Sample records for prolonged treatment period

  1. Deciding about treatments that prolong life

    Palliative care - treatments that prolong life; Palliative care - life support; End-of-life-treatments that prolong life; Ventilator - treatments that prolong life; Respirator - treatments that prolong life; ...

  2. Treatment of postcatheterization femoral arteriovenous fistulas with simple prolonged bandaging

    ZHOU Tao; LIU Zhen-jiang; ZHOU Sheng-hua; SHEN Xiang-qian; LIU Qi-ming; FANG Zhen-fei; HU Xin-qun; LI Jiang; L(U) Xiao-lin


    Background The methods for the treatment of postcatheterization femoral arteriovenous fistulas (AVF-s) - simple observation, ultrasound guided compression, covered stents implantation and coil embolization have poor outcome.Surgery is the standard method for treatment of femoral AVFs, but it is a traumatic operation. In this study, we report the results of the treatment of postcatheterization femoral AVFs by simple prolonged compressing bandage.Methods To treat iatrogenic femoral AVFs caused by transfemoral catheterization, prolonged binding with elastic or common bandage was applied in 16 cases. Catheterization was performed in 7 cases for radiofrequency current catheter ablation, in 4 for occlusion of congenital heart disease, in 3 for percutaneous coronary intervention, in 1 for coronary angiography and in 1 for right heart catheterization.Results All iatrogenic femoral AVFs were healed after simple binding with elastic or common bandage for 4-46 days (mean (15±10) days). During the period of binding, local skins ulceration occurred at puncture site in two cases and femoral vein thrombus was found in one patient. During 6-24 months (mean (11.8±3.6) months) followup with colour Doppler ultrasonography, no recurrent arteriovenous shunting or other complications were observed.Conclusion The results suggest that simple prolonged bandaging for postcatheterization femoral AVFs is an effective and economical procedure.

  3. Treatment for periodic paralysis.

    Sansone, V; Meola, G; Links, T P; Panzeri, M; Rose, M R


    Primary periodic paralyses are rare inherited muscle diseases characterised by episodes of flaccid weakness affecting one or more limbs, lasting several hours to several days, caused by mutations in skeletal muscle channel genes. The objective of this review was to systematically review treatment of periodic paralyses. We searched the Cochrane Neuromuscular Disease Group Trials Register, MEDLINE (from January 1966 to July 2007), and EMBASE (from January 1980 to July 2007) and any other available international medical library sources from the University of Milan for randomised trials. We included randomised (including cross-over studies) and quasi-randomised trials in participants with primary periodic paralyses, in which any form of treatment, including physical therapy and alternative therapies, was compared to placebo or another treatment. Our primary outcome measure was the change in attack severity or frequency by eight weeks from the start of treatment. Our secondary outcome measures were: change in muscle strength and mass; change in Quality of Life, using Short Form 36 (SF36) or similar; preference of treatment strategy; adverse effects at eight weeks. Three studies met our inclusion criteria. In one study dichlorphenamide (DCP) vs placebo was tested in two groups of participants: 42 with hypokalemic periodic paralysis (HypoPP) and 31 with hyperkalemic periodic paralysis (HyperPP), based on clinical criteria. Thirty-four of 42 participants with hypokalemic periodic paralysis completed both treatment phases. For the 34 participants having attack rate data for both treatment phases, the mean improvement in attack rate (P = 0.02) and severity-weighted attack rate (P = 0.01) on DCP relative to placebo were statistically significant. Fifteen preferred DCP, three placebo and six their baseline medication. Twenty-four of 31 participants with hyperkalemic periodic paralysis completed both treatment phases: for the 16 participants who had attack rate data for both

  4. Risk Factors for Prolonged Treatment of Whiplash-Associated Disorders.

    Hiroyuki Oka

    Full Text Available Whiplash-associated disorders (WAD are the most common injuries that are associated with car collisions in Japan and many Western countries. However, there is no clear evidence regarding the potential risk factors for poor recovery from WAD. Therefore, we used an online survey of the Japanese population to examine the association between potential risk factors and the persistence of symptoms in individuals with WAD.An online survey was completed by 127,956 participants, including 4,164 participants who had been involved in a traffic collision. A random sample of the collision participants (n = 1,698 were provided with a secondary questionnaire. From among the 974 (57.4% respondents to the secondary questionnaire, we selected 183 cases (intractable neck pain that was treated over a period of 6 months and 333 controls (minor neck pain that was treated within 3 months. Multivariable logistic regression analysis was used to evaluate the potential risk factors for prolonged treatment of WAD.Female sex, the severity of the collision, poor expectations of recovery, victim mentality, dizziness, numbness or pain in the arms, and lower back pain were associated with a poor recovery from WAD.In the present study, the baseline symptoms (dizziness, numbness or pain in the arms, and lower back pain had the strongest associations with prolonged treatment for WAD, although the psychological and behavioral factors were also important. These risk factors should be considered when evaluating patients who may have the potential for poor outcomes.

  5. Prolonged incubation period of imported P. vivax malaria in London.

    Warwick, R; Swimer, G J; Britt, R P


    Between January 1976 and July 1979, 453 cases of malaria were seen at Hillingdon Hospital. The majority of cases were Plasmodium vivax infections in Asians from the Punjab in Northern India-either new immigrants or United Kingdom resident Asians returning from holidays. Twenty-four cases were contracted in Africa or the Middle East. Figures are presented showing a considerable increase in cases during the period of study. In P. vivax infections the time interval between arrival and development of the acute illness was significantly greater for those subjects entering the United Kingdom in autumn or winter.

  6. Picasso's prolonged adolescence, Blue Period, and blind figures.

    Blum, Harold P


    This paper explores early issues of separation-individuation, unconscious conflict, and trauma, revived and reworked in Picasso's turbulent protracted adolescence. During this critical period Picasso traveled between Barcelona and Paris four times, from age 19 to 23. His melancholic mood, related both to separation conflict and the current realities of his uprooted life and emerging career, was expressed in his painting of emaciated, despondent figures, the predominance of monochromatic blue, and his choice of social outcasts as subjects. Of particular significance are his paintings of blind persons. Separation and loss, his depressive disposition, and his choice of blind subjects were psychologically interrelated. Picasso's developmental transformation from adolescence to adulthood, marked by his finally settling in Paris, encompassed change in his personal and artistic identity.

  7. Atria selective prolongation by NIP-142, an antiarrhythmic agent, of refractory period and action potential duration in guinea pig myocardium.

    Matsuda, Tomoyuki; Takeda, Kentaro; Ito, Mie; Yamagishi, Reiko; Tamura, Miku; Nakamura, Hideki; Tsuruoka, Noriko; Saito, Tomoaki; Masumiya, Haruko; Suzuki, Takeshi; Iida-Tanaka, Naoko; Itokawa-Matsuda, Maho; Yamashita, Toru; Tsuruzoe, Nobutomo; Tanaka, Hikaru; Shigenobu, Koki


    NIP-142 is a novel benzopyran compound that was shown to prolong the atrial effective refractory period and terminate experimental atrial fibrillation in the dog. In the present study, we examined the effects of NIP-142 on isolated guinea pig myocardium and on the G-protein-coupled inwardly rectifying potassium channel current (acetylcholine-activated potassium current; I(KACh)) expressed in Xenopus oocytes. NIP-142 (10 and 100 microM) concentration-dependently prolonged the refractory period and action potential duration in the atrium but not in the ventricle. E-4031 and 4-aminopyridine prolonged action potential duration in both left atrium and right ventricle. Prolongation by NIP-142 of the atrial action potential duration was observed at stimulation frequencies between 0.5 and 5 Hz. In contrast, the prolongation by E-4031 was not observed at higher frequencies. Tertiapin, a blocker of I(KACh), prolonged action potential duration in the atrium but not in the ventricle. NIP-142 completely reversed the carbachol-induced shortening of atrial action potential duration. NIP-142 (1 to 100 microM), as well as tertiapin (0.1 to 100 nM), concentration-dependently blocked I(KACh) expressed in Xenopus oocytes; the blockade by NIP-142 was not affected by membrane voltage. In conclusion, NIP-142 was shown to prolong atrial refractory period and action potential duration through blockade of I(KACh) which may possibly explain its previously described antiarrhythmic activity. NIP-142 has pharmacological properties that are different from classical class III antiarrhythmic agents such as atria specificity and lack of reverse frequency dependence, and thus appears promising for the treatment of supraventricular arrhythmia.

  8. Treatment for periodic paralysis

    Sansone, [No Value; Meola, G.; Links, T. P.; Panzeri, M.; Rose, M. R.


    Background Primary periodic paralyses are rare inherited muscle diseases characterised by episodes of flaccid weakness affecting one or more limbs, lasting several hours to several days, caused by mutations in skeletal muscle channel genes. Objectives The objective of this review was to systematical

  9. Treatment for periodic paralysis

    Sansone, [No Value; Meola, G.; Links, T. P.; Panzeri, M.; Rose, M. R.


    Background Primary periodic paralyses are rare inherited muscle diseases characterised by episodes of flaccid weakness affecting one or more limbs, lasting several hours to several days, caused by mutations in skeletal muscle channel genes. Objectives The objective of this review was to systematical

  10. Prolonged Remission in Neuromyelitis Optica Following Cessation of Rituximab Treatment.

    Weinfurtner, Kelley; Graves, Jennifer; Ness, Jayne; Krupp, Lauren; Milazzo, Maria; Waubant, Emmanuelle


    Neuromyelitis optica is an autoimmune disease characterized by acute episodes of transverse myelitis and optic neuritis. Several small, open-label studies suggest rituximab, a monoclonal antibody against CD20, prevents relapses in neuromyelitis optica; however, there is little consensus on timing or duration of treatment. Here we report four patients with severe relapsing neuromyelitis optica who were stabilized on rituximab and, after discontinuing treatment, continued to experience prolonged remission of their disease. Remission ranged from 4.5 to 10.5 years total, including 3 to 9 years off all therapies. The patients had sustained clinical responses despite normal B-lymphocyte levels and, in at least 2 patients, continued seropositivity for aquaporin-4 antibodies. These cases suggest that rituximab may induce prolonged remission in certain neuromyelitis optica patients, and they highlight the need for further elucidation of rituximab's mechanism in neuromyelitis optica.

  11. Distinguishing among prolonged, recurrent, and periodic fever syndromes: approach of a pediatric infectious diseases subspecialist.

    Long, Sarah S


    Most children with prolonged, recurrent, or periodic fever are healthy and have self-limited, common illnesses, and the primary care practitioner usually can reassure families and continue to reassess the patient as circumstances dictate. For a child with true fever of unknown origin, a pediatric infectious diseases subspecialist should be consulted. This article discusses three objectives for the clinician: (1) to categorize patterns of fever illnesses and prioritize differential diagnoses; (2) to diagnose and manage the most frequently encountered prolonged fever syndrome, deconditioning; and (3) to expand knowledge and approach to diagnosing periodic fever syndromes. The approach described in this article represents the honed, 30-year experience of a pediatric infectious diseases subspecialist.

  12. Prolonged treatment of refractory status epilepticus in a child.

    Sahin, M; Riviello, J J


    Barbiturate anesthesia, which is commonly used for refractory status epilepticus, is an effective treatment, but with many significant complications. The relationship between the duration of this extreme therapy and the ultimate outcome of refractory status epilepticus has not been well studied. We report a 7-year-old girl who presented with refractory status epilepticus secondary to presumed encephalitis with a focal lesion on cranial magnetic resonance imaging. She was treated for 70 days with high-dose antiepileptic drugs and recovered with a residual seizure disorder. This case suggests that, if the status epilepticus is due to a reversible cause such as encephalitis, neurologic recovery may occur despite this very prolonged course of extreme therapy.

  13. Prolonged treatment with ursodeoxycholic acid for primary biliary cirrhosis.

    Crippa, G; Cagnoni, C; Castelli, A; Concesi, C; Girometta, S; Pancotti, D; Sverzellati, E; Tacchini, G; Pierfranceschi, M G; Carrara, G C


    Eighteen patients affected with biopsy-proved primary biliary cirrhosis (PBC) (histological stage III and IV) received ursodeoxicholic acid (UDCA) 600 mg for 1 year. Signs and symptoms and biochemical tests (glutamic and oxalcetic transaminase, glutamic and pyruvic transaminase, bilirubine, gamma-glutamyl transpeptidase, alkaline phosphatase, leucine aminopeptidase, bile acids, plasma proteins electrophoresis, immunoglubulins A, G and M) and antimitochondrial antibodies were evaluated before the treatment and every four months during the treatment. The results were compared with those obtained in 8 untreated patients affected PBC. The control group of patients were comparable (as far as age, histological stage, biochemical tests are concerned) to the group who received UDCA. Bilirubine, ALP, gamma-GT and LAP decreased during the treatment with UDCA and remained lower than baseline values until the end of the observation (12 months), while no changes occurred in the untreated patients. Both in the treated and untreated group plasma protein electrophoresis, serum immunoglubulins A, G and M remained unchanged, as well as anti-mitochondrial antibody. A moderate reduction of transaminases and bile acids was observed in the group of patients receiving UDCA but it did not reach statistical significance. In 16 out of the 18 treated patients pruritus disappeared and resulted diminished in the remaining 2 patients. No significant amelioration of pruritus was observed in the patients who did not receive UDCA. In conclusion, our data show that prolonged treatment with UDCA drastically reduces pruritus and improves cholestasis biochemical tests in patients affected with symptomatic PBC.(ABSTRACT TRUNCATED AT 250 WORDS)

  14. Diverse definitions of prolonged labour and its consequences with sometimes subsequent inappropriate treatment

    Nystedt, Astrid; Hildingsson, Ingegerd


    Background: Prolonged labour very often causes suffering from difficulties that may have lifelong implications. This study aimed to explore the prevalence and treatment of prolonged labour and to compare birth outcome and women's experiences of prolonged and normal labour. Method: Women with spontaneous onset of labour, living in a Swedish county, were recruited two months after birth, to a cross-sectional study. Women (n = 829) completed a questionnaire that investigated socio-demographic an...

  15. Sleep Duration and “on” Time during Different Periods of the Day and Night in Patients with Advanced Parkinson's Disease Receiving Adjunctive Ropinirole Prolonged Release

    Heinz Reichmann


    Full Text Available Patients undergoing long-term therapy for PD often experience motor fluctuations and nocturnal disturbances. In a post-hoc analysis, we explored effects of ropinirole prolonged release on sleep, night-time awakenings, and “on” time over 24 hours. Patients with advanced PD suboptimally controlled with L-dopa were randomized to adjunctive ropinirole prolonged release (2–24 mg/day or placebo for 24 weeks. Awake/asleep and, if awake, “on”/“off” status was recorded via diary cards. At week 24 last observation carried forward, changes in nighttime or daytime sleep duration were not significantly different between treatments. Of patients with baseline awakenings, a significantly higher proportion in the ropinirole prolonged release group had a reduction in awakenings versus placebo. Patients receiving ropinirole prolonged release had a significantly greater increase in amount/percentage of awake time “on”/“on” without troublesome dyskinesia during all periods assessed (including night-time and early morning, versus placebo, and higher odds for being “on” on waking. Adjunctive once-daily ropinirole prolonged release may help provide 24-hour symptom control in patients with advanced PD not optimally controlled with L-dopa.

  16. Sleep Duration and “on” Time during Different Periods of the Day and Night in Patients with Advanced Parkinson's Disease Receiving Adjunctive Ropinirole Prolonged Release

    Reichmann, Heinz; Cooper, James; Rolfe, Katie; Martinez-Martin, Pablo


    Patients undergoing long-term therapy for PD often experience motor fluctuations and nocturnal disturbances. In a post-hoc analysis, we explored effects of ropinirole prolonged release on sleep, night-time awakenings, and “on” time over 24 hours. Patients with advanced PD suboptimally controlled with L-dopa were randomized to adjunctive ropinirole prolonged release (2–24 mg/day) or placebo for 24 weeks. Awake/asleep and, if awake, “on”/“off” status was recorded via diary cards. At week 24 last observation carried forward, changes in nighttime or daytime sleep duration were not significantly different between treatments. Of patients with baseline awakenings, a significantly higher proportion in the ropinirole prolonged release group had a reduction in awakenings versus placebo. Patients receiving ropinirole prolonged release had a significantly greater increase in amount/percentage of awake time “on”/“on” without troublesome dyskinesia during all periods assessed (including night-time and early morning), versus placebo, and higher odds for being “on” on waking. Adjunctive once-daily ropinirole prolonged release may help provide 24-hour symptom control in patients with advanced PD not optimally controlled with L-dopa. PMID:21687750

  17. The impact of dissociation and depression on the efficacy of prolonged exposure treatment for PTSD

    Hagenaars, M.A.; Minnen, A. van; Hoogduin, C.A.L.


    This study investigates the impact of dissociative phenomena and depression on the efficacy of prolonged exposure treatment in 71 patients with posttraumatic stress disorder (PTSD). Diagnoses, comorbidity, pretreatment depressive symptoms, PTSD symptom severity, and dissociative phenomena (trait dis

  18. Quality assessment of palm products upon prolonged heat treatment.

    Tarmizi, Azmil Haizam Ahmad; Lin, Siew Wai


    Extending the frying-life of oils is of commercial and economic importance. Due to this fact, assessment on the thermal stability of frying oils could provide considerable savings to the food processors. In this study, the physico-chemical properties of five palm products mainly palm oil, single-fractionated palm olein, double-fractionated palm olein, red palm olein and palm-based shortening during 80 hours of heating at 180 degrees C were investigated. Heating properties of these products were then compared with that of high oleic sunflower oil, which was used as reference oil. The indices applied in evaluating the quality changes of oils were free fatty acid, smoke point, p-anisidine value, tocols, polar and polymer compounds. Three palm products i.e. palm oil, single-fractionated palm olein and double-fractionated palm olein were identified to be the most stable in terms of lower formation of free fatty acid, polar and polymer compounds as well as preserving higher smoke point and tocols content compared to the other three oils. The low intensity of hydrolytic and oxidative changes due to prolonged heating, suggests that these palm products are inherently suitable for frying purposes.

  19. Myoclonus during prolonged treatment with sertraline in an adolescent patient.

    Ghaziuddin, N; Iqbal, A; Khetarpal, S


    A 15-year-old female adolescent with depression developed myoclonus after uninterrupted treatment with sertraline over 6 years. She was also receiving methylphenidate. Withdrawal of sertraline and continuation of methylphenidate did not result in any improvement. Treatment with valproic acid resulted in improvement of the movement disorder. This report suggests that myoclonus may be a side effect of sertraline in some adolescents. Further, we hypothesized that extended treatment over several years, young age, and a compromised central nervous system due to underlying disorders may be risk factors for the development of this side effect.

  20. Fluorosis and periostitis deformans as complications of prolonged voriconazole treatment.

    Rad, Babak; Saleem, Mohamed; Grant, Susan; Florkowski, Christopher; Coates, Penelope; Gordon, David; Rankin, Wayne


    We describe a case of development of painful periostitis deformans in a 39-year-old woman who was receiving long-term voriconazole treatment for Aspergillus infection as a complication of orthotopic liver transplant. Measurement of fluoride levels strongly supports fluorosis to be the mechanism of the voriconazole-induced periostitis deformans and supports the concept that such measurements might be of use in predicting this complication of long-term voriconazole treatment.

  1. Antibiotic-eluting hydrophilized PMMA bone cement with prolonged bactericidal effect for the treatment of osteomyelitis.

    Oh, Eun Jo; Oh, Se Heang; Lee, In Soo; Kwon, Oh Soo; Lee, Jin Ho


    Osteomyelitis is still considered to be one of the major challenges for orthopedic surgeons despite advanced antiseptic surgical procedures and pharmaceutical therapeutics. In this study, hydrophilized poly(methyl methacrylate) (PMMA) bone cements containing Pluronic F68 (EG79PG28EG79) as a hydrophilic additive and vancomycin (F68-VAcements) were prepared to allow the sustained release of the antibiotic for adequate periods of time without any significant loss of mechanical properties. The compressive strengths of the bone cements with Pluronic F68 compositions less than 7 wt% were not significantly different compared with the control vancomycin-loaded bone cement (VAcement). TheF68 (7 wt%)-VAcement showed sustained release of the antibiotic for up to 11 weeks and almost 100% release from the bone cement. It also prohibited the growth ofS. aureus(zone of inhibition) over six weeks (the required period to treat osteomyelitis), and it did not show any notable cytotoxicity. From an animal study using a femoral osteomyelitis rat model, it was observed that theF68 (7 wt%)-VAcement was effective for the treatment of osteomyelitis, probably as a result of the prolonged release of antibiotic from the PMMA bone cement. On the basis of these findings, it can be suggested that the use of Pluronic F68 as a hydrophilic additive for antibiotic-eluting PMMA bone cement can be a promising strategy for the treatment of osteomyelitis.

  2. FTY720 treatment prolongs skin graft survival in a completely incompatible strain combination.

    Lima, R S M; Nogueira-Martins, M F; Silva, H T; Pestana, J O M; Bueno, V


    FTY720 has shown potent immunomodulatory activity in a variety of animal organ transplant models. However, the in vivo immunosuppressive mechanism of FTY720 is still not fully understood. It has been suggested that the marked decrease in the number of peripheral blood lymphocytes during FTY720 administration could be responsible for its immunosuppressive effects. Our aims were: (1) to study the effects of FTY720 treatment on skin graft survival using a fully mismatched strain combination and (2) to evaluate lymphocyte numbers in different sites at 5 days after skin transplant. C57BL/6 mice and BALB/c mice were the donors and recipients respectively. BALB/c mice received FTY720 (1 mg/kg/d) orally for 4 consecutive days. Drug administration started 1 day before skin transplants. A small segment of tail skin was affixed on the right dorsal side of the mouse via sutures. The administration of FTY720 (4 mg/kg) prolonged skin graft survival from 12.6 +/- 2.2 days (no treatment) to 16.6 +/- 4.2 days. The histologic findings of rejection were similar for all groups. Five days after transplant, lymphocyte numbers were significantly increased in lymph nodes compared with nontransplanted or isogenic graft mice. FTY720 decreased lymphocyte numbers only in the spleen. In conclusion, FTY720 prolonged skin graft survival in a fully mismatched strain combination when administered for 4 days (day -1 to day +2) at a dose of 1 mg/kg/d. The decreased number of lymphocytes in the spleen suggests that the spleen may be a target of FTY720 activity, during the early posttransplant period.

  3. Identifying Molecular Targets for PTSD Treatment Using Single Prolonged Stress


    Neurobiological Mechanisms 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT 18. NO. OF PAGES 19a. NAME OF RESPONSIBLE PERSON USAMRMC changes in protein transcription that modulates glutamatergic and GABAergic function. In turn this could lead to aberrant excitatory and/or...will test novel pharmacological treatment strategies to prevent and reverse stress-induced change, and explore mechanisms of vulnerability and

  4. Lasting treatment effects in a postmarketing surveillance study of prolonged-release melatonin.

    Hajak, Göran; Lemme, Kathrin; Zisapel, Nava


    Surveillance studies are useful to evaluate how a new medicinal product performs in everyday treatment and how the patient who takes it feels and functions, thereby determining the benefit/risk ratio of the drug under real-life conditions. Prolonged-release melatonin (PRM; Circadin) was approved in Europe for the management of primary insomnia patients age 55 years or older suffering from poor quality of sleep. With traditional hypnotics (e.g. benzodiazepine-receptor agonists), there are concerns about rebound insomnia and/or withdrawal symptoms. We report data from a postmarketing surveillance study in Germany on the effects of 3 weeks of treatment with PRM on sleep in patients with insomnia during treatment and at early (1-2 days) and late (around 2 weeks) withdrawal. In total, 653 patients (597 evaluable) were recruited at 204 sites (mean age 62.7 years, 68% previously treated with hypnotics, 65% women). With PRM treatment, the mean sleep quality (on a scale of 1-5 on which 1 is very good and 5 is very bad) improved from 4.2 to 2.6 and morning alertness improved from 4.0 to 2.5. The improvements persisted over the post-treatment observation period. Rebound insomnia, defined as a one-point deterioration in sleep quality below baseline values, was found in 3.2% (early withdrawal) and 2.0% (late withdrawal). Most of the patients (77%) who used traditional hypnotics before PRM treatment had stopped using them and only 5.6% of naive patients started such drugs after PRM discontinuation. PRM was well tolerated during treatment and the most frequently reported adverse events were nausea (10 patients, 1.5%), dizziness, restlessness and headache (five patients each, insomnia.

  5. The effect of prolonged duration of untreated depression on antidepressant treatment outcome

    Bukh, Jens Otto Drachmann; Bock, Camilla; Vinberg, Maj;


    The duration of untreated illness has been considered a likely predictor of the course of psychotic disorders. However, there is only sparse data concerning the influence of treatment delay on the outcome of mood disorders. The present study aimed to assess the effect of prolonged untreated depre...... depression on the outcome of antidepressant treatment.......The duration of untreated illness has been considered a likely predictor of the course of psychotic disorders. However, there is only sparse data concerning the influence of treatment delay on the outcome of mood disorders. The present study aimed to assess the effect of prolonged untreated...

  6. Low liver stiffness among cirrhotic patients with hepatitis B after prolonged treatment with nucleoside analogs

    Andersen, Ellen Sloth; Weiland, Ola; Leutscher, Peter


    Case reports and short-term clinical trials have suggested that treatment for chronic hepatitis B (CHB) may lead to improvement of cirrhosis. The aim of the present study was to measure liver stiffness in patients diagnosed with advanced fibrosis or cirrhosis prior to prolonged treatment...

  7. Using a pneumatic support to correct sitting posture for prolonged periods: a study using airline seats.

    McGill, Stuart M; Fenwick, Chad M J


    Prolonged sitting with spine flexion has been linked to low back disorders. A variety of mechanisms account for this based on biomechanical and neurological variables. Airline seats typically cause pronounced lumbar flexion due to their hollowed seat back design. A pneumatic support, placed between the seat back and the lumbar spine, was tested to see if lumbar flexion was reduced. Results showed that when the seats were positioned in the upright position, 15 of 20 participants experienced reduced lumbar flexion (by 15 degrees on average) with the support. The study was repeated on the five non-responders with the seatback set in the reclined position. This resulted in another four experiencing less lumbar flexion. Since seated flexion is associated with disc stress, reducing flexion with the support reduced lumbar stress. Spine flexion that results from prolonged sitting is associated with disc stress and pain. The pneumatic support tested here reduced spine flexion. While it is not known why airline seats are designed with no lumbar support, which causes excessive lumbar flexion while seated, the pneumatic support corrected this deficit. Reclining the seatback enhanced this effect.

  8. [Prolonged blockade of nervus ischiadicus in a system of complex treatment of patients, suffering complicated diabetic foot syndrome].

    Shapoval, S D; Savon, I L; Sofilkanych, M M


    General principles of treatment in patients, suffering diabetic foot syndrome, are adduced. There was proved, that reconvalescence of the patients depends not only on quality of complex treatment, but from optimal choice of anesthesia method, its impact on postoperative period course. Application of prolonged blockade of n. ischiadicus gives possibility to perform operative intervention on the lower extremity in full volume, guarantees sufficient motor and sensory block, permits patients to reject from application of narcotic analgetics, to reduce the dose of strong nonnarcotic analgetics, the terms of transition of the wound process phase I into phase II, promotes early activization of patients postoperatively, constitutes alternative for other methods of anesthesiological support.

  9. Early and Periodic Screening, Diagnosis and Treatment

    U.S. Department of Health & Human Services — The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who...

  10. Experimental therapy of epilepsy with transcranial magnetic stimulation: lack of additional benefit with prolonged treatment

    Brasil-Neto Joaquim P.


    Full Text Available OBJECTIVE: To investigate the effect of three months of low-frequency repetitive transcranial magnetic stimulation (rTMS treatment in intractable epilepsy. METHODS: Five patients (four males, one female; ages 6 to 50 years, were enrolled in the study; their epilepsy could not be controlled by medical treatment and surgery was not indicated. rTMS was performed twice a week for three months; patients kept records of seizure frequency for an equal period of time before, during, and after rTMS sessions. rTMS was delivered to the vertex with a round coil, at an intensity 5 % below motor threshold. During rTMS sessions, 100 stimuli (five series of 20 stimuli, with one-minute intervals between series were delivered at a frequency of 0.3 Hz. RESULTS: Mean daily number of seizures (MDNS decreased in three patients and increased in two during rTMS- one of these was treated for only one month; the best result was achieved in a patient with focal cortical dysplasia (reduction of 43.09 % in MDNS. In the whole patient group, there was a significant (p<0.01 decrease in MDNS of 22.8 %. CONCLUSION: Although prolonged rTMS treatment is safe and moderately decreases MDNS in a group of patients with intractable epilepsy, individual patient responses were mostly subtle and clinical relevance of this method is probably low. Our data suggest, however, that patients with focal cortical lesions may indeed benefit from this novel treatment. Further studies should concentrate on that patient subgroup.

  11. Assessing the effect of extrinsic incubation period (EIP) prolongation in controlling dengue transmission with wolbachia-infected mosquito intervention

    Putri, Y. E.; Rozi, S.; Tasman, H.; Aldila, D.


    A mathematical model of dengue disease transmission with involving Extrinsic Incubation Period (EIP) effect as a consequence of wolbachia introduction into mossquito population will be discussed in this article. Mathematical model analysis to find equilibrium points, basic reproductive ratio (ℛ0), and criteria of endemic occurrence which depend on some parameters were performed. From analytical result, we find that ℛ0 hold an important role to determine the existence and local stability of equilibrium points. From sensitivity analysis of ℛ0 and numerical simulation, we conclude that prolongation of EIP with wolbachia intervention succeed to reduce number of infected human and mosquito significantly.

  12. Treatment of hypokalemic periodic paralysis with topiramate.

    Fiore, Darren M; Strober, Jonathan B


    Hypokalemic periodic paralysis (hypoPP), the most common form of periodic paralysis, is a disorder characterized by attacks of transient muscle weakness associated with a drop in serum potassium level.The mainstay of treatment is potassium supplementation and drugs that inhibit the enzyme carbonic anhydrase. In this report we describe 11-year-old twins with hypoPP who were treated with topiramate, an anti-epileptic drug known to have carbonic anhydrase inhibitory properties. The patients experienced a decrease in the severity of their attacks upon initiation of treatment. Topiramate may warrant further investigation as a treatment option in hypoPP.

  13. Treatment of prolonged convulsive seizures in children; a single centre, retrospective, observational study

    Vlaskamp, Danique R. M.; Brouwer, Oebele F.; Callenbach, Petra M. C.


    Objectives: To evaluate treatment of children with Prolonged Convulsive Seizures (PCS) at the University Medical Centre Groningen (UMCG). Material and methods: PCS were identified from an UMCG database of children with epilepsy aged = 10 mm and occurred between January 2000 and October 2012 in child

  14. Prolonged antibiotic treatment does not prevent intra-abdominal abscesses in perforated appendicitis.

    Wijck, K. van; Jong, J.R. de; Heurn, L.W.E. van; Zee, D.C. van der


    BACKGROUND: Children with perforated appendicitis have a relatively high risk of intra-abdominal abscesses. There is no evidence that prolonged antibiotic treatment after surgery reduces intra-abdominal abscess formation. We compared two patient groups with perforated appendicitis with different

  15. Low liver stiffness among cirrhotic patients with hepatitis B after prolonged treatment with nucleoside analogs

    Andersen, Ellen Sloth; Weiland, Ola; Leutscher, Peter


    Abstract Objective. Case reports and short-term clinical trials have suggested that treatment for chronic hepatitis B (CHB) may lead to improvement of cirrhosis. The aim of the present study was to measure liver stiffness in patients diagnosed with advanced fibrosis or cirrhosis prior to prolonged...

  16. Prolonged antibiotic treatment does not prevent intra-abdominal abscesses in perforated appendicitis.

    Wijck, K. van; Jong, J.R. de; Heurn, L.W.E. van; Zee, D.C. van der


    BACKGROUND: Children with perforated appendicitis have a relatively high risk of intra-abdominal abscesses. There is no evidence that prolonged antibiotic treatment after surgery reduces intra-abdominal abscess formation. We compared two patient groups with perforated appendicitis with different pos

  17. Review of current clinical experience with prolonged (oral) etoposide in cancer treatment

    DeJong, RS; Mulder, NH; Dijksterhuis, D; DeVries, EGE


    Prolonged oral etoposide monotherapy is an effective treatment in patients with small cell lung cancer (SCLC) and refractory malignant lymphoma. It shows remarkable activity in relapsed or refractory breast and ovarian cancer (response rates up to 35% and 26%), and was also active in refractory germ

  18. MOFCOM Decided to Prolong the Period of Anti-Dumping Measures against Imports of Spandex Originated in Japan, Singapore, ROK, Taiwan Region and the U.S.


    Ministry of Commerce released, on October 12, Announcement No. 62 of 2012, deciding to prolong the period of anti-dumping measures against imports of spandex originated in Japan, Singapore, ROK, Taiwan region and the U.S.

  19. Prolongation of electrode lifetime in biofuel cells by periodic enzyme renewal

    Rubenwolf, S.; Sane, S.; Kestel, J.; Stetten, F. von; Kerzenmacher, S. [Freiburg Univ. (Germany). Lab. for MEMS Applications; Hussein, L.; Urban, G.; Krueger, M. [Freiburg Univ. (Germany). Freiburg Materials Research Centre (FMF); Freiburg Univ. (Germany). Lab. for Sensors; Zengerle, R. [Freiburg Univ. (Germany). Lab. for MEMS Applications; Freiburg Univ. (Germany). BIOSS Centre for Biological Signalling Studies


    Enzymatically catalyzed biofuel cells show unique specificity and promise high power densities, but suffer from a limited lifetime due to enzyme deactivation. In the present work, we demonstrate a novel concept to extend the lifetime of a laccase-catalyzed oxygen reduction cathode in which we decouple the electrode lifetime from the limited enzyme lifetime by a regular resupply of fresh enzymes. Thereto, the adsorption behavior of laccase from Trametes versicolor to buckypaper electrode material, as well as its time-dependent deactivation characteristics, has been investigated. Laccase shows a Langmuir-type adsorption to the carbon nanotube-based buckypaper electrodes, with a mean residence time of 2 days per molecule. In a citrate buffer of pH 5, laccase does not show any deactivation at room temperature for 2 days and exhibits a half-life of 9 days. In a long-term experiment, the laccase electrodes were operated at a constant galvanostatic load. The laccase-containing catholyte was periodically exchanged against a freshly prepared one every second day to provide sufficient active enzymes in the catholyte for the replacement of desorbed inactive enzymes. Compared to a corresponding control experiment without catholyte exchange, this procedure resulted in a 2.5 times longer cathode lifetime of 19 {+-} 9 days in which the electrode showed a potential above 0.744 V vs. normal hydrogen electrode at 110 {mu}A cm{sup -2}. This clearly indicates the successful exchange of molecules by desorption and re-adsorption and is a first step toward the realization of a self-regenerating enzymatic biofuel cell in which enzyme-producing microorganisms are integrated into the electrode to continuously resupply fresh enzymes. (orig.)

  20. Prolonging the hydration and active metabolism from light periods into nights substantially enhances lichen growth.

    Bidussi, Massimo; Gauslaa, Yngvar; Solhaug, Knut Asbjørn


    This study investigates how hydration during light and dark periods influences growth in two epiphytic old forest lichens, the green algal Lobaria pulmonaria and the cyanobacterial L. scrobiculata. The lichens were cultivated in growth chambers for 14 days (200 μmol m(-1) s(-2); 12 h photoperiod) at four temperature regimes (25/20 °C, 21/16 °C, 13/8 °C, and 6/1 °C; day/night temperatures) and two hydration regimes (12 h day-time hydration; 12 h day-time + 12 h night-time hydration). Growth was highly dynamic, showing that short-term growth experiments in growth cabinets have a high, but largely unexplored potential in functional lichen studies. The highest measured growth rates were not far from the maximal dry matter gain estimated from published net photosynthetic CO2 uptake data. For the entire data set, photobiont type, temperature, hydration regime and specific thallus mass accounted for 46.6 % of the variation in relative growth rate (RGR). Both species showed substantially higher relative growth rates based on both biomass (RGR) and thallus area (RTAGR) when they were hydrated day and night compared to hydration in light only. Chronic photoinhibition was substantial in thalli hydrated only during the day time and kept at the highest and lowest temperature regimes, resulting in exponential increases in RGR with increasing maximal PSII efficiency (F v/F m) in both species. However, the depression in F v/F m was stronger for the cyanolichen than for the cephalolichen at extreme temperatures. The growth-stimulating effect of night-time hydration suggests that nocturnal metabolic activity improves recovery of photoinhibition and/or enhances the conversion rate of photosynthates into thallus extension.

  1. QT interval prolongation related to psychoactive drug treatment: a comparison of monotherapy versus polytherapy

    Piccinelli Marco


    Full Text Available Abstract Background Several antipsychotic agents are known to prolong the QT interval in a dose dependent manner. Corrected QT interval (QTc exceeding a threshold value of 450 ms may be associated with an increased risk of life threatening arrhythmias. Antipsychotic agents are often given in combination with other psychotropic drugs, such as antidepressants, that may also contribute to QT prolongation. This observational study compares the effects observed on QT interval between antipsychotic monotherapy and psychoactive polytherapy, which included an additional antidepressant or lithium treatment. Method We examined two groups of hospitalized women with Schizophrenia, Bipolar Disorder and Schizoaffective Disorder in a naturalistic setting. Group 1 was composed of nineteen hospitalized women treated with antipsychotic monotherapy (either haloperidol, olanzapine, risperidone or clozapine and Group 2 was composed of nineteen hospitalized women treated with an antipsychotic (either haloperidol, olanzapine, risperidone or quetiapine with an additional antidepressant (citalopram, escitalopram, sertraline, paroxetine, fluvoxamine, mirtazapine, venlafaxine or clomipramine or lithium. An Electrocardiogram (ECG was carried out before the beginning of the treatment for both groups and at a second time after four days of therapy at full dosage, when blood was also drawn for determination of serum levels of the antipsychotic. Statistical analysis included repeated measures ANOVA, Fisher Exact Test and Indipendent T Test. Results Mean QTc intervals significantly increased in Group 2 (24 ± 21 ms however this was not the case in Group 1 (-1 ± 30 ms (Repeated measures ANOVA p Conclusions No significant prolongation of the QT interval was found following monotherapy with an antipsychotic agent, while combination of these drugs with antidepressants caused a significant QT prolongation. Careful monitoring of the QT interval is suggested in patients taking a

  2. Effect of prolonged hydroxytamoxifen treatment of MCF-7 cells on mitogen activated kinase cascade.

    Rabenoelina, Fanjaniriana; Semlali, Abdelhabib; Duchesne, Marie-Josèphe; Freiss, Gilles; Pons, Michel; Badia, Eric


    Resistance to the antiestrogen tamoxifen is the main stumbling block for the success of breast cancer therapy. We focused our study on cellular alterations induced by a prolonged treatment with the active tamoxifen metabolite hydroxytamoxifen (OHT). We show that a prolonged OHT treatment (for up to 7 days) led to a progressive increase in the level of phosphorylated p44/42 mitogen activated kinase (MAP kinase) induced by 10(-7) M TPA stimulation, without any significant change in the protein level. This effect was also observed in MCF-7 cells grown first in medium containing dextran-coated charcoal-treated FCS (DCC medium) for 20 days prior to OHT treatment, indicating a specific effect of the antiestrogen and not an effect of estrogen deprivation. It was prevented by cotreatment with estradiol and not observed in the estrogen receptor negative HeLa cell line, suggesting that it was mediated by the estrogen receptor. TPA induced phosphorylation of MEK1/2 was also raised by OHT treatment, without any change in their protein level or Raf-1 and H-Ras levels. When the MCF-7R OHT resistant cell line was grown in antiestrogen containing medium, the level of phosphorylated p44/42 MAP kinase was also high but reversed when the antiestrogen was removed. The 2 other MAP kinase, JNK and P38 pathways were not affected in the same way by OHT treatment. In conclusion, our data reveal that a prolonged OHT treatment, by increasing p44/42 MAPK activity, affects a key step in the growth control of MCF-7 cells, although not sufficiently to overcome the growth inhibitory effect of the drug. Copyright 2002 Wiley-Liss, Inc.

  3. Theranostic 3-Dimensional nano brain-implant for prolonged and localized treatment of recurrent glioma

    Ramachandran, Ranjith; Junnuthula, Vijayabhaskar Reddy; Gowd, G. Siddaramana; Ashokan, Anusha; Thomas, John; Peethambaran, Reshmi; Thomas, Anoop; Unni, Ayalur Kodakara Kochugovindan; Panikar, Dilip; Nair, Shantikumar V.; Koyakutty, Manzoor


    Localized and controlled delivery of chemotherapeutics directly in brain-tumor for prolonged periods may radically improve the prognosis of recurrent glioblastoma. Here, we report a unique method of nanofiber by fiber controlled delivery of anti-cancer drug, Temozolomide, in orthotopic brain-tumor for one month using flexible polymeric nano-implant. A library of drug loaded (20 wt%) electrospun nanofiber of PLGA-PLA-PCL blends with distinct in vivo brain-release kinetics (hours to months) were numerically selected and a single nano-implant was formed by co-electrospinning of nano-fiber such that different set of fibres releases the drug for a specific periods from days to months by fiber-by-fiber switching. Orthotopic rat glioma implanted wafers showed constant drug release (116.6 μg/day) with negligible leakage into the peripheral blood (4 month) survival of 85.7% animals whereas 07 day releasing implant showed tumor recurrence in 54.6% animals, rendering a median survival of only 74 days. In effect, we show that highly controlled drug delivery is possible for prolonged periods in orthotopic brain-tumor using combinatorial nanofibre libraries of bulk-eroding polymers, thereby controlling glioma recurrence.

  4. Diffuse alveolar damage in a patient with rheumatoid arthritis under prolonged leflunomide treatment: A Case Report and Literature Review.

    Keng, Li-Ta; Lin, Mong-Wei; Huang, Hsien-Neng; Chung, Kuei-Pin


    Patients with rheumatoid arthritis (RA) often have pulmonary involvement, and interstitial lung disease (ILD) is the primary manifestation, in which diffuse alveolar damage (DAD) is a rare histopathologic pattern. Leflunomide (LEF) is a frequently prescribed disease-modifying antirheumatic drug for treating RA. LEF-related ILD in the form of DAD has been reported in patients with RA, with the duration of LEF treatment before symptom onset ranging from 6 to 1204 days.We present a case of elderly woman with RA under prolonged LEF treatment for >9 years (3291 days), who had acute respiratory failure with the initial presentation of exertional dyspnea, fever, chills, and productive cough for 2 days. The histopathologic result of surgical lung biopsy was compatible with DAD. She was diagnosed as having LEF-related ILD, based on correlated clinical history, compatible histopathologic examination and excluding possible infection after extensive survey.Although the causative role of LEF cannot be confirmed, this case still hints that LEF-related DAD may occur even if LEF has been prescribed for a prolonged period.

  5. Prolonged vertigo and ataxia after mandibular nerve block for treatment of trigeminal neuralgia

    Arvind Chaturvedi


    Full Text Available Common complications of neurolytic mandibular nerve block are hypoesthesia, dysesthesia, and chemical neuritis. We report a rare complication, prolonged severe vertigo and ataxia, after neurolytic mandibular blockade in a patient suffering from trigeminal neuralgia. Coronoid approach was used for right sided mandibular block. After successful test injection with local anesthetic, absolute alcohol was given for neurolytic block. Immediately after alcohol injection, patient developed nausea and vomiting along with severe vertigo, ataxia and hypertension. Neurological evaluation was normal except for the presence of vertigo and ataxia. Computerised tomography scan brain was also normal. Patient was admitted for observation and symptomatic treatment was given. Vertigo and ataxia gradually improved over 24 hours.

  6. Resveratrol treatment controls microbial flora, prolongs shelf life, and preserves nutritional quality of fruit.

    Jiménez, Jorge Bernardo; Orea, José María; Montero, Carlos; Ureña, Angel González; Navas, Elena; Slowing, Karla; Gómez-Serranillos, María Pilar; Carretero, Emilia; De Martinis, Domenico


    Resveratrol is known as a grapevine secondary metabolite with fungicide activity. Its exogenous application on harvested grapes resulted in the reduction of microbial flora growth, and consequently, prolonged shelf life, without affecting the nutritional quality of the fruit. Resveratrol treatment also resulted in being effective on fruit that normally does not accumulate such metabolites as, for example, tomatoes, apples, avocado pears, and peppers. As a result, all treated fruits maintained their post-harvest quality and health longer than the untreated ones. This study demonstrates the potential use of resveratrol as a natural pesticide to reduce post-harvest fungi development on a broad spectrum of fruit types.

  7. Falsely elevated cyclosporin and tacrolimus concentrations over prolonged periods of time due to reversible adsorption to central venous catheters.

    Hacker, Charlotte; Verbeek, Mareike; Schneider, Heike; Steimer, Werner


    Falsely elevated concentrations of immunosuppressants can be caused by reversible adsorption to central venous catheter (CVC) systems. If undetected, this may lead to dose reduction resulting in underdosage which may even entail graft-versus-host disease or organ rejection. We analyzed the adsorption and release for cyclosporine A (CsA) and tacrolimus (Tac) in vitro and in vivo. Four types of CVCs were examined in vitro: two made from polyurethane (PU), one from silicone and one from PU with an incorporated silver ion-based antimicrobial agent. All 26 CVCs analyzed in vitro showed significant reversible adsorption of CsA (n=13; p=0.001) and Tac (n=13; p=0.001, Wilcoxon signed rank test). Immediately after infusing the drugs, the mean concentrations of 6420ng/mL of CsA and 250ng/mL of Tac were measured. Flushing with NaCl lowered the drug release. Besides, blood samples of fifteen patients were taken simultaneously from all lumina of the CVC and via venipuncture. The samples from contaminated lumina showed the mean elevations by a factor of 11 for CsA (n=12) and 89 for Tac (n=3). Blood sampling for immunosuppressant monitoring should thus never be performed from lumina previously used for infusing the drug even after prolonged periods of time and extensive rinsing. Copyright © 2014 Elsevier B.V. All rights reserved.

  8. Life-threatening asthma attack during prolonged fingolimod treatment: case report

    Zecca C


    Full Text Available Chiara Zecca,1,* Matteo Caporro,1,* Sandor Györik,2 Claudio Gobbi11Neurocenter of Southern Switzerland, Department of Neurology, Ospedale Regionale di Lugano, Lugano, Switzerland; 2Department of Internal Medicine, Ospedale Regionale di Bellinzona, Bellinzona, Switzerland*These authors contributed equally to this workBackground: Fingolimod (FTY mediates bronchoconstriction by interacting with sphingosine-1-phosphate receptors. The majority of the reported adverse respiratory events occur during the first weeks of treatment.Case presentation: A 49-year-old woman developed a life-threatening asthma attack after 6 months of continuous FTY treatment. The adverse event required prolonged hospitalization, and the patient recovered without sequelae after FTY interruption. A history of previous airway hyperreactivity and a concurrent viral respiratory infection possibly acted as predisposing factors.Conclusion: This first description of a severe, life-threatening asthma attack during prolonged FTY treatment suggests the need for long-term clinical surveillance, especially in patients with known predisposing factors.Keywords: multiple sclerosis, bronchial hyper-reactivity

  9. Greater occipital nerve block for the acute treatment of prolonged or persistent migraine aura.

    Cuadrado, María L; Aledo-Serrano, Ángel; López-Ruiz, Pedro; Gutiérrez-Viedma, Álvaro; Fernández, Cristina; Orviz, Aida; Arias, José A


    Background Presently, there is no evidence to guide the acute treatment of migraine aura. We aimed to describe the effect of greater occipital nerve (GON) anaesthetic block as a symptomatic treatment for long-lasting (prolonged or persistent) migraine aura. Methods Patients who presented with migraine aura lasting > 2 hours were consecutively recruited during one year at the Headache Unit and the Emergency Department of a tertiary hospital. All patients underwent a bilateral GON block with bupivacaine 0.5%. Patients were followed up for 24 hours. Results A total of 22 auras were treated in 18 patients. Auras consisted of visual ( n = 13), visual and sensory ( n = 4) or sensory symptoms alone ( n = 5). Eleven episodes met diagnostic criteria for persistent aura (>1 week) without infarction. The response was complete without early recurrence in 11 cases (50%), complete with recurrence in auras lasting auras (72.7% vs. 27.3%; p = 0.033). Conclusions GON block could be an effective symptomatic treatment for prolonged or persistent migraine aura. Randomised controlled trials are still required to confirm these results.

  10. Neural and behavioural changes in male periadolescent mice after prolonged nicotine-MDMA treatment.

    Adeniyi, Philip A; Ishola, Azeez O; Laoye, Babafemi J; Olatunji, Babawale P; Bankole, Oluwamolakun O; Shallie, Philemon D; Ogundele, Olalekan M


    The interaction between MDMA and Nicotine affects multiple brain centres and neurotransmitter systems (serotonin, dopamine and glutamate) involved in motor coordination and cognition. In this study, we have elucidated the effect of prolonged (10 days) MDMA, Nicotine and a combined Nicotine-MDMA treatment on motor-cognitive neural functions. In addition, we have shown the correlation between the observed behavioural change and neural structural changes induced by these treatments in BALB/c mice. We observed that MDMA (2 mg/Kg body weight; subcutaneous) induced a decline in motor function, while Nicotine (2 mg/Kg body weight; subcutaneous) improved motor function in male periadolescent mice. In combined treatment, Nicotine reduced the motor function decline observed in MDMA treatment, thus no significant change in motor function for the combined treatment versus the control. Nicotine or MDMA treatment reduced memory function and altered hippocampal structure. Similarly, a combined Nicotine-MDMA treatment reduced memory function when compared with the control. Ultimately, the metabolic and structural changes in these neural systems were seen to vary for the various forms of treatment. It is noteworthy to mention that a combined treatment increased the rate of lipid peroxidation in brain tissue.

  11. Recurrent toxocariasis due to chronic urticaria and successful treatment with prolonged albendazole therapy.

    Karagöz, Ergenekon; Selek, Mehmet Burak; Aydın, Ersin; Hatipoğlu, Mustafa; Turhan, Vedat; Acar, Ali; Öncül, Oral; Görenek, Levent


    Toxocariasis is a worldwide human helminthiasis, especially seen in temperate and tropical climate regions around the world. The diagnosis of this disease is performed on the basis of clinical symptoms and laboratory findings. Albendazole is one of the treatment choices for toxocariasis, with a currently recommended regimen of 10 mg/kg/day in two doses (400 mg twice daily) for 5 days. However, there is no precise consensus about the duration of the treatment. In this article, we report a case of toxocariasis; the patient visited our infectious disease polyclinic with complaints of long-term itching and urticarial skin lesions that were resistant to routine treatment and that recurred. Then, recurrent disease was resolved and skin lesions were diminished after prolonged albendazole therapy.

  12. Therapeutic evaluation of prolonged infusions of β-lactam antibiotics in the treatment and management of critically ill patients

    Jorge S. Amador


    Full Text Available Context: Critically ill patients has a large number of pathophysiological changes product of commitment and organ systems. Therefore, knowledge of the pharmacological properties of antimicrobials is essential to choose the best treatment. In order to optimize the response of antibiotic therapy and these drugs, new strategies have been proposed dosage, the most used drug application of the model, called: Pharmacokinetics/Pharmacodynamics (PK/PD. In the case of β-lactam antibiotics, the PK/PD model is known as time-dependent on the Minimum Inhibitory Concentration (Time > MIC. For optimal concentrations in β-lactam antibiotics, prolonged or continuous infusions, thus exposing the drug on the pathogen is achieved in a longer optimal concentrations through are used. Aims: To evaluate the therapeutic response of β-lactam antibiotics in critically ill patients with prolonged infusions by applying the model PK/ PD. Methods: Prospective observational study (concurrent cohort, taking as a control non-concurrent historic cohort, conducted for a period of seven months in the intensive care unit of the Hospital Clínico San Borja Arriarán (HCSBA, Santiago, Chile. Results: It was found a significant difference in number of days of hospitalization in ICU for the group bolus versus infusion group (12.5 ± 5.4 vs. 18 ± 9.7 days, IC: 1.5-9.5; p = 0.009. Conclusions: This study suggests that there would be a therapeutic advantage in the use of prolonged infusion in ICU stay duration.

  13. Risk of lower extremity arterial disease in a cohort of workers occupationally exposed to ionizing radiation over a prolonged period

    Azizova, Tamara V.; Bannikova, Maria V.; Grigorieva, Evgenia S.; Bagaeva, Yaroslava P.; Azizova, Elena V. [Southern Urals Biophysics Institute, Ozyorsk Chelyabinsk Region (Russian Federation)


    In this study the incidence risk of lower extremity arterial disease (LEAD; international classification of diseases version 9 code 440.2) was assessed in a cohort of workers occupationally exposed to radiation over a prolonged period. The study cohort includes 22,377 workers of the Mayak Production Association (25 % of whom are females) first employed at one of the main facilities in 1948-1982 and followed up to the end of 2008. Dose estimates used in the study are provided by Mayak Worker Dosimetry System 2008. The mean total dose from external gamma-rays is 0.54 Gy for males and 0.44 Gy for females. The mean absorbed liver dose from internal alpha-radiation due to incorporated plutonium is 0.23 Gy in males and 0.44 Gy in females. Relative risks and excess relative risks per unit dose (ERR/Gy) are calculated based on maximum likelihood. A total of 943 cases of LEAD are registered in the study cohort during the follow-up of 512,801 person-years. A significant association of LEAD incidence with total dose from external gamma-rays (based on a linear model) was revealed, and the ERR/Gy is 0.27 (95 % confidence interval (CI) 0.11; 0.48). It turned out that a linear-exponential model provides a better fit of the data (∇AIC = 9.957). Inclusion of an adjustment for internal alpha-radiation dose resulted in the reduction of the ERR/Gy to 0.19 (95 % CI 0.05; 0.39), but the risk remains significant. No association of LEAD incidence with dose from internal alpha-radiation was found in the study worker cohort. It is concluded that this study provides evidence for an association of LEAD incidence with dose from external gamma-rays taking non-radiation factors into account. (orig.)

  14. Prolonged treatment with DNMT inhibitors induces distinct effects in promoters and gene-bodies.

    Yan-Fung Wong

    Full Text Available Treatment with the demethylating drugs 5-azacytidine (AZA and decitabine (DAC is now recognised as an effective therapy for patients with Myelodysplastic Syndromes (MDS, a range of disorders arising in clones of hematopoietic progenitor cells. A variety of cell models have been used to study the effect of these drugs on the methylation of promoter regions of tumour suppressor genes, with recent efforts focusing on the ability of these drugs to inhibit DNA methylation at low doses. However, it is still not clear how nano-molar drug treatment exerts its effects on the methylome. In this study, we have characterised changes in DNA methylation caused by prolonged low-dose treatment in a leukemic cell model (SKM-1, and present a genome-wide analysis of the effects of AZA and DAC. At nano-molar dosages, a one-month continuous treatment halved the total number of hypermethylated probes in leukemic cells and our analysis identified 803 candidate regions with significant demethylation after treatment. Demethylated regions were enriched in promoter sequences whereas gene-body CGIs were more resistant to the demethylation process. CGI methylation in promoters was strongly correlated with gene expression but this correlation was lost after treatment. Our results indicate that CGI demethylation occurs preferentially at promoters, but that it is not generally sufficient to modify expression patterns, and emphasises the roles of other means of maintaining cell state.

  15. Serum proteomic changes after randomized prolonged erythropoietin treatment and/or endurance training: detection of novel biomarkers.

    Britt Christensen

    Full Text Available Despite implementation of the biological passport to detect erythropoietin abuse, a need for additional biomarkers remains. We used a proteomic approach to identify novel serum biomarkers of prolonged erythropoiesis-stimulating agent (ESA exposure (Darbepoietin-α and/or aerobic training.Thirty-six healthy young males were randomly assigned to the following groups: Sedentary-placebo (n = 9, Sedentary-ESA (n = 9, Training-placebo (n = 10, or Training-ESA (n = 8. They were treated with placebo/Darbepoietin-α subcutaneously once/week for 10 weeks followed by a 3-week washout period. Training consisted of supervised biking 3/week for 13 weeks at the highest possible intensity. Serum was collected at baseline, week 3 (high dose Darbepoietin-α, week 10 (reduced dose Darbepoietin-α, and after a 3-week washout period.Serum proteins were separated according to charge and molecular mass (2D-gel electrophoresis. The identity of proteins from spots exhibiting altered intensity was determined by mass spectrometry.Six protein spots changed in response to Darbepoietin-α treatment. Comparing all 4 experimental groups, two protein spots (serotransferrin and haptoglobin/haptoglobin related protein showed a significant response to Darbepoietin-α treatment. The haptoglobin/haptoglobin related protein spot showed a significantly lower intensity in all subjects in the training-ESA group during the treatment period and increased during the washout period.An isoform of haptoglobin/haptoglobin related protein could be a new anti-doping marker and merits further NCT01320449.

  16. Neonatal recurrent prolonged hypothermia associated with maternal mirtazapine treatment during pregnancy.

    Sokolover, Nir; Merlob, Paul; Klinger, Gil


    We present a case of recurrent hypothermia in concordant monozygotic twins born to a mirtazapine treated mother. The twins were born at 35 weeks gestation at birth weights of 2426 g and 2355 g. Both twins presented with recurrent hypothermia continuing until day 10 of life. Possible etiologies of hypothermia were excluded. The degree of prematurity and the weight of the twins were not consistent with prolonged thermal instability. The twins' mother was treated with mirtazapine during the entire pregnancy. Due to its serotonin and alpha 2 receptors antagonism mirtazapine is known to influence thermoregulation in adult humans and other mammals. We suggest that maternal mirtazapine treatment during pregnancy was associated with recurrent hypothermia in both identical twins.

  17. Prolonged venous bleeding due to traditional treatment with leech bite: a case report

    Altun Hasan


    Full Text Available Abstract Introduction The medicinal leech, Hirudo medicinalis, has been used in the treatment of many diseases for thousands of years. In Turkey, it is used most commonly in the management of venous diseases of lower extremities. Case presentation A 25-year-old Turkish woman presented to our emergency room with bleeding from her left leg. She had been treated for varicose veins in her lower extremities with leeches about 24 hours before admission to the emergency room. The bleeding was controlled by applying pressure with sterile gauze upon the wound, and she was discharged. She returned after four hours having started bleeding again. Hemostasis was achieved by vein ligation under local anesthesia. Conclusions Leech bite should be evaluated as a special injury. Prolonged bleeding can be seen after leech bites. In such cases, hemostasis either with local pressure or ligation of the bleeding vessel is mandatory.

  18. Melatonin prolonged release: in the treatment of insomnia in patients aged ≥55 years.

    Lyseng-Williamson, Katherine A


    Melatonin prolonged release (PR) 2 mg is approved for the treatment of primary insomnia characterized by poor sleep quality in patients aged ≥55 years in the EU and elsewhere. Patients may receive treatment with melatonin PR for up to 13 weeks. Production of endogenous nocturnal melatonin, which helps regulate circadian rhythm, may be decreased in older adults. Administration of melatonin PR 2 mg 1-2 h before bedtime mimics the natural secretion pattern of melatonin, thereby leading to improvements in the circadian regulation of the sleep-wake cycle. In older adults, melatonin PR 2 mg had no effect on psychomotor functions, memory recall or driving skills during the night or the next morning relative to placebo, and was associated with significantly less impairment on many of these tasks relative to zolpidem 10 mg alone or in combination with melatonin PR 2 mg. In 3-week and 6-month, randomized, double-blind clinical trials in patients with primary insomnia aged ≥55 years, melatonin PR 2 mg 1-2 h before bedtime was associated with significant improvements relative to placebo in many sleep and daytime parameters, including sleep quality and latency, morning alertness and health-related quality of life. Melatonin PR 2 mg was very well tolerated in clinical trials in older patients, with a tolerability profile that was similar to that of placebo. Short- or longer-term treatment with melatonin PR 2 mg was not associated with dependence, tolerance, rebound insomnia or withdrawal symptoms.

  19. Utilization of squid pen for the efficient production of chitosanase and antioxidants through prolonged autoclave treatment.

    Wang, San-Lang; Wu, Pei-Chen; Liang, Tzu-Wen


    We have developed a culture system for efficient production of chitosanase by Bacillus sp. TKU004. TKU004 was cultivated by using squid pen powder as the sole carbon/nitrogen source. The effects of autoclave treatments of the medium on the production of chitosanase were investigated. Autoclave treatment of squid pen powder for 45 min remarkably promoted enzyme productivity. When the culture medium containing an initial squid pen powder concentration of 3% was autoclaved for 45 min, the chitosanase activity was optimal and reached 0.14-0.16 U/mL. In addition, extracellular surfactant-stable chitosanase was purified from the TKU004 culture supernatant. The antioxidant activity of TKU004 culture supernatant was determined through the scavenging ability of DPPH, with 70% per mL. With this method, we have shown that marine wastes can be utilized efficiently through prolonged autoclave treatments to generate a high value-added product, and have revealed its hidden potential in the production of functional foods.

  20. QT interval prolongation in opioid agonist treatment: analysis of continuous 12-lead electrocardiogram recordings.

    Isbister, Geoffrey K; Brown, Amanda L; Gill, Anthony; Scott, Alexander J; Calver, Leonie; Dunlop, Adrian J


    Methadone is a widely used opioid agonist treatment associated with QT prolongation and torsades de pointes. We investigated the QT interval in patients treated with methadone or buprenorphine using continuous 12-lead Holter recordings. We prospectively made 24-h Holter recordings in patients prescribed methadone or buprenorphine, compared to controls. After their normal dose a continuous 12-lead Holter recorder was attached for 24 h. Digital electrocardiograms were extracted hourly from the Holter recordings. The QT interval was measured automatically (H-scribe software, Mortara Pty Ltd) and checked manually. The QT interval was plotted against heart rate (HR) on the QT nomogram to determine abnormality. Demographics, dosing, medical history and laboratory investigations were recorded. There were 58 patients (19 methadone, 20 buprenorphine and 19 control); median age 35 years (20-56 years); 33 males. Baseline characteristics were similar. Median dose of methadone was 110 mg day(-1) (70-170 mg day(-1) ) and buprenorphine was 16 mg day(-1) (12-32 mg day(-1) ). Seven participants had abnormal QT intervals. There was a significant difference in the proportion of prescribed methadone with abnormal QT intervals, 7/19 (37%; 95% confidence interval: 17-61%), compared to controls 0/19 (0%; 95% confidence interval: 0-21%; P = 0.008), but no difference between buprenorphine and controls (0/20). QT vs. HR plots showed patients prescribed methadone had higher QT-HR pairs over 24 h compared to controls. There was no difference in dose for patients prescribed methadone with abnormal QT intervals and those without. Methadone is associated with prolonged QT intervals, but there was no association with dose. Buprenorphine did not prolong the QT interval. Twenty four-hour Holter recordings using the QT nomogram is a feasible method to assess the QT interval in patients prescribed methadone. © 2017 The Authors. British Journal of Clinical Pharmacology published by John

  1. Prolonged period of acute bronchitis with late progression to acute respiratory distress syndrome as possible result of influenza A (H1N1) virus infection.

    Homsi, Samer; Milojkovic, Natasa; Alawad, Bashar; Homsi, Yamen


    Young adults with underlying medical conditions who are infected with the H1N1 virus are at risk of quickly progressing from mild upper airways infection to severe ARDS within 4 to 5 days after the onset of the illness. Here, we report the case of a 46-year-old morbidly obese and diabetic woman infected with the H1N1 virus who developed acute bronchitis that lasted for 4 weeks and then progressed to ARDS. We discuss the month-long persistence of the H1N1 viral bronchitis and its late progression to ARDS which may reflect prolonged viral activity. Such a prolonged, rather than quick, course of deterioration can cause clinicians to misdiagnose the etiology of the ARDS and may cause the patient to receive a prolonged treatment with steroids to treat bronchitis symptoms. These steroids may cause increased viral replication and promote parenchymal involvement and the development of ARDS.

  2. Treatment of Experimental Candida Sepsis with a Janus Kinase Inhibitor Controls Inflammation and Prolongs Survival.

    Tsirigotis, P; Papanikolaou, N; Elefanti, A; Konstantinou, P; Gkirkas, K; Rontogianni, D; Siafakas, N; Karakitsos, P; Roilides, E; Dimitriadis, G; Zerva, L; Meletiadis, J


    Janus kinases (JAK) are intracellular tyrosine kinases that transduce cytokine-mediated signals to the nucleus, promoting gene expression. Cytokines play a major role in microbial sepsis, which is often associated with uncontrolled inflammation leading to death. JAK inhibitors have been used for the treatment of several autoimmune diseases by modulating immune response, but they have never been tested against microbial sepsis. Ruxolitinib is a small-molecule inhibitor of JAK1/2 proteins, which are involved in the downstream signaling pathway of the vast majority of proinflammatory and anti-inflammatory cytokines. We therefore studied the effect of ruxolitinib in a mouse model of sepsis due to Candida albicans. When ruxolitinib therapy (50 mg/kg [of body weight]/day) was started 1 day before infection, the median survival time was reduced by 3 days, the fungal loads in all organs were higher, the inflammation was significantly less, and serum tumor necrosis factor alpha (TNF-α) and interleukin 10 (IL-10) levels and IL-10/TNF-α ratios were higher than in controls. When ruxolitinib therapy (50 to 1.5 mg/kg/day) was started 1 day after infection, an inverted-U relationship was found, with 6.25 mg/kg/day prolonging median survival time by 6 days, resulting in similar fungal loads, less inflammation, and similar cytokine levels but higher IL-10/TNF-α ratios than the controls. The optimal dose of ruxolitinib controlled infection and prolonged survival with less inflammation than in control animals. Administration of JAK inhibitors may be a promising therapeutic adjunct that needs further investigation.

  3. Microdomain Ca{sup 2+} dynamics in mammalian muscle following prolonged high pressure treatments

    Schnee, S; Schuermann, S; Fink, R [Medical Biophysics, Institute of Physiology and Pathophysiology, University of Heidelberg, INF326, 69120 Heidelberg (Germany); Ludwig, H [Physical Chemistry, Institute of Molecular Biotechnology and Biopharmacy, University of Heidelberg, INF 366 (Germany); Wegner, F von; Friedrich, O, E-mail:


    High pressure (HP) applications are an important thermodynamic tool to influence cellular processes. Especially processes that undergo large volume changes, e.g. opening or closing of ion channels, are in particular susceptible to HP treatments. Such volume changes are extremely difficult to assess for intracellular ion channels, like ryanodine receptors (RyR) residing in the membrane of organelles. In skeletal muscle, RyR act as Ca{sup 2+} release channels. We previously showed that plasmalemmal Na{sup +} and Ca{sup 2+} ion channels were irreversibly altered after prolonged 20 MPa treatments. Here, changes in microdomain Ca{sup 2+} levels due to elementary Ca{sup 2+} release events (ECRE) were monitored using confocal fluorescence microscopy. We studied ECRE in mammalian skeletal muscle following 3 h HP treatments up to 30 MPa to clarify whether RyR induced intracellular microdomain Ca{sup 2+} dynamics was more susceptible to HP treatment compared to surface membrane ion currents. ECRE frequencies exponentially declined with pressure. ECRE amplitudes and rise times (RT) were quite robust towards HP treatments. In contrast, spatial and temporal ECRE extension showed a tendency towards larger values up to 20 MPa but declined for higher pressures. Activation volumes for pressure-induced persistent ECRE alterations were zero for RT but showed a bimodal behavior for event duration. It seems that although ECRE frequencies are markedly reduced, ECRE morphology is less affected by HP. In particular, RyR opening time is practically unaltered and the observed morphological ECRE changes might reflect alterations in local Ca{sup 2+} buffers and Ca{sup 2+} concentration profiles rather than involvement of RyR in mammalian skeletal muscle.

  4. One-Year Outcome of Geriatric Hip-Fracture Patients following Prolonged ICU Treatment

    Daphne Eschbach


    Full Text Available Purpose. Incidence of geriatric fractures is increasing. Knowledge of outcome data for hip-fracture patients undergoing intensive-care unit (ICU treatment, including invasive ventilatory management (IVM and hemodiafiltration (CVVHDF, is sparse. Methods. Single-center prospective observational study including 402 geriatric hip-fracture patients. Age, gender, the American Society of Anesthesiologists (ASA classification, and the Barthel index (BI were documented. Underlying reasons for prolonged ICU stay were registered, as well as assessed procedures like IVM and CVVHDF. Outcome parameters were in-hospital, 6-month, and 1-year mortality and need for nursing care. Results. 15% were treated > 3 days and 68% 3d cohort were significantly increased (p=0.001. Most frequent indications were cardiocirculatory pathology followed by respiratory failure, renal impairment, and infection. 18% of patients needed CVVHDF and 41% IVM. In these cohorts, 6-month mortality ranged > 80% and 12-month mortality > 90%. 100% needed nursing care after 6 and 12 months. Conclusions. ICU treatment > 3 days showed considerable difference in mortality and nursing care needed after 6 and 12 months. Particularly, patients requiring CVVHDF or IVM had disastrous long-term results. Our study may add one further element in complex decision making serving this vulnerable patient cohort.

  5. Cerebral blood flow and end-tidal PCO2 during prolonged acetazolamide treatment in humans

    Friberg, L; Kastrup, J; Rizzi, Dominick Albert


    decreasing alveolar PCO2 to 70% of the control value at the end of the treatment period. In healthy humans the hyperventilation will not increase brain oxygenation significantly at sea level. But at high altitudes the enhanced ventilatory drive will improve oxygenation of the brain, and this may account...

  6. Prolonged treatment for acute symptomatic refractory status epilepticus: outcome in children.

    Sahin, Mustafa; Menache, Caroline C; Holmes, Gregory L; Riviello, James J


    High-dose suppressive therapy (HDST) is used to treat refractory status epilepticus (RSE). Prolonged therapy is required in some cases, and prognosis is important in making therapeutic decisions. The authors therefore studied the long-term outcome in previously normal children who survived prolonged HDST for acute symptomatic RSE. All have intractable epilepsy, and none returned to baseline.

  7. Successful treatment of massive pulmonary embolism with prolonged catheter-directed thrombolysis.

    Kelly, Peter


    This is a case report of a young woman who presented with an extensive pulmonary embolism and echocardiographic evidence of right ventricular dysfunction. Although hemodynamically stable, the patient\\'s clinical condition failed to improve with standard heparin anticoagulation. Successful local catheter-directed thrombolysis was performed over an extended period of 48 h with regular monitoring of response to therapy by computed tomography-pulmonary angiography and echocardiography. To our knowledge, treatment of a pulmonary embolism by catheter-directed thrombolytic infusion over an extended period of 48 h has not previously been described.

  8. Neural changes in extinction recall following prolonged exposure treatment for PTSD: A longitudinal fMRI study

    Liat Helpman, PhD


    Conclusions: Prolonged exposure treatment appears to alter neural activation in PTSD patients during recall of fear extinction, and change in extinction recall (measured by SCR is associated with symptom reduction. We discuss results in the context of neural systems involved in response to affective stimuli.

  9. Prolonged niacin treatment leads to increased adipose tissue PUFA synthesis and anti-inflammatory lipid and oxylipin plasma profile.

    Heemskerk, Mattijs M; Dharuri, Harish K; van den Berg, Sjoerd A A; Jónasdóttir, Hulda S; Kloos, Dick-Paul; Giera, Martin; van Dijk, Ko Willems; van Harmelen, Vanessa


    Prolonged niacin treatment elicits beneficial effects on the plasma lipid and lipoprotein profile that is associated with a protective CVD risk profile. Acute niacin treatment inhibits nonesterified fatty acid release from adipocytes and stimulates prostaglandin release from skin Langerhans cells, but the acute effects diminish upon prolonged treatment, while the beneficial effects remain. To gain insight in the prolonged effects of niacin on lipid metabolism in adipocytes, we used a mouse model with a human-like lipoprotein metabolism and drug response [female APOE*3-Leiden.CETP (apoE3 Leiden cholesteryl ester transfer protein) mice] treated with and without niacin for 15 weeks. The gene expression profile of gonadal white adipose tissue (gWAT) from niacin-treated mice showed an upregulation of the "biosynthesis of unsaturated fatty acids" pathway, which was corroborated by quantitative PCR and analysis of the FA ratios in gWAT. Also, adipocytes from niacin-treated mice secreted more of the PUFA DHA ex vivo. This resulted in an increased DHA/arachidonic acid (AA) ratio in the adipocyte FA secretion profile and in plasma of niacin-treated mice. Interestingly, the DHA metabolite 19,20-dihydroxy docosapentaenoic acid (19,20-diHDPA) was increased in plasma of niacin-treated mice. Both an increased DHA/AA ratio and increased 19,20-diHDPA are indicative for an anti-inflammatory profile and may indirectly contribute to the atheroprotective lipid and lipoprotein profile associated with prolonged niacin treatment.

