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Sample records for receiving combination treatment

  1. Treatment Outcomes in Patients Receiving Combination ...

    African Journals Online (AJOL)

    Erah

    196) was 20.3 deaths per 100 patient-months; 31.6 % occurred in < 30 days while 52.6 % occurred post-120 days of treatment. ... The level of adherence reported after 18 months on ART was 73.8 %. Conclusion: In this setting, patients ..... taking one to three pills per day while 36.2 % were taking at least five pills per day.

  2. Impairment of cold injury-induced muscle regeneration in mice receiving a combination of bone fracture and alendronate treatment.

    Science.gov (United States)

    Kawada, Shigeo; Harada, Atsushi; Hashimoto, Naohiro

    2017-01-01

    Alendronate, a nitrogen-containing bisphosphonate, is well established as a treatment for osteoporosis through regulation of osteoclast activity. Previously, the pharmacological effects of bisphosphonates on cells outside the bone environment have been considered irrelevant because bisphosphonates target bone. Here we show that administration of alendronate impairs muscle regeneration in mice after bone fracture. A series of injections of alendronate alone or bone fracture alone did not affect muscle regeneration induced by cold injury. In contrast, alendronate treatment plus bone fracture severely impaired the regeneration of muscle that closely contacts the bone fracture site after cold injury. After cold injury, M-cadherin-positive myogenic cells disappeared in the damaged muscle areas of mice receiving the combination of alendronate treatment and bone fracture. The present results suggest that the muscle regeneration capacity is impaired by bone fracture in mice receiving alendronate treatment. The present research on the pharmacological effects of alendronate on muscle regeneration will aid in understanding of the in vivo action of alendronate on skeletal muscles.

  3. Stereotactic Radiosurgery for Melanoma Brain Metastases in Patients Receiving Ipilimumab: Safety Profile and Efficacy of Combined Treatment

    Energy Technology Data Exchange (ETDEWEB)

    Kiess, Ana P. [Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland (United States); Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Wolchok, Jedd D. [Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Barker, Christopher A. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Postow, Michael A. [Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Tabar, Viviane [Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Huse, Jason T. [Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Chan, Timothy A.; Yamada, Yoshiya [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Beal, Kathryn, E-mail: bealk@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

    2015-06-01

    Purpose: Ipilimumab (Ipi), a monoclonal antibody against cytotoxic T-lymphocyte antigen-4, has been shown to improve survival in patients with metastatic melanoma. In this single-institution study, we investigated the safety and efficacy of stereotactic radiosurgery (SRS) for patients with melanoma brain metastases (BMs) who also received Ipi. Methods and Materials: From 2005 to 2011, 46 patients with melanoma received Ipi and underwent single-fraction SRS for BMs. A total of 113 BMs (91% intact, 9% postoperative) were treated with a median dose of 21 Gy (range, 15-24 Gy). Ipi was given at 3 mg/kg (54%) or 10 mg/kg (46%) for a median of 4 doses (range, 1-21). Adverse events were recorded with the use of the Common Terminology Criteria for Adverse Events 3.0. Kaplan-Meier methods were used to estimate survival, and Cox regression was used to investigate associations. Results: Fifteen patients received SRS during Ipi, 19 received SRS before Ipi, and 12 received SRS after Ipi. Overall survival (OS) was significantly associated with the timing of SRS/Ipi (P=.035) and melanoma-specific graded prognostic assessment (P=.013). Patients treated with SRS during or before Ipi had better OS and less regional recurrence than did those treated with SRS after Ipi (1-year OS 65% vs 56% vs 40%, P=.008; 1-year regional recurrence 69% vs 64% vs 92%, P=.003). SRS during Ipi also yielded a trend toward less local recurrence than did SRS before or after Ipi (1-year local recurrence 0% vs 13% vs 11%, P=.21). On magnetic resonance imaging, an increase in BM diameter to >150% was seen in 50% of patients treated during or before Ipi but in only 13% of patients treated after Ipi. Grade 3 to 4 toxicities were seen in 20% of patients. Conclusion: Overall, the combination of Ipi and SRS appears to be well tolerated. Concurrent delivery of Ipi and SRS is associated with favorable locoregional control and possibly longer survival. It may also cause a temporary increase in tumor size, possibly

  4. Treatment efficacy and methotrexate-related toxicity in patients with rheumatoid arthritis receiving methotrexate in combination with adalimumab.

    Science.gov (United States)

    Burmester, Gerd R; Kaeley, Gurjit S; Kavanaugh, Arthur F; Gabay, Cem; MacCarter, Daryl K; Nash, Peter; Takeuchi, Tsutomu; Goss, Sandra L; Rodila, Ramona; Chen, Kun; Kupper, Hartmut; Kalabic, Jasmina

    2017-01-01

    Treatment of rheumatoid arthritis (RA) with a combination of methotrexate (MTX)+adalimumab (ADA) is more effective than ADA monotherapy. We assessed the toxicity of different doses of MTX and treatment efficacy of ADA+MTX in two trials. Data originated from CONCERTO, in patients with early RA initiating ADA+ 2.5, 5, 10 or 20 mg/week MTX for 26 weeks; and MUSICA, in patients with an inadequate response to MTX initiating ADA+ 7.5 or 20 mg/week MTX for 24 weeks. Efficacy was assessed by the American College of Rheumatology 50 (ACR50). Patient-reported MTX-related toxicity information was collected at each visit on 18 prespecified MTX-related adverse events (AE) in the MTX label. In CONCERTO, ACR50 rates increased over time, ranging from 54% to 68% at week 26, while AE rates remained steady, ranging from 2.4% to 17.8% at week 26. Of 395 patients, 113 (28.6%) reported 345 MTX-related AEs, including one serious AE (SAE, excessive fatigue and/or malaise); 10 AEs (in two patients) led to study discontinuation. In MUSICA, ACR50 rates increased over time, and were 32.3% and 37.5% at week 24, while MTX-related AE rates remained steady and were 6.5% at week 24. Of 309 patients, 71 (23%) reported 185 MTX-related AEs, including 5 SAEs (four infections and one fever/chills); six AEs (in four patients) led to study discontinuation. In patients with RA initiating ADA+MTX combination, treatment efficacy was achieved and increased throughout both trials, while rates of MTX-related AEs remained steady. MTX-related AEs were observed in up to 30% of patients and most were mild. MTX was discontinued by 0.5%-1.3% of patients. MUSICA (NCT01185288), CONCERTO (NCT01185301), Post results.

  5. Treatment efficacy and methotrexate-related toxicity in patients with rheumatoid arthritis receiving methotrexate in combination with adalimumab

    Science.gov (United States)

    Burmester, Gerd R; Kaeley, Gurjit S; Kavanaugh, Arthur F; Gabay, Cem; MacCarter, Daryl K; Nash, Peter; Takeuchi, Tsutomu; Goss, Sandra L; Rodila, Ramona; Chen, Kun; Kupper, Hartmut; Kalabic, Jasmina

    2017-01-01

    Background Treatment of rheumatoid arthritis (RA) with a combination of methotrexate (MTX)+adalimumab (ADA) is more effective than ADA monotherapy. We assessed the toxicity of different doses of MTX and treatment efficacy of ADA+MTX in two trials. Methods Data originated from CONCERTO, in patients with early RA initiating ADA+ 2.5, 5, 10 or 20 mg/week MTX for 26 weeks; and MUSICA, in patients with an inadequate response to MTX initiating ADA+ 7.5 or 20 mg/week MTX for 24 weeks. Efficacy was assessed by the American College of Rheumatology 50 (ACR50). Patient-reported MTX-related toxicity information was collected at each visit on 18 prespecified MTX-related adverse events (AE) in the MTX label. Results In CONCERTO, ACR50 rates increased over time, ranging from 54% to 68% at week 26, while AE rates remained steady, ranging from 2.4% to 17.8% at week 26. Of 395 patients, 113 (28.6%) reported 345 MTX-related AEs, including one serious AE (SAE, excessive fatigue and/or malaise); 10 AEs (in two patients) led to study discontinuation. In MUSICA, ACR50 rates increased over time, and were 32.3% and 37.5% at week 24, while MTX-related AE rates remained steady and were 6.5% at week 24. Of 309 patients, 71 (23%) reported 185 MTX-related AEs, including 5 SAEs (four infections and one fever/chills); six AEs (in four patients) led to study discontinuation. Conclusion In patients with RA initiating ADA+MTX combination, treatment efficacy was achieved and increased throughout both trials, while rates of MTX-related AEs remained steady. MTX-related AEs were observed in up to 30% of patients and most were mild. MTX was discontinued by 0.5%–1.3% of patients. Trial registration number MUSICA (NCT01185288), CONCERTO (NCT01185301), Post results. PMID:28955494

  6. Comparison of the effects of combination diuretic therapy with oral hydrochlorothiazide or intravenous chlorothiazide in patients receiving intravenous furosemide therapy for the treatment of heart failure.

    Science.gov (United States)

    Kissling, Kevin T; Pickworth, Kerry K

    2014-08-01

    To compare the effects of combination diuretic therapy with oral hydrochlorothiazide or intravenous chlorothiazide added to background intravenous loop diuretic therapy among patients hospitalized with heart failure. Single-center, retrospective review. Cardiovascular hospital within a university-affiliated teaching institution. Eighty-two patients hospitalized for heart failure between September 1, 2009, and August 31, 2011, who were receiving background intravenous furosemide therapy (total daily dose ≥ 160 mg); of those patients, 28 patients also received oral hydrochlorothiazide (median dose 25 mg [interquartile range 25-50 mg]), and 54 patients also received intravenous chlorothiazide (median dose 500 mg [interquartile range 250-750 mg]). The primary outcome was change in 24-hour urine output. Urine output was recorded from the 24 hours before and after the first administration of either oral hydrochlorothiazide or intravenous chlorothiazide. Baseline characteristics, with the exception of female sex (p=0.01) and home loop diuretic dose (p=0.03), were similar between groups. Twenty-four-hour urine output before administration of the thiazide diuretic was not significantly different between groups. After treatment, 24-hour urine output increased in both groups; however, urine output increased to a lesser extent with oral hydrochlorothiazide (from mean ± SD 2104 ± 830 ml to 3038 ± 917 ml) than with intravenous chlorothiazide (from 2342 ± 978 ml to 4128 ± 1755 ml) (p=0.005). Hypokalemia occurred frequently in both groups: 71.4% and 83.3% in the oral hydrochlorothiazide and intravenous chlorothiazide groups, respectively (p=0.21). Among hospitalized patients with heart failure receiving intravenous loop diuretics, the addition of either oral hydrochlorothiazide or intravenous chlorothiazide augmented diuresis. Urine output increased to a greater extent with intravenous chlorothiazide compared with oral hydrochlorothiazide. However

  7. Abnormal liver stiffness assessed using transient elastography (Fibroscan® in HIV-infected patients without HBV/HCV coinfection receiving combined antiretroviral treatment.

    Directory of Open Access Journals (Sweden)

    Sang Hoon Han

    Full Text Available BACKGROUND AND AIMS: Liver stiffness measurement (LSM using transient elastography (Fibroscan® can identify individuals with potential underlying liver disease. We evaluated the prevalence of abnormal LSM values as assessed using LSM and its predictors in HIV-infected asymptomatic patients receiving combined antiretroviral treatment (cART without HBV/HCV coinfection. METHODS: We prospectively recruited 93 patients who had consistently been undergoing cART for more than 12 months at Severance Hospital in Seoul, Republic of Korea, from June to December 2010. LSM values >5.3 kPa were defined as abnormal. RESULTS: Thirty-nine (41.9% had abnormal LSM values. On multivariate correlation analysis, the cumulative duration of boosted and unboosted protease inhibitors (PIs were the independent factors which showed a negative and positive correlation to LSM values, respectively (β = -0.234, P = 0.023 and β = 0.430, P<0.001. In multivariate logistic regression analysis, the cumulative exposure duration of boosted-PIs and γ-glutamyltranspeptidase levels were selected as the independent predictors which showed a negative and positive correlation with abnormal LSM values, respectively (odds ratio [OR], 0.941; 95% confidence interval [CI], 0.889-0.997; P = 0.039 and OR, 1.032; 95% CI, 1.004-1.060; P = 0.023. CONCLUSION: The high percentage of HIV-infected asymptomatic patients receiving cART without HBV/HCV coinfection had abnormal LSM values. The cumulative exposure duration of boosted-PIs and γ-GT level were independent predictors which showed a negative and positive correlation with abnormal LSM values, respectively.

  8. Magnetic resonance imaging for accelerated assessment of drug effect and prediction of subsequent radiographic progression in rheumatoid arthritis: a study of patients receiving combined anakinra and methotrexate treatment

    DEFF Research Database (Denmark)

    Østergaard, Mikkel; Duer, Anne; Nielsen, H

    2005-01-01

    : 100 mg anakinra subcutaneously/day was added to the treatment of 17 patients with clinically active RA despite methotrexate. MRI of the non-dominant wrist and 2nd-5th MCP joints (OMERACT evaluation) was performed at weeks 0, 12, and 36, and radiography of both hands and wrists (modified Sharp...... evaluation) at weeks 0 and 36. RESULTS: MRI synovitis scores were not significantly changed. Radiography of both hands and wrists after 36 weeks showed erosive progression in 11 patients, and MRI after 12 weeks in 10 patients. Nine of 10 patients with MRI progression at 12 weeks had radiographic progression....... Baseline MRI findings predicted subsequent radiographic erosive progression. Unilateral wrist and MCP joint MRI after 12 weeks had a similar sensitivity for detection of erosive progression as bilateral hand and wrist radiography after 36 weeks....

  9. Combination treatment for hypertension

    African Journals Online (AJOL)

    pressure, and the potential benefit of a low dose of aspirin in the treatment of hypertension. 18 790 patients, aged 50-80 years ... In addition, 9 399 patients were randomly assigned 75 mg/day aspirin and. 9 391 patients were ... hypertensive and non-hypertensive patients with a history of stroke or transient ischaemic attack.

  10. Perceived stigma among patients receiving antiretroviral treatment ...

    African Journals Online (AJOL)

    DOT) supports antiretroviral treatment (ART) adherence but little is known about its association with perceived stigma in resource-constrained settings. In 2003, 234 HIV-infected adults enrolled in a two-arm randomised trial comparing a health ...

  11. Twenty-six-week efficacy and safety study of mometasone furoate/formoterol 200/10 microg combination treatment in patients with persistent asthma previously receiving medium-dose inhaled corticosteroids

    DEFF Research Database (Denmark)

    Nathan, Robert A; Nolte, Hendrik; Pearlman, David S

    2010-01-01

    with MF/F 200/10 microg reduced asthma deteriorations and clinically judged deteriorations (i.e., deterioration resulting in emergency treatment, hospitalization, or treatment with additional excluded asthma medication [i.e., systemic corticosteroids]). The proportion of patients experiencing asthma......Asthma is a heterogeneous condition characterized by reduced lung function, chronic inflammation, and periodic asthma deteriorations. This study was performed to evaluate the effect of mometasone furoate (MF)/formoterol (F) combination, 200/10 microg, administered twice daily (b.i.d.) on asthma...... deteriorations and pulmonary function in patients with asthma uncontrolled on medium-dose inhaled corticosteroid (ICS). After 2- to 3-week open-label run-in with MF 200 microg b.i.d., patients (>or=12 years) were randomized to 26 weeks of treatment with MF/F 200/10 microg, MF 200 microg, F 10 microg, or placebo...

  12. Combinations of Types of Mental Health Services Received in the Past Year Among Young Adults

    Science.gov (United States)

    ... Spotlight December 08, 2015* Combinations of types of mental health services received in the past year among young adults Combinations of types of mental health services received in the past year among young ...

  13. The Prevalence and Impact of Hyperglycemia and Hyperlipidemia in Patients With Advanced Cancer Receiving Combination Treatment With the Mammalian Target of Rapamycin Inhibitor Temsirolimus and Insulin Growth Factor-Receptor Antibody Cixutumumab.

    Science.gov (United States)

    Busaidy, Naifa L; LoRusso, Patricia; Lawhorn, Kristie; Hess, Kenneth R; Habra, Mohammed Amir; Fu, Siqing; Hong, David S; Chen, Helen X; Doyle, Lawrence A; Kurzrock, Razelle; Naing, Aung

    2015-07-01

    Cixutumumab (a humanized monoclonal antibody against insulin-like growth factor-1 receptor [IGF-1R]) and the mammalian target of rapamycin (mTOR) inhibitor temsirolimus were combined in a phase I study of patients with advanced cancer. We investigated the prevalence of metabolic toxicities, their management, and impact on outcome. The temsirolimus dose was 25 mg or 37.5 mg i.v. weekly with escalating doses of cixutumumab (3, 5, or 6 mg/kg i.v. weekly). No patients with diabetes or hyperlipidemia at baseline were eligible until the expansion cohort. We assessed metabolic derangements in our patient cohort, their management, and their association with tumor shrinkage, time to progression (TTP) and overall survival (OS). Of the 57 patients analyzed, hyperglycemia was seen in 36 (63%) (grade 1-2: 33 [58%]; grade 3-4: 3 [5%]). The median blood sugar level (fasting and nonfasting) across cohorts was 149 mg/dL (upper limit of normal: 110 mg/dL). No patient developed diabetic ketoacidosis or nonketotic hyperosmolar coma or pancreatitis during treatment. Median maximum triglyceride, cholesterol, and low-density lipoprotein levels achieved were 247 mg/dL (range: 65-702 mg/dL), 243 mg/dL (range: 103-424 mg/dL), and 153 mg/dL (range 50-375 mg/dL), respectively. Higher glucose levels were associated with more RECIST tumor shrinkage (r = -.30 [95% confidence interval: -.52, -.03; p = .03]). There was no association between metabolic toxicities of the mTOR and IGF-1R combination and TTP or OS. The combination of temsirolimus and cixutumumab was safe and resulted in manageable metabolic toxicities. More tumor shrinkage was seen in patients who developed these adverse events. Although perhaps limited by the small number of patients, no significant association was discerned between hyperglycemia, hypertriglyceridemia, or hypercholesterolemia and TTP or OS. Results of this study show that the combination of temsirolimus and cixutumumab is safe. The most common side effects

  14. Should a hospitalized child receive empiric treatment with acyclovir?

    Directory of Open Access Journals (Sweden)

    Kulik Dina M

    2012-12-01

    Full Text Available Abstract Background Herpes simplex encephalitis is associated with substantial morbidity and mortality and may be related to timely diagnosis and treatment. While awaiting the results of testing, hospitalization and empiric treatment with acyclovir is recommended, though the direct and indirect costs associated with this management are substantial. We sought to examine children hospitalized for possible herpes simplex encephalitis, following clinical and laboratory assessment in the emergency department, and empiric treatment with acyclovir, in order to describe the proportion receiving a complete course of treatment; and to identify the clinical variables which are associated with receiving a complete course, as compared with an incomplete course of acyclovir. Methods Hospitalized children prescribed acyclovir were included in this case control study. Clinical, laboratory and diagnostic variables were abstracted for children prescribed a complete (≥ 14 days or an incomplete course ( Results 289 children met eligibility criteria, 30 (10% received a complete course and 259 (90% received an incomplete course. A history of mucocutaneous herpes simplex virus infection (p  Conclusions Many children did not complete a full course of therapy. Unnecessary testing and treatment is burdensome to families and the health care system. Possible predictive variables include abnormal Glascow Coma Scale, focal neurologic findings and cerebrospinal fluid pleocytosis.

  15. The impact of inadequate wastewater treatment on the receiving ...

    African Journals Online (AJOL)

    1 Tshwane University of Technology, Water Care Department, Arcadia Campus, P/Bag x 680 Pretoria 0002, South Africa ... pollution point sources into their respective receiving water bodies (Tembisa Dam, the Nahoon and Eastern Beach which are ... municipalities' sewage treatment works, i.e. design weaknesses,.

  16. The impact of inadequate wastewater treatment on the receiving ...

    African Journals Online (AJOL)

    687. The impact of inadequate wastewater treatment on the receiving water bodies – Case study: Buffalo City and. Nkokonbe Municipalities of the Eastern Cape Province. MNB Momba1*, AN Osode2 and M Sibewu1. 1 Tshwane University of Technology, Water Care Department, Arcadia Campus, P/Bag x 680 Pretoria 0002, ...

  17. Patient satisfaction after receiving dental treatment among patients ...

    African Journals Online (AJOL)

    Background: Patient satisfaction is one of the indicators of the quality of care. Therefore it is one of the tools for evaluating the quality of care. Aim: To determine patient satisfaction after receiving dental treatment among patients attending public dental clinics in Dar-Es-Salaam. Material and methods: Five public dental clinics ...

  18. Twenty-six-week efficacy and safety study of mometasone furoate/formoterol 200/10 microg combination treatment in patients with persistent asthma previously receiving medium-dose inhaled corticosteroids

    DEFF Research Database (Denmark)

    Nathan, Robert A; Nolte, Hendrik; Pearlman, David S

    2010-01-01

    deteriorations and pulmonary function in patients with asthma uncontrolled on medium-dose inhaled corticosteroid (ICS). After 2- to 3-week open-label run-in with MF 200 microg b.i.d., patients (>or=12 years) were randomized to 26 weeks of treatment with MF/F 200/10 microg, MF 200 microg, F 10 microg, or placebo...... with MF/F 200/10 microg reduced asthma deteriorations and clinically judged deteriorations (i.e., deterioration resulting in emergency treatment, hospitalization, or treatment with additional excluded asthma medication [i.e., systemic corticosteroids]). The proportion of patients experiencing asthma...

  19. [Dental Implant Treatment in Patients Receiving Anti-resorptive Agents.

    Science.gov (United States)

    Kuroshima, Shinichiro

    Dental implant treatment is one of the most reliable therapeutic options for replacing missing teeth. In 2003, it was demonstrated that osteonecrosis of the jaw(ONJ)occurred in patients taking bisphosphonates(BRONJ). Recently, ONJ has also been demonstrated to occur in patients taking anti-receptor activator of nuclear factor-kappaB ligand antibody(denosumab:DRONJ). However, the precise mechanisms of ONJ remain unclear and definitive treatment strategies for ONJ have not been developed. There has been little information regarding the relationship between ONJ and dental implant treatment. However, a recent systematic review indicated that dental implant treatment is a triggering factor for BRONJ. The aim of this study was to provide the most current information on dental implant treatment in patients receiving anti-resorptive agents. A literature search has suggested that implant treatment becomes a risk factor for BRONJ around dental implants. Implantitis may also be a risk factor for BRONJ around dental implants. No available information regarding DRONJ around dental implants was noted. Hence, caution should be exercised when dental implant treatment is carried out in the patients taking anti-resorptive agents such as bisphosphonates and denosumab.

  20. Twelve-week efficacy and safety study of mometasone furoate/formoterol 200/10 microg and 400/10 microg combination treatments in patients with persistent asthma previously receiving high-dose inhaled corticosteroids

    DEFF Research Database (Denmark)

    Weinstein, Steven F; Corren, Jonathan; Murphy, Kevin

    2010-01-01

    improvement in lung function throughout 12 weeks. Both MF/F doses were superior to MF in improving asthma control and reducing nocturnal awakenings due to asthma requiring short-acting beta(2)-agonist use. All treatments were well tolerated. Asthma patients who were poorly controlled on high-dose ICS...

  1. Antipsychotic Polypharmacy in a Treatment-Refractory Schizophrenia Population Receiving Adjunctive Treatment With Electroconvulsive Therapy

    DEFF Research Database (Denmark)

    Kristensen, Diana; Hageman, Ida; Bauer, Jeanett

    2013-01-01

    Antipsychotic polypharmacy (APP) is frequent, but its pattern is unknown in treatment-refractory schizophrenia-spectrum patients receiving electroconvulsive therapy (ECT).......Antipsychotic polypharmacy (APP) is frequent, but its pattern is unknown in treatment-refractory schizophrenia-spectrum patients receiving electroconvulsive therapy (ECT)....

  2. Modulation-Index Estimation in a Combined CPM/OFDM Receiver

    NARCIS (Netherlands)

    Hoeksema, F.W.; Schiphorst, Roelof; Slump, Cornelis H.

    2004-01-01

    In this paper we develop a blind modulation-index estimator for a combined CPM/OFDM Receiver. The performance of the estimator in an AWGN channel is assessed by simulation and analysis and its suitability for our receiver is established.

  3. A comparison of two intravenous infusion devices in lung carcinoma patients receiving combined radiotherapy and chemotherapy

    Directory of Open Access Journals (Sweden)

    Xing-Hua Bai

    2013-01-01

    Full Text Available Purpose: To investigate the clinical effects of intravenous (IV devices in the patients with lung cancer undergoing radiotherapy and chemotherapy. Materials and Methods: A total of 128 patients were divided into two groups : t0 hose who received chemotherapy through a peripherally inserted central catheter (PICC group; n = 64, and those who received therapy through an IV remaining needle (n = 64. Statistical Analysis: Patient characteristics and complication rates were compared using Fisher′s exact tests or the χ2 test. During the treatment times, the time and the average nursing costs for both infusion methods and their complications were compared using the student′s t -test. Data is presented as mean ± SEM 0 P value <0.05 was considered significant. Statistical analyses were carried out using SPSS V.12.0 for Windows (SPSS, Inc.. Results and Conclusions: The non-retention type venous detaining needle appears to be the preferred patient choice for those undergoing combined radiotherapy and chemotherapy.

  4. Systemic combination treatment for psoriasis: a review

    DEFF Research Database (Denmark)

    Jensen, Peter; Skov, Lone; Zachariae, Claus

    2010-01-01

    Psoriasis is a chronic inflammatory skin disease, which affects approximately 2.6% of the population in Northern Europe and Scandinavia. In order to achieve disease control, combinations of systemic treatments are sometimes needed for variable time periods. However, no evidence-based guidelines e...... treatments. The most thoroughly investigated combination was retinoid and phototherapy. Further controlled research is needed to define the safest and most effective combination regimens....

  5. Power and Efficiency Analysis of a Solar Central Receiver Combined Cycle Plant with a Small Particle Heat Exchanger Receiver

    Science.gov (United States)

    Virgen, Matthew Miguel

    Two significant goals in solar plant operation are lower cost and higher efficiencies. To achieve those goals, a combined cycle gas turbine (CCGT) system, which uses the hot gas turbine exhaust to produce superheated steam for a bottoming Rankine cycle by way of a heat recovery steam generator (HRSG), is investigated in this work. Building off of a previous gas turbine model created at the Combustion and Solar Energy Laboratory at SDSU, here are added the HRSG and steam turbine model, which had to handle significant change in the mass flow and temperature of air exiting the gas turbine due to varying solar input. A wide range of cases were run to explore options for maximizing both power and efficiency from the proposed CSP CCGT plant. Variable guide vanes (VGVs) were found in the earlier model to be an effective tool in providing operational flexibility to address the variable nature of solar input. Combined cycle efficiencies in the range of 50% were found to result from this plant configuration. However, a combustor inlet temperature (CIT) limit leads to two distinct Modes of operation, with a sharp drop in both plant efficiency and power occurring when the air flow through the receiver exceeded the CIT limit. This drawback can be partially addressed through strategic use of the VGVs. Since system response is fully established for the relevant range of solar input and variable guide vane angles, the System Advisor Model (SAM) from NREL can be used to find what the actual expected solar input would be over the course of the day, and plan accordingly. While the SAM software is not yet equipped to model a Brayton cycle cavity receiver, appropriate approximations were made in order to produce a suitable heliostat field to fit this system. Since the SPHER uses carbon nano-particles as the solar absorbers, questions of particle longevity and how the particles might affect the flame behavior in the combustor were addressed using the chemical kinetics software Chemkin

  6. Intraoperative end-tidal concentration of isoflurane in cats undergoing ovariectomy that received tramadol, buprenorphine or a combination of both.

    Science.gov (United States)

    Bellini, Luca; Mollo, Antonio; Contiero, Barbara; Busetto, Roberto

    2017-02-01

    Objectives The aim of the study was to evaluate the end-tidal concentration of isoflurane required to maintain heart and respiratory rate within ± 20% of basal measurement in cats undergoing ovariectomy that received buprenorphine, tramadol or a combination of both. Methods Thirty cats, divided into three groups, were enrolled in a simple operator-blinded, randomised study. Cats received acepromazine (0.03 mg/kg) and one of the following treatments: buprenorphine (0.02 mg/kg), tramadol (2 mg/kg) or a combination of both. Anaesthesia was induced with propofol and maintained with isoflurane titrated in order to maintain heart and respiratory rate within the target values recorded before premedication. Results Groups were similar for age, weight, dose of propofol administered, sedation and recovery scores. Cats receiving tramadol with buprenorphine were extubated earlier after isoflurane discontinuation. No statistical differences were detected in end-tidal fraction of isoflurane between buprenorphine alone or with tramadol. In cats that received tramadol or buprenorphine alone, ovarian pedicle traction caused a statistical increase in end-tidal isoflurane concentration compared with that measured during incision and suture of the skin. In cats that received the combination of tramadol plus buprenorphine no differences among surgical time points were observed. Conclusions and relevance Tramadol added to buprenorphine did not provide any advantage in decreasing the end-tidal fraction of isoflurane compared with buprenorphine alone, although it is speculated there may be an infra-additive interaction between tramadol and buprenorphine in cats.

  7. Combining classifiers using their receiver operating characteristics and maximum likelihood estimation.

    Science.gov (United States)

    Haker, Steven; Wells, William M; Warfield, Simon K; Talos, Ion-Florin; Bhagwat, Jui G; Goldberg-Zimring, Daniel; Mian, Asim; Ohno-Machado, Lucila; Zou, Kelly H

    2005-01-01

    In any medical domain, it is common to have more than one test (classifier) to diagnose a disease. In image analysis, for example, there is often more than one reader or more than one algorithm applied to a certain data set. Combining of classifiers is often helpful, but determining the way in which classifiers should be combined is not trivial. Standard strategies are based on learning classifier combination functions from data. We describe a simple strategy to combine results from classifiers that have not been applied to a common data set, and therefore can not undergo this type of joint training. The strategy, which assumes conditional independence of classifiers, is based on the calculation of a combined Receiver Operating Characteristic (ROC) curve, using maximum likelihood analysis to determine a combination rule for each ROC operating point. We offer some insights into the use of ROC analysis in the field of medical imaging.

  8. Combining Classifiers Using Their Receiver Operating Characteristics and Maximum Likelihood Estimation*

    Science.gov (United States)

    Haker, Steven; Wells, William M.; Warfield, Simon K.; Talos, Ion-Florin; Bhagwat, Jui G.; Goldberg-Zimring, Daniel; Mian, Asim; Ohno-Machado, Lucila; Zou, Kelly H.

    2010-01-01

    In any medical domain, it is common to have more than one test (classifier) to diagnose a disease. In image analysis, for example, there is often more than one reader or more than one algorithm applied to a certain data set. Combining of classifiers is often helpful, but determining the way in which classifiers should be combined is not trivial. Standard strategies are based on learning classifier combination functions from data. We describe a simple strategy to combine results from classifiers that have not been applied to a common data set, and therefore can not undergo this type of joint training. The strategy, which assumes conditional independence of classifiers, is based on the calculation of a combined Receiver Operating Characteristic (ROC) curve, using maximum likelihood analysis to determine a combination rule for each ROC operating point. We offer some insights into the use of ROC analysis in the field of medical imaging. PMID:16685884

  9. Iterative Receiver Design for ISI Channels Using Combined Belief- and Expectation-Propagation

    DEFF Research Database (Denmark)

    Sun, Peng; Zhang, Chuanzong; Wang, Zhongyong

    2015-01-01

    In this letter, a message-passing algorithm that combines belief propagation and expectation propagation is applied to design an iterative receiver for intersymbol interference channels. We detail the derivation of the messages passed along the nodes of a vector-form factor graph representing the...

  10. Development of drug resistance in patients receiving combinations of zidovudine, didanosine and nevirapine

    NARCIS (Netherlands)

    Conway, B.; Wainberg, M. A.; Hall, D.; Harris, M.; Reiss, P.; Cooper, D.; Vella, S.; Curry, R.; Robinson, P.; Lange, J. M.; Montaner, J. S.

    2001-01-01

    OBJECTIVE: To evaluate the development of phenotypic and genotypic resistance to zidovudine, didanosine and nevirapine as a function of the virologic response to therapy in a group of drug-naive individuals receiving various combinations of these agents. DESIGN: All patients were enrolled in a

  11. Retinoid plus antimicrobial combination treatments for acne

    Science.gov (United States)

    Feneran, Ashley N; Kaufman, William S; Dabade, Tushar S; Feldman, Steven R

    2011-01-01

    Background: Acne vulgaris is a chronic disease with several pathogenic factors. Multiple medications are typically used that can lead to nonadherence and treatment failure. Combination medications target multiple pathways of acne formation and may offer therapeutic benefit. Purpose: To explore the efficacy and tolerability of combination retinoid plus antimicrobial treatments in acne vulgaris. Methods: A PubMed and Google search was conducted for combination therapies of clindamycin and tretinoin, with secondary analysis of related citations and references. Similar searches were completed for the combination medications of benzoyl peroxide plus clindamycin or erythromycin, and for the combination therapy of adapalene and benzoyl peroxide. Results: Combination clindamycin phosphate and tretinoin gel was found to be more efficacious than monotherapy of either drug or its vehicle for acne, including inflammatory acne, and has a greater onset of action than either drug alone. Clindamycin phosphate and tretinoin gel was well-tolerated, and adherence to its use exceeded that of using both medications in separate formulations. Benzoyl peroxide-containing combination medications with clindamycin or erythromycin were both more effective in the treatment of acne than either drug alone. Both medications were well-tolerated, with dry skin being the most common adverse effect. Conclusions: Combination medications have superior efficacy and adherence, and have a similar tolerability profile compared with monotherapy of its components. Several studies have found antibiotic-containing combination products with a retinoid effective for acne. The use of antibiotic-containing combination medications for acne can lead to bacterial resistance. Due to this potential for bacterial resistance, benzoyl peroxide treatments are also recommended in combination with a retinoid. PMID:21760743

  12. patient receiving the treatment needs to be satisfied with the ...

    African Journals Online (AJOL)

    and subsequently the impact of this satisfaction in. 13 treatment ... treatments to improve the appearance of their teeth as well as the desired treatment. Data collected ..... perceptions of aesthetic, function, speech and ... Self-evaluated dental.

  13. GPS/GLONASS Combined Precise Point Positioning with Receiver Clock Modeling.

    Science.gov (United States)

    Wang, Fuhong; Chen, Xinghan; Guo, Fei

    2015-06-30

    Research has demonstrated that receiver clock modeling can reduce the correlation coefficients among the parameters of receiver clock bias, station height and zenith tropospheric delay. This paper introduces the receiver clock modeling to GPS/GLONASS combined precise point positioning (PPP), aiming to better separate the receiver clock bias and station coordinates and therefore improve positioning accuracy. Firstly, the basic mathematic models including the GPS/GLONASS observation equations, stochastic model, and receiver clock model are briefly introduced. Then datasets from several IGS stations equipped with high-stability atomic clocks are used for kinematic PPP tests. To investigate the performance of PPP, including the positioning accuracy and convergence time, a week of (1-7 January 2014) GPS/GLONASS data retrieved from these IGS stations are processed with different schemes. The results indicate that the positioning accuracy as well as convergence time can benefit from the receiver clock modeling. This is particularly pronounced for the vertical component. Statistic RMSs show that the average improvement of three-dimensional positioning accuracy reaches up to 30%-40%. Sometimes, it even reaches over 60% for specific stations. Compared to the GPS-only PPP, solutions of the GPS/GLONASS combined PPP are much better no matter if the receiver clock offsets are modeled or not, indicating that the positioning accuracy and reliability are significantly improved with the additional GLONASS satellites in the case of insufficient number of GPS satellites or poor geometry conditions. In addition to the receiver clock modeling, the impacts of different inter-system timing bias (ISB) models are investigated. For the case of a sufficient number of satellites with fairly good geometry, the PPP performances are not seriously affected by the ISB model due to the low correlation between the ISB and the other parameters. However, the refinement of ISB model weakens the

  14. Combined treatment of diabetic nephropathy with alprostadil and calcium dobesilate.

    Science.gov (United States)

    Qin, Lili; Qin, Wenjun; Wang, Jianfei; Lin, Lin

    2017-11-01

    This study investigated the effects of alprostadil combined with calcium dobesilate on the treatment of diabetic nephropathy. We recruited 80 patients with diabetic nephropathy, who were randomly divided into experimental (n=40) and control (n=40) groups. Patients received high-quality low-protein diabetic diet intervention and subcutaneous injection of insulin to adjust blood glucose, combined with antihypertensive, antiplatelet drugs, and other comprehensive treatments. The control group received alprostadil and the experimental group received alprostadil combined with calcium dobesilate. Both groups were treated for 12 weeks as one treatment cycle. The time to remission of clinical symptoms such as mental fatigue and weakness, limb edema, soreness and swelling of waist and knee, cold limbs and limb numbness and pain was significantly shorter in the experimental group than that in the control group (pdobesilate in patients with diabetic nephropathy can effectively relieve clinical symptoms, improve renal functions, reduce blood levels small proteins, alleviate the inflammatory response, and regulate the levels of BDNF and IGF-1, thus improving the clinical treatment effect.

  15. Reduced-Complexity Radio Architectures for Enhanced Receive Selection Combining in Multiuser Diversity Systems

    Directory of Open Access Journals (Sweden)

    Elpiniki P. Tsakalaki

    2012-01-01

    Full Text Available Although antenna selection is a simple and efficient technique for enhancing the downlink performance of multiuser diversity systems, the large antenna interelement spacing required for achieving spatial diversity is prohibitive for user terminals due to size restrictions. In order to allay this problem, we propose miniaturized switched beam receiver designs assisted by low-cost passive reflectors. Unlike conventional spatial receive diversity systems, the proposed angular diversity architectures occupy a small volume whereas the antenna system properties are optimized by controlling the strong reactive fields present at small dimensions. The systems are designed for maximum antenna efficiency and low interbeam correlation, thus yielding N practically uncorrelated receive diversity branches. The simulation results show that the proposed enhanced diversity combining systems improve the average throughput of a multiuser network outperforming classical antenna selection especially for small user populations and compact user terminal size.

  16. The impact of combined sewage overflows on the viral contamination of receiving waters.

    Science.gov (United States)

    Rodríguez, Roberto A; Gundy, Patricia M; Rijal, Geeta K; Gerba, Charles P

    2012-03-01

    The contribution of combined sewer overflows (CSO) to the viral contamination of receiving waters was determined. Adenovirus concentrations were determined using the Primary Liver Carcinoma (PLC/PRF/5) cell line and confirmed by Polymerase Chain Reaction (PCR). Norovirus concentration was determined using the Most Probable Number (MPN) and Reverse Transcription-Polymerase Chain Reaction (RT-PCR). Seventy-five water samples were collected during dry weather and 50 samples were collected during wet weather. CSO events significantly increased the concentration of culturable viruses, adenoviruses, and noroviruses in the receiving waters (P effects (CPE), adenoviruses were detected in 41% of the positive cell cultures, and noroviruses in 6% of the concentrates by direct RT-PCR. During wet weather, 100% of the samples were positive by CPE, 84% for adenoviruses, and 40% in the concentrates for norovirus. Our results demonstrate that CSOs can contribute significant viral loading to receiving waters.

  17. Reduced-complexity radio architectures for enhanced receive selection combining in multiuser diversity systems

    DEFF Research Database (Denmark)

    Tsakalaki, Elpiniki; Alrabadi, Osama; Papadias, Constantinos B.

    2012-01-01

    Although antenna selection is a simple and efficient technique for enhancing the downlink performance of multiuser diversity systems, the large antenna interelement spacing required for achieving spatial diversity is prohibitive for user terminals due to size restrictions. In order to allay...... this problem, we propose miniaturized switched beam receiver designs assisted by low-cost passive reflectors. Unlike conventional spatial receive diversity systems, the proposed angular diversity architectures occupy a small volume whereas the antenna system properties are optimized by controlling the strong...... reactive fields present at small dimensions. The systems are designed for maximum antenna efficiency and low interbeam correlation, thus yielding N practically uncorrelated receive diversity branches. The simulation results show that the proposed enhanced diversity combining systems improve the average...

  18. Solar power satellite rectenna design study: Directional receiving elements and parallel-series combining analysis

    Science.gov (United States)

    Gutmann, R. J.; Borrego, J. M.

    1978-01-01

    Rectenna conversion efficiencies (RF to dc) approximating 85 percent were demonstrated on a small scale, clearly indicating the feasibility and potential of efficiency of microwave power to dc. The overall cost estimates of the solar power satellite indicate that the baseline rectenna subsystem will be between 25 to 40 percent of the system cost. The directional receiving elements and element extensions were studied, along with power combining evaluation and evaluation extensions.

  19. Ectopic pregnancy treatment by combination therapy

    Directory of Open Access Journals (Sweden)

    Cymbaluk-Płoska Aneta

    2016-01-01

    Full Text Available Detectability of early stages of ectopic pregnancies has increased due to improvements in ultrasonographic and biochemical techniques. Since the patients’ future procreative plans must be taken into consideration when commencing treatment, the goal of this work was to compare the effects of treatment methods and their impact on fertility. The study included 91 patients treated surgically for ectopic pregnancy. The choice of treatment depended on patients’ general condition, ultrasonographic evaluation and serum level of beta-hCG. A combination of laparoscopic and conservative systemic treatment was applied in 70% of cases. More rapid beta-hCG reduction was noted when laparoscopy and intra-oviductal injection of hyperosmolar glucose or methotrexate (MTX were combined with intramuscular administration of MTX at a dose of 50 mg/m2. Follow-up examination of 66 patients revealed that the greatest number of spontaneous pregnancies (48% resulted after this combination therapy. We conclude that this combination treatment is safe and provides satisfactory results in terms of future fertility.

  20. Ectopic pregnancy treatment by combination therapy.

    Science.gov (United States)

    Cymbaluk-Płoska, Aneta; Chudecka-Głaz, Anita; Kuźniak, Sławomir; Menkiszak, Janusz

    2016-01-01

    Detectability of early stages of ectopic pregnancies has increased due to improvements in ultrasonographic and biochemical techniques. Since the patients' future procreative plans must be taken into consideration when commencing treatment, the goal of this work was to compare the effects of treatment methods and their impact on fertility. The study included 91 patients treated surgically for ectopic pregnancy. The choice of treatment depended on patients' general condition, ultrasonographic evaluation and serum level of beta-hCG. A combination of laparoscopic and conservative systemic treatment was applied in 70% of cases. More rapid beta-hCG reduction was noted when laparoscopy and intra-oviductal injection of hyperosmolar glucose or methotrexate (MTX) were combined with intramuscular administration of MTX at a dose of 50 mg/m2. Follow-up examination of 66 patients revealed that the greatest number of spontaneous pregnancies (48%) resulted after this combination therapy. We conclude that this combination treatment is safe and provides satisfactory results in terms of future fertility.

  1. Combined treatment in punctate inner choroidopathy

    Directory of Open Access Journals (Sweden)

    Terelak-Borys B

    2016-09-01

    Full Text Available Barbara Terelak-Borys, Katarzyna Zagajewska, Irmina Jankowska-Lech, Piotr Tesla, Iwona Grabska-Liberek Department of Ophthalmology, Centre of Postgraduate Medical Education, Prof W Orlowski Clinical Hospital, Warsaw, Poland Purpose: The purpose of this study was to describe a combination treatment for choroidal neovascular (CNV membrane, secondary to punctate inner choroidopathy (PIC.Patient and methods: A 44-year-old female patient was diagnosed with PIC complicated by the development of recurrent juxtafoveal neovascular membrane. The treatment included a sequence of monotherapy regimens: systemic steroid therapy, photodynamic therapy, and intravitreal injections of vascular endothelial growth factor (VEGF inhibitor (anti-VEGF. Owing to the CNV membrane resistance to various types of monotherapy, a combination treatment consisting of local injections of steroid underneath the Tenon’s capsule and intravitreal anti-VEGF injections was used.Results: Systemic steroid therapy resulted in rapid local improvement with a very short remission period. No positive effects of photodynamic therapy were observed. Sequential anti-VEGF injections led to remission periods of several months. Permanent regression of CNV membrane was achieved following combined local application of steroid and intravitreal anti-VEGF injections.Conclusion: A combination treatment including steroid and anti-VEGF medication characterized by anti-inflammatory and antiangiogenic effects may be a very beneficial option for the treatment of recurrent CNV membrane as a complication of PIC. Keywords: punctate inner choroidopathy, neovascular membrane, anti-VEGF injections, photodynamic therapy, steroids

  2. Retinoid plus antimicrobial combination treatments for acne

    Directory of Open Access Journals (Sweden)

    Feneran A

    2011-07-01

    Full Text Available Ashley N Feneran1, William S Kaufman2, Tushar S Dabade1, Steven R Feldman1,3,41Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA; 2Medical College of Virginia, Richmond, VA, USA; 3Department of Pathology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA; 4Department of Public Health Sciences, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USABackground: Acne vulgaris is a chronic disease with several pathogenic factors. Multiple medications are typically used that can lead to nonadherence and treatment failure. Combination medications target multiple pathways of acne formation and may offer therapeutic benefit.Purpose: To explore the efficacy and tolerability of combination retinoid plus antimicrobial treatments in acne vulgaris.Methods: A PubMed and Google search was conducted for combination therapies of clindamycin and tretinoin, with secondary analysis of related citations and references. Similar searches were completed for the combination medications of benzoyl peroxide plus clindamycin or erythromycin, and for the combination therapy of adapalene and benzoyl peroxide.Results: Combination clindamycin phosphate and tretinoin gel was found to be more efficacious than monotherapy of either drug or its vehicle for acne, including inflammatory acne, and has a greater onset of action than either drug alone. Clindamycin phosphate and tretinoin gel was well-tolerated, and adherence to its use exceeded that of using both medications in separate formulations. Benzoyl peroxide-containing combination medications with clindamycin or erythromycin were both more effective in the treatment of acne than either drug alone. Both medications were well-tolerated, with dry skin being the most common adverse effect.Conclusions: Combination medications have superior efficacy and adherence, and

  3. patient receiving the treatment needs to be satisfied with the ...

    African Journals Online (AJOL)

    Objective: To assess the satisfaction with dental appearance, desired treatments to improve dental appearance, and factors that ..... with double crown-retained removable partial dentures and oral health-related quality of life in middle and ...

  4. Combined cycle solar central receiver hybrid power system study. Final technical report. Volume II

    Energy Technology Data Exchange (ETDEWEB)

    None

    1979-11-01

    This study develops the conceptual design for a commercial-scale (nominal 100 MWe) central receiver solar/fossil fuel hybrid power system with combined cycle energy conversion. A near-term, metallic heat pipe receiver and an advanced ceramic tube receiver hybrid system are defined through parametric and market potential analyses. Comparative evaluations of the cost of power generation, the fuel displacement potential, and the technological readiness of these two systems indicate that the near-term hybrid system has better potential for commercialization by 1990. Based on the assessment of the conceptual design, major cost and performance improvements are projected for the near-term system. Constraints preventing wide-spread use were not identified. Energy storage is not required for this system and analyses show no economic advantages with energy storage provisions. It is concluded that the solar hybrid system is a cost effective alternative to conventional gas turbines and combined cycle generating plants, and has potential for intermediate-load market penetration at 15% annual fuel escalation rate. Due to their flexibility, simple solar/nonsolar interfacing, and short startup cycles, these hybrid plants have significant operating advantages. Utility company comments suggest that hybrid power systems will precede stand-alone solar plants.

  5. Use of combination therapy to successfully treat breakthrough Trichosporon asahii infection in an acute leukemia patient receiving voriconazole

    Directory of Open Access Journals (Sweden)

    Jia Chen

    2014-10-01

    Full Text Available Trichosporon species is an important life-threatening opportunistic systemic pathogen, especially in leukemia patients. Voriconazole is proved to be a promising agent in past decade. However, recently we observed a case of breakthrough Trichosporon asahii infection while receiving voriconazole, which calls for an alternative treatment strategy. A combination therapy of liposomal amphotericin B (AmB plus caspofungin – in which liposomal AmB dose was reduced due to renal toxicity – was administered to successfully treat this patient.

  6. Alcohol in Primary Care. Differential characteristics between alcohol-dependent patients who are receiving or not receiving treatment.

    Science.gov (United States)

    Barrio, Pablo; Miquel, Laia; Moreno-España, Jose; Martínez, Alicia; Ortega, Lluisa; Teixidor, Lidia; Manthey, Jakob; Rehm, Jürgen; Gual, Antoni

    2016-03-02

    primary health care services for other reasons. The aim of the present study is to describe the differential characteristics of AD patients in primary care, distinguishing between those who receive treatment and those who do not, and their reasons for not seeking it. In a cross-sectional study patients were evaluated by their general practitioner (GP) and interviewed by a member of the research team. Sociodemographic, diagnostic and clinical data were collected. From 1,372 patients interviewed in Catalonia, 118 (8.6%) were diagnosed as AD. These patients showed a lower socioeconomic status (48.3% vs 33.3%, odds ratio 2.02), higher unemployment rates (32.2% vs 19.2 %, odds ratio 2.11), and greater psychological distress and disability. Patients with AD receiving treatment (16.9%), were older (44 vs 36 years of age), reported higher unemployment rates (66% vs 25.5%, odds ratio 6.32) and higher daily alcohol consumption (61.5 vs 23.7 grams), suggesting a more advanced disease. Patients with AD in general showed a higher degree of comorbidity compared to other patients, with patients in treatment showing the most elevated level. The main reasons given for not seeking treatment were shame, fear of giving up drinking and barriers to treatment. Taken together, the data suggest the need to implement earlier strategies for the detection and treatment of AD.

  7. Acupuncture as a complementary treatment for cancer patients receiving chemotherapy.

    Science.gov (United States)

    Tas, Demet; Uncu, Dogan; Sendur, Mehmet Ali; Koca, Nuran; Zengin, Nurullah

    2014-01-01

    Medical treatment for eliminating the side effects of cancer therapy may not always be efficacious. Acupuncture is one of the most widely accepted alternative and complementary therapies in use today. In this study, we investigated the efficacy of acupuncture in patients experiencing cancer treatment side effects, including nausea, vomiting, pain, poor sleep quality and anxiety. A total of 45 inpatients who underwent chemotherapy between February and April 2013 in the Oncology Department of Numune Hospital were included in our study. Acupuncture was administered to the patients one day prior to chemotherapy, on the day of chemotherapy and one day after chemotherapy. The patients were evaluated on nausea, vomiting, pain, sleep quality and anxiety before the chemotherapy and on the 4th day of chemotherapy. Of the 45 patients included in the study, 18 (40%) were female and 27 (60%) were male. A total of 25 (55.6%) had an elementary school education; 32 patients (71%) had stage 4 cancer and were treated with palliative chemotherapy (the patient characteristics are shown in Table 1). Statistically significant decreases (panxiety scores were observed after the acupuncture treatment compared to baseline. There were no differences in the age, gender, education level, stage or metastasis levels between the patient groups whose symptoms improved or were unchanged. Our study showed that acupuncture has positive effects in cancer treatment patients who experience nausea, vomiting, pain, poor sleep quality and anxiety as side effects of chemotherapy. Chemotherapy-related side effects in cancer patients could be decreased by the concurrent use of acupuncture.

  8. BRUCELLA ENDOCARDITIS IN IRANIAN PATIENTS: COMBINED MEDICAL AND SURGICAL TREATMENT

    Directory of Open Access Journals (Sweden)

    Ebrahim Nematipour

    1995-06-01

    Full Text Available Brucella endocarditis is a Tare but serious complication ofbrucellosis and is the main cause of death reuuedto thisdisease: Itis not rare in the endemic areas and aaualiy accounts for up to 8~lO% ofendocarditis infections: We report seven adult cases of brucella endocarditis in lmam-Khorneini Hospual: Contrary to previous independent reports, female patients were not rare in this study and accountedfor three out ofseven. Four patients were cared for by combined medical and surgical treatment and were recovered Three of the patients that did not receive the combined theraPl could not he saved This report confirms the necessity of prompt combined medical and surgical treatment ofbrucella endocarditis.

  9. Cone damage in patients receiving high-dose irofulven treatment.

    Science.gov (United States)

    Lee, Michael S; Gupta, Nisha; Penson, Richard T; Loewenstein, John; Wepner, Meredith S; Seiden, Michael V; Milam, Ann H

    2005-01-01

    To describe the clinical, perimetric, and electroretinographic (ERG) results of 4 patients with cone dysfunction following irofulven treatment including the histopathologic and immunocytochemical features of one patient's retinas. Observational case series. The patients were examined clinically, including perimetric and ERG evaluations. Eyes from patient 1 and healthy postmortem eyes were processed for histopathologic and immunocytochemistry studies with antibodies specific for cones, rods, and reactive Müller cells. Clinical signs and symptoms, perimetry, ERG, retinal histopathologic and immunocytochemistry study results. All 4 patients had ERG changes consistent with abnormal cone responses and relatively normal rod responses. Compared with control eyes, the retina of patient 1 had approximately half the normal numbers of macular cones and fewer peripheral cones. The number of rods were normal but all rod and cone outer segments were shortened. High-dose irofulven treatment causes cone-specific damage with relative sparing of rods.

  10. Premorbid and current neuropsychological function in opiate abusers receiving treatment.

    Science.gov (United States)

    Pluck, Graham; Lee, Kwang-Hyuk; Rele, Ruta; Spence, Sean A; Sarkar, Sugato; Lagundoye, Olawale; Parks, Randolph W

    2012-07-01

    There is an established corpus of evidence linking substance abuse with neuropsychological impairment, particularly implicating frontal lobe functions. These could potentially be premorbid to, rather than consequences of, direct effects of substance abuse. A matched pairs design was employed in which currently abstinent opiate abusers in treatment were matched to 22 healthy control individuals. These were compared for premorbid and current neurobehavioral abnormalities with the self-report Frontal Systems Behavior Scale (FrSBe). Estimated premorbid and current IQ scores were also ascertained. There was no difference between the groups regarding socioeconomic background. There was no evidence for an alteration in cognitive function as measured by current IQ associated with opiate abuse, nor evidence of premorbidly lower IQ. However, with the FrSBe, the opiate abusers reported overall higher levels of apathy. They also had raised FrSBe total scores, indicating the presence of neurobehavioral features associated with frontal lobe impairment. Furthermore, the opiate abusers reported higher levels of these neurobehavioral abnormalities compared to their matched controls, even in the period preceding substance abuse. The results suggest that some substance abusing individuals in treatment demonstrate raised levels of neurobehavioral abnormalities, independently of general intellectual functioning. Furthermore, the results imply that these abnormalities may have already been present prior to the effects on the nervous system of substance abuse. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  11. Optimal combination of biomarkers for time-dependent receiver operating characteristic estimation and related problems.

    Science.gov (United States)

    Guan, Zhong; Qin, Jing

    2017-04-01

    The receiver operating characteristic curve is commonly used for assessing diagnostic test accuracy and for discriminatory ability of a medical diagnostic test in distinguishing between diseases and non-diseased individuals. With the advance of technology, many genetic variables and biomarker variables are easily collected. The most challenging problem is how to combine clinical, genetic, and biomarker variables together to predict disease status. If one is interested in predicting t-year survival, however, the status of "case" (death) and "control" (survival) at the given t-year is unknown for those individuals who were censored before t-year. To conduct a receiver operating characteristic analysis, one has to impute those ambiguous statuses. In this paper, we study a maximum pseudo likelihood method to estimate the underlying parameters and baseline distribution functions. The proposed approach produces more efficient and smoother estimate of the optimal time-dependent receiver operating characteristic curve and more stable estimation of the prediction rule for the t-year survivors. More importantly, the proposal is equipped with a goodness-of-fit test for the model assumption based on the bootstrap method. Two real medical data sets are used for illustration.

  12. An OFDM Receiver with Frequency Domain Diversity Combined Impulsive Noise Canceller for Underwater Network.

    Science.gov (United States)

    Saotome, Rie; Hai, Tran Minh; Matsuda, Yasuto; Suzuki, Taisaku; Wada, Tomohisa

    2015-01-01

    In order to explore marine natural resources using remote robotic sensor or to enable rapid information exchange between ROV (remotely operated vehicles), AUV (autonomous underwater vehicle), divers, and ships, ultrasonic underwater communication systems are used. However, if the communication system is applied to rich living creature marine environment such as shallow sea, it suffers from generated Impulsive Noise so-called Shrimp Noise, which is randomly generated in time domain and seriously degrades communication performance in underwater acoustic network. With the purpose of supporting high performance underwater communication, a robust digital communication method for Impulsive Noise environments is necessary. In this paper, we propose OFDM ultrasonic communication system with diversity receiver. The main feature of the receiver is a newly proposed Frequency Domain Diversity Combined Impulsive Noise Canceller. The OFDM receiver utilizes 20-28 KHz ultrasonic channel and subcarrier spacing of 46.875 Hz (MODE3) and 93.750 Hz (MODE2) OFDM modulations. In addition, the paper shows Impulsive Noise distribution data measured at a fishing port in Okinawa and at a barge in Shizuoka prefectures and then proposed diversity OFDM transceivers architecture and experimental results are described. By the proposed Impulsive Noise Canceller, frame bit error rate has been decreased by 20-30%.

  13. An OFDM Receiver with Frequency Domain Diversity Combined Impulsive Noise Canceller for Underwater Network

    Directory of Open Access Journals (Sweden)

    Rie Saotome

    2015-01-01

    Full Text Available In order to explore marine natural resources using remote robotic sensor or to enable rapid information exchange between ROV (remotely operated vehicles, AUV (autonomous underwater vehicle, divers, and ships, ultrasonic underwater communication systems are used. However, if the communication system is applied to rich living creature marine environment such as shallow sea, it suffers from generated Impulsive Noise so-called Shrimp Noise, which is randomly generated in time domain and seriously degrades communication performance in underwater acoustic network. With the purpose of supporting high performance underwater communication, a robust digital communication method for Impulsive Noise environments is necessary. In this paper, we propose OFDM ultrasonic communication system with diversity receiver. The main feature of the receiver is a newly proposed Frequency Domain Diversity Combined Impulsive Noise Canceller. The OFDM receiver utilizes 20–28 KHz ultrasonic channel and subcarrier spacing of 46.875 Hz (MODE3 and 93.750 Hz (MODE2 OFDM modulations. In addition, the paper shows Impulsive Noise distribution data measured at a fishing port in Okinawa and at a barge in Shizuoka prefectures and then proposed diversity OFDM transceivers architecture and experimental results are described. By the proposed Impulsive Noise Canceller, frame bit error rate has been decreased by 20–30%.

  14. Combined Treatment of Old Sanitary Landfill Leachate

    Directory of Open Access Journals (Sweden)

    Visnja Orescanin

    2016-06-01

    Full Text Available Landfill leachate presents hardly treatable, highly complex and very toxic environmental effluent originated in the municipal solid waste degradation process. Although, numerous treatment methods were developed so far, none of them alone could achieve permissible limits of the primary pollutants to discharge into natural recipients. The current study aimed to develop and apply the process to treat landfill leachate by simultaneous application of electrochemical methods, ultrasound, electromagnetic field and ozonation to achieve the legal criteria for its discharge into natural recipient and minimize its adverse environmental impacts. For this purpose, old landfill leachate was taken from the Piskornica (Koprivnica, Croatia sanitary landfill. Prior to the treatment, the leachate was supplemented with NaCl (2 g/L and subjected to simultaneous treatment with stainless steel electrode plates, ultrasound and recirculation through electromagnetic field. After 45 minutes, stainless steel electrode plates were replaced by iron electrodes and treated for another 10 minutes followed by 15 minutes of the treatment with aluminum electrode plates. Ultrasound and recirculation through electromagnetic field were also applied during Fe and Al electrode treatment. Finally, the electrodes were removed and the suspension was mixed with ozone for another 30 minutes and allowed to settle for an hour. Following the combined treatment, the removal efficiency for the turbidity, color, suspended solids, ammonium, phosphates and heavy metals was 99% or higher, while the removal of COD was 97%. All the measured parameters in the treated leachate were lower compared to upper permissible limit for discharge into natural recipient.

  15. Fixed Dose Combination for TB treatment

    Directory of Open Access Journals (Sweden)

    Tjandra Y. Aditama

    2003-06-01

    Full Text Available According to the World Health Organization, a third of the world’s population is infected with tuberculosis. The disease is responsible for nearly 2 million deaths each year and over 8 million were developing active diseases. Moreover, according to WHO (2000, tuberculosis deaths are estimated to increase to 35 million between 2000-2020. The majority of tuberculosis patients worldwide are still treated with single drugs, or with 2-drug fixed-dose combinations (FDCs. To improve tuberculosis treatment, 2- and 3-drug FDCs were recommended by the World Health Organization (WHO as part of the DOTS strategy. Since 1999 a 4-drug FDC was included on the WHO Model List of Essential Drugs. Today, FDCs are important tools to further improve the quality of care for people with TB, and accelerate DOTS expansion to reach the global TB control targets. Fixed dose combination TB drugs could simplifies both treatment and management of drug supply, and may prevent the emergence of drug resistance .Prevention of drug resistance is just one of the potential benefits of the use of FDCs. FDCs simplify administration of drugs by reducing the number of pills a patient takes each day and decreasing the risk of incorrect prescriptions. Most tuberculosis patients need only take 3–4 FDCs tablets per day during the intensive phase of treatment, instead of the 15–16 tablets per day that is common with single-drug formulations It is much simpler to explain to patients that they need to take four tablets of the same type and colour, rather than a mixture of tablets of different shapes, colours and sizes. Also, the chance of taking an incomplete combination of drugs is eliminated, since the four essential drugs are combined into one tablet. FDCs are also simpler for care-givers as they minimize the risk of confusion. Finally, drug procurement, in all its components (stock management, shipping, distribution, is simplified by FDCs. Adverse reactions to drugs are not more

  16. Psychiatric treatment received by primary care patients with panic disorder with and without agoraphobia.

    Science.gov (United States)

    Marcks, Brook A; Weisberg, Risa B; Keller, Martin B

    2009-06-01

    Although the majority of individuals with panic disorder first present to the primary care setting, little is known about the psychiatric treatment that primary care patients with the disorder typically receive. The purpose of this study was to explore characteristics of treatment received by patients with panic disorder with agoraphobia and by those with panic disorder without agoraphobia, examine demographic and clinical predictors of receiving treatment, and explore treatment barriers. This study used data from the Primary Care Anxiety Project (PCAP), which is a naturalistic, longitudinal study of anxiety disorders among primary care patients. This study presents data for 235 PCAP participants diagnosed at the study intake assessment as having panic disorder with agoraphobia (N=150) or without agoraphobia (N=85). Many patients with panic disorder were not receiving psychiatric treatment at study intake (38%), with those without agoraphobia being less likely to receive treatment. Psychotropic medications were the treatment of choice, with selective serotonin reuptake inhibitors or serotonin and norepinephrine reuptake inhibitors being the most commonly received class of medications (34%). Only 38% of those with panic disorder with agoraphobia and 24% of those with panic disorder without agoraphobia were receiving psychotherapy, and the use of empirically supported interventions was rare. The most common treatment barriers were not believing in using medication or therapy for emotional problems and not receiving a treatment recommendation from one's provider. The findings suggest a need for better treatment dissemination, in addition to making interventions more accessible or adapting them to the particular needs of primary care patients.

  17. Treatment of Comorbid Obesity and Major Depressive Disorder: A Prospective Pilot Study for their Combined Treatment

    Directory of Open Access Journals (Sweden)

    Lucy F. Faulconbridge

    2011-01-01

    Full Text Available Background. Obese individuals who suffer from major depressive disorder are routinely screened out of weight loss trials. Treatments targeting obesity and depression concurrently have not been tested. Purpose. To test the short-term efficacy of a treatment that combined behavioral weight management and cognitive behavioral therapy (CBT for obese adults with depression. Methods. Twelve obese females diagnosed with major depressive disorder received weekly group behavioral weight management, combined with CBT for depression, for 16 weeks. Weight, symptoms of depression, and cardiovascular disease (CVD risk factors were measured at baseline and week 16. Results. Participants lost 11.4% of initial weight and achieved significant improvements in symptoms of depression and CVD risk factors. Conclusions. Obese individuals suffering from major depressive disorder can lose weight and achieve improvements in symptoms of depression and CVD risk factors with 16 weeks of combined treatment. A larger randomized controlled trial is needed to establish the efficacy of this treatment.

  18. Results of combined treatment of anaplastic thyroid carcinoma (ATC

    Directory of Open Access Journals (Sweden)

    Bournaud Claire

    2011-11-01

    Full Text Available Abstract Background Anaplastic thyroid carcinoma (ATC is among the most aggressive human malignancies. It is associated with a high rate of local recurrence and with poor prognosis. Methods We retrospectively reviewed 44 consecutive patients treated between 1996 and 2010 at Leon Berard Cancer Centre, Lyon, France. The combined treatment strategy derived from the one developed at the Institut Gustave Roussy included total thyroidectomy and cervical lymph-node dissection, when feasible, combined with 2 cycles of doxorubicin (60 mg/m2 and cisplatin (100 mg/m2 Q3W, hyperfractionated (1.2 Gy twice daily radiation to the neck and upper mediastinum (46-50 Gy, and then four cycles of doxorubicin-cisplatin. Results Thirty-five patients received the three-phase combined treatment. Complete response after treatment was achieved in 14/44 patients (31.8%. Eight patients had a partial response (18.2%. Twenty-two (50% had progressive disease. All patients with metastases at diagnosis died shortly afterwards. Thirteen patients are still alive. The median survival of the entire population was 8 months. Conclusion Despite the ultimately dismal prognosis of ATC, multimodality treatment significantly improves local control and appears to afford long-term survival in some patients. There is active ongoing research, and results obtained with new targeted systemic treatment appear encouraging.

  19. Efficacy of Olanzapine Combined Therapy for Patients Receiving Highly Emetogenic Chemotherapy Resistant to Standard Antiemetic Therapy.

    Science.gov (United States)

    Abe, Masakazu; Kasamatsu, Yuka; Kado, Nobuhiro; Kuji, Shiho; Tanaka, Aki; Takahashi, Nobutaka; Takekuma, Munetaka; Hirashima, Yasuyuki

    2015-01-01

    Olanzapine is proved to be effective for chemotherapy induced nausea and vomiting (CINV). But its efficacy in combination with standard antiemetic therapy is unknown. The purpose of this study is to prove the preventive effect of olanzapine for the prevention of CINV caused by highly emetogenic chemotherapy when used with standard antiemetic therapy. Gynecologic cancer patients receiving cisplatin-based chemotherapy who had grade 2 or 3 nausea in overall phase (0-120 h after chemotherapy) despite standard therapy were assigned to this study. From the next cycles to cycles in which patients developed grade 2 or 3 nausea, they received olanzapine with standard therapy. 5 mg oral olanzapine was administered for 7 days from the day before chemotherapy. The effectiveness of preventive administration of olanzapine was evaluated retrospectively. The primary endpoint was nausea control rate (grade 0 or 1) with olanzapine. Fifty patients were evaluable. The nausea control rate with olanzapine was improved from 58% to 98% in acute phase (0-24 h after chemotherapy) and 2% to 94% in delayed phase (24-120 h after chemotherapy). In overall phase, the nausea control rate improved from 0% to 92%, and it was statistically significant (P improvement in control of refractory nausea.

  20. Combined treatment of uveal melanoma liver metastases

    Directory of Open Access Journals (Sweden)

    Brasiuniene B

    2011-02-01

    Full Text Available Abstract Uveal melanoma (UM is the most prevalent intraocular malignant tumor in the Western world. The prognosis of survival in the presence of metastatic disease is 2-7 months, depending on the treatment applied. This article presents a case of metastatic UM with successful complex treatment of liver metastases. A 49-year old female, underwent removal of the right eyeball in 1996 due to a histologically confirmed uveal melanoma. After 11 years, CT revealed a mass in the left kidney and multiple metastases in the liver. After left nephrectomy, 6 chemotherapy courses with dacarbazine were performed. The increasing liver metastases were observed. Additional 4 intraarterial (i/a chemotherapy courses were administered using cisplatin, doxorubicin, fluorouracil, and interferon alfa. After few courses increase in CTC Grade 4 liver transaminases was seen. A partial response was observed, and in December 2008 the patient underwent surgery removing all liver metastases by 7 wedge or atypical resections. All margins were tumor-free. 21 months after liver resections and 14 years since diagnosis, the patient is alive without evidence of disease. Successful treatment of metastatic uveal melanoma was due to a timely application of a combination of several treatment methods and good prognostic factors of the patient.

  1. Plaque, caries level and oral hygiene habits in young patients receiving orthodontic treatment

    DEFF Research Database (Denmark)

    Martignon, S; Ekstrand, K R; Lemos, M I

    2010-01-01

    To assess plaque, caries, and oral hygiene habits amongst patients receiving fixed-orthodontic treatment at the Dental-Clinic, Universidad-El-Bosque, Bogotá, Colombia.......To assess plaque, caries, and oral hygiene habits amongst patients receiving fixed-orthodontic treatment at the Dental-Clinic, Universidad-El-Bosque, Bogotá, Colombia....

  2. Reasons and Determinants for Not Receiving Treatment for Common Mental Disorders

    NARCIS (Netherlands)

    van Beljouw, Ilse; Verhaak, Peter; Prins, Marijn; Cuijpers, Pim; Penninx, Brenda; Bensing, Jozien

    Objectives: This study focused on patients in the general population whose anxiety or depressive disorder is untreated. It explored reasons for not receiving treatment and compared four groups of patients-three that did not receive treatment for different reasons (no problem perceived, no perceived

  3. Women with Bulimic Eating Disorders: When Do They Receive Treatment for an Eating Problem?

    Science.gov (United States)

    Mond, J. M.; Hay, P. J.; Darby, A.; Paxton, S. J.; Quirk, F.; Buttner, P.; Owen, C.; Rodgers, B.

    2009-01-01

    Variables associated with the use of health services were examined in a prospective, community-based study of women with bulimic-type eating disorders who did (n = 33) or did not (n = 58) receive treatment for an eating problem during a 12-month follow-up period. Participants who received treatment for an eating problem differed from those who did…

  4. Do patients discussed at a lung cancer multidisciplinary team meeting receive guideline-recommended treatment?

    Science.gov (United States)

    Boxer, Miriam M; Duggan, Kirsten J; Descallar, Joseph; Vinod, Shalini K

    2016-03-01

    Clinical guidelines provide evidence-based management recommendations to guide practice. This study aimed to evaluate whether patients discussed at a lung cancer multidisciplinary team meeting received guideline-recommended treatment and determine reasons for not receiving guideline-recommended treatment. All new lung cancer patients discussed at the Liverpool/Macarthur lung cancer multidisciplinary team meeting between 1 December 2005 and 31 December 2010 were included. Guideline-recommended treatment was assigned according to pathology, stage and ECOG (Eastern Co-operative Oncology Group) performance status as per the 2004 Australian Lung Cancer Guidelines. This was compared with actual treatment received to determine adherence to guidelines. For those patients who did not receive guideline-recommended treatment, the medical record was reviewed to determine the reason(s) for this. Survival was compared between those who did and did not receive guideline-recommended treatment. 808 new patients were discussed at the multidisciplinary team meeting. Guideline-recommended treatment could not be assigned in 2% of patients due to missing data. 435 patients (54%) received guideline-recommended treatment, and 356 (44%) did not. The most common reasons for not receiving guideline-recommended treatment were a decline in ECOG performance status (24%), large tumor volume precluding radical radiotherapy (17%), comorbidities (15%) and patient preference (13%). Patients less than 70 years who received guideline-recommended treatment had improved survival compared with those who did not. A significant proportion of lung cancer patients did not receive guideline-recommended treatment due to legitimate reasons. Alternative guidelines are needed for patients not suitable for current best practice. Treatment according to guidelines was a predictor for survival. © 2015 Wiley Publishing Asia Pty Ltd.

  5. Assessing Progress during Treatment for Young Children with Autism Receiving Intensive Behavioural Interventions

    Science.gov (United States)

    Hayward, Diane; Eikeseth, Svein; Gale, Catherine; Morgan, Sally

    2009-01-01

    This study examined progress after 1 year of treatment for children with autism who received a mean of 36 hours per week one-to-one University of California at Los Angeles Applied Behavior Analysis (UCLA ABA) treatment. Two types of service provision were compared: an intensive clinic based treatment model with all treatment personnel (N = 23),…

  6. [Treatment of chronic aphthous stomatitis combined with duodenal ulcer].

    Science.gov (United States)

    Dudchenko, M A; Skrypnikova, T P; Dudchenko, M A

    2014-01-01

    It is currently proved ulcerous stomatitis and duodenal ulcer to have common pathogenetic infectious link (the most studied agent being Helicobacter pylori) by concominant decrease of local and general immunity with hyperoxidation events. Eighty patients (44 female and 36 male aged 15-60) with chronic aphthous stomatitis (AS) combined with duodenal ulcer were included in the study and divided in two equal groups according to treatment received (control group of 40 patients was treated according to conventional scheme, while in 40 patients a new formulation Vipromak was added to treatment protocol). The symptoms of AS tend to resolve faster in vipromak group thus proving its efficiency in treatment of AS and duodenal ulcer.

  7. Recombinant Human Thrombopoietin Treatment Promotes Hematopoiesis Recovery in Patients with Severe Aplastic Anemia Receiving Immunosuppressive Therapy

    Directory of Open Access Journals (Sweden)

    Huaquan Wang

    2015-01-01

    Full Text Available Objective. To assess the effectiveness of recombinant human thrombopoietin (rhTPO in severe aplastic anemia (SAA patients receiving immunosuppressive therapy (IST. Methods. Eighty-eight SAA patients receiving IST from January 2007 to December 2012 were included in this retrospective analysis. Of these, 40 subjects received rhTPO treatment (15000 U, subcutaneously, three times a week. rhTPO treatment was discontinued when the platelet count returned to normal range. Hematologic response, bone marrow megakaryocyte recovery, and time to transfusion independence were compared. Results. Hematologic response was achieved in 42.5%, 62.5%, and 67.5% of patients receiving rhTPO and 22.9%, 41.6%, and 47.9% of patients not receiving rhTPO at 3, 6, and 9 months after treatment, respectively (P = 0.0665, P = 0.0579, and P = 0.0847, resp.. Subjects receiving rhTPO presented an elevated number of megakaryocytes at 3, 6, and 9 months when compared with those without treatment (P = 0.025, P = 0.021, and P = 0.011, resp.. The time to platelet and red blood cell transfusion independence was shorter in patients who received rhTPO than in those without rhTPO treatment. Overall survival rate presented no differences between the two groups. Conclusion. rhTPO could improve hematologic response and promote bone marrow recovery in SAA patients receiving IST.

