WorldWideScience

Sample records for current treatment approaches

  1. Bruxism and Current Treatment Approaches

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    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

  2. Narcolepsy: current treatment options and future approaches

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    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

  3. Current approaches in atrial fibrillation treatment

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    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.

  4. Current Approaches in the Treatment of Prostatitis

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    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

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

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    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.

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

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    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

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

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    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.

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

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    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.

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

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    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

  10. Current treatment approaches in patients with ankylosing spondylitis

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    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.

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

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    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.

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

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    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. Treatment of preeclampsia: current approach and future perspectives.

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    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.

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

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    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

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

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    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.

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

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    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

  17. Treatment of cutaneous melanoma: current approaches and future prospects

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    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

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

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    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

  19. Current Approaches in the Treatment of Relapsed and Refractory Acute Myeloid Leukemia

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    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.

  20. A multi-faceted treatment approach for anterior reconstructions using current ceramics, implants, and adhesive systems.

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    Hajtó, Jan; Gehringer, Uwe; Ozcan, Mutlu

    2010-01-01

    Of all developments in dental technology, fulfilling the esthetic and functional demands of the patient, especially regarding anterior reconstructions, is still a challenge for both dentists and dental technicians. This becomes more difficult for patients with a previous treatment history that is not ideal. This case presentation demonstrates reconstruction of an anterior zirconia resin-bonded fixed dental prosthesis (RBFDP) for the mandible with a combined approach utilizing veneers for harmonized space distribution on the abutment teeth and an implant-supported zirconia fixed dental prosthesis in the anterior segment of the maxilla. Adhesive cementation of the restorations is also presented in a step-by-step approach based on the current state of the art.

  1. Current approaches to the diagnosis and treatment of idiopathic pulmonary fibrosis in Europe: the AIR survey

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    Vincent Cottin

    2014-06-01

    Full Text Available This review presents the results of the 2013 Advancing IPF Research (AIR survey, which assessed current approaches to the diagnosis and treatment of idiopathic pulmonary fibrosis (IPF by experienced physicians. A total of 149 physicians, predominantly from European countries, replied to the 28-question survey. The results of the AIR survey were compared with a similar survey of 509 French pulmonologists conducted by the French National Reference Centre and the Network of Regional Competence Centres for Rare Lung Diseases. A number of positive findings emerged from the AIR survey, including the high level of multidisciplinary team involvement in both diagnosis and management. This survey, when taken together with the French survey, suggests that there is still a need to improve earlier diagnosis of IPF.

  2. Treatment of Thrombotic Antiphospholipid Syndrome: The Rationale of Current Management—An Insight into Future Approaches

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    Cecilia Beatrice Chighizola

    2015-01-01

    Full Text Available Vascular thrombosis and pregnancy morbidity represent the clinical manifestations of antiphospholipid syndrome (APS, which is serologically characterized by the persistent positivity of antiphospholipid antibodies (aPL. Antiplatelet and anticoagulant agents currently provide the mainstay of APS treatment. However, the debate is still open: controversies involve the intensity and the duration of anticoagulation and the treatment of stroke and refractory cases. Unfortunately, the literature cannot provide definite answers to these controversial issues as it is flawed by many limitations, mainly due to the recruitment of patients not fulfilling laboratory and clinical criteria for APS. The recommended therapeutic management of different aPL-related clinical manifestations is hereby presented, with a critical appraisal of the evidence supporting such approaches. Cutting edge therapeutic strategies are also discussed, presenting the pioneer reports about the efficacy of novel pharmacological agents in APS. Thanks to a better understanding of aPL pathogenic mechanisms, new therapeutic targets will soon be explored. Much work is still to be done to unravel the most controversial issues about APS management: future studies are warranted to define the optimal management according to aPL risk profile and to assess the impact of a strict control of cardiovascular risk factors on disease control.

  3. Current Approaches to the Treatment of Systemic-Sclerosis-Associated Pulmonary Arterial Hypertension (SSc-PAH).

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    Sobanski, Vincent; Launay, David; Hachulla, Eric; Humbert, Marc

    2016-02-01

    Pulmonary arterial hypertension (PAH) is a severe condition causing significant morbidity and mortality in patients with systemic sclerosis (SSc). Despite the use of specific treatments, SSc-PAH survival remains poorer than in idiopathic PAH (IPAH). Recent therapeutic advances in PAH show a lower magnitude of response in SSc-PAH and a higher risk of adverse events, as compared to IPAH. The multifaceted underlying mechanisms and the multisystem nature of SSc probably explain part of the worse outcomes in SSc-PAH compared to IPAH. This review describes the current management of SSc-PAH with an emphasis on the impact of the different organ involvements in the prognosis and treatment response. An earlier detection of PAH and a better characterization of the clinical phenotypes of SSc-PAH are warranted in clinical practice and future trials. Determinants of prognosis, surrogate markers of clinical improvement or worsening, and relevance of the common endpoints used in clinical trials should be evaluated in this specific population. A multidisciplinary approach in expert referral centers is mandatory for SSc-PAH management.

  4. Treatment of Thrombotic Antiphospholipid Syndrome: The Rationale of Current Management-An Insight into Future Approaches.

    Science.gov (United States)

    Chighizola, Cecilia Beatrice; Ubiali, Tania; Meroni, Pier Luigi

    2015-01-01

    Vascular thrombosis and pregnancy morbidity represent the clinical manifestations of antiphospholipid syndrome (APS), which is serologically characterized by the persistent positivity of antiphospholipid antibodies (aPL). Antiplatelet and anticoagulant agents currently provide the mainstay of APS treatment. However, the debate is still open: controversies involve the intensity and the duration of anticoagulation and the treatment of stroke and refractory cases. Unfortunately, the literature cannot provide definite answers to these controversial issues as it is flawed by many limitations, mainly due to the recruitment of patients not fulfilling laboratory and clinical criteria for APS. The recommended therapeutic management of different aPL-related clinical manifestations is hereby presented, with a critical appraisal of the evidence supporting such approaches. Cutting edge therapeutic strategies are also discussed, presenting the pioneer reports about the efficacy of novel pharmacological agents in APS. Thanks to a better understanding of aPL pathogenic mechanisms, new therapeutic targets will soon be explored. Much work is still to be done to unravel the most controversial issues about APS management: future studies are warranted to define the optimal management according to aPL risk profile and to assess the impact of a strict control of cardiovascular risk factors on disease control.

  5. Our Approach to Toxic Epidermal Necrolysis and Review of Current Treatment Alternatives

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    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.

  6. 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

  7. Neonatal infections due to multi-resistant strains: Epidemiology, current treatment, emerging therapeutic approaches and prevention.

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    Tzialla, Chryssoula; Borghesi, Alessandro; Pozzi, Margherita; Stronati, Mauro

    2015-12-07

    Severe infections represent the main cause of neonatal mortality accounting for more than one million neonatal deaths worldwide every year. Antibiotics are the most commonly prescribed medications in neonatal intensive care units. The benefits of antibiotic therapy when indicated are clearly enormous, but the continued and widespread use of antibiotics has generated over the years a strong selective pressure on microorganisms, favoring the emergence of resistant strains. Health agencies worldwide are galvanizing attention toward antibiotic resistance in gram-positive and gram-negative bacteria. Infections in neonatal units due to multidrug and extensively multidrug resistant bacteria are rising and are already seriously challenging antibiotic treatment options. While there is a growing choice of agents against multi-resistant gram-positive bacteria, new options for multi-resistant gram-negative bacteria in the clinical practice have decreased significantly in the last 20 years making the treatment of infections caused by multidrug-resistant pathogens challenging mostly in neonates. Treatment options are currently limited and will be some years before any new treatment for neonates become available for clinical use, if ever. The aim of the review is to highlight the current knowledge on antibiotic resistance in the neonatal population, the possible therapeutic choices, and the prevention strategies to adopt in order to reduce the emergency and spread of resistant strains.

  8. Current approach to male infertility treatment: sperm selection procedure based on hyaluronic acid binding ability

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    A. V. Zobova

    2015-01-01

    Full Text Available Intracytoplasmic sperm injection into an oocyte is widely used throughout the world in assisted reproductive technologies programs in the presence of male infertility factor. However, this approach can allow selection of a single sperm, which is carrying different types of pathologies. Minimizing of any potential risks, entailing the occurrence of abnormalities in the embryos development (apoptosis, fragmentation of embryos, alterations in gene expression, aneuploidies is a very important condition for reducing the potential negative consequences resulting the manipulation with gametes. Processes that could be influenced by the embryologist must be fulfilled in safe and physiological way as much as it is possible. Data of numerous publications reporting about the positive effects of using the technology of sperm selection by hyaluronic acid binding, let make a conclusion about the high prospects of this approach in the treatment of male infertility by methods of in vitro fertilization. The selection of sperm with improved characteristics, which determine the maturity and genetic integrity, provides an opportunity to improve the parameters of pre-implantation embryogenesis, having thus a positive effect on clinical outcomes of assisted reproductive technologies programs.

  9. Missing Data in Substance Abuse Treatment Research: Current Methods and Modern Approaches

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    McPherson, Sterling; Barbosa-Leiker, Celestina; Burns, G. Leonard; Howell, Donelle; Roll, John

    2013-01-01

    Two common procedures for the treatment of missing information, listwise deletion and positive urine analysis (UA) imputation (e.g., if the participant fails to provide urine for analysis, then score the UA positive), may result in significant biases during the interpretation of treatment effects. To compare these approaches and to offer a possible alternative, these two procedures were compared to the multiple imputation (MI) procedure with publicly available data from a recent clinical trial. Listwise deletion, single imputation (i.e., positive UA imputation), and MI missing data procedures were used to comparatively examine the effect of two different buprenorphine/naloxone tapering schedules (7- or 28-days) for opioid addiction on the likelihood of a positive UA (Clinical Trial Network 0003; Ling et al., 2009). The listwise deletion of missing data resulted in a nonsignificant effect for the taper while the positive UA imputation procedure resulted in a significant effect, replicating the original findings by Ling et al. (2009). Although the MI procedure also resulted in a significant effect, the effect size was meaningfully smaller and the standard errors meaningfully larger when compared to the positive UA procedure. This study demonstrates that the researcher can obtain markedly different results depending on how the missing data are handled. Missing data theory suggests that listwise deletion and single imputation procedures should not be used to account for missing information, and that MI has advantages with respect to internal and external validity when the assumption of missing at random can be reasonably supported. PMID:22329556

  10. Long-term catheterization: current approaches in the diagnosis and treatment of port-related infections

    Directory of Open Access Journals (Sweden)

    Bustos C

    2014-02-01

    Full Text Available Cesar Bustos,1 Aitziber Aguinaga,1 Francisco Carmona-Torre,2 Jose Luis Del Pozo1,3 1Department of Clinical Microbiology, 2Department of Internal Medicine, 3Division of Infectious Diseases, Clinica Universidad de Navarra, Pamplona, Spain Abstract: Since the first description in 1982, totally implanted venous access ports have progressively improved patients' quality of life and medical assistance when a medical condition requires the use of long-term venous access. Currently, they are part of the standard medical care for oncohematologic patients. However, apart from mechanical and thrombotic complications, there are also complications associated with biofilm development inside the catheters. These biofilms increase the cost of medical assistance and extend hospitalization. The most frequently involved micro-organisms in these infections are gram-positive cocci. Many efforts have been made to understand biofilm formation within the lumen catheters, and to resolve catheter-related infection once it has been established. Apart from systemic antibiotic treatment, the use of local catheter treatment (ie, antibiotic lock technique is widely employed. Many different antimicrobial options have been tested, with different outcomes, in clinical and in in vitro assays. The stability of antibiotic concentration in the lock solution once instilled inside the catheter lumen remains unresolved. To prevent infection, it is mandatory to perform hand hygiene before catheter insertion and manipulation, and to disinfect catheter hubs, connectors, and injection ports before accessing the catheter. At present, there are still unresolved questions regarding the best antimicrobial agent for catheter-related bloodstream infection treatment and the duration of concentration stability of the antibiotic solution within the lumen of the port. Keywords: catheter-related infection, bacteremia, biofilm

  11. Weight management in type 2 diabetes: current and emerging approaches to treatment.

    Science.gov (United States)

    Van Gaal, Luc; Scheen, André

    2015-06-01

    Diabetes is a growing global health concern, as is obesity. Diabetes and obesity are intrinsically linked: obesity increases the risk of diabetes and also contributes to disease progression and cardiovascular disease. Although the benefits of weight loss in the prevention of diabetes and as a critical component of managing the condition are well established, weight reduction remains challenging for individuals with type 2 diabetes due to a host of metabolic and psychological factors. For many patients, lifestyle intervention is not enough to achieve weight loss, and alternative options, such as pharmacotherapy, need to be considered. However, many traditional glucose-lowering medications may lead to weight gain. This article focuses on the potential of currently available pharmacological strategies and on emerging approaches in development to support the glycemic and weight-loss goals of individuals with type 2 diabetes. Two pharmacotherapy types are considered: those developed primarily for blood glucose control that have a favorable effect on body weight and those developed primarily to induce weight loss that have a favorable effect on blood glucose control. Finally, the potential of combination therapies for the management of obese patients with type 2 diabetes is discussed.

  12. Current Treatment Approaches to HCC with a Special Consideration to Transplantation

    Science.gov (United States)

    Perera, M. T. P. R.; Silva, M. A.

    2016-01-01

    Hepatocellular carcinoma (HCC) is the third leading cause of cancer deaths worldwide. The mainstay of treatment of HCC has been both resectional and transplantation surgery. It is well known that, in selected, optimized patients, hepatectomy for HCC may be an option, even in patients with underlying cirrhosis. Resectable patients with early HCC and underlying liver disease are however increasingly being considered for transplantation because of potential for better disease-free survival and resolution of underlying liver disease, although this approach is limited by the availability of donor livers, especially in resectable patients. Outcomes following liver transplantation improved dramatically for patients with HCC following the implementation of the Milan criteria in the late 1990s. Ever since, the rather restrictive nature of the Milan criteria has been challenged with good outcomes. There has also been an increase in the donor pool with marginal donors including organs retrieved following cardiac death being used. Even so, patients still continue to die while waiting for a liver transplant. In order to reduce this attrition, bridging techniques and methods for downstaging disease have evolved. Additionally new techniques for organ preservation have increased the prospect of this potentially curative procedure being available for a greater number of patients. PMID:27413539

  13. Current Treatment Approaches to HCC with a Special Consideration to Transplantation

    Directory of Open Access Journals (Sweden)

    N. Bhardwaj

    2016-01-01

    Full Text Available Hepatocellular carcinoma (HCC is the third leading cause of cancer deaths worldwide. The mainstay of treatment of HCC has been both resectional and transplantation surgery. It is well known that, in selected, optimized patients, hepatectomy for HCC may be an option, even in patients with underlying cirrhosis. Resectable patients with early HCC and underlying liver disease are however increasingly being considered for transplantation because of potential for better disease-free survival and resolution of underlying liver disease, although this approach is limited by the availability of donor livers, especially in resectable patients. Outcomes following liver transplantation improved dramatically for patients with HCC following the implementation of the Milan criteria in the late 1990s. Ever since, the rather restrictive nature of the Milan criteria has been challenged with good outcomes. There has also been an increase in the donor pool with marginal donors including organs retrieved following cardiac death being used. Even so, patients still continue to die while waiting for a liver transplant. In order to reduce this attrition, bridging techniques and methods for downstaging disease have evolved. Additionally new techniques for organ preservation have increased the prospect of this potentially curative procedure being available for a greater number of patients.

  14. Pharmacological Treatment of Idiopathic Pulmonary Fibrosis: Current Approaches, Unsolved Issues, and Future Perspectives

    Directory of Open Access Journals (Sweden)

    Michael Kreuter

    2015-01-01

    Full Text Available Idiopathic pulmonary fibrosis (IPF is a devastating condition with a 5-year survival of approximately 20%. The disease primarily occurs in elderly patients. IPF is a highly heterogeneous disorder with a clinical course that varies from prolonged periods of stability to episodes of rapid deterioration. In the last decade, improved understanding of disease mechanisms along with a more precise disease definition has allowed the design and completion of a number of high-quality clinical trials. Yet, until recently, IPF was essentially an untreatable disease. Finally, pirfenidone and nintedanib, two compounds with antifibrotic properties, have consistently proven effective in reducing functional decline and disease progression in IPF. This is a major breakthrough for patients and physicians alike, but there is still a long way to go. In fact, neither pirfenidone nor nintedanib is a cure for IPF, and most patients continue to progress despite treatment. As such, comprehensive care of patients with IPF, including management of comorbidities/complications and physical debility and timely referral for palliative care or, in a small number of highly selected patients, lung transplantation, remains essential. Several agents with high potential are currently being tested and many more are ready to be evaluated in clinical trials.

  15. Current approaches to treatments for schizophrenia spectrum disorders, part II: psychosocial interventions and patient-focused perspectives in psychiatric care

    Directory of Open Access Journals (Sweden)

    Chien WT

    2013-09-01

    functioning, and/or relapse rate. However, the comparative effects between these five approaches have not been well studied; thus, we are not able to clearly understand the superiority of any of these interventions. With the exception of patient relapse, the longer-term (eg, >2 years effects of these approaches on most psychosocial outcomes are not well-established among these patients. Despite the fact that patients' perspectives on treatment and care have been increasingly concerned, not many studies have evaluated the effect of interventions on this perspective, and where they did, the findings were inconclusive. To conclude, current approaches to psychosocial interventions for schizophrenia have their strengths and weaknesses, particularly indicating limited evidence on long-term effects. To improve the longer-term outcomes of people with schizophrenia, future treatment strategies should focus on risk identification, early intervention, person-focused therapy, partnership with family caregivers, and the integration of evidence-based psychosocial interventions into existing services. Keywords: schizophrenia, psychosocial intervention, patient-focused perspectives

  16. Current approaches to treatments for schizophrenia spectrum disorders, part II: psychosocial interventions and patient-focused perspectives in psychiatric care.

    Science.gov (United States)

    Chien, Wai Tong; Leung, Sau Fong; Yeung, Frederick Kk; Wong, Wai Kit

    2013-01-01

    exception of patient relapse, the longer-term (eg, >2 years) effects of these approaches on most psychosocial outcomes are not well-established among these patients. Despite the fact that patients' perspectives on treatment and care have been increasingly concerned, not many studies have evaluated the effect of interventions on this perspective, and where they did, the findings were inconclusive. To conclude, current approaches to psychosocial interventions for schizophrenia have their strengths and weaknesses, particularly indicating limited evidence on long-term effects. To improve the longer-term outcomes of people with schizophrenia, future treatment strategies should focus on risk identification, early intervention, person-focused therapy, partnership with family caregivers, and the integration of evidence-based psychosocial interventions into existing services.

  17. Current Approach to Treatment and Follow-Up of Pre-School Children with Wheezing

    Directory of Open Access Journals (Sweden)

    Pınar Uysal

    2012-12-01

    Full Text Available Exacerbations of wheezing or airway hyperreactivity in early years of life might be the first sign of developing asthma. Therefore, management of these children is important. The first and the most important step of the management is the primary prevention against asthma with education of the patient and his caregivers. In acute exacerbation of wheezing the most preferred treatment should be β2-agonists for both of the episodic and multi-trigger wheezing. Bronchodilators provide symptomatic relief in acute wheezy episodes but the evidence for oral steroid usage is contraversial for children. Parent initiated oral steroid courses cannot be recommended. Although maintenance treatment with low to moderate continuous inhaled corticosteroids (ICS in pure episodic (viral wheeze is ineffective, it has beneficial effects in multi-trigger wheezing.High dose ICS used intermittently are effective in children with both of the wheezing types, but this is associated with short term effects on growth and cannot be recommended as a routine. Leucotrien receptor antagonists (LTRA might be recommended as continuous treatment for children with multi-trigger wheezing. Antihistamines, ketotifen and cromolyns do not have a role in management of wheezing in children. (Jo­ur­nal of Cur­rent Pe­di­at­rics 2012; 10: 98-102

  18. Current approaches to the treatment of endometrial hyperplasia in women with uterine leiomyoma

    Directory of Open Access Journals (Sweden)

    Potapov V.A.

    2014-09-01

    Full Text Available The study involved 155 women, of which 30 healthy women were in the control group. 125 women with uterine leiomyomas and endometrial hyperplasia constituted the main groups. In all women with uterine leiomyoma myomectomy was performed. Further treatment included randomized study of a new regimen of GnRH agonists together with COCs after myomectomy using comparison techniques: monotherapy with a-GnRH, progestins (dydrogesterone or COCs. The treatment using different medication regimens of endometrial hyperplasia after myomectomy convincingly demonstrated significantly greater efficacy of GnRH-a and COCs com¬bination in reducing frequency of symptoms of these diseases, volume of menstrual blood loss and improvement quality of life through the entire observation period. Greater efficacy of COCs and a-GnRH combination, to our opinion, is associated with a greater degree of suppression of cell proliferation and angiogenesis as a result of local (COCs, and systemic effects (a-GnRH.Thus, the proposed method of adjuvant therapy after myomectomy for women with associated endometrial hyperplasia has significant clinical benefits with minimal impact on bone mineral density and other menopausal signs caused by a-GnRH monotherapy.

  19. Current nanotechnological approaches for an effective delivery of bio-active drug molecules in the treatment of acne.

    Science.gov (United States)

    Garg, Tarun

    2016-01-01

    Acne is a chronic inflammatory human skin disease, characterized by areas of skin with seborrhoea, comedones, papules, nodules, pimples, and possibly scarring with lesions occurring on face, neck, and back. Nanotechnological approaches such as particulate (solid lipid nanoparticles and microspheres), vesicular (liposomes and niosomes), colloidal drug delivery systems (micro-emulsion and nano-emulsion), and miscellaneous systems (aerosol foams and micro-sponges) have an important place in acne therapy. These approaches have an enormous opportunity for the designing of a novel, low-dose and effective treatment systems to control acne disease. In this review, we specially focus on the different nanotechnological approaches for an effective treatment of acne.

  20. [Current Approaches in Cancer Immunotherapy].

    Science.gov (United States)

    Otáhal, P; Trněný, M

    2015-01-01

    Methods of cancer immunotherapy have finally entered clinical medicine after years of preclinical research. Currently, there are several methods, which have proven to be very effective even in cases of incurable cancer. Antitumor monoclonal antibodies are among major therapeutic anti-cancer drugs and have been successfully used for many ears. Novel group of antibodies are immunomodulatory antibodies which can break tumor -specific immune tolerance and induce regression of tumors by nonspecific activation of immune system. Bispecific antibodies represent a novel class of anticancer agents which can induce expansion of T cells in vivo, blinatumomab is an example of such agents and is currently available for the treatment of acute B -cell leukemia. Cellular immunotherapy is also very effective, especially the use of Chimeric receptor modified T-cells for the therapy of B- cell lymphoproliferative diseases. Although it is a very complicated and expensive method, it is highly effective approach which can induce remission even in previously hopeless conditions. The goal of this article is to explain the basic principles of cancer immunotherapy and summarize the newest findings in this field.

  1. Current clinical approach to achalasia

    Institute of Scientific and Technical Information of China (English)

    Alexander J Eckardt; Volker F Eckardt

    2009-01-01

    Idiopathic achalasia is a rare primary motility disorder of the esophagus.The classical features are incomplete relaxation of a frequently hypertensive lower esophageal sphincter (LES) and a lack of peristalsis in the tubular esophagus.These motor abnormalities lead to dysphagia,stasis,regurgitation,weight loss,or secondary respiratory complications.Although major strides have been made in understanding the pathogenesis of this rare disorder,including a probable autoimmune mediated destruction of inhibitory neurons in response to an unknown insult in genetically susceptible individuals,a definite trigger has not been identified.The diagnosis of achalasia is suggested by clinical features and confirmed by further diagnostic tests,such as esophagogastroduodenoscopy (EGD),manometry or barium swallow.These studies are not only used to exclude pseudoachalasia,but also might help to categorize the disease by severity or clinical subtype.Recent advances in diagnostic methods,including high resolution manometry (HRM),might allow prediction of treatment responses.The primary treatments for achieving long-term symptom relief are surgery and endoscopic methods.Although limited high-quality data exist,it appears that laparoscopic Heller myotomy with partial fundoplication is superior to endoscopic methods in achieving long-term relief of symptoms in the majority of patients.However,the current clinical approach to achalasia will depend not only on patients' characteristics and clinical subtypes of the disease,but also on local expertise and patient preferences.

  2. 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.

  3. 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

  4. 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...

  5. Current Treatment Limitations in Age-Related Macular Degeneration and Future Approaches Based on Cell Therapy and Tissue Engineering

    Directory of Open Access Journals (Sweden)

    P. Fernández-Robredo

    2014-01-01

    Full Text Available Age-related macular degeneration (AMD is the leading cause of blindness in the Western world. With an ageing population, it is anticipated that the number of AMD cases will increase dramatically, making a solution to this debilitating disease an urgent requirement for the socioeconomic future of the European Union and worldwide. The present paper reviews the limitations of the current therapies as well as the socioeconomic impact of the AMD. There is currently no cure available for AMD, and even palliative treatments are rare. Treatment options show several side effects, are of high cost, and only treat the consequence, not the cause of the pathology. For that reason, many options involving cell therapy mainly based on retinal and iris pigment epithelium cells as well as stem cells are being tested. Moreover, tissue engineering strategies to design and manufacture scaffolds to mimic Bruch’s membrane are very diverse and under investigation. Both alternative therapies are aimed to prevent and/or cure AMD and are reviewed herein.

  6. [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.

  7. Cell Transplantation and Neuroengineering Approach for Spinal Cord Injury Treatment: A Summary of Current Laboratory Findings and Review of Literature.

    Science.gov (United States)

    Lin, Xin-Yi; Lai, Bi-Qin; Zeng, Xiang; Che, Ming-Tian; Ling, Eng-Ang; Wu, Wutian; Zeng, Yuan-Shan

    2016-01-01

    Spinal cord injury (SCI) can cause severe traumatic injury to the central nervous system (CNS). Current therapeutic effects achieved for SCI in clinical medicine show that there is still a long way to go to reach the desired goal of full or significant functional recovery. In basic medical research, however, cell transplantation, gene therapy, application of cytokines, and biomaterial scaffolds have been widely used and investigated as treatments for SCI. All of these strategies when used separately would help rebuild, to some extent, the neural circuits in the lesion area of the spinal cord. In light of this, it is generally accepted that a combined treatment may be a more effective strategy. This review focuses primarily on our recent series of work on transplantation of Schwann cells and adult stem cells, and transplantation of stem cell-derived neural network scaffolds with functional synapses. Arising from this, an artificial neural network (an exogenous neuronal relay) has been designed and fabricated by us-a biomaterial scaffold implanted with Schwann cells modified by the neurotrophin-3 (NT-3) gene and adult stem cells modified with the TrkC (receptor of NT-3) gene. More importantly, experimental evidence suggests that the novel artificial network can integrate with the host tissue and serve as an exogenous neuronal relay for signal transfer and functional improvement of SCI.

  8. Nanorobotics current approaches and techniques

    CERN Document Server

    Ferreira, Antoine

    2013-01-01

    Nanorobot devices now perform a wide variety of tasks at the nanoscale in a wide variety of fields including but not limited to fields such as manufacturing, medicine, supply chain, biology, and outer space. Nanorobotics: Current Approaches and Techniques is a comprehensive overview of this interdisciplinary field with a wide ranging discussion that includes nano-manipulation and industrial nanorobotics, nanorobotics in biology and medicine, nanorobotic sensing, navigation and swarm behavior, and protein and DNA-based nanorobotics. Also included is the latest on topics such as bio-nano-actuators and propulsion and navigation of nanorobotic systems using magnetic fields. Nanorobotics: Current Approaches and Techniques is an ideal book for scientists, researchers, and engineers actively involved in applied and robotic research and development.

  9. Current Understanding of HSP90 as a Novel Therapeutic Target: An Emerging Approach for the Treatment of Cancer.

    Science.gov (United States)

    Haque, Absarul; Alam, Qamre; Alam, Mohammad Zubair; Azhar, Esam I; Sait, Khalid Hussain Wali; Anfinan, Nisrin; Mushtaq, Gohar; Kamal, Mohammad Amjad; Rasool, Mahmood

    2016-01-01

    Heat Shock Protein 90 (HSP90) is a ubiquitous molecular chaperone that is considered to be the most abundantly expressed protein in various human cancers such as breast, lung, colon, prostate, leukemia and skin. The master regulator, HSP90 plays a pivotal role in the conformational stabilization, maturation and activity of its various labile oncogenic client proteins such as p53, ErbB2, Bcr-Abl, Akt, Her-2, Cdk4, Cdk6, Raf-1 and v-Src in altered cells. Hence, making a guaranteed attempt to inhibit such a master regulator for cancer therapy appears to be a potential approach for combinatorial inhibition of numerous oncogenic signaling pathways simultaneously. Considerable efforts are being under way to develop novel molecular targets and its inhibitors that may block key signaling pathways involved in the process of tumorigenesis and metastasis. In this regards, HSP90 has acquired immense interest as a potent anticancer drug-target due to its key functional link with multiple signaling pathways involved in the process of cell proliferation and cell survival. Notably, geldanamycin and its derivatives (17-AAG, 17-DMAG) have shown quite encouraging results in inhibiting HSP90 function in several cancers and currently almost 17 drug candidates known to be target HSP90 are being under clinical trials either as single agents or combinatorial therapy. Hence, this review is an attempt to get new insight into novel drug target therapy by focusing on recent advances made in understanding HSP90 chaperone structure-function relationships, identification of new HSP90 client proteins and, more importantly, on the advancements of HSP90 targeted therapy based on various existing and emerging classical inhibitors.

  10. Carious dentine removal: current approach

    Directory of Open Access Journals (Sweden)

    Germana Coeli de Farias Sales

    2008-01-01

    Full Text Available Dentistry is renewed day after day through the results of qualified researches. The approach as regards carious dentin removal is goingthrough questioning and innovation. The scope of this study was to perform a literature review in the sense of elucidating questions pertaining to the problem of whether or not it is necessary to completely remove carious dentin, and the possibility of performing restoration in a single session, in addition to a discussion about which type of material should be applied in this type of substrate. After analyzing the referenced articles, it was concluded that the stepwise treatment controls caries progression; there is a trend in the literature to partially remove the carious dentin in deep lesions and perform definitive restoration; Calcium hydroxide cement is a classical liner in these situations, while glass ionomer cement and resinous materials are other possibilities of materials that can be in close contact with the remaining dentin.

  11. Approaches to Methadone Treatment

    DEFF Research Database (Denmark)

    Järvinen, Margaretha

    2008-01-01

    The paper analyses methadone treatment in Copenhagen – as it is described by methadone users and staff at different outpatient centres. The starting point is a theoretical model distinguishing between two different approaches to methadone treatment: ‘palliative’ and ‘curative’. Included...... in the model are three dimensions (1) treatment goals at the methadone centres (abstinence vs. stabilisation) (2) treatment focus (focus on addiction vs. focus on the consequences of addiction) and (3) conceptualisation of methadone (methadone as similar to or different from heroin). The paper shows...... that there is a discrepancy between the attitudes of the staff and those of the users. While the staff favour an almost clear-cut palliative approach to methadone treatment, defining curative goals as both unrealistic and as belonging to the past, the users prefer an approach that does not exclude the goal of abstinence...

