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Sample records for current treatment algorithms

  1. Introducing New Biosimilars Into Current Treatment Algorithms

    Directory of Open Access Journals (Sweden)

    John D. Isaacs

    2016-07-01

    Full Text Available Three biosimilar products are now licensed for the treatment of rheumatic diseases in Europe. The European Medicines Agency (EMA requires that similarity between a biosimilar and its reference product is demonstrated using a rigorous, stepwise process that includes extensive physicochemical and biological analytical testing, non-clinical pharmacology, clinical evaluations, and pharmacovigilance plans. Each step is highly sensitive to any differences between products and progressively reduces any uncertainty over similarity; all steps must be satisfied to demonstrate biosimilarity. The US Food and Drug Administration (FDA requires a similar stringent biosimilar development process. The etanercept biosimilar SB4 (Benepali®, recently approved for the treatment of rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis (ankylosing spondylitis, non-radiographic axial spondyloarthritis, and plaque psoriasis, is herein used to demonstrate the detailed analytical characterisation and clinical testing that are required by the EMA before biosimilars are approved for use. A comprehensive characterisation study involving >55 physiochemical and >25 biological assays demonstrated that SB4 has highly similar structural, physicochemical, and biological quality attributes to reference etanercept. A Phase I study demonstrated pharmacokinetic equivalence between SB4 and reference etanercept in healthy male subjects. Furthermore, a Phase III, randomised, controlled trial performed in patients with moderate-to-severe rheumatoid arthritis despite treatment with methotrexate (MTX showed that SB4 was equivalent to etanercept in terms of efficacy, safety, and immunogenicity. In conclusion, the biosimilar development process performed according to EMA or FDA guidelines is highly rigorous and comprehensive. Biosimilars such as SB4 are now available in clinical practice and are likely to improve access, reduce costs, and ultimately, improve health outcomes.

  2. Current state of the art brachytherapy treatment planning dosimetry algorithms.

    Science.gov (United States)

    Papagiannis, P; Pantelis, E; Karaiskos, P

    2014-09-01

    Following literature contributions delineating the deficiencies introduced by the approximations of conventional brachytherapy dosimetry, different model-based dosimetry algorithms have been incorporated into commercial systems for (192)Ir brachytherapy treatment planning. The calculation settings of these algorithms are pre-configured according to criteria established by their developers for optimizing computation speed vs accuracy. Their clinical use is hence straightforward. A basic understanding of these algorithms and their limitations is essential, however, for commissioning; detecting differences from conventional algorithms; explaining their origin; assessing their impact; and maintaining global uniformity of clinical practice.

  3. Current concepts on posterior meniscal root lesion: A treatment algorithm based on the currently available evidence

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    Guan-Yang Song

    2014-07-01

    Full Text Available Meniscal root lesion is defined as an avulsion of the tibial insertion of the meniscus or a radial tear close to the meniscal insertion, which is commonly observed at the posterior region in the clinical practice. Although a number of biomechanical and clinical studies have shown the importance of the integrity of the posterior meniscal roots, the appropriate treatment is still controversial. The purposes of this review are to develop a current understanding of how the posterior meniscal root functions and to review the available treatment options for posterior meniscal root lesion.

  4. Current idea of an algorithm for drug treatment and optimal succession of using targeted drugs

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    D. A. Nosov

    2014-11-01

    Full Text Available The application of targeted and pathogenetically sound medicational approaches could considerably improve the results of therapy in patients with metastatic renal-cell carcinoma (mRCC. To date, VEGF/VEGFR inhibitors continue to remain a basic and most effective drug treatment in patients with mRCC and the choice of a drug for first-line therapy is based on the following factors: disease prognosis, a patient’s general somatic state, and the understanding of immediate therapy goals, anticipated toxicity and tolerability.Most patients develop resistance to VEGFR inhibitors within 6–11 months after treatment initiation. The basis for resistance development may be the following mechanisms: activation of alternative proangiogenic signaling pathways, that of angiogenesis-independent progression pathways, a microenvironment-induced phenotypic change of tumor cells to form their resistance to targeted drugs, and pharmacokinetic and pharmacodynamic changes in the drug itself during therapy. To overcome resistance to VEGFR inhibitors, there are 2 possible options: 1 switching to a drug having another mechanism of action (the mTOR inhibitor everolimus; 2 that to a more selective and potent tyrosine kinase inhibitor (axitinib that selectively affects and suppresses the activityof the same targets – VEGFR (Vascular Endothelial Growth Factor Receptor 1–3. As before, there is scanty convincing evidence for unique benefits in a particular succession of targeted drugs: a VEGFR inhibitor – a VEGFR inhibitor or a VEGFR inhibitor – an mТOR inhibitor. In a number of cases, the succession of prescribing of targeted drugs may be practically determined by clinical criteria, specifically by the possibility of controlling toxic complications that may be typical for VEFGR inhibitors and may accumulate in case of their successive use. It must be also remembered that VEGFR inhibitors may be successfully reused in patients who have received second- or

  5. Current idea of an algorithm for drug treatment and optimal succession of using targeted drugs

    Directory of Open Access Journals (Sweden)

    D. A. Nosov

    2014-01-01

    Full Text Available The application of targeted and pathogenetically sound medicational approaches could considerably improve the results of therapy in patients with metastatic renal-cell carcinoma (mRCC. To date, VEGF/VEGFR inhibitors continue to remain a basic and most effective drug treatment in patients with mRCC and the choice of a drug for first-line therapy is based on the following factors: disease prognosis, a patient’s general somatic state, and the understanding of immediate therapy goals, anticipated toxicity and tolerability.Most patients develop resistance to VEGFR inhibitors within 6–11 months after treatment initiation. The basis for resistance development may be the following mechanisms: activation of alternative proangiogenic signaling pathways, that of angiogenesis-independent progression pathways, a microenvironment-induced phenotypic change of tumor cells to form their resistance to targeted drugs, and pharmacokinetic and pharmacodynamic changes in the drug itself during therapy. To overcome resistance to VEGFR inhibitors, there are 2 possible options: 1 switching to a drug having another mechanism of action (the mTOR inhibitor everolimus; 2 that to a more selective and potent tyrosine kinase inhibitor (axitinib that selectively affects and suppresses the activityof the same targets – VEGFR (Vascular Endothelial Growth Factor Receptor 1–3. As before, there is scanty convincing evidence for unique benefits in a particular succession of targeted drugs: a VEGFR inhibitor – a VEGFR inhibitor or a VEGFR inhibitor – an mТOR inhibitor. In a number of cases, the succession of prescribing of targeted drugs may be practically determined by clinical criteria, specifically by the possibility of controlling toxic complications that may be typical for VEFGR inhibitors and may accumulate in case of their successive use. It must be also remembered that VEGFR inhibitors may be successfully reused in patients who have received second- or

  6. BLOCKING ALGORITHM FOR CURRENT PROTECTION DURING INRUSH MAGNETIZATION CURRENT

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    F. A. Romaniuk

    2014-01-01

    Full Text Available The paper presents blocking algorithm for current protection during inrush process. The algorithm is based on the evaluation of the ratio of the positive sequence second harmonic current to the negative sequence first harmonic current.

  7. [Current treatment of ureteral lithiasis].

    Science.gov (United States)

    Reina Ruiz, C; Quintero Rodríguez, R; Espinosa Olmedo, J; Arrabal Martín, M; Campoy Martínez, P; Salazar Murillo, R; García Pérez, M

    1995-01-01

    The treatment of ureteral lithiasis has undergone a revolution since the arrival of new techniques offering different therapeutical choices for which time is gradually elucidating the indications for each of the new procedures; although, to a large extent, a degree of controversy still persists. This paper reviews the different methods for ureteral lithiasis; spontaneous ejection and medical treatment, surgery, early endoscopic manoeuvres, backward and forward urethroscopy and, finally, extracorporeal lithority. This therapeutical experience in 3 series of ureteral lithiasis addressed with different criteria are revised together with 182 obstructive calculi of the lumbar ureter. We believe that grading the ureteral calculi according to their anatomical and functional features improves the results, since improved adjustment can be achieved for the indications of the various methods. Also it is noted that support endourology for extracorporeal lithotrity does not improve the results of treatment in lumbar calculi under 2 cm, and therefore our current approach is towards "in situ" treatment without complementary manoeuvres. Finally we show the therapeutic algorithm we are following actually to manage ureteral litiasis.

  8. Cancer Treatment - Cancer Currents Blog

    Science.gov (United States)

    A catalog of posts from NCI’s Cancer Currents blog on cancer treatment research. Includes posts on new treatments for cancer and their effects, clinical trial results, and overcoming treatment resistance.

  9. SLAP lesions: a treatment algorithm.

    Science.gov (United States)

    Brockmeyer, Matthias; Tompkins, Marc; Kohn, Dieter M; Lorbach, Olaf

    2016-02-01

    Tears of the superior labrum involving the biceps anchor are a common entity, especially in athletes, and may highly impair shoulder function. If conservative treatment fails, successful arthroscopic repair of symptomatic SLAP lesions has been described in the literature particularly for young athletes. However, the results in throwing athletes are less successful with a significant amount of patients who will not regain their pre-injury level of performance. The clinical results of SLAP repairs in middle-aged and older patients are mixed, with worse results and higher revision rates as compared to younger patients. In this population, tenotomy or tenodesis of the biceps tendon is a viable alternative to SLAP repairs in order to improve clinical outcomes. The present article introduces a treatment algorithm for SLAP lesions based upon the recent literature as well as the authors' clinical experience. The type of lesion, age of patient, concomitant lesions, and functional requirements, as well as sport activity level of the patient, need to be considered. Moreover, normal variations and degenerative changes in the SLAP complex have to be distinguished from "true" SLAP lesions in order to improve results and avoid overtreatment. The suggestion for a treatment algorithm includes: type I: conservative treatment or arthroscopic debridement, type II: SLAP repair or biceps tenotomy/tenodesis, type III: resection of the instable bucket-handle tear, type IV: SLAP repair (biceps tenotomy/tenodesis if >50 % of biceps tendon is affected), type V: Bankart repair and SLAP repair, type VI: resection of the flap and SLAP repair, and type VII: refixation of the anterosuperior labrum and SLAP repair.

  10. Current treatments for scabies.

    Science.gov (United States)

    Buffet, M; Dupin, N

    2003-04-01

    Scabies is a frequent interhuman ectoparasitic infection. Several treatments are available worldwide. There are local treatments: synthetic pyrethrins, benzyl benzoate, lindane, crotamiton. Recently a few studies were published concerning ivermectin, systemic antiparasitic agent use in onchocercosis treatment. We reviewed the literature with an evidence-based medicine method. We attempt to answer two questions in particular: what is the treatment of choice for common scabies in a patient otherwise in good health? What is the role of systemic ivermectin? We also report specific situations. Among local treatments, studies are heterogeneous according to products, countries, group of treated patients, with or without contact subjects, and the method of treatment application. There are very few high proof-level controlled studies. In France, a combination of benzyl benzoate 10% and sulfiram 2% is used most, according to professional consensus. The most studied product is the cream permethrin 5%, available in the USA and UK. Its efficacy seems slightly superior to lindane and less toxic. It is more efficient than crotamiton. There is no study comparing benzyl benzoate and permethrin. Concerning systemic ivermectin, five controlled studies showed its efficiency in common scabies. But its relative efficiency over local treatment has not been established. A few open studies showed its efficacy in institutional epidemic, profuse scabies and in HIV-positive patients. Local treatment of choice in common scabies remains to be determined among the four principal molecules. There is no study comparing permethrin or esdepallethrin to benzyl benzoate. In what cases should we prescribe crotamiton or lindane? Indication of ivermectin seems proved in common scabies and probably for HIV-positive patients. It remains to be determined if it should be prescribed in the first instance, be double or triple, be associated or not with local treatment. In case of keratotic scabies, ivermectin

  11. Current Treatments of Bruxism

    OpenAIRE

    Guaita, Marc; Högl, Birgit

    2016-01-01

    Opinion statement Despite numerous case reports, the evidence for treatment of bruxism is still low. Different treatment modalities (behavioral techniques, intraoral devices, medications, and contingent electrical stimulation) have been applied. A clinical evaluation is needed to differentiate between awake bruxism and sleep bruxism and rule out any medical disorder or medication that could be behind its appearance (secondary bruxism). A polysomnography is required only in a few cases of slee...

  12. [Osteoarthrosis: implementation of current diagnostic and therapeutic algorithms].

    Science.gov (United States)

    Meza-Reyes, Gilberto; Aldrete-Velasco, Jorge; Espinosa-Morales, Rolando; Torres-Roldán, Fernando; Díaz-Borjón, Alejandro; Robles-San Román, Manuel

    2017-01-01

    In the modern world, among the different clinical presentations of osteoarthritis, gonarthrosis and coxarthrosis exhibit the highest prevalence. In this paper, the characteristics of osteoarthritis and the different scales of assessment and classification of this pathology are exposed, to provide an exhibition of current evidence generated around diagnostic algorithms and treatment of osteoarthritis, with emphasis set out in the knee and hip, as these are the most frequent; a rational procedure for monitoring patients with osteoarthritis based on characteristic symptoms and the severity of the condition is also set. Finally, reference is made to the therapeutic benefits of the recent introduction of viscosupplementation with Hylan GF-20.

  13. Bruxism and Current Treatment Approaches

    Directory of Open Access Journals (Sweden)

    Selin Eren

    2016-06-01

    Full Text Available Among the mastication system disorders bruxism is a parafunctional behavior that comes from psychophysiological origin. Epidemiologic studies have reported great variability of bruxism prevalence. The factors that could cause bruxism is highly controversial. There are different opinions on this issue. The etiologic factors of bruxism include stress, malnutrition, allergic and endocrinologic diseases, central nervous system disorders, genetic factors, medicines, malocclusion, and wrong dental treatment. The aim of treatment of bruxism is to prevent damage that may occur on teeth and in the temporomandibular joint and to eliminate pain. Dental treatment, physical therapy, pharmacological treatment and behavioral and cognitive therapy can be considered for this purpose of treatment. This review summarizes the etiologic factors, epidemiology, diagnosis, and current treatment approaches of patient with bruxism. [Archives Medical Review Journal 2016; 25(2.000: 241-258

  14. INVESTIGATION OF BLOCKING ALGORITHM FOR TRANSFORMER CURRENT PROTECTIONS IN MAGNETIZING INRUSH CURRENT MODES

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    A. N. Kuzovlev

    2014-01-01

    Full Text Available Presents investigations on blocking  algorithm for transformer  current  protections  during magnetizing  inrush  current. The investigations have shown that the algorithm has high sensitivity and reliably determines magnetizing  inrush current modes.

  15. Treatment algorithm of acetabular periprosthetic fractures.

    Science.gov (United States)

    Simon, Paul; von Roth, Philipp; Perka, Carsten

    2015-10-01

    Periprosthetic fractures of the acetabulum represent a rare incident in primary and revision total hip arthroplasty. The management of these fractures can be challenging. At present, there are no reliable guidelines for the treatment of periprosthetic acetabular fractures. Periprosthetic acetabular fractures can occur intra-operatively, in particular during insertion of non-cemented cups or in the context of revision surgery. Post-operative causes for periprosthetic acetabular fractures are traumatic events or, more commonly, pelvic discontinuity due to severe bone loss related to osteolysis. Despite their aetiology, the main objective of surgery is to achieve a stable acetabular component and fracture. While stable fractures and implants could be treated non-operatively, unstable fractures require surgery to achieve component stability and allow appropriate biological fixation of the revision cup. Assessment of the stability plays a crucial role before determining the treatment strategy. There is a large variety of surgical techniques available for the management of these fractures. This review article outlines the epidemiology, aetiology and current classification systems, and provides a distinct diagnostic and therapeutic algorithm for the treatment of periprosthetic acetabular fractures.

  16. Current treatment of ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    JohannesMeier; AndreasSturm

    2011-01-01

    Ulcerative colitis (UC) is a chronic disease featuring re- current inflammation of the colonic mucosa. The goal of medical treatment is to rapidly induce a steroid-free remission while at the same time preventing complica- tions of the disease itself and its treatment. The choice of treatment depends on severity, localization and the course of the disease. For proctitis, topical therapy with 5-aminosalicylic acid (5-ASA) compounds is used. More extensive or severe disease should be treated with oral and local 5-ASA compounds and corticosteroids to induce remission. Patients who do not respond to this treatment require hospitalization. Intravenous steroids or, when refractory, calcineurin inhibitors (cyclosporine, tacrolimus), tumor necrosis factor-α antibodies (infliximab) or immunomodulators (azathioprine, 6-mercaptopurine) are then called for. Indications for emergency surgery include refractory toxic megacolon, perforation, and continuous severe colorectal bleeding. Close collaboration between gastroenterologist and surgeon is mandatory in order not to delay surgical therapy when needed. This article is intended to give a general, practice-orientated overview of the key issues in ulcerative colitis treatment. Recommendations are based on published consensus guidelines derived from national and international guidelines on the treatment of ulcerative colitis.

  17. Current treatments for radiation retinopathy

    Energy Technology Data Exchange (ETDEWEB)

    Giuliari, Gian Paolo; Simpson, E. Rand (Princess Margaret Hospital, Univ. of Toronto, Dept. of Ophthalmology and Vision Sciences, Toronto (Canada)), e-mail: gpgiuliari@gmail.com; Sadaka, Ama (Schepens Eye Research Inst., Boston, MA (United States)); Hinkle, David M. (Massachusetts Eye Research and Surgery Institution, Cambridge, MA (United States))

    2011-01-15

    Background. To review the currently available therapeutic modalities for radiation retinopathy (RR), including newer investigational interventions directed towards specific aspects of the pathophysiology of this refractory complication. Methods. A review of the literature encompassing the pathogenesis of RR and the current therapeutic modalities available was performed. Results. RR is a chronic and progressive condition that results from exposure to any source of radiation. It might be secondary to radiation treatment of intraocular tumors such as choroidal melanomas, retinoblastomas, and choroidal metastasis, or from unavoidable exposure to excessive radiation from the treatment of extraocular tumors like cephalic, nasopharyngeal, orbital, and paranasal malignancies. After the results of the Collaborative Ocular Melanoma Study, most of the choroidal melanomas are being treated with plaque brachytherapy increasing by that the incidence of this radiation complication. RR has been reported to occur in as many as 60% of eyes treated with plaque radiation, with higher rates associated with larger tumors. Initially, the condition manifests as a radiation vasculopathy clinically seen as microaneurysms and telangiectasis, with posterior development of retinal hard exudates and hemorrhages, macular edema, neovascularization and tractional retinal detachment. Regrettably, the management of these eyes remains limited. Photodynamic therapy, laser photocoagulation, oral pentoxyphylline and hyperbaric oxygen have been attempted as treatment modalities with inconclusive results. Intravitreal injections of anti-vascular endothelial growth factor such as bevacizumab, ranibizumab and pegaptanib sodium have been recently used, also with variable results. Discussion. RR is a common vision threatening complication following radiation therapy. The available therapeutic options are limited and show unsatisfactory results. Further large investigative studies are required for developing

  18. Output Current Ripple Reduction Algorithms for Home Energy Storage Systems

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    Jin-Hyuk Park

    2013-10-01

    Full Text Available This paper proposes an output current ripple reduction algorithm using a proportional-integral (PI controller for an energy storage system (ESS. In single-phase systems, the DC/AC inverter has a second-order harmonic at twice the grid frequency of a DC-link voltage caused by pulsation of the DC-link voltage. The output current of a DC/DC converter has a ripple component because of the ripple of the DC-link voltage. The second-order harmonic adversely affects the battery lifetime. The proposed algorithm has an advantage of reducing the second-order harmonic of the output current in the variable frequency system. The proposed algorithm is verified from the PSIM simulation and experiment with the 3 kW ESS model.

  19. Current Treatments in Familial Dysautonomia

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    Palma, Jose-Alberto; Kaufmann, Lucy; Fuente, Cristina; Percival, Leila; Mendoza, Carlos; Kaufmann, Horacio

    2014-01-01

    Introduction Familial dysautonomia (FD) is a rare hereditary sensory and autonomic neuropathy (type III). The disease is caused by a point mutation in the IKBKAP gene that affects the splicing of the elongator-1 protein (also known as IKAP). Patients have dramatic blood pressure instability due to baroreflex failure, chronic kidney disease, and impaired swallowing leading to recurrent aspiration pneumonia, which results in chronic lung disease. Diminished pain and temperature perception results in neuropathic joints and thermal injuries. Impaired proprioception leads to gait ataxia. Optic neuropathy and corneal opacities lead to progressive visual loss. Areas covered This article reviews current therapeutic strategies for the symptomatic treatment of FD, as well as the potential of new gene modifying agents. Expert opinion Therapeutic focus on FD is centered on reducing the catecholamine surges caused by baroreflex failure. Managing neurogenic dysphagia with effective protection of the airway passages and prompt treatment of aspiration pneumonias is necessary to prevent respiratory failure. Sedative medications should be used cautiously due to risk of respiratory depression. Non-invasive ventilation during sleep effectively manages apneas and prevents hypercapnia. Clinical trials of compounds that increase levels of IKAP (ELP-1) are underway and will determine whether they can reverse or slow disease progression. PMID:25323828

  20. Principles of a new treatment algorithm in multiple sclerosis

    DEFF Research Database (Denmark)

    Hartung, Hans-Peter; Montalban, Xavier; Sorensen, Per Soelberg

    2011-01-01

    We are entering a new era in the management of patients with multiple sclerosis (MS). The first oral treatment (fingolimod) has now gained US FDA approval, addressing an unmet need for patients with MS who wish to avoid parenteral administration. A second agent (cladribine) is currently being...... considered for approval. With the arrival of these oral agents, a key question is where they may fit into the existing MS treatment algorithm. This article aims to help answer this question by analyzing the trial data for the new oral therapies, as well as for existing MS treatments, by applying practical...

  1. Eddy current testing probe optimization using a parallel genetic algorithm

    Directory of Open Access Journals (Sweden)

    Dolapchiev Ivaylo

    2008-01-01

    Full Text Available This paper uses the developed parallel version of Michalewicz's Genocop III Genetic Algorithm (GA searching technique to optimize the coil geometry of an eddy current non-destructive testing probe (ECTP. The electromagnetic field is computed using FEMM 2D finite element code. The aim of this optimization was to determine coil dimensions and positions that improve ECTP sensitivity to physical properties of the tested devices.

  2. Orthognathic Surgery in Craniofacial Microsomia: Treatment Algorithm

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    Rodrigo Fariña, DDS, Med

    2015-01-01

    Full Text Available Summary: Craniofacial microsomia is a broad term that covers a variety of craniofacial malformation conditions that are caused by alterations in the derivatives of the first and second pharyngeal arches. In general terms, diverse therapeutic alternatives are proposed according to the growth stage and the severity of the alteration. When craniofacial growth has concluded, conventional orthognathic surgery (Le Fort I osteotomy, bilateral sagittal split osteotomy, and genioplasty provides good alternatives for MI and MIIA type cases. Reconstruction of the mandibular ramus and temporomandibular joint before orthognathic surgery is the indicated treatment for cases MIIB and MIII. The goal of this article is to establish a surgical treatment algorithm for orthognathic surgery on patients with craniofacial microsomia, analyzing the points that allow the ideal treatment for each patient to be chosen.

  3. Discrimination of Inrush Currents from Faults Current in Power Transformers using Gravitational Search Algorithm (GSA

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    Mohamad Kazem Daryabari

    2011-01-01

    Full Text Available The magnetizing inrush current phenomenon is a large transient condition, which occurs when a transformer is energized. The inrush current magnitude may be as high as ten times of transformer rated current that causes mal-operation of protection systems. Indeed, the similarity between signatures of Inrush current and internal fault condition make this failure. So, for safe running of a transformer, it is necessary to distinguish inrush current from fault currents. In this project, an Artificial Neural Network (ANN which is trained by two different swarm based algorithms; Gravitational Search Algorithm (GSA and Particle Swarm Optimization (PSO have been used to discriminate inrush current from fault currents in power transformers. GSA works based on gravity laws and in opposite of other swarm based algorithms, particles have identity and PSO is based on behaviors of bird flocking. Proposed approach has two general stages, in first step, obtained data from simulation have been processed and applied to ANN, and then in step two, using training data considered ANN has been trained by GSA & PSO. Proposed method has been compared with one of the common training approach which is called Back Propagation (BP and Results show that proposed method is so quick and can do discrimination very accurate.

  4. Current treatment of ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    Johannes Meier; Andreas Sturm

    2011-01-01

    Ulcerative colitis (UC) is a chronic disease featuring recurrent inflammation of the colonic mucosa. The goal of medical treatment is to rapidly induce a steroid-free remission while at the same time preventing complications of the disease itself and its treatment. The choice of treatment depends on severity, localization and the course of the disease. For proctitis, topical therapy with 5-aminosalicylic acid (5-ASA) compounds is used. More extensive or severe disease should be treated with oral and local 5-ASA compounds and corticosteroids to induce remission. Patients who do not respond to this treatment require hospitalization. Intravenous steroids or, when refractory, calcineurin inhibitors (cyclosporine, tacrolimus), tumor necrosis factor-α antibodies (infliximab) or immunomodulators (azathioprine, 6-mercaptopurine) are then called for. Indications for emergency surgery include refractory toxic megacolon, perforation, and continuous severe colorectal bleeding. Close collaboration between gastroenterologist and surgeon is mandatory in order not to delay surgical therapy when needed. This article is intended to give a general, practice- orientated overview of the key issues in ulcerative colitis treatment. Recommendations are based on published consensus guidelines derived from national and international guidelines on the treatment of ulcerative colitis.

  5. Current evidence for osteoarthritis treatments.

    Science.gov (United States)

    Anandacoomarasamy, Ananthila; March, Lyn

    2010-02-01

    Osteoarthritis (OA) is the most common form of arthritis and the leading cause of chronic disability among older people. The burden of the disease is expected to rise with an aging population and the increasing prevalence of obesity. Despite this, there is as yet no cure for OA. However, in recent years, a number of potential therapeutic advances have been made, in part due to improved understanding of the underlying pathophysiology. This review provides the current evidence for symptomatic management of OA including nonpharmacological, pharmacological and surgical approaches. The current state of evidence for disease-modifying therapy in OA is also reviewed.

  6. Treatment Algorithms in Systemic Lupus Erythematosus.

    Science.gov (United States)

    Muangchan, Chayawee; van Vollenhoven, Ronald F; Bernatsky, Sasha R; Smith, C Douglas; Hudson, Marie; Inanç, Murat; Rothfield, Naomi F; Nash, Peter T; Furie, Richard A; Senécal, Jean-Luc; Chandran, Vinod; Burgos-Vargas, Ruben; Ramsey-Goldman, Rosalind; Pope, Janet E

    2015-09-01

    To establish agreement on systemic lupus erythematosus (SLE) treatment. SLE experts (n = 69) were e-mailed scenarios and indicated preferred treatments. Algorithms were constructed and agreement determined (≥50% respondents indicating ≥70% agreement). Initially, 54% (n = 37) responded suggesting treatment for scenarios; 13 experts rated agreement with scenarios. Fourteen of 16 scenarios had agreement as follows: discoid lupus: first-line therapy was topical agents and hydroxychloroquine and/or glucocorticoids then azathioprine and subsequently mycophenolate (mofetil); uncomplicated cutaneous vasculitis: initial treatment was glucocorticoids ± hydroxychloroquine ± methotrexate, followed by azathioprine or mycophenolate and then cyclophosphamide; arthritis: initial therapy was hydroxychloroquine and/or glucocorticoids, then methotrexate and subsequently rituximab; pericarditis: first-line therapy was nonsteroidal antiinflammatory drugs, then glucocorticoids with/without hydroxychloroquine, then azathioprine, mycophenolate, or methotrexate and finally belimumab or rituximab, and/or a pericardial window; interstitial lung disease/alveolitis: induction was glucocorticoids and mycophenolate or cyclophosphamide, then rituximab or intravenous gamma globulin (IVIG), and maintenance followed with azathioprine or mycophenolate; pulmonary hypertension: glucocorticoids and mycophenolate or cyclophosphamide and an endothelin receptor antagonist were initial therapies, subsequent treatments were phosphodiesterase-5 inhibitors and then prostanoids and rituximab; antiphospholipid antibody syndrome: standard anticoagulation with/without hydroxychloroquine, then a thrombin inhibitor for venous thrombosis, versus adding aspirin or platelet inhibition drugs for arterial events; mononeuritis multiplex and central nervous system vasculitis: first-line therapy was glucocorticoids and cyclophosphamide followed by maintenance with azathioprine or mycophenolate, and

  7. Current antifungal treatment of fusariosis.

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    Al-Hatmi, Abdullah M S; Bonifaz, Alexandro; Ranque, Stephane; de Hoog, G Sybren; Verweij, Paul E; Meis, Jacques F

    2017-07-10

    Fungi of the genus Fusarium are well known as major plant pathogens and soil inhabitants but also cause a broad spectrum of human infections. Fusariosis is the second most common mould infection after aspergillosis and keratitis is the most encountered implantation infection in immunocompetent individuals. Natamycin is active against Fusarium species both in vitro and in vivo, and it is used along with voriconazole as the mainstay of treatment for Fusarium keratitis. Onychomycosis is treated with terbinafine, voriconazole and sometimes itraconazole. Cure is possible despite high in vitro MICs. Recently disseminated infections have increased dramatically, mainly affecting severely immunocompromised patients. The remarkable intrinsic resistance of Fusarium species to most antifungal agents results in high mortality rates in this patient population. Recovery of neutropenia is essential for patient survival and treatment should include voriconazole or amphotericin B as first line and posaconazole as salvage therapy. Copyright © 2017. Published by Elsevier B.V.

  8. An algorithm for the pharmacological treatment of depression

    NARCIS (Netherlands)

    Spijker, J.; Nolen, W. A.

    2010-01-01

    Objective: Non-response to treatment with antidepressants (AD) is a clinical problem. Method: The algorithm for pharmacological treatment of the Dutch multidisciplinary guideline for depression is compared with four other algorithms. Results: The Dutch algorithm consists of five subsequent steps. Tr

  9. An algorithm for the pharmacological treatment of depression

    NARCIS (Netherlands)

    Spijker, J.; Nolen, W.A.

    2010-01-01

    Objective: Non-response to treatment with antidepressants (AD) is a clinical problem. Method: The algorithm for pharmacological treatment of the Dutch multidisciplinary guideline for depression is compared with four other algorithms. Results: The Dutch algorithm consists of five subsequent steps.

  10. An algorithm for the pharmacological treatment of depression

    NARCIS (Netherlands)

    Spijker, J.; Nolen, W. A.

    Objective: Non-response to treatment with antidepressants (AD) is a clinical problem. Method: The algorithm for pharmacological treatment of the Dutch multidisciplinary guideline for depression is compared with four other algorithms. Results: The Dutch algorithm consists of five subsequent steps.

  11. Chronic Constipation: Current Treatment Options

    Directory of Open Access Journals (Sweden)

    Louis Wing Cheong Liu

    2011-01-01

    Full Text Available Chronic constipation is a common functional gastrointestinal disorder that affects patients of all ages. In 2007, a consensus group of 10 Canadian gastroenterologists developed a set of recommendations pertaining to the management of chronic constipation and constipation-dominant irritable bowel syndrome. Since then, tegaserod has been withdrawn from the Canadian market. A new, highly selective serotonin receptor subtype 4 agonist, prucalopride, has been examined in several large, randomized, placebo-controlled trials demonstrating its efficacy and safety in the management of patients with chronic constipation. Additional studies evaluating the use of stimulant laxatives, polyethylene glycol and probiotics in the management of chronic constipation have also been published. The present review summarizes the previous recommendations and new evidence supporting different treatment modalities – namely, diet and lifestyle, bulking agents, stool softeners, osmotic and stimulant laxatives, prucalopride and probiotics in the management of chronic constipation. A brief summary of lubiprostone and linaclotide is also presented. The quality of evidence is presented by adopting the Grading of Recommendations, Assessment, Development and Evaluation system. Finally, a management pyramid for patients with chronic constipation is proposed based on the quality of evidence, impact of each modality on constipation and on general health, and their availabilities in Canada.

  12. Current status in diabetic macular edema treatments

    National Research Council Canada - National Science Library

    Pedro Romero-Aroca

    2013-01-01

    ... status.The photocoagulation laser is currently restricted to focal macular edema in some countries,but due the high cost of intravitreal drugs,the use of laser treatment for focal and diffuse diabetic macular edema(DME...

  13. LIMITATIONS OF CURRENT APPROACHES FOR THE TREATMENT OF ACROMEGALY.

    Science.gov (United States)

    Shanik, Michael H

    2016-02-01

    Acromegaly is a rare disease characterized by hypersecretion of growth hormone (GH), typically from a benign pituitary somatotroph adenoma, that leads to subsequent hypersecretion of insulin-like growth factor 1 (IGF-1). Patients with acromegaly have an increased risk of mortality and progressive worsening of comorbidities. Surgery, medical therapy, and radiotherapy are currently available treatment approaches for patients with acromegaly, with overall therapeutic goals of lowering GH levels and achieving normal IGF-1 levels, reducing tumor size, improving comorbidities, and minimizing mortality risk. Although surgery can lead to biochemical remission in some patients with acromegaly, many patients will continue to have uncontrolled disease and require additional treatment. We reviewed recently published reports and present a summary of the safety and efficacy of current treatment modalities for patients with acromegaly. A substantial proportion of patients who receive medical therapy or radiotherapy will have persistently elevated GH and/or IGF-1. Because of the serious health consequences of continued elevation of GH and IGF-1, there is a need to improve therapeutic approaches to optimize biochemical control, particularly in high-need patient populations for whom current treatment options provide limited benefit. This review discusses current treatment options for patients with acromegaly, limitations associated with each treatment approach, and areas within the current treatment algorithm, as well as patient populations for which improved therapeutic options are needed. Novel agents in development were also highlighted, which have the potential to improve management of patients with uncontrolled or persistent acromegaly.

  14. Current Treatment Options in Vestibular Migraine

    Science.gov (United States)

    Obermann, Mark; Strupp, Michael

    2014-01-01

    Approximately 1% of the general population in western industrialized countries suffers from vestibular migraine. However, it remains widely unknown and often under diagnosed despite the recently published diagnostic criteria for vestibular migraine. Treatment trials that specialize on vestibular migraine are scarce and systematic randomized controlled clinical trials are now only emerging. This review summarizes the knowledge on the currently available treatment options that were tested specifically for vestibular migraine and gives an evidence-based, informed treatment recommendation with all its limitations. To date only two randomized controlled treatment trials provide limited evidence for the use of rizatriptan and zolmitriptan for the treatment of vestibular migraine attacks because of methodological shortcomings. There is an ongoing multicenter randomized placebo-controlled trial testing metoprolol 95 mg vs. placebo (PROVEMIG-trial). Therefore, the therapeutic recommendations for the prophylactic treatment of vestibular migraine are currently widely based on the guidelines of migraine with and without aura as well as expert opinion. PMID:25538676

  15. Current drug treatments for vestibular disorders

    OpenAIRE

    Maksim Valeryevich Zamergrad

    2012-01-01

    There has recently been significant progress in the treatment of different diseases accompanied by dizziness. First and foremost, this is due to the development of highly effective medical positioning maneuvers for benign paroxysmal positional vertigo and to their introduction into practice. At the same time, drug treatments for vertigo are being continued under development. The paper considers the current methods of symptomatic and pathogenetic treatment for different diseases of the vestibu...

  16. CURRENT OPTIONS FOR SURGICAL TREATMENT OF GLAUCOMA.

    Science.gov (United States)

    Stefan, Cornel; Batras, Mehdi; Iliescu Daniela, Adriana; Timaru Cristina, Mihaela; De Simone, Algerino; Hosseini-Ramhormozi, Jalaladin

    2015-01-01

    The purpose of this study is to review current surgical treatment and new and better alternatives for patients with glaucoma. Glaucoma refers to a group of related eye disorders that have in common an optic neuropathy associated with visual function loss. It is one of the leading causes of irreversible blindness worldwide. Optic nerve damage and glaucoma-related vision loss can be prevented or limited by early diagnosis and treatment. Surgery offers a better control of the intraocular pressure then medical therapy. Nowadays, research continues for improving current surgical alternatives for treatment.

  17. A Comparison of Prediction Algorithms for Prefetching in the Current Web

    OpenAIRE

    Josep Domenech; Sahuquillo Borrás, Julio; Gil Salinas, José Antonio; Pont Sanjuan, Ana

    2012-01-01

    This paper reviews a representative subset of the prediction algorithms used for Web prefetching classifying them according to the information gathered. Then, the DDG algorithm is described. The main novelty of this algorithm lies in the fact that, unlike previous algorithms, it creates a prediction model according to the structure of the current web. To this end, the algorithm distinguishes between container objects and embedded objects. Its performance is compared against important existing...

  18. A pharmacological treatment algorithm for localized neuropathic pain.

    Science.gov (United States)

    Allegri, Massimo; Baron, Ralf; Hans, Guy; Correa-Illanes, Gerardo; Mayoral Rojals, Victor; Mick, Gerard; Serpell, Michael

    2016-01-01

    Neuropathic pain is caused by a lesion or disease affecting the somatosensory system and is difficult to manage, often proving refractory to existing treatments. In more than half of cases, it is localized and affects a specific, clearly circumscribed area of the body (localized neuropathic pain, or LNP). A recently developed screening tool enables patients with probable neuropathic pain/LNP to be identified quickly and easily. In view of the conflicting current treatment recommendations, an advisory board of pain specialists met in June 2015 to develop a complementary treatment guidance algorithm, for use in the primary care setting and by non-pain specialists. The starting point of the algorithm is a diagnosis of LNP and there was consensus that first-line treatment should be a topical analgesic agent, because the benefit/risk ratios are far better than for systemic agents. Topical application offers site-specific delivery, a lower total systemic dose and avoidance of first-pass metabolism, reducing the risk of adverse events and drug/drug interactions. The 5% lidocaine medicated plaster has most evidence supporting its use in LNP, producing effective analgesia and reducing the associated area of allodynia, but other topical agents include capsaicin, clonidine and botulinum toxin type A. Treatment should be commenced with the topical agent of choice, and the patient re-assessed after an appropriate period. Where the response is good the topical agent is continued, with a re-evaluation after 3-6 months. A systemic agent (e.g. gabapentin, pregabalin, duloxetine, venlafaxine) is added if there is only a partial response, or substituted if there is no response, and the patient re-assessed after a month. If there is poor or no response to the systemic agent the patient should be switched to an alternative one and, if this also proves ineffective, referred to a pain specialist.

  19. Current drug treatments for vestibular disorders

    Directory of Open Access Journals (Sweden)

    Maksim Valeryevich Zamergrad

    2012-01-01

    Full Text Available There has recently been significant progress in the treatment of different diseases accompanied by dizziness. First and foremost, this is due to the development of highly effective medical positioning maneuvers for benign paroxysmal positional vertigo and to their introduction into practice. At the same time, drug treatments for vertigo are being continued under development. The paper considers the current methods of symptomatic and pathogenetic treatment for different diseases of the vestibular system. It gives data on current medicinal approaches to the treatment of vestibular neuronitis, Mеniеre's disease, migraine-associated vertigo, and central vestibulopathies. Furthermore, prospects for the use of drugs together with vestibular exercises to stimulate central vestibular compensation are discussed.

  20. Premature ejaculation: current and future treatments

    Institute of Scientific and Technical Information of China (English)

    Levent Gurkan; Matthew Oommen; Wayne J. G. Hellstrom

    2008-01-01

    Premature ejaculation (PE) is recognized to be the most common male sexual disorder. PE provides difficulties for professionals who treat this condition because there is neither a universally accepted definition nor a medication approved by the Food and Drug Administration (FDA). Despite these shortcomings, physicians continue to diagnose their patients with PE according to major guidelines and treat them with either behavioral therapies or off-label medications. This review focuses on current and emerging treatment options and medications for PE. Advantages and limitations of each treatment option are discussed in the light of current published peer-reviewed literature.

  1. Current treatment of low grade astrocytoma

    DEFF Research Database (Denmark)

    Pedersen, Christina Louise; Romner, Bertil

    2013-01-01

    Through a comprehensive review of the current literature, the present article investigates several aspects of low grade astrocytomas (LGA), including prognostic factors, treatment strategies and follow-up regimes. LGA are in general relatively slow-growing primary brain tumours, but they have...... as the course of disease. The current literature seems to support the idea that treatment with radical tumour resection, where possible, yields better long term outcome for patients with LGA. However, adjuvant therapy is often necessary. Administering early postoperative radiotherapy to patients with partially...... effective in discriminating between tumour progression and radiation necrosis. The research into biomarkers is currently limited with regards to their applications in LGA diagnostics, and therefore further studies including larger patient populations are needed....

  2. Current treatment options in vestibular migraine

    Directory of Open Access Journals (Sweden)

    Mark eObermann

    2014-12-01

    Full Text Available Approximately 1% of the general population in western industrialized countries suffers from vestibular migraine. However, it remains widely unknown and often under diagnosed even despite the recently published diagnostic criteria for vestibular migraine. Treatment trials that specialize on vestibular migraine are scarce and systematic randomized controlled clinical trials are only now emerging.This review summarizes the knowledge on the currently available treatment options that were tested specifically for vestibular migraine and gives an evidence-based, informed treatment recommendation with all its limitations.To date only two randomized controlled treatment trials provide limited evidence for the use of rizatriptan and zolmitriptan for the treatment of vestibular migraine attacks because of methodological shortcommings. There is an on-going a multicenter randomized placebo-controlled trial testing metoprolol 95 mg vs. placebo (PROVEMIG-trial. Therefore, the therapeutic recommendations for the prophylactic treatment of vestibular migraine are currently widely based on the guidelines of migraine with and without aura as well as expert opinion.

  3. Current Perspectives on the Pedagogical Value of Algorithm Visualization

    DEFF Research Database (Denmark)

    Demetriadis, Stavros N.; Papadopoulos, Pantelis M.

    2004-01-01

    The advent of computer technology offers the opportunity for developing multimodal, dynamic and interactive representations of knowledge which are expected to significantly enhance learning. This chapter presents an overview of the pedagogical effectiveness of the algorithm visualization systems......, which make use of dynamic visual representations for supporting the instruction in the domain of computer algorithms. The author highlights the most important conceptual and methodological advances in the field, analyzing the properties of the representations that are usually displayed by such systems...... and presenting significant research results concerning their pedagogical efficiency. Available studies indicate that it is not the quality of the graphical display (“what the students see”) but students’ engagement in active learning situations with algorithm visualization systems (“what the students do...

  4. The Goddard Profiling Algorithm (GPROF): Description and Current Applications

    Science.gov (United States)

    Olson, William S.; Yang, Song; Stout, John E.; Grecu, Mircea

    2004-01-01

    Atmospheric scientists use different methods for interpreting satellite data. In the early days of satellite meteorology, the analysis of cloud pictures from satellites was primarily subjective. As computer technology improved, satellite pictures could be processed digitally, and mathematical algorithms were developed and applied to the digital images in different wavelength bands to extract information about the atmosphere in an objective way. The kind of mathematical algorithm one applies to satellite data may depend on the complexity of the physical processes that lead to the observed image, and how much information is contained in the satellite images both spatially and at different wavelengths. Imagery from satellite-borne passive microwave radiometers has limited horizontal resolution, and the observed microwave radiances are the result of complex physical processes that are not easily modeled. For this reason, a type of algorithm called a Bayesian estimation method is utilized to interpret passive microwave imagery in an objective, yet computationally efficient manner.

  5. [Current treatment of primary immune thrombocytopenia].

    Science.gov (United States)

    Lozano, María L; Vicente, Vicente

    2014-05-06

    Primary immune thrombocytopenia, also termed immune thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by premature platelet destruction and impaired platelet production. Traditional treatment of ITP has predominantly consisted of immune suppression and/or modulation. However, the understanding of the immune mediated impairment of platelet production has led to the development of new treatments that target the thrombopoietin receptor, promoting formation of megakaryocytes and increasing platelet counts. Best practice for the management of ITP has not yet been established because data from comparative studies are lacking. While some disagreement might still remain among experts concerning therapy (when, who, and how should be treated), in recent years different evidence-based practice guidelines have been published to assist healthcare professionals in the diagnosis and treatment of ITP. This review describes the current treatment landscape of ITP. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  6. Current approaches in atrial fibrillation treatment

    Directory of Open Access Journals (Sweden)

    Cenk Sarı

    2014-09-01

    Full Text Available Atrial fibrillation (AF is the most common sustained arrhythmia encountered in clinical practice. Its incidence increases with age. AF is classified into subtypes according to the duration and/or able to provide sinus rhytym. İnitially, patients should be evaluated for rhythm or rate control for appropriate treatment. Second stage of strategy aimed to investigate the feasibility of anticoagulation therapy. Recently, due to the progress made in treatment with rhythm control and anticoagulation therapy, either American or European guidelines have been renovated. These developments have taken place in the newly published guide. In this article, the current change in the management of AF is discussed.

  7. Algorithmic parameterization of mixed treatment comparisons

    NARCIS (Netherlands)

    van Valkenhoef, Gert; Tervonen, Tommi; de Brock, Bert; Hillege, Hans

    2012-01-01

    Mixed Treatment Comparisons (MTCs) enable the simultaneous meta-analysis (data pooling) of networks of clinical trials comparing a parts per thousand yen2 alternative treatments. Inconsistency models are critical in MTC to assess the overall consistency between evidence sources. Only in the absence

  8. Fast voxel and polygon ray-tracing algorithms in intensity modulated radiation therapy treatment planning.

    Science.gov (United States)

    Fox, Christopher; Romeijn, H Edwin; Dempsey, James F

    2006-05-01

    We present work on combining three algorithms to improve ray-tracing efficiency in radiation therapy dose computation. The three algorithms include: An improved point-in-polygon algorithm, incremental voxel ray tracing algorithm, and stereographic projection of beamlets for voxel truncation. The point-in-polygon and incremental voxel ray-tracing algorithms have been used in computer graphics and nuclear medicine applications while the stereographic projection algorithm was developed by our group. These algorithms demonstrate significant improvements over the current standard algorithms in peer reviewed literature, i.e., the polygon and voxel ray-tracing algorithms of Siddon for voxel classification (point-in-polygon testing) and dose computation, respectively, and radius testing for voxel truncation. The presented polygon ray-tracing technique was tested on 10 intensity modulated radiation therapy (IMRT) treatment planning cases that required the classification of between 0.58 and 2.0 million voxels on a 2.5 mm isotropic dose grid into 1-4 targets and 5-14 structures represented as extruded polygons (a.k.a. Siddon prisms). Incremental voxel ray tracing and voxel truncation employing virtual stereographic projection was tested on the same IMRT treatment planning cases where voxel dose was required for 230-2400 beamlets using a finite-size pencil-beam algorithm. Between a 100 and 360 fold cpu time improvement over Siddon's method was observed for the polygon ray-tracing algorithm to perform classification of voxels for target and structure membership. Between a 2.6 and 3.1 fold reduction in cpu time over current algorithms was found for the implementation of incremental ray tracing. Additionally, voxel truncation via stereographic projection was observed to be 11-25 times faster than the radial-testing beamlet extent approach and was further improved 1.7-2.0 fold through point-classification using the method of translation over the cross product technique.

  9. Treatment of Hypogonadism: Current and Future Therapies

    Science.gov (United States)

    Thirumalai, Arthi; Berkseth, Kathryn E.; Amory, John K.

    2017-01-01

    The treatment of hypogonadism in men is of great interest to both patients and providers. There are a number of testosterone formulations currently available and several additional formulations under development. In addition, there are some lesser-used alternative therapies for the management of male hypogonadism, which may have advantages for certain patient groups. The future of hypogonadism therapy may lie in the development of selective androgen receptor modulators that allow the benefits of androgens whilst minimizing unwanted side effects. PMID:28149506

  10. Invisalign: current guidelines for effective treatment.

    Science.gov (United States)

    Kuncio, Daniel A

    2014-03-01

    Invisalign is an increasingly popular technique for aligning teeth and correcting malocclusions orthodontically. This article analyzes the current professional literature published on Invisalign and the benefits and risks of using the technique for both patients and doctors. The steady increase in the number of cases treated with Invisalign and where the technique is going in the future is investigated. Ten guidelines for Invisalign treatment and patient selection are given, along with case examples.

  11. Current treatments for patients with Alzheimer disease.

    Science.gov (United States)

    Osborn, Gerald G; Saunders, Amanda Vaughn

    2010-09-01

    There is neither proven effective prevention for Alzheimer disease nor a cure for patients with this disorder. Nevertheless, a spectrum of biopsychosocial therapeutic measures is available for slowing progression of the illness and enhancing quality of life for patients. These measures include a range of educational, psychological, social, and behavioral interventions that remain fundamental to effective care. Also available are a number of pharmacologic treatments, including prescription medications approved by the US Food and Drug Administration for Alzheimer disease, "off-label" uses of medications to manage target symptoms, and controversial complementary therapies. Physicians must make the earliest possible diagnosis to use these treatments most effectively. Physicians' goals should be to educate patients and their caregivers, to plan long-term care options, to maximally manage concurrent illnesses, to slow and ameliorate the most disabling symptoms, and to preserve effective functioning for as long as possible. The authors review the various current treatments for patients with Alzheimer disease.

  12. Narcolepsy: current treatment options and future approaches

    Directory of Open Access Journals (Sweden)

    Michel Billiard

    2008-06-01

    Full Text Available Michel BilliardDepartment of Neurology, Gui de Chauliac Hospital, Montpellier, FranceAbstract: The management of narcolepsy is presently at a turning point. Three main avenues are considered in this review: 1 Two tendencies characterize the conventional treatment of narcolepsy. Modafinil has replaced methylphenidate and amphetamine as the first-line treatment of excessive daytime sleepiness (EDS and sleep attacks, based on randomized, double blind, placebo-controlled clinical trials of modafinil, but on no direct comparison of modafinil versus traditional stimulants. For cataplexy, sleep paralysis, and hypnagogic hallucinations, new antidepressants tend to replace tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs in spite of a lack of randomized, double blind, placebo-controlled clinical trials of these compounds; 2 The conventional treatment of narcolepsy is now challenged by sodium oxybate, the sodium salt of gammahydroxybutyrate, based on a series of randomized, double-blind, placebo-controlled clinical trials and a long-term open label study. This treatment has a fairly good efficacy and is active on all symptoms of narcolepsy. Careful titration up to an adequate level is essential both to obtain positive results and avoid adverse effects; 3 A series of new treatments are currently being tested, either in animal models or in humans, They include novel stimulant and anticataplectic drugs, endocrine therapy, and, more attractively, totally new approaches based on the present state of knowledge of the pathophysiology of narcolepsy with cataplexy, hypocretine-based therapies, and immunotherapy.Keywords: narcolepsy, treatment, conventional drugs, modafinil, sodium oxybate, future treatments

  13. Current practice of gastric cancer treatment

    Institute of Scientific and Technical Information of China (English)

    Yoon Young Choi; Ji Yeong An; Hyung-Il Kim; Jae-Ho Cheong; Woo Jin Hyung; Sung Hoon Noh

    2014-01-01

    Objective The aim of this review was to overview the current practice of gastric cancer treatment including surgery and other adjuvant modalities.Data sources The review was based on data obtained from the published articles and main guidelines in the East and West.Study selection Articles with high level of evidence or current best evidence in each issue were selected to be reviewed.Results Although varied adjuvant modalities have been proved to be benefit for treating gastric cancer,surgery is still the most important treatment strategy against gastric cancer.Actively adapting to new technology is important but it should be balanced with an effort to establish sound scientific rationale that adheres to oncologic principles.Conclusions Future treatment of gastric cancer will be focused on tailored,personalized therapy.For achieving it,collaboration across disciplines is essential.Also the philosophy of caring for the patients with gastric cancer should be rooted in the realization of true patient benefit regardless of who is providing the care.With these philosophies,we can shift the scientific and technological advances toward triumph over gastric cancer.

  14. Exercise after breast cancer treatment: current perspectives

    Directory of Open Access Journals (Sweden)

    Dieli-Conwright CM

    2015-10-01

    Full Text Available Christina M Dieli-Conwright, Breanna Z Orozco Division of Biokinesiology and Physical Therapy, Women's Health and Exercise Laboratory, University of Southern California, Los Angeles, CA, USA Abstract: Over the past 2 decades, great strides have been made in the field of exercise-oncology research, particularly with breast cancer. This area of research is particularly important since there are >2.8 million breast cancer survivors who are in need of an intervention that can offset treatment-related side effects. Noticeable reductions in physical fitness (ie, cardiopulmonary fitness and muscular strength, negative changes in body composition (ie, increase in body mass, decrease in lean body mass, and increase in fat mass, increased fatigue, depression, or anxiety are some of the common side effects of cancer treatments that negatively impact overall quality of life and increase the risk for the development of comorbidities. Exercise plays a vital role in improving cardiopulmonary function, psychological events, muscular strength, and endurance in breast cancer survivors, and thus should be considered as a key factor of lifestyle intervention to reverse negative treatment-related side effects. The purpose of this review is to address current perspectives on the benefits of aerobic and resistance exercise after breast cancer treatments. This review is focused on the well-established benefits of exercise on physical and emotional well-being, bone health, lymphedema management, and the postulated benefits of exercise on risk reduction for recurrence of breast cancer. Keywords: breast cancer, exercise, physical well-being

  15. Current surgical treatment of knee osteoarthritis.

    Science.gov (United States)

    Rönn, Karolin; Reischl, Nikolaus; Gautier, Emanuel; Jacobi, Matthias

    2011-01-01

    Osteoathritis (OA) of the knee is common, and the chances of suffering from OA increase with age. Its treatment should be initially nonoperative-and requires both pharmacological and nonpharmacological treatment modalities. If conservative therapy fails, surgery should be considered. Surgical treatments for knee OA include arthroscopy, cartilage repair, osteotomy, and knee arthroplasty. Determining which of these procedures is most appropriate depends on several factors, including the location, stage of OA, comorbidities on the one side and patients suffering on the other side. Arthroscopic lavage and débridement is often carried out, but does not alter disease progression. If OA is limited to one compartment, unicompartmental knee arthroplasty or unloading osteotomy can be considered. They are recommended in young and active patients in regard to the risks and limited durability of total knee replacement. Total arthroplasty of the knee is a common and safe method in the elderly patients with advanced knee OA. This paper summarizes current surgical treatment strategies for knee OA, with a focus on the latest developments, indications and level of evidence.

  16. Current Surgical Treatment of Knee Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Karolin Rönn

    2011-01-01

    Full Text Available Osteoathritis (OA of the knee is common, and the chances of suffering from OA increase with age. Its treatment should be initially nonoperative—and requires both pharmacological and nonpharmacological treatment modalities. If conservative therapy fails, surgery should be considered. Surgical treatments for knee OA include arthroscopy, cartilage repair, osteotomy, and knee arthroplasty. Determining which of these procedures is most appropriate depends on several factors, including the location, stage of OA, comorbidities on the one side and patients suffering on the other side. Arthroscopic lavage and débridement is often carried out, but does not alter disease progression. If OA is limited to one compartment, unicompartmental knee arthroplasty or unloading osteotomy can be considered. They are recommended in young and active patients in regard to the risks and limited durability of total knee replacement. Total arthroplasty of the knee is a common and safe method in the elderly patients with advanced knee OA. This paper summarizes current surgical treatment strategies for knee OA, with a focus on the latest developments, indications and level of evidence.

  17. Treatment Algorithms Based on Tumor Molecular Profiling: The Essence of Precision Medicine Trials.

    Science.gov (United States)

    Le Tourneau, Christophe; Kamal, Maud; Tsimberidou, Apostolia-Maria; Bedard, Philippe; Pierron, Gaëlle; Callens, Céline; Rouleau, Etienne; Vincent-Salomon, Anne; Servant, Nicolas; Alt, Marie; Rouzier, Roman; Paoletti, Xavier; Delattre, Olivier; Bièche, Ivan

    2016-04-01

    With the advent of high-throughput molecular technologies, several precision medicine (PM) studies are currently ongoing that include molecular screening programs and PM clinical trials. Molecular profiling programs establish the molecular profile of patients' tumors with the aim to guide therapy based on identified molecular alterations. The aim of prospective PM clinical trials is to assess the clinical utility of tumor molecular profiling and to determine whether treatment selection based on molecular alterations produces superior outcomes compared with unselected treatment. These trials use treatment algorithms to assign patients to specific targeted therapies based on tumor molecular alterations. These algorithms should be governed by fixed rules to ensure standardization and reproducibility. Here, we summarize key molecular, biological, and technical criteria that, in our view, should be addressed when establishing treatment algorithms based on tumor molecular profiling for PM trials. © The Author 2015. Published by Oxford University Press.

  18. Current and future treatment options in osteoporosis.

    LENUS (Irish Health Repository)

    Brewer, Linda

    2012-02-01

    PURPOSE: The incidence of osteoporosis-related fractures will increase substantially over the coming decades as the population ages globally. This has important economic and public health implications, contributing substantially to morbidity and excess mortality in this population. METHODS: When prescribing for older patients the effectiveness profile of drugs needs to be balanced against their tolerability in individual patients. RESULTS: Currently we have good anti-fracture data to support the use of many available anti-resorptive and anabolic drugs including bisphosphonates, strontium ranelate and recombinant human parathyroid hormone. We also have evidence to demonstrate the importance of calcium and vitamin D repletion in these patients. However, in recent years our understanding of normal bone physiology and the mechanisms underlying the development of osteoporosis has significantly advanced and this has led to the development of new therapies. Novel agents, particularly denosumab, but also inhibitors of cathepsin K and anabolic agents that act on Wnt signalling, will increase the therapeutic options for clinicians in the coming years. CONCLUSION: This review discusses the evidence supporting the use of currently available treatment options for osteoporosis and potential future advances in drug therapy. Particular consideration should be given when prescribing for certain older patients who have issues with compliance or tolerance and also in those with co-morbidities or levels of frailty that may restrict the choice of therapy. Understanding the evidence for the benefit and possible harm of osteoporosis treatments is critical to appropriate management of this patient population.

  19. Pressure ulcers: Current understanding and newer modalities of treatment

    Science.gov (United States)

    Bhattacharya, Surajit; Mishra, R. K.

    2015-01-01

    This article reviews the mechanism, symptoms, causes, severity, diagnosis, prevention and present recommendations for surgical as well as non-surgical management of pressure ulcers. Particular focus has been placed on the current understandings and the newer modalities for the treatment of pressure ulcers. The paper also covers the role of nutrition and pressure-release devices such as cushions and mattresses as a part of the treatment algorithm for preventing and quick healing process of these wounds. Pressure ulcers develop primarily from pressure and shear; are progressive in nature and most frequently found in bedridden, chair bound or immobile people. They often develop in people who have been hospitalised for a long time generally for a different problem and increase the overall time as well as cost of hospitalisation that have detrimental effects on patient's quality of life. Loss of sensation compounds the problem manifold, and failure of reactive hyperaemia cycle of the pressure prone area remains the most important aetiopathology. Pressure ulcers are largely preventable in nature, and their management depends on their severity. The available literature about severity of pressure ulcers, their classification and medical care protocols have been described in this paper. The present treatment options include various approaches of cleaning the wound, debridement, optimised dressings, role of antibiotics and reconstructive surgery. The newer treatment options such as negative pressure wound therapy, hyperbaric oxygen therapy, cell therapy have been discussed, and the advantages and disadvantages of current and newer methods have also been described. PMID:25991879

  20. Pressure ulcers: Current understanding and newer modalities of treatment

    Directory of Open Access Journals (Sweden)

    Surajit Bhattacharya

    2015-01-01

    Full Text Available This article reviews the mechanism, symptoms, causes, severity, diagnosis, prevention and present recommendations for surgical as well as non-surgical management of pressure ulcers. Particular focus has been placed on the current understandings and the newer modalities for the treatment of pressure ulcers. The paper also covers the role of nutrition and pressure-release devices such as cushions and mattresses as a part of the treatment algorithm for preventing and quick healing process of these wounds. Pressure ulcers develop primarily from pressure and shear; are progressive in nature and most frequently found in bedridden, chair bound or immobile people. They often develop in people who have been hospitalised for a long time generally for a different problem and increase the overall time as well as cost of hospitalisation that have detrimental effects on patient′s quality of life. Loss of sensation compounds the problem manifold, and failure of reactive hyperaemia cycle of the pressure prone area remains the most important aetiopathology. Pressure ulcers are largely preventable in nature, and their management depends on their severity. The available literature about severity of pressure ulcers, their classification and medical care protocols have been described in this paper. The present treatment options include various approaches of cleaning the wound, debridement, optimised dressings, role of antibiotics and reconstructive surgery. The newer treatment options such as negative pressure wound therapy, hyperbaric oxygen therapy, cell therapy have been discussed, and the advantages and disadvantages of current and newer methods have also been described.

  1. Tuberculosis: current trends in diagnosis and treatment.

    Science.gov (United States)

    Bello, A K; Njoku, C H; Njoku, A K

    2005-12-01

    Among communicable diseases, tuberculosis (TB) is the second leading cause of death worldwide, killing nearly 2 million people each year. It is estimated that about one-third of the world population are infected with TB (2 billion people) and about 10% of this figure will progress to disease state. Most cases are in the less-developed countries of the world. Tuberculosis incidence has been on the increase in Africa, mainly as a result of the burden of HIV infection. Definitive diagnosis of tuberculosis remains based on culture for Mycobacterium tuberculosis, but rapid diagnosis of infectious tuberculosis by simple sputum smear for acid fast bacilli remains an important tool, as more rapid molecular techniques are being developed. Treatment with several drugs for 6 months or more can cure more than 95% of patients. Direct observation of treatment, a component of the recommended five-element DOTS strategy, is judged to be the standard of care by most authorities. Currently only a third of cases worldwide are treated using this approach. There may be need to modify the treatment modalities especially with the choice of drugs and duration of therapy when TB infection occurs in special situation like pregnancy, liver disease, renal failure or even in coexistence with HlV/AIDS or the drug resistant state.

  2. Hepatitis C Treatment: current and future perspectives

    Directory of Open Access Journals (Sweden)

    Akram Madiha

    2010-11-01

    Full Text Available Abstract Hepatitis C virus (HCV is a member of Flaviviridae family and one of the major causes of liver disease. There are about 175 million HCV infected patients worldwide that constitute 3% of world's population. The main route of HCV transmission is parental however 90% intravenous drug users are at highest risk. Standard interferon and ribavirin remained a gold standard of chronic HCV treatment having 38-43% sustained virological response rates. Currently the standard therapy for HCV is pegylated interferon (PEG-INF with ribavirin. This therapy achieves 50% sustained virological response (SVR for genotype 1 and 80% for genotype 2 & 3. As pegylated interferon is expensive, standard interferon is still the main therapy for HCV treatment in under developed countries. On the other hand, studies showed that pegylated IFN and RBV therapy has severe side effects like hematological complications. Herbal medicines (laccase, proanthocyandin, Rhodiola kirilowii are also being in use as a natural and alternative way for treatment of HCV but there is not a single significant report documented yet. Best SVR indicators are genotype 3 and 2,

  3. Current status in diabetic macular edema treatments

    Institute of Scientific and Technical Information of China (English)

    Pedro; Romero-Aroca

    2013-01-01

    Diabetes is a serious chronic condition,which increase the risk of cardiovascular diseases,kidney failure and nerve damage leading to amputation.Furthermore the ocular complications include diabetic macular edema,is the leading cause of blindness among adults in the industrialized countries.Today,blindness from diabetic macular edema is largely preventable with timely detection and appropriate interventional therapy.The treatment should include an optimized control of glycemia,arterial tension,lipids and renal status.The photocoagulation laser is currently restricted to focal macular edema in some countries,but due the high cost of intravitreal drugs,the use of laser treatment for focal and diffuse diabetic macular edema(DME),can be valid as gold standard in many countries.The intravitreal anti vascular endothelial growth factor drugs(ranibizumab and bevacizumab),are indicated in the treatment of all types of DME,but the correct protocol for administration should be defined for the different Retina Scientific Societies.The corticosteroids for diffuse DME,has a place in pseudophakic patients,but its complications restricted the use of these drugs for some patients.Finally the intravitreal interface plays an important role and its exploration is mandatory in all DME patients.

  4. Current status of endovascular stroke treatment.

    Science.gov (United States)

    Meyers, Philip M; Schumacher, H Christian; Connolly, E Sander; Heyer, Eric J; Gray, William A; Higashida, Randall T

    2011-06-07

    interventional methods. Few would challenge neurologists over the responsibility for emergency evaluation and triage of stroke victims for intra intravenous fibrinolysis, even though emergency physicians are most commonly the first to evaluate these patients. There are many unanswered questions about the role of imaging in defining best treatment. Perfusion imaging with CT or MRI appears to have relevance even though its role remains undefined and is the subject of ongoing research. Meanwhile, investigators are exploring new, and perhaps more specific,imaging methods with cerebral metabolic rate of oxygen and cellular acid-base imbalance. There are currently 6 ongoing trials of stroke intervention, many with proprietary technologies and private funding, competing for the same patient population as multicenter trials funded by the NIH. At the same time, much of the interventional stroke treatment currently occurs outside of trials in the community and academic settings without the collection of much-needed data. Market forces will certainly shape future stroke therapy, but it is unclear whether the current combination of private and public funding for these endeavors is the best method of development.

  5. [Current treatment strategies for paediatric burns].

    Science.gov (United States)

    Küntscher, M V; Hartmann, B

    2006-06-01

    Paediatric burns occupy the third place in the severe accident statistics in Germany after traffic injuries and drowning. The paper reviews current treatment concepts of pre-hospital management, fluid resuscitation and surgical therapy in paediatric burned patients. Specific features in the approximation of the total body surface area burn and indications for transfer of paediatric burn victims to specialized units are discussed. The therapy of severe paediatric burns requires an interdisciplinary team consisting of especially skilled plastic or paediatric surgeons,anaesthetists, psychiatrists or psychologists, specifically trained nurses, physiotherapists and social workers. The rehabilitation process starts basically with admission to the burn unit. A tight cooperation between therapists and the relatives of the paediatric burn victim is needed for psychological recovery and reintegration into society.'The adaptation to the suffered trauma resulting in life-long disability and disfigurement is the main task of psychotherapy.

  6. Brachytherapy treatment planning algorithm applied to prostate cancer

    Science.gov (United States)

    Herrera-Rodríguez, M. R.; Martínez-Dávalos, A.

    2000-10-01

    An application of Genetic Algorithms (GAs) for treatment planning optimization in prostate brachytherapy is presented. The importance of multi-objective selection criteria based on the contour of the volume of interest and radiosensitive structures such as the rectum and urethra is discussed. First results are obtained for a simple test case which presents radial symmetry.

  7. Implementation of a Novel Algorithm on Acoustic Doppler Current Profiler Signal Processing System

    Institute of Scientific and Technical Information of China (English)

    ZHU Hao; LIU Wenyao

    2005-01-01

    Acoustic Doppler current profiler (ADCP) uses acoustic energy directed along narrow beams for current measurement. In conventional method, the quantity of sampling affects the precision of fast Fourier transform (FFT) algorithm, and the algorithm needs a large amount of data to process. A novel frequency estimator,enhanced least mean square (ELMS) algorithm for a single complex sinusoid in complex white Gaussian noise, is proposed in ADCP system. As sampling frequency equals 120 krad/s and the sampling number equals 240, the minimum resolving is 0.5 krad/s. All variances keep 11.11%. ELMS algorithm needs less data than FFT. And the robust algorithm can estimate the spectrum true value to 99.9% when the signal to noise ratio (SNR) is equal to 0 dB. Experiments prove that the estimation values will diverge much from the ideal when SNR is less than -6 dB.

  8. NEW ALGORITHM OF IDENTIFYING SHAPE OF FLAWS OR CRACKS IN EDDY CURRENT TESTING

    Institute of Scientific and Technical Information of China (English)

    ZHUANG Hong-wei; MA Yi-chen; ZHANG Zhi-bin; WANG Ying-xi; CAO Jian-feng

    2005-01-01

    Eddy-current inverse technique is a very important method to reconstruct the shape of flaws or cracks. Using the domain derivative of the far-field pattern for eddy-current inverse problem with Dirichlet boundary condition, a new algorithm to recover the shape of cracks was constructed and some numerical examples were given.The algorithm demonstrates that the algorithm is feasible and correct for obtaining a reasonable reconstruction of a shape of flaws or cracks from the far-field measurements even though using less data of directions of incidence and observations for fewer wave numbers are gived.

  9. A comparison between anisotropic analytical and multigrid superposition dose calculation algorithms in radiotherapy treatment planning.

    Science.gov (United States)

    Wu, Vincent W C; Tse, Teddy K H; Ho, Cola L M; Yeung, Eric C Y

    2013-01-01

    Monte Carlo (MC) simulation is currently the most accurate dose calculation algorithm in radiotherapy planning but requires relatively long processing time. Faster model-based algorithms such as the anisotropic analytical algorithm (AAA) by the Eclipse treatment planning system and multigrid superposition (MGS) by the XiO treatment planning system are 2 commonly used algorithms. This study compared AAA and MGS against MC, as the gold standard, on brain, nasopharynx, lung, and prostate cancer patients. Computed tomography of 6 patients of each cancer type was used. The same hypothetical treatment plan using the same machine and treatment prescription was computed for each case by each planning system using their respective dose calculation algorithm. The doses at reference points including (1) soft tissues only, (2) bones only, (3) air cavities only, (4) soft tissue-bone boundary (Soft/Bone), (5) soft tissue-air boundary (Soft/Air), and (6) bone-air boundary (Bone/Air), were measured and compared using the mean absolute percentage error (MAPE), which was a function of the percentage dose deviations from MC. Besides, the computation time of each treatment plan was recorded and compared. The MAPEs of MGS were significantly lower than AAA in all types of cancers (pplans was significantly lower than that of the MGS (palgorithms demonstrated dose deviations of less than 4.0% in most clinical cases and their performance was better in homogeneous tissues than at tissue boundaries. In general, MGS demonstrated relatively smaller dose deviations than AAA but required longer computation time.

  10. [Treatment of osteoporosis: current aspects and perspectives].

    Science.gov (United States)

    Body, J J

    1994-01-01

    The risk of osteoporotic fractures is currently easily assessed by densitometry. The entities "osteopenia" and "osteoporosis" are less and less separated and, along the same line, it becomes somewhat arbitrary to separate "prevention" and "treatment" of osteoporosis when low bone mass has been diagnosed. An adequate calcium intake is most important in childhood and adolescence, pregnancy and lactation, and in the older population which, moreover, often suffers from vitamin D deficiency leading to cortical bone loss. Supplements of calcium and vitamin D to institutionalized elderly people could reduce by more than one third the risk of hip fractures. Estrogen replacement therapy remains the best means to prevent postmenopausal bone loss; too few women are treated but replacement therapy must be given for at least 7 years to keep a significant residual effect in the old age. Calcitonin has a proved analgesic effect for painful crush fractures and its long term administration can prevent postmenopausal trabecular bone loss. Nasal calcitonin considerably improves treatment tolerance and compliance but its price remains prohibitive. Etidronate is the only oral bisphosphonate available in Belgium. It can increase bone mass but its therapeutic index is too narrow and its antifracture efficacy has not been satisfactorily demonstrated. Pamidronate is a second generation bisphosphonate which has a much better therapeutic index but its usefulness is limited by the absence of an oral formulation. The introduction of third generation compounds will improve the therapeutic approach of osteoporosis if adequate therapeutic schemes are used. Much progress is also awaited concerning stimulators of osteoblastic activity.(ABSTRACT TRUNCATED AT 250 WORDS)

  11. Epstein-Barr infection: Current treatment options

    Directory of Open Access Journals (Sweden)

    Abubakar Yaro

    2013-01-01

    Full Text Available Epstein-Barr virus is one of the causes of known human cancers such as PLTD, BL and XLP. It is persistent in about 90% of the global population. Prevalent antiviral agents are not effective. A systematic review was undertaken to discuss current treatment options available for EBV infection. A search was made of PubMed to identify relevant papers published from 2000 to 2010 using various search indexes. The review is based on 11 articles included in the study. The result showed that there is no studies which analyzed antiviral agents in EBV infection. Combinational therapy using antiviral agents, immunotherapy and anticancer agents should be considered while antibiotic regimen should be considered to take care of any sepsis. Resistance to antiviral agents especially cross-resistance is burden in EBV infection Studies should be undertaken to evaluate resistance pattern in EBV infection. To assess the efficacy of EBV therapeutics. Viral load using molecular techniques should be used as biomarker of efficacy.