  8. Comparison of intelligence quotient in children surviving leukemia who received different prophylactic central nervous system treatments

    Directory of Open Access Journals (Sweden)

    Reisi Nahid

    2012-01-01

    Conclusion: We can that reveal that CNS prophylaxis treatment, especially the combined treatment, is associated with IQ score decline in ALL survivors. Therefore,a baseline and an annual assessment of their educational progress are suggested.

  9. Risk of epilepsy in stroke patients receiving acupuncture treatment: a nationwide retrospective matched-cohort study.

    Science.gov (United States)

    Weng, Shu-Wen; Liao, Chien-Chang; Yeh, Chun-Chieh; Chen, Ta-Liang; Lane, Hsin-Long; Lin, Jaung-Geng; Shih, Chun-Chuan

    2016-07-13

    To investigate the risk of epilepsy in stroke patients receiving and not receiving acupuncture treatment. Retrospective cohort study. This study was based on Taiwan's National Health Insurance Research Database that included information on stroke patients hospitalised between 1 January 2000 and 31 December 2004. We identified 42 040 patients hospitalised with newly diagnosed stroke who were aged 20 years and above. We compared incident epilepsy during the follow-up period until the end of 2009 in stroke patients who were and were not receiving acupuncture. The adjusted HRs and 95% CIs of epilepsy associated with acupuncture were calculated using multivariate Cox proportional hazard regression. Stroke patients who received acupuncture treatment (9.8 per 1000 person-years) experienced a reduced incidence of epilepsy compared to those who did not receive acupuncture treatment (11.5 per 1000 person-years), with an HR of 0.74 (95% CI 0.68 to 0.80) after adjustment for sociodemographic factors and coexisting medical conditions. Acupuncture treatment was associated with a decreased risk of epilepsy, particularly among stroke patients aged 20-69 years. The log-rank test probability curve indicated that stroke patients receiving acupuncture treatment had a reduced probability of epilepsy compared with individuals who did not receive acupuncture treatment during the follow-up period (pacupuncture treatment had a reduced risk of epilepsy compared with those not receiving acupuncture treatment. However, the protective effects associated with acupuncture treatment require further validation in prospective cohort studies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  10. Combined teleseismic surface wave and receiver function analysis of the crust and upper mantle of Madagascar

    Science.gov (United States)

    Pratt, M. J.; Aleqabi, G. I.; Wysession, M. E.; Wiens, D. A.; Nyblade, A.; Shore, P.; Rambolamanana, G.; Tsiriandrimanana, R.; Andriampenomanana Ny Ony, F. S. T.

    2014-12-01

    The continental crust and upper mantle velocity structure beneath Madagascar remained poorly constrained until recent deployments of broadband seismic instrumentation across the island. The MACOMO (MAdagascar, COmoros and MOzambique), RHUM-RUM (Réunion Hotspot and Upper Mantle - Réunions Unterer Mantel) and the Madagascar Seismic Profile experiments have opened up this region to be studied in detail for the first time. The island is an amalgamation of an Archean craton, associated with the Western Dhawar craton of southern India, and a series of Proterozoic terranes that comprise the backbone of the island (Tucker et al., 2010). A receiver-function analysis has provided both the first Moho depth measurements and spatially discrete 1-D shear velocity results that matched well with known tectonic regions. To provide a more continuous 2-D and 3-D velocity structure map, teleseismic surface wave analysis is employed. Using Helmholtz tomography as implemented by the ASWMS package (Ge, Gaherty and Hutko; 2014), we are able to map phase velocities from the cross-correlation of station pairs at periods 20-100 s. At periods 20-40 s our results compare well with ambient noise analysis results (see poster by Wysession et al. (this meeting)). The prominent features of these results are a distinct low phase-velocity sector beneath the central Itasy region, with a secondary low phase-velocity region to the north of the island. Both the central part of the island and the northern region have experienced geothermal activity in recent times as well as volcanic activity within the last 10,000 years. This may suggest that the crust and underlying mantle in these regions remains at relatively higher temperatures than the surrounding rock. Combining this information with receiver-function analysis, we jointly invert our data for the shear velocity structure. These analyses will constrain the upper mantle seismic velocities in the region, allowing further analysis from body waves to

  11. The combined use of virtual reality exposure in the treatment of agoraphobia.

    Science.gov (United States)

    Pitti, Carmen T; Peñate, Wenceslao; de la Fuente, Juan; Bethencourt, Juan M; Roca-Sánchez, María J; Acosta, Leopoldo; Villaverde, María L; Gracia, Ramón

    2015-01-01

    This study compares the differential efficacy of three groups of treatments for agoraphobia: paroxetine combined with cognitive-behavioral therapy, paroxetine combined with cognitive-behavioral therapy and virtual reality exposure, and a group with only paroxetine. 99 patients with agoraphobia were finally selected. Both combined treatment groups received 11 sessions of cognitive-behavioral therapy, and one of the groups was also exposed to 4 sessions of virtual reality treatment. Treatments were applied in individual sessions once a week for 3 months. The three treatment groups showed statistically significant improvements. In some measures, combined treatment groups showed greater improvements. The virtual reality exposure group showed greater improvement confronting phobic stimuli. Treatments combining psychopharmacological and psychological therapy showed greater efficacy. Although the use of new technologies led to greater improvement, treatment adherence problems still remain.

  12. Prospective evaluation of physical activity in patients with idiopathic scoliosis or kyphosis receiving brace treatment

    National Research Council Canada - National Science Library

    Müller, Carsten; Fuchs, Katharina; Winter, Corinna; Rosenbaum, Dieter; Schmidt, Carolin; Bullmann, Viola; Schulte, Tobias L

    2011-01-01

    .... The aim of this prospective, controlled study was to objectify the impact of spinal bracing on daily step activity in patients receiving conservative treatment for adolescent idiopathic scoliosis (AIS...

  13. Combination Treatment for Nicotine Dependence: State of the Science

    OpenAIRE

    INGERSOLL, KAREN S.; COHEN, JESSYE

    2005-01-01

    Both nicotine replacement and sustained-release buproprion double the odds of achieving short- and moderate-term abstinence from nicotine. However, questions remain about the efficacy of combining pharmacotherapies. Our purposes were to review the evidence for (1) combined pharmacotherapy and (2) multimodal treatment combining pharmacotherapy and behavioral treatment and to recommend combinations of treatments to reduce nicotine dependence. Combining first-line pharmacotherapies with each oth...

  14. Self-Reported Reasons for Not Receiving Mental Health Treatment in Adults With Serious Suicidal Thoughts.

    Science.gov (United States)

    Kuramoto-Crawford, S Janet; Han, Beth; McKeon, Richard T

    2017-06-01

    This study examined self-reported reasons for not receiving mental health treatment among adults with past-year serious suicidal thoughts and their sociodemographic characteristics associated with these reasons. Using the 2008-2013 National Surveys on Drug Use and Health, we examined 8,400 respondents aged 18 years or older who had past-year serious thoughts of suicide and did not receive mental health treatment that year. Logistic regression analyses were conducted to estimate the associations between sociodemographic characteristics and self-reported reasons for not receiving mental health treatment among these suicidal adults. Among adults with serious suicidal thoughts who did not receive mental health treatment in the past year, three-fourths did not feel the need for treatment. Of the one-fourth of those who felt the need for treatment, the main reason for not receiving treatment was financial (58.4%), followed by logistical reasons such as not knowing where to go (36.1%). A greater proportion of suicidal adults than nonsuicidal adults perceived more than 1 barrier to treatment (43.8% vs 34.3%). Among suicidal adults who did not receive mental health treatment that year, the odds of not feeling the need for mental health treatment were higher in men (adjusted odds ratio [AOR] = 1.68; 95% CI, 1.42-1.99), adults aged 50 years or older (AOR = 3.02; 95% CI, 2.02-4.51), racial and ethnic minorities (AORs = 1.59-2.13), publicly insured (AOR = 1.54; 95% CI, 1.14-2.07), and nonmetropolitan residents (AOR = 1.50; 95% CI, 1.20-1.88). Most suicidal adults did not feel the need for mental health treatment. Of those who felt the need, multiple barriers were identified. A multifaceted approach to address these barriers is needed to promote receipt of mental health treatment among this vulnerable population.

  15. A Proposal For The Securitization Of SMEs Receivables And/Or Cash Flows By Combined Financing

    OpenAIRE

    Jose Luis Gonzalez Narro

    2013-01-01

    The expression credit is the name of the game is becoming more relevant as financing credit sales is increasingly becoming a challenge for small and medium-sized enterprises (SMEs) in Mexico. The securitization of receivables, also called monetization, helps to address the challenges of obtaining cash to finance new receivables. SMEs have to be able to offer credit and the securitizations allow them to do this by using the receivables they already have to obtain more cash to help them finance...

  16. Systemic combination treatment for psoriasis: a review

    DEFF Research Database (Denmark)

    Jensen, Peter; Skov, Lone; Zachariae, Claus

    2010-01-01

    exist for the use of systemic combination therapy. Therefore, our aim was to review the current literature on systemic anti-psoriatic combination regimens. We searched PubMed and identified 98 papers describing 116 studies (23 randomized) reporting on the effect of various systemic combination...

  17. Adequacy of treatment received by primary care patients with anxiety disorders.

    Science.gov (United States)

    Weisberg, Risa B; Beard, Courtney; Moitra, Ethan; Dyck, Ingrid; Keller, Martin B

    2014-05-01

    We examined the adequacy of pharmacotherapy and psychotherapy received by primary care patients with anxiety disorders over up to 5 years of follow-up. Five hundred thirty-four primary care patients at 15 US sites, who screened positive for anxiety symptoms, were assessed for anxiety disorders. Those meeting anxiety disorder criteria were offered participation and interviewed again at six and 12 months postintake, and yearly thereafter for up to 5 years. We utilized existing definitions of appropriate pharmacotherapy and created definitions of potentially adequate psychotherapy/cognitive-behavioral therapy (CBT). At intake, of 534 primary care participants with anxiety disorders, 19% reported receiving appropriate pharmacotherapy and 14% potentially adequate CBT. Overall, 28% of participants reported receiving potentially adequate anxiety treatment, whether pharmacotherapy, psychotherapy, or both. Over up to five years of follow-up, appropriate pharmacotherapy was received by 60% and potentially adequate CBT by 36% of the sample. Examined together, 69% of participants received any potentially adequate treatment during the follow-up period. Over the course of follow-up, primary care patients with MDD, panic disorder with agoraphobia, and with medicaid/medicare were more likely to receive appropriate anxiety treatment. Ethnic minority members were less likely to receive potentially adequate care. Potentially adequate anxiety treatment was rarely received by primary care patients with anxiety disorders at intake. Encouragingly, rates improved over the course of the study. However, potentially adequate CBT remained much less utilized than pharmacotherapy and racial-ethnic minority members were less likely to received care, suggesting much room for improved dissemination of quality treatment. © 2013 Wiley Periodicals, Inc.

  18. Combined Treatment of Residual, Recurrent and Unresectable Gastric Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Hoon Sik [Maryknoll Hospital, Pusan (Korea, Republic of)

    1990-06-15

    A series of 25 patients with residual, recurrent, and unresectable gastric cancer received various combination of surgery, radiotherapy (RT), chemotherapy (CT), and hyperthermia (HT). They were placed INTO 7 categories; 1) CT and HT-14 patients; 2) RT and HT-15 patients; 3) surgery, RT and HT-2 patients; 4) surgery, RT, HT and CT-1 patient; 5) RT, HT and CT-1 patient; 6) RT and CT-1 patient; 7) RT alone-1 patient. Three patients had curative resection. 21 patients received irradiation with tightly contoured portals to spare as much small bowel, kidney and marrow as possible. Hyperthermia was applied regionally once or twice a week for 23 patients using 8 MHz radiofrequency capacitive heating device (Thermotron RF-8). HT was given approximately 30 min after RT. 7 patients were treated with CT: 4 patients received HT and concomitant Mitomycin-C; 3 patients received HT and sequential 5-FU+Adriamycin+Mitomycin-C. There was not any treatment related deaths. There was also no evidence of treatment related problems with liver, kidney, stomach, or spinal cord except only one case of transient diabetic ketoacidosis. The tumor response was evaluable in 22 patients. None achieved complete remission. 11(50%) achieved partial remission. The response rate was correlated with total radiation dose and achieved maximum temperature. 9 of 14 (64%) received more than 4000 cGy showed partial remission; especially, all 3 patients received more than 5500 cGy achieved partial response. 8 of the 12 patients (67%) who achieved maximal temperature more than 41 .deg. C showed partial response in comparing with 25% (2 of 8 patients, below 41 .deg. C). The numbers of HT, however, was not correlated with the response. 3 of the 25 patients (12%) remain alive. The one who was surgically unresectable and underwent irradiation alone is in progression of the disease with distant metastases. The remaining two patients with curative resection are alive with free of disease, 24 and 35 months

  19. Receiver Architectures for MIMO-OFDM Based on a Combined VMP-SP Algorithm

    DEFF Research Database (Denmark)

    Manchón, Carles Navarro; Kirkelund, Gunvor Elisabeth; Riegler, Erwin

    2011-01-01

    the equations of the stationary points of a constrained region-based free energy approximation. When applied to a MIMO-OFDM probabilistic model, we obtain a generic receiver architecture performing iterative channel weight and noise precision estimation, equalization and data decoding. We show that this generic......Iterative information processing, either based on heuristics or analytical frameworks, has been shown to be a very powerful tool for the design of efficient, yet feasible, wireless receiver architectures. Within this context, algorithms performing message-passing on a probabilistic graph...... scheme can be particularized to a variety of different receiver structures, ranging from high-performance iterative structures to low complexity receivers. This allows for a flexible design of the signal processing specially tailored for the requirements of each specific application. The numerical...

  20. Treatment as usual (TAU) for depression: a comparison of psychotherapy, pharmacotherapy, and combined treatment at a large academic medical center.

    Science.gov (United States)

    Blais, Mark A; Malone, Johanna C; Stein, Michelle B; Slavin-Mulford, Jenelle; O'Keefe, Sheila M; Renna, Megan; Sinclair, Samuel J

    2013-03-01

    Depression is among the most prevalent and burdensome psychiatric disorders in the United States (Kessler et al., Achieves of General Psychiatry 62:617-627, 2005). There is substantial empirical support regarding efficacy of pharmacotherapy, psychotherapy, and combined treatment (both pharmacotherapy and psychotherapy) for treating depression. However, far less is known about the effectiveness of these treatments for real-world patients treated within routine clinical care settings (Cahill et al., The British Journal of Clinical Psychology 49:421-453, 2010). This study seeks to explore the effectiveness of treatment as usual (TAU) for depression in a large cohort of psychiatric outpatients receiving psychotherapy, pharmacotherapy, or combined treatment within an academic medical center. Initial and follow-up self-report assessments were analyzed for 1,322 patients receiving treatment for depression. Using these data, we determined treatment effect sizes, rates of reliable improvement (and deterioration), and rates of clinically significant improvement for psychotherapy, pharmacotherapy, and combined care. On average, all treatments produced significant improvement with effect sizes surpassing our no-treatment benchmark. No significant between-group (treatment) differences in self-report outcomes were found. The rates of reliable change were similar for all treatment groups consistent with past research. The present findings support the effectiveness of psychotherapy, pharmacotherapy, and combined treatment as routinely provided within a large academic medical center for the treatment of real-world patients suffering with depression.

  1. Adaptive Jamming Suppression in Coherent FFH System Using Weighted Equal Gain Combining Receiver over Fading Channels with Imperfect CSI

    Directory of Open Access Journals (Sweden)

    Yishan He

    2015-01-01

    Full Text Available Fast frequency hopping (FFH is commonly used as an antijamming communication method. In this paper, we propose efficient adaptive jamming suppression schemes for binary phase shift keying (BPSK based coherent FFH system, namely, weighted equal gain combining (W-EGC with the optimum and suboptimum weighting coefficient. We analyze the bit error ratio (BER of EGC and W-EGC receivers with partial band noise jamming (PBNJ, frequency selective Rayleigh fading, and channel estimation errors. Particularly, closed-form BER expressions are presented with diversity order two. Our analysis is verified by simulations. It is shown that W-EGC receivers significantly outperform EGC. As compared to the maximum likelihood (ML receiver in conventional noncoherent frequency shift keying (FSK based FFH, coherent FFH/BPSK W-EGC receivers also show significant advantages in terms of BER. Moreover, W-EGC receivers greatly reduce the hostile jammers’ jamming efficiency.

  2. Barriers to receiving substance abuse treatment among rural pregnant women in Kentucky.

    Science.gov (United States)

    Jackson, Afton; Shannon, Lisa

    2012-12-01

    Research presenting outcomes for women who enter substance abuse treatment during pregnancy consistently shows benefits. While treatment has nearly universal benefits, there are many barriers to seeking substance abuse treatment for pregnant women. The purpose of this study is to explore barriers for rural pregnant women seeking substance abuse treatment. There were three eligibility criteria for study participation: (1) aged 18 and older, (2) pregnant, and (3) undergoing short-term inpatient detoxification at the University of Kentucky Chandler Medical Center. Eighty-five rural women (N = 85) were included in the analysis. Substance use history and previous treatment were assessed with measures adapted from the Addiction Severity Index. Treatment barriers were measured with three qualitative questions and were coded into four overarching categories: availability, accessibility, affordability, and acceptability barriers. This sample had an extensive substance use history. Almost all participants had used alcohol (98%), marijuana (98%), illicit opiates (99%), and cigarettes (97%). On average, participants reported about two barriers to receiving treatment (Mean = 1.8; SD = 1.3), with over 80% of the sample reporting having experienced any barrier to treatment. The majority experienced acceptability (51%) and accessibility (49%) barriers. Twenty-six percent (26%) of the sample reported availability barriers. A smaller percentage of participants reported affordability barriers (13%). Rural pregnant women seeking substance abuse treatment face many obstacles to receiving needed treatment. More studies on barriers to substance abuse treatment among rural pregnant women are needed. Identifying these barriers can help in improving treatment access and services.

  3. Patients Undergoing Substance Abuse Treatment and Receiving Financial Assistance for a Physical Disability Respond Well to Contingency Management Treatment.

    Science.gov (United States)

    Burch, Ashley E; Morasco, Benjamin J; Petry, Nancy M

    2015-11-01

    Physical illness and disability are common in individuals with substance use disorders, but little is known about the impact of physical disability status on substance use treatment outcomes. This study examined the main and interactive effects of physical disability payment status on substance use treatment. Participants (N = 1,013) were enrolled in one of six prior randomized clinical trials comparing contingency management (CM) to standard care; 79 (7.8%) participants reported receiving disability payments, CM improved all three primary substance use outcomes: treatment retention, percent negative samples and longest duration of abstinence. There was no significant main effect of physical disability payment status on treatment outcomes; however, a significant treatment condition by physical disability status interaction effect emerged in terms of retention in treatment and duration of abstinence achieved. Patients who were receiving physical disability payments responded particularly well to CM, and their time in treatment and durations of drug and alcohol abstinence increased even more markedly with CM than did that of their counterparts who were not receiving physical disability assistance. These findings suggest an objectively defined cohort of patients receiving substance use treatment who respond particularly well to CM. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Ectopic pregnancy treatment by combination therapy

    OpenAIRE

    Cymbaluk-Płoska Aneta; Chudecka-Głaz Anita; Kuźniak Sławomir; Menkiszak Janusz

    2016-01-01

    Abstract Detectability of early stages of ectopic pregnancies has increased due to improvements in ultrasonographic and biochemical techniques. Since the patients? future procreative plans must be taken into consideration when commencing treatment, the goal of this work was to compare the effects of treatment methods and their impact on fertility. The study included 91 patients treated surgically for ectopic pregnancy. The choice of treatment depended on patients? general condition, ultrasono...

  5. Risk of epilepsy in stroke patients receiving acupuncture treatment: a nationwide retrospective matched-cohort study

    OpenAIRE

    Weng, Shu-Wen; Liao, Chien-Chang; Yeh, Chun-Chieh; Chen, Ta-Liang; Lane, Hsin-Long; Lin, Jaung-Geng; Shih, Chun-Chuan

    2016-01-01

    Objective To investigate the risk of epilepsy in stroke patients receiving and not receiving acupuncture treatment. Design Retrospective cohort study. Setting This study was based on Taiwan's National Health Insurance Research Database that included information on stroke patients hospitalised between 1 January 2000 and 31 December 2004. Participants We identified 42?040 patients hospitalised with newly diagnosed stroke who were aged 20?years and above. Primary and secondary outcome measures W...

  6. Treatment of premature ejaculation: a new combined approach

    Directory of Open Access Journals (Sweden)

    Adel Kurkar

    2015-01-01

    Causes of PE differ considerably. In this paper, we compared the outcomes of two single treatment lines together with a combination of both. The combination therapy was more effective than either line alone.

  7. High level of virological suppression among HIV-infected adults receiving combination antiretroviral therapy in Addis Ababa, Ethiopia

    NARCIS (Netherlands)

    Mekuria, Legese A.; Nieuwkerk, Pythia T.; Yalew, Alemayehu W.; Sprangers, Mirjam Ag; Prins, Jan M.

    2016-01-01

    Background: Plasma viral load (pVL) is a key indicator of therapeutic response in HIV-infected patients receiving combination antiretroviral therapy (cART), but is often unavailable in routine clinical care in resource-limited settings. Previous model-based simulation studies have suggested that the

  8. High level of virological suppression among HIV-infected adults receiving combination antiretroviral therapy in Addis Ababa, Ethiopia

    NARCIS (Netherlands)

    Mekuria, Legese A.; Nieuwkerk, Pythia T.; Yalew, Alemayehu W.; Sprangers, Mirjam Ag; Prins, Jan M.

    2016-01-01

    Plasma viral load (pVL) is a key indicator of therapeutic response in HIV-infected patients receiving combination antiretroviral therapy (cART), but is often unavailable in routine clinical care in resource-limited settings. Previous model-based simulation studies have suggested that the benefits of

  9. [Treatment results for different categories of vaginal intraepithelial neoplasia with electrocoagulation, 5-fluorouracil and combined treatment].

    Science.gov (United States)

    Veloz-Martínez, María Guadalupe; Quintana-Romero, Verónica; Contreras-Morales, María del Rosario Sandra; Jiménez-Vieyra, Carlos Ramón

    2015-10-01

    Vaginal intraepithelial neoplasia (VAIN) represents a variety of changes that initiate as an intraepithelial squamous lesion with the possibility of resulting in cancer. To compare the results of the treatment for the different categories of VAIN with electrocoagulation, 5-fluorouracil and combined treatment. Observational an analytical study. We stablished groups according to the category of VAIN evaluating and comparing remission, persistence, recurrence, or progression of the disease ac- cording to the received treatment, with a 1-year follow up. The results were compared by chi2 and Kruskal Wallis. The statistics analysis was done with the SPSS program version 20. One hundred thirty seven patients between 20 and 81 years of age (mean age: 52.49 years) were included. Seventy-four percent of the patients had a history of premalignant or malignant cervical lesions. Seventy-four patients had VAIN I, 34 patients had VAIN II, 22 patients had VAIN III and there were seven cases of vaginal carcinoma in situ. Fifty-eight patients were treated with electrocoagulation, 55 patients were treated with 5-FU, 16 patients had combined treatment, and eight patients received expectant management. Sixty three percent of patients had total remission of the lesion, 34% had persistence and 3% showed progression, and there were no cases of recurrence. Results were better in patients with VAIN I treated with 5-FU (bigger percentage of remission P .026), for the remaining categories of VAIN, no treatment showed superior results. The superior response occurs in patients with VAIN I treated with 5-FU. None of the treatments achieves a 100% remission. The VAIN frequency is high, patients with a history of malignant or premalignant cervical pathology should undergo a closer surveillance through cytocolposcopic control with respect to the remaining population.

  10. Receiving palliative treatment moderates the effect of age and gender on demoralization in patients with cancer.

    Directory of Open Access Journals (Sweden)

    Sigrun Vehling

    Full Text Available BACKGROUND: Existential distress is an important factor affecting psychological well-being in cancer patients. We studied occurrence and predictors of demoralization, a syndrome of existential distress, in particular the interaction of age, gender, and curative vs. palliative treatment phase. METHODS: A cross-sectional sample of N = 750 patients with different tumor sites was recruited from in- and outpatient treatment facilities. Patients completed the following self-report questionnaires: Demoralization Scale, Patient Health Questionnaire-9, Illness-Specific Social Support Scale Short Version-8, and physical problems list of the NCCN Distress Thermometer. Moderated multiple regression analyses were conducted. RESULTS: We found high demoralization in 15% and moderate demoralization in 8% of the sample. Curative vs. palliative treatment phase moderated the impact of age and gender on demoralization (three-way interaction: b = 1.30, P = .02: the effect of age on demoralization was negative for women receiving palliative treatment (b = -.26, P = .02 and positive for men receiving palliative treatment (b = .25, P = .03. Effects of age and gender were not significant among patients receiving curative treatment. Female gender was associated with higher demoralization among younger patients receiving palliative treatment only. Analyses were controlled for significant effects of the number of physical problems (b = 6.10, P<.001 and social support (b = -3.17, P<.001. CONCLUSIONS: Existential distress in terms of demoralization is a relevant problem within the spectrum of cancer-related distress. It is associated with a complex interaction of demographic and medical patient characteristics; existential challenges related to palliative treatment may exacerbate the impact of age- and gender-related vulnerability factors on demoralization. Psychosocial interventions should acknowledge this interaction in order to address the individual nature of existential

  11. [Urinary lithiasis treatment by laparoscopy. Combined techniques.

    Science.gov (United States)

    Fernández González, Inmaculada; Brime Menendez, Ricardo; Celada Luis, Guillermo; Acosta Reveles, Marco Antonio; Albers Acosta, Eduardo Mariano; Mejía Celemin, Pilar; San José Manso, Luis Alberto; Casado Varela, Javier

    2017-01-01

    Over the last 30 years, the treatment of urinary lithiasis has changed dramatically. With the advent of extracorporeal lithotripsy and the advances on ureterorenoscopy and percutaneous nephrolithotomy, the need to turn to open and laparoscopic/robotic surgery has diminished. The objective of this article is to review the different indications for open and/or laparoscopic treatment of urinary lithiasis, to achieve its complete elimination with the less invasive possible means and trying to minimize the number of secondary procedures as well as complications.

  12. Evaluation of electrolyte imbalance among tuberculosis patients receiving treatments in Southwestern Nigeria

    Directory of Open Access Journals (Sweden)

    Adebimpe Wasiu Olalekan

    2015-09-01

    Conclusion: Hyponatraemia, hyperkalaemia, and hypochloremia characterized some of the electrolyte imbalance among TB patients receiving treatments. The raised level of bicarbonate may be attributed to overcorrection of respiratory acidosis often found in patients with tuberculosis. Monitoring electrolytes is therefore an important component of TB management.

  13. Analysis of information received during treatment and adherence to tamoxifen in breast cancer patients.

    Science.gov (United States)

    Cruz, Aline; Rodrigues, Aline; Ferracini, Amanda; Stahlschmidt, Rebeca; Silva, Nice; Mazzola, Priscila

    2017-01-01

    This study examines whether women with breast cancer, who are adherent and non-adherent to tamoxifen, differ in their perceptions of information received during treatment. This cross-sectional study included women receiving tamoxifen as adjuvant treatment for breast cancer recruited from a teaching hospital specialised in women's health in the state of São Paulo (Brazil). Women were interviewed and their records were reviewed for socio demographic data and clinical characteristics. We assessed tamoxifen adherence using the Morisky-Green Test, and the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire - Information module (EORTC QLQ-INFO25) was used to evaluate the information received by the women. The sample contained 31 women (mean age = 55.4; SD = 11.6 years). According to the Morisky-Green Test, 74.2% of the women had suboptimal tamoxifen adherence. The global score for women's perceptions of information they received about the treatment and disease was 57.0 ±19.1 on a scale of 0 to 100, and no significant differences in scores were observed between adherents and non-adherents. A high prevalence of suboptimal tamoxifen adherence was observed. We found no significant differences between women with breast cancer who were adherent and non-adherent to tamoxifen.

  14. Combination treatment for nicotine dependence: state of the science.

    Science.gov (United States)

    Ingersoll, Karen S; Cohen, Jessye

    2005-01-01

    Both nicotine replacement and sustained-release buproprion double the odds of achieving short- and moderate-term abstinence from nicotine. However, questions remain about the efficacy of combining pharmacotherapies. Our purposes were to review the evidence for (1) combined pharmacotherapy and (2) multimodal treatment combining pharmacotherapy and behavioral treatment and to recommend combinations of treatments to reduce nicotine dependence. Combining first-line pharmacotherapies with each other or with investigational drugs shows little benefit. In contrast, trials combining specific behavioral treatments with first-line pharmacotherapies show enhanced smoking cessation rates, but benefits are not seen in all populations. We recommend future directions for research, including better specification of behavioral components and further examination of the length and timing of treatment.

  15. On Modeling Regional Total Electron Content and Receiver Differential Code Bias Using Combined GPS/BeiDou Observations

    Science.gov (United States)

    Abdelazeem, M.; Çelik, R. N.; El-Rabbany, A.

    2016-12-01

    This study aims to develop an effective regional model for vertical total electron content (VTEC) and receiver differential code bias (DCB) estimation based on the GPS-only and the combined GPS/BeiDou observations over Europe. GPS/BeiDou observations from a regional network consisting of 16 reference stations are processed in the zero-differenced mode in order to extract the geometry-free linear combination of the code observations. The bi-linear expansion function is used to model the VTEC and the receiver DCBs. A least-squares (LS) estimation algorithm is developed in order to estimate those parameters for a 15-minute time interval. To validate the proposed model, GPS and BeiDou receiver DCB for three stations are determined and compared with the international global navigation satellite system (GNSS) service multi-GNSS experiment (IGS-MGEX) counterparts in three successive days. The examined stations are selected to represent different latitudes and receiver types. In addition, the estimated VTEC values at those stations are compared with the final IGS global ionospheric map (IGS-GIM) counterparts. The results indicate that the estimated DCB and VTEC values have good agreement with the IGS-MGEX and the IGS-GIM counterparts, respectively, particularly for the combined GPS/BeiDou system.

  16. PERİODONTAL TREATMENT OUTCOMES IN POST MENOPAUSAL WOMEN RECEIVING HORMONE REPLACEMENT THERAPY

    Directory of Open Access Journals (Sweden)

    Ali ÇEKİCİ

    2015-10-01

    Full Text Available Purpose: To evaluate the effect of hormone replacement therapy(HRT on periodontal treatment outcomes in a group of postmenopausal women with periodontitis. Materials and Methods: 23 post-menopausal chronic periodontitis patients were included in this study. The test group(n=11 consisted of women who started HRT with this study and received conjugated estrogen and medroxyprogesteron. The control group(n=12 was women not taking any HRT or supplement therapy. Study groups received the same periodontal treatment. All subjects examiend by recording the following: plaque index (PI, sulcus bleeding index (SBI, periodontal pocket depth (PD and relative attachment level (RAL from 6 sites in each tooth. Measurements were recorded at the baseline, 1 month, 3 months, and 6 months following periodontal treatment. Serum estrogene level and bone mineral density was recorded at baseline and 6 months following periodontal treatment. Results: The GI change was greater in the control group. There wasn’t significant difference by means of PD, the attachment gain was significantly greater in the HRT receiving group. Conclusion: HRT seems to have a positive effect on periodontal treatment outcomes.

  17. Which female cancer patients fail to receive fertility counseling before treatment in the state of Georgia?

    Science.gov (United States)

    Chin, Helen B; Howards, Penelope P; Kramer, Michael R; Mertens, Ann C; Spencer, Jessica B

    2016-12-01

    To assess which characteristics are associated with failure to receive fertility counseling among a cohort of young women diagnosed with cancer. Population-based cohort study. Not applicable. A total of 1,282 cancer survivors, of whom 1,116 met the inclusion criteria for the analysis. None. The main outcome in this study was whether or not women reported receiving any information at the time of their cancer diagnosis on how cancer treatment might affect their ability to become pregnant. Forty percent of cancer survivors reported that they did not receive fertility counseling at the time of cancer diagnosis. Women were more likely to fail to receive counseling if they had only a high school education or less or if they had given birth. Cancer-related variables that were associated with a lack of counseling included not receiving chemotherapy as part of treatment and diagnosis with certain cancer types. Counseling about the risk of infertility and available fertility preservation options is important to cancer patients. Additionally, counseling can make women aware of other adverse reproductive outcomes, such as early menopause and its associated symptoms. Less-educated women and parous women are at particular risk of not getting fertility-related information. Programs that focus on training not just the oncologist, but also other health care providers involved with cancer care, to provide fertility counseling may help to expand access. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  18. Therapeutic alliance in youth with autism spectrum disorder receiving cognitive-behavioral treatment for anxiety.

    Science.gov (United States)

    Kerns, Connor M; Collier, Amanda; Lewin, Adam B; Storch, Eric A

    2017-05-01

    Symptoms of autism spectrum disorder may influence alliance in psychotherapy. This study examined therapeutic alliance and its relationship with child characteristics and anxiety treatment outcomes in youth with autism spectrum disorder. Youth ( N = 64) with autism spectrum disorder and co-occurring anxiety (7-16 years, IQ > 70) received 16 sessions of modular cognitive-behavioral therapy. Post-treatment therapist, youth and parent ratings of alliance as well as pre- and post-treatment ratings of child behavior were gathered. Ratings of alliance were commensurate to ratings seen in children without autism spectrum disorder. Measures of treatment outcome, but not pretreatment characteristics, were significantly associated with therapist ratings of alliance strength. Data suggest that therapeutic alliance may not be impaired in anxious youth with autism spectrum disorder and may be associated with treatment outcome.

  19. Efficient FPGA Implementation of a STBC-OFDM Combiner for an IEEE 802.16 Software Radio Receiver

    DEFF Research Database (Denmark)

    Cattoni, Andrea Fabio; Le Moullec, Yannick; Sacchi, Claudio

    2014-01-01

    In this paper, an efficient FPGA implementation of a 4x4 Space-Time Block Coding (STBC) combiner for MIMO-OFDM software radio receivers is considered. The proposed combiner is based on a low-complexity algorithm which reduces the interference due to the Quasi-Orthogonality of the STBC decoding....... In the literature, feedback techniques have been proposed to solve this problem. However, the algorithm introduced in this paper has been conceived in order to avoid the transmission feedback, by estimating the interference factors and removing them. The proposed algorithm exhibits a low computational complexity...

  20. Evaluation study of treatment outcome in Tuberculosis patients receiving DOTS under RNTCP

    Directory of Open Access Journals (Sweden)

    Mayank Jain

    2016-12-01

    Full Text Available Background: Tuberculosis is a global emergency and its control in community wholly depends on outcome of treatment taken by patient. India has 2nd position in total number of cases in World. Objective: To evaluate the factors which affect treatment outcome? Material & Methods: The study was a follow up study, for treatment outcome of tuberculosis patients receiving DOTS under RNTCP. Data were collected into SPSS version 16 and analyzed using appropriate statistical tests. Results: 241 patients were included in the study. Overall treatment success rate was 87.1%, default rate was 4.6%, failure rate was 2.1% and death rate was 6.2 %. Treatment success rate was 91.2% in category I and 70.2% in category II. Failure rate was 0.5% and 8.5%, default rate was 3.6% and 8.5%, death rate was 4.6% and 12 % for category I and category II respectively. In univariate analysis, variable education, occupation, socio-economic status, overcrowding, habit of tobacco consumption, presence of pre–existing illness and category of tuberculosis significantly affect the treatment outcome but on multiple logistic regression analysis education, occupation, habit of tobacco consumption and category of TB had significant effect on treatment outcome. Conclusion: Treatment success was 87.1% in present study conclude that DOTs is an effective form of tuberculosis treatment. Education, occupation, socio economic status and overcrowding have significant effect on treatment outcome.

  1. Estimation receiver operating characteristic curve and ideal observers for combined detection/estimation tasks.

    Science.gov (United States)

    Clarkson, Eric

    2007-12-01

    The localization receiver operating characteristic (LROC) curve is a standard method to quantify performance for the task of detecting and locating a signal. This curve is generalized to arbitrary detection/estimation tasks to give the estimation ROC (EROC) curve. For a two-alternative forced-choice study, where the observer must decide which of a pair of images has the signal and then estimate parameters pertaining to the signal, it is shown that the average value of the utility on those image pairs where the observer chooses the correct image is an estimate of the area under the EROC curve (AEROC). The ideal LROC observer is generalized to the ideal EROC observer, whose EROC curve lies above those of all other observers for the given detection/estimation task. When the utility function is nonnegative, the ideal EROC observer is shown to share many mathematical properties with the ideal observer for the pure detection task. When the utility function is concave, the ideal EROC observer makes use of the posterior mean estimator. Other estimators that arise as special cases include maximum a posteriori estimators and maximum-likelihood estimators.

  2. Dental esthetic satisfaction, received and desired dental treatments for improvement of esthetics

    Directory of Open Access Journals (Sweden)

    Akarslan Zuhre

    2009-01-01

    Full Text Available Aim: The purposes of this research were to investigate factors influencing patients′ satisfaction with their present dental esthetic, received previous dental treatments on anterior teeth and basic treatments that they wanted to undergo to improve their dental appearance. Materials and Methods: A total of 1014 patients who attended a dental school in a major city in Turkey participated in the study. The participants were surveyed with a questionnaire containing questions about gender, age, education level, self-reported tooth appearance, received previous dental treatments on anterior teeth and desired basic esthetic dental treatments. Statistical analysis of the verifying data was made with descriptive statistics, χ2 test and multiple logistic regression analyses. Results: According to the analyses of the verifying data, 55.1% of the patients were dissatisfied with the color of their teeth, 42.7% with dental appearance, 29.9% with crowding of anterior teeth, 23.3% were hiding teeth while smiling, 16.1% had non-esthetic restorations and 11.9% thought that their anterior teeth were protruding. Esthetic restoration was found to be the most-performed treatment recently (29.0% and whitening of teeth was the most-desired dental treatment (49.0%. Gender, age and education level had an effect on satisfaction and received previous and desired dental treatments for improvement of esthetics. Conclusion: Many of the Turkish patients surveyed in the study were dissatisfied and desired the improvement of dental esthetics. Therefore, dentists should consider this as an important dimension in their practice.

  3. Markerless attenuation correction for carotid MRI surface receiver coils in combined PET/MR imaging

    Science.gov (United States)

    Eldib, Mootaz; Bini, Jason; Robson, Philip M.; Calcagno, Claudia; Faul, David D.; Tsoumpas, Charalampos; Fayad, Zahi A.

    2015-06-01

    The purpose of the study was to evaluate the effect of attenuation of MR coils on quantitative carotid PET/MR exams. Additionally, an automated attenuation correction method for flexible carotid MR coils was developed and evaluated. The attenuation of the carotid coil was measured by imaging a uniform water phantom injected with 37 MBq of 18F-FDG in a combined PET/MR scanner for 24 min with and without the coil. In the same session, an ultra-short echo time (UTE) image of the coil on top of the phantom was acquired. Using a combination of rigid and non-rigid registration, a CT-based attenuation map was registered to the UTE image of the coil for attenuation and scatter correction. After phantom validation, the effect of the carotid coil attenuation and the attenuation correction method were evaluated in five subjects. Phantom studies indicated that the overall loss of PET counts due to the coil was 6.3% with local region-of-interest (ROI) errors reaching up to 18.8%. Our registration method to correct for attenuation from the coil decreased the global error and local error (ROI) to 0.8% and 3.8%, respectively. The proposed registration method accurately captured the location and shape of the coil with a maximum spatial error of 2.6 mm. Quantitative analysis in human studies correlated with the phantom findings, but was dependent on the size of the ROI used in the analysis. MR coils result in significant error in PET quantification and thus attenuation correction is needed. The proposed strategy provides an operator-free method for attenuation and scatter correction for a flexible MRI carotid surface coil for routine clinical use.

  4. Markless Attenuation Correction for Carotid MRI Surface Receiver Coils in Combined PET/MR Imaging

    Science.gov (United States)

    Eldib, Mootaz; Bini, Jason; Robson, Philip M.; Calcagno, Claudia; Faul, David D.; Tsoumpas, Charalampos; Fayad, Zahi A.

    2015-01-01

    Purpose To evaluate the effect of attenuation of MR coils on quantitative carotid PET/MR exams. Additionally, to develop and evaluate automated attenuation correction method for flexible carotid MR coils was developed and evaluated. Methods The attenuation of the carotid coil was measured by imaging a uniform water phantom injected with 37 MBq of 18F-FDG in a combined PET/MR scanner for 24 minutes with and without the coil. In the same session, an ultra-short echo time (UTE) image of the coil on top of the phantom was acquired. Using a combination of rigid and non-rigid registration, a CT-based attenuation map was registered to the UTE image of the coil for attenuation and scatter correction. After phantom validation, the effect of the carotid coil attenuation and the attenuation correction method were evaluated in five subjects. Results Phantom studies indicated that the overall loss of PET counts due to the coil was 6.3% with local region-of-interest (ROI) errors reaching up to 18.8%. Our registration method to correct for attenuation from the coil decreased the global error and local error (ROI) to 0.8% and 3.8%, respectively. The proposed registration method accurately captured the location and shape of the coil with a maximum spatial error of 2.6 mm. Quantitative analysis in human studies correlated with the phantom findings, but was dependent on the size of the ROI used in the analysis. Conclusions MR coils result in significant error in PET quantification and thus attenuation correction is needed. The proposed strategy provides an operator-free method for attenuation and scatter correction for a flexible MRI carotid surface coil for routine clinical use. PMID:26020273

  5. Combined modality treatment of aromatherapy, footsoak, and reflexology relieves fatigue in patients with cancer.

    Science.gov (United States)

    Kohara, Hiroyuki; Miyauchi, Takako; Suehiro, Yoko; Ueoka, Hiroshi; Takeyama, Hiroyasu; Morita, Tatsuya

    2004-12-01

    Fatigue is one of the most distressful symptoms experienced by patients with advanced cancer. Aromatherapy, footsoak, and reflexology are popular health care modality treatments in Japan, however, the effectiveness of each treatment for cancer-related fatigue has not been fully established. To investigate the effectiveness of combined modality treatment consisting of aromatherapy, footsoak, and reflexology against fatigue, an open study was performed in 20 terminally ill patients with cancer. After a patch test was performed, patients received aromatherapy that was accompanied with footsoak in warm water containing lavender essential oil for 3 minutes, followed by reflexology treatment with jojoba oil containing lavender for 10 min. Fatigue was evaluated using the Cancer Fatigue Scale (CFS) before, 1 hour after, and 4 hours after treatment. Total CFS scores improved significantly after this treatment (from 25.6 +/- 11.0 to 18.1 +/- 10.0, p < 0.001). Among three CFS subscales, physical and cognitive subscale scores were reduced significantly (11.3 +/- 6.1 to 6.7 +/- 6.1, p < 0.001; 4.5 +/- 3.2 to 2.4 +/- 2.4, p < 0.001). No adverse effects were experienced. Because all patients desired to continue this treatment, they received treatment eight times on average. Combined modality treatment consisting of aromatherapy, footsoak, and reflexology appears to be effective for alleviating fatigue in terminally ill cancer patients. To confirm safety and effectiveness of this combined modality treatment, further investigation including randomized treatment assignment is warranted.

  6. Dental implant placement with bone augmentation in a patient who received intravenous bisphosphonate treatment for osteoporosis.

    Science.gov (United States)

    Mattheos, Nikos; Caldwell, Patrick; Petcu, Eugen B; Ivanovski, Saso; Reher, Peter

    2013-01-01

    Intravenous (IV) administration of bisphosphonates has been considered an absolute contraindication for placement of dental implants, because of the increased risk of bisphosphonate-related osteonecrosis of the jaw (BRONJ). However, the evidence regarding this association originates from patients being treated for various forms of metastatic cancer. In the case reported here, a patient received a dental implant while undergoing IV treatment with zoledronic acid for osteoporosis. The authors discuss the current evidence regarding the risks of dental procedures in patients receiving IV bisphosphonates for this indication. They also evaluate important risk factors and the decision-making pathway in such cases. On the basis of existing evidence, receipt of a single IV infusion of zoledronic acid for the treatment of osteoporosis does not appear to be an absolute contraindication to implant placement.

  7. Evidence for Adverse Phonatory Change Following an Inhaled Combination Treatment

    Science.gov (United States)

    Erickson, Elizabeth; Sivasankar, Mahalakshmi

    2010-01-01

    Purpose: Voice problems are reported as a frequent side effect of inhaled combination (IC) treatments. The purpose of this experimental study was to investigate whether IC treatments are detrimental to phonation. We hypothesized that IC treatment would significantly increase phonation threshold pressure (PTP) and perceived phonatory effort (PPE),…

  8. Effects of metformin on body weight in patients with type 2 diabetes mellitus,receiving insulin analogue treatment

    Directory of Open Access Journals (Sweden)

    T I Romantsova

    2013-03-01

    Full Text Available Aims. To study the dynamics of body weight, waist circumference, blood lipid and insulin demand in patients with type 2 diabetes mellitus (T2DM during first year of combined treatment with metformin and insulin analogues, compared with insulin analogue monotherapy.Materials and Methods. We examined 78 patients with T2DM on newly initiated insulin therapy, including 54 females and 24 males. Median age was 56 [51.0; 64.0] years, median disease duration – 9 [6.8;14.0] years. Participants were subdivided in two groups. First group was comprised of 48 subjects (33 females and 15 males, who received monotherapy with insulin analogues (glargine, de- temir, biphasic Aspart 30 and Humalog Mix 25 or rapid-acting lispro and aspart. Second group included 30 patients (18 females and12 males, who were treated with combined therapy (insulin analogues plus metformin. We measured HbA1c, plasma lipid composition, BMI, waist circumference and insulin demand initially and after one year of follow-up.Results. We showed that combined therapy vs. insulin monotherapy allows better glycemic compensation while reducing insulin demand and lowering risks for weight gain.Conclusions. Combined insulin analogue plus metformin treatment delivers better metabolic control in patients with T2DM and is as- sociated with lower risks for body weight gain and increase in insulin demand against monotherapy with insulin analogues.

  9. Single versus combination immunotherapy drug treatment in melanoma.

    Science.gov (United States)

    Grimaldi, Antonio Maria; Marincola, Francesco M; Ascierto, Paolo Antonio

    2016-01-01

    The advent of new immunotherapies for the treatment of metastatic melanoma has resulted in various novel combination strategies. Because of their distinct modes of action, different immunotherapies have been investigated in combination with one another, as well as combined with targeted therapies and other treatment modalities. Anti-CTLA-4 and anti-PD-1 treatments enhance antitumor immunity through complementary and non-redundant mechanisms. The combination of the anti-CTLA-4 agent ipilimumab and the anti-PD-1 agent nivolumab has been shown to improve progression-free survival and objective response rate compared with either agent alone as monotherapy in patients with advanced melanoma. However, the combination was associated with significant toxicity, with around one-third of patients discontinuing treatment as a result. The sequential use of nivolumab and ipilimumab was associated with similar outcomes and comparable toxicity to concurrent therapy. Clinical trials assessing various combinations of immunomodulating antibodies are ongoing or planned. Ipilimumab and pembrolizumab have also been investigated in combination with the oncolytic virus, talimogene laherparepvec (T-VEC), with promising results. In addition, immunotherapies have also been combined with chemotherapy, radiotherapy and electrochemotherapy. Investigation of combination approaches represents the start of a new story that begins with melanoma treatment and expands to embrace other solid and hematological cancers.

  10. Preferred intensity exercise for adolescents receiving treatment for depression: a pragmatic randomised controlled trial

    OpenAIRE

    Carter, Tim; Guo, Boliang; Turner, David; Morres, Ioannis; Khalil, Elizabeth; Brighton, Emily; Armstrong, Marie; Callaghan, Patrick

    2015-01-01

    Background: Exercise has been shown to be effective in treating depression, but trials testing the effect of exercise for depressed adolescents utilising mental health services are rare. The aim of this study was to determine the effectiveness of a preferred intensity exercise intervention on the depressive symptoms of adolescents with depression. Methods: We randomly assigned 87 adolescents who were receiving treatment for depression to either 12 sessions of aerobic exercise at preferred int...

  11. Combining structured and unstructured data to identify a cohort of ICU patients who received dialysis.

    Science.gov (United States)

    Abhyankar, Swapna; Demner-Fushman, Dina; Callaghan, Fiona M; McDonald, Clement J

    2014-01-01

    To develop a generalizable method for identifying patient cohorts from electronic health record (EHR) data-in this case, patients having dialysis-that uses simple information retrieval (IR) tools. We used the coded data and clinical notes from the 24,506 adult patients in the Multiparameter Intelligent Monitoring in Intensive Care database to identify patients who had dialysis. We used SQL queries to search the procedure, diagnosis, and coded nursing observations tables based on ICD-9 and local codes. We used a domain-specific search engine to find clinical notes containing terms related to dialysis. We manually validated the available records for a 10% random sample of patients who potentially had dialysis and a random sample of 200 patients who were not identified as having dialysis based on any of the sources. We identified 1844 patients that potentially had dialysis: 1481 from the three coded sources and 1624 from the clinical notes. Precision for identifying dialysis patients based on available data was estimated to be 78.4% (95% CI 71.9% to 84.2%) and recall was 100% (95% CI 86% to 100%). Combining structured EHR data with information from clinical notes using simple queries increases the utility of both types of data for cohort identification. Patients identified by more than one source are more likely to meet the inclusion criteria; however, including patients found in any of the sources increases recall. This method is attractive because it is available to researchers with access to EHR data and off-the-shelf IR tools. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  12. Assessment of cardiac valve dysfunction in patients receiving cabergoline treatment for hyperprolactinaemia.

    Science.gov (United States)

    Tan, Tricia; Cabrita, Ines Z; Hensman, Davina; Grogono, Joanna; Dhillo, Waljit S; Baynes, Kevin C; Eliahoo, Joseph; Meeran, Karim; Robinson, Stephen; Nihoyannopoulos, Petros; Martin, Niamh M

    2010-09-01

    Cabergoline is a highly effective medical treatment for patients with hyperprolactinaemia. There is an increased risk of valvular heart disease in patients receiving cabergoline for Parkinson's disease. This study examined whether cabergoline treatment of hyperprolactinaemia is associated with a greater prevalence of valvulopathy. Cross-sectional, two-dimensional echocardiographic study performed by a single echocardiographer. Seventy-two patients (median age 36 years, 19 men) receiving cabergoline for hyperprolactinaemia, and 72 controls prospectively matched for age, sex and cardiovascular risk factors. Measurements Assessment of valvular mobility, regurgitation and morphology. Median cumulative dose exposure for cabergoline was 126 (58-258) mg, and patients had received cabergoline for 53 (26-96) months. The frequency of mild mitral regurgitation was identical (5/72, 7%) in patient and control groups. Mild aortic regurgitation was not significantly different between groups (4/72 [controls] vs 2/72 [patients], P = 0.681). There was only one case of tricuspid regurgitation, which was mild and observed in a cabergoline-treated patient. Nodular thickening of the right coronary cusp, noncoronary cusp or left coronary cusp of the aortic valve was observed at a similar frequency in both groups. There were no cases of extensive thickening of any valvular leaflet. Our data demonstrates that there is no association between cabergoline treatment for hyperprolactinaemia and valvulopathy. This study therefore supports continued use of low-dose cabergoline for patients with hyperprolactinaemia.

  13. An interactional test of the reformulated helplessness theory of depression in women receiving clinical treatment for eating disorders.

    Science.gov (United States)

    Rotenberg, Ken J; Costa, Paula; Trueman, Mark; Lattimore, Paul

    2012-08-01

    The study tested the Reformulated Helplessness model that individuals who show combined internal locus of control, high stability and high globality attributions for negative life events are prone to depression. Thirty-six women (M=29 years-8 months of age) receiving clinical treatment for eating disorders completed: the Attribution Style Questionnaire, the Beck Depression Inventory, and the Stirling Eating Disorder Scales. An HRA yielded a three-way interaction among the attributional dimensions on depressive symptoms. Plotting of the slopes showed that the attribution of negative life events to the combination of internal locus of control, high stability, and a high globality, was associated with the optimal level of depressive symptoms. The findings supported the Reformulated Helplessness as a model of depression. Copyright © 2012 Elsevier Ltd. All rights reserved.

  14. High-Risk Offenders Participating in Court-Supervised Substance Abuse Treatment: Characteristics, Treatment Received, and Factors Associated with Recidivism

    Science.gov (United States)

    Huang, David; Hser, Yih-Ing

    2011-01-01

    High-risk offenders treated by California’s Proposition 36 court-supervised drug treatment initiative account for a disproportionate number of re-arrests (Hawken 2008) undermining the many successes of the program, yet little is known about their characteristics, treatment experiences, or factors that influence re-arrest. To better understand this group, self-reported and administrative data were analyzed on 78 high-risk (five or more convictions in the previous 5 years) and 1,009 low-risk offenders enrolled during 2004. At intake, high-risk offenders were younger, more were male, and more had prior contact with psychiatric and criminal justice systems. Treatment received and the proportion recidivated during the 30-months after treatment assessment were similar across groups, but high-risk offenders had a greater number of re-arrests. The number of re-arrests was increased by high-risk classification, but decreased by receipt of more treatment services and longer treatment length. Moreover, the number of re-arrests was highest among high-risk offenders with shorter treatment lengths, whereas it was similar to that among low-risk offenders if treatment length was longer. To reduce recidivism among high-risk offenders in court-supervised drug treatment, consideration of psychiatric problems and criminal history is needed, as is receipt of sufficient treatment. PMID:21479770

  15. A case study of single-pill combination therapy: the ezetimibe/simvastatin combination for treatment of hyperlipidemia.

    Science.gov (United States)

    Huang, Xianhai; Chen, David Y-K

    2012-11-01

    In recent years, combination therapy has received growing popularity as a powerful therapeutic tactic for the treatment of diseases. The justifications and benefits of combination therapy are far-reaching, including but not limited to addressing unmet medical needs such as cancer, malaria, and HIV/AIDS, improved clinical efficacy and safety with reduced dosage of a single medication, understanding the underlying science of the disease, alleviating pharmaco-economic impacts, and better drug life-cycle management. Using the ezetimibe/simvastatin combination therapy as a case study, a comprehensive overview of the successful discovery and development of the single-pill combination, Vytorin, is presented in this review. A cursory introduction to combination therapy and the rationale for the ezetimibe/simvastatin combination for the treatment of hyperlipidemia provides an instructive entry point. The discovery and mode of action of simvastatin and ezetimibe monotherapies set the scene for a detailed discussion on the discovery and development of Vytorin, with emphasis on bioequivalency studies, clinical efficacy and safety profile studies, and the economic consequences of the single-pill combination therapy. Large-scale outcome clinical trials are also discussed to demonstrate the long-term effects of Vytorin. Copyright © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  16. Determinants for receiving acupuncture for LBP and associated treatments: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Baum Erika

    2006-11-01

    Full Text Available Abstract Background Acupuncture is a frequently used but controversial adjunct to the treatment of chronic low back pain (LBP. Acupuncture is now considered to be effective for chronic LBP and health care systems are pressured to make a decision whether or not acupuncture should be covered. It has been suggested that providing such services might reduce the use of other health care services. Therefore, we explored factors associated with acupuncture treatment for LBP and the relation of acupuncture with other health care services. Methods This is a post hoc analysis of a longitudinal prospective cohort study. General practitioners (GPs recruited consecutive adult patients with LBP. Data on physical function, subjective mood and utilization of health care services was collected at the first consultation and at follow-up telephone interviews for a period of twelve months. Results A total of 179 (13 % out of 1,345 patients received acupuncture treatment. The majority of those (59 % had chronic LBP. Women and elderly patients were more likely to be given acupuncture. Additional determinants of acupuncture therapy were low functional capacity and chronicity of pain. Chronic (vs. acute back pain OR 1.6 (CL 1.4–2.9 was the only significant disease-related factor associated with the treatment. The strongest predictors for receiving acupuncture were consultation with a GP who offers acupuncture OR 3.5 (CL 2.9–4.1 and consultation with a specialist OR 2.1 (CL 1.9–2.3. After adjustment for patient characteristics, acupuncture remained associated with higher consultation rates and an increased use of other health care services like physiotherapy. Conclusion Receiving acupuncture for LBP depends mostly on the availability of the treatment. It is associated with increased use of other health services even after adjustment for patient characteristics. In our study, we found that receiving acupuncture does not offset the use of other health care resources

  17. Facebook Usage Amongst Those Who Have Received Treatment for an Eating Disorder in a Group Setting

    Science.gov (United States)

    Saffran, Kristina; Fitzsimmons-Craft, Ellen E.; Kass, Andrea E.; Wilfley, Denise E.; Taylor, C. Barr; Trockel, Mickey

    2017-01-01

    Objective This study explored Facebook use among individuals with a history of receiving treatment for an eating disorder (ED) in a group setting (e.g., inpatient, residential, outpatient group), focusing primarily on comparisons individuals make about their bodies, eating, or exercise to those of their peers from treatment on Facebook and the relation between these comparisons and ED pathology. Method Individuals (N = 415; mean age 28.15 years ± 8.41; 98.1% female) who self-reported receipt of ED treatment in a group setting were recruited via email and social media to complete an online survey. Results Participants reported having an average of 10–19 Facebook friends from treatment and spending up to 30 minutes per day interacting on Facebook with individuals from treatment or ED-related organizations. More comparison to treatment peers on Facebook was associated with greater ED psychopathology and ED-related impairment. Conversely, positive interaction with treatment peers on Facebook was associated with lower ED psychopathology and ED-related impairment. Individuals who had been in treatment longer, more times, and more recently had more Facebook friends from treatment and ED-related organizations as well as spent more time in ED groups’ pages on Facebook. Few participants (19.5%) reported that a therapist asked about the impact of Facebook on pathology. Discussion Interactions on Facebook could affect patients’ recovery and potential for relapse. It may be helpful for treatment providers to discuss Facebook use and its potential benefits and drawbacks with patients preparing for discharge from group treatment. PMID:27302908

  18. Facebook usage among those who have received treatment for an eating disorder in a group setting.

    Science.gov (United States)

    Saffran, Kristina; Fitzsimmons-Craft, Ellen E; Kass, Andrea E; Wilfley, Denise E; Taylor, Craig Barr; Trockel, Mickey

    2016-08-01

    This study explored Facebook use among individuals with a history of receiving treatment for an eating disorder (ED) in a group setting (e.g., inpatient, residential, outpatient group), focusing primarily on comparisons individuals make about their bodies, eating, or exercise to those of their peers from treatment on Facebook and the relation between these comparisons and ED pathology. Individuals (N = 415; mean age 28.15 years ± 8.41; 98.1% female) who self-reported receipt of ED treatment in a group setting were recruited via e-mail and social media to complete an online survey. Participants reported having an average of 10-19 Facebook friends from treatment and spending up to 30 min per day interacting on Facebook with individuals from treatment or ED-related organizations. More comparison to treatment peers on Facebook was associated with greater ED psychopathology and ED-related impairment. Conversely, positive interaction with treatment peers on Facebook was associated with lower ED psychopathology and ED-related impairment. Individuals who had been in treatment longer, more times, and more recently had more Facebook friends from treatment and ED-related organizations as well as spent more time in ED groups' pages on Facebook. Few participants (19.5%) reported that a therapist asked about the impact of Facebook on pathology. Interactions on Facebook could affect patients' recovery and potential for relapse. It may be helpful for treatment providers to discuss Facebook use and its potential benefits and drawbacks with patients preparing for discharge from group treatment. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:764-777). © 2016 Wiley Periodicals, Inc.

  19. Brief interpersonal psychotherapy for depressed mothers whose children are receiving psychiatric treatment.

    Science.gov (United States)

    Swartz, Holly A; Frank, Ellen; Zuckoff, Allan; Cyranowski, Jill M; Houck, Patricia R; Cheng, Yu; Fleming, M A Dana; Grote, Nancy K; Brent, David A; Shear, M Katherine

    2008-09-01

    Depressed mothers of children with psychiatric illness struggle with both their own psychiatric disorder and the demands of caring for ill children. When maternal depression remains untreated, mothers suffer, and psychiatric illness in their offspring is less likely to improve. This randomized, controlled trial compared the interpersonal psychotherapy for depressed mothers (IPT-MOMS), a nine-session intervention based on standard interpersonal psychotherapy, to treatment as usual for depressed mothers with psychiatrically ill offspring. Forty-seven mothers meeting DSM-IV criteria for major depression were recruited from a pediatric mental health clinic where their school-age children were receiving psychiatric treatment and randomly assigned to IPT-MOMS (N=26) or treatment as usual (N=21). Mother-child pairs were assessed at three time points: baseline, 3-month follow-up, and 9-month follow-up. Child treatment was not determined by the study. Compared to subjects assigned to treatment as usual, subjects assigned to IPT-MOMS showed significantly lower levels of depression symptoms, as measured by the Hamilton Depression Rating Scale, and higher levels of functioning, as measured by the Global Assessment of Functioning, at 3-month and 9-month follow-ups. Compared to the offspring of mothers receiving treatment as usual, the offspring of mothers assigned to IPT-MOMS showed significantly lower levels of depression as measured by the Children's Depressive Inventory at the 9-month follow-up. Assignment to IPT-MOMS was associated with reduced levels of maternal symptoms and improved functioning at the 3- and 9-month follow-ups compared to treatment as usual. Maternal improvement preceded improvement in offspring, suggesting that maternal changes may mediate child outcomes.

  20. Assessing progress during treatment for young children with autism receiving intensive behavioural interventions.

    Science.gov (United States)

    Hayward, Diane; Eikeseth, Svein; Gale, Catherine; Morgan, Sally

    2009-11-01

    This study examined progress after 1 year of treatment for children with autism who received a mean of 36 hours per week one-to-one University of California at Los Angeles Applied Behavior Analysis (UCLA ABA) treatment. Two types of service provision were compared: an intensive clinic based treatment model with all treatment personnel (N = 23), and an intensive parent managed treatment model with intensive supervision only (N = 21). A non-concurrent multiple baseline design across participants (N = 13) examined whether progress was associated with ABA treatment or confounders. Between intake and follow-up, children in both groups improved significantly on IQ, visual-spatial IQ, language comprehension, expressive language, social skills, motor skills and adaptive behaviour. There were no significant differences between the two groups on any of the measures at follow-up. Mean IQ for participants in both groups increased by 16 points between intake and follow-up. These findings are consistent with previous studies demonstrating the benefits of ABA treatment.

  1. Hybrid drug combination: Anti-diabetic treatment of type 2 diabetic Wistar rats with combination of ellagic acid and pioglitazone.

    Science.gov (United States)

    Nankar, Rakesh P; Doble, Mukesh

    2017-12-15

    Pioglitazone is an effective drug for the treatment of type 2 diabetes. The drug was suspended from Indian market in June 2013 due to the risk of bladder cancer but was reintroduced in July 2013 because its benefits outweighed the risks. The risks associated with pioglitazone can be minimized if its dose is reduced. Ellagic acid, a polyphenolic antioxidant, is reported to reduce blood sugar in diabetic rats. The mechanism of anti-diabetic action of ellagic acid is not known. Drugs with same pharmacological action but different mechanism may act in synergistic way when combined together. The combination of ellagic acid with pioglitazone could enhance its activity and hence reduce its dose. Diabetes was induced in Wistar rats by intraperitoneal administration of 175 mg of nicotinamide/kg body weight in combination with 65 mg of streptozotocin/kg body weight and then fed with high fat diet for 4 weeks (Group II-VII). Non-diabetic rats were fed with normal chow diet (Group I). Group I and II received vehicle only whereas group III to VII received ellagic acid, pioglitazone or their combination. The treatment was given orally once a day for 21 days. The induction of type 2 diabetes in rats caused increase in blood glucose, LDL, triglyceride, and cholesterol and decrease in HDL. The diabetic rats showed improvement in hyperglycemia, dyslipidemia, liver and kidney function markers after treatment with ellagic acid, pioglitazone or their combinations. A combination of 10 mg of ellagic acid/kg BW with 10 mg of pioglitazone/kg BW resulted in significant improvement in all the biochemical parameters when compared to any of the individual treatment. The treatment of diabetic rats with the same combination significantly increased the expression levels of GLUT4, PPAR-γ and adiponectin in skeletal muscle. The present study indicates that the dose of pioglitazone, required to achieve normoglycemia in diabetic rats, can be reduced by two folds by combining it with ellagic

  2. Combination irradiation treatments for food safety and phytosanitary uses

    Science.gov (United States)

    Combination of irradiation treatment with other preservation techniques is of potential importance in enhancing the effectiveness and reducing the energy or dose requirement for destroying food borne illness and spoilage organisms while retaining or improving product quality. Phytosanitary irradiati...

  3. Effect of Antipyretic Therapy on Mortality in Critically Ill Patients with Sepsis Receiving Mechanical Ventilation Treatment

    Directory of Open Access Journals (Sweden)

    Sheng Ye

    2017-01-01

    Full Text Available Purpose. The study aimed to investigate the effectiveness of antipyretic therapy on mortality in critically ill patients with sepsis requiring mechanical ventilation. Methods. In this study, we employed the multiparameter intelligent monitoring in intensive care II (MIMIC-II database (version 2.6. All patients meeting the criteria for sepsis and also receiving mechanical ventilation treatment were included for analysis, all of whom suffer from fever or hyperthermia. Logistic regression model and R language (R version 3.2.3 2015-12-10 were used to explore the association of antipyretic therapy and mortality risk in critically ill patients with sepsis receiving mechanical ventilation treatment. Results. A total of 8,711 patients with mechanical ventilator were included in our analysis, and 1523 patients died. We did not find any significant difference in the proportion of patients receiving antipyretic medication between survivors and nonsurvivors (7.9% versus 7.4%, p=0.49. External cooling was associated with increased risk of death (13.5% versus 9.5%, p<0.001. In our regression model, antipyretic therapy was positively associated with mortality risk (odds ratio [OR]: 1.41, 95% CI: 1.20–1.66, p<0.001. Conclusions. The use of antipyretic therapy is associated with increased risk of mortality in septic ICU patients requiring mechanical ventilation. External cooling may even be deleterious.

  4. INVESTIGATIONS ON SEWAGE TREATMENT PROCESS USING COMBINED BIO-OXIDIZERS

    Directory of Open Access Journals (Sweden)

    V. N. Jaromsky

    2010-01-01

    Full Text Available The paper presents results of investigations on process of aerobic waste water treatment with combined bio-oxidizers at milk processing enterprises. It has been shown that attached biocenosis, free-floating biocenosis and also bio-module rotation frequency  have exerted a significant influence on the process of an aerobic sewage treatment. It has been established that combined bio-oxidizers can be used for cleaning high concentrated waste water at the enterprises of food industry.

  5. Impact of Cannabis Use on Treatment Outcomes among Adults Receiving Cognitive-Behavioral Treatment for PTSD and Substance Use Disorders

    Directory of Open Access Journals (Sweden)

    Lesia M. Ruglass

    2017-02-01

    Full Text Available Background: Background: Research has demonstrated a strong link between trauma, posttraumatic stress disorder (PTSD and substance use disorders (SUDs in general and cannabis use disorders in particular. Yet, few studies have examined the impact of cannabis use on treatment outcomes for individuals with co-occurring PTSD and SUDs. Methods: Participants were 136 individuals who received cognitive-behavioral therapies for co-occurring PTSD and SUD. Multivariate regressions were utilized to examine the associations between baseline cannabis use and end-of-treatment outcomes. Multilevel linear growth models were fit to the data to examine the cross-lagged associations between weekly cannabis use and weekly PTSD symptom severity and primary substance use during treatment. Results: There were no significant positive nor negative associations between baseline cannabis use and end-of-treatment PTSD symptom severity and days of primary substance use. Cross-lagged models revealed that as cannabis use increased, subsequent primary substance use decreased and vice versa. Moreover, results revealed a crossover lagged effect, whereby higher cannabis use was associated with greater PTSD symptom severity early in treatment, but lower weekly PTSD symptom severity later in treatment. Conclusion: Cannabis use was not associated with adverse outcomes in end-of-treatment PTSD and primary substance use, suggesting independent pathways of change. The theoretical and clinical implications of the reciprocal associations between weekly cannabis use and subsequent PTSD and primary substance use symptoms during treatment are discussed.

  6. Evaluation of Laboratory Parameters in Patients Receiving Isotretinoin For Treatment of Acne Vulgaris

    Directory of Open Access Journals (Sweden)

    Arzu Ataseven

    2013-09-01

    Full Text Available Objective: Oral isotretinoin (13-cis retinoic acid is the most effective medication in the treatment of acne vulgaris. The present study investigates the changes in the parameters such as lipid profile, liver enzymes, urea and creatinine, following the oral retinoic acid treatment in patients with acne vulgaris. Methods: The study group consisted of 110 patients who presented to the dermatology clinic of Konya Research and Training Hospital; they were clinically diagnosed with acne and received isotretinoin treatment. The levels of total cholesterol, triglyceride, high-density lipoprotein (HDL, low-density lipoprotein (LDL, alanine aminotranspherase (ALT, aspartate aminotranspherase (AST, urea and creatinine were evaluated retrospectively prior to and three months after the treatment. Results: When the levels prior to and following the treatment were compared, total cholesterol, triglyceride and AST were significantly increased (p0.05. Conclusion: The levels of serum lipids should be closely monitored during isotretinoin treatment, which is an effective agent particularly in the severe form of acne.

  7. The Evaluation of Minimal Erythema Dose For Narrowband UVB in Patients Receiving Isotretinoin Treatment

    Directory of Open Access Journals (Sweden)

    Tuba Çetiner

    2012-09-01

    Full Text Available Background and Design: Although photosensitivity is considered as one of the side effects of retinoids, there is no consensus on this issue. In this study, we aimed to evaluate the minimal erythema dose (MED for narrowband ultraviolet B in patients receiving isotretinoin treatmentMaterial and Method: Phototesting was done by narrowband ultraviolet B irradiation on fifty patients for whom isotretinoin treatment was planned. MED values were calculated before treatment (MED1 and during treatment after reaching half of the target dose (kgx120 mg (MED2, and it was evaluated whether there was statistically significant difference between the two MED values. In addition, the patients were assessed according to their skin phototypes in this respect. Results: When the mean values of MED1 and MED2 were compared in all patients who were treated with 0.5-0.7 mg/kg/day isotretinoin, the mean of MED2 values was found to be lower than the mean of MED1 values. Clinically, sunburn erythema was seen in only 3 (6% patients during the treatment. When the patients were evaluated according to their skin phototypes, significant difference between the means of MED 1 and MED 2 values was not determined. Conclusion: Although isotretinoin treatment does not cause clinically sunburn erythema, it was associated with decrease in MED values.

  8. Reductions in anxiety and depression symptoms in youth receiving substance use treatment.

    Science.gov (United States)

    Horigian, Viviana E; Weems, Carl F; Robbins, Michael S; Feaster, Daniel J; Ucha, Jessica; Miller, Michael; Werstlein, Robert

    2013-01-01

    Research shows that interventions for substance use disorders may be helpful in reducing internalizing disorders in adolescents. This paper examines the prevalence and reductions of anxiety and depression symptoms among youth receiving substance use treatment. Four hundred eighty adolescents ages 12-17 who received treatment for substance abuse as part of the Brief Strategic Family Therapy effectiveness trial were screened for anxiety and depression using the Diagnostic Interview Schedule for Children-Predictive Scales (DISC-PS). Twelve-month post-randomization assessments were completed by 327 parents and 315 youth. Sixty-five percent of the sample was found to have probability of at least one anxiety disorder or depression diagnosis. Significant reduction of anxiety and depressive symptoms and significant reductions in probable anxiety and depression diagnoses were observed at follow-up. Few differences by treatment type and by ethnic group were noticed. Findings indicate that substance use interventions might help reduce the prevalence of anxiety and depressive symptoms and the probability of these disorders. Copyright © American Academy of Addiction Psychiatry.

  9. Visualizing the Comorbidity Burden in Children with Autism Spectrum Disorder Receiving Dental Treatment Under General Anesthesia.

    Science.gov (United States)

    Mathu-Muju, Kavita R; Li, Hsin-Fang; Nam, Lisa H; Bush, Heather M

    2016-01-01

    The purposes of this study were to: (1) describe the comorbidity burden in children with autism spectrum disorder (ASD) receiving dental treatment under general anesthesia (GA); and (2) characterize the complexity of these concurrent comorbidities. A retrospective chart review was completed of 303 children with ASD who received dental treatment under GA. All comorbidities, in addition to the primary diagnosis of ASD, were categorized using the International Classification of Diseases-10 codes. The interconnectedness of the comorbidities was graphically displayed using a network plot. Network indices (degree centrality, betweenness centrality, closeness centrality) were used to characterize the comorbidities that exhibited the highest connectedness to ASD. The network plot of medical diagnoses for children with ASD was highly complex, with multiple connected comorbidities. Developmental delay, speech delay, intellectual disability, and seizure disorders exhibited the highest connectedness to ASD. Children with autism spectrum disorder may have a significant comorbidity burden of closely related neurodevelopmental disorders. The medical history review should assess the severity of these concurrent disorders to evaluate a patient's potential ability to cooperate for dental treatment and to determine appropriate behavior guidance techniques to facilitate the delivery of dental care.

  10. Women's experiences of having depression during pregnancy and receiving acupuncture treatment-A qualitative study.

    Science.gov (United States)

    Ormsby, Simone M; Dahlen, Hannah G; Smith, Caroline A

    2017-11-15

    Research indicates some women experiencing depression during pregnancy are dissatisfied with conventional depression treatments due to incomplete effectiveness, dislike of side effects, unsatisfactory experiences with providers and concerns regarding in-utero and breastfeeding safety. Consequently, many explore alternative options including acupuncture. To further understand women's views, preferences and motivations in this regard, as well as their experiences of receiving acupuncture as part of a three-armed pragmatic randomised controlled trial evaluating acupuncture for antenatal depression in Sydney, Australia, in-depth interviews were conducted with a group of acupuncture recipients. Eight participants who had completed the eight-treatment intervention were interviewed. Data was analysed using thematic analysis. The overarching theme to emerge was that women 'felt trapped between a rock and a hard place', in not wanting to feel the way they did, but also not knowing what else to do, as conventional treatments had been inadequate or unsatisfactory, or were now unacceptable during pregnancy. With a mixture of curiosity and open-mindedness, or scepticism and desperation, the women in this study decided to try acupuncture, to 'give it a go', in the hope of receiving benefits. After treatment, these women reported being surprised by 'gaining relief' from symptoms, that they also felt were cumulative and ongoing. The women in this study described gaining benefits from acupuncture that they felt enabled them to better manage their lives and the changes that pregnancy brings. These findings provide new understanding regarding the possible role acupuncture could provide as a supportive treatment for antenatal depression. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  11. Combinations of drugs in the Treatment of Obesity

    Directory of Open Access Journals (Sweden)

    Marcio C. Mancini

    2010-07-01

    Full Text Available Obesity is a chronic disease associated with excess morbidity and mortality. Clinical treatment, however, currently offers disappointing results, with very high rates of weight loss failure or weight regain cycles, and only two drugs (orlistat and sibutramine approved for long-term use. Drugs combinations can be an option for its treatment but, although widely used in clinical practice, very few data are available in literature for its validation. Our review focuses on the rationale for their use, with advantages and disadvantages; on combinations often used, with or without studies; and on new perspectives of combinations being studied mainly by the pharmaceutical industry.