  10. Seminal vesicles and diabetic neuropathy: ultrasound evaluation after prolonged treatment with a selective phosphodiesterase-5 inhibitor.

    La Vignera, S; Condorelli, R A; Vicari, E; Lotti, F; Favilla, V; Morgia, G; Maggi, M; Calogero, A E


    We have previously reported that infertile patients with diabetes mellitus (DM) have a particular ultrasound features of the seminal vesicles (SV) characterized by higher fundus-to-body ratio and lower pre- and post-ejaculatory difference in body antero-posterior diameter (APD). Based on these premises the aim of the present study was to investigate possible ultrasound SV changes in infertile patients with DM and diabetic neuropathy (DN), after prolonged administration of tadalafil (TAD) (a specific phosphodiesterase-5 inhibitor). To accomplish this, 20 infertile patients with symptomatic DN and erectile dysfunction were selected and arbitrarily divided into two groups which were assigned to: daily administration of 5 mg TAD for 3 months (Group A) (n = 10) and administration of placebo (Group B) (n = 10). All patients underwent to scrotal and prostate-vesicular transrectal ultrasound evaluation and semen analysis (Laboratory Manual for the Examination and Processing of Human Semen, WHO, 2010) before and after treatment. The following SV US parameters were recorded: (i) body APD; (ii) fundus APD; (iii) parietal thickness of the right and left SVs; and (iv) number of polycyclic areas within both SVs. We then calculated the following parameters: (i) fundus/body (F/B) ratio; (ii) difference of the parietal thickness between the right and the left SV and (iii) pre- and post-ejaculatory APD difference. In addition, we also evaluated the SV ejection fraction. Group A patients showed a significant reduction in F/B ratio and higher pre- and post-ejaculatory body SV APD difference compared with baseline or Group B after 3 months. These patients showed also a significant increase in SV ejection fraction and a significant improvement of the total sperm count, progressive motility, seminal levels of fructose, leucocytes and ejaculate volume. In conclusion, these results suggest that infertile DM patients with DN and erectile dysfunction had an improvement of ultrasound features

  11. Prolonged exposure therapy for combat- and terror-related posttraumatic stress disorder: a randomized control comparison with treatment as usual.

    Nacasch, Nitzah; Foa, Edna B; Huppert, Jonathan D; Tzur, Dana; Fostick, Leah; Dinstein, Yula; Polliack, Michael; Zohar, Joseph


    Empirically based studies have demonstrated that prolonged exposure therapy effectively reduces posttraumatic stress disorder (PTSD) symptoms in a vast range of traumas, yet reports of the efficacy of such therapies in combat- and terror-related PTSD are scarce. In this article, we examine the efficacy of prolonged exposure therapy in combat- and terror-related PTSD in comparison to treatment as usual (TAU). Between July 2002 and October 2005, 30 patients of a trauma unit within a psychiatric outpatient clinic were recruited and randomized into prolonged exposure versus TAU therapies. Patients were diagnosed with chronic PTSD (Mini-International Neuropsychiatric Interview criteria) related to combat- (n = 19) or terror-related (n = 11) trauma. Main outcome measures included symptoms of PTSD and depression, as measured by the PTSD Symptom Scale-Interview Version and the Beck Depression Inventory. Posttraumatic stress disorder symptom severity was significantly lower in patients who received prolonged exposure therapy in comparison to patients who received TAU (F(1,24) = 35.3, P terror-related PTSD symptoms. In addition, prolonged exposure was superior to TAU in the short- and long-term reduction of PTSD and depression symptoms. Identifier: NCT00229372. © Copyright 2011 Physicians Postgraduate Press, Inc.

  12. Effect of switching off unidirectional downflow systems of operating theaters during prolonged inactivity on the period before the operating theater can safely be used.

    Traversari, A A L; Bottenheft, C; van Heumen, S P M; Goedhart, C A; Vos, M C


    Switching off air handling systems in operating theaters during periods of prolonged inactivity (eg, nights, weekends) can produce a substantial reduction of energy expenditure. However, little evidence is available regarding the effect of switching off the air handling system during periods of prolonged inactivity on the air quality in operating theaters during operational periods. The aim of this study is to determine the amount of time needed after restarting the ventilation system to return to a stable situation, with air quality at least equal to the situation before switching off the system. Measurements were performed in 3 operating theaters, all of them equipped with a unidirectional downflow (UDF) system. Measurements (particle counts of emitted particles with a particle size ≥0.5 µm) were taken during the start-up of the ventilation system to determine when prespecified degrees of protection were achieved. Temperature readings were taken to determine when a stable temperature difference between the periphery and the protected area was reached, signifying achievement of a stable condition. After starting up the system, the protected area achieved the required degrees of protection within 20 minutes (95% upper confidence limit). A stable temperature difference was achieved within 23 minutes (95% upper confidence limit). Both findings lie well within the period of 25 minutes normally required for preparations before the start of surgical procedures. Switching off the ventilation system during prolonged inactivity (during the night and weekend) has no negative effect on the air quality in UDF operating theaters during normal operational hours. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  13. Prolonged paradoxical reaction to antituberculous treatment after discontinuation of TNF-alpha- blocker therapy with adalimumab. Rare clinical documentation

    Falkenstern-Ge Roger Fei


    Full Text Available In the past decades, tumor necrosis factor alpha (TNF-a antagonist has been a milestone in the treatment of many chronic inflammatory diseases. TNF antagonist can increase patients´ susceptibility to many different kinds of infections especially those requiring granuloma formations despite regular performance of Screening for latent tuberculosis infection (LTBI. We report 2 cases of patients who developed tuberculosis under treatment with adalimumab, which was discontinued after the diagnosis of tuberculosis. During the tuberculosis therapy they unexpectedly developed a prolonged paradoxical reaction. In both cases we were only able to manage the progress of the paradoxical reaction through high steroid doses. Patients undergoing therapy with TNF- alphablocker are prone to develop tuberculosis infection, which could in turn lead to severe prolonged paradoxical reaction during anti-tuberculous treatment. An increased steroid dose may be required and is sometimes necessary

  14. Economic evaluation of ropinirole prolonged release for treatment of Parkinson's disease in The Netherlands

    van Boven, Job F. M.; Novak, Annoesjka; Driessen, Maurice T.; Boersma, Cornelis; Boomsma, Maarten M.; Postma, Maarten J.


    BACKGROUND: By using the findings obtained from the PREPARED study, we aimed to estimate the cost effectiveness of ropinirole prolonged release (PR) [Requip-Modutab(®)] in Parkinson's disease (PD) versus ropinirole immediate release (IR). In the PREPARED study, ropinirole PR provided a significantly

  15. New developments in the treatment of primary insomnia in elderly patients: focus on prolonged-release melatonin

    Vigo DE


    Full Text Available Daniel P Cardinali, María F Vidal, Daniel E VigoDepartment of Teaching and Research, Faculty of Medical Sciences, Pontificia Universidad Católica Argentina, Buenos Aires, ArgentinaAbstract: A temporal relationship between the nocturnal rise in melatonin secretion and the increase in sleep propensity at the beginning of the night, coupled with the sleep-promoting effects of exogenous melatonin, indicate that melatonin is involved in the regulation of sleep. This action is attributed to the MT1 and MT2 melatonin receptors present in the hypothalamic suprachiasmatic nucleus and other brain areas. The sleep-promoting actions of melatonin, which are demonstrable in healthy humans, have been found to be useful in subjects suffering from circadian rhythm sleep disorders and in elderly patients, who had low nocturnal melatonin production and secretion. The effectiveness of melatonin in treating sleep disturbances in these patients is relevant because the sleep-promoting compounds that are usually prescribed, such as benzodiazepines and related drugs, have many adverse effects, such as next-day hangover, dependence, and impairment of memory. Melatonin has been used for improving sleep in patients with insomnia mainly because it does not cause any hangover or show any addictive potential. However, there is a lack of consistency concerning its therapeutic value (partly because of its short half-life and the small quantities of melatonin used. Thus, attention has been focused either on the development of more potent melatonin analogs with prolonged effects or on the design of slow-release melatonin preparations. A prolonged-release preparation of melatonin 2 mg (Circadin® has been approved for the treatment of primary insomnia in patients aged ≥55 years in the European Union. This prolonged-release preparation of melatonin had no effect on psychomotor functions, memory recall, or driving skills during the night or the next morning relative to placebo

  16. Global changes in the rat heart proteome induced by prolonged morphine treatment and withdrawal.

    Zdenka Drastichova

    Full Text Available Morphine belongs among the most commonly used opioids in medical practice due to its strong analgesic effects. However, sustained administration of morphine leads to the development of tolerance and dependence and may cause long-lasting alterations in nervous tissue. Although proteomic approaches enabled to reveal changes in multiple gene expression in the brain as a consequence of morphine treatment, there is lack of information about the effect of this drug on heart tissue. Here we studied the effect of 10-day morphine exposure and subsequent drug withdrawal (3 or 6 days on the rat heart proteome. Using the iTRAQ technique, we identified 541 proteins in the cytosol, 595 proteins in the plasma membrane-enriched fraction and 538 proteins in the mitochondria-enriched fraction derived from the left ventricles. Altogether, the expression levels of 237 proteins were altered by morphine treatment or withdrawal. The majority of changes (58 proteins occurred in the cytosol after a 3-day abstinence period. Significant alterations were found in the expression of heat shock proteins (HSP27, α-B crystallin, HSP70, HSP10 and HSP60, whose levels were markedly up-regulated after morphine treatment or withdrawal. Besides that morphine exposure up-regulated MAPK p38 (isoform CRA_b which is a well-known up-stream mediator of phosphorylation and activation of HSP27 and α-B crystallin. Whereas there were no alterations in the levels of proteins involved in oxidative stress, several changes were determined in the levels of pro- and anti-apoptotic proteins. These data provide a complex view on quantitative changes in the cardiac proteome induced by morphine treatment or withdrawal and demonstrate great sensitivity of this organ to morphine.

  17. Global changes in the rat heart proteome induced by prolonged morphine treatment and withdrawal.

    Drastichova, Zdenka; Skrabalova, Jitka; Jedelsky, Petr; Neckar, Jan; Kolar, Frantisek; Novotny, Jiri


    Morphine belongs among the most commonly used opioids in medical practice due to its strong analgesic effects. However, sustained administration of morphine leads to the development of tolerance and dependence and may cause long-lasting alterations in nervous tissue. Although proteomic approaches enabled to reveal changes in multiple gene expression in the brain as a consequence of morphine treatment, there is lack of information about the effect of this drug on heart tissue. Here we studied the effect of 10-day morphine exposure and subsequent drug withdrawal (3 or 6 days) on the rat heart proteome. Using the iTRAQ technique, we identified 541 proteins in the cytosol, 595 proteins in the plasma membrane-enriched fraction and 538 proteins in the mitochondria-enriched fraction derived from the left ventricles. Altogether, the expression levels of 237 proteins were altered by morphine treatment or withdrawal. The majority of changes (58 proteins) occurred in the cytosol after a 3-day abstinence period. Significant alterations were found in the expression of heat shock proteins (HSP27, α-B crystallin, HSP70, HSP10 and HSP60), whose levels were markedly up-regulated after morphine treatment or withdrawal. Besides that morphine exposure up-regulated MAPK p38 (isoform CRA_b) which is a well-known up-stream mediator of phosphorylation and activation of HSP27 and α-B crystallin. Whereas there were no alterations in the levels of proteins involved in oxidative stress, several changes were determined in the levels of pro- and anti-apoptotic proteins. These data provide a complex view on quantitative changes in the cardiac proteome induced by morphine treatment or withdrawal and demonstrate great sensitivity of this organ to morphine.

  18. Tolrestat treatment prevents modification of the formalin test model of prolonged pain in hyperglycemic rats.

    Calcutt, N A; Malmberg, A B; Yamamoto, T; Yaksh, T L


    This study examined the effects of hyperglycemia and treatment with the aldose reductase inhibitor, Tolrestat, on the pain behavior evoked by injection of formalin into the dorsum of a single hind paw. In control rats, injection of formalin (50 microliters of a 5% solution) evoked two phases of flinching of the injected paw (phases 1 and 2), separated by a quiescent period. Four weeks of streptozotocin-induced diabetes or galactose intoxication did not alter the frequency of flinching during either of the active phases but significantly (P hyperalgesia in a paradigm that is used to model persistent pain and suggest that exaggerated flux through aldose reductase may initiate changes in nociceptive pathways that could contribute to some of the pain states experienced by patients with diabetic neuropathy.

  19. Prolonged conservative treatment or 'early' surgery in sciatica caused by a lumbar disc herniation: rationale and design of a randomized trial [ISRCT 26872154

    Tans Joseph


    Full Text Available Abstract Background The design of a randomized multicenter trial is presented on the effectiveness of a prolonged conservative treatment strategy compared with surgery in patients with persisting intense sciatica (lumbosacral radicular syndrome. Methods/design Patients presenting themselves to their general practitioner with disabling sciatica lasting less than twelve weeks are referred to the neurology outpatient department of one of the participating hospitals. After confirmation of the diagnosis and surgical indication MRI scanning is performed. If a distinct disc herniation is discerned which in addition covers the clinically expected site the patient is eligible for randomization. Depending on the outcome of the randomization scheme the patient will either be submitted to prolonged conservative care or surgery. Surgery will be carried out according to the guidelines and between six and twelve weeks after onset of complaints. The experimental therapy consists of a prolonged conservative treatment under supervision of the general practitioner, which may be followed by surgical intervention in case of persisting or progressive disability. The main primary outcome measure is the disease specific disability of daily functioning. Other primary outcome measures are perceived recovery and intensity of legpain. Secondary outcome measures encompass severity of complaints, quality of life, medical consumption, absenteeism, costs and preference. The main research question will be answered at 12 months after randomization. The total follow-up period covers two years. Discussion Evidence is lacking concerning the optimal treatment of lumbar disc induced sciatica. This pragmatic randomized trial, focusses on the 'timing' of intervention, and will contribute to the decision of the general practictioner and neurologist, regarding referral of patients for surgery.

  20. Efforts to explain and control the prolonged thermophilic period in two-phase olive oil mill sludge composting.

    Manios, Thrassyvoulos; Maniadakis, Konstantinos; Kalogeraki, Maria; Mari, Eirini; Stratakis, Emmanouil; Terzakis, Stelios; Boytzakis, Panagiotis; Naziridis, Yiannis; Zampetakis, Leonidas


    The aim of this paper was to evaluate the use of different bulking agents in different ratios as a means to control, optimise and eventually reduce the duration of the thermophilic period in two-phase olive oil mill sludge (OOMS) composting. The bulking agents used were: (i) olive tree leaves (OTL), (ii) olive tree shredded branches (OTB) and (iii) woodchips (WDC). The selection of these materials was based on their abundance and availability on the island of Crete, the southernmost point of Greece. The ratios studied were: Pile 1, OOMS:OTL in 1:1 v/v; Pile 2, OOMS:WDC in 1:1.5 v/v; Pile 3, OOMS:OTL in 1:2 v/v; Pile 4, OOMS:OTL:OTB in 1:1:1 v/v; and Pile 5, OOMS:OTL:OTB in 1:1:2 v/v. The composting system used was that of windrows with the volume of each pile approximately 20-25 m3. The experiments took place over two consecutive years. A composting turner was used and turnings were performed at one and two week intervals. In each pile a variety of physiochemical parameters were monitored. Temperature remained high in all five trials. Piles 1, 2, 3, 4 and 5 temperatures recorded values of above 50 degrees C for 106, 158, 160, 175 and 183 days, respectively. Volumes were reduced by approximately 67%, 62%, 63%, 80% and 84%, respectively. Temperature remained high, mainly due to the presence in large amounts of oily substances which during their complete oxidation release important amounts of energy and aid the cometabolism of more stable molecules such as lignin. This process is better described as the slow "burning" of a "fuel" mixture in an "engine" than composting. This approach is based on the extensive similarities of this process to that of crude oil sludge or similar waste composting.

  1. Prolonged anti-bacterial activity of ion-complexed doxycycline for the treatment of osteomyelitis.

    Oh, Se Heang; Nam, Bo Ra; Lee, In Soo; Lee, Jin Ho


    The main purposes of the present study are the fabrication of an ion-complexed antibiotic which allows for the continuous release of the drug for sufficient periods of time without any additional matrix leading to unfavorable tissue responses, and the feasibility study of the ion-complexed antibiotic as a therapeutic system for osteomyelitis using an animal model. An ion-complexed doxycycline (icDX) as an antibiotic was prepared by simple mixing of positively charged doxycycline hyclate (DX) and negatively charged multivalent Na2HPO4 (2Na(+) HPO4(2-)) aqueous solutions. The icDX showed a controlled release of the DX up to 6 weeks. From the in vivo feasibility study using an osteomyelitis rat model, the icDX group showed a more effective therapeutic effect for the osteomyelitis, at 3 and 6 weeks, compared to the non-treated control and free DX groups. This was due to the sustained release of DX from the icDX in the osteomyelitis bone (medullary cavity) without migration. These findings suggest that the icDX may be a promising local delivery system in the clinical field for the treatment of the osteomyelitis.

  2. Comparison of Methods for Prolonging Green Period of Northern Turf Grass%北方草坪延长绿期的方法比较

    王亚静; 徐小洲; 秦一统; 张丽娟


    Through the analysis the reasons of northern lawn withered and yellow in winter,the effects of different methods on prolonging green period of turf grass were compared from the following aspectslawn management of water and fertilizer,coverage,plant growth regulators,application of new material and green agent,in order to provide reference for improving the ornamental value of turf grass in winter.%通过分析冬季北方草坪枯黄的原因,从草坪水肥管理、覆盖、植物生长调节剂、新型材料和增绿剂的应用等方面比较不同方法延长草坪绿期的影响,以期为提高草坪冬季观赏价值研究提供借鉴和参考。

  3. Higher Viral Load and Prolonged Viral Shedding Period is Associated with Impaired Th17 Cell Response in Patients with H1N1 Influenza A

    Gui-lin; Yang; Ying-xia; Liu; Mu-tong; Fang; Wei-long; Liu; Xin-chun; Chen; John; Nunnari; Jing-jing; Xie; Ming-feng; Liao; Ming-xia; Zhang; Guo-bao; Li; Pei-ze; Zhang; Yi; Guan; Bo-ping; Zhou


    Objective To explore whether age,disease severity,cytokines and lymphocytes in H1N1 influenza A patients correlate with viral load and clearance.Methods Total of 70 mild and 16 severe patients infected with H1N1 influenza A virus were enrolled in this study.Results It was found that the patients under 14 years old and severe patients displayed significantly higher viral loads and prolonged viral shedding periods compared with the patients over 14 years old and mild patients,respectively(P < 0.05).Moreover,the patients under 14 years old and severe patients displayed significantly lower Th17 cell frequency than the patients over 14 years old and mild patients(P < 0.01).The viral shedding period inversely correlated with the frequency of IL-17+IFN-γ-CD4+ T cells.Additionally,the decreased concentration of serum TGF-β correlated with the decreased frequency of IL-17+IFN-γ-CD4+ T cells.Conclusions Both younger and severe patients are associated with higher viral loads and longer viral shedding periods,which may partially be attributed to the impaired Th17 cell response.

  4. Prolonged rest period enables the detection of micronucleated hepatocytes in the liver of young adult rats after a single dose of diethylnitrosamine or mitomycin C.

    Shimada, Keisuke; Yamamoto, Mika; Takashima, Miyuki; Seki, Jiro; Miyamae, Yoichi; Wakata, Akihiro


    A repeated-dose micronucleus assay utilizing young adult rat hepatocytes was recently developed to evaluate the genotoxicity. In this assay, accumulation of micronucleated hepatocytes (MNHEPs) induced by repeated dosing of genotoxic chemicals is considered to be a key factor in the detection of micronuclei induction. Then, we hypothesized that the period following chemical exposure enable the detection of MNHEP induction in young adult rats, namely that MNHEPs can be generated from chromosomally damaged cells and accumulate following initiation of chemical exposure until sampling. We therefore measured MNHEP induction at 2 or 4 weeks after a single oral administration of 12.5, 50, or 100mg/kg of diethylnitrosamine (DEN) or an intraperitoneal administration of 0.5, 1.0, or 2.0mg/kg of mitomycin C (MMC) to young adult rats. Results showed a statistically significant, dose-dependent increase in the numbers of MNHEPs in DEN- or MMC-treated rats, indicating that prolonged rest period following a single dose of a genotoxic chemical enables the detection of MNHEP induction in the liver of young adult rats. From these results, a single oral administration of 50mg/kg of DEN with a 2- or 4- week rest period can be used as a positive control in repeated-dose liver micronucleus assays. This procedure is superior in terms of labor saving and animal welfare to repeated dosing of DEN.

  5. [The treatment of recent myocardial infarction by prolonged infusion of trinitrin (author's transl)].

    Chiche, P; Derrida, J P; Baligadoo, S; Sal, R


    Seventy four clinically comparable cases of myocardial infarction, admitted on average at the 10th hour were divided at random in two groups: thirty nine were treated with a prolonged intravenous infusion of trinitrin lasting for 24 hours in 12 cases and during 5 at 7 days in 27 cases: 35 served as controls. The results showed the following: a) the good tolerance of the drug used in this way; b) on the basis of precordial cartography, a reduction of 56.2 +/- 14.5% to 30 +/- 7.3% in the index of secondary extension of necrosis; c) clinical signs of left ventricular failure developed in 60% of the controls as compared with 45.8% of the treated group; d) the prevalence of rhythm disturbances was also lower in those treated; e) overall mortality during the first 4 weeks was 8 amongst the 35 controls and 2 of the treated patients (p less than 0.05).

  6. Atraumatic intracapsular neck of femur fractures after prolonged bisphosphonate treatment: a new atypical variant?

    Khan, Sameer Khalid; Savaridas, Terence; Hemers, Jennifer S.; Maarouf, Zouheir; Orgee, Jane M.; Orr, Michael M.


    Summary We present 2 cases of elderly females presenting with atraumatic, near-vertical (Pauwells grade 3), intracapsular neck of femur fractures. Following diagnosis of osteoporosis on DEXA scans, they had received alendronic acid for 7 and 10 years respectively. Routine blood tests and serum estimations of calcium, vitamin-D and thyroid-stimulating hormone, done at admission, were within the normal ranges. These patients were managed with a hemiarthroplasty and a dynamic hip screw (DHS) respectively, following discontinuation of bisphosphonates. We present these 2 cases in light of emerging evidence that associates long-term bisphosphonate use with atypical low energy femoral fractures. Only subtrochanteric/diaphyseal fractures have been reported to date. We present a new variant of atypical femoral neck fractures in metaphyseal bone related to prolonged bisphosphonate therapy. PMID:27252743

  7. Determinants of acceptance of end-of-life interventions: a comparison between withdrawing life-prolonging treatment and euthanasia in Austria

    Stolz, Erwin; Großschädl, Franziska; Mayerl, Hannes; Rásky, Éva; Freidl, Wolfgang


    .... Previous studies on determinants of the acceptance of end-of-life interventions in the general population have not systematically assessed whether determinants differ between withdrawal of life-prolonging treatment (WLPT) and euthanasia (EUT...

  8. Prolonged conservative treatment or 'early' surgery in sciatica caused by a lumbar disc herniation: Rationale and design of a randomized trial [ISRCT 26872154

    W.C. Peul (Wilco); H.C. van Houwelingen (Hans); W.B. van den Hout (Wilbert); R. Brand (René); J.A.H. Eekhof (Just); J.T.J. Tans (Th); R.T.W.M. Thomeer (Raph); B.W. Koes (Bart)


    textabstractBackground: The design of a randomized multicenter trial is presented on the effectiveness of a prolonged conservative treatment strategy compared with surgery in patients with persisting intense sciatica (lumbosacral radicular syndrome). Methods/design: Patients presenting themselves to

  9. Dosed versus prolonged exposure in the treatment of fear: an experimental evaluation and review of behavioral mechanisms.

    Rubin, Sophie; Spates, C Richard; Johnson, Douglas A; Jouppi, Leigh


    Exposure-based treatments have proven effective in treating a range of fears and phobias and can be accounted for by mechanisms described in behavioral theory. Enhanced dosed and dosed-only exposure are promising new behavioral approaches for treating fears and phobias. Thirty-nine participants with speech anxiety were randomly assigned to a prolonged exposure (PE) condition, a positively enhanced dosed exposure (PDE) condition, a dosed-only exposure (DE) condition, or a negatively-supplemented dosed exposure (NDE) condition. Results indicated that both the PDE and DE conditions produced less measured aversive arousal and significantly more rapid arousal reduction than the tested alternatives. These techniques may represent an important advancement, in that the treatment gains of traditional exposure therapies might be achieved without the degree of aversive arousal (and possibly high drop out rates) typically seen in exposure therapies. Additionally, these data contradict prevailing opinion concerning the necessity for sustained aversive arousal during exposure-based treatment.

  10. Prolonged sulforaphane treatment does not enhance tumorigenesis in oncogenic K-ras and xenograft mouse models of lung cancer

    Ponvijay Kombairaju


    Full Text Available Background: Sulforaphane (SFN, an activator of nuclear factor erythroid-2 related factor 2 (Nrf2, is a promising chemopreventive agent which is undergoing clinical trial for several diseases. Studies have indicated that there is gain of Nrf2 function in lung cancer and other solid tumors because of mutations in the inhibitor Kelch-like ECH-associated protein 1 (Keap1. More recently, several oncogenes have been shown to activate Nrf2 signaling as the main prosurvival pathway mediating ROS detoxification, senescence evasion, and neoplastic transformation. Thus, it is important to determine if there is any risk of enhanced lung tumorigenesis associated with prolonged administration of SFN using mouse models of cancer. Materials and Methods: We evaluated the effect of prolonged SFN treatment on oncogenic K-ras (K-ras LSL-G12D -driven lung tumorigenesis. One week post mutant-K-ras expression, mice were treated with SFN (0.5 mg, 5 d/wk for 3 months by means of a nebulizer. Fourteen weeks after mutant K-ras expression (K-ras LSL-G12D , mice were sacrificed, and lung sections were screened for neoplastic foci. Expression of Nrf2-dependent genes was measured using real time RT-PCR. We also determined the effect of prolonged SFN treatment on the growth of preclinical xenograft models using human A549 (with mutant K-ras and Keap1 allele and H1975 [with mutant epidermal growth factor receptor (EGFR allele] nonsmall cell lung cancer cells. Results: Systemic SFN administration did not promote the growth of K-ras LSL-G12D -induced lung tumors and had no significant effect on the growth of A549 and H1975 established tumor xenografts in nude mice. Interestingly, localized delivery of SFN significantly attenuated the growth of A549 tumors in nude mice, suggesting an Nrf2-independent antitumorigenic activity of SFN. Conclusions: Our results demonstrate that prolonged SFN treatment does not promote lung tumorigenesis in various mouse models of lung cancer.

  11. The effect of prolonged heat treatments on the microstructural evolution of Al/Ni intermetallic compounds in multi layered composites

    Brunelli, K., E-mail: [Dipartimento di Ingegneria Industriale, University of Padova, Via Marzolo 9, Padova (Italy); Peruzzo, L. [CNR, Istituto di Geoscienze e Georisorse, Via Gradenigo 6, Padova (Italy); Dabalà, M. [Dipartimento di Ingegneria Industriale, University of Padova, Via Marzolo 9, Padova (Italy)


    In this work the effects of prolonged heat treatments on the microstructural and crystallographic evolution of Al–Ni intermetallic compounds were studied in Al/Ni multilayer samples, produced by accumulative roll bonding (ARB) process. Starting from aluminium and nickel sheets, the stacks were composed alternating three aluminium with two nickel sheets. After six rolling passes, the roll-bonded material was heat treated in a tubular furnace at 500, 550 and 600 °C for different times (1–20 h). The ARB process followed by the diffusion heat treatments allowed the formation of four Al–Ni intermetallic phases (Al{sub 3}Ni, Al{sub 3}Ni{sub 2}, AlNi and AlNi{sub 3}). Microstructural analyses of the obtained samples were carried out by scanning electron microscopy (SEM). The electron backscattered diffraction (EBSD) technique was used for the crystallographic analysis of the samples. After the prolonged annealing, three different sequences of phases, starting from Al, were observed: Al{sub 3}Ni{sub 2}–AlNi–AlNi{sub 3}, Al{sub 3}Ni and AlNi–Al{sub 3}Ni. The EBSD analysis showed that the intermetallic phases grew with a mean grain size between 0.5 μm and 3 μm and without a preferential crystallographic orientation. - Highlights: • Study of the prolonged annealing on Al/Ni system. • The presence of AlNi{sub 3} phase, not detected in similar researches, has been observed. • Three different sequences of phases were detected. • From EBSD analysis the intermetallic compounds have no preferred orientation.

  12. Lack of mucosal immune reconstitution during prolonged treatment of acute and early HIV-1 infection.

    Saurabh Mehandru


    Full Text Available BACKGROUND: During acute and early HIV-1 infection (AEI, up to 60% of CD4(+ T cells in the lamina propria of the lower gastrointestinal (GI tract are lost as early as 2-4 wk after infection. Reconstitution in the peripheral blood during therapy with highly active antiretroviral therapy (HAART is well established. However, the extent of immune reconstitution in the GI tract is unknown. METHODS AND FINDINGS: Fifty-four AEI patients and 18 uninfected control participants underwent colonic biopsy. Forty of the 54 AEI patients were followed after initiation of antiretroviral therapy (18 were studied longitudinally with sequential biopsies over a 3-y period after beginning HAART, and 22 were studied cross sectionally after 1-7 y of uninterrupted therapy. Lymphocyte subsets, markers of immune activation and memory in the peripheral blood and GI tract were determined by flow cytometry and immunohistochemistry. In situ hybridization was performed in order to identify persistent HIV-1 RNA expression. Of the patients studied, 70% maintained, on average, a 50%-60% depletion of lamina propria lymphocytes despite 1-7 y of HAART. Lymphocytes expressing CCR5 and both CCR5 and CXCR4 were persistently and preferentially depleted. Levels of immune activation in the memory cell population, CD45RO+ HLA-DR+, returned to levels seen in the uninfected control participants in the peripheral blood, but were elevated in the GI tract of patients with persistent CD4+ T cell depletion despite therapy. Rare HIV-1 RNA-expressing cells were detected by in situ hybridization. CONCLUSIONS: Apparently suppressive treatment with HAART during acute and early infection does not lead to complete immune reconstitution in the GI mucosa in the majority of patients studied, despite immune reconstitution in the peripheral blood. Though the mechanism remains obscure, the data suggest that there is either viral or immune-mediated accelerated T cell destruction or, possibly, alterations in T

  13. Optimizing the treatment of mood disorders in the perinatal period

    Meltzer-Brody, Samantha; Jones, Ian


    The perinatal period is a time of high risk for women with unipolar and bipolar mood disorders. We discuss treatment considerations for perinatal mood disorders, including unipolar and bipolar depression as well as postpartum psychosis. We further explore the unique issues faced by women and their families across the full trajectory of the perinatal period from preconception planning through pregnancy and following childbirth. Treatment of perinatal mood disorders requires a collaborative care approach between obstetrics practitioners and mental health providers, to ensure that a thoughtful risk : benefit analysis is conducted. It is vital to consider the risks of the underlying illness versus risks of medication exposure during pregnancy or lactation. When considering medication treatment, attention must be paid to prior medication trials that were most efficacious and best tolerated. Lastly, it is important to assess the impact of individual psychosocial stressors and lifestyle factors on treatment response. PMID:26246794

  14. Early treatment with noninvasive positive pressure ventilation prolongs survival in Amyotrophic Lateral Sclerosis patients with nocturnal respiratory insufficiency

    Scoditti Cristina


    Full Text Available Abstract Background Amyotrophic lateral sclerosis (ALS is a neurodegenerative disease, which rapidly leads to chronic respiratory failure requiring mechanical ventilation. Currently, forced vital capacity (FVC 75%, independently by any treatment. Aim To assess the role of NPPV in improving outcome of ALS, a retrospective analysis was performed to investigate 1 year survival of ALS patients with FVC Methods We investigated seventy-two consecutive ALS patients who underwent pulmonary function test. Forty-four presented a FVC > 75% and served as control group. Twenty-eight patients presented a FVC Results Increased survival rate at 1 year in patients with FVC Conclusion This report demonstrates that early treatment with NPPV prolongs survival and reduces decline of FVC% in ALS.

  15. Functional and metabolic adaptation of the heart to prolonged thyroid hormone treatment.

    Degens, H.; Gilde, A.J.; Lindhout, M.; Willemsen, P.H.; Vusse, G.J. van der; Bilsen, M. van


    In heart failure, thyroid hormone (TH) treatment improves cardiac performance. The long-term effects of TH on cardiac function and metabolism, however, are incompletely known. To investigate the effects of up to 28 days of TH treatment, male Wistar rats received 3,3',5-triiodo-l-thyronine (200 micro

  16. Cultural Adaptations of Prolonged Exposure Therapy for Treatment and Prevention of Posttraumatic Stress Disorder in African Americans

    Monnica T. Williams


    Full Text Available Posttraumatic stress disorder (PTSD is a highly disabling disorder, afflicting African Americans at disproportionately higher rates than the general population. When receiving treatment, African Americans may feel differently towards a European American clinician due to cultural mistrust. Furthermore, racism and discrimination experienced before or during the traumatic event may compound posttrauma reactions, impacting the severity of symptoms. Failure to adapt treatment approaches to encompass cultural differences and racism-related traumas may decrease treatment success for African American clients. Cognitive behavioral treatment approaches are highly effective, and Prolonged Exposure (PE in particular has the most empirical support for the treatment of PTSD. This article discusses culturally-informed adaptations of PE that incorporates race-related trauma themes specific to the Black experience. These include adding more sessions at the front end to better establish rapport, asking directly about race-related themes during the assessment process, and deliberately bringing to the forefront race-related experiences and discrimination during treatment when indicated. Guidelines for assessment and the development of appropriate exposures are provided. Case examples are presented demonstrating adaptation of PE for a survivor of race-related trauma and for a woman who developed internalized racism following a sexual assault. Both individuals experienced improvement in their posttrauma reactions using culturally-informed adaptations to PE.

  17. An open trial of 'grief-help': a cognitive-behavioural treatment for prolonged grief in children and adolescents.

    Spuij, Mariken; Dekovic, Maja; Boelen, Paul A


    In the past years, there is growing recognition of a syndrome of disturbed grief referred to as prolonged grief disorder (PGD). Although mostly studied in adults, clinically significant PGD symptoms have also been observed in children and adolescents. To date, no effective treatment for childhood PGD yet exists. We recently developed a nine-session cognitive-behavioural treatment for childhood PGD combined with five sessions of parental counselling. In the current article, we present outcomes of treatment of 10 consecutive children and adolescents turning to our university clinic with elevated PGD symptoms as their primary problem and main reason to seek therapy. Patients were significantly improved at post-treatment, with large improvements in self-rated PGD and post-traumatic stress (effect sizes > 0.8) and small to moderate improvement in depression and parent-rated internalizing and externalizing problems (0.2 < effect sizes < 0.8). Additional predictor analysis of outcomes suggested that, among other things, this treatment approach is less efficacious for children and adolescents further removed from loss and those confronted with suicidal loss. That said, the treatment appears promising, and controlled evaluation is clearly indicated.

  18. The Effect of Prolonged Treatment with Belimumab on B cells in Human SLE

    Jacobi, Annett M; Huang, Weiqing; Wang, Tao; Freimuth, William; Sanz, Inaki; Furie, Richard; Mackay, Meggan; Aranow, Cynthia; Diamond, Betty; Davidson, Anne


    Objectives To understand the effects of prolonged BLyS inhibition in human SLE. Methods 17 SLE patients enrolled in a clinical trial of belimumab, a BLyS-specific inhibitor, plus standard of care therapy were studied. Phenotypic analysis of lymphocytes was performed using flow cytometry. Circulating antibody-secreting cells were enumerated using ELISpot assay. Serum was analyzed by ELISA using an antibody that recognizes products of the VH4-34 gene. Lymphocyte counts, Ig levels and anti-dsDNA antibody levels were available as part of the clinical trial analyses. Results Samples were collected at days 0, 84, 168, 365, 532 and >730. The total B cell number decreased from baseline starting between days 84–168. This was due to a decrease in naïve and transitional B cells. CD27+/IgD+memory B cells and plasmablasts decreased only after 532 days, whereas CD27+/IgD− memory B cells were not affected, and there were no changes in T cells. Serum IgM levels began to decline between days 84–168, but there were no changes in serum levels of IgG, IgG anti-DNA antibodies or VH4-34 antibodies during the study. SLE patients had more IgM-, IgG-, and autoantibody-producing B cells than normal controls at Day 0. There was only a modest decrease in the frequency of total IgM-producing but not IgG-producing cells at Days 365 and 532, consistent with the phenotypic and serologic data. Conclusions Our data confirm the dependence of newly formed B cells on BLyS for survival in humans. In contrast, memory B cells and plasma cells are less susceptible to selective BLyS inhibition. PMID:20039404

  19. Donor dopamine treatment limits pulmonary oedema and inflammation in lung allografts subjected to prolonged hypothermia

    Hanusch, Christine; Nowak, Kai; Toerlitz, Patrizia; Gill, Ishar S.; Song, Hui; Rafat, Neysan; Brinkkoetter, Paul T.; Leuvenink, Henri G.; Van Ackern, Klaus C.; Yard, Benito A.; Beck, Grietje C.


    Background. Endothelial barrier dysfunction severely compromises organ function after reperfusion. Because dopamine pretreatment improves hypothermia mediated barrier dysfunction, we tested the hypothesis that dopamine treatment of lung allografts positively affects tissue damage associated with hyp

  20. Comparing Virtual Reality Exposure Therapy to Prolonged Exposure in the Treatment of Soldiers with PTSD


    Hodges LF: The use of virtual reality exposure in the treatment of anxiety disorders . Behav Modif 1999; 23(4):507-25 4. Difede J, Cukor J, Ivy P, Giosan C...RD: Virtual reality exposure therapy for Vietnam veterans with posttraumatic stress disorder . J Clin Psychiatry 2001; 62(8):617-22 3. Rothbaum BO...Hoffman H: The Application of Virtual Reality to the Treatment of PTSD Following the WTC Attack, in Psychobiology of Posttraumatic Stress Disorders

  1. Prolonged bisphosphonate release after treatment in women with osteoporosis. Relationship with bone turnover.

    Peris, P; Torra, M; Olivares, V; Reyes, R; Monegal, A; Martínez-Ferrer, A; Guañabens, N


    Bisphosphonates (BP), especially alendronate and risedronate, are the drugs most commonly used for osteoporosis treatment, being incorporated into the skeleton where they inhibit bone resorption and are thereafter slowly released during bone turnover. However, there are few data on the release of BP in patients who have received treatment with these drugs for osteoporosis. This information is essential for evaluating the possibility of BP cyclic therapy in these patients and for controlling their long-term presence in bone tissue. This study evaluated the urinary excretion of alendronate and risedronate in patients treated with these drugs for osteoporosis and analysed its relationship with bone turnover, time of previous drug exposure and time of treatment discontinuation. We included 43 women (aged 65±9.4 years) previously treated with alendronate (36) or risedronate (7) during a mean of 51±3 and 53±3 months, respectively, who had not been treated with other antiosteoporotic treatment and with a median time of discontinuation of 13.5 and 14 months, respectively. Both BP were detected in 24-hour urine by HPLC. In addition, bone formation (PINP) and resorption (NTx) markers were analysed. Both BP were also determined in a control group of women during treatment. Alendronate was detected in 41% of women previously treated with this drug whereas no patient previously treated with risedronate showed detectable urinary values. All control patients showed detectable values of both BP. In patients with detectable alendronate levels, the time of drug cessation was shorter than in patients with undetectable values (12 [6-19] versus 31 [7-72] months, prisedronate, which was not detected in patients after cessation of treatment, alendronate was frequently detected in women previously treated with this agent up to 19 months after discontinuation of therapy. The relationship between alendronate levels and both bone resorption and time of treatment cessation further

  2. FcεR1-mediated mast cell reactivity is amplified through prolonged Toll-like receptor-ligand treatment.

    Rohit Saluja

    Full Text Available BACKGROUND: Mast cell-derived mediators mediate several of the pathological features of asthma. Microbial infections induce asthma exacerbations in which the contribution of mast cells remains incomprehensible. PRINCIPAL FINDINGS: In this study we have investigated the characteristic expression pattern of Toll-like receptors (TLRs 1-9 and the effect of TLR ligand treatment on IgE-receptor mediated mast cell reactivity. For the studies we employed in vitro differentiated connective tissue like mast cells (CTLMC and mucosal like mast cells (MLMC from mice. Both phenotypes were treated for 24 h or 96 h with ligands for TLR1/2, TLR2/6, TLR3 and TLR4, before activation with IgE and antigen. Prolonged exposure (96 h with TLR-ligands promoted mast cell reactivity following IgE-receptor activation. TLR4 activation with LPS generated the most pronounced effect, with an enhanced degranulation and secretion of leukotrienes, cytokines and chemokines, in both CTLMC and MLMC. The effect of LPS was mediated through a Myd88-dependent pathway and the increased effect involved JNK-dependent pathway. CONCLUSION: We find that prolonged exposure of mast cells to pathogens/TLR-ligands modulates their effector responses by priming them for increased release of several inflammatory mediators when subsequently activated by IgE-receptors. These data suggest that infections might exaggerate the severity of allergic reactions such as in asthma, by enhancing mediator release from mast cells.

  3. Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE): A Pilot Study in Alcohol-dependent Women.

    Persson, Anna; Back, Sudie E; Killeen, Therese K; Brady, Kathleen T; Schwandt, Melanie L; Heilig, Markus; Magnusson, Åsa

    Posttraumatic stress disorder (PTSD) and substance use disorders are highly comorbid. Effective treatments are largely lacking. This pilot study evaluated the safety and feasibility of a novel intervention, Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE), in preparation for a randomized controlled trial. Twenty-two treatment-seeking women with current DSM-IV-TR PTSD and alcohol dependence (AD) were recruited. Participants received COPE. Safety and feasibility were evaluated, as were efficacy-related outcomes: PTSD and depression symptom severity, alcohol use, craving, and dependence severity. No adverse events occurred. COPE was implemented in routine clinical practice. Among the assessed women, 95.8% were eligible to participate. Treatment attendance and completion were higher than in previous studies. Post treatment, all efficacy-related outcomes, including PTSD and depression symptom severity, alcohol use, craving, and dependence severity, were significantly reduced. COPE was safe and feasible to use. Concerns that trauma-focused, exposure-based therapy might promote relapse in this population appear unwarranted. Our findings provide initial evidence suggestive of COPE efficacy for comorbid PTSD and AD in women. These results provide a strong rationale for investigating the efficacy of COPE for comorbid PTSD and AD in women in a randomized controlled trial.

  4. Treatment delay period: the case of arsenicosis in rural Bangladesh.

    Paul, Bimal Kanti; Brock, Vicki L Tinnon


    Arsenic concentrations of tubewell water that exceed acceptable limits poses a serious health problem in Bangladesh. Many Bangladeshis are now suffering from arsenic-related diseases. The objectives of this paper are to examine the extent of delay in seeking medical treatment by victims of arsenic poisoning and to identify factors contributing to this delay. Questionnaire survey successfully administered to 663 victims living in two rural areas of Bangladesh provided the major data source for this study. Analysis of survey data reveal that median delay period was 12 months, but the delay period ranged from 1 month to 18 years. Because of this extremely large range, the mean delay period was about 22 months. The study identified time of identification of symptoms of arsenicosis as the most significant determinant of treatment delay followed by treatment sought from members of mobile medical teams, perceived threat, and level of education. Based on the study findings, it is recommended that the Bangladesh government and NGOs involved in arsenic mitigation and prevention efforts should educate individuals at risk for arsenic poisoning about the benefits of seeking early treatment. This study also recommends to continue to dispatch mobile medical teams to the arsenic-impacted areas.

  5. Treatment of extraskeletal osteosarcoma at a previous injection site resulting in prolonged survival in 1 dog.

    Selmic, Laura E; Griffin, Lynn R; Rector, Megan H; Lafferty, Mary; Pool, Roy; Ehrhart, Nicole P


    A rare presentation of an extraskeletal osteosarcoma at a previous interscapular injection site in a dog is described. Treatment included surgical excision of the tumor followed by 6 rounds of intravenous carboplatin, oral toceranib, and cyclophosphamide. The dog survived for 20.5 months after diagnosis despite early development of pulmonary metastases.

  6. Current treatment of nasal vestibular stenosis with CO2-laser surgery: prolonged vestibular stenting versus intraoperative mitomycin application. A case series of 3 patients.

    van Schijndel, Olaf; van Heerbeek, Niels; Ingels, Koen J A O


    These case studies describe three cases of unilateral nasal vestibular stenoses caused by chemical cauterization. Each case was treated with CO2-laser surgery together with intraoperative topic application of mitomycin or prolonged vestibular stenting for prevention of restenosis. Two patients received intraoperative mitomycin application and one patient received prolonged vestibular stenting. Results were documented using high-resolution photographs. The follow up period ranged from 1 year and 3 months to 4 years and 9 months. All patients improved after CO2-laser surgery. No complications were reported. We consider CO2-laser surgery for relief of nasal vestibular stenosis as a feasible surgical technique for relieve of nasal vestibular stenosis. Prolonged vestibular stenting seems to be an important factor for the prevention of restenosis in which the value of intraoperative mitomycin application without prolonged vestibular stenting remains uncertain.

  7. Evaluating treatment of posttraumatic stress disorder with cognitive processing therapy and prolonged exposure therapy in a VHA specialty clinic.

    Jeffreys, Matthew D; Reinfeld, Courtney; Nair, Prakash V; Garcia, Hector A; Mata-Galan, Emma; Rentz, Timothy O


    This retrospective chart review evaluates the effectiveness of manualized cognitive processing therapy (CPT) protocols (individual CPT, CPT group only, and CPT group and individual combined) and manualized prolonged exposure (PE) therapy on veterans' posttraumatic stress disorder (PTSD) symptoms in one Veterans Health Administration (VHA) specialty clinic. A total of 517 charts were reviewed, and analyses included 178 charts for CPT and 85 charts for PE. Results demonstrated CPT and PE to significantly reduce PTSD Checklist (PCL) scores. However, PE was significantly more effective than CPT after controlling for variables of age, service era, and ethnicity. Additional findings included different outcomes among CPT formats, decreased treatment dropouts for older veterans, and no significant differences in outcome between Hispanic and White veterans. Study limitations and future research directions are discussed. Published by Elsevier Ltd.

  8. Combination with γ-secretase inhibitor prolongs treatment efficacy of BRAF inhibitor in BRAF-mutated melanoma cells.

    Zhu, Guannan; Yi, Xiuli; Haferkamp, Sebastian; Hesbacher, Sonja; Li, Chunying; Goebeler, Matthias; Gao, Tianwen; Houben, Roland; Schrama, David


    Oncogenic triggering of the MAPK pathway in melanocytes results in senescence, and senescence escape is considered as one critical step for melanocytic transformation. In melanoma, induction of a senescent-like state by BRAF-inhibitors (BRAFi) in a fraction of treated cells - instead of killing - contributes to the repression of tumor growth, but may also provide a source for relapse. Here, we demonstrate that NOTCH activation in melanocytes is not only growth-promoting but it also protects these cells against oncogene-induced senescence. In turn, treatment of melanoma cells with an inhibitor of the NOTCH-activating enzyme γ-secretase led to induction of a senescent-like status in a fraction of the cells but overall achieved only a moderate inhibition of melanoma cell growth. However, combination of γ-secretase inhibitor (GSI) with BRAFi markedly increased the treatment efficacy particularly in long-term culture. Moreover, even melanoma cells starting to regrow after continuous BRAFi treatment - the major problem of BRAFi therapy in patients - can still be affected by the combination treatment. Thus, combining GSI with BRAFi increases the therapeutic efficacy by, at least partially, prolonging the senescent-like state of treated cells.

  9. Prolongation of islet allograft survival in mice by combined treatment with pravastatin and low-dose cyclosporine.

    Arita, S; Kasraie, A; Une, S; Ohtsuka, S; Smith, C V; Mullen, Y


    Pravastatin, a 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor, is known to have suppressive effects on immune and inflammatory cells. We have previously shown in mice and dogs that this agent prevents primary nonfunction of islet iso- and autografts by reducing inflammation at the graft site. The present study was designed to further investigate whether pravastatin has a synergistic effect with cyclosporine (Cs) to prolong islet allograft survival in mice. Unpurified 3000 BALB/c newborn islets were transplanted under the renal capsule of a streptozotocin-diabetic C57BL/6 mouse. Pravastatin and Cs were administered for 10 days starting on the day of grafting (day 0). Five groups were set up based on the treatment protocol: group 1, treatment with 40 mg/kg pravastatin; group 2, 30 mg/kg Cs; group 3, 50 mg/kg Cs; group 4, 40 mg/kg pravastatin and 30 mg/kg Cs; group 5, vehicle alone. Graft survival was indicated by blood glucose levels sustained at 250 mg/dl for 2 consecutive days. Hyperglycemia persisted in six of the eight (75%) mice and grafts were rejected in 3.6 +/- 0.5 days (mean +/- SD) in group 5. In group 1, grafts were also rejected in 3.8 +/- 0.8 days, but blood glucose was transiently 60 days, the other rejected the graft on day 15, and the remaining four died with functioning grafts between 9 and 13 days due to Cs toxicity. A combination of a low dose of Cs and pravastatin (group 4) prolonged graft survival for >19 days in five of the eight mice, and for 7-13 days in the remaining three mice. Histological examination of the grafts in this group showed significantly reduced local inflammation. Results indicate a synergistic effect of pravastatin and Cs on prevention of islet allograft rejection.

  10. Prolonged treatment with pramipexole promotes physical interaction of striatal dopamine D3 autoreceptors with dopamine transporters to reduce dopamine uptake.

    Castro-Hernández, Javier; Afonso-Oramas, Domingo; Cruz-Muros, Ignacio; Salas-Hernández, Josmar; Barroso-Chinea, Pedro; Moratalla, Rosario; Millan, Mark J; González-Hernández, Tomás


    The dopamine (DA) transporter (DAT), a membrane glycoprotein expressed in dopaminergic neurons, clears DA from extracellular space and is regulated by diverse presynaptic proteins like protein kinases, α-synuclein, D2 and D3 autoreceptors. DAT dysfunction is implicated in Parkinson's disease and depression, which are therapeutically treated by dopaminergic D2/D3 receptor (D2/D3R) agonists. It is, then, important to improve our understanding of interactions between D3R and DAT. We show that prolonged administration of pramipexole (0.1mg/kg/day, 6 to 21 days), a preferential D3R agonist, leads to a decrease in DA uptake in mouse striatum that reflects a reduction in DAT affinity for DA in the absence of any change in DAT density or subcellular distribution. The effect of pramipexole was absent in mice with genetically-deleted D3R (D3R(-/-)), yet unaffected in mice genetically deprived of D2R (D2R(-/-)). Pramipexole treatment induced a physical interaction between D3R and DAT, as assessed by co-immunoprecipitation and in situ proximity ligation assay. Furthermore, it promoted the formation of DAT dimers and DAT association with both D2R and α-synuclein, effects that were abolished in D3R(-/-) mice, yet unaffected in D2R(-/-) mice, indicating dependence upon D3R. Collectively, these data suggest that prolonged treatment with dopaminergic D3 agonists provokes a reduction in DA reuptake by dopaminergic neurons related to a hitherto-unsuspected modification of the DAT interactome. These observations provide novel insights into the long-term antiparkinson, antidepressant and additional clinical actions of pramipexole and other D3R agonists.

  11. Tactile Electrosurgical Ablation: A Technique for the Treatment of Intractable Heavy and Prolonged Menstrual Bleeding

    Ali M. El Saman


    Full Text Available Objective. To study the efficacy and safety of tactile electrosurgical ablation (TEA in stopping a persistent attack of abnormal uterine bleeding not responding to medical and hormonal therapy. Methods. This is a case series of 19 cases with intractable abnormal uterine bleeding, who underwent TEA at the Women’s Health Center of Assiut University. The outcomes measured were; patient’s acceptability, operative time, complications, menstrual outcomes, and reintervention. Results. None of the 19 counseled cases refused the TEA procedure which took 6–10 minutes without intraoperative complications. The procedure was successful in the immediate cessation of bleeding in 18 out of 19 cases. During the 24-month follow-up period, 9 cases developed amenorrhea, 5 had scanty menstrual bleeding, 3 were regularly menstruating, 1 case underwent repeat TEA ablation, and one underwent a hysterectomy. Conclusions. TEA represents a safe, inexpensive, and successful method for management of uterine bleeding emergencies with additional long-term beneficial effects. However, more studies with more cases and longer follow-up periods are warranted.

  12. Efficacy and tolerability of prolonged linezolid therapy in the treatment of orthopedic implant infections.

    Soriano, A; Gómez, J; Gómez, L; Azanza, J R; Pérez, R; Romero, F; Pons, M; Bella, F; Velasco, M; Mensa, J


    The aim of the study presented here was to assess the efficacy and tolerability of linezolid in the treatment of orthopedic implant infections (OII). Eighty-five patients with an OII treated with linezolid were prospectively followed up for a minimum of 12 months from the end of antibiotic therapy. Outcome was evaluated in relation to the duration and type of symptoms (acute or chronic) and the retention or removal of the implant. For acute and chronic infections, the respective success rates were 100 and 92.3% when the implant was removed and 72.2 and 42.8% when it was not. The median length of linezolid treatment in acute and chronic infections was 47 and 60 days, respectively. Thrombocytopenia was observed in four (4.7%) patients and anemia in five (5.8%). The results suggest oral linezolid is an effective and well-tolerated alternative for treating OII.

  13. Surgery versus prolonged conservative treatment for sciatica: 5-year results of a randomised controlled trial

    Lequin, Michiel B.; Verbaan, Dagmar; Jacobs, Wilco C. H.; Brand, Ronald; Gerrit J. Bouma; Vandertop, William P.; Peul, Wilco C; ,


    Objective This study describes the 5 years’ results of the Sciatica trial focused on pain, disability, (un)satisfactory recovery and predictors for unsatisfactory recovery. Design A randomised controlled trial. Setting Nine Dutch hospitals. Participants Five years’ follow-up data from 231 of 283 patients (82%) were collected. Intervention Early surgery or an intended 6 months of conservative treatment. Main outcome measures Scores from Roland disability questionnaire, visual analogue scale (V...

  14. Global Changes in the Rat Heart Proteome Induced by Prolonged Morphine Treatment and Withdrawal

    Zdenka Drastichova; Jitka Skrabalova; Petr Jedelsky; Jan Neckar; Frantisek Kolar; Jiri Novotny


    Morphine belongs among the most commonly used opioids in medical practice due to its strong analgesic effects. However, sustained administration of morphine leads to the development of tolerance and dependence and may cause long-lasting alterations in nervous tissue. Although proteomic approaches enabled to reveal changes in multiple gene expression in the brain as a consequence of morphine treatment, there is lack of information about the effect of this drug on heart tissue. Here we studied ...

  15. Treating Low-Income and Minority Women with Posttraumatic Stress Disorder: A Pilot Study Comparing Prolonged Exposure and Treatment as Usual Conducted by Community Therapists

    Feske, Ulrike


    Twenty-one female psychiatric outpatients with chronic posttraumatic stress disorder (PTSD) are randomly assigned to prolonged exposure (PE; n = 9) for PTSD or treatment as usual (TAU; n = 12). Participants are predominately low income and African American with complex trauma and psychiatric histories. Treatment is delivered by community…

  16. Predictors of anti-convulsant treatment failure in children presenting with malaria and prolonged seizures in Kampala, Uganda

    Byarugaba Justus


    Full Text Available Abstract Background In endemic areas, falciparum malaria remains the leading cause of seizures in children presenting to emergency departments. In addition, seizures in malaria have been shown to increase morbidity and mortality in these patients. The management of seizures in malaria is sometimes complicated by the refractory nature of these seizures to readily available anti-convulsants. The objective of this study was to determine predictors of anti-convulsant treatment failure and seizure recurrence after initial control among children with malaria. Methods In a previous study, the efficacy and safety of buccal midazolam was compared to that of rectal diazepam in the treatment of prolonged seizures in children aged three months to 12 years in Kampala, Uganda. For this study, predictive models were used to determine risk factors for anti-convulsant treatment failure and seizure recurrence among the 221 of these children with malaria. Results Using predictive models, focal seizures (OR 3.21; 95% CI 1.42–7.25, p = 0.005, cerebral malaria (OR 2.43; 95% CI 1.20–4.91, p = 0.01 and a blood sugar ≥200 mg/dl at presentation (OR 2.84; 95% CI 1.11–7.20, p = 0.02 were independent predictors of treatment failure (seizure persistence beyond 10 minutes or recurrence within one hour of treatment. Predictors of seizure recurrence included: 1 cerebral malaria (HR 3.32; 95% CI 1.94–5.66, p Conclusion Specific predictors, including cerebral malaria, can identify patients with malaria at risk of anti-convulsant treatment failure and seizure recurrence.

  17. Treatment of Metformin Intoxication Complicated by Lactic Acidosis and Acute Kidney Injury: The Role of Prolonged Intermittent Hemodialysis.

    Regolisti, Giuseppe; Antoniotti, Riccardo; Fani, Filippo; Greco, Paolo; Fiaccadori, Enrico


    Metformin intoxication with lactic acidosis, a potentially lethal condition, may develop in diabetic patients when the drug dose is inappropriate and/or its clearance is reduced. Diagnosis and therapy may be delayed due to nonspecific symptoms at presentation, with severe anion gap metabolic acidosis and elevated serum creatinine values being the most prominent laboratory findings. Confirmation requires measurement of serum metformin by high-performance liquid chromatography-tandem mass spectrometry, but this technique is available only at specialized institutions and cannot be relied on as a guide to immediate treatment. Thus, based on strong clinical suspicion, renal replacement therapy must be started promptly to achieve efficient drug clearance and correct the metabolic acidosis. However, because metformin accumulates in the intracellular compartment with prolonged treatment, a rebound in serum concentrations due to redistribution is expected at the end of dialysis. We report a case of metformin intoxication, severe lactic acidosis, and acute kidney injury in a diabetic patient with pre-existing chronic kidney disease stage 3, treated effectively with sustained low-efficiency dialysis. We discuss the pathophysiology, differential diagnosis, and treatment options and highlight specific pharmacokinetic issues that should be considered in selecting the appropriate modality of renal replacement therapy.

  18. [Treatment of head injury coma with prolonged pentobarbital anaesthesia (author's transl)].

    Artru, F; Guerin, J M; Latarjet, J; Deleuze, R


    Forty-five patients in deep coma resulting from head injury were treated with pentobarbital in doses adjusted to maintain serum barbiturate levels between 15 and 25 mg/l and short burst suppression phases on EEG. Brain death occurred in 20%. The overall mortality rate was 60%, no death being attributable to treatment; 24% of the patients were able to resume active life. Patients with non-reactive pupils during the early phase of coma were compared with patients of similar ages and neurological symptoms non treated with pentobarbital. In treated patients the incidence of brain death was reduced by 50% and the mortality rate by 25% (p less than 0.05), without increase in deaths from intercurrent complications and in severe sequelae among survivors.

  19. Causes of Activation and Deactivation of Modified Nanogold Catalysts during Prolonged Storage and Redox Treatments

    Ekaterina Kolobova


    Full Text Available The catalytic properties of modified Au/TiO2 catalysts for low-temperature CO oxidation are affected by deactivation and reactivation after long-term storage and by redox treatments. The effect of these phenomena on the catalysts was studied by HRTEM, BET, SEM, FTIR CO, XPS and H2 TPR methods. The main cause for the deactivation and reactivation of catalytic properties is the variation in the electronic state of the supported gold, mainly, the proportion of singly charged ions Au+. The most active samples are those with the highest proportion of singly charged gold ions, while catalysts with a high content of trivalent gold ions are inactive at low-temperatures. Active states of gold, resistant to changes caused by the reaction process and storage conditions, can be stabilized by modification of the titanium oxide support with transition metals oxides. The catalyst modified with lanthanum oxide shows the highest stability and activity.

  20. [Electrogastroenterographic study of the digestive motor effects of prolonged psychotropic treatment].

    Martin, A; Etienne, T; Rigalleau, J; Moline, J; Masson, J M; Arlot, J C; David, C


    Functional digestive complaints are frequent in psychiatri patients: simple constipation, which cannot be explained solely by the loss of the sensation of rectal fullness; occlusions, occasionally hemorragies; the late complication of dolichomegacolon (Bourgeois, 1973). In 160 subjects, an attempt to understand the physio-pathology were made by recording diurnal digestive motor activity using skin electrodes placed on the abdomen and extremities (electrogastroenterography or E.G.E.G.). A hypoactive E.G.E.G. was observed in 2/3 of 18 psychotic depressive patients, in 3/4 of 36 schizophrenies. The nocive effect of giving sedative phenothiazine and antiparkinsonian drugs (trihexyphenidyl or ethybenzatropine) during long periods is clear. Whereas non sedative phenothiazine and clotiapine gicen in small doses, do not have an undesirable effect. Sulpiride has been used in gastroduodenal dyskinesia. The dyskinesia noted by the E.G.E.G., sometimes found in the large intestin, were found in 55% of 30 patients with caracter disorders; they coincide with the high frequency of electro-encephalogram dysrythmies. Finally, in hysterical patients, one usually observes normal E.G.E.G., tracings which confirms the clinical observation that hysterical and psychosomatic symptoms, may succeed each other, but do not appear at the same time. In the same categories of patients, no longer treated in a classical psychiatric environment but in a group with institutional objectives, the same clinic results were obtained with fewer digestive disturbances. This tends to show the inutility and nocivity of excessive doses of psychotropic drugs given alone or in complexe association.

  1. Manipulation with prolonged epidural analgesia for treatment of TKA complicated by arthrofibrosis.

    Pariente, Gerardo Mangino; Lombardi, Adolph V; Berend, Keith R; Mallory, Thomas H; Adams, Joanne B


    Inability to achieve adequate range of motion (ROM) after total knee arthroplasty (TKA) represents a frustrating complication for both patient and surgeon. Manipulation under anesthesia is indicated in TKA having less than 90 degrees ROM after six weeks, with no progression or regression in ROM. A modified technique has evolved for patients with chronic regional pain syndrome (CRPS) symptoms or persistent stiffness after standard manipulation. A retrospective review was conducted to determine the efficacy of the modified technique, which uses epidural anesthesia continued for postoperative analgesia, hospital stay of one to three days, continuous passive motion (CPM) for two to three days, and daily physical therapy (PT). Between 1997 and 2003, 5714 TKAs were performed in 4106 patients. Manipulation using a standard technique was performed on 334 (5.8%) knees in 273 patients. Manipulation using a modified technique was performed on 65 (1%) knees in 60 patients. Age averaged 58 years and body mass index (BMI) averaged 34.39. Follow up averaged 18.4 months. ROM improved significantly from 71 degrees to 102 degrees (p arthrofibrosis, which included one full revision, five polyethylene exchanges, and three revisions of femoral component and polyethylene. Two significant complications occurred: one subdural hematoma and one death due to pulmonary embolism. Although not without complications, manipulation under epidural anesthesia represents a viable option for treatment of persistent stiffness after TKA; 80% of these difficult cases achieved successful results.

  2. Restless legs syndrome: a new entity of neuropathic pain? Treatment with prolonged release oxycodone/naloxone combination

    Gemignani F


    Full Text Available Franco Gemignani,1 Andrea Melpignano,1,2 Giulia Milioli,1,2 Silvia Riccardi,1,2 Liborio Parrino1,2 1Neurology Unit, Department of Neurosciences, University of Parma, Parma, Italy; 2Sleep Disorders Center, Department of Neurosciences, University of Parma, Parma, Italy Abstract: Restless legs syndrome (RLS is a disorder of sensorimotor integration characterized by an urge to move the legs when at rest, especially at night or in the evening, which is relieved by movement. Sensory symptoms may be prominent, often exhibiting features consistent with neuropathic pain. Iron deficiency and genetic factors are implicated in RLS causation in most patients. The pathogenetic model of impaired circadian dopaminergic modulation of sensorimotor integration circuitry at the spinal level is fitting with the co-occurrence of movement disorders, sensory symptoms, and sleep disruption in RLS. Accordingly, levodopa and dopamine agonists are effective for RLS symptoms, which compensate for the impaired descending control by diencephalo-spinal dopa(minergic pathway. Dopamine agonists are usually indicated as the first-line therapy, but their use in long-term treatment is often complicated by augmentation and impulse control disorder, thus alpha-2-delta ligands also are now considered the first line of treatment. It has been recognized that endogenous opioid system is also involved in the mechanisms generating RLS, possibly through an impaired modulation of pain pathways. Opioids can be considered as an alternative therapy, particularly in patients with augmentation and/or refractory to other treatments. Recently introduced prolonged-release oxycodone–naloxone was efficacious for short-term treatment of patients with severe RLS inadequately controlled with previous treatment. It will be important to assess whether opioids, as well as other drugs, are especially effective in definite RLS subtypes such as the painful phenotype. Keywords: small fiber neuropathy

  3. Prolonged exposure for the treatment of Spanish-speaking Puerto Ricans with posttraumatic stress disorder: a feasibility study

    Olmo Alicia


    Full Text Available Abstract Background Most of the empirical studies that support the efficacy of prolonged exposure (PE for treating posttraumatic stress disorder (PTSD have been conducted on white mainstream English-speaking populations. Although high PTSD rates have been reported for Puerto Ricans, the appropriateness of PE for this population remains unclear. The purpose of this study was to examine the feasibility of providing PE to Spanish speaking Puerto Ricans with PTSD. Particular attention was also focused on identifying challenges faced by clinicians with limited experience in PE. This information is relevant to help inform practice implications for training Spanish-speaking clinicians in PE. Results Fourteen patients with PTSD were randomly assigned to receive PE (n = 7 or usual care (UC (n = 7. PE therapy consisted of 15 weekly sessions focused on gradually confronting and emotionally processing distressing trauma-related memories and reminders. Five patients completed PE treatment; all patients attended the 15 sessions available to them. In UC, patients received mental health services available within the health care setting where they were recruited. They also had the option of self-referring to a mental health provider outside the study setting. The Clinician-Administered PTSD Scale (CAPS was administered at baseline, mid-treatment, and post-treatment to assess PTSD symptom severity. Treatment completers in the PE group demonstrated significantly greater reductions in PTSD symptoms than the UC group. Forty percent of the PE patients showed clinically meaningful reductions in PTSD symptoms from pre- to post-treatment. Conclusions PE appears to be viable for treating Puerto Rican Spanish-speaking patients with PTSD. This therapy had good patient acceptability and led to improvements in PTSD symptoms. Attention to the clinicians' training process contributed strongly to helping them overcome the challenges posed by the intervention and increased their

  4. Prolonged antibiotic treatment induces a diabetogenic intestinal microbiome that accelerates diabetes in NOD mice.

    Brown, Kirsty; Godovannyi, Artem; Ma, Caixia; Zhang, YiQun; Ahmadi-Vand, Zahra; Dai, Chaunbin; Gorzelak, Monika A; Chan, YeeKwan; Chan, Justin M; Lochner, Arion; Dutz, Jan P; Vallance, Bruce A; Gibson, Deanna L


    Accumulating evidence supports that the intestinal microbiome is involved in Type 1 diabetes (T1D) pathogenesis through the gut-pancreas nexus. Our aim was to determine whether the intestinal microbiota in the non-obese diabetic (NOD) mouse model played a role in T1D through the gut. To examine the effect of the intestinal microbiota on T1D onset, we manipulated gut microbes by: (1) the fecal transplantation between non-obese diabetic (NOD) and resistant (NOR) mice and (2) the oral antibiotic and probiotic treatment of NOD mice. We monitored diabetes onset, quantified CD4+T cells in the Peyer's patches, profiled the microbiome and measured fecal short-chain fatty acids (SCFA). The gut microbiota from NOD mice harbored more pathobionts and fewer beneficial microbes in comparison with NOR mice. Fecal transplantation of NOD microbes induced insulitis in NOR hosts suggesting that the NOD microbiome is diabetogenic. Moreover, antibiotic exposure accelerated diabetes onset in NOD mice accompanied by increased T-helper type 1 (Th1) and reduced Th17 cells in the intestinal lymphoid tissues. The diabetogenic microbiome was characterized by a metagenome altered in several metabolic gene clusters. Furthermore, diabetes susceptibility correlated with reduced fecal SCFAs. In an attempt to correct the diabetogenic microbiome, we administered VLS#3 probiotics to NOD mice but found that VSL#3 colonized the intestine poorly and did not delay diabetes. We conclude that NOD mice harbor gut microbes that induce diabetes and that their diabetogenic microbiome can be amplified early in life through antibiotic exposure. Protective microbes like VSL#3 are insufficient to overcome the effects of a diabetogenic microbiome.

  5. Presymptomatic Treatment with Acetylcholinesterase Antisense Oligonucleotides Prolongs Survival in ALS (G93A-SOD1 Mice

    Gotkine Marc


    Full Text Available Objective. Previous research suggests that acetylcholinesterase (AChE may be involved in ALS pathogenesis. AChE enzyme inhibitors can upregulate AChE transcription which in certain contexts can have deleterious (noncatalytic effects, making them theoretically harmful in ALS, whilst AChE antisense-oligonucleotides (mEN101, which downregulate AChE may be beneficial. Our aim was to investigate whether downregulation of AChE using mEN101 is beneficial in an ALS mouse model. Methods. ALS (G93A-SOD1 mice received saline, mEN101, inverse-EN101, or neostigmine. Treatments were administered from 5 weeks. Disease-onset and survival were recorded. Additional mice were sacrificed for pathological analysis at 15 weeks of age. In a follow-up experiment treatment was started at the symptomatic stage at a higher dose. Results. mEN101 given at the presymptomatic (but not symptomatic stage prolonged survival and attenuated motor-neuron loss in ALS mice. In contrast, neostigmine exacerbated the clinical parameters. Conclusions. These results suggest that AChE may be involved in ALS pathogenesis. The accelerated disease course with neostigmine suggests that any beneficial effects of mEN101 occur through a non-catalytic rather than cholinergic mechanism.

  6. [Emergence of beta-lactam-dependent Bacillus cereus associated with prolonged treatment with cefepime in a neutropenic patient].

    Ko, Sun-Young; Chung, Hee-Jung; Sung, Heong-Sup; Kim, Mi-Na


    Antibiotic dependence in clinical isolates has been reported, albeit rarely, such as vancomycin-dependent enterococcus and beta-lactam-dependent Staphylococcus saprophyticus. We report herein a clinical isolate of beta-lactam-dependent Bacillus cereus. A 16-yr-old female was admitted on 8 September 2005 with neutropenic fever during chemotherapy following surgical removal of peripheral neuroectodermal tumor. She had had an indwelling chemoport since August 2004 and experienced B. cereus bacteremia three times during the recent 3-month period prior to the admission; the bacteremias were treated with cefepime-based chemotherapy. On hospital days 1 and 3, B. cereus was isolated from blood drawn through the chemoport. The isolates were resistant to penicillin, ceftriaxone, and erythromycin, and susceptible to vancomycin and ciprofloxacin. The isolate of hospital day 3 grew only nearby the beta-lactam disks including penicillin and ceftriaxone on disk diffusion testing. The beta-lactam-dependent isolate required a minimum of 0.064 microg/mL of penicillin or 0.023 microgram/mL of cefotaxime for growth, which was demonstrated by E test (AB Biodisk, Sweden). Light microscopy and transmission electron microscopy revealed a marked elongation of the dependent strain compared with the non-dependent strain. Prolonged therapy with beta-lactams in the patient with an indwelling intravenous catheter seemed to be a risk factor for the emergence of beta-lactam-dependence in B. cereus.