  12. 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.

  13. 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.

  14. Bruxism and Current Treatment Approaches

    OpenAIRE

    Selin Eren; Humeyra Kocaelli Arikan; Cuneyt Tamam; Cetin Kasapoglu

    2016-01-01

    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 ...

  15. 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.

  16. 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

  17. Reconciling current approaches to blindsight

    DEFF Research Database (Denmark)

    Overgaard, Morten; Mogensen, Jesper

    2015-01-01

    After decades of research, blindsight is still a mysterious and controversial topic in consciousness research. Currently, many researchers tend to think of it as an ideal phenomenon to investigate neural correlates of consciousness, whereas others believe that blindsight is in fact a kind...

  18. Reconciling current approaches to blindsight

    DEFF Research Database (Denmark)

    Overgaard, Morten; Mogensen, Jesper

    2015-01-01

    After decades of research, blindsight is still a mysterious and controversial topic in consciousness research. Currently, many researchers tend to think of it as an ideal phenomenon to investigate neural correlates of consciousness, whereas others believe that blindsight is in fact a kind...

  19. Current Treatments in Familial Dysautonomia

    Science.gov (United States)

    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. [Carpal tunnel syndrome. Current approaches].

    Science.gov (United States)

    Kouyoumdjian, J A

    1999-06-01

    A clinical, epidemiological and nerve conduction studies report on carpal tunnel syndrome was done after electrophysiological author's experience on 668 cases and literature review. The median nerve underwent focal (nodal) or segmental demyelination after compression on carpal tunnel, 3-4 distal to wrist fold. The symptomatic complex includes nocturnal hands numbness and paraesthesia, mostly bilateral and between 40-60 years old. Familial cases are described and the gene could encode thick transverse carpal ligament. Anthropomorphic findings could also bring about an additional risk, but with low significance. Magnetic resonance could be a useful tool for selected atypical cases. Conservative treatment and controversies on surgery timing are discussed. Classical conduction studies on median nerve reveal a prolonged distal segmental sensory latency and also on distal motor latency. Increasing sensitivity may be reach using additional methods such as, median mixed mid-palm latency, comparative mid-palm latency median/ulnar, comparative sensory latency median/radial and median/ulnar, inching method from wrist to palm recording on index/middle finger and comparative motor median/ulnar recording on lumbrical/interosseous muscle.

  1. Treatment Approaches for Drug Addiction

    Science.gov (United States)

    ... Approaches for Drug Addiction Treatment Approaches for Drug Addiction Email Facebook Twitter Revised July 2016 NOTE: This ... treatment options in your state. What is drug addiction? Drug addiction is a chronic disease characterized by ...

  2. 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.

  3. Current antifungal treatment of fusariosis.

    Science.gov (United States)

    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.

  4. 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.

  5. 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.

  6. Current approach to burn critical care.

    Science.gov (United States)

    Sakallioglu, A E; Haberal, M

    2007-10-01

    Burn trauma is a frequent cause of morbidity and mortality all over the world. Advancements in resuscitation, surgical tecniques, infection control and nutritional/metaolic support decreased mortality and morbidity. This article intends to review current outlines for initial treatment and resuscitation nutritional/metabolic support and wound management peculiar to burn patients.

  7. 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

  8. 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...

  9. Current therapeutic approaches for plantar fasciitis

    Directory of Open Access Journals (Sweden)

    Martinelli N

    2014-03-01

    Full Text Available Nicolò Martinelli, Carlo Bonifacini, Giovanni RomeoDepartment of Ankle and Foot Surgery, IRCCS Galeazzi Orthopaedic Institute, Milan, ItalyAbstract: Almost 1 million Americans are affected by plantar fasciitis (PF, which is the commonest cause of chronic heel pain. This condition is often managed conservatively, and many rehabilitation protocols, some with the aid of orthoses, have been adopted, with good-to-excellent clinical results. Although most cases of chronic PF can be successfully managed with a conservative approach, alternative treatments, including high-energy shock wave therapy and corticosteroid injections, are commonly accepted as second-line treatment when traditional conservative therapy fails. However, surgery is still an important mode of treatment. Recently, new minimally invasive surgical techniques that offer numerous advantages (faster recovery time, early weight-bearing, lower postoperative pain over standard surgical approaches have been proposed, with good results and low complication rates. The purpose of this review is to report new conservative and surgical techniques for the treatment of PF. A literature search for articles about plantar fasciitis was conducted on the PubMed database in order to identify publications addressing the treatments of PF. The literature suggests that, initially, traditional conservative treatments consisting of rest, oral nonsteroidal anti-inflammatory drugs, foot orthotics, and stretching exercises can be tried for several weeks. In patients with chronic recalcitrant PF, extracorporeal shock wave therapy or corticosteroid injection can be considered. Surgery (minimally invasive techniques should be considered only after failure of the conservative treatments.Keywords: heel pain, surgery, plantar fasciosis

  10. CURRENT APPROACHES TO CHEMORADIOTHERAPY FOR MALIGNANT GLIOMAS

    Directory of Open Access Journals (Sweden)

    Ye. L. Choinzonov

    2014-01-01

    Full Text Available High-grade malignant gliomas (WHO grade G III–IV account for more than 50% of all primary brain tumors. Despite aggressive treatment, survival rates are still very low with a median reported survival of no more than 1.5 years.Radiation therapy is an integral part of the combined treatment, but often does not influence lethally on resistant tumor cells. Thereby, in recent decades there has been an active search for novel approaches to the treatment of malignant gliomas (chemotherapeutic drugs, biological modifiers, local hyperthermia. Experimental data showed that the effect of high temperatures has both a direct damaging effect on tumor cells and a sensitizing effect. Significant advantages are achieved when the complex treatment of different malignant tumorsincludes local hyperthermia. However data on the treatment of patients with primary and recurrent gliomas G III–IV using local hyperthermia are scarce.The literature review is given in the article provides an overview of the existing treatment methods for brain tumors.

  11. 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

  12. The Outcomes of Minimally Invasive versus Open Posterior Approach Spinal Fusion in Treatment of Lumbar Spondylolisthesis: The Current Evidence from Prospective Comparative Studies

    Science.gov (United States)

    Wu, Ai-Min; Chen, Chun-Hui; Shen, Zhi-Hao; Feng, Zhen-Hua; Weng, Wan-Qing; Li, Shu-Min; Chi, Yong-Long; Yin, Li-Hui

    2017-01-01

    Purpose. To investigate the evidence of minimally invasive (MI) versus open (OP) posterior lumbar fusion in treatment of lumbar spondylolisthesis from current prospective literatures. Methods. The electronic literature database of Pubmed, Embase, and Cochrane library was searched at April 2016. The data of operative time, estimated blood loss and length of hospital stay, visual analog scale (VAS) of both lower back pain and leg pain, Oswestry disability index (ODI), SF-36 PCS (physical component scores) and SF-36 MCS (mental component scores), complications, fusion rate, and secondary surgery were extracted and analyzed by STATA 12.0 software. Results. Five nonrandom prospective comparative studies were included in this meta-analysis. The meta-analysis showed that the MI group had a significantly longer operative time than OP group, less blood loss, and shorter hospital stay. No significant difference was found in back pain, leg pain, ODI, SF-36 PCS, SF-36 MCS, complications, fusion rate, and secondary surgery between MI and OP groups. Conclusion. The prospective evidence suggested that MI posterior fusion for spondylolisthesis had less EBL and hospital stay than OP fusion; however it took more operative time. Both MI and OP fusion had similar results in pain and functional outcomes, complication, fusion rate, and secondary surgery. PMID:28154826

  13. The Outcomes of Minimally Invasive versus Open Posterior Approach Spinal Fusion in Treatment of Lumbar Spondylolisthesis: The Current Evidence from Prospective Comparative Studies

    Directory of Open Access Journals (Sweden)

    Ai-Min Wu

    2017-01-01

    Full Text Available Purpose. To investigate the evidence of minimally invasive (MI versus open (OP posterior lumbar fusion in treatment of lumbar spondylolisthesis from current prospective literatures. Methods. The electronic literature database of Pubmed, Embase, and Cochrane library was searched at April 2016. The data of operative time, estimated blood loss and length of hospital stay, visual analog scale (VAS of both lower back pain and leg pain, Oswestry disability index (ODI, SF-36 PCS (physical component scores and SF-36 MCS (mental component scores, complications, fusion rate, and secondary surgery were extracted and analyzed by STATA 12.0 software. Results. Five nonrandom prospective comparative studies were included in this meta-analysis. The meta-analysis showed that the MI group had a significantly longer operative time than OP group, less blood loss, and shorter hospital stay. No significant difference was found in back pain, leg pain, ODI, SF-36 PCS, SF-36 MCS, complications, fusion rate, and secondary surgery between MI and OP groups. Conclusion. The prospective evidence suggested that MI posterior fusion for spondylolisthesis had less EBL and hospital stay than OP fusion; however it took more operative time. Both MI and OP fusion had similar results in pain and functional outcomes, complication, fusion rate, and secondary surgery.

  14. 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...

  15. 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.

  16. [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)

  17. Comparing Teaching Approaches About Maxwell's Displacement Current

    Science.gov (United States)

    Karam, Ricardo; Coimbra, Debora; Pietrocola, Maurício

    2014-08-01

    Due to its fundamental role for the consolidation of Maxwell's equations, the displacement current is one of the most important topics of any introductory course on electromagnetism. Moreover, this episode is widely used by historians and philosophers of science as a case study to investigate several issues (e.g. the theory-experiment relationship). Despite the consensus among physics educators concerning the relevance of the topic, there are many possible ways to interpret and justify the need for the displacement current term. With the goal of understanding the didactical transposition of this topic more deeply, we investigate three of its domains: (1) The historical development of Maxwell's reasoning; (2) Different approaches to justify the term insertion in physics textbooks; and (3) Four lectures devoted to introduce the topic in undergraduate level given by four different professors. By reflecting on the differences between these three domains, significant evidence for the knowledge transformation caused by the didactization of this episode is provided. The main purpose of this comparative analysis is to assist physics educators in developing an epistemological surveillance regarding the teaching and learning of the displacement current.

  18. 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.

  19. [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.

  20. 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.

  1. Computational approaches to analogical reasoning current trends

    CERN Document Server

    Richard, Gilles

    2014-01-01

    Analogical reasoning is known as a powerful mode for drawing plausible conclusions and solving problems. It has been the topic of a huge number of works by philosophers, anthropologists, linguists, psychologists, and computer scientists. As such, it has been early studied in artificial intelligence, with a particular renewal of interest in the last decade. The present volume provides a structured view of current research trends on computational approaches to analogical reasoning. It starts with an overview of the field, with an extensive bibliography. The 14 collected contributions cover a large scope of issues. First, the use of analogical proportions and analogies is explained and discussed in various natural language processing problems, as well as in automated deduction. Then, different formal frameworks for handling analogies are presented, dealing with case-based reasoning, heuristic-driven theory projection, commonsense reasoning about incomplete rule bases, logical proportions induced by similarity an...

  2. Current approach to cutaneous mastocytosis in childhood.

    Science.gov (United States)

    Tamay, Zeynep; Özçeker, Deniz

    2016-09-01

    Mastocytosis is a heterogeneous disorder characterized by clonal proliferation and accumulation of mast cells in one of more organs which may lead to different clinical pictures. Pathological increase and activation of mast cells in various tissues can cause different clinical pictures. Cutaneous mastocytosis limited to the skin is the most typical clinical picture observed in children and systemic mastocytosis is very rare in the pediatric age group. The diagnosis of cutaneous mastocytosis is based on clinical findings, but is often delayed due to lack of clinical awareness of the disease and lack of its consideration in the differential diagnosis. This article focuses on the current diagnosis, management and treatment of cutaneous mastocytosis in children in order to increase awareness about this issue.

  3. 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....

  4. Multidisciplinary treatment approach in Treacher Collins syndrome.

    Science.gov (United States)

    Hylton, Joseph B; Leon-Salazar, Vladimir; Anderson, Gary C; De Felippe, Nanci L O

    2012-01-01

    Treacher Collins syndrome (TCS) is a common genetic disorder with high penetrance and phenotypic variability. First and second branchial arches are affected in TCS, resulting in craniofacial and intraoral anomalies such as: severe convex facial profile; mid-face hypoplasia; microtia; eyelid colobomas; mandibular retrognathism; cleft palate; dental hypoplasia; heterotopic teeth; maxillary transverse hypoplasia; anterior open bite; and Angle Class II molar relationship. A high incidence of caries is also a typical finding in TCS patients. Nonetheless, even simple dental restorative procedures can be challenging in this patient population due to other associated medical conditions, such as: congenital heart defects; decreased oropharyngeal airways; hearing loss; and anxiety toward treatment. These patients often require a multidisciplinary treatment approach, including: audiology; speech and language pathology; otorhinolaryngology; general dentistry; orthodontics; oral and maxillofacial surgery; and plastic and reconstructive surgeries to improve facial appearance. This paper's purpose was to present a current understanding of Treacher Collins syndrome etiology, phenotype, and current treatment approaches.

  5. 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.

  6. [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.

  7. Current Therapeutic Strategies and Novel Approaches in Osteosarcoma

    Science.gov (United States)

    Ando, Kosei; Heymann, Marie-Françoise; Stresing, Verena; Mori, Kanji; Rédini, Françoise; Heymann, Dominique

    2013-01-01

    Osteosarcoma is the most frequent malignant primary bone tumor and a main cause of cancer-related death in children and adolescents. Although long-term survival in localized osteosarcoma has improved to about 60% during the 1960s and 1970s, long-term survival in both localized and metastatic osteosarcoma has stagnated in the past several decades. Thus, current conventional therapy consists of multi-agent chemotherapy, surgery and radiation, which is not fully adequate for osteosarcoma treatment. Innovative drugs and approaches are needed to further improve outcome in osteosarcoma patients. This review describes the current management of osteosarcoma as well as potential new therapies. PMID:24216993

  8. Current Therapeutic Strategies and Novel Approaches in Osteosarcoma

    Energy Technology Data Exchange (ETDEWEB)

    Ando, Kosei, E-mail: andokercgv@gmail.com [INSERM, UMR 957, 1 Rue Gaston Veil, 44035 Nantes (France); Physiopathologie de la Résorption Osseuse et Therapie des Tumeurs Osseuses Primitives, Université de Nantes, Nantes Atlantique Universités, 1 Rue Gaston Veil, 44035 Nantes (France); Equipe Labellisee Ligue 2012, Nantes, 44035 (France); Heymann, Marie-Françoise [INSERM, UMR 957, 1 Rue Gaston Veil, 44035 Nantes (France); Physiopathologie de la Résorption Osseuse et Therapie des Tumeurs Osseuses Primitives, Université de Nantes, Nantes Atlantique Universités, 1 Rue Gaston Veil, 44035 Nantes (France); Equipe Labellisee Ligue 2012, Nantes, 44035 (France); Nantes University Hospital, Nantes 44035 (France); Stresing, Verena [INSERM, UMR 957, 1 Rue Gaston Veil, 44035 Nantes (France); Physiopathologie de la Résorption Osseuse et Therapie des Tumeurs Osseuses Primitives, Université de Nantes, Nantes Atlantique Universités, 1 Rue Gaston Veil, 44035 Nantes (France); Nantes University Hospital, Nantes 44035 (France); Mori, Kanji [Department of Orthopaedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192 (Japan); Rédini, Françoise; Heymann, Dominique [INSERM, UMR 957, 1 Rue Gaston Veil, 44035 Nantes (France); Physiopathologie de la Résorption Osseuse et Therapie des Tumeurs Osseuses Primitives, Université de Nantes, Nantes Atlantique Universités, 1 Rue Gaston Veil, 44035 Nantes (France); Equipe Labellisee Ligue 2012, Nantes, 44035 (France); Nantes University Hospital, Nantes 44035 (France)

    2013-05-24

    Osteosarcoma is the most frequent malignant primary bone tumor and a main cause of cancer-related death in children and adolescents. Although long-term survival in localized osteosarcoma has improved to about 60% during the 1960s and 1970s, long-term survival in both localized and metastatic osteosarcoma has stagnated in the past several decades. Thus, current conventional therapy consists of multi-agent chemotherapy, surgery and radiation, which is not fully adequate for osteosarcoma treatment. Innovative drugs and approaches are needed to further improve outcome in osteosarcoma patients. This review describes the current management of osteosarcoma as well as potential new therapies.

  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. 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.

  13. Recent considerations in regenerative endodontic treatment approaches

    Directory of Open Access Journals (Sweden)

    Hacer Aksel

    2014-09-01

    Conclusion: Although the regenerative treatment approaches have good clinical outcomes in the majority of case reports, the outcomes are unpredictable. Since the current clinical protocols for regenerative endodontics do not fully fulfill the triad of tissue engineering ((growth factors, scaffold and stem cells, further translational studies are required to achieve more pulp- and dentin-like tissue in the root canal system to achieve pulp regeneration.

  14. Treatment for Anhedonia: A Neuroscience Driven Approach.

    Science.gov (United States)

    Craske, Michelle G; Meuret, Alicia E; Ritz, Thomas; Treanor, Michael; Dour, Halina J

    2016-10-01

    Anhedonia, or loss of interest or pleasure in usual activities, is characteristic of depression, some types of anxiety, as well as substance abuse and schizophrenia. Anhedonia is a predictor of poor long-term outcomes, including suicide, and poor treatment response. Because extant psychological and pharmacological treatments are relatively ineffective for anhedonia, there is an unmet therapeutic need for this high-risk symptom. Current psychological and drug treatments for anxiety and depression focus largely on reducing excesses in negative affect rather than improving deficits in positive affect. Recent advances in affective neuroscience posit that anhedonia is associated with deficits in the appetitive reward system, specifically the anticipation, consumption, and learning of reward. In this paper, we review the evidence for positive affect as a symptom cluster, and its neural underpinnings, and introduce a novel psychological treatment for anxiety and depression that targets appetitive responding. First, we review anhedonia in relation to positive and negative valence systems and current treatment approaches. Second, we discuss the evidence linking anhedonia to biological, experiential, and behavioral deficits in the reward subsystems. Third, we describe the therapeutic approach for Positive Affect Treatment (PAT), an intervention designed to specifically target deficits in reward sensitivity. © 2016 Wiley Periodicals, Inc.

  15. 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.

  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. 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

  18. 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.

  19. 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.

  20. 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

  1. 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.

  2. Pemphigus vulgaris: approach to treatment.

    Science.gov (United States)

    Sinha, Animesh A; Hoffman, Melissa B; Janicke, Elise C

    2015-04-01

    The therapeutic management of pemphigus vulgaris (PV) is centered around immunosuppression, which can be generalized, as in the use of corticosteroids or steroid sparing agents, or specific, as in therapeutic blockage of autoantibody production, certain cytokines, or signaling pathways. Currently, the backbone of treatment for PV, particularly, first line therapy, remains systemic corticosteroids. Although very effective, the significant side effects of long-term corticosteroid usage are well documented. Adjunctive therapies aim to eliminate, or at least decrease, the necessary dose of corticosteroids. Specifically, azathioprine, cyclophosphamide, methotrexate, cyclosporine, mycophenolate mofetil and dapsone are now widely used in PV. Intravenous immunoglobulin (IVIG), plasmapheresis, immunoadsorption, and most recently, rituximab, are other members of the therapeutic armamentarium. However, despite the widening range of treatment options in PV, well-controlled clinical trials and consensus guidelines are lacking.

  3. Current Cognitive Approaches to Childhood Psychopathology.

    Science.gov (United States)

    Garfield, Sol L., Ed.

    1984-01-01

    Presents six developmentally oriented articles on childhood psychopathology. Reviews research dealing with autism, social isolation, interpersonal understanding, sociomoral reasoning, cognitive controls, and aggression and includes an overview of progress and problems in the cognitive approach to clinical child psychology. (JAC)

  4. 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,

  5. 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.

  6. Current nutritional approaches in managing autism spectrum disorder: A review.

    Science.gov (United States)

    Cekici, Hande; Sanlier, Nevin

    2017-08-01

    The link between nutrition and autism spectrum disorder (ASD), which is a complex developmental disorder manifesting itself in significant delays or deviation in interaction and communication, has provided a fresh point of view and signals that nutrition may have a role in the aetiology of ASD, as well as play an active role in treatment by alleviating symptoms. In this review study aimed at evaluating, with scientific and concrete proof, the current medical nutrition implementations on ASD, existing medical nutrition therapies have been addressed and their effects on ASD symptoms have been discussed in light of current research. We reviewed articles regarding the medical nutritional therapy of autism on current nutritional approaches selected from PubMed, Science Direct, EBSCO, and databases about autism and nutrition. The research put forward that in individuals with ASD, while gluten-free/casein-free and ketogenic diets, camel milk, curcumin, probiotics, and fermentable foods can play a role in alleviating ASD symptoms, consumption of sugar, additives, pesticides, genetically modified organisms, inorganic processed foods, and hard-to-digest starches may aggravate symptoms. Further prospective controlled trials with large sample sizes are needed before recommendations can be made regarding the ideal ASD diet. This review emphasizes the value of identifying current nutritional approaches specific to individuals with ASD and integrating their effects on symptoms to the conversation and presents suggestions for future research designed to identify medical nutrition therapies targeting this population to better understand the link between ASD and nutrition.

  7. 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.

  8. [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.

  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. Current approaches to gene regulatory network modelling

    Directory of Open Access Journals (Sweden)

    Brazma Alvis

    2007-09-01

    Full Text Available Abstract Many different approaches have been developed to model and simulate gene regulatory networks. We proposed the following categories for gene regulatory network models: network parts lists, network topology models, network control logic models, and dynamic models. Here we will describe some examples for each of these categories. We will study the topology of gene regulatory networks in yeast in more detail, comparing a direct network derived from transcription factor binding data and an indirect network derived from genome-wide expression data in mutants. Regarding the network dynamics we briefly describe discrete and continuous approaches to network modelling, then describe a hybrid model called Finite State Linear Model and demonstrate that some simple network dynamics can be simulated in this model.

  11. Thalassemia: current approach to an old disease.

    Science.gov (United States)

    Lo, Louise; Singer, Sylvia Titi

    2002-12-01

    This article discusses the approach for recognition, diagnosis, and management of the thalassemias, and reviews new prospects of therapy, focusing mostly on the beta-thalassemias--the more severe and clinically important type, beta-thalassemia major is typically treated with regular transfusion and chelation therapy. New strategies for specific therapy including monitoring of iron induced organ damage, fetal hemoglobin augmentation as an alternative for transfusions, bone marrow transplantation offer hope for prevention of complications and better care of the beta-thalassemias.

  12. Vascular dementia: Pharmacological treatment approaches and perspectives

    Directory of Open Access Journals (Sweden)

    Andrius Baskys

    2007-10-01

    Full Text Available Andrius Baskys1,3, Anthony C Hou21Department of Psychiatry and Human Behavior; 2Program in Geriatrics, University of California at Irvine, Irvine, California; 3Memory Disorders Program, VA Health Care System Long Beach, Long Beach, California, USAAbstract: Vascular dementia is a common condition for which there are no effective approved pharmacological treatments available. Absence of effective treatments creates a difficult situation for those suffering from the disease, their caregivers, and healthcare providers. This review will address our current understanding of the mechanisms of nerve cell damage due to ischemia and summarize available clinical trial data on several commonly used compounds including memantine, donepezil, galantamine, rivastigmine, nimodipine, hydergine, nicergoline, CDPcholine, folic acid, as well as such nonpharmacological approaches as validation therapy.Keywords: vascular dementia, excitotoxicity, treatment, NMDA, memantine, donepezil, galantamine, rivastigmine, nimodipine, hydergine, nicergoline, CDP-choline, folic acid

  13. My Treatment Approach to Gout.

    Science.gov (United States)

    Aslam, Fawad; Michet, Clement

    2017-08-01

    Gout is the most common form of inflammatory arthritis in the United States. Nevertheless, gout remains misunderstood, misdiagnosed, underdiagnosed, and undertreated. Several new recommendation and guideline documents regarding the management of gout have been published in the past few years. New diagnostic modalities, such as ultrasound and dual-energy computed tomography, are now available. Newer treatment options exist, and older agents and their interactions are now better understood. This review addresses these recent diagnostic and therapeutic developments and describes our management protocol with the aim of providing the clinician with a pragmatic approach to gout management. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  14. New approaches to pharmacological treatment of osteoporosis.

    Science.gov (United States)

    Akesson, Kristina

    2003-01-01

    Osteoporosis has been recognized as a major public health problem for less than two decades. The increasing incidence of fragility fractures, such as vertebral, hip, and wrist fractures, first became apparent from epidemiological studies in the early and mid-1980s, when effective treatment was virtually unavailable. Pharmacological therapies that effectively reduce the number of fractures by improving bone mass are now available widely in countries around the world. Most current agents inhibit bone loss by reducing bone resorption, but emerging therapies may increase bone mass by directly promoting bone formation--as is the case with parathyroid hormone. Current treatment alternatives include bisphosphonates, calcitonin, and selective estrogen receptor modulators, but sufficient calcium and vitamin D are a prerequisite. The availability of evidence-based data that show reductions in the incidence of fractures of 30-50% during treatment has been a major step forward in the pharmacological prevention of fractures. With all agents, fracture reduction is most pronounced for vertebral fracture in high-risk individuals; alendronate and risedronate also may protect against hip fracture in the elderly. New approaches to pharmacological treatment will include further development of existing drugs, especially with regard to tolerance and frequency of dosing. New avenues for targeting the condition will emerge as our knowledge of the regulatory mechanisms of bone remodelling increases, although issues of tissue specificity may be difficult to solve. In the long term, information gained through knowledge of bone genetics may be used to adapt pharmacological treatments more precisely to each individual.

  15. Novel Immunologic Approaches to Melanoma Treatment.

    Science.gov (United States)

    Escandell, I; Martín, J M; Jordá, E

    2017-10-01

    Approaches to treating melanoma have changed radically since the introduction of immunotherapy, and survival figures are now higher than possible with earlier therapies. The immunomodulators currently available mainly block CTLA-4 (cytotoxicT lymphocyte-associated molecule-4) and PD-1 (programed cell death protein 1) translocated to the cell surface, where they inhibit the antitumor immune response. Treatments blocking these molecules are being more widely used. Research now seeks new molecular targets, the best combinations of available drugs, and biomarkers that can identify ideal candidates for each one. Copyright © 2017 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. MEMS Packaging - Current Issues and Approaches

    Energy Technology Data Exchange (ETDEWEB)

    DRESSENDORFER,PAUL V.; PETERSON,DAVID W.; REBER,CATHLEEN ANN

    2000-01-19

    The assembly and packaging of MEMS (Microelectromechanical Systems) devices raise a number of issues over and above those normally associated with the assembly of standard microelectronic circuits. MEMS components include a variety of sensors, microengines, optical components, and other devices. They often have exposed mechanical structures which during assembly require particulate control, space in the package, non-contact handling procedures, low-stress die attach, precision die placement, unique process schedules, hermetic sealing in controlled environments (including vacuum), and other special constraints. These constraints force changes in the techniques used to separate die on a wafer, in the types of packages which can be used in the assembly processes and materials, and in the sealing environment and process. This paper discusses a number of these issues and provides information on approaches being taken or proposed to address them.

  17. Current endoscopic approach to indeterminate biliary strictures

    Institute of Scientific and Technical Information of China (English)

    David W Victor; Stuart Sherman; Tarkan Karakan; Mouen A Khashab

    2012-01-01

    Biliary strictures are considered indeterminate when basic work-up,including transabdominal imaging and endoscopic retrograde cholangiopancreatography with routine cytologic brushing,are non-diagnostic.Indeterminate biliary strictures can easily be mischaracterized which may dramatically affect patient's outcome.Early and accurate diagnosis of malignancy impacts not only a patient's candidacy for surgery,but also potential timely targeted chemotherapies.A significant portion of patients with indeterminate biliary strictures have benign disease and accurate diagnosis is,thus,paramount to avoid unnecessary surgery.Current sampling strategies have suboptimal accuracy for the diagnosis of malignancy.Emerging data on other diagnostic modalities,such as ancillary cytology techniques,single operator cholangioscopy,and endoscopic ultrasonography-guided fine needle aspiration,revealed promising results with much improved sensitivity.

  18. Catastrophic antiphospholipid syndrome: The current management approach.

    Science.gov (United States)

    Rodriguez-Pintó, Ignasi; Espinosa, Gerard; Cervera, Ricard

    2016-04-01

    The current recommendation for catastrophic antiphospholipid syndrome (CAPS) management is the standard triple therapy with anticoagulation (AC), glucocorticoids (GCs), plasma exchange (PE), and/or intravenous immunoglobulins (IVIGs). Of note, only AC has a significant effect on the prognosis of these patients. However, from the experimental or basic point of view, there is only indirect evidence to advocate the use of these immunomodulatory therapies (GC, PE, and IVIG) in CAPS. Recently, there have been reports of severe or refractory CAPS patients treated with the monoclonal antibodies rituximab and eculizumab. The first blocks CD20, a surface protein expressed on the cytoplasmic membrane of B cells, and decreases the generation of pathogenic autoantibodies such as antiphospholipid (aPL) antibodies. The second binds with high affinity to C5 complement protein, inhibiting its cleavage and thus preventing the generation of C5b-C9 complex. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. THE CURRENT APPROACHES TO ZIKA VIRUS VACCINATION

    Directory of Open Access Journals (Sweden)

    Can

    2016-08-01

    Full Text Available The aim of the review was to emphasize the importance of producing new generation high standardized synthetic peptide Zika vaccines which induce both humoral and cellular immunity and eliminate side effects of traditional vaccines. The information was done about Zika virus that is an artropod-born virus, member of the genus Flavivirus in the family Flaviviridae. Zika virus has caused outbreaks in many countries the conditions in adults such as Guillain–Barre syndrome by the dramatically increasing number of cases. According to announcement by World Health Organization, 4 million people could be infected with Zika virus in Americas. The importance of the development of peptide vaccines against the virus Zika of the new generation, which are the most promising direction of the prevention and treatment of viral infection has emphasized.

  20. 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.

  1. [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.

  2. [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.

  3. 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.

  4. 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.

  5. 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.