  12. (Helianthus annuus L.) by separate and combined treatment

    African Journals Online (AJOL)

    The effect of single treatment with gamma-rays, sodium azide and combination treatments of gammarays and sodium azide on seed germination, seedling survival, pollen fertility and seed set in sunflower (Helianthus annuus L.) M2 generation was studied in the varieties of USH-430 and SHSF-333. There was gradual ...

  13. Biological black water treatment combined with membrane separation

    NARCIS (Netherlands)

    Voorthuizen, van E.M.; Zwijnenburg, A.; Meer, van der W.; Temmink, H.

    2008-01-01

    Separate treatment of black (toilet) water offers the possibility to recover energy and nutrients. In this study three combinations of biological treatment and membrane filtration were compared for their biological and membrane performance and nutrient conservation: a UASB followed by effluent

  14. [Device diagnosis and combined treatment of hyperventilation syndrome].

    Science.gov (United States)

    2012-01-01

    Hyperventilation syndrome is a separate disease and a symptom of other psychosomatic diseases. A variant of device diagnosis of the disease is proposed--integral rheoplethysmography by M. I. Tischenko and cardiointervalography by R. M. Baevsky. Hyper- and asthenic courses of the disease are described, the pathological psychoemotional pattern is recognized. The proposed treatment combines physiohemotherapy (laser treatment) and pharmacotherapy.

  15. Preferred treatment frequency in patients receiving androgen deprivation therapy for advanced prostate cancer

    DEFF Research Database (Denmark)

    Fode, Mikkel; Nielsen, Torben K; Al-Hamadani, Muhammad

    2014-01-01

    OBJECTIVE: The aim of this study was to assess patient preference regarding the length of treatment intervals of androgen deprivation therapy (ADT) with gonadotropin-releasing hormone agonists for prostate cancer. MATERIAL AND METHODS: The study was conducted as a questionnaire-based, cross...... satisfaction and side-effects. Overall, 238 men receiving ADT for prostate cancer were presented with the questionnaire between September 2011 and May 2012. Descriptive statistics, the chi-squared test and multiple regression were used for analyses. RESULTS: In total, 176 questionnaires (74%) were available...

  16. Cancer treatment: the combination of vaccination with other therapies

    DEFF Research Database (Denmark)

    Andersen, M.H.; Sorensen, R.B.; Schrama, D.

    2008-01-01

    approach to fight cancer, the combination with additional therapy could create a number of synergistic effects. Herein we discuss the possibilities and prospects of vaccination when combined with other treatments. In this regard, cell death upon drug exposure may be immunogenic or non-immunogenic depending...... and endothelial cells. The efficacy of therapeutic vaccination against cancer will over the next few years be studied in settings taking advantage of strategies in which vaccination is combined with other treatment modalities. These combinations should be based on current knowledge not only regarding the biology...... of the cancer cell per se, but also considering how treatment may influence the malignant cell population as well as the immune system Udgivelsesdato: 2008/11...

  17. Combining psychosocial treatment with pharmacotherapy for alcohol dependence.

    Science.gov (United States)

    Weiss, Roger D; Kueppenbender, Karsten D

    2006-12-01

    Pharmacotherapy for alcohol dependence is always delivered in a psychosocial context that may affect the outcome of the treatment. The rigorous study of different psychotherapeutic treatments for alcohol dependence has shown several distinct approaches to be effective. This article reviews the combination of alcohol dependence pharmacotherapies, including disulfiram, naltrexone, and acamprosate, with different psychosocial interventions. Many psychosocial interventions for alcohol dependence, including Alcoholics Anonymous, can be integrated successfully with pharmacotherapy. Psychosocial interventions, ranging from brief medical management to more intensive manualized psychotherapies, have all been shown to produce positive outcomes in certain studies, depending on the specific medication and the study context. Particularly successful combinations may include the use of behavioral marital therapy plus a disulfiram contract for patients taking that medication, and the combination of naltrexone or acamprosate with cognitive-behavioral therapy or psychosocial support. Ongoing research examining the optimal combinations of medications with different psychosocial treatments for alcohol dependence may further inform the field.

  18. Patient experiences of autonomy and coercion while receiving legal leverage in forensic assertive community treatment.

    Science.gov (United States)

    Lamberti, J Steven; Russ, Ann; Cerulli, Catherine; Weisman, Robert L; Jacobowitz, David; Williams, Geoffrey C

    2014-01-01

    Legal leverage is broadly defined as the use of legal authority to promote treatment adherence. It is widely utilized within mental health courts, drug courts, mandated outpatient treatment programs, and other intervention strategies for individuals with mental illness or chemical dependency who have contact with the criminal justice system. Nonetheless, the ethics of using legal authority to promote treatment adherence remains a hotly debated issue within public and professional circles alike. While critics characterize legal leverage as a coercive form of social control that undermines personal autonomy, advocates contend that it supports autonomy because treatment strategies using legal leverage are designed to promote health and independence. Despite the controversy, there is little evidence regarding the impact of legal leverage on patient autonomy as experienced and expressed by patients themselves. This report presents findings from a qualitative study involving six focus groups with severely mentally ill outpatients who received legal leverage through three forensic assertive community treatment (FACT) programs in Northeastern, Midwestern, and West Coast cities. Findings are discussed in the context of the self-determination theory of human motivation, and practical implications for the use of legal leverage are considered.

  19. Early Treatment Response in Children and Adolescents Receiving CBT for Trauma.

    Science.gov (United States)

    Wamser-Nanney, Rachel; Scheeringa, Michael S; Weems, Carl F

    2016-01-01

    To investigate the incidence and correlates of early treatment response among youth receiving cognitive behavioral therapy (CBT) for posttraumatic stress disorder (PTSD). 56 youth who participated in a randomized controlled trial of CBT for PTSD and D-cycloserine were included. Youth with PTSD symptoms below clinical cutoff after Session 4 of a 12-session protocol were classified as early treatment responders (32% of parent reports, 44.6% of child reports). Pretreatment characteristics were examined in relation to responder status. Lower levels of pretreatment PTSD, depression, and anxiety symptoms and fewer trauma types were related to child- and parent-reported responder status (d = .57, d = .52, respectively). Early treatment response was maintained at follow-up. Pretreatment symptoms levels and number of traumas may play an important role in predicting early treatment response. Correlates of early treatment response may provide avenues for identifying youth who could benefit from abbreviated protocols. © The Author 2014. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  20. Phenol removal through combined biological and enzymatic treatments

    OpenAIRE

    Bevilaqua J.V.; Cammarota M.C.; Freire D.M.G.; Sant?Anna Jr G.L.

    2002-01-01

    This work studies the use of biological and combined biological/enzymatic treatments in phenol degradation. The systems studied were conventional batch aerobic biological followed or preceded by enzymatic treatment. Tyrosinase extracted from the mushroom Agaricus bispora was employed. Biological treatment efficiently degraded effluents containing up to 420 mg.L-1 of phenol, removing 97% of the COD and 99% of the phenol in 48-hour batches. Alterations in phenol concentration intake reduced tre...

  1. Bupropion and sertraline combination treatment in refractory depression.

    Science.gov (United States)

    Marshall, R D; Johannet, C M; Collins, P Y; Smith, H; Kahn, D A; Douglas, C J

    1995-01-01

    A sizeable minority of depressed patients, estimated at 15-20%, suffer chronic symptoms which often persist despite appropriate treatment. The search for new, more efficacious pharmacotherapies has included testing existing medications for additional therapeutic effects, such as in combination treatment. Four treatment- refractory patients who presented to the authors for clinical care are described, in which the combination of bupropion and sertraline was effective for a major depressive episode. None of the patients experienced adverse effects. Two carried the diagnosis of unipolar depression, and two, bipolar disorder. All had prior adequate, but ineffective, separate trials of buproprion and a selective serotonin re-uptake inhibitor (SSRI), including sertraline. All had chronic depression with multiple failed medication treatments, arguing against the alternative explanation that their improvement represented a placebo response or spontaneous remission. The efficacious combination of sertraline and bupropion may be due to synergism of its two distinct antidepressant mechanisms involving serotonergic, dopaminergic and noradrenergic systems.

  2. A famciclovir + celecoxib combination treatment is safe and efficacious in the treatment of fibromyalgia.

    Science.gov (United States)

    Pridgen, William L; Duffy, Carol; Gendreau, Judy F; Gendreau, R Michael

    2017-01-01

    Infections and other stressors have been implicated in the development of fibromyalgia. We hypothesized that these stressors could result in recurrent reactivations of latent herpes virus infections, which could lead to the development of fibromyalgia. This study evaluated a famciclovir + celecoxib drug combination (IMC-1), active against suspected herpes virus reactivation and infection, for the treatment of fibromyalgia. A total of 143 fibromyalgia patients were enrolled at 12 sites in a 16-week, double-blinded, placebo-controlled proof-of-concept trial. Randomized patients received either IMC-1 or placebo in a 1:1 ratio. Outcome measures included a 24-hour recall pain Numerical Rating Scale, the Revised Fibromyalgia Impact Questionnaire (FIQ-R), the Patient's Global Impression of Change (PGIC) questionnaire, the Multidimensional Fatigue Inventory, the NIH Patient-Reported Outcomes Measurement Information System (PROMIS), and the Beck Depression Inventory-II conducted at baseline and weeks 6, 12, and 16 of the study. A significant decrease in fibromyalgia-related pain was observed for patients on IMC-1 treatment versus placebo. PGIC response rates were significantly improved with IMC-1 treatment. Overall, patient self-reported functioning, as measured by the FIQ-R, was significantly improved. Fatigue was also significantly improved as measured by the PROMIS fatigue inventory. The safety profile was encouraging. Despite the celecoxib component of IMC-1, gastrointestinal and nervous system treatment emergent adverse events were reported less frequently in the IMC-1 group, and study completion rates favored IMC-1 treatment. IMC-1 was efficacious and safe in treating symptoms of fibromyalgia, supporting the hypothesis that herpes virus infections may contribute to this syndrome. Improved retention rates, decreased adverse event rates, and evidence of efficacy on a broad spectrum of outcome measures are suggestive that IMC-1 may represent an effective, novel treatment

  3. Predictors of cessation treatment outcome and treatment moderators among smoking parents receiving quitline counselling or self-help material.

    Science.gov (United States)

    Schuck, Kathrin; Otten, Roy; Kleinjan, Marloes; Bricker, Jonathan B; Engels, Rutger C M E

    2014-12-01

    Several cessation treatments effectively enhance cessation, but it is not always clear which treatment may be most suitable for a particular client. We examined predictors of treatment outcome and treatment moderators among smoking parents in the Netherlands. We conducted secondary analyses of a randomized controlled trial in which smoking parents received either quitline counselling (n=256) or a self-help brochure (n=256). Data collection was completed in October 2012. Endpoints were 7-day point prevalence abstinence and 6-month prolonged abstinence at 12-month follow-up. Potential predictors and moderators included socio-demographic characteristics, smoking-related variables, and child-related variables. Male gender, higher employment status, lower daily cigarette consumption, higher levels of confidence in quitting, presence of a child with a chronic respiratory illness, and wanting to quit for the health of one's child predicted abstinence at 12months. Significant treatment moderators were intention to quit and educational level. Quitline counselling was effective regardless of intention to quit and educational level, but self-help material was less effective among less motivated and lower educated parents. Certain subgroups of smokers, such as parents who are concerned about the health of their child, are particularly receptive to cessation support. Individual characteristics should be considered in treatment selections. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Plasma Level Formaldehyde in Children Receiving Pulpotomy Treatment under General Anesthesia.

    Science.gov (United States)

    Bagrizan, Majid; Pourgolshani, Pouya; Hosseinpour, Sepanta; Jalalpour, Golnoush; Shahrestani, Mostafa Zahmatkesh

    Formocresol has long been used by dentists for pulpotomy of primary teeth. Due to some concerns regarding its possible carcinogenicity, formocresol has been the topic of numerous studies. This study sought to assess the changes in plasma level of formaldehyde of children after receiving pulpotomy under general anesthesia. Twenty-five children between 2-6 years requiring dental treatments under general anesthesia were studied. Blood samples were taken of children before and after the procedure. Plasma level of formaldehyde was measured using high performance liquid chromatography (HPLC). A total of 106 pulpotomy treatments were performed in 25 children using 126 cotton pellets dipped in formocresol. An increase and a decrease in plasma level of formaldehyde were noted in 5 (20%) and 20 (80%) children, respectively post-operatively compared to baseline. The t-test showed no significant difference in plasma level of formaldehyde pre- and postoperatively (P=0.12). the plasma level of formaldehyde in children who had higher levels of formaldehyde prior to the operation was also higher than that of others after the operation and this association was statistically significant (P=0.001, r=0.64). The results showed no significant change in the mean plasma level of formaldehyde in children who received pulpotomy under general anesthesia compared to its baseline value.

  5. Complex PTSD, interpersonal trauma and relational consequences: findings from a treatment-receiving Northern Irish sample.

    Science.gov (United States)

    Dorahy, Martin J; Corry, Mary; Shannon, Maria; Macsherry, Anne; Hamilton, Geraldine; McRobert, Geordie; Elder, Rhonda; Hanna, Donncha

    2009-01-01

    The relationship between PTSD and complex PTSD remains unclear. As well as further addressing this issue, the current study aimed to assess the degree to which DESNOS (complex PTSD) was related to interpersonal trauma and had relational consequences. Eighty one treatment-receiving participants with a history of exposure to the 'Troubles' in Northern Ireland, were assessed on various forms of interpersonal trauma, including exposure to the Troubles, and measures of interpersonal and community connectedness. DESNOS symptom severity was related to childhood sexual abuse and perceived psychological impact of Troubles-related exposure. A lifetime diagnosis of DESNOS was related to childhood Troubles-related experiences, while a current diagnosis of DESNOS was associated with childhood emotional neglect. PTSD avoidance predicted current DESNOS diagnosis and severity. Feeling emotionally disconnected from family and friends (i.e., interpersonal disconnectedness) was related to all three indices of DESNOS (i.e., lifetime diagnosis, current diagnosis and current symptom severity). Sample characteristics (i.e., treatment-receiving) and size may limit the generalizability of findings. Complex PTSD is associated with PTSD but when present should be considered a superordinate diagnosis.

  6. Effects of acetaminophen and ibuprofen in children with migraine receiving preventive treatment with magnesium.

    Science.gov (United States)

    Gallelli, Luca; Avenoso, Tiziana; Falcone, Daniela; Palleria, Caterina; Peltrone, Francesco; Esposito, Maria; De Sarro, Giovambattista; Carotenuto, Marco; Guidetti, Vincenzo

    2014-02-01

    The purpose of this study was to evaluate both the effects of ibuprofen and/or acetaminophen for the acute treatment of primary migraine in children in or out prophylactic treatment with magnesium. Children ranging from the ages of 5 to 16 years with at least 4 attack/month of primary migraine were eligible for participation the study. A visual analog scale was used to evaluate pain intensity at the moment of admission to the study (start of the study) and every month up to 18 months later (end of the study). One hundred sixty children of both sexes aged 5-16 years were enrolled and assigned in 4 groups to receive a treatment with acetaminophen or ibuprofen without or with magnesium. Migraine pain endurance and monthly frequency were similar in the 4 groups. Both acetaminophen and ibuprofen induced a significant decrease in pain intensity (P ibuprofen-treated children and also significantly reduced (P ibuprofen treatment (P ibuprofen groups, magnesium pretreatment significantly reduced the pain frequency (P ibuprofen and acetaminophen with not age-related effects. © 2013 American Headache Society.

  7. [Feeling of Liberty and Internalized Stigma: Comparison of Inpatient and Outpatient Cases Receiving Psychiatric Treatment].

    Science.gov (United States)

    Kamışlı, Songül; Dil, Satı; Daştan, Leyla; Eni, Nurhayat

    2016-01-01

    In this study, we investigated whether liberty-restricting and other factors can predict internalized stigma among psychiatric inpatients and outpatients. The study sample comprised of 129 inpatients, admitted at least once to psychiatry ward, and 100 outpatients who have never been hospitalized, receiving psychiatric treatment. In addition to demographic and clinical features, patients were evaluated for perceived deprivation of liberty and internalized stigma levels. Patients stated that their liberty was restrained mostly due to involuntary treatment, communication problems, side effects of medical treatment and inability to choose their treatment team. Regression analysis showed that internalized stigma was predicted by perceived deprivation of liberty, marital status and number of admissions to ward. Stigma was related to marital status and admissions to the psychiatry ward. Perceived deprivation of liberty predicts stigma regardless of the disease severity CONCLUSION: Perception of stigma leads to self-isolation, behavioral avoidance and refusal of aid-seeking. Our study indicated that perceived deprivation of liberty is one of the most important factors that lead to increased stigma. Based on our findings, we can say that as patients experience less perceived deprivation of liberty, they would have less stigma and thus, their compliance would increase.

  8. Limited Bacterial Diversity within a Treatment Plant Receiving Antibiotic-Containing Waste from Bulk Drug Production.

    Directory of Open Access Journals (Sweden)

    Nachiket P Marathe

    Full Text Available Biological treatment of waste water from bulk drug production, contaminated with high levels of fluoroquinolone antibiotics, can lead to massive enrichment of antibiotic resistant bacteria, resistance genes and associated mobile elements, as previously shown. Such strong selection may be boosted by the use of activated sludge (AS technology, where microbes that are able to thrive on the chemicals within the wastewater are reintroduced at an earlier stage of the process to further enhance degradation of incoming chemicals. The microbial community structure within such a treatment plant is, however, largely unclear. In this study, Illumina-based 16S rRNA amplicon sequencing was applied to investigate the bacterial communities of different stages from an Indian treatment plant operated by Patancheru Environment Technology Limited (PETL in Hyderabad, India. The plant receives waste water with high levels of fluoroquinolones and applies AS technology. A total of 1,019,400 sequences from samples of different stages of the treatment process were analyzed. In total 202, 303, 732, 652, 947 and 864 operational taxonomic units (OTUs were obtained at 3% distance cutoff in the equilibrator, aeration tanks 1 and 2, settling tank, secondary sludge and old sludge samples from PETL, respectively. Proteobacteria was the most dominant phyla in all samples with Gammaproteobacteria and Betaproteobacteria being the dominant classes. Alcaligenaceae and Pseudomonadaceae, bacterial families from PETL previously reported to be highly multidrug resistant, were the dominant families in aeration tank samples. Despite regular addition of human sewage (approximately 20% to uphold microbial activity, the bacterial diversity within aeration tanks from PETL was considerably lower than corresponding samples from seven, regular municipal waste water treatment plants. The strong selection pressure from antibiotics present may be one important factor in structuring the microbial

  9. Limited Bacterial Diversity within a Treatment Plant Receiving Antibiotic-Containing Waste from Bulk Drug Production.

    Science.gov (United States)

    Marathe, Nachiket P; Shetty, Sudarshan A; Shouche, Yogesh S; Larsson, D G Joakim

    2016-01-01

    Biological treatment of waste water from bulk drug production, contaminated with high levels of fluoroquinolone antibiotics, can lead to massive enrichment of antibiotic resistant bacteria, resistance genes and associated mobile elements, as previously shown. Such strong selection may be boosted by the use of activated sludge (AS) technology, where microbes that are able to thrive on the chemicals within the wastewater are reintroduced at an earlier stage of the process to further enhance degradation of incoming chemicals. The microbial community structure within such a treatment plant is, however, largely unclear. In this study, Illumina-based 16S rRNA amplicon sequencing was applied to investigate the bacterial communities of different stages from an Indian treatment plant operated by Patancheru Environment Technology Limited (PETL) in Hyderabad, India. The plant receives waste water with high levels of fluoroquinolones and applies AS technology. A total of 1,019,400 sequences from samples of different stages of the treatment process were analyzed. In total 202, 303, 732, 652, 947 and 864 operational taxonomic units (OTUs) were obtained at 3% distance cutoff in the equilibrator, aeration tanks 1 and 2, settling tank, secondary sludge and old sludge samples from PETL, respectively. Proteobacteria was the most dominant phyla in all samples with Gammaproteobacteria and Betaproteobacteria being the dominant classes. Alcaligenaceae and Pseudomonadaceae, bacterial families from PETL previously reported to be highly multidrug resistant, were the dominant families in aeration tank samples. Despite regular addition of human sewage (approximately 20%) to uphold microbial activity, the bacterial diversity within aeration tanks from PETL was considerably lower than corresponding samples from seven, regular municipal waste water treatment plants. The strong selection pressure from antibiotics present may be one important factor in structuring the microbial community in PETL

  10. Combination treatment of physical modalities in the treatment of musculoskeletal pain syndromes: a prospective-controlled study

    Directory of Open Access Journals (Sweden)

    Karin Pieber

    2010-12-01

    Full Text Available The aim of the study was to evaluate the effect of combinations of several physical therapies in the treatment of musculoskeletal pain syndromes by a prospective, controlled study. Forty patients (5 men and 35 women, 18-80 years with musculoskeletal pain syndrome were included. Thirty patients were assigned to the intervention group and 10 patients to the control group. The intervention group received a combination of physical therapies according to the clinical needs (electrotherapy, fango packs, mud packs, ultrasound, massage, exercise therapy. Treatment consisted of 10 sessions. The control group did not receive any physical therapy in the waiting period. The intervention group was examined at the beginning and the end of the treatment period. The control group was evaluated at the beginning and the end of the waiting period (before their physical therapy treatment started. Main outcome measurements were: Visual analogue scale for pain (VAS; Timed Get up and Go Test (TUG; Functional Reach Test (FRT. In addition bodily, emotional and social functioning was accessed by selected ICF-Items and items of the SF-36 health survey (SF-36. The main outcome measures showed significant improvement in the intervention group compared to the control group. Furthermore, ICF- and SF-36-Items also improved. In conclusion significant pain relief and improvement of function was achieved by a combination treatment of physical therapies in patients with musculoskeletal pain syndromes.

  11. Investigation of PON1 activity and MDA levels in patients with epilepsy not receiving antiepileptic treatment

    Directory of Open Access Journals (Sweden)

    Dönmezdil N

    2016-04-01

    Full Text Available Nilüfer Dönmezdil, Mehmet Uğur Çevik, Hasan Hüseyin Özdemir, Muhterem Taşin Department of Neurology, Dicle University, Diyarbakır, Turkey Purpose: There are many studies dedicated to researching the etiopathogenesis of epilepsy. In such research, oxidative and antioxidant indicators of etiopathogenesis have also been examined under the scope. Drawing on a group of patients with epilepsy who were receiving no treatment, we have tried to evaluate whether or not an increase in oxidative indicators is linked directly with the disorder, independent of epileptic medicaments.Methods: Thirty people in good health and 30 newly diagnosed with epilepsy and who received ambulatory treatment in the polyclinic of the Neurology Department took part in the study. The tests relating to serum malondialdehyde (MDA levels and paraoxonase 1 (PON1 activity were carried out in the biochemistry laboratory.Results: Even though the levels of MDA in the patient group (14.34±3.59 nmol/mL were found to be high compared to those of the control group, which consisted of people in good health (13.53±3.56 nmol/mL, there was no statistically significant difference. PON1 activity in the serum taken from people in the patient group (0.65±0.17 was lower in comparison to that observed in the serum of the control group (0.71±0.17 U/L. Nonetheless, it was not so low as to have significance from a statistical point of view.Conclusion: We conclude that such a high level of oxidative parameters should have been related to the disease and that statistically significant findings that emerged in some other studies could have been related to an antiepileptic treatment. Keywords: epilepsy, paraoxonase 1, malondialdehyde, oxidative stress, epilepsy, biochemical marker

  12. Potential Risk Factors Associated With Vascular Diseases in Patients Receiving Treatment for Hypertension.

    Science.gov (United States)

    Kim, Hyunjung; Park, Joonhong; Chae, Hyojin; Lee, Gun Dong; Lee, Sang Yoon; Lee, Jong Min; Oh, Yong Seog; Kim, Myungshin; Kim, Yonggoo

    2016-05-01

    Currently, the hypertension (HTN) patients undergo appropriate medical treatment, and traditional risk factors are highly controlled. Therefore, potential risk factors of atherosclerotic vascular diseases (AVD) and venous thromboembolisms (VTE) in HTN should be reconsidered. We investigated thrombophilic genetic mutations and existing biomarkers for AVD or VTE in HTN patients receiving treatment. A total of 183 patients were enrolled: AVD with HTN (group A, n=45), VTE with HTN (group B, n=62), and HTN patients without any vascular diseases (group C, n=76). The lipid profile, homocysteine (Hcy) levels, D-dimers, fibrinogen, antithrombin, lupus anticoagulant, and anti-cardiolipin antibody (aCL) were evaluated. Prothrombin G20210A, Factor V G1691A, and methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C were analyzed. All patients revealed wild type prothrombin G20210A and Factor V G1691A polymorphisms. The frequency of MTHFR polymorphisms was 677CT (n=84, 45.9%); 677TT (n=46, 25.1%); 1298AC (n=46, 25.1%); and 1298CC (n=2, 1.1%). The MTHFR 677TT genotype tended to increase the odds ratio (OR) to AVD events in HTN patients (OR 2.648, confidence interval 0.982-7.143, P=0.05). The group A demonstrated significantly higher Hcy levels (P=0.009), fibrinogen (P=0.004), and platelet counts (P=0.04) than group C. Group B had significantly higher levels of D-dimers (P=0.0001), platelet count (P=0.0002), and aCL (P=0.02) frequency than group C. The MTHFR 677TT genotype and Hcy level could be potential risk factors associated with development of AVD in HTN patients receiving treatment. D-dimer and aCL might be useful to estimate the occurrence of VTE in them.

  13. Combined Treatment with Morphine and Δ9-Tetrahydrocannabinol in Rhesus Monkeys: Antinociceptive Tolerance and Withdrawal.

    Science.gov (United States)

    Gerak, L R; France, C P

    2016-05-01

    Opioid receptor agonists are effective for treating pain; however, tolerance and dependence can develop with repeated use. Combining opioids with cannabinoids can enhance their analgesic potency, although it is less clear whether combined treatment alters opioid tolerance and dependence. In this study, four monkeys received 3.2 mg/kg morphine alone or in combination with 1 mg/kg Δ(9)-tetrahydrocannabinol (THC) twice daily; the antinociceptive effects (warm water tail withdrawal) of morphine, the cannabinoid receptor agonists WIN 55,212 [(R)-(1)-[2,3-dihydro-5-methyl-3-(4-morpholinylmethyl)pyrrolo[1,2,3-de]-1,4-benzoxazin-6-yl]-1-naphthalenylmethanone mesylate] and CP 55,940 (2-[(1R,2R,5R)-5-hydroxy-2-(3-hydroxypropyl) cyclohexyl]-5-(2-methyloctan-2-yl)phenol), and the κ opioid receptor agonist U-50,488 (trans-3,4-dichloro-N-methyl-N-[2-(1-pyrrolidinyl)-cyclohexyl]benzenacetamide methanesulfonate) were examined before, during, and after treatment. To determine whether concurrent THC treatment altered morphine dependence, behavioral signs indicative of withdrawal were monitored when treatment was discontinued. Before treatment, each drug increased tail withdrawal latency to 20 seconds (maximum possible effect). During treatment, latencies did not reach 20 seconds for morphine or the cannabinoids up to doses 3- to 10-fold larger than those that were fully effective before treatment. Rightward and downward shifts in antinociceptive dose-effect curves were greater for monkeys receiving the morphine/THC combination than monkeys receiving morphine alone. When treatment was discontinued, heart rate and directly observable withdrawal signs increased, although they were generally similar in monkeys that received morphine alone or with THC. These results demonstrated that antinociceptive tolerance was greater during treatment with the combination, and although treatment conditions were sufficient to result in the development of dependence on morphine, withdrawal was not

  14. Optical treatment of strabismic and combined strabismic-anisometropic amblyopia.

    Science.gov (United States)

    Cotter, Susan A; Foster, Nicole C; Holmes, Jonathan M; Melia, B Michele; Wallace, David K; Repka, Michael X; Tamkins, Susanna M; Kraker, Raymond T; Beck, Roy W; Hoover, Darren L; Crouch, Eric R; Miller, Aaron M; Morse, Christie L; Suh, Donny W

    2012-01-01

    To determine visual acuity improvement in children with strabismic and combined strabismic-anisometropic (combined-mechanism) amblyopia treated with optical correction alone and to explore factors associated with improvement. Prospective, multicenter, cohort study. We included 146 children 3 to amblyopia (n = 52) or combined-mechanism amblyopia (n = 94). Optical treatment was provided as spectacles (prescription based on a cycloplegic refraction) that were worn for the first time at the baseline visit. Visual acuity with spectacles was measured using the Amblyopia Treatment Study HOTV visual acuity protocol at baseline and every 9 weeks thereafter until no further improvement in visual acuity. Ocular alignment was assessed at each visit. Visual acuity 18 weeks after baseline. Overall, amblyopic eye visual acuity improved a mean of 2.6 lines (95% confidence interval [CI], 2.3-3.0), with 75% of children improving ≥ 2 lines and 54% improving ≥ 3 lines. Resolution of amblyopia occurred in 32% (95% CI, 24%-41%) of the children. The treatment effect was greater for strabismic amblyopia than for combined-mechanism amblyopia (3.2 vs 2.3 lines; adjusted P = 0.003). Visual acuity improved regardless of whether eye alignment improved. Optical treatment alone of strabismic and combined-mechanism amblyopia results in clinically meaningful improvement in amblyopic eye visual acuity for most 3- to treatment. Consideration should be given to prescribing refractive correction as the sole initial treatment for children with strabismic or combined-mechanism amblyopia before initiating other therapies. The authors have no proprietary or commercial interest in any of the materials discussed in this article. Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

  15. Optical Treatment of Strabismic and Combined Strabismic-Anisometropic Amblyopia

    Science.gov (United States)

    2011-01-01

    Objective To determine visual acuity improvement in children with strabismic and combined strabismic-anisometropic (combined-mechanism) amblyopia treated with optical correction alone and to explore factors associated with improvement. Design Prospective multi-center cohort study Participants 146 children 3 to amblyopia (N=52) or combined-mechanism amblyopia (N=94). Methods Optical treatment was provided as spectacles (prescription based on a cycloplegic refraction) that were worn for the first time at the baseline visit. Visual acuity with spectacles was measured using the Amblyopia Treatment Study HOTV© visual acuity protocol at baseline and every 9 weeks thereafter until no further improvement in visual acuity. Ocular alignment was assessed at each visit. Main outcome measure Visual acuity 18 weeks after baseline. Results Overall, amblyopic eye visual acuity improved a mean of 2.6 lines (95% confidence interval: 2.3 to 3.0), with 75% of children improving ≥2 lines and 54% improving ≥3 lines. Resolution of amblyopia occurred in 32% (95% confidence interval: 24% to 41%) of the children. The treatment effect was greater for strabismic amblyopia than for combined-mechanism amblyopia (3.2 versus 2.3 lines, adjusted P=0.003). Visual acuity improved regardless of whether eye alignment improved. Conclusions Optical treatment alone of strabismic and combined-mechanism amblyopia results in clinically meaningful improvement in amblyopic eye visual acuity for most 3 to amblyopia before initiating other therapies. PMID:21959371

  16. Interventions for preventing oral mucositis in patients with cancer receiving treatment: oral cryotherapy.

    Science.gov (United States)

    Riley, Philip; Glenny, Anne-Marie; Worthington, Helen V; Littlewood, Anne; Clarkson, Jan E; McCabe, Martin G

    2015-12-23

    Oral mucositis is a side effect of chemotherapy, head and neck radiotherapy, and targeted therapy, affecting over 75% of high risk patients. Ulceration can lead to severe pain and difficulty eating and drinking, which may necessitate opioid analgesics, hospitalisation and nasogastric or intravenous nutrition. These complications may lead to interruptions or alterations to cancer therapy, which may reduce survival. There is also a risk of death from sepsis if pathogens enter the ulcers of immunocompromised patients. Ulcerative oral mucositis can be costly to healthcare systems, yet there are few preventive interventions proven to be beneficial. Oral cryotherapy is a low-cost, simple intervention which is unlikely to cause side-effects. It has shown promise in clinical trials and warrants an up-to-date Cochrane review to assess and summarise the international evidence. To assess the effects of oral cryotherapy for preventing oral mucositis in patients with cancer who are receiving treatment. We searched the following databases: the Cochrane Oral Health Group Trials Register (to 17 June 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library 2015, Issue 5), MEDLINE via Ovid (1946 to 17 June 2015), EMBASE via Ovid (1980 to 17 June 2015), CANCERLIT via PubMed (1950 to 17 June 2015) and CINAHL via EBSCO (1937 to 17 June 2015). We searched the US National Institutes of Health Trials Registry, and the WHO Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching databases. We included parallel-design randomised controlled trials (RCTs) assessing the effects of oral cryotherapy in patients with cancer receiving treatment. We used outcomes from a published core outcome set registered on the COMET website. Two review authors independently screened the results of electronic searches, extracted data and assessed risk of bias. We contacted study authors for information

  17. Do patients receive recommended treatment of osteoporosis following hip fracture in primary care?

    Directory of Open Access Journals (Sweden)

    Petrella Robert J

    2006-05-01

    Full Text Available Abstract Background Osteoporosis results in fractures and treatment of osteoporosis has been shown to reduce risk of fracture particularly in those who have had a history of fracture. Methods A prospective study was conducted using patients admitted to a hip fracture rehabilitation program at a large referral center to evaluate the use of treatments recommended for secondary prevention of osteoporotic fracture between September 1, 2001 and September 30, 2003. The frequency of medication use for the treatment of osteoporosis including estrogen replacement therapy, bisphosponates, calcitonin, calcium and vitamin D therapy was determined on admission, at 6 weeks post discharge and one year following discharge. All patients were discharged to the care of their family physician. All family physicians in the referral region received a copy of the Canadian Consensus recommendations for osteoporosis management 1–3 months prior to the study. Results During the study period, 174 patients were enrolled and 121 completed all assessments. Fifty-seven family physicians were identified as caring for 1 or more of the study patients. Only 7 patients had previous BMD, only 5 patients had previously been prescribed a bisphosponate and 14 patients were taking calcium and/or vitamin D. All patients were prescribed 2500 mg calcium, 400 IU vitamin D and 5 mg residronate daily during rehabilitation and at discharge. Following discharge, a significant improvement was seen in all clinical indices of functional mobility, including the functional independence measure (FIM, walking distance, fear of falling score (FFS, and the Berg balance score (BBS. At six weeks a significant (p Conclusion Few patients admitted for hip fracture had previously taken recommended osteoporosis therapy including bisphosphonates. While compliance with Canadian Consensus recommendations was observed at six weeks, this was not the case at twelve months post hip fracture rehabilitation

  18. Do patients receive recommended treatment of osteoporosis following hip fracture in primary care?

    Science.gov (United States)

    Petrella, Robert J; Jones, Tim J

    2006-05-09

    Osteoporosis results in fractures and treatment of osteoporosis has been shown to reduce risk of fracture particularly in those who have had a history of fracture. A prospective study was conducted using patients admitted to a hip fracture rehabilitation program at a large referral center to evaluate the use of treatments recommended for secondary prevention of osteoporotic fracture between September 1, 2001 and September 30, 2003. The frequency of medication use for the treatment of osteoporosis including estrogen replacement therapy, bisphosponates, calcitonin, calcium and vitamin D therapy was determined on admission, at 6 weeks post discharge and one year following discharge. All patients were discharged to the care of their family physician. All family physicians in the referral region received a copy of the Canadian Consensus recommendations for osteoporosis management 1-3 months prior to the study. During the study period, 174 patients were enrolled and 121 completed all assessments. Fifty-seven family physicians were identified as caring for 1 or more of the study patients. Only 7 patients had previous BMD, only 5 patients had previously been prescribed a bisphosponate and 14 patients were taking calcium and/or vitamin D. All patients were prescribed 2500 mg calcium, 400 IU vitamin D and 5 mg residronate daily during rehabilitation and at discharge.Following discharge, a significant improvement was seen in all clinical indices of functional mobility, including the functional independence measure (FIM), walking distance, fear of falling score (FFS), and the Berg balance score (BBS). At six weeks a significant (p osteoporosis therapy including bisphosphonates. While compliance with Canadian Consensus recommendations was observed at six weeks, this was not the case at twelve months post hip fracture rehabilitation. Interventions to improve not only the detection and treatment of osteoporosis but also the ongoing treatment and management post-fracture need to

  19. Effects of progressive muscle relaxation training on anxiety and quality of life of inpatients with ectopic pregnancy receiving methotrexate treatment.

    Science.gov (United States)

    Pan, Li; Zhang, Jingping; Li, Lihua

    2012-08-01

    We explored the effects of progressive muscle relaxation training on anxiety and health-related quality of life of patients with ectopic pregnancy receiving methotrexate treatment. Ninety inpatients receiving this treatment were randomly assigned to a progressive muscle relaxation group (n = 45) or a control group (n = 45). The control group received standard single-dose methotrexate treatment, and the experimental group received methotrexate and additional muscle relaxation training until hospital discharge. The patients were evaluated with the state form of the State-Trait Anxiety Inventory and SF-36 shortly after admission and before discharge from the hospital. Both covariance analysis and repeated measures ANOVA showed that muscle relaxation training can effectively improve the anxiety and health-related quality of life of patients with ectopic pregnancy receiving methotrexate treatment in an inpatient setting. Copyright © 2012 Wiley Periodicals, Inc.

  20. Social networks and their influence on drinking behaviors: differences related to cognitive impairment in clients receiving alcoholism treatment.

    Science.gov (United States)

    Buckman, Jennifer F; Bates, Marsha E; Cisler, Ron A

    2007-09-01

    Mechanisms of behavioral change that support positive addiction treatment outcomes in individuals with co-occurring alcohol-use disorders and cognitive impairment remain largely unknown. This article combines person- and variable-centered approaches to examine the interrelated influence of cognitive impairment and social support on stability of and changes in drinking behaviors of Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) outpatients and aftercare clients (N = 1,726) during the first year after their entry into treatment. Latent class analysis identified homogeneous groups of clients based on the nature and extent of social support for abstinence or drinking at treatment entry. Cognitive impairment and drinking outcomes were compared across latent classes, and the interaction between impairment and social support on drinking outcomes was examined using mixture probit regression. Three independent social support classes (frequent positive, limited positive, and negative) were identified. In the outpatient sample, the frequent positive support class had greater cognitive impairment at treatment entry versus other classes, and extent of impairment significantly predicted improved drinking outcomes in this class. In the aftercare sample, the frequent positive and negative support classes had heightened impairment, yet cognitive impairment significantly predicted relatively poorer drinking outcomes in the negative support class only. Cognitive impairment may increase the influence of the social network on the drinking outcomes of persons receiving treatment for alcohol-use disorders, but more research is needed to understand client characteristics that determine whether this influence is more likely to be manifest as increased salience of helping agents or of hindering agents in the social network.

  1. The treatment performance of different subsoils in Ireland receiving on-site wastewater effluent.

    Science.gov (United States)

    Gill, L W; O'Súlleabháin, C; Misstear, B D R; Johnston, P J

    2007-01-01

    Current Irish guidelines require a comprehensive site assessment of a percolation area for wastewater disposal before planning permission is granted for dwellings in rural areas. For a site to be deemed suitable, the subsoil must have a percolation value equivalent to a field saturated hydraulic conductivity in the range 0.08 to 4.2 m d(-1) using a falling head percolation test. A minimum of 1.2 m of unsaturated subsoil must also exist below the invert of the percolation area receiving effluent from a septic tank (or 0.6 m for secondary treated effluent). During a 2-yr period, the three-dimensional performance of four percolation areas treating domestic wastewater was monitored. At each site samples were taken at 0, 10, and 20 m along each of the four percolation trenches at depths of 0.3, 0.6, and 1.0 m below each trench to ascertain the attenuation effects of the unsaturated subsoil. The two sites with septic tanks installed performed at least as well as the other two sites with secondary treatment systems installed and appeared to discharge a better quality effluent in terms of nutrient load. An average of 2.1 and 6.8 g total N d(-1) remained after passing through 1-m depth of subsoil beneath the trenches receiving septic tank effluent compared with 12.7 and 16.7 g total N d(-1) on the sites receiving secondary effluent. The research also indicates that the septic tank effluent was of an equivalent quality to the secondary treated effluent in terms of indicator bacteria (E. coli) after percolating through 0.6-m depth of unsaturated subsoil.

  2. Cognitive adaptation training combined with assertive community treatment

    DEFF Research Database (Denmark)

    Hansen, Jens Peter; Ostergaard, Birte; Nordentoft, Merete

    2012-01-01

    Cognitive adaptation training (CAT) targets the adaptive behaviour of patients with schizophrenia and has shown promising results regarding the social aspects of psychosocial treatment. As yet, no reports have appeared on the use of CAT in combination with assertive community treatment (ACT). Our...... purpose was to evaluate the effect of CAT in comparison with ACT, focusing on social functions (primary outcome), symptoms, relapse, re-hospitalisation, and quality of life of outpatients with schizophrenia....

  3. Nutrient transport within three vegetative treatment areas receiving silage bunker runoff.

    Science.gov (United States)

    Faulkner, Joshua W; Zhang, Wei; Geohring, Larry D; Steenhuis, Tammo S

    2011-03-01

    Silage bunker runoff can be a very polluting substance and is increasingly being treated by vegetative treatment areas (VTAs), but little information exists regarding nutrient removal performance of systems receiving this wastewater. Nutrient transport through the shallow subsurface of three VTAs (i.e. one VTA at Farm WNY and two VTAs at Farm CNY) in glaciated soils containing a restrictive layer (i.e., fragipan) was assessed using a mass balance approach. At Farm WNY, the mass removal of ammonium was 63%, nitrate was 0%, and soluble reactive phosphorus (SRP) was 39%. At Farm CNY, the mass removal of ammonium was 79% in the West VTA, but nitrate and SRP increased by 200% and 533%, respectively. Mass removal of ammonium was 67% in the East VTA at Farm CNY; nitrate removal was 86% and SRP removal was 88%. The East VTA received a much higher nutrient loading, which was attributed to a malfunctioning low-flow collection apparatus within the settling basin. Results demonstrate that nutrient reduction mechanisms other than vegetative uptake can be significant within VTAs. Even though increases in nitrate mass were observed, concentrations in 1.65m deep wells indicated that groundwater impairment from leaching of nitrate was not likely. These results offer one of the first evaluations of VTAs treating silage bunker runoff, and highlight the importance of capturing concentrated low flows in VTA systems. Copyright © 2010 Elsevier Ltd. All rights reserved.

  4. Multistrain models predict sequential multidrug treatment strategies to result in less antimicrobial resistance than combination treatment

    DEFF Research Database (Denmark)

    Ahmad, Amais; Zachariasen, Camilla; Christiansen, Lasse Engbo

    2016-01-01

    Background: Combination treatment is increasingly used to fight infections caused by bacteria resistant to two or more antimicrobials. While multiple studies have evaluated treatment strategies to minimize the emergence of resistant strains for single antimicrobial treatment, fewer studies have...... considered combination treatments. The current study modeled bacterial growth in the intestine of pigs after intramuscular combination treatment (i.e. using two antibiotics simultaneously) and sequential treatments (i.e. alternating between two antibiotics) in order to identify the factors that favor...... generated by a mathematical model of the competitive growth of multiple strains of Escherichia coli.Results: Simulation studies showed that sequential use of tetracycline and ampicillin reduced the level of double resistance, when compared to the combination treatment. The effect of the cycling frequency...

  5. Chromium(VI)-resistant yeast isolated from a sewage treatment plant receiving tannery wastes.

    Science.gov (United States)

    Baldi, F; Vaughan, A M; Olson, G J

    1990-01-01

    A Cr(VI)-resistant yeast, designated strain DBVPG 6502, was isolated from a sewage treatment plant receiving wastes from tannery industries in Italy. The strain was tentatively identified as a species of Candida based on morphological and physiological analyses. This strain was highly resistant to Cr(VI) when compared with eight other yeast species, growing at Cr(VI) concentrations of up to 500 micrograms/ml (10 mM). This resistance was constitutive. The Cr(VI)-resistant yeast did not reduce Cr(VI) to Cr(III) species under aerobic conditions. The yeast showed very little accumulation of Cr(VI). Consequently, the mechanism of resistance of the yeast to Cr(VI) appears to involve reduced accumulation of Cr, as has been shown in Cr(VI)-resistant bacteria. Images PMID:2339879

  6. Cerebral tuberculoma in a patient receiving anti-TNF alpha (adalimumab) treatment.

    LENUS (Irish Health Repository)

    Lynch, Karen

    2010-10-01

    We report a case of a cerebral tuberculoma in a 60-year-old woman with rheumatoid arthritis while receiving the anti-tumor necrosis factor alpha monoclonal antibody, adalimumab (Humira), for active disease. MR brain imaging for dyspraxia revealed a left parietal ring-enhancing lesion, which on resection was shown to be a necrotizing granuloma. There were no associated pulmonary lesions, and the patient was systemically well. Sputum and urine cultures were negative for tuberculosis. The patient was treated with anti-tuberculous medications and made an excellent recovery. We consider this to be the first documented case of tuberculosis involving the central nervous system occurring in the setting of adalimumab treatment.

  7. Ovulatory disorders are an independent risk factor for pregnancy complications in women receiving assisted reproduction treatments.

    Science.gov (United States)

    Barua, Sumita; Hng, Tien-Ming; Smith, Howard; Bradford, Jennifer; McLean, Mark

    2017-06-01

    Conception using assisted reproduction treatments (ART) has been associated with an increased risk of pregnancy complications. It is uncertain if this is caused by ART directly, or is an association of the underlying factors causing infertility. We assessed the relationship between assisted conception (AC) and maternal or fetal complications in a large retrospective cohort study. In a nested cohort of women receiving infertility treatment, we determined if such risk rests predominantly with certain causes of infertility. Retrospective database analysis of 50 381 women delivering a singleton pregnancy in four public hospital obstetric units in western Sydney, and a nested cohort of 508 women receiving ART at a single fertility centre, in whom the cause of infertility was known. A total of 1727 pregnancies followed AC; 48 654 were spontaneous conceptions. Adjusted for age, body mass index and smoking, AC was associated with increased risk of preterm delivery (OR 1.73, 95% CI 1.50-2.02), hypertension (OR 1.55, 95% CI 1.34-1.82) and diabetes (OR 1.51, 95% CI 1.30-1.75). In the nested cohort, ovulatory dysfunction was present in 145 women and 336 had infertility despite normal ovulatory function. Ovulatory dysfunction was associated with increased risk of diabetes (OR 2.94, 95% CI 1.72-5.02) and hypertension (OR 2.40, 95% CI 1.15-5.00) compared to women with normal ovulatory function. Assisted conception is associated with increased risk of pregnancy complications. This risk appears greatest for women whose underlying infertility involves ovulatory dysfunction. Such disorders probably predispose towards diabetes and hypertension, which is then exacerbated by pregnancy. © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  8. Tensions in relation: How peer support is experienced and received in a hepatitis C treatment intervention.

    Science.gov (United States)

    Bonnington, Oliver; Harris, Magdalena

    2017-09-01

    Peer support and involvement is recognised as a vital component of hepatitis C (HCV) treatment provision for marginalised populations, such as people who inject drugs (PWID). Developments in HCV treatments enable increased provision in community settings - expanding the possibilities for meaningful peer involvement in HCV treatment plans. To date, HCV peer support has generally been viewed as a positive intervention, with little critical reflection on the ways social structures, policies, health and drug services and social identity impact on how peer support is experienced and received. We report on the qualitative component of a UK-based intervention designed to increase HCV diagnosis and treatment in primary care and drug treatment settings. Data were collected between 2014 and 2016. Pre-intervention, a total of 35 PWID clients took part in nine in-depth interviews and four focus groups. In addition, 22 drug services and intervention providers took part in two focus groups and nine interviews. Post-intervention, one focus group and eight interviews were conducted with 13 PWID clients, and four focus groups and ten interviews were conducted with 26 drug services and intervention providers. Our data generation and thematic analysis focused on the peer education and buddy support component of the intervention. Participants had common expectations of the peer role (to 'just be there') and its occupants' attributes (empathy, trustworthy, etc.). However, in practice, peers faced constraints on realising these expectations. A 'recovery' dominated drug treatment ethos in the UK appeared to influence the selection of 'recovery champions' as peers for the intervention. This created tensions in relations with clients, particularly when risk-adverse discourses were internalised by the peers. Peers were poorly integrated and supported within the service, affecting opportunities to relate and build trust with clients. Thus, the scope for peer support to impact on the nature

  9. Preferred intensity exercise for adolescents receiving treatment for depression: a pragmatic randomised controlled trial.

    Science.gov (United States)

    Carter, Tim; Guo, Boliang; Turner, David; Morres, Ioannis; Khalil, Elizabeth; Brighton, Emily; Armstrong, Marie; Callaghan, Patrick

    2015-10-14

    Exercise has been shown to be effective in treating depression, but trials testing the effect of exercise for depressed adolescents utilising mental health services are rare. The aim of this study was to determine the effectiveness of a preferred intensity exercise intervention on the depressive symptoms of adolescents with depression. We randomly assigned 87 adolescents who were receiving treatment for depression to either 12 sessions of aerobic exercise at preferred intensity alongside treatment as usual or treatment as usual only. The primary outcome was depressive symptom change using the Children's Depression Inventory 2(nd) Version (CDI-2) at post intervention. Secondary outcomes were health-related quality of life and physical activity rates. Outcomes were taken at baseline, post intervention and at six month follow up. CDI-2 score reduction did not differ significantly between groups at post-intervention (est. 95% CI -6.82, 1.68, p = 0.23). However, there was a difference in CDI-2 score reduction at six month follow-up in favour of the intervention of -4.81 (est. 95% CI -9.49, -0.12, p = 0.03). Health-related quality of life and physical activity rates did not differ significantly between groups at post-intervention and follow-up. There was no additional effect of preferred intensity exercise alongside treatment as usual on depressive reduction immediately post intervention. However, effects were observed at six months post-intervention, suggesting a delayed response. However, further trials, with larger samples are required to determine the validity of this finding. ClinicalTrials.gov NCT01474837, March 16 2011.

  10. Effect of combined treatment with recombinant interleukin-2 and allicin on pancreatic cancer.

    Science.gov (United States)

    Wang, Cong-Jun; Wang, Chao; Han, Jiang; Wang, Yong-Kun; Tang, Lin; Shen, Dong-Wei; Zhao, Yi; Xu, Rong-Hua; Zhang, Hui

    2013-12-01

    This study aimed to evaluate the efficacy of combined treatment with recombinant interleukin-2 (rIL-2) and allicin on pancreatic cancer and explore the potential immunological mechanism. A total of 60 C57/BL6 nude mice pancreatic cancer xenograft models were randomized into four groups of 15 mice per group: control group, allicin treatment group, rIL-2 treatment group, combined treatment with allicin and rIL-2 group. Mice in each group were treated with saline, rIL-2, allicin, or combination of rIL-2 and allicin by weekly i.v injection for four weeks. After four weeks of treatment, eyeballs of the mice were extracted and blood was drawn, percentages of CD4+T, CD8+T and NK cell were analyzed by FACS, IFN-γ level was detected by ELISA. One mouse in each group was sacrificed to measure the weight and volume of the tumor and prepared to the paraffin section of tumor tissue. Apoptosis of the tumor cells was analyzed by TUNEL and FACS. Other mice continued to receive treatment, survival period were compared between each group. We observed a significant suppression of xenograft growth and a significant prolonged survival time in the combined treatment with allicin and rIL-2 group (P allicin and rIL-2 resulted in suppression of tumor growth and prolonged survival time possibly through activation of CD4+T, CD8+T and NK cell.

  11. [Efficacy of cognitive-behavioral psychotherapy in combined treatment of patients with initial hypertensive encephalopathy].

    Science.gov (United States)

    Golubev, M V; Bukharov, Ia M; Golovkin, I S

    2007-01-01

    To assess efficacy of cognitive-behavioral psychotherapy in patients with initial hypertensive encephalopathy, we made a study including 65 neurological patients. Of them, 35 patients received basic therapy plus cognitive-behavioral therapy, 25 patients were given basic therapy only. The results of the study demonstrate high therapeutic efficacy of cognitive-behavioral psychotherapy in combined treatment of patients with initial hypertensive encephalopathy. The highest effect was shown in anxious symptoms and high critical attitude of the patients to their negative emotions.

  12. Combined effect of hormonal priming and salt treatments on ...

    African Journals Online (AJOL)

    Combined effect of hormonal priming and salt treatments on germination percentage and antioxidant activities in lettuce seedlings. Mahmoudi Hela, Zargouni Hanen, Tarchoune Imen, Baatour Olfa, Nasri Nawel, Ben Massoud Raouia, Zaghdoudi Maha, Abidi wissal, Huang Jun, Hannoufa Abdelali, Lachaâl Mokhtar, Ouerghi ...

  13. Novel Molecular Insights into the Combination Treatment of Acromegaly

    NARCIS (Netherlands)

    S.E. Franck (Sanne)

    2017-01-01

    markdownabstractIn chapter 2 of this thesis we have confirmed that LA-SSA in combination with PEGV as a treatment modality for acromegaly still appears to be highly effective, after almost a decade of experience in the Rotterdam cohort (n=112). Normalization of IGF-I levels occurred in 97% of the

  14. Effect of combination pre-treatment on physicochemical, sensory ...

    African Journals Online (AJOL)

    Effect of combination pre-treatment on physicochemical, sensory and microbial characteristics of fresh aerobically stored minced goat (Black Bengal) meat organs. ... African Journal of Biotechnology ... However, acetic acid and glucose pretreatment controlled the fungal growth in meat samples most effectively. The

  15. Antibiotic Combinations with Daptomycin for Treatment of Staphylococcus aureus Infections

    Directory of Open Access Journals (Sweden)

    Kristina Nadrah

    2011-01-01

    Full Text Available Daptomycin is a lipopeptide antibiotic with a unique mechanism of action on Gram-positive bacteria. It is approved for treatment of skin and soft-tissue infections with Gram-positive bacteria, bacteraemia and right-sided infective endocarditis caused by Staphylococcus aureus. Diminishing susceptibility of S. aureus to daptomycin during treatment of complicated infections and clinical failure have been described. Combinations of daptomycin with other antibiotics including gentamicin, rifampin, beta-lactams, trimethoprim/sulfamethoxazole (TMP-SMX, or clarithromycin present a new approach for therapy. In vitro and animal studies have shown that such combinations may, in some cases, be superior to daptomycin monotherapy. In this paper we focus on the antibiotic combinations for complicated S. aureus infections.

  16. Combined coagulation flocculation pre treatment unit for municipal wastewater

    Directory of Open Access Journals (Sweden)

    Ibrahim M. Ismail

    2012-10-01

    Full Text Available The potentials of using the hydraulic technique in combined unit for municipal wastewater treatment were studied. A combined unit in which processes of coagulation, flocculation and sedimentation, has been designed utilizing hydraulic mixing instead of mechanical mixing. A jar test treatability study has been conducted to locate the optimum dose of the coagulants to be used. Alum, ferrous sulfate, ferric sulfate, a mixture of ferric and ferrous sulfates, and mixture of lime and ferrous sulfate were all tested. A pilot unit was constructed in the existing wastewater treatment plant at El Mansoura governorate located in north Egypt. The optimum dose of coagulants used in the combined unit gives removal efficiencies for COD, BOD, and total phosphorous as 65%, 55%, and 83%, respectively.

  17. Vancomycin intermediate-resistant Staphylococcus aureus (VISA) isolated from a patient who never received vancomycin treatment.

    Science.gov (United States)

    Zhu, Xuhui; Liu, Cailin; Gao, Sui; Lu, Yanfang; Chen, Zhongju; Sun, Ziyong

    2015-04-01

    With the abuse of antibiotics, the methicillin-resistant Staphylococcus aureus (MRSA) strain became prevalent. Furthermore, Staphylococcus aureus with a character of vancomycin intermediate-resistance (VISA) has been found globally since the first report in Japan. The main objectives of this study were to report a case of VISA isolated from a Chinese patient who had never undergone Vancomycin treatment, and to determine its molecular character. A total of 9 strains were recovered from a patient during the therapeutic process. Antimicrobial susceptibility testing was performed to determine their antibiotic susceptibility patterns. To detect the VISA strain's molecular epidemiological features, growth and morphological characters, we used multilocus sequence typing, autolysis assay and transmission electric microscope tests. Pulsed-field gel electrophoresis (PFGE) was performed to characterize the heterogeneities of all isolates. One isolate was found to exhibit vancomycin intermediated-resistant with MIC of 8 μg/ml. It was ST239-T030-agr-1, had thickened cell wall, and displayed a slower growth rate and reduced susceptibility to Triton X-100-induced autolysis than other strains. All 9 strains exhibited the same PFGE pattern. This is the first report of VISA found in central China from a patient who had never received vancomycin treatment. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  18. Operator decision support system for integrated wastewater management including wastewater treatment plants and receiving water bodies.

    Science.gov (United States)

    Kim, Minsoo; Kim, Yejin; Kim, Hyosoo; Piao, Wenhua; Kim, Changwon

    2016-06-01

    An operator decision support system (ODSS) is proposed to support operators of wastewater treatment plants (WWTPs) in making appropriate decisions. This system accounts for water quality (WQ) variations in WWTP influent and effluent and in the receiving water body (RWB). The proposed system is comprised of two diagnosis modules, three prediction modules, and a scenario-based supporting module (SSM). In the diagnosis modules, the WQs of the influent and effluent WWTP and of the RWB are assessed via multivariate analysis. Three prediction modules based on the k-nearest neighbors (k-NN) method, activated sludge model no. 2d (ASM2d) model, and QUAL2E model are used to forecast WQs for 3 days in advance. To compare various operating alternatives, SSM is applied to test various predetermined operating conditions in terms of overall oxygen transfer coefficient (Kla), waste sludge flow rate (Qw), return sludge flow rate (Qr), and internal recycle flow rate (Qir). In the case of unacceptable total phosphorus (TP), SSM provides appropriate information for the chemical treatment. The constructed ODSS was tested using data collected from Geumho River, which was the RWB, and S WWTP in Daegu City, South Korea. The results demonstrate the capability of the proposed ODSS to provide WWTP operators with more objective qualitative and quantitative assessments of WWTP and RWB WQs. Moreover, the current study shows that ODSS, using data collected from the study area, can be used to identify operational alternatives through SSM at an integrated urban wastewater management level.

  19. Severe tricuspid regurgitation in a patient receiving low-dose cabergoline for the treatment of acromegaly.

    Science.gov (United States)

    Izgi, Cemil; Feray, Hasan; Cevik, Cihan; Saltan, Yelda; Mansuroglu, Denyan; Nugent, Kenneth

    2010-11-01

    Cabergoline, an ergot-derived dopamine receptor agonist, is used widely in the treatment of Parkinson's disease (PD) and hyperprolactinemia, but may cause heart valve fibrosis, retraction, and clinically significant regurgitation in PD patients. While cabergoline has been used at much lower doses in patients with hyperprolactinemia, controversy persists as to whether it may cause heart valve disease in this situation. Cabergoline is also used in acromegaly at doses similar to those used in hyperprolactinemia. The case is reported of a female patient with acromegaly who had been taking low-dose (0.5 mg/day) cabergoline for one year, and presented with signs and symptoms of right-sided heart failure. Echocardiography revealed a thickened and retracted tricuspid valve associated with severe tricuspid regurgitation and enlargement of the right-heart chambers. The morphology of the tricuspid valve was typical for cabergoline-related valvulopathy. Cabergoline may not be totally safe even at lower doses, and close echocardiographic monitoring is recommended in patients receiving cabergoline treatment, regardless of the dose level employed.

  20. Appropriate insulin initiation dosage for insulin-naive type 2 diabetes outpatients receiving insulin monotherapy or in combination with metformin and/or pioglitazone.

    Science.gov (United States)

    Liao, Lin; Yang, Ming; Qiu, Lu-Lu; Mou, Ya-Ru; Zhao, Jia-Jun; Dong, Jian-Jun

    2010-12-01

    Few studies have given suggestions on appropriate initiation insulin dosage when combined with oral antidiabetic drugs (OADs). This research was to investigate appropriate initiation insulin doses for insulin-naive type 2 diabetes patients with different combinations and the relationship between insulin dosage and relevant factors. This was a randomized, open-label, treat to target study. The target was 20% decrease of both fasting plasma glucose (FPG) and 2 hours post-breakfast blood glucose (P2hBG). One hundred and forty-seven insulin-naive Chinese patients recruited were randomly assigned to 3 groups: group A, patients received insulin monotherapy; group B, received insulin plus metformin (0.5 g, tid) and group C, received insulin plus metformin (0.5 g, tid) and pioglitazone (15 mg, qd). Insulin doses were initiated with a dose of 0.3 U×kg(-1)×d(-1) and titrated according to FPG and P2hBG till reached the targets. Both the time of getting 20% reduction of FPG and P2hBG showed significant differences among the three groups. The time was shortest in Group C. The insulin doses needed to achieve glucose reduction of 20% in three treatment groups were (0.40 ± 0.04) U×kg(-1)×d(-1) for Group A, (0.37 ± 0.04) U×kg(-1)×d(-1) for Group B, and (0.35 ± 0.03) U×kg(-1)×d(-1) for Group C, respectively. Multiple linear stepwise regression analysis showed that insulin doses correlated with body weight, FPG, diabetes duration, age and history of sulfonylurea treatment. The standardized regression coefficients were 0.871, 0.322, 0.089, 0.067 and 0.063 (with all P metformin treatment, and 0.35 U×kg(-1)×d(-1) for insulin plus metformin and pioglitazone treatment in Chinese type 2 diabetes outpatients. Body weight is found the most closely related factor to the insulin dosage.

  1. High satisfaction with direct switching from antimuscarinics to mirabegron in patients receiving stable antimuscarinic treatment.

    Science.gov (United States)

    Liao, Chun-Hou; Kuo, Hann-Chorng

    2016-11-01

    Mirabegron, which was the first β3-adrenoceptor agonist introduced for use in clinical practice, has been extensively evaluated in overactive bladder (OAB) patients in several phase II and III studies. However, most of the enrolled patients were treatment naive or had experienced a wash-out period before the introduction of mirabegron. No study has reported the treatment results of a direct switch from antimuscarinics to mirabegron, which may more commonly occur in clinical practice. This is an observational study to assess the therapeutic efficacy and safety of directly switching from antimuscarinics to mirabegron in patients with OAB receiving stable antimuscarinic treatment. Moreover, we sought to identify the patients who benefited more from the change.Patients aged ≥20 years with OAB receiving stable antimuscarinics for >3 months were enrolled. Antimuscarinics were discontinued in all patients and mirabegron 25 mg, once daily was initiated. Primary end-point was global response assessment (GRA) at 1 month after medication switching. Baseline parameters and parameters changed 1 month after medication switching were compared between patients with GRA ≥ 1 and GRA < 1.Of the 282 enrolled patients (209 men, 73 women; mean age, 74.4 years), 55.3% had better (GRA ≥ 1), 31.2% had similar (GRA = 0), and 10.3% had worse (GRA < 0) outcomes. The overall adverse events (AE) rate decreased from 24.1% to 12.8%. In overall patients, there was no significant improvement of OAB symptoms, but postvoid residual (PVR) urine decreased and voiding symptoms and quality of life index improved significantly. Patients with GRA ≥ 1 had significantly improved both storage and voiding symptoms. A total of 195 patients (69.1%) can maintain mirabegron without adding or resuming antimuscarinics for more than 3 months. Logistic regression analysis indicated that higher baseline OAB symptoms scores were predictor of satisfactory outcome.More than 50% patients

  2. Spa treatment for primary fibromyalgia syndrom: a combination of thalassotherapy , exercise and patient education improves symptoms and quality of life.

    OpenAIRE

    Zijlstra, T.R.; van de Laar, Mart A F J; Bernelot Moens, H.J.; Taal, Erik; Zakraoui, L.; Rasker, Hans J.

    2005-01-01

    Objectives: To study the effect of a combination of thalassotherapy, exercise and patient education in people with fibromyalgia. - Methods: Patients with fibromyalgia, selected from a rheumatology out-patient department and from members of the Dutch fibromyalgia patient association, were pre-randomized to receive either 2 weeks of treatment in a Tunisian spa resort, including thalassotherapy, supervised exercise and group education (active treatment) or treatment as usual (control treatment)....

  3. Wastewater treatment plant effluent introduces recoverable shifts in microbial community composition in receiving streams.

    Science.gov (United States)

    Price, Jacob R; Ledford, Sarah H; Ryan, Michael O; Toran, Laura; Sales, Christopher M

    2018-02-01

    Through a combined approach using analytical chemistry, real-time quantitative polymerase chain reaction (qPCR), and targeted amplicon sequencing, we studied the impact of wastewater treatment plant effluent sources at six sites on two sampling dates on the chemical and microbial population regimes within the Wissahickon Creek, and its tributary, Sandy Run, in Montgomery County, Pennsylvania, USA. These water bodies contribute flow to the Schuylkill River, one of the major drinking water sources for Philadelphia, Pennsylvania. Effluent was observed to be a significant source of nutrients, human and non-specific fecal associated taxa. There was an observed increase in the alpha diversity at locations immediately below effluent outflows, which contributed many taxa involved in wastewater treatment processes and nutrient cycling to the stream's microbial community. Unexpectedly, modeling of microbial community shifts along the stream was not controlled by concentrations of measured nutrients. Furthermore, partial recovery, in the form of decreasing abundances of bacteria and nutrients associated with wastewater treatment plant processes, nutrient cycling bacteria, and taxa associated with fecal and sewage sources, was observed between effluent sources, which we hypothesize is controlled by distance from effluent source. Antecedent moisture conditions were observed to impact overall microbial community diversity, with higher diversity occurring after rainfall. Finally, the efficacy of using a subset of the microbial community including the orders of Bifidobacteriales, Bacteroidales, and Clostridiales to estimate the degree of influence due to sewage and fecal sources was explored and verified. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. Combined Endodontic-Periodontal Treatment of a Palatogingival Groove.

    Science.gov (United States)

    Castelo-Baz, Pablo; Ramos-Barbosa, Isabel; Martín-Biedma, Benjamín; Dablanca-Blanco, Ana Belén; Varela-Patiño, Purificación; Blanco-Carrión, Juan

    2015-11-01

    A palatogingival groove is a developmental anomaly that predisposes the involved tooth to develop a severe periodontal lesion. These grooves often present a clinical challenge because diagnosis and treatment planning require an interdisciplinary approach. This case report describes the successful management of a right maxillary lateral incisor with a deep palatogingival groove in combination with an extensive periodontal pocket and pulp necrosis of the involved tooth. Collaborative management used a combination of endodontic treatment, periodontal therapy, odontoplasty, and a periodontal regenerative procedure using protein complex derived from enamel matrix (Emdogain; Straumann, Basel, Switzerland). Despite a predicted poor prognosis, the tooth lesion healed. This report also discusses the rationale behind the treatment modalities. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  5. Removal of micropollutants, facultative pathogenic and antibiotic resistant bacteria in a full-scale retention soil filter receiving combined sewer overflow.

    Science.gov (United States)

    Scheurer, Marco; Heß, Stefanie; Lüddeke, Frauke; Sacher, Frank; Güde, Hans; Löffler, Herbert; Gallert, Claudia

    2015-01-01

    Combined sewer systems collect surface runoff as well as wastewater of industrial and domestic origin. During periods of heavy rainfall the capacity of the sewer system is exceeded and the overflow is discharged into receiving waters without any treatment. Consequently, combined sewer overflow (CSO) is considered as a major source of water pollution. This study investigates the effectiveness of a retention soil filter (RSF) for the removal of micropollutants as well as facultative pathogenic and antibiotic resistant bacteria from CSO. The removal of organic group parameters like total organic carbon was excellent and the removal efficiency for micropollutants of the RSF and the wastewater treatment plant (WWTP), which treats wastewater of the same origin during dry and normal weather conditions, was comparable. Compounds of high environmental concern like estrogens or certain pharmaceuticals, e.g. diclofenac, were completely eliminated or removed to a high degree during RSF passage. RSF treatment also reduced the number of E. coli, enterococci and staphylococci by 2.7, 2.2 and 2.4 log-units (median values), respectively. Obviously, some Staphylococcus species can better adapt to the conditions of the RSF than others as a shift of the abundance of the different species was observed when comparing the diversity of staphylococci obtained from the RSF influent and effluent. RSF treatment also decreased the absolute number of antibiotic resistant bacteria. The percentage of antibiotic resistant E. coli and staphylococci isolates also decreased during passage of the RSF, whereas the percentage of resistant enterococci did not change. For E. coli ampicillin and for enterococci and staphylococci erythromycin determined the antibiotic resistance level. The results demonstrate that RSFs can be considered as an adequate treatment option for CSO. The performance for the removal of micropollutants is comparable with a medium sized WWTP with conventional activated sludge

  6. Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors.

    Science.gov (United States)

    Riley, Philip; Glenny, Anne-Marie; Worthington, Helen V; Littlewood, Anne; Fernandez Mauleffinch, Luisa M; Clarkson, Jan E; McCabe, Martin G

    2017-11-28

    Oral mucositis is a side effect of chemotherapy, head and neck radiotherapy, and targeted therapy, affecting over 75% of high-risk patients. Ulceration can lead to severe pain and difficulty with eating and drinking, which may necessitate opioid analgesics, hospitalisation and supplemental nutrition. These complications may disrupt cancer therapy, which may reduce survival. There is also a risk of death from sepsis if pathogens enter the ulcers of immunocompromised patients. Ulcerative oral mucositis can be costly to healthcare systems, yet there are few preventive interventions proven to be beneficial. Cytokines and growth factors may help the regeneration of cells lining of the mouth, thus preventing or reducing oral mucositis and its negative effects. To assess the effects of cytokines and growth factors for preventing oral mucositis in patients with cancer who are receiving treatment. Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (searched 10 May 2017); the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 4) in the Cochrane Library (searched 10 May 2017); MEDLINE Ovid (1946 to 10 May 2017); Embase Ovid (7 December 2015 to 10 May 2017); CINAHL EBSCO (Cumulative Index to Nursing and Allied Health Literature; 1937 to 10 May 2017); and CANCERLIT PubMed (1950 to 10 May 2017). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. We included parallel-design randomised controlled trials (RCTs) assessing the effects of cytokines and growth factors in patients with cancer receiving treatment. Two review authors independently screened the results of electronic searches, extracted data and assessed risk of bias. For dichotomous outcomes, we reported risk ratios (RR) and 95% confidence intervals (CI). For continuous outcomes, we reported

  7. The Care Burden and the Affecting Factors of Individuals Receiving Hemodialysis Treatment

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    Merve Gulpak

    2014-04-01

    Full Text Available AIM: This study was performed to determine the care burden and the affecting factors of individuals receiving hemodialysis treatment METHOD: The study sample consisted of the caregivers of 235 individuals undergoing hemodialysis treatment. The data were collected by using a survey form of 48 questions and the Zarit Caregiver Burden Scale. The mean, percentage distributions, chi-square, Kruskal-Wallis and Mann-Whitney U tests, and the Spearman Brown correlation coefficient were used in the statistical evaluation of data. RESULTS: The median care burden scores were high for caregivers who were 60 years of age or older, had a very low or low income, were primary school graduates, developed health issues while caregiving, provided care full-time and had difficulty in meeting the health care costs. The median care burden scores of caregivers who provided care to individuals who were completely dependent for eating and drinking, bathing, getting dressed, walking-strolling, and stair climbing were found to be higher than the group who looked after patients who could administer self-care (p<0.05. Care burden scores were found to be increased with increasing age of caregivers (p<0.05. We also found the care burden score to decrease with increasing disease and treatment duration of HD patients (p<0.05. CONCLUSION: In conclusion, we recommend developing awareness of conditions that increase the care burden of caregivers and to provide the necessary interventions and establish support groups so that these conditions do not have a negative effect on family and social life [TAF Prev Med Bull 2014; 13(2.000: 99-108

  8. A famciclovir + celecoxib combination treatment is safe and efficacious in the treatment of fibromyalgia

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    Pridgen WL

    2017-02-01

    Full Text Available William L Pridgen,1 Carol Duffy,2 Judy F Gendreau,3 R Michael Gendreau3 1Innovative Med Concepts, LLC, 2Department of Biological Sciences, University of Alabama, Tuscaloosa, AL, 3Gendreau Consulting, LLC, Poway, CA, USA Objective: Infections and other stressors have been implicated in the development of fibromyalgia. We hypothesized that these stressors could result in recurrent reactivations of latent herpes virus infections, which could lead to the development of fibromyalgia. This study evaluated a famciclovir + celecoxib drug combination (IMC-1, active against suspected herpes virus reactivation and infection, for the treatment of fibromyalgia.Methods: A total of 143 fibromyalgia patients were enrolled at 12 sites in a 16-week, double-blinded, placebo-controlled proof-of-concept trial. Randomized patients received either IMC-1 or placebo in a 1:1 ratio. Outcome measures included a 24-hour recall pain Numerical Rating Scale, the Revised Fibromyalgia Impact Questionnaire (FIQ-R, the Patient’s Global Impression of Change (PGIC questionnaire, the Multidimensional Fatigue Inventory, the NIH Patient-Reported Outcomes Measurement Information System (PROMIS, and the Beck Depression Inventory-II conducted at baseline and weeks 6, 12, and 16 of the study.Results: A significant decrease in fibromyalgia-related pain was observed for patients on IMC-1 treatment versus placebo. PGIC response rates were significantly improved with IMC-1 treatment. Overall, patient self-reported functioning, as measured by the FIQ-R, was significantly improved. Fatigue was also significantly improved as measured by the PROMIS fatigue inventory. The safety profile was encouraging. Despite the celecoxib component of IMC-1, gastrointestinal and nervous system treatment emergent adverse events were reported less frequently in the IMC-1 group, and study completion rates favored IMC-1 treatment.Conclusion: IMC-1 was efficacious and safe in treating symptoms of fibromyalgia

  9. Evaluation of the Patient-Generated Subjective Global Assessment (PG-SGA) as a predictor of febrile neutropenia in gynecologic cancer patients receiving combination chemotherapy: a pilot study.

