

  12. Concomitant pseudopolymorphs of 10-deacetyl baccatin III.

    Science.gov (United States)

    Tatini, Lakshmi Kumar; Rao, N Someswara; Khan, Muzaffar; Peraka, Krishna Sumanth; Reddy, K V S R Krishna

    2013-06-01

    Three new solvates [mono-dimethyl sulfoxide (mono-DMSO), mono-dimethyl acetamide (mono-DMA) and mono-dimethyl formamide (mono-DMF)] of 10-Deacetyl baccatin III, were generated by slow evaporation in DMSO, DMF, and DMSO/DMA (1:1) solvent systems respectively. Two concomitant forms mono-DMSO(a new form) and di-DMSO (a known form) were obtained in the DMSO solvent system. Yet two other concomitant forms mono-DMA (a new form) and di-DMSO (a known form) were obtained in DMSO/DMA (1:1) solvent system. A fourth solvate mono-DMF (a new form) was crystallized in unimolar ratio using DMF as a solvent. These solvates were characterized using powder X-ray diffraction, differential scanning calorimeter, thermogravimetric analysis (TGA), and spectroscopic [(13)C solid-state nuclear magnetic spectroscopy, solution (1)H NMR, and Fourier transform infrared] techniques. The interactions between host and guest molecules were elucitated by single-crystal X-ray diffraction data. In all the cases, guest molecules are connected to the host molecules by O-H∙∙∙O hydrogen bonds. A remarkable difference in the desolvation onset temperatures of di- and mono-DMSO solvates was observed which was also featured by a corresponding weight loss during TGA analysis.

  13. Phase II study of concurrent capecitabine and external beam radiotherapy for pain control of bone metastases of breast cancer origin.

    Directory of Open Access Journals (Sweden)

    Yulia Kundel

    Full Text Available Pain from bone metastases of breast cancer origin is treated with localized radiation. Modulating doses and schedules has shown little efficacy in improving results. Given the synergistic therapeutic effect reported for combined systemic chemotherapy with local radiation in anal, rectal, and head and neck malignancies, we sought to evaluate the tolerability and efficacy of combined capecitabine and radiation for palliation of pain due to bone metastases from breast cancer.Twenty-nine women with painful bone metastases from breast cancer were treated with external beam radiation in 10 fractions of 3 Gy, 5 fractions a week for 2 consecutive weeks. Oral capecitabine 700 mg/m(2 twice daily was administered throughout radiation therapy. Rates of complete response, defined as a score of 0 on a 10-point pain scale and no increase in analgesic consumption, were 14% at 1 week, 38% at 2 weeks, 52% at 4 weeks, 52% at 8 weeks, and 48% at 12 weeks. Corresponding rates of partial response, defined as a reduction of at least 2 points in pain score without an increase in analgesics consumption, were 31%, 38%, 28%, 34% and 38%. The overall response rate (complete and partial at 12 weeks was 86%. Side effects were of mild intensity (grade I or II and included nausea (38% of patients, weakness (24%, diarrhea (24%, mucositis (10%, and hand and foot syndrome (7%.External beam radiation with concurrent capecitabine is safe and tolerable for the treatment of pain from bone metastases of breast cancer origin. The overall and complete response rates in our study are unusually high compared to those reported for radiation alone. Further evaluation of this approach, in a randomized study, is warranted.ClinicalTrials.gov NCT01784393NCT01784393.

  14. Pilot study of postoperative adjuvant chemoradiation for advanced gastric cancer: Adjuvant 5-FU/cisplatin and chemoradiation with capecitabine

    Institute of Scientific and Technical Information of China (English)

    Hyung-Sik Lee; Min-Chan Kim; Youngmin Choi; Won-Joo Hur; Hyo-Jin Kim; Hyuk-Chan Kwon; Sung-Hyun Kim; Jae-Seok Kim; Jong-Hoon Lee; Ghap-Joong Jung

    2006-01-01

    AIM: To evaluate the efficacy and toxicity of postoperative chemoradiation using FP chemotherapy and oral capecitabine during radiation for advanced gastric cancer following curative resection.METHODS: Thirty-one patients who had underwent a potentially curative resection for Stage Ⅲ and Ⅳ (MO) gastric cancer were enrolled. Therapy consists of one cycle of FP (continuous infusion of 5-FU 1000 mg/m2 on d 1 to 5 and cisplatin 60 mg/m2 on d 1) followed by 4500 cGy (180 cGy/d) with capecitabine (1650 mg/m2 daily throughout radiotherapy). Four wk after completion of the radiotherapy, patients received three additional cycles of FP every three wk. The median follow-up duration was 22.2 mo.RESULTS: The 3-year disease free and overall survival in this study were 82.7% and 83.4%, respectively. Four patients (12.9%) showed relapse during follow-up. Eight patients did not complete all planned adjuvant therapy.Grade 3/4 toxicities included neutropenia in 50.2%, anemia in 12.9%, thrombocytopenia in 3.2% and nausea/vomiting in 3.2%. Neither grade 3/4 hand foot syndrome nor treatment related febrile neutropenia or death were observed.CONCLUSION: These preliminary results suggest that this postoperative adjuvant chemoradiation regimen of FP before and after capecitabine and concurrent radiotherapy appears well tolerated and offers a comparable toxicity profile to the chemoradiation regimen utilized in INT-0116. This treatment modality allowed successful loco-regional control rate and 3-year overall survival.

  15. [Emphysematous gastritis with concomitant portal venous air].

    Science.gov (United States)

    Jeong, Min Yeong; Kim, Jin Il; Kim, Jae Young; Kim, Hyun Ho; Jo, Ik Hyun; Seo, Jae Hyun; Kim, Il Kyu; Cheung, Dae Young

    2015-02-01

    Emphysematous gastritis is a rare form of gastritis caused by infection of the stomach wall by gas forming bacteria. It is a very rare condition that carries a high mortality rate. Portal venous gas shadow represents elevation of intestinal luminal pressure which manifests as emphysematous gastritis or gastric emphysema. Literature reviews show that the mortality rate is especially high when portal venous gas shadow is present on CT scan. Until recently, the treatment of emphysematous gastritis has been immediate surgical intervention. However, there is a recent trend of avoiding surgery because of the frequent occurrence of post-operative complications such as anastomosis leakage. In addition, aggressive surgical treatment has failed to show significant improvement in prognosis. Recently, the authors experienced a case of emphysematous gastritis accompanied by portal venous gas which was treated successfully by conservative treatment without immediate surgical intervention. Herein, we present a case of emphysematous gastritis with concomitant portal venous air along with literature review.

  16. [Atrial fibrillation concomitant with valvular heart disease].

    Science.gov (United States)

    Ishii, Yosuke

    2013-01-01

    Patients with valvular heart disease frequently have atrial fibrillation(AF) due to elevated pressure and dilatation of the left and right atria and pulmonary veins. Guidelines for valvular heart disease and AF recommend that surgical treatment for the valvular heart disease should be performed concomitantly with AF surgery. The Full-Maze procedure has evolved into the gold standard of treatment for medically refractory AF. In addition to the pulmonary vein isolation, the right and left atrial incisions of the Full-Maze procedure are designed to block potential macroreentrant pathways. According to the mechanisms of AF with valvular heart disease, the Full-Maze procedure is more effective for the patients than the pulmonary vein isolation alone.

  17. Superselective arterial infusion and concomitant radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Homma, Akihiro; Suzuki, Fumiyuki; Inuyama, Yukio; Fukuda, Satoshi [Hokkaido Univ., Sapporo (Japan). School of Medicine

    2003-05-01

    Superselective arterial infusion for patients with advanced head and neck cancer has been increasingly applied in Japan. We analyzed our experiences and evaluated the efficacy and safety of this treatment. Through October 1999 to March 2002, 29 patients, ranging in age between 33 and 71 years (median 52 years), received superselective intra-arterial infusion therapy of cisplatin (100-120 mg/m{sup 2}/week) with simultaneous intravenous infusion of thiosulfate for neutralizing cisplatin toxicity, and conventional concomitant extrabeam radiotherapy (65 Gy/26 f/6.5 weeks). Four patients were diagnosed with stage III and 25 with stage IV. Thirteen patients were considered contraindicated for surgery, and the other 16 patients rejected radical surgery. Primary tumor sites included paranasal sinus (11 patients), hypopharynx (7), oropharynx (6), oral cavity (4), and parotid gland (1). During the median follow-up period of 20 months, there was no apparent recurrence in 14 (48.3%) of 29 patients. Eleven (37.9%) patients died of disease, and three (10.3%) were alive with disease. In twenty-one patients (72.4%) the primary lesions were well-controlled. Acute toxic effects were moderate, and severe toxic events occurred in four cases, namely, methicillin-resistant staphylococcus aureus (MRSA) pneumonia, sepsis, tetraplasia, and osteoradionecrosis. We confirmed the effectiveness and safety of superselective arterial infusion and concomitant radiotherapy. Furthermore, we must establish the optimal procedures and schedule, as well as the indications for this treatment. This treatment protocol may improve the prognosis of patients with unresectable disease and patients rejecting surgical treatment. Further study in this particular area is needed. (author)

  18. Concomitant medication use and its implications on the hazard pattern in pharmacoepidemiological studies: example of antidepressants, benzodiazepines and fracture risk

    Directory of Open Access Journals (Sweden)

    Marie Louise De Bruin

    2015-09-01

    Full Text Available Background: Antidepressants and benzodiazepines are often co-prescribed and both associated with an increased fracture risk, albeit with distinctive hazard patterns. Timing of initiation of one with respect to the other and duration of use may influence the combined fracture hazard.The objective of our study was to describe patterns of concomitant use of benzodiazepine and antidepressants in terms of timing of initiation and duration and to illustrate the potential impact of various scenarios of timing of co-use on hip fracture hazard. Methods: Patients initiating antidepressant therapy (2002-2009 were identified from the Netherlands Primary Care Research Database. Concomitant benzodiazepine use was assessed according to the start time of benzodiazepine with respect to antidepressant therapy start. Duration of concomitant use was estimated relative to the length of antidepressant treatment episode. Results: Among 16,087 incident antidepressant users, 39.0% used benzodiazepines concomitantly during their first antidepressant treatment episode. The time of initiation of benzodiazepine use was variable (64.4% starting before, 13.7% simultaneous and 21.9% after antidepressants. Duration of concomitant use in the three groups varied. Conclusions: Co-prescribed medications with a common adverse event, may not only require accounting for concomitant use, but also the timing of start and duration of use as the overall hazard may vary accordingly.

  19. Preoperative chemoradiotherapy with capecitabine and oxaliplatin in locally advanced rectal cancer. A phase I-II multicenter study of the Dutch colorectal cancer group

    NARCIS (Netherlands)

    Hospers, Geke A.; Punt, Cornelis J. A.; Tesselaar, Margot E.; Cats, Annemieke; Havenga, Klaas; Leer, Jan W. H.; Marijnen, Corrie A.; Jansen, Edwin P.; Van Krieken, Han H. J. M.; Wiggers, Theo; de Velde, Cornelis J. H. Van; Mulder, Nanno H.

    2007-01-01

    Background: We studied the maximum tolerated dose (MTD) and efficacy of oxaliplatin added to capecitabine and radiotherapy (Capox-RT) as neoadjuvant therapy for rectal cancer. Methods: T3-4 rectal cancer patients received escalating doses of oxaliplatin (day 1 and 29) with a fixed dose of capecitabi

  20. Preoperative chemoradiotherapy with capecitabine and oxaliplatin in locally advanced rectal cancer. A phase I-II multicenter study of the Dutch Colorectal Cancer Group.

    NARCIS (Netherlands)

    Hospers, G.A.; Punt, C.J.A.; Tesselaar, M.E.; Cats, A.; Havenga, K.; Leer, J.W.H.; Marijnen, C.A.M.; Jansen, E.P.W.A.; Krieken, J.H.J.M. van; Wiggers, T.; Velde, C.J. van de; Mulder, N.H.

    2007-01-01

    BACKGROUND: We studied the maximum tolerated dose (MTD) and efficacy of oxaliplatin added to capecitabine and radiotherapy (Capox-RT) as neoadjuvant therapy for rectal cancer. METHODS: T3-4 rectal cancer patients received escalating doses of oxaliplatin (day 1 and 29) with a fixed dose of capecitabi

  1. A Phase I-II dose escalation study of fixed-dose rate gemcitabine, oxaliplatin and capecitabine every two weeks in advanced cholangiocarcinomas

    DEFF Research Database (Denmark)

    Lassen, Ulrik; Jensen, Lars Henrik; Sorensen, Morten;

    2011-01-01

    Gemcitabine based regimens have been widely used in patients with advanced cholangiocarcinoma (CC), but no standard therapy exists. In this study we aimed to find the maximally tolerated dose (MTD) of a two-week schedule of fixed dose rate (FDR) gemcitabine (G), oxaliplatin (O) and capecitabine (...

  2. A Phase I-II dose escalation study of fixed-dose rate gemcitabine, oxaliplatin and capecitabine every two weeks in advanced cholangiocarcinomas

    DEFF Research Database (Denmark)

    Lassen, Ulrik; Jensen, Lars Henrik; Sorensen, Morten;

    2011-01-01

    ) and capecitabine (C), and evaluate the safety and efficacy of this regimen in patients with advanced cholangiocarcinoma (CC). METHODS: In the Phase I part of the study a dose-escalation schedule of FDR G, O and C, administered every two weeks, was performed in patients with solid tumours and no other treatments...

  3. 19F MRSI of capecitabine in the liver at 7T using broadband transmit-receive antennas and dual-band RF pulses

    NARCIS (Netherlands)

    van Gorp, Sjoerd; Seevinck, Peter R.; Andreychenko, Anna; Raaijmakers, AJE; Luijten, Peter R.; Viergever, Max A.; Koopman, Miriam; Boer, Vincent O.; Klomp, Dennis W J

    2015-01-01

    Capecitabine (Cap) is an often prescribed chemotherapeutic agent, successfully used to cure some patients from cancer or reduce tumor burden for palliative care. However, the efficacy of the drug is limited, it is not known in advance who will respond to the drug and it can come with severe toxicity

  4. Phase II study of capecitabine as palliative treatment for patients with recurrent and metastatic squamous head and neck cancer after previous platinum-based treatment

    Science.gov (United States)

    Martinez-Trufero, J; Isla, D; Adansa, J C; Irigoyen, A; Hitt, R; Gil-Arnaiz, I; Lambea, J; Lecumberri, M J; Cruz, J J

    2010-01-01

    Background: Platinum-based therapy (PBT) is the standard therapy for recurrent and/or metastatic head and neck cancer (HNC), but the incidence of recurrence remains high. This study evaluates the efficacy and tolerability of capecitabine as palliative monotherapy for recurrent HNC previously treated with PBT. Methods: Patients aged 18–75 years, with Eastern Cooperative Oncology Group performance status 0–2, squamous HNC with locoregional and/or metastatic recurrence previously treated with PBT and adequate organ functions, were included. Capecitabine (1.250 mg m−2 BID) was administered on days 1–14 every 21 days for at least two cycles. Results: A total of 40 male patients with a median age of 58 years were analysed. All patients received a median number of four cycles of capecitabine (range: 1–9) and the median relative dose intensity was 91%. Seven patients were not evaluable for response. Overall response rate was 24.2%. Median time to progression and overall survival were 4.8 and 7.3 months, respectively. Haematological adverse events (AEs) grade 3/4 were reported in six patients. Most common grade 3/4 non-haematological AEs were asthenia (12.5%), palmar-plantar eritrodisestesia (10%), mucositis (10%), dysphagia (10%) and diarrhoea (7.5%). Conclusions: Capecitabine seems to be an active, feasible and well-tolerated mode of palliative treatment for advanced HNC patients who have previously received PBT schedules. PMID:20485287

  5. A Pooled Analysis of Gemcitabine Plus Docetaxel Versus Capecitabine Plus Docetaxel in Metastatic Breast Cancer

    Science.gov (United States)

    Seidman, Andrew D.; Chan, Stephen; Wang, Jin; Zhu, Chao; Xu, Cong

    2014-01-01

    Introduction. In two randomized phase III trials of patients with metastatic breast cancer (MBC), gemcitabine-docetaxel (GD) and capecitabine-docetaxel (CD) had similar efficacy, but distinct safety profiles. Methods. Data from two GD versus CD studies were pooled; overall survival (OS), progression-free survival (PFS), and overall response rate (ORR) were determined. Cox proportional hazards models identified prognostic factors associated with improved OS and PFS. Using a multivariate prognostic model incorporating identified adverse prognostic factors, we grouped MBC patients into low-, intermediate-, and high-risk categories. Hazard ratios (HRs) of GD over CD for OS and PFS were determined for subsets of patients. Results. Baseline demographics of the pooled population were mostly well balanced. In the pooled population, there were no significant differences between GD versus CD for OS (HR = 1.02; p = .824), PFS (HR = 1.15; p = .079), and ORR (p = .526). In the pooled crossover population, there were trends toward improved OS (HR = 0.82; p = .171) and PFS (HR = 0.93; p = .557) with GD. Several prognostic factors (including prior adjuvant taxane) for improved OS or PFS were identified; however, there were no significant interactions between treatment arms and prognostic factors for PFS or OS, except number of metastatic sites. In the prognostic model, median OS and PFS were numerically lower in the high-risk group versus the intermediate- and low-risk groups. Conclusion. This analysis confirms the lack of efficacy difference between GD and CD in the pooled population, crossover population, and almost all subpopulations. Several prognostic factors were associated with improved outcomes in the pooled population. PMID:24705980

  6. Evaluation of Outcome and Tolerability of Combination Chemotherapy with Capecitabine and Oxaliplatin as First Line Therapy in Advanced Gastric Cancer

    Science.gov (United States)

    Mashhadi, Mohammad Ali; Sepehri, Zahra; Bakhshipour, Ali Reza; Zivari, Ali; Danesh, Hossein Ali; Metanat, Hasan Ali; Karimkoshteh, Azra; Hashemi, Seyed Mehdi; Rahimi, Hossein; Kiani, Zohre

    2016-01-01

    Background: Combination chemotherapy is accepted as a high efficacy treatment for gastric cancer, whereas choice of standard treatment is unclear. Multiple chemotherapeutic regimens have been used to achieve higher efficacy and lower toxicity. This study was designed to evaluate the treatment results of advanced gastric cancer with Capecitabine and Oxaliplatin regimen. Subjects and Methods : All cases with documented gastric adenocarcinoma and advanced disease were candidates for receiving Xelox regimen (Capecitabine – 750 mg/m2/twice daily/ 1-14 days and Oxaliplatin 125 mg/m2 in 1st day). Results: Twenty five cases with advanced gastric cancer entered in study while 24 cases continued treatment protocol and were evaluated. Mean age was 59.5 ± 12.1 years (range: 20-75), male and female cases were 66.7% and 33.3%, respectively. All cases received at least four cycles of Xelox regimen. Overall response rate was 74.99% with 29.16% complete response. Overall survival rate was 13 ± 0.53 months and DFS (disease-free survival) was 6 ± 1.09 months. Extremities neuropathy (62.5%), headache (45.8%) and muscle cramps (29.2%) were the most common complains. Haematological changes were rare and 16.7% of cases had mild cytopenia. Treatment related death was not observed. Conclusion: Xelox regimen is a safe and highly effective first line treatment for gastric cancer; however, considering it as first line therapy needs larger studies. PMID:27928475

  7. Reports and document analysis on hypokalemia caused by capecitabine%卡培他滨导致低钾血症的临床分析

    Institute of Scientific and Technical Information of China (English)

    宋芳华; 单丹妮; 姜雪滨; 尹晓芹

    2014-01-01

    Objective To discuss the occurrence the reasons and the treatment of the hypokalemia caused by capecitabine.Methods The clinical data of 126 patients with colorectal cancer,stomach cancer and breast cancer in Xin-Hua hospital affliated to Dalian university treated only by Capecitabine (doses and appilication:1 000-1 250 mg/m2 every time,twice a day,continuing to the fourteenth day,and stopping in 7 days)were retrospectively analyzed,and all patients took Capecitabine more than 3 cycles and less than 10 cycles,then we discovered the patients with hypokalemia,and the occurrence,the reasons and the treatment of the hypokalemia caused by capecitabine were summarized and analyzed.Results The occurrence of the hypokalemia caused by capecitabine was 14.3% (18/126),and the occurrence of hypokalemia indirectly by capecitabine was 77.8% (14/18),and the occurrence of hypokalemia directly by capecitabine was 22.2% (4/18).The serum potassium returned to normality after treatment that potassium was supplemented by oral or intravenous drip,and no patients quited because of hypokalemia.Conclusions Capecitabine can directly lead to hypokalemia and capecitabine can also directly lead to hypokalemia.Doctors should make a point of the hypokalemia caused by capecitabine.%目的 探讨卡培他滨导致低钾血症的发生率、原因及治疗.方法 回顾性分析大连大学附属新华医院126例接受卡培他滨单药治疗(剂量及用法:每次1 000 ~1 250 mg/m2,每日2次,口服14 d,停用7d,21 d为1周期)的结直肠癌、胃癌、乳腺癌患者的临床资料,患者用药均超过3个周期,不超过10个周期,查找出其中出现低钾血症的患者,总结分析低钾血症的发生率、原因及治疗方法.结果 126例患者中,低钾血症发生率为14.3%(18/126),其中卡培他滨间接导致的低钾血症占77.8%(14/18),卡培他滨直接导致低钾血症占22.2%(4/18).经过及时的口服或静脉补钾治疗,患者的

  8. Preoperative oxaliplatin, capecitabine, and external beam radiotherapy in patients with newly diagnosed, primary operable, cT3NxMo, low rectal cancer. A phase II study

    Energy Technology Data Exchange (ETDEWEB)

    Oefner, Dietmar [Paracelsus Private Medical Univ., Salzburg (Austria). Dept. of Surgery; Innsbruck Medical Univ. (Austria). Dept. of Visceral, Transplant and Thoracic Surgery; DeVries, Alexander F. [Feldkirch Hospital (Austria). Dept. of Radio-Oncology; Schaberl-Moser, Renate [Medical Univ. Graz (AT). Div. of Oncology] (and others)

    2011-02-15

    Purpose: In patients with locally advanced rectal cancer (LARC), preoperative chemoradiation is known to improve local control, and down-staging of the tumor serves as a surrogate for survival. Intensification of the systemic therapy may lead to higher downstaging rates and, thus, enhance survival. This phase II study investigated the efficacy and safety of preoperative capecitabine and oxaliplatin in combination with radiotherapy. Patients and Methods: Patients with LARC of the mid and lower rectum, T3NxM0 staged by MRI received radiotherapy (total dose 45 Gy) in combination with oral capecitabine (825 mg/m{sup 2} twice a day on radiotherapy days; weeks 1-4) and oxaliplatin 50 mg/m{sup 2} intravenously (days 1, 8, 15, and 22). Efficacy was evaluated as rate of tumor down-categorization at the T level. Results: A total of 59 patients were enrolled (19 women, 40 men; median age of 61 years) and all were evaluable for efficacy and toxicity. Down-categorization at the T level was observed in 53% with pathological complete response in 6 patients (10%). Actual total radiotherapy, oxaliplatin and capecitabine doses received were 97%, 90%, and 93% of the protocol-specified preplanned doses, respectively. Grade 3/4 toxicity was observed in 15 patients (25%). The most frequent was diarrhea (12%). Conclusions: Preoperative chemoradiation with capecitabine and oxaliplatin is feasible in patients with MRI-proven cT3 LARC. The only clinically relevant toxicity was diarrhea. Overall, efficacy of the multimodality treatment was good, but not markedly exceeding that of 5-FU- or capecitabine-based chemoradiation approaches. (orig.)

  9. Standard Versus Continuous Administration of Capecitabine in Metastatic Breast Cancer (GEICAM/2009-05): A Randomized, Noninferiority Phase II Trial With a Pharmacogenetic Analysis

    Science.gov (United States)

    Martínez, Noelia; Ramos, Manuel; Calvo, Lourdes; Lluch, Ana; Zamora, Pilar; Muñoz, Montserrat; Carrasco, Eva; Caballero, Rosalía; García-Sáenz, José Ángel; Guerra, Eva; Caronia, Daniela; Casado, Antonio; Ruíz-Borrego, Manuel; Hernando, Blanca; Chacón, José Ignacio; De la Torre-Montero, Julio César; Jimeno, María Ángeles; Heras, Lucía; Alonso, Rosario; De la Haba, Juan; Pita, Guillermo; Constenla, Manuel; González-Neira, Anna

    2015-01-01

    Background. The approved capecitabine regimen as monotherapy in metastatic breast cancer (MBC) is 1,250 mg/m2 twice daily for 2 weeks on and 1 week off (Cint). Dose modifications are often required because of severe hand-foot syndrome (HFS). We tested a continuous regimen with a lower daily dose but a similar cumulative dose in an attempt to reduce the severity of adverse events (AEs) while maintaining efficacy. Methods. We randomized 195 patients with HER-2/neu-negative MBC to capecitabine 800 mg/m2 twice daily throughout the 21-day cycle (Ccont) or to Cint to assess noninferiority in the percentage of patients free of progression at 1 year. Secondary endpoints included efficacy and safety. Associations between polymorphisms in capecitabine metabolism-related genes and drug response were assessed. Results. The percentage of patients free of progression at 1 year was 27.3% with Cint versus 25.3% with Ccont (difference of −2.0%; 95% confidence interval: −15.5% to 11.5%, exceeding the 15% deemed noninferior). Differences regarding other efficacy variables were also not found. Grade 3–4 HFS was the most frequent AE (41.1% in Cint vs. 42.3% in Ccont). Grade 3–4 neutropenia, thrombocytopenia, diarrhea, and stomatitis were more frequent with Cint. A 5′ untranslated region polymorphism in the carboxylesterase 2 gene was associated with HFS. One polymorphism in cytidine deaminase and two in thymidine phosphorylase were associated with survival. Conclusion. Our study was unable to show noninferiority with the continuous capecitabine regimen (Ccont) compared with the approved intermittent regimen (Cint). Further investigation is required to improve HFS. Polymorphisms in several genes might contribute to interindividual differences in response to capecitabine. PMID:25601966

  10. Concomitant overdosing of other drugs in patients with paracetamol poisoning

    DEFF Research Database (Denmark)

    Schmidt, Lars E; Dalhoff, Kim

    2002-01-01

    ), acetylsalicylic acid (33 cases), and NSAID (32 cases) predominated. Concomitant benzodiazepine overdose was an independent risk factor in the development of hepatic encephalopathy (odds ratio [OR] 1.91; CI 1.00, 3.65) and renal dysfunction (OR 1.81; CI 1.00, 3.22). Concomitant overdosing of opioid analgesics...... was a protective factor in the development of hepatic encephalopathy (OR 0.26; CI 0.07, 0.96). Concomitant acetylsalicylic acid overdose was a risk factor in the development of hepatic encephalopathy (OR 4.87; CI 1.52, 15.7) and death or liver transplantation (OR 6.04; CI 1.69, 21.6). A tendency towards a more...... favourable outcome was observed in patients with concomitant NSAID overdose. CONCLUSIONS: Concomitant overdosing of benzodiazepines or analgesics is frequent in patients admitted with paracetamol poisoning. Concomitant benzodiazepine or acetylsalicylic acid overdose was associated with more severe toxicity...

  11. Final results of a phase I/II pilot study of capecitabine with or without vinorelbine after sequential dose-dense epirubicin and paclitaxel in high-risk early breast cancer

    Directory of Open Access Journals (Sweden)

    Müller Volkmar

    2010-08-01

    Full Text Available Abstract Background The integration of the non-cross-resistant chemotherapeutic agents capecitabine and vinorelbine into an intensified dose-dense sequential anthracycline- and taxane-containing regimen in high-risk early breast cancer (EBC could improve efficacy, but this combination was not examined in this context so far. Methods Patients with stage II/IIIA EBC (four or more positive lymph nodes received post-operative intensified dose-dense sequential epirubicin (150 mg/m² every 2 weeks and paclitaxel (225 mg/m² every 2 weeks with filgrastim and darbepoetin alfa, followed by capecitabine alone (dose levels 1 and 3 or with vinorelbine (dose levels 2 and 4. Capecitabine was given on days 1-14 every 21 days at 1000 or 1250 mg/m2 twice daily (dose levels 1/2 and 3/4, respectively. Vinorelbine 25 mg/m2 was given on days 1 and 8 of each 21-day course (dose levels 2 and 4. Results Fifty-one patients were treated. There was one dose-limiting toxicity (DLT at dose level 1. At dose level 2 (capecitabine and vinorelbine, five of 10 patients experienced DLTs. Therefore evaluation of vinorelbine was abandoned and dose level 3 (capecitabine monotherapy was expanded. Hand-foot syndrome and diarrhoea were dose limiting with capecitabine 1250 mg/m2 twice daily. At 35.2 months' median follow-up, the estimated 3-year relapse-free and overall survival rates were 82% and 91%, respectively. Conclusions Administration of capecitabine monotherapy after sequential dose-dense epirubicin and paclitaxel is feasible in node-positive EBC, while the combination of capecitabine and vinorelbine as used here caused more DLTs. Trial registration Current Controlled Trials ISRCTN38983527.

  12. Feasibility of capecitabine immunotherapy in a taxane-refractory metastatic breast cancer patient: A rural cancer hospital experience

    Directory of Open Access Journals (Sweden)

    Vivek Tiwari

    2014-05-01

    Full Text Available To manage a metastatic cancer patient in a rural setting is a daunting task owing to the lack of resources and infrastructure. Intravenous chemotherapy (CT, with its debilitating side effects, often causes a decrease in the quality of life (QOL of the patient. When the treatment is of palliative intent, efforts should be made to provide maximum symptom relief to the patient, striking a balance between the patient’s wishes and a sound scientific rationale. We describe our experience with a patient with extensively metastatic breast cancer treated in our rural center with single-agent oral capecitabine, without development of any severe toxicity and with a significant improvement in disease process and patient’s performance status (PS.

  13. [Neoadjuvant chemotherapy with capecitabine plus oxaliplatin and bevacizumab for the treatment of patients with resectable metastatic colorectal cancer].

    Science.gov (United States)

    Kemmochi, Takeshi; Egawa, Tomohisa; Mihara, Koki; Ito, Yasuhiro; Ohkubo, Yusuke; Mori, Takayuki; Nagashima, Atsushi; Makino, Hiroyuki; Yamamuro, Wataru

    2013-11-01

    We analyzed the clinical efficacy and safety of capecitabine plus oxaliplatin( XELOX) and bevacizumab( BV) as neoadjuvant chemotherapy, administered for the treatment of patients with resectable metastatic colorectal cancer between October 2009 and December 2012. Of the 15 patients who received chemotherapy, 9 received XELOX plus BV and 6 patients received XELOX alone. The median number of therapy courses was 4. The overall response rate was 73.3%. All patients underwent R0 resection. The median disease-free survival was 522 days. The median follow-up time was 607 days. No major Grade 3 or 4 adverse events occurred during chemotherapy and no perioperative complications were noted. Our findings suggest that XELOX (plus BV) as neoadjuvant therapy is useful for the prevention of early recurrence and is clinically efficacious and safe for the treatment of colorectal cancer with resectable metastases.

  14. Concomitant occurrence of Turner syndrome and growth hormone deficiency.

    Science.gov (United States)

    Yu, Jung; Shin, Ha Young; Lee, Chong Guk; Kim, Jae Hyun

    2016-11-01

    Turner syndrome (TS) is a genetic disorder in phenotypic females that has characteristic physical features and presents as partial or complete absence of the second sex chromosome. Growth hormone deficiency (GHD) is a condition caused by insufficient release of growth hormone from the pituitary gland. The concomitant occurrence of TS and GHD is rare and has not yet been reported in Korea. Here we report 2 cases of TS and GHD. In case 1, GHD was initially diagnosed. Karyotyping was performed because of the presence of the typical phenotype and poor response to growth hormone therapy, which revealed 45,X/45,X+mar. The patient showed increased growth velocity after the growth hormone dose was increased. In case 2, a growth hormone provocation test and chromosomal analysis were performed simultaneously because of decreased growth velocity and the typical TS phenotype, which showed GHD and a mosaic karyotype of 45,X/46,XX. The patient showed spontaneous pubertal development. In female patients with short stature, it is important to perform a throughout physical examination and test for hormonal and chromosomal abnormalities because diagnostic accuracy is important for treatment and prognosis.

  15. Hyperkalemia with concomitant watery diarrhea: an unusual association.

    Science.gov (United States)

    Taylor, Jeremy G C; Zwillich, Clifford W; Kaehny, William D; Levi, Moshe; Popovtzer, Mordecai M

    2003-08-01

    Four patients presented to the emergency room with life-threatening hyperkalemia and concomitant watery diarrhea. Hypovolemia, acidosis, and renal insufficiency were present in all 4 cases. In 2 patients, hyperkalemia followed initiation of angiotensin-converting enzyme (ACE) inhibitor therapy, whereas 1 patient experienced hyperkalemia after a dose increase of an ACE inhibitor, and the fourth patient was on continuous ACE-inhibitor therapy at the time of the hyperkalemia episode. Two of the 3 patients with functioning kidneys required hemodialysis to correct the hyperkalemia, whereas the other patient was on long-term hemodialysis therapy. In the 2 patients in whom transtubular potassium (K+) gradients were available, their values ranged far below normal, indicating tubular failure to secrete K+. This abnormality was attributed to decreased distal delivery of sodium and water and to renin/angiotensin II/aldosterone blockade. It has been proposed that aldosterone blockade impairs the capacity of the colonic epithelial cells to secrete K+. In all 4 patients the watery diarrhea ceased in parallel with the correction of serum K+ to normal values. It is suggested that hyperkalemia, most likely by stimulating intestinal motility, induced the watery diarrhea in all 4 patients. The watery diarrhea, however, failed to compensate for the renal tubular failure to secrete K+.

  16. Phase II study of short-time oxaliplatin, capecitabine and epirubicin (EXE) as first-line therapy in patients with non-resectable gastric cancer

    DEFF Research Database (Denmark)

    Schonnemann, K.R.; Jensen, H.A.; Yilmaz, M.

    2008-01-01

    Epirubicin, cisplatin and continuous infusion of 5-FU is a widely used palliative regimen in patients with gastric cancer. If cisplatin is substituted by oxaliplatin and 5-FU by capecitabine this regimen can be administered in the outpatient setting. Dose-limiting toxicity of oxaliplatin...... is peripheral sensory neuropathy and it is recommended to give oxaliplatin as a 120 min infusion. However, in patients with colorectal cancer a 30 min infusion of oxaliplatin can safely be administered without increasing neurotoxicity, standard infusion time is 30 min at our departments. In our phase I study...... the recommended doses of EXE was established (Dupont et al, 2006). Patients with non-resectable gastric adenocarcinoma were eligible. Patients received EXE (epirubicin 50 mg m(-2) day 1; capecitabine 1000 mg m(-2) day(-1) continuously and oxaliplatin 130 mg m(-2) day 1) as outpatient therapy every third week...

  17. Capecitabine-related intracranial hypotension syndrome mimicking dural metastasis in a breast cancer patient: Case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Cosar-Alas Rusen

    2010-01-01

    Full Text Available Spontaneous intracranial hypotension (SICH is an entity, which is secondary to iatrogenic manipulation and breaching of dura. Postural headache in patients should be suspected, cranial magnetic resonance imaging (MRI is essential for precise diagnosis. Hallmark of MRI is regular shape of pachymeningeal gadolinium enhancement and subdural effusion. It may mimic central nervous system (CNS metastasis. Prevention of such cases from receiving cranial radiotherapy by misinterpretation of the gadolinium enhancement as CNS metastasis is an important issue. Capecitabine is an antineoplastic agent, of which metabolites can cross blood-brain barrier in CNS via epithelial tissue. It may cause decrease in CSF production. SICH might be the clinical reflection of this decrease in CSF production. Review of the English literature revealed limited data because of the very little experience with oncologic patients suffering from intracranial hypotension. We report a case of spontaneous intracranial hypotension during capecitabine treatment. Patient was completely well following drug discontinuation and supportive treatment.

  18. Nursing of patients undergoing chemotherapy with capecitabine%应用卡培他滨化疗患者的护理

    Institute of Scientific and Technical Information of China (English)

    王芬; 金美娟

    2008-01-01

    Objective To discuss the adverse effect caused by capecitabine chemotherapy and its nuning measures.Methods A retrospective analysis was carried out for the adverse effect,occurrence regularity and nursing measures in 58 patients undergoing chemotherapy with capecitabine from June 2004 to December 2007.Results Handfoot syndrome happened in 30 cases,nausea and vomiting 23 cases,diarrhea 20 cases and stomatitis 15 cases in 58 patients.After positive prevention and effective nursing 57 patients successfully accomplished capecitabine chemotherapy.Only one patient withdrew due to grade 3 handfoot syndrome.Conclusions Positive prevention and eady detection and treatment can alleviate the adverse effect of capecitabine chemotherapy,so the psychological burden of patients can be relieved.%目的 探讨卡培他滨化疗所引起的不良反应及护理对策.方法 回顾性分析2004年6月-2007年12月58例应用卡培他滨化疗患者发生的不良反应、发生规律和护理对策. 结果 58例患者中发生手足综合征30例,恶心呕吐23例,腹泻20例,口腔炎15例.经积极的预防和有效护理,57例患者顺利完成卡培他滨治疗,仅1例因3级手足综合征而停用卡培他滨. 结论 积极的预防,早期发现处理可明显缓解卡培他滨治疗常见不良反应症状,减轻患者的心理负担.

  19. Re-irradiation combined with capecitabine in locally recurrent squamous cell carcinoma of the head and neck. A prospective phase II trial

    Energy Technology Data Exchange (ETDEWEB)

    Vormittag, L.; Kornek, G. [Medical Univ. Vienna (Austria). Div. of Clinical Oncology; Lemaire, C.; Radonjic, D.; Selzer, E. [Medical Univ. Vienna (Austria). Dept. for Radiotherapy and Radiobiology

    2012-03-15

    We performed a prospective phase II trial to investigate the safety and efficacy of radiotherapy combined with capecitabine in patients suffering from a recurrence of a squamous cell carcinoma of the head and neck (SCCHN) within a previously irradiated field. A total of 31 evaluable patients with recurrent SCCHN received re-irradiation with a total dose of 50 Gy (25 fractions over 5 weeks) up to a maximum of 60 Gy combined with 900 mg/m{sup 2}/day capecitabine given on the days of radiotherapy. The median time to relapse after the first course of radiotherapy was 15 months. The overall response rate in our study was 68% including 6 patients with a complete response. The median overall survival was 8.4 months. Grade 3 or 4 mucositis occurred in 4 patients and 1 patient, respectively. No grade 4 hematological toxicities were observed; 1 patient had grade 3 anemia. The cumulative median lifetime dose was 116 Gy. Capecitabine combined with re-irradiation is a well-tolerated treatment in patients with recurrent SCCHN. In light of its good tolerability, it appears to be a potential option for patients with a reduced performance status and may also serve as a basis for novel treatment concepts, such as in combination with targeted therapies.

  20. Report on short-term side effects of treatments with {sup 177}Lu-octreotate in combination with capecitabine in seven patients with gastroenteropancreatic neuroendocrine tumours

    Energy Technology Data Exchange (ETDEWEB)

    Essen, Martijn van; Kam, Boen L.; Kwekkeboom, Dik J. [Erasmus MC, Department of Nuclear Medicine, Rotterdam (Netherlands); Krenning, Eric P. [Erasmus MC, Department of Nuclear Medicine, Rotterdam (Netherlands); Erasmus MC, Department of Internal Medicine, Rotterdam (Netherlands); Herder, Wouter W. de; Aken, Maarten O. van [Erasmus MC, Department of Internal Medicine, Rotterdam (Netherlands)

    2008-04-15

    Treatment with the radiolabelled somatostatin analogue {sup 177}Lu-octreotate results in tumour remission in 47% of patients with gastroenteropancreatic neuroendocrine tumours. Adding capecitabine to {sup 177}Lu-octreotate, as a radio-sensitiser, may enhance these anti-tumour effects. We now present the short-term toxicity profile of this novel combination. Seven patients were treated with 7.4 GBq {sup 177}Lu-octreotate and capecitabine (1650 mg/m{sup 2} per day) for 2 weeks with an intended number of four cycles. Toxicity, and especially haematological and renal parameters, were monitored on a weekly basis for the first two cycles and 4 and 6 weeks after subsequent cycles. None of the patients had hand-foot syndrome. One patient had grade 1 stomatitis occurring after one of four cycles. Grade 3 or 4 leukopenia or neutropenia did not occur. One patient had grade 3 anaemia, but none had grade 4 anaemia. One patient had grade 2 thrombocytopenia after the fourth cycle, and one had grade 3 thrombocytopenia. Grade 4 thrombocytopenia did not occur. No significant changes in serum creatinine levels were observed. None of the patients had symptoms of cardiac ischaemia. Treatment with the combination of {sup 177}Lu-octreotate and capecitabine was feasible and safe considering acute and subacute side effects. We therefore started a randomised, controlled clinical trial to compare this combination with {sup 177}Lu-octreotate as single agent with regard to anti-tumour effects and side effects. (orig.)

  1. Concomitant Urothelial Cancer and Renal Tuberculosis

    Directory of Open Access Journals (Sweden)

    Sheray N. Chin

    2014-01-01

    Full Text Available We report a case of coexisting urothelial cancer and renal tuberculosis in the same kidney. The patient is a 72-year-old female with a remote history of treated pulmonary tuberculosis who presented with haematuria, initial investigation of which elucidated no definitive cause. Almost 1 year later, a diagnosis of metastatic urinary tract cancer was made. The patient received chemotherapy for advanced collecting duct type renal cell carcinoma, based on histological features of renal biopsy. Subsequent confirmatory immunostains however led to a revised diagnosis of urothelial cancer, necessitating a change in chemotherapy regimen. A diagnosis of ipsilateral renal tuberculosis was made based on TB-PCR testing of renal biopsy tissue and anti-TB therapy was coadministered with chemotherapy. The patient died 9 months after diagnosis of metastatic urothelial cancer.

  2. Congenital Cases of Concomitant Harlequin and Horner Syndromes.

    Science.gov (United States)

    Miquel, Juliette; Piyaraly, Saguiraly; Dupuy, Alain; Cochat, Pierre; Phan, Alice

    2017-03-01

    We report three pediatric cases of concomitant congenital Horner and Harlequin syndromes. This association suggests a lesion at the superior cervical ganglion or just inferior. Often, no underlying lesion is documented.

  3. Concomitant pseudomembranous colitis in colonic resection for acute diverticulitis.

    Science.gov (United States)

    Byrns, Simon; Canterbury, Laura A

    2015-06-01

    Diverticulitis and Clostridium difficile infection (CDI) are common conditions in the surgical population. However, they are usually 2 distinct clinical entities. Here, we report the case of acute diverticulitis with concomitant pseudomembranous colitis, presumably due to CDI. The clinical course as well as gross and microscopic pathology findings are discussed. A literature search revealed a single previous report of these findings concomitant in a surgical specimen. A brief discussion of the pathophysiology of CDI and acute diverticulitis is included.

  4. Comparison of the effectiveness and toxicity of neoadjuvant chemotherapy regimens, capecitabine/epirubicin/cyclophosphamide vs 5-fluorouracil/epirubicin/cyclophosphamide, followed by adjuvant, capecitabine/docetaxel vs docetaxel, in patients with operable breast cancer

    Directory of Open Access Journals (Sweden)

    Zhang MM

    2016-06-01

    Full Text Available Minmin Zhang,* Wei Wei,* Jianlun Liu, Huawei Yang, Yi Jiang, Wei Tang, Qiuyun Li, Xiaoming Liao Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China *These authors contributed equally to this work Abstract: The aim of this study was to compare the effectiveness and toxicity of neoadjuvant chemotherapy regimens, xeloda/epirubicin/cyclophosphamide (XEC vs 5-fluorouracil/epirubicin/cyclophosphamide (FEC, followed by adjuvant chemotherapy regimens, capecitabine/taxotere (XT vs taxotere (T, in axillary lymph node (LN-positive early-stage breast cancer. In this randomized, Phase III trial, 137 patients with operable primary breast cancer (T2-0, N0-1 who were tested axillary LN positive through aspiration biopsy of axillary LNs were randomized (1:1 to four 3-weekly cycles of XEC or FEC. Patients underwent surgery within 4–6 weeks after the fourth cycle, followed by four adjuvant cycles of 3-weekly XT or T. The primary end point was tumor pathological complete response. Toxicity profiles were secondary objectives. In total, 131 patients had clinical and radiological evaluation of response and underwent surgery. Treatment with XEC led to an increased rate of pathological complete response in primary tumor (18% vs 6%, respectively, P=0.027 and objective remission rate (87% vs 73%, P=0.048 compared to FEC. Clinical complete response occurred in 20% and 7% for XEC and FEC, respectively. Compared to FEC, XEC was associated with more hand-foot syndrome (57% vs 11%, P<0.001 and 3/4 grade nausea/vomiting/diarrhea (30% vs 14%, P=0.034 but less phlebitis (3% vs 14%, P=0.035. XT and T adjuvant chemotherapy regimens were well tolerated: treatment-related 3/4 grade adverse events occurred in 28% and 17% of patients receiving XT and T, respectively. Keywords: breast cancer, capecitabine, docetaxel, neoadjuvant chemotherapy, curative effect, toxic side effects

  5. Concomitant medication use and its implications on the hazard pattern in pharmacoepidemiological studies: example of antidepressants, benzodiazepines and fracture risk

    OpenAIRE

    2015-01-01

    Background: Antidepressants and benzodiazepines are often co-prescribed and both associated with an increased fracture risk, albeit with distinctive hazard patterns. Timing of initiation of one with respect to the other and duration of use may influence the combined fracture hazard.The objective of our study was to describe patterns of concomitant use of benzodiazepine and antidepressants in terms of timing of initiation and duration and to illustrate the potential impact of various scenarios...

  6. Concomitant medication use and its implications on the hazard pattern in pharmacoepidemiological studies : Example of antidepressants, benzodiazepines and fracture risk

    OpenAIRE

    2015-01-01

    Background: Antidepressants and benzodiazepines are often co-prescribed and both associated with an increased fracture risk, albeit with distinctive hazard patterns. Timing of initiation of one with respect to the other and duration of use may influence the combined fracture hazard. The objective of our study was to describe patterns of concomitant use of benzodiazepine and antidepressants in terms of timing of initiation and duration and to illustrate the potential impact of various scenario...

  7. [Combined physiotherapy of patients with dorsopathies and concomitant osteoarthrosis].

    Science.gov (United States)

    Miriutova, N F; Zaĭtsev, A A; Popova, A V; Mikhaĭlova, E V

    2011-01-01

    The combined treatment of patients presenting with dorsopathies and concomitant osteoarthrosis using magnetic stimulation, ultrasonic and peloidotherapy was shown to promote the recovery of the locomotor function of the vertebral column and the affected limb joints, alleviate pain sensation, and exert anti-inflammatory effect. Moreover, it contributed to the improvement of the overall orthopedic situation in the region. The inclusion of vibrotraction in the combined treatment of patients presenting with dorsopathies and concomitant osteoarthrosis resulted in a marked decrease of the severity of static and dynamic disturbances of the spine, increase in the activity of spinal muscles, extension of the range of locomotor movements, and improvement of working ability of the patients.

  8. Dental trauma. Combination injuries 2. The risk of pulp necrosis in permanent teeth with subluxation injuries and concomitant crown fractures

    DEFF Research Database (Denmark)

    Lauridsen, Eva Fejerskov; Hermann, Nuno Vibe; Gerds, Thomas Alexander;

    2012-01-01

    The reported risk of pulp necrosis (PN) is generally low in teeth with subluxation injuries. A concomitant crown fracture may increase the risk of PN in such teeth. Aim:  To analyse the influence of a concomitant trauma-related infraction, enamel-, enamel–dentin- or enamel–dentin–pulp fracture...... age, crown fracture type, mobility and response to an electric pulp test (EPT) at the initial examination. Results:  Teeth with immature root development: The risk of PN was increased in teeth with a concomitant enamel fracture (log-rank test: P = 0.002), enamel–dentin fracture (log-rank test: P ....0001), enamel–dentin–pulp fracture (log-rank test: P

  9. Immobilization of Neutral Protease from Bacillus subtilis for Regioselective Hydrolysis of Acetylated Nucleosides: Application to Capecitabine Synthesis

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    Teodora Bavaro

    2016-11-01

    Full Text Available This paper describes the immobilization of the neutral protease from Bacillus subtilis and its application in the regioselective hydrolysis of acetylated nucleosides, including building blocks useful for the preparation of anticancer products. Regarding the immobilization study, different results have been obtained depending on the immobilization procedure. Epoxy hydrophobic carriers gave a poorly stable derivative that released almost 50% of the immobilized protein under the required reaction conditions. On the contrary, covalent immobilization on a differently activated hydrophilic carrier (agarose resulted in very stable enzyme derivatives. In an attempt to explain the obtained enzyme immobilization results, the hypothetical localization of lysines on the enzyme surface was predicted in a 3D structure model of B. subtilis protease N built in silico by using the structure of Staphylococcus aureus metalloproteinase as the template. The immobilized enzyme shown a high regioselectivity in the hydrolysis of different peracetylated nucleosides. A stable enzyme derivative was obtained and successfully used in the development of efficient preparative bioprocesses for the hydrolysis of acetylated nucleosides, giving new intermediates for the synthesis of capecitabine in high yield.

  10. Laparoendoscopic Rendezvous for Concomitant Cholecystocholedocholithiasis: A Successful Modality Even in the Most Difficult Presentations Including Pregnancy

    Science.gov (United States)

    Mikwar, Zaher Abdulaziz; Ahmad, Akram Neyaz

    2016-01-01

    Background. Laparoendoscopic rendezvous (LERV) technique is emerging as an attractive treatment option for concomitant cholecystocholedocholithiasis. In this paper, we report our experience in performing the LERV technique in patients with unusual presentations in terms of anatomical difficulty, pregnancy, multiple comorbid diseases, and postlaparotomy. We aim to highlight the effectiveness of the LERV technique in some clinical situations where conventional methods would fail or carry high risks in adequately managing concomitant cholecystocholedocholithiasis. Methods. Four patients diagnosed to have concomitant cholecystocholedocholithiasis with associated difficult presentation or comorbid diseases were treated using the LERV technique. One patient presented with difficult anatomy where ERCP failed at initial attempts. Another patient was pregnant (first trimester). A third patient had complex comorbid diseases (bronchial asthma, hypertension, congestive heart failure, and end-stage renal disease on regular hemodialysis). A fourth patient had previous laparotomy and sigmoidectomy for diverticular disease and had severe hospital phobia. Results. All patients tolerated the LERV technique very well; no intraoperative occurrence was reported. The mean operative time was 86.3 ± 17.2 minutes; mean time of the endoscopic part was 29.4 ± 3.57 minutes. The mean blood loss was 44.3 ± 18.2 mL (range 20–85). Residual stone, postoperative complications, postoperative morbidity, and postoperative mortality were 0 (0%). Postoperative short hospital stay was reported in all patients, average 3 days (range 2–4). Conclusion. LERV procedure is a safe and effective treatment option for the management of concomitant cholecystocholedocholithiasis, even in difficult situations where other methods would fail or carry high risks, or in patients presenting with severe comorbid diseases or pregnancy. This procedure may emerge as an attractive alternative option for high

  11. Laparoendoscopic Rendezvous for Concomitant Cholecystocholedocholithiasis: A Successful Modality Even in the Most Difficult Presentations Including Pregnancy

    Directory of Open Access Journals (Sweden)

    Bader Hamza Shirah

    2016-01-01

    Full Text Available Background. Laparoendoscopic rendezvous (LERV technique is emerging as an attractive treatment option for concomitant cholecystocholedocholithiasis. In this paper, we report our experience in performing the LERV technique in patients with unusual presentations in terms of anatomical difficulty, pregnancy, multiple comorbid diseases, and postlaparotomy. We aim to highlight the effectiveness of the LERV technique in some clinical situations where conventional methods would fail or carry high risks in adequately managing concomitant cholecystocholedocholithiasis. Methods. Four patients diagnosed to have concomitant cholecystocholedocholithiasis with associated difficult presentation or comorbid diseases were treated using the LERV technique. One patient presented with difficult anatomy where ERCP failed at initial attempts. Another patient was pregnant (first trimester. A third patient had complex comorbid diseases (bronchial asthma, hypertension, congestive heart failure, and end-stage renal disease on regular hemodialysis. A fourth patient had previous laparotomy and sigmoidectomy for diverticular disease and had severe hospital phobia. Results. All patients tolerated the LERV technique very well; no intraoperative occurrence was reported. The mean operative time was 86.3±17.2 minutes; mean time of the endoscopic part was 29.4±3.57 minutes. The mean blood loss was 44.3±18.2 mL (range 20–85. Residual stone, postoperative complications, postoperative morbidity, and postoperative mortality were 0 (0%. Postoperative short hospital stay was reported in all patients, average 3 days (range 2–4. Conclusion. LERV procedure is a safe and effective treatment option for the management of concomitant cholecystocholedocholithiasis, even in difficult situations where other methods would fail or carry high risks, or in patients presenting with severe comorbid diseases or pregnancy. This procedure may emerge as an attractive alternative option for high

  12. Management of pelvic fractures with concomitant urologic injuries.

    Science.gov (United States)

    Taffet, R

    1997-07-01

    Controversy exists regarding the management of pelvic fractures with concomitant injuries to the lower urologic tract. This can be seen in both the urologic and orthopedic literature as it pertains to the ideal form of treatment for either problem and the timing of surgical intervention, if it is needed. This article reviews the anatomy, mechanism of injury, diagnostic approach, and treatment.

  13. Concomitant sublay mesh repair of umbilical hernia and abdominoplasty

    OpenAIRE

    2012-01-01

    Concomitant mesh repair of large umbilical hernias and abdominoplasty pose a serious risk of devascularizing the umbilical stalk. A technique of placing mesh in a sublay manner, deep to the fascial defect, for an umbilical herniorrhaphy to avoid damage to the deep umbilical perforators during an abdominoplasty is described.

  14. Black esophagus with concomitant candidiasis developed after diabetic ketoacidosis

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Black esophagus is a very rare disease and its pathogenesis has been unclear. Black esophagus developed concomitantly with candidiasis after diabetic ketoacidosis has not been reported yet. We report a case who developed esophageal stricture after the treatment of black esophagus and thus balloon dilatation was performed several times but failed, hence, surgical treatment was performed.

  15. Concomitant crystallization for in situ encapsulation of organic materials

    NARCIS (Netherlands)

    Reus, M.A.; Hoetmer, G.; Heijden, A.E.D.M. van der; Horst, J.H. ter

    2014-01-01

    Concomitant crystallization leads to process intensification through the synergistic combination of the partial processes of particle formation and encapsulation within a single process step. Both cooling and electrospray crystallization in multi-component solutions were used to create (sub-)micron

  16. A Retrospective Study of Capecitabine/Temozolomide (CAPTEM Regimen in the Treatment of Metastatic Pancreatic Neuroendocrine Tumors (pNETs after Failing Previous Therapy

    Directory of Open Access Journals (Sweden)

    Muhammad Wasif Saif

    2013-09-01

    Full Text Available Context Pancreatic neuroendocrine tumors (pNETs are notoriously resistant to currently available chemotherapy agents.Preclinical data has suggested synergy between temozolomide and capecitabine. Objective To report a retrospective data on the efficacy and safety of capecitabine and temozolomide (CAPTEM regimen in patients with metastatic pancreaticneuroendocrine tumors (pNETs who have failed prior therapies. Methods We reviewed the medical records of 7 patientswith metastatic pNETs who had had progressive cancer prior to treatment despite therapy, including long-acting releaseoctreotide (60 mg/month, chemotherapy and hepatic chemoembolization. Capecitabine was administered at a flat dose of1,000 mg orally twice daily on days 1-14 and temozolomide 200 mg/m2 was given in two divided doses daily on days 10-14of a 28-day cycle. Tumor assessments were repeated every two cycles and serum tumor markers were measured every cycle. Response to treatment was assessed using Response Evaluation Criteria in Solid Tumors (RECIST parameters, and toxicity was graded using the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE, version 3.0. Results Among 7 patients treated, three patients achieved a partial response, and two patients had stable disease. Totalresponse rate was 43%, and clinical benefit (responders and stable disease was 71%. Median duration of response was 8months (range: 4-12 months. Grade 3 and 4 toxicities included grade 3 thrombocytopenia in one patient and grade 3 fatigue in one patient. The most common toxicities were grade 1 and 2 neutropenia, grade 1 fatigue, grade 1 and 2 hand-foot syndrome. Conclusions Our retrospective study showed that modified CAPTEM regimen was well-tolerated and produced comparable response to historical data in neuroendocrine tumors, including pNETs. Our study is unique as it only included patients with pNETs. Further prospective studies are warranted to evaluate the combination of

  17. Comparison of the effectiveness and toxicity of neoadjuvant chemotherapy regimens, capecitabine/epirubicin/cyclophosphamide vs 5-fluorouracil/epirubicin/cyclophosphamide, followed by adjuvant, capecitabine/docetaxel vs docetaxel, in patients with operable breast cancer

    Science.gov (United States)

    Zhang, Minmin; Wei, Wei; Liu, Jianlun; Yang, Huawei; Jiang, Yi; Tang, Wei; Li, Qiuyun; Liao, Xiaoming

    2016-01-01

    The aim of this study was to compare the effectiveness and toxicity of neoadjuvant chemotherapy regimens, xeloda/epirubicin/cyclophosphamide (XEC) vs 5-fluorouracil/epirubicin/cyclophosphamide (FEC), followed by adjuvant chemotherapy regimens, capecitabine/taxotere (XT) vs taxotere (T), in axillary lymph node (LN)-positive early-stage breast cancer. In this randomized, Phase III trial, 137 patients with operable primary breast cancer (T2-0, N0-1) who were tested axillary LN positive through aspiration biopsy of axillary LNs were randomized (1:1) to four 3-weekly cycles of XEC or FEC. Patients underwent surgery within 4–6 weeks after the fourth cycle, followed by four adjuvant cycles of 3-weekly XT or T. The primary end point was tumor pathological complete response. Toxicity profiles were secondary objectives. In total, 131 patients had clinical and radiological evaluation of response and underwent surgery. Treatment with XEC led to an increased rate of pathological complete response in primary tumor (18% vs 6%, respectively, P=0.027) and objective remission rate (87% vs 73%, P=0.048) compared to FEC. Clinical complete response occurred in 20% and 7% for XEC and FEC, respectively. Compared to FEC, XEC was associated with more hand-foot syndrome (57% vs 11%, P<0.001) and 3/4 grade nausea/vomiting/diarrhea (30% vs 14%, P=0.034) but less phlebitis (3% vs 14%, P=0.035). XT and T adjuvant chemotherapy regimens were well tolerated: treatment-related 3/4 grade adverse events occurred in 28% and 17% of patients receiving XT and T, respectively. PMID:27354816

  18. NEOSCOPE: a randomised Phase II study of induction chemotherapy followed by either oxaliplatin/capecitabine or paclitaxel/carboplatin based chemoradiation as pre-operative regimen for resectable oesophageal adenocarcinoma

    NARCIS (Netherlands)

    Mukherjee, Somnath; Hurt, Christopher N; Gwynne, Sarah; Bateman, Andrew; Gollins, Simon; Radhakrishna, Ganesh; Hawkins, Maria; Canham, Jo; Lewis, Wyn; Grabsch, Heike I; Sharma, Ricky A; Wade, Wendy; Maggs, Rhydian; Tranter, Bethan; Roberts, Ashley; Sebag-Montefiore, David; Maughan, Timothy; Griffiths, Gareth; Crosby, Tom

    2015-01-01

    BACKGROUND Both oxaliplatin/capecitabine-based chemoradiation (OXCAP-RT) and carboplatin-paclitaxel based radiation (CarPac-RT) are active regimens in oesophageal adenocarcinoma, but no randomised study has compared their efficacy and toxicity. This randomised phase II "pick a winner" trial will ide

  19. Chemoradiation With Concomitant Boosts Followed by Radical Surgery in Locally Advanced Cervical Cancer: Long-term Results of the ROMA-2 Prospective Phase 2 Study

    Energy Technology Data Exchange (ETDEWEB)

    Ferrandina, Gabriella, E-mail: gabriella.ferrandina@libero.it [Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome (Italy); Gambacorta, Antonietta [Division of Radiotherapy, Catholic University of the Sacred Heart, Rome (Italy); Gallotta, Valerio [Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome (Italy); Smaniotto, Daniela [Division of Radiotherapy, Catholic University of the Sacred Heart, Rome (Italy); Fagotti, Anna [Gynecologic Surgery, University of Perugia, Terni (Italy); Tagliaferri, Luca [Division of Radiotherapy, Catholic University of the Sacred Heart, Rome (Italy); Foti, Elvira; Fanfani, Francesco [Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome (Italy); Autorino, Rosa [Division of Radiotherapy, Catholic University of the Sacred Heart, Rome (Italy); Scambia, Giovanni [Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome (Italy); Valentini, Vincenzo [Division of Radiotherapy, Catholic University of the Sacred Heart, Rome (Italy)

    2014-11-15

    Purpose: This prospective, phase 2 study aimed at assessing the efficacy of accelerated fractionation radiation therapy by concomitant boosts (CBs) associated with chemoradiation therapy (CRT) of the whole pelvis, in improving the rate of pathological complete response (pCR) to treatment in patients with International Federation of Gynaecology and Obstetrics (FIGO) stage IB2-IVA locally advanced cervical cancer. Methods and Materials: Neoadjuvant CRT included conformal irradiation of the whole pelvis with a total dose of 39.6 Gy (1.8 cGy/fraction, 22 fractions), plus additional irradiation of primary tumor and parametria with 10.8 Gy administered with CBs (0.9 cGy/fraction, 12 fractions, every other day). Concomitant chemotherapy included cisplatin (20 mg/m{sup 2}, days 1-4 and 26-30 of treatment), and capecitabine (1300 mg/m{sup 2}/daily, orally) during the first 2 and the last 2 weeks of treatment. Radical hysterectomy plus pelvic with or without aortic lymphadenectomy was performed within 6 to 8 weeks from CRT. Toxicity was recorded according to Radiation Therapy Oncology Group toxicity criteria and Chassagne grading system. Based on the Simon design, 103 cases were required, and the regimen would be considered active if >45 pCR were registered (α error = 0.05; β error = 0.1). Results: pCR was documented in 51 cases (50.5%), and the regimen was considered active, according to the planned statistical assumptions. At median follow-up of 36 months (range: 7-85 months), the 3-year local failure rate was 7%, whereas the 3-year disease-free and overall survival rates were 73.0% and 86.1%, respectively. Grade 3 leukopenia and neutropenia were reported in only 1 and 2 cases, respectively. Gastrointestinal toxicity was always grade 1 or 2. Conclusions: Addition of CBs in the accelerated fractionation modality to the whole pelvis chemoradiation followed by radical surgery results in a high rate of pathologically assessed complete response to CRT and a very

  20. Central retinal vein occlusion concomitant with dengue fever

    OpenAIRE

    Velaitham, Punithamalar; Vijayasingham, Nandini

    2016-01-01

    Background Dengue virus infection is on the rise and there is increasing number of ocular complications that are being reported. Most common ocular complications are macular edema, macular hemorrhages, and foveolitis. There are case reports on branch retinal vessel occlusions. Most of the ocular complications are attributed to the bleeding tendency and transudative process in dengue viral infection. This is a case report of ischemic central retinal vein occlusion (CRVO) concomitant with dengu...

  1. Local anesthesia selection algorithm in patients with concomitant somatic diseases.

    Science.gov (United States)

    Anisimova, E N; Sokhov, S T; Letunova, N Yu; Orekhova, I V; Gromovik, M V; Erilin, E A; Ryazantsev, N A

    2016-01-01

    The paper presents basic principles of local anesthesia selection in patients with concomitant somatic diseases. These principles are history taking; analysis of drugs interaction with local anesthetic and sedation agents; determination of the functional status of the patient; patient anxiety correction; dental care with monitoring of hemodynamics parameters. It was found that adhering to this algorithm promotes prevention of urgent conditions in patients in outpatient dentistry.

  2. Clinical outcomes of HER2-positive metastatic breast cancer patients with brain metastasis treated with lapatinib and capecitabine: an open-label expanded access study in Korea

    Directory of Open Access Journals (Sweden)

    Ro Jungsil

    2012-07-01

    Full Text Available Abstract Background To evaluate efficacy in patients with brain metastasis (BM on entry into the lapatinib expanded access program (LEAP. Methods LEAP is a worldwide, single-arm, open-label study. HER2-positive, locally-advanced or metastatic breast cancer patients with progression after an anthracycline, taxane, and trastuzumab were eligible. Patients received capecitabine 2000 mg/m2 daily in two divided doses, days 1–14, every 21 days and lapatinib 1250 mg once daily. Results Among 186 patients enrolled in 6 Korean centers, 58 had BM. Progression-free survival (PFS was 18.7 weeks in patients with BM and 19.4 weeks without BM (P = 0.88. In patients with BM, brain response was synchronized with systemic responses (P = 0.0001. Overall survival (OS was 48.9 weeks in patients with BM and 64.6 weeks without BM (P = 0.23. Multivariable analysis found hormone receptor positivity (P = 0.003 and clinical benefit rate (CBR of combined systemic and brain disease (P  Conclusion Lapatinib plus capecitabine is equally effective in patients with or without BM. Trial registration ClinicalTrials.gov (NCT00338247

  3. Perceptual reversals during binocular rivalry: ERP components and their concomitant source differences.

    Science.gov (United States)

    Britz, Juliane; Pitts, Michael A

    2011-11-01

    We used an intermittent stimulus presentation to investigate event-related potential (ERP) components associated with perceptual reversals during binocular rivalry. The combination of spatiotemporal ERP analysis with source imaging and statistical parametric mapping of the concomitant source differences yielded differences in three time windows: reversals showed increased activity in early visual (∼120 ms) and in inferior frontal and anterior temporal areas (∼400-600 ms) and decreased activity in the ventral stream (∼250-350 ms). The combination of source imaging and statistical parametric mapping suggests that these differences were due to differences in generator strength and not generator configuration, unlike the initiation of reversals in right inferior parietal areas. These results are discussed within the context of the extensive network of brain areas that has been implicated in the initiation, implementation, and appraisal of bistable perceptual reversals.