  6. Comprehensive approach to sarcopenia treatment.

    Science.gov (United States)

    Wakabayashi, Hidetaka; Sakuma, Kunihiro

    2014-05-01

    Sarcopenia is characterized by progressive and generalized loss of skeletal muscle mass and strength with a risk of adverse outcomes such as physical disability, poor quality of life, and death. Primary sarcopenia is considered to be age-related when no other cause is evident, other than ageing itself. Secondary sarcopenia should be considered when one or more other causes are evident, such as activity-, disease-, or nutrition-related sarcopenia. In this narrative review that focused on human studies, we summarize the pharmaceutical therapies (testosterone, dehydroepiandrosterone, estrogen, growth hormone, ghrelin, vitamin D, angiotensin converting enzyme inhibitor, and eicosapentaenoic acid) and nonpharmaceutical therapies (resistance training, protein and amino acid supplementation, and non-smoking) for counteracting primary sarcopenia. Testosterone and growth hormone improve muscle mass and muscle strength, but have several side effects. Although there are some intriguing pharmaceutical therapies to combat sarcopenia, resistance training combined with supplements containing amino acids are the most effective for preventing and treating age-related muscle wasting and weakness. The etiology of sarcopenia in the elderly is multi-factorial. Patients with disuse syndrome and deconditioning often complicate the diagnosis, of not only activity-related sarcopenia, but also age-, disease-, and nutrition-related sarcopenia. In these cases a comprehensive approach to sarcopenia treatment should include pharmaceutical therapies for age-related sarcopenia and comorbid chronic diseases, resistance training, early ambulation, nutrition management, protein and amino acid supplementation, and non-smoking. The effect of pharmaceutical therapies for sarcopenia can be enhanced by this comprehensive approach. Future research on pharmaceutical therapies for counteracting sarcopenia should consider non-pharmaceutical therapies and also the causes of sarcopenia.

  7. Current Perspectives on Desmoid Tumors: The Mayo Clinic Approach

    Directory of Open Access Journals (Sweden)

    Scott Okuno

    2011-08-01

    Full Text Available Desmoid tumors are a rare group of locally aggressive, non malignant tumors of fibroblastic origin that can lead to significant morbidity due to local invasion. Despite advances in the understanding of these tumors, their natural history is incompletely understood and the optimal treatment is still a matter of debate. Local control is the main goal of treatment and there has been a change in philosophy regarding the management of these tumors from aggressive surgical resection to function preservation. A multidisciplinary approach is essential to plan local control with acceptable morbidity. The current Mayo Clinic algorithm for the treatment of these tumors is based on institutional experience and the available evidence in the literature: asymptomatic/non progressive lesions away from vital structures are managed with observation and regular imaging; primary or recurrent desmoid tumors which are symptomatic or progressive or near vital structures are managed with wide surgical resection when wide surgical margins are possible with minimal functional and cosmetic loss. When positive or close surgical margins are likely, surgical resection with adjuvant radiotherapy or definitive radiotherapy is preferred. If likely functional or cosmetic deficit is unacceptable, radiotherapy is the treatment of choice. Unresectable lesions are considered for radiotherapy, chemotherapy or newer modalities however an unresectable lesion associated with a painful, functionless, infected extremity is managed with an amputation.

  8. Current Approach to the Evaluation and Management of Microscopic Colitis.

    Science.gov (United States)

    Cotter, Thomas G; Pardi, Darrell S

    2017-02-01

    Microscopic colitis is a common cause of chronic watery diarrhea, particularly in the elderly. The accompanying symptoms, which include abdominal pain and fatigue, can markedly impair patients' quality of life. Diagnosis is based upon characteristic histologic findings of the colonic mucosa. This review focuses on the current approach to evaluation and management of patients with microscopic colitis. Although the incidence of microscopic colitis has been increasing over time, recent epidemiological studies show stabilization at 21.0-24.7 cases per 100,000 person-years. Recent research has further expanded our knowledge of the underlying pathophysiology and emphasized the entity of drug-induced microscopic colitis and the association with celiac disease. Two recent randomized studies have confirmed the effectiveness of oral budesonide for both induction and maintenance treatment of microscopic colitis and is now endorsed by the American Gastroenterological Association as first-line treatment. The incidence of microscopic colitis has stabilized at just over 20 cases per 100,000 person-years. Celiac disease and drug-induced microscopic colitis should be considered in all patients diagnosed with microscopic colitis. There are a number of treatments available for patients with microscopic colitis; however, budesonide is the only option well studied in controlled trials and is effective for both induction and maintenance treatment.

  9. Current Perspectives on Desmoid Tumors: The Mayo Clinic Approach

    Energy Technology Data Exchange (ETDEWEB)

    Joglekar, Siddharth B. [Musculoskeletal Oncology, Mayo Clinic, Rochester, MN55905 (United States); Rose, Peter S.; Sim, Franklin, E-mail: sim.franklin@mayo.edu [Department of Orthopedics, Mayo Clinic, 200 1st ST SW, Rochester, MN 55905 (United States); Okuno, Scott [Department of Oncology, Mayo Clinic, Rochester, MN55905 (United States); Petersen, Ivy [Department of Radiation Oncology, Mayo Clinic, Rochester, MN55905 (United States)

    2011-08-08

    Desmoid tumors are a rare group of locally aggressive, non malignant tumors of fibroblastic origin that can lead to significant morbidity due to local invasion. Despite advances in the understanding of these tumors, their natural history is incompletely understood and the optimal treatment is still a matter of debate. Local control is the main goal of treatment and there has been a change in philosophy regarding the management of these tumors from aggressive surgical resection to function preservation. A multidisciplinary approach is essential to plan local control with acceptable morbidity. The current Mayo Clinic algorithm for the treatment of these tumors is based on institutional experience and the available evidence in the literature: asymptomatic/non progressive lesions away from vital structures are managed with observation and regular imaging; primary or recurrent desmoid tumors which are symptomatic or progressive or near vital structures are managed with wide surgical resection when wide surgical margins are possible with minimal functional and cosmetic loss. When positive or close surgical margins are likely, surgical resection with adjuvant radiotherapy or definitive radiotherapy is preferred. If likely functional or cosmetic deficit is unacceptable, radiotherapy is the treatment of choice. Unresectable lesions are considered for radiotherapy, chemotherapy or newer modalities however an unresectable lesion associated with a painful, functionless, infected extremity is managed with an amputation.

  10. Pulp regeneration: Current approaches and future challenges

    Directory of Open Access Journals (Sweden)

    Jingwen eYANG

    2016-03-01

    Full Text Available Regenerative endodontics aims to replace inflamed/necrotic pulp tissues with regenerated pulp-like tissues to revitalize teeth and improve life quality. Pulp revascularization case reports, which showed successful clinical and radiographic outcomes, indicated the possible clinical application of pulp regeneration via cell homing strategy. From a clinical point of view, functional pulp-like tissues should be regenerated with the characterization of vascularization, re-innervation, and dentin deposition with a regulated rate similar to that of normal pulp. Efficient root canal disinfection and proper size of the apical foramen are the two requisite preconditions for pulp regeneration. Progress has been made on pulp regeneration via cell homing strategies. This review focused on the requisite preconditions and cell homing strategies for pulp regeneration. In addition to the traditionally used mechanical preparation and irrigation, antibiotics, irrigation assisted with EndoVac apical negative-pressure system, and ultrasonic and laser irradiation are now being used in root canal disinfection. In addition, pulp-like tissues could be formed with the apical foramen less than 1 mm, although more studies are needed to determine the appropriate size. Moreover, signaling molecules including stromal cell derived factor (SDF-1α, basic Fibroblast Growth Factor (bFGF, Platelet Derived Growth Factor (PDGF, stem cell factor (SCF, and Granulocyte Colony-Stimulating Factor (G-CSF were used to achieve pulp-like tissue formation via a cell homing strategy. Studies on the cell sources of pulp regeneration might give some indications on the signaling molecular selection. The active recruitment of endogenous cells into root canals to regenerate pulp-like tissues is a novel concept that may offer an unprecedented opportunity for the near-term clinical translation of current biology-based therapies for dental pulp regeneration.

  11. Pulp Regeneration: Current Approaches and Future Challenges.

    Science.gov (United States)

    Yang, Jingwen; Yuan, Guohua; Chen, Zhi

    2016-01-01

    Regenerative endodontics aims to replace inflamed/necrotic pulp tissues with regenerated pulp-like tissues to revitalize teeth and improve life quality. Pulp revascularization case reports, which showed successful clinical and radiographic outcomes, indicated the possible clinical application of pulp regeneration via cell homing strategy. From a clinical point of view, functional pulp-like tissues should be regenerated with the characterization of vascularization, re-innervation, and dentin deposition with a regulated rate similar to that of normal pulp. Efficient root canal disinfection and proper size of the apical foramen are the two requisite preconditions for pulp regeneration. Progress has been made on pulp regeneration via cell homing strategies. This review focused on the requisite preconditions and cell homing strategies for pulp regeneration. In addition to the traditionally used mechanical preparation and irrigation, antibiotics, irrigation assisted with EndoVac apical negative-pressure system, and ultrasonic and laser irradiation are now being used in root canal disinfection. In addition, pulp-like tissues could be formed with the apical foramen less than 1 mm, although more studies are needed to determine the appropriate size. Moreover, signaling molecules including stromal cell derived factor (SDF-1α), basic Fibroblast Growth Factor (bFGF), Platelet Derived Growth Factor (PDGF), stem cell factor (SCF), and Granulocyte Colony-Stimulating Factor (G-CSF) were used to achieve pulp-like tissue formation via a cell homing strategy. Studies on the cell sources of pulp regeneration might give some indications on the signaling molecular selection. The active recruitment of endogenous cells into root canals to regenerate pulp-like tissues is a novel concept that may offer an unprecedented opportunity for the near-term clinical translation of current biology-based therapies for dental pulp regeneration.

  12. Pulp Regeneration: Current Approaches and Future Challenges

    Science.gov (United States)

    Yang, Jingwen; Yuan, Guohua; Chen, Zhi

    2016-01-01

    Regenerative endodontics aims to replace inflamed/necrotic pulp tissues with regenerated pulp-like tissues to revitalize teeth and improve life quality. Pulp revascularization case reports, which showed successful clinical and radiographic outcomes, indicated the possible clinical application of pulp regeneration via cell homing strategy. From a clinical point of view, functional pulp-like tissues should be regenerated with the characterization of vascularization, re-innervation, and dentin deposition with a regulated rate similar to that of normal pulp. Efficient root canal disinfection and proper size of the apical foramen are the two requisite preconditions for pulp regeneration. Progress has been made on pulp regeneration via cell homing strategies. This review focused on the requisite preconditions and cell homing strategies for pulp regeneration. In addition to the traditionally used mechanical preparation and irrigation, antibiotics, irrigation assisted with EndoVac apical negative-pressure system, and ultrasonic and laser irradiation are now being used in root canal disinfection. In addition, pulp-like tissues could be formed with the apical foramen less than 1 mm, although more studies are needed to determine the appropriate size. Moreover, signaling molecules including stromal cell derived factor (SDF-1α), basic Fibroblast Growth Factor (bFGF), Platelet Derived Growth Factor (PDGF), stem cell factor (SCF), and Granulocyte Colony-Stimulating Factor (G-CSF) were used to achieve pulp-like tissue formation via a cell homing strategy. Studies on the cell sources of pulp regeneration might give some indications on the signaling molecular selection. The active recruitment of endogenous cells into root canals to regenerate pulp-like tissues is a novel concept that may offer an unprecedented opportunity for the near-term clinical translation of current biology-based therapies for dental pulp regeneration. PMID:27014076

  13. 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

  14. Angioedema: Diagnosis and treatment approaches

    Directory of Open Access Journals (Sweden)

    Ali Tahsin Güneş

    2013-03-01

    Full Text Available Angioedema (AE is defined as sudden, localized and transient swelling of the skin and/or mucous membranes. This swelling condition is a result of interstitial edema from vasoactive mediators increasing the permeability of postcapillary venules of the subcutaneous and submucosal tissues. When localized to the skin, it presents as asymmetric, nonpitting, nondependent, and occasionally painful edema. However, mucosal attacks, such as laryngeal edema and bowel involvement can produce severe discomfort and life-threatening symptoms. There are several forms including those involving dysfunction or depletion of the C1-inhibitor gene (classical hereditary AE types and acquired AE, allergic AE, drug-induced AE (nonsteroidal anti-inflammatory drug-induced AE, angiotensin converting enzyme inhibitor-induced AE, idiopathic and a recently described form, HAE type 3. These various forms of AE have overlapping symptoms, but some unique clinical and historical features as well as presence of accompanying urticaria can aid in the differential diagnosis. The key to successful management is to rule out conditions that masquerade as AE, detection and avoidance of triggers, early recognition of attacks, and aggressive airway management when warranted. In this article, common and rare forms as well as clinical symptoms, differential diagnosis, and treatment approaches for AE are reviewed.

  15. Neuropsychiatric involvement in systemic lupus erythematosus: current therapeutic approach.

    Science.gov (United States)

    Sanna, Giovanni; Bertolaccini, Maria Laura; Khamashta, Munther A

    2008-01-01

    The involvement of the central nervous system (CNS) is one of the major causes of morbidity and mortality in systemic lupus erythematosus (SLE) patients and the less understood aspect of the disease. Its recognition and treatment continue to represent a major diagnostic and therapeutic challenge. Due to the lack of controlled randomized trials, current therapeutic approach is still empirical and based on clinical experience. The therapeutic choice depends on accurate diagnosis, identification of underlying pathogenic mechanism, severity of the presenting neuropsychiatric symptoms, and on prompt identification and management of contributing causes of CNS disease. Mild neuropsychiatric manifestations may need symptomatic treatment only. In more severe CNS disease it is important to distinguish between thrombotic and non-thrombotic mechanisms. Focal CNS manifestations, particularly TIA and stroke, are associated with the presence of antiphospholipid antibodies (aPL). Anticoagulation is warranted in patients with thrombotic disease, particularly in those with the antiphospholipid (Hughes) syndrome (APS). Other CNS manifestations, such as demyelinating syndrome, transverse myelitis, chorea, seizures, migraine and/or cognitive dysfunction, when associated with persistent positivity for aPL, may also benefit from anticoagulation in selected patients. Severe diffuse CNS manifestations, such as acute confusional state, generalised seizures, mood disorders and psychosis, generally require corticosteroids in the first instance. Pulse intravenous cyclophosphamide therapy may help when more severe manifestations are refractory to corticosteroids and other immunosuppressive agents, generally when response is not seen in 3-5 days. Plasmapheresis may also be added in severe cases of symptoms refractory to conventional treatment. Intravenous immunoglobulins, mycophenolate mofetil, rituximab, intratecal methotrexate and dexametasone deserve further studies to confirm their

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

    Directory of Open Access Journals (Sweden)

    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.

  17. DIABETIC POLYNEUROPATHY: CURRENT APPROACHES TO DIAGNOSIS AND PATHOGENETIC THERAPY

    Directory of Open Access Journals (Sweden)

    O. S. Levin

    2013-01-01

    Full Text Available The paper considers the current views of the prevalence, clinical picture, approaches to the diagnosis and treatment of one of the most commonneurological complications of diabetes mellitus – diabetic polyneuropathy, and both its somatic and autonomous manifestations. Neuropathy ismost common in diabetic patients and its clinical forms reflect the severe course of diabetes mellitus and serve as an unfavorable prognostic signthat is associated with an approximately 5-fold increase in mortality. At the same time, the timely detection and adequate correction of the manifestations of neuropathy may substantially improve quality of life in the patients. The possibilities of pathogenetic therapy for diabetic polyneuropathy associated mainly with the use of benfotiamine and alpha-lipoic acid, as well as symptomatic therapy for its individual manifestationsare considered.

  18. Molecular Basis and Current Treatment for Alcoholic Liver Disease

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    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.

  19. 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

  20. [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

  1. 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.

  2. 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.

  3. 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.

  4. 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

  5. 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

  6. 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.

  7. 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.

  8. Poisoining with Tricyclic Antidepressants and Current Treatment

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    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

  9. [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.

  10. [Irritable Bowel Syndrome treatment: a multidisciplinary approach].

    Science.gov (United States)

    Shani-Zur, Dana; Wolkomir, Keren

    2015-01-01

    Irritable Bowel Syndrome affects 9-23% of the general population. This diagnosis contributes to more frequent doctor visits and multiple consultations by patients. The current approach to treating IBS is symptomatic and consists of a regimen of first line pharmacological treatment options; the use of anti-depressant drugs is also common. The efficiency of complementary medicine in the treatment of IBS has been studied in the last few years. Qualitative multidisciplinary approach studies, using personalized medicines with complementary therapies are needed. We present the case of a 39-year-old woman with a diagnosis of IBS since 2009, who complained about gastrointestinal symptoms since the age of 13 and severe episodes of spasmodic stomach aches in the last year self-ranked as 10, on a 0-10 scale; 3-4 episodes a month, which last for 5 days, accompanied by severe flatulence and bloating. In addition, she has constipation (one bowel movement every 10 days), alternating with multiple diarrheic bowel movements (6 times a day). Using a multidisciplinary approach, including medicinal care, Chinese medicine, reflexology and naturopathy resulted in significant improvement in symptoms and quality of life, as well as gradual reduction of drugs, approved by her physician. Stomach ache self-ranked now as 1, on a 0-10 scale; and flatulence and bloating self-ranked as mild. Bowel movement frequency increased and is now every other day. She no longer has diarrheic and/or multiple bowel movements. This case report emphasizes the importance of integrative treatment in IBS and its benefit in improving patients' quality of life.

  11. [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.

  12. 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

  13. 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

  14. [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.

  15. 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.

  16. 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.

  17. 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.

  18. Implementing two treatment approaches to childhood dysarthria.

    Science.gov (United States)

    Levy, Erika S

    2014-08-01

    The paucity of evidence and detail in the literature regarding speech treatment for children with dysarthria due to cerebral palsy (CP) renders it difficult for researchers to replicate studies and make further inroads into this area in need of exploration. Furthermore, for speech-language pathologists (SLPs) wishing to follow treatments that the literature indicates have promise, little guidance is available on the details of the treatments that yielded the positive results. The present article details the implementation of two treatment approaches in speech treatment research for children with dysarthria: Speech Systems Intelligibility Treatment (SSIT) and the Lee Silverman Voice Treatment LOUD (LSVT LOUD). Specific strategies, primarily for treatment, but also for outcome measurement and acoustic analysis of dysarthric speech, are described. These techniques are provided for researchers and clinicians to consider implementing in order to advance speech treatment for this population. New data from research using these approaches are presented, including findings of acoustic vowel space changes following both speech treatments.

  19. Current Antioxidant Treatments in Organ Transplantation

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    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.

  20. 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

  1. 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

  2. Introducing New Biosimilars Into Current Treatment Algorithms

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    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.

  3. 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.

  4. 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.

  5. 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

  6. Treatment Approaches for Cutaneous Leishmaniasis

    Directory of Open Access Journals (Sweden)

    Sema Aytekin

    2009-06-01

    Full Text Available Cutaneous leishmaniasis (CL is a widespread tropical infection caused by numerous different species of Leishmania protozoa. In our country, CL is due frequently to L. major and L. tropica. Its clinical presentation is extremely diverse. Treatment of CL aims to prevent mucosal invasion, to accelerate the healing of skin lesions, and avoid disfiguring scar. Local and physical treatment modalities including topical paromomycin, cryotherapy, localized controlled heat, carbon dioxide laser therapy, or pentavalant antimonals can be effective against. Intralesional antimonals are still the drug of choice may patients. WHO recommends an injection of drug under edges of the lesions and the entire lesion until the surface has blanched. Parenteral antimonials are useful for large, persistent or recurrent lesions. Combinations with other drugs such as allopurinol, pentoxifylline must be used for antimony unresponsive lesions.

  7. 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.

  8. Current treatment for colorectal liver metastases

    Institute of Scientific and Technical Information of China (English)

    Evangelos P Misiakos; Nikolaos P Karidis; Gregoryr Kouraklis

    2011-01-01

    Surgical resection offers the best opportunity for survival in patients with colorectal cancer metastatic to the liver, with five-year survival rates up to 58% in selected cases. However, only a minority are resectable at the time of diagnosis. Continuous research in this field aims at increasing the percentage of patients eligible for resection, refining the indications and contraindications for surgery , and improving overall survival. The use of surgical innovations, such as staged resection, portal vein embolization, and repeat resection has allowed higher resection rates in patients with bilobar disease. The use of neoadjuvant chemotherapy allows up to 38% of patients previously considered unresectable to be significantly downstaged and eligible for hepatic resection. Ablative techniques have gained wide acceptance as an adjunct to surgical resection and in the management of patients who are not surgical candidates. Curent management of colorectal liver metastases requires a multidisciplinary approach, which should be individu alized in each case.

  9. 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.

  10. 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.

  11. 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

  12. Current Diagnosis and Treatment of Halitosis

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    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

  13. 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

  14. 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

  15. Alternative approaches to epilepsy treatment.

    Science.gov (United States)

    McElroy-Cox, Caitlin

    2009-07-01

    Complementary and alternative medicine (CAM) is a diverse group of health care practices and products that fall outside the realm of traditional Western medical theory and practice and that are used to complement or replace conventional medical therapies. The use of CAM has increased over the past two decades, and surveys have shown that up to 44% of patients with epilepsy are using some form of CAM treatment. This article reviews the CAM modalities of meditation, yoga, relaxation techniques, biofeedback, nutritional and herbal supplements, dietary measures, chiropractic care, acupuncture, Reiki, and homeopathy and what is known about their potential efficacy in patients with epilepsy.

  16. 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.

  17. Current Approaches and Future Trends to Promote Tendon Repair.

    Science.gov (United States)

    Morais, D S; Torres, J; Guedes, R M; Lopes, M A

    2015-09-01

    Tendons are composed by extracellular collagen fibres arranged in regular arrays and are responsible to transmit tensile forces from a muscle to a bone. Due to their poor healing ability, in some cases tendons injuries are debilitating impairments that affect life quality among adult population worldwide. In the last years, attending to the social and economic concern associated to the high prevalence of tendons injuries and the limited success of the available current treatments, several scaffolds have been developed. Some of these scaffolds are intended to be used as graft-augmentation devices and others to fully replace a damaged tendon. The synthetic ones present superior mechanical characteristics compared to biological scaffolds. However, attending to the specific tendons physiology, even the synthetic scaffolds still don´t present the ideal mechanical properties to accomplish a complete and long-term functional tissue repair. Therefore, to enhance tendogenesis when using a tendon engineering approach, several methodologies have been developed to associate with scaffolds, including surface modification and cell seeding.

  18. Cancer of the cervix: current management and new approaches.

    Science.gov (United States)

    Shivnani, Anand T; Rimel, B J; Schink, Julian; Small, William

    2006-11-01

    This article summarizes the current management of patients with newly diagnosed cervical cancer. The topics range from the management of early-stage disease to the phase III randomized studies that have established the current standard of care for patients with locally advanced cancer of the cervix. New approaches to combined-modality therapy with the goal of improving outcomes and decreasing complications are also described.

  19. CURRENT APPROACHES FOR RESEARCH OF MULTIPLE SCLEROSIS BIOMARKERS

    Directory of Open Access Journals (Sweden)

    Kolyada T.I

    2016-12-01

    Full Text Available Current data concerning features of multiple sclerosis (MS etiology, pathogenesis, clinical course and treatment of disease indicate the necessity of personalized approach to the management of MS patients. These features are the variety of possible etiological factors and mechanisms that trigger the development of MS, different courses of disease, and significant differences in treatment efficiency. Phenotypic and pathogenetic heterogeneity of MS requires, on the one hand, the stratification of patients into groups with different treatment depending on a number of criteria including genetic characteristics, disease course, stage of the pathological process, and forms of the disease. On the other hand, it requires the use of modern methods for assessment of individual risk of developing MS, its early diagnosis, evaluation and prognosis of the disease course and the treatment efficiency. This approach is based on the identification and determination of biomarkers of MS including the use of systems biology technology platforms such as genomics, proteomics, metabolomics and bioinformatics. Research and practical use of biomarkers of MS in clinical and laboratory practice requires the use of a wide range of modern medical and biological, mathematical and physicochemical methods. The group of "classical" methods used to study MS biomarkers includes physicochemical and immunological methods aimed at the selection and identification of single molecular biomarkers, as well as methods of molecular genetic analysis. This group of methods includes ELISA, western blotting, isoelectric focusing, immunohistochemical methods, flow cytometry, spectrophotometric and nephelometric methods. These techniques make it possible to carry out both qualitative and quantitative assay of molecular biomarkers. The group of "classical methods" can also include methods based on polymerase chain reaction (including multiplex and allele-specific PCR and genome sequencing

  20. [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

  1. A Systematic Treatment Approach to Wife Battering.

    Science.gov (United States)

    Cook, David R.; Frantz-Cook, Anne

    1984-01-01

    Discusses the problem of wife battering in a systemic framework. Reviews literature that bears most directly on a systemic understanding and treatment of wife battering and outlines a comprehensive approach to treatment as it might be utilized by marriage and family therapists. A case example is presented. (Author/JAC)

  2. Microscopic Colitis: An Approach to Treatment

    Directory of Open Access Journals (Sweden)

    Nilesh Chande

    2008-01-01

    Full Text Available Microscopic colitis – including collagenous colitis and lymphocytic colitis – causes chronic watery diarrhea, usually in middle-aged or elderly patients. There is an association with celiac disease and certain medications. Medical treatment includes various antidiarrheal agents, mesalamine, corticosteroids and immunosuppressant drugs. Rarely, patients require surgery for refractory disease. An evidence-based and practical approach to treatment should optimize the treatment response while minimizing potential adverse events.

  3. Current approaches for detection of carcinoma in situ testis

    DEFF Research Database (Denmark)

    Hoei-Hansen, Christina E; Olesen, Inge A; Jørgensen, Niels

    2007-01-01

    of carcinoma in situ (CIS). This review describes current possible approaches for the detection of CIS. At present, an open testicular biopsy is the only definitive way of establishing the presence of CIS. The tissue section should be of an adequate size, be properly fixed, and evaluation be supported...

  4. Current Approaches for Diagnosis of Influenza Virus Infections in Humans

    Directory of Open Access Journals (Sweden)

    Sai Vikram Vemula

    2016-04-01

    Full Text Available Despite significant advancement in vaccine and virus research, influenza continues to be a major public health concern. Each year in the United States of America, influenza viruses are responsible for seasonal epidemics resulting in over 200,000 hospitalizations and 30,000–50,000 deaths. Accurate and early diagnosis of influenza viral infections are critical for rapid initiation of antiviral therapy to reduce influenza related morbidity and mortality both during seasonal epidemics and pandemics. Several different approaches are currently available for diagnosis of influenza infections in humans. These include viral isolation in cell culture, immunofluorescence assays, nucleic acid amplification tests, immunochromatography-based rapid diagnostic tests, etc. Newer diagnostic approaches are being developed to overcome the limitations associated with some of the conventional detection methods. This review discusses diagnostic approaches currently available for detection of influenza viruses in humans.

  5. Current Approaches to the Understanding of Early Infantile Autism.

    Science.gov (United States)

    Rickman, David L.

    This review of the literature provides summaries of the genetic, neurophysiological, and biochemical approaches to understanding autism, with special reference to neuroanatomic, cognitive, and neuropsychological studies of this disorder. Available instruments for the assessment of autism and various treatment alternatives including drug therapy,…

  6. 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.

  7. 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

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. 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

  13. Chiral lagrangian approach to exchange vector currents in nuclei

    CERN Document Server

    Park, T S; Rho, M; Park, Tae Sun; Min, Dong Pil; Rho, Mannque

    1995-01-01

    Exchange vector currents are calculated up to one-loop order (corresponding to next-to-next-to-leading order) in chiral perturbation theory. As an illustration of the power of the approach, we apply the formalism to the classic nuclear process n+p\\rightarrow d +\\gamma at thermal energy. The exchange current correction comes out to be (4.5 \\pm 0.3) \\% in amplitude giving a predicted cross section \\sigma= (334\\pm 3)\\ {\\mbox mb} in excellent agreement with the experimental value (334.2\\pm 0.5)\\ {\\mbox mb}. Together with the axial charge transitions computed previously, this result provides a strong support for the power of chiral Lagrangians in nuclear physics. As a by-product of our results, we suggest an open problem in the application of chiral Lagrangian approach to nuclear processes that has to do with giving a physical meaning to the short-range correlations that play an important role in nuclei.

  14. MELiSSA Food Characterization general approach and current status

    Science.gov (United States)

    Weihreter, Martin; Chaerle, Laury; Secco, Benjamin; Molders, Katrien; van der Straeten, Dominique; Duliere, Eric; Pieters, Serge; Maclean, Heather; Dochain, Denis; Quinet, Muriel; Lutts, Stanley; Graham, Thomas; Stasiak, Michael; Rondeau Vuk, Theresa; Zheng, Youbin; Dixon, Mike; Laniau, Martine; Larreture, Alain; Timsit, Michel; Aronne, Giovanna; Barbieri, Giancarlo; Buonomo, Roberta; Veronica; Paradiso, Roberta; de Pascale, Stafania; Galbiati, Massimo; Troia, A. R.; Nobili, Matteo; Bucchieri, Lorenzo; Page, Valérie; Feller, Urs; Lasseur, Christophe

    . Available MELiSSA closed environment crop growth data were used to develop a first photosynthetic model representing the basic carbon fixation mechanisms. This model will be further elaborated in the course of this study to predict yield, oxygen production and transpi-ration. As an ultimate goal the model is intended to simulate the composition of the different plant organs (root, shoot, fruit/seed or tuber) for each crop under various conditions. For the validation of this model an extensive amount of data sets are needed. Current plant growth bench test setups will provide part of the required data. To gain more precise and detailed datasets, a highly closed plant growth chamber (Plant Characterization Unit, PCU) is under development. The PCU will provide accurate mass balances for carbon, water, oxygen and other elements with statistical reliability. This reliability is achieved through a high degree of closure and environment homogeneity. The PCU will also provide data for the above described plant characterization studies. The general work approach, the current status and future steps will be illustrated.

  15. Bioaugmentative Approaches for Dairy Wastewater Treatment

    OpenAIRE

    Irina Schneider; Yana Topalova

    2010-01-01

    Problem statement: The achievement of a good ecological status of water receivers after discharge of waste or partially treated water from dairy industry requires harmonic interaction between water treatment technology and self-purification processes. Approach: The present research included two modules. First: an anaerobic treatment process for dairy wastewater in broadly spread sequencing batch bioreactor with fixed biomass was studied. As a source of active biological sy...

  16. Current Approaches of Photothermal Therapy in Treating Cancer Metastasis with Nanotherapeutics

    OpenAIRE

    Zou, Lili; Wang, Hong; He, Bin; Zeng, Lijuan; Tan, Tao; Cao, Haiqiang; He, Xinyu; Zhang, Zhiwen; Guo, Shengrong; Li, Yaping

    2016-01-01

    Cancer metastasis accounts for the high mortality of many types of cancer. Owing to the unique advantages of high specificity and minimal invasiveness, photothermal therapy (PTT) has been evidenced with great potential in treating cancer metastasis. In this review, we outline the current approaches of PTT with respect to its application in treating metastatic cancer. PTT can be used alone, guided with multimodal imaging, or combined with the current available therapies for effective treatment...

  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. Treatment and Counseling Approaches for Eating Disorders.

    Science.gov (United States)

    Hamilton, Kristin L.

    Maladaptive eating behaviors are a growing phenomenon which has captured the interest of not only health and psychology professionals, but also the general public. This paper examines the various types of treatment and counseling approaches for treating anorexia nervosa and bulimia nervosa. Definitions for both disorders are provided, followed by…

  19. 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

  20. 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.