  12. A Primary and Backup Protection Algorithm based on Voltage and Current Measurements for HVDC Grids

    OpenAIRE

    Abedrabbo, Mudar; Van Hertem, Dirk

    2016-01-01

    DC grids are susceptible to DC side faults, which lead to a rapid rise of the DC side currents. DC side faults should be detected in a very short time before fault currents cause damage to the system or equipment, e.g., exceed the maximum interruptible limits of DC circuit breaker. This paper presents a primary and backup protective data-based algorithm. The proposed algorithm depends on the local voltage and current measurements to detect and identify various kinds of faults in the HVDC grid...

  13. An adaptive attitude algorithm based on a current statistical model for maneuvering acceleration

    Directory of Open Access Journals (Sweden)

    Menglong Wang

    2017-02-01

    Full Text Available A current statistical model for maneuvering acceleration using an adaptive extended Kalman filter (CS-MAEKF algorithm is proposed to solve problems existing in conventional extended Kalman filters such as large estimation error and divergent tendencies in the presence of continuous maneuvering acceleration. A membership function is introduced in this algorithm to adaptively modify the upper and lower limits of loitering vehicles’ maneuvering acceleration and for real-time adjustment of maneuvering acceleration variance. This allows the algorithm to have superior static and dynamic performance for loitering vehicles undergoing different maneuvers. Digital simulations and dynamic flight testing show that the yaw angle accuracy of the algorithm is 30% better than conventional algorithms, and pitch and roll angle calculation precision is improved by 60%. The mean square deviation of heading and attitude angle error during dynamic flight is less than 3.05°. Experimental results show that CS-MAEKF meets the application requirements of miniature loitering vehicles.

  14. Current and future treatment options in SIADH

    NARCIS (Netherlands)

    R. Zietse (Robert); N. van der Lubbe (Nils); E.J. Hoorn (Ewout)

    2009-01-01

    textabstractThe treatment of hyponatraemia due to SIADH is not always as straightforward as it seems. Although acute treatment with hypertonic saline and chronic treatment with fluid restriction are well established, both approaches have severe limitations. These limitations are not readily overcome

  15. An evidence-based algorithm for the treatment of neuropathic pain

    DEFF Research Database (Denmark)

    Finnerup, Nanna Brix; Otto, Marit; Jensen, Troels Staehelin;

    2007-01-01

    OBJECTIVE: The purpose of this article is to discuss an evidence-based algorithm that can be implemented by the primary care physician in his/her daily clinical practice for the treatment of patients with neuropathic pain conditions. METHOD: A treatment algorithm for neuropathic pain was formulated...... on the basis of a review of 105 high-quality, randomized, placebo-controlled clinical trials. The number needed to treat (NNT) and number needed to harm (NNH) were used to compare the safety and effectiveness of current treatments for neuropathic pain syndromes. Most of the clinical trials reviewed...... with different experimental designs and outcomes. CONCLUSION: Patients presenting with neuropathic pain are becoming a more frequent occurrence for the primary care physician as the population ages. Evidence-based treatment options allow for the most efficient and effective pharmacotherapy regimen...

  16. An evidence-based algorithm for the treatment of neuropathic pain

    DEFF Research Database (Denmark)

    Finnerup, Nanna B; Otto, Marit; Jensen, Troels S

    2007-01-01

    OBJECTIVE: The purpose of this article is to discuss an evidence-based algorithm that can be implemented by the primary care physician in his/her daily clinical practice for the treatment of patients with neuropathic pain conditions. METHOD: A treatment algorithm for neuropathic pain was formulated...... on the basis of a review of 105 high-quality, randomized, placebo-controlled clinical trials. The number needed to treat (NNT) and number needed to harm (NNH) were used to compare the safety and effectiveness of current treatments for neuropathic pain syndromes. Most of the clinical trials reviewed...... with different experimental designs and outcomes. CONCLUSION: Patients presenting with neuropathic pain are becoming a more frequent occurrence for the primary care physician as the population ages. Evidence-based treatment options allow for the most efficient and effective pharmacotherapy regimen...

  17. [Treatment of osteoporosis: current data and prospects].

    Science.gov (United States)

    Reginster, J Y; Deroisy, R; Franchimont, P

    1994-12-15

    Postmenopausal osteoporosis is characterized not only by a reduction in bone mass but also by bone microarchitecture alterations, which result in greater bone frailty and in an increased fracture risk. Many drugs have been studied to determine whether they prevent bone loss or reduce the incidence of additional fractures in patients with established osteoporosis. Primary prevention of osteoporosis rests on regular exercising and adequate intake of dietary calcium. For secondary prevention in women undergoing menopause, replacement estrogen therapy given for at least ten years is associated with substantial reductions in fractures of the radius, hip, and spine. Other drugs capable of arresting postmenopausal bone loss include parenteral, nasal or rectal calcitonin and diphosphonates. However, the long-term safety of the latter requires further evaluation. Current studies are evaluating new molecules with potential preventive efficacy, such as ipriflavone. There is no general consensus about the efficacy of treatments for established osteoporosis with fractures. To date, no controlled studies have demonstrated a reduction in the incidence of further fractures in patients given calcium alone. Studies of hydroxylated vitamin D derivatives have been disappointing, although daily administration of vitamin D3 in combination with calcium significantly reduced the incidence of nonvertebral fractures in a population of elderly institutionalized subjects. Plausible explanations for this effect include increased vitamin D levels and reduced parathyroid levels in the bloodstream. Parenteral or nasal calcitonin stabilizes or increases bone mineral content in both cancellous and cortical bone. This effect is especially marked in high-turn-over patients. Several lines of evidence suggest that calcitonin therapy has a protective effect against vertebral and hip fractures. In patients with osteoporosis, oral or intravenous diphosphonates are associated with a significant increase in

  18. Current progress in the treatment of chronic hepatitis C

    Institute of Scientific and Technical Information of China (English)

    Alexandra Alexopoulou; George V Papatheodoridis

    2012-01-01

    Over the last decade,the standard of care for the treatment of chronic hepatitis C has been the combination of pegylated-interferon-alfa (PEG-IFN) and ribavirin (RBV)which results in sustained virological response (SVR)rates of 75%-85% in patients with genotypes 2 or 3 but only of 40%-50% in patients with genotype 1.Currently,there are rapid and continuous developments of numerous new agents against hepatitis C virus (HCV),which are the focus of this review.Boceprevir and telaprevir,two first-generation NS3/4A HCV protease inhibitors,have been recently licensed in several countries around the world to be used in combination with PEGIFN and RBV for the treatment of genotype 1 patients.Boceprevir or telaprevir based triple regimens,compared with the PEG-IFN/RBV combination,improve the SVR rates by 25%-31% in treatment-naive genotype 1 patients,by 40%-64% in prior relapsers,by 33%-45% in prior partial responders and by 24%-28% in prior null responders.At the same time,the application of response-guided treatment algorithms according to the on-treatment virological response results in shortening of the total therapy duration to only 24 wk in 45%-55% of treatment-naive patients.There are,however,several challenges with the use of the new triple combinations in genotype 1 patients,such as the need for immediate results of HCV RNA testing using sensitive quantitative assays,new and more frequent adverse events (anemia and dysgeusia for boceprevir; pruritus,rash and anemia for telaprevir),new drug interactions and increasing difficulties in compliance.Moreover,the SVR rates are still poor in very difficult to treat subgroups of genotype 1 patients,such as null responders with cirrhosis,while there is no benefit for patients who cannot tolerate PEGIFN/RBV or who are infected with non-1 HCV genotype.Many newer anti-HCV agents of different classes and numerous combinations are currently under evaluation with encouraging results.Preliminary data

  19. Plantar fasciitis: current diagnostic modalities and treatments.

    Science.gov (United States)

    Healey, Kevin; Chen, Katherine

    2010-07-01

    Plantar fasciitis is a common cause of heel pain. The diagnosis is made clinically and validated with different diagnostic modalities ranging from ultrasound to magnetic resonance imaging. Treatments vary from stretching exercises to different surgical options. No single treatment is guaranteed to alleviate the heel pain.

  20. The Current Treatment for SLE Nephritis

    Directory of Open Access Journals (Sweden)

    Davut Akın

    2008-01-01

    Full Text Available Renal involvement in systemic lupus erythematosus (SLE is a serious and common complication of the disease that significantly worsens morbidity and mortality. However, the optimal treatment of lupus nephritis remains unclear. Treatment may be divided into immunologic and non-immunologic categories. Non-immunologic treatment consists of anti-hypertensive, anti-proteinüric, and anti-hyperlipidemic options. Immunologic treatment must be designed according to the classification by International Society of Nephrology/Renal Pathology Society (ISN/RPS in induction and remission topics. New regimens consisting mycophenolate are successful in induction and remission. The potential of other new therapeutic agents is discussed together with results of studies performed with commonly used drugs. As a conclusion, treatment must be based histological classification of ISN/RPS and individualized.

  1. The current treatment of erectile dysfunction

    Directory of Open Access Journals (Sweden)

    Maria Isabela Sarbu

    2016-10-01

    Full Text Available Erectile dysfunction (ED is the inability to achieve and maintain an erection sufficient for satisfactory sexual intercourse. It is the most frequent sexual dysfunction in elderly men and its prevalence increases with age. Ever since ED was recognized as a real health problem, several treatment options became available and some of them proved to be very efficient. PDE5 inhibitors are the mainstay treatment of ED. However, other treatment options such as intracorporal injections, surgery, vacuum devices and prosthesis are also available for patients who are unresponsive to PDE5 inhibitors. Since none of the treatment options available so far has proven ideal, research in the field of sexual medicine continues. The aim of this paper is to review the most advances in the treatment of ED.

  2. Corrosion current density prediction in reinforced concrete by imperialist competitive algorithm.

    Science.gov (United States)

    Sadowski, Lukasz; Nikoo, Mehdi

    2014-01-01

    This study attempted to predict corrosion current density in concrete using artificial neural networks (ANN) combined with imperialist competitive algorithm (ICA) used to optimize weights of ANN. For that reason, temperature, AC resistivity over the steel bar, AC resistivity remote from the steel bar, and the DC resistivity over the steel bar are considered as input parameters and corrosion current density as output parameter. The ICA-ANN model has been compared with the genetic algorithm to evaluate its accuracy in three phases of training, testing, and prediction. The results showed that the ICA-ANN model enjoys more ability, flexibility, and accuracy.

  3. Poisoining with Tricyclic Antidepressants and Current Treatment

    Directory of Open Access Journals (Sweden)

    Muge Gulen

    2016-12-01

    Full Text Available Poisoning with tricyclic antidepressants is one of the main causes of morbidity and mortality compared to all the antidepressants. Main toxic effects are on the cardiovascular system and central nervous system and manifests itself as anticholinergic symptoms. There is no antidote known to be used in the treatment. But sodium bicarbonate treatment is effective in preventing ventricular arrhythmias and hypotension, and resolving metabolic acidosis. There are some treatments that has been used for relief of symptoms and some of them still are in research stage. The drugs that are used can be customized according to the patients symptoms. [Archives Medical Review Journal 2016; 25(4.000: 608-621

  4. [Treatment of epicondylitis - a current review].

    Science.gov (United States)

    Schleicher, I; Szalay, G; Kordelle, J

    2010-12-01

    Lateral epicondylitis or tennis elbow is a common injury, which affects not only people who play tennis but occurs with many different activities. It reflects overuse of the extensor muscles of the forearm. There are some other pathologies which have to be separated from epicondylitis. The choice of different treatments is hard to overlook and there are only a few good clinical trials which support one treatment option by means of evidence based medicine. During the acute phase topical NSAIR, steroid injections, ultrasound and acupuncture are helpful. There is no consensus about the effectiveness of physiotherapy, orthoses, laser, electrotherapy or botulinumtoxininjections. During the chronic phase none of the different treatment modalities is effective according to criterias of evidence based medicine. By now, it has not been proven whether patients profit during that time of physiotherapy, orthoses, extracorporeal shock wave therapy or an operation. Whether orthobiological treatment options may play a role in the future is presently uncertain.

  5. [Hilar cholangiocarcinoma (Klatskin tumor) - current treatment options].

    Science.gov (United States)

    Bělina, F

    2013-01-01

    Hilar cholangiocarcinoma is a rare tumor with a rather poor prognosis, and thus remains a challenge for diagnosis and treatment. The sole potentionally curative treatment is the complete resection of the tumor. A negative surgical margin is one of the most important factors in achieving prolonged survival. A preoperative evaluation of the tumor is important for the evaluation of resectability and the extent of surgery. Unfortunately, only a small number of patients with hilar cholangiocarcinoma is indicated for the radical procedure. Liver transplantation is not a standard method in the treatment of the Klatskin tumor and it is reserved only for carefully selected patients in a few transplant centres. The main aim of the palliative treatment is biliary drainage, reduction of the pain and pruritus and overall improvement of the quality of life. Adjuvant chemotherapy and radiotherapy are the important parts of the complex therapy, however, no definite regimen has been established to date. Further evidence is needed to define the role of liver transplantation and (neo)adjuvant new therapeutic modalities. Key words: hilar cholangiocarcinoma - radical surgery - palliative treatment - liver transplantation - (neo) adjuvant chemotherapy - radiotherapy.

  6. Female pattern hair loss: Current treatment concepts

    Directory of Open Access Journals (Sweden)

    Quan Q Dinh

    2007-07-01

    Full Text Available Quan Q Dinh, Rodney SinclairDepartment of Dermatology, St Vincent’s Hospital, Fitzroy, Victoria, AustraliaAbstract: Fewer than 45% of women go through life with a full head of hair. Female pattern hair loss is the commonest cause of hair loss in women and prevalence increases with advancing age. Affected women may experience psychological distress and impaired social functioning. In most cases the diagnosis can be made clinically and the condition treated medically. While many women using oral antiandrogens and topical minoxidil will regrow some hair, early diagnosis and initiation of treatment is desirable as these treatments are more effective at arresting progression of hair loss than stimulating regrowth. Adjunctive nonpharmacological treatment modalities such as counseling, cosmetic camouflage and hair transplantation are important measures for some patients. The histology of female pattern hair loss is identical to that of male androgenetic alopecia. While the clinical pattern of the hair loss differs between men, the response to oral antiandrogens suggests that female pattern hair loss is an androgen dependant condition, at least in the majority of cases. Female pattern hair loss is a chronic progressive condition. All treatments need to be continued to maintain the effect. An initial therapeutic response often takes 12 or even 24 months. Given this delay, monitoring for treatment effect through clinical photography or standardized clinical severity scales is helpful.Keywords: female pattern hair loss, androgenetic alopecia

  7. Early-onset scoliosis: current treatment.

    Science.gov (United States)

    Cunin, V

    2015-02-01

    Early-onset scoliosis, which appears before the age of 10, can be due to congenital vertebral anomalies, neuromuscular diseases, scoliosis-associated syndromes, or idiopathic causes. It can have serious consequences for lung development and significantly reduce the life expectancy compared to adolescent scoliosis. Extended posterior fusion must be avoided to prevent the crankshaft phenomenon, uneven growth of the trunk and especially restrictive lung disease. Conservative (non-surgical) treatment is used first. If this fails, fusionless surgery can be performed to delay the final fusion procedure until the patient is older. The gold standard delaying surgical treatment is the implantation of growing rods as described by Moe and colleagues in the mid-1980s. These rods, which are lengthened during short surgical procedures at regular intervals, curb the scoliosis progression until the patient reaches an age where fusion can be performed. Knowledge of this technique and its complications has led to several mechanical improvements being made, namely use of rods that can be distracted magnetically on an outpatient basis, without the need for anesthesia. Devices based on the same principle have been designed that preferentially attach to the ribs to specifically address chest wall and spine dysplasia. The second category of surgical devices consists of rods used to guide spinal growth that do not require repeated surgical procedures. The third type of fusionless surgical treatment involves slowing the growth of the scoliosis convexity to help reduce the Cobb angle. The indications are constantly changing. Improvements in surgical techniques and greater surgeon experience may help to reduce the number of complications and make this lengthy treatment acceptable to patients and their family. Long-term effects of surgery on the Cobb angle have not been compared to those involving conservative "delaying" treatments. Because the latter has fewer complications associated with

  8. [Current trends in neovascular glaucoma treatment].

    Science.gov (United States)

    Vancea, P P; Abu-Taleb, A

    2005-01-01

    Neovascular glaucoma is divided in three clinical stages: rubeosis iridis, secondary open-angle glaucoma, and synechia of the angle-closure glaucoma. 36% of neovascular glaucomas occurs after central retinal vein occlusion, 32% after diabetic proliferative retinopathy, and 13% occurs after carotid artery obstructive. The key of success in the treatment of neovascular glaucoma is the early and rightly diagnosis, the treatment is aimed mainly at relieving pain, as the prognosis for maintaining visual function is extremely poor. The most important surgical procedures are trabeculectomy, artificial drainage shunts and cyclo-distraction by trans-scleral diode laser. This essay presents a synthesis of modern principle data concerning neovascular glaucoma.

  9. Current and future treatment options for acne.

    NARCIS (Netherlands)

    Kerkhof, P.C.M. van de; Kleinpenning, M.M.; Jong, E.M.G.J. de; Gerritsen, M.J.P.; Dooren-Greebe, R.J. van; Alkemade, J.A.C.

    2006-01-01

    Acne is a frequent skin disease with abnormalities in the process of keratinization, sebaceous gland functioning and inflammation. In this review, our understanding of the pathogenesis of acne has been updated. An overview of efficacy and side effects of available anti-acne treatments is presented.

  10. Current Treatments of Diabetic Macular Edema

    Directory of Open Access Journals (Sweden)

    Wei-Chun Chan

    2011-12-01

    Full Text Available Diabetic macular edema (DME is a major cause of visual impairment in diabetic patients. Laser photocoagulation is the standard management strategy for macular edema, but its results remain unsatisfactory. Several clinical trials of new treatment modalities for DME have been conducted over the past 10 years. We performed a literature search of English articles, published between 2000 and 2010, by using the PubMed database. The keywords searched included “diabetic macular edema and treatment” with limits set to include only clinical trials and review articles, over 50 articles were reviewed. Among the newer treatment modalities reviewed, therapy with anti-vascular endothelial growth factor (VEGF antibodies showed significantly better efficacy, with level I evidence. However, multiple injections were required to maintain its efficacy. Therefore, the associated complications and cost implications are the major limitations of this treatment. Several combinations of different modalities have been evaluated in the literature, but none are more efficacious than monotherapy with anti-VEGF antibodies. Since DME is a multifactorial disease, further studies involving combinations of modalities or new treatments modalities may be needed to reduce the number of injections required or improve the visual outcomes in case of DME.

  11. Current and future treatment options for acne.

    NARCIS (Netherlands)

    Kerkhof, P.C.M. van de; Kleinpenning, M.M.; Jong, E.M.G.J. de; Gerritsen, M.J.P.; Dooren-Greebe, R.J. van; Alkemade, J.A.C.

    2006-01-01

    Acne is a frequent skin disease with abnormalities in the process of keratinization, sebaceous gland functioning and inflammation. In this review, our understanding of the pathogenesis of acne has been updated. An overview of efficacy and side effects of available anti-acne treatments is presented.

  12. Treatment algorithms for high-energy traumas of lower extremities

    Directory of Open Access Journals (Sweden)

    Jovanović Mladen

    2002-01-01

    Full Text Available Introduction High-energy traumas are open or closed injuries caused by force (missile, traffic injuries, crush or blust injuries, falling from heights, affecting the body surface and transferring high amount of kinetic energy inducing great damage to the tissue. Management of such lower extremity injuries has evolved over past several decades, but still remains a difficult task for every surgical team. Specific anatomic and functional characteristics combined with extensive injuries demands specific treatment protocols. Multiple injuries In a multiple injured patient the first priority is management of life-threatening trauma. Despite other injuries, surgical treatment of limb-threatening injuries must start as soon as life-threatening condition has been managed. Treatment algorithms Algorithms are especially beneficial in management of severely injured, but salvageable extremities and in making decision on amputation. Insight into mechanisms of injury, as well as systematic examination of the affected limb, should help us understand the extensiveness of trauma and make an adequate management plan. Prevention of infection and surgical approach Prevention of wound infection and surgical approach to high- energy limb trauma, which includes wound extension, wound excision, skeletal stabilization and if necessary muscle compartment release, should be done in the first 6 hours after injury. Methods of soft tissue reconstruction Commonly used methods for soft tissue defects must provide wound coverage in less than five days following injury. Rehabilitation Early passive and active mobilization and verticalization of patients is very important for successful treatment. Conclusion Good and timely evaluation of the injured and collaboration between plastic and orthopedic surgeons from the beginning of treatment, are crucial for final outcome.

  13. Current Antioxidant Treatments in Organ Transplantation

    Directory of Open Access Journals (Sweden)

    Shaojun Shi

    2016-01-01

    Full Text Available Oxidative stress is one of the key mechanisms affecting the outcome throughout the course of organ transplantation. It is widely believed that the redox balance is dysregulated during ischemia and reperfusion (I/R and causes subsequent oxidative injury, resulting from the formation of reactive oxygen species (ROS. Moreover, in order to alleviate organ shortage, increasing number of grafts is retrieved from fatty, older, and even non-heart-beating donors that are particularly vulnerable to the accumulation of ROS. To improve the viability of grafts and reduce the risk of posttransplant dysfunction, a large number of studies have been done focusing on the antioxidant treatments for the purpose of maintaining the redox balance and thereby protecting the grafts. This review provides an overview of these emerging antioxidant treatments, targeting donor, graft preservation, and recipient as well.

  14. Chronic migraine: current concepts and ongoing treatments.

    Science.gov (United States)

    Negro, A; Rocchietti-March, M; Fiorillo, M; Martelletti, P

    2011-12-01

    Migraine is an episodic painful disorder occasionally developing into a chronic form. Such disorder represents one of the most common neurological diseases in clinical practice. Chronicization is often accompanied by the appearance of acute drugs overuse. Chronic migraine (CM) constitutes migraine's natural evolution in its chronic form and involves headache frequency of 15 days/month, with features similar to those of migraine attacks. Medication Overuse Headache (MOH) has been defined as a headache present on > or = 15 days/month, with regular overuse for > 3 months of one or more drugs used for acute and/or symptomatic headache management. Subtypes of MOH attributed to different medications were delineated. Misuse of ergots, triptans, opioids or combination analgesics on > or = 10 days/month was required to make the diagnosis of MOH, while > or = 15 days/month were needed for simple analgesic-overuse headache. CM's low prevalence produces an extremely high disability grade. Therefore, special attention should be paid to both control and reduction of risk factors which might favour the migraine chronicization process and/or the outbreak of MOH. In MOH sufferers, the only treatment of choice is represented by drug withdrawal. Successful detoxification is necessary to ensure improvement in the headache status when treating patients who overuse acute medications. Different procedures have been suggested for withdrawal namely at home, at the hospital, with or without the use of steroids, with re-prophylaxis performed immediately or at the end of the washout period. At the moment we have not a total agreement whether prophylactic treatment should be started before, during, or after discontinuation of the overuse drug. Both drugs have been approved for CM treatment in view of their well-defined resistance to previous prophylaxis drugs. Recently, the PREEMPT clinical program has confirmed onabotulinumtoxinA as an effective, safe, and well-tolerated prophylactic

  15. [Comments on current guidelines of type 2 diabetes mellitus treatment].

    Science.gov (United States)

    Martinka, Emil

    In an effort to facilitate the widest possible application of recent findings in diabetology and the related medical fields, with regard to characteristics of medicines and current possibilities of using modern procedures, but also to their limitations due to the financial capacities of health insurance companies, SDS innovates its therapeutic recommendations for the treatment of diabetes mellitus on a regular basis. The most recent recommendations were issued by SDS in August 2016. The review discusses and describes several factors which the authors considered during their preparation: (1) Compliance with the findings of evidence-based medicine, compliance with reference recommendations (therapeutic recommendations ADA/EASD), compliance with summary characteristics of active substances in the treatment of diabetes mellitus and approved possibilities of their use, and compliance with indica-tive restrictions (IO) which define medical and economic conditions for health insurance covered treatment. (2) Certain departure from the "glucocentric" approach to therapy, in favour of the approach preferring the selection of drugs based on clinical characteristics of the patient and proven benefits/risks of individual drugs (3) Preference of groups as well as individual active substances within groups based on evidence medicine regarding the individual active substances for specific patient groups. (4) Emphasis on individualization of goals for glycemic control (5) Emphasis on the right classification of diabetes mellitus as the basic condition for the selection of an optimum thera-peutic procedure, and (6) Emphasis on education and overcoming of clinical inertia, and patient medication adherence and medication "literacy" as the basic condition for successful therapy. The discussion also considers the outcomes of the most recent studies including of the studies focusing on empagliflozin and liraglutide, as well as recent modifications of the therapeutic recommendations of

  16. The K-nearest neighbor algorithm predicted rehabilitation potential better than current Clinical Assessment Protocol.

    Science.gov (United States)

    Zhu, Mu; Chen, Wenhong; Hirdes, John P; Stolee, Paul

    2007-10-01

    There may be great potential for using computer-modeling techniques and machine-learning algorithms in clinical decision making, if these can be shown to produce results superior to clinical protocols currently in use. We aim to explore the potential to use an automatic, data-driven, machine-learning algorithm in clinical decision making. Using a database containing comprehensive health assessment information (the interRAI-HC) on home care clients (N=24,724) from eight community-care regions in Ontario, Canada, we compare the performance of the K-nearest neighbor (KNN) algorithm and a Clinical Assessment Protocol (the "ADLCAP") currently used to predict rehabilitation potential. For our purposes, we define a patient as having rehabilitation potential if the patient had functional improvement or remained at home over a follow-up period of approximately 1 year. The KNN algorithm has a lower false positive rate in all but one of the eight regions in the sample, and lower false negative rates in all regions. Compared using likelihood ratio statistics, KNN is uniformly more informative than the ADLCAP. This article illustrates the potential for a machine-learning algorithm to enhance clinical decision making.

  17. Current Approaches in the Treatment of Prostatitis

    Directory of Open Access Journals (Sweden)

    Volkan Izol

    2013-02-01

    Full Text Available Prostatitis is an infection or inflammation of the prostate gland that presents as several syndromes with varying clinical features. This painful condition mostly affects young and middle-aged men and diminishes their quality of life. With the recent introduction of a new classification for this disease, more effective approach for the evaluation and management of the patients with chronic pelvic pain syndrome has emerged. Nonetheless, no definitely effective treatment regime has yet been described in the literature. [Archives Medical Review Journal 2013; 22(1.000: 130-140

  18. Current surgical treatment for bile duct cancer

    Institute of Scientific and Technical Information of China (English)

    Yasuji Seyama; Masatoshi Makuuchi

    2007-01-01

    Since extrahepatic bile duct cancer is difficult to diagnose and to cure, a safe and radical surgical strategy is needed. In this review, the modes of infiltration and spread of extrahepatic bile duct cancer and surgical strategy are discussed. Extended hemihepatectomy, with or without pancreatoduodenectomy (PD), plus extrahepatic bile duct resection and regional lymphadenectomy has recently been recognized as the standard curative treatment for hilar bile duct cancer. On the other hand, PD is the choice of treatment for middle and distal bile duct cancer. Major hepatectomy concomitant with PD (hepatopancreatoduodenectomy) has been applied to selected patients with widespread tumors. Preoperative biliary drainage (BD) followed by portal vein embolization (PVE) enables major hepatectomy in patients with hilar bile duct cancer without mortality. BD should be performed considering the surgical procedure, especially, in patients with separated intrahepatic bile ducts caused by hilar bile duct cancer. Right or left trisectoriectomy are indicated according to the tumor spread and biliary anatomy. As a result, extended radical resection offers a chance for cure of hilar bile duct cancer with improved resectability, curability, and a 5-year survival rate of 40%. A 5-year survival rate has ranged from 24% to 39% after PD for middle and distal bile duct cancer.

  19. Lung cancer: current diagnosis and treatment.

    Science.gov (United States)

    Hammerschmidt, Stefan; Wirtz, Hubert

    2009-12-01

    Much progress has been made in the treatment of lung cancer in the last ten years (adjuvant chemotherapy, targeted therapy, individualized therapy). Nonetheless, lung cancer is still the leading cause of death due to cancer and thus remains a major medical, scientific, and social problem. This review is based on national and international recommendations and selected articles from the literature. Cigarette smoking is the major pathogenic factor for lung cancer. Lung cancer can be divided into two major types that differ in their biological behavior, small cell lung cancer and non-small cell lung cancer. Whenever possible, the diagnosis should be confirmed by biopsy, the extent of disease should be documented in detail (international TNM classification/staging), and the patient's functional level should be assessed with a view toward treatment planning. Surgery for non-small cell lung cancer with curative intent is possible up to stage IIIA, while stage IIIB is the domain of radiotherapy. Surgery for small cell lung cancer with curative intent is possible for rare cases in early stages (T1N0 and T2N0, i.e., stage IA and IB). As long as small cell lung cancer is restricted to one side of the chest, simultaneous radiation therapy and chemotherapy are indicated. If a malignant pleural effusion or distant metastases are present, both lung cancers are treated palliatively with platinum-based chemotherapy.

  20. Current Consensus Guidelines for Treatment of Neurocysticercosis

    Science.gov (United States)

    García, Hector H.; Evans, Carlton A. W.; Nash, Theodore E.; Takayanagui, Osvaldo M.; White, A. Clinton; Botero, David; Rajshekhar, Vedantam; Tsang, Victor C. W.; Schantz, Peter M.; Allan, James C.; Flisser, Ana; Correa, Dolores; Sarti, Elsa; Friedland, Jon S.; Martinez, S. Manuel; Gonzalez, Armando E.; Gilman, Robert H.; Del Brutto, Oscar H.

    2002-01-01

    Taenia solium neurocysticercosis is a common cause of epileptic seizures and other neurological morbidity in most developing countries. It is also an increasingly common diagnosis in industrialized countries because of immigration from areas where it is endemic. Its clinical manifestations are highly variable and depend on the number, stage, and size of the lesions and the host's immune response. In part due to this variability, major discrepancies exist in the treatment of neurocysticercosis. A panel of experts in taeniasis/cysticercosis discussed the evidence on treatment of neurocysticercosis for each clinical presentation, and we present the panel's consensus and areas of disagreement. Overall, four general recommendations were made: (i) individualize therapeutic decisions, including whether to use antiparasitic drugs, based on the number, location, and viability of the parasites within the nervous system; (ii) actively manage growing cysticerci either with antiparasitic drugs or surgical excision; (iii) prioritize the management of intracranial hypertension secondary to neurocysticercosis before considering any other form of therapy; and (iv) manage seizures as done for seizures due to other causes of secondary seizures (remote symptomatic seizures) because they are due to an organic focus that has been present for a long time. PMID:12364377

  1. Upper cervical injuries: Clinical results using a new treatment algorithm

    Directory of Open Access Journals (Sweden)

    Andrei F Joaquim

    2015-01-01

    Full Text Available Introduction: Upper cervical injuries (UCI have a wide range of radiological and clinical presentation due to the unique complex bony, ligamentous and vascular anatomy. We recently proposed a rational approach in an attempt to unify prior classification system and guide treatment. In this paper, we evaluate the clinical results of our algorithm for UCI treatment. Materials and Methods: A prospective cohort series of patients with UCI was performed. The primary outcome was the AIS. Surgical treatment was proposed based on our protocol: Ligamentous injuries (abnormal misalignment, facet perched or locked, increase atlanto-dens interval were treated surgically. Bone fractures without ligamentous injuries were treated with a rigid cervical orthosis, with exception of fractures in the dens base with risk factors for non-union. Results: Twenty-three patients treated initially conservatively had some follow-up (mean of 171 days, range from 60 to 436 days. All of them were neurologically intact. None of the patients developed a new neurological deficit. Fifteen patients were initially surgically treated (mean of 140 days of follow-up, ranging from 60 to 270 days. In the surgical group, preoperatively, 11 (73.3% patients were AIS E, 2 (13.3% AIS C and 2 (13.3% AIS D. At the final follow-up, the American Spine Injury Association (ASIA score was: 13 (86.6% AIS E and 2 (13.3% AIS D. None of the patients had neurological worsening during the follow-up. Conclusions: This prospective cohort suggested that our UCI treatment algorithm can be safely used. Further prospective studies with longer follow-up are necessary to further establish its clinical validity and safety.

  2. Current concepts and controversies in the treatment of alcoholic hepatitis

    Institute of Scientific and Technical Information of China (English)

    Catherine Rongey; Neil Kaplowitz

    2006-01-01

    The treatment of alcoholic hepatitis remains one of the most debated topics in medicine and a field of continued research. In this review, we discuss the evolution of scoring systems, including the recent development of the Glasgow alcoholic hepatitis score, role of liver biopsy and current treatment interventions. Studies of treatment interventions with glucocorticoids, pentoxifylline,infliximab, s-adenosyl-methionine, and colchicine are reviewed with discussion on quality. Glucocorticoids currently remain the mainstay of treatment for severe alcoholic hepatitis.

  3. Clinical characteristics and current treatment of glaucoma.

    Science.gov (United States)

    Cohen, Laura P; Pasquale, Louis R

    2014-06-02

    Glaucoma is a neurodegenerative disorder in which degenerating retinal ganglion cells (RGC) produce significant visual disability. Clinically, glaucoma refers to an array of conditions associated with variably elevated intraocular pressure (IOP) that contributes to RGC loss via mechanical stress, vascular abnormalities, and other mechanisms, such as immune phenomena. The clinical diagnosis of glaucoma requires assessment of the ocular anterior segment with slit lamp biomicroscopy, which allows the clinician to recognize signs of conditions that can produce elevated IOP. After measurement of IOP, a specialized prismatic lens called a gonioscope is used to determine whether the angle is physically open or closed. The structural manifestation of RGC loss is optic nerve head atrophy and excavation of the neuroretinal rim tissue. Treatment is guided by addressing secondary causes for elevated IOP (such as inflammation, infection, and ischemia) whenever possible. Subsequently, a variety of medical, laser, and surgical options are used to achieve a target IOP.

  4. Current diagnosis and treatment of Castleman's disease.

    Science.gov (United States)

    González García, A; Moreno Cobo, M Á; Patier de la Peña, J L

    2016-04-01

    Castleman's disease is not just a single disease but rather an uncommon, heterogeneous group of nonclonal lymphoproliferative disorders, which have a broad spectrum of clinical expression. Three histological types have been reported, along with several clinical forms according to clinical presentation, histological substrate and associated diseases. Interleukin-6, its receptor polymorphisms, the human immunodeficiency virus and the human herpes virus 8 are involved in the etiopathogenesis of Castleman's disease. The study of this disease has shed light on a syndrome whose incidence is unknown. Despite recent significant advances in our understanding of this disease and the increasing therapeutic experience with rituximab, tocilizumab and siltuximab, there are still difficult questions concerning its aetiology, prognosis and optimal treatment. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  5. Opiate addiction - current trends and treatment options

    Directory of Open Access Journals (Sweden)

    Achal Bhatt

    2016-07-01

    Full Text Available Opioids are widely used drugs for treatment of pain and related disorders. Opiate addiction is a major public health concern in the United States causing significant increase in healthcare expenditure. They produce euphoria and sense of well-being which makes them addictive to some people. Used in higher doses they can lead to cardiac or respiratory compromise. They also impair cognition leading to impaired decision making. Opioids exert their effects by acting on three different types of receptors mu, delta, and kappa located on neuronal cell membranes causing inhibition of neurotransmitter release. Prolonged use of these drugs can lead to physical dependence causing withdrawal symptoms if a person stops using them. Commonly used medications to treat opiate addiction are methadone, LAAM (longer acting derivative of methadone, buprenorphine, and naltrexone. [Int J Res Med Sci 2016; 4(7.000: 2503-2507

  6. Current Diagnosis and Treatment of Halitosis

    Directory of Open Access Journals (Sweden)

    Mehmet Mustafa Kılıçkaya

    2015-11-01

    Full Text Available Halitosis or oral malodor is not a diagnosis, but is symptom. Halitosis, that we frequently encounter in ear, nose and throat practice can be the harbinger of some serious underlying disease. Therefore, diagnosis and to find the cause of the halitosis are important. Also halitosis treatment is necessary due to the social and psychological effects. Breath contains hundreds of volatile organic compounds that are by-products of our metabolism. Certain diseases such as nasopharynx cancer, larynx cancer ve lung cancer alter the mix of gases. Thus, the analysis of exhaled air has gained importance. New technologies lead to the development of new devices. And with these called electronic noses the analysis of exhaled air has becomes an important non-invasive diagnostic method. In the literature, halitosis and bad breath which is used as synonymus with oral malodor is the emission of unpleasant odor from mouth and nasal passage. It occurs in 25% of the population, approximately and it has a significant social and economic impact. Halitosis is classified as true halitosis (physiologic halitosis and pathologic halitosis, pseudohalitosis and halitophobia. The most common cause is intra-oral diseases. Among all these factors, the most important etiologic factor are the coating tongue. Other ear, nose and throat diseases such as rhinitis and sinusitis are seen among the most common extraoral causes. Treponema denticola, Porphyromonas gingivalis, Tanneralla forsythia, Fusobacterium nucleatum, Prevotella intermedia, Prevotella nigrescens, Actinobacilli and Solobacterium moorei are the bacteria which are commonly isolated from patients with halitosis and they are volatile sulfur compounds (VSCs producing ones as well. The treatment of halitosis should be carried out according to the etiology. In the physiologic halitosis tooth brushing, use of dental floss, tongue cleaning and chlorhexidine, cetylpyridinium chloride and zinc containing antimicrobial mouthwashes

  7. Current treatment in chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    李嘉惠

    2008-01-01

    Chronic obstructive pulmonary disease (COPD) is defined by fixed airflow limitation associated with an abnormal pulmonary and systemic inflammatory response of the lungs to cigarette smoke. COPD represents an increasing burden worldwide, reported to be the sixth leading cause of death in 1990 and the fourth in 2000. Discouragingly, it is projected to jump to third place by the year 2020.There is increasing evidence that COPD is a more complex systemic disease than an airway and lung disease. In particular, cachexia, skeletal muscle abnormalities, diabetes, coronary artery disease, heart failure, cancer and pulmonary vascular disease are the most common comorbidities. It is associated with a wide variety of systemic consequences, most notably systemic inflammation. Because COPD patients have in general ahigher cardiovascular risk than the average population, cardiovascular safety in a COPD medication is of critical importance.SINGH et al performed a systematic review and recta-analysis of 17 clinical trials enrolling 14 783 patients treated with inhaled anticholinergic drugs used for the treatment of COPD. Inhaled anticholinergics significantly increased the risk of cardiovascular death, MI, or stroke ( 1.8 % vs 1.2 % for control; RR, 1.58 (95 % CI,1.21 - 2.06); P < 0.001 ). However, UPLIIFT (Understanding the Potential Long-Term Impacts on Function with Tiotropium) , a large, 4-year, placebo controlled clinical trial with tiotropium in approximately 6 000 patients with COPD. The preliminary results of UPLIFT showed that there was no increased risk of stroke with tiotropium bromide compared to placebo.A meta-analysis is always considered less convincing than a large prospective trial designed to assess the outcome of interest. However, COPD is a systemic disease. COPD management needs to focus on four major areas: smoking cessation, pharmacologic therapy, exercise training, and pulmonary rehabilitation. Clinicians and patients should always carefully consider any

  8. Erythrodermic psoriasis: pathophysiology and current treatment perspectives

    Directory of Open Access Journals (Sweden)

    Singh RK

    2016-07-01

    Full Text Available Rasnik K Singh,1 Kristina M Lee,2 Derya Ucmak,2 Merrick Brodsky,3 Zaza Atanelov,4 Benjamin Farahnik,5 Michael Abrouk,3 Mio Nakamura,2 Tian Hao Zhu,6 Wilson Liao2 1Department of Medicine, University of California – Los Angeles, David Geffen School of Medicine, Los Angeles, 2Department of Dermatology, University of California – San Francisco, San Francisco, 3Department of Medicine, University of California – Irvine, School of Medicine, Irvine, CA, 4Department of Medicine, New York Medical College, Valhalla, NY, 5Department of Medicine, University of Vermont College of Medicine, Burlington, VT, 6Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA Abstract: Erythrodermic psoriasis (EP is a rare and severe variant of psoriasis vulgaris, with an estimated prevalence of 1%–2.25% among psoriatic patients. The condition presents with distinct histopathologic and clinical findings, which include a generalized inflammatory erythema involving at least 75% of the body surface area. The pathogenesis of EP is not well understood; however, several studies suggest that the disease is associated with a predominantly T helper 2 (Th2 phenotype. Given the morbidity and potential mortality associated with the condition, there is a need for a better understanding of its pathophysiology. The management of EP begins with a comprehensive assessment of the patient’s presentation and often requires multidisciplinary supportive measures. In 2010, the medical board of the US National Psoriasis Foundation published consensus guidelines advocating the use of cyclosporine or infliximab as first-line therapy in unstable cases, with acitretin and methotrexate reserved for more stable cases. Since the time of that publication, additional information regarding the efficacy of newer agents has emerged. We review the latest data with regard to the treatment of EP, which includes biologic therapies such as ustekinumab and

  9. Algorithms for the diagnosis and treatment of restless legs syndrome in primary care

    Science.gov (United States)

    2011-01-01

    Background Restless legs syndrome (RLS) is a neurological disorder with a lifetime prevalence of 3-10%. in European studies. However, the diagnosis of RLS in primary care remains low and mistreatment is common. Methods The current article reports on the considerations of RLS diagnosis and management that were made during a European Restless Legs Syndrome Study Group (EURLSSG)-sponsored task force consisting of experts and primary care practioners. The task force sought to develop a better understanding of barriers to diagnosis in primary care practice and overcome these barriers with diagnostic and treatment algorithms. Results The barriers to diagnosis identified by the task force include the presentation of symptoms, the language used to describe them, the actual term "restless legs syndrome" and difficulties in the differential diagnosis of RLS. Conclusion The EURLSSG task force reached a consensus and agreed on the diagnostic and treatment algorithms published here. PMID:21352569

  10. A new compensation current real-time computing method for power active filter based on double linear construction algorithm

    Institute of Scientific and Technical Information of China (English)

    LI; Zicheng; SUN; Yukun

    2006-01-01

    Considering the detection principle that "when load current is periodic current, the integral in a cycle for absolute value of load current subtracting fundamental active current is the least", harmonic current real-time detection methods for power active filter are proposed based on direct computation, simple iterative algorithm and optimal iterative algorithm. According to the direct computation method, the amplitude of the fundamental active current can be accurately calculated when load current is placed in stable state. The simple iterative algorithm and the optimal iterative algorithm provide an idea about judging the state of load current. On the basis of the direct computation method, the simple iterative algorithm, the optimal iterative algorithm and precise definition of the basic concepts such as the true amplitude of the fundamental active current when load current is placed in varying state, etc., the double linear construction idea is proposed in which the amplitude of the fundamental active current at the moment of the sample is accurately calculated by using the first linear construction and the condition which disposes the next sample is created by using the second linear construction. On the basis of the double linear construction idea, a harmonic current real-time detection method for power active filter is proposed based on the double linear construction algorithm. This method has the characteristics of small computing quantity, fine real-time performance, being capable of accurately calculating the amplitude of the fundamental active current and so on.

  11. An algorithm for assessment and treatment of postherniorrhaphy pain

    NARCIS (Netherlands)

    Voorbrood, C. E H; Burgmans, J. P J; Van Dalen, T.; Breel, J.; Clevers, G. J.; Wille, F.; Simmermacher, R. K J

    2015-01-01

    Background: Inguinal pain after groin hernia repair is a challenging issue. About 50 % of postherniorrhaphy pain allegedly is neuropathic, treatment of which is cumbersome given the limited efficacy of current therapeutic modalities. Possibly a clear protocol assessing the type of pain and treating

  12. Principles of a new treatment algorithm in multiple sclerosis

    DEFF Research Database (Denmark)

    Hartung, Hans-Peter; Montalban, Xavier; Sorensen, Per Soelberg

    2011-01-01

    We are entering a new era in the management of patients with multiple sclerosis (MS). The first oral treatment (fingolimod) has now gained US FDA approval, addressing an unmet need for patients with MS who wish to avoid parenteral administration. A second agent (cladribine) is currently being...

  13. Current treatment of the inflammatory myopathies.

    Science.gov (United States)

    Dalakas, M C

    1994-11-01

    Among the main concerns regarding the current therapy for the inflammatory myopathies are a lack of adequate controlled trials, a lack of objective means to reliably measure muscle strength, lack of natural history data, consideration of polymyositis, dermatomyositis, and inclusion-body myositis as a homogeneous group of inflammatory myopathies, and reliance on nonspecific markers for determining prognosis and assessing response to therapies. Prednisone remains the drug of choice in treating these disorders, although a controlled trial has never been undertaken to study its efficacy. Among the steroid-sparing agents, azathioprine, methotrexate, cyclosporine, and chlorambucil are used with invariably low to moderate success. There are no results of controlled trials to indicate whether one of these drugs is superior to another. Intravenous immunoglobulin, which is very expensive, was shown in a controlled trial to be effective in steroid-resistant dermatomyositis not only in dramatically improving muscle strength and skin rash but also in resolving the underlying immunopathology. Controlled trials of intravenous immunoglobulin in patients with polymyositis and inclusion-body myositis are under way. Inclusion-body myositis has emerged as a common inflammatory myopathy that is predictably disabling and resistant to most therapies.

  14. Current treatment of sepsis and endotoxaemia.

    Science.gov (United States)

    Periti, P

    2000-09-01

    This article reviews the new criteria for selecting the proper antimicrobial agent and dosage regimen for standard treatment of severe sepsis, with the intention of preventing septic shock. After introducing new concepts on the pathogenesis of sepsis and septic shock, the authors analyse the parameters of beta-lactam antibacterial activity, the antibiotic-induced release of bacterial endotoxin and the interrelationships between pharmacokinetics and pharmacodynamics of antibiotics in the search for an optimum dosage regimen of antimicrobial mono- or polytherapy for severely ill septic patients admitted to the intensive care unit. The mortality rate resulting from severe bacterial sepsis, particularly that associated with shock, still approaches 50% in spite of appropriate antimicrobial therapy and optimum supportive care. Bacterial endotoxins that are part of the cell wall are one of the cofactors in the pathogenesis of sepsis and septic shock and are often induced by antimicrobial chemotherapy, even if administered rationally. Not all antimicrobial agents are equally capable of inducing septic shock; this is dependent on their mechanism of action rather than on the causative pathogen species. The quantity of endotoxin released depends on the drug dose and whether filaments or spheroplast formation predominate. Some antibiotics, such as carbapenems, ceftriaxone, cefepime, glycopeptides, aminoglycosides and quinolones, do not have the propensity to provoke septic shock because their rapid bacterial activity induces mainly spheroplast or fragile spheroplast-like bacterial forms.

  15. [Current diagnosis and treatment of acromegaly].

    Science.gov (United States)

    Melgar, Virgilio; Espinosa, Etual; Cuenca, Dalia; Valle, Vanessa; Mercado, Moisés

    2015-01-01

    Acromegaly is a rare condition characterized by the excessive secretion of growth hormone (GH), usually by a pituitary adenoma. The clinical manifestations of acromegaly include enlarged hands, feet and face, headaches, arthralgias, fatigue and hyperhydrosis. This condition is also associated with comorbidities such as hypertension and diabetes in a significant proportion of patients and frequently compromises life quality and life expectancy. The biochemical diagnosis of acromegaly rests on the demonstration of an autonomous secretion of GH by means of the measurement of glucose-suppressed GH levels and the serum concentration of insulin like growth factor type 1 (IGF-1). The localizing method of choice is magnetic resonance image of the selar area, which in 70 % of the cases reveals the presence of a macroadenoma. Even though the primary treatment is usually the transsphenoidal resection of the adenoma, the majority of patients require a multimodal intervention that includes radiotherapy, as well as pharmacological therapy with somatostatin analogs and dopamine agonists. The latter approach has resulted in a significant reduction in mortality and in an improvement in the quality of life.

  16. [Current diagnosis and treatment of hyperprolactinemia].

    Science.gov (United States)

    Melgar, Virgilio; Espinosa, Etual; Sosa, Ernesto; Rangel, María José; Cuenca, Dalia; Ramírez, Claudia; Mercado, Moisés

    2016-01-01

    Hyperprolactinemia is a frequent neuroendocrinological condition that should be approached in an orderly and integral fashion, starting with a complete clinical history. Once physiological causes such as pregnancy, systemic disorders such as primary hypothyroidism and the use of drugs with dopamine antagonistic actions such as metochlopramide have been ruled out, the most common cause of hyperprolactinemia is a PRL-secreting pituitary adenoma or prolactinoma. Prolactinomas are usually classified as microprolactinomas (less than 1 cm) or macroprolactinomas (larger than 1 cm), which can either be confined or invasive. The hormonal consequence of hypeprolactinemia is hypogonadism; in women, this is manifested as amenorrhea/oligomenorreha, anovulation and galactorrhea, whereas in men the main complaints are a diminished libido and erectile dysfunction. Macroprolactinomas can also present with symptoms and signs resulting form mass effect of the tumor, such as headaches and visual field defects. Other structural causes of hyperprolactinemia include non-functioning pituitary adenomas and infiltrative disorders, which can interrupt the inhibitory, descending dopaminergic tone. The primary treatment of prolactinomas is pharmacological with dopamine agonists such as cabergoline.

  17. Birdshot uveitis: current and emerging treatment options

    Directory of Open Access Journals (Sweden)

    Menezo V

    2013-12-01

    Full Text Available Victor Menezo,1,2 Simon RJ Taylor3,4 1Institut Catala de Retina, Barcelona, Spain; 2Department of Ophthalmology, Provincial Hospital Consortium Castellon, Castello, Spain; 3Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, UK; 4Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK Abstract: Birdshot chorioretinopathy is a relatively uncommon subtype of idiopathic posterior uveitis with distinct clinical characteristics and a strong genetic association with the Human Leukocyte Antigen (HLA-A29 allele. The diagnosis remains clinical and is based on the presence of typical clinical features, including multiple, distinctive, hypopigmented choroidal lesions throughout the fundus. The long-term visual prognosis of this disorder, however, remains guarded – central visual acuity can be preserved until late in the disease and it is not uncommon for patients to receive inadequate immunosuppressive treatment, leading to a poor long-term outcome in which peripheral retinal damage eventually leads to visual deterioration. Birdshot chorioretinopathy has proven a particularly attractive area of study within the field of uveitis, as it is a relatively easily defined disease with an associated human leukocyte antigen haplotype. Despite this, however, the immune mechanisms involved in its pathogenesis remain unclear, and some patients continue to lose retinal function despite therapy with corticosteroids and conventional immunosuppressive agents. Laboratory research continues to investigate the underlying mechanisms of disease, and clinical research is now being driven to improve the phenotyping and monitoring of this condition as, in the era of so-called personalized medicine, it is becoming increasingly important to identify patients at risk of visual loss early so that they can be treated more aggressively with targeted therapies such as the newer biological agents. This approach requires the formation of collaborative

  18. Conductivity and current density image reconstruction using harmonic Bz algorithm in magnetic resonance electrical impedance tomography.

    Science.gov (United States)

    Oh, Suk Hoon; Lee, Byung Il; Woo, Eung Je; Lee, Soo Yeol; Cho, Min Hyoung; Kwon, Ohin; Seo, Jin Keun

    2003-10-07

    Magnetic resonance electrical impedance tomography (MREIT) is to provide cross-sectional images of the conductivity distribution sigma of a subject. While injecting current into the subject, we measure one component Bz of the induced magnetic flux density B = (Bx, By, Bz) using an MRI scanner. Based on the relation between (inverted delta)2 Bz and inverted delta sigma, the harmonic Bz algorithm reconstructs an image of sigma using the measured Bz data from multiple imaging slices. After we obtain sigma, we can reconstruct images of current density distributions for any given current injection method. Following the description of the harmonic Bz algorithm, this paper presents reconstructed conductivity and current density images from computer simulations and phantom experiments using four recessed electrodes injecting six different currents of 26 mA. For experimental results, we used a three-dimensional saline phantom with two polyacrylamide objects inside. We used our 0.3 T (tesla) experimental MRI scanner to measure the induced Bz. Using the harmonic Bz algorithm, we could reconstruct conductivity and current density images with 82 x 82 pixels. The pixel size was 0.6 x 0.6 mm2. The relative L2 errors of the reconstructed images were between 13.8 and 21.5% when the signal-to-noise ratio (SNR) of the corresponding MR magnitude images was about 30. The results suggest that in vitro and in vivo experimental studies with animal subjects are feasible. Further studies are requested to reduce the amount of injection current down to less than 1 mA for human subjects.

  19. Development of computer algorithms for radiation treatment planning.

    Science.gov (United States)

    Cunningham, J R

    1989-06-01

    As a result of an analysis of data relating tissue response to radiation absorbed dose the ICRU has recommended a target for accuracy of +/- 5 for dose delivery in radiation therapy. This is a difficult overall objective to achieve because of the many steps that make up a course of radiotherapy. The calculation of absorbed dose is only one of the steps and so to achieve an overall accuracy of better than +/- 5% the accuracy in dose calculation must be better yet. The physics behind the problem is sufficiently complicated so that no exact method of calculation has been found and consequently approximate solutions must be used. The development of computer algorithms for this task involves the search for better and better approximate solutions. To achieve the desired target of accuracy a fairly sophisticated calculation procedure must be used. Only when this is done can we hope to further improve our knowledge of the way in which tissues respond to radiation treatments.

  20. An Algorithm for Surface Current Retrieval from X-band Marine Radar Images

    Directory of Open Access Journals (Sweden)

    Chengxi Shen

    2015-06-01

    Full Text Available In this paper, a novel current inversion algorithm from X-band marine radar images is proposed. The routine, for which deep water is assumed, begins with 3-D FFT of the radar image sequence, followed by the extraction of the dispersion shell from the 3-D image spectrum. Next, the dispersion shell is converted to a polar current shell (PCS using a polar coordinate transformation. After removing outliers along each radial direction of the PCS, a robust sinusoidal curve fitting is applied to the data points along each circumferential direction of the PCS. The angle corresponding to the maximum of the estimated sinusoid function is determined to be the current direction, and the amplitude of this sinusoidal function is the current speed. For validation, the algorithm is tested against both simulated radar images and field data collected by a vertically-polarized X-band system and ground-truthed with measurements from an acoustic Doppler current profiler (ADCP. From the field data, it is observed that when the current speed is less than 0.5 m/s, the root mean square differences between the radar-derived and the ADCP-measured current speed and direction are 7.3 cm/s and 32.7°, respectively. The results indicate that the proposed procedure, unlike most existing current inversion schemes, is not susceptible to high current speeds and circumvents the need to consider aliasing. Meanwhile, the relatively low computational cost makes it an excellent choice in practical marine applications.

  1. Boosting runtime-performance of photon pencil beam algorithms for radiotherapy treatment planning.

    Science.gov (United States)

    Siggel, M; Ziegenhein, P; Nill, S; Oelfke, U

    2012-10-01

    Pencil beam algorithms are still considered as standard photon dose calculation methods in Radiotherapy treatment planning for many clinical applications. Despite their established role in radiotherapy planning their performance and clinical applicability has to be continuously adapted to evolving complex treatment techniques such as adaptive radiation therapy (ART). We herewith report on a new highly efficient version of a well-established pencil beam convolution algorithm which relies purely on measured input data. A method was developed that improves raytracing efficiency by exploiting the capability of modern CPU architecture for a runtime reduction. Since most of the current desktop computers provide more than one calculation unit we used symmetric multiprocessing extensively to parallelize the workload and thus decreasing the algorithmic runtime. To maximize the advantage of code parallelization, we present two implementation strategies - one for the dose calculation in inverse planning software, and one for traditional forward planning. As a result, we could achieve on a 16-core personal computer with AMD processors a superlinear speedup factor of approx. 18 for calculating the dose distribution of typical forward IMRT treatment plans.

  2. Korean Medication Algorithm for Depressive Disorder: Comparisons with Other Treatment Guidelines

    Science.gov (United States)

    Wang, Hee Ryung; Park, Young-Min; Lee, Hwang Bin; Song, Hoo Rim; Jeong, Jong-Hyun; Seo, Jeong Seok; Lim, Eun-Sung; Hong, Jeong-Wan; Kim, Won; Jon, Duk-In; Hong, Jin-Pyo; Woo, Young Sup; Min, Kyung Joon

    2014-01-01

    We aimed to compare the recommendations of the Korean Medication Algorithm Project for Depressive Disorder 2012 (KMAP-DD 2012) with other recently published treatment guidelines for depressive disorder. We reviewed a total of five recently published global treatment guidelines and compared each treatment recommendation of the KMAP-DD 2012 with those in other guidelines. For initial treatment recommendations, there were no significant major differences across guidelines. However, in the case of nonresponse or incomplete response to initial treatment, the second recommended treatment step varied across guidelines. For maintenance therapy, medication dose and duration differed among treatment guidelines. Further, there were several discrepancies in the recommendations for each subtype of depressive disorder across guidelines. For treatment in special populations, there were no significant differences in overall recommendations. This comparison identifies that, by and large, the treatment recommendations of the KMAP-DD 2012 are similar to those of other treatment guidelines and reflect current changes in prescription pattern for depression based on accumulated research data. Further studies will be needed to address several issues identified in our review. PMID:24605117

  3. Bat algorithm optimized fuzzy PD based speed controller for brushless direct current motor

    Directory of Open Access Journals (Sweden)

    K. Premkumar

    2016-06-01

    Full Text Available In this paper, design of fuzzy proportional derivative controller and fuzzy proportional derivative integral controller for speed control of brushless direct current drive has been presented. Optimization of the above controllers design is carried out using nature inspired optimization algorithms such as particle swarm, cuckoo search, and bat algorithms. Time domain specifications such as overshoot, undershoot, settling time, recovery time, and steady state error and performance indices such as root mean squared error, integral of absolute error, integral of time multiplied absolute error and integral of squared error are measured and compared for the above controllers under different operating conditions such as varying set speed and load disturbance conditions. The precise investigation through simulation is performed using simulink toolbox. From the simulation test results, it is evident that bat optimized fuzzy proportional derivative controller has superior performance than the other controllers considered. Experimental test results have also been taken and analyzed for the optimal controller identified through simulation.

  4. Agreement between a simple dyspnea-guided treatment algorithm for stable COPD and the GOLD guidelines: a pilot study

    Science.gov (United States)

    Cabrera, Carlos; Casanova, Ciro; Martín, Yolanda; Mirabal, Virginia; Sánchez, María del Carmen; Álvarez, Felisa; Juliá, Gabriel; Cabrera-Navarro, Pedro; García-Bello, Miguel Ángel; Marín, José María; de-Torres, Juan Pablo; Divo, Miguel; Celli, Bartolomé

    2016-01-01

    Introduction Guidelines recommendations for the treatment of COPD are poorly followed. This could be related to the complexity of classification and treatment algorithms. The purpose of this study was to validate a simpler dyspnea-based treatment algorithm for inhaled pharmacotherapy in stable COPD, comparing its concordance with the current Global Initiative for Obstructive Lung Disease (GOLD) guideline. Methods We enrolled patients who had been diagnosed with COPD in three primary care facilities and two tertiary hospitals in Spain. We determined anthropometric data, forced expiratory volume in the 1st second (percent), exacerbations, and dyspnea based on the modified Medical Research Council scale. We evaluated the new algorithm based on dyspnea and exacerbations and calculated the concordance with the current GOLD recommendations. Results We enrolled 100 patients in primary care and 150 attending specialized care in a respiratory clinic. There were differences in the sample distribution between cohorts with 41% vs 26% in grade A, 16% vs 12% in grade B, 16% vs 22% in grade C, and 27% vs 40% in grade D for primary and respiratory care, respectively (P=0.005). The coincidence of the algorithm with the GOLD recommendations in primary care was 93% and 91.8% in the respiratory care cohort. Conclusion A simple dyspnea-based treatment algorithm for inhaled pharmacotherapy of COPD could be useful in the management of COPD patients and concurs very well with the recommended schema suggested by the GOLD initiative. PMID:27354780

  5. Current and emerging treatment options for myopic choroidal neovascularization

    Directory of Open Access Journals (Sweden)

    El Matri L

    2015-04-01

    Full Text Available Leila El Matri, Ahmed Chebil, Fedra Kort Department B of Ophthalmology, Hedi Rais Institute of Ophthalmology, Faculty of Medicine of Tunis, University of El Manar, Tunis, Tunisia Abstract: Choroidal neovascularization (CNV is the main cause of visual impairment in highly myopic patients younger than 50 years of age. There are different treatments for myopic CNV (mCNV, with 5- to 10-year outcomes currently. Chorioretinal atrophy is still the most important determinant factor for visual outcome. The purpose of this study is to provide an overview of the current treatments for mCNV, including laser, surgical management, verteporfin photodynamic therapy, and mainly anti-vascular endothelial growth factor therapy. Emerging treatment options are also discussed. Keywords: myopia, choroidal neovascularization, current treatment, emerging treatment

  6. Diagnosis and Treatment of a Neck Node Swelling Suspicious for a Malignancy: An Algorithmic Approach

    Directory of Open Access Journals (Sweden)

    A. J. M. Balm

    2010-01-01

    Full Text Available Aim. To present an up-to-date algorithm incorporating recent advances regarding its diagnosis and treatment. Method. A Medline/Pubmed search was performed to identify relevant studies published in English from 1990 until 2008. Only clinical studies were identified and were used as basis for the diagnostic algorithm. Results. The eligible literature provided only observational evidence. The vast majority of neck nodes from occult primaries (>90% represent SCC with a high incidence among middle aged man. Smoking and alcohol abuse are important risk factors. Asiatic and North African patients with neck node metastases are at risk of harbouring an occult nasopharyngeal carcinoma. The remainder are adenocarcinoma, undifferentiated carcinoma, melanoma, thyroid carcinoma and Merkel cell carcinoma. Fine needle aspiration cytology (FNAC reaches sensitivity and specificity percentages of 81% and 100%, respectively and plays an important role as the second diagnostic step after routine ENT mirror and/or endoscopic examination. FDG-PET/CT has proven to be helpful in identifying occult primary carcinomas of the head and neck, especially when applied as a guiding tool prior to panendoscopy, and may induce treatment related clinical decisions in up to 60% of cases. Conclusion. Although reports on the diagnostic process offer mainly descriptive studies, current information seems sufficient to formulate a diagnostic algorithm to contribute to a more systematic diagnostic approach preventing unnecessary steps.

  7. [Clinical algorithms in the treatment of status epilepticus in children].

    Science.gov (United States)

    Zubcević, S; Buljina, A; Gavranović, M; Uzicanin, S; Catibusić, F

    1999-01-01

    The clinical algorithm is a text format that is specially suited for presenting a sequence of clinical decisions, for teaching clinical decision making, and for guiding patient care. Clinical algorithms are compared as to their clinical usefulness with decision analysis. We have tried to make clinical algorithm for managing status epilepticus in children that can be applicable to our conditions. Most of the algorithms that are made on this subject include drugs and procedures that are not available at our hospital. We identified performance requirement, defined the set of problems to be solved as well as who would solve them, developed drafts in several versions and put them in the discussion with experts in this field. Algorithm was tested and revised and graphical acceptability was achieved. In the algorithm we tried to clearly define how the clinician should make the decision and to be provided with appropriate feedback. In one year period of experience in working we found this algorithm very useful in managing status epilepticus in children, as well as in teaching young doctors the specifities of algorithms and this specific issue. Their feedback is that they find that it provides the framework for facilitating thinking about clinical problems. Sometimes we hear objection that algorithms may not apply to a specific patient. This objection is based on misunderstanding how algorithms are used and should be corrected by a proper explanation of their use. We conclude that methods should be sought for writing clinical algorithms that represent expert consensus. A clinical algorithm can then be written for many areas of medical decision making that can be standardized. Medical practice would then be presented to students more effectively, accurately and understood better.

  8. Current treatment of rectovaginal fistula in Crohn's disease

    Institute of Scientific and Technical Information of China (English)

    Yan-Fei Zhu; Guo-Qing Tao; Ning Zhou; Chen Xiang

    2011-01-01

    Rectovaginal fistula (RVF) continues to be the most difficult perianal manifestation of Crohn's disease to treat. This devastating and disabling complication has a significant impact on patients' quality of life and presents unique management challenges.Current therapeutic approaches include many medical therapeutics and surgical treatments with a wide range of success rates reported. However,current evidence is lacking to support any recommendation. The choice of repair depends on various patient and disease factors and basic surgical tenets.In this article,we review the current options to consider in the treatment of Crohn's-related RVF,and try to evaluate their effects on fistulae closure and quality of life.

  9. Comprehensive assessment of flexible-ligand docking algorithms: current effectiveness and challenges.

    Science.gov (United States)

    Huang, Sheng-You

    2017-03-14

    Protein-ligand docking has been playing an important role in modern drug discovery. To model drug-target binding in real systems, a number of flexible-ligand docking algorithms with different sampling strategies and scoring methods have been subsequently developed over the past three decades, while rigid-ligand docking is still being used because of its compelling computational efficiency. Here, a comprehensive assessment has been conducted to investigate the effectiveness of flexible-ligand docking versus rigid-ligand docking for three representative docking algorithms (global optimization, incremental construction and multi-conformer docking) in virtual screening and pose prediction on the Directory of Useful Decoys. It was found that overall flexible-ligand docking did not achieve a statistically significant improvement in enrichments over rigid-ligand docking in virtual screening, but all docking programs significantly improved the success rates when considering ligand flexibility in pose prediction. The worse effectiveness of flexible-ligand docking in virtual screening than in pose prediction suggests that the challenges of current docking algorithms exist in ranking more than docking, although the use of flexible-ligand docking in virtual screening was justified by its better effectiveness for more flexible ligand in virtual screening. Challenges for scoring, including internal energy, charge polarization, entropy and flexibility, were investigated and discussed. An empirical way was also proposed to consider loss of ligand conformational entropy for virtual screening. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  10. Computer Algorithms and Architectures for Three-Dimensional Eddy-Current Nondestructive Evaluation. Volume 3. Chapters 6-11

    Science.gov (United States)

    1989-01-20

    mflC FILE. OOR SA/TR-2/89 A003: FINAL REPORT COMPUTER ALGORITHMS AND ARCHITECTURES FOR THREE-DIMENSIONAL EDDY-CURRENT NONDESTRUCTIVE EVALUATION CD...J., Ullman, J., The Design and Analysis of Computer Algorithms , Addison-Wesley Publishing Company, 1974. [A2] Anderson, B., Moore, J., Optimal...actual data. DC- 17 I I I I [All Aho, A., Hopcroft, J., Ullman, J., The Design and Analysis of Computer Algorithms , Addison-Wesley Publishing Company

  11. Cost-effectiveness of lanreotide Autogel in treatment algorithms of acromegaly.

    Science.gov (United States)

    Biermasz, Nienke R; Roelfsema, Ferdinand; Pereira, Alberto M; Romijn, Johannes A

    2009-06-01

    The introduction of effective pharmacological treatments has changed the management of acromegaly. However, chronic, life-long treatment with somatostatin analogues and/or growth hormone receptor antagonists is very expensive. We estimated the costs of treatment algorithms to control acromegaly from a Dutch perspective. We used the following assumptions: after the diagnosis of acromegaly there is a mean remaining lifespan of approximately 33 years; the success rates of surgery and somatostatin analogues in controlling the disease are approximately 60%; and the lifelong costs of different algorithms to control acromegaly in 100 patients ranged from 43 million euros (primary surgery and secondary somatostatin analogues) to 57 million euros (primary somatostatin analogues and secondary surgery) and even reached 95 million euros (medical treatment only). In algorithms that include trans-sphenoidal surgery, the lifetime treatment costs are almost 46-59% cheaper per 100 patients than in algorithms with medical treatment but without trans-sphenoidal surgery. Algorithms with primary surgery and secondary somatostatin analogs are 30% cheaper per 100 patients than algorithms with primary somatostatin analogues and secondary surgery. Per 100 patients, algorithms including lanreotide Autogel are 14-34% more expensive than algorithms including octreotide long-acting release. These life-long costs should be taken into consideration when making choices between treatment algorithms.

  12. Computer Algorithms and Architectures for Three-Dimensional Eddy-Current Nondestructive Evaluation. Volume 1. Executive Summary

    Science.gov (United States)

    1989-01-20

    LLAA6 .l iI -SA/TR-2/89 A003: FINAL REPORT * COMPUTER ALGORITHMS AND ARCHITECTURES N FOR THREE-DIMENSIONAL EDDY-CURRENT NONDESTRUCTIVE EVALUATION...Ciasuication) COMPUTER ALGORITHMS AND ARCHITECTURES FOR THREE-DIMENSIONAL EDD~j~~JRRN iv ummary Q PERSONAL AUTriOR(S) SBAHASCAE 1 3a. TYPE Of REPORT

  13. Direct reconstruction algorithm of current dipoles for vector magnetoencephalography and electroencephalography

    Energy Technology Data Exchange (ETDEWEB)

    Nara, Takaaki [Graduate School of Information Science and Technology, University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo 113-8656 (Japan); Oohama, Junji [Graduate School of Information Science and Technology, University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo 113-8656 (Japan); Hashimoto, Masaru [Graduate School of Information Science and Technology, University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo 113-8656 (Japan); Takeda, Tsunehiro [Graduate School of Frontier Science, University of Tokyo, 5-1-5 Kashiwa-no-ha, Kashiwa, Chiba 277-8561 (Japan); Ando, Shigeru [Graduate School of Information Science and Technology, University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo 113-8656 (Japan)

    2007-07-07

    This paper presents a novel algorithm to reconstruct parameters of a sufficient number of current dipoles that describe data (equivalent current dipoles, ECDs, hereafter) from radial/vector magnetoencephalography (MEG) with and without electroencephalography (EEG). We assume a three-compartment head model and arbitrary surfaces on which the MEG sensors and EEG electrodes are placed. Via the multipole expansion of the magnetic field, we obtain algebraic equations relating the dipole parameters to the vector MEG/EEG data. By solving them directly, without providing initial parameter guesses and computing forward solutions iteratively, the dipole positions and moments projected onto the xy-plane (equatorial plane) are reconstructed from a single time shot of the data. In addition, when the head layers and the sensor surfaces are spherically symmetric, we show that the required data reduce to radial MEG only. This clarifies the advantage of vector MEG/EEG measurements and algorithms for a generally-shaped head and sensor surfaces. In the numerical simulations, the centroids of the patch sources are well localized using vector/radial MEG measured on the upper hemisphere. By assuming the model order to be larger than the actual dipole number, the resultant spurious dipole is shown to have a much smaller strength magnetic moment (about 0.05 times smaller when the SNR = 16 dB), so that the number of ECDs is reasonably estimated. We consider that our direct method with greatly reduced computational cost can also be used to provide a good initial guess for conventional dipolar/multipolar fitting algorithms.