  7. Treatment of hemodialysis vascular access rupture irresponsive to prolonged balloon tamponade: Retrospective evaluation of the effectiveness of N-butyl cyanoacrylate seal-off technique

    Weng, Mei Jul; Liang, Huei Lung; Pan, Huay Ben [Dept. of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung (China); Chen, Matt Chiung Yu [Dept. of Radiology, Yuan' s General Hospital, Kaohsiung (China)


    The current study retrospectively evaluated whether the percutaneous N-butyl cyanoacrylate (NBCA) seal-off technique is an effective treatment for controlling the angioplasty-related ruptures, which are irresponsive to prolonged balloon tamponade, during interventions for failed or failing hemodialysis vascular accesses. We reviewed 1588 interventions performed during a 2-year period for dysfunction and/or failed hemodialysis vascular access sites in 1569 patients. For the angioplasty-related ruptures, which could not be controlled with repeated prolonged balloon tamponade, the rupture sites were sealed off with an injection of a glue mixture (NBCA and lipiodol), via a needle/needle sheath to the rupture site, under a sonographic guidance. Technical success rate, complications and clinical success rate were reported. The post-seal-off primary and secondary functional patency rates were calculated by a survival analysis with the Kaplan-Meier method. Twenty ruptures irresponsive to prolonged balloon tamponade occurred in 1588 interventions (1.3%). Two technical failures were noted; one was salvaged with a bailout stent-graft insertion and the other was lost after access embolization. Eighteen accesses (90.0%) were salvaged with the seal-off technique; of them, 16 ruptures were completely sealed off, and two lesions were controlled as acute pseudoaneurysms. Acute pseudoaneurysms were corrected with stentgraft insertion in one patient, and access ligation in the other. The most significant complication during the follow-up was delayed pseudoaneurysm, which occurred in 43.8% (7 of 16) of the completely sealed off accesses. Delayed pseudoaneurysms were treated with surgical revision (n = 2), access ligation (n = 2) and observation (n = 3). During the follow-up, despite the presence of pseudoaneurysms (acute = 1, delayed = 7), a high clinical success rate of 94.4% (17 of 18) was achieved, and they were utilized for hemodialysis at the mean of 411.0 days. The post

  8. Hydrogen gas treatment prolongs replicative lifespan of bone marrow multipotential stromal cells in vitro while preserving differentiation and paracrine potentials.

    Kawasaki, Haruhisa; Guan, Jianjun; Tamama, Kenichi


    Cell therapy with bone marrow multipotential stromal cells/mesenchymal stem cells (MSCs) represents a promising approach in the field of regenerative medicine. Low frequency of MSCs in adult bone marrow necessitates ex vivo expansion of MSCs after harvest; however, such a manipulation causes cellular senescence with loss of differentiation, proliferative, and therapeutic potentials of MSCs. Hydrogen molecules have been shown to exert organ protective effects through selective reduction of hydroxyl radicals. As oxidative stress is one of the key insults promoting cell senescence in vivo as well as in vitro, we hypothesized that hydrogen molecules prevent senescent process during MSC expansion. Addition of 3% hydrogen gas enhanced preservation of colony forming early progenitor cells within MSC preparation and prolonged the in vitro replicative lifespan of MSCs without losing differentiation potentials and paracrine capabilities. Interestingly, 3% hydrogen gas treatment did not decrease hydroxyl radical, protein carbonyl, and 8-hydroxydeoxyguanosine, suggesting that scavenging hydroxyl radical might not be responsible for these effects of hydrogen gas in this study.

  9. Surgical treatment for thyrotoxic hypokalemic periodic paralysis: case report

    Lin Yi-Chu


    Full Text Available Abstract Thyrotoxic hypokalemic periodic paralysis (THPP is a rare, potentially life-threatening endocrine emergency. It is characterized by recurrent muscle weakness and hypokalemia. Because many THPP patients do not have obvious symptoms and signs of hyperthyroidism, misdiagnosis may occur. The published studies revealed that definitive therapy for THPP is control of hyperthyroidism by medical therapy, radioactive iodine or surgery, but the long-term post-operative follow-up result was not observed. We reported two cases of medically refractory THPP with recurrent paralysis of extremities and hypokalemia, and both were combined with thyroid nodules. Both patients were treated with total thyroidectomy; the pathology revealed that one is Graves' disease with thyroid papillary carcinoma, and the other is adenomatous goiter with papillary hyperplasia. No episode of periodic paralysis was noted and laboratory evaluation revealed normal potassium level during the post-operative follow up. Our experience suggests that total thyroidectomy by experienced surgeon is an appropriate and definite treatment for medically refractory THPP, especially in cases combined with thyroid nodules.

  10. Surgical treatment for thyrotoxic hypokalemic periodic paralysis: case report.

    Lin, Yi-Chu; Wu, Che-Wei; Chen, Hui-Chun; Chen, Hsiu-Ya; Lu, I-Cheng; Tsai, Cheng-Jing; Kuo, Wen-Rei; Chiang, Feng-Yu


    Thyrotoxic hypokalemic periodic paralysis (THPP) is a rare, potentially life-threatening endocrine emergency. It is characterized by recurrent muscle weakness and hypokalemia. Because many THPP patients do not have obvious symptoms and signs of hyperthyroidism, misdiagnosis may occur. The published studies revealed that definitive therapy for THPP is control of hyperthyroidism by medical therapy, radioactive iodine or surgery, but the long-term post-operative follow-up result was not observed. We reported two cases of medically refractory THPP with recurrent paralysis of extremities and hypokalemia, and both were combined with thyroid nodules. Both patients were treated with total thyroidectomy; the pathology revealed that one is Graves' disease with thyroid papillary carcinoma, and the other is adenomatous goiter with papillary hyperplasia. No episode of periodic paralysis was noted and laboratory evaluation revealed normal potassium level during the post-operative follow up. Our experience suggests that total thyroidectomy by experienced surgeon is an appropriate and definite treatment for medically refractory THPP, especially in cases combined with thyroid nodules.

  11. Extended ankle and foot fasciotomy as an enhancement to the surgical treatment of patients with prolonged ischemia of the lower extremities

    Mišović Sidor


    Full Text Available Aim. To present the technique and efficacy of extended ankle and foot fasciotomy, as a surgical limb-salvage procedure associated with the successful revascularization after the gold interval. Method. A retrospective review of six patients at the age of 16−79 years (mean 39 in the period from 1996 to 2003, treated with the extended ankle and foot fasciotomy. There were four males undergoing the delayed treatment of war injuries to the lower extremity, and two females with atherosclerotic occlusive disease (a. illiacae dex and a. poplitealis dex.. The average ishemic time in the wounded patients was 22 hours (range, 14−30 hours, and ischemic time in occlusive disease (range, 48−72 hours. Clinical signs, indications, surgical access and the technique of extended ankle and foot fasciotomy was reported. Results. The obtained results were classified as early and late. There was no cases with lethal outcome. Incisional wounds closed 15 days after the intervention, using secondary suture or skin transplant sec. Thiersch. The satisfactory functional results were achieved in 4 of the patients, 1 had a small edema, while amputation was performed in 1 patient. Conclusion. In cases of prolonged foot ischemia with edema and paresthesia in the toes, extended ankle and foot fasciotomy should be performed as a surgical limb-salvage procedure.

  12. Prolonged release oxycodone and naloxone treatment counteracts opioid-induced constipation in patients with severe pain compared to previous analgesic treatment.

    Koopmans-Klein, Gineke; Van Op den Bosch, Joeri; van Megen, Yvonne; Prenen, Hans; Huygen, Frank; Mancini, Isabelle


    Treatment with prolonged-release oxycodone/naloxone (PR OXN) has been shown to improve opioid induced constipation (OIC) in constipated patients. This publication reports on a real-life observational study investigating the efficacy of PR OXN with regard to bowel function in patients switching to PR OXN from WHO-step 1, step 2 and step 3 opioids. Patients with chronic pain experiencing insufficient pain relief and/or unacceptable side effects were switched to PR OXN and monitored in this observational study with respect to efficacy regarding bowel function and efficacy regarding pain relief in comparison with previous analgesic therapy. A patient was considered responder with respect to efficacy if this assessment was 'slightly better', 'better' or 'much better' compared with previous therapy. Bowel function index, pain intensity, quality of life, laxative medication use, and safety analgesic were also evaluated. 1,338 patients (mean (sd) age 64.3 (14.9), 63% female) were observed for 43 [3-166] days (median [range]) during treatment with PR OXN. Overall response rate regarding bowel function efficacy was 82.5%. Patients with symptoms of constipation at study entry obtained a clinically relevant improvement of the bowel function index (BFI) within the first 2 weeks of PR OXN treatment. Non-constipated patients at study entry maintained normal bowel function despite switching to treatment with the opioid PR OXN. In conclusion, treatment with PR OXN results in a significant and clinically relevant improvement of bowel function. During the observation of the treatment with PR OXN patients reported an improvement of QoL. More interestingly, non-constipated patients maintained a normal bowel function, showing prevention of constipation despite the use of an opioid.

  13. Sleep difficulties are correlated with emotional problems following loss and residual symptoms of effective prolonged grief disorder treatment

    Boelen, P.A.; Lancee, J.


    There is preliminary evidence that poor sleep quality is associated with emotional problems following loss, including symptoms of prolonged grief disorder (PGD) and depression. We conducted two studies to improve existing knowledge about the role of sleep difficulties in recovery from loss. Study 1

  14. Prolonged survival after sequential multimodal treatment in metastatic renal cell carcinoma: two case reports and a review of the literature

    Syrios John


    palliative radiotherapy. Ten years after the initial diagnosis of renal cell cancer, his disease is stable and he is on a third antiangiogenic factor and leads an active life. Conclusions One multidisciplinary approach to patients with metastatic renal cell cancer combines nephrectomy, metastasectomy, and radiotherapy (when feasible with medical therapy based on cytokines and targeted treatment employing agents inhibiting angiogenesis, other receptor tyrosine kinases, and mammalian target of rapamycin. This approach could prolong survival and improve quality of life.

  15. Prolonged conservative treatment or 'early' surgery in sciatica caused by a lumbar disc herniation: rationale and design of a randomized trial [ISRCT 26872154

    Tans Joseph; Eekhof Just AH; Brand Ronald; van der Hout Wilbert B; van Houwelingen Hans C; Peul Wilco C; Thomeer Ralph TWM; Koes Bart W


    Abstract Background The design of a randomized multicenter trial is presented on the effectiveness of a prolonged conservative treatment strategy compared with surgery in patients with persisting intense sciatica (lumbosacral radicular syndrome). Methods/design Patients presenting themselves to their general practitioner with disabling sciatica lasting less than twelve weeks are referred to the neurology outpatient department of one of the participating hospitals. After confirmation of the di...

  16. 生长期喷钙提高锦橙果实品质及延长贮藏期%Improve fruit quality and prolong storage time of Jincheng orange by calcium sprayed in growth period

    温明霞; 石孝均


    order to make clear the effect of Ca nutrition sprayed on citrus trees in different growing periods on citrus fruit quality and senescence during storage time and propose comprehensive management measures for Ca nutrition of citrus orchards, the effect of Ca on fruit quality including vitamin C, total sugar, acid, total soluble solid (TSS), some enzymes and materials related to fruit senescence including peroxidase(POD), catalase(CAT), superoxide dismutase(SOD), polygalacturonase(PG), cellulose(CX), malonaldehyde(MDA), protopectin(PP) and soluble pectin(SP) were studied in this paper. The effects of Ca on quality and enzyme activities of citrus fruits were studied by spraying calcium nitrate in different growth periods on Beibei-447 Jincheng orange (Citrus sinensis Osbeck, Beibei-447 orange). The results showed that Ca mass fraction in citrus fruits increased significantly, the oxygenolysis of vitamin C was restrained, total soluble solid (TSS), the ratio of sugar and acid increased and the fruit quality were maintained during storage by spraying Ca on citrus trees in different growth periods. The activities of polygalacturonase (PG), cellulase (CX) and peroxidase (POD) of different Ca treatments decreased but those of superoxide dismutase (SOD), catalase (CAT) increased because of high Ca mass fraction in fruits. The structure of cell was protected and lipid peroxidation was alleviated so that the mass fraction of malonaldehyde (MDA) and soluble pectin decreased, the senescence of fruit was postponed and the fruit was eventually kept in good during storage. The best effect on prolonging storage time of citrus fruit was to spray Ca on citrus trees in young fruit period, then spraying Ca on citrus trees in fruit rapid growth period and the worst was in fruit mature period. Spraying Ca on citrus trees in young fruit period and fruit rapid growth period were important measures to keep citrus fruit in good quality during storage.

  17. Prolonged infusion versus intermittent boluses of β-lactam antibiotics for treatment of acute infections: a meta-analysis.

    Teo, Jocelyn; Liew, Yixin; Lee, Winnie; Kwa, Andrea Lay-Hoon


    The clinical advantages of prolonged (extended/continuous) infusion remain controversial. Previous studies and reviews have failed to show consistent clinical benefits of extending the infusion time. This meta-analysis sought to determine whether prolonged β-lactam infusions were associated with a reduction in mortality and improvement in clinical success. A search of PubMed, EMBASE and The Cochrane Library for randomised controlled trials (RCTs) and observational studies comparing prolonged infusion with intermittent bolus administration of the same antibiotic in hospitalised adult patients was conducted. Primary outcomes evaluated were mortality and clinical success. A total of 29 studies with 2206 patients (18 RCTs and 11 observational studies) were included in the meta-analysis. Compared with intermittent boluses, use of prolonged infusion appeared to be associated with a significant reduction in mortality [pooled relative risk (RR) = 0.66, 95% confidence interval (CI) 0.53-0.83] and improvement in clinical success (RR = 1.12, 95% CI 1.03-1.21). Statistically significant benefit was supported by non-randomised studies (mortality, RR = 0.57, 95% CI 0.43-0.76; clinical success, RR = 1.34, 95% CI 1.02-1.76) but not by RCTs (mortality, RR = 0.83, 95% CI 0.57-1.21; clinical success, RR = 1.05, 95% CI 0.99-1.12). The positive results from observational studies, especially in the face of increasing antibiotic resistance, serve to justify the imperative need to conduct a large-scale, well-designed, multicentre RCT involving critically ill patients infected with high minimum inhibitory concentration pathogens to clearly substantiate this benefit.

  18. Genetic diagnosis and treatment progress of primary periodic paralysis

    Qing KE


    Full Text Available Primary periodic paralysis is autosomal dominant genetic skeletal muscle ion channelopathy. It is characterized by episodes of muscle weakness associated with lower, normal or elevated serum potassium. The genetic diagnosis process of periodic paralysis is proposed based on the latest research progress and clinical classifications. Advances in therapy also are reviewed in this study. doi: 10.3969/j.issn.1672-6731.2014.06.003

  19. Nightly treatment of primary insomnia with prolonged release melatonin for 6 months: a randomized placebo controlled trial on age and endogenous melatonin as predictors of efficacy and safety

    Wade Alan G


    Full Text Available Abstract Background Melatonin is extensively used in the USA in a non-regulated manner for sleep disorders. Prolonged release melatonin (PRM is licensed in Europe and other countries for the short term treatment of primary insomnia in patients aged 55 years and over. However, a clear definition of the target patient population and well-controlled studies of long-term efficacy and safety are lacking. It is known that melatonin production declines with age. Some young insomnia patients also may have low melatonin levels. The study investigated whether older age or low melatonin excretion is a better predictor of response to PRM, whether the efficacy observed in short-term studies is sustained during continued treatment and the long term safety of such treatment. Methods Adult outpatients (791, aged 18-80 years with primary insomnia, were treated with placebo (2 weeks and then randomized, double-blind to 3 weeks with PRM or placebo nightly. PRM patients continued whereas placebo completers were re-randomized 1:1 to PRM or placebo for 26 weeks with 2 weeks of single-blind placebo run-out. Main outcome measures were sleep latency derived from a sleep diary, Pittsburgh Sleep Quality Index (PSQI, Quality of Life (World Health Organzaton-5 Clinical Global Impression of Improvement (CGI-I and adverse effects and vital signs recorded at each visit. Results On the primary efficacy variable, sleep latency, the effects of PRM (3 weeks in patients with low endogenous melatonin (6-sulphatoxymelatonin [6-SMT] ≤8 μg/night regardless of age did not differ from the placebo, whereas PRM significantly reduced sleep latency compared to the placebo in elderly patients regardless of melatonin levels (-19.1 versus -1.7 min; P = 0.002. The effects on sleep latency and additional sleep and daytime parameters that improved with PRM were maintained or enhanced over the 6-month period with no signs of tolerance. Most adverse events were mild in severity with no clinically

  20. Corticosteroid treatment normalizes QTc prolongation and improves heart block in an elderly patient with anti-Ro-positive systemic lupus erythematosus.

    Saribayev, Maksat; Tufan, Fatih; Oz, Fahrettin; Erer, Burak; Ozpolat, Tahsin; Ozturk, Gulistan Bahat; Akin, Sibel; Saka, Bulent; Erten, Nilgun; Tascioglu, Cemil; Karan, Akif


    Systemic lupus erythematosus (SLE) is a multisystemic disease which potentially involves various organs including the skin, joints, kidneys, liver, hematopoetic system, and serous membranes. It is rarely seen in elderly males. The most common cardiovascular involvement type is pericarditis. Anti-Ro antibodies may be associated with neonatal lupus which causes heart blocks. Recent literature indicates that anti-Ro antibodies may be associated with various rhythm and conduction disturbances in the adulthood. The most common finding associated with anti-Ro antibodies is prolonged corrected QT (QTc) interval. Herein, we present an elderly male patient with anti-Ro-positive SLE associated with prolonged QTc interval and AV blocks that significantly improved after corticosteroid treatment.

  1. [Clinical and pharmacoeconomic peculiarities of the treatment with cerebrolysin in the period of rehabilitation of is ischemic stroke.].

    Gusev, E I; Gekht, A B; Belousov, Iu B; Pavlov, N A; Galanov, D V; Popov, G R; Mil'chakova, L E


    The results of the clinical and pharmacoeconomic study of cerebrolysin in the rehabilitative therapy of ischemic stroke presented in the paper revealed the statistically significant regress of neurological disturbances in patients receiving cerebrolysin in daily dosages of 10 and 20 ml as compared to the control group. The rehabilitation of motor functions was more rapid than sensitive ones in patients receiving cerebrolysin comparing to those switched to the basic antihypertensive and antiaggregate therapy. The positive dynamics of speech rehabilitation was observed, the regress of aphatic disturbances being more significant for daily dosage of 20 ml. Rehabilitation rate in the period of treatment with cerebrolysin was higher for daily dosage of 20 ml than that of 10 ml. A prolonged effect of the drug during the long period after its withdrawal was found that resulted in higher rates of rehabilitation to the 11th week in patients receiving cerebrolysin as compared to the control group. Average total cost of direct medical expenses per a patient estimated in the pharmacoeconomic analysis for the groups receiving cerebrolysin and the control group was higher in the former groups, in particular in that with 20 ml dosage of cerebrolysin. A cost-efficacy analysis revealed that the cost of cerebrolysin treatment per effective unit (a cost of one score on the Lindmark scale and the Barthel scale) was less or comparable in patients receiving cerebrolysin comparing to the control group. The study suggests clinical and pharmacoeconomic expediency of cerebrolysin treatment in rehabilitative period of ischemic stroke.

  2. Familial gastric cancer : guidelines for diagnosis, treatment and periodic surveillance

    Kluijt, Irma; Sijmons, Rolf H.; Hoogerbrugge, Nicoline; Plukker, John T.; de Jong, Daphne; van Krieken, J. Han; van Hillegersberg, Richard; Ligtenberg, Marjolijn; Bleiker, Eveline; Cats, Anemieke


    Hereditary diffuse gastric cancer (HDGC) is a relatively rare disorder, with a mutated CDH1 gene as the only known cause. Carriers of a germline mutation in CDH1 have a lifetime risk of > 80% of developing diffuse gastric cancer. As periodic gastric surveillance is of limited value in detecting earl

  3. [Familial gastric cancer: diagnosis, treatment and periodic surveillance

    Kluijt, I.; Sijmons, R.H.; Hoogerbrugge, N.; Vasen, H.F.; Cats, A.


    The only known genetic causes of hereditary diffuse gastric cancer (HDGC) are germline mutations in the CDH1 gene.- CDH1 mutation carriers have a lifetime risk of 70-80% of developing diffuse gastric cancer. As periodic gastric surveillance is of limited value in detecting early stages of HDGC, prop

  4. Factors associated with prolonged duration of post-tympanoplasty local treatment in adult chronic otitis media patients: A retrospective observational study using a Japanese inpatient database.

    Suzuki, Sayaka; Yasunaga, Hideo; Matsui, Hiroki; Fushimi, Kiyohide; Yamasoba, Tatsuya


    The occurrence of persistent infection following tympanoplasty has been reported in many studies, and it is important to know the risks for site infection after tympanoplasty. In this study, we aimed to explore the factors affecting early wound complications after tympanoplasty for chronic otitis media. We conducted a retrospective cohort study using the Diagnosis Procedure Combination database. Data on a total of 13,094 adult patients from 420 acute-care hospitals who received tympanoplasty for chronic otitis media from 2010 to 2013 were extracted. The duration (days) of postsurgical local wound treatment was measured as an outcome, because this duration was assumed to be prolonged by the existence of wound infection. The associations between treatment duration and background characteristics (age, sex, body mass index, smoking status, diabetes mellitus, use of antithrombotic agents, with or without cholesteatoma, duration of anesthesia, academic hospital or not, and hospital volume) were assessed by multivariable linear regression analyses, fitted with a generalized estimating equation to adjust for within-hospital clustering. The median treatment duration in each hospital was 8 days (interquartile range: 7-11). Factors significantly associated with longer treatment duration were: older age (0.2 days for 10-year increase), use of antithrombotic agents during hospitalization (1.8 days), and prolonged duration of anesthesia (vs. otitis media. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  5. Prolonging the duration of masseter muscle reduction by adjusting the masticatory movements after the treatment of masseter muscle hypertrophy with botulinum toxin type a injection.

    Wei, Jiao; Xu, Hua; Dong, Jiasheng; Li, Qingfeng; Dai, Chuanchang


    Botulinum toxin type A (BTX-A) is widely used for the clinical treatment of masseteric hypertrophy. Until now, few reports have discussed how to prolong the duration of its effectiveness. This study evaluated that purposely adjusting the masticatory movements is possible of postponing the masseter muscle rehypertrophy. Ninety-eight patients were randomly and equally divided into 2 groups, and 35 U BTX-A per side was injected into the masseters. The thickness and volume of the masticatory muscles were measured by ultrasound and computerized tomography, respectively. Patients in Group 1 were instructed to strengthen their masticatory effort during the denervated atrophic stage of the masseter (the interval was evaluated by real-time ultrasound monitoring), whereas patients in Group 2 were not given this instruction. When the masseter muscle began to recover, patients in both groups were instructed to reduce their chewing. The duration of the masseter muscle rehypertrophy was significantly prolonged in Group 1 patients. The thickness and the volume of the other masticatory muscles were significantly increased in Group 1 but were either slightly decreased or insignificantly different in Group 2. Purposely strengthening masticatory muscle movement during the denervated atrophic stage of the masseter can prolong the duration of masseter rehypertrophy.

  6. Treatment of Anxiety and Depression in the Preschool Period

    Luby, Joan L.


    Objective: Empirical studies have established that clinical anxiety and depressive disorders may arise in preschool children as young as 3.0 years. Because empirical studies validating and characterizing these disorders in preschoolers are relatively recent, less work has been done on the development and testing of age-appropriate treatments.…

  7. Treatment of Anxiety and Depression in the Preschool Period

    Luby, Joan L.


    Objective: Empirical studies have established that clinical anxiety and depressive disorders may arise in preschool children as young as 3.0 years. Because empirical studies validating and characterizing these disorders in preschoolers are relatively recent, less work has been done on the development and testing of age-appropriate treatments.…

  8. The effectiveness of Grief-Help, a cognitive behavioural treatment for prolonged grief in children: study protocol for a randomised controlled trial.

    Spuij, Mariken; Prinzie, Peter; Dekovic, Maja; van den Bout, Jan; Boelen, Paul A


    There is growing recognition of a syndrome of disturbed grief referred to as prolonged grief disorder (PGD). PGD is mostly studied in adults, but clinically significant PGD symptoms have also been observed in children and adolescents. Yet, to date no effective treatment for childhood PGD exists. The aims of this study are: (1) to investigate the effectiveness of Grief-Help, a nine-session cognitive-behavioural treatment for childhood PGD, combined with five sessions of parental counselling, immediately after the treatment and at three, six and twelve months follow-up; (2) to examine tentative mediators of the effects of Grief-Help, (i.e., maladaptive cognitions and behaviours and positive parenting), and (3) to determine whether demographic variables, child personality, as well as symptoms of PGD, anxiety, and depression in parents moderate the treatment effectiveness. We will conduct a Randomised Controlled Trial (RCT) in which 160 children and adolescents aged 8-18 years are randomly allocated to cognitive behavioural Grief-Help or to a supportive counselling intervention; both treatments are combined with five sessions of parental counselling. We will recruit participants from clinics for mental health in the Netherlands. The primary outcome measure will be the severity of Prolonged Grief Disorder symptoms according to the Inventory of Prolonged Grief for Children (IPG-C). Secondary outcomes will include PTSD, depression and parent-rated internalizing and externalizing problems. Mediators like positive parenting and maladaptive cognitions and behaviours will be identified. We will also examine possible moderators including demographic variables (e.g. time since loss, cause of death), psychopathology symptoms in parents (PGD, anxiety and depression) and child personality. Assessments will take place in both groups at baseline, after the treatment-phase and three, six and twelve months after the post-treatment assessment. We aim to contribute to the improvement

  9. Nanomedical strategy to prolong survival period, heighten cure rate, and lower systemic toxicity of S180 mice treated with MTX/MIT.

    Song, Ning; Zhao, Ming; Wang, Yuji; Hu, Xi; Wu, Jianhui; Jiang, Xueyun; Li, Shan; Cui, Chunying; Peng, Shiqi


    In spite of the usual combination form of methotrexate (MTX)/mitoxantrone (MIT) and various complex combination regimens of MTX/MIT with other anticancer drugs, the survival period, cure rate, and systemic toxicity still need to be improved. For this purpose, a nanostructured amino group-modified mesoporous silica nanoparticles (MSNN)-MTX/MIT was designed. In the preparation, the surface of mesoporous silica nanoparticles (MSNs) was modified with amino groups to form MSNN. The covalent modification of the amino groups on the surface of MSNN with MTX resulted in MSNN-MTX. The loading of MIT into the surface pores of MSNN-MTX produced nanostructured MSNN-MTX/MIT. Compared with the usual combination form (MTX/MIT), nanostructured MSNN-MTX/MIT increased the survival period greatly, heightened the cure rate to a great extent, and lowered the systemic toxicity of the treated S180 mice, significantly. These superior in vivo properties of nanostructured MSNN-MTX/MIT over the usual combination form (MTX/MIT) were correlated with the former selectively releasing MTX and MIT in tumor tissue and inside cancer cells in vitro. The chemical structure and the nanostructure of MSNN-MTX/MIT were characterized using infrared and differential scanning calorimeter spectra as well as transmission electron microscope images, respectively.

  10. Zebra mussel control using periodic chlorine dioxide treatments

    Tsou, J. [Electric Power Research Institute, Palo Alto, CA (United States); Coyle, J. [Central Illinois Public Service, Merdosia, IL (United States); Crone, D. [Illinois Power Company, Alton, IL (United States)] [and others


    This paper summarizes the EPRI report (TR-105202) on the same topic as well as presents changes in current thinking on the suitability (applicability) of chlorine dioxide for fouling control. Chlorine dioxide was tested as a zebra mussel biocide at two steam electric generating stations in Illinois and one in Indiana. The purpose of these studies was to determine the efficacy of chlorine dioxide in killing zebra mussels and to develop site specific treatment programs for the three utilities. The Electric Power Research Institute (EPRI) Zebra Mussel Consortium sponsored the testing of this recent use of chlorine dioxide. The raw water system at Central Illinois Public Service`s Meredosia Station, on the Illinois River, received applications of chlorine dioxide in April, July, and September 1994. The raw water system at Illinois Power Company`s Wood River Station, on the Mississippi River, received applications in July 1993, January, April, May, July, and September 1994. The Gallagher Station, on the Ohio River, was treated in July and October 1994. Chlorine dioxide was generated on-site and injected into the water intake structure. Both cooling and service water systems were treated at the facilities. 6 refs., 13 figs.

  11. Comparing the inhibitory thresholds of dairy manure co-digesters after prolonged acclimation periods: Part 2--correlations between microbiomes and environment.

    Regueiro, Leticia; Spirito, Catherine M; Usack, Joseph G; Hospodsky, Denina; Werner, Jeffrey J; Angenent, Largus T


    Here, we studied the microbiome succession and time-scale variability of four mesophilic anaerobic reactors in a co-digestion study with the objective to find links between changing environmental conditions and the microbiome composition. The changing environmental conditions were ensured by gradual increases in loading rates and mixing ratios of three co-substrates with a constant manure-feeding scheme during an operating period longer than 900 days. Each co-substrate (i.e., alkaline hydrolysate, food waste, and glycerol) was co-digested separately. High throughput 16S rRNA gene sequencing was used to examine the microbiome succession. The alkaline hydrolysate reactor microbiome shifted and adapted to high concentrations of free ammonia, total volatile fatty acids, and potassium to maintain its function. The addition of food waste and glycerol as co-substrates also led to microbiome changes, but to a lesser extent, especially in the case of the glycerol reactor microbiome. The divergence of the food waste reactor microbiome was primarily linked to increasing free ammonia levels in the reactor; though, these levels remained below previously reported inhibitory levels for acclimated biomass. The glycerol reactor microbiome succession included an increase in Syntrophomonadaceae family members, which have previously been linked to long-chain fatty acid degradation. The glycerol reactor exhibited rapid failure and limited adaptation at the end of the study.

  12. Complete Response after Treatment with Neoadjuvant Chemoradiation with Prolonged Chemotherapy for Locally Advanced, Unresectable Adenocarcinoma of the Pancreas

    Tiffany A. Pompa


    Full Text Available Surgery is the only chance for cure in pancreatic ductal adenocarcinoma. In unresectable, locally advanced pancreatic cancer (LAPC, the National Comprehensive Cancer Network (NCCN suggests chemotherapy and consideration for radiation in cases of unresectable LAPC. Here we present a rare case of unresectable LAPC with a complete histopathological response after chemoradiation followed by surgical resection. A 54-year-old female presented to our clinic in December 2013 with complaints of abdominal pain and 30-pound weight loss. An MRI demonstrated a mass in the pancreatic body measuring 6.2×3.2 cm; biopsy revealed proven ductal adenocarcinoma. Due to splenic vein/artery and contiguous celiac artery encasement, she was deemed surgically unresectable. She was started on FOLFIRINOX therapy (three cycles, intensity modulated radiation to a dose of 54 Gy in 30 fractions concurrent with capecitabine, followed by FOLFIRI, and finally XELIRI. After 8 cycles of ongoing XELIRI completed in March 2015, restaging showed a remarkable decrease in tumor size, along with PET-CT revealing no FDG-avid uptake. She was reevaluated by surgery and taken for definitive resection. Histopathological evaluation demonstrated a complete R0 resection and no residual tumor. Based on this patient and literature review, this strategy demonstrates potential efficacy of neoadjuvant chemoradiation with prolonged chemotherapy, followed by surgery, which may improve outcomes in patients deemed previously unresectable.

  13. Expression of early and late cellular damage markers by ARPE-19 cells following prolonged treatment with UV-A radiation.

    Tringali, Giuseppe; Sampaolese, Beatrice; Clementi, Maria Elisabetta


    Pathological alterations to the retinal pigment epithelium underlie several eye diseases, which lead to visual impairment and even blindness. Exposure to ultraviolet (UV) radiation is associated with some skin and ocular pathologies; UV radiation may induce DNA breakdown and cause cellular damage through the production of reactive oxygen species (ROS), thus leading to programmed cell death. The present study aimed to investigate the production of ROS and the gene expression levels of anti‑ and proapoptotic proteins [B‑cell lymphoma 2 (Bcl‑2), Bcl‑2‑associated X protein (Bax) and caspase‑3] in human retinal pigment epithelial cells (ARPE‑19) treated with UV‑A for 5 h consecutively. The results demonstrated that prolonged exposure to UV‑A induced: i) Cell death, the decrease in cell viability was time‑dependent and reached statistical significance after 3 h; ii) a significant and substantial increase in ROS levels that remained constant for the duration of the experiment, the levels were significantly increased after 1 h of exposure; iii) an activation of apoptotic genes (Bax and caspase‑3) after 1 h of treatment, which was accompanied by a decrease in the anti‑apoptotic gene Bcl‑2; and iv) a loss of apoptotic signals and a rapid decrease in cellular viability after 3 h of consecutive treatment. These processes may trigger necrosis, which was observed in the cells following treatment with UV‑A for 5 consecutive hours. In conclusion, the present study is the first, to the best of our knowledge, to provide in vitro evidence regarding the sequence of events that underlie the cellular damage induced by prolonged UV‑A radiation, starting from the first 30 min of treatment. UV‑A radiation resulted in the activation of apoptotic events, and subsequently led to irreversible cell necrosis.

  14. Does corticosteroid treatment cause prolonged recovery and increased total bilirubin level in severe ADAMTS-13-deficient TTP patient?

    Sayiner, Zeynel Abidin; Acik, Didar Yanardag; Yilmaz, Mehmet; Subari, Salih; Mete, Ayse Ozlem; Dai, M Sinan


    A 41-year-old female patient complaining of fatigue, headache, mild confusion, and rush on her lower extremities was admitted to our emergency department. Laboratory tests revealed that he had anemia, thrombocytopenia, and increased levels of indirect bilirubin and lactic dehydrogenase (LDH) in blood tests. Direct and indirect Coombs tests were negative, and fragmented erythrocytes were observed in peripheral blood smears. The patient was diagnosed with thrombotic thrombocytopenic purpura (TTP). The best supportive care was provided. Therapeutic plasma exchange (TPE) and 1 mg/kg methylprednisolone treatments were administered. On the 10th day of treatment, LDH level and fragmented red blood cells in peripheral blood smear were decreased, but his direct and indirect bilirubin levels increased despite the fact that he was treated with 1 mg/kg methylprednisolone and TPE. The patient had severe ADAMTS-13 deficiency. After discontinued steroids treatment, his bilirubin level normalized within 4 days. On the 4th day after bilirubin level normalized, vincristine treatment was administered. TPE was also continued. There was no consensus about the optimal schedule for discontinuing plasmapheresis therapy, and also we observed total bilirubin level improvement with discontinued corticosteroid treatment. In this case, corticosteroid treatment was linked with the increase of total bilirubin level in severe ADAMTS-13-deficient TTP patient.

  15. Prolonged running, not fluoxetine treatment, increases neurogenesis, but does not alter neuropathology, in the 3xTg mouse model of Alzheimer's disease.

    Marlatt, Michael W; Potter, Michelle C; Bayer, Thomas A; van Praag, Henriette; Lucassen, Paul J


    Reductions in adult neurogenesis have been documented in the original 3xTg mouse model of Alzheimer's disease (AD), notably occurring at the same age when spatial memory deficits and amyloid plaque pathology appeared. As this suggested reduced neurogenesis was associated with behavioral deficits, we tested whether activity and pharmacological stimulation could prevent memory deficits and modify neurogenesis and/or neuropathology in the 3xTg model backcrossed to the C57Bl/6 strain. We chronically administered the antidepressant fluoxetine to one group of mice, allowed access to a running wheel in another, and combined both treatments in a third cohort. All treatments lasted for 11 months. The female 3xTg mice failed to exhibit any deficits in spatial learning and memory as measured in the Morris water maze, indicating that when backcrossed to the C57Bl/6 strain, the 3xTg mice lost the behavioral phenotype that was present in the original 3xTg mouse maintained on a hybrid background. Despite this, the backcrossed 3xTg mice expressed prominent intraneuronal amyloid beta (Aβ) levels in the cortex and amygdala, with lower levels in the CA1 area of the hippocampus. In the combined cohort, fluoxetine treatment interfered with exercise and reduced the total distance run. The extent of Aβ neuropathology, the tau accumulations, or BDNF levels, were not altered by prolonged exercise. Thus, neuropathology was present but not paralleled by spatial memory deficits in the backcrossed 3xTg mouse model of AD. Prolonged exercise for 11 months did improve the long-term survival of newborn neurons generated during middle-age, whereas fluoxetine had no effect. We further review and discuss the relevant literature in this respect.

  16. Superior efficacy of liposomal amphotericin B with prolonged circulation in blood in the treatment of severe candidiasis in leukopenic mice

    E.W.M. van Etten (Els); S.V. Snijders (Susan); W. van Vianen (Wim); I.A.J.M. Bakker-Woudenberg (Irma)


    textabstractIn leukopenic mice with severe systemic candidiasis, single-dose treatment (5 mg of amphotericin B [AMB]/kg of body weight) with long-circulating polyethylene glycol-coated AMB liposomes (PEG-AMB-LIP) resulted in zero mortality and a significant reduction in

  17. Limited prolonged effects of rifaximin treatment on irritable bowel syndrome-related differences in the fecal microbiome and metabolome.

    Zeber-Lubecka, Natalia; Kulecka, Maria; Ambrozkiewicz, Filip; Paziewska, Agnieszka; Goryca, Krzysztof; Karczmarski, Jakub; Rubel, Tymon; Wojtowicz, Wojciech; Mlynarz, Piotr; Marczak, Lukasz; Tomecki, Roman; Mikula, Michal; Ostrowski, Jerzy


    Irritable bowel syndrome (IBS) is a chronic functional disorder and its development may be linked, directly and indirectly, to intestinal dysbiosis. Here we investigated the interactions between IBS symptoms and the gut microbiome, including the relation to rifaximin (1200 mg daily; 11.2 g per a treatment). We recruited 72 patients, including 31 with IBS-D (diarrhea), 11 with IBS-C (constipation), and 30 with IBS-M (mixed constipation and diarrhea) and 30 healthy controls (HCs). Of them, 68%, 64%, and 53% patients with IBS-D, IBS-C, and IBS-M, respectively, achieved 10-12 week-term improvement after the rifaximin treatment. Stool samples were collected before and after the treatment, and fecal microbiotic profiles were analyzed by deep sequencing of 16S rRNA, while stool metabolic profiles were studied by hydrogen 1-nuclear magnetic resonance ((1)H-NMR) and gas chromatography-mass spectrometry (GC-MS). Of 26 identified phyla, only Bacteroidetes, Firmicutes, Proteobacteria, and Actinobacteria were consistently found in all samples. Bacteroidetes was predominant in fecal samples from HCs and IBS-D and IBS-M subjects, whereas Firmicutes was predominant in samples from IBS-C subjects. Species richness, but not community diversity, differentiated all IBS patients from HCs. Metabolic fingerprinting, using NMR spectra, distinguished HCs from all IBS patients. Thirteen metabolites identified by GC-MS differed HCs and IBS patients. However, neither metagenomics nor metabolomics analyses identified significant differences between patients with and without improvement after treatment.

  18. Demonstrating the Efficacy of Group Prolonged Exposure Treatment of PTSD in OEF/OIF/OND Male Veterans


    other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a...behaviors. PCT is a non-trauma focused treatment for PTSD, where the mechanisms of change include altering current maladaptive relational patterns and...RESPONSIBLE PERSON USAMRMC a. REPORT Unclassified b. ABSTRACT Unclassified c. THIS PAGE Unclassified Unclassified 19b. TELEPHONE NUMBER (include

  19. Treatment with an orthopedic appliance system in relation to treatment intensity and growth periods. A study of initial effects.

    Malmgren, O; Omblus, J; Hägg, U; Pancherz, H


    The study comprises an analysis of the effect of treatment with a modified activator combined with a high-pull headgear during a standardized observation period of the initial 6 months of treatment. All patients (24 girls and 32 boys, aged 8.5 to 15 years) had severe skeletal Class II malocclusion. In the first part of the study, the effect of treatment with the appliance both day and night is compared with the effect when it was worn only at night. Only a small and nonsignificant difference was found, but the patients tended to cooperate better if they were instructed to wear the appliance continuously. In the second part of the study, the effect of treatment is related to the somatic maturation of the patients. Longitudinal records of standing height were used to assess whether treatment had been performed before maximal pubertal growth (prepeak period), during maximal pubertal growth (peak period), or after maximal pubertal growth (postpeak period). The skeletal effect was significantly greater in boys treated during the peak period than in those treated during the prepeak period and a similar tendency, although not significant, was found among girls. The number of patients treated during the postpeak period was too small for statistical analysis.

  20. Lack of effect of prolonged treatment with liraglutide on cardiac remodeling in rats after acute myocardial infarction

    Kyhl, Kasper; Lønborg, Jacob; Hartmann, Bolette


    infarction. In 134 male Sprague Dawley rats myocardial infarctions were induced by ligation of the left anterior descending coronary artery. Rats were randomized to either subcutaneous injection of placebo or 0.3. mg liraglutide once daily. Cardiac magnetic resonance imaging was performed after 4 weeks...... oxidation was impaired. Liraglutide did not affect any of these alterations. Four-week treatment with liraglutide did not affect cardiac remodeling following a non-reperfused myocardial infarction, as assessed by cardiac magnetic resonance imaging, histological and molecular analysis and measurements...

  1. n-butylidenephthalide treatment prolongs life span and attenuates motor neuron loss in SOD1(G93A) mouse model of amyotrophic lateral sclerosis.

    Zhou, Qin-Ming; Zhang, Jing-Jing; Li, Song; Chen, Sheng; Le, Wei-Dong


    To evaluate the therapeutic effects of n-butylidenephthalide (BP) in SOD1(G93A) mouse model of amyotrophic lateral sclerosis and explore the possible mechanisms. The SOD1(G93A) mice were treated by oral administration of BP (q.d., 400 mg/kg d) starting from 60 days of age and continuing until death. The rotarod test was performed to assess the disease onset. The expression levels of apoptosis-related proteins, inflammatory molecules, and autophagy-associated proteins were determined. The number of apoptotic motor neurons and the extent of microglial and astroglial activation were also assessed in the lumbar spinal cords of BP-treated mice. Grip strength test, hematoxylin-eosin staining, nicotinamide adenine dinucleotide hydrogen staining, and malondialdehyde assay were conducted to evaluate the muscle function and pathology. Although BP treatment did not delay the disease onset, it prolonged the life span and thereafter extended the disease duration in SOD1(G93A) mouse model of ALS. BP treatment also reduced the motor neuron loss through inhibiting apoptosis. We further demonstrated that the neuroprotective effects of BP might be resulted from the inhibition of inflammatory, oxidative stress, and autophagy. Our study suggests that BP may be a promising candidate for the treatment of ALS. © 2017 John Wiley & Sons Ltd.

  2. Periodicity in cell dynamics in some mathematical models for the treatment of leukemia

    Halanay, A.


    A model for the evolution of short-term hematopoietic stem cells and of leukocytes in leucemia under periodic treatment is introduced. It consists of a system of periodic delay differential equations and takes into consideration the asymmetric division. A guiding function is used, together with a theorem of Krasnoselskii, to prove the existence of a strictly positive periodic solution and its stability is investigated.

  3. [Hyperkalemic periodic paralysis or congenital paramyotonia: an attempt of treatment with phenytoin].

    Tomczykiewicz, K; Tutaj, A; Jaszczuk, E; Balcewicz, J


    Authors describe 2 patients with hyperkalemic period paralysis where positive therapeutic effect was achieved after treatment with phenytoin. They compare the features of paramyotonia congenital with hyperkalemic period paralysis and they think that they are the same disease with different clinical signs.

  4. Severe postpartum sepsis with prolonged myocardial dysfunction: a case report

    Chen Katherine T


    Full Text Available Abstract Introduction Severe sepsis during pregnancy or in the postpartum period is a rare clinical event. In non obstetric surviving patients, the cardiovascular changes seen in sepsis and septic shock are fully reversible five to ten days after their onset. We report a case of septic myocardial dysfunction lasting longer than ten days. To the best of our knowledge, this is the first report of prolonged septic myocardial dysfunction in a parturient. Case presentation A 24 year old Hispanic woman with no previous medical history developed pyelonephritis and severe sepsis with prolonged myocardial dysfunction after a normal spontaneous vaginal delivery. Conclusions Septic myocardial dysfunction may be prolonged in parturients requiring longer term follow up and pharmacologic treatment.

  5. Seminal vesicles of infertile patients with male accessory gland infection: ultrasound evaluation after prolonged treatment with tadalafil, a selective phosphodiesterase-5 inhibitor.

    La Vignera, S


    The aim of this study was to investigate possible ultrasound seminal vesicle (SV) changes in infertile patients with 'hypertrophic-congestive' (HCUF) or 'fibro-sclerotic' (FSUF) ultrasound form of male accessory gland infection (MAGI) after prolonged administration of tadalafil (TAD), a selective phosphodiesterase-5 inhibitor. Forty infertile patients with HCUF and 40 patients with FSUF and erectile dysfunction were selected and arbitrarily divided into two groups, who were prescribed TAD 5 mg daily for 3 months, the first 20 consecutive patients with HCUF (group A1) or FSUF (group A2) or placebo, the second 20 consecutive patients with HCUF (group B1) or FSUF (group B2). All patients underwent scrotal and prostate-vesicular transrectal ultrasound evaluation and semen analysis (WHO, 2010) before and after treatment. Group A1 patients showed a significant reduction in fundus/body ratio and higher pre- and post-ejaculatory body SV antero-posterior diameter difference compared with the other three groups. These patients showed also a significant increase in SV ejection fraction and a significant improvement in the total sperm count, progressive motility, seminal levels of fructose and ejaculate volume. These results suggest that infertile patients with HCUF had an improvement in SV ultrasound features suggestive of chronic inflammation after daily treatment with low doses of TAD.

  6. Restoration of nerve growth factor in organs of mice injected with cobra venom followed by specific treatment and reversal period.

    Lipps, Binie V


    Research from this laboratory reported the decreased levels of endogenously present nerve growth factor (NGF) in organs of mice as a consequence of sub-lethal injection of Naja kaouthia venom. This research reports that the decreased levels of NGF in organs of mice were prevented by (1) specific treatment and (2) restored to normal by a prolonged period. Adult female Balb/c mice were injected intramuscularly (IM) with a sub-lethal dose of cobra venom. The injected mice were divided into five groups. Mice in group I were injected with PBS, group II with anti-cobra venom, and group III with lethal toxin neutralizing factor (LTNF). Mice in group IV were treated IM with synthetic LTNF (LT-10), and mice in group V were treated orally with LT-10. After 24 hr. mice were sacrificed and NGF levels in organ homogenates were assayed and compared with control mice not injected with venom. It was observed that the organs from group I treated with PBS showed a tremendous drop in NGF level in comparison to the organs of the control mice. It was further revealed that the decreased levels of NGF in organs of injected mice were prevented by treatment with anti-cobra venom, LTNF and LT-10 by IM, or oral routes. In the second series of experiments, mice injected with sub-lethal dose of cobra venom were sacrificed after 1, 3, 7, and 10 days, and the organs were assayed for NGF levels. It was observed that the recovery period for normal homeostasis of NGF was between 7 and 10 days in the brain, heart, liver, salivary glands, and ovaries.

  7. [Actinomycosis of the minor pelvis associated with prolonged use of intrauterine contraceptive devices (IUD)].

    Durdević, S; Vejnović, T; Novakov, A


    Pelvic actinomycosis is a rare disorder caused by Gram-positive anaerobic bacteria Actinomyces Israeli, and it is commonly associated with the prolonged use of IUD. The authors present two cases of pelvic actinomycosis in patients who used IUD for prolonged periods of time (eight and fourteen years). The diagnostic procedure in both cases lasted long and the definite diagnosis was made only after the pathohistological examination of the material taken during the surgical treatment. Actinomyces Israeli should be considered as one of the causes of the diagnosed pelvic inflammation especially when it is associated with the prolonged use of IUD.

  8. [Dopplerometry at prolonged pregnancy].

    Salii-Prenichi, L; Milchev, N; Markova, D; Apiosjan, Zh


    Prolonged pregnancy, associated with low amniotic fluid is a reason for the increase of fetal mortality and morbidity. There is no a define test at prolonged pregnancy which can determine which pregnancy are at a risk for adverse outcome and complications. Dopplerometry as a noninvasive method for examination of blood circulation, and especially a. cerebri media and a. umbilicalis can be used for the prediction of the outcome of prolonged pregnancy.

  9. Dopamine treatment of brain-dead Fisher rats improves renal histology but not early renal function in Lewis recipients after prolonged static cold storage.

    Fontana, J; Yard, B; Stamellou, E; Wenz, H; Benck, U; Schnuelle, P; Hoeger, S


    Brain death (BD) and cold preservation are major risk factors for an unfavorable transplantation outcome. Although donor dopamine treatment in brain-dead rats improves renal function and histology in allogeneic recipients, it remains to be assessed if this also holds true for the combinations of BD and prolonged static cold preservation. BD was induced in F344 donor rats, which were subsequently treated with NaCl 1 mL/h (BD, n = 11), NaCl/hydroxy ethyl starch (BD-norm, n = 10), or 10 μg/min/kg dopamine (BD-dopa, n = 10). Renal grafts were harvested 4 h after BD and transplanted into bilateral nephrectomized Lewis recipients 6 h after cold preservation in University of Wisconsin solution. Renal function was evaluated by use of serum creatinine and urea concentrations at days 0, 1, 3, 5, and 10. Ten days after transplantation, recipients were killed and the renal allografts were processed for light microscopy and immune histology. Serum urea concentrations at days 5 and 10 were significantly lower in recipients that received a renal graft from dopamine-treated rats; for serum creatinine, only a trend was observed at day 10. Immune histology revealed a lower degree of ED1-positive cells in the donor dopamine-treated group. Under light microscopy, Banff classification revealed significantly less intimal arteritis in these grafts (P dopamine treatment clearly improves renal histology in this model, the beneficial effect on early renal function was marginal. It remains to be assessed if donor dopamine treatment has a beneficial effect on renal function in long-term follow-up. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. Smoking prolongs the infectivity of patients with tuberculosis.

    Siddiqui, U A


    We sought to establish if smokers on anti-tuberculosis treatment are more likely to have a prolonged period of infectivity, compared to non-smoking tuberculosis patients, in a low tuberculosis prevalence country. We conducted a cross-sectional, retrospective study in Ireland that recruited 53 microbiologically confirmed cases of pulmonary tuberculosis (PTB). The age-sex adjusted odds ratios (AOR) suggest that the infectivity status of PTB on treatment was four times more likely to be prolonged beyond 6-8 weeks, if the cases had a smoking history (AOR: 4.42; 95% CI: 1.23; 15.9). Smoking was associated with delayed sputum smear conversion in PTB patients on treatment.

  11. Determinants of acceptance of end-of-life interventions: a comparison between withdrawing life-prolonging treatment and euthanasia in Austria.

    Stolz, Erwin; Großschädl, Franziska; Mayerl, Hannes; Rásky, Éva; Freidl, Wolfgang


    End-of-life decisions remain a hotly debated issue in many European countries and the acceptance in the general population can act as an important anchor point in these discussions. Previous studies on determinants of the acceptance of end-of-life interventions in the general population have not systematically assessed whether determinants differ between withdrawal of life-prolonging treatment (WLPT) and euthanasia (EUT). A large, representative survey of the Austrian adult population conducted in 2014 (n = 1,971) included items on WLPT and EUT. We constructed the following categorical outcome: (1) rejection of both WLPT and EUT, (2) approval of WLPT but rejection of EUT, and (3) approval of both WLPT and EUT. The influence of socio-demographics, personal experiences, and religious and socio-cultural orientations on the three levels of approval were assessed via multinomial logistic regression analysis. Higher education and stronger socio-cultural liberal orientations increased the likelihood of approving both WLPT and EUT; personal experience with end-of-life care increased only the likelihood of approval of WLPT; and religiosity decreased approval of EUT only. This study found evidence for both shared (education, liberalism) and different (religiosity, care experiences) determinants for the acceptance of WLPT and EUT.


    Periods of vertebral column sensitivity to boric acid treatment in CD-1 mice in utero.Cherrington JW, Chernoff N.Department of Toxicology, North Carolina State University, Raleigh, NC 27695, USA. jana_cherrington@hotmail.comBoric acid (BA) has many uses as...


    Periods of vertebral column sensitivity to boric acid treatment in CD-1 mice in utero.Cherrington JW, Chernoff N.Department of Toxicology, North Carolina State University, Raleigh, NC 27695, USA. jana_cherrington@hotmail.comBoric acid (BA) has many uses as...

  14. Treatment of acquired periodic alternating nystagmus with memantine: a case report.

    Kumar, Anil; Thomas, Shery; McLean, Rebecca; Proudlock, Frank A; Roberts, Eryl; Boggild, Mike; Gottlob, Irene


    We report a case of acquired periodic alternating nystagmus associated with common variable immunodeficiency and cutaneous sarcoid. The patient was initially treated with baclofen with minimal subjective improvement. We found a significant improvement in the patient's symptoms and nystagmus intensity after treatment with memantine.

  15. Stress perception among patients in pre-colonoscopy period and those undergoing chemotherapy treatment

    Graziela de Souza Alves da Silva


    Full Text Available Objective: comparing the perception of stress among patients with colorectal cancer undergoing chemotherapy with those in pre-colonoscopy period. Methods: a comparative descriptive study developed with 144 people receiving chemotherapy and 100 patients in the pre-colonoscopy period, using biosocial and clinical data, Stress Assessment Tool and Perceived Stress Scale. Results: a predominance of females (73%, aged over 65 (50% were predominant for the pre-colonoscopy period patients. In patients receiving chemotherapy, gender parity with ages ranging from 40-64 years (68.1% was observed. Pre-colonoscopy patients showed higher perceived stress compared to those receiving chemotherapy (p <0.001. Conclusion: the phase of diagnostic definition represents greater stress to patients in comparison to period of treatment, even despite the characteristic manifestations of chemotherapy.

  16. Romidepsin for the treatment of relapsed/refractory peripheral T cell lymphoma: prolonged stable disease provides clinical benefits for patients in the pivotal trial

    Francine Foss


    Full Text Available Abstract Background Achievement of durable responses in patients with relapsed/refractory peripheral T cell lymphoma (PTCL is challenging with current therapies, and there are few data regarding the potential benefits of continuing treatment in patients with the best response of stable disease (SD. Histone deacetylase inhibitors are a novel class of drugs with activity in T cell malignancies. Romidepsin was approved by the US Food and Drug Administration for the treatment of relapsed/refractory PTCL based on a pivotal trial demonstrating an objective response rate of 25 % (33/130, including 15 % with confirmed/unconfirmed complete response and a median duration of response of 28 months. Our objective was to further study the clinical benefits of romidepsin in patients that had the best response of SD. Methods Patients with PTCL relapsed/refractory to ≥1 prior therapy were treated with the approved dose of 14 mg/m2 romidepsin on days 1, 8, and 15 of six 28-day cycles; patients with SD or response after cycle 6 were allowed to continue on study until progression. By protocol amendment, patients treated for ≥12 cycles could receive maintenance dosing twice per cycle; after cycle 24, dosing could be further reduced to once per cycle in those who had received maintenance dosing for ≥6 months. Results Of the 32 patients (25 % with the best response of SD, 22 had SD for ≥90 days (SD90; cycle 4 response assessment. The longest SD was >3 years in a patient who received maintenance dosing of 14 mg/m2 on days 1 and 15 beginning in cycle 13. Patients with the best response of SD90 or partial response achieved similar overall and progression-free survival. Prolonged dosing of romidepsin was well tolerated. Conclusions We concluded that patients who achieve SD may consider continuing treatment because the clinical benefits of romidepsin may extend beyond objective responses. Trial registration NCT00426764

  17. Lessons learned from muscle fatigue: implications for treatment of patients with hyperkalemic periodic paralysis.

    Renaud, Jean-Marc; Hayward, Lawrence J


    Hyperkalemic periodic paralysis (HyperKPP) is a disease characterized by periods of myotonic discharges and paralytic attacks causing weakness, the latter associated with increases in plasma [K(+)]. The myotonic discharge is due to increased Na(+) influx through defective Na(+) channels that triggers generation of several action potentials. The subsequent increase in extracellular K(+) concentration causes excessive membrane depolarization that inactivates Na(+) channels triggering the paralysis. None of the available treatments is fully effective. This paper reviews the capacity of Na(+) K(+)ATPase pumps, KATP and ClC-1 Cl(-) channels in improving membrane excitability during muscle activity and how using these three membrane components we can study future and more effective treatments for HyperKPP patients. The review of current patents related to HyperKPP reinforces the need of novel approaches for the treatment of this channelopathy.

  18. Daily Oxygen/O3 Treatment Reduces Muscular Fatigue and Improves Cardiac Performance in Rats Subjected to Prolonged High Intensity Physical Exercise

    C. Di Filippo


    Full Text Available Rats receiving daily intraperitoneal administration of O2 and running on a treadmill covered an average distance of 482.8 ± 21.8 m/week as calculated during 5-week observation. This distance was increased in rats receiving daily intraperitoneal administration of an oxygen/O3 mixture at a dose of 100; 150; and 300 μg/kg with the maximum increase being +34.5% at 300 μg/kg and still present after stopping the administration of oxygen/O3. Oxygen/O3 decreased the mean arterial blood pressure (−13%, the heart rate (−6%, the gastrocnemius and cardiac hypertrophy, and fibrosis and reduced by 49% the left ventricular mass and relative wall thickness measurements. Systolic and diastolic functions were improved in exercised oxygen/O3 rats compared to O2 rats. Oxygen/O3 treatment led to higher MPI index starting from the dose of 150 μg/kg (p<0.05 and more effective (+14% at a dose of 300 μg/kg oxygen/O3. Oxygen/O3 dose-dependently increased the expression of the antioxidant enzymes Mn-SOD and GPx1 and of eNOS compared to the exercised O2 rats. The same doses resulted in decrease of LDH levels, CPK, TnI, and nitrotyrosine concentration in the heart and gastrocnemius tissues, arguing a beneficial effect of the ozone molecule against the fatigue induced by a prolonged high intensity exercise.


    G.D. Alemanova


    Full Text Available Bronchial asthma is one of the widespread chronic diseases of lungs. Immune mechanisms of disorder are one of the causes which lead to pathologic changes in lungs. The aim: to determine the clinical and immunologic effectiveness of pressure adaptation to the periodical hypobaric hypoxic stimulation of treatment of children with bronchial asthma of prepubertal and pubertal periods. In the present work there were observed the clinical and immunologic parameters of 129 children with the verified atopic bronchial asthma of different degree at the remission period before and after the course of pressure adaptation to the periodical hypobaric hypoxic stimulation in conditions of the medical hypobaric pressure chamber with many seats «Ural'1». Clinic effectiveness of hypobaric hypoxic stimulation revealed in continuation of remissions and diminishing of total numerical score of asthma degree. The positive dynamic indexes of cytokine profile was observed. It revealed in reduction of IL 1_, IL 4, IL 5, IL 18 levels and stimulated production of IFN - in blood serum. The course of hypobaric hypoxic stimulation has the positive impact on the named indexes of the patients with bronchial asthma and its intensity depends on the degree of disease and of the age of the child' patient. Thus the use of pressure adaptation to the periodical hypobaric hypoxic stimulation in treatment of children's with bronchial asthma led to the immunologic positive dynamics, especially of the children of prepubertal period. Determination of the immunologic indexes and the level of the cytokines can be used as the additional tests for the evaluation of the effectiveness of pressure adaptation to the periodical hypobaric hypoxic stimulation of children.Key words: bronchial asthma, periodical hypobaric hypoxic stimulation, cytokines, children.

  20. Regeneration of Aqueous Periodate Solutions by Ozone Treatment: A Sustainable Approach for Dialdehyde Cellulose Production.

    Koprivica, Slavica; Siller, Martin; Hosoya, Takashi; Roggenstein, Walter; Rosenau, Thomas; Potthast, Antje


    A method for easy and fast regeneration of aqueous periodate solutions from dialdehyde cellulose (DAC) production by ozone treatment is presented, along with a direct and reliable simultaneous quantification of iodate and periodate by reversed-phase HPLC. The influence of iodate and ozone concentration, solution pH, and reaction time on the regeneration efficiency was studied, as well as the reaction kinetics. Regeneration of spent periodate solutions by ozone was successfully performed in alkaline medium, which favors the formation of free (.) OH radicals, as supported by the addition of radical scavengers and quantum mechanical calculations. At pH 13 and an ozone concentration of approximately 150 mg L(-1) , periodate was completely regenerated from a 100 mm solution of iodate within 1 h at room temperature. A cyclic process of cellulose oxidation and subsequent regeneration of spent periodate with 90 % efficiency has been developed. So far, commercial applications of DAC have been hampered by difficulties in reusing the costly periodate. This work overcomes this hurdle and presents a highly efficient, clean, and low-cost protocol for the preparation of DAC with integrated periodate recycling, with the possibility of scaling the process up.

  1. Treatment and Prognosis for an Esthesioneuroblastoma over a 20-Year Period: Impact of Treatment Era

    Song, Chang Hoon; Kim, Il Han; Wu, Hong Gyun; Kim, Dong Wan; Rhee, Chae Seo [Seoul National University College of Medicine, Seoul (Korea, Republic of)


    The aim of this study was to evaluate the results of postoperative radiotherapy in a case of perihilar cholagiocarcinoma by analyzing overall survival rate, patterns of failure, prognostic factors for overall survival, and toxicity. Between January 1998 and March 2008, 38 patients with perihilar cholangiocarcinoma underwent a surgical resection and adjuvant radiotherapy. The median patient age was 59 years (range, 28 to 72 years), which included 23 men and 15 women. The extent of surgery was complete resection in 9 patients, microscopically positive margins in 25 patients, and a subtotal resection in 4 patients. The tumor bed and regional lymphatics initially received 45 Gy or 50 Gy, but was subsequently boosted to a total dose of 59.4 Gy or 60 Gy in incompletely resected patients. The median radiotherapy dose was 59.4 Gy. Concurrent chemotherapy was administered in 30 patients. The median follow-up period was 14 months (range, 6 to 45 months). The 3-year overall survival and 3-year progression free survival rates were 30% and 8%, respectively. The median survival time was 28 months. A multivariate analysis showed that differentiation was the only significant factor for overall survival. The 3-year overall survival was 34% in R0 patients and 20% in R1 patients. No statistically significant differences in survival were found between the 2 groups (p=0.3067). The first site of failure was local in 18 patients (47%). No patient experienced grade 3 or higher acute toxicity and duodenal bleeding developed in 2 patients. Our results suggest that adjuvant RT might be a significant factor in patients with a positive margin following a radical resection. However, there was still a high locoregional recurrence rate following surgery and postoperative radiotherapy. Further study is necessary to enhance the effect of the adjuvant radiotherapy.

  2. Does prolonged pituitary down-regulation with gonadotropin-releasing hormone agonist improve the live-birth rate in in vitro fertilization treatment?

    Ren, Jianzhi; Sha, Aiguo; Han, Dongmei; Li, Ping; Geng, Jie; Ma, Chaihui


    To evaluate the effects of a prolonged duration of gonadotropin-releasing hormone agonist (GnRH-a) in pituitary down-regulation for controlled ovarian hyperstimulation (COH) on the live-birth rate in nonendometriotic women undergoing in vitro fertilization and embryo transfer (IVF-ET). Retrospective cohort study. University-affiliated hospital. Normogonadotropic women undergoing IVF. Three hundred seventy-eight patients receiving a prolonged pituitary down-regulation with GnRH-a before ovarian stimulation and 422 patients receiving a GnRH-a long protocol. Live-birth rate per fresh ET. In comparison with the long protocol, the prolonged down-regulation protocol required a higher total dose of gonadotropins. A lower serum luteinizing hormone (LH) level on the starting day of gonadotropin and the day of human chorionic gonadotropin (hCG) and a fewer number of oocytes and embryos were observed in the prolonged down-regulation protocol. However, the duration of stimulation and number of high-quality embryos were comparable between the two groups. A statistically significantly higher implantation rate (50.27% vs. 39.69%), clinical pregnancy rate (64.02% vs. 56.87%) and live-birth rate per fresh transfer cycle (55.56% vs. 45.73%) were observed in the prolonged protocol. Prolonged down-regulation in a GnRH-a protocol might increase the live-birth rates in normogonadotropic women. Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  3. Current treatment of nasal vestibular stenosis with CO2-laser surgery; prolonged vestibular stenting versus intraoperative mitomycin application. A case series of 3 patients

    Schijndel, O. van; Heerbeek, N. van; Ingels, K.J.A.O.


    These case studies describe three cases of unilateral nasal vestibular stenoses caused by chemical cauterization. Each case was treated with CO2-laser surgery together with intraoperative topic application of mitomycin or prolonged vestibular stenting for prevention of restenosis. Two patients recei

  4. Treatment of chronic generalized periodontitis at women in the period of postmenopause

    Ostrovskaya L.U.


    Full Text Available Purpose: an assessment of efficiency of complex treatment of periodontitis at women in a period of postmenopause with the use of zoledronic acid. Material and methods. Examination and treatment of 90 patients with a chronic generalized periodontitis against post-menopausal osteoporosis has been conducted. Material is processed statistically. Results. Application of preparations of zoledronic acid in complex treatment of system osteoporosis and periodontitis allows to reduce the frequency of recurrence of periodontal disease and to improve indicators of bone remodeling. Conclusion. In conclusion it is worth while determining that zoledronic acid in complex therapy of periodontitis is an effective method of drug correction of a mineral exchange before periodontological surgery.

  5. Prolonged Exposure Therapy For Post Traumatic Stress Disorder

    Levent SÜTÇİGİL


    Full Text Available Post-traumatic Stress Disorder (PTSD is a psychiatric illness that usually develops after an event that threatens one’s life and body integrity and it affects quality of life and impairs social functioning significantly. Many studies have shown therapeutic effect of cognitive behavioral therapies on posttraumatic stress disorder, so that these therapies take part in the first step of treatment guides. Exposure is a practice that is generally used to reduce pathological fear and related emotions common in posttraumatic stress disorder (PTSD and other anxiety disorders. During exposure, patients intentionally confront with feared objects, situations, thoughts and similar stimuli in order to reduce anxiety level. Exposure can be divided into two main techniques as in vivo exposure and imaginal exposure. Prolonged exposure therapy is a specialized treatment program configured for the treatment of posttraumatic stress disorder and it is based on emotional processing theory. Program is comprised of four main components: (a Psycho-education about trauma and posttraumatic disorders, (b Training for breathing exercises, (c repeated facing with objects, persons, situations and thoughts which causes re-experience about trauma, (d Patient are instructed for telling repeatedly and loudly about traumatic experiences . Prolonged exposure usually involves 9 to 12 sessions, each lasting about 60-90 minutes, administered once or twice a week. Prolonged exposure therapy was started to be implemented since the 1980s, during this period the effectiveness of the therapy has been shown in various empirical studies.

  6. Exhaustion from prolonged gambling

    Fatimah Lateef


    Full Text Available Complaints of fatigue and physical exhaustion are frequently seen in the acute medical setting, especially amongst athletes, army recruits and persons involved in strenuous and exertional physical activities. Stress-induced exhaustion, on the other hand, is less often seen, but can present with very similar symptoms to physical exhaustion. Recently, three patients were seen at the Department of Emergency Medicine, presenting with exhaustion from prolonged involvement in gambling activities. The cases serve to highlight some of the physical consequences of prolonged gambling.

  7. Exhaustion from prolonged gambling

    Fatimah Lateef


    Complaints of fatigue and physical exhaustion are frequently seen in the acute medical setting, especially amongst athletes, army recruits and persons involved in strenuous and exertional physical activities.Stress-induced exhaustion, on the other hand, is less often seen, but can present with very similar symptoms to physical exhaustion.Recently, three patients were seen at theDepartment ofEmergencyMedicine, presenting with exhaustion from prolonged involvement in gambling activities.The cases serve to highlight some of the physical consequences of prolonged gambling.

  8. Treatment of Class II, Division 2 in the late growth period.

    Eberhard, H; Hirschfelder, U


    The "Deckbiss" with skeletal Class II jaw relationship sometimes presents a considerable therapeutic problem, particularly in the late growth period (DP3U), as regards the coordination of dental and skeletal treatment objectives. An effective treatment approach was demonstrated: a modified Herbst appliance used simultaneously with fixed appliances in the maxilla. The sample comprised 12 male (14.0 +/- 0.9 years old) and 10 female (12.3 +/- 0.4 years old) patients. Correction of the distal occlusion was achieved in all patients by means of the Herbst appliance, which was removed after an average time period of 6.4 +/- 0.2 months. In the mandible the multibracket appliances were then immediately inserted, and Class II elastics were used for retention. Maximum anchorage was required in the maxilla as well as in the mandible. Complete diagnostic records were made at the beginning of the treatment as well as 6 and 12 months later, in order to document skeletal and dental changes. A dental and skeletal Class I relationship was achieved in all cases. A significant improvement was recorded in the vertical jaw base relationship; this was still stable after a period of 12 months. In the dental area in particular, a so-called high-pull headgear effect (intrusion and distalization 16, 26) and intrusion of teeth 34, 44 were registered. Only a minor protrusion of the mandibular incisors was observed. Reinforcement of the bands reduced the failure rate significantly. The Herbst appliance does not represent a standard treatment for Class II. Its indication range is limited.

  9. The comparative analysis of results of surgical treatment of myasthenia in the remote periods of disease

    L. Zaslavsky


    Full Text Available Based on long-term follow-up to perform comparative analysis of long-term results of surgical treatment of myasthenia. A retrospective analysis of long-term results of surgical treatment of 146 patients with myasthenia has been carried out. We used the modified Keynes classification to estimate the severity of myasthenia and to summarize the data relating to therapy volume and treatment results. In dependence on the type of thymus lesion patients were divided into two groups. Thymus hyperplasia was verified at — 106 (72.6 % patients, tumor lesion of the thymus gland (thymoma — at 40 (27.4 % ones. The results were estimated in the following periods after thymectomy: 1—2 years, 3—4 years, 5—6 years, 7 — 9 years, 10—14 years, and over 15 years. Short- and longterm results of surgical treatment of myasthenia for the patients without tumor lesions of the thymus gland were significantly better. Positive effects of surgical treatment of myasthenia in patients with hyperplasia are observed after 1 year of surgery (p = 0.0023, and the best results are observed after 5 — 6 year of the disease, then after 7 — 9 year one notes some deterioration of state (p = 0.026. In the myasthenia patients with thymoma one notes the similar trends in dynamics of state, but in general, the results are significantly (p = 0.042 badly than in the group of the patients with hyperplasia. Starting from the first year after operation treatment the patients with myasthenia with thymus hyperplasia have statistically significant (p = 0.048 decrease of average doses of glucocorticoids, and anticholinesterase drugs. The statistically best treatment results were noted for the patients operated at the first year of the disease. Positive result of surgical treatment of myasthenia is noted both in the short- and long-term period and at thymomas. In the group of patients with thymoma one has noted significantly badly results in comparison with group of hyperplasia. It is


    V. V. Apollonov


    Full Text Available The purpose of the paper is to estimate an application of pulse-periodical mode for improvement of laser treatment efficiency. Laser technologies have been widely used in the processes of material treatment with the purpose to provide them the required surface properties and also for high accuracy cutting of sheet materials. Application of complex treatment is of great interest and especially when it is used for worn-out surfaces with formation of a coating by gas-flame laying of powder mixture of specific composition and subsequent laser fusion.Increase of laser unit capacity is very important task for higher efficiency of laser technology application in mechanical engineering. Nowadays technological processes using lasers with high average power (more than 100 W have been applying only sources that are working in two modes, namely: continuous and pulse- periodical (P-P with pulse repetition rate from some units to several hundred hertz and pulse duration within dozens to hundreds of microseconds and even within milliseconds. On the other hand, in some cases shielding effect of plasma cloud formed during laser alloying, cladding or welding reduces the efficiency of laser treatment up to 50 % depending on plasma composition and laser beam length. High frequency P-P laser systems with high average power working in mode of Q-factor modulation allow to realize principally other mechanism of irradiation interaction with materials that is an ablation. In this case it is possible to provide local energy release both in space and time.The performed analysis has revealed that P-P mode of laser operation for a majority of treatment processes is much better and more efficient from energetic point of view in comparison with the continuous mode. On the basis of the developments it is possible to make a conclusion that there is a possibility to create laser systems working in high frequency P-P mode with high average power above hundreds watt.

  11. Surgical treatment of eye injuries in five-year survey period

    Vukosavljević Miroslav


    Full Text Available Introduction: Eye injuries represent one of the biggest problems in eye surgery all around the world, including our country. Treatment of eye injuries demands highly skilled personnel and adequate technical equipment. Objective: To show a total number of eye injuries, including the surgical methods used for their treatment. Methods: In our study, retrospective analysis of all performed surgical methods used in treatment of hospitalized patients in our Clinic during 2000-2004 was carried out. A special attention was paid to pars plana vitrectomy, together with combined anterior-posterior segment procedures. Results: During 2000-2004, a total of 347 pars plana vitrectomy, and 27 traumatic retinal detachments (conventional methods were performed. In addition, 314 patients with contusion trauma of the eyes were treated. Out of 297 patients with penetrant eye injuries, 196 (66% had intraocular foreign bodies (IOFB, and 101 (34% were without IOFB. A total number of endophthalmitis was 34 (8.73%. The number of combined anterior-posterior segment operations during this period was 227. Conclusion: Vitreoretinal operations are the most prevailing in treatment of serious eye injuries. Pars plana vitrectomy is also the most common method of surgical treatment of eye injuries.