  1. 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.

  2. [Immunotherapeutic approach for the prevention and treatment of chronic diseases].

    Science.gov (United States)

    Bagnato, Barbara; Marino, Maria Giulia; Franco, Elisabetta

    2013-01-01

    Alzheimer disease, diabetes and cardiovascular diseases are among the leading causes of morbidity and mortality worldwide. Different immunotherapeutic approaches for prevention and treatment of these diseases are currently object of several researches. In this paper, recent trials describing active and passive immunotherapy for the management of these pathologies are discussed. The recent immunotherapeutic and preventive approaches for the treatment of Alzheimer's disease are based on the use of β-amyloid peptides and to tau-based immunization strategies but new possibility are explored. Immunotherapeutic vaccine against angiotensin II showed promising results for the management of hypertension. Heath shock proteins and β2-glycoprotein I have been tested to reduce atherosclerosis. Insulin agonists were used for preventing type 1 diabetes in mouse; IL-1β was effective in experimental type 2 diabetes. Research in the field of immunological approach to treatment and prevention of chronic diseases is promising even if the present results have been obtained mainly in animal models.

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

    Directory of Open Access Journals (Sweden)

    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

  4. A Treatment Train Approach To Catchment Management

    Science.gov (United States)

    Barber, Nick; Quinn, Paul; Org, EdenDTC

    2017-04-01

    The treatment train approach has been attempted in a 1.6km2 catchment in the River Eden as part of the UK Demonstration Test Catchment Project. The catchment is one of three detailed study catchments of 10km2 that are investigating diffuse pollution losses from an intense grassland farming system. The catchment is very susceptible to saturation and high losses of fine sediment and phosphorus in storm events. The poster will show how a sequence of mitigation features that target nutrient sources and flow pathways can reduce nutrient losses. 5 features have been installed from farmyard runoff control, along polluting tracks and sediment traps in the farm ditch network. Together the features can slow, store and trap sediment and pollutants. The potential to have further impacts on flood generation and drought mitigation are also being studied. Although the features are currently small in size the ability to directly reduce pollution can be demonstrated. Hence, the potential to scale up these features to a broader catchment scale can be explored and the likely costs and benefits can be simulated. This work builds upon similar work addressing flood control features, sediment trapping on farms and methods for the direct mitigation of fast polluting pathways often referred to as Nature Based Solutions. The designs and construction of the completed features will be shown in the poster. Early results show that the combined effect of the 5 features can significantly impact on sediment and pollution during storm events. The specific yield of the impact was 42 kg of suspended sediment/ha 0.06 kg P/ha of P trapped and 0.16 kg of N/ha. This mitigation impact is derived from an area of only 0.02% of the catchment. The potential to increase the mitigated area is thus large. Payment schemes for farmers could encourage the take up the of these methods and future maintenance regimes for managing the features would also have to be created. However, the potential to mitigate fast

  5. Current approach in the diagnosis and management of panuveitis

    Directory of Open Access Journals (Sweden)

    Bansal Reema

    2010-01-01

    Full Text Available Panuveitis is a generalized inflammation of not only the whole of the uveal tract but also involves the retina and vitreous humor. It differs from other anatomical sites of inflammation in terms of causes as well as distribution. The common causes of panuveitis in our population are tuberculosis, Vogt-Koyanagi-Harada syndrome, sympathetic ophthalmia, Behcet′s disease and sarcoidosis. A large number of cases still remain idiopathic. A stepwise approach is essential while evaluating these patients to be able to identify and treat the disease timely and correctly. Ancillary tests can be appropriately applied once the anatomic site of inflammation is identified. An exhaustive approach comprising a full battery of tests is obsolete. Only specific tailored investigations are ordered as suggested by the preliminary clinical and ocular examination. The mainstay of the treatment of uveitis is corticosteroids. Immunosuppressive agents are administered if the inflammation is not adequately controlled with corticosteroids. One of the recent breakthroughs in the treatment of refractory uveitis includes the introduction of immunomodulating drugs: Tumor necrosis factor-alpha antagonist and Interferon-alpha. Vitrectomy has been used in uveitis for over a few decades for diagnostic and therapeutic purposes. When compared to other anatomical sites of inflammation, panuveitis has poor visual outcome due to more widespread inflammation. The side-effects of the chronic treatment that these patients receive cannot be overlooked and should be specifically monitored under the supervision of an internist with special interest in inflammatory diseases.

  6. Adult orthodontics: multi- or interdisciplinary treatment approach

    DEFF Research Database (Denmark)

    Melsen, Birte

    2007-01-01

    of the conservative approach practiced in many places within periodontology, it should be appreciated that any orthodontic tooth movement involving intrusive components should not be performed in the presence of pathological pockets. New regenerative periodontal treatment procedures have improved the prognosis...... for treatment of tooth movement even of teeth with vertical defects. The appliances should be selected taking the periodontal status and the eventual metabolic factors into consideration. The importance of the correct biomechanical system has a crucial influence on long-term prognosis for the dentition. Animal......An increasing number of adult patients seen in the orthodontic offices are presenting with an ongoing degeneration caused either by loss of one or more teeth and/or progressing periodontal disease. The treatment of these patients can rarely stand alone and both diagnosis and treatment planning...

  7. Adult orthodontics: multi- or interdisciplinary treatment approach

    DEFF Research Database (Denmark)

    Melsen, Birte

    2007-01-01

    An increasing number of adult patients seen in the orthodontic offices are presenting with an ongoing degeneration caused either by loss of one or more teeth and/or progressing periodontal disease. The treatment of these patients can rarely stand alone and both diagnosis and treatment planning...... of the conservative approach practiced in many places within periodontology, it should be appreciated that any orthodontic tooth movement involving intrusive components should not be performed in the presence of pathological pockets. New regenerative periodontal treatment procedures have improved the prognosis...... experiments carried out on monkeys and dogs have repeatedly demonstrated that it is possible to regain lost attachment even in the case of horizontal bone loss through a carefully conducted combined periodontal- and orthodontic treatment and long-term follow-up have confirmed that the results can...

  8. Electrostatic discharge current linear approach and circuit design method

    Energy Technology Data Exchange (ETDEWEB)

    Katsivelis, P. K.; Fotis, G. P.; Gonos, I. F.; Koussiouris, T. G.; Stathopulos, I. A. [School of Electrical and Computer Engineering, National Technical University of Athens, 9 Iroon Polytechniou Str., Zographou 157 80, Athens (Greece)

    2010-11-15

    The electrostatic discharge (ESD) phenomenon is a great threat to all electronic devices and ICs. An electric charge passing rapidly from a charged body to another can seriously harm the last one. However, there is a lack in a linear mathematical approach which will make it possible to design a circuit capable of producing such a sophisticated current waveform. The commonly accepted electrostatic discharge current waveform is the one set by the IEC 61000-4-2. However, the over-simplified circuit included in the same standard is incapable of producing such a waveform. Treating the electrostatic discharge current waveform of the IEC 61000-4-2 as reference, an approximation method, based on Prony's method, is developed and applied in order to obtain a linear system's response. Considering a known input, a method to design a circuit, able to generate this ESD current waveform in presented. The circuit synthesis assumes ideal active elements. A simulation is carried out using the PSpice software. (authors)

  9. Bioaugmentative Approaches for Dairy Wastewater Treatment

    Directory of Open Access Journals (Sweden)

    Irina Schneider

    2010-01-01

    Full Text Available Problem statement: The achievement of a good ecological status of water receivers after discharge of waste or partially treated water from dairy industry requires harmonic interaction between water treatment technology and self-purification processes. Approach: The present research included two modules. First: an anaerobic treatment process for dairy wastewater in broadly spread sequencing batch bioreactor with fixed biomass was studied. As a source of active biological system specially treated and acclimated activated sludge from Sofia Wastewater Treatment Plant was used. The acclimation and immobilization of initially inoculated biomass, the addition of microbiological preparations and its modification for increase of the biodegradation activity to target pollutants were studied as opportunities for the stimulation of water treatment process in bioreactors and water receiver. Second: self-purification processes in а water receiver for partially treated dairy wastewater were investigated. The functional role and restructuring of the microbial communities in the water, sediment water and sediments were studied. Results: The results showed that the most important approaches for achieving high effectiveness of wastewater treatment process were both the acclimation and immobilization of biomass. In that aspect the data for the water receiver confirmed this conclusion. These two processes increased biodegradation effectiveness of the target pollutant (protein with 67%. Conclusion: The effect of the added preparations was smaller (protein biodegradation was increased to 9% for the different biological systems. It was thoroughly related to low improvement of the rate of metabolism and functioning of the biological system mainly on an enzyme level.

  10. Intratumoral Approaches for the Treatment of Melanoma.

    Science.gov (United States)

    Bommareddy, Praveen K; Silk, Ann W; Kaufman, Howard L

    There have been significant advances in the immunotherapy of melanoma over the last decade. The tumor microenvironment is now known to promote an immune-suppressive milieu that can block effective immune-mediated tumor rejection. Several novel strategies designed to overcome local immunosuppression hold promise for treatment of melanoma and other cancers. These approaches include oncolytic viruses, plasmid DNA delivery, Toll-like receptor agonists, inflammatory dyes, cytokines, checkpoint inhibitors, immunomodulatory agents, and host and pathogenic cell-based vectors. In addition, there are several novel methods for local drug delivery, including direct injection, image-guided, electroporation, and nanodelivery techniques under study. The approval of talimogene laherparepvec (Imlygic), an attenuated, recombinant oncolytic herpesvirus, for melanoma treatment is the first intratumoral agent to receive regulatory approval for the treatment of patients with melanoma. This review will focus on the rationale for intratumoral treatment in melanoma, describe the clinical and safety data for some of the agents in clinical development, and provide a perspective for future clinical investigation with intratumoral approaches. Melanoma has been a paradigm tumor for progress in targeted therapy and immunotherapy and will likely also be the tumor to establish the therapeutic role of intratumoral treatment for cancer.

  11. Current approach for urinary system stone disease in pregnant women

    Directory of Open Access Journals (Sweden)

    Orcun Celik

    2016-01-01

    Full Text Available Urinary system stones can be classified according to size, location, X-ray characteristics, aetiology of formation, composition, and risk of recurrence. Especially urolithiasis during pregnancy is a diagnostic and therapeutic challenge. In most cases, it becomes symptomatic in the second or third trimester. Diagnostic options in pregnant women are limited due to the possible teratogenic, carcinogenic, and mutagenic risk of foetal radiation exposure. Clinical management of a pregnant urolithiasis patient is complex and demands close collaboration between patient, obstetrician and urologist. We would like to review current diagnosis and treatment modalities of stone disease of pregnant woman.

  12. Current approach for urinary system stone disease in pregnant women.

    Science.gov (United States)

    Celik, Orcun; Türk, Hakan; Cakmak, Ozgur; Budak, Salih; Ekin, Rahmi Gokhan; Keskin, Mehmet Zeynel; Yildiz, Guner; Ilbey, Yusuf Ozlem

    2016-01-14

    Urinary system stones can be classified according to size, location, X-ray characteristics, aetiology of formation, composition, and risk of recurrence. Especially urolithiasis during pregnancy is a diagnostic and therapeutic challenge. In most cases, it becomes symptomatic in the second or third trimester. Diagnostic options in pregnant women are limited due to the possible teratogenic, carcinogenic, and mutagenic risk of foetal radiation exposure. Clinical management of a pregnant urolithiasis patient is complex and demands close collaboration between patient, obstetrician and urologist. We would like to review current diagnosis and treatment modalities of stone disease of pregnant woman.

  13. My Treatment Approach to Rheumatoid Arthritis

    Science.gov (United States)

    Davis, John M.; Matteson, Eric L.

    2012-01-01

    The past decade has brought important advances in the understanding of rheumatoid arthritis and its management and treatment. New classification criteria for rheumatoid arthritis, better definitions of treatment outcome and remission, and the introduction of biologic response-modifying drugs designed to inhibit the inflammatory process have greatly altered the approach to managing this disease. More aggressive management of rheumatoid arthritis early after diagnosis and throughout the course of the disease has resulted in improvement in patient functioning and quality of life, reduction in comorbid conditions, and enhanced survival. PMID:22766086

  14. 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.

  15. 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...

  16. 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.

  17. 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.

  18. 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.

  19. Current Approaches to the Establishment of Credit Risk Specific Provisions

    Directory of Open Access Journals (Sweden)

    Ion Nitu

    2008-10-01

    Full Text Available The aim of the new Basel II and IFRS approaches is to make the operations of financial institutions more transparent and thus to create a better basis for the market participants and supervisory authorities to acquire information and make decisions. In the banking sector, a continuous debate is being led, related to the similarities and differences between IFRS approach on loan loss provisions and Basel II approach on calculating the capital requirements, judging against the classical method regarding loan provisions, currently used by the Romanian banks following the Central Bank’s regulations.Banks must take into consideration that IFRS and Basel II objectives are fundamentally different. While IFRS aims to ensure that the financial papers reflect adequately the losses recorded at each balance sheet date, the Basel II objective is to ensure that the bank has enough provisions or capital in order to face expected losses in the next 12 months and eventual unexpected losses.Consequently, there are clear differences between the objectives of the two models. Basel II works on statistical modeling of expected losses while IFRS, although allowing statistical models, requires a trigger event to have occurred before they can be used. IAS 39 specifically states that losses that are expected as a result of future events, no matter how likely, are not recognized. This is a clear and fundamental area of difference between the two frameworks.

  20. Towards an Airframe Noise Prediction Methodology: Survey of Current Approaches

    Science.gov (United States)

    Farassat, Fereidoun; Casper, Jay H.

    2006-01-01

    In this paper, we present a critical survey of the current airframe noise (AFN) prediction methodologies. Four methodologies are recognized. These are the fully analytic method, CFD combined with the acoustic analogy, the semi-empirical method and fully numerical method. It is argued that for the immediate need of the aircraft industry, the semi-empirical method based on recent high quality acoustic database is the best available method. The method based on CFD and the Ffowcs William- Hawkings (FW-H) equation with penetrable data surface (FW-Hpds ) has advanced considerably and much experience has been gained in its use. However, more research is needed in the near future particularly in the area of turbulence simulation. The fully numerical method will take longer to reach maturity. Based on the current trends, it is predicted that this method will eventually develop into the method of choice. Both the turbulence simulation and propagation methods need to develop more for this method to become useful. Nonetheless, the authors propose that the method based on a combination of numerical and analytical techniques, e.g., CFD combined with FW-H equation, should also be worked on. In this effort, the current symbolic algebra software will allow more analytical approaches to be incorporated into AFN prediction methods.

  1. Treatment of aging vocal folds: surgical approaches.

    Science.gov (United States)

    Seino, Yutomo; Allen, Jacqui E

    2014-12-01

    Aging may affect the voice through either physiological or pathological changes. Globally society is aging and the working lifetime is extending. Increasing numbers of elderly will present with voice issues. This review examines current thinking regarding surgical treatment of the aging voice. The mainstay of surgical treatment remains injection laryngoplasty and medialization thyroplasty. In-office injection laryngoplasty is increasingly common. Data suggest that patients with vocal fold atrophy do not achieve as much benefit from augmentation treatments as other causes of glottal incompetence. In addition the timing of injection laryngoplasty may influence the rate of subsequent medialization thyroplasty. Disease-specific treatments can provide some benefit to voice, such as deep brain stimulation in Parkinson's disease. Novel treatments including growth factor therapy are entering clinical practice and will provide new options for the clinician in future. Voice disorders affect approximately 20% of the elderly population. Causes include neurologic, malignant, iatrogenic and benign vocal fold disorders. These should be ruled out before accepting dysphonia is age-related in nature. Treatment should be specific to recognized vocal disorders but may also address physiologic changes in the glottis. Injection laryngoplasty and thyroplasty remain effective options for treating glottal incompetence but novel therapies are showing promising results.

  2. 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.

  3. 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

  4. A team approach to assisted conception treatment.

    Science.gov (United States)

    Muirhead, Margaret; Lawton, Janet

    1998-01-01

    A programme to improve 'continuity of care' was initiated at Bourn Hall Clinic in direct response to patient demand to see the same doctors and nurses throughout assisted conception treatment cycles. A working party comprising individuals from all disciplines involved in assisted conception care was set up to review practices and aims and to establish an action plan. As a result, in 1996, a team approach to in vitro fertilization (IVF) and frozen embryo transfer (FET) treatment cycles was introduced at the clinic. The nursing staff were divided into two teams, each with a leader, an appropriate skill mix of full- and part-time nurses, and one full-time and one relief doctor. Treatment cycles were scheduled using pituitary downregulation with gonadotrophin-releasing hormone (GnRH) agonist when appropriate, and a programme was devised in which groups of 40--45 couples started treatment during the same 5 day period. Each couple was assigned to one of the teams and starting dates for each group were separated by 2 week intervals. The objectives of the working party were successfully achieved. The team approach to treating a finite number of couples provides a better opportunity for individualized care. Couples appreciate the advantages of continuity of care and the improved rapport with team staff. Forward planning of treatment cycles provides greater flexibility for incorporating clinic visits into patients' normal routines. Staff have benefited from increased job satisfaction due to greater involvement with couples from initial contact to the completion of treatment. The new working practice provides opportunities for training and research. Staff costs have been rationalized with benefits both to couples and to the business unit.

  5. New approaches in the treatment of hypertension.

    Science.gov (United States)

    Oparil, Suzanne; Schmieder, Roland E

    2015-03-13

    Hypertension is the most common modifiable risk factor for cardiovascular disease and death, and lowering blood pressure with antihypertensive drugs reduces target organ damage and prevents cardiovascular disease outcomes. Despite a plethora of available treatment options, a substantial portion of the hypertensive population has uncontrolled blood pressure. The unmet need of controlling blood pressure in this population may be addressed, in part, by developing new drugs and devices/procedures to treat hypertension and its comorbidities. In this Compendium Review, we discuss new drugs and interventional treatments that are undergoing preclinical or clinical testing for hypertension treatment. New drug classes, eg, inhibitors of vasopeptidases, aldosterone synthase and soluble epoxide hydrolase, agonists of natriuretic peptide A and vasoactive intestinal peptide receptor 2, and a novel mineralocorticoid receptor antagonist are in phase II/III of development, while inhibitors of aminopeptidase A, dopamine β-hydroxylase, and the intestinal Na(+)/H(+) exchanger 3, agonists of components of the angiotensin-converting enzyme 2/angiotensin(1-7)/Mas receptor axis and vaccines directed toward angiotensin II and its type 1 receptor are in phase I or preclinical development. The two main interventional approaches, transcatheter renal denervation and baroreflex activation therapy, are used in clinical practice for severe treatment resistant hypertension in some countries. Renal denervation is also being evaluated for treatment of various comorbidities, eg, chronic heart failure, cardiac arrhythmias and chronic renal failure. Novel interventional approaches in early development include carotid body ablation and arteriovenous fistula placement. Importantly, none of these novel drug or device treatments has been shown to prevent cardiovascular disease outcomes or death in hypertensive patients.

  6. Ocular Behçet disease: current therapeutic approaches.

    Science.gov (United States)

    Evereklioglu, Cem

    2011-11-01

    To alert physician to timely recognition and current treatment of recurrent hypopyon iridocyclitis or panuveitis in ocular Behçet disease (OBD). Interferon-α, rituximab, intravitreal triamcinolone, and biological response modifiers by tumor necrosis factor inhibitors such as infliximab and adalimumab are being used increasingly for the treatment of severe sight-threatening ocular inflammation including retinal vasculitis and cystoid macular edema (CME). Biological agents offer tremendous potential in the treatment of OBD. Given that OBD predominantly afflicts the younger adults in their most productive years, dermatologist, rheumatologist, internist, or general practitioners supervising patients with oculo-articulo-oromucocutaneous syndromes should be aware of systemic Behçet disease. Early recognition of ocular involvement is important and such patients should strongly be instructed to visit immediately an ophthalmologist, as uveitis management differs from extraocular involvements with high ocular morbidity from sight-threatening complications due to relapsing inflammatory attacks in the posterior segment of the eye. A single infliximab infusion should be considered for the control of acute panuveitis, whereas repeated long-term infliximab infusions were proved to be more effective in reducing the number of episodes in refractory uveoretinitis with faster regression and complete remission of CME.

  7. Up-to-Date Approach to the Treatment of Hypertension

    Directory of Open Access Journals (Sweden)

    Zeki Aydın

    2014-12-01

    Full Text Available Hypertension remains one of the most important medical problems in spite of significant medical advances. In many studies, both systolic and diastolic blood pressures have been found to be closely related with cardiovascular (CV morbidity and mortality. The primary aim in the treatment of hypertension is to reduce CV disease risk and the related morbidity and mortality. Hypertension is one of the most common causes of death worldwide due to its high prevalence. Because it is thought that it will be an important public health problem in the future, as it is now, the need for developing new guidelines based on new studies emerges. Individualized treatment plans based on up-to-date guidelines would be the most appropriate approach for physicians. Herein, the current approach to the treatment of hypertension has been summarized in the light of recent guidelines.

  8. 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.

  9. Phantom Limb Pain: Mechanisms and Treatment Approaches

    Directory of Open Access Journals (Sweden)

    Bishnu Subedi

    2011-01-01

    Full Text Available The vast amount of research over the past decades has significantly added to our knowledge of phantom limb pain. Multiple factors including site of amputation or presence of preamputation pain have been found to have a positive correlation with the development of phantom limb pain. The paradigms of proposed mechanisms have shifted over the past years from the psychogenic theory to peripheral and central neural changes involving cortical reorganization. More recently, the role of mirror neurons in the brain has been proposed in the generation of phantom pain. A wide variety of treatment approaches have been employed, but mechanism-based specific treatment guidelines are yet to evolve. Phantom limb pain is considered a neuropathic pain, and most treatment recommendations are based on recommendations for neuropathic pain syndromes. Mirror therapy, a relatively recently proposed therapy for phantom limb pain, has mixed results in randomized controlled trials. Most successful treatment outcomes include multidisciplinary measures. This paper attempts to review and summarize recent research relative to the proposed mechanisms of and treatments for phantom limb pain.

  10. Two complementary approaches to right-handed currents

    Energy Technology Data Exchange (ETDEWEB)

    Gemmler, Katrin M.

    2012-04-17

    Flavour observables impose strong constraints on models of new physics. We study whether right-handed currents can provide a realistic extension to the Standard Model. We analyse two complementary models. These setups lead to new flavour violating interactions in the right-handed sector. We first consider a bottom-up approach assuming a left-right symmetric flavour group broken only by the Yukawa couplings. In this model the vertical stroke V{sub ub} vertical stroke problem can be solved. Secondly we study the Left-Right Model. We perform a comprehensive numerical analysis, including all known experimental constraints from {Delta}F=2 observables and the decay B {yields}X{sub s}{gamma} simultaneously. We observe that there exist regions in parameter space in accordance with the all data. In this model all flavour anomalies can be resolved except the vertical stroke V{sub ub} vertical stroke problem.

  11. 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.

  12. Ebola virus vaccines: an overview of current approaches.

    Science.gov (United States)

    Marzi, Andrea; Feldmann, Heinz

    2014-04-01

    Ebola hemorrhagic fever is one of the most fatal viral diseases worldwide affecting humans and nonhuman primates. Although infections only occur frequently in Central Africa, the virus has the potential to spread globally and is classified as a category A pathogen that could be misused as a bioterrorism agent. As of today there is no vaccine or treatment licensed to counteract Ebola virus infections. DNA, subunit and several viral vector approaches, replicating and non-replicating, have been tested as potential vaccine platforms and their protective efficacy has been evaluated in nonhuman primate models for Ebola virus infections, which closely resemble disease progression in humans. Though these vaccine platforms seem to confer protection through different mechanisms, several of them are efficacious against lethal disease in nonhuman primates attesting that vaccination against Ebola virus infections is feasible.

  13. 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.

  14. 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

  15. Public Economy versus Planned Economy. Current Approaches and Problems

    Directory of Open Access Journals (Sweden)

    Ani Matei

    2006-03-01

    Full Text Available he present paper proposes a review of the current object and problems facing the public economy. For the past decade and a half, public economy has clearly come back in the attention of the research interests of specialists from the Central and Eastern European countries. Among these, the scientific research encompassed by the public economy area interrelates with the international trends. At a closer look, public economy appears to be a science, particularly interdisciplinary, with sociological, political, econometrical or systemic approaches possible to prevail. To continue, the author makes reference to four pillars of the public economy: optimum, welfare, social choice and economic justice that allow different approaches to develop. A science branch, equally theoretical and practical, public economy will stress its connections with the economic and mathematic modeling, systemic analysis or sociological and political research. Still, seve¬ral problems in public economy remain open. These concentrate on the public interest, intervention and decision. Conceptualization, understanding and description of the mechanisms that allow the operationalisation may form the basis for further developments on both theoretical and practical level. A clear distinction in order to justify the title of this article needs to be made. Public economy is not to be confused with planning economy. The state remains but one of the producers and delivery agents of public goods and services.

  16. Public Economy versus Planned Economy. Current Approaches and Problems

    Directory of Open Access Journals (Sweden)

    Ani Matei

    2006-01-01

    Full Text Available The present paper proposes a review of the current object and problems facing the public economy. For the past decade and a half, public economy has clearly come back in the attention of the research interests of specialists from the Central and Eastern European countries. Among these, the scientific research encompassed by the public economy area interrelates with the international trends. At a closer look, public economy appears to be a science, particularly interdisciplinary, with sociological, political, econometrical or systemic approaches possible to prevail. To continue, the author makes reference to four pillars of the public economy: optimum, welfare, social choice and economic justice that allow different approaches to develop. A science branch, equally theoretical and practical, public economy will stress its connections with the economic and mathematic modeling, systemic analysis or sociological and political research. Still, seve¬ral problems in public economy remain open. These concentrate on the public interest, intervention and decision. Conceptualization, understanding and description of the mechanisms that allow the operationalisation may form the basis for further developments on both theoretical and practical level. A clear distinction in order to justify the title of this article needs to be made. Public economy is not to be confused with planning economy. The state remains but one of the producers and delivery agents of public goods and services.

  17. 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

  18. 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.

  19. 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

  20. 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.

  1. Obesity in asthma: approaches to treatment.

    Science.gov (United States)

    Pradeepan, Shyamala; Garrison, Garth; Dixon, Anne E

    2013-10-01

    There is mounting evidence that obesity is associated with asthma, both of which are seeing a dramatic increase in prevalence. Not only is obesity a risk factor for the development of asthma but it is also associated with poor asthma control. Asthma phenotypes associated with obesity include early-onset allergic asthma and late-onset non-allergic asthma. The pathogenesis of the linkage is complex; obesity causes a variety of mechanical, metabolic, and immunological changes that can affect the airways. The treatment of asthma in obesity can be challenging, as obesity is associated with poor response to standard controller medications. A tailored approach that involves combining pharmacologic and non-pharmacologic therapies including weight loss, dietary interventions, and exercise, along with identification and treatment of obstructive sleep apnea, should therefore be considered in this population.

  2. POSTSTROKE SPASTICITY: AN INDIVIDUALIZED APPROACH TO TREATMENT

    Directory of Open Access Journals (Sweden)

    V. A. Tolmacheva

    2016-01-01

    Full Text Available Poststroke spasticity is common in many patients and frequently hampers the recovery of lost motor functions. Therapeutic exercises and a gradual increase in motion loads and social and daily living activities play a leading role in the treatment of spasticity. Botulinium toxin type A is recognized to offer a highly effective and safe treatment for poststroke spasticity, as confirmed by clinical trials conducted in accordance with the principles of evidence-based medicine. The application of a personalized poststroke rehabilitation program permits the maximum result to be achieved in a considerable number of patients. The paper reviews the literature on spasticity and a clinical case that demonstrates an individual approach to treating poststroke spasticity.

  3. 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

  4. Precision Obesity Treatments Including Pharmacogenetic and Nutrigenetic Approaches.

    Science.gov (United States)

    Solas, Maite; Milagro, Fermin I; Martínez-Urbistondo, Diego; Ramirez, Maria J; Martínez, J Alfredo

    2016-07-01

    Five pharmaceutical strategies are currently approved by the US FDA for the treatment of obesity: orlistat, lorcaserin, liraglutide, phentermine/topiramate, and bupropion/naltrexone. The most effective treatment seems to be the combined administration of phentermine/topiramate followed by lorcaserin and bupropion/naltrexone. In relation to the management of excessive weight, other aspects also need to be considered, including comorbidities accompanying obesity, drug interactions, and the risk of negative collateral effects, as well as individualized treatments based on the genetic make-up. This review aims to provide an overview of the approved anti-obesity drugs and newer molecules that could affect different targets in the central nervous system or peripheral tissues, the molecular mechanisms, emerging dietary treatments and phytogenic compounds, and pharmacogenetic/nutrigenetic approaches for personalized obesity management.

  5. 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

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

    Directory of Open Access Journals (Sweden)

    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.

  7. 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.

  8. 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.

  9. 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

  10. 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

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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

  16. CURRENT APPROACHES TO UNIVERSAL VACCINE AGAINST INFLUENZA VIRUS

    Directory of Open Access Journals (Sweden)

    I. B. Esmagambetov

    2016-01-01

    Full Text Available Influenza is a seasonal infectious disease widespread across the globe. In Russia the share of influenza and other acute respiratory viral infections account for up to 90% of all infectious diseases. Scientific and reasonable method of influenza prevention is vaccination. However, traditional current influenza vaccines can’t induce protection against various virus strains that differ substantially in terms of their antigenic structure, and thus require periodic updates to its immunogenic components. In addition, there is the risk of a pandemic caused by an entirely new antigen in relation to variants of influenza virus A. Attempts to improve on traditional approaches to vaccination have focused primarily on improving production technologies and to increase immunogenicity of vaccines. Therefore, the urgent task is the creation of vaccines able to induce immune response a broad spectrum against different influenza virus strains and human strains of avian influenza, also can cause disease in humans. Protective effect of universal vaccine should be the induction of integrated immune response, based on the formulation of cross-reactive antibodies and T cells. The development of such universal vaccine could remove the need for periodical strain composition update of existing vaccines and, accor dingly, will be able to give the vaccine manufacturer itself, production planning regardless of epidemic seasons. Currently, the most widely studied antigens as key components of flu vaccines are proteins M2 and NP as well as the hemagglutinin of influenza virus. This review summarizes and lists some data of domestic and foreign research on a universal influenza virus vaccine.

  17. 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.