  4. GH-Producing Pituitary Adenoma and Concomitant Rathke’s Cleft Cyst: A Case Report and Short Review

    Directory of Open Access Journals (Sweden)

    Ryota Tamura

    2015-01-01

    Full Text Available Concomitant pituitary adenoma (PA and Rathke’s cleft cyst (RCC are rare. In some cases, such PA is known to produce pituitary hormones. A 53-year-old man was admitted to our hospital with a diagnosis of lacunar infarction in the left basal ganglia. Magnetic resonance imaging (MRI incidentally showed a suprasellar mass with radiographic features of RCC. When he consulted with a neurosurgical outpatient clinic, acromegaly was suspected based on his appearance. A diagnosis of growth hormone- (GH- producing PA was confirmed from hormonal examinations and additional MRI. Retrospectively, initial MR images also showed intrasellar mass that is compatible with the diagnosis of PA other than suprasellar RCC. The patient underwent endonasal-endoscopic removal of the PA. Since we judged that the RCC of the patient was asymptomatic, only the PA was completely removed. The postoperative course of the patient was uneventful and GH levels gradually normalized. Only 40 cases of PA with concomitant RCC have been reported to date, including 13 cases of GH-producing PA. In those 13 cases, RCC tended to be located in the sella turcica, and suprasellar RCC like this case appears rare. In a few cases, concomitant RCCs were fenestrated, but GH levels normalized postoperatively as in the cases without RCC fenestration. If radiographic imaging shows typical RCC, and PA is not obvious at first glance, the possibility of concomitant PA still needs to be considered. In terms of treatment, removal of the RCC is not needed to achieve hormone normalization.

  5. The Concomitant Presence of Two Anomalous Muscles in the Forearm

    OpenAIRE

    Ogun, Tunç Cevat; Karalezli, Nazım; Ogun, Cemile Oztin

    2007-01-01

    This article describes the concomitant presence of two anomalous forearm muscles in a 20-year-old man, discovered accidentally during an operation for a forearm injury. The first one was similar to a reverse palmaris longus muscle except for its direction to the Guyon’s canal. The second one originated from the radial antebrachial fascia, superficial to all other forearm muscles in the lower half of the forearm, then diverged medially and extended into the Guyon’s canal and was innervated by ...

  6. Successful Treatment of Ptyalism Gravidarum With Concomitant Hyperemesis Using Hypnosis.

    Science.gov (United States)

    Beevi, Zuhrah; Low, Wah Yun; Hassan, Jamiyah

    2015-10-01

    Ptyalism gravidarum, or sialorrhea, is the excessive secretion of saliva during pregnancy. Treatment of ptyalism gravidarum is often challenging due to its unknown etiologies. This article discusses a case of ptyalism gravidarum with concomitant hyperemesis in which the condition was successfully treated with hypnosis. A 28-year-old woman presented with ptyalism 2 months into her pregnancy and hyperemesis 3 months into pregnancy with associated vomiting that occurred following every meal. Hypnosis was administered at week 16 of pregnancy to eliminate ptyalism and hyperemesis, to prepare for childbirth, and to increase overall psychological well-being. Ptyalism resolved by week 36, concurrent with the final hypnosis session.

  7. Concomitant Graves' disease and Hashimoto's thyroiditis, presenting as primary hypothyroidism.

    LENUS (Irish Health Repository)

    Cronin, C C

    2012-02-03

    Hypothyroidism in patients with Graves\\' disease is usually the result of ablative treatment. We describe a 58 year old man with Graves\\' ophthalmopathy and pre-tibial myxoedema, who presented with spontaneous primary hypothyroidism. Circulating TSH receptor antibody activity was increased, while thyroid microsomal antibody was detectable in titres greater than one in one hundred thousand. It is likely that the TSH receptor antibody of Graves\\' disease was ineffective in stimulating hyperthyroidism because of concomitant thyroid destruction due to Hashimoto\\'s disease. Alternatively, primary hypothyroidism could have resulted from the effects of a circulating TSH receptor blocking antibody.

  8. Treatment of infrarenal abdominal aortic dissection concomitant with an aneurysm

    Institute of Scientific and Technical Information of China (English)

    WANG Li-xin; ZHU Ting; FU Wei-guo; WANG Yu-qi; XI Xun; GUO Da-qiao; CHEN Bin; JIANG Jun-hao; YANG Ju; SHI Zhen-yu

    2007-01-01

    @@ Aortic dissection occurs when layers of the aortic walls are separated by the blood flow through an intimal tear. Dissection of the aorta most frequently originates in the ascending aorta (70%), followed by the descending aorta (22%), the aortic arch (7%) and the abdominal aorta (1/%).1 The dissection limited to the abdominal aorta is rare.2 An isolated abdominal aortic dissection (IAAD) concomitant with an abdominal aortic aneurysm (AAA) is uncommon. We present here one patient with IAAD and AAA treated by endovascular therapy.

  9. Concomitant Persistent Pain in Classical Trigeminal Neuralgia – Evidence for Different Subtypes

    DEFF Research Database (Denmark)

    Maarbjerg, Stine; Gozalov, Aydin; Olesen, Jes

    2014-01-01

    OBJECTIVE: To describe the clinical characteristics in classical trigeminal neuralgia (TN) with concomitant persistent pain and to investigate whether TN with concomitant persistent pain represents a distinct phenotype. BACKGROUND: There has been much debate about the possible pathophysiological...

  10. Rhizopus arrhizus and Fusarium solani Concomitant Infection in an Immunocompromised Host.

    Science.gov (United States)

    de Almeida Júnior, João N; Ibrahim, Karim Y; Del Negro, Gilda M B; Bezerra, Evandro D; Duarte Neto, Amaro N; Batista, Marjorie V; Siciliano, Rinaldo F; Giudice, Mauro C; Motta, Adriana L; Rossi, Flávia; Pierrotti, Ligia C; Freire, Maristela P; Bellesso, Marcelo; Pereira, Juliana; Abdala, Edson; Benard, Gil

    2016-02-01

    Neutropenic patients are at risk of the development of hyalohyphomycosis and mucormycosis. Correct identification is essential for the initiation of the specific treatment, but concomitant mold infections are rarely reported. We report one unprecedented case of concomitant mucormycosis and fusariosis in a neutropenic patient with acute myeloid leukemia. The patient developed rhino-orbital infection by Rhizopus arrhizus and disseminated infection by Fusarium solani. The first culture from a sinus biopsy grew Rhizopus, which was consistent with the histopathology report of mucormycosis. A second sinus biopsy collected later during the patient's clinical deterioration was reported as hyalohyphomycosis, and the culture yielded F. solani. Due to the discordant reports, the second biopsy was reviewed and two hyphae types suggestive of both hyalohyphomycetes and mucormycetes were found. The dual mold infection was confirmed by PCR assays from paraffinized tissue sections. Increased awareness of the existence of dual mold infections in at-risk patients is necessary. PCR methods in tissue sections may increase the diagnosis of dual mold infections. In case of sequential biopsies showing discrepant results, mixed infections have to be suspected.

  11. Clinical characteristics of pulmonary embolism with concomitant pneumonia.

    Science.gov (United States)

    Cha, Seung-Ick; Choi, Keum-Ju; Shin, Kyung-Min; Lim, Jae-Kwang; Yoo, Seung-Soo; Lee, Jaehee; Lee, Shin-Yup; Kim, Chang-Ho; Park, Jae-Yong

    2016-04-01

    Although pneumonia is associated with an increased risk of venous thromboembolism, patients with pulmonary embolism and concomitant pneumonia are uncommon. The aim of the present study was to investigate the clinical features of pulmonary embolism with coexisting pneumonia. We retrospectively compared clinical, radiologic and laboratory parameters between patients with pulmonary embolism and concomitant pneumonia (pneumonia group) and those with unprovoked pulmonary embolism (unprovoked group), and then between the pneumonia group and those with pulmonary infarction (infarction group). Of 794 patients with pulmonary embolism, 36 (5%) had coexisting pneumonia and six (1%) had no provoking factor other than pneumonia. Stroke was significantly more common in the pneumonia group, than either the unprovoked group or the infarction group. In the pneumonia group, fever was significantly more common and serum C-reactive protein levels were significantly higher. By contrast, central pulmonary embolism and right ventricular dilation on computed tomography were significantly less frequent in the pneumonia group. In addition, an adverse outcome due to pulmonary embolism was less common in the pneumonia group than in either of the other two groups. The coexistence of pulmonary embolism and pneumonia is rarely encountered in clinical practice, especially without the presence of other factors that could provoke venous thromboembolism and is commonly associated with stroke. It is characterized by lower incidences of central pulmonary embolism and right ventricular dilation and by a lower rate of adverse outcomes due to pulmonary embolism itself.

  12. [Differentiation of concomitant glaucomatous optic neuropathy in optic disc drusen].

    Science.gov (United States)

    Mamikonian, V R; Galoian, N S; Sheremet, N L; Kazarian, E E; Kharlap, S I; Shemeleva-Demir, O A; Tatevosian, A A; Andzhelova, D V; Eksarenko, O V

    2013-01-01

    Characteristics of ocular blood flow (OBF) in primary open-angle glaucoma (POAG) in eyes with optic disc drusen have been investigated. The study enrolled 21 patient (35 eyes) with optic disc drusen, of which 7 (8 eyes) were diagnosed with POAG. Besides the standard tests, the ophthalmological assessment included evaluation of OBF (flowmetry) and an individual normal range of intraocular pressure (IOP). The results showed that optic disc drusen are not associated with OBF changes. Concomitant POAG might be suspected in a patient with optic disc drusen whose OBF is significantly decreased and IOP is above the individual normal range. Differentiation of morphofunctional changes in chronic optic neuropathy, which might be due to either glaucomatous optic neuropathy or optic disc drusen, is complicated when actual IOP lies within the average normal range. Ocular blood flow evaluation by means of flowmetry with calculation of an individual normal range of IOP has been demonstrated as a highly effective predictor of concomitant POAG in patients with optic disc drusen.

  13. Dental trauma. Combination injuries 1. The risk of pulp necrosis in permanent teeth with concussion injuries and concomitant crown fractures

    DEFF Research Database (Denmark)

    Lauridsen, Eva Fejerskov; Hermann, Nuno Vibe; Gerds, Thomas Alexander;

    2012-01-01

    The reported risk of pulp necrosis (PN) is low in teeth with concussion injuries. A concomitant crown fracture may affect the risk of PN. Aim:  To analyze the influence of a crown fracture (with and without pulp exposure) on the risk of PN in teeth with concussion injury. Material:  The study...... included 469 permanent incisors with concussion from 358 patients (226 male, 132 female). Among these, 292 had a concomitant crown fracture (70 with and 222 without pulp exposure). All teeth were examined and treated according to standardized protocol. Statistical analysis:  The risk of PN was analyzed...... by the Kaplan–Meier method and Cox regression. Risk factors included in the analysis: gender, age, stage of root development, type of crown fracture, and response to electric pulp test (EPT) at the initial examination. The level of significance was set at 5%. Results:  The risk of PN was low in teeth...

  14. A Unique Cause of Proteinuria in Pregnancy: Class II Lupus Nephritis with Concomitant Minimal Change Disease

    Science.gov (United States)

    Kunjal, Ryan; Adam-Eldien, Rabie; Makary, Raafat; Jo-Hoy, Francois; Heilig, Charles W.

    2016-01-01

    We report the case of a 22-year-old African American female who presented to another facility for routine follow-up in the 34th week of pregnancy with lower extremity swelling and nephrotic-range proteinuria. Although she was normotensive, it was initially thought that she had preeclampsia. She was monitored carefully and delivery was induced at 37 weeks of gestation. She was transferred to our hospital, where she was diagnosed with systemic lupus erythematosus (SLE) based on clinical and laboratory criteria. Renal biopsy revealed a surprising finding of minimal change disease (MCD) concomitant with class II lupus nephritis (LN). She was managed with pulses and then tapering doses of steroid therapy with dramatic resolution of the nephrotic syndrome. This case demonstrates not only the rare de novo occurrence of SLE in pregnancy, but the unique finding of MCD coexisting with class II LN. We propose that altered T cell activity may be the link between these seemingly distinct entities.

  15. Four-Week Neoadjuvant Intensity-Modulated Radiation Therapy With Concurrent Capecitabine and Oxaliplatin in Locally Advanced Rectal Cancer Patients: A Validation Phase II Trial

    Energy Technology Data Exchange (ETDEWEB)

    Arbea, Leire, E-mail: larbea@unav.es [Department of Oncology, Clinica Universidad de Navarra, Navarra (Spain); Martinez-Monge, Rafael; Diaz-Gonzalez, Juan A.; Moreno, Marta; Rodriguez, Javier [Department of Oncology, Clinica Universidad de Navarra, Navarra (Spain); Hernandez, Jose Luis [Department of General Surgery, Clinica Universidad de Navarra, Navarra (Spain); Sola, Jesus Javier [Department of Pathology, Clinica Universidad de Navarra, Navarra (Spain); Ramos, Luis Isaac [Department of Oncology, Clinica Universidad de Navarra, Navarra (Spain); Subtil, Jose Carlos [Department of Gastroenterology, Clinica Universidad de Navarra, Navarra (Spain); Nunez, Jorge [Department of Preventive Medicine and Public Health, Clinica Universidad de Navarra, Navarra (Spain); Chopitea, Ana; Cambeiro, Mauricio; Gaztanaga, Miren; Garcia-Foncillas, Jesus; Aristu, Javier [Department of Oncology, Clinica Universidad de Navarra, Navarra (Spain)

    2012-06-01

    Purpose: To validate tolerance and pathological complete response rate (pCR) of a 4-week preoperative course of intensity-modulated radiation therapy (IMRT) with concurrent capecitabine and oxaliplatin (CAPOX) in patients with locally advanced rectal cancer. Methods and Materials: Patients with T3 to T4 and/or N+ rectal cancer received preoperative IMRT (47.5 Gy in 19 fractions) with concurrent capecitabine (825 mg/m{sup 2} b.i.d., Monday to Friday) and oxaliplatin (60 mg/m{sup 2} on Days 1, 8, and 15). Surgery was scheduled 4 to 6 weeks after the completion of chemoradiation. Primary end points were toxicity and pathological response rate. Local control (LC), disease-free survival (DFS), and overall survival (OS) were also analyzed. Results: A total of 100 patients were evaluated. Grade 1 to 2 proctitis was observed in 73 patients (73%). Grade 3 diarrhea occurred in 9% of the patients. Grade 3 proctitis in 18% of the first 50 patients led to reduction of the dose per fraction to 47.5 Gy in 20 treatments. The rate of Grade 3 proctitis decreased to 4% thereafter (odds ratio, 0.27). A total of 99 patients underwent surgery. A pCR was observed in 13% of the patients, major response (96-100% of histological response) in 48%, and pN downstaging in 78%. An R0 resection was performed in 97% of the patients. After a median follow-up of 55 months, the LC, DFS, and OS rates were 100%, 84%, and 87%, respectively. Conclusions: Preoperative CAPOX-IMRT therapy (47.5 Gy in 20 fractions) is feasible and safe, and produces major pathological responses in approximately 50% of patients.

  16. Phase 2 Trial of Induction Gemcitabine, Oxaliplatin, and Cetuximab Followed by Selective Capecitabine-Based Chemoradiation in Patients With Borderline Resectable or Unresectable Locally Advanced Pancreatic Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Esnaola, Nestor F. [Department of Surgery, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (United States); Chaudhary, Uzair B.; O' Brien, Paul [Division of Hematology and Oncology, Department of Internal Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (United States); Garrett-Mayer, Elizabeth [Division of Biostatistics and Epidemiology, Department of Internal Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (United States); Camp, E. Ramsay [Department of Surgery, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (United States); Thomas, Melanie B. [Division of Hematology and Oncology, Department of Internal Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (United States); Cole, David J. [Department of Surgery, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (United States); Montero, Alberto J. [Division of Hematology and Oncology, Department of Internal Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (United States); Hoffman, Brenda J.; Romagnuolo, Joseph [Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (United States); Orwat, Kelly P. [Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (United States); Marshall, David T., E-mail: marshadt@musc.edu [Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (United States)

    2014-03-15

    Purpose: To evaluate, in a phase 2 study, the safety and efficacy of induction gemcitabine, oxaliplatin, and cetuximab followed by selective capecitabine-based chemoradiation in patients with borderline resectable or unresectable locally advanced pancreatic cancer (BRPC or LAPC, respectively). Methods and Materials: Patients received gemcitabine and oxaliplatin chemotherapy repeated every 14 days for 6 cycles, combined with weekly cetuximab. Patients were then restaged; “downstaged” patients with resectable disease underwent attempted resection. Remaining patients were treated with chemoradiation consisting of intensity modulated radiation therapy (54 Gy) and concurrent capecitabine; patients with borderline resectable disease or better at restaging underwent attempted resection. Results: A total of 39 patients were enrolled, of whom 37 were evaluable. Protocol treatment was generally well tolerated. Median follow-up for all patients was 11.9 months. Overall, 29.7% of patients underwent R0 surgical resection (69.2% of patients with BRPC; 8.3% of patients with LAPC). Overall 6-month progression-free survival (PFS) was 62%, and median PFS was 10.4 months. Median overall survival (OS) was 11.8 months. In patients with LAPC, median OS was 9.3 months; in patients with BRPC, median OS was 24.1 months. In the group of patients who underwent R0 resection (all of which were R0 resections), median survival had not yet been reached at the time of analysis. Conclusions: This regimen was well tolerated in patients with BRPC or LAPC, and almost one-third of patients underwent R0 resection. Although OS for the entire cohort was comparable to that in historical controls, PFS and OS in patients with BRPC and/or who underwent R0 resection was markedly improved.

  17. Phase 1 Study of ABT-751 in Combination With CAPIRI (Capecitabine and Irinotecan) and Bevacizumab in Patients With Advanced Colorectal Cancer.

    Science.gov (United States)

    Rudek, Michelle A; Dasari, Arvind; Laheru, Daniel; He, Ping; Jin, Runyan; Walker, Rosalind; Taylor, Gretchen E; Jimeno, Antonio; Donehower, Ross C; Hidalgo, Manuel; Messersmith, Wells A; Purcell, W Thomas

    2016-08-01

    ABT-751 is an orally bioavailable sulfonamide with antimitotic properties. A nonrandomized phase 1 dose-escalation study of ABT-751 in combination with CAPIRI (capecitabine and irinotecan) and bevacizumab was conducted to define the maximum tolerated dose, dose-limiting toxicity (DLT), and pharmacokinetics in patients with advanced colorectal cancer. Patients were treated with ABT-751 daily for 7 days (alone) and then began 21-day cycles of treatment with ABT-751 daily and capecitabine twice daily for 14 days plus irinotecan on day 1 intravenously. Bevacizumab was added as standard of care at 7.5 mg/kg on day 1 after the first 2 dose levels. Because of intolerance to the regimen, a reduced dose of ABT-751 was also explored with reduced-dose and full-dose CAPIRI with bevacizumab. ABT-751 and irinotecan pharmacokinetics, ABT-751 glucuronidation, and protein binding were explored. Twenty-four patients were treated over 5 dose levels. The maximum tolerated dose was ABT-751 125 mg combined with full-dose CAPIRI and bevacizumab 7.5 mg/kg on day 1. DLTs were hypokalemia, elevated liver tests, and febrile neutropenia. ABT-751 is metabolized by UGT1A8 and to a lesser extent UGT1A4 and UGT1A1. Irinotecan and APC exposure were increased, SN-38 exposure was similar, and SN-38 glucuronide exposure was decreased. Clinically relevant alterations in ABT-751 and irinotecan pharmacokinetics were not observed. Despite modest efficacy, the combination of ABT-751, CAPIRI, and bevacizumab will not be studied further in colorectal cancer.

  18. The concomitant presence of two anomalous muscles in the forearm.

    Science.gov (United States)

    Ogun, Tunç Cevat; Karalezli, Nazim; Ogun, Cemile Oztin

    2007-09-01

    This article describes the concomitant presence of two anomalous forearm muscles in a 20-year-old man, discovered accidentally during an operation for a forearm injury. The first one was similar to a reverse palmaris longus muscle except for its direction to the Guyon's canal. The second one originated from the radial antebrachial fascia, superficial to all other forearm muscles in the lower half of the forearm, then diverged medially and extended into the Guyon's canal and was innervated by the ulnar nerve. The patient had no symptoms related to overcrowding of the Guyon's canal before the injury. A hand surgeon should be well informed about the anatomic variations of the hand to be comfortable during surgical practice.

  19. Treatment of alcoholism and concomitant drugs of abuse.

    Science.gov (United States)

    Zeiner, A R; Stanitis, T; Spurgeon, M; Nichols, N

    1985-01-01

    It has been proposed that concomitant substances of abuse may have additive or synergistic properties such that alcoholics using other substances of abuse concurrently may have a harder time giving up alcohol than alcoholics abusing only alcohol. The present study surveyed 291 alcoholics in an alcohol treatment program and 86 social drinker controls matched on age, education, SES and gender. Alcohol consumption, smoking, coffee intake, other substances of abuse. Beck depression and Spielberger Anxiety (State) were measured. Alcoholics drank significantly more alcohol than did social drinkers per day (350.19 cc versus 28.08 cc, p less than 0.001), consumed more caffeine/day (486.3 mg versus 339.9 mg, p less than 0.002), smoked more cigarettes/day (27.8 versus 12.8, p less than 0.001), were more depressed (16.8 versus 4.4 (Beck), p less than 0.0001), had lower internal locus of control scores (37.6 versus 39.7, p less than 0.005), had higher scores on control by chance (22.7 versus 20.2, p less than 0.03) and were significantly more anxious (52.5 versus 33.9 on Spielberger's State Inventory p less than 0.0001). Some patients used stimulants, tranquilizers, depressants, narcotics or toluene. Only 3/258 abused alcohol without using other drugs. Results support earlier studies showing strong associations between alcohol and smoking and between alcohol and caffeine consumption. The alcoholic abusing only alcohol is very rare. Treatment programs need to pay attention to concomitant drugs of abuse.

  20. 卡培他滨联合奥沙利铂治疗进展期胃癌68例%Clinical observation of capecitabine plus oxaliplatin in treatment of 68 cases with advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Chaoying Liu; Jiang Li; Runjie Wang; Hong Hu; Juanying Xu

    2009-01-01

    Objective: The aim of this study was to evaluate the response rate, time to progression (TTP), overall survival, and safety of the combination of capecitabine plus oxaliplatin in treatment of advanced gastric cancer (AGC). Methods: All the patients with advanced gastric cancer who were not received any prior chemotherapy or radiotherapy were treated with combination of capecitabine (1250 mg/m2 twice daily, days 1-14) plus oxaliplatin (130 mg/m2 as a 2-h intravenous infusion on day 1) every 3 weeks. Results: Two cases of complete response (CR) and 34 cases of partial response (PR) were confirmed, giving an overall response rate of 52.9%, of the 68 patients with advanced gastric cancer. The median TTP and overall survival for all patients were 7.3 and 11.9 months, respectively. Grade 3 leukopenia, thrembocytopenia, nausealvomiting, and diarrhea were observed in 3, 5, 1, and 4 patients, respectively. Yet, no grade 4 toxicity was observed. Conclusion: Capecitabine/ oxaliplatin combination chemotherapy is active in patients with advanced gastric cancer.

  1. Impact of ileocecal resection and concomitant antibiotics on the microbiome of the murine jejunum and colon.

    Directory of Open Access Journals (Sweden)

    Anthony A Devine

    Full Text Available Ileocecal resection (ICR is a commonly required surgical intervention in unmanageable Crohn's disease and necrotizing enterocolitis. However, the impact of ICR, and the concomitant doses of antibiotic routinely given with ICR, on the intestinal commensal microbiota has not been determined. In this study, wild-type C57BL6 mice were subjected to ICR and concomitant single intraperitoneal antibiotic injection. Intestinal lumen contents were collected from jejunum and colon at 7, 14, and 28 days after resection and compared to non-ICR controls. Samples were analyzed by 16S rRNA gene pyrosequencing and quantitative PCR. The intestinal microbiota was altered by 7 days after ICR and accompanying antibiotic treatment, with decreased diversity in the colon. Phylogenetic diversity (PD decreased from 11.8 ± 1.8 in non-ICR controls to 5.9 ± 0.5 in 7-day post-ICR samples. There were also minor effects in the jejunum where PD values decreased from 8.3 ± 0.4 to 7.5 ± 1.4. PCoA analysis indicated that bacterial populations 28 days post-ICR differed significantly from non-ICR controls. Moreover, colon and jejunum bacterial populations were remarkably similar 28 days after resection, whereas the initial communities differed markedly. Firmicutes and Bacteroidetes were the predominant phyla in jejunum and colon before ICR; however, Firmicutes became the vastly predominant phylum in jejunum and colon 28 days after ICR. Although the microbiota returned towards a homeostatic state, with re-establishment of Firmicutes as the predominant phylum, we did not detect Bacteroidetes in the colon 28 days after ICR. In the jejunum Bacteroidetes was detected at a 0.01% abundance after this time period. The changes in jejunal and colonic microbiota induced by ICR and concomitant antibiotic injection may therefore be considered as potential regulators of post-surgical adaptive growth or function, and in a setting of active IBD, potential contributors to post

  2. Impact of ileocecal resection and concomitant antibiotics on the microbiome of the murine jejunum and colon.

    Science.gov (United States)

    Devine, Anthony A; Gonzalez, Antonio; Speck, K Elizabeth; Knight, Rob; Helmrath, Michael; Lund, P Kay; Azcarate-Peril, M Andrea

    2013-01-01

    Ileocecal resection (ICR) is a commonly required surgical intervention in unmanageable Crohn's disease and necrotizing enterocolitis. However, the impact of ICR, and the concomitant doses of antibiotic routinely given with ICR, on the intestinal commensal microbiota has not been determined. In this study, wild-type C57BL6 mice were subjected to ICR and concomitant single intraperitoneal antibiotic injection. Intestinal lumen contents were collected from jejunum and colon at 7, 14, and 28 days after resection and compared to non-ICR controls. Samples were analyzed by 16S rRNA gene pyrosequencing and quantitative PCR. The intestinal microbiota was altered by 7 days after ICR and accompanying antibiotic treatment, with decreased diversity in the colon. Phylogenetic diversity (PD) decreased from 11.8 ± 1.8 in non-ICR controls to 5.9 ± 0.5 in 7-day post-ICR samples. There were also minor effects in the jejunum where PD values decreased from 8.3 ± 0.4 to 7.5 ± 1.4. PCoA analysis indicated that bacterial populations 28 days post-ICR differed significantly from non-ICR controls. Moreover, colon and jejunum bacterial populations were remarkably similar 28 days after resection, whereas the initial communities differed markedly. Firmicutes and Bacteroidetes were the predominant phyla in jejunum and colon before ICR; however, Firmicutes became the vastly predominant phylum in jejunum and colon 28 days after ICR. Although the microbiota returned towards a homeostatic state, with re-establishment of Firmicutes as the predominant phylum, we did not detect Bacteroidetes in the colon 28 days after ICR. In the jejunum Bacteroidetes was detected at a 0.01% abundance after this time period. The changes in jejunal and colonic microbiota induced by ICR and concomitant antibiotic injection may therefore be considered as potential regulators of post-surgical adaptive growth or function, and in a setting of active IBD, potential contributors to post-surgical pathophysiology of disease

  3. Concomitant macro and microvascular complications in diabetic nephropathy

    Directory of Open Access Journals (Sweden)

    Alwakeel Jamal

    2009-01-01

    Full Text Available To determine the prevalence of concomitant microvascular and macrovascular complica-tions of diabetic nephropathy we retrospectively reviewed the medical records of all 1,952 type 2 dia-betic patients followed-up at Security Forces Hospital, Riyadh, Saudi Arabia from January 1989 to December 2004. There were 626 (32.1% patients (294 (47% were males who developed diabetic nephropathy. Their mean age was 66.9 ± 11.4 years, mean duration of diabetes was 15.4 ± 7.5 years, mean age at the onset of nephropathy was 61.5 ± 12.4 years, and mean duration of nephropathy was 3.9 ± 3.8 years. Concomitant diabetic complications included cataract (38.2%, acute coronary syndrome (36.1%, peripheral neuropathy (24.9%, myocardial infarction (24.1%, background retinopathy (22.4%, stroke (17.6%, proliferative retinopathy (11.7%, foot infection (7.3%, limb amputation (3.7% and blindness (3%. Hypertension was documented in 577 (92.2% patients, dyslipidemia in 266 (42.5% and mortality from all causes in 86 (13.7%. There were 148 (23.6% patients with one complication, 81 (12.9% with two, 83 (13.3% with three, and 61 (9.7% with four or more. Dete-rioration of glomerular filtration rate was observed in 464 (74% patients and doubling of serum creatinine in 250 (39.9%, while 95 (15.2% developed end-stage renal disease (ESRD at the end of study and 79 (12.6% required dialysis. Complications were significantly more prevalent among males with greater number reaching ESRD level than females (P< 0.05. Relative risks of developing com-plications were significant after the onset of nephropathy; ACS (1.41, MI (1.49, stroke (1.48, diabetic foot (1.6, amputation (1.58 and death (1.93. We conclude that complications of diabetes are aggre-ssive and progressive including high prevalence of diabetic nephropathy. Careful monitoring and proper institution of management protocols should be implemented to identify diabetic patients at high risk for complications and mitigate progression

  4. Impact of perampanel on pharmacokinetics of concomitant antiepileptics in patients with partial‐onset seizures: pooled analysis of clinical trials

    Science.gov (United States)

    Laurenza, Antonio; Ferry, Jim; Hussein, Ziad

    2016-01-01

    Aims To evaluate the impact of perampanel and demographics on clearance of concomitant antiepileptic drugs (AEDs), in patients with refractory partial‐onset seizures. Methods Pooled data from three Phase III clinical studies with adjunctive perampanel were used. Blood samples for evaluation of 11 concomitant AEDs were taken during baseline (before perampanel initiation), and at weeks 10, 14, and 19 during the maintenance phase of perampanel treatment (2–12 mg/day, once daily at bedtime). Models estimating apparent clearance of each concomitant AED were fitted to the data, and the effects of perampanel and demographic variables on clearance were determined. Final models were assessed with goodness of fit plots including population predictions and individual predictions against observations. Results No significant impact of perampanel on clearance was found for clonazepam (n = 81), levetiracetam (n = 330), phenobarbital (n = 54), phenytoin (n = 90), topiramate (n = 226) or zonisamide (n = 93). Statistically significant, but small and not clinically relevant increases in model‐predicted clearance were detected for carbamazepine (+4.3% with 12 mg perampanel; n = 379), clobazam (+3.4% males, +7.7% females, 12 mg; n = 114), lamotrigine (+9.3%, 12 mg; n = 356), and valproic acid (+5.0%, 12 mg; n = 349). Oxcarbazepine clearance was reduced (26%; n = 200), but the clinical relevance is unclear as levels of the active metabolite (the monohydroxy derivative of oxcarbazepine) were not measured. Conclusions Population PK data show that perampanel (2–12 mg/day, once daily at bedtime) has no relevant impact on the clearance of the most commonly used concomitant AEDs. PMID:27038098

  5. Radiation and concomitant chemotherapy for patients with glioblastoma multiforme

    Institute of Scientific and Technical Information of China (English)

    Salvador Vill; Carme Bala; Slvia Comas

    2014-01-01

    Postoperative external beam radiotherapy was considered the standard adjuvant treatment for patients with glioblastoma multiforme until the advent of using the drug temozolomide (TMZ) in addition to radiotherapy. High-dose volume should be focal, minimizing whole brain irradiation. Modern imaging, using several magnetic resonance sequences, has improved the planning target volume definition. The total dose delivered should be in the range of 60 Gy in fraction sizes of 1.8-2.0 Gy. Currently, TMZ concomitant and adjuvant to radiotherapy has become the standard of care for glioblastoma multiforme patients. Radiotherapy dose-intensification and radiosensitizer approaches have not improved the outcome. In spite of the lack of high quality evidence, stereotactic radiotherapy can be considered for a selected group of patients. For elderly patients, data suggest that the same survival benefit can be achieved with similar morbidity using a shorter course of radiotherapy (hypofractionation). Elderly patients with tumors that exhibit methylation of the O-6-methylguanine-DNA methyltransferase promoter can benefit from TMZ alone.

  6. Concomitant Hamiltonian and topological structures of extended magnetohydrodynamics

    Energy Technology Data Exchange (ETDEWEB)

    Lingam, Manasvi, E-mail: mlingam@princeton.edu [Department of Astrophysical Sciences, Princeton University, Princeton, NJ 08544 (United States); Department of Physics and Institute for Fusion Studies, The University of Texas at Austin, Austin, TX 78712 (United States); Miloshevich, George, E-mail: gmilosh@physics.utexas.edu [Department of Physics and Institute for Fusion Studies, The University of Texas at Austin, Austin, TX 78712 (United States); Morrison, Philip J., E-mail: morrison@physics.utexas.edu [Department of Physics and Institute for Fusion Studies, The University of Texas at Austin, Austin, TX 78712 (United States)

    2016-07-15

    Highlights: • Common Hamiltonian structure of the extended MHD models presented. • The generalized helicities of extended MHD shown to be topological invariants analogous to fluid/magnetic helicity. • Generalized helicities can be studied through powerful topological and knot-theoretic methods such as the Jones polynomial. • Each extended MHD model shown to possess two Lie-dragged 2-forms, which are interpreted as the generalized vorticity fluxes. - Abstract: The paper describes the unique geometric properties of ideal magnetohydrodynamics (MHD), and demonstrates how such features are inherited by extended MHD, viz. models that incorporate two-fluid effects (the Hall term and electron inertia). The generalized helicities, and other geometric expressions for these models are presented in a topological context, emphasizing their universal facets. Some of the results presented include: the generalized Kelvin circulation theorems; the existence of two Lie-dragged 2-forms; and two concomitant helicities that can be studied via the Jones polynomial, which is widely utilized in Chern–Simons theory. The ensuing commonality is traced to the existence of an underlying Hamiltonian structure for all the extended MHD models, exemplified by the presence of a unique noncanonical Poisson bracket, and its associated energy.

  7. Identification of workers exposed concomitantly to heat stress and chemicals.

    Science.gov (United States)

    Bourbonnais, Robert; Zayed, Joseph; Lévesque, Martine; Busque, Marc-Antoine; Duguay, Patrice; Truchon, Ginette

    2013-01-01

    In the context of climate change, concomitant exposure to heat stress and chemicals takes on great importance. However, little information is available in this regard. The purpose of this research, therefore, was to develop an approach aimed at identifying worker groups that would be potentially most at risk. The approach comprises 5 consecutive steps: - Establishment of a list of occupations for all industry sectors - Determination of heat stress parameters - Identification of occupations at risk of heat stress - Determination of exposure to chemicals - Identification of occupations potentially most at risk. Overall, 1,010 occupations were selected due to their representativeness of employment sectors in Québec. Using a rating matrix, the risk stemming from exposure to heat stress was judged "critical" or "significant" for 257 occupations. Among these, 136 occupations were identified as showing a high potential of simultaneous exposure to heat stress and chemicals. Lastly, a consultation with thirteen experts made it possible to establish a list of 22 priority occupations, that is, 20 occupations in the metal manufacturing sector, as well as roofers and firefighters. These occupations would merit special attention for an investigation and evaluation of the potential effects on workers' health.

  8. Delirium and concomitant use of lithium+electroconvulsive therapy (ECT

    Directory of Open Access Journals (Sweden)

    Sadeghi M

    2001-09-01

    Full Text Available Concomitant use of lithium and E.C.T has always been accused to cause delirium in patients receiving such a combination. In this study incidence of delirium in patients who receive lithium+E.C.T. concurrently has been compared with those who have been treated with E.C.T. only. Of 49 patients who had Bipolar Mood Disorder (B.M.D. 1 disorder (manic episode 24 were given E.C.T.+lithium and 25 were treated with E.C.T. Only, 3 patients of the first group and 2 patients of the second group developed delirium. The difference between two groups was not statistically significant. Another finding was that all cases of delirium developed in patients who were above 35 years old (P value=0.001. These findings show that combination of E.C.T. and Lithium may not be so harmful as it was once considered. On the other hand it could be concluded that increased age may be a risk factor for delirium in such a combination.

  9. Comparison of concurrent chemoradiotherapy with capecitabine and oxaliplatin versus capecitabine alone in stage Ⅱ/Ⅲ rectal cancer patients after radical operation%Ⅱ+Ⅲ期直肠癌根治术后卡培他滨单药±奥沙利铂同期放化疗疗效对比

    Institute of Scientific and Technical Information of China (English)

    冯燕茹; 金晶; 王鑫; 肖琴; 王维虎; 王淑莲; 刘跃平; 宋永文; 任骅

    2014-01-01

    目的 比较Ⅱ、Ⅲ期直肠癌根治术后卡培他滨±奥沙利铂同期放化疗疗效.方法 回顾分析2002-2010年分别接受卡培他滨术后同期放化疗(单药组,427例)和奥沙利铂+卡培他滨术后同期放化疗(双药组,248例)的临床资料.治疗模式均为全直肠系膜切除术+同期放化疗±辅助化疗.放疗方法为真骨盆45.0~50.4 Gy分25次.结果 采用倾向评分配比法按1∶1平衡基线特征后产生单双药组各248例,其中单药、双药组5年样本数分别为81、104例.匹配后单、双药组的5年OS (78.1%∶74.9%)、DFS (74.4%∶67.9%)、LRC (94.5%∶ 92.8%)和DMFS (77.1%∶ 70.9%)均相近(P=0.547、0.292、0.484、0.364),但双药组3、4级不良反应发生率显著高于单药组(38.3%∶24.6%,P=0.001).结论 Ⅱ、Ⅲ期直肠癌根治术后卡培他滨+奥沙利铂同期放化疗疗效未优于卡培他滨单药同期放化疗,而不良反应增加.单药卡培他滨同期放化疗仍为标准方案.%Objective To compare the efficacy of concurrent chemoradiotherapy (CCRT) with capecitabine and oxaliplatin versus capecitabine alone in stage Ⅱ/Ⅲ rectal cancer patients after radical operation.Methods A retrospective analysis was performed on the clinical data of 675 patients with stage Ⅱ/Ⅲ rectal cancer who received postoperative concurrent chemoradiotherapy (CCRT) with capecitabine (CAP group,n =427) or capecitabine and oxaliplatin (CAPOX group,n =248) from 2002 to 2010.The treatment modality was total mesorectal excision + CCRT ± adjuvant chemotherapy.Radiotherapy was delivered to the true pelvis at a dose of 45.0-50.4 Gy/25 fractions.Results The propensity score matching method (1 ∶ 1) was applied to balance the baseline characteristics and assign 248 patients to each group.The 5-year sample sizes for CAP group and CAPOX group were 81,104.There were no significant differences between the two groups in 5-year overall survival (78.1% vs.74.9%,P =0

  10. A Phase 1/2 and Biomarker Study of Preoperative Short Course Chemoradiation With Proton Beam Therapy and Capecitabine Followed By Early Surgery for Resectable Pancreatic Ductal Adenocarcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Theodore S., E-mail: tshong1@partners.org [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); Ryan, David P.; Borger, Darrell R.; Blaszkowsky, Lawrence S.; Yeap, Beow Y. [Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); Ancukiewicz, Marek [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); Deshpande, Vikram; Shinagare, Shweta [Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); Wo, Jennifer Y.; Boucher, Yves [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); Wadlow, Raymond C.; Kwak, Eunice L.; Allen, Jill N.; Clark, Jeffrey W.; Zhu, Andrew X. [Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); Ferrone, Cristina R. [Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); Mamon, Harvey J. [Department of Radiation Oncology, Brigham and Women' s Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Adams, Judith; Winrich, Barbara; Grillo, Tarin [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); and others

    2014-07-15

    Purpose: To evaluate the safety, efficacy and biomarkers of short-course proton beam radiation and capecitabine, followed by pancreaticoduodenectomy in a phase 1/2 study in pancreatic ductal adenocarcinoma (PDAC) patients. Methods and Materials: Patients with radiographically resectable, biopsy-proven PDAC were treated with neoadjuvant short-course (2-week) proton-based radiation with capecitabine, followed by surgery and adjuvant gemcitabine. The primary objective was to demonstrate a rate of toxicity grade ≥3 of <20%. Exploratory biomarker studies were performed using surgical specimen tissues and peripheral blood. Results: The phase 2 dose was established at 5 daily doses of 5 GyE. Fifty patients were enrolled, of whom 35 patients were treated in the phase 2 portion. There were no grade 4 or 5 toxicities, and only 2 of 35 patients (4.1%) experienced a grade 3 toxicity event (chest wall pain grade 1, colitis grade 1). Of 48 patients eligible for analysis, 37 underwent pancreaticoduodenectomy. Thirty of 37 (81%) had positive nodes. Locoregional failure occurred in 6 of 37 resected patients (16.2%), and distant recurrence occurred in 35 of 48 patients (72.9%). With median follow-up of 38 months, the median progression-free survival for the entire group was 10 months, and overall survival was 17 months. Biomarker studies showed significant associations between worse survival outcomes and the KRAS point mutation change from glycine to aspartic acid at position 12, stromal CXCR7 expression, and circulating biomarkers CEA, CA19-9, and HGF (all, P<.05). Conclusions: This study met the primary endpoint by showing a rate of 4.1% grade 3 toxicity for neoadjuvant short-course proton-based chemoradiation. Treatment was associated with favorable local control. In exploratory analyses, KRAS{sup G12D} status and high CXCR7 expression and circulating CEA, CA19-9, and HGF levels were associated with poor survival.

  11. Apixaban vs. warfarin with concomitant aspirin in patients with atrial fibrillation: insights from the ARISTOTLE trial

    NARCIS (Netherlands)

    Alexander, J.H.; Lopes, R.D.; Thomas, L.; Alings, M.; Atar, D.; Aylward, P.; Goto, S.; Hanna, M.; Huber, K.; Husted, S.; Lewis, B.S.; McMurray, J.J.; Pais, P.; Pouleur, H.; Steg, P.G.; Verheugt, F.W.A.; Wojdyla, D.M.; Granger, C.B.; Wallentin, L.

    2014-01-01

    AIMS: We assessed the effect of concomitant aspirin use on the efficacy and safety of apixaban compared with warfarin in patients with atrial fibrillation (AF). METHODS AND RESULTS: In ARISTOTLE, 18 201 patients were randomized to apixaban 5 mg twice daily or warfarin. Concomitant aspirin use was le

  12. Timing of concomitant drug use in pharmacoepidemiological studies

    NARCIS (Netherlands)

    Abbing-Karahagopian, Victoria; Gardarsdottir, Helga; Souverein, Patrick C.; Klungel, Olaf H.; Leufkens, Bert G.M.; Egberts, Toine C.G.; De Bruin, Marieke L.

    2012-01-01

    Background: Both antidepressants (AD) and benzodiazepines (BZD) have been associated with an increased risk for hip fracture. However, the hazard function is not constant over exposure time and differs for these two medication classes. Hence, the timing of initiation of co-use will determine the ove

  13. Concomitant administration of zoster and pneumococcal vaccines in adults ≥60 years old.

    Science.gov (United States)

    MacIntyre, C Raina; Egerton, Tony; McCaughey, Malcolm; Parrino, Janie; Campbell, Bernadette V; Su, Shu-Chih; Pagnoni, Marco F; Stek, Jon E; Xu, Jin; Annunziato, Paula W; Chan, Ivan S F; Silber, Jeffrey L

    2010-11-01

    This study evaluated safety & immunogenicity of ZOSTAVAX® (zoster vaccine: ZV) administered concomitantly versus nonconcomitantly with PNEUMOVAX® 23 (pneumococcal vaccine: PPV23). This randomized, double-blind, placebo-controlled study enrolled 473 subjects ≥60 years old in 1:1 ratio to receive ZV & PPV23 concomitantly (Day 1) or nonconcomitantly (PPV23 Day 1, ZV Week 4). Blood samples obtained for pneumococcal polysaccharide (PnPs) antibody (Ab) testing by enzyme-linked immunosorbent assay (ELISA) and varicella-zoster virus (VZV) Ab testing by glycoprotein ELISA. Subjects followed for adverse experiences (AEs) for 28 days postvaccination. Mean baseline VZV geometric mean titers (GMT) in nonconcomitant group were lower than concomitant group. Four weeks postvaccination with ZV, VZV Ab response in concomitant group was not similar to nonconcomitant group; estimated VZV GMT ratio [concomitant/nonconcomitant] was 0.70 (95% CI, 0.61-0.80). VZV Ab response was acceptable in concomitant group; estimated geometric mean foldrise (GMFR) from baseline was 1.9 (95% CI, 1.7-2.1). PnPs serotype-specific Ab responses were similar in both groups. All 6 reported serious AEs were deemed not related to study vaccine. Postvaccination of ZV, incidence of injection-site AEs was similar in both groups; clinical AEs were numerically but not significantly higher in nonconcomitant group. In summary, VZV GMT Ab response induced by ZV administered concomitantly with PPV23 was inferior to that induced nonconcomitantly. These results indicate that, to avoid a potential decrease in ZV immunogenicity, ZV & PPV23 should not be given concomitantly. Concomitant administration did not affect response to PPV23 serotypes tested. When administered concomitantly, ZV & PPV23 vaccines were generally well tolerated.

  14. 局部晚期直肠癌术前同步放化疗中卡培他滨联合奥沙利铂剂量递增的Ⅰ期临床研究%Phase Ⅰ study of dose escalation of oxaliplatin added to capecitabine during intensity-modulated radiation therapy patients with locally advanced rectal cancer

    Institute of Scientific and Technical Information of China (English)

    耿建昊; 李小凡; 李永恒; 蔡勇

    2016-01-01

    Objective To discuss the maximum tolerated dose of oxaliplatin based on 5-fluorouracil derivative in patients with locally advanced rectal cancer who underwent neoadjuvant chemoradiotherapy.Methods From Mar 2015 to Oct 2015,15 locally advanced rectal cancer patients (T3,T4/N +) who received intensity modulated radiotherapy and concurrent chemotherapy with capecitabine and oxaliplatin were enrolled in this study.The prescription dose was 50.6 Gy for gross tumor volume(GTV) and 41.8 Gy for clinical tumor volume(CTV) in 22 fractions within 30 d with concomitant boost.There were four dose-level groups of oxaliplatin as 100,110,120 and 130 mg/m2 tri-weekly and fixed capecitabine dose (825 mg/m2 bid d1-5 per week).The first 12 patients were randomly assigned into 4 groups.For the 130 mg/m3 group,another 3 patients were enrolled because of dose-limiting toxicity (DLT).Treatment related toxicities and response rates were evaluated.Results The most common adverse events(AE) were radiation enteritis,skin reactions,nausea,fatigue,urinary system AE and bone marrow suppression.There was a trend of increase by the dose level of oxaliplatin for toxicities.Groups 100,110 and 120 mg/m2 had none DLT,while group 130 mg/m2 had 1 patient for grade 3 thrombopenia and 1 patient for grade 3 nausea.Postoperative pathology showed that all patients achieved tumor downstaging,among which 0,1,2,3 cases achieved complete remission of the four groups,respectively.Conclusions The combination regimen of capecitabine and oxaliplatin is safe and effective according to the preliminary results.The maximum tolerated dose of oxaliplatin was 130 mg/m2 tri-weekly.%目的 探讨局部晚期直肠癌术前同步放化疗基于5-Fu类药物的联合方案中奥沙利铂的最大耐受剂量.方法 本试验设计为前瞻性研究,自2015年3月至2015年10月,入组经病理确诊的局部晚期(T3、T4/N+)直肠癌患者15例,接受调强放疗以及卡培他滨联合奥沙利铂方案的同步化疗.放

  15. Comparison of vinorelbine plus cisplatin with vinorelbine plus capecitabine in patients with anthracyclines-and taxanes-refractory advanced breast cancer

    Institute of Scientific and Technical Information of China (English)

    Zhendong Zheng; Shuxian Qu; Xiaoxia Chen; Yongye Liu; Ying Piao; Yaling Han; Xiaodong Xie

    2014-01-01

    Objective:The aim of our study was to compare the ef icacy and toxicities of vinorelbine plus cisplatin (NP) regimen with that of vinorelbine plus capecitabine (NX) regimen in the treatment of anthracycline- and taxane-refractory advanced breast cancer. Methods:Forty-six patients with anthracycline-and taxane-refractory advanced breast cancer were equal y randomized into a NP group (n=23) and a NX group (n=23). Response rates and toxicities were evaluated after 2 cycles of chemotherapy. Results:The overal response rate were 48.0%in both groups. There were no significant dif erences in disease control rates (78.0%vs. 83%) or 1-year survival rates (54.6%vs. 55.9%). The main adverse events were bone marrow depression and gastrointestinal reaction, and no significant dif erence was found in toxicities between the groups. Conclusion:For anthracycline-and taxane-refractory advanced breast cancer, NP and NX regimens exerted similar curative ef ects with acceptable toxicity.

  16. Concomitant production of detergent compatible enzymes by Bacillus flexus XJU-1.

    Science.gov (United States)

    Niyonzima, Francois N; More, Sunil S

    2014-01-01

    A soil screened Bacillus flexus XJU-1 was induced to simultaneously produce alkaline amylase, alkaline lipase and alkaline protease at their optimum levels on a common medium under submerged fermentation. The basal cultivation medium consisted of 0.5% casein, 0.5% starch and 0.5% cottonseed oil as an inducer for protease, amylase, and lipase, respectively. The casein also served as nitrogen source for all 3 enzymes. The starch was also found to act as carbon source additive for both lipase and protease. Maximum enzyme production occurred on fermentation medium with 1.5% casein, 1.5% soluble starch, 2% cottonseed oil, 2% inoculum size, initial pH of 11.0, incubation temperature of 37 °C and 1% soybean meal as a nitrogen source supplement. The analysis of time course study showed that 24 h was optimum incubation time for amylase whereas 48 h was the best time for both lipase and protease. After optimization, a 3.36-, 18.64-, and 27.33-fold increase in protease, amylase and lipase, respectively was recorded. The lipase was produced in higher amounts (37.72 U/mL) than amylase and protease about 1.27 and 5.85 times, respectively. As the 3 enzymes are used in detergent formulations, the bacterium can be commercially exploited to secrete the alkaline enzymes for use in detergent industry. This is the first report for concomitant production of 3 alkaline enzymes by a bacterium.

  17. HPLC法测定胃癌患者卡培他滨血药浓度及其药动学研究%Determination of Plasma Concentration of Capecitabine in Patients with Gastric Cancer and Its Pharmacokinetics Study

    Institute of Scientific and Technical Information of China (English)

    余俊先; 孟化; 王康里; 史丽敏; 王汝龙

    2013-01-01

    目的:建立卡培他滨的血药浓度测定方法并对其在胃癌患者体内的药动学进行初步探讨.方法:入组4例胃癌患者,其血浆以替硝唑为内标,以叔丁基甲醚进行提取后进样测定,色谱柱为Eclipse C18,流动相为乙腈-水(26∶74),检测波长为310nm,流速为1.0 ml/min.血药浓度数据用DAS药动学计算机程序处理.结果:卡培他滨与内标替硝唑分离良好,保留时间分别为8.15、3.15 min,卡培他滨血药浓度在0.05~8.00 μg/ml范围内线性关系良好;日内、日间RSD均<7%,提取回收率在77.04%~87.53%范围内;卡培他滨的药动学参数Cmax、tmax、t1/2β、AUC0-6h分别为(5.42±2.90)μg/ml、(1.0±0.71)h、(1.01±0.50)h和(9.54±5.32)mg·h/L.结论:胃癌患者口服卡培他滨后吸收迅速,消除半衰期短,个体之间生物利用度差异显著.%OBJECTIVE: To establish a method for the determination of plasma concentration of capecitabine, and to explore its pharmacokinetics in gastric carcinoma subject. METHODS: 4 gastric carcinoma subjects were enrolled. Using tinidazole as internal standard, plasma was extracted with tert-butyl methyl ether. The determination was performed on Eclipse C18 column with mobile phase consisted of acetonitrile-water (26:74) at the flow rate of 1.0 ml/min. The detection wavelength was set at 310 nm. The plasma concentration of capecitabine was processed by DAS computer program. RESULTS: Capecitabine was well-separated from tinidazole, and the retention time of them were about 8.15 min and 3.15 min, respectively. Linear range of capecitabine was 0.05-8.00 μg/ml. RSD of intra-day and inter-day were lower than 7% and extraction recoveries were 77.04%-87.53% ; pharmacoki-netic parameters of capecitabine were as follows: Cmax was (5.42 ± 2.90)μg/ml; tmax was (1.0 ± 0.71)h; tmax was (1.01 ± 0.50)h; AUC0-6h was (9.54 ± 5.32)mg·h/L, respectively. CONCLUSION: Capecitabine in gastric carcinoma subjects is quickly absorbed and

  18. Pharmacokinetics and Pulmonary Distribution of Clarithromycin and Rifampicin after Concomitant and Consecutive Administration in Foals.

    Science.gov (United States)

    Berlin, Sarah; Spieckermann, Lena; Oswald, Stefan; Keiser, Markus; Lumpe, Stefan; Ullrich, Anett; Grube, Markus; Hasan, Mahmoud; Venner, Monica; Siegmund, Werner

    2016-03-07

    Drug interactions often result from multiple pharmacokinetic changes, such as after rifampicin (RIF) and clarithromycin (CLA) in the treatment of abscessing lung diseases. Comedication of RIF may interact with CLA disposition by either induction of presystemic elimination processes and/or inhibition of uptake mechanisms because it regulates gene transcription and modulates function of various CYP enzymes, multidrug efflux and uptake transporters for which CLA is a substrate. To distinguish the transcriptional changes from the modulating interaction components upon CLA absorption and pulmonary distribution, we initiated a repeated-dose study in 12 healthy foals with CLA (7.5 mg/kg, p.o., b.i.d.) in comedication with RIF (10 mg/kg, p.o., b.i.d.) given either concomitantly with CLA or consecutively 4 h after CLA. Affinity of CLA to human P-gp, MRP2, and MRP3 and to OCT1, OCT3, and PEPT1 was measured using Sf9-derived inside-out membrane vesicles and transfected HEK293 cells, respectively. ABCB1 (P-gp) induction by RIF and affinity of CLA to equine P-gp were studied using primary equine hepatocytes. Absolute bioavailability of CLA was reduced from ∼40% to below 5% after comedication of RIF in both schedules of administration, and Tmax occurred ∼2-3 h earlier. The loss of bioavailability was not associated with increased 14-hydroxyclarithromycin (14-OH-CLA) exposure. After consecutive dosing, absolute bioavailability and pulmonary penetration of CLA increased ∼2-fold compared to concomitant use. In vitro, CLA showed affinity to human and equine P-gp. Expression of ABCB1 mRNA was upregulated by RIF in 7 of 8 duodenal biopsy specimens and in primary equine hepatocytes. In conclusion, the major undesired influence of RIF on oral absorption and pulmonary distribution of CLA is associated with induction of intestinal P-gp. Consecutive administration to avoid competition with its intestinal uptake transport results in significantly, although not clinically relevant

  19. Perinatal Outcomes in HIV Positive Pregnant Women with Concomitant Sexually Transmitted Infections

    Directory of Open Access Journals (Sweden)

    Erin Burnett

    2015-01-01

    Full Text Available Objective. To evaluate whether HIV infected pregnant women with concomitant sexually transmitted infection (STIs are at increased risk of adverse perinatal and neonatal outcomes. Methods. We conducted a cohort study of HIV positive women who delivered at an inner-city hospital in Atlanta, Georgia, from 2003 to 2013. Demographics, presence of concomitant STIs, prenatal care information, and maternal and neonatal outcomes were collected. The outcomes examined were the association of the presence of concomitant STIs on the risk of preterm birth (PTB, postpartum hemorrhage, chorioamnionitis, preeclampsia, intrauterine growth restriction, small for gestational age, low Apgar scores, and neonatal intensive care admission. Multiple logistic regression was performed to adjust for potential confounders. Results. HIV positive pregnant women with concomitant STIs had an increased risk of spontaneous PTB (odds ratio (OR 2.11, 95% confidence interval [CI] 1.12–3.97. After adjusting for a history of preterm birth, maternal age, and low CD4+ count at prenatal care entry the association between concomitant STIs and spontaneous PTB persisted (adjusted OR 1.96, 95% CI 1.01–3.78. Conclusions. HIV infected pregnant women with concomitant STIs relative to HIV positive pregnant women without a concomitant STI are at increased risk of spontaneous PTB.

  20. Rapidly progressive lupus nephritis and concomitant thrombotic microangiopathy.

    Science.gov (United States)

    Gharbi, Chems; Bourry, Edward; Rouvier, Philippe; Hacini, Sabria; Letaief, Ahmed; Baumelou, Alain; Izzedine, Hassane

    2010-10-01

    Although uncommon, thrombotic microangiopathy (TMA) is one of the most serious complications in patients with systemic lupus erythematosus. A 30-year-old black woman admitted to our hospital because of fever, fatigue, 'dark' urine and rapidly progressive renal failure was found to have systemic lupus erythematous and atypical hemolytic uremic syndrome. Kidney biopsy showed WHO class IV lupus nephritis with crescents and TMA. Hemodialysis was initiated for worsening renal failure. The patient was treated with corticosteroids, monthly pulse intravenous Cyclophosphamide, plasmapheresis and Rituximab on a weekly basis for 4 weeks. The patient's blood pressure was aggressively controlled using antihypertensive agents. Despite this extensive therapy, she remained dialysis dependent although hematological parameters returned to normal values.

  1. Management of moderate functional tricuspid valve regurgitation at the time of pulmonary valve replacement: is concomitant tricuspid valve repair necessary?

    Science.gov (United States)

    Kogon, Brian; Patel, Manisha; Leong, Traci; McConnell, Michael; Book, Wendy

    2010-08-01

    Congenital heart defects with a component of pulmonary stenosis are often palliated in childhood by disrupting the pulmonary valve. Patients often undergo subsequent pulmonary valve replacement (PVR) to protect the heart from the consequences of pulmonary regurgitation. In the presence of associated moderate functional tricuspid valve (TV) regurgitation, it is unclear what factors contribute to persistent TV regurgitation following PVR. In particular, it is unknown whether PVR alone will reduce the right ventricular (RV) size and restore TV function or whether concomitant TV annuloplasty is required as well. Thirty-five patients were analyzed. Each patient underwent initial palliation of congenital pulmonary stenosis or tetralogy of Fallot, underwent subsequent PVR between 2002 and 2008, and had at least moderate TV regurgitation at the time of valve replacement. Serial echocardiograms were analyzed. Pulmonary and TV regurgitation, along with RV dilation and dysfunction, were scored (0, none; 1, mild; 2, moderate; 3, severe). RV volume and area were also calculated. Potential risk factors for persistent postoperative TV regurgitation were evaluated. One month following PVR, there was a significant reduction in pulmonary valve regurgitation (mean, 3 vs. 0.39; P regurgitation (mean, 2.33 vs. 1.3; P regurgitation postoperatively between those patients who underwent PVR alone and those who underwent concomitant tricuspid annuloplasty (mean, 1.29 vs. 1.31; P = 0.81). We conclude that following PVR, improvement in TV regurgitation and RV size occurs primarily in the first postoperative month. TV function improved to a similar degree with or without annuloplasty.

  2. Concomitant biohydrogen and poly-β-hydroxybutyrate production from dark fermentation effluents by adapted Rhodobacter sphaeroides and mixed photofermentative cultures.

    Science.gov (United States)

    Ghimire, Anish; Valentino, Serena; Frunzo, Luigi; Pirozzi, Francesco; Lens, Piet N L; Esposito, Giovanni

    2016-10-01

    This work aimed at investigating concomitant production of biohydrogen and poly-β-hydroxybutyrate (PHB) by photofermentation (PF) using dark fermentation effluents (DFE). An adapted culture of Rhodobacter sphaeroides AV1b (pH 6.5, 24±2°C) achieved H2 and PHB yields of 256 (±2) NmLH2/g Chemical Oxygen Demand (COD) and 273.8mgPHB/gCOD (32.5±3% of the dry cells weight (DCW)), respectively. When a diluted (1:2) DFE medium was applied to the adapted pure and mixed photofermentative culture, the respective H2 yields were 164.0 (±12) and 71.3 (±6) NmLH2/gCOD and the PHB yields were 212.1 (±105.2) and 50.7 (±2.7) mgPHB/gCOD added, corresponding to 24 (±0.7) and 6.3 (±0) % DCW, respectively. The concomitant H2 and PHB production from the PF process gave a good DFE post treatment achieving up to 80% COD removal from the initial DFE.

  3. Association between filaggrin null mutations and concomitant atopic dermatitis and contact allergy

    DEFF Research Database (Denmark)

    Carlsen, B C; Thyssen, J P; Menné, T;

    2011-01-01

    The phenotypic traits of people with the filaggrin mutation (FLG) genotype and atopic dermatitis (AD) are still under elucidation, and the association with concomitant AD and contact allergy (CA) has not previously been examined....

  4. Osteoporosis among Fallers without Concomitant Fracture Identified in an Emergency Department: Frequencies and Risk Factors

    DEFF Research Database (Denmark)

    Glintborg, Bente; Hesse, Ulrik; Houe, Thomas;

    2011-01-01

    We aimed to determine whether the Emergency Department (ED) is a suitable entrance point for osteoporosis screening among fallers without concomitant fracture compared to referral from general practice. Furthermore, to identify factors associated with osteoporosis among fallers. Methods. Patients...

  5. Pain in adolescent girls receiving human papillomavirus vaccine with concomitantly administered vaccines.

    Science.gov (United States)

    Walter, Emmanuel B; Kemper, Alex R; Dolor, Rowena J; Dunne, Eileen F

    2015-02-01

    Using the Faces Pain Scale - Revised, we assessed injection site pain 10 minutes after vaccination in young females randomized to receive either quadrivalent human papillomavirus vaccine (HPV4) before or after concomitantly administered vaccines. Although pain was modestly more after HPV4 injection than after other vaccines, the pain intensity after HPV4 injection was significantly less in those who received HPV4 before receiving other concomitant vaccines.

  6. A phase I/II study of biweekly capecitabine and irinotecan plus bevacizumab as second-line chemotherapy in patients with metastatic colorectal cancer

    Directory of Open Access Journals (Sweden)

    Suenaga M

    2015-03-01

    Full Text Available Mitsukuni Suenaga,1 Nobuyuki Mizunuma,1 Satoshi Matsusaka,1 Eiji Shinozaki,1 Masato Ozaka,1 Mariko Ogura,1 Keisho Chin,1 Toshiharu Yamaguchi2 1Department of Gastroenterology, 2Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake, Koto-ku, Tokyo, Japan Background: Triweekly capecitabine plus irinotecan (XELIRI is not completely regarded as a valid substitute for fluorouracil, leucovorin, and irinotecan (FOLFIRI in metastatic colorectal cancer (mCRC because of the potential for greater toxicity. We conducted a phase I/II study to assess the efficacy and safety of biweekly XELIRI plus bevacizumab (BV as second-line chemotherapy for mCRC.Methods: Patients with mCRC who had received prior chemotherapy including oxaliplatin and BV and had a UGT1A1 genotype of wild-type or heterozygous for UGT1A1*6 or *28 were eligible for this study. Treatment comprised capecitabine 1,000 mg/m2 twice daily from the evening of day 1 to the morning of day 8, intravenous irinotecan on day 1, and BV 5 mg/kg on day 1 every 2 weeks. The phase I study consisted of two steps (irinotecan 150 and 180 mg/m2, and dose-limiting toxicity was assessed during the first treatment cycle. The primary endpoint of the phase II study was progression-free survival (PFS.  Results: The recommended dose of irinotecan was determined to be 180 mg/m2 in the phase I study. Between November 2010 and August 2013, 44 patients were enrolled in phase II. The patients’ characteristics were as follows (N=44: median age, 60 years (range 32–80; male/female, 21/23; and UGT1A1 wild-type/heterozygous, 29/15. The median PFS was 6.8 months (95% confidence interval, 5.3–8.2 months, and the primary endpoint was met. Median overall survival was 18.3 months. The response rate was 22.7%. There was no significant difference in PFS or overall survival according to UGT1A1 status. Grade 3 or higher adverse events were mainly neutropenia in six

  7. Concomitant administration of hepatitis A vaccine with measles/mumps/rubella/varicella and pneumococcal vaccines in healthy 12- to 23-month-old children.

    Science.gov (United States)

    Yetman, Robert J; Shepard, Julie S; Duke, Anton; Stek, Jon E; Petrecz, Maria; Klopfer, Stephanie O; Kuter, Barbara J; Schödel, Florian P; Lee, Andrew W

    2013-08-01

    This open-label, multicenter, randomized, comparative study evaluated immunogenicity, safety and tolerability of concomitant (Group 1; n=330) vs. non-concomitant (Group 2; n=323) VAQTA™ (25U/0.5 mL) (hepatitis A vaccine; HAV) with ProQuad™ (measles/mumps/rubella/varicella; MMRV) and Prevnar™ (7-valent pneumococcal; PCV-7) in healthy, 12-23 mo old children. Group 1 received HAV/MMRV/PCV-7 concomitantly on Day 1 and second doses of HAV/MMRV at Week 24. Group 2 received MMRV/PCV-7 on Day 1, HAV at Weeks 6 and 30 and MMRV at Week 34. Hepatitis A seropositivity rate (SPR: ≥10 mIU/mL; 4 weeks postdose 2), varicella zoster-virus (VZV) SPR (≥5 gpELISA units/mL) and geometric mean titers (GMT) to S. pneumoniae were examined. Injection-site and systemic adverse experiences (AEs) and daily temperatures were collected. Hepatitis A SPR were 100% for Group 1 and 99.4% for Group 2 after two HAV doses; risk difference=0.7 (95%CI: -1.4,3.8, non-inferior) regardless of initial serostatus. VZV SPR was 93.3% for Group 1 and 98.3% for Group 2; risk difference=-5.1 (95%CI: -9.3, -1.4; non-inferior). S. pneumoniae GMT fold-difference (7 serotypes) ranged from 0.9 to 1.1; non-inferior. No statistically significant differences in the incidence of individual AEs were seen when HAV was administered concomitantly vs. non-concomitantly. Three (all Group 2 post-administration of MMRV/PCV-7) of 11 serious AEs were considered possibly vaccine-related: dehydration and gastroenteritis (same subject) on Day 52; febrile seizure on Day 9. No deaths were reported. Antibody responses to each vaccine given concomitantly were non-inferior to HAV given non-concomitantly with MMRV and PCV-7. Administration of HAV with PCV-7 and MMRV had an acceptable safety profile in 12- to 23-mo-old children.