  12. Sulphasalazine: a safe, effective agent for prolonged control of rheumatoid arthritis. A comparison with sodium aurothiomalate.

    Bax, D E; Amos, R S


    The place of sulphasalazine in the management of rheumatoid arthritis over prolonged periods of time has been compared and contrasted with that of sodium aurothiomalate. One hundred and forty-three patients (59 on sulphasalazine, 84 on sodium aurothiomalate) have been treated for periods of up to 42 months. Sulphasalazine is highly effective for some patients, though probably less frequently than sodium aurothiomalate. However, its safety profile is far superior, and very long-term treatment ...

  13. Sulphasalazine: a safe, effective agent for prolonged control of rheumatoid arthritis. A comparison with sodium aurothiomalate.

    Bax, D E; Amos, R S


    The place of sulphasalazine in the management of rheumatoid arthritis over prolonged periods of time has been compared and contrasted with that of sodium aurothiomalate. One hundred and forty-three patients (59 on sulphasalazine, 84 on sodium aurothiomalate) have been treated for periods of up to 42 months. Sulphasalazine is highly effective for some patients, though probably less frequently than sodium aurothiomalate. However, its safety profile is far superior, and very long-term treatment ...


    Ye. S. Kulikov


    Full Text Available Introduction: The leading mechanisms and causes of severe therapy resistant asthma are poorly understood. The aim of this study was to define global patterns of gene expression in adults with severe therapy-resistant asthma in dynamic during treatment period.Methods: Performed 24-week prospective interventional study in parallel groups. Severe asthma patients was aposterior divided at therapy sensitive and resistant patients according to ATS criteria. Global transcriptome profile was characterized using the Affymetrix HuGene ST1.0 chip. Cluster analysis was performed.Results and conclusion: According to our data several mechanisms of therapy resistance may be considered: increased levels of nitric oxide and beta2-agonists nitration, dysregulation of endogenous steroids secretion and involvement in the pathogenesis of Staphylococcus aureus. Absence of suppression of gene expression KEGG-pathway “asthma" may reflect the low efficiency or long period of anti-inflammatory therapy effect realization.

  15. The significance of HPV in the follow-up period after treatment for CIN.

    Gallwas, J; Ditsch, N; Hillemanns, P; Friese, K; Thaler, C; Dannecker, C


    High-risk anogenital human papillomavirus (HPV) infections are causally related to cervical cancer. Successful treatment of cervical intraepithelial neoplasia (CIN) results in complete eradication of HPV in most cases. There is an increasing interest regarding the role of HPV testing in the follow-up period after treatment for CIN. This retrospective study includes 107 women who underwent conization for histologically verified CIN. All of them had HPV testing pre- and postoperatively. HPV testing was carried out using a hybrid capture assay (HC2). The mean follow-up period was 21.4 months (range 2-76 months). The data were analyzed with respect to success of conization, HPV persistence/recurrence and CIN recurrence. Sensitivity, specificity and negative predictive value (NPV) of HPV testing were assessed and compared to the cytological results. Preoperatively, 97 of 107 women were HPV positive. Ninety-seven conizations showed negative resection margins with 86 women becoming HPV negative. In the following months, nine of these HPV negative women became HPV positive again. Out of ten conizations with positive resection margins, six women became HPV negative. Recurrent CIN 2/3 lesions were observed in 11 women, nine of whom had persistent positive HPV testing throughout the entire study period. Regarding CIN recurrence HPV testing showed a sensitivity of 93%, a specificity of 85% and a NPV of 99%. The sensitivity of HPV testing concerning persistent or recurrent CIN as well as the NPV are high. The present data suggest that HPV testing should be integrated in a follow-up algorithm after treatment for CIN by conization.

  16. Meaning of leprosy for people who have experienced treatment during the sulfonic and multidrug therapy periods

    Karen da Silva Santos


    Full Text Available AbstractObjective: to analyze the meanings of leprosy for people treated during the sulfonic and multidrug therapy periods.Method: qualitative nature study based on the Vigotski's historical-cultural approach, which guided the production and analysis of data. It included eight respondents who have had leprosy and were submitted to sulfonic and multidrug therapy treatments. The participants are also members of the Movement for Reintegration of People Affected by Leprosy.Results: the meanings were organized into three meaning cores: spots on the body: something is out of order; leprosy or hanseniasis? and leprosy from the inclusion in the Movement for Reintegration of People Affected by Leprosy.Conclusion: the meanings of leprosy for people submitted to both regimens point to a complex construction thereof, indicating differences and similarities in both treatments. Health professionals may contribute to the change of the meanings, since these are socially constructed and the changes are continuous.

  17. Impact of periodic selective mebendazole treatment on soil-transmitted helminth infections in Cuban schoolchildren.

    van der Werff, Suzanne D; Vereecken, Kim; van der Laan, Kim; Campos Ponce, Maiza; Junco Díaz, Raquel; Núñez, Fidel A; Rojas Rivero, Lázara; Bonet Gorbea, Mariano; Polman, Katja


    To evaluate the impact of periodic selective treatment with 500 mg mebendazole on soil-transmitted helminth (STH) infections in Cuban schoolchildren. We followed up a cohort of 268 STH-positive schoolchildren, aged 5-14 years at baseline, at six-month intervals for two years and a final follow-up after three years. Kato-Katz stool examination was used to detect infections with Ascaris lumbricoides, Trichuris trichiura and hookworm. Common risk factors related to STHs were assessed by parental questionnaire. A significant reduction in the number of STH infections was obtained after three years with the highest reduction for T. trichiura (87.8%) and the lowest for hookworm (57.9%). After six months, cure rates (CRs) were 76.9% for A. lumbricoides, 67.4% for T. trichiura and 44.4% for hookworm. After two treatment rounds, more than 75% of all STH-positive children at baseline were cured, but with important differences between STH species (95.2% for A. lumbricoides, 80.5% for T. trichiura and 76.5% for hookworm). At the end of the study, these cumulative CRs were almost 100% for all three STHs. Risk factors for STHs were sex, sanitary disposal and habit of playing in the soil. Our results indicate that periodic selective treatment with 500 mg mebendazole is effective in reducing the number of STH infections in Cuban schoolchildren. Although important differences were found between helminth species, two rounds of treatment appeared sufficient to obtain substantial reductions. © 2014 John Wiley & Sons Ltd.

  18. Evolving Frontiers in the Treatment of Periodic Fever, Aphthous Stomatitis, Pharyngitis, Cervical Adenitis (PFAPA) Syndrome.

    Rigante, Donato; Gentileschi, Stefano; Vitale, Antonio; Tarantino, Giusyda; Cantarini, Luca


    Fevers recurring at a nearly predictable rate every 3-8 weeks are the signature symptom of periodic fever, aphthous stomatitis, pharyngitis, cervical adenitis (PFAPA) syndrome, an acquired autoinflammatory disorder which recurs in association with at least one sign among aphthous stomatitis, pharyngitis, and/or cervical lymph node enlargement without clinical signs related to upper respiratory airways or other localized infections. The disease usually has a rather benign course, although it might relapse during adulthood after a spontaneous or treatment-induced resolution in childhood. The number of treatment choices currently available for PFAPA syndrome has grown in recent years, but data from clinical trials dedicated to this disorder are limited to small cohorts of patients or single case reports. The response of PFAPA patients to a single dose of corticosteroids is usually striking, while little data exist for treatment with cimetidine and colchicine. Preliminary interesting results have been published with regard to vitamin D supplementation in PFAPA syndrome, while inhibition of interleukin-1 might represent an intriguing treatment for PFAPA patients who have not responded to standard therapies. Tonsillectomy has been proven curative in many studies related to PFAPA syndrome, although the evidence of its efficacy is not widely shared by different specialists, including pediatricians, rheumatologists and otorhynolaryngologists.

  19. Prolonged bradycardia, asystole and outcome of high spinal cord injury patients: Risk factors and management

    Shaikh, Nissar; Rhaman, M. A.; Raza, Ali; Shabana, Adel; Malstrom, Mahommad Faisal; Al-Sulaiti, Ghanem


    Background: High spinal cord injury (HSCI) is one of the devastating traumatic injuries. 80% of these patients are young male, and 93% will have major neurological disabilities. There is a paucity of literature about prolonged bradycardia in HSCI patients. The aim of this study was to know the prevalence, risk factors, precipitating factors for prolonged bradycardia in the HSCI patients. Materials and Methods: All patients who were admitted to the Intensive Care Unit (ICU) of a tertiary hospital, with spinal cord injury above level of dorsal (D4) were enrolled in this study prospectively. Patient's demographic data, mechanism, level and type of spinal injury, associated injuries, injury severity score (ISS), spinal shock, vasopressors used, time of occurrence of bradycardia, treatment for bradycardia, precipitating as well as risk factors and outcome were recorded. Results: During the study period, a total of 138 patients were admitted to the ICU with HSCI. Majority of patients were male. The most frequently associated injury in these patients was skeletal fractures (38.4%). Most common complication was pneumonia 56 (41%). Forty-five (33%) of the total patients had prolonged bradycardia; 87% of these patients had pneumonia when bradycardia occurred. 53.4% had cardiac asystole. 29 (21%) patients had bradycardia at the time of endotracheal suctioning, whereas 27 (20%) patients developed bradycardia at the time of positioning. Majority of the patients were managed conservatively. Those HSCI patients who developed prolonged bradycardia, their ISS score was statistically higher, ICU and hospital stay was significantly higher compared with those HSCI patient who did not have prolonged bradycardia. Multivariate analysis revealed that hypotension on admission; pneumonia, and tracheostomy were risk factors for the development of prolonged bradycardia in HSCI patients. Conclusion: Prolonged bradycardia was associated with significantly higher incidence of asystole

  20. Evaluating the Efficacy of Primary Treatment for Graves’ Disease Complicated by Thyrotoxic Periodic Paralysis

    Rita Yuk-Kwan Chang


    Full Text Available Objective. Thyrotoxic periodic paralysis (TPP is a potentially life-threatening complication of Graves’ disease (GD. The present study compared the long-term efficacy of antithyroid drugs (ATD, radioactive iodine (RAI, and surgery in GD/TPP. Methods. Sixteen patients with GD/TPP were followed over a 14-year period. ATD was generally prescribed upfront for 12–18 months before RAI or surgery was considered. Outcomes such as thyrotoxic or TPP relapses were compared between the three modalities. Results. Eight (50.0% patients had ATD alone, 4 (25.0% had RAI, and 4 (25.0% had surgery as primary treatment. Despite being able to withdraw ATD in all 8 patients for 37.5 (22–247 months, all subsequently developed thyrotoxic relapses and 4 (50.0% had ≥1 TPP relapses. Of the four patients who had RAI, two (50% developed thyrotoxic relapse after 12 and 29 months, respectively, and two (50.0% became hypothyroid. The median required RAI dose to render hypothyroidism was 550 (350–700 MBq. Of the 4 patients who underwent surgery, none developed relapses but all became hypothyroid. Conclusion. To minimize future relapses, more definitive primary treatment such as RAI or surgery is preferred over ATD alone. If RAI is chosen over surgery, a higher dose (>550 MBq is recommended.

  1. Obsessive-compulsive disorder in the perinatal period: epidemiology, phenomenology, pathogenesis, and treatment

    Álvaro Frías


    Full Text Available The aim of this review is to describe the main theoretical findings and research conclusions about obsessive-compulsive disorder (OCD in the perinatal period. On one hand, epidemiological studies show that the risk of OCD onset and/or exacerbation could increase in this period, particularly in the puerperium. Phenomenologically, in this stage aggressive and contamination obsessions are very common and are related to the fetus or newborn. On the other hand, regarding OCD pathogenesis in this period, there is indirect evidence to suggest the participation of neuroendocrine (e.g. female gonadal steroids and oxytocin and cognitive behavioural variables (e.g. hyper-responsibility, threat overestimation, and mental control. In terms of research, more empirical studies are needed to contrast these specific vulnerability factors. Moreover, no empirically validated psychotherapeutic treatments (controlled trials adapted to this OCD sub-group were found, although some studies highlight the role of cognitive behavioural therapy (CBT as an effective intervention in the context of selective primary prevention.

  2. Treatment of bronchial asthma with low-level laser in attack-free period at children

    Ailioaie, C.; Ailioaie, Laura


    Bronchial asthma is a common disease in both the pediatric and adult populations, characterized by wide variations over short periods of time in resistance to airflow in intrapulmonary airways. A primary goal in the use of low- level laser therapy (LLLT) was the safe, effective and rapid palliation of symptoms owing to tracheal or bronchial obstruction. We have investigated the effects of LLLT comparatively with other modality trials in children's asthma. In the study were included 98 patients aged 10-18 years diagnosed with moderate or severe asthma, in attack- free period. The patients were divided into 3 groups. Group 1 received only laser therapy using extra meridian acupuncture points and scanning technique. Group 2 was treated only with inhaled Serevent 2 X 25 micrometers , two times daily, 3 months. Group 3 was tread with Theophylline retard in dosage of 15-mg/kg/12 h, 3 months. At the end of treatment we remarked a noticeable improvement of the clinical, functional and immunological characteristics at 83 percent of patients in group 1, comparatively with only 70 percent (group 2) and 53 percent (group 3). The LLLT had a very good action on bronchial patency , displayed an immunocorrecting action and is recommended in attack-free periods at children.

  3. Comparison of mortality in hyperthyroidism during periods of treatment with thionamides and after radioiodine.

    Boelaert, Kristien; Maisonneuve, Patrick; Torlinska, Barbara; Franklyn, Jayne A


    Hyperthyroidism is common, but opinions regarding optimal therapy with antithyroid drugs or radioiodine (131-I) differ. There are no randomized trials comparing these options in terms of mortality. The aim of the study was to determine whether mortality associated with hyperthyroidism varies with treatment administered or other factors. We conducted a prospective observational population-based study of 1036 subjects aged ≥ 40 years presenting to a single specialist clinic from 1989-2003 with a first episode of hyperthyroidism who were followed until June 2012. Antithyroid drugs or radioiodine (131-I) were administered. We compared causes of death with age-, sex-, and period-specific mortality in England and Wales and used within-cohort analysis of influence of treatment modality, outcome, disease etiology, severity and control, and comorbidities. In 12 868 person-years of follow-up, 334 died vs 290.6 expected (standardized mortality ratio [SMR], 1.15 [95% confidence interval (CI),1.03-1.28]; P = .01). Increased all-cause mortality largely reflected increased circulatory deaths (SMR, 1.20 [95% CI, 1.01-1.43]; P = .04). All-cause mortality was increased for the person-years accumulated during thionamide treatment (SMR, 1.30 [95% CI, 1.05-1.61]; P = .02) and after 131-I not associated with hypothyroidism (SMR, 1.24 [95% CI, 1.04-1.46]; P = .01) but not during T₄ replacement for 131-I-induced hypothyroidism (SMR, 0.98 [95% CI, 0.82-1.18]; P = .85). Within-cohort analysis comparing mortality during thionamide treatment showed a similar hazard ratio (HR) for all-cause mortality when 131-I did not result in hypothyroidism (HR, 0.95 [95% CI, 0.70-1.29]), but reduced mortality with 131-I-induced hypothyroidism (HR, 0.70 [95% CI, 0.51-0.96]). Reduced mortality associated with hypothyroidism was seen only in those without significant comorbidities and not in those with other serious diseases. Atrial fibrillation at presentation (P = .02) and an increment of 10 pmol/L in

  4. Prolonged labour : women's experiences

    Nystedt, Astrid


    Aim: The overall aim of this thesis was to illuminate, describe, and promote understanding of women’s experiences of prolonged labour. The thesis compromises four studies. Methods: Paper I describes a case-referent study that recruited women (n = 255) giving singleton live birth to their first child by spontaneous labour after more than 37 completed weeks’ pregnancy. Participants completed a questionnaire that investigated childbirth experiences, previous family relationships, and childhood e...

  5. Comparing different treatment modalities for partial nephrectomies without ischemic period: laser, Hydro-Jet and RF

    de Boorder, Tjeerd; Boeken Kruger, Arto; Klaessens, John; Grimbergen, Matthijs; Verdaasdonk, Rudolf


    The treatment of partial nefrectomies is usually performed under a warm ischemic period. Recently, various treatment modalities have become available to perform a partial nefrectomy without clamping off the blood circulation. We have studied three devices in laboratory setting, investigating the thermal and high speed imaging techniques in tissue models and consequently, applying the instruments in the clinic during open procedures especially looking at efficacy and blood loss. The continuous wave 2.0 micron laser of 70 W (Revolix, LISA laser) is used as a fiber delivered knife cutting through circulated tissue with controlled hemostasis for vessels up to 3 mm diameter. The 2 μm wavelength effectively vaporizes tissue water and coagulates the smaller vessels. The Hydro-Jet (ERBE, Germany) uses high pressure (20-80 bar) to ejects a water jet of 40 um diameter at high velocity (10-30 m/s). The parenchyma is resected while vessels are preserved. Consequently, the exposed vessels can be coagulated in a controlled way with minimal blood loss. The water jet showed to induce cavitation bubbles that resect the soft tissue from the matrix leaving the elastic microvessels intact. Various systems are based on bipolar RF technology. We are using the Habib device (Rita 1500X RF generator) to create a coagulation zone around the tumor. Subsequently, the tumor can be resected along the coagulation zone with minimal bleeding. The treatment modalities investigated, have their own advantages and, stand-alone or in combination, can facilitate laparoscopic partial nephrectomies without an ischemic period.

  6. Induction of ovarian activity in Bulgarian Murrah buffaloes by hormonal treatment in the early postpartum period

    Stanimir A Yotov; Anatoli S Atanasov; Yordanka Y Ilieva


    Objective: To determine the possibilities for induction of ovarian activity in Bulgarian Murrah buffaloes by hormonal treatment in the early postpartum period. Methods: Twenty six clinically healthy animals, weighing 480-520 kg, 3-5 years of age, with normal parturition, without clinical signs of endometritis during the entire experimental period were divided into 2 groups: control (n=10) and experimental (n=16). Primiparous and multiparous buffaloes were proportionally allotted into both groups. By 5, 21, and 28 postpartum days, control animals were intramuscularly treated with 2 mL physiological saline, whereas experimental buffaloes received 500 mg PGF2αby the 5th postpartum day, 100 μg GnRH by the 21st postpartum day and a second prostaglandin dose 7 days later. All buffaloes were submitted to transrectal ultrasound examination on days 5, 21 and 28 after calving. Evaluation of ovarian activity was made on the basis of follicle type and detection of a newly formed corpus luteum. The percentage of animals with small, medium or dominant follicle and corpus luteum after either spontaneous or induced ovulation was determined. Insemination management included introduction of two proven fertile bulls into the herd at the start of the treatment. Pregnancy ultrasound checks were performed on postpartum days 58, 68, 120 and 150. The proportion of buffaloes with clinical signs of spontaneous or induced oestrus until the 35th postpartum day, pregnancy rates by the 35th and 90th postpartum days and service periods 90 days were registered. Results: On the 5th day after calving, small follicles were predominating in the ovaries of buffaloes from both groups. Similar findings were established on the 21st day in the control group, whereas the share of experimental buffaloes with small follicles was significantly (P<0.01) lower. By the 21st day, there were no medium follicles in untreated animals, while in hormonally treated ones they were found out in 25% of cases. The

  7. Studies on Relationship between Serum Nitric Oxide and Plasma Cyclic Guanosine Monophosphate and Prolonged Bleeding after Medical Abortion as well as Prophylaxis and Treatment of Bleeding with Traditional Chinese Medicine

    廖玎玲; 谭布珍; 辛华; 贺晓菊


    Objectives To study the relationship between serum nitric oxide(NO and plasma cyclic guanosine monophosphate(cGMP)and prolonged bleeding after medical abortion.Methods A total of 120women having received medical abortions at random were recruited and divided into two groups:the one(Group A,n=60) taking “Gong-Fu Mixture(Uterus-Recovering Mixture)”and the other(Group B,n=60)not taking it after abortion.On d 10,20 and 30 after medical abortion,serum NO and plasma cGMP were tested before and after mifepristone administration and 10 d later by Gresis reac-tion method and radioimmunoassay respectively.Results NO concentration in serum and cGMP concentration in plasma decreased signifi-cantly after taking mifeprlstone given(P<0. 05).Ten days later,the number of thos ewith bleeding discontinuation in the group A was significantly greater than that in the group B(P<0.05).Serum NO level and plasma cGMP level in the group A de-creased more significantly than those in the group B(P<0. 05).Conclusion The slow decrease of serum NO and plasma cGMP is closely related to prolonged bleeding after medical abortion.“Gong-Fu Mixture(uterus-recovering mixture)”is effective in prevention and treatment of prolonged bleeding.

  8. Is colchicine an effective treatment in periodic fever, aphtous stomatitis, pharyngitis, cervical adenitis (PFAPA) syndrome?

    Dusser, Perrine; Hentgen, Véronique; Neven, Bénédicte; Koné-Paut, Isabelle


    PFAPA syndrome is the most frequent periodic fever syndrome in non-Mediterranean patients. The pathogenesis is unclear and the treatment is purely symptomatic and not standardized. The aim of this study was to assess colchicine's efficacy as prophylactic treatment in PFAPA syndrome and to identify factors able to predict response to treatment. We performed a retrospective, multicentric, cohort study of PFAPA patients under colchicine prophylaxis. PFAPA diagnosis was established according to Feder's criteria. Medical records were reviewed and analyzed for demographic, clinical and laboratory data. We distinguished one responder's group, defined as patients who had no more or twice fewer crises under colchicine and another one of non-responders. Subgroup analyses were performed using non-parametric Mann-Whitney test for quantitative data and calculating odds ratio and confidence interval for qualitative data. Difference between the two groups was considered significant for P-value<0.05 or a confidence interval different from 1. Twenty children, 65% of whom were boys, were analyzed. Their mean age at disease onset was 2.3±1.5 years. Among the nine responder patients, five were MEFV (71%) heterozygotes: M694V mutation in four and V726A once. Heterozygous MEFV gene mutation tended to be more frequent in the responders group (71% versus 43%; OR=0.3 [0.03-2.7]). Non-responder patients had more chronic fatigue (82% versus 33%; OR=9 [1,14-71]) and had more oral aphtosis (82% versus 11%; OR=36 [1,7-141]) than the responders ones. Although not significant, colchicine treatment appeared more effective in patients with less complete PFAPA phenotype and MEFV heterozygosity. Copyright © 2016 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  9. Treatment trends during a thirteen-year period in a student pediatric dentistry clinic.

    Bimstein, E; Eidelman, E


    This manuscript reports the treatment trends in a pediatric dentistry clinic from 1980 to 1992 and discusses their implication in clinical teaching. Analysis of the records of the senior year pediatric dentistry students indicated: no significant change with time in the patients/student ratio, the number of preformed crowns, pulpotomies, and pulpectomies by student or by patient; a significant decrease in the number of one-surface and > or = 2-surface restorations by student and by patient; a significant increase in the number of pit-and-fissure sealants and preventive resin restorations by student and by patient. During the thirteen-year period, the students performed an average of 7.3 one-surface; 12.9 > or = 2-surface restorations; 5.5 preformed crowns; 6.4 pit-and-fissure sealants; 2.4 pulpotomies. There was a significant increase with time in the number of students who performed pit-and-fissure sealants.

  10. Reference datasets for 2-treatment, 2-sequence, 2-period bioequivalence studies.

    Schütz, Helmut; Labes, Detlew; Fuglsang, Anders


    It is difficult to validate statistical software used to assess bioequivalence since very few datasets with known results are in the public domain, and the few that are published are of moderate size and balanced. The purpose of this paper is therefore to introduce reference datasets of varying complexity in terms of dataset size and characteristics (balance, range, outlier presence, residual error distribution) for 2-treatment, 2-period, 2-sequence bioequivalence studies and to report their point estimates and 90% confidence intervals which companies can use to validate their installations. The results for these datasets were calculated using the commercial packages EquivTest, Kinetica, SAS and WinNonlin, and the non-commercial package R. The results of three of these packages mostly agree, but imbalance between sequences seems to provoke questionable results with one package, which illustrates well the need for proper software validation.

  11. Periodic Presumptive Treatment for Vaginal Infections May Reduce the Incidence of Sexually Transmitted Bacterial Infections.

    Balkus, Jennifer E; Manhart, Lisa E; Lee, Jeannette; Anzala, Omu; Kimani, Joshua; Schwebke, Jane; Shafi, Juma; Rivers, Charles; Kabare, Emanuel; Scott McClelland, R


    Bacterial vaginosis (BV) may increase women's susceptibility to sexually transmitted infections (STIs). In a randomized trial of periodic presumptive treatment (PPT) to reduce vaginal infections, we observed a significant reduction in BV. We further assessed the intervention effect on incident Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium infection. Nonpregnant, human immunodeficiency virus-uninfected women from the United States and Kenya received intravaginal metronidazole (750 mg) plus miconazole (200 mg) or placebo for 5 consecutive nights each month for 12 months. Genital fluid specimens were collected every other month. Poisson regression models were used to assess the intervention effect on STI acquisition. Of 234 women enrolled, 221 had specimens available for analysis. Incidence of any bacterial STI (C. trachomatis, N. gonorrhoeae, or M. genitalium infection) was lower in the intervention arm, compared with the placebo arm (incidence rate ratio [IRR], 0.54; 95% confidence interval [CI], .32-.91). When assessed individually, reductions in STI incidences were similar but not statistically significant (IRRs, 0.50 [95% confidence interval {CI}, .20-1.23] for C. trachomatis infection, 0.56 [95% CI, .19-1.67] for N. gonorrhoeae infection, and 0.66 [95% CI, .38-1.15] for M. genitalium infection). In addition to reducing BV, this PPT intervention may also reduce the risk of bacterial STI among women. Because BV is highly prevalent, often persists, and frequently recurs after treatment, interventions that reduce BV over extended periods could play a role in decreasing STI incidence globally. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail

  12. Muscle channelopathies: does the predicted channel gating pore offer new treatment insights for hypokalaemic periodic paralysis?

    Matthews, E; Hanna, M G


    Hypokalaemic periodic paralysis (hypoPP) is the archetypal skeletal muscle channelopathy caused by dysfunction of one of two sarcolemmal ion channels, either the sodium channel Nav1.4 or the calcium channel Cav1.1. Clinically, hypoPP is characterised by episodes of often severe flaccid muscle paralysis, in which the muscle fibre membrane becomes electrically inexcitable, and which may be precipitated by low serum potassium levels. Initial functional characterisation of hypoPP mutations failed to adequately explain the pathomechanism of the disease. Recently, as more pathogenic mutations involving loss of positive charge have been identified in the S4 segments of either channel, the hypothesis that an abnormal gating pore current may be important has emerged. Such an aberrant gating pore current has been identified in mutant Nav1.4 channels and has prompted potentially significant advances in this area. The carbonic anhydrase inhibitor acetazolamide has been used as a treatment for hypokalaemic periodic paralysis for over 40 years but its precise therapeutic mechanism of action is unclear. In this review we summarise the recent advances in the understanding of the molecular pathophysiology of hypoPP and consider how these may relate to the reported beneficial effects of acetazolamide. We also consider potential areas for future therapeutic development. PMID:20123788

  13. Low socioeconomic status is associated with prolonged times to assessment and treatment, sepsis and infectious death in pediatric fever in El Salvador.

    Ronald Gavidia

    Full Text Available BACKGROUND: Infection remains the most common cause of death from toxicity in children with cancer in low- and middle-income countries. Rapid administration of antibiotics when fever develops can prevent progression to sepsis and shock, and serves as an important indicator of the quality of care in children with acute lymphoblastic leukemia and acute myeloid leukemia. We analyzed factors associated with (1 Longer times from fever onset to hospital presentation/antibiotic treatment and (2 Sepsis and infection-related mortality. METHOD: This prospective cohort study included children aged 0-16 years with newly diagnosed acute leukemia treated at Benjamin Bloom Hospital, San Salvador. We interviewed parents/caregivers within one month of diagnosis and at the onset of each new febrile episode. Times from initial fever to first antibiotic administration and occurrence of sepsis and infection-related mortality were documented. FINDINGS: Of 251 children enrolled, 215 had acute lymphoblastic leukemia (85.7%. Among 269 outpatient febrile episodes, median times from fever to deciding to seek medical care was 10.0 hours (interquartile range [IQR] 5.0-20.0, and from decision to seek care to first hospital visit was 1.8 hours (IQR 1.0-3.0. Forty-seven (17.5% patients developed sepsis and 7 (2.6% died of infection. Maternal illiteracy was associated with longer time from fever to decision to seek care (P = 0.029 and sepsis (odds ratio [OR] 3.06, 95% confidence interval [CI] 1.09-8.63; P = 0.034. More infectious deaths occurred in those with longer travel time to hospital (OR 1.36, 95% CI 1.03-1.81; P = 0.031 and in families with an annual household income treatment of fever and with sepsis and infectious mortality in pediatric leukemia. Providing additional education to high-risk families

  14. Prolonged acute hepatitis A mimicking autoimmune hepatitis

    Rintaro Mikata; Osamu Yokosuka; Fumio Imazeki; Kenichi Fukai; Tatsuo Kanda; Hiromitsu Saisho


    AIM: We report a case with a prolonged course of hepatitisA, with alanine aminotransferase (ALT) higher than 500 IU/Lfor more than 2 mo.METHODS: A middle-aged woman had an elevated IgG level of more than 2 000 mg/dL, positive arti-nudear antibodies (ANA) and anti-smooth muscle antibodies (ASMA), but no evidence of persistent hepatitis A virus (HAV) infection. Liver biopsy findings were compatible with prolonged acute hepatitis, although acute onset of autoimmune hepatitis could not be ruled out.RESULTS: It was assumed that she developed a course of hepatitis similar to autoimmune hepatitis triggered by HAV infection. Ursodeoxycholic acid (UDCA) treatment was initiated and a favorable outcome was obtained. CONCLUSION: We describe a case of a middle-aged woman who showed a prolonged course of acute hepatitis A mimicking autoimmune hepatitis. Treatment with UDCAproved to be effective.

  15. Principles of treatment planning for compromised first permanent molars in mixed dentition period: A review article

    Behrad Tanbakuchi


    Full Text Available Background and Aims: The first permanent molar is susceptible to caries, endodontic complications and developmental anomalies. Compromised teeth with poor prognosis could cause the clinician to face dilemmas. The aim of this review article was to assess recent guidelines on the treatment planning of compromised first permanent molars in mixed dentition period. Materials and Methods: The design of the study was based on review of literature by searching the MEDLINE, Web of science and Google scholar. Key words (permanent first molar, extraction, treatment plan were used. This search was limited to the English articles published after the year 2000. Conclusion: A number of factors influenced decision-making process regarding compromised first permanent molars including the restorative status of the tooth, dental age of the patient, degree of crowding and occlusal relationships were assessed. The ideal time for removal of these teeth was 8-9 years of age. However, the current evidence for managing compromised first permanent molars demands clinical trials.

  16. Efficacy and safety of prolonged-release melatonin in insomnia patients with diabetes: a randomized, double-blind, crossover study

    Garfinkel, Doron; Zorin, Mariana; Wainstein, Julio; Matas, Zipora; Laudon, Moshe; Zisapel, Nava


    Background: Diabetes is a major comorbidity in insomnia patients. The efficacy and safety of prolonged-release melatonin 2 mg in the treatment of glucose, lipid metabolism, and sleep was studied in 36 type 2 diabetic patients with insomnia (11 men, 25 women, age 46–77 years). Methods: In a randomized, double-blind, crossover study, the subjects were treated for 3 weeks (period 1) with prolonged-release melatonin or placebo, followed by a one-week washout period, and then crossed over for anot...

  17. Interleukin-1 antagonists in the treatment of autoinflammatory syndromes, including cryopyrin-associated periodic syndrome

    Pierre Quartier


    Full Text Available Pierre QuartierUnité d'Immunologie-Hématologie et Rhumatologie pédiatriques, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, FranceAbstract: Cryopyrin-associated periodic syndrome (CAPS include a group of rare autoinflammatory disorders, the spectrum of which ranges from the mildest form, ie, familial cold autoinflammatory syndrome to more severe phenotypes, ie, Muckle-Wells syndrome, and chronic infantile neurological cutaneous and articular syndrome, also known as neonatal-onset multisystem inflammatory disease. Three interleukin (IL-1 antagonists have been tested in adults and children with CAPS, ie, anakinra, a recombinant homolog of the human IL-1 receptor antagonist; rilonacept, a fusion protein comprising the extracellular domains of IL-1 receptor I and the IL-1 adaptor protein, IL-1RAcP, attached to a human immunoglobulin G molecule; and canakinumab, the anti-IL-1β monoclonal antibody. Following rapid clinical development, rilonacept and canakinumab were approved by both the US Food and Drug Administration and the European Medicines Agency for use in adults and children. This review describes how the study of CAPS has helped us to understand better the way the innate immune system works, the pathogenesis of autoinflammatory syndromes, and the key role of IL-1. It also reviews the effects of IL-1 blockade in CAPS and other disorders, in particular systemic juvenile idiopathic arthritis, adult-onset Still's disease, and gout. Finally, this review covers some issues addressed by very recent and ongoing work regarding treatment indications, from orphan diseases to common disorders, continuous versus intermittent treatment, the pharmacokinetics, pharmacodynamics, and optimal dosages of the different drugs, as well as the need for Phase IV trials, exhaustive registries, and long-term follow-up of several patient cohorts.Keywords: inflammation, interleukin-1, cytokines, treatment

  18. Metabolic observations during the treatment of obese patients by periods of total starvation

    Riet, H.G. van; Schwarz, F.; Kinderen, P.J. der; Veeman, W.


    Ten very obese female patients were treated by periods of total starvation lasting 10 days each. In the interval between these starvation periods, a diet of 600 calories was given. Twenty-one periods were completed, 6 patients went through 3 periods each. The fasting was generally well tolerated; wi

  19. Metabolic observations during the treatment of obese patients by periods of total starvation

    Riet, H.G. van; Schwarz, F.; Kinderen, P.J. der; Veeman, W.


    Ten very obese female patients were treated by periods of total starvation lasting 10 days each. In the interval between these starvation periods, a diet of 600 calories was given. Twenty-one periods were completed, 6 patients went through 3 periods each. The fasting was generally well tolerated; wi

  20. [The prevalence, prevention and treatment of cattle epidemic during the Han-Tang Period].

    Han, Yi


    About 21 times of cattle epidemic with rather strong infectivity happened during the Han-Tang Period, including 6 in the Eastern Han Dynasty, 2 in the Jin Dynasty, 4 in the Southern and Northern Dynasties, 8 in the Tang Dynasty and 1in the Five Dynasty. Most of them were spread along the Yellow River and the northern region of the Huai River. The type of cattle epidemic included the acute cattle plague, cattle bovine mange, cattle yellow fever and cattle rotten hoof disease, etc. Its occurrence and prevalence brought a serious influentce on the society of the Han and Tang Dynasties, causing massive mortality of farm cattle, and then the shortage of animal power, and threatening the agriculture, which drew the attention of the governments, physicians, agriculturists, astrologists and Taoists. The medical measures and economic measures were adopted for the prevention and treatment of cattle epidemic. Especially, prescriptions in the books of medicine and agriculture exerted positive effects on the containment of cattle epidemic. On the other hand, its prevalence and the mass mortality of farm cattle, in a way, promoted, to certain extent, the improvement of the government's function of relief, the updating of the methods of agriculture and the creation of new farm tools, and being regarded as a main cause for the technological innovation of agriculture.

  1. Interleukin-1β inhibitors for the treatment of cryopyrin-associated periodic syndrome

    Eugen Dhimolea


    Full Text Available Eugen DhimoleaTufts University School of Medicine, Boston, MA, USAAbstract: Cryopyrin-associated periodic syndrome (CAPS comprises a group of rare, but severe, inherited autoinflammatory disorders associated with aberrant secretion of interleukin (IL-1. These distinct conditions of autoinflammatory origin include Muckle–Wells syndrome, familial cold autoinflammatory syndrome, and neonatal-onset multisystem inflammatory disease (NOMID, which is also referred to as chronic infantile neurologic cutaneous and articular syndrome. Recently, this group of diseases has been associated with mutations in the NLRP3 gene that encodes for the protein cryopyrin, a component of the inflammasome complex that regulates the maturation and secretion of inflammatory cytokine IL-1β. Immune cells from patients with NOMID secrete higher levels of active IL-1β compared with monocytes from healthy subjects. Overproduction of IL-1 is believed to promote aberrant inflammatory response in CAPS patients. Evidence supporting the clinical value of IL-1β in CAPS has been provided from the complete response of patients after treatment with IL-1 blocking agents.Keywords: CAPS, IL-1β, NLRP3, canakinumab, anakinra

  2. Theoretical treatment of the interaction between two-level atoms and periodic waveguides

    Zang, Xiaorun


    Light transport in periodic waveguides coupled to a two-level atom is investigated. By using optical Bloch equations and a photonic modal formalism, we derive semi-analytical expressions for the scattering matrix of one atom trapped in a periodic waveguide. The derivation is general, as the expressions hold for any periodic photonic or plasmonic waveguides. It provides a basic building block to study collective effects arising from photon-mediated multi-atom interactions in periodic waveguides.

  3. Sleep-stage sequencing of sleep-onset REM periods in MSLT predicts treatment response in patients with narcolepsy.

    Drakatos, Panagis; Patel, Kishankumar; Thakrar, Chiraag; Williams, Adrian J; Kent, Brian D; Leschziner, Guy D


    Current treatment recommendations for narcolepsy suggest that modafinil should be used as a first-line treatment ahead of conventional stimulants or sodium oxybate. In this study, performed in a tertiary sleep disorders centre, treatment responses were examined following these recommendations, and the ability of sleep-stage sequencing of sleep-onset rapid eye movement periods in the multiple sleep latency test to predict treatment response. Over a 3.5-year period, 255 patients were retrospectively identified in the authors' database as patients diagnosed with narcolepsy, type 1 (with cataplexy) or type 2 (without) using clinical and polysomnographic criteria. Eligible patients were examined in detail, sleep study data were abstracted and sleep-stage sequencing of sleep-onset rapid eye movement periods were analysed. Response to treatment was graded utilizing an internally developed scale. Seventy-five patients were included (39% males). Forty (53%) were diagnosed with type 1 narcolepsy with a mean follow-up of 2.37 ± 1.35 years. Ninety-seven percent of the patients were initially started on modafinil, and overall 59% reported complete response on the last follow-up. Twenty-nine patients (39%) had the sequence of sleep stage 1 or wake to rapid eye movement in all of their sleep-onset rapid eye movement periods, with most of these diagnosed as narcolepsy type 1 (72%). The presence of this specific sleep-stage sequence in all sleep-onset rapid eye movement periods was associated with worse treatment response (P = 0.0023). Sleep-stage sequence analysis of sleep-onset rapid eye movement periods in the multiple sleep latency test may aid the prediction of treatment response in narcoleptics and provide a useful prognostic tool in clinical practice, above and beyond their classification as narcolepsy type 1 or 2.

  4. Brain metastases in women with epithelial ovarian cancer: multimodal treatment including surgery or gamma-knife radiation is associated with prolonged survival.

    Niu, Xiaoyu; Rajanbabu, Anupama; Delisle, Megan; Peng, Feng; Vijaykumar, Dehannathuparambil K; Pavithran, Keechilattu; Feng, Yukuan; Lau, Susie; Gotlieb, Walter H; Press, Joshua Z


    To explore the impact of treatment modality on survival in patients with brain metastases from epithelial ovarian cancer. We conducted a retrospective review of cases of ovarian cancer with brain metastases treated at institutions in three countries (Canada, China, and India) and conducted a search for studies regarding brain metastases in ovarian cancer reporting survival related to treatment modality. Survival was analyzed according to treatment regimens involving (1) some form of surgical excision or gamma-knife radiation with or without other modalities, (2) other modalities without surgery or gamma-knife radiation, or (3) palliation only. Twelve patients (mean age 56 years) with detailed treatment/outcome data were included; five were from China, four from Canada, and three from India. Median time from diagnosis of ovarian cancer to brain metastasis was 19 months (range 10 to 37 months), and overall median survival time from diagnosis of ovarian cancer was 38 months (13 to 82 months). Median survival time from diagnosis of brain metastasis was 17 months (1 to 45 months). Among patients who had multimodal treatment including gamma-knife radiotherapy or surgical excision, the median survival time after the identification of brain metastasis was 25.6 months, compared with 6.0 months in patients whose treatment did not include this type of focused localized modality (P = 0.006). Analysis of 20 studies also indicated that use of gamma-knife radiotherapy and excisional surgery in multi-modal treatment resulted in improved median survival interval (25 months vs. 6.0 months, P gamma-knife radiotherapy and surgical excision.

  5. Napping and Human Functioning during Prolonged Work


    alternative to napping is prolonged wakefulness. Polyphasic sleep , with frequent naps rather than a single sleep period per 24 hours, is natural for both the...very young and for the aged. It is not practiced by most adults, perhaps because of societal demands. Possibly a polyphasic sleep schedule could be...Functioning 1.2 Scope of this Chapter 2. REVIEW OF LITERATURE 2.1 Partial Sleep Deprivation Studies 2.2 Nap Studies: Four Nap Factors Affecting Performance

  6. Successful treatment of anti-NMDA receptor encephalitis with a prompt ovarian tumour removal and prolonged course of plasmapheresis: A case report

    Rypulak, Elzbieta; Borys, Michal; Piwowarczyk, Pawel; Fijalkowska, Magdalena; Potrec, Beata; Sysiak, Justyna; Spustek, Janusz; Bartkowska-Sniatkowska, Alicja; Kotarski, Jan; Turski, Waldemar A.; Rejdak, Konrad; Czuczwar, Miroslaw


    Anti-N-methyl-d-aspartate-receptor (NMDAR) encephalitis is an uncommon autoimmune disorder with a wide spectrum of neuropsychiatric symptoms. There is a great requirement to emphasize the importance of a multidisciplinary team approach in the process of diagnosis and treatment of the potentially fatal condition, including psychiatrists, neurologists, gynaecologists and intensivists. Physicians must be aware that psychiatric and neurological disorders, which are typical features for NMDAR encephalitis in young women with ovarian tumours, may progress into status epilepticus and respiratory insufficiency. This disease can only be successfully treated with prompt surgical intervention and an early implementation of a wide array of immunosuppressive therapies. Optimal timing of initiation of therapeutic plasma exchange, as well as duration of treatment necessary to achieve desirable outcomes in patients with NMDAR remains unknown. The present case report aims to raise awareness about the importance of early implementation of this potentially life-saving therapy and continuing the treatment courses until full subsidence of symptoms. PMID:28101360

  7. Laryngotracheal Injury following Prolonged Endotracheal Intubation

    J. Mehdizadeh


    Full Text Available Background: Prolonged endotracheal intubation is a growing method for supporting ventilation in patients who require intensive care. Despite considerable advancement in endotracheal intubation, this method still has some complications; the most important is laryngo-tracheal injuries. Methods: Over a 2-year period, this retrospective study was conducted on 57 patients with history of prolonged intubation who were referred to the ENT Department of Amir Alam Hospital. For each patient, a complete evaluation including history, physical examination, and direct laryngoscopy and bronchoscopy was done under general anesthesia. Results: Fifty-seven patients (44 male; mean age, 23.014.7 years were studied. Mean intubation period was 15.88 days. The most common presenting symptom was dyspnea (62%. Head trauma was responsible for most cases of intubation (72.4%. The most common types of tracheal and laryngeal lesions were tracheal (56.9% and subglottic (55.2% stenosis, respectively. Mean length of tracheal stenosis was 0.810.83 cm. There was a statistically significant relationship between length of tracheal stenosis and intubation period (P=0.0001 but no relation was observed between tracheal stenosis and age, sex, and etiology of intubation (All P=NS. Among the glottic lesions, inter- arytenoids adhesion was the most common lesion (25.9%. No statistically significant relation was found between glottic and subglottic lesions and age, sex and intubation period (all P=NS. Length of stenosis and intubation period was significantly greater in tracheal/ subglottic lesions than those in glottic/ supraglottic lesions (all P=NS. Conclusion: After prolonged endotracheal intubation, laryngo-tracheal lesions had no relation with patient’s age, sex, and cause of intubation.There was direct relation between length of tracheal stenosis and intubation period. Glottic lesions were more commonly observed in head trauma patients. Lesion length and intubation

  8. [The statement of Polish Gynecological Society Experts on the treatment of acute vulvovaginal candidiasis with prolonged releasing 2% butoconazole nitrate vaginal cream--state of art in 2008].

    Expert Board of Polish Gynecological Society


    Vulvovaginal infection is the most common cause of gynecological problems in sexually active women. Knowledge about pharmacological properties of drugs used in treatment vulvovaginal candidiasis allows for tailoring therapy to each patient. 2% butoconazole nitrate vaginal cream is modern and up to date option for treatment of acute vulvovaginal candidiasis. Short- and long-term therapeutic efficacy of butoconazole vaginal cream was confirmed in numerous high reliability clinical trials. Good tolerance, high effectiveness of single therapeutic dose and high level of patient's acceptance gives the specialist powerful and efficient tool for management of VVC.

  9. Efficacy and safety of prolonged-release melatonin in insomnia patients with diabetes: a randomized, double-blind, crossover study

    Garfinkel D


    Full Text Available Doron Garfinkel1, Mariana Zorin2, Julio Wainstein2, Zipora Matas3, Moshe Laudon4, Nava Zisapel4,51Geriatric Palliative Department, Shoham Geriatric Medical Center, Pardes Hana, Israel; 2Diabetes Unit, 3Biochemistry Laboratory, The E Wolfson Medical Center, Holon, Israel; 4Neurim Pharmaceuticals Ltd, 5Department of Neurobiology, Tel Aviv University, Tel Aviv, IsraelBackground: Diabetes is a major comorbidity in insomnia patients. The efficacy and safety of prolonged-release melatonin 2 mg in the treatment of glucose, lipid metabolism, and sleep was studied in 36 type 2 diabetic patients with insomnia (11 men, 25 women, age 46–77 years.Methods: In a randomized, double-blind, crossover study, the subjects were treated for 3 weeks (period 1 with prolonged-release melatonin or placebo, followed by a one-week washout period, and then crossed over for another 3 weeks (period 2 of treatment with the other preparation. All tablets were taken 2 hours before bedtime for a period of 3 weeks. In an extension period of 5 months, prolonged-release melatonin was given nightly to all patients in an open-label design. Sleep was objectively monitored in a subgroup of 22 patients using wrist actigraphy. Fasting glucose, fructosamine, insulin, C-peptide, triglycerides, total cholesterol, high-density and low-density lipoprotein cholesterol, and some antioxidants, as well as glycosylated hemoglobin (HbA1c levels were measured at baseline and at the end of the study. All concomitant medications were continued throughout the study.Results: No significant changes in serum glucose, fructosamine, insulin, C-peptide, antioxidant levels or blood chemistry were observed after 3 weeks of prolonged-release melatonin treatment. Sleep efficiency, wake time after sleep onset, and number of awakenings improved significantly with prolonged-release melatonin as compared with placebo. Following 5 months of prolonged-release melatonin treatment, mean HbA1c (±standard deviation was

  10. Prolonged first-line PEG-asparaginase treatment in pediatric acute lymphoblastic leukemia in the NOPHO ALL2008 protocol-Pharmacokinetics and antibody formation

    Tram Henriksen, Louise; Gottschalk Højfeldt, Sofie; Schmiegelow, Kjeld


    NOPHO is Nordic Society of Paediatric Haematology and Oncology) were included. In the NOPHO ALL2008 protocol, patients are randomized to 8 or 15 doses of intramuscular PEG-asparaginase (Oncaspar(®) ) 1,000 IU/m²/dose, at 2-week or 6-week intervals with a total of 30-week treatment (Clinical trials...

  11. Cladribine prolongs progression-free survival and time to second treatment compared to fludarabine and high-dose chlorambucil in chronic lymphocytic leukemia.

    Mulligan, Stephen P; Karlsson, Karin; Strömberg, Mats; Jønsson, Viggo; Gill, Devinder; Hammerström, Jens; Hertzberg, Mark; McLennan, Roger; Uggla, Bertil; Norman, John; Wallvik, Jonas; Sundström, Gunnel; Johansson, Hemming; Brandberg, Yvonne; Liliemark, Jan; Juliusson, Gunnar


    We conducted a randomized phase III trial to compare the efficacy and safety of two purine analogs, cladribine and fludarabine, with high-dose chlorambucil, in patients with previously untreated chronic lymphocytic leukemia (CLL). Between 1997 and 2004, 223 patients with CLL were randomly assigned to cladribine, fludarabine or chlorambucil, for six cycles of therapy with frequent health-related quality of life assessments. There was no statistical difference for the primary endpoint of overall response with cladribine (70%), fludarabine (67%) and chlorambucil (59%), or complete remission (12%, 7% and 8%), respectively. However, the median progression-free survival (25, 10, 9 months) and median time to second treatment (40, 22, 21 months) were superior with cladribine. There was no significant difference in overall survival (96, 82 and 91 months), nor in toxicity or HRQoL assessments. Monotherapy with cladribine gives superior PFS and longer response duration than fludarabine and chlorambucil as first-line treatment of CLL.

  12. Use of antidepressants in the treatment of major depressive disorder in primary care during a period of economic crisis

    Sicras-Mainar A


    Full Text Available Antoni Sicras-Mainar,1 Ruth Navarro-Artieda2 1Research Unit, Badalona Serveis Assistencials SA, 2Medical Documentation Unit, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain Objective: To describe antidepressant (AD use in the treatment of major depressive disorder during a period of economic crisis.Patients and methods: This was a retrospective, observational study using population-based databases. Two periods were considered: 1 2008–2009, precrisis, and 2 2012–2013, economic crisis. Certain inclusion/exclusion criteria were taken into account for the study (initiation of AD treatment. Patients were followed up for 12 months. The main measures were use (defined daily doses, epidemiologic measures, strategies used and treatment persistence, referrals, and use of resources. Statistical significance was set at P<0.05.Results: In the precrisis period, 3,662 patients were enrolled, and 5,722 were enrolled in the period of economic crisis. Average age was 58.8 years and 65.4% were women. Comparing the two periods, major depressive disorder prevalence was 5.4% vs 8.1%, P<0.001. During the period of economic crisis, AD use rose by 35.2% and drug expenditures decreased by 38.7%. Defined daily dose per patient per day was 10.0 mg vs 13.5 mg, respectively, P<0.001. At 12-month follow-up, the majority of patients (60.8% discontinued the treatment or continued on the same medication as before, and in 23.3% a change of AD was made.Conclusion: Primary health care professionals are highly involved in the management of the illness; in addition, during the period of economic crisis, patients with major depressive disorder showed higher rates of prevalence of the illness, with increased use of AD drugs. Keywords: consumption, antidepressants, economic crisis

  13. Integrated MRSA-Management (IMM with prolonged decolonization treatment after hospital discharge is effective: a single centre, non-randomised open-label trial

    Bernhard Jahn


    Full Text Available Abstract Background Guidelines for the control of hospital-acquired MRSA include decolonization measures to end MRSA carrier status in colonized and infected patients. Successful decolonization typically requires up to 22 days of treatment, which is longer than the average hospital length of stay (LOS. Incomplete decolonization is therefore common, with long-term MRSA carriage as a consequence. To overcome this, we developed an integrated MRSA Management (IMM by extending MRSA decolonization to the outpatient and domestic setting. The protocol makes use of polyhexanide-based products, in view of reported qac-mediated resistance to chlorhexidine in S. aureus and MRSA. Methods This is a prospective, single centre, controlled, non-randomized, open-label study to evaluate the efficiency of the IMM concept. The outcome of guideline-approved decolonization during hospital stay only (control group; n = 201 was compared to the outcome following IMM treatment whereby decolonization was continued after discharge in the domestic setting or in a long-term care facility (study group; n = 99. As a secondary outcome, the effect of MRSA-status of skin alterations was assessed. Results The overall decolonization rate was 47 % in the IMM patient group compared to 12 % in the control group (p  0.05. For patients with skin alterations (e.g. wounds and entry sites, decolonization success was 50 % if the skin alterations were MRSA-negative at baseline, compared to 22 % success for patients entering the study with MRSA-positive skin alterations (p < 0.01. Conclusions The IMM strategy offers an MRSA decolonization protocol that is feasible in the domestic setting and is equally effective compared with inpatient decolonization treatment when hospital LOS is long enough to complete the treatment. Moreover, for patients with average LOS, decolonization rates obtained with IMM are significantly higher than for in-hospital treatment. IMM is a promising

  14. Withdrawal periods and tissue tolerance after intramammary antibiotic treatment of dairy goats with clinical mastitis

    J. Karzis; E.F. Donkin; I.M. Petzer


    The aim of this study was to determine withdrawal periods (WP) and tissue irritation after administration of three intramammary antibiotics [Curaclox LC (Norbrook (ARK AH)], Spectrazol Milking Cow (Schering-Plough AH) and Rilexine 200 LC [Logos Agvet (Virbac)] in goats with clinical mastitis.Withdrawal periods in goats with clinical mastitis treated with Curaclox LC, were not significantly different from those recommended for use in cows (72 h) with (67 h) or without (48 h) the 24 h man...

  15. Prolonged response to calling songs by the L3 auditory interneuron in female crickets (Acheta domesticus): possible roles in regulating phonotactic threshold and selectiveness for call carrier frequency.

    Bronsert, Michael; Bingol, Hilary; Atkins, Gordon; Stout, John


    L3, an auditory interneuron in the prothoracic ganglion of female crickets (Acheta domesticus) exhibited two kinds of responses to models of the male's calling song (CS): a previously described, phasically encoded immediate response; a more tonically encoded prolonged response. The onset of the prolonged response required 3-8 sec of stimulation to reach its maximum spiking rate and 6-20 sec to decay once the calling song ceased. It did not encode the syllables of the chirp. The prolonged response was sharply selective for the 4-5 kHz carrier frequency of the male's calling songs and its threshold tuning matched the threshold tuning of phonotaxis, while the immediate response of the same neuron was broadly tuned to a wide range of carrier frequencies. The thresholds for the prolonged response covaried with the changing phonotactic thresholds of 2- and 5-day-old females. Treatment of females with juvenile hormone reduced the thresholds for both phonotaxis and the prolonged response by equivalent amounts. Of the 3 types of responses to CSs provided by the ascending L1 and L3 auditory interneurons, the threshold for L3's prolonged response, on average, best matched the same females phonotactic threshold. The prolonged response was stimulated by inputs from both ears while L3's immediate response was driven only from its axon-ipsilateral ear. The prolonged response was not selective for either the CS's syllable period or chirp rate.

  16. Prolonged metformin treatment leads to reduced transcription of Nrf2 and neurotrophic factors without cognitive impairment in older C57BL/6J mice

    Allard, Joanne S.; Perez, Evelyn J; Fukui, Koji; Carpenter, Priscilla; Ingram, Donald K.; de Cabo, Rafael


    Long-term use of anti-diabetic agents has become commonplace as rates of obesity, metabolic syndrome and diabetes continue to escalate. Metformin, a commonly used anti-diabetic drug, has been shown to have many beneficial effects outside of its therapeutic regulation of glucose metabolism and insulin sensitivity. Studies on metformin’s effects on the central nervous system are limited and predominantly consist of in vitro studies and a few in vivo studies with short-term treatment in relatively young animals; some provide support for metformin as a neuroprotective agent while others show evidence that metformin may be deleterious to neuronal survival. In this study, we examined the effect of long-term metformin treatment on brain neurotrophins and cognition in aged male C57Bl/6 mice. Mice were fed control (C), high-fat (HF) or a high-fat diet supplemented with metformin (HFM) for 6 months. Metformin decreased body fat composition and attenuated declines in motor function induced by a HF diet. Performance in the Morris water maze test of hippocampal based memory function, showed that metformin prevented impairment of spatial reference memory associated with the HF diet. Quantitative RT-PCR on brain homogenates revealed decreased transcription of BDNF, NGF and NTF3; however protein levels were not altered. Metformin treatment also decreased expression of the antioxidant pathway regulator, Nrf2. The decrease in transcription of neurotrophic factors and Nrf2 with chronic metformin intake, cautions of the possibility that extended metformin use may alter brain biochemistry in a manner that creates a vulnerable brain environment and warrants further investigation. PMID:26698400

  17. Prolonged metformin treatment leads to reduced transcription of Nrf2 and neurotrophic factors without cognitive impairment in older C57BL/6J mice.

    Allard, Joanne S; Perez, Evelyn J; Fukui, Koji; Carpenter, Priscilla; Ingram, Donald K; de Cabo, Rafael


    Long-term use of anti-diabetic agents has become commonplace as rates of obesity, metabolic syndrome and diabetes continue to escalate. Metformin, a commonly used anti-diabetic drug, has been shown to have many beneficial effects outside of its therapeutic regulation of glucose metabolism and insulin sensitivity. Studies on metformin's effects on the central nervous system are limited and predominantly consist of in vitro studies and a few in vivo studies with short-term treatment in relatively young animals; some provide support for metformin as a neuroprotective agent while others show evidence that metformin may be deleterious to neuronal survival. In this study, we examined the effect of long-term metformin treatment on brain neurotrophins and cognition in aged male C57Bl/6 mice. Mice were fed control (C), high-fat (HF) or a high-fat diet supplemented with metformin (HFM) for 6 months. Metformin decreased body fat composition and attenuated declines in motor function induced by a HF diet. Performance in the Morris water maze test of hippocampal based memory function, showed that metformin prevented impairment of spatial reference memory associated with the HF diet. Quantitative RT-PCR on brain homogenates revealed decreased transcription of BDNF, NGF and NTF3; however protein levels were not altered. Metformin treatment also decreased expression of the antioxidant pathway regulator, Nrf2. The decrease in transcription of neurotrophic factors and Nrf2 with chronic metformin intake, cautions of the possibility that extended metformin use may alter brain biochemistry in a manner that creates a vulnerable brain environment and warrants further investigation.

  18. The Effectiveness of Life Skills Training on Enhancement of Self-Esteem and Marital Satisfaction among Addicts in Treatment Period

    R Nooripour


    Full Text Available Objective: This study has been done to determine the impact of life skills training on enhancement of self-esteem and marital satisfaction among addicts in treatment period. Method: The research design was semi experimental pretest-posttest with witness group. For each group 12men addicts in treatment period in Qazvin city were selected by available sampling. Rosenberg self-esteem and Enrich marital satisfaction questionnaires were administered among selected samples. Training workshop was conducted on role playing, questioning and answering which was taught by psychology professors in experimental group. Results: Results showed life skills training improved self-esteem and marital satisfaction of addicts in treatment period. Conclusion: Life skills training have a positive impact on self-esteem and marital satisfaction of individuals especially on addicts in treatment period, also life skills training in the field of smoking prevention enhances individuals’ skills (such as self-esteem, marital satisfaction, etc…. Life skills training empower person to actualize his knowledge, attitudes and values, and enable him to have motivation for healthy behavior which this will have significant impact on his relationship with his wife.

  19. Treatment of knee prosthesis infections: evaluation of 15 patients over a 5-year period.

    Kosters, K.; Crevel, R. van; Sturm, P.D.J.; Schreurs, B.W.; Waal Malefijt, M.C. de; Kampen, A. van; Kullberg, B.J.


    Our objective was to evaluate different treatment alternatives for total knee arthroplasty (TKA) infection and to compare outcomes depending on adherence to a current treatment algorithm. All patients treated for a first episode of TKA infection between January 2000 and July 2005 were included. Pati

  20. State estimation and optimal long period clinical treatment of HIV seropositive patients

    Juliana M. Grégio


    Full Text Available Optimal control theory provides a very interesting quantitative method that can be used to assist the decision making process in several areas of application, such as engineering, biology, economics and sociology. The main idea is to determine the values of the manipulated variables, such as drug doses, so that some cost function is minimized, subject to physical constraints. In this work, the cost function reflects the number of CD4+T cells, viral particles and the drug doses. It is worth noticing that high drug doses are related to more intense side-effects, apart from the impact on the actual cost of the treatment. In a previous paper by the authors, the LQR - Linear Quadratic Regulator approach was proposed for the computation of long period maintenance doses for the drugs, which turns out to be of state feedback form. However, it is not practical to determine all the components of the state vector, due to the fact that infected and uninfected CD4+T cells are not microscopically distinguishable. In order to overcome this difficulty, this work proposes the use of Extended Kalman Filter to estimate the state, even though, because of the nonlinear nature of the involved state equations, the separation principle may not be valid. Extensive simulations were then carried out to investigate numerically if the control strategy consisting of the feedback of estimated states yielded satisfactory clinical results.A teoria de controle ótimo apresenta um método quantitativo muito interessante que pode ajudar no processo de tomada de decisão em algumas áreas de aplicação, tais como engenharia, biologia, economia e sociologia. A principal idéia é determinar os valores das variáveis controladas, tais como doses de medicamentos, onde alguma função-custo é minimizada, sujeito às restrições físicas. Neste trabalho, a função-custo reflete o número de células CD4+T, partículas virais e doses de medicamentos. É fato que altas dosagens de

  1. Prolonged grief: setting the research agenda

    Rita Rosner


    Full Text Available Background: Prolonged grief disorder is proposed for the International Classification of Diseases (ICD-11, though it was rejected as a diagnosis for DSM-5. Objective: This review outlines findings and defines important areas for future research viewed from a lifespan perspective. Results: The development and psychometric evaluation of measures for the new diagnosis is paramount, specifically for children and adolescents. Treatments need to be adapted for specific subgroups and research findings have to be disseminated into various professional settings.

  2. Carotid Baroreflex Function During Prolonged Exercise

    Raven, P. B.


    Astronauts are often required to work (exercise) at moderate to high intensities for extended periods while performing extra-vehicular activities (EVA). Although the physiologic responses associated with prolonged exercise have been documented, the mechanisms involved in blood pressure regulation under these conditions have not yet been fully elucidated. An understanding of this issue is pertinent to the ability of humans to perform work in microgravity and complies with the emphasis of NASA's Space Physiology and Countermeasures Program. Prolonged exercise at a constant workload is know to result in a progressive decrease in mean arterial pressure (MAP) concomitant with a decrease in stroke volume and a compensatory increase in heart rate. The continuous decrease in MAP during the exercise, which is related to the thermoregulatory redistribution of circulating blood volume to the cutaneous circulation, raises the question as to whether there is a loss of baroreflex regulation of arterial blood pressure. We propose that with prolongation of the exercise to 60 minutes, progressive increases on central command reflect a progressive upward resetting of the carotid baroreflex (CBR) such that the operating point of the CBR is shifted to a pressure below the threshold of the reflex rendering it ineffectual in correcting the downward drift in MAP. In order to test this hypothesis, experiments have been designed to uncouple the global hemodynamic response to prolonged exercise from the central command mediated response via: (1) continuous maintenance of cardiac filling volume by intravenous infusion of a dextran solution; and (2) whole body surface cooling to counteract thermoregulatory cutaneous vasodialation. As the type of work (exercise) performed by astronauts is inherently arm and upper body dependent, we will also examine the physiologic responses to prolonged leg cycling and arm ergometry exercise in the supine positions with and without level lower body negative

  3. Prolonged efficacy of the 300IR 5-grass pollen tablet up to 2 years after treatment cessation, as measured by a recommended daily combined score

    Didier, Alain; Malling, Hans-Jørgen; Worm, Margitta


    BACKGROUND: The 300IR (index of reactivity) 5-grass pollen tablet has favorable short-term and sustained clinical efficacy in patients with grass pollen-induced allergic rhinoconjunctivitis (ARC). Here, we report maintenance of efficacy and safety over 2 years following treatment discontinuation....... METHODS: Randomized, double-blind, placebo-controlled, parallel-group, multicenter Phase 3 trial in patients aged 18-50 years with ARC. During study years 1-3, patients received a daily sublingual tablet containing either 300IR 5-grass pollen extract or placebo, according to a discontinuous pre...... medication score (DRMS). RESULTS: 633 patients with ARC were randomized to placebo (n = 219) or 300IR 5-grass pollen tablet, beginning 4 months (4 M, n = 207) or 2 months (2 M, n = 207) prior to the estimated start of the grass pollen season and continuing until season's end. During the first post...

  4. [Effects on the coagulation-fibrinolysis system of a single oral dose of mesoglycan at the beginning and at the end of a prolonged treatment in man].

    Blardi, P; Messa, G; Puccetti, L; La Placa, G; Ghezzi, A


    We evaluated the mesoglycan effects on the coagulative-fibrinolytic system in 10 patients with euglobulin lysis time (ELT) over 180 minutes. A mathematical model was used to analyze such phenomena. 100 mg of mesoglycan was administered to 10 patients for 14 days. The following parameters were evaluated: tissue plasminogen activator (t-PA), plasminogen activator inhibitor (PAI-1), euglobulin lysis time (ELT), plasminogen, alpha 2 antiplasmin, prothrombin time (PT), activated partial thromboplastin time (aPTT), thrombin clotting time (TCT), and fibrinogen. Those parameters were evaluated on the first and on the last day of the mesoglycan treatment at the following times: 0 (basal), 2, 4, 6, 8, 10 and 12 hours. Our results suggest that the mesoglycan is able to reduce a profibrinolytic activity without any influence on the coagulative-fibrinolytic system, at the baseline conditions and after chronic administration. The pharmacodynamic study and the statistical analysis using our mathematic model resulted to be statistically significant.

  5. The long-term effects of a life-prolonging heat treatment on the Drosophila melanogaster transcriptome suggest that heat shock proteins extend lifespan

    Sarup, Pernille Merete; Sørensen, Peter; Loeschcke, Volker


    -treated flies. Several hsp70 probe sets were up-regulated 1.7–2-fold in the mildly stressed flies weeks after the last heat treatment (P heat shock protein, Hsp70, is reported to return to normal levels of expression shortly after heat stress. We......Heat-induced hormesis, i.e. the beneficial effect of mild heat-induced stress, increases the average lifespan of many organisms. This effect, which depends on the heat shock factor, decreases the log mortality rate weeks after the stress has ceased. To identify candidate genes that mediate...... conclude that the heat shock response, and Hsp70 in particular, may be central to the heat-induced increase in the average lifespan in flies that are exposed to mild heat stress early in life....


    O. V. Nelyubina


    Full Text Available Velopharyngeal insufficiency is one of the main causes of speech disorders in children with congenital cleft palate, leading to social exclusion and disability of patients. This article describes an integrated approach to the treatment of velopharyngeal insufficiency, aimed in improving the anatomical and physiological function of velopharyngeal ring. Velopharyngeal ring is considered as the nervemuscle complex in the treatment of patients with this pathology. It is shown that a one-time complex treatment of velopharyngeal insufficiency, estimated with the program «Compare» in the below-described clinical example, increased velopharyngeal closure ring by 25%, thus eliminating nasality and significantly improve the quality of speech.

  7. Does the initiation of urate-lowering treatment during an acute gout attack prolong the current episode and precipitate recurrent attacks: a systematic literature review.

    Eminaga, Fatma; La-Crette, Jonathan; Jones, Adrian; Abhishek, A


    The aim of this study was to systematically review the literature on effect of initiating urate-lowering treatment (ULT) during an acute attack of gout on duration of index attack and persistence on ULT. OVID (Medline), EMBASE and AMED were searched to identify randomized controlled trials (RCTs) of ULT initiation during acute gout attack published in English language. Two reviewers appraised the study quality and extracted data independently. Standardized mean difference (SMD) and relative risk (RR) were used to pool continuous and categorical data. Meta-analysis was carried out using STATA version 14. A total of 537 studies were selected. A total of 487 titles and abstracts were reviewed after removing duplicates. Three RCTs were identified. There was evidence from two high-quality studies that early initiation of allopurinol did not increase pain severity at days 10-15 [SMDpooled (95 % CI) 0.18 (-0.58, 0.93)]. Data from three studies suggested that initiation of ULT during an acute attack of gout did not associate with dropouts [RRpooled (95 % CI) 1.16 (0.58, 2.31)]. There is moderate-quality evidence that the initiation of ULT during an acute attack of gout does not increase pain severity and risk of ULT discontinuation. Larger studies are required to confirm these findings so that patients with acute gout can be initiated on ULT with confidence.

  8. Characterization of persistent follicles induced by prolonged treatment with progesterone in dairy cows: an experimental model for the study of ovarian follicular cysts.

    Díaz, Pablo U; Stangaferro, Matías L; Gareis, Natalia C; Silvia, William J; Matiller, Valentina; Salvetti, Natalia R; Rey, Florencia; Barberis, Fabián; Cattaneo, Luciano; Ortega, Hugo H


    Cystic ovarian disease (COD) is a major factor contributing to poor reproductive efficiency of lactating dairy cows. The objective of the present study was to analyze the endocrine profile, growth dynamics, and histologic characteristics of persistent ovarian follicles-cysts developing in response to long-term administration of intermediate levels of progesterone. To this end, after synchronization of cows, a low dose of progesterone was administered for 5, 10, and 15 days after the expected day of ovulation in treated cows (groups P5, P10, and P15, respectively), using an intravaginal progesterone-releasing device. A significant increase in diameter was detected on Day 11 of progesterone treatment and thereafter (P Day 15 of persistence, the diameter of the persistent follicle reached a mean of 23 ± 0.6 mm. Microscopically, the persistent follicles had a complete granulosa, an intensely vascularized theca interna, and a collagenous theca externa layer. Temporal changes in the serum concentrations of estradiol, progesterone, and FSH were detected (effects of time, P days of persistence and declined (P days of persistence. The LH pulse concentration and pulse amplitude had a significant reduction (P Day 10 of follicular persistence (P Day 5 of follicular persistence, 17-hydroxyprogesterone showed a significant decrease at 5 days of follicular persistence in relation to proestrus, and testosterone showed a significant increase (P Day 5 of persistence through Day 15 of follicular persistence. Correlation between serum and follicular fluid steroid concentrations was significant for testosterone (P < 0.0001) and not significant for estradiol and progesterone. These findings indicate that ovarian cysts in COD are similar in many ways to the persistent follicles induced by progesterone, with an analogous hormonal and morphologic context, thus confirming a local role of subluteal levels of progesterone in COD pathogenesis and in the regulatory mechanisms of the ovarian

  9. Prescott tests of equality in binary data under a three-treatment three-period crossover design.

    Zhu, Lixia; Lui, Kung-Jong


    Three test procedures accounting for patients with tied responses based on Prescott's ideas are developed for comparing three treatments under a three-period crossover trial in binary data. Monte Carlo simulation is employed to evaluate the performance of these test procedures in a variety of situations. The test procedures proposed here are noted to have power larger than those procedures, which utilize only those patients with un-tied responses. The data taken from a three-period crossover trial comparing two different doses of an analgesic with placebo for the relief of primary dysmenorrhea are used to illustrate the use of the test procedures developed here.

  10. Effect of storage period and chemical treatment on sunflower parents lines seedling dry matter content

    Mrđa Jelena


    Full Text Available In modern agricultural production, high quality seed which germinates quickly and evenly in different environments is the main requirement for high yields. The research was carried out in the Laboratory for Seed Testing in Institute of Field and Vegetable Crops in Novi Sad. Two cytoplasmic male sterile lines L-1 and L-2 were used for the research. Seed treatments with fungicides (benomil, metalaxyl and fludioxonil and insecticides (tiametoxam and imidacloprid were applied to evaluate effects of chemical treatments and storage duration on seedlings dry matter content. This treated seed was kept in a storage facility where all commercial seed is stored. The first assessment was done after the treatments and had been repeated every three months. Analysis of variance of the tested parameters showed statistically significant effects of chemical treatments and storage duration on seedling dry matter content in L-1 line. In line L-2, statistically significant effect of chemical treatment on seedling dry matter content was observed, whereas the effect of storage duration on seedlings dry matter content was highly significant. Double interactions were highly significant. .

  11. Effect on epileptogenesis of carbamazepine treatment during the silent period of the pilocarpine model of epilepsy.

    Capella, H M; Lemos, T


    This study addresses the question of epileptogenesis by investigating the effects of carbamazepine (CBZ) on the silent period of the pilocarpine model of epilepsy. Adult Wistar rats were subjected to status epilepticus (SE) induced by pilocarpine and treated with CBZ or saline, i.p, during 56 days. Latency for the first spontaneous seizure, incidence, frequency, and duration of seizures were monitored for seizures and the hippocampal damage. CBZ did not abort the epileptogenesis but minimized the expression of seizures and hippocampal damage.

  12. A new treatment for some periodic Schr\\"{o}dinger operators II: the wavefunction

    He, Wei


    Following the approach of our previous paper we continue to study the asymptotic solution of periodic Schr\\"{o}dinger operators. Using the eigenvalues obtained earlier the corresponding asymptotic wavefunctions are derived. This gives further evidence in favor of the monodromy relations for the Floquet exponent proposed in the previous paper. In particular, the large energy asymptotic wavefunctions are related to the instanton partition function of N=2 supersymmetric gauge theory with surface operator. A relevant number theoretic dessert is appended.