  18. A review of the surgical approaches to glaucoma treatment

    Directory of Open Access Journals (Sweden)

    Spratt Alexander

    2013-07-01

    Full Text Available The conventional approach of initially treating glaucoma medically and holding surgical intervention as a reserve option was endorsed by the findings of the Collaborative Initial Glaucoma Treatment Study (CIGTS study.1 This study reported that patients had similar visual field outcomes at five years from either medical treatment or immediate filtration surgery and supported the status quo of glaucoma management. The market for medical treatments has since increased and polypharmacy is now an accepted norm for glaucoma treatment. Surgical remedies for glaucoma have existed in a less pressured environment such that trabeculectomy, after four decades of slow evolution and complications, remains the most commonly performed type of glaucoma surgery worldwide. This ecosystem has begun to change in recent years. New surgical alternatives have arrived, reached a sizeable number and gained considerable traction as viable competitors to conventional glaucoma medical and surgical treatments. This raises important questions as to how these advances in glaucoma surgical options may affect the future landscape of glaucoma treatment. Has trabeculectomy already yielded some of its high ground? Why has trabeculectomy not been able to evolve more rapidly in response to new competitive pressures? If trabeculectomy has reached its evolutionary zenith are the newer alternatives any better? And, is it time to re-examine the conventional ‘medical before surgical’ approach to glaucoma? This article reviews the evidence for current surgical techniques available to patients with glaucoma.

  19. Stem Cell-Based Approaches for the Treatment of Diabetes

    Directory of Open Access Journals (Sweden)

    Catriona Kelly

    2011-01-01

    Full Text Available The incidence of diabetes and the associated debilitating complications are increasing at an alarming rate worldwide. Current therapies for type 1 diabetes focus primarily on administration of exogenous insulin to help restore glucose homeostasis. However, such treatment rarely prevents the long-term complications of this serious metabolic disorder, including neuropathy, nephropathy, retinopathy, and cardiovascular disease. Whole pancreas or islet transplantations have enjoyed limited success in some individuals, but these approaches are hampered by the shortage of suitable donors and the burden of lifelong immunosuppression. Here, we review current approaches to differentiate nonislet cell types towards an islet-cell phenotype which may be used for larger-scale cell replacement strategies. In particular, the differentiation protocols used to direct embryonic stem cells, progenitor cells of both endocrine and nonendocrine origin, and induced pluripotent stem cells towards an islet-cell phenotype are discussed.

  20. 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

  1. A new approach for water treatment

    CERN Document Server

    Principe, R

    1999-01-01

    A quantity of up to 4000 m3/h of water is used at CERN for cooling purposes: experiments, magnets and radio frequency cavities are refrigerated by closed circuits filled with deionized water; other utilities, such as air-conditioning, use chilled/hot water, also in closed circuits. All these methods all employ a cold source, the primary supply of water, coming from the cooling towers. About 500 kCHF are spent every year on water treatment in order to keep the water within these networks in operational conditions. In the line of further rationalization of resources, the next generation of contracts with the water treatment industry will aim for improved performance and better monitoring of quality related parameters in this context. The author will provide a concise report based upon an examination of the state of the installations and of the philosophy followed up until now for water treatment. Furthermore, he/she will propose a new approach from both a technical and contractual point of view, in preparation ...

  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. RECURRENT ORAL CANCER: CURRENT AND EMERGING THERAPEUTIC APPROACHES

    Directory of Open Access Journals (Sweden)

    Sabrina Daniela Silva

    2012-07-01

    Full Text Available Oral cancer cavity (OCC is associated with high incidence of loco-regional recurrences, which account for the majority of treatment failures post-surgery and radiotherapy. The time-course of relapse manifestation and metastasis are unpredictable. Relapsed OCC represents a major clinical challenge in part due to their aggressive and invasive behaviors. Chemotherapy remains the only option for advanced OCC whenever salvage surgery or re-irradiation is not feasible, but its efficacy is limited as a result of the drug resistance development. Alternatives to use of different permutations of standard cytotoxic drugs or combinations with modulators of drug resistance have led to incremental therapeutic benefits. The introduction of targeted agents and biologics against selective targets that drive cancer progression has opened-up optimism to achieve superior therapeutic activity and overcome drug resistance because, unlike the non-selective cytotoxic, the target can be monitored at molecular levels to identify patients who can benefit from the drug. This review discusses the multifactorial aspects of clinical drug resistance and emerging therapeutic approaches in recurrent OCC, emphasizing recent advances in targeted therapies, immunotherapy, and potential relevance of new concepts such as epithelial-mesenchymal transition and cancer stem cell hypothesis to drug resistance.

  4. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  6. 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

  7. BACK PAIN ASSOCIATED WITH OSTEOPOROSIS — TREATMENT PATTERNS, APPROACHES TO THERAPY

    Directory of Open Access Journals (Sweden)

    N. A. Shostak

    2014-07-01

    Full Text Available The article highlights current approaches to diagnosis and treatment of back pain, associated with osteoporosis. An algorithm for management of patients with vertebral compression fracture, complicated by pain, the main approaches to drug treatment of back pain and osteoporosis are described.

  8. 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

  9. Respiratory syncytial virus: current and emerging treatment options

    Directory of Open Access Journals (Sweden)

    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

  10. 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.

  11. 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

  12. 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.

  13. 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.

  14. 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.

  15. Robotic surgery for gastric tumor: current status and new approaches.

    Science.gov (United States)

    Lim, Seung Hyun; Lee, Hae Min; Son, Taeil; Hyung, Woo Jin; Kim, Hyoung-Il

    2016-01-01

    Surgical techniques have evolved tremendously over this past century. To maximize the efficacy and minimize the invasiveness of laparoscopic surgery, researchers have sought to implement wider application of robotics. Nevertheless, both optimism without sound evidence and fear of new technology obscure the appropriate uses of robotic surgery. In the present review, we attempted to provide a balanced perspective on the current state of robotic gastrectomy, outlining evidence and opportunities for the use thereof. Although evidence is limited, the use of robotics is feasible for gastric cancer surgery, and less than 10 cases of robotic surgery are needed to become proficient therein. Compared to the clinical impact of laparoscopy on gastric cancer surgery, the additional benefits of robotic surgery to patients seem to be limited. Despite additional costs and longer surgeries, robotic surgery reportedly does not offer surgical outcomes superior to those for laparoscopic surgery, according to a recent multicenter study. Meanwhile, however, our in-depth review of retrospective and prospective reports revealed that robots could expand the indications of minimally invasive gastrectomy for patients requiring total gastrectomy and D2 lymph node dissection. Moreover, we found that robotic gastrectomy is associated with a higher number of retrieved lymph nodes, less bleeding, fewer complications, and shorter hospital stay, compared to laparoscopic gastrectomy. Accordingly, new surgical approaches using advanced technologies, such as near infrared detectors, the Tilepro(®) multi-input display, dual consoles, and the Single-Site(®) system, are under investigation. In conclusion, measuring the additional benefits of robotic over laparoscopic surgery would be difficult and clinically insignificant. Thus, developing new surgical procedures that extend the benefits of conventional laparoscopic surgery to patients in whom minimally invasive surgery would not be possible is

  16. Robotic surgery for gastric tumor: current status and new approaches

    Science.gov (United States)

    Lim, Seung Hyun; Lee, Hae Min; Son, Taeil; Hyung, Woo Jin

    2016-01-01

    Surgical techniques have evolved tremendously over this past century. To maximize the efficacy and minimize the invasiveness of laparoscopic surgery, researchers have sought to implement wider application of robotics. Nevertheless, both optimism without sound evidence and fear of new technology obscure the appropriate uses of robotic surgery. In the present review, we attempted to provide a balanced perspective on the current state of robotic gastrectomy, outlining evidence and opportunities for the use thereof. Although evidence is limited, the use of robotics is feasible for gastric cancer surgery, and less than 10 cases of robotic surgery are needed to become proficient therein. Compared to the clinical impact of laparoscopy on gastric cancer surgery, the additional benefits of robotic surgery to patients seem to be limited. Despite additional costs and longer surgeries, robotic surgery reportedly does not offer surgical outcomes superior to those for laparoscopic surgery, according to a recent multicenter study. Meanwhile, however, our in-depth review of retrospective and prospective reports revealed that robots could expand the indications of minimally invasive gastrectomy for patients requiring total gastrectomy and D2 lymph node dissection. Moreover, we found that robotic gastrectomy is associated with a higher number of retrieved lymph nodes, less bleeding, fewer complications, and shorter hospital stay, compared to laparoscopic gastrectomy. Accordingly, new surgical approaches using advanced technologies, such as near infrared detectors, the Tilepro® multi-input display, dual consoles, and the Single-Site® system, are under investigation. In conclusion, measuring the additional benefits of robotic over laparoscopic surgery would be difficult and clinically insignificant. Thus, developing new surgical procedures that extend the benefits of conventional laparoscopic surgery to patients in whom minimally invasive surgery would not be possible is necessary

  17. 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

  18. 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.

  19. Oral nanomedicine approaches for the treatment of psychiatric illnesses.

    Science.gov (United States)

    Dening, Tahnee J; Rao, Shasha; Thomas, Nicky; Prestidge, Clive A

    2016-02-10

    Psychiatric illnesses are a leading cause of disability and morbidity globally. However, the preferred orally dosed pharmacological treatment options available for depression, anxiety and schizophrenia are often limited by factors such as low drug aqueous solubility, food effects, high hepatic first-pass metabolism effects and short half-lives. Furthermore, the discovery and development of more effective psychotropic agents has stalled in recent times, with the majority of new drugs reaching the market offering similar efficacy, but suffering from the same oral delivery concerns. As such, the application of nanomedicine formulation approaches to currently available drugs is a viable option for optimizing oral drug delivery and maximizing treatment efficacy. This review focuses on the various delivery challenges encountered by psychotropic drugs, and the ability of nanomedicine formulation strategies to overcome these. Specifically, we critically review proof of concept in vitro and in vivo studies of nanoemulsions/microemulsions, solid lipid nanoparticles, dendrimers, polymeric micelles, nanoparticles of biodegradable polymers and nanosuspensions, and provide new insight into the various mechanisms for improved drug performance. The advantages and limitations of current oral nanomedicine approaches for psychotropic drugs are discussed, which will provide guidance for future research directions and assist in fostering the translation of such delivery systems to the clinical setting. Accordingly, emphasis has been placed on correlating the in vitro/in vivo performance of these nanomedicine approaches with their potential clinical outcomes and benefits for patients.

  20. [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.

  1. 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.

  2. [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.

  3. The Current and Future Treatment of Brain Metastases

    Directory of Open Access Journals (Sweden)

    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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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

  9. 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.

  10. 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.

  11. My approach to the treatment of scleroderma.

    Science.gov (United States)

    Shah, Ami A; Wigley, Fredrick M

    2013-04-01

    Systemic sclerosis (scleroderma) is unique among the rheumatic diseases because it presents the challenge of managing a chronic multisystem autoimmune disease with a widespread obliterative vasculopathy of small arteries that is associated with varying degrees of tissue fibrosis. The hallmark of scleroderma is clinical heterogeneity with subsets that vary in the degree of disease expression, organ involvement, and ultimate prognosis. Thus, the term scleroderma is used to describe patients who have common manifestations that link them together, whereas a highly variable clinical course exists that spans from mild and subtle findings to aggressive, life-threatening multisystem disease. The physician needs to carefully characterize each patient to understand the specific manifestations and level of disease activity to decide appropriate treatment. This is particularly important in treating a patient with scleroderma because there is no treatment that has been proven to modify the overall disease course, although therapy that targets specific organ involvement early before irreversible damage occurs improves both quality of life and survival. This review describes our approach as defined by evidence, expert opinion, and our experience treating patients. Scleroderma is a multisystem disease with variable expression; thus, any treatment plan must be holistic, yet at the same time focus on the dominant organ disease. The goal of therapy is to improve quality of life by minimizing specific organ involvement and subsequent life-threatening disease. At the same time the many factors that alter daily function need to be addressed, including nutrition, pain, deconditioning, musculoskeletal disuse, comorbid conditions, and the emotional aspects of the disease, such as fear, depression, and the social withdrawal caused by disfigurement.

  12. Current Approaches of Photothermal Therapy in Treating Cancer Metastasis with Nanotherapeutics.

    Science.gov (United States)

    Zou, Lili; Wang, Hong; He, Bin; Zeng, Lijuan; Tan, Tao; Cao, Haiqiang; He, Xinyu; Zhang, Zhiwen; Guo, Shengrong; Li, Yaping

    2016-01-01

    Cancer metastasis accounts for the high mortality of many types of cancer. Owing to the unique advantages of high specificity and minimal invasiveness, photothermal therapy (PTT) has been evidenced with great potential in treating cancer metastasis. In this review, we outline the current approaches of PTT with respect to its application in treating metastatic cancer. PTT can be used alone, guided with multimodal imaging, or combined with the current available therapies for effective treatment of cancer metastasis. Numerous types of photothermal nanotherapeutics (PTN) have been developed with encouraging therapeutic efficacy on metastatic cancer in many preclinical animal experiments. We summarize the design and performance of various PTN in PTT alone and their combinational therapy. We also point out the lacking area and the most promising approaches in this challenging field. In conclusion, PTT or their combinational therapy can provide an essential promising therapeutic modality against cancer metastasis.

  13. [Current approaches to explain the virulence of Acinetobacter baumannii].

    Science.gov (United States)

    Aşık, Gülşah

    2011-04-01

    Acinetobacter baumannii which is one of the most frequent nosocomial pathogens, has drawn attention in the last years owing to multi-drug resistant strains. A.baumannii may give rise to nosocomial epidemics especially in intensive care units and may lead to treatment failure due to its increasing antimicrobial resistance. These gram-negative non-fermentative coccobacilli may be encountered also in community associated infections. However, they are frequently isolated in pneumonia, urinary tract infection, bacteremia, meningitis and wound infections that develop in patients hospitalized for serious diseases. Although detailed data about the epidemiology and antimicrobial resistance patterns related to this bacteria exist, relatively limited data is present about the virulence factors and environmental physiology of A.baumannii. The role of some bacterial virulence factors in the pathogenesis of Acinetobacter infections have been enlightened by recent investigations. Among these virulence factors, production of extracellular enzymes with lipolytic and cytolytic activities, outer membrane protein (AbOmpA) with apoptotic effects on epithelial cells, adhesion molecules (fimbria and AbOmpA) that function during attachment to epithelial cells, K1 type capsular structure, type-1 pili and AbOmpA induced biofilm formation, siderophore (acinetobactin) or hemin mediated iron acquisition mechanisms, quorum sensing system that functions by the help of N-acyl homoserine lacton signal molecules and cellular components that enable Acinetobacter species to live under inappropriate environmental conditions like dryness, low temperature, restricted nutritional elements, can be counted. New information about the virulence factors will help better understanding of the adaptive response of A.baumannii in the host setting. This review is focused on the current information about the virulence factors of of A.baumannii.

  14. Treatment Approaches to Urinary Stones Caused by Forgotten DJ Stents

    Directory of Open Access Journals (Sweden)

    Ergun Alma

    2015-03-01

    Full Text Available Ureteral DJ stents have been used widely for years in urology practice. With increased use, complications have been increased and forgotton stents have started to cause problems. The most common complications are early pain and irritative symptoms. Late complications are bacterial colonization and stone formation because of the biofilm covering the stents. Treatment for a forgotten stent varies on many factors, such as stent localization and stone formation. In this article, we aimed to discuss our clinic approach on two different cases in light to current literature. [Cukurova Med J 2015; 40(Suppl 1: 58-63

  15. 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.

  16. 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.

  17. Evaluation of a Combined Treatment Approach for Childhood Apraxia of Speech

    Science.gov (United States)

    Iuzzini, Jenya; Forrest, Karen

    2010-01-01

    The current study investigated the impact of a dual treatment approach that included stimulability training protocol (STP) paired with a modified core vocabulary treatment (mCVT) on the speech sounds produced by children with CAS. The combined treatment was assessed for changes in consistency and expansion of the phonetic inventories of four…

  18. Evaluation of a Combined Treatment Approach for Childhood Apraxia of Speech

    Science.gov (United States)

    Iuzzini, Jenya; Forrest, Karen

    2010-01-01

    The current study investigated the impact of a dual treatment approach that included stimulability training protocol (STP) paired with a modified core vocabulary treatment (mCVT) on the speech sounds produced by children with CAS. The combined treatment was assessed for changes in consistency and expansion of the phonetic inventories of four…

  19. 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.

  20. Beyond (eco)design: current approaches to sustainable packaging design

    OpenAIRE

    Wever, R.

    2014-01-01

    Packaging has always received a lot of attention within the field of design for sustainability. The classical approach has been to mainly focus on reducing the impact of the packaging. This approach stems from the ill-informed position that packaging is superfluous, or at best there only for marketing reasons. This is a rather guild-based approach that, if taken to extremes, would lead to complete elimination of packaging, or at most a quintessential brown paper bag. In industry reality thoug...

  1. 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

  2. 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

  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. Beyond (eco)design: current approaches to sustainable packaging design

    NARCIS (Netherlands)

    Wever, R.

    2014-01-01

    Packaging has always received a lot of attention within the field of design for sustainability. The classical approach has been to mainly focus on reducing the impact of the packaging. This approach stems from the ill-informed position that packaging is superfluous, or at best there only for marketi

  13. Beyond (eco)design: current approaches to sustainable packaging design

    NARCIS (Netherlands)

    Wever, R.

    2014-01-01

    Packaging has always received a lot of attention within the field of design for sustainability. The classical approach has been to mainly focus on reducing the impact of the packaging. This approach stems from the ill-informed position that packaging is superfluous, or at best there only for

  14. 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

  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

    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.

  16. 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

  17. [Nanotechnology offers a promising therapeutic approach for hypertension treatment].

    Science.gov (United States)

    Martín Giménez, V M; Kassuha, D; Manucha, W

    Hypertension is a medical condition considered one of the most important public health problems in developed countries, affecting around one billion people. Therefore, the study of its mechanisms, development and treatment is a priority. Of particular interest are the multiple contributing factors, and efforts by experts to fully understand it are also important. However, studies are currently insufficient and consequently, attention is focused on the exploration of new therapeutic approaches. This raises a growing interest in nanotechnology given the ability of certain structures to mimic the behavior of extracellular matrices. This opens a promising field in the treatment of diseases such as hypertension, where it stands to tissue engineering and its potential applications incorporating concepts such as controlled release drug, reduced side effects and receptor activation locally. Copyright © 2016 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. HEADROOM APPROACH TO DEVICE DEVELOPMENT: CURRENT AND FUTURE DIRECTIONS

    OpenAIRE

    Girling, A; Lilford, R; Cole, A; Young, T

    2015-01-01

    OBJECTIVES: The headroom approach to medical device development relies on the estimation of a value-based price ceiling at different stages of the development cycle. Such price-ceilings delineate the commercial opportunities for new products in many healthcare systems. We apply a simple model to obtain critical business information as the product proceeds along a development pathway, and indicate some future directions for the development of the approach. METHODS: Health economic modelling in...

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  4. 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.

  5. Current migraine management – patient acceptability and future approaches

    Directory of Open Access Journals (Sweden)

    Jean Schoenen

    2008-10-01

    Full Text Available Arnaud Fumal, Jean SchoenenDepartments of Neurology and Functional Neuroanatomy, Headache Research Unit, University of Liège, BelgiumAbstract: Despite its high prevalence and individual as well as societal burden, migraine remains underdiagnosed and undertreated. In recent years, the options for the management of migraine patients have greatly expanded. A number of drugs belonging to various pharmacological classes and deliverable by several routes are now available both for the acute and the preventive treatments of migraine. Nevertheless, disability and satisfaction remain low in many subjects because treatments are not accessible, not optimized, not effective, or simply not tolerated. There is thus still considerable room for better education, for more efficient therapies and for greater support from national health systems. In spite of useful internationally accepted guidelines, anti-migraine treatment has to be individually tailored to each patient taking into account the migraine subtype, the ensuing disability, the patient’s previous history and present expectations, and the co-morbid disorders. In this article we will summarize the phenotypic presentations of migraine and review recommendations for acute and preventive treatment, highlighting recent advances which are relevant for clinical practice in terms of both diagnosis and management.Keywords: migraine, disability, acute treatment, preventive treatment, management

  6. 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.

  7. 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

  8. Current and emerging treatment strategies for vertebral compression fractures

    Directory of Open Access Journals (Sweden)

    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

  9. Post-fundoplication symptoms and complications: Diagnostic approach and treatment.

    Science.gov (United States)

    Sobrino-Cossío, S; Soto-Pérez, J C; Coss-Adame, E; Mateos-Pérez, G; Teramoto Matsubara, O; Tawil, J; Vallejo-Soto, M; Sáez-Ríos, A; Vargas-Romero, J A; Zárate-Guzmán, A M; Galvis-García, E S; Morales-Arámbula, M; Quiroz-Castro, O; Carrasco-Rojas, A; Remes-Troche, J M

    Laparoscopic Nissen fundoplication is currently considered the surgical treatment of choice for gastroesophageal reflux disease (GERD) and its long-term effectiveness is above 90%. Adequate patient selection and the experience of the surgeon are among the predictive factors of good clinical response. However, there can be new, persistent, and recurrent symptoms after the antireflux procedure in up to 30% of the cases. There are numerous causes, but in general, they are due to one or more anatomic abnormalities and esophageal and gastric function alterations. When there are persistent symptoms after the surgical procedure, the surgery should be described as "failed". In the case of a patient that initially manifests symptom control, but the symptoms then reappear, the term "dysfunction" could be used. When symptoms worsen, or when symptoms or clinical situations appear that did not exist before the surgery, this should be considered a "complication". Postoperative dysphagia and dyspeptic symptoms are very frequent and require an integrated approach to determine the best possible treatment. This review details the pathophysiologic aspects, diagnostic approach, and treatment of the symptoms and complications after fundoplication for the management of GERD. Copyright © 2016 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.

  10. Post-fundoplication symptoms and complications: Diagnostic approach and treatment

    Directory of Open Access Journals (Sweden)

    S. Sobrino-Cossío

    2017-07-01

    Full Text Available Laparoscopic Nissen fundoplication is currently considered the surgical treatment of choice for gastroesophageal reflux disease (GERD and its long-term effectiveness is above 90%. Adequate patient selection and the experience of the surgeon are among the predictive factors of good clinical response. However, there can be new, persistent, and recurrent symptoms after the antireflux procedure in up to 30% of the cases. There are numerous causes, but in general, they are due to one or more anatomic abnormalities and esophageal and gastric function alterations. When there are persistent symptoms after the surgical procedure, the surgery should be described as “failed”. In the case of a patient that initially manifests symptom control, but the symptoms then reappear, the term “dysfunction” could be used. When symptoms worsen, or when symptoms or clinical situations appear that did not exist before the surgery, this should be considered a “complication”. Postoperative dysphagia and dyspeptic symptoms are very frequent and require an integrated approach to determine the best possible treatment. This review details the pathophysiologic aspects, diagnostic approach, and treatment of the symptoms and complications after fundoplication for the management of GERD.

  11. Pharmacological Approach for Treatment of Retinopathy of Prematurity

    Directory of Open Access Journals (Sweden)

    İmren Akkoyun

    2012-12-01

    Full Text Available Current standard of screening examination for retinopathy of prematurity (ROP is determined in international guidelines. The criteria for classification and therapy are also determined in international guidelines, and currently, retinal laser fotocoagulation of peripheral avascular retinal area is gold standard (ETROP, Early Treatment for Retinopathy of Prematurity Cooperative Group for proliferative ROP. Vitreoretinal surgery will be used in cases with retinal detachment. In case series after off-label injection of anti-VEGF (vascular endothelial growth factor agent bevacizumab and in the first report of BEAT-ROP study in proliferative ROP the results are promising. Furthermore, beside the intravitreal anti-VEGF therapy, systemic therapy with mediators like IGF-1 (insulin-like growth factor and/or ω3-fatty acids outlines pharmacological approach to treatment of ROP. The results of well-designed clinical trials of intravitreal anti-VEGF therapy and pharmacological systemic therapy with the above-mentioned mediators for ROP are needed in order to provide information as to the balance of risk versus benefit, as well as practical guidance regarding optimal treatment parameters and follow-up.(Turk J Ophthalmol 2012; 42: 466-73

  12. Current approaches to model extracellular electrical neural microstimulation

    Directory of Open Access Journals (Sweden)

    Sébastien eJoucla

    2014-02-01

    Full Text Available Nowadays, high-density microelectrode arrays provide unprecedented possibilities to precisely activate spatially well-controlled central nervous system (CNS areas. However, this requires optimizing stimulating devices, which in turn requires a good understanding of the effects of microstimulation on cells and tissues. In this context, modeling approaches provide flexible ways to predict the outcome of electrical stimulation in terms of CNS activation. In this paper, we present state-of-the-art modeling methods with sufficient details to allow the reader to rapidly build numerical models of neuronal extracellular microstimulation. These include 1 the computation of the electrical potential field created by the stimulation in the tissue, and 2 the response of a target neuron to this field. Two main approaches are described: First we describe the classical hybrid approach that combines the finite element modeling of the potential field with the calculation of the neuron’s response in a cable equation framework (compartmentalized neuron models. Then, we present a whole finite element approach allows the simultaneous calculation of the extracellular and intracellular potentials, by representing the neuronal membrane with a thin-film approximation. This approach was previously introduced in the frame of neural recording, but has never been implemented to determine the effect of extracellular stimulation on the neural response at a sub-compartment level. Here, we show on an example that the latter modeling scheme can reveal important sub-compartment behavior of the neural membrane that cannot be resolved using the hybrid approach. The goal of this paper is also to describe in detail the practical implementation of these methods to allow the reader to easily build new models using standard software packages. These modeling paradigms, depending on the situation, should help build more efficient high-density neural prostheses for CNS rehabilitation.

  13. The Intertemporal Approach to the Current Account: Evidence for Chile

    Directory of Open Access Journals (Sweden)

    Sergio A. Salas Landeau

    2002-03-01

    Full Text Available This paper studies the existence of "excess" current-account imbalances in Chile in the 1960-1999 period. This phenomenon is modelled using present value tests that allow for variable interest rates and exchange rate fluctuations. Despite its simplicity, most of the observed imbalances in the current account are accounted for by the model. Results suggest that using models where agents behave as forward-looking rational agents, is a valid framework. Moreover, the analysis highlights the rel-evance of variable interest rates and exchange rates. Results also imply that capital controls, that were widely used in the period under study, were not effective.

  14. Current approaches in treatment of triple-negative breast cancer

    Institute of Scientific and Technical Information of China (English)

    Hanan Ahmed Wahba; Hend Ahmed El-Hadaad

    2015-01-01

    Triple-negative breast cancer (TNBC) is diagnosed more frequently in younger and premenopausal women and is highly prevalent in African American women. TNBC is a term derived from tumors that are characterized by the absence of ER, PgR, and HER2. So patients with TNBC do not beneift from hormonal or trastuzumab-based therapies. TNBCs are biologically aggressive, although some reports suggest that they respond to chemotherapy better than other types of breast cancer, prognosis remains poor. hTis is due to:shortened disease-free interval in the adjuvant and neoadjuvant setting and a more aggressive course in the metastatic setting.

  15. Current approaches for assessment and treatment of women with ...

    African Journals Online (AJOL)

    2013-11-01

    Nov 1, 2013 ... part of a study to determine feasibility of EPAUs in Nigeria, we surveyed a group of Nigerian Gynecologists attending the 46th Annual Scientific Conference of the Society of. Gynaecologists .... health facility that had a dedicated location where women ..... nice.org.uk/nicemedia/live/14000/61854/61854.pdf.

  16. Diagnostic approach and current treatment options in childhood vasculitis

    OpenAIRE

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

    2015-01-01

    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 con...

  17. Automatic object recognition: critical issues and current approaches

    Science.gov (United States)

    Sadjadi, Firooz A.

    1991-08-01

    Automatic object recognition, with its diverse applications in numerous fields of science and technology, is permeating many aspects of military and civilian industries. This paper gives an overview of the issues confronting the automatic object recognition field and the approaches being used to address these issues.

  18. Current Approaches to Improving Access to Government Documents.

    Science.gov (United States)

    Turner, Carol; Latta, Ann

    Based on the responses of 77 Association of Research Libraries (ARL) member libraries to a December 1986 survey of 106 ARL libraries (a 73% response rate), this report profiles the current state of bibliographic access to federal publications. Following a brief discussion of survey background and methodology, a summary of survey results indicates…

  19. Methodological Approaches in Conducting Overviews: Current State in HTA Agencies

    Science.gov (United States)

    Pieper, Dawid; Antoine, Sunya-Lee; Morfeld, Jana-Carina; Mathes, Tim; Eikermann, Michaela

    2014-01-01

    Objectives: Overviews search for reviews rather than for primary studies. They might have the potential to support decision making within a shorter time frame by reducing production time. We aimed to summarize available instructions for authors intending to conduct overviews as well as the currently applied methodology of overviews in…

  20. Experimental typography : reviewing the modernist and the current approaches

    OpenAIRE

    Makal, Eray

    1993-01-01

    Ankara : The Department of Graphic Design and Institute of Fine Arts, Bilkent Univ., 1993. Thesis (Master's) -- Bilkent University, 1993. Includes bibliographical references leaves 65-66. The intention of this study is to evaluate the experimental typography within the history of graphic design by taking in consideration of two epochs. The Modernist and The Current. Makal, Eray M.S.

  1. 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

  2. Biomarker approaches in major depressive disorder evaluated in the context of current hypotheses.

    Science.gov (United States)

    Jentsch, Mike C; Van Buel, Erin M; Bosker, Fokko J; Gladkevich, Anatoliy V; Klein, Hans C; Oude Voshaar, Richard C; Ruhé, Eric G; Eisel, Uli L M; Schoevers, Robert A

    2015-01-01

    Major depressive disorder is a heterogeneous disorder, mostly diagnosed on the basis of symptomatic criteria alone. It would be of great help when specific biomarkers for various subtypes and symptom clusters of depression become available to assist in diagnosis and subtyping of depression, and to enable monitoring and prognosis of treatment response. However, currently known biomarkers do not reach sufficient sensitivity and specificity, and often the relation to underlying pathophysiology is unclear. In this review, we evaluate various biomarker approaches in terms of scientific merit and clinical applicability. Finally, we discuss how combined biomarker approaches in both preclinical and clinical studies can help to make the connection between the clinical manifestations of depression and the underlying pathophysiology.

  3. Modelling of eddy-current interaction with cracks in the thin-skin regime. Two approaches

    Energy Technology Data Exchange (ETDEWEB)

    Mastorchio, S. [Electricite de France, 78 - Chatou (France). Research and Development Div.; Harfield, N. [Surrey Univ. (United Kingdom). Dept. of Physics

    1998-02-01

    EDF uses TRIFOU code for eddy current testing modelling. This general electromagnetic code is to be further adapted to Non Destructive Testing applications, not only for nuclear NDT but also in other fields such as aeronautical. This paper compares experimental data for aluminium and steel specimens with two methods of solving the forward problem in the thin-skin regime. The first approach is a 3D Finite Element / Boundary Integral Element method (TRIFOU) developed by EDF/RD Division (France). The second approach is specialized for the treatment of surface cracks in the thin-skin regime developed by the University of Surrey (England). In the thin-skin regime, the electromagnetic skin-depth is small compared with the depth of the crack. Such conditions are common in tests on steels and sometimes on aluminium. (K.A.) 4 refs.