  8. Concomitant Pancreas Divisum and Double Pylorus: A Case Report

    Directory of Open Access Journals (Sweden)

    Gurhan Sisman

    2014-11-01

    Full Text Available Double pylorus (DP is a rare condition that is usually discovered incidentally through an upper endoscopy (UE examination. While acquired DP, which is the most common type, often develops as a complication of peptic ulcer disease (PUD, congenital DP can be isolated associated with other congenital abnormalities such as heterotopic pancreatic tissue or gastric duplication [1, 2]. This article presents the first case of DP associated with pancreas divisum (PD. A twenty two-year-old woman was admitted to our hospital because of mild epigastric pain. Her medical history was unremarkable. The laboratory tests that were requested on admission were normal except for amylase 920 U/L (reference range: 60-180 U/L.The patient denied having had any history of PUD or of having used nonsteroidal anti-inflammatory drugs (NSAIDs. A UE examination revealed two pyloric openings into the duodenal bulb. However, there was no evidence of PUD on the UE. The presence of Helicobacter pylori was not observed in the histologic examination of the gastric antrum tissue. Magnetic resonance cholangiopancreatogram (MRCP imaging showed PD (Figure 1 A-B. The patient was treated symptomatically, and she recovered. When the UE and MRCP were repeated for control on the sixth month of the treatment, they demonstrated the same findings as the initial UE and MRCP.

  9. Management of Concomitant Cancer and Abdominal Aortic Aneurysm

    Directory of Open Access Journals (Sweden)

    Abdullah Jibawi

    2011-01-01

    Full Text Available Background. The coexistence of neoplasm and abdominal aortic aneurysm (AAA presents a real management challenge. This paper reviews the literature on the prevalence, diagnosis, and management dilemmas of concurrent visceral malignancy and abdominal aortic aneurysm. Method. The MEDLINE and HIGHWIRE databases (1966-present were searched. Papers detailing relevant data were assessed for quality and validity. All case series, review articles, and references of such articles were searched for additional relevant papers. Results. Current challenges in decision making, the effect of major body-cavity surgery on an untreated aneurysm, the effects of major vascular surgery on the treatment of malignancy, the use of EVAR (endovascular aortic aneurysm repair as a fairly low-risk procedure and its role in the management of malignancy, and the effect of other challenging issues such as the use of adjuvant therapy, and patients informed decision-making were reviewed and discussed. Conclusion. In synchronous malignancy and abdominal aortic aneurysm, the most life-threatening lesion should be addressed first. Endovascular aneurysm repair where possible, followed by malignancy resection, is becoming the preferred initial treatment choice in most centres.

  10. Cognitive function in older women with breast cancer treated with standard chemotherapy and capecitabine on Cancer and Leukemia Group B 49907.

    Science.gov (United States)

    Freedman, Rachel A; Pitcher, Brandelyn; Keating, Nancy L; Ballman, Karla V; Mandelblatt, Jeanne; Kornblith, Alice B; Kimmick, Gretchen G; Hurria, Arti; Winer, Eric P; Hudis, Clifford A; Cohen, Harvey Jay; Muss, Hyman B

    2013-06-01

    Cognitive changes in older women receiving chemotherapy are poorly understood. We examined self-reported cognitive function for older women who received adjuvant chemotherapy on Cancer and Leukemia Group B (CALGB) 49907. CALGB 49907 randomized 633 women aged ≥65 with stage I-III breast cancer to standard adjuvant chemotherapy (cyclophosphamide-methotrexate-5-fluorouracil or doxorubicin-cyclophosphamide) versus capecitabine. We examined self-reported cognitive function in 297 women (CALGB 361002) who enrolled on the quality of life substudy and had no gross impairment on cognitive screening. Women were evaluated using an 18-item instrument at six time points (baseline through 24 months). At each time point for each patient, we calculated a cognitive function score (CFS) defined as the mean response of items 1-18 and defined impairment as a score >1.5 standard deviations above the overall average baseline score. Differences in scores by patient characteristics were evaluated using a Kruskal-Wallis test. A linear mixed-effects model was used to assess CFSs by treatment over time. Among 297 women, the median age was 71.5 (range 65-85) and 73 % had performance status of 0. Baseline depression and fatigue were reported in 6 and 14 % of patients, respectively. The average CFS at baseline was 2.08 (corresponding to "normal ability"), and baseline cognitive function did not differ by treatment regimen (p = 0.350). Over 24 months, women reported minimal changes at each time point and insignificant differences by treatment arm were observed. In a healthy group of older women, chemotherapy was not associated with longitudinal changes in self-reported cognitive function.

  11. The potential predictive role of nuclear NHERF1 expression in advanced gastric cancer patients treated with epirubicin/oxaliplatin/capecitabine first line chemotherapy

    Science.gov (United States)

    Mangia, Anita; Caldarola, Lucia; Dell'Endice, Stefania; Scarpi, Emanuela; Saragoni, Luca; Monti, Manlio; Santini, Daniele; Brunetti, Oronzo; Simone, Giovanni; Silvestris, Nicola

    2015-01-01

    Cellular resistance in advanced gastric cancer (GC) might be related to function of multidrug resistance (MDR) proteins. The adaptor protein NHERF1 (Na+/H+ exchanger regulatory factor) is an important player in cancer progression for a number of solid malignancies, even if its role to develop drug resistance remains uncertain. Herein, we aimed to analyze the potential association between NHERF1 expression and P-gp, sorcin and HIF-1α MDR-related proteins in advanced GC patients treated with epirubicin/oxaliplatin/capecitabine (EOX) chemotherapy regimen, and its relation to response. Total number of 28 untreated patients were included into the study. Expression and subcellular localization of all proteins were assessed by immunohistochemistry on formalin-fixed paraffin embedded tumor samples. We did not found significant association between NHERF1 expression and the MDR-related proteins. A trend was observed between positive cytoplasmic NHERF1 (cNHERF1) expression and negative nuclear HIF-1α (nHIF-1α) expression (68.8% versus 31.3% respectively, P = 0.054). However, cytoplasmic P-gp (cP-gp) expression was positively correlated with both cHIF-1α and sorcin expression (P = 0.011; P = 0.002, respectively). Interestingly, nuclear NHERF1 (nNHERF1) staining was statistically associated with clinical response. In detail, 66.7% of patients with high nNHERF1 expression had a disease control rate, while 84.6% of subjects with negative nuclear expression of the protein showed progressive disease (P = 0.009). Multivariate analysis confirmed a significant correlation between nNHERF1 and clinical response (OR 0.06, P = 0.019). These results suggest that nuclear NHERF1 could be related to resistance to the EOX regimen in advanced GC patients, identifying this marker as a possible independent predictive factor. PMID:26126066

  12. Quality of life in women with metastatic breast cancer during 9 months after randomization in the TEX trial (epirubicin and paclitaxel w/o capecitabine).

    Science.gov (United States)

    Svensson, Helene; Einbeigi, Zakaria; Johansson, Hemming; Hatschek, Thomas; Brandberg, Yvonne

    2010-10-01

    The aim of this study was to compare the effects on health-related quality of life (HRQOL) of two treatment regimens in the TEX trial during 9 month from random assignment, with emphasis on the 2- and 9-months assessments. A total of 287 patients were randomized to treatment in 3-week cycles with either epirubicin plus paclitaxel (ET, 143 patients), or epirubicin, paclitaxel and capecitabine (TEX, 144 patients). HRQOL was assessed by the EORTC-QLQ C30 and EORTC QLQ-BR23 questionnaires at five points during 9 months. A total of 252 (88%) completed questionnaires before randomization. Response rate for the following assessments was >75%. There were no statistically significant differences between the TEX group and the ET group on any of the subscales 2 months after randomization. Small clinical differences (5-10 points) in favor of the ET group were found for global quality of life, role functioning, social functioning, and insomnia. At the 9-months assessment, the TEX group scored statistically significantly higher on global quality of life and physical functioning. Small clinically significant differences were found for global quality of life, physical functioning, role functioning, emotional functioning, dyspnoea, and insomnia, all in favour of the TEX group. At the 2-months assessment, when side-effects of chemotherapy were present, patients in the TEX group appeared to fare a bit worse than those receiving ET. However, after 9 months, when the patients had adapted to treatment, the TEX group seemed to have a slightly better quality of life.

  13. (19)F MRSI of capecitabine in the liver at 7 T using broadband transmit-receive antennas and dual-band RF pulses.

    Science.gov (United States)

    van Gorp, Jetse S; Seevinck, Peter R; Andreychenko, Anna; Raaijmakers, Alexander J E; Luijten, Peter R; Viergever, Max A; Koopman, Miriam; Boer, Vincent O; Klomp, Dennis W J

    2015-11-01

    Capecitabine (Cap) is an often prescribed chemotherapeutic agent, successfully used to cure some patients from cancer or reduce tumor burden for palliative care. However, the efficacy of the drug is limited, it is not known in advance who will respond to the drug and it can come with severe toxicity. (19)F Magnetic Resonance Spectroscopy (MRS) and Magnetic Resonance Spectroscopic Imaging (MRSI) have been used to non-invasively study Cap metabolism in vivo to find a marker for personalized treatment. In vivo detection, however, is hampered by low concentrations and the use of radiofrequency (RF) surface coils limiting spatial coverage. In this work, the use of a 7T MR system with radiative multi-channel transmit-receive antennas was investigated with the aim of maximizing the sensitivity and spatial coverage of (19)F detection protocols. The antennas were broadband optimized to facilitate both the (1)H (298 MHz) and (19)F (280 MHz) frequencies for accurate shimming, imaging and signal combination. B1(+) simulations, phantom and noise measurements showed that more than 90% of the theoretical maximum sensitivity could be obtained when using B1(+) and B1(-) information provided at the (1)H frequency for the optimization of B1(+) and B1(-) at the (19)F frequency. Furthermore, to overcome the limits in maximum available RF power, whilst ensuring simultaneous excitation of all detectable conversion products of Cap, a dual-band RF pulse was designed and evaluated. Finally, (19)F MRS(I) measurements were performed to detect (19)F metabolites in vitro and in vivo. In two patients, at 10 h (patient 1) and 1 h (patient 2) after Cap intake, (19)F metabolites were detected in the liver and the surrounding organs, illustrating the potential of the set-up for in vivo detection of metabolic rates and drug distribution in the body.

  14. Concomitant herpes simplex virus colitis and hepatitis in a man with ulcerative colitis

    Science.gov (United States)

    Phadke, Varun K.; Friedman-Moraco, Rachel J.; Quigley, Brian C.; Farris, Alton B.; Norvell, J. P.

    2016-01-01

    Abstract Background: Herpesvirus infections often complicate the clinical course of patients with inflammatory bowel disease; however, invasive disease due to herpes simplex virus is distinctly uncommon. Methods: We present a case of herpes simplex virus colitis and hepatitis, review all the previously published cases of herpes simplex virus colitis, and discuss common clinical features and outcomes. We also discuss the epidemiology, clinical manifestations, diagnosis, and management of herpes simplex virus infections, focusing specifically on patients with inflammatory bowel disease. Results: A 43-year-old man with ulcerative colitis, previously controlled with an oral 5-aminosalicylic agent, developed symptoms of a colitis flare that did not respond to treatment with systemic corticosteroid therapy. One week later he developed orolabial ulcers and progressive hepatic dysfunction, with markedly elevated transaminases and coagulopathy. He underwent emergent total colectomy when imaging suggested bowel micro-perforation. Pathology from both the colon and liver was consistent with herpes simplex virus infection, and a viral culture of his orolabial lesions and a serum polymerase chain reaction assay also identified herpes simplex virus. He was treated with systemic antiviral therapy and made a complete recovery. Conclusions: Disseminated herpes simplex virus infection with concomitant involvement of the colon and liver has been reported only 3 times in the published literature, and to our knowledge this is the first such case in a patient with inflammatory bowel disease. The risk of invasive herpes simplex virus infections increases with some, but not all immunomodulatory therapies. Optimal management of herpes simplex virus in patients with inflammatory bowel disease includes targeted prophylactic therapy for patients with evidence of latent infection, and timely initiation of antiviral therapy for those patients suspected to have invasive disease. PMID:27759636

  15. Maximum Inhibition of Breast Cancer/Stem Cell Growth by Concomitant Blockage of Key Receptors

    Directory of Open Access Journals (Sweden)

    Mossa Gardaneh

    2012-01-01

    Full Text Available The blockage of cancer cell growth and division is the prime objective in clinical cancer therapy both at early stages and for inhibition of minimal residual disease and relapse. The failure of conventional therapies in treating breast cancer (BC has prompted dissection of signalling pathways involved in BC cell growth and characterisation of cellular receptors. Specific sets of membrane-bound receptors promote disarrayed self-renewal of BC stem cells and deregulated BC cell proliferation. Individual blockage of each receptor promotes only incomplete inhibition of BC cell growth and partial regression of metastasis. Such monotherapies are based on either chemotherapy or monoclonal antibodies. However, they do not provide long-lasting benefits and are further compromised by increasing resistance the cancer cells acquire against therapeutic agents, by their evasion of receptor blockage and by adoption of alternative growth routes that are induced by cross-talks between key receptors. On the other hand, dual targeting approaches, including receptor blockage combined with chemotherapy, produce prolonged overall survival but, nevertheless, complicate treatment by inducing side effects. Based on the complex nature of BC, combined targeted strategies that potentially confer maximum coverage for treatment cannot be effective without overcoming drug resistance initiated and further induced by inter-receptor communications. This implies that a comprehensive strategy based on concomitant inhibition of key receptors could provide an ultimate solution for effective treatment of aggressive types of BC. Such a strategy would likely be capable of targeting breast tumour cells and BC stem cells alike eventually forcing the cancer to regress.

  16. Clinical observation of capecitabine in the maintenance treatment of advanced breast cancer%卡培他滨维持治疗晚期乳腺癌的临床观察

    Institute of Scientific and Technical Information of China (English)

    李剑英; 季从飞; 陈佳; 谭清和

    2014-01-01

    Background and purpose: Capecitabine, which is widely used in the first-line treatment of advanced breast cancer, was known little in the maintenance treatment of advanced breast cancer. The present study aimed to explore the efficacy and safety of capecitabine in the maintenance treatment of advanced breast cancer. Methods: A total of 62 advanced breast cancer patients confirmed by histopathology and/or cytology, who had been evaluated as CR/PR/SD after first-line treatment, were divided into two groups. Thirty-one of them received capecitabine orally as maintenance treatment, while the others were followed up without any treatment. The clinical response was evaluated every two cycles. Results:The median time to progression (TTP) of the capecitabine group was 12 (2-24) months, which was signiifcantly higher than the control group. In the subgroup analysis, similar results were detected in the premenopausal group, hormone receptor positive group, HER-2 positive group, metastasis group, no capecitabine used history group. Among the capecitabine group,the overall response rate (CR+PR) was 19.4%, and the disease control rate (CR+PR+SD) was 74.2%. The most common adverse effects were hand-foot syndrome, hematologic toxicity and gastrointestinal reaction, all of which could be tolerated. The overall score of the capecitabine group evaluated by the Chinese vesion of the FACT-B was signiifcantly higher than the control group. Conclusion:Capecitabine can effectively and tolerably prolong survival time and improve the quality of life of patients in the maintenance treatment of advanced breast cancer.%背景与目的:卡培他滨是晚期乳腺癌一线治疗方案用药,但在晚期乳腺癌的维持治疗中的研究较少。本文旨在探讨卡培他滨维持治疗晚期乳腺癌的疗效及不良反应。方法:将一线化疗后处于完全缓解(complete response,CR)、部分缓解(partial response,PR)或疾病稳定(stable disease,SD)的62例患者分为2

  17. [Clinical and immunological features of acute hepatitis B in patients with concomitant chronic toxic liver damage].

    Science.gov (United States)

    Furyk, E; Ryabokon, E

    2013-02-01

    The article presents information obtained during the survey in 64 patients with acute hepatitis B. We show that acute hepatitis B in patients with concomitant chronic toxic liver characterized by a marked imbalance of cytokine status due to a lower level of interleukin-2 and a higher content of interleukin-8, the highest levels of nitrite content, spontaneous oxidative modifications of blood proteins and the lowest content of L -arginine in the blood serum in the dynamics of disease compared with patients without this concomitant factor. In the period of convalescence these changes in patients with acute hepatitis B with concomitant chronic toxic liver characterized combined with higher cytolysis of liver cells, often circulating in the blood of HBsAg seroconversion and less frequently with the advent of anti-HBeAg.

  18. Role of concomitant therapy for Helicobacter pylori eradication: A technical note

    Science.gov (United States)

    Losurdo, Giuseppe; Giorgio, Floriana; Iannone, Andrea; Principi, Mariabeatrice; Barone, Michele; Di Leo, Alfredo; Ierardi, Enzo

    2016-01-01

    We read with interest the recent meta-analysis by Lin et al who evaluated the effectiveness of concomitant regimen for Helicobacter pylori (H. pylori) in Chinese regions. They found that 7-d concomitant regimen is undoubtedly superior to 7-d triple therapy (91.2% vs 77.9%, P < 0.0001). However, it is a common belief that a triple therapy lasting 7 d should be definitively removed from the clinical practice for its ineffectiveness. Only its prolongation to 14 d may give satisfactory success rate. Thus, the assessment of an old and outdated treatment versus a more recent and successful one does not seem to bring novel and useful information. Moreover, a 7-d duration has not been ascertained for concomitant regimen, as main guidelines recommend a 10-d schedule for this scheme. Therefore, only studies comparing 10-d concomitant versus 14-d triple seem to be appropriate according to current Guidelines and would clarify which regimen is the most suitable worldwide. Additionally, in this meta-analysis concomitant and sequential therapy showed similar performances, despite it is common opinion that sequential is more prone than concomitant therapy to fail when metronidazole resistance occurs, and China is characterized by high rate of resistance to this antibiotic. None of the included studies evaluated a priori antibiotic resistances, and the lack of this detail hampers the unveiling of this apparent contradiction. In conclusion, the lack of the evaluation of the quality of included trials as well as their high heterogeneity constitute a burdensome limit to draw solid conclusions in this meta-analysis. On the bases of these considerations and the low number of examined trials, we believe that further studies and the knowledge of antibiotic resistances will support with high quality evidence which is the best regimen and its optimal duration. PMID:27784977

  19. Dental trauma. Combination injuries 3. The risk of pulp necrosis in permanent teeth with extrusion or lateral luxation and concomitant crown fractures without pulp exposure

    DEFF Research Database (Denmark)

    Lauridsen, Eva Fejerskov; Hermann, Nuno Vibe; Gerds, Thomas Alexander;

    2012-01-01

    Aim: To analyze the influence of a crown fracture without pulp exposure on the risk of pulp necrosis (PN) in teeth with extrusion or lateral luxation. Material and methods: The study included 82 permanent incisors with extrusion from 78 patients (57 male, 21 female) and 179 permanent incisors......, and response to electric pulp test at the initial examination. Results: A concomitant crown fracture significantly increased the risk of PN in teeth with lateral luxation. For teeth with immature root development (hazard ratio: 10 [95% confidence interval (CI): 1.1–100] P = 0.04), the overall risk increased...... increased from 56.5% (95% CI: 37.7–75.4) to 76.5% (95% CI: 58.9–94) in case of a concomitant crown fracture, but the difference was not statistically significant (P > 0.05). Conclusion: A concomitant crown fracture without pulp exposure significantly increased the risk of PN in teeth with lateral luxation...

  20. The Evolution of Massive Stars and the Concomitant Non-explosive and Explosive Nucleosynthesis

    Science.gov (United States)

    Arnould, Marcel

    These lectures are concerned with some aspects of the evolution of massive stars and of the concomitant nucleosynthesis. They complement other lectures in this volume. Special emphasis is put on the production of the nuclides heavier than iron by the r- and p-processes.

  1. Oxidized limonene and oxidized linalool - Concomitant contact allergy to common fragrance terpenes

    DEFF Research Database (Denmark)

    Bråred Christensson, Johanna; Karlberg, Ann Therese; Andersen, Klaus E.;

    2016-01-01

    of the reactions. The concomitant reactions to the two fragrance allergens suggest multiple sensitizations, which most likely reflect the exposure to the different fragrance materials in various types of consumer products. This is in accordance with what is generally seen for patch test reactions to fragrance...

  2. Dental management of a patient fitted with subcutaneous Implantable Cardioverter Defibrillator device and concomitant warfarin treatment

    Directory of Open Access Journals (Sweden)

    Altaf Hussain Shah

    2015-07-01

    This article presents the dental management of a 60 year-old person with an ICD and concomitant anticoagulant therapy. The patient was on multiple medications and was treated for a grossly neglected mouth with multiple carious root stumps. This case report outlines the important issues in managing patients fitted with an ICD device and at a risk of sudden cardiac death.

  3. Two Atypical Cases of Kingella kingae Invasive Infection with Concomitant Human Rhinovirus Infection

    Science.gov (United States)

    Basmaci, Romain; Ilharreborde, Brice; Doit, Catherine; Presedo, Ana; Lorrot, Mathie; Alison, Marianne; Mazda, Keyvan; Bidet, Philippe

    2013-01-01

    We describe two atypical cases of Kingella kingae infection in children diagnosed by PCR, one case involving a soft tissue abscess and one case a femoral Brodie abscess. Both patients had concomitant human rhinovirus infection. K. kingae strains, isolated from an oropharyngeal swab, were characterized by multilocus sequence typing and rtxA sequencing. PMID:23784119

  4. Concomitant lamotrigine use is associated with decreased efficacy of the ketogenic diet in childhood refractory epilepsy

    NARCIS (Netherlands)

    E.J.T.M. van der Louw (Elles J.T.M.); Desadien, R. (Raakhee); F.O.L. Vehmeijer (Florianne O.L.); I.H. van der Sijs (Heleen); C.E. Catsman-Berrevoets (Coriene); R.F. Neuteboom (Rinze)

    2015-01-01

    textabstractPurpose Anti-epileptic drugs (AEDs) and the ketogenic diet (KD) are often used concomitantly in children with refractory epilepsy. It has been hypothesised that certain AEDs may interfere with KD. The purpose of this study was to elucidate relationships between efficacy of KD and use of

  5. Considering the antimicrobial sensitivity of the intestinal botulism agent Clostridium butyricum when treating concomitant infections.

    Science.gov (United States)

    Fenicia, Lucia; Ferrini, Anna Maria; Anniballi, Fabrizio; Mannoni, Veruscka; Aureli, Paolo

    2003-01-01

    In Italy, neurotoxigenic Clostridium butyricum has been reported as a new agent of intestinal toxemia botulism, and most of the cases have been associated with enterocolitis. Although infections concomitant with botulism must be treated with antibiotics, this can increase the severity of botulism. We discuss the sensitivity of this agent to certain antibiotics, compared to findings on the sensitivity of C. botulinum.

  6. CHOICE OF LISINOPRIL FOR TREATMENT OF HYPERTENSION IN PATIENTS WITH CONCOMITANT DISEASES

    Directory of Open Access Journals (Sweden)

    N. A. Dzhaiani

    2014-01-01

    Full Text Available Rationale and benefits of the use of the ACE inhibitor lisinopril in the clinical practice as an antihypertensive drug are considered. Special attention is paid to the organ protective effects of lisinopril and its application in some clinical situations (combination of hypertension with chronic obstructive pulmonary disease, elderly patients, and concomitant liver diseases.

  7. CONCOMITANT INFECTION OF LEPTOSPIROSIS WITH DENGUE AT A TERTIARY CARE HOSPITAL IN CHENNAI

    Directory of Open Access Journals (Sweden)

    Ananthi

    2014-02-01

    Full Text Available BACKGROUND : Concomitant infection of leptospirosis with dengue has been reported in places where these diseases are endemic and leptospirosis may be overlooked in such cases. Recognition of leptospirosis is especially important since antimicrobial agents can reduce its severity a nd duration. Failure to identify leptospirosis in these patients will result in high mortality rate for this infection . Hence this study was conducted to have a detailed knowledge and awareness about the concomitant infection of leptospirosis with dengue. MATERIALS AND METHODS : Patients admitted to the medical ward of Government General Hospital , Chennai with fever of ≥ 5days and of the age group twelve years and above were evaluated for leptospirosis by doing the screening test MSAT (Macroscopic Slide Aggl utination Test. All patients who tested positive for MSAT were further confirmed by MAT (Microscopic Agglutination Test. Those patients who tested positive for leptospirosis were investigated for concomitant infection with dengue utilising IgM ELISA. Pat ients positive for both leptospirosis and dengue were taken up for the study and were evaluated for relevant clinical features and laboratory profile. RESULTS : 143 patients were found to be positive for leptospirosis and among them 4 (2.8% patients were p ositive for the concomitant dengue infection. In the four concomitant infection patients , two were males and two were females , all in the age group of 20 to 30 years. Fever and myalgia were the predominant symptoms in these patients. Thrombocytopenia was s een in 3 (75% patients. With fluid resuscitation , platelet transfusion , appropriate drug and supportive therapy all the four patients recovered. No mortality was observed in this study. CONCLUSION: Increased awareness of concomitant infection and an enhan ced ability to diagnose it early in illness is necessary so that appropriate treatment and supportive measures can be given to reduce the morbidity

  8. OCCURRENCE OF DISSOCIATED VERTICAL DEVIATION IN HORIZONTAL CONCOMITANT HETEROTROPIA: A HOSPITAL-BASED STUDY

    Directory of Open Access Journals (Sweden)

    Sagar Karmakar

    2016-07-01

    Full Text Available BACKGROUND Dissociated Vertical Deviation (DVD is a poorly understood supranuclear strabismic disorder in which there is slow upward and sometimes temporal movement of one eye with cortical suppression of vision in that eye when it is occluded. In DVD, one eye get dissociated from the fellow eye, so they don’t follow Hering's and Sherrington's laws of innervation. DVD is also a marker of disruption of normal binocular function, which causes unbalanced input to vestibular system resulting in latent nystagmus with a cyclovertical component. To overcome this cyclovertical component, vertical vergence is invoked for which vision is aided in the fixing eye, but unfortunately it also produces DVD of the fellow eye. DVD is most commonly associated with infantile esotropia. AIM  To determine whether age of onset of strabismus is related to the development of dissociated vertical deviation in patients with horizontal concomitant heterotropia (HCH. To find out the occurrence of dissociated vertical deviation among patients with horizontal concomitant heterotropia and also to calculate how many of them is suffering from refractive error.  DESIGN This is a cross-sectional, observational hospital-based study. MATERIALS AND METHOD This study was done in 100 children presenting with horizontal concomitant heterotropia randomly chosen in the age group 5 yrs.–19 yrs. attending outpatient department and squint clinic of Regional Institute of Ophthalmology, Kolkata. After taking proper history regarding time of onset of strabismus, age of onset of DVD, they underwent a full ophthalmic examination including visual acuity assessment, cycloplegic refraction, assessment and measurement of squint and DVD, and stereopsis. RESULT Mean age of horizontal concomitant heterotropes was 9.28 yrs. ± 3.94 yrs. of which 48% were male and 52% were female. Among horizontal concomitant heterotropes 24% were exotropes and 76% esotropes. The mean age of onset of strabismus

  9. [Identification of the primary lesion in a patient with concomitant breast and kidney cancer following fracture of the femur].

    Science.gov (United States)

    Sato, Yasufumi; Okishiro, Masatsugu; Ishida, Tomo; Morimoto, Yoshihiro; Kusama, Hiroki; Matsusita, Katsunori; Hashimoto, Tadayoshi; Kimura, Kei; Katsura, Yoshiteru; Nitta, Kanae; Kagawa, Yoshinori; Takeno, Atsushi; Sakisaka, Hideki; Nakahira, Shin; Taniguchi, Hirokazu; Egawa, Chiyomi; Takeda, Yutaka; Kato, Takeshi; Tamura, Shigeyuki; Takatsuka, Yuichi; Oku, Kazuko; Goto, Takayoshi; Nagano, Teruaki; Nakatsuka, Shinichi

    2014-11-01

    A 61-year-old woman was diagnosed with breast cancer [T3N3cM0: Stage IIIC, estrogen receptor [ER] (+), progesterone receptor [PgR] (+), human epidermal growth factor receptor 2[HER2] (-)]at the time of initial presentation. Following diagnosis, combined modality therapy including hormone therapy and chemotherapy were initiated, but hemorrhage from the primary lesion and bone metastases were observed. Priority was given to treatment of the breast cancer, and chemotherapy was administered, after which, right mastectomy and axillary lymph node sampling were performed to assess local disease control. In addition, concurrent right kidney enucleation was performed for a renal lesion. The renal neoplasm was diagnosed as T1aN0M0, Stage I. After this intervention, treatment of the breast cancer was continued, but pain of the right femoral region developed, and bone metastasis was diagnosed on close inspection. The bone metastasis was considered to derive from the breast cancer. During hospitalization, the patient fell and broke her right femur. Open reduction and internal fixation was performed immediately, and bone metastasis of kidney cancer was diagnosed via perioperative cytodiagnosis. Pulmonary metastasis, local recurrence, and metastasis to the shoulder blade have been detected. The metastases are considered to derive from the breast cancer, for which treatment has been continued. In the case of concomitant cancers, biopsy for metastatic foci can be considered essential, whenever it can be performed safely.

  10. Endovenous Laser Ablation and Concomitant Foam Sclerotherapy: Experience in 504 Patients

    Energy Technology Data Exchange (ETDEWEB)

    Yilmaz, Saim, E-mail: ysaim@akdeniz.edu.tr; Ceken, Kagan; Alparslan, Ahmet; Durmaz, Sedat; Sindel, Timur [Akdeniz University School of Medicine, Department of Radiology (Turkey)

    2012-12-15

    Purpose: To investigate the value of endovenous laser ablation (ELA) and concomitant ultrasound-guided foam sclerotherapy (USGFS) in patients with chronic venous insufficiency. Methods: During a 6-year period, concomitant USGFS of the varicose veins were performed in 504 out of 610 patients who underwent ELA for truncal or perforating vein insufficiency. In these 504 patients (944 legs; bilateral in 440 patients), the incompetent veins were greater saphenous vein in 615 legs, small saphenous vein in 118 veins, perforating veins in 42 legs, and a combination of these in 169 legs. In all patients, after ELA of the incompetent veins, USGFS was performed for the remaining varicosities with 1-3% polidocanol foam. Patients were followed up clinically and with color Doppler ultrasound at 1, 6, and 12 months. Results: ELA was technically successful in all cases, although another venous puncture was necessary in 29 legs. Concomitant USGFS was also technically successful in all cases, but one to three additional sclerotherapy sessions were performed in 203 legs with persistent varicosities. During the follow-up, recanalization of the laser-ablated refluxing veins occurred in 16 legs (1.7%) and was treated with repeat ELA or USGFS. Major complications occurred in 1.4% of the treated legs and included skin necrosis and calf vein thrombosis. Conclusion: ELA and concomitant foam sclerotherapy is feasible and effective. The procedures are associated with a low complication rate and can be performed in both legs in the same session. Concomitant use of laser and foam may potentially decrease the recanalization rate of laser-ablated vessels.

  11. The observation of capecitabine in the maintenance treatment ofmetastatic breast cancer%希罗达在转移性乳腺癌维持治疗中的疗效观察

    Institute of Scientific and Technical Information of China (English)

    赵韬; 邵清; 张汀荣; 赵臻; 殷华芳; 陆向东

    2011-01-01

    目的 探讨希罗达在转移性乳腺癌(MBC)维持治疗中的疗效及安全性.方法 已进行6~8周期一线治疗的患者65例,根据治疗方法不同分为实验组与对照组.实验组(n=45)患者给予希罗达800~1000 mg/m2,每日2次,持续给药.对照组(n=20)患者不接受希罗达维持治疗,以观察为主.观察比较两组患者总生存率(OS),无进展生存率(PFS),完全缓解(CR),部分缓解(PR),总有效率(RR)与安全性.结果 与实验组比较,对照组进展概率增加的更加明显,无进展概率及累计无进展生存率降低更明显.但两组各时间段的累计无进展生存率比较,差异无统计学意义(P>O.05).各时问段实验组OS明显高于对照组,但差异无统计学意义(P>0.05).实验组治疗的总有效率高于对照组(P<0.05),不良反应发生率高于对照组.结论 在一线治疗结束后给予的延长治疗,希罗达可以显著延长患者生存时间,提高临床治疗效果,但不良反应发生率较高.%Objective To explore the efficacy and safety of Capecitabine in the maintenance treatment of metastatic breast cancer (MBC). Methods Sixty-five patients, who have been carried out 6 to 8 cycles of first - line treatment, were divided into experimental group and control group according to the different treatment methods. Within the experimental group ( n = 45), patients were given Capecitabine 800~ 1 000 mg/m2, bid with sustained drug delivery. Within the control group ( n = 20), the effect was observed and Capecitabine maintenance therapy was not giver. The OS, PFS, CR, PR, RR and security in these two groups were observed and compared.Results Compared with the experimental group, the probability of progress, no progress and thecumulative probability of progression- free survival rate were reduced even more apparently in control group. But each time, the cumulative progression-free survival difference was not statistically significant in the two groups (P>0.05). The OS time

  12. 大肠癌术后应用卡培他滨联合奥沙利铂治疗的不良反应护理体会%Colorectal Postoperative Capecitabine Gemcitabine Plus Oxaliplatin Treatment Nursing Experience Adverse Reactions

    Institute of Scientific and Technical Information of China (English)

    张艳莉; 廖明芬

    2012-01-01

      Objective: To investigate patients with colorectal cancer postoperative capecitabine gemcitabine plus oxaliplatin chemotherapy adverse reactions nursing strategy. Method: 32 cases of capecitabine and oxaliplatin in colorectal cancer patients due to adverse reactions accordingly care. Result:32 patients completed a total of 192 cycles of chemotherapy,adverse reactions mainly peripheral neurotoxicity,hand-foot syndrome,gastrointestinal reactions,bone marrow suppression,most Ⅰ or Ⅱ remission after symptomatic treatment and care to survive the chemotherapy period of daily living. Conclusion: The appropriate and effective care measures to prevent or mitigate adverse events,to ensure the smooth progress of chemotherapy.%  目的:探讨大肠癌患者术后应用卡培他滨联合奥沙利铂化疗不良反应的护理对策。方法:对32例卡培他滨联合奥沙利铂治疗大肠癌术后患者所致不良反应进行相应护理。结果:32例患者共完成192周期化疗,不良反应主要表现为周围神经毒性、手足综合征、消化道反应、骨髓抑制等,多数为Ⅰ度或Ⅱ度,经对症处理及护理后缓解,顺利度过化疗期,生活自理。结论:恰当有效的护理措施可以预防或减轻不良反应的发生,确保化疗顺利进行。

  13. Initial Study

    DEFF Research Database (Denmark)

    Torp, Kristian

    2009-01-01

    Congestion is a major problem in most cities and the problem is growing (Quiroga, 2000) (Faghri & Hamad, 2002). When the congestion level is increased the drivers notice this as delays in the traffic (Taylor, Woolley, & Zito, 2000), i.e., the travel time for the individual driver is simply...... increased. In the initial study presented here, the time it takes to pass an intersection is studied in details. Two major signal-controlled four-way intersections in the center of the city Aalborg are studied in details to estimate the congestion levels in these intersections, based on the time it takes...

  14. 卡培他滨维持治疗在激素受体阴性晚期乳腺癌中的临床观察%Clinical observation of Capecitabine maintenance treatment in hormone receptor-negative metastatic breast cancer

    Institute of Scientific and Technical Information of China (English)

    吴凡; 刘健

    2014-01-01

    目的:观察卡培他滨维持治疗激素受体阴性转移性乳腺癌的近期、远期疗效及不良反应方法:对一线化疗疾病获得控制的晚期转移性乳腺癌予卡培他滨单药维持化疗直至疾病进展结果:卡培他滨维持化疗总有效率(CR+PR)为10.5%,肿瘤控制率(CR+PR+SD)为52.6%。中位疾病进展时间(mTTP)为13.4个月。主要不良反应为白细胞减少、手足综合征及口腔黏膜炎结论:卡培他滨维持治疗在转移性乳腺癌中疗效肯定,不良反应可耐受。%Objective: To explore the efficacy and adverse reactions of capecitabine in the maintenance treatment of hormone receptor-negative metastatic breast cancer. methods: Metastatic breast cancer patients who gain control by first-line chemotherapy was treated by capecitabine monotherapy maintenance regiment until disease progression. Results: Total effective rate (CR + PR) was 10.5%, the tumor control rate (CR + PR + SD) was 52.6% and median time to progression (mTTP) was 13.4 months in metastatic breast cancer patients treated by capecitabine maintenance chemotherapy. The main adverse events were hand-foot syndrome, leukopenia and mucositis Conclusion: Capecitabine maintenance therapy has a definite curative effect in metastatic breast cancer, which adverse reactions can be tolerated.

  15. Gilbert Syndrome with Concomitant Hereditary Spherocytosis Presenting with Moderate Unconjugated Hyperbilirubinemia.

    Science.gov (United States)

    Aiso, Mitsuhiko; Yagi, Minami; Tanaka, Atsushi; Miura, Kotaro; Miura, Ryo; Arizumi, Toshihiko; Takamori, Yoriyuki; Nakahara, Sayuri; Maruo, Yoshihiro; Takikawa, Hajime

    2017-01-01

    We experienced a case of a 19-year-old man with Gilbert syndrome with concomitant hereditary spherocytosis. The patient presented with moderate unconjugated hyperbilirubinemia, and inherited etiology was strongly suspected. The diagnosis of Gilbert syndrome was confirmed by the genetic analysis of the UGT1A1 gene, demonstrating UGT1A1*28 and compound heterozygote UGT1A1*6. In addition, since the laboratory findings and imaging studies revealed lysemia as well as gallstone and splenomegaly, a diagnosis of hereditary spherocytosis was made as a comorbidity. Both Gilbert syndrome and hereditary spherocytosis are hereditary diseases with a high frequency, and the hyperbilirubinemia may be exacerbated when these two diseases are concomitant.

  16. Evaluation of the Prevalence of Concomitant Idiopathic Cyclic Edema and Cellulite

    OpenAIRE

    José Maria Pereira de Godoy, Maria de Fátima Guerreiro de Godoy

    2011-01-01

    The aim of this study was to evaluate the prevalence of concomitant idiopathic cyclic edema with Grade II and III cellulite. All patients treated for Grade II and III cellulite were evaluated for idiopathic cyclic edema in a retrospective, quantitative and cross-sectional study. The study was carried out at the Godoy Clinic in the period from 2006 to 2010. All patients with body mass indexes > 25, Grade I cellulite and other causes of edema were excluded. The diagnosis of idiopathic cycli...

  17. Intrauterine device infection causing concomitant streptococcal toxic shock syndrome and pelvic abscess with Actinomyces odontolyticus bacteraemia.

    Science.gov (United States)

    Wu, Carolyn M Yu; Noska, Amanda

    2016-03-10

    Intrauterine devices (IUDs) are rarely associated with serious infections. We report an unusual concomitant infection of group A Streptococcus (GAS) causing toxic shock syndrome and pelvic abscess with Actinomyces odontolyticus associated with an IUD in a healthy 50-year-old patient. The IUD was subsequently removed and the patient recovered on the appropriate antibiotics. This case highlights the importance of clinicians' high index of suspicion of an IUD infection and prompt removal of the infected foreign body to obtain source control.

  18. Allergic contact dermatitis to benzocaine: the importance of concomitant positive patch test results.

    Science.gov (United States)

    González-Rodríguez, A J; Gutiérrez-Paredes, E M; Revert Fernández, Á; Jordá-Cuevas, E

    2013-03-01

    Local anesthetics are widely used in clinical practice, and adverse effects are not uncommon. Delayed hypersensitivity reactions are among the most common effects, but immediate-type reactions may also occur. Patch testing should be considered in patients with hypersensitivity reactions. We present a case of allergic contact dermatitis to benzocaine that was detected incidentally by patch testing and highlight the importance of correctly interpreting patch test results when there are concomitant positive reactions.

  19. New potential for enhancing concomitant chemoradiotherapy with FDA approved concentrations of cisplatin via the photoelectric effect.

    Science.gov (United States)

    Altundal, Yucel; Cifter, Gizem; Detappe, Alexandre; Sajo, Erno; Tsiamas, Panagiotis; Zygmanski, Piotr; Berbeco, Ross; Cormack, Robert A; Makrigiorgos, Mike; Ngwa, Wilfred

    2015-02-01

    We predict, for the first time, that by using United States Food and Drug Administration approved concentrations of cisplatin, major radiosensitization may be achieved via photoelectric mechanism during concomitant chemoradiotherapy (CCRT). Our analytical calculations estimate that radiotherapy (RT) dose to cancer cells may be enhanced via this mechanism by over 100% during CCRT. The results proffer new potential for significantly enhancing CCRT via an emerging clinical scenario, where the cisplatin is released in-situ from RT biomaterials loaded with cisplatin nanoparticles.

  20. Concomitant parenteral nutrition and systemic cytotoxic therapy in a metastatic colorectal cancer patient

    Directory of Open Access Journals (Sweden)

    A. A. Popov

    2012-01-01

    Full Text Available Pathologic nutrients metabolism presents a severe problem in metastatic colorectal cancer patients, especially those with canceromatosis. A hypermetabolism-catabolism syndrome frequently develops in in patients with progressing canceromatosis. This leads to cachexia anorexia syndrome, which significantly impedes available treatment options. Artificial nutrition allows to improve available treatment in such patients. We present a successful case of concomitant parenteral nutrition and systemic cytotoxic therapy in metastatic colorectal cancer patient with peritoneal canceromatosis.

  1. Schistosoma japonicum:establishment of a mouse model that demonstrates concomitant immunity

    Institute of Scientific and Technical Information of China (English)

    HE Li 何立; YI Xin-yuan 易新元; JIANG Ming-sen 蒋明森; ZENG Xian-fang 曾宪芳; OUYANG Li 欧阳理; Larry McReynolds

    2004-01-01

    @@ Concomitant immunity to schistosome reinfection in vivo is generally thought to be the immune response induced by and relying on living adult worms.1,2 However, a few authors3,4 have suggested that the mechanism of resistance may be related to the hepatic pathology caused by the primary infection. The vascular pathology might enable the challenge schistosomula to escape from the hepatic portal system, thus preventing normal parasite sequestration and maturation in the liver.

  2. Guyon's tunnel syndrome during pregnancy with concomitant anomalous arch of the ulnar nerve: a case report.

    OpenAIRE

    2014-01-01

    Numerous causes are reported for ulnar nerve compression at the wrist, known as Guyon's tunnel syndrome. In the present article, a patient with Guyon's tunnel syndrome during pregnancy concomitant with an anomaly of ulnar nerve is described. A 29-year-old Iranian woman presented with clinical features of Guyon's tunnel syndrome (pain and paresthesia in the fifth finger of the left hand and atrophy of the first dorsal interosseus muscle). Symptoms of the patient appeared during the third trime...

  3. Concomitant sensitization to glutaraldehyde and methacrylic monomers among dentists and their patients

    OpenAIRE

    Maya Grigorievna Lyapina; Maria Dencheva; Assya Krasteva-Panova; Mariana Tzekova-Yaneva; Mariela Deliverska; Angelina Kisselova-Yaneva

    2016-01-01

    Background: A multitude of methacrylic monomers is used in dentistry. Glutaraldehyde (G) is used in dental practice and consumer products as a broad-spectrum antimicrobial agent. The purpose of our study is to evaluate the frequency and the risk of concomitant sensitization to some methacrylic monomers (methyl methacrylate (MMA), triethyleneglycol dimethacrylate (TEGDMA), ethyleneglycol dimethacrylate (EGDMA), 2,2-bis-[4-(2-hydroxy-3-methacrylo-xypropoxy)phenyl]-propane (Bis-GMA), 2-hydroxy-e...

  4. Anti-NMDA Receptor antibody encephalitis with concomitant detection of Varicella zoster virus.

    Science.gov (United States)

    Solís, Natalia; Salazar, Lucrecia; Hasbun, Rodrigo

    2016-10-01

    The typical presentation of anti-NMDA (N-Methyl-d-Aspartate) receptor encephalitis involves young women with psychiatric, neurologic and autonomic symptoms; it is often associated with mature ovarian teratomas. NMDA receptor encephalitis has been described following Herpes simplex virus (HSV) encephalitis. This case describes a classic presentation of anti-NMDA receptor encephalitis with the concomitant presence of Varicella zoster virus in the cerebrospinal fluid.

  5. T-Bar Utilization for Concomitant Coronary Artery Bypass Graft Operation and Left Upper Lobectomy.

    Science.gov (United States)

    Mitropoulos, Fotios; Kanakis, Meletios A; Apostolou, Anastasios; Chatzis, Andrew; Contrafouris, Constantinos; Apostolidis, Christos; Lioulias, Achilleas

    2016-01-01

    Management in patients with coexisting coronary artery disease and lung carcinoma is usually a two-stage operation, with the cardiac surgery procedure followed by pulmonary resection at a later time. Delayed tumor resection on the other hand may be detrimental. Off-pump coronary artery bypass grafting could facilitate concomitant lung resection at one stage via median sternotomy. T-bar retractor may be a useful tool in the surgical approach of this combined operation.

  6. T-Bar Utilization for Concomitant Coronary Artery Bypass Graft Operation and Left Upper Lobectomy

    Directory of Open Access Journals (Sweden)

    Fotios Mitropoulos

    2016-01-01

    Full Text Available Management in patients with coexisting coronary artery disease and lung carcinoma is usually a two-stage operation, with the cardiac surgery procedure followed by pulmonary resection at a later time. Delayed tumor resection on the other hand may be detrimental. Off-pump coronary artery bypass grafting could facilitate concomitant lung resection at one stage via median sternotomy. T-bar retractor may be a useful tool in the surgical approach of this combined operation.

  7. Toxic epidermal necrolysis due to concomitant use of valproic asid and lamotrigine

    Directory of Open Access Journals (Sweden)

    Hamdi Özcan

    2015-06-01

    Full Text Available Toxic epidermal necrolysis (TEN is a rare but life-threatening acute mucacutaneous hypersensitivity reaction, usually related to medications. Concomitant use of lamotrigine and valproic asid can cause this serious reaction. A 36 year-old-man admitted to emergency department with high fever, burning sensation at eyes, oral and genital mucous erosions, generalized rush and weakness. He had been taking valproic asid, olanzapine, and sertraline for bipolar affective disorder. Lamotrigine 25 mg/day treatment was added his treatment protocol 15 days ago before the rush and lamotgine dose was increased 50 mg/day 10 days later. The patient was diagnosed as TEN caused by concomitant use of valproic asid and lamotrigine. The patient followed up and treated at burn unit with intravenous immunoglobulin, corticosteroid and antibiotics. Concomitant use of valproic asid and lamotrigine increases the frequency of adverse reaction. TEN may cause serious complications and mortality. The patients with TEN should be followed by a multi-disciplinary team. Early determination of complications and suitable management can increase survival.

  8. Evaluation of concomitant methylphenidate and opioid use in patients with pain.

    Science.gov (United States)

    Jiang, Joy Y; Best, Brookie M; Morello, Candis M; Atayee, Rabia S; Ma, Joseph D

    2014-09-01

    Methylphenidate is a central nervous system simulant that is used for management of opioid-induced sedation. Sparse data exist regarding use patterns of methylphenidate and opioids in patients with pain. This retrospective data analysis evaluated concomitant methylphenidate and opioid use from physician-reported medication lists and in urine specimens of patients with pain. All specimens were analyzed and quantified with LC-MS-MS. Concomitant methylphenidate and opioid use (e.g., sample population) were compared with a baseline population of patients taking opioids. There were 3,326 patients with physician-reported use of methylphenidate. Of these, 1,089 patients were tested for the presence of methylphenidate in urine. Methylphenidate was positive in urine for 551 patients (detection rate of 50.6%). Ritalinic acid was positive in 776 patients (detection rate of 71.3%). The current study observed differences in the use pattern of methylphenidate based on opioid type. Physician-reported use revealed methadone had the highest percent difference between the sample and baseline populations (77%, P ≤ 0.05). Fentanyl, morphine and hydromorphone also had higher percent differences of 19.6, 25.3 and 32.3%, respectively. Further studies need to examine the apparent discrepancies between the physician-reported medication lists and urine drug testing of concomitant methylphenidate and opioid use in patients with pain.

  9. Presumed Isotretinoin-Induced, Concomitant Autoimmune Thyroid Disease and Ocular Myasthenia Gravis: A Case Report

    Directory of Open Access Journals (Sweden)

    Huseyin Gursoy

    2012-11-01

    Full Text Available Introduction: There are many adverse effects that have been described for isotretinoin. To the best of our knowledge, this is the first report of a possible association of oral isotretinoin intake with autoimmune thyroiditis and ocular myasthenia gravis (OMG. Case Presentation: A 19-year-old Caucasian male, who had used oral isotretinoin for severe acne disease for the previous six months, was referred to our clinic. He had a three-week history of diplopia and variable bilateral ptosis. Physical examination showed moderate periorbital edema and limitations of up- and down-gaze in the left eye. Laboratory findings and thyroid ultrasound were consistent with autoimmune thyroiditis. Antithyroid therapy did not relieve the clinical symptoms. Concomitant OMG was suspected. Variable ptosis and a positive response to oral prednisolone of 40 mg/day and pyridostigmine of 360 mg/day supported the diagnosis of concomitant autoimmune thyroiditis and OMG. Conclusion: Autoimmune disorders may be triggered by oral isotretinoin treatment. Clinicians prescribing isotretinoin should be aware of the possible association between isotretinoin intake and concomitant autoimmune thyroiditis and OMG.

  10. Incidence Rate of Concomitant Systemic Diseases in the Aging Population with Postmenopausal Osteoporosis

    Directory of Open Access Journals (Sweden)

    Selçuk Sayılır

    2016-08-01

    Full Text Available Objective: To evaluate the concomitant systemic diseases with postmenopausal osteoporosis and to investigate the points to be considered in treatment approach of patients with osteoporosis. Materials and Methods: The study included 110 female patients admitted to our clinic and followed up after postmenopausal osteoporosis diagnosis. Besides the demographic data; the concomitant diseases of the patients such as hypertension, hypo-hyperthyroidism, diabetes mellitus, Alzheimer’s disease, malignancy, osteoarthritis, gastrointestinal system diseases, chronic obstructive pulmonary disease (COPD- asthma and depression were also recorded. Results: The mean age of the patients included in our study was 65.9±9.8 years. When the concomitant systemic diseases were examined; 40 patients had hypertension, 32 patients had osteoarthritis, 24 patients had gastrointestinal tract problems, 22 patients had thyroid disease, 21 patients had depression, 15 patients had hyperlipidemia, 12 patients had diabetes mellitus, 10 patients had COPD - asthma, 7 patients had cardiac diseases, 5 patients had malignancy and 2 patients had Alzheimer disease. Conclusion: Osteoporosis is a common disease in the geriatric population. As a chronic disease with an increasing incidence with aging; it can cause many health problems, prevalently pathological bone fractures, in our country and all over the world. Constitutively, prophylaxis of osteoporosis should be the first step. Because systemic diseases with increasing incidence with aging may affect the severity of osteoporosis and impair the treatment; it is important for both clinicians and the society to have sufficient information about osteoporosis.

  11. Small gastrointestinal stromal tumor concomitant with early gastric cancer: A case report

    Institute of Scientific and Technical Information of China (English)

    Ying-Lung Lin; Jeh-En Tzeng; Chang-Kou Wei; Chih-Wen Lin

    2006-01-01

    The term gastrointestinal stromal tumors (GISTs)is defined diagnostically as the main group of mesenchymal tumors with spindle or epithelioid cells arising from the wall of the gastrointestinal tract with immunohistochemical reactivity for CD117 antibody.Previous studies revealed that cells in GISTs express a growth factor receptor with tyrosine kinase activity (termed c-kit), which is the product of the c-kit protooncogene. The most specific and practical diagnostic criteria for GISTs are: immunohistochemically determined c-kit (CD117) expression; mitotic score; and tumor size.A small GIST concomitant with early gastric cancer is rarely encountered clinically. Herein we have reported a case of a 1.1-cm GIST detected by esophagogastroduo denoscopy concomitant with a Ⅱc type of early gastric cancer (signet ring cell type). It was detected during a routine physical health examination. To our knowledge,this is the first report of a small GIST concomitant with a signet ring cell type of early gastric cancer.

  12. Openness initiative

    Energy Technology Data Exchange (ETDEWEB)

    Duncan, S.S. [Los Alamos National Lab., NM (United States)

    1995-12-31

    Although antinuclear campaigns seem to be effective, public communication and education efforts on low-level radioactive waste have mixed results. Attempts at public information programs on low-level radioactive waste still focus on influencing public opinion. A question then is: {open_quotes}Is it preferable to have a program focus on public education that will empower individuals to make informed decisions rather than trying to influence them in their decisions?{close_quotes} To address this question, a case study with both quantitative and qualitative data will be used. The Ohio Low-Level Radioactive Waste Education Program has a goal to provide people with information they want/need to make their own decisions. The program initiated its efforts by conducting a statewide survey to determine information needed by people and where they turned for that information. This presentation reports data from the survey and then explores the program development process in which programs were designed and presented using the information. Pre and post data from the programs reveal attitude and knowledge shifts.

  13. Efficacy of Concomitant Therapy with Fluoride and Chlorhexidine Varnish on Remineralization of Incipient Lesions in Young Children

    Science.gov (United States)

    Tandon, Shobha; Nayak, Rashmi; Ratnanag, P Venkat; Prajapati, Deepesh; Kamath, Namitha

    2016-01-01

    Aim To assess the effect of combined use of chlorhexidine and fluoride varnish on the remineralization of incipient carious lesions in young children. Materials and methods Twenty caries-active children (80 lesions) were randomly divided into four groups and subjected to initial examination. Caries status was assessed visually and with the aid of DIAGNOdent. Baseline enamel biopsies were obtained. Subjects of groups I and II received fluoride and chlorhexidine varnish respectively. Group III received both fluoride and chlorhexidine varnish alternatively, for a period of 4 weeks. Group IV served as the control. At 3-month follow-up, the incipient lesions were assessed again with DIAGNOdent and enamel biopsy. Results Increased calcium, phosphate, and fluoride levels were noticed in groups I, II, III compared to group IV, at the 3-month follow-up (p < 0.001). Conclusion The combined therapy with fluoride and chlorhex-idine varnish may be considered an alternative therapy for early reversal of incipient lesions. How to cite this article Naidu S, Tandon S, Nayak R, Ratnanag PV, Prajapati D, Kamath N. Efficacy of Concomitant Therapy with Fluoride and Chlorhexidine Varnish on Remineralization of Incipient Lesions in Young Children. Int J Clin Pediatr Dent 2016;9(4):296-302. PMID:28127159

  14. 卡培他滨单药维持治疗晚期胃癌疗效分析%Efficacy of capecitabine monotherapy maintenance treatment for patients with advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    房慧; 苏丹; 张婷婷; 张勇; 夏学名; 白莉

    2015-01-01

    目的:评价卡培他滨单药维持治疗晚期胃癌的效果和不良反应。方法回顾性分析我院2008年1月-2014年6月的82例一线给予化疗的晚期胃癌患者,均经全身化疗后完全缓解(CR)、部分缓解(PR)或稳定(SD)。其中41例在化疗后应用卡培他滨单药维持治疗,给予卡培他滨剂量为1250 mg/m2,2次/d,连用14 d,每3周为1个周期,用药至疾病进展或未进展的末次随访时间,所有患者至少接受2周期治疗。化疗后未进行维持治疗的41例为对照组。观察两组中位无疾病进展时间和1年、2年生存率,以及卡培他滨的不良反应。结果维持治疗组与对照组中位无进展生存期分别为7.90个月、5.10个月(P<0.05)。1年生存率分别为48.8%、26.8%(P<0.05);2年生存率分别为9.8%、4.9%(P>0.05)。不良反应主要为手足综合征20例(48.8%)、骨髓抑制16例(39.0%)和胃肠道反应15例(36.6%,以1~2度为主),大多可以耐受。结论卡培他滨单药维持治疗一线化疗后的晚期胃癌可延长疾病未进展时间和提高1年生存率,依从性好,不良反应可耐受。%Objective To estimate the efficacy and toxic reaction of capecitabine monotherapy for patients with advanced gastric cancer. Methods Retrospective analysis was performed in 82 patients with advanced gastric cancer treated in our hospital form January 2008 to June 2014, and all patients had achieved complete response (CR), partial remission (PR) or stable disease (SD) after the systemic chemotherapy. Of the 82 cases, 41 patients were given capecitabine maintenance treatment with a dose of capecitabine accounting for 1 250 mg/m2, 2 times/d, continually for 14 days, 3 weeks for a period. Treatment was followed during disease progression or progression of last follow-up. All patients had achieved at least 2 cycles of treatment. Another 41 patients without maintenance treatment were served as control group. The median progression

  15. [Concomitant impact of organic pathology on the development of cognitive impairment in patients with attack-like paranoid schizophrenia].

    Science.gov (United States)

    Libin, L Ia; Tagil'tseva, A V; Lifanova, D E; Ganzenko, M A; Gritsevskaia, T M; Ivanov, M B

    2014-01-01

    The study included 47 patients (23 men, 24 women) with ICD-10 diagnosis of attack-like paranoid schizophrenia. Patients were divided into two groups: with- (25 patients) or without (22 patients) a concomitant organic disease. Memory, attention and thinking were assessed with psychometric tests. Inter- and intra-group differences were identified that indicated a considerable impact of a concomitant CNS organic pathology on the development of cognitive impairment in the schizophrenic process and active antipsychotic therapy. The data obtained can be used in the development of a differentiated approach to the treatment of patients with concomitant organic pathology.

  16. Concomitant administration of bevacizumab, irinotecan, 5-fluorouracil, and leucovorin: nonclinical safety and pharmacokinetics.

    Science.gov (United States)

    Gaudreault, Jacques; Shiu, Vanessa; Bricarello, Ann; Christian, Brian J; Zuch, Christina L; Mounho, Barbara

    2005-01-01

    Bevacizumab (Avastin) is a humanized monoclonal antibody against vascular endothelial growth factor approved for use in combination with 5-fluorouracil (5-FU)-based chemotherapy for first-line treatment of metastatic colorectal cancer. The Saltz regimen (irinotecan/5-FU/leucovorin [LV]) is a first-line treatment for this indication. The objective of this study was to evaluate the safety of bevacizumab when administered concomitantly with the Saltz regimen to cynomolgus monkeys, and to determine if the pharmacokinetics of bevacizumab, irinotecan, SN38 (the active metabolite of irinotecan), or 5-FU were affected by combined administration. Male cynomolgus monkeys were intravenously administered the Saltz regimen (125 mg/m2 irinotecan, 500 mg/m2 5-FU, 20 mg/m2 LV) alone (n = 4) or concomitantly with 10 mg/kg bevacizumab (n = 5) on days 1 and 8. All animals survived to euthanasia on day 15. Adverse effects associated with the Saltz regimen included diarrhea and neutropenia. Macroscopically, two animals from each group had small thymus glands that correlated microscopically with lymphoid depletion. Myeloid hypoplasia and/or erythroid hyperplasia was observed in the sternal bone marrow of most animals. These effects were considered to be associated with the Saltz regimen; concomitant bevacizumab administration did not alter the severity of these findings. Irinotecan and 5-FU were observed to be rapidly eliminated (t1/2 = 1 h and 0.5 h, respectively). Although the number of animals in each group was small and no statistical comparison between groups was performed, bevacizumab did not affect the disposition of either agent. These results indicate that bevacizumab can be safely administered in combination with the Saltz regimen without pharmacokinetic interaction.

  17. [Neuromyelitis optica presenting concomitantly with systemic lupus erythematosus: Report of one case].

    Science.gov (United States)

    Suárez H, Felipe; Urrutia E, Daniela; Canales P, Felipe; Gutiérrez O, Camila

    2016-09-01

    Neuromyelitis optica (NMO) is a severe demyelinating disease of the central nervous system, which preferentially attacks the optic nerve and spinal cord. It is associated with antibodies against aquaporin 4. Morbidity and mortality are higher than in multiple sclerosis and its treatment focuses on immunosuppressive drugs. Immunomodulators are contraindicated. We report a previously healthy 35-year-old man, presenting with NMO concomitantly with systemic lupus erythematosus. His evolution was torpid with three outbreaks in the 10 months after the diagnosis, requiring a first-line therapy with methylprednisolone and cyclophosphamide and then a second-line therapy with rituximab.

  18. Concomitant Tricuspid Valve Surgery Affects Outcomes Following Mitral Operations: A multi-institutional, statewide analysis

    Science.gov (United States)

    LaPar, Damien J.; Mulloy, Daniel P.; Stone, Matthew L.; Crosby, Ivan K.; Lau, Christine L; Kron, Irving L.; Ailawadi, Gorav

    2012-01-01

    Background Mitral valve disease is often accompanied by concomitant tricuspid valve disease. The purpose of this study was to determine the influence of performing tricuspid procedures in the setting of mitral valve surgery within a multi-institutional patient population. Methods From 2001–2008, 5,495 mitral valve operations were performed at 17 different statewide centers. Patients underwent either mitral valve alone (MV alone, n=5,062, age=63.4±13.0 years) or mitral + tricuspid valve operations (MV+TV, n=433, age=64.0±14.2 years). Univariate and multivariate analyses were used to assess the influence of concomitant tricuspid procedures on operative mortality and the composite incidence of major complications. Results Patients undergoing MV+TV were more commonly female (62.7% vs. 45.5%, p<0.001), had higher rates of heart failure (73.7% vs. 50.9%, p<0.001), and more frequently underwent reoperations (17.1% vs. 7.4%, p<0.001) compared to MV alone patients. Other patient characteristics, including preoperative endocarditis (8.5% vs. 8.2%, p=0.78), were similar between groups. Mitral replacement (63.5%) was more common than repair (36.5%, p<0.001) in MV+TV operations, and MV+TV operations incurred longer median cardiopulmonary bypass (181 min. vs. 149 min, p<0.001) times. Unadjusted operative mortality (6.0% vs. 10.4%, p=0.001) and postoperative complications were higher following MV+TV compared to MV alone. Importantly, after risk adjustment, performance of concomitant tricuspid valve procedures proved an independent predictor of operative mortality (OR=1.50, p=0.03) and major complications (OR=1.39, p=0.004). Conclusions Concomitant tricuspid surgery is a proxy for more advanced valve disease. Compared to mitral operations alone, simultaneous mitral-tricuspid valve operations are associated with elevated morbidity and mortality even after risk adjustment. This elevated risk should be considered during preoperative patient risk stratification. PMID:22607786

  19. Evaluation of the Prevalence of Concomitant Idiopathic Cyclic Edema and Cellulite

    OpenAIRE

    de Godoy, José Maria Pereira; Godoy,Maria de Fátima Guerreiro

    2011-01-01

    The aim of this study was to evaluate the prevalence of concomitant idiopathic cyclic edema with Grade II and III cellulite. All patients treated for Grade II and III cellulite were evaluated for idiopathic cyclic edema in a retrospective, quantitative and cross-sectional study. The study was carried out at the Godoy Clinic in the period from 2006 to 2010. All patients with body mass indexes > 25, Grade I cellulite and other causes of edema were excluded. The diagnosis of idiopathic cyclic ed...

  20. Concomitant polymorphs of 1,3-bis(3-fluorophenyl)urea.

    Science.gov (United States)

    Capacci-Daniel, Christina A; Bertke, Jeffery A; Dehghan, Shoaleh; Hiremath-Darji, Rupa; Swift, Jennifer A

    2016-09-01

    Hydrogen bonding between urea functionalities is a common structural motif employed in crystal-engineering studies. Crystallization of 1,3-bis(3-fluorophenyl)urea, C13H10F2N2O, from many solvents yielded concomitant mixtures of at least two polymorphs. In the monoclinic form, one-dimensional chains of hydrogen-bonded urea molecules align in an antiparallel orientation, as is typical of many diphenylureas. In the orthorhombic form, one-dimensional chains of hydrogen-bonded urea molecules have a parallel orientation rarely observed in symmetrically substituted diphenylureas.

  1. CONCOMITANT CARDIOVASCULAR DISEASES AND ANTIHYPERTENSIVE TREATMENT IN OUTPATIENT PRACTICE (BY THE RECVASA REGISTRY DATA

    Directory of Open Access Journals (Sweden)

    M. M. Loukianov

    2016-01-01

    Full Text Available Aim. To study a pattern of concomitant cardiovascular diseases (CVDs and to estimate particularities and quality of medical antihypertensive therapy in hypertensive patients in real outpatient practice with a help of the Registry in Ryazan region.Material and methods. A total of 3690 patients with hypertension, ischemic heart disease, chronic heart failure and atrial fibrillation, who had attended general practitioners and cardiologists of 3 outpatient clinics in Ryazan city, were enrolled in the outpatient Registry of cardiovascular diseases (RECVASA. The diagnosis of hypertension was recorded in 3648 of 3690 (98.9% outpatient charts, 28.1% of the subjects were men and 71.9% - women.Results. A total of 2907 (79.7% of 3648 patients had combination of hypertension with other CVDs. Combination of 3-4 cardiovascular diagnoses was registered in 63.8% of the cases. 11.5% and 9.5% of the patients had a history of myocardial infarction and cerebral stroke, respectively. Diagnosis of hypertension was verified in 448 of 450 randomized hypertensive patients (99.6%. The incidence of prescription of one and two antihypertensive drugs (AHDs was 25% and 39%, respectively, of 3 AHDs – 21%, 4 and more – 2%. AHDs were not prescribed in 13% of hypertensive patients. The mean number of prescribed AHDs was 1.73. The mean incidence rate of target blood pressure achievement was 26.1%. We have noted insufficient ACE inhibitors/angiotensin receptor blockers (ARB and beta-blockers prescription in different concomitant CVDs. Patients with 3-4 cardiovascular diagnoses were more often prescribed combined antihypertensive treatment. Prescription of ACE inhibitors/ARB, beta-blockers and thiazide diuretics combination was preferable in 74.1% of the cases, when taking into account absolute and relative contraindications for betablockers use – in 64.0%. 15.2% of the hypertensive patients used reimbursed drugs for CVDs at the moment of the Registry enrollment as

  2. [A case of pseudomembranous colitis concomitant with toxic megacolon and paralytic ileus].