  14. Age-related macular degeneration: current treatment and future options.

    Science.gov (United States)

    Moutray, Tanya; Chakravarthy, Usha

    2011-09-01

    Age-related macular degeneration is the leading cause of visual impairment among older adults in the developed world. Epidemiological studies have revealed a number of genetic, ocular and environmental risk factors for this condition, which can be addressed by disease reduction strategies. We discuss the various treatment options for dry and exudative age-related macular degeneration available and explain how the recommended treatment depends on the exact type, location and extent of the degeneration. Currently, vascular endothelial growth factor (VEGF) inhibition therapy is the best available treatment for exudative age-related macular degeneration but is limited by the need for repeated intravitreal injections. The current treatment regime is being refined through research on optimal treatment frequency and duration and type of anti-VEGF drug. Different modes of drug delivery are being developed and in the future other methods of VEGF inhibition may be used.

  15. The current situation of treatment systems for alcoholism in Korea.

    Science.gov (United States)

    Kim, Jee Wook; Lee, Boung Chul; Kang, Tae-Cheon; Choi, Ihn-Geun

    2013-02-01

    Alcoholism is becoming one of the most serious issues in Korea. The purpose of this review article was to understand the present status of the treatment system for alcoholism in Korea compared to the United States and to suggest its developmental direction in Korea. Current modalities of alcoholism treatment in Korea including withdrawal treatment, pharmacotherapy, and psychosocial treatment are available according to Korean evidence-based treatment guidelines. Benzodiazepines and supportive care including vitamin and nutritional support are mainly used to treat alcohol withdrawal in Korea. Naltrexone and acamprosate are the drugs of first choice to treat chronic alcoholism. Psychosocial treatment methods such as individual psychotherapy, group psychotherapy, family therapy, cognitive behavior therapy, cue exposure therapy, 12-step facilitation therapy, self-help group therapy, and community-based treatment have been carried out to treat chronic alcoholism in Korea. However, current alcohol treatment system in Korea is not integrative compared to that in the United States. To establish the treatment system, it is important to set up an independent governmental administration on alcohol abuse, to secure experts on alcoholism, and to conduct outpatient alcoholism treatment programs and facilities in an open system including some form of continuing care.

  16. Remote sensing of cloud top pressure/height from SEVIRI: analysis of ten current retrieval algorithms

    Science.gov (United States)

    Hamann, U.; Walther, A.; Baum, B.; Bennartz, R.; Bugliaro, L.; Derrien, M.; Francis, P. N.; Heidinger, A.; Joro, S.; Kniffka, A.; Le Gléau, H.; Lockhoff, M.; Lutz, H.-J.; Meirink, J. F.; Minnis, P.; Palikonda, R.; Roebeling, R.; Thoss, A.; Platnick, S.; Watts, P.; Wind, G.

    2014-09-01

    The role of clouds remains the largest uncertainty in climate projections. They influence solar and thermal radiative transfer and the earth's water cycle. Therefore, there is an urgent need for accurate cloud observations to validate climate models and to monitor climate change. Passive satellite imagers measuring radiation at visible to thermal infrared (IR) wavelengths provide a wealth of information on cloud properties. Among others, the cloud top height (CTH) - a crucial parameter to estimate the thermal cloud radiative forcing - can be retrieved. In this paper we investigate the skill of ten current retrieval algorithms to estimate the CTH using observations from the Spinning Enhanced Visible and InfraRed Imager (SEVIRI) onboard Meteosat Second Generation (MSG). In the first part we compare ten SEVIRI cloud top pressure (CTP) data sets with each other. The SEVIRI algorithms catch the latitudinal variation of the CTP in a similar way. The agreement is better in the extratropics than in the tropics. In the tropics multi-layer clouds and thin cirrus layers complicate the CTP retrieval, whereas a good agreement among the algorithms is found for trade wind cumulus, marine stratocumulus and the optically thick cores of the deep convective system. In the second part of the paper the SEVIRI retrievals are compared to CTH observations from the Cloud-Aerosol LIdar with Orthogonal Polarization (CALIOP) and Cloud Profiling Radar (CPR) instruments. It is important to note that the different measurement techniques cause differences in the retrieved CTH data. SEVIRI measures a radiatively effective CTH, while the CTH of the active instruments is derived from the return time of the emitted radar or lidar signal. Therefore, some systematic differences are expected. On average the CTHs detected by the SEVIRI algorithms are 1.0 to 2.5 km lower than CALIOP observations, and the correlation coefficients between the SEVIRI and the CALIOP data sets range between 0.77 and 0.90. The

  17. Remote sensing of cloud top pressure/height from SEVIRI: analysis of ten current retrieval algorithms

    Directory of Open Access Journals (Sweden)

    U. Hamann

    2014-01-01

    Full Text Available The role of clouds remains the largest uncertainty in climate projections. They influence solar and thermal radiative transfer and the earth's water cycle. Therefore, there is an urgent need for accurate cloud observations to validate climate models and to monitor climate change. Passive satellite imagers measuring radiation at visible to thermal infrared wavelengths provide a wealth of information on cloud properties. Among others, the cloud top height (CTH – a crucial parameter to estimate the thermal cloud radiative forcing – can be retrieved. In this paper we investigate the skill of ten current retrieval algorithms to estimate the CTH using observations from the Spinning Enhanced Visible and InfraRed Imager (SEVIRI onboard Meteosat Second Generation (MSG. In the first part we compare the ten SEVIRI cloud top pressure (CTP datasets with each other. The SEVIRI algorithms catch the latitudinal variation of the CTP in a similar way. The agreement is better in the extratropics than in the tropics. In the tropics multi-layer clouds and thin cirrus layers complicate the CTP retrieval, whereas good agreement is found for the cores of the deep convective system having a high optical depth. Furthermore, a good agreement between the algorithms is observed for trade wind cumulus and marine stratocumulus clouds. In the second part of the paper the SEVIRI retrievals are compared to CTH observations from the Cloud-Aerosol LIdar with Orthogonal Polarization (CALIOP and Cloud Profiling Radar (CPR instruments. It is important to note that the different measurement techniques cause differences in the retrieved CHT data. SEVIRI measures a radiatively effective CTH, while the CTH of the active instruments is derived from the return time of the emitted signal. Therefore some systematic diffrences are expected. On average the CTHs detected by the SEVIRI algorithms are 1.0 to 2.5 km lower than CALIOP observations, and the correlation coefficients between the

  18. Remote sensing of cloud top pressure/height from SEVIRI: analysis of ten current retrieval algorithms

    Directory of Open Access Journals (Sweden)

    U. Hamann

    2014-09-01

    Full Text Available The role of clouds remains the largest uncertainty in climate projections. They influence solar and thermal radiative transfer and the earth's water cycle. Therefore, there is an urgent need for accurate cloud observations to validate climate models and to monitor climate change. Passive satellite imagers measuring radiation at visible to thermal infrared (IR wavelengths provide a wealth of information on cloud properties. Among others, the cloud top height (CTH – a crucial parameter to estimate the thermal cloud radiative forcing – can be retrieved. In this paper we investigate the skill of ten current retrieval algorithms to estimate the CTH using observations from the Spinning Enhanced Visible and InfraRed Imager (SEVIRI onboard Meteosat Second Generation (MSG. In the first part we compare ten SEVIRI cloud top pressure (CTP data sets with each other. The SEVIRI algorithms catch the latitudinal variation of the CTP in a similar way. The agreement is better in the extratropics than in the tropics. In the tropics multi-layer clouds and thin cirrus layers complicate the CTP retrieval, whereas a good agreement among the algorithms is found for trade wind cumulus, marine stratocumulus and the optically thick cores of the deep convective system. In the second part of the paper the SEVIRI retrievals are compared to CTH observations from the Cloud–Aerosol LIdar with Orthogonal Polarization (CALIOP and Cloud Profiling Radar (CPR instruments. It is important to note that the different measurement techniques cause differences in the retrieved CTH data. SEVIRI measures a radiatively effective CTH, while the CTH of the active instruments is derived from the return time of the emitted radar or lidar signal. Therefore, some systematic differences are expected. On average the CTHs detected by the SEVIRI algorithms are 1.0 to 2.5 km lower than CALIOP observations, and the correlation coefficients between the SEVIRI and the CALIOP data sets range between

  19. Remote Sensing of Cloud Top Height from SEVIRI: Analysis of Eleven Current Retrieval Algorithms

    Science.gov (United States)

    Hamann, U.; Walther, A.; Baum, B.; Bennartz, R.; Bugliaro, L.; Derrien, M.; Francis, P. N.; Heidinger, A.; Joro, S.; Kniffka, A.; hide

    2014-01-01

    The role of clouds remains the largest uncertainty in climate projections. They influence solar and thermal radiative transfer and the earth's water cycle. Therefore, there is an urgent need for accurate cloud observations to validate climate models and to monitor climate change. Passive satellite imagers measuring radiation at visible to thermal infrared (IR) wavelengths provide a wealth of information on cloud properties. Among others, the cloud top height (CTH) - a crucial parameter to estimate the thermal cloud radiative forcing - can be retrieved. In this paper we investigate the skill of ten current retrieval algorithms to estimate the CTH using observations from the Spinning Enhanced Visible and InfraRed Imager (SEVIRI) onboard Meteosat Second Generation (MSG). In the first part we compare ten SEVIRI cloud top pressure (CTP) data sets with each other. The SEVIRI algorithms catch the latitudinal variation of the CTP in a similar way. The agreement is better in the extratropics than in the tropics. In the tropics multi-layer clouds and thin cirrus layers complicate the CTP retrieval, whereas a good agreement among the algorithms is found for trade wind cumulus, marine stratocumulus and the optically thick cores of the deep convective system. In the second part of the paper the SEVIRI retrievals are compared to CTH observations from the Cloud-Aerosol LIdar with Orthogonal Polarization (CALIOP) and Cloud Profiling Radar (CPR) instruments. It is important to note that the different measurement techniques cause differences in the retrieved CTH data. SEVIRI measures a radiatively effective CTH, while the CTH of the active instruments is derived from the return time of the emitted radar or lidar signal. Therefore, some systematic differences are expected. On average the CTHs detected by the SEVIRI algorithms are 1.0 to 2.5 kilometers lower than CALIOP observations, and the correlation coefficients between the SEVIRI and the CALIOP data sets range between 0.77 and 0

  20. Remote Sensing of Cloud Top Height from SEVIRI: Analysis of Eleven Current Retrieval Algorithms

    Science.gov (United States)

    Hamann, U.; Walther, A.; Baum, B.; Bennartz, R.; Bugliaro, L.; Derrien, M.; Francis, P. N.; Heidinger, A.; Joro, S.; Kniffka, A.; Le Gleau, H.; Lockhoff, M.; Lutz, H.-J.; Meirink, J. F.; Minnis, P.; Palikonda, R.; Roebeling, R.; Thoss, A.; Platnick, S.; Watts, P.; Wind, G.

    2014-01-01

    The role of clouds remains the largest uncertainty in climate projections. They influence solar and thermal radiative transfer and the earth's water cycle. Therefore, there is an urgent need for accurate cloud observations to validate climate models and to monitor climate change. Passive satellite imagers measuring radiation at visible to thermal infrared (IR) wavelengths provide a wealth of information on cloud properties. Among others, the cloud top height (CTH) - a crucial parameter to estimate the thermal cloud radiative forcing - can be retrieved. In this paper we investigate the skill of ten current retrieval algorithms to estimate the CTH using observations from the Spinning Enhanced Visible and InfraRed Imager (SEVIRI) onboard Meteosat Second Generation (MSG). In the first part we compare ten SEVIRI cloud top pressure (CTP) data sets with each other. The SEVIRI algorithms catch the latitudinal variation of the CTP in a similar way. The agreement is better in the extratropics than in the tropics. In the tropics multi-layer clouds and thin cirrus layers complicate the CTP retrieval, whereas a good agreement among the algorithms is found for trade wind cumulus, marine stratocumulus and the optically thick cores of the deep convective system. In the second part of the paper the SEVIRI retrievals are compared to CTH observations from the Cloud-Aerosol LIdar with Orthogonal Polarization (CALIOP) and Cloud Profiling Radar (CPR) instruments. It is important to note that the different measurement techniques cause differences in the retrieved CTH data. SEVIRI measures a radiatively effective CTH, while the CTH of the active instruments is derived from the return time of the emitted radar or lidar signal. Therefore, some systematic differences are expected. On average the CTHs detected by the SEVIRI algorithms are 1.0 to 2.5 kilometers lower than CALIOP observations, and the correlation coefficients between the SEVIRI and the CALIOP data sets range between 0.77 and 0

  1. Using genetic algorithms to optimise current and future health planning - the example of ambulance locations

    Science.gov (United States)

    2010-01-01

    Background Ambulance response time is a crucial factor in patient survival. The number of emergency cases (EMS cases) requiring an ambulance is increasing due to changes in population demographics. This is decreasing ambulance response times to the emergency scene. This paper predicts EMS cases for 5-year intervals from 2020, to 2050 by correlating current EMS cases with demographic factors at the level of the census area and predicted population changes. It then applies a modified grouping genetic algorithm to compare current and future optimal locations and numbers of ambulances. Sets of potential locations were evaluated in terms of the (current and predicted) EMS case distances to those locations. Results Future EMS demands were predicted to increase by 2030 using the model (R2 = 0.71). The optimal locations of ambulances based on future EMS cases were compared with current locations and with optimal locations modelled on current EMS case data. Optimising the location of ambulance stations locations reduced the average response times by 57 seconds. Current and predicted future EMS demand at modelled locations were calculated and compared. Conclusions The reallocation of ambulances to optimal locations improved response times and could contribute to higher survival rates from life-threatening medical events. Modelling EMS case 'demand' over census areas allows the data to be correlated to population characteristics and optimal 'supply' locations to be identified. Comparing current and future optimal scenarios allows more nuanced planning decisions to be made. This is a generic methodology that could be used to provide evidence in support of public health planning and decision making. PMID:20109172

  2. Current approaches and future directions in the treatment of leprosy

    Directory of Open Access Journals (Sweden)

    Worobec SM

    2012-08-01

    Full Text Available Sophie M WorobecDepartment of Dermatology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USAAbstract: This review surveys current treatments and future treatment trends in leprosy from a clinical perspective. The World Health Organization provides a multidrug treatment regimen that targets the Mycobacterium leprae bacillus which causes leprosy. Several investigational drugs are available for the treatment of drug-resistant M. leprae. Future directions in leprosy treatment will focus on: the molecular signaling mechanism M. leprae uses to avoid triggering an immune response; prospective studies of the side effects experienced during multiple-drug therapy; recognition of relapse rates post-completion of designated treatments; combating multidrug resistance; vaccine development; development of new diagnostic tests; and the implications of the recent discovery of a genetically distinct leprosy-causing bacillus, Mycobacterium lepromatosis.Keywords: epidemiology, leprosy, Hansen’s disease, multidrug resistance, multidrug therapy

  3. Current treatment approaches in patients with ankylosing spondylitis

    Directory of Open Access Journals (Sweden)

    Bilal Elbey

    2015-03-01

    Full Text Available Ankylosing spondylitis (AS is a chronic, inflammatory, rheumatic disease that mainly affects sacroiliac joints and spine. AS predominantly occurs more often in males and typically begins in the second or third decade. The mainstay of therapy in AS are nonsteroidal anti-inflammatory drugs, which reduce inflammation and pain. Disease modifying antirheumatic drugs (DMARD did not have enough evidence to prove their effect in AS treatment. The use of DMARD may not sufficient to improve the treatment and symptoms. Currently, TNF-blockers such as, Golimumab Etanersept Adalimumab İnfliksimab have promising results in the treatment of AS. TNF-blockers improve the clinical signs and symptoms, and improve the patients’ physical function and quality of life. This manuscript is focused that Current pharmacological treatments in patients with ankylosing spondylitis.

  4. Current Treatment Options in Challenging Oral Diseases: Burning Mouth Syndrome

    Directory of Open Access Journals (Sweden)

    Bilgen Erdoğan

    2012-12-01

    Full Text Available Burning mouth syndrome is a chronic condition characterized by burning pain without any signs of an oral mucosal pathology, that usually affects postmenopausal women. Burning sensation is often accompanied by dysgeusia and xerostomia. The pathogenesis of the disease is unknown and an effective treatment option for most of the patients has not been defined yet. The aim of this review is to present current pharmacological and physicological treatments of burning mouth syndrome.

  5. Transcranial direct current stimulation as a treatment for auditory hallucinations

    OpenAIRE

    Sanne eKoops; Hilde evan den Brink; Sommer, Iris E C

    2015-01-01

    Auditory hallucinations (AH) are a symptom of several psychiatric disorders, such as schizophrenia. In a significant minority of patients, AH are resistant to antipsychotic medication. Alternative treatment options for this medication-resistant group are scarce and most of them focus on coping with the hallucinations. Finding an alternative treatment that can diminish AH is of great importance.Transcranial direct current stimulation (tDCS) is a safe and non-invasive technique that is able to...

  6. Current review and a simplified "five-point management algorithm" for keratoconus

    Directory of Open Access Journals (Sweden)

    Rohit Shetty

    2015-01-01

    Full Text Available Keratoconus is a slowly progressive, noninflammatory ectatic corneal disease characterized by changes in corneal collagen structure and organization. Though the etiology remains unknown, novel techniques are continuously emerging for the diagnosis and management of the disease. Demographical parameters are known to affect the rate of progression of the disease. Common methods of vision correction for keratoconus range from spectacles and rigid gas-permeable contact lenses to other specialized lenses such as piggyback, Rose-K or Boston scleral lenses. Corneal collagen cross-linking is effective in stabilizing the progression of the disease. Intra-corneal ring segments can improve vision by flattening the cornea in patients with mild to moderate keratoconus. Topography-guided custom ablation treatment betters the quality of vision by correcting the refractive error and improving the contact lens fit. In advanced keratoconus with corneal scarring, lamellar or full thickness penetrating keratoplasty will be the treatment of choice. With such a wide spectrum of alternatives available, it is necessary to choose the best possible treatment option for each patient. Based on a brief review of the literature and our own studies we have designed a five-point management algorithm for the treatment of keratoconus.

  7. Current review and a simplified "five-point management algorithm" for keratoconus.

    Science.gov (United States)

    Shetty, Rohit; Kaweri, Luci; Pahuja, Natasha; Nagaraja, Harsha; Wadia, Kareeshma; Jayadev, Chaitra; Nuijts, Rudy; Arora, Vishal

    2015-01-01

    Keratoconus is a slowly progressive, noninflammatory ectatic corneal disease characterized by changes in corneal collagen structure and organization. Though the etiology remains unknown, novel techniques are continuously emerging for the diagnosis and management of the disease. Demographical parameters are known to affect the rate of progression of the disease. Common methods of vision correction for keratoconus range from spectacles and rigid gas-permeable contact lenses to other specialized lenses such as piggyback, Rose-K or Boston scleral lenses. Corneal collagen cross-linking is effective in stabilizing the progression of the disease. Intra-corneal ring segments can improve vision by flattening the cornea in patients with mild to moderate keratoconus. Topography-guided custom ablation treatment betters the quality of vision by correcting the refractive error and improving the contact lens fit. In advanced keratoconus with corneal scarring, lamellar or full thickness penetrating keratoplasty will be the treatment of choice. With such a wide spectrum of alternatives available, it is necessary to choose the best possible treatment option for each patient. Based on a brief review of the literature and our own studies we have designed a five-point management algorithm for the treatment of keratoconus.

  8. Current and Future Treatment of Hypertension in the SPRINT Era.

    Science.gov (United States)

    Phillips, Robert A

    2015-01-01

    Based on the SPRINT trial, it is highly likely that new SPRINT-era guidelines will establish a blood pressure (BP) goal of SPRINT demonstrated that assignment to an intensive-treatment systolic BP (SBP) goal of SPRINT-era guidelines in the elderly, African Americans, and patients with uncomplicated essential hypertension, diabetes, chronic kidney disease, cardiovascular disease, and coronary artery disease. Specific attention is paid to BP goals and preferred pharmacological antihypertensive therapy in these populations, and an algorithm that incorporates the SPRINT trial results is presented. Inhibitors of the renin-angiotensin-aldosterone system as well as calcium channel blockers are universally accepted as first-line therapy in uncomplicated hypertension, but controversy exists over the role of thiazide diuretics and beta blockers. This review also discusses a physiologically and outcomes-based approach to combination therapy for treatment of hypertension.

  9. Current status of diagnosis and treatment of hepatic echinococcosis

    Science.gov (United States)

    Mihmanli, Memmet; Idiz, Ufuk Oguz; Kaya, Cemal; Demir, Uygar; Bostanci, Ozgur; Omeroglu, Sinan; Bozkurt, Emre

    2016-01-01

    Echinococcus granulosus (E. granulosus) and Echinococcus multilocularis (E. multilocularis) infections are the most common parasitic diseases that affect the liver. The disease course is typically slow and the patients tend to remain asymptomatic for many years. Often the diagnosis is incidental. Right upper quadrant abdominal pain, hepatitis, cholangitis, and anaphylaxis due to dissemination of the cyst are the main presenting symptoms. Ultrasonography is important in diagnosis. The World Health Organization classification, based on ultrasonographic findings, is used for staging of the disease and treatment selection. In addition to the imaging methods, immunological investigations are used to support the diagnosis. The available treatment options for E. granulosus infection include open surgery, percutaneous interventions, and pharmacotherapy. Aggressive surgery is the first-choice treatment for E. multilocularis infection, while pharmacotherapy is used as an adjunct to surgery. Due to a paucity of clinical studies, empirical evidence on the treatment of E. granulosus and E. multilocularis infections is largely lacking; there are no prominent and widely accepted clinical algorithms yet. In this article, we review the diagnosis and treatment of E. granulosus and E. multilocularis infections in the light of recent evidence. PMID:27729953

  10. Solar Cell Parameters Extraction from a Current-Voltage Characteristic Using Genetic Algorithm

    Directory of Open Access Journals (Sweden)

    Sanjaykumar J. Patel

    2013-05-01

    Full Text Available The determination of solar cell parameters is very important for the evaluation of the cell performance as well as to extract maximum possible output power from the cell. In this paper, we propose a computational based binary-coded genetic algorithm (GA to extract the parameters (I0, Iph and n for a single diode model of solar cell from its current-voltage (I-V characteristic. The algorithm was implemented using LabVIEW as a programming tool and validated by applying it to the I-V curve synthesized from the literature using reported values. The values of parameters obtained by GA are in good agreement with those of the reported values for silicon and plastic solar cells. change to “After the validation of the program, it was used to extract parameters for an experimental I-V characteristic of 4 × 4 cm2 polycrystalline silicon solar cell measured under 900 W/m. The I-V characteristic obtained using GA shows excellent match with the experimental one.

  11. An iterative algorithm for determining depth profiles of collection probability by electron-beam-induced current

    Science.gov (United States)

    Konovalov, Igor; Breitenstein, Otwin

    2001-01-01

    An iterative algorithm for the derivation of depth profiles of the minority carrier collection probability in a semiconductor with or without a coating on the top is presented using energy-resolved electron-beam-induced current measurements in planar geometry. The calculation is based on the depth-dose function of Everhart and Hoff (Everhart T E and Hoff P H 1971 J. Appl. Phys. 42 5837) and on the penetration-range function of Kanaya and Okayama (Kanaya K and Okayama S 1972 J. Phys. D: Appl. Phys. 5 43) or on that of Fitting (Fitting H-J 1974 Phys. Status Solidi/ a 26 525). It can also be performed with any other depth-dose functions. Using this algorithm does not require us to make any assumptions on the shape of the collection profile within the depth of interest. The influence of an absorbing top contact and/or a limited thickness of the semiconductor layer appear in the result, but can also be taken explicitly into account. Examples using silicon and CIS solar cells as well as a GaAs LED are presented.

  12. Advanced model of eddy-current NDE inverse problem with sparse grid algorithm

    Science.gov (United States)

    Zhou, Liming; Sabbagh, Harold A.; Sabbagh, Elias H.; Murphy, R. Kim; Bernacchi, William

    2017-02-01

    In model-based inverse problem, some unknown parameters need to be estimated. These parameters are used not only to characterize the physical properties of cracks, but also to describe the position of the probes (such as lift off and angles) in the calibration. After considering the effect of the position of the probes in the inverse problem, the accuracy of the inverse result will be improved. With increasing the number of the parameters in the inverse problems, the burden of calculations will increase exponentially in the traditional full grid method. The sparse grid algorithm, which was introduced by Sergey A. Smolyak, was used in our work. With this algorithm, we obtain a powerful interpolation method that requires significantly fewer support nodes than conventional interpolation on a full grid. In this work, we combined sparse grid toolbox TASMANIAN, which is produced by Oak Ridge National Laboratory, and professional eddy-current NDE software, VIC-3D R◯, to solve a specific inverse problem. An advanced model based on our previous one is used to estimate length and depth of the crack, lift off and two angles of the position of probes. Considering the calibration process, pseudorandom noise is considered in the model and statistical behavior is discussed.

  13. Personalized medicine and treatment approaches in hypertension: current perspectives

    Directory of Open Access Journals (Sweden)

    Byrd JB

    2016-04-01

    Full Text Available James Brian Byrd Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI, USA Abstract: In the US, hypertension affects one in three adults. Current guideline-based treatment of hypertension involves little diagnostic testing. A more personalized approach to the treatment of hypertension might be of use. Several methods of personalized treatment have been proposed and vetted to varying degrees. The purpose of this narrative review is to discuss the rationale for personalized therapy in hypertension, barriers to its development and implementation, some influential examples of proposed personalization measures, and a view of future efforts. Keywords: hypertension, blood pressure, personalized medicine

  14. Low-grade oligodendroglioma: current treatments and future hopes.

    Science.gov (United States)

    Lwin, Zarnie; Gan, Hui K; Mason, Warren P

    2009-11-01

    Current treatment modalities for low-grade gliomas include surgery, radiotherapy and chemotherapy. Management of these ultimately incurable tumors remains controversial, particularly the timing and extent of surgery, and the optimal sequence of radiotherapy and chemotherapy thereafter. Two ongoing Phase III trials should provide definitive answers to some of these controversial issues in the treatment of low-grade gliomas and confirm the impact of molecular predictors of response and outcome. This review will discuss recent progress and topical issues in the treatment of low-grade gliomas.

  15. CURRENT OPTIONS IN TREATMENT OF FISTULA-IN-ANO

    Directory of Open Access Journals (Sweden)

    Mohanlal Khadia

    2016-08-01

    Full Text Available Fistula-in-ano has long been notorious for its tendency to recur after operation. Although surgery remains the main modality of treatment, still no clear recommendations are available and its treatment is still debatable. Treating anal fistula remains a challenging issue because of the anatomical location, the potential risks of septic complications and postoperative stool incontinence. Nowadays several sphincter sparing procedures are preferred, but they carry their own risk of recurrence and some degree of incontinence. So here we will discuss current procedures used in treatment of different types of fistula-in-ano.

  16. Current Status of Immunotherapy Treatments for Pancreatic Cancer.

    Science.gov (United States)

    Jimenez-Luna, Cristina; Prados, Jose; Ortiz, Raul; Melguizo, Consolacion; Torres, Carolina; Caba, Octavio

    Pancreatic cancer (PC) is a lethal disease representing the seventh most frequent cause of death from cancer worldwide. Resistance of pancreatic tumors to current treatments leads to disappointing survival rates, and more specific and effective therapies are urgently needed. In recent years, immunotherapy has been proposed as a promising approach to the treatment of PC, and encouraging results have been published by various preclinical and clinical studies. This review provides an overview of the latest developments in the immunotherapeutic treatment of PC and summarizes the most recent and important clinical trials.

  17. Transcranial direct current stimulation as a treatment for auditory hallucinations.

    Directory of Open Access Journals (Sweden)

    Sanne eKoops

    2015-03-01

    Full Text Available Auditory hallucinations (AH are a symptom of several psychiatric disorders, such as schizophrenia. In a significant minority of patients, AH are resistant to antipsychotic medication. Alternative treatment options for this medication-resistant group are scarce and most of them focus on coping with the hallucinations. Finding an alternative treatment that can diminish AH is of great importance.Transcranial direct current stimulation (tDCS is a safe and non-invasive technique that is able to directly influence cortical excitability through the application of very low electric currents. A 1-2 mA direct current is applied between two surface electrodes, one serving as the anode and the other as the cathode. Cortical excitability is increased in the vicinity of the anode and reduced near the cathode. The technique, which has only a few transient side effects and is cheap and portable, is increasingly explored as a treatment for neurological and psychiatric symptoms. It has shown efficacy on symptoms of depression, bipolar disorder, schizophrenia, Alzheimer’s disease, Parkinson’s disease, epilepsy and stroke. However, the application of tDCS as a treatment for AH is relatively new. This article provides an overview of the current knowledge in this field and provides guidelines for future research.

  18. Fabry disease - current treatment and new drug development.

    Science.gov (United States)

    Motabar, Omid; Sidransky, Ellen; Goldin, Ehud; Zheng, Wei

    2010-07-23

    Fabry disease is a rare inherited lysosomal storage disorder caused by a partial or complete deficiency of α-galactosidase A (GLA), resulting in the storage of excess cellular glycosphingolipids. Enzyme replacement therapy is available for the treatment of Fabry disease, but it is a costly, intravenous treatment. Alternative therapeutic approaches, including small molecule chaperone therapy, are currently being explored. High throughput screening (HTS) technologies can be utilized to discover other small molecule compounds, including non-inhibitory chaperones, enzyme activators, molecules that reduce GLA substrate, and molecules that activate GLA gene promoters. This review outlines the current therapeutic approaches, emerging treatment strategies, and the process of drug discovery and development for Fabry disease.

  19. Reliability and safety of a new upper cervical spine injury treatment algorithm

    Directory of Open Access Journals (Sweden)

    Andrei Fernandes Joaquim

    Full Text Available ABSTRACT In the present study, we evaluated the reliability and safety of a new upper cervical spine injury treatment algorithm to help in the selection of the best treatment modality for these injuries. Methods Thirty cases, previously treated according to the new algorithm, were presented to four spine surgeons who were questioned about their personal suggestion for treatment, and the treatment suggested according to the application of the algorithm. After four weeks, the same questions were asked again to evaluate reliability (intra- and inter-observer using the Kappa index. Results The reliability of the treatment suggested by applying the algorithm was superior to the reliability of the surgeons’ personal suggestion for treatment. When applying the upper cervical spine injury treatment algorithm, an agreement with the treatment actually performed was obtained in more than 89% of the cases. Conclusion The system is safe and reliable for treating traumatic upper cervical spine injuries. The algorithm can be used to help surgeons in the decision between conservative versus surgical treatment of these injuries.

  20. Consensus on Current Injectable Treatment Strategies in the Asian Face.

    Science.gov (United States)

    Wu, Woffles T L; Liew, Steven; Chan, Henry H; Ho, Wilson W S; Supapannachart, Nantapat; Lee, Hong-Ki; Prasetyo, Adri; Yu, Jonathan Nevin; Rogers, John D

    2016-04-01

    The desire for and use of nonsurgical injectable esthetic facial treatments are increasing in Asia. The structural and anatomical features specific to the Asian face, and differences from Western populations in facial aging, necessitate unique esthetic treatment strategies, but published recommendations and clinical evidence for injectable treatments in Asians are scarce. The Asian Facial Aesthetics Expert Consensus Group met to discuss current practices and consensus opinions on the cosmetic use of botulinum toxin and hyaluronic acid (HA) fillers, alone and in combination, for facial applications in Southeastern and Eastern Asians. Consensus opinions and statements on treatment aims and current practice were developed following discussions regarding pre-meeting and meeting survey outcomes, peer-reviewed literature, and the experts' clinical experience. The indications and patterns of use of injectable treatments vary among patients of different ages, and among Asian countries. The combination use of botulinum toxin and fillers increases as patients age. Treatment aims in Asians and current practice regarding the use of botulinum toxin and HA fillers in the upper, middle, and lower face of patients aged 18 to >55 years are presented. In younger Asian patients, addressing proportion and structural features and deficiencies are important to achieve desired esthetic outcomes. In older patients, maintaining facial structure and volume and addressing lines and folds are essential to reduce the appearance of aging. This paper provides guidance on treatment strategies to address the complex esthetic requirements in Asian patients of all ages. This journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

  1. Discharges Classification using Genetic Algorithms and Feature Selection Algorithms on Time and Frequency Domain Data Extracted from Leakage Current Measurements

    Directory of Open Access Journals (Sweden)

    D. Pylarinos

    2013-12-01

    Full Text Available A number of 387 discharge portraying waveforms recorded on 18 different 150 kV post insulators installed at two different Substations in Crete, Greece are considered in this paper. Twenty different features are extracted from each waveform and two feature selection algorithms (t-test and mRMR are employed. Genetic algorithms are used to classify waveforms in two different classes related to the portrayed discharges. Five different data sets are employed (1. the original feature vector, 2. time domain features, 3. frequency domain features, 4. t-test selected features 5. mRMR selected features. Results are discussed and compared with previous classification implementations on this particular data group.

  2. [Current treatment concepts for olecranon and prepatellar bursitis in Austria].

    Science.gov (United States)

    Baumbach, S F; Michel, M; Wyen, H; Buschmann, C T; Kdolsky, R; Kanz, K-G

    2013-04-01

    The limited evidence available on the diagnosis and treatment of olecranon and prepatellar bursitis indicates nationally varying treatment approaches. Therefore the aim of this study was to survey the current treatment concepts of olecranon and prepatellar bursitis in Austria. An online questionnaire comprising of demographic data, questions regarding diagnostics and differentiation between septic bursitis (SB) and non-septic bursitis (NSB) as well as two case reports for therapy appraisal were sent to members of the Austrian Society of Orthopaedics and Orthopaedic Surgery (ÖGO) and the Austrian Society of Traumatology (ÖGU). The overall response rates were 46 % (ÖGU)/12 % (ÖGO). Differentiation between SB and NSB was predominantly based on medical history/clinical presentation (ÖGU: 100 %/ÖGO: 84 %) and blood sampling (ÖGU: 82 %/ÖGO: 77 %). 64/36 % of surveyed members of ÖGO/OGU performed a bursal aspiration. 95/55 % of Austrian ÖGU opinion leaders favoured a surgical treatment approach in cases of SB/NSB. Conversely, ÖGO members rather favoured a conservative treatment approach (28/27 %). Significant differences were found between ÖGO and ÖGU, with the latter favouring a surgical treatment approach in cases of SB and NSB. However, the international literature argues for a conservative treatment approach. Further high quality research is needed to establish an evidence-based treatment approach. Georg Thieme Verlag KG Stuttgart · New York.

  3. Current trends in endodontic practice: emergency treatments and technological armamentarium.

    Science.gov (United States)

    Lee, Michelle; Winkler, Johnathon; Hartwell, Gary; Stewart, Jeffrey; Caine, Rufus

    2009-01-01

    The current clinical practice of endodontics includes the utilization of a variety of new technological advances and materials. The last comprehensive survey that compared treatment modalities used in endodontic practices was conducted in 1990. The purpose of the current survey was to determine the frequency with which these new endodontic technologies and materials are being used in endodontic practices today. An e-mail questionnaire was sent to the 636 active diplomates of the American Board of Endodontics with current e-mail addresses. Two hundred thirty-two diplomates responded for a response rate of 35%. Calcium hydroxide was found to be the most frequently used intracanal medicament for all cases diagnosed with necrotic pulps. Ibuprofen was the most frequently prescribed medication for pain, and penicillin was the most frequently prescribed antibiotic when an active infection was present. Eighty-two percent of the respondents are still incorporating hand files in some fashion during the cleansing and shaping phase of treatment. Lateral condensation and continuous wave were the most common methods used for obturation. Digital radiography was reported as being used by 72.5% of the respondents, whereas 45.3% reported using the microscope greater than 75% of the patient treatment. Ultrasonics was used by 97.8% of the respondents. It appears from the results that new endodontic technology is currently being used in the endodontic offices of those who responded to the survey.

  4. Treatment of meniscal injury: a current concept review

    Institute of Scientific and Technical Information of China (English)

    GU Yang-lin; WANG Yu-bin

    2010-01-01

    Meniscal injury is one of the most common injuries to the knee. The menisci are important for normal knee function. And loss of a meniscus increases the risk of subsequent development of degenerative changes in the knee. Now there are different techniques available for meniscal injury. These techniques include expectant treatment, meniscectomy, meniscal repair, meniscal replacement, and meniscal tissue engineering. Expectant treatment is the appropriate treatment for minor tears of the menisci. Meniscectomy being favored at the beginning is now obsolete. Meniscus repair has become a standard procedure. Meniscal replacement and tissue engineering are used to deal with considerable meniscal injuries. The purpose of this paper is to provide current knowledge regarding the anatomy and function of the menisci, incidence,aetiology, symptoms, signs, investigations and treatments of meniscal injury.

  5. Current treatment of choice for chronic hepatitis C infection

    Directory of Open Access Journals (Sweden)

    Tareq Yasin

    2011-01-01

    Full Text Available Tareq Yasin, Thomas R Riley, Ian R SchreibmanPenn State Hershey Medical Center and College of Medicine, Pennsylvania, USAAbstract: More than three million Americans have chronic hepatitis C infection, and the disease remains one of the most common blood-borne infections in the US. Treatment is focused on the chronic form of the disease, because the acute one tends to be self-limiting. In this article, we review the recent literature regarding the most effective therapy against hepatitis C infection, to confirm the current treatment of choice for the disease. We conclude that combination therapy with pegylated interferon and ribavirin remains the initial treatment of choice. New research focusing on adjuvant therapies, such as protease and polymerase inhibitors, has yielded early data that appear to be promising.Keywords: hepatitis C virus, infection, chronic, treatment, pegylated interferon, ribavirin

  6. Current and emerging options for the drug treatment of narcolepsy.

    Science.gov (United States)

    De la Herrán-Arita, Alberto K; García-García, Fabio

    2013-11-01

    Narcolepsy/hypocretin deficiency (now called type 1 narcolepsy) is a lifelong neurologic disorder with well-established diagnostic criteria and etiology. Narcolepsy is a chronic sleep disorder characterized by excessive daytime sleepiness (EDS) and symptoms of dissociated rapid eye movement sleep such as cataplexy (sudden loss of muscle tone), hypnagogic hallucinations (sensory events that occur at the transition from wakefulness to sleep), sleep paralysis (inability to perform movements upon wakening or sleep onset), and nocturnal sleep disruption. As these symptoms are often disabling, most patients need life-long treatment. The treatment of narcolepsy is well defined, and, traditionally, amphetamine-like stimulants (i.e., dopaminergic release enhancers) have been used for clinical management to improve EDS and sleep attacks, whereas tricyclic antidepressants have been used as anticataplectics. However, treatments have evolved to better-tolerated compounds such as modafinil or armodafinil (for EDS) and adrenergic/serotonergic selective reuptake inhibitors (as anticataplectics). In addition, night-time administration of a short-acting sedative, c-hydroxybutyrate (sodium oxybate), has been used for the treatment for EDS and cataplexy. These therapies are almost always needed in combination with non-pharmacologic treatments (i.e., behavioral modification). A series of new drugs is currently being tested in animal models and in humans. These include a wide variety of hypocretin agonists, melanin- concentrating hormone receptor antagonists, antigenspecific immunopharmacology, and histamine H3 receptor antagonists/inverse agonists (e.g., pitolisant), which have been proposed for specific therapeutic applications, including the treatment of Alzheimer's disease, attention-deficit hyperactivity disorder, epilepsy, and more recently, narcolepsy. Even though current treatment is strictly symptomatic, based on the present state of knowledge of the pathophysiology of

  7. Pelvic inflammatory disease: current concepts in pathogenesis, diagnosis and treatment.

    Science.gov (United States)

    Mitchell, Caroline; Prabhu, Malavika

    2013-12-01

    Pelvic inflammatory disease (PID) is characterized by infection and inflammation of the upper genital tract in women and can cause significant reproductive health sequelae for women. Although a definitive diagnosis of PID is made by laparoscopic visualization of inflamed, purulent fallopian tubes, PID is generally a clinical diagnosis and thus represents a diagnostic challenge. Therefore, diagnosis and treatment algorithms advise a high index of suspicion for PID in any woman of reproductive age with pelvic or abdominal pain. Antibiotic therapy should be started early, and given for an adequate period of time to reduce the risk of complications. Coverage for anaerobic organisms should be considered in most cases. Copyright © 2013 Elsevier Inc. All rights reserved.

  8. Review of current and emerging treatment options in acromegaly.

    Science.gov (United States)

    Muhammad, A; van der Lely, A J; Neggers, S J C M M

    2015-10-01

    In almost every patient, acromegaly is caused by a growth hormone secreting pituitary adenoma. Clinical features are the result of excessive growth hormone secretion and the consecutive excess in insulin-like growth factor I levels. This results in somatic overgrowth and metabolic disturbances with a higher morbidity and mortality than in the general population. With optimal disease management, mortality can be reduced to that seen in the general population. The current treatment of acromegaly is based on a combination of surgery, radiotherapy and medical therapy. This review provides an overview of the current and upcoming therapies with a focus on medical therapy.

  9. Oligometastatic non-small-cell lung cancer: current treatment strategies

    Directory of Open Access Journals (Sweden)

    Richard PJ

    2016-11-01

    Full Text Available Patrick J Richard, Ramesh Rengan Department of Radiation Oncology, University of Washington, Seattle, WA, USA Abstract: The oligometastatic disease theory was initially described in 1995 by Hellman and Weichselbaum. Since then, much work has been performed to investigate its existence in many solid tumors. This has led to subclassifications of stage IV cancer, which could redefine our treatment approaches and the therapeutic outcomes for this historically “incurable” entity. With a high incidence of stage IV disease, non-small-cell lung cancer (NSCLC remains a difficult cancer to treat and cure. Recent work has proven the existence of an oligometastatic state in NSCLC in terms of properly selecting patients who may benefit from aggressive therapy and experience long-term overall survival. This review discusses the current treatment approaches used in oligometastatic NSCLC and provides the evidence and rationale for each approach. The prognostic factors of many trials are discussed, which can be used to properly select patients for aggressive treatment regimens. Future advances in both molecular profiling of NSCLC to find targetable mutations and investigating patient selection may increase the number of patients diagnosed with oligometastatic NSCLC. As this disease entity increases, it is of utmost importance for oncologists treating NSCLC to be aware of the current treatment strategies that exist and the potential advantages/disadvantages of each. Keywords: oligometastatic, non-small-cell lung cancer, oligoprogressive, treatment

  10. Current and Under Development Treatment Modalities of Psoriasis: A Review.

    Science.gov (United States)

    Albaghdadi, Abdul

    2017-08-04

    Psoriasis is a chronic and complex autoimmune inflammatory skin disease that affects over 125 million people worldwide. It can exhibit at any age, in spite of the fact that children are less normally influenced than adults. It is characterized by distinct erythematous plaques shielded with conspicuous silvery scales that shows up in different areas of the skin. Knowledge of pathophysiology, especially the pathogenesis of psoriasis, has significantly progressed in the recent decade. Advancement in molecular knowledge leads to better understanding of the disease, thus influencing the development of efficient treatment modalities. However, even with the availability of various options of treatment most of the efficient treatment modalities are costly. Expenses of health care bring about major financial weight to the patients as well as to health care systems. Thus, it was important to review the available current treatment options and those which are under development, in terms of efficacy, safety and cost to assist in selecting the most appropriate treatment for psoriasis patients. Literatures were searched by using key words psoriasis, topical treatment, systemic treatment, biologics and phototherapies, on Embase, Medline, Jstor, Cochrane and Merck Index databases. Life-style choices such as smoking, alcohol consumption, obesity and stress are recognised as risk factors and triggers associated with psoriasis. Psoriasis poses psycho-social and economic burden on affected patients that sometimes leads to depression, reduced social interaction and suicidal tendencies in patients. Depending on the type, severity and extent of the disease, comorbidities, patient preference, efficacy and safety profile, numerous treatment modalities and therapeutic agents are available such as topical, systemic, biologic and phototherapeutic treatments. However, it was found that among all the current available treatments for psoriasis, biologic agents and phototherapeutic modalities are

  11. Real-time MRI-guided hyperthermia treatment using a fast adaptive algorithm.

    Science.gov (United States)

    Stakhursky, Vadim L; Arabe, Omar; Cheng, Kung-Shan; Macfall, James; Maccarini, Paolo; Craciunescu, Oana; Dewhirst, Mark; Stauffer, Paul; Das, Shiva K

    2009-04-01

    Magnetic resonance (MR) imaging is promising for monitoring and guiding hyperthermia treatments. The goal of this work is to investigate the stability of an algorithm for online MR thermal image guided steering and focusing of heat into the target volume. The control platform comprised a four-antenna mini-annular phased array (MAPA) applicator operating at 140 MHz (used for extremity sarcoma heating) and a GE Signa Excite 1.5 T MR system, both of which were driven by a control workstation. MR proton resonance frequency shift images acquired during heating were used to iteratively update a model of the heated object, starting with an initial finite element computed model estimate. At each iterative step, the current model was used to compute a focusing vector, which was then used to drive the next iteration, until convergence. Perturbation of the driving vector was used to prevent the process from stalling away from the desired focus. Experimental validation of the performance of the automatic treatment platform was conducted with two cylindrical phantom studies, one homogeneous and one muscle equivalent with tumor tissue (conductivity 50% higher) inserted, with initial focal spots being intentionally rotated 90 degrees and 50 degrees away from the desired focus, mimicking initial setup errors in applicator rotation. The integrated MR-HT treatment platform steered the focus of heating into the desired target volume in two quite different phantom tissue loads which model expected patient treatment configurations. For the homogeneous phantom test where the target was intentionally offset by 90 degrees rotation of the applicator, convergence to the proper phase focus in the target occurred after 16 iterations of the algorithm. For the more realistic test with a muscle equivalent phantom with tumor inserted with 50 degrees applicator displacement, only two iterations were necessary to steer the focus into the tumor target. Convergence improved the heating efficacy (the

  12. Real-time MRI-guided hyperthermia treatment using a fast adaptive algorithm

    Science.gov (United States)

    Stakhursky, Vadim L.; Arabe, Omar; Cheng, Kung-Shan; MacFall, James; Maccarini, Paolo; Craciunescu, Oana; Dewhirst, Mark; Stauffer, Paul; Das, Shiva K.

    2009-04-01

    Magnetic resonance (MR) imaging is promising for monitoring and guiding hyperthermia treatments. The goal of this work is to investigate the stability of an algorithm for online MR thermal image guided steering and focusing of heat into the target volume. The control platform comprised a four-antenna mini-annular phased array (MAPA) applicator operating at 140 MHz (used for extremity sarcoma heating) and a GE Signa Excite 1.5 T MR system, both of which were driven by a control workstation. MR proton resonance frequency shift images acquired during heating were used to iteratively update a model of the heated object, starting with an initial finite element computed model estimate. At each iterative step, the current model was used to compute a focusing vector, which was then used to drive the next iteration, until convergence. Perturbation of the driving vector was used to prevent the process from stalling away from the desired focus. Experimental validation of the performance of the automatic treatment platform was conducted with two cylindrical phantom studies, one homogeneous and one muscle equivalent with tumor tissue (conductivity 50% higher) inserted, with initial focal spots being intentionally rotated 90° and 50° away from the desired focus, mimicking initial setup errors in applicator rotation. The integrated MR-HT treatment platform steered the focus of heating into the desired target volume in two quite different phantom tissue loads which model expected patient treatment configurations. For the homogeneous phantom test where the target was intentionally offset by 90° rotation of the applicator, convergence to the proper phase focus in the target occurred after 16 iterations of the algorithm. For the more realistic test with a muscle equivalent phantom with tumor inserted with 50° applicator displacement, only two iterations were necessary to steer the focus into the tumor target. Convergence improved the heating efficacy (the ratio of integral

  13. Current treatment for anorexia nervosa: efficacy, safety, and adherence

    Directory of Open Access Journals (Sweden)

    Lindsay P Bodell

    2010-10-01

    Full Text Available Lindsay P Bodell, Pamela K KeelDepartment of Psychology, Florida State University, Tallahassee, FL, USAAbstract: Anorexia nervosa (AN is a serious psychiatric illness associated with significant medical and psychiatric morbidity, psychosocial impairment, increased risk of death, and chronicity. Given the severity of the disorder, the establishment of safe and effective treatments is necessary. Several treatments have been tried in AN, but few favorable results have emerged. This paper reviews randomized controlled trials in AN, and provides a synthesis of existing data regarding the efficacy, safety, and adherence associated with pharmacologic and psychological interventions. Randomized controlled trials for the treatment of AN published in peer-reviewed journals were identified by electronic and manual searches. Overall, pharmacotherapy has limited benefits in the treatment of AN, with some promising preliminary findings associated with olanzapine, an antipsychotic agent. No single psychological intervention has demonstrated clear superiority in treating adults with AN. In adolescents with AN, the evidence base is strongest for the use of family therapy over alternative individual psychotherapies. Results highlight challenges in both treating individuals with AN and in studying the effects of those treatments, and further emphasize the importance of continued efforts to develop novel interventions. Treatment trials currently underway and areas for future research are discussed.Keywords: anorexia nervosa, treatment, pharmacotherapy, psychotherapy, randomized controlled trials

  14. Simulation for Path Planning of SLOCUM Glider in Near-bottom Ocean Currents Using Heuristic Algorithms and Q-Learning

    Directory of Open Access Journals (Sweden)

    Utkarsh Gautam

    2015-05-01

    Full Text Available Addressing the need for exploration of benthic zones utilising autonomous underwater vehicles, this paper presents a simulation for an optimised path planning from the source node to the destination node of the autonomous underwater vehicle SLOCUM Glider in near-bottom ocean environment. Near-bottom ocean current data from the Bedford Institute of Oceanography, Canada, have been used for this simulation. A cost function is formulated to describe the dynamics of the autonomous underwater vehicle in near-bottom ocean currents. This cost function is then optimised using various biologically-inspired algorithms such as genetic algorithm, Ant Colony optimisation algorithm and particle swarm optimisation algorithm. The simulation of path planning is also performed using Q-learning technique and the results are compared with the biologically-inspired algorithms. The results clearly show that the Q-learning algorithm is better in computational complexity than the biologically-inspired algorithms. The ease of simulating the environment is also more in the case of Q-learning techniques. Hence this paper presents an effective path planning technique, which has been tested for the SLOCUM glider and it may be extended for use in any standard autonomous underwater vehicle.Defence Science Journal, Vol. 65, No. 3, May 2015, pp.220-225, DOI: http://dx.doi.org/10.14429/dsj.65.7855

  15. Current Standards and Novel Treatment Options for Metastatic Pancreatic Adenocarcinoma.

    Science.gov (United States)

    Weinberg, Benjamin A; Yabar, Cinthya S; Brody, Jonathan R; Pishvaian, Michael J

    2015-11-01

    Pancreatic cancer is one of the most lethal solid tumors. The prognosis of metastatic pancreatic adenocarcinoma remains dismal, with a median survival of less than 1 year, due in large part to the fact that pancreatic adenocarcinoma is notoriously refractory to chemotherapy. However, there recently have been significant improvements in outcomes for patients with pancreatic adenocarcinoma: ongoing trials have shown promise, and these may lead to still further progress. Here we review the current treatment paradigms for metastatic disease, focusing on ways to ameliorate symptoms and lengthen survival. We then summarize recent advances in our understanding of the molecular and cellular aspects of pancreatic cancer. Finally, we outline new approaches currently under development for the treatment of metastatic disease, arising from our improved understanding of the genetic and nongenetic alterations within pancreatic cancer cells-and of interactions between cancer cells, the tumor microenvironment, and the immune system.

  16. Current and future medical treatments for patients with acromegaly.

    Science.gov (United States)

    Maffezzoni, Filippo; Formenti, Anna Maria; Mazziotti, Gherardo; Frara, Stefano; Giustina, Andrea

    2016-08-01

    Acromegaly is a relatively rare condition of growth hormone (GH) excess associated with significant morbidity and, when left untreated, high mortality. Therapy for acromegaly is targeted at decreasing GH and insulin-like growth hormone 1 levels, ameliorating patients' symptoms and decreasing any local compressive effects of the pituitary adenoma. The therapeutic options for acromegaly include surgery, medical therapies (such as dopamine agonists, somatostatin receptor ligands and the GH receptor antagonist pegvisomant) and radiotherapy. However, despite all these treatments option, approximately 50% of patients are not adequately controlled. In this paper, the authors discuss: 1) efficacy and safety of current medical therapy 2) the efficacy and safety of the new multireceptor-targeted somatostatin ligand pasireotide 3) medical treatments currently under clinical investigation (oral octreotide, ITF2984, ATL1103), and 4) preliminary data on the use of new injectable and transdermal/transmucosal formulations of octreotide. This expert opinion supports the need for new therapeutic agents and modalities for patients with acromegaly.

  17. Angina pectoris: current therapy and future treatment options.

    Science.gov (United States)

    Parikh, Raj; Kadowitz, Philip J

    2014-02-01

    Angina pectoris is the consequence of an inequality between the demand and supply of blood to the heart. Angina manifests itself as chest pain or discomfort and is a common complaint of patients in the hospital and in the clinic. There are, in fact, roughly half a million new cases of angina per year. Chest pain, while having many etiologies, is generally considered to be most lethal when related to a cardiac cause. In this review, the authors outline the current medical and surgical therapies that are used in the management of angina. Highlights of the various clinical trials that have assisted in the investigation of these therapies are summarized also. Then, the authors provide a focused review of the novel therapy options for angina that are currently being explored. From new medical treatments to revised surgical techniques to the discovery of stem cell therapy, many innovative options are being investigated for the treatment of angina.

  18. Current aortic endografts for the treatment of abdominal aortic aneurysms.

    Science.gov (United States)

    Colvard, Benjamin; Georg, Yannick; Chakfe, Nabil; Swanstrom, Lee

    2016-05-01

    Endovascular Aneurysm Repair is a widely adopted method of treatment for patients with abdominal aortic aneurysms. The minimally invasive approach offered with EVAR has become popular not only among physicians and patients, but in the medical device industry as well. Over the past 25 years the global market for aortic endografts has increased rapidly, resulting in a wide range of devices from various companies. Currently, there are seven endografts approved by the FDA for the treatment of abdominal aortic aneurysms. These devices offer a wide range of designs intended to increase inclusion criteria while decreasing technical complications such as endoleak and migration. Despite advances in device design, secondary interventions and follow-up requirements remain a significant issue. New devices are currently being studied in the U.S. and abroad and may significantly reduce complications and secondary interventions.

  19. A Fundamental Wave Amplitude Prediction Algorithm Based on Fuzzy Neural Network for Harmonic Elimination of Electric Arc Furnace Current

    Directory of Open Access Journals (Sweden)

    Wanjun Lei

    2015-01-01

    Full Text Available Electric arc furnace (EAF causes the harmonics to impact on the supply network greatly and harmonic elimination is a very important research work for the power quality associated with EAF. In the paper, a fundamental wave amplitude prediction algorithm based on fuzzy neural network for harmonic elimination of EAF current is proposed. The proposed algorithm uses the learning ability of the neural network to refine Takagi-Sugeno type fuzzy rules and the inputs are the average of the current measured value in different time intervals. To verify the effectiveness of the proposed algorithm, some experiments are performed to compare the proposed algorithm with the back-propagation neural networks, and the field data collected at an EAF are used in the experiments. Moreover, the measured amplitudes of fundamental waves of field data are obtained by the sliding-window-based discrete Fourier transform on the field data. The experiments results show that the proposed algorithm has higher precision. The real curves also verify that the amplitude of fundamental wave current could be predicted accurately and the harmonic elimination of EAF would be realized based on the proposed algorithm.

  20. Ragweed-induced allergic rhinoconjunctivitis: current and emerging treatment options

    Directory of Open Access Journals (Sweden)

    Ihler F

    2015-02-01

    Full Text Available Friedrich Ihler, Martin CanisDepartment of Otorhinolaryngology, University Medical Center Göttingen, Göttingen, GermanyAbstract: Ragweed (Ambrosia spp. is an annually flowering plant whose pollen bears high allergenic potential. Ragweed-induced allergic rhinoconjunctivitis has long been seen as a major immunologic condition in Northern America with high exposure and sensitization rates in the general population. The invasive occurrence of ragweed (A. artemisiifolia poses an increasing challenge to public health in Europe and Asia as well. Possible explanations for its worldwide spread are climate change and urbanization, as well as pollen transport over long distances by globalized traffic and winds. Due to the increasing disease burden worldwide, and to the lack of a current and comprehensive overview, this study aims to review the current and emerging treatment options for ragweed-induced rhinoconjunctivitis. Sound clinical evidence is present for the symptomatic treatment of ragweed-induced allergic rhinoconjunctivitis with oral third-generation H1-antihistamines and leukotriene antagonists. The topical application of glucocorticoids has also been efficient in randomized controlled clinical trials. Combined approaches employing multiple agents are common. The mainstay of causal treatment to date, especially in Northern America, is subcutaneous immunotherapy with the focus on the major allergen, Amb a 1. Beyond this, growing evidence from several geographical regions documents the benefit of sublingual immunotherapy. Future treatment options promise more specific symptomatic treatment and fewer side effects during causal therapy. Novel antihistamines for symptomatic treatment are aimed at the histamine H3-receptor. New adjuvants with toll-like receptor 4 activity or the application of the monoclonal anti-immunoglobulin E antibody, omalizumab, are supposed to enhance conventional immunotherapy. An approach targeting toll-like receptor 9 by

  1. Antibacterial treatment of bacterial vaginosis: current and emerging therapies

    Science.gov (United States)

    Menard, Jean-Pierre

    2011-01-01

    Bacterial vaginosis is a common cause of malodorous vaginal discharge. It is also associated with sexually transmitted infections and adverse pregnancy outcomes. The magnitude of the gynecological and obstetrical consequences has stimulated therapeutic research and led to the testing of several therapies. The objective of this work is to present the currently available therapeutic strategies for the treatment of bacterial vaginosis and associated recommendations, and discuss the emerging therapies. PMID:21976983

  2. Current and emerging treatment options for nasopharyngeal carcinoma

    Directory of Open Access Journals (Sweden)

    Spratt DE

    2012-10-01

    Full Text Available Daniel E Spratt, Nancy LeeDepartment of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USAAbstract: In this article, we focus on the current and emerging treatments in nasopharyngeal cancer (NPC. A detailed evolution of the current standard of care, and new techniques and treatment options will be reviewed. Intergroup 0099 established the role for chemoradiotherapy (chemo-RT in the treatment of nasopharyngeal carcinoma. Multiple randomized Phase III trials have shown the benefit of chemo-RT; however, none of these studies utilized modern radiotherapy (RT techniques of intensity-modulated radiation therapy (IMRT. IMRT has the ability to deliver high doses of radiation to the target structures while sparing adjacent bystander healthy tissues, and has now become the preferred RT treatment modality. Chemotherapy also has had a shifting paradigm of induction and/or adjuvant chemotherapy combined with RT alone, to the investigation with concurrent chemo-RT. New treatment options including targeted monoclonal antibodies and small molecule tyrosine kinase inhibitors are being studied in NPC. These new biologic therapies have promising in vitro activity for NPC, and emerging clinical studies are beginning to define their role. RT continues to expand its capabilities, and since IMRT and particle therapy, specifically intensity-modulated proton therapy (IMPT, has reports of impressive dosimetric efficacy in-silica. Adaptive RT is attempting to reduce toxicity while maintaining treatment efficacy, and the clinical results are still in their youth. Lastly, Epstein–Barr virus (EBV DNA has recently been studied for prediction of tumor response and its use as a biomarker is increasingly promising to aid in early detection as well as supplementing the current staging system. RT with or without chemotherapy remains the standard of care for nasopharyngeal carcinoma. Advances in RT technique, timing of chemotherapy, biologically

  3. In touch with psoriasis: topical treatments and current guidelines.

    LENUS (Irish Health Repository)

    Murphy, G

    2011-06-01

    This article describes topical therapies and treatment guidelines for psoriasis and is based on a presentation given by the authors at a satellite symposium held during the 19th Congress of the European Academy of Dermatology and Venereology, 6-10 October, 2010, in Gothenburg, Sweden. The highly variable nature of psoriasis and its individual presentation in patients can make it difficult to choose the most appropriate treatment. There are many treatment options, from topical treatment with emollients for very mild psoriasis, to systemic therapy with fumaric acid esters, methotrexate or biologics for severe disease. For the treatment of mild-to-moderate psoriasis, topical therapy is generally the most appropriate and a variety of options, both historical and recent, are available. Newer therapies offer greater convenience and fewer side-effects. Of the more recently available therapies, vitamin D analogues and topical corticosteroids are the two with the greatest proven efficacy in randomized clinical trials. A recent Cochrane review showed the highest efficacy overall with the fixed combination vitamin D analogue (calcipotriol) and corticosteroid (betamethasone dipropionate). Indeed, clinical trials have shown that two-compound calcipotriol\\/betamethasone dipropionate ointment has higher efficacy than calcipotriol or betamethasone dipropionate alone. With regard to safety, two-compound calcipotriol\\/betamethasone dipropionate was shown to be suitable for intermittent long-term treatment of mild-to-moderate psoriasis. The findings of the Cochrane review are reflected in the current treatment guidelines from the USA and Germany regarding the treatment of mild-to-moderate psoriasis. In both these guidelines, which will be discussed in this article, the recommended treatments for this patient group are vitamin D analogues and corticosteroids, particularly when used in combination.

  4. In touch with psoriasis: topical treatments and current guidelines.

    LENUS (Irish Health Repository)

    Murphy, G

    2012-02-01

    This article describes topical therapies and treatment guidelines for psoriasis and is based on a presentation given by the authors at a satellite symposium held during the 19th Congress of the European Academy of Dermatology and Venereology, 6-10 October, 2010, in Gothenburg, Sweden. The highly variable nature of psoriasis and its individual presentation in patients can make it difficult to choose the most appropriate treatment. There are many treatment options, from topical treatment with emollients for very mild psoriasis, to systemic therapy with fumaric acid esters, methotrexate or biologics for severe disease. For the treatment of mild-to-moderate psoriasis, topical therapy is generally the most appropriate and a variety of options, both historical and recent, are available. Newer therapies offer greater convenience and fewer side-effects. Of the more recently available therapies, vitamin D analogues and topical corticosteroids are the two with the greatest proven efficacy in randomized clinical trials. A recent Cochrane review showed the highest efficacy overall with the fixed combination vitamin D analogue (calcipotriol) and corticosteroid (betamethasone dipropionate). Indeed, clinical trials have shown that two-compound calcipotriol\\/betamethasone dipropionate ointment has higher efficacy than calcipotriol or betamethasone dipropionate alone. With regard to safety, two-compound calcipotriol\\/betamethasone dipropionate was shown to be suitable for intermittent long-term treatment of mild-to-moderate psoriasis. The findings of the Cochrane review are reflected in the current treatment guidelines from the USA and Germany regarding the treatment of mild-to-moderate psoriasis. In both these guidelines, which will be discussed in this article, the recommended treatments for this patient group are vitamin D analogues and corticosteroids, particularly when used in combination.

  5. Current status in the treatment options for esophageal achalasia.

    Science.gov (United States)

    Chuah, Seng-Kee; Chiu, Chien-Hua; Tai, Wei-Chen; Lee, Jyong-Hong; Lu, Hung-I; Changchien, Chi-Sin; Tseng, Ping-Huei; Wu, Keng-Liang

    2013-09-07

    Recent advances in the treatment of achalasia include the use of high-resolution manometry to predict the outcome of patients and the introduction of peroral endoscopic myotomy (POEM). The first multicenter randomized, controlled, 2-year follow-up study conducted by the European Achalasia Trial group indicated that laparoscopic Heller myotomy (LHM) was not superior to pneumatic dilations (PD). Publications on the long-term success of laparoscopic surgery continue to emerge. In addition, laparoscopic single-site surgery is applicable to advanced laparoscopic operations such as LHM and anterior fundoplication. The optimal treatment option is an ongoing matter of debate. In this review, we provide an update of the current progress in the treatment of esophageal achalasia. Unless new conclusive data prove otherwise, LHM is considered the most durable treatment for achalasia at the expense of increased reflux-associated complications. However, PD is the first choice for non-surgical treatment and is more cost-effective. Repeated PD according to an "on-demand" strategy based on symptom recurrence can achieve long-term remission. Decision making should be based on clinical evidence that identifies a subcategory of patients who would benefit from specific treatment options. POEM has shown promise but its long-term efficacy and safety need to be assessed further.

  6. Treatment of Helicobacter pylori infection: Current and future insights

    Science.gov (United States)

    Safavi, Maliheh; Sabourian, Reyhaneh; Foroumadi, Alireza

    2016-01-01

    Helicobacter pylori (H. pylori) is an important major cause of peptic ulcer disease and gastric malignancies such as mucosa-associated lymphoid tissue lymphoma and gastric adenocarcinoma worldwide. H. pylori treatment still remains a challenge, since many determinants for successful therapy are involved such as individual primary or secondary antibiotics resistance, mucosal drug concentration, patient compliance, side-effect profile and cost. While no new drug has been developed, current therapy still relies on different mixture of known antibiotics and anti-secretory agents. A standard triple therapy consisting of two antibiotics and a proton-pump inhibitor proposed as the first-line regimen. Bismuth-containing quadruple treatment, sequential treatment or a non-bismuth quadruple treatment (concomitant) are also an alternative therapy. Levofloxacin containing triple treatment are recommended as rescue treatment for infection of H. pylori after defeat of first-line therapy. The rapid acquisition of antibiotic resistance reduces the effectiveness of any regimens involving these remedies. Therefore, adding probiotic to the medications, developing anti-H. pylori photodynamic or phytomedicine therapy, and achieving a successful H. pylori vaccine may have the promising to present synergistic or additive consequence against H. pylori, because each of them exert different effects. PMID:26798626

  7. Current and emerging treatment options for uveal melanoma

    Directory of Open Access Journals (Sweden)

    Pereira PR

    2013-08-01

    Full Text Available Patricia Rusa Pereira,1 Alexandre Nakao Odashiro,2 Li-Anne Lim,1 Cristina Miyamoto,1 Paula L Blanco,4 Macanori Odashiro,3 Shawn Maloney,1 Dominique F De Souza,1 Miguel N Burnier Jr1 1The Henry C Witelson Ocular Pathology Laboratory, McGill University, Montreal, QC, Canada; 2Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada; 3Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil; 4Department of Pathology and Laboratory Medicine, University of Ottawa, ON, Canada Abstract: Uveal melanoma (UM is the most common primary malignant intraocular tumor in adults, with a 10-year cumulative metastatic rate of 34%. The most common site of metastasis is the liver (95%. Unfortunately, the current treatment of metastatic UM is limited by the lack of effective systemic therapy. Options for the management of the primary intraocular tumor include radical surgery as well as conservative treatments in order to preserve visual acuity. For metastatic disease, several approaches have been described with no standard method. Nevertheless, median survival after liver metastasis is poor, being around 4–6 months, with a 1-year survival of 10%–15%. In this review, the authors summarize current and promising new treatments for UM. Keywords: uveal melanoma, choroidal melanoma, eye, metastasis, treatment, therapy

  8. Treatments for Pulmonary Ricin Intoxication: Current Aspects and Future Prospects

    Directory of Open Access Journals (Sweden)

    Yoav Gal

    2017-10-01

    Full Text Available Ricin, a plant-derived toxin originating from the seeds of Ricinus communis (castor beans, is one of the most lethal toxins known, particularly if inhaled. Ricin is considered a potential biological threat agent due to its high availability and ease of production. The clinical manifestation of pulmonary ricin intoxication in animal models is closely related to acute respiratory distress syndrome (ARDS, which involves pulmonary proinflammatory cytokine upregulation, massive neutrophil infiltration and severe edema. Currently, the only post-exposure measure that is effective against pulmonary ricinosis at clinically relevant time-points following intoxication in pre-clinical studies is passive immunization with anti-ricin neutralizing antibodies. The efficacy of this antitoxin treatment depends on antibody affinity and the time of treatment initiation within a limited therapeutic time window. Small-molecule compounds that interfere directly with the toxin or inhibit its intracellular trafficking may also be beneficial against ricinosis. Another approach relies on the co-administration of antitoxin antibodies with immunomodulatory drugs, thereby neutralizing the toxin while attenuating lung injury. Immunomodulators and other pharmacological-based treatment options should be tailored according to the particular pathogenesis pathways of pulmonary ricinosis. This review focuses on the current treatment options for pulmonary ricin intoxication using anti-ricin antibodies, disease-modifying countermeasures, anti-ricin small molecules and their various combinations.

  9. [Drug treatment of obesity--current situation and perspectives].

    Science.gov (United States)

    Hainer, Vojtech

    2010-01-01

    Pharmacotherapy of obesity should be an integral part of the comprehensive obesity management program which includes diet, exercise and cognitive behavioural intervention. Currently available antiobesity drugs result in only modest weight loss, however it is still accompanied by reduction of cardiometabolic health risks. In the past several antiobesity drugs were removed from the market because of serious adverse effects (psychostimulatory, cardiovascular, pulmonary hypertension, valvular disease, depression, addiction etc.). Such situations led some investigators and clinicians to nihilistic approaches to the drug treatment of obesity. This paper aims to review the data on clinical efficiency and safety of currently available antiobesity drugs and to summarize our knowledge on the recently discovered antiobesity agents which underwent clinical trials (such as lorcaserin, tesofensine, cetilistat, combination drugs, gut hormone analogues etc.). Approaches with two drug combination of decreased doses were recommended to increase both safety and efficacy of antiobesity treatment. However, previous experiences that antiobesity drug combinations (e.g. fenfluramine/phentermine) may also potentiate adverse events should be carefully considered in the evaluation of recently tested compounds. Administration of physiological doses of gut hormones - derived appetite regulating agents seems to be a promising, efficient, specific and thus, low side-effect approach in the treatment of obesity. To confirm the strong role of antiobesity drugs in the treatment of obesity and its complications further long-term studies evaluating their effect on morbidity and mortality end points in appropriate target populations are needed.

  10. Transcranial direct current stimulation in the treatment of anorexia.

    Science.gov (United States)

    Hecht, David

    2010-06-01

    Transcranial direct current stimulation (tDCS) is a non-invasive technique for brain stimulation and it increasingly being used in the treatments of some neurological/psychiatric conditions (e.g. chronic pain, epilepsy, depression, motor rehabilitation after stroke and Parkinson's disease). With tDCS, cortical neurons excitability increases in the vicinity of the anodal electrode and suppressed near the cathodal electrode. There is evidence that anorexia is associated with hyperactivity in right-hemisphere frontal regions. tDCS, therefore has a promising potential in facilitating inter-hemispheric balance. A tDCS protocol is proposed: the anode electrode placed over the left prefrontal cortex and the cathode electrode located, either on the right homotopic region for non-SSRI-medicated anorexics, or on a non-cephalic site for SSRI-medicated anorexics. Together with nutritional supplements, psychotherapy and other treatments, tDCS have a good potential, as a complementary tool, in the treatment of anorexia.