  4. Current Approaches for Management of Postpenetrating Keratoplasty Astigmatism

    Directory of Open Access Journals (Sweden)

    Sepehr Feizi

    2011-01-01

    Full Text Available A successful corneal graft requires both clarity and an acceptable refraction. A clear corneal graft may be an optical failure if high astigmatism limits visual acuity. Intraoperative measures to reduce postkeratoplasty astigmatism include round and central trephination of cornea with an adequate size, appropriate sutures with evenly distributed tension, and perfect graft-host apposition. Suture manipulation has been described for minimising early postoperative astigmatism. If significant astigmatism remains after suture removal, which cannot be corrected by optical means, then further surgical procedures containing relaxing incisions, compression sutures, laser refractive surgery, insertion of intrastromal corneal ring segments, wedge resection, and toric intraocular lens implantation can be performed. When astigmatism cannot be reduced using one or more abovementioned approaches, repeat penetrating keratoplasty should inevitably be considered. However, none of these techniques has emerged as an ideal one, and corneal surgeons may require combining two or more approaches to exploit the maximum advantages.

  5. Asthma and obesity in children: current evidence and potential systems biology approaches.

    Science.gov (United States)

    Frey, U; Latzin, P; Usemann, J; Maccora, J; Zumsteg, U; Kriemler, S

    2015-01-01

    Both obesity and asthma are highly prevalent, complex diseases modified by multiple factors. Genetic, developmental, lung mechanical, immunological and behavioural factors have all been suggested as playing a causal role between the two entities; however, their complex mechanistic interactions are still poorly understood and evidence of causality in children remains scant. Equally lacking is evidence of effective treatment strategies, despite the fact that imbalances at vulnerable phases in childhood can impact long-term health. This review is targeted at both clinicians frequently faced with the dilemma of how to investigate and treat the obese asthmatic child and researchers interested in the topic. Highlighting the breadth of the spectrum of factors involved, this review collates evidence regarding the investigation and treatment of asthma in obese children, particularly in comparison with current approaches in 'difficult-to-treat' childhood asthma. Finally, the authors propose hypotheses for future research from a systems-based perspective.

  6. Modification of Current Feedback Strategies: A Text Synthesis Approach.

    Science.gov (United States)

    1984-03-01

    f c o lorad I Technic Report No. 127 This research was aponsored byiwtut ot Cogniive Science The Air Force Office of Scienlbc Uriverulty of Cooado...SYNTHESIS APPROACH(UA COLORADO ANIA AT BOXLDEN INST OF COONITXE SCIENCE P LANGEB ET AL MAN 84 N6 SIID AORT-408 FS-304 / /0 N EA-1216 OIIATOh E CR E...ADDRESS 10. PROGRAM ELEMENT, PROJECT. TASK AREA & WORK( UNIT NUMIERS Institute of Cognitive Science University of Colorado 61103F Boulder, CO 80309

  7. Current approaches and problems in social crime prevention

    OpenAIRE

    Vuković, Slaviša

    2011-01-01

    In this paper the topic of consideration focuses on current methods and forms of implementation social crime prevention, as well as problems that often arise in practice during its implementation. This is one of the most important areas in crime prevention, which is also known as crime prevention through social development, and often includes legal activities of state and non-state actors aimed at preventing delinquency of children and minors through the weakening and, if possible, eliminatin...

  8. Direct current stimulation : new approach to enhancing heavy oil production

    Energy Technology Data Exchange (ETDEWEB)

    Whittle, J.K. [Electro-Petroleum Inc., Wayne, PA (United States); Hill, D.G. [Southern California Univ., Los Angeles, CA (United States)

    2006-07-01

    The limited recovery of heavy crude oil can be attributed to the high viscosity of the liquids in the oil reservoirs. A viable technology has been lacking for the economic recovery of heavy oil. This paper discussed the advantages of direct current electrical stimulation or electro-enhanced oil recovery (EEOR). The paper outlined the advantages, including data produced from field demonstrations as well as the results of recent laboratory studies. The paper provided a historical and electro-chemical background of EEOR. Field operations that were discussed included electric field maps and a comparison of direct current versus alternating current electrical power. A series of EEOR field demonstrations were presented for the Santa Maria basin in California and the eastern Alberta plains. The paper also discussed produced fluid chemical changes and electro-osmosis and effective permeability. Last, the paper provided a comparison of EEOR to other existing and emerging technologies including steam flood; surfactant flood; co-solvent flood; carbon dioxide flood; and fire flood. It was concluded that the biggest EEOR limitation is its limited field application portfolio. EEOR has produced encouraging field demonstrations to date and has facilitated beneficial chemical changes in the produced fluids. 26 refs., 5 tabs., 10 figs.

  9. 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.

  10. Current Treatment of Bacterial Vaginosis—Limitations and Need for Innovation

    Science.gov (United States)

    Bradshaw, Catriona S.; Sobel, Jack D.

    2016-01-01

    Practitioners and patients alike widely recognize the limitations of current therapeutic approaches to the treatment of bacterial vaginosis (BV). Options remain extremely limited, and our inability to prevent the frequently, often relentless symptomatic recurrences of BV and to reduce serious sequelae such as preterm delivery, remains an acknowledged but unresolved shortcoming. Our incomplete understanding of the pathophysiology of this unique form of vaginal dysbiosis has been a significant impediment to developing optimal treatment and prevention approaches. New drugs have not been forthcoming and are not likely to be available in the immediate future; hence, reliance on the optimal use of available agents has become essential as improvised often unproven regimens are implemented. In this review, we will explore the limitations of currently recommended therapies, with a particular focus on the contribution of reinfection and pathogen persistence to BV recurrence, and the development of interventions that target these mechanisms. Ultimately, to achieve sustained cure and effectiveness against BV-associated sequelae, it is possible that we will need approaches that combine antimicrobials with biofilm-disrupting agents and partner treatments in those at risk of reinfection. PMID:27449869

  11. Current Treatment of Bacterial Vaginosis-Limitations and Need for Innovation.

    Science.gov (United States)

    Bradshaw, Catriona S; Sobel, Jack D

    2016-08-15

    Practitioners and patients alike widely recognize the limitations of current therapeutic approaches to the treatment of bacterial vaginosis (BV). Options remain extremely limited, and our inability to prevent the frequently, often relentless symptomatic recurrences of BV and to reduce serious sequelae such as preterm delivery, remains an acknowledged but unresolved shortcoming. Our incomplete understanding of the pathophysiology of this unique form of vaginal dysbiosis has been a significant impediment to developing optimal treatment and prevention approaches. New drugs have not been forthcoming and are not likely to be available in the immediate future; hence, reliance on the optimal use of available agents has become essential as improvised often unproven regimens are implemented. In this review, we will explore the limitations of currently recommended therapies, with a particular focus on the contribution of reinfection and pathogen persistence to BV recurrence, and the development of interventions that target these mechanisms. Ultimately, to achieve sustained cure and effectiveness against BV-associated sequelae, it is possible that we will need approaches that combine antimicrobials with biofilm-disrupting agents and partner treatments in those at risk of reinfection. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  12. Current approaches to the management of new-onset ulcerative colitis

    Directory of Open Access Journals (Sweden)

    Marchioni Beery R

    2014-05-01

    Full Text Available Renée Marchioni Beery,1 Sunanda Kane21Division of Gastroenterology and Hepatology, University of Connecticut Health Center, Farmington, CT, USA; 2Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USAAbstract: Ulcerative colitis (UC is an idiopathic, inflammatory gastrointestinal disease of the colon. As a chronic condition, UC follows a relapsing and remitting course with medical maintenance during periods of quiescent disease and appropriate escalation of therapy during times of flare. Initial treatment strategies must not only take into account current clinical presentation (with specific regard for extent and severity of disease activity but must also take into consideration treatment options for the long-term. The following review offers an approach to new-onset UC with a focus on early treatment strategies. An introduction to the disease entity is provided along with an approach to initial diagnosis. Stratification of patients based on clinical parameters, disease extent, and severity of illness is paramount to determining course of therapy. Frequent assessments are required to determine clinical response, and treatment intensification may be warranted if expected improvement goals are not appropriately reached. Mild-to-moderate UC can be managed with aminosalicylates, mesalamine, and topical corticosteroids with oral corticosteroids reserved for unresponsive cases. Moderate-to-severe UC generally requires oral or intravenous corticosteroids in the short-term with consideration of long-term management options such as biologic agents (as initial therapy or in transition from steroids or thiopurines (as bridging therapy. Patients with severe or fulminant UC who are recalcitrant to medical therapy or who develop disease complications (such as toxic megacolon should be considered for colectomy. Early surgical referral in severe or refractory UC is crucial, and colectomy may be a life-saving procedure. The authors provide

  13. 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.

  14. 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

  15. 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.

  16. 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

  17. Current approaches in evolution: from molecules to cells and organisms.

    Science.gov (United States)

    Thattai, Mukund; Peisajovich, Sergio G

    2014-11-01

    This is an exciting time to be an evolutionary biologist. Indeed, it is difficult to keep up with all the studies that fall under the broad category of "Evolution" since they span species, traits, and scales of organization. This special issue gives a flavor of exciting new approaches in evolutionary biology, but also emphasizes universal themes. The reviews contained here discuss important aspects of molecular evolution at multiple scales, from individual proteins to complex regulatory networks, as well as from unicellular organisms to macroscopic traits in animals. Though the model systems are diverse, the issues addressed are fundamental: the origin of evolutionary novelties, and the forces that drive them to fixation.

  18. Current clinical approach to patients with disorders of consciousness

    Directory of Open Access Journals (Sweden)

    Robson Luis Oliveira de Amorim

    Full Text Available Summary In clinical practice, hospital admission of patients with altered level of consciousness, sleepy or in a non-responsive state is extremely common. This clinical condition requires an effective investigation and early treatment. Performing a focused and objective evaluation is critical, with quality history taking and physical examination capable to locate the lesion and define conducts. Imaging and laboratory exams have played an increasingly important role in supporting clinical research. In this review, the main types of changes in consciousness are discussed as well as the essential points that should be evaluated in the clinical management of these patients.

  19. 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

  20. Current Concepts and Management Approaches in Nonalcoholic Fatty Liver Disease

    Directory of Open Access Journals (Sweden)

    Bashar M. Attar

    2013-01-01

    Full Text Available Nonalcoholic fatty liver disease (NAFLD is the most common cause of liver dysfunction worldwide. NAFLD may progress to nonalcoholic steatohepatitis (NASH and in turn cirrhosis. Importantly, hepatic cancer can occur in NASH in the absence of cirrhosis. The cardinal histologic feature of NAFLD is the presence of an excessive accumulation of triacylglycerols and diacylglycerols in hepatocytes. The presence of obesity and insulin resistance lead to an increased hepatic-free fatty acid (FFA flux creating an environment appropriate for the development of NAFLD. The generation of toxic reactive oxygen species with the production of hepatic injury and inflammation as a consequence of FFA oxidation will ultimately lead to the initiation and progression of fibrosis. Lifestyle modifications specifically weight loss, physical exercise, and cognitive behavior therapy have been recommended as treatments for NASH. Dietary fructose is an independent risk factor for the development of NAFLD. Pioglitazone can be used to treat biopsy-proven NASH; however, its safety risks should be considered carefully. Greater consumption for coffee, independent of its caffeine component, has been associated with a significant reduced risk of advanced fibrosis in NASH. Additional data are needed before recommending bariatric surgery as an established option for the specific treatment of NASH.

  1. Minimally invasive approaches for the treatment of inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Marco Zoccali; Alessandro Fichera

    2012-01-01

    Despite significant improvements in medical management of inflammatory bowel disease,many of these patients still require surgery at some point in the course of their disease.Their young age and poor general conditions,worsened by the aggressive medical treatments,make minimally invasive approaches particularly enticing to this patient population.However,the typical inflammatory changes that characterize these diseases have hindered wide diffusion of laparoscopy in this setting,currently mostly pursued in high-volume referral centers,despite accumulating evidences in the literature supporting the benefits of minimally invasive surgery.The largest body of evidence currently available for terminal ileal Crohn's disease shows improved short term outcomes after laparoscopic surgery,with prolonged operative times.For Crohn's colitis,high quality evidence supporting laparoscopic surgery is lacking.Encouraging preliminary results have been obtained with the adoption of laparoscopic restorative total proctocolectomy for the treatment of ulcerative colitis.A consensus about patients' selection and the need for staging has not been reached yet.Despite the lack of conclusive evidence,a wave of enthusiasm is pushing towards less invasive strategies,to further minimize surgical trauma,with single incision laparoscopic surgery being the most realistic future development.

  2. Current Approaches in Implementing Citizen Science in the Classroom.

    Science.gov (United States)

    Shah, Harsh R; Martinez, Luis R

    2016-03-01

    Citizen science involves a partnership between inexperienced volunteers and trained scientists engaging in research. In addition to its obvious benefit of accelerating data collection, citizen science has an unexplored role in the classroom, from K-12 schools to higher education. With recent studies showing a weakening in scientific competency of American students, incorporating citizen science initiatives in the curriculum provides a means to address deficiencies in a fragmented educational system. The integration of traditional and innovative pedagogical methods to reform our educational system is therefore imperative in order to provide practical experiences in scientific inquiry, critical thinking, and problem solving for school-age individuals. Citizen science can be used to emphasize the recognition and use of systematic approaches to solve problems affecting the community.

  3. Cognitive enrichment and welfare: Current approaches and future directions

    Directory of Open Access Journals (Sweden)

    Fay E. Clark

    2017-02-01

    Full Text Available “Cognitive enrichment” is a subset of enrichment that has gained interest from researchers over the past decade, particularly those working in zoos. This review explores the forms of cognitive enrichment that have been attempted for laboratory, farmed and zoo animals with a focus on the latter, including various definitions, aims, and approaches. This review reveals the fundamental theoretical and practical problems associated with cognitive enrichment, leading to recommendations for further research in this field. Critically, more research is needed to elucidate what makes challenges appropriate for certain taxa, acknowledging that individual differences exist. Going forward, we should be prepared to incorporate more computer technology into cognitive tasks, and examine novel welfare indicators such as flow, competence, and agency.

  4. Current Approaches in Implementing Citizen Science in the Classroom

    Directory of Open Access Journals (Sweden)

    Harsh R. Shah

    2015-12-01

    Full Text Available Citizen science involves a partnership between inexperienced volunteers and trained scientists engaging in research. In addition to its obvious benefit of accelerating data collection, citizen science has an unexplored role in the classroom, from K–12 schools to higher education. With recent studies showing a weakening in scientific competency of American students, incorporating citizen science initiatives in the curriculum provides a means to address deficiencies in a fragmented educational system. The integration of traditional and innovative pedagogical methods to reform our educational system is therefore imperative in order to provide practical experiences in scientific inquiry, critical thinking, and problem solving for school-age individuals. Citizen science can be used to emphasize the recognition and use of systematic approaches to solve problems affecting the community.

  5. Current approaches on viral infection: proteomics and functional validations

    Directory of Open Access Journals (Sweden)

    Jie eZheng

    2012-11-01

    Full Text Available Viruses could manipulate cellular machinery to ensure their continuous survival and thus become parasites of living organisms. Delineation of sophisticated host responses upon virus infection is a challenging task. It lies in identifying the repertoire of host factors actively involved in the viral infectious cycle and characterizing host responses qualitatively and quantitatively during viral pathogenesis. Mass spectrometry based proteomics could be used to efficiently study pathogen-host interactions and virus-hijacked cellular signaling pathways. Moreover, direct host and viral responses upon infection could be further investigated by activity based functional validation studies. These approaches involve drug inhibition of secretory pathway, immunofluorescence staining, dominant negative mutation of protein target, real time PCR, small interfering siRNA-mediated knockdown, and molecular cloning studies. In this way, functional validation could gain novel insights into the high-content proteomic dataset in an unbiased and comprehensive way.

  6. Current approach in diagnosis and management of anterior uveitis

    Directory of Open Access Journals (Sweden)

    Agrawal Rupesh

    2010-01-01

    Full Text Available Uveitis is composed of a diverse group of disease entities, which in total has been estimated to cause approximately 10% of blindness. Uveitis is broadly classified into anterior, intermediate, posterior and panuveitis based on the anatomical involvement of the eye. Anterior uveitis is, however, the commonest form of uveitis with varying incidences reported in worldwide literature. Anterior uveitis can be very benign to present with but often can lead to severe morbidity if not treated appropriately. The present article will assist ophthalmologists in accurately diagnosing anterior uveitis, improving the quality of care rendered to patients with anterior uveitis, minimizing the adverse effects of anterior uveitis, developing a decision-making strategy for management of patients at risk of permanent visual loss from anterior uveitis, informing and educating patients and other healthcare practitioners about the visual complications, risk factors, and treatment options associated with anterior uveitis.

  7. Treatment of endometriosis: a hormonal approach.

    Science.gov (United States)

    Budinetz, T; Sanfilippo, J S

    2010-08-01

    Endometriosis continues to plague women of reproductive age. It is a chronic disease leading to a decreased quality of life, infertility, and increased societal costs. The gold standard for diagnosis remains visualization and or biopsy of lesions at the time of intraoperative diagnosis, i.e. laparoscopy or laparotomy. The severity of pain does not correlate with the stage of endometriosis, which complicates the treatment process. Hormonal therapies have long been used as a treatment for endometriosis. Therapy is targeted at symptom relief as a cure is lacking. While some regimes use hormonal therapy exclusively, others combine such with surgical excision of lesions. Although hormonal modalities are successful in alleviating or suppressing symptoms, they fail to treat the infertility associated with endometriosis. Therefore, those, desiring to achieve pregnancy should be excluded from hormonal treatment in the short term. Future studies are needed to understand the pathophysiology and allow design of specific, targeted treatment.

  8. 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.

  9. [Clinical laboratory approaches to parodontitis treatment optimization].

    Science.gov (United States)

    Soboleva, L A; Shul'diakov, A A; Oseeva, A O; Aleksandrova, E A

    2010-01-01

    In order to determine cycloferon liniment clinical-pathogenetic efficacy in comprehensive parodontitis therapy examination and treatment of 80 patients was done. It was determined that the cycloferon liniment use in comprehensive treatment of patients with parodontitis let to reduce infectious load in parodontal pockets and local inflammation intensity, to normalize the secretory immunoglobulin level and immune status indices that provided speed up of healing process and reduction relapse frequency.

  10. Selection of approach and fixation in the treatment of

    Directory of Open Access Journals (Sweden)

    QI Xin

    2010-06-01

    Full Text Available Unlike the common distal humeral fracture in children, the prevalence of fractures at this site is not high in adults and accounts for only 2% of all fractures.Moreover, intraarticular fractures, especially the type C fracture, are rare and usually caused by high energy injury. After fractures occur, there are problems of disconnection between the condyles and diaphysis, and of disruption between the medial and lateral condyles. The two condyle fragments rotate along their own axes and the trochlea is usually intact. All these factors create difficulties for reduction and fixation. The currently employed surgical approaches are usually not able to provide enough exposure, and sufficient stability can not be achieved by internal fixation to allow early functional exercises. There are still difficulties in the management of intra-articular fractures of the distal humerus in adults.1, 2 Our objective is to study the surgical treatment for distal humeral fractures in adults by patients’ follow-up.

  11. 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.

  12. 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

  13. Tratamento atual dos miomas Current treatment of leiomyomas

    Directory of Open Access Journals (Sweden)

    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.

  14. A systematic review of current and emergent manipulator control approaches

    Science.gov (United States)

    Ajwad, Syed Ali; Iqbal, Jamshed; Ullah, Muhammad Imran; Mehmood, Adeel

    2015-06-01

    Pressing demands of productivity and accuracy in today's robotic applications have highlighted an urge to replace classical control strategies with their modern control counterparts. This recent trend is further justified by the fact that the robotic manipulators have complex nonlinear dynamic structure with uncertain parameters. Highlighting the authors' research achievements in the domain of manipulator design and control, this paper presents a systematic and comprehensive review of the state-of-the-art control techniques that find enormous potential in controlling manipulators to execute cuttingedge applications. In particular, three kinds of strategies, i.e., intelligent proportional-integral-derivative (PID) scheme, robust control and adaptation based approaches, are reviewed. Future trend in the subject area is commented. Open-source simulators to facilitate controller design are also tabulated. With a comprehensive list of references, it is anticipated that the review will act as a firsthand reference for researchers, engineers and industrialinterns to realize the control laws for multi-degree of freedom (DOF) manipulators.

  15. Current Approaches Toward Quantitative Mapping of the Interactome.

    Science.gov (United States)

    Buntru, Alexander; Trepte, Philipp; Klockmeier, Konrad; Schnoegl, Sigrid; Wanker, Erich E

    2016-01-01

    Protein-protein interactions (PPIs) play a key role in many, if not all, cellular processes. Disease is often caused by perturbation of PPIs, as recently indicated by studies of missense mutations. To understand the associations of proteins and to unravel the global picture of PPIs in the cell, different experimental detection techniques for PPIs have been established. Genetic and biochemical methods such as the yeast two-hybrid system or affinity purification-based approaches are well suited to high-throughput, proteome-wide screening and are mainly used to obtain qualitative results. However, they have been criticized for not reflecting the cellular situation or the dynamic nature of PPIs. In this review, we provide an overview of various genetic methods that go beyond qualitative detection and allow quantitative measuring of PPIs in mammalian cells, such as dual luminescence-based co-immunoprecipitation, Förster resonance energy transfer or luminescence-based mammalian interactome mapping with bait control. We discuss the strengths and weaknesses of different techniques and their potential applications in biomedical research.

  16. Current approaches to fine mapping of antigen-antibody interactions.

    Science.gov (United States)

    Abbott, W Mark; Damschroder, Melissa M; Lowe, David C

    2014-08-01

    A number of different methods are commonly used to map the fine details of the interaction between an antigen and an antibody. Undoubtedly the method that is now most commonly used to give details at the level of individual amino acids and atoms is X-ray crystallography. The feasibility of undertaking crystallographic studies has increased over recent years through the introduction of automation, miniaturization and high throughput processes. However, this still requires a high level of sophistication and expense and cannot be used when the antigen is not amenable to crystallization. Nuclear magnetic resonance spectroscopy offers a similar level of detail to crystallography but the technical hurdles are even higher such that it is rarely used in this context. Mutagenesis of either antigen or antibody offers the potential to give information at the amino acid level but suffers from the uncertainty of not knowing whether an effect is direct or indirect due to an effect on the folding of a protein. Other methods such as hydrogen deuterium exchange coupled to mass spectrometry and the use of short peptides coupled with ELISA-based approaches tend to give mapping information over a peptide region rather than at the level of individual amino acids. It is quite common to use more than one method because of the limitations and even with a crystal structure it can be useful to use mutagenesis to tease apart the contribution of individual amino acids to binding affinity.

  17. Current approaches towards quantitative mapping of the interactome

    Directory of Open Access Journals (Sweden)

    Alexander eBuntru

    2016-05-01

    Full Text Available Protein-protein interactions (PPIs play a key role in many, if not all, cellular processes. Disease is often caused by perturbation of PPIs, as recently indicated by studies of missense mutations. To understand the associations of proteins and to unravel the global picture of PPIs in the cell, different experimental detection techniques for PPIs have been established. Genetic and biochemical methods such as the yeast two-hybrid (Y2H system or affinity purification-based approaches are well suited to high-throughput, proteome-wide screening and are mainly used to obtain qualitative results. However, they have been criticized for not reflecting the cellular situation or the dynamic nature of PPIs. In this review, we provide an overview of various genetic methods that go beyond qualitative detection and allow quantitative measuring of PPIs in mammalian cells, such as DULIP, FRET or LUMIER with BACON. We discuss the strengths and weaknesses of different techniques and their potential applications in biomedical research.

  18. New approaches to business cycle theory in current economic science

    Directory of Open Access Journals (Sweden)

    Monica DOBRESCU

    2012-07-01

    Full Text Available In modern economies, current research generally acknowledges that the central issues in macroeconomics are essentially the same as those identified by Keynes in the General Theory of Employment, Interest and Money. One way or the other, economists are trying to address the same macroeconomic issues that they did seven decades ago: How can we account for the different growth rates and various fluctuations observed in national economies? Which are the economic policies most suitable to solve the issues of growth and cyclic behavior? Both the new classicals and the new Keynesians have made considerable progress within their research paradigms: to explain economic fluctuations, the new classicals focus on technological perturbations, the intertemporal substitution of leisure and real business cycles; on the other hand, the new Keynesians speak in terms of monopolistic competition, menu costs or efficiency wages. On the whole, the new classicals believe that the business cycle can best be understood within the market-clearing model, whereas the new keynesians believe that business fluctuations are due to certain market failures of various sorts.The present paper focuses on the main directions of research of the new classical school on the business cycle, given that the theoretical progress in this field has been significant and relevant for economic policy during the past four decades.

  19. The aetiology ofautism spectrum disorders. An overview of current approaches

    Directory of Open Access Journals (Sweden)

    Paulina Gołaska

    2013-03-01

    Full Text Available Despite the great popularity of autism among researchers, its main cause still remains unknown. However, there are many theories which describe the mechanisms of this disorder. On the other hand, one who tries to integrate them seems to be helpless according to their contradictory and – in most cases – hypothetical status. In a context of this inac‑ curacy, focusing only on one of the concepts would be probably very disadvantageous. As many researchers suggest, the etiology of autism is complex and it is the interaction of multiple factors which implies the disorder appears. It seems that the nature of autism is equifinal and heterogeneous. Thus, the aim of this article is to present a review of current biological theories of autism etiology and to indicate the environmental as well as innate risk factors which may disturb the natural pathway of child development: prenatal (which increase the probability of autism emergence as early as in the first or second year of life or perinatal ones (low birth weight, hypoxia, age of the mother, her educational sta‑ tus. The foetal testosterone theory of autism and its general consequences for the child development will be described also. Finally, the neurological, neurochemical and neuroanatomical dysfunctions in autism will be presented.

  20. Current approaches toward production of secondary plant metabolites

    Directory of Open Access Journals (Sweden)

    Md. Sarfaraj Hussain

    2012-01-01

    Full Text Available Plants are the tremendous source for the discovery of new products with medicinal importance in drug development. Today several distinct chemicals derived from plants are important drugs, which are currently used in one or more countries in the world. Secondary metabolites are economically important as drugs, flavor and fragrances, dye and pigments, pesticides, and food additives. Many of the drugs sold today are simple synthetic modifications or copies of the naturally obtained substances. The evolving commercial importance of secondary metabolites has in recent years resulted in a great interest in secondary metabolism, particularly in the possibility of altering the production of bioactive plant metabolites by means of tissue culture technology. Plant cell and tissue culture technologies can be established routinely under sterile conditions from explants, such as plant leaves, stems, roots, and meristems for both the ways for multiplication and extraction of secondary metabolites. In vitro production of secondary metabolite in plant cell suspension cultures has been reported from various medicinal plants, and bioreactors are the key step for their commercial production. Based on this lime light, the present review is aimed to cover phytotherapeutic application and recent advancement for the production of some important plant pharmaceuticals.

  1. Assessment methods for angiogenesis and current approaches for its quantification

    Directory of Open Access Journals (Sweden)

    Waleed Hassan AlMalki

    2014-01-01

    Full Text Available Angiogenesis is a physiological process which describes the development of new blood vessels from the existing vessels. It is a common and the most important process in the formation and development of blood vessels, so it is supportive in the healing of wounds and granulation of tissues. The different assays for the evaluation of angiogenesis have been described with distinct advantages and some limitations. In order to develop angiogenic and antiangiogenic techniques, continuous efforts have been resulted to give animal models for more quantitative analysis of angiogenesis. Most of the studies on angiogenic inducers and inhibitors rely on various models, both in vitro, in vivo and in ova, as indicators of efficacy. The angiogenesis assays are very much helpful to test efficacy of both pro- and anti- angiogenic agents. The development of non-invasive procedures for quantification of angiogenesis will facilitate this process significantly. The main objective of this review article is to focus on the novel and existing methods of angiogenesis and their quantification techniques. These findings will be helpful to establish the most convenient methods for the detection, quantification of angiogenesis and to develop a novel, well tolerated and cost effective anti-angiogenic treatment in the near future.

  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. Improving current immunoglobulin therapy for patients with primary immunodeficiency: quality of life and views on treatment.

    Science.gov (United States)

    Espanol, Teresa; Prevot, Johan; Drabwell, Jose; Sondhi, Seema; Olding, Laurence

    2014-01-01

    Subcutaneous or intravenous immunoglobulin replacement is the mainstay of treatment for most patients with primary immunodeficiency disease (PID). The purpose of this study was to gain an understanding of how existing PID therapies affect patient lives and to identify desired improvements to immunoglobulin treatments. An online questionnaire was made available through the International Patient Organisation for Primary Immunodeficiencies to patients with PID and their caregivers regarding current treatment satisfaction, living with PID, and patient preferences using a conjoint approach. Health-related quality of life was canvassed via questionnaires using the Short Form 12 Health Survey and EuroQoL 5 Dimensions. A total of 300 responded to the survey (72% patients with PID and 28% caregivers) from across 21 countries, mostly the UK, Sweden, Canada, France, Germany, and Spain. Fifty-three percent and 45% of patients received intravenous and subcutaneous therapy, respectively. Most respondents (76%) were satisfied with their current treatment, reflecting the benefits that immunoglobulin therapy provides for patient health and well-being. However, patients remained below the physical and mental well-being norms for health-related quality of life as determined by the questionnaire. All respondents expressed a desire for 4-weekly infusions, the ability to administer these at home, self-administration, shorter duration of administration, and fewer needle sticks. The results of this survey highlight the importance of providing access to different treatment options and modes of administration to ensure individual patient needs are best met.