    Science.gov (United States)

    Aoki, Takaya; Kataoka, Mikinori; Sou, Yoshiya; Naitou, Sakiko; Takeuchi, Mami; Tsuji, Yuichirou; Harada, Asuka; Sugimoto, Hiroko; Hayama, Yasutaka; Yamamoto, Kei; Nonaka, Masaya; Yagi, Kenji; Fujiwara, Mari; Fukuzawa, Masakatsu; Kawakami, Kouhei; Kawai, Takashi; Moriyasu, Fuminori

    2012-08-01

    A 60-year-old man was diagnosed as pseudomembranous colitis with chief complaint of fever and abdominal distension after a cerebral operation. It was ineffective although vancomycin hydrochloride (VCM) was given orally. Complications occurred. The patient had toxic megacolon and paralytic ileus. VCM was administrated via an ileus tube. In addition, the bowel was lavaged and VCM was sprayed by colonoscopy. This therapy was very effective. Generally, a patient with pseudomembranous colitis concomitant with toxic megacolon or/and paralytic ileus is considered to have a poor prognosis, however, he completely recovered by a combination of medical treatment.

  3. Solitary Endobronchial Papilloma with Malignant Transformation and Concomitant TB Infection: Case Report and Literature Review

    Science.gov (United States)

    2017-01-01

    We are reporting a case of solitary endobronchial papilloma located in posterior segment of the left upper lobe of the lung with malignant transformation and negative human papilloma virus (HPV) strains in a 40-year-old Saudi nonsmoker man. The patient had a concomitant tuberculosis (TB) infection. The patient received appropriate treatment in the form of anti-TB medication and surgical resection of the squamous cell carcinoma followed by chemotherapy. There was no evidence of tumor recurrence, resulting in a complete cure. We are reporting the case as well as a literature review related to the topic.

  4. Etravirine: a good option for concomitant use with chemotherapy for Hodgkin's lymphoma.

    Science.gov (United States)

    Kurz, Mario; Stoeckle, Marcel; Krasniqi, Fatime; Battegay, Manuel; Marzolini, Catia

    2015-03-01

    The treatment of malignancies in HIV patients is challenged by the issue of drug-drug interactions between antiretroviral therapy and antineoplastic agents. While protease inhibitors have been shown to increase the incidence and severity of cancer therapy-related side effects, the impact of other antiretroviral agents on the tolerability and response to chemotherapy is less well documented. We report the successful use of an etravirine-based regimen in a patient treated with BEACOPP chemotherapy for advanced Hodgkin's lymphoma. Etravirine constitutes a valuable option for concomitant use with chemotherapy due to its moderate inducing effect on drug metabolising enzymes.

  5. Concomitant gastric adenocarcinoma and stromal tumor in a woman with polymyalgia rheumatica

    Institute of Scientific and Technical Information of China (English)

    Panteleimon Kountourakis; Niki Arnogiannaki; Ilias Stavrinides; Nikiforos Apostolikas; Gerasimos Rigatos

    2008-01-01

    Gastrointestinal stromal tumors (GISTs) are rare neoplasms (1%) of the gastrointestinal tract and to our knowledge only rare cases of synchronous presentation of gastric carcinomas and GISTs are reported in the literature.A 72-year-old female with a simultaneous presentation of gastric adenocarcinoma and GIST is presented.Moreover,due to polymyalgia rheumatica the patient received corticosteroids as treatment for the last 3 years.The concomitant occurrence of these neoplasms may involve common carcinogenic factors and there could be an association with polymyalgia rheumatica either as a paraneoplastic presentation or due to its treatment with corticosteroids.

  6. Analysis of the growth of concomitant nitride layers produced by a post-discharge assisted process

    Energy Technology Data Exchange (ETDEWEB)

    Oseguera, J. [ITESM-CEM, Carretera al Lago de Guadalupe km. 3.5 Atizapan, 52926 (Mexico)]. E-mail: joseguer@itesm.mx; Castillo, F. [ITESM-CEM, Carretera al Lago de Guadalupe km. 3.5 Atizapan, 52926 (Mexico); Gomez, A. [UFRO, Av. Francisco Salazar 01145, Temuco, Casilla 54-d (Chile); Fraguela, A. [BUAP, Rio Verde y Ave. San Claudio, San Manuel, Puebla, 72570 (Mexico)

    2006-11-23

    In the present work, the growth of concomitant nitride layers during a post-discharge process is studied. The analysis takes into account the similarities and differences between nitriding post-discharge processes and other nitriding processes, employing a mathematical simulation of nitrogen diffusion. The considered differences are related to the thermodynamic standard states, the nitrogen concentration on the surface and the sputtering of the surface (this one for plasma processes). Nitrogen diffusion and layer formation are described from the beginning of the process by means of a mathematical model.

  7. A CASE OF CONCOMITANT ADENOCARCINOMA OF LUNG AND PULMONARY TUBERCULOSIS IN A YOUNG FEMALE

    Directory of Open Access Journals (Sweden)

    Pujari Vishwanath

    2014-07-01

    Full Text Available 28 year female presented to us with X-ray chest suggestive of right opaque hemithorax. She was on anti-tubercular treatment for the presence of Acid Fast Bacilli (AFB in pleural fluid. Clinical examination revealed bronchial breathing on right side. CT thorax showed large mass lesion in right hemi thorax with mild pleural effusion. Thoracocentesis and bronchoscopy showed no evidence of malignancy however AFB were detected in bronchial washing. Transthoracic biopsy was positive for malignancy. On Immunohistochemistry (IHC, Thyroid Transcription Factor 1(TTF1 and NAPSIN A were positive, confirming the diagnosis of adenocarcinoma lung. Final diagnosis of primary adenocarcinoma lung with concomitant tuberculosis was established.

  8. A meta-analysis assessing the benefits of concomitant pleural tent procedure after upper lobectomy.

    Science.gov (United States)

    Uzzaman, Mohammed M; Daniel Robb, J; Mhandu, Peter C E; Khan, Habib; Baig, Kamran; Chaubey, Sanjay; Whitaker, Donald C

    2014-01-01

    A meta-analysis comparing outcomes of upper lobectomies with or without pleural tenting was performed. Five trials comprising 396 patients were selected. There was significantly reduced duration of hospital stay, chest drain use, and air leak in the pleural tenting group compared with the group without the pleural tent. There was also a significant reduction in number of patients with prolonged air leak more than 7 days in pleural tenting group. No other difference was noted in other outcomes such as total drainage, operative time, or hospital costs. In patients at high-risk of air leak, we advocate concomitant use of the pleural tent after upper lobectomies.

  9. NRG Oncology Radiation Therapy Oncology Group 0822: A Phase 2 Study of Preoperative Chemoradiation Therapy Using Intensity Modulated Radiation Therapy in Combination With Capecitabine and Oxaliplatin for Patients With Locally Advanced Rectal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Theodore S., E-mail: tshong1@mgh.harvard.edu [Massachusetts General Hospital, Boston, Massachusetts (United States); Moughan, Jennifer [NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania (United States); Garofalo, Michael C. [University of Maryland School of Medicine, Baltimore, Maryland (United States); Bendell, Johanna [Sarah Cannon Research Institute, Nashville, Tennessee (United States); Berger, Adam C. [Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (United States); Oldenburg, Nicklas B.E. [North Main Radiation Oncology, Providence, Rhode Island (United States); Anne, Pramila Rani [Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (United States); Perera, Francisco [London Regional Cancer Program/Western Ontario, London, Ontario (Canada); Lee, R. Jeffrey [Intermountain Medical Center, Salt Lake City, Utah (United States); Jabbour, Salma K. [Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey (United States); Nowlan, Adam [Piedmont Hospital, Atlanta, Georgia (United States); DeNittis, Albert [Main Line Community Clinical Oncology Program, Wynnewood, Pennsylvania (United States); Crane, Christopher [University of Texas-MD Anderson Cancer Center, Houston, Texas (United States)

    2015-09-01

    Purpose: To evaluate the rate of gastrointestinal (GI) toxicity of neoadjuvant chemoradiation with capecitabine, oxaliplatin, and intensity modulated radiation therapy (IMRT) in cT3-4 rectal cancer. Methods and Materials: Patients with localized, nonmetastatic T3 or T4 rectal cancer <12 cm from the anal verge were enrolled in a prospective, multi-institutional, single-arm study of preoperative chemoradiation. Patients received 45 Gy with IMRT in 25 fractions, followed by a 3-dimensional conformal boost of 5.4 Gy in 3 fractions with concurrent capecitabine/oxaliplatin (CAPOX). Surgery was performed 4 to 8 weeks after the completion of therapy. Patients were recommended to receive FOLFOX chemotherapy after surgery. The primary endpoint of the study was acute grade 2 to 5 GI toxicity. Seventy-one patients provided 80% probability to detect at least a 12% reduction in the specified GI toxicity with the treatment of CAPOX and IMRT, at a significance level of .10 (1-sided). Results: Seventy-nine patients were accrued, of whom 68 were evaluable. Sixty-one patients (89.7%) had cT3 disease, and 37 (54.4%) had cN (+) disease. Postoperative chemotherapy was given to 42 of 68 patients. Fifty-eight patients had target contours drawn per protocol, 5 patients with acceptable variation, and 5 patients with unacceptable variations. Thirty-five patients (51.5%) experienced grade ≥2 GI toxicity, 12 patients (17.6%) experienced grade 3 or 4 diarrhea, and pCR was achieved in 10 patients (14.7%). With a median follow-up time of 3.98 years, the 4-year rate of locoregional failure was 7.4% (95% confidence interval [CI]: 1.0%-13.7%). The 4-year rates of OS and DFS were 82.9% (95% CI: 70.1%-90.6%) and 60.6% (95% CI: 47.5%-71.4%), respectively. Conclusion: The use of IMRT in neoadjuvant chemoradiation for rectal cancer did not reduce the rate of GI toxicity.

  10. 奥沙利铂联合卡培他滨治疗晚期胃癌的21例临床探讨%Combination of oxaliplatin and capecitabine in treatment of twenty-one advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    徐满珍; 李小兵

    2013-01-01

    Objective: To observe the efficacy and side efferts of oxalipatin plus capecitabine for the treatment of ad-vanced gastric cancer Methods: Twenty-one cases of patients . Oxaliplatin was given at a dose of 130mg/m2 by intravenous injection at day 1; Cape citabine was orally given at a dose of 2500 mg/m2, twice a day for two weeks. Twenty-one days was one cycle.Results: Among 21 patients , the response rate (CR+PR) was 57.1% with 2CR, 10PR, 3SD,6PD. MST was 9 months, mttp was 7 months. The major side effects were hand-foot syn-drome in 7(33.3%), newel toxity 12(57.1%), diarrhea 14 .conclusion: oxaplatin cornbined with capecitabine is a good chernother-appy with high clinical remission rate and could signiticartly improve life quality .And side effects could be tolerable.%目的观察奥沙利铂联合卡培他滨治疗晚期胃癌的疗效和安全性。方法21例晚期胃癌患者,静脉滴注奥沙利铂130mg/m2,d1;卡培他滨2500 mg/m2,分早晚2次口服,d1-14,21天为1周期。结果21例患者中,CR 2例,PR10例,SD3例,PD6例,近期有效率(CR+PR)为57.1%,中位生存期9个月,中位疾病进展时间为7个月。不良反应为手足综合征、神经毒性,多为Ⅰ-Ⅱ度。结论奥沙利铂联合卡培他滨化疗方案,缓解率高,能提高生活质量,毒副反应小,患者易耐受。

  11. Protocol for concomitant temporomandibular joint custom-fitted total joint reconstruction and orthognathic surgery using computer-assisted surgical simulation.

    Science.gov (United States)

    Movahed, Reza; Wolford, Larry M

    2015-02-01

    Combined orthognathic and total joint reconstruction cases can be predictably performed in 1 stage. Use of virtual surgical planning can eliminate a significant time requirement in preparation of concomitant orthognathic and temporomandibular joint (TMJ) prostheses cases. The concomitant TMJ and orthognathic surgery-computer-assisted surgical simulation technique increases the accuracy of combined cases. In order to have flexibility in positioning of the total joint prosthesis, recontouring of the lateral aspect of the rami is advantageous.

  12. Diseases Concomitant With Asthma in Middle-Aged and Elderly Subjects in Korea: A Population-Based Study

    OpenAIRE

    2012-01-01

    Purpose Asthma is prevalent in many countries. Few studies have investigated the association between asthma and concomitant diseases. We retrospectively analyzed the fourth Korean National Health and Nutrition Survey database, performed in 2008 using nationwide stratified random sampling to obtain a representative cohort of the Korean population. Methods We evaluated the association between both self-reported ever-asthmatics and wheezers and concomitant diseases such as arthritis, hypertensio...

  13. Concomitant chemo-radiotherapy for the locally advanced rectum cancer; Chimioradiotherapie concomitante dans le cancer du rectum localement evolue

    Energy Technology Data Exchange (ETDEWEB)

    Haoui, M.; Aksil, N.; Boualga, K.; Moussaoui, D.; Ladj, O. [Service de radiotherapie-oncologie, centre anti-cancer, Blida (Algeria)

    2010-10-15

    The authors report a retrospective study which aimed at assessing the use of a concomitant chemo-radiotherapy, its tolerance and its feasibility in the case of a locally advanced rectum cancer. Based on data obtained among 62 patients presenting a rectum cancer, they analyse the results in terms of tolerance (cases of leukopenia, anemia, diarrhea, radiodermatitis), of relapses, and survival. Toxicity is acceptable and the concomitant treatment renders the tumour operable in many cases. Short communication

  14. Hepatocellular carcinoma with concomitant hepatic angiomyolipoma and cavernous hemangioma in one patient.

    Science.gov (United States)

    Ge, Xiao-Wen; Zeng, Hai-Ying; Su-Jie, Akesu; Du, Min; Ji, Yuan; Tan, Yun-Shan; Hou, Ying-Yong; Xu, Jian-Fang

    2015-03-21

    The risk of developing hepatocellular carcinoma (HCC) is strongly associated with hepatitis B virus infection. Hepatic angiomyolipoma (AML), a rare benign tumor, is composed of a heterogeneous mixture of adipose cells, smooth muscle cells and blood vessels. Here, we report the case of a 44-year-old man who developed HCC with a concomitant hepatic AML and a cavernous hemangioma, in the absence of cirrhosis. To our knowledge, based on an extensive literature search using the www.pubmed.gov website, this is the first report of an HCC case with both concomitant AML and cavernous hemangioma at the same position in the liver. The presence of the hepatitis B surface antigen was detected, but the liver function was normal. Clinical and pathological data were collected before and during the treatment. Hepatic AML was diagnosed based on the typical histological characteristics and immunohistochemical staining, which revealed, a positive staining with a melanocytic cell-specific monoclonal antibody. There was no evidence of tuberous sclerosis complex in this patient. Although the HCC was poor- to moderately-differentiated, the characteristics of the AML and the cavernous hemangioma in this patient did not match any criteria for malignancy. Hepatectomy followed by transarterial chemoembolization treatment were effective therapeutic methods for the adjacent lesions in this patient. This case is an interesting coincidence.

  15. Concomitant Radiotherapy and Chemotherapy for High-Risk Nonmelanoma Skin Carcinomas of the Head and Neck

    Directory of Open Access Journals (Sweden)

    Smith Apisarnthanarax

    2011-01-01

    Full Text Available Background. To report on the use and feasibility of a multimodality approach using concomitant radiotherapy and chemotherapy in patients with high-risk nonmelanoma skin carcinoma (NMSC of the head and neck. Methods. Records of patients with NMSC of the head and neck who received concomitant CRT at the University of North Carolina between 2001 and 2007 were reviewed. Results. Fifteen identified patients had at least one of the following high-risk factors: T4 disease (93%, unresectability (60%, regional nodal involvement (40%, and/or recurrence (47%. Ten patients were treated in the definitive setting and five in the postoperative setting. Platinum based chemotherapy was given in 14 (93% patients. Ten of fifteen (67% patients completed all planned chemotherapy treatments, and thirteen patients (87% completed at least 80% of planned chemotherapy. Mild radiation dermatitis occurred in all patients and reached grade 3 in 13% of patients. No patients experienced grade 4 or 5 toxicity. With a median followup of 31 months in surviving patients, the 2-year actuarial locoregional control and relapse-free survival were 79% and 49%, respectively. Conclusions. Definitive or postoperative chemoradiotherapy for patients with locally advanced or regionally metastasized NMSC of the head and neck appears feasible with acceptable toxicities and favorable locoregional control.

  16. Lacosamide neurotoxicity associated with concomitant use of sodium channel-blocking antiepileptic drugs: a pharmacodynamic interaction?

    Science.gov (United States)

    Novy, Jan; Patsalos, Philip N; Sander, Josemir W; Sisodiya, Sanjay M

    2011-01-01

    Lacosamide is a new antiepileptic drug (AED) apparently devoid of major pharmacokinetic interactions. Data from a small postmarketing assessment suggest people who had lacosamide co-prescribed with a voltage-gated sodium channel (VGSC)-blocking AED seemed more likely to discontinue lacosamide because of tolerability problems. Among 39 people with refractory epilepsy who developed neurotoxicity (diplopia, dizziness, drowsiness) on lacosamide treatment given in combination with VGSC-blocking AEDs, we identified 7 (17.9%) without any changes in serum levels of other AEDs in whom the symptoms were ameliorated by dose reduction of the concomitant VGSC-blocking AED. Symptoms in these people seem to have arisen from a pharmacodynamic interaction between lacosamide and other VGSC-blocking AEDs. Slow-inactivated VGSCs targeted by lacosamide might be more sensitive to the effects of conventional VGSC-blocking AEDs. Advising people to reduce concomitantly the conventional VGSC-blocking AEDs during lacosamide uptitration in cases of neurotoxicity might improve the tolerability of combination treatment.

  17. Efficacy and safety of calcium channel blockers in hypertensive patients with concomitant left ventricular dysfunction.

    Science.gov (United States)

    Parmley, W W

    1992-04-01

    The use of calcium channel blockers (CCBs) in the treatment of hypertension and concomitant left ventricular dysfunction is reviewed. Some CCBs, particularly second-generation dihydropyridine agents such as felodipine, isradipine, nicardipine, nimodipine, and nitrendipine, have properties that enhance their usefulness in these patients. All CCBs have a similar mechanism of action. Differences in their selective action at various tissue sites determine which are most appropriate for patients with concomitant hypertension and left ventricular dysfunction. Most CCBs do not produce reflex stimulation of the heart or induce intravascular expansion. While all CCBs produce arteriolar dilation, all local beds and regional circulations in target organs are not affected equally. Most CCBs can decrease cardiac mass, and second-generation CCBs tend to have little or no negative inotropic effects at therapeutic dosages. In addition, they increase blood flow and reduce myocardial oxygen requirements. Because of differences in functional and electrophysiologic effects, specific CCBs may not be appropriate for all patients. Since second-generation dihydropyridine CCBs lack clinically relevant negative inotropic effects, and have been shown to improve exercise tolerance and coronary artery perfusion, they are appropriate for hypertensive patients with left ventricular dysfunction, angina, and coronary heart disease. Second-generation CCBs tend to lack cardiodepressant side effects and are less likely to react with digoxin than are first-generation CCBs.

  18. The enhancement of cardiac toxicity by concomitant administration of Berberine and macrolides.

    Science.gov (United States)

    Zhi, Duo; Feng, Pan-Feng; Sun, Jia-Liang; Guo, Fengfeng; Zhang, Rui; Zhao, Xin; Li, Bao-Xin

    2015-08-30

    As is well-known, hERG plays an essential role in phase III repolarization of cardiac action potentials. Blocking of hERG channels can lead to LQTS. Inhibition of the metabolism of CYPs activities may elevate plasma levels, to further increase accumulation of drug on cardiac. The elevated serum levels may however elicit unexpected toxicities. Therefore, the inhibition tests of hERG and CYP are central to the preclinical studies because they may lead to severe cardiac toxicity. Berberine is widely used as an antibacterial agent and often combined with macrolides to treat gastropathy. Our objective was to assess cardiac toxicity during the combined use of Berberine with macrolides. (1) Azithromycin reduced hERG currents by accelerated channel inactivation. (2) The combination of Berberine with Azithromycin reduced hERG currents, producing an inhibitive effect stronger than use of a single drug alone, due to the high binding affinity for the onset of inactivation. (3) When cells were perfused concomitantly with Berberine and Clarithromycin, they showed a stronger inhibitive effect on hERG currents by decreasing the time constant for the onset of inactivation. (4) The combined administration of Berberine with Clarithromycin had a powerful inhibitive effect on CYP3A activities than use of a single drug alone. Collectively, these results demonstrated that concomitant use of Berberine with macrolides may require close monitoring because of potential drug toxicities, especially cardiac toxicity.

  19. Concomitant spuriously elevated white blood cell count, a previously underestimated phenomenon in EDTA-dependent pseudothrombocytopenia.

    Science.gov (United States)

    Xiao, Yufei; Xu, Yang

    2015-01-01

    The proportion and potential risk of concomitant spuriously elevated white blood cell count (SEWC) are underestimated in ethylenediaminetetraacetic acid (EDTA)-dependent pseudothrombocytopenia (PTCP). The proportion, kinetics and prevention of SEWC remain poorly understood. A total of 25 patients with EDTA-dependent PTCP were enrolled in this study. With the hematology analyzer Coulter LH 750, we determined the time courses of WBC count, WBC differential and platelet count in EDTA- and sodium citrate-anticoagulated blood, respectively. Blood smears were prepared to inspect the presence of platelet clumps using light microscopy. The effect of automatic instrumental correction on the extent of SEWC was evaluated. The proportion of SEWC was 92% in EDTA-dependent PTCP and 73.9% of SEWCs were within the normal range. The development of SEWC was time-dependent, and neutrophils and lymphocytes were the main subpopulations involved in SEWC. A strong and significant correlation (r = 0.9937, p EDTA were significantly higher than their basal counts, respectively, p 0.05. A high proportion of concomitant SEWCs, which are mainly within normal range, are present in patients with EDTA-dependent PTCP. Proper interpretation of SEWC is crucial to avoid clinic errors. SEWC develops in a time-dependent pattern, although the Coulter LH 750 only partly mitigates the extent of SEWC, sodium citrate is able to effectively prevent SEWC.

  20. Pattern of midface trauma with associated concomitant injuries in a Nigerian Referral Centre

    Directory of Open Access Journals (Sweden)

    Samuel Udeabor

    2014-01-01

    Full Text Available Aim: The aim of this study was to determine the pattern of midface trauma with associated concomitant injuries seen in our environment. Methodology: This was a prospective analysis of trauma patients with midfacial injuries presenting at a referral center in South West Nigeria. In addition to socio-demographic data, the following information was also obtained: Mechanism of injuries, type of midfacial injuries, concomitant/associated injuries and treatment. Results: A total of 101 patients with midfacial injuries were involved. They were made up of 85 males and 16 females. The 20-29 year age group was mostly affected (44.6% and the most common cause of midface injuries was road traffic accident (91.1%. The zygoma was fractured more than any other midfacial bone (46.0%. A total of 144 associated injuries were recorded among these patients, head and ocular injuries accounted for 49 (34% and 35 (24.3% respectively. The patients were mostly treated conservatively or by closed reduction. Conclusion: The rate of head and ocular injuries among patients with midfacial injury was high. Knowledge of these associated injuries provides useful strategies for patient care and prevention of further complications. A multidisciplinary approach is important for optimum management of these patients.

  1. Clinical features of Crohn disease concomitant with ankylosing spondylitis: A preliminary single-center study.

    Science.gov (United States)

    Liu, Song; Ding, Jie; Wang, Meng; Zhou, Wanqing; Feng, Min; Guan, Wenxian

    2016-07-01

    Extraintestinal manifestations (EIMs) cause increased morbidity and decreased quality of life in Crohn disease (CD). Ankylosing spondylitis (AS) belongs to EIMs. Very little is known on the clinical features of CD concomitant with AS. This study is to investigate the clinical features of CD patients with AS.We retrospectively collected all CD patients with AS in our hospital, and established a comparison group (CD without AS) with age, sex, and duration of Crohn disease matched. Clinical information was retrieved for comparison.Eight CD + AS patients were identified from 195 CD patients. Sixteen CD patients were randomly selected into comparison group. All CD + AS patients were male, HLA-B27 (+), and rheumatoid factor (-) with an average age of 40.8 ± 4.52 years. Significant correlation between disease activity of CD and AS was revealed (r = 0.857, P = 0.011). Significant correlation between disease activity of CD and functional limitation associated with AS was identified (r = 0.881, P Crohn disease activity index (CDAI), Bath AS disease activity index, and Bath AS functional index(BASFI) scores (r = 0.73-0.93, P Disease activity of CD correlates with disease activity of AS and functional limitation caused by AS. CRP, ESR, and Alb/Glo may serve as biomarkers for disease activity and functional limitation in CD patients concomitant with AS, although future studies are expected.

  2. Surgical outcome in patients taking concomitant or recent intake of oral isotretinoin: A multicentric Study-ISO-AIMS study

    Directory of Open Access Journals (Sweden)

    Omprakash Heggadahalli Mahadevappa

    2016-01-01

    Full Text Available Background: The current standard recommendation is to avoid surgical interventions in patients taking oral isotretinoin. However, this recommendation has been questioned in several recent publications. Aim: To document the safety of cosmetic and surgical interventions, among patients receiving or recently received oral isotretinoin. Materials and Methods: Association of Cutaneous Surgeons, India, in May 2012, initiated this study, at 11 centers in different parts of India. The data of 183 cases were collected monthly, from June 2012 to May 2013. Of these 61 patients had stopped oral isotretinoin before surgery and 122 were concomitantly taking oral isotretinoin during the study period. In these 183 patients, a total of 504 interventions were performed. These included[1] 246 sessions of chemical peels such as glycolic acid, salicylic acid, trichloroacetic acid, and combination peels;[2] 158 sessions of lasers such as ablative fractional laser resurfacing with erbium-doped yttrium aluminum garnet and CO2, conventional full face CO2laser resurfacing, laser-assisted hair reduction with long-pulsed neodymium-doped yttrium aluminum garnet, diode laser, and LASIK surgery;[3] 27 sessions of cold steel surgeries such as microneedling, skin biopsy, subcision, punch elevation of scars, excision of skin lesion, and wisdom tooth extraction;[4] 1 session of electrosurgery. Results: No significant side effects were noted in most patients. 2 cases of keloid were documented which amounted to 0.4% of side effects in 504 interventions, with a significant P value of 0.000. Reversible transient side effects were erythema in 10 interventions and hyperpigmentation in 15. Conclusion: The study showed that performing dermatosurgical and laser procedures in patients receiving or recently received isotretinoin is safe, and the current guidelines of avoiding dermatosurgical and laser interventions in such patients taking isotretinoin need to be revised.

  3. Nanoscale Particulate Matter from Urban Traffic Rapidly Induces Oxidative Stress and Inflammation in Olfactory Epithelium with Concomitant Effects on Brain

    Science.gov (United States)

    Cheng, Hank; Saffari, Arian; Sioutas, Constantinos; Forman, Henry J.; Morgan, Todd E.; Finch, Caleb E.

    2016-01-01

    Background: Rodent models for urban air pollution show consistent induction of inflammatory responses in major brain regions. However, the initial impact of air pollution particulate material on olfactory gateways has not been reported. Objective: We evaluated the olfactory neuroepithelium (OE) and brain regional responses to a nanosized subfraction of urban traffic ultrafine particulate matter (nPM, < 200 nm) in vivo, ex vivo, and in vitro. Methods: Adult mice were exposed to reaerosolized nPM for 5, 20, and 45 cumulative hours over 3 weeks. The OE, the olfactory bulb (OB), the cerebral cortex, and the cerebellum were analyzed for oxidative stress and inflammatory responses. Acute responses of the OE to liquid nPM suspensions were studied with ex vivo and primary OE cultures. Results: After exposure to nPM, the OE and OB had rapid increases of 4-hydroxy-2-nonenal (4-HNE) and 3-nitrotyrosine (3-NT) protein adducts, whereas the cerebral cortex and cerebellum did not respond at any time. All brain regions showed increased levels of tumor necrosis factor-α (TNFα) protein by 45 hr, with earlier induction of TNFα mRNA in OE and OB. These responses corresponded to in vitro OE and mixed glial responses, with rapid induction of nitrite and inducible nitric oxide synthase (iNOS), followed by induction of TNFα. Conclusions: These findings show the differential time course of oxidative stress and inflammatory responses to nPM between the OE and the brain. Slow cumulative transport of inhaled nPM into the brain may contribute to delayed responses of proximal and distal brain regions, with potential input from systemic factors. Citation: Cheng H, Saffari A, Sioutas C, Forman HJ, Morgan TE, Finch CE. 2016. Nanoscale particulate matter from urban traffic rapidly induces oxidative stress and inflammation in olfactory epithelium with concomitant effects on brain. Environ Health Perspect 124:1537–1546; http://dx.doi.org/10.1289/EHP134 PMID:27187980

  4. Cultured senescent myoblasts derived from human vastus lateralis exhibit normal mitochondrial ATP synthesis capacities with correlating concomitant ROS production while whole cell ATP production is decreased

    DEFF Research Database (Denmark)

    Minet, Ariane D; Gaster, Michael

    2012-01-01

    The free radical theory of aging says that increased oxidative stress and mitochondrial dysfunction are associated with old age. In the present study we have investigated the effects of cellular senescence on muscle energetic by comparing mitochondrial content and function in cultured muscle...... satellite cells at early and late passage numbers. We show that cultured muscle satellite cells undergoing senescence express a reduced mitochondrial mass, decreased whole cell ATP level, normal to increased mitochondrial ATP production under ATP utilization, increased mitochondrial membrane potential......, but the existent mitochondria express normal to increased functional capabilities. The present data suggest that the origin of aging lies outside the mitochondria and that a malfunction in the cell might be preceding and initiating the increase of mitochondrial ATP synthesis and concomitant ROS production...

  5. Short-term Effect of Chemotherapy Concomitant with Multiple Autologous Immunocytes on Patients with Colorectal Carcinoma

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    Junquan Liu

    2013-12-01

    Full Text Available Objective: To compare the differences of cellular immunological functional changes and survival time of chemotherapy concomitant with multiple autologous immunocytes with single chemotherapy on patients with colorectal carcinoma (CRC. Methods: Of the 83 CRC patients, 43 were treated with single chemotherapy (single chemotherapy group while the other 40 were given chemotherapy concomitant with multiple autologous immunocytes (combined chemotherapy group. Blood cell separator was applied to collect autologous peripheral blood mononuclear (PBMC which was used to induce the cultures of peripheral blood CD3AK cell, CIK cell, dendritic cell (DC, γδT cell and NK cell based on routine approaches. Peripheral blood CD3+, CD4+, CD8+, CD19+, CD16+, CD56+, CD4/CD8 and γδT cell ratio as well as the positive expression rates of perforin, granular enzyme B and CD107a in PBMC were determined by flow cytometer. Same chemotherapy (oxaliplatin + CF + 5-FU was intravenously given to both groups, while in combination group, 4, 6, 9, 11 and 10 patients received 3, 6, 7, 10 and > 16 courses of treatment, respectively. Results: Subgroup of immunocytes and absolute value in combined chemotherapy group were evidently higher than in single chemotherapy group, but there was no significant difference in Karnofsky score. In addition, combined chemotherapy group was apparently higher after treatment than treatment before and single chemotherapy group in the results of perforin, granular enzyme B (GranB and CD107a in PBMC. Additionally, 1-, 2- and 5-year survival rates in combined chemotherapy group (in phases Ⅱ , Ⅲ and Ⅳ were 70.0% (28/40, 20.0% (8/40 and 10.0% (4/40, higher than those in single chemotherapy group [23.2% (10/43, 7.0% (3/43 and 4.6% (2/43], respectively, in which the differences in phases Ⅱ and Ⅲ were more significant (P <0.05, but no difference was observed between two groups in 5-year survival rate in patients in phase Ⅳ . Conclusion

  6. An Epidemiological Study of Concomitant Use of Chinese Medicine and Antipsychotics in Schizophrenic Patients: Implication for Herb-Drug Interaction

    Science.gov (United States)

    Zhang, Zhang-Jin; Tan, Qing-Rong; Tong, Yao; Wang, Xue-Yi; Wang, Huai-Hai; Ho, Lai-Ming; Wong, Hei Kiu; Feng, Yi-Bin; Wang, Di; Ng, Roger; McAlonan, Grainne M.; Wang, Chuan-Yue; Wong, Vivian Taam

    2011-01-01

    Background Herb-drug interactions are an important issue in drug safety and clinical practice. The aim of this epidemiological study was to characterize associations of clinical outcomes with concomitant herbal and antipsychotic use in patients with schizophrenia. Methods and Findings In this retrospective, cross-sectional study, 1795 patients with schizophrenia who were randomly selected from 17 psychiatric hospitals in China were interviewed face-to-face using a structured questionnaire. Association analyses were conducted to examine correlates between Chinese medicine (CM) use and demographic, clinical variables, antipsychotic medication mode, and clinical outcomes. The prevalence of concomitant CM and antipsychotic treatment was 36.4% [95% confidence interval (95% CI) 34.2%–38.6%]. Patients using concomitant CM had a significantly greater chance of improved outcomes than non-CM use (61.1% vs. 34.3%, OR = 3.44, 95% CI 2.80–4.24). However, a small but significant number of patients treated concomitantly with CM had a greater risk of developing worse outcomes (7.2% vs. 4.4%, OR = 2.06, 95% CI 2.06–4.83). Significant predictors for concomitant CM treatment-associated outcomes were residence in urban areas, paranoid psychosis, and exceeding 3 months of CM use. Herbal medicine regimens containing Radix Bupleuri, Fructus Gardenia, Fructus Schisandrae, Radix Rehmanniae, Akebia Caulis, and Semen Plantaginis in concomitant use with quetiapine, clozapine, and olanzepine were associated with nearly 60% of the risk of adverse outcomes. Conclusions Concomitant herbal and antipsychotic treatment could produce either beneficial or adverse clinical effects in schizophrenic population. Potential herb-drug pharmacokinetic interactions need to be further evaluated. PMID:21359185

  7. An epidemiological study of concomitant use of Chinese medicine and antipsychotics in schizophrenic patients: implication for herb-drug interaction.

    Directory of Open Access Journals (Sweden)

    Zhang-Jin Zhang

    Full Text Available BACKGROUND: Herb-drug interactions are an important issue in drug safety and clinical practice. The aim of this epidemiological study was to characterize associations of clinical outcomes with concomitant herbal and antipsychotic use in patients with schizophrenia. METHODS AND FINDINGS: In this retrospective, cross-sectional study, 1795 patients with schizophrenia who were randomly selected from 17 psychiatric hospitals in China were interviewed face-to-face using a structured questionnaire. Association analyses were conducted to examine correlates between Chinese medicine (CM use and demographic, clinical variables, antipsychotic medication mode, and clinical outcomes. The prevalence of concomitant CM and antipsychotic treatment was 36.4% [95% confidence interval (95% CI 34.2%-38.6%]. Patients using concomitant CM had a significantly greater chance of improved outcomes than non-CM use (61.1% vs. 34.3%, OR = 3.44, 95% CI 2.80-4.24. However, a small but significant number of patients treated concomitantly with CM had a greater risk of developing worse outcomes (7.2% vs. 4.4%, OR = 2.06, 95% CI 2.06-4.83. Significant predictors for concomitant CM treatment-associated outcomes were residence in urban areas, paranoid psychosis, and exceeding 3 months of CM use. Herbal medicine regimens containing Radix Bupleuri, Fructus Gardenia, Fructus Schisandrae, Radix Rehmanniae, Akebia Caulis, and Semen Plantaginis in concomitant use with quetiapine, clozapine, and olanzepine were associated with nearly 60% of the risk of adverse outcomes. CONCLUSIONS: Concomitant herbal and antipsychotic treatment could produce either beneficial or adverse clinical effects in schizophrenic population. Potential herb-drug pharmacokinetic interactions need to be further evaluated.

  8. [Use of analgesia and sedation in dental implantology in patients with concomitant hypertension].

    Science.gov (United States)

    Sitkin, S I; Davydova, O B; Kostin, I O; Gasparian, A L

    2015-01-01

    Dental implants surgery in patients with hypertension increases the risk of vascular complications. The aim of the study was to examine the effect of analgesia and sedation on blood pressure and postoperative pain in dental implantology. In 76 patients with hypertension implant surgery was performed under local anesthesia only (40 patients) or under local anesthesia with propofol sedation and pre-emptive analgesia with ketorolac (36 patients). Intraoperative systolic blood pressure in the second group was 20% less than in the first group while the intensity of pain in the postoperative period in the second group was three times less than in the first one. Propofol sedation in dental implantology provides hemodynamic stability in patients with concomitant hypertension and preemptive analgesia with ketorolac allows minimizing postoperative pain.

  9. Thyroid Cancer Presenting with Concomitant Metastatic Breast Cancer in the Thyroid

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    Chung-Chen Wang

    2014-12-01

    Full Text Available The thyroid is an unusual site to find cancer metastasis. When it does occur, such cancer spread is often manifested in multiple metastases and generally suggests a poor prognosis. We presented here a 49-year-old woman recently diagnosed with thyroid cancer, who had been treated for stage IIA breast cancer 8 years ago. After radical right thyroidectomy and left subtotal thyroidectomy, her pathological report showed papillary thyroid carcinoma, right thyroid, with concomitant metastatic breast carcinoma. This is the first case of which we are aware involving coexisting thyroid cancer and metastatic breast cancer in the ipsilateral lobe. Moreover, the circumstances of this case show a very unique clinical course compared with previous studies. Given the unusual circumstances of our case, we further discuss the relationship between thyroid cancer and breast cancer.

  10. Subdural haematoma complicating shunting for normal pressure hydrocephalus in the setting of concomitant antiplatelet medication

    DEFF Research Database (Denmark)

    Birkeland, Peter; Lauritsen, Jens; Poulsen, Frantz Rom

    2016-01-01

    OBJECTIVE: To report on the occurrence and management of subdural haematoma after shunt implantation for normal pressure hydrocephalus and to determine the risk of recurrence in the setting of antiplatelet medication. METHODS: From a consecutive series of 80 patients implanted with a cerebrospinal...... fluid shunt for normal pressure hydrocephalus, records from 11 patients taking antiplatelet drugs, who subsequently had surgery for subdural haematoma were extracted and retrospectively reviewed. RESULTS: Patients were followed up for a mean of 1819 days after shunt implantation. Subdural haematomas...... reoperations done before the subdural collection disappeared. Only one patient had a late recurrence almost 11 years after shunt implantation. CONCLUSIONS: Subdural haematoma in the setting of a ventriculoperitoneal implantation for normal pressure hydrocephalus and concomitant antiplatelet medication can...

  11. Carcinoid of the Esophagus Concomitant with Adenocarcinoma of the Esophagus: One Case Report and Literature Review

    Institute of Scientific and Technical Information of China (English)

    Chun-hui LI; Li-hui PAN; Bei-bei XU; De-li ZHANG; Xiao-ping JIN

    2010-01-01

    @@ Introduction Neuroendocrine tumor covers a wide range of neoplasms that originate in the neuroendocrine cells which spread throughout the body.Carcinoid tumor, and neuroendocrine tumor are low-grade malignant tumors, their growth is slow, and mainly in the gastrointestinal epithelium. Esophageal adenocarcinoma tumor is a big problem in esophageal cancer. Combined esophageal adenocarcinoma and carcinoid tumor both as primary tumors is very rare[1]. Neuroendocrine tumors of the esophagus are derived from the diffuse neuroendocrine system in the gastrointestinal tract. Neuroendocrine tumors in the esophagus can be distinguished from other mesenchymal tumors by immunostaining for synaptophysin and chromogranin-A. Both carcinoid of the esophagus and adenocarcinoma of the esophagus are malignant tumors and considered to have a specifi c molecular pathogenesis. This paper presents a rare case diagnosed as carcinoid of the esophagus concomitant with an adenocarcinoma of the esophagus, a review of the literature is also presented here.

  12. Central retinal artery occlusion with concomitant ipsilateral cerebral infarction after cosmetic facial injections.

    Science.gov (United States)

    Hong, Jeong-Ho; Ahn, Seong Joon; Woo, Se Joon; Jung, Cheolkyu; Chang, Jun Young; Chung, Jin-Heon; Han, Moon-Ku

    2014-11-15

    We report 2 cases of central retinal artery occlusion with concomitant ipsilateral cerebral infarction after cosmetic facial injections and a literature review. The 2 patients were two healthy women, in which cosmetic facial injections with autologous fat and filler were performed, respectively. The patients had no light perception at the final visit and their conditions led to memory retrieval disturbance in case 1 and right arm weakness, dysarthria, facial palsy, and ophthalmoplegia in case 2. Neuroimaging showed multifocal small infarctions in the ipsilateral frontal lobe with occlusion of the ophthalmic artery in case 1 and multiple infarctions in the ipsilateral anterior and middle cerebral artery territories with subsequent hemorrhagic transformation in case 2. Poor visual prognosis and neurological complications can occur in healthy adults undergoing cosmetic facial injection, and all patients should be informed of this risk before the procedure.

  13. Systemic lupus erythematosus as the concomitant manifestation of angioimmunoblastic T-cell lymphoma.

    Science.gov (United States)

    Suzuki, Akitake; Shoji, Norikazu; Aoki, Naoko; Asazuma, Naoki; Machinami, Rikuo; Kojima, Masaru; Okai, Takahiro

    2017-03-01

    Herein we report a case of the simultaneous occurrence of angioimmunoblastic T-cell lymphoma (AITL) and systemic lupus erythematosus (SLE) in a 76-year-old woman. She presented with fever, night sweats, and general malaise. A laboratory examination revealed leukopenia, anemia, polyclonal hypergammaglobulinemia, hypocomplementemia, positive results for anti-nuclear antibodies and anti-double strand DNA (anti-dsDNA) antibodies, and mild proteinuria. A computed tomography scan of the abdominal cavity showed multiple swollen intra-abdominal and intra-pelvic lymph nodes. A biopsy specimen obtained from the peri-iliac lymph node confirmed the diagnosis of AITL, while renal biopsy results were consistent with lupus nephritis, International Society of Nephrology and Renal Pathology Society class V. These results indicated that our patient developed SLE concomitantly with AITL. These findings will lead to further understanding of the pathogenic mechanism of SLE.

  14. Concomitant Imperforate Hymen and Transverse Vaginal Septum Complicated with Pyocolpos and Abdominovaginal Fistula

    Directory of Open Access Journals (Sweden)

    Berna Dilbaz

    2014-01-01

    Full Text Available A 13-year-old patient with a complaint of worsening lower abdominal pain during the past 4 months was admitted to the emergency department. An abdominopelvic ultrasound scan revealed a distended uterocervical cavity suggestive of hematometrocolpos. Imperforate hymen was observed on examination of the external genitalia. MRI scan revealed an air-fluid level representing pyometrocolpos within a distended vagina. Posterior vaginal extraperitoneal leakage as the sign of a fistula between the vagina and the rectovaginal space was detected. Although laparoscopic approach was planned, malodorous pus expelled after the insertion of the Veress needle, it was decided to proceed to laparotomy. Pus with peritoneal microabscess formations was observed at laparotomy. The imperforate hymen and TVS were excised vaginally. A more complex anomaly should be suspected in cases with hematometra and concomitant imperforated hymen without any bulging and thorough evaluation using radiological imaging techniques should be performed before surgical approach.

  15. Successful Hematopoietic Stem Cell Transplantation Following a Cyclophosphamide-Containing Preparative Regimen with Concomitant Phenobarbital Administration

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    Catherine Weber

    2012-01-01

    Full Text Available Cyclophosphamide is an immunosuppressive agent and an anticancer prodrug which requires bioactivation catalyzed primarily by cytochrome P450 enzymes in order to be transformed into its active alkylating compounds. Concomitant administration of drugs known to inhibit or induce this enzyme system is a clinical concern. Herein, we present the case of a chronically ill 21-year-old patient who received high-dose cyclophosphamide, equine antithymocyte globulin (eATG, and total body irradiation (TBI followed by an allogeneic hematopoietic stem cell transplant (HSCT for severe aplastic anemia. Throughout her hospitalization, she continued to receive quadruple anticonvulsant therapy including phenobarbital for her long-standing seizure history. The preparative regimen was tolerated well aside from a hypersensitivity reaction to eATG, and minimal cyclophosphamide-related toxicities. Safe and effective administration of high-dose cyclophosphamide was possible with multidisciplinary care consisting of physician, nursing, pharmacy, neurology consultation, as well as social work and case management.

  16. [Concomitant gastric and pancreatic metastases from renal cell carcinoma: case study].

    Science.gov (United States)

    Portanova, Michel; Yabar, Alejandro; Lombardi, Emilio; Vargas, Fernando; Mena, Víctor; Carbajal, Ramiro; Palacios, Néstor; Orrego, Jorge

    2006-01-01

    This report describes the case of a patient who underwent total gastrectomy, splenectomy and pancreatomy corporo-postero as a consequence of gastric and pancreatic metastasis from carcinoma to clear cells, five years after having undergone radical nephrectomy. Upper digestive bleeding was the first symptom, and pancreatic lesion was detected in previous CT scans. There are many documented cases of pancreatic metastasis, but only eight gastric metastasis in the last 15 years, although we did not find reports about surgical treatment for concomitant gastric and pancreatic injury. Surgical treatment which in some reports include highly complex surgeries such as gastrectomies with combined resections of invaded organs and pancreatoduodenectomy, are good options for select cases, because good survival rates have been reported.

  17. Complexity in caring for an ageing heart failure population: concomitant chronic conditions and age related impairments.

    Science.gov (United States)

    De Geest, Sabina; Steeman, Els; Leventhal, Marcia E; Mahrer-Imhof, Romy; Hengartner-Kopp, Beatrice; Conca, Antoinette; Bernasconi, Arlette T; Petry, Heidi; Brunner-La Rocca, Hanspeter

    2004-12-01

    The complexity of caring for the ageing heart failure (HF) population is further complicated by concomitant chronic conditions (i.e., polypharmacy, depression), age related impairments (i.e., hearing, visual and cognitive impairments, impairments in activities of daily living (ADL/IADL), and other issues (e.g., health illiteracy, lack of social support). This paper provides an overview of these risk factors, outlines how they individually and in interplay endanger favourable outcome by putting patients at risk for poor self-management. Moreover, suggestions are made on how these issues could be addressed and integrated in heart failure management by applying gerontological care principles in caring for the ageing heart failure population.

  18. Hybrid treatment of recurring thoracoabdominal aortic aneurysm concomitant with retrograde type A aortic dissection

    Institute of Scientific and Technical Information of China (English)

    ZHANG Min-hong; GUO Wei; DU Xin; XIONG Jiang

    2010-01-01

    So far, standard therapy of complex thoracoabdominal aortic disease is open surgical repair requiring aortic clamping and replacement of the involved segment.Despite significant improvements, morbidity and mortality of open surgery remain high.I As a result, open surgery is often withheld owing to severe comorbidities of the patients. Endovascular technique has emerged as an alternative for treatment of these diseases in high risk patients,2 and has enlarged the options of treatment of complex aortic diseases. However, an endovascular approach alone is often deemed unsuitable for some complex aortic disorders because of the close proximity of the supraaortic or visceral branches. A hybrid open-endovascular approach has therefore been proposed as a viable alternative. We present here a unique patient with recurring thoracoabdominal aortic aneurysm (TAAA) concomitant with an aortic dissection (AD) treated by a hybrid open-endovascular approach.

  19. Concomitant Antibiotic and Mercury Resistance Among Gastrointestinal Microflora of Feral Brook Trout, Salvelinus fontinalis

    Science.gov (United States)

    Meredith, Matthew M.; Parry, Erin M.; Guay, Justin A.; Markham, Nicholas O.; Danner, G. Russell; Johnson, Keith A.; Barkay, Tamar; Fekete, Frank A.

    2013-01-01

    Twenty-nine bacterial isolates representing eight genera from the gastrointestinal tracts of feral brook trout Salvelinus fontinalis (Mitchell) demonstrated multiple maximal antibiotic resistances and concomitant broad-spectrum mercury (Hg) resistance. Equivalent viable plate counts on tryptic soy agar supplemented with either 0 or 25 μM HgCl2 verified the ubiquity of mercury resistance in this microbial environment. Mercury levels in lake water samples measured 1.5 ng L−1; mercury concentrations in fish filets ranged from 81.8 to 1,080 ng g−1 and correlated with fish length. The presence of similar antibiotic and Hg resistance patterns in multiple genera of gastrointestinal microflora supports a growing body of research that multiple selective genes can be transferred horizontally in the presence of an unrelated individual selective pressure. We present data that bioaccumulation of non-point source Hg pollution could be a selective pressure to accumulate both antibiotic and Hg resistant bacteria. PMID:22850694

  20. A Case of Turner Syndrome with Concomitant Transient Hypogammaglobulinaemia of Infancy and Central Diabetes Insipidus

    Science.gov (United States)

    Korkmaz, Hüseyin Anıl; Özkan, Behzat; Hazan, Filiz; Büyükinan, Muammer; Çelik, Tanju

    2013-01-01

    Turner syndrome (TS) is a genetic disorder that affects development in females and is characterized by the complete or partial absence of the second sex chromosome, or monosomy X. TS is associated with abnormalities in lymphatic and skeletal development, in growth, and in gonadal function. Cardiac and renal malformations and a number of specific cognitive findings may also be encountered in these patients. An increased risk for hypothyroidism, sensorineural hearing loss, hypertension, and other problems has also been reported. We present the case of a patient with TS accompanied by transient hypogammaglobulinaemia of infancy (THI) and central diabetes insipidus, which we believe is the first reported TS patient with these concomitant disorders. Conflict of interest:None declared. PMID:23419422

  1. Subacute combined degeneration of the spinal cord concomitant with gastric cancer.

    Science.gov (United States)

    Hirata, Ayako; Nomoto, Nobuatsu; Konno, Shingo; Nakazora, Hiroshi; Sugimoto, Hideki; Nemoto, Hiroshi; Kurihara, Teruyuki; Wakata, Nobuo

    2006-01-01

    We report a rare case of subacute combined degeneration of the spinal cord concomitant with gastric cancer. A 67-year-old man was admitted because of posterior column symptoms, pyramidal tract sign and peripheral neuropathy with severe hyperchromic anemia. He was treated with mecobalamin 1 mg IM, after which his anemia and neurological signs recovered. He was diagnosed as having subacute combined degeneration with pernicious anemia. Subsequent stomach biopsy revealed gastric cancer, and the patient underwent gastrectomy. It is a well known association that chronic atrophic gastritis is associated with gastric cancer or subacute combined degeneration. Our findings suggest that in this case subacute combined degeneration and gastric cancer are independent of each other; rather, both resulted from chronic atrophic gastritis.

  2. Concomitant fibromyalgia in rheumatoid arthritis is associated with the more frequent use of biological therapy

    DEFF Research Database (Denmark)

    Lage-Hansen, P R; Chrysidis, S; Lage-Hansen, M;

    2015-01-01

    OBJECTIVES: To compare the 28-joint Disease Activity Score (DAS28) and its components in patients with rheumatoid arthritis (RA) with and without concomitant fibromyalgia (FM), and to investigate the use of biological treatment in the two groups. METHOD: Questionnaires developed to diagnose FM were...... handed out among RA patients during their planned visits. Values for DAS28 were obtained from the DANBIO registry. Demographic data and data on patients' medical treatment, disease duration, serological and radiological status were retrieved from patients' files. The χ(2) test and an unpaired t-test were...... with a higher DAS28 due to subjective parameters and with the more frequent use of biological treatments. This raises the question of whether the more frequent use of biologics in these patients is justified by inflammation, or is instead due to persistent pain and other centrally mediated symptoms....

  3. Concomitant prevalence of severe wasting, stunting and underweight amongst under five children in Meerut district, India

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    Rahul Bansal

    2016-12-01

    Full Text Available Background: National Family Health Survey (NFHS documented that nearly 5.8 million children (6.4% are undernourished in India which is 1/3rd of the world’s share. Objective: i To assess the concomitant prevalence of severe wasting, severe stunting and severe underweight among children 6-59 months in a rural population of Northern India. Methods: A cross-sectional study was conducted in 2 blocks of district Meerut, Uttar Pradesh during 2013-2015. A total of 70 villages were included and all children in the age group of 6–59 months were covered by house to house visits. Data on socio-demographic profile and anthropometry was collected utilizing standards methods and equipment’s. The Z-scores for weight-for-height (WFH, height-for-age (HFA, and weight-for-age (WFA were calculated using WHO child growth standards. Results: A total of 19449 children in the age group of 6-59 months from house to house survey were approached. Out of 19449 children, 464 children were excluded due to erroneous age estimation; knock knees; physically handicapped and spinal deformities. Thus, 18985 children were enrolled for the present study. The weight, height and age were available for 18474, 18595 and 18983 children. The prevalence of severe wasting, severe stunting and severe underweight was found to be 2.2%, 16.2% and 12.2%, respectively. Concomitant presence of severe wasting, severe stunting and severe underweight was found in 0.9% (171/18,463 children. Conclusion: High prevalence of severe wasting, severe stunting and severe underweight was found in children from district Meerut indicating poor nutritional status.

  4. Concomitant treatment of F98 glioma cells with new liposomal platinum compounds and ionizing radiation.

    Science.gov (United States)

    Charest, Gabriel; Paquette, Benoit; Fortin, David; Mathieu, David; Sanche, Léon

    2010-04-01

    Despite significant advances, the radiotherapy and chemotherapy protocols marginally improve the overall survival of patients with glioblastoma. Lipoplatin(TM), and Lipoxal(TM), the liposomal formulations of cisplatin and oxaliplatin respectively, were tested on the F98 glioma cells for their ability to improve the cell uptake and increase the synergic effect when combined with ionizing radiation. The cytotoxicity and synergic effect of platinum compounds were assessed by colony formation assay, while the cellular uptake was measured by Inductively Coupled Plasma Mass Spectrometer (ICP-MS). After 4 h exposure with platinum compounds, cells were irradiated (1.5-6.6 Gy) with a (60)Co source. The liposomal formulations were compared to their liposome-free analogs and to carboplatin. The concomitant treatment of F98 cells with carboplatin and radiation produced the highest radiosensitizing effect (30-fold increase). Among the platinum compounds tested, Lipoplatin(TM) produced the most promising results. This liposomal formulation of cisplatin improved the cell uptake by 3-fold, and its radiosensitizing potential was enhanced by 14-fold. Although Lipoxal(TM) can potentially reduce the adverse effect of oxaliplatin, a synergic effect with radiation was measured only when incubated at a concentration higher than its IC50. Conversely, concomitant treatment with cisplatin did not result in a synergic effect, as in fact a radioprotective effect was measured on the F98 cells. In conclusion, among the five platinum compounds tested, carboplatin and Lipoplatin(TM) showed the best radiosensitizing effect. Lipoplatin(TM) seems the most promising since it led to the best cellular incorporation and has already been reported to be less neurotoxic than other platinum compounds.

  5. Citicoline (CDP-choline) increases Sirtuin1 expression concomitant to neuroprotection in experimental stroke.

    Science.gov (United States)

    Hurtado, Olivia; Hernández-Jiménez, Macarena; Zarruk, Juan G; Cuartero, María I; Ballesteros, Iván; Camarero, Guadalupe; Moraga, Ana; Pradillo, Jesús M; Moro, María A; Lizasoain, Ignacio

    2013-09-01

    CDP-choline has shown neuroprotective effects in cerebral ischemia. In humans, although a recent trial International Citicoline Trial on Acute Stroke (ICTUS) has shown that global recovery is similar in CDP-choline and placebo groups, CDP-choline was shown to be more beneficial in some patients, such as those with moderate stroke severity and not treated with t-PA. Several mechanisms have been proposed to explain the beneficial actions of CDP-choline. We have now studied the participation of Sirtuin1 (SIRT1) in the neuroprotective actions of CDP-choline. Fischer rats and Sirt1⁻/⁻ mice were subjected to permanent focal ischemia. CDP-choline (0.2 or 2 g/kg), sirtinol (a SIRT1 inhibitor; 10 mg/kg), and resveratrol (a SIRT1 activator; 2.5 mg/kg) were administered intraperitoneally. Brains were removed 24 and 48 h after ischemia for western blot analysis and infarct volume determination. Treatment with CDP-choline increased SIRT1 protein levels in brain concomitantly to neuroprotection. Treatment with sirtinol blocked the reduction in infarct volume caused by CDP-choline, whereas resveratrol elicited a strong synergistic neuroprotective effect with CDP-choline. CDP-choline failed to reduce infarct volume in Sirt1⁻/⁻ mice. Our present results demonstrate a robust effect of CDP-choline like SIRT1 activator by up-regulating its expression. Our findings suggest that therapeutic strategies to activate SIRT1 may be useful in the treatment of stroke. Sirtuin 1 (SIRT1) is implicated in a wide range of cellular functions. Regarding stroke, there is no direct evidence. We have demonstrated that citicoline increases SIRT1 protein levels in brain concomitantly to neuroprotection. Citicoline fails to reduce infarct volume in Sirt1⁻/⁻ mice. Our findings suggest that therapeutic strategies acting on SIRT1 may be useful in the treatment of stroke.

  6. Concomitant pulmonary tuberculosis in hospitalized healthcare-associated pneumonia in a tuberculosis endemic area: a multi-center retrospective study.

    Directory of Open Access Journals (Sweden)

    Jia-Yih Feng

    Full Text Available BACKGROUND: In tuberculosis (TB endemic areas, Mycobacterium tuberculosis is an important but easily misdiagnosed pathogen in community-acquired pneumonia (CAP. However, the occurrence of concomitant pulmonary tuberculosis (PTB in hospitalized healthcare-associated pneumonia (HCAP has never been investigated. METHODS AND FINDINGS: Seven hundred and one hospitalized HCAP and 934 hospitalized CAP patients from six medical centers in Taiwan were included in this nationwide retrospective study. Concomitant PTB was defined as active PTB diagnosed within 60 days of admission due to HCAP or CAP. The predictors for concomitant PTB and the impact of PTB on the outcomes of pneumonia were investigated. Among the enrolled subjects, 21/701 (3% of the HCAP patients and 25/934 (2.7% of the CAP patients were documented to have concomitant PTB. In multivariate analysis, a history of previous anti-TB treatment (OR = 5.84, 95% CI: 2.29-20.37 in HCAP; OR = 3.33, 95% CI: 1.09-10.22 in CAP and escalated pneumonia severity index (PSI scores (OR = 1.014, 95% CI: 1.002-1.026, in HCAP; OR = 1.013, 95% CI: 1.001-1.026, in CAP were independent predictors for concomitant PTB in both CAP and HCAP patients. Regarding treatment outcomes, HCAP patients with concomitant PTB were associated with more acute respiratory failure within 48 hours of admission (47.6% vs. 22.6%, p = 0.008, higher intensive care unit admission rate (61.9% vs. 35.7%, p = 0.014, longer hospitalization (39.6±34.1 vs. 23.7±27 days, p = 0.009, and higher in-hospital mortality (47.6% vs. 26.3%, p = 0.03 than those without concomitant PTB. Exposure to certain groups of antibiotics for the treatment of pneumonia was not associated with the occurrence of concomitant PTB. CONCLUSIONS: In HCAP patients, the occurrence of concomitant PTB is comparable with that in CAP patients and associated with higher PSI scores, more acute respiratory failure, and higher in-hospital mortality.

  7. Cor a 14 is the superior serological marker for hazelnut allergy in children, independent of concomitant peanut allergy

    DEFF Research Database (Denmark)

    Eller, Esben; Mortz, Charlotte G; Bindslev-Jensen, Carsten

    2016-01-01

    BACKGROUND: Hazelnut is the most frequent cause of tree-nut allergy, but up to half of all children with hazelnut allergy additionally suffers from peanut allergy. Our aim was to identify diagnostic values of the most promising serological markers (Cor a 9 and Cor a 14) and to address the influence...... of concomitant peanut allergy and PR10 sensitization. METHOD: We included 155 children suspected off hazelnut allergy and challenged according to guidelines. Concomitant allergy to peanuts was verified or ruled out by challenge. Skin Prick Test, s-IgE and CRD to hazelnut, peanut, PR10 and LPT protein families...... were measured using ImmunoCap. RESULTS: Sixty-five children had a positive hazelnut challenge, and 60% of these also had concomitant peanut allergy. Children allergic to hazelnut were sensitized to Cor a 9 and Cor a 14; peanut allergic children to Ara h 2. Sensitization to PR10 protein components were...

  8. LBA50 - Influence of concomitant clopidogrel consumption on development of paclitaxel-associated toxicity: A pharmacoepidemiological study

    DEFF Research Database (Denmark)

    K, Agergaard; Mau-Sørensen, M; Stage, Tore Bjerregaard

    LBA50 - Influence of concomitant clopidogrel consumption on development of paclitaxel-associated toxicity: A pharmacoepidemiological study Background Paclitaxel is mainly eliminated via metabolism by the liver enzyme CYP2C8. It has recently been demonstrated in vitro that glucuronidation converts...... clopidogrel to a metabolite, which is a strong inhibitor of CYP2C8. To determine if this interaction has clinical relevance, we investigated whether concomitant clopidogrel and paclitaxel was associated with severe paclitaxel toxicity, primarily peripheral sensory neuropathy. Methods Patients concomitantly...... treated with clopidogrel and paclitaxel were identified using treatment registers and the Danish National Database of Reimbursed Prescriptions (DNDRP). Each patient was matched using age and gender with two controls treated with low-dose aspirin and paclitaxel. Paclitaxel induced toxicity was evaluated...

  9. Role of concomitant tricuspid surgery in moderate functional tricuspid regurgitation in patients undergoing left heart valve surgery.

    Science.gov (United States)

    Mahesh, Balakrishnan; Wells, Francis; Nashef, Samer; Nair, Sukumaran

    2013-01-01

    Functional tricuspid regurgitation (FTR) is frequently present in patients undergoing aortic, and particularly mitral valve, surgery. Untreated FTR may lead to right heart failure. Reoperative cardiac surgery for late FTR is associated with high morbidity and mortality. Therefore, severe FTR has emerged as a Class I indication for concomitant tricuspid valve surgery in patients undergoing left valve surgery. Concomitant tricuspid valve surgery during left heart valve surgery to address moderate and mild FTR is controversial. This review addresses this issue and proposes an algorithm for the treatment of FTR in patients undergoing left heart valve surgery.

  10. Overlap syndrome consisting of PSC-AIH with concomitant presence of a membranous glomerulonephritis and ulcerative colitis.

    Science.gov (United States)

    Warling, Odile; Bovy, Christophe; Coïmbra, Carla; Noterdaeme, Timothée; Delwaide, Jean; Louis, Edouard

    2014-04-28

    The association of primary sclerosing cholangitis (PSC) and autoimmune hepatitis (AIH) is known as an overlap syndrome (OS). OS can also be described in the setting of concomitant presence of AIH and PSC. These diseases can in some cases be associated with ulcerative colitis. In this case report we describe, to our knowledge, the first case in the literature of a young Caucasian male suffering from ulcerative colitis and an overlap syndrome consisting of an association between PSC-AIH, with the concomitant presence of a membranous glomerulonephritis.

  11. Concomitant sensitization to inhaled budesonide and oral nystatin presenting as allergic contact stomatitis and systemic allergic contact dermatitis.

    Science.gov (United States)

    Vega, Francisco; Ramos, Tania; Las Heras, Paloma; Blanco, Carlos

    2016-01-01

    Concomitant allergic reactions to multiple drugs are uncommon. We report the case of a 66-year-old woman who presented with concomitant sensitization to inhaled budesonide and oral nystatin presenting as allergic contact stomatitis and systemic allergic contact dermatitis. It is notable that one of the reactions was caused by oral nystatin, which generally is not considered to be allergenic due to its poor intestinal absorption. Diagnoses were confirmed on patch testing with histologic examination along with oral challenge testing. We also used challenge testing to rule out cross-reactivity among nystatin and other macrolide drugs, both antifungals and antibiotics.

  12. Poor response to gefitinib in lung adenocarcinoma with concomitant epidermal growth factor receptor mutation and anaplastic lymphoma kinase rearrangement.

    Science.gov (United States)

    Zhou, Jianya; Zheng, Jing; Zhao, Jing; Sheng, Yihong; Ding, Wei; Zhou, Jianying

    2015-03-01

    A patient presenting with concomitant epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) translocation is rare. We report a non-small cell lung cancer (NSCLC) patient with concomitant ALK rearrangement and exon 19 (E746-A750del) EGFR mutation. The ALK rearrangement was confirmed not only in the primary tumor biopsy specimen, but also in the pleural effusion cell block by reverse transcriptase-polymerase chain reaction (RT-PCR), Ventana ALK immunohistochemistry assay, and fluorescence in situ hybridization. No clinical benefit using chemotherapy or EGFR tyrosine kinase inhibitor gefitinib was obtained in this case.