  11. Current treatment of visceral leishmaniasis (Kala-azar: an overview

    Directory of Open Access Journals (Sweden)

    Premshanker S. Singh

    2014-06-01

    Full Text Available Visceral Leishmaniasis (VL is also popularly known as kala-azar which was first reported in early forties and since then it continues to affect millions of people. The ranges of common drugs available for the treatment of visceral leishmaniasis are limited. It mainly includes pentavalent antimonials e.g. stibogluconate (SbV, amphotericin B deoxycholate (AB, lipid formulations of amphotericin B (L-AB, miltefosine (MF and paromomycin (PM - all of which have limitations in terms of toxicity, variable efficacy, price and inconvenient treatment schedules. Most are parenteral except MF which is administered orally. Due to the parasite and #8217;s drug resistance, the most widely used (SbV of these drugs is now of little use in northern Bihar, India, which alone accounts for 50% of the worlds burden of visceral leishmaniasis. In areas of resistance to SbV, AB is highly effective. The formulation of AB in liposomes (L-AB has been a major advancement in the treatment of visceral leishmaniasis. However, despite a significant reduction in price, this treatment remains very expensive for endemic countries like India. Combination short course therapy has been reported by many researchers who found that it is equally effective as conventional monotherapy with added benefits of less side effects, better compliance and less resistance. The aim of this article is to review the current aspects of the treatment for leishmaniasis, giving an overview of current agents clinically used to new agents and modalities of treatment under development. [Int J Res Med Sci 2014; 2(3.000: 810-817

  12. Estimating the chance of success in IVF treatment using a ranking algorithm.

    Science.gov (United States)

    Güvenir, H Altay; Misirli, Gizem; Dilbaz, Serdar; Ozdegirmenci, Ozlem; Demir, Berfu; Dilbaz, Berna

    2015-09-01

    In medicine, estimating the chance of success for treatment is important in deciding whether to begin the treatment or not. This paper focuses on the domain of in vitro fertilization (IVF), where estimating the outcome of a treatment is very crucial in the decision to proceed with treatment for both the clinicians and the infertile couples. IVF treatment is a stressful and costly process. It is very stressful for couples who want to have a baby. If an initial evaluation indicates a low pregnancy rate, decision of the couple may change not to start the IVF treatment. The aim of this study is twofold, firstly, to develop a technique that can be used to estimate the chance of success for a couple who wants to have a baby and secondly, to determine the attributes and their particular values affecting the outcome in IVF treatment. We propose a new technique, called success estimation using a ranking algorithm (SERA), for estimating the success of a treatment using a ranking-based algorithm. The particular ranking algorithm used here is RIMARC. The performance of the new algorithm is compared with two well-known algorithms that assign class probabilities to query instances. The algorithms used in the comparison are Naïve Bayes Classifier and Random Forest. The comparison is done in terms of area under the ROC curve, accuracy and execution time, using tenfold stratified cross-validation. The results indicate that the proposed SERA algorithm has a potential to be used successfully to estimate the probability of success in medical treatment.

  13. Focal congenital hyperinsulinism managed by medical treatment: a diagnostic algorithm based on molecular genetic screening.

    Science.gov (United States)

    Maiorana, Arianna; Barbetti, Fabrizio; Boiani, Arianna; Rufini, Vittoria; Pizzoferro, Milena; Francalanci, Paola; Faletra, Flavio; Nichols, Colin G; Grimaldi, Chiara; de Ville de Goyet, Jean; Rahier, Jacques; Henquin, Jean-Claude; Dionisi-Vici, Carlo

    2014-11-01

    Congenital hyperinsulinism (CHI) requires rapid diagnosis and treatment to avoid irreversible neurological sequelae due to hypoglycaemia. Aetiological diagnosis is instrumental in directing the appropriate therapy. Current diagnostic algorithms provide a complete set of diagnostic tools including (i) biochemical assays, (ii) genetic facility and (iii) state-of-the-art imaging. They consider the response to a therapeutic diazoxide trial an early, crucial step before proceeding (or not) to specific genetic testing and eventually imaging, aimed at distinguishing diffuse vs focal CHI. However, interpretation of the diazoxide test is not trivial and can vary between research groups, which may lead to inappropriate decisions. Objective of this report is proposing a new algorithm in which early genetic screening, rather than diazoxide trial, dictates subsequent clinical decisions. Two CHI patients weaned from parenteral glucose infusion and glucagon after starting diazoxide. No hypoglycaemia was registered during a 72-h continuous glucose monitoring (CGMS), or hypoglycaemic episodes were present for no longer than 3% of 72-h. Normoglycaemia was obtained by low-medium dose diazoxide combined with frequent carbohydrate feeds for several years. We identified monoallelic, paternally inherited mutations in KATP channel genes, and (18) F-DOPA PET-CT revealed a focal lesion that was surgically resected, resulting in complete remission of hypoglycaemia. Although rare, some patients with focal lesions may be responsive to diazoxide. As a consequence, we propose an algorithm that is not based on a 'formal' diazoxide response but on genetic testing, in which patients carrying paternally inherited ABCC8 or KCNJ11 mutations should always be subjected to (18) F-DOPA PET-CT. © 2014 John Wiley & Sons Ltd.

  14. Does videothoracoscopy improve clinical outcomes when implemented as part of a pleural empyema treatment algorithm?

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    Ricardo Mingarini Terra

    Full Text Available OBJECTIVE: We aimed to evaluate whether the inclusion of videothoracoscopy in a pleural empyema treatment algorithm would change the clinical outcome of such patients. METHODS: This study performed quality-improvement research. We conducted a retrospective review of patients who underwent pleural decortication for pleural empyema at our institution from 2002 to 2008. With the old algorithm (January 2002 to September 2005, open decortication was the procedure of choice, and videothoracoscopy was only performed in certain sporadic mid-stage cases. With the new algorithm (October 2005 to December 2008, videothoracoscopy became the first-line treatment option, whereas open decortication was only performed in patients with a thick pleural peel (>2 cm observed by chest scan. The patients were divided into an old algorithm (n = 93 and new algorithm (n = 113 group and compared. The main outcome variables assessed included treatment failure (pleural space reintervention or death up to 60 days after medical discharge and the occurrence of complications. RESULTS: Videothoracoscopy and open decortication were performed in 13 and 80 patients from the old algorithm group and in 81 and 32 patients from the new algorithm group, respectively (p<0.01. The patients in the new algorithm group were older (41 +1 vs. 46.3+ 16.7 years, p = 0.014 and had higher Charlson Comorbidity Index scores [0(0-3 vs. 2(0-4, p = 0.032]. The occurrence of treatment failure was similar in both groups (19.35% vs. 24.77%, p = 0.35, although the complication rate was lower in the new algorithm group (48.3% vs. 33.6%, p = 0.04. CONCLUSIONS: The wider use of videothoracoscopy in pleural empyema treatment was associated with fewer complications and unaltered rates of mortality and reoperation even though more severely ill patients were subjected to videothoracoscopic surgery.

  15. Current and emerging treatment options for Peyronie's disease

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    Gokce A

    2013-01-01

    Full Text Available Ahmet Gokce, Julie C Wang, Mary K Powers, Wayne JG HellstromDepartment of Urology, Tulane University – School of Medicine, New Orleans, LA, USAAbstract: Peyronie's disease (PD is a condition of the penis, characterized by the presence of localized fibrotic plaque in the tunica albuginea. PD is not an uncommon disorder, with recent epidemiologic studies documenting a prevalence of 3–9% of adult men affected. The actual prevalence of PD may be even higher. It is often associated with penile pain, anatomical deformities in the erect penis, and difficulty with intromission. As the definitive pathophysiology of PD has not been completely elucidated, further basic research is required to make progress in the understanding of this enigmatic condition. Similarly, research on effective therapies is limited. Currently, nonsurgical treatments are used for those men who are in the acute stage of PD, whereas surgical options are reserved for men with established PD who cannot successfully penetrate. Intralesional treatments are growing in clinical popularity as a minimally invasive approach in the initial treatment of PD. A surgical approach should be considered when men with PD do not respond to conservative, medical, or minimally invasive therapies for approximately 1 year and cannot have satisfactory sexual intercourse. As scientific breakthroughs in the understanding of the mechanisms of this disease process evolve, novel treatments for the many men suffering with PD are anticipated.Keywords: oral therapy, intralesional treatment, topical therapy, extracorporeal shockwave therapy, traction devices, plication, incision and grafting, penile prosthesis.

  16. Current treatment of antiphospholipid syndrome: lights and shadows.

    Science.gov (United States)

    Espinosa, Gerard; Cervera, Ricard

    2015-10-01

    For patients with antiphospholipid syndrome (APS), the consensus is to treat those who develop thrombosis with long-term oral anticoagulation therapy and to prevent obstetric manifestations by use of aspirin and heparin. These recommendations are based on data from randomized controlled trials and observational studies. Despite this body of knowledge, areas of uncertainty regarding the management of APS exist where evidence is scarce or nonexistent. In other words, for a subset of patients the course of management is unclear. Some examples are patients with 'seronegative' APS, those who do not fulfil the formal (clinical or serological) classification criteria for definite APS, and those with recurrent thrombotic events despite optimal anticoagulation. Other challenges include the treatment of clinical manifestations not included in the classification criteria, such as haematologic manifestations (thrombocytopenia and haemolytic anaemia), neurologic manifestations (chorea, myelitis and multiple sclerosis-like lesions), and nephropathy and heart valve disease associated with antiphospholipid antibodies (aPL), as well as the possible withdrawal of anticoagulation treatment in selected cases of thrombotic APS in which assays for aPL become persistently negative. This Review focuses on the current recommendations for thrombotic and obstetric manifestations of APS, as well as the management of difficult cases. Some aspects of treatment, such as secondary prophylaxis of venous thrombosis, are based on strong evidence--the 'lights' of APS treatment. Conversely, other areas, such as the treatment of non-criteria manifestations of APS, are based only on expert consensus or common sense and remain the 'shadows' of APS therapy.

  17. Current Treatment of Toxoplasma Retinochoroiditis: An Evidence-Based Review

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    Meredith Harrell

    2014-01-01

    Full Text Available Objective. To perform an evidence-based review of treatments for Toxoplasma retinochoroiditis (TRC. Methods. A systematic literature search was performed using the PubMed database and the key phrase “ocular toxoplasmosis treatment” and the filter for “controlled clinical trial” and “randomized clinical trial” as well as OVID medline (1946 to May week 2 2014 using the keyword ‘‘ocular toxoplasmosis’’. The included studies were used to evaluate the various treatment modalities of TRC. Results. The electronic search yielded a total of 974 publications of which 44 reported on the treatment of ocular toxoplasmosis. There were 9 randomized controlled studies and an additional 3 comparative studies on the treatment of acute TRC with systemic or intravitreous antibiotics or on reducing the recurrences of TRC. Endpoints of studies included visual acuity improvement, inflammatory response, lesion size changes, recurrences of lesions, and adverse effects of medications. Conclusions. There was conflicting evidence as to the effectiveness of systemic antibiotics for TRC. There is no evidence to support that one antibiotic regimen is superior to another so choice needs to be informed by the safety profile. Intravitreous clindamycin with dexamethasone seems to be as effective as systemic treatments. There is currently level I evidence that intermittent trimethoprim-sulfamethoxazole prevents recurrence of the disease.

  18. Current approaches for the treatment of autoimmune hemolytic anemia.

    Science.gov (United States)

    Jaime-Pérez, José Carlos; Rodríguez-Martínez, Marisol; Gómez-de-León, Andrés; Tarín-Arzaga, Luz; Gómez-Almaguer, David

    2013-10-01

    Autoimmune hemolytic anemia (AIHA) is an infrequent group of diseases defined by autoantibody mediated red blood cell destruction. Correct diagnosis and classification of this condition are essential to provide appropriate treatment. AIHA is divided into warm and cold types according to the characteristics of the autoantibody involved and by the presence of an underlying or associated disorder into primary and secondary AIHA. Due to its low frequency, treatment for AIHA is largely based on small prospective trials, case series, and empirical observations. This review describes in detail the different treatment approaches for autoimmune hemolytic anemia. Warm antibody type AIHA should be treated with steroids, to which most patients respond, although relapse can occur and maintenance doses are frequently required. Splenectomy is an effective second line treatment and can provide long-term remission without medication. Rituximab is a useful alternative for steroid refractory patients, those requiring high maintenance doses and unfavorable candidates for surgery. Promising therapeutic modifications with this monoclonal antibody are emerging including drug combinations, lower doses, and long-term use. Primary cold agglutinin disease has been recognized as having a lymphoproliferative monoclonal origin. It is unresponsive to both steroids and splenectomy. Rituximab is currently the best therapeutic alternative for this condition, and several treatment regimens are available with variable responses.

  19. Robust low frequency current ripple elimination algorithm for grid-connected fuel cell systems with power balancing technique

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jong-Soo; Choe, Gyu-Yeong; Lee, Byoung-Kuk [School of Information and Communication Engineering, Sungkyunkwan University, 300 Cheoncheon-dong, Jangan-gu, Suwon, Gyeonggi-do 440-746 (Korea, Republic of); Kang, Hyun-Soo [R and D Center, Advanced Drive Technology (ADT) Company, 689-26 Geumjeong-dong, Gunpo-si, Gyeonggi-do 435-862 (Korea, Republic of)

    2011-05-15

    The low frequency current ripple in grid-connected fuel cell systems is generated from dc-ac inverter operation, which generates 60 Hz fundamental component, and gives harmful effects on fuel cell stack itself, such as making cathode surface responses slower, causing an increase of more than 10% in the fuel consumption, creating oxygen starvation, causing a reduction in the operating lifetime, and incurring a nuisance tripping such as overload situation. With these reasons, low frequency current ripple makes fuel cell system unstable and lifetime of fuel cell stack itself short. This paper presents a fast and robust control algorithm to eliminate low frequency current ripple in grid-connected fuel cell systems. Compared with the conventional methods, in the proposed control algorithm, dc link voltage controller is shifted from dc-dc converter to dc-ac inverter, resulting that dc-ac inverter handles dc link voltage control and output current control simultaneously with help of power balancing technique. The results indicate that the proposed algorithm can not only completely eliminate current ripple but also significantly reduce the overshoot or undershoot during transient states without any extra hardware. The validity of the proposed algorithm is verified by computer simulations and also by experiments with a 1 kW laboratory prototype. (author)

  20. Current perspective in the treatment of bile duct injuries

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    Juan Jos and eacute; Granados-Romero

    2016-03-01

    Full Text Available The laparoscopic cholecystectomy is considered the gold standard for the treatment of benign gallbladder disease, which is associated with an increased incidence of biliary injuries. These types of injuries are multicausal, and anatomical variations or anatomical perception errors are the most common risk factors. The objective of this study is to describe the evolution in the management of bile duct injuries and actual, diagnostic tools, incidence, prognosis and treatment. A literature research about diagnosis and treatment of iatrogenic bile duct injuries as well as their impact on the incidence of morbidity and mortality, based on a 30-year period, was performed on Medline, Cochrane, Embase, MedScape and PubMed database, for all studies that met the eligibility criteria. A thorough quality assessment of all included studies was performed. Synthesis of the results was achieved by narrative review. The bile duct injury is a complication that requires a complex therapy and multidisciplinary management. Reconstruction and treatment techniques have been evolving. The selection of adequate treatment will impact on the patient and acute;s quality of life. The results of the existing studies reporting on iatrogenic bile duct injuries are useful; because the iatrogenic bile duct injuries are complex alterations and constitute one of the most serious complications of a cholecystectomy and require a comprehensive approach, immediate repair, proper drainage and timely referral to adequate treatment to improve long-term prognosis. According to the literature review, currently there better treatments such as absorbable prosthesis, which improve the prognosis and patient and acute;s quality of life, and represent less risk of complications in short/long term. [Int J Res Med Sci 2016; 4(3.000: 677-684

  1. Algorithm of physical rehabilitation of athletes in polyclinic stage of treatment of osteochondrosis

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    MAKAROVA E. V.

    2014-12-01

    Full Text Available Purpose: develop an algorithm which improves the physical rehabilitation of athletes with osteochondrosis on polyclinic stage of treatment. Material: processed of scientific literature and Internet. Results: this research analyzes traditional recovery of athletes with spinal osteochondrosis on polyclinic stage of treatment. The practical and clinical study showed that etiopathogenesis injuries and diseases of the musculoskeletal system of athletes of different specialties have similar evidences. Therefore, a recovery of sports working capacity during medical rehabilitation treatment does not differ from ordinary patients. We propose an algorithm of physical rehabilitation, aimed for the fast recovery of health of athletes and return them to the athletic training, and conducting therapeutic exercises with specific objects such as balancing disk and preventive "Osan". Conclusions : established that the physical rehabilitation of athletes at polyclinic stage of treatment similar to the rehabilitation of patients non-athletes, and improved algorithm for the physical rehabilitation of athletes with osteochondrosis in the polyclinic stage of treatment.

  2. Respiratory syncytial virus: current and emerging treatment options

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    Turner TL

    2014-04-01

    Full Text Available Tiffany L Turner,1 Benjamin T Kopp,1 Grace Paul,1 Lindsay C Landgrave,2 Don Hayes Jr,1 Rohan Thompson11Department of Pediatrics, Ohio State University College of Medicine, 2Clinical Pharmacy, Nationwide Children's Hospital, Columbus, OH, USAAbstract: Respiratory syncytial virus (RSV is an important respiratory pathogen in infants and children worldwide. Although RSV typically causes mild upper respiratory infections, it frequently causes severe morbidity and mortality, especially in premature infants and children with other chronic diseases. Treatment of RSV is limited by a lack of effective antiviral treatments; however, ribavirin has been used in complicated cases, along with the addition of intravenous immune globulin in specific patients. Vaccination strategies for RSV prevention are heavily studied, but only palivizumab (Synagis® has been approved for use in the United States in very select patient populations. Research is ongoing in developing additional vaccines, along with alternative therapies that may help prevent or decrease the severity of RSV infections in infants and children. To date, we have not seen a decrement in RSV morbidity and mortality with our current options; therefore, there is a clear need for novel RSV preventative and therapeutic strategies. In this review, we discuss the current and evolving trends in RSV treatment for infants and children.Keywords: bronchiolitis, lower respiratory tract infection, respiratory syncytial virus, probiotics, vitamin D

  3. An Algorithm to Identify the Development of Lymphedema After Breast Cancer Treatment

    Science.gov (United States)

    Yen, Tina W.F.; Laud, Purushuttom W.; Sparapani, Rodney A.; Li, Jianing; Nattinger, Ann B.

    2014-01-01

    Purpose Large, population-based studies are needed to better understand lymphedema, a major source of morbidity among breast cancer survivors. One challenge is identifying lymphedema in a consistent fashion. We sought to develop and validate an algorithm using Medicare claims to identify lymphedema after breast cancer surgery. Methods From a population-based cohort of 2,597 elderly (65+) women who underwent incident breast cancer surgery in 2003 and completed annual telephone surveys through 2008, two algorithms were developed using Medicare claims from half of the cohort and validated in the remaining half. A lymphedema-positive case was defined by patient report. Results A simple two ICD-9 code algorithm had 69% sensitivity, 96% specificity, positive predictive value >75% if prevalence of lymphedema is >16%, negative predictive value >90%, and area under receiver operating characteristic curve (AUC) of 0.82 (95% CI: 0.80 – 0.85). A more sophisticated, multi-step algorithm utilizing diagnostic and treatment codes, logistic regression methods, and a reclassification step performed similarly to the two-code algorithm. Conclusions Given the similar performance of the two validated algorithms, the ease of implementing the simple algorithm and the fact that the simple algorithm does not include treatment codes, we recommend that this two-code algorithm be validated in and applied to other population-based breast cancer cohorts. Implications for Cancer Survivors This validated lymphedema algorithm will facilitate the conduct of large, population-based studies in key areas (incidence rates, risk factors, prevention measures, treatment and cost/economic analyses) that are critical to advancing our understanding and management of this challenging and debilitating chronic disease. PMID:25187004

  4. Evolutionary algorithms and other metaheuristics in water resources: Current status, research challenges and future directions

    NARCIS (Netherlands)

    Maier, H.R.; Kapelan, Z.; Kasprzyk, J.; Kollat, J.; Matott, L.S.; Cunha, M.C.; Dandy, G.C.; Gibbs, M.S.; Keedwell, E.; Marchi, A.; Ostfeld, A.; Savic, D.; Solomatine, D.P.; Vrugt, J.A.; Zecchin, A.C.; Minsker, B.S.; Barbour, E.J.; Kuczera, G.; Pasha, F.; Castelletti, A.; Giuliani, M.; Reed, P.M.

    2014-01-01

    The development and application of evolutionary algorithms (EAs) and other metaheuristics for the optimisation of water resources systems has been an active research field for over two decades. Research to date has emphasized algorithmic improvements and individual applications in specific areas (e.

  5. Evolutionary algorithms and other metaheuristics in water resources: Current status, research challenges and future directions

    NARCIS (Netherlands)

    Maier, H.R.; Kapelan, Z.; Kasprzyk, J.; Kollat, J.; Matott, L.S.; Cunha, M.C.; Dandy, G.C.; Gibbs, M.S.; Keedwell, E.; Marchi, A.; Ostfeld, A.; Savic, D.; Solomatine, D.P.; Vrugt, J.A.; Zecchin, A.C.; Minsker, B.S.; Barbour, E.J.; Kuczera, G.; Pasha, F.; Castelletti, A.; Giuliani, M.; Reed, P.M.

    2014-01-01

    The development and application of evolutionary algorithms (EAs) and other metaheuristics for the optimisation of water resources systems has been an active research field for over two decades. Research to date has emphasized algorithmic improvements and individual applications in specific areas

  6. Eddy current characterization of magnetic treatment of materials

    Science.gov (United States)

    Chern, E. James

    1992-01-01

    Eddy current impedance measuring methods have been applied to study the effect that magnetically treated materials have on service life extension. Eddy current impedance measurements have been performed on Nickel 200 specimens that have been subjected to many mechanical and magnetic engineering processes: annealing, applied strain, magnetic field, shot peening, and magnetic field after peening. Experimental results have demonstrated a functional relationship between coil impedance, resistance and reactance, and specimens subjected to various engineering processes. It has shown that magnetic treatment does induce changes in a material's electromagnetic properties and does exhibit evidence of stress relief. However, further fundamental studies are necessary for a thorough understanding of the exact mechanism of the magnetic-field processing effect on machine tool service life.

  7. Current treatment of dyslipidaemia: PCSK9 inhibitors and statin intolerance.

    Science.gov (United States)

    Koskinas, Konstantinos; Wilhelm, Matthias; Windecker, Stephan

    2016-01-01

    Statins are the cornerstone of the management of dyslipidaemias and prevention of cardiovascular disease. Although statins are, overall, safe and well tolerated, adverse events can occur and constitute an important barrier to maintaining long-term adherence to statin treatment. In patients who cannot tolerate statins, alternative treatments include switch to another statin, intermittent-dosage regimens and non-statin lipid-lowering medications. Nonetheless, a high proportion of statin-intolerant patients are unable to achieve recommended low-density lipoprotein (LDL) cholesterol goals, thereby resulting in substantial residual cardiovascular risk. Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a protease implicated in LDL receptor degradation and plays a central role in cholesterol metabolism. In recent studies, PCSK9 inhibition by means of monoclonal antibodies achieved LDL cholesterol reductions of 50% to 70% across various patient populations and background lipid-lowering therapies, while maintaining a favourable safety profile. The efficacy and safety of the monoclonal antibodies alirocumab and evolocumab were confirmed in statin-intolerant patients, indicating that PCSK9 inhibitors represent an attractive treatment option in this challenging clinical setting. PCSK9 inhibitors recently received regulatory approval for clinical use and may be considered in properly selected patients according to current consensus documents, including patients with statin intolerance. In this review we summarise current evidence regarding diagnostic evaluation of statin-related adverse events, particularly statin-associated muscle symptoms, and we discuss current recommendations on the management of statin-intolerant patients. In view of emerging evidence of the efficacy and safety of PCSK9 inhibitors, we further discuss the role of monoclonal PCSK9 antibodies in the management of statin-intolerant hypercholesterolaemic patients.

  8. Eddy current characterization of magnetic treatment of nickel 200

    Science.gov (United States)

    Chern, E. J.

    1993-01-01

    Eddy current methods have been applied to characterize the effect of magnetic treatments on component service-life extension. Coil impedance measurements were acquired and analyzed on nickel 200 specimens that have been subjected to many mechanical and magnetic engineering processes: annealing, applied strain, magnetic field, shot peening, and magnetic field after peening. Experimental results have demonstrated a functional relationship between coil impedance, resistance and reactance, and specimens subjected to various engineering processes. It has shown that magnetic treatment does induce changes in electromagnetic properties of nickel 200 that then exhibit evidence of stress relief. However, further fundamental studies are necessary for a thorough understanding of the exact mechanism of the magnetic field processing effect on machine-tool service life.

  9. [Cystinic lithiasis. Current aspects of the urologic treatment].

    Science.gov (United States)

    Dore, B; Irani, J; Marroncle, M; Aubert, J

    1990-01-01

    On the basis of a series of 9 patients (12 renal units) gathered over 19 years, the authors analyze the current possibilities of treatment of cystine lithiasis. They first describe the characteristics of this litiasis, which is rare but serious, being naturally prone to recurrence because it is caused by a genetic defect. The development of extracorporeal lithotripsy raised great hopes for the treatment of this lithiasis, but it was soon realized that cystine strones were hard to break. However, even the mere fragmentation of the stones improves the dissolving action of the various drugs proposed to modify the pH of urine. The authors consider that open surgery by means of posterior vertical lumbar section still is indicated for larger stones, and percutaneous nephrolithotomy seems to be a very useful technique, either exclusively or as a complement of extracorporeal lithotrity.

  10. The Current and Future Treatment of Brain Metastases

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    Douglas A Hardesty

    2016-05-01

    Full Text Available Brain metastases are the most common intracranial malignancy, accounting for significant morbidity and mortality in oncology patients. The current treatment paradigm for brain metastasis depends on the patient’s overall health status, the primary tumor pathology, and the number and location of brain lesions. Herein, we review the modern management options for these tumors, including surgical resection, radiotherapy, and chemotherapy. Recent operative advances, such as fluorescence, confocal microscopy, and brachytherapy, are highlighted. With an increased understanding of the pathophysiology of brain metastasis come increased future therapeutic options. Therapy targeted to specific tumor molecular pathways, such as those involved in blood-brain barrier transgression, cell-cell adhesion, and angiogenesis, are also reviewed. A personalized plan for each patient, based on molecular characterizations of the tumor that are used to better target radiotherapy and chemotherapy, is undoubtedly the future of brain metastasis treatment.

  11. The Current and Future Treatment of Brain Metastases.

    Science.gov (United States)

    Hardesty, Douglas A; Nakaji, Peter

    2016-01-01

    Brain metastases are the most common intracranial malignancy, accounting for significant morbidity and mortality in oncology patients. The current treatment paradigm for brain metastasis depends on the patient's overall health status, the primary tumor pathology, and the number and location of brain lesions. Herein, we review the modern management options for these tumors, including surgical resection, radiotherapy, and chemotherapy. Recent operative advances, such as fluorescence, confocal microscopy, and brachytherapy, are highlighted. With an increased understanding of the pathophysiology of brain metastasis come increased future therapeutic options. Therapy targeted to specific tumor molecular pathways, such as those involved in blood-brain barrier transgression, cell-cell adhesion, and angiogenesis, are also reviewed. A personalized plan for each patient, based on molecular characterizations of the tumor that are used to better target radiotherapy and chemotherapy, is undoubtedly the future of brain metastasis treatment.

  12. Azelaic acid in dermatological treatmentcurrent state of knowledge

    Directory of Open Access Journals (Sweden)

    Radomir Reszke

    2016-09-01

    Full Text Available Azelaic acid (AZA is a naturally occurring substance produced by Malassezia furfur which exerts various effects on the skin. Azelaic acid has antibacterial, anti-inflammatory, keratolytic, comedolytic, sebostatic and tyrosinase-inhibiting properties. Topical application of AZA as 20% cream or 15% gel is a well-established therapeutic method in various common dermatoses, mainly acne vulgaris, rosacea and disorders associated with hyperpigmentation. Azelaic acid is used as a component of chemical peels as well. The paper summarizes the most relevant issues concerning AZA application in dermatological treatment based on current knowledge.

  13. Acne scarring: a review and current treatment modalities.

    Science.gov (United States)

    Rivera, Albert E

    2008-10-01

    Acne is a prevalent condition in society and often results in secondary damage in the form of scarring. Of course, prevention is the optimal method to avoid having to correct the physically or emotionally troublesome scars. However, even with the best efforts, scars will certainly arise. This article attempts to give a broad overview of multiple management options, whether medically, surgically, or procedurally based. The hope is that a general knowledge of the current available alternatives will be of value to the physician when confronted with the difficult task of developing a treatment plan for acne-scarred individuals, even in challenging cases.

  14. Molecular Basis and Current Treatment for Alcoholic Liver Disease

    Directory of Open Access Journals (Sweden)

    Juan Armendariz-Borunda

    2010-04-01

    Full Text Available Alcohol use disorders and alcohol dependency affect millions of individuals worldwide. The impact of these facts lies in the elevated social and economic costs. Alcoholic liver disease is caused by acute and chronic exposure to ethanol which promotes oxidative stress and inflammatory response. Chronic consumption of ethanol implies liver steatosis, which is the first morphological change in the liver, followed by liver fibrosis and cirrhosis. This review comprises a broad approach of alcohol use disorders, and a more specific assessment of the pathophysiologic molecular basis, and genetics, as well as clinical presentation and current modalities of treatment for alcoholic liver disease.

  15. Current readings: Status of surgical treatment for endocarditis.

    Science.gov (United States)

    Neely, Robert C; Leacche, Marzia; Shah, Jinesh; Byrne, John G

    2014-01-01

    Valve endocarditis is associated with high morbidity and mortality and requires a thorough evaluation including early surgical consultation to identify patients who may benefit from surgery. We review 5 recent articles that highlight the current debates related to best treatment strategies for valve endocarditis. Recent publications have focused on neurologic risk assessment, timing of surgery, and prognostic factors associated with native and prosthetic valve endocarditis. The initial patient assessment and management is best performed by a multidisciplinary team. Future investigations should focus on identifying surgical candidates early and the outcomes affected by replacement valve choice in both native and prosthetic valve endocarditis.

  16. Treatment of neovascular age-related macular degeneration: Current therapies

    Directory of Open Access Journals (Sweden)

    Albert J Augustin

    2009-01-01

    Full Text Available Albert J Augustin, Stefan Scholl, Janna KirchhofDepartment of Ophthalmology, Klinikum Karlsruhe, GermanyAbstract: Choroidal neovascularization (CNV secondary to age-related macular degeneration (AMD is now the leading cause of blindness and severe vision loss among people over the age of 40 in the Western world. Its prevalence is certain to increase substantially as the population ages. Treatments currently available for the disease include laser photocoagulation, verteporfin photodynamic therapy, and intravitreal injections of corticosteroids and anti-angiogenic agents. Many studies have reported the benefits of each of these treatments, although none is without its risks. No intervention actually cures AMD, nor the neovascularization associated with it. However, its symptoms are treated with varying degrees of success. Some treatments stabilize or arrest the progress of the disease. Others have been shown to reverse some of the damage that has already been done. These treatments can even lead to visual improvement. This paper will review the major classes of drugs and therapies designed to treat this condition.Keywords: wet AMD, neovascularization, PDT, steroids, anti-angiogenesis

  17. Current pharmacological agents for the treatment of premature ejaculation

    Directory of Open Access Journals (Sweden)

    Onur Dede

    2014-06-01

    Full Text Available This study was aimed to review and assess the update studies regarding medical treatment for premature ejaculation (PE. It is the most common sexual problem affecting men. It can affect men at all ages and has a serious impact on the quality of life for men and their partners. A wide variety of therapeutic modalities have been tried for treatment of premature ejaculation. Psychological therapies may be helpful for patients with complaint PE. Several topical therapies have been used including lidocaine cream, lidocaine-prilocaine cream. There has been recent interest in the selective serotonin reuptake inhibitors (SSRI for the treatment of PE, due to the fact that one of their common side effects is delayed ejaculation. Currently used SSRIs have several non-sexual side effects and long half lives, therefore there has been interest in developing a short acting, and efficacious SSRI that can be used on-demand for PE. Dapoxetine has been recently evaluated for the treatment of PE by several groups, and results so far appear promising.

  18. Current Status of Interventional Radiology Treatment of Infrapopliteal Arterial Disease

    Energy Technology Data Exchange (ETDEWEB)

    Rand, T., E-mail: thomas.rand@wienkav.at [General Hospital Hietzing, Department of Radiology (Austria); Uberoi, R. [John Radcliffe Hospital, Department of Radiology (United Kingdom)

    2013-06-15

    Treatment of infrapopliteal arteries has developed to a standard technique during the past two decades. With the introduction of innovative devices, a variety of techniques has been created and is still under investigation. Treatment options range from plain balloon angioplasty (POBA), all sorts of stent applications, such as bare metal, balloon expanding, self-expanding, coated and drug-eluting stents, and bio-absorbable stents, to latest developments, such as drug-eluting balloons. Regarding the scientific background, several prospective, randomized studies with relevant numbers of patients have been (or will be) published that are Level I evidence. In contrast to older studies, which primarily were based mostly on numeric parameters, such as diameters or residual stenoses, more recent study concepts focus increasingly on clinical features, such as amputation rate improvement or changes of clinical stages and quality of life standards. Although it is still not decided, which of the individual techniques might be the best one, we can definitely conclude that whatever treatment of infrapopliteal arteries will be used it is of substantial benefit for the patient. Therefore, the goal of this review is to give an overview about the current developments and techniques for the treatment of infrapopliteal arteries, to present clinical and technical results, to weigh individual techniques, and to discuss the recent developments.

  19. Current Pharmaceutical Treatments and Alternative Therapies of Parkinson's Disease.

    Science.gov (United States)

    Dong, Jie; Cui, Yanhua; Li, Song; Le, Weidong

    2016-01-01

    Over the decades, pharmaceutical treatments, particularly dopaminergic (DAergic) drugs have been considered as the main therapy against motor symptoms of Parkinson's disease (PD). It is proposed that DAergic drugs in combination with other medications, such as monoamine oxidase type B inhibitors, catechol-O-methyl transferase inhibitors, anticholinergics and other newly developed non-DAergic drugs can make a better control of motor symptoms or alleviate levodopa-induced motor complications. Moreover, non-motor symptoms of PD, such as cognitive, neuropsychiatric, sleep, autonomic and sensory disturbances caused by intrinsic PD pathology or drug-induced side effects, are gaining increasing attention and urgently need to be taken care of due to their impact on quality of life. Currently, neuroprotective therapies have been investigated extensively in pre-clinical studies, and some of them have been subjected to clinical trials. Furthermore, non-pharmaceutical treatments, including deep brain stimulation (DBS), gene therapy, cell replacement therapy and some complementary managements, such as Tai chi, Yoga, traditional herbs and molecular targeted therapies have also been considered as effective alternative therapies to classical pharmaceutics. This review will provide us updated information regarding the current drugs and non-drugs therapies for PD.

  20. Cancer of the endometrium: current aspects of diagnostics and treatment

    Directory of Open Access Journals (Sweden)

    Roth Gabriele

    2004-07-01

    Full Text Available Abstract Background Endometrial cancer represents a tumor entity with a great variation in its incidence throughout the world (range 1 to 25. This suggests enormous possibilities of cancer prevention due to the fact that the incidence is very much endocrine-related, chiefly with obesity, and thus most frequent in the developed world. As far as treatment is concerned, it is generally accepted that surgery represents the first choice of treatment. However, several recommendations seem reasonable especially with lymphadenectomy, even though they are not based on evidence. All high-risk cases are generally recommended for radiotherapy. Methods A literature search of the Medline was carried out for all articles on endometrial carcinoma related to diagnosis and treatment. The articles were systematically reviewed and were categorized into incidence, etiology, precancerosis, early diagnosis, classification, staging, prevention, and treatment. The article is organized into several similar subheadings. Conclusions In spite of the overall good prognosis during the early stages of the disease, the survival is poor in advanced stages or recurrences. Diagnostic measures are very well able to detect asymptomatic recurrences. These only seem justified if patients' chances are likely to improve, otherwise such measures increases costs as well as decrease the patients' quality of life. To date neither current nor improved concepts of endocrine treatment or chemotherapy have been able to substantially increase patients' chances of survival. Therefore, newer concepts into the use of antibodies e.g. trastuzumab in HER2-overexpressing tumors and the newer endocrine compounds will need to be investigated. Furthermore, it would seem highly desirable if future studies were to identify valid criteria for an individualized management, thereby maximizing the benefits and minimizing the risks.

  1. Current and emerging treatment options for hairy cell leukemia

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    López-Rubio M

    2015-08-01

    Full Text Available Montserrat López-Rubio,1 Jose Antonio Garcia-Marco2 1Department of Hematology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, 2Department of Hematology, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain Abstract: Hairy cell leukemia (HCL is a lymphoproliferative B-cell disorder characterized by pancytopenia, splenomegaly, and characteristic cytoplasmic hairy projections. Precise diagnosis is essential in order to differentiate classic forms from HCL variants, such as the HCL-variant and VH4-34 molecular variant, which are more resistant to available treatments. The current standard of care is treatment with purine analogs (PAs, such as cladribine or pentostatin, which provide a high rate of long-lasting clinical remissions. Nevertheless, ~30%–40% of the patients relapse, and moreover, some of these are difficult-to-treat refractory cases. The use of the monoclonal antibody rituximab in combination with PA appears to produce even higher responses, and it is often employed to minimize or eliminate residual disease. Currently, research in the field of HCL is focused on identifying novel therapeutic targets and potential agents that are safe and can universally cure the disease. The discovery of the BRAF mutation and progress in understanding the biology of the disease has enabled the scientific community to explore new therapeutic targets. Ongoing clinical trials are assessing various treatment strategies such as the combination of PA and anti-CD20 monoclonal antibodies, recombinant immunotoxins targeting CD22, BRAF inhibitors, and B-cell receptor signal inhibitors. Keywords: hairy cell leukemia, purine analogs, rituximab, immunotoxins, vemurafenib, ibrutinib

  2. A study of experimental evaluations of neural network learning algorithms: current research practice

    OpenAIRE

    Prechelt, Lutz

    2007-01-01

    113 articles about neural network learning algorithms published in 1993 and 1994 are examined for the amount of experimental evaluation they contain. Every third of them does employ not even a single realistic or real learning problem. Only 6% of all articles present results for more than one problem using real world data.Furthermore, one third of all articles does not present any quantitative comparison with a previously known algorithm. These results indicate that the q...

  3. Anti-Influenza Treatment: Drugs Currently Used and Under Development.

    Science.gov (United States)

    Amarelle, Luciano; Lecuona, Emilia; Sznajder, Jacob I

    2017-01-01

    Influenza is a very common contagious disease that carries significant morbidity and mortality. Treatment with antiviral drugs is available, which if administered early, can reduce the risk of severe complications. However, many virus types develop resistance to those drugs, leading to a notable loss of efficacy. There has been great interest in the development of new drugs to combat this disease. A wide range of drugs has shown anti-influenza activity, but they are not yet available for use in the clinic. Many of these target viral components, which others are aimed at elements in the host cell which participate in the viral cycle. Modulating host components is a strategy which minimizes the development of resistance, since host components are not subject to the genetic variability of the virus. The main disadvantage is the risk of treatment-related side effects. The aim of this review is to describe the main pharmacological agents currently available and new drugs in the pipeline with potential benefit in the treatment of influenza. Copyright © 2016 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Autoimmune Hepatitis: A Review of Current Diagnosis and Treatment

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    Ashima Makol

    2011-01-01

    Full Text Available Autoimmune hepatitis (AIH is a chronic inflammatory disorder characterized by periportal inflammation, elevated immunoglobulins, autoantibodies, and a dramatic response to immunosuppression. An environmental agent is hypothesized to trigger an immune-mediated attack directed against liver antigens in genetically predisposed individuals. A plethora of clinical presentations can be seen ranging from chronic indolent disease to fulminant hepatic failure, and diagnosis requires exclusion of other causes of liver disease. Corticosteroid therapy must be instituted early and modified in an individualized fashion. Treatment decisions are often complicated by the diverse clinical manifestations, uncertainty about natural history, evolving ideas about treatment end points, and a multitude of alternative immunosuppressive agents. Achieving normal liver tests and tissue is the ideal treatment end point, but needs to be weighed against the risk of side effects. Decompensated patients may benefit from early liver transplantation. Long-term prognosis is excellent with early and aggressive initiation of therapy. Our paper discusses AIH, giving a detailed overview of its clinical presentation, risk factors, immunopathogenesis, up-to-date diagnostic criteria, current updates in therapy with a brief discussion of AIH in pregnancy, and long-term implications for cirrhosis and hepatocellular carcinoma in AIH patients.

  5. Gastric Cancer: Current Status of Diagnosis and Treatment

    Energy Technology Data Exchange (ETDEWEB)

    Takahashi, Tsunehiro; Saikawa, Yoshiro, E-mail: saiky@z8.keio.jp; Kitagawa, Yuko [Department of Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo 1608582 (Japan)

    2013-01-16

    Gastric cancer is the second leading cause of death from malignant disease worldwide and most frequently discovered in advanced stages. Because curative surgery is regarded as the only option for cure, early detection of resectable gastric cancer is extremely important for good patient outcomes. Therefore, noninvasive diagnostic modalities such as evolutionary endoscopy and positron emission tomography are utilized as screening tools for gastric cancer. To date, early gastric cancer is being treated using minimally invasive methods such as endoscopic treatment and laparoscopic surgery, while in advanced cancer it is necessary to consider multimodality treatment including chemotherapy, radiotherapy, and surgery. Because of the results of large clinical trials, surgery with extended lymphadenectomy could not be recommended as a standard therapy for advanced gastric cancer. Recent clinical trials had shown survival benefits of adjuvant chemotherapy after curative resection compared with surgery alone. In addition, recent advances of molecular targeted agents would play an important role as one of the modalities for advanced gastric cancer. In this review, we summarize the current status of diagnostic technology and treatment for gastric cancer.

  6. Traumatic Brain Injury: Current Treatment Strategies and Future Endeavors.

    Science.gov (United States)

    Galgano, Michael; Toshkezi, Gentian; Qiu, Xuecheng; Russell, Thomas; Chin, Lawrence; Zhao, Li-Ru

    2016-11-22

    Traumatic brain injury presents in various forms ranging from mild alterations of consciousness to an unrelenting comatose state and death. In the most severe form of traumatic brain injury, the entirety of the brain is affected by a diffuse type of injury and swelling. Treatment modalities vary extensively based on the severity of the injury and range from daily cognitive therapy sessions to radical surgery such as bilateral decompressive craniectomies. Guidelines have been set forth regarding the optimal management of traumatic brain injury, but they must be taken in context of the situation and cannot be used in every individual circumstance. In this review article, we have summarized the current status of treatment for traumatic brain injury in both clinical practice and basic research. We have put forth a brief overview of the various subtypes of traumatic injuries, optimal medical management, as well as both the non-invasive and invasive monitoring modalities, in addition to the surgical interventions necessary in particular instances. We have overviewed the main achievements in searching for therapeutic strategies of traumatic brain injury in basic science. We have also discussed the future direction for developing traumatic brain injury treatment from an experimental perspective.

  7. Current treatment for acute viral bronchiolitis in infants.

    Science.gov (United States)

    Martinón-Torres, Federico

    2003-08-01

    This paper provides an update and critical review of available data on the treatment of acute viral bronchiolitis in previously healthy infants, with special focus on new or promising therapies. The main potential benefits of medical assistance in these patients reside in the careful monitoring of their clinical status, the maintenance of adequate hydration and oxygenation, the preservation of the airway opened and cleared of secretions and the option to perform parental education. There is no convincing evidence that any other form of therapy will reliably provide beneficial effects in infants with bronchiolitis and currently, any treatment beyond supportive care should be prescribed on a case-by-case basis with watchful appraisal of its effects. Therapies such as ribavirin, IFN, vitamin A, antibiotics, mist therapy or anticholinergics, have not demonstrated any measurable clinical effect. Several studies and meta-analyses with beta(2)-agonists and corticosteroids have failed to show any benefit of significant extent, however, physicians keep favouring their use. Presently, adrenaline has received rather consistent support from clinical trials but it is not yet widely prescribed. There are other therapeutic strategies, for instance, heliox, hypertonic saline, noninvasive ventilation, physical therapy techniques, thickened feeds or palivizumab that have shown promising potential benefits, but evidence supporting its use is still limited and further studies should be warranted. In the meantime, infants with acute viral bronchiolitis should be treated following evidence-based clinical practice guidelines, keeping the patient central in the process and being sensitive to social, cultural and familiar influences on their treatment strategy.

  8. Current status of atypical antipsychotics for the treatment of fibromyalgia.

    Science.gov (United States)

    Rico-Villademoros, F; Calandre, E P; Slim, M

    2014-06-01

    The treatment of fibromyalgia requires pharmacological and nonpharmacological therapies. The pharmacological treatment of fibromyalgia is limited to a few drugs that have been demonstrated to be moderately effective in some but not all dimensions of the disease. Therefore, the search for new drugs to treat this condition is warranted. Atypical antipsychotics offered an attractive alternative because they had been shown to be active against several key symptoms of fibromyalgia. The results of open-label studies, however, appear to indicate that atypical antipsychotics are poorly tolerated in patients with fibromyalgia, and only quetiapine XR has been studied in randomized controlled trials. Quetiapine XR has demonstrated effectiveness in treating comorbid major depression, anxiety and sleep disturbance. However, in two randomized controlled trials, quetiapine XR was not differentiated from placebo and failed to demonstrate noninferiority to amitriptyline in terms of improving overall symptomatology. The effect of quetiapine XR on pain and its usefulness as part of a combination pharmacological regimen should be further evaluated. Overall, the use of quetiapine (initiated at a low dose and slowly titrated) in fibromyalgia should be limited to patients with comorbid major depression or patients who are currently receiving other treatments and have unresolved and disabling depressive and/or anxiety symptoms.

  9. Current and emerging treatment options in the management of lupus

    Directory of Open Access Journals (Sweden)

    Jordan N

    2016-03-01

    Full Text Available Natasha Jordan,1 David D’Cruz2 1Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, 2Louise Coote Lupus Unit, Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, UK Abstract: Systemic lupus erythematosus (SLE is a complex autoimmune disease with variable clinical manifestations. While the clearest guidelines for the treatment of SLE exist in the context of lupus nephritis, patients with other lupus manifestations such as neuropsychiatric, hematologic, musculoskeletal, and severe cutaneous lupus frequently require immunosuppression and/or biologic therapy. Conventional immunosuppressive agents such as mycophenolate mofetil, azathioprine, and cyclophosphamide are widely used in the management of SLE with current more rationalized treatment regimens optimizing the use of these agents while minimizing potential toxicity. The advent of biologic therapies has advanced the treatment of SLE particularly in patients with refractory disease. The CD20 monoclonal antibody rituximab and the anti-BLyS agent belimumab are now widely in use in clinical practice. Several other biologic agents are in ongoing clinical trials. While immunosuppressive and biologic agents are the foundation of inflammatory disease control in SLE, the importance of managing comorbidities such as cardiovascular risk factors, bone health, and minimizing susceptibility to infection should not be neglected. Keywords: hydroxychloroquine, mycophenolate mofetil, azathioprine, cyclophosphamide, rituximab, belimumab

  10. Current and emerging treatment options in the management of lupus.

    Science.gov (United States)

    Jordan, Natasha; D'Cruz, David

    2016-01-01

    Systemic lupus erythematosus (SLE) is a complex autoimmune disease with variable clinical manifestations. While the clearest guidelines for the treatment of SLE exist in the context of lupus nephritis, patients with other lupus manifestations such as neuropsychiatric, hematologic, musculoskeletal, and severe cutaneous lupus frequently require immunosuppression and/or biologic therapy. Conventional immunosuppressive agents such as mycophenolate mofetil, azathioprine, and cyclophosphamide are widely used in the management of SLE with current more rationalized treatment regimens optimizing the use of these agents while minimizing potential toxicity. The advent of biologic therapies has advanced the treatment of SLE particularly in patients with refractory disease. The CD20 monoclonal antibody rituximab and the anti-BLyS agent belimumab are now widely in use in clinical practice. Several other biologic agents are in ongoing clinical trials. While immunosuppressive and biologic agents are the foundation of inflammatory disease control in SLE, the importance of managing comorbidities such as cardiovascular risk factors, bone health, and minimizing susceptibility to infection should not be neglected.

  11. Current systemic treatment of hepatocellular carcinoma: Areview of the literature

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Hepatocellular carcinoma (HCC) is the fifth mostcommon form of human cancer worldwide and the thirdmost common cause of cancer-related deaths. Thestrategies of various treatments for HCC depend onthe stage of tumor, the status of patient's performanceand the reserved hepatic function. The Barcelona ClinicLiver Cancer (BCLC) staging system is currently usedmost for patients with HCC. For example, for patientswith BCLC stage 0 (very early stage) and stage A (earlystage) HCC, the curable treatment modalities, includingresection, transplantation and radiofrequency ablation,are taken into consideration. If the patients are in BCLCstage B (intermediate stage) and stage C (advancedstage) HCC, they may need the palliative transarterialchemoembolization and even the target medicationof sorafenib. In addition, symptomatic treatment isalways recommended for patients with BCLC stage D(end stage) HCC. In this review, we will attempt tosummarize the historical perspective and the currentdevelopments of systemic therapies in BCLC stage Band C in HCC.

  12. SAPHO Syndrome: Current Developments and Approaches to Clinical Treatment.

    Science.gov (United States)

    Firinu, Davide; Garcia-Larsen, Vanessa; Manconi, Paolo Emilio; Del Giacco, Stefano R

    2016-06-01

    SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, and osteitis) is a rare autoimmune disease which, due to its clinical presentation and symptoms, is often misdiagnosed and unrecognized. Its main features are prominent inflammatory cutaneous and articular manifestations. Treatments with immunosuppressive drugs have been used for the management of SAPHO with variable results. To date, the use of anti-TNF-α agents has proved to be an effective alternative to conventional treatment for unresponsive or refractory SAPHO cases. TNF-α is a pro-inflammatory cytokine and pivotal regulator of other cytokines, including IL-1 β, IL-6, and IL-8, involved in inflammation, acute-phase response induction, and chemotaxis. IL-1 inhibition strategies with anakinra have shown efficacy as first and second lines of treatment. In this review, we will describe the main characteristics of biological drugs currently used for SAPHO syndrome. We also describe some of the promising therapeutic effects of ustekinumab, an antibody against the p40 subunit of IL-12 and IL-23, after failure of multiple drugs including anti-TNF-α and anakinra. We discuss the use and impact of the new anti-IL-1 antagonists involved in the IL-17 blockade, in particular for the most difficult-to-treat SAPHO cases.

  13. Development of a voltage-dependent current noise algorithm for conductance-based stochastic modelling of auditory nerve fibres.

    Science.gov (United States)

    Badenhorst, Werner; Hanekom, Tania; Hanekom, Johan J

    2016-12-01

    This study presents the development of an alternative noise current term and novel voltage-dependent current noise algorithm for conductance-based stochastic auditory nerve fibre (ANF) models. ANFs are known to have significant variance in threshold stimulus which affects temporal characteristics such as latency. This variance is primarily caused by the stochastic behaviour or microscopic fluctuations of the node of Ranvier's voltage-dependent sodium channels of which the intensity is a function of membrane voltage. Though easy to implement and low in computational cost, existing current noise models have two deficiencies: it is independent of membrane voltage, and it is unable to inherently determine the noise intensity required to produce in vivo measured discharge probability functions. The proposed algorithm overcomes these deficiencies while maintaining its low computational cost and ease of implementation compared to other conductance and Markovian-based stochastic models. The algorithm is applied to a Hodgkin-Huxley-based compartmental cat ANF model and validated via comparison of the threshold probability and latency distributions to measured cat ANF data. Simulation results show the algorithm's adherence to in vivo stochastic fibre characteristics such as an exponential relationship between the membrane noise and transmembrane voltage, a negative linear relationship between the log of the relative spread of the discharge probability and the log of the fibre diameter and a decrease in latency with an increase in stimulus intensity.

  14. Korean Medication Algorithm for Bipolar Disorder 2014: comparisons with other treatment guidelines

    Directory of Open Access Journals (Sweden)

    Jeong JH

    2015-06-01

    with MS or AAP for dysphoric/psychotic mania. Aripiprazole, olanzapine, quetiapine, and risperidone were the first-line AAPs in nearly all of the phases of bipolar disorder across the guidelines. Most guidelines advocated newer AAPs as first-line treatment options in all phases, and lamotrigine in depressive and maintenance phases. Lithium and valproic acid were commonly used as MSs in all phases of bipolar disorder. As research evidence accumulated over time, recommendations of newer AAPs – such as asenapine, paliperidone, lurasidone, and long-acting injectable risperidone – became prominent. This comparison identifies that the treatment recommendations of the KMAP-BP 2014 are similar to those of other treatment guidelines and reflect current changes in prescription patterns for bipolar disorder based on accumulated research data. Further studies are needed to address several issues identified in our review. Keywords: bipolar disorder, pharmacotherapy, treatment algorithm, guideline comparison, KMAP-2014

  15. Current Advances in Detection and Treatment of Babesiosis

    Science.gov (United States)

    Mosqueda, J; Olvera-Ramírez, A; Aguilar-Tipacamú, G; Cantó, GJ

    2012-01-01

    Babesiosis is a disease with a world-wide distribution affecting many species of mammals principally cattle and man. The major impact occurs in the cattle industry where bovine babesiosis has had a huge economic effect due to loss of meat and beef production of infected animals and death. Nowadays to those costs there must be added the high cost of tick control, disease detection, prevention and treatment. In almost a century and a quarter since the first report of the disease, the truth is: there is no a safe and efficient vaccine available, there are limited chemotherapeutic choices and few low-cost, reliable and fast detection methods. Detection and treatment of babesiosis are important tools to control babesiosis. Microscopy detection methods are still the cheapest and fastest methods used to identify Babesia parasites although their sensitivity and specificity are limited. Newer immunological methods are being developed and they offer faster, more sensitive and more specific options to conventional methods, although the direct immunological diagnoses of parasite antigens in host tissues are still missing. Detection methods based on nucleic acid identification and their amplification are the most sensitive and reliable techniques available today; importantly, most of those methodologies were developed before the genomics and bioinformatics era, which leaves ample room for optimization. For years, babesiosis treatment has been based on the use of very few drugs like imidocarb or diminazene aceturate. Recently, several pharmacological compounds were developed and evaluated, offering new options to control the disease. With the complete sequence of the Babesia bovis genome and the B. bigemina genome project in progress, the post-genomic era brings a new light on the development of diagnosis methods and new chemotherapy targets. In this review, we will present the current advances in detection and treatment of babesiosis in cattle and other animals, with additional

  16. Heuristic algorithm for planning and scheduling of forged pieces heat treatment

    Directory of Open Access Journals (Sweden)

    R. Lenort

    2012-04-01

    Full Text Available The paper presents a heuristic algorithm for planning and scheduling of forged pieces heat treatment which allows maximizing the capacity exploitation of the heat treatment process and the entire forging process. Five Focusing Steps continuous improvement process was selected as a methodological basis for the algorithm design. Its application was supported by simulation experiments performed on a dynamic computer model of the researched process. The experimental work has made it possible to elicit the general rules for planning and scheduling of the heat treatment process of forged pieces which reduce losses caused by equipment conversion and setup times, and which increase the throughput of this process. The HIPO diagram was used to design the algorithm.

  17. Viral myocarditis--diagnosis, treatment options, and current controversies.

    Science.gov (United States)

    Pollack, Ari; Kontorovich, Amy R; Fuster, Valentin; Dec, G William

    2015-11-01

    Myocarditis--a frequent cause of dilated cardiomyopathy and sudden cardiac death--typically results from cardiotropic viral infection followed by active inflammatory destruction of the myocardium. Characterization of this disease has been hampered by its heterogeneous clinical presentations and diverse aetiologies. Advances in cardiac MRI and molecular detection of viruses by endomyocardial biopsy have improved our ability to diagnose and understand the pathophysiological mechanisms of this elusive disease. However, therapeutic options are currently limited for both the acute and chronic phases of myocarditis. Several randomized, controlled trials have demonstrated potential benefit with immunosuppressive and immunomodulatory therapies, but further investigations are warranted. In this Review, we explore the pathophysiology, natural history, and modes of diagnosis of myocarditis, as well as evidence-based treatment strategies. As novel imaging techniques and human in vitro models of the disease emerge, the landscape of therapies for myocarditis is poised to improve.

  18. Current treatment options for colon cancer peritoneal carcinomatosis.

    Science.gov (United States)

    Aoyagi, Tomoyoshi; Terracina, Krista P; Raza, Ali; Takabe, Kazuaki

    2014-09-21

    Peritoneal carcinomatosis (PC), the dissemination of cancer cells throughout the lining of the abdominal cavity, is the second most common presentation of colon cancer distant metastasis. Despite remarkable advances in cytotoxic chemotherapy and targeted therapy for colon cancer over the last 15 years, it has been repeatedly shown that these therapies remain ineffective for colon cancer PC. Recently, there has been a rapid accumulation of reports that cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) prolongs the life of colon cancer PC patients. Here, we will review the clinical presentation, the mechanisms of disease progression, and current treatment options for colon cancer PC, with a focus on the benefits and limitations of CRS-HIPEC.

  19. Current concepts in the diagnosis and treatment of shoulder impingement

    Directory of Open Access Journals (Sweden)

    Bijayendra Singh

    2017-01-01

    Full Text Available Subacromial impingement syndrome (SIS is a very common cause of shoulder pain in the young adults. It can cause debilitating pain, dysfunction, and affects the activities of daily living. It represents a spectrum of pathology ranging from bursitis to rotator cuff tendinopathy which can ultimately lead to degenerative tear of the rotator cuff. Various theories and concepts have been described and it is still a matter of debate. However, most published studies suggest that both extrinsic and intrinsic factors have a role in the development of SIS. The management is controversial as both nonoperative and operative treatments have shown to provide good results. This article aims to provide a comprehensive current concepts review of the pathogenesis, etiologies, clinical diagnosis, appropriate use of investigations, and discussion on the management of SIS.

  20. Catatonia in autistic spectrum disorders: a medical treatment algorithm.

    Science.gov (United States)

    Fink, Max; Taylor, Michael A; Ghaziuddin, Neera

    2006-01-01

    Autism is a developmental syndrome with an unknown biology and inadequate therapeutics. Assessing the elements of the syndrome for the presence of depression, psychosis, mania, or catatonia, offers opportunities for systematic intervention. Since almost all descriptions of autism highlight the presence of motor symptoms that characterize catatonia, an assessment for this eminently treatable syndrome is recommended for all patients considered to be autistic. A minimum examination includes a catatonia rating scale and for those patients with defined catatonia, a lorazepam test. For those whose catatonia responds to lorazepam, high dose lorazepam therapy is recommended. If this fails, electroconvulsive therapy is recommended. The assessment and treatment of catatonia offers positive medical therapy for the victims of autism and their families.

  1. Current algorithmic solutions for peptide-based proteomics data generation and identification.

    Science.gov (United States)

    Hoopmann, Michael R; Moritz, Robert L

    2013-02-01

    Peptide-based proteomic data sets are ever increasing in size and complexity. These data sets provide computational challenges when attempting to quickly analyze spectra and obtain correct protein identifications. Database search and de novo algorithms must consider high-resolution MS/MS spectra and alternative fragmentation methods. Protein inference is a tricky problem when analyzing large data sets of degenerate peptide identifications. Combining multiple algorithms for improved peptide identification puts significant strain on computational systems when investigating large data sets. This review highlights some of the recent developments in peptide and protein identification algorithms for analyzing shotgun mass spectrometry data when encountering the aforementioned hurdles. Also explored are the roles that analytical pipelines, public spectral libraries, and cloud computing play in the evolution of peptide-based proteomics.

  2. Current Research Therapeutic Strategies for Alzheimer's Disease Treatment

    Science.gov (United States)

    Folch, Jaume; Petrov, Dmitry; Ettcheto, Miren; Abad, Sonia; Sánchez-López, Elena; García, M. Luisa; Olloquequi, Jordi; Beas-Zarate, Carlos; Auladell, Carme; Camins, Antoni

    2016-01-01

    Alzheimer's disease (AD) currently presents one of the biggest healthcare issues in the developed countries. There is no effective treatment capable of slowing down disease progression. In recent years the main focus of research on novel pharmacotherapies was based on the amyloidogenic hypothesis of AD, which posits that the beta amyloid (Aβ) peptide is chiefly responsible for cognitive impairment and neuronal death. The goal of such treatments is (a) to reduce Aβ production through the inhibition of β and γ secretase enzymes and (b) to promote dissolution of existing cerebral Aβ plaques. However, this approach has proven to be only modestly effective. Recent studies suggest an alternative strategy centred on the inhibition of the downstream Aβ signalling, particularly at the synapse. Aβ oligomers may cause aberrant N-methyl-D-aspartate receptor (NMDAR) activation postsynaptically by forming complexes with the cell-surface prion protein (PrPC). PrPC is enriched at the neuronal postsynaptic density, where it interacts with Fyn tyrosine kinase. Fyn activation occurs when Aβ is bound to PrPC-Fyn complex. Fyn causes tyrosine phosphorylation of the NR2B subunit of metabotropic glutamate receptor 5 (mGluR5). Fyn kinase blockers masitinib and saracatinib have proven to be efficacious in treating AD symptoms in experimental mouse models of the disease. PMID:26881137

  3. Inflammatory bowel diseases: an update of current treatment alternatives.

    Directory of Open Access Journals (Sweden)

    Lucrecia Suárez

    2009-11-01

    Full Text Available Inflammatory bowel diseases (IBD are characterized for having an unpredictable clinical course with periods of inactivity alternating with relapses, a very variable response to treatment and the constant threat of diverse complications. Management of IBD in children may be of particular complexity, added to the fact that published clinical trials are limited, and scientific evidence seems contradictory, explain in part why to current date there is no international consensus regarding treatment in this age group. A suitable therapy should aim at inducing and maintaining remission for as long as possible, encourage adequate growth and preventing potential complications from appearing. In more recent years, development of new therapeutic agents has allowed a more integrative approach which takes in consideration other aspects of the disease such as nutritional status, psychological welfare and general quality of life. One must also keep in mind that none of these therapeutic resources is exempt of side effects on short and long term basis, consequently, it is imperative to be thoughtful of individual features in order to make accurate clinical decisions and offer a tailored management plan which should be able to modify the disease evolution.

  4. Medical treatment of radiation injuries-Current US status

    Energy Technology Data Exchange (ETDEWEB)

    Jarrett, D.G. [OSA - CBD and CDP, 3050 Defense Pentagon, Room 3C257, Washington, DC 20301-3050 (United States)], E-mail: david.jarrett@us.army.mil; Sedlak, R.G.; Dickerson, W.E. [Uniformed Services University, Armed Forces Radiobiology Research Institute, 8901 Wisconsin Avenue, Bethesda, MD 20889-5603 (United States); Reeves, G.I. [Northrop Grumman IT, 8211 Terminal Road, Lorton, VA 22079-1421 (United States)

    2007-07-15

    A nuclear incident or major release of radioactive materials likely would result in vast numbers of patients, many of whom would require novel therapy. Fortunately, the numbers of radiation victims in the United States (USA) have been limited to date. If a mass-casualty situation occurs, there will be a need to perform rapid, accurate dose estimates and to provide appropriate medications and other treatment to ameliorate radiation injury. The medical management of radiation injury is complex. Radiation injury may include acute radiation sickness (ARS) from external and/or internal radiation exposure, internal organ damage from incorporated radioactive isotopes, and cutaneous injury. Human and animal data have shown that optimal medical care may nearly double the survivable dose of ionizing radiation. Current treatment strategies for radiation injuries are discussed with concentration on the medical management of the hematopoietic syndrome. In addition, priority areas for continuing and future research into both acute deterministic injuries and also long-term stochastic sequelae of radiation exposure have been identified. There are several near-term novel therapies that appear to offer excellent prognosis for radiation casualties, and these are also described.

  5. Treatment of preeclampsia: current approach and future perspectives.

    Science.gov (United States)

    Berzan, Ecaterina; Doyle, Ross; Brown, Catherine M

    2014-09-01

    Hypertension is the most common medical disorder encountered during pregnancy, occurring in about 6-8 % of pregnancies. Preeclampsia is a pregnancy-specific disorder that occurs after 20 weeks' gestation, characterized by hypertension and proteinuria. Preeclampsia can also occur superimposed upon chronic hypertension. Eclampsia is the convulsive form of preeclampsia, and affects 0.1 % of all pregnancies. In low-income and middle-income countries, preeclampsia and eclampsia are associated with 10-15 % of direct maternal deaths. Women who develop preeclampsia in pregnancy are at greater risk of cardiovascular and cerebrovascular events even years after their pregnancies. There is significant progress in the elucidation of the underlying mechanisms and pathophysiology of preeclampsia, although its therapeutics remains challenging; delivery of the fetus is still the definitive treatment. Different international societies have produced recommendations and guidelines for clinicians treating preeclampsia, with an overall goal of improving maternal and fetal outcomes. In this review, we focus on the level of blood pressure at which to commence treatment and the current clinical management strategies available to treat and possibly prevent preeclampsia. We also briefly outline some newer perspectives on management of the disorder.

  6. Current and emerging treatment options for Graves’ hyperthyroidism

    Directory of Open Access Journals (Sweden)

    Prakash Abraham

    2009-12-01

    Full Text Available Prakash Abraham1, Shamasunder Acharya21Department of Endocrinology, Aberdeen Royal Infirmary, Aberdeen, UK; 2Department of Endocrinology, John Hunter Hospital, New Lambton NSW, AustraliaAbstract: Radioiodine, antithyroid drugs and surgery have been well established therapies for Graves’ hyperthyroidism for several decades. However there remain large variations in practice among physicians in the preferred modality and the method of administration. Patient choice and perceptions also play a big role in the choice of treatment. Radioiodine may be given using fixed high doses or by calculated doses following uptake studies. The risks of radioiodine including eye disease and the role of prophylactic steroid therapy are discussed. The commonly used antithyroid drugs include carbimazole, methimazole and propylthiouracil; however a number of other agents have been tried in special situations or in combination with these drugs. The antithyroid drugs may be given in high (using additional levothyroxine in a block–replace regimen or low doses (in a titration regimen. This review examines the current evidence and relative benefits for these options as well as looking at emerging therapies including immunomodulatory treatments such as rituximab which have come into early clinical trials. The use of antithyroid therapies in special situations is also discussed as well as clinical practice issues which may influence the choices.Keywords: Graves’ hyperthyroidism, radioiodine, antithyroid drugs, methimazole, propylthiouracil

  7. Current Research Therapeutic Strategies for Alzheimer’s Disease Treatment

    Directory of Open Access Journals (Sweden)

    Jaume Folch

    2016-01-01

    Full Text Available Alzheimer’s disease (AD currently presents one of the biggest healthcare issues in the developed countries. There is no effective treatment capable of slowing down disease progression. In recent years the main focus of research on novel pharmacotherapies was based on the amyloidogenic hypothesis of AD, which posits that the beta amyloid (Aβ peptide is chiefly responsible for cognitive impairment and neuronal death. The goal of such treatments is (a to reduce Aβ production through the inhibition of β and γ secretase enzymes and (b to promote dissolution of existing cerebral Aβ plaques. However, this approach has proven to be only modestly effective. Recent studies suggest an alternative strategy centred on the inhibition of the downstream Aβ signalling, particularly at the synapse. Aβ oligomers may cause aberrant N-methyl-D-aspartate receptor (NMDAR activation postsynaptically by forming complexes with the cell-surface prion protein (PrPC. PrPC is enriched at the neuronal postsynaptic density, where it interacts with Fyn tyrosine kinase. Fyn activation occurs when Aβ is bound to PrPC-Fyn complex. Fyn causes tyrosine phosphorylation of the NR2B subunit of metabotropic glutamate receptor 5 (mGluR5. Fyn kinase blockers masitinib and saracatinib have proven to be efficacious in treating AD symptoms in experimental mouse models of the disease.

  8. Current management and treatment of cerebral vasospasm complicating SAH.

    Science.gov (United States)

    Kühn, Anna Luisa; Balami, Joyce Saleh; Grunwald, Iris Quasar

    2013-03-01

    Cerebral vasospasm is a common and serious complication of aneurysmal subarachnoid haemorrhage. Despite the improvements in treatment of aneurysmal subarachnoid haemorrhage (aSAH), cerebral vasospasm complicating aSAH has remained the main cause of morbidity and mortality. Subarachnoid haemorrhage (SAH)-induced vasospasm is a complex entity caused by vasculopathy, impaired autoregulation, and hypovolaemia, causing a regional reduction of cerebral brain perfusion which can then induce ischaemia. Cerebral vasospasm can present either asymptomatically detected only radiologically or symptomatically (delayed ischaemic neurologic deficit). The various diagnostic approaches include the use of transcranial doppler, digital subtraction angiography and multimodal computed tomography (CT) and magnetic resonance (MR) techniques. Although digital subtraction angiography is usually the gold standard for the diagnosis of cerebral vasospam, transcranial doppler is commonly the first-screening method for the detection of cerebral vasospam. The treatment of subarachnoid haemorrhage -induced vasospasm include the use of both medical and endovascular therapy. The aim of this review is to discuss the various current therapeutic options and future perspective measures for reducing cerebral vasospasm induced stroke after SAH.

  9. Investigation of Line Current Harmonics in Cascaded Multi-level Inverter Based Induction Motor Drive and an Adaptive On-line Selective Current Harmonic Elimination Algorithm

    Directory of Open Access Journals (Sweden)

    P. Avirajamanjula

    2015-03-01

    Full Text Available Multilevel Inverters (MLIs have drawn increasing attention in numerous applications, especially in drives, distributed energy resources area, utility etc. MLIs have the ability to synthesize a near sinusoidal output voltage wave with minimal Total Harmonic Distortion (THD in low frequency switching. Even though they offer lower THD, the presence of lower order harmonics is objectionable and harmonics elimination in Multilevel Inverters (MLIs has been receiving immense attention for the past few decades. Existing Selective Harmonic Elimination (SHE techniques can eliminate the objectionable lower order voltage harmonics with low switching frequency by solving the Fourier non-linear transcendental equations of the output voltage. The line current harmonics has a direct role to play on the magneto-motive force and results in increase of mismatching of air-gap permeance, vibrations, acoustic noise etc. This study proposes Normalized Least Mean Squares (NLMS algorithm based scheme to eliminate the selected dominant harmonics in load current using only the knowledge of the frequencies to be eliminated. The algorithm is simulated using MATLAB/SIMULINK tool for a three-phase VSI to eliminate the fifth and seventh harmonics. The informative simulation results verify the validity and effectiveness of the proposed algorithm. The system performance is analyzed based on the simulation results considering Total Harmonic Distortion (THD, magnitude of eliminated harmonics and frequency spectrum.