    Science.gov (United States)

    Phippen, Neil T; Lowery, William J; Barnett, J Cory; Hall, Lisa A; Landt, Cristy; Leath, Charles A

    2011-11-01

    Determine if pre-treatment Patient-Generated Subjective Global Assessment (PG-SGA) predicts febrile neutropenia (FN) in gynecologic cancer patients receiving primary combination chemotherapy. Following IRB approval, clinicopathologic variables, pre-treatment laboratory values and PG-SGA were recorded from eligible patients. Bone marrow toxicity (CTC 3.0) divided groups of patients: (1) No grade 3 or 4 neutropenia, (2) grade 3 or 4 neutropenia, (3) FN. Statistical analysis with Kruskal-Wallis one-way analysis of variance and a receiver operating characteristic (ROC) curve were performed. 58 patients met study inclusion: 25 in group 1, 28 in group 2, and 5 in group 3. Mean age was 61 and the majority, 42 (72%), had ovarian cancer. Median PG-SGA scores were: 6 (group 1) vs. 7 (group 2) vs. 14 (group 3) (p=0.019). Both median albumin: (1) 4.2 vs. (2) 4.0 vs. (3) 3.4 g/dl (p=0.041), and hemoglobin: (1) 12.1 vs. (2) 11.75 vs. (3) 10.6g/dl (p=0.05) differed between the groups. The overall AUC of the ROC curve for PG-SGA was 0.831 ± 0.064 (95% CI=0.706 to 0.956, p=0.015). Using the ROC, selecting a PG-SGA score of 7.5 to be predictive of febrile neutropenia yields a sensitivity of 100% and a specificity of 60%. When the cutoff value is set at 12.5, the specificity improves to 81% while decreasing sensitivity to 80%. PG-SGA scores were higher for patients experiencing FN and may be a reasonably predictive marker of FN in patients receiving multi-agent primary chemotherapy and likely benefactors of prophylactic GCSF. Published by Elsevier Inc.

  10. Combined treatment for facial rejuvenation using an optimized pulsed light source followed by a fractional non-ablative laser.

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    Chan, C Stanley; Saedi, Nazanin; Mickle, Clinzo; Dover, Jeffrey S

    2013-09-01

    Combination laser treatments can potentially increase the effectiveness of treatment without the additional downtime associated with another procedure. To assess the effectiveness and safety of combining non-ablative fractional treatments with optimized intense pulsed light. Ten subjects (Group A) received full face treatments with a non-ablative fractional either followed or preceded by an optimized intense pulsed light source. Twenty-six subjects (Group B) received only full face treatments with the same non-ablative, fractional laser device. For Group A, the overall average Fitzpatrick Wrinkle Scale for all patients improved from 6.3 ± 1.1 at baseline to 5.9 ± 0.8 one month following one treatment for an average improvement of 0.4 ± 0.6 (P ablative fractional laser during the same treatment session is safe and effective. © 2013 Wiley Periodicals, Inc.

  11. Breast cancer development in transsexual subjects receiving cross-sex hormone treatment.

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    Gooren, Louis J; van Trotsenburg, Michael A A; Giltay, Erik J; van Diest, Paul J

    2013-12-01

    Transsexual people receive cross-sex hormones as part of their treatment, potentially inducing hormone-sensitive malignancies. To examine the occurrence of breast cancer in a large cohort of Dutch male and female transsexual persons, also evaluating whether the epidemiology accords with the natal sex or the new sex. Number of people with breast cancer between 1975 and 2011. We researched the occurrence of breast cancer among transsexual persons 18-80 years with an exposure to cross-sex hormones between 5 to >30 years. Our study included 2,307 male-to-female (MtF) transsexual persons undergoing androgen deprivation and estrogen administration (52,370 person-years of exposure), and 795 female-to-male (FtM) subjects receiving testosterone (15,974 total years of exposure). Among MtF individuals one case was encountered, as well as a probable but not proven second case. The estimated rate of 4.1 per 100,000 person-years (95% confidence interval [CI]: 0.8-13.0) was lower than expected if these two cases are regarded as female breast cancer, but within expectations if viewed as male breast cancer. In FtM subjects, who were younger and had shorter exposure to cross-sex hormones compared with the MtF group, one breast cancer case occurred. This translated into a rate of 5.9 per 100,000 person-years (95% CI: 0.5-27.4), again lower than expected for female breast cancer but within expected norms for male breast cancer. The number of people studied and duration of hormone exposure are limited but it would appear that cross-sex hormone administration does not increase the risk of breast cancer development, in either MtF or FtM transsexual individuals. Breast carcinoma incidences in both groups are comparable to male breast cancers. Cross-sex hormone treatment of transsexual subjects does not seem to be associated with an increased risk of malignant breast development. © 2013 International Society for Sexual Medicine.

  12. Combining DCQGMP-Based Sparse Decomposition and MPDR Beamformer for Multi-Type Interferences Mitigation for GNSS Receivers.

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    Guo, Qiang; Qi, Liangang

    2017-04-10

    In the coexistence of multiple types of interfering signals, the performance of interference suppression methods based on time and frequency domains is degraded seriously, and the technique using an antenna array requires a large enough size and huge hardware costs. To combat multi-type interferences better for GNSS receivers, this paper proposes a cascaded multi-type interferences mitigation method combining improved double chain quantum genetic matching pursuit (DCQGMP)-based sparse decomposition and an MPDR beamformer. The key idea behind the proposed method is that the multiple types of interfering signals can be excised by taking advantage of their sparse features in different domains. In the first stage, the single-tone (multi-tone) and linear chirp interfering signals are canceled by sparse decomposition according to their sparsity in the over-complete dictionary. In order to improve the timeliness of matching pursuit (MP)-based sparse decomposition, a DCQGMP is introduced by combining an improved double chain quantum genetic algorithm (DCQGA) and the MP algorithm, and the DCQGMP algorithm is extended to handle the multi-channel signals according to the correlation among the signals in different channels. In the second stage, the minimum power distortionless response (MPDR) beamformer is utilized to nullify the residuary interferences (e.g., wideband Gaussian noise interferences). Several simulation results show that the proposed method can not only improve the interference mitigation degree of freedom (DoF) of the array antenna, but also effectively deal with the interference arriving from the same direction with the GNSS signal, which can be sparse represented in the over-complete dictionary. Moreover, it does not bring serious distortions into the navigation signal.

  13. Combining DCQGMP-Based Sparse Decomposition and MPDR Beamformer for Multi-Type Interferences Mitigation for GNSS Receivers

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    Qiang Guo

    2017-04-01

    Full Text Available In the coexistence of multiple types of interfering signals, the performance of interference suppression methods based on time and frequency domains is degraded seriously, and the technique using an antenna array requires a large enough size and huge hardware costs. To combat multi-type interferences better for GNSS receivers, this paper proposes a cascaded multi-type interferences mitigation method combining improved double chain quantum genetic matching pursuit (DCQGMP-based sparse decomposition and an MPDR beamformer. The key idea behind the proposed method is that the multiple types of interfering signals can be excised by taking advantage of their sparse features in different domains. In the first stage, the single-tone (multi-tone and linear chirp interfering signals are canceled by sparse decomposition according to their sparsity in the over-complete dictionary. In order to improve the timeliness of matching pursuit (MP-based sparse decomposition, a DCQGMP is introduced by combining an improved double chain quantum genetic algorithm (DCQGA and the MP algorithm, and the DCQGMP algorithm is extended to handle the multi-channel signals according to the correlation among the signals in different channels. In the second stage, the minimum power distortionless response (MPDR beamformer is utilized to nullify the residuary interferences (e.g., wideband Gaussian noise interferences. Several simulation results show that the proposed method can not only improve the interference mitigation degree of freedom (DoF of the array antenna, but also effectively deal with the interference arriving from the same direction with the GNSS signal, which can be sparse represented in the over-complete dictionary. Moreover, it does not bring serious distortions into the navigation signal.

  14. Quantitative and qualitative assessment of the impact of climate change on a combined sewer overflow and its receiving water body.

    Science.gov (United States)

    Bi, Eustache Gooré; Monette, Frédéric; Gachon, Philippe; Gaspéri, Johnny; Perrodin, Yves

    2015-08-01

    Projections from the Canadian Regional Climate Model (CRCM) for the southern part of the province of Québec, Canada, suggest an increase in extreme precipitation events for the 2050 horizon (2041-2070). The main goal of this study consisted in a quantitative and qualitative assessment of the impact of the 20 % increase in rainfall intensity that led, in the summer of 2013, to overflows in the "Rolland-Therrien" combined sewer system in the city of Longueuil, Canada. The PCSWMM 2013 model was used to assess the sensitivity of this overflow under current (2013) and future (2050) climate conditions. The simulated quantitative variables (peak flow, Q(CSO), and volume discharged, VD) served as the basis for deriving ecotoxicological risk indices and event fluxes (EFs) transported to the St. Lawrence (SL) River. Results highlighted 15 to 500% increases in VD and 13 to 148% increases in Q(CSO) by 2050 (compared to 2013), based on eight rainfall events measured from May to October. These results show that (i) the relationships between precipitation and combined sewer overflow variables are not linear and (ii) the design criteria for current hydraulic infrastructure must be revised to account for the impact of climate change (CC) arising from changes in precipitation regimes. EFs discharged into the SL River will be 2.24 times larger in the future than they are now (2013) due to large VDs resulting from CC. This will, in turn, lead to excessive inputs of total suspended solids (TSSs) and tracers for numerous urban pollutants (organic matter and nutrients, metals) into the receiving water body. Ecotoxicological risk indices will increase by more than 100% by 2050 compared to 2013. Given that substantial VDs are at play, and although CC scenarios have many sources of uncertainty, strategies to adapt this drainage network to the effects of CC will have to be developed.

  15. Comparison of combined treatment with desmopressin plus oxybutynin and desmopressin plus tolterodine in treatment of children with primary nocturnal enuresis

    Science.gov (United States)

    Azarfar, Anoush; Esmaeili, Mohammad; Naseri, Mitra; Ghane, Fatemeh; Ravanshad, Yalda; Vejdani, Marjan; Ghanei, Neda; Babaei-Heydarabadi, Akbar; Saffari, Seyed-Ehsan

    2015-01-01

    Introduction: Nocturnal enuresis (enuresis) is one of the most common developmental problems of childhood, which has often a familial basis, causes mental and psychological damage to the child and disrupts family solace. Objectives: In this study, we compared therapeutic effects of combination therapy of desmopressin plus oxybutynin with desmopressin plus tolterodine, in the treatment of children with primary nocturnal enuresis. Patients and Methods: The present study is a clinical trial study, where 59 patients with primary nocturnal enuresis in the age range of 5 to 14 years old were selected from the visitors of nephrology clinic of Dr. Sheikh pediatrics hospital (Mashhad, Iran). Patients were divided into 2 treatment groups where the first group received combined therapy with desmopressin and oxybutynin, and the second group received combined therapy with desmopressin and tolterodine. Data was analyzed using SPSS 16 software and descriptive and analytical statistics (chi-square test). Results: The mean of age of patients in total was 2.55 ± 7.90 years. In the treatment group with desmopressin and oxybutynin, 26 of 30 patients (86.7%) achieved a complete remission and 4 patients (13.3%) still suffered from enuresis during a 3-month evaluation. The comparison of 2 groups, in terms of the outcome of the 3-month treatment, showed significant differences between the remission and recovery of 2 groups, where the recovery in the group with desmopressin plus tolterodine was higher than the group with desmopressin plus oxybutynin (P = 0.001). Conclusion: The results showed that combined treatment with desmopressin plus tolterodine performs better than desmopressin plus oxybutynin . PMID:26468479

  16. Resistance analysis of hepatitis C virus genotype 1 prior treatment null responders receiving daclatasvir and asunaprevir.

    Science.gov (United States)

    McPhee, Fiona; Hernandez, Dennis; Yu, Fei; Ueland, Joseph; Monikowski, Aaron; Carifa, Arlene; Falk, Paul; Wang, Chunfu; Fridell, Robert; Eley, Timothy; Zhou, Nannan; Gardiner, David

    2013-09-01

    In a sentinel cohort, hepatitis C virus (HCV) patients (primarily genotype [GT] 1a) were treated with daclatasvir (NS5A inhibitor) and asunaprevir (NS3 protease inhibitor). Preexistence, emergence, and persistence of resistance variants in patients who failed this treatment are described. HCV-infected null responders received daclatasvir (60 mg once daily) and asunaprevir (600 mg twice daily) alone (Group A, 11 patients) or with peginterferon alfa-2a and ribavirin (Group B, 10 patients) for 24 weeks. Resistance testing was performed on baseline samples and samples with HCV RNA ≥1,000 IU/mL at Week 1 through posttreatment Week 48. Resistance substitution susceptibility to inhibition by asunaprevir and daclatasvir was assessed using HCV replicon assays. In Group A, six GT1a patients experiencing viral breakthrough and one GT1a patient who relapsed had detectable NS5A (Q30E/R, L31V/M, Y93C/N) and NS3 (R155K, D168A/E/V/Y) resistance-associated variants at failure. Two of six viral breakthrough patients achieved SVR48 after treatment intensification with peginterferon alfa-2a and ribavirin. For 2/4 viral breakthrough patients not responding to treatment intensification, NS3 resistance variants changed (D168Y to D168T; R155K to V36M-R155K). At posttreatment Week 48, daclatasvir-resistant variants persisted while asunaprevir-resistant variants were generally replaced by wild-type sequences. The NS3 sequence remained unchanged in the one patient with NS3-R155K at baseline, relapse, and posttreatment Week 48. In Group B, no viral breakthrough was observed. The treatment failure of daclatasvir and asunaprevir in HCV GT1a patients was associated with both NS5A and NS3 resistance variants in prior null responders. NS5A resistance variants persisted while NS3 resistance variants generally decayed, suggesting a higher relative fitness of NS5A variants. Copyright © 2013 by the American Association for the Study of Liver Diseases.

  17. Electrolytes imbalance caused by amikacin in patients receiving multi drug resistance- tuberculosis treatment at Hazara region Kpk, Pakistan.

    Science.gov (United States)

    Jan, Faheem; Hassan, Mukhtiar; Muhammad, Naveed; Wali, Shahid; Akbar, Hafiz Sajid; Atta, Qazi Mashhood; Gul, Farzana

    2017-09-01

    Multi drug resistance-tuberculosis (MDR-TB) is considered amongst one of the fatal medical and public health issue. Greater frequency of adverse reactions has been observed using 2nd line antituberculosis drugs, which rises the rate of morbidity. Hypokalemia and hyponatremia are common in patients receiving MDR-TB treatment. This study was aimed to assess the effect of amikacin as multidrug resistance tuberculosis treatment on serum sodium and potassium level. A total 179 subjects (82 males and 97 females) were screened within the period of one year for their serum electrolyte levels before and during the treatment. Their body weight and sociodemographic characteristics were also taken into considerations. Data were expressed in the form of mean ± standard error using One-way analysis of variance (ANOVA), followed by Dunnett's test. All the statistical analyses were performed using GraphPad Prism v. 6. The results showed that amikacin caused a significant (p< 0.05) hypokalemia when used in combination with other drugs having no known effect on serum potassium level which proved to be the side effect of amikacin. The average serum potassium level in both intensive and continuation phase was significantly lower (p< 0.05) than the baseline (3.73 mmol/L), however, in the continuation phase the potassium level (3.58 mmol/L) was slightly higher than that of intensive phase (3.54 mmol/L). The average serum sodium level in both phases; intensive and continuation, remained in steady state (137.25 mmol/L and 137.87 mmol/L respectively) throughout the study period as compared to the base line (135.5 mmol/L). The amikacin drug lowered serum potassium level but had no effect on sodium level. It is concluded that the serum electrolytes should be monitored during the course of treatment and corrected accordingly.

  18. [Optimization of long-term treatment with rosuvastatin of patients with myocardial infarction in combination with non-alcoholic steatohepatitis].

    Science.gov (United States)

    Skrypnyk, I M; Dubrovins'ka, T V

    2014-01-01

    Dynamics of indices of lipidograma, functional state of liver and level C-reactive of protein (CRP) was investigated in 36 patients with heart attack of myocardium diseases in combination with non-alcoholic steatohepatitis, who received 9-months treatment by rosuvastatin of 20 mg dose and rosuvastatin of 10 mg dose in combination with ursodeoxycholic acid (UDCA), in a comparative aspect. The equivalence of hypolipidemia effect of both conditions reliable advantage in decline of triglycerides level and CRP normalization under the influence of combined therapy was discovered. The treatment by combination of rosuvastatin of 10 mg dose with UDCA has shown the advantages in comparison with the treatment by rosuvastatin of 20 mg dose in decline and normalization of transaminases and gamma-glutamiltranspeptidase activity. The data obtained resulted in optimization of standard treatment by statins of patients with heart attack of myocardium diseases in combination with non-alcoholic steatohepatitis by means of combination the initial rosuvastatin dose with UDCA.

  19. Interventions for treating oral mucositis for patients with cancer receiving treatment.

    Science.gov (United States)

    Clarkson, Jan E; Worthington, Helen V; Furness, Susan; McCabe, Martin; Khalid, Tasneem; Meyer, Stefan

    2010-08-04

    Treatment of cancer is increasingly effective but associated with short and long term side effects. Oral side effects, including oral mucositis (mouth ulceration), remain a major source of illness despite the use of a variety of agents to treat them. To assess the effectiveness of interventions for treating oral mucositis or its associated pain in patients with cancer receiving chemotherapy or radiotherapy or both. Electronic searches of Cochrane Oral Health Group and PaPaS Trials Registers (to 1 June 2010), CENTRAL via The Cochrane Library (to Issue 2, 2010), MEDLINE via OVID (1950 to 1 June 2010), EMBASE via OVID (1980 to 1 June 2010), CINAHL via EBSCO (1980 to 1 June 2010), CANCERLIT via PubMed (1950 to 1 June 2010), OpenSIGLE (1980 to 1 June 2010) and LILACS via the Virtual Health Library (1980 to 1 June 2010) were undertaken. Reference lists from relevant articles were searched and the authors of eligible trials were contacted to identify trials and obtain additional information. All randomised controlled trials comparing agents prescribed to treat oral mucositis in people receiving chemotherapy or radiotherapy or both. Outcomes were oral mucositis, time to heal mucositis, oral pain, duration of pain control, dysphagia, systemic infection, amount of analgesia, length of hospitalisation, cost and quality of life. Data were independently extracted, in duplicate, by two review authors. Authors were contacted for details of randomisation, blindness and withdrawals. Risk of bias assessment was carried out on six domains. The Cochrane Collaboration statistical guidelines were followed and risk ratio (RR) values calculated using fixed-effect models (less than 3 trials in each meta-analysis). Thirty-two trials involving 1505 patients satisfied the inclusion criteria. Three comparisons for mucositis treatment including two or more trials were: benzydamine HCl versus placebo, sucralfate versus placebo and low level laser versus sham procedure. Only the low level laser

  20. Efficacy of combination of glycolic acid peeling with topical regimen in treatment of melasma.

    Science.gov (United States)

    Chaudhary, Savita; Dayal, Surabhi

    2013-10-01

    Various treatment modalities are available for management of melasma, ranging from topical and oral to chemical peeling, but none is promising alone. Very few studies are available regarding efficacy of combination of topical treatment with chemical peeling. Combination of chemical peeling and topical regimen can be a good treatment modality in the management of this recalcitrant disorder. To assess the efficacy of combination of topical regimen (2% hydroquinone, 1% hydrocortisone and 0.05% tretinoin) with serial glycolic acid peeling in the treatment of melasma in Indian patients. Forty Indian patients of moderate to severe epidermal variety melasma were divided into two groups of 20 each. One Group i.e. peel group received topical regimen (2% hydroquinone, 1% hydrocortisone and 0.05% tretinoin) with serial glycolic acid peeling and other group i.e. control group received topical regimen (2% hydroquinone, 1% hydrocortisone, 0.05% tretinoin). There was an overall decrease in MASI from baseline in 24 weeks of therapy in both the groups (P value melasma.

  1. Combination of modafinil and d-Amphetamine for the treatment of cocaine dependence: A preliminary investigation

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    Joy M Schmitz

    2012-08-01

    Full Text Available Background: Two stimulant medications, modafinil and d-amphetamine, when tested individually, have shown safety and efficacy for treatment of cocaine addiction. We hypothesized that the combination of modafinil and d-amphetamine, at low doses, would show equivalent or greater benefit in reducing cocaine use compared to higher doses of each individual medication or placebo. Methods: Sixteen week, randomized, parallel-group design with four treatment arms comparing placebo to modafinil 400 mg; d-amphetamine 60 mg; modafinil 200 mg plus d-amphetamine 30 mg. Primary outcome variables, retention and cocaine use, were analyzed on the sample of 73 participants who received the first dose of the study medication. Results: Retention rates did not differ between groups and were generally low, with 40% remaining in treatment at week 12 and 20% at week 16. Participants receiving the combination of modafinil and d-amphetamine showed a trend of increased cocaine use over time with a corresponding low Bayesian probability of benefit (33%. Relatively better cocaine outcomes were observed in the placebo and d-amphetamine only groups. The study medications were generally well-tolerated with few adverse effects, yet rates of adherence were suboptimal (≤ 80%. Conclusion: Data from this preliminary investigation fail to provide evidential support for conducting a larger study of this dual-agonist medication combination for treatment of cocaine dependence.

  2. Health-related quality of life in infertile couples receiving IVF or ICSI treatment

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    Rashidi Batool

    2008-09-01

    Full Text Available Abstract Background Infertile couples might experience psychological distress and suffer from impaired health-related quality of life. This study aimed to examine health-related quality of life in infertile couples receiving either in-vitro fertilization (IVF or intracytoplasmic sperm injection (ICSI treatment. Methods This was a cross-sectional study of quality of life in infertile couples attending to Vali-e-Asr Reproductive Health Research Center or Royan Institute for either IVF or ICSI treatment in Tehran, Iran. Health-related quality of life was assessed using the Short Form Health Survey (SF-36. Patients' demographic and clinical characteristics were also recorded. Data were analyzed to compare quality of life in infertile women and men and to indicate what variables predict quality of life in infertile couples. Results In all 514 women and 514 men (n = 1028 were studied. There were significant differences between women and men indicating that male patients had a better health-related quality of life. Also health-related quality of life was found to be better in infertility due to male factor. Performing logistic regression analysis it was found that female gender, and lower educational level were significant predictors of poorer physical health-related quality of life. For mental health-related quality of life in addition to female gender and lower educational level, younger age also was found to be a significant predictor of poorer condition. No significant results were observed for infertility duration or causes of infertility either for physical or mental health-related quality of life. Conclusion The findings suggest that infertility duration or causes of infertility do not have significant effects on health-related quality of life in infertile couples. However, infertile couples, especially less educated younger women, are at risk of a sub-optimal health-related quality of life and they should be provided help and support in order

  3. Receiving treatment for attention-deficit hyperactivity disorder: do the perspectives of adolescents matter?

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    Bussing, Regina; Zima, Bonnie T; Mason, Dana M; Porter, Phillip C; Garvan, Cynthia W

    2011-07-01

    This study describes the perspectives of parents and adolescents regarding clinical need for and attitudes toward care for attention-deficit hyperactivity disorder (ADHD). In addition, it explores as to how these views relate to past year usage of mental health services. Parents and adolescents were interviewed 6 years after the school district was screened for ADHD. Using standardized measures, mental health service usage, adolescent and parent perceived clinical needs (ADHD symptoms, disruptive behavior disorders, anxiety and/or depression, functioning), and enabling attitudes (treatment receptivity, ADHD stigma), as well as parent factors (caregiver strain, distress, instrumental social support) were assessed. Nested logistic regression modeling was used to determine the hierarchical contribution of parent and adolescent perspectives on past year service usage, after adjusting for previous usage of mental health services. Stepwise regression was conducted to identify the variables that were most predictive of service usage. Among the adolescents who were at a high risk for ADHD, 79% had a history of lifetime mental health service usage, but only 42% had received any kind of mental health services in the past year. In hierarchical modeling, only parent inattention ratings and medication receptivity and adolescent ADHD stigma perceptions contributed significantly toward improved model fit. Stepwise regression confirmed these three variables to be predictors (OR: 1.2, 3.8, and .2, respectively) and identified adolescents-reported functioning as an additional predictor of service usage (OR: 1.1). Perceptions of adolescents regarding the stigma related to ADHD are influential in treatment receipt. Quality improvement interventions for adolescents with ADHD should include psychoeducational interventions for adolescents and their parents that target medication receptivity and the stigma related to ADHD. Copyright © 2011 Society for Adolescent Health and Medicine

  4. Benznidazole/Itraconazole Combination Treatment Enhances Anti-Trypanosoma cruzi Activity in Experimental Chagas Disease.

    Directory of Open Access Journals (Sweden)

    Tassiane Assíria Fontes Martins

    Full Text Available The nitroheterocyclic drugs nifurtimox and benznidazole are first-line drugs available to treat Chagas disease; however, they have limitations, including long treatment courses and toxicity. Strategies to overcome these limitations include the identification of new drugs with specific target profiles, re-dosing regimens for the current drugs, drug repositioning and combination therapy. In this work, we evaluated combination therapy as an approach for optimization of the current therapeutic regimen for Chagas disease. The curative action of benznidazole/itraconazole combinations was explored in an established infection of the mice model with the T. cruzi Y strain. The activities of the benznidazole/itraconazole combinations were compared with the results from those receiving the same dosage of each individual drug. The administration of benznidazole/itraconazole in combination eliminated parasites from the blood more efficiently than each drug alone. Here, there was a significant reduction of the number of treatment days (number of doses necessary to induce parasitemia suppression with the benznidazole/itraconazole combination, as compared to each compound administered alone. These results clearly indicate the enhanced effects of these drugs in combination, particularly at the dose of 75 mg/kg, as the effects observed with the drug combinations were four times more effective than those of each drug used alone. Moreover, benznidazole/itraconazole treatment was shown to prevent or decrease the typical lesions associated with chronic experimental Chagas disease, as illustrated by similar levels of inflammatory cells and fibrosis in the cardiac muscle tissue of healthy and treated mice. These results emphasize the importance of exploring the potential of combination treatments with currently available compounds to specifically treat Chagas disease.

  5. Benznidazole/Itraconazole Combination Treatment Enhances Anti-Trypanosoma cruzi Activity in Experimental Chagas Disease.

    Science.gov (United States)

    Assíria Fontes Martins, Tassiane; de Figueiredo Diniz, Lívia; Mazzeti, Ana Lia; da Silva do Nascimento, Álvaro Fernando; Caldas, Sérgio; Caldas, Ivo Santana; de Andrade, Isabel Mayer; Ribeiro, Isabela; Bahia, Maria Terezinha

    2015-01-01

    The nitroheterocyclic drugs nifurtimox and benznidazole are first-line drugs available to treat Chagas disease; however, they have limitations, including long treatment courses and toxicity. Strategies to overcome these limitations include the identification of new drugs with specific target profiles, re-dosing regimens for the current drugs, drug repositioning and combination therapy. In this work, we evaluated combination therapy as an approach for optimization of the current therapeutic regimen for Chagas disease. The curative action of benznidazole/itraconazole combinations was explored in an established infection of the mice model with the T. cruzi Y strain. The activities of the benznidazole/itraconazole combinations were compared with the results from those receiving the same dosage of each individual drug. The administration of benznidazole/itraconazole in combination eliminated parasites from the blood more efficiently than each drug alone. Here, there was a significant reduction of the number of treatment days (number of doses) necessary to induce parasitemia suppression with the benznidazole/itraconazole combination, as compared to each compound administered alone. These results clearly indicate the enhanced effects of these drugs in combination, particularly at the dose of 75 mg/kg, as the effects observed with the drug combinations were four times more effective than those of each drug used alone. Moreover, benznidazole/itraconazole treatment was shown to prevent or decrease the typical lesions associated with chronic experimental Chagas disease, as illustrated by similar levels of inflammatory cells and fibrosis in the cardiac muscle tissue of healthy and treated mice. These results emphasize the importance of exploring the potential of combination treatments with currently available compounds to specifically treat Chagas disease.

  6. [First experience with intrasurgical brachytherapy in the combined treatment for locally advanced laryngeal cancer].

    Science.gov (United States)

    Vasil'chenko, I L; Vinogradov, V M; Pastushenko, D A; Samsonova, N N; Iudin, A L

    2011-01-01

    Results of combined radiosurgical treatment with larynx preservation, and pre- and postoperative distant external irradiation, were evaluated. Forty-eight patients with locally advanced laryngeal cancer received single-step individually-tailored tissue application, followed by high-dose brachytherapy. Discriminative function of the larynx was restored in all patients within 2 days involving swallowing disturbances in 8%. Breathing function was restored in 98% within 2 days to 6 months after completion of treatment. Three-year relapse-free survival was 95.8%.

  7. [The combined treatment of osteogenesis imperfecta in children].

    Science.gov (United States)

    Berezhnoĭ, A P; Shilov, A V; Belova, N A; Snetkov, A I

    1989-12-01

    The authors present the results of complex drug and orthopaedic treatment of children with imperfect osteogenesis. 40 patients were treated with a somatotropic hormone, calcitrin and vitamin D metabolites (oxydevit and dihydrocholecalciferol). In 20 of these patients corrective osteotomies of the long bones of the lower extremities combined with metal osteosynthesis with rods and massive plates were performed. In a number of patients osteoplasty with long cortical allografts was made. After the treatment all the children were able to move independently either with the aid of unloading orthopaedic apparatuses (17 patients), or without them (3 patients).

  8. Benchmarking Combined Biological Phosphorus and Nitrogen Removal Wastewater Treatment Processes

    DEFF Research Database (Denmark)

    Gernaey, Krist; Jørgensen, Sten Bay

    2004-01-01

    This paper describes the implementation of a simulation benchmark for studying the influence of control strategy implementations on combined nitrogen and phosphorus removal processes in a biological wastewater treatment plant. The presented simulation benchmark plant and its performance criteria...... are to a large extent based on the already existing nitrogen removal simulation benchmark. The paper illustrates and motivates the selection of the treatment plant lay-out, the selection of the biological process model, the development of realistic influent disturbance scenarios for dry, rain and storm weather...

  9. Diabetes and Hypertension among Patients Receiving Antiretroviral Treatment Since 1998 in Senegal: Prevalence and Associated Factors

    Science.gov (United States)

    Diouf, Assane; Cournil, Amandine; Ba-Fall, Khadidiatou; Ngom-Guèye, Ndèye Fatou; Eymard-Duvernay, Sabrina; Ndiaye, Ibrahima; Batista, Gilbert; Guèye, Papa Mandoumbé; Bâ, Pape Samba; Taverne, Bernard; Delaporte, Eric; Sow, Papa Salif

    2012-01-01

    Cardiovascular risk factors in people on antiretroviral treatment (ART) are poorly documented in resource-constrained settings. A cross-sectional study was conducted in 2009 to assess prevalence of diabetes and hypertension in a sample of 242 HIV-infected patients who had initiated ART between 1998 and 2002 in Dakar, Senegal (ANRS 1215 observational cohort). World Health Organization (WHO) criteria were applied to diagnose diabetes and hypertension. Multiple logistic regressions were used to identify factors associated with diabetes and hypertension. Patients had a median age of 46 years and had received ART for a median duration of about 9 years. 14.5% had diabetes and 28.1% had hypertension. Long duration of ART (≥119 months), older age, higher body mass index (BMI), and higher levels of total cholesterol were associated with higher risks of diabetes. Older age, higher BMI at ART initiation, and higher levels of triglycerides were associated with higher risk of hypertension. This study shows that diabetes and hypertension were frequent in these Senegalese HIV patients on ART. It confirms the association between duration of ART and diabetes and highlights the need to implement programs for prevention of cardiovascular risk factors in HIV patients from resource-constrained settings. PMID:24052880

  10. Factors associated with chronic diseases among the elderly receiving treatment under the Family Health Strategy.

    Science.gov (United States)

    Pimenta, Fernanda Batista; Pinho, Lucinéia; Silveira, Marise Fagundes; Botelho, Ana Cristina de Carvalho

    2015-08-01

    The profile of a sample population of elderly receiving treatment under the Family Health Strategy in the municipality of Teófilo Otoni, State of Minas Gerais, Brazil, is described, and the factors associated with diseases prevalence examined. Using simple random sampling, 385 elderly were interviewed using Form A and Elderly Form from the Primary Health Care Information System. The majority of the sample (83.1%) self-reported at least one disease, 69.9% had hypertension, and 17.7% had diabetes. Poisson regression analysis showed that the main factors associated with hypertension and other diseases were being non-white, having a low level of education, medication use, dental prosthesis use, and lack of a private health plan. The prevalence of diabetes was greater among women and individuals who depended on other people to live. It can be concluded that this sample population of elderly has a generally low socioeconomic status and are more susceptible to developing diseases, particularly hypertension. Diabetes should be controlled although had relatively low prevalence. It is suggested investments in structuring the health system network to provide adequate care for the elderly and in training health professionals to play an effective role in improving the quality of life of the elderly in Brazil.

  11. Partitioning of heavy metals in sub-surface flow treatment wetlands receiving high-strength wastewater.

    Science.gov (United States)

    Wojciechowska, Ewa; Gajewska, Magdalena

    2013-01-01

    The retention of heavy metals at two pilot-scale treatment wetlands (TWs), consisting of two vertical flow beds (VSSF) followed by a horizontal flow bed (HSSF) was studied. The TWs received high-strength wastewater: reject waters from sewage sludge centrifugation (RW) and landfill leachate (LL). The concentrations of the metals Fe, Mn, Zn, Al, Pb, Cu, Cd, Co, and Ni were measured in treated wastewater, substrate of the beds and in plant material harvested from the beds (separately in above ground (ABG) parts and below ground (BG) parts). The TWs differed in metals retention. In the RW treating TW the metal removal efficiencies varied from 27% for Pb to over 97% for Fe and Al. In the LL treating system the concentrations of most metals decreased after VSSF-1 and VSSF-2 beds; however, in the outflow from the last (HSSF) bed, the concentrations of metals (apart from Al) increased again, probably due to the anaerobic conditions at the bed. A major removal pathway was sedimentation and adsorption onto soil substrate as well as precipitation and co-precipitation. In the LL treating facility the plants contained substantially higher metal concentrations in BG parts, while the upward movement of metals was restricted. In the RW treating facility the BG/ABG ratios were lower, indicating that metals were transported to shoots.

  12. Combined Treatment Of Purulent Wounds With CO2 Laser

    Science.gov (United States)

    Tolstych, P. I.; Skobelkin, O. K.; Derbenev, V. A.

    1988-06-01

    The authors have worked out a programme for combined treatment of purulent wounds with CO2 laser. It consists of following components: a) laserinsision of suppurative wounds,necrectomy,or irradiation of the incised wound with the defocused laser beam; b )diplication of proteinerses and antiseptics immobilized on the textile dressing and dranaige materials; c) applications of biocompatible materials with the immobilized antiseptics and enzyme agents; d) application of low energy laser irradiation in the postoperative period; e) lavage of the sutured wound if indicated. The points of the above-mentioned programme can be used separately as independed methods in several thousands of patients. Their combined applications has been studied on 400 patients. Such treatment allowed to refuse the antibioticotherapy in 98,3% of cases,to reduce the terms of trestment in I,5-2 % times as compared with traditional methods, and to low significantely costs.

  13. Therapeutic Advances using Combinational Therapy in the Treatment of Glioblastoma

    DEFF Research Database (Denmark)

    Staberg, Mikkel

    2017-01-01

    Glioblastoma is the most malignant brain tumor in adults. Median survival is only about 15 months despite aggressive treatment, consisting of surgery followed by radio- and chemotherapy, stressing the need for new therapies. Development of glioblastoma is thought to be a result of both genetic...... of glioblastoma cells, an effect that is even more pronounced when combined with traditional chemotherapeutic agents. The EGFR and Notch pathways are shown to be of great importance for glioblastoma cell survival and for the formation of new blood vessels, a process known as angiogenesis. Results presented herein...... suggests that targeting redundant signaling pathways can overcome required or initial treatment resistance, thus leading to improved tumor cell elimination. We hypothesize that future therapies will likely be a result of combination therapies for glioblastoma patients based on their molecular tumor profile...

  14. Combined photo-Fenton-SBR process for antibiotic wastewater treatment

    Energy Technology Data Exchange (ETDEWEB)

    Elmolla, Emad S., E-mail: em_civil@yahoo.com [Department of Civil Engineering, Faculty of Engineering, Al-Azhar University, Cairo (Egypt); Chaudhuri, Malay [Department of Civil Engineering, Universiti Teknologi PETRONAS, Bandar Seri Iskandar, 31750 Tronoh, Perak (Malaysia)

    2011-09-15

    Highlights: {center_dot} The work focused on hazardous wastewater (antibiotic wastewater) treatment. {center_dot} Complete degradation of the antibiotics achieved by the treatment process. {center_dot} The SBR performance was found to be very sensitive to BOD{sub 5}/COD ratio below 0.40. {center_dot} Combined photo-Fenton-SBR process is a feasible treatment process for the antibiotic wastewater. - Abstract: The study examined combined photo-Fenton-SBR treatment of an antibiotic wastewater containing amoxicillin and cloxacillin. Optimum H{sub 2}O{sub 2}/COD and H{sub 2}O{sub 2}/Fe{sup 2+} molar ratio of the photo-Fenton pretreatment were observed to be 2.5 and 20, respectively. Complete degradation of the antibiotics occurred in one min. The sequencing batch reactor (SBR) was operated at different hydraulic retention times (HRTs) with the wastewater treated under different photo-Fenton operating conditions (H{sub 2}O{sub 2}/COD and H{sub 2}O{sub 2}/Fe{sup 2+} molar ratio). The SBR performance was found to be very sensitive to BOD{sub 5}/COD ratio of the photo-Fenton treated wastewater. Statistical analysis of the results indicated that it was possible to reduce the Fe{sup 2+} dose and increase the irradiation time of the photo-Fenton pretreatment. The best operating conditions of the combined photo-Fenton-SBR treatment were observed to be H{sub 2}O{sub 2}/COD molar ratio 2, H{sub 2}O{sub 2}/Fe{sup 2+} molar ratio 150, irradiation time 90 min and HRT of 12 h. Under the best operating conditions, 89% removal of sCOD with complete nitrification was achieved and the SBR effluent met the discharge standards.

  15. Treatment of B-cells non-Hodgkin lymphomas with combined immunochemotherapy: ability to treatment optimization

    Directory of Open Access Journals (Sweden)

    N. V. Smirnova

    2015-01-01

    Full Text Available The results of two consecutive multicenter clinical trials enrolled 241 patient with childhood mature B-cells non-Hodgkin lymphomas/leukemia are presented. Patients received treatment according B-NHL 2004mab protocol (n = 83 and B-NHL 2010M (n = 158 with combined immunochemotherapy (ICT in Russian and Belarus pediatric clinics from 2004 to 2015 years. Primary patients with different mature B-NHL (Burkitt lymphoma/leukemia, diffuse large B-cell lymphoma and primary mediastinal B-cell lymphoma (DLBCL and PMBCL aged from 2 to 18 years are included in the studies.Protocol B-NHL 2004mab for treatment of children and adolescents with B-NHL/B-AL, stage III and IV, includes a combination of chemotherapy (PCT and rituximab – an antibody against the B-cells receptor CD20. PCT courses similar to those in the B-NHL BFM90 protocol (group III with the exception of methotrexate dose in induction courses, reduced to 1 g/m2 /24 h in order to reduce toxicity. Rituximab (Mabthera, 375 mg/m2 /h used for the first time in the treatment of children and adolescents with B-NHL. Of the 83 patients included, clinical remission was achieved in 77 (92.8 %. With a median follow time of 51.6 months, remission continued in 23 (85.2 % patients with B-AL, in 32 (88.9 % patients with LB and 19 (95.0 % patients – with DLBCL. With median follow time of 65.2 months, event-free and overall survival was 84 ± 6 and 82 ± 8 %, respectively.Based on previous experience in order to further optimize B-NHL treatment, new protocol B-NHL 2010M with effect-adapted therapy and improvement of stratification risk group criteria was proposed. Overall survival in patients of 1st and 2nd risk groups with full implementation of diagnosis and treatment is approaching 100 %. In interim analysis of 3rd risk group patients, pOS was 88 ± 3 %. The incidence of induction death (infections, metabolic complications remains within 2.7 % (n = 4; refractory cases (n = 2; 1.3 % and relapses (n = 4; 2

  16. Multivariate therapeutic approach to binge-eating disorder: combined nutritional, psychological and pharmacological treatment.

    Science.gov (United States)

    Brambilla, Francesca; Samek, Lorenzo; Company, Marta; Lovo, Francesca; Cioni, Luisa; Mellado, Carmen

    2009-11-01

    Treatment for binge-eating disorder (BED) is directed towards either the physical or psychopathological impairments, and often does not cover all the alterations characterizing the disease. In 30 BED patients, we monitored the effects of three types of 6-month treatment, randomly assigned to one of the three treatment groups, each consisting of 10 patients. Group 1 received a 1700-kcal diet (21% proteins, 27% lipids, 52% carbohydrate), cognitive-behavioural therapy (CBT), sertraline (50-150 mg/day) and topiramate (25-150 mg/day); group 2 received the same diet, CBT, sertraline; and group 3 received nutritional counselling and CBT. Binge frequency and weight were assessed every month. The Eating Disorder Inventory-2, the Symptoms Check List-90-Revised (SCL-90-R) and the Personality Diagnostic Questionnaire-4-Revised (PDQ-4-R) were administered before and after treatment. Binge frequency and excessive weight decreased significantly only in group 1 patients, in whom improvement was noted in total Eating Disorder Inventory-2 scores and the subitems 'bulimia', 'drive for thinness', 'maturity fear', 'ascetism', in total SCL-90-R scores and in the subitem 'somatization', in PDQ-4-R subitems 'schizotypic personality' and 'dependent personality'. Group 2 patients improved on the SCL-90-R subitems 'depression' and 'interpersonal relationship' and in the PDQ-4-R 'schizoid personality'. Combination therapy seems to be the only fully effective treatment in BED patients.

  17. Protective effect of gonadotropin-releasing hormone analog on the ovarian reserve in rats receiving cyclophosphamide treatment

    Directory of Open Access Journals (Sweden)

    Gui T

    2015-03-01

    Full Text Available Ting Gui,1,* Guangwen Yuan,2,* Keng Shen,1 Dongyan Cao,1 Jiaxin Yang,1 Ming Wu,1 Jinghe Lang11Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, 2Department of Gynecologic Oncology, Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, People’s Republic of China*These authors contributed equally to this workObjective: The aim of the study reported here was to investigate the protective effect of gonadotropin-releasing hormone analog (GnRHa against cyclophosphamide (CTX-induced gonadotoxicity.Methods: Eighty Fischer 344 rats were divided randomly into four groups (20 per group. One group received normal saline, one GnRHa, one CTX, and one GnRHa+CTX. Several parameters were used to observe the ovarian reserve, including ovary weight, follicle number and diameter, concentrations of estradiol (E2 and follicle-stimulating hormone (FSH, and expressions of sex hormone receptors.Results: When treatment was finished, the number of small follicles in the GnRHa+CTX group was significantly higher than in the CTX-alone group. Thirty days after treatment, the ovary weight, percentage of small follicles, mean follicular diameter, and serum concentrations of E2 and FSH in the GnRHa+CTX group all recovered, approaching normal levels. Sex hormone receptors did not show significant differences between the four groups.Conclusion: Combination treatment with GnRHa could prevent CTX-induced damage to ovarian reserve.Keywords: gonadotoxicity, ovarian reserve, GnRHa, CTX, premature ovarian failure

  18. [Clinical efficacy of structured institution-based teaching programme combined with family rehabilitation training in treatment of childhood autism].

    Science.gov (United States)

    Liu, Chao; Lu, Bin; Zhang, Yu; Xu, Chuan-Guo; Peng, Feng-Xiang; Ma, Li-Fang; Liu, Li-Li; Nie, Wen-Ying

    2015-12-01

    To investigate the clinical efficacy of a structured institution-based teaching programme combined with family rehabilitation training in the treatment of childhood autism. One hundred children with autism were divided into a combination therapy group (n=50) and a control group (n=50). The children in the control group received a structured institution-based teaching programme, and the children in the combination therapy group received a family rehabilitation training besides the structured institution-based teaching programme. Comparisons were made between the two groups by the Autism Behavior Checklist (ABC) score, Autism Treatment Evaluation Checklist (ATEC) score, and Chinese version of Psychoeducational Profile (C-PEP) sore. After 12-months training, each dimension score and total score of ABC in the combination therapy group were all significantly lower than those in the control group (Pautism, structured institution-based teaching programme combined with family rehabilitation training is worthy of clinical promotion and application.

  19. Household food insecurity, maternal nutritional status, and infant feeding practices among HIV-infected Ugandan women receiving combination antiretroviral therapy

    Science.gov (United States)

    YOUNG, Sera L.; PLENTY, Albert H. J.; LUWEDDE, Flavia A.; NATAMBA, Barnabas K.; NATUREEBA, Paul; ACHAN, Jane; MWESIGWA, Julia; RUEL, Theodore D.; ADES, Veronica; OSTERBAUER, Beth; CLARK, Tamara D.; DORSEY, Grant; CHARLEBOIS, Edwin D.; KAMYA, Moses; HAVLIR, Diane V.; COHAN, Deborah L.

    2015-01-01

    Objectives Household food insecurity may be a barrier to both optimal maternal nutritional status and infant feeding practices, but few studies have tested this relationship quantitatively, and never among HIV-infected individuals. We therefore explored if greater household food insecurity was associated with poorer maternal nutritional status, shorter duration of exclusive breastfeeding (EBF) and fewer animal-source complementary foods. Methods We assessed these outcomes among 180 HIV-infected pregnant and breastfeeding (BF) women receiving combination antiretroviral therapy in the PROMOTE trial (NCT00993031), a prospective, longitudinal cohort study in Tororo, Uganda. Results Household food insecurity was common; the prevalence of severe, moderate, and little to no household hunger was 7.3%, 40.5%, and 52.2%, respectively. Poor maternal nutritional status was common and women in households experiencing moderate to severe household hunger (MSHH) had statistically significantly lower BMIs at enrollment (21.3 vs 22.5, p<0.01) and prior to delivery (22.6 vs. 23.8, p<0.01). However, MSHH was not associated with maternal BMI or gestational weight gain in multivariate models. The prevalence (95% CI) of EBF at 6 months was 66.4% (59.0%-72.8%), and the proportion of women breastfeeding at 12 months was 80.0% (73.0%-85.3%).MSHH was not associated with EBF at 6 months or breastfeeding at 12 months. However, among those women still EBF at 4 months (81.0% of population), those experiencing MSHH were significantly more likely to cease EBF between 4 and 6 months (aHR: 2.52, 95% CI 1.03-6.19). Conclusions Interventions addressing household food insecurity, maternal malnutrition and suboptimal breastfeeding practices are urgently needed. PMID:24585398

  20. A Pilot Study on the Combination of Applied Behavior Analysis and Bumetanide Treatment for Children with Autism.

    Science.gov (United States)

    Du, Lin; Shan, Ling; Wang, Bing; Li, Honghua; Xu, Zhida; Staal, Wouter G; Jia, Feiyong

    2015-09-01

    The purpose of this study was to investigate the therapeutic effects of combined bumetanide and applied behavior analysis (ABA) treatment in children with autism. Sixty children diagnosed with autism according to the International Classification of Diseases, Tenth Revision (ICD-10) criteria (mean age of 4.5 years) were randomly divided into two groups: A single treatment group (n=28) and a combined treatment group (n=32). The combined treatment group received ABA training combined with oral bumetanide (0.5 mg twice a day). The single treatment group received ABA training only. Autism symptoms were evaluated with the Autism Behavior Checklist (ABC) and the Childhood Autism Rating Scale (CARS), whereas severity of disease (SI) and global improvement (GI) were measured with the Clinical Global Impressions (CGI). Assessment of ABC, CARS, and CGI was performed immediately before and 3 months after initiation of the treatment(s). Prior to intervention(s) no statistically significant differences in scores on the ABC, CARS, SI, or GI were found between the two groups. Total scores of the ABC, CARS, and SI were decreased in both groups after 3 months (p<0.05) compared with the scores prior to treatment. The total scores of the ABC and the CGI were significantly (p<0.05) lower in the combined treatment group than in the single treatment group. Although the total and item scores of the CARS in the combined treatment group were lower than in the single treatment group after a 3 month intervention, they did not reach statistical significance. No adverse effects of bumetanide were observed. Treatment with bumetanide combined with ABA training may result in a better outcome in children with autism than ABA training alone.

  1. Comparison of doses received in the mandibular condyle, cochlea, and parotid gland in neuroaxial treatment

    Energy Technology Data Exchange (ETDEWEB)

    Oliveira, Fernanda L.; Lima, Fabiana F. de; Vilela, Eudice, E-mail: fluoliveira@gmail.com [Centro Regional de Ciencias Nucleares do Nordeste (CRCN-NE/CNEN-PE), Recife, PE (Brazil); Fo, Joao Antonio, E-mail: jaf@ufpe.br [Universidade Federal de Pernambuco (UFPE), Recife, PE (Brazil). Departamento de Energia Nuclear

    2015-07-01

    Sensorineural hearing loss is a common side effect in patients who undergo radiotherapy for the treatment of cancer tumors in the head and neck. In fractioned doses of radiotherapy, in the majority of intracranial tumors, the cochlea is the most affected organ. In addition to the cochlea, the mandible and the parotid glands are also exposed to radiation, which commonly leads to Osteoradionecrosis of the mandible and Xerostomia. In the head and neck regions, this can be complicated by the semi-independence of the positioning in this region, as regards the rigid cranium, connected to the semi-rigid mandible, and successive levels of the upper cervical spine and thoracic spine, which can lead to uncertainty in rotation as well as in head-neck movements, both up and down and side to side. The present study performed an intercomparison of the doses applied through four radiotherapy planning techniques for the neuro axial regions of the cochlea, mandible, and parotid glands, considering the changes carried out in each planning technique, including the protective shield, the angulations gantry and the field size. The results obtained by applying the half beam and angled field techniques varied in the cochlea by an average of 113.8% from the prescribed dose, whereas when applying the angled field technique with and without the mobile gap, the results varied in 104.5%. In the mandible, the half beam and angled field techniques showed that the dose varied an average of 16.5%, while in the techniques with and without the mobile gap, the variation showed an average of 116.4%. These values were also received by the parotid glands, which overlap the mandible. It can therefore be concluded that the protection shields of the first two techniques were less efficient in protecting the mandible due to its modeling. (author)

  2. Patients' experiences of living with and receiving treatment for fibromyalgia syndrome: a qualitative study

    Directory of Open Access Journals (Sweden)

    Carville Serene F

    2009-10-01

    Full Text Available Abstract Background Fibromyalgia syndrome (FMS presents a challenge for patients and health care staff across many medical specialities. The aetiology is multi-dimensional, involving somatic, psychological and social factors. Patients' views were obtained to understand their experience of living with this long-term condition, using qualitative interviews. Methods 12 patients were recruited and stratified by age, gender and ethnicity from one rheumatology outpatient clinic, and a departmental held database of patients diagnosed with FMS. Results Patients' accounts of their experience of FMS resonated well with two central concepts: social identity and illness intrusiveness. These suggested three themes for the analytical framework: life before and after diagnosis (e.g. lack of information about FMS, invisibility of FMS; change in health identity (e.g. mental distress, impact on social life and perceived quality of care (e.g. lack of contact with nurses, attitudes of specialists. The information provided from one male participant did not differ from the female patients, but black and ethnic community patients expressed a degree of suspicion towards the medication prescribed, and the attitudes displayed by some doctors, a finding that has not been previously reported amongst this patient group. Patients expected more consultation time and effective treatment than they received. Subjective experiences and objective physical and emotional changes were non-overlapping. Patients' accounts revealed that their physical, mental and social health was compromised, at times overwhelming and affected their identity. Conclusion FMS is a condition that intrudes upon many aspects of patients' lives and is little understood. At the same time, it is a syndrome that evokes uneasiness in health care staff (as current diagnostic criteria are not well supported by objective markers of physiological or biochemical nature, and indeed because of doubt about the existence

  3. Clinical efficacy and prognostic factors of chemoreduction combined with topical treatment for advanced intraocular retinoblastoma.

    Science.gov (United States)

    Liu, Yan; Zhang, Xi; Liu, Fang; Wang, Ke-Lei

    2014-01-01

    To explore the clinical efficacy and prognostic factors of chemoreduction combined with topical treatment of advanced intraocular retinoblastoma (RB). A total of 22 eyes from 17 children with RB were selected for the study and treated with chemoreduction combined with topical cryotherapy, transpupillary thermotherapy (TTT) or episcleral plaque brachytherapy. Clinical and follow-up data were retrospectively analyzed. All children received 2~6 courses of chemoreduction treatment, (4.5±0.8 courses on average); 17 eyes from 13 children were treated by chemoreduction combined with cryotherapy or TTT and 5 eyes from 4 children with chemoreduction combined with 125I episcleral plaque brachytherapy. The eye retention rate was 81.8% (18/22), among which 38.9% (7/18) featured restored or maintained good vision. Postoperative follow-up period was 7 to 34 months, (18.6 ± 5.2 months on average). The recurrence rate was 41.2% (7/17), among which 57.1% (4/7) were controlled by supplementing or appending cryotherapy or TTT treatment during the follow-up period. The tumor basal diameter and thickness were significantly reduced (P<0.05 or P<0.01) after treatment. All children demonstrated different degrees of hair loss, 70.6% (12/17) with different degrees of gastrointestinal reactions, 5.88% (1/17) with neutropenia and 11.8% (2/17) being seriously infected during the chemotherapeutic treatment. Univariate and logistic regression analysis showed that tumor basal diameter before treatment had a significant effect on the prognosis (P<0.01). Chemoreduction combined with topical therapy can effectively control RB in the short term, and tumor basal diameter before treatment is an independent risk factor for prognosis.

  4. Combining clinical variables to optimize prediction of antidepressant treatment outcomes.

    Science.gov (United States)

    Iniesta, Raquel; Malki, Karim; Maier, Wolfgang; Rietschel, Marcella; Mors, Ole; Hauser, Joanna; Henigsberg, Neven; Dernovsek, Mojca Zvezdana; Souery, Daniel; Stahl, Daniel; Dobson, Richard; Aitchison, Katherine J; Farmer, Anne; Lewis, Cathryn M; McGuffin, Peter; Uher, Rudolf

    2016-07-01

    The outcome of treatment with antidepressants varies markedly across people with the same diagnosis. A clinically significant prediction of outcomes could spare the frustration of trial and error approach and improve the outcomes of major depressive disorder through individualized treatment selection. It is likely that a combination of multiple predictors is needed to achieve such prediction. We used elastic net regularized regression to optimize prediction of symptom improvement and remission during treatment with escitalopram or nortriptyline and to identify contributing predictors from a range of demographic and clinical variables in 793 adults with major depressive disorder. A combination of demographic and clinical variables, with strong contributions from symptoms of depressed mood, reduced interest, decreased activity, indecisiveness, pessimism and anxiety significantly predicted treatment outcomes, explaining 5-10% of variance in symptom improvement with escitalopram. Similar combinations of variables predicted remission with area under the curve 0.72, explaining approximately 15% of variance (pseudo R(2)) in who achieves remission, with strong contributions from body mass index, appetite, interest-activity symptom dimension and anxious-somatizing depression subtype. Escitalopram-specific outcome prediction was more accurate than generic outcome prediction, and reached effect sizes that were near or above a previously established benchmark for clinical significance. Outcome prediction on the nortriptyline arm did not significantly differ from chance. These results suggest that easily obtained demographic and clinical variables can predict therapeutic response to escitalopram with clinically meaningful accuracy, suggesting a potential for individualized prescription of this antidepressant drug. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  5. Clinical trial of lutein in patients with retinitis pigmentosa receiving vitamin A treatment

    Science.gov (United States)

    We sought to determine whether lutein supplementation will slow visual function decline in patients with retinitis pigmentosa receiving vitamin A. DESIGN: Randomized, controlled, double-masked trial of 225 nonsmoking patients, aged 18 to 60 years, evaluated over a 4-year interval. Patients received ...

  6. Fc-gamma receptor polymorphisms as predictive and prognostic factors in patients receiving oncolytic adenovirus treatment

    Science.gov (United States)

    2013-01-01

    Background Oncolytic viruses have shown potential as cancer therapeutics, but not all patients seem to benefit from therapy. Polymorphisms in Fc gamma receptors (FcgRs) lead to altered binding affinity of IgG between the receptor allotypes and therefore contribute to differences in immune defense mechanisms. Associations have been identified between FcgR polymorphisms and responsiveness to different immunotherapies. Taken together with the increasing understanding that immunological factors might determine the efficacy of oncolytic virotherapy we studied whether FcgR polymorphisms would have prognostic and/or predictive significance in the context of oncolytic adenovirus treatments. Methods 235 patients with advanced solid tumors were genotyped for two FcgR polymorphisms, FcgRIIa-H131R (rs1801274) and FcgRIIIa-V158F (rs396991), using TaqMan based qPCR. The genotypes were correlated with patient survival and tumor imaging data. Results In patients treated with oncolytic adenoviruses, overall survival was significantly shorter if the patient had an FcgRIIIa-VV/ FcgRIIa-HR (VVHR) genotype combination (P = 0,032). In contrast, patients with FFHR and FFRR genotypes had significantly longer overall survival (P = 0,004 and P = 0,006, respectively) if they were treated with GM-CSF-armed adenovirus in comparison to other viruses. Treatment of these patients with unarmed virus correlated with shorter survival (P treatment with other viruses (P = 0,047). Conclusions Our data are compatible with the hypothesis that individual differences in effector cell functions, such as NK cell-mediated antibody-dependent cellular cytotoxicity (ADCC) and tumor antigen presentation by APCs caused by polymorphisms in FcgRs could play role in the effectiveness of oncolytic virotherapies. If confirmed in larger populations, FcgR polymorphisms could have potential as prognostic and predictive biomarkers for oncolytic adenovirus therapies to enable better selection of patients

  7. Scores on the eysenck personality questionnaire for a sample of children and adolescents receiving psychological treatment in Puerto Rico.

    Science.gov (United States)

    Porrata, Jose Luis; Rosa, Abraham; Mendez, Viviana

    2003-08-01

    Personality questionnaire scores obtained by children and adolescents (n = 28) receiving psychological treatment at a health facility in Humacao, Puerto Rico were examined. The scores were compared with those of regular school children of the same age, of Gurabo, Puerto Rico, who were not in treatment (n = 30). The children in treatment obtained higher scores on Psychoticism, lower scores on Extraversion, and similar scores on Neuroticism and Dissimulation by comparison with regular students.

  8. Liposomal dexamethasone-diclofenac combinations for local osteoarthritis treatment.

    Science.gov (United States)

    Elron-Gross, Inbar; Glucksam, Yifat; Margalit, Rimona

    2009-07-06

    Conventional chronic and acute treatments for osteoarthritis (OA) are by oral NSAIDs (such as diclofenac) and intra-articular injected glucocorticosteroids (such as dexamethasone). In free form, diclofenac and dexamethasone generate severe adverse effects with risks of toxicity. To reduce these drawbacks, we investigated local injections of liposomal formulations for diclofenac and dexamethasone (each alone, and their combination). Bioadhesive liposomes carrying hyaluronan (HA-BAL) or collagen (COL-BAL) as their surface-anchored ligand were used for the task. Each drug alone or their combination showed high efficiency encapsulations (> or =80%) and performance as slow-release depots (half-lives in the range of 1-3 days under the fastest conditions). Employing RIA and immunoblot assay techniques, it was verified that the encapsulated drugs retained their biological activities: inhibitions of Cyclooxygenases enzyme-activity (diclofenac) and of Cyclooxygenases protein-expression (dexamethasone). Using live-animal MRI, a single intra-articular injection of each liposome-drug(s) formulation sufficed to reduce knee joint inflammation in OA rats over a time span of 17 days, HA-BAL better than COL-BAL. The most effective treatment was by the combination of both drugs in HA-BAL, a single dose reducing the inflammation volume down to 12.9% from initial over that time span. We find all three HA-BAL formulations worthy of further studies.

  9. Treatment of gastroduodenal ulcers with cimetidine in combination with low-dose propantheline

    DEFF Research Database (Denmark)

    Paerregaard, A; Hendel, L; Schultz-Larsen, K

    1983-01-01

    Fifty-eight adult outpatients with endoscopically verified gastric, prepyloric or duodenal ulcers completed a double-blind trial of treatment with either cimetidine, 1 g daily, plus propantheline, 45 mg daily (group A) or cimetidine, 1 g daily, plus placebo (group B). After neither three nor six...... weeks of treatment was there any significant difference between the two groups with regard to ulcer healing or symptomatic relief. The ulcers of 22 (79%) of the 28 patients in group A and 25 (83%) of the 30 patients in group B were healed after six weeks, and 93% of the patients in both groups became...... painfree. We were thus not able to show any advantage in combining cimetidine treatment for ulcer healing with low-dose propantheline. In a small open trial the patients with healed ulcers received prophylactic treatment for 12 months with 1) cimetidine 800 mg daily, 2) cimetidine 400 mg at bedtime plus...

  10. Platelet-rich plasma: combinational treatment modalities for musculoskeletal conditions.

    Science.gov (United States)

    Andia, Isabel; Abate, Michele

    2017-10-18

    Current research on common musculoskeletal problems, including osteoarticular conditions, tendinopathies, and muscle injuries, focuses on regenerative translational medicine. Platelet-rich plasma therapies have emerged as a potential approach to enhance tissue repair and regeneration. Platelet-rich plasma application aims to provide supraphysiological concentrations of platelets and optionally leukocytes at injured/pathological tissues mimicking the initial stages of healing. However, the efficacy of platelet-rich plasma is controversial in chronic diseases because patients' outcomes show partial improvements. Platelet-rich plasma can be customized to specific conditions by selecting the most appropriate formulation and timing for application or by combining platelet-rich plasma with synergistic or complementary treatments. To achieve this goal, researchers should identify and enhance the main mechanisms of healing. In this review, the interactions between platelet-rich plasma and healing mechanisms were addressed and research opportunities for customized treatment modalities were outlined. The development of combinational platelet-rich plasma treatments that can be used safely and effectively to manipulate healing mechanisms would be valuable and would provide insights into the processes involved in physiological healing and pathological failure.

  11. Pyronaridine-artesunate combination therapy for the treatment of malaria.

    Science.gov (United States)

    Kurth, Florian; Bélard, Sabine; Basra, Arti; Ramharter, Michael

    2011-12-01

    Pyronaridine-artesunate is among the most promising novel artemisinin combination therapies for the treatment of malaria. A series of clinical phase II and III trials have been conducted for the indications of uncomplicated falciparum and vivax malaria in Africa and Asia. On the basis of these novel data, this review aims to provide an appraisal of current evidence and a perspective for its future role in the antimalarial portfolio. Pyronaridine-artesunate demonstrated repeatedly high efficacy in the treatment of vivax and falciparum malaria and noninferiority was established compared to standard comparator regimens. An innovative paediatric drug formulation was developed in parallel to the tablet formulation for the treatment of young children. Pharmacokinetic analysis showed dose linearity, low interindividual variation and absence of a clinically important effect of food on the bioavailability of this drug combination. Overall tolerability and safety data are reassuring; however, further surveillance of safety in special patient populations including young children is warranted. Pyronaridine-artesunate - currently under evaluation by the European Medicines Agency - may become a preferred choice as first-line therapy in malaria endemic regions based on its low cost, long shelf-life, simplified once-daily dosing regimen, proven efficacy against falciparum and vivax malaria, and the parallel clinical development of a paediatric drug formulation.

  12. [Treatment of combined hyperlipidemia: fibrate and/or statin?].

    Science.gov (United States)

    Scheen, A J

    1999-07-01

    Combined hyperlipidaemia, associating hypercholesterolaemia and hypertriglyceridaemia, is a common metabolic disorder with a prevalence of about 1/500. It has a genetic background, but its phenotype is triggered by various predisposing factors such as obesity, type 2 diabetes and alcohol consumption. Combined hyperlipidaemia is undoubtedly associated with an increased cardiovascular risk and thus deserves specific management. After diet failure, the first drug choice remains controversial. Indeed, fibrates are more active on hypertriglyceridaemia while statins are more active on hypercholesterolaemia (LDL subfraction). Both pharmacological classes have their advantages and disadvantages, and there is no prospective study comparing the cardiovascular protective efficacy of these two treatments in patients with such dyslipidemia. Furthermore, monotherapy is generally incapable of normalizing the lipid profile in the presence of severe combined hyperlipidaemia. Ideally, a statin-fibrate combination would be most appropriate in order to act on the two components of such hyperlipidaemia and to benefit of the complementary and additive action of the two pharmacological classes. Such association is still contra-indicated because of the description of some cases of rhabdomyolysis is high risk patients; however, it now deserves much interest and is currently being tested in large prospective studies, especially in the population with type 2 diabetes.

  13. Insulin pump for the treatment of diabetes in combination with ulcerative foot infections.

    Science.gov (United States)

    Fan, H J; Yu, J H; Cui, G M; Zhang, W Y; Yang, X; Dong, Q J

    2016-01-01

    Ulcerative foot infection is a chronic complication frequently seen in diabetic patients, and can result in disability. To evaluate insulin pump treatment for type 2 diabetes in combination with ulcerative foot infection, we selected 168 diabetic patients who developed foot ulcers and received treatment from April 2012 to April 2014 in the People’s Hospital of Zhengzhou, Henan, China. The patients were divided into a treatment group and a control group, 84 in each group. Besides anti-infection treatment, patients in the control group were given multiple subcutaneous insulin injection (MSII), while patients in the treatment group were given continuous subcutaneous insulin infusion (CSII). Ulcer area, fasting plasma glucose (FPG), C-reactive protein (CRP) and count of white blood cells (WBC) were recorded before treatment, one week after treatment, two weeks after treatment and four weeks after treatment; moreover, ulcer healing condition was recorded four weeks after treatment and the related factors were analyzed. Patients in the treatment group showed an obviously narrowed ulcer area two and four weeks after treatment (P less than 0.05) and significantly lowered levels of FPG, CRP and WBC in the 1st, 2nd and 3rd weeks after treatment (P less than 0.05); four weeks after treatment, 88.1% of patients in the treatment group and 66.7% in the control group had healed well, and the difference between two groups was statistically significant (χ2=5.509, P=0.019). Multi-factor logistic regression analysis indicated that levels of FPG, CRP and WBC at baseline and four weeks after treatment had a positive correlation to ulcer healing (P less than 0.05). All the above findings suggest that insulin pump can improve ulcer healing of patients suffering from diabetic foot ulcers as it effectively controls blood glucose level, restrains inflammatory reaction and prevents spreading of infection.

  14. COMBINED TREATMENT OF LOCALLY-ADVANCED BLADDER CANCER

    Directory of Open Access Journals (Sweden)

    I. V. Chernyshev

    2015-01-01

    Full Text Available Bladder cancer (BC is an important clinical and scientific challenge. In 2013, in Russia, the absolute number of patients with first-ever diagnosis of bladder cancer was 12 992 people. There is an increasing proportion of detection of bladder cancer stage I–II disease patterns: 2003–50.8% in 2013–69.6%, while the number of newly diagnosed patients in III and IV clinical stages remains at 30%. The proportion of individuals who completed the treatment of the number of newly diagnosed patients with bladder cancer in 2013, was as follows: only surgical method — 65.4%, 33.5% combined. Purpose. Improvement of the results of treatment of patients with locally advanced bladder cancer. Materials and methods. The main treatment for muscle-invasive bladder cancer is radical cystectomy. In the combined treatment of bladder cancer chemotherapy is the component that systemic exposure to the tumor, the way of regional and distant metastases. The study included 132 patients with locally advanced bladder cancer who were treated for 2005–2013, divided into four groups: NACT + CE — 27 people (20.5%, CE + ACT — 21 (15.9%, NACT + CE + ACT — 21 (15.9% only CE — 63 (47.7%. An important component of treatment has been the use of platinum (cisplatin or carboplatin in Schemes M–VAC and GP. An objective response is possible in 44.7%, and the stabilization process in 40.4% of patients.Results. The clinical effect is evaluated in all patients. In the group of NACT 21% of patients survived for more than 4 years, but did not survive the 5‑year mark. In the group of CE + ACT the indicator achieved only 3‑year survival rate, which amounted to 43%. In the group of CE — none of the patients did not live up to 3 years, with 2‑year survival rate was 30%. In the group of ACT + NCT + CE 3 patients (15% were alive at the time, passed the threshold of the 5‑year survival rate, there is no progression of cancer.Conclusion. Combined treatment mode NACT

  15. Emerging treatments and combinations in the management of NSCLC

    DEFF Research Database (Denmark)

    Reck, Martin; Mellemgaard, Anders

    2015-01-01

    There remains an unmet need for effective, well-tolerated treatment options in advanced non-small cell lung cancer (NSCLC) to alleviate the disease burden for a broad selection of patients. Nintedanib is a potent, oral, triple angiokinase inhibitor of vascular endothelial growth factor, fibroblast...... to the approval of nintedanib, addition of nintedanib to docetaxel significantly improved overall survival in patients with adenocarcinoma histology. Nintedanib demonstrated a manageable safety profile in combination with docetaxel. This review focuses on the clinical experience with nintedanib in NSCLC...... investigated extensively in preclinical research and in a number of clinical studies, the most important of which was the Phase III LUME-Lung 1 study, which investigated nintedanib in combination with docetaxel in patients with advanced NSCLC after failure of first-line chemotherapy. In this study, which led...

  16. Suicidal Behavior Among People Living with HIV (PLHIV) in Medical Care in Estonia and Factors Associated with Receiving Psychological Treatment.

    Science.gov (United States)

    Lemsalu, Liis; Rüütel, Kristi; Laisaar, Kaja-Triin; Lõhmus, Liilia; Raidvee, Aire; Uusküla, Anneli

    2017-06-01

    People living with HIV (PLHIV) have higher rates of suicidal behavior than the general population. This study assessed suicidal behavior (ideation and/or attempts, ever and in the past 12 months) among PLHIV receiving outpatient HIV medical care in Estonia and associations between suicidal behavior and psychological treatment. The cross-sectional study collected data from January to November 2013 using a self-report questionnaire. Eight hundred PLHIV participated, 39 % (n = 306) of whom had been suicidal. Lifetime prevalence was 36 % for suicidal ideation and 20 % for attempts. Younger age, incarceration, having ever abused alcohol and also injected drugs, having lived with HIV for more than 10 years, and being depressed were associated with lifetime suicidal behavior. Suicidal behavior within the past 12 months was reported by 20 % (n = 156) of respondents. Of these, 27 % received psychological treatment (counseling and/or psychotherapy), 20 % had taken antidepressants, and 49 % sedatives. Individuals perceiving a need for treatment were significantly more likely to receive psychological treatment when experiencing suicidal behavior (OR 25.65, 95 % CI 2.92-225.47). In conclusion, suicidal behavior is frequent among PLHIV but psychological treatment is not often received. One of the barriers to treatment is patients' lack of perceived need for help.

  17. Combination treatment of tamoxifen with risperidone in breast cancer.

    Directory of Open Access Journals (Sweden)

    Wei-Lan Yeh

    Full Text Available Tamoxifen has long been used and still is the most commonly used endocrine therapy for treatment of both early and advanced estrogen receptor-positive breast cancer in pre- and post-menopause women. Tamoxifen exerts its cytotoxic effect primarily through cytostasis which is associated with the accumulation of cells in the G0/G1 phase of the cell cycle. Apoptotic activity can also be exerted by tamoxifen which involves cleavage of caspase 9, caspase 7, caspase 3, and poly-ADP-ribose polymerase (PARP. Down-regulation of anti-apoptotic proteins Bcl-2 and Bcl-xL and up-regulation of pro-apoptotic proteins Bax and Bak have also been observed. In addition, stress response protein of GRP 94 and GRP 78 have also been induced by tamoxifen in our study. However, side effects occur during tamoxifen treatment in breast cancer patients. Researching into combination regimen of tamoxifen and drug(s that relieves tamoxifen-induced hot flushes is important, because drug interactions may decrease tamoxifen efficacy. Risperidone has been shown to be effective in reducing or eliminating hot flushes on women with hormonal variations. In this present study, we demonstrated that combination of tamoxifen with risperidone did not interfered tamoxifen-induced cytotoxic effects in both in vitro and in vivo models, while fluoxetine abrogated the effects of tamoxifen. This is the first paper suggesting the possibility of combination treatment of tamoxifen with risperidone in breast cancer patients, providing a conceivable resolution of tamoxifen-induced side effects without interfering the efficacy of tamoxifen against breast cancer.