  13. Cholesterol Exchange, DNA Damages, Apoptosis and Necrosis of Blood Cells in Severe Concomitant Injury

    Directory of Open Access Journals (Sweden)

    V. V. Moroz

    2008-01-01

    Full Text Available Objective: to study a number of free-radical reactions, the parameters of cholesterol exchange, and the extent of blood cell DNA damages in victims early after concomitant injury. Subjects and methods. The study covered 77 patients who had experienced severe mechanical injury. The patients’ condition on admission was an APACHE II of 19.1±5.4 scores. According to the outcome of the disease, all the patients were divided into 2 groups: 1 deceased patients and 2 survivors. The study was conducted on admission to an intensive care unit and on days 3, 5, 7, and 15. The extent of blood cell DNA damages and the proportion of apoptotic and necrotic blood cells were estimated by gel isolated cell elec-trophoresis (DNA rocket electrophoresis. The «Human 8-oxoGuanine DNA Glycosylate (OGG1 FLARE Assay» kit was used to measure the content of 8-hydroxy-2-deoxyguanosine in cell DNA. The cholesterol and overall antioxida-tive statuses and biochemical parameters were determined on an automatic biochemical Cobas Miras Plus analyzer. Very low-density lipoproteins (VLDL and low-density lipoproteins (LDL were calculated. Results and discussion. In severe concomitant injury, there were increases in DNA damages in the blood cells and in their apoptotic and necrotic processes, which were particularly pronounced on days 3—5. In the group of deceased patients, the increase of 8-hydroxy-2-deoxyguanosine was greater than the normal values on days 5 and 7. On admission, the systemic antioxidative status was greater than the normal values in the survivors and deceased patients and tended to diminish in both groups during an observation. The average statistical values of total cholesterol were lower at all stages of the study. At the stages of the study, the concentration of triglycerides and VLDL were in the normal range in all the patients. At week 1 of the observation, the level of LDL was normal or greater in the survivors than in the deceased. The changes in high

  14. Tolerability of diclofenac sodium 1% gel with concomitant medications known to interact with diclofenac

    Directory of Open Access Journals (Sweden)

    Peniston JH

    2013-04-01

    Full Text Available John H Peniston,1 Morris S Gold,2 Matthew S Wieman,3 Lawrence K Alwine4 1Feasterville Family Health Care Center, Feasterville, PA, 2Novartis Consumer Health, Inc, Parsippany, NJ, 3Endo Pharmaceuticals Inc, Malvern, PA, 4Downingtown Family Medicine, Downingtown, PA, USA Background: Topical diclofenac sodium 1% gel (DSG has demonstrated efficacy and tolerability in patients with osteoarthritis (OA of the knees or hands, including elderly patients and those with an increased risk of gastrointestinal, cardiovascular, and renal adverse events (AEs. Medications known to interact with diclofenac were disallowed in a clinical trial of DSG for knee OA; however, patients were not to be discontinued for intake of disallowed treatment, unless there was a safety issue. This post hoc analysis examined the frequency and type of AEs in patients who received DSG concomitantly with drugs known to have potential interactions with diclofenac. Materials and methods: This was a post hoc analysis of a randomized controlled trial of DSG for knee OA pain. Patients (n = 254 aged ≥ 35 years with OA in one or both knees, but with clinical OA symptoms in only one knee, administered DSG topically to the target knee four times daily (total dose, 16 g/d for 12 weeks. Drugs with the potential for major or moderate drug–drug interactions (DDIs were identified via Drugs.com. AE rates were compared in patients with versus those without ≥1 potential DDI. Results: At least one AE was experienced by 62.6% (107/171 of patients with ≥1 DDI and by 55.4% (46/83 of patients with no DDIs. Gastrointestinal AEs (upper and lower were reported in 5.3% (9/171 and 7.2% (6/83, cardiovascular AEs in 4.7% (8/171 and 1.2% (1/83, renal AEs in 1.2% (2/171 and 0%, and hepatic AEs in 0% and 1.2% (1/83 of patients with ≥1 DDI compared with patients with no DDIs, respectively. Conclusion: Concurrent use of DSG with medications that had potential for major to moderate DDIs had little impact on

  15. Phase II Study of Concomitant Thalidomide During Radiotherapy for Hepatocellular Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Ch' ang, Hui-Ju, E-mail: hjmc@nhri.org.tw [National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (China); Department of Radiation Oncology, National Cheng Kung University Hospital, Tainan, Taiwan (China); Hsu, Chiun [Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (China); Chen, Chien-Hung [Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (China); Chang, Ya-Hui; Chang, Jeffrey S. [National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (China); Chen, Li-Tzong [National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (China); Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan (China)

    2012-02-01

    Purpose: Thalidomide has been demonstrated to possess antitumor activity in patients with advanced hepatocellular carcinoma (HCC). The objective of the present study was to determine whether the combined treatment of thalidomide with radiotherapy (RT) is associated with acceptable toxicity and an improved clinical outcome in HCC patients. Methods and Materials: A total of 24 patients were enrolled to receive RT combined with thalidomide. A total dose of 50 Gy was delivered in 2-Gy fractions within 5 weeks. Thalidomide was administered 100 mg twice daily starting 3 days before RT until the development of unacceptable toxicity or disease progression. Blood samples were collected before, during, and after treatment to measure the levels of angiogenic factors and cytokines. The results of patients receiving the combined therapy were compared with those from 18 HCC patients receiving RT only. Results: No significant difference in the clinical parameters was noted between the two groups, except for the baseline interleukin-6 level, which was greater in the concomitant group (p = .05). The most common toxicities related to thalidomide use were skin rash (54.2%), somnolence (37.5%), and constipation (33.3%). No significant differences were seen in the response rate (55.6% vs. 58.3%, p = .48), median progression-free survival (182 {+-} 48.9 vs. 148 {+-} 6.2 days, p = .15), or median overall survival (258 {+-} 45.6 vs. 241 {+-} 38.6, p = .16) between those who received concomitant therapy and those who received RT alone. Thalidomide suppressed the serum basic fibroblast growth factor level significantly during RT (p = .03) and, to a lesser extent, the interleukin-6 and tumor necrosis factor-{alpha} levels. After adjusting for other potential prognostic factors in the multivariate analysis, only the baseline interleukin-6 level and stem cell-derived factor-1 during RT independently predicted the progression-free survival. A decreased serum stem cell-derived factor-1 level 1

  16. Thymidylate synthase, dihydropyrimidine dehydrogenase, ERCC1, and thymidine phosphorylase gene expression in primary and metastatic gastrointestinal adenocarcinoma tissue in patients treated on a phase I trial of oxaliplatin and capecitabine

    Directory of Open Access Journals (Sweden)

    Danenberg Kathleen D

    2008-12-01

    Full Text Available Abstract Background Over-expression of thymidylate synthase (TS and dihydropyrimidine dehydrogenase (DPD in tumor tissue is associated with insensitivity to 5-fluorouracil (5-FU. Over-expression of ERCC1 correlates with insensitivity to oxaliplatin (OX therapy, while high thymidine phosphorylase (TP levels predict for increased sensitivity to capecitabine (Xel. Methods Biopsies of metastatic tumor were taken before OX (130 mg/m2 day 1 given with Xel (1200–3000 mg/m2 in two divided doses days 1–5 and 8–12 every 3-weeks. Micro-dissected metastatic and primary tumors were analyzed for relative gene expression by real-time quantitative polymerase chain reaction. The clinical protocol prospectively identified the molecular targets of interest that would be tested. Endpoints for the molecular analyses were correlation of median, first and third quartiles for relative gene expression of each target with response, time to treatment failure (TTF, and survival. Results Among 91 patients participating in this trial; 97% had colorectal cancer. The median number of prior chemotherapy regimens was 2, and most had prior 5-FU and irinotecan. In paired samples, median mRNA levels were significantly higher in metastatic versus primary tumor (-fold: TS (1.9, DPD (3.8, ERCC1 (2.1 and TP (1.6. A strong positive correlation was noted between DPD and TP mRNA levels in both primary (r = 0.693, p Conclusion Target gene expression in primary tumor was significantly lower than that in paired metastatic tissue. High ERCC1 mRNA levels in metastatic tumor was associated with a shorter TTF. Lower expression of TS mRNA correlated with a lower chance of early PD with XelOX therapy and improved overall survival.

  17. AMS method validation for quantitation in pharmacokinetic studies with concomitant extravascular and intravenous administration.

    Science.gov (United States)

    Lappin, Graham; Seymour, Mark; Young, Graeme; Higton, David; Hill, Howard M

    2011-02-01

    A technique has emerged in the past few years that has enabled a drug's intravenous pharmacokinetics to be readily obtained in humans without having to conduct extensive toxicology studies by this route of administration or expand protracted effort in formulation. The technique involves the intravenous administration of a low dose of (14)C-labelled drug (termed a tracer dose) concomitantly with a non-labelled extravascular dose given at therapeutically levels. Plasma samples collected over time are analysed to determine the total parent drug concentration by LC-MS (which essentially measures that arising from the oral dose) and by LC followed by accelerator mass spectrometry (AMS) to determine the (14)C-drug concentration (i.e., that arising from the intravenous dose). There are currently no published accounts of how the principles of bioanalytical validation might be applied to intravenous studies using AMS as an analytical technique. The authors describe the primary elements of AMS when used with LC separation and how this off-line technique differs from LC-MS. They then discuss how the principles of bioanalytical validation might be applied to determine selectivity, accuracy, precision and stability of methods involving LC followed by AMS analysis.

  18. Concomitant production of protease and lipase by Bacillus licheniformis VSG1: production, purification and characterization

    Directory of Open Access Journals (Sweden)

    R. Sangeetha

    2010-03-01

    Full Text Available This study was aimed at producing protease and lipase simultaneously on a common medium by Bacillus licheniformis VSG1, which was isolated from a tannery effluent. The effect of media composition with respect to protein source, lipid source and emulsifier on the production of protease and lipase was analysed. Both those enzymes were produced under optimized conditions like pH, temperature and incubation time. The enzyme mixture comprising of both protease and lipase was purified by ammonium sulphate precipitation, dialysis and gel filtration chromatography to obtain 20-fold pure enzymes. The purified enzyme mixture was characterized to determine the optimum pH and temperature of protease and lipase, the response of the enzymes to inhibitors, additives and solvents. The molecular weight of both the enzymes was determined as 40 kDa on SDS-PAGE. The concomitant production of protease and lipase and the purification of both the enzymes in a single mixture have industrial significance, as many industrial processes use both protease and lipase together.

  19. [Concomitant radiochemotherapy in cancer of the cervix uteri: modifications of the standards].

    Science.gov (United States)

    Haie-Meder, C; Lhommé, C; de Crevoisier, R; Morice, P; Resbeut, M

    2000-11-01

    For a long time, combined external irradiation and brachytherapy has been considered as the standard treatment in patients with advanced cervical cancers. Recently, five clinical randomized trials assessing the role of cis-platin-based chemotherapy delivered concomitantly to radiotherapy have been conducted in the United States. Another clinical randomized trial assessing the role of epirubicin was conducted by the Queen Mary Hospital in Hong Kong. With more than 2,000 enrolled patients, these studies showed converging results with an overall and disease-free survival improvement in the arms combining cis-platin and epirubicin-based chemotherapy and irradiation. These combinations led to a significant decrease in loco-regional evolution or recurrence rates, or even in pulmonary metastases rates. The relative risk of recurrences was decreased by 50%. The relative risk of death was decreased by 40%. The differences, however, were less significant in patients with advanced stages III or IVA. Hematological and digestive acute toxicity was significantly higher in the radiochemotherapy groups, but long-term complications were comparable. The results of these randomized trials have led to a modification in the standard of treatment in these poor prognosis cervix cancers. Five of the randomized trials evidenced the superiority of cis-platin-based chemotherapy, but the optimal chemotherapeutic regimens remain to be defined.

  20. Labile cochlear tuning in the mustached bat. II. Concomitant shifts in neural tuning.

    Science.gov (United States)

    Huffman, R F; Henson, O W

    1993-01-01

    Acoustic stimuli near 60 kHz elicit pronounced resonance in the cochlea of the mustached bat (Pteronotus parnellii parnellii). The cochlear resonance frequency (CRF) is near the second harmonic, constant frequency (CF2) component of the bat's biosonar signals. Within narrow bands where CF2 and third harmonic (CF3) echoes are maintained, the cochlea has sharp tuning characteristics that are conserved throughout the central auditory system. The purpose of this study was to examine the effects of temperature-related shifts in the CRF on the tuning properties of neurons in the cochlear nucleus and inferior colliculus. Eighty-two single and multi-unit recordings were characterized in 6 awake bats with chronically implanted cochlear microphonic electrodes. As the CRF changed with body temperature, the tuning curves of neurons sharply tuned to frequencies near the CF2 and CF3 shifted with the CRF in every case, yielding a change in the unit's best frequency. The results show that cochlear tuning is labile in the mustached bat, and that this lability produces tonotopic shifts in the frequency response of central auditory neurons. Furthermore, results provide evidence of shifts in the frequency-to-place code within the sharply tuned CF2 and CF3 regions of the cochlea. In conjunction with the finding that biosonar emission frequency and the CRF shift concomitantly with temperature and flight, it is concluded that the adjustment of biosonar signals accommodates the shifts in cochlear and neural tuning that occur with active echolocation.

  1. Cisplatin-induced premature senescence with concomitant reduction of gap junctions in human fibroblasts

    Institute of Scientific and Technical Information of China (English)

    Wei ZHAO; Zhong Xiang LIN; Zhi Qian ZHANG

    2004-01-01

    To examine the role of gap junctions in cell senescence,the changes of gap junctions in cisplatin-induced premature senescence of primary cultured fibroblasts were studied and compared with the replicative senescent human fibroblasts.Dye transfer assay for gap junction function and immunofluorescent staining for connexin 43 protein distribution were done respectively. Furthermore,cytofluorimetry and DAPI fluorescence staining were performed for cell cycle and apoptosis analysis. p53 gene expression level was detected with indirect immunofluorescence. We found that cisplatin (10 mM) treatment could block cell growth cycle at G1 and induced premature senescence. The premature senescence changes included high frequency of apoptosis,elevation of p53 expression,loss of membranous gap junctions and reduction of dye-transfer capacity. These changes were comparable to the changes of replicative senescence of human fibroblasts. It was also concluded that cisplatin could induce premature senescence concomitant with inhibition of gap junctions in the fibroblasts. Loss of functional gap junctions from the cell membrane may account for the reduced intercellular communication in the premature senescent fibroblasts. The cell system we used may provide a model useful for the study of the gap junction thus promoting agents against premature senescence.

  2. Evaluation of the Prevalence of Concomitant Idiopathic Cyclic Edema and Cellulite

    Directory of Open Access Journals (Sweden)

    José Maria Pereira de Godoy, Maria de Fátima Guerreiro de Godoy

    2011-01-01

    Full Text Available The aim of this study was to evaluate the prevalence of concomitant idiopathic cyclic edema with Grade II and III cellulite. All patients treated for Grade II and III cellulite were evaluated for idiopathic cyclic edema in a retrospective, quantitative and cross-sectional study. The study was carried out at the Godoy Clinic in the period from 2006 to 2010. All patients with body mass indexes > 25, Grade I cellulite and other causes of edema were excluded. The diagnosis of idiopathic cyclic edema was based on a clinical history and fluid retention throughout the day, in particular difficulty in removing rings on waking in the morning which improves later in the day. All patients with cyclic edema were treated with 75 mg aminaphtone three times daily. Statistical analysis considered the frequency of edema.Of the 82 women evaluated with ages between 18 and 58 years old (mean of 34.9 years 41 (50.0% were diagnosed with idiopathic cyclic edema.Idiopathic cyclic edema is an aggravating factor for cellulite and is frequently associated with the more advanced stages of the disease. Its control is essential in the treatment of cellulite.

  3. Evaluation of the prevalence of concomitant idiopathic cyclic edema and cellulite.

    Science.gov (United States)

    de Godoy, José Maria Pereira; de Godoy, Maria de Fátima Guerreiro

    2011-01-01

    The aim of this study was to evaluate the prevalence of concomitant idiopathic cyclic edema with Grade II and III cellulite. All patients treated for Grade II and III cellulite were evaluated for idiopathic cyclic edema in a retrospective, quantitative and cross-sectional study. The study was carried out at the Godoy Clinic in the period from 2006 to 2010. All patients with body mass indexes > 25, Grade I cellulite and other causes of edema were excluded. The diagnosis of idiopathic cyclic edema was based on a clinical history and fluid retention throughout the day, in particular difficulty in removing rings on waking in the morning which improves later in the day. All patients with cyclic edema were treated with 75 mg aminaphtone three times daily. Statistical analysis considered the frequency of edema. Of the 82 women evaluated with ages between 18 and 58 years old (mean of 34.9 years) 41 (50.0%) were diagnosed with idiopathic cyclic edema. Idiopathic cyclic edema is an aggravating factor for cellulite and is frequently associated with the more advanced stages of the disease. Its control is essential in the treatment of cellulite.

  4. Concomitant Prevalence of Low Serum Diamine Oxidase Activity and Carbohydrate Malabsorption

    Directory of Open Access Journals (Sweden)

    Dietmar Enko

    2016-01-01

    Full Text Available The aim of this retrospective study was to analyze the concomitant prevalence rates for lactose malabsorption (LM, fructose malabsorption (FM, and histamine intolerance (HI in patients with so far unexplained gastrointestinal (GI symptoms. A total of 439 outpatients, who presented unclear abdominal discomfort, underwent lactose (50 g and fructose (25 g hydrogen (H2 breath tests. Additionally, serum diamine oxidase (DAO measurements were performed. Individuals with low serum DAO activity (<10 U/mL, GI symptoms, and response to histamine-free diet were diagnosed with HI. Of all 439 patients, 341 (77.7% were found with 7 various GI conditions. In total, 94 (21.4%, 31 (7.1%, and 100 (22.8% individuals presented LM, FM, or HI only, whereas 116 (26.4% patients showed an overlap of GI entities investigated here. Interestingly, 89 out of 241 (36.9% individuals with carbohydrate malabsorption were also diagnosed with HI (LM + HI: 52 [11.8%], FM + HI: 23 [5.2%], and LM + FM + HI 14 [3.2%] individuals. In conclusion different combinations of LM, FM, and HI are present in individuals with unclear abdominal discomfort/pain. In clinical practice we suggest testing for LM, FM, and additional HI in the diagnostic work-up of these patients. Depending on these various diagnoses possible, patients should get an individualized dietary advice.

  5. Endovascular Exclusion of an Abdominal Aortic Aneurysm in Patients with Concomitant Abdominal Malignancy: Early Experience

    Energy Technology Data Exchange (ETDEWEB)

    Choi, You Ri; Chang, Nam Kyu [Chonnam National University Hwasun Hospital, Hwasun (Korea, Republic of); Shin, Hyo Hyun; Oh, Hyun Jun; Kim, Jae Kyu; Choi, Soo Jin Na; Chung, Sang Young [Chonnam National University Hospital, Gwangju (Korea, Republic of); Yim, Nam Yeol [Armed Forces Yangju Hospital, Yangju (Korea, Republic of)

    2010-08-15

    To assess the outcomes of endovascular aortic aneurysm repair (EVAR) for the treatment of an abdominal aortic aneurysm in patients undergoing curative surgical treatment for concomitant abdominal malignancy. The study included 12 patients with abdominal neoplasia and an abdominal aortic aneurysm (AAA), which was treated by surgery and stent EVAR. The neoplasm consisted of the gastric, colorectal, pancreas, prostate, and gall bladder. The follow up period was 3-21 months (mean 11.8 months). All medical records and imaging analyses were reviewed by CTA and/or color Doppler US, retrospectively. Successful endoluminal repair was accomplished in all twelve patients. The mean interval time between EVAR and surgery was 58.6 days. Small amounts of type 2 endoleaks were detected in two patients (17%). One patient developed adult respiratory distress syndrome after Whipple's operation 20 days after surgery, which led to hopeless discharge. No procedure-related mortality, morbidity, or graft-related infection was noted. Exclusion of AAA in patients with accompanying malignancy show with a relatively low procedure morbidity and mortality. Hence, endoluminal AAA repair in patients with synchronous neoplasia may allow greater flexibility in the management of an offending malignancy

  6. [A case of chronic inflammatory demyelinating polyradiculoneuropathy concomitant with acquired von Willebrand syndrome].

    Science.gov (United States)

    Ueda, Maki; Kawamura, Nobutoshi; Tateishi, Takahisa; Shigeto, Hiroshi; Ohyagi, Yasumasa; Kira, Jun-ichi

    2011-05-01

    We report a case of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) concomitant with acquired von Willebrand syndrome. A 33-year-old man developed motor and sensory polyneuropathy with electrophysiological conduction slowing. At this time, M-protein was absent He was diagnosed with CIDP and received intravenous immunoglobulin and subsequent oral corticosteroids, which resulted in almost complete remission for over 10 years. At the age of 44, he presented with chronic anemia. Laboratory tests and colonoscopy revealed that he had acquired von Willebrand syndrome with monoclonal gammopathy of undetermined significance (IgG lambda type) and colon cancer. Bleeding symptoms were.resolved with intravenous immunoglobulin, but not with supplementation of factor VIII. Shortly after successful excision of the cancer, CIDP and acquired von Willebrand syndrome simultaneously recurred. Intravenous immunoglobulin produced rapid improvement of both neurological and hematological abnormalities. Concurring CIDP and acquired von Willebrand syndrome in the present case may indicate that the conditions have a partly common immunological background including monoclonal gammopathy and a potential common autoantibody-mediated mechanism. Alternatively, dysfunction of von Willebrand factor may increase blood-nerve barrier permeability, inducing the recurrence of CIDP.

  7. [Side effects of chemotherapy in patients with pulmonary tuberculosis and concomitant diseases].

    Science.gov (United States)

    Nikolaeva, O D

    2003-01-01

    As many as 395 patients with pulmonary tuberculosis concurrent with other illnesses were examined. It has been ascertained that in 57.8 percent of cases there occurs a side effect in the wake of the antituberculous drug administration. The following were recognized as ill effects of the drugs employed--allergic reactions, candidiasis, disbacteriosis, toxic reactions,--in 25.44%, 3.07%, 7.02%, and 64.47% of cases respectively. Revealed in the above series was a marked side effect on the digestive organs, neurotoxic reactions, toxic effect on the cardiovascular system in 28.08%, 15.35%, 10.53% of cases respectively. The most frequently seen side effect was due to rifampicin (23.25%), streptomycin (18.42%), isoniazid (17.08%). The least number of complications was with taking etambutol--3.94%. In 43.42% of cases, the identified side effect necessitates withdrawal of the drug, in 56.58% of cases, the management of the concomitant medical problems, a change in routes of administration of medicines, and combined employment of antihistaminic drugs and hyposensitizing methodological approaches to the management of the condition permitted carrying on with the therapy instituted.

  8. Concomitant production of lipids and carotenoids in Rhodosporidium toruloides under osmotic stress using response surface methodology

    Directory of Open Access Journals (Sweden)

    Gunjan Singh

    2016-10-01

    Full Text Available As a replacement to existing fossil fuels, biofuels, have proven their worth; however, their widespread use is limited due to inconsistent yields, higher costs and poor productivity. An oleaginous yeast, Rhodosporidium toruloides has been reported to accumulate substantial amounts of lipids (that can be converted to biofuels and therefore, it was selected for study and optimization. Apart from lipids, R. toruloides is also reported to produce carotene that can be used as a therapeutic agent. In this study, the culture medium was statistically modelled and optimized for concomitant production of lipids and carotenoids and for improving and maximizing the productivity of lipids as well as carotenes. The two metabolites were expressed differentially in the growth cycle of this organism. Culture medium components were simultaneously varied at 5 different levels using statistical modelling employing RSM. Osmotic stress was introduced in order to simulate saline conditions and optimize the production process to be used in conditions with high salt contents. In this study, we demonstrate 36.2% (w/v lipid production and 27.2% (w/v carotenoid production, under osmotic stress with high salt concentrations, for the first time.

  9. FASTR: A novel data format for concomitant representation of RNA sequence and secondary structure information

    Indian Academy of Sciences (India)

    Tungadri Bose; Anirban Dutta; Mohammed Mh; Hemang Gandhi; Sharmila S Mande

    2015-09-01

    Given the importance of RNA secondary structures in defining their biological role, it would be convenient for researchers seeking RNA data if both sequence and structural information pertaining to RNA molecules are made available together. Current nucleotide data repositories archive only RNA sequence data. Furthermore, storage formats which can frugally represent RNA sequence as well as structure data in a single file, are currently unavailable. This article proposes a novel storage format, `FASTR’, for concomitant representation of RNA sequence and structure. The storage efficiency of the proposed FASTR format has been evaluated using RNA data from various microorganisms. Results indicate that the size of FASTR formatted files (containing both RNA sequence as well as structure information) are equivalent to that of FASTA-format files, which contain only RNA sequence information. RNA secondary structure is typically represented using a combination of a string of nucleotide characters along with the corresponding dot-bracket notation indicating structural attributes. `FASTR’ – the novel storage format proposed in the present study enables a frugal representation of both RNA sequence and structural information in the form of a single string. In spite of having a relatively smaller storage footprint, the resultant `fastr’ string(s) retain all sequence as well as secondary structural information that could be stored using a dot-bracket notation. An implementation of the `FASTR’ methodology is available for download at http://metagenomics.atc.tcs.com/compression/fastr.

  10. RDW as differential parameter between microcytic anemias in "pure" and concomitant forms

    Directory of Open Access Journals (Sweden)

    Januária F. Matos

    2015-02-01

    Full Text Available Introduction: Iron deficiency anemia and thalassemia minor are microcytic and hypochromic types of anemia commonly found in our environment. The correct differentiation between them is of great clinical importance, although it is often hampered by the coexistence of diseases that may alter the results of standard tests for their discrimination, in addition to the significant costs of such tests. Objective: The objective of this study was to investigate the discriminatory power of red cell distribution width (RDW between iron deficiency anemia and thalassemia minor. Method: Blood parameters were compared in 227 patients with iron deficiency anemia and/or thalassemia minor after diagnosis confirmed by molecular biology and HbA2 measurement for alpha thalassemia and beta thalassemia trait respectively. The frequency of alpha thalassemia trait in a population from two public hospitals of Minas Gerais was also determined. Result and conclusion: RDW was able to differentiate iron deficiency anemia from thalassemia trait, what indicates that this blood count parameter is a useful tool since concomitant disorders are excluded. In addition, a high frequency of the -α3.7 mutation was observed in the study population (20.3%, justifying its investigation when another cause for microcytic anemia is absent.

  11. Monthly Deaths Number And Concomitant Environmental Physical Activity: 192 Months Observation (1990-2005)

    Science.gov (United States)

    Stoupel, E.; Kalediene, R.; Petrauskiene, J.; Starkuviene, S.; Abramson, E.; Israelevich, P.; Sulkes, J.

    2007-12-01

    Human life and health state are dependent on many endogenous and exogenous influence factors. The aim of this study is to check the possible links between monthly deaths distribution and concomitant activity of three groups of cosmophysical factors: solar (SA), geomagnetic (GMA) and cosmic ray (CRA) activities. 192 months death number in years 1990-2005 (n=674004) at the Republic of Lithuania were analyzed. Total and both gender data were considered. In addition to the total death numbers, groups of ischemic heart disease (IHD), stroke (CVA), non-cardiovascular (NCV), accident, traffic accident and suicide-related deaths were studied. Sunspot number and solar radio flux (for SA), Ap, Cp and Am indices (for GMA) and neutron activity on the Earth s surface (for CRA) were the environmental physical activity parameters used in this study. Yearly and monthly deaths distributions were also studied. Pearson correlation coefficients (r) and their probabilities (p) were calculated. Multivariate analysis was conducted. Results revealed: 1) significant correlation of monthly deaths number with CRA (total, stroke, NCV and suicides) and inverse with SA and GMA; 2) significant correlation of monthly number of traffic accidents number with SA and GMA, and inverse with CRA; 3) a strong negative relationship between year and IHD/CVA victims number (an evidence for growing role of stroke in cardiovascular mortality); 4) significant links of rising cardiovascular deaths number at the beginning of the year and traffic accidents victims at the end of the year. It is concluded that CRA is related to monthly deaths distribution.

  12. Spinal Cord Stimulation Therapy for the Treatment of Concomitant Phantom Limb Pain and Critical Limb Ischemia.

    Science.gov (United States)

    De Caridi, Giovanni; Massara, Mafalda; Serra, Raffaele; Risitano, Claudia; Giardina, Massimiliano; Acri, Ignazio Eduardo; Volpe, Pietro; David, Antonio

    2016-04-01

    Phantom limb pain (PLP) is a chronic condition experienced by about 80% of patients who have undergone amputation. In most patients, both the frequency and the intensity of pain attacks diminish with time, but severe pain persists in about 5-10%. Probably, factors in both the peripheral and central nervous system play a role in the occurrence and persistence of pain in the amputated lower limb. The classical treatment of PLP can be divided into pharmacologic, surgical, anesthetic, and psychological modalities. Spinal cord stimulation (SCS) does not represent a new method of treatment for this condition. However, the concomitant treatment of PLP and critical lower limb ischemia by using SCS therapy has not yet been described in the current literature. The aim of the present article is to highlight the possibility of apply SCS for the simultaneous treatment of PLP and critical lower limb ischemia on the contralateral lower limb after failure of medical therapy in a group of 3 patients, obtaining pain relief in both lower limbs, delaying an endovascular or surgical revascularization. After SCS implantation and test stimulation, the pain was reduced by 50% on both the right and the left side in all our patients. The main indications for permanent SCS therapy after 1 week of test stimulation were represented by transcutaneous oxygen (TcPO2) increase >75%, decrease of opioids analgesics use of at least 50% and a pain maintained to within 20-30/100 mm on visual analog scale.

  13. Outcomes in Newly Diagnosed Elderly Glioblastoma Patients after Concomitant Temozolomide Administration and Hypofractionated Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Nguyen, Ludovic T. [Neurology Department, CHU Hautepierre, rue Molière, Strasbourg 67000 (France); Touch, Socheat [Radiation Oncology University Department, Paul Strauss Center, 3, rue de la Porte de l’Hôpital, BP 42, Strasbourg cedex 67065 (France); Radiation Oncology Department, Soviet-Khmer Friendship Hospital, Pnom-Pehn 12400 (Cambodia); Nehme-Schuster, Hélène [Oncology Geriatric Department, Paul Strauss Center, 3, rue de la Porte de l’Hôpital, BP 42, Strasbourg cedex 67065 (France); Antoni, Delphine [Radiation Oncology University Department, Paul Strauss Center, 3, rue de la Porte de l’Hôpital, BP 42, Strasbourg cedex 67065 (France); Eav, Sokha [Radiation Oncology Department, Soviet-Khmer Friendship Hospital, Pnom-Pehn 12400 (Cambodia); Clavier, Jean-Baptiste; Bauer, Nicolas; Vigneron, Céline [Radiation Oncology University Department, Paul Strauss Center, 3, rue de la Porte de l’Hôpital, BP 42, Strasbourg cedex 67065 (France); Schott, Roland [Oncology Department, Paul Strauss Center, 3, rue de la Porte de l’Hôpital, BP 42, Strasbourg cedex 67065 (France); Kehrli, Pierre [Neurosurgery Department, CHU Hautepierre, rue Molière, Strasbourg 67000 (France); Noël, Georges, E-mail: gnoel@strasbourg.unicancer.fr [Radiation Oncology University Department, Paul Strauss Center, 3, rue de la Porte de l’Hôpital, BP 42, Strasbourg cedex 67065 (France); Laboratoire EA 3430, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg 67000 (France)

    2013-09-24

    This study aimed to analyze the treatment and outcomes of older glioblastoma patients. Forty-four patients older than 70 years of age were referred to the Paul Strauss Center for chemotherapy and radiotherapy. The median age was 75.5 years old (range: 70–84), and the patients included 18 females and 26 males. The median Karnofsky index (KI) was 70%. The Charlson indices varied from 4 to 6. All of the patients underwent surgery. O{sub 6}-methylguanine–DNA methyltransferase (MGMT) methylation status was determined in 25 patients. All of the patients received radiation therapy. Thirty-eight patients adhered to a hypofractionated radiation therapy schedule and six patients to a normofractionated schedule. Neoadjuvant, concomitant and adjuvant chemotherapy regimens were administered to 12, 35 and 20 patients, respectively. At the time of this analysis, 41 patients had died. The median time to relapse was 6.7 months. Twenty-nine patients relapsed, and 10 patients received chemotherapy upon relapse. The median overall survival (OS) was 7.2 months and the one- and two-year OS rates were 32% and 12%, respectively. In a multivariate analysis, only the Karnofsky index was a prognostic factor. Hypofractionated radiotherapy and chemotherapy with temozolomide are feasible and acceptably tolerated in older patients. However, relevant prognostic factors are needed to optimize treatment proposals.

  14. Pinus mugo Krummholz Dynamics During Concomitant Change in Pastoralism and Climate in the Central Apennines

    Directory of Open Access Journals (Sweden)

    Li Dai

    2017-02-01

    Full Text Available The dynamics of Pinus mugo krummholz during concomitant change in pastoral land use and climate in central Italy since the mid-20th century was investigated. Krummholz dynamics were detected using sequential aerial photography and fitted to a logistic regression model with elevation, grazing, proximity to beech forest, and proximity to krummholz as explanatory variables. Dendrochronological series were correlated with temperature and precipitation and fitted to a linear model. During this period krummholz doubled in extent and migrated 35–65 m upslope. Expansion was positively associated with krummholz proximity, residual pastoral grazing, and proximity to beech forest beyond 10 m and negatively associated with elevation and beech forest closer than 10 m. The logistic regression model forecasts krummholz migration by an additional 30 m upslope by 2060. During the 20th century, winter and spring minimum temperatures increased but did not result in increased radial stem growth of P. mugo. The combined evidence suggests that krummholz dynamics can be explained by the legacy of summer pastoralism and the dispersal limitations of P. mugo, rather than by climate change.

  15. Adjustable versus non-adjustable suture techniques for concomitant horizontal strabismus: a comparative study

    Directory of Open Access Journals (Sweden)

    Galton C. Vasconcelos

    2015-12-01

    Full Text Available ABSTRACT Purpose: To compare the surgical results of adjustable and non-adjustable horizontal strabismus surgery for concomitant horizontal strabismus. Methods: The charts of 231 patients, who underwent horizontal strabismus surgery, selected using probabilistic sampling, were retrospectively reviewed. Patients were divided into two groups according to the surgical technique used and strabismus type. The adjustable suture technique was used for 107 patients (Group 1, and non-adjustable or conventional surgery was performed in the remaining 124 patients (Group 2. Patients with esotropia (ET or exotropia (XT of 5 PD, syndromes, restrictive or paretic strabismus, reoperations, botulinum toxin injection, and patients postoperatively followed up for 50% was present in all subgroups. Significant differences between strabismus groups submitted to adjustable technique and non-adjustable on postoperative day 1 were observed (p=0.00 for ET and p=0.01 for XT and at the last visit for the XT group with a follow-up of at least 1 year (p=0.05. Conclusion: The adjustable suture technique produced a higher success rate than non-adjustable strabismus surgery for both ET and XT groups on postoperative day 1. For XT patients, the adjustable suture technique appears to produce better surgical results than non-adjustable surgery, when the surgical goal is long-lasting maintenance of a small hypercorrection.

  16. Dental management of a patient fitted with subcutaneous Implantable Cardioverter Defibrillator device and concomitant warfarin treatment.

    Science.gov (United States)

    Shah, Altaf Hussain; Khalil, Hesham Saleh; Kola, Mohammed Zaheer

    2015-07-01

    Automated Implantable Cardioverter Defibrillators (AICD), simply known as an Implantable Cardioverter Defibrillator (ICD), has been used in patients for more than 30 years. An Implantable Cardioverter Defibrillator (ICD) is a small battery-powered electrical impulse generator that is implanted in patients who are at a risk of sudden cardiac death due to ventricular fibrillation, ventricular tachycardia or any such related event. Typically, patients with these types of occurrences are on anticoagulant therapy. The desired International Normalized Ratio (INR) for these patients is in the range of 2-3 to prevent any subsequent cardiac event. These patients possess a challenge to the dentist in many ways, especially during oral surgical procedures, and these challenges include risk of sudden death, control of post-operative bleeding and pain. This article presents the dental management of a 60 year-old person with an ICD and concomitant anticoagulant therapy. The patient was on multiple medications and was treated for a grossly neglected mouth with multiple carious root stumps. This case report outlines the important issues in managing patients fitted with an ICD device and at a risk of sudden cardiac death.

  17. Peroxidase complex with concomitant anodal and cathodal variation in red-fruited tomato species.

    Science.gov (United States)

    Rick, C M; Fobes, J F

    1976-03-01

    Four groups of bands (a-d) are controlled by 19 alleles of the Peroxidase-4 (Prx-4) complex in the red-fruited tomato species, Lycopersicon esculentum and L. pimpinellifolium. Heterozygotes can be detected by virtue of codominance in all combinations except a few in which bands of single groups are absent ("semi-null" alleles). No recombinations were detected in 7419 F(2) segregants of 53 different combinations of alleles. A maximum fiducial limit (P = 0.01) of 0.08% crossing-over between any Prx-4 band groups is estimated. Variation of the anodal b bands is absolutely associated with that of the cathodal d band in respect to presence versus absence and direction of migration. In respect to the origin of these variants, the probability of 18 instances of simultaneous mutation of genes at two loci, always in such complete agreement, is so remote that no more than one locus could conceivably govern b and d. The disposition of a is not similarly associated with that of the other bands, while that of the faint-staining c could not always be reliably resolved. The negation of all save extremely low recombination rates and the observed concomitant variation of b and d strongly support the concept of single locus control of all Prx-4 banding, this hypothesis being espoused until rejection should be required be required by future research. Models of single locus control of several isozymes are discussed.

  18. Importance of concomitant topical therapy in moderate-to-severe atopic dermatitis treated with cyclosporine.

    Science.gov (United States)

    Kim, Jeong Eun; Shin, Jae Min; Ko, Joo Yeon; Ro, Young Suck

    2016-01-01

    Cyclosporine (CS) is widely used in patients with refractory atopic dermatitis (AD). During CS treatment, many patients have a tendency to decrease their adherence to topical agents as their disease improves. Our aim was to compare the efficacy and relapse rate of CS treatment combined with topical therapy and CS monotherapy. This prospective, randomized, 6 month study involved 60 patients with moderate-to-severe AD who were randomly assigned to two groups, one receiving CS and topical agents and the other, CS only. Clinical outcomes were based on investigators' global assessment (IGA) scores, eczema areas and severity index scores, and trans-epidermal water loss. If a patient achieved treatment success (IGA score ≤2) during the study period, CS was stopped. Relapse rate and time to relapse were evaluated during the 3 months after discontinuation of CS. The treatment success rate was significantly higher in the combination group (p = 0.028). The combination group had a shorter median time to response (p = 0.040), a lower cumulative dose (p = 0.041), and a longer time to relapse (p topical agents should be used concomitantly.

  19. Labile cochlear tuning in the mustached bat. I. Concomitant shifts in biosonar emission frequency.

    Science.gov (United States)

    Huffman, R F; Henson, O W

    1993-01-01

    The cochlea of the mustached bat (Pteronotus parnellii) has sharp tuning characteristics and pronounced resonance within a narrow band near the second harmonic, constant frequency (CF2) component of the animal's biosonar signals. That fine frequency discrimination occurs within this narrow band is evident from Doppler-shift compensation, whereby bats in flight lower the frequency of emitted CF2s to maintain returning echoes within this band. This study examined various factors capable of producing shifts in both the cochlear resonance frequency (CRF) and CF2s emitted by stationary bats and bats actively Doppler-shift compensating on a pendulum. Each of three experimental factors shifted the CRF in a reversible manner. Changes in body temperature produced an average CRF shift of 39 +/- 18 Hz/degrees C. The CRF increased with flight by 150 +/- 100 Hz and returned to baseline values within 10 min after flight. Contralateral sound exposure produced smaller (100 +/- 20 Hz), rapid shifts in the CRF, suggesting that a mechanism different from the temperature- and flight-related shifts was involved. Changes in the CRF induced by temperature and flight were accompanied by shifts in the emitted CF2 of stationary and moving bats. Coupled with a companion study of associated shifts in neural tuning, the concomitant changes in CRF and CF2 provide evidence of cochlear tuning lability in the mustached bat.

  20. Guyon's tunnel syndrome during pregnancy with concomitant anomalous arch of the ulnar nerve: a case report.

    Science.gov (United States)

    Janmohammadi, Nasser

    2014-01-01

    Numerous causes are reported for ulnar nerve compression at the wrist, known as Guyon's tunnel syndrome. In the present article, a patient with Guyon's tunnel syndrome during pregnancy concomitant with an anomaly of ulnar nerve is described. A 29-year-old Iranian woman presented with clinical features of Guyon's tunnel syndrome (pain and paresthesia in the fifth finger of the left hand and atrophy of the first dorsal interosseus muscle). Symptoms of the patient appeared during the third trimester of pregnancy. Electro diagnostic studies confirmed Guyon's tunnel syndrome. Surgical exploration revealed an anomalous arch of the ulnar nerve passing through the flexor carpi ulnaris (FCU) tendon. The anomalous arch of the ulnar nerve was released by resection of the segment of FCU tendon passing through the ulnar nerve arch. Therefore, in patients with Guyon's tunnel syndrome, the ulnar nerve anomaly should be kept in mind as a cause. Moreover, pregnancy may have a provocative effect on Guyon's tunnel syndrome similar to carpal tunnel syndrome (CTS).

  1. Guyon's tunnel syndrome during pregnancy with concomitant anomalous arch of the ulnar nerve: a case report.

    Directory of Open Access Journals (Sweden)

    Nasser Janmohammadi

    2014-07-01

    Full Text Available Numerous causes are reported for ulnar nerve compression at the wrist, known as Guyon's tunnel syndrome. In the present article, a patient with Guyon's tunnel syndrome during pregnancy concomitant with an anomaly of ulnar nerve is described. A 29-year-old Iranian woman presented with clinical features of Guyon's tunnel syndrome (pain and paresthesia in the fifth finger of the left hand and atrophy of the first dorsal interosseus muscle. Symptoms of the patient appeared during the third trimester of pregnancy. Electro diagnostic studies confirmed Guyon's tunnel syndrome. Surgical exploration revealed an anomalous arch of the ulnar nerve passing through the flexor carpi ulnaris (FCU tendon. The anomalous arch of the ulnar nerve was released by resection of the segment of FCU tendon passing through the ulnar nerve arch. Therefore, in patients with Guyon's tunnel syndrome, the ulnar nerve anomaly should be kept in mind as a cause. Moreover, pregnancy may have a provocative effect on Guyon's tunnel syndrome similar to carpal tunnel syndrome (CTS.

  2. Does the information content of payout initiations and omissions influence firm risks?

    NARCIS (Netherlands)

    Goyal, Abhinav; Muckley, Cal B.; von Eije, Johan

    2014-01-01

    We study the influence on firm risks of NASDAQ and NYSE firm payout initiations and omissions. These payout events can be interpreted as managerial signals of firm financial life-cycle maturation resulting in concomitant changes in firm risks. We remove confounding payout types and we match on the p

  3. 卡培他滨单药治疗老年晚期结直肠癌的临床观察%Clinical efficiency of capecitabine alone on advanced colorectal cancer in the elderly

    Institute of Scientific and Technical Information of China (English)

    刘宁红

    2015-01-01

    ObjectiveTo observe the short-term efficacy, side effects, impact on quality of life (QOL) of capecitabine alone in treating elderly patients with advanced colorectal cancer.Methods Thirty-nine elderly patients [aged (73.2±2.5) years, ranging from 69 to 82 years] with pathological identified advanced colorectal cancer admitted in our hospital from October 2009 to February 2014 were enrolled in this study, and they all were treated with 2500mg/(m2·d) capecitabine for 14 consecutive days and an interval of 7d (a cycle). The effectiveness and side effects were evaluated for every 2 cycles. Quality of Life Questionnaire (QLQ-C30), designed by European Organization for Research on Treatment of Cancer (EORTC), was conducted on the patients before and in 6 weeks after the therapy.Results Among the 39 patients, there were 1 case of complete remission, 11 cases of partial remission, 18 cases of stable disease, and 9 cases of progressive disease. The efficient rate was 30.76%, and tumor control rate was as high as 76.92%. The main side effects were hand-foot syndrome (61.54%), bone marrow depression (66.67%), and skin pigmentation (64.10%), and all these symptoms were mild. Their physical function, role function, social function and overall health score were increased significantly when compared with the conditions before treatment (P<0.05).Conclusion Capecitabine therapy alone is effective and only causes mild side effects for the elderly patients with advanced colorectal cancer, and it also improves their QOL.%目的:观察卡培他滨单药治疗老年晚期结直肠癌的近期疗效、毒副反应及对生存质量的影响。方法入选2009年10月至2014年2月在北京老年医院肿瘤科治疗的39例具有可测量指标的老年晚期结直肠癌患者,其中男26例,女13例,年龄69~82(73.2±2.5)岁,采用单药卡培他滨化疗,所有患者均给予卡培他滨,连服14d,休息7d(1个周期)每2个周期判定疗效及毒副反

  4. Clinical trial of oxaliplatin combined with capecitabine in the treatment of advanced colon cancer%奥沙利铂联合卡培他滨治疗晚期结肠癌的临床研究

    Institute of Scientific and Technical Information of China (English)

    毛跃伟; 杨松鹏; 高磊; 胡德升; 尹宁伟; 刘寒松

    2016-01-01

    目的:观察奥沙利铂联合卡培他滨治疗晚期结肠癌的临床疗效及安全性。方法将40例晚期结肠癌患者随机分为对照组20例和试验组20例。对照组予以静脉滴注130 mg・ m-2奥沙利铂,第1天+静脉滴注500 mg・ m-2氟尿嘧啶,第1~5天,14 d为1个周期,共治疗3个周期;试验组予以静脉滴注130 mg・ m-2奥沙利铂,第1天+口服1250 mg・ m-2卡培他滨,第1~14天,21 d为1个周期,共治疗2个周期。比较2组患者的临床疗效、血清卵巢癌缺失基因蛋白、癌基因ras产物P21蛋白、原癌基因蛋白以及白细胞介素-6,以及不良反应发生率。结果治疗后,试验组的总有效率为85.00%(17/20例)显著高于对照组的45.00%(9/20例,P<0.05)。治疗后,试验组的血清巢癌缺失基因蛋白水平为(25.65±3.14)μg・ mL-1明显高于对照组的(17.45±2.27)μg・ mL-1。治疗后,试验组与对照组的血清癌基因ras产物P21蛋白分别为(8.54±1.23),(15.67±2.11) ng・ mL-1;原癌基因蛋白分别为(1.76±1.15),(19.54±2.31) ng・ mL-1;白细胞介素-6分别为(108.62±10.77),(122.45±14.25) pg・ mL-1,差异有统计学意义( P<0.05)。试验组和对照组的不良反应以神经系统、消化系统和皮肤系统的症状为主,其发生率分别为15.00%和30.00%,差异无统计学意义( P>0.05)。结论奥沙利铂联合卡培他滨治疗晚期结肠癌的临床疗效显著,能显著降低结肠癌患者血清癌基因ras产物P21蛋白、原癌基因蛋白及白细胞介素-6水平,促进巢癌缺失基因蛋白表达,安全性较高。%Objective To evaluate the clinical efficacy and safety of oxaliplatin combined with capecitabine in the treatment of advanced colon cancer.Methods A total of 40 patients with advanced colon cancer were randomly divided

  5. 伊立替康联合卡培他滨治疗转移性结直肠癌的临床研究%Study of Irinotecan plus Capecitabine combination in the treatment of patients with metastatic colorectal cancer

    Institute of Scientific and Technical Information of China (English)

    罗秦英; 罗敏娜; 唐露; 魏友霞; 赵新汉

    2013-01-01

    Objective To investigate the efficacy,the side effects and the survival of the combination of Irinotecan and Capecitabine in patients with metastatic colorectal cancer (MCRC).Methods 135 patients (median age 57 years)with histologic or cytologic confirmnation of metastatic colorectal cancer received Irinotecan 350 mg/m2 intravenously on day 1 for 90 minutes and Capecitabine 1000 mg/m2 orally twice daily on days 1 to 14 in a 21-day treatment cycle as palliative chemotherapy.Each patient was received at least six cycles.Results The complete response rate(CR) was 0% (0/135).The partial response rate (PR) was 46.7% (63/135),stable disease (SD) rate was 31.1% (42/135),and disease progression (PD) rate was 22.2% (30/135).The overall rate (CR + PR) was 46.7% and the clinical benefit rate(RR + SD) was 77.8%.The main toxicities were leukopenia(48.9%),nausea and vomiting(44.4%),diarrhea (64.4%)and hand-foot syndrome (28.9%).No grade 4 events from the entire cohort was found.The median progression-free survival was 10 months (95% CI 6.8-13.1 months),and median overall survival was 18 months (95% CI 16.5-19.5 months).The 1-year,2-year and 3-year survival rates were 57.8%,31.1% and 21.5% respectively.High Karnofsky performance status,single metastatic lesion and response to the regimen indicated respectively good prognosis.Conclusion It was demonstrated that Irinotecan plus Capecitabine regimen was efficient and tolerable in MCRC.The regimen improve the survival moderately and merits further study.%目的 探讨伊立替康(CPT-11)联合卡培他滨治疗转移性结直肠癌的近期疗效、毒性反应及生存状况.方法 135例病理学证实的转移性结直肠腺癌患者接受了伊立替康350 mg/m2,静脉滴注90 min,第1天;卡培他滨1000 mg/m2,第1~14天,2次/d,口服;每3周为一周期,至少6周期方案治疗.评价近期疗效、毒副反应,并进行随访观察生存情况.结果 全组135例患者疗效及

  6. Cell-associated HIV DNA measured early during infection has prognostic value independent of serum HIV RNA measured concomitantly

    DEFF Research Database (Denmark)

    Katzenstein, Terese L; Oliveri, Roberto S; Benfield, Thomas

    2002-01-01

    Using data from the Danish AIDS Cohort of HIV-infected homosexual men established in the 1980s, the prognostic value of early HIV DNA loads was evaluated. In addition to DNA measurements, concomitant serum HIV RNA levels, CD4 cell counts and CCR5 genotypes were determined. The patients were divided...

  7. Comprehensive safety analysis of concomitant drotrecogin alfa (activated) and prophylactic heparin use in patients with severe sepsis

    NARCIS (Netherlands)

    M. Levy; M. Levi; M.D. Williams; M. Antonelli; D. Wang; M.A. Mignini

    2009-01-01

    Purpose: The safety of using heparin concomitantly with drotrecogin alfa (activated) {DrotAA} was explored in the XPRESS study. No heparin effect on mortality was observed. Safety results from that study are explored in more detail. Methods: A randomized, double-blind trial of prophylactic heparin v

  8. Concomitant testicular seminoma and ectopic adrenal tissue of the cord in a 45-year-old male.

    Science.gov (United States)

    Floyd, Michael S; Itam, Sarah; Nasir, Nyla; Weerasinghe, Suboda M; Irwin, Paul P; Maddineni, Satish B

    2014-01-01

    Aberrant adrenal tissue near the adrenal gland is common, but the finding of ectopic adrenal tissue in structures around the spermatic cord and testis is rare. We describe a case of concomitant seminoma and ectopic adrenal tissue of the spermatic cord occurring in an adult patient who had undergone orchidopexy as a child.

  9. Concomitant consumption of lycopene and fish oil inhibits tumor growth and progression in a mouse xenograft model of colon cancer

    Science.gov (United States)

    Our previous report showed that concomitant supplementation of lycopene and eicosa-pentaenoic acid synergistically inhibited the proliferation of human colon cancer HT-29 cells in vitro. To validate our findings, the present study investigated whether consumption of lycopene and fish oil would help ...

  10. Protection of salivary function by concomitant pilocarpine during radiotherapy : A double-blind, randomized, placebo-controlled study

    NARCIS (Netherlands)

    Burlage, Fred R.; Roesink, Judith M.; Kampinga, Harm H.; Coppes, Rob P.; Terhaard, Chris; Langendijk, Johannes A.; van Luijk, Peter; Stokman, Monique A.; Vissink, Arjan

    2008-01-01

    Purpose: To investigate the effect of concomitant administration of pilocarpine during radiotherapy for head-and-neck squamous cell carcinoma (HNSCC) on postradiotherapy xerostomia. Methods and Materials: A prospective, double blind, placebo-controlled randomized trial including 170 patients with HN

  11. Meta-Analysis of Therapeutic Efficacy and Safety of Capecitabine plus Docetaxel and Epirubicin plus Docetaxel in Treatment of Metastatic Breast Cancer%卡培他滨或表柔比星联合多西他赛治疗转移性乳腺癌的疗效与安全性Meta分析

    Institute of Scientific and Technical Information of China (English)

    高靓; 郑晓辉; 赵振营; 史桂玲; 张惠娟

    2015-01-01

    Objective To systematically evaluate the clinical effect and safety of capecitabine plus docetaxel in the treatment of the pa-tients with anthracycline-failed metastatic breast cancer. Methods The English databases of Medline, Embase, Pubmed, Cochrane library and the Chinese databases of CNKI, VIP, Wanfang were retrieved by computer. The randomized controlled trials ( RCTs ) on the combina-tion therapy of capecitabine plus docetaxel in the anthracycline-failed patients with metastatic breast cancer were included. The retrieval cut-off date was up to December 2013. The retrieval was limited to English and Chinese languages. The methodological quality of the included RCTs was evaluated by the Cochrane system evaluation method. After extracting the effective data, the RevMan 5. 0 software was applied for conducting the meta-analysis on the objective response rate ( ORR ) , stable disease ( SD ) , time to progression ( TTP ) and adverse events. Results 4 RCTs involving 419 patients were included. The meta-analysis results showed that capecitabine plus docetaxel and epirubicin plus docetaxel for treating anthracycline-failed metastatic breast cancer had no obvious differences in ORR [ RR=1. 17, 95% CI(0. 98, 1. 39),P=0. 08], SD[ RR=0. 79,95% CI(0. 58,1. 08),P=0. 14] and TTP[ RR=1. 11,95% CI(0. 92, 1. 33),P<0. 28], indicating that the efficacy of the two regimens was similar. The meta-analysis showed that the adverse reactions of capecitabine were hand-foot syndrome, anemia, nausea, vomiting as well as myalgia with statistical significance ( P<0. 01 );in which the RR value revealed that the occurrence rate of the hand-foot syndrome in the capecitabine group was greater than that in the non-capecitabine group, but the RR< 1 in anemia, vomiting, nausea and myalgia, which revealing that their occurrence rates in the epirubicin group were greater;other adverse reactions had no statistical significance. Conclusion Capecitabine plus docetaxel and epirubicin plus docetaxel have

  12. A survey on concomitant common bile duct stone and symptomatic gallstone and clinical values in Shiraz, Southern Iran

    Science.gov (United States)

    Hosseini, Seyed Vahid; Ayoub, Abbass; Rezaianzadeh, Abbas; Bananzadeh, Ali Mohammad; Ghahramani, Leila; Rahimikazerooni, Salar; Khazraei, Hajar

    2016-01-01

    Background: Common bile duct stone (CBDS) as a result of gallstone is one of the gastrointestinal disorders. In this study, the incidence of CBDS and symptomatic gallstone in Shiraz were investigated, and their management suggested. Materials and Methods: This is a retrospective study that enrolled among 560 patients. The incidence of gallstone together with CBDS was evaluated using an ultrasonography studyand clinical data in the period between March 2014 and 2014 in Shiraz. Comparison between data was done using Student’s t-test or Chi-square test. Results: Of these patients, 18.6% were male, and 81.4% were female with a mean age of 47.67 ± 0.74 years. The concomitant rate of gallstone and CBDS was 8.6%. 6.8% of patients with concomitant of gallstone and CBDS showed symptoms while 1.8% had not been diagnosed before the operation. The mean of serum alkaline phosphatase level in patients with the only gallstone was 255.80 IU/L and patients with concomitant gallstone, and CBDS was 580.88 IU/L with a significant difference between two groups (P < 0.001). Furthermore, liver function tests (aspartate aminotransferase, alanine transaminase) showed a significant difference between two groups of patients (P < 0.01, P < 0.001). Conclusions: Clinical variables such as tenderness, fever, and Morphy sign were more severein patients with concomitant gallstone and CBDS. The concomitant rate of gallstone and CBDS in our society is less that Western countries and asymptomatic patients showed fewer ratios than other countries. We think the approach for asymptomatic CBDS patients with gallstone can be affected by our results. PMID:27656616

  13. Clinical Efficacy of Capecitabine Combined with Autologous Cytokine-induced Killer Cells Maintenance Therapy in Treatment of Metastatic Triple Negative Breast Cancer%自体CIK细胞联合卡培他滨维持治疗复发转移性三阴性乳腺癌效果观察

    Institute of Scientific and Technical Information of China (English)

    宋树玺; 刘永叶; 丁震宇; 于卉影; 韩雅玲; 谢晓冬

    2015-01-01

    Objective To analyze the clinical efficacy and safety of capecitabine combined with autologous cytokine-induced killer cells ( CIK) maintenance therapy in treatment of metastatic triple negative breast cancer ( MTNBC) . Methods The MTNBC patients undergoing capecitabine-based chemotherapy as first line treatment, whose therapeutic effect was SD or above were selected and divided into treatment group and control group randomly. The treatment group received capecitabine maintenance therapy with autologous CIK after the first line treatment. The control group underwent only capecitabine mainte-nance therapy. Baseline assessment was taken 15 d after the end of the last cycle of chemotherapy. The patients were followed up once every two cycles. The median follow-up time was 11. 2 months. T lymphocyte subpopulation in peripheral blood was measured, the side effects, PFS and OS of both groups were observed. Results CD3+CD8+CTL and CD4+CD25+Treg of treatment group were compared at the time of baseline assessment and 1 month after three cycles of chemotherapy. There was no statistically significant difference (P>0. 05). CD3+T, CD3+CD4+Th, CD3+CD56+CIK showed significant im-provement, compared with that before treatment (P0. 05). Conclusion Maintenance therapy of Capecitabine combined with autologous CIK cells in treatment of MTNBC after first-line treatment improves the immune function to enhance the ability of antitumor by natural immunity, which can prolong PFS, and is safe as well. In short, it can improve the therapeutic effect of maintenance therapy in patients with MTNBC.%目的 探讨自体细胞因子诱导杀伤细胞( CIK)免疫治疗联合卡培他滨治疗复发转移性三阴性乳腺癌( metastatic triple negative breast cancer, MTNBC)的临床效果和安全性. 方法 选取一线应用卡培他滨化疗后效果评价病情稳定( SD)或以上的MTNBC患者,随机分为治疗组和对照组. 两组均应用卡培他滨维持化疗,治疗组在此

  14. Preoperative localization and minimally invasive management of primary hyperparathyroidism concomitant with thyroid disease

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    The coexistence of thyroid diseases with primary hyperparathyroidism (PHPT) can present a challenge in the clinical diagnosis and management for these patients. This study aims to determine the frequency of coexisting thyroid gland lesions in a consecutive series patients with PHPT, and to analyze the clinical features, diagnosis and treatment of these patients. Twenty-two cases of a total of 52 PHPT patients who had synchronous thyroid and parathyroid pathology were surgically managed in this study.Thirteen patients had ipsilateral thyroid nodules, and 9 patients had thyroid nodules in contralateral or bilateral side. Seven patients underwent direct parathyroidectomy and hemithyroidectomy via a mini-incision (about 3 cm), while other 15 procedures were converted to Kocher incision. Seventeen nodular goiter (32.7%), 2 thyroiditis (3.8%), 2 thyroid adenoma (3.8%) and 1 thyroid carcinoma (1.9%) coexisting with parathyroid adenoma were pathologically diagnosed. The sensitivity of preoperative ultrasonography (US) and methoxy-isobutyl-isonitrile (MIBI) scintigraphy for parathyroid lesions was 63.6% and 85.7%; and the overall positive predictive values for MIBI and US were 100% and 95.5% respectively. A high incidence of thyroid diseases that coexisted with PHPT in literatures was briefly reviewed. Our study illustrated the need for clinical awareness of concomitant PHPT and thyroid disease. A combination of US, computed tomography (CT) and MIBI scintigraphy would be recommended for preoperative localization of enlarged parathyroid adenoma and for evaluation of thyroid lesions. Synchronous treatment of associated thyroid abnormalities is desirable, and open minimally invasive surgical approach with additional resection of isolated ipsilateral thyroid nodules is possible in some of these patients.

  15. Physiological concomitants of perseverative cognition: A systematic review and meta-analysis.

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    Ottaviani, Cristina; Thayer, Julian F; Verkuil, Bart; Lonigro, Antonia; Medea, Barbara; Couyoumdjian, Alessandro; Brosschot, Jos F

    2016-03-01

    Rumination about the past and worries about the future (perseverative cognition) are extremely common, although pervasive and distressing, dysfunctional cognitive processes. Perseverative cognition is not only implicated in psychological health, contributing to mood worsening and psychopathology but, due to its ability to elicit prolonged physiological activity, is also considered to play a role in somatic health. Although there is emerging evidence that such negative and persistent thoughts have consequences on the body, this association has not yet been quantified. The aim of this study was to meta-analyze available studies on the physiological concomitants of perseverative cognition in healthy subjects. Separate meta-analyses were performed on each examined physiological parameter. Sixty studies were eligible for the analyses. Associations emerged between perseverative cognition and higher systolic blood pressure (SBP) (g = .45) and diastolic blood pressure (DBP) (g = .51) in experimental studies, and higher heart rate (HR) (g = .28 and g = .20) and cortisol (g = .36 and g = .32), and lower heart rate variability (HRV) (g = .15 and g = .27) in experimental and correlational studies, respectively. Significant moderators were sex, ethnicity, type of induction used to elicit perseverative cognition, assessment of state versus trait perseverative cognition, focus on worry or rumination, duration of physiological assessment, and quality of the studies. With the exception of blood pressure, results were not influenced by publication bias. Results show that perseverative cognition affects cardiovascular, autonomic, and endocrine nervous system activity, suggesting a pathogenic pathway to long-term disease outcomes and clarifying the still unexplained relationship between chronic stress and health vulnerability.

  16. Concomitant Benznidazole and Suramin Chemotherapy in Mice Infected with a Virulent Strain of Trypanosoma cruzi.

    Science.gov (United States)

    Santos, Eliziária C; Novaes, Rômulo D; Cupertino, Marli C; Bastos, Daniel S S; Klein, Raphael C; Silva, Eduardo A M; Fietto, Juliana L R; Talvani, André; Bahia, Maria T; Oliveira, Leandro L

    2015-10-01

    Although suramin (Sur) is suggested as a potential drug candidate in the management of Chagas disease, this issue has not been objectively tested. In this study, we examined the applicability of concomitant treatment with benznidazole (Bz) and suramin in mice infected with a virulent strain of Trypanosoma cruzi. Eighty 12-week-old male C57BL/6 mice were equally randomized in eight groups: (i) noninfected mice (negative control) and mice infected with T. cruzi Y strain receiving (ii) no treatment (positive control), (iii) Bz, 100 mg/kg of body weight per day, (iv) Sur, 20 mg/kg/day, and (v to viii) Sur, 20 mg/kg/day, combined with Bz, 100, 50, 25, or 5 mg/kg/day. Bz was administered by gavage, and Sur was administered intraperitoneally. Sur dramatically increased the parasitemia, cardiac content of parasite DNA, inflammation, oxidative tissue damage, and mortality. In response to high parasitic load in cardiac tissue, Sur stimulated the immune system in a manner typical of the acute phase of Chagas disease, increasing tissue levels of gamma interferon (IFN-γ) and tumor necrosis factor alpha (TNF-α) and inducing a preferential IgG2a anti-T. cruzi serum pattern. When Sur and Bz were combined, the infection severity was attenuated, showing a dose-dependent Bz response. Sur therapy had a more harmful effect on the host than on the parasite and reduced the efficacy of Bz against T. cruzi infection. Considering that Sur drastically reinforced the infection evolution, potentiating the inflammatory process and the severity of cardiac lesions, the in vivo findings contradicted the in vitro anti-T. cruzi potential described for this drug.

  17. Adiponectin gene polymorphism is selectively associated with the concomitant presence of metabolic syndrome and essential hypertension.

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    Hsin-Bang Leu

    Full Text Available OBJECTIVE: Cardiovascular risk increases with the presence of both metabolic syndrome (MetS and hypertension (HTN. Although the adiponectin (ADIPOQ gene has been reported to be involved in MetS, its association with HTN remained undetermined. This study aimed to investigate the association of ADIPOQ gene with the phenotypes of HTN and MetS. METHODS: A total of 962 participants from 302 families from the Taiwan young-onset hypertension genetic study were enrolled. Plasma adiponectin were measured, and association analysis was conducted by using GEE regression-based method. Another study, of 1448 unrelated participants, was conducted to replicate the association between ADIPOQ gene and variable phenotypes of MetS with or without HTN. RESULTS: Among 962 subjects from family samples, the lowest plasma adiponectin value was observed in MetS with HTN component (9.3±0.47 µg/ml compared with hypertensives (13.4±0.74 µg /ml or MetS without HTN (11.9±0.60 µg/ml, P<0.05. The SNP rs1501299 (G276T in ADIPOQ gene was found associated with the presence of HTN in MetS (odds ratio for GG+GT vs. TT = 2.46; 95% CI: 1.14-5.3, p = 0.02, but not rs2241766 (T45G. No association of ADIPOQ gene with HTN alone or MetS without HTN was observed. The significant association of the SNP rs1501299 (G276T with the phenotype of presence of HTN in MetS was confirmed (odds ratio for GG+GT vs. TT = 2.15; 95% CI: 1.1-4.3 in the replication study. CONCLUSIONS: ADIPOQ genetic variants were selectively and specifically associated with the concomitant presence of MetS and HTN, suggesting potential genetic linkage between MetS and HTN.

  18. Radiotherapy plus concomitant adjuvant temozolomide for glioblastoma: Japanese mono-institutional results.

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    Takahiro Oike

    Full Text Available This study was conducted to investigate the feasibility and survival benefits of combined treatment with radiotherapy and temozolomide (TMZ, which has been covered by the national health insurance in Japanese patients with glioblastoma since September 2006. Between September 2006 and December 2011, 47 patients with newly diagnosed and histologically confirmed glioblastoma received radiotherapy for 60 Gy in 30 fractions. Among them, 45 patients (TMZ group received concomitant TMZ (75 mg/m(2/day, every day and adjuvant TMZ (200 mg/m(2/day, 5 days during each 28-days. All 36 of the glioblastoma patients receiving radiotherapy between January 1988 and August 2006 were analyzed as historical controls (control group. All patients were followed for at least 1 year or until they died. The median survival was 15.8 months in the TMZ group and 12.0 months in the control group after a median follow-up of 14.0 months. The hazard ratio for death in the TMZ group relative to the control group was 0.52 (P<0.01; the 2-year survival rate was 27.7% in the TMZ group and 14.6% in the control group. Hematologic toxicity of grade 3 and higher was observed in 20.4% in the TMZ group. Multivariate analysis showed that extent of surgery had the strongest impact on survival (P<0.01, while the use of TMZ had the second largest impact on survival (P = 0.035. The results indicate that combined treatment with radiotherapy and TMZ has a significant survival benefit for Japanese patients with newly diagnosed glioblastoma with slightly higher toxicities than previously reported.