  10. Current and emerging treatment strategies for vertebral compression fractures

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    Hacein-Bey L

    2012-05-01

    Full Text Available Lotfi Hacein-BeyRadiological Associates of Sacramento Medical Group Inc, Sacramento, CA, USABackground: Vertebral compression fractures are most commonly related to osteoporosis or cancer, both of which are on the rise throughout the world. Once a vertebra is fractured, gradual deterioration of quality of life due to crippling pain and spinal instability usually follows. Although a number of traditional management options have been available to promote pain relief and to allow for increased activities, such as bed rest, bracing, pain medications, and light exercise programs, these have limited effectiveness in the majority of patients. Over 20 years ago, percutaneous vertebroplasty, which is a minimally invasive procedure consisting of the injection of polymethylmethacrylate directly into the fractured vertebra, emerged as an effective treatment. Various vertebral augmentation procedures were subsequently designed, all of which aim at eliminating pain, limiting or reversing vertebral collapse, and providing stability to the affected segment of the spine.Objective: This article discusses clinical aspects of vertebral compression fractures, current indications and contraindications and summarizes technical aspects of vertebroplasty, kyphoplasty, lordoplasty, and device-implanting vertebral augmentation procedures. Treatment effectiveness, which is significant despite recent criticism of vertebroplasty and other vertebral augmentation procedures, is also discussed. As economic pressures on health care systems are increasing in all countries, it is expected that the appropriateness, clinical effectiveness, and cost-effectiveness of vertebral augmentation procedures will be increasingly established by outcome analyses.Conclusion: It is important that physicians are familiar with vertebroplasty and other procedures designed to treat vertebral fractures in patients with advanced osteoporosis or cancer. These fractures, which are common and often

  11. Cartilage lesions and ankle osteoarthrosis: review of the literature and treatment algorithm,

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    Alexandre Leme Godoy Santos

    2014-12-01

    Full Text Available The main etiology of ankle osteoarthrosis is post-traumatic and its prevalence is highest amongyoung individuals. Thus, this disease has a great socioeconomic impact and gives rise to significant losses of patients' quality of life. The objective of its treatment is to eliminate pain and keep patients active. Therefore, the treatment should be staged according to the degree of degenerative evolution, etiology, joint location, systemic condition, bone quality, lower-limb alignment, ligament stability and age. The treatment algorithm is divided into non-surgical therapeutic methods and options for surgical treatment. Joint preservation, joint replacement and arthrodesis surgical procedures have precise indications. This article presents a review on this topic and a proposal for a treatment algorithm for this disease.

  12. Cost of treating chronic hepatitis B: Comparison of current treatment guidelines

    Institute of Scientific and Technical Information of China (English)

    Monica Robotin; Yumi Patton; Melanie Kansil; Andrew Penman; Jacob George

    2012-01-01

    AIM:To compare program costs of chronic hepatitis B (CHB) screening and treatment using Australian and other published CHB treatment guidelines.METHODS:Economic modeling demonstrated that in Australia a strategy of hepatocellular cancer (HCC)prevention in patients with CHB is more cost-effective than current standard care,or HCC screening.Based upon this model,we developed the B positive program to optimize CHB management of Australians born in countries of high CHB prevalence.We estimated CHB program costs using the B positive program algorithm and compared them to estimated costs of using the CHB treatment guidelines published by the AsianPacific,American and European Associations for the Study of Liver Disease (APASL,AASLD,EASL) and those suggested by an independent United States hepatology panel.We used a Markov model that factored in the costs of CHB screening and treatment,individualized by viral load and alanine aminotransferase levels,and calculated the relative costs of program components.Costs were discounted by 5% and calculated in Australian dollars (AUD).RESULTS:Using the B positive algorithm,total program costs amount to 13 979 224 AUD,or 9634 AUD per patient.The least costly strategy is based upon using the AASLD guidelines,which would cost 34% less than our B positive algorithm.Using the EASL and the United States Expert Group guidelines would increase program costs by 46%.The largest expenditure relates to the cost of drug treatment (66.9% of total program costs).The contribution of CHB surveillance (20.2%)and HCC screening and surveillance (6.6%) is small -and together they represent only approximately a quarter of the total program costs.CONCLUSION:The significant cost variations in CHB screening and treatment using different guidelines are relevant for clinicians and policy makers involved in designing population-based disease control programs.(C) 2012 Baishideng.All rights reserved.

  13. Algorithms for Computing the Magnetic Field, Vector Potential, and Field Derivatives for a Thin Solenoid with Uniform Current Density

    Energy Technology Data Exchange (ETDEWEB)

    Walstrom, Peter Lowell [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2017-08-07

    A numerical algorithm for computing the field components Br and Bz and their r and z derivatives with open boundaries in cylindrical coordinates for radially thin solenoids with uniform current density is described in this note. An algorithm for computing the vector potential Aθ is also described. For the convenience of the reader, derivations of the final expressions from their defining integrals are given in detail, since their derivations are not all easily found in textbooks. Numerical calculations are based on evaluation of complete elliptic integrals using the Bulirsch algorithm cel. The (apparently) new feature of the algorithms described in this note applies to cases where the field point is outside of the bore of the solenoid and the field-point radius approaches the solenoid radius. Since the elliptic integrals of the third kind normally used in computing Bz and Aθ become infinite in this region of parameter space, fields for points with the axial coordinate z outside of the ends of the solenoid and near the solenoid radius are treated by use of elliptic integrals of the third kind of modified argument, derived by use of an addition theorem. Also, the algorithms also avoid the numerical difficulties the textbook solutions have for points near the axis arising from explicit factors of 1/r or 1/r2 in the some of the expressions.

  14. Diagnosing α1-antitrypsin deficiency: how to improve the current algorithm

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    Noel G. McElvaney

    2015-03-01

    Full Text Available Over the past 10–15 years, the diagnosis of α1-antitrypsin deficiency (AATD has markedly improved as a result of increasing awareness and the publication of diagnostic recommendations by the American Thoracic Society (ATS/European Respiratory Society (ERS. Nevertheless, the condition remains substantially underdiagnosed. Furthermore, when AATD is diagnosed there is a delay before treatment is introduced. This may help explain why AATD is the fourth most common cause of lung transplantation. Clearly we need to do better. The ATS/ERS recommend testing high-risk groups, such as: all chronic obstructive pulmonary disease patients; all nonresponsive asthmatic adults/adolescents; all cases of cryptogenic cirrhosis/liver disease; subjects with granulomatosis with polyangitis; bronchiectasis of unknown aetiology; panniculitis and first-degree relatives of patients with AATD. In terms of laboratory diagnosis, measurement of α1-antitrypsin levels will identify patients with protein deficiency, but cannot differentiate between the various genetic subtypes of AATD. Phenotyping is the current gold standard for detecting rare variants of AATD (except null variants, while advances in molecular diagnostics are making genotyping more effective. An accurate diagnosis facilitates the physician's ability to actively intervene with measures such as smoking cessation and perhaps augmentation therapy, and it will also help provide a better understanding of the natural history of the disease.

  15. New algorithm for MODIS chlorophyll fluorescence height retrieval: performance and comparison with the current product

    Science.gov (United States)

    Ioannou, I.; Zhou, J.; Gilerson, A.; Gross, B.; Moshary, F.; Ahmed, S.

    2009-09-01

    Our previous studies showed that the Fluorescence Line Height (FLH) product, which uses 3 NIR bands at 667, 678, and 746 nm on the MODerate-resolution Imaging Spectroradiometer (MODIS) sensor, and similar bands on MERIS sensor, is not reliable in coastal waters because of a peak in the elastic reflectance spectra which occurs due to the confluence of chlorophyll and water absorption spectra and which overlaps spectrally the chlorophyll fluorescence. This combination of two overlapping peaks makes fluorescence signal retrieval inaccurate. As a consequence, the present FLH algorithm significantly underestimates fluorescence magnitudes in coastal waters. To overcome this problem, we introduce a new and more accurate approach for the retrieval of FLH in turbid waters by the MODIS sensor, which exploits the correlation between the blue-green and red bands reflectance ratios. We show that by making use of the combined remote sensing reflectance's (Rrs) at 488nm, 547nm, 667nm and 678nm we can retrieve fluorescence accurately in case 2 waters even for low fluorescence quantum yield when fluorescence magnitudes are low. The derivation and validation of our algorithm was performed using extensive synthetic datasets which cover a large variability of parameters typical of coastal waters: with CDOM absorption at 400nm 0-2 m-1, mineral concentration 0-5g/m3 and chlorophyll concentration of 0.5-100 mg/m3. In addition, we applied this proposed algorithm to MODIS satellite data and compared it with the traditional FLH algorithm.

  16. Current and emerging treatment strategies for Duchenne muscular dystrophy

    Directory of Open Access Journals (Sweden)

    Mah JK

    2016-07-01

    Full Text Available Jean K Mah Department of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada Abstract: Duchenne muscular dystrophy (DMD is the most common form of muscular dystrophy in childhood. It is caused by mutations of the DMD gene, leading to progressive muscle weakness, loss of independent ambulation by early teens, and premature death due to cardiorespiratory complications. The diagnosis can usually be made after careful review of the history and examination of affected boys presenting with developmental delay, proximal weakness, and elevated serum creatine kinase, plus confirmation by muscle biopsy or genetic testing. Precise characterization of the DMD mutation is important for genetic counseling and individualized treatment. Current standard of care includes the use of corticosteroids to prolong ambulation and to delay the onset of secondary complications. Early use of cardioprotective agents, noninvasive positive pressure ventilation, and other supportive strategies has improved the life expectancy and health-related quality of life for many young adults with DMD. New emerging treatment includes viral-mediated microdystrophin gene replacement, exon skipping to restore the reading frame, and nonsense suppression therapy to allow translation and production of a modified dystrophin protein. Other potential therapeutic targets involve upregulation of compensatory proteins, reduction of the inflammatory cascade, and enhancement of muscle regeneration. So far, data from DMD clinical trials have shown limited success in delaying disease progression; unforeseen obstacles included immune response against the generated mini-dystrophin, inconsistent evidence of dystrophin production in muscle biopsies, and failure to demonstrate a significant improvement in the primary outcome measure, as defined by the 6-minute walk test in some studies. The long-term safety and efficacy of emerging treatments

  17. Experimental evaluation of a GPU-based Monte Carlo dose calculation algorithm in the Monaco treatment planning system.

    Science.gov (United States)

    Paudel, Moti R; Kim, Anthony; Sarfehnia, Arman; Ahmad, Sayed B; Beachey, David J; Sahgal, Arjun; Keller, Brian M

    2016-11-01

    A new GPU-based Monte Carlo dose calculation algorithm (GPUMCD), developed by the vendor Elekta for the Monaco treatment planning system (TPS), is capable of modeling dose for both a standard linear accelerator and an Elekta MRI linear accelerator. We have experimentally evaluated this algorithm for a standard Elekta Agility linear accelerator. A beam model was developed in the Monaco TPS (research version 5.09.06) using the commissioned beam data for a 6 MV Agility linac. A heterogeneous phantom representing several scenarios - tumor-in-lung, lung, and bone-in-tissue - was designed and built. Dose calculations in Monaco were done using both the current clinical Monte Carlo algorithm, XVMC, and the new GPUMCD algorithm. Dose calculations in a Pinnacle TPS were also produced using the collapsed cone convolution (CCC) algorithm with heterogeneity correction. Calculations were compared with the measured doses using an ionization chamber (A1SL) and Gafchromic EBT3 films for 2×2 cm2,5×5 cm2, and 10×2 cm2 field sizes. The percentage depth doses (PDDs) calculated by XVMC and GPUMCD in a homogeneous solid water phantom were within 2%/2 mm of film measurements and within 1% of ion chamber measurements. For the tumor-in-lung phantom, the calculated doses were within 2.5%/2.5 mm of film measurements for GPUMCD. For the lung phantom, doses calculated by all of the algorithms were within 3%/3 mm of film measurements, except for the 2×2 cm2 field size where the CCC algorithm underestimated the depth dose by ∼5% in a larger extent of the lung region. For the bone phantom, all of the algorithms were equivalent and calculated dose to within 2%/2 mm of film measurements, except at the interfaces. Both GPUMCD and XVMC showed interface effects, which were more pronounced for GPUMCD and were comparable to film measurements, whereas the CCC algorithm showed these effects poorly. PACS number(s): 87.53.Bn, 87.55.dh, 87.55.km. © 2016 The Authors.

  18. Inrush Current Simulation of Power Transformer using Machine Parameters Estimated by Design Procedure of Winding Structure and Genetic Algorithm

    Science.gov (United States)

    Tokunaga, Yoshitaka

    This paper presents estimation techniques of machine parameters for power transformer using design procedure of transformer and genetic algorithm with real coding. Especially, it is very difficult to obtain machine parameters for transformers in customers' facilities. Using estimation techniques, machine parameters could be calculated from the only nameplate data of these transformers. Subsequently, EMTP-ATP simulation of the inrush current was carried out using machine parameters estimated by techniques developed in this study and simulation results were reproduced measured waveforms.

  19. The PIC Cystogram: Its Place in the Treatment Algorithm of Recurrent Febrile UTIs

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    Jennifer A. Hagerty

    2008-01-01

    Full Text Available Purpose. A common pediatric dilemma involves management of children with recurrent febrile urinary tract infections (UTIs who have normal voiding cystourethrograms. Vesicoureteral reflux (VUR has been demonstrated in such cases by performing a cystogram which positions the instillation of contrast (PIC at the ureteral orifice. We describe the evidence supporting this diagnostic test. Materials and Methods. The literature was searched to identify and subsequently evaluate all studies investigating PIC cystography. Results. In patients with febrile UTIs and negative VCUGs, the PIC cystogram has been demonstrated to identify occult reflux (PIC-VUR. When identified and treated, these patients have a significant reduction in the incidence of febrile UTIs. Conclusions. Although the current literature on PIC cystography is limited, it appears to be a clinically useful test in a select group of patients with recurrent febrile UTIs, that are not found to have VUR on a conventional VCUG. A prospective randomized trial is underway to further define its role in the treatment algorithm of febrile UTIs.

  20. Osteoporosis – a current view of pharmacological prevention and treatment

    Directory of Open Access Journals (Sweden)

    Das S

    2013-05-01

    Full Text Available Subhajit Das, Julie C Crockett Musculoskeletal Research Programme, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK Abstract: Postmenopausal osteoporosis is the most common bone disease, associated with low bone mineral density (BMD and pathological fractures which lead to significant morbidity. It is defined clinically by a BMD of 2.5 standard deviations or more below the young female adult mean (T-score = −2.5. Osteoporosis was a huge global problem both socially and economically – in the UK alone, in 2011 £6 million per day was spent on treatment and social care of the 230,000 osteoporotic fracture patients – and therefore viable preventative and therapeutic approaches are key to managing this problem within the aging population of today. One of the main issues surrounding the potential of osteoporosis management is diagnosing patients at risk before they develop a fracture. We discuss the current and future possibilities for identifying susceptible patients, from fracture risk assessment to shape modeling and in relation to the high heritability of osteoporosis now that a plethora of genes have been associated with low BMD and osteoporotic fracture. This review highlights the current therapeutics in clinical use (including bisphosphonates, anti-RANKL [receptor activator of NF-κB ligand], intermittent low dose parathyroid hormone, and strontium ranelate and some of those in development (anti-sclerostin antibodies and cathepsin K inhibitors. By highlighting the intimate relationship between the activities of bone forming (osteoblasts and bone-resorbing (osteoclasts cells, we include an overview and comparison of the molecular mechanisms exploited in each therapy. Keywords: BMD, fracture, bisphosphonate, strontium, denosumab, teriparatide, raloxifene

  1. Pivotal response treatment for autism spectrum disorder: current perspectives

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    Lei J

    2017-06-01

    Full Text Available Jiedi Lei, Pamela Ventola Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA Abstract: Pivotal response treatment (PRT is an evidence-based behavioral intervention based on applied behavior analysis principles aimed to improve social communication skills in individuals with autism spectrum disorder (ASD. PRT adopts a more naturalistic approach and focuses on using a number of strategies to help increase children’s motivation during intervention. Since its conceptualization, PRT has received much empirical support for eliciting therapeutic gains in greater use of functional social communication skills in individuals with ASD. Building upon the empirical evidence supporting PRT, recent advancements have increasingly turned to using interdisciplinary research integrating neuroimaging techniques and behavioral measures to help identify objective biomarkers of treatment, which have two primary purposes. First, neuroimaging results can help characterize how PRT may elicit change, and facilitate partitioning of the heterogeneous profiles of neural mechanisms underlying similar profile of behavioral changes observed over PRT. Second, neuroimaging provides an objective means to both map and track how biomarkers may serve as reliable and sensitive predictors of responder profiles to PRT, assisting clinicians to identify who will most likely benefit from PRT. Together, a better understanding of both mechanisms of change and predictors of responder profile will help PRT to serve as a more precise and targeted intervention for individuals with ASD, thus moving towards the goal of precision medicine and improving quality of care. This review focuses on the recent emerging neuroimaging evidences supporting PRT, offering current perspectives on the importance of interdisciplinary research to help clinicians better understand how PRT works and predict who will respond to PRT. Keywords: PRT, ASD, biomarkers, neuroimaging

  2. Current medical treatment of estrogen receptor-positive breast cancer

    Institute of Scientific and Technical Information of China (English)

    Franco; Lumachi; Davide; A; Santeufemia; Stefano; MM; Basso

    2015-01-01

    Approximately 80% of breast cancers(BC) are estrogen receptor(ER)-positive and thus endocrine therapy(ET) should be considered complementary to surgery in the majority of patients. The advantages of oophorectomy, adrenalectomy and hypophysectomy in women with advanced BC have been demonstrated many years ago, and currently ET consist of(1) ovarian function suppression(OFS), usually obtained using gonadotropinreleasing hormone agonists(Gn RHa);(2) selective estrogen receptor modulators or down-regulators(SERMs or SERDs); and(3) aromatase inhibitors(AIs), or a combination of two or more drugs. For patients aged less than 50 years and ER+ BC, there is no conclusive evidence that the combination of OFS and SERMs(i.e., tamoxifen) or chemotherapy is superior to OFS alone. Tamoxifen users exhibit a reduced risk of BC, both invasive and in situ, especially during the first 5 years of therapy, and extending the treatment to 10 years further reduced the risk of recurrences. SERDs(i.e., fulvestrant) are especially useful in the neoadjuvant treatment of advanced BC, alone or in combination with either cytotoxic agents or AIs. There are two types of AIs: type Ⅰ are permanent steroidal inhibitors of aromatase, while type Ⅱ are reversible nonsteroidal inhibitors. Several studies demonstrated the superiority of the third-generation AIs(i.e., anastrozole and letrozole) compared with tamoxifen, and adjuvant therapy with AIs reduces the recurrence risk especially in patients with advanced BC. Unfortunately, some cancers are or became ET-resistant, and thus other drugs have been suggested in combination with SERMs or AIs, including cyclin-dependent kinase 4/6 inhibitors(palbociclib) and mammalian target of rapamycin(m TOR) inhibitors, such as everolimus. Further studies are required to confirm their real usefulness.

  3. Diagnostic approach and current treatment options in childhood vasculitis.

    Science.gov (United States)

    Barut, Kenan; Şahin, Sezgin; Adroviç, Amra; Kasapçopur, Özgür

    2015-12-01

    All inflammatory changes in the vessel wall are defined as vasculitis. Pediatric vasculitis may present with different clinical findings. Although Henoch-Schönlein purpura which is the most common pediatric vasculitis generally recovers spontaneously, it should be monitorized closely because of the risk of renal failure. Although Kawasaki disease is easy to diagnose with its classical findings, the diagnosis may be delayed in case of incomplete Kawasaki disease. Kawasaki disease should be considered especially in infants in case of prolonged fever even if the criteria are not fully met and intravenous immunoglobulin treatment should be administered without delay in order to prevent development of coronary artery aneurism. Reaction at the site of administration of Bacillus Calmette-Guerin (BCG) vaccine may be observed as commonly as cervical lymphadenopathy in Kawasaki disease and may be used as a valuable finding in suspicious cases. Although anti-neutrophil cytoplasmic antibody-associated vasculitides are rare in children, renal involvement is more common and progression is more severe compared to adults. Hence, efficient and aggressive treatment is required. Takayasu's arteritis is observed commonly in young adult women and rarely in adolescent girls. Therefore, a careful physical examination and blood pressure measurement should be performed in addition to a detailed history in daily practice. In children with unexplained neurological findings, cerebral vasculitis should be considered in the absence of other systemic vasculitides and necessary radiological investigations should be performed in this regard. This review will provide an insight into the understanding of pediatric vasculitis, current diagnostic approaches and prognosis by the aid of new studies.

  4. Implementation of Human Trafficking Education and Treatment Algorithm in the Emergency Department.

    Science.gov (United States)

    Egyud, Amber; Stephens, Kimberly; Swanson-Bierman, Brenda; DiCuccio, Marge; Whiteman, Kimberly

    2017-04-18

    Health care professionals have not been successful in recognizing or rescuing victims of human trafficking. The purpose of this project was to implement a screening system and treatment algorithm in the emergency department to improve the identification and rescue of victims of human trafficking. The lack of recognition by health care professionals is related to inadequate education and training tools and confusion with other forms of violence such as trauma and sexual assault. A multidisciplinary team was formed to assess the evidence related to human trafficking and make recommendations for practice. After receiving education, staff completed a survey about knowledge gained from the training. An algorithm for identification and treatment of sex trafficking victims was implemented and included a 2-pronged identification approach: (1) medical red flags created by a risk-assessment tool embedded in the electronic health record and (2) a silent notification process. Outcome measures were the number of victims who were identified either by the medical red flags or by silent notification and were offered and accepted intervention. Survey results indicated that 75% of participants reported that the education improved their competence level. The results demonstrated that an education and treatment algorithm may be an effective strategy to improve recognition. One patient was identified as an actual victim of human trafficking; the remaining patients reported other forms of abuse. Education and a treatment algorithm were effective strategies to improve recognition and rescue of human trafficking victims and increase identification of other forms of abuse. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. An algorithm for the evaluation and treatment of sacroiliac joint dysfunction.

    Science.gov (United States)

    Carlson, Samuel W; Magee, Sean; Carlson, Walter O

    2014-11-01

    Approximately 90 percent of adults experience an episode of low back pain in their lifetime. Sacroiliac joint (SIJ) dysfunction has been shown to cause approximately 13-30 percent of LBP in the adult population. SIJ fusion is becoming an increasingly popular treatment alternative for SIJ dysfunction. This paper presents a literature-based algorithm to assist the clinician in the evaluation and treatment of patients with suspected SIJ dysfunction.

  6. MREIT experiments with 200μA injected currents: a feasibility study using two reconstruction algorithms, SMM and Harmonic BZ

    Science.gov (United States)

    Arpinar, V E; Hamamura, M J; Degirmenci, E; Muftuler, L T

    2012-01-01

    Magnetic resonance electrical impedance tomography (MREIT) is a technique that produces images of conductivity in tissues and phantoms. In this technique electrical currents are applied to an object and the resulting magnetic flux density is measured using magnetic resonance imaging (MRI) and the conductivity distribution is reconstructed using these MRI data. Currently the technique is used in research environments, primarily studying phantoms and animals. In order to translate MREIT to clinical applications, strict safety standards need to be established, especially for safe current limits. However, there are currently no standards for safe current limits specific to MREIT. Until such standards are established, human MREIT applications need to conform to existing electrical safety standards in medical instrumentation, such as the IEC601. This protocol limits patient auxiliary currents to 100μA for low frequencies. However, published MREIT studies have utilized currents 10 to 400 times larger than this limit, bringing into question whether the clinical applications of MREIT are attainable under current standards. In this study, we investigated the feasibility of MREIT to accurately reconstruct the relative conductivity of a simple agarose phantom using 200μA total injected current and we tested the performance of two MREIT reconstruction algorithms. These reconstruction algorithms used are the iterative sensitivity matrix method (SMM) by Ider and Birgul in 1998 with Tikhonov regularization and the Harmonic BZ proposed by Oh et al in 2003. The reconstruction techniques were tested at both 200μA and 5mA injected currents to investigate their noise sensitivity at low and high current conditions. It should be noted that 200μA total injected current into a cylindrical phantom generates only 14.7μA current in imaging slice. Similarly, 5mA total injected current results in 367μA in imaging slice. Total acquisition time for 200μA and 5mA experiments were about one

  7. Current Pharmacological Advances in the Treatment of Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Andry Papastylianou

    2012-01-01

    Full Text Available Cardiac arrest is defined as the sudden cessation of spontaneous ventilation and circulation. Within 15 seconds of cardiac arrest, the patient loses consciousness, electroencephalogram becomes flat after 30 seconds, pupils dilate fully after 60 seconds, and cerebral damage takes place within 90–300 seconds. It is essential to act immediately as irreversible damage can occur in a short time. Cardiopulmonary resuscitation (CPR is an attempt to restore spontaneous circulation through a broad range of interventions which are early defibrillation, high-quality and uninterrupted chest compressions, advanced airway interventions, and pharmacological interventions. Drugs should be considered only after initial shocks have been delivered (when indicated and chest compressions and ventilation have been started. During cardiopulmonary resuscitation, no specific drug therapy has been shown to improve survival to hospital discharge after cardiac arrest, and only few drugs have a proven benefit for short-term survival. This paper reviews current pharmacological treatment of cardiac arrest. There are three groups of drugs relevant to the management of cardiac arrest: vasopressors, antiarrhythmics, and other drugs such as sodium bicarbonate, calcium, magnesium, atropine, fibrinolytic drugs, and corticosteroids.

  8. Managing pediatric hepatitis C: current and emerging treatment options

    Directory of Open Access Journals (Sweden)

    Wikrom Karnsakul

    2009-08-01

    Full Text Available Wikrom Karnsakul, Mary Kay Alford, Kathleen B SchwarzPediatric Liver Center, Division of Pediatric Gastroenterology and Nutrition, Johns Hopkins School of Medicine, Baltimore, MD, USAAbstract: Since 1992, the maternal–fetal route of transmission has become the dominant route for acquisition of hepatitis C (HCV infection by children. With increasing knowledge of antiviral treatment for HCV infection, the main goal of therapy is to achieve a sustained virological response (SVR as defined by undetectable serum HCV RNA by polymerase chain reaction assay six months after cessation of therapy. In young children, interferon therapy is more effective than in adults with chronic HCV infection (CHC. Although children clearly have a milder degree of liver pathology, data have indicated that hepatic inflammation from HCV infection can progress to fibrosis or cirrhosis in children. Hepatocellular carcinoma has been reported in adolescents with CHC. In this article, recent improvements in therapy of children with CHC and in the clinical development of new emerging drugs with potential use in children will be reviewed.Keywords: chronic hepatitis C, children, current therapy, pegylated interferon

  9. Current advances in gene therapy for the treatment of genodermatoses.

    Science.gov (United States)

    Long, Heather A; McMillan, James R; Qiao, Hongjiang; Akiyama, Masashi; Shimizu, Hiroshi

    2009-12-01

    Gene therapy provides the possibility of long term treatment for the severest of congenital disorders. In this review we will examine the recent advances in gene therapy for genodermatoses. Congenital diseases of the skin exhibit a wide range of severity and underlying causes and there are many possible therapeutic avenues. Gene therapy approaches can follow three paths-in vivo, ex vivo and fetal gene therapy, though the later is currently theoretical only it can provide potential results for even the most severe congenital diseases. All approaches utilize the many different vector systems available, including viral and the emerging use of non- viral integrating vectors. In addition, the use of RNAi based techniques to prevent dominant mutant protein expression has been explored as a therapy for specific dominant disorders such as keratin mutation disorders. Progress has been rapid in the past few years with some initial successful clinical trials reported. However, there are still some issues surrounding long term expression, transgene sustainability and safety issues that need to be addressed to further shift from experimental to clinically therapeutic applications. With the continuing development, merger and refinement of existing techniques there is an ever increasing likelihood of gene therapies becoming available for the more severe genodermatoses within the next decade or shortly thereafter.

  10. Current and emerging pharmacological treatments for sarcoidosis: a review

    Science.gov (United States)

    Beegle, Scott H; Barba, Kerry; Gobunsuy, Romel; Judson, Marc A

    2013-01-01

    The treatment of sarcoidosis is not standardized. Because sarcoidosis may never cause significant symptoms or organ dysfunction, treatment is not mandatory. When treatment is indicated, oral corticosteroids are usually recommended because they are highly likely to be effective in a relative short period of time. However, because sarcoidosis is often a chronic condition, long-term treatment with corticosteroids may cause significant toxicity. Therefore, corticosteroid sparing agents are often indicated in patients requiring chronic therapy. This review outlines the indications for treatment, corticosteroid treatment, and corticosteroid sparing treatments for sarcoidosis. PMID:23596348

  11. Algorithms for Computing the Magnetic Field, Vector Potential, and Field Derivatives for Circular Current Loops in Cylindrical Coordinates

    Energy Technology Data Exchange (ETDEWEB)

    Walstrom, Peter Lowell [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2017-08-24

    A numerical algorithm for computing the field components Br and Bz and their r and z derivatives with open boundaries in cylindrical coordinates for circular current loops is described. An algorithm for computing the vector potential is also described. For the convenience of the reader, derivations of the final expressions from their defining integrals are given in detail, since their derivations (especially for the field derivatives) are not all easily found in textbooks. Numerical calculations are based on evaluation of complete elliptic integrals using the Bulirsch algorithm cel. Since cel can evaluate complete elliptic integrals of a fairly general type, in some cases the elliptic integrals can be evaluated without first reducing them to forms containing standard Legendre forms. The algorithms avoid the numerical difficulties that many of the textbook solutions have for points near the axis because of explicit factors of 1=r or 1=r2 in the some of the expressions.

  12. Current Sensorless Control Algorithm for Single-Phase Three-Level NPC Inverter

    Directory of Open Access Journals (Sweden)

    Suzdalenko Alexander

    2014-12-01

    Full Text Available The current measurement is becoming a challenging task in power converters operating at high switching frequencies, moreover traditional control system requires two control loops - first (slow regulates DC-link voltage, second (fast controls the shape of current, that all together results in complicated transfer function and long transition periods. The current sensorless control (CSC allows neglecting the mentioned problems. This research for the first time presents the solution of CSC implementation in single-phase three-level neutral point clamped inverter. Mathematical equations were defined for inductor current peaks and transistor conduction time during discontinuous and continuous conduction modes, as well as major problem of current fitting between different voltage levels (consequently with different current peak-to-peak values was solved, providing two solutions - pre-fitting and post-fitting trajectories. The verification of our theoretical assumptions and analytical equations was confirmed by the simulation analysis. Challenges of real experiments are discussed in the conclusion.

  13. Comment on genetic and global algorithms for optimization of three-dimensional conformal radiotherapy treatment planning

    Energy Technology Data Exchange (ETDEWEB)

    Vaarkamp, Jaap [Joint Department of Physics, Royal Marsden NHS Trust, Sutton, Surrey (United Kingdom). E-mail: jaap@icr.ac.uk

    2001-06-01

    aspects considered much less important when originally designing the plan. However, it can not be concluded, as the authors do, that: 'The results showed that our plan is better than the manual plan.' (Wu and Zhu 2000). Second, the objective function the authors use seems too simple to be really capable of finding any clinically meaningful solutions. An incomplete and least-relevant set of OARs is defined, and in one case none at all, all OARs are weighted equally, and the dose limit to an OAR is specified by just one dose level. Very interesting is that for the brain examples and when defining only the left and right eye and either the thyroid or the spinal cord as OARs in the objective function, the optimal plan should be two lateral fields. That gives a 'perfectly' homogeneous dose to the target and the lowest scatter dose to both eyes and either thyroid oi spinal cord. To avoid any misunderstanding, that plan would in most cases not be clinically optimal, or even acceptable, but it leaves the very interesting question as to why this plan wasn't actually found in any of the three papers. Third, the authors seem to put all their efforts into replicating efficient, i.e. fast, function optimization algorithms. That is no surprise given their explicit statement: 'We believe that almost all 3D radiotherapy treatment planning problems are multiple-minima problems.' (Wu and Zhu 2001). However, even if true, is not the proper route to first design an objective function that incorporates and mimics the current body of clinical knowledge and then to see which optimization algorithms will be required? Perhaps we might be so lucky that a well-defined objective function is smooth near the global optimum (Aasell et al 1999, Soederstroem and Brahme 1993), or that the local optima are so close to each other that the treatment plans are not clinically different. Fourth, the authors must be using another definition for beam weights than is conventional

  14. Tratamiento actual del tabaquismo Current treatment for smoking

    Directory of Open Access Journals (Sweden)

    Justino Regalado-Pineda

    2007-01-01

    receptors blocker, rimonabant. As for non-pharmaceutical treatments, medical advice is a useful tool whose success can range from 2 to 4%, but only 35% of medical professionals provide it (RM 1.74, IC95% 1.48-2.05. Group psychological therapy helps to modify the perception of cigarettes and its noxious effects. The success of this modality is between 20% and 35% per year (RM 2.17, IC95% 1.42-3.45. Some of the disadvantages are the time invested and the cost of the treatment, which can be considerable. Finally, self-help materials can increase success (RM 1.24, IC95% 1.07-1.45. In summary, multiple modalities currently exist that have been proven effective in the treatment for quitting smoking; however, the treatment should be individualized according to each particular case.

  15. Optimization Of Pulsed Current Parameters To Minimize Pitting Corrosion İn Pulsed Current Micro Plasma Arc Welded Aısı 304l Sheets Using Genetic Algorithm

    Directory of Open Access Journals (Sweden)

    Kondapalli Siva Prasad

    2013-06-01

    Full Text Available Austenitic stainless steel sheets have gathered wide acceptance in the fabrication of components, which require high temperature resistance and corrosion resistance, such as metal bellows used in expansion joints in aircraft, aerospace and petroleum industry. In case of single pass welding of thinner sections of this alloy, Pulsed Current Micro Plasma Arc Welding (PCMPAW was found beneficial due to its advantages over the conventional continuous current process. This paper highlights the development of empirical mathematical equations using multiple regression analysis, correlating various process parameters to pitting corrosion rates in PCMPAW of AISI 304L sheets in 1 Normal HCl. The experiments were conducted based on a five factor, five level central composite rotatable design matrix. A Genetic Algorithm (GA was developed to optimize the process parameters for minimizing the pitting corrosion rates.

  16. Randomized algorithms for high quality treatment planning in volumetric modulated arc therapy

    Science.gov (United States)

    Yang, Yu; Dong, Bin; Wen, Zaiwen

    2017-02-01

    In recent years, volumetric modulated arc therapy (VMAT) has been becoming a more and more important radiation technique widely used in clinical application for cancer treatment. One of the key problems in VMAT is treatment plan optimization, which is complicated due to the constraints imposed by the involved equipments. In this paper, we consider a model with four major constraints: the bound on the beam intensity, an upper bound on the rate of the change of the beam intensity, the moving speed of leaves of the multi-leaf collimator (MLC) and its directional-convexity. We solve the model by a two-stage algorithm: performing minimization with respect to the shapes of the aperture and the beam intensities alternatively. Specifically, the shapes of the aperture are obtained by a greedy algorithm whose performance is enhanced by random sampling in the leaf pairs with a decremental rate. The beam intensity is optimized using a gradient projection method with non-monotonic line search. We further improve the proposed algorithm by an incremental random importance sampling of the voxels to reduce the computational cost of the energy functional. Numerical simulations on two clinical cancer date sets demonstrate that our method is highly competitive to the state-of-the-art algorithms in terms of both computational time and quality of treatment planning.

  17. Four-dimensional IMRT treatment planning using a DMLC motion-tracking algorithm

    Energy Technology Data Exchange (ETDEWEB)

    Suh, Yelin [Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA (United States); Sawant, Amit; Venkat, Raghu; Keall, Paul J [Department of Radiation Oncology, Stanford University, 875 Black Wilbur Drive, Stanford, CA 94305-5847 (United States)], E-mail: ysuh@stanford.edu

    2009-06-21

    The purpose of this study is to develop a four-dimensional (4D) intensity-modulated radiation therapy (IMRT) treatment-planning method by modifying and applying a dynamic multileaf collimator (DMLC) motion-tracking algorithm. The 4D radiotherapy treatment scenario investigated is to obtain a 4D treatment plan based on a 4D computed tomography (CT) planning scan and to have the delivery flexible enough to account for changes in tumor position during treatment delivery. For each of 4D CT planning scans from 12 lung cancer patients, a reference phase plan was created; with its MLC leaf positions and three-dimensional (3D) tumor motion, the DMLC motion-tracking algorithm generated MLC leaf sequences for the plans of other respiratory phases. Then, a deformable dose-summed 4D plan was created by merging the leaf sequences of individual phase plans. Individual phase plans, as well as the deformable dose-summed 4D plan, are similar for each patient, indicating that this method is dosimetrically robust to the variations of fractional time spent in respiratory phases on a given 4D CT planning scan. The 4D IMRT treatment-planning method utilizing the DMLC motion-tracking algorithm explicitly accounts for 3D tumor motion and thus hysteresis and nonlinear motion, and is deliverable on a linear accelerator.

  18. Current drug treatments targeting dopamine D3 receptor.

    Science.gov (United States)

    Leggio, Gian Marco; Bucolo, Claudio; Platania, Chiara Bianca Maria; Salomone, Salvatore; Drago, Filippo

    2016-09-01

    Dopamine receptors (DR) have been extensively studied, but only in recent years they became object of investigation to elucidate the specific role of different subtypes (D1R, D2R, D3R, D4R, D5R) in neural transmission and circuitry. D1-like receptors (D1R and D5R) and D2-like receptors (D2R, D2R and D4R) differ in signal transduction, binding profile, localization in the central nervous system and physiological effects. D3R is involved in a number of pathological conditions, including schizophrenia, Parkinson's disease, addiction, anxiety, depression and glaucoma. Development of selective D3R ligands has been so far challenging, due to the high sequence identity and homology shared by D2R and D3R. As a consequence, despite a rational design of selective DR ligands has been carried out, none of currently available medicines selectively target a given D2-like receptor subtype. The availability of the D3R ligand [(11)C]-(+)-PHNO for positron emission tomography studies in animal models as well as in humans, allows researchers to estimate the expression of D3R in vivo; displacement of [(11)C]-(+)-PHNO binding by concurrent drug treatments is used to estimate the in vivo occupancy of D3R. Here we provide an overview of studies indicating D3R as a target for pharmacological therapy, and a review of market approved drugs endowed with significant affinity at D3R that are used to treat disorders where D3R plays a relevant role.

  19. Pharmacological Treatments of Alzheimer’s Disease: Current Medication,

    Directory of Open Access Journals (Sweden)

    Arash Mowla

    2010-12-01

    Full Text Available Background: Alzheimer’s disease (AD that is identified by progressive cognitive deficit and behavioral disturbances (BD are the most common form of dementia. As the population is aging, patients with AD are becoming a serious burden for societies. In this study, current medication for cognitive deficit and behavioral disturbances are reviewed. Also the new treatment strategies for cognitive dysfunction and behavioral disturbances are surveyed. Methods: The method employed in this researh was a systematic bibliographic review, in which only the double-blind placebo-controlled studies or the clinically detailed enough open-labeled studies using validated scales were retained. Results: The efficacy of cholinesterase inhibitors (Tacrine, Rivastigmine, Donapezil and Galantamine has been demonstrated in several double blind placebo controlled clinical trials. They have shown a mild efficacy in mild to moderate AD. Memantine, a NMDA antagonist is the only drug that has demonstrated mild efficacy in moderate to severe AD in controlled clinical trial. Clinical trials surveying the efficacy of active and passive immunization against B amyloid protoin has halted due to serious adverse events. Studies of inducing neurogenesis in brain of AD patients are preliminary. Antipsychotics have shown efficacy for controlling BD of AD patients but they are associated with adverse events. Except for carbamazepine, there is not enough evidence for other anticanvulsants to be effective for behavioral disturbances of AD patients. A controlled clinical trial and some open studies have shown the efficacy of citalopram for BD. Further studies are needed to confirm the efficacy of other medications like trazadon, buspiron and beta blockers for BD. Conclusion: Cholinesterase inhibitors have demonstrated disappointing results. Memantine is only mildly effective for cognitive deficit. To date, no amyloid-modifying therapy has yet been successful in phase 3 clinical trials

  20. Tratamento atual dos miomas Current treatment of leiomyomas

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    Helena von Eye Corleta

    2007-06-01

    Full Text Available Leiomiomas são tumores benignos. Eles surgem no miométrio e contêm quantidade variável de tecido conjuntivo fibroso. Cerca de 75% dos casos são assintomáticos, encontrados ocasionalmente durante exame abdominal, pélvico bimanual ou ultra-sonografia. Os sintomas são relacionados diretamente ao tamanho, ao número e à localização dos miomas. Nessa revisão, são apresentadas as abordagens terapêuticas atuais clínicas (anticoncepcionais orais, progestágenos e antiprogestágenos, análogos do hormônio liberador das gonadotrofinas (GnRH, e antiinflamatórios não esteróides e cirúrgicas (histerectomia, miomectomia e embolização para o tratamento de leiomiomas.Leiomyomas are benign tumors. They appear in the myometrium and present a variable amount of fibrous conjunctive tissue. About 75% of the cases are not symptomatic and are usually found during abdominal, bimanual pelvic examination or during ultrasonography. The symptoms are directly related to the size, number and localization of the myomas. In the present review, the current clinical therapeutic procedures (oral anti-conceptive drugs, progestins and anti-progestins, analogues of the gonadothrophins’ releasing hormone (GnRH, and non-steroid anti-inflammatory drugs, and also the surgical procedures (hysterectomy, myomectomy, embolization are presented for the treatment of leiomyomas.

  1. Current trends in colchicine treatment in familial Mediterranean fever.

    Science.gov (United States)

    La Regina, Micaela; Ben-Chetrit, Eldad; Gasparyan, Armen Yuri; Livneh, Avi; Ozdogan, Huri; Manna, Raffaele

    2013-01-01

    Since the publication of the first reports on the efficiency of colchicine in familial Mediterranean fever (FMF), very few randomised studies have investigated issues related to its long-term use. Thus, different approaches taken by physicians involved in FMF care, are exclusively empiric, emulative, and based on case-reports or case-series. Problems such as colchicine intolerance and colchicine resistance have not been solved yet. This paper aims to evaluate trends in colchicine therapy among physicians taking care of FMF patients around the world. We conducted a survey by sending questionnaires to FMF research and treatment centres in Europe and Asia. Many issues (such as dosages, schedules, side effects, interactions, efficacy and toxicity monitoring, definition of colchicine intolerance, colchicine resistance and responsiveness, etc) have been investigated. When more than 70% of physicians responded giving similar answers to an item, the response was considered as a 'trend'. A comparison between answers of physicians from FMF-prevalent and non-prevalent countries was also made. Thirty-five physicians from 11 countries filled the questionnaires, taking care of a total of more than 15000 FMF patients (pts). Different approaches were evident among the various physicians. Statistically significant different approaches between physicians from FMF-prevalent countries with respect to those from non-prevalent countries were found in items like colchicine during pregnancy, severity score and blood tests for disease monitoring. No consensus was found regarding the definition of colchicine resistance. The current study demonstrated significant variations in the strategy of colchicine therapy for FMF around the world and re-emphasised the need for standardised definitions of colchicine resistance and colchicine intolerance.

  2. Current treatment of oral candidiasis: a literature review

    OpenAIRE

    Garcia Cuesta, Carla; Sarrión Pérez, María Gracia; Bagán Sebastián, José Vicente

    2014-01-01

    Candidiasis or oral candidosis is one of the most common human opportunistic fungal infections of the oral cavity. This pathology has a wide variety of treatment which has been studied until these days. The present study offers a literature review on the treatment of oral candidiasis, with the purpose of establish which treatment is the most suitable in each case. Searching the 24 latest articles about treatment of candidiasis it concluded that the incidence depends on the type of the candidi...

  3. Current treatment of oral candidiasis: A literature review

    OpenAIRE

    Garcia Cuesta, Carla; Sarrión Pérez, María Gracia; Bagán Sebastián, José Vicente

    2014-01-01

    Candidiasis or oral candidosis is one of the most common human opportunistic fungal infections of the oral cavity. This pathology has a wide variety of treatment which has been studied until these days. The present study offers a literature review on the treatment of oral candidiasis, with the purpose of establish which treatment is the most suitable in each case. Searching the 24 latest articles about treatment of candidiasis it concluded that the incidence depends on the type of the candidi...

  4. HOW DOES FINGOLIMOD (GILENYA® FIT IN THE TREATMENT ALGORITHM FOR HIGHLY ACTIVE RELAPSING-REMITTING MULTIPLE SCLEROSIS?

    Directory of Open Access Journals (Sweden)

    Franz eFazekas

    2013-05-01

    Full Text Available Multiple sclerosis (MS is a neurological disorder characterised by inflammatory demyelination and neurodegeneration in the central nervous system (CNS. Until recently, disease modifying treatment was based on agents requiring parenteral delivery, thus limiting long-term compliance. Basic treatments such as beta-interferon provide only moderate efficacy, and although therapies for second-line treatment and highly active MS are more effective, they are associated with potentially severe side effects. Fingolimod (Gilenya® is the first oral treatment of MS and has recently been approved as single disease-modifying therapy in highly active relapsing-remitting multiple sclerosis (RRMS for adult patients with high disease activity despite basic treatment (beta-interferon and for treatment-naïve patients with rapidly evolving severe RRMS. At a scientific meeting that took place in Vienna on November 18th, 2011, experts from 10 Central and Eastern European countries discussed the clinical benefits and potential risks of fingolimod for MS, suggested how the new therapy fits within the current treatment algorithm and provided expert opinion for the selection and management of patients.

  5. Radiotherapy treatment planning with dynamic wedges--an algorithm for generating wedge factors and beam data.

    Science.gov (United States)

    Thomas, S J; Foster, K R

    1995-09-01

    If the jaws of a linear accelerator are moved under computer control during irradiation, dose distributions similar to those with wedge filters can be produced. Varian linear accelerators utilize this effect to give a 'dynamic wedge', using segmented treatment tables (STTs). An algorithm is described to generate the dose per monitor unit at any point in a beam, using the STT values. Dynamically wedged beams are modelled as the superposition of static asymmetric beams, using an algorithm based on beam data measured for symmetric beams. Predictions of wedge factors, depth doses and profiles generated using the algorithm are compared with measurements. Good agreement is found between predictions and measurements. The calculation time is typically 5 ms/dose point on a PC with a 486DX processor.

  6. Advantages of multiple algorithm support in treatment planning system for external beam dose calculations

    Directory of Open Access Journals (Sweden)

    Animesh

    2005-01-01

    Full Text Available The complexity of interactions and the nature of the approximations made in the formulation of the algorithm require that the user be familiar with the limitations of various models. As computer power keeps growing, calculation algorithms are tending more towards physically based models. The nature and quantity of the data required varies according to the model which may be either measurement based models or physical based models. Multiple dose calculation algorithm support found in XiO Treatment Planning System can be used to advantage when choice is to be made between speed and accuracy. Thus XiO allows end users generate plans accurately and quickly to optimize the delivery of radiation therapy.

  7. Latin American algorithm for treatment of relapsing-remitting multiple sclerosis using disease-modifying agents

    Directory of Open Access Journals (Sweden)

    Alessandro Finkelsztejn

    2012-10-01

    Full Text Available OBJECTIVE: It is estimated that circa 50,000 individuals have relapsing-remitting multiple sclerosis in Latin America. European and North-American algorithms for the treatment of multiple sclerosis do not foresee our regional difficulties and the access of patients to treatment. METHODS: The Latin American Multiple Sclerosis Forum is an independent and supra-institutional group of experts that has assessed the latest scientific evidence regarding efficacy and safety of disease-modifying treatments. Accesses to treatment and pharmacovigilance programs for each of the eight countries represented at the Forum were also analyzed. RESULTS: A specific set of guidelines based upon evidence-based recommendations was designed for Latin America. Future perspectives of multiple sclerosis treatment were also discussed. CONCLUSIONS: The present paper translated an effort from representatives of eight countries discussing a matter that cannot be adapted to our region directly from purely European and North-American guidelines for treatment.

  8. A computational implementation and comparison of several intensity modulated proton therapy treatment planning algorithms.

    Science.gov (United States)

    Li, Haisen S; Romeijn, H Edwin; Fox, Christopher; Palta, Jatinder R; Dempsey, James F

    2008-03-01

    The authors present a comparative study of intensity modulated proton therapy (IMPT) treatment planning employing algorithms of three-dimensional (3D) modulation, and 2.5-dimensional (2.5D) modulation, and intensity modulated distal edge tracking (DET) [A. Lomax, Phys. Med. Biol. 44, 185-205 (1999)] applied to the treatment of head-and-neck cancer radiotherapy. These three approaches were also compared with 6 MV photon intensity modulated radiation therapy (IMRT). All algorithms were implemented in the University of Florida Optimized Radiation Therapy system using a finite sized pencil beam dose model and a convex fluence map optimization model. The 3D IMPT and the DET algorithms showed considerable advantages over the photon IMRT in terms of dose conformity and sparing of organs at risk when the beam number was not constrained. The 2.5D algorithm did not show an advantage over the photon IMRT except in the dose reduction to the distant healthy tissues, which is inherent in proton beam delivery. The influences of proton beam number and pencil beam size on the IMPT plan quality were also studied. Out of 24 cases studied, three cases could be adequately planned with one beam and 12 cases could be adequately planned with two beams, but the dose uniformity was often marginally acceptable. Adding one or two more beams in each case dramatically improved the dose uniformity. The finite pencil beam size had more influence on the plan quality of the 2.5D and DET algorithms than that of the 3D IMPT. To obtain a satisfactory plan quality, a 0.5 cm pencil beam size was required for the 3D IMPT and a 0.3 cm size was required for the 2.5D and the DET algorithms. Delivery of the IMPT plans produced in this study would require a proton beam spot scanning technique that has yet to be developed clinically.

  9. [Impact of optimization algorithms on the intensity map in IMRT treatment planning.].

    Science.gov (United States)

    Shimada, Mari; Nakamura, Mitsuhiro; Miyabe, Yuki; Yamamoto, Tokihiro; Teshima, Teruki; Narita, Yuichiro; Mizowaki, Takashi; Nagata, Yasushi; Hiraoka, Masahiro

    2006-01-01

    In inverse planning of IMRT, optimum intensity maps are generated using an optimization algorithm. In this paper, impacts of two different optimization algorithms on the intensity map in IMRT treatment planning were evaluated. These were from the steepest descent (SD) and simulated annealing (SA) methods. The following five patterns were compared: [1] SD with calculation time of 5 min; [2] SD with the terminal criterion based on cost function; [3] SA with calculation time of 5 min; [4] SA with the terminal criterion; and [5] SA with the terminal criterion using a smoothing filter. Differences of D(95%) for the planning target volume, V(70Gy) for the rectum wall and the bladder wall were up to 0.5, 1.8 and 3.2 %, respectively in all patterns. The dosimetric impact was negligible. In contrast, generated intensity maps were sensitive to the algorithms. Intensity maps generated by SA tended to have much fluctuation due to numerical artifacts compared to those generated by SD. The difference in the profile was over 7 % between the algorithms. The smoothing filter decreased the fluctuation in intensity maps of SA. In conclusion, it is important to understand impacts of optimization algorithms on the intensity map and the dose distribution.

  10. Enhancements to commissioning techniques and quality assurance of brachytherapy treatment planning systems that use model-based dose calculation algorithms.

    Science.gov (United States)

    Rivard, Mark J; Beaulieu, Luc; Mourtada, Firas

    2010-06-01

    The current standard for brachytherapy dose calculations is based on the AAPM TG-43 formalism. Simplifications used in the TG-43 formalism have been challenged by many publications over the past decade. With the continuous increase in computing power, approaches based on fundamental physics processes or physics models such as the linear-Boltzmann transport equation are now applicable in a clinical setting. Thus, model-based dose calculation algorithms (MBDCAs) have been introduced to address TG-43 limitations for brachytherapy. The MBDCA approach results in a paradigm shift, which will require a concerted effort to integrate them properly into the radiation therapy community. MBDCA will improve treatment planning relative to the implementation of the traditional TG-43 formalism by accounting for individualized, patient-specific radiation scatter conditions, and the radiological effect of material heterogeneities differing from water. A snapshot of the current status of MBDCA and AAPM Task Group reports related to the subject of QA recommendations for brachytherapy treatment planning is presented. Some simplified Monte Carlo simulation results are also presented to delineate the effects MBDCA are called to account for and facilitate the discussion on suggestions for (i) new QA standards to augment current societal recommendations, (ii) consideration of dose specification such as dose to medium in medium, collisional kerma to medium in medium, or collisional kerma to water in medium, and (iii) infrastructure needed to uniformly introduce these new algorithms. Suggestions in this Vision 20/20 article may serve as a basis for developing future standards to be recommended by professional societies such as the AAPM, ESTRO, and ABS toward providing consistent clinical implementation throughout the brachytherapy community and rigorous quality management of MBDCA-based treatment planning systems.

  11. A new algorithm for attitude-independent magnetometer calibration

    Science.gov (United States)

    Alonso, Roberto; Shuster, Malcolm D.

    1994-01-01

    A new algorithm is developed for inflight magnetometer bias determination without knowledge of the attitude. This algorithm combines the fast convergence of a heuristic algorithm currently in use with the correct treatment of the statistics and without discarding data. The algorithm performance is examined using simulated data and compared with previous algorithms.

  12. Models and Algorithms for Production Planning and Scheduling in Foundries – Current State and Development Perspectives

    Directory of Open Access Journals (Sweden)

    A. Stawowy

    2012-04-01

    Full Text Available Mathematical programming, constraint programming and computational intelligence techniques, presented in the literature in the field of operations research and production management, are generally inadequate for planning real-life production process. These methods are in fact dedicated to solving the standard problems such as shop floor scheduling or lot-sizing, or their simple combinations such as scheduling with batching. Whereas many real-world production planning problems require the simultaneous solution of several problems (in addition to task scheduling and lot-sizing, the problems such as cutting, workforce scheduling, packing and transport issues, including the problems that are difficult to structure. The article presents examples and classification of production planning and scheduling systems in the foundry industry described in the literature, and also outlines the possible development directions of models and algorithms used in such systems.

  13. Adaptive Hybrid Fuzzy-Proportional Plus Crisp-Integral Current Control Algorithm for Shunt Active Power Filter Operation

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    Nor Farahaida Abdul Rahman

    2016-09-01

    Full Text Available An adaptive hybrid fuzzy-proportional plus crisp-integral current control algorithm (CCA for regulating supply current and enhancing the operation of a shunt active power filter (SAPF is presented. It introduces a unique integration of fuzzy-proportional (Fuzzy-P and crisp-integral (Crisp-I current controllers. The Fuzzy-P current controller is developed to perform gain tuning procedure and proportional control action. This controller inherits the simplest configuration; it is constructed using a single-input single-output fuzzy rule configuration. Thus, an execution of few fuzzy rules is sufficient for the controller’s operation. Furthermore, the fuzzy rule is developed using the relationship of currents only. Hence, it simplifies the controller development. Meanwhile, the Crisp-I current controller is developed to perform integral control action using a controllable gain value; to improve the steady-state control mechanism. The gain value is modified and controlled using the Fuzzy-P current controller’s output variable. Therefore, the gain value will continuously be adjusted at every sample period (or throughout the SAPF operation. The effectiveness of the proposed CCA in regulating supply current is validated in both simulation and experimental work. All results have proven that the SAPF using the proposed CCA is capable to regulate supply current during steady-state and dynamic-state operations. At the same time, the SAPF is able to enhance its operation in compensating harmonic currents and reactive power. Furthermore, the implementation of the proposed CCA has resulted more stable dc-link voltage waveform.

  14. Digital Technologies in Providing Development of Algorithms Surgical Treatment of Supraventricular Arrhythmias

    Directory of Open Access Journals (Sweden)

    Evtushenko Vladimir

    2016-01-01

    Full Text Available The aim of the study was the development and clinical application of patient selection algorithm for surgical treatment of longlasting persistent atrial fibrillation. The study included 235 patients with acquired heart disease and coronary artery disease, which in the period from 1999 to 2015 performed surgical treatment of long-term persistent atrial fibrillation (RF “MAZE III” procedure in conjunction with the correction of the underlying heart disease. The patients were divided into 2 groups according to the method of operation: the group 1 – 135 patients (76 women and 59 men who have applied an integrated approach to surgery for atrial fibrillation, including penetrating method of RF effects on atrial myocardium and the study of the function of the sinus node before and after the operation (these patients were operated on from 2008 to 2015. The group 2 – 100 patients (62 women and 38 men with a “classical” method of monopolar RF “MAZE III”, which the sinus node function was not studied. We used the combined (epi- and endocardial method of RF «MAZE». This algorithm is decreasing of possible permanent pacemaker postoperatively. The initial sinus node function in these patients, measured using the original method, the basic line of this algorithm was taken. The results showed that use this algorithm for selection of patients allows significantly reduce the possibility of pacemaker implantation in the postoperative period.

  15. Joint Custody: Current Issues and Implications for Treatment.

    Science.gov (United States)

    Richards, Carol A.; Goldenberg, Irene

    1985-01-01

    Describes what joint physical custody involves, the kinds of families who currently have this type of custody arrangement, and the effects on parents and children. Current research supporting two perspectives on joint custody, one emphasizing the continuity of psychological care from one parent, the other emphasizing the importance of the father's…

  16. Current role of rufinamide in the treatment of childhood epilepsy: literature review and treatment guidelines.

    Science.gov (United States)

    Coppola, Giangennaro; Besag, Frank; Cusmai, Raffaella; Dulac, Olivier; Kluger, Gerhard; Moavero, Romina; Nabbout, Rima; Nikanorova, Marina; Pisani, Francesco; Verrotti, Alberto; von Stülpnagel, Celina; Curatolo, Paolo

    2014-11-01

    The literature on the efficacy and safety of rufinamide in childhood-onset epilepsy syndromes currently includes approximately 600 paediatric patients. This paper summarizes the views of a panel of experienced European epileptologists with regard to the current role of rufinamide in the treatment of childhood epilepsies. Rufinamide is effective in decreasing the seizure frequency in the Lennox-Gastaut syndrome (LGS), especially tonic and atonic seizures. It might consequently be preferred to other drugs as a second-line treatment for LGS when drop-attacks are frequent. The mean responder rate in the published studies is 38% with seizure freedom achieved in 2.4% of patients. Rufinamide has shown some efficacy in epileptic encephalopathies other than LGS. It can be also effective as adjunctive therapy in children and adolescents with drug-resistant partial seizures. The available data suggest that rufinamide has an acceptable risk/benefit ratio with quite a low risk of aggravating seizures. Common adverse effects (somnolence, nausea and vomiting) are usually mild and self-limiting; they are more frequently observed during titration than in the maintenance phase, suggesting that low escalation rates might be associated with fewer adverse effects. Rufinamide appears to have a favourable cognitive profile compared with other antiepileptic drugs. Rufinamide is only approved for adjunctive treatment of seizures associated with LGS in children 4 years of age and older. There are very few data on rufinamide treatment at the onset of LGS or early in the course of the disorder; whether early treatment will improve outcome has yet to be determined. Copyright © 2014 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  17. Current treatment options for management of anal intraepithelial neoplasia

    Science.gov (United States)

    Weis, Stephen E

    2013-01-01

    Anal squamous cell cancer is an uncommon malignancy caused by infection with oncogenic strains of Human papilloma virus. Anal cancer is much more common in immunocompromised persons, including those infected with Human immunodeficiency virus. High-grade anal intraepithelial neoplasia (HGAIN), the precursor of anal cancer, is identified by clinicians providing care for patients with anorectal disease, and is increasingly being identified during screening of immunosuppressed patients for anal dysplasia. The traditional treatment for HGAIN has been excision of macroscopic disease with margins. This approach is effective for patients with small unifocal HGAIN lesions. Patients with extensive multifocal HGAIN frequently have recurrence of HGAIN after excision, and may have postoperative complications of anal stenosis or fecal incontinence. This led to the suggestion by some that treatment for HGAIN should be delayed until patients developed anal cancer. Alternative approaches in identification and treatment have been developed to treat patients with multifocal or extensive HGAIN lesions. High-resolution anoscopy combines magnification with anoscopy and is being used to identify HGAIN and determine treatment margins. HGAIN can then be ablated with a number of modalities, including infrared coagulation, CO2 laser, and electrocautery. These methods for HGAIN ablation can be performed with local anesthesia on outpatients and are relatively well tolerated. High-resolution anoscopy-directed HGAIN ablation is evolving into a standard approach for initial treatment and then subsequent monitoring of a disease which should be expected to be recurrent. Another treatment approach for HGAIN is topical treatment, principally with 5-fluorouracil or imiquimod. Topical therapies have the advantage of being nonsurgical and are well suited for treating widespread multifocal disease. Topical treatments have the disadvantage of requiring extended treatment courses and causing a symptomatic

  18. Current multiple myeloma treatment strategies with novel agents

    DEFF Research Database (Denmark)

    Ludwig, Heinz; Beksac, Meral; Bladé, Joan

    2010-01-01

    The treatment of multiple myeloma (MM) has undergone significant developments in recent years. The availability of the novel agents thalidomide, bortezomib, and lenalidomide has expanded treatment options and has improved the outcome of patients with MM. Following the introduction of these agents...

  19. Seasonal affective disorder, winter type : current insights and treatment options

    NARCIS (Netherlands)

    Meesters, Ybe; Gordijn, Margaretha

    2016-01-01

    Seasonal affective disorder (SAD), winter type, is a seasonal pattern of recurrent major depressive episodes most commonly occurring in autumn or winter and remitting in spring/summer. The syndrome has been well-known for more than three decades, with light treatment being the treatment of first

  20. Cryogenic heat treatment — a review of the current state

    Directory of Open Access Journals (Sweden)

    Kamran Amini

    2017-03-01

    Full Text Available The deep cryogenic heat treatment is an old and effective heat treatment, performed on steels and cast irons to improve the wear resistance and hardness. This process includes cooling down to the liquid nitrogen temperature, holding the samples at that temperature and heating at the room temperature. The benefits of this process are significant on the ferrous materials, but recently some studies focused on other nonferrous materials. This study attempts to clarify the different behavior of some materials subjected to the deep cryogenic heat treatment, as well as explaining the common theories about the effect of the cryogenic heat treatment on these materials. Results showed that polymers exhibit different behavior regarding to their crystallinity, however the magnesium alloys, titanium alloys and tungsten carbide show a noticeable improvement after the deep cryogenic heat treatment due to their crystal structure.

  1. Treatment of congenital pseudarthrosis of the tibia with direct current.

    Science.gov (United States)

    Lavine, L S; Lustrin, I; Shamos, M H

    1977-05-01

    Bone possesses a bioelectric property that is important in maintaining its structural and architectural integrity. In vivo experiments demonstrate that bone formation can be accelerated by the application of direct current. We hypothesize that bone formation occurs through an electrochemical rather than an electromechanical effect. Two cases of congenital pseudarthrosis of the tibia treated by direct current stimulation are presented. A bone graft may be added to enhance bony union in conjunction with direct current. The implications of this work are that there is need for further fundamental studies including ultrastructural observations.

  2. Seasonal affective disorder, winter type: current insights and treatment options

    Directory of Open Access Journals (Sweden)

    Meesters Y

    2016-11-01

    Full Text Available Ybe Meesters,1 Marijke CM Gordijn,2,3 1University Center for Psychiatry, University Medical Center Groningen, 2Department of Chronobiology, GeLifes, University of Groningen, Groningen, the Netherlands; 3Chrono@Work B.V., Groningen, the Netherlands Abstract: Seasonal affective disorder (SAD, winter type, is a seasonal pattern of recurrent major depressive episodes most commonly occurring in autumn or winter and remitting in spring/summer. The syndrome has been well-known for more than three decades, with light treatment being the treatment of first choice. In this paper, an overview is presented of the present insights in SAD. Description of the syndrome, etiology, and treatment options are mentioned. Apart from light treatment, medication and psychotherapy are other treatment options. The predictable, repetitive nature of the syndrome makes it possible to discuss preventive treatment options. Furthermore, critical views on the concept of SAD as a distinct diagnosis are discussed. Keywords: seasonal affective disorder, review, light treatment, medication, psychotherapy, prevention

  3. Current treatment of oral candidiasis: A literature review.

    Science.gov (United States)

    Garcia-Cuesta, Carla; Sarrion-Pérez, Maria-Gracia; Bagán, Jose V

    2014-12-01

    Candidiasis or oral candidosis is one of the most common human opportunistic fungal infections of the oral cavity. This pathology has a wide variety of treatment which has been studied until these days. The present study offers a literature review on the treatment of oral candidiasis, with the purpose of establish which treatment is the most suitable in each case. Searching the 24 latest articles about treatment of candidiasis it concluded that the incidence depends on the type of the candidiasis and the virulence of the infection. Although nystatin and amphotericin b were the most drugs used locally, fluconazole oral suspension is proving to be a very effective drug in the treatment of oral candidiasis. Fluconazole was found to be the drug of choice as a systemic treatment of oral candidiasis. Due to its good antifungal properties, its high acceptance of the patient and its efficacy compared with other antifungal drugs. But this drug is not always effective, so we need to evaluate and distinguish others like itraconazole or ketoconazole, in that cases when Candida strains resist to fluconazole. Key words:Candidiasis, treatment, miconazole, fluconazole, nystatin.

  4. Depression in Parkinson Disease: Current Understanding and Treatment

    Directory of Open Access Journals (Sweden)

    Pei-Hao Chen

    2008-12-01

    Full Text Available Depression has a negative impact on activities of daily living, cognitive performance, and quality of life. Despite the high prevalence of depressive symptoms in Parkinson disease (PD, this important clinical feature is under-recognized by physicians. Effective diagnosis, assessment and treatment of depression are, therefore, important aspects of PD management. In this article, we review the literature concerning depression associated with PD, paying specific attention to clinical presentation, diagnosis, etiology, and the principles of management and treatment. The efficacy and safety of antidepressants must rely on empiric assessments of known risks and putative benefits to guide treatment decisions.

  5. Current concepts in the assessment and treatment of hepatic encephalopathy.

    LENUS (Irish Health Repository)

    Cash, W J

    2012-02-01

    Hepatic encephalopathy (HE) is defined as a metabolically induced, potentially reversible, functional disturbance of the brain that may occur in acute or chronic liver disease. Standardized nomenclature has been proposed but a standardized approach to the treatment, particularly of persistent, episodic and recurrent encephalopathy associated with liver cirrhosis has not been proposed. This review focuses on the pathogenesis and treatment of HE in patients with cirrhosis. The pathogenesis and treatment of hepatic encephalopathy in fulminant hepatic failure is quite different and is reviewed elsewhere.

  6. Development of a novel algorithm to determine adherence to chronic pain treatment guidelines using administrative claims

    Science.gov (United States)

    Margolis, Jay M; Princic, Nicole; Smith, David M; Abraham, Lucy; Cappelleri, Joseph C; Shah, Sonali N; Park, Peter W

    2017-01-01

    Objective To develop a claims-based algorithm for identifying patients who are adherent versus nonadherent to published guidelines for chronic pain management. Methods Using medical and pharmacy health care claims from the MarketScan® Commercial and Medicare Supplemental Databases, patients were selected during July 1, 2010, to June 30, 2012, with the following chronic pain conditions: osteoarthritis (OA), gout (GT), painful diabetic peripheral neuropathy (pDPN), post-herpetic neuralgia (PHN), and fibromyalgia (FM). Patients newly diagnosed with 12 months of continuous medical and pharmacy benefits both before and after initial diagnosis (index date) were categorized as adherent, nonadherent, or unsure according to the guidelines-based algorithm using disease-specific pain medication classes grouped as first-line, later-line, or not recommended. Descriptive and multivariate analyses compared patient outcomes with algorithm-derived categorization endpoints. Results A total of 441,465 OA patients, 76,361 GT patients, 10,645 pDPN, 4,010 PHN patients, and 150,321 FM patients were included in the development of the algorithm. Patients found adherent to guidelines included 51.1% for OA, 25% for GT, 59.5% for pDPN, 54.9% for PHN, and 33.5% for FM. The majority (~90%) of patients adherent to the guidelines initiated therapy with prescriptions for first-line pain medications written for a minimum of 30 days. Patients found nonadherent to guidelines included 30.7% for OA, 6.8% for GT, 34.9% for pDPN, 23.1% for PHN, and 34.7% for FM. Conclusion This novel algorithm used real-world pharmacotherapy treatment patterns to evaluate adherence to pain management guidelines in five chronic pain conditions. Findings suggest that one-third to one-half of patients are managed according to guidelines. This method may have valuable applications for health care payers and providers analyzing treatment guideline adherence. PMID:28223842

  7. Endovascular and microsurgical treatment of cerebral arteriovenous malformations: Current recommendations

    Directory of Open Access Journals (Sweden)

    Andrew Conger

    2015-01-01

    Conclusions: These lesions are among the most technically difficult pathological entities handled by the cerebrovascular specialist, and an overview of technical concepts to help systematize this challenging and variable endeavor can improve the safety of their treatment.

  8. Fault Diagnosis System of Induction Motors Based on Neural Network and Genetic Algorithm Using Stator Current Signals

    Directory of Open Access Journals (Sweden)

    Tian Han

    2006-01-01

    Full Text Available This paper proposes an online fault diagnosis system for induction motors through the combination of discrete wavelet transform (DWT, feature extraction, genetic algorithm (GA, and neural network (ANN techniques. The wavelet transform improves the signal-to-noise ratio during a preprocessing. Features are extracted from motor stator current, while reducing data transfers and making online application available. GA is used to select the most significant features from the whole feature database and optimize the ANN structure parameter. Optimized ANN is trained and tested by the selected features of the measurement data of stator current. The combination of advanced techniques reduces the learning time and increases the diagnosis accuracy. The efficiency of the proposed system is demonstrated through motor faults of electrical and mechanical origins on the induction motors. The results of the test indicate that the proposed system is promising for the real-time application.