  13. Withdrawal periods and tissue tolerance after intramammary antibiotic treatment of dairy goats with clinical mastitis

    J. Karzis


    Full Text Available The aim of this study was to determine withdrawal periods (WP and tissue irritation after administration of three intramammary antibiotics [Curaclox LC (Norbrook (ARK AH], Spectrazol Milking Cow (Schering-Plough AH and Rilexine 200 LC [Logos Agvet (Virbac] in goats with clinical mastitis.Withdrawal periods in goats with clinical mastitis treated with Curaclox LC, were not significantly different from those recommended for use in cows (72 h with (67 h or without (48 h the 24 h mandatory safety margin while Spectrazol caused a significantly longer withdrawal period (122 h than that recommended for use in cattle with (60 h and without (36 h the 24h safety margin. The withdrawal period of clinical mastitis cases treated with Rilexine 200 LC was 48 h compared to the 96 h recommended for use in cows.A linear model of regression with factors influencing the WP in goats with clinical mastitis was as follows : WP = 30.21 + 4.692 (sampling time + 22.11 (udder pathology - 13.6 (floccules - 0.00649 (milk yield.Somatic Cell Counts (SCC of milk from udder halves with clinical mastitis ranged from 7 053 x 103 to 7 948 x 103 cells per mℓ without isolations of bacteria and between 6 476 x 103 and 8 479 x 103 cells per mℓ with isolations of bacteria. Most of the variation in SCC could not be explained and the California Milk Cell Test (CMCT and SCC on their own were not reliable methods for mastitis diagnosis. However, CMCT and SCC were indicators of udder irritation. In goats without clinical mastitis, Spectrazol Milking Cow caused the least tissue irritation followed by Rilexine 200 LC and Curaclox LC. For goats with clinical mastitis, Rilexine 200 LC caused the least irritation, followed by Curaclox LC while Spectrazol Milking Cow caused the most irritation.

  14. Withdrawal periods and tissue tolerance after intramammary antibiotic treatment of dairy goats with clinical mastitis.

    Karzis, J; Donkin, E F; Petzer, I M


    The aim of this study was to determine withdrawal periods (WP) and tissue irritation after administration of three intramammary antibiotics [Curaclox LC (Norbrook (ARK AH)], Spectrazol Milking Cow (Schering-Plough AH) and Rilexine 200 LC [Logos Agvet (Virbac)] in goats with clinical mastitis. Withdrawal periods in goats with clinical mastitis treated with Curaclox LC, were not significantly different from those recommended for use in cows (72 h) with (67 h) or without (48 h) the 24 h mandatory safety margin while Spectrazol caused a significantly longer withdrawal period (122 h) than that recommended for use in cattle with (60 h) and without (36 h) the 24h safety margin. The withdrawal period of clinical mastitis cases treated with Rilexine 200 LC was 48 h compared to the 96 h recommended for use in cows. A linear model of regression with factors influencing the WP in goats with clinical mastitis was as follows: WP = 30.21 + 4.692 (sampling time) + 22.11 (udder pathology) - 13.6 (floccules) - 0.00649 (milk yield). Somatic Cell Counts (SCC) of milk from udder halves with clinical mastitis ranged from 7,053 x 10(3) to 7,948 x 10(3) cells per ml without isolations of bacteria and between 6,476 x 10(3) and 8,479 x 10(3) cells per ml with isolations of bacteria. Most of the variation in SCC could not be explained and the California Milk Cell Test (CMCT) and SCC on their own were not reliable methods for mastitis diagnosis. However, CMCT and SCC were indicators of udder irritation. In goats without clinical mastitis, Spectrazol Milking Cow caused the least tissue irritation followed by Rilexine 200 LC and Curaclox LC. For goats with clinical mastitis, Rilexine 200 LC caused the least irritation, followed by Curaclox LC while Spectrazol Milking Cow caused the most irritation.

  15. Undesirable financial effects of head and neck cancer radiotherapy during the initial treatment period

    Helen Egestad


    Full Text Available Background: Healthcare cost and reforms are at the forefront of international debates. One of the current discussion themes in oncology is whether and how patients’ life changes due to costs of cancer care. In Norway, the main part of the treatment costs is supported by general taxpayer revenues. Objectives: The objective of this study was to clarify whether head and neck cancer patients (n=67 in northern Norway experienced financial health-related quality of life (HRQOL deterioration due to costs associated with treatment. Design: HRQOL was examined by the European Organization for Research and Treatment of Cancer (EORTC QLQ-C30 in the beginning and in the end of radiation treatment in patients treated at the University Hospital in Northern Norway. Changes in financial HRQOL were calculated and compared by paired sample T-tests. Multiple regression analyses were used to examine correlations among gender, marital status, age and treatment with or without additional chemotherapy and changes in the HRQOL domain of financial difficulties. Results: The majority of score results at both time points were in the lower range (mean 15–25, indicating limited financial difficulties. We observed no statistically significant differences by gender, marital status and age. Increasing financial difficulties during treatment were reported by male patients and those younger than 65, that is, patients who were younger than retirement age. The largest effect was seen in singles. However, differences were not statistically significant. Conclusions: During the initial phase of the disease trajectory, no significant increase in financial difficulties was found. This is in line with the aims of the Norwegian public healthcare model. However, long-term longitudinal studies should be performed, especially with regard to the trends we observed in single, male and younger patients.

  16. Prolonged ulcerative laryngitis: a new disease entity.

    Hsiao, Tzu-Yu


    Over the last decade, a new disease entity, prolonged ulcerative laryngitis (PUL), with unique clinical presentation and prolonged disease course, has been recognized. Until now, very few studies dealing with this disease have been reported in the literature. From 1999 to 2008, we analyzed clinical data from a series of 39 PUL patients who were treated with an observational approach without implementing specific treatments. This disease affects adults, predominantly females. The age of patients in our series ranged from 26 to 76 years with a median of 49.5 years. This disease is characterized by ulcers and signs of acute inflammation on the membranous portion of the vocal folds with a prolonged clinical course. The recovery times of patients ranged from 4 to 20 weeks with an average of 9.4 weeks. The data in this study may reflect a natural history of this disease. PUL seems to be a self-limited disease, but the etiology of this disease is unknown. Specific infections or systemic inflammatory processes involving the larynx must be ruled out before diagnosis, and conservative treatments are suggested.

  17. Influence of temperature of the short-period heat treatment on mechanical properties of the NiTi alloy

    Jaroslav Čapek


    Full Text Available The equiatomic alloy of nickel and titanium, known as nitinol, possesses unique properties such as superelasticity, pseudoplasticity, shape memory, while maintaining good corrosion resistance and sufficient biocompatibility. Therefore it is used for production of various devices including surgery implants. Heat treatment of nickel-rich NiTi alloys can result in precipitation of nickel-rich phases, which strongly influence tensile and fatigue behaviour of the material.In this work we have studied influence of short-period heat treatment on tensile behaviour and fatigue life of the NiTi (50.9 at. % Ni wire intended for fabrication of surgery stents.

  18. Treatment for retinopathy of prematurity in Denmark in a ten-year period (1996-2005): Is the incidence increasing?

    Slidsborg, C.; Olesen, H.B.; Jensen, Peter Koch


    OBJECTIVE. The objective of this study was to analyze the population incidence of retinopathy of prematurity treatment in Denmark in the 10-year period from 1996 to 2005. METHODS. Patient charts of infants treated for retinopathy of prematurity and the national birth registry provide information...... about neonatal parameters. These parameters, along with birth in the latter half of the period (2001-2005), were analyzed as risk factors for retinopathy of prematurity. The national registry for blind and visually impaired children was accessed to obtain information about visual impairment attributable....... The incidence of treated retinopathy of prematurity cases increased significantly from 1.3% in 1996 to 2000 to 3.5% in 2001 to 2005. Significant risk factors for retinopathy of prematurity treatment were low gestational age, small for gestational age, male gender, and multiple birth. Other, yet unknown factors...

  19. Severe bradycardia and prolonged hypotension in ciguatera.

    Chan, Thomas Yan Keung


    Ciguatera results when ciguatoxin-contaminated coral reef fish from tropical or subtropical waters are consumed. The clinical features that present in affected persons are mainly gastrointestinal, neurological, general, and much less commonly, cardiovascular. We report the case of a 50-year-old man who developed the characteristic combination of acute gastrointestinal and neurological symptoms after the consumption of an unidentified coral reef fish head. In addition to those symptoms, he developed dizziness, severe bradycardia (46 bpm) and prolonged hypotension, which required the administration of intravenous atropine and over three days of intravenous fluid replacement with dopamine infusion. Patients with ciguatera can develop severe bradycardia and prolonged hypotension. Physicians should recognise the possible cardiovascular complications of ciguatera and promptly initiate treatment with intravenous atropine, intravenous fluid replacement and inotropic therapy if such complications are observed.

  20. Prolonged drought results in starvation of African elephant (Loxodonta africana)

    Wato, Yussuf A.; Heitkonig, Ignas; Wieren, van Sipke E.; Wahungu, Geoffrey; Prins, Herbert H.T.; Langevelde, van Frank


    Elephant inhabiting arid and semi-arid savannas often experience periods of drought, which, if prolonged, may cause mortality. During dry periods, elephant aggregate around water sources and deplete local forage availability. However, the relationships between adult elephant mortality and both hi

  1. Prolonged drought results in starvation of African elephant (Loxodonta africana)

    Wato, Yussuf A.; Heitkonig, Ignas; Wieren, van Sipke E.; Wahungu, Geoffrey; Prins, Herbert H.T.; Langevelde, van Frank


    Elephant inhabiting arid and semi-arid savannas often experience periods of drought, which, if prolonged, may cause mortality. During dry periods, elephant aggregate around water sources and deplete local forage availability. However, the relationships between adult elephant mortality and both

  2. Retention period after treatment of posterior crossbite with maxillary expansion: a systematic review

    Costa, Julia Garcia; Galindo, Thaís Magalhães; Mattos, Claudia Trindade; Cury-Saramago, Adriana de Alcantara


    ABSTRACT OBJECTIVE: The aim of this systematic review was to evaluate the duration of the retention period in growing patients undergoing maxillary expansion and its relation with posterior crossbite stability. METHODS: Search strategies were executed for electronic databases Cochrane Library, Web of Science, PubMed and Scopus, which were completed on January 15, 2016. The inclusion criteria included randomized, prospective or retrospective controlled trials in growing subjects with posterior crossbite; treated with maxillary expanders; retention phase after expansion; post-retention phase of at least 6 months. The exclusion criteria were anterior crossbite, craniofacial anomalies, surgery or another orthodontic intervention; case reports; author’s opinions articles, thesis, literature reviews and systematic reviews. The risk of bias of selected articles was assessed with Cochrane risk of bias tool for RCTs and Downs and Black checklist for non-RCTs. RESULTS: A total of 156 titles/abstracts was retrieved, 44 full-texts were examined, and 6 articles were selected and assessed for their methodological quality. The retention period after maxillary expansion ranged between 4 weeks and 16 months. Fixed (acrylic plate, Haas, Hyrax and quad-helix) or removable (Hawley and Hawley expander) appliances were used for retention. CONCLUSIONS: Six months of retention with either fixed or removable appliances seem to be enough to avoid relapse or to guarantee minimal changes in a short-term follow-up. PMID:28658354

  3. The role of screening, brief intervention, and referral to treatment in the perinatal period.

    Wright, Tricia E; Terplan, Mishka; Ondersma, Steven J; Boyce, Cheryl; Yonkers, Kimberly; Chang, Grace; Creanga, Andreea A


    Substance use during pregnancy is at least as common as many of the medical conditions screened for and managed during pregnancy. While harmful and costly, it is often ignored or managed poorly. Screening, brief intervention, and referral to treatment is an evidence-based approach to manage substance use. In September 2012, the US Centers for Disease Control and Prevention convened an Expert Meeting on Perinatal Illicit Drug Abuse to help address key issues around drug use in pregnancy in the United States. This article reflects the formal conclusions of the expert panel that discussed the use of screening, brief intervention, and referral to treatment during pregnancy. Screening for substance use during pregnancy should be universal. It allows stratification of women into zones of risk given their pattern of use. Low-risk women should receive brief advice, those classified as moderate risk should receive a brief intervention, whereas those who are high risk need referral to specialty care. A brief intervention is a patient-centered form of counseling using the principles of motivational interviewing. Screening, brief intervention, and referral to treatment has the potential to reduce the burden of substance use in pregnancy and should be integrated into prenatal care. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Cost of glaucoma treatment in a developing country over a 5-year period

    Lazcano-Gomez, Gabriel; Ramos-Cadena, María de los Angeles; Torres-Tamayo, Margarita; Hernandez de Oteyza, Alejandra; Turati-Acosta, Mauricio; Jimenez-Román, Jesús


    Abstract The aim of the study was to disclose a realistic estimate of primary open-angle glaucoma treatment, follow-up costs, and patients’ monthly glaucoma-economic burden in an ophthalmology hospital in Mexico City. Prospective survey of 462 primary open-angle glaucoma patients from 2007 to 2012 was carried out. Costs from visits, glaucoma follow-up studies, laser, and glaucoma surgical procedures were obtained from hospital pricings. Education, employment, and monthly income were interrogated. Total cost was divided into hypotensive treatment cost, nonpharmacologic treatment cost (laser and surgeries), and follow-up studies and consults. Average wholesale price for drugs analyzed was obtained from IMS Health data; monthly cost was calculated using: Monthly cost  = ([average wholesale price/number of drops per eye dropper] × number of daily applications) × 30 days. Patients were classified according to their glaucoma severity, and data were analyzed based on monthly income (average annual exchange rate: 12.85 Mexican pesos = 1 USD). The mean age was 70 ± 10 years, women = 81%, elementary school = 39%, and unemployed = 53%. Low-income group = 266 patients (57%), 146 with mild glaucoma; moderate-income group = 176 patients (38%), 81 with mild glaucoma; high-income group = 20 patients (4.3%), 10 with mild glaucoma. Patients’ monthly average economic burden in glaucoma treatment: low-income patients = 61.5%, moderate-income patients = 19.5%, and high-income patients = 7.9%. Glaucoma-economic burden is substantial not only for health systems, but for the family and the patient. Therefore, screening plans for earlier diagnosis, and health policies that lessen the cost of disease management and increase adherence to treatment, and reduce the prevalence of blindness attributed to glaucoma are essential. These would improve quality of life, reduce personal and national expenditure, and help increase national

  5. Vojta and Bobath combined treatment for high risk infants with brain damage at early period

    Chunyan Wu; Xiaohui Peng; Xuesong Li; Qingling Niu; Hong Guo; Huitao Huang


    BACKGROUND: In the process of early screening and interventions to high risk infants with brain damage,the occasion and choosing methods of interventions and the combined application of different interventions are still at the exploratory phase.OBJECTIVE: To observe the efficacy of early intervention using Vojta and Bobath combined treatment in high risk infants with brain damage, and investigate the effect of early rehabilitation on the prognosis.DESIGN: A randomized controlled comparative observation.SETTING: Daqing Oil Field General Hospital of Heilongjiang Province.PARTICIPANTS: Eighty-four high risk infants younger than 1 year were selected from the Department of Pediatrics, Daqing Oil Field General Hospital of Heilongjiang Province from October 2005 to October 2006,including 52 boys (62%) and 32 girls (38%). The treatment started at the age of 0 - 3 months in 11 cases (13%), 4 - 6 months in 28 cases (33%), 7 - 9 months in 35 cases (42%), and 10 - 12 months in 10 cases (12%). Infants with at least two of the followings were enrolled, including 7 Vojta abnormal postural reflexes,slow or disorder of motor development, increase of muscular tension, postural abnormality, primary reflection residual and CT/MRI abnormalities. Informed consents were obtained from their guardians. The 84 infants were randomly divided into treatment group (n =42) and control group (n =42).METHODS: All the children were intravenously injected with cerebroprotein hydrolysate injection or cattle encephalon glycoside and ignotin injection, 10 times as a course for 2 - 5 courses; Besides, the infants in the treatment group also received early rehabilitative training of Vojta and Bobath combined treatment, once a day, 40 minutes per time, 5 times a week followed by a 2-day rest, 1 month as a course, and totally 2 - 5 courses. The Vojta method was to facilitate the automatic regulation by reflexlocomotion. Bobath method was to inhibit abnormal posture but facilitate the normal one, thus it is

  6. A Case Report on Juvenile Neuromyelitis Optica: Early Onset, Long Remission Period, and Atypical Treatment Response.

    Elpers, Christiane; Gross, Catharina C; Fiedler, Barbara; Meuth, Sven G; Kurlemann, Gerhard


    Neuromyelitis optica (NMO) is a severe inflammatory demyelinating disease of the central nervous system and preferentially targets the optic nerves and spinal cord. NMO is rare in children and clinical course of the disease is highly variable as described in studies. Here, we present a case report of a young girl presenting with a rare course of pediatric NMO with an early disease onset at the age of 12 years, a relapse free interval of 4 years, evidence of NMO immunoglobulin G (IgG) and an unusual response against immunosuppressive therapy. The aim of this report is to highlight the potentially long remission period between relapses complicating proper diagnosis despite well defined diagnostic criteria. In addition, we want to encourage the use of rituximab in pediatric NMO, although larger cohorts are warranted to establish B cell depleting therapies in juvenile NMO.

  7. Survival of soil bacteria during prolonged desiccation.

    Chen, M.; Alexander, M.


    A determination was made of the kinds and numbers of bacteria surviving when two soils were maintained in the laboratory under dry conditions for more than half a year. Certain non-spore-forming bacteria were found to survive in the dry condition for long periods. A higher percentage of drought-tolerant than drought-sensitive bacteria was able to grow at low water activities. When they were grown in media with high salt concentrations, bacteria generally became more tolerant of prolonged drought and they persisted longer. The percent of cells in a bacterial population that remained viable when exposed to drought stress varied with the stage of growth.

  8. [Experience with treatment of chronic polypoid rhinosinusitis using low doses of clarithromycin in the postoperative period].

    Piskunov, G Z; Bobacheva, T Iu


    A total of 37 patients at the age from 25 to 65 years presenting with chronic polipoid rhinosinusitis (CPRS) were available for the observation. They were allocated to two groups based on the results of endoscopic polyposinusotomy. The patients in group 1 (n=18) were instructed at discharge from the clinic to take 250 mg of clarithromycin daily for 3 months in combination with the local application of a topical corticosteroid. The patients in group 2 (n=19) were prescribed topical corticosteroids alone. It was shown that clarithromycin at low doses caused significant stabilization of CPRS remission and prevented the development of relapses in the majority of the patients (66%). Therapy of CPRS with low doses of clarithromycin was associated with a significant decrease of the frequency of acute retroviral infections (ARVI). The intake of clarithromycin had no effect on the development and/or aggravation of intestinal dysbacteriosis nor did it provoke deviation of blood biochemical characteristics from the normal values both at the onset of therapy and after a follow-up period of 3 months.

  9. Dark Period Following UV-C Treatment Enhances Killing of Botrytis cinerea Conidia and Controls Gray Mold of Strawberries.

    Janisiewicz, Wojciech J; Takeda, Fumiomi; Glenn, D Michael; Camp, Mary J; Jurick, Wayne M


    Strawberries are available throughout the year either from production in the field or from high and low tunnel culture. Diversity of production conditions results in new challenges in controlling diseases before and after harvest. Fungicides have traditionally been used to control these diseases; however, their limitations necessitate a search for new approaches. We found that UV-C irradiation of Botrytis cinerea, a major pathogen of strawberry, can effectively kill this fungus if a dark period follows the treatment. The inclusion of a 4-h dark period resulted in almost complete kill of B. cinerea conidia on agar media at a dose of 12.36 J/m2. The UV-C dose did not cause a reduction in photosynthesis in strawberry leaves or discoloration of sepals, even after exposing plants repeatedly (twice a week) for 7 weeks. Although irradiation of dry conidia of B. cinerea with this dose resulted in some survival, the conidia were not infective and not able to cause decay even when inoculated onto a highly susceptible mature apple fruit. Irradiation of strawberry pollen at 12.36 J/m2 did not affect pollen germination, tube growth and length in vitro, or germination and tube growth in the style of hand-pollinated emasculated strawberry flowers. No negative effect of the UV-C treatment was observed on fruit yield and quality in high tunnel culture. In the fruit and flower petal inoculation tests, the UV-C treatment was highly effective in reducing fruit decay and petal infection. This UV-C treatment with an exposure time of 60 s may be useful in controlling gray mold in tunnel production of strawberries and may also have the potential for use in intensive field and indoor production of other fruits and vegetables providing that a 4-h dark period follows the irradiation.

  10. [Sideroblastic anemia after prolonged linezolid therapy].

    Kakimoto, Tsunayuki; Nakazato, Tomonori; Miura, Reiko; Kurai, Hanako; Yamashita, Daisuke; Sagara, Yuko; Ishida, Akaru


    Linezolid is an effective and well-tolerated antibiotic for the treatment of infections caused by Gram-positive pathogens. Some reports have shown that linezolid treatment for more than 2 weeks has been associated with reversible bone marrow suppression, especially thrombocytopenia and anemia. We encountered a case of sideroblastic anemia following prolonged linezolid therapy in a laryngeal cancer patient. He received linezolid therapy for multiple abscesses due to MRSA. Before treatment, the Hb level was 12.5 g/dl and then slowly decreased to 5.9 g/dl for 2 months during treatment. Ringed sideroblasts were detected in the bone marrow. Linezolid was discontinued and the Hb level was slowly increased. This case was considered to reflect a rare complication of linezolid therapy.

  11. Guidelines for the management and treatment of periodic fever syndromes familial Mediterranean fever.

    Terreri, Maria Teresa R A; Bernardo, Wanderley Marques; Len, Claudio Arnaldo; da Silva, Clovis Artur Almeida; de Magalhães, Cristina Medeiros Ribeiro; Sacchetti, Silvana B; Ferriani, Virgínia Paes Leme; Piotto, Daniela Gerent Petry; de Souza Cavalcanti, André; de Moraes, Ana Júlia Pantoja; Sztajnbok, Flavio Roberto; de Oliveira, Sheila Knupp Feitosa; Campos, Lucia Maria Arruda; Bandeira, Marcia; Santos, Flávia Patricia Sena Teixeira; Magalhães, Claudia Saad


    To establish guidelines based on scientific evidence for the management of familial Mediterranean fever. The Guideline was prepared from 5 clinical questions that were structured through PICO (Patient, Intervention or indicator, Comparison and Outcome), to search key primary scientific information databases. After defining the potential studies to support the recommendations, these were graduated considering their strength of evidence and grade of recommendation. 10,341 articles were retrieved and evaluated by title and abstract; from these, 46 articles were selected to support the recommendations. 1. The diagnosis of FMF is based on clinical manifestations, characterized by recurrent febrile episodes associated with abdominal pain, chest or arthritis of large joints. 2. FMF is a genetic disease presenting an autosomal recessive trait, caused by mutation in the MEFV gene. 3. Laboratory tests are not specific, demonstrating high serum levels of inflammatory proteins in the acute phase of the disease, but also often showing high levels even between attacks. SAA serum levels may be especially useful in monitoring the effectiveness of treatment. 4. The therapy of choice is colchicine; this drug has proven its effectiveness in preventing acute inflammatory episodes and progression toward amyloidosis in adults. 5. Based on the available information, the use of biological drugs appears to be an alternative for patients with FMF who do not respond or are intolerant to therapy with colchicine. Copyright © 2015 Elsevier Editora Ltda. All rights reserved.

  12. [Asthenic syndrome in clinical course of acute period of brain concussion during complex treatment using nootropic agents].

    Tkachov, A V


    The comparative analysis of a complex examination of 108 persons aged from 16 till 60 years in acute period of closed craniocerebral injury (CCCT) has been done. Every participants have been divided into 2 groups depending on a nootrop medication they receive in a complex treatment. A control group consisted of 30 practically healthy people. Objective examination by means of tests was done on the 1-st, 10-th that 30-th day of treatment. Patients of 1-st (37 persons) group received piracetam in complex treatment and patients of the 2-nd group (71 persons) pramistar. Patients of the first group received a base treatment (analgetics, tranquilizers, vitamins of group B, magnesium sulfate, diuretic preparations) as well as piracetam at dosage 0.2, two tablets three times per day. The Patients of the 2-nd group received a base treatment as well as pramistar at dosage 0.6, one tablet 2 times per day. Specially developed multiaspects scales and questionnaires, MRT of the brain and EEG have been used for objectification of patient, complaints. During a complex clinico-neuropsychological examination it was found that all cases of concussion of the brain are accompanied by those or other asthenic disorders.

  13. Are ECG monitoring recommendations before prescription of QT-prolonging drugs applied in daily practice?

    Warnier, Miriam Jacoba; Rutten, Frans Hendrik; Souverein, Patrick Cyriel


    PURPOSE: Monitoring of the QT duration by electrocardiography (ECG) prior to treatment is frequently recommended in the label of QT-prolonging drugs. It is, however, unknown how often general practitioners in daily clinical practice are adhering to these risk-minimization measures. We assessed...... the frequency of ECG measurements in patients where haloperidol was initiated in primary care. METHODS: Patients (≥18 years) with a first prescription of haloperidol in the UK Clinical Practice Research Datalink (2009-2013) were included. The proportion of ECGs made was determined in two blocks of 4 weeks......: during the exposure period when haloperidol was initiated, and during the control period, 1 year before. Conditional logistic regression analysis was applied to calculate the relative risk of having an ECG in the exposure period compared with the control period. Subgroup analyses were performed to assess...

  14. Prolonged unexplained fatigue in paediatrics

    Bakker, R.J.


    Prolonged Unexplained Fatigue in Paediatrics. Fatigue, as the result of mental or physical exertion, will disappear after rest, drinks and food. Fatigue as a symptom of illness will recover with the recovering of the illness. But when fatigue is ongoing for a long time, and not the result of exertio

  15. Prolongation structures for supersymmetric equations

    Roelofs, G.H.M.; Hijligenberg, van den N.W.


    The well known prolongation technique of Wahlquist and Estabrook (1975) for nonlinear evolution equations is generalized for supersymmetric equations and applied to the supersymmetric extension of the KdV equation of Manin-Radul. Using the theory of Kac-Moody Lie superalgebras, the explicit form of

  16. Prolonged parenteral nutrition after neonatal gastrointestinal surgery

    Estmann, Anne; Qvist, Niels; Husby, Steffen


    INTRODUCTION: Long-term treatment with parenteral nutrition (PN) may be essential for survival in infants after neonatal gastrointestinal surgery. It seemed well indicated in a population-based study to estimate the need for long-term PN and to characterize the infants that received TPN with regard...... to diagnosis and clinical course. METHODOLOGY: This study reviews the clinical course of infants with gastrointestinal disease (gastroschisis, intestinal atresia, omphalocele, volvulus, Hirschsprung's disease and necrotizing enterocolitis) with a prolonged need for parenteral nutrition in the Western part...

  17. Prolonged parenteral nutrition after neonatal gastrointestinal surgery

    Estmann, Anne; Qvist, Niels; Husby, Steffen


    INTRODUCTION: Long-term treatment with parenteral nutrition (PN) may be essential for survival in infants after neonatal gastrointestinal surgery. It seemed well indicated in a population-based study to estimate the need for long-term PN and to characterize the infants that received TPN with regard...... to diagnosis and clinical course. METHODOLOGY: This study reviews the clinical course of infants with gastrointestinal disease (gastroschisis, intestinal atresia, omphalocele, volvulus, Hirschsprung's disease and necrotizing enterocolitis) with a prolonged need for parenteral nutrition in the Western part...

  18. [Experience of systematization on the treatment of patients with upper jaws fractures, during the period 1991-2000].

    Khinkov, D


    A retrospecive analysis was done of the 128 patients with fractures in a upper jaw, treated during the period 1991-2000. The treatment of the patients with partial fractures in a alveolar part of maxilla and frontal wall of maxillary sinus, consist of debridement on the open wound, primery stiched and stabilization by arch bar of perspective teeth. In the cases with fractures of tuber maxilla and opening of maxillary sinus they tray to clouse it by Rhermann technique, with or without radical antrothomy by Caldwell-Luc technique. On the patients by total upper jaw fractures they try lead by princip of duble stage fixation: from one side-of intact upper bone structures and the other side-on a mandible. On the cases of upper jaw fractures, combine with barain traums. was treated conservativly - the specialize treatment of facial injures was postpoun until stabilization of brain status.

  19. The optimal period of Ca-EDTA treatment for parthenogenetic activation of porcine oocytes during maturation culture

    MORITA, Yasuhiro; TANIGUCHI, Masayasu; TANIHARA, Fuminori; ITO, Aya; NAMULA, Zhao; DO, Lanh Thi Kim; TAKAGI, Mitsuhiro; TAKEMOTO, Tatsuya; OTOI, Takeshige


    The changes triggered by sperm-induced activation of oocytes, which are required for normal oocyte development, can be mediated by other agents, thereby inducing the parthenogenesis. In this study, we exposed porcine oocytes to 1 mM Ca-EDTA, a metal-ion chelator, at various intervals during 48 hr of in vitro maturation to determine the optimum period of Ca-EDTA treatment for parthenogenetic activation. When the oocytes were cultured with or without Ca-EDTA from 36 hr (post-12), 24 hr (post-24), 12 hr (post-36) and 0 hr (post-48) after the start of maturation culture, the blastocyst formation rates were significantly higher (P<0.05) in the post-24, post-36 and post-48 groups (3.3%, 4.0% and 2.6%, respectively) than those in the control group without treatment (0%). Furthermore, when the oocytes were cultured with Ca-EDTA for 0 hr (control), 12 hr (pre-12), 24 hr (pre-24), 36 hr (pre-36) and 48 hr (pre-48) from the start of maturation culture, the oocytes formed blastocysts only in the pre-36 and pre-48 groups (0.4% or 0.8%, respectively). Pronuclei (<66.7%) were observed only when the periods of Ca-EDTA treatment were more than 12 hr during maturation culture. In the control group, no pronuclei were detected. Our findings demonstrate that porcine immature oocytes can be parthenogenetically activated by Ca-EDTA treatment for at least 24 hr to 36 hr during maturation culture, leading to pronucleus formation followed by the formation of blastocysts. PMID:26947170

  20. Impact of periodic health examination on surgical treatment for uterine fibroids in Beijing: a case-control study

    Yang Ling-Ling


    Full Text Available Abstract Background During the past 2 decades, there has been a rapid proliferation of "health examination center (HEC" across China. The effects of their services on public's health have not been systemically investigated. This study aimed to assess the impact of periodic health examination (PHE at HEC on surgical treatment for uterine fibroids in Beijing residents. Methods We identified 224 patients with a primary diagnosis of uterine fibroids who had surgical treatment at four Level-1 general hospitals in Beijing, from June 1, 2009 to October 20, 2009. Controls were women who did not have surgery for uterine fibroids, matched (1:1 ratio for age (within 2 years. A standard questionnaire was used to inquire about whether participants had PHE at HEC during the previous 2 years. Results PHE at HEC within 2 years were associated with surgical treatment for uterine fibroids. Odds ratios was 4.05 (95% CI, 2.61-6.29 P Conclusions Our study showed PHE currently provided at HEC in China were associated with significantly increased use of surgical treatment for uterine fibroids in women. Further studies are needed to assess the effects of PHE on clinical as well as on broad societal outcomes in Chinese in contemporary medical settings.

  1. Comparison between dopaminergic agents and physical exercise as treatment for periodic limb movements in patients with spinal cord injury.

    De Mello, M T; Esteves, A M; Tufik, S


    Randomized controlled trial of physical exercise and dopaminergic agonist in persons with spinal cord injury and periodic leg movement (PLM). The objective of the present study was to compare the effectiveness of physical exercise and of a dopaminergic agonist in reducing the frequency of PLM. Centro de Estudos em Psicobiologia e Exercício. Universidade Federal de São Paulo, Brazil. A total of 13 volunteers (mean age: 31.6+/-8.3 years) received L-DOPA (200 mg) and benserazide (50 mg) 1 h before sleeping time for 30 days and were then submitted to a physical exercise program on a manual bicycle ergometer for 45 days (3 times a week). Both L-DOPA administration (35.11-19.87 PLM/h, P<0.03) and physical exercise (35.11-18.53 PLM/h, P<0.012) significantly reduced PLM; however, no significant difference was observed between the two types of treatment. The two types of treatment were found to be effective in the reduction of PLM; however, physical exercise is indicated as the first treatment approach, while dopaminergic agonists or other drugs should only be recommended for patients who do not respond to this type of treatment.

  2. The Nursing Treatment of Mediastinal Disease in Surgery Period%纵隔疾病围手术期的护理



    目的:探讨纵隔疾病围手术期的护理对策。方法针对收治入院的30例纵隔肿瘤切除患者术前给予心理护理的临床资料进行分析。结果经过行外科手术治疗30例患者手术顺利,切口Ⅰ期愈合,无术后并发症的发生。结论严密的围手术期护理对提高手术成功率,减少术后并发症起到了重要作用,促进患者早日康复出院。%Objective Make a discussion on the nursery treatment of mediastinal disease in surgery period.MethodsAnalyzing the clinical data taken from 30 hospitalized patients who have received psychological care before they were operated with mediastinal cancer surgery.Results Having been operated surgery,30patients got satisfactory results and the wound were healed during first phrase and no complications occurred.Conclusion Strict nursery treatment and care in surgical period make significance in improving the surgical successful probabilities, decrease the occurrence of complications and aid patients with being into rehab.

  3. Homogenous UV/periodate process in treatment of p-nitrophenol aqueous solutions under mild operating conditions.

    Saien, Javad; Bazkiaei, Marzieh Fallah Vahed


    Aqueous solutions of p-nitrophenol (PNP) were treated with UV-activated potassium periodate (UV/KPI) in an efficient photo-reactor. Either periodate or UV alone had little effect; however, their combination led to a significant degradation and mineralization. The response surface methodology was employed for design of experiments and optimization. The optimum conditions for treatment of 30 mg/L of the substrate were determined as [KPI] = 386.3 mg/L, pH = 6.2 and T = 34.6°C, under which 79.5% degradation was achieved after 60 min. Use of 25 and 40 kHz ultrasound waves caused the degradation to enhance to 88.3% and 92.3%, respectively. The intermediates were identified by gas chromatography-mass spectroscopy analysis, leading to propose the reaction pathway. The presence of water conventional bicarbonate, chloride, sulfate and nitrate anions caused unfavorable effects in efficiency. Meanwhile, the kinetic study showed that PNP degradation follows a pseudo-first-order reaction and the activation energy was determined. The irradiation energy consumption required for one order of magnitude degradation was estimated as 11.18 kWh/m(3). Accordingly, comparison with the previously reported processes showed the superiority of PNP treatment with the employed process.

  4. Monitoring a Prison Opioid Treatment Program Over a Period of Change to Clinical Governance Arrangements, 2007-2013.

    Larney, Sarah; Lai, Wilson; Dolan, Kate; Zador, Deborah


    Opioid substitution therapy (OST) is an effective treatment for opioid dependence that is provided in many correctional settings, including New South Wales (NSW), Australia. In 2011, changes to the clinical governance of the NSW prison OST program were implemented, including a more comprehensive assessment, additional specialist nurses, and centralization of program management and planning. This study aimed to document the NSW prison OST program, and assess the impact of the enhanced clinical governance arrangements on retention in treatment until release, the provision of an OST prescription to patients at release, and presentation to a community OST clinic within 48 hours of release from custody. Data from the NSW prison OST program were obtained for the calendar years 2007-2013. Outcomes were analyzed quarterly using log binomial segmented regression. 8577 people were treated with OST in NSW correctional centers, 2007-2013. Over the entire study period, patients were retained in OST until release in 82% of treatment episodes; a prescription for OST was able to be arranged prior to release in 90% of releases; and patients presented to a community clinic within 48 hours of release in 94% of releases with prescriptions. Following the introduction of the changes to clinical governance, there was a significant increasing trend in retention in OST until release, and in provision of an OST prescription at release. There was an initial increase, followed by a decreasing trend, in presentation to a community clinic within 48 hours of release. This large prison-based OST program has high rates of retention in treatment and continuity of care as patients transition from custody to the community. Strengthened clinical governance arrangements were associated with increased retention in treatment until release and increased provision of an OST prescription at release, but did not improve clinic attendance following release from custody. Copyright © 2016 Elsevier Inc. All

  5. Prolonged fever after Infliximab infusion

    Jennifer; Katz; Michael; Frank


    Pharmacologic management for ulcerative colitis (UC) has recently been expanded to include antitumor necrosis factor (TNF) therapy for severe disease. Infliximab, a chimeric monoclonal antibody directed again TNF α was first tested in patients with Crohn’s disease. In addition to serious infections, malignancy, drug induced lupus and other autoimmune diseases, serum sickness-like reactions, neurological disease, and infusion reactions further complicate the use of Infliximab. We report a case of prolonged fever after Infliximab infusion to treat steroid refractory UC.

  6. Diagnosis, antenatal surveillance and management of prolonged pregnancy: current perspectives.

    Vitale, S G; Marilli, I; Rapisarda, A M; Iapichino, V; Stancanelli, F; Cianci, A


    Prolonged pregnancy is defined as a pregnancy that extends beyond 42 weeks of gestation (294 days) from the first day of the last normal menstrual period. An accurate estimation of the 'natural' incidence of prolonged pregnancy would require meticulous early pregnancy dating. The use of ultrasound to establish gestational age reduces the number of pregnancies that are classified as prolonged. Prolonged pregnancy is associated with an increased perinatal mortality and morbidity in pregnancies which appear to be otherwise low risk. Postterm births are easily preventable by intervening to deliver with the use of induction of labor. Thus, this potentially problematic condition deserves further attention and careful consideration. The focus of this article is to review and challenge some current concepts surrounding the diagnosis and management of prolonged pregnancy. We outline how to identify those women with prolonged pregnancy and which is the appropriate moment to start monitoring the fetal wellbeing. Finally we address the question of benefits and hazards of induction of labor strategies.

  7. Prolonged energy harvesting for ingestible devices.

    Nadeau, Phillip; El-Damak, Dina; Glettig, Dean; Kong, Yong Lin; Mo, Stacy; Cleveland, Cody; Booth, Lucas; Roxhed, Niclas; Langer, Robert; Chandrakasan, Anantha P; Traverso, Giovanni


    Ingestible electronics have revolutionized the standard of care for a variety of health conditions. Extending the capacity and safety of these devices, and reducing the costs of powering them, could enable broad deployment of prolonged monitoring systems for patients. Although prior biocompatible power harvesting systems for in vivo use have demonstrated short minute-long bursts of power from the stomach, not much is known about the capacity to power electronics in the longer term and throughout the gastrointestinal tract. Here, we report the design and operation of an energy-harvesting galvanic cell for continuous in vivo temperature sensing and wireless communication. The device delivered an average power of 0.23 μW per mm(2) of electrode area for an average of 6.1 days of temperature measurements in the gastrointestinal tract of pigs. This power-harvesting cell has the capacity to provide power for prolonged periods of time to the next generation of ingestible electronic devices located in the gastrointestinal tract.

  8. Restoration of physical performance capacity of athletes after prolonged restriction of their motor activity

    Soldatov, A. D.; Finogeyev, V. I.


    The effects of different regimens of treatment following prolonged hypokinesia were studied in order to determine the most effective program. The types of programs considered were passive means, consisting of physical therapy; active means, consisting of athletic training; and a combined program. In the first stage of the experiment, the effects of a 10 day period of hypokinesia were studied. It was determined that the restoration programs must address the problems of: (1) increasing defense function and general tone of the body; (2) restore orthostatic stability; and (3) increase general endurance. In later stages, groups of athletes and nonathletes underwent 30 day periods of hypokinesia. Restoration was carefully monitored for groups treated with the various regimens. It was determined that the most effective treatment was a comprehensive program of passive and active therapy.

  9. Apomorphine Penject – Emerging Evidence and Treatment Strategies for Delayed on and off Periods in Parkinson’s disease

    Olivier Rascol


    Full Text Available This educational symposium was held during the Joint Congress of European Neurology (EFNS–ENS, which took place from 31st May to 3rd June 2014 in Istanbul, Turkey, and was sponsored by Britannia Pharmaceuticals Limited. The symposium debated the problem of delayed ON and OFF periods in Parkinson’s disease that can occur even in patients optimised on oral medication. Emerging evidence for the rapid and effective resolution of such complications using apomorphine intermittent injection (penject was reviewed with particular reference to the positive results of the recent AM IMPAKT trial in patients with morning akinaesia. The discussions were illustrated with examples of ‘real life’ patient case studies to help determine which patients might be best suited for treatment with apomorphine injection.

  10. Comparison of the efficacy of dexmedetomidine and esmolol in the treatment of increased hemodynamic response during the recovery period

    Ayşe Neslihan Bebek


    Full Text Available Objectives: Our aim was to compare effectiveness of esmololand dexmedetomidine in the treatment of increasedhemodynamic response during anesthesia recovery period.Materials and methods: 60 ASA I-II patients whomscheduled for elective surgery with endotracheal intubationwere randomized before extubation according to theirhemodynamic parameters that were increased 20% oftheir baseline values in order to receive 1mg/kg esmolol(Group Esmolol, n= 30 or 0.5 μg/kg dexmedetomidine(Group Dexmedetomidine, n= 30. Heart rate (HR, systolicand diastolic blood pressures (SBP,DBP, peripheral oxygensaturation (SpO2, end tidal carbon dioxide (ETCO2values, extubation time, recovery time were recorded. Theduration till having pain requiring analgesic was recordedand cognitive functions were evaluated with short memoryorientation concentration test at 20th and 50th minutes.Results: After drug, HR reductions were significant at allperiods in group Dexmedetomidine (Z2-Z10: p<0.001,Z11:p=0.001, Z12, p=0.006. In group DexmedetomidineSBP value was high at 3rd min after drug (p<0.001, andSBP values were lower in all periods before and after extubation(Z6- Z10: p<0.001, Z11: p=0.02, Z12: p=0.04.In group Dexmedetomidine DBP value was higher at 1stmin after drug (p=0.001, DBP values were lower at 10thmin after drug and before extubation (p= 0.045, p=0.001.The duration of pain requiring analgesic and recoveryperiod were longer in dexmedetomidine group (p<0.001,p<0.001.Conclusions: Although esmolol and dexmedetotimidineattenuated hemodynamic response during recovery period,dexmedetotimidine was more effective in hemodynamicstabilization and the duration of pain requiring analgesicwas longer. Esmolol provided faster recovery time. JClin Exp Invest 2012; 3(1: 53-60

  11. Tumor necrosis factor receptor-associated periodic syndrome (TRAPS): definition, semiology, prognosis, pathogenesis, treatment, and place relative to other periodic joint diseases.

    Masson, Charles; Simon, Virginie; Hoppé, Emmanuel; Insalaco, Paolo; Cissé, Idrissa; Audran, Maurice


    Tumor necrosis factor receptor-associated periodic syndrome (TRAPS) is an autosomal dominant inherited condition of periodic fever and pain. Most patients are of northern European descent. The attacks manifest as fever and pain in the joints, abdomen, muscles, skin, or eyes, with variations across patients. An acute-phase response occurs during the attacks. Patients with TRAPS are at risk for AA amyloidosis, the most common targets being the kidneys and liver. Soluble TNFRSF1A is usually low between the attacks and may be normal during the attacks, when TNF levels are high. TNFRSF1A is found in abnormally high numbers on leukocyte cell membranes. TRAPS is the first condition for which naturally occurring mutations in a TNF receptor were found; the mutations affect the soluble TNFRSF1A gene in the 12p13 region. In some patients, the pathogenesis involves defective TNFRSF1A shedding from cell membranes in response to a given stimulus. Thus, TRAPS is a model for a novel pathogenic concept characterized by failure to shed a cytokine receptor. This review compares TRAPS to other inherited periodic febrile conditions, namely, familial Mediterranean fever, Muckle-Wells syndrome, cold urticaria, and hyper-IgD syndrome. The place of TRAPS relative to other intermittent systemic joint diseases is discussed. Colchicine neither relieves nor prevents the attacks, whereas oral glucocorticoid therapy is effective when used in dosages greater than 20 mg/day. The pathogenic hypothesis involving defective TNFRSF1A shedding suggests that medications targeting TNF may be effective in TRAPS.

  12. The influence of dry matter, applied heat treatment and storage period on the viscosity of stirred yogurt

    Denin-Đurđević Jelena D.


    Full Text Available Skim milk powder reconstituted to 8.44% TS, 9.65% TS and 10.84% TS respectively was used for investigation. Untreated milk and milk heat treated at 85ºC/20 min and 90ºC/10 min, respectively, were used for the investigation. Milk was inoculated with 2.5% of yogurt culture (containing Lactobacillus delbrueckii subsp. bulgaricus and Streptococcus thermophilus in the ratio 1:1 at 43ºC. Samples were incubated until pH 4.6 was reached. Samples were immediately cooled to 4ºC and held at that temperature during 14 days. Acid casein gel was stirred after 1, 7 and 14 days of storage. Measurements were done at 30 rpm during 2 min, at 20ºC. According to the investigation, it could be concluded that both applied heat treatment and dry matter content influence viscosity of stirred yogurt. Viscosity increases when dry matter content increases. The smallest viscosity had yogurt produced from untreated milk with 8.44% TS, while samples produced from milk with 10.84% TS had the highest viscosity. Applied heat treatments had significant influence on viscosity of yogurt gained by stirring of acid casein gels after 7 and 14 days of storage. Stirred yogurt produced from milk heat treated at 90ºC/10 min had a higher viscosity than samples produced from milk heat treated at 85ºC/20 min. Storage period influenced average viscosity of stirred yogurt. Samples of stirred yogurt produced from milk with 8.44% TS showed a decrease of average viscosity during storage regardless of the applied heat treatment of milk. The highest average viscosity had samples produced from milk with 10.84% TS.

  13. Patient preference with respect to QoL and reduction in opioid-induced constipation (OIC) after treatment with prolonged-release (PR) oxycodone/naloxone compared with previous analgesic therapy [PREFER study].

    van Dongen, V C P C; Vanelderen, P J L; Koopmans-Klein, G; van Megen, Y J B; Van Zundert, J; Huygen, F J P M


    The aim of this study was to assess patient preference in terms of quality of life (QoL), analgesia and bowel function for patients with moderate to severe chronic non-malignant pain, when treated with oxycodone PR/naloxone PR compared with the previous WHO-step I and/or WHO-step II analgesic treatment . This was a 3-week open-label phase 3b study conducted in Belgium and the Netherlands, after 3 weeks patients could enter an extension phase. Patient preference with respect to QoL for oxycodone PR/naloxone PR treatment compared with previous WHO-step I and/or WHO-step II analgesics was assessed. A patient was considered a responder with respect to QoL if this assessment was 'better' or 'much better' compared with previous WHO-step I or II analgesics at any time point. Response rate with respect to QoL was 59.2% (95% CI: 51.7-66.8%) for the Full Analysis (FA)-population, for the Per Protocol-population response rate was 71.7% (95% CI: 63.1-80.3%). Explorative analysis showed that response rate with respect to QoL was highest in constipated patients pretreated with WHO-step II analgesics (73.8%). Mean ± SD pain score in the FA-population at start was 74.7 ± 16.6 decreasing to 53.9 ± 24.3 after a median (range) treatment period of 173.5 (31-771) days. For constipated subjects the significant reduction in constipation [improvement of the Bowel Function Index (BFI)], was -24.8 points (95% CI: -17.1 to -32.5). BFI for non-constipated subjects remained well below 28.8. Adverse events with oxycodone PR/naloxone PR treatment were well-known opioid-related adverse events. This study shows that the studied patients previously treated with WHO-step I and/or WHO-step II analgesics prefer treatment with oxycodone PR/naloxone PR with respect to QoL. Moreover, the study shows that treatment with oxycodone PR/naloxone PR significantly reduces OIC in constipated patients and that non-constipated patients do not develop OIC during treatment with oxycodone PR/naloxone PR.

  14. Multifactorial QT Interval Prolongation and Takotsubo Cardiomyopathy

    Michael Gysel


    Full Text Available A 71-year-old woman collapsed while working as a grocery store cashier. CPR was performed and an AED revealed torsades de pointes (TdP. She was subsequently defibrillated resulting in restoration of sinus rhythm with a QTc interval of 544 msec. Further evaluation revealed a diagnosis of Takotsubo Cardiomyopathy (TCM contributing to the development of a multifactorial acquired long QT syndrome (LQTS. The case highlights the role of TCM as a cause of LQTS in the setting of multiple risk factors including old age, female gender, hypokalemia, and treatment with QT prolonging medications. It also highlights the multifactorial nature of acquired LQTS and lends support to growing evidence of an association with TCM.

  15. Examining potential contraindications for prolonged exposure therapy for PTSD

    Minnen, A. van; Harned, M.S.; Zöllner, L.; Mills, K.


    Although prolonged exposure (PE) has received the most empirical support of any treatment for posttraumatic stress disorder (PTSD), clinicians are often hesitant to use PE due to beliefs that it is contraindicated for many patients with PTSD. This is especially true for PTSD patients with comorbid p

  16. Simultaneous biohydrogen production and wastewater treatment in biofilm configured anaerobic periodic discontinuous batch reactor using distillery wastewater

    Venkata Mohan, S.; Mohanakrishna, G.; Ramanaiah, S.V.; Sarma, P.N. [Bioengineering and Environmental Centre, Indian Institute of Chemical Technology, Hyderabad 500007 (India)


    Biohydrogen (H{sub 2}) production with simultaneous wastewater treatment was studied in anaerobic sequencing batch biofilm reactor (AnSBBR) using distillery wastewater as substrate at two operating pH values. Selectively enriched anaerobic mixed consortia sequentially pretreated with repeated heat-shock (100{sup o}C; 2 h) and acid (pH -3.0; 24 h) methods, was used as parent inoculum to startup the bioreactor. The reactor was operated at ambient temperature (28{+-}2 {sup circle} C) with detention time of 24 h in periodic discontinuous batch mode. Experimental data showed the feasibility of hydrogen production along with substrate degradation with distillery wastewater as substrate. The performance of the reactor was found to be dependent on the operating pH. Adopted acidophilic microenvironment (pH 6.0) favored H{sub 2} production (H{sub 2} production rate - 26 mmol H{sub 2}/day; specific H{sub 2} production - 6.98 mol H{sub 2}/kg COD{sub R}-day) over neutral microenvironment (H{sub 2} production rate - 7 mmol H{sub 2}/day; specific H{sub 2} production - 1.63 mol H{sub 2}/kg COD{sub R}-day). However, COD removal efficiency was found to be effective in operated neutral microenvironment (pH 7 - 69.68%; pH 6.0 - 56.25%). The described process documented the dual benefit of renewable energy generation in the form of H{sub 2} with simultaneous wastewater treatment utilizing it as substrate. (author)

  17. Intramammary antibiotics in dairy goats : effect of stage of lactation, parity and milk volume on withdrawal periods, and the effect of treatment on milk compositional quality

    J. Karzis


    Full Text Available The length of the antibiotic withdrawal period after intramammary treatment was influenced by the milk yield of dairy goats during this trial. Shorter withdrawal periods were seen in relatively high yielding dairy goats (production above 1.5 ℓ per day compared to low producers (less than 1.3 ℓ per day. High yielding goats treated with Curaclox LC (Norbrook [Pharmacia AH] had a withdrawal period of 42 h, while low yielding goats, treated with the same product, had a withdrawal period of 74 h. The recommended withdrawal period for Curaclox LC for use in cattle is 72 h. Relatively high yielding goats treated with Rilexine 200 LC (Logos Agvet [Virbac] had a significantly shorter withdrawal period (37 h than that recommended for use in cattle (96 h. Low yielding goats treated with Spectrazol Milking Cow (Schering-Plough Animal Health had a significantly longer (95 h withdrawal period than that recommended for use in cattle (60 h. Withdrawal periods were also influenced by stage of lactation and parity. There was a moderate positive correlation between lactation number and withdrawal period, as measured by TRIS (R2 = 0.621, and a moderate negative correlation between stage of lactation and withdrawal period (R2 = -0.669. In Trials 1, 2 and 3 combined there was a moderate negative correlation between withdrawal period and volume (R2 = -0.511 and a strong positive correlation between withdrawal period and lactation number (R2 = 0.720. The differences in percentage milk fat, protein and lactose before, during and after treatment were not statistically significant except in Trial 3 (Curaclox LC and Rilexine 200 LC where protein and lactose differed significantly. In Trial 2 (Spectrazol Milking Cow milk fat percentages differed significantly between treatment and control groups as did protein percentages in Trial 3. These differences are however, not biologically meaningful.

  18. Effect of germination periods and hydrothermal treatments on in vitro protein and starch digestibility of germinated legumes.

    Uppal, Veny; Bains, Kiran


    Germination of legumes followed by hydrothermal treatments is an effective mean of improving nutritive value of legumes. The protein content of mungbean, chickpea and cowpea increased by 9-11, 11-16 and 8-11% after germination. A significant (p ≤ 0.05) decrease in protein content was observed on pressure cooking and microwaving in all three legumes. The carbohydrates decreased by 1 to 3% during soaking and 2 to 6% during germination. A significant (p ≤ 0.05) improvement in in vitro protein digestibility (IVPD) was observed after soaking as well as after three germination periods. Germination resulted in an increase in IVPD from 15 to 25% in mungbean, 6 to 17% in chickpea and 6 to 17% in cowpea. A significant (p ≤ 0.05) increase in IVPD was observed when raw sprouts of three legumes were subjected to pressure cooking and microwaving. In vitro starch digestibility (IVSD) increased significantly (p ≤ 0.05) after germination, the percent increase being 8 to 12% in mungbean, 9 to 11% in chickpea and 10 to 13% in cowpea. The duration of germination had significant (p ≤ 0.05) effect on IVSD. A significant (p ≤ 0.05) improvement in IVSD was observed when legume sprouts were subjected to pressure cooking and microwave cooking.

  19. Electrocardiographic corrected QT interval prolongation and its risk factors in patients with clozapine treatment%氯氮平治疗相关心电图校正QT间期延长及其危险因素

    吕建宝; 张向阳; 李娟; 杨甫德


    目的:调查精神分裂症患者在氯氮平治疗期间心电图校正QT间期(corrected QT interval,QTc)的变化及其相关因素。方法收集使用氯氮平治疗的210例精神分裂症患者,检测心肌酶等生化指标,检查心电图,按Bazett’s公式计算QTc间期,并以桡动脉搏动次数作为心率。结果 QTc间期延长发生率15.24%,女性QTc间期延长发生率高于男性(29.23%vs.8.98%),差异有统计学意义(P0.05)。多因素线性回归分析示,心率与QTc间期有关联(β=0.719,标准化β=0.691,P=0.027)。结论精神分裂症患者在氯氮平治疗期间QTc间期延长发生率高,心率快可能是其危险因素。%Objective To investigate risk factors of corrected QT (QTc) interval prolongation in schizophrenia pa-tients treated with clozapine. Methods Two hundred and ten schizophrenia patients treated with clozapine were included in the study. Measurement of myocardial enzymes and electrocardiography were performed to determine QTc interval. QTc interval was calculated according to Bazett’s formula. Results QTc prolongation prevalence rate was 15.24%, The QTc prolongation prevalence rate was higher in female than in male (29.23%vs. 8.98%, P0.05). Multi-factors linear regression analysis showed that heart rate was related with QTc interval (β=0.719, standardizedβ=0.691, P=0.027). Conclusions QTc interval prolonga-tion prevalence rate is high in patients treated with clozapine. And increased heart rate might be risk factor of QTc inter-val prolongation.

  20. QT prolongation in a child with thyroid storm

    Albert, Benjamin B; Eckersley, Luke Gerard; Skinner, Jonathan Robert; Jefferies, Craig


    Summary A 12-year-old girl presented with an acute confusional state and a 2-year history of weight loss, anxiety, agitation and recurrent fever. Thyroid function tests confirmed severe hyperthyroidism, and a diagnosis of thyroid storm was made (Burch and Wartofsky score=75). ECG showed a prolonged QTc interval of 506 ms. Acute treatment for thyroid storm consisted of Lugol's iodine, prednisolone, carbimazole and propranolol. She made a steady recovery and by 3 months her thyroid function had normalised; a repeat ECG showed a QTc within the normal range (430 ms). There was no relevant family history. This is a case of QTc prolongation with hyperthyroidism and normalisation with euthyroidism. It is not commonly recognised that hyperthyroidism in children may be associated with QTc prolongation. QTc measurement should be incorporated into management protocols for hyperthyroidism. PMID:24729112

  1. Disseminated Mycobacterium celatum disease with prolonged pulmonary involvement

    Patsche, Cecilie Blenstrup; Svensson, Erik; Wejse, Christian


    Mycobacterium celatum is a rare cause of human infection, causing disseminated disease in immunosuppressed individuals. Infections localized to the lungs and the lymph nodes have also been reported in immunocompetent individuals. The existing literature on the subject is limited as are experience....... The treatment regimen was changed to azithromycin, ciprofloxacin, and pyrazinamide and the treatment duration was prolonged to a total of 24 months, with good effect....

  2. Prolonged morphine administration alters protein expression in the rat myocardium

    Drastichova Zdenka; Skrabalova Jitka; Neckar Jan; Kolar Frantisek; Novotny Jiri


    Abstract Background Morphine is used in clinical practice as a highly effective painkiller as well as the drug of choice for treatment of certain heart diseases. However, there is lack of information about its effect on protein expression in the heart. Therefore, here we aimed to identify the presumed alterations in rat myocardial protein levels after prolonged morphine treatment. Methods Morphine was administered to adult male Wistar rats in high doses (10 mg/kg per day) for 10 days. Protein...

  3. Prolonged blockade of the brachial plexus for the early rehabilitation of children with posttraumatic elbow contractures

    D. V. Zabolotsky


    Full Text Available Objective. Improvement of surgical treatment outcomes in children with post-traumatic elbow contractures. Materials and methods. The study is based on the diagnostic findings of 48 children with post-traumatic elbow contractures who were treated at the Turner Scientific and Research Institute for Children’s Orthopedics. All children underwent complex rehabilitation after reconstructive intra-articular surgery to work out passive motions in the elbow using ARTROMOT-E2 device. The patients of the study group started rehabilitation in the first days after reconstructive intra-articular surgery in the background of prolonged blockade of the brachial plexus. In the control group, the rehabilitation was carried out traditionally on the 6th day after surgery without regional anesthesia. The patients of the study group were supplied with Contiplex SU perinural catheters for prolonged blockade of the brachial plexus using ultrasound (Edge SonoSite and neurostimulation (Stimuplex® HNS12 before surgery. For perioperative blockade of the brachial plexus we used intermittent injection of 0.5% ropivacaine (2 mg / kg. The severity of pain at the stages of rehabilitation was assessed using 10-point grading scale (FPS-R. The range of active and passive motions in the joints was evaluated by measuring the range of motions with a fleximeter. Results. Intermittent injection of ropivacaine before rehabilitation allowed to correct post-traumatic elbow contractures in children in the first days after surgery associated with the minimum subjective pain level and stable hemodynamic parameteres, accompanied with a significant increase of the elbow motion range in comparison with the group of the patients who were not performed regional anesthesia . Conclusion. Prolonged blockade of the brachial plexus in rehabilitation treatment of children with post-traumatic contractures provides appropriate analgesic and myoneural block components from the 1st day after intra

  4. Prolonged QT interval in Rett syndrome


    Rett syndrome is a severe neurodevelopmental disorder of unknown aetiology. A prolonged QT interval has been described previously in patients with Rett syndrome. To investigate QT prolongation and the presence of cardiac tachyarrhythmias in Rett syndrome electrocardiography and 24 hour Holter monitoring were performed prospectively in a cohort of 34 girls with Rett syndrome. The corrected QT value was prolonged in nine patients. Compared with a group of healthy controls of a...

  5. Ingrown toenails (unguis incarnatus): Nail braces/bracing treatment

    Chiriac, Anca; Solovan, Caius


    Nail bracing is a safe, simple, and inexpensive treatment option that avoids surgery, requires no anesthetic, requires no recovery period, allows wearing the existing shoes, offers immediate relief from pain, and allows the practice of daily activities. Braces can be used for prolonged periods of times. If recurrence occurs, reapplication of bracing is usually required. PMID:24688206

  6. 恩替卡韦治疗失代偿期乙型肝炎肝硬化的效果观察%Clinical observation of entecavir for the treatment of decompensation period of hepatitis B cirrhosis

    葛亮; 林宾; 田瑞; 胡爱华


    ,Child-Pugh score,adverse reactions,and so on. Results In treatment group,HBV DNA quantitative improvement was not only better than that of before treatment (P0.05);Child-Pugh score was better than the control group (P<0.05),and there was no significant adverse reactions. Conclusion The application of entecavir for the treatment of decompensation period of hepatitis B cirrhosis can obviously improve the patient's liver function,prolong patients' survival, improve the patient's quality of life,the effect is much ideal.

  7. Surgical treatment of partial atrioventricular septal defect: functional analysis of the mitral valve in the postoperative period

    Josué Viana Castro Neto


    Full Text Available OBJECTIVE: To study mitral valve function in the postoperative period after correction of the partial form of atrioventricular septal defect. METHODS: Fifty patients underwent surgical correction of the partial form of atrioventricular septal defect. Their mean age was 11.8 years and 62% of the patients were males. Preoperative echocardiography showed moderate and severe mitral insufficiency in 44% of the patients. The mitral valve cleft was sutured in 45 (90% patients (group II - GII. Echocardiographies were performed in the early postoperative period, and 6 and 12 months after hospital discharge. RESULTS: The patients who had some type of arrhythmia in the postoperative period had ostium primum atrial septal defect of a larger size (2.74 x 2.08 cm. All 5 patients in group I (GI, who did not undergo closure of the cleft, had a competent mitral valve or mild mitral insufficiency in the preoperative period. One of these patients began to have moderate mitral insufficiency in the postoperative period. On the other hand, in GII, 88.8% and 82.2% of the patients had competent mitral valve or mild mitral insufficiency in the early and late postoperative periods, respectively. CONCLUSION: The mitral valve cleft was repaired in 90% of cases. Echocardiography revealed competent mitral valve or mild mitral insufficiency in 88.8% and 82.2% of GII patients in the early and late postoperative periods, respectively.

  8. Prolonged Pregnancy: Methods, Causal Determinants and Outcome

    Olesen, Annette Wind

    Summary Prolonged pregnancy, defined as a pregnancy with a gestational length of 294 days or more, is a frequent condition. It is associated with an increased risk of fetal and maternal complications. Little is known about the aetiology of prolonged pregnancy. The aims of the thesis were 1...

  9. Prenatal risk indicators of a prolonged pregnancy

    Olesen, Annette Wind; Westergaard, Jes Grabow; Olsen, Jørn


    BACKGROUND: Few prenatal risk factors of prolonged pregnancy, a pregnancy of 42 weeks or more, are known. The objective was to examine whether sociodemographic, reproductive, toxicologic, or medical health conditions were associated with the risk of prolonged pregnancy. METHODS: Data from the Dan...

  10. Secular, Spiritual and religious Existential concerns during final diagnostics and treatment period – The lived experiences of women undergoing ovarian cancer surgery

    Hounsgaard, Lise; Seibæk, L.; Hvidt, N. C.


    Introduction. This paper deals with secular, spiritual, and religious existential concerns during severe illness. Materials and Methods. Qualitative research interviews were made before and after surgery with women who underwent final diagnostics, surgery, and chemotherapy for ovarian cancer...... a woman with ovarian cancer during her first treatment period. Although the women experienced their health to be seriously threatened, they also felt hope, will, and courage. The diagnostic procedures and treatment had comprehensive impact on their lives. However, hope and spirituality were important...

  11. Discussion of treatment of older rheumatoid arthritis through “prolonged illness enters into venation”%试从"久病入络"探讨老年类风湿关节炎的治疗

    熊志强; 马健


    从"久病入络"学说出发,结合老年类风湿关节炎的发病特点及临床症状,探讨血瘀与老年类风湿关节炎病因病机的相关性,进而讨论活血通络法在老年类风湿关节炎治疗中的价值.%Through “prolonged illness enters into venation” theory,combining the pathogenic characteristics and clinical symptoms of elderly rheumatoid arthritis,it was discussed that the relevancy of blood stasis and elderly rheumatoid arthritis pathogenesis,and discuss the therapy of promoting blood circulation to dredge collaterals in older rheumatoid arthritis in therapeutic value.

  12. Changes in fecal microbiota and metabolomics in a child with juvenile idiopathic arthritis (JIA) responding to two treatment periods with exclusive enteral nutrition (EEN).

    Berntson, Lillemor; Agback, Peter; Dicksved, Johan


    The microbiome and immune system of the digestive tract are highly important in both health and disease. Exclusive enteral nutrition (EEN) is a common anti-inflammatory treatment in children with Crohn's disease in the European countries, and the mechanism is most likely linked to changes in the intestinal microbiome. In the present study, EEN was given in two treatment periods several months apart to a patient with very severe, disabling juvenile idiopathic arthritis (JIA), with a remarkable clinical response as the result. The aim of the present study was to study how the EEN treatment influenced the microbiome and metabolome of this patient. Fecal samples from before, during, and between treatments with EEN were studied. The microbiome was analyzed by sequencing of 16S rRNA amplicons using Illumina MiSeq, and the metabolome was analyzed using nuclear magnetic resonance. The microbiome changed markedly from treatment with EEN, with a strong reduction of the Bacteroidetes phylum. Metabolic profiles showed clear differences before, during, and between treatment with EEN, where butyrate, propionate, and acetate followed a cyclic pattern with the lowest levels at the end of each treatment period. This patient with JIA showed remarkable clinical improvement after EEN treatment, and we found corresponding changes in both the fecal microbiome and the metabolome. Further studies are needed to explore the pathophysiological role of the intestinal canal in children with JIA.

  13. Clinical Observation of Recombinant Human Vascular Endostatin Durative Transfusion Combined with Window Period Arterial Infusion Chemotherapy in the Treatment of 
Advanced Lung Squamous Carcinoma

    Yuan LV


    Full Text Available Background and objective Lung cancer is one of the most common malignant tumors in China. The aim of this study is to observe the efficacy and safety of recombinant human vascular endostatin (endostar durative transfusion combined with window period arterial infusion chemotherapy in the treatment of advanced lung squamous carcinoma. Methods From February 2014 to January 2015, 10 cases of the cytological or histological pathology diagnosed stage IIIb - stage IV lung squamous carcinoma were treated with recombinant human vascular endostatin (30 mg/d durative transfusion combined with window period arterial infusion chemotherapy. Over the same period of 10 cases stage IIIb - stage IV lung squamous carcinoma patients for pure arterial perfusion chemotherapy were compared. Recombinant human vascular endostatin was durative transfused every 24 hours for 7 days in combination group, and in the 4th day of window period, the 10 patients were received artery infusion chemotherapy, using docetaxel combined with cisplatin. Pure treatment group received the same arterial perfusion chemotherapy regimen. 4 weeks was a cycle. 4 weeks after 2 cycles, to evaluate the short-term effects and the adverse drug reactions. Results 2 groups of patients were received 2 cycles treatments. The response rate (RR was 70.0%, and the disease control rate (DCR was 90.0% in the combination group; In the pure treatment group were 50.0%, 70.0% respectively, there were no statistically significant difference (P=0.650, 0.582. The adverse reactions of the treatment were mild, including level 1-2 of gastrointestinal reaction and blood toxicity, there were no statistically significant difference (P=0.999, P=0.628. In the combination group, 1 patient occurred level 1 of cardiac toxicity. Conclusion Recombinant human vascular endostatin durative transfusion combined with window period arterial infusion chemotherapy in the treatment of advanced lung squamous carcinoma could take a

  14. Decreased strongyle egg re-appearance period after treatment with ivermectin and moxidectin in horses in Belgium, Italy and The Netherlands

    Geurden, Thomas; van Doorn, Deborah; Claerebout, Edwin; Kooyman, Frans; De Keersmaecker, Sofie; Vercruysse, Jozef; Besognet, Bruno; Vanimisetti, Bindu; di Regalbono, Antonio Frangipane; Beraldo, Paola; Di Cesare, Angela; Traversa, Donato


    The objective of the present study was to evaluate the efficacy of an oral treatment with ivermectin (IVM) or moxidectin (MOX) against gastro-intestinal strongyles in naturally infected horses by performing a faecal egg count reduction test (FECRT) and by monitoring the egg reappearance period (ERP)

  15. 3种处理方式对冬枣货架期品质的影响%Effects of Different Treatments on Storage Quality of Dongzao Jujube Fruits during Shelf-life Period

    武杰; 张引成; 李梅玲; 钱金


    In order to prolong the shelf life of Dongzao jujube fruits,the effects of three treatments were studied.Through the determination of respiration intensity,firmness,total soluble solids,vitamin C,ethylene release amount and ethanol production,effects of hot-water treatment,1-MCP and nano-package on the storage quality of Dongzao jujube fruits were studied during the shelf-life period.The results showed that all treatments could keep the storage quality of Dongzao jujube in some degree during the shelf-life period.The nano-package revealed the best effect on maintaining firmness,vitamin C content and fruit color,increasing total soluble solid amount,and inhibiting respiration rate,ethylene release amount and ethanol production.Therefore,nano-package could extend the shelf life of Dongzao jujube fruits up to 15 days.%以冬枣为试材,研究3种处理方式对其货架期品质的影响。通过测定冬枣的呼吸强度、硬度、总可溶性固形物、VC、乙烯释放量、乙醇积累等指标,研究热水浸泡、1-MCP熏蒸、纳米袋包装3种处理对冬枣果实的保鲜效果。结果表明:3种处理方法均不同程度保持了枣果货架期品质,其中纳米袋包装保鲜效果最佳,有效维持了冬枣果肉硬度和VC含量,延缓其色泽由绿到红的转变和总可溶性固形物上升,抑制了冬枣的呼吸强度及乙烯和乙醇的产生,货架期15d后,仍具有商品价值。

  16. 高压氧治疗各期糖尿病足间歇性跛行的疗效观察%Hyperbaric Oxygen Treatment of Diabetic Foot Every Period Curative Effect Observation of Intermittent Claudication



    Objective To observe patients with hyperbaric oxygen treatment of diabetic foot every period of intermittent claudication.Methods Select 26 patients with diabetic foot, no burst but plantar skin dark purple 0 grade diabetic foot 7 cases, the foot has burst 19 cases, observation on foot pain. ResultsAfter hyperbaric oxygen therapy group, on foot pain signiifcantly prolong time data to compare the two groups have statistical signiifcance (P< 0.05). Ankle brachial index (ABI) and local skin temperature is improved. Blood glucose significantly lower after treatment. Ulcer healing in 11 cases, remaining signiifcant reduction, 8 cases of ulcer surface can avoid amputation. Resting at night sex signiifcantly reduce pain, show the sleep quality improved.Conclusion Hyperbaric oxygen treatment of diabetic foot every period all can obtain satisfactory curative effect.%目的:观测高压氧治疗各期糖尿病足患者间歇性跛行的疗效。方法选取糖尿病足患者26例,无破溃但足趾皮肤暗紫色的0级糖尿病足7例,足部破溃19例,观察步行引起疼痛的时间。结果经过高压氧治疗组,步行引起疼痛的时间明显延长,两组数据比较有统计学意义,P<0.05。踝肱指数(ABI)及局部皮温有所改善。治疗后血糖下降明显。溃疡面愈合11例,剩余8例溃疡面明显缩小,可以避免截肢。夜间静息性疼痛明显减轻,表现为睡眠质量改善。结论高压氧治疗各期糖尿病足均可获得满意疗效。

  17. Short-day treatment during the growing period limits shoot growth and increases frost hardiness of hybrid aspen plants in the nursery

    Zhang Gang; Jaana Luoranen; Heikki Smolander


    In Finland, under nursery conditions hybrid aspen may continue their shoot growth until early September. Thus,frost hardening is usually delayed. To solve this problem, We used a three-week period of short-day (SD) treatment between late July and mid-August. During autumn after frost exposure,frost hardiness (FH) Was assessed three times with a stem-browning test. The resuits showed that after SD treatment shoot growth ceased and FH increased when compared to untreated hybrid aspen. Furthermore,the height of SD-treated hybrid aspen varied much less than that of the control plants. We conclude that SD treatment in the nursery during the growing period can be used as a supplementary method for producing well-hardened and uniform hybrid aspen plants.