  18. Combination Treatment of Tamoxifen with Risperidone in Breast Cancer

    Science.gov (United States)

    Yeh, Wei-Lan; Lin, Hui-Yi; Wu, Hung-Ming; Chen, Dar-Ren

    2014-01-01

    Tamoxifen has long been used and still is the most commonly used endocrine therapy for treatment of both early and advanced estrogen receptor-positive breast cancer in pre- and post-menopause women. Tamoxifen exerts its cytotoxic effect primarily through cytostasis which is associated with the accumulation of cells in the G0/G1 phase of the cell cycle. Apoptotic activity can also be exerted by tamoxifen which involves cleavage of caspase 9, caspase 7, caspase 3, and poly-ADP-ribose polymerase (PARP). Down-regulation of anti-apoptotic proteins Bcl-2 and Bcl-xL and up-regulation of pro-apoptotic proteins Bax and Bak have also been observed. In addition, stress response protein of GRP 94 and GRP 78 have also been induced by tamoxifen in our study. However, side effects occur during tamoxifen treatment in breast cancer patients. Researching into combination regimen of tamoxifen and drug(s) that relieves tamoxifen-induced hot flushes is important, because drug interactions may decrease tamoxifen efficacy. Risperidone has been shown to be effective in reducing or eliminating hot flushes on women with hormonal variations. In this present study, we demonstrated that combination of tamoxifen with risperidone did not interfered tamoxifen-induced cytotoxic effects in both in vitro and in vivo models, while fluoxetine abrogated the effects of tamoxifen. This is the first paper suggesting the possibility of combination treatment of tamoxifen with risperidone in breast cancer patients, providing a conceivable resolution of tamoxifen-induced side effects without interfering the efficacy of tamoxifen against breast cancer. PMID:24886861

  19. Sex differences in reinstatement of cocaine-seeking with combination treatments of progesterone and atomoxetine.

    Science.gov (United States)

    Swalve, Natashia; Smethells, John R; Zlebnik, Natalie E; Carroll, Marilyn E

    2016-06-01

    Two repurposed medications have been proposed to treat cocaine abuse. Progesterone, a gonadal hormone, and atomoxetine, a medication commonly used to treat attention deficit/hyperactivity disorder, have both been separately shown to reduce cocaine self-administration and reinstatement (i.e., relapse). The goal of the present study was to examine sex differences in the individual effects of PRO and ATO as well as the combination PRO+ATO treatment on cocaine (COC), caffeine (CAF), and/or cue-primed reinstatement of cocaine-seeking. Adult male and female Wistar rats lever-pressed under a FR 1 schedule for cocaine infusions (0.4mg/kg/inf). After 14 sessions of stable responding in daily 2-h sessions, rats underwent a 21-day extinction period when no drug or drug-related stimuli were present. Rats were then separated into four groups that received PRO (0.5mg/kg) alone (PRO+SAL), ATO (1.5mg/kg) alone (VEH+ATO), control (VEH+SAL) or combination (PRO+ATO) treatments prior to the reinstatement condition. Reinstatement of cocaine-seeking to cues and/or drug injections of cocaine or caffeine was tested after extinction. During maintenance, females self-administered more cocaine than males, but no sex differences were seen during extinction. Females showed greater cocaine-seeking than males after a CAF priming injection. Individual treatment with ATO did not decrease reinstatement under any priming condition; however, the combination treatment decreased cocaine-seeking under the COC+CUES priming condition in males, and both PRO alone and the combination treatment decreased cocaine-seeking in the CAF+CUES condition in females. Overall, PRO alone was only effective in reducing reinstatement in females, while the combination treatment was consistently effective in reducing reinstatement in both sexes. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Combined hemofiltration and desferrioxamine treatment for aluminum induced osteomalacia.

    Science.gov (United States)

    Barré, P E; Prichard, S

    1986-05-01

    A 61-year-old male hemodialysis patient developed the syndrome of aluminum intoxication including bone pain, fractures, proximal myopathy, progressive anemia and expressive aphasia. Serum aluminum was 130 micrograms/l and rose to 445 micrograms/l after the administration of 2 grams of desferrioxamine. Bone biopsy of the iliac crest revealed severe osteomalacia, heavy staining for aluminum and a bone aluminum content of 229 mg/kg dry bone. Treatment with combined hemofiltration and desferrioxamine administration led to a marked clinical improvement and a repeat bone biopsy striking healing of the osteomalacia with a bone aluminum content of 11 mg/kg dry bone.

  1. Household food insecurity, maternal nutritional status, and infant feeding practices among HIV-infected Ugandan women receiving combination antiretroviral therapy.

    Science.gov (United States)

    Young, Sera L; Plenty, Albert H J; Luwedde, Flavia A; Natamba, Barnabas K; Natureeba, Paul; Achan, Jane; Mwesigwa, Julia; Ruel, Theodore D; Ades, Veronica; Osterbauer, Beth; Clark, Tamara D; Dorsey, Grant; Charlebois, Edwin D; Kamya, Moses; Havlir, Diane V; Cohan, Deborah L

    2014-11-01

    Household food insecurity (HHFI) may be a barrier to both optimal maternal nutritional status and infant feeding practices, but few studies have tested this relationship quantitatively, and never among HIV-infected individuals. We therefore described the prevalence of HHFI and explored if it was associated with poorer maternal nutritional status, shorter duration of exclusive breastfeeding (EBF) and fewer animal-source complementary foods. We assessed these outcomes using bivariate and multivariate analyses among 178 HIV-infected pregnant and breastfeeding (BF) women receiving combination antiretroviral therapy in the PROMOTE trial (NCT00993031), a prospective, longitudinal cohort study in Tororo, Uganda. HHFI was common; the prevalence of severe, moderate, and little to no household hunger was 7.3, 39.9, and 52.8 %, respectively. Poor maternal nutritional status was common and women in households experiencing moderate to severe household hunger (MSHH) had statistically significantly lower body mass index (BMIs) at enrollment (21.3 vs. 22.5, p < 0.01) and prior to delivery (22.6 vs. 23.8, p < 0.01). BMI across time during pregnancy, but not gestational weight gain, was significantly lower for MSHH [adjusted beta (95 % CI) -0.79 (-1.56, -0.02), p = 0.04; -2.06 (-4.31, 0.19), p = 0.07], respectively. The prevalence (95 % CI) of EBF at 6 months was 67.2 % (59.7-73.5 %), and the proportion of women BF at 12 months was 80.4 % (73.3-85.7 %). MSHH was not associated with prevalence of EBF at 6 months or BF at 12 months. However, among those women still EBF at 4 months (81.4 % of population), those experiencing MSHH were significantly more likely to cease EBF between 4 and 6 months (aHR 2.38, 95 % CI 1.02-5.58). The prevalence of HHFI, maternal malnutrition, and suboptimal infant feeding practices are high and the causal relationships among these phenomena must be further explored.

  2. Severe hyperpigmentation and scarring following glycolic acid peel treatment in combination with low-dose isotretinoin.

    Science.gov (United States)

    Gerber, Peter Arne; Kukova, Gabriela; Bölke, Edwin; Homey, Bernhard; Diedrichson, Evelyn

    2014-11-07

    The application of systemic isotretinoin in the treatment of cutaneous photoaging has been well investigated. In addition, well-recognized topical antiaging therapies such as superficial chemical peeling (CP) with α-hydroxy acids have been shown to be more helpful when combined with low-dose oral isotretinoin. Even though the combination of systemic isotretinoin and medium to deep CP has been associated with serious side effects such as delayed wound healing and enlarged incidence of scarring, to date superficial CP and concomitant systemic isotretinoin have been considered safe. In this report, we present the case of a patient receiving low-dose oral isotretinoin therapy who developed severe painful erythema and erosions that led to permanent hyperpigmentation and scarring of her face and neck after undergoing superficial CP with glycolic acid. There is a potential risk of hyperpigmentation and scarring with the use of a combination of low-dose oral isotretinoin and glycolic acid peeling.

  3. Effectiveness of medication / auricular therapy / phyto-therapy combination in the treatment of hypertensive patients

    Directory of Open Access Journals (Sweden)

    José Ramón Martínez Pérez

    2015-10-01

    Full Text Available Background: hypertension is one of the main cardiovascular risk factors, so its control improves the life expectancy of patients.Objective: to assess the effects of a treatment combining medication with auricular therapy and phyto-therapy in hypertensive patients assisted at the health area of ”Romárico Oro” Polyclinic, in Puerto Padre, Las Tunas province.Methods: an intervention study was carried out in 68 hypertensive patients of the health area of “Romárico Oro” Polyclinic in Puerto Padre from April, 2013 to April, 2014. The patients were distributed at random into two equal groups; the first received medication combined with auricular therapy and phyto-therapy, while the second one received only medication. The statistical analysis was done by means of Statistic system, t-student and Chi-Square tests were used and p< or =0.05 was considered as level of statistical significance.Results: by the end of the intervention, 73, 53% of the patients of the group with the combination of drug treatment and auricular therapy and phyto-therapy were controlled. In this group, the diastolic filling pressure diminished to 2, 2 mm Hg and the systolic gradient to 3, 66 mm, regarding the group treated only with drugs. Only one patient, representing the 2, 94% showed adverse reaction to the natural and traditional treatment.Conclusions: the combination of medication with auricular therapy and phyto-therapy proved to be effective, corroborated by a significant decrease of quantity of crisis, diastolic and systolic filling pressure values and increase of number of patients with their disease controlled; the report of only one complication shows the innocuousness of the auricular therapy and phyto-therapy treatment.

  4. The safe delivery of fractional ablative carbon dioxide laser treatment for acne scars in Asian patients receiving oral isotretinoin.

    Science.gov (United States)

    Kim, Hyun Woo; Chang, Sung Eun; Kim, Jeong Eun; Ko, Joo Yeon; Ro, Young Suck

    2014-12-01

    Because acne scarring is associated with substantially reduced quality of life, early initiation of effective treatment is desirable. In previous reports, isotretinoin treatment was associated with increased scarring after cosmetic procedures, such as laser treatment, dermabrasion, and chemical peeling. To evaluate wound healing after ablative carbon dioxide (CO2) fractional resurfacing for acne scarring conducted during and/or within 1 to 3 months of oral isotretinoin treatment. The records of 20 patients with facial acne scars were included in this retrospective study. All patients were receiving isotretinoin treatment or had completed it within the previous 1 to 3 months. All patients received full-face fractional ablative CO2 laser treatment. Follow-up was for at least 6 months to evaluate side effects. All patients showed normal reepithelialization and were satisfied with the results of the laser treatments. All adverse events were minor, and there were no hypertrophic scars or keloids. Ablative CO2 fractional laser treatment for acne scarring seems to be safe regardless of isotretinoin use (10-60 mg/d). The authors' findings contribute to the discussion of whether oral isotretinoin treatment impairs wound healing after ablative laser treatment.

  5. Combined photo-Fenton-SBR process for antibiotic wastewater treatment.

    Science.gov (United States)

    Elmolla, Emad S; Chaudhuri, Malay

    2011-09-15

    The study examined combined photo-Fenton-SBR treatment of an antibiotic wastewater containing amoxicillin and cloxacillin. Optimum H(2)O(2)/COD and H(2)O(2)/Fe(2+) molar ratio of the photo-Fenton pretreatment were observed to be 2.5 and 20, respectively. Complete degradation of the antibiotics occurred in one min. The sequencing batch reactor (SBR) was operated at different hydraulic retention times (HRTs) with the wastewater treated under different photo-Fenton operating conditions (H(2)O(2)/COD and H(2)O(2)/Fe(2+) molar ratio). The SBR performance was found to be very sensitive to BOD(5)/COD ratio of the photo-Fenton treated wastewater. Statistical analysis of the results indicated that it was possible to reduce the Fe(2+) dose and increase the irradiation time of the photo-Fenton pretreatment. The best operating conditions of the combined photo-Fenton-SBR treatment were observed to be H(2)O(2)/COD molar ratio 2, H(2)O(2)/Fe(2+) molar ratio 150, irradiation time 90 min and HRT of 12h. Under the best operating conditions, 89% removal of sCOD with complete nitrification was achieved and the SBR effluent met the discharge standards. Copyright © 2011 Elsevier B.V. All rights reserved.

  6. The Role of Treatment Expectancy in Youth Receiving Exposure-based CBT for Obsessive Compulsive Disorder

    OpenAIRE

    Lewin, Adam B.; Peris, Tara S.; Bergman, R. Lindsey; McCracken, James T.; Piacentini, John

    2011-01-01

    The purpose of this investigation was to examine correlates of parent, child, and therapist treatment expectations and their role in the exposure-based treatment of childhood obsessive compulsive disorder (OCD). Treatment expectations were assessed among 49 youth with primary OCD, their parents, and therapists as part of the baseline evaluation and post-treatment clinical outcomes were determined by blind evaluators. Baseline depressive symptoms, child/parent-rated functional impairment, exte...

  7. Efficacy of combined orthodontic-periodontic treatment for patients with periodontitis and its effect on inflammatory cytokines: A comparative study.

    Science.gov (United States)

    Zhang, Jin; Zhang, Ai-Min; Zhang, Zong-Mei; Jia, Jin-Lin; Sui, Xin-Xin; Yu, Lu-Rui; Liu, Hai-Tao

    2017-10-01

    In this study, we aimed to investigate the efficacy of combined orthodontic-periodontic treatment in the treatment of patients with periodontitis and its effects on the levels of inflammatory cytokines. A total of 117 patients with periodontitis were randomly assigned to the basic group (receiving basic periodontic treatment, n = 58) and the combined group (receiving combined orthodontic-periodontic treatment, n = 59). In addition, 52 healthy people without periodontal disease were selected as the normal group. Probing depth, tooth mobility, plaque index, clinical attachment level, and sulcus bleeding index were recorded. ELISA was applied to detect gingival crevicular fluid (GCF) and serum levels of inflammatory cytokines. A 2-year clinical follow-up was conducted. Before treatment, the periodontal parameters (probing depth, tooth mobility, plaque index, clinical attachement level, and sulcus bleeding index) and GCF and serum levels of inflammatory cytokines (high-sensitivity C-reactive protein, interleukin-1β, interleukin-5, interleukin-6, interleukin-8, tumor necrosis factor-α, and prostaglandin E2) in the combined and basic groups were higher than those in the normal group. After 6 and 18 months of treatment, the periodontal parameters and GCF and serum levels of inflammatory cytokines decreased in the combined and basic groups. The periodontal parameters and the GCF and serum levels of inflammatory cytokines in the combined group were significantly lower than those in the basic group after 18 months of treatment. The combined group had a lower recurrence rate compared with the basic group. Combined orthodontic-periodontic treatment had good clinical efficacy in the treatment of periodontitis and could effectively decrease the levels of inflammatory cytokines. Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

  8. Effectiveness of standardized combination therapy for migraine treatment in the pediatric emergency department.

    Science.gov (United States)

    Leung, Stephanie; Bulloch, Blake; Young, Christine; Yonker, Marcy; Hostetler, Mark

    2013-03-01

    To compare outcomes of pediatric migraine patients treated in an emergency department (ED) before and after implementation of a standardized combination intravenous therapy regimen aimed toward improving and standardizing abortive migraine therapy. In a pediatric ED, migraines represent 8-18% of all headache visits. Despite this large number, no standard treatment for acute migraine therapy currently exists. The study utilized a retrospective chart review of patients seeking acute migraine treatment at a tertiary care, pediatric ED from August 2006 to March 2010. Inclusion criteria were pediatric migraine patients as defined by International Headache Society guidelines. The comparison population received various migraine therapies based on attending practice preference. After October 2008, patients received standardized intravenous combination therapy involving a normal saline fluid bolus, ketorolac, prochlorperazine, and diphenhydramine. Occasionally, metoclopramide was substituted during prochlorperazine shortages. Reduction in headache pain score was the primary outcome. Secondary outcome measures included length of ED stay, hospital admission rate, and ED readmission rate within 48 hours. The study yielded 87 patients who received standardized combination therapy and 165 comparison patients. No significant difference in patient characteristics existed when evaluating patient demographics, outpatient medication use, and initial headache pain score. When compared with the non-standardized therapy population, the combination therapy patients revealed significant reductions in pain score (decrease of 5.3 vs. 6.9, difference -1.6, 95% confidence interval -2.2 to -0.8, P pediatric migraine therapy in the ED by significantly reducing headache pain scores, length of ED stay, and hospital admission rates. © 2013 American Headache Society.

  9. Combined treatment with headgear and the Frog appliance for maxillary molar distalization: a randomized controlled trial.

    Science.gov (United States)

    Burhan, Ahmad Sharafeddin

    2013-04-01

    To evaluate the efficiency of the Frog appliance (FA) alone or in combination with headgear for distalizing the maxillary molars. Fifty patients (25 males and 25 females) aged 12.6 - 16.7 years who received treatment for Class II malocclusion at the Orthodontic Clinic of Al-Baath University were selected for this study and randomly divided into 2 equal groups. Maxillary molar distalization was achieved using the FA alone (group 1) or a combination of the FA with high-pull headgear worn at night (group 2). Lateral cephalograms were obtained before and after treatment. The maxillary molars moved distally by 5.51 and 5.93 mm in groups 1 and 2, respectively. Distal movements were associated with axial tipping by 4.96° and 1.25°, and with loss of anchorage by mesial movement of the second maxillary premolars by 2.70 and 0.90 mm in groups 1 and 2, respectively. The combined use of the FA and nighttime high-pull headgear decreased the distalization time and improved the ratio of maxillary molar distalization movement relative to the overall opening space between the first maxillary molars and second premolars. The FA can effectively distalize the maxillary molars, this distalization associates with some unfavorable changes. Nighttime use of high-pull headgear combined with the FA can reduce these unfavorable changes and improve treatment outcomes.

  10. Macrofilaricidal Activity in Wuchereria bancrofti after 2 Weeks Treatment with a Combination of Rifampicin plus Doxycycline

    Directory of Open Access Journals (Sweden)

    Alexander Yaw Debrah

    2011-01-01

    Full Text Available Infection with the filarial nematode Wuchereria bancrofti can lead to lymphedema, hydrocele, and elephantiasis. Since adult worms cause pathology in lymphatic filariasis (LF, it is imperative to discover macrofilaricidal drugs for the treatment of the infection. Endosymbiotic Wolbachia in filariae have emerged as a new target for antibiotics which can lead to macrofilaricidal effects. In Ghana, a pilot study was carried out with 39 LF-infected men; 12 were treated with 200 mg doxycycline/day for 4 weeks, 16 were treated with a combination of 200 mg doxycycline/day + 10 mg/kg/day rifampicin for 2 weeks, and 11 patients received placebo. Patients were monitored for Wolbachia and microfilaria loads, antigenaemia, and filarial dance sign (FDS. Both 4-week doxycycline and the 2-week combination treatment reduced Wolbachia load significantly. At 18 months posttreatment, four-week doxycycline resulted in 100% adult worm loss, and the 2-week combination treatment resulted in a 50% adult worm loss. In conclusion, this pilot study with a combination of 2-week doxycycline and rifampicin demonstrates moderate macrofilaricidal activity against W. bancrofti.

  11. Improved Clinical Functioning for Patients Receiving Fee Discounts That Reward Treatment Engagement.

    Science.gov (United States)

    Stanley, Ian H; Chu, Carol; Brown, Tiffany A; Sawyer, Kathryn A; Joiner, Thomas E

    2016-01-01

    Financial incentives may have utility in promoting psychotherapy attendance and adherence, leading to improved clinical functioning. This study presents results from a novel application of financial incentives-a progressively lowered pay scale that rewards therapy attendance and adherence. Overall, 110 outpatients participated; 56 patients (51%) were enrolled in the financial incentives condition and received a 5% fee discount-applied iteratively across sessions-if they followed defined criteria (e.g., completed homework). There were no statistically significant differences between groups in terms of the number of sessions attended, therapy duration, and number of no-shows and cancellations. However, adjusting for Global Assessment of Functioning (GAF) at intake, patients receiving the financial incentives had significantly higher GAF rating at termination compared with those who did not receive the intervention. Financial incentives that reward therapy attendance and adherence with discounted fees is associated with improved clinical functioning. © 2015 Wiley Periodicals, Inc.

  12. Combined fractional ablative and nonablative laser resurfacing treatment: a split-face comparative study.

    Science.gov (United States)

    Cohen, Joel L; Ross, E Victor

    2013-02-01

    Fractional ablative and nonablative lasers are useful tools for facial rejuvenation; however, ablative lasers require a period of downtime during reepthelialization. A procedure that combines both ablative and nonablative lasers may deliver good cosmetic results and reduce downtime or other side effects of treatment. The purpose of this study was to compare a combined fractional ablative and nonablative laser procedure to ablative-only procedures for facial rejuvenation. A total of 8 subjects in 2 study groups received a single, split-face, facial rejuvenation procedure in this study. In group A, we compared a combined procedure using a fractional nonablative 1,440-nm neodymium-doped yttrium aluminum garnet (YAG) laser and a fractional ablative 2,940-nm erbium (Er)-doped YAG laser on one side of the face, and a combined confluent/fractional ablative Er:YAG laser on the other. In group B, we compared the same 1,440/2,940 treatment as group A on one side of the face, and a fractional ablative CO2 laser on the other. Subjects were followed for 3 months to assess side effects and improvement in Fitzpatrick Wrinkle Score and pigmentation. Improvement in wrinkles and pigment were seen with all techniques in both groups, and results were equivalent. Areas treated with combined fractional nonablative and ablative technique demonstrated fewer immediate side effects. Facial rejuvenation using a combination treatment of fractional ablative 2,940 and nonablative 1,440 lasers provides improvement in wrinkles and pigment similar to conservative purely ablative approaches. These purely ablative approaches include the Er:YAG laser used in a sequential confluent fractional manner, or fractional CO2 laser alone. Reduced side effects make the combined procedure an attractive option for facial rejuvenation.

  13. Metformin and clofibrate in maturity onset diabetes mellitus: advantages of combined treatment.

    Science.gov (United States)

    De Silva, S R; Betteridge, D J; Shawe, J E; Cudworth, A G; Alberti, K G

    1979-09-01

    Blood glucose, lipoproteins, non-esterified fatty acids, fibrinogen and intermediary metabolites were measured in twenty-two diet failed maturity onset diabetics during a double blind crossover study of metformin (1.7 g/day) or clofibrate (2 g/day) therapy. Patients received combined therapy for a final two month period. Four patients had 12 hour metabolic profiles performed during each treatment period. A more significant improvement in fasting blood glucose and glycosuria occured with metformin and combined therapy. However, clofibrate and combined therapy significantly decreased total and low density lipoprotein cholesterol, total and very low density lipoprotein triglyceride and fibrinogen. Metabolic profiles demonstrated significant elevations of blood lactate and alanine with metformin treatment but these parameters returned to normal with combined therapy. Non-esterified fatty acids and glycerol were significantly lower during combined therapy compared with metformin or clofibrate alone. Despite the recent adverse report on clofibrate, this study indicates that the addition of clofibrate to metformin therapy may have advantages in the management of maturity onset diabetics.

  14. Predictors of cessation treatment outcome and treatment moderators among smoking parents receiving quitline counselling or self-help material

    NARCIS (Netherlands)

    Schuck, K.; Otten, R.; Kleinjan, M.; Bricker, J.B.; Engels, R.C.M.E.

    2014-01-01

    Objective Several cessation treatments effectively enhance cessation, but it is not always clear which treatment may be most suitable for a particular client. We examined predictors of treatment outcome and treatment moderators among smoking parents in the Netherlands. Method We conducted secondary

  15. Platelet-rich plasma combined with intralesional triamcinolone acetonide for the treatment of alopecia areata: A case report

    Directory of Open Access Journals (Sweden)

    Thamer Mubki

    2016-01-01

    Full Text Available Treatment of long standing alopecia areata can be extremely difficult. Combining more than one treatment modality may be needed. Promising results have been previously reported using platelet-rich plasma. However, combining this treatment modality with other therapies has never been evaluated. We report a patient with long standing alopecia areata treated with a combination of triamcinolone acetonide and platelet-rich plasma intradermal injections. The trial was performed in a half-head design. One half of the scalp was treated with both platelet-rich plasma and intralesional triamcinolone acetonide. The other half received intralesional triamcinolone acetonide only. The half head treated with the combined therapy showed more regrowing hairs and larger hair fiber diameter. Our limited findings suggest that combining platelet-rich plasma with intradermal triamcinolone acetonide may have a positive synergistic effect for treating alopecia areata. Controlled studies with a large number of patients are needed.

  16. Use of a novel combined radiofrequency and ultrasound device for lipolysis, skin tightening and cellulite treatment.

    Science.gov (United States)

    Kapoor, Rinky; Shome, Debraj; Ranjan, Anima

    2017-10-01

    Skin laxity and excessive subcutaneous fat are growing cosmetic concerns. The objective of this study is to evaluate the efficacy and safety of a novel radiofrequency and ultrasound workstation for lipolysis, circumference reduction, treatment of skin laxity and cellulite. Two hundred seventy-five (235 women and 40 men) patients were enrolled into the study. Each patient received 3 treatment sessions, each session comprising Ultrasound and Radiofrequency treatments, at two-week intervals. Some received treatment for the abdomen, some for the thighs and some for both. Efficacy was assessed accordingly by measuring changes in abdominal circumference, thigh circumference and appearance of cellulite. Any adverse effect was noted. Paired t-test between measurements at baseline and 4 weeks after 3rd session was significant amongst all the groups, showing that most patients showed improvement in abdominal and/or thigh circumferences. No significant adverse effects were noted during or after the treatment. A combination of alternating hot and cold module Ultrasound and Radiofrequency technologies is a safe and effective modality for lipolysis and to treat skin laxity and cellulite.

  17. Acupuncture Treatment for Dyspnea due to Combined Pulmonary Fibrosis and Emphysema: A Case Report.

    Science.gov (United States)

    Matsumoto-Miyazaki, Jun; Miyazaki, Nagisa; Nishiwaki, Ayuko; Endo, Junki; Ushikoshi, Hiroaki; Ohno, Yasushi; Minatoguchi, Shinya

    2015-12-01

    Combined idiopathic pulmonary fibrosis with pulmonary emphysema (CPFE) is a syndrome with a characteristic presentation of upper lobe emphysema and lower lobe fibrosis. Dyspnea on exertion (DOE) is a major symptom of CPFE. We report a patient with DOE due to CPFE who was successfully treated with acupuncture. Case report. A 72-year-old Japanese man with a 4-year history of DOE was diagnosed with CPFE 2 years previously in another hospital. He received standard Western medicine treatment, which included bronchodilators. However, his DOE did not improve. Consequently, he visited our hospital for acupuncture treatment and received acupuncture treatment once a week for 1 year. After 10 weeks of acupuncture treatment, the results of the 6-minute walk test (6-minute walking distance, 379 m; lowest oxygen saturation, 86%; modified Borg dyspnea scale score: 2 units) were better than those at baseline (352 m, 84%, 4 units, respectively). These values were sustained at both 30 weeks (470 m, 88%, 1 unit) and 60 weeks (473 m, 85%, 2 units). Serum interstitial biomarkers, Krebs von den Lungen and surfactant protein-D, decreased after commencement of acupuncture therapy. A patient with CPFE showed improvements in dyspnea scores, exercise tolerance, and serum biomarkers during a 1-year course of acupuncture treatment. Use of acupuncture might be an effective adjunct therapy in relieving DOE due to CPFE. A large, well-designed cohort study that includes patients with CPFE treated with acupuncture should be conducted.

  18. Antischistosomal efficacy of artesunate combination therapies administered as curative treatments for malaria attacks.

    Science.gov (United States)

    Boulanger, Denis; Dieng, Yemou; Cisse, Badara; Remoue, Franck; Capuano, Frederic; Dieme, Jean-Louis; Ndiaye, Tofene; Sokhna, Cheikh; Trape, Jean-François; Greenwood, Brian; Simondon, Francois

    2007-02-01

    Artesunate is a highly effective antimalarial and there is some evidence that it is also active against schistosome infections. We therefore investigated whether treatment with artesunate of acute malaria in Senegalese children had an impact on their level of infection with Schistosoma haematobium. Twenty-seven children who were entered into a clinical trial of antimalaria treatment were excreting S. haematobium eggs in their urine on the day of treatment. Fifteen children received a combination of a single dose of sulfadoxine/pyrimethamine together with three daily doses of artesunate (4 mg/kg); the remaining 12 children received three daily doses of amodiaquine and artesunate. The overall cure rate and reduction in the mean number of excreted eggs at 28 days post treatment were 92.6% and 94.5%, respectively. Our findings indicate that artesunate, in addition to being a very effective treatment for uncomplicated malaria, can also sharply reduce the S. haematobium loads harboured by pre-school African children.

  19. Combined Immune Therapy for the Treatment of Visceral Leishmaniasis.

    Directory of Open Access Journals (Sweden)

    Rebecca J Faleiro

    2016-02-01

    Full Text Available Chronic disease caused by infections, cancer or autoimmunity can result in profound immune suppression. Immunoregulatory networks are established to prevent tissue damage caused by inflammation. Although these immune checkpoints preserve tissue function, they allow pathogens and tumors to persist, and even expand. Immune checkpoint blockade has recently been successfully employed to treat cancer. This strategy modulates immunoregulatory mechanisms to allow host immune cells to kill or control tumors. However, the utility of this approach for controlling established infections has not been extensively investigated. Here, we examined the potential of modulating glucocorticoid-induced TNF receptor-related protein (GITR on T cells to improve anti-parasitic immunity in blood and spleen tissue from visceral leishmaniasis (VL patients infected with Leishmania donovani. We found little effect on parasite growth or parasite-specific IFNγ production. However, this treatment reversed the improved anti-parasitic immunity achieved by IL-10 signaling blockade. Further investigations using an experimental VL model caused by infection of C57BL/6 mice with L. donovani revealed that this negative effect was prominent in the liver, dependent on parasite burden and associated with an accumulation of Th1 cells expressing high levels of KLRG-1. Nevertheless, combined anti-IL-10 and anti-GITR mAb treatment could improve anti-parasitic immunity when used with sub-optimal doses of anti-parasitic drug. However, additional studies with VL patient samples indicated that targeting GITR had no overall benefit over IL-10 signaling blockade alone at improving anti-parasitic immune responses, even with drug treatment cover. These findings identify several important factors that influence the effectiveness of immune modulation, including parasite burden, target tissue and the use of anti-parasitic drug. Critically, these results also highlight potential negative effects of

  20. Evaluation of QTc interval in Iranian causalities (Janbazan) of Iran-Iraq war receiving maintenance methadone treatment

    OpenAIRE

    Morteza Abdar Esfahani; Ali Akbar Vosughi; Mohamad Hossein Fatehi; Armindokht shahsanaee; Azam Teimuri

    2012-01-01

    Background: Methadone is a synthetic opioid, used in treatment of chronic pains. The current study was carried out to evaluate the QTc interval in Iranian causalities (Janbazan) of Iran-Iraq war receiving maintenance methadone treatment. Materials and Methods: In 2010, one hundred war causalities in Isfahan who chronically take daily dose of 20 mg or more of methadone (more than 2 weeks), and did not have the history of cerebrovascular or coronary artery diseases, cardiac pacemaker, congenita...

  1. Combined targeted treatment in early onset epilepsy associated with tuberous sclerosis

    Directory of Open Access Journals (Sweden)

    Romina Moavero

    2016-01-01

    Full Text Available Tuberous sclerosis is associated with epilepsy in up to 85% of cases, and in 2/3, the onset is within the first year of life. An early antiepileptic treatment is crucial to minimize the consequences of epilepsy on cognition and behavior. We present a case report of a child with tuberous sclerosis who presented with infantile spasms at the age of 6 months, immediately treated with vigabatrin. Because of the presence of a subependymal giant cell astrocytoma, he also received everolimus since 18 months of age. We might wonder if an earlier treatment could have produced a better outcome; in fact, despite a targeted combined treatment, he continues to suffer from sporadic focal motor seizures, and at the age of 40 months, he presents severe developmental delay with autism-like behavior.

  2. Combination and Integration of DPF-SCR After-treatment

    Energy Technology Data Exchange (ETDEWEB)

    Rappe, Kenneth G.; Lee, Jong H.; Stewart, Mark L.; Devarakonda, Maruthi N.; Maupin, Gary D.

    2012-01-08

    Exhaust after-treatment is considered an enabler for widespread implication of higher fuel efficient diesel engines. In the last decade extensive research has resulted in the development and advancement of many after-treatment technologies. However there are still many unanswered questions that relate to how these technologies can work together synergistically versus in opposition if intimately integrated with one another. It is anticipated that in the future there will be a need to minimize the volume and mass of after-treatment systems on ever increasingly more complex truck platforms. However, to-date research focused on combining technologies into an integrated system has been relatively sparse. With the inevitable need to consider how SCR and DPF technologies will function in synergy to reduce both NOx and PM, as well as how CO and hydrocarbons (HC) need to be managed, an intergraded investigation and approach is essentially mandatory. The determination of important synergies will require study both under steady-state and through transient conditions.

  3. Landfill Leachate Toxicity Removal in Combined Treatment with Municipal Wastewater

    Directory of Open Access Journals (Sweden)

    J. Kalka

    2012-01-01

    Full Text Available Combined treatment of landfill leachate and municipal wastewater was performed in order to investigate the changes of leachate toxicity during biological treatment. Three laboratory A2O lab-scale reactors were operating under the same parameters (Q-8.5–10 L/d; HRT-1.4–1.6 d; MLSS 1.6–2.5 g/L except for the influent characteristic and load. The influent of reactor I consisted of municipal wastewater amended with leachate from postclosure landfill; influent of reactor II consisted of leachate collected from transient landfill and municipal wastewater; reactor III served as a control and its influent consisted of municipal wastewater only. Toxicity of raw and treated wastewater was determinted by four acute toxicity tests with Daphnia magna, Thamnocephalus platyurus, Vibrio fischeri, and Raphidocelis subcapitata. Landfill leachate increased initial toxicity of wastewater. During biological treatment, significant decline of acute toxicity was observed, but still mixture of leachate and wastewater was harmful to all tested organisms.

  4. Sialendoscopy and Combined Minimally Invasive Treatment for Large Parotid Stones

    Science.gov (United States)

    Zavázalová, Šárka; Vorobiov, Olexii; Astl, Jaromír

    2016-01-01

    Sialendoscopy (SE) represents nowadays one of the standard diagnostic and therapeutic procedures in the treatment of major salivary glands lithiasis. We know from experience that it is successful only in small percentage of patients, when used in monotherapy. However, it represents an indispensable part of all of the combined minimally invasive gland-preserving treatment techniques, the success rate of which is around 90%. In this work, we focused on the role of sialendoscopy in the treatment of patients with larger inflamed fixed stones in glandula parotis. We conducted a total of 364 sialendoscopy procedures in 332 patients on our site. We have confirmed lithiasis as a cause of salivary gland obstruction in 246 (74%) patients. In 9 patients there was larger, single, or multiple inflamed fixed lithiasis of glandula parotis. In this subgroup of patients endoscopically assisted sialolithectomy from external mini-incision has become the method of choice. In 9 of the 9 (100%) cases we have achieved complete elimination of stones, and in 8 of the 9 (89%) cases we have achieved complete elimination of complaints. Sialoendoscopically assisted sialolithectomy of glandula parotis from external mini-incision has proved to be highly effective technique to eliminate stones with minimal complications. PMID:27882318

  5. 75 FR 934 - Treatment by the Federal Deposit Insurance Corporation as Conservator or Receiver of Financial...

    Science.gov (United States)

    2010-01-07

    ... Krimminger, Office of the Chairman, 202-898-8950; George Alexander, Division of Resolutions and Receiverships... to breach a contract or lease entered into by an IDI and be legally excused from further performance... to pay timely principal and interest in the event the FDIC is appointed receiver or conservator of...

  6. Self-Stigma and Quality of Life among People with Mental Illness Who Receive Compulsory Community Treatment Services

    Science.gov (United States)

    Livingston, James

    2012-01-01

    The present study was designed to examine the relationship between self-stigma and quality of life over a one year time period for 71 people with mental illness who were receiving compulsory community mental health treatment. It was hypothesized that, over time, self-stigma would have the direct effect of eroding quality of life among people with…

  7. Persistence and adherence in multiple sclerosis patients starting glatiramer acetate treatment : assessment of relationship with care received from multiple disciplines

    NARCIS (Netherlands)

    Jongen, Peter Joseph; Lemmens, Wim A.; Hupperts, Raymond; Hoogervorst, Erwin L. J.; Schrijver, Hans M.; Slettenaar, Astrid; de Schryver, Els L.; Boringa, Jan; van Noort, Esther; Donders, Rogier

    2016-01-01

    Background: In multiple sclerosis patients, the persistence of, and adherence to, disease-modifying treatment are often insufficient. The degree of persistence and adherence may relate to the care received from various disciplines. Methods: In an observational study of 203 patients treated with

  8. Exploring the effects of galacto-oligosaccharides on the gut microbiota of healthy adults receiving amoxicillin treatment

    NARCIS (Netherlands)

    Ladirat, S.E.; Schoterman, M.H.C.; Rahaoui, H.; Mars, M.; Schuren, F.H.J.; Gruppen, H.; Nauta, A.; Schols, H.A.

    2014-01-01

    In the present double-blind, randomised, parallel intervention study, the effects of the intake of galacto-oligosaccharides (GOS) on the gut microbiota of twelve healthy adult subjects (aged 18-45 years with a normal BMI (18-25 kg/m2)) receiving amoxicillin (AMX) treatment were determined. All the

  9. Estimating the risk of HIV transmission from homosexual men receiving treatment to their HIV-uninfected partners

    NARCIS (Netherlands)

    Hallett, Timothy B.; Smit, Colette; Garnett, Geoff P.; de Wolf, Frank

    2011-01-01

    To determine how the risk of HIV transmission from homosexual men receiving antiretroviral treatment is related to patterns of patient monitoring and condom use. A stochastic mathematical simulation model was developed of cohorts of men in the Netherlands who have sex with men (MSM), defining the

  10. Estimating the risk of HIV transmission from homosexual men receiving treatment to their HIV-uninfected partners

    NARCIS (Netherlands)

    Hallett, T.B.; Smit, C.; Garnett, G.P.; de Wolf, F.

    2011-01-01

    Objective To determine how the risk of HIV transmission from homosexual men receiving antiretroviral treatment is related to patterns of patient monitoring and condom use. Methods A stochastic mathematical simulation model was developed of cohorts of men in the Netherlands who have sex with men

  11. Advanced receiver autonomous integrity monitoring using triple frequency data with a focus on treatment of biases

    Science.gov (United States)

    El-Mowafy, Ahmed

    2017-04-01

    Most current Advanced Receiver Autonomous Integrity Monitoring (ARAIM) methods are designed to use dual-frequency ionosphere-free observations. These methods assume that receiver bias is absorbed in the common receiver clock offset and bound satellite biases by nominal values. However, most multi-constellation Global Navigation Satellite Systems (GNSS) can offer triple frequency data that can be used for civilian applications in the future, which can improve observation redundancy, solution precision and detection of faults. In this contribution, we explore the use of this type of observations from GPS, Galileo and BeiDou in ARAIM. Nevertheless, the use of triple frequency data introduces receiver differential biases that have to be taken into consideration. To demonstrate the significance of these additional biases we first present a method to quantify them at stations of known coordinates and using available products from the International GNSS service (IGS). To deal with the additional receiver biases, we use a between-satellite single difference (BSSD) observation model that eliminates their effect. A pilot test was performed to evaluate ARAIM availability for Localizer Performance with Vertical guidance down to 200 feet (LPV-200) when using the triple-frequency observations. Real data were collected for one month at stations of known coordinates located in regions of different satellite coverage characteristics. The BSSD triple-frequency model was evaluated to give early indication about its feasibility, where the implementation phase still requires further comprehensive studies. The vertical position error was always found to be bounded by the protection level proven initial validity of the proposed integrity model.

  12. The role of treatment expectancy in youth receiving exposure-based CBT for obsessive compulsive disorder.

    Science.gov (United States)

    Lewin, Adam B; Peris, Tara S; Lindsey Bergman, R; McCracken, James T; Piacentini, John

    2011-09-01

    The purpose of this investigation was to examine correlates of parent, child, and therapist treatment expectations and their role in the exposure-based treatment of childhood obsessive compulsive disorder (OCD). Treatment expectations were assessed among 49 youth with primary OCD, their parents, and therapists as part of the baseline evaluation and post-treatment clinical outcomes were determined by blind evaluators. Baseline depressive symptoms, child/parent-rated functional impairment, externalizing behavior problems, number of comorbid psychiatric disorders, and a lower perception of control were associated with lower pre-treatment expectations. Parent expectation was associated with parental OCD symptoms, child depressive symptoms and child-reported impairment. Therapist expectations inversely correlated with child depressive symptoms, externalizing problems, and child-rated impairment. Pre-treatment OCD severity and prior treatment history were not linked to expectancy. Finally, higher treatment expectations were linked to better treatment response, lower attrition, better homework compliance, and reduced impairment. Copyright © 2011 Elsevier Ltd. All rights reserved.

  13. Combined Treatment of Wrist and Trapeziometacarpal Joint Arthritis

    Science.gov (United States)

    Waitzenegger, Thomas; Leclercq, Caroline; Masmejean, Emmanuel; Lenoir, Hubert; Harir, Amir; Coulet, Bertrand; Chammas, Michel

    2015-01-01

    Background Combined thumb basal and wrist joint arthritis (excluding scaphotrapeziotrapezoid arthritis) is rare considering the frequency of arthritis of either joint alone. Combined surgical treatment has never been described in the literature. Furthermore, the scaphoidectomy common to all interventions for Watson stage 2 or 3 wrist arthritis theoretically makes it impossible to perform a trapeziectomy for thumb basal joint arthritis. Question/Purpose The aim of this study was to present and analyze the results of two types of surgical treatment when both wrist and thumb arthritis was present. Materials and Methods Our retrospective series included 11 patients suffering from Eaton Stage III thumb basal joint arthritis and scapholunate advanced collapse (SLAC) II and III-type wrist arthritis. Five patients (group A) underwent trapeziectomy and palliative surgery for their wrist with conservation of the distal pole of the scaphoid (one proximal row carpectomy [PRC] and four four-corner fusions), and six (group B) patients had a trapeziometacarpal arthroplasty either with PRC (two cases) or four-corner arthrodesis (four cases) including total scaphoidectomy. Results The mean follow-up was 57 months. The overall visual analog scale (VAS) score for pain was 1.5 at rest, with no difference between the trapeziectomy and arthroplasty groups. The average Kapandji score was 9.3 (9 in group A and 9.5 in group B). The flexion/extension range of motion for the wrist was 64° following four-corner arthrodesis and 75° following PRC. Only one case of algodystrophy was observed. The radiological analysis revealed no complications. Discussion This study shows that thumb basal joint arthritis and SLAC type wrist arthritis may be treated by combined treatment during the same intervention without any complications. The results of palliative surgery for the wrist, either with trapeziectomy or with a trapeziometacarpal arthroplasty, are comparable. With a trapeziectomy, the

  14. Income received during treatment does not affect response to contingency management treatments in cocaine-dependent outpatients

    Science.gov (United States)

    Andrade, Leonardo F.; Petry, Nancy M.

    2013-01-01

    Background Prior studies find no effect of baseline income on response to contingency management (CM) interventions. However, income among substance disordered patients is variable, particularly at treatment entry. This study investigated the impact of during-treatment income, a more proximal estimate of economic resources at the time that CM is in effect, on response to standard treatment or the standard treatment plus CM. Method These secondary analyses included 418 cocaine dependent participants initiating community intensive outpatient treatment. We examined whether differences were present in pretreatment and during-treatment overall income, as well as specific income sources. We then conducted a series of regression models to investigate the impact of during-treatment income on treatment outcome. Results Participants’ during-treatment income was significantly lower compared to pretreatment income, and this difference was largely attributable to decreases in earned income, illegal income, and support from friends and family. Neither the main effect of income, nor the interaction of income and treatment condition, was significantly associated with treatment outcome. CM, however, was a significant predictor of improved treatment outcome relative to standard treatment. Income sources and some demographic characteristics were also significant predictors of outcomes; public assistance income was associated with improved outcomes and illegal income was associated with poorer outcomes. Conclusions These results suggest that substance abusers benefit from CM regardless of their income level, and these data add to the growing literature supporting the generalizability of CM across a variety of patient characteristics. PMID:23631869

  15. Analysis of the burden of treatment in patients receiving an EpiPen for yellow jacket anaphylaxis.

    Science.gov (United States)

    Oude Elberink, Joanne N G; van der Heide, S; Guyatt, Gordon H; Dubois, Anthony E J

    2006-09-01

    Venom immunotherapy (VIT) is a treatment with established efficacy for the prevention of repeated anaphylactic reactions in patients with Hymenoptera allergy, which also allows patients to discontinue carrying an EpiPen. Despite their merits, both treatments can have negative aspects potentially important to patients. We examined possible negative aspects of the EpiPen in comparison with VIT as perceived by patients. Positive and negative aspects of both treatments were measured by using a burden of treatment questionnaire together with statements about the EpiPen. One hundred ninety-three patients were included, of whom 94 consented to randomization: 47 received VIT, and 47 received the EpiPen. Of the remaining 99, 75 chose VIT, and 26 chose the EpiPen. Of the patients receiving VIT, 91.5% were (extremely) positive about their treatment, and 85% would choose VIT again. Of the patients receiving the EpiPen, only 48% were positive about their treatment, and even of these patients, 68% preferred to be treated with VIT after 1 year of carrying the EpiPen. Although most patients indicated that it is reassuring to carry an EpiPen and makes them feel safe, many patients also indicated that it is inconvenient and troublesome. Especially patients who were negative about the EpiPen indicated that they would not dare use the EpiPen if necessary and were afraid at possible side effects. In contrast to VIT, the EpiPen is perceived as burdensome by most patients with venom allergy. For most patients, an EpiPen is an unsuitable definitive treatment. As VIT enables patients with venom allergy to get rid of the EpiPen, patients should be offered VIT.

  16. The efficacy of long-term psychodynamic psychotherapy, fluoxetine and their combination in the outpatient treatment of depression.

    Science.gov (United States)

    Bastos, Andre Goettems; Guimaraes, Luciano Santos Pinto; Trentini, Clarissa Marceli

    2015-01-01

    There are few randomized controlled trials examining the efficacy of long-term psychodynamic psychotherapy (LTPP) in depression treatment. LTPP was compared with fluoxetine treatment and their combination; 272 depressed patients (aged 26-34, 72% with a first episode of depression) were randomized to receive LTPP (one session/week), fluoxetine treatment (20-60 mg/day) or their combination for 24 months. Beck Depression Inventory (BDI) was the outcome measure. The psychotherapy was not manualized and the treatment took place under real-life conditions in an outpatient psychiatric clinic. Intention-to-treat analyses indicated that all the treatments were associated with significant reductions in the BDI scores (mean reduction of 18.88 BDI points). Furthermore, LTPP and combination therapy were more effective in reducing BDI scores than fluoxetine alone (22.08 and 22.04 vs. 12.53 BDI points). LTPP, pharmacological treatment with fluoxetine and their combination are effective in reducing symptoms of patients with moderate depression. LTPP and combined treatment were more effective compared to fluoxetine alone. These findings have implications for patients with depression who may benefit from long-term psychotherapy or combined treatment, or for depressed patients who do not wish to take medications such as fluoxetine.

  17. Efficacy of entecavir combined with alprostadil in treatment of hepatitis B-related cirrhotic ascites

    Directory of Open Access Journals (Sweden)

    LI Huili

    2016-02-01

    Full Text Available ObjectiveTo investigate the efficacy of entecavir combined with alprostadil in the treatment of hepatitis B-related cirrhotic ascites. MethodsA total of 100 patients with hepatitis B-related cirrhotic ascites who were admitted to Dezhou Hospital of Traditional Chinese Medicine from May 2012 to February 2014 were selected and randomly divided into treatment group and control group, with 50 patients in each group. The patients in both groups received the liver-protecting treatment, diuretic treatment, and intermittent supplementation of albumin(Alb. Additionally, the patients in the treatment group received oral entecavir 0.5 mg once a day, combined with intravenous infusion of alprostadil 20 μg+5% glucose injection 100 ml once a day, and those in the observation group only received oral entecavir 0.5 mg once a day. The patients were hospitalized and treated for 4 weeks. Ascites regression, changes in the levels of alanine aminotransferase (ALT, total bilirubin (TBil, Alb, blood urea nitrogen (BUN, creatinine (Cr, and hepatitis B virus (HBV DNA, and prothrombin activity (PTA were observed in both groups. After discharge, the patients in both groups continued to take oral entecavir 0.5 mg once a day, and the long-term therapeutic effect was observed through follow-up for 3 months. The t-test was applied for comparison of continuous data between groups, and the chi-square test was applied for comparison of categorical data between groups. ResultsThe patients in both groups had varying degrees of reduction in the amount of ascites after treatment, and the treatment group had a significantly higher overall response rate than the control group (χ2=6.018, P<0.05. The patients in both groups had varying degrees of improvement in each index of liver and renal function (ALT, TBil, Alb, BUN, and Cr and PTA after treatment; the treatment group had a better treatment outcome than the control group, and there were significant differences in each index

  18. SweepSAR: Beam-forming on Receive Using a Reflector-Phased Array Feed Combination for Spaceborne SAR

    Science.gov (United States)

    Freeman, A.; Krieger, G.; Rosen, P.; Younis, M.; Johnson, W. T. K.; Huber, S.; Jordan, R.; Moreira, A.

    2012-01-01

    In this paper, an alternative approach is described that is suited for longer wavelength SARs in particular, employing a large, deployable reflector antenna and a much simpler phased array feed. To illuminate a wide swath, a substantial fraction of the phased array feed is excited on transmit to sub-illuminate the reflector. Shorter transmit pulses are required than for conventional SAR. On receive, a much smaller portion of the phased array feed is used to collect the return echo, so that a greater portion of the reflector antenna area is used. The locus of the portion of the phased array used on receive is adjusted using an analog beam steering network, to 'sweep' the receive beam(s) across the illuminated swath, tracking the return echo. This is similar in some respects to the whiskbroom approach to optical sensors, hence the name: SweepSAR.SweepSAR has advantages over conventional SAR in that it requires less transmit power, and if the receive beam is narrow enough, it is relatively immune to range ambiguities. Compared to direct radiating arrays with digital beam- forming, it is much simpler to implement, uses currently available technologies, is better suited for longer wavelength systems, and does not require extremely high data rates or onboard processing.

  19. Randomized comparative trial of efficacy of paracetamol, ibuprofen and paracetamol-ibuprofen combination for treatment of febrile children.

    Science.gov (United States)

    Vyas, Falgun Indravadan; Rana, Devang Ashwinkumar; Patel, Piyush M; Patel, Varsha Jitendra; Bhavsar, Rekha H

    2014-01-01

    Paracetamol and ibuprofen are widely used for fever in children as monotherapy and as combined therapy. None of the treatments is proven clearly superior to others. Hence, the study was planned to compare the efficacy of paracetamol, ibuprofen and paracetamol-ibuprofen combination for treatment of febrile children. This was an investigator blind, randomized, comparative, parallel clinical trial conducted in 99 febrile children, 6 months to 12 years of age, allocated to three groups. First group received paracetamol 15 mg/kg, second group received ibuprofen 10 mg/kg and third group received both paracetamol and ibuprofen, all as a single dose by the oral route. Patients were followed-up at intervals of 1, 2, 3 and 4 h post dose by tympanic thermometry. Mean tympanic temperature after 4 h of drug administration was significantly lower in the combination group compared with paracetamol group (P children any time post dose until 4 h was highest in the combination group. Difference between combination and paracetamol was significant for the 1(st) h (P = 0.04). Highest fall of temperature was noted in the 1(st) h of drug administration in all the groups. No serious adverse events were observed in any of the groups. Paracetamol and ibuprofen combination caused quicker temperature reduction than either paracetamol or ibuprofen alone. If quicker reduction of body temperature is the desired goal of therapy, the use of combination of paracetamol + ibuprofen may be advocated.

  20. Phase II, open-label, multicenter study of combined intrathecal morphine and ziconotide: addition of ziconotide in patients receiving intrathecal morphine for severe chronic pain.

    Science.gov (United States)

    Wallace, Mark S; Kosek, Peter S; Staats, Peter; Fisher, Robert; Schultz, David M; Leong, Michael

    2008-04-01

    To assess the safety and efficacy of adding intrathecal ziconotide to intrathecal morphine in patients being treated with a stable intrathecal morphine dose. Phase II, multicenter, open-label study with a 5-week titration phase and an extension phase. Outpatient clinics. Patients with suboptimal pain relief receiving stable intrathecal morphine doses (2-20 mg/day). Intrathecal morphine dosing remained constant during the titration phase. Ziconotide therapy began at 0.60 microg/day and was titrated to a maximum of 7.2 microg/day. During the extension phase, ziconotide and intrathecal morphine dosing were adjusted at the investigator's discretion. Safety was assessed primarily via adverse event reports. Efficacy was analyzed via percentage change on the visual analog scale of pain intensity and in weekly systemic opioid consumption. Twenty-six patients were enrolled. Treatment-emergent adverse events were generally mild or moderate; the most common (> or = 15% of patients in either study phase) study drug-related (i.e., ziconotide/morphine combination [or ziconotide monotherapy in the extension phase only]) events were confusion, dizziness, abnormal gait, hallucinations, and anxiety. The mean percentage improvement in visual analog scale of pain intensity scores was 14.5% (95% confidence interval: -9.4% to 38.5%) from baseline to week 5 and varied during the extension phase (range: -0.4% to 42.8%). Mean percentage change from baseline in systemic opioid consumption was -14.3% at week 5 and varied considerably during the extension phase. Ziconotide, combined with stable intrathecal morphine, may reduce pain and decrease systemic opioid use in patients with pain inadequately controlled by intrathecal morphine alone.

  1. Open-label, multicenter study of combined intrathecal morphine and ziconotide: addition of morphine in patients receiving ziconotide for severe chronic pain.

    Science.gov (United States)

    Webster, Lynn R; Fakata, Keri L; Charapata, Steven; Fisher, Robert; MineHart, Michael

    2008-04-01

    To assess the safety and efficacy of adding intrathecal morphine to intrathecal ziconotide in patients treated with stable ziconotide doses. Multicenter, open-label study with a 4-week morphine titration phase during which ziconotide was held constant and an extension phase during which dosing of either drug could vary. Outpatient clinics. Patients with suboptimal pain relief receiving stable ziconotide doses (> or = 4.8 microg/day) in one of two ongoing ziconotide trials. Ziconotide dosing remained constant during the titration phase; intrathecal morphine titration was based on each patient's daily systemic opioid dose at the study's start. During the extension phase, intrathecal ziconotide and morphine dosing were adjusted per investigator discretion. Safety was assessed primarily via adverse events. Efficacy was analyzed via percentage change on the visual analog scale of pain intensity and in weekly systemic opioid consumption. Twenty-five patients enrolled. The most common (> or = 10% of patients in either study phase) study drug-related (i.e., ziconotide/morphine combination [or ziconotide monotherapy in the extension phase only]) treatment-emergent adverse events included dizziness, peripheral edema, pruritus, and nausea. From the initial visit to week 4, visual analog scale of pain intensity scores improved by a mean of 26.3% (95% confidence interval: 15.6%-37.1%) but varied during the extension phase (mean percentage change from the initial visit ranged from -0.4% at week 16 to -35.0% at week 72). Mean percentage decrease in systemic opioid consumption from the initial visit was 49.1% at week 4 and 51.2% at week 56 of the extension phase. Intrathecal morphine, combined with stable intrathecal ziconotide doses, reduced pain in patients with previously suboptimal pain relief on ziconotide monotherapy.

  2. Impairment of the executive function in breast cancer patients receiving chemotherapy treatment: a functional MRI study.

    Science.gov (United States)

    Tao, L; Lin, H; Yan, Y; Xu, X; Wang, L; Zhang, J; Yu, Y

    2017-11-01

    The aim of this study is to investigate chemotherapy-induced alterations in the functional framework of the brain, and probe the relationship between these changes and executive function impairments in breast cancer patients. Thirty-three breast cancer patients (BC) after receiving chemotherapy and 31 matched healthy controls (HC) were enrolled in this study. All participants received resting-state functional connectivity magnetic resonance imaging (rs-fcMRI) and neuropsychological background tests. The lower functional connectivity of the posterior cingulate cortex (PCC) was found in the left postcentral gyrus, left precentral gyrus, right superior temporal gyrus, right cingulate gyrus and right middle frontal gyrus. A significant negative correlation was found between the response time on the Trail Making Tests and the functional connectivity strength between the PCC and right middle frontal and right cingulate gyri in breast cancer patients. In addition, the strength of the functional connectivity between the PCC and right middle frontal gyrus had a negative correlation with the response times on the Stroop Interference Test in breast cancer patients. This study demonstrated that BC patients after receiving chemotherapy have abnormal functional connectivity. These findings suggest that functional connectivity changes might play an important role in chemotherapy-induced executive function impairments in breast cancer patients. © 2016 John Wiley & Sons Ltd.

  3. Combining Motivational Interviewing with Cognitive-Behavioral Treatments for Substance Abuse: Lessons from the COMBINE Research Project

    Science.gov (United States)

    Moyers, Theresa B.; Houck, Jon

    2011-01-01

    Motivational Interviewing began as a treatment for substance misuse and has strong empirical support as an intervention for these disorders. It is very common for MI to be combined with other types of treatment when it is used for substance abuse, and this article focuses on one example of this: the COMBINE Research Project. We examine the…

  4. Slaughterhouse wastewater treatment by combined chemical coagulation and electrocoagulation process.

    Science.gov (United States)

    Bazrafshan, Edris; Kord Mostafapour, Ferdos; Farzadkia, Mehdi; Ownagh, Kamal Aldin; Mahvi, Amir Hossein

    2012-01-01

    Slaughterhouse wastewater contains various and high amounts of organic matter (e.g., proteins, blood, fat and lard). In order to produce an effluent suitable for stream discharge, chemical coagulation and electrocoagulation techniques have been particularly explored at the laboratory pilot scale for organic compounds removal from slaughterhouse effluent. The purpose of this work was to investigate the feasibility of treating cattle-slaughterhouse wastewater by combined chemical coagulation and electrocoagulation process to achieve the required standards. The influence of the operating variables such as coagulant dose, electrical potential and reaction time on the removal efficiencies of major pollutants was determined. The rate of removal of pollutants linearly increased with increasing doses of PACl and applied voltage. COD and BOD(5) removal of more than 99% was obtained by adding 100 mg/L PACl and applied voltage 40 V. The experiments demonstrated the effectiveness of chemical and electrochemical techniques for the treatment of slaughterhouse wastewaters. Consequently, combined processes are inferred to be superior to electrocoagulation alone for the removal of both organic and inorganic compounds from cattle-slaughterhouse wastewater.

  5. Slaughterhouse Wastewater Treatment by Combined Chemical Coagulation and Electrocoagulation Process

    Science.gov (United States)

    Bazrafshan, Edris; Kord Mostafapour, Ferdos; Farzadkia, Mehdi; Ownagh, Kamal Aldin; Mahvi, Amir Hossein

    2012-01-01

    Slaughterhouse wastewater contains various and high amounts of organic matter (e.g., proteins, blood, fat and lard). In order to produce an effluent suitable for stream discharge, chemical coagulation and electrocoagulation techniques have been particularly explored at the laboratory pilot scale for organic compounds removal from slaughterhouse effluent. The purpose of this work was to investigate the feasibility of treating cattle-slaughterhouse wastewater by combined chemical coagulation and electrocoagulation process to achieve the required standards. The influence of the operating variables such as coagulant dose, electrical potential and reaction time on the removal efficiencies of major pollutants was determined. The rate of removal of pollutants linearly increased with increasing doses of PACl and applied voltage. COD and BOD5 removal of more than 99% was obtained by adding 100 mg/L PACl and applied voltage 40 V. The experiments demonstrated the effectiveness of chemical and electrochemical techniques for the treatment of slaughterhouse wastewaters. Consequently, combined processes are inferred to be superior to electrocoagulation alone for the removal of both organic and inorganic compounds from cattle-slaughterhouse wastewater. PMID:22768233

  6. Fibromyalgia: should the treatment paradigm be monotherapy or combination pharmacotherapy?

    Science.gov (United States)

    Mease, Philip J; Seymour, Kristin

    2008-12-01

    Fibromyalgia (FM) is a disorder characterized by chronic widespread pain, tenderness, and associated symptoms such as fatigue, sleep disturbance, mood disorder, and cognitive dysfunction. Research on the pathophysiology of FM has focused on dysregulation of sensory processing in the central nervous system, as well as genetic and sociobiologic background factors. Abnormalities include excessive pronociceptive input and deficiency of modulatory signaling via noradrenergic and serotonergic pathways. Effective pharmacotherapy of FM includes medications that inhibit pronociceptive input and augment modulatory signaling. Several other dysregulated pathways may be involved and be potential targets for therapeutic intervention. This article reviews positive results of recent monotherapy trials of several norepinephrine and serotonin reuptake inhibitors. Although there has been little assessment of combination therapy in FM, this review outlines the basis for rational treatment using this approach (in order to most effectively treat multiple symptom domains). Controlled monotherapy trials of medications currently being approved for FM demonstrate significant effect on pain, patient global impression of change, and function. Trials are currently being developed to assess the potential additive or synergistic effects of combined central pharmacotherapy and to assess the safety and tolerability of this approach.

  7. Slaughterhouse wastewater treatment by combined chemical coagulation and electrocoagulation process.

    Directory of Open Access Journals (Sweden)

    Edris Bazrafshan

    Full Text Available Slaughterhouse wastewater contains various and high amounts of organic matter (e.g., proteins, blood, fat and lard. In order to produce an effluent suitable for stream discharge, chemical coagulation and electrocoagulation techniques have been particularly explored at the laboratory pilot scale for organic compounds removal from slaughterhouse effluent. The purpose of this work was to investigate the feasibility of treating cattle-slaughterhouse wastewater by combined chemical coagulation and electrocoagulation process to achieve the required standards. The influence of the operating variables such as coagulant dose, electrical potential and reaction time on the removal efficiencies of major pollutants was determined. The rate of removal of pollutants linearly increased with increasing doses of PACl and applied voltage. COD and BOD(5 removal of more than 99% was obtained by adding 100 mg/L PACl and applied voltage 40 V. The experiments demonstrated the effectiveness of chemical and electrochemical techniques for the treatment of slaughterhouse wastewaters. Consequently, combined processes are inferred to be superior to electrocoagulation alone for the removal of both organic and inorganic compounds from cattle-slaughterhouse wastewater.

  8. Effects of combination treatment with alendronate and raloxifene on skeletal properties in a beagle dog model.

    Directory of Open Access Journals (Sweden)

    Matthew R Allen

    Full Text Available A growing number of studies have investigated combination treatment as an approach to treat bone disease. The goal of this study was to investigate the combination of alendronate and raloxifene with a particular focus on mechanical properties. To achieve this goal we utilized a large animal model, the beagle dog, used previously by our laboratory to study both alendronate and raloxifene monotherapies. Forty-eight skeletally mature female beagles (1-2 years old received daily oral treatment: saline vehicle (VEH, alendronate (ALN, raloxifene (RAL or both ALN and RAL. After 6 and 12 months of treatment, all animals underwent assessment of bone material properties using in vivo reference point indentation (RPI and skeletal hydration using ultra-short echo magnetic resonance imaging (UTE-MRI. End point measures include imaging, histomorphometry, and mechanical properties. Bone formation rate was significantly lower in iliac crest trabecular bone of animals treated with ALN (-71% and ALN+RAL (-81% compared to VEH. In vivo assessment of properties by RPI yielded minimal differences between groups while UTE-MRI showed a RAL and RAL+ALN treatment regimens resulted in significantly higher bound water compared to VEH (+23 and +18%, respectively. There was no significant difference among groups for DXA- or CT-based measures lumbar vertebra, or femoral diaphysis. Ribs of RAL-treated animals were smaller and less dense compared to VEH and although mechanical properties were lower the material-level properties were equivalent to normal. In conclusion, we present a suite of data in a beagle dog model treated for one year with clinically-relevant doses of alendronate and raloxifene monotherapies or combination treatment with both agents. Despite the expected effects on bone remodeling, our study did not find the expected benefit of ALN to BMD or structural mechanical properties, and thus the viability of the combination therapy remains unclear.

  9. Effects of combination treatment with alendronate and raloxifene on skeletal properties in a beagle dog model.

    Science.gov (United States)

    Allen, Matthew R; McNerny, Erin; Aref, Mohammad; Organ, Jason M; Newman, Christopher L; McGowan, Brian; Jang, Tim; Burr, David B; Brown, Drew M; Hammond, Max; Territo, Paul R; Lin, Chen; Persohn, Scott; Jiang, Lei; Riley, Amanda A; McCarthy, Brian P; Hutchins, Gary D; Wallace, Joseph M

    2017-01-01

    A growing number of studies have investigated combination treatment as an approach to treat bone disease. The goal of this study was to investigate the combination of alendronate and raloxifene with a particular focus on mechanical properties. To achieve this goal we utilized a large animal model, the beagle dog, used previously by our laboratory to study both alendronate and raloxifene monotherapies. Forty-eight skeletally mature female beagles (1-2 years old) received daily oral treatment: saline vehicle (VEH), alendronate (ALN), raloxifene (RAL) or both ALN and RAL. After 6 and 12 months of treatment, all animals underwent assessment of bone material properties using in vivo reference point indentation (RPI) and skeletal hydration using ultra-short echo magnetic resonance imaging (UTE-MRI). End point measures include imaging, histomorphometry, and mechanical properties. Bone formation rate was significantly lower in iliac crest trabecular bone of animals treated with ALN (-71%) and ALN+RAL (-81%) compared to VEH. In vivo assessment of properties by RPI yielded minimal differences between groups while UTE-MRI showed a RAL and RAL+ALN treatment regimens resulted in significantly higher bound water compared to VEH (+23 and +18%, respectively). There was no significant difference among groups for DXA- or CT-based measures lumbar vertebra, or femoral diaphysis. Ribs of RAL-treated animals were smaller and less dense compared to VEH and although mechanical properties were lower the material-level properties were equivalent to normal. In conclusion, we present a suite of data in a beagle dog model treated for one year with clinically-relevant doses of alendronate and raloxifene monotherapies or combination treatment with both agents. Despite the expected effects on bone remodeling, our study did not find the expected benefit of ALN to BMD or structural mechanical properties, and thus the viability of the combination therapy remains unclear.

  10. Pulsed light and antimicrobial combination treatments for surface decontamination of cheese: Favorable and antagonistic effects.

    Science.gov (United States)

    Proulx, J; Sullivan, G; Marostegan, L F; VanWees, S; Hsu, L C; Moraru, C I

    2017-03-01

    Postprocessing cross-contamination of cheese can lead to both food safety issues and significant losses due to spoilage. Pulsed light (PL) treatment, consisting of short, high-energy, broad-spectrum light pulses, has been proven effective in reducing the microbial load on cheese surface. As PL treatment effectiveness is limited by light-cheese interactions, the possibility to improve its effectiveness by combining it with the antimicrobial nisin was explored. The effect of natamycin, which is added to cheeses as an antifungal agent, on PL effectiveness was also investigated. Pseudomonas fluorescens, Escherichia coli ATCC 25922, and Listeria innocua were used as challenge microorganisms. Bacterial cultures in stationary growth phase were diluted to initial inoculum levels of 5 or 7 log cfu per cheese slice. Slices of sharp white Cheddar cheese and white American singles were cut in rectangles of 2.5 × 5 cm. For cheese slices receiving antimicrobial treatment before PL, slices were dipped in natamycin or nisin, spot inoculated with 100 μL of bacterial suspension, and then treated with PL. Cheese slices receiving PL treatment before antimicrobials were spot inoculated, treated with PL, and then treated with antimicrobials. The PL fluence levels from 1.02 to 12.29 J/cm 2 were used. Survivors were enumerated by standard plate counting or the most probable number technique, as appropriate. All treatments were performed in triplicate, and the data were analyzed using a general linear model. Treatment with nisin or natamycin before PL decreased the effectiveness of PL for all bacteria tested. For instance, PL reduced P. fluorescens on Cheddar cheese by 2.19 ± 0.27 log after 6.14 J/cm 2 , whereas combination treatments at the same PL fluence yielded barely 1 log reduction. Inactivation of L. innocua on Cheddar was only 0.78 ± 0.01 log when using PL after nisin, compared with a 1.30 ± 0.76 log reduction by nisin alone. This was attributed to the absorption of UV light

  11. Retention in HIV Care and Predictors of Attrition from Care among HIV-Infected Adults Receiving Combination Anti-Retroviral Therapy in Addis Ababa

    NARCIS (Netherlands)

    Mekuria, Legese A.; Prins, Jan M.; Yalew, Alemayehu W.; Sprangers, Mirjam A. G.; Nieuwkerk, Pythia T.

    2015-01-01

    Patient retention in chronic HIV care is a major challenge following the rapid expansion of combination antiretroviral therapy (cART) in Ethiopia. To describe the proportion of patients who are retained in HIV care and characterize predictors of attrition among HIV-infected adults receiving cART in

  12. A North American study of adapalene-benzoyl peroxide combination gel in the treatment of acne.

    Science.gov (United States)

    Gold, Linda Stein; Tan, Jerry; Cruz-Santana, Alma; Papp, Kim; Poulin, Yves; Schlessinger, Joel; Gidner, Judi; Liu, Yin; Graeber, Michael

    2009-08-01

    A fixed-dose combination gel with adapalene 0.1% and benzoyl peroxide (BPO) 2.5% recently has been developed for the treatment of acne vulgaris. In this multicenter, randomized, double-blind, parallel-group, active- and vehicle-controlled study conducted at 60 centers in the United States, Puerto Rico, and Canada, we assessed the efficacy and safety of adapalene-BPO combination gel in comparison with adapalene and BPO monotherapies as well as the gel vehicle. Participants with moderate facial acne vulgaris (rated 3 on the 5-point investigator global assessment of acne severity scale) were recruited and randomized to receive once-daily treatment with adapalene-BPO combination gel, adapalene monotherapy, BPO monotherapy, or gel vehicle for 12 weeks. They were assessed for success rate (the percentage of participants with investigator global assessment of acne severity rated clear or almost clear) and percentage change in inflammatory lesion (IL), noninflammatory lesion (NIL), and total lesion counts. Of the 1668 participants enrolled, 1429 (85.7%) completed the study. At study end point, adapalene-BPO combination gel showed a significantly higher success rate (P BPO combination gel at week 1 compared with adapalene monotherapy and vehicle also was observed for all lesion count reductions (PBPO combination gel was comparable with adapalene and BPO monotherapies and vehicle. In a large clinical trial, the adapalene-BPO fixed-dose combination gel has shown superiority in efficacy compared with adapalene and BPO monotherapies and vehicle, with an early onset of efficacy and a good safety profile.

  13. High satisfaction with direct switching from antimuscarinics to mirabegron in patients receiving stable antimuscarinic treatment

    OpenAIRE

    Liao, Chun-Hou; Kuo, Hann-Chorng

    2016-01-01

    Abstract Mirabegron, which was the first ?3-adrenoceptor agonist introduced for use in clinical practice, has been extensively evaluated in overactive bladder (OAB) patients in several phase II and III studies. However, most of the enrolled patients were treatment naive or had experienced a wash-out period before the introduction of mirabegron. No study has reported the treatment results of a direct switch from antimuscarinics to mirabegron, which may more commonly occur in clinical practice....

  14. Assessing treatment motivation among patients receiving antiretroviral therapy: A multidimensional approach

    Science.gov (United States)

    Houston, Eric; McKirnan, David J.; Cervone, Daniel; Johnson, Matthew S.; Sandfort, Theo G.M.

    2011-01-01

    Using multidimensional scaling analysis (MDS), this study examined how patient conceptualisations of treatment motivation compare with theoretically-based assumptions used in current assessment approaches. Patients undergoing antiretroviral therapy for HIV/AIDS (n = 39) rated for similarity all possible pairings of 23 treatment descriptions, including descriptors of intrinsic, extrinsic, approach, and avoidance motivation. MDS analyses revealed that patient perceptions of intrinsic and extrinsic motivation often differ from those based on definitions derived from common interpretations of self-determination theory. Findings also showed that patients reported motivation for avoiding treatment when they associated their medication regimens with side effects and other negatively-valenced outcomes. The study describes new applications of MDS in assessing how patients perceive the relationship between treatment behaviours and specific forms of motivation, such as intrinsic and extrinsic motivation. In addition, the study suggests how MDS may be used to develop behavioural strategies aimed at helping patients follow their regimens consistently by identifying treatment conceptualisations and contexts that facilitate or impede adherence. PMID:21942538

  15. Assessing treatment motivation among patients receiving antiretroviral therapy: a multidimensional approach.

    Science.gov (United States)

    Houston, Eric; McKirnan, David J; Cervone, Daniel; Johnson, Matthew S; Sandfort, Theo G M

    2012-01-01

    Using multidimensional scaling (MDS) analysis, this study examined how patient conceptualisations of treatment motivation compare with theoretically based assumptions used in current assessment approaches. Patients undergoing antiretroviral therapy for HIV/AIDS (n=39) rated for similarity between all possible pairings of 23 treatment descriptions, including descriptors of intrinsic, extrinsic, approach and avoidance motivation. MDS analyses revealed that patient perceptions of intrinsic and extrinsic motivations often differ from those based on definitions derived from common interpretations of self-determination theory. Findings also showed that patients reported motivation for avoiding treatment when they associated their medication regimens with side effects and other negatively valenced outcomes. The study describes new applications of MDS in assessing how patients perceive the relationship between treatment behaviours and specific forms of motivation, such as intrinsic and extrinsic motivations. In addition, the study suggests how MDS may be used to develop behavioural strategies aimed at helping patients follow their regimens consistently by identifying treatment conceptualisations and contexts that facilitate or impede adherence.

  16. Women who conceived with infertility treatment were more likely to receive planned cesarean deliveries in Taiwan.

    Science.gov (United States)

    Chien, Li-Yin; Lee, Yu-Hsiang; Lin, Yu-Hung; Tai, Chen-Jei

    2015-06-01

    The objective of this study was to examine the effect of conception with infertility treatment on planned cesarean delivery. The participants were from a panel of primiparous pregnant women in northern Taiwan. The data analysis included 771 women with a singleton pregnancy, of whom 160 had a planned cesarean delivery and 611 who had a vaginal delivery. The study women answered structured questionnaires during the second and third trimesters of pregnancy, and at one-month postpartum. Women who conceived with infertility treatment were more likely to have planned cesarean deliveries than women who conceived without it (44.7% versus 18.1%, p infertility treatment were 2.95 times (95% CI: 1.47-5.92) more likely to have planned cesarean deliveries. The increased risk for planned cesarean deliveries among singleton women who conceived with infertility treatment cannot be explained by older maternal age or higher number of morbidities during pregnancy. Counseling for women who conceive with infertility treatments may be needed to decrease unnecessary cesarean deliveries.

  17. Persistence and adherence in multiple sclerosis patients starting glatiramer acetate treatment: assessment of relationship with care received from multiple disciplines.

    Science.gov (United States)

    Jongen, Peter Joseph; Lemmens, Wim A; Hupperts, Raymond; Hoogervorst, Erwin Lj; Schrijver, Hans M; Slettenaar, Astrid; de Schryver, Els L; Boringa, Jan; van Noort, Esther; Donders, Rogier

    2016-01-01

    In multiple sclerosis patients, the persistence of, and adherence to, disease-modifying treatment are often insufficient. The degree of persistence and adherence may relate to the care received from various disciplines. In an observational study of 203 patients treated with glatiramer acetate 20 mg subcutaneous daily, we assess the persistence and adherence in relation to the amount of care received in various disciplines. The frequencies and durations of care per discipline were reported by patients online, as were missed doses and eventual treatment discontinuation. The associations between the care provided by neurologists, nurses, psychologists, pharmacists, and rehabilitative doctors and persistence and adherence were the primary outcomes; the associations between care received from general practitioners, occupational therapists, physiotherapists, social workers, dieticians, home caregivers, informal caregivers, other medical specialists, and other caregivers and persistence and adherence were secondary outcomes. It was found that the 12-month persistence rate was 62% and that 85% of the persistent patients were 95% adherent (missed relationship between adherence and persistence, nonadherence in Q2 was related to discontinuation after Q2 (P=0.0001). We obtained no evidence that, in multiple sclerosis patients, persistence of and adherence to disease-modifying treatment are associated with the amount of neurological, nursing, pharmaceutical, or rehabilitative care. However, findings suggest that the treatment of psychological problems in Q3 may relate to persistence and that home care and informal care may relate to adherence.