  19. Concomitant therapy in people with epilepsy: potential drug-drug interactions and patient awareness.

    Science.gov (United States)

    Eyal, Sara; Rasaby, Sivan; Ekstein, Dana

    2014-02-01

    People with epilepsy (PWE) may use prescription and over-the-counter (OTC) drugs for the treatment of concomitant diseases. Combinations of these drugs, as well as dietary supplements, with antiepileptic drugs (AEDs) may lead to reduced control of seizures and of coexisting medical conditions and increased risk of adverse drug reactions (ADRs). The aims of this study were to obtain comprehensive lists of medications, dietary supplements, botanicals, and specific food components used by adult PWE and to evaluate the potential for interactions involving AEDs and patients' awareness of such potential interactions. We conducted a prospective, questionnaire-based study of PWE attending the Hadassah-Hebrew University Epilepsy Clinic over a period of 7months. The questionnaire interview included the listing of medications, medicinal herbs, dietary supplements, and specific food components consumed and the knowledge of potential drug-drug interactions (DDIs), and it was conducted by a pharmacist. Drug-drug interactions were analyzed via the Micromedex online database. Out of 179 patients who attended the clinic over the study period, we interviewed 73 PWE, of which 71 were included in our final analysis. The mean number of AEDs consumed per subject was 1.7 (SD: 0.8, range: 1-4). Forty (56%) subjects were also treated with other prescription and/or OTC medications, and thirty-four (48%) took dietary supplements. Drug families most prone to DDIs involving AEDs included antipsychotic agents, selective serotonin reuptake inhibitors, and statins. Two-thirds of study participants (67%) knew that DDIs may lead to ADRs, but only half (56%) were aware of the potential for reduced seizure control. Only 44% always reported treatment with AEDs to medical professionals. This study provides for the first time a comprehensive picture of prescription and OTC drugs and food supplements used by PWE. Despite a considerable potential for DDIs involving AEDs, patient awareness is limited

  20. Concomitant duplications of opioid peptide and receptor genes before the origin of jawed vertebrates.

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    Görel Sundström

    Full Text Available BACKGROUND: The opioid system is involved in reward and pain mechanisms and consists in mammals of four receptors and several peptides. The peptides are derived from four prepropeptide genes, PENK, PDYN, PNOC and POMC, encoding enkephalins, dynorphins, orphanin/nociceptin and beta-endorphin, respectively. Previously we have described how two rounds of genome doubling (2R before the origin of jawed vertebrates formed the receptor family. METHODOLOGY/PRINCIPAL FINDINGS: Opioid peptide gene family members were investigated using a combination of sequence-based phylogeny and chromosomal locations of the peptide genes in various vertebrates. Several adjacent gene families were investigated similarly. The results show that the ancestral peptide gene gave rise to two additional copies in the genome doublings. The fourth member was generated by a local gene duplication, as the genes encoding POMC and PNOC are located on the same chromosome in the chicken genome and all three teleost genomes that we have studied. A translocation has disrupted this synteny in mammals. The PDYN gene seems to have been lost in chicken, but not in zebra finch. Duplicates of some peptide genes have arisen in the teleost fishes. Within the prepropeptide precursors, peptides have been lost or gained in different lineages. CONCLUSIONS/SIGNIFICANCE: The ancestral peptide and receptor genes were located on the same chromosome and were thus duplicated concomitantly. However, subsequently genetic linkage has been lost. In conclusion, the system of opioid peptides and receptors was largely formed by the genome doublings that took place early in vertebrate evolution.

  1. SURGICAL TREATMENT OF UPPER AND MIDDLE FACIAL ZONE TRAUMAS IN PROGRESS OF CONCOMITANT TRAUMATIC CRANIOFACIAL INJURIES.

    Science.gov (United States)

    Lagvilava, G; Gvenetadze, Z; Toradze, G; Devidze, I; Gvenetadze, G

    2015-09-01

    In 2012-2015, 207 patients with concomitant craniofacial injuries, who underwent surgical treatment, were observed; among them 176 were men and 31- women. Age of the patients ranged from 16 to 60 years. According to localization and severity of trauma and a priority of surgical intervention, the patients conventionally were divided into 3 groups by the authors: I group (65 patients) - craniofacial injuries; the skull as well as upper and middle areas of face (subcranial and frontobasal fractures) were affected (fractured). II group (80 patients) - severe traumatic injuries of upper and especially middle zones of the face, accompanied with closed craniocerebral trauma, no need in neurosurgery. III group (62 patients) -on the background of serious head traumas, the injuries of face bones were less severe (injury of one or two anatomic areas with displacement of fractured fragments but without bone tissue defects) According to the obtained results a priority was always given to the neurosurgery (vital testimony).The reconstructive surgeries on face skeleton was conducted in combination involving neurosurgeons (I group patients). Reconstructive surgeries of facial bones were conducted in the patients of II group, immediately or at primary deferred period of time but in the patients of III group the surgical procedures for removal of early secondary or traumatic residual fractures have been performed. Reposition of the fractured facial bone fragments was performed in an open way and fixation was carried out by titanium plates and mesh cage (at bone tissue defect). For prevention and elimination of post-traumatic inflammatory processes, the final stage of surgical intervention was: sanation of nasal accessory sinuses and catheterization (5-7 days) of external carotid arteries for administration of antibiotics and other medical preparations. Early and differentiated approach to face injuries, worsening in the course of craniocephalic trauma was not revealed in any patient

  2. Pontomedullary lacerations and concomitant injuries: A review of possible underlying mechanisms

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    Živković Vladimir

    2013-01-01

    Full Text Available Anatomically, brainstem is constituted of medulla oblongata, pons and mesencephalon. Traumatic lesions of brainstem most commonly occur on pontomedullary junction. There are several possible mechanisms of pontomedullary lacerations. The first mechanism includes impact to the chin, with or without a skull base fracture, and most often leads to this fatal injury, due to impact force transmission through the jawbone and temporomandibular joint. The second mechanism includes lateral and posterior head impacts with subsequent hinge fractures, where occurrence of pontomedullary lacerations in these cases may depend on the energy of impact, as well as on the exact position of the fracture line, but less so on the head’s movement. The third mechanism includes frontoposterior hyperextension of the head, due to frontal impact, concomitant with fractures or dislocations of upper spine. In the fourth mechanism, there is an absence of direct impact to the head, due to the indirect force of action after feet or buttocks­first impact. Most of these cases are accompanied by ring fractures as well. In situations such as these, the impact force is transmitted up the spinal column and upper vertebrae, and telescopically intruded into the skull, causing brainstem laceration. The jawbone and other facial bones can act as shock absorbers, and their fracture could diminish the energy transfer towards the skull and protect the brain and brainstem from injury. In all the cases with pontomedullary laceration posterior neck dissection should be performed during the autopsy, since upper spine injuries are often associated with this type of injury. [Projekat Ministarstva nauke Republike Srbije, br. 45005

  3. Benznidazole and posaconazole in experimental Chagas disease: positive interaction in concomitant and sequential treatments.

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    Lívia de Figueiredo Diniz

    Full Text Available BACKGROUND: Current chemotherapy for Chagas disease is unsatisfactory due to its limited efficacy, particularly in the chronic phase, with frequent side effects that can lead to treatment discontinuation. Combined therapy is envisioned as an ideal approach since it may improve treatment efficacy whilst decreasing toxicity and the likelihood of resistance development. We evaluated the efficacy of posaconazole in combination with benznidazole on Trypanosoma cruzi infection in vivo. METHODS AND FINDINGS: Benznidazole and posaconazole were administered individually or in combination in an experimental acute murine infection model. Using a rapid treatment protocol for 7 days, the combined treatments were more efficacious in reducing parasitemia levels than the drugs given alone, with the effects most evident in combinations of sub-optimal doses of the drugs. Subsequently, the curative action of these drug combinations was investigated, using the same infection model and 25, 50, 75 or 100 mg/kg/day (mpk of benznidazole in combination with 5, 10 or 20 mpk of posaconazole, given alone or concomitantly for 20 days. The effects of the combination treatments on parasitological cures were higher than the sum of such effects when the drugs were administered separately at the same doses, indicating synergistic activity. Finally, sequential therapy experiments were carried out with benznidazole or posaconazole over a short interval (10 days, followed by the second drug administered for the same period of time. It was found that the sequence of benznidazole (100 mpk followed by posaconazole (20 mpk provided cure rates comparable to those obtained with the full (20 days treatments with either drug alone, and no cure was observed for the short treatments with drugs given alone. CONCLUSIONS: Our data demonstrate the importance of investigating the potential beneficial effects of combination treatments with marketed compounds, and showed that combinations of

  4. Concomitant renal insufficiency and diabetes mellitus as prognostic factors for acute myocardial infarction

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    Kim Chang Seong

    2011-10-01

    Full Text Available Abstract Background Diabetes mellitus and renal dysfunction are prognostic factors after acute myocardial infarction (AMI. However, few studies have assessed the effects of renal insufficiency in association with diabetes in the context of AMI. Here, we investigated the clinical outcomes according to the concomitance of renal dysfunction and diabetes mellitus in patients with AMI. Methods From November 2005 to August 2008, 9905 patients (63 ± 13 years; 70% men with AMI were enrolled in a nationwide prospective Korea Acute Myocardial Infarction Registry (KAMIR and were categorized into 4 groups: Group I (n = 5700 had neither diabetes nor renal insufficiency (glomerular filtration rate [GFR] ≥ 60 ml/min/1.73 m2, Group II (n = 1730 had diabetes but no renal insufficiency, Group III (n = 1431 had no diabetes but renal insufficiency, and Group IV (n = 1044 had both diabetes and renal insufficiency. The primary endpoints were major adverse cardiac events (MACE, including a composite of all cause-of-death, myocardial infarction, target lesion revascularization, and coronary artery bypass graft after 1-year clinical follow-up. Results Primary endpoints occurred in 1804 (18.2% patients. There were significant differences in composite MACE among the 4 groups (Group I, 12.5%; Group II, 15.7%; Group III, 30.5%; Group IV, 36.5%; p p = 0.001; and HR, 2.42; 95% CI, 1.62-3.62; p Conclusions Renal insufficiency, especially in association with diabetes, is associated with the occurrence of composite MACE and indicates poor prognosis in patients with AMI. Categorization of patients with diabetes and/or renal insufficiency provides valuable information for early-risk stratification of AMI patients.

  5. A single centre experience with sequential and concomitant chemoradiotherapy in locally advanced stage IV tonsillar cancer

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    Coyle Catherine

    2010-12-01

    Full Text Available Abstract Background Chemo-radiotherapy offers an alternative to primary surgery and adjuvant therapy for the management of locally advanced stage IV squamous cell carcinomas of the tonsil. Methods A retrospective analysis was performed of the outcomes of 41 patients with locoregionally advanced squamous cell carcinoma of the tonsil treated non-surgically at the Yorkshire Cancer Centre between January 2004 and December 2005. Due to long radiotherapy waiting times, patients received induction chemotherapy with cisplatin and 5-fluorouracil followed by either cisplatin concurrent chemoradiotherapy or radiotherapy alone. Results Median age was 55 years (range 34-76 years and 28 (68% patients were male. 35/41 patients (85% received 2 or more cycles of induction chemotherapy. Following induction chemotherapy, 32/41 patients (78% had a clinical response. Concomitant chemotherapy was given to 30/41 (73%. All patients received the planned radiotherapy dose with no delays. There were no treatment related deaths. Six (15% patients had gastrostomy tubes placed before treatment, and 22 (54% required nasogastric tube placement during or after treatment for nutritional support. 17 patients required unplanned admissions during treatment for supportive care. At 4 months post treatment assessment 35 out of 41 (85% patients achieved complete clinical and radiographic response. Median follow-up is 38 months (8-61 months. Local and regional control rate in complete responders at 3 years was 91%. Distant metastases have been found in 4 (9.8% patients. Three year progression-free survival rate in all patients is 75%. The 3-year cause specific survival and overall survival are 75% and 66% respectively. Conclusion Cisplatin-based induction and concurrent chemoradiotherapy provides excellent tumour control with acceptable toxicity for patients with locally advanced tonsillar cancer.

  6. Phase 1 Clinical Trial of Stereotactic Body Radiation Therapy Concomitant With Neoadjuvant Chemotherapy for Breast Cancer

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    Bondiau, Pierre-Yves, E-mail: pierre-yves.bondiau@nice.unicancer.fr [Department of Radiotherapy, Centre Antoine Lacassagne, Nice (France); Courdi, Adel [Department of Radiotherapy, Centre Antoine Lacassagne, Nice (France); Bahadoran, Phillipe [Department of Dermatology, University Hospital of Nice, Nice (France); Chamorey, Emmanuel [Department of Radiotherapy, Centre Antoine Lacassagne, Nice (France); Queille-Roussel, Catherine [Centre de Pharmacologie Clinique Appliquée à la Dermatologie, Nice (France); Lallement, Michel; Birtwisle-Peyrottes, Isabelle; Chapellier, Claire; Pacquelet-Cheli, Sandrine; Ferrero, Jean-Marc [Department of Radiotherapy, Centre Antoine Lacassagne, Nice (France)

    2013-04-01

    Purpose: Stereotactic body radiation therapy (SBRT) allows stereotactic irradiation of thoracic tumors. It may have a real impact on patients who may not otherwise qualify for breast-conserving surgery. We conducted a phase 1 trial that tested 5 dose levels of SBRT concomitant with neoadjuvant chemotherapy (NACT) before to surgery. The purpose of the current dose escalation study was to determine the maximum tolerable dose of SBRT in the treatment of breast cancer. Methods and Materials: To define toxicity, we performed dermatologic examinations that included clinical examinations by 2 separate physicians and technical evaluations using colorimetry, dermoscopy, and skin ultrasonography. Dermatologic examinations were performed before NACT, 36 and 56 days after the beginning of NACT, and before surgery. Surgery was performed 4 to 8 weeks after the last chemotherapy session. Efficacy, the primary endpoint, was determined by the pathologic complete response (pCR) rate. Results: Maximum tolerable dose was not reached. Only 1 case of dose-limiting toxicity was reported (grade 3 dermatologic toxicity), and SBRT was overall well tolerated. The pCR rate was 36%, with none being observed at the first 2 dose levels, and the highest rate being obtained at dose level 3 (25.5 Gy delivered in 3 fractions). Furthermore, the breast-conserving surgery rate was up to 92% compared with an 8% total mastectomy rate. No surgical complications were reported. Conclusions: This study demonstrates that SBRT can be safely combined with NACT. Regarding the efficacy endpoints, this trial showed promising results in terms of pCR rate (36%) and breast-conserving rate (92%). The findings provide a strong rationale for extending the study into a phase 2 trial. In view of the absence of correlation between dose and pCR, and given that the data from dose level 3 met the statistical requirements, a dose of 25.5 Gy in 3 fractions should be used for the phase 2 trial.

  7. Modified port placement and pedicle first approach for laparoscopic concomitant cholecystectomy and splenectomy in children

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    Pal Kamalesh

    2010-01-01

    Full Text Available Aim : Laparoscopy is becoming the preferred modality for concomitant cholecystectomy and splenectomy (CAS. Usually, six to seven ports are employed for CAS, and spleen is removed by classical lateral approach or anterior approach. We report here our modified five-port and pedicle first approach for CAS in children to minimize the intraoperative bleeding and maximize the access. Materials and Methods : Twenty-one children underwent laparoscopic CAS with this new approach and their data were recorded prospectively. Following cholecystectomy (with ports 1-4, left side was elevated by 30°. The spleen was lifted by a grasper/fan retractor through port no. 5. The pedicle was dissected and splenic vessels were divided by ligasure (vessels < 8 mm, and for bulkier pedicle, vascular endo-GIA stapler was used. Short gastric and gastrosplenic ligament, lower pole and phrenico-colic attachments and upper pole attachments were dissected by ligasure in that sequence. Spleen was placed in endosac and delivered by digital fracture technique. Occasionally, lower transverse incision was made to deliver a massive spleen. Results : There were 12 males and 9 females with an average age of 8 years. Fourteen had sickle cell disease (SCD and 7 had SCD and beta thalassemia. All CAS were completed successfully without any complication. Total duration was 160 minutes. Cholecystectomy took an average of 35 minutes. Average blood loss was 140 ml. The mean splenic weight was 900 g and mean length was 20 cm. Duration of hospitalization was 3-4 days. Conclusion : CAS can be successfully performed by five ports. The pedicle first approach is extremely helpful in moderate to massive spleens as it reduces splenic size, vascularity and bleeding from capsular adhesions or inadvertant lacerations.

  8. The Plus 50 Initiative Evaluation: Initiative Impact

    Science.gov (United States)

    American Association of Community Colleges (NJ1), 2012

    2012-01-01

    The American Association of Community Colleges (AACC), with funding from The Atlantic Philanthropies, created the Plus 50 Initiative (2008-2012). This initiative was designed to build the capacity of community colleges nationwide to develop programming that engages the plus 50 learner. This report contains: (1) An overview of the Plus 50…

  9. Initialized Fractional Calculus

    Science.gov (United States)

    Lorenzo, Carl F.; Hartley, Tom T.

    2000-01-01

    This paper demonstrates the need for a nonconstant initialization for the fractional calculus and establishes a basic definition set for the initialized fractional differintegral. This definition set allows the formalization of an initialized fractional calculus. Two basis calculi are considered; the Riemann-Liouville and the Grunwald fractional calculi. Two forms of initialization, terminal and side are developed.

  10. Palonosetron and prednisolone for the prevention of nausea and emesis during fractionated radiotherapy and 5 cycles of concomitant weekly cisplatin-a phase II study

    DEFF Research Database (Denmark)

    Ruhlmann, Christina H; Belli, Charlotte; Dahl, Tina;

    2013-01-01

    Recommendations for antiemetic prophylaxis supportive to radiotherapy and concomitant chemotherapy are not evidence-based. The purpose of this study was to evaluate the efficacy of the antiemetic regimen concurrent to fractionated radiotherapy and concomitant weekly cisplatin in two Danish depart...

  11. Rate of change in adiposity and its relationship to concomitant changes in cardiovascular risk variables among biracial (black-white) children and young adults: The Bogalusa Heart Study.

    Science.gov (United States)

    Srinivasan, S R; Myers, L; Berenson, G S

    2001-03-01

    To assess the annual rate of change in adiposity and its relationship to concomitant changes in cardiovascular risk variables during childhood and young adulthood, serial data on black and white children (n = 3,459; initial and follow-up mean age, 8.1 and 14.4 years) and young adults (n = 1,263; initial and follow-up mean age, 22.5 and 30.9 years) enrolled in the Bogalusa Heart Study were examined. Body mass index (BMI) and sum of subscapular and triceps skinfolds were used as indicators of adiposity. In addition, measurements were made of systolic and diastolic blood pressure and fasting levels of low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, insulin, and glucose. Annualized rate of change for each variable was estimated. The rate of increase in adiposity was significantly more pronounced during childhood versus adulthood. Race difference (blacks > whites) in the rate of increase in adiposity was seen only among females. Females, black females in particular, displayed greater rate of increase in adiposity than males. In a multivariate analysis, the rate of increase in adiposity was related independently of baseline age and baseline adiposity to adverse changes in measured cardiovascular risk variables, except glucose. Many of these associations were modulated significantly by race, sex, and age group. The impact was relatively greater for blood pressure and LDL cholesterol in adults and for triglycerides in children. The changes in blood pressure, LDL cholesterol, and HDL cholesterol were greater in whites, while the rate of increase in insulin was greater in blacks. Females displayed greater changes in blood pressure, HDL cholesterol, and insulin. On the other hand, the rate of increase in triglycerides was greater in males. These results indicate that increases in adiposity regardless of initial status of body fatness alter cardiovascular risk variables towards increased risk beginning in childhood, and

  12. Two-stage vs single-stage management for concomitant gallstones and common bile duct stones

    Institute of Scientific and Technical Information of China (English)

    Jiong Lu; Yao Cheng; Xian-Ze Xiong; Yi-Xin Lin; Si-Jia Wu; Nan-Sheng Cheng

    2012-01-01

    AIM:To evaluate the safety and effectiveness of two-stage vs single-stage management for concomitant gallstones and common bile duct stones.METHODS:Four databases,including PubMed,Embase,the Cochrane Central Register of Controlled Trials and the Science Citation Index up to September 2011,were searched to identify all randomized controlled trials (RCTs).Data were extracted from the studies by two independent reviewers.The primary outcomes were stone clearance from the common bile duct,postoperative morbidity and mortality.The secondary outcomes were conversion to other procedures,number of procedures per patient,length of hospital stay,total operative time,hospitalization charges,patient acceptance and quality of life scores.RESULTS:Seven eligible RCTs [five trials (n =621)comparing preoperative endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic sphincterotomy (EST) + laparoscopic cholecystectomy (LC) with LC +laparoscopic common bile duct exploration (LCBDE);two trials (n =166) comparing postoperative ERCP/EST + LC with LC + LCBDE],composed of 787 patients in total,were included in the final analysis.The metaanalysis detected no statistically significant difference between the two groups in stone clearance from the common bile duct [risk ratios (RR) =-0.10,95% confidence intervals (CI):-0.24 to 0.04,P =0.17],postoperative morbidity (RR =0.79,95% CI:0.58 to 1.10,P =0.16),mortality (RR =2.19,95% CI:0.33 to 14.67,P =0.42),conversion to other procedures (RR =1.21,95% CI:0.54 to 2.70,P =0.39),length of hospital stay (MD =0.99,95% CI:-1.59 to 3.57,P =0.45),total operative time (MD =12.14,95% CI:-1.83 to 26.10,P =0.09).Two-stage (LC + ERCP/EST) management clearly required more procedures per patient than single-stage (LC + LCBDE) management.CONCLUSION:Single-stage management is equivalent to two-stage management but requires fewer procedures.However,patient's condition,operator's expertise and local resources should be taken into account in

  13. Concomitant expression of adrenomedullin and its receptor components in rat adipose tissues.

    Science.gov (United States)

    Fukai, Nozomi; Yoshimoto, Takanobu; Sugiyama, Toru; Ozawa, Naoko; Sato, Ryuji; Shichiri, Masayoshi; Hirata, Yukio

    2005-01-01

    Adrenomedullin (AM) expressed by and secreted from a variety of cells plays pluripotent roles in an autocrine/paracrine fashion. The present study was undertaken to explore the expression of AM and its receptor genes in adipose tissues, their changes during the development of obesity, and the process of preadipocyte differentiation. Both mature adipocytes and stromal vascular cells constituting adipose tissue expressed AM transcript. AM and its receptor component [calcitonin receptor-like receptor and receptor activity-modifying protein-2 (CRLR/RAMP2)] mRNAs were expressed in a variety of rat adipose tissues, including epididymal, mesenteric, retroperitoneal, and subcutaneous adipose tissue. AM mRNA levels in rat and human epididymal adipose tissue were about one-tenth of those in the kidney. Steady-state mRNA levels of AM and CRLR/RAMP2 in epididymal, mesenteric, and retroperitoneal adipose tissues in rats fed a high-fat diet for 4 wk were far greater than those in rats with normal diet accompanied by increased plasma AM levels, whereas steady-state AM mRNA levels conversely decreased in other organs, such as kidney and liver. AM mRNA expressed in a mouse preadipocyte cell line (3T3-L1) transiently decreased by day 3, returned to basal level by day 6, and then increased by day 9 during preadipocyte differentiation, which paralleled AM secretion from the cells. However, the addition of either exogenous AM or AM receptor antagonist calcitonin gene-related peptide-(8-37), to block endogenous AM did not affect lipid droplet accumulation during preadipocyte differentiation. The present study demonstrates for the first time that AM and its receptor component (CRLR/RAMP2) mRNAs were concomitantly expressed in various adipose tissues, whose tissue-specific upregulation was induced during the development of obesity. These data suggest that AM may act as a new member of adipokines, although its functional role, as well as its pathophysiological significance in obesity

  14. Mechanism of Shenyi Capsule Concomitant with Endostar and Chemotherapy on the Growth and Apoptosis of MCF-7 Breast Cancer Cells

    Institute of Scientific and Technical Information of China (English)

    Shao Mingwen; Qiu Jinrong; Wu Hao; Liu Yiqian; Liu Lianke

    2014-01-01

    Objective:To observe the effect of Shenyi Capsule concomitant with Endosatr and chemotherapy in improving the proliferative activity and apoptosis of MCF-7 breast cancer cells. Methods:The cultured cells were randomly divided into control group, 5-Fu group, combination group 1, combination group 2 and combination group 3. The morphological changes were observed under inverted microscope, activity inhibition rate was calculated by methyl thiazolyl tetrazolium (MTT) method and lfuorescence microscope was applied to observe the apoptotic cells. Results: There were different degrees of morphological changes and functions of inhibiting cellactivity and improving apoptosis in each group except control group, which were the most signiifcant in combination group 3. Conclusion: Shenyi Capsule concomitant with endostar can be an optimal choice for the treatment of breast cancer.

  15. [Influence of dopamine receptors agonists on clinical and hemodynamic and neurohumoral indicators in hypertensive patients with concomitant obesity].

    Science.gov (United States)

    Lyzogub, V H; Sobol', V O; Moshkovs'ka, Iu O; Bondarchuk, O M

    2014-01-01

    The article analyzes the results of studying the effects of antihypertensive treatment with the use of agonists dopamine receptors on clinical and hemodynamic and neurohumoral indicators in hypertensive patients with concomitant obesity. Special role is given to the patogenetice factor as dopamine and his relationship with the renin - angiotensin.- aldosterone system, endothelial function, which are aimed at the regulation of blood pressure and obesity formation and progression.

  16. Influence of low-dose proton pump inhibitors administered concomitantly or separately on the anti-platelet function of clopidogrel.

    Science.gov (United States)

    Furuta, Takahisa; Sugimoto, Mitsushige; Kodaira, Chise; Nishino, Masafumi; Yamade, Mihoko; Uotani, Takahiro; Sahara, Shu; Ichikawa, Hitomi; Kagami, Takuma; Iwaizumi, Moriya; Hamaya, Yasushi; Osawa, Satoshi; Sugimoto, Ken; Umemura, Kazuo

    2017-04-01

    Proton pump inhibitors (PPIs) at low doses can effectively prevent gastrointestinal bleeding due to aspirin and are widely used in Japan for gastroprotection in patients taking anti-platelet agents. We examined the influence of different PPIs at low doses administered concomitantly or separately on anti-platelet functions of clopidogrel. In 41 healthy Japanese volunteers with different CYP2C19 genotypes who took clopidogrel 75 mg in the morning alone, or with omeprazole 10 mg, esomeprazole 10 mg, lansoprazole 15 mg, or rabeprazole 10 mg, either concomitantly in the morning or separately in the evening, we measured the inhibition of platelet aggregation (IPA, %) using VerifyNow P2Y12 assay at 4 h after the last clopidogrel dose on Day 7 of each regimen. IPA by clopidogrel with rabeprazole administered at lunchtime, approximately 4 h after clopidogrel, was also measured. Mean IPAs in those concomitantly receiving omeprazole, esomeprazole, lansoprazole or rabeprazole (47.2 ± 21.1%, 43.2 ± 20.2%, 46.4 ± 18.8%, and 47.3 ± 19.2%, respectively) were significantly decreased compared with those receiving clopidogrel alone (56.0%) (all ps clopidogrel with rabeprazole administered at lunchtime was 51.6%, which was markedly similar to that of clopidogrel alone (p = 0.114). All tested PPIs reduce the efficacy of clopidogrel when administered concomitantly. Our preliminary data suggest that administration of rabeprazole 4 h following clopidogrel may minimize potential drug-drug interactions.

  17. Increased morbidity and mortality of a concomitant colectomy during a pancreaticoduodenectomy: an NSQIP propensity-score matched analysis

    Science.gov (United States)

    Harris, Jennifer W; Martin, Jeremiah T; Maynard, Erin C; McGrath, Patrick C; Tzeng, Ching-Wei D

    2015-01-01

    Background Select patients with peri-ampullary cancers require concomitant colon resection (CR) during a pancreaticoduodenectomy (PD) for margin-negative resections. This study analysed the impact of concomitant CR on major morbidity (MM) and mortality. Methods National Surgical Quality Improvement Program (NSQIP) patients undergoing PD for peri-ampullary cancers were identified from 2005 to 2012. A 4: 1 propensity-score matched analysis isolated the impact of CR upon PD. Risk factors for 30-day MM and mortality were analysed to determine post-operative sequelae of PD+CR. Results From 10 965 PD and 159 PD+CR patients, 624 and 156, respectively, were selected for 4: 1 matched analysis. PD+CR resulted in a higher MM and mortality (50.0% and 9.0%) versus PD alone (28.8% and 2.9%, respectively, P < 0.001). Multivariate analysis identified risk factors for MM after PD: concomitant CR [odds ratio (OR)–3.19, P < 0.001], smoking (OR–1.92, P = 0.005), a lack of functional independence (OR–3.29, P = 0.018), cardiac disease (OR–2.39, P = 0.011), decreased albumin (per g/dl, OR–1.38, P = 0.033) and a longer operative time (versus median time, OR–1.56, P = 0.029). Independent predictors of mortality included concomitant CR (OR–3.16, P = 0.010), ventilator dependence (OR–13.87, P < 0.001) and septic shock (OR–6.02, P < 0.001). Conclusions CR was an independent predictor of MM and mortality after a PD. Patients requiring PD+CR should be identified pre-operatively, maximally optimized and referred to experienced surgeons at expert centres. PMID:26223475

  18. Synchronous isolated splenic metastasis from colon carcinoma and concomitant splenic abscess: A case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    This study aimed to describe a case in which an isolated splenic metastasis was synchronous with the colonic primary and a concomitant splenic abscess was associated. A wide review of the literature was also performed. A.54-year-old woman with abdominal pain and fever was admitted to our department. Abdominal CT revealed two low-density areas in the spleen and wall-thickening of the left colonic flexure, which was indistinguishable from the spleen parenchyma. The patient underwent emergency celiotomy, with the presumptive diagnosis of obstructing colon carcinoma of the splenic flexure, and concomitant splenic abscess. Subtotal colectomy and splenectomy were performed. Pathological findings were consistent with mucinous colonic carcinoma, synchronous isolated splenic metastasis and concomitant splenic abscess.This paper is also a review of the existing literature on the association between colorectal cancer and splenic metastasis. Only 41 cases of isolated splenic metastasis from colon carcinoma have been reported in the literature. This report is the third described case of synchronous isolated splenic metastasis from colon carcinoma. Only one case with concomitant splenic abscess has been previously reported. When obstructing left-sided colorectal cancer is suspected, careful CT examination can allow early diagnosis of splenic involvement by the tumor. The literature review suggests that there might be a significant improvement in survival following splenectomy for a metachronous isolated splenic metastasis from colon carcinoma. Prognosis for synchronous splenic metastasis seems to be related to the advanced stage of the disease. Nevertheless, no definitive conclusions can be drawn because of the small number of cases.

  19. A preliminary study of genes related to concomitant chemoradiotherapy resistance in advanced uterine cervical squamous cell carcinoma

    Institute of Scientific and Technical Information of China (English)

    AN Ju-sheng; HUANG Man-ni; SONG Yong-mei; LI Nan; WU Ling-ying; ZHAN Qi-min

    2013-01-01

    Background Tumor intrinsic chemoradiotherapy resistance is the primary factor in concomitant chemoradiotherapy failure in advanced uterine cervical squamous cell carcinoma.This study aims to identify a set of genes and molecular pathways related to this condition.Methods Forty patients with uterine cervical squamous cell carcinoma in International Federation of Gynecology and Obstetrics stage lib or IIIb,treated with platinum-based concomitant chemoradiotherapy between May 2007 and December 2012,were enrolled in this trial.Patients included chemoradiotherapy resistant (n=20) and sensitive (n=20) groups.Total RNA was extracted from fresh tumor tissues obtained by biopsy before treatment and microarray analysis was performed to identify genes differentially expressed between the two groups.Results Microarray analysis identified 108 genes differentially expressed between concomitant chemoradiotherapy resistant and sensitive patients.Functional pathway cluster analysis of these genes revealed that DNA damage repair,apoptosis,cell cycle,Map kinase signal transduction,anaerobic glycolysis and glutathione metabolism were the most relevant pathways.Platelet-derived growth factor receptor alpha (PDGFRA) and protein kinase A type 1A (PRKAR1A)were significantly upregulated in the chemoradiosensitive group,while lactate dehydrogenase A (LDHA),bcl2 antagonist/killer 1 (BAK1),bcl2/adenovirus E1B 19 kDa interacting protein 3 (BNIP3),single-strand-selective monofunctional uracilDNA glycosylase 1 (SMUG1),and cyclin-dependent kinase 7 (CDK7) were upregulated in the chemoradiotherapy resistant group.Conclusion We have identified seven genes that are differentially expressed in concomitant chemoradiotherapy resistant and sensitive uterine cervical squamous cell carcinomas,which may represent primary predictors for this condition.

  20. Concomitant predation on parasites is highly variable but constrains the ways in which parasites contribute to food web structure.

    Science.gov (United States)

    Cirtwill, Alyssa R; Stouffer, Daniel B

    2015-05-01

    Previous analyses of empirical food webs (the networks of who eats whom in a community) have revealed that parasites exert a strong influence over observed food web structure and alter many network properties such as connectance and degree distributions. It remains unclear, however, whether these community-level effects are fully explained by differences in the ways that parasites and free-living species interact within a food web. To rigorously quantify the interrelationship between food web structure, the types of species in a web and the distinct types of feeding links between them, we introduce a shared methodology to quantify the structural roles of both species and feeding links. Roles are quantified based on the frequencies with which a species (or link) appears in different food web motifs - the building blocks of networks. We hypothesized that different types of species (e.g. top predators, basal resources, parasites) and different types of links between species (e.g. classic predation, parasitism, concomitant predation on parasites along with their hosts) will show characteristic differences in their food web roles. We found that parasites do indeed have unique structural roles in food webs. Moreover, we demonstrate that different types of feeding links (e.g. parasitism, predation or concomitant predation) are distributed differently in a food web context. More than any other interaction type, concomitant predation appears to constrain the roles of parasites. In contrast, concomitant predation links themselves have more variable roles than any other type of interaction. Together, our results provide a novel perspective on how both species and feeding link composition shape the structure of an ecological community and vice versa.

  1. Bilateral posterior RION after concomitant radiochemotherapy with temozolomide in a patient with glioblastoma multiforme: a case report

    Directory of Open Access Journals (Sweden)

    Gademann Guenther

    2010-10-01

    Full Text Available Abstract Background Radiation induced optic neuropathy (RION is a rare but severe consequence of radiation therapy that is associated with adjuvant chemotherapy, specifically therapy with vincristine or nitrosoureas. However, there is very little evidence regarding the occurrence of RION after concomitant radiochemotherapy with temozolomide. Case Presentation The case of a 63 year old woman with glioblastoma multiforme and concomitant radiochemotherapy with temozolomide is described. Due to a slight depressive episode the patient also took hypericum perforatum. Five months after cessation of fractionated radiation and adjuvant chemotherapy with temozolomide (cumulative dose of 11040 mg the patient developed bilateral amaurosis due to RION. Tumor regrowth was excluded by magnetic resonance imaging. After the application of gadolinium a pathognomonic contrast enhancement of both prechiasmatic optic nerves could be observed. Conclusions In this patient, the occurrence of RION may have been the result of radiosensitization by temozolomide, which could have been strengthened by hypericin. Consequently, physicians should avoid a concomitant application of hypericum perforatum and radiochemotherapy.

  2. Single-stage repair of adult aortic coarctation and concomitant cardiovascular pathologies: a new alternative surgical approach

    Directory of Open Access Journals (Sweden)

    Saba Davit

    2006-06-01

    Full Text Available Abstract Background Coarctation of the aorta in the adulthood is sometimes associated with additional cardiovascular pathologies that require intervention. Ideal approach in such patients is uncertain. Anatomic left-sided short aortic bypass from the arcus aorta to descending aorta via median sternotomy allows simultaneuos repair of both complex aortic coarctation and concomitant cardiac operation. Materials Four adult patients were underwent Anatomic left-sided short aortic bypass operation for complex aortic coarctation through median sternotomy using deep hypothermic circulatory arrest. Concomitant cardiac operations were Bentall procedure for annuloaortic ectasia in one patient, coronary artery bypass grafting for three vessel disease in two patient, and patch closure of ventricular septal defect in one patient. Results All patients survived the operation and were alive with patent bypass at a mean follow-up of 36 months. No graft-related complications occurred, and there were no instances of stroke or paraplegia. Conclusion We conclude that single-stage repair of adult aortic coarctation with concomitant cardiovascular lesions can be performed safely using this newest technique.

  3. Results of a modeling workshop concerning economic and environmental trends and concomitant resource management issues in the Mobile Bay area

    Science.gov (United States)

    Hamilton, David B.; Andrews, Austin K.; Auble, Gregor T.; Ellison, Richard A.; Johnson, Richard A.; Roelle, James E.; Staley, Michael J.

    1982-01-01

    During the past decade, the southern regions of the U.S. have experienced rapid change which is expected to continue into the foreseeable future. Growth in population, industry, and resource development has been attributed to a variety of advantages such as an abundant and inexpensive labor force, a mild climate, and the availability of energy, water, land, and other natural resources. While this growth has many benefits for the region, it also creates the potential for increased air, water, and solid waste pollution, and modification of natural habitats. A workshop was convened to consider the Mobile Bay area as a site-specific case of growth and its environmental consequences in the southern region. The objectives of the modeling workshop were to: (1) identify major factors of economic development as they relate to growth in the area over the immediate and longer term; (2) identify major environmental and resource management issues associated with this expected growth; and (3) identify and characterize the complex interrelationships among economic and environmental factors. This report summarizes the activities and results of a modeling workshop concerning economic growth and concomitant resource management issues in the Mobile Bay area. The workshop was organized around construction of a simulation model representing the relationships between a series of actions and indicators identified by participants. The workshop model had five major components. An Industry Submodel generated scenarios of growth in several industrial and transportation sectors. A Human Population/Economy Submodel calculated human population and economic variables in response to employment opportunities. A Land Use/Air Quality Submodel tabulated changes in land use, shoreline use, and air quality. A Water Submodel calculated indicators of water quality and quantity for fresh surface water, ground water, and Mobile Bay based on discharge information provided by the Industry and Human

  4. 卡培他滨在蒽环和紫杉类失败的晚期乳腺癌中疗效与安全性的分析%Analysis of the Efficacy and Safety of Capecitabine in Advanced Breast Cancer with Anthracycline and Taxane Failure

    Institute of Scientific and Technical Information of China (English)

    曾娟紫; 吴国武

    2013-01-01

      目的:探究卡培他滨在蒽环和紫杉类失败的晚期乳腺癌中的疗效与安全性。方法:选择20例蒽环和紫杉类失败的晚期乳腺癌患者,给予卡培他滨治疗,观察临床疗效及用药安全。结果:结束化疗4周后 ORR 率为25%,5例 PR 患者均接受蒽环和紫杉类单纯使用或联合使用方案治疗。主要药物不良反应有手足综合征、食欲不振、恶心、呕吐、便秘、中性粒细胞减少,且大部分为1~2级,3~4级毒性发病率较低。结论:卡培他滨在蒽环和紫杉类失败的晚期乳腺癌患者中疗效确切,且用药较安全,口服用药方便,成为晚期乳腺癌首选药物。%Objective:To explore efficacy and safety of capecitabine in advanced breast cancer with anthracycline and taxane failure.Method:20 patients with anthracycline and taxane failure in patients with advanced breast cancer,capecitabine,to observe the clinical efficacy and drug safety. Result:4 weeks after the end of chemotherapy,the ORR was 25%,five cases of PR patients underwent anthracycline and taxane simple to use or joint use regimen.The main adverse drug reactions hand-foot syndrome,loss of appetite,nausea,vomiting,constipation,neutropenia,and most of 1 to 2,3 to 4 toxicity incidence is relatively low.Conclusion:The exact efficacy of capecitabine in anthracycline and taxane failure in patients with advanced breast cancer,and the drug is safer,convenient oral medication,the drug of choice for advanced breast cancer.

  5. Orthogonal Methods for Characterizing the Unfolding of Therapeutic Monoclonal Antibodies: Differential Scanning Calorimetry, Isothermal Chemical Denaturation, and Intrinsic Fluorescence with Concomitant Static Light Scattering.

    Science.gov (United States)

    Temel, Deniz B; Landsman, Pavel; Brader, Mark L

    2016-01-01

    Evaluating prospective protein pharmaceutical stability from accelerated screening is a critical challenge in biotherapeutic discovery and development. Measurements of protein unfolding transitions are widely employed for comparing candidate molecules and formulations; however, the interrelationships between intrinsic protein conformational stability and pharmaceutical robustness are complex and thermal unfolding measurements can be misleading. Beyond the discovery phase of drug development, astute formulation design is one of the most crucial factors enabling the protein to resist damage to its higher order structure-initially from bioprocessing stresses, then from stresses encountered during its journey from the product manufacturing site to the bloodstream of the patient. Therapeutic monoclonal antibodies are multidomain proteins that represent a large and growing segment of the biotechnology pipeline. In this chapter, we describe how differential scanning calorimetry may be leveraged synergistically with isothermal chemical denaturation and intrinsic fluorescence with concomitant static light scattering to elucidate characteristics of mAb unfolding and aggregation that are helpful toward understanding and designing optimal pharmaceutical compositions for these molecules.

  6. Cultured senescent myoblasts derived from human vastus lateralis exhibit normal mitochondrial ATP synthesis capacities with correlating concomitant ROS production while whole cell ATP production is decreased.

    Science.gov (United States)

    Minet, Ariane D; Gaster, Michael

    2012-06-01

    The free radical theory of aging says that increased oxidative stress and mitochondrial dysfunction are associated with old age. In the present study we have investigated the effects of cellular senescence on muscle energetic by comparing mitochondrial content and function in cultured muscle satellite cells at early and late passage numbers. We show that cultured muscle satellite cells undergoing senescence express a reduced mitochondrial mass, decreased whole cell ATP level, normal to increased mitochondrial ATP production under ATP utilization, increased mitochondrial membrane potential and increased superoxide/mitochondrial mass and hydrogen peroxide/mitochondrial mass ratios. Moreover, the increased ROS production correlates with the corresponding mitochondrial ATP production. Thus, myotubes differentiated from human myoblasts undergoing senescence have a reduced mitochondrial content, but the existent mitochondria express normal to increased functional capabilities. The present data suggest that the origin of aging lies outside the mitochondria and that a malfunction in the cell might be preceding and initiating the increase of mitochondrial ATP synthesis and concomitant ROS production in the single mitochondrion in response to decreased mitochondrial mass and reduced extra-mitochondrial energy supply. This then can lead to the increased damage of DNA, lipids and proteins of the mitochondria as postulated by the free radical theory of aging.

  7. Mouse hepatitis coronavirus replication induces host translational shutoff and mRNA decay, with concomitant formation of stress granules and processing bodies.

    Science.gov (United States)

    Raaben, Matthijs; Groot Koerkamp, Marian J A; Rottier, Peter J M; de Haan, Cornelis A M

    2007-09-01

    Many viruses, including coronaviruses, induce host translational shutoff, while maintaining synthesis of their own gene products. In this study we performed genome-wide microarray analyses of the expression patterns of mouse hepatitis coronavirus (MHV)-infected cells. At the time of MHV-induced host translational shutoff, downregulation of numerous mRNAs, many of which encode protein translation-related factors, was observed. This downregulation, which is reminiscent of a cellular stress response, was dependent on viral replication and caused by mRNA decay. Concomitantly, phosphorylation of the eukaryotic translation initiation factor 2alpha was increased in MHV-infected cells. In addition, stress granules and processing bodies appeared, which are sites for mRNA stalling and degradation respectively. We propose that MHV replication induces host translational shutoff by triggering an integrated stress response. However, MHV replication per se does not appear to benefit from the inhibition of host protein synthesis, at least in vitro, since viral replication was not negatively affected but rather enhanced in cells with impaired translational shutoff.

  8. When "Other" Initiate Repair.

    Science.gov (United States)

    Schegloff, Emanuel A.

    2000-01-01

    Elaborates on the locus of other-initiated repair, and reports on a number of environments in which others initiate repair turns later than the one directly following the trouble-source turn. Describes several ways that other initiation of repair, which occurs in next-turn position, may be delayed within that position. (Author/VWL)

  9. Metastatic Pulmonary Adenocarcinoma 6 Years After Curative Resection for Ampullary Adenocarcinoma. Metastatic Disease from Initial Primary or Metachronous Tumour?

    Directory of Open Access Journals (Sweden)

    Alexandros Giakoustidis

    2011-01-01

    Full Text Available Context With patients surviving longer after pancreatic resection, the challenges now is the management of the unresolved longerterm issues. Case report A 53-year-old woman with painless obstructive jaundice, underwent a pylorous preserving pancreaticoduodenectomy for a pT3N0M0 ampullary adenocarcinoma in 2001 (patchy chronic pancreatitis with mucinous metaplasia of background pancreatic duct epithelium and acinar atrophy were noted. Despite adjuvant chemotherapy, at month 54 she required a pulmonary wedge resection for metastatic adenocarcinoma, followed by a pulmonary relapse at 76 months when she underwent 6 neoadjuvant cycles of gemcitabine/capecitabine and a left pneumonectomy. Finally 7 years after the initial Whipple’s, a single 18F fluorodeoxyglucose (FDG avid pancreatic tail lesion led to completion pancreatectomy for a well-differentiated ductal adenocarcinoma with clear resection margins albeit peripancreatic adipose tissue infiltration. On review all resected tumour cells had identical immunophenotype (CK7+/CK20-/MUC1+/MUC2- as that of the primary. She is currently asymptomatic on follow-up. Conclusions These findings suggest that in selected cases even in the presence of pulmonary metastasis, repeat resections could result in long-term survival of patients with metachronous ampullary cancer. Second, even ampullary tumours maybe should be regarded as index tumors in the presence of ductal precursor lesions in the resection specimen. Three distant metastases, particularly if long after the initial tumour, should instigate a search for metachronous tumour, especially in the presence of field change in the initial specimen. Risk-adapted follow-up protocols with recognition of such factors could result in cost-effective surveillance and potentially improved outcomes.

  10. Analysis of adverse reactions of docetaxel combined with capecitabine in the treatment of recurrent and metastatic breast cancer and pharmaceutical care%多西他赛联合卡培他滨治疗复发转移乳腺癌的不良反应分析及药学监护

    Institute of Scientific and Technical Information of China (English)

    林玉燕

    2014-01-01

    Objective To explore adverse reactions and pharmaceutical care of docetaxel combined with capecitabine in the treatment of recurrent and metastatic breast cancer to study the application value of the pharmaceutical care. Methods Divided 80 cases of recurrent and metastatic breast cancer patients into observation group and control group according to the digital method, 40 cases in each group, observation group was given docetaxel combined with capecitabine treatment, and pharmacist pharmaceutical care, control group was given docetaxel combined with capecitabine treatment only. Observed the satisfaction and adverse reactions of two groups. Results Syndrome of leukopenia, hands and feet syndrome, thrombocytopenia, diarrhea, nausea, vomiting, late onset, hair loss, and so on in the observation group were significantly less than the control group, the difference was statistically significant(P<0.05);observation group had significantly higher satisfaction, the difference was statistically significant(P<0.05). Conclusion Docetaxel combined with capecitabine in the treatment of recurrent and metastatic breast cancer has a precis clinical effect, and pharmaceutical care gives specific guidance to patients, which can effectively reduce the occurrence of adverse reactions, improve patients satisfaction, so it is worthy of popularization and application in clinic.%目的探究多西他赛联合卡培他滨治疗复发转移乳腺癌的不良反应及药学监护,研究药学监护的应用价值。方法80例复发转移乳腺癌患者,按数字法随机分为观察组与对照组各40例,观察组给予多西他赛联合卡培他滨治疗,并由临床药师进行药学监护。对照组给予多西他赛联合卡培他滨治疗。观察两组患者不良反应情况及满意度。结果观察组患者中出现白细胞减少、手足综合征、血小板减少、恶心呕吐、迟发型腹泻、脱发等情况明显少于对照组,差异有统计学意义(P<0.05)

  11. 超声药物透入疗法防治卡培他滨相关性手足综合征35例%Prevention and treatment of 35 cases with capecitabine hand-foot-related syndrome by ultrasound drug penetration therapy

    Institute of Scientific and Technical Information of China (English)

    闻飞飞; 赵美随

    2015-01-01

    目的:观察超声药物透入疗法预防及治疗卡培他滨所致手足综合征(hand foot s yndrom e , H FS)的疗效。方法:选取卡培他滨化疗患者共35例,35例均为经病理学或细胞学确诊的乳腺癌、结肠癌、胃癌患者。随机分为试验组18例和对照组17例。卡培他滨每日量为2500 mg/m2,分2次口服,连用14 d,休息7 d,21 d为1个周期。预防组18例,化疗同时运用超声药物透入仪导入维生素B6注射液,隔日1次。对照组17例,化疗同时给予维生素B6口服至化疗结束。结果:试验组18例患者中3例发生Ⅰ级手足综合征,发生率为16.7%,对照组手足综合征发生率为44.4%,两者有显著性差异(P<0.05)。结论:超声药物透入疗法可有效防治卡培他滨化疗所致手足综合征。%Objective:To investigate the effects of prevention and treatmentof ultrasound therapy drug penetration on capecitabine induced hand-footsyndrome (hand footsyndrome e, HFS) [1] . Methods:35 cases with capecitabine chemotherapy confirmed by pathology or cytology of breastcancer, colon cancer, stomach cancer were selected and randomly divided into an experimental group with 18 cases and a control group with 17 cases. The amountof capecitabine was 2500 mg/m2, twice orally, 14 days continuously, rest7 days, 21 days for a p eriod.18 pa tients in the prevention group were treated with ultrasound dru g pe netration i nstrumenti mported vi tamin B6 i njection, every other day, while 17 cases in the control group were treated with vitamin B6 oral chemotherapy until the end of chemotherapy. Results:3 cases among 18 patients in the experimental group occurredⅠgrade hand-footsyndrome, the rate was 16.7%, while thatin the control group hand-footsyndrome was 44.4%with significantdifference (P<0.05).Conclusion:Ultrasound drug penetration therapy can effectively control capecitabine chemotherapy induced hand-footsyndrome.

  12. Concomitant stress potentiates the preference for, and consumption of, ethanol induced by chronic pre-exposure to ethanol

    Directory of Open Access Journals (Sweden)

    G. Morais-Silva

    2016-01-01

    Full Text Available Ethanol abuse is linked to several acute and chronic injuries that can lead to health problems. Ethanol addiction is one of the most severe diseases linked to the abuse of this drug. Symptoms of ethanol addiction include compulsive substance intake and withdrawal syndrome. Stress exposure has an important role in addictive behavior for many drugs of abuse (including ethanol, but the consequences of stress and ethanol in the organism when these factors are concomitant results in a complex interaction. We investigated the effects of concomitant, chronic administration of ethanol and stress exposure on the withdrawal and consumption of, as well as the preference for, ethanol in mice. Male Swiss mice (30–35 g, 8-10 per group were exposed to an ethanol liquid diet as the only source of food for 15 days. In the final 5 days, they were exposed to forced swimming stress. Twelve hours after removal of the ethanol liquid diet, animals were evaluated for ethanol withdrawal by measuring anxiety-related behaviors and locomotor activity. Twenty-four hours after evaluation of ethanol withdrawal, they were evaluated for voluntary consumption of ethanol in a “three-bottle choice” paradigm. Mice exposed to chronic consumption of ethanol had decreased locomotor activity during withdrawal. Contrary to our expectations, a concomitant forced swimming stress did not aggravate ethanol withdrawal. Nevertheless, simultaneous ethanol administration and stress exposure increased voluntary consumption of ethanol, mainly solutions containing high concentrations of ethanol. These results showed that stressful situations during ethanol intake may aggravate specific addiction-related behaviors.

  13. Concomitant stress potentiates the preference for, and consumption of, ethanol induced by chronic pre-exposure to ethanol.

    Science.gov (United States)

    Morais-Silva, G; Fernandes-Santos, J; Moreira-Silva, D; Marin, M T

    2016-01-01

    Ethanol abuse is linked to several acute and chronic injuries that can lead to health problems. Ethanol addiction is one of the most severe diseases linked to the abuse of this drug. Symptoms of ethanol addiction include compulsive substance intake and withdrawal syndrome. Stress exposure has an important role in addictive behavior for many drugs of abuse (including ethanol), but the consequences of stress and ethanol in the organism when these factors are concomitant results in a complex interaction. We investigated the effects of concomitant, chronic administration of ethanol and stress exposure on the withdrawal and consumption of, as well as the preference for, ethanol in mice. Male Swiss mice (30-35 g, 8-10 per group) were exposed to an ethanol liquid diet as the only source of food for 15 days. In the final 5 days, they were exposed to forced swimming stress. Twelve hours after removal of the ethanol liquid diet, animals were evaluated for ethanol withdrawal by measuring anxiety-related behaviors and locomotor activity. Twenty-four hours after evaluation of ethanol withdrawal, they were evaluated for voluntary consumption of ethanol in a "three-bottle choice" paradigm. Mice exposed to chronic consumption of ethanol had decreased locomotor activity during withdrawal. Contrary to our expectations, a concomitant forced swimming stress did not aggravate ethanol withdrawal. Nevertheless, simultaneous ethanol administration and stress exposure increased voluntary consumption of ethanol, mainly solutions containing high concentrations of ethanol. These results showed that stressful situations during ethanol intake may aggravate specific addiction-related behaviors.

  14. Inoperable nonmetastatic squamous cell carcinoma of the esophagus managed by concomitant chemotherapy (5-fluorouracil and cisplatin) and radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Seitz, J.F.; Giovannini, M.; Padaut-Cesana, J.; Fuentes, P.; Giudicelli, R.; Gauthier, A.P.; Carcassonne, Y. (Institut J. Paoli-I. Calmettes, Marseilles (France))

    1990-07-15

    Thirty-five patients with nonmetastatic squamous cell carcinoma of the esophagus were treated with chemotherapy (5-fluorouracil, cisplatin) and concomitant split-course radiation therapy. All of the patients presented with dysphagia. Treatment consisted of two courses of chemotherapy with 5-FU (1 g/m2/day in continuous infusion for 5 days (days 1 to 5 and days 29 to 33) ) and cisplatin (70 mg/m2 intravenous bolus at days 2 and 30). Radiation therapy was concomitant in two courses delivering 20 Gy in 5 days (days 1 to 5 and days 29 to 33). On the first day of treatment, endoscopic peroral dilation or Nd-YAG laser therapy was usually carried out. At the end of the treatment, all of the patients were capable of oral nutrition. Histoendoscopic confirmation was made 8 weeks after the beginning of the therapy. Twenty-five of the 35 patients had a complete response with negative biopsy findings. There was only one serious complication (fatal myelosuppression) in the only patient who received more than two courses of chemotherapy. Sixteen patients died and 19 were still alive at 3 to 42 months after the beginning of treatment. Overall median survival for the 35 patients is 17 months. Actuarial survival was 55 +/- 18% at 1 year and 41 +/- 21% at 2 years. The median survival of the Stage I and II patients is 28 months. These results confirm that concomitant chemoradiotherapy is capable of producing a very high histoendoscopic complete response rate and improved 1-year and 2-year survival. The use of concentrated split-course radiotherapy enabled the authors to reduce the total length of the treatment to two periods of 5 days, with results that are similar to previous studies using classic radiotherapy for a 5-week to 7-week period.

  15. Distribution of hypodontia and hyperdontia in concomitant hypo-hyperdontia patients: Critical appraisal of the published data

    Directory of Open Access Journals (Sweden)

    Yong Chen

    2017-01-01

    Full Text Available Aim: Distribution of hypodontia and hyperdontia in the reported concomitant hypo-hyperdontia (CHH patients. Materials and Methods: An extensive search of the reported literature from January 1966 to December 2015 was conducted using the "EmBase," "Google Scholar," "Medline," and "PubMed" databases. The search words used were "agenesis," "concomitant," "hypodontia," "hyperdontia," "hypo-hyperdontia" "concomitant hypo-hyperdontia" and "supernumerary teeth" in different combinations. The citation lists from the included references were subsequently examined, and a hand search was performed in an attempt to find additional data. Detailed analyses of the incidence of hyperdontia and tooth type of hypodontia were evaluated to determine the occurrence of hypodontia and hyperdontia in this condition. Descriptive statistics were carried out using a Chi-square test to determine the occurrence of hypodontia and hyperdontia in CHH, the value of P < 0.05 was considered statistically significant. Results: Overall, 103 individuals were reported on CHH in published English literature. The average age of them was 11.29 years and frequently observed in males (P < 0.05. Overall 63% of teeth were missing in all the cases that were reported on CHH, whereas 37% of supernumerary teeth were documented (P < 0.05. Most of the cases involved are an anterior region of the both arches (57%. Second premolars are the most commonly missing teeth in both maxillary and mandibular arches, and maxillary mesiodens (50% are frequent supernumeraries in CHH patients. Conclusion: Hypodontia is more common in CHH patients than hyperdontia. Second premolars are the commonly missing teeth while maxillary mesiodens are the frequently reported in CHH patients. Posterior CHH has not been reported.

  16. Sustainable Agricultural Marketing Initiatives

    OpenAIRE

    Hakan Adanacıoğlu

    2015-01-01

    Sustainable marketing is a holistic approach that puts equal emphasis on environmental, social equity, and economic concerns in the development of marketing strategies. The purpose of the study is to examine and discuss the sustainable agricultural marketing initiatives practiced throughout the World and Turkey, and to put forth suggestions to further improve the performance of agricultural marketing initiatives in Turkey. Some of the sustainable agricultural marketing initiatives practiced a...

  17. Emerging Pathogens Initiative (EPI)

    Data.gov (United States)

    Department of Veterans Affairs — The Emerging Pathogens Initiative (EPI) database contains emerging pathogens information from the local Veterans Affairs Medical Centers (VAMCs). The EPI software...

  18. [Specific clinical and functional features in the patients presenting with neurologic manifestations of deforming dorsopathies and concomitant osteoarthrosis].

    Science.gov (United States)

    Miriutova, N F; Zaĭtsev, A A; Popova, A V

    2012-01-01

    The present study has revealed some specific clinical and functional features in the patients presenting with neurologic manifestations of deforming dorsopathies and concomitant osteoarthrosis. The negative influence of the latter condition on the pain intensity, microcirculation, and duration of the exacerbation of neurologic syndrome has been demonstrated based on the analysis of correlational relationships between the severity of referred projectional nerve root pain and articular pain syndrome. Special emphasis is laid on the interrelation between the duration of pain syndrome and characteristics of microcirculation.

  19. Early Hemodynamic Disorders and Their Association with the Development of Acute Pulmonary Lesion in Severe Concomitant Injury

    Directory of Open Access Journals (Sweden)

    V. V. Moroz

    2005-01-01

    Full Text Available Early changes in the parameters of central hemodynamics and pulmonary extravascular fluid were studied in patients who had sustained a severe concomitant injury in combination with acute massive blood loss. Early postoperative monitoring of these parameters by a «Pulsion Picco Plus» invasive monitoring apparatus was ascertained to verify the early stages on non-cardiogenic pulmonary edema, to assess a risk for acute lung lesion and acute respiratory distress syndrome in the phase of reperfusion lesions, and to perform an adequate correction of therapy.

  20. Concomitant chemoradiotherapy in the treatment of the locally evolved larynx carcinoma; Chimioradiotherapie concomitante dans le traitement du carcinome du larynx localement evolue

    Energy Technology Data Exchange (ETDEWEB)

    Houjami, M.; Tarkouki, K.; Benjelloun, H.; Benchakroun, N.; Jouhadi, H.; Tawfiq, N.; Sahraoui, S.; Benider, A. [Centre d' Oncologie Ibn-Rochd, Casablanca (Morocco)

    2007-11-15

    The objective of this was to evaluate the contribution of concomitant chemoradiotherapy in the treatment of locally evolved larynx carcinomas. The results of the series are comparable to these ones got by several studies. The concomitant chemoradiotherapy tends to give a good local control with the advantage of organ conservation, at the price of an acceptable toxicity.The improvement of larynx cancer prognostic is through an early diagnosis but the fight against smoking constitutes the only means of prevention. (N.C.)

  1. Analysis of Road Traffic Crashes–Related Maxillofacial Injuries Severity and Concomitant Injuries in 201 Patients Seen at the UCH, Ibadan

    OpenAIRE

    2014-01-01

    The objective of this study was to determine the prevalence of road traffic crashes (RTC)–related maxillofacial injuries, the concomitant injuries occurring with them, and to assess the relationship between the severity of maxillofacial and concomitant injuries. This was a prospective study involving 201 victims of RTC seen at the Accident and Emergency Department of the University College Hospital, Ibadan with maxillofacial injuries during the study period. Demographic data of the patients, ...

  2. Researching of cardos activity for chronic heart failure treatment in case of concomitant chronic kidney disease (stage V, conventional hemodialysis

    Directory of Open Access Journals (Sweden)

    Chepurina N.G.

    2011-06-01

    Full Text Available Aim: comparative investigation of cardos (antibodies to angiotensin II receptor subtype 1 (AT., C-terminal fragment, diovan (Valsartan or both drug combination effects (changing of clinical picture, physical exertion tolerance and quality of life for treatment chronic heart failure (CHF patients. Methods. 12-month open-label randomized research was performed. CHF patients (NYHA Class l-ll, n=30 with concomitant chronic kidney disease (stage V, conventional hemodialysis were randomized (10 patients in each group for 6-month treatment by cardos (group I, average dose 1,8g/day, diovan (group II, average dose 80mg/dayorboth drug combination (group III, cardos 1,8g/day and diovan 80mg/day. CHD basic treatment was prescribed for all patients. In a 6-month drug crossover between groups I and I was performed, group III was divided into 2 subgroups (subgroup IIIA— cardos, subgroup NIB — diovan followed by next 6-month treatment. Results. Long-term treatment by cardos has improved functional class (NYHA of CHF patients with concomitant chronic kidney disease (stage V, conventional hemodialysis. cardos, diovan and both drug combination have demonstrated improvement of physical exertion tolerance, quality of life and patient clinical status during 6-min walking test. Conclusion. Cardos and diovan have shown the same efficacy. Cardos can be used as real alternative in case of ARA administration necessity

  3. Decreased level of endogenous secretory receptor for advanced glycation end-products in diabetes with concomitant hyperlipidemia.

    Science.gov (United States)

    Turk, Z; Ljubić, S; Boras, J

    2014-01-01

    Endogenous secretory receptor (esRAGE) for advanced glycation end-product (AGE) acts as decoy for AGEs. The AGE-to-esRAGE ratio was hypothesized to be implicated in diabetic vasculopathy. We investigated an association of esRAGE and methylglyoxal-adducts serum level, as well as AGE-to-esRAGE ratio in subpopulation of diabetic patients with or without concomitant hyperlipidemia and macrovascular disease in history. In diabetes with concomitant hyperlipidemia esRAGE was significantly decreased compared to hyperlipidemia with normal glucose metabolism (0.306+/-0.2 vs. 0.367+/-0.1; p=0.019) or diabetes alone (0.306+/-0.2 vs. 0.404+/-0.1; p=0.004). High AGE/esRAGE ratio, found in diabetic patients with hyperlipidemia, pointed to increased production of AGEs and low expression of esRAGE. In multivariable analysis adjusted for several confounding factors, increased AGE/esRAGE ratio was recognized as a high risk for vascular disease outcomes.

  4. Effect of concomitant administration of coenzyme Q10 with sitagliptin on experimentally induced diabetic nephropathy in rats.

    Science.gov (United States)

    Maheshwari, Rajesh; Balaraman, Ramachandran; Sen, Ashim Kumar; Shukla, Disha; Seth, Avinash

    2017-11-01

    This study was aimed to investigate the therapeutic potential of coenzyme Q10 and its combination with sitagliptin in experimentally induced diabetic nephropathy. The diabetic rats were treated with coenzyme Q10 or sitagliptin and their concomitant administration. Various parameters of renal function like serum creatinine, urea, uric acid and markers of oxidative stress such as renal malondialdehyde content (MDA), glutathione (GSH) level and superoxide dismutase (SOD), catalase activities were measured. TNF-α, TGF-β, MPO activity and nitrite content were estimated in renal tissue with histopathological observation. Diabetic rats showed a significant reduction in renal function, which was reflected with an increase in serum creatinine, urea and uric acid levels. Streptozotocin-nicotinamide caused renal tubular damage with a higher MDA level, depletion of SOD and CAT activity and GSH level. In addition, TNF-α, TGF- β, MPO activity and nitrite content were significantly increased in diabetic rats. Treatment with coenzyme Q10 or sitagliptin and their co-administration ameliorated STZ-nicotinamide-induced renal damage which was reflected by decreased oxidative stress, TNF-α, TGF-β, MPO activity, nitrite content along with histopathological changes. To conclude, concomitant administration of coenzyme Q10 and sitagliptin showed a better renoprotective effect than coenzyme Q10 or sitagliptin when given alone.