  18. Prolonged cholestasis and ductopenia associated with tenoxicam.

    Trak-Smayra, Viviane; Cazals-Hatem, Dominique; Asselah, Tarik; Duchatelle, Veronique; Degott, Claude


    Cholestatic liver diseases leading to progressive destruction of intra-hepatic bile ducts and ductopenia encompass multiple etiologies. Pathophysiology and natural history of drug-induced cholangiopathies remain unclear. We report a case of prolonged ductopenia attributed to Tenoxicam (Tilcotil o--a non-steroidal anti-inflammatory drug of the oxicam family) ingested at therapeutic dose. A 36 year-old male patient was admitted for jaundice and Lyell syndrome starting 1 week after the ingestion of Tenoxicam. Liver biopsy showed cholestasis, non-suppurative cholangitis and polymorphous inflammatory infiltrate of the portal tracts (round cells, macrophages an eosinophils). Treatment with ursodesoxycholic acid and cholestyramine was instituted and the patient was asymptomatic 1 year after. Three years later mild biological cholestasis persisted and ductopenia was evidenced on liver biopsy. In this report we found that: (1) The toxicity of tenoxicam was probably mediated by an immunoallergic mechanism (Lyell syndrome and eosinophils on histology); (2) ductopenia was secondary to inflammatory cholangitis. Factors responsible for this chronic evolution are still unknown (genetic predisposition, vascular factors, etc.); and (3) the presence of ductopenia contrasted with the "clinical recovery" of the disease suggesting accessory bile drainage by cholangioles or partial reconstruction of the biliary tree.

  19. [Prospective study of patients with prolonged fever].

    Calderón, E; Legorreta, J; Sztabinski, G; Hernández, M; Wilkins, A; Gómez, D; Dávila, A


    A prospective study was made in 283 patients who attended IMAN's Children's Hospital, with fever the main symptom. A clinical and paraclinical procedure was designed for the study of each patient. 112 patients were eliminated because they did not follow the established criteria. All patients had acute infectious diseases considered trivial; 85% were 3 weeks to 2 years of age. They all had an antibacterial treatment without precise diagnosis. It was considered that on admission the patients showed a normal course in the natural history of the basic disease. The study group included 171 patients 2 months to 13 years of age; 62.5% had fever due to infection, 12.2% to collagenopathies, 7% to neoplasias 5.2% to miscellaneous causes and 12.8% were not diagnosed. The most common infectious causes for prolonged fever were tuberculosis, upper respiratory infections, amoebic liver abscess, typhoid fever and malaria. Careful questioning and clinical examination were enough to enlighten diagnosis in more than 80% of the patients.

  20. Risk Factors of Prolonged Hospitalization in Patients with Hyperemesis Gravidarum

    Hasan Onur Topcu


    Conclusion: Number of vomiting per day and maternal serum TSH levels could help physicians to estimate the risk of prolonged hospitalization; however further investigations are needed in large population studies. Identifying the high risk patients is important both for prevention of HEG and beginning appropriate antiemetic treatment to avoid complications to reduce the economic costs. [Cukurova Med J 2015; 40(1.000: 113-118

  1. High-Dose Glycine Treatment of Refractory Obsessive-Compulsive Disorder and Body Dysmorphic Disorder in a 5-Year Period

    W. Louis Cleveland


    Full Text Available This paper describes an individual who was diagnosed with obsessive-compulsive disorder (OCD and body dysmorphic disorder (BDD at age 17 when education was discontinued. By age 19, he was housebound without social contacts except for parents. Adequate trials of three selective serotonin reuptake inhibitors, two with atypical neuroleptics, were ineffective. Major exacerbations following ear infections involving Group A -hemolytic streptococcus at ages 19 and 20 led to intravenous immune globulin therapy, which was also ineffective. At age 22, another severe exacerbation followed antibiotic treatment for H. pylori. This led to a hypothesis that postulates deficient signal transduction by the N-methyl-D-aspartate receptor (NMDAR. Treatment with glycine, an NMDAR coagonist, over 5 years led to robust reduction of OCD/BDD signs and symptoms except for partial relapses during treatment cessation. Education and social life were resumed and evidence suggests improved cognition. Our findings motivate further study of glycine treatment of OCD and BDD.

  2. Reversal of prolonged isoniazid-induced coma by pyridoxine.

    Brent, J; Vo, N; Kulig, K; Rumack, B H


    Isoniazid overdose is known to result in the rapid onset of seizures, metabolic acidosis, and prolonged obtundation. Pyridoxine has been reported to be effective in treating isoniazid-induced seizures. We report three cases of obtundation secondary to isoniazid overdose that was immediately reversed by intravenous pyridoxine. In two of these cases, status seizures were stopped by intravenous pyridoxine administration, but the patients remained comatose for prolonged periods. The comas were immediately reversed by the administration of additional pyridoxine. In the third case, the patient's lethargy was treated by intravenous pyridoxine on presentation and was followed by immediate awakening. Pyridoxine is effective in treating not only isoniazid-induced seizures, but also the mental status changes associated with this overdose. The dose required to induce awakening may be higher than that required to control seizures.

  3. Estimating long-term effects of treatment from placebo-controlled trials with an extension period, using virtual twins.

    Vittinghoff, Eric; McCulloch, Charles E; Woo, Claudine; Cummings, Steven R


    The best information about the benefits of long-term treatment is obtained from a long-term placebo-controlled trial. However, once efficacy has been demonstrated in relatively brief trials, it may not be possible to conduct long-term placebo-controlled trials, for ethical or practical reasons. This paper presents a method for estimating long-term effects of a treatment from a placebo-controlled trial in which some participants originally randomized to active-treatment volunteer to continue on treatment during an extension study, but follow-up of participants originally assigned to placebo ends with the trial, or they are crossed over to active treatment during the extension. We propose using data from the trial to project the outcomes for a 'virtual twin' for each active-treatment volunteer under the counterfactual placebo condition, and using bootstrap methods for inference. The proposed method is validated using simulation, and applied to data from the Fracture Intervention Trial and its extension, FLEX.

  4. Effectiveness of prolonged use of continuous passive motion (CPM, as an adjunct to physiotherapy, after total knee arthroplasty

    Geesink Ruud JT


    Full Text Available Abstract Background Adequate and intensive rehabilitation is an important requirement for successful total knee arthroplasty. Although research suggests that Continuous Passive Motion (CPM should be implemented in the first rehabilitation phase after surgery, there is substantial debate about the duration of each session and the total period of CPM application. A Cochrane review on this topic concluded that short-term use of CPM leads to greater short-term range of motion. It also suggested, however, that future research should concentrate on the treatment period during which CPM should be administered. Methods In a randomised controlled trial we investigated the effectiveness of prolonged CPM use in the home situation as an adjunct to standardised PT. Efficacy was assessed in terms of faster improvements in range of motion (RoM and functional recovery, measured at the end of the active treatment period, 17 days after surgery. Sixty patients with knee osteoarthritis undergoing TKA and experiencing early postoperative flexion impairment were randomised over two treatment groups. The experimental group received CPM + PT for 17 consecutive days after surgery, whereas the usual care group received the same treatment during the in-hospital phase (i.e. about four days, followed by PT alone (usual care in the first two weeks after hospital discharge. From 18 days to three months after surgery, both groups received standardised PT. The primary focus of rehabilitation was functional recovery (e.g. ambulation and regaining RoM in the knee. Results Prolonged use of CPM slightly improved short-term RoM in patients with limited RoM at the time of discharge after total knee arthroplasty when added to a semi-standard PT programme. Assessment at 6 weeks and three months after surgery found no long-term effects of this intervention Neither did we detect functional benefits of the improved RoM at any of the outcome assessments. Conclusion Although results

  5. 经行风疹的中药周期性治疗%Periodical treatment of Chinese herbs for menstrual rubella



    The mechanism of menstrual rubella formed to be different shapes, characterized by itchy welts and attacked patient recurrently, they frequently came before menstruation and through the menstrual period. The mechanism of menstrual rubella in Chinese theory is heat accumulated in Yangming meridian and fur offended by wind-heat. The treatment for menstrual rubella is periodical treatment according to menstrual cycle. The basic principal is abreacting wind, nourishing Wood and eliminating heat in the premenstrual period, driving wind and removing heat in the menstrual period, nourishing blood and calming wind after menstruation. After the treatment, the chronic urticaria was cured and never attacked the patients before or during menstruation days any more.%经行风疹块,每值临经或行经期间,全身皮肤突起疹块,疹形大小不一,瘙痒异常,甚则融合成片,经净渐退,常反复发作,迁延不愈.若经行风疹为阳明积热于内,风热外侵皮毛;治疗可按月经周期性治疗,经前疏风养血,清热除湿;经期祛风清热;经后主要予以养血熄风治疗为基本治疗原则.

  6. Correlates of satisfaction with pain treatment in the acute postoperative period: results from the international PAIN OUT registry.

    Schwenkglenks, Matthias; Gerbershagen, Hans J; Taylor, Rod S; Pogatzki-Zahn, Esther; Komann, Marcus; Rothaug, Judith; Volk, Thomas; Yahiaoui-Doktor, Maryam; Zaslansky, Ruth; Brill, Silviu; Ullrich, Kristin; Gordon, Debra B; Meissner, Winfried


    Patient ratings of satisfaction with their postoperative pain treatment tend to be high even in those with substantial pain. Determinants are poorly understood and have not previously been studied in large-scale, international datasets. PAIN OUT, a European Union-funded acute pain registry and research project, collects patient-reported outcome data on postoperative day 1 using the self-reported International Pain Outcome Questionnaire (IPO), and patient, clinical, and treatment characteristics. We investigated correlates of satisfaction and consistency of effects across centres and countries using multilevel regression modelling. Our sample comprised 16,868 patients (median age 55 years; 55% female) from 42 centres in 11 European countries plus Israel, USA, and Malaysia, who underwent a wide range of surgical procedures, for example, joint, limb, and digestive tract surgeries. Median satisfaction was 9 (interquartile range 7-10) on a 0-10 scale. Three IPO items showed strong associations and explained 35% of the variability present in the satisfaction variable: more pain relief received, higher allowed participation in pain treatment decisions, and no desire to have received more pain treatment. Patient factors and additional IPO items reflecting pain experience (eg, worst pain intensity), pain-related impairment, and information on pain treatment added little explanatory value, partially due to covariate correlations. Effects were highly consistent across centres and countries. We conclude that satisfaction with postoperative pain treatment is associated with the patients' actual pain experience, but more strongly with impressions of improvement and appropriateness of care. To the degree they desire, patients should be provided with information and involved in pain treatment decisions.

  7. Response of grassland ecosystems to prolonged soil moisture deficit

    Ross, Morgan A.; Ponce-Campos, Guillermo E.; Barnes, Mallory L.; Hottenstein, John D.; Moran, M. Susan


    Soil moisture is commonly used for predictions of plant response and productivity. Climate change is predicted to cause an increase in the frequency and duration of droughts over the next century, which will result in prolonged periods of below-normal soil moisture. This, in turn, is expected to impact regional plant production, erosion and air quality. In fact, the number of consecutive months of soil moisture content below the drought-period mean has recently been linked to regional tree and shrub mortality in the southwest United States. This study investigated the effects of extended periods of below average soil moisture on the response of grassland ANPP to precipitation. Grassland ecosystems were selected for this study because of their ecological sensitivity to precipitation patterns. It has been postulated that the quick ecological response of grasslands to droughts can provide insight to large scale functional responses of regions to predicted climate change. The study sites included 21 grassland biomes throughout arid-to-humid climates in the United States with continuous surface soil moisture records for 2-13 years during the drought period from 2000-2013. Annual net primary production (ANPP) was estimated from the 13-year record of NASA MODIS Enhanced Vegetation Index extracted for each site. Prolonged soil moisture deficit was defined as a period of at least 10 consecutive months during which soil moisture was below the drought-period mean. ANPP was monitored before, during and after prolonged soil moisture deficit to quantify shifts in the functional response of grasslands to precipitation, and in some cases, new species assemblages that included invasive species. Preliminary results indicated that when altered climatic conditions on grasslands led to an increase in the duration of soil water deficit, then the precipitation-to-ANPP relation became non-linear. Non-linearity was associated with extreme grassland dieback and changes in the historic

  8. QT Prolongation due to Graves’ Disease

    Zain Kulairi


    Full Text Available Hyperthyroidism is a highly prevalent disease affecting over 4 million people in the US. The disease is associated with many cardiac complications including atrial fibrillation and also less commonly with ventricular tachycardia and fibrillation. Many cardiac pathologies have been extensively studied; however, the relationship between hyperthyroidism and rate of ventricular repolarization manifesting as a prolonged QTc interval is not well known. Prolonged QTc interval regardless of thyroid status is a risk factor for cardiovascular mortality and life-threatening ventricular arrhythmia. The mechanism regarding the prolongation of the QT interval in a hyperthyroid patient has not been extensively investigated although its clinical implications are relevant. Herein, we describe a case of prolonged QTc in a patient who presented with signs of hyperthyroidism that was corrected with return to euthyroid status.

  9. Hippocampal Abnormalities in Prolonged Febrile Seizures

    J Gordon Millichap


    Full Text Available Apparent diffusion coefficient (ADC measurements were used to characterize hippocampal edema within 5 days of a prolonged febrile seizure (PFS in a study at Great Ormond Street Hospital, London, UK.

  10. MRI Abnormalities After Prolonged Febrile Seizures

    J Gordon Millichap


    Full Text Available The clinical, radiologic, and laboratory findings of 17 Asian patients with encephalopathy following a prolonged febrile seizure were reviewed retrospectively at Kameda Medical Center, and other centers in Japan and San Francisco, USA.

  11. QT Prolongation due to Graves' Disease

    Deol, Nisha; Tolly, Renee; Manocha, Rohan; Naseer, Maliha


    Hyperthyroidism is a highly prevalent disease affecting over 4 million people in the US. The disease is associated with many cardiac complications including atrial fibrillation and also less commonly with ventricular tachycardia and fibrillation. Many cardiac pathologies have been extensively studied; however, the relationship between hyperthyroidism and rate of ventricular repolarization manifesting as a prolonged QTc interval is not well known. Prolonged QTc interval regardless of thyroid status is a risk factor for cardiovascular mortality and life-threatening ventricular arrhythmia. The mechanism regarding the prolongation of the QT interval in a hyperthyroid patient has not been extensively investigated although its clinical implications are relevant. Herein, we describe a case of prolonged QTc in a patient who presented with signs of hyperthyroidism that was corrected with return to euthyroid status. PMID:28154763

  12. Exceptionally prolonged tooth formation in elasmosaurid plesiosaurians

    Kear, Benjamin P.; Larsson, Dennis; Lindgren, Johan; Kundrát, Martin


    Elasmosaurid plesiosaurians were globally prolific marine reptiles that dominated the Mesozoic seas for over 70 million years. Their iconic body-plan incorporated an exceedingly long neck and small skull equipped with prominent intermeshing ‘fangs’. How this bizarre dental apparatus was employed in feeding is uncertain, but fossilized gut contents indicate a diverse diet of small pelagic vertebrates, cephalopods and epifaunal benthos. Here we report the first plesiosaurian tooth formation rates as a mechanism for servicing the functional dentition. Multiple dentine thin sections were taken through isolated elasmosaurid teeth from the Upper Cretaceous of Sweden. These specimens revealed an average of 950 daily incremental lines of von Ebner, and infer a remarkably protracted tooth formation cycle of about 2–3 years–other polyphyodont amniotes normally take ~1–2 years to form their teeth. Such delayed odontogenesis might reflect differences in crown length and function within an originally uneven tooth array. Indeed, slower replacement periodicity has been found to distinguish larger caniniform teeth in macrophagous pliosaurid plesiosaurians. However, the archetypal sauropterygian dental replacement system likely also imposed constraints via segregation of the developing tooth germs within discrete bony crypts; these partly resorbed to allow maturation of the replacement teeth within the primary alveoli after displacement of the functional crowns. Prolonged dental formation has otherwise been linked to tooth robustness and adaption for vigorous food processing. Conversely, elasmosaurids possessed narrow crowns with an elongate profile that denotes structural fragility. Their apparent predilection for easily subdued prey could thus have minimized this potential for damage, and was perhaps coupled with selective feeding strategies that ecologically optimized elasmosaurids towards more delicate middle trophic level aquatic predation. PMID:28241059

  13. Familial Periodic Paralyses

    ... and less severe than the hypokalemic form. Muscle spasms are common. × Definition Familial periodic paralyses are a ... and less severe than the hypokalemic form. Muscle spasms are common. View Full Definition Treatment Treatment of ...

  14. Period Cramps

    ... Too Tall or Too Short All About Puberty Period Cramps KidsHealth > For Kids > Period Cramps Print A ... re a girl who gets them. What Are Period Cramps? Lots of girls experience cramps before or ...

  15. Quality of drug label information on QT interval prolongation

    Warnier, Miriam J; Holtkamp, Frank A; Rutten, Frans H;


    characteristics (SPC) of recently approved medicinal products. METHODS: Drug labels of products centrally approved in Europe between 2006 and 2012 were screened. Of drugs including the term 'QT' in the SPC, the message on QT-prolongation ('no prolongation'/'unclear drug-QT association'/'possibly QT......-prolongation'/'QT-prolongation') and the advice on cautionary measures pertaining to QT-prolongation in the label were examined, as well as their association. RESULTS: Of the 175 screened products, 44 contained information on QT in the SPC ('no QT-prolongation': 23%, 'unclear drug-QT association': 43%, 'possibly QT-prolongation': 16%, 'QT......-prolongation': 18%). 62% contained advices to act with caution in patients with additional risk factors for QT-prolongation. Products that more likely to have QT-prolonging properties according to the SPC provided more information on QT-prolongation in the SPC ('no prolongation': 10% and for the category 'QT...

  16. Left Ventricular Function After Prolonged Exercise in Equine Endurance Athletes

    Flethøj, M.; Schwarzwald, C. C.; Haugaard, M. M.;


    Background: Prolonged exercise in human athletes is associated with transient impairment of left ventricular (LV) function, known as cardiac fatigue. Cardiac effects of prolonged exercise in horses remain unknown. Objectives :To investigate the effects of prolonged exercise on LV systolic...

  17. Early exposure of infants to GI nematodes induces Th2 dominant immune responses which are unaffected by periodic anthelminthic treatment.

    Victoria J Wright

    Full Text Available We have previously shown a reduction in anaemia and wasting malnutrition in infants <3 years old in Pemba Island, Zanzibar, following repeated anthelminthic treatment for the endemic gastrointestinal (GI nematodes Ascaris lumbricoides, hookworm and Trichuris trichiura. In view of the low intensity of worm infections in this age group, this was unexpected, and it was proposed that immune responses to the worms rather than their direct effects may play a significant role in morbidity in infants and that anthelminthic treatment may alleviate such effects. Therefore, the primary aims of this study were to characterise the immune response to initial/early GI nematode infections in infants and the effects of anthelminthic treatment on such immune responses. The frequency and levels of Th1/Th2 cytokines (IL-5, IL-13, IFN-gamma and IL-10 induced by the worms were evaluated in 666 infants aged 6-24 months using the Whole Blood Assay. Ascaris and hookworm antigens induced predominantly Th2 cytokine responses, and levels of IL-5 and IL-13 were significantly correlated. The frequencies and levels of responses were higher for both Ascaris positive and hookworm positive infants compared with worm negative individuals, but very few infants made Trichuris-specific cytokine responses. Infants treated every 3 months with mebendazole showed a significantly lower prevalence of infection compared with placebo-treated controls at one year following baseline. At follow-up, cytokine responses to Ascaris and hookworm antigens, which remained Th2 biased, were increased compared with baseline but were not significantly affected by treatment. However, blood eosinophil levels, which were elevated in worm-infected children, were significantly lower in treated children. Thus the effect of deworming in this age group on anaemia and wasting malnutrition, which were replicated in this study, could not be explained by modification of cytokine responses but may be related to

  18. Rates and determinants of reinitiating antihypertensive therapy after prolonged stoppage : a population-based study

    van Wijk, Boris L G; Avorn, Jerry; Solomon, Daniel H; Klungel, Olaf H; Heerdink, Eibert R; de Boer, Anthonius; Brookhart, Alan M


    OBJECTIVE: To assess patterns of restarting antihypertensive drugs after a prolonged period of discontinuation. METHODS: We conducted a retrospective cohort study among new users of blood pressure-lowering medication in the PHARMO database in The Netherlands, who had a period of at least 180 days wi

  19. Flakka-Induced Prolonged Psychosis

    Craig Crespi


    Full Text Available In South Florida, there has been a highly addictive new synthetic drug flooding the streets for people looking for a cheap high. Alpha-PVP, better known as Flakka, is an illegal substance that sells on the streets for as little as $5 a hit and delivers an instant high that can last from hours to days with lingering effects for weeks after it has been ingested. Although people use Flakka for its potential euphoric high, symptoms are known to easily escalate into frightening delusions, paranoid psychosis, extreme agitation, and a multitude of other altered mental states. According to the National Institute on Drug Abuse, Florida appears to be the nation’s hot spot for reports of Flakka. In this case report, a 17-year-old female with no prior psychiatric diagnosis presents to the hospital under a 72-hour involuntary placement for altered mental status with agitation and psychotic behaviors. After multiple days of symptomatic treatment with benzodiazepines and antipsychotics, the patient became coherent enough to give a history of a “friend” putting Flakka in her food at school as a joke. Although she continues to have residual symptoms including psychomotor agitation and slowing of cognition, she was alert, oriented, and able to be discharged home with proper follow-up.

  20. [MVK gene abnormality and new approach to treatment of hyper IgD syndrome and periodic fever syndrome].

    Naruto, Takuya


    Hyper IgD and periodic fever syndrome (HIDS; OMIM 260920) is one of the hereditary autoinflammatory syndromes characterized by recurrent episodes of fever and inflammation.. HIDS is an autosomal recessive disorder characterized by recurrent fever attacks in early childhood. HIDS caused by mevalonate kinase (MK) mutations, also that is the gene of mevalonic aciduria (OMIM 251170). During febrile episodes, urinary mevalonate concentrations were found to be significantly elevated in patients. Diagnosis of HIDS was retrieving gene or measurement of the enzyme activity in peripheral blood lymphocyte in general. This of HIDS is an activity decline of MK, and a complete deficiency of MK becomes a mevalonic aciduria with a nervous symptom. The relation between the fever and inflammation of mevalonate or isoprenoid products are uncertain. The therapy attempt with statins, which is inhibited the next enzyme after HMG-CoA reductase, or inhibit the proinflammatory cytokines.

  1. Levo-α-acetylmethadol (LAAM induced QTc-prolongation - results from a controlled clinical trial

    Wieneke H


    Full Text Available Abstract Background Due to potential proarrhythmic side-effects levo-α-Acetylmethadol (LAAM is currently not available in EU countries as maintenance drug in the treatment of opiate addiction. However, recent studies and meta-analyses underline the clinical advantages of LAAM with respect to the reduction of heroin use. Thus a reappraisal of LAAM has been demanded. The aim of the present study was to evaluate the relative impact of LAAM on QTc-interval, as a measure of pro-arrhythmic risk, in comparison to methadone, the current standard in substitution therapy. Methods ECG recordings were analysed within a randomized, controlled clinical trial evaluating the efficacy and tolerability of maintenance treatment with LAAM compared with racemic methadone. Recordings were done at two points: 1 during a run-in period with all patients on methadone and 2 24 weeks after randomisation into methadone or LAAM treatment group. These ECG recordings were analysed with respect to QTc-values and QTc-dispersion. Mean values as well as individual changes compared to baseline parameters were evaluated. QTc-intervals were classified according to CPMP-guidelines. Results Complete ECG data sets could be obtained in 53 patients (31 LAAM-group, 22 methadone-group. No clinical cardiac complications were observed in either group. After 24 weeks, patients receiving LAAM showed a significant increase in QTc-interval (0.409 s ± 0.022 s versus 0.418 s ± 0.028 s, p = 0.046, whereas no significant changes could be observed in patients remaining on methadone. There was no statistically significant change in QTc-dispersion in either group. More patients with borderline prolonged and prolonged QTc-intervals were observed in the LAAM than in the methadone treatment group (n = 7 vs. n = 1; p = 0.1. Conclusions In this controlled trial LAAM induced QTc-prolongation in a higher degree than methadone. Given reports of severe arrhythmic events, careful ECG-monitoring is recommended

  2. Characterization of anxiety-related responses in male rats following prolonged exposure to therapeutic doses of oral methylphenidate.

    Britton, Gabrielle B; Bethancourt, José A


    Increases in the rates of attention-deficit/hyperactivity disorder (ADHD) diagnosis and the prescribed use of methylphenidate (MPH) in recent years have raised concerns over the potential effects of early MPH exposure on brain structure and function in adulthood. Animal studies have shown that long-term MPH exposure can modify anxiety-related behaviors and related neural circuitry in adulthood. The present study employed a battery of behavioral tests and repeated testing to assess the long-term effects of MPH exposure on anxious responding. Male Wistar rats beginning on post-natal day 27 were exposed to 4 or 7 weeks of twice daily MPH administration at doses of 2, 3, or 5 mg/kg. MPH was administered orally and on weekdays only in order to approximate drug treatment in clinical populations. Behavioral testing began 18 days following the last drug administration. Our results indicate that prolonged oral MPH treatment at therapeutic doses has little or no enduring effects on anxious behaviors. However, a comparison of MPH groups that received treatment for 4 or 7 weeks suggests that the two treatment periods influenced anxious behaviors in observably different manners in adulthood; namely, a more prolonged period of exposure produced less anxiety relative to the shorter period of MPH exposure as indicated by behaviors in the light-dark transition, elevated plus-maze, and fear conditioning tests. These findings were interpreted as evidence of the importance of considering length of drug exposure in pre-clinical studies aimed at investigating the effects of MPH exposure in ADHD populations.

  3. Effect of germination periods and hydrothermal treatments on in vitro protein and starch digestibility of germinated legumes

    Uppal, Veny; Bains, Kiran


    Germination of legumes followed by hydrothermal treatments is an effective mean of improving nutritive value of legumes. The protein content of mungbean, chickpea and cowpea increased by 9–11, 11–16 and 8–11% after germination. A significant (p ≤ 0.05) decrease in protein content was observed on pressure cooking and microwaving in all three legumes. The carbohydrates decreased by 1 to 3% during soaking and 2 to 6% during germination. A significant (p ≤ 0.05) improvement in in vitro protein di...

  4. Does Modafinil improve the level of consciousness for people with a prolonged disorder of consciousness? a retrospective pilot study.

    Dhamapurkar, Samira Kashinath; Wilson, Barbara A; Rose, Anita; Watson, Peter; Shiel, Agnes


    Modafinil is best known as a sleep regulator among healthy individuals, but studies suggest that it reduces excessive daytime sleepiness in patients with brain injury. This retrospective pilot study evaluated the effectiveness of Modafinil for people with a prolonged disorder of consciousness and whether those with a traumatic brain injury did better than those with a non-traumatic brain injury. Twenty four prolonged disorder of consciousness patients who were prescribed Modafinil, were assessed at least four times both before and during treatment. The Coma Recovery Scale-Revised was used to determine if patients had a disorder of consciousness and the Wessex Head Injury Matrix was used to monitor behavior during baseline and treatment periods. Patients with a traumatic brain injury (N = 12) were compared with those with non-traumatic brain injury (N = 12). A chi-square test with significance at 0.05 was used and when frequencies were below 5 a Fisher's Exact Test was used. Cognitive improvements were noted in domains of wakefulness, awareness, concentration, tracking and following commands. Significant differences were found for the whole group between baseline and Modafinil (x(2 )=( )9.80; p = 0.002). Eleven of the 12 traumatic brain injury patients had higher Wessex Head Injury Matrix scores when on Modafinil (x(2 )=( )8.33, p < 0.004). Six non-traumatic brain injury patients had higher scores with Modafinil, two had lower scores and four showed no change. There was no significant difference in the number of patients showing an increase compared to those showing a decrease (Fisher's exact test p = 0.29). Modafinil appears to be beneficial for enhancing cognition in prolonged disorder of consciousness patients. Traumatic brain injury patients benefited more than non-traumatic brain injury patients. Implications for Rehabilitation People with prolonged disorders of consciousness are those in coma, a vegetative state or a minimally

  5. [Correlation between social support and quality of life in patients with breast cancer at different periods of treatment].

    Yang, L; Song, W P; Chen, Z L; Wang, Y; Chen, Y Y; Hua, Y H; Chen, M; Zou, W B


    Objective: To analyze the differences between the social support for breast cancer patients and healthy female, and to explore the correlation between social support and quality of life (QOL) in the patients. Methods: From January 2013 to December 2014, 101 patients with operable breast cancer treated at Xinyu City People's Hospital were recruited as the experimental group. They completed questionnaires in the preoperative, postoperative chemoradiotherapy and rehabilitation periods, respectively.101 healthy female volunteers recruited from the community were included as control group, whose age and level of education were matched with those of the experimental group.The general questionnaire including basic information, disease conditions and other projects, perceived social support scale (PSSS), quality of life of breast cancer patients (FACT-B) were applied to evaluate the general situation, social support and QOL of the subjects. The differences in PSSS scores between the experimental and control groups were compared. The correlation between PSSS score and FACT-B score in the experimental group was analyzed. SPSS 18.0 software was used for statistical analysis. Results: The general situations of the experimental and control groups were comparable (all P>0.05). The rates of the total social support score ≥50 in the experimental and control groups were not significantly different (93.6% vs. 94.7%, P=0.067). Compared with that of the control group (23.2±4.8), the scores of family support in the experimental group in preoperative, postoperative chemoradiotherapy and rehabilitation periods were statistically higher (25.6±3.2, 24.2±4.2 and 24.0±3.4, respectively, P=0.034). The social support scores of patients with different demographic characteristics were different. Among the demographic characteristics, years of education and place of residence had the largest impact. The scores of social support in patients with longer education years and living in the urban

  6. Time trends of cannabis use among treatment-seeking individuals at government de-addiction centers across India over a period of 7 years

    Yatan Pal Singh Balhara


    Full Text Available Background: Cannabis continues to be the most commonly used illicit psychoactive substance globally. The National Survey in India conducted in the year 2004 also reported it to be the most commonly used illicit substance in the country. Furthermore, it was reported to be the second most commonly used psychoactive substance by the treatment seekers at de-addiction centers in the country. Objectives: To assess time trends of cannabis use among treatment-seeking individuals at government de-addiction centers across India over a period of 7 years. Materials and Methods: The study utilized data collected through Drug Abuse Monitoring System across India. The data of treatment seekers from de-addiction centers established under the Drug De-addiction Program, Ministry of Health and Family Welfare, Government of India and supported by the Ministry of Social Justice and Empowerment, Government of India (122 in number across the country were analyzed. Results: A total of 107,469 individuals sought treatment from government de-addiction centers over the 7 years (2007–2013 period. With the exception of an aberration for the year 2012, there has been a steady decline in the proportion of treatment seekers who are not current cannabis users. A significantly greater proportion (Chi-square: 586.30, df: 1, P < 0.001 of individuals with current cannabis use alone or along with tobacco (20.4% tend to have a co-morbid psychiatric disorder as compared to treatment seekers with current use of substances other than cannabis (6.1%. Conclusions: It is important to focus on cannabis in clinical service delivery and research in the country.

  7. Biomineralization of azo dye bearing wastewater in periodic discontinuous batch reactor: Effect of microaerophilic conditions on treatment efficiency.

    Naresh Kumar, A; Nagendranatha Reddy, C; Venkata Mohan, S


    The present study illustrates the influence of microaerophilic condition on periodic discontinuous batch reactor (PDBR) operation in treating azo dye containing wastewater. The process performance was evaluated with the function of various dye load operations (50-750 mg/l) by keeping the organic load (1.6 kg COD/m(3)-day) constant. Initially, lower dye operation (50mg dye/l) resulted in higher dye [45 mg dye/l (90%)] and COD [SDR: 1.29 kg COD/m(3)-day (92%)] removal efficiencies. Higher dye load operation (750 mg dye/l) also showed non-inhibitory performance with respect to dye [600 mg dye/l (80%)] and COD [1.25 kg COD/m(3)-day (80%)] removal efficiencies. Increment in dye load showed increment in azo reductase and dehydrogenase activities (39.6 U; 4.96 μg/ml; 750 mg/l). UV-Vis spectroscopy (200-800 nm), FTIR and (1)H NMR studies revealed the disappearance of azo bond (-NN-). First derivative cyclic voltammogram supported the involvement of various membrane bound redox shuttlers, viz., cytochrome-C, cytochrome-bc1 and flavoproteins (FAD (H)).

  8. Finding an Optimum Period of Oxidative Heat Treatment on SS 316 Catalyst for Nanocarbon Production from LDPE Plastic Waste

    Praswasti P.D.K. Wulan


    Full Text Available Plastic waste accumulation has become a major health and environmental problems in many parts of the world. Many efforts have been taken to reduce the accumulation, one of which is to convert it into a more useful products, such as CNT. CNT have been used for several products to enhance its properties. In this work, Low Density Polyethylene (LDPE plastic waste was used as a feed to produce CNT with the help of wired mesh stainless steel type 316 serving as the catalyst. The stainless steel was pretreated by applying heat under oxidative environment at 800oC. The time of the pretreatment was varied from 0, 1, 5, 10, and 20 minutes to determine the relationship between the period of the pretreatment and the produced CNT quality. The collected nanocarbons were characterized by using XRD, SEM-EDX, TEM, and TGA. It was discovered that CNT was formed from the pretreated catalyst. The best result was obtained from the 10 minutes pretreatment shown by formation of buckling and continuous growth CNT having an evenly spread carbon with a mean CNT diameter of 7.70 nm, carbon percentage up to 93.3%, and oxidation temperature up to 530oC.

  9. [Baseline characteristics and changes in treatment after a period of optimization of the patients included in the study EFICAR].

    Gómez-Marcos, Manuel A; Agudo-Conde, Cristina; Torcal, Jesús; Echevarria, Pilar; Domingo, Mar; Arietaleanizbeascoa, María; Sanz-Guinea, Aitor; de la Torre, Maria M; Ramírez, Jose I; García-Ortiz, Luis


    To describe the baseline date and drugs therapy changes during treatment optimization in patients with heart failure with depressed systolic function included in the EFICAR study. Multicenter randomized clinical trial. Seven Health Centers. 150 patients (ICFSD) age 68±10 years, 77% male. Sociodemographic variables, comorbidities (Charlson index), functional capacity and quality of life. Drug therapy optimization was performed. The main etiology was ischemic heart disease (45%), with 89% in functional class II. The Charlson index was 2.03±1.05. The ejection fraction mean was 37%±8, 19% with ejection fraction <30%. With the stress test 6.3±1.6 mean was reached, with the 6 minutes test 446±78 meters and the chair test 13.7±4.4 seconds. The overall quality of life with ejection fraction was 22.8±18.7 and with the Short Form-36 Health Survey, physical health 43.3±8.4 and mental health 50.1±10.6. After optimizing the treatment, the percentage of patients on drugs therapy and the dose of angiotensin converting enzyme inhibitors, angiotensin II receptor antagonists and beta-blockers were not changed. The majority of the subjects are in functional class II, with functional capacity and quality of life decreased and comorbidity index high. A protocolized drug therapy adjustment did not increase the dose or number of patients with effective drugs for heart failure with depressed systolic function. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  10. Safety information on QT-interval prolongation

    Warnier, Miriam J; Holtkamp, Frank A; Rutten, Frans H;


    Prolongation of the QT interval can predispose to fatal ventricular arrhythmias. Differences in QT-labeling language can result in miscommunication and suboptimal risk mitigation. We systematically compared the phraseology used to communicate on QT-prolonging properties of 144 drugs newly approve......) was moderate (kappa 0.434). However, the agreement in expected clinical decisions based on the product labels was much higher (kappa 0.673). The US drug label tends to be more explicit, especially when it considers absence of QT effects....

  11. Subtleties in practical application of prolonged infusion of β-lactam antibiotics.

    De Waele, Jan J; Lipman, Jeffrey; Carlier, Mieke; Roberts, Jason A


    Prolonged infusion (PI) of β-lactam antibiotics is increasingly used in order to optimise antibiotic exposure in critically ill patients. Physicians are often not aware of a number of subtleties that may jeopardise the treatment. In this clinically based paper, we stress pragmatic issues, such as the importance of a loading dose before PI, and discuss a number of important practicalities that are mandatory to benefit from the pharmacokinetic advantages of prolonged β-lactam antibiotic administration.

  12. Induction of anoxic microenvironment in multi-phase metabolic shift strategy during periodic discontinuous batch mode operation enhances treatment of azo dye wastewater.

    Nagendranatha Reddy, C; Naresh Kumar, A; Annie Modestra, J; Venkata Mohan, S


    Variation in anoxic microenvironment (multi-phase (MP) metabolic shift strategy) during cycle operation of periodic discontinuous batch/sequencing batch (PDBR/SBR) mode operation showed enhanced degradation of recalcitrant azo dye (C.I. Acid Black 10B) at higher dye load (1250mg/l). The process performance was evaluated by varying anoxic phasing period during cycle operation. Before multiphase (BMP) operation with 2.1% of anoxic period showed color/COD removal efficiency of 41.9%/46.3%. Increment in anoxic period responded favorable in enhancing treatment efficiency [AMPI (16.2%), 49.4%/52.4%; AMPII (26.6%), 54.7%/57.2%; AMPIII (34.9%), 58.4%/61.5%]. Relatively higher bio-electrochemical activity, persistent reductive behavior (redox catalytic currents, 0.26/-0.72μA), prevalence of redox shuttlers (Fe-S proteins, cytochromes, quinones) facilitating enhanced electron transfer by minimization of associated losses and higher enzyme activities were observed with induction of anoxic phase. Anoxic condition shifts system microenvironment between oxidation and reduction assisting reduction of dye to its intermediates followed by their mineralization.

  13. Administration of Mycobacterium phlei cell wall-nucleic acid complex in the immediate postoperative period for the treatment of non-muscle-invasive bladder cancer

    Morales, Álvaro


    Introduction: This review sought to investigate the safety of intravesical administration of Mycobacterium phlei cell wall-nucleic acid (MCNA) in the immediate postoperative period after biopsy/resection for non-muscle-invasive bladder cancer (NMIBC). Methods: Patients with NMIBC who failed bacillus Calmette-Guérin (BCG) therapy and at high risk of recurrence and progression participated in this study. Treatment involved an induction phase of six weeks and maintenance of three weekly instillations every six months for two years. Biopsies were mandatory at six months and resections/biopsies as indicated. Of the 129 patients enrolled, 18 (14%) received one or more instillations of MCNA within 24 hours of an endoscopic procedure for a total of 32 instillations. Results: Fourteen patients (78%) received MCNA in the immediate postoperative period. Two (11%) received treatment the day after surgery, but a second treatment immediately after a transurethral resection of the bladder tumour (TURBT). The remaining two patients received an instillation each the day after surgery. Adverse events (AEs) occurred in 31.3% of those treated immediately after the procedure; they were mild, limited to the lower urinary tract, and not drug-related. Only one patient experienced systemic symptoms of moderate severity. None of the AEs resulted in postponement of treatment. There were no AEs among those receiving MCNA the day after surgery. Conclusions: The dual mechanism of action of MCNA suggests that early treatment would take advantage of its chemotherapeutic (pro-apoptotic) activity. Concerns about early administration due to the presence of live bacteria are circumvented with this sterile preparation. These preliminary results warrant further investigation to confirm the safety of perioperative administration of MCNA. PMID:27800054

  14. Efficacy and safety of oral deferasirox treatment in the posttransplant period for patients who have undergone allogeneic hematopoietic stem cell transplantation (alloHSCT).

    Sivgin, Serdar; Eser, Bulent; Bahcebasi, Sami; Kaynar, Leylagul; Kurnaz, Fatih; Uzer, Elmas; Pala, Cigdem; Deniz, Kemal; Ozturk, Ahmet; Cetin, Mustafa; Unal, Ali


    Iron overload is considered to be associated with various complications in patients who undergo both allogeneic (allo) and autologous hematopoietic stem cell transplantation (HSCT). A total of 23 alloHSCT recipients who started deferasirox treatment due to hyperferritinemia (ferritin ≥1,000 ng/mL) were analyzed retrospectively. The demographic characteristics, data about deferasirox treatment, and history of phlebotomy were obtained from the patients' files. The reduction in posttreatment ferritin levels was found statistically significant compared with pretreatment ferritin levels in both def+phlebotomy and def+nonphlebotomy groups (p = 0.025 and 0.017, respectively). The liver enzymes, especially ALT and bilirubins, were significantly reduced after the treatment (p deferasirox treatment reduced pretreatment ferritin levels below the level of 1,000 ng/mL in a median period of 94 days, and these data were found to be statistically significant (p deferasirox was 94 days (72-122). The most common adverse effects were nausea and vomiting, which occurred in three of the patients (13%). In conclusion, our data suggest that oral deferasirox treatment may be used as a safe and effective alternative method for reducing iron overload in alloHSCT recipients, whether combined with or without phlebotomy.

  15. A comparative study on the adverse effects of two anti-tuberculosis drugs regimen in initial two-month treatment period

    Begum Lutfun Nahar, A.K.M. Mosharrof Hossain, M. Monirul Islam and Dipti Rani Saha


    Full Text Available Tuberculosis (TB is a leading cause of death throughout the world and Bangladesh stands 4th among high burden countries. Treatment of TB hampered with poor patient compliance and intolerance at least partly due to the adverse drug reactions.A prospective longitudinal non-randomized case study was conducted on 64 admitted patients in Chest Disease Hospital and Shahid Shamsuddin Hospital, Sylhet diagnosed as primary (Category I and resistant or treatment failure (Category II to compare adverse effects between two anti-TB drug treatment regimen based on diagnostic category. Category I received four drug (rifampicin, isoniazide, ethambutol, pyrazinamide and Category II received five drug (rifampicin, isoniazide, ethambutol, pyrazinamide, sparfloxacin combination treatment for initial 2 months under DOTS during the period of July 2004 to July 2005. Adverse effect parameters e.g. GI disturbances, arthralgia, hepatic dysfunction and renal impairment were estimated before, two and eight weeks after initiation of treatment. Predisposing risk factors for adverse effects e.g. age, sex, nutritional status, associated disease, habits were also analyzed. In our study, 76.47% of total patients experienced some sorts of adverse effects. In four and five drug regimen group adverse reaction were observed in 50% and 95% of patients respectively. Serum bilirubin, SGPT, creatinine did not change in neither of the treated group while alkaline phosphatase tended to decrease and uric acid to increase . TB was common in males of poor nutritious group. No disease was established to be risk factor for drug intolerance.

  16. Study of platelet-rich plasma injections in the treatment of androgenetic alopecia through an one-year period

    Maria-Angeliki Gkini


    Full Text Available Background: Platelet-rich plasma (PRP is defined as an autologous concentration of plasma with a greater count of platelets than that of whole blood. Its action depends on the released growth factors from platelets. It has been investigated and used in numerous fields of medicine. Recently, PRP has received growing attention as a potential therapeutic tool for hair loss. Aims: To evaluate the efficacy and safety of PRP injections in the scalp of patients with androgenetic alopecia. Settings and Design: Prospective cohort study. Materials and Methods: 20 patients, 18 males and 2 females, with androgenetic alopecia were enrolled in the study. PRP was prepared using a single spin method (Regenlab SA. Upon activation, it was injected in the androgen-related areas of scalp. Three treatment sessions were performed with an interval of 21 days and a booster session at 6 months following the onset of therapy. Statistical Analysis: Statistical analysis of the data was performed using the Statistical Package for the Social Sciences (SPSS, version 19.0 (IBM, NY, USA. Results: Hair loss reduced and at 3 months it reached normal levels. Hair density reached a peak at 3 months (170.70 ± 37.81, P < 0.001. At 6 months and at 1 year, it was significantly increased, 156.25 ± 37.75 (P < 0.001 and 153.70 ± 39.92 (P < 0.001 respectively, comparing to baseline. Patients were satisfied with a mean result rating of 7.1 on a scale of 1-10. No remarkable adverse effects were noted. Conclusions: Our data suggest that PRP injections may have a positive therapeutic effect on male and female pattern hair loss without remarkable major side effects. Further studies are needed to confirm its efficacy.

  17. The course of pain drawings during a 10-week treatment period in patients with acute and sub-acute low back pain

    Delaney Heléne


    Full Text Available Abstract Background Pain drawings are widely used as an assessment of patients' subjective pain in low back pain patients being considered for surgery. Less work has been done on primary health care patients. Moreover, the possible correlation between pain drawing modalities and other pain assessment methods, such as pain score and functional variables needs to be described. Thus, the objectives were to describe the course of pain drawings during treatment in primary health care for low back pain patients. Methods 160 primary health care outpatients with acute or sub-acute low back pain were studied during 10 weeks of a stay active concept versus manual therapy in addition to the stay active concept. The patients filled out 3 pain drawings each, at baseline and after 5 and 10 weeks of treatment. In addition the patients also reported pain and functional variables during the 3 measurement periods. Results The proportion of areas marked, the mean number of areas marked (pain drawing score, mean number of modalities used (area score, and the proportion of patients with pain radiation all decreased during the 10-week treatment period. Most of the improvement occurred during the first half of the period. The seven different pain modalities in the pain drawing were correlated to pain and functional variables. In case of no radiation some modalities were associated with more pain and disability than others, a finding that grew stronger over time. For patients with pain radiation, the modality differences were smaller and inconsistent. Conclusion Pain modalities are significantly correlated with pain and functional variables. There is a shift from painful modalities to less painful ones over time.

  18. Ruptured intracranial aneurysms: the outcome of surgical treatment in experienced hands in the period prior to the advent of endovascular coiling

    Lafuente, J; Maurice-Williams, R


    Objectives: To evaluate the results of treatment of patients with a ruptured intracranial aneurysm treated by a single experienced vascular neurosurgeon in the period prior to the introduction of endovascular coiling. Methods: Over a mean (SD) period of 9 (2) years, between January 1990 and June 1999, 245 consecutive patients with ruptured intracranial aneurysms were treated. Patients' details were obtained from a database that had been constructed prospectively. The patients consisted of all those patients treated by the senior author (Mr Maurice-Williams) over this period—that is, every third day on call at his unit. During this period, all patients under the age of 75 years with a diagnosis of subarachnoid haemorrhage were admitted to the neurosurgical unit as soon as was practicable regardless of clinical grade. Results: Of 245 patients, 190 (77.6%) underwent treatment by open surgery using standard microsurgical techniques. At 1 year, the mortality of the operated patients was 2.6%, while 89.5% of the patients had a Glasgow Outcome Score (GOS) of 4 and 5. The overall management outcome (all patients treated, including operated and non-operated cases) at 1 year was: 17.1 % dead while 74.3% had GOS 4 and 5. Of the 190 patients who underwent surgery, 38 (20%) required additional operations, totalling 72 operations in all. Of these, 32 were for hydrocephalus and 17 for the evacuation of intracranial haematomas/collections. Complications of surgery occurred in 56 patients (29.5%). Conclusion: Open surgery, despite good eventual results, is associated with a significant rate of re-operations and complications that would probably be largely avoided with endovascular treatment. Nevertheless, although endovascular coiling has these immediate advantages over surgery it is still not certain that the long term results will be superior to surgery which leads to permanent obliteration of the aneurysm. There may still be a need for open surgery in the future. PMID:14638889


    Suzanne Schneider


    Full Text Available Prolonged exercise may compromise immunity through a reduction of salivary antimicrobial proteins (AMPs. Salivary IgA (IgA has been extensively studied, but little is known about the effect of acute, prolonged exercise on AMPs including lysozyme (Lys and lactoferrin (Lac. Objective: To determine the effect of a 50-km trail race on salivary cortisol (Cort, IgA, Lys, and Lac. Methods: 14 subjects: (6 females, 8 males completed a 50km ultramarathon. Saliva was collected pre, immediately after (post and 1.5 hrs post race ( 1.5. Results: Lac concentration was higher at 1.5 hrs post race compared to post exercise (p0.05. IgA concentration, secretion rate, and IgA/Osm were lower 1.5 hrs post compared to pre race (p<0.05. Cort concentration was higher at post compared to 1.5 (p<0.05, but was unaltered from pre race levels. Subjects finished in 7.81 ± 1.2 hrs. Saliva flow rate did not differ between time points. Saliva Osm increased at post (p<0.05 compared to pre race. Conclusions: The intensity could have been too low to alter Lys and Lac secretion rates and thus, may not be as sensitive as IgA to changes in response to prolonged running. Results expand our understanding of the mucosal immune system and may have implications for predicting illness after prolonged running.

  20. Restless Legs Syndrome/Willis-Ekbom Disease and Periodic Limb Movements: A Comprehensive Review of Epidemiology, Pathophysiology, Diagnosis and Treatment Considerations.

    Pratt, Dyveke P


    Restless legs syndrome (RLS) or Willis-Ekbom Disease is a common, but frequently under- recognized and misdiagnosed condition seen in many subspecialty practices including neurology, sleep medicine, primary care and rheumatology. Periodic limb movements are a frequent co-morbid diagnosis in RLS. Despite prior beliefs that the condition was "benign", it has been demonstrated to have a considerable impact on sufferers quality of life, physically and psychologically, as well as socially. This chapter is meant as a comprehensive review of RLS encompassing epidemiology, pathophysiology, diagnosis, and treatment considerations.

  1. Effects of prolonged exposure to perchlorate on thyroid and reproductive function in zebrafish

    Mukhi, S.; Patino, R.


    The objectives of this study were to determine the effects of prolonged exposure to perchlorate on (1) thyroid status and reproductive performance of adult zebrafish (Danio rerio) and (2) F1 embryo survival and early larval development. Using a static-renewal procedure, mixed sex populations of adult zebrafish were exposed to 0, 10, and 100 mg/l nominal concentrations of waterborne perchlorate for 10 weeks. Thyroid histology was qualitatively assessed, and females and males were separated and further exposed to their respective treatments for six additional weeks. Eight females in each tank replicate (n = 3) were paired weekly with four males from the same respective treatment, and packed-egg (spawn) volume (PEV) was measured each of the last five weeks. At least once during weeks 14-16 of exposure, other end points measured included fertilization rate, fertilized egg diameter, hatching rate, standard length, and craniofacial development of 4-day-postfertilization larvae and thyroid hormone content of 3.5-h embryos and of exposed mothers. At 10 weeks of exposure, perchlorate at both concentrations caused thyroidal hypertrophy and colloid depletion. A marked reduction in PEV was observed toward the end of the 6-week spawning period, but fertilization and embryo hatching rates were unaffected. Fertilized egg diameter and larval length were increased by parental exposure to perchlorate. Larval head depth was unaffected but the forward protrusion of the lower jaw-associated cartilage complexes, Meckel's and ceratohyal, was decreased. Exposure to both concentrations of perchlorate inhibited whole-body thyroxine content in mothers and embryos, but triiodothyronine content was unchanged. In conclusion, prolonged exposure of adult zebrafish to perchlorate not only disrupts their thyroid endocrine system but also impairs reproduction and influences early F1 development. ?? 2007 Oxford University Press.


    Bronfenbrenner, J; Favour, C B


    (1) Restriction of fluid intake to 1,500 cc and the salt intake to 3 gm a day doubles the penicillin blood level following interrupted intramuscular [See Figure in the PDF file] injections of penicillin. (2) The administration of benzoic acid to a patient on an unrestricted diet Ilay double the penicillin blood level during similar treatment. (3) The combination of these two procedures results in a four- to eight-fold increase in penicillin blood level with a prolonged effective blood concentration.

  3. Overview of clinical efficacy and risk data of benzodiazepines for prolonged seizures.

    Lagae, Lieven


    An historical overview is provided regarding the use of benzodiazepines for the treatment of acute prolonged convulsive seizures. It is clear that intravenous benzodiazepines remain a first step for the in-hospital treatment of prolonged seizures or status epilepticus. However, in the community, in a pre-hospital situation, intravenous administration is not possible. In recent years, it was shown that rectal, buccal, intranasal, and intramuscular administration of benzodiazepines is very effective as a first and safe treatment step. In many cases, rectal diazepam is not socially acceptable anymore, and therefore more emphasis is now put on buccal, intranasal, and intramuscular administration. At present, based on the available data, midazolam is the product of choice for the acute treatment of prolonged convulsive seizures.

  4. Prolonged morphine administration alters protein expression in the rat myocardium

    Drastichova Zdenka


    Full Text Available Abstract Background Morphine is used in clinical practice as a highly effective painkiller as well as the drug of choice for treatment of certain heart diseases. However, there is lack of information about its effect on protein expression in the heart. Therefore, here we aimed to identify the presumed alterations in rat myocardial protein levels after prolonged morphine treatment. Methods Morphine was administered to adult male Wistar rats in high doses (10 mg/kg per day for 10 days. Proteins from the plasma membrane- and mitochondria-enriched fractions or cytosolic proteins isolated from left ventricles were run on 2D gel electrophoresis, scanned and quantified with specific software to reveal differentially expressed proteins. Results Nine proteins were found to show markedly altered expression levels in samples from morphine-treaded rats and these proteins were identified by mass spectrometric analysis. They belong to different cell pathways including signaling, cytoprotective, and structural elements. Conclusions The present identification of several important myocardial proteins altered by prolonged morphine treatment points to global effects of this drug on heart tissue. These findings represent an initial step toward a more complex view on the action of morphine on the heart.

  5. Mortality and loss-to-follow-up during the pre-treatment period in an antiretroviral therapy programme under normal health service conditions in Uganda

    Levin Jonathan


    Full Text Available Abstract Background In many HIV programmes in Africa, patients are assessed clinically and prepared for antiretroviral treatment over a period of 4–12 weeks. Mortality rates following initiation of ART are very high largely because patients present late with advanced disease. The rates of mortality and retention during the pre-treatment period are not well understood. We conducted an observational study to determine these rates. Methods HIV-infected subjects presenting at The AIDS Support Clinic in Jinja, SE Uganda, were assessed for antiretroviral therapy (ART. Eligible subjects were given information and counselling in 3 visits done over 4–6 weeks in preparation for treatment. Those who did not complete screening were followed-up at home. Survival analysis was done using poisson regression. Results 4321 HIV-infected subjects were screened of whom 2483 were eligible for ART on clinical or immunological grounds. Of these, 637 (26% did not complete screening and did not start ART. Male sex and low CD4 count were associated independently with not completing screening. At follow-up at a median 351 days, 181 (28% had died, 189 (30% reported that they were on ART with a different provider, 158 (25% were alive but said they were not on ART and 109 (17% were lost to follow-up. Death rates (95% CI per 100 person-years were 34 (22, 55 (n.18 within one month and 37 (29, 48 (n.33 within 3 months. 70/158 (44% subjects seen at follow-up said they had not started ART because they could not afford transport. Conclusion About a quarter of subjects eligible for ART did not complete screening and pre-treatment mortality was very high even though patients in this setting were well informed. For many families, the high cost of transport is a major barrier preventing access to ART.

  6. Chronic caffeine treatment during prepubertal period confers long-term cognitive benefits in adult spontaneously hypertensive rats (SHR), an animal model of attention deficit hyperactivity disorder (ADHD).

    Pires, Vanessa A; Pamplona, Fabrício A; Pandolfo, Pablo; Prediger, Rui D S; Takahashi, Reinaldo N


    The spontaneously hypertensive rat (SHR) is frequently used as an experimental model for the study of attention deficit hyperactivity disorder (ADHD) since it displays behavioural and neurochemical features of ADHD. Increasing evidence suggests that caffeine might represent an important therapeutic tool for the treatment of ADHD and we recently demonstrated that the acute administration of caffeine improves several learning and memory impairments in adult SHR rats. Here we further evaluated the potential of caffeine in ADHD therapy. Female Wistar (WIS) and SHR rats were treated with caffeine (3mg/kg, i.p.) or methylphenidate (MPD, 2mg/kg, i.p.) for 14 consecutive days during the prepubertal period (post-natal days 25-38) and they were tested later in adulthood in the object-recognition task. WIS rats discriminated all the objects used, whereas SHR were not able to discriminate pairs of objects with subtle structural differences. Chronic treatment with caffeine or MPD improved the object-recognition deficits in SHR rats. Surprisingly, these treatments impaired the short-term object-recognition ability in adult WIS rats. The present drug effects are independent of changes in locomotor activity, arterial blood pressure and body weight in both rat strains. These findings suggest that chronic caffeine treatment during prepubertal period confers long-term cognitive benefits in discriminative learning impairments of SHR, suggesting caffeine as an alternative therapeutic strategy for the early management of ADHD symptoms. Nevertheless, our results also emphasize the importance of a correct diagnosis and the caution in the use of stimulant drugs such as caffeine and MPD during neurodevelopment since they can disrupt discriminative learning in non-ADHD phenotypes.

  7. Comparison of different combined treatment processes to address the source water with high concentration of natural organic matter during snowmelt period

    Pengfei Lin; Xiaojian Zhang; Jun Wang; Yani Zeng; Shuming Liu; Chao Chen


    The source water in one forest region of the Northeast China had very high natural organic matter (NOM) concentration and heavy color during snowmelt period.The efficiency of five combined treatment processes was compared to address the high concentration of NOM and the mechanisms were also analyzed.Conventional treatment can hardly remove dissolved organic carbon (DOC) in the source water.KMnO4 pre-oxidization could improve the DOC removal to 22.0%.Post activated carbon adsorption improved the DOC removal of conventional treatment to 28.8%.The non-sufficient NOM removal could be attributed to the dominance of large molecular weight organic matters in raw water,which cannot be adsorbed by the micropore upon activated carbon.O3 + activated carbon treatment are another available technology for eliminating the color and UV254 in water.However,its performance of DOC removal was only 36.4%,which could not satisfy the requirement for organic matter.The limited ozone dosage is not sufficient to mineralize the high concentration of NOM.Magnetic ion-exchange resin combined with conventional treatment could remove 96.2% of color,96.0% of UV254 and 87.1% of DOC,enabling effluents to meet the drinking water quality standard.The high removal efficiency could be explained by the negative charge on the surface of NOM which benefits the static adsorption of NOM on the anion exchange resin.The results indicated that magnetic ion-exchange resin combined with conventional treatment is the best available technology to remove high concentration of NOM.

  8. International Retrospective Chart Review of Treatment Patterns in Severe Familial Mediterranean Fever, Tumor Necrosis Factor Receptor-Associated Periodic Syndrome, and Mevalonate Kinase Deficiency/Hyperimmunoglobulinemia D Syndrome.

    Ozen, Seza; Kuemmerle-Deschner, Jasmin B; Cimaz, Rolando; Livneh, Avi; Quartier, Pierre; Kone-Paut, Isabelle; Zeft, Andrew; Spalding, Steve; Gul, Ahmet; Hentgen, Veronique; Savic, Sinisa; Foeldvari, Ivan; Frenkel, Joost; Cantarini, Luca; Patel, Dony; Weiss, Jeffrey; Marinsek, Nina; Degun, Ravi; Lomax, Kathleen G; Lachmann, Helen J


    Periodic fever syndrome (PFS) conditions are characterized by recurrent attacks of fever and localized inflammation. This study examined the diagnostic pathway and treatments at tertiary centers for familial Mediterranean fever (FMF), tumor necrosis factor receptor-associated periodic syndrome (TRAPS), and mevalonate kinase deficiency (MKD)/hyperimmunoglobulinemia D syndrome (HIDS). PFS specialists at medical centers in the US, the European Union, and the eastern Mediterranean participated in a retrospective chart review, providing de-identified data in an electronic case report form. Patients were treated between 2008 and 2012, with at least 1 year of followup; all had clinical and/or genetically proven disease and were on/eligible for biologic treatment. A total of 134 patients were analyzed: FMF (n = 49), TRAPS (n = 47), and MKD/HIDS (n = 38). Fever was commonly reported as severe across all indications. Other frequently reported severe symptoms were serositis for FMF patients and elevated acute-phase reactants and gastrointestinal upset for TRAPS and MKD/HIDS. A long delay from disease onset to diagnosis was seen within TRAPS and MKD/HIDS (5.8 and 7.1 years, respectively) compared to a 1.8-year delay in FMF patients. An equal proportion of TRAPS patients first received anti-interleukin-1 (anti-IL-1) and anti-tumor necrosis factor (anti-TNF) biologic agents, whereas IL-1 blockade was the main choice for FMF patients resistant to colchicine and MKD/HIDS patients. For TRAPS patients, treatment with anakinra versus anti-TNF treatments as first biologic agent resulted in significantly higher clinical and biochemical responses (P = 0.03 and P < 0.01, respectively). No significant differences in responses were observed between biologic agents among other cohorts. Referral patterns and diagnostic delays highlight the need for greater awareness and improved diagnostics for PFS. This real-world treatment assessment supports the need for further

  9. Prolonged Exposure Therapy for a Vietnam Veteran with PTSD and Early-Stage Dementia

    Duax, Jeanne M.; Waldron-Perrine, Brigid; Rauch, Sheila A. M.; Adams, Kenneth M.


    Although prolonged exposure therapy (PE) is considered an evidence-based treatment for PTSD, there has been little published about the use of this treatment for older adults with comorbid early-stage dementia. As the number of older adults in the United States continues to grow, so will their unique mental health needs. The present article…

  10. Periodic paralysis.

    Fontaine, Bertrand


    Periodic paralyses are rare diseases characterized by severe episodes of muscle weakness concomitant to variations in blood potassium levels. It is thus usual to differentiate hypokalemic, normokalemic, and hyperkalemic periodic paralysis. Except for thyrotoxic hypokalemic periodic paralysis and periodic paralyses secondary to permanent changes of blood potassium levels, all of these diseases are of genetic origin, transmitted with an autosomal-dominant mode of inheritance. Periodic paralyses are channelopathies, that is, diseases caused by mutations in genes encoding ion channels. The culprit genes encode for potassium, calcium, and sodium channels. Mutations of the potassium and calcium channel genes cause periodic paralysis of the same type (Andersen-Tawil syndrome or hypokalemic periodic paralysis). In contrast, distinct mutations in the muscle sodium channel gene are responsible for all different types of periodic paralyses (hyper-, normo-, and hypokalemic). The physiological consequences of the mutations have been studied by patch-clamp techniques and electromyography (EMG). Globally speaking, ion channel mutations modify the cycle of muscle membrane excitability which results in a loss of function (paralysis). Clinical physiological studies using EMG have shown a good correlation between symptoms and EMG parameters, enabling the description of patterns that greatly enhance molecular diagnosis accuracy. The understanding of the genetics and pathophysiology of periodic paralysis has contributed to refine and rationalize therapeutic intervention and will be without doubts the basis of further advances.

  11. Bryostatin and its synthetic analog, picolog rescue dermal fibroblasts from prolonged stress and contribute to survival and rejuvenation of human skin equivalents.

    Khan, Tapan K; Wender, Paul A; Alkon, Daniel L


    Skin health is associated with the day-to-day activity of fibroblasts. The primary function of fibroblasts is to synthesize structural proteins, such as collagen, extracellular matrix proteins, and other proteins that support the structural integrity of the skin and are associated with younger, firmer, and more elastic skin that is better able to resist and recover from injury. At sub-nanomolar concentrations (0.03-0.3 nM), bryostatin-1 and its synthetic analog, picolog (0.1-10 nM) sustained the survival and activation of human dermal fibroblasts cultured under the stressful condition of prolonged serum deprivation. Bryostatin-1 treatment stabilized human skin equivalents (HSEs), a bioengineered combination of primary human skin cells (keratinocytes and dermal fibroblasts) on an extracellular matrix composed of mainly collagen. Fibroblasts activated by bryostatin-1 protected the structural integrity of HSEs. Bryostatin-1 and picolog prolonged activation of Erk in fibroblasts to promote cell survival. Chronic stress promotes the progression of apoptosis. Dermal fibroblasts constitutively express all components of Fas associated apoptosis, including caspase-8, an initiator enzyme of apoptosis. Prolong bryostatin-1 treatment reduced apoptosis by decreasing caspase-8 and protected dermal fibroblasts. Our data suggest that bryostatin-1 and picolog could be useful in anti-aging skincare, and could have applications in tissue engineering and regenerative medicine. © 2017 Wiley Periodicals, Inc.

  12. Increased expression of miR-126 and miR-10a predict prolonged relapse-free time of primary oestrogen receptor-positive breast cancer following tamoxifen treatment.

    Hoppe, Reiner; Achinger-Kawecka, Joanna; Winter, Stefan; Fritz, Peter; Lo, Wing-Yee; Schroth, Werner; Brauch, Hiltrud


    Adjuvant tamoxifen is a valid treatment option for women with oestrogen receptor (ER)-positive breast cancer. However, up to 40% of patients experience distant or local recurrence or die. MicroRNAs have been suggested to be important prognosticators in breast cancer. This study aims to identify microRNAs with the potential to predict tamoxifen response. We performed a global microRNA screen (1105 human microRNAs) in primary tumours of six matched pairs of postmenopausal, ER-positive breast cancer patients treated with tamoxifen, who were either recurrence free or had developed a recurrence (median follow up: 8.84 years; range: 1.28-12.7 years). Patients of this discovery set and the 81 patients of the validation set (median follow up: 8.64 years; range: 0.21-19.85 years) were treated at the Robert Bosch Hospital, Stuttgart, Germany, between 1986 and 2005. Out of the top 20 deregulated microRNAs (12 up-regulated, eight down-regulated) miR-126 (Hazard Ratio (HR) = 0.56, 95% confidence interval (CI): 0.38-0.83; Holm-adj. P = 0.022) and miR-10a (HR = 0.53, 95% CI: 0.33-0.85; Holm-adj. P = 0.031) were identified as significant predictors of tamoxifen outcome by multivariate Cox regression analysis in the independent validation set of 81 postmenopausal, ER-positive patients. Kaplan-Meier survival analyses based on cut-offs determined by receiver operating characteristics curves confirmed that a higher expression of miR-126 and miR-10a in the patients tumour was associated with longer relapse-free time (log-rank P = 0.037, Ptamoxifen. Copyright © 2013 Elsevier Ltd. All rights reserved.

  13. Abnormal vascular function in PR-interval prolongation.

    Chan, Yap-Hang; Siu, Chung-Wah; Yiu, Kai-Hang; Li, Sheung-Wai; Lau, Kui-Kai; Lam, Tai-Hing; Lau, Chu-Pak; Tse, Hung-Fat


    Underlying mechanisms of PR-interval prolongation leading to increased risk of adverse cardiovascular outcomes, including atrial fibrillation, are unclear. This study aims to investigate the relation between PR interval and changes in vascular function. We hypothesize that there exists an intermediate pathological stage between electrocardiographic PR prolongation and adverse cardiovascular outcomes, which could be reflected by changes in surrogate measurements of vascular function. We recruited 88 healthy subjects (mean age 57.5 ± 9.8 y, 46% male) from a community-based health screening program who had no history of cardiovascular disease or diabetes mellitus. PR interval was determined from a resting 12-lead electrocardiogram. Vascular function was noninvasively assessed by flow-mediated dilation (FMD) using high-resolution ultrasound and brachial-ankle pulse wave velocity (PWV) using a vascular profiling system. Only 3 subjects had a PR-interval length longer than the conventional cutoff of 200 ms. The PR-interval length was associated inversely with FMD (Pearson r = -0.30, P = 0.004) and positively with PWV (r = 0.40, P PR-interval length by each 25 ms was independently associated with reduced FMD by -1 unit (absolute %, B = -0.04 [95% confidence interval: -0.080 to -0.002, P = 0.040)] and increased PWV by +103 cm/second (B = +4.1 [95% confidence interval: 0.6-7.6, P = 0.023]). This study shows that PR-interval length, even in the conventionally normal range, is independently associated with endothelial dysfunction and increased arterial stiffness in healthy subjects free of atherosclerotic disease. This suggests the presence of a systemic, intermediate pathologic stage of the vasculature in PR prolongation before clinically manifest cardiovascular events, and could represent a mediating mechanism. © 2011 Wiley Periodicals, Inc.

  14. Prolonged Paroxysmal Sympathetic Storming Associated with Spontaneous Subarachnoid Hemorrhage

    Yan Liu


    Full Text Available Paroxysmal sympathetic storming (PSS is a rare disorder characterized by acute onset of nonstimulated tachycardia, hypertension, tachypnea, hyperthermia, external posturing, and diaphoresis. It is most frequently associated with severe traumatic brain injuries and has been reported in intracranial tumors, hydrocephalous, severe hypoxic brain injury, and intracerebral hemorrhage. Although excessive release of catecholamine and therefore increased sympathetic activities have been reported in subarachnoid hemorrhage (SAH, there is no descriptive report of PSS primarily caused by spontaneous SAH up to date. Here, we report a case of prolonged PSS in a patient with spontaneous subarachnoid hemorrhage and consequent vasospasm. The sympathetic storming started shortly after patient was rewarmed from hypothermia protocol and symptoms responded to Labetalol, but intermittent recurrence did not resolve until 3 weeks later with treatment involving Midazolam, Fentanyl, Dexmedetomidine, Propofol, Bromocriptine, and minimizing frequency of neurological and vital checks. In conclusion, prolonged sympathetic storming can also be caused by spontaneous SAH. In this case, vasospasm might be a precipitating factor. Paralytics and hypothermia could mask the manifestations of PSS. The treatment of the refractory case will need both timely adjustment of medications and minimization of exogenous stressors or stimuli.

  15. [Prolonged pain in neonates: retrospective analysis].

    Lilla, Michèle; Stadelman-Diaw, Corinne; Ramelet, Anne-Sylvie


    Infants hospitalised in neonatology are inevitably exposed to pain repeatedly. Premature infants are particularly vulnerable, because they are hypersensitive to pain and demonstrate diminished behavioural responses to pain. They are therefore at risk of developing short and long-term complications if pain remains untreated. Compared to acute pain, there is limited evidence in the literature on prolonged pain in infants. However, the prevalence is reported between 20 and 40 %. This single case study aimed to identify the bio-contextual characteristics of neonates who experienced prolonged pain. This study was carried out in the neonatal unit of a tertiary referral centre in Western Switzerland. A retrospective data analysis of seven infants' profile, who experienced prolonged pain ,was performed using five different data sources. The mean gestational age of the seven infants was 32weeks. The main diagnosis included prematurity and respiratory distress syndrome. The total observations (N=55) showed that the participants had in average 21.8 (SD 6.9) painful procedures that were estimated to be of moderate to severe intensity each day. Out of the 164 recorded pain scores (2.9 pain assessment/day/infant), 14.6 % confirmed acute pain. Out of those experiencing acute pain, analgesia was given in 16.6 % of them and 79.1 % received no analgesia. This study highlighted the difficulty in managing pain in neonates who are exposed to numerous painful procedures. Pain in this population remains underevaluated and as a result undertreated.Results of this study showed that nursing documentation related to pain assessment is not systematic.Regular assessment and documentation of acute and prolonged pain are recommended. This could be achieved with clear guidelines on the Assessment Intervention Reassessment (AIR) cyclewith validated measures adapted to neonates. The adequacy of pain assessment is a pre-requisite for appropriate pain relief in neonates.

  16. 丁丙诺啡舌下含片与美沙酮用于海洛因依赖门诊稽延期治疗的对照研究%Control study of buprenorphine sublingual tablets and methadone for heroin addicts on out patients treatment during recovery period

    牛光胜; 杜万君; 王玉明; 郑杰


    目的 观察丁丙诺啡舌下含片与美沙酮用于海洛因依赖者稽延期治疗的价值。方法 对完成脱毒治疗患者,依先后次序交叉纳入观察组与对照组,分别给予丁丙诺啡舌下含片和美沙酮治疗6个月,观察操守时间,并于入组前后做焦虑量表评分。结果 丁丙诺啡舌下含片组比美沙酮组的操守时间长(P<0.01),焦虑评分低(P<0.05)。结论 丁丙诺啡舌下含片于海洛因依赖门诊稽延期治疗能更好地缓解焦虑情绪并延长操守时间。%Objective To observe the effect of buprenorphine sublingual tablets (Bup) and methadone for heroin addicts on out patients treatment during recovery period. Methods Heroin addicts who completed acute drug detoxification treatment were assigned in the order of cross to the observation group and control group. The observation group and the control group were treated with Bup and methadone, respectively for six months. Both groups were observed on the time of keeping heroin abstinence during the treatment and were assessed with Anxiety Scale before and after Bup or methadone treatment. Results Bup group kept abstinence from heroin longer than methadone group ( P <0.01 ) ,and had lower anxiety scores( P <0.05). Conclusion Bupernorphine sublingual tablets used for out patients at recovery period could better alleviate heroin addicts' anxiety and prolong their abstinence time.