  18. Triple combination as adjuvant to cryotherapy in the treatment of solar lentigines: investigator-blinded, randomized clinical trial.

    Science.gov (United States)

    Hexsel, D; Hexsel, C; Porto, M D; Siega, C

    2015-01-01

    Post-inflammatory hyperpigmentation is a frequent concern when treating solar lentigines. To assess the safety and efficacy of a triple combination cream with fluocinolone acetonide 0.01%, hydroquinone 4% and tretinoin 0.05% as adjuvant to cryotherapy in the treatment of solar lentigines in hands dorsum, and in the prevention of post-inflammatory hyperpigmentation after cryotherapy. This prospective, randomized, controlled, investigator-blinded, single-centre study enrolled 50 patients. Twenty-five patients received a 2-week daily triple combination cream plus sunscreen pre-treatment and 25 received sunscreen alone. After that, cryotherapy was performed in all patients followed by a 3-week recovery period. After this period, patients received the same initial treatment and were followed up for 8 weeks. Melanin and erythema levels of a target and a control lentigo were objectively measured using a narrowband reflectance spectrophotometer. Lentigines count, colour homogeneity and global improvement were also assessed. The number of solar lentigines reduced in the first 2 weeks only in patients who used the triple combination 25 ± 7 vs. 22 ± 8 (P cryotherapy were the reported adverse reactions. Triple combination cream can be used to enhance the resolution of solar lentigines, and to significantly reduce melanin levels and lentigines count, improving treatment results. It was well-tolerated and did not increase the occurrence of neither erythema nor other side-effects after the cryotherapy. © 2014 European Academy of Dermatology and Venereology.

  19. Quality of Life of SGA Children with Short Stature Receiving GH Treatment in Japan.

    Science.gov (United States)

    Takahashi, Ryo; Ogawa, Madoka; Osada, Hisao

    2017-03-01

    The objective of this study was to compare the quality of life (QOL) of small for gestational age (SGA) children with short stature with that of children with normal height, and examine the effects of growth hormone (GH) treatment on the QOL of the SGA children using questionnaires administered to their parents or guardians. The results showed that QOL in daily living of SGA children with short stature was lower than that of normal children based on the perceptions of their parents or guardians. In addition, GH treatment improved the physical domain of QOL of SGA children with short stature. This study suggests that GH treatment can improve QOL and reduce psychosocial problems related to short stature. Copyright© of YS Medical Media ltd.

  20. IMMEDIATE RESULTS OF RADICAL SURGERY UNDER CONDITIONS OF COMBINED MODALITY TREATMENT OF RECTAL CANCE

    Directory of Open Access Journals (Sweden)

    S. G. Afanasyev

    2016-01-01

    Full Text Available The purpose of the study was to assess the immediate response to combination therapy including prolonged preoperative concurrent chemoradiotherapy with capecitabine as a radiosensitizer and local hyperthermia for patients with rectal cancer.Materials and methods. A total of 25 patients received combined modality treatment. The proportions of patients with stages II (T3–4N0 M0 , III (T1–4N1–2M0 and IVa (T1–4N0–2M1 were 3 (12 %, 13 (52 % and 9 (36 %, respectively. The rectal ampulla was diagnosed most frequently (68 %. The patients received preoperative radiation therapy (1.3 Gy twice daily for 5 days per week to a total dose of 54 Gy concurrently with capecitabine (825 мg/m2 , twice a day for 5 days a week and local hyperthermia (3 times a week, 3 hours before irradiation session, at temperatures between 42–44°С, for 45–60 minutes, to a maximum of 10 sessions.Results. Grade 1-2 radiation-induced skin reactions were observed in 3 (12 % patients. By assessing immediate tumor response 6 months after completing radiotherapy, histologically confirmed complete regression was registered in 2 (8% patients and partial regression in 23 (92% patients. Rectal extirpation was performed on 8 (32% patients and sphincter-preserving surgeries on 15 (68% patients. Patients with complete regression were followed up. Postoperative complications were observed in 3(12% patients. None of the patients died. No local recurrence and distant metastases were registered at the 12–18 month follow-up.Conclusion. Short-and long-term outcomes of combined modality treatment including preoperative concurrent chemoradiotherapy with capecitabine as a radiosensitizer and local hyperthermia indicate that this treatment protocol is effective and safe for patients with stage II–IVа rectal cancer. Concurrent chemoradiotherapy results in a significant tumor regression, thus extending the indications for sphincter-preserving surgery.

  1. [The analysis of the effectiveness of the combined treatment of the patients presenting with laryngeal papillomatosis].

    Science.gov (United States)

    Svistushkin, V M; Starostina, S V; Egorov, V I; Ragimov, A A; Mustafaev, D M; Matveev, A V; Volkova, K B

    The objective of the present work was to evaluate the effectiveness of the application of the inducer of endogenous interferon synthesis in the course of the combined treatment of the adult patients presenting with laryngeal papillomatosis. A total of 50 patients with this pathology were admitted and examined at the ENT Clinics of I.M. Sechenov First Moscow State Medical University and M.F. Vladimirsky Moscow Regional Research Clinical Institute during 24 months. The patients comprising group 1 (n=25) were treated with the use of cold plasma surgery and the inducer of endogenous interferon synthesis while those included in group 2 (n=25) received only surgical treatment. It was shown that the combined treatment including the surgical step (cold plasma surgery) followed by the treatment with the inducer of endogenous interferon synthesis to prevent relapses makes it possible to reduce the number of secondary surgical interventions, increase the duration of the intervals between relapses, and decrease the content of types 6 and 11 human papilloma virus in the saliva.

  2. A combined screening platform for HIV treatment failure and resistance.

    Directory of Open Access Journals (Sweden)

    Myres W Tilghman

    Full Text Available To develop a low cost method to screen for virologic failure of antiretroviral therapy (ART and HIV-1 drug resistance, we performed a retrospective evaluation of a screening assay using serial dilutions of HIV-1 RNA-spiked blood plasma and samples from patients receiving >6 months of first-line ART.Serial dilution testing was used to assess sensitivity of a simple PCR-based assay (targeted at ≥1,000 HIV RNA copies/mL. We created blood plasma minipools of five samples, extracted HIV RNA from the pools, PCR amplified the reverse transcriptase (RT coding region of the HIV-1 pol gene from extracted RNA, sequenced PCR product of positive pools, and used sequences to determine drug resistance. Sensitivity, specificity, and predictive values were determined for different levels of virologic failure based on maximum viral loads of individual samples within a pool.Of 295 samples analyzed, 43 (15% had virologic failure at ≥50 copies/mL (range 50-10,500 copies/mL, four at ≥1,000 copies/mL. The assay demonstrated 100% sensitivity to detect virus from these four samples, requiring only one round of PCR, and 56% and 89% sensitivity to detect samples with ≥50 and ≥500 copies/mL using two rounds. Amplified PCR products of all positive pools were successfully sequenced and 30% harbored ≥1 major resistance mutation. This method would have cost 10% of the combined costs of individual viral load and resistance testing.We present a novel method that can screen for both virologic failure of first-line ART and drug resistance. The method is much less expensive than current methods, which may offer sustainability in resource-limited settings.

  3. A combined screening platform for HIV treatment failure and resistance.

    Science.gov (United States)

    Tilghman, Myres W; May, Susanne; Pérez-Santiago, Josué; Ignacio, Caroline C; Little, Susan J; Richman, Douglas D; Smith, Davey M

    2012-01-01

    To develop a low cost method to screen for virologic failure of antiretroviral therapy (ART) and HIV-1 drug resistance, we performed a retrospective evaluation of a screening assay using serial dilutions of HIV-1 RNA-spiked blood plasma and samples from patients receiving >6 months of first-line ART. Serial dilution testing was used to assess sensitivity of a simple PCR-based assay (targeted at ≥1,000 HIV RNA copies/mL). We created blood plasma minipools of five samples, extracted HIV RNA from the pools, PCR amplified the reverse transcriptase (RT) coding region of the HIV-1 pol gene from extracted RNA, sequenced PCR product of positive pools, and used sequences to determine drug resistance. Sensitivity, specificity, and predictive values were determined for different levels of virologic failure based on maximum viral loads of individual samples within a pool. Of 295 samples analyzed, 43 (15%) had virologic failure at ≥50 copies/mL (range 50-10,500 copies/mL, four at ≥1,000 copies/mL). The assay demonstrated 100% sensitivity to detect virus from these four samples, requiring only one round of PCR, and 56% and 89% sensitivity to detect samples with ≥50 and ≥500 copies/mL using two rounds. Amplified PCR products of all positive pools were successfully sequenced and 30% harbored ≥1 major resistance mutation. This method would have cost 10% of the combined costs of individual viral load and resistance testing. We present a novel method that can screen for both virologic failure of first-line ART and drug resistance. The method is much less expensive than current methods, which may offer sustainability in resource-limited settings.

  4. HYBRID TREATMENT OF COMPLEX COMBINED CORONARY AND VALVE DISEASE FOR PATIENTS WITH HIGH LEVEL OF OPERATIONAL RISK

    Directory of Open Access Journals (Sweden)

    G. V. Aniskevich

    2011-01-01

    Full Text Available The analysis of results of hybrid treatment of complex combined coronary and valve disease at patients with high level of operational risk between January 2005 and December 2010. The hybrid treatment of complex combined coronary and valve disease, provides performance of percutaneous coronary interventions (PCI in a combinati- on valve surgery. 118 patients, with a median age 64.4 ± 8.9 years, are included in research. 2 approaches of a hy- brid method of treatment – 2-Staged (n = 86 and a method «1-stop» (n = 32 are applied. The оperative mortality has made 4.2%. On the basis of the received results were the conclusion is drawn that at high-risk patients with complex combined coronary and valve disease the hybrid method of treatment allows to lower risk of operation. 

  5. Bactericidal activity and killing rate of serum in volunteers receiving teicoplanin alone or in combination with oral or intravenous rifampin.

    OpenAIRE

    Van der Auwera, P; Klastersky, J

    1987-01-01

    A total of 10 volunteers, in two groups of 5 each, received the following on separate days: group 1,200 mg of teicoplanin intravenously (i.v.), 600 mg of rifampin orally, or teicoplanin-rifampin; group 2,400 mg of teicoplanin i.v., 300 mg of rifampin i.v. in 60 min, or teicoplanin-rifampin. Blood samples were obtained before, at the end, and at 1 and 6 h after the administration of the antibiotics. Bactericidal activity in serum (SBA) was measured in microtiter plates against 20 clinical isol...

  6. Combination of ozonation and photocatalysis for pharmaceutical wastewater treatment

    Science.gov (United States)

    Ratnawati, Enjarlis, Slamet

    2017-11-01

    The chemical oxygen demand (COD) and phenol removal from pharmaceutical wastewater were investigated using configuration of two circulation batch reactors in a series with ozonation and photocatalytic processes. The ozonation is conducted with O3/granulated activated carbon (O3/GAC), whereas photocatalysis with TiO2 that immobilized on pumice stone (PS-TiO2). The effect of circulation flow rate (10; 12; 15 L/min) and the amount PS-TiO2 (200 g, 250 g, 300 g) were examined. Wastewater of 20 L was circulated pass through the pipe that injected with O3 by the ozone generator, and subsequently flow through two GAC columns, and finally, go through photoreactor that contains photocatalyst PS-TiO2 which equipped with mercury lamp as a photon source. At a time interval, COD and phenol concentration were measured to assess the performance of the process. FESEM imaging confirmed that TiO2 was successfully impregnated on PS, as corroborated by EDX spectra. Meanwhile, degradation process indicated that the combined ozonation and photocatalytic processes (O3/GAC-TiO2) is more efficient compared to the ozonation and photocatalysis alone. For combination process with the circulation flow rate of 10 L/min and 300 g of PS-TiO2,the influent COD of around 1000 ppm are effectively degraded to a final effluent COD of 290 ppm (71% removal) and initial phenol concentration of 4.75 ppm down to 0 ppm for 4 h which this condition fulfill the discharge standards quality. Therefore, this portable prototype reactor is effective that can be used in the pharmaceutical wastewater treatment. For the future, this process condition will be developed for orientation on the industrial applications (portable equipment) since pharmaceutical industries produce wastewater relatively in the small amount.

  7. Limited bacterial diversity within a treatment plant receiving antibiotic containing waste from bulk drug production

    NARCIS (Netherlands)

    Marathe, Nachiket P.; Shetty, Sudarshan A.; Shouche, Yogesh S.; Larsson, D.G.J.

    2016-01-01

    Biological treatment of waste water from bulk drug production, contaminated with high levels of fluoroquinolone antibiotics, can lead to massive enrichment of antibiotic resistant bacteria, resistance genes and associated mobile elements, as previously shown. Such strong selection may be boosted

  8. The Incidence of Incest Histories among Clients Receiving Substance Abuse Treatment.

    Science.gov (United States)

    Glover, Noreen M.; And Others

    1995-01-01

    Volunteer participants (n=77) enrolled in 8 substance abuse treatment facilities were surveyed in order to examine the prevalence and nature of incest contacts among the group. Results indicated that approximately 49 percent of the participants had reported histories of incest. Data are presented under various parameters. Also gives comparisons by…

  9. Abundance and fate of antibiotics and hormones in a vegetative treatment system receiving cattle feedlot runoff

    Science.gov (United States)

    Vegetative treatment systems (VTS) have been developed and built as an alternative to conventional holding pond systems for managing run-off from animal feeding operations. Initially developed to manage runoff nutrients via uptake by grasses, their effectiveness at removing other runoff contaminant...

  10. Hospital of diagnosis and probability to receive a curative treatment for oesophageal cancer

    NARCIS (Netherlands)

    Koeter, M.; van Steenbergen, L. N.; Lemmens, V. E. P. P.; Rutten, H.J.; Roukema, J. A.; Wijnhoven, B. P. L.; Nieuwenhuijzen, G. A. P.

    2014-01-01

    Background Surgical treatment of oesophageal cancer in the Netherland is performed in high volume centres. However, the decision to refer patients for curative surgery is made in the referring hospital of diagnosis. The objective of this study was to determine the influence of hospital of diagnosis

  11. Autism Treatment Survey: Services Received by Children with Autism Spectrum Disorders in Public School Classrooms

    Science.gov (United States)

    Hess, Kristen L.; Morrier, Michael J.; Heflin, L.; Ivey, Michelle L.

    2008-01-01

    The Autism Treatment Survey was developed to identify strategies used in education of children with autism spectrum disorders (ASD) in Georgia. Respondents of the web-based survey included a representative sample of 185 teachers across the state, reporting on 226 children with ASD in grades preschool-12th. The top five strategies being used in…

  12. Treatment of a soft tissue calcification in a patient receiving peritoneal dialysis

    DEFF Research Database (Denmark)

    Rasmussen, Inger Kristine Lindhard; Broberg, Bo; Groenberg, Henrik

    2017-01-01

    . We describe a case of a massive soft tissue calcification in the right gluteal region in a peritoneal dialysis patient. The patient had severe pain and were disabled. The treatment was converted to an intensive hemodialysis regimen with a minimal calcium load and high dose of cinacalcet. During...

  13. Impact of combination antiretroviral therapy initiation on adherence to antituberculosis treatment

    Directory of Open Access Journals (Sweden)

    Marlene Knight

    2015-10-01

    Full Text Available Background: Healthcare workers are often reluctant to start combination antiretroviral therapy (ART in patients receiving tuberculosis (TB treatment because of the fear of high pill burden, immune reconstitution inflammatory syndrome, and side-effects. Object: To quantify changes in adherence to tuberculosis treatment following ART initiation. Design: A prospective observational cohort study of ART-naïve individuals with baseline CD4 count between 50 cells/mm3 and 350 cells/mm3 at start of TB treatment at a primary care clinic in Johannesburg, South Africa. Adherence to TB treatment was measured by pill count,self-report, and electronic Medication Event Monitoring System (eMEMS before and after initiation of ART. Results: ART tended to negatively affect adherence to TB treatment, with an 8% – 10% decrease in the proportion of patients adherent according to pill count and an 18% – 22% decrease in the proportion of patients adherent according to eMEMS in the first month following ART initiation, independent of the cut-off used to define adherence (90%, 95% or 100%. Reasons for non-adherence were multi factorial, and employment was the only predictor for optimal adherence (adjusted odds ratio 4.11, 95% confidence interval 1.06–16.0. Conclusion: Adherence support in the period immediately following ART initiation could optimise treatment outcomes for people living with TB and HIV.

  14. Impact of combination antiretroviral therapy initiation on adherence to antituberculosis treatment

    Directory of Open Access Journals (Sweden)

    Marlene Knight

    2015-04-01

    Full Text Available Background: Healthcare workers are often reluctant to start combination antiretroviral therapy (ART in patients receiving tuberculosis (TB treatment because of the fear of high pill burden, immune reconstitution inflammatory syndrome, and side-effects.Object: To quantify changes in adherence to tuberculosis treatment following ART initiation.Design: A prospective observational cohort study of ART-naïve individuals with baseline CD4 count between 50 cells/mm3 and 350 cells/mm3 at start of TB treatment at a primary care clinic in Johannesburg, South Africa. Adherence to TB treatment was measured by pill count,self-report, and electronic Medication Event Monitoring System (eMEMS before and after initiation of ART.Results: ART tended to negatively affect adherence to TB treatment, with an 8% – 10% decrease in the proportion of patients adherent according to pill count and an 18% – 22% decrease in the proportion of patients adherent according to eMEMS in the first month following ART initiation, independent of the cut-off used to define adherence (90%, 95% or 100%. Reasons for non-adherence were multi factorial, and employment was the only predictor for optimal adherence (adjusted odds ratio 4.11, 95% confidence interval 1.06–16.0.Conclusion: Adherence support in the period immediately following ART initiation could optimise treatment outcomes for people living with TB and HIV.

  15. INCREASED RATES OF SMOKING CESSATION OBSERVED AMONG TRANSGENDER WOMEN RECEIVING HORMONE TREATMENT.

    Science.gov (United States)

    Myers, Steven C; Safer, Joshua D

    2017-01-01

    According to the Centers for Disease Control, while 68% of adult smokers nationally desire to quit, only 6.2% successfully quit in a given year. Transgender women seen for hormone therapy at Boston Medical Center (BMC) are strongly advised to quit smoking before the start of treatment, not only due to general health benefits, but also because of the concern for increased thromboembolic events with estrogen therapy. Transgender men are given the same recommendation regarding tobacco as any patient. We retrospectively examined 156 patients' charts, 120 transgender women and 36 transgender men, from the Transgender Center at BMC. Thirty-five charts were excluded, as they did not contain smoking data (29 transgender women and 6 transgender men). Twenty-eight transgender women (31%) were current smokers when they began treatment. Of those, 64% quit smoking over the course of initiating treatment. Of the 30 transgender men included in this study, 8 (27%) were current smokers when they began treatment. Of those, 25% quit smoking over the course of initiating treatment. Although others report that discussing tobacco use with a healthcare provider can increase rates of smoking cessation as seen with transgender men at our center, the substantially increased rate of smoking cessation among our transgender women suggests that greater impact can be achieved when a life-changing event is leveraged. Further, while some physicians raise concern over morbidity from hormone therapy, in our experience, good health habits initiated with care in our system more than outweigh the modest risks currently described. Abbreviation: BMC = Boston Medical Center.

  16. System design and treatment efficiency of a surface flow constructed wetland receiving runoff impacted stream water.

    Science.gov (United States)

    Maniquiz, M C; Choi, J Y; Lee, S Y; Kang, C G; Yi, G S; Kim, L H

    2012-01-01

    This study reported the efficiency of a free water surface flow constructed wetland (CW) system that receives runoff impacted stream water from a forested and agricultural watershed. Investigations were conducted to examine the potential effect of hydraulic fluctuations on the CW as a result of storm events and the changes in water quality along the flow path of the CW. Based on the results, the incoming pollutant concentrations were increased during storm events and greater at the near end of the storm than at the initial time of storm. A similar trend was observed to the concentrations exiting the CW due to the wetland being a relatively small percentage of the watershed (time during storm events. The concentrations of most pollutants were significantly reduced (p retention of most pollutants during storm events as the actual water quality of the outflow was significantly better by 21-71% than the inflow and the levels of pollutants were reduced to appreciable levels.

  17. Magnetic resonance imaging findings as predictors of clinical outcome in patients with sciatica receiving active conservative treatment

    DEFF Research Database (Denmark)

    Jensen, Tue Secher; Albert, Hanne B; Sorensen, Joan S

    2007-01-01

    OBJECTIVE: The aims of this study were to investigate the possible prognostic value of disk-related magnetic resonance imaging (MRI) findings in relation to recovery at 14 months in patients with severe sciatica, and whether improvement of disk herniation and/or nerve root compromise is concurrent...... with recovery. METHODS: All patients included in this prospective observational study of patients with sciatica receiving active conservative treatment were scanned at baseline and at 14 months' follow-up. Definite recovery at follow-up was defined as an absence of sciatic leg pain and a Roland Morris...... in that the prevalence of disk-related MRI findings was different for men and women, and they had different recovery rates. Improvement of disk herniations and nerve root compromise over time did not coincide with definite recovery. CONCLUSIONS: In patients with sciatica receiving active conservative treatment, broad...

  18. Effect of Pre-treatment Education Programs on the Anxiety of Patients Receiving Radiotherapy: An Integrative Literature Review

    Directory of Open Access Journals (Sweden)

    Fatemeh Heshmati Nabavi

    2016-04-01

    Full Text Available Background: Stress and anxiety in cancer patients are caused by disease diagnosis, unfamiliar experiences, and therapy-related problems. In addition to the short duration of radiotherapy, receiving and understanding of the information about this treatment could be difficult for patients due to anxiety, fatigue, and mental pressure. Training of cancer patients about radiotherapy via educational programs could reduce pre-treatment anxiety. Aim: This systematic review aimed to integrate the information regarding the effects of pre-treatment educational training on the level of anxiety and distress symptoms of cancer patients receiving RT. Method: This systematic review was conducted to identify the studies comparing different methods of pre-treatment patient education before radiotherapy via searching in databases such as MEDLINE, PsycINFO, Web of Science, ClinicalKey, ProQuest, and PubMed. Selected studies included clinical reports on the effects of educational interventions on the anxiety of patients receiving radiotherapy. Excluded samples were commentaries and studies without intervention. Results: In total, we reviewed eight articles assessing the effect of educational interventions before radiotherapy on the anxiety of cancer patients. Educational interventions used in these studies included face-to-face consultation with a radiotherapist, group instructions with routine individual training using visual materials (e.g., brochures, booklets, videotapes, and PowerPoint presentations, group discussions, electronic instructions, written materials, and phone contact with a nurse. Implications for Practice: According our findings, pre-treatment education could reduce the anxiety of cancer patients before radiotherapy. These educational programs could be performed using written, visual, electronic, or face-to-face instructions. However, considering the condition of cancer patients and their treatment, selection of the appropriate training method

  19. Stevens-Johnson Syndrome Patient Received Combination Chemotherapy Gemcitabine, Cisplatin, and 5-FU for Biliary Tract Cancer.

    Science.gov (United States)

    Aznab, Mozaffar; Khazaei, Mansour

    2016-06-01

    Stevens-Johnson syndrome has been an acute, usually self-limiting disease of the skin and mucous membranes. This case report has presented an evidence of the development Stevens - Johnson syndrome associated with combination chemotherapy administration of 5FU, gemcitabin and cisplatin in a patient with biliary tract cancer. Our case was a 54-year-old woman patient, a case of biliary tract cancer who has developed more severe symptoms of Stevens-Johnson syndrome. Diagnosis has confirmed by skin biopsy of an affected area .The patient has improved with supportive care, and during 25 day occurred recovery. Although Stevens-Johnson syndrome has been a rare toxicity, physicians should pay a special attention to the monitoring of biliary tract cancer patients on combination chemotherapy with 5FU, cisplatin and gemcitabin.

  20. Maternal Nutritional Status Predicts Adverse Birth Outcomes among HIV-Infected Rural Ugandan Women Receiving Combination Antiretroviral Therapy

    OpenAIRE

    Sera Young; Katherine Murray; Julia Mwesigwa; Paul Natureeba; Beth Osterbauer; Jane Achan; Emmanuel Arinaitwe; Tamara Clark; Veronica Ades; Albert Plenty; Edwin Charlebois; Theodore Ruel; Moses Kamya; Diane Havlir; Deborah Cohan

    2012-01-01

    Objective Maternal nutritional status is an important predictor of birth outcomes, yet little is known about the nutritional status of HIV-infected pregnant women treated with combination antiretroviral therapy (cART). We therefore examined the relationship between maternal BMI at study enrollment, gestational weight gain (GWG), and hemoglobin concentration (Hb) among 166 women initiating cART in rural Uganda. Design Prospective cohort. Methods HIV-infected, ART-naïve pregnant women were enro...

  1. Effect of olanzapine treatment on INR of a patient receiving warfarin therapy

    Directory of Open Access Journals (Sweden)

    Derya Arslan

    2016-06-01

    Full Text Available Olanzapine is an atypical antipsychotic drug, commonly used in the management of psychotic symptoms in patients with schizoprenia and bipolar affective disorder. Deep venous thrombosis is a manifestation of venous thromboembolism. It is very well known that use of antipsychotic drugs increase the risk of thrombosis in a patient with schizophrenia. It has been reported in many studies the effects of olanzapine on thrombosis but there isn't any report about the effect of olanzapine on international normalized ratio (INR. in the medical literature. In this paper, a patient with schizophrenia and also family history of deep venous thrombosis who emerged deep venous thrombosis after being started on olanzapine treatment and effect of olanzapine treatment on INR has been reported. [Cukurova Med J 2016; 41(2.000: 370-373

  2. Rare severe mycotic infections in children receiving empirical caspofungin treatment for febrile neutropenia

    Directory of Open Access Journals (Sweden)

    Deniz Yilmaz Karapinar

    Full Text Available ABSTRACTEmpirical antifungal therapy is most often given to patients with leukemia. However breakthrough fungal infections under antifungal therapy are not uncommon. Four children, with hematologic malignant disease developed mycotic breakthrough infections while on empirical caspofungin treatment for a median of 14 (range 11-19 days. Trichosporon asahii was detected in the blood culture of two patients and Geotrichum capitatum in the other two (one patient also had positive cerebrospinal fluid culture. Because the patients' clinical situation worsened, voriconazole was empirically added for two patients three and five days before the agent was detected. The first sterile blood culture was obtained 3-7 days of voriconazole treatment. All patients reached clear cultures but one patient died. One patient with central nervous system infection with G. capitatum had severe neurological sequelae. Very severe fungal infections can occur during empirical caspofungin therapy. Therefore, patients should be followed closely.

  3. Emergency patients receiving anaesthesiologist-based pre-hospital treatment and subsequently released at the scene

    DEFF Research Database (Denmark)

    Højfeldt, S G; Sørensen, L P; Mikkelsen, Søren

    2014-01-01

    diagnoses were assigned to patients released at the scene following treatment, to investigate the need for secondary contact with the hospital and to assess mortality in patients released at the scene. METHODS: All records regarding patients released at the scene from 1 January 2008 to 31 December 2010 were......BACKGROUND: The Mobile Emergency Care Unit in Odense, Denmark consists of a rapid response car, manned with an anaesthesiologist and an emergency medical technician. Eleven per cent of the patients are released at the scene following treatment. The aim of the study was to investigate which...... investigated. In each patient, diagnosis as well as any renewed contact with the Mobile Emergency Care Unit or the hospital within 24 h was registered. RESULTS: ONE THOUSAND SIX HUNDRED NINE: patients were released at the scene. Diagnoses within the category 'examination and investigation' [International...

  4. Treatment of a soft tissue calcification in a patient receiving peritoneal dialysis.

    Science.gov (United States)

    Lindhard, Kristine; Broberg, Bo; Groenberg, Henrik; Post Hansen, Henrik

    2017-04-01

    Chronic Kidney Disease patients suffer from Mineral and Bone Disorder (CKD-MBD) leading to increased vascular and soft-tissue calcification. The prevalence of soft tissue calcification in dialysis patients is not well described, and most cases describe such calcifications in hemodialysis patients. We describe a case of a massive soft tissue calcification in the right gluteal region in a peritoneal dialysis patient. The patient had severe pain and were disabled. The treatment was converted to an intensive hemodialysis regimen with a minimal calcium load and high dose of cinacalcet. During the treatment, the calcification diminished rapidly from a diameter of 26.6 to 2.9 cm, and the patient symptoms were relieved, leaving the patient with no pain or restriction in mobilization. © 2016 International Society for Hemodialysis.

  5. Initiation and persistence to statin treatment in patients with diabetes receiving glucose-lowering medications 1997- 2006

    DEFF Research Database (Denmark)

    Dominguez, H; Schramm, T K; Norgaard, M L

    2009-01-01

    citizens 30 years and older who claimed prescriptions of GLM between 1997 and 2006 were identified from nationwide registers of drug dispensing from pharmacies and hospitalizations, and followed until 2006. Statin treatment was registered if a prescription was claimed during the period. By logistic...... regression we analyzed factors related to initiation and persistence to statin treatment. RESULTS: In total 128,106 patients were included. In 1997 only 7% of the patients receiving GLM claimed statins within the first year after GLM initiation. Despite increasing statin prescriptions the following years...

  6. Nutrition accesses among patients receiving enteral treatment in the home environment.

    Science.gov (United States)

    Sznajder, Janusz; Ślefarska-Wasilewska, Marta; Wójcik, Piotr

    2017-10-31

    Enteral feeding in the home environment is connected with creating access to digestive tract, and thanks to that, this kind of treatment is possible. The gold standard in enteral nutrition is PEG, other types of access are: nasogastric tube, gastronomy and jejunostomy. In the article 851 patients who were treated nutritionally in the home environment, in the nutrition clinic, Nutrimed Górny Śląsk, were analyzed. It was described how, in practice, the schedule of nutrition access looks like in the nutrition clinic at a time of qualifying patients to the treatment (PEG 47,35%, gastronomy 18,91%, nasogastric tube 17,39%,jejunostomy 16,33%) and how it changes among patients treated in the nutrition clinic during specific period of time - to the treatment there were qualified patients with at least three-month period of therapy ( second evaluation: PEG 37,01%, gastrostomy 31,13%, nasogastric tube 16,98%, jejunostomy 15,86%). The structure of changes was described, also the routine and the place in what exchanging or changing nutrition access was analyzed. The biggest changes in quantity, among all groups of ill people concerned patients with PEG and gastronomy. In most cases the intervention connected with exchanging access to the digestive tract could be implemented at patient's home.

  7. Sexual function of patients with schizophrenia receiving first-generation (FGA) or second-generation antipsychotic (SGA) treatment.

    Science.gov (United States)

    Mahmoud, Ahmed; Hayhurst, Karen P; Drake, Richard J; Lewis, Shôn W

    2012-06-01

    The aim of the study was to investigate sexual function in patients with schizophrenia receiving treatment with a first-generation antipsychotic (FGA) or a second-generation antipsychotic (SGA) drug. Sexual function is an important aspect of human experience, which can be affected by antipsychotic drug treatment. Sexual dysfunction in patients with schizophrenia may be less prevalent with SGA than with FGA drug treatment. A cross-sectional prevalence study assessed sexual function in a sample of 144 patients with DSM-IV schizophrenia aged between 18 and 65, using the Derogatis Interview for Sexual Functioning (self-report version: DISF-SR). Two equal-sized groups (N = 72) received treatment with an FGA or an SGA drug for at least 12 weeks. No significant differences were seen on DISF-SR total score or subscale score between the two treatment groups. There are no differences in measured sexual function of non-randomised patients with schizophrenia treated with an FGA compared with SGA-treated patients.

  8. Arsenate removal using a combination treatment of precipitation and nanofiltration.

    Science.gov (United States)

    Chang, F F; Liu, W J

    2012-01-01

    A combination treatment of Ca-precipitation and nanofiltration membrane was studied to remove arsenate from water. The selected nanofiltration membrane was an amphoteric charged membrane, proved by the results of ATR-FTIR spectra and zeta potential. The arsenate and calcium removal efficiencies had the lowest values at the isoelectric point of the nanofiltration membrane, attributed to the loosest steric hindrance and the weakest electrostatic repulsion. Above the isoelectric point, arsenate precipitated with calcium ion to form the low solubility compound calcium arsenate, while steric hindrance was the main mechanism of arsenate removal. In contrast, below the isoelectric point, the nanofiltration membrane with positive charges rejected calcium ion by electrostatic repulsion. The high electrostatic shielding of calcium ion prevented arsenate from coming close to the NF membrane. Either high feed arsenate concentration or high calcium oxide dose improved the removal amount of arsenate during the nanofiltration membrane separation process. In addition, the arsenate removal efficiency approached the highest value at 200 μg/L of feed arsenate concentration. The optimal transmembrane pressure was in a range of 0.5-0.7 MPa to restrict the formation of fouling cake on the nanofiltration membrane surface.

  9. Nivolumab in combination with ipilimumab for the treatment of melanoma

    Science.gov (United States)

    Somasundaram, Rajasekharan; Herlyn, Meenhard

    2015-01-01

    Melanoma patients develop resistance to most therapies, including chemo- and targeted-therapy drugs. Single-agent therapies are ineffective due to the heterogeneous nature of tumors comprising several subpopulations. Treatment of melanoma with immune-based therapies such as anti-cytotoxic T-lymphocyte activation-4 and anti-programmed death-1 antibodies has shown modest but long-lasting responses. Unfortunately, only subsets of melanoma patients respond to antibody-based therapies. Heterogeneity in lymphocyte infiltration and low frequency of anti-melanoma-reactive T-cells in tumor lesions are partly responsible for a lack of response to antibody-based therapies. Both antibodies have same biological function but they bind to different ligands at various phases of T-cell activity. Thus, combination therapy of antibodies has shown superior response rates than single-agent therapy. However, toxicity is a cause of concern in these therapies. Future identification of therapy-response biomarkers, mobilization of tumor-reactive T-cell infiltration using cancer vaccines, or non-specific targeted-therapy drugs will minimize toxicity levels and provide long-term remissions in melanoma patients. PMID:26402246

  10. Combined Hyperthermia and Radiotherapy for the Treatment of Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kaur, Punit [Department of Pathology, Scott & White Hospital and the Texas A& M Health Science Center, College of Medicine, Temple, TX 76504 (United States); Hurwitz, Mark D. [Department of Radiation Oncology, Dana-Farber/Brigham and Women' s Cancer Center and Harvard Medical School, Boston, MA 02115 (United States); Krishnan, Sunil [Department of Radiation Oncology, The University of Texas MD Anderson Medical Center, Houston, TX 77030 (United States); Asea, Alexzander, E-mail: asea@medicine.tamhsc.edu [Department of Pathology, Scott & White Hospital and the Texas A& M Health Science Center, College of Medicine, Temple, TX 76504 (United States)

    2011-09-30

    alterations in tumors and the development of treatments combining pharmacological interventions with ionizing radiation that more specifically target either tumor or normal tissue, leading to improvements in efficacy.

  11. Safety and Efficacy Evaluation of Pulsed Dye Laser Treatment, CO2 Ablative Fractional Resurfacing, and Combined Treatment for Surgical Scar Clearance.

    Science.gov (United States)

    Cohen, Joel L; Geronemus, Roy

    2016-11-01

    Surgical scars are an unwanted sequela following surgical procedures. Several different treatment modalities and approaches are currently being employed to improve the cosmesis of surgical scars with each having varying degrees of success. The objective of this study was to assess the ef cacy and safety pulsed dye laser treatment, CO2 ablative fractional resurfacing, and a combined treatment with these two modalities for the cosmetic improvement of surgical scarring that occurred following the surgical removal of skin cancer from different anatomic areas. Twenty-five patients with surgical scarring most frequently on the face following recent surgical excision of skin cancer with Mohs surgery were included in this multicenter, prospective clinical study. Patients were randomized into 4 treatment arms, namely, pulsed dye laser alone, CO2 laser alone, a combined treatment with these two modalities, and CO2 ablative fractional resurfacing on the same day of surgery to half of the scar, followed by a combined treatment with the two modalities to that half of the scar. Patients in each study arm received a total of 3-4 treatments, while those patients in Arm 4 underwent an additional treatment with CO2 laser immediately after surgery. Patients were followed up at 1 and 3 months after the final treatment session. No adverse events were seen. Significant improvements in the appearance of scars were achieved in all study arms, as as- sessed by the Vancouver Scar Scale and Global Evaluation Response scales, with the best clinical outcomes seen in those scars that underwent a combination treatment. All patients reported very high satisfaction from treatment. Both pulsed dye laser treatment and CO2 ablative fractional resurfacing, when used as a monotherapy, are safe and effective in the treatment and improvement of recent surgical scarring. When both of these modalities are used in combination, however, they appear to potentially have a synergistic effect and an accelerated

  12. Therapeutic touch for nausea in breast cancer patients receiving chemotherapy: Composing a treatment.

    Science.gov (United States)

    Vanaki, Zohreh; Matourypour, Pegah; Gholami, Roya; Zare, Zahra; Mehrzad, Valiolah; Dehghan, Mojtaba

    2016-02-01

    Therapeutic touch (TT) is independent nursing intervention which is effective on nausea induced by chemotherapy but technique, steps and variables affected by this therapy are not yet well known. The aim of this study was to elicit descriptions of how TT is used with cancer patients, providing a basis for the systematic use and evaluation of TT with patients. In this research, 108 patients were examined with intentional sampling and random allocation in 3 groups (control, placebo and intervention) in 2013 (each group 36). Intervention received therapeutic touch (touching of first energy layer) and demographic form, visual analog scale (VAS) for intensity of nausea, check list for duration and times of nausea in the morning, noon, afternoon and night at acute phase were used. Data were analyzed by Kruskal Wallis, χ(2) and analysis of variance (ANOVA). Duration, frequency and intensity of nausea were significantly lower in the test group (P < 0.001, P < 0.001 and P < 0.001). The mean duration of intervention (whole process) was 21.38 min [SD 6.04]. In 69.4% of women there was a need for re-intervention after reassessment phase. Results of this randomized control trial showed that TT is effective on duration, times and intensity of nausea; therefore, TT can be used as an alternative method for patients who are willing to use this technique. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. A hypnotherapy intervention for the treatment of anxiety in patients with cancer receiving palliative care.

    Science.gov (United States)

    Plaskota, Marek; Lucas, Caroline; Evans, Rosie; Cook, Karen; Pizzoferro, Kathleen; Saini, Treena

    2012-02-01

    This pilot study aimed to assess the benefits of hypnotherapy in the management of anxiety and other symptoms, including depression and sleep disturbance, in palliative care patients with cancer. Eleven hospice patients received four sessions of hypnotherapy and completed the Hospital Anxiety and Depression Scale, the Edmonton Symptom Assessment System, and the Verran and Snyder-Halpern Scale at set time points. Wrist actigraphy also provided an objective assessment of sleep quality. After the second hypnotherapy session there was a statistically significant reduction in mean anxiety and symptom severity, but not in depression or sleep disturbance. After the fourth session there was a statistically significant reduction in all four patient-reported measures but not in actigraphy. These results offer evidence that hypnotherapy can reduce anxiety in palliative care patients, as well as improving sleep and the severity of psychological and physical symptoms. Further studies are needed to explore whether the observed benefits were a direct result of the hypnotherapy and how the intervention could most benefit this patient population.

  14. Virus isolations from sewage and from a stream receiving effluents of sewage treatment plants*

    Science.gov (United States)

    Grinstein, Saul; Melnick, Joseph L.; Wallis, Craig

    1970-01-01

    In order to detect viruses in sewage or streams, it is first necessary to concentrate the virus present in the fluid sample. Available methods are not readily manageable for concentrating virus from large volumes of fluid, and have not always yielded high recovery rates. In the study described in this paper, a method for concentration of viruses by adsorption on insoluble cross-linked maleic anhydride polyelectrolytes has been utilized to survey the viral flora of sewage and of a stream receiving sewage effluents, in a residential area of Houston, Texas. On a single day the virus flow at different points along the stream varied from 304 000 to 6 014 000 PFU/min. From 84 samples each of 1 US gal, 14 520 isolates were obtained, chiefly echovirus type 7 and polioviruses of all 3 types, some of them with characteristics of virulent wild strains. With virus isolation rates as high as those achieved, it is now possible to monitor virus in natural waters more effectively. PMID:4315865

  15. Development of a radioimmunoassay for measuring gonadotrophin releasing hormone in patients receiving treatment

    Energy Technology Data Exchange (ETDEWEB)

    Mobsby, V.A.; Knapp, M.L.; Mayne, P.D. (Charing Cross and Westminster Medical School, Westminster, London (UK)); Fink, R.S. (West Middlesex Univ. Hospital, Isleworth (UK)); Osgood, V.M. (Royal Free Hospital, London (UK))

    1989-05-01

    This gonadotrophin releasing hormone (GnRH) assay showed good precision, recovery, and parallelism over a wide range of GnRH concentrations with a sensitivity of 15 pg/ml. The assay was compared with a commercially available kit (Buhlmann Laboratories). Although the Buhlmann kit showed acceptable precision, recovery, sensitivity, and correlation with the developed GnRH assay for plasma samples, lack of parallelism of serially diluted plasma and urine samples was consistently observed, together with poor correlation with the developed GnRH assay for urine, suggesting a matrix effect with the Buhlmann kit. The developed assay is suitable for measuring GnRH in samples obtained from patients receiving pulsatile infusions of GnRH. In contrast, the commercially available Buhlmann kit was unsuitable for measuring plasma GnRH as the kit had a top standard of only 160 pg/ml, well below peak plasma concentration. It would not be possible to dilute samples for analysis because of lack of parallelism of diluted samples compared with standards obtained with the Buhlmann assay. (author).

  16. Development of a radioimmunoassay for measuring gonadotrophin releasing hormone in patients receiving treatment.

    Science.gov (United States)

    Mosby, V A; Knapp, M L; Fink, R S; Osgood, V M; Mayne, P D

    1989-05-01

    A radioimmunoassay for the measurement of gonadotrophin releasing hormone (GnRH) in plasma and urine using readily available reagents was developed. The GnRH assay showed good precision, recovery, and parallelism over a wide range of GnRH concentrations with a sensitivity of 15 pg/ml. The assay was compared with a commercially available kit (Buhlmann Laboratories). Although the Buhlmann kit showed acceptable precision, recovery, sensitivity, and correlation with the developed GnRH assay for plasma samples, lack of parallelism of serially diluted plasma and urine samples was consistently observed, together with a poor correlation with the developed GnRH assay for urine, suggesting a matrix effect with the Buhlmann kit. The developed assay is suitable for measuring GnRH in samples obtained from patients receiving pulsatile infusions of GnRH. In contrast, the commercially available Buhlmann kit was unsuitable for measuring plasma GnRH as the kit had a top standard of only 160 pg/ml, well below the peak plasma concentration. It would not be possible to dilute samples for analysis because of the lack of parallelism of diluted samples compared with standards obtained with the Buhlmann assay.

  17. PROFILE AND RISK FACTORS OF ADVERSE REACTIONS IN NEW TUBERCULOSIS CASES RECEIVING TREATMENT

    OpenAIRE

    D. A. Ivаnovа; S. E. Borisov

    2017-01-01

    In order to evaluate  the frequency  and risk factors of adverse reactions,  the monitoring results  of clinical and laboratory tests  of 435 new cases of respiratory tuberculosis being on the intensive phase of chemotherapy have been analyzed. 95.2% of patients had adverse reactions (95% CI 92.7-96.9); 48.7% demonstrated severe adverse reactions and in 72.7% treatment regimen had to be changed. Regarding the profile of adverse reactions, hepatotoxic ones prevailed (59.3%), they were followed...

  18. Antibiotic resistance genes in municipal wastewater treatment systems and receiving waters in Arctic Canada

    DEFF Research Database (Denmark)

    Neudorf, Kara D.; Huang, Yan Nan; Ragush, Colin M.

    2017-01-01

    -term storage in WSPs benefitted removal of organic material and some ARGs. However, one WSP system showed evidence of the enrichment of sul1, sul2, mecA, tet(O) and qnr(S). Further research is needed to fully understand if these ARG releases pose a risk to human health, especially in the context of traditional......Domestic wastewater discharges may adversely impact arctic ecosystems and local indigenous people, who rely on being able to hunt and harvest food from their local environment. Therefore, there is a need to develop efficient wastewater treatment plants (WWTPs), which can be operated in remote...

  19. Evaluation of a combination tumor treatment using thermo-triggered liposomal drug delivery and carbon ion irradiation.

    Science.gov (United States)

    Kokuryo, Daisuke; Aoki, Ichio; Yuba, Eiji; Kono, Kenji; Aoshima, Sadahito; Kershaw, Jeff; Saga, Tsuneo

    2017-07-01

    The combination of radiotherapy with chemotherapy is one of the most promising strategies for cancer treatment. Here, a novel combination strategy utilizing carbon ion irradiation as a high-linear energy transfer (LET) radiotherapy and a thermo-triggered nanodevice is proposed, and drug accumulation in the tumor and treatment effects are evaluated using magnetic resonance imaging relaxometry and immunohistology (Ki-67, n = 15). The thermo-triggered liposomal anticancer nanodevice was administered into colon-26 tumor-grafted mice, and drug accumulation and efficacy was compared for 6 groups (n = 32) that received or did not receive the radiotherapy and thermo trigger. In vivo quantitative R1 maps visually demonstrated that the multimodal thermosensitive polymer-modified liposomes (MTPLs) can accumulate in the tumor tissue regardless of whether the region was irradiated by carbon ions or not. The tumor volume after combination treatment with carbon ion irradiation and MTPLs with thermo-triggering was significantly smaller than all the control groups at 8 days after treatment. The proposed strategy of combining high-LET irradiation and the nanodevice provides an effective approach for minimally invasive cancer treatment. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

  20. [Commemorative lecture of receiving Imamura Memorial Prize. Studies on prevention and treatment of childhood tuberculosis].

    Science.gov (United States)

    Takamatsu, I

    1999-11-01

    We performed a retrospective analysis of 394 patients who were treated for active tuberculosis (TB) at our hospital from 1976 to 1997. We had started early BCG vaccination campaign in Osaka Prefecture from 1995 and the coverage of BCG vaccination in infants rose up to about 90%. From that experience, we studied the current situations and measures on prevention and treatment of childhood tuberculosis. Pulmonary TB in children is successfully treated with 6-month standard short-course chemotherapy using isoniazid, rifampin, and pyrazinamide daily for 2 months, followed by isoniazid and rifampin daily for 4 months. Prognosis of childhood tuberculous meningitis (TBM) is poor, early diagnosis and prevention of TBM is important. In order to promote TB control and eliminate childhood TB, especially in infants, the following is necessary; 1) early detection and treatment of adult TB patients, source of infection, 2) prompt and appropriate contact examination and chemoprophylaxis, 3) BCG vaccination during early infancy, 4) protection from MDR-TB are most important.

  1. Prevalence of Listeria monocytogenes in the river receiving the effluent of municipal wastewater treatment plant

    Directory of Open Access Journals (Sweden)

    Atefeh Taherkhani

    2013-01-01

    Full Text Available Aims: The objective of this study was to evaluate the prevalence of Listeria spp. in the river water before and after discharge of the effluent of the municipal wastewater treatment plant (WWTP in Isfahan, Iran. Materials and Methods: A total of 66 samples were collected bi-weekly over 4 months from eleven discrete sampling locations in Zayandehrood River, Iran. Three sampling sites were located above the discharge point and five sites were located after the discharge point of WWTP. Samples were also collected from the influent and the effluent of WWTP. Listeria spp. were isolated using a selective enrichment procedure and a subculture onto polymyxin-acriflavine-lithium chloride-ceftazidime-esculin-mannitol Agar. All isolates were subjected to standard biochemical tests. Results: L. monocytogenes was isolated from influent (83%, effluent (50% and (18.5% river water. Listeria spp. was not found before the discharge point in river water. However, L. monocytogenes was isolated in samples collected from 200 m (33%, 500 m (33%, 2 km (16.5%, 5 km (16.5% and 10 km (16.5% downstream from the WWTP. Listeria innocua (9% and Listeria seeligeri (10% were the second most frequently isolated species. Conclusion: During the wastewater treatment, Listeria spp. is not removed completely. L. monocytogenes is widely distributed in the Zayandehrood river. L. monocytogenes released into surface water demonstrates a potential risk for public health. These results indicate the need for appropriate water management in order to reduce human and animal exposure to such pathogens.

  2. Maternal nutritional status predicts adverse birth outcomes among HIV-infected rural Ugandan women receiving combination antiretroviral therapy.

    Science.gov (United States)

    Young, Sera; Murray, Katherine; Mwesigwa, Julia; Natureeba, Paul; Osterbauer, Beth; Achan, Jane; Arinaitwe, Emmanuel; Clark, Tamara; Ades, Veronica; Plenty, Albert; Charlebois, Edwin; Ruel, Theodore; Kamya, Moses; Havlir, Diane; Cohan, Deborah

    2012-01-01

    Maternal nutritional status is an important predictor of birth outcomes, yet little is known about the nutritional status of HIV-infected pregnant women treated with combination antiretroviral therapy (cART). We therefore examined the relationship between maternal BMI at study enrollment, gestational weight gain (GWG), and hemoglobin concentration (Hb) among 166 women initiating cART in rural Uganda. Prospective cohort. HIV-infected, ART-naïve pregnant women were enrolled between 12 and 28 weeks gestation and treated with a protease inhibitor or non-nucleoside reverse transcriptase inhibitor-based combination regimen. Nutritional status was assessed monthly. Neonatal anthropometry was examined at birth. Outcomes were evaluated using multivariate analysis. Mean GWG was 0.17 kg/week, 14.6% of women experienced weight loss during pregnancy, and 44.9% were anemic. Adverse fetal outcomes included low birth weight (LBW) (19.6%), preterm delivery (17.7%), fetal death (3.9%), stunting (21.1%), small-for-gestational age (15.1%), and head-sparing growth restriction (26%). No infants were HIV-infected. Gaining HIV-infected women initiating cART during pregnancy, grossly inadequate GWG was common. Infants whose mothers gained HIV-infected women. Clinicaltrials.gov NCT00993031.

  3. Evaluation of emergency contraception use among women receiving gynecological treatment in the Brazilian Amazon

    Directory of Open Access Journals (Sweden)

    Paulo Sérgio Barbalho Priante

    2014-06-01

    Full Text Available Introduction: The use of a postcoital hormonal contraception regimen has been described and is known as emergency contraception (EC or “the morning-after pill”. The aim of this study was to evaluate the use and level of knowledge about emergency oral contraception (EC among women attending the gynecology outpatient clinic of the Hospital Fundação Santa Casa de Misericórdia of the State ofPará, the second largest state in the Brazilian Amazon. Methods: a cross-sectional study was conducted with 316 sexually active women, aged 18 to 50 years, who attended the gynecology outpatient clinic. Participants were included based on spontaneous demand between June and July 2012. Patients answered a questionnaire with 29 questions, including: age in years, educational attainment, knowledge about EC, and previous use of the method. The primary outcome was knowledge on EC use. Results: Participants' mean age was 31.84 years (SD ± 8.00. As for their educational level, 46.84% of them had completed high school, and only 8.55% had higher education. Most of the women obtained information about EC through friends (48.61%, n = 152, and only 7.30% from their doctors. Although most participants (83.54% reported to be aware of the method, only 0.63% reported that EC could be used up to 5 days after unprotected intercourse; 57.59% did not know how to use it; and 76.58% (n = 242 had never used the method. Conclusion: The women in our study seem to have a high level of knowledge and prevalence of use of emergency contraception, although few of them knew about the time limit for its use. They should receive more information about emergency contraception.

  4. Interest in Use of Technology for Healthcare Among Veterans Receiving Treatment for Mental Health.

    Science.gov (United States)

    Miller, Christopher J; McInnes, D Keith; Stolzmann, Kelly; Bauer, Mark S

    2016-10-01

    There is great interest in leveraging technology, including cell phones and computers, to improve healthcare. A range of e-health applications pertaining to mental health such as messaging for prescription refill or mobile device videoconferencing are becoming more available, but little is known about the mental health patient's interest in using these newer applications. We mailed a survey to 300 patients seen in the general mental health clinic of a local Veterans Affairs Medical Center. Survey questions focused on interest in use of cell phones, tablets, and other computers in patients' interactions with the healthcare system. A total of 74 patients, primarily treated for depression, post-traumatic stress disorder, or anxiety disorders, returned completed surveys. Nearly all reported having a cell phone (72/74, 97%), but fewer than half reported having a smartphone (35/74, 47%). Overall, a substantial majority (64/74, 86%) had access to an Internet-capable device (smartphone or computer, including tablets). Respondents appeared to prefer computers to cell phones for some health-related communications, but did not express differential interest for other tasks (such as receiving appointment reminders). Interest in use was higher among younger veterans. Most veterans with a mental health diagnosis have access to technology (including cell phones and computers) and are interested in using that technology for some types of healthcare-related communications. While there is capacity to utilize information technology for healthcare purposes in this population, interests vary widely, and a substantial minority does not have access to relevant devices. Although interest in using computers for health-related communication was higher than interest in using cell phones, single-platform technology-based interventions may nonetheless exclude crucial segments of the population.

  5. Mechanisms of Dexamethasone-Induced Disturbed Sleep and Fatigue in Paediatric Patients Receiving Treatment for ALL

    Science.gov (United States)

    Vallance, Kelly; Liu, Wei; Mandrell, Belinda N.; Panetta, John C; Gattuso, Jami S.; Hockenberry, Marilyn; Zupanec, Sue; Yang, Lei; Yang, Jie; Hinds, Pamela S.

    2010-01-01

    Background Dexamethasone contributes to high cure rates in pediatric acute lymphoblastic leukaemia (ALL) but significantly and adversely alters sleep and fatigue. Herein we explored three mechanisms (pharmacokinetics, serum albumin, and pharmacogenetics) through which dexamethasone may cause debilitating fatigue and disrupted sleep. Methods We enrolled 100 patients on a 10-day study: 5 days of no dexamethasone (OFF DEX) followed by 5 days of dexamethasone (ON DEX) during continuation chemotherapy. Sleep variables were collected with continuous actigraphy on Days 1 through 5, both OFF DEX and ON DEX. On Days 2 and 5 of each 5-day period, parents and patients 7 years of age and older completed a sleep diary and Fatigue Scale questionnaire. Blood was collected at 0 (pre-dexamethasone), 1, 2, 4, and 8 hours after the first oral dexamethasone dose for pharmacokinetic analysis. Serum albumin concentration was retrospectively analyzed in stored samples. Patient DNA was genotyped for 99 polymorphic loci in candidate genes associated with glucocorticoid metabolism. Results Dexamethasone clearance was significantly greater in younger patients than in older ones and in lower risk patients. In multiple regression models, risk group was significantly related to pharmacokinetic parameters. We found that polymorphisms in three genes (AHSG, IL6, POLDIP3) were significantly associated with sleep measures but not fatigue. Conclusion Risk group had the most significant relationship with disrupted sleep in patients while on dexamethasone. Serum albumin levels had neither a direct relationship with sleep or fatigue variables nor an indirect relationship through systemic exposure to dexamethasone. We identified candidate genes that may help explain the adverse events of disrupted sleep in pediatric patients receiving dexamethasone. PMID:20400291

  6. Combined Aphasia and Apraxia of Speech Treatment (CAAST): effects of a novel therapy.

    Science.gov (United States)

    Wambaugh, Julie L; Wright, Sandra; Nessler, Christina; Mauszycki, Shannon C

    2014-12-01

    This investigation was designed to examine the effects of a newly developed treatment for aphasia and acquired apraxia of speech (AOS). Combined Aphasia and Apraxia of Speech Treatment (CAAST) targets language and speech production simultaneously, with treatment techniques derived from Response Elaboration Training (Kearns, 1985) and Sound Production Treatment (Wambaugh, Kalinyak-Fliszar, West, & Doyle, 1998). The purpose of this study was to determine whether CAAST was associated with positive changes in verbal language and speech production with speakers with aphasia and AOS. Four participants with chronic aphasia and AOS received CAAST applied sequentially to sets of pictures in the context of multiple baseline designs. CAAST entailed elaboration of participant-initiated utterances, with sound production training applied as needed to the elaborated productions. The dependent variables were (a) production of correct information units (CIUs; Nicholas & Brookshire, 1993) in response to experimental picture stimuli, (b) percentage of consonants correct in sentence repetition, and (c) speech intelligibility. CAAST was associated with increased CIU production in trained and untrained picture sets for all participants. Gains in sound production accuracy and speech intelligibility varied across participants; a modification of CAAST to provide additional speech production treatment may be desirable.

  7. [Ozone therapy combined with sulfasalazine delivered via a colon therapy system for treatment of ulcerative colitis].

    Science.gov (United States)

    Geng, Yan; Wang, Wei; Ma, Qiang; Peng, Li-qiong; Liang, Zhong-hui

    2010-12-01

    To assess the therapeutic effect of ozone therapy combined with sulfasalazine sulfasalazine delivered via a colon therapy system in the treatment of distal ulcerative colitis. This prospective randomized controlled clinical trial involved 54 patients with mild to moderate active distal ulcerative colitis, who were randomize into 3 groups in accordance with the inclusion criteria (n=18). Each group was given sulfasalazine at the daily dose of 2 g, and in colon therapy group and ozone therapy plus sulfasalazine therapy group, sulfasalazine was delivered via a colon therapy system on a daily basis; the control group received sulfasalazine via retention enema only. At 0, 2, and 4 weeks of the treatment, colonoscopy was performed to evaluate the disease activity, and biopsy samples were obtained at 0 and 4 weeks for histological examination. In comparison with colon therapy group and control group, ozone therapy plus colon therapy resulted in more rapid alleviation of the clinical symptoms and better histological improvement without any adverse effects. Ozone therapy combined with sulfasalazine delivered via a colon therapy system is feasible and effective for treatment of ulcerative colitis.

  8. Preparing general practitioners to receive cancer patients following treatment in secondary care

    DEFF Research Database (Denmark)

    Guassora, Ann Dorrit Kristiane; Jarlbæk, Lene; Thorsen, Thorkil

    2015-01-01

    for professionals in both primary and secondary healthcare. Participants discussed solutions to problems which had previously been identified in patient interviews and in focus groups with general practitioners (GPs), hospital doctors, and nursing staff. The data were analyzed using framework analysis. Results......Background: Many patients consider the interface between secondary and primary care difficult, and in particular, the transition of care between these different parts of the healthcare system presents problems. This interface has long been recognized as a critical point for quality of care....... The purpose of our study is to formulate solutions to problems identified by cancer patients and healthcare professionals during the transition from hospital back to general practice on completion of primary treatment for cancer. Methods: A qualitative study based on focus groups at a seminar...

  9. Usefulness of the Brief Pain Inventory in Patients with Opioid Addiction Receiving Methadone Maintenance Treatment.

    Science.gov (United States)

    Dennis, Brittany B; Roshanov, Pavel S; Bawor, Monica; Paul, James; Varenbut, Michael; Daiter, Jeff; Plater, Carolyn; Pare, Guillame; Marsh, David C; Worster, Andrew; Desai, Dipika; Thabane, Lehana; Samaan, Zainab

    2016-01-01

    Chronic pain is implicated as a risk factor for illicit opioid use among patients with opioid addiction treated with methadone. However, there exists conflicting evidence that supports and refutes this claim. These discrepancies may stem from the large variability in pain measurement reported across studies. We aim to determine the clinical and demographic characteristics of patients reporting pain and evaluate the prognostic value of different pain classification measures in a sample of opioid addiction patients. Multi-center prospective cohort study. Methadone maintenance treatment facilities for managing patients with opioid addiction. This study includes participants from the Genetics of Opioid Addiction (GENOA) prospective cohort study. We assessed the prognostic value of different pain measures for predicting opioid relapse. Pain measures include the Brief Pain Inventory (BPI) and patients' response to a direct pain question all study participants were asked from the GENOA case report form (CRF) "are you currently experiencing or have been diagnosed with chronic pain?" Performance characteristics of the GENOA CRF pain measure was estimated with sensitivity and specificity using the BPI as the gold standard reference. Prognostic value was assessed using pain classification as the primary independent variable in an adjusted analysis using 1) the percentage of positive opioid urine screens and 2) high-risk opioid use (= 50% positive opioid urine screens) as the dependent variables in a linear and logistic regression analyses, respectively. Among participants eligible for inclusion (n = 444) the BPI was found to be highly sensitive, classifying a large number of GENOA participants with pain (n = 281 of the 297 classified with pain, 94.6%) in comparison to the GENOA CRF (n = 154 of 297 classified with pain, 51.8%). Participants concordantly classified as having pain according to the GENOA CRF and BPI were found to have an estimated 7.79% increase in positive

  10. Aspergillosis in a Patient Receiving Temozolomide for the Treatment of Glioblastoma

    Directory of Open Access Journals (Sweden)

    Rodrigo Ramella Munhoz

    2013-08-01

    Full Text Available Leukopenia and selective CD4+ lymphopenia represent major adverse events associated with the use of temozolomide (TMZ, an oral alkylating agent incorporated in the treatment of glioblastoma (GBM. The increased risk of opportunistic infections, including those caused by Pneumocystis jiroveci and cytomegalovirus, has been previously described in the literature. Here we report the case, the first to our knowledge, of a patient with pulmonary invasive aspergillosis immediately after the completion of chemoradiation with TMZ for GBM. Diagnosis was confirmed through a CT-guided lung biopsy, and the patient had excellent response to systemic voriconazole. This case illustrates that TMZ can be associated with severe opportunistic infections, presumably associated with T lymphocyte immune dysfunction, and patients exposed to this agent should be carefully monitored.

  11. The indirect cost due to pulmonary Tuberculosis in patients receiving treatment in Bauchi State—Nigeria

    Directory of Open Access Journals (Sweden)

    Umar Nisser

    2012-05-01

    Full Text Available Objective To determine the time spent and income lost by patients and their households for seeking tuberculosis diagnosis and treatment in Bauchi State-Nigeria. Method A cross sectional study where 242 TB patients were sampled from 27 out of 67 facilities providing TB services in a north-eastern state of Nigeria. Sampling was stratified based on facility type, patients’ HIV status and gender. Results The income lost among the hospitalized group was estimated at $156/patient and about $114 in the non-hospitalized patients group. Age, gender, facility of diagnosis, level of education and occupation were significant (p-values Conclusion Tuberculosis poses causes tremendous burden in terms of time and productivity lost to both patients and their households in Bauchi State Nigeria.

  12. Hemolytic anemia in patients receiving daily dapsone for the treatment of leprosy.

    Science.gov (United States)

    Deps, Patricia; Guerra, Patrícia; Nasser, Sofia; Simon, Marisa

    2012-09-01

    Multidrug therapy for leprosy is currently done with dapsone, clofazimine and rifampicin. Dapsone is known to cause hemolytic anemia (HA) and this adverse event during MDT seems to be more frequent than reported. The aim of this report is to discuss and grade HA due to dapsone during MDT treatment for leprosy. This is a retrospective study of 194 leprosy patients from a Leprosy Control Programme Unit in Vit6ria-ES, Brazil. HA was observed in 48 (24.7%) patients and occurred within the first 3 months in 51% of these. Mean hematocrit levels fell from 38.5 to 31.5 and hemoglobin from 12.8 to 10.3. Dapsone used in the MDT regime for leprosy decreases the hematocrit and hemoglobin levels due to a low grade hemolysis, which can result in significant anemia.

  13. LOW POWER BRACHYTHERAPY IN COMBINED TREATMENT IN PATIENTS WITH INTERMEDIATE RISK OF LOCALIZED PROST ATE CANCER

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    V. A. Biryukov

    2014-01-01

    Full Text Available Objective. Estimation of the effectiveness of low power brachytherapy sources I-125 in the combined treatment in group of patients of intermediate risk of localized prostate cancer.Material and methods. The study included 126 patients with prostate cancer of intermediate risk. 104 patients (83,9% were conducted low power brachytherapy I‑125 in combination with hormone therapy by analogues of LHWG. 22 patients (16.1% received external beam irradiation in combination with brachytherapy I‑125 and hormonal treatment. Relapse-free survival of patients was evaluated in accordance with the criteria Phoenix (Nadir PSA + ng/ml. Evaluation of side effects of radiation treatment were carried out according to the RTOG criteria.Results. PSA relapse-free survival in the group of brachytherapy and hormone treatment at the time of observation 5 years amounted to 97.1%. In the group of combined radiation therapy with brachytherapy, and hormonal treatment PSA relapse-free survival rate was 95.5%.In both groups, relapse-free survival was noted in 96,8% of cases. Tumor-specific and overall survival in bothgroups was 100%. The major complications of treatment in both groups were radiation urethritis 1 to 2 degrees in 9.5% of cases (12 patients, urethral stricture in 5 patients (3.9% of cases, acute urinary retention in 1 patient (0.8% of cases and late radiation rectitis of 2 degree in 1.58% of cases (2 patients.Conclusions. It is possible to draw tentative conclusions about the high rate of survival without progression in both treatment groups on the background of the relatively low frequency of adverse reactions. It is necessary further follow-up for patients with estimating of survival for a longer period.

  14. Statistical and Epistemological Issues in the Evaluation of Treatment Efficacy of Pharmaceutical, Psychological, and Combination Treatments for Women's Sexual Desire Difficulties.

    Science.gov (United States)

    Chivers, Meredith L; Basson, Rosemary; Brotto, Lori A; Graham, Cynthia A; Stephenson, Kyle R

    2017-04-03

    We were grateful to receive responses from Leonore Tiefer, Anita Clayton and Robert Pyke, and Richard Balon and Robert Segraves, to our commentary (Brotto et al., 2016 ) on Pyke and Clayton ( 2015 ). These commentaries raise a number of substantive statistical and epistemological issues relating to the evaluation of treatment efficacy in pharmaceutical, psychological, and combination treatments for sexual desire difficulties and caution researchers to remain mindful of sources of bias as we do the science. In what follows, we discuss each of these issues in turn in hopes of encouraging our field to adopt the highest possible standards when carrying out and interpreting treatment outcome research.

  15. Maternal nutritional status predicts adverse birth outcomes among HIV-infected rural Ugandan women receiving combination antiretroviral therapy.

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    Sera Young

    Full Text Available Maternal nutritional status is an important predictor of birth outcomes, yet little is known about the nutritional status of HIV-infected pregnant women treated with combination antiretroviral therapy (cART. We therefore examined the relationship between maternal BMI at study enrollment, gestational weight gain (GWG, and hemoglobin concentration (Hb among 166 women initiating cART in rural Uganda.Prospective cohort.HIV-infected, ART-naïve pregnant women were enrolled between 12 and 28 weeks gestation and treated with a protease inhibitor or non-nucleoside reverse transcriptase inhibitor-based combination regimen. Nutritional status was assessed monthly. Neonatal anthropometry was examined at birth. Outcomes were evaluated using multivariate analysis.Mean GWG was 0.17 kg/week, 14.6% of women experienced weight loss during pregnancy, and 44.9% were anemic. Adverse fetal outcomes included low birth weight (LBW (19.6%, preterm delivery (17.7%, fetal death (3.9%, stunting (21.1%, small-for-gestational age (15.1%, and head-sparing growth restriction (26%. No infants were HIV-infected. Gaining <0.1 kg/week was associated with LBW, preterm delivery, and a composite adverse obstetric/fetal outcome. Maternal weight at 7 months gestation predicted LBW. For each g/dL higher mean Hb, the odds of small-for-gestational age decreased by 52%.In our cohort of HIV-infected women initiating cART during pregnancy, grossly inadequate GWG was common. Infants whose mothers gained <0.1 kg/week were at increased risk for LBW, preterm delivery, and composite adverse birth outcomes. cART by itself may not be sufficient for decreasing the burden of adverse birth outcomes among HIV-infected women.Clinicaltrials.gov NCT00993031.

  16. An effective day case treatment combination for refractory neuropathic mixed incontinence

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    Prasad Patki

    2008-02-01

    Full Text Available OBJECTIVE: Women with drug refractory neurogenic mixed incontinence (NMI have limited minimally invasive treatment options and require reconstructive surgery. We examined efficacy of a combination of day case intradetrusor (ID botulinum toxin (BTX-A bladder injections and transobturator (TOT or tension free vaginal tape (TVT. MATERIALS AND METHODS: Eleven women who are pharmacotherapy intolerant or who have drug refractory NMI were treated. Two opted for open surgery and the remaining 9 received 1000 units of Dysport diluted in 30 mL saline cystoscopically at 30 ID sites followed by TOT in 6 or TVT in 3 as a day case combination treatment. Patient demographics, pre and post treatment videocystometrogram (VCMG, pad test and International Committee on Incontinence Questionnaire (ICIQ scores were recorded. At 6 weeks (repeat ICIQ, pad test and patient satisfaction, at 3 and 12 months (VCMG and 'current' (ICIQ and patient satisfaction was recorded. RESULTS: The mean age was 56.7 years (range 41 to 78 with a mean follow up of 19.1 months (range 7 to 33. All women were continent at 3 and 12 months. Quality of life (ICIQ scores improved at 6 weeks (p > 0.001 and remained stable up to the last follow up (p > 0.001. Eight women have stopped using pads. At 3 months, there was significant improvement in MDP (p > 0.014 and MCC (p = 0.002. Anticholinergics were discontinued in 7 with global high satisfaction with the treatment BTX-A injections were repeated in 4 (mean 13.5 months. CONCLUSION: Anticholinergic refractory women with NMI can be effectively treated as a day case with combination of ID BTX-A injections and TVT or TOT.

  17. [Diagnosis of Vater's papilla cancer and its combination treatment and radiotherapy].

    Science.gov (United States)

    Kharchenko, V P; Liutfaliev, T A; Khmelevskiĭ, E V; Kunda, M A; Zapirov, G M; Eptyshev, N A

    2008-01-01

    The paper considers the problems of enhancing the efficiency of diagnosis and treatment of Vater's papilla cancer complicated by jaundice, by maximally realizing the capacities of instrumental studies and by improving the procedures of combination treatment and radiotherapy for this disease. The achieved treatment results show it expedient to use combination treatment and, if radical surgery is contraindicated, radiotherapy for Vater's papilla cancer.

  18. Gestrinone combined with ultrasound-guided aspiration and ethanol injection for treatment of chocolate cyst of ovary.

    Science.gov (United States)

    Wu, Xiaoyun; Xu, Yun

    2015-05-01

    The aim of this study was to determine clinical performance of gestrinone combined with ultrasound-guided aspiration and ethanol injection in treating chocolate cyst of ovary. Sixty-eight patients enrolled in this study were randomly divided into two groups: control group and combination treatment group. In the control group, 34 patients were treated with ultrasound-guided aspiration and ethanol injection. In the combination treatment group, 34 patients received gestrinone p.o. following ultrasound-guided aspiration and ethanol injection. The recurrence rate of chocolate cyst was 10-fold lower in the combination treatment group (2.94%, 1/34) than in the control group (29.4%, 10/34) at 12 months. The effective rate for reduction of chocolate cyst was significantly higher in the combination treatment group (94.12%, 32/34) than in the control group (64.71%, 22/34) (P = 0.009). Gestrinone combined with ultrasound-guided aspiration and ethanol injection therapy is an effective treatment for ovarian chocolate cyst with low recurrence rate. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

  19. Overgeneralized Beliefs, Accommodation, and Treatment Outcome in Youth Receiving Trauma-Focused Cognitive Behavioral Therapy for Childhood Trauma

    Science.gov (United States)

    Ready, C. Beth; Hayes, Adele M.; Yasinski, Carly W.; Webb, Charles; Gallop, Robert; Deblinger, Esther; Laurenceau, Jean-Philippe

    2015-01-01

    Inhibition of fear generalization with new learning is an important process in treatments for anxiety disorders. Generalization of maladaptive cognitions related to traumatic experiences (overgeneralized beliefs) have been demonstrated to be associated with posttraumatic stress disorder (PTSD) in adult populations, whereas more balanced, accommodated beliefs are associated with symptom improvement. It is not yet clear whether: 1) overgeneralization and accommodation are associated with PTSD treatment outcome in youth, or 2) whether accommodated beliefs can interact with or inhibit cognitive overgeneralization, as has been demonstrated in research on behavior-based fear generalization. The current study examined the relationships between overgeneralized and accommodated beliefs, child age, and symptom reduction in a sample of 81 youth (age 7-17 years), who received Trauma-Focused Cognitive Behavioral Therapy. Overgeneralized and accommodated beliefs expressed during the exposure phase of treatment were coded in audio-recorded therapy sessions. Overgeneralization predicted (a) higher internalizing symptom scores at post-treatment, particularly for younger children, and less improvement over treatment, and (b) higher externalizing scores at 1 year follow-up and steeper symptom increases over this period. In contrast, accommodation was associated with (a) lower post-treatment internalizing symptoms and greater improvement over treatment, and (b) lower externalizing scores at 1 year follow-up, particularly for younger children. High levels of accommodation moderated the relationship between overgeneralization and worse symptom outcomes, except when predicting the slope of internalizing scores over treatment, and age did not moderate these effects. There were no significant predictors of child-reported PTSD-specific symptoms, although PTSD symptoms did decrease significantly over the course of treatment and maintain one year after treatment. PMID:26459847

  20. Oxidative stress and antioxidant capacity in sickle cell anaemia patients receiving different treatments and medications for different periods of time.

    Science.gov (United States)

    Belini Junior, Edis; da Silva, Danilo Grünig Humberto; Torres, Lidiane de Souza; de Almeida, Eduardo Alves; Cancado, Rodolfo Delfini; Chiattone, Carlos; Bonini-Domingos, Claudia Regina

    2012-04-01

    To evaluate, in a longitudinal study, the profile of lipid peroxidation and antioxidant capacity markers in sickle cell anaemia patients receiving different treatments and medication over different time periods. The three groups were: patients undergoing transfusion therapy and receiving iron chelator deferasirox (DFX group, n = 20); patients receiving deferasirox and hydroxyurea (DFX + HU group, n = 10), and patients receiving only folic acid (FA group, n = 15). Thiobarbituric acid-reactive substance (TBARS) assays and trolox-equivalent antioxidant capacity (TEAC) assays were evaluated during two different periods of analysis, T0 and T1 (after ~388 days). Higher FA group TBARS values were observed compared with the DFX + HU group (p = 0.016) at T0; and at T1, higher FA group TBARS values were also observed compared with both the DFX group (p = 0.003) and the DFX + HU group (p = 0.0002). No variation in TEAC values was seen between groups, at either T0 or T1. The mean values of TBARS and TEAC for both the DFX and DFX + HU groups decreased at T1. The antioxidant effects of HU and DFX were observed by through an increase in TEAC levels in DFX and DFX + HU groups when compared with those of normal subjects. Increased TEAC values were not recorded in the FA group, and lipid peroxidation was seen to decrease after DFX and HU use.