  9. Current treatment options for management of anal intraepithelial neoplasia

    Directory of Open Access Journals (Sweden)

    Weis SE

    2013-06-01

    Full Text Available Stephen E Weis1,2 1Division of Dermatology, Department of Internal Medicine, University of North Texas Health Science Center at Fort Worth, 2Preventive Medicine Clinic, Tarrant County Public Health, Fort Worth, TX, USA Abstract: Anal squamous cell cancer is an uncommon malignancy caused by infection with oncogenic strains of Human papilloma virus. Anal cancer is much more common in immunocompromised persons, including those infected with Human immunodeficiency virus. High-grade anal intraepithelial neoplasia (HGAIN, the precursor of anal cancer, is identified by clinicians providing care for patients with anorectal disease, and is increasingly being identified during screening of immunosuppressed patients for anal dysplasia. The traditional treatment for HGAIN has been excision of macroscopic disease with margins. This approach is effective for patients with small unifocal HGAIN lesions. Patients with extensive multifocal HGAIN frequently have recurrence of HGAIN after excision, and may have postoperative complications of anal stenosis or fecal incontinence. This led to the suggestion by some that treatment for HGAIN should be delayed until patients developed anal cancer. Alternative approaches in identification and treatment have been developed to treat patients with multifocal or extensive HGAIN lesions. High-resolution anoscopy combines magnification with anoscopy and is being used to identify HGAIN and determine treatment margins. HGAIN can then be ablated with a number of modalities, including infrared coagulation, CO2 laser, and electrocautery. These methods for HGAIN ablation can be performed with local anesthesia on outpatients and are relatively well tolerated. High-resolution anoscopy-directed HGAIN ablation is evolving into a standard approach for initial treatment and then subsequent monitoring of a disease which should be expected to be recurrent. Another treatment approach for HGAIN is topical treatment, principally with 5

  10. Optimizing pulsed current gas tungsten arc welding parameters of AA6061 aluminium alloy using Hooke and Jeeves algorithm

    Institute of Scientific and Technical Information of China (English)

    S. BABU; T. SENTHIL KUMAR; V. BALASUBRAMANIAN

    2008-01-01

    Though the preferred welding process to weld aluminium alloy is frequently constant current gas tungsten arc welding (CCGTAW), it resulted in grain coarsening at the fusion zone and heat affected zone(HAZ). Hence, pulsed current gas tungsten arc welding(PCGTAW) was performed, to yield finer fusion zone grains, which leads to higher strength of AA6061 (Al-Mg-Si) aluminium alloy joints. In order to determine the most influential control factors which will yield minimum fusion zone grain size and maximum tensile strength of the joints, the traditional Hooke and Jeeves pattern search method was used. The experiments were carried out based on central composite design with 31 runs and an algorithm was developed to optimize the fusion zone grain size and the tensile strength of pulsed current gas tungsten arc welded AA6061 aluminium aUoy joints. The results indicate that the peak current (Ip) and base current (IB) are the most significant parameters, to decide the fusion zone grain size and the tensile strength of the AA6061 aluminum alloy joints.

  11. Current treatment of dyslipidaemia: PCSK9 inhibitors and statin intolerance.

    OpenAIRE

    Koskinas,Konstantinos; Wilhelm, Matthias; Windecker, Stephan

    2016-01-01

    Statins are the cornerstone of the management of dyslipidaemias and prevention of cardiovascular disease. Although statins are, overall, safe and well tolerated, adverse events can occur and constitute an important barrier to maintaining long-term adherence to statin treatment. In patients who cannot tolerate statins, alternative treatments include switch to another statin, intermittent-dosage regimens and non-statin lipid-lowering medications. Nonetheless, a high proportion of statin-intoler...

  12. Treatment of periodontal patients-current clinical concepts

    Institute of Scientific and Technical Information of China (English)

    Cristiano Tomasi; Claudio Soldini; Jan L Wennstr(o)m

    2007-01-01

    The main goal of the treatment of patients with periodontitis is to establish adequate infection control.To satisfy demands for acceptable aesthetics and chewing function with good long-term prognosis in patients with periodontitis requires the establishment of adequate infection control.Pocket instrumentation (scaling and root planing with or without flap elevation),combined with effective self-performed supragingival plaque control measures,constitutes the basic treatment modalities.

  13. An open-label study of algorithm-based treatment versus treatment-as-usual for patients with schizophrenia

    Directory of Open Access Journals (Sweden)

    Hirano J

    2013-10-01

    Full Text Available Jinichi Hirano,1,2 Koichiro Watanabe,3 Takefumi Suzuki,1,4 Hiroyuki Uchida,1 Ryosuke Den,5 Taishiro Kishimoto,1 Takashi Nagasawa,5 Yusuke Tomita,4 Koichiro Hara,6 Hiromi Ochi,7 Yoshimi Kobayashi,1 Mutsuko Ishii,1 Akane Fujita,1 Yoshihiko Kanai,1 Megumi Goto,1 Hiromi Hayashi,1 Kanako Inamura,1 Fumiko Ooshima,1 Mariko Sumida,1 Tomoko Ozawa,1 Kayoko Sekigawa,1 Maki Nagaoka,1 Kae Yoshimura,1 Mika Konishi,1 Ataru Inagaki,1 Takuya Saito,8 Nobutaka Motohashi,9 Masaru Mimura,1 Yoshiro Okubo,8 Motoichiro Kato,11Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; 2Ohizumi Hospital, Tokyo, Japan; 3Department of Psychiatry School of Medicine, Kyorin University, Tokyo, Japan; 4Inokashira Hospital, Tokyo, Japan; 5Komagino Hospital, Tokyo, Japan; 6Asai Hospital, Chiba, Japan; 7Kurumegaoka Hospital, Tokyo, Japan; 8Department of Psychiatry School of Medicine, Nippon Medical School, Tokyo, Japan; 9Department of Psychiatry, School of Medicine, University of Yamanashi, Yamanashi, JapanObjective: The use of an algorithm may facilitate measurement-based treatment and result in more rational therapy. We conducted a 1-year, open-label study to compare various outcomes of algorithm-based treatment (ALGO for schizophrenia versus treatment-as-usual (TAU, for which evidence has been very scarce.Methods: In ALGO, patients with schizophrenia (Diagnostic and Statistical Manual of Mental Disorders, fourth edition were treated with an algorithm consisting of a series of antipsychotic monotherapies that was guided by the total scores in the positive and negative syndrome scale (PANSS. When posttreatment PANSS total scores were above 70% of those at baseline in the first and second stages, or above 80% in the 3rd stage, patients proceeded to the next treatment stage with different antipsychotics. In contrast, TAU represented the best clinical judgment by treating psychiatrists.Results: Forty-two patients (21 females, 39.0 ± 10.9 years

  14. Current approaches to treatments for schizophrenia spectrum disorders, part I: an overview and medical treatments

    Directory of Open Access Journals (Sweden)

    Chien WT

    2013-09-01

    Full Text Available Wai Tong Chien, Annie LK Yip School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong Abstract: During the last three decades, an increasing understanding of the etiology, psychopathology, and clinical manifestations of schizophrenia spectrum disorders, in addition to the introduction of second-generation antipsychotics, has optimized the potential for recovery from the illness. Continued development of various models of psychosocial intervention promotes the goal of schizophrenia treatment from one of symptom control and social adaptation to an optimal restoration of functioning and/or recovery. However, it is still questionable whether these new treatment approaches can address the patients' needs for treatment and services and contribute to better patient outcomes. This article provides an overview of different treatment approaches currently used in schizophrenia spectrum disorders to address complex health problems and a wide range of abnormalities and impairments resulting from the illness. There are different treatment strategies and targets for patients at different stages of the illness, ranging from prophylactic antipsychotics and cognitive–behavioral therapy in the premorbid stage to various psychosocial interventions in addition to antipsychotics for relapse prevention and rehabilitation in the later stages of the illness. The use of antipsychotics alone as the main treatment modality may be limited not only in being unable to tackle the frequently occurring negative symptoms and cognitive impairments but also in producing a wide variety of adverse effects to the body or organ functioning. Because of varied pharmacokinetics and treatment responsiveness across agents, the medication regimen should be determined on an individual basis to ensure an optimal effect in its long-term use. This review also highlights that the recent practice guidelines and standards have

  15. Current approaches to the treatment of Parkinson’s disease

    Directory of Open Access Journals (Sweden)

    Joseph Jankovic

    2008-09-01

    Full Text Available Joseph Jankovic, L Giselle AguilarParkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of MedicineAbstract: Enormous progress has been made in the treatment of Parkinson’s disease (PD. As a result of advances in experimental therapeutics, many promising therapies for PD are emerging. Levodopa remains the most potent drug for controlling PD symptoms, yet is associated with significant complications such as the “wearing off” effect, levodopa-induced dyskinesias and other motor complications. Catechol-o-methyl-transferase inhibitors, dopamine agonists and nondopaminergic therapy are alternative modalities in the management of PD and may be used concomitantly with levodopa or one another. The neurosurgical treatment, focusing on deep brain stimulation, is reviewed briefly. Although this review has attempted to highlight the most recent advances in the treatment of PD, it is important to note that new treatments are not necessarily better than the established conventional therapy and that the treatment options must be individualized and tailored to the needs of each individual patient.Keywords: Parkinson’s disease, levodopa, medical treatment, pallidotomy, deep brain stimulation

  16. Treatment of cutaneous lupus erythematosus: current practice variations.

    Science.gov (United States)

    Reich, A; Werth, V P; Furukawa, F; Kuhn, A; Szczęch, J; Samotij, D; Szepietowski, J C

    2016-08-01

    The treatment of cutaneous lupus erythematous (CLE) remains a challenge. Most of the therapeutic options used in CLE have not been tested in randomized controlled studies and to date no agent has been approved. Therefore, CLE treatment is mostly based on personal experience. To better characterize therapeutic habits among physicians treating CLE patients, a questionnaire-based study about various aspects of topical and systemic treatment for CLE has been performed. The questionnaire was distributed among CLE experts, mostly from Japan, the USA, and Europe. A total of 82 completed questionnaires were assessed. High-potent and potent corticosteroids as well as calcineurin inhibitors were the most often recommended topical treatment for all CLE subtypes. The most relevant factors for initiation of systemic therapy were severity of skin lesions, concomitant involvement of internal organs, CLE subtype and lack of response to topical therapies. Corticosteroids and antimalarials were considered as the most suitable and effective systemic drugs for CLE patients. However, significant differences were observed between various CLE subtypes and between different countries regarding the assessment of various topical and systemic treatment options. In conclusion, great variability of obtained answers underlines the need of development of CLE treatment guidelines suitable for different disease subtypes.

  17. Current options for the treatment of optic neuritis

    Directory of Open Access Journals (Sweden)

    Pula JH

    2012-07-01

    Full Text Available John H Pula,1 Christopher J MacDonald21Division of Neuro-ophthalmology, University of Illinois College of Medicine at Peoria, Peoria; 2University of Illinois College of Medicine at Urbana-Champaign, Champaign, IL, USAAbstract: Optic neuritis can be defined as typical (associated with multiple sclerosis, improving independent of steroid treatment, or atypical (not associated with multiple sclerosis, steroid-dependent improvement. Causes of atypical optic neuritis include connective tissue diseases (eg, lupus, vasculitis, sarcoidosis, or neuromyelitis optica. In this manuscript, updated treatment options for both typical and atypical optic neuritis are reviewed. Conventional treatments, such as corticosteroids, therapeutic plasma exchange, and intravenous immunoglobulin therapy are all discussed with commentary regarding evidence-based outcomes. Less commonly used treatments and novel purported therapies for optic neuritis are also reviewed. Special scenarios in the treatment of optic neuritis – pediatric optic neuritis, acute demyelinating encephalomyelitis, and optic neuritis occurring during pregnancy – are specifically examined.Keywords: optic neuritis, optic neuropathy, treatment, neuroophthalmology

  18. Current aspects of treatment and rehabilitation of patients with pharyngeal cancer

    Directory of Open Access Journals (Sweden)

    A. L. Kozhanov

    2016-01-01

    Full Text Available Annually in Russia primary diagnosis of new-onset pharyngeal cancer is made in approximately 6–7 thousand people. To modern methods of diagnosing pharyngeal cancer belong: direct and indirect laryngoscopy, microlaryngoscopy, stroboscopy, fibrolaryngoscopy, X-ray study examination, computed tomography, multispiral computed tomography, magnetic resonance tomography, ultrasonographic examination of the throat and organs of the neck, acoustic analysis of voice and morphological studies.Recent years witnessed the development of novel methods of both conservative and surgical management of patient with pharyngeal cancer. Treatment of patients with stage T1–2 and in some patients with stage T3 includes the following methods: radiotherapy, chemoradiotherapy, endolaryngeal surgery with laser, photodynamic therapy, open functionally sparing operations. According to the data of the authors, today currently there is no common algorithm for treatment of stage T1–3 pharyngeal malignant neoplasms.Locally disseminated tumors of the throat and laryngopharynx, corresponding to stages T3–4N0–2M0 as a rule are treated by combined management with pre- or postoperative irradiation. Such approach results in leads to impairment of all functions of the organ and invalidity disablement of patients. The most important task after combined treatment is rehabilitation of the voice function, which may be restored by means of logopedic methods, voice-forming devices and reconstructive plastic operations.Hence novel approaches to treatment of pharyngeal cancer – both conservative and surgical have recently been worked out. However the problem concerning regarding therapeutic decision-making followed by rehabilitation of patients remains disputable.

  19. An efficient and portable SIMD algorithm for charge/current deposition in Particle-In-Cell codes

    CERN Document Server

    Vincenti, H; Sasanka, R; Vay, J-L

    2016-01-01

    In current computer architectures, data movement (from die to network) is by far the most energy consuming part of an algorithm (10pJ/word on-die to 10,000pJ/word on the network). To increase memory locality at the hardware level and reduce energy consumption related to data movement, future exascale computers tend to use more and more cores on each compute nodes ("fat nodes") that will have a reduced clock speed to allow for efficient cooling. To compensate for frequency decrease, machine vendors are making use of long SIMD instruction registers that are able to process multiple data with one arithmetic operator in one clock cycle. SIMD register length is expected to double every four years. As a consequence, Particle-In-Cell (PIC) codes will have to achieve good vectorization to fully take advantage of these upcoming architectures. In this paper, we present a new algorithm that allows for efficient and portable SIMD vectorization of current/charge deposition routines that are, along with the field gathering...

  20. [The current views of the treatment of diffuse external otitis].

    Science.gov (United States)

    Fedorova, O V; Shadrin, G B

    2016-01-01

    The objective of the present study was to evaluate the clinical effectiveness and safety of the local application of triderm for the treatment of diffuse external otitis. The study included 68 patients presenting with bacterial and fungal diffuse external otitis. The treatment in the form of local empiric therapy was continued till the results of microbiological treatment became apparent. The beneficial outcome achieved in 91.2% of the patients was clinically manifest as the regression of the inflammatory process in the external auditory meatus. No complications, such as ototoxic events, either local or systemic allergic reactions, were documented. The authors substantiate the possibility of the application of the medication under consideration for the treatment of diffuse external otitis based on the knowledge of the mechanism of the actin of its constituent components, viz. betamethasone, dipropionate, gentamicin sulfate, and clotrimazole, taking into account the occurrence of the most common causative agents of diffuse external otitis. It is concluded that triderm is a safe medication for the local application and, probably, for the initial empiric therapy of diffuse external otitis to be continued till the results of the microbiological treatment become apparent.

  1. Treatment Algorithm for Patients with Non-arthritic Hip Pain, Suspect for an Intraarticular Pathology

    DEFF Research Database (Denmark)

    Jørgensen, Rasmus Wejnold; Dippmann, Christian; Dahl, L

    2016-01-01

    BACKGROUND: The amount of patients referred with longstanding, non-arthritic hip pain is increasing, as are the treatment options. Left untreated hip dysplasia, acetabular retroversion and femoroacetabular impingement (FAI) may lead to osteoarthritis (OA). Finding the right treatment option...... associated with acetabular retroversion described in the literature were the crossover sign, the posterior wall sign and the ischial spine sign, while Wiberg's lateral center-edge angle (CE-angle) together with Leqeusne's acetabular index indicate hip dysplasia. A Tönnis index >2 indicates osteoarthritis...... for the right patient can be challenging in patients with non-arthritic hip pain. PURPOSE: The purpose of this study was to categorize the radiographic findings seen in patients with longstanding hip pain, suspect for an intraarticular pathology, and provide a treatment algorithm allocating a specific treatment...

  2. Palmoplantar Psoriasis and Palmoplantar Pustulosis: Current Treatment and Future Prospects.

    Science.gov (United States)

    Raposo, Inês; Torres, Tiago

    2016-08-01

    Palmoplantar psoriasis and palmoplantar pustulosis are chronic skin diseases with a large impact on patient quality of life. They are frequently refractory to treatment, being generally described as a therapeutic challenge. This article aims to review the definitions of palmoplantar psoriasis and palmoplantar pustulosis, highlighting the similarities and differences in terms of epidemiology, clinical presentation, genetics, histopathology, and pathogenesis, as well as treatment options for both entities. Classical management of mild to moderate palmoplantar pustulosis and palmoplantar psoriasis relies on use of potent topical corticosteroids, phototherapy, and/or acitretin. Nevertheless, these drugs have proven to be insufficient in long-term control of extensive disease. Biologic therapy-namely, anti-interleukin-17 agents and phosphodiesterase type 4 inhibitors-has recently shown promising results in the treatment of palmoplantar psoriasis. Knowledge of the pathophysiologic pathways of both entities is of utmost importance and may, in the future, allow development of molecularly targeted therapeutics.

  3. Current state of prostate cancer treatment in Jamaica.

    Science.gov (United States)

    Morrison, Belinda F; Aiken, William D; Mayhew, Richard

    2014-01-01

    Prostate cancer is the commonest cancer in Jamaica as well as the leading cause of cancer-related deaths. One report suggested that Jamaica has the highest incidence rate of prostate cancer in the world, with an age-standardised rate of 304/100,000 per year. The Caribbean region is reported to have the highest mortality rate of prostate cancer worldwide. Prostate cancer accounts for a large portion of the clinical practice for health-care practitioners in Jamaica. The Jamaica Urological Society is a professional body comprising 19 urologists in Jamaica who provide most of the care for men with prostate cancer in collaboration with medical oncologists, radiation oncologists, and a palliative care physician. The health-care system is structured in two tiers in Jamaica: public and private. The urologist-to-patient ratio is high, and this limits adequate urological care. Screening for prostate cancer is not a national policy in Jamaica. However, the Jamaica Urological Society and the Jamaica Cancer Society work synergistically to promote screening as well as to provide patient education for prostate cancer. Adequate treatment for localised prostate cancer is available in Jamaica in the forms of active surveillance, nerve-sparing radical retropubic prostatectomy, external beam radiation, and brachytherapy. However, there is a geographic maldistribution of centres that provide prostate cancer treatment, which leads to treatment delays. Also, there is difficulty in affording some treatment options in the private health-care sectors. Androgen deprivation therapy is available for treatment of locally advanced and metastatic prostate cancer and is subsidised through a programme called the National Health Fund. Second-line hormonal agents and chemotherapeutic agents are available but are costly to most of the population. The infrastructure for treatment of prostate cancer in Jamaica is good, but it requires additional technological advances as well as additional specialist

  4. Current concepts in the treatment of hereditary ataxias

    Directory of Open Access Journals (Sweden)

    Pedro Braga Neto

    2016-03-01

    Full Text Available ABSTRACT Hereditary ataxias (HA represents an extensive group of clinically and genetically heterogeneous neurodegenerative diseases, characterized by progressive ataxia combined with extra-cerebellar and multi-systemic involvements, including peripheral neuropathy, pyramidal signs, movement disorders, seizures, and cognitive dysfunction. There is no effective treatment for HA, and management remains supportive and symptomatic. In this review, we will focus on the symptomatic treatment of the main autosomal recessive ataxias, autosomal dominant ataxias, X-linked cerebellar ataxias and mitochondrial ataxias. We describe management for different clinical symptoms, mechanism-based approaches, rehabilitation therapy, disease modifying therapy, future clinical trials and perspectives, genetic counseling and preimplantation genetic diagnosis.

  5. [Current trends in medical and surgical treatment of epilepsy].

    Science.gov (United States)

    Ambrosetto, C; Ambrosetto, P

    1979-01-01

    The AA., after a critical review of the literature, discuss the actual problems related to the various forms of the epilepsie susceptible of an appropriate surgical treatment. The AA. consider that the modern S.E.E.G. techniques, such as the formed in the highly specialized center of Bancaud and Talairach, open new perspectives particularly for the cases resistant to medical treatment and without evidence of focalisation. The AA. discuss the criteria, justifying such limitations and auspicate the institution of a much limited number of such centers, also in Italy.

  6. The pathophysiology of heterotopic ossification: Current treatment considerations in dentistry

    Directory of Open Access Journals (Sweden)

    Kengo Shimono

    2014-02-01

    Full Text Available Heterotopic ossification (HO consists of the formation of ectopic cartilage followed by endochondral bone, and is triggered by major surgeries, large wounds, and other conditions. Daily functions of HO patients can be hampered by the loss of normal posture, pain, inflammation, reduced mobility, formation of pressure ulcers, deep venous thrombosis, and other complications. Research so far revealed the molecular and cellular pathways leading HO formation, and proposed several possible mechanisms behind such pathways. Nonsteroidal anti-inflammatory drug (NSAID regimens and localized low-dose irradiation are currently available as prophylaxis of HO formation. However, they are not always effective and do not target skeletogenic processes directly. New therapeutic modalities targeting pathological process of HO formation, such as bone morphogenetic proteins (BMP inhibitors like Noggin, BMP type 1 receptor inhibitor, and nuclear retinoic acid receptor-gamma (RARγ agonists are currently under investigation. In this review, we will summarize our current understanding of the pathology and molecular and cellular mechanisms of HO, especially endochondral heterotopic ossification, and then discuss its current and future therapies. We will also discuss the potential application of heterotopic ossification in the dental field.

  7. Human pharmacology of current and new treatments for schizophrenia

    NARCIS (Netherlands)

    Liem-Moolenaar, Marieke

    2012-01-01

    The studies in this thesis together show different ways of studying human pharmacology, give an impression of the current drug development in schizophrenia, and provide examples how human pharmacology can be applied in an early stage of drug development in healthy volunteers. The investigated compou

  8. Current Trends in Treatment Outcomes of Orbital Cellulitis in a ...

    African Journals Online (AJOL)

    The aim of this study is to determine the current trends in the outcomes following the management of orbital cellulitis at the. University of Benin ... the Statistical Package for Social Sciences Version 21 software program (SPSS Inc. .... or periocular surgery, dental infection, otitis media, dacryocystitis, and endophthalmitis.

  9. Human pharmacology of current and new treatments for schizophrenia

    NARCIS (Netherlands)

    Liem-Moolenaar, Marieke

    2012-01-01

    The studies in this thesis together show different ways of studying human pharmacology, give an impression of the current drug development in schizophrenia, and provide examples how human pharmacology can be applied in an early stage of drug development in healthy volunteers. The investigated

  10. Current concepts in the treatment of gouty arthritis.

    Science.gov (United States)

    Fang, Zhen-hua; Waizy, Hazibullah

    2013-02-01

    Gouty arthritis is an extremely painful condition that causes functional impairment. Gouty arthritis has become increasingly complex because of multiple comorbidities, iatrogenic factors and hyperuricemia that is refractory to treatment. In this review, we present a general overview of gouty arthritis including its pathophysiology, clinical presentations, diagnosis, predisposing factors and prophylactic therapy for preventing gouty arthritis flares.

  11. Current trends in the treatment of hepatic encephalopathy

    Directory of Open Access Journals (Sweden)

    Mohamad Rasm Al Sibae

    2009-07-01

    Full Text Available Mohamad Rasm Al Sibae, Brendan M McGuireDepartment of Medicine, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL, USAAbstract: Hepatic encephalopathy (HE is a common reversible neuropsychiatric syndrome associated with chronic and acute liver dysfunction and significant morbidity and mortality. Although a clear pathogenesis is yet to be determined, elevated ammonia in the serum and central nervous system are the mainstay for pathogenesis and treatment. Management includes early diagnosis and prompt treatment of precipitating factors (infection, gastrointestinal bleeding, electrolyte disturbances, hepatocellular carcinoma, dehydration, hypotension, and use of benzodiazepines, psychoactive drugs, and/or alcohol. Clinical trials have established the efficacy of lactulose and lactitol enemas in the treatment of acute hepatic encephalopathy. Extensive clinical experience has demonstrated the efficacy of oral lactulose and lactitol with the goal of two to three soft bowel movements a day for the treatment of chronic HE. However, lactulose and lactitol have significant gastrointestinal side effects. For patients unable to tolerate lactulose or lactitol or who still have persistent chronic HE with lactulose or lactitol, neomycin, metronidazole and rifaximin are second-line agents. More recent data supports the benefits of rifaximin used solely and as an additional agent with fewer side effects than neomycin or metronidazole. Newer therapies being investigated in humans with clinical promise include nitazoxanide, the molecular adsorbent recirculating system (MARS, L-ornithine phenylacetate, sodium benzoate, and/or sodium phenylacetate and Kremezin® (AST-120.Keywords: hepatic encephalopathy, liver dysfunction, lactulose, lactitol

  12. Taking the negative view of current migraine treatments

    DEFF Research Database (Denmark)

    Tfelt-Hansen, Peer; Olesen, Jes

    2012-01-01

    , valproate, topiramate) a response (at least a 50% reduction in migraine frequency) is observed in 40-50%. In addition, prophylactic treatment is hampered by adverse events and withdrawals. There is a need for new acute anti-migraine drugs and targets are already available and there are more to come. It has...

  13. Gastric cancer:current and evolving treatment landscape

    Institute of Scientific and Technical Information of China (English)

    Weijing Sun; Li Yan

    2016-01-01

    Gastric (including gastroesophageal junction) cancer is the third leading cause of cancer-related death in the world. In China, an estimated 420,000 patients were diagnosed with gastric cancer in 2011, ranking this malignancy the second most prevalent cancer type and resulting in near 300,000 deaths. The treatment landscape of gastric cancer has evolved in recent years. Although systemic chemotherapy is still the mainstay treatment of metastatic disease, the introduction of agents targeting human epidermal growth factor receptor 2 and vascular endothelial growth factor/vascular endothelia growth factor receptor has brought this disease into the molecular and personalized medicine era. The preliminary yet encouraging clinical effcacy observed with immune checkpoint inhibitors, e.g., anti-pro-grammed cell death protein 1/programmed death-ligand 1, will further shape the treatment landscape for gastric cancer. Molecular characterization of patients will play a critical role in developing new agents, as well as in imple-menting new treatment options for this disease.

  14. Transcranial direct current stimulation as a treatment for auditory hallucinations

    NARCIS (Netherlands)

    Koops, Sanne; van den Brink, Hilde; Sommer, Iris E C

    2015-01-01

    Auditory hallucinations (AH) are a symptom of several psychiatric disorders, such as schizophrenia. In a significant minority of patients, AH are resistant to antipsychotic medication. Alternative treatment options for this medication resistant group are scarce and most of them focus on coping with

  15. The multi-objective optimization of the horizontal-axis marine current turbine based on NSGA-II algorithm

    Science.gov (United States)

    Zhu, G. J.; Guo, P. C.; Luo, X. Q.; Feng, J. J.

    2012-11-01

    The present paper describes a hydrodynamic optimization technique for horizontal-axial marine current turbine. The pitch angle distribution is important to marine current turbine. In this paper, the pitch angle distribution curve is parameterized as four control points by Bezier curve method. The coordinates of the four control points are chosen as optimization variables, and the sample space are structured according to the Box-Behnken experimental design method (BBD). Then the power capture coefficient and axial thrust coefficient in design tip-speed ratio is obtained for all the elements in the sample space by CFD numerical simulation. The power capture coefficient and axial thrust are chosen as objective function, and quadratic polynomial regression equations are constructed to fit the relationship between the optimization variables and each objective function according to response surface model. With the obtained quadratic polynomial regression equations as performance prediction model, the marine current turbine is optimized using the NSGA-II multi-objective genetic algorithm, which finally offers an improved marine current turbine.

  16. [Thrombocytopenia induced by heparin. Diagnosis, treatment, physiopathology: current concepts].

    Science.gov (United States)

    Gruel, Y; Drouet, L

    1986-01-01

    Iatrogenic thrombocytopenia is a rare, but severe complication of treatments with heparin and heparinoids. Mean temporary thrombocytopenia failing to show any complications are usually diagnosed as quite different from acute and delayed thrombocytopenia of which severity depends mainly on thrombotic symptoms demonstrated in 65 p. 100 of cases; the initial evolution of an average thrombocytopenia is not easy to diagnose; it may as well exist a connection between the two diseases, from a physiopathogenic point of view. The diagnosis of severe thrombocytopenia depends:--clinically, on the initial data, delayed as compared with the heparin treatment beginning and existence of arterial and/or venous thrombosis;--biologically, by demonstrating an aggregating activity for platelets in presence of heparin, in the patient plasma. Such an activity requires the suppression of standard heparinotherapy as well as the choice of substitutive anticoagulant treatment in case of evolutive thrombosis. Low molecular weight heparins are prescribed only if in vitro tests of platelet aggregation with the patient's plasma are negative. Antivitamins K are to be used as soon as possible alone or combined with heparin fractions. Antiaggregants are prescribed alone, above all in case of isolated thrombocytopenia and combined with AVK. Treatment of thrombotic complications depends on surgical disobstruction if arterial thrombosis, and use of fibrinolytics if pulmonary embolisms. The acute reaction of some thrombocytopenia to heparin as well as therapeutic difficulties demonstrate the efficiency of an early diagnosis performed thanks to systematic platelet numerations during the first 15 days of a treatment with heparin, as well as to the prevention along with systematic association with aspirin, especially if replaced with AVK.

  17. Heuristic algorithms for scheduling heat-treatment furnaces of steel casting industries

    Indian Academy of Sciences (India)

    M Mathirajan; V Chandru; A I Sivakumar

    2007-10-01

    This paper addresses a research problem of scheduling parallel, nonidentical batch processors in the presence of dynamic job arrivals, incompatible job-families and non-identical job sizes. We were led to this problem through a realworld application involving the scheduling of heat-treatment operations of steel casting. The scheduling of furnaces for heat-treatment of castings is of considerable interest as a large proportion of the total production time is the processing times of these operations. In view of the computational intractability of this type of problem, a few heuristic algorithms have been designed for maximizing the utilization of heat-treatment furnaces of steel casting manufacturing. Extensive computational experiments were carried out to compare the performance of the heuristics with the estimated optimal value (using the Weibull technique) and for relative effectiveness among the heuristics. Further, the computational experiments show that the heuristic algorithms proposed in this paper are capable of obtaining near (statistically estimated) optimal utilization of heat-treatment furnaces and are also capable of solving any large size real-life problems with a relatively low computational effort.

  18. Current treatment options for the management of esophageal cancer

    Directory of Open Access Journals (Sweden)

    Mawhinney MR

    2012-11-01

    Full Text Available Mark R Mawhinney, Robert E GlasgowDepartment of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USAAbstract: In recent years, esophageal cancer characteristics and management options have evolved significantly. There has been a sharp increase in the frequency of esophageal adenocarcinoma and a decline in the frequency of squamous cell carcinoma. A more comprehensive understanding of prognostic factors influencing outcome has also been developed. This has led to more management options for esophageal cancer at all stages than ever before. A multidisciplinary, team approach to management in a high volume center is the preferred approach. Each patient should be individually assessed based on type of cancer, local or regional involvement, and his or her own functional status to determine an appropriate treatment regimen. This review will discuss management of esophageal cancer relative to disease progression and patient functional status.Keywords: esophageal adenocarcinoma, squamous cell carcinoma, treatment regimen, disease progression, patient functional status

  19. Optimization of stereotactic body radiotherapy treatment planning using a multicriteria optimization algorithm

    Energy Technology Data Exchange (ETDEWEB)

    Ghandour, Sarah; Cosinschi, Adrien; Mazouni, Zohra; Pachoud, Marc; Matzinger, Oscar [Riviera-Chablais Hospital, Vevey (Switzerland). Cancer Center, Radiotherapy Dept.

    2016-07-01

    To provide high-quality and efficient dosimetric planning for various types of stereotactic body radiotherapy (SBRT) for tumor treatment using a multicriteria optimization (MCO) technique fine-tuned with direct machine parameter optimization (DMPO). Eighteen patients with lung (n = 11), liver (n = 5) or adrenal cell cancer (n = 2) were treated using SBRT in our clinic between December 2014 and June 2015. Plans were generated using the RayStation trademark Treatment Planning System (TPS) with the VMAT technique. Optimal deliverable SBRT plans were first generated using an MCO algorithm to find a well-balanced tradeoff between tumor control and normal tissue sparing in an efficient treatment planning time. Then, the deliverable plan was post-processed using the MCO solution as the starting point for the DMPO algorithm to improve the dose gradient around the planning target volume (PTV) while maintaining the clinician's priorities. The dosimetric quality of the plans was evaluated using dose-volume histogram (DVH) parameters, which account for target coverage and the sparing of healthy tissue, as well as the CI100 and CI50 conformity indexes. Using a combination of the MCO and DMPO algorithms showed that the treatment plans were clinically optimal and conformed to all organ risk dose volume constraints reported in the literature, with a computation time of approximately one hour. The coverage of the PTV (D99% and D95%) and sparing of organs at risk (OAR) were similar between the MCO and MCO + DMPO plans, with no significant differences (p > 0.05) for all the SBRT plans. The average CI100 and CI50 values using MCO + DMPO were significantly better than those with MCO alone (p < 0.05). The MCO technique allows for convergence on an optimal solution for SBRT within an efficient planning time. The combination of the MCO and DMPO techniques yields a better dose gradient, especially for lung tumors.

  20. The Current Management at Diagnosis and Treatment of Allergic Rhinitis

    Directory of Open Access Journals (Sweden)

    Ozgur Tarkan

    2009-06-01

    Full Text Available Allergic rhinitis is a common disease with a remarkable social impact. The semptoms of allerjic rhinitis include itching, nasal discharge and sneezing. Similar to lethargy, fatigue, somnolence, decreased cognition, difficulty in concentration and decreased sleep and appetite is commonly seen besides physical symptoms. The treatment of allergic rhinitis consists of allergen avoidance, pharmacotherapy and immunotherapy. [Archives Medical Review Journal 2009; 18(3.000: 156-170

  1. Current Pharmaceutical Treatments and Alternative Therapies of Parkinson's Disease

    OpenAIRE

    Dong, Jie; Cui, Yanhua; Li, Song; Le, Weidong

    2016-01-01

    Over the decades, pharmaceutical treatments, particularly dopaminergic (DAergic) drugs have been considered as the main therapy against motor symptoms of Parkinson's disease (PD). It is proposed that DAergic drugs in combination with other medications, such as monoamine oxidase type B inhibitors, catechol-O-methyl transferase inhibitors, anticholinergics and other newly developed non-DAergic drugs can make a better control of motor symptoms or alleviate levodopa-induced motor complications. M...

  2. Treatment of retinoblastoma: current status and future perspectives.

    Science.gov (United States)

    Rodriguez-Galindo, Carlos; Chantada, Guillermo L; Haik, Barrett G; Wilson, Matthew W

    2007-07-01

    Treatment of retinoblastoma must be individualized. Most patients with unilateral, non-metastatic retinoblastoma can be cured with enucleation alone. In patients with histologic risk factors, adjuvant chemotherapy is recommended, with the addition of orbital radiation for patients with trans-scleral involvement or tumor present at the level of the cut end of the optic nerve. Patients with metastases require intensive chemotherapy and consolidation with autologous hematopoietic stem cell rescue. Patients with bilateral or multifocal disease represent a major challenge. Cure of the disease is the first priority, but the therapeutic approach also has to consider eye and vision preservation. The approach is conservative, and only eyes with very advanced disease are enucleated upfront. Patients are treated with chemotherapy and intensive focal treatments, with the aim of delaying or avoiding radiation therapy and enucleation. For patients with early intraocular stage (Reese-Ellsworth groups I-III and International Groups A-B), the two-drug combination of vincristine and carboplatin is recommended. Patients with more advanced intraocular disease (Reese-Ellsworth groups IV-V and International Groups C-D) require more intensive chemotherapy. Standard of care for these patients incorporates etoposide into the regimen. Effective agents with good intraocular penetration, such as topotecan, are being investigated. Because most failures are secondary to progression of the vitreous seeds, subconjunctival carboplatin is added in cases with poor response of the vitreous tumors. Patients must be monitored very closely, with examinations under anesthesia every 4 to 6 weeks, and focal treatments are applied during the procedure. These include cryotherapy for small anterior tumors, thermotherapy and laser photocoagulation for small posterior tumors, and brachytherapy for larger tumors. New treatment approaches under development include the refinement of periocular chemotherapy

  3. Treatment of osteoporosis: current state of the art.

    Science.gov (United States)

    Hamrick, Irene; Schrager, Sarina; Nye, Ann Marie

    2015-02-01

    Osteoporosis can be treated with medications and lifestyle changes, including avoiding a sedentary lifestyle, alcohol, and smoking. We will identify medications that protect against hip fractures in addition to vertebral fractures, and explore new evidence of adverse effects and risks. Bisphosphonates are used as first-line treatment. We will discuss the latest osteoporosis medications, drug interactions, potential bone protective effects of other drug classes, and the evidence of exercise and kyphoplasty.

  4. Disordered Gambling in Finland : Epidemiology and a Current Treatment Option

    OpenAIRE

    2013-01-01

    Disordered gambling is a multifaceted phenomenon, and consequently many factors have a role in its development and maintenance. Adverse consequences of disordered gambling can be mental, social and legal. Only a few epidemiological studies of disordered gambling have previously been conducted in Finland, and none of these studies have been published internationally. Gambling research in Finland has increased during the past years, especially the investigation of treatment options for disorder...

  5. Endovascular and microsurgical treatment of cerebral arteriovenous malformations: Current recommendations

    OpenAIRE

    Andrew Conger; Charles Kulwin; Lawton, Michael T; Cohen-Gadol, Aaron A.

    2015-01-01

    Background: Cerebral arteriovenous malformations (AVMs) can be a heterogeneous pathological entity whose management requires a complex decision-making process due to the risks associated with their treatment and natural history. Despite the recently published conclusions of the aborted Randomized Trial of Brain Unruptured AVMs (ARUBA) trial, the authors of this article believe multimodality intervention in general and microsurgical resection in particular continue to play a major role in the ...

  6. Current surgical treatment of diverticular disease in the Netherlands

    Institute of Scientific and Technical Information of China (English)

    Annelien; N; Morks; Bastiaan; R; Klarenbeek; Elvira; R; Flikweert; Donald; L; van; der; Peet; Thomas; M; Karsten; Eric; H; Eddes; Miguel; A; Cuesta; Peter; W; de; Graaf

    2010-01-01

    AIM: To evaluate the development of diagnostic tools, indications for surgery and treatment modalities concerning diverticular disease (DD) in the Netherlands. METHODS: Data were collected from 100 patients who underwent surgery for DD in three Dutch hospitals. All hospitals used the same standardized data base. The collected data included patient demographics, patient history, type of surgery and complications. Patients were divided into two groups, one undergoing elective surgery (elective group) and the ...

  7. Current and emerging treatment options in the management of lupus

    OpenAIRE

    Jordan N; D’Cruz D

    2016-01-01

    Natasha Jordan,1 David D’Cruz2 1Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, 2Louise Coote Lupus Unit, Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, UK Abstract: Systemic lupus erythematosus (SLE) is a complex autoimmune disease with variable clinical manifestations. While the clearest guidelines for the treatment of SLE exist in the context of lupus nephritis, patients with other lupus manifestations ...

  8. CURRENT CONCEPTS IN THE TREATMENT OF PATELLAR TENDINOPATHY

    Science.gov (United States)

    2016-01-01

    Patellar tendon pain is a significant problem in athletes who participate in jumping and running sports and can interfere with athletic participation. This clinical commentary reviews patellar tendon anatomy and histopathology, the language used to describe patellar tendon pathology, risk factors for patellar tendinopathy and common interventions used to address patellar tendon pain. Evidence is presented to guide clinicians in their decision-making regarding the treatment of athletes with patellar tendon pain. Level of Evidence 5 PMID:27904789

  9. Metastatic melanoma: Pathologic characterization, current treatment, and complications of therapy.

    Science.gov (United States)

    Wick, Mark R; Gru, Alejandro A

    2016-07-01

    Metastatic melanoma (MM) has the potential to involve virtually any anatomical site, and it also has a wide spectrum of histological appearances. General clinicopathologic data pertaining to MM are presented in this review, together with a discussion of its differential diagnosis and therapy. "Biological" agents used in the treatment of melanoma are considered, along with the pathological features of the complications that they may cause. Copyright © 2016. Published by Elsevier Inc.

  10. Current options for the treatment of optic neuritis

    OpenAIRE

    Pula JH; MacDonald CJ

    2012-01-01

    John H Pula,1 Christopher J MacDonald21Division of Neuro-ophthalmology, University of Illinois College of Medicine at Peoria, Peoria; 2University of Illinois College of Medicine at Urbana-Champaign, Champaign, IL, USAAbstract: Optic neuritis can be defined as typical (associated with multiple sclerosis, improving independent of steroid treatment), or atypical (not associated with multiple sclerosis, steroid-dependent improvement). Causes of atypical optic neuritis include connective tissue di...

  11. HYPOPARATHYROIDISM: ETIOLOGY, CLINICAL MANIFESTATION, CURRENT DIAGNOSTICS AND TREATMENT

    Directory of Open Access Journals (Sweden)

    N. G. Mokrysheva

    2016-01-01

    Full Text Available Parathyroid hormone (PTH is the main regulator of calcium and phosphorus metabolism. PTH deficiency or tissue resistance to its effects results in hypoparathyroidism characterized by low serum calcium and elevated serum phosphate levels. The most common is post-operative hypoparathyroidism caused by an inadvertent damage or removal of the parathyroid glands, deterioration of blood supply to the neck region, most often during thyroid surgery. The second common form of the disease is the autoimmune one related with immune destruction of parathyroid cells. Less frequent causes of hypoparathyroidism include a variety of genetic syndromes, mitochondrial genome defects, and hypomagnesemia. The main signs and symptoms of hypoparathyroidism are related to hypocalcaemia and hyperphosphatemia land result in increased neuromuscular irritability and general autonomic reactivity, with finger and toe tingling, muscle cramps, tonic seizures, laryngo- and bronchospasm, and neurosis. These symptoms are closely associated with serum calcium levels; their severity depends on the degree of hypocalcaemia. Laboratory parameters confirming the diagnosis of hypoparathyroidism are hypocalcaemia, hyperphosphatemia, and reduced serum PTH. Treatment of hypoparathyroidism involves management of hypocalcaemic crisis and maintenance therapy. Acute hypocalcaemia, a  potentially life-threatening condition, is treated as an emergency with intravenous calcium combined with oral calcium and active vitamin D. Standard chronic treatment for hypoparathyroidism is based on oral calcium and active metabolites of vitamin  D / vitamin  D analogs and is aimed at the balance between optimal low-normal serum calcium concentrations and normocalciuria. Worsening hypercalciuria is often underestimated by specialists, although it can cause severe renal problems, such as nephrocalcinosis and neprolithiasis. Hypoparathyroidism is one of the few endocrine deficiencies for which replacement

  12. Current and emerging treatments for absence seizures in young patients

    Directory of Open Access Journals (Sweden)

    Vrielynck P

    2013-07-01

    Full Text Available Pascal VrielynckWilliam Lennox Neurological Center, Reference Centre for Refractory Epilepsy, Catholic University of Louvain, BelgiumAbstract: In this report, we review the pharmacological and non-pharmacological treatments of the different absence seizure types as recently recognized by the International League Against Epilepsy: typical absences, atypical absences, myoclonic absences, and eyelid myoclonia with absences. Overall, valproate and ethosuximide remain the principal anti-absence drugs. Typical absence seizures exhibit a specific electroclinical semiology, pathophysiology, and pharmacological response profile. A large-scale comparative study has recently confirmed the key role of ethosuximide in the treatment of childhood absence epilepsy, more than 50 years after its introduction. No new antiepileptic drug has proven major efficacy against typical absences. Of the medications under development, brivaracetam might be an efficacious anti-absence drug. Some experimental drugs also show efficacy in animal models of typical absence seizures. The treatment of other absence seizure types is not supported with a high level of evidence. Rufinamide appears to be the most promising new antiepileptic drug for atypical absences and possibly for myoclonic absences. The efficacy of vagal nerve stimulation should be further evaluated for atypical absences. Levetiracetam appears to display a particular efficacy in eyelid myoclonia with absences. Finally, it is important to remember that the majority of antiepileptic drugs, whether they be old or new, may aggravate typical and atypical absence seizures.Keywords: antiepileptic drug, typical absence, atypical absence, myoclonic absence, eyelid myoclonia with absence

  13. Current and emerging treatments for the management of osteogenesis imperfecta

    Science.gov (United States)

    Monti, Elena; Mottes, Monica; Fraschini, Paolo; Brunelli, PierCarlo; Forlino, Antonella; Venturi, Giacomo; Doro, Francesco; Perlini, Silvia; Cavarzere, Paolo; Antoniazzi, Franco

    2010-01-01

    Osteogenesis imperfecta (OI) is the most common bone genetic disorder and it is characterized by bone brittleness and various degrees of growth disorder. Clinical severity varies widely; nowadays eight types are distinguished and two new forms have been recently described although not yet classified. The approach to such a variable and heterogeneous disease should be global and therefore multidisciplinary. For simplicity, the objectives of treatment can be reduced to three typical situations: the lethal perinatal form (type II), in which the problem is survival at birth; the severe and moderate forms (types III–IX), in which the objective is ‘autonomy’; and the mild form (type I), in which the aim is to reach ‘normal life’. Three types of treatment are available: non-surgical management (physical therapy, rehabilitation, bracing and splinting), surgical management (intramedullary rod positioning, spinal and basilar impression surgery) and medical-pharmacological management (drugs to increase the strength of bone and decrease the number of fractures as bisphosphonates or growth hormone, depending on the type of OI). Suggestions and guidelines for a therapeutic approach are indicated and updated with the most recent findings in OI diagnosis and treatment. PMID:20856683

  14. Development of a novel algorithm to determine adherence to chronic pain treatment guidelines using administrative claims

    Directory of Open Access Journals (Sweden)

    Margolis JM

    2017-02-01

    Full Text Available Jay M Margolis,1 Nicole Princic,2 David M Smith,2 Lucy Abraham,3 Joseph C Cappelleri,4 Sonali N Shah,5 Peter W Park5 1Truven Health Analytics, Bethesda, MD, 2Truven Health Analytics, Cambridge, MA, USA; 3Pfizer Ltd, Tadworth, UK; 4Pfizer Inc, Groton, CT, 5Pfizer Inc, New York, NY, USA Objective: To develop a claims-based algorithm for identifying patients who are adherent versus nonadherent to published guidelines for chronic pain management. Methods: Using medical and pharmacy health care claims from the MarketScan® Commercial and Medicare Supplemental Databases, patients were selected during July 1, 2010, to June 30, 2012, with the following chronic pain conditions: osteoarthritis (OA, gout (GT, painful diabetic peripheral neuropathy (pDPN, post-herpetic neuralgia (PHN, and fibromyalgia (FM. Patients newly diagnosed with 12 months of continuous medical and pharmacy benefits both before and after initial diagnosis (index date were categorized as adherent, nonadherent, or unsure according to the guidelines-based algorithm using disease-specific pain medication classes grouped as first-line, later-line, or not recommended. Descriptive and multivariate analyses compared patient outcomes with algorithm-derived categorization endpoints. Results: A total of 441,465 OA patients, 76,361 GT patients, 10,645 pDPN, 4,010 PHN patients, and 150,321 FM patients were included in the development of the algorithm. Patients found adherent to guidelines included 51.1% for OA, 25% for GT, 59.5% for pDPN, 54.9% for PHN, and 33.5% for FM. The majority (~90% of patients adherent to the guidelines initiated therapy with prescriptions for first-line pain medications written for a minimum of 30 days. Patients found nonadherent to guidelines included 30.7% for OA, 6.8% for GT, 34.9% for pDPN, 23.1% for PHN, and 34.7% for FM. Conclusion: This novel algorithm used real-world pharmacotherapy treatment patterns to evaluate adherence to pain management guidelines in five

  15. Surgical treatment of scoliosis: a review of techniques currently applied

    Directory of Open Access Journals (Sweden)

    Maruyama Toru

    2008-04-01

    Full Text Available Abstract In this review, basic knowledge and recent innovation of surgical treatment for scoliosis will be described. Surgical treatment for scoliosis is indicated, in general, for the curve exceeding 45 or 50 degrees by the Cobb's method on the ground that: 1 Curves larger than 50 degrees progress even after skeletal maturity. 2 Curves of greater magnitude cause loss of pulmonary function, and much larger curves cause respiratory failure. 3 Larger the curve progress, more difficult to treat with surgery. Posterior fusion with instrumentation has been a standard of the surgical treatment for scoliosis. In modern instrumentation systems, more anchors are used to connect the rod and the spine, resulting in better correction and less frequent implant failures. Segmental pedicle screw constructs or hybrid constructs using pedicle screws, hooks, and wires are the trend of today. Anterior instrumentation surgery had been a choice of treatment for the thoracolumbar and lumbar scoliosis because better correction can be obtained with shorter fusion levels. Recently, superiority of anterior surgery for the thoracolumbar and lumbar scoliosis has been lost. Initial enthusiasm for anterior instrumentation for the thoracic curve using video assisted thoracoscopic surgery technique has faded out. Various attempts are being made with use of fusionless surgery. To control growth, epiphysiodesis on the convex side of the deformity with or without instrumentation is a technique to provide gradual progressive correction and to arrest the deterioration of the curves. To avoid fusion for skeletally immature children with spinal cord injury or myelodysplasia, vertebral wedge ostetomies are performed for the treatment of progressive paralytic scoliosis. For right thoracic curve with idiopathic scoliosis, multiple vertebral wedge osteotomies without fusion are performed. To provide correction and maintain it during the growing years while allowing spinal growth for

  16. Current Treatment Strategies for Recurrent Urinary Tract Infections

    Directory of Open Access Journals (Sweden)

    Murat Zor

    2014-04-01

    Full Text Available Urinary tract infections (UTIs are the most common bacterial infections among all age groups. Three UTI episodes with positive culture results in a one year period are called recurrent UTIs. Recurrent UTIs are common health problems threatening physical and mental health of the individuals in all age groups. Unconscious antibiotic usages lead multi-antibiotic resistant agents. In a multidisciplinary manner the patient must be evaluated if he/she has a genetic, physiological or anatomical disorder. Several current approaches such herbal products and vaccines are increasingly used to avoid antibiotic overuse [TAF Prev Med Bull 2014; 13(2.000: 161-168

  17. A fast and frugal algorithm to strengthen diagnosis and treatment decisions for catheter-associated bacteriuria.

    Science.gov (United States)

    Naik, Aanand D; Skelton, Felicia; Amspoker, Amber B; Glasgow, Russell A; Trautner, Barbara W

    2017-01-01

    Guidelines for managing catheter-associated urinary tract infection (CAUTI) and asymptomatic bacteria (ASB) are poorly translated into routine care due in part to cognitive diagnostic errors. This study determines if the accuracy for CAUTI and ASB diagnosis and treatment improves after implementation of a fast and frugal algorithm compared with traditional education methods. A pre and post-intervention with contemporaneous comparison site involving inpatient and long term care wards at two regional Veterans Affairs Systems in United States. Participants included 216 internal medicine residents and 16 primary care clinicians. Intervention clinicians received training with a fast and frugal algorithm. Comparison site clinicians received guidelines education. Diagnosis and treatment accuracy compared with a criterion standard was assessed during similar three-month, pre- and post-intervention periods. Sensitivity, specificity, and likelihood ratios were compared for both periods at each site. Bacteriuria management was evaluated against criterion standard in 196 cases pre-implementation and 117 cases post-implementation. Accuracy of bacteriuria management among intervention participants was significantly higher, post-implementation, than those at the comparison site (Intervention: positive likelihood ratio (LR+) = 8.5, specificity = 0.89, 95% confidence interval (CI) = 0.78-1.00; comparison: LR+ = 4.62, specificity (95%CI) = 0.79 (0.63-0.95). Further, improvements at the intervention site were statistically significant (pre-implementation: LR+ = 2.1, specificity (95%CI) = 0.60 (0.50-0.71); post-implementation: LR+ = 8.5, specificity (95%CI) = 0.89 (0.78-1.00). At both sites, there were similar improvements in negative LR from pre- to post-implementation: [Intervention site = 0.28 to 0.08; comparison site = 0.13 to 0.04]. Inappropriate management of ASB declined markedly from 32 (40%) to 3 (11%) cases at the intervention site. A fast and frugal algorithm improves

  18. Management of patients with resistant hypertension: current treatment options

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    Kumar N

    2013-10-01

    Full Text Available Nilay Kumar,1 David A Calhoun,2 Tanja Dudenbostel21Department of Medicine, 2Division of Cardiovascular Disease, Hypertension and Vascular Biology Program, University of Alabama at Birmingham, Birmingham, AL, USAAbstract: Resistant hypertension (RHTN is an increasingly common clinical problem that is often heterogeneous in etiology, risk factors, and comorbidities. It is defined as uncontrolled blood pressure on optimal doses of three antihypertensive agents, ideally one being a diuretic. The definition also includes controlled hypertension with use of four or more antihypertensive agents. Recent observational studies have advanced the characterization of patients with RHTN. Patients with RHTN have higher rates of cardiovascular events and mortality compared with patients with more easily controlled hypertension. Secondary causes of hypertension, including obstructive sleep apnea, primary aldosteronism, renovascular disease, are common in patients with RHTN and often coexist in the same patient. In addition, RHTN is often complicated by metabolic abnormalities. Patients with RHTN require a thorough evaluation to confirm the diagnosis and optimize treatment, which typically includes a combination of lifestyle adjustments, and pharmacologic and interventional treatment. Combination therapy including a diuretic, a long-acting calcium channel blocker, an angiotensin-converting enzyme inhibitor, a beta blocker, and a mineralocorticoid receptor antagonist where warranted is the classic regimen for patients with treatment-resistant hypertension. Mineralocorticoid receptor antagonists like spironolactone or eplerenone have been shown to be efficacious in patients with RHTN, heart failure, chronic kidney disease, and primary aldosteronism. Novel interventional therapies, including baroreflex activation and renal denervation, have shown that both of these methods may be used to lower blood pressure safely, thereby providing exciting and promising new

  19. Hamstring injuries. Current trends in treatment and prevention.

    Science.gov (United States)

    Kujala, U M; Orava, S; Järvinen, M

    1997-06-01

    Pre-exercise stretching and adequate warm-up are important in the prevention of hamstring injuries. A previous mild injury or fatigue may increase the risk of injury. Hamstring muscle tear is typically partial and takes place during eccentric exercise when the muscle develops tension while lengthening, but variation in injury mechanisms is possible. Diagnosis of typical hamstring muscle injury is usually based on typical injury mechanism and clinical findings of local pain and loss of function. Diagnosis of avulsion in the ischial tuberosity, with the need for longer immobilisation, and a complete rupture of the hamstring origin, in which immediate operative treatment is necessary, poses a challenge to the treating physician. X-rays, ultrasonography or magnetic resonance imaging (MRI) may be helpful in differential diagnostics. After first aid with rest, compression, cold and elevation, the treatment of hamstring muscle injury must be tailored to the grade of injury. Conservative treatment is based on a knowledge of the biological background of the healing process of the muscle. Experimental studies have shown that a short period of immobilisation is needed to accelerate formation of the granulation tissue matrix following injury. The length of the immobilisation is, however, dependent on the grade of injury and should be optimised so that the scar can bear the pulling forces operating on it without re-rupture. Mobilisation, on the other hand, is required in order to regain the original strength of the muscle and to achieve good final results in resorption of the connective tissue scar and re-capillarisation of the damaged area. Another important aim of mobilisation--especially in sports medical practice--is to avoid muscle atrophy and loss of strength and extensibility, which rapidly result from prolonged immobilisation. Complete ruptures with loss of function should be operated on, as should cases resistant to conservative therapy in which, in the late phase of

  20. Current and emerging treatments for the management of osteogenesis imperfecta

    Directory of Open Access Journals (Sweden)

    Elena Monti

    2010-08-01

    Full Text Available Elena Monti1, Monica Mottes1, Paolo Fraschini2, PierCarlo Brunelli3, Antonella Forlino4, Giacomo Venturi1, Francesco Doro1, Silvia Perlini1, Paolo Cavarzere1, Franco Antoniazzi11Department of Life Sciences and Reproduction, Pediatric Clinic University of Verona, Verona, Italy; 2Istituto Di Ricovero e Cura a Carattere Scientifico, ‘E. Medea’, Associazione La Nostra Famiglia, Bosisio Parini (LC, Italy; 3Divisione di Ortopedia Pediatrica, Spedali Civili, Brescia, Italy; 4Department of Biochemistry “A. Castellani”, University of Pavia, ItalyAbstract: Osteogenesis imperfecta (OI is the most common bone genetic disorder and it is characterized by bone brittleness and various degrees of growth disorder. Clinical severity varies widely; nowadays eight types are distinguished and two new forms have been recently described although not yet classified. The approach to such a variable and heterogeneous disease should be global and therefore multidisciplinary. For simplicity, the objectives of treatment can be reduced to three typical situations: the lethal perinatal form (type II, in which the problem is survival at birth; the severe and moderate forms (types III–IX, in which the objective is ‘autonomy’; and the mild form (type I, in which the aim is to reach ‘normal life’. Three types of treatment are available: non-surgical management (physical therapy, rehabilitation, bracing and splinting, surgical management (intramedullary rod positioning, spinal and basilar impression surgery and medical-pharmacological management (drugs to increase the strength of bone and decrease the number of fractures as bisphosphonates or growth hormone, depending on the type of OI. Suggestions and guidelines for a therapeutic approach are indicated and updated with the most recent findings in OI diagnosis and treatment.Keywords: osteogenesis imperfecta, bone genetic disorder, bone brittleness, “brittle bone disease”, connective tissue malfunction, short

  1. Profile of secukinumab in the treatment of psoriasis: current perspectives

    Directory of Open Access Journals (Sweden)

    Roman M

    2015-12-01

    Full Text Available Michael Roman, Vandana K Madkan, Melvin W Chiu Division of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA Abstract: Secukinumab (Cosentyx™ is a human monoclonal IgG1k antibody that has been developed to target and block the actions of IL-17A. It is known that this cytokine is elevated in lesions of psoriasis. Interleukins in the Th17 pathway play a pivotal role in the pathogenesis of psoriasis and have thus become targets for recent biologic drug development. As a monoclonal antibody immune modulator, secukinumab exhibits the expected pharmacokinetic properties of slow subcutaneous absorption, low clearance, and long half-life, although formal studies examining the impact of impaired hepatic or renal function on the overall pharmacokinetic profile have not been conducted. Both Phase II and III clinical trials have demonstrated the effectiveness of secukinumab in the treatment of moderate-to-severe plaque psoriasis, psoriatic arthritis, rheumatoid arthritis, ankylosing spondylitis, and noninfectious uveitis. In June 2015, secukinumab was approved by the US Food and Drug Administration for the treatment of adults with moderate-to-severe plaque psoriasis, with a wealth of clinical trials showcasing its efficacy in improving psoriasis area and severity index scores, and it is superior to other comparable biologics on the market, including the TNF inhibitor etanercept. As such, this review focuses on the marquee clinical trials involving secukinumab treatment of plaque psoriasis, while also exploring this drug’s efficacy in treating patients with psoriatic arthritis, a disease that has a well-documented comorbidity in patients diagnosed with moderate-to-severe plaque psoriasis. Finally, the safety and tolerability of this drug in a variety of clinical trials to date have also been reviewed, and will undoubtedly have a large impact on this drug’s postmarketing surveillance and future studies regarding its long

  2. Current Status of the Treatment of Fulminant Colitis.

    Science.gov (United States)

    Ferrer Márquez, Manuel; Hernández Martínez, Álvaro; Reina Duarte, Ángel; Rosado Cobián, Rafael

    2015-05-01

    Fulminant colitis is not a well-defined entity, that constitutes a severe complication. It usually occurs in the course of úlcerative colitis and Clostridium difficile colitis. A multidisciplinary management combining gastroenterologist and surgeons is crucial with intensive medical treatment and early surgery in non-responders. It is important to distinguish if we are facing a flare of IBD or, on the contrary, it is an infectious colitis, due to the fact that although general therapeutic measures to adopt will be the same, they will demand opposed specific measures.

  3. When is facial paralysis Bell palsy? Current diagnosis and treatment.

    Science.gov (United States)

    Ahmed, Anwar

    2005-05-01

    Bell palsy is largely a diagnosis of exclusion, but certain features in the history and physical examination help distinguish it from facial paralysis due to other conditions: eg, abrupt onset with complete, unilateral facial weakness at 24 to 72 hours, and, on the affected side, numbness or pain around the ear, a reduction in taste, and hypersensitivity to sounds. Corticosteroids and antivirals given within 10 days of onset have been shown to help. But Bell palsy resolves spontaneously without treatment in most patients within 6 months.

  4. Current treatment strategies: Collagen vascular diseases in children

    Directory of Open Access Journals (Sweden)

    Aparna Palit

    2012-01-01

    Full Text Available Of the various collagen vascular diseases seen in pediatric age group, discoid lupus erythematosus, systemic lupus erythematosus, neonatal lupus erythematosus, juvenile dermatomyositis and childhood scleroderma are common and of practical importance to clinicians. Various treatment modalities of these conditions have been discussed at length. Of these, some are conventional and routine,while others are used in challenging situations of these diseases. Autologous stem cell transplant, biological therapies, intravenous immunoglobulin and narrow band ultraviolet B are among the latest therapeutic options for these difficult-to-treat conditions in children.

  5. [Current protocols for diagnosis and treatment of sexually transmitted diseases].

    Science.gov (United States)

    Di Carlo, A

    2000-01-01

    This report presents the guidelines for the treatment of individuals with sexually transmitted diseases (STD) that were developed by the STD Study Group "GIRVE" of the Società Italiana di Dermatologia e Venereologia (Italian Society of Dermatology and Venerology) in accordance with those developed by the US Centers for Disease Control and Prevention in 1998. The guidelines represent a useful tool for physicians and other health-care providers in preventing and controlling STDs. The guidelines include new recommendations for treating genital herpes and genital warts.

  6. [Origin and treatment of insomnia: current status of knowledge].

    Science.gov (United States)

    Poluektov, M G

    2012-10-01

    Insomnia is the clinical syndrome that is characterized by the disturbances of night sleep and daytime wakefulness with the presence of the sufficient time for sleep. It is the most common and clinically important sleep disorder among the mentioned in the international classification. Insomnia is the geterogeneous condition including the primary and secondary, acute and chronic types. Specific and nonspecific approaches are utilized in the treatment of insomnia, and the methods of normalization of sleep hygiene and behavioral therapy are effective independently of the type of insomnia. Hypnotics and other medicines are recommended to use in acute and some secondary types of insomnia.

  7. Cancer Treatment-Related Cardiotoxicity: Understanding the Current State of Knowledge and Developing Future Research Priorities

    Science.gov (United States)

    Cancer Treatment-Related Cardiotoxicity: Understanding the Current State of Knowledge and Developing Future Research Priorities, a 2013 workshop sponsored by the Epidemiology and Genomics Research Program.

  8. [Current status and trends in treatment of scleroderma].

    Science.gov (United States)

    Haustein, U F

    1992-07-01

    Owing to the wide variety of symptoms, the long clinical course, the inadequate knowledge of the points at which therapeutic action is appropriate and the difficulty of obtaining objective measurements of the treatment results, therapy for systemic sclerosis has to be planned individually. Besides basic recommendations (avoidance of noxious substances, sensible diet, keeping warm, active exercises), physiotherapy and psychological guidance, the therapy is directed at three pathogenetic complexes. Among the vasoactive substances the prostacyclins, calcium channel blockers and angiotensin-converting-enzyme inhibitors (in the case of complicated renal involvement) are recommended. They inhibit the thrombocyte hyperaggregation and lead to vasodilatation. The anti-inflammatory substances prednisolone and azathioprine also exert immunosuppressant (and cytotoxic) effect. Their use is indicated in inflammatory, immunologically active forms of systemic sclerosis. Antifibrotic agents inhibit cross-link formation, prolylhydroxylase, extrusion of collagen from fibroblasts and, thus, collagen synthesis. In addition, they favour the degradation of collagen via the activation of collagenase. Good results have been reported with penicillamine and penicillin G. Pentoxyphyllin leads to vasodilatation and also inhibits collagen metabolism. Promising agents and procedures for future use include cyclosporin A, CD4 antibodies, photopheresis, interferon gamma and factor XIII. A critical attitude to therapy and a great deal of patience are necessary to avoid harming the patients, especially as it is often some months before any effects of the treatment are seen.

  9. Current and emerging therapies for the treatment of myasthenia gravis

    Directory of Open Access Journals (Sweden)

    Renato Mantegazza

    2011-03-01

    Full Text Available Renato Mantegazza, Silvia Bonanno, Giorgia Camera, Carlo AntozziDepartment of Neuromuscular Diseases and Neuroimmunology, Fondazione Istituto Neurologico Carlo Besta, Milan, ItalyAbstract: Myasthenia gravis (MG is an autoimmmune disease in which autoantibodies to different antigens of the neuromuscular junction cause the typical weakness and fatigability. Treatment includes anticholinesterase drugs, immunosuppression, immunomodulation, and thymectomy. The autoimmune response is maintained under control by corticosteroids frequently associated with immunosuppressive drugs, with improvement in the majority of patients. In case of acute exacerbations with bulbar symptoms or repeated relapses, modulation of autoantibody activity by plasmapheresis or intravenous immunoglobulins provides rapid improvement. Recently, techniques removing only circulating immunoglobulins have been developed for the chronic management of treatment-resistant patients. The rationale for thymectomy relies on the central role of the thymus. Despite the lack of controlled studies, thymectomy is recommended as an option to improve the clinical outcome or promote complete remission. New videothoracoscopic techniques have been developed to offer the maximal surgical approach with the minimal invasiveness and hence patient tolerability. The use of biological drugs such as anti-CD20 antibodies is still limited but promising. Studies performed in the animal model of MG demonstrated that several more selective or antigen-specific approaches, ranging from mucosal tolerization to inhibition of complement activity or cellular therapy, might be feasible. Investigation of the transfer of these therapeutic approaches to the human disease will be the challenge for the future.Keywords: myasthenia gravis, therapy, immunosuppression, thymectomy, plasmapheresis

  10. Endovascular and microsurgical treatment of cerebral arteriovenous malformations: Current recommendations

    Science.gov (United States)

    Conger, Andrew; Kulwin, Charles; Lawton, Michael T.; Cohen-Gadol, Aaron A.

    2015-01-01

    Background: Cerebral arteriovenous malformations (AVMs) can be a heterogeneous pathological entity whose management requires a complex decision-making process due to the risks associated with their treatment and natural history. Despite the recently published conclusions of the aborted Randomized Trial of Brain Unruptured AVMs (ARUBA) trial, the authors of this article believe multimodality intervention in general and microsurgical resection in particular continue to play a major role in the management of carefully selected ruptured or unruptured AVMs. Methods: The authors provide an overview of their methodology for endovascular intervention and microsurgical resection and share their technical nuances for successful embolization and microsurgical resection of AVMs with special emphasis on complication avoidance. Results: The authors have achieved successful outcomes in embolization and resection of cerebral AVMs when using their methodology. Conclusions: These lesions are among the most technically difficult pathological entities handled by the cerebrovascular specialist, and an overview of technical concepts to help systematize this challenging and variable endeavor can improve the safety of their treatment. PMID:25883831

  11. Neonatal cholestasis – differential diagnoses, current diagnostic procedures and treatment

    Directory of Open Access Journals (Sweden)

    Thomas eGötze

    2015-06-01

    Full Text Available Cholestatic jaundice in early infancy is a complex diagnostic problem. Misdiagnosis of cholestasis as physiologic jaundice delays the identification of severe liver diseases. In the majority of infants it may represent benign cases of breast milk jaundice, but few among them are masked and caused by neonatal cholestasis that requires a prompt diagnosis and treatment. Therefore, a prolonged neonatal jaundice longer than two weeks after birth must always be scrutinized because an early diagnosis is essential for appropriate management. To rapidly identify the cholestatic cases, the conjugated bilirubin needs to be determined in any infant presenting with prolonged jaundice at 14 days of age with or without depigmented stool. Once neonatal cholestasis is confirmed, a systematic approach is the key to reliably achieve the diagnosis in order to promptly initiate the specific, and in many cases, life saving therapy. This strategy is most important to promptly identify and treat infants with biliary atresia, the most common cause of neonatal cholestasis that requires a hepatoportoenterostomy as soon as possible.Here, we provide a detailed work-up approach including initial treatment recommendations and a clinically oriented overview of possible differential diagnoses in order to facilitate an early recognition and a timely diagnosis. This warrants a broad spectrum of diagnostic procedures and investigations including new methods that are described in this review.

  12. Cytotherapies in multiple myeloma: a complementary approach to current treatments?

    Science.gov (United States)

    Ciavarella, Sabino; Caselli, Anna; Savonarola, Annalisa; Tamma, Antonella Valentina; Tucci, Marco; Silvestris, Franco

    2013-06-01

    Based on their tumor tropism, mesenchymal stem cells (MSCs) have been proposed as carriers of cytotoxic molecules in pioneering strategies of anti-cancer gene therapy. Similar to solid tumors, MSCs, genetically modified to stably express the TNF-related apoptosis-inducing ligand (TRAIL), have been applied to counter-attack multiple myeloma (MM) in vitro and envisioned as a promising strategy for future anti-MM treatments. Accumulating evidence based on the detection of genetic and functional abnormalities in MSCs from MM patients points to the supportive function of MSCs in both the development and progression of MM, driven by chronic interplays with malignant cells within the marrow milieu. In this review, we revisit the function of MSCs in the pathophysiology of MM and explore the pivotal mechanisms of their interaction with myeloma cells. We also discuss the therapeutic significance of novel strategies using TRAIL-engineered MSCs in this cancer model, dissecting their role as new tools for future treatments against MM. A cytotherapy based on TRAIL-engineered MSCs against MM may be successfully combined with either conventional approaches of autologous stem cell transplantation or with novel anti-MM drugs. Intensive preclinical investigations are required to identify the best sources as well as modalities of MSC administration, thus defining the translational suitability of this strategy in the clinical setting.

  13. Dosimetric Study of Current Treatment Options for Radiotherapy in Retinoblastoma

    Energy Technology Data Exchange (ETDEWEB)

    Eldebawy, Eman [Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec (Canada); Department of Radiation Oncology, Children' s Cancer Hospital, Cairo (Egypt); Parker, William, E-mail: william.parker@mcgill.ca [Department of Medical Physics, McGill University Health Centre, Montreal, Quebec (Canada); Abdel Rahman, Wamied [Department of Medical Physics, McGill University Health Centre, Montreal, Quebec (Canada); Freeman, Carolyn R. [Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec (Canada)

    2012-03-01

    Purpose: To determine the best treatment technique for patients with retinoblastoma requiring radiotherapy to the whole eye. Methods and Materials: Treatment plans for 3 patients with retinoblastoma were developed using 10 radiotherapy techniques including electron beams, photon beam wedge pair (WP), photon beam three-dimensional conformal radiotherapy (3D-CRT), fixed gantry intensity-modulated radiotherapy (IMRT), photon volumetric arc therapy (VMAT), fractionated stereotactic radiotherapy, and helical tomotherapy (HT). Dose-volume analyses were carried out for each technique. Results: All techniques provided similar target coverage; conformity was highest for VMAT, nine-field (9F) IMRT, and HT (conformity index [CI] = 1.3) and lowest for the WP and two electron techniques (CI = 1.8). The electron techniques had the highest planning target volume dose gradient (131% of maximum dose received [D{sub max}]), and the CRT techniques had the lowest (103% D{sub max}) gradient. The volume receiving at least 20 Gy (V{sub 20Gy}) for the ipsilateral bony orbit was lowest for the VMAT and HT techniques (56%) and highest for the CRT techniques (90%). Generally, the electron beam techniques were superior in terms of brain sparing and delivered approximately one-third of the integral dose of the photon techniques. Conclusions: Inverse planned image-guided radiotherapy delivered using HT or VMAT gives better conformity index, improved orbital bone and brain sparing, and a lower integral dose than other techniques.