  17. Cyclodextrin modified PLLA parietal reinforcement implant with prolonged antibacterial activity.

    Vermet, G; Degoutin, S; Chai, F; Maton, M; Flores, C; Neut, C; Danjou, P E; Martel, B; Blanchemain, N


    The use of textile meshes in hernia repair is widespread in visceral surgery. Though, mesh infection is a complication that may prolong the patient recovery period and consequently presents an impact on public health economy. Such concern can be avoided thanks to a local and extended antibiotic release on the operative site. In recent developments, poly-l-lactic acid (PLLA) has been used in complement of polyethyleneterephthalate (Dacron®) (PET) or polypropylene (PP) yarns in the manufacture of semi-resorbable parietal implants. The goal of the present study consisted in assigning drug reservoir properties and prolonged antibacterial effect to a 100% PLLA knit through its functionalization with a cyclodextrin polymer (polyCD) and activation with ciprofloxacin. The study focused i) on the control of degree of polyCD functionalization of the PLLA support and on its physical and biological characterization by Scanning Electron Microscopy (SEM), Differential Scanning Calorimetry (DSC) and cell viability, ii) on the understanding of drug/meshes interaction using mathematic model and iii) on the correlation between drug release studies in phosphate buffer saline (PBS) and microbiological evaluation of meshes and release medium against E. coli and S. aureus. All above mentioned tests highlighted the contribution of polyCD on the improved performances of the resulting antibacterial implantable material.

  18. Evaluation of periodontal status and effectiveness of non-surgical treatment in patients with type 2 diabetes mellitus in Taiwan for a 1-year period.

    Auyeung, Ling; Wang, Pei-Wen; Lin, Rue-Tsuan; Hsieh, Ching-Jung; Lee, Pei-Yu; Zhuang, Rui-Yeh; Chang, Hsueh-Wen


    The periodontal status and effects of non-surgical periodontal treatment in patients with type 2 diabetes mellitus and periodontal disease are assessed. One-hundred patients with type 2 diabetes (mean ± SD hemoglobin (Hb)A1c level: 7.3% ± 0.94%) and periodontal disease were recruited for this study. The group with moderate-to-severe periodontal disease included patients with >1 tooth with a probing depth (PD) ≥5 mm and >2 teeth with a clinical attachment loss (AL) ≥ 6mm, and the group with mild periodontal disease included patients with 2 affected with a clinical AL ≥ 6mm. Patients (28 patients in the mild group and 72 patients in the moderate-to-severe group) underwent non-surgical periodontal treatments. We analyzed differences in serum concentrations of metabolic parameters (glycated hemoglobin and low-density lipoprotein), inflammatory parameters (interleukin [IL]-1β and C-reactive protein [CRP]), and periodontal parameters between the two groups before treatment and at 3, 6, 9, and 12 months post-therapy. Seventy-five patients with diabetes (21 patients in the mild group and 54 patients in the moderate-to-severe group) completed the study. Significant differences in the plaque index (PI), gingival index (GI), PD, and clinical AL at examination times were observed in the whole cohort (P periodontal treatment improved and maintained the periodontal health of patients with well-controlled diabetes, but no significant reduction of metabolic parameters was observed over a 1-year period.

  19. Effect of prolonged annealing on the performance of coaxial Ge gamma-ray detectors

    Owens, A.; Brandenburg, S.; Buis, E. -J.; Kozorezov, A. G.; Kraft, S.; Ostendorf, R. W.; Quarati, F.


    The effects of prolonged annealing at elevated temperatures have been investigated in a 53 cm(3) closed-end coaxial high purity germanium detector in the reverse electrode configuration. The detector was multiply annealed at 100 degrees C in block periods of 7 days. After each anneal cycle it was co

  20. Is duration of postoperative fasting associated with infection and prolonged length of stay in surgical patients?

    Assis, Michelli Cristina Silva de; Carla Rosane de Moraes SILVEIRA; Beghetto, Mariur Gomes; Mello, Elza Daniel de


    Objective: Verify whether the postoperative fasting period increases the risk for infection and prolonged length of stay. Methods: Prospective cohort study. Elective surgery patients were included. Excluded: those with no conditions for nutritional assessment, admitted in minimal care units, as well as with

  1. Prolonged remission of leukemia associated with polycythemia vera.

    Hazani, A; Tatarsky, I; Barzilai, D


    A patient with polycythemia vera (PV) received successive treatment by phlebotomies, radioactive phosphorus, myleran and cyclophosphamide. Sixteen years after the diagnosis, he developed acute myeloblastic leukemia. A complete remission was achieved following two courses of COAP (cyclophosphamide, vincristine, Cytosine Arabinoside, and prednisone) therapy. Four months later, while still in leukemic remission, he became mildly polycythemic again and the treatment with phlebotomies and cyclophosphamide was resume. The patient has subsequently been in complete remission of leukemia for over three years and his polycythemia is controlled by small doses of cyclophosphamide. This appears to be a unique case of such a prolonged remission of leukemia in the course of PV, with a return to a mild polycythemia state.

  2. ASME N511-19XX, Standard for periodic in-service testing of nuclear air treatment, heating, ventilating and air conditioning systems



    A draft version of the Standard is presented in this document. The Standard covers the requirements for periodic in-service testing of nuclear safety-related air treatment, heating, ventilating, and air conditioning systems in nuclear facilities. The Standard provides a basis for the development of test programs and does not include acceptance criteria, except in cases where the results of one test influence the performance of other tests. The Standard covers general inspection and test requirements, reference values, inspection and test requirements, generic tests, acceptance criteria, in-service test requirements, testing following an abnormal incident, corrective action requirements, and quality assurance. Mandatory appendices provide a visual inspection checklist and four test procedures. Non-mandatory appendices provide additional information and guidance on mounting frame pressure leak test procedure, corrective action, challenge gas substitute selection criteria, and test program development. 8 refs., 10 tabs.

  3. Establishing and sustaining a healthy vaginal environment: analysis of data from a randomized trial of periodic presumptive treatment for vaginal infections.

    Balkus, Jennifer E; Richardson, Barbra A; Mandaliya, Kishorchandra; Kiarie, James; Jaoko, Walter; Ndinya-Achola, Jeckoniah O; Marrazzo, Jeanne; Farquhar, Carey; McClelland, R Scott


    Data from a randomized trial of oral periodic presumptive treatment (PPT) to reduce vaginal infections were analyzed to assess the effect of the intervention on a healthy vaginal environment (normal flora confirmed by Gram stain with no candidiasis or trichomoniasis). The incidence of a healthy vaginal environment was 608 cases per 100 person-years in the intervention arm and 454 cases per 100 person-years in the placebo arm (hazard ratio [HR], 1.36; 95% confidence interval [CI], 1.17-1.58). Sustained vaginal health (healthy vaginal environment for ≥3 consecutive visits) was also more frequent in the intervention arm (HR, 1.69; 95% CI, 1.23-2.33). PPT is effective at establishing and sustaining a healthy vaginal environment.

  4. Prolonged sleep fragmentation of mice exacerbates febrile responses to lipopolysaccharide

    Ringgold, Kristyn M.; Barf, R. Paulien; George, Amrita; Sutton, Blair C.; Opp, Mark R.


    Background Sleep disruption is a frequent occurrence in modern society. Whereas many studies have focused on the consequences of total sleep deprivation, few have investigated the condition of sleep disruption. New Method We disrupted sleep of mice during the light period for 9 consecutive days using an intermittently-rotating disc. Results Electroencephalogram (EEG) data demonstrated that non-rapid eye movement (NREM) sleep was severely fragmented and REM sleep was essentially abolished during the 12 h light period. During the dark period, when sleep was not disrupted, neither NREM sleep nor REM sleep times differed from control values. Analysis of the EEG revealed a trend for increased power in the peak frequency of the NREM EEG spectra during the dark period. The fragmentation protocol was not overly stressful as body weights and water consumption remained unchanged, and plasma corticosterone did not differ between mice subjected to 3 or 9 days of sleep disruption and home cage controls. However, mice subjected to 9 days of sleep disruption by this method responded to lipopolysaccharide with an exacerbated febrile response. Comparison with existing methods Existing methods to disrupt sleep of laboratory rodents often subject the animal to excessive locomotion, vibration, or sudden movements. This method does not suffer from any of these confounds. Conclusions This study demonstrates that prolonged sleep disruption of mice exacerbates febrile responses to lipopolysaccharide. This device provides a method to determine mechanisms by which chronic insufficient sleep contributes to the etiology of many pathologies, particularly those with an inflammatory component. PMID:23872243

  5. Irregular Periods

    ... blood become too low or too high. Some women have irregular periods because their bodies produce too much androgen, which is a hormone that causes increased muscle mass, facial hair, and deepening of the voice in males and ...

  6. Period Pain

    ... You may also have other symptoms, such as lower back pain, nausea, diarrhea, and headaches. Period pain is not ... Taking a hot bath Doing relaxation techniques, including yoga and meditation You might also try taking over- ...

  7. [Effectiveness of pidotimod in combination with bacterial lysates in the treatment of the pfapa (periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis) syndrome].

    Buongiorno, A; Pierossi, N


    PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis) syndrome is the most common autoinflammatory syndrome in pediatrics, accepted as an hyperimmune condition. Pidotimod is a molecule with immunomodulatory activity on both innate and adaptive immune responses; it also has the capacity to modulate the function of the respiratory epithelial cells through the activation of a NK-KB pathway which would involve the host-virus interaction. Moreover, the proven beneficial effect of Pidotimod in enhancing the immune response during vaccination, and its benefits in the prevention of respiratory tract infections, should be noted. A joint combination of Pidotimod and bacterial lysates was used to treat 37 children with a clinical diagnosis of PFAPA; within the end of the first year of therapy, the healing rate of PFAPA symptoms was 67.5% (25 children), with a 10.8% (4 cases) still in complete remission within the end of the second year of follow-up. It is important to highlight that 29 children (78.3%) had benefitted from this therapy, in terms of healing, with a marked decrease in the incidence of fever from a total of 360 to 106 episodes, and episodes of periodic fever occurring almost 4 times less frequently. The use of Pidotimod determined a significant reduction of surgical tonsillectomy's treatment. This approach had a strong impact on the children's quality of life; a significant decrement in the use of antipyretic drugs, as well as a lower rate of antibiotic prescription, were also noted. It also had a dramatic impact on families' lives, because the treatment lowers the number of absences of family members from work or school/kindergarten.

  8. Reduced gastric acid production in burn shock period and its significance in the prevention and treatment of acute gastric mucosal lesions

    Li Zhu; Zhong Cheng Yang; Ao Li; De Chang Cheng


    AIM To investigate the changes of gastric acid production and its mechanism in shock period of severe burn in rats.METHODS A rat model with 30% TBSA fullthickness burn injury was employed and the gastric acid production, together with gastric mucosal blood flow (GMBF) and energy charge ( EC ) were measured serially within 48h postburn.RESULTS The gastric acid production in the acute shock period was markedly inhibited after severe burn injury. At the 3rd h postburn, the gastric juice volume, total acidity and acid output were already significantly decreased (P<0.01), and reached the lowest point,0.63mL/L ± 0.20mL/L, 10.81mmol/L ±2.58mmol/L and 2.23 mmol/h ± 0.73mmol/h respectively, at the 12th h postburn. Although restored to some degree 24 h after thermal injury, the variables above were still statistically lower, compared with those of control animals at the 48th h postburn. The GMBF and EC were also significantly reduced after severe burns, consistent with the trend of gastric acid production changes.CONCLUSION Gastric acid production, as well as GMBF and EC was predominantly decreased in the early postburn stage, suggesting that gastric mucosal ischemia and hypoxia with resultant disturbance in energy metabolism, but not gastric acid proper, might be the decisive factor in the pathogenesis of AGML after thermal injury, and that the preventive use of anti-acid drugs during burn shock period was unreasonable in some respects. Therefore,taking effective measures to improve gastric mucosal blood perfusion as early as possible postburn might be more preferable for the AGML prevention and treatment.


    V. N. Poptsov


    Full Text Available Aim: of our clinical study was to present own experience of veno-venous extracorporeal membrane oxygenation (VV ECMO for the treatment of an adult patient (female, 28 yrs, 150 cm, 35 kg with acute respiratory distress syndrome (ARDS in the early period after liver transplantation against satisfactory liver graft function. Materials and methods. Double-lumen cannula 22 F was placed percutaneously in the right internal jugular vein. The ext- racorporeal contour reduced in length and the polymethylpeptene oxygenator (priming volume 175 ml were also. Results. In 1 hour after the beginning of VV ECMO, we registered the noted improvement of arterial blood gas and acid-base balance (regress of respiratory acidosis, improvement of arterial oxygenation which allowed us to use the «protective» mode of mechanical ventilation. Improvement of gas exchange and regress of clinical and radiological manifestations of ARDS allowed for VV ECMO weaning and decannulation on day 7. The patient was discharged from ICU and then from our Centre to a homestay respectively on the 9th and 16th day after VV ECMO weaning with the satisfactory liver graft and lungs function. Conclusion. VV ECMO can be successfully applied to correct the life-threatening acute respiratory failure in the early period after liver transplantation. 

  10. Eyelid hygiene as a tool for prevention and treatment of complications due to ocular surface diseases in early post-LASIK period

    V. V. Kurenkov


    Full Text Available Purpose: to analyze the effect of eyelid hygiene and therapy on early post-op period following excimer laser refractive surgery.Methods: 144 patients (288 eyes aged 18-57 yrs who underwent excimer laser vision correction (LASIK were followed. All patients were divided into two groups depending on therapy. In treatment group (70 patients/140 eyes, eyelid hygiene was prescribed 7 days before and 7 days again following refractive surgery for 1 or 2 months. In control group (74 patients/148 eyes, no eyelid hygiene was prescribed.Results: Complex method of eyelid hygiene and therapy was developed that consisted in eyelid margins self-massage using Blepharogel 1 or Blepharogel 2 and warm compresses using Blepharopads impregnated with Blepharolotion. When using in combina- tion with antibacterial and tear replacement therapy, this method provides significant decrease in infectious complications rate and effective recovery of tear production in early post-op period following excimer laser surgery. these observations are confirmed by the dynamics of clinical, functional and subjective parameters.Conclusion: 7-days eyelid hygiene and therapy course that is prescribed immediately before and following laser vision correctionprovides multi-factorial effect, i.e., reduces post-op inflammatory complications rate and increases tear film stability.

  11. Eyelid hygiene as a tool for prevention and treatment of complications due to ocular surface diseases in early post-LASIK period

    V. V. Kurenkov


    Full Text Available Purpose: to analyze the effect of eyelid hygiene and therapy on early post-op period following excimer laser refractive surgery.Methods: 144 patients (288 eyes aged 18-57 yrs who underwent excimer laser vision correction (LASIK were followed. All patients were divided into two groups depending on therapy. In treatment group (70 patients/140 eyes, eyelid hygiene was prescribed 7 days before and 7 days again following refractive surgery for 1 or 2 months. In control group (74 patients/148 eyes, no eyelid hygiene was prescribed.Results: Complex method of eyelid hygiene and therapy was developed that consisted in eyelid margins self-massage using Blepharogel 1 or Blepharogel 2 and warm compresses using Blepharopads impregnated with Blepharolotion. When using in combina- tion with antibacterial and tear replacement therapy, this method provides significant decrease in infectious complications rate and effective recovery of tear production in early post-op period following excimer laser surgery. these observations are confirmed by the dynamics of clinical, functional and subjective parameters.Conclusion: 7-days eyelid hygiene and therapy course that is prescribed immediately before and following laser vision correctionprovides multi-factorial effect, i.e., reduces post-op inflammatory complications rate and increases tear film stability.

  12. Development of rabbit embryos during a 96-h period of in vitro culture after superovulatory treatment under conditions of elevated ambient temperature.

    Cheng, H; Dooley, M P; Hopkins, S M; Anderson, L L; Yibchok-anun, S; Hsu, W H


    The effects of elevated ambient temperature on the response to exogenous gonadotropins were evaluated in female New Zealand White rabbits exposed to 33+/-1 degrees C (mean +/- SE) and 10-30% relative humidity (8 h/day) during a 5-day period. Does were treated with pFSH (0.3 mg/0.3 ml Standard Armour) twice daily during three consecutive days with a minimum interval of 8 h between injections. Six hours after the last FSH injection all does were removed from the experimental chamber, given hCG (25 IU/kg) and paired overnight. Nineteen hours after pairing, embryos were flushed from the reproductive tracts, evaluated, and subjected to in vitro culture during a 96-h period. The ovulatory responses to exogenous gonadotropins and fertilization rates did not differ significantly under conditions of elevated ambient temperature, whereas fewer blastocysts and increased number of degenerate embryos were observed after culture. We conclude that although hyperthermia was induced during exposure to elevated ambient temperature, it did not alter the ovulatory responses to gonadotropin treatment and plasma concentrations of FSH and LH compared with does in a thermoneutral environment. Exposure of donor rabbits to elevated ambient temperature before mating, however, increased embryonic degeneration.

  13. Prevention of neutropenia during chemotherapy by prolonged myelostimulatory preparations

    V. V. Ptushkin


    Full Text Available Neutropenia and associated infection, resulting in hospitalization and use of antibiotics, has a negative effect on chemotherapy. The need to reduce the dose of cytotoxic drugs during neutropenia leads to lower survival rates in patients with hematological malignancies and solid tumors. Since 1990s myelocytokines – proteins that accelerate neutrophil recovery after cytostatic chemotherapy and reduce the risk of infection – is widely used in the clinical practice. The use of these drugs can support the planned dose intensity of chemotherapy and improves the treatment efficacy. The disadvantages of these drugs include the need for their daily parenteral administration for 7–10 days. The development of long-acting forms (pegfilgrastim and lipegfilgrastim has solved this problem. Self-regulating clearance of prolonged forms allowed to use them only once on a chemotherapy course. Results of pegfilgrastim administration in 25 patients with hematological malignancies (8 patients and solid tumors (17 patients included in our analysis. Prolonged preparation showed high efficacy in secondary prophylaxis of neutropenia and infection decreasing the risk by 82 %. The single administration of pegfilgrastim allowed safe dose intensity chemotherapy with shorter intervals between courses (AC-14 in 8 patients with breast cancer. Tolerability was good; cases of hyperleukocytosis have notbeen reported. Recently in Europe and the Russian Federation a new drug from prolonged myelocytokine group – lipegfilgrastim – has been registered. The results of two controlled trials in patients with breast cancer (n = 410 receiving doxorubicin/docetaxel showed high efficacy of the drug as the pegfilgrastim with comparable tolerability.

  14. Prolonged labour as indication for emergency caesarean section

    Maaløe, Nanna; Sorensen, B L; Onesmo, R


    To audit the quality of obstetric management preceding emergency caesarean sections for prolonged labour.......To audit the quality of obstetric management preceding emergency caesarean sections for prolonged labour....

  15. Kerathocyst odontogenic tumor: Importance of selection the best treatment modality and a periodical follow-up to prevent from recurrence: A case report and literature review

    Nasim Jafaripozve


    Full Text Available The keratocystic odontogenic tumor (KCOT is a relatively common oral and maxillofacial lesion with specific characteristics such us rapid growth, extension into the surrounding tissues and high rates of recurrence. Various treatment modalities have been reported. Due to the very thin and friable lining characteristic of the tumor, enucleation can be difficult undertaken and for this reason it is associated with the highest recurrence rates. A 22-year-old male referred to our clinic due to a slight expansion in the right mandible from 2 years ago. He has a history of occurrence of KCOT in this region that was treated surgically by enucleation and curettage 5 years ago. Cone beam computed tomography showed a multilocular radiolucent lesion that extended from the angle of the mandible to the symphysis. Incisional biopsy showed a KCOT recurrence that surgically treated with resection of the right mandible by continuity preservation. Selection of the best treatment modality and also a periodical lifelong follow-up is very important to reduce the rate of recurrence and morbidity of the patient.

  16. Quality Assessment of Palm Products upon Prolonged Heat Treatment

    Tarmizi, Azmil Haizam Ahmad; Lin, Siew Wai


    Extending the frying-life of oils is of commercial and economic importance. Due to this fact, assessment on the thermal stability of frying oils could provide considerable savings to the food processors...

  17. Identifying Molecular Targets For PTSD Treatment Using Single Prolonged Stress


    2012 Mindfulness and Self-compassion Meditation for Coping with Deployment-Related Posttraumatic...Shalev) 04/1/2014 - 03/31/2019 Other support now closed Using the neuroscience of parental behavior to inform the science of

  18. New Heterogeneous Clustering Protocol for Prolonging Wireless Sensor Networks Lifetime

    Md. Golam Rashed


    Full Text Available Clustering in wireless sensor networks is one of the crucial methods for increasing of network lifetime. The network characteristics of existing classical clustering protocols for wireless sensor network are homogeneous. Clustering protocols fail to maintain the stability of the system, especially when nodes are heterogeneous. We have seen that the behavior of Heterogeneous-Hierarchical Energy Aware Routing Protocol (H-HEARP becomes very unstable once the first node dies, especially in the presence of node heterogeneity. In this paper we assume a new clustering protocol whose network characteristics is heterogeneous for prolonging of network lifetime. The computer simulation results demonstrate that the proposed clustering algorithm outperforms than other clustering algorithms in terms of the time interval before the death of the first node (we refer to as stability period. The simulation results also show the high performance of the proposed clustering algorithm for higher values of extra energy brought by more powerful nodes.

  19. Oleanolic acid reduces hyperglycemia beyond treatment period with Akt/FoxO1-induced suppression of hepatic gluconeogenesis in type-2 diabetic mice.

    Xiao-Yi Zeng

    Full Text Available The present study investigated the chronic efficacy of oleanolic acid (OA, a triterpenoid selected from our recent screening, on hyperglycemia in type-2 diabetic mice. C57BL/6J mice were fed a high-fat diet followed by low doses of streptozotocin to generate a type-2 diabetic model. OA (100 mg/kg/day was administered orally for 2 weeks with its effects monitored for 6 weeks. High-fat feeding and streptozotocin generated a steady hyperglycemia (21.2 ± 1.1 mM but OA administration reversed the hyperglycemia by ~60%. Interestingly, after the cessation of OA administration, the reversed hyperglycemia was sustained for the entire post-treatment period of the study (4 weeks despite the reoccurrence of dyslipidemia. Examination of insulin secretion and pancreas morphology did not indicate improved β-cell function as a likely mechanism. Urine glucose loss was decreased with substantial improvement of diabetic nephropathy after the OA treatment. Pair-feeding the OA-treated mice to an untreated group ruled out food intake as a main factor attributable for this sustained reduction in hyperglycemia. Studies with the use of glucose tracers revealed no increase in glucose influx into muscle, adipose tissue or liver in the OA-treated mice. Finally, we analyzed key regulators of gluconeogenesis in the liver and found significant increases in the phosphorylation of both Akt and FoxO1 after treatment with OA. Importantly, these increases were significantly correlated with a down-regulation of glucose-6-phosphatase expression. Our findings suggest triterpenoids are a potential source of new efficacious drugs for sustained control of hyperglycemia. The liver appears to be a major site of action, possibly by the suppression of hepatic glucose production via the Akt/FoxO1 axis.

  20. [Prolonged acute pancreatitis after bone marrow transplantation].

    De Singly, B; Simon, M; Bennani, J; Wittnebel, S; Zagadanski, A-M; Pacault, V; Gornet, J-M; Allez, M; Lémann, M


    Acute pancreatitis is not infrequent after allogenic marrow transplantation. Several causes can predispose to pancreatitis, including Graft-Versus-Host Disease (GVHD), a condition which is probably underestimated. In the literature, few description of pancreatic GVHD can be found. Pancreatic GVHD diagnosis can be difficult if pancreatic involvement occurs without other typical manifestations of GVHD. We report the case of a woman, 54 years old, suffering from prolonged, painful pancreatitis two months after allogenic bone marrow transplantation for acute myeloid leucemia. Pancreatic GVHD diagnosis was performed after five weeks on duodenal biopsies despite the absence of diarrheoa. The patient dramatically improved within few days on corticosteroids.

  1. Resistance to corrosion by water at high temperatures of Al-Fe-Ni alloy after prolonged heat treatment. Influence of Ti and Zr additions; Tenue a la corrosion par l'eau a haute temperature de l'alliage Al-Fe-Ni apres des chauffages de longue duree. Influence des additions Ti et Zr

    Lelong, P.; Moisan, J.; Herenguel, J. [Commissariat a l' Energie Atomique, Saclay (France).Centre d' Etudes Nucleaires; Centre de Recherches de la Ste des Trefileries et Laminoirs du Havre, 92 - Antony (France)


    The influence of titanium and zirconium additions on the heterogeneity texture of Al-Fe-Ni alloys, and the resultant effect on their corrosion resistance, is briefly recalled. The present article records the results of corrosion tests on these alloys after prolonged heat treatment. Without additions, the eutectic structure of the basis alloy is subject to a coalescence, which results in a deterioration of corrosion resistance. This effect applies equally to the as-cast and to the wrought conditions. The addition of titanium or zirconium retards this deterioration very considerably, both for the as-cast and wrought alloys. (author) [French] Apres un rappel de l'influence la texture d'heterogeneite sur la tenue a la corrosion, et du role joue par les additions de titane et de zirconium sur cette texture, il est rapporte dans le present travail les resultats d'essais de corrosion apres ces chauffages de longue duree. Pour l'alliage de base, la coalescence de l'eutectique dans l'etat de fonderie comme dans l'etat corroye, suivie micrographiquement, s'accompagne d'une degradation sensible de la tenue a la corrosion. Les additions de zirconium et de titane retardent tres fortement cette degradation, qu'il s'agisse encore de la texture de fonderie ou de celle de corroyage. (auteur)

  2. Periodic behaviors

    Napp, Diego; Shankar, Shiva


    This paper studies behaviors that are defined on a torus, or equivalently, behaviors defined in spaces of periodic functions, and establishes their basic properties analogous to classical results of Malgrange, Palamodov, Oberst et al. for behaviors on R^n. These properties - in particular the Nullstellensatz describing the Willems closure - are closely related to integral and rational points on affine algebraic varieties.


    Napp, Diego; Put, Marius van der; Shankar, Shiva


    This paper studies behaviors that are defined on a torus, or equivalently, behaviors defined in spaces of periodic functions, and establishes their basic properties analogous to classical results of Malgrange, Palamodov, Oberst et al. for behaviors on R(n). These properties-in particular the Nullste

  4. Lifetime Prolonging Algorithms for Underwater Sensor Networks

    GUO Zhong-wen; LI Zhi-wei; YU Lei


    Underwater acoustic modem technology has attained a level of maturity to support underwater acoustic sensor networks (UASNs) which are generally formed by acoustically connected sensor nodes and a surface station providing a link to an on-shore control center. While many applications require long-term monitoring of the deployment area, the battery-powered network nodes limit the lifetime of UASNs. Therefore, designing a UASN that minimizes the power consumption while maximizing lifetime becomes a very difficult task. In this paper, a method is proposed to determine the optimum number of clusters through combining an application-specific protocol architecture and underwater acoustic communication model so as to reduce the energy dissipation of UASNs. Deploying more sensor nodes which work alternately is another way to prolong the lifetime of UASNs. An algorithm is presented for selecting sensor nodes and putting them into operation in each round, ensuring the monitoring to the whole given area. The present results show that the algorithm can help prolong system lifetime remarkably when it is applied to other conventional approaches for sensor networks under the condition that the sensor node density is high.

  5. Effectiveness of Cognitive Processing Therapy and Prolonged Exposure in the Department of Veterans Affairs.

    Rutt, Benjamin T; Oehlert, Mary E; Krieshok, Thomas S; Lichtenberg, James W


    Objective This study evaluated the effectiveness of cognitive processing therapy and prolonged exposure in conditions reflective of current clinical practice within the Veterans Health Administration. Method This study involved a retrospective review of 2030 charts. A total of 750 veterans from 10 U.S. states who received cognitive processing therapy or prolonged exposure in individual psychotherapy were included in the study (participants in cognitive processing therapy, N = 376; participants in prolonged exposure, N = 374). The main dependent variable was self-reported posttraumatic stress disorder symptoms as measured by total scores on the Posttraumatic Stress Disorder Checklist. The study used multilevel modeling to evaluate the absolute and relative effectiveness of both treatments and determine the relationship between patient-level variables and total Posttraumatic Stress Disorder Checklist scores during treatment. Results Cognitive processing therapy and prolonged exposure were equally effective at reducing total Posttraumatic Stress Disorder Checklist scores. Veterans who completed therapy reported significantly larger reductions in the Posttraumatic Stress Disorder Checklist than patients who did not complete therapy. There were no significant differences in the improvement of posttraumatic stress disorder symptoms with respect to age and three racial/ethnic groups (Caucasian, African American, and Hispanic). Conclusions Cognitive processing therapy and prolonged exposure were shown to be effective in conditions highly reflective of clinical practice and with a highly diverse sample of veterans. Challenges related to dropout from trauma focused therapy should continue to be researched.

  6. An Automatic Prolongation Detection Approach in Continuous Speech With Robustness Against Speaking Rate Variations

    Esmaili, Iman; Dabanloo, Nader Jafarnia; Vali, Mansour


    In recent years, many methods have been introduced for supporting the diagnosis of stuttering for automatic detection of prolongation in the speech of people who stutter. However, less attention has been paid to treatment processes in which clients learn to speak more slowly. The aim of this study was to develop a method to help speech-language pathologists (SLPs) during diagnosis and treatment sessions. To this end, speech signals were initially parameterized to perceptual linear predictive (PLP) features. To detect the prolonged segments, the similarities between successive frames of speech signals were calculated based on correlation similarity measures. The segments were labeled as prolongation when the duration of highly similar successive frames exceeded a threshold specified by the speaking rate. The proposed method was evaluated by UCLASS and self-recorded Persian speech databases. The results were also compared with three high-performance studies in automatic prolongation detection. The best accuracies of prolongation detection were 99 and 97.1% for UCLASS and Persian databases, respectively. The proposed method also indicated promising robustness against artificial variation of speaking rate from 70 to 130% of normal speaking rate. PMID:28487827

  7. 儿童周期性内斜视的屈光状态与治疗%Refractive status and treatment of children of periodic esotropia



    目的:通过临床病例资料回顾性分析探讨儿童周期性内斜视的屈光状态,并探讨相应的临床治疗方法。方法:以2013年1月至2014年12月期间在我院我院门诊筛查的1321例3到7岁学龄前儿童作为本组研究的观察对象,用复方托品卡胺眼水点眼散瞳验光,检验患儿的屈光度;斜视日与正位日用三棱镜测量斜视度;用同视机检验双眼立体视觉;手术量根据斜视日最大斜视角设计。结果:本组1321例3到7岁学龄前儿童中共筛查出17例周期性内斜视,检测出现轻度远视11例(11眼)、中度远视5例(5眼)、无屈光不正1例(1眼),发生率为1.28%;经手术矫正治疗后斜视日均有复视,正位日有双眼立体视觉,在斜视日与非斜视日眼位均得到矫正并有正常的立体视觉。结论:周期性内斜视与远视屈光状态密切相关,通过早期屈光状态检测,给予戴镜矫正并及时手术治疗效果较为确切。%Objective:through the clinical data of retrospective analysis of refractive status of children of periodic esotropia,and discuss the corresponding methods of clinical treatment.Methods:during the December January 2013 to 2014 in our hospital outpatient screening of 1321 cases of 3 to 7 years old pre-school children as the research object of observation,compound tropine card amine water eye drops mydriasis optometry,test with diopter;strabismus,and is a daily three prism measurement strabismus degree;with the same visual machine test binocular stereo vision;strabismus,the largest angle according to the amount of the operation.Results:in this group of 1321 cases of 3 to 7 years old preschool children CPC screening out of 17 cases of periodic esotropia,detecting the presence of a mild hyperopia in 11 cases (11 eyes),moderate hyperopia in 5 cases (5 eyes),refractive error in 1 case (1 eye),incidence rate of 1.28%;sur-gically corrected treatment of strabismus after daily

  8. Imatinib treatment of poor prognosis mesenchymal-type primary colon cancer: a proof-of-concept study in the preoperative window period (ImPACCT).

    Ubink, I; Bloemendal, H J; Elias, S G; Brink, M A; Schwartz, M P; Holierhoek, Y C W; Verheijen, P M; Boerman, A W; Mathijssen, R H J; de Leng, W W J; de Weger, R A; van Grevenstein, W M U; Koopman, M; Lolkema, M P; Kranenburg, O; Borel Rinkes, I H M


    than non-selected patients with late-stage disease. By making use of the pre-operative window period, the biological effect of imatinib treatment on CMS4 tumours can be rapidly assessed. Delivering proof-of-concept for drug action in early stage disease should form the basis for the design of future trials with subtype-targeted therapies in colon cancer patients. NCT02685046 . Registration date: February 9, 2016.

  9. Quetiapine, QTc interval prolongation, and torsade de pointes: a review of case reports.

    Hasnain, Mehrul; Vieweg, W Victor R; Howland, Robert H; Kogut, Christopher; Breden Crouse, Ericka L; Koneru, Jayanthi N; Hancox, Jules C; Digby, Geneviève C; Baranchuk, Adrian; Deshmukh, Anand; Pandurangi, Ananda K


    Recently, both the manufacturer of quetiapine and the US Food and Drug Administration warned healthcare providers and patients about quetiapine-induced QTc interval prolongation and torsade de pointes (TdP) when using this drug within the approved labeling.  We reviewed the case-report literature and found 12 case reports of QTc interval prolongation in the setting of quetiapine administration. There were no cases of quetiapine-induced TdP or sudden cardiac death (SCD) among patients using quetiapine appropriately and free of additional risk factors for QTc interval prolongation and TdP. Among the 12 case reports risk factors included female sex (nine cases), coadministration of a drug associated with QTc interval prolongation (eight cases), hypokalemia or hypomagnesemia (six cases) quetiapine overdose (five cases), cardiac problems (four cases), and coadministration of cytochrome P450 3A4 inhibitors (two cases). There were four cases of TdP. As drug-induced TdP is a rare event, prospective studies to evaluate the risk factors associated with QTc prolongation and TdP are difficult to design, would be very costly, and would require very large samples to capture TdP rather than its surrogate markers. Furthermore, conventional statistical methods may not apply to studies of TdP, which is rare and an 'outlier' manifestation of QTc prolongation. We urge drug manufacturers and regulatory agencies to periodically publish full case reports of psychotropic drug-induced QTc interval prolongation, TdP, and SCD so that clinicians and investigators may better understand the clinical implications of prescribing such drugs as quetiapine.

  10. Entacapone prolongs the reduction of PLM by levodopa/carbidopa in restless legs syndrome.

    Polo, Olli; Ylä-Sahra, Riitta; Hirvonen, Kari; Karvinen, Johanna; Vahteristo, Mikko; Ellmén, Juha


    Levodopa is effective in the treatment of restless legs syndrome (RLS). However, due to the short duration of action of conventional levodopa/decarboxylase inhibitor formulations, multiple dosing may be required in individual patients with persisting symptoms. We assessed whether a new levodopa formulation containing levodopa, carbidopa, and entacapone (LCE) improves levodopa action in RLS. Twenty-eight RLS patients with periodic limb movement (PLM) received single doses of Stalevo 50 (LCE50; 50/12.5/200 mg), Stalevo 100 (LCE100; 100/25/200 mg), Stalevo 150 (LCE150; 150/37.5/200 mg), Sinemet 100 (LC100; 100/25 mg), or placebo in a randomized, double-blind, crossover study with polysomnography. Periodic limb movements per hour (PLM/h) during total sleep time and PLM during total time in bed were the primary and secondary variables, respectively. Mean PLM/h during total sleep time after Stalevo 50 (12.6/h, P PLM/h during total time in bed for all treatments (P < 0.01) and a significant dose response observed between LCE doses (P < 0.05). Compared with LC100, LCE100 and LCE150 reduced PLMs during the second half (P = 0.06 and P < 0.001, respectively) or during the last 3 early morning hours (hours 5-7 from the start of recording) of the night (P < 0.05 and P < 0.01, respectively). All formulations were well tolerated. Single doses of LCE tablets decreased PLMs in a dose-related manner in RLS patients. Prolonged effects of levodopa on PLMs suggest that, compared with standard levodopa, this new levodopa formulation provides longer symptom control throughout the night in patients with previously untreated RLS.

  11. Canakinumab treatment for patients with active recurrent or chronic TNF receptor-associated periodic syndrome (TRAPS): an open-label, phase II study

    Gattorno, Marco; Obici, Laura; Cattalini, Marco; Tormey, Vincent; Abrams, Ken; Davis, Nicole; Speziale, Antonio; Bhansali, Suraj G; Martini, Alberto; Lachmann, Helen J


    Objective To evaluate the efficacy of canakinumab, a high-affinity human monoclonal anti-interleukin-1β antibody, in inducing complete or almost complete responses in patients with active tumour necrosis factor receptor-associated periodic syndrome (TRAPS). Methods Twenty patients (aged 7–78 years) with active recurrent or chronic TRAPS were treated with canakinumab 150 mg every 4 weeks for 4 months (2 mg/kg for those ≤40 kg) in this open-label, proof-of-concept, phase II study. Canakinumab was then withdrawn for up to 5 months, with reintroduction on relapse, and 4 weekly administration (subsequently increased to every 8 weeks) for 24 months. The primary efficacy variable was the proportion of patients achieving complete or almost complete response at day 15, defined as clinical remission (Physician's Global Assessment score ≤1) and full or partial serological remission. Results Nineteen patients (19/20, 95%; 95% CI 75.1% to 99.9%) achieved the primary efficacy variable. Responses to canakinumab occurred rapidly; median time to clinical remission 4 days (95% CI 3 to 8 days). All patients relapsed after canakinumab was withdrawn; median time to relapse 91.5 days (95% CI 65 to 117 days). On reintroduction of canakinumab, clinical and serological responses were similar to those seen during the first phase, and were sustained throughout treatment. Canakinumab was well tolerated and clinical responses were accompanied by rapid and sustained improvement in health-related quality of life. Weight normalised pharmacokinetics of canakinumab, although limited, appeared to be consistent with historical canakinumab data. Conclusions Canakinumab induces rapid disease control in patients with active TRAPS, and clinical benefits are sustained during long-term treatment. Trial registration number NCT01242813; Results. PMID:27269295

  12. Antimicrobial Resistance in Commensal Escherichia coli from Pigs during Metaphylactic Trimethoprim and Sulfamethoxazole Treatment and in the Post-Exposure Period

    Justyna Mazurek


    Full Text Available The prevalence of trimethoprim (TMP and sulfamethoxazole (SMX resistance in commensal E. coli from pigs was tested in this study. E. coli was derived from three groups of piglets in successive stages of metaphylactic therapy and from two groups of sows 10 and 18 weeks after the treatment. MIC values of TMP and SMX were determined for a total of 352 strains. The presence of resistance genes (dfrA1, dfrA5, dfrA7, dfrA12, dfrA17, sul1, sul2, sul3 and class 1 and 2 integron-associated dfrA gene cassettes was tested. Resistance to TMP was very high during the administration of the antimicrobial (from 97 to 100% and amounted to 86% and 69% in the post-exposure period; MIC > 32 mg/L. The isolates from all groups of pigs were resistant to sulfamethoxazole, with MIC > 1028 mg/L. The dfrA1 and sul1 genes (as part of integrons dominated in E. coli from piglets, but the dfrA12 and sul1 genes were prevalent in E. coli from sows. Coexistence of the different dfrA genes was detected in 71 isolates from all groups of swine. Transcription analysis revealed that most of these genes were not transcribed, particularly gene cassettes of class 1 integrons. The research revealed a high level of resistance associated with the metaphylactic treatment, persistence and circulation of resistance in bacterial populations. Diverse genetic background with multiple and not transcribed resistance genes was observed.

  13. Antimicrobial resistance in commensal Escherichia coli from pigs during metaphylactic trimethoprim and sulfamethoxazole treatment and in the post-exposure period.

    Mazurek, Justyna; Bok, Ewa; Stosik, Michał; Baldy-Chudzik, Katarzyna


    The prevalence of trimethoprim (TMP) and sulfamethoxazole (SMX) resistance in commensal E. coli from pigs was tested in this study. E. coli was derived from three groups of piglets in successive stages of metaphylactic therapy and from two groups of sows 10 and 18 weeks after the treatment. MIC values of TMP and SMX were determined for a total of 352 strains. The presence of resistance genes (dfrA1, dfrA5, dfrA7, dfrA12, dfrA17, sul1, sul2, sul3) and class 1 and 2 integron-associated dfrA gene cassettes was tested. Resistance to TMP was very high during the administration of the antimicrobial (from 97 to 100%) and amounted to 86% and 69% in the post-exposure period; MIC > 32 mg/L. The isolates from all groups of pigs were resistant to sulfamethoxazole, with MIC > 1028 mg/L. The dfrA1 and sul1 genes (as part of integrons) dominated in E. coli from piglets, but the dfrA12 and sul1 genes were prevalent in E. coli from sows. Coexistence of the different dfrA genes was detected in 71 isolates from all groups of swine. Transcription analysis revealed that most of these genes were not transcribed, particularly gene cassettes of class 1 integrons. The research revealed a high level of resistance associated with the metaphylactic treatment, persistence and circulation of resistance in bacterial populations. Diverse genetic background with multiple and not transcribed resistance genes was observed.

  14. Effect of estradiol, vitamin A, E and selenium treatment with varying sexual rest period on recovery rate in cross-bred cows with chronic endometritis

    Dipyaman Sengupta


    Full Text Available Aim:This work was done to study the effect of vitamin A, E and Se with varying sexual rest period in cross-bred cows with chronic endometritis. Materials and Methods: Cross-bred cows (n=396 from different villages of West Bengal with purulent or muco-purulent discharge with a history of infertility and repeat breeding for 3 to 6 months were chosen for the present study. These cows received uterine wash with lugol's iodine, intra-uterine and parenteral antibiotics and de-worming as general treatment. They were then divided into six groups viz. SR12 × EV (n=59, SR12 × Control (n=67, SR21 × EV (n=65, SR21 × Control (n=70, SR24 × EV (n=66, SR24 × Control (n=69 receiving sexual rest of 12 (SR12, 21 (SR21 and 24 (SR24 days with (EV group or without (control estradiol + vitamin A, E and Se. Results: The results indicate that the recovery rate of EV and control group was 76.27 % and 37.31 % respectively (P<0.01 in SR 12, 72.31 % and 47.14 % respectively (P<0.01 in SR 21 and 92.41 % and 63.77 % respectively (P<0.01 in SR 24. SR 24 showed significantly better (P<0.01 recovery rate compared to SR 12 and SR 21. Lowest recovery and conception rate of EV and control group in SR 12 might be due to insufficient time for the recovery of endometrium. Conclusion: The results indicate that parenteral and intra-uterine antibiotics had synergistic effect with estradiol, vitamin A, E and Se treatment in recovery from endometritis, though a minimum time interval is required for complete recovery of the endometrium for best conception rate. [Vet World 2013; 6(2.000: 106-108

  15. Tracheoesophageal fistula--a complication of prolonged tracheal intubation.

    Paraschiv, M


    Tracheoesophageal fistula most commonly occurs as a complication of prolonged tracheal intubation. The incidence decreased after the use of low pressure and high volume endotracheal cuffs, but the intensive care units continue to provide such cases. The abnormal tracheoesophageal communication causes pulmonary contamination (with severe suppuration) and impossibility to feed the patient. The prognosis is reserved, because most patients are debilitated and ventilator dependent, with severe neurological and cardiovascular diseases. The therapeutic options are elected based on respiratory, neurological and nutritional status. The aim of conservative treatment is to stop the contamination (drainage gastrostomy, feeding jejunostomy) and to treat the pulmonary infection and biological deficits. Endoscopic therapies can be tried in cases with surgical contraindication. Operation is addressed to selected cases and consists in the dissolution of the fistula, esophageal suture with or without segmental tracheal resection associated. Esophageal diversion is rarely required. The correct indication and timing of surgery, proper surgical technique and postoperative care are prerequisites for adequate results.

  16. Safety and Efficacy of BAY 94-9027, a Prolonged-Half-Life Factor VIII

    Reding, M T; Ng, H J; Poulsen, Lone Hvitfeldt


    BACKGROUND: BAY 94-9027 is a B-domain-deleted prolonged-half-life recombinant factor VIII (FVIII) conjugates in a site-specific manner with polyethylene glycol. OBJECTIVE: Assess efficacy and safety of BAY 94-9027 for prophylaxis and treatment of bleeds in patients with severe hemophilia A PATIEN...

  17. Rat pancreatic islet function during prolonged glucose stimulation in vitro : Effect of sex and reproductive state

    Moes, H; Koiter, TR


    Prolonged stimulation with glucose may induce desensitisation of pancreatic beta-cell function in male rats. The effects of such a treatment on pancreatic islets of pregnant (P) rats, in which beta-cell function is enhanced, were studied in a perifusion design and compared with the effects on islets

  18. Heart block and prolonged Q-Tc interval following muscle relaxant reversal: a case report.

    Shields, John A


    Heart block and Q-Tc interval prolongation have been reported with several agents used in anesthesia, and the US Food and Drug Administration mandates evaluation of the Q-T interval with new drugs. Drug-induced Q-T interval prolongation may precipitate life-threatening arrhythmias, is considered a precursor for torsades de pointes, and may predict cardiovascular complications. In the patient described in this article, heart block occurred and the Q-Tc interval became prolonged after muscle relaxant reversal with neostigmine; both were considered to be related to the combination of agents used in the case, as well as to other predisposing factors such as morbid obesity. The agents used that affected cardiac conduction were neostigmine, desflurane, droperidol, dolasetron, and dexmedetomidine. Although the heart block was resolved after 2 doses of atropine, prolonged P-R and Q-Tc intervals persisted into the immediate postoperative period but returned to baseline within 4 hours. Clinical implications of this report include increasing awareness of the multitude of factors affecting Q-T interval prolongation during anesthesia.

  19. Cesium-induced QT-interval prolongation in an adolescent.

    O'Brien, Catherine E; Harik, Nada; James, Laura P; Seib, Paul M; Stowe, Cindy D


    Alternative medicine is becoming increasingly popular, especially with terminally ill patients. Most alternative remedies have not been adequately studied or proven effective for the diseases for which they are promoted. In the worst cases, these therapies are harmful. We describe a 16-year-old girl with metastatic hepatocellular carcinoma who experienced cesium-induced QT-interval prolongation after the start of a cesium chloride-based alternative treatment regimen. She had received seven courses of chemotherapy, with a cumulative doxorubicin dose of 500 mg/m(2) over 5 months, resulting in minimal tumor regression. Against the advice of her oncologist, she abandoned traditional therapy and started an alternative regimen that included cesium chloride supplements. Two weeks later, the patient went to a local emergency department after experiencing two brief syncopal episodes. An electrocardiogram revealed occasional premature ventricular contractions, a QTc interval of 683 msec (normal range for females 450-460 msec), and R on T phenomenon. She was admitted to the hospital and later experienced monomorphic ventricular tachycardia, which resolved spontaneously. Lidocaine therapy was started, and the patient was transferred to a cardiac intensive care unit at our hospital. Her plasma cesium level was 2400 microg/dl (normal cesium level was 1800 microg/dl, and her QTc interval was 494 msec. According to the Naranjo adverse drug reaction probability scale, cesium was the probable cause of the patient's arrhythmia. In animal models, cesium chloride has induced cardiac arrhythmias, including torsade de pointes. It inhibits delayed rectifier potassium channels in the myocardium, causing delayed repolarization and QT-interval prolongation. Patients with cancer should be aware that alternative remedies may be harmful and ineffective. Because patients may be unlikely to self-report alternative remedies, health care providers should specifically ask their patients about any

  20. Prolongation of injection interval after switching therapy from ranibizumab to aflibercept in Japanese patients with macular edema secondary to branch retinal vein occlusion

    Tagami, Mizuki; Sai, Ryuto; Fukuda, Masahide; Azumi, Atsushi


    Purpose This study was conducted to investigate the outcome of switching therapy from ranibizumab to aflibercept in Japanese patients with macular edema (ME) secondary to branch retinal vein occlusion (BRVO) in daily practice. Materials and methods This retrospective study enrolled 15 eyes in 15 Japanese patients with ME secondary to BRVO who had been receiving a pro re nata regimen of ranibizumab and had provided written informed consent to switch to aflibercept therapy. The intravitreal injection interval, central retinal thickness, and visual acuity were evaluated before and after switching. Results The mean period of ranibizumab treatment was 11.8±4.2 months. The mean observation period after switching to aflibercept was 10.6±3.4 months, and seven patients were observed for more than 12 months after switching. The mean intravitreal injection interval was prolonged by 23.6 days with aflibercept (68.2±26.4 days with ranibizumab vs 91.8±33.2 days with aflibercept; P=0.0011). The mean intravitreal injection interval just before the switch was 81.3±35.6 days and was significantly prolonged to 100.8±34.2 days just after the switch to aflibercept (P=0.0309). The mean central retinal thickness did not change before or after the switch to aflibercept (295±55 μm with ranibizumab vs 276±25 μm with aflibercept; P=0.12). The mean visual acuity also remained at an improved level after the switch. No systemic or ocular side effects were evident during the study period. Conclusion Switching therapy from ranibizumab to aflibercept in Japanese patients with ME secondary to BRVO prolonged the intravitreal injection interval without anatomical or functional degradation.

  1. Prolongation of injection interval after switching therapy from ranibizumab to aflibercept in Japanese patients with macular edema secondary to branch retinal vein occlusion

    Tagami M


    Full Text Available Mizuki Tagami, Ryuto Sai, Masahide Fukuda, Atsushi Azumi Ophthalmology Department, Eye Center, Kobe Kaisei Hospital, Kobe, Hyogo, Japan Purpose: This study was conducted to investigate the outcome of switching therapy from ranibizumab to aflibercept in Japanese patients with macular edema (ME secondary to branch retinal vein occlusion (BRVO in daily practice. Materials and methods: This retrospective study enrolled 15 eyes in 15 Japanese patients with ME secondary to BRVO who had been receiving a pro re nata regimen of ranibizumab and had provided written informed consent to switch to aflibercept therapy. The intravitreal injection interval, central retinal thickness, and visual acuity were evaluated before and after switching. Results: The mean period of ranibizumab treatment was 11.8±4.2 months. The mean observation period after switching to aflibercept was 10.6±3.4 months, and seven patients were observed for more than 12 months after switching. The mean intravitreal injection interval was prolonged by 23.6 days with aflibercept (68.2±26.4 days with ranibizumab vs 91.8±33.2 days with aflibercept; P=0.0011. The mean intravitreal injection interval just before the switch was 81.3±35.6 days and was significantly prolonged to 100.8±34.2 days just after the switch to aflibercept (P=0.0309. The mean central retinal thickness did not change before or after the switch to aflibercept (295±55 µm with ranibizumab vs 276±25 µm with aflibercept; P=0.12. The mean visual acuity also remained at an improved level after the switch. No systemic or ocular side effects were evident during the study period. Conclusion: Switching therapy from ranibizumab to aflibercept in Japanese patients with ME secondary to BRVO prolonged the intravitreal injection interval without anatomical or functional degradation. Keywords: branch retinal vein occlusion, macular edema, ranibizumab, aflibercept

  2. Impact of Periodic Presumptive Treatment for Bacterial Vaginosis on the Vaginal Microbiome among Women Participating in the Preventing Vaginal Infections Trial.

    Balkus, Jennifer E; Srinivasan, Sujatha; Anzala, Omu; Kimani, Joshua; Andac, Chloe; Schwebke, Jane; Fredricks, David N; McClelland, R Scott


    Evidence suggests that specific vaginal bacteria associated with bacterial vaginosis (BV) may increase the risk of adverse health outcomes in women. Among women participating in a randomized, double-blinded trial, we assessed the effect of periodic presumptive treatment (PPT) on detection of select vaginal bacteria. High-risk women from the United States and Kenya with a recent vaginal infection received intravaginal metronidazole 750 mg plus miconazole 200 mg or placebo for 5 consecutive nights each month for 12 months. Vaginal fluid specimens were collected via polyester/polyethylene terephthalate swabs every other month and tested for bacteria, using quantitative polymerase chain reaction (PCR) assays targeting the 16S ribosomal RNA gene. The effect of PPT on bacterium detection was assessed among all participants and stratified by country. Of 234 women enrolled, 221 had specimens available for analysis. The proportion of follow-up visits with detectable quantities was lower in the PPT arm versus the placebo arm for the following bacteria: BVAB1, BVAB2, Atopobium vaginae, Leptotrichia/Sneathia, and Megasphaera. The magnitude of reductions was greater among Kenyan participants as compared to US participants. Use of monthly PPT for 1 year reduced colonization with several bacteria strongly associated with BV. The role of PPT to improve vaginal health should be considered, and efforts to improve the impact of PPT regimens are warranted.

  3. Randomized, observer-blind, split-face study to compare the irritation potential of 2 topical acne formulations over a 14-day treatment period.

    Ting, William


    This randomized, observer-blind, split-face study assessed the irritation potential and likelihood of continued use of clindamycin phosphate 1.2%--benzoyl peroxide (BPO) 2.5% gel or adapalene 0.1%--BPO 2.5% gel once daily over a 14-day treatment period in 21 participants (11 males; 10 females) with acne who were 18 years or older. Investigator clinical assessment (erythema and dryness) and self-assessment (dryness and burning/stinging) were performed at baseline and each study visit (days 1-14) using a 4-point scale (O = none; 3 = severe). Transepidermal water loss (TEWL) and corneometry measurements were performed at baseline and days 3, 5, 7, 9, 11, and 14. Lesions were counted at baseline and on day 14. Participant satisfaction questionnaires were completed on days 7 and 14. At the end of the study, investigators reported none or only mild erythema in 86% (18/21) of participants treated with clindamycin phosphate 1.2%--BPO 2.5% gel compared with 62% (13/21) of participants treated with adapalene 0.1%--BPO 2.5% gel. No severe erythema was reported with clindamycin phosphate 1.2%--BPO 2.5% gel. Adapalene 0.1%--BPO 2.5% gel was prematurely discontinued due to severe erythema in 1 participant on day 5 and a second participant on day 9. Additionally, 2 more participants reported severe erythema on day 14. Mean erythema scores were 0.9 (mean change from baseline, 0.7) with clindamycin phosphate 1.2%--BPO 2.5% gel and 1.4 (mean change from baseline, 1.3) with adapalene 0. 1%--BPO 2.5% gel on day 14 (P BPO 2.5% gel. Continued use and efficacy results for the treatment of acne were influenced by the potential of the product to cause irritation and the participant preferences. Irritation potential was more pronounced and severe with adapalene 0.1%--BPO 2.5% gel. Undoubtedly, as a result more participants preferred treatment with clindamycin phosphate 1.2%--BPO 2.5% gel and were more likely to continue to use the product.

  4. Long-term remission of CIDP after pulsed dexamethasone or short-term prednisolone treatment

    Eftimov, F.; Vermeulen, M.; Doorn, P.A. van; Brusse, E.; Schaik, I.N. van; Berg, L.H. van den; Pol, W.L. van der; Faber, C.G.; Oostrom, J.C. van; Vogels, O.J.; Kleine, B.U.; Norden, A.G.W. van; Verschuuren, J.J.; Hadden, R.D.


    OBJECTIVE: Achieving long-term remission after a limited more intense treatment period would prevent prolonged use of corticosteroids or IV immunoglobulin (IVIg) in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). In this prospective cohort study we present long-term follow-up data

  5. 不同处理方式对牛干巴贮藏期品质的影响%Effects of different treatments on the quality of dry-cured beef during storage period

    胡凯弟; 甘芳瑗; 刘书亮; 王成; 何利; 陈姝娟


    为延长干巴牛肉货架期,文中分别采用热力、化学、热力结合化学与超高压4种方式处理干巴牛肉,以真空包装干巴牛肉为对照,于37℃保温贮藏35天,通过对其理化、微生物及感官指标进行测定,分析其在贮藏过程中品质变化规律;结果显示:热力处理组干巴牛肉品质变化较小,微生物数量减少速度较快,35天后酸价(AV)和总挥发性盐基氮(TVBN)较低;化学处理组35天后亚硝酸盐含量较其他处理组低,为0.7 mg/kg,但AV和TVBN值偏高,为1.83 mg/g和59.6 mg/kg,对细菌和酵母菌抑制效果较差;热力结合化学处理组亚硝酸盐含量较低,AV和TVBN值均最低,为1.50 mg/g和52.5 mg/kg,与热力处理组感官评分接近,微生物减少较热力组快;超高压处理组杀菌效果较好,但色泽较差.对照组35天后亚硝酸盐含量、AV、TVBN值和微生物数量均高于各处理组.4个处理组在整个贮藏过程中亚硝酸盐含量、细菌总数与酵母菌数均下降,亚硝酸盐含量均低于1.5mg/kg,远低于国家标准30 mg/kg,且无过氧化值、霉菌检出.热力结合化学组为最优处理组.%To prolong the shelf life of dry-cured beef.Different inhibition or sterilization methods including thermal,chemical,thermal cooperated with chemical and ultra-high pressure were used in dry-cured beef,respectively.The variation of quality during storage period (35 days,37 ℃) were analyzed on physical,chemical,microbiological and sensory indexes,and vacuum-packed product was used as a control.The sensory qualities of thermal-treated group changed slightly,and the amount of microorganisms decreased faster,both of acid value (AV) and total volatile basic nitrogen (TVBN) were lower after 35 days in that group;at the end of storage period,the nitrite content of chemical group was lower than others,as 0.7 mg/kg,but its AV and TVBN were higher at 1.83 mg/g and 59.6 mg/kg respectively,with poor inhibition effect on bacteria and yeast

  6. Neurohumoral responses during prolonged exercise in humans

    Nybo, Lars; Nielsen, Bodil; Blomstrand, Eva


    in the hyperthermic trial, with a concomitant increase in perceived exertion (P brain had a small release of tryptophan (arteriovenous difference of -1.2 +/- 0.3 micromol/l), whereas a net balance was obtained during the two exercise trials. Both the arterial and jugular venous dopamine levels...... became elevated during the hyperthermic trial, but the net release from the brain was unchanged. During exercise, the O2/CHO was similar across trials, but, during recovery from the hyperthermic trial, the ratio decreased to 3.8 +/- 0.3 (P ...This study examined neurohumoral alterations during prolonged exercise with and without hyperthermia. The cerebral oxygen-to-carbohydrate uptake ratio (O2/CHO = arteriovenous oxygen difference divided by arteriovenous glucose difference plus one-half lactate), the cerebral balances of dopamine...

  7. Prolonged asthma after smoke inhalation: A report of three cases and a review of previous reports

    Moisan, T.C. (Department of Preventive Medicine, Loyola University-Stritch School of Medicine, Maywood, IL (USA))


    The development of prolonged obstructive airways disease after smoke inhalation is of concern to fire victims and fire fighters. Three cases of asthma that developed following the inhalation of pyrolysis products are presented along with a review of previous reports of airway injury from smoke inhalation. Polyvinyl chloride pyrolysis products seem to pose a high risk, but other toxic inhalants are also implicated. There is substantial evidence that prolonged airway hyper-responsiveness and asthma may follow numerous inflammatory insults including smoke inhalation. Studies to identify specific individual risk factors and asthmagenic pyrolysis products are needed. Early, postexposure anti-inflammatory treatment may modify the outcome. 42 refs.

  8. Anti-infective treatment for the HIV-infected patient during perioperative period%围手术期HIV感染者的抗感染治疗

    刘保池; 张磊; 李垒; 司炎辉; 宋言峥; 赵中辛


      Objective:To investigate anti-infective treatments in HIV-infected surgical patients during the perioperative period. Methods 〓 A retrospective study of sepsis and surgical site infections (SSIs) was conducted in 266 HIV-infected patients from January 2009 to December 2011 in Shanghai Public Health Clinical Center. The patients were divided into 3 groups based on CD4 cells counts in the preoperative period: group A (<200 cell/μl), group B (200-349 cell/μl) and group C (≥350 cell/μl). Highly active anti-retrovirus therapy (HAART) was started in group B. Preoperative antibiotic medication SMZ and fluconazole against Pneumocystis carinii pneumonia (PCP) and other fungal infection was started in group A. No special treatment in group C. Results〓There were only 6 patients dead at 30 days after surgery, with the death rate of 2.3%. Sepsis appeared in 110 patients (41.3%). Patients in group A were more likely to get sepsis than patients in the other two groups (P <0.01). Conclusion〓Complete evalua- tion of surgical risk and suitable perioperative anti-infective treatment may lead to better outcome for HIV-infected surgical patients.%  〓〓[]〓目的〓探讨 HIV 感染者围手术期合理的抗感染治疗.方法〓回顾性分析上海市公共卫生临床中心外科2009年1月至2011年12月救治的266例 HIV 感染患者围手术期临床资料,根据患者术前 CD4 T 淋巴细胞水平分 A 组<200 cell/μl,B 组200~349 cell/μl 和 C 组≥350 cell/μl 三组,对 B 组给予抗 HIV 病毒治疗,对 A 组给予抗 HIV 病毒、磺胺甲唑(SMZ)和氟康唑预防肺孢子虫和真菌感染,对已经合并结核、真菌等机会性感染者给予相应的抗感染治疗.对 C组无特殊处理.结果〓经适当的抗感染治疗,266例患者手术后30 d 内死亡6例,病死率2.3%.110例发生脓毒症,脓毒症发生率41.3%.A 组脓毒症发病率明显高于 B 组和 C 组(P <0.01).结论〓精细的手术与合理的围手术

  9. Inhibition of spontaneous recovery of fear by mGluR5 after prolonged extinction training.

    Sheng-Chun Mao

    Full Text Available Fear behavior is vital for survival and involves learning contingent associations of non-threatening cues with aversive stimuli. In contrast, excessive levels of fear can be maladaptive and lead to anxiety disorders. Generally, extensive sessions of extinction training correlates with reduced spontaneous recovery. The molecular mechanisms underlying the long-term inhibition of fear recovery following repeated extinction training are not fully understood. Here we show that in rats, prolonged extinction training causes greater reduction in both fear-potentiated startle and spontaneous recovery. This effect was specifically blocked by metabotropic glutamate receptor 5 (mGluR5, but not by mGluR1 antagonists and by a protein synthesis inhibitor. Similar inhibition of memory recovery following prolonged extinction training was also observed in mice. In agreement with the instrumental role of mGluR5 in the prolonged inhibition of fear recovery, we found that FMR1-/- mice which exhibit enhanced mGluR5-mediated signaling exhibit lower spontaneous recovery of fear after extinction training than wild-type littermates. At the molecular level, we discovered that prolonged extinction training reversed the fear conditioning-induced increase in surface expression of GluR1, AMPA/NMDA ratio, postsynaptic density-95 (PSD-95 and synapse-associated protein-97 (SAP97. Accordingly, delivery of Tat-GluR2(3Y, a synthetic peptide that blocks AMPA receptor endocytosis, inhibited prolonged extinction training-induced inhibition of fear recovery. Together, our results demonstrate that prolonged extinction training results in the mGluR5-dependent long-term inhibition of fear recovery. This effect may involve the degradation of original memory and may explain the beneficial effects of prolonged exposure therapy for the treatment of phobias.

  10. Inhibition of spontaneous recovery of fear by mGluR5 after prolonged extinction training.

    Mao, Sheng-Chun; Chang, Chih-Hua; Wu, Chia-Chen; Orejarena, M Juliana; Orejanera, Maria Juliana; Manzoni, Olivier J; Gean, Po-Wu


    Fear behavior is vital for survival and involves learning contingent associations of non-threatening cues with aversive stimuli. In contrast, excessive levels of fear can be maladaptive and lead to anxiety disorders. Generally, extensive sessions of extinction training correlates with reduced spontaneous recovery. The molecular mechanisms underlying the long-term inhibition of fear recovery following repeated extinction training are not fully understood. Here we show that in rats, prolonged extinction training causes greater reduction in both fear-potentiated startle and spontaneous recovery. This effect was specifically blocked by metabotropic glutamate receptor 5 (mGluR5), but not by mGluR1 antagonists and by a protein synthesis inhibitor. Similar inhibition of memory recovery following prolonged extinction training was also observed in mice. In agreement with the instrumental role of mGluR5 in the prolonged inhibition of fear recovery, we found that FMR1-/- mice which exhibit enhanced mGluR5-mediated signaling exhibit lower spontaneous recovery of fear after extinction training than wild-type littermates. At the molecular level, we discovered that prolonged extinction training reversed the fear conditioning-induced increase in surface expression of GluR1, AMPA/NMDA ratio, postsynaptic density-95 (PSD-95) and synapse-associated protein-97 (SAP97). Accordingly, delivery of Tat-GluR2(3Y), a synthetic peptide that blocks AMPA receptor endocytosis, inhibited prolonged extinction training-induced inhibition of fear recovery. Together, our results demonstrate that prolonged extinction training results in the mGluR5-dependent long-term inhibition of fear recovery. This effect may involve the degradation of original memory and may explain the beneficial effects of prolonged exposure therapy for the treatment of phobias.


    张春驰; 李小梅; 董艳娟; 何跃


    Objective:To observe and evaluate the analgesic efficacy and safety of gabapentin combined with low dose prolonged-release oxycodone hydrochloride for the treatment of diabetic peripheral neuropathic pain (DPNP).Method:A total of 70 elderly patients with DPNP were randomized into 2 groups (each contains 35 cases),one accepted gabapentin monotherapy (G1),and the other received both gabapentin and low dose prolonged-release oxycodone hydrochloride (G2).The initial dose of gabapentin was 100 mg/d and gradually titrated.The dose of prolonged-release oxycodone hydrochloride was fixed at 10 mg/q 12 h,and the therapy keeps 2 weeks.VAS was evaluated before and at the 8th and 15th day of the treatment.Side effects were observed and recorded.Results:Totally 62 (G1 =30,G2 =32) patients completed the 2 weeks treatment.Basic characteristics have no significant difference including mean VAS scores between the 2 groups.After the treatment,the total rate of pain relief at the 8th and 15th day were significantly higher in G 1 compared with G2 (P < 0.05) and the rate of excellent pain relief in G1 was higher than G2 at the 8th day (P < 0.05).The mean daily dose of gabapentin at the 8th day have no significant difference between G1 and G2,but at the 15th day,G2 was significant higher than G1 (P < 0.05).The occurrence rate of constipation in G2 was obviously higher compared with G1 (P < 0.05).Conclusion:Gabapentin monotherapy or combined with low dose Prolongedrelease oxycodone hydrochloride could effectively release elderly patients' DPNP,and the efficacy of the combination therapy was better,but should give preventive measures to constipation.%目的:观察加巴喷丁联合低剂量盐酸羟考酮缓释片治疗老年糖尿病周围神经痛(diabeticperipheral neuropathic pain,DPNP)的疗效及安全性.方法:70例老年DPNP患者随机均分为两组(n=35),分别接受2周加巴喷丁单药(单药组)或加巴喷丁联合低剂量盐酸羟考酮缓释

  12. Vertical root fracture associated with prolonged use of calcium hydroxide during apexification. A case report.

    Jennifer Ribadeneira


    Full Text Available Apexification is a procedure performed in young permanent teeth to promote apical closure and root elongation if Hertwig’s epithelial sheath has not been irreversibly damaged. The objective of this article is to describe vertical root fracture as a complication during apexification when using calcium hydroxide for extended periods of time. The patient was a 9-year-old female student who went to the Faculty of Dentistry of the Universidad Andres Bello in Concepcion. She presented strong and spontaneous pain and pressure and swelling on the left cheek. Clinically, the vestibule of the lower left first molar (3.6 was edematous and had pus. Radiographically, lesions and open apices were seen in the apical zone. Diagnosis was pulp necrosis and acute apical abscess. The tooth was trephined to perform intracanal drainage and an oral antibiotic was prescribed. Afterwards, she was referred to the endodontic specialty office. The selected treatment was apexification with calcium hydroxide until achieving the formation of an apical barrier. When the apical formation was observed, a vertical root fracture was discovered as well, confirming that the use of calcium hydroxide should not be prolonged because dehydration processes lead to weakening of the walls and therefore of the tooth

  13. Efficacy of the "baby-sitter" procedure after prolonged denervation.

    Mersa, B; Tiangco, D A; Terzis, J K


    This study was undertaken to evaluate whether 40 percent of the hypoglossal nerve, which showed optimal efficacy in restoring orbicularis oculi muscle (OOM) function after different percentages of partial neurectomy in a previous study would be effective after prolonged denervation time. Twenty Sprague-Dawley rats were divided into four groups. In first-stage surgery the left facial nerve of all animals was transected at the level of the stylomastoid foramen and main zygomatic branch. Group A (controls) consisted of animals with only left facial nerves transected (no repair). In Groups B, C, and D the facial nerve was transected and the facial musculature was denervated for a period of 4, 8, and 12 weeks respectively. During a second-stage procedure, a 40 percent neurectomy was performed on the hypoglossal nerve. Subsequently, a nerve transfer was performed by coaptations of a saphenous nerve graft to the neurectomized hypoglossal nerve and the main zygomatic branch of the facial nerve that innervated the OOM. Behavioral analysis of blink reflex, electrophysiology, and axon and motor end-plate counts in Groups B, C, and D showed superior results compared to Group A. There was no statistically significant difference observed among Groups B, C, and D (p > 0.05). Despite the diminished number of axons in the zygomatic branch and motor end-plates in the orbicularis oculi muscle after 12 weeks of denervation, there was still sufficient muscle target recovery to effect some eye closure in all groups except the controls. This study demonstrated in this model that the 40 percent partial neurectomy of the XII to VII component of the "baby-sitter" procedure was effective even after prolonged denervation.

  14. Efeitos da posição sentada na força de músculos respiratórios durante o desmame de pacientes sob ventilação mecânica prolongada no pós-operatório de cirurgia cardiovascular Effects of sitting position on the strength of respiratory muscles during weaning of patients under prolonged mechanical ventilation in the postoperative period of cardiovascular surgery

    Emília Nozawa


    Full Text Available O objetivo do estudo foi investigar os efeitos da posição sentada, nos parâmetros ventilatórios e hemodinâmicos, em pacientes com suporte ventilatório mecânico prolongado, estáveis hemodinamicamente. Participaram do estudo 40 pacientes que foram randomizados em grupo controle (n=17 e grupo intervenção (n=23. Foram mensurados parâmetros hemodinâmicos, gasometria arterial, força muscular respiratória e ventilometria, realizados em dois momentos: primeira e segunda avaliação, com intervalo de 30 minutos entre as medidas. No grupo controle, as duas avaliações foram realizadas no leito, com a cabeceira elevada a 30°. No grupo intervenção, a primeira avaliação foi realizada no leito (30° e a segunda, 30 minutos após transferência para a poltrona, na posição sentada (90°. A idade média da amostra foi de 64,7±11,2 anos. O resultado do estudo demonstrou que não houve diferenças em relação às variáveis, hemodinâmicas, gasométricas, capacidade vital forçada, volume minuto e volume de ar corrente. Entretanto, ocorreu aumento significativo da pressão inspiratória máxima (PImáx no grupo intervenção (pThe purpose was to study the effects of sitting position, in ventilatory and hemodynamic parameters, in patients under prolonged mechanical ventilation, in the postoperative of cardiovascular surgery. Participated 40 postoperative cardiovascular patients, intubated and mechanically ventilated, were randomized into control group (n=17 and intervention group (n=23. Hemodynamic parameters, arterial blood gases, respiratory muscle strength and ventilometry, were measured in two moments: first and second evaluation, with 30-minute interval between measurements. In the control group, both evaluations were performed at head of the bed elevated at 30°. In the sitting group, the first evaluation was developed at 30° and the second, (30 minutes after transfer to the armchair in the sitting position (90°. The mean age of

  15. Prolonged pain and disability are common after rib fractures.

    Fabricant, Loic; Ham, Bruce; Mullins, Richard; Mayberry, John


    The contribution of rib fractures to prolonged pain and disability may be underappreciated and undertreated. Clinicians are traditionally taught that the pain and disability of rib fractures resolves in 6 to 8 weeks. This study was a prospective observation of 203 patients with rib fractures at a level 1 trauma center. Chest wall pain was evaluated by the McGill Pain Questionnaire (MPQ) pain rating index (PRI) and present pain intensity (PPI). Prolonged pain was defined as a PRI of 8 or more at 2 months after injury. Prolonged disability was defined as a decrease in 1 or more levels of work or functional status at 2 months after injury. Predictors of prolonged pain and disability were determined by multivariate analysis. One hundred forty-five male patients and 58 female patients with a mean injury severity score (ISS) of 20 (range, 1 to 59) had a mean of 5.4 rib fractures (range, 1 to 29). Forty-four (22%) patients had bilateral fractures, 15 (7%) had flail chest, and 92 (45%) had associated injury. One hundred eighty-seven patients were followed 2 months or more. One hundred ten (59%) patients had prolonged chest wall pain and 142 (76%) had prolonged disability. Among 111 patients with isolated rib fractures, 67 (64%) had prolonged chest wall pain and 69 (66%) had prolonged disability. MPQ PPI was predictive of prolonged pain (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.4 to 2.5), and prolonged disability (OR, 2.2; 95% CI, 1.5 to 3.4). The presence of significant associated injuries was predictive of prolonged disability (OR, 5.9; 95% CI, 1.4 to 29). Prolonged chest wall pain is common, and the contribution of rib fractures to disability is greater than traditionally expected. Further investigation into more effective therapies that prevent prolonged pain and disability after rib fractures is needed. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. Mean arterial pressure following prolonged exercise in the heat

    Gagnon, D; Lynn, A G; Binder, K


    Prolonged exercise in the heat without fluid replacement represents a significant challenge to the regulation of mean arterial pressure (MAP). It is unknown, however, if MAP is equally challenged during the post-exercise period, and whether regular endurance exercise training can provide any...... benefit to its regulation. We examined MAP (Finometer) in eight trained (T) and eight untrained (UT) individuals prior to, and following, 120 min of cycling at 42 °C with (HYD) and without (DEHY) fluid replacement. Exercise during DEHY induced significant hyperthermia (T: 39.20 ± 0.52 °C vs UT: 38.70 ± 0.......36 °C, P = 0.941) and body weight losses (T: 3.4 ± 1.2% vs UT: 2.7 ± 0.9%, P = 0.332), which did not differ between groups. Although MAP was equally reduced 5 min into the post-exercise period of DEHY (T: -20 ± 11 mmHg vs UT: -22 ± 13 mmHg, P = 0.800), its subsequent recovery was significantly different...