  1. Treatment received, satisfaction with health care services, and psychiatric symptoms 3 months after hospitalization for self-poisoning

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    Grimholt Tine K

    2012-04-01

    Full Text Available Abstract Background Patients who self-poison have high repetition and high mortality rates. Therefore, appropriate follow-up is important. The aims of the present work were to study treatment received, satisfaction with health care services, and psychiatric symptoms after hospitalization for self-poisoning. Methods A cohort of patients who self-poisoned (n = 867 over a period of 1 year received a questionnaire 3 months after discharge. The Beck Depression Inventory (BDI, Beck Hopelessness Scale (BHS, and Generalized Self-Efficacy Scale (GSE were used. The participation rate was 28% (n = 242; mean age, 41 years; 66% females. Results Although only 14% of patients were registered without follow-up referrals at discharge, 41% reported no such measures. Overall, satisfaction with treatment was fairly good, although 29% of patients waited more than 3 weeks for their first appointment. A total of 22% reported repeated self-poisoning and 17% cutting. The mean BDI and BHS scores were 23.3 and 10.1, respectively (both moderate to severe. The GSE score was 25.2. BDI score was 25.6 among patients with suicide attempts, 24.9 for appeals, and 20.1 for substance-use-related poisonings. Conclusions Despite plans for follow-up, many patients reported that they did not receive any. The reported frequency of psychiatric symptoms and self-harm behavior indicate that a more active follow-up is needed.

  2. [Children and adolescents after child abuse and neglect: Do they receive appropriate treatment?].

    Science.gov (United States)

    Ganser, Helene Gertrud; Münzer, Annika; Plener, Paul Lukas; Witt, Andreas; Goldbeck, Lutz

    2016-06-01

    Child abuse and neglect (CAN) is a risk factor for the development of psychiatric disorders. Untreated, disorders can sustain into adulthood. This study compares rates of psychiatric disorders to mental health care utilization in victims of CAN. From three regions in Germany, 322 children and adolescents aged between 4 and 17 and a non-abusive caregiver were assessed for the child's history of CAN, mental health and mental health care utilization via semi-structured interviews. Approximately two thirds of the participants (present state 64.29 %; lifetime 69.57 %) suffered from a psychiatric disorder classifiable with ICD-10. Posttraumatic stress disorder (25.16 %), conduct disorders (21.34 %) and attention and hyperactivity disorders (16.15 %) were most frequently diagnosed. Merely 19.88 % were using mental health care at the time of the assessment. The provision of mental health care for victims of CAN is insufficient. To improve access to appropriate services for this vulnerable clientele, cooperation between psychiatrists and psychotherapists and the child welfare system is essential. The implementation and dissemination of evidence-based diagnostic methods and treatments must be further advanced.

  3. Orofacial pain and predictors in oral squamous cell carcinoma patients receiving treatment.

    Science.gov (United States)

    Chen, Shu-Ching; Liao, Chun-Ta; Chang, Joseph Tung-Chien

    2011-02-01

    Surgical and radiation therapy for oral squamous cell carcinoma (OSCC) may generate orofacial pain. The aims of this study were to (1) characterize the pain experienced by people with orofacial pain, and (2) determine the factors associated with changes in orofacial pain in OSCC patients during the postoperative and post-radiation therapy periods. The study had a prospective longitudinal design with consecutive sampling. Seventy-two eligible patients were recruited from the outpatient department of otolaryngology, head and neck cancer, and radiation therapy of a medical center in northern Taiwan. A set of questionnaires was used for patient assessment, including the University of California San Francisco Oral Cancer Pain Questionnaire, Symptom Severity Scale, Hospital Anxiety and Depression Scale, and Karnofsky's Performance Status Index. Patients were assessed at two time points: 1 month after surgery (T1) and 1 month after completion of radiation treatment (T2). The findings showed that (1) patients reported moderate orofacial pain at both time points; (2) orofacial pain, oral function-related symptoms, and psychological distress were significantly higher at T1 than at T2; and (3) older age, eating difficulty, speech difficulty, and depression were significant predictors of orofacial pain. Oral rehabilitation and relaxation training may reduce orofacial pain in this patient population. Copyright © 2010 Elsevier Ltd. All rights reserved.

  4. Ovarian responsiveness in women receiving fertility treatment after methotrexate for ectopic pregnancy: a systematic review and meta-analysis.

    Science.gov (United States)

    Ohannessian, A; Loundou, A; Courbière, B; Cravello, L; Agostini, A

    2014-09-01

    Does previous methotrexate (MTX) treatment for ectopic pregnancy (EP) have an effect on ovarian response in women receiving fertility treatment? MTX treatment for EP does not seem to affect subsequent fertility treatment. MTX is commonly used to treat EPs that are diagnosed early. Previous studies have reported conflicting results about its effect on subsequent fertility treatments. This systematic review and meta-analysis included a total of 329 patients who had participated in 7 observational studies. A search of the MEDLINE, EMBASE and PUBMED databases was conducted to identify studies about fertility treatments after MTX treatment for EP, published in English or French up to December 2013. Studies were eligible for inclusion only if they compared indicators of ovarian responsiveness during ART in the cycles before and after an injection of MTX for EP. The primary outcome measure was the number of oocytes retrieved. Secondary outcomes included the basal serum FSH level, duration of stimulation, total gonadotrophin dose and serum E2 level on the day of hCG triggering. The mean number of oocytes retrieved during the cycles before and after the MTX treatment did not differ significantly (P = 0.4). The comparisons before and after MTX treatment of the basal plasma FSH level, the duration of stimulation, the total gonadotrophin dose used for stimulation and the estradiol level on the day ovulation was triggered did not find any significant differences. The literature on this topic is sparse, with few studies and even fewer of high methodological quality. These results indicate that MTX to treat EP in infertile patients does not have any negative effect on their subsequent fertility treatment, but further studies should be performed before this result can be considered definitive. This work received support from the Department of Gynecology and Obstetrics, La Conception Hospital, Marseille, France. The authors have no competing interests to declare. N/A. © The Author

  5. Quality of Life of Head and Neck Cancer Patients Receiving Cancer Specific Treatments

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    James Gonsalves

    2013-01-01

    Full Text Available Background: Head and neck cancer (HNC remains a considerable challenge to both patient and health care provider as the disease can have profound effect on Quality of life (QOL. Aims and Objectives: To assess the QOL and performance status of HNC patients, to find relation between domains of QOL and to find association between QOL and demographic and disease variables. Settings and Design: The study was conducted at Manipal group of hospitals, Manipal and Mangalore, using descriptive survey design. Material and Methods: The study comprised of 89 samples with all stages of HNC. Patients primarily diagnosed with HNC and undergoing disease specific treatment were included in the study. Tool on demographic, disease variables and quality of life were developed and content validity was established. Reliability of the tool was established. Karnofsky Performance Status (KPS scale was used to assess performance status. Corelational analysis was done to find relation between the domains of QOL. Association was found between the quality of life and demographic and disease variables. Results: Majority (83% of the participants were males, 39% had cancer arising from oral cavity, and 35% each were in cancer stage III and IV. Quality of life was poor among 30% of the subjects and 65% had KPS scores<80 %. There was moderate positive relation between the domains of QOL and a positive correlation between the QOL and performance status. No statistically significant association was found between QOL and disease and demographic variables. Conclusion: Physical, psychological, social and spiritual domains of QOL and functional status are affected in patients with HNC. The impact on one domain area of well being, significantly affects the other domain of QOL and there is relationship between the performance status and QOL

  6. Premature ejaculation and other sexual dysfunctions in opiate dependent men receiving methadone substitution treatment.

    Science.gov (United States)

    Chekuri, Venkat; Gerber, David; Brodie, Adam; Krishnadas, Rajeev

    2012-01-01

    A significant number of men with opiate misuse have sexual problems. Premature ejaculation (PE) occurs predominantly on discontinuation of the opiate but seems to persist in some cases. The aims of this study were to determine the rates of PE and other sexual dysfunctions in patients maintained on methadone; to determine the time of onset of PE in relation to onset of opiate misuse; and to look at the patients' perception of the effect of heroin and methadone on PE. Sixty five men attending a tertiary referral clinic for methadone maintenance treatment were assessed cross-sectionally using a semi-structured questionnaire, clinical interview, review of clinical records and the International Index of Erectile Function (IIEF). Thirty eight (58.5%) subjects reported a "lifetime" history of PE. Twenty (30.76%) of them reported "current" history of PE. Eleven (16.9%) people reported that PE preceded opiate misuse. Twenty four (63.2%) felt that heroin helped their PE and 7 (18.4%) felt that heroin worsened it. Fourteen (36.8%) felt that methadone helped PE, while 10 (26.3%) felt methadone worsened PE. Only 2 out of 65 (3.07%) reported that they had been asked about their sex life by the addiction services. Prevalence of "current" premature ejaculation was almost 3 times greater than reported in the general population. A significant number of patients perceived heroin to be beneficial on PE. Presence of sexual dysfunction could therefore be a risk factor for relapse into heroin misuse. Most clinicians avoid asking patients questions of a sexual nature. Nevertheless, managing sexual difficulties among patients with opiate misuse could be a significant step in relapse prevention. Copyright © 2011 Elsevier Ltd. All rights reserved.

  7. Relationship of specific MRI findings to treatment outcomes in patients receiving transforaminal epidural steroid injections

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    Lechmann, Marco; Rosskopf, Andrea; Ehrmann, Christine; Sutter, Reto; Pfirrmann, Christian W.A.; Peterson, Cynthia K. [University of Zuerich, Department of Radiology, Orthopaedic University Hospital Balgrist, Zuerich (Switzerland)

    2016-12-15

    To determine whether specific MRI findings are related to outcomes after lumbar transforaminal epidural steroid injections (TFESI) and to assess the inter-rater reliability of imaging diagnosis. A prospective outcomes study on 156 consecutive patients with 1-month follow-up outcomes data and MRI within 3 months of TFESI was conducted. Pain levels (numerical rating scale) (NRS) were recorded prior to injection. Overall 'improvement' was determined using the Patients Global Impression of Change (PGIC) scale and NRS data were collected at three time points post injection. Two radiologists independently evaluated all images blinded to treatment outcome for reliability of diagnosis. The Chi-square test compared MRI findings for the senior radiologist to 'improvement'. NRS change scores were compared to MRI findings with the unpaired t-test or ANOVA. Kappa and percent agreement assessed inter-rater agreement of diagnosis. The only abnormality linked to 'improvement' (p = 0.03) and higher NRS change scores (p = 0.0001) at 1 month was the disc herniation morphology 'protrusion + sequestration'. Patients with degeneration by osteophytes (p = 0.034), grade 3 foraminal nerve root compression (p = 0.01) and foraminal/extraforaminal location of herniation (p = 0.014) also had higher 1 month NRS change scores. Reliability of diagnosis was 'fair' to 'substantial' depending on MRI findings. Patients with disc protrusion plus sequestration were significantly more likely to report overall improvement and more pain reduction at 1 month. Higher pain reduction was noted in patients with degeneration by osteophytes, grade 3 foraminal nerve root compression, or foraminal/extraforaminal disc herniation location. (orig.)

  8. Combining biological agents and chemotherapy in the treatment of cholangiocarcinoma

    DEFF Research Database (Denmark)

    Jensen, Lars Henrik; Jakobsen, Anders

    2011-01-01

    The nonsurgical treatment of cholangiocarcinoma has seen major changes within the last few years. A multidisciplinary approach is the cornerstone in planning optimal treatment, but despite several examinations the diagnosis is often based on a certain probability, and histopathological confirmation...

  9. Long-term outcomes in patients with type 2 diabetes receiving glimepiride combined with liraglutide or rosiglitazone

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    Hammer Mette

    2009-02-01

    Full Text Available Abstract Background Poor control of type 2 diabetes results in substantial long-term consequences. Studies of new diabetes treatments are rarely designed to assess mortality, complication rates and costs. We sought to estimate the long-term consequences of liraglutide and rosiglitazone both added to glimepiride. Methods To estimate long-term clinical and economic consequences, we used the CORE diabetes model, a validated cohort model that uses epidemiologic data from long-term clinical trials to simulate morbidity, mortality and costs of diabetes. Clinical data were extracted from the LEAD-1 trial evaluating two doses (1.2 mg and 1.8 mg of a once daily GLP-1 analog liraglutide, or rosiglitazone 4 mg, on a background of glimepiride in type 2 diabetes. CORE was calibrated to the LEAD-1 baseline patient characteristics. Survival, cumulative incidence of cardiovascular, ocular and renal events and healthcare costs were estimated over three periods: 10, 20 and 30 years. Results In a hypothetical cohort of 5000 patients per treatment followed for 30 years, liraglutide 1.2 mg and 1.8 mg had higher survival rates compared to the group treated with rosiglitazone (15.0% and 16.0% vs. 12.6% after 30 years, and fewer cardiovascular, renal, and ocular events. Cardiovascular death rates after 30 years were 69.7%, 68.4% and 72.5%, for liraglutide 1.2 mg, 1.8 mg, and rosiglitazone, respectively. First and recurrent amputations were lower in the rosiglitazone group, probably due to a 'survival paradox' in the liraglutide arms (number of events: 565, 529, and 507, respectively. Overall cumulative costs per patient, were lower in both liraglutide groups compared to rosiglitazone (US$38,963, $39,239, and $40,401 for liraglutide 1.2 mg, 1.8 mg, and rosiglitazone, respectively, mainly driven by the costs of cardiovascular events in all groups. Conclusion Using data from LEAD-1 and epidemiologic evidence from the CORE diabetes model, projected rates of mortality

  10. Pregnancy and delivery while receiving vagus nerve stimulation for the treatment of major depression: a case report

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    Stegman Diane

    2005-09-01

    Full Text Available Abstract Background Depression during pregnancy can have significant health consequences for the mother and her infant. Antidepressant medications, which pass through the placenta, may increase the risk of low birth weight and preterm delivery. The use of selective serotonin reuptake inhibitors (SSRIs during pregnancy may induce serotonergic symptoms in the infant after delivery. Antidepressant medications in breast milk may also be passed to an infant. Vagus nerve stimulation (VNS therapy is an effective non-pharmacologic treatment for treatment-resistant depression (TRD, but little information exists regarding the use of VNS therapy during pregnancy. Case presentation The patient began receiving VNS therapy for TRD in March 1999. The therapy was effective, producing substantial reductions in depressive symptoms and improvement of function. In 2002, the patient reported that she was pregnant. She continued receiving VNS therapy throughout her pregnancy, labor, and delivery, which enabled the sustained remission of her depression. The pregnancy was uneventful; a healthy daughter was delivered at full term. Conclusion In this case, VNS therapy provided effective treatment for TRD during pregnancy and delivery. VNS was safe for the patient and her child.

  11. Virtual reality-based therapy for the treatment of balance deficits in patients receiving inpatient rehabilitation for traumatic brain injury.

    Science.gov (United States)

    Cuthbert, Jeffrey P; Staniszewski, Kristi; Hays, Kaitlin; Gerber, Don; Natale, Audrey; O'Dell, Denise

    2014-01-01

    To evaluate the feasibility and safety of utilizing a commercially available virtual reality gaming system as a treatment intervention for balance training. A randomized controlled trial in which assessment and analysis were blinded. An inpatient rehabilitation facility. Interventions included balance-based physical therapy using a Nintendo Wii, as monitored by a physical therapist, and receipt of one-on-one balance-based physical therapy using standard physical therapy modalities available for use in the therapy gym. Participants in the standard physical therapy group were found to have slightly higher enjoyment at mid-intervention, while those receiving the virtual reality-based balance intervention were found to have higher enjoyment at study completion. Both groups demonstrated improved static and dynamic balance over the course of the study, with no significant differences between groups. Correlational analyses suggest a relationship exists between Wii balance board game scores and BBS scores for measures taken beyond the baseline assessment. This study provides a modest level of evidence to support using commercially available VR gaming systems for the treatment of balance deficits in patients with a primary diagnosis of TBI receiving inpatient rehabilitation. Additional research of these types of interventions for the treatment of balance deficits is warranted.

  12. Investigation of herb-drug interactions with ginkgo biloba in women receiving hormonal treatment for early breast cancer.

    Science.gov (United States)

    Vardy, Janette; Dhillon, Haryana M; Clarke, Stephen J; Olesen, Inger; Leslie, Felicity; Warby, Anne; Beith, Jane; Sullivan, Anne; Hamilton, Anne; Beale, Philip; Rittau, Anneliese; McLachlan, Andrew J

    2013-12-01

    Women receiving treatment for breast cancer commonly ingest herbal medicines. Little is known about the potential for herb-drug interactions in this population. The aim of this study is to investigate the effect of ginkgo biloba co-administration on the pharmacokinetics of tamoxifen, anastrozole and letrozole. This was a prospective open-label cross-over study in 60 women with early stage breast cancer taking either tamoxifen, anastrozole or letrozole (n=20/group). Participants received ginkgo biloba (EGb 761) for 3 weeks (120 mg twice daily). Trough concentrations of drugs were measured before and after ginkgo biloba treatment using LC-MS/MS. Toxicities were graded according to National Cancer Institute Common Terminology Criteria for Adverse Events. Trough concentrations before and after treatment with ginkgo biloba were not significantly different for tamoxifen (93.5 ± 29.0, 86.5 ± 25.3 ng/mL; p=0.16), letrozole (91.1 ± 50.4, 89.6 ± 52.14 ng/mL; p=0.60) or anastrozole (29.1 ± 8.6, 29.1 ± 7.6 ng/mL; p=0.97). Ginkgo biloba was well tolerated, with no difference in toxicity during ginkgo biloba. Co-administration of ginkgo biloba does not significantly affect the pharmacokinetics of tamoxifen, anastrozole or letrozole. There was no difference in the toxicity profile of hormone therapy with ginkgo biloba use in women with early stage breast cancer.

  13. Efficiency of a Combination of Pharmacological Treatment and Nondrug Interventions in Childhood Narcolepsy.

    Science.gov (United States)

    Kacar Bayram, Ayşe; Per, Hüseyin; Ismailoğullari, Sevda; Canpolat, Mehmet; Gumus, Hakan; Aksu, Murat

    2016-12-01

    Objective  Narcolepsy is a chronic sleep disorder characterized by excessive daytime sleepiness, cataplexy, hypnagogic and/or hypnopompic hallucinations, and sleep paralysis. It is one of the most important causes of excessive daytime sleepiness in the pediatric population. The aim of this study is to present the clinical and laboratory findings, and treatment results of pediatric patients with narcolepsy. Materials and Methods  We studied five unrelated consecutive children with narcolepsy, focusing on clinical and laboratory features, the therapy and outcome over the 33-month follow-up period. Results  The study subjects included two boys and three girls. The mean age at diagnosis was 11.8 ± 3.3 years (range: 8-16 years). Three patients had cataplexy. There were no hypnagogic hallucinations and/or sleep paralysis in any patients. All patients were educated about sleep hygiene, appropriate nutrition, and regular exercise. Three patients were treated with modafinil, while two patients received methylphenidate. Sodium oxybate was added to existing treatment in patients with cataplexy. Cataplexy attacks did not respond well to the treatment in one patient; therefore intravenous immunoglobulin therapy was given. Conclusions  Early diagnosis is important to help narcoleptic patients in improving their quality of life. A combination of pharmacological treatment and nondrug interventions can greatly improve children's clinical symptoms. Georg Thieme Verlag KG Stuttgart · New York.

  14. Randomized comparative trial of efficacy of paracetamol, ibuprofen and paracetamol-ibuprofen combination for treatment of febrile children

    Directory of Open Access Journals (Sweden)

    Falgun Indravadan Vyas

    2014-01-01

    Full Text Available Objective: Paracetamol and ibuprofen are widely used for fever in children as monotherapy and as combined therapy. None of the treatments is proven clearly superior to others. Hence, the study was planned to compare the efficacy of paracetamol, ibuprofen and paracetamol-ibuprofen combination for treatment of febrile children. Materials and Methods: This was an investigator blind, randomized, comparative, parallel clinical trial conducted in 99 febrile children, 6 months to 12 years of age, allocated to three groups. First group received paracetamol 15 mg/kg, second group received ibuprofen 10 mg/kg and third group received both paracetamol and ibuprofen, all as a single dose by the oral route. Patients were followed-up at intervals of 1, 2, 3 and 4 h post dose by tympanic thermometry. Results: Mean tympanic temperature after 4 h of drug administration was significantly lower in the combination group compared with paracetamol group (P < 0.05; however, the difference was not clinically significant (<1΀C. The rate of fall of temperature was highest in the combination group. Number of afebrile children any time post dose until 4 h was highest in the combination group. Difference between combination and paracetamol was significant for the 1 st h (P = 0.04. Highest fall of temperature was noted in the 1 st h of drug administration in all the groups. No serious adverse events were observed in any of the groups. Conclusion: Paracetamol and ibuprofen combination caused quicker temperature reduction than either paracetamol or ibuprofen alone. If quicker reduction of body temperature is the desired goal of therapy, the use of combination of paracetamol + ibuprofen may be advocated.

  15. [Transport and treatment of patients with STEMI in rural Iceland--Only a few patients receive PPCI within 120 minutes].

    Science.gov (United States)

    Sigmundsson, Thórir S; Arnarson, Daníel; Rafnsson, Arnar; Magnússon, Viðar; Gunnarsson, Gunnar Thór; Thorgeirsson, Gestur

    2016-01-01

    ST-segment Elevation Myocardial Infarction (STEMI) is a life-threatening disease and good outcome depends on early restoration of coronary blood flow. Primary percutaneous coronary intervention (PPCI) is the treatment of choice if performed within 120 minutes of first medical contact (FMC) but in case of anticipated long transport or delays, pre-hospital fibrinolysis is indicated. The aim was to study transport times and adherence to clinical guidelines in patients with STEMI transported from outside of the Reykjavik area to Landspitali University Hospital in Iceland. Retrospective chart review was conducted of all patients diagnosed with STEMI outside of the Reykjavik area and transported to Landspitali University Hospital in Reykjavik in 2011-2012. Descriptive statistical analysis and hypothesis testing was applied. Eighty-six patients had signs of STEMI on electrocardiogram (ECG) at FMC. In southern Iceland nine patients (21%) underwent PPCI within 120 minutes (median 157 minutes) and no patient received fibrinolysis. In northern Iceland and The Vestman Islands, where long transport times are expected, 96% of patients eligible for fibrinolysis (n=31) received appropriate therapy in a median time of 57 minutes. Significantly fewer patients received appropriate anticoagulation treatment with clopidogrel and enoxaparin in southern Iceland compared to the northern part. Mortality rate was 7% and median length of stay in hospital was 6 days. Time from FMC to PPCI is longer than 120 minutes in the majority of cases. Pre-hospital fibrinolysis should be considered as first line treatment in all parts of Iceland outside of the Reykjavik area. Directly electronically transmitted ECGs and contact with cardiologist could hasten diagnosis and decrease risk of unnecessary interhospital transfer. A STEMI database should be established in Iceland to facilitate quality control.

  16. Occurrence of antibiotics and antibiotic resistance genes in a sewage treatment plant and its effluent-receiving river.

    Science.gov (United States)

    Xu, Jian; Xu, Yan; Wang, Hongmei; Guo, Changsheng; Qiu, Huiyun; He, Yan; Zhang, Yuan; Li, Xiaochen; Meng, Wei

    2015-01-01

    The extensive use of antibiotics has caused the contamination of both antibiotics and antibiotic resistance genes (ARGs) in the environment. In this study, the abundance and distribution of antibiotics and ARGs from a sewage treatment plant (STP) and its effluent-receiving river in Beijing China were characterized. Three classes of antibiotics including tetracycline, sulfonamide and quinolone were quantified by LC-MS/MS. In the secondary effluent they were detected at 195, 2001 and 3866 ng L(-1), respectively, which were higher than in the receiving river water. A total of 13 ARGs (6 tet genes: tetA, tetB, tetE, tetW, tetM and tetZ, 3 sulfonamide genes: sul1, sul2 and sul3, and 4 quinolone genes: gryA, parC, qnrC and qnrD) were determined by quantitative PCR. For all ARGs, sulfonamide resistance genes were present at relatively high concentrations in all samples, with the highest ARG concentration above 10(-1). ARGs remained relatively stable along each sewage treatment process. The abundances of detected ARGs from the STP were also higher than its receiving river. Bivariate correlation analysis showed that relative tet gene copies (tetB/16S-rRNA and tetW/16S-rRNA) were strongly correlated with the concentrations of tetracycline residues (r(2)>0.8, presistance gene (qnrC/16S-rRNA) and the concentrations of enrofloxacin (ENR) was also determined. The difference of ARGs levels in the raw influent and secondary effluent suggested that the STP treatment process may induce to increase the abundance of resistance genes. The results showed that the sewage was an important repository of the resistance genes, which need to be effectively treated before discharge into the natural water body. Copyright © 2014 Elsevier Ltd. All rights reserved.

  17. Genetic polymorphisms associated with fatty liver disease and fibrosis in HIV positive patients receiving combined antiretroviral therapy (cART).

    Science.gov (United States)

    Dold, Leona; Luda, Carolin; Schwarze-Zander, Carolynne; Boesecke, Christoph; Hansel, Cordula; Nischalke, Hans-Dieter; Lutz, Philipp; Mohr, Raphael; Wasmuth, Jan-Christian; Strassburg, Christian P; Trebicka, Jonel; Rockstroh, Jürgen Kurt; Spengler, Ulrich

    2017-01-01

    Hepatic steatosis can occur with any antiretroviral therapy (cART). Although single nucleotide polymorphisms (SNPs) have been identified to predispose to alcoholic and non-alcoholic fatty liver disease, their role for treatment-associated steatosis in HIV-positive patients remains unclear. We determined the frequency of PNPLA3 (rs738409), CSPG3/NCAN (rs2228603), GCKR (rs780094), PPP1R3B (rs4240624), TM6SF (rs8542926), LYPLAL1 (rs12137855) and MBOAT7 (rs626283) by RT-PCR in 117 HIV-positive patients on cART and stratified participants based on their "controlled attenuation parameter" (CAP) into probable (CAP: 215-300 dB/m) and definite (CAP >300 dB/m) hepatic steatosis. We analyzed CAP values and routine metabolic parameters according to the allele frequencies. Sixty-five (55.6%) and 13 (11.1%) patients were allocated to probable and definite steatosis. CAP values (p = 0.012) and serum triglycerides (p = 0.043) were increased in carriers of the GCKR (rs780094) A allele. Cox logistic regression identified triglycerides (p = 0.006), bilirubin (p = 0.021) and BMI (p = 0.068), but not the genetic parameters as risk factors for the occurrence of hepatic steatosis. Taken together, according to the limited sample size, this exploratory study generates the hypothesis that genetic polymorphisms seem to exert minor effects on the risk for fatty liver disease in HIV-positive patients on cART. Nevertheless, SNPs may modify metabolic complications once metabolic abnormalities have developed. Hence, subsequent analysis of a larger cohort is needed.

  18. Potential Mechanisms of Hematological Adverse Drug Reactions in Patients Receiving Clozapine in Combination With Proton Pump Inhibitors.

    Science.gov (United States)

    Wiciński, Michał; Węclewicz, Mateusz M; Miętkiewicz, Mateusz; Malinowski, Bartosz; Grześk, Elżbieta; Klonowska, Joanna

    2017-03-01

    Clozapine is a second-generation antipsychotic which has proven efficacy in treating the symptoms of schizophrenia. Although clozapine therapy is associated with a number of adverse drug reactions, it is frequently used. One of the most common adverse drug reactions is gastroesophageal reflux disease which is an indication for treatment with proton pump inhibitors (PPIs). Coadministration of clozapine and PPIs increases the risk of hematological adverse drug reactions, including neutropenia and agranulocytosis. The mechanism in idiosyncratic agranulocytosis is not dose related and involves either a direct toxic or an immune-allergic effect. It is suspected that the clozapine metabolites nitrenium ion and N-desmethylclozapine may cause apoptosis or impair growth of granulocytes. Formation of N-desmethylclozapine is correlated with activity of the cytochrome P450 enzymes 1A2 and 3A4 (CYP1A2 and CYP3A4). Nitrenium ion is produced by the flavin-containing monooxygenase system of leukocytes. A drug interaction between clozapine and a PPI is a consequence of the induction of common metabolic pathways either by the PPI or clozapine. Findings to date suggest that indirect induction of flavin-containing monooxygenase by omeprazole through the aryl hydrocarbon receptor increases the expression of the enzyme mRNA and in the long term may cause the increase in activity. Moreover, induction of CYP1A2, especially by omeprazole and lansoprazole, may increase the serum concentration of N-desmethylclozapine, which can accumulate in lymphocytes and may achieve toxic levels. Another hypothesis that may explain hematological adverse drug reactions is competitive inhibition of CYP2C19, which may contribute to increased serum concentrations of toxic metabolites.

  19. [Surgical treatment of unstable pelvic fractures combined with acetabular fractures].

    Science.gov (United States)

    Wang, Tao; Wang, Jun; Li, Zong-yuan; Liu, Gang

    2015-05-01

    To discuss the treatment strategy of acetabular fractures and unstable pelvic fracture of the hip and to evaluate its outcome. Retrospective analysis of clinical data in 32 patients with unstable pelvic fracture and acetabular fractures from January 2007 to June 2013 were collected. There were 18 males and 14 females aged from 18 to 62 years old (means 38 years old). According to Tile classification of pelvic fracture, 11 cases were type B1, 8 were type B2.1, 7 were type B2.2, 3 were type C1.1, 2 were type C1.2, 1 was type C3. According to Judet-Letournel classification, anterior column fracture was in 1 case, transverse fracture in 8, transverse plus posterior wall fracture in 6, T-type fracture in 1, anterior column plus half transverse fractures in 5, double column fracture in 11. Other combined injuries were treated early, the surgical operation were performed after stable condition. The hip joint function and the fracture reduction were assessed during follow-up. The operative time was from 1.8 to 6.5 hours (averaged 3 hours). Two fat patients' incision occurred in fat liquefaction and healed after dressing, no incision infection happened. Only 1 case was lost to follow-up, 31 patients were followed up with a mean time of 23 months (6 to 42 months). The healing time of pelvic fracture was from 8 to 18 weeks (averaged in 10.6 weeks). The hip function was evaluated according to the Matta and Tornetta standard postoperatively, the result was excellent in 15 cases, good in 14 cases, fair and poor in 1 case respectively. The Majeed score of the hip function was 83.65? 7.67, the result was excellent in 15 cases, good in 12 cases and fair in 4 cases. The healing time of acetabular fractures was from 8 to 16 weeks (averaged in 10.2 weeks). The fracture reduction was assessed by Matta standard, the result was excellent in 15 cases, good in 12 cases and fair in 4 cases. The heterotopic ossification was evaluated by Brooker standard, 4 cases were grade I, 1 case was

  20. Overgeneralized Beliefs, Accommodation, and Treatment Outcome in Youth Receiving Trauma-Focused Cognitive Behavioral Therapy for Childhood Trauma.

    Science.gov (United States)

    Ready, C Beth; Hayes, Adele M; Yasinski, Carly W; Webb, Charles; Gallop, Robert; Deblinger, Esther; Laurenceau, Jean-Philippe

    2015-09-01

    Inhibition of fear generalization with new learning is an important process in treatments for anxiety disorders. Generalization of maladaptive cognitions related to traumatic experiences (overgeneralized beliefs) have been demonstrated to be associated with posttraumatic stress disorder (PTSD) in adult populations, whereas more balanced, accommodated beliefs are associated with symptom improvement. It is not yet clear whether (a) overgeneralization and accommodation are associated with PTSD treatment outcome in youth, or (b whether accommodated beliefs can interact with or inhibit cognitive overgeneralization, as has been demonstrated in research on behavior-based fear generalization. The current study examined the relationships between overgeneralized and accommodated beliefs, child age, and symptom reduction in a sample of 81 youth (age 7-17 years), who received Trauma-Focused Cognitive Behavioral Therapy. Overgeneralized and accommodated beliefs expressed during the exposure phase of treatment were coded in audio-recorded therapy sessions. Overgeneralization predicted (a) higher internalizing symptom scores at posttreatment, particularly for younger children, and less improvement over treatment, and (b) higher externalizing scores at 1-year follow-up and steeper symptom increases over this period. In contrast, accommodation was associated with (a) lower posttreatment internalizing symptoms and greater improvement over treatment, and (b) lower externalizing scores at 1-year follow-up, particularly for younger children. High levels of accommodation moderated the relationship between overgeneralization and worse symptom outcomes, except when predicting the slope of internalizing scores over treatment, and age did not moderate these effects. There were no significant predictors of child-reported PTSD-specific symptoms, although PTSD symptoms did decrease significantly over the course of treatment and maintain 1year after treatment. Copyright © 2015. Published by

  1. Association between cannabis use and treatment outcomes in patients receiving methadone maintenance treatment: a systematic review protocol.

    Science.gov (United States)

    Zielinski, Laura; Bhatt, Meha; Eisen, Rebecca B; Perera, Stefan; Bhatnagar, Neera; MacKillop, James; Steiner, Meir; McDermid Vaz, Stephanie; Thabane, Lehana; Samaan, Zainab

    2016-08-16

    With the non-medical use of prescription opioids increasingly becoming a method of abuse in Canada, the number of patients requiring methadone maintenance treatment (MMT) for opioid use disorder has increased dramatically. The rate of cannabis use in this population is disproportionately high (~50 %). Because its use is generally perceived as harmless, cannabis use is often not monitored during MMT. Current literature regarding the effects of cannabis use on MMT is conflicting, and the presence and nature of an association has not been clearly established. The primary objective of this review will be to conduct a systematic review of the literature and, if appropriate, a meta-analysis to determine whether there is an association between cannabis use and MMT outcomes. A secondary objective will be to perform subgroup analyses (by age, sex, method of cannabis measurement, and country) to determine whether cannabis use differentially influences MMT outcomes within these subgroups. The search will be conducted on the following electronic databases using a predefined search strategy: MEDLINE, EMBASE, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Two authors (LZ and MB) will independently screen articles using predetermined inclusion/exclusion criteria and will extract data from included articles using a pilot-tested data extraction form. Disagreements at all stages of the screening process will be settled through discussion, and when consensus cannot be reached, a third author (ZS) will be consulted. An assessment of quality and risk of bias will be conducted on all included articles, and a sensitivity analysis will be used to compare results of studies with high and low risk of bias. We will perform random- and fixed-effects meta-analyses, if appropriate, with heterogeneity calculated using the I (2) statistic and formal evaluation of publication bias. Results of this systematic review will elucidate the association between cannabis

  2. Serum indicators and endothelial function of hyperbaric oxygen combined with memantine and Aricept treatment of senile vascular dementia

    Directory of Open Access Journals (Sweden)

    Yao-Yi Yin

    2016-05-01

    Full Text Available Objective: To find the effect of hyperbaric oxygen combined with memantine and Aricept treatment of senile vascular dementia on serum indicators and endothelial function. Methods: A total of 126 cases of patients with senile vascular dementia treated in our hospital from March 2012 to December 2014 were selected as research subjects, treatment that patients received was retrospectively analyzed, and patients were divided into observation group 64 cases and control group 62 cases. Control group received memantine and Aricept therapy, observation group received hyperbaric oxygen combined with memantine and Aricept therapy, and then differences in levels of serum TGF-β, IGF-1 and ICAM-1, Hcy, MDA and SOD, NPY, sFas, sFasL and so on, ET and EPC between two groups were compared. Results: Serum TGF-β ad IGF-1 levels of observation group after treatment were higher than those of control group, and ICAM-1 levels were lower than those of control group; Hcy and MDA levels of observation group after treatment were lower than those of control group at corresponding points in time, and SOD levels were higher than those of control group; serum NPY, sFas, sFasL and Ca2+ values of observation group after treatment were lower than those of control group, and PON-1 value was higher than that of control group; ET values of observation group at various points in time after treatment were lower than those of control group, and EPC contents were higher than those of control group. Conclusion: Hyperbaric oxygen combined with memantine and Aricept treatment for patients with senile vascular dementia can effectively improve the disease and optimize endothelial function, and it has active clinical significance.

  3. The European Medicines Agency Review of Carfilzomib for the Treatment of Adult Patients with Multiple Myeloma Who Have Received at Least One Prior Therapy.

    Science.gov (United States)

    Tzogani, Kyriaki; Camarero Jiménez, Jorge; Garcia, Isabel; Sancho-López, Arantxa; Martin, Marc; Moreau, Alexandre; Demolis, Pierre; Salmonson, Tomas; Bergh, Jonas; Laane, Edward; Ludwig, Heinz; Gisselbrecht, Christian; Pignatti, Francesco

    2017-09-21

    On November 19, 2015, a marketing authorization valid through the European Union was issued for carfilzomib in combination with lenalidomide and dexamethasone for the treatment of adult patients with multiple myeloma (MM) who have received at least one prior therapy.In a phase III trial in patients with relapsed MM, median progression-free survival (PFS) for patients treated with carfilzomib in combination with lenalidomide and dexamethasone (CRd) was 26.3 months versus 17.6 months for those receiving lenalidomide and dexamethasone alone (hazard ratio = 0.69; 95% confidence interval, 0.57-0.83; one-sided log-rank p value free survival compared with lenalidomide and dexamethasone, which was supported by a clear trend in overall survival benefit, although the data were not mature. At the time of the marketing authorization of carfilzomib, the delay in disease progression appeared superior to available alternatives in the setting of relapsed multiple myeloma. In terms of safety, the overall accepted safety profile was considered manageable. © AlphaMed Press 2017.

  4. Myxoma virus combined with rapamycin treatment enhances adoptive T cell therapy for murine melanoma brain tumors.

    Science.gov (United States)

    Thomas, Diana L; Doty, Rosalinda; Tosic, Vesna; Liu, Jia; Kranz, David M; McFadden, Grant; Macneill, Amy L; Roy, Edward J

    2011-10-01

    Adoptive transfer of tumor-specific T cells has shown some success for treating metastatic melanoma. We evaluated a novel strategy to improve adoptive therapy by administering both T cells and oncolytic myxoma virus to mice with syngeneic B16.SIY melanoma brain tumors. Adoptive transfer of activated CD8(+) 2C T cells that recognize SIY peptide doubled survival time, but SIY-negative tumors recurred. Myxoma virus killed B16.SIY cells in vitro, and intratumoral injection of virus led to selective and transient infection of the tumor. Virus treatment recruited innate immune cells to the tumor and induced IFNβ production in the brain, resulting in limited oncolytic effects in vivo. To counter this, we evaluated the safety and efficacy of co-administering 2C T cells, myxoma virus, and either rapamycin or neutralizing antibodies against IFNβ. Mice that received either triple combination therapy survived significantly longer with no apparent side effects, but eventually relapsed. Importantly, rapamycin treatment did not impair T cell-mediated tumor destruction, supporting the feasibility of combining adoptive immunotherapy and rapamycin-enhanced virotherapy. Myxoma virus may be a useful vector for transient delivery of therapeutic genes to a tumor to enhance T cell responses.

  5. Effects of music in combination with vibration in acupuncture points on the treatment of fibromyalgia.

    Science.gov (United States)

    Weber, Augusto; Werneck, Lineu; Paiva, Eduardo; Gans, Paulo

    2015-02-01

    Fibromyalgia (FM) is a disease that causes widespread pain and increased sensitivity to pain because of a dysfunction in the central nervous system. This study investigated the effect of music combined with vibration on acupuncture points for the treatment of FM. A total of 120 patients with FM were allocated randomly to four groups (30 patients each). One group listened to a sequence of Bach's compositions. The second group was subjected to vibratory stimuli on a combination of acupuncture points on the skin. The third group (complete) underwent both procedures in a simultaneous and synchronized manner, with inclusion of binaural beats. The fourth group (control) received no stimulation. The participants underwent the experimental procedure during five sessions performed on alternate days. They were assessed by the Fibromyalgia Impact Questionnaire (FIQ) and the Health Assessment Questionnaire (HAQ) before the first session and after the last session (20 days). All groups showed a significant improvement in FIQ and HAQ scores at the evaluation after the intervention. The complete group exhibited the best result on both the FIQ and HAQ (peffect in FM may be substantial. However, comparison between groups revealed that the complete group had the greatest reduction in both FIQ and HAQ, with a significant improvement in HAQ, suggesting that the combined use of music and vibration exerts a greater effect on FM symptoms.

  6. Long term combination treatment for severe idiopathic pulmonary arterial hypertension

    Science.gov (United States)

    Affuso, Flora; Cirillo, Plinio; Ruvolo, Antonio; Carlomagno, Guido; Fazio, Serafino

    2010-01-01

    We report the long-term follow-up of 3 cases of severe idiopathic pulmonary arterial hypertension, in whom tadalafil plus sitaxentan combination therapy improved the clinical condition and exercise performance without any relevant adverse event. PMID:21160759

  7. Schizophrenia symptoms and functioning in patients receiving long-term treatment with olanzapine long-acting injection formulation

    DEFF Research Database (Denmark)

    Peuskens, Joseph; Porsdal, Vibeke; Pecenak, Jan

    2012-01-01

    but good functioning, and 162 (13.7%) had minimal symptoms and good functioning. Baseline category was significantly associated with Clinical Global Impression - Severity (CGI-S), extrapyramidal symptoms, working status, age, and number of previous episodes. The majority of all patients starting OLAI......ABSTRACT: BACKGROUND: This analysis of pooled data evaluates maintenance treatment outcomes of patients with schizophrenia receiving maintenance treatment with olanzapine long-acting injection (OLAI) by means of a categorical approach addressing the symptomatic and functional status of patients......: At baseline, 434 (36.8%) patients had minimal Positive and Negative Syndrome Scale (PANSS) symptoms but seriously impaired Heinrich Carpenter's Quality of Life Scale (QLS) functioning; 303 (25.6%) had moderate to severe symptoms and seriously impaired function; 208 (17.6%) had mild to moderate symptoms...

  8. Olmesartan medoxomil combined with hydrochlorothiazide for the treatment of hypertension

    Directory of Open Access Journals (Sweden)

    Mark Greathouse

    2006-12-01

    Full Text Available Mark GreathouseSouth Hills Cardiology Associates of Pittsburgh, Pittsburgh, PA, USAAbstract: In most patients with hypertension, especially Stage 2 hypertension, adequate control of blood pressure (BP is only achieved with combination drug therapy. When using combination therapy, antihypertensive agents with complementary mechanisms of action are recommended, for example, an angiotensin receptor blocker (ARB in combination with hydrochlorothiazide (HCTZ, a β-blocker + HCTZ, an ACE inhibitor + HCTZ, or a calcium channel blocker + an ACE inhibitor. One such combination is olmesartan medoxomil + HCTZ, which is available as fixed-dose, single-tablet combinations for once-daily administration. In clinical trials, olmesartan medoxomil/HCTZ reduced systolic BP (SBP and diastolic BP (DBP to a greater extent than either component as monotherapy. A clinical study in patients with Stage 1 or 2 hypertension showed that olmesartan medoxomil/HCTZ achieved a similar mean reduction in DBP, but a significantly greater mean reduction in SBP and higher rate of BP control (<140/90 mmHg than observed with losartan/HCTZ, at US/European-approved starting doses. In a non-inferiority trial, the antihypertensive efficacy of olmesartan medoxomil/HCTZ was comparable to that of atenolol/HCTZ. Furthermore, indirect comparisons have shown that olmesartan medoxomil/HCTZ compares favorably with other antihypertensive combination therapies, including other ARB/HCTZ combinations and amlodipine besylate/benazepril. Olmesartan medoxomil/HCTZ is generally well tolerated. In conclusion, olmesartan medoxomil/HCTZ is an effective and well-tolerated combination antihypertensive therapy that results in significant BP reductions and BP control in many patients. Keywords: olmesartan medoxomil, hydrochlorothiazide, angiotensin II receptor blocker, hypertension

  9. Malnutrition in rectal cancer patients receiving preoperative chemoradiotherapy is common and associated with treatment tolerability and anastomotic leakage.

    Science.gov (United States)

    Yamano, Tomoki; Yoshimura, Mie; Kobayashi, Masayoshi; Beppu, Naohito; Hamanaka, Michiko; Babaya, Akihito; Tsukamoto, Kiyoshi; Noda, Masafumi; Matsubara, Nagahide; Tomita, Naohiro

    2016-04-01

    This study assessed the incidence of malnutrition caused by preoperative chemoradiotherapy (CRT) in rectal cancer patients, which is seemingly underestimated; however, malnutrition affects treatment tolerability, postoperative complications, including anastomotic leakage (AL), and oncological outcomes. Between January 2008 and December 2014, 54 consecutive patients with T3-4, N0-2, M0-1 resectable rectal cancer received CRT comprising 45 Gy radiotherapy and S-1 alone or with irinotecan for 5 weeks and then underwent curative surgery with diverting or permanent stomas 6-8 weeks after CRT. We assessed malnutrition after completion of CRT (5-6 weeks after CRT start date) and at surgery (11-14 weeks after CRT start date), defining weight loss as ≥5 % of pre-CRT weight; this definition differs from commonly used criteria for adverse events. We evaluated the incidence of malnutrition associated with CRT and influence of malnutrition on treatment tolerability, AL, and disease-free survival (DFS). We also assessed the influence of CRT on the rate of postoperative complications by comparing the study group with 61 patients who had undergone excision with diverting or permanent stomas alone. Malnutrition was observed in 51 % of patients after CRT and in 29 % at surgery. Malnutrition after CRT was associated with treatment tolerability, and malnutrition at surgery was significantly associated with AL, which significantly influenced DFS in stage 1-3 patients. Malnutrition caused by CRT is common and is associated with treatment tolerability and AL. Nutritional assessment and support seem indispensable for the rectal cancer patients receiving CRT.

  10. [Acupuncture therapy for the improvement of sleep quality of outpatients receiving methadone maintenance treatment: a randomized controlled trial].

    Science.gov (United States)

    Li, Yi; Liu, Xue-bing; Zhang, Yao

    2012-08-01

    To study the efficacy and safety of acupuncture therapy for the improvement of sleep quality of outpatients receiving methadone maintenance treatment (MMT). Using randomized double-blinded controlled design, seventy-five MMT outpatients with low sleep quality [score of Pittsburgh sleep quality index (PSQI) > or = 8], were randomly assigned to the acupuncture group (38 cases) and the sham-acupuncture group (37 cases). All patients maintained previous MMT. Acupuncture was applied to Baihui (GV20), Shenmen (bilateral, TF4), Shenting (GV24), Sanyinjiao (bilateral, SP6), and Sishencong (EX-HN1) in the acupuncture group. The same procedures were performed in the sham-acupuncture group, but not to the acupoints (5 mm lateral to the acupoints selected in the acupuncture group) with shallow needling technique. The treatment was performed 5 times each week for 8 successive weeks. The PSQI was assessed before treatment, at the end of the 2nd, 4th, 6th, and 8th week of the treatment. The detection ratio of low sleep quality and the incidence of adverse acupuncture reactions were compared between the two groups at the end of the 8th week. The overall PSQI score was obviously higher in the acupuncture group than in the sham-acupuncture group with statistical difference (P acupuncture group (60.53%, 23/38 cases) than in the sham-acupuncture group (83.78%, 31/37 cases) with statistical difference (P acupuncture reaction was 5.26% (2/38 cases) in the acupuncture group and 2.70% (1/37 cases) in the sham-acupuncture group respectively, showing no statistical difference (P > 0.05). Acupuncture therapy could effectively and safely improve the sleep quality of outpatients receiving MMT.

  11. Evaluation of QTc interval in Iranian causalities (Janbazan of Iran-Iraq war receiving maintenance methadone treatment

    Directory of Open Access Journals (Sweden)

    Morteza Abdar Esfahani

    2012-01-01

    Full Text Available Background: Methadone is a synthetic opioid, used in treatment of chronic pains. The current study was carried out to evaluate the QTc interval in Iranian causalities (Janbazan of Iran-Iraq war receiving maintenance methadone treatment. Materials and Methods: In 2010, one hundred war causalities in Isfahan who chronically take daily dose of 20 mg or more of methadone (more than 2 weeks, and did not have the history of cerebrovascular or coronary artery diseases, cardiac pacemaker, congenital prolonged QTC, or taking drugs affecting QTc, or having electrolyte abnormalities, were selected for the study. An electrocardiogram was taken from each patient using cardiofax instrument, and QTC was calculated manually. The data was analyzed using SPSS software with descriptive statistical methods and Pearson′s correlation coefficient. Findings: All patients were male and had the mean age of 45.6 ΁ 6.1 years. The patients received 20-240 mg methadone daily for 1 to 108 months. The QTc was prolonged in 25% of the patients (QTc 5 450 ms, with the mean of 472.72 ΁ 18.5 ms (range 450-508 ms and the mean daily dose of methadone 85.2 ΁ 59.0 mg. No significant relationship was observed between QTC interval on the one hand, and methadone dose (R = 0.025, P = 0.8, duration of treatment (R =-0.048, P = 0.68, age (R = 0.037, P = 0.71, and weight (R = 0.1, P = 0.21 of the patients, on the other hand. None of the patients had faint, syncope, arrhythmia, or sudden death. Conclusion: Oral methadone causes prolongation of QTC interval. However, the dosage of methadone and duration of treatment were not statistically related to QTC interval.

  12. Evaluation of QTc interval in Iranian causalities (Janbazan) of Iran-Iraq war receiving maintenance methadone treatment.

    Science.gov (United States)

    Esfahani, Morteza Abdar; Vosughi, Ali Akbar; Fatehi, Mohamad Hossein; Shahsanaee, Armindokht; Teimuri, Azam

    2012-03-01

    Methadone is a synthetic opioid, used in treatment of chronic pains. The current study was carried out to evaluate the QTc interval in Iranian causalities (Janbazan) of Iran-Iraq war receiving maintenance methadone treatment. In 2010, one hundred war causalities in Isfahan who chronically take daily dose of 20 mg or more of methadone (more than 2 weeks), and did not have the history of cerebrovascular or coronary artery diseases, cardiac pacemaker, congenital prolonged QTC, or taking drugs affecting QTc, or having electrolyte abnormalities, were selected for the study. An electrocardiogram was taken from each patient using cardiofax instrument, and QTC was calculated manually. The data was analyzed using SPSS software with descriptive statistical methods and Pearson's correlation coefficient. All patients were male and had the mean age of 45.6 ± 6.1 years. The patients received 20-240 mg methadone daily for 1 to 108 months. The QTc was prolonged in 25% of the patients (QTc 5 450 ms), with the mean of 472.72 ± 18.5 ms (range 450-508 ms) and the mean daily dose of methadone 85.2 ± 59.0 mg. No significant relationship was observed between QTC interval on the one hand, and methadone dose (R = 0.025, P = 0.8), duration of treatment (R =-0.048, P = 0.68), age (R = 0.037, P = 0.71), and weight (R = 0.1, P = 0.21) of the patients, on the other hand. None of the patients had faint, syncope, arrhythmia, or sudden death. Oral methadone causes prolongation of QTC interval. However, the dosage of methadone and duration of treatment were not statistically related to QTC interval.

  13. Bidirectional relationships between retention and health-related quality of life in Chinese mainland patients receiving methadone maintenance treatment.

    Directory of Open Access Journals (Sweden)

    Kaina Zhou

    Full Text Available This study aimed to explore the bidirectional relationships between retention and health-related quality of life (HRQoL in patients from mainland China receiving methadone maintenance treatment (MMT. This prospective cohort study recruited 1,212 eligible MMT patients from the two largest MMT clinics (one privately and another publicly funded in Xi'an. This study started in March 2012 with a 2-year follow-up until March 2014. Retention was assessed by repeated terminations, past treatment duration, premature terminations, and follow-up treatment duration. HRQoL was evaluated using the Chinese (simple short-form 36 health survey version 2 (SF-36v2 and the quality of life scale for drug addicts (QOL-DAv2.0. Linear and Cox regression analyses were used to explore relationships between retention and HRQoL. A general linear model was used to further examine the global effect of past treatment duration on HRQoL. Multivariate analyses showed that repeated terminations had no significant impact on HRQoL scores in MMT patients; however, past treatment time (year influenced the SF-36v2PCS (P = 0.004: treatment for ≥4 years showed a lower SF-36v2PCS score (regression coefficient: -2.39; 95% confidence interval [CI]: -3.80, -0.97; P = 0.001 than treatment for 49 (hazard ratio: 0.83; 95% CI: 0.69, 0.98; P = 0.03 were 17% less likely to terminate MMT than those with scores of ≤49. In conclusion, retention and HRQoL tended to have a bidirectional relationship, which should be considered in the development of retention and health-management programs for patients with MMT.

  14. Indoor positioning algorithm combined with angular vibration compensation and the trust region technique based on received signal strength-visible light communication

    Science.gov (United States)

    Wang, Jin; Li, Haoxu; Zhang, Xiaofeng; Wu, Rangzhong

    2017-05-01

    Indoor positioning using visible light communication has become a topic of intensive research in recent years. Because the normal of the receiver always deviates from that of the transmitter in application, the positioning systems which require that the normal of the receiver be aligned with that of the transmitter have large positioning errors. Some algorithms take the angular vibrations into account; nevertheless, these positioning algorithms cannot meet the requirement of high accuracy or low complexity. A visible light positioning algorithm combined with angular vibration compensation is proposed. The angle information from the accelerometer or other angle acquisition devices is used to calculate the angle of incidence even when the receiver is not horizontal. Meanwhile, a received signal strength technique with high accuracy is employed to determine the location. Moreover, an eight-light-emitting-diode (LED) system model is provided to improve the accuracy. The simulation results show that the proposed system can achieve a low positioning error with low complexity, and the eight-LED system exhibits improved performance. Furthermore, trust region-based positioning is proposed to determine three-dimensional locations and achieves high accuracy in both the horizontal and the vertical components.

  15. Efficiency of combined treatment and conventional physical treatment in bilateral knee arthrosis

    Directory of Open Access Journals (Sweden)

    Samir Bojičić

    2013-04-01

    Full Text Available Introduction: Degenerative joint disease, which is standardized in Europe by the name of arthrosis or osteoarthrosis, while in the Anglo-Saxon literature is in use for a long time by the name of osteoarthritis (OA although this is not a classical inflammation,is the most common joint disease in general and the most common cause of functional damage of the musculoskeletal system. Recently, the term osteoarthritisappears more frequently in domestic literature. Arthroses are degenerative joint diseases with progressive character, also one of the most frequent diseases in orthopedics. The disease fi rst affects the articular cartilage, then the bony edges of the articular surfaces, and then the articular lining.Methods: Retrospective analysis and evaluation of data of treated patients, with the "Praxis" physical treatment during the period of time from 2000 to the end of 2010 on a sample of 79 patients,valorized the efficacy of Praxis treatment. The  correlation of these results, with valorisation of the efficacy of standard physical treatment in clinics D.Z. " Novi Grad " on a sample of 81 patients, during the period of time from 2000 to the end of 2010, a statistical analysis was performed for comparing the effi cacy of the two methods.Results: There is a functional difference after therapy of bilateral gonarthrosis in clinics D.Z. "Novi Grad" and "Praxis" with statistical reliability.Conclusion: A combined approach in the treatment of knee arthrosis has a wider range of treatment procedures, comprehensively approaches to the problem and gives better results, so we can say that this method has priority compared to the standard approach to the knee arthrosis treatment.

  16. Efficiency of different coagulants combination for the treatment of ...

    African Journals Online (AJOL)

    use

    This study has focused on the physico-chemical parameter of tannery effluents as well as the treatment efficiency of alum, ferric chloride and lime, addressed as different treatments. Sample collection and analysis were performed using standard method. Pollutant removal efficiency was measured in terms of reduction in ...

  17. Combined treatment of somatostatin analogues with pegvisomant in acromegaly

    NARCIS (Netherlands)

    S.E. Franck (Sanne); A. Muhammad (Ammar); A-J. van der Lely (Aart-Jan); S.J.C.M.M. Neggers (Bas)

    2016-01-01

    textabstractTreatment of acromegaly with monotherapy long-acting somatostatin analogues (LA-SSA) as primary treatment or after neurosurgery can only achieve complete normalization of insulin-like growth factor I (IGF-I) in roughly 40 % of patients. Recently, one of the acromegaly consensus groups

  18. Embedding global barrier and collective in torus network with each node combining input from receivers according to class map for output to senders

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Dong; Coteus, Paul W; Eisley, Noel A; Gara, Alan; Heidelberger, Philip; Senger, Robert M; Salapura, Valentina; Steinmacher-Burow, Burkhard; Sugawara, Yutaka; Takken, Todd E

    2013-08-27

    Embodiments of the invention provide a method, system and computer program product for embedding a global barrier and global interrupt network in a parallel computer system organized as a torus network. The computer system includes a multitude of nodes. In one embodiment, the method comprises taking inputs from a set of receivers of the nodes, dividing the inputs from the receivers into a plurality of classes, combining the inputs of each of the classes to obtain a result, and sending said result to a set of senders of the nodes. Embodiments of the invention provide a method, system and computer program product for embedding a collective network in a parallel computer system organized as a torus network. In one embodiment, the method comprises adding to a torus network a central collective logic to route messages among at least a group of nodes in a tree structure.

  19. Occurrence of selected pharmaceuticals in the principal sewage treatment plants in Rome (Italy) and in the receiving surface waters.

    Science.gov (United States)

    Patrolecco, Luisa; Capri, Silvio; Ademollo, Nicoletta

    2015-04-01

    This paper provides data on the occurrence of selected human pharmaceuticals (carbamazepine, clofibric acid, diclofenac, fenofibrate, fenoprofen, gemfibrozil, ibuprofen, ketoprofen, and naproxen) including steroid hormones (17β-estradiol, 17α-ethinylestradiol, and estrone) in influents/effluents to/from the four principal wastewater treatment plants (WWTPs) serving the city of Rome (Italy), in two different sampling campaigns. Target compounds were also analyzed in the receiving River Tiber and River Aniene. Analytical determination was carried out by LC-MS/MS after sample cleanup and concentration by off-line solid-phase extraction (SPE). The aim of the study was to increase the information currently available on the presence and persistence of pharmaceuticals in Italian urban wastewaters and to evaluate the environmental impact of the pharmaceutical residues discharged through effluents into the receiving rivers. Results indicated that after the treatment processes, most of pharmaceuticals were not completely eliminated, as average removal efficiencies were in the 14-100% wide range during both sampling periods, with higher yields in spring than in winter. Levels detected in overall samples ranged from 5 to 2,230 ng/L in influents and from 5 to 1,424 ng/L in effluents. Carbamazepine, diclofenac, ibuprofen, and gemfibrozil showed the highest persistence to removal. Concentrations in the receiving waters were about one order of magnitude lower than in effluents, with a tendency to increase progressively through the urban tract of the river. Finally, an environmental risk analysis showed that carbamazepine, gemfibrozil, and estrone can pose a high risk at the concentrations detected in effluents and a medium risk in rivers, highlighting their potential hazard for the health of the aquatic ecosystem.

  20. Relative efficacy of psychotherapy and combined therapy in the treatment of depression: A meta-analysis.

    NARCIS (Netherlands)

    Maat, S.M.; Dekker, J.J.M.; Schoevers, R.A.; Jonghe, de F.

    2007-01-01

    0.001). Conclusions In the acute treatment of adult psychiatric outpatients with major depressive disorder, patient compliance with combined therapy matches compliance with psychotherapy alone. Combined therapy is more efficacious than psychotherapy alone. However, these results depend on severity

  1. An open-label trial of enhanced brief interpersonal psychotherapy in depressed mothers whose children are receiving psychiatric treatment.

    Science.gov (United States)

    Swartz, Holly A; Zuckoff, Allan; Frank, Ellen; Spielvogle, Heather N; Shear, M Katherine; Fleming, M A Dana; Scott, John

    2006-01-01

    Major depression affects one out of five women during her lifetime. Depressed mothers with psychiatrically ill children represent an especially vulnerable population. Challenged by the demands of caring for ill children, these mothers often put their own needs last; consequently, their depressions remain untreated. This population is especially difficult to engage in treatment. We have developed a nine-session intervention, an engagement session followed by eight sessions of brief interpersonal psychotherapy designed to increase maternal participation in their own psychotherapy, resolve symptoms of maternal depression, and enhance relationships (IPT-MOMS). This open-label trial assesses the feasibility and acceptability of providing this treatment to depressed mothers. Thirteen mothers meeting DSM-IV criteria for major depression were recruited from a pediatric mental health clinic where their school-age children were receiving psychiatric treatment. Subjects (mothers) were treated openly with IPT-MOMS. Eighty-five percent (11/13) completed the study. Subjects were evaluated with the Hamilton Rating Scale for Depression, and completed self-report measures of quality of life and functioning at three time points: baseline, after treatment completion, and 6-months posttreatment. A signed rank test was used to compare measurement changes between assessment time points. Subjects showed significant improvement from baseline to posttreatment on measures of maternal symptoms and functioning. These gains were maintained at 6-month follow-up. Therapy was well tolerated and accepted by depressed mothers, who are typically difficult to engage in treatment. A high proportion of subjects completed treatment and experienced improvements in functioning. Future randomized clinical trials are needed to establish the efficacy of this approach.

  2. Physical therapy combined with a laxative fruit drink for treatment of chagasic megacolon

    Directory of Open Access Journals (Sweden)

    Egle Pereira Leão

    2011-03-01

    Full Text Available CONTEXT: The treatment of Chagas' disease colopathy is limited to clinical management in the initial of the process, and for patients for whom surgery is not indicated or is not possible, anti-constipation diets are used, along with judicious administration of laxatives and enemas. OBJECTIVE: To evaluate over time the effects of physical-therapy interventions combined with daily ingestion of a laxative fruit drink in the treatment of chagasic megacolon. METHOD: In a quantitative, prospective, and comparative study, 12 patients of both sexes and with a mean age of 67 ± 12 years were clinically evaluated to receive 12 sessions of physical therapy twice a week, along with fruit drink, and were evaluated for intestinal constipation before and after treatment. RESULTS: A significant difference (P0.05. CONCLUSION: The proposed protocol is easy to implement, safe, non-invasive, and low-cost, with the potential to be deployed in health care by providing benefits independent of gender, age, or whether the participant has undergone surgery, improving the condition of patients with chagasic megacolon.

  3. Evaluation of combined fractional radiofrequency and fractional laser treatment for acne scars in Asians.

    Science.gov (United States)

    Yeung, Chi K; Chan, Nicola P Y; Shek, Samantha Y N; Chan, Henry H L

    2012-10-01

    Fractionated radiofrequency (RF) induces deep dermal heating and leaves the epidermis less affected. We studied the efficacy and safety of bipolar RF and fractional diode laser followed by fractional RF in Asians with acne scars. Twenty-four patients (skin types III and IV) with acne scars received up to five treatments of combined fractional 915-nm laser and bipolar RF using a Matrix IR applicator (Syneron Medical Ltd, Yokneam, Israel) with fluence ranging from 50 to 70 J/cm(2) , RF at 70-100 J/cm(3) , double passes followed by full-face bipolar fractional RF treatment using Matrix RF at energy ranging from 50 to 62 mJ/pin, at 4-week intervals. Changes in acne scars, skin texture, pore size, pigmentation irregularity, and complications were assessed up to 3 months post-treatment by standardized photographs obtained with Canfield Visia-CR system®. Subjective improvement and patient satisfaction were assessed by questionnaire. Twenty patients (age 27.7 ± 8.4 years) completed the study. Modest but statistically significant improvement was noted in acne scars, with the mean grade decreased by 29% (P acne scars with modest improvement and low PIH rate comparable to other resurfacing techniques in this Asian case series. Adequate pain control and recduced energy level when treating areas in close proximity to bone are advised. Lasers Surg. Med. 44: 622-630, 2012. © 2012 Wiley Periodicals, Inc. Copyright © 2012 Wiley Periodicals, Inc.

  4. Prevalence and Correlates of Cannabis Use in Outpatients with Serious Mental Illness Receiving Treatment for Alcohol Use Disorders.

    Science.gov (United States)

    Skalisky, Jordan; Leickly, Emily; Oluwoye, Oladunni; McPherson, Sterling M; Srebnik, Debra; Roll, John M; Ries, Richard K; McDonell, Michael G

    2017-01-01

    Introduction: People with serious mental illness (SMI) use cannabis more than any other illicit drug. Cannabis use is associated with increased psychotic symptoms and is highly comorbid with alcohol use disorders (AUDs). Despite the national trend toward decriminalization, little is known about the prevalence, correlates, and impact of cannabis use on those with SMI receiving treatment for substance use disorders, a group at high risk for the negative effects of cannabis use. Methods: In this secondary data analysis, cannabis use prevalence, correlates, and impact on treatment outcomes were examined in 121 adults with cooccurring SMI and AUDs receiving outpatient addiction treatment in a randomized trial of contingency management (CM) for alcohol. Prevalence and frequency of cannabis use were calculated across the 7-month study period using self-report and urine tests. Cannabis users were compared with nonusers by SMI diagnosis, psychiatric symptoms, medical problems, legal problems, and HIV-risk behavior. The relationship between cannabis use and longest duration of alcohol abstinence in participants randomized to CM (n=40) was assessed. Results: Fifty-seven (47%) of participants submitted at least one cannabis-positive urine sample during the study. Out of the 2834 total samples submitted, 751 (27%) were positive for cannabis. Cannabis users were 2.2 times more likely to submit an alcohol-positive sample, and 2.5 times more likely to submit a cocaine-positive sample at baseline, relative to noncannabis users (p=0.01). Cannabis users were more likely to engage in risky sexual behavior (p=0.01) and to report being homeless (p=0.03) than nonusers. When controlling for pretreatment alcohol use, the relationship between comorbid cannabis use and alcohol abstinence during CM was not significant (p=0.77). Conclusion: Rates of comorbid cannabis use were high in this sample of adults with SMI and AUDs. Cannabis use was correlated with recent alcohol and cocaine use, risky

  5. Increasing incidence of pregnancy among women receiving HIV care and treatment at a large urban facility in western Uganda.

    Science.gov (United States)

    Kabami, Jane; Turyakira, Eleanor; Biraro, Sam; Bajunirwe, Francis

    2014-12-06

    Antiretroviral treatment restores physical functioning and may have an impact on fertility desires. Counseling is given to HIV positive women to create awareness and to provide information on pregnancy and delivery. The purpose of this study was to determine the incidence of pregnancy and factors that predict pregnancy among women of reproductive age receiving HIV care and treatment at a large urban center in western Uganda. We conducted a retrospective cohort study using routinely collected data at the Immune Suppression (ISS) Clinic of Mbarara Regional Referral Hospital located in Mbarara District, western Uganda collected between January 2006 and June 2010. Women aged 15 to 50 years were eligible for analysis. The primary outcome was incidence of pregnancy calculated as number of pregnancies per 1000 person years (PY). Data was analyzed by calendar year and year of enrolment and used survival analysis to determine the predictors of pregnancy. A total of 3144 women were included with a median follow up of 12.5 months. The overall incidence rate was 90.7 pregnancies per 1000 person years. Incidence increased from 29.8 pregnancies per 1000 PY in 2006 to 122 pregnancies per 1000 PY in 2010 (p HIV status of the spouse (HR 1.46, 95%CI 1.13-1.93) compared to knowing. The use of family planning (HR 0.23 95% CI 0.18- 0.30) and an increase in CD4 count between baseline and most recent count were protective against pregnancy. ART use was not a significant predictor. Incidence of pregnancy among women receiving routine HIV care and treatment has increased and is almost comparable to that in the general population. Thus routine HIV care should integrate reproductive health needs for these women.

  6. Oral combination chemotherapy in the treatment of AIDS ...

    African Journals Online (AJOL)

    Objectives: To determine the effectiveness of an oral combination chemotherapy regimen administered to patients with AIDS-associated Hodgkin's disease. Design: Prospective, pilot phase II clinical trial. Setting: Consecutive patient recruitment occurred at two medical centers in the United States: Albany Medical Center, ...

  7. Treatment of skeletal class II malocclusion with the combination of twin-block and combination-pull headgear

    Directory of Open Access Journals (Sweden)

    Sameer S Patil

    2014-01-01

    Full Text Available The patient was a girl with a Class II division 1 malocclusion, a large overjet, an excessively deep overbite, and a slightly increased mandibular plane angle. Treatment started with the Twin-block appliance combined with combination-pull headgear to promote growth of the mandible, restrain the maxilla in the anteroposterior plane, and improve her profile. This was later, followed by fixed appliance therapy.

  8. Treatment of skeletal class II malocclusion with the combination of twin-block and combination-pull headgear

    OpenAIRE

    Sameer S Patil; Sandesh S Baralay; Sheetal S Potnis

    2014-01-01

    The patient was a girl with a Class II division 1 malocclusion, a large overjet, an excessively deep overbite, and a slightly increased mandibular plane angle. Treatment started with the Twin-block appliance combined with combination-pull headgear to promote growth of the mandible, restrain the maxilla in the anteroposterior plane, and improve her profile. This was later, followed by fixed appliance therapy.

  9. [Clinical efficacy of high-frequency oscillatory ventilation combined with pulmonary surfactant in treatment of neonatal pulmonary hemorrhage].

    Science.gov (United States)

    Lin, Xin-Zhu; Lai, Ji-Dong; Lv, Mei; Zhu, Yao; Wang, Lian; Chen, Chao

    2015-04-01

    To explore the clinical efficacy of high-frequency oscillatory ventilation (HFOV) combined with pulmonary surfactant (PS) in the treatment of neonatal pulmonary hemorrhage (NPH). A total of 122 neonates diagnosed with NPH between January 2010 and June 2014 were enrolled. After being stratified by gestational age, the neonates were randomly divided into treatment (HFOV+PS) and control (HFOV alone) groups (n=61 each). Both groups were treated with HFOV after the onset of NPH. After 2-4 hours of HFOV treatment, the treatment group received PS via intratracheal injections, followed by continuous use of HFOV. Dynamic changes in the blood gas, oxygenation index (OI), and PaO2/FiO2 (P/F) values of the neonates were determined before HFOV treatment and after 6, 12, and 24 hours of HFOV treatment. The time to hemostasis, duration of ventilation, incidence of complications, and cure rate were compared between groups. After 6, 12, and 24 hours of HFOV treatment, the treatment group had significantly improved PaO2, PaCO2, O/I, and P/F values compared with the control group (P0.05). HFOV combined with PS is an effective treatment to improve oxygenation, shorten the time to hemostasis and the duration of ventilation, and reduce the incidence of complications in neonates with NPH. However, the dual therapy is unable to reduce the mortality of neonates compared with HFOV monotherapy.

  10. 3D radiobiological evaluation of combined radiotherapy and hyperthermia treatments.

    Science.gov (United States)

    van Leeuwen, C M; Crezee, J; Oei, A L; Franken, N A P; Stalpers, L J A; Bel, A; Kok, H P

    2016-10-17

    Currently, clinical decisions regarding thermoradiotherapy treatments are based on clinical experience. Quantification of the radiosensitising effect of hyperthermia allows comparison of different treatment strategies, and can support clinical decision-making regarding the optimal treatment. The software presented here enables biological evaluation of thermoradiotherapy plans through calculation of equivalent 3D dose distributions. Our in-house developed software (X-Term) uses an extended version of the linear-quadratic model to calculate equivalent radiation dose, i.e. the radiation dose yielding the same effect as the thermoradiotherapy treatment. Separate sets of model parameters can be assigned to each delineated structure, allowing tissue specific modelling of hyperthermic radiosensitisation. After calculation, the equivalent radiation dose can be evaluated according to conventional radiotherapy planning criteria. The procedure is illustrated using two realistic examples. First, for a previously irradiated patient, normal tissue dose for a radiotherapy and thermoradiotherapy plan (with equal predicted tumour control) is compared. Second, tumour control probability (TCP) is assessed for two (otherwise identical) thermoradiotherapy schedules with different time intervals between radiotherapy and hyperthermia. The examples demonstrate that our software can be used for individualised treatment decisions (first example) and treatment optimisation (second example) in thermoradiotherapy. In the first example, clinically acceptable doses to the bowel were exceeded for the conventional plan, and a substantial reduction of this excess was predicted for the thermoradiotherapy plan. In the second example, the thermoradiotherapy schedule with long time interval was shown to result in a substantially lower TCP. Using biological modelling, our software can facilitate the evaluation of thermoradiotherapy plans and support individualised treatment decisions.

  11. Thermoradiation therapy in combined modality treatment for locally advanced laryngeal and hypopharyngeal cancer

    Science.gov (United States)

    Choynzonov, E. L.; Startseva, Zh. A.; Gribova, O. V.; Mukhamedov, M. R.; Spivakova, I. O.

    2017-09-01

    The article presents the results of combined modality treatment for stage III-IV (T3N0-2M0) laryngeal and hypopharyngeal cancers. All patients (55) were divided into 2 groups. Group I patients (n = 25) received pre-operative thermoradiation therapy and Group II patients (n = 30) received pre-operative radiation therapy alone. The follow-up period was 6-24 months. In Group I patients, partial tumor regression was achieved in 21 (84%) patients and stable disease was observed in 4 (16%) patients. In group II patients, partial tumor regression and stable disease were diagnosed in 18 (60%) and 12 (49%) patients, respectively. Local and regional recurrences occurred in 1 patient (4%) of Group I within the first year of follow-up and in 11 patients of Group II (7 within the first year and 4 within two years of follow-up). The 2-year overall survival rate was 100% in Group I patients and 76.7% ± 10.1% in Group II patients. Disease-free survival rates were 96.6 ± 3.5% and 63.3 ± 13.9%, respectively.