  14. Extrahepatic complications of chronic cholestasis: current diagnosis and treatment.

    Science.gov (United States)

    Prelipcean, Cristina Cijevschi; Mihai, Cătălina; Gogălniceanu, P; Mihai, B

    2012-01-01

    Pruritus, fatigue and osteoporosis are the main symptoms of the extra hepatic manifestations of chronic cholestasis that affect patients' quality of life. Pruritus affects more often female patients, varies as intensity during a day and for longer period of time, typically can be localized on the palms of hands and soles of feet or can be generalized. Pruritus can be treated with anions resines exchange--cholestiramine, the pregnanne X receptor agonist Rifampicine, Naltrexone. Liver transplantation can be considered if severe pruritus remains refractory to all medical treatments. Fatigue is the most disabling complain in chronic colestasis. No specific therapies are available for fatigue and liver transplantation doesn't improve it. Osteoporosis and the risk of fractures are more severe with the duration and severity of hepatic disease. For treatment are recommended regular physical exercise, vitamin D and Ca supplimentation and bisphosphonates (Alendronate 70 mg/week) in severe cases. Only patients with atherosclerotic risk and hyperlipemia can be treated with statines. Fat soluble vitamin supplementation can be administrated only in symptomatic and proved vitamin deficiency.

  15. Curative treatment of oesophageal carcinoma: current options and future developments

    Directory of Open Access Journals (Sweden)

    Bruns Christiane

    2011-05-01

    Full Text Available Abstract Since the 1980s major advances in surgery, radiotherapy and chemotherapy have established multimodal approaches as curative treatment options for oesophageal cancer. In addition the introduction of functional imaging modalities such as PET-CT created new opportunities for a more adequate patient selection and therapy response assessment. The majority of oesophageal carcinomas are represented by two histologies: squamous cell carcinoma and adenocarcinoma. In recent years an epidemiological shift towards the latter was observed. From a surgical point of view, adenocarcinomas, which are usually located in the distal third of the oesophagus, may be treated with a transhiatal resection, whereas squamous cell carcinomas, which are typically found in the middle and the upper third, require a transthoracic approach. Since overall survival after surgery alone is poor, multimodality approaches have been developed. At least for patients with locally advanced tumors, surgery alone can no longer be advocated as routine treatment. Nowadays, scientific interest is focused on tumor response to induction radiochemotherapy. A neoadjuvant approach includes the early and accurate assessment of clinical response, optimally performed by repeated PET-CT imaging and endoscopic ultrasound, which may permit early adaption of the therapeutic concept. Patients with SCC that show clinical response by PET CT are considered to have a better prognosis, regardless of whether surgery will be performed or not. In non-responding patients salvage surgery improves survival, especially if complete resection is achieved.

  16. Building a diagnostic algorithm on localized neuropathic pain (LNP) and targeted topical treatment: focus on 5% lidocaine-medicated plaster

    Science.gov (United States)

    Casale, Roberto; Mattia, Consalvo

    2014-01-01

    Within the broad definition of neuropathic pain, the refinement of clinical diagnostic procedures has led to the introduction of the concept of localized neuropathic pain (LNP). It is characterized by consistent and circumscribed area(s) of maximum pain, which are associated with negative or positive sensory signs and/or spontaneous symptoms typical of neuropathic pain. This description outlines the clinical features (currently lacking in guidelines and treatment recommendations) in patients for whom topical targeted treatment with 5% lidocaine-medicated plaster is suggested as first-line therapy. Few epidemiologic data are present in the literature but it is generally estimated that about 60% of neuropathic pain conditions are localized, and therefore identifiable as LNP. A mandatory clinical criterion for the diagnosis of LNP is that signs and symptoms must be present in a clearly identified and defined area(s). Cartographic recordings can help to define each area and to assess variations. The diagnosis of LNP relies on careful neurological examination more than on pain questionnaires, but it is recognized that they can be extremely useful for recording the symptom profiles and establishing a more targeted treatment. The most widely studied frequent/relevant clinical presentations of LNP are postherpetic neuralgia, diabetic neuropathy, and neuropathic postoperative pain. They successfully respond to treatment with 5% lidocaine-medicated plaster with equal if not better pain control but with fewer side effects versus conventional systemic treatments. Generally, the more localized the pain (ie, the area of an A4 sheet of paper) the better the results of topical treatment. This paper proposes an easy-to-understand algorithm to identify patients with LNP and to guide targeted topical treatments with 5% lidocaine medicated plaster. PMID:24790451

  17. Insulin dose during glucocorticoid treatment for fetal lung maturation in diabetic pregnancy: test of an algorithm [correction of analgoritm

    DEFF Research Database (Denmark)

    Mathiesen, Elisabeth R; Christensen, Ann-Birgitte L; Hellmuth, Ellinor

    2002-01-01

    Poor glycemic control is often a serious clinical problem during glucocorticoid treatment for fetal lung maturation in pregnant women with diabetes. An algorithm for improved subcutaneous insulin treatment during glucocorticoid treatment in insulin-dependent diabetic women was developed and tested....

  18. Treatment of sepsis: current status of clinical immunotherapy.

    LENUS (Irish Health Repository)

    O'Callaghan, A

    2012-02-03

    While antibiotics address the root cause of sepsis--that of pathogen infection--they fail to provide an adequate cure for the condition. Currently, 30% to 50% of septic patients die, and this figure is likely to increase in line with the proliferation of multi-drug resistant bacteria. With an increased understanding of the immune response, it has been proposed that modulation of this defence mechanism offers the best hope of cure. Many entry-points in the immune system have been identified and targeted therapies have been developed,but why are these not in routine clinical practice? This review examines the latest evidence for the use of immuno-modulating drugs, obtained from human clinical trials. We discuss cytokine-based therapies, steroids and anti-coagulants. Finally, consideration is given as to why successful therapies in the laboratory, and in vivo models, do not automatically translate into clinical benefit

  19. Comparison of dose calculation algorithms for treatment planning in external photon beam therapy for clinical situations.

    Science.gov (United States)

    Knöös, Tommy; Wieslander, Elinore; Cozzi, Luca; Brink, Carsten; Fogliata, Antonella; Albers, Dirk; Nyström, Håkan; Lassen, Søren

    2006-11-21

    A study of the performance of five commercial radiotherapy treatment planning systems (TPSs) for common treatment sites regarding their ability to model heterogeneities and scattered photons has been performed. The comparison was based on CT information for prostate, head and neck, breast and lung cancer cases. The TPSs were installed locally at different institutions and commissioned for clinical use based on local procedures. For the evaluation, beam qualities as identical as possible were used: low energy (6 MV) and high energy (15 or 18 MV) x-rays. All relevant anatomical structures were outlined and simple treatment plans were set up. Images, structures and plans were exported, anonymized and distributed to the participating institutions using the DICOM protocol. The plans were then re-calculated locally and exported back for evaluation. The TPSs cover dose calculation techniques from correction-based equivalent path length algorithms to model-based algorithms. These were divided into two groups based on how changes in electron transport are accounted for ((a) not considered and (b) considered). Increasing the complexity from the relatively homogeneous pelvic region to the very inhomogeneous lung region resulted in less accurate dose distributions. Improvements in the calculated dose have been shown when models consider volume scatter and changes in electron transport, especially when the extension of the irradiated volume was limited and when low densities were present in or adjacent to the fields. A Monte Carlo calculated algorithm input data set and a benchmark set for a virtual linear accelerator have been produced which have facilitated the analysis and interpretation of the results. The more sophisticated models in the type b group exhibit changes in both absorbed dose and its distribution which are congruent with the simulations performed by Monte Carlo-based virtual accelerator.

  20. Contracted Nose after Silicone Implantation: A New Classification System and Treatment Algorithm

    Science.gov (United States)

    Kim, Yong Kyu; Shin, Seungho; Kim, Joo Heon

    2017-01-01

    Background Silicone implants are frequently used in augmentation rhinoplasty in Asians. A common complication of silicone augmentation rhinoplasty is capsular contracture. This is similar to the capsular contracture after augmentation mammoplasty, but a classification for secondary contracture after augmentation rhinoplasty with silicone implants has not yet been established, and treatment algorithms by grade or severity have yet to be developed. Methods Photographs of 695 patients who underwent augmentation rhinoplasty with a silicone implant from May 2001 to May 2015 were analyzed. The mean observation period was 11.4 months. Of the patients, 81 were male and 614 were female, with a mean age of 35.9 years. Grades were assigned according to postoperative appearance. Grade I was a natural appearance, as if an implant had not been inserted. Grade II was an unnatural lateral margin of the implant. Clearly identifiable implant deviation was classified as grade III, and short nose deformation was grade IV. Results Grade I outcomes were found in 498 patients (71.7%), grade II outcomes in 101 (14.5%), grade III outcomes in 75 (10.8%), and grade IV outcomes in 21 patients (3.0%). Revision surgery was indicated for the 13.8% of all patients who had grade III or IV outcomes. Conclusions It is important to clinically classify the deformations due to secondary contracture after surgery and to establish treatment algorithms to improve scientific communication among rhinoplasty surgeons. In this study, we suggest guidelines for the clinical classification of secondary capsular contracture after augmentation rhinoplasty, and also propose a treatment algorithm. PMID:28194349

  1. Contracted Nose after Silicone Implantation: A New Classification System and Treatment Algorithm

    Directory of Open Access Journals (Sweden)

    Yong Kyu Kim

    2017-01-01

    Full Text Available BackgroundSilicone implants are frequently used in augmentation rhinoplasty in Asians. A common complication of silicone augmentation rhinoplasty is capsular contracture. This is similar to the capsular contracture after augmentation mammoplasty, but a classification for secondary contracture after augmentation rhinoplasty with silicone implants has not yet been established, and treatment algorithms by grade or severity have yet to be developed.MethodsPhotographs of 695 patients who underwent augmentation rhinoplasty with a silicone implant from May 2001 to May 2015 were analyzed. The mean observation period was 11.4 months. Of the patients, 81 were male and 614 were female, with a mean age of 35.9 years. Grades were assigned according to postoperative appearance. Grade I was a natural appearance, as if an implant had not been inserted. Grade II was an unnatural lateral margin of the implant. Clearly identifiable implant deviation was classified as grade III, and short nose deformation was grade IV.ResultsGrade I outcomes were found in 498 patients (71.7%, grade II outcomes in 101 (14.5%, grade III outcomes in 75 (10.8%, and grade IV outcomes in 21 patients (3.0%. Revision surgery was indicated for the 13.8% of all patients who had grade III or IV outcomes.ConclusionsIt is important to clinically classify the deformations due to secondary contracture after surgery and to establish treatment algorithms to improve scientific communication among rhinoplasty surgeons. In this study, we suggest guidelines for the clinical classification of secondary capsular contracture after augmentation rhinoplasty, and also propose a treatment algorithm.

  2. Current State of the Surgical Treatment of Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Elena Sandoval

    2011-01-01

    Full Text Available Surgery of atrial fibrillation (AF was first described in 1991 by James Cox in what was named the Cox-Maze procedure, and over the years it has been considered the gold-standard treatment, with best results in maintaining sinus rhythm in the long term. Nevertheless, the complexity and aggressivity of the first techniques of cut-and-sew limited the application of this procedure, and few centers were dedicated to AF surgery. In the past years, however, new devices able to ablate atrial tissue with cryotherapy, radiofrequency, or ultrasounds have facilitated this operation. In the mid-term, other energy devices with laser or microwave have been abandoned due to a lack of consistency in getting transmural lesions in a consistent and reproducible manner. Additionally, better knowledge of the physiopathology of AF, with the importance of triggering zones around the pulmonary veins, has started new minimally invasive techniques to approach paroxysmal and persistent AF patients through thoracoscopy.

  3. Human toxocariasis: current advances in diagnostics, treatment, and interventions.

    Science.gov (United States)

    Moreira, Gustavo Marçal Schmidt Garcia; Telmo, Paula de Lima; Mendonça, Marcelo; Moreira, Angela Nunes; McBride, Alan John Alexander; Scaini, Carlos James; Conceição, Fabricio Rochedo

    2014-09-01

    Toxocariasis is a neglected zoonosis caused by the nematodes Toxocara canis and Toxocara cati. This disease is widespread in many countries, reaching high prevalence independently of the economic conditions. However, the true number of cases of toxocariasis is likely to be underestimated owing to the lack of adequate surveillance programs. Although some diagnostic tests are available, their sensitivity and specificity need to be improved. In addition, treatment options for toxocariasis are limited and are non-specific. Toxocariasis is listed as one of the five most important neglected diseases by the CDC. This review presents recent advances related to the control of toxocariasis, including new immunodiagnostics, therapies, and drug formulations, as well as novel interventions using DNA vaccines, immunomodulators, and probiotics.

  4. Chronic perineal pain: current pathophysiological aspects, diagnostic approaches and treatment.

    Science.gov (United States)

    Andromanakos, Nikolaos P; Kouraklis, Grigorios; Alkiviadis, Kostakis

    2011-01-01

    Chronic perineal pain is the anorectal and perineal pain without underlying organic disease, anorectal or endopelvic, which has been excluded by careful physical examination, radiological and endoscopic investigations. A variety of neuromuscular disorders of the pelvic floor lead to the different pathological conditions such as anorectal incontinence, urinary incontinence and constipation of obstructed defecation, sexual dysfunction and pain syndromes. The most common functional disorders of the pelvic floor muscles, accompanied by perineal pain are levator ani syndrome, proctalgia fugax, myofascial syndrome and coccygodynia. In the diagnosis of these syndromes, contributing to a thorough history, physical examination, selected specialized investigations and the exclusion of organic disease with proctalgia is carried out. Accurate diagnosis of the syndromes helps in choosing an appropriate treatment and in avoiding unnecessary and ineffective surgical procedures, which often are performed in an attempt to alleviate the patient's symptoms.

  5. Achilles tendinopathy: A review of the current concepts of treatment.

    Science.gov (United States)

    Roche, A J; Calder, J D F

    2013-10-01

    The two main categories of Achilles tendon disorder are broadly classified by anatomical location to include non-insertional and insertional conditions. Non-insertional Achilles tendinopathy is often managed conservatively, and many rehabilitation protocols have been adapted and modified, with excellent clinical results. Emerging and popular alternative therapies, including a variety of injections and extracorporeal shockwave therapy, are often combined with rehabilitation protocols. Surgical approaches have developed, with minimally invasive procedures proving popular. The management of insertional Achilles tendinopathy is improved by recognising coexisting pathologies around the insertion. Conservative rehabilitation protocols as used in non-insertional disorders are thought to prove less successful, but such methods are being modified, with improving results. Treatment such as shockwave therapy is also proving successful. Surgical approaches specific to the diagnosis are constantly evolving, and good results have been achieved.

  6. Current Concepts in the Treatment of Retinitis Pigmentosa

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    Maria A. Musarella

    2011-01-01

    Full Text Available Inherited retinal degenerations, including retinitis pigmentosa (RP and Leber congenital amaurosis (LCA, affect 1 in 4000 individuals in the general population. A majority of the genes which are mutated in these conditions are expressed in either photoreceptors or the retinal pigment epithelium (RPE. There is considerable variation in the clinical severity of these conditions; the most severe being autosomal recessive LCA, a heterogeneous retinal degenerative disease and the commonest cause of congenital blindness in children. Here, we discuss all the potential treatments that are now available for retinal degeneration. A number of therapeutic avenues are being explored based on our knowledge of the pathophysiology of retinal degeneration derived from research on animal models, including: gene therapy, antiapoptosis agents, neurotrophic factors, and dietary supplementation. Technological advances in retinal implant devices continue to provide the promise of vision for patients with end-stage disease.

  7. An optimized treatment for algorithmic differentiation of an important glaciological fixed-point problem

    Science.gov (United States)

    Goldberg, Daniel N.; Krishna Narayanan, Sri Hari; Hascoet, Laurent; Utke, Jean

    2016-05-01

    We apply an optimized method to the adjoint generation of a time-evolving land ice model through algorithmic differentiation (AD). The optimization involves a special treatment of the fixed-point iteration required to solve the nonlinear stress balance, which differs from a straightforward application of AD software, and leads to smaller memory requirements and in some cases shorter computation times of the adjoint. The optimization is done via implementation of the algorithm of Christianson (1994) for reverse accumulation of fixed-point problems, with the AD tool OpenAD. For test problems, the optimized adjoint is shown to have far lower memory requirements, potentially enabling larger problem sizes on memory-limited machines. In the case of the land ice model, implementation of the algorithm allows further optimization by having the adjoint model solve a sequence of linear systems with identical (as opposed to varying) matrices, greatly improving performance. The methods introduced here will be of value to other efforts applying AD tools to ice models, particularly ones which solve a hybrid shallow ice/shallow shelf approximation to the Stokes equations.

  8. Post-traumatic epilepsy: current and emerging treatment options

    Directory of Open Access Journals (Sweden)

    Szaflarski JP

    2014-08-01

    Full Text Available Jerzy P Szaflarski,1,3 Yara Nazzal,1,3 Laura E Dreer2 1Department of Neurology, 2Department of Ophthalmology, 3UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA Abstract: Traumatic brain injury (TBI leads to many undesired problems and complications, including immediate and long-term seizures/epilepsy, changes in mood, behavioral, and personality problems, cognitive and motor deficits, movement disorders, and sleep problems. Clinicians involved in the treatment of patients with acute TBI need to be aware of a number of issues, including the incidence and prevalence of early seizures and post-traumatic epilepsy (PTE, comorbidities associated with seizures and anticonvulsant therapies, and factors that can contribute to their emergence. While strong scientific evidence for early seizure prevention in TBI is available for phenytoin (PHT, other antiepileptic medications, eg, levetiracetam (LEV, are also being utilized in clinical settings. The use of PHT has its drawbacks, including cognitive side effects and effects on function recovery. Rates of recovery after TBI are expected to plateau after a certain period of time. Nevertheless, some patients continue to improve while others deteriorate without any clear contributing factors. Thus, one must ask, ‘Are there any actions that can be taken to decrease the chance of post-traumatic seizures and epilepsy while minimizing potential short- and long-term effects of anticonvulsants?’ While the answer is ‘probably,’ more evidence is needed to replace PHT with LEV on a permanent basis. Some have proposed studies to address this issue, while others look toward different options, including other anticonvulsants (eg, perampanel or other AMPA antagonists, or less established treatments (eg, ketamine. In this review, we focus on a comparison of the use of PHT versus LEV in the acute TBI setting and summarize the clinical aspects of seizure prevention in humans with

  9. Current trends in the diagnosis and treatment of tuboovarian abscess

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    Landers, D.V.; Sweet, R.L.

    1985-04-15

    Tuboovarian abscess is a well-recognized complication of acute salpingitis and has been reported in as many as one third of hospital admissions for acute salpingitis. The incidence of tuboovarian abscess is expected to increase as a result of the current epidemic of sexually transmitted diseases and their sequelae. Patients with tuboovarian abscess most commonly present with lower abdominal pain and an adnexal mass(es). Fever and leukocytosis may be absent. Ultrasound, computed tomographic scans, laparoscopy, or laparotomy may be necessary to confirm the diagnosis. Tuboovarian abscess may be unilateral or bilateral regardless of intrauterine contraceptive device usage. Tuboovarian abscess is polymicrobial with a preponderance of anaerobic organisms. An initial conservative antimicrobial approach to the management of the unruptured tuboovarian abscess is appropriate if the antimicrobial agents used can penetrate abscesses, remain active within the abscess environment, and are active against the major pathogens in tuboovarian abscess, including the resistant gram-negative anaerobes such as Bacteroides fragilis and Bacteroides bivius. However, if the patient does not begin to show a response within a reasonable amount of time, about 48 to 72 hours, surgical intervention should be undertaken. Suspicion of rupture should remain an indication for immediate operation. Once operation is undertaken, a conservative approach with unilateral adnexectomy for one-side tuboovarian abscess is appropriate if future fertility or hormone production is desired.

  10. Amyotrophic lateral sclerosis: clinical features and current treatment approaches

    Directory of Open Access Journals (Sweden)

    Tuba Tulay Koca

    2015-06-01

    Full Text Available Amyotrophic lateral sclerosis also known as Lou Gehring's disease, is the most common motor neuron disease characterized by motor neuron degeneration in the primary cortex, brainstem and spinal cord. This leads to widespread paralysis, respiratory insufficiency and death within an average of 3-5 years from disease onset. Majority of cases is sporadic and only 10% have a family story. One of the most interesting discovery in the field of neurodegeneration in recent years is genetic mutation in the C9orf72 (chromosome 9 open reading frame 72 gene, the most common mutation found to be causative of frontotemporal dementia, amyotrophic lateral sclerosis and concomitant of these two diseases. Currently curative therapy for amyotrophic lateral sclerosis is lacking. To date, one medication, Riluzole, has been proved to prolong survival, approximately 3-5 months, in amyotrophic lateral sclerosis. Researches aim to slow disease progression by targeting known pathophysiological pathways or genetics defects. Only symptomatic care to improve quality of life and survival is suggested. These includes respiratory and nutrition support; dysphagia and gastrostomy management; communication and mobility programs; spasticity prevention; pain medication; management of cognitive dysfunction, depression, mood dysorders (especially apathy, fatigue, sleep disturbance and prevention of deep venous thrombosis. [Archives Medical Review Journal 2015; 24(2.000: 182-194

  11. Catatonia: Our current understanding of its diagnosis, treatment and pathophysiology

    Science.gov (United States)

    Rasmussen, Sean A; Mazurek, Michael F; Rosebush, Patricia I

    2016-01-01

    Catatonia is a psychomotor syndrome that has been reported to occur in more than 10% of patients with acute psychiatric illnesses. Two subtypes of the syndrome have been identified. Catatonia of the retarded type is characterized by immobility, mutism, staring, rigidity, and a host of other clinical signs. Excited catatonia is a less common presentation in which patients develop prolonged periods of psychomotor agitation. Once thought to be a subtype of schizophrenia, catatonia is now recognized to occur with a broad spectrum of medical and psychiatric illnesses, particularly affective disorders. In many cases, the catatonia must be treated before any underlying conditions can be accurately diagnosed. Most patients with the syndrome respond rapidly to low-dose benzodiazepines, but electroconvulsive therapy is occasionally required. Patients with longstanding catatonia or a diagnosis of schizophrenia may be less likely to respond. The pathobiology of catatonia is poorly understood, although abnormalities in gamma-aminobutyric acid and glutamate signaling have been suggested as causative factors. Because catatonia is common, highly treatable, and associated with significant morbidity and mortality if left untreated, physicians should maintain a high level of suspicion for this complex clinical syndrome. Since 1989, we have systematically assessed patients presenting to our psychiatry service with signs of retarded catatonia. In this paper, we present a review of the current literature on catatonia along with findings from the 220 cases we have assessed and treated. PMID:28078203

  12. Catatonia: Our current understanding of its diagnosis, treatment and pathophysiology.

    Science.gov (United States)

    Rasmussen, Sean A; Mazurek, Michael F; Rosebush, Patricia I

    2016-12-22

    Catatonia is a psychomotor syndrome that has been reported to occur in more than 10% of patients with acute psychiatric illnesses. Two subtypes of the syndrome have been identified. Catatonia of the retarded type is characterized by immobility, mutism, staring, rigidity, and a host of other clinical signs. Excited catatonia is a less common presentation in which patients develop prolonged periods of psychomotor agitation. Once thought to be a subtype of schizophrenia, catatonia is now recognized to occur with a broad spectrum of medical and psychiatric illnesses, particularly affective disorders. In many cases, the catatonia must be treated before any underlying conditions can be accurately diagnosed. Most patients with the syndrome respond rapidly to low-dose benzodiazepines, but electroconvulsive therapy is occasionally required. Patients with longstanding catatonia or a diagnosis of schizophrenia may be less likely to respond. The pathobiology of catatonia is poorly understood, although abnormalities in gamma-aminobutyric acid and glutamate signaling have been suggested as causative factors. Because catatonia is common, highly treatable, and associated with significant morbidity and mortality if left untreated, physicians should maintain a high level of suspicion for this complex clinical syndrome. Since 1989, we have systematically assessed patients presenting to our psychiatry service with signs of retarded catatonia. In this paper, we present a review of the current literature on catatonia along with findings from the 220 cases we have assessed and treated.

  13. Therapeutic eyelids hygiene in the algorithms of prevention and treatment of ocular surface diseases

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    V. N. Trubilin

    2016-01-01

    Full Text Available When acute inflammation in anterior eye segment of a forward piece of an eye was stopped, ophthalmologists face a problem of absence of acute inflammation signs and at the same time complaints to the remain discomfort feelings. It causes dissatisfaction from the treatment. The complaints are typically caused by disturbance of tears productions. No accidental that the new group of diseases was allocated — the diseases of the ocular surface. Ocular surface is a difficult biologic system, including epithelium of the conjunctiva, cornea and limb, as well as the area costal margin eyelid and meibomian gland ducts. Pathological processes in conjunctiva, cornea and eyelids are linked with tears production. Ophthalmologists prescribes tears substitutions, providing short-term relief to patients. However, in respect that the lipid component of the tear film plays the key role in the preservation of its stability, eyelids hygiene is the basis for the treatment of dry eye associated with ocular surface diseases. Eyelids hygiene provides normal functioning of glands, restores the metabolic processes in skin and ensures the formation of a complete tear film. Protection of eyelids, especially the marginal edge from aggressive environmental agents, infections and parasites and is the basis for the prevention and treatment of blepharitis and dry eye syndrome. The most common clinical situations and algorithms of their treatment and prevention of dysfunction of the meibomian glands; demodectic blepharitis; seborrheic blepharitis; staphylococcal blepharitis; allergic blepharitis; barley and chalazion are discussed in the article. The prevention keratoconjunctival xerosis (before and postoperative period, caused by contact lenses, computer vision syndrome, remission after acute conjunctiva and cornea inflammation is also presented. The first part of the article presents the treatment and prevention algorithms for dysfunction of the meibomian glands, as well as

  14. Eltrombopag for the treatment of aplastic anemia: current perspectives

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    Lum SH

    2016-09-01

    Full Text Available Su Han Lum, John D GraingerDepartment of Blood and Marrow Transplant, Royal Manchester Children’s Hospital, Manchester, UK Abstract: Aplastic anemia (AA is a potential life-threatening hematopoietic stem cell (HSC disorder resulting in cytopenia. The mainstays of treatment for AA are definitive therapy to restore HSCs and supportive measures to ameliorate cytopenia-related complications. The standard definitive therapy is HSC transplantation for young and medically fit patients with suitable donors and immunosuppressive therapy (IST with antithymocyte globulin and cyclosporine for the remaining patients. A significant proportion of patients are refractory to IST or relapse after IST. Various strategies have been explored in these patients, including second course of antithymocyte globulin, high-dose cyclophosphamide, and alemtuzumab. Eltrombopag, a thrombopoietin mimetic, has recently emerged as an encouraging and promising agent for patients with refractory AA. It has demonstrated efficacy in restoring trilineage hematopoiesis, and this positive effect continues after discontinuation of the drug. There are ongoing clinical trials exploring the role of eltrombopag as a first-line therapy in moderate to severe AA and a combination of eltrombopag with IST in severe AA.Keywords: eltrombopag, aplastic anemia, thrombopoietin, c-Mpl receptors

  15. Osteosarcoma: Current Treatment and a Collaborative Pathway to Success

    Science.gov (United States)

    Isakoff, Michael S.; Bielack, Stefan S.; Meltzer, Paul; Gorlick, Richard

    2015-01-01

    Osteosarcoma is the bone tumor that most commonly affects children, adolescents, and young adults. Before 1970, treatment primarily included surgical resection. However, the introduction of chemotherapy led to a dramatic improvement in prognosis for patients with localized osteosarcoma; long-term survival rates of less than 20% improved to 65% to 70% after the advent of multiagent chemotherapy regimens. Controversy concerning the ideal combination of chemotherapy agents ensued throughout the last quarter of the 20th century because of conflicting and often nonrandomized data. However, large cooperative group studies and international collaboration have demonstrated that the most effective regimens include the combination of high-dose methotrexate, doxorubicin, and cisplatin (MAP). The introduction of biologic agents such as muramyl tripeptide and the use of additional cytotoxic chemotherapy such as ifosfamide have not definitively improved the survival of patients with osteosarcoma. Collaborative efforts to increase understanding of the biology of osteosarcoma and the use of preclinical models to test novel agents will be critical to identify the path toward improving outcomes for patients. Once promising agents are identified, an international infrastructure exists for clinical trials. Herein, biologic, preclinical, and clinical trial efforts will be described along with future international collaborative strategies to improve outcomes for patients who develop this challenging tumor. PMID:26304877

  16. Osteosarcoma: Current Treatment and a Collaborative Pathway to Success.

    Science.gov (United States)

    Isakoff, Michael S; Bielack, Stefan S; Meltzer, Paul; Gorlick, Richard

    2015-09-20

    Osteosarcoma is the bone tumor that most commonly affects children, adolescents, and young adults. Before 1970, treatment primarily included surgical resection. However, the introduction of chemotherapy led to a dramatic improvement in prognosis for patients with localized osteosarcoma; long-term survival rates of less than 20% improved to 65% to 70% after the advent of multiagent chemotherapy regimens. Controversy concerning the ideal combination of chemotherapy agents ensued throughout the last quarter of the 20th century because of conflicting and often nonrandomized data. However, large cooperative group studies and international collaboration have demonstrated that the most effective regimens include the combination of high-dose methotrexate, doxorubicin, and cisplatin (MAP). The introduction of biologic agents such as muramyl tripeptide and the use of additional cytotoxic chemotherapy such as ifosfamide have not definitively improved the survival of patients with osteosarcoma. Collaborative efforts to increase understanding of the biology of osteosarcoma and the use of preclinical models to test novel agents will be critical to identify the path toward improving outcomes for patients. Once promising agents are identified, an international infrastructure exists for clinical trials. Herein, biologic, preclinical, and clinical trial efforts will be described along with future international collaborative strategies to improve outcomes for patients who develop this challenging tumor. © 2015 by American Society of Clinical Oncology.

  17. Current Surgical Aspects of Palliative Treatment for Unresectable Pancreatic Cancer

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    Karapanos, Konstantinos, E-mail: dr.kostaskarapanos@gmail.com; Nomikos, Iakovos N. [Department of Surgery (B' Unit), METAXA Cancer Memorial Hospital, Piraeus (Greece)

    2011-02-11

    Despite all improvements in both surgical and other conservative therapies, pancreatic cancer is steadily associated with a poor overall prognosis and remains a major cause of cancer mortality. Radical surgical resection has been established as the best chance these patients have for long-term survival. However, in most cases the disease has reached an incurable state at the time of diagnosis, mainly due to the silent clinical course at its early stages. The role of palliative surgery in locally advanced pancreatic cancer mainly involves patients who are found unresectable during open surgical exploration and consists of combined biliary and duodenal bypass procedures. Chemical splanchnicectomy is another modality that should also be applied intraoperatively with good results. There are no randomized controlled trials evaluating the outcomes of palliative pancreatic resection. Nevertheless, data from retrospective reports suggest that this practice, compared with bypass procedures, may lead to improved survival without increasing perioperative morbidity and mortality. All efforts at developing a more effective treatment for unresectable pancreatic cancer have been directed towards neoadjuvant and targeted therapies. The scenario of downstaging tumors in anticipation of a future oncological surgical resection has been advocated by trials combining gemcitabine with radiation therapy or with the tyrosine kinase inhibitor erlotinib, with promising early results.

  18. Surgical treatment of familial adenomatous polyposis: dilemmas and current recommendations.

    Science.gov (United States)

    Campos, Fábio Guilherme

    2014-11-28

    Familial adenomatous polyposis (FAP) is an autosomal dominant inherited syndrome characterized by multiple adenomatous polyps (predisposing to colorectal cancer development) and numerous extracolonic manifestations. The underlying genetic burden generates variable clinical features that may influence operative management. As a precancerous hereditary condition, the rationale of performing a prophylactic surgery is a mainstay of FAP management. The purpose of the present paper is to bring up many controversial aspects regarding surgical treatment for FAP, and to discuss the results and perspectives of the operative choices and approaches. Preferably, the decision-making process should not be limited to the conventional confrontation of pros and cons of ileorectal anastomosis or restorative proctocolectomy. A wide discussion with the patient may evaluate issues such as age, genotype, family history, sphincter function, the presence or risk of desmoid disease, potential complications of each procedure and chances of postoperative surveillance. Therefore, the definition of the best moment and the choice of appropriate procedure constitute an individual decision that must take into consideration patient's preferences and full information about the complex nature of the disease. All these facts reinforce the idea that FAP patients should be managed by experienced surgeons working in specialized centers to achieve the best immediate and long-term results.

  19. Severe alcoholic hepatitis-current concepts, diagnosis and treatment options

    Institute of Scientific and Technical Information of China (English)

    Won; Kim; Dong; Joon; Kim

    2014-01-01

    Alcoholic hepatitis(AH) is an acute hepatic manifesta-tion occurring from heavy alcohol ingestion. Alcoholic steatohepatitis(ASH) is histologically characterized by steatosis, inflammation, and fibrosis in the liver. Despite the wide range of severity at presentation, those with severe ASH(Maddrey’s discriminant function ≥ 32) typically present with fever, jaundice, and abdominal tenderness. Alcohol abstinence is the cornerstone of therapy for AH and, in the milder forms, is sufficient for clinical recovery. Severe ASH may progress to multi-or-gan failure including acute kidney injury and infection. Thus, infection and renal failure have a major impact on survival and should be closely monitored in patients with severe ASH. Patients with severe ASH have a re-ported short-term mortality of up to 40%-50%. Severe ASH at risk of early death should be identified by one of the available prognostic scoring systems before consid-ering specific therapies. Corticosteroids are the main-stay of treatment for severe ASH. When corticosteroids are contraindicated, pentoxifylline may be alternatively used. Responsiveness to steroids should be assessed at day 7 and stopping rules based on Lille score should come into action. Strategically, future studies for pa-tients with severe ASH should focus on suppressing inflammation based on cytokine profiles, balancing he-patocellular death and regeneration, limiting activation of the innate immune response, and maintaining gut mucosal integrity.

  20. Current Status of Treatment of Spinal and Bulbar Muscular Atrophy

    Directory of Open Access Journals (Sweden)

    Fumiaki Tanaka

    2012-01-01

    Full Text Available Spinal and bulbar muscular atrophy (SBMA is the first member identified among polyglutamine diseases characterized by slowly progressive muscle weakness and atrophy of the bulbar, facial, and limb muscles pathologically associated with motor neuron loss in the spinal cord and brainstem. Androgen receptor (AR, a disease-causing protein of SBMA, is a well-characterized ligand-activated transcription factor, and androgen binding induces nuclear translocation, conformational change and recruitment of coregulators for transactivation of AR target genes. Some therapeutic strategies for SBMA are based on these native functions of AR. Since ligand-induced nuclear translocation of mutant AR has been shown to be a critical step in motor neuron degeneration in SBMA, androgen deprivation therapies using leuprorelin and dutasteride have been developed and translated into clinical trials. Although the results of these trials are inconclusive, renewed clinical trials with more sophisticated design might prove the effectiveness of hormonal intervention in the near future. Furthermore, based on the normal function of AR, therapies targeted for conformational changes of AR including amino-terminal (N and carboxy-terminal (C (N/C interaction and transcriptional coregulators might be promising. Other treatments targeted for mitochondrial function, ubiquitin-proteasome system (UPS, and autophagy could be applicable for all types of polyglutamine diseases.

  1. Current and Emerging Drug Treatments for Binge Eating Disorder

    Science.gov (United States)

    Reas, Deborah L.; Grilo, Carlos M.

    2014-01-01

    Introduction This study evaluated controlled treatment studies of pharmacotherapy for binge eating disorder (BED). Areas Covered The primary focus of the review was on phase II and III controlled trials testing medications for BED. A total of 46 studies were considered and 26 were reviewed in detail. BED outcomes included binge-eating remission, binge-eating frequency, associated eating-disorder psychopathology, associated depression, and weight loss. Expert Opinion Data from controlled trials suggests that certain medications are superior to placebo for stopping binge-eating and for producing faster reductions in binge eating, and - to varying degrees - for reducing associated eating-disorder psychopathology, depression, and weight loss over the short-term. Almost no data exist regarding longer-term effects of medication for BED. Except for topiramate, which reduces both binge eating and weight, weight loss is minimal with medications tested for BED. Psychological interventions and the combination of medication with psychological interventions produce binge-eating outcomes that are superior to medication-only approaches. Combining medications with psychological interventions does not significantly enhance binge-eating outcomes, although the addition of certain medications enhances weight losses achieved with cognitive-behavioral therapy and behavioral weight loss, albeit modestly. PMID:24460483

  2. Treatment of cutaneous melanoma: current approaches and future prospects

    Directory of Open Access Journals (Sweden)

    Alain P Algazi

    2010-08-01

    Full Text Available Alain P Algazi1, Christopher W Soon2, Adil I Daud11Department of Medicine, Division of Hematology and Oncology, 2Department of Dermatology, University of California, San Francisco San Francisco, CA, USAAbstract: Melanoma is the most aggressive and deadly type of skin cancer. Surgical resection with or without lymph node sampling is the standard of care for primary cutaneous melanoma. Adjuvant therapy decisions may be informed by careful consideration of prognostic factors. High-dose adjuvant interferon alpha-2b increases disease-free survival and may modestly improve overall survival. Less toxic alternatives for adjuvant therapy are currently under study. External beam radiation therapy is an option for nodal beds where the risk of local recurrence is very high. In-transit melanoma metastases may be treated locally with surgery, immunotherapy, radiation, or heated limb perfusion. For metastatic melanoma, the options include chemotherapy or immunotherapy; targeted anti-BRAF and anti-KIT therapy is under active investigation. Standard chemotherapy yields objective tumor responses in approximately 10%–20% of patients, and sustained remissions are uncommon. Immunotherapy with high-dose interleukin-2 yields objective tumor responses in a minority of patients; however, some of these responses may be durable. Identification of activating mutations of BRAF, NRAS, c-KIT, and GNAQ in distinct clinical subtypes of melanoma suggest that these are molecularly distinct. Emerging data from clinical trials suggest that substantial improvements in the standard of care for melanoma may be possible.Keywords: melanoma, resection, immune modulation, small molecule kinase inhibitors, chemotherapy, clinical trials

  3. Childhood food allergies: current diagnosis, treatment, and management strategies.

    Science.gov (United States)

    Gupta, Ruchi S; Dyer, Ashley A; Jain, Namrita; Greenhawt, Matthew J

    2013-05-01

    Food allergy is a growing public health concern in the United States that affects an estimated 8% of children. Food allergy is defined as an adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a specific food. Nearly 40% of children with food allergy have a history of severe reactions that if not treated immediately with proper medication can lead to hospitalization or even death. The National Institute of Allergy and Infectious Diseases (NIAID) convened an expert panel in 2010 to develop guidelines outlining evidence-based practices in diagnosing and managing food allergy. The purpose of this review is to aid clinicians in translating the NIAID guidelines into primary care practice and includes the following content domains: (1) the definition and mechanism of childhood food allergy, (2) differences between food allergy and food intolerance, (3) the epidemiology of childhood food allergy in the United States, (4) best practices derived from the NIAID guidelines focused on primary care clinicians' management of childhood food allergy, (5) emerging food allergy treatments, and (6) future directions in food allergy research and practice. Articles focused on childhood food allergy were considered for inclusion in this review. Studies were restricted to the English language and to those published within the past 40 years. A cross-listed combination of the following words, phrases, and MeSH terms was searched in PubMed and Google Scholar to identify relevant articles: food allergy, food hypersensitivity, child, pediatric, prevalence, and epidemiology. Additional sources were identified through the bibliographies of the retrieved articles.

  4. The Impact of a Line Probe Assay Based Diagnostic Algorithm on Time to Treatment Initiation and Treatment Outcomes for Multidrug Resistant TB Patients in Arkhangelsk Region, Russia

    Science.gov (United States)

    Eliseev, Platon; Balantcev, Grigory; Nikishova, Elena; Gaida, Anastasia; Bogdanova, Elena; Enarson, Donald; Ornstein, Tara; Detjen, Anne; Dacombe, Russell; Gospodarevskaya, Elena; Phillips, Patrick P. J.; Mann, Gillian; Squire, Stephen Bertel; Mariandyshev, Andrei

    2016-01-01

    Background In the Arkhangelsk region of Northern Russia, multidrug-resistant (MDR) tuberculosis (TB) rates in new cases are amongst the highest in the world. In 2014, MDR-TB rates reached 31.7% among new cases and 56.9% among retreatment cases. The development of new diagnostic tools allows for faster detection of both TB and MDR-TB and should lead to reduced transmission by earlier initiation of anti-TB therapy. Study Aim The PROVE-IT (Policy Relevant Outcomes from Validating Evidence on Impact) Russia study aimed to assess the impact of the implementation of line probe assay (LPA) as part of an LPA-based diagnostic algorithm for patients with presumptive MDR-TB focusing on time to treatment initiation with time from first-care seeking visit to the initiation of MDR-TB treatment rather than diagnostic accuracy as the primary outcome, and to assess treatment outcomes. We hypothesized that the implementation of LPA would result in faster time to treatment initiation and better treatment outcomes. Methods A culture-based diagnostic algorithm used prior to LPA implementation was compared to an LPA-based algorithm that replaced BacTAlert and Löwenstein Jensen (LJ) for drug sensitivity testing. A total of 295 MDR-TB patients were included in the study, 163 diagnosed with the culture-based algorithm, 132 with the LPA-based algorithm. Results Among smear positive patients, the implementation of the LPA-based algorithm was associated with a median decrease in time to MDR-TB treatment initiation of 50 and 66 days compared to the culture-based algorithm (BacTAlert and LJ respectively, p<0.001). In smear negative patients, the LPA-based algorithm was associated with a median decrease in time to MDR-TB treatment initiation of 78 days when compared to the culture-based algorithm (LJ, p<0.001). However, several weeks were still needed for treatment initiation in LPA-based algorithm, 24 days in smear positive, and 62 days in smear negative patients. Overall treatment outcomes

  5. Behavioral effects of current Alzheimer's disease treatments: a descriptive review.

    Science.gov (United States)

    Cummings, Jeffrey L; Mackell, Joan; Kaufer, Daniel

    2008-01-01

    Behavioral abnormalities and neuropsychiatric symptoms are common manifestations of Alzheimer's disease (AD). Many clinical trials of cholinesterase inhibitors (ChE-Is) and memantine have included behavioral measures as primary or secondary outcomes, and most have observed behavioral benefits in conjunction with treatment. The purpose of this review was to determine the frequency of positive behavioral outcomes in AD clinical trials and clinical reports, to determine the symptoms most responsive to antidementia agents, and to explore factors that correlate with negative outcomes in clinical trials of antidementia agents with regard to behavioral measures. We performed a computerized search of randomized clinical trials and open-label studies of ChE-Is and memantine for AD including a behavioral outcome measure. Studies involving 10 or more patients using therapeutic doses of the target agents and including a behavioral measure as a primary or secondary outcome were included in this review. One hundred fifty-seven peer-reviewed articles and 68 publicly presented abstracts were identified in the literature search. Subsequent review established that 15 publications arising from 13 randomized, double-blind, placebo-controlled AD trials met the review inclusion criteria. Positive outcomes on behavioral measures were reported in 8 of 15 publications as a primary or secondary outcome. In most blinded AD clinical trials, behavioral measures were secondary outcomes. Mood symptoms and apathy have most commonly responded to ChE-Is, whereas memantine has been associated with a reduction in irritability and agitation. However, there is substantial variability among trials in terms of behavioral outcomes. Studies that assessed patients with more severe dementia, included patients with less severe behavioral disturbances at baseline, involved institutionalized patients, or were international in scope tended to have negative outcomes. In institutionalized patients there is

  6. Optimization of total harmonic current distortion and torque pulsation reduction in high-power induction motors using genetic algorithms

    Institute of Scientific and Technical Information of China (English)

    Arash SAYYAH; Mitra AFLAK; Alireza REZAZADEH

    2008-01-01

    This paper presents a powerful application of genetic algorithm (GA) for the minimization of the total harmonic current distortion (THCD) in high-power induction motors fed by voltage source inverters,based on an approximate harmonic model. That is,having defined a desired fundamental output voltage,optimal pulse patterns (switching angles) are determined to produce the fundamental output voltage while minimizing the THCD. The complete results for the two cases of three and five switching instants in the first quarter period of pulse width modulation (PWM) waveform are presented. Presence of harmonics in the stator excitation leads to a pulsing-torque component. Considering the fact that if the pulsing-torques are at low frequencies,they can cause troublesome speed fluctuations,shaft fatigue,and unsatisfactory performance in the feedback control system,the 5th,7th,11 th,and 13th current harmonics (in the case of five switching angles) are con strained at some pre-specified values,to mitigate the detrimental effects of low-frequency harmonics. At the same time,the THCD is optimized while the required fun-damental output voltage is maintained.

  7. Low Resolution Limits and Inaccurate Algorithms Decrease Significantly the Value of Late Loss in Current Drug-Eluting Stent Trials

    Directory of Open Access Journals (Sweden)

    Johannes B. Dahm

    2012-01-01

    Full Text Available Quantitative coronary and vascular angiography (QCA resp., QVA remains the current gold standard for evaluation of restenosis. Late loss as one of the most commonly accepted parameters to highlight efficacy of the various devices has shown high correlation to clinical parameters but, surprisingly, has no impact on the evaluation of the remaining amount of restenostic tissue. The current clinical practice leads to unrealistic late loss calculations. Smaller late loss differences are usually not greater than the inherited resolution limits of QCA, which is especially the case in small differences between the various stents in the drug-eluting stent era. Late loss include additional systematic and random errors, due to the fact that measurements were taken at two different time points including the inherited resolution and calibration limits of QCA on two occasions. Due to the limited value of late loss in discriminating the small differences between the one and other DES, late lumen area loss and clearly defined calculation algorithms (e.g., MLD-relocation should be used in future DES studies also to fulfill the more stringent regulatory requirements.

  8. Diagnosis and Treatment of Chronic Exertional Compartment Syndrome - a Proposition for an Algorithm

    DEFF Research Database (Denmark)

    Larsen, Peter Birk; Jensen, Steffen Skov

    Title: Diagnosis and treatment of chronic exertional compartment syndrome - a proposition for an algorithm based on case series of patients treated at Sports Medicine Division, Department of Orthopaedic Surgery, Viborg Regional Hospital, Denmark Background: Chronic exertional compartment syndrome...... that specific activity induced strain (SAIS) can be used to diagnose the specific affected compartments, and in this way be able to safely and effectively treat this disorder using endoscopic assisted selective fasciotomy (EASF). Materials and Methods: Retrospective follow-up study of 13 consecutive selected...... in conjunction with a thorough medical history formed the basis for the diagnosis. Results: 11 patients were offered surgical treatment consisting of EASF of the affected compartment (10 bilateral and 1 unilateral, 8 affected in specific compartments and 3 affected in all compartments. Only 1 patient required...

  9. Randomized Algorithms For High Quality Treatment Planning in Volumetric Modulated Arc Therapy

    CERN Document Server

    Yang, Yu; Wen, Zaiwen

    2015-01-01

    In recent years, volumetric modulated arc therapy (VMAT) has been becoming a more and more important radiation technique widely used in clinical application for cancer treatment. One of the key problems in VMAT is treatment plan optimization, which is complicated due to the constraints imposed by the involved equipments. In this paper, we consider a model with four major constraints: the bound on the beam intensity, an upper bound on the rate of the change of the beam intensity, the moving speed of leaves of the multi-leaf collimator (MLC) and its directional-convexity. We solve the model by a two-stage algorithm: performing minimization with respect to the shapes of the aperture and the beam intensities alternatively. Specifically, the shapes of the aperture are obtained by a greedy algorithm whose performance is enhanced by random sampling in the leaf pairs with a decremental rate. The beam intensity is optimized using a gradient projection method with non-monotonic line search. We further improve the propo...

  10. SU-E-T-202: Impact of Monte Carlo Dose Calculation Algorithm On Prostate SBRT Treatments

    Energy Technology Data Exchange (ETDEWEB)

    Venencia, C; Garrigo, E; Cardenas, J; Castro Pena, P [Instituto de Radioterapia - Fundacion Marie Curie, Cordoba (Argentina)

    2014-06-01

    Purpose: The purpose of this work was to quantify the dosimetric impact of using Monte Carlo algorithm on pre calculated SBRT prostate treatment with pencil beam dose calculation algorithm. Methods: A 6MV photon beam produced by a Novalis TX (BrainLAB-Varian) linear accelerator equipped with HDMLC was used. Treatment plans were done using 9 fields with Iplanv4.5 (BrainLAB) and dynamic IMRT modality. Institutional SBRT protocol uses a total dose to the prostate of 40Gy in 5 fractions, every other day. Dose calculation is done by pencil beam (2mm dose resolution), heterogeneity correction and dose volume constraint (UCLA) for PTV D95%=40Gy and D98%>39.2Gy, Rectum V20Gy<50%, V32Gy<20%, V36Gy<10% and V40Gy<5%, Bladder V20Gy<40% and V40Gy<10%, femoral heads V16Gy<5%, penile bulb V25Gy<3cc, urethra and overlap region between PTV and PRV Rectum Dmax<42Gy. 10 SBRT treatments plans were selected and recalculated using Monte Carlo with 2mm spatial resolution and mean variance of 2%. DVH comparisons between plans were done. Results: The average difference between PTV doses constraints were within 2%. However 3 plans have differences higher than 3% which does not meet the D98% criteria (>39.2Gy) and should have been renormalized. Dose volume constraint differences for rectum, bladder, femoral heads and penile bulb were les than 2% and within tolerances. Urethra region and overlapping between PTV and PRV Rectum shows increment of dose in all plans. The average difference for urethra region was 2.1% with a maximum of 7.8% and for the overlapping region 2.5% with a maximum of 8.7%. Conclusion: Monte Carlo dose calculation on dynamic IMRT treatments could affects on plan normalization. Dose increment in critical region of urethra and PTV overlapping region with PTV could have clinical consequences which need to be studied. The use of Monte Carlo dose calculation algorithm is limited because inverse planning dose optimization use only pencil beam.

  11. Novel algorithm for identifying T-wave current density alternans using synthesized 187-channel vector-projected body surface mapping.

    Science.gov (United States)

    Nakai, Kenji; Takahashi, Shin; Suzuki, Atsushi; Hagiwara, Nobuhisa; Futagawa, Keisuke; Shoda, Morio; Shiga, Tsuyoshi; Takahashi, Ken; Okabayashi, Hitoshi; Itoh, Manabu; Kasanuki, Hiroshi

    2011-03-01

    The noninvasive evaluation of ventricular T-wave alternans (TWA) in patients with lethal ventricular arrhythmias is an important issue. In this study, we propose a novel algorithm to identify T-wave current density alternans (TWCA) using synthesized 187-channel vector-projected body surface mapping (187-ch SAVP-ECG). We recorded 10 min of 187-ch SAVP-ECG using a Mason-Likar lead system in the supine position. A recovery time (RT) dispersion map was obtained by averaging the 187-ch SAVP-ECG. The TWCA value was determined from the relative changes in the averaged current density in the T-wave zone (Tpeak ± 50 ms) for two T-wave types. We registered 20 ECG recordings from normal controls and 11 ECG recordings from nine subjects with long QT syndrome (LQT). We divided LQT syndrome subjects into two groups: group 1 provided 9 ECG recordings without visually apparent TWAs, and group 2 provided 2 ECG recordings with visually apparent TWAs. The QTc interval values in the LQT groups were higher than those in the control (515 ± 60 ms in LQT G-1, 600 ± 27 ms in LQT G-2 vs. 415 ± 19 ms in control, P < 0.001). The RTendc dispersion values among the LQT subjects were higher than those of the control subjects (48 ± 19 ms in LQT G-1, 65 ± 30 ms in LQT G-2 vs. 24 ± 10 ms in control, P < 0.01). The mean TWCA value was significantly higher in the LQT G-2 group with visually apparent TWCAs (0.5 ± 0.2% in control, 2.1 ± 1.2% in LQT G-1, and 32.3 ± 6.9% in LQT G-2). Interestingly, the two-dimensional distribution of TWCA in LQT was inhomogeneous and correlated with the distribution of increased RT dispersion. We conclude that a novel algorithm using 187-ch SAVP-ECG might provide new insights into body surface TWCA.

  12. Parallel algorithms

    CERN Document Server

    Casanova, Henri; Robert, Yves

    2008-01-01

    ""…The authors of the present book, who have extensive credentials in both research and instruction in the area of parallelism, present a sound, principled treatment of parallel algorithms. … This book is very well written and extremely well designed from an instructional point of view. … The authors have created an instructive and fascinating text. The book will serve researchers as well as instructors who need a solid, readable text for a course on parallelism in computing. Indeed, for anyone who wants an understandable text from which to acquire a current, rigorous, and broad vi

  13. A Boosting Algorithm for Estimating Generalized Propensity Scores with Continuous Treatments.

    Science.gov (United States)

    Zhu, Yeying; Coffman, Donna L; Ghosh, Debashis

    2015-03-01

    In this article, we study the causal inference problem with a continuous treatment variable using propensity score-based methods. For a continuous treatment, the generalized propensity score is defined as the conditional density of the treatment-level given covariates (confounders). The dose-response function is then estimated by inverse probability weighting, where the weights are calculated from the estimated propensity scores. When the dimension of the covariates is large, the traditional nonparametric density estimation suffers from the curse of dimensionality. Some researchers have suggested a two-step estimation procedure by first modeling the mean function. In this study, we suggest a boosting algorithm to estimate the mean function of the treatment given covariates. In boosting, an important tuning parameter is the number of trees to be generated, which essentially determines the trade-off between bias and variance of the causal estimator. We propose a criterion called average absolute correlation coefficient (AACC) to determine the optimal number of trees. Simulation results show that the proposed approach performs better than a simple linear approximation or L2 boosting. The proposed methodology is also illustrated through the Early Dieting in Girls study, which examines the influence of mothers' overall weight concern on daughters' dieting behavior.

  14. Dosimetric impact of Acuros XB dose calculation algorithm in prostate cancer treatment using RapidArc

    Directory of Open Access Journals (Sweden)

    Suresh Rana

    2013-01-01

    Full Text Available Purpose: The purpose of this study is to assess the dosimetric impact of Acuros XB dose calculation algorithm (AXB, in comparisons with Anisotropic Analytical Algorithm (AAA calculations in prostate cancer treatment using RapidArc. Materials and Methods: A computed tomography (CT dataset of low-risk prostate cancer patients treated at Arizona Center for Cancer Care was selected and contoured for prostate, seminal vesicles, and organs at risk (OARs(rectum, bladder, and femur heads. Plans were created for 6 MV photon beam using RapidArc technique in Eclipse treatment planning system. Dose calculations were performed with AAA and AXB for same number of monitor units and identical beam setup. Mean and maximum doses to planning target volume (PTV and OARs were analyzed. Additionally, minimum dose to PTV and V100 was analyzed. Finally, point-dose difference between planar dose distributions of AAA and AXB plans was investigated. Results: The highest dose difference was up to 0.43% (range: 0.05−0.43%, P> 0.05 for PTV and 1.98% (range: 0.22−1.98%, P> 0.05 for OARs with AAA predicting higher dose than AXB. The V100 values of AAA plans (95 % and AXB plans (range: 93.1−97.9 % had an average difference of 0.89±1.47% with no statistical significance (P = 0.25411. The point-dose difference analysis showed that AAA predicted higher dose than AXB at significantly higher percentage (in average 94.15 of total evaluated points. Conclusion: The dosimetric results of this study suggest that the AXB can perform the dose computation comparable to AAA in RapidArc prostate cancer treatment plans that are generated by a partial single-arc technique.

  15. Computer algorithms and applications used to assist the evaluation and treatment of adolescent idiopathic scoliosis: a review of published articles 2000-2009.

    Science.gov (United States)

    Phan, Philippe; Mezghani, Neila; Aubin, Carl-Éric; de Guise, Jacques A; Labelle, Hubert

    2011-07-01

    Adolescent idiopathic scoliosis (AIS) is a complex spinal deformity whose assessment and treatment present many challenges. Computer applications have been developed to assist clinicians. A literature review on computer applications used in AIS evaluation and treatment has been undertaken. The algorithms used, their accuracy and clinical usability were analyzed. Computer applications have been used to create new classifications for AIS based on 2D and 3D features, assess scoliosis severity or risk of progression and assist bracing and surgical treatment. It was found that classification accuracy could be improved using computer algorithms that AIS patient follow-up and screening could be done using surface topography thereby limiting radiation and that bracing and surgical treatment could be optimized using simulations. Yet few computer applications are routinely used in clinics. With the development of 3D imaging and databases, huge amounts of clinical and geometrical data need to be taken into consideration when researching and managing AIS. Computer applications based on advanced algorithms will be able to handle tasks that could otherwise not be done which can possibly improve AIS patients' management. Clinically oriented applications and evidence that they can improve current care will be required for their integration in the clinical setting.

  16. Individualized model predicts brain current flow during transcranial direct-current stimulation treatment in responsive stroke patient.

    Science.gov (United States)

    Datta, Abhishek; Baker, Julie M; Bikson, Marom; Fridriksson, Julius

    2011-07-01

    Although numerous published reports have demonstrated the beneficial effects of transcranial direct-current stimulation (tDCS) on task performance, fundamental questions remain regarding the optimal electrode configuration on the scalp. Moreover, it is expected that lesioned brain tissue will influence current flow and should therefore be considered (and perhaps leveraged) in the design of individualized tDCS therapies for stroke. The current report demonstrates how different electrode configurations influence the flow of electrical current through brain tissue in a patient who responded positively to a tDCS treatment targeting aphasia. The patient, a 60-year-old man, sustained a left hemisphere ischemic stroke (lesion size = 87.42 mL) 64 months before his participation. In this study, we present results from the first high-resolution (1 mm(3)) model of tDCS in a brain with considerable stroke-related damage; the model was individualized for the patient who received anodal tDCS to his left frontal cortex with the reference cathode electrode placed on his right shoulder. We modeled the resulting brain current flow and also considered three additional reference electrode positions: right mastoid, right orbitofrontal cortex, and a "mirror" configuration with the anode over the undamaged right cortex. Our results demonstrate the profound effect of lesioned tissue on resulting current flow and the ability to modulate current pattern through the brain, including perilesional regions, through electrode montage design. The complexity of brain current flow modulation by detailed normal and pathologic anatomy suggest: (1) That computational models are critical for the rational interpretation and design of individualized tDCS stroke-therapy; and (2) These models must accurately reproduce head anatomy as shown here.

  17. A Review of Closed-Loop Algorithms for Glycemic Control in the Treatment of Type 1 Diabetes

    Directory of Open Access Journals (Sweden)

    Joseph El Youssef

    2009-03-01

    Full Text Available With the discovery of insulin came a deeper understanding of therapeutic options for one of the most devastating chronic diseases of the modern era, diabetes mellitus. The use of insulin in the treatment of diabetes, especially in those with severe insulin deficiency (type 1 diabetes, with multiple injections or continuous subcutaneous infusion, has been largely successful, but the risk for short term and long term complications remains substantial. Insulin treatment decisions are based on the patient’s knowledge of meal size, exercise plans and the intermittent knowledge of blood glucose values. As such, these are open loop methods that require human input. The idea of closed loop control of diabetes treatment is quite different: automated control of a device that delivers insulin (and possibly glucagon or other medications and is based on continuous or very frequent glucose measurements. Closed loop insulin control for type 1 diabetes is not new but is far from optimized. The goal of such a system is to avoid short-term complications (hypoglycemia and long-term complications (diseases of the eyes, kidneys, nerves and cardiovascular system by mimicking the normal insulin secretion pattern of the pancreatic beta cell. A control system for automated diabetes treatment consists of three major components, (1 a glucose sensing device that serves as the afferent limb of the system; (2 an automated control unit that uses algorithms which acquires sensor input and generates treatment outputs; and (3 a drug delivery device (primarily for delivery of insulin, which serves as the system’s efferent limb. There are several major issues that highlight the difficulty of interacting with the complex unknowns of the biological world. For example, development of accurate continuous glucose monitors is crucial; the state of the art in 2009 is that such devices sometimes experience drift and are intended only to supplement information received from standard

  18. Design and development of a new micro-beam treatment planning system: effectiveness of algorithms of optimization and dose calculations and potential of micro-beam treatment.

    Science.gov (United States)

    Tachibana, Hidenobu; Kojima, Hiroyuki; Yusa, Noritaka; Miyajima, Satoshi; Tsuda, Akihisa; Yamashita, Takashi

    2012-07-01

    A new treatment planning system (TPS) was designed and developed for a new treatment system, which consisted of a micro-beam-enabled linac with robotics and a real-time tracking system. We also evaluated the effectiveness of the implemented algorithms of optimization and dose calculations in the TPS for the new treatment system. In the TPS, the optimization procedure consisted of the pseudo Beam's-Eye-View method for finding the optimized beam directions and the steepest-descent method for determination of beam intensities. We used the superposition-/convolution-based (SC-based) algorithm and Monte Carlo-based (MC-based) algorithm to calculate dose distributions using CT image data sets. In the SC-based algorithm, dose density scaling was applied for the calculation of inhomogeneous corrections. The MC-based algorithm was implemented with Geant4 toolkit and a phase-based approach using a network-parallel computing. From the evaluation of the TPS, the system can optimize the direction and intensity of individual beams. The accuracy of the dose calculated by the SC-based algorithm was less than 1% on average with the calculation time of 15 s for one beam. However, the MC-based algorithm needed 72 min for one beam using the phase-based approach, even though the MC-based algorithm with the parallel computing could decrease multiple beam calculations and had 18.4 times faster calculation speed using the parallel computing. The SC-based algorithm could be practically acceptable for the dose calculation in terms of the accuracy and computation time. Additionally, we have found a dosimetric advantage of proton Bragg peak-like dose distribution in micro-beam treatment.

  19. Automated treatment planning for a dedicated multi-source intracranial radiosurgery treatment unit using projected gradient and grassfire algorithms.

    Science.gov (United States)

    Ghobadi, Kimia; Ghaffari, Hamid R; Aleman, Dionne M; Jaffray, David A; Ruschin, Mark

    2012-06-01

    The purpose of this work is to develop a framework to the inverse problem for radiosurgery treatment planning on the Gamma Knife(®) Perfexion™ (PFX) for intracranial targets. The approach taken in the present study consists of two parts. First, a hybrid grassfire and sphere-packing algorithm is used to obtain shot positions (isocenters) based on the geometry of the target to be treated. For the selected isocenters, a sector duration optimization (SDO) model is used to optimize the duration of radiation delivery from each collimator size from each individual source bank. The SDO model is solved using a projected gradient algorithm. This approach has been retrospectively tested on seven manually planned clinical cases (comprising 11 lesions) including acoustic neuromas and brain metastases. In terms of conformity and organ-at-risk (OAR) sparing, the quality of plans achieved with the inverse planning approach were, on average, improved compared to the manually generated plans. The mean difference in conformity index between inverse and forward plans was -0.12 (range: -0.27 to +0.03) and +0.08 (range: 0.00-0.17) for classic and Paddick definitions, respectively, favoring the inverse plans. The mean difference in volume receiving the prescribed dose (V(100)) between forward and inverse plans was 0.2% (range: -2.4% to +2.0%). After plan renormalization for equivalent coverage (i.e., V(100)), the mean difference in dose to 1 mm(3) of brainstem between forward and inverse plans was -0.24 Gy (range: -2.40 to +2.02 Gy) favoring the inverse plans. Beam-on time varied with the number of isocenters but for the most optimal plans was on average 33 min longer than manual plans (range: -17 to +91 min) when normalized to a calibration dose rate of 3.5 Gy/min. In terms of algorithm performance, the isocenter selection for all the presented plans was performed in less than 3 s, while the SDO was performed in an average of 215 min. PFX inverse planning can be performed using

  20. Automated treatment planning for a dedicated multi-source intracranial radiosurgery treatment unit using projected gradient and grassfire algorithms

    Energy Technology Data Exchange (ETDEWEB)

    Ghobadi, Kimia; Ghaffari, Hamid R.; Aleman, Dionne M.; Jaffray, David A.; Ruschin, Mark [Department of Mechanical and Industrial Engineering, University of Toronto, 5 King' s College Road, Toronto, Ontario M5S 3G8 (Canada); Department of Radiation Oncology, University of Toronto, Radiation Medicine Program, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario M5G 2M9 (Canada)

    2012-06-15

    Purpose: The purpose of this work is to develop a framework to the inverse problem for radiosurgery treatment planning on the Gamma Knife{sup Registered-Sign} Perfexion Trade-Mark-Sign (PFX) for intracranial targets. Methods: The approach taken in the present study consists of two parts. First, a hybrid grassfire and sphere-packing algorithm is used to obtain shot positions (isocenters) based on the geometry of the target to be treated. For the selected isocenters, a sector duration optimization (SDO) model is used to optimize the duration of radiation delivery from each collimator size from each individual source bank. The SDO model is solved using a projected gradient algorithm. This approach has been retrospectively tested on seven manually planned clinical cases (comprising 11 lesions) including acoustic neuromas and brain metastases. Results: In terms of conformity and organ-at-risk (OAR) sparing, the quality of plans achieved with the inverse planning approach were, on average, improved compared to the manually generated plans. The mean difference in conformity index between inverse and forward plans was -0.12 (range: -0.27 to +0.03) and +0.08 (range: 0.00-0.17) for classic and Paddick definitions, respectively, favoring the inverse plans. The mean difference in volume receiving the prescribed dose (V{sub 100}) between forward and inverse plans was 0.2% (range: -2.4% to +2.0%). After plan renormalization for equivalent coverage (i.e., V{sub 100}), the mean difference in dose to 1 mm{sup 3} of brainstem between forward and inverse plans was -0.24 Gy (range: -2.40 to +2.02 Gy) favoring the inverse plans. Beam-on time varied with the number of isocenters but for the most optimal plans was on average 33 min longer than manual plans (range: -17 to +91 min) when normalized to a calibration dose rate of 3.5 Gy/min. In terms of algorithm performance, the isocenter selection for all the presented plans was performed in less than 3 s, while the SDO was performed in an

  1. Comparison of different breast planning techniques and algorithms for radiation therapy treatment.

    Science.gov (United States)

    Borges, C; Cunha, G; Monteiro-Grillo, I; Vaz, P; Teixeira, N

    2014-03-01

    This work aims at investigating the impact of treating breast cancer using different radiation therapy (RT) techniques--forwardly-planned intensity-modulated, f-IMRT, inversely-planned IMRT and dynamic conformal arc (DCART) RT--and their effects on the whole-breast irradiation and in the undesirable irradiation of the surrounding healthy tissues. Two algorithms of iPlan BrainLAB treatment planning system were compared: Pencil Beam Convolution (PBC) and commercial Monte Carlo (iMC). Seven left-sided breast patients submitted to breast-conserving surgery were enrolled in the study. For each patient, four RT techniques--f-IMRT, IMRT using 2-fields and 5-fields (IMRT2 and IMRT5, respectively) and DCART - were applied. The dose distributions in the planned target volume (PTV) and the dose to the organs at risk (OAR) were compared analyzing dose-volume histograms; further statistical analysis was performed using IBM SPSS v20 software. For PBC, all techniques provided adequate coverage of the PTV. However, statistically significant dose differences were observed between the techniques, in the PTV, OAR and also in the pattern of dose distribution spreading into normal tissues. IMRT5 and DCART spread low doses into greater volumes of normal tissue, right breast, right lung and heart than tangential techniques. However, IMRT5 plans improved distributions for the PTV, exhibiting better conformity and homogeneity in target and reduced high dose percentages in ipsilateral OAR. DCART did not present advantages over any of the techniques investigated. Differences were also found comparing the calculation algorithms: PBC estimated higher doses for the PTV, ipsilateral lung and heart than the iMC algorithm predicted.

  2. A novel algorithm for discrimination between inrush current and internal faults in power transformer differential protection based on discrete wavelet transform

    Energy Technology Data Exchange (ETDEWEB)

    Eldin, A.A. Hossam; Refaey, M.A. [Electrical Engineering Department, Alexandria University, Alexandria (Egypt)

    2011-01-15

    This paper proposes a novel methodology for transformer differential protection, based on wave shape recognition of the discriminating criterion extracted of the instantaneous differential currents. Discrete wavelet transform has been applied to the differential currents due to internal fault and inrush currents. The diagnosis criterion is based on median absolute deviation (MAD) of wavelet coefficients over a specified frequency band. The proposed algorithm is examined using various simulated inrush and internal fault current cases on a power transformer that has been modeled using electromagnetic transients program EMTDC software. Results of evaluation study show that, proposed wavelet based differential protection scheme can discriminate internal faults from inrush currents. (author)

  3. A review of the current treatment methods for posthaemorrhagic hydrocephalus of infants

    Directory of Open Access Journals (Sweden)

    Sparrow Owen

    2009-01-01

    Full Text Available Abstract Posthaemorrhagic hydrocephalus (PHH is a major problem for premature infants, generally requiring lifelong care. It results from small blood clots inducing scarring within CSF channels impeding CSF circulation. Transforming growth factor – beta is released into CSF and cytokines stimulate deposition of extracellular matrix proteins which potentially obstruct CSF pathways. Prolonged raised pressures and free radical damage incur poor neurodevelopmental outcomes. The most common treatment involves permanent ventricular shunting with all its risks and consequences. This is a review of the current evidence for the treatment and prevention of PHH and shunt dependency. The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library and PubMed (from 1966 to August 2008 were searched. Trials using random or quasi-random patient allocation for any intervention were considered in infants less than 12 months old with PHH. Thirteen trials were identified although speculative interventions were also evaluated. The literature confirms that lumbar punctures, diuretic drugs and intraventricular fibrinolytic therapy can have significant adverse effects and fail to prevent shunt dependence, death or disability. There is no evidence that postnatal phenobarbital administration prevents intraventricular haemorrhage (IVH. Subcutaneous reservoirs and external drains have not been tested in randomized controlled trials, but can be useful as a temporising measure. Drainage, irrigation and fibrinolytic therapy as a way of removing blood to inhibit progressive deposition of matrix proteins, permanent hydrocephalus and shunt dependency, are invasive and experimental. Studies of ventriculo-subgaleal shunts show potential as a temporary method of CSF diversion, but have high infection rates. At present no clinical intervention has been shown to reduce shunt surgery in these infants. A ventricular shunt is not advisable in the early phase after

  4. A genetic algorithm for variable selection in logistic regression analysis of radiotherapy treatment outcomes.

    Science.gov (United States)

    Gayou, Olivier; Das, Shiva K; Zhou, Su-Min; Marks, Lawrence B; Parda, David S; Miften, Moyed

    2008-12-01

    A given outcome of radiotherapy treatment can be modeled by analyzing its correlation with a combination of dosimetric, physiological, biological, and clinical factors, through a logistic regression fit of a large patient population. The quality of the fit is measured by the combination of the predictive power of this particular set of factors and the statistical significance of the individual factors in the model. We developed a genetic algorithm (GA), in which a small sample of all the possible combinations of variables are fitted to the patient data. New models are derived from the best models, through crossover and mutation operations, and are in turn fitted. The process is repeated until the sample converges to the combination of factors that best predicts the outcome. The GA was tested on a data set that investigated the incidence of lung injury in NSCLC patients treated with 3DCRT. The GA identified a model with two variables as the best predictor of radiation pneumonitis: the V30 (p=0.048) and the ongoing use of tobacco at the time of referral (p=0.074). This two-variable model was confirmed as the best model by analyzing all possible combinations of factors. In conclusion, genetic algorithms provide a reliable and fast way to select significant factors in logistic regression analysis of large clinical studies.