  5. Managing Behçet’s disease: An update on current and emerging treatment options

    Directory of Open Access Journals (Sweden)

    P LA van Daele

    2009-05-01

    Full Text Available P LA van Daele, J H Kappen, P M van Hagen, J AM van LaarDepartment of Internal Medicine, Department of Immunology, Erasmus MC, ‘s Gravendijkwal 230, 3015 Ce Rotterdam, The NetherlandsAbstract: Behçet’s disease is an autoinflammatory vasculitis of unknown origin characterized by recurrent oral and genital ulcers, uveitis, arthritis and skin lesions. Additionally, involvement of the gastrointestinal tract, central nervous system and large vessels may occur. The disease is prevalent in countries along the ancient Silk Road from Eastern Asia to the Mediterranean Basin. Many treatment modalities are currently available. The choice of treatment depends on organ involvement and severity of disease. Topical treatment with corticosteroids is often sufficient for mucocutaneous involvement, however for more severe disease with vasculitis or neurological involvement a more aggressive approach is warranted. Newer drugs (biologicals influencing cytokines and thereby T-cell function are promising with an acceptable side effect profile. Unfortunately, reimbursement of the costs of biologicals for rare disease is still a problem in various countries. In this report we discuss the current treatment modalities for Behçet’s disease.Keywords: Behçet’s disease, biologicals, treatment

  6. Nanotechnology-Based Approach in Tuberculosis Treatment

    Science.gov (United States)

    Neyaz, Md. Kausar; Das, Shilpi

    2017-01-01

    Tuberculosis, commonly known as TB, is the second most fatal infectious disease after AIDS, caused by bacterium called Mycobacterium tuberculosis. Prolonged treatment, high pill burden, low compliance, and stiff administration schedules are factors that are responsible for emergence of MDR and XDR cases of tuberculosis. Till date, only BCG vaccine is available which is ineffective against adult pulmonary TB, which is the most common form of disease. Various unique antibodies have been developed to overcome drug resistance, reduce the treatment regimen, and elevate the compliance to treatment. Therefore, we need an effective and robust system to subdue technological drawbacks and improve the effectiveness of therapeutic drugs which still remains a major challenge for pharmaceutical technology. Nanoparticle-based ideology has shown convincing treatment and promising outcomes for chronic infectious diseases. Different types of nanocarriers have been evaluated as promising drug delivery systems for various administration routes. Controlled and sustained release of drugs is one of the advantages of nanoparticle-based antituberculosis drugs over free drug. It also reduces the dosage frequency and resolves the difficulty of low poor compliance. This paper reviews various nanotechnology-based therapies which can be used for the treatment of TB. PMID:28210505

  7. Current approaches to gastric cancer in Peru and Mexico.

    Science.gov (United States)

    Santos, Erlan

    2017-01-01

    In Peru, the incidence of gastric cancer is reported to be around 15.8 per 100,000 inhabitants and it is the second most common oncological disease in men and the third one in women. Additionally, a high mortality index was reported, especially among poor people. To address this issue, in 2008, Peru initiated several insurance treatment plans of oncological diseases with promising results. In Mexico, there is a high predominance of gastric cancer in male gender compared to female gender, even reaching a 2/1 ratio, and the detection rate of early gastric cancer is low (10% to 20%) which results in a mainly palliative treatment with an overall survival rate in 5 years about 10% to 15% only. In Peru, the average age at diagnosis is around 62.96±14.75 years old and the most frequent symptoms includes abdominal pain, indigestion, loss of appetite, weight loss and gastrointestinal bleeding, while in Mexico, some studies reported an average age at diagnosis around 60.3±4.1 years old (range, 23-78 years old) and the most frequent symptoms were postprandial fullness (74.4%), abdominal pain (37.2%), weight loss (18.6%), and melena (4.6%). The anemia rate was 65.1% with a mean Hb level of 6.14 g/dL. In Peru, the most common gastric cancer type is the intestinal-type adenocarcinoma (around 34%), followed by the diffuse-type adenocarcinoma (18.7%), whilst among Mexicans, the diffuse-type was reported in 55.2% of cases, the intestinal-type was reported in 28.2% and the undifferentiated-type corresponded to 6%. In both, Peru and Mexico, 90% of the associated factors includes tabaquismo, diets rich in salt, smoked foods, and a sedentary lifestyle. Family inheritance and advanced age and pharmacological-resistant Helicobacter pylori infection are also important. Poverty has been heavily associated with a higher incidence of gastric cancer. The management of gastric cancer patients in Peru is carried out by general surgeons or general surgical oncologists. In recent years, efforts

  8. Juvenile Fibromyalgia: A Multidisciplinary Approach to Treatment.

    Science.gov (United States)

    Tesher, Melissa S

    2015-06-01

    A 14-year-old boy presented with months of severe widespread musculoskeletal pain. He was profoundly fatigued and unable to attend school. Laboratory evaluation, including complete blood count, comprehensive metabolic panel, inflammatory markers, and thyroid function, was unrevealing. Physical examination was also normal except for multiple tender points. The patient was diagnosed with juvenile primary fibromyalgia syndrome and referred for multidisciplinary treatment including physical therapy, exercise, and counseling, and his daily functioning gradually improves. Juvenile fibromyalgia is a complex syndrome that often severely limits patients' activities and can impede normal adolescent development. Effective treatment requires an understanding of the biologic, psychologic, and social factors contributing to the perpetuation of chronic pain. The author reviews the diagnostic criteria, pathophysiology, and treatment of juvenile fibromyalgia. Medications, particularly antidepressants and anticonvulsants, can be useful adjuncts to therapy. However, multimodal pain management including intensive physical therapy, exercise, counseling, and sleep hygiene is most effective in treating fibromyalgia.

  9. The Current Case of Quinolones: Synthetic Approaches and Antibacterial Activity

    Directory of Open Access Journals (Sweden)

    Abdul Naeem

    2016-03-01

    Full Text Available Quinolones are broad-spectrum synthetic antibacterial drugs first obtained during the synthesis of chloroquine. Nalidixic acid, the prototype of quinolones, first became available for clinical consumption in 1962 and was used mainly for urinary tract infections caused by Escherichia coli and other pathogenic Gram-negative bacteria. Recently, significant work has been carried out to synthesize novel quinolone analogues with enhanced activity and potential usage for the treatment of different bacterial diseases. These novel analogues are made by substitution at different sites—the variation at the C-6 and C-8 positions gives more effective drugs. Substitution of a fluorine atom at the C-6 position produces fluroquinolones, which account for a large proportion of the quinolones in clinical use. Among others, substitution of piperazine or methylpiperazine, pyrrolidinyl and piperidinyl rings also yields effective analogues. A total of twenty six analogues are reported in this review. The targets of quinolones are two bacterial enzymes of the class II topoisomerase family, namely gyrase and topoisomerase IV. Quinolones increase the concentration of drug-enzyme-DNA cleavage complexes and convert them into cellular toxins; as a result they are bactericidal. High bioavailability, relative low toxicity and favorable pharmacokinetics have resulted in the clinical success of fluoroquinolones and quinolones. Due to these superior properties, quinolones have been extensively utilized and this increased usage has resulted in some quinolone-resistant bacterial strains. Bacteria become resistant to quinolones by three mechanisms: (1 mutation in the target site (gyrase and/or topoisomerase IV of quinolones; (2 plasmid-mediated resistance; and (3 chromosome-mediated quinolone resistance. In plasmid-mediated resistance, the efflux of quinolones is increased along with a decrease in the interaction of the drug with gyrase (topoisomerase IV. In the case of

  10. The Current Case of Quinolones: Synthetic Approaches and Antibacterial Activity.

    Science.gov (United States)

    Naeem, Abdul; Badshah, Syed Lal; Muska, Mairman; Ahmad, Nasir; Khan, Khalid

    2016-03-28

    Quinolones are broad-spectrum synthetic antibacterial drugs first obtained during the synthesis of chloroquine. Nalidixic acid, the prototype of quinolones, first became available for clinical consumption in 1962 and was used mainly for urinary tract infections caused by Escherichia coli and other pathogenic Gram-negative bacteria. Recently, significant work has been carried out to synthesize novel quinolone analogues with enhanced activity and potential usage for the treatment of different bacterial diseases. These novel analogues are made by substitution at different sites--the variation at the C-6 and C-8 positions gives more effective drugs. Substitution of a fluorine atom at the C-6 position produces fluroquinolones, which account for a large proportion of the quinolones in clinical use. Among others, substitution of piperazine or methylpiperazine, pyrrolidinyl and piperidinyl rings also yields effective analogues. A total of twenty six analogues are reported in this review. The targets of quinolones are two bacterial enzymes of the class II topoisomerase family, namely gyrase and topoisomerase IV. Quinolones increase the concentration of drug-enzyme-DNA cleavage complexes and convert them into cellular toxins; as a result they are bactericidal. High bioavailability, relative low toxicity and favorable pharmacokinetics have resulted in the clinical success of fluoroquinolones and quinolones. Due to these superior properties, quinolones have been extensively utilized and this increased usage has resulted in some quinolone-resistant bacterial strains. Bacteria become resistant to quinolones by three mechanisms: (1) mutation in the target site (gyrase and/or topoisomerase IV) of quinolones; (2) plasmid-mediated resistance; and (3) chromosome-mediated quinolone resistance. In plasmid-mediated resistance, the efflux of quinolones is increased along with a decrease in the interaction of the drug with gyrase (topoisomerase IV). In the case of chromosome

  11. CHOICE OF SURGICAL APPROACH FOR ACETABULAR COMPONENT’S IMPLANTATION USING CURRENT CLASSIFICATION FOR ARTHRITIS FOLLOWING ACETABULAR FRACTURE

    Directory of Open Access Journals (Sweden)

    R. M. Tikhilov

    2011-01-01

    Full Text Available Degenerative-dystrophic changes in hip after treatment of acetabular fracture, over the time, develops about in 60% of affected people. In such cases, total hip replacement is used. Existing classifications (for example AO or Letournel are good for fracture treatment, but not for arthritis following acetabular fracture. The group of patients, with post traumatic arthritis, is heterogeneous with severity of post traumatic anatomic changes. Basis for surgical approach, could be current classification for post traumatic changes – taking into account features of anatomic functional changes in hip and the bone defects of acetabulum. In this article is demonstrated X-ray and clinical basing for current classification.

  12. Pharmacologic approaches to the treatment of cocaine dependence.

    OpenAIRE

    Taylor, W. A.; Gold, M. S.

    1990-01-01

    When pharmacologic agents are considered in the treatment of cocaine addiction, the objective of such treatment--sustained abstinence--must be considered. Medication and medical approaches have been disappointing in the treatment of cocaine overdose. The central neurobiologic mechanism(s) involved in cocaine toxicity are poorly understood. Without a cocaine antagonist, pharmacologic approaches have been less than promising in preventing relapse. Various psychoactive medications have been trie...

  13. Treatment of Test Anxiety: A Computerized Approach

    Science.gov (United States)

    Pless, Anica

    2010-01-01

    Test anxiety creates problems for many students, and can have a negative impact on the academic performance of many who suffer from it (Jones & Petruzzi, 1995). Typical treatment components for test anxiety involve psychoeducation, relaxation training, gradual exposure, cognitive restructuring, study skills training, and relapse prevention.…

  14. Dumping Syndrome: A Review of the Current Concepts of Pathophysiology, Diagnosis, and Treatment.

    Science.gov (United States)

    Berg, Patrick; McCallum, Richard

    2016-01-01

    Gastric surgery has long been known to be a cause of dumping syndrome (DS). However, the increasing incidence of gastric bypass surgery, as well as reports of DS unrelated to previous gastric surgeries, has increased the importance of understanding DS in recent years. DS is due to the gastrointestinal response to voluminous and hyperosmolar chyme that is rapidly expelled from the stomach into the small intestine. This response involves neural and hormonal mechanisms. This review encompasses the symptoms, diagnosis, and treatment approaches of DS and also focuses on the current research status of the pathophysiology of DS.

  15. Treatment of Hip Dislocations and Associated Injuries: Current State of Care.

    Science.gov (United States)

    Beebe, Michael J; Bauer, Jennifer M; Mir, Hassan R

    2016-07-01

    Hip dislocations, most often caused by motor vehicle accidents or similar high-energy trauma, traverse a large subset of distinct injury patterns. Understanding these patterns and their associated injuries allows surgeons to provide optimal care for these patients both in the early and late postinjury periods. Nonoperative care requires surgeons to understand the indications. Surgical care requires the surgeon to understand the benefits and limitations of several surgical approaches. This article presents the current understanding of hip dislocation treatment, focusing on anatomy, injury classifications, nonoperative and operative management, and postinjury care.

  16. Treatment of crown dilaceration: an interdisciplinary approach.

    Science.gov (United States)

    Subramaniam, P; Naidu, P

    2010-01-01

    Trauma to primary teeth can result in a wide range of disturbances to the underlying permanent teeth, such as dilaceration. Root dilacerations occur more commonly than crown dilacerations. This paper is a report of an 11-year-old girl with a missing maxillary left anterior tooth. Past history revealed premature loss of primary maxillary anterior teeth due to trauma. Radiographic examination revealed crown dilaceration of permanent maxillary left central incisor. An interdisciplinary approach in the management of this child is presented herewith.

  17. 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…

  18. New approaches to the treatment of depression.

    Science.gov (United States)

    Leonard, B E

    1996-01-01

    This review considers the various modes of action and possible advantages of the different types of second generation antidepressants. The biochemical changes that may be causally related to depression and the mechanisms whereby these changes may be attenuated by antidepressant treatment are briefly considered. Whereas the monoamine theory of depression and the receptor adaptation hypothesis of antidepressant action have been influential in helping to unify the mechanisms of action of antidepressants with the possible pathologic basis of depression, the introduction of novel antidepressants and the development of treatment strategies suggestive of a rapid onset of antidepressant response may initiate a revision of these concepts. The review ends with a consideration of the nonaminergic changes that may be of fundamental importance not only in the pathologic basis of depression but also to the means whereby antidepressants bring about their clinical effects.

  19. An holistic approach to substance abuse treatment.

    Science.gov (United States)

    Breslin, Kathy T; Reed, Maria R; Malone, Sandra B

    2003-01-01

    The purpose of this article is to describe a model outpatient substance abuse treatment program. This program is designed to provide patients with not only traditional modalities of treatment such as individual, group, and family therapy, but also to provide an opportunity for patients to express thoughts and feelings through holistic modalities. These modalities include dance/movement therapy, Tai Chi, art therapy, leisure and recreational skills, spiritual growth and development, cultural awareness and appreciation, vocational services, psychiatric care and physical health. The authors describe features of this program that they believe to be unique and that focus on ways to help patients develop a stronger sense of self-identity, self-esteem and self-confidence.

  20. Non-Conventional Treatment Approaches in Pemphigus

    Directory of Open Access Journals (Sweden)

    Mutlu Çayırlı

    2013-09-01

    Full Text Available Pemphigus is a bullous auto-immune disease which has high mortality and morbidity rates and affects the skin and mucosa. Corticosteroids are still the baseline treatment modality of pemphigus management. However, non-steroidal drugs and methods have been used more frequently in patients with pemphigus who are non-responders to conventional therapy or have severe side effects. In this article we aimed to review unconventional therapy modalities in patients with pemphigus.

  1. Manual Therapy: The Historical, Current, and Future Role in the Treatment of Pain

    Directory of Open Access Journals (Sweden)

    A. Russell Smith

    2007-01-01

    Full Text Available Manual therapy has been an approach in the management of patients with various disorders dating back to ancient times and continues to play a significant role in current health care. The future role of manual therapy in health care is an important area of research. This paper reviews the history of manual therapy, examines the current literature related to the use of manual techniques (including manipulation, massage, and nerve manipulation, and discusses future research topics. The literature related to manual therapy has historically been anecdotal and theoretical, and current research tends to have a generic approach with broad definitions of manual therapy and inconsistencies in the classification of specific disorders. Systematic reviews of various types of manual therapy have differed on their conclusions regarding the effectiveness of this treatment modality. The current demand in health care for evidence-based practice necessitates a movement towards more specificity in the research of the effectiveness of manual therapy, with emphasis on specific patient signs and symptoms and specific manual techniques that result in effective care.

  2. Approach to the Treatment of Diabetic Ketoacidosis.

    Science.gov (United States)

    Kamel, Kamel S; Schreiber, Martin; Carlotti, Ana P C P; Halperin, Mitchell L

    2016-12-01

    Diabetic ketoacidosis (DKA), a common cause of severe metabolic acidosis, remains a life-threatening condition due to complications of both the disease and its treatment. This Acid-Base and Electrolyte Teaching Case discusses DKA management, emphasizing complications of treatment. Because cerebral edema is the most common cause of mortality and morbidity, especially in children with DKA, we emphasize its pathophysiology and implications for therapy. The risk for cerebral edema may be minimized by avoiding a bolus of insulin, excessive saline resuscitation, and a decrease in effective plasma osmolality early in treatment. A goal of fluid therapy is to lower muscle venous Pco2 to ensure effective removal of hydrogen ions by bicarbonate buffer in muscle and diminish the binding of hydrogen ions to intracellular proteins in vital organs (such as the brain). In patients with DKA and a relatively low plasma potassium level, insulin administration may cause hypokalemia and cardiac arrhythmias. It is suggested in these cases to temporarily delay insulin administration and first administer potassium chloride intravenously to bring the plasma potassium level close to 4mmol/L. Sodium bicarbonate administration in adult patients should be individualized. We suggest it be considered in a subset of patients with moderately severe acidemia (pH<7.20 and plasma bicarbonate level < 12mmol/L) who are at risk for worsening acidemia, particularly if hemodynamically unstable. Sodium bicarbonate should not be administered to children with DKA, except if acidemia is very severe and hemodynamic instability is refractory to saline administration.

  3. Computational neuroscience approach to biomarkers and treatments for mental disorders.

    Science.gov (United States)

    Yahata, Noriaki; Kasai, Kiyoto; Kawato, Mitsuo

    2017-04-01

    Psychiatry research has long experienced a stagnation stemming from a lack of understanding of the neurobiological underpinnings of phenomenologically defined mental disorders. Recently, the application of computational neuroscience to psychiatry research has shown great promise in establishing a link between phenomenological and pathophysiological aspects of mental disorders, thereby recasting current nosology in more biologically meaningful dimensions. In this review, we highlight recent investigations into computational neuroscience that have undertaken either theory- or data-driven approaches to quantitatively delineate the mechanisms of mental disorders. The theory-driven approach, including reinforcement learning models, plays an integrative role in this process by enabling correspondence between behavior and disorder-specific alterations at multiple levels of brain organization, ranging from molecules to cells to circuits. Previous studies have explicated a plethora of defining symptoms of mental disorders, including anhedonia, inattention, and poor executive function. The data-driven approach, on the other hand, is an emerging field in computational neuroscience seeking to identify disorder-specific features among high-dimensional big data. Remarkably, various machine-learning techniques have been applied to neuroimaging data, and the extracted disorder-specific features have been used for automatic case-control classification. For many disorders, the reported accuracies have reached 90% or more. However, we note that rigorous tests on independent cohorts are critically required to translate this research into clinical applications. Finally, we discuss the utility of the disorder-specific features found by the data-driven approach to psychiatric therapies, including neurofeedback. Such developments will allow simultaneous diagnosis and treatment of mental disorders using neuroimaging, thereby establishing 'theranostics' for the first time in clinical

  4. 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.

  5. 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...

  6. 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

  7. Combining Upper Limb Robotic Rehabilitation with Other Therapeutic Approaches after Stroke: Current Status, Rationale, and Challenges

    Directory of Open Access Journals (Sweden)

    Stefano Mazzoleni

    2017-01-01

    Full Text Available A better understanding of the neural substrates that underlie motor recovery after stroke has led to the development of innovative rehabilitation strategies and tools that incorporate key elements of motor skill relearning, that is, intensive motor training involving goal-oriented repeated movements. Robotic devices for the upper limb are increasingly used in rehabilitation. Studies have demonstrated the effectiveness of these devices in reducing motor impairments, but less so for the improvement of upper limb function. Other studies have begun to investigate the benefits of combined approaches that target muscle function (functional electrical stimulation and botulinum toxin injections, modulate neural activity (noninvasive brain stimulation, and enhance motivation (virtual reality in an attempt to potentialize the benefits of robot-mediated training. The aim of this paper is to overview the current status of such combined treatments and to analyze the rationale behind them.

  8. Treatment of crown dilaceration: An interdisciplinary approach

    Directory of Open Access Journals (Sweden)

    Subramaniam P

    2010-03-01

    Full Text Available Trauma to primary teeth can result in a wide range of disturbances to the underlying permanent teeth, such as dilaceration. Root dilacerations occur more commonly than crown dilacerations. This paper is a report of an 11-year-old girl with a missing maxillary left anterior tooth. Past history revealed premature loss of primary maxillary anterior teeth due to trauma. Radiographic examination revealed crown dilaceration of permanent maxillary left central incisor. An interdisciplinary approach in the management of this child is presented herewith.

  9. Current Status of Pharmaceutical and Genetic Therapeutic Approaches to Treat DMD

    Science.gov (United States)

    Pichavant, Christophe; Aartsma-Rus, Annemieke; Clemens, Paula R; Davies, Kay E; Dickson, George; Takeda, Shin'ichi; Wilton, Steve D; Wolff, Jon A; Wooddell, Christine I; Xiao, Xiao; Tremblay, Jacques P

    2011-01-01

    Duchenne muscular dystrophy (DMD) is a genetic disease affecting about one in every 3,500 boys. This X-linked pathology is due to the absence of dystrophin in muscle fibers. This lack of dystrophin leads to the progressive muscle degeneration that is often responsible for the death of the DMD patients during the third decade of their life. There are currently no curative treatments for this disease but different therapeutic approaches are being studied. Gene therapy consists of introducing a transgene coding for full-length or a truncated version of dystrophin complementary DNA (cDNA) in muscles, whereas pharmaceutical therapy includes the use of chemical/biochemical substances to restore dystrophin expression or alleviate the DMD phenotype. Over the past years, many potential drugs were explored. This led to several clinical trials for gentamicin and ataluren (PTC124) allowing stop codon read-through. An alternative approach is to induce the expression of an internally deleted, partially functional dystrophin protein through exon skipping. The vectors and the methods used in gene therapy have been continually improving in order to obtain greater encapsidation capacity and better transduction efficiency. The most promising experimental approaches using pharmaceutical and gene therapies are reviewed in this article. PMID:21468001

  10. [New approaches for the treatment of dyslipidemia].

    Science.gov (United States)

    Mostaza, José María; Lahoz, Carlos

    2014-04-07

    Reduction in the risk of cardiovascular complications through modification of lipids is currently focused on lowering low density lipoproteins-cholesterol, with statins being the preferred drugs. New agents, under research, such as antibodies neutralizing PCSK9, will have a special place for the management of patients with intolerance to statins of severe dyslipemias. Drugs used to modify the concentration of high density lipoproteins-cholesterol and triglycerides have not been accompanied by the expected reductions in the rate of cardiovascular complications. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  11. 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.

  12. 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.

  13. Molecular approaches to treatments for cocaine abuse

    Science.gov (United States)

    Flippen-Anderson, Judith L.; George, Clifford; Deschamps, Jeffrey R.

    2003-02-01

    Cocaine is a potent stimulant of the central nervous system with severe addiction potential. Its abuse is a major problem worldwide. The exact mechanism of action of cocaine is still uncertain but it is known that its reinforcing and stimulant effects are related to its ability to inhibit the membrane bound dopamine transporter (DAT). This paper discusses efforts that are underway to identify ligands for possible use in the treatment of cocaine abuse. Much of this effort has been focussed on understanding cocaine interactions at DAT receptor sites.

  14. Gastrointestinal Amyloidosis: Diagnostic Approach and Treatment

    Directory of Open Access Journals (Sweden)

    Catarina Budyono

    2015-12-01

    Full Text Available Amyloidosis is a disease marked by deposition of misfolded proteins, known as amyloids, in the extracellular space, including gastrointestinal tract. According to the precursor protein, amyloidosis is classified into six types; all of which can be involved in the gastrointestinal tract. Amyloidosis has weight loss and gastrointestinal bleeding as the most frequent symptoms. Gastrointestinal tract biopsy is diagnostic in most cases of amyloidosis and Congo red stain is used to confirm the amyloid proteins deposit. Treatment of amyloidosis consists of controlling symptoms, terminating protein formation and deposit, and treating the underlying diseases. Chemotherapy might be applied depends on the type of amyloidosis.

  15. NANOCARRIERS: A NOVEL TREATMENT APPROACH FOR ARTHRITIS

    Directory of Open Access Journals (Sweden)

    Prachi Pandey* and S.S Pancholi

    2013-11-01

    Full Text Available Arthritis is a major cause of disability conventionally treated for long term with nonsteroidal anti-inflammatory drugs and corticosteroids. NSAIDs are nonselective inhibitors of cyclooxygenase and cause GI toxicity, antiplatelet effects, cardiotoxicity, renal toxicity and anaphylactic reactions in selected patients. Corticosteroids have multiple side effects, including gastrointestinal bleeding, upset stomach, thinning of bones, high blood pressure, cataracts, and increased infections. The currently available dosage forms of NSAIDs and steroids possess inherent risk of adverse effects in many different tissues in patients. The most satisfactory delivery system that overcomes the difficulties cited above shall be capable of delivering appropriate concentration of drug at site of action without involvement of other tissue and organs. This review focuses on current trends of development of drug delivery system in particular carriers, with enhanced localization to the target site and sustained drug release. The most prominent advantage of nanoscaled drug carriers such as liposomes, transferosomes, and niosomes over conventional drug delivery systems is the option to improve selective delivery of drugs to the site of action and sustained release.

  16. 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

  17. 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.

  18. Novel immunotherapeutic approaches for treatment of infertility.

    Science.gov (United States)

    Abdolmohammadi-Vahid, Samaneh; Danaii, Shahla; Hamdi, Kobra; Jadidi-Niaragh, Farhad; Ahmadi, Majid; Yousefi, Mehdi

    2016-12-01

    One of the most important reasons of infertility and human reproductive failure is related to uncontrolled immunological response of maternal immune system to early embryo or fetus, that cause rejection of this semi-allograft. Therefore, a tolerance in the immune system is essential to modulate the reactions against the fetus to avoid rejection. The immune system imbalance during implantation or pregnancy may lead to implantation failure or miscarriage. So, use of immunosuppressive or immunomodulator agents can be helpful to prevent immunological attack. Initially, there was a focus on steroids like prednisolone or intralipids in treatment of miscarriage that suppressed the activity of most immune cells, Intravenous Immunoglobulin (IVIG) was then introduced with various mechanisms. Nowadays, novel and specific strategies are established such as monoclonal antibodies and cytokines. More recently, Tacrolimus and Cyclosporine, which were utilized in prevention of transplantation reject, are used as immunosuppressive factors in modulation of immune responses against the fetus. This review is focused on the main immunotherapeutic methods of infertility treatment.

  19. Is a regenerative approach viable for the treatment of COPD?

    Science.gov (United States)

    Hind, Matthew; Maden, Malcolm

    2011-05-01

    Degenerative lung diseases such as chronic obstructive pulmonary disease (COPD) are common with huge worldwide morbidity. Anti-inflammatory drug development strategies have proved disappointing and current treatment is aimed at symptomatic relief. Only lung transplantation with all its attendant difficulties offers hope of cure and the outlook for affected patients is bleak. Lung regeneration therapies aim to reverse the structural and functional deficits in COPD either by delivery of exogenous lung cells to replace lost tissue, delivery of exogenous stem cells to induce a local paracrine effect probably through an anti-inflammatory action or by the administration of small molecules to stimulate the endogenous regenerative ability of lung cells. In animal models of emphysema and disrupted alveolar development each of these strategies has shown some success but there are potential tumour-inducing dangers with a cellular approach. Small molecules such as all-trans retinoic acid have been successful in animal models although the mechanism is not completely understood. There are currently two Pharma-sponsored trials in progress concerning patients with COPD, one of a specific retinoic acid receptor gamma agonist and another using mesenchymal stem cells.

  20. 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.

  1. Metabolic Dysfunction Underlying Autism Spectrum Disorder and Potential Treatment Approaches

    Science.gov (United States)

    Cheng, Ning; Rho, Jong M.; Masino, Susan A.

    2017-01-01

    Autism spectrum disorder (ASD) is characterized by deficits in sociability and communication, and increased repetitive and/or restrictive behaviors. While the etio-pathogenesis of ASD is unknown, clinical manifestations are diverse and many possible genetic and environmental factors have been implicated. As such, it has been a great challenge to identify key neurobiological mechanisms and to develop effective treatments. Current therapies focus on co-morbid conditions (such as epileptic seizures and sleep disturbances) and there is no cure for the core symptoms. Recent studies have increasingly implicated mitochondrial dysfunction in ASD. The fact that mitochondria are an integral part of diverse cellular functions and are susceptible to many insults could explain how a wide range of factors can contribute to a consistent behavioral phenotype in ASD. Meanwhile, the high-fat, low-carbohydrate ketogenic diet (KD), used for nearly a century to treat medically intractable epilepsy, has been shown to enhance mitochondrial function through a multiplicity of mechanisms and affect additional molecular targets that may address symptoms and comorbidities of ASD. Here, we review the evidence for the use of metabolism-based therapies such as the KD in the treatment of ASD as well as emerging co-morbid models of epilepsy and autism. Future research directions aimed at validating such therapeutic approaches and identifying additional and novel mechanistic targets are also discussed. PMID:28270747

  2. Metabolic Dysfunction Underlying Autism Spectrum Disorder and Potential Treatment Approaches.

    Science.gov (United States)

    Cheng, Ning; Rho, Jong M; Masino, Susan A

    2017-01-01

    Autism spectrum disorder (ASD) is characterized by deficits in sociability and communication, and increased repetitive and/or restrictive behaviors. While the etio-pathogenesis of ASD is unknown, clinical manifestations are diverse and many possible genetic and environmental factors have been implicated. As such, it has been a great challenge to identify key neurobiological mechanisms and to develop effective treatments. Current therapies focus on co-morbid conditions (such as epileptic seizures and sleep disturbances) and there is no cure for the core symptoms. Recent studies have increasingly implicated mitochondrial dysfunction in ASD. The fact that mitochondria are an integral part of diverse cellular functions and are susceptible to many insults could explain how a wide range of factors can contribute to a consistent behavioral phenotype in ASD. Meanwhile, the high-fat, low-carbohydrate ketogenic diet (KD), used for nearly a century to treat medically intractable epilepsy, has been shown to enhance mitochondrial function through a multiplicity of mechanisms and affect additional molecular targets that may address symptoms and comorbidities of ASD. Here, we review the evidence for the use of metabolism-based therapies such as the KD in the treatment of ASD as well as emerging co-morbid models of epilepsy and autism. Future research directions aimed at validating such therapeutic approaches and identifying additional and novel mechanistic targets are also discussed.

  3. 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.

  4. Current and upcoming approaches to exploit the reversibility of epigenetic mutations in breast cancer.

    Science.gov (United States)

    Falahi, Fahimeh; van Kruchten, Michel; Martinet, Nadine; Hospers, Geke A P; Rots, Marianne G

    2014-07-29

    DNA methylation and histone modifications are important epigenetic modifications associated with gene (dys)regulation. The epigenetic modifications are balanced by epigenetic enzymes, so-called writers and erasers, such as DNA (de)methylases and histone (de)acetylases. Aberrant epigenetic alterations have been associated with various diseases, including breast cancer. Since aberrant epigenetic modifications are potentially reversible, they might represent targets for breast cancer therapy. Indeed, several drugs have been designed to inhibit epigenetic enzymes (epi-drugs), thereby reversing epigenetic modifications. US Food and Drug Administration approval has been obtained for some epi-drugs for hematological malignancies. However, these drugs have had very modest anti-tumor efficacy in phase I and II clinical trials in breast cancer patients as monotherapy. Therefore, current clinical trials focus on the combination of epi-drugs with other therapies to enhance or restore the sensitivity to such therapies. This approach has yielded some promising results in early phase II trials. The disadvantage of epi-drugs, however, is genome-wide effects, which may cause unwanted upregulation of, for example, pro-metastatic genes. Development of gene-targeted epigenetic modifications (epigenetic editing) in breast cancer can provide a novel approach to prevent such unwanted events. In this context, identification of crucial epigenetic modifications regulating key genes in breast cancer is of critical importance. In this review, we first describe aberrant DNA methylation and histone modifications as two important classes of epigenetic mutations in breast cancer. Then we focus on the preclinical and clinical epigenetic-based therapies currently being explored for breast cancer. Finally, we describe epigenetic editing as a promising new approach for possible applications towards more targeted breast cancer treatment.

  5. 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...

  6. 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.

  7. 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.