  5. Concomitant treatment of brain metastasis with Whole Brain Radiotherapy [WBRT] and Temozolomide [TMZ] is active and improves Quality of Life

    Directory of Open Access Journals (Sweden)

    Montella Liliana

    2007-01-01

    Full Text Available Abstract Background Brain metastases (BM represent one of the most frequent complications related to cancer, and their treatment continues to evolve. We have evaluated the activity, toxicity and the impact on Quality of Life (QoL of a concomitant treatment with whole brain radiotherapy (WBRT and Temozolomide (TMZ in patients with brain metastases from solid tumors in a prospective Simon two stage study. Methods Fifty-nine patients were enrolled and received 30 Gy WBRT with concomitant TMZ (75 mg/m2/day for ten days, and subsequently TMZ (150 mg/m2/day for up to six cycles. The primary end points were clinical symptoms and radiologic response. Results Five patients had a complete response, 21 patients had a partial response, while 18 patients had stable disease. The overall response rate (45% exceeded the target activity per study design. The median time to progression was 9 months. Median overall survival was 13 months. The most frequent toxicities included grade 3 neutropenia (15% and anemia (13%, and only one patient developed a grade 4 thrombocytopenia. Age, Karnofsky performance status, presence of extracranial metastases and the recursive partitioning analysis (RPA were found to be predictive factors for response in patients. Overall survival (OS and progression-free survival (PFS were dependent on age and on the RPA class. Conclusion We conclude that this treatment is well tolerated, with an encouraging objective response rate, and a significant improvement in quality of life (p

  6. Closed head experimental traumatic brain injury increases size and bone volume of callus in mice with concomitant tibial fracture

    Science.gov (United States)

    Brady, Rhys D; Grills, Brian L; Church, Jarrod E; Walsh, Nicole C; McDonald, Aaron C; Agoston, Denes V; Sun, Mujun; O’Brien, Terence J; Shultz, Sandy R; McDonald, Stuart J

    2016-01-01

    Concomitant traumatic brain injury (TBI) and long bone fracture are commonly observed in multitrauma and polytrauma. Despite clinical observations of enhanced bone healing in patients with TBI, the relationship between TBI and fracture healing remains poorly understood, with clinical data limited by the presence of several confounding variables. Here we developed a novel trauma model featuring closed-skull weight-drop TBI and concomitant tibial fracture in order to investigate the effect of TBI on fracture healing. Male mice were assigned into Fracture + Sham TBI (FX) or Fracture + TBI (MULTI) groups and sacrificed at 21 and 35 days post-injury for analysis of healing fractures by micro computed tomography (μCT) and histomorphometry. μCT analysis revealed calluses from MULTI mice had a greater bone and total tissue volume, and displayed higher mean polar moment of inertia when compared to calluses from FX mice at 21 days post-injury. Histomorphometric results demonstrated an increased amount of trabecular bone in MULTI calluses at 21 days post-injury. These findings indicate that closed head TBI results in calluses that are larger in size and have an increased bone volume, which is consistent with the notion that TBI induces the formation of a more robust callus. PMID:27682431

  7. Increased Plasma Matrix Metalloproteinase-9 Levels Contribute to Intracerebral Hemorrhage during Thrombolysis after Concomitant Stroke and Influenza Infection

    Directory of Open Access Journals (Sweden)

    Sajjad Muhammad

    2016-08-01

    Full Text Available Background: Thrombolysis is the only approved therapy for acute stroke. However, life-threatening complications such as intracerebral hemorrhage (ICH can develop after intravenous administration of tissue plasminogen activator (tPA. Both infection and thrombolysis during cerebral ischemia disrupt the blood-brain barrier (BBB. tPA can induce matrix metalloproteinase-9 (MMP-9, which is known to be involved in BBB disruption. However, it has still not been investigated whether preexisting influenza virus infection during thrombolysis after acute stroke affects systemic levels of MMP-9 and its inhibitor TIMP-1 and whether increased systemic MMP-9 levels affect ICH. This study aimed to investigate the influence of influenza virus infection on plasma levels of MMP-9 and TIMP-1 after thrombolysis in acute stroke, and to determine whether the infection correlates with intracerebral bleeding. Methods: C57BL/6 mice were infected by administering 1 × 105 plaque-forming units of human influenza (H1N1 virus intranasally. After 3 days of infection the middle cerebral artery was occluded for 45 min and then reperfused. Intravenous tPA (10 mg/kg treatment was started 10 min after stroke onset. Twenty-four hours after stroke onset, mice were deeply anesthetized with ketamine, venous blood was drawn from the caval vein and centrifuged at 2,000 rpm, and the supernatant was collected and frozen at -80°C. Plasma levels of MMP-9 and TIMP-1 were quantified by using ELISA. Results: After stroke, plasma MMP-9 was significantly increased in mice with a concomitant influenza infection that were treated with tPA (9.99 ± 0.62 ng/ml, n = 7 as compared to noninfected control mice that were treated with tPA (4.74 ± 0.48 ng/ml, n = 8. Moreover, plasma levels of TIMP-1, an inhibitor of MMP-9, were also significantly increased in mice treated with tPA after concomitant infection and stroke (42.17 ± 7.02 ng/ml, n = 7 as compared to noninfected control mice that were treated

  8. Treatment and Patient Reported Outcome in Children with Hirschsprung Disease and Concomitant Congenital Heart Disease

    Science.gov (United States)

    Hasserius, Johan; Hedbys, Josefine

    2017-01-01

    Purpose. Congenital heart disease (CHD) is reported to be associated with Hirschsprung disease (HD). The aim was to evaluate any differences between children with HD with and without CHD, respectively, with regard to patient characteristics, medical care, and patient reported bowel function. Method. This is a retrospective chart study and a cross-sectional long-term follow-up of patients older than 4 years old, including all children with HD operated on with transanal endorectal pull-through (TERPT) at a tertiary center of pediatric surgery. Information about patient characteristics, diagnostics, surgery, and medical care was compiled. At long-term follow-up, bowel function was assessed by Bowel Function Score. Results. Included were 53 HD-patients, 13 with CHD and 40 without CHD. Children with CHD more commonly presented with failure to thrive; 4 (23%) compared to those without CHD (0%) (p < 0.01). In the long-term follow-up, including 32 patients (6 with CHD), constipation was more commonly reported by children with CHD 5 (83%) than by children without CHD 4 (27%) (p = 0.01). No differences were shown in the other parameters such as fecal control and incontinence. Conclusion. HD-patients with CHD more commonly presented with failure to thrive and more frequently reported constipation than HD-patients without CHD. The findings indicate that HD-patients with CHD might need special consideration in their initial care and long-term follow-up.

  9. Salinomycin induces autophagy in colon and breast cancer cells with concomitant generation of reactive oxygen species.

    Directory of Open Access Journals (Sweden)

    Berlinda Verdoodt

    Full Text Available BACKGROUND: Salinomycin is a polyether ionophore antibiotic that has recently been shown to induce cell death in human cancer cells displaying multiple mechanisms of drug resistance. The underlying mechanisms leading to cell death after salinomycin treatment have not been well characterized. We therefore investigated the role of salinomycin in caspase dependent and independent cell death in colon cancer (SW480, SW620, RKO and breast cancer cell lines (MCF-7, T47D, MDA-MB-453. METHODOLOGY/PRINCIPAL FINDINGS: We detected features of apoptosis in all cell lines tested, but the executor caspases 3 and 7 were only strongly activated in RKO and MDA-MB-453 cells. MCF-7 and SW620 cells instead presented features of autophagy such as cytoplasmic vacuolization and LC3 processing. Caspase proficient cell lines activated autophagy at lower salinomycin concentrations and before the onset of caspase activation. Salinomycin also led to the formation of reactive oxygen species (ROS eliciting JNK activation and induction of the transcription factor JUN. Salinomycin mediated cell death could be partially inhibited by the free radical scavenger N-acetyl-cysteine, implicating ROS formation in the mechanism of salinomycin toxicity. CONCLUSIONS: Our data indicate that, in addition to its previously reported induction of caspase dependent apoptosis, the initiation of autophagy is an important and early effect of salinomycin in tumor cells.

  10. Levodopa Withdrawal Presenting as Fever in a Critically Ill Patient Receiving Concomitant Enteral Nutrition.

    Science.gov (United States)

    Whitman, Craig B; Ablordeppey, Enyo; Taylor, Beth

    2016-12-01

    Nutritional protein may decrease levodopa absorption and has resulted in withdrawal and neuroleptic malignant-like syndromes in critically ill patients. A 72-year-old male was admitted with shortness of breath. His medical history included Parkinson's disease for over 30 years for which he took carbidopa/levodopa 5 times daily. The patient's home medications were continued. On day 2, he was intubated and transferred to the intensive care unit (ICU). He was extubated the next day and reintubated on day 4. Enteral nutrition was initiated at 85 mL/h overnight. The patient's carbidopa/levodopa was administered to limit coadministration with nutrition. Throughout his ICU stay, the patient did not demonstrate changes in mental status. Despite resolution of his pneumonia, he developed fever after administration of one dose overlapping with nutrition, with defervescence throughout the rest of the day. On hospital day 10, that dose was empirically increased. After this dosing change, the patient failed to develop fever during the rest of his hospital stay. On day 16, the patient was discharged to a long-term care facility without any other complications. Our case highlights the interaction between levodopa and enteral nutrition and the potential of fever as the sole sign of withdrawal.

  11. Stroke Volume During Concomitant Apnea and Exercise: Influence of Gravity and Venous Return

    Science.gov (United States)

    Hoffmann, Uwe; Drager, Tobias; Steegmanns, Ansgar; Koesterer, Thomas; Linnarsson, Dag

    2008-06-01

    The responses of the cardiovascular system to intensive exercise (hiP) and combined stimuli by hiP and breath-hold (hiP-BH) for 20 s were examined during changing gravity (parabolic flight) and constant gravity (1g). The basic response to microgravity (μg) during low-intensity exercise was an increase in cardiac output (CO) and stroke volume (SV) as a result of augmented venous return. When onset of hiP was superimposed, the initial augmentation of CO and SV were increased further. In contrast, when BH was added, the increases of CO and SV were slowed. We propose that this was due to a transient increase of the pulmonary blood volume with the combination of μg and BH at large lung volume, creating a temporary imbalance between right ventricular input and left ventricular output. In addition, the BH- induced relative bradycardia may have contributed to a prolongation of the right-to- left indirect ventricular interdependence.

  12. Superoxide anion radicals induce IGF-1 resistance through concomitant activation of PTP1B and PTEN.

    Science.gov (United States)

    Singh, Karmveer; Maity, Pallab; Krug, Linda; Meyer, Patrick; Treiber, Nicolai; Lucas, Tanja; Basu, Abhijit; Kochanek, Stefan; Wlaschek, Meinhard; Geiger, Hartmut; Scharffetter-Kochanek, Karin

    2015-01-01

    The evolutionarily conserved IGF-1 signalling pathway is associated with longevity, metabolism, tissue homeostasis, and cancer progression. Its regulation relies on the delicate balance between activating kinases and suppressing phosphatases and is still not very well understood. We report here that IGF-1 signalling in vitro and in a murine ageing model in vivo is suppressed in response to accumulation of superoxide anions (O2∙-) in mitochondria, either by chemical inhibition of complex I or by genetic silencing of O2∙--dismutating mitochondrial Sod2. The O2∙--dependent suppression of IGF-1 signalling resulted in decreased proliferation of murine dermal fibroblasts, affected translation initiation factors and suppressed the expression of α1(I), α1(III), and α2(I) collagen, the hallmarks of skin ageing. Enhanced O2∙- led to activation of the phosphatases PTP1B and PTEN, which via dephosphorylation of the IGF-1 receptor and phosphatidylinositol 3,4,5-triphosphate dampened IGF-1 signalling. Genetic and pharmacologic inhibition of PTP1B and PTEN abrogated O2∙--induced IGF-1 resistance and rescued the ageing skin phenotype. We thus identify previously unreported signature events with O2∙-, PTP1B, and PTEN as promising targets for drug development to prevent IGF-1 resistance-related pathologies.

  13. The Yekaterinburg headache initiative

    DEFF Research Database (Denmark)

    Lebedeva, Elena R; Olesen, Jes; Osipova, Vera V

    2013-01-01

    for a demonstrational interventional project in Russia, undertaken within the Global Campaign against Headache. The initiative proposes three actions: 1) raise awareness of need for improvement; 2) design and implement a three-tier model (from primary care to a single highly specialized centre with academic affiliation...... of a health-care needs assessment, and as a model for all Russia. We present and discuss early progress of the initiative, justify the investment of resources required for implementation and call for the political support that full implementation requires. The more that the Yekaterinburg headache initiative...

  14. Phase I clinical trial of HER2-specific immunotherapy with concomitant HER2 kinase inhibtion

    Directory of Open Access Journals (Sweden)

    Hamilton Erika

    2012-02-01

    Full Text Available Abstract Background Patients with HER2-overexpressing metastatic breast cancer, despite initially benefiting from the monoclonal antibody trastuzumab and the EGFR/HER2 tyrosine kinase inhibitor lapatinib, will eventually have progressive disease. HER2-based vaccines induce polyclonal antibody responses against HER2 that demonstrate enhanced anti-tumor activity when combined with lapatinib in murine models. We wished to test the clinical safety, immunogenicity, and activity of a HER2-based cancer vaccine, when combined with lapatinib. Methods We immunized women (n = 12 with metastatic, trastuzumab-refractory, HER2-overexpressing breast cancer with dHER2, a recombinant protein consisting of extracellular domain (ECD and a portion of the intracellular domain (ICD of HER2 combined with the adjuvant AS15, containing MPL, QS21, CpG and liposome. Lapatinib (1250 mg/day was administered concurrently. Peripheral blood antibody and T cell responses were measured. Results This regimen was well tolerated, with no cardiotoxicity. Anti-HER2-specific antibody was induced in all patients whereas HER2-specific T cells were detected in one patient. Preliminary analyses of patient serum demonstrated downstream signaling inhibition in HER2 expressing tumor cells. The median time to progression was 55 days, with the majority of patients progressing prior to induction of peak anti-HER2 immune responses; however, 300-day overall survival was 92% (95% CI: 77-100%. Conclusions dHER2 combined with lapatinib was safe and immunogenic with promising long term survival in those with HER2-overexpressing breast cancers refractory to trastuzumab. Further studies to define the anticancer activity of the antibodies induced by HER2 vaccines along with lapatinib are underway. Trial registry ClinicalTrials.gov NCT00952692

  15. Concomitant administration of GonaCon™ and rabies vaccine in female dogs (Canis familiaris) in Mexico.

    Science.gov (United States)

    Vargas-Pino, Fernando; Gutiérrez-Cedillo, Verónica; Canales-Vargas, Erick J; Gress-Ortega, Luis R; Miller, Lowell A; Rupprecht, Charles E; Bender, Scott C; García-Reyna, Patricia; Ocampo-López, Juan; Slate, Dennis

    2013-09-13

    Mexico serves as a global model for advances in rabies prevention and control in dogs. The Mexican Ministry of Health (MMH) annual application of approximately 16 million doses of parenteral rabies vaccine has resulted in significant reductions in canine rabies during the past 20 years. One collateral parameter of rabies programs is dog population management. Enhanced public awareness is critical to reinforce responsible pet ownership. Surgical spaying and neutering remain important to prevent reproduction, but are impractical for achieving dog population management goals. GonaCon™, an anti-gonadotropin releasing hormone (GnRH) vaccine, was initially tested in captive female dogs on the Navajo Nation, 2008. The MMH led this international collaborative study on an improved formulation of GonaCon™ in captive dogs with local representatives in Hidalgo, Mexico in 2011. This study contained 20 bitches assigned to Group A (6 control), Group B (7 GonaCon™), and Group C (7 GonaCon™ and rabies vaccine). Vaccines were delivered IM. Animals were placed under observation and evaluated during the 61-day trial. Clinically, all dogs behaved normally. No limping or prostration was observed, in spite of minor muscle atrophy post-mortem in the left hind leg of dogs that received GonaCon™. Two dogs that began the study pregnant give birth to healthy pups. Dogs that received a GonaCon™ injection had macro and microscopic lesions consistent with prior findings, but the adverse injection effects were less frequent and lower in intensity. Both vaccines were immunogenic based on significant increases in rabies virus neutralizing antibodies and anti-GnRH antibodies in treatment Groups B and C. Simultaneous administration of GonaCon™ and rabies vaccine in Group C did not affect immunogenicity. Progesterone was suppressed significantly in comparison to controls. Future studies that monitor fertility through multiple breeding cycles represent a research need to determine the

  16. Self-organized ECM-mimetic model based on an amphiphilic multiblock silk-elastin-like corecombinamer with a concomitant dual physical gelation process.

    Science.gov (United States)

    Fernández-Colino, Alicia; Arias, F Javier; Alonso, Matilde; Rodríguez-Cabello, J Carlos

    2014-10-13

    Although significant progress has been made in the area of injectable hydrogels for biomedical applications and model cell niches, further improvements are still needed, especially in terms of mechanical performance, stability, and biomimicry of the native fibrillar architecture found in the extracellular matrix (ECM). This work focuses on the design and production of a silk-elastin-based injectable multiblock corecombinamer that spontaneously forms a stable physical nanofibrillar hydrogel under physiological conditions. That differs from previously reported silk-elastin-like polymers on a major content and predominance of the elastin-like part, as well as a more complex structure and behavior of such a part of the molecule, which is aimed to obtain well-defined hydrogels. Rheological and DSC experiments showed that this system displays a coordinated and concomitant dual gelation mechanism. In a first stage, a rapid, thermally driven gelation of the corecombinamer solution takes place once the system reaches body temperature due to the thermal responsiveness of the elastin-like (EL) parts and the amphiphilic multiblock design of the corecombinamer. A bridged micellar structure is the dominant microscopic feature of this stage, as demonstrated by AFM and TEM. Completion of the initial stage triggers the second, which is comprised of a stabilization, reinforcement, and microstructuring of the gel. FTIR analysis shows that these events involve the formation of β-sheets around the silk motifs. The emergence of such β-sheet structures leads to the spontaneous self-organization of the gel into the final fibrous structure. Despite the absence of biological cues, here we set the basis of the minimal structure that is able to display such a set of physical properties and undergo microscopic transformation from a solution to a fibrous hydrogel. The results point to the potential of this system as a basis for the development of injectable fibrillar biomaterial platforms

  17. Increased Risks of Spontaneous Bacterial Peritonitis and Interstitial Lung Disease in Primary Biliary Cirrhosis Patients With Concomitant Sjögren Syndrome.

    Science.gov (United States)

    Chen, Chun-Ting; Tseng, Yu-Chen; Yang, Chih-Wei; Lin, Hsuan-Hwai; Chen, Peng-Jen; Huang, Tien-Yu; Shih, Yu-Lueng; Chang, Wei-Kuo; Hsieh, Tsai-Yuan; Chu, Heng-Cheng

    2016-01-01

    The incidence of Sjögren syndrome (SS) in primary biliary cirrhosis (PBC) patients is high. The influence of SS on the clinical outcomes of PBC patients, however, remains unclear. Our study retrospectively collected data on PBC-only patients and PBC patients with concomitant SS (PBC-SS) to compare the clinical differences of long-term outcomes between them.A total of 183 patients were diagnosed with PBC from January 1999 to December 2014 at our hospital. Of these, the authors excluded patients with diabetes, hypertension, advanced liver cirrhosis at initial diagnosis of PBC (Child-Turcotte-Pugh classification score of ≥7) and other liver diseases (ie, alcoholic liver disease, alpha-antitrypsin deficiency, viral hepatitis, and primary sclerosing cholangitis), and autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis. Of the remaining 125 patients, 77 (61.6%) were PBC-only and 48 (38.4%) were PBC-SS patients.The mean follow-up duration was 8.76 years. During the observation period, the incidence of interstitial lung disease was higher in the PBC-SS group than in the PBC-only group (P = 0.005). The occurrence of spontaneous bacterial peritonitis was significantly different in PBC-SS patients than in PBC-only patients (P = 0.002). The overall survival was lower in PBC-SS patients than in PBC-only patients (P = 0.033). Although the incidence of hepatocellular carcinoma, end-stage renal disease, variceal bleeding, and hypothyroidism were all higher in the PBC-SS group than in the PBC-only group, the differences were not significant.Our study suggests that PBC-SS patients have a higher risk of developing interstitial lung disease and spontaneous bacterial peritonitis and have a poor prognosis. Aggressive surveillance of thyroid and pulmonary functions should therefore be performed in these patients.

  18. RAS Initiative - Events

    Science.gov (United States)

    The NCI RAS Initiative has organized multiple events with outside experts to discuss how the latest scientific and technological breakthroughs can be applied to discover vulnerabilities in RAS-driven cancers.

  19. Prairie Reconstruction Initiative Project

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The purpose of the Prairie Reconstruction Initiative Advisory Team (PRIAT) is to identify and take steps to resolve uncertainties in the process of prairie...

  20. Surgical Critical Care Initiative

    Data.gov (United States)

    Federal Laboratory Consortium — The Surgical Critical Care Initiative (SC2i) is a USU research program established in October 2013 to develop, translate, and validate biology-driven critical care....

  1. Quality Initiatives - General Information

    Data.gov (United States)

    U.S. Department of Health & Human Services — CMS has developed a standardized approach for the development of quality measures that it uses in its quality initiatives. Known as the Measures Management System...

  2. RAS Initiative - Community Outreach

    Science.gov (United States)

    Through community and technical collaborations, workshops and symposia, and the distribution of reference reagents, the RAS Initiative seeks to increase the sharing of knowledge and resources essential to defeating cancers caused by mutant RAS genes.

  3. Nursing Home Quality Initiative

    Data.gov (United States)

    U.S. Department of Health & Human Services — This Nursing Home Quality Initiative (NHQI) website provides consumer and provider information regarding the quality of care in nursing homes. NHQI discusses quality...

  4. Prairie Reconstruction Initiative

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The purpose of the Prairie Reconstruction Initiative Advisory Team (PRIAT) is to identify and take steps to resolve uncertainties in the process of prairie...

  5. Nursing Home Quality Initiative

    Data.gov (United States)

    U.S. Department of Health & Human Services — This Nursing Home Quality Initiative (NHQI) website provides consumer and provider information regarding the quality of care in nursing homes. NHQI discusses...

  6. Progress in Initiator Modeling

    Energy Technology Data Exchange (ETDEWEB)

    Hrousis, C A; Christensen, J S

    2009-05-04

    There is great interest in applying magnetohydrodynamic (MHD) simulation techniques to the designs of electrical high explosive (HE) initiators, for the purpose of better understanding a design's sensitivities, optimizing its performance, and/or predicting its useful lifetime. Two MHD-capable LLNL codes, CALE and ALE3D, are being used to simulate the process of ohmic heating, vaporization, and plasma formation in the bridge of an initiator, be it an exploding bridgewire (EBW), exploding bridgefoil (EBF) or slapper type initiator. The initiation of the HE is simulated using Tarver Ignition & Growth reactive flow models. 1-D, 2-D and 3-D models have been constructed and studied. The models provide some intuitive explanation of the initiation process and are useful for evaluating the potential impact of identified aging mechanisms (such as the growth of intermetallic compounds or powder sintering). The end product of this work is a simulation capability for evaluating margin in proposed, modified or aged initiation system designs.

  7. Choice of initial therapy

    Directory of Open Access Journals (Sweden)

    Manuel Battegay

    2014-11-01

    Full Text Available Current international and national treatment guidelines such as EACS, BHIVA, DHHS or IAS update regularly recommendations on the choice of initial combination antiretroviral treatment (cART regimens. Preferred cART regimens include a backbone with two nucleoside (nucleotide reverse transcriptase inhibitors combined either with one non-nucleoside reverse transcriptase inhibitor or one ritonavir boosted protease inhibitor or more recently one integrase inhibitor. Response rates according to viral load measurements increased in recent years, in particular due to better tolerability. The choice of initial therapy is flexible and influenced by several factors such as height of viral load, genotypic resistance testing, CD4 cell count, co-morbidities, interactions, potential adverse events, (potential for pregnancy, convenience, adherence, costs as well as physician's and patient's preferences. Diverse highly potent initial cART regimens exist. Following the many possibilities, the choice of a regimen is based on a mixture of evidence-informed data and individualized concepts, some of the latter only partly supported by strong evidence. For example, different perceptions and personal experiences exist about boosted protease inhibitors compared to non-nucleoside reverse transcriptase inhibitors or integrase inhibitors and vice versa which may influence the initial choice. This lecture will discuss choices of initial cART in view of international guidelines and the evidence for individualization of initial HIV therapy.

  8. Use of concomitant inhaled corticosteroids: pooled data from two phase III studies of aclidinium plus formoterol in COPD.

    Science.gov (United States)

    D'Urzo, Anthony; Singh, Dave; Garcia Gil, Esther

    2017-12-01

    Bronchodilator therapy is the backbone of the management of chronic obstructive pulmonary disease. In some patients, inhaled corticosteroids can be prescribed in combination with bronchodilators. Through a subgroup analysis of pooled data from two large phase III clinical trials of bronchodilator therapy according to concomitant inhaled corticosteroid use (user vs. non-user), we sought to evaluate the clinical benefit of adding inhaled corticosteroids to dual bronchodilator therapy in chronic obstructive pulmonary disease. The primary focus of this analysis of pooled data from the phase III ACLIFORM and AUGMENT studies was to evaluate the efficacy of aclidinium/formoterol on lung function stratified by inhaled corticosteroid use. We found that lung-function end points were significantly improved regardless of concomitant inhaled corticosteroid use among patients treated with the dual bronchodilator aclidinium/formoterol 400/12 µg twice daily compared with placebo and both monotherapies. Together with the previously reported observations that aclidinium/formoterol 400/12 µg reduces exacerbations vs. placebo in inhaled corticosteroid users and improves dyspnoea compared to monotherapy in inhaled corticosteroid non-users, these data suggest that both groups achieve lung function improvements, which translates to different clinical benefits depending on whether or not a patient is receiving concomitant inhaled corticosteroids.CHRONIC LUNG DISEASE: 'TRIPLE' THERAPY COULD PROVE BENEFICIAL: A dual bronchodilator therapy taken together with corticosteroid inhalers may benefit patients with severe chronic lung disease. Bronchodilator drugs relax the lungs and widen airways in patients with chronic obstructive pulmonary disease (COPD). While recent studies have shown that a dual bronchodilator therapy containing aclidinium and formoterol significantly improves lung function in COPD, little is known about combining the dual therapy with inhaled corticosteroids (ICSs

  9. Concomitant Superior Mesenteric, Celiac, Renal, and Aortoiliac Aneurysm; Ultrasonography, CT and MRA Findings in A Case Report

    Directory of Open Access Journals (Sweden)

    S. A. Nabavizadeh

    2008-01-01

    Full Text Available Introduction: Visceral artery aneurysms are rare vas-cular diseases whose pathogenesis and natural history remain incompletely understood. Herein we describe an 80 year-old man with concomitant superior mes-enteric, celiac, renal, and aorto-iliac aneurysms. To the best of our knowledge this constellation of arte-rial aneurysms has not been described yet."nCase Presentation: An 80-year-old man was referred to our institution due to presence of tarry stool and one episode of vomiting of coffee ground material. The patient underwent an upper GI endoscopy which revealed esophageal varicosities. Due to presence of esophageal varicosities and clinical suspicion of portal vein thrombosis an ultrasonographic Doppler study of portal venous system was performed in this patient which revealed normal diameter and flow in portal and splenic veins with no evidence of thrombosis; however incidentally aneurismal dilatation of celiac and superior mesenteric arteries and lower part of abdominal aorta and both iliac arteries were found during the ultrasonographic examination. Abdominal CT scan was performed in this patient, which re-vealed aneurismal dilatation of main celiac artery and its main branches. There was also aneurismal dilata-tion of superior mesenteric artery. Aneurismal dilata-tion of distal abdominal aorta with extension to both side common, external, and internal iliac arteries was also seen. MRA of abdomen was also performed which revealed the previous findings plus apparent dilatation of proximal part of right main renal artery which was not considered in previous abdominal CT scan. Since then; he has remained asymptomatic and stable, with no evidence of further expansion of his aneurysms in routine sonographic examinations."nDiscussion: Our patient was a hypertensive hyperlip-idemic old man with history of previous TIA and atherosclerotic carotid plaques, so the most important predisposing factor seemed to be atherosclerosis. Sev-eral work

  10. A study of longitudinal data examining concomitance of pain and cognition in an elderly long-term care population

    Directory of Open Access Journals (Sweden)

    Burfield AH

    2012-03-01

    Full Text Available Allison H Burfield1, Thomas TH Wan2, Mary Lou Sole3, James W Cooper41Gerontology Program, School of Nursing, College of Health and Human Services, University of North Carolina, Charlotte, NC, USA; 2Health Services, Administration, and Medical Education, Director, Doctoral Program in Public Affairs, Associate Dean for Research, College of Health and Public Affairs, 3College of Nursing, University of Central Florida, Orlando, FL, USA; 4College of Pharmacy, University of Georgia, Athens, GA, USAPurpose: To examine if a concomitant relationship exists between cognition and pain in an elderly population residing in long-term care.Background/significance: Prior research has found that cognitive load mediates interpretation of a stimulus. In the presence of decreased cognitive capacity as with dementia, the relationship between cognition and increasing pain is unknown in the elderly.Patients and methods: Longitudinal cohort design. Data collected from the Minimum Data Set-Resident Assessment Instrument (MDS-RAI from the 2001–2003 annual assessments of nursing home residents. A covariance model was used to evaluate the relationship between cognition and pain at three intervals.Results: The sample included 56,494 subjects from nursing homes across the United States, with an average age of 83 ± 8.2 years. Analysis of variance scores (ANOVAs indicated a significant effect (P < 0.01 for pain and cognition, with protected t test revealing scores decreasing significantly with these two measures. Relative stability was found for pain and cognition over time. Greater stability was found in the cognitive measure than the pain measure. Cross-legged effects observed between cognition and pain measures were inconsistent. A concomitant relationship was not found between cognition and pain. Even though the relationship was significant at the 0.01 level, the correlations were low (r ≤ 0.08, indicating a weak association between cognition and pain

  11. Reflux esophagitis and hiatal hernia as concomitant abnormality in patients presenting with active duodenal or gastric ulcer: cross-sectional endoscopic study in consecutive patients.

    Science.gov (United States)

    Loffeld, R J.L.F.; van der Putten, A B.M.M.

    2002-05-01

    BACKGROUND: Follow-up studies have shown that patients with ulcer disease are at risk of developing reflux esophagitis (RE) after successful eradication of Heliobacter pylori. It is still not clear whether this is induced by eradication of H. pylori or whether RE is already present at the time the ulcer is diagnosed. A cross-sectional study was done in consecutive patients suffering from active ulcer disease in order to assess coincidental RE. METHODS: Patients with an active duodenal or gastric ulcer were included in the study. Concomitant RE and the presence of hiatal hernia (HH) were scored. Biopsy specimens were taken for detection of H. pylori. RESULTS: In 375 patients (77%), an active duodenal ulcer was the only abnormality. In 43 patients (8.8%), duodenal ulcer and concomitant RE were present and 69 patients (14.2%) had a duodenal ulcer with concomitant HH. Patients with a duodenal ulcer were significantly younger than patients with concomitant RE or HH. From 374 patients (76.8%) with a duodenal ulcer, biopsy specimens were available for the detection of H. pylori. The majority of duodenal ulcer patients were H. pylori-positive. H. pylori was significantly more often present in patients with an active duodenal ulcer than it was in duodenal ulcer patients suffering from concomitant RE (P=0.04). In 218 patients (76%), a gastric ulcer was the only abnormality. Fifteen patients (5.2%) also had RE and 54 patients (18.8%) had a concomitant HH. There was no difference in H. pylori status in these three groups of patients. CONCLUSIONS: Given the low prevalence of concomitant RE, it is concluded that this condition is likely to occur in a large percentage of patients suffering from H. pylori-positive ulcer disease after successful eradication therapy.

  12. Concomitant treatment of mandibular ameloblastoma and bilateral temporomandibular joint osteoarthritis with bone graft and total joint prostheses.

    Science.gov (United States)

    Rodrigues, Daniel B; Wolford, Larry M; Malaquias, Pietry; Campos, Paulo S F

    2015-01-01

    Temporomandibular joint (TMJ) osteoarthritis is a degenerative disease that can create clinical problems in the masticatory musculature, jaws, occlusion, and other associated structures and is commonly accompanied by inflammatory changes and pain. Many cases of TMJ dysfunction can be managed with nonsurgical therapies, but patients with irreversible TMJ damage may require surgical intervention for repair or reconstruction. Despite various methods of TMJ reconstruction, the patient-fitted total joint prostheses may be the best option to achieve good outcomes. Multicystic ameloblastoma is a benign odontogenic neoplasm of the jaws that is found most often in the mandible, in the region of the molars, and the ramus. Ameloblastomas usually progress slowly, but are locally invasive and may cause significant morbidity and sometimes death. This report describes a case of concomitant treatment of recurrent mandibular ameloblastoma and severe bilateral TMJ osteoarthritis treated by resection of the tumor, reconstruction with bone grafting, and bilateral TMJ reconstruction in a 63-year-old woman.

  13. Concomitance of primary insular carcinoid developing in mature cystic teratoma of the ovary and endometrial papillary serous carcinoma

    Directory of Open Access Journals (Sweden)

    Ayten LİVAOĞLU

    2006-09-01

    Full Text Available The primary ovarian carcinoid tumor is rare and must be differentiated from metastatic carcinoid tumors. Uterine serous papillary carcinoma is a highly aggressive type of endometrial carcinoma. A 70 year old patient referred to the clinic with the complaint of postmenapousal bleeding. Endometrial biopsy was performed and papillary serous carcinoma was diagnosed. Total hysterectomy and bilateral salpingoopherectomy was performed. Beside the tumor in the uterine cavity, the left ovary was 6x4,5x4 cm in size and had a multiloculated cystic appearance with a mural nodule 1,5 cm in diameter. With histopathologic examination, concomitance of insular carcinoid tumor developing in ovarian mature cystic teratoma and endometrial papillary serous carcinoma was found to be interesting and presented.

  14. Successful experience of rituximab therapy for systemic sclerosis-associated interstitial lung disease with concomitant systemic lupus erythematosus.

    Science.gov (United States)

    Sumida, Hayakazu; Asano, Yoshihide; Tamaki, Zenshiro; Aozasa, Naohiko; Taniguchi, Takashi; Takahashi, Takehiro; Toyama, Tetsuo; Ichimura, Yohei; Noda, Shinji; Akamata, Kaname; Miyazaki, Miki; Kuwano, Yoshihiro; Yanaba, Koichi; Sato, Shinichi

    2014-05-01

    Previous studies have demonstrated that B cells play critical roles in autoimmune disorders including systemic sclerosis (SSc) and systemic lupus erythematosus (SLE). However, the effectiveness of rituximab (RTX), a chimeric anti-CD20 antibody, for SSc-associated interstitial lung disease (ILD) or SLE disease activity remains controversial. We herein report an SSc patient with severely progressed ILD and concomitant SLE treated by two cycles of RTX at baseline and half a year later. This treatment improved ILD and SLE activities, along with reduction of dermal sclerosis and serum anti-topoisomerase I antibody levels. In addition, our detailed time-course data indicate that half a year may be appropriate as an interval between each cycle of RTX therapy aimed at SSc-associated ILD or SLE. Overall, the current report could pave the way to establish RTX as a disease-modifying drug for patients with SSc and/or SLE showing resistance to other already approved medications.

  15. Cell-associated HIV DNA measured early during infection has prognostic value independent of serum HIV RNA measured concomitantly

    DEFF Research Database (Denmark)

    Katzenstein, Terese L; Oliveri, Roberto S; Benfield, Thomas;

    2002-01-01

    into 3 groups, according to whether their cell-associated HIV DNA load was or = 2,500 DNA copies/10(6) peripheral blood mononuclear cells. Clinical progression rates differed significantly between the groups (p HIV DNA load had prognostic value independent......Using data from the Danish AIDS Cohort of HIV-infected homosexual men established in the 1980s, the prognostic value of early HIV DNA loads was evaluated. In addition to DNA measurements, concomitant serum HIV RNA levels, CD4 cell counts and CCR5 genotypes were determined. The patients were divided...... of serum HIV RNA (p HIV DNA, HIV RNA and CD4 cell counts were all included in a Cox model, only serum HIV RNA had independent prognostic value. Patients heterozygous for the CCR5 delta 32 allele had significantly lower HIV DNA loads than those homozygous for the normal allele (p

  16. Previous antibacterial treatment due to concomitant infections in preschool children is associated with a lower Helicobacter pylori positivity.

    Science.gov (United States)

    Daugule, Ilva; Rumba, Ingrida; Ejderhamn, Jan

    2005-01-01

    Use of antimicrobial agents has been proposed as 1 of the factors that contribute to the loss of Helicobacter pylori (H. pylori) infection. The aim of the study was to investigate the influence of a previous treatment with antibiotics on the prevalence of H. pylori infection in preschool children. Parents of 146 asymptomatic children (aged 0.5-5 y; no antibiotic treatment during the previous 4 weeks) completed a questionnaire about previous treatment with antibiotics and socioeconomic status. Infection with H. pylori was assessed by the monoclonal stool antigen test. H. pylori positivity was 18% (27/146). It was significantly lower in children who had been treated with antibiotics previously compared to those who had been never treated (12.5% (12/96) vs 30% (15/50), p=0.01). It is concluded that previous antibiotic treatment for concomitant infections is associated with a lower prevalence of H. pylori infection in preschool children.

  17. Protocol for concomitant temporomandibular joint custom-fitted total joint reconstruction and orthognathic surgery utilizing computer-assisted surgical simulation.

    Science.gov (United States)

    Movahed, Reza; Teschke, Marcus; Wolford, Larry M

    2013-12-01

    Clinicians who address temporomandibular joint (TMJ) pathology and dentofacial deformities surgically can perform the surgery in 1 stage or 2 separate stages. The 2-stage approach requires the patient to undergo 2 separate operations and anesthesia, significantly prolonging the overall treatment. However, performing concomitant TMJ and orthognathic surgery (CTOS) in these cases requires careful treatment planning and surgical proficiency in the 2 surgical areas. This article presents a new treatment protocol for the application of computer-assisted surgical simulation in CTOS cases requiring reconstruction with patient-fitted total joint prostheses. The traditional and new CTOS protocols are described and compared. The new CTOS protocol helps decrease the preoperative workup time and increase the accuracy of model surgery.

  18. Evaluation of Asymptomatic Peripheral Arterial Disease by Ankle-brachial Index in Patients with Concomitant Coronary Arterial Disease

    Directory of Open Access Journals (Sweden)

    Hosein Vakili

    2012-12-01

    Full Text Available Background: Peripheral arterial disease is associated with adverse cardiovascular outcomes. As such, it is found that screening for peripheral arterial disease (PAD improves risk assessment. Thus, intensive risk factor modification and medical treatment in these patients are necessary. Objectives: The purpose of this study was to determine the prevalence of asymptomatic peripheral arterial disease in patients with concomitant coronary arterial disease. Methods: Asymptomatic peripheral arterial disease was investigated in 400 patients (60% males, 40% females, aged 59.7± 11.3 with a documented coronary arterial disease. Results: Among patients with documented CAD, 12% had asymptomatic PAD with the ABI ratio of less than 0.9. Conclusions: It is advisable to screen for PAD not only as a disease but also as a risk assessment method for atherosclerosis.

  19. THE PROBLEM OF STATIN USE IN PATIENTS WITH CARDIOVASCULAR DISEASES AND CONCOMITANT LIVER DISEASES. WHAT PREVENTS OVERCOMING STATINOPHOBIA?

    Directory of Open Access Journals (Sweden)

    S. N. Bel'diev

    2016-01-01

    Full Text Available According to a recent study, Russian physicians often and sometimes unreasonably find it impossible to use statins in patients with cardiovascular diseases and concomitant chronic liver diseases. Analysis of domestic publications of recent years reveals the following factors which can impede overcoming statinophobia: 1 fragmentary and contradictory statement of the problem "Statins and liver" in Russian clinical guidelines for management of patients with high cardiovascular risk; 2 common perception that isolated transaminase increase in response to statin therapy is an indicator of "cytolysis" or "cytolytic syndrome"; 3 unreasonably overestimated lipid-lowering activity of combination therapy with low doses of statins and ursodeoxycholic acid; 4 view of the inadmissibility of statin use in patients with transaminase levels more than three upper limit of normal. To overcome these shortcomings and mistakes it seems appropriate to issue national clinical guidelines on statin use in high cardiovascular risk patients with underlying liver disease and/or with elevated transaminases.

  20. Quantitative sensory testing in classical trigeminal neuralgia-a blinded study in patients with and without concomitant persistent pain

    DEFF Research Database (Denmark)

    Younis, Samaira; Maarbjerg, Stine; Reimer, Maren

    2016-01-01

    The diagnostic criteria of the third International Classification of Headache Disorders state that there should be no neurological deficits in patients with classical trigeminal neuralgia (TN) at clinical examination. However, studies demonstrating sensory abnormalities at bedside examination in TN...... scores were calculated to process frequency analyses and Z-profiles. We found increased mechanical detection threshold on the symptomatic side (47.2% vs 0%, P = 0.008), asymptomatic side (33.3% vs 0%, P = 0.011), and hand (36% vs 0%, P ... increased mechanical detection threshold on the symptomatic side compared with the asymptomatic side (-2.980 vs -2.166, P = 0.040). Thermal and mechanical hyperalgesia was detected bilaterally in the face and the hand. Trigeminal neuralgia patients with concomitant persistent pain tended to have higher mean...

  1. Implantable loop recorder monitoring after concomitant surgical ablation for atrial fibrillation (AF): insights from more than 200 continuously monitored patients.

    Science.gov (United States)

    Pecha, Simon; Aydin, Muhammet Ali; Ahmadzade, Teymour; Hartel, Friederike; Hoffmann, Boris; Steven, Daniel; Willems, Stephan; Reichenspurner, Hermann; Wagner, Florian Mathias

    2016-08-01

    Different follow-up methods have been used to report success rates after AF ablation. Recent studies have shown that intermittent rhythm monitoring underestimates the actual AF recurrence rate. We therefore report our experience with continuous rhythm monitoring by implantable loop recorder (ILR) in a large patient cohort. Between 09/2008 and 12/2012, 343 cardiac surgical patients underwent concomitant surgical AF ablation. ILR implantation was performed in 206 patients. ILR interrogation was accomplished at 3, 6 and 12 months postoperatively. Successful ablation was defined as AF Burden <0.5 %. Primary outcome of the study was freedom from AF at 12-month follow-up. Mean patient's age was 70.5 ± 7.4 years. No major ablation- or ILR-related complications occurred. In 4 patients (1.9 %) ILR had to be explanted due to ILR-related wound infection (n = 2) or chronic pain (n = 2). Survival rate at 1-year follow-up was 96.6 %. Freedom from AF rate after 1-year follow-up was 68.5 and 63.6 % off antiarrhythmic drugs, respectively. Statistically significant predictors for successful ablation at 1-year follow-up were smaller LA diameter, shorter duration of AF and preoperative paroxysmal AF. Demographic data, indication for surgery, lesion set and used energy source had no impact on freedom from AF after 1 year. Continuous ILR monitoring after concomitant surgical AF ablation was safe and feasible, with registered freedom from AF rate of 68.5 % at 1-year follow-up. Thus continuous rhythm monitoring provides reliable outcome data and helps to guide antiarrhythmic therapy.

  2. Concomitant targeting of EGF receptor, TGF-beta and SRC points to a novel therapeutic approach in pancreatic cancer.

    Directory of Open Access Journals (Sweden)

    Sophie Deharvengt

    Full Text Available To test the hypothesis that concomitant targeting of the epidermal growth factor receptor (EGFR and transforming growth factor-beta (TGF-β may offer a novel therapeutic approach in pancreatic cancer, EGFR silencing by RNA interference (shEGFR was combined with TGF-β sequestration by soluble TGF-β receptor II (sTβRII. Effects on colony formation in 3-dimensional culture, tumor formation in nude mice, and downstream signaling were monitored. In both ASPC-1 and T3M4 cells, either shEGFR or sTβRII significantly inhibited colony formation. However, in ASPC-1 cells, combining shEGFR with sTβRII reduced colony formation more efficiently than either approach alone, whereas in T3M4 cells, shEGFR-mediated inhibition of colony formation was reversed by sTβRII. Similarly, in vivo growth of ASPC-1-derived tumors was attenuated by either shEGFR or sTβRII, and was markedly suppressed by both vectors. By contrast, T3M4-derived tumors either failed to form or were very small when EGFR alone was silenced, and these effects were reversed by sTβRII due to increased cancer cell proliferation. The combination of shEGFR and sTβRII decreased phospho-HER2, phospho-HER3, phoshpo-ERK and phospho-src (Tyr416 levels in ASPC-1 cells but increased their levels in T3M4 cells. Moreover, inhibition of both EGFR and HER2 by lapatinib or of src by SSKI-606, PP2, or dasatinib, blocked the sTβRII-mediated antagonism of colony formation in T3M4 cells. Together, these observations suggest that concomitantly targeting EGFR, TGF-β, and src may constitute a novel therapeutic approach in PDAC that prevents deleterious cross-talk between EGFR family members and TGF-β-dependent pathways.

  3. Phase II Study of Short-Course Radiotherapy Plus Concomitant and Adjuvant Temozolomide in Elderly Patients With Glioblastoma

    Energy Technology Data Exchange (ETDEWEB)

    Minniti, Giuseppe, E-mail: Giuseppe.Minniti@ospedalesantandrea.it [Department of Radiation Oncology, Sant' Andrea Hospital, University ' La Sapienza,' Rome (Italy); Department of Neurological Sciences, Neuromed Institute, Pozzilli (Italy); Lanzetta, Gaetano [Department of Neurological Sciences, Neuromed Institute, Pozzilli (Italy); Scaringi, Claudia [Department of Radiation Oncology, Sant' Andrea Hospital, University ' La Sapienza,' Rome (Italy); Caporello, Paola [Department of Medical Oncology, Sant' Andrea Hospital, University ' La Sapienza,' Rome (Italy); Salvati, Maurizio [Department of Neurosurgery, Umberto I Hospital, University ' La Sapienza,' Rome (Italy); Arcella, Antonella [Department of Neurological Sciences, Neuromed Institute, Pozzilli (Italy); De Sanctis, Vitaliana [Department of Radiation Oncology, Sant' Andrea Hospital, University ' La Sapienza,' Rome (Italy); Giangaspero, Felice [Department of Neurological Sciences, Neuromed Institute, Pozzilli (Italy); Department of Pathology, Umberto I Hospital, University ' La Sapienza,' Rome (Italy); Enrici, Riccardo Maurizi [Department of Radiation Oncology, Sant' Andrea Hospital, University ' La Sapienza,' Rome (Italy)

    2012-05-01

    Purpose: Radiotherapy (RT) and chemotherapy may prolong survival in older patients (age {>=}70 years) with glioblastoma multiforme (GBM), although the survival benefits remain poor. This Phase II multicenter study was designed to evaluate the efficacy and safety of an abbreviated course of RT plus concomitant and adjuvant temozolomide (TMZ) in older patients with GBM. Patients and Methods: Seventy-one eligible patients 70 years of age or older with newly diagnosed GBM and a Karnofsky performance status {>=}60 were treated with a short course of RT (40 Gy in 15 fractions over 3 weeks) plus TMZ at the dosage of 75 mg/m{sup 2} per day followed by 12 cycles of adjuvant TMZ (150-200 mg/m{sup 2} for 5 days during each 28-day cycle). The primary endpoint was overall survival (OS). Secondary endpoints included progression-free survival and toxicity. Results: The Median OS was 12.4 months, and the 1-year and 2-year OS rates were 58% and 20%, respectively. The median and 1-year rates of progression-free survival were 6 months and 20%, respectively. All patients completed the planned programme of RT. Grade 3 or 4 adverse events occurred in 16 patients (22%). Grade 3 and 4 neutropenia and/or thrombocytopenia occurred in 10 patients (15%), leading to the interruption of treatment in 6 patients (8%). Nonhematologic Grade 3 toxicity was rare, and included fatigue in 4 patients and cognitive disability in 1 patient. Conclusions: A combination of an abbreviated course of RT plus concomitant and adjuvant TMZ is well tolerated and may prolong survival in elderly patients with GBM. Future randomized studies need to evaluate the efficacy and toxicity of different schedules of RT in association with chemotherapy.

  4. Tumor necrosis factor-α antagonist therapy for concomitant rheumatoid arthritis and hepatitis C virus infection: a case series study.

    Science.gov (United States)

    Lin, Ko-Ming; Cheng, Tien-Tsai; Lin, Jing-Chi; Chen, Chung-Jen

    2015-06-01

    The aim of this study was to investigate treatment response and hepatic safety of anti-tumor necrosis factor-α therapy among patients with concomitant rheumatoid arthritis (RA) and hepatitis C virus (HCV) infection. We reviewed the charts of 101 consecutive RA patients who were eligible for anti-TNF-α therapy in the Chiayi Branch of Chang Gung Memorial Hospital. Group A patients were sero-positive for anti-HCV antibodies and had HCV RNA but were negative for hepatitis B surface antigen (HBsAg). Group B (the control group) patients were sero-negative for both anti-HCV antibodies and HBsAg. Response to anti-TNF-α treatment was assessed by calculating disease activity score at 28 joints (DAS28) at baseline and 5, 8, and 11 months after the start of TNF-α antagonist therapy. Percentage change in DAS28 from baseline to month 5 was 21.36 ± 8.01 % in group A and 26.98 ± 10.43 % in group B (p = 0.011). However, there was no obvious difference in treatment response between groups at other time points. Anti-TNF-α therapy was discontinued within 1 year of starting treatment in two subjects in group A and 4 in group B. Response to anti-TNF-α was better in group B than in group A at 5 months, but there was no substantial difference in response at the 1-year evaluation. Although the study sample was small, our results suggest that the safety of anti-TNF-α therapy is similar in RA patients with and without concomitant HCV infection.

  5. Concomitant relationship and clinical signifiance of the arteries and veins of hand%手部动静脉伴行关系及临床意义

    Institute of Scientific and Technical Information of China (English)

    李忠华; 钟世镇; 石瑾; 王兴海; 洪辉文; 刘畅

    2001-01-01

    目的:为手外科提供手部动、静脉伴行关系的规律性。方法:10例新鲜带前臂的手部标本,血管分别灌注过氯乙烯乙酸乙酯或乳胶填充剂,制成动、静脉分色腐蚀铸型标本和解剖剥制标本,观察手部动、静脉伴行关系。结果:手部浅、深血管弓,掌心血管,指掌侧总血管动、静脉呈紧密伴行关系。手掌侧和背侧部浅血管以及手指的掌侧和背侧部血管,动、静脉无伴行关系或伴行不紧密。结论:手部动静脉血管配布规律是:浅层血管呈网络型分布,动静脉无伴行关系,越接近深部,动静脉伴行关系越紧密。指部血管伴行关系都不紧密或没有伴行关系。%Objective: To provide hand surgery with the regularity of concomitant relationship between the arteries and veins of hand.Methods: Concomitant relationship between the arteries and veins of hand were observed in 10 sides decicolor cast specimens and stuffing specimens perfused with hyperchlororinylaceticether or emulsoid.Results: Tight concomitant relationship was observed in the superficial and deep arcus vasclar, palmar metacarpal vessels and common palmar digital vessels.In the palm and the opisthenar, the superficial vessels were not concomitant or not concomitant tightly, so were the vessels of maniphalanx.Conclusion: The distribution regularity between the arteries and veins of hand was showed as follow: Like a network, vessels are not concomitant in the superficial laminae of hand.However, deeper to the partes profunda of the hand, more tight concomitant relationship between the arteries and veins was found.The vessels of the maniphalanx are not concomitant or not tight concomitant.

  6. Analysis of Road Traffic Crashes-Related Maxillofacial Injuries Severity and Concomitant Injuries in 201 Patients Seen at the UCH, Ibadan.

    Science.gov (United States)

    Aladelusi, Timothy; Akinmoladun, Victor; Olusanya, Adeola; Akadiri, Oladimeji; Fasola, Abiodun

    2014-12-01

    The objective of this study was to determine the prevalence of road traffic crashes (RTC)-related maxillofacial injuries, the concomitant injuries occurring with them, and to assess the relationship between the severity of maxillofacial and concomitant injuries. This was a prospective study involving 201 victims of RTC seen at the Accident and Emergency Department of the University College Hospital, Ibadan with maxillofacial injuries during the study period. Demographic data of the patients, the types of maxillofacial injuries, and concomitant injuries sustained were recorded. Severity of maxillofacial injury was determined using the maxillofacial injury severity scale (MFISS), while the severity of concomitant injuries was based on the ISS. Correlations between types and severity of maxillofacial injury and types and severity of concomitant injury were conducted to determine the predictability of concomitant injuries based on maxillofacial injury severity. Data were processed using SPSS Statistical software (SPSS, version 20.0 for windows, IBM SPSS Inc, Chicago, IL). Maxillofacial injuries constituted 25.4% of RTC-related admission by the Accident and Emergency Department. A total of 151 (75.1%) patients who presented with concomitant injuries participated in the study. Eighty-one (53.6%) sustained injuries to more than one body region. Head injury was the commonest (99, 65.6%) concomitant injury, followed by orthopedic injury (69, 45.7%). Increasing severity of maxillofacial injury showed a positive correlation with increasing ISS. Also, positive correlation was noted with increasing severity of maxillofacial injury and presence of polytrauma (p = 0.01), traumatic brain injury (p = 0.034), and eye injuries (p = 0.034). There was a high prevalence of maxillofacial injuries in victims of RTC. There was a high incidence of concomitant injuries noted with these maxillofacial injuries. Significantly, this study showed a direct relationship between the

  7. Initial conditions for inflation

    CERN Document Server

    Dimopoulos, Konstantinos

    2016-01-01

    A novel proposal is presented, which manages to overcome the initial conditions problem of inflation with a plateau. An earlier period of proto-inflation, beginning at Planck scale, accounts for the Universe expansion and arranges the required initial conditions for inflation on the plateu to commence. We show that, if proto-inflation is power-law, it does not suffer from any eternal inflationary stage. A simple model realisation is constructed in the context of $\\alpha$-attractors, which can both generate the inflationary plateau and the exponential slopes around it, necessary for the two inflation stages. Our mechanism allows to assume chaotic initial conditions at the Planck scale for proto-inflation, it is generic and it is shown to work without fine-tunings.

  8. Win-win initiatives

    Energy Technology Data Exchange (ETDEWEB)

    Specter, Herschel

    1999-03-01

    This paper explores the use of win-win initiatives as a means of making safety improvements while simultaneously reducing plant operating costs. A two-phased process for implementing these initiatives is provided. Near-term progress is emphasized in the first phase by using presently available information. The second phase addresses complex issues such as closure in the regulatory process, modernizing the role of determinism in decisionmaking, closer coupling of performance-based regulation and risk-informed regulation, modernizing the testing of important plant equipment, and the treatment of uncertainties.

  9. Initiation of HIV therapy

    OpenAIRE

    Ho, Charlotte Yuk-Fan; Ling, Bingo Wing-Kuen

    2010-01-01

    In this paper, we numerically show that the dynamics of the HIV system is sensitive to both the initial condition and the system parameters. These phenomena imply that the system is chaotic and exhibits a bifurcation behavior. To control the system, we propose to initiate an HIV therapy based on both the concentration of the HIV-1 viral load and the ratio of the CD4 lymphocyte population to the CD8 lymphocyte population. If the concentration of the HIV-1 viral load is higher than a threshold,...

  10. Information Technology Initiative (Videorecording),

    Science.gov (United States)

    Physical description: 1 VHS video; col.; sd.; mono.; standard playback sp.; 35:40 mins.; 1/2 in. In this video, Dr. Kurt Fisher, Deputy Director for Information Technology , introduces the Corporate Information Management (CIM) program and explains the following major technical initiatives: reuse/repositories; I-case; data administration; information technology architecture; software process improvement; standards.

  11. Best Practices & Outstanding Initiatives

    Science.gov (United States)

    Training, 2011

    2011-01-01

    In this article, "Training" editors recognize innovative and successful learning and development programs and practices. They share best practices from Automatic Data Processing, Inc., Farmers Insurance Group, FedEx Express, InterContinental Hotels Group, and Oakwood Temporary Housing. They also present the outstanding initiatives of EMD Serono,…

  12. Global healthy backpack initiatives.

    Science.gov (United States)

    Jayaratne, Kapila; Jacobs, Karen; Fernando, Dulitha

    2012-01-01

    Schoolbag use by children is a global common concern.. Children carry school books and other amenities in their school bags. Global evidence indicates that daily load carried by school children may have negative health implications. Backpack as a school bag model, is the healthiest way of load carriage for school children. Several initiatives have been launched world over to minimize unhealthy consequences resulting from schoolbags. Based on a situation analysis, Sri Lanka implemented a national healthy schoolbag campaign by joint efforts of Ministries of Health and Education. Actions were contemplated on; strategies for bag weight reduction, introduction of an ergonomically modeled schoolbag and bag behaviour change. New strategies were introduced with awareness campaigns to policy makers, bag manufacturers, parents, teachers and children. Four million schoolchildren benefitted. In 2000, the backpack strategy of "Pack it Light, Wear it Right" was started as a public health initiative in the United States by the American Occupational Therapy Association (AOTA). Over the last eleven years, thousands of occupational therapy practitioners and students participated in educational programs and outreach activities. In 2004, modeled after the success AOTA initiative, the Icelandic Occupational Therapy Association launched a national backpack awareness initiative. This article shares examples of practices that could be implemented in any context to the promote health of children.

  13. The SEED Initiative

    Science.gov (United States)

    Teich, Carolyn R.

    2011-01-01

    Committed to fulfilling the promise of the green economy, the American Association of Community Colleges (AACC) launched the Sustainability Education and Economic Development (SEED) initiative (www.theseedcenter.org) in October 2010. The project advances sustainability and clean energy workforce development practices at community colleges by…

  14. Initial Symptoms of ALS

    Science.gov (United States)

    ... Research In Your Community Advocate Get Involved Donate Symptoms and Diagnosis En español Symptoms The initial symptoms of ALS can be quite ... the eyes and bladder are generally not affected. Diagnosis ALS is a difficult disease to diagnose. There ...

  15. Ontario's Student Voice Initiative

    Science.gov (United States)

    Courtney, Jean

    2014-01-01

    This article describes in some detail aspects of the Student Voice initiative funded and championed by Ontario's Ministry of Education since 2008. The project enables thousands of students to make their voices heard in meaningful ways and to participate in student-led research. Some students from grades 7 to 12 become members of the Student…

  16. 多西他赛联合卡培他滨方案在新辅助化疗三阴乳腺癌与非三阴乳腺癌中的近期疗效观察%Short-term Curative Effects of Docetaxel Combined with Capecitabine in Neoadjuvant Chemotherapy of Triple-negative Breast Cancer and Non Triple-negative Brest Cancer

    Institute of Scientific and Technical Information of China (English)

    张淼; 宋敏; 屈淑贤; 章国晶; 郭放; 韩雅玲; 谢晓冬

    2015-01-01

    目的:探讨三阴乳腺癌( triple-negative breast cancer, TNBC)与非三阴乳腺癌患者应用多西他赛联合卡培他滨( DX)方案行新辅助化疗的临床疗效及不良反应。方法选择2008年7月—2013年8月收治的102例乳腺癌患者,其中TNBC 27例,非TNBC75例,均应用DX方案新辅助化疗。观察临床疗效和毒副反应发生情况。结果TNBC患者总有效率与非TNBC患者比较差异无统计学意义( P>0.05)。 TNBC患者病理完全缓解率、临床完全缓解率高于非TNBC患者(P0.05)。结论 TNBC患者较非TNBC患者对DX方案新辅助化疗更敏感,且未增加毒副反应发生率。%Objective To compare the curative effect and adverse reactions of Docetaxel combined with Capecit-abine (DX) in neoadjuvant chemotherapy of patients with triple-negative breast cancer (TNBC) or non triple-negative breast cancer. Methods A total of 102 patients with breast cancer during July 2008 and August 2013 underwent DX neoadjuvant chemotherapy, including 27 patients and 75 non-TNBC patients. The curative effect and adverse reactions were observed. Results There was no significant difference in the overall response ( OR) between TNBC patients and non-TNBC patients (P>0. 05). The pathological complete response and clinical complete remission rates of TNBC pa-tients were significantly higher than those of non-TNBC patients (P0. 05). Conclusion The neoadjuvant chemotherapy using Docetaxel combined with Capecitabine shows a higher sensi-tivity in TNBC patients, compared with that in non-TNBC patients without an increase of incidence rate of adverse reac-tions.

  17. Concomitant septic arthritis and tophaceous gout of the knee managed with intermittent closed joint irrigation combined with negative pressure therapy: a case study and literature review.

    Science.gov (United States)

    V N, Panicker; J K, Turner; M J, Chehade

    2014-01-01

    Tophaceous gout complicated by septic arthritis presents a management dilemma which can often require multiple surgical debridements. There is little published in the literature regarding treatment of these concomitant conditions. We postulate that biofilm may play a role increasing the difficulty of sterilising a tophaceous joint. The use of topical negative pressure therapy that targets biofilm has been well established for a range of wounds. A new device that incorporates both intermittent negative pressure therapy and wound irrigation was introduced in 2012. This case report describes the use of this topical negative device with the instillation option in the management of severe septic arthritis with concomitant gout and suggests directions for further research.

  18. A RARE PRESENTATION OF A CONCOMITANT LUMBAR SPINE BURST FRACTURE WITH A DISTAL CORPUS STERNI FRACTURE DUE TO A FLEXION DISTRACTION INJURY

    Directory of Open Access Journals (Sweden)

    Ravi Kumar TV, GadiDaksh, Jain Vinay, Rangaswamy BT

    2015-04-01

    Full Text Available ABSTRACT Sternum fractures are a rare entity and occur either due to direct trauma or indirectly associated to a flexion compression injury. Earlier literatures used to describe the association of sternum fractures with upper thoracic vertebral fractures. To the best of our knowledge very few cases have been described in literature with concomitant lumbar vertebral fracture with associated sternum fracture. We hereby report a rare presentation of a flexion distraction injury leading to a concomitant sternum fracture with a L1 vertebral burst fracture.

  19. INITIAL TRAINING OF RESEARCHERS

    Directory of Open Access Journals (Sweden)

    Karina Alejandra Cruz-Pallares

    2015-07-01

    Full Text Available The document presents results of a research that used as strategy a complementary training project with thirty-three students of a Bachelors Degree in Primary School 1997(DPS,1997 of an Education Faculty for the initial training of investigators, applied by four teachers members of the academic research group in Mexico; that develops through process of action research methodology. Highlighted in results is the strengthening of the competition of reading, understanding and writing scientific texts, which is analogous to the first feature of the graduate profile called intellectual skills. Among the conclusions it is emphasized that the initial training of teachers in a task that is quite interesting, challenging and complex, as is the educational complex phenomenon.

  20. Rosmarinus officinalis vitroculture initiation

    Directory of Open Access Journals (Sweden)

    Liviu POP

    2007-05-01

    Full Text Available In this experiment we have initiated a Rosmarinus officinalis vitroculture, on different growth media. As biological material we used apexes, taken from an only plant. The development medium have consisted in Murashige and Skoog standard mixture, where growth regulators were added, resulting 4 experimental variants: V0 – control variant – basic medium (BM, V1 – BM + 2mg/l BA + 1mg/l IBA, V2 - BM + 2mg/l BA + 1mg/l IAA, V3 –BM + 2mg/l BA + 1mg/l NAA. The experiment lasted for 90 days. We have found that the initiation of Rosmarinus officinalis vitroculture is possible, the best growth medium for this purpose being the basic one (V0 - Murashige and Skoog without growth regulators.

  1. Renormalizing an initial state

    CERN Document Server

    Collins, Hael; Vardanyan, Tereza

    2014-01-01

    The intricate machinery of perturbative quantum field theory has largely been devoted to the 'dynamical' side of the theory: simple states are evolved in complicated ways. This article begins to address this lopsided treatment. Although it is rarely possible to solve for the eigenstates of an interacting theory exactly, a general state and its evolution can nonetheless be constructed perturbatively in terms of the propagators and structures defined with respect to the free theory. The detailed form of the initial state in this picture is fixed by imposing suitable `renormalization conditions' on the Green's functions. This technique is illustrated with an example drawn from inflation, where the presence of nonrenormalizable operators and where an expansion that naturally couples early times with short distances make the ability to start the theory at a finite initial time especially desirable.

  2. Self-initiated expatriates

    DEFF Research Database (Denmark)

    Selmer, Jan; Lauring, Jakob

    2014-01-01

    Purpose – As it has been suggested that adult third-culture kids may be more culturally adaptable than others, they have been labelled “the ideal” expatriates. In this article, we explore the adjustment of self-initiated expatriate academics in Hong Kong, comparing adult third-culture kids...... with adult mono-culture kids. Design/methodology/approach – We use survey results from 267 self-initiated expatriate academics in Hong Kong. Findings – Exploratory results show that adult third-culture kids had a higher extent of general adjustment. No significant results were found in relation...... to interaction adjustment and job adjustment. We also found that recent expatriate experiences generally had a positive association with the adjustment of adult mono-culture kids, but this association only existed in terms of general adjustment for adult third-culture kids. Originality/value – Once corroborated...

  3. CO2 SELECTIVE CERAMIC MEMBRANE FOR WATER-GAS-SHIFT REACTION WITH CONCOMITANT RECOVERY OF CO2

    Energy Technology Data Exchange (ETDEWEB)

    Paul K.T. Liu

    2005-07-15

    A high temperature membrane reactor (MR) has been developed to enhance the water-gas-shift (WGS) reaction efficiency with concomitant CO{sub 2} removal for sequestration. This improved WGS-MR with CO{sub 2} recovery capability is ideally suitable for integration into the Integrated Gasification Combined-Cycle (IGCC) power generation system. Two different CO{sub 2}-affinity materials were selected in this study. The Mg-Al-CO{sub 3}-layered double hydroxide (LDH) was investigated as an adsorbent or a membrane for CO{sub 2} separation. The adsorption isotherm and intraparticle diffusivity for the LDH-based adsorbent were experimentally determined, and suitable for low temperature shift (LTS) of WGS. The LDH-based membranes were synthesized using our commercial ceramic membranes as substrate. These experimental membranes were characterized comprehensively in terms of their morphology, and CO{sub 2} permeance and selectivity to demonstrate the technical feasibility. In parallel, an alternative material-base membrane, carbonaceous membrane developed by us, was characterized, which also demonstrated enhanced CO{sub 2} selectivity at the LTS-WGS condition. With optimization on membrane defect reduction, these two types of membrane could be used commercially as CO{sub 2}-affinity membranes for the proposed application. Based upon the unique CO{sub 2} affinity of the LDHs at the LTS/WGS environment, we developed an innovative membrane reactor, Hybrid Adsorption and Membrane Reactor (HAMR), to achieve {approx}100% CO conversion, produce a high purity hydrogen product and deliver a concentrated CO{sub 2} stream for disposal. A mathematical model was developed to simulate this unique one -step process. Finally a benchtop reactor was employed to generate experimental data, which were consistent with the prediction from the HAMR mathematical model. In summary, the project objective, enhancing WGS efficiency for hydrogen production with concomitant CO{sub 2} removal for

  4. Northwest Manufacturing Initiative

    Science.gov (United States)

    2012-03-27

    Training areas included Total Productive Maintenance, First Aide and Safety, Lean Training, Inventory Management, Purchasing Supply Chain, ISO 13485 ...improve their business through quality certifications and initiatives such as AS9100, ISO 9001-2000, and implementing Lean Manufacturing. All of these...not show up on a visible profile. 13 Certifications: Quality Certifications such as AS9100, ISO etc. a. List Certifying Agency and number

  5. Complete Remission Obtained with Azacitidine in a Patient with Concomitant Therapy Related Myeloid Neoplasm and Pulmonary Mucormycosis

    Directory of Open Access Journals (Sweden)

    Saveria Capria

    2013-07-01

    Full Text Available Mucormycosis is the third cause of invasive mycosis after candidiasis and aspergillosis in AML patients, representing a poor prognostic factor associated with a high rate of fatal outcome. We report  a case of a patient with AML and a concomitant pulmonary mucormycosis at diagnosis,  who obtained a  complete remission both of her AML and of the fungal infection. The incidence of the infection at the onset of leukemia is extremely unusual, and, to our knowledge, the sporadic cases reported in the literature are included in heterogeneous series retrospectively examined. In our case, Liposomal Amphotericin B as single agent appeared incapable of controlling the infection, so anti-infective therapy was intensified with posaconazole and simultaneously antileukemic treatment with 5-azacitidine was started, with the understanding that the only antifungal treatment would not have been able to keep the infection under control for a long time if not associated with a reversal of neutropenia related to the disease. We observed a progressive improvement of the general conditions, a healing of pneumonia and a complete remission of the leukemic disease, suggesting that a careful utilization of the new compounds available today, in terms of both antifungal and antileukemic treatment, may offer a curative chance a patient who would have otherwise been considered unfit for a potentially curative therapeutic strategy.