  5. SU-E-T-793: Validation of COMPASS 3D Dosimetry as Pre Treatment Verification with Commercial TPS Algorithms

    Energy Technology Data Exchange (ETDEWEB)

    Vikraman, S; Ramu, M; Karrthick, Kp; Rajesh, T; Senniandavar, V; Sambasivaselli, R; Maragathaveni, S; Dhivya, N; Tejinder, K [Medanta The Medicity Hospital, Gurgaon, Haryana (India); Manigandan, D [Fortis Hospital, Mohali, Punjab (India); Muthukumaran, M [Apollo Speciality Hospital, Chennai, Tamilnadu (India)

    2015-06-15

    Purpose: The purpose of this study was to validate the advent of COMPASS 3D dosimetry as a routine pre treatment verification tool with commercially available CMS Monaco and Oncentra Masterplan planning system. Methods: Twenty esophagus patients were selected for this study. All these patients underwent radical VMAT treatment in Elekta Linac and plans were generated in Monaco v5.0 with MonteCarlo(MC) dose calculation algorithm. COMPASS 3D dosimetry comprises an advanced dose calculation algorithm of collapsed cone convolution(CCC). To validate CCC algorithm in COMPASS, The DICOM RT Plans generated using Monaco MC algorithm were transferred to Oncentra Masterplan v4.3 TPS. Only final dose calculations were performed using CCC algorithm with out optimization in Masterplan planning system. It is proven that MC algorithm is an accurate algorithm and obvious that there will be a difference with MC and CCC algorithms. Hence CCC in COMPASS should be validated with other commercially available CCC algorithm. To use the CCC as pretreatment verification tool with reference to MC generated treatment plans, CCC in OMP and CCC in COMPASS were validated using dose volume based indices such as D98, D95 for target volumes and OAR doses. Results: The point doses for open beams were observed <1% with reference to Monaco MC algorithms. Comparisons of CCC(OMP) Vs CCC(COMPASS) showed a mean difference of 1.82%±1.12SD and 1.65%±0.67SD for D98 and D95 respectively for Target coverage. Maximum point dose of −2.15%±0.60SD difference was observed in target volume. The mean lung dose of −2.68%±1.67SD was noticed between OMP and COMPASS. The maximum point doses for spinal cord were −1.82%±0.287SD. Conclusion: In this study, the accuracy of CCC algorithm in COMPASS 3D dosimetry was validated by compared with CCC algorithm in OMP TPS. Dose calculation in COMPASS is feasible within < 2% in comparison with commercially available TPS algorithms.

  6. Current and future therapies for the treatment of histamine-induced angioedema

    Science.gov (United States)

    James, Christine; Bernstein, Jonathan A.

    2017-01-01

    Introduction Angioedema, a sudden, self-limited swelling of localized areas of any part of the body that may or may not be associated with urticaria, is thought to be the result of a mast-cell mediated process versus a bradykinin etiology. Understanding the mechanism is key in determining the proper treatment. Areas Covered Clinical presentation of varying angioedema types may be similar; however, the appropriate treatment algorithm is dependent upon clinicians’ knowledge of the underlying pathophysiology and classification of angioedema. Literature review of recent guidelines, available medications, and alternative therapies was completed to provide an overview of options. Conclusion There are no formal guidelines for treatment of acute or chronic histamine-mediated angioedema, and therefore, algorithms for the treatment of acute and chronic urticaria should be followed until such information becomes available. Differentiating histamine-mediated versus bradykinin mediated angioedema is essential, as treatments and treatment responses are quite different. Further research is needed to better understand idiopathic angioedema that is unresponsive to H1/H2 antagonists, LTMAs, or medications designed to treat bradykinin-mediated angioedema. PMID:28081650

  7. Nonlinear PI Control with Adaptive Interaction Algorithm for Multivariable Wastewater Treatment Process

    Directory of Open Access Journals (Sweden)

    S. I. Samsudin

    2014-01-01

    Full Text Available The wastewater treatment plant (WWTP is highly known with the nonlinearity of the control parameters, thus it is difficult to be controlled. In this paper, the enhancement of nonlinear PI controller (ENon-PI to compensate the nonlinearity of the activated sludge WWTP is proposed. The ENon-PI controller is designed by cascading a sector-bounded nonlinear gain to linear PI controller. The rate variation of the nonlinear gain kn is automatically updated based on adaptive interaction algorithm. Initiative to simplify the ENon-PI control structure by adapting kn has been proved by significant improvement under various dynamic influents. More than 30% of integral square error and 14% of integral absolute error are reduced compared to benchmark PI for DO control and nitrate in nitrogen removal control. Better average effluent qualities, less number of effluent violations, and lower aeration energy consumption resulted.

  8. The OPTIMA Study: Assessing a New Cinacalcet (Sensipar/Mimpara) Treatment Algorithm for Secondary Hyperparathyroidism

    Science.gov (United States)

    Messa, Piergiorgio; Macário, Fernando; Yaqoob, Magdi; Bouman, Koen; Braun, Johann; von Albertini, Beat; Brink, Hans; Maduell, Francisco; Graf, Helmut; Frazão, João M.; Bos, Willem Jan; Torregrosa, Vicente; Saha, Heikki; Reichel, Helmut; Wilkie, Martin; Zani, Valter J.; Molemans, Bart; Carter, Dave; Locatelli, Francesco

    2008-01-01

    Background and objectives: Cinacalcet, a novel calcimimetic, targets the calcium-sensing receptor to lower parathyroid hormone (PTH), calcium, and phosphorus levels in dialysis patients with secondary hyperparathyroidism (SHPT). This study compared the efficacy of a cinacalcet-based regimen with unrestricted conventional care (vitamin D and phosphate binders) for achieving the stringent National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI) targets for dialysis patients. Study design: In this multicenter, open-label study, hemodialysis patients with poorly controlled SHPT were randomized to receive conventional care (n = 184) or a cinacalcet-based regimen (n = 368). Doses of cinacalcet, vitamin D sterols, and phosphate binders were adjusted during a 16-wk dose-optimization phase with the use of algorithms that allowed cinacalcet to be used with adjusted doses of vitamin D. The primary end point was the proportion of patients with mean intact PTH ≤300 pg/ml during a 7-wk efficacy assessment phase. Results: A higher proportion of patients receiving the cinacalcet-based regimen versus conventional care achieved the targets for PTH (71% versus 22%, respectively; P < 0.001), Ca × P (77% versus 58%, respectively; P < 0.001), calcium (76% versus 33%, respectively; P < 0.001), phosphorus (63% versus 50%, respectively; P = 0.002), and PTH and Ca × P (59% versus 16%, respectively, P < 0.001), and allowed a 22% reduction in vitamin D dosage in patients receiving vitamin D at baseline. Achievement of targets was greatest in patients with less severe disease (intact PTH range, 300 to 500 pg/ml) and the cinacalcet dose required was lower in these patients (median = 30 mg/d). Conclusions: Compared with conventional therapy, a cinacalcet-based treatment algorithm increased achievement of KDOQI treatment targets in dialysis patients in whom conventional therapy was no longer effective in controlling this disease. PMID:18178780

  9. Building a diagnostic algorithm on localized neuropathic pain (LNP and targeted topical treatment: focus on 5% lidocaine-medicated plaster

    Directory of Open Access Journals (Sweden)

    Casale R

    2014-04-01

    Full Text Available Roberto Casale,1,2 Consalvo Mattia31Department of Clinical Neurophysiology and Pain Rehabilitation Unit, Foundation “Salvatore Maugeri”, Research and Care Institute, IRCCS, Pavia, Italy; 2EFIC Montescano Pain School, Montescano, Italy; 3Department of Medical-Surgical Sciences, Section of Anaesthesia, Intensive Care and Pain Medicine, Faculty of Medicine and Pharmacy, Sapienza University of Rome, ItalyAbstract: Within the broad definition of neuropathic pain, the refinement of clinical diagnostic procedures has led to the introduction of the concept of localized neuropathic pain (LNP. It is characterized by consistent and circumscribed area(s of maximum pain, which are associated with negative or positive sensory signs and/or spontaneous symptoms typical of neuropathic pain. This description outlines the clinical features (currently lacking in guidelines and treatment recommendations in patients for whom topical targeted treatment with 5% lidocaine-medicated plaster is suggested as first-line therapy. Few epidemiologic data are present in the literature but it is generally estimated that about 60% of neuropathic pain conditions are localized, and therefore identifiable as LNP. A mandatory clinical criterion for the diagnosis of LNP is that signs and symptoms must be present in a clearly identified and defined area(s. Cartographic recordings can help to define each area and to assess variations. The diagnosis of LNP relies on careful neurological examination more than on pain questionnaires, but it is recognized that they can be extremely useful for recording the symptom profiles and establishing a more targeted treatment. The most widely studied frequent/relevant clinical presentations of LNP are postherpetic neuralgia, diabetic neuropathy, and neuropathic postoperative pain. They successfully respond to treatment with 5% lidocaine-medicated plaster with equal if not better pain control but with fewer side effects versus conventional systemic

  10. Current state of methodological and decisions for radiation treatment of blood, its components and products

    Directory of Open Access Journals (Sweden)

    Gordeev A.V.

    2014-12-01

    Full Text Available This article presents currently used blood transfusion media — components and blood products, therapeutic effects, reactions and complications of blood transfusion, use of radiation treatment for blood transfusion fluids. There had been discussed in detail the practice of radiation processing of blood components and for the prevention of reaction "graft versus host" and studies of plasma radiation treatment for its infectious safety. There was presented the current state of techniques and technical solutions of radiation treatment of transfusion-transmissible environments. There were also considered an alternative to radiation treatment of blood.

  11. Prepatellar and olecranon bursitis: literature review and development of a treatment algorithm.

    Science.gov (United States)

    Baumbach, Sebastian F; Lobo, Christopher M; Badyine, Ilias; Mutschler, Wolf; Kanz, Karl-Georg

    2014-03-01

    Olecranon bursitis and prepatellar bursitis are common entities, with a minimum annual incidence of 10/100,000, predominantly affecting male patients (80 %) aged 40-60 years. Approximately 1/3 of cases are septic (SB) and 2/3 of cases are non-septic (NSB), with substantial variations in treatment regimens internationally. The aim of the study was the development of a literature review-based treatment algorithm for prepatellar and olecranon bursitis. Following a systematic review of Pubmed, the Cochrane Library, textbooks of emergency medicine and surgery, and a manual reference search, 52 relevant papers were identified. The initial differentiation between SB and NSB was based on clinical presentation, bursal aspirate, and blood sampling analysis. Physical findings suggesting SB were fever >37.8 °C, prebursal temperature difference greater 2.2 °C, and skin lesions. Relevant findings for bursal aspirate were purulent aspirate, fluid-to-serum glucose ratio 3,000 cells/μl, polymorphonuclear cells >50 %, positive Gram staining, and positive culture. General treatment measures for SB and NSB consist of bursal aspiration, NSAIDs, and PRICE. For patients with confirmed NSB and high athletic or occupational demands, intrabursal steroid injection may be performed. In the case of SB, antibiotic therapy should be initiated. Surgical treatment, i.e., incision, drainage, or bursectomy, should be restricted to severe, refractory, or chronic/recurrent cases. The available evidence did not support the central European concept of immediate bursectomy in cases of SB. A conservative treatment regimen should be pursued, following bursal aspirate-based differentiation between SB and NSB.

  12. Gastric tubes and airway management in patients at risk of aspiration: history, current concepts, and proposal of an algorithm.

    Science.gov (United States)

    Salem, M Ramez; Khorasani, Arjang; Saatee, Siavosh; Crystal, George J; El-Orbany, Mohammad

    2014-03-01

    Rapid sequence induction and intubation (RSII) and awake tracheal intubation are commonly used anesthetic techniques in patients at risk of pulmonary aspiration of gastric or esophageal contents. Some of these patients may have a gastric tube (GT) placed preoperatively. Currently, there are no guidelines regarding which patient should have a GT placed before anesthetic induction. Furthermore, clinicians are not in agreement as to whether to keep a GT in situ, or to partially or completely withdraw it before anesthetic induction. In this review we provide a historical perspective of the use of GTs during anesthetic induction in patients at risk of pulmonary aspiration. Before the introduction of cricoid pressure (CP) in 1961, various techniques were used including RSII combined with a head-up tilt. Sellick initially recommended the withdrawal of the GT before anesthetic induction. He hypothesized that a GT increases the risk of regurgitation and interferes with the compression of the upper esophagus during CP. He later modified his view and emphasized the safety of CP in the presence of a GT. Despite subsequent studies supporting the effectiveness of CP in occluding the esophagus around a GT, Sellick's early view has been perpetuated by investigators who recommend partial or complete withdrawal of the GT. On the basis of available information, we have formulated an algorithm for airway management in patients at risk of aspiration of gastric or esophageal contents. The approach in an individual patient depends on: the procedure; type and severity of the underlying pathology; state of consciousness; likelihood of difficult airway; whether or not the GT is in place; contraindications to the use of RSII or CP. The algorithm calls for the preanesthetic use of a large-bore GT to remove undigested food particles and awake intubation in patients with achalasia, and emptying the pouch by external pressure and avoidance of a GT in patients with Zenker diverticulum. It also

  13. Pharmacological treatment of endometriosis: review of current and new options for treatment

    Directory of Open Access Journals (Sweden)

    Maja Jakič

    2016-10-01

    Full Text Available Endometriosis is a gynecological disease that is defined as the presence of endometrium-like tissue outside the uterine cavity, and it is one of the main causes of female infertility. Although there is unfortunately no known ‘optimal’ treatment for endometriosis, there are three treatment options: medication, surgical treatment, and a combination of both. The gold standard for diagnosis of endometriosis is a diagnostic laparoscopy, which is also therapeutic. Indications for pharmacological treatment of endometriosis include empirical treatment for patients with pelvic pain who are normal on gynecological examination, or who have recurrent disease after surgical treatment or in combination with surgical treatment. In everyday practice, non-steroid anti-inflammatory drugs, oral contraceptives, and progestins per os are used as first-line pharmacological treatments of endometriosis. Gonadoliberin agonists can be used as second-line treatment, although their use is discouraged. These medications can be used alone or in combination. Studies over the last 10 years have shown that many other agents have potential for treatment of endometriosis. These can be broadly classified into several groups: anti-inflammatory agents, and agents that interfere with the hormonal system, or with other pathophysiological processes, such as a disturbed immune system, reduced apoptosis, enhanced angiogenesis, degradation of the extracellular matrix, increased oxidative stress, and epigenetic changes. However, their introduction into routine use requires more convincing clinical studies to confirm their effectiveness.

  14. Demagnetization treatment of remanent composite microspheres studied by alternating current susceptibility measurements

    NARCIS (Netherlands)

    van Berkum, S.; Erné, B.H.

    2013-01-01

    The magnetic remanence of silica microspheres with a low concentration of embedded cobalt ferrite nanoparticles is studied after demagnetization and remagnetization treatments. When the microspheres are dispersed in a liquid, alternating current (AC) magnetic susceptibility spectra reveal a constant

  15. Introduction of a treatment algorithm can improve the early management of emergency patients in the resuscitation room.

    Science.gov (United States)

    Bernhard, Michael; Becker, Torben K; Nowe, Tim; Mohorovicic, Marko; Sikinger, Marcus; Brenner, Thorsten; Richter, Goetz M; Radeleff, Boris; Meeder, Peter-Jürgen; Büchler, Markus W; Böttiger, Bernd W; Martin, Eike; Gries, André

    2007-06-01

    Successful management of emergency patients with multiple trauma in the hospital resuscitation room depends on the immediate diagnosis and rapid treatment of the most life-threatening injuries. In order to reduce the time spent in the resuscitation room, an in-hospital algorithm was developed in an interdisciplinary team approach with respect to local structures. The aim of the study was to analyse whether this algorithm affects the interval between hospital admission and the completion of diagnostic procedures and the start of life-saving interventions. Moreover, in-hospital mortality was investigated before and after the algorithm was introduced. In this prospective study, all consecutive trauma patients in the resuscitation room were investigated before (group I, 01/04-10/04) and after (group II, 01/05-11/05) introduction of the algorithm. The times between hospital admission and the end of the diagnostic procedures (ultrasound [sono], chest X-ray [CF], and cranial computed tomography [CCT]), and between hospital admission and the start of life-saving interventions were registered and in-hospital mortality analysed. In the study period, 170 patients in group I and 199 patients in group II were investigated. Injury severity score (ISS) were comparable between the two groups. The intervals between admission and completion of diagnostic procedures were significantly lower after the algorithm was introduced (mean+/-S.D.): sono (11 +/- 10 min versus 7 +/- 6 min, p or=25). The introduction of an algorithm for early management of emergency patients significantly reduced the time spent in the resuscitation room. The periods to completion of sono, CF, and CCT, respectively, and the start of life-saving interventions were significantly shorter after introduction of the algorithm. Moreover, introduction of the algorithm reduced mortality in the most severely injured patients. Although further investigations are needed to evaluate the effects of the Heidelberg treatment

  16. European audit of current practice in diagnosis and treatment of childhood growth hormone deficiency

    DEFF Research Database (Denmark)

    Juul, Anders; Bernasconi, Sergio; Clayton, Peter E

    2002-01-01

    The present survey among members of the ESPE on current practice in diagnosis and treatment of growth hormone (GH) deficiency (GHD) is of great clinical relevance and importance in the light of the recently published guidelines for diagnosis and treatment of GHD by the Growth Hormone Research...... Society. We have found much conformity but also numerous discrepancies between the recommendations of the Growth Hormone Research Society and the current practice in Europe....

  17. Hypereosinophilic Syndrome and Clonal Eosinophilia: Point-of-Care Diagnostic Algorithm and Treatment Update

    Science.gov (United States)

    Tefferi, Ayalew; Gotlib, Jason; Pardanani, Animesh

    2010-01-01

    Acquired eosinophilia is operationally categorized into secondary, clonal, and idiopathic types. Causes of secondary eosinophilia include parasite infections, allergic or vasculitis conditions, drugs, and lymphoma. Clonal eosinophilia is distinguished from idiopathic eosinophilia by the presence of histologic, cytogenetic, or molecular evidence of an underlying myeloid malignancy. The World Health Organization classification system for hematologic malignancies recognizes 2 distinct subcategories of clonal eosinophilia: chronic eosinophilic leukemia, not otherwise specified and myeloid/lymphoid neoplasms with eosinophilia and mutations involving platelet-derived growth factor receptor α/β or fibroblast growth factor receptor 1. Clonal eosinophilia might also accompany other World Health Organization—defined myeloid malignancies, including chronic myelogenous leukemia, myelodysplastic syndromes, chronic myelomonocytic leukemia, and systemic mastocytosis. Hypereosinophilic syndrome, a subcategory of idiopathic eosinophilia, is defined by the presence of a peripheral blood eosinophil count of 1.5 × 109/L or greater for at least 6 months (a shorter duration is acceptable in the presence of symptoms that require eosinophil-lowering therapy), exclusion of both secondary and clonal eosinophilia, evidence of organ involvement, and absence of phenotypically abnormal and/or clonal T lymphocytes. The presence of the latter defines lymphocytic variant hyper eosinophilia, which is best classified under secondary eosinophilia. In the current review, we provide a simplified algorithm for distinguishing the various causes of clonal and idiopathic eosinophilia and discuss current therapy, including new drugs (imatinib mesylate, alemtuzumab, and mepolizumab). PMID:20053713

  18. Astigmatism treatment during phacoemulsification: a review of current surgical strategies and their rationale

    Directory of Open Access Journals (Sweden)

    Giuliano de Oliveira Freitas

    2013-12-01

    Full Text Available Preexisting corneal astigmatism, present at the time of cataract surgery, is reviewed in detail throughout this article on its most important aspects such as occurrence rates, clinical relevance and current treatment options. Special emphasis is given to the latter aspect. Each method's rationale, advantage and limitation ishigh lightened. Comparisons between treatment options, whenever possible, are also provided.

  19. The Current State of Empirical Support for the Pharmacological Treatment of Selective Mutism

    Science.gov (United States)

    Carlson, John S.; Mitchell, Angela D.; Segool, Natasha

    2008-01-01

    This article reviews the current state of evidence for the psychopharmacological treatment of children diagnosed with selective mutism within the context of its link to social anxiety disorder. An increased focus on potential medication treatment for this disorder has resulted from significant monetary and resource limitations in typical practice,…

  20. Current concepts in cancer: the staging and treatment of Hodgkin's disease. [Treatment complications

    Energy Technology Data Exchange (ETDEWEB)

    Aisenberg, A.C.

    1978-11-30

    The serious and life-threatening risks of treatment do not constitute an argument against vigorous therapy of Hodgkin's disease, therapy which has increased national five-year survival figures from 36 to 55% in less than a decade. However, it is now clear that carrying the intensity of treatment beyond the level needed for cure entails additional and unnecessary hazards. In Hodgkin's disease, the highest survival figures will be realized by the clinics that can achieve the optimal balance between the risks and benefits of treatment.

  1. An algorithm for treatment of patients with hypersensitivity reactions after vaccines.

    Science.gov (United States)

    Wood, Robert A; Berger, Melvin; Dreskin, Stephen C; Setse, Rosanna; Engler, Renata J M; Dekker, Cornelia L; Halsey, Neal A

    2008-09-01

    Concerns about possible allergic reactions to immunizations are raised frequently by both patients/parents and primary care providers. Estimates of true allergic, or immediate hypersensitivity, reactions to routine vaccines range from 1 per 50000 doses for diphtheria-tetanus-pertussis to approximately 1 per 500000 to 1000000 doses for most other vaccines. In a large study from New Zealand, data were collected during a 5-year period on 15 marketed vaccines and revealed an estimated rate of 1 immediate hypersensitivity reaction per 450000 doses of vaccine administered. Another large study, conducted within the Vaccine Safety Datalink, described a range of reaction rates to >7.5 million doses. Depending on the study design and the time after the immunization event, reaction rates varied from 0.65 cases per million doses to 1.53 cases per million doses when additional allergy codes were included. For some vaccines, particularly when allergens such as gelatin are part of the formulation (eg, Japanese encephalitis), higher rates of serious allergic reactions may occur. Although these per-dose estimates suggest that true hypersensitivity reactions are quite rare, the large number of doses that are administered, especially for the commonly used vaccines, makes this a relatively common clinical problem. In this review, we present background information on vaccine hypersensitivity, followed by a detailed algorithm that provides a rational and organized approach for the evaluation and treatment of patients with suspected hypersensitivity. We then include 3 cases of suspected allergic reactions to vaccines that have been referred to the Clinical Immunization Safety Assessment network to demonstrate the practical application of the algorithm.

  2. Current knowledge on evidence-based shockwave treatments for shoulder pathology.

    Science.gov (United States)

    Moya, Daniel; Ramón, Silvia; Guiloff, Leonardo; Gerdesmeyer, Ludger

    2015-12-01

    Shoulder pain is one of the most common musculoskeletal pathologies. Treatment by ESWT (extracorporeal shockwave therapy) has emerged as an alternative when conservative treatment fails in rotator cuff calcific tendinopathy, prior to invasive procedures. The clinical efficacy of ESWT in non-calcific tendinopathy remains controversial. The good results in the treatment of rotator cuff calcifications, have led to indications of ESWT being expanded to other shoulder pathologies. We review the current state of indications and evidence based practice.

  3. Our Approach to Toxic Epidermal Necrolysis and Review of Current Treatment Alternatives

    Directory of Open Access Journals (Sweden)

    Fatih Uygur

    2008-09-01

    Full Text Available Toxic epidermal necrolysis (TEN is a clinical entity which has a 30 to 40 % mortality rate, with necrolysis affecting the entire epidermis. Antibiotics, nonsteroidal anti-inflammatory drugs and anticonvulsants are offender drugs in TEN etiology. A standard treatment protocol with proven efficacy is still lacking. In this study, current treatment practice and our treatment strategy for TEN is discussed and eight patients treated in our clinic between the years 2001 and 2008 are reviewed.

  4. Current status and development of traumatic brain injury treatments in China

    Institute of Scientific and Technical Information of China (English)

    Baiyun Liu

    2015-01-01

    Due to its high incidence,high disability rate,and high mortality rate,traumatic brain injury (TBI) poses a serious threat to human health.This manuscript describes the urgent problems currently existing in China's TBI treatment and proposes a scheme of a nationwide collaboration platform for the treatment of TBI so as to improve the overall level of TBI treatment in China,and reduce disability and mortality rates in TBI patients.

  5. An Algorithm Approach to Determining Smoking Cessation Treatment for Persons Living with HIV/AIDS: Results of a Pilot Trial

    Science.gov (United States)

    Cropsey, Karen L.; Jardin, Bianca; Burkholder, Greer; Clark, C. Brendan; Raper, James L.; Saag, Michael

    2015-01-01

    Background Smoking now represents one of the biggest modifiable risk factors for disease and mortality in PLHIV. To produce significant changes in smoking rates among this population, treatments will need to be both acceptable to the larger segment of PLHIV smokers as well as feasible to implement in busy HIV clinics. The purpose of this study was to evaluate the feasibility and effects of a novel proactive algorithm-based intervention in an HIV/AIDS clinic. Methods PLHIV smokers (N =100) were proactively identified via their electronic medical records and were subsequently randomized at baseline to receive a 12-week pharmacotherapy-based algorithm treatment or treatment as usual. Participants were tracked in-person for 12-weeks. Participants provided information on smoking behaviors and associated constructs of cessation at each follow-up session. Results The findings revealed that many smokers reported utilizing prescribed medications when provided with a supply of cessation medication as determined by an algorithm. Compared to smokers receiving treatment as usual, PLHIV smokers prescribed these medications reported more quit attempts and greater reduction in smoking. Proxy measures of cessation readiness (e.g., motivation, self-efficacy) also favored participants receiving algorithm treatment. Conclusions This algorithm-derived treatment produced positive changes across a number of important clinical markers associated with smoking cessation. Given these promising findings coupled with the brief nature of this treatment, the overall pattern of results suggests strong potential for dissemination into clinical settings as well as significant promise for further advancing clinical health outcomes in this population. PMID:26181705

  6. BAYER COUNTER CURRENT SYSTEMS IN COMPARISON WITH CONVENTIONAL CO—CURRENT SYSTEM IN THE FIELD OF WATER TREATMENT

    Institute of Scientific and Technical Information of China (English)

    Mitschker.A; RauchfuB.K

    1994-01-01

    From an economical point of view both the quality of the ion exchange resins and the technology used in the field of industrial water treatment are important for a successful performance.In general,two different technologies have been established on the market:The main differneces between the CO-and counter current technologes will be discussed and data concerning the requirement of chemicals for regeneration and the quality of the deionized water will be opposed.In addition several different varieties of the modern counter current technologies,developed and patented by Bayer AG,will be described and the advantages,depending on the application and the demand on the quality of the deionized water,pointed out .In view of stronger regulations concerning the consumption of regeneration chemicals,and waste water,and also because of the superior quality of the produced water,the market share of counter current technologies will continue to increase world-wide.

  7. Control algorithm for the inverter fed induction motor drive with DC current feedback loop based on principles of the vector control

    Energy Technology Data Exchange (ETDEWEB)

    Vuckovic, V.; Vukosavic, S. (Electrical Engineering Inst. Nikola Tesla, Viktora Igoa 3, Belgrade, 11000 (Yugoslavia))

    1992-01-01

    This paper brings out a control algorithm for VSI fed induction motor drives based on the converter DC link current feedback. It is shown that the speed and flux can be controlled over the wide speed and load range quite satisfactorily for simpler drives. The base commands of both the inverter voltage and frequency are proportional to the reference speed, but each of them is further modified by the signals derived from the DC current sensor. The algorithm is based on the equations well known from the vector control theory, and is aimed to obtain the constant rotor flux and proportionality between the electrical torque, the slip frequency and the active component of the stator current. In this way, the problems of slip compensation, Ri compensation and correction of U/f characteristics are solved in the same time. Analytical considerations and computer simulations of the proposed control structure are in close agreement with the experimental results measured on a prototype drive.

  8. Stator Current Harmonics Evaluation by Flexible Neural Network Method With Reconstruction Structure During Learning Step Based On CFE/SS Algorithm for ACEC Generator of Rey Power Plant

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Yousefi

    2010-07-01

    Full Text Available One method for on-line fault detection in synchronous generator is stator current harmonics analysis. In this paper, the flexible neural network with reconstruction structure during learning has been used to evaluate the stator current harmonics in different loads. Generator modeling, finite element method and state space model make training set of flexible neural network. Many points from generator capability curve are used to complete this set. Flexible neural network that is used in this paper is a perception network with single hidden layer, flexible hidden layer neuron and back propagation algorithms. Results are show that the trained flexible neural network can identify stator current harmonics for desired load from the capability curve. The error is less than 10% in compared to the values obtained directly from the CFE-SS algorithms. The parameters of modeled generator are 43950(KVA, 11(kV, 3000(rpm, 50(HZ, (PF=0.5.

  9. Three dimensional intensity modulated brachytherapy (IMBT): Dosimetry algorithm and inverse treatment planning

    Energy Technology Data Exchange (ETDEWEB)

    Shi Chengyu; Guo Bingqi; Cheng, Chih-Yao; Esquivel, Carlos; Eng, Tony; Papanikolaou, Niko [Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229 (United States); Department of Radiation Oncology, Oklahoma University Health Science Center, Oklahoma City, Oklahoma 73104 (United States); Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229 (United States)

    2010-07-15

    Purpose: The feasibility of intensity modulated brachytherapy (IMBT) to improve dose conformity for irregularly shaped targets has been previously investigated by researchers by means of using partially shielded sources. However, partial shielding does not fully explore the potential of IMBT. The goal of this study is to introduce the concept of three dimensional (3D) intensity modulated brachytherapy and solve two fundamental issues regarding the application of 3D IMBT treatment planning: The dose calculation algorithm and the inverse treatment planning method. Methods: A 3D IMBT treatment planning system prototype was developed using the MATLAB platform. This system consists of three major components: (1) A comprehensive IMBT source calibration method with dosimetric inputs from Monte Carlo (EGSnrc) simulations; (2) a ''modified TG-43'' (mTG-43) dose calculation formalism for IMBT dosimetry; and (3) a physical constraint based inverse IMBT treatment planning platform utilizing a simulated annealing optimization algorithm. The model S700 Axxent electronic brachytherapy source developed by Xoft, Inc. (Fremont, CA), was simulated in this application. Ten intracavitary accelerated partial breast irradiation (APBI) cases were studied. For each case, an ''isotropic plan'' with only optimized source dwell time and a fully optimized IMBT plan were generated and compared to the original plan in various dosimetric aspects, such as the plan quality, planning, and delivery time. The issue of the mechanical complexity of the IMBT applicator is not addressed in this study. Results: IMBT approaches showed superior plan quality compared to the original plans and the isotropic plans to different extents in all studied cases. An extremely difficult case with a small breast and a small distance to the ribs and skin, the IMBT plan minimized the high dose volume V{sub 200} by 16.1% and 4.8%, respectively, compared to the original and the

  10. Alternating Pulse Current in Electrocoagulation for Wastewater Treatment to Prevent the Passivation or Al Electrode

    Institute of Scientific and Technical Information of China (English)

    MAO Xuhui; HONG Song; ZHU Hua; LIN Hui; WEI Lin; GAN Fuxing

    2008-01-01

    A novel current feed style, alternating pulse current, was proposed in electrocoagulation aiming at preventing the passivation of electrode materials. The open circuit potential (OCP) measurements after anodic and cathodic potentiodynamic polarization showed that cathodic polarization could activate Al electrode. The surface of Al electrode after alternating pulse current electrocoagulation was investigated by scanning electron microscope (SEM) and X-ray photoelectron spectroscopy (XPS), and the results indicate that passivation of Al is not observed. Furthermore, the simulated wastewater treatment tests show that alternating pulse current electrocoagulation has a visible energy saving effect and is worthy of generalization.

  11. [Current status and progress in diagnosis and treatments of pediatric optic neuritis].

    Science.gov (United States)

    Chen, Lanlan; Jiang, Libin

    2014-12-01

    Pediatric optic neuritis (ON) is different from its adult counterpart in terms of epidemiology, etiology, clinical manifestations, and prognosis. Although adult optic neuritis was well described in treatments by the Optic Neuritis Treatment Trial (ONTT), there is no universal agreement on the treatments in a pediatric population. Since there is an inadequate knowledge about pediatric ON in our nation, we compared the clinical manifestations of pediatric ON with its adult population, reviewed the existing understanding of the relationship between pediatric ON and various diseases of CNS, and summarized the current treatments, expecting to provide useful reference in clinic.

  12. Morphometric justification of algorithm of the choice of method of surgical treatment of dysplastic coxarthrosis

    Directory of Open Access Journals (Sweden)

    Norkin I.A.

    2015-06-01

    Full Text Available Purpose: to define regularities of variability of bone structures of a hip joint depending on type of dysplastic coxarthrosis and to develop tactics of total endoprosthesis replacement. Objects of research. 106 patients with dysplastic coxarthrosis of varying severity, passing treatment on the basis of Federal State Budget Institution of Saratov Scientific Research Institute of Traumatology and Orthopedics from 2005 to 2014 applying methods X, KT-, MRT-metry variation and statistical methods. Results: According to anatomic features of a hip joint at dysplastic coxarthrosis of various types algorithms of choice of acetabularand femoral components of endoprosthesis, and also tactics of total endoprosthesis replacement in groups of research are developed. Conclusion. The choice of a standard size of an endoprosthesis of a hip joint needs to be carried out taking into account X-ray anatomic features of a hip joint and degree of expressiveness of the dysplastic changes. At dysplastic coxarthrosis of the l-ll types it is necessary to carry out standard total endoprosthesis replacement; at coxarthrosis of the III type —total endoprosthesis replacement in combination with plasticity of a roof of acetabular hollow; at coxarthrosis of the IV type — total endoprosthesis replacement in a combination from the shortening femur osteotomy.

  13. Optimization of Residual Stress of High Temperature Treatment Using Genetic Algorithm and Neural Network

    Directory of Open Access Journals (Sweden)

    M. Susmikanti

    2015-12-01

    Full Text Available In a nuclear industry area, high temperature treatment of materials is a factor which requires special attention. Assessment needs to be conducted on the properties of the materials used, including the strength of the materials. The measurement of material properties under thermal processes may reflect residual stresses. The use of Genetic Algorithm (GA to determine the optimal residual stress is one way to determine the strength of a material. In residual stress modeling with several parameters, it is sometimes difficult to solve for the optimal value through analytical or numerical calculations. Here, GA is an efficient algorithm which can generate the optimal values, both minima and maxima. The purposes of this research are to obtain the optimization of variable in residual stress models using GA and to predict the center of residual stress distribution, using fuzzy neural network (FNN while the artificial neural network (ANN used for modeling. In this work a single-material 316/316L stainless steel bar is modeled. The minimal residual stresses of the material at high temperatures were obtained with GA and analytical calculations. At a temperature of 6500C, the GA optimal residual stress estimation converged at –711.3689 MPa at adistance of 0.002934 mm from center point, whereas the analytical calculation result at that temperature and position is -975.556 MPa . At a temperature of 8500C, the GA result was -969.868 MPa at 0.002757 mm from the center point, while with analytical result was -1061.13 MPa. The difference in residual stress between GA and analytical results at a temperatureof6500C is about 27 %, while at 8500C it is 8.67 %. The distribution of residual stress showed a grouping concentrated around a coordinate of (-76; 76 MPa. The residuals stress model is a degree-two polynomial with coefficients of 50.33, -76.54, and -55.2, respectively, with a standard deviation of 7.874.

  14. Practical aspects of treatment with target specific anticoagulants: initiation, payment and current market, transitions, and venous thromboembolism treatment.

    Science.gov (United States)

    Mahan, Charles E

    2015-04-01

    Target specific anticoagulants (TSOACs) have recently been introduced to the US market for multiple indications including venous thromboembolism (VTE) prevention in total hip and knee replacement surgeries, VTE treatment and reduction in the risk of stroke in patients with non-valvular atrial fibrillation (NVAF). Currently, three TSOACs are available including rivaroxaban, apixaban, and dabigatran with edoxaban currently under Food and Drug Administration review for VTE treatment and stroke prevention in NVAF. The introduction of these agents has created a paradigm shift in anticoagulation by considerably simplifying treatment and anticoagulant initiation for patients by giving clinicians the opportunity to use a rapid onset, rapid offset, oral agent. The availability of these rapid onset TSOACs is allowing for outpatient treatment of low risk pulmonary embolism and deep vein thrombosis which can greatly reduce healthcare costs by avoiding inpatient hospitalizations and treatment for the disease. Additionally with this practice, the complications of an inpatient hospitalization may also be avoided such as nosocomial infections. Single-agent approaches with TSOACs represent a paradigm shift in the treatment of VTE versus the complicated overlap of a parenteral agent with warfarin. Transitions between anticoagulants, including TSOACs, are a high-risk period for the patient, and clinicians must carefully consider patient characteristics such as renal function as well as the agents that are being transitioned. TSOAC use appears to be growing slowly with improved payment coverage throughout the US.

  15. Psychosocial treatments for negative symptoms in schizophrenia: Current practices and future directions

    Science.gov (United States)

    Elis, Ori; Caponigro, Janelle M.; Kring, Ann M.

    2014-01-01

    Schizophrenia can be a chronic and debilitating psychiatric disorder. Though advancements have been made in the psychosocial treatment of some symptoms of schizophrenia, people with schizophrenia often continue to experience some level of symptoms, particularly negative symptoms, throughout their lives. Because negative symptoms are associated with poor functioning and quality of life, the treatment of negative symptoms is a high priority for intervention development. However, current psychosocial treatments primarily focus on the reduction of positive symptoms with comparatively few studies investigating the efficacy of psychosocial treatments for negative symptoms. In this article, we review and evaluate the existing literature on three categories of psychosocial treatments – cognitive behavioral therapy (CBT), social skills training (SST), and combined treatment interventions – and their impact on the negative symptoms of schizophrenia. Of the interventions reviewed, CBT and SST appear to have the most empirical support, with some evidence suggesting that CBT is associated with maintenance of negative symptom improvement beyond six months after treatment. It remains unclear if a combined treatment approach provides improvements above and beyond those associated with each individual treatment modality. Although psychosocial treatments show promise for the treatment of negative symptoms, there are many unanswered questions about how best to intervene. We conclude with a general discussion of these unanswered questions, future directions and methodological considerations, and suggestions for the further development of negative symptom interventions. PMID:23988452

  16. Psychosocial treatments for negative symptoms in schizophrenia: current practices and future directions.

    Science.gov (United States)

    Elis, Ori; Caponigro, Janelle M; Kring, Ann M

    2013-12-01

    Schizophrenia can be a chronic and debilitating psychiatric disorder. Though advancements have been made in the psychosocial treatment of some symptoms of schizophrenia, people with schizophrenia often continue to experience some level of symptoms, particularly negative symptoms, throughout their lives. Because negative symptoms are associated with poor functioning and quality of life, the treatment of negative symptoms is a high priority for intervention development. However, current psychosocial treatments primarily focus on the reduction of positive symptoms with comparatively few studies investigating the efficacy of psychosocial treatments for negative symptoms. In this article, we review and evaluate the existing literature on three categories of psychosocial treatments--cognitive behavioral therapy (CBT), social skills training (SST), and combined treatment interventions--and their impact on the negative symptoms of schizophrenia. Of the interventions reviewed, CBT and SST appear to have the most empirical support, with some evidence suggesting that CBT is associated with maintenance of negative symptom improvement beyond six months after treatment. It remains unclear if a combined treatment approach provides improvements above and beyond those associated with each individual treatment modality. Although psychosocial treatments show promise for the treatment of negative symptoms, there are many unanswered questions about how best to intervene. We conclude with a general discussion of these unanswered questions, future directions and methodological considerations, and suggestions for the further development of negative symptom interventions.

  17. Analysis of Various Multi-Objective Optimization Evolutionary Algorithms for Monte Carlo Treatment Planning System

    CERN Document Server

    Tydrichova, Magdalena

    2017-01-01

    In this project, various available multi-objective optimization evolutionary algorithms were compared considering their performance and distribution of solutions. The main goal was to select the most suitable algorithms for applications in cancer hadron therapy planning. For our purposes, a complex testing and analysis software was developed. Also, many conclusions and hypothesis have been done for the further research.

  18. A current view of the diagnostics and treatment of phenylketonuria in Slovakia

    Directory of Open Access Journals (Sweden)

    Ürge Oto

    2015-12-01

    Full Text Available An overview of the diagnostics and treatment of phenylketonuria in Slovakia is presented in this paper. The nature of diseases, incidence and prevalence in Slovakia, its genetic characteristics, current laboratory diagnostics and treatment options are defined. A new method of phenylketonuria screening in Slovakia, which has brought substantial improvement in early detection of the disease and shortening time for definitive diagnosis since 1995 as well as the importance of a tandem MS/MS (mass spectrometry introduced in the diagnosis of inherited metabolic disorders, is presented. The current state of phenylketonuria treatment focusing on low-protein dietary treatment and supplementation of amino acid mixtures is analysed. The use of sapropterin, enzyme replacement therapy, large neutral amino acids supplementation and gene therapy are also discussed.

  19. Current status and perspective of diagnosis and treatment of thoracolumbar fracture in China

    Institute of Scientific and Technical Information of China (English)

    唐天驷; 俞杭平

    2003-01-01

    @@ Since the late 20th century owing to the improvement of spinal surgery techniques, the diagnosis and treatment of thoracolumbar fracture have been perfected more and more. Although the advent of modern spinal surgery in China was late, we have gained some advanced achievements owing to various international communications benefited from the open policy. Therefore, it is essential to evaluate the current status and perspective of diagnosis and treatment of thoracolumbar fracture. There are several issues we would like to discuss here.

  20. Improving Treatment Adherence in Bipolar Disorder: A Review of Current Psychosocial Treatment Efficacy and Recommendations for Future Treatment Development

    Science.gov (United States)

    Gaudiano, Brandon A.; Weinstock, Lauren M.; Miller, Ivan W.

    2008-01-01

    Treatment adherence is a frequent problem in bipolar disorder, with research showing that more than 60% of bipolar patients are at least partially nonadherent to medications. Treatment nonadherence is consistently predictive of a number of negative outcomes in bipolar samples, and the discontinuation of mood stabilizers places these patients at…

  1. Current medical treatment of diabetes type 2 and long term morbidity: how to balance efficacy and safety?

    Science.gov (United States)

    Carrera Boada, C A; Martínez-Moreno, J M

    2013-03-01

    Current medical treatment of type 2 diabetes mellitus (T2DM) requires special attention to different comorbidities that often are associated with hyperglycemia, such as overweight or obesity, dyslipidemia, hypertension, microvascular or macrovascular complications, etc. .. The control of these factors risk to health is as important as the glucose control in diabetes type 2, it is essential for the antidiabetes drugs consider these risk factors. The consensus statement published by the ADA/EASD and AACE emphasizes that the potential effects of antidiabetes medications on CV risk factors besides hyperglycemia (ie, overweight/obesity, hypertension, and dyslipidemia) should be considered in pharmacotherapy selection. Since T2DM is a progressive disease with worsening HbA1C values over time, monotherapy, even with different agents, will eventually fail to maintain the glycemic target. Because insulin resistance occurs in a variety of organs and tissues, many patients may achieve fasting glycemic control but develop postprandial hyperglycemia. Other issues include the risk for hypoglycaemia or weight gain with traditional glucose-lowering medications. The AACE/ACE algorithm for glycemic control is structured according to categories of HbA1C and suggests an HbA1C goal of =6.5%, although that may not be appropriate for all patients.42 The algorithm recommends monotherapy, dual therapy, or triple therapy based on initial HbA1C level of 6.5% to 7.5%, 7.6% to 9%, and >9% and reserves initiation of insulin therapy until treatment with oral or other injectable agents has failed. GLP-1 receptor agonists and DPP-4 inhibitors are novel options to improve glycemic control and reduce the incidence of weight gain. Combination therapy with newer and traditional agents improves glycemic control with a low incidence of hypoglycemia.

  2. Somatization of anxiety disorders in the practice of a neurologist: Algorithms and approaches to differentiated treatment

    Directory of Open Access Journals (Sweden)

    E. G. Mendelevich

    2014-01-01

    Full Text Available As of now, somatization of disorders when its physical symptoms may be caused by mental, psychological, or emotional factors is an extremely common event in clinical practice. The somatization is considered to mean the conversion of mental stress to somatic symptoms. The mechanisms and specific features of somatization disorders within generalized anxiety disorder and panic disorder are of interest. One of the theories about the causes of somatization disorders proposes that somatization is as a way of avoiding psychological stress: it serves to protect from psychological pain, which allows the label of a psychiatric diagnosis to be circumvented in the majority of cases. Some patients unconsciously substitute theexperienced symptoms of anxiety or depression for the development of physical symptoms; anxiety disorders are one of the most common mental disorders. Among various forms of anxiety disorders, panic attacks and generalized anxiety disorders are most often met with neurologists. In some patients, the clinical picture is characterized by a concurrence of both the permanent and paroxysmal symptoms of anxiety, which is not only important to analyze the individual course of the disease, but also responsible for the addressness of a therapeutic approach to a greater extent.There are data of clinical trials and current algorithms for the therapy of generalized anxiety and related disorders reflecting the complexity of a therapeutic approach. The trials of the therapeutic effectiveness of these or those psychopharmacological agents demonstrate the importance of different groups of drugs in relation to the clinical features of detectable disorders. A number of trials indicate that the use of benzodiazepines (such as phenazepam may be considered irreplaceable as an emergency care on an exacerbation of anxiety and exceptional therapeutic orientation by using selective antidepressants not always can solve diverse clinical problems.

  3. Pharmacogenomics and Pancreatic Cancer Treatment. Optimizing Current Therapy and Individualizing Future Therapy

    Directory of Open Access Journals (Sweden)

    Soonmo Peter Kang

    2008-05-01

    Full Text Available Each year, more than 30,000 Americans are diagnosed with pancreatic cancer. We have only made incremental advancements in treatment of pancreatic cancer despite our best efforts. Research has revealed that pancreatic cancer is a genetic disease which is associated with various forms of cancer associated genetic alterations. Identification and understanding of these carcinogenic gene alterations is the base upon which we can overcome drug resistance and develop novel treatment approaches. In this paper, we review current understanding of pharmacogenomics of pancreatic cancer treatment and address future direction of the field.

  4. The Challenge in Diagnosis and Current Treatment of Chronic Thromboembolic Pulmonary Hypertension

    Directory of Open Access Journals (Sweden)

    Anggoro Budi Hartopo

    2017-04-01

    Full Text Available Chronic thromboembolic pulmonary hypertension (CTEPH is currently underdiagnosis and consequently undertreatment in the clinical practice. A deficient in diagnostic modality and treatment availability especially in developing countries makes the CTEPH diagnosis unlikely to confirm. However, high index of clinical suspicion of CTEPH will lead to proper diagnosis and correct treatment  with significant reduction in morbidity and mortality. Left untreated, the mean survival time is 6.8 years and the three year mortality rate may be as high as 90 %. The pathophysiology, diagnosis and treatment of CTEPH are necessary to be shared among internists and primary care physicians, in order to improve the overall outcome of the patients.

  5. Stem Cell Therapy for Treatment of Stress Urinary Incontinence: The Current Status and Challenges

    Directory of Open Access Journals (Sweden)

    Shukui Zhou

    2016-01-01

    Full Text Available Stress urinary incontinence (SUI is a common urinary system disease that mostly affects women. Current treatments still do not solve the critical problem of urethral sphincter dysfunction. In recent years, there have been major developments in techniques to obtain, culture, and characterize autologous stem cells as well as many studies describing their applications for the treatment of SUI. In this paper, we review recent publications and clinical trials investigating the applications of several stem cell types as potential treatments for SUI and the underlying challenges of such therapy.

  6. Current issues in the treatment of specific phobia: recommendations for innovative applications of hypnosis.

    Science.gov (United States)

    Spiegel, Sharon B

    2014-04-01

    Specific phobia is the most common and treatable of the anxiety disorders. Exposure-based therapies are the treatment of choice and empirically validated protocols are available that promise rapid and effective results. In many cases, however, patients are reluctant to comply with demanding schedules of exposure, increasing the risk of treatment failure. Furthermore, in clinical practice, patients often present with multiple phobias and other Axis I and Axis II disorders that can further complicate therapy. This article covers four important issues that have been addressed in the literature: (a) managing resistance to treatment, (b) reducing length of treatment, (c) clarifying the optimal application of relaxation training, and (d) applying advances in cognitive neuroscience. These issues are reviewed and recommendations proposed for ways in which to modify current treatments. Specific suggestions are provided for implementing these recommendations including examples of innovative applications of standard hypnotic techniques.

  7. Chronic ischaemic mitral regurgitation. Current treatment results and new mechanism-based surgical approaches

    NARCIS (Netherlands)

    Bouma, Wobbe; van der Horst, Iwan C. C.; Wijdh-den Hamer, Inez J.; Erasmus, Michiel E.; Zijlstra, Felix; Mariani, Massimo A.; Ebels, Tjark

    2010-01-01

    Chronic ischaemic mitral regurgitation (CIMR) remains one of the most complex and unresolved aspects in the management of ischaemic heart disease. This review provides an overview of the present knowledge about the different aspects of CIMR with an emphasis on mechanisms, current surgical treatment

  8. Effects of previous growth hormone excess and current medical treatment for acromegaly on cognition

    NARCIS (Netherlands)

    Brummelman, Pauline; Koerts, Janneke; Dullaart, Robin P. F.; van den Berg, Gerrit; Tucha, Oliver; Wolffenbuttel, Bruce H. R.; van Beek, Andre P.

    2012-01-01

    Background In untreated acromegaly patients, decreased cognitive functioning is reported to be associated with the degree of growth hormone (GH) and IGF-1 excess. Whether previous GH excess or current medical treatment for acromegaly specifically affects cognition remains unclear. The aim of this

  9. Effects of previous growth hormone excess and current medical treatment for acromegaly on cognition

    NARCIS (Netherlands)

    Brummelman, Pauline; Koerts, Janneke; Dullaart, Robin P. F.; van den Berg, Gerrit; Tucha, Oliver; Wolffenbuttel, Bruce H. R.; van Beek, Andre P.

    2012-01-01

    Background In untreated acromegaly patients, decreased cognitive functioning is reported to be associated with the degree of growth hormone (GH) and IGF-1 excess. Whether previous GH excess or current medical treatment for acromegaly specifically affects cognition remains unclear. The aim of this st

  10. Critical analysis of the current treatment guidelines for complex ptsd in adults

    NARCIS (Netherlands)

    de Jongh, A.; Resick, P.A.; Zoelner, L.A.; van Minnen, A.; Lee, C.W.; Monson, C.M.; Foa, E.B.; Wheeler, K.; ten Broeke, E.; Feeny, N.; Rauch, S.A.M.; Chard, K.M.; Mueser, K.T.; Sloan, D.M.; van der Gaag, M.; Rothbaum, B.O.; Neuner, F.; de Roos, C.; Hehenkamp, L.M.J.; Rosner, R.; Bicanic, I.A.E.

    2016-01-01

    According to current treatment guidelines for Complex PTSD (cPTSD), psychotherapy for adults with cPTSD should start with a “stabilization phase.” This phase, focusing on teaching self-regulation strategies, was designed to ensure that an individual would be better able to tolerate trauma-focused

  11. CRITICAL ANALYSIS of the CURRENT TREATMENT GUIDELINES for COMPLEX PTSD in ADULTS

    NARCIS (Netherlands)

    De Jongh, Ad; Resick, Patricia A.; Zoellner, Lori A.; Van Minnen, Agnes; Lee, Christopher W.; Monson, Candice M.; Foa, Edna B.; Wheeler, Kathleen; Broeke, Erik Ten; Feeny, Norah; Rauch, Sheila A M; Chard, Kathleen M.; Mueser, Kim T.; Sloan, Denise M.; Van Der Gaag, Mark; Rothbaum, Barbara Olasov; Neuner, Frank; De Roos, Carlijn; Hehenkamp, Lieve M J; Rosner, Rita; Bicanic, Iva A E

    2016-01-01

    According to current treatment guidelines for Complex PTSD (cPTSD), psychotherapy for adults with cPTSD should start with a "stabilization phase." This phase, focusing on teaching self-regulation strategies, was designed to ensure that an individual would be better able to tolerate trauma-focused

  12. The utility and limitations of current web-available algorithms to predict peptides recognized by CD4 T cells in response to pathogen infection #

    Science.gov (United States)

    Chaves, Francisco A.; Lee, Alvin H.; Nayak, Jennifer; Richards, Katherine A.; Sant, Andrea J.

    2012-01-01

    The ability to track CD4 T cells elicited in response to pathogen infection or vaccination is critical because of the role these cells play in protective immunity. Coupled with advances in genome sequencing of pathogenic organisms, there is considerable appeal for implementation of computer-based algorithms to predict peptides that bind to the class II molecules, forming the complex recognized by CD4 T cells. Despite recent progress in this area, there is a paucity of data regarding their success in identifying actual pathogen-derived epitopes. In this study, we sought to rigorously evaluate the performance of multiple web-available algorithms by comparing their predictions and our results using purely empirical methods for epitope discovery in influenza that utilized overlapping peptides and cytokine Elispots, for three independent class II molecules. We analyzed the data in different ways, trying to anticipate how an investigator might use these computational tools for epitope discovery. We come to the conclusion that currently available algorithms can indeed facilitate epitope discovery, but all shared a high degree of false positive and false negative predictions. Therefore, efficiencies were low. We also found dramatic disparities among algorithms and between predicted IC50 values and true dissociation rates of peptide:MHC class II complexes. We suggest that improved success of predictive algorithms will depend less on changes in computational methods or increased data sets and more on changes in parameters used to “train” the algorithms that factor in elements of T cell repertoire and peptide acquisition by class II molecules. PMID:22467652

  13. Evaluation of machine learning algorithms for treatment outcome prediction in patients with epilepsy based on structural connectome data.

    Science.gov (United States)

    Munsell, Brent C; Wee, Chong-Yaw; Keller, Simon S; Weber, Bernd; Elger, Christian; da Silva, Laura Angelica Tomaz; Nesland, Travis; Styner, Martin; Shen, Dinggang; Bonilha, Leonardo

    2015-09-01

    The objective of this study is to evaluate machine learning algorithms aimed at predicting surgical treatment outcomes in groups of patients with temporal lobe epilepsy (TLE) using only the structural brain connectome. Specifically, the brain connectome is reconstructed using white matter fiber tracts from presurgical diffusion tensor imaging. To achieve our objective, a two-stage connectome-based prediction framework is developed that gradually selects a small number of abnormal network connections that contribute to the surgical treatment outcome, and in each stage a linear kernel operation is used to further improve the accuracy of the learned classifier. Using a 10-fold cross validation strategy, the first stage in the connectome-based framework is able to separate patients with TLE from normal controls with 80% accuracy, and second stage in the connectome-based framework is able to correctly predict the surgical treatment outcome of patients with TLE with 70% accuracy. Compared to existing state-of-the-art methods that use VBM data, the proposed two-stage connectome-based prediction framework is a suitable alternative with comparable prediction performance. Our results additionally show that machine learning algorithms that exclusively use structural connectome data can predict treatment outcomes in epilepsy with similar accuracy compared with "expert-based" clinical decision. In summary, using the unprecedented information provided in the brain connectome, machine learning algorithms may uncover pathological changes in brain network organization and improve outcome forecasting in the context of epilepsy. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Prior doctor shopping resulting from differential treatment correlates with differences in current patient-provider relationships.

    Science.gov (United States)

    Gudzune, Kimberly A; Bennett, Wendy L; Cooper, Lisa A; Clark, Jeanne M; Bleich, Sara N

    2014-09-01

    To determine the prevalence of doctor shopping resulting from differential treatment and to examine associations between this shopping and current primary care relationships. In 2012, a national internet-based survey of 600 adults receiving primary care in the past year with a BMI ≥ 25 kg/m(2) was conducted. Our independent variable was "switching doctors because I felt treated differently because of my weight." Logistic regression models to examine the association of prior doctor shopping with characteristics of current primary care relationships: duration, trust in primary care provider (PCP), and perceived PCP weight-related judgment, adjusted for patient factors were used. Overall, 13% of adults with overweight/obesity reported previously doctor shopping resulting from differential treatment. Prior shoppers were more likely to report shorter durations of their current relationships [73% vs. 52%; p = 0.01] or perceive that their current PCP judged them because of their weight [74% vs. 11%; p shop resulting from perceived differential treatment. These prior negative experiences have no association with trust in current relationships, but our results suggest that patients may remain sensitive to provider weight bias. © 2014 The Obesity Society.

  15. TREATMENT FOR ACUTE/SUBACUTE MUSCULOSKELETAL PAIN, BY USING AN ALGORITHM FOR STEPWISE CHOICE OF ANALGESIC DRUGS AND FOR MONITORING THEIR EFFICACY: PRELIMINARY DATA OF THE ANALGESIC TREATMENT USING SYSTEMIC ALGORITHM (ATUSA PROGRAM

    Directory of Open Access Journals (Sweden)

    N. V. Gontarenko

    2016-01-01

    Full Text Available To optimize treatment for musculoskeletal pain (MSP is a topical medical and social problem. A meeting of experts was held inMoscowin June 2015 to discuss the possibility of forming an interdisciplinary approach and elaborating a unified MSP treatment algorithm based on the com prehensive pathogenetically justified use of different classes of medicines. The Analgesic Treatment Using a Systemic Algorithm (ATUSA trial is a retrospective observational study of the effectiveness of this approach in clinical practice.Objective: to investigate the efficiency of combination treatment for MSP in real clinical practice.Patients and methods. A study group consisted of 3304 patients (women (54.3% and men (45.7%; mean age 48.9±14.6 years with osteoarthritis, nonspecific back pain, and rheumatic juxta-articular soft tissue pathology who had visited their doctors for acute/subacute MSP. Treatment was performed in accordance with the following algorithm: the first appointment was a nonsteroidal anti-inflammatory drug (NSAID, such as aceclofenac, in case of contraindications, paracetamol and/or tramadol + a topical NSAID, in case of indications, muscle relaxants. The therapeutic efficiency was monitored every 7 days (a total of 4 visits; during each visit, therapy could be changed: switching to another NSAID, local administration of glucocorticoids (GC, as well as antidepressants or anticonvulsants. The dynamics of pain (a 0–10 pain intensity numeric rating scale, the number of patients in whom MSP had been resolved completely, as well as treatment satisfaction were taken into account to assess the results of treatment.Results. The first appointment in 97.5% of the patients was NSAIDs, mainly aceclofenac (93.7%, that was used in combination with a muscle relaxant in 67.7%. By Visit 4, there was a reduction in MSP from 6.9±1.5–2.2±1.3 scores. MSP was completely resolved in 77.0% of the patients. The vast majority (88.4% of the patients rated their

  16. MREIT experiments with 200 µA injected currents: a feasibility study using two reconstruction algorithms, SMM and harmonic B(Z).

    Science.gov (United States)

    Arpinar, V E; Hamamura, M J; Degirmenci, E; Muftuler, L T

    2012-07-07

    Magnetic resonance electrical impedance tomography (MREIT) is a technique that produces images of conductivity in tissues and phantoms. In this technique, electrical currents are applied to an object and the resulting magnetic flux density is measured using magnetic resonance imaging (MRI) and the conductivity distribution is reconstructed using these MRI data. Currently, the technique is used in research environments, primarily studying phantoms and animals. In order to translate MREIT to clinical applications, strict safety standards need to be established, especially for safe current limits. However, there are currently no standards for safe current limits specific to MREIT. Until such standards are established, human MREIT applications need to conform to existing electrical safety standards in medical instrumentation, such as IEC601. This protocol limits patient auxiliary currents to 100 µA for low frequencies. However, published MREIT studies have utilized currents 10-400 times larger than this limit, bringing into question whether the clinical applications of MREIT are attainable under current standards. In this study, we investigated the feasibility of MREIT to accurately reconstruct the relative conductivity of a simple agarose phantom using 200 µA total injected current and tested the performance of two MREIT reconstruction algorithms. These reconstruction algorithms used are the iterative sensitivity matrix method (SMM) by Ider and Birgul (1998 Elektrik 6 215-25) with Tikhonov regularization and the harmonic B(Z) proposed by Oh et al (2003 Magn. Reason. Med. 50 875-8). The reconstruction techniques were tested at both 200 µA and 5 mA injected currents to investigate their noise sensitivity at low and high current conditions. It should be noted that 200 µA total injected current into a cylindrical phantom generates only 14.7 µA current in imaging slice. Similarly, 5 mA total injected current results in 367 µA in imaging slice. Total

  17. A current analysis of chemotherapy strategies for the treatment of human African trypanosomiasis.

    Science.gov (United States)

    Babokhov, Peter; Sanyaolu, Adekunle O; Oyibo, Wellington A; Fagbenro-Beyioku, Adetayo F; Iriemenam, Nnaemeka C

    2013-07-01

    Despite the recent advances in drug research, finding a safe, effective, and easy to use chemotherapy for human African trypanosomiasis (HAT) remains a challenging task. The four current anti-trypanosomiasis drugs have major disadvantages that limit more widespread use of these drugs in the endemic regions of sub-Saharan Africa. Pentamidine and suramin are limited by their effectiveness against the only first stage of Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense, respectively. In addition, melarsoprol and eflornithine (two second stage drugs) each have disadvantages of their own. The former is toxic and has increasing treatment failures while the latter is expensive, laborious to administer, and lacks efficacy against T. b. rhodesiense. Furthermore, melarsoprol's toxicity and decreasing efficacy are glaring problems and phasing out the drug as a frontline treatment against T. b. gambiense is now possible with the emergence of competent, safe combination chemotherapies such as nifurtimox-eflornithine combination treatment (NECT). The future of eflornithine, on the other hand, is more promising. The drug is useful in the context of combination chemotherapy and potential orally administered analogues. Due to the limits of monotherapies, greater emphasis should be placed on the research and development of combination chemotherapies, based on the successful clinical tests with NECT and its current use as a frontline anti-trypanosomiasis treatment. This review discussed the current and future chemotherapy strategies for the treatment of HAT.

  18. Current Approaches in the Treatment of Relapsed and Refractory Acute Myeloid Leukemia

    Directory of Open Access Journals (Sweden)

    Nestor R. Ramos

    2015-04-01

    Full Text Available The limited sensitivity of the historical treatment response criteria for acute myeloid leukemia (AML has resulted in a different paradigm for treatment compared with most other cancers presenting with widely disseminated disease. Initial cytotoxic induction chemotherapy is often able to reduce tumor burden to a level sufficient to meet the current criteria for “complete” remission. Nevertheless, most AML patients ultimately die from their disease, most commonly as clinically evident relapsed AML. Despite a variety of available salvage therapy options, prognosis in patients with relapsed or refractory AML is generally poor. In this review, we outline the commonly utilized salvage cytotoxic therapy interventions and then highlight novel investigational efforts currently in clinical trials using both pathway-targeted agents and immunotherapy based approaches. We conclude that there is no current standard of care for adult relapsed or refractory AML other than offering referral to an appropriate clinical trial.

  19. The promise of ketamine for treatment-resistant depression: current evidence and future directions

    Science.gov (United States)

    DeWilde, Kaitlin E.; Levitch, Cara F.; Murrough, James W.; Mathew, Sanjay J.; Iosifescu, Dan V.

    2014-01-01

    Major depressive disorder (MDD) is one of the most disabling diseases worldwide and is a significant public health threat. Current treatments for MDD primarily consist of monoamine-targeting agents and have limited efficacy. However, the glutamate neurotransmitter system has recently come into focus as a promising alternative for novel antidepressant treatments. We review the current data on the glutamate NMDA receptor antagonist ketamine, which has been shown in clinical trials to act as a rapid antidepressant in MDD. We also examine ketamine efficacy on dimensions of psychopathology, including anhedonia, cognition, and suicidality, consistent with the NIMH Research Domain Criteria (RDoC) initiative. Other aspects of ketamine reviewed in this paper include safety and efficacy, different administration methods, and the risks of misuse of ketamine outside of medical settings. Finally, we conclude with a discussion of other glutamatergic agents other than ketamine currently being tested as novel antidepressants. PMID:25649308

  20. Effect of melt pulse electric current and thermal treatment on A356 alloy

    Institute of Scientific and Technical Information of China (English)

    何树先; 王俊; 江莞; 孙宝德; 周尧和

    2003-01-01

    Effects of the melt pulse electric current and thermal treatment on solidification structures of A356 alloywere investigated. In the experiments, the low temperature melt(953 K and 903 K) treated by pulse electric currentwas mixed with high temperature melt(1 223 K). By the control experiments, the results show that the solidificationstructure of A356 alloy is refined apparently by the pulse electric current togeth er with melt thermal treatmentprocess, and the mechanical properties, especially the elongation ratio of the specimen treated is improved greatly.The structure change of the melt by pulse electric current and melt thermal treatment is the main reason for the re-finement of the solidification structure of A356 alloy.

  1. Current Concepts and New Trends in the Treatment of Cardiogenic Shock Complicating Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Benedek Theodora

    2015-03-01

    Full Text Available Cardiogenic shock (CS is a critical condition which often complicates the evolution of an acute myocardial infarction (AMI. At the same time, co-existence of chronic multi-vessel disease can lead to the development of cardiogenic shock in cases with pronounced haemodynamic instability. Different clinical studies have tried to identify the most appropriate treatment for critical cases of CS complicating AMI. This review aims to present the current status of recommended therapeutic strategies for severe cases of CS presenting as a complication of AMI, and try to shed light on the most appropriate therapeutic strategy as outlined in the current literature. The paper will discuss the different current strategies available for use in the treatment of this condition, includig interventional revascularisation, (complete or culprit, the role of new devices for providing mechanical circulatory support, and the potential role of new drug therapies and of hypothermia.

  2. 高光谱图像目标检测算法分析%A summary on the development of current target detection algorithms for hyperspectral imagery

    Institute of Scientific and Technical Information of China (English)

    孙林; 鲍金河; 刘一超

    2012-01-01

    Target detection for hyperspectral imagery is an important part in the application oi hyperspectral imagery, and the research on target detection will be helpful to the deep use of hyperspectral imagery. This paper divided target detection algorithms for hyperspectral imagery into three categories, which are spectral anomaly detection, spectral matching detection and target detection making use of both hyperspectral and high spatial resolution imagery. Then, the development of current algorithms was summarized. This paper also analyzed the theories, application characteristics and limitations of these three algorithms. In the end, the direction of future target detection algorithms was discussed.%本文将国内外的高光谱图像目标检测算法分为光谱异常检测、光谱匹配检测和高光谱与高空间分辨率结合目标检测三种检测算法,分析了三种检测算法的原理、应用特点和局限性,并探讨了目标检测算法的发展的可能性.

  3. Optimizing control of acromegaly: integrating a growth hormone receptor antagonist into the treatment algorithm.

    Science.gov (United States)

    Clemmons, David R; Chihara, Kazuo; Freda, Pamela U; Ho, Ken K Y; Klibanski, Anne; Melmed, Shlomo; Shalet, Stephen M; Strasburger, Christian J; Trainer, Peter J; Thorner, Michael O

    2003-10-01

    Acromegaly is associated with significant morbidities and a 2- to 3-fold increase in mortality because of the excessive metabolic action of GH and IGF-I, a marker of GH output. Reductions in morbidity correspond with decreases in IGF-I, and mortality is lowered following normalization of IGF-I or GH levels. Therefore, this has become an important end point. Current guidelines for the treatment of acromegaly have not considered recent advances in medical therapy, in particular, the place of pegvisomant, a GH receptor antagonist. Treatment goals include normalizing biochemical markers, controlling tumor mass, preserving pituitary function, and relieving signs and symptoms. Surgery reduces tumor volume and is considered first-line therapy. Radiation reduces tumor volume and GH and IGF-I levels, but the onset of action is slow and hypopituitarism typically develops. Therefore, pharmacotherapy is often used following surgery or as first-line therapy for nonresectable tumors. Dopamine agonists can be considered in patients exhibiting minimal disease or those with GH-prolactin-cosecreting tumors but will not achieve hormone normalization in most patients. Somatostatin analogs effectively suppress GH and IGF-I in most patients, but intolerance (e.g. diarrhea, cramping, gallstones) can occur. Pegvisomant, the newest therapeutic option, blocks GH action at peripheral receptors, normalizes IGF-I levels, reduces signs and symptoms, and corrects metabolic defects. Pegvisomant does not appear to affect tumor size and has few adverse effects. Pegvisomant is the most effective drug treatment for acromegaly in normalizing IGF-I and producing a clinical response; it is the preferred agent in patients resistant to or intolerant of somatostatin analogs.

  4. Current and experimental treatments of Parkinson disease: A guide for neuroscientists.

    Science.gov (United States)

    Oertel, Wolfgang; Schulz, Jörg B

    2016-10-01

    Over a period of more than 50 years, the symptomatic treatment of the motor symptoms of Parkinson disease (PD) has been optimized using pharmacotherapy, deep brain stimulation, and physiotherapy. The arsenal of pharmacotherapies includes L-Dopa, several dopamine agonists, inhibitors of monoamine oxidase (MAO)-B and catechol-o-methyltransferase (COMT), and amantadine. In the later course of the disease, motor complications occur, at which stage different oral formulations of L-Dopa or dopamine agonists with long half-life, a transdermal application or parenteral pumps for continuous drug supply can be subscribed. Alternatively, the patient is offered deep brain stimulation of the subthalamic nucleus (STN) or the internal part of the globus pallidus (GPi). For a more efficacious treatment of motor complications, new formulations of L-Dopa, dopamine agonists, and amantadine as well as new MAO-B and COMT inhibitors are currently tested in clinical trials, and some of them already yielding positive results in phase 3 trials. In addition, non-dopaminergic agents have been tested in the early clinical phase for the treatment of motor fluctuations and dyskinesia, including adenosine A2A antagonists (istradefylline, preladenant, and tozadenant) and modulators of the metabolic glutamate receptor 5 (mGluR5 - mavoglurant) and serotonin (eltoprazine) receptors. Recent clinical trials testing coenzyme Q10, the dopamine agonist pramipexole, creatine monohydrate, pioglitazone, or AAV-mediated gene therapy aimed at increasing expression of neurturin, did not prove efficacious. Treatment with nicotine, caffeine, inosine (a precursor of urate), and isradipine (a dihydropyridine calcium channel blocker), as well as active and passive immunization against α-synuclein and inhibitors or modulators of α-synuclein-aggregation are currently studied in clinical trials. However, to date, no disease-modifying treatment is available. We here review the current status of treatment options for

  5. Comparison of Pencil beam, Collapsed cone and Monte-Carlo algorithm in radiotherapy treatment planning for 6 MV photon

    CERN Document Server

    Kim, Sung Jin; Kim, Sung Kyu

    2015-01-01

    Treatment planning system calculations in inhomogeneous regions may present significant inaccuracies due to loss of electronic equilibrium. In this study, three different dose calculation algorithms, pencil beam, collapsed cone, and Monte-Carlo, provided by our planning system were compared to assess their impact on the three-dimensional planning of lung and breast cases. A total