  8. 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

  9. New therapeutic approaches for treatment of tularaemia: a review

    Directory of Open Access Journals (Sweden)

    Sandrine eBOISSET

    2014-03-01

    Full Text Available Antibiotic treatment of tularaemia is based on a few drugs, including the fluoroquinolones, the tetracyclines and the aminoglycosides. Because no effective and safe vaccine is currently available, tularaemia prophylaxis following proven exposure to F. tularensis also relies on administration of antibiotics. A number of reasons make it necessary to search for new therapeutic alternatives: the potential toxicity of first-line drugs, especially in children and pregnant women; a high rate of treatment relapses and failures, especially for severe and/or suppurated forms of the disease; and the possible use of antibiotic-resistant strains in the context of a biological threat. This review presents novel therapeutic approaches that have been explored in recent years to improve tularaemia patients’ management and prognosis. First, the activities of newly available antibiotic compounds were evaluated against F. tularensis, including tigecycline (a glycylcycline, ketolides (telithromycin and cethromycin and fluoroquinolones (moxifloxacin, gatifloxacin, trovafloxacin and grepafloxacin. The liposome delivery of some antibiotics was evaluated. The effect of antimicrobial peptides against F. tularensis was also considered. Other drugs were evaluated for their ability to suppress the intracellular multiplication of F. tularensis. The effects of the modulation of the innate immune response (especially via TLR receptors on the course of F. tularensis infection were characterized. Another approach was the administration of specific antibodies to induce passive resistance to F. tularensis infection. All of these studies highlight the need to develop new therapeutic strategies to improve the management of patients with tularaemia. Many possibilities exist, some unexplored. Moreover, it is likely that new therapeutic alternatives that are effective against this intracellular pathogen could be, at least partially, extrapolated to other human pathogens.

  10. The Lesch alcoholism typology - psychiatric and psychosocial treatment approaches.

    Science.gov (United States)

    Schlaff, Golda; Walter, Henriette; Lesch, Otto Michael

    2011-01-01

    In the past three decades, researchers have been attempting to replace the obsolete concept of homogeneity of alcohol dependence, by classifying these patients into specific heterogeneous subtypes. Based on 30 years of experience and research, the Lesch Typology has proved to be very useful in clinical daily routine. The aim of the Lesch Typology is to provide targeted subtype-specific treatments to patients, thereby increasing their probability of long-term abstinence and hence improving their prognosis. The Lesch Typology is based on data from a longitudinal prospective study (with follow ups even 19 years later) on alcohol dependent patients (n=436). By observing the long term development of these patients, four distinct courses could be identified. In the meantime, a computerized version of the Lesch Typology had been created and translated into many languages, and is currently being employed in numerous psychiatric institutions while assisting clinicians in quickly determining a patient's subtype (www.lat-online.at). Based on the patients' drinking patterns and origin of substance craving, hence according to the Lesch Typology, four subtypes of alcohol dependent patients can be distinguished: 1. the "allergy model" (craving caused by alcohol); 2. the "conflict resolution and anxiety model" (craving caused by stress); 3. the "depressive model" (craving caused by mood); and 4. the "conditioning model" (craving caused by compulsion). Pharmacological treatments are not always the most effective way of preventing relapses in alcohol dependent patients. Many times, a combination with psychosocial as well as psychotherapeutic approaches is necessary and essential for helping patients to stay sober. Depending on the patient's Lesch Type, certain therapeutic approaches are more appropriate and subsequently lead to better results and higher chances of lasting abstinence.

  11. Treatment of pediculosis capitis: a critical appraisal of the current literature.

    Science.gov (United States)

    Feldmeier, Hermann

    2014-10-01

    Pediculosis capitis is the most common ectoparasitic disease in children in industrialized countries and extremely common in resource-poor communities of the developing world. The extensive use of pediculicides with a neurotoxic mode of action has led to the development and spread of resistant head lice populations all over the world. This triggered the development of compounds with other modes of action. The current literature on treatment approaches of head lice infestation was searched, and published randomized controlled trials were critically analyzed. The following compounds/family of compounds were identified: spinosad, a novel compound with a new neurotoxic mode of action, isopropyl myristate, 1,2-octanediol, ivermectin, plant-based products, and dimeticones. The efficacy and safety of these compounds are reviewed and recommendations for the treatment of pediculosis capitis in individuals as well as the interruption of ongoing epidemics are provided.

  12. Candidiasis: a fungal infection--current challenges and progress in prevention and treatment.

    Science.gov (United States)

    Hani, Umme; Shivakumar, Hosakote G; Vaghela, Rudra; Osmani, Riyaz Ali M; Shrivastava, Atul

    2015-01-01

    Despite therapeutic advances candidiasis remains a common fungal infection most frequently caused by C. albicans and may occur as vulvovaginal candidiasis or thrush, a mucocutaneous candidiasis. Candidiasis frequently occurs in newborns, in immune-deficient people like AIDS patients, and in people being treated with broad spectrum antibiotics. It is mainly due to C. albicans while other species such as C. tropicalis, C. glabrata, C. parapsilosis and C. krusei are increasingly isolated. OTC antifungal dosage forms such as creams and gels can be used for effective treatment of local candidiasis. Whereas, for preventing spread of the disease to deeper vital organs, candidiasis antifungal chemotherapy is preferred. Use of probiotics and development of novel vaccines is an advanced approach for the prevention of candidiasis. Present review summarizes the diagnosis, current status and challenges in the treatment and prevention of candidiasis with prime focus on host defense against candidiasis, advancements in diagnosis, probiotics role and recent progress in the development of vaccines against candidiasis.

  13. Current and future treatment options for adult chronic rhinosinusitis: Focus on nasal polyposis.

    Science.gov (United States)

    Bachert, Claus; Zhang, Luo; Gevaert, Phillippe

    2015-12-01

    Chronic rhinosinusitis (CRS) affects more than 10% of the population in the United States and Europe. Recent findings point to a considerable variation of inflammatory subtypes in patients with CRS with nasal polyps and patients with CRS without nasal polyps. According to current guidelines, glucocorticosteroids and antibiotics are the principle pharmacotherapeutic approaches; however, they fail in a group of patients who share common clinical and laboratory markers. Several clinical phenotypes often leading to uncontrolled disease, including adult nasal polyposis, aspirin-exacerbated respiratory disease, and allergic fungal rhinosinusitis, are characterized by a common endotype: a TH2 bias is associated with a higher likelihood of comorbid asthma and recurrence after surgical treatment. As a consequence, several innovative approaches targeting the TH2 bias with humanized mAbs have been subjected to proof-of-concept studies in patients with CRS with nasal polyps with or without comorbid asthma: omalizumab, reslizumab, mepolizumab, and recently dupilumab. Future concepts using upstream targets, such as GATA-3, also focus on this endotype. This current development might result in advantages in the treatment of patients with the most severe CRS.

  14. 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

  15. [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.

  16. Clinical approach in treatment of resistant hypertension

    Directory of Open Access Journals (Sweden)

    Jennifer Frank

    2009-07-01

    Full Text Available Jennifer Frank, David SommerfeldUniversity of Wisconsin School of Medicine and Public Health, Department of Family Medicine, Appleton, WI, USAAbstract: Resistant hypertension, defined as failure to achieve target blood pressure despite the use of optimal or maximum doses of at least 3 agents, one of which is a diuretic, or requiring 4 or more medications to achieve blood pressure goal, is likely to affect up to 20% of all patients with hypertension. Apparent resistant hypertension may be caused by medication nonadherence, substances that either interfere with antihypertensive mediations or cause blood pressure elevation, and under- or inappropriate medication treatment. Certain patient characteristics are associated with the presence of resistant hypertension and include chronic kidney disease, diabetes, obesity, and presence of end-organ damage (microalbuminuria, retinopathy, left-ventricular hypertrophy. Secondary causes of resistant hypertension are not uncommon and include obstructive sleep apnea, chronic kidney disease, primary aldosteronism, renal artery stenosis, pheochromocytoma, and Cushing’s disease. Initial medication management usually includes adding or increasing the dose of a diuretic, which is effective in lowering the blood pressure of a large number of patients with resistant hypertension. Additional management options include maximizing lifestyle modification, combination therapy of antihypertensive agents depending on individual patient characteristics, adding less-commonly used fourth- or fifth-line antihypertensive agents, and referral to a hypertension specialist.Keywords: resistant hypertension, blood pressure, diuretic

  17. Mialgias: Approaches to differential diagnosis, treatment

    Directory of Open Access Journals (Sweden)

    Nadezhda Aleksandrovna Shostak

    2013-01-01

    Full Text Available Differential diagnosis in muscle pains often presents great difficulties so all existing signs of the disease should be carefully considered to make its diagnosis and to prescribe adequate therapy. The paper considers the causes of muscle pains, laboratory and instrumental studies (immunological tests, determination of the level of specific muscular enzymes, primarily creatine phosphokinase – CPK, etc., and the main reasons for enhanced plasma CPK activity. It also describes acute and chronic mialgias associated with enhanced plasma CPK activity, as well as diseases in which mialgias are related to the normal level of CPK, myofascial syndrome (MFS and fibromyalgia (FM in particular. The characteristic features of MFS are given in its diagnostic criteria. It is stated that a differential diagnosis should be made between MFS and major muscle pain-associated abnormalities, such as polymyalgia rheumatica, FM, etc. Diagnosticcriteria for polymyalgia rheumatica are given. A MFS treatment algorithm is presented. Local exposure methods applied to altered musculoligamentous structures in combination with myorelaxants and non-steroidal anti-inflammatory drugs assume paramount importance in MFS.

  18. [Treatment approaches for synthetic drug addiction].

    Science.gov (United States)

    Kobayashi, Ohji

    2015-09-01

    In Japan, synthetic drugs have emerged since late 2000s, and cases of emergency visits and fatal traffic accidents due to acute intoxication have rapidly increased. The synthetic drugs gained popularity mainly because they were cheap and thought to be "legal". The Japanese government restricted not only production and distribution, but also its possession and use in April 2014. As the synthetic drug dependent patients have better social profiles compared to methamphetamine abusers, this legal sanction may have triggered the decrease in the number of synthetic drug dependent patient visits observed at Kanagawa Psychiatric Center since July 2014. Treatment of the synthetic drug dependent patients should begin with empathic inquiry into the motives and positive psychological effects of the drug use. In the maintenance phase, training patients to trust others and express their hidden negative emotions through verbal communications is essential. The recovery is a process of understanding the relationship between psychological isolation and drug abuse, and gaining trust in others to cope with negative emotions that the patients inevitably would face in their subsequent lives.

  19. 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.

  20. 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

  1. [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.

  2. 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.

  3. 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

  4. 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.

  5. 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

  6. Meson-exchange currents and quasielastic predictions for charged-current neutrino-12C scattering in the superscaling approach

    CERN Document Server

    Megias, G D; Moreno, O; Williamson, C F; Caballero, J A; Gonzalez-Jimenez, R; De Pace, A; Barbaro, M B; Alberico, W M; Nardi, M; Amaro, J E

    2014-01-01

    We evaluate and discuss the impact of meson-exchange currents (MEC) on charged-current quasielastic (QE) neutrino cross sections. We consider the nuclear transverse response arising from 2p-2h states excited by the action of electromagnetic, purely isovector meson-exchange currents in a fully relativistic framework, based on the work by the Torino collaboration [1]. An accurate parametrization of this MEC response as a function of the momentum and energy transfers involved is presented. Results of neutrino-nucleus cross sections using this MEC parametrization together with a recent scaling approach for the 1p-1h contributions (SuSAv2) are compared with experimental data (MiniBooNE, MINERvA, NOMAD and T2K Collaborations).

  7. Immunotherapy in castration-resistant prostate cancer: integrating sipuleucel-T into our current treatment paradigm.

    Science.gov (United States)

    Garcia, Jorge A; Dreicer, Robert

    2011-03-01

    The availability of several novel antibodies, coupled with viral, DNA, and dendritic-cell vaccines, has renewed interest in immunotherapeutic approaches to the treatment of advanced prostate cancer. Although promising, none of these approaches have led to major clinical activity, and in the case of cell-based immunotherapy with GVAX, new concerns about safety arose when this therapy was used in the castration-resistant setting. A more attractive yet toxic approach has also utilized a check-point blockade with CTLA-4 antibodies. Although initial clinical efficacy has been observed, toxicity appears to be the major limitation of its use in prostate cancer. Sipuleucel-T (Provenge) is an autologous active cellular immunotherapy product that includes autologous dendritic cells pulsed ex vivo with PAP2024, a recombinant fusion protein made of prostatic acid phosphataase (PAP) and granulocyte-macrophage colony-stimulating factor (GM-CSF). Despite the lack of objective anti-tumor activity seen with sipuleucel-T, a recently reported phase III trial demonstrated a significant improvement in the overall survival of men with asymptomatic, minimally symptomatic metastatic castration-resistant prostate cancer (CRPC). This agent is the first FDA-approved novel immunotherapeutic compound for the treatment of a solid malignancy. A better understanding of how clinicians should incorporate this novel agent into the current management of CRPC is needed.

  8. 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.

  9. 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

  10. 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...

  11. 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.

  12. 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

  13. [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.

  14. Substance use and Dependency Problems, Psychotherapeutic Approaches and Special Treatment Approaches for Girls and Women

    NARCIS (Netherlands)

    Vogt, I.

    2010-01-01

    Evidenced-based research shows that we can draw on a number of efficient treatments for substance use problems. Best researched and evaluated are treatment approaches which are derived from cognitive behavior therapy (CBT). Dialectic behaviour therapy is most useful for the treatment of women (and m

  15. Superiority of preventive antibiotic treatment compared with standard treatment of poststroke pneumonia in experimental stroke: a bed to bench approach

    Science.gov (United States)

    Hetze, Susann; Engel, Odilo; Römer, Christine; Mueller, Susanne; Dirnagl, Ulrich; Meisel, Christian; Meisel, Andreas

    2013-01-01

    Stroke patients are prone to life-threatening bacterial pneumonia. Previous experimental stroke studies have demonstrated that preventive antibiotic treatment (PAT) improves outcome compared with placebo treatment, which however does not model the clinical setting properly. Here we investigate whether PAT is superior to the current clinical ‘gold standard' for treating poststroke infections. Therefore, we modeled stroke care according to the current stroke guidelines recommending early antibiotic treatment after diagnosing infections. To reliably diagnose pneumonia in living mice, we established a general health score and a magnetic resonance imaging protocol for radiologic confirmation. Compared with standard treatment after diagnosis by these methods, PAT not only abolished pneumonia successfully but also improved general medical outcome. Both, preventive and standard antibiotic treatment using enrofloxacin improved survival in a similar way compared with placebo treatment. However, in contrast to standard treatment, only PAT improved functional outcome assessed by gait analysis. In conclusion, standard and preventive treatment approach reduced poststroke mortality, however at the cost of a worse neurologic outcome compared with preventive approach. These data support the concept of PAT for treating patients at risk for poststroke infections and warrant phase III trials to prove this concept in clinical setting. PMID:23361393

  16. Adolescents and Learning Disability: An Approach to Treatment.

    Science.gov (United States)

    Pabis, Roman

    A treatment approach to adolescents with learning disabilities which incorporates remediation and psychotherapy is explored through two case studies of two youngsters (ages 14 and 17). After a review of earlier studies, the author focuses on the diagnosis and treatment of a 17 year old boy with a ninth grade education. Once a diagnosis of dyslexia…

  17. Treatment of Conduct Disorder with a Multisystemic and Multimodal Approach

    Science.gov (United States)

    Ubinger, Nicole

    2006-01-01

    Conduct disorder is a childhood disorder that is often resistant to treatment. Current treatment methods often focus on separate interventions for each environment that the child or adolescent is exhibiting antisocial behavior. Additionally the focus is on the behavior of the child and often does not focus on the family unit or the biology behind…

  18. Current and future approaches to treat graft failure after allogeneic hematopoietic stem cell transplantation.

    Science.gov (United States)

    Locatelli, Franco; Lucarelli, Barbarella; Merli, Pietro

    2014-01-01

    One significant obstacle to the success of allogeneic hematopoietic stem cell transplantation (HSCT) is represented by graft failure, defined as either lack of initial engraftment of donor cells (primary graft failure) or loss of donor cells after initial engraftment (secondary graft failure). Graft failure mediated by host immune cells attacking donor stem cells is named graft rejection. Factors associated with graft failure include HLA disparity in the donor/recipient pair, underlying disease, viral infections, type of conditioning regimen and stem cell source employed. In this article, the experts summarize current approaches to treat graft failure/rejection after HSCT, and they discuss new strategies of graft manipulation and immune therapy of particular interest for preventing/treating this complication. A limited array of options is available to treat graft failure. The experts believe that re-transplantation from another donor or the same donor (if there is no evidence of immunologically mediated graft failure) is the treatment of choice for patients with primary graft failure or acute graft rejection. The experts think that strategies based on innovative approaches of graft manipulation, new agents or cellular therapies could render in the future graft failure a much less relevant problem for HSCT recipients.

  19. Current Advance and Future Prospects of Tissue Engineering Approach to Dentin/Pulp Regenerative Therapy

    Directory of Open Access Journals (Sweden)

    Ting Gong

    2016-01-01

    Full Text Available Recent advances in biomaterial science and tissue engineering technology have greatly spurred the development of regenerative endodontics. This has led to a paradigm shift in endodontic treatment from simply filling the root canal systems with biologically inert materials to restoring the infected dental pulp with functional replacement tissues. Currently, cell transplantation has gained increasing attention as a scientifically valid method for dentin-pulp complex regeneration. This multidisciplinary approach which involves the interplay of three key elements of tissue engineering—stem cells, scaffolds, and signaling molecules—has produced an impressive number of favorable outcomes in preclinical animal studies. Nevertheless, many practical hurdles need to be overcome prior to its application in clinical settings. Apart from the potential health risks of immunological rejection and pathogenic transmission, the lack of a well-established banking system for the isolation and storage of dental-derived stem cells is the most pressing issue that awaits resolution and the properties of supportive scaffold materials vary across different studies and remain inconsistent. This review critically examines the classic triad of tissue engineering utilized in current regenerative endodontics and summarizes the possible techniques developed for dentin/pulp regeneration.

  20. Current Advance and Future Prospects of Tissue Engineering Approach to Dentin/Pulp Regenerative Therapy.

    Science.gov (United States)

    Gong, Ting; Heng, Boon Chin; Lo, Edward Chin Man; Zhang, Chengfei

    2016-01-01

    Recent advances in biomaterial science and tissue engineering technology have greatly spurred the development of regenerative endodontics. This has led to a paradigm shift in endodontic treatment from simply filling the root canal systems with biologically inert materials to restoring the infected dental pulp with functional replacement tissues. Currently, cell transplantation has gained increasing attention as a scientifically valid method for dentin-pulp complex regeneration. This multidisciplinary approach which involves the interplay of three key elements of tissue engineering-stem cells, scaffolds, and signaling molecules-has produced an impressive number of favorable outcomes in preclinical animal studies. Nevertheless, many practical hurdles need to be overcome prior to its application in clinical settings. Apart from the potential health risks of immunological rejection and pathogenic transmission, the lack of a well-established banking system for the isolation and storage of dental-derived stem cells is the most pressing issue that awaits resolution and the properties of supportive scaffold materials vary across different studies and remain inconsistent. This review critically examines the classic triad of tissue engineering utilized in current regenerative endodontics and summarizes the possible techniques developed for dentin/pulp regeneration.

  1. Current Advance and Future Prospects of Tissue Engineering Approach to Dentin/Pulp Regenerative Therapy

    Science.gov (United States)

    Gong, Ting; Heng, Boon Chin; Lo, Edward Chin Man; Zhang, Chengfei

    2016-01-01

    Recent advances in biomaterial science and tissue engineering technology have greatly spurred the development of regenerative endodontics. This has led to a paradigm shift in endodontic treatment from simply filling the root canal systems with biologically inert materials to restoring the infected dental pulp with functional replacement tissues. Currently, cell transplantation has gained increasing attention as a scientifically valid method for dentin-pulp complex regeneration. This multidisciplinary approach which involves the interplay of three key elements of tissue engineering—stem cells, scaffolds, and signaling molecules—has produced an impressive number of favorable outcomes in preclinical animal studies. Nevertheless, many practical hurdles need to be overcome prior to its application in clinical settings. Apart from the potential health risks of immunological rejection and pathogenic transmission, the lack of a well-established banking system for the isolation and storage of dental-derived stem cells is the most pressing issue that awaits resolution and the properties of supportive scaffold materials vary across different studies and remain inconsistent. This review critically examines the classic triad of tissue engineering utilized in current regenerative endodontics and summarizes the possible techniques developed for dentin/pulp regeneration. PMID:27069484

  2. 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

  3. 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...

  4. 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.

  5. 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...

  6. 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 ...

  7. 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 ...

  8. 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 ...

  9. 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

  10. 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.

  11. 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...

  12. 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

  13. 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

  14. 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

  15. A Novel Approach to Evaluate the Benefits of Casing Treatment in Axial Compressors

    Directory of Open Access Journals (Sweden)

    Guillaume Legras

    2012-01-01

    Full Text Available Passive control devices based on casing treatments have already shown their capability to improve the flow stability in axial compressors. However, their optimization remains complex due to a partial understanding of the related physical mechanisms. In order to quantitatively assess the interaction between slots and the blade tip flow, the present paper develops a novel analysis methodology based on a control-volume approach located in the rotor tip region. This methodology may be used for analyzing the casing treatment based on both axi- and non-axisymmetric slots design. The second issue of the paper focuses on the application of the current approach to better understand the effects of axi- and non-axisymmetric grooves in three different axial compressors which differ by the flow regime (subsonic/transonic and the smooth casing shape (cylindrical/concave. Numerical simulations are performed, and results of the current approach with and without casing treatments are compared.

  16. Approach to osteomyelitis treatment with antibiotic loaded PMMA.

    Science.gov (United States)

    Wentao, Zhang; Lei, Guangyu; Liu, Yang; Wang, Wei; Song, Tao; Fan, Jinzhu

    2017-01-01

    To reduce the incidence of osteomyelitis infection, local antibiotic impregnated delivery systems are commonly used as a promising and effective approach to deliver high antibiotic concentrations at the infection site. The objective of this review was to provide a literature review regarding approach to osteomyelitis treatment with antibiotic loaded PMMA. Literature study regarding osteomyelitis treatment with antibiotic loaded carriers using key terms Antibiotic, osteomyelitis, biodegradable PMMA through published articles. Hands searching of bibliographies of identified articles were also undertaken. We concluded that Antibiotic-impregnated PMMA beads are useful options for the treatment of osteomyelitis for prolonged drug therapy. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. Modulating Endogenous Electric Currents in Human Corneal Wounds—A Novel Approach of Bioelectric Stimulation Without Electrodes

    Science.gov (United States)

    Reid, Brian; Graue-Hernandez, Enrique O.; Mannis, Mark J.; Zhao, Min

    2011-01-01

    Purpose To measure electric current in human corneal wounds and test the feasibility of pharmacologically enhancing the current to promote corneal wound healing. Methods Using a noninvasive vibrating probe, corneal electric current was measured before and after wounding of the epithelium of donated postmortem human corneas. The effects of drug aminophylline and chloride-free solution on wound current were also tested. Results Unwounded cornea had small outward currents (0.07 μA/cm2). Wounding increased the current more than 5 fold (0.41 μA/cm2). Monitoring the wound current over time showed that it seemed to be actively regulated and maintained above normal unwounded levels for at least 6 hours. The time course was similar to that previously measured in rat cornea. Drug treatment or chloride-free solution more than doubled the size of wound currents. Conclusions Electric current at human corneal wounds can be significantly increased with aminophylline or chloride-free solution. Because corneal wound current directly correlates with wound healing rate, our results suggest a role for chloride-free and/or aminophylline eyedrops to enhance healing of damaged cornea in patients with reduced wound healing such as the elderly or diabetic patient. This novel approach offers bioelectric stimulation without electrodes and can be readily tested in patients. PMID:21099404

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

    Directory of Open Access Journals (Sweden)

    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. 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

  1. 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.

  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. 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. Clinical utility of ulipristal acetate for the treatment of uterine fibroids: current evidence

    Directory of Open Access Journals (Sweden)

    Trefoux Bourdet A

    2015-03-01

    Full Text Available Alice Trefoux Bourdet, Dominique Luton, Martin Koskas Department of Obstetrics and Gynecology, Bichat University Hospital, Paris Diderot University, Paris, France Abstract: Uterine myoma is the most common benign uterine tumor in women of reproductive age and occurs in 20%–25% of the worldwide population. No currently approved medical treatment is able to completely eliminate fibroids. Surgery, particularly hysterectomy, predominates as the treatment strategy of choice, even though it is associated with risks and complications and causes infertility. Until recently, gonadotropin-releasing hormone agonists were the only available drugs for the preoperative treatment of fibroids. However, ulipristal acetate (UPA, an oral selective progesterone receptor modulator, was recently licensed in Europe for the same indication. Recent studies have demonstrated the efficacy and safety of UPA in the medical management of fibroids before surgery, with a better tolerability profile than leuprolide acetate. Analyzing the literature, we identified new management strategies involving UPA and surgery, considering advantages of both medical and surgical therapy. The advent of UPA will undoubtedly modify the surgical approach to fibroids, but the heterogeneity of these possible indications now requires various original clinical studies to identify the optimal indications for UPA in patients with symptomatic fibroid(s. Keywords: uterine fibroids, medical treatment, selective progesterone receptor modulator, ulipristal acetate, surgery

  7. Current treatment options for gastroenteropancreatic neuroendocrine tumors with a focus on the role of lanreotide.

    Science.gov (United States)

    Kos-Kudła, Beata; Ćwikła, Jarosław; Ruchała, Marek; Hubalewska-Dydejczyk, Alicja; Jarzab, Barbara; Krajewska, Jolanta; Kamiński, Grzegorz

    2017-01-01

    Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are a large and very diverse group of neoplasms. Clinical presentation of NETs depends on the site of the primary tumor and whether the tumor is functioning (i.e., secreting peptides or neuroamines that produce symptoms). The diagnosis of GEP-NET is further complicated by symptomatic differences that occur depending on the type of secreted peptide or neuroamine. Due to their heterogeneity and unique characteristics, early diagnosis of GEP-NETs is difficult, which increases the likelihood of metastatic disease and reduces the scope of therapeutic possibilities. Thus, a multidisciplinary approach for the treatment of GEP-NETs is necessary. This review is the result of presentations that were delivered during an expert meeting on the treatment of GEP-NETs supported by Ipsen. We summarize the current knowledge on the epidemiology, incidence, diagnosis, and treatment of GEP-NETs. We examined the role of the somatostatin analog (SSA) lanreotide and the impact of the data from the recently published, randomized, double-blind, placebo-controlled CLARINET study (Controlled study of Lanreotide Antiproliferative Response In Neuroendocrine Tumors) on disease management. We also review the recent treatment options and recommendations for GEP-NETs.

  8. 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.

  9. [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.

  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. 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.

  12. 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.

  13. National Conference on Mining-Influenced Waters: Approaches for Characterization, Source Control and Treatment

    Science.gov (United States)

    The conference goal was to provide a forum for the exchange of scientific information on current and emerging approaches to assessing characterization, monitoring, source control, treatment and/or remediation on mining-influenced waters. The conference was aimed at mining remedi...

  14. Not Another Quiz: An Approach to Engage Today's Students in Meaningful Current Events Discussions

    Science.gov (United States)

    Wright, Leigh L.; Shemberger, Melony; Price, Elizabeth

    2016-01-01

    Journalism professors are concerned with how effectively students understand current news events and engage with mainstream news sources. This essay is based on a survey administered to students in a newswriting course and analyzed the kinds of current news that students followed in weekly assignments designed with a digital, interactive approach.…

  15. 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

  16. Tuberculosis treatment --new approach to an old problem

    Institute of Scientific and Technical Information of China (English)

    Lakshmi Kiran Chelluri; Prasad C E; Murthy K J R; Ratnakar K S

    2009-01-01

    Chronic mycobacterium infections are major causes of disease burden of 20% in a tropical country like India. The inflammatory cascade following these bacterial infections often leads to tissue damage and perpetuates nec-rosis,fibrosis and the disease process.Pulmonary tuberculosis,multi-drug resistant tuberculosis not only af-fects individuals but society at large.Current remedial measures using various technology platforms singularly did not produce effective and appreciable reduction in global disease burden.On the contrary,the conventional chemotherapeutic chemical moieties have demonstrated variable pharmacogenomic expression,increased drug resistance,non compliance of strict prolonged drug regimens with debilitating side effects and contraindica-tions.Furthermore,secreted inflammatory cytokines results in chronic infection,immune deviation,and im-munopathology in the lungs.Hence,identification of immune escape mechanisms leading to chronic mycobac-terial infections is crucial for development of new treatments.The review would dwell into the basic pathogenic mechanism and the newer approaches that may need to be considered for developing novel therapeutic strate-gies.

  17. National Treatment and American Foreign Policy - The Evolution of National Treatment Approaches in International Trade

    OpenAIRE

    Kucherepa, Peter

    2006-01-01

    The National Treatment Clause, Article 1102 of the North American Free Trade Agreement, protects foreign investors from discrimination, including expropriation of their investments. This national treatment approach - equal treatment of foreign investors and local investors by states - was developed to encourage investment in Europe after the Second World War. Over the course of fifty years, the approach has evolved to provide foreign investors with protections over and above those provided to...

  18. Current status of bariatric surgery in the treatment of type 2 diabetes.

    Science.gov (United States)

    Pinkney, J; Kerrigan, D

    2004-02-01

    Bariatric surgery (from the Greek words baros meaning 'weight' and iatrikos 'the art of healing') is a rapidly evolving branch of surgical science. The aim is to induce major weight loss in those whose obesity places them at high risk of serious health problems. In an attempt to balance the risks of surgery against the benefits of weight loss, bariatric operations are currently performed only in the morbidly obese, or those with a body mass index (BMI) > 35 kgm(-2) who already have developed comorbidity such as type 2 diabetes. Although weight loss is beneficial for obese patients with diabetes, current medical treatment for obesity is difficult. In contrast, observational studies show a major impact of bariatric surgery on diabetes, raising the question whether this approach should be used more widely to treat diabetes in obese patients? If bariatric surgery were shown to be the best way to treat diabetes in obese subjects the implications for health services would be wide-ranging. Bariatric surgery leads to withdrawal of diabetic treatment in about 60% or more of patients, and reductions of therapy for many others. Although data on bariatric surgery in subjects with diabetes are provocative, most studies have been uncontrolled or flawed in other ways. Most importantly, bariatric surgery has not yet been compared against standard medical treatment for diabetes in randomized controlled trials with diabetes-specific endpoints in all relevant patient groups. Potential indications for bariatric surgery are discussed, and the unanswered questions that need to be addressed by clinical trials are summarized. Although small numbers of patients may be interested in bariatric surgery for type 2 diabetes, current data are insufficient to endorse its wide scale use for this indication. Until essential studies are undertaken the role and economics of bariatric surgery in the diabetic clinic will remain uncertain.

  19. 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.

  20. 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.