  6. Need for surveillance of concomitant peripheral artery disease in patients with coronary disease: results of the AGATHA survey in Malaysia

    Institute of Scientific and Technical Information of China (English)

    Kui Hian Sim; Kok Han Chee; Inderjit Singh; Choon Kiat Ang; Houng Bang Liew; Kim Heung Tan; Omar Ismail

    2007-01-01

    Background For patients with cardiovascular disease (CVD), co-existence of peripheral artery disease (PAD) predicts increased mortality, and such patients are also more likely to benefit from aggressive therapy. Surveillance of PAD is often neglected at health clinics. Our aim is to highlight the importance and ease of surveillance of PAD in patients with CVD. Objective To determine the prevalence of symptomatic and asymptomatic PAD in a Malaysian patient population with documented CVD. Methods and Results A total of 393 subjects with established CVD were recruited from three centres (85 women and 308 men), as part of a larger international (AGATHA) survey. PAD, determined by presence of claudicant symptoms on interview and/or abnormal ankle-brachial index (ABI)score of less than 0.9, was present in 21.4% of patients - of whom 64% were asymptomatic. Abnormal ABI is associated with higher systolic blood pressure and number of arterial beds affected. Conclusions Concomitant PAD is prevalent among CVD patients in Malaysia. ABI screening is simple and yields a high proportion of patients with extensive atherosclerosis who may require more aggressive atherosclerotic risk management.

  7. Features of the autonomic nervous system in elderly patients with paratraumatic eczema with concomitant varicosis and arterial hypertension

    Directory of Open Access Journals (Sweden)

    Ahmad Mohammadamin Ahmad Baninaser

    2016-01-01

    Full Text Available Relevance. In elderly and senile age there are changes in the neuroendocrine regulation in the body. Aim. In order to determine the status of cardiac activity autonomic regulation in elderly and old age patients with paratraumatic eczema 25 patients with paratraumatic eczema on the background of varicose symptom complex and hypertension aged 60-74 years, 25 patients with paratraumatic eczema on the background of varicose symptom. complex and hypertension aged 75-89 years, 15 patients with paratraumatic eczema on the background of varicose veins, but no concomitant hypertension and 15 patients aged 20-35 years were studied. Methods and results. Significant decrease in HRV fluctuations has been established, especially in the high frequency HF, describing parasympathetic influence on the heart. Statistically significant difference (p<0.05 among patients with varicose eczema on the background of hypertension was established as compared with older patients (60-74 years and patients without hypertension: 311.61±95 ms² (р<0.001, 544.7±131 ms² (р<0.01 and 662.9±127 ms² (р<0.01, respectively. Conclusion. These data indicate that the state of cardiac autonomic regulation of patients with paratraumatic eczema directly correlates with the age and the presence of comorbidity (chronic venous failure and hypertension.

  8. Concomitant Carboxylate and Oxalate Formation From the Activation of CO2 by a Thorium(III) Complex

    Science.gov (United States)

    Formanuik, Alasdair; Ortu, Fabrizio; Inman, Christopher J.; Kerridge, Andrew; Castro, Ludovic

    2016-01-01

    Abstract Improving our comprehension of diverse CO2 activation pathways is of vital importance for the widespread future utilization of this abundant greenhouse gas. CO2 activation by uranium(III) complexes is now relatively well understood, with oxo/carbonate formation predominating as CO2 is readily reduced to CO, but isolated thorium(III) CO2 activation is unprecedented. We show that the thorium(III) complex, [Th(Cp′′)3] (1, Cp′′={C5H3(SiMe3)2‐1,3}), reacts with CO2 to give the mixed oxalate‐carboxylate thorium(IV) complex [{Th(Cp′′)2[κ2‐O2C{C5H3‐3,3′‐(SiMe3)2}]}2(μ‐κ2:κ2‐C2O4)] (3). The concomitant formation of oxalate and carboxylate is unique for CO2 activation, as in previous examples either reduction or insertion is favored to yield a single product. Therefore, thorium(III) CO2 activation can differ from better understood uranium(III) chemistry. PMID:27714966

  9. An evaluation of Cognitive Stimulation Therapy sessions for people with dementia and a concomitant support group for their carers.

    Science.gov (United States)

    Bailey, Jan; Kingston, Paul; Alford, Simon; Taylor, Louise; Tolhurst, Edward

    2016-01-18

    This research aimed to ascertain the impact of a pragmatic Cognitive Stimulation Therapy course of 10 sessions on the cognitive function of people living with dementia and whether attending a concomitant carers support group was beneficial to carers. A mixed method quasi-experimental approach was adopted; data were collected pre- and post-intervention. The quantitative arm utilised three validated questionnaires rated by the carers. Qualitative data were collected via semi-structured interviews with carers regarding their perceptions of the impact of Cognitive Stimulation Therapy and the carers support group. Quantitative data analysis found no statistically significant differences within or between groups. The qualitative data demonstrated that carers perceived Cognitive Stimulation Therapy had some benefits for the people living with dementia, especially social benefits. Carers also perceived that attending the carers support group was beneficial for them in terms of gaining a better understanding of dementia, developing coping skills and having peer support. The study was limited in scale and further research with a larger sample, using direct measures of the impact of Cognitive Stimulation Therapy with people living with dementia and supplementary research exploring which characteristic of carers support groups are effective would be worthwhile.

  10. Pineal Diffuse Large B-Cell Lymphoma Concomitant With Pituitary Prolactinoma: Possible Correlation Between 2 Distinguished Pathologies

    Science.gov (United States)

    Kim, Yeong-Jin; Kim, Hee Kyung; Yang, Deok-Hwan; Jung, Shin; Noh, Myung-Giun; Lee, Jae-Hyuk; Lee, Kyung-Hwa; Moon, Kyung-Sub

    2016-01-01

    Abstract This is the first reported case of pineal lymphoma with concomitant prolactin-producing pituitary adenoma. A 51-year-old male experienced worsening headaches accompanied by nausea, diplopia, and memory loss for 1 month. Cranial nerve examination revealed bilateral upward gaze limitation with convergence impairment, which is known as Parinaud syndrome. Magnetic resonance images revealed a mass in the pineal gland with a coexisting mass within the enlarged sella fossa. Hormone analysis revealed hyperprolactinemia. The pineal mass was removed without injuring the hypothalamus, brain stem, or any neighboring vessels. Pathology examination confirmed the diagnosis of diffuse large B-cell lymphoma (DLBCL) involving the pineal gland. After further studies, the pineal lymphoma was determined to be a secondary tumor from a gastric primary tumor. The patient died 6 months after diagnosis due to systemic progression of DLBCL. Although the mechanistic link between hyperprolactinemia and lymphoma progression has not been clarified on a clinical basis, high prolactin levels may contribute to the rapid progression and therapeutic resistance of the lymphoma. PMID:26937937

  11. Comparison of blood neoangiogenesis and lymphatic vascularization in colorectal adenomas from patients with and without concomitant colorectal cancer

    Directory of Open Access Journals (Sweden)

    L.R. Moreira

    2009-07-01

    Full Text Available Blood and lymphatic vessel proliferation is essential for tumor growth and progression. Most colorectal carcinomas develop from adenomas (adenoma-carcinoma sequence in a process due to accumulation of molecular genetic alterations. About 5% of adenomatous polyps are expected to become malignant, but data on the differential angiogenic patterns of these lesions in patients with and without concomitant cancer are missing. The aim of the present study is to compare the angiogenic and lymphatic patterns of adenomatous polyps from patients with and without sporadic cancer. Thirty adenomatous polyps (15 from patients with another principal malignant lesion, and 15 from patients without cancer were submitted to immunohistochemical staining for CD105 (marker for neoangiogenesis and D2-40 (marker for lymphatic endothelium. Microvessel density and total vascular area were determined by computer image analysis to quantify the immunostained and total areas, and to assess the number of microvessels. Adenomas from patients with carcinoma showed significantly higher values of total vascular area determined by immunostaining for CD105 (cutoff value = 4386 µm²; P = 0.019 and of lymphatic microvessel density determined by immunostaining with D2-40 (cutoff value = 11.5; P = 0.041 when compared with those from patients without cancer. The present data indicate a significant increase in blood microvascular area and in lymphatic microvascular counts in adenomas removed from patients with cancer.

  12. Twenty-eight years after the complete ban on the physical punishment of children in Finland: trends and psychosocial concomitants.

    Science.gov (United States)

    Österman, Karin; Björkqvist, Kaj; Wahlbeck, Kristian

    2014-01-01

    In 1983 Finland became the second country in the world, after Sweden, to adopt a law prohibiting all kinds of physical punishment towards children, also by parents. The present investigation was carried out in 2011, 28 years after the law was adopted. Changes in exposure to various types of physical punishment towards respondents born between 1931 and 1996 are presented. A representative sample from Western Finland, consisting of 4,609 respondents (2,632 females, 1,977 males) between 15 and 80 years, filled in a paper-and-pencil questionnaire. A number of psychosocial concomitants were measured. The results showed a significant drop in reports of being slapped and beaten with an object among respondents who were born after the law was adopted. The decline in physical punishment was associated with a similar decline in the number of murdered children. Respondents who had been exposed to higher amounts of physical punishment than average scored significantly higher on alcohol abuse, depression, mental health problems, and schizotypal personality. Divorced respondents had been significantly more physically punished than others. Respondents who had attempted suicide during the last 12 months had been exposed to physical punishment during childhood significantly more often than those who had not attempted suicide.

  13. Nonlinear optical response induced by a second-harmonic electric-field component concomitant with optical near-field excitation

    Science.gov (United States)

    Yamaguchi, Maiku; Nobusada, Katsuyuki; Yatsui, Takashi

    2015-10-01

    Electron dynamics excited by an optical near field (ONF) in a two-dimensional quantum dot model was investigated by solving a time-dependent Schrödinger equation. It was found that the ONF excitation of the electron caused two characteristic phenomena: a two-photon absorption and an induction of a magnetic dipole moment with a strong third-harmonic component. By analyzing the interaction dynamics of the ONF and the electron, we explained that the physical mechanism underlying these phenomena was the second-harmonic electric-field component concomitant with the near-field excitation originating from the nonuniformity of the ONF. Despite a y -polarized ONF source, the second-harmonic component of an x -polarized electric field was inherently generated. The effect of the second-harmonic electric-field component is not due to usual second-order nonlinear response but appears only when we explicitly consider the electron dynamics interacting with the ONF beyond the conventional optical response assuming the dipole approximation.

  14. Combined surgical resective and regenerative therapy for advanced peri-implantitis with concomitant soft tissue volume augmentation: a case report.

    Science.gov (United States)

    Schwarz, Frank; John, Gordon; Sahm, Narja; Becker, Jürgen

    2014-01-01

    This case report presents a 3-year follow-up of the clinical outcomes of a combined surgical therapy for advanced peri-implantitis with concomitant soft tissue volume augmentation using a collagen matrix. One patient suffering from advanced peri-implantitis and a thin mucosal biotype underwent access flap surgery, implantoplasty at buccally and supracrestally exposed implant parts, and augmentation of the intrabony components using a natural bone mineral and a native collagen membrane after surface decontamination. A collagen matrix was applied to the wound area to increase soft tissue volume and support transmucosal healing. The following clinical parameters were recorded over a period of 3 years: bleeding on probing (BOP), probing depth (PD), mucosal recession (MR), clinical attachment level (CAL), and width of keratinized mucosa (KM). At 36 months, the combined surgical procedure was associated with a clinically important reduction in mean BOP (100%), PD (4.3 ± 0.5 mm), and CAL (4.4 ± 0.4 mm). Site-level analysis of the buccal aspects pointed to an increase in MR (-1.0 ± 0.4 mm) and a decrease in KM (-1.3 ± 0.5 mm) values at 12 months. However, a regain in mucosal height and KM was noted at 24 months, even reaching respective baseline values after 36 months of healing. The presented combined surgical procedure was effective in controlling an advanced peri-implantitis lesion without compromising the overall esthetic outcome in the long term.

  15. Pineal Diffuse Large B-Cell Lymphoma Concomitant With Pituitary Prolactinoma: Possible Correlation Between 2 Distinguished Pathologies: A Case Report.

    Science.gov (United States)

    Kim, Yeong-Jin; Kim, Hee Kyung; Yang, Deok-Hwan; Jung, Shin; Noh, Myung-Giun; Lee, Jae-Hyuk; Lee, Kyung-Hwa; Moon, Kyung-Sub

    2016-02-01

    This is the first reported case of pineal lymphoma with concomitant prolactin-producing pituitary adenoma.A 51-year-old male experienced worsening headaches accompanied by nausea, diplopia, and memory loss for 1 month. Cranial nerve examination revealed bilateral upward gaze limitation with convergence impairment, which is known as Parinaud syndrome. Magnetic resonance images revealed a mass in the pineal gland with a coexisting mass within the enlarged sella fossa. Hormone analysis revealed hyperprolactinemia. The pineal mass was removed without injuring the hypothalamus, brain stem, or any neighboring vessels. Pathology examination confirmed the diagnosis of diffuse large B-cell lymphoma (DLBCL) involving the pineal gland. After further studies, the pineal lymphoma was determined to be a secondary tumor from a gastric primary tumor. The patient died 6 months after diagnosis due to systemic progression of DLBCL.Although the mechanistic link between hyperprolactinemia and lymphoma progression has not been clarified on a clinical basis, high prolactin levels may contribute to the rapid progression and therapeutic resistance of the lymphoma.

  16. [Bilateral dysfunction of the quadriceps muscle after unilateral cruciate ligament rupture with concomitant injury central activation deficit].

    Science.gov (United States)

    Urbach, D; Nebelung, W; Röpke, M; Becker, R; Awiszus, F

    2000-11-01

    The aim of the study was to investigate the ability to activate the quadriceps femoris muscle voluntarily in patients after severe knee injuries and it's influence on muscle function. 33 male patients after ACL-rupture with concomitant injuries were investigated with a twitch-interpolation-method to determine the maximal voluntary contraction force (MVC) and the ability to activate the quadriceps muscle voluntarily. The results were compared to a previously investigated group of patients after isolated ACL-rupture and to an aged-matched control group. The patients with extensive knee injuries presented a significant higher deficit of voluntary quadriceps muscle activation on the injured (78.8 +/- 2.09%, mean +/- SEM) and equally on the uninjured side (78.9 +/- 1.91%) compared to the patients after isolated ACL-rupture and to controls. A minor MVC-deficit of the patients quadriceps muscle of the uninjured side could be explained by the voluntary activation deficit alone, the major MVC deficit of the injured side by muscle atrophy and a voluntary activation deficit. The activation deficit is probably the underlying reason for persisting muscle wasting and [not readable: see text

  17. Valve Replacement with a Sutureless Aortic Prosthesis in a Patient with Concomitant Mitral Valve Disease and Severe Aortic Root Calcification.

    Science.gov (United States)

    Lio, Antonio; Scafuri, Antonio; Nicolò, Francesca; Chiariello, Luigi

    2016-04-01

    Aortic valve replacement with concomitant mitral valve surgery in the presence of severe aortic root calcification is technically difficult, with long cardiopulmonary bypass and aortic cross-clamp times. We performed sutureless aortic valve replacement and mitral valve annuloplasty in a 68-year-old man who had severe aortic stenosis and moderate-to-severe mitral regurgitation. Intraoperatively, we found severe calcification of the aortic root. We approached the aortic valve through a transverse aortotomy, performed in a higher position than usual, and we replaced the valve with a Sorin Perceval S sutureless prosthesis. In addition, we performed mitral annuloplasty with use of an open rigid ring. The aortic cross-clamp time was 63 minutes, and the cardiopulmonary bypass time was 83 minutes. No paravalvular leakage of the aortic prosthesis was detected 30 days postoperatively. Our case shows that the Perceval S sutureless bioprosthesis can be safely implanted in patients with aortic root calcification, even when mitral valve disease needs surgical correction.

  18. Multiple system atrophy of the cerebellar type (MSA-C) with concomitant beta-amyloid and tau pathology.

    Science.gov (United States)

    Bujan, Bartosz; Hofer, Markus J; Oertel, Wolfgang H; Pagenstecher, Axel; Bürk, Katrin

    2013-01-01

    Multiple system atrophy (MSA) is a rapidly progressive sporadic α-synucleinopathy with adult onset characterized by progressive cerebellar ataxia, basal ganglia symptoms, autonomic dysfunction and pyramidal tract signs. While full-blown dementia is considered an exclusion criterion according to Consensus Guidelines, mild cognitive deficits such as fronto-executive dysfunction have been reported in some MSA individuals. However, the underlying anatomic correlate still has to be elucidated. We here report a 74-year-old patient with a clinical diagnosis of "probable MSA of the cerebellar type (MSA-C)" who developed pronounced clinical symptoms of fronto-executive dysfunction. Neuropathologic investigations revealed (1) numerous glial cytoplasmic inclusions (GCI) in the putamen, mesencephalon and cerebellum, (2) pronounced betaamyloid pathology in the frontal lobe and (3) mild hippocampal τ-pathology. In this patient, fronto-executive dysfunction can easily be explained by frontal degeneration typical for AD. These findings challenge the concept of cognitive dysfunction as a core feature of MSA as long as concomitant pathology other than MSA has not been reliably excluded by post mortem analysis.

  19. Decreased Glutathione Peroxidase Activities with Concomitant Increased Oxidized Glutathione Levels among Residents in an Arsenic Contaminated Community of Southern Thailand

    Directory of Open Access Journals (Sweden)

    Warangkana CHUNGLOK

    2008-01-01

    Full Text Available Glutathione peroxidase (GPx and glutathione are important antioxidants responsible for the scavenging of reactive oxygen species (ROS. It has been shown that changes in GPx activities and glutathione levels are associated with various diseases including toxic chemical related diseases and cancers. The study aimed to determine the levels of GPx activity and glutathione among residents in Ron Phibun district, an arsenic-exposed area. Blood samples were obtained from 32 volunteers in the Thasala group, a nearby nonarsenic-exposed area and 36 residents in the Ron Phibun group. Red cell lysates were subjected to analysis of GPx activity and glutathione. The results showed that GPx activities were significantly decreased among study subjects from Ron Phibun (p < 0.05. Interestingly, oxidized glutathione (GSSG levels were significantly increased compared with those from Thasala (p < 0.05. Total glutathione and reduced glutathione (GSH levels were not different among the two groups. Mean values of GPx activities, total glutathione and GSH tended to decrease among high-exposure subjects compared to low-exposure subjects. This was concomitant with a slight increase in GSSG levels among high-exposure subjects. The levels of GPx activities and GSSG may be early biomarkers for low levels of oxidative stress in a mining area affected with arsenic poisoning.

  20. Initial Cooling Experiment (ICE)

    CERN Multimedia

    Photographic Service

    1978-01-01

    In 1977, in a record-time of 9 months, the magnets of the g-2 experiment were modified and used to build a proton/antiproton storage ring: the "Initial Cooling Experiment" (ICE). It served for the verification of the cooling methods to be used for the "Antiproton Project". Stochastic cooling was proven the same year, electron cooling followed later. Also, with ICE the experimental lower limit for the antiproton lifetime was raised by 9 orders of magnitude: from 2 microseconds to 32 hours. For its previous life as g-2 storage ring, see 7405430. More on ICE: 7711282, 7809081, 7908242.

  1. Hanford tanks initiative plan

    Energy Technology Data Exchange (ETDEWEB)

    McKinney, K.E.

    1997-07-01

    Abstract: The Hanford Tanks Initiative (HTI) is a five-year project resulting from the technical and financial partnership of the U.S. Department of Energy`s Office of Waste Management (EM-30) and Office of Science and Technology Development (EM-50). The HTI project accelerates activities to gain key technical, cost performance, and regulatory information on two high-level waste tanks. The HTI will provide a basis for design and regulatory decisions affecting the remainder of the Tank Waste Remediation System`s tank waste retrieval Program.

  2. Stirling to Flight Initiative

    Science.gov (United States)

    Hibbard, Kenneth E.; Mason, Lee S.; Ndu, Obi; Smith, Clayton; Withrow, James P.

    2016-01-01

    Flight (S2F) initiative with the objective of developing a 100-500 We Stirling generator system. Additionally, a different approach is being devised for this initiative to avoid pitfalls of the past, and apply lessons learned from the recent ASRG experience. Two key aspects of this initiative are a Stirling System Technology Maturation Effort, and a Surrogate Mission Team (SMT) intended to provide clear mission pull and requirements context. The S2F project seeks to lead directly into a DOE flight system development of a new SRG. This paper will detail the proposed S2F initiative, and provide specifics on the key efforts designed to pave a forward path for bringing Stirling technology to flight.

  3. UNLV Nuclear Hydrogen Initiative

    Energy Technology Data Exchange (ETDEWEB)

    Hechanova, Anthony E.; Johnson, Allen; O' Toole, Brendan; Trabia, Mohamed; Peterson, Per

    2012-10-25

    Evaluation of the Crack growth rate (CGR) of Alloy 617 and Alloy 276 under constant K at ambient temperature has been completed. Creep deformation of Alloy 230 at different temperature range and load level has been completed and heat to heat variation has been noticed. Creep deformation study of Alloy 276 has been completed under an applied initial stress level of 10% of yield stress at 950ºC. The grain size evaluation of the tested creep specimens of Alloy 276 has been completed.

  4. Initiation of slug flow

    Energy Technology Data Exchange (ETDEWEB)

    Hanratty, T.J.; Woods, B.D. [Univ. of Illinois, Urbana, IL (United States)

    1995-12-31

    The initiation of slug flow in a horizontal pipe can be predicted either by considering the stability of a slug or by considering the stability of a stratified flow. Measurements of the shedding rate of slugs are used to define necessary conditions for the existence of a slug. Recent results show that slugs develop from an unstable stratified flow through the evolution of small wavelength waves into large wavelength waves that have the possibility of growing to form a slug. The mechanism appears to be quite different for fluids with viscosities close to water than for fluids with large viscosities (20 centipoise).

  5. Student Discipline Intervention Strategies: A Case Study of Two Institutions' Processes Utilized to Resolve Misconduct of Students Who Concomitantly Experience a Mental Health Crisis

    Science.gov (United States)

    Dickstein, Gary G.

    2011-01-01

    This study contributes to the research regarding processes and procedures utilized by two institutions of higher education to respond to students who participate in inappropriate behavior and who are concomitantly experiencing a mental health crisis. A case study analysis of two institutions of higher education was used to examine this issue. The…

  6. Effect of concomitant artesunate administration and cytochrome P4502C8 polymorphisms on the pharmacokinetics of amodiaquine in Ghanaian children with uncomplicated malaria

    DEFF Research Database (Denmark)

    Adjei, George O; Kristensen, Kim; Goka, Bamenla Q;

    2008-01-01

    Artesunate (AS) is used in combination with amodiaquine (AQ) as first-line treatment for uncomplicated malaria in many countries. We investigated the effect of concomitant AS administration on the pharmacokinetics of AQ and compared concentrations of desethylamodiaquine (DEAQ), the main metabolite...

  7. De samenhang tussen werkstress, coping en burn-out bij fysiotherapeuten. / The relationship between work stress and concomitant symptoms of burn-out in physiotherapists.

    NARCIS (Netherlands)

    de Vries, T.A.; Hoogstraten, J.

    2000-01-01

    Studied (1) the relationship between active vs denial-focused coping strategies, work stress, and concomitant symptoms of burnout and (2) the relationship between work stress and burnout as moderated by coping. 444 male and female physiotherapists aged 24-62 yrs in the Netherlands completed the Dutc

  8. The influence of previous and concomitant leflunomide on the efficacy and safety of infliximab therapy in patients with rheumatoid arthritis; a longitudinal observational study.

    NARCIS (Netherlands)

    Flendrie, M.; Creemers, M.C.W.; Welsing, P.M.J.; Riel, P.L.C.M. van

    2005-01-01

    OBJECTIVE: To investigate the influence of previous and concomitant leflunomide on the efficacy and safety of infliximab therapy in rheumatoid arthritis (RA) and to compare it to infliximab in combination with other disease-modifying anti-rheumatic drugs. METHODS: RA patients starting infliximab the

  9. Ozone initiated reactions and human comfort in indoor environments

    DEFF Research Database (Denmark)

    Tamas, Gyöngyi

    2006-01-01

    their precursors. The present thesis investigates the effects of ozone-initiated reactions with limonene and with various interior surfaces, including those associated with people, on short-term sensory responses. The evaluations were conducted using a perceived air quality (PAQ) method introduced by Fanger (1988...... that are typical for ozone-limonene chemistry have been concomitantly identified with real time measurement using proton-transfer-reaction mass spectrometry (PTR-MS), at concentrations high enough to be responsible for the sensory effects reported. The stabilized reaction products of ozone-limonene chemistry...... to be proportional to the magnitude of the sensory responses. However, the particles themselves did not appear to be the primary causative agent, but instead are co-varying surrogates for sensory offending gas-phase species. The experiments involving heterogeneous reactions of ozone with various indoor materials...

  10. Initiatives for proliferation prevention

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-04-01

    Preventing the proliferation of weapons of mass destruction is a central part of US national security policy. A principal instrument of the Department of Energy`s (DOE`s) program for securing weapons of mass destruction technology and expertise and removing incentives for scientists, engineers and technicians in the newly independent states (NIS) of the former Soviet Union to go to rogue countries or assist terrorist groups is the Initiatives for Proliferation Prevention (IPP). IPP was initiated pursuant to the 1994 Foreign Operations Appropriations Act. IPP is a nonproliferation program with a commercialization strategy. IPP seeks to enhance US national security and to achieve nonproliferation objectives by engaging scientists, engineers and technicians from former NIS weapons institutes; redirecting their activities in cooperatively-developed, commercially viable non-weapons related projects. These projects lead to commercial and economic benefits for both the NIS and the US IPP projects are funded in Russian, Ukraine, Kazakhstan and Belarus. This booklet offers an overview of the IPP program as well as a sampling of some of the projects which are currently underway.

  11. Global cancer research initiative

    Directory of Open Access Journals (Sweden)

    Richard R Love

    2010-05-01

    Full Text Available Richard R LoveThe Ohio State University Comprehensive Cancer Center, Columbus, OH, USAAbstract: Cancer is an increasing problem for low- and middle-income countries undergoing an epidemiologic transition from dominantly acute communicable disease to more frequent chronic disease with increased public health successes in the former domain. Progress against cancer in high-income countries has been modest and has come at enormous expense. There are several well-conceived global policy and planning initiatives which, with adequate political will, can favorably impact the growing global cancer challenges. Most financial resources for cancer, however, are spent on diagnosis and management of patients with disease in circumstances where specific knowledge about effective approaches is significantly limited, and the majority of interventions, other than surgery, are not cost-effective in resource-limited countries by global standards. In summary, how to intervene effectively on a global scale for the majority of citizens who develop cancer is poorly defined. In contrast to technology-transfer approaches, markedly increased clinical research activities are more likely to benefit cancer sufferers. In these contexts, a global cancer research initiative is proposed, and mechanisms for realizing such an effort are suggested.Keywords: breast cancer, research, global, international, low-income, middle-income

  12. 老年女性晚期乳腺癌卡培他滨节律化疗与常规化疗的临床疗效比较%Comparison of the Clinical Efficacy of Capecitabine Metronomic Chemotherapy and Conventional ;Chemotherapy in the Treatment of Elderly Female Patients with Advanced Breast Cancer

    Institute of Scientific and Technical Information of China (English)

    蒋琳; 谭榜宪; 赵妍丽; 刘芳; 杜国波; 侯敏; 皈燕; 柳弥

    2015-01-01

    目的:评价以小剂量卡培他滨持续给药的节律化疗方式与常规化疗方式治疗老年女性晚期乳腺癌的临床疗效和不良反应,了解前者是否存在优势。方法:研究对象为2013年4月-2014年10月本院收治的54例老年女性晚期乳腺癌患者。其中31例给予小剂量卡培他滨的持续给药方式(口服卡培他滨1500 mg/m2,1次/d,连服4周,休息1周,每5周为1个化疗周期)进行治疗,共完成2~12个化疗周期,中位化疗周期数为3个。23例给予卡培他滨单药常规化疗(卡培他滨1250 mg/m2,2次/d,连服2周,休息1周,每3周为1个化疗周期),共完成2~19个化疗周期,中位化疗周期数为4个。对至少接受过2个化疗周期的患者进行疗效评估。结果:卡培他滨节律化疗组,疾病控制率(DCR)为38.7%(12/31),中位TTP为3.8个月,中位OS为7.1个月;卡培他滨常规化疗组,疾病控制率(DCR)为39.1%(9/23),中位TTP为3.0个月,中位OS为7.3个月。两者比较差异均无统计学意义(P>0.05)。卡培他滨节律化疗组,消化系统不良反应、骨髓抑制、手足综合征大多为Ⅰ~Ⅱ度,患者能够很好耐受治疗,中途无需中断治疗。常规化疗组Ⅲ~Ⅳ度毒性反应明显,主要表现在白细胞降低、血小板下降、乏力、手足综合征等。卡培他滨节律化疗组患者生活质量较卡培他滨常规化疗组明显改善,差异有统计学意义(P0.05).In Capecitabine metronomic chemotherapy group,hand foot syndrome,bone marrow depression, digestive system adverse reactions were atⅠ-Ⅱdegree mostly.Patients could tolerate the therapy without stopping drug.In conventional chemotherapy group,the toxicity ofⅢ-Ⅳdegree were obvious,mainly in the decrease of white blood cell,platelet decrease,fatigue,hand foot syndrome.The life quality of patients in Capecitabine metronomic chemotherapy group was significantly improved

  13. Pursuing shell-isolated nanoparticle-enhanced Raman spectroscopy (SHINERS) for concomitant detection of breast lesions and microcalcifications

    Science.gov (United States)

    Zheng, Chao; Shao, Wanting; Paidi, Santosh Kumar; Han, Bing; Fu, Tong; Wu, Di; Bi, Lirong; Xu, Weiqing; Fan, Zhimin; Barman, Ishan

    2015-10-01

    Although tissue staining followed by morphologic identification remains the gold standard for diagnosis of most cancers, such determinations relying solely on morphology are often hampered by inter- and intra-observer variability. Vibrational spectroscopic techniques, in contrast, offer objective markers for diagnoses and can afford disease detection prior to alterations in cellular and extracellular architecture by furnishing a rapid ``omics''-like view of the biochemical status of the probed specimen. Here, we report a classification approach to concomitantly detect microcalcification status and local pathological state in breast tissue, featuring a combination of vibrational spectroscopy that focuses on the tumor and its microenvironment, and multivariate data analysis of spectral markers reflecting molecular expression. We employ the unprecedented sensitivity and exquisite molecular specificity offered by Au@SiO2 shell-isolated nanoparticle-enhanced Raman spectroscopy (SHINERS) to probe the presence of calcified deposits and distinguish between normal breast tissues, fibroadenoma, atypical ductal hyperplasia, ductal carcinoma in situ (DCIS), and invasive ductal carcinoma (IDC). By correlating the spectra with the corresponding histologic assessment, we developed partial least squares-discriminant analysis derived decision algorithm that provides excellent diagnostic power in the fresh frozen sections (overall accuracy of 99.4% and 93.6% using SHINs for breast lesions with and without microcalcifications, respectively). The performance of this decision algorithm is competitive with or supersedes that of analogous algorithms employing spontaneous Raman spectroscopy while enabling facile detection due to the considerably higher intensity of SHINERS. Our results pave the way for rapid tissue spectral pathology measurements using SHINERS that can offer a novel stain-free route to accurate and economical diagnoses without human interpretation.Although tissue staining

  14. The Ombudperson Initiative Group

    CERN Multimedia

    Laura Stewart

    Following many discussions that took place at some of the ATLAS Women's Network lunch gatherings, a few ATLAS women joined forces with similarly concerned CERN staff women to form a small group last Fall to discuss the need for a CERN-wide Ombudsperson. This has since evolved into the Ombudsperson Initiative Group (OIG) currently composed of the following members: Barbro Asman, Stockholm University; Pierre Charrue, CERN AB; Anna Cook, CERN IT; Catherine Delamare, CERN and IT Ombudsperson; Paula Eerola, Lund University; Pauline Gagnon, Indiana University; Eugenia Hatziangeli, CERN AB; Doreen Klem, CERN IT; Bertrand Nicquevert, CERN TS and Laura Stewart, CERN AT. On June 12, members of the OIG met with representatives of Human Resources (HR) and the Equal Opportunity Advisory Panel (EOAP) to discuss the proposal drafted by the OIG. The meeting was very positive. Everybody agreed that the current procedures at CERN applicable in the event of conflict required a thorough review, and that a professionnally trai...

  15. Quality initiative at ESO

    Science.gov (United States)

    Rupprecht, Gero; Arsenault, Robin; Hanuschik, Reinhard; Kraus, Maximilian; Sivera, Paola; Tromp, Arnout; Verzichelli, Gianluca

    2016-08-01

    An initiative is under way at ESO Headquarters to optimise operations, in particular in the engineering, technical and associated management areas. A systematic approach to strengthen the operating processes is in preparation, starting with a mapping of the extensive existing process network. Processes identified as sufficiently important and complex to merit an in-depth analysis will be properly specified and their implementation optimised to strike a sensible balance between organisational overhead (documentation) and efficiency. By applying methods and tools tried and tested in industry we expect to achieve a more unified approach to address recurrent tasks. This will enable staff to concentrate more on new challenges and improvement and avoid spending effort on issues already resolved in the past.

  16. Breckinridge Project, initial effort

    Energy Technology Data Exchange (ETDEWEB)

    None, None

    1982-09-01

    Report III, Volume 1 contains those specifications numbered A through J, as follows: General Specifications (A); Specifications for Pressure Vessels (C); Specifications for Tanks (D); Specifications for Exchangers (E); Specifications for Fired Heaters (F); Specifications for Pumps and Drivers (G); and Specifications for Instrumentation (J). The standard specifications of Bechtel Petroleum Incorporated have been amended as necessary to reflect the specific requirements of the Breckinridge Project, and the more stringent specifications of Ashland Synthetic Fuels, Inc. These standard specifications are available to the Initial Effort (Phase Zero) work performed by all contractors and subcontractors. Report III, Volume 1 also contains the unique specifications prepared for Plants 8, 15, and 27. These specifications will be substantially reviewed during Phase I of the project, and modified as necessary for use during the engineering, procurement, and construction of this project.

  17. Instrumented Pipeline Initiative

    Energy Technology Data Exchange (ETDEWEB)

    Thomas Piro; Michael Ream

    2010-07-31

    This report summarizes technical progress achieved during the cooperative agreement between Concurrent Technologies Corporation (CTC) and U.S. Department of Energy to address the need for a for low-cost monitoring and inspection sensor system as identified in the Department of Energy (DOE) National Gas Infrastructure Research & Development (R&D) Delivery Reliability Program Roadmap.. The Instrumented Pipeline Initiative (IPI) achieved the objective by researching technologies for the monitoring of pipeline delivery integrity, through a ubiquitous network of sensors and controllers to detect and diagnose incipient defects, leaks, and failures. This report is organized by tasks as detailed in the Statement of Project Objectives (SOPO). The sections all state the objective and approach before detailing results of work.

  18. Ⅱ和Ⅲ期直肠癌术后卡培他滨±奥沙利铂同步放化疗急性副反应比较%Comparison of acute toxicities between two postoperative concurrent chemoradiotherapy regimens of capecitabine with or without oxaliplatin in patients with stage Ⅱ and Ⅲ rectal cancer

    Institute of Scientific and Technical Information of China (English)

    金晶; 曲媛; 刘新帆; 余子豪; 李晔雄; 王维虎; 王凯; 宋永文; 王淑莲; 张世平; 刘跃平; 房辉

    2009-01-01

    目的 比较两个前瞻性非随机对照直肠癌术后同步放化疗临床Ⅱ期研究的急性毒副反应及耐受性.方法 2005年3月至2007年11月分别进行卡培他滨术后同步放化疗(单药组,n=118)和奥沙利铂+卡培他滨术后同步放化疗(双药组,n=90)的Ⅱ期临床研究.两组均予真骨盆放疗DT50 Gy分25次5周完成,化疗药物予以连用2周停1周,放疗中共用2周期的方法 .单药组卡培他滨每天2次1600 mg/m2双药组奥沙利铂每周1次70 mg/m2,卡培他滨每天2次1300 mg/m2.结果 双药组患者中断放疗(10.2%:6.7%,X2=0.80,P=0.460)或化疗的比率(9.3%:19.1%,X2=4.80,P=0.090)与单药组相似.双药组1~4级急性非血液学毒副反应发生率显著高于单药组,主要为恶心(X2=46.90,P=0.000),腹泻(X2=13.50,P=0.009),乏力(X2=18.90,P=0.000),手足综合症(X2=7.10,P=0.029)和食欲下降(X2=19.90,P=0.000).全组发生3、4级以上严重副反应包括腹泻(24.0%、1.0%)、白细胞下降(4.3%、0.0%)、放射性皮炎(3.8%、0.0%)、腹痛(1.0%、0.0%)和乏力(0.5%、0.0%),但只有3、4级腹泻发生率双药组显著高于单药组(33.0%:18.6%,X2=5.90,P=0.023).结论 接受奥沙利铂+卡培他滨双药同步放化疗患者3、4级腹泻发生率显著高于卡培他滨单药同步放化疗,但其他严重副反应发生率低且两组相似.%Objective To compare the acute toxicities between two prospective, non-randomize phase Ⅱ trials on adjuvant radiochemotherapy of capecitabine with or without oxaliplatin in patients with stage Ⅱ and Ⅲ rectal cancer. Methods From March 2005 to November 2007,based on two fulfilled phase Ⅰ studies,two phase Ⅱ trials were launched respectively to further observe the tolerance and toxicity. In one tria1,118 patients were treated with concurrent capecitabine and radiotherapy (Cap-CRT trial), with radio-therapy of DT50 Gy/25 F/5 wks to the pelvis, and capecitabine at a dose of 1600 mg/m2/d(d1-d14,3 weeks per cycle). In the other trial

  19. Leukocyte counts in urine reflect the risk of concomitant sepsis in bacteriuric infants: A retrospective cohort study

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    Harper Marvin B

    2007-06-01

    Full Text Available Abstract Background When urine infections are missed in febrile young infants with normal urinalysis, clinicians may worry about the risk – hitherto unverified – of concomitant invasion of blood and cerebrospinal fluid by uropathogens. In this study, we determine the extent of this risk. Methods In a retrospective cohort study of febrile 0–89 day old infants evaluated for sepsis in an urban academic pediatric emergency department (1993–1999, we estimated rates of bacteriuric sepsis (urinary tract infections complicated by sepsis after stratifying infants by urine leukocyte counts higher, or lower than 10 cells/hpf. We compared the global accuracy of leukocytes in urine, leukocytes in peripheral blood, body temperature, and age for predicting bacteruric sepsis. The global accuracy of each test was estimated by calculating the area under its receiver operating characteristic curve (AUC. Chi-square and Fisher exact tests compared count data. Medians for data not normally distributed were compared by the Kruskal-Wallis test. Results Two thousand two hundred forty-nine young infants had a normal screening dipstick. None of these developed bacteremia or meningitis despite positive urine culture in 41 (1.8%. Of 1516 additional urine specimens sent for formal urinalysis, 1279 had 0–9 leukocytes/hpf. Urine pathogens were isolated less commonly (6% vs. 76% and at lower concentrations in infants with few, compared to many urine leukocytes. Urine leukocytes (AUC: 0.94 were the most accurate predictors of bacteruric sepsis. Infants with urinary leukocytes Conclusion In young infants evaluated for fever, leukocytes in urine reflect the likelihood of bacteriuric sepsis. Infants with urinary tract infections missed because of few leukocytes in urine are at relatively low risk of invasive bacterial sepsis by pathogens isolated from urine.

  20. Acute Coronary Syndromes, Gastrointestinal Protection, and Recommendations Regarding Concomitant Administration of Proton-Pump Inhibitors (Omeprazol/Esomeprazole) and Clopidogrel.

    Science.gov (United States)

    Lozano, Iñigo; Sanchez-Insa, Esther; de Leiras, Sergio Rodríguez; Carrillo, Pilar; Ruiz-Quevedo, Valeriano; Pinar, Eduardo; Gopar-Gopar, Silvia; Bayon, Jeremías; Mañas, Pilar; Lasa, Garikoitz; CruzGonzalez, Ignacio; Hernandez, Felipe; Fernandez-Portales, Javier; Fernandez-Fernandez, Javier; Pérez-Serradilla, Ana; de la Torre Hernandez, José M; Gomez-Jaume, Alfredo

    2016-02-01

    The Food and Drug Administration and the European Medicines Agency sent a warning in 2010 discouraging the concomitant use of clopidogrel with omeprazole or esomeprazole. The purpose is to know the gastroprotective approach in patients with acute coronary syndrome (ACS) and the level of follow-up of the alert. In 17 hospitals with catheterization laboratory in Spain, 1 per region, we studied 25 consecutive patients per hospital whose diagnosis of discharge since October 1, 2013, had been any type of ACS. We analyzed their baseline clinical profile, the gatroprotective agents at admission and discharge and the antiplatelet therapy at discharge. The number of patients included was 425: age 67.2 ± 12.5 years, women 29.8%, diabetes 36.5%. The patients presented unstable angina in 21.6%, non-ST-elevation myocardial infarction in 35.3% and ST-elevation myocardial infarction in 43.1%. Conservative approach was chosen in 17.9%, bare-metal stents 32.2%, ≥ 1 drug-eluting stent 48.5%, and surgery 1.4%. Aspirin was indicated in 1.9%, aspirin + clopidogrel 73.6%, aspirin + prasugrel 17.6%, and aspririn + ticagrelor 6.8%. Gastroprotective agents were present in 40.2% patients at admission and this percentage increased to 93.7% at discharge. Of the 313 (73.6%) on clopidogrel in 96 (30.6%) was combined with omeprazole and 3 (0.95%) with esomeprazole, whereas the most commonly used was pantoprazole with 190 patients (44.7%). In conclusion, almost the totality of the patients with an ACS receive gastroprotective agents at the moment of discharge, most of them with proton-pump inhibitors. In one every 3 cases of the patients who are on clopidogrel, the recommendation of the Food and Drug Administration and the European Medicines Agency is not followed.

  1. Lactate and glucose concomitant consumption as a self-regulated pH detoxification mechanism in HEK293 cell cultures.

    Science.gov (United States)

    Liste-Calleja, Leticia; Lecina, Martí; Lopez-Repullo, Jonatan; Albiol, Joan; Solà, Carles; Cairó, Jordi Joan

    2015-12-01

    One of the most important limitations of mammalian cell-based processes is the secretion and accumulation of lactate as a by-product of their metabolism. Among the cell lines commonly used in industrial bioprocesses, HEK293 has been gaining importance over the last years. Up recently, HEK293 cells were known to consume lactate in late stages of cell culture usually when glucose and/or glutamine were depleted from media. Remarkably, in both scenarios, no significant cell growth was reported. However, we have observed a different metabolic behavior regarding lactate production and consumption in HEK293 cultures. HEK293 cells were able to co-metabolize glucose and lactate simultaneously, even in exponentially growing cell cultures. Our deep study of the effects of environmental conditions on lactate metabolism revealed that pH was the key to trigger the metabolic shift from lactate production to lactate and glucose concomitant consumption. Remarkably, this shift could be triggered at will when pH was set at 6.8. Even more interesting was the fact that lowering pH to 6.6 and supplementing media with exogenous lactate resulted in co-consumption of glucose and lactate from the beginning of cell culture, without affecting cell growth or protein productivity. On the contrary, cell growth was clearly hampered at this low pH if extracellular lactate was lacking. From our results, we hypothesize that HEK293 cells metabolize extracellular lactate as a strategy for pH detoxification, by means of co-transporting extracellular protons together with lactate into the cytosol. This novel hypothesis for unraveling lactate metabolism in HEK293 cells could open a door to re-direct genetic engineering strategies in order to obtain more efficient cell lines and also to further develop animal cell technology applications.

  2. Concomitant occurrence of IgG4-related pleuritis and periaortitis: a case report with review of the literature.

    Science.gov (United States)

    Ishida, Mitsuaki; Hodohara, Keiko; Furuya, Aya; Fujishiro, Aya; Okuno, Hiroko; Yoshii, Miyuki; Horinouchi, Akiko; Shirakawa, Ayaka; Harada, Ayumi; Iwai, Muneo; Yoshida, Keiko; Kagotani, Akiko; Yoshida, Takashi; Okabe, Hidetoshi

    2014-01-01

    IgG4-related sclerosing disease is an established disease entity with characteristic clinicopathological features. Some recent reports have demonstrated that this disease can occur in the respiratory system including the pleura. Herein, we describe the first documented case of concomitant occurrence of IgG4-related pleuritis and periaortitis. A 71-year-old Japanese female with a history of essential thrombocythemia presented with persistent cough and difficulty in breathing. Computed tomography demonstrated thickening of the right parietal pleura, pericardium, and periaortic tissue and pleural and cardiac effusions. Histopathological study of the surgical biopsy specimen of the parietal pleura revealed marked fibrous thickening with lymphoplasmacytic infiltration. Phlebitis was noted, however, only a few eosinophils had infiltrated. Immunohistochemical study revealed abundant IgG4-positive plasma cell infiltration and high ratio of IgG4-/IgG-positive plasma cells (84%). Therefore, a diagnosis of IgG4-related pleuritis was made with consideration of the elevated serum IgG4 level (684 mg/dL). Recently, the spectrum of IgG4-related sclerosing disease has expanded, and this disease can occur in the pleura, pericardium, and periaortic tissue. Although histopathological analysis of the pericardium and periaortic tissue was not performed in the present case, it was suspected that thickening of the pericardium and periaortic tissue was clinically due to IgG4-related sclerosing disease. Our clinicopathological analyses of IgG4-related pleuritis and pericarditis reveal that this disease can present as dyspnea and pleural and pericardial effusion as seen in the present case, therefore, it is important to recognize that IgG4-related sclerosing disease can occur in these organs for accurate diagnosis and treatment.

  3. IL23R gene confers susceptibility to ankylosing spondylitis concomitant with uveitis in a Han Chinese population.

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    Hongtao Dong

    Full Text Available PURPOSE: The interleukin-23 receptor (IL-23R has been shown to be associated with ankylosing spondylitis (AS in many different populations. This study examined whether IL-23R polymorphisms were associated with susceptibility to this disease in a Chinese Han population. METHODS: Three single-nucleotide polymorphisms (SNP, rs7517847, rs11209032, and rs17375018, were genotyped in 291 AS patients and 312 age-, sex-, and ethnically matched healthy controls using a polymerase chain reaction (PCR restriction fragment length polymorphism (RFLP assay. RESULTS: The genotype and allele frequencies of rs17375018, rs7517847, and rs11209032 were not different between the patients with AS and the healthy controls. On the one hand, stratification analysis indicated that the rs17375018 GG genotype and the G allele were increased in AS patients who were HLA-B27 positive (corrected p = 0.024, odds ratio [OR] 2.35, 95% CI 1.30-4.24; p c = 0.006, OR 1.98, 95% CI 1.28-3.07, respectively. On the other hand, the analysis according to clinical characteristics showed a significantly increased prevalence of the homozygous rs17375018 GG genotype and the G allele in patients with AS and uveitis compared with the controls (p c = 0.024 and p c = 0.024, respectively. In addition, haplotype analysis performed with the SHEsis platform revealed no significant difference concerning the haplotypes between AS patients and healthy controls. CONCLUSIONS: In this study, the results suggested that the rs17375018 of IL23R was positively associated with HLA-B27-positive AS and that the rs17375018 GG of IL-23R was associated with AS concomitant with uveitis. We found no evidence for an association between the other two SNPs of IL-23R and AS.

  4. Oral Gentamicin Gut Decontamination for Prevention of KPC-Producing Klebsiella pneumoniae Infections: Relevance of Concomitant Systemic Antibiotic Therapy

    Science.gov (United States)

    Tascini, Carlo; Sbrana, Francesco; Flammini, Sarah; Tagliaferri, Enrico; Arena, Fabio; Leonildi, Alessandro; Ciullo, Ilaria; Amadori, Francesco; Di Paolo, Antonello; Ripoli, Andrea; Lewis, Russell; Rossolini, Gian Maria

    2014-01-01

    Gut colonization represents the main source for KPC-producing Klebsiella pneumoniae (KPC-Kp) epidemic dissemination. Oral gentamicin, 80 mg four times daily, was administered to 50 consecutive patients with gut colonization by gentamicin-susceptible KPC-Kp in cases of planned surgery, major medical intervention, or need for patient transfer. The overall decontamination rate was 68% (34/50). The median duration of gentamicin treatment was 9 days (interquartile range, 7 to 15 days) in decontaminated patients compared to 24 days (interquartile range, 20 to 30 days) in those with persistent colonization (P < 0.001). In the six-month period of follow-up, KPC-Kp infections were documented in 5/34 (15%) successfully decontaminated patients compared to 12/16 (73%) persistent carriers (P < 0.001). The decontamination rate was 96% (22/23) in patients receiving oral gentamicin only, compared to 44% (12/27) of those treated with oral gentamicin and concomitant systemic antibiotic therapy (CSAT) (P < 0.001). The multivariate analysis confirmed CSAT and KPC-Kp infection as the variables associated with gut decontamination. In the follow-up period, KPC-Kp infections were documented in 2/23 (9%) of patients treated with oral gentamicin only and in 15/27 (56%) of those also receiving CSAT (P = 0.003). No difference in overall death rate between different groups was documented. Gentamicin-resistant KPC-Kp strains were isolated from stools of 4/16 persistent carriers. Peak gentamicin blood levels were below 1 mg/liter in 12/14 tested patients. Oral gentamicin was shown to be potentially useful for gut decontamination and prevention of infection due to KPC-Kp, especially in patients not receiving CSAT. The risk of emergence of gentamicin-resistant KPC-Kp should be considered. PMID:24419337

  5. A rare case of concomitant sicca keratopathy and ipsilateral central facial palsy in Wallenberg’s dorsolateral medullary syndrome

    Science.gov (United States)

    De Bruyn, Deborah; Van Aken, Elisabeth; Herman, Kristien

    2017-01-01

    Objective: To describe a patient with a right-sided supranuclear facial palsy and concomitant sicca keratopathy of the right eye following right-sided dorsolateral medullary infarction. Methods: Our patient underwent a complete ophthalmologic and neurologic examination including biomicroscopy, fundus examination, cranial nerve examination, Shirmer I test, and magnetic resonance imaging of the brain. Results: A 61-year-old woman presented in emergency with a central facial nerve palsy on the right side and truncal ataxia. Neurologic assessment revealed a concurrent dysphagia, dysarthria, hypoesthesia of the right face, and weakness of the right upper limb. Magnetic resonance imaging of the brain showed an old left-sided cerebellar infarction, but a recent ischemic infarction at the level of the right dorsolateral medulla oblongata was the cause of our patient’s current problems. One month after diagnosis of the right-sided dorsolateral medullary syndrome, there were complaints of ocular irritation and a diminished visual acuity in the right eye. Biomicroscopy showed a sicca keratopathy with nearly complete absence of tear secretion on the Shirmer I test, but with normal eye closure and preserved corneal reflexes and sensitivity. Conclusion: A dorsolateral medullary syndrome can have a variable expression in symptomatology. Our case is special because of the combination of an ipsilateral supranuclear facial palsy with normal upper facial muscle function together with an ipsilateral sicca keratopathy as a result of a nearly absent tear secretion. We hypothesized that the mechanism underlying the patient’s sicca keratopathy ipsilateral to the supranuclear facial palsy involved the superior salivatory nucleus, which is situated in the caudal pons inferiorly of the motor facial nucleus and is most probably affected by a superior extension of the infarcted area in the right medulla oblongata. PMID:28293537

  6. Low-dose fractionated radiotherapy and concomitant chemotherapy for recurrent or progressive glioblastoma. Final report of a pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Balducci, M.; Diletto, B.; Chiesa, S.; D' Agostino, G.R.; Gambacorta, M.A.; Ferro, M.; Valentini, V. [Catholic University of the Sacred Heart, Department of Radiation Oncology, Rome (Italy); Colosimo, C. [Catholic University of the Sacred Heart, Department of Radiology, Rome (Italy); Maira, G.; Anile, C. [Catholic University of the Sacred Heart, Department of Neurosurgery, Rome (Italy)

    2014-04-15

    Evaluated in this study were the feasibility and the efficacy of concurrent low dose fractionated radiotherapy (LD-FRT) and chemotherapy as palliative treatment for recurrent/progressive glioblastoma multiforme (GBM). Eligible patients had recurrent or progressive GBM, Karnofsky performance status ≥70, prior surgery, and standard radiochemotherapy treatment. Recurrence/progression disease during temozolomide (TMZ) received cisplatin (CDDP; 30 mg/m{sup 2} on days 1, 8, 15), fotemustine (FTM; 40 mg/m{sup 2} on days 2, 9, 16), and concurrent LD-FRT (0.3 Gy twice daily); recurrence/progression after 4 months from the end of adjuvant TMZ were treated by TMZ (150/200 mg/m{sup 2} on days 1-5) concomitant with LD-FRT (0.4 Gy twice daily). Primary endpoints were safety and toxicity. A total of 32 patients were enrolled. Hematologic toxicity G1-2 was observed in 18.7% of patients and G3-4 in 9.4%. One patient (3.1%) had complete response, 3 (9.4%) had partial response, 8 (25%) had stable disease for at least 8 weeks, while 20 patients (62.5%) experienced progressive disease. The clinical benefit was 37.5%. Median progression-free survival (PFS) and overall survival (OS) were 5 and 8 months, respectively. Survival rate at 12 months was of 27.8%. LD-FRT and chemotherapy for recurrent/progressive GBM have a good toxicity profile and clinical outcomes, even though further investigation of this novel palliative treatment approach is warranted. (orig.)

  7. Sequential versus concomitant therapy for eradication of Helicobacter Pylori in patients with perforated duodenal ulcer: A randomized trial

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    Roby Das

    2016-01-01

    Full Text Available Objectives: Comparison of Helicobacter pylori eradication rates, side effects, compliance, cost, and ulcer recurrence of sequential therapy (ST with that of concomitant therapy (CT in patients with perforated duodenal ulcer following simple omental patch closure. Methods: Sixty-eight patients with perforated duodenal ulcer treated with simple closure and found to be H. pylori positive on three months follow-up were randomized to receive either ST or CT for H. pylori eradication. Urease test and Giemsa stain were used to assess for H. pylori eradication status. Follow-up endoscopies were done after 3 months, 6 months, and 1 year to evaluate the ulcer recurrence. Results: H. pylori eradication rates were similar in ST and CT groups on intention-to-treat (ITT analysis (71.43% vs 81.80%,P = 0.40. Similar eradication rates were also found in per-protocol (PP analysis (86.20% vs 90%,P = 0.71. Ulcer recurrence rate in ST groups and CT groups at 3 months (17.14% vs 6.06%,P = 0.26, 6 months (22.86% vs 9.09%,P = 0.19, and at 1 year (25.71% vs 15.15%,P = 0.37 of follow-up was also similar by ITT analysis. Compliance and side effects to therapies were comparable between the groups. The most common side effects were diarrhoea and metallic taste in ST and CT groups, respectively. A complete course of ST costs Indian Rupees (INR 570.00, whereas CT costs INR 1080.00. Conclusion: H. pylori eradication rates, side effects, compliance, cost, and ulcer recurrences were similar between the two groups. The ST was more economical compared with CT.

  8. Loss of p53 expression is accompanied by upregulation of beta-catenin in meningiomas: a concomitant reciprocal expression.

    Science.gov (United States)

    Pećina-Šlaus, Nives; Kafka, Anja; Vladušić, Tomislav; Tomas, Davor; Logara, Monika; Skoko, Josip; Hrašćan, Reno

    2016-04-01

    Crosstalk between Wnt and p53 signalling pathways in cancer has long been suggested. Therefore in this study we have investigated the involvement of these pathways in meningiomas by analysing their main effector molecules, beta-catenin and p53. Cellular expression of p53 and beta-catenin proteins and genetic changes in TP53 were analysed by immunohistochemistry, PCR/RFLP and direct sequencing of TP53 exon 4. All the findings were analysed statistically. Our analysis showed that 47.5% of the 59 meningiomas demonstrated loss of expression of p53 protein. Moderate and strong p53 expression in the nuclei was observed in 8.5% and 6.8% of meningiomas respectively. Gross deletion of TP53 gene was observed in one meningioma, but nucleotide alterations were observed in 35.7% of meningiomas. In contrast, beta-catenin, the main Wnt signalling molecule, was upregulated in 71.2%, while strong expression was observed in 28.8% of meningiomas. The concomitant expressions of p53 and beta-catenin were investigated in the same patients. In the analysed meningiomas, the levels of the two proteins were significantly negatively correlated (P = 0.002). This indicates that meningiomas with lost p53 upregulate beta-catenin and activate Wnt signalling. Besides showing the reciprocal relationship between proteins, we also showed that the expression of p53 was significantly (P = 0.021) associated with higher meningioma grades (II and III), while beta-catenin upregulation was not associated with malignancy grades. Additionally, women exhibited significantly higher values of p53 loss when compared to males (P = 0.005). Our findings provide novel information about p53 involvement in meningeal brain tumours and reveal the complex relationship between Wnt and p53 signalling, they suggest an important role for beta-catenin in these tumours.

  9. Barbiturate ingestion in three adult captive tigers (Panthera tigris and concomitant fatal botulism of one : clinical communication

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    J. H. Williams

    2011-05-01

    neutralisation test, confirming that this male had had concomitant barbiturate toxicity and botulism, and had succumbed to aspiration bronchopneumonia secondary to pharyngeal, laryngeal and oesophageal paralysis and oesophageal impaction.

  10. Concomitant Use of Sea Cucumber Organic Extract and Radiotherapy on Proliferation and Apoptosis of Cervical (HeLa Cell Line

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    Javad Baharara

    2016-04-01

    Full Text Available Background Cervical carcinoma is gynecologic malignancy with conventional treatment modality but drug resistance interferes with current therapeutic methods. Therefore, identification of novel new modality with low toxicity has uniquely favorable strategy. Objectives The aim of this study is evaluation of concomitant use of sea cucumber organic extract and radiotherapy on ovarian cancer. Materials and Methods In this in vitro experimental study, HeLa cancer cells were cultured and suspended in RPMI (Roswell Park Memorial Institute 1640 medium supplemented with 10 % FBS (Fetal Bovine Serum, 1 % antibiotic. Cells were treated with extract at different concentrations (0 to 100 μg/mL for 24 hours. After determination of suitable concentration, the cells were exposed to 2 Gray gamma radiation in presence of extract for 192 seconds and 66 hours were kept in incubator till anti-proliferative assay were evaluated. To assess apoptosis, flow cytometry with PI (Propodium Iodide and acridine orange staining were performed. Results Morphological analysis and results from cytotoxicity assay exhibited that 50 µg/mL of sea cucumber extract alone is considered IC50 and combination of gamma radiation became more valuable in growth inhibition. Also, flow cytometry histogram of treated cells indicated sub-G1 peak demonstrating disturbance in membrane integrity and apoptosis cell death. Fluorescence images have been confirmed apoptosis cell death in treatment groups. Conclusions These data indicate that sea cucumber extract as novel resource of aquatic natural products significantly can inhibit cervical cancer cell growth and synergistic effect of natural extract along with radiation therapy was more effective in anti-cervical cancer therapy.

  11. Initial Egyptian ECMO experience

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    Akram Abdelbary

    2016-04-01

    Results: A total of twelve patients received ECMO between January 2014 and June 2015. The mean age was 35.9 years. (range 13–65 years, 8 males, with VV ECMO in 10 patients, and VA ECMO in 2 patients. Out of ten patients of VV ECMO, one had H1N1 pneumonia, one had advanced vasculitic lung, four had bacterial pneumonia, two traumatic lung contusions and one with organophosphorus poisoning, and one undiagnosed etiology leading to severe ARDS. Lung injury score range was 3–3.8, PaO2/FiO2 (20–76 mechanical ventilation duration before ECMO 1–14 days, Femoro-jugular cannulation in 7 patients and femoro-femoral in 2 patients and femoro-subclavian in 1 patient; all patients were initially sedated and paralyzed for (2–4 days and ventilated on pressure controlled ventilation with Pmax of 25 cm H2O and PEEP of 10 cm H2O. In VA ECMO patients were cannulated percutaneously using femoro-femoral approach. One patient showed no neurologic recovery and died after 24 h, the other had CABG on ECMO however the heart didn’t recover and died after 9 days. Heparin intravenous infusion was used initially in all patients and changed to Bivalirudin in 2 patients due to possible HIT. Pump flow ranged from 2.6 to 6.5 L/min. Average support time was 12 days (range 2–24 days. Seven patients (63.3% were successfully separated from ECMO and survived to hospital discharge. Hospital length of stay ranged from 3 to 42 days, tracheostomy was done percutaneously in 5 patients and surgically in 3. Gastrointestinal bleeding occurred in 6 patients, VAP in 7 patients, neurologic complications in 1 patient with complete recovery, cardiac arrhythmias in 3 patients, pneumothorax in 9 patients, and deep venous thrombosis in 2 patients.

  12. MONTANA PALLADIUM RESEARCH INITIATIVE

    Energy Technology Data Exchange (ETDEWEB)

    Peters, John; McCloskey, Jay; Douglas, Trevor; Young, Mark; Snyder, Stuart; Gurney, Brian

    2012-05-09

    Project Objective: The overarching objective of the Montana Palladium Research Initiative is to perform scientific research on the properties and uses of palladium in the context of the U.S. Department of Energy's Hydrogen, Fuel Cells and Infrastructure Technologies Program. The purpose of the research will be to explore possible palladium as an alternative to platinum in hydrogen-economy applications. To achieve this objective, the Initiatives activities will focus on several cutting-edge research approaches across a range of disciplines, including metallurgy, biomimetics, instrumentation development, and systems analysis. Background: Platinum-group elements (PGEs) play significant roles in processing hydrogen, an element that shows high potential to address this need in the U.S. and the world for inexpensive, reliable, clean energy. Platinum, however, is a very expensive component of current and planned systems, so less-expensive alternatives that have similar physical properties are being sought. To this end, several tasks have been defined under the rubric of the Montana Palladium Research Iniative. This broad swath of activities will allow progress on several fronts. The membrane-related activities of Task 1 employs state-of-the-art and leading-edge technologies to develop new, ceramic-substrate metallic membranes for the production of high-purity hydrogen, and develop techniques for the production of thin, defect-free platinum group element catalytic membranes for energy production and pollution control. The biomimetic work in Task 2 explores the use of substrate-attached hydrogen-producing enzymes and the encapsulation of palladium in virion-based protein coats to determine their utility for distributed hydrogen production. Task 3 work involves developing laser-induced breakdown spectroscopy (LIBS) as a real-time, in situ diagnostic technique to characterize PGEs nanoparticles for process monitoring and control. The systems engineering work in task 4

  13. Scientific Component Technology Initiative

    Energy Technology Data Exchange (ETDEWEB)

    Kohn, S; Bosl, B; Dahlgren, T; Kumfert, G; Smith, S

    2003-02-07

    The laboratory has invested a significant amount of resources towards the development of high-performance scientific simulation software, including numerical libraries, visualization, steering, software frameworks, and physics packages. Unfortunately, because this software was not designed for interoperability and re-use, it is often difficult to share these sophisticated software packages among applications due to differences in implementation language, programming style, or calling interfaces. This LDRD Strategic Initiative investigated and developed software component technology for high-performance parallel scientific computing to address problems of complexity, re-use, and interoperability for laboratory software. Component technology is an extension of scripting and object-oriented software development techniques that specifically focuses on the needs of software interoperability. Component approaches based on CORBA, COM, and Java technologies are widely used in industry; however, they do not support massively parallel applications in science and engineering. Our research focused on the unique requirements of scientific computing on ASCI-class machines, such as fast in-process connections among components, language interoperability for scientific languages, and data distribution support for massively parallel SPMD components.

  14. The new childcare initiative

    CERN Document Server

    Cigdem Issever

    The ATLAS Women's Network recently sent out a general mailing to all ATLAS and CMS members to announce a new initiative aimed at improving childcare facilities for Users coming to CERN. Several people have expressed the need that CERN should provide or facilitate affordable day care for children of temporary visitors at CERN. The ATLAS Women's Network is now forming a child care task force from concerned people and invites all those interested to join this effort. You can do so by either adding your name to the mailing list cern-users-childcare@cern.ch in Simba or by contacting Cigdem.Issever@cern.NOSPAM.ch and Pauline.Gagnon@cern.NOSPAM.ch. More than 50 people have already joined this effort. Those w