  17. Axial elongation following prolonged near work in myopes and emmetropes.

    Woodman, Emily C; Read, Scott A; Collins, Michael J; Hegarty, Katherine J; Priddle, Scott B; Smith, Josephine M; Perro, Judd V


    To investigate the influence of a period of sustained near work upon axial length in groups of emmetropes (EMM) and myopes. Forty young adult subjects (20 myopes and 20 emmetropes) were recruited for the study. Myopes were further classified as early onset (EOM), late onset (LOM), stable (SM) or progressing (PM) subgroups. Axial length was measured with the IOLMaster instrument before, immediately after and then again 10 min after a continuous 30 min near task of 5 D accommodation demand. Measures of distance objective refraction were also collected. Significant changes in axial length were observed immediately following the near task. EOM axial length elongated on average by 0.027±0.021 mm, LOM by 0.014±0.020 mm, EMM by 0.010±0.015 mm, PM by 0.031±0.022 mm and SM by 0.014±0.018 mm. At the conclusion of the 10 min regression period, axial length measures were not significantly different from baseline values. Axial elongation was observed following a prolonged near task. Both EOM and PM groups showed increases in axial length that were significantly greater than emmetropes.

  18. Prolonging β-lactam infusion: a review of the rationale and evidence, and guidance for implementation.

    MacVane, Shawn H; Kuti, Joseph L; Nicolau, David P


    Given the sparse antibiotic pipeline and the increasing prevalence of resistant organisms, efforts should be made to optimise the pharmacodynamic exposure of currently available agents. Prolonging the infusion duration is a strategy used to increase the percentage of the dosing interval that free drug concentrations remain above the minimum inhibitory concentration (fT>MIC), the pharmacodynamic efficacy driver for time-dependent antibiotics such as β-lactams. β-Lactams, the most commonly prescribed class of antibiotics owing to their efficacy and safety profile, have been the mainstay of therapy since the discovery of penicillin over 60 years ago. Mounting evidence, including the use of population pharmacokinetic modelling and Monte Carlo simulation, suggests that prolonging the infusion time of β-lactam antibiotics may have advantages over standard infusion techniques, including an enhanced probability of achieving requisite fT>MIC exposures, lower mortality and potentially reductions in infection/antibiotic-related costs. As a result of these favourable attributes, clinical practice guidelines support the use of prolonged-infusion β-lactams in the treatment of many severe infections. This article discusses the rationale and evidence for prolonging the infusion of β-lactam antibiotics and provides guidance for the implementation of a prolonged-infusion programme.


    A case of chronic disseminated histoplasmosis in an ex-serviceman is described. Evidence is presented to support a latency period of over sixty years between acquisition of infection and clinical manifestation. This is the longest latency period for histoplasmosis described in the medical literature...

  20. 针刺治疗周围性面瘫(急性期)的系统评价%Acupuncture Treatment of Peripheral Facial Paralysis(Acute Period)

    潘江; 章薇; 陈武善; 石文英


    Objective :To systematically analyze the effectiveness of acupuncture for the treatment of peripheral facial paralysis at acute period.Methods:Through the VIP datebase, index.htm Shuofang doctoral dissertation,the national databases, Wanfang database electronic retrieval and refer to the relevant professional information and network information.The test data taken by the Cochrane pensonnel provide Revman4.2.7 on Meta analysis.Results:Through selecting, only eight articles which met criteria were chosen from total checked 79 related paper, using Jadad rating criteria for 8 articles methodological quality evaluation, including a literature which is of high quality and the rest are low quality documents.We can see that acupuncture trcatment of peripheral facial paralysis has a better efficacy.The difference was statistically significant( Z = 5.89, P < 0.00001 ).Conclusion:Using acupuncture treatment for peripheral facial paralysis at acute period is better, and it could shorten the time.However, the quality of RCT literatures is not high, and quantity is less.This study still needs further large - scale development to further improve the intensity of evidence.%目的:评价针刺治疗周围性面瘫急性期的疗效.方法:通过对维普网、中国知网、全国硕博士论文数据库、万方数据库进行电子检索以及查阅相关的专业资料和网络信息.试验数据采取由Cochrane协作网提供的Revman4.2.7进行Meta分析.结果:共查到79篇相关文献,经过筛选,只有8篇文章符合纳入标准,采用Jadad评分标准对8篇文献的方法学质量进行评价,其中1篇文献质量高,其余均是低质量文献.Meta分析显示,周围性面瘫急性期针刺治疗结果比不使用针刺治疗的效果好,其差异有统计学意义(P<0.01).结论:现有的临床证据表明,周围性面瘫的急性期应用针刺治疗比不使用针刺治疗更能改善病人的症状,提高治疗的效果,缩短面瘫恢复的时间.但是,由

  1. Surgical treatment of 137 cases with chronic subdural hematoma at the university clinical center of Kosovo during the period 2008–2012

    Mekaj, Agon Y.; Morina, Arsim A.; Mekaj, Ymer H.; Manxhuka-Kerliu, Suzana; Miftari, Ermira I.; Duci, Shkelzen B.; Hamza, Astrit R.; Gashi, Musli M.; Xhelaj, Mentor R.; Kelmendi, Fatos M.; Morina, Qamile Sh.


    Background: Chronic subdural hematoma (CSDH) is frequent pathology in neurosurgical practice. The aim of this study is to present the first series of patients with CSDH, who got surgically treated in Clinic of Neurosurgery, University Clinical Center of Kosovo. Materials and Methods: This is a retrospective study that included 137 patients with CSDH who had been treated during the period 2008–2012. The data were collected and analyzed from the archives and protocols of the University Clinical Center of Kosovo. Patients were analyzed in many aspects such as age, gender, etiological factors, clinical features, localization, diagnoses, methods of surgical interventions, recurrences and mortality of patients. Results: From 137 patients with CSDH, 106 (77.3%) were males and 31 (22.7%) females. Average age of patients was 62.85 years. Analyzed according to the decades, the highest number of causes with CSDH was between 70 and 79 years (46%). The head trauma has been responsible for CSDH in 88 patients (64.3%), while the main symptom was headache (92 patients or 67.1%). One burr-hole trepanation with closed drainage system has been used in majority of cases (in 101 patients or 73.7%). The recurrence of CSDH was 6.5%, whereas mortality 2.9%. Conclusion: CSDH is more common in elderly patients. The male-female ratio is 3.4:1. Like other authors we also think that treatment with one burr-hole and drainage is a method of choice, because of its simplicity and safety. PMID:25883478

  2. Radical hysterectomy in surgical treatment of invasive cervical cancer at the Department of gynecology and obstetrics in Novi Sad in the period 1993-2013.

    Đurđević Srđan


    Full Text Available Introduction. During the period from 1993 - 2013, 175 women with invasive cervical cancer underwent radical hysterectomy sec. Wertheim-Meigs at the Department of Gynecology and Obstetrics, Clinical Center of Vojvodina in Novi Sad. Indications for radical hysterectomy comprise histopathologically confirmed invasive cervical cancer in stages I B 1 - II B according to the International Federation of Gynecology and Obstetrics. Material and Methods. Stage of the disease or extent of the disease spread to the adjacent structures was assessed in accordance with the International Federation of Gynecology and Obstetrics staging system from 2009. Exclusion criteria were all other stages of this disease: I A and stages higher than II B, as well as the absence of definite histological confirmation of the cervical cancer (primary endometrial or vaginal cancer which infiltrates the uterine cervix. Prior the operation, the following had to be done: the imaging of pelvis and abdomen, chest X-ray in two directions, electrocardiography, internist and anesthesiological examination. Results. The patients’ age ranged from 24-79 years (x : 46 years, and the operation duration was 120-300 minutes (x : 210 min.. Stage I B 1 was found in 64.6% of operated patients, 14.8% of the patients were in stage I B 2, 9.1% were in stage II A and 11.4 % were in stage II B. Blood loss during the operation ranged from 50-800 ml (on average 300 ml, and the number of removed lymph nodes per operation was 14-75 (x : 32. Intraoperative and postoperative complications developed in 6.8% of and 17.7% of patients, respectively. Recurrence was reported in 22 (12.5% patients, most often in paraaortic lymph nodes (3.4% and parametria (2.8%, while the overall 5-year survival rate was 87% until 2008. Concluision. Wertheim-Meigs radical hysterectomy is a basic surgical technique for the treatment of initial stages of invasive cervical cancer.

  3. Surgical treatment of 137 cases with chronic subdural hematoma at the university clinical center of Kosovo during the period 2008-2012

    Agon Y Mekaj


    Full Text Available Background: Chronic subdural hematoma (CSDH is frequent pathology in neurosurgical practice. The aim of this study is to present the first series of patients with CSDH, who got surgically treated in Clinic of Neurosurgery, University Clinical Center of Kosovo. Materials and Methods: This is a retrospective study that included 137 patients with CSDH who had been treated during the period 2008-2012. The data were collected and analyzed from the archives and protocols of the University Clinical Center of Kosovo. Patients were analyzed in many aspects such as age, gender, etiological factors, clinical features, localization, diagnoses, methods of surgical interventions, recurrences and mortality of patients. Results: From 137 patients with CSDH, 106 (77.3% were males and 31 (22.7% females. Average age of patients was 62.85 years. Analyzed according to the decades, the highest number of causes with CSDH was between 70 and 79 years (46%. The head trauma has been responsible for CSDH in 88 patients (64.3%, while the main symptom was headache (92 patients or 67.1%. One burr-hole trepanation with closed drainage system has been used in majority of cases (in 101 patients or 73.7%. The recurrence of CSDH was 6.5%, whereas mortality 2.9%. Conclusion: CSDH is more common in elderly patients. The male-female ratio is 3.4:1. Like other authors we also think that treatment with one burr-hole and drainage is a method of choice, because of its simplicity and safety.

  4. Retrospective Analysis of Corticosteroid Treatment in Stevens-Johnson Syndrome and/or Toxic Epidermal Necrolysis over a Period of 10 Years in Vajira Hospital, Navamindradhiraj University, Bangkok.

    Roongpisuthipong, Wanjarus; Prompongsa, Sirikarn; Klangjareonchai, Theerawut


    Background. Stevens-Johnson syndrome (SJS) and/or toxic epidermal necrolysis (TEN) are uncommon and life-threatening drug reaction associated with a high morbidity and mortality. Objective. We studied SJS and/or TEN by conducting a retrospective analysis of 87 patients treated during a 10-year period. Methods. We conducted a retrospective review of the records of all patients with a diagnosis of SJS and/or TEN based on clinical features and histological confirmation of SJS and/or TEN was not available at the Department of Medicine, Vajira hospital, Bangkok, Thailand. The data were collected from two groups from 2003 to 2007 and 2008 to 2012. Results. A total of 87 cases of SJS and/or TEN were found, comprising 44 males and 43 females whose mean age was 46.5 years. The average length of stay was 17 days. Antibiotics, anticonvulsants, and allopurinol were the major culprit drugs in both groups. The mean SCORTEN on admission was 2.1 in first the group while 1.7 in second the group. From 2008 to 2012, thirty-nine patients (76.5%) were treated with corticosteroids while only eight patients (22.2%) were treated between 2003 and 2007. The mortality rate declined from 25% from the first group to 13.7% in the second group. Complications between first and second groups had no significant differences. Conclusions. Short-term corticosteroids may contribute to a reduced mortality rate in SJS and/or TEN without increasing secondary infection. Further well-designed studies are required to compare the effect of corticosteroids treatment for SJS and/or TEN.

  5. Computer mouse use predicts acute pain but not prolonged or chronic pain in the neck and shoulder

    Andersen, JH; Harhoff, M.; Grimstrup, S.


    BACKGROUND: Computer use may have an adverse effect on musculoskeletal outcomes. This study assessed the risk of neck and shoulder pain associated with objectively recorded professional computer use. METHODS: A computer programme was used to collect data on mouse and keyboard usage and weekly...... quartile increase in weekly mouse usage time. Mouse and keyboard usage time did not predict the onset of prolonged or chronic pain in the neck or shoulder. Women had higher risks for neck and shoulder pain. Number of keystrokes and mouse clicks, length of the average activity period, and micro-pauses did...... not influence reports of acute or prolonged pain. A few psychosocial factors predicted the risk of prolonged pain. CONCLUSIONS: Most computer workers have no or minor neck and shoulder pain, few experience prolonged pain, and even fewer, chronic neck and shoulder pain. Moreover, there seems...

  6. The pattern of northern hemisphere surface air temperature during prolonged periods of low solar output

    Ruzmaikin, A.; Feyman, J.; Jiang, X.; Noone, D. C.; Waple, A. M.; Yung, Y. L.


    We show that the reconstructed sensitivity of the sea level temperature to long term solar forcing in the Northern Hemisphere is in very good agreement with the empirical temperature pattern corresponding to changes of the North Annular Mode (NAM).

  7. Prolonging sensor networks lifetime using convex clusters

    Payam Salehi


    Full Text Available Reducing the energy consumption of nodes in sensor networks and prolonging the network life time has been proposed as one of the most important challenges facing researchers in the field of sensor networks. Therefore, designing an energy-aware protocol to gather data from network level and transmitting it to sink is placed on the agenda at this paper. After presenting an analysis of the processes of clustering in sensory networks and investigating the effect of sending interval on the amount of energy consumption, We have shown that if the use of convex static casters be done such as all the communications within the cluster with the sending distance less than the optimal threshold, it Will help to increase the lifetime of nodes. also have shown that if we create a virtual backbone between cluster heads to transfer far cluster heads data from sink to sink , will has a significant impact on increasing the network lifetime. For this reason, a detailed discussion on how to determine the size of clusters and partitioning of the network environment to them is presented in Chapter 4.Simulation results show considerable improvement of the proposed algorithm.

  8. Persistent telomere cohesion triggers a prolonged anaphase.

    Kim, Mi Kyung; Smith, Susan


    Telomeres use distinct mechanisms (not used by arms or centromeres) to mediate cohesion between sister chromatids. However, the motivation for a specialized mechanism at telomeres is not well understood. Here we show, using fluorescence in situ hybridization and live-cell imaging, that persistent sister chromatid cohesion at telomeres triggers a prolonged anaphase in normal human cells and cancer cells. Excess cohesion at telomeres can be induced by inhibition of tankyrase 1, a poly(ADP-ribose) polymerase that is required for resolution of telomere cohesion, or by overexpression of proteins required to establish telomere cohesion, the shelterin subunit TIN2 and the cohesin subunit SA1. Regardless of the method of induction, excess cohesion at telomeres in mitosis prevents a robust and efficient anaphase. SA1- or TIN2-induced excess cohesion and anaphase delay can be rescued by overexpression of tankyrase 1. Moreover, we show that primary fibroblasts, which accumulate excess telomere cohesion at mitosis naturally during replicative aging, undergo a similar delay in anaphase progression that can also be rescued by overexpression of tankyrase 1. Our study demonstrates that there are opposing forces that regulate telomere cohesion. The observation that cells respond to unresolved telomere cohesion by delaying (but not completely disrupting) anaphase progression suggests a mechanism for tolerating excess cohesion and maintaining telomere integrity. This attempt to deal with telomere damage may be ultimately futile for aging fibroblasts but useful for cancer cells.


    Ah. Yusuf


    Full Text Available Introduction: Decision for cesarean section may lead to the stress for women in delivery. Stress response requires longer recovery time in post cesarean section patients. Most of patients who experience stress before and after surgical is associated with wound healing delay. When this condition continues, the wound will have a higher risk of infection. The objective of this study was to analyze correlation between stress and wound healing phase in post cesarean section patients. Method: A cross sectional design was used in this study. The population were women with cesarean section, both elective or emergency, in Delivery Room I RSU Dr. Soetomo Surabaya. Samples were recruited by using purposive sampling, with 28 samples who met to the inclusion criterias. The observed variables were stress and wound healing phase in post cesarean section patient. Stress data were collected by interview and wound healing measurement done by observation on the 3rd day post cesarean section. Result: The result showed that women with stress experience wound healing delay. The characteristic of wound healing delay was prolonged on inflammation phase, nevertheless there was presence of granulation tissue. Spearman’s rho correlation showed that correlation value r=0.675 with p=0.000. Discussion: It can be concluded that there was strong significant correlation between stress and wound healing phase in post cesarean section patients. It is important to give this information to the patients with cesarean section in order to prevent stress and delay in wound healing phase.

  10. Gluteal Compartment Syndrome After Prolonged Immobilisation

    H.L. Liu


    Full Text Available Muscles in the gluteal region are confined by distinct fascial attachments which can potentially result in compartment syndrome. A 74-year-old chronic drinker was admitted to the medical ward after being found drunk on the street. He noticed acute painful swelling of the right side of his buttock the following morning and recalled a slip and fall prior to his blackout. The whole right half of the buttock was tense with erythematous overlying skin. Examination revealed sciatic nerve palsy and myoglobinuria. Emergency fasciotomy and debridement were performed. Intra-operative pressure measurement confirmed a grossly elevated intra-compartmental pressure. Gluteal compartment syndrome is an extremely rare condition and has only been scantily documented previously in case reports. Early diagnosis is crucial but delay recognition is common from lack of knowledge of the condition and readily results in permanent sciatic nerve injury and acute renal shutdown from myoglobinuria. Awareness of the condition, early diagnosis and prompt exploration provide the only chance of avoiding these devastating consequences. Acute swelling diffusely affecting the whole or one side of the buttock, a history of trauma and prolonged local pressure impingement associated with pain out of proportion to the clinical signs should raise a suspicion of this rare condition.

  11. Effects of Prolonged Standing on Gait in Children with Spastic Cerebral Palsy

    Salem, Yasser; Lovelace-Chandler, Venita; Zabel, Reta J.; McMillan, Amy Gross


    The purpose of this study was to determine the effects of prolonged standing on gait characteristics in children with spastic cerebral palsy. Six children with spastic cerebral palsy participated in this study with an average age of 6.5 years (SD = 2.5, range = 4.0-9.8 years). A reverse baseline design (A-B-A) was used over a 9-week period. During…

  12. Effects of Prolonged Standing on Gait in Children with Spastic Cerebral Palsy

    Salem, Yasser; Lovelace-Chandler, Venita; Zabel, Reta J.; McMillan, Amy Gross


    The purpose of this study was to determine the effects of prolonged standing on gait characteristics in children with spastic cerebral palsy. Six children with spastic cerebral palsy participated in this study with an average age of 6.5 years (SD = 2.5, range = 4.0-9.8 years). A reverse baseline design (A-B-A) was used over a 9-week period. During…

  13. Prolonged reversal of the phencyclidine-induced impairment in novel object recognition by a serotonin (5-HT)1A-dependent mechanism.

    Horiguchi, Masakuni; Miyauchi, Masanori; Neugebauer, Nichole M; Oyamada, Yoshihiro; Meltzer, Herbert Y


    Many acute treatments transiently reverse the deficit in novel object recognition (NOR) produced by subchronic treatment with the N-methyl-d-aspartate receptor non-competitive antagonist, phencyclidine (PCP), in rodents. Treatments which restore NOR for prolonged periods after subchronic PCP treatment may have greater relevance for treating the cognitive impairment in schizophrenia than those which restore NOR transiently. We examined the ability of post-PCP subchronic lurasidone, an atypical APD with potent serotonin (5-HT)1A partial agonism and subchronic tandospirone, a selective 5-HT1A partial agonist, to enable prolonged reversal of the subchronic PCP-induced NOR deficit. Rats treated with subchronic PCP (2mg/kg, twice daily for 7 days) or vehicle, followed by a 7day washout period were subsequently administered lurasidone or tandospirone twice daily for 7 days (day 15-21), and tested for NOR weekly for up to two additional weeks. Subchronic lurasidone (1, but not 0.1mg/kg) or tandospirone (5, but not 0.6mg/kg) significantly reversed the PCP-induced NOR deficit at 24h and 7days after the last injection, respectively. The effect of lurasidone persisted for one more week (day 36, 14 days after the last lurasidone dose), while tandospirone-treated rats were able to perform NOR at 7, but not 14, days after the last tandospirone dose. Co-administration of WAY100635 (0.6mg/kg), a 5-HT1A antagonist, with lurasidone, blocked the ability of lurasidone to restore NOR, suggesting that 5-HT1A receptor stimulation is necessary for lurasidone to reverse the effects of PCP. The role of dopamine, GABA and the MAPK/ERK signalling pathway in the persistent, but not indefinite, restoration of NOR is discussed.

  14. What prolongs a butterfly's life?: Trade-offs between dormancy, fecundity and body size.

    Elena Haeler

    Full Text Available In butterflies, life span often increases only at the expense of fecundity. Prolonged life span, on the other hand, provides more opportunities for oviposition. Here, we studied the association between life span and summer dormancy in two closely related species of Palearctic Meadow Brown butterflies, the endemic Maniola nurag and the widespread M. jurtina, from two climatic provenances, a Mediterranean and a Central European site, and tested the relationships between longevity, body size and fecundity. We experimentally induced summer dormancy and hence prolonged the butterflies' life in order to study the effects of such a prolonged life. We were able to modulate longevity only in Mediterranean females by rearing them under summer photoperiodic conditions (light 16 h : dark 8 h, thereby more than doubling their natural life span, to up to 246 days. Central European individuals kept their natural average live span under all treatments, as did Mediterranean individuals under autumn treatment (light 11: dark 13. Body size only had a significant effect in the smaller species, M. nurag, where it affected the duration of dormancy and lifetime fecundity. In the larger species, M. jurtina, a prolonged adult life span did, surprisingly, not convey any fecundity loss. In M. nurag, which generally deposited fewer eggs, extended life had a fecundity cost. We conclude that Mediterranen M. jurtina butterflies have an extraordinary plasticity in aging which allows them to extend life span in response to adverse environmental conditions and relieve the time limitation on egg-laying while maintaining egg production at equal levels.

  15. Examining potential contraindications for prolonged exposure therapy for PTSD

    Agnes van Minnen


    Full Text Available Although prolonged exposure (PE has received the most empirical support of any treatment for post-traumatic stress disorder (PTSD, clinicians are often hesitant to use PE due to beliefs that it is contraindicated for many patients with PTSD. This is especially true for PTSD patients with comorbid problems. Because PTSD has high rates of comorbidity, it is important to consider whether PE is indeed contraindicated for patients with various comorbid problems. Therefore, in this study, we examine the evidence for or against the use of PE with patients with problems that often co-occur with PTSD, including dissociation, borderline personality disorder, psychosis, suicidal behavior and non-suicidal self-injury, substance use disorders, and major depression. It is concluded that PE can be safely and effectively used with patients with these comorbidities, and is often associated with a decrease in PTSD as well as the comorbid problem. In cases with severe comorbidity, however, it is recommended to treat PTSD with PE while providing integrated or concurrent treatment to monitor and address the comorbid problems.

  16. Glucocorticoid augmentation of prolonged exposure therapy: rationale and case report

    Laura Pratchett


    Full Text Available Rationale: Prolonged exposure (PE therapy has been found to reduce symptoms of posttraumatic stress disorder (PTSD; however, it is difficult for many patients to engage fully in the obligatory retelling of their traumatic experiences. This problem is compounded by the fact that habituation and cognitive restructuring – the main mechanisms through which PE is hypothesized to work – are not instantaneous processes, and often require several weeks before the distress associated with imaginal exposure abates. Case reports: Two cases are described that respectively illustrate the use of hydrocortisone and placebo, in combination with PE, for the treatment of combat-related PTSD. Based on known effects of glucocorticoids on learning and memory performance, we hypothesized that augmentation with hydrocortisone would improve the therapeutic effects of PE by hastening “new” learning and facilitating decreases in the emotional impact of fear memories during the course of treatment. The veteran receiving hydrocortisone augmentation of PE displayed an accelerated and ultimately greater decline in PTSD symptoms than the veteran receiving placebo. Conclusions: While no general conclusion can be derived from comparison of two patients, the findings are consistent with the rationale for augmentation. These case reports support the potential for an appropriately designed and powered clinical trial to examine the efficacy of glucocorticoids in augmenting the effects of psychotherapy for PTSD.

  17. Venous and arterial thrombo-embolic complications of hormonal treatment in a male-to-female transgender patient.

    Mullins, G M


    We present a male-to-female (MTF) transgender patient admitted with a pulmonary embolism. The patient had been treated with high-dose oestrogens since the age of 16. Following a prolonged period of hypotension, our patient sustained cerebral border zone infarcts. There was evidence of bilateral carotid stenosis on Doppler ultrasound. We discuss the treatment and vascular complications of gender dysphoria.

  18. Encephalitis with Prolonged but Reversible Splenial Lesion

    Alena Meleková


    Full Text Available Introduction: The splenium of the corpus callosum has a specific structure of blood supply with a tendency towards blood-brain barrier breakdown, intramyelinic edema, and damage due to hypoxia or toxins. Signs and symptoms of reversible syndrome of the splenium of the corpus callosum typically include disorientation, confusion, impaired consciousness, and epileptic seizures. Case report: A previously healthy 32-year-old man suffered from weakness, headache, and fever. Subsequently, he developed apathy, ataxia, and inability to walk, and therefore was admitted to the hospital. Cerebrospinal fluid showed protein elevation (0.9 g/l and pleocytosis (232/1 ul. A brain MRI showed hyperintense lesions in the middle of the corpus callosum. The patient was treated with antibiotics, and subsequently, in combination with steroids. Two months later, the hyperintense lesions in the splenium and the basal ganglia had disappeared. Almost seven months since his hospitalization in the Department of Neurology, the patient has returned to his previous employment. He now does not exhibit any mental changes, an optic edema and urological problems have improved. In addition, he is now actively engaged in sports. Conclusion: We have described a case of a 32-year-old man with confusion, ataxia, and inability to stand and walk. The man developed a febrile meningeal syndrome and a hyperintense lesion of the splenium, which lasted for two months. Neurological changes, optic nerve edema, and urinary retention have resolved over the course of seven months. We think that the prolonged but transient lesion of the splenium may have been caused by encephalitis of viral origin.

  19. Diaphragmatic energetics during prolonged exhaustive exercise.

    Manohar, M; Hassan, A S


    The present study was carried out to examine diaphragmatic O2 extraction and lactate and ammonia production during prolonged exhaustive exercise. Experiments were performed on nine healthy exercise-conditioned ponies in which catheters had been implanted in the phrenic vein previously. Blood-gas variables and lactate and ammonia concentrations were determined on simultaneously obtained arterial and phrenic-venous blood samples at rest and during 30 min of exertion at 15 mph + 7% grade (heart rate, 200 beats/min; approximately 90% of maximum). Arterial O2 tension and saturation were maintained near resting value but CO2 tension decreased markedly with exercise, and because of increased hemoglobin concentration, arterial O2 content rose. Concomitantly, phrenic venous O2 tension, saturation and content decreased markedly (23.6 +/- 1 mm Hg, 24.5 +/- 2%, 5.2 +/- 0.3 ml/dl at 3 min of exertion) and significant fluctuations did not occur as exercise duration progressed to 30 min. Diaphragmatic arteriovenous O2 content difference and O2 extraction rose from 4 +/- 0.3 to 16 +/- 0.5 ml/dl and from 30 +/- 3 to 75 +/- 1% at 3 min of exercise, and significant deviations did not occur as exercise duration progressed. Arterial lactate and ammonia levels increased during exercise, indicating their release from working limb muscles. Phrenic-venous values of lactate and ammonia did not exceed arterial values. Ponies sweated profusely and were unable to keep up with the belt speed in the last 4 to 5 min of exercise. Constancy of phrenic arteriovenous O2 content difference in exercise indicated ability to adjust perfusion in diaphragm so as to adequately meet its O2 needs.(ABSTRACT TRUNCATED AT 250 WORDS)

  20. Fatigue associated with prolonged graded running.

    Giandolini, Marlene; Vernillo, Gianluca; Samozino, Pierre; Horvais, Nicolas; Edwards, W Brent; Morin, Jean-Benoît; Millet, Guillaume Y


    Scientific experiments on running mainly consider level running. However, the magnitude and etiology of fatigue depend on the exercise under consideration, particularly the predominant type of contraction, which differs between level, uphill, and downhill running. The purpose of this review is to comprehensively summarize the neurophysiological and biomechanical changes due to fatigue in graded running. When comparing prolonged hilly running (i.e., a combination of uphill and downhill running) to level running, it is found that (1) the general shape of the neuromuscular fatigue-exercise duration curve as well as the etiology of fatigue in knee extensor and plantar flexor muscles are similar and (2) the biomechanical consequences are also relatively comparable, suggesting that duration rather than elevation changes affects neuromuscular function and running patterns. However, 'pure' uphill or downhill running has several fatigue-related intrinsic features compared with the level running. Downhill running induces severe lower limb tissue damage, indirectly evidenced by massive increases in plasma creatine kinase/myoglobin concentration or inflammatory markers. In addition, low-frequency fatigue (i.e., excitation-contraction coupling failure) is systematically observed after downhill running, although it has also been found in high-intensity uphill running for different reasons. Indeed, low-frequency fatigue in downhill running is attributed to mechanical stress at the interface sarcoplasmic reticulum/T-tubule, while the inorganic phosphate accumulation probably plays a central role in intense uphill running. Other fatigue-related specificities of graded running such as strategies to minimize the deleterious effects of downhill running on muscle function, the difference of energy cost versus heat storage or muscle activity changes in downhill, level, and uphill running are also discussed.

  1. Late-responding normal tissue cells benefit from high-precision radiotherapy with prolonged fraction delivery times via enhanced autophagy

    Yao, Qiwei; Zheng, Rong; Xie, Guozhu; Liao, Guixiang; Du, Shasha; Ren, Chen; Li, Rong; Lin, Xiaoshan; Hu, Daokun; Yuan, Yawei


    High-precision radiotherapy (HPR) has established its important role in the treatment of tumors due to its precise dose distribution. Given its more complicated delivery process, HPR commonly requires more fraction delivery time (FDT). However, it is unknown whether it has an identical response of prolonged FDT on different normal tissues. Our results showed that fractionated irradiation with prolonged FDTs (15, 36, and 50 minutes) enhanced cell surviving fractions for normal tissue cells compared with irradiation with an FDT of 2 minutes. However, the late-responding normal cell line HEI-OC1 was more responsive to prolonged FDTs and demonstrated higher surviving fractions and significantly decreased apoptosis and DNA damage compared to the acute-responding normal cell line HaCaT. Increased autophagy mediated via the ATM-AMPK pathway was observed in HEI-OC1 cells compared with HaCaT cells when irradiated with prolonged FDTs. Furthermore, treatment with the autophagy inhibitor 3-MA or ATM inhibitor KU55933 resulted in enhanced ROS accumulation and attenuation of the effect of prolonged FDT-mediated protection on irradiated HEI-OC1 cells. Our results indicated that late-responding normal tissue cells benefitted more from prolonged FDTs compared with acute-responding tissue cells, which was mainly attributed to enhanced cytoprotective autophagy mediated via the ATM/AMPK signaling pathway. PMID:25766900

  2. QT interval prolongation after Premature Ventricular Contractions (PVCs

    Mohammed Haroon Rashid


    Full Text Available Long QT syndrome (LQTS is an inherited ion channelopathy resulting in abnormal ventricular repolarization and abnormal prolongation of QT interval on the ECG. Syncope, fainting, cardiac arrest, and sudden death are common manifestations of LQTS. We present a case report that describes a patient with prolonged QT interval after extrasystoles and a family history of sudden cardiac deaths.

  3. Association Among Sociodemograhic Factors, Work Ability, Health Behavior, and Mental Health Status for Young People After Prolonged Unemployment.

    Lappalainen, Kirsi; Manninen, Pirjo; Räsänen, Kimmo


    The purpose of this study was to explore the associations of prolonged unemployment, health, and work ability among young workers using data from the 2008-2010 Occupational Health Counselling project in Kuopio, Eastern Finland. The total sample for this study was 190 young unemployed adults. The questionnaire included the Work Ability Index (WAI), the Beck Depression Inventory, the Alcohol Use Disorders Identification Test, and the Occupational Health Counselling Survey. Multivariate analyses revealed that men had a higher prevalence of prolonged unemployment than women. Using drugs for purposes other than treatment was associated independently with an increased prevalence of prolonged unemployment. Low WAI scores were associated with a higher prevalence of prolonged unemployment. This study showed that attention should be paid to male workers, those who have poor or moderate work ability and workers who use drugs. Young unemployed workers should be recognized at an early stage. A comprehensive, flexible network of community resources is essential to support young unemployed adults.

  4. Converting everolimus to mycophenolate mofetil ameliorated prolonged respiratory syncytial virus infection in a child after heart transplantation.

    Suginobe, Hidehiro; Nawa, Nobutoshi; Ishida, Hidekazu; Kogaki, Shigetoyo


    In immunocompromised patients, respiratory syncytial virus (RSV) infections are known to be severe and prolonged, and have significant mortality and morbidity. However, little is known about the clinical courses and treatment strategy of RSV infection in heart transplant recipients. Here, we report a 6-year-old female with heart transplantation who had exhibited prolonged respiratory symptoms and shedding of RSV. She had received everolimus as an immunosuppressant. As immunosuppressants could have been responsible for the prolonged activation of RSV, we converted everolimus to mycophenolate mofetil. After the conversion, RSV promptly disappeared, and her symptoms improved. We speculate that converting the immunosuppressant may be effective for prolonged RSV infection due to the different immunosuppressive mechanisms. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  5. As time goes by: reasons and characteristics of prolonged episodes of mechanical restraint in forensic psychiatry.

    Gildberg, Frederik A; Fristed, Peter; Makransky, Guido; Moeller, Elsebeth H; Nielsen, Lea D; Bradley, Stephen K


    Evidence suggests the prevalence and duration of mechanical restraint are particularly high among forensic psychiatric inpatients. However, only sparse knowledge exists regarding the reasons for, and characteristics of, prolonged use of mechanical restraint in forensic psychiatry. This study therefore aimed to investigate prolonged episodes of mechanical restraint on forensic psychiatric inpatients. Documentary data from medical records were thematically analyzed. Results show that the reasons for prolonged episodes of mechanical restraint on forensic psychiatric inpatients can be characterized by multiple factors: "confounding" (behaviors associated with psychiatric conditions, substance abuse, medical noncompliance, etc.), "risk" (behaviors posing a risk for violence), and "alliance parameters" (qualities of the staff-patient alliance and the patients' openness to alliance with staff), altogether woven into a mechanical restraint spiral that in itself becomes a reason for prolonged mechanical restraint. The study also shows lack of consistent clinical assessment during periods of restraint. Further investigation is indicated to develop an assessment tool with the capability to reduce time spent in mechanical restraint.

  6. Characterization of renal response to prolonged immersion in normal man

    Epstein, M.; Denunzio, A. G.; Ramachandran, M.


    ?jDuring the initial phase of space flight, there is a translocation of fluid from the lower parts of the body to the central vascular compartment with a resultant natriuresis, diuresis, and weight loss. Because water immersion is regarded as an appropriate model for studying the redistribution of fluid that occurs in weightlessness, an immersion study of relatively prolonged duration was carried out in order to characterize the temporal profile of the renal adaptation to central hypervolemia. Twelve normal male subjects underwent an immersion study of 8-h duration in the sodium-replete state. Immersion resulted in marked natriuresis and diuresis which were sustained throughout the immersion period. The failure of that natriuresis and diuresis of immersion to abate or cease despite marked extracellular fluid volume contraction as evidenced by a mean weight loss of -2.2 + or - 0.3 kg suggests that central blood volume was not restored to normal and that some degree of central hypervolemia probably persisted.

  7. Can the rat donor liver tolerate prolonged warm ischemia ?

    Ji Qi Yan; Hong Wei Li; Wei Yao Cai; Ming Jun Zhang; Wei Ping Yang


    The last two decades of the twentieth century have witnessed increasingly successful rates of liver transplantation. The number of liver transplantations has increased steadily while the number of organ donors has remained relatively constant. Thus a great disparity has developed between the demand and supply of donor organs and remains a major limiting factor for further expansion of liver transplantation. Although many procedures, such as split liver[1] , living-related transplantation[2] , and xenotransplantation[3], have been attempted clinically to overcome the shortage, it is hoped that livers harvested from non-heart-beating donors (NHBDs) would alleviatethe problem of organ shortage, which again becomes the focus of attention[4-9]. However, sensitivity of the liver to warm ischemia remains a major worry for use of theNHBDs. The aim of this animal study was to assess if murine liver could tolerate prolonged period of warm ischemia and to determine the optimum timing of intervention in the cadaver donor in order to preserve liver viability.

  8. Drugs, QTc prolongation and sudden cardiac death

    S.M.J.M. Straus (Sabine)


    textabstract__Abstract__ The term sudden cardiac death pertains to an unexpected death from cardiac causes within a short time period and has been described throughout history. The ancient Egyptians inscribed on the tomb of a nobleman some 4500 years ago that he had died suddenly and without appare

  9. Drugs, QTc prolongation and sudden cardiac death

    S.M.J.M. Straus (Sabine)


    textabstract__Abstract__ The term sudden cardiac death pertains to an unexpected death from cardiac causes within a short time period and has been described throughout history. The ancient Egyptians inscribed on the tomb of a nobleman some 4500 years ago that he had died suddenly and without

  10. Prolonged penile strangulation with metal clamps

    Chirag Patel; Richard Kim; Michael Delterzo; Run Wang


    Various different objects have been reported to strangulate the penis. We reported on a patient who used metal radiator clamps for an extended period of time. Workup included history, physical examination and urinalysis. The patient was taken to the operating room for further evaluation with cystourethroscopy and orthopedic wire cutters were used to break the metal bands.

  11. Changes of ecosystem functions in a Mediterranean shrubland exposed for eight years to prolonged summer droughts

    de Dato, Giovanbattista; de Angelis, Paolo; Cesaraccio, Carla; Pellizzaro, Grazia; Duce, Pierpaolo; Sirca, Costantino; Spano, Donatella; Beier, Claus


    Where water is a limiting factor, like in arid and semiarid shrubland ecosystems of the Mediterranean basin, soil moisture, strengthen by high temperatures, is the key limiting factor controlling biogeochemical cycles. During the drought season, the unavailable water reduces plant growth, litter decomposition and microbial soil respiration. In order to assess the impacts of precipitation reduction on Mediterranean shrublands, a natural community has been exposed since 2001 to prolonged summer droughts by means of mobile plastic roofs, covering three experimental plots (20 m2) during rain events, in spring and in autumn. Three additional plots were used as control. The vegetation reaches a maximum height of 1.0 m and the main shrub species are Cistus monspeliensis, Helichrysum italicum and Dorycnium pentaphyllum. Bare soil constitutes about 20% of the plot surface. The aim of this paper is to summarize the impact of the treatment on the plant community structure and on ecosystem functions, after 8 years of experimentation. A general increase of vegetation cover was observed in the whole community during the years, as result of a natural process of recolonisation. This positive temporal pattern was mainly observed in the control plots, whereas in the drought treatment it was less evident and practically null in the year 2003. At species-specific level, a clear negative effect of drought treatment was observed for C. monspeliensis. Moreover, anticipated drought reduced C assimilation and induced an earlier change of leaf morphology in Cistus. These effects produced the reduction of LAI and of whole plant productivity. The seasonal pattern of soil CO2 efflux was characterized by higher rates during the wet vegetative season (autumn-spring) and lower rates during the dry non-vegetative season (summer). Significant negative effects were occasionally recorded during the period with the treatment turned on. The relation of soil respiration with temperature and soil water

  12. pH-dependent inhibition of K2P3.1 prolongs atrial refractoriness in whole hearts

    Skarsfeldt, Mark A; Jepps, Thomas A; Bomholtz, Sofia H


    displayed a more uniform expression of KCNK3 between atria and ventricle. In voltage-clamp experiments, ML365 and A293 were found to be potent and selective inhibitors of K2P3.1, but at pH 7.4, they failed to prolong atrial APD and refractory period (effective refractory period (ERP)) in isolated perfused...... rat and guinea pig hearts. At pH 7.8, which augments K2P3.1 currents, pharmacological channel inhibition produced a significant prolongation of atrial ERP (11.6 %, p = 0.004) without prolonging ventricular APD but did not display a significant antiarrhythmic effect in our guinea pig AF model (3...

  13. Risk factors for prolonged operative time in single-incision laparoscopic cholecystectomy

    Cheon, Seong Uk; Moon, Ju Ik; Choi, In Seok


    Purpose We performed 3-channel single incision laparoscopic cholecystectomy (SILC) in earlier period of this study and modified our method to 4-channel SILC using a snake retractor for better operative field in later period. This study has been designed to evaluate the risk factors for prolonged operative time in SILC. Methods From April 2010 to August 2014, 323 cases of 3-channel SILC (Konyang standard method [KSM] group) and 399 cases of 4-channel SILC (modified KSM [mKSM] group) using a sn...

  14. The prevalence, prevention and treatment of cattle epidemic during the Han-Tang Period%汉唐时期牛疫的流行与防治



    About 21 times of cattle epidemic with rather strong infectivity happened during the Han-Tang Period,including 6 in the Eastern Han Dynasty,2 in the Jin Dynasty,4 in the Southern and Northern Dynasties,8 in the Tang Dynasty and 1 in the Five Dynasty.Most of them were spread along the Yellow River and the northern region of the Huai River.The type of cattle epidemic included the acute cattle plague,cattle bovine mange,cattle yellow fever and cattle rotten hoof disease,etc.Its occurrence and prevalence brought a serious influentce on the society of the Han and Tang Dynasties,causing massive mortality of farm cattle,and then the shortage of animal power,and threatening the agriculture,which drew the attention of the governments,physicians,agriculturists,astrologists and Taoists.The medical measures and economic measures were adopted for the prevention and treatment of cattle epidemic.Especially,prescriptions in the books of medicine and agriculture exerted positive effects on the containment of cattle epidemic.On the other hand,its prevalence and the mass mortality of farm cattle,in a way,promoted,to certain extent,the improvement of the government's function of relief,the updating of the methods of agriculture and the creation of new farm tools,and being regarded as a main cause for the technological innovation of agriculture.%汉唐时期约发生了21次传染性较强的牛疫,其中东汉时期6次,两晋时期2次,南北朝时期4次,唐代8次,五代1次,大多分布在黄河流域和淮河以北地区.牛疫种类主要有急性牛疫、牛疥癣病、牛黄热病和牛漏蹄病等.牛疫的发生和流行对汉唐社会产生了严重影响,不仅引起耕牛的大量死亡,而且造成畜力短缺,威胁到农业生产的正常进行,从而引起历代政府、医学家、农学家、星占学家、道家等不同社会阶层的关注和重视.防治牛疫的措施主要有医学措施和经济措施两方面,尤其是医学本草、方书、农书等类著

  15. Pharmacokinetics and effect of food after oral administration of prolonged-release tablets of ropinirole hydrochloride in Japanese patients with Parkinson's disease.

    Hattori, N; Hasegawa, K; Sakamoto, T


    Ropinirole hydrochloride, a dopamine receptor agonist with a non-ergot alkaloid structure, is highly selective for the dopamine D(2) /D(3) receptors. This study was conducted to evaluate the steady-state pharmacokinetics, safety and efficacy after repeated oral administration of prolonged-release tablets of ropinirole hydrochloride in the absence of L-dopa preparations in Japanese patients with Parkinson's disease (PD). This was a multicenter, open-label, uncontrolled study. The total duration of participation in the study ranged from 56 to 63 weeks. In the study, the plasma concentrations of ropinirole, its major metabolite SK&F104557 (N-depropyl ropinirole) and another metabolite SK&F89124 (ropinirole hydroxylated at the seventh position of the indole ring) were assessed. Safety based on adverse events, haematology, biochemistry, urinalysis and electrocardiography (ECG) (standard 12-lead ECG) were evaluated, and vital signs (blood pressure/pulse rate) were measured. Efficacy based on the Japanese version of Unified Parkinson's Disease Rating Scale (UPDRS) Parts III (motor) and II [activities of daily living (ADL)] as well as tolerability was evaluated. After repeated oral administration of prolonged-release tablets of ropinirole hydrochloride in Japanese patients with PD, ropinirole, SK&F104557 and low levels of SK&F89124 were detected in plasma. The trough concentrations of ropinirole and the two metabolites increased in proportion to the dose when ropinirole hydrochloride prolonged-release tablets were administered at doses ranging from 2 to 16 mg/day. The plasma exposure to ropinirole and its two metabolites after intake of normal diet was comparable to that in the fasting state. The most common adverse events (10% or more) were somnolence, nausea, constipation, hallucination and nasopharyngitis. Most adverse events were mild or moderate in severity, and with no death. During the treatment period, serious adverse events were reported in five patients. Efficacy

  16. Implementation of Intranasal Midazolam for Prolonged Seizures in a Child Neurology Practice.

    Crawford, Daniel


    Currently, evidence supports the use of intranasal midazolam as an effective, and in many cases, preferable treatment option for prolonged seizures in children. Despite this knowledge, intranasal midazolam is not routinely found as a standard of care. The goal of this project was to implement the use of intranasal midazolam as a rescue medication for prolonged seizures within a child neurology practice and, in doing so, create a model for implementation that would be replicable for other practice sites. This project focused on the development of a process to make intranasal midazolam available as a treatment option and then the creation of an educational intervention for providers within a child neurology practice. Provider surveys analyzed provider attitudes toward intranasal midazolam and its frequency of use. Because of this project, a dramatic increase in the prescribing of intranasal midazolam was observed within a child neurology practice.

  17. Questions raised by artificial prolongation of life of the aged patient.

    Rougé, D; Telmon, N; Albar ede, J L; Arbus, L


    The existence of treatments which now make it possible to prolong life beyond the point when it would previously have ended, gives rise to particular questions in the context of the care of aged patients: the distinction between curative and palliative treatment, the evaluation of incurability, the right to refuse treatment, competence to make such a decision and the use of the limited objective and pure objective tests in the event of incompetence. The natural role of the physician as protector adds a further ethical dimension to what is also a medicolegal question.

  18. Delayed replantation after prolonged dry storage

    Anita Rao


    Full Text Available Management of tooth avulsion in the permanent dentition often presents a challenge. Definitive treatment planning and consultation with specialists is seldom possible at the time of emergency treatment. Replantation of the avulsed tooth can restore esthetic appearance and occlusal function shortly after the injury. This article describes the management of a patient with an avulsed maxillary permanent incisor that had been air-dried for about 40 h. The replanted incisor retained its esthetic appearance and functionality 1 year after replantation, yet the long-term prognosis is not good because of progressive replacement root resorption.

  19. Uremic retention solute indoxyl sulfate level is associated with prolonged QTc interval in early CKD patients.

    Tang, Wei-Hua; Wang, Chao-Ping; Chung, Fu-Mei; Huang, Lynn L H; Yu, Teng-Hung; Hung, Wei-Chin; Lu, Li-Fen; Chen, Po-Yuan; Luo, Ching-Hsing; Lee, Kun-Tai; Lee, Yau-Jiunn; Lai, Wen-Ter


    Total mortality and sudden cardiac death is highly prevalent in patients with chronic kidney disease (CKD). In CKD patients, the protein-bound uremic retention solute indoxyl sulfate (IS) is independently associated with cardiovascular disease. However, the underlying mechanisms of this association have yet to be elucidated. The relationship between IS and cardiac electrocardiographic parameters was investigated in a prospective observational study among early CKD patients. IS arrhythmogenic effect was evaluated by in vitro cardiomyocyte electrophysiological study and mathematical computer simulation. In a cohort of 100 early CKD patients, patients with corrected QT (QTc) prolongation had higher IS levels. Furthermore, serum IS level was independently associated with prolonged QTc interval. In vitro, the delay rectifier potassium current (IK) was found to be significantly decreased after the treatment of IS in a dose-dependent manner. The modulation of IS to the IK was through the regulation of the major potassium ion channel protein Kv 2.1 phosphorylation. In a computer simulation, the decrease of IK by IS could prolong the action potential duration (APD) and induce early afterdepolarization, which is known to be a trigger mechanism of lethal ventricular arrhythmias. In conclusion, serum IS level is independently associated with the prolonged QTc interval in early CKD patients. IS down-regulated IK channel protein phosphorylation and the IK current activity that in turn increased the cardiomyocyte APD and QTc interval in vitro and in the computer ORd model. These findings suggest that IS may play a role in the development of arrhythmogenesis in CKD patients.

  20. Prolonged menstruation and increased menstrual blood with generalized δ electroencephalogram power: A case report.

    Peng, Fenghua; Zhang, Lianping


    Estradiol changes associated with the menstrual cycle have a great impact on brain activation. δ frequency mainly appears during normal sleep status or brain injury diseases, including encephalitis and mental confusion. The current case report presents a 51-year-old female with prolonged menstruation and increased menstrual blood volume whose electroencephalogram (EEG) recording demonstrated a rare generalized 3 Hz δ frequency band in the waking status. The patient had been suffering from heart palpitations and dizziness for 6 months and was receiving treatment in the Department of Neurology (Second Xiangya Hospital). The individual had been experiencing prolonged menstruation and increased menstrual blood volume for 6 years. Gynecologial examination revealed secondary anemia and hysteromyoma. Hemoglobin levels were decreased to 69 g/l. Physical and neurological examinations, and computed tomography results appeared normal. The EEG recording indicated a generalized 3 Hz δ frequency band with 30-80 μV power and a long-range δ frequency band when the patient was hyperventilating. The prolonged menstruation and increased menstrual blood volume may have induced the generalized δ frequency without brain injury. To the best of our knowledge, this is the first formal case report of prolonged menstruation and increased menstrual blood volume with the abnormality of δ EEG power.

  1. Thyrotoxic periodic paralysis

    Ferreiro, J.E.; Arguelles, D.J.; Rams, H. Jr.


    A case of thyrotoxic periodic paralysis is reported in a Hispanic man with an unusual recurrence six weeks after radioactive iodine treatment. Thyrotoxic periodic paralysis has now been well characterized in the literature: it occurs primarily in Orientals with an overwhelming male preponderance and a higher association of specific HLA antigens. Clinical manifestations include onset after high carbohydrate ingestion or heavy exertion, with progressive symmetric weakness leading to flaccid paralysis of the extremities and other muscle groups, lasting several hours. If hypokalemia is present, potassium administration may help abort the attack. Although propranolol can be efficacious in preventing further episodes, the only definitive treatment is establishing a euthyroid state. The pathophysiology is still controversial, but reflects altered potassium and calcium dynamics as well as certain morphologic characteristics within the muscle unit itself.

  2. Prolonged chewing at lunch decreases later snack intake.

    Higgs, Suzanne; Jones, Alison


    Prolonged chewing of food can reduce meal intake. However, whether prolonged chewing influences intake at a subsequent eating occasion is unknown. We hypothesised that chewing each mouthful for 30s would reduce afternoon snack intake more than (a) an habitual chewing control condition, and (b) an habitual chewing condition with a pauses in between each mouthful to equate the meal durations. We further hypothesised that this effect may be related to effects of prolonged chewing on lunch memory. Forty three participants ate a fixed lunch of sandwiches in the laboratory. They were randomly allocated to one of the three experimental groups according to a between-subjects design. Appetite, mood and lunch enjoyment ratings were taken before and after lunch and before snacking. Snack intake of candies at a taste test 2h after lunch was measured as well as rated vividness of lunch memory. Participants in the prolonged chewing group ate significantly fewer candies than participants in the habitual chewing group. Snack intake by the pauses group did not differ from either the prolonged or habitual chewing groups. Participants in the prolonged chewing group were less happy and enjoyed their lunch significantly less than participants in other conditions. Appetite ratings were not different across groups. Rated vividness of lunch memory was negatively correlated with intake but there was no correlation with rated lunch enjoyment. Prolonged chewing of a meal can reduce later snack intake and further investigation of this technique for appetite control is warranted.

  3. A Case of Prolonged Cholestatic Hepatitis Induced by Azithromycin in a Young Woman

    Caterina Maggioli


    Full Text Available Azithromycin, a semisynthetic macrolides, is frequently prescribed for the treatment of middle ear and upper respiratory tract infections, bronchitis, and community-acquired pneumonia. This antibiotic is usually well tolerated, and a rapid resolving cholestatic hepatitis has been described up to now only in six patients all, except one, over 65 years of age. We here report the case of a prolonged cholestatic hepatitis after administration of azithromycin in a young woman with no history of liver disease.

  4. Prolonged latent schistosomiasis diagnosed 38 years after infestation in a HIV patient.

    Payet, Barry; Chaumentin, Gilles; Boyer, Michelle; Amaranto, Paula; Lemonon-Meric, Claire; Lucht, Frederic


    We report a case of Schistosoma mansoni bilharziasis in a HIV patient 38 y after leaving an endemic region. A viable S. mansoni egg on a liver biopsy sample was diagnostic. Despite severe concomitant immunodeficiency the effective treatment was a single dose of praziquantel. Worms' intravascular longevity and the role of immunodeficiency as a possible factor in eggs retention after such prolonged latent schistosomiasis are discussed.

  5. Phentolamine mesylate: It′s role as a reversal agent for unwarranted prolonged local analgesia

    Harpreet Singh Grover; Anil Gupta; Neha Saksena; Neha Saini


    Administration of local anesthesia is an integral procedure prior to dental treatments to minimize the associated pain. It is learned that its effect stays more than the time required for the dental procedure to be completed. This prolonged soft tissue anesthesia (STA) can be detrimental, inconvenient, and unnecessary. Phentolamine mesylate, a Food and Drug Administration-approved drug essentially serves the purpose of faster recovery from numbness at the site of local anesthesia. This articl...

  6. Effects of a prolonged submersion on bone strength and metabolism in young healthy submariners.

    Luria, Tal; Matsliah, Yinnon; Adir, Yochai; Josephy, Noam; Moran, Daniel S; Evans, Rachel K; Abramovich, Amir; Eliakim, Alon; Nemet, Dan


    Submariners taking part in prolonged missions are exposed to environmental factors that may adversely affect bone health. Among these, relatively high levels of CO(2), lack of sunlight exposure affecting vitamin D metabolism, limited physical activity, and altered dietary habits. The aims of this study were to examine the effect of a prolonged submersion (30 days) on changes in bone strength using quantitative bone speed of sound and in markers of bone metabolism that include bone turnover (BAP, PINP, TRAP5b, and CTx) and endocrine regulators (serum calcium, PTH, and 25[OH]D) in a group of 32 young healthy male submariners. The prolonged submersion led to increases in body weight and BMI and to a decrease in fitness level. There was a significant decrease in bone strength following the submersion. Speed of sound exhibited continued decline at 4 weeks after return to shore and returned to baseline levels at the 6-month follow-up. There was a significant increase in circulating calcium level. PTH and 25(OH)D levels decreased significantly. Significant decreases were observed in both TRAP5b and CTx levels, markers of bone resorption, as well as in N-terminal propeptide of type I collagen (PINP), a bone formation marker. Prolonged submersion led to a significant decrease in bone strength, accompanied by an overall decrease in bone metabolism. Bone strength was regained only 6 months after return to shore. Prevention and/or rehabilitation programs should be developed following periods of relative disuse even for young submariners. The effects of repeated prolonged submersions on bone health are yet to be determined.

  7. Stream thermal heterogeneity prolongs aquatic-terrestrial subsidy and enhances riparian spider growth.

    Uno, Hiromi


    Emerging aquatic insects from streams are important food sources for riparian predators, yet their availability is seasonally limited. Spatial heterogeneity in stream water temperature was found to spatially desynchronize the emergence timing of aquatic insects, and prolong their flight period, potentially enhancing consumer growth. While a mayfly Ephemerella maculata emergence lasted for 12-22 d in local sites along a river, mayflies emerged 19 days earlier from warmer than cooler sites. Therefore, the overall emergence of E. maculata from the river lasted for 37 d, and adult swarms were observed over that same period in an adjacent reproductive habitat. A feeding experiment with the riparian spider Tetragnatha versicolor showed that a prolonged subsidy, as would occur in a heterogeneous river, led to higher juvenile growth than a synchronous pulsed subsidy of equal total biomass, as would typify a more homogeneous river. Since larger female adult spiders produce more eggs, spiders that received prolonged subsidy as juveniles should achieve higher fecundity. Restoring spatial heterogeneity in streams may benefit not only stream communities but also riparian predators.

  8. Prolonged ventilation post cardiac surgery - tips and pitfalls of the prediction game

    Knapik Piotr


    Full Text Available Abstract Background Few available models aim to identify patients at risk of prolonged ventilation after cardiac surgery. We compared prediction models developed in ICU in two adjacent periods of time, when significant changes were observed both in population characteristics and the perioperative management. Methods We performed a retrospective review of two cohorts of patients in our department in two subsequent time periods (July 2007 - December 2008, n = 2165; January 2009 - July 2010, n = 2192. The study was approved by the Institutional Ethics Committee and the individual patient consent was not required. Patients were divided with regard to ventilation time of more or less than 48 hours. Preoperative and procedure-related variables for prolonged ventilation were identified and multivariate logistic regression analysis was performed separately for each cohort. Results Most recent patients were older, with more co-morbidities, more frequently undergoing off-pump surgery. At the beginning of 2009 we also changed the technique of postoperative ventilation. Percentage of patients with prolonged ventilation decreased from 5.7% to 2.4% (p Conclusions Prediction models for postoperative ventilation should be regularly updated, particularly when major changes are noted in patients' demographics and surgical or anaesthetic technique.

  9. Fistula Tunnel Method to Suture a Period of Treatment, the Clinical Effect of the Treatment of Anal Fistula%瘘管隧道法切除一期缝合术治疗肛瘘的临床疗效



    目的:探讨利用瘘管隧道法切除一期缝合术进行肛瘘治疗的临床疗效。方法方便选取2013年1月—2014年1月期间入住该院治疗肛瘘的120例患者,按治疗方法不同将其随机分为A、B、C 3组各40例,A组采用瘘管隧道切除一期缝合术,B组采用肛瘘切除缝合术,C组采用肛瘘切除术,对比3个组患者创面愈合时间、术后伤疤情况、感染情况以及肛门的括约肌功能恢复等。结果 A、B两组患者手术后伤口的愈合时间分别为(4±11)d和(5±12)d,相比于C组的愈合时间(9±18)d要更短,疤痕也较小,P<0.05;在手术后伤口出现感染情况以及复发情况的比较上,A组1例,B组15例,C组5例,B组又比A、C两组更高,P<0.05;肛门的变形数量方面A组2例,B组3例,C组18例,A、B两组明显比C组少,P<0.05;另外,A、B两组患者都没有出现因为肛门括约肌损伤而导致大小便时常的病例。结论治疗肛瘘疾病采用瘘管隧道法切除一期缝合术,有效减少了患者伤口创面痊愈的时间,且手术后的疤痕比较小,手术复发率低,最大限度的保护了患者肛门括约肌的功能,提高治疗肛瘘的疗效,值得在临床上广泛推广和应用。%Objective To study the fistula tunnel method is used to suture the first phase of treatment for anal fistula of clinical efficacy. Methods Convenient selection between January 2013 to January 2014 during the period of stay in the hos-pital for the treatment of anal fistula, 120 patients in treatment methods, based on the random divided into A, B, C three groups (40 cases, group A with fistula tunnel suture issue, group B with anal fistula resection decompression, group C with anal fistula resection, compare the three groups of patients with wound healing time, postoperative scar size, postoperative wound infection situation and anal deformation of anal sphincter function, and the postoperative recurrence 2 years of fol-low-up, and statistical analysis

  10. The effect of prolonged-release melatonin on sleep measures and psychomotor performance in elderly patients with insomnia.

    Luthringer, Remy; Muzet, Muriel; Zisapel, Nava; Staner, Luc


    Objectives of this study were to investigate the effects of prolonged-release melatonin 2 mg (PRM) on sleep and subsequent daytime psychomotor performance in patients aged > or =55 years with primary insomnia, as defined by fourth revision of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association. Patients (N = 40) were treated nightly single-blind with placebo (2 weeks), randomized double-blind to PRM or placebo (3 weeks) followed by withdrawal period (3 weeks). Sleep was assessed by polysomnography, all-night sleep electroencephalography spectral analysis and questionnaires. Psychomotor performance was assessed by the Leeds Psychomotor Test battery. By the end of the double-blind treatment, the PRM group had significantly shorter sleep onset latency (9 min; P = 0.02) compared with the placebo group and scored significantly better in the Critical Flicker Fusion Test (P = 0.008) without negatively affecting sleep structure and architecture. Half of the patients reported substantial improvement in sleep quality at home with PRM compared with 15% with placebo (P = 0.018). No rebound effects were observed during withdrawal. In conclusion, nightly treatment with PRM effectively induced sleep and improved perceived quality of sleep in patients with primary insomnia aged > or =55 years. Daytime psychomotor performance was not impaired and was consistently better with PRM compared with placebo. PRM was well tolerated with no evidence of rebound effects.

  11. Change in the direct cost of treatment for children and adolescents with hyperkinetic disorder in Germany over a period of four years

    Rothenberger Aribert


    Full Text Available Abstract Background In many developed countries, the treatment of hyperkinetic disorder (or ADHD consumes a considerable amount of resources. The primary aim of this study was to determine change in the direct cost of treatment for children and adolescents with hyperkinetic disorder in Germany over time, and compare the cost with the cost of treatment for two physical disorders: epilepsy and asthma. Methods The German Federal Statistical Office provided data on the direct cost of treating hyperkinetic disorder, epilepsy and asthma in Germany for 2002, 2004, and 2006. The direct costs of treatment incurred by hyperkinetic disorder in these years were compared with those incurred by epilepsy and asthma. Results The total direct cost of treatment for the hyperkinetic disorder was € 177 million in 2002, € 234 million in 2004, and € 341 million in 2006. The largest proportion of the cost was incurred by the age group Conclusion The direct cost of treatment for hyperkinetic disorder in the age group

  12. Predictors for Prolonged Intensive Care Unit Stay After Adult Orthotopic Liver Transplantation

    Aycan Kundakcı


    Full Text Available Objective: Intensive care unit (ICU stay consumes physical and financial resources and may increase the risk of complications and possibly mortality. The purpose of this study was to evaluate the factors predicting prolonged ICU length of stay (LOS after orthotopic liver transplantation (OLT. Materials and Methods: We reviewed the data of 112 adult patients who underwent OLT between January 2000 and February 2009. The data included the demographic and clinical features, preoperative laboratory values, intraoperative hemodynamic parameters and transfusions, and mortalities. Prolonged ICU LOS was defined as more than 3 days stay in the ICU after OLT. Results: Out of 112 patients 59 (53% of them required prolonged ICU LOS. Patients who required prolonged ICU LOS compared to those who did not had higher model for end stage liver disease (MELD and Child-Pugh scores (p<0.001, had a lower mean preoperative hemoglobin level (p=0.04, had a higher mean preoperative blood urea nitrogen level (p=0.013, less frequently had coronary artery disease (p=0.046, required higher amounts of blood products transfusions intraoperatively (p=0.004, and had a longer duration of anesthesia (p=0.010. Multivariate logistic regression revealed that only higher MELD scores (odds ratio: 1.4, CI%95:1.2-1.7, p=0.010 was an independent risk factor for prolonged ICU stay after liver transplantation Patients who had developed renal failure in the early postoperative period according to the RIFLE criteria had stayed in the ICU longer [74% (23 vs 44%(36, p=0.006]. Patients who had stayed in the ICU for more than 3 days had higher rates of mortalities [41% (24 vs 9% (5, p<0.001]. Conclusion: In conclusion, 53% of our liver transplant recipients required prolonged ICU stay postoperatively and a higher MELD score was an independent risk factor for prolonged ICU requirement. (Journal of the Turkish Society of Intensive Care 2011; 9: 14-8

  13. [Beta lactam antibiotics and the question of dose regimen for severe infection. Prolonged infusion theoretically appealing--yet no evidence of clinical benefit].

    Leander, Gunilla; Eliasson, Erik; Hanberger, Håkan; Giske, Christian


    Patients with severe sepsis/septic shock have a high mortality. Beta-lactam antibiotics are normally first line treatment. This antimicrobial class has been associated with time-dependent efficacy. It is therefore plausible that administration as prolonged infusion will increase the therapeutic effect, as compared to short term bolus injections, which is the most common practice today. We have reviewed 14 randomized controlled studies to investigate whether prolonged infusion provides lower mortality and/or increased clinical cure. In summary, convincing advantages with prolonged infusion could not be found, however randomized studies are heterogeneous, and it cannot be excluded that some subgroups of critically ill patients could benefit from such treatment.

  14. Effects of Interrupted Wetness Periods on Conidial Germination, Germ Tube Elongation and Infection Periods of Botryosphaeria dothidea Causing Apple White Rot

    Ki Woo Kim


    Full Text Available Responses of Botryosphaeria dothidea to interrupted wetness periods were investigated under in vivo and in vitro conditions. Conidia of B. dothidea were allowed to germinate on apple fruits under wetting condition at 25ºC for 5 hr. They were air-dried for 0, 1, 2 or 4 hr, and then rewetted at 25ºC for 5 hr. Following an initial wetness period of 5 hr, 83% of the conidia germinated. The percent conidial germination increased to 96% when wetting was extended continuously another 5 hr. However, no further conidial germination was observed when wetting was interrupted by dry periods of 1, 2 and 4 hr, resulting in 83, 81 and 82%, respectively. The mean length of the germ tubes was 37 μm after 5 hr of wetting and elongated to 157 μm after 10 hr of continuous wetting. On the other hand, interruption of wetting by a dry period of 1 hr or longer after the 5 hr of initial wetting arrested the germ tube elongation at approximately 42 μm long. Prolonged rewetting up to 40 hr did not restore germ tube elongation on slide glasses under substrate treatments. Model simulation using weather data sets revealed that ending infection periods by a dry period of at least 1 hr decreased the daily infection periods, avoiding the overestimation of infection warning. This information can be incorpo- rated into infection models for scheduling fungicide sprays to control apple white rot with fewer fungicide applications.

  15. Prolonged remission maintenance in acute myeloid leukaemia.

    Spiers, A S; Goldman, J M; Catovsky, D; Costello, C; Galton, D A; Pitcher, C S


    Twenty-five patients with acute myeloid leukaemia were treated with three quadruple drug combinations in predetermined rotation: TRAP (thioguanine, daunorubicin, cytarabine, prednisolone); COAP (cyclophosphamide, vincristine, cytarabine, prednisolone); and POMP (prednisolone, vincristine, methotrexate, mercaptopurine). Fifteen patients (60%) achieved complete remission and five (20%) partial remission. For maintenance, five-day courses of drugs were administered every 14 to 21 days and doses were increased to tolerance. The median length of complete remission was 66 weeks. In eight patients remission maintenance treatment was discontinued and some remained in complete remission for over two years. In this series the remission induction rate was comparable with that reported for other regimens and complete remission lasted longer with this intensive maintenance regimen than with others. Nevertheless, the TRAP programme must still be regarded as only palliative treatment for acute myeloid leukaemia.

  16. Ketone supplementation decreases tumor cell viability and prolongs survival of mice with metastatic cancer.

    Poff, A M; Ari, C; Arnold, P; Seyfried, T N; D'Agostino, D P


    Cancer cells express an abnormal metabolism characterized by increased glucose consumption owing to genetic mutations and mitochondrial dysfunction. Previous studies indicate that unlike healthy tissues, cancer cells are unable to effectively use ketone bodies for energy. Furthermore, ketones inhibit the proliferation and viability of cultured tumor cells. As the Warburg effect is especially prominent in metastatic cells, we hypothesized that dietary ketone supplementation would inhibit metastatic cancer progression in vivo. Proliferation and viability were measured in the highly metastatic VM-M3 cells cultured in the presence and absence of β-hydroxybutyrate (βHB). Adult male inbred VM mice were implanted subcutaneously with firefly luciferase-tagged syngeneic VM-M3 cells. Mice were fed a standard diet supplemented with either 1,3-butanediol (BD) or a ketone ester (KE), which are metabolized to the ketone bodies βHB and acetoacetate. Tumor growth was monitored by in vivo bioluminescent imaging. Survival time, tumor growth rate, blood glucose, blood βHB and body weight were measured throughout the survival study. Ketone supplementation decreased proliferation and viability of the VM-M3 cells grown in vitro, even in the presence of high glucose. Dietary ketone supplementation with BD and KE prolonged survival in VM-M3 mice with systemic metastatic cancer by 51 and 69%, respectively (p Ketone administration elicited anticancer effects in vitro and in vivo independent of glucose levels or calorie restriction. The use of supplemental ketone precursors as a cancer treatment should be further investigated in animal models to determine potential for future clinical use. © 2014 The Authors Published by Wiley Periodicals, Inc. on behalf of UICC.

  17. Surgical treatment of 137 cases with chronic subdural hematoma at the university clinical center of Kosovo during the period 2008–2012

    Mekaj, Agon Y; Morina, Arsim A; Mekaj, Ymer H; Suzana Manxhuka-Kerliu; Miftari, Ermira I; Duci, Shkelzen B; Hamza, Astrit R.; Gashi, Musli M.; Mentor R Gjelaj; Kelmendi, Fatos M; Qamile Sh. Morina


    Background: Chronic subdural hematoma (CSDH) is frequent pathology in neurosurgical practice. The aim of this study is to present the first series of patients with CSDH, who got surgically treated in Clinic of Neurosurgery, University Clinical Center of Kosovo. Materials and Methods: This is a retrospective study that included 137 patients with CSDH who had been treated during the period 2008-2012. The data were collected and analyzed from the archives and protocols of the University Clinical...

  18. Anaerobic treatment of tequila vinasses under seasonal operating conditions: start-up, normal operation and restart-up after a long stop and starvation period.

    Jáuregui-Jáuregui, J A; Méndez-Acosta, H O; González-Álvarez, V; Snell-Castro, R; Alcaraz-González, V; Godon, J J


    This study examines the performance of an anaerobic fixed-film bioreactor under seasonal operating conditions prevailing in medium and small size Tequila factories: start-up, normal operation and particularly, during the restart-up after a long stop and starvation period. The proposed start-up procedure attained a stable biofilm in a rather short period (28 days) despite unbalanced COD/N/P ratio and the use of non-acclimated inoculum. The bioreactor was restarted-up after being shut down for 6 months during which the inoculum starved. Even when biofilm detachment and bioreactor clogging were detected at the very beginning of restart-up, results show that the bioreactor performed better as higher COD removal and methane yield were attained. CE-SSCP and Q-PCR analyses, conducted on the biofilm prokaryotic communities for each operating condition, confirmed that the high COD removal results after the bioreactor clogging and the severe starvation period were mainly due to the stable archaeal and resilient bacterial populations.

  19. Supplementation of Ascorbic Acid in Weanling Horses Following Prolonged Transportation

    Michelle Stives


    Full Text Available Though horses synthesize ascorbic acid in their liver in amounts that meet their needs under normal circumstances, prolonged stress results in low plasma concentrations due to enhanced utilization and renal excretion and can reduce immune function. It was hypothesized that plasma ascorbic acid could be maintained in weanling horses by oral supplementation following prolonged transportation. Weanlings were supplemented with no ascorbic acid (Tx 0: n = 4, 5 grams ascorbic acid twice daily for 5 days (Tx 1: n = 4 or for 10 days (Tx 2: n = 4 following >50 hours of transportation. Supplementation caused slight (P < 0.2 increases in plasma ascorbic acid concentrations. Both supplemented groups had decreased (P < 0.05 plasma concentrations for 1 to 3 weeks following cessation of supplementation, possibly due to increased renal excretion or suppressed hepatic synthesis. Supplementation of ascorbic acid following prolonged stress will increase plasma concentrations, but prolonged supplementation should be avoided.

  20. Prolongation structure of the Landau–Lifshitz equation

    Roelofs, G.H.M.; Martini, R.


    The prolongation method of Wahlquist and Estabrook is applied to the Landau–Lifshitz equation. The resulting prolongation algebra is shown to be isomorphic to a subalgebra of the tensor product of the Lie algebra so(3) with the elliptic curve v α 2−v β 2=j β−j α (α,β=1,2,3), which is essentially a s