  12. Assessment of the renal function, peroxidation damage and inflammatory injury after epalrestat combined with alprostadil treatment of early diabetic nephropathy

    Directory of Open Access Journals (Sweden)

    Hai-Xia Li

    2017-05-01

    Full Text Available Objective: To study the renal function, peroxidation damage and inflammatory injury after epalrestat combined with alprostadil treatment of early diabetic nephropathy. Methods: 90 patients with early diabetic nephropathy treated in our hospital between June 2011 and November 2015 were collected and divided into observation group and control group (n=45 according to the single-blind randomized control method. Observation group received epalrestat combined with alprostadil treatment, control group received alprostadil treatment alone, and the treatment of both groups lasted for 3 months. Before treatment and after 3 months of treatment, turbidimetric immunoassay was used to detect the renal function indexes in peripheral blood, rate method was used to detect the renal function indexes in urine, and ELISA method was used to detect the levels of peroxidation indexes and inflammation indexes. Results: Before treatment, differences in renal function, peroxidation damage and inflammatory damage indexes were not statistically significant between two groups of patients (P>0.05. After 3 months of treatment, creatinine (Scr, cystatin C (CysC, β2 microglobulin (β2-MG, N-acetyl-β-D-glucosaminidase (NAG, reactive oxygen species (ROS, advanced protein oxidation products (AOPPs, interleukin-8 (IL-8, interleukin-27 (IL-27 and procalcitonin (PCT levels of observation group were lower than those of control group while catalase (CAT, total superoxide dismutase (TSOD, interleukin-4 (IL-4, interleukin-10 (IL-10 and interleukin-13 (IL-13 levels were higher than those of control group (P<0.05. Conclusions: Epalrestat combined with alprostadil can protect the renal function and inhibit the peroxidation damage and inflammatory injury in patients with early diabetic nephropathy.

  13. Risk score model for the development of hepatocellular carcinoma in treatment-naïve patients receiving oral antiviral treatment for chronic hepatitis B

    Directory of Open Access Journals (Sweden)

    Won Sohn

    2017-06-01

    Full Text Available Background/Aims This study aimed to develop and validate a risk prediction model for the development of hepatocellular carcinoma (HCC in treatment-naïve patients receiving oral antiviral treatment for chronic hepatitis B (CHB. Methods We investigated 2,061 Korean treatment-naïve patients with CHB treated with entecavir as an initial therapy. A risk score model for HCC development was developed based on multivariable Cox regression model in a single center (n=990 and was validated using the time-dependent area under the receiver operating characteristic curve (AUROC in three other centers (n=1,071. The difference of HCC development among risk groups (low, intermediate, and high categorized by risk score was also investigated. Results The cumulative incidence rates of HCC at 5 years were 11.2% and 8.9% in the testing and validation cohorts, respectively. HCC-Risk Estimating Score in CHB patients Under Entecavir (HCC-RESCUE is formulated as (age+15×gender [female=0 / male=1]+23×cirrhosis [absence=0 / presence=1]. The AUROCs at 1 year, 3 years, and 5 years were 0.82, 0.81, and 0.81, respectively, in the validation cohort. A significant difference of HCC development in each risk group was determined by the 5-year HCC risk score in the validation cohort (low risk group, 2.1%; intermediate risk group, 9.3%; high risk group, 41.2%, p<0.001. Conclusions The study presents a new risk score model with a good ability to predict HCC development and determine high risk patients for HCC development consisting of readily available clinical factors in treatment-naïve CHB patients receiving entecavir.

  14. The Effect of Combined Aspirin and Clopidogrel Treatment on Cancer Incidence.

    Science.gov (United States)

    Leader, Avi; Zelikson-Saporta, Ravit; Pereg, David; Spectre, Galia; Rozovski, Uri; Raanani, Pia; Hermoni, Doron; Lishner, Michael

    2017-07-01

    Multiple studies have shown an association between aspirin treatment and a reduction in newly diagnosed cancer. Conversely, there are conflicting clinical and laboratory data on the effect of combined clopidogrel and aspirin therapy on cancer incidence, including analyses suggesting an increased cancer risk. No large-scale cohort study has been performed to address this issue in a heterogeneous real-world scenario. We investigated the effect of clopidogrel and aspirin on cancer incidence compared with aspirin alone and no antiplatelet therapy. A population-based historical cohort study of subjects aged ≥50 years covered by Clalit Health Services, an Israeli health maintenance organization, was performed. Patients treated with the newer antiplatelet drugs, prasugrel or ticagrelor, which, like clopidogrel, inhibit adenosine diphosphate receptors, and those with prior cancer were excluded. Prescription records of antiplatelet medication were retrieved. The cohort included 183,912 subjects diagnosed with 21,974 cancer cases based upon the International Classification of Diseases, Ninth Revision. Dual aspirin and clopidogrel was prescribed in 9.6%, while 49% received aspirin alone and 41% used neither. Compared with nonusers, there was a lower risk of cancer in subjects exposed to aspirin with (hazard ratio [HR] 0.46; 95% confidence interval [CI], 0.44-0.49) or without clopidogrel (HR 0.54; 95% CI, 0.52-0.56), on long-term follow-up. Combined treatment was associated with a lower cancer risk than the aspirin-only group (HR 0.92; 95% CI, 0.86-0.97). Dual clopidogrel and aspirin treatment is safe regarding the cancer risk. This study generates the hypothesis that clopidogrel may reduce cancer incidence. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Statistical and systematic treatment issues in top quark mass combinations

    CERN Document Server

    Maier, Andreas Alexander; The ATLAS collaboration

    2015-01-01

    The past years have seen tremendous improvements in the precision of top quark mass measurements at hadron colliders. Since these measurements are mostly limited by systematic uncertainties, the achievable precision of a single measurement depends on developments in the experimental and theoretical understanding of top quark events. Complementing these efforts, a precision gain can also be obtained by a combination of measurements, exploiting their correlation. With ever increasing precision of single experiment top quark mass measurements, this approach becomes more and more promising, because the absolute precision gain of refined techniques in both theory and experiment tends to saturate. This requires a precise matching of uncertainty categories and a detailed evaluation of the correlations of observables. This article reviews the status and points out the challenges faced in the ATLAS and CMS LHC top quark mass combination effort.

  16. Bacteriophages displaying anticancer peptides in combined antibacterial and anticancer treatment.

    Science.gov (United States)

    Dąbrowska, Krystyna; Kaźmierczak, Zuzanna; Majewska, Joanna; Miernikiewicz, Paulina; Piotrowicz, Agnieszka; Wietrzyk, Joanna; Lecion, Dorota; Hodyra, Katarzyna; Nasulewicz-Goldeman, Anna; Owczarek, Barbara; Górski, Andrzej

    2014-01-01

    Novel anticancer strategies have employed bacteriophages as drug carriers and display platforms for anticancer agents; however, bacteriophage-based platforms maintain their natural antibacterial activity. This study provides the assessment of combined anticancer (engineered) and antibacterial (natural) phage activity in therapies. An in vivo BALB/c mouse model of 4T1 tumor growth accompanied by surgical wound infection was applied. The wounds were located in the areas of tumors. Bacteriophages (T4) were modified with anticancer Tyr-Ile-Gly-Ser-Arg (YIGSR) peptides by phage display and injected intraperitoneally. Tumor growth was decreased in mice treated with YIGSR-displaying phages. The acuteness of wounds, bacterial load and inflammatory markers in phages-treated mice were markedly decreased. Thus, engineered bacteriophages combine antibacterial and anticancer activity.

  17. Combined Periodontal, Orthodontic, and Prosthetic Treatment in an Adult Patient

    Directory of Open Access Journals (Sweden)

    Claudio Vinicius Sabatoski

    2015-01-01

    Full Text Available A 41-year-old man had a significant loss of bone and supporting tissues with pathologic migration of several teeth and several missing teeth. He was treated with an interdisciplinary therapeutic protocol that included nonsurgical periodontal therapy based on strict control of supragingival plaque, subgingival periodontal therapy, orthodontic and endodontic treatment, and replacement of restorations. The orthodontic therapy was performed in a severely reduced bone support and the presence of pathological tooth migration after periodontal disease control. The interdisciplinary treatment protocol was the key to achieve a significant improvement in his facial and dental esthetics, masticatory function, and quality of life.

  18. New Strategies Using Antibody Combinations to Increase Cancer Treatment Effectiveness

    Directory of Open Access Journals (Sweden)

    Isabel Corraliza-Gorjón

    2017-12-01

    Full Text Available Antibodies have proven their high value in antitumor therapy over the last two decades. They are currently being used as the first-choice to treat some of the most frequent metastatic cancers, like HER2+ breast cancers or colorectal cancers, currently treated with trastuzumab (Herceptin and bevacizumab (Avastin, respectively. The impressive therapeutic success of antibodies inhibiting immune checkpoints has extended the use of therapeutic antibodies to previously unanticipated tumor types. These anti-immune checkpoint antibodies allowed the cure of patients devoid of other therapeutic options, through the recovery of the patient’s own immune response against the tumor. In this review, we describe how the antibody-based therapies will evolve, including the use of antibodies in combinations, their main characteristics, advantages, and how they could contribute to significantly increase the chances of success in cancer therapy. Indeed, novel combinations will consist of mixtures of antibodies against either different epitopes of the same molecule or different targets on the same tumor cell; bispecific or multispecific antibodies able of simultaneously binding tumor cells, immune cells or extracellular molecules; immunomodulatory antibodies; antibody-based molecules, including fusion proteins between a ligand or a receptor domain and the IgG Fab or Fc fragments; autologous or heterologous cells; and different formats of vaccines. Through complementary mechanisms of action, these combinations could contribute to elude the current limitations of a single antibody which recognizes only one particular epitope. These combinations may allow the simultaneous attack of the cancer cells by using the help of the own immune cells and exerting wider therapeutic effects, based on a more specific, fast, and robust response, trying to mimic the action of the immune system.

  19. New treatment paradigm of combined raloxifene and conjugated ...

    African Journals Online (AJOL)

    Marwa N. Emam

    2016-07-25

    Jul 25, 2016 ... Abstract Introduction: The decreased ovarian estrogen production that occurs at menopause, results in osteoporosis and climacteric manifestations, and decreases women's quality of life. The hormone replacement therapy (HRT) is the primary treatment options but has been associated with increased ...

  20. Induced polygenic variability using combination treatment of gamma ...

    African Journals Online (AJOL)

    The mean values for plant height, number of primary branches, number of clusters per plant, number of pods per plant, number of seeds per pod and single plant yield decreased below the control in most of the treatments. The mean single plant yield was more than for the control at 400 Gy+60 mM and 600 Gy+50 mM.

  1. Combined effect of hormonal priming and salt treatments on ...

    African Journals Online (AJOL)

    ajl11

    2012-06-05

    Jun 5, 2012 ... Hormonal priming is a pre-sowing treatment that improves seed germination performance and stress tolerance. To understand the physiology of hormonal priming and its association with post priming stress tolerance, we investigated the effect of hormonal priming with increasing gibberellic acid (GA3).

  2. Combined tamoxifen-lynestrenol treatment in benign breast disease.

    Science.gov (United States)

    Cupceancu, B

    1985-01-01

    In order to avoid secondary induction of estrogens caused by tamoxifen treatment, tamoxifen was associated with the progestative lynestrenol in 48 menstrual women with benign breast disease (adenoma or fibroadenoma, cystic, simple or complex dysplasia). In one variant tamoxifen dosage was 20 mg (2 tablets) daily taken orally from day 5 to day 25 of the menstrual cycle, associated with 10 mg (2 tablets) of lynestrenol daily, only during the last 15 days. In another variant the above mentioned drugs were given concomitantly from day 10 to 15 of the cycle (according to cycle length) for 10 days. The average duration of the treatment was 4 cycles. The results are analysed according to surface percentage reduction of the main and associated lesions within the same case. In all cases of simple dysplasia, in 78% of the cases with complex dysplasia and in 54% of the adenomas, the lesions decreased to less than half their initial size, and in some instances the lesions disappeared altogether and the breasts became normally soft. Breast pain was improved or disappeared altogether in 96% of the cases. Despite its positive results the associated treatment used should be applied only in certain cases, especially those diagnozed as complex dysplasia and only in those medical units that have adequate diagnosis and treatment follow-up facilities.

  3. New treatment paradigm of combined raloxifene and conjugated ...

    African Journals Online (AJOL)

    Introduction: The decreased ovarian estrogen production that occurs at menopause, results in osteoporosis and climacteric manifestations, and decreases women's quality of life. The hormone replacement therapy (HRT) is the primary treatment options but has been associated with increased oncogenic potential. The tissue ...

  4. Eutrophication and Bacterial Pathogens as Risk Factors for Avian Botulism Outbreaks in Wetlands Receiving Effluents from Urban Wastewater Treatment Plants

    Science.gov (United States)

    Vidal, Dolors; Laguna, Celia; Díaz-Sánchez, Sandra; Sánchez, Sergio; Chicote, Álvaro; Florín, Máximo; Mateo, Rafael

    2014-01-01

    Due to the scarcity of water resources in the “Mancha Húmeda” Biosphere Reserve, the use of treated wastewater has been proposed as a solution for the conservation of natural threatened floodplain wetlands. In addition, wastewater treatment plants of many villages pour their effluent into nearby natural lakes. We hypothesized that certain avian pathogens present in wastewater may cause avian mortalities which would trigger avian botulism outbreaks. With the aim of testing our hypothesis, 24 locations distributed in three wetlands, two that receive wastewater effluents and one serving as a control, were monitored during a year. Sediment, water, water bird feces, and invertebrates were collected for the detection of putative avian pathogenic Escherichia coli (APEC), Salmonella spp., Clostridium perfringens type A, and Clostridium botulinum type C/D. Also, water and sediment physicochemical properties were determined. Overall, APEC, C. perfringens, and C. botulinum were significantly more prevalent in samples belonging to the wetlands which receive wastewater. The occurrence of a botulism outbreak in one of the studied wetlands coincided with high water temperatures and sediment 5-day biochemical oxygen demand (BOD5), a decrease in water redox potential, chlorophyll a, and sulfate levels, and an increase in water inorganic carbon levels. The presence of C. botulinum in bird feces before the onset of the outbreak indicates that carrier birds exist and highlights the risk of botulinum toxin production in their carcasses if they die by other causes such as bacterial diseases, which are more probable in wastewater wetlands. PMID:24795377

  5. Current concepts in combination therapy for the treatment of hypertension: combined calcium channel blockers and RAAS inhibitors

    Directory of Open Access Journals (Sweden)

    Alberto F Rubio-Guerra

    2009-11-01

    Full Text Available Alberto F Rubio-Guerra1, David Castro-Serna2, Cesar I Elizalde Barrera2, Luz M Ramos-Brizuela21Metabolic and Research Clinic, 2Internal Medicine Department, Hospital General de Ticomán SS DF, MéxicoAbstract: Recent guidelines for the management of hypertension recommend target blood pressures <140/90 mmHg in hypertensive patients, or <130/80 mmHg in subjects with diabetes, chronic kidney disease, or coronary artery disease. Despite the availability and efficacy of antihypertensive drugs, most hypertensive patients do not reach the recommended treatment targets with monotherapy, making combination therapy necessary to achieve the therapeutic goal. Combination therapy with 2 or more agents is the most effective method for achieving strict blood pressure goals. Fixed-dose combination simplifies treatment, reduces costs, and improves adherence. There are many drug choices for combination therapy, but few data are available about the efficacy and safety of some specific combinations. Combination therapy of calcium antagonists and inhibitors of the renin-angiotensin-aldosterone system (RAAS are efficacious and safe, and have been considered rational by both the JNC 7 and the 2007 European Society of Hypertension – European Society of Cardiology guidelines for the management of arterial hypertension. The aim of this review is to discuss some relevant issues about the use of combinations with calcium channel blockers and RAAS inhibitors in the treatment of hypertension.Keywords: hypertension, calcium channel blockers, renin-angiotensin-aldosterone system inhibitors, fixed-dose combination, adherence

  6. Residual stress reduction by combined treatment of pulsed magnetic field and pulsed current

    Energy Technology Data Exchange (ETDEWEB)

    Cai Zhipeng, E-mail: czpdme@gmail.com [Department of Mechanical Engineering, Tsinghua University, Beijing 100084 (China); Huang Xinquan [Department of Mechanical Engineering, Tsinghua University, Beijing 100084 (China)

    2011-07-25

    Highlights: {yields} The combination of magnetic field and current releases stress significantly. {yields} Both magneto and electro-plasticity may exit in the combined treatment. {yields} Stress increase caused by current should be studied later. - Abstract: This paper reports a significant decrease on residual stress by combined treatment of a pulsed magnetic field and a pulse current on steel samples with pre-induced residual stress conditions, compared to a separately single treatment by either the pulsed magnetic field or the pulsed current. Briefly, 10% stress decrease by pulsed magnetic field treatment and 20% increase by pulsed current treatment were observed respectively. While 60% stress release is achieved by the combined treatments, in which the same magnetic field and current parameters were applied. It is supposed that the magnetic field facilitates dislocations depinning and pulsed current provides conduction electrons to drive dislocations to move further and faster. The combined effects lead to electro-magneto-plasticity and further residual stress release.

  7. Transarterial chemoembolization combined with sorafenib for the treatment of hepatocellular carcinoma with hepatic vein tumor thrombus

    Directory of Open Access Journals (Sweden)

    Zhang YF

    2016-07-01

    Full Text Available Yong-Fa Zhang,1–3,* Wei Wei,1–3,* Jia-Hong Wang,1–3,* Li Xu,1–3 Pei-En Jian,1–3 Cheng-Zuo Xiao,4 Xiao-Ping Zhong,1–3 Ming Shi,1–3 Rong-Ping Guo1–3 1Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, 2State Key Laboratory of Oncology in South China, 3Collaborative Innovation Center for Cancer Medicine, Guangzhou, 4Department of General Surgery, Shenzhen Shajing Affiliated Hospital of Guangzhou Medical University, Shenzhen, People’s Republic of China *These authors contributed equally to this work Objective: To compare the treatment outcomes of sorafenib plus transarterial chemoembolization (TACE vs TACE alone in patients with hepatocellular carcinoma (HCC and hepatic vein tumor thrombus (HVTT.Methods: Twenty patients who were initially diagnosed with HCC and HVTT and received TACE combined with sorafenib during February 2009 to October 2013 were included in the study. To minimize selection bias, these patients were compared with 60 case-matched controls selected from a pool of 81 patients (in a 1:3 ratio who received TACE alone during the same period. The primary end point was overall survival (OS. The secondary end points were time to progression, disease control rate, and adverse events.Results: After a median follow-up period of 12.5 months (range, 1.03–44.23 months, the OS of the combined group was found to be significantly higher compared with the monotherapy group (14.9 vs 6.1 months, P=0.010. The time to progression was found to be significantly longer in the combined group (4.9 vs 2.4 months, P=0.016. Univariate and multivariate analyses revealed that the treatment allocation was an independent predictor of OS.Conclusion: Sorafenib plus TACE was well tolerated and was more effective in treating patients with advanced HCC and HVTT. Future trials with prospective larger samples are required to validate these results. Keywords: hepatocellular carcinoma, hepatic vein tumor thrombus, prognosis

  8. Effects of donepezil dose escalation in Parkinson's patients with dementia receiving long-term donepezil treatment: an exploratory study.

    Science.gov (United States)

    Ishikawa, Kei-Ichi; Motoi, Yumiko; Mizuno, Yoshikuni; Kubo, Shin-Ichiro; Hattori, Nobutaka

    2014-06-01

    The benefits of escalating the dose of donepezil in patients who are already receiving long-term treatment with it have not been well evaluated. Therefore, an exploratory study to assess the effects of donepezil dose escalation in patients with Parkinson's disease with dementia, and specifically on patients receiving long-term treatment with donepezil, was performed. Patients treated with 5-mg/day donepezil for at least 3 months and having a Mini-Mental State Examination (MMSE) score between 10 and 26 were included in this study. Donepezil dosage was then increased to 10 mg/day for 12 weeks. The outcome measures were a modified form of the Neuropsychiatric Inventory (NPI) with an extra domain for additional evaluation of fluctuation in cognitive functions (NPI-11) and the MMSE. Of the nine patients enrolled, two withdrew because of nausea and inability to be assessed on the predetermined date; this left seven participants (four men and three women) with a mean age of 74.6 ± 6.9 years, a mean period of Parkinson's disease of 11.7 ± 7.5 years, and median donepezil use of 7 months (range: 3-56 months). At baseline, the mean total NPI-11 and mean MMSE scores were 18.3 ± 5.6 points and 21.3 ± 5.3 points, respectively. At week 12, they improved by 8.3 points (P donepezil from 5 mg/day to 10 mg/day may be therapeutically useful for patients with Parkinson's disease with dementia who have taken donepezil 5 mg/day in the long term. © 2014 The Authors. Psychogeriatrics © 2014 Japanese Psychogeriatric Society.

  9. Efficacy of Surgery Combined with Autologous Bone Marrow Stromal Cell Transplantation for Treatment of Intracerebral Hemorrhage

    Directory of Open Access Journals (Sweden)

    Jianxin Zhu

    2015-01-01

    Full Text Available Bone marrow stromal cells (BMSCs may differentiate into nerve cells under a certain condition; however, the clinical application for treating nervous system disease remains unclear. The aim is to assess the safety profile, feasibility, and effectiveness of surgery combined with autologous BMSCs transplantation for treating ICH. 206 ICH patients who had received surgical procedure were divided into transplantation (n=110 or control group (n=96. For transplantation group, BMSCs were injected into the perihemorrhage area in the base ganglia through an intracranial drainage tube 5.5 (3.01–6.89 days after surgery, followed by a second injection into the subarachnoid space through lumbar puncture 4 weeks later. Neurologic impairment and daily activities were assessed with National Institute Stroke Scale (NIHSS, Barthel index, and Rankin scale before transplantation and 6 months and 12 months after transplantation. Our results revealed that, compared with control group, NIHSS score and Rankin scale were both significantly decreased but Barthel index was increased in transplantation group after 6 months. Interestingly, no significant difference was observed between 12 months and 6 months. No transplantation-related adverse effects were investigated during follow-up assessments. Our findings suggest that surgery combined with autologous BMSCs transplantation is safe for treatment of ICH, providing short-term therapeutic benefits.

  10. Natural compounds and combination therapy in colorectal cancer treatment.

    Science.gov (United States)

    Rejhová, A; Opattová, A; Čumová, A; Slíva, D; Vodička, P

    2018-01-20

    Colorectal cancer (CRC) therapy using conventional chemotherapeutics represents a considerable burden for the patient's organism because of high toxicity while the response is relatively low. Our review summarizes the findings about natural compounds as chemoprotective agents for decreasing risk of CRC. It also identifies natural compounds which possess anti-tumor effects of various characteristics, mainly in vitro on colorectal cell lines or in vivo studies on experimental models, but also in a few clinical trials. Many of natural compounds suppress proliferation by inducing cell cycle arrest or induce apoptosis of CRC cells resulting in the inhibition of tumor growth. A novel employment of natural substances is a so-called combination therapy - administration of two or more substances - conventional chemotherapeutics and a natural compound or more natural compounds at a time. Some natural compounds may sensitize to conventional cytotoxic therapy, reinforce the drug effective concentration, intensify the combined effect of both administered therapeutics or exert cytotoxic effects specifically on tumor cells. Moreover, combined therapy by targeting multiple signaling pathways, uses various mechanisms to reduce the development of resistance to antitumor drugs. The desired effect could be to diminish burden on the patient's organism by replacing part of the dose of a conventional chemotherapeutic with a natural substance with a defined effect. Many natural compounds are well tolerated by the patients and do not cause toxic effects even at high doses. Interaction of conventional chemotherapeutics with natural compounds introduces a new aspect in the research and therapy of cancer. It could be a promising approach to potentially achieve improvements, while minimizing of adverse effects associated with conventional chemotherapy. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  11. The link between social anxiety disorder, treatment outcome, and sleep difficulties among patients receiving cognitive behavioral group therapy.

    Science.gov (United States)

    Kushnir, Jonathan; Marom, Sofi; Mazar, Mika; Sadeh, Avi; Hermesh, Haggai

    2014-05-01

    The aim of our study was to examine the association between sleep disturbances and social anxiety disorder (SAD). Another aim was to explore the impact of cognitive behavioral group therapy (CBGT) for SAD on co-occurring sleep difficulties. Data were obtained retrospectively from patient files receiving CBGT for SAD. The sample included 63 patients with SAD (mean age, 30.42 years [standard deviation, 6.92 years]). There were 41 men and 22 women, of whom 41 participants completed the treatment protocol. Before treatment onset participants completed the Liebowitz Social Anxiety Scale (LSAS), the Beck Depression Inventory (BDI), the Pittsburgh Sleep Quality Index, and several sociodemographic questions. On completion of the treatment protocol, the same measures were completed, with the addition of the Sheehan Disabilities Scale (SDS). The results of our study suggest that: (1) subjective insomnia is associated with SAD severity even after controlling for depression severity and additional variables; (2) participants with SAD with co-occurring clinical levels of subjective insomnia present a more severe clinical picture both at treatment onset and termination; and (3) although CBGT lead to reduction in SAD and depression symptoms severity, it had no significant impact on co-occurring sleep difficulties. Sleep difficulties predict SAD severity regardless of depressive symptoms and may be linked to a more severe clinical picture. Clinicians should be aware of these sleep difficulties co-occurring with SAD and consider implementing specific sleep interventions. Future studies should incorporate larger samples sizes from clinical populations outside of Israel. Copyright © 2014 Elsevier B.V. All rights reserved.

  12. Combined treatment of mezcal vinasses by ozonation and activated sludge.

    Science.gov (United States)

    2017-10-18

    In Mexico, mezcal production generates huge amounts of vinasses (MV) that cause negative environmental impacts. Thus, MV treatment is necessary before discharge to water bodies. Although there is no information for mezcal vinasses, similar effluents have been treated by biological processes (i.e. anaerobic and aerobic) usually complemented by oxidative chemical pretreatments (ozonation) and physico-chemical methods. In this work MV were first ozonated and followed by batch aerobic biological degradation. In the ozonation stage, organic matter removals were 4.5-11 % as COD, whereas the removal of aromatic compounds and phenols were 16-32 % and 48-83 % respectively. In the aerobic post-treatment, COD depletions up to 85 % were achieved; removals in ozone pre-treated vinasses were higher (80 to 85 %) than that of raw vinasse (69 %). It seems that ozonation preferentially attacked the recalcitrant fraction of organic matter present in the vinasses and increased its aerobic biodegradability.

  13. A controlled study of intravenous immunoglobulin combined with prednisone in the treatment of IBM.

    Science.gov (United States)

    Dalakas, M C; Koffman, B; Fujii, M; Spector, S; Sivakumar, K; Cupler, E

    2001-02-13

    To investigate whether the combination of intravenous immunoglobulin (IVIg) with prednisone improves muscle strength and alters endomysial inflammation in patients with sporadic inclusion body myositis (s-IBM). In a previous controlled trial in s-IBM, IVIg did not significantly improve strength in spite of modest benefits in some muscle groups. The possibility that prednisone may have a synergistic effect with IVIg prompted another controlled trial. Thirty-six patients with biopsy-proven IBM were randomized to receive IVIg or placebo monthly for 3 months. Before infusions, all patients were started on high-dose prednisone for 3 months. Primary outcome measures were differences in the 1) Quantitative Muscle Strength (QMT) testing; and 2) modified Medical Research Council (MRC) scores, between the patients randomized to IVIg + prednisone compared with those randomized to placebo + prednisone. Repeated open muscle biopsies were performed at random in 24 patients to determine changes in the number of autoinvasive T cells and necrotic muscle fibers. Nineteen patients were randomized to IVIg + prednisone and 17 to placebo + prednisone. No significant change was noted in muscle strength, assessed by QMT and MRC, from baseline to the 2nd, 3rd, or 4th month after treatment between the two groups. The number of necrotic fibers was reduced in the IVIg randomized group (p IBM. Endomysial inflammation was significantly reduced after treatment, but the reduction was not of clinical significance.

  14. Targeting Strategies for the Combination Treatment of Cancer Using Drug Delivery Systems

    Directory of Open Access Journals (Sweden)

    Janel Kydd

    2017-10-01

    Full Text Available Cancer cells have characteristics of acquired and intrinsic resistances to chemotherapy treatment—due to the hostile tumor microenvironment—that create a significant challenge for effective therapeutic regimens. Multidrug resistance, collateral toxicity to normal cells, and detrimental systemic side effects present significant obstacles, necessitating alternative and safer treatment strategies. Traditional administration of chemotherapeutics has demonstrated minimal success due to the non-specificity of action, uptake and rapid clearance by the immune system, and subsequent metabolic alteration and poor tumor penetration. Nanomedicine can provide a more effective approach to targeting cancer by focusing on the vascular, tissue, and cellular characteristics that are unique to solid tumors. Targeted methods of treatment using nanoparticles can decrease the likelihood of resistant clonal populations of cancerous cells. Dual encapsulation of chemotherapeutic drug allows simultaneous targeting of more than one characteristic of the tumor. Several first-generation, non-targeted nanomedicines have received clinical approval starting with Doxil® in 1995. However, more than two decades later, second-generation or targeted nanomedicines have yet to be approved for treatment despite promising results in pre-clinical studies. This review highlights recent studies using targeted nanoparticles for cancer treatment focusing on approaches that target either the tumor vasculature (referred to as ‘vascular targeting’, the tumor microenvironment (‘tissue targeting’ or the individual cancer cells (‘cellular targeting’. Recent studies combining these different targeting methods are also discussed in this review. Finally, this review summarizes some of the reasons for the lack of clinical success in the field of targeted nanomedicines.

  15. rTMS treatments combined with speech training for a conduction aphasia patient

    Science.gov (United States)

    Zhang, Hui; Chen, Ying; Hu, Ruiping; Yang, Liqing; Wang, Mengxing; Zhang, Jilei; Lu, Haifeng; Wu, Yi; Du, Xiaoxia

    2017-01-01

    Abstract Rationale: To date, little is known regarding the neural mechanisms of the functional recovery of language after repetitive transcranial magnetic stimulation (rTMS) in aphasia. Our aim was to investigate the mechanism that underlies rTMS and speech training in a case report. Patient concerns and diagnoses: We report the case of a 39-year-old woman who was initially diagnosed with conduction aphasia following a left hemisphere stroke. Interventions: The rTMS location comprised the left Broca area, and a frequency of 5 Hz for 20 min/d for 10 days during a 2-week period was used. She had received speech rehabilitation training 1 month after stroke. Functional magnetic resonance imaging (fMRI) and diffusion tensor imaging were used to investigate the functional and microstructural changes before and after rTMS treatment. Outcomes: The results demonstrated that the Western Aphasia Battery scores significantly improved for language ability at 2 weeks post-treatment, and the gains were steadily increased at 2.5 months post-treatment. The fMRI results indicated a more focused activation pattern and showed significant activation in the left dominant hemisphere relative to the right hemisphere, especially in the perilesional areas, post-treatment during 2 language tasks compared with pretreatment. Moreover, the fractional anisotropy increased in the left superior temporal gyrus, which comprises an important area that is involved in language processing. Lessons: Our findings suggest that rTMS combined with speech training improved the speech-language ability of this chronic conduction aphasia patient and enhanced the cerebral functional and microstructural reorganization. PMID:28796033

  16. Duloxetine-bupropion combination for treatment-resistant atypical depression: a double-blind, randomized, placebo-controlled trial.

    Science.gov (United States)

    Fornaro, Michele; Martino, Matteo; Mattei, Chiara; Prestia, Davide; Vinciguerra, Valentina; De Berardis, Domenico; De Pasquale, Concetta; Iasevoli, Felice; Mungo, Sergio; Fornaro, Pantaleo

    2014-08-01

    The efficacy, safety, and tolerability of combined bupropion versus placebo using duloxetine as active reference drug, in patients with a DSM-IV diagnosis of major depression with atypical features and a history of treatment resistance, were evaluated in this preliminary six-week study. Patients (n=46) had a baseline Hamilton Depression Scale (HAM-D) ≥14 and were randomly assigned to 150/300 mg/day bupropion vs. placebo, which was added to 60 to 120 mg/day duloxetine depending on baseline depression severity. Atypical features of depression were assessed using the additional eight-item module of the Structured Interview Guide for the HAM-D with the Atypical Depression Supplement. By week 6, only five (21.7%) patients receiving duloxetine+placebo vs. six (26.1%) patients on the bupropion combination achieved response. No significant difference in final HAM-D scores between the two groups was observed between those patients achieving response. The presence of a higher number of atypical features significantly predicted non-response, with the relevant binary logistic regression model correctly classifying 17 out 22 (77.3%) of non-responders [Exp(B)=0.294; p=0.016] vs. 17 out 23 (73.9%) [Exp(B)=0.353; p=0.028] non-responder cases in the "+placebo" and "+bupropion" groups, respectively. In those patients receiving bupropion, treatment-emergent adverse events leading to withdrawal were more common among those receiving lower doses of the combination drug, and no life-threating dangers were noted. Additional studies, including an adequate course of duloxetine trial, are nonetheless aimed to allow a firm conclusion about the usefulness of the combination of duloxetine and bupropion for treatment-resistant cases of major depression with atypical features. Copyright © 2014 Elsevier B.V. and ECNP. All rights reserved.

  17. Periodontal disease preceding osteonecrosis of the jaw (ONJ) in cancer patients receiving antiresorptives alone or combined with targeted therapies: report of 5 cases and literature review.

    Science.gov (United States)

    Nicolatou-Galitis, Ourania; Razis, Evangelia; Galiti, Dimitra; Galitis, Evangelos; Labropoulos, Stefanos; Tsimpidakis, Antonis; Sgouros, Joseph; Karampeazis, Athanasios; Migliorati, Cesar

    2015-12-01

    We present clinical and radiologic data of periodontal tissue involvement preceding the appearance of osteonecrosis of the jaw (ONJ) in 5 patients with solid tumors, who received antiresorptives alone or in combination with targeted therapies. Five patients with osteonecrosis before dental extraction were studied. Periodontal involvement was evidenced by pain, bleeding, fistula, purulence, swelling, periodontal pocket, and tooth mobility. Combined endoperiodontal lesions were considered in 1 patient. Duration of symptoms before ONJ diagnosis lasted 8 to 24 weeks. Routine therapy was performed in 2 of 5 patients. Widening of the periodontal ligament was observed in 4 patients, and dense alveolar bone was seen in 1 patient. Local complications of ONJ required dental extractions in 4 of 5 patients. Spontaneous tooth exfoliation was observed in 1 patient. Alveolar bone biopsies, after the extraction in 2 patients, confirmed osteonecrosis. Osteonecrosis healed in 2 patients--1 after the dental extraction and 1 after 3 dental extractions and surgical debridement. Postextraction socket healed in 1 patient, and the area with exposed bone remained asymptomatic. Osteonecrosis progressed in 2 patients. Clinical and radiologic signs of periodontal tissue involvement, before dental extraction in patients treated with antiresorptives alone or in combination with targeted therapy, may represent developing osteonecrosis. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Antiamnesic effect of combined treatment with galantamine and estradiol in middle-aged ovariectomized female rats.

    Science.gov (United States)

    Losev, N A; Fedotova, Yu O; Sapronov, N S

    2006-04-01

    The effect of chronic combined treatment with galantamine and 17beta-estradiol on passive avoidance retention was studied in middle-aged ovariectomized female rats (15 months) with scopolamine-induced amnesia. Combined treatment with galantamine and estradiol completely restored retrieval of memory traces in middle-aged ovariectomized female rats.

  19. Brain network properties in depressed patients receiving seizure therapy: A graph theoretical analysis of peri-treatment resting EEG.

    Science.gov (United States)

    Deng, Zhi-De; McClinctock, Shawn M; Lisanby, Sarah H

    2015-08-01

    Electroconvulsive therapy (ECT), the most efficacious antidepressant therapy for treatment-resistant depression, has been reported to alter functional brain network architecture by down-regulating connectivity in frontotemporal circuitry. Magnetic seizure therapy (MST), which induces therapeutic seizures with high dose repetitive transcranial magnetic stimulation, has been introduced to improve the seizure therapy risk/benefit ratio. Unfortunately, there is limited understanding of seizure therapy's underlying mechanisms of action. In this study, we apply graph theory-based connectivity analysis to peri-treatment, resting-state, topographical electroencephalography (EEG) in patients with depression receiving seizure therapy. Functional connectivity was assessed using the de-biased weighted phase lag index, a measure of EEG phase synchronization. Brain network structure was quantified using graph theory metrics, including betweenness centrality, clustering coefficient, network density, and characteristic path length. We found a significant reduction in the phase synchronization and aberration of the small-world architecture in the beta frequency band, which could be related to acute clinical and cognitive effects of seizure therapy.

  20. [Taurin in combined treatment of metabolic syndrome and diabetes mellitus].

    Science.gov (United States)

    2011-01-01

    In addition to information on the prevalence, etiology and pathogenesis of metabolic syndrome and type 2 diabetes mellitus, the role of insulin resistance, lipotoxicity, hyperglycemia and glucose toxicity in development complications of metabolic syndrome and diabetes mellitus, the article presents evidence from multicenter clinical trials of taurin/dibicor efficacy in the treatment of metabolic syndrome, diabetes mellitus, cardiovascular complications, diabetic retinopathy. It is demonstrated that taurin/ dibicor has a positive effect on insulin resistance and body mass in obesity, on carbohydrate and lipid metabolism, on cell membranes, blood pressure, acuity of vision. Taurin/dibicor protects against macro- and microvascular diabetic complications, improves vision, cardiovascular system condition, quality and duration of life.

  1. IMPROVED MANUFACTURING CANNED "COMPOTE CHERRY" USING COMBINED HEAT TREATMENT

    Directory of Open Access Journals (Sweden)

    A. F. Demirova

    2013-01-01

    Full Text Available The results of studies on the development of new modes of heat sterilization compote cherry using stepwise heating in a stream of hot air and hot water dushevaniem air cooled rotating container. Revealed that the modes provide commercial sterility of finished products, reducing the length of the heat treatment and the quality of the finished product. Are some of the modes of heat sterilization step of cherry compote in a stream of heated air and water dushevaniem air-cooled rotating container.

  2. Characteristics and response to treatment among Indigenous people receiving injectable diacetylmorphine or hydromorphone in a randomised controlled trial for the treatment of long-term opioid dependence.

    Science.gov (United States)

    Oviedo-Joekes, Eugenia; Palis, Heather; Guh, Daphne; Marchand, Kirsten; Brissette, Suzanne; Lock, Kurt; MacDonald, Scott; Harrison, Scott; Anis, Aslam H; Krausz, Michael; Marsh, David C; Schechter, Martin T

    2018-01-01

    treatment among Indigenous people receiving injectable diacetylmorphine or hydromorphone in a randomised controlled trial for the treatment of long-termopioid dependence. Drug Alcohol Rev 2018;37:137-146]. © 2017 Australasian Professional Society on Alcohol and other Drugs.

  3. Combined treatment of acute deep vein thrombosis of the lower limbs

    Directory of Open Access Journals (Sweden)

    Vasylij Rusin

    2017-06-01

    Full Text Available The article represents the combined treatment results analysis of 50 patients with deep vein thromboses of inferior vena cava system. The complex clinical and instrumental examination of patients included duplex ultrasound scan, X-ray phlebography, multislice computed tomography with intravenous contrast and radionuclide fleboscintigrahpy. All patients were performed the regional thrombolytic therapy, combined with an open palliative thrombectomy in 19 (38% patients and endovascular implantation of a temporary or constant cava-filter in 31 (62% patients. In postoperative period for 12 months’ monitoring the local and general complications after combined treatment were found in 4 (8.0% out of 50 patients, who were performed the combined treatment.

  4. Effect of different combinations of physiotherapy treatment approaches on functional outcomes in stroke patients: A retrospective analysis

    Directory of Open Access Journals (Sweden)

    Bryan Ping Ho Chung, MSc in Health Care

    2014-06-01

    Full Text Available This retrospective study compared the functional outcomes among stroke patients who had received rehabilitation based on different physiotherapy treatment approaches. The participants were divided into three groups according to the physiotherapist in charge of their treatment. The primary treatment approaches applied in Group A, Group B, and Group C were the functional approach, the Bobath approach, and the motor learning approach, respectively. For each participant, the Berg's Balance Scale score, the Modified Barthel Index, and the Modified Rivermead Mobility Index were compared among these three groups prior to and after the stroke rehabilitation programme. Within-group analysis showed that Group A, Group B, and Group C participants had a statistically significant improvement in their Modified Barthel Index (p  0.05. In summary, this study showed that different combinations of treatment approaches may induce similar improvement in functional outcomes after stroke rehabilitation.

  5. [Evaluation of combined determinations of Epstein-Barr virus antibodies for nasopharyngeal carcinoma assessed with receiver operating characteristic curve based on logistic regression].

    Science.gov (United States)

    Cai, Yong-lin; Zheng, Yu-ming; Cheng, Ji-ru; Li, Jun; Mo, Yong-kun; Zhong, Qing-yan

    2009-10-01

    This study was aimed to investigate the diagnostic value of combined determination of Epstein-Barr virus (EBV) antibodies for nasopharyngeal carcinoma (NPC), including immunoglobulin (Ig) A against EBV capsid antigens (VCA), IgA against early antigens (EA), IgG against BRLF1 transcription activator (Rta) and IgA against EBV nuclear antigen-1 (EBNA1), assessed with receiver operating characteristic (ROC) curve based on logistic regression. Serum samples derived from 211 untreated patients with NPC and 203 non-NPC ENT patients were examined for the presence of VCA/IgA and EA/IgA by immunoenzymatic assay, Rta/IgG and EBNA1/IgA by enzyme-linked immnunosorbent assay (ELISA). The different Logistic regression models were established for various combined determinations of antibodies, respectively. Using the predicted probability as the analyzed variable, ROC curve was applied to evaluate the diagnostic accuracy of different combined determinations. The sensitivity of VCA/IgA (98.1%) and the specificity of EA/IgA (98.5%) were the highest while detecting solely. The results which were analyzed by ROC curve based on Logistic regression showed that the sensitivity and specificity were improved. In two-marker combinations, VCA/IgA + Rta/IgG whose area under ROC curve (AUC) was 0.991 had the highest diagnostic accuracy, and its sensitivity, specificity and Youden index were 94.8%, 98.0% and 0.928 respectively. No significant difference of AUC were found comparing VCA/IgA + Rta/IgG with VCA/IgA + Rta/IgG + EBNA1/IgA and four-marker combination( P > 0.05), of which sensitivity, specificity and Youden index were 94.8%, 98.5%, 0.933 and 96.7%, 97.0%, 0.937, respectively. The approach of ROC curve based on Logistic regression can improve synthetic efficiency for combined determination of multiple markers. The combined determination of VCA/IgA and Rta/IgG with a complementary effect is optimal for NPC serodiagnosis.

  6. Drug use, health and social outcomes of hard-to-treat heroin addicts receiving supervised injectable opiate treatment: secondary outcomes from the Randomized Injectable Opioid Treatment Trial (RIOTT).

    Science.gov (United States)

    Metrebian, Nicola; Groshkova, Teodora; Hellier, Jennifer; Charles, Vikki; Martin, Anthea; Forzisi, Luciana; Lintzeris, Nicholas; Zador, Deborah; Williams, Hugh; Carnwath, Tom; Mayet, Soraya; Strang, John

    2015-03-01

    The Randomized Injectable Opioid Treatment Trial (RIOTT) compared supervised injectable heroin (SIH) and supervised injectable methadone (SIM) with optimized oral methadone (OOM) (ISRCTN0133807). Heroin addicts (previously unresponsive to treatment) made significant reductions in street heroin use at 6 months when treated with SIH. We now examine secondary outcomes. Multi-site randomized controlled trial (RCT) comparing SIH versus OOM and SIM versus OOM. Three supervised injectable opiate clinics in England. Chronic refractory heroin addicts continuing to inject street heroin virtually daily despite oral substitution treatment (n = 127), randomized to either SIH(n = 43), SIM(n = 42) or OOM(n = 42). All received high levels of medical and psychosocial support. wider drug use, crime, health and social functioning at 6 months. At 6 months, no significant differences were found between treatment groups in wider drug use (crack/cocaine, benzodiazepines, alcohol), physical and mental health (SF-36) or social functioning. Within each treatment group, significant reductions were observed in crime [SIH = odds ratio (OR) 0.05; P health for SIH and SIM (SIH = mean change 3.97; P = 0.008; SIM = mean change 4.73; P = 0.002) and mental health for OOM (mean change 6.04; P = 0.013). Supervised injectable heroin treatment and supervised injectable methadone treatment showed no clearly identified benefit over optimized oral methadone in terms of wider drug use, crime, physical and mental health within a 6-month period, despite reducing street heroin use to a greater extent. However, all interventions were associated with improvements in these outcomes. © 2014 Society for the Study of Addiction.

  7. Effects of massage treatment combined with topical cactus and aloe on puerperal milk stasis.

    Science.gov (United States)

    Meng, Shan; Deng, Qingchun; Feng, Chunyu; Pan, Yinglian; Chang, Qing

    2015-01-01

    Puerperal milk stasis is one of the most common puerperal complication that directly affects breastfeeding. Massage treatment with topical cactus and aloe for puerperal milk stasis might be a superior treatment, and it does not affect breastfeeding. The intervention group was treated with massages with cactus and aloe cold compresses, and the control group was treated with massage treatment or cactus and aloe cold compresses alone. We evaluated the efficacies of the treatments through comparisons of the feeding patterns, hardness, and pain after treatment between the three groups. We found that breastfeeding rates were significantly increased in the massage combine with combined with cactus and aloe cold compress group (P massage combine with combined with cactus and aloe cold compress group than in the massage or cold compress group (P Massage treatment with topical cactus and aloe topical effectively improved the pain status, hard lump of puerperal milk stasis and increase breastfeeding rate.

  8. [Effects of a combined regime of auricular-plaster and body acupuncture in treatment of cervical spondylosis of vertebral artery type].

    Science.gov (United States)

    Zhang, Hui-Lan; Zhong, Yuan-Ming; Peng, Guo-Min; Wan, Yi-Gang

    2006-10-01

    To study effects of a combined regime of auricular-plaster and body acupuncture in treatment of cervical spondylosis of vertebral artery type and make a preliminary revelation of the mechanism. Ninety-two patients were randomly divided into 2 groups, the treatment group (n = 56) received the combined regime of auricular-plaster and body acupuncture, and the control group (n = 36) received treatment with body acupuncture. Clinical symptoms and signs, therapeutic effect and some indexes about vertebrobasilar hema-kinetics and hema-rheology were investigated before and after treatment. The treatment group was better than the control group in the clinical overall effective rate (89.29%) and the clinically control rate (17. 85%), and in improving the following indexes, including dizziness and headache, the vertebrobasilar volume and rate of blood flow etab and IR (P Malaysia and in China.

  9. Radiation therapy combined with intracerebral administration of carboplatin for the treatment of brain tumors

    Science.gov (United States)

    2014-01-01

    Background In this study we determined if treatment combining radiation therapy (RT) with intracerebral (i.c.) administration of carboplatin to F98 glioma bearing rats could improve survival over that previously reported by us with a 15 Gy dose (5 Gy × 3) of 6 MV photons. Methods First, in order to reduce tumor interstitial pressure, a biodistribution study was carried out to determine if pretreatment with dexamethasone alone or in combination with mannitol and furosemide (DMF) would increase carboplatin uptake following convection enhanced delivery (CED). Next, therapy studies were carried out in rats that had received carboplatin either by CED over 30 min (20 μg) or by Alzet pumps over 7 d (84 μg), followed by RT using a LINAC to deliver either 20 Gy (5 Gy × 4) or 15 Gy (7.5 Gy × 2) dose at 6 or 24 hrs after drug administration. Finally, a study was carried out to determine if efficacy could be improved by decreasing the time interval between drug administration and RT. Results Tumor carboplatin values for D and DMF-treated rats were 9.4 ±4.4 and 12.4 ±3.2 μg/g, respectively, which were not significantly different (P = 0.14). The best survival data were obtained by combining pump delivery with 5 Gy × 4 of X-irradiation with a mean survival time (MST) of 107.7 d and a 43% cure rate vs. 83.6 d with CED vs. 30-35 d for RT alone and 24.6 d for untreated controls. Treatment-related mortality was observed when RT was initiated 6 h after CED of carboplatin and RT was started 7 d after tumor implantation. Dividing carboplatin into two 10 μg doses and RT into two 7.5 Gy fractions, administered 24 hrs later, yielded survival data (MST 82.1 d with a 25% cure rate) equivalent to that previously reported with 5 Gy × 3 and 20 μg of carboplatin. Conclusions Although the best survival data were obtained by pump delivery, CED was highly effective in combination with 20 Gy, or as previously reported, 15 Gy, and the latter would be preferable since it would produce less

  10. Retention in opioid substitution treatment: a major predictor of long-term virological success for HIV-infected injection drug users receiving antiretroviral treatment.

    Science.gov (United States)

    Roux, Perrine; Carrieri, M Patrizia; Cohen, Julien; Ravaux, Isabelle; Poizot-Martin, Isabelle; Dellamonica, Pierre; Spire, Bruno

    2009-11-01

    The positive impact of opioid substitution treatment (OST) on opioid-dependent individuals with human immunodeficiency virus (HIV) infection is well documented, especially with regard to adherence to highly active antiretroviral therapy (HAART). We used the data from a 5-year longitudinal study of the MANIF 2000 cohort of individuals infected with HIV (as a result of injection drug use) and receiving HAART to investigate the predictors of long-term virological success. Design. Data were collected every 6 months from outpatient hospital services delivering HIV care in France. We selected all patients who were receiving HAART for at least 6 months (baseline visit) and who had indications for OST (ie, still dependent on opioids). We selected a total of 113 patients, accounting for a total of 562 visits for all the analyses. Long-term virological success was defined as an undetectable viral load after at least 6 months on HAART. Retention in OST was defined as the time interval between the last initiation or reinitiation of OST during HAART follow-up and any given visit on OST. A mixed logistic model was used to identify predictors of long-term virological success. At baseline, 53 patients were receiving buprenorphine, 28 patients were receiving methadone, and 32 patients were not on OST. The median duration of OST was 25 months (range, 3-42 months). In the multivariate analysis, after adjustment for significant predictors of long-term virological success such as adherence to HAART and early virological response, retention in OST was associated with long-term virological success (odds ratio, 1.20 per 6-month increase; 95% confidence interval, 1.09-1.32). Our study presents important evidence of the positive impact of retention in OST on HIV outcomes. Increasing access to OST based on a comprehensive model of care for HIV-infected patients who have indications for OST may foster adherence and ensure long-term response to HAART.

  11. Relevance of angiopoietin-2 and soluble P-selectin levels in patients with pulmonary arterial hypertension receiving combination therapy with oral treprostinil: a FREEDOM-C2 biomarker substudy

    Science.gov (United States)

    Schermuly, Ralph; Seeger, Werner; Rao, Youlan; Ghofrani, Hossein A.; Gall, Henning

    2016-01-01

    Abstract Studies have suggested roles for angiopoietin-2 (Ang-2) and soluble P-selectin (sP-selectin) as biomarkers of disease severity and treatment response in pulmonary arterial hypertension (PAH), but additional data are required for validation. We evaluated these biomarkers using data from FREEDOM-C2, in which patients with PAH receiving stable monotherapy or combination therapy were randomized to receive additional treatment with oral treprostinil (up-titrated from 0.25 mg twice daily) or placebo for 16 weeks. Biomarker analysis was optional in FREEDOM-C2. We measured plasma Ang-2 and sP-selectin levels at baseline and at week 16, and we assessed their association with predefined outcomes (6-minute walk distance [6MWD] change from baseline >40 m, 6MWD >380 m, functional class I/II, and/or N-terminal pro-brain natriuretic peptide [NT-proBNP] <1,800 pg/mL at week 16) using Spearman correlation, receiver operating characteristics, and logistic regression. Biomarker data were available for 83 of 157 and 95 of 153 patients in the oral treprostinil and placebo groups, respectively. In the oral treprostinil group, baseline Ang-2 levels correlated with week 16 NT-proBNP levels (P < 0.0001). Baseline Ang-2 ≥12 ng/mL was associated with a reduced likelihood of having NT-proBNP <1,800 pg/mL at week 16 (multivariate odds ratio: 0.08; 95% confidence interval: 0.02–0.32). However, Ang-2 showed no significant association with the other assessed outcomes, and sP-selectin was not associated or correlated with any of the outcomes. These data suggest that Ang-2 and sP-selectin are not associated with response to oral treprostinil in patients already receiving stable PAH therapy. Trial registration: Clinicaltrials.gov identifier NCT00887978. PMID:28090293

  12. Design of a Combined Beacon Receiver and Digital Radiometer for 40 GHz Propagation Measurements at the Madrid Deep Space Communications Complex

    Science.gov (United States)

    Zemba, Michael J.; Nessel, James A.; Morabito, David D.

    2017-01-01

    NASA Glenn Research Center (GRC) and the Jet Propulsion Laboratory (JPL) have jointly developed an atmospheric propagation terminal to measure and characterize propagation phenomena at 40 GHz at the Madrid Deep Space Communications Complex (MDSCC) in Robledo de Chavela, Spain. The hybrid Q-band system combines a 40 GHz beacon receiver and digital radiometer into the same RF front-end and observes the 39.402 GHz beacon of the European Space Agencys Alphasat Aldo Paraboni TDP5 experiment. The goals of these measurements are to assist MDSCC mission operations as well as to contribute to the development and improvement of International Telecommunications Union (ITU) models for prediction of communications systems performance within the Q-band. Herein, we provide an overview of the system design, characterization, and plan of operations to commence at the MDSCC beginning in March 2017.

  13. Eutrophication and bacterial pathogens as risk factors for avian botulism outbreaks in wetlands receiving effluents from urban wastewater treatment plants.

    Science.gov (United States)

    Anza, Ibone; Vidal, Dolors; Laguna, Celia; Díaz-Sánchez, Sandra; Sánchez, Sergio; Chicote, Alvaro; Florín, Máximo; Mateo, Rafael

    2014-07-01

    Due to the scarcity of water resources in the "Mancha Húmeda" Biosphere Reserve, the use of treated wastewater has been proposed as a solution for the conservation of natural threatened floodplain wetlands. In addition, wastewater treatment plants of many villages pour their effluent into nearby natural lakes. We hypothesized that certain avian pathogens present in wastewater may cause avian mortalities which would trigger avian botulism outbreaks. With the aim of testing our hypothesis, 24 locations distributed in three wetlands, two that receive wastewater effluents and one serving as a control, were monitored during a year. Sediment, water, water bird feces, and invertebrates were collected for the detection of putative avian pathogenic Escherichia coli (APEC), Salmonella spp., Clostridium perfringens type A, and Clostridium botulinum type C/D. Also, water and sediment physicochemical properties were determined. Overall, APEC, C. perfringens, and C. botulinum were significantly more prevalent in samples belonging to the wetlands which receive wastewater. The occurrence of a botulism outbreak in one of the studied wetlands coincided with high water temperatures and sediment 5-day biochemical oxygen demand (BOD5), a decrease in water redox potential, chlorophyll a, and sulfate levels, and an increase in water inorganic carbon levels. The presence of C. botulinum in bird feces before the onset of the outbreak indicates that carrier birds exist and highlights the risk of botulinum toxin production in their carcasses if they die by other causes such as bacterial diseases, which are more probable in wastewater wetlands. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

  14. Meta-analysis of transarterial chemoembolization combined with microwave coagulation therapy in treatment of advanced liver cancer

    Directory of Open Access Journals (Sweden)

    ZHOU Zhendong

    2013-08-01

    Full Text Available ObjectiveTo evaluate the clinical efficacy of transarterial chemoembolization (TACE combined with microwave coagulation therapy (MCT in the treatment of advanced liver cancer and to provide a more convincing basis for the clinical application of this therapy. MethodsA search was performed using Cochrane Library, PubMed, Em-base, CBM, CNKI, VIP WanFang Data as well as other sources to collect randomised controlled trials (RCTs of TACE combined with MCT in the treatment of advanced primary liver cancer. The literature was selected according to inclusion criteria. The quality of included studies was assessed according to Cochrane review criteria. A Meta-analysis was performed on homogeneous studies using RevMan 5.0. The patients receiving TACE combined with MCT were compared with those receiving TACE alone in terms of 0.5-year, 1-year, and 2-year survival rates and negative conversion rate of alpha-fetoprotein (AFP. ResultsA total of 12 RCTs involving 872 cases were included in the analysis. Compared with those receiving TACE alone, the patients receiving TACE combined with MCT had a significantly higher 0.5-year survival rate (OR=7.21, 95% CI: 1.92-2708, P=0.003, a significantly higher 1-year survival rate (OR=4.47, 95% CI:3.14-6.36, P<0.000 01, a significantly higher 2-year survival rate (OR=3.66, 95% CI:2.45-4.84, P<0.000 01, and a significantly higher negative conversion rate of AFP (OR=2.65, 95% CI:1.73-4.07, P<0.000 1. ConclusionCompared with TACE alone, TACE combined with MCT can produce better short-term and long-term treatment outcomes and significantly improve the survival rate in patients with unresectable advanced liver cancer, according to the meta-analysis. This combination therapy might be clinically effective, but which needs to be confirmed by a large number of high-quality controlled clinical trials.

  15. Clinical outcome in heart transplant recipients receiving everolimus in combination with dosage reduction of the calcineurin inhibitor cyclosporine A or tacrolimus.

    Science.gov (United States)

    Fuchs, Uwe; Zittermann, Armin; Ensminger, Stephan M; Schulz, Uwe; Gummert, Jan F

    2014-08-01

    The mTOR inhibitor everolimus (EVL) can be used for calcineurin inhibitor-sparing immunosuppression in heart transplantation (HTx). However, comparable data regarding clinical outcomes in HTx recipients receiving EVL either with dosage reduction of cyclosporine A (CSA) or with dosage reduction of tacrolimus (TAC) is scarce. In a retrospective data analysis, we compared 5-year clinical outcomes in 154 maintenance patients receiving EVL with CSA (n=106) or TAC (n=48). The primary endpoint was a composite of death, graft loss and EVL discontinuation (treatment failure). Secondary endpoints were kidney function, cardiac rejection, cytomegalovirus infection and biochemical safety parameters. In the CSA and TAC group, the primary endpoint was reached by 59.8% and 53.1%, respectively (P=0.716). Five-year mortality was 30.4% (CSA group) and 23.13% (TAC group), respectively (P=0.371), and freedom from EVL discontinuation was 53.3% and 59.6% (P=0.566) in the respective groups. Covariate-adjusted relative risk of treatment failure was in the CSA group=1.28 (95% CI: 0.70-2.34; P=0.43) compared with the TAC group. The course of covariate-adjusted estimated glomerular filtration rate and freedom from cytomegalovirus infection was similar in the two groups (P=0.502 and P=0.476), whereas covariate-adjusted freedom from rejection was lower in the CSA group compared with the TAC group (P=0.023). Lipid status and blood cell counts were comparable between groups. In conclusion, data indicate that EVL plus reduced TAC is not superior to EVL plus reduced CSA regarding treatment failure and kidney function. However, compared with EVL plus reduced CSA, EVL plus reduced TAC seems to reduce cardiac rejections. Copyright © 2014 Elsevier B.V. All rights reserved.

  16. Ceftazidime-avibactam: novel antimicrobial combination for the treatment of complicated urinary tract infections.

    Science.gov (United States)

    Alidjanov, Jakhongir F; Fritzenwanker, Moritz; Hoffman, Ivan; Wagenlehner, Florian M

    2017-06-01

    Ceftazidime-avibactam is a combination of a third-generation cephalosporin and a novel non-beta-lactam beta-lactamase inhibitor. This combination was recently recommended for the treatment of complicated urinary tract infections, including acute pyelonephritis, in adults with limited or no alternative treatment options. The current review is aimed to determine activity, efficacy and safety of ceftazidime-avibactam in the treatment of patients with complicated urinary tract infections.

  17. A Randomized, Double-Blind Study Assessing Changes in Cognitive Function in Indian School Children Receiving a Combination of Bacopa monnieri and Micronutrient Supplementation vs. Placebo

    Directory of Open Access Journals (Sweden)

    Tora Mitra-Ganguli

    2017-11-01

    Full Text Available Several studies have indicated a chronic cognitive enhancing effect of Bacopa monnieri across different ages and cognitive impairment associated with vitamin and mineral deficiencies in children. Therefore, we investigated the effects of 4-month supplementation with a combination of B. monnieri extract and multiple micronutrients on cognitive functions in Indian school children aged 7–12 years. This was a randomized, double-blind, parallel design, single-center study in which 300 children were randomized to receive a beverage either fortified with B. monnieri and multiple micronutrients (“fortified” or a non-fortified isocaloric equivalent (“control” twice-daily for 4 months. Cognitive function was assessed by the Cambridge Neuropsychological Automated Test Battery (CANTAB administered at baseline, Day 60 and Day 121. The primary endpoint was change in short-term memory (working memory from baseline in subjects receiving “fortified” vs. “control” beverages after 4 months. Secondary endpoints included sustained attention, episodic memory, and executive function. The “fortified” beverage did not significantly improve short-term memory or any of the secondary outcomes tested relative to the “control” beverage. However, the spatial working memory “strategy” score showed significant improvement on Day 60 (difference between groups in change from baseline: −0.55; p < 0.05, but not on Day 121 due to the active intervention. Study products were well-tolerated. Reasons for these unexpected findings are discussed.

  18. Combined teleseismic imaging of the structure of southern African cratons using P-receiver functions and P-and S-finite-frequency tomography

    DEFF Research Database (Denmark)

    Soliman, Mohammad Youssof Ahmad; Thybo, Hans; Levander, Alan

    2011-01-01

    We present a seismic model of the South-African cratonic region obtained by combining receiver functions and teleseismic P and S traveltime tomography. We determined receiver functions (RFs) for 82 stations by iterative deconvolution. Based on HK analysis (Zhou and Kananmori, JGR,2001), we measure...... bands (1, 0.5 and 0.25 Hz for P and 0.1, 0.05 and 0.02 Hz for S) to obtain 3-D P- and S-wave perturbation models for the upper mantle. Crustal corrections are based on the RF models. Tests showed that our dataset is able to resolve structure of 3°x3° up to 400 km depth. The high-velocity cratonic roots...... extend to 300-350 km depth. Lower velocities are detected below the Bushveld complex and the mobile belts. The model also suggests a stratified structure, since we found a low velocity zone (LVZ) at about 170 km depth in the cratonic areas. SdP RFs and surface-wave tomography are in progress and should...

  19. A matrix risk model for the prediction of rapid radiographic progression in patients with rheumatoid arthritis receiving different dynamic treatment strategies: post hoc analyses from the BeSt study.

    Science.gov (United States)

    Visser, K; Goekoop-Ruiterman, Y P M; de Vries-Bouwstra, J K; Ronday, H K; Seys, P E H; Kerstens, P J S M; Huizinga, T W J; Dijkmans, B A C; Allaart, C F

    2010-07-01

    To develop a matrix model for the prediction of rapid radiographic progression (RRP) in subpopulations of patients with recent-onset rheumatoid arthritis (RA) receiving different dynamic treatment strategies. Data from 465 patients with recent-onset RA randomised to receive initial monotherapy or combination therapy were used. Predictors for RRP (increase in Sharp-van der Heijde score > or =5 after 1 year) were identified by multivariate logistic regression analysis. For subpopulations, the estimated risk of RRP per treatment group and the number needed to treat (NNT) were visualised in a matrix. The presence of autoantibodies, baseline C-reactive protein (CRP) level, erosion score and treatment group were significant independent predictors of RRP in the matrix. Combination therapy was associated with a markedly reduced risk of RRP. The positive and negative predictive values of the matrix were 62% and 91%, respectively. The NNT with initial combination therapy to prevent one patient from RRP with monotherapy was in the range 2-3, 3-7 and 7-25 for patients with a high, intermediate and low predicted risk, respectively. The matrix model visualises the risk of RRP for subpopulations of patients with recent-onset RA if treated dynamically with initial monotherapy or combination therapy. Rheumatologists might use the matrix for weighing their initial treatment choice.

  20. Combined surgical and medical treatment of giant prolactinoma: case report

    Directory of Open Access Journals (Sweden)

    Rădoi Mugurel

    2016-06-01

    Full Text Available The operative management of giant pituitary prolactinoma represents a significant challenge for neurosurgeons, due to the degree of local tumor infiltration into adjacent structures such as cavernous sinus. The degree of parasellar tumor extension can be classified according to the Knosp grading system’ while suprasellar extension is qualified in accordance with the modified Hardys classification system. This report describes the case of a male patient with a giant pituitary prolactinoma in which a partial tumor resection via a subfrontal approach was achieved. Typically, resection rates of less than 50% have been reported following surgery on giant pituitary adenomas. Prolactin levels were very high, consistent with invasive giant prolactinoma. Our patient was treated with Cabergoline which eventually normalized the prolactin level and significantly reduced the size of the residual tumor. This case serves to illustrate that in the presence of significant suprasellar and parasellar extension, multi-modal treatment strategies with surgery and dopamine agonist, is the gold standard in the management of locally aggressive pituitary prolactinomas.

  1. Intraoperative radiotherapy in combined treatment of sinonasal malignant tumors

    Science.gov (United States)

    Novikov, V. A.; Gribova, O. V.; Vasiljev, R. V.; Choynzonov, E. L.; Shtin, V. I.; Shiianova, A. A.; Surkova, P. V.; Starceva, Zh. A.; Shilova, O. G.

    2017-09-01

    Obvious advantage of IORT (intraoperative radiotherapy) is that the radiation source is delivered directly to the bed of the tumor during surgery, thus avoiding the negative impact on the skin, subcutaneous tissue and reducing the risk of fibrosis. Sinonasal tumors—a convenient object for intraoperative radiotherapy application (surface location, relatively small size tumors, good operational access). The surface location and comparatively small size of neoplasms, good operational access provide an efficient and accurate transfer of the electron beam to the postoperative cavity to increase the irradiation dose in the areas of the most probable recurrence, which makes the tumors of this localization a convenient object for the use of the intraoperative radiation therapy. The treatment was conducted using a mobile compact betatron (MIB-6E), 10-12 Gy single dose. IORT session extends surgery period by 30 min. There were no pathological clinical and laboratory reactions on IORT in the early postoperative period. Carrying out the procedure is possible in various standard operating rooms. It does not require special security measures for the patients and the staff. IORT with the help of electron beam allows avoiding post-radiation reactions and achieving a 5-year—disease-free survival of 66% of the patients. IORT session is possible through a minimal incision during organ preservation surgeries. Evident economic feasibility provides the prospects of applying IORT in the clinical practice.

  2. A phase III clinical trial of exercise modalities on treatment side-effects in men receiving therapy for prostate cancer

    Directory of Open Access Journals (Sweden)

    Wall Bradley

    2009-06-01

    Full Text Available Abstract Background Androgen deprivation therapy (ADT is accompanied by a number of adverse side effects including reduced bone mass and increased risk for fracture, reduced lean mass and muscle strength, mood disturbance and increased fat mass compromising physical functioning, independence, and quality of life. The purpose of this investigation is to examine the effects of long term exercise on reversing musculoskeletal-related side effects, and cardiovascular and diabetes risk factors in men receiving androgen deprivation for their prostate cancer. Specifically, we aim to investigate the effects of a 12-month exercise program designed to load the musculoskeletal system and reduce cardiovascular and diabetes disease progression on the following primary endpoints: 1 bone mineral density; 2 cardiorespiratory function and maximal oxygen capacity; 3 body composition (lean mass and fat mass; 4 blood pressure and cardiovascular function; 5 lipids and glycemic control; and 6 quality of life and psychological distress. Methods/Design Multi-site randomized controlled trial of 195 men (65 subjects per arm undergoing treatment for prostate cancer involving ADT in the cities of Perth and Brisbane in Australia. Participants will be randomized to (1 resistance/impact loading exercise, (2 resistance/cardiovascular exercise groups and (3 usual care/delayed exercise. Participants will then undergo progressive training for 12 months. Measurements for primary and secondary endpoints will take place at baseline, 6 and 12 months (end of the intervention. Discussion The principal outcome of this project will be the determination of the strength of effect of exercise on the well established musculoskeletal, cardiovascular and insulin metabolism side effects of androgen deprivation in prostate cancer patients. As this project is much longer term than previous investigations in the area of exercise and cancer, we will gain knowledge as to the continuing effects of

  3. Pharmacotherapeutic efficiency and advantages of the combined treatment of patients with type 2 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    V.I. Pankiv

    2017-09-01

    Full Text Available Background. The early prescription of a combination of extended-release metformin with glimepiride influencing different links of the pathogenesis of type 2 diabetes mellitus (DM is grounded in the article. The purpose of the research was to evaluate the dynamics of glycated haemoglobin (HbA1c after the period of supervision as compared to the baseline, and also to determine additional parameters of efficiency, safety, and tolerability of Duglimax manufactured by Кusum Pharm (Ukraine in the therapy of type 2 DM. Materials and methods. The study included 46 patients with type 2 DM divided into two groups. For the patients of the first group (n = 26, who previously received metformin preparations at a dose of up to 2000 mg/day, the combined preparation Duglimax (metformin 500 mg and glimepiride 2 mg was prescribed, and also extended-release metformin (Metamin SR in the evening. The patients of the second group (n = 20 continued the reception of extended-release metformin twice daily in a dose of 2000–2500 mg/day. Results. After 12 weeks of therapy, in patients of the first group, the level of НbА1с significantly decreased to 6.72 ± 0.29 %. The level of insulin in the first group was 14.06 ± 1.81 mIU/ml after treatment (in baseline level of 19.17 ± 2.05 mIU/ml, HOMA-IR — 3.14 ± 0.21 (vs initial one of 5.92 ± 1.46. Results of the clinical study show the absence of hypoglycemia development in patients receiving Duglimax during the follow-up period. Conclusions. Combined antidiabetic therapy with Duglimax for 12 weeks results in the substantial decrease of HbA1c level and achievement of target indexes of carbohydrate metabolism in type 2 DM patients. The good tolerability and high safety of Duglimax were registered during the period of supervision.

  4. Combination use of paclitaxel and avastin enhances treatment effect for the NSCLC patients with malignant pleural effusion.

    Science.gov (United States)

    Qi, Nan; Li, Fang; Li, Xiaosong; Kang, Huanrong; Zhao, Hui; Du, Nan

    2016-11-01

    The current study is conducted to investigate efficacy of the chemotherapy drug paclitaxel in combination with Avastin (Roche Diagnostics GmbH., Mannheim, Germany) (antiangiogenic agent) in treatment of malignant pleural effusions (MPEs).Twenty-four patients with non-small cell lung cancer were randomly assigned for 2 treatment approaches. Ten patients received paclitaxel (175 mg/m) alone, and 14 patients took a combination therapy of paclitaxel and Avastin (5 mg/kg). Efficacy of the treatment approaches in the patients was validated with the change in the MPE volume. Pharmacokinetic (PK) profile and urinary excretion rate of paclitaxel were analyzed with serum vascular endothelial growth factor (VEGF) level, and adverse events were examined as well.The combination therapy reduced the MPE level with a successful rate of 29% and a survival rate of 25% over the single paclitaxel treatment in the study cohort (both P < 0.05). PKs for the combined treatment displayed a rapid distribution of the anticancer drug paclitaxel with an obvious increase in its elimination half-life in the pleural fluid (both P < 0.01). Mean residence time of paclitaxel increased in the presence of Avastin (P < 0.01). Serum VEGF levels significantly reduced in the Avastin-treated patients as compared to the paclitaxel-treated ones (P < 0.01). The urinary excretion rate was similar in the study cohort. Incidence of adverse events for the 2 treatment approaches was similar in the patients.Intervention of Avastin enhances potency of paclitaxel in treatment of MPEs with the increased survival rate of the patients through inhibiting VEGF production and prolonging time of ongoing interaction between the chemotherapy drug and the tumor tissues.

  5. Systematic review of studies comparing combined treatment with paracetamol and ibuprofen, with either drug alone.

    Science.gov (United States)

    Purssell, Edward

    2011-12-01

    To evaluate the evidence surrounding the use of combinations of paracetamol and ibuprofen in the treatment of fever. Systematic narrative review of randomised controlled trials using the UK Economic and Social Research Council guidance on the conduct of narrative synthesis. Inpatient, outpatient and home care. Children with fever. The effect of combination treatments of paracetamol and ibuprofen on fever and comfort, and identification of side effects. Seven studies were identified, six of which provided useful data for the evaluation of the effect of treatment on temperature. Overall these studies showed limited benefit from the combined treatment until around 4 h, after which there was a statistically but only marginally clinically significant benefit. Two studies contained data directly relating to comfort; these suggest a marginal benefit from the combined treatment, but the clinical significance of this was limited. There was no evidence of greater side effects or toxicities associated with the combined treatment. However, it is important to note that these studies were small, short term, and not conducted in the normal setting in which these treatments are given. There is little evidence of any benefit or harm from the combined treatment compared with the use of each drug alone. In the absence of such benefit, there is little to recommend the unnecessary use of polypharmaceutical methods to treat a symptom that does not require treatment, when effective monotherapies exist.

  6. Voglibose in Combination of Three Hypoglycemic Agents in the Treatment of Type 2 Diabetes Mellitus

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    V.I. Pankivn

    2016-09-01

    Full Text Available The aim of the study — clinical and metabolic rationale for the selection of the third hypoglycemic agent to enhance the effectiveness of treatment in patients with diabetes mellitus (DM type 2, assessment of the impact of the therapy intensification due to the addition of voglibose on carbohydrate metabolism parameters, which have not reached target levels during the combination therapy with metformin and glimepiride. Materials and methods. We observed 45 patients with DM type 2, who have not reached the targets of carbohydrate metabolism under the influence of previous treatments (metformin and glimepiride. After the initial clinical examination, patients were divided into two groups. In the first group (n = 30, wе added to the treatment the drug voglibose (Voxid, production of Kusum Pharm Ltd, Ukraine 0.2 mg before breakfast, lunch and dinner for 12 weeks. Results. After 12 weeks of treatment, the level of glycated hemoglobin (НbА1с in the first group decreased by 1.5 [1.1; 1.9] % (p  0.05. 80 % of patients achieved target levels of glycemia. The first group of patients showed a significant increase in HOMA-β index by 24.9 %, as well as a reduction of insulin resistance (HOMA-IR by 31.5 %. After 12 weeks of therapy, there was a statistically significant decrease in body weight by 2.1 kg in the first group of patients and no response in patients of the second group. Safety has been proveв in terms of the functional state of the liver and kidneys in this therapy. Conclusions. Adding voglibose for intensification of therapy in patients with type 2 DM, who had previously received metformin and glimepiride, has led to a significant improvement in carbohydrate metabolism (decrease in HbA1c by 1.5 %. Better control of carbohydrate metabolism during the combination therapy with metformin, glimepiride, and voglibose is accompanied by an increase of functional activity of pancreatic β-cells, a decrease in insulin resistance in the

  7. [Evaluating an effectiveness of surgical treatment of gastroesophageal reflux disease combined with hiatal hernia].

    Science.gov (United States)

    Mozharovskiy, V V; Tsyganov, A A; Mozharovskiy, K V; Tarasov, A A

    To assess an effectiveness of surgical treatment of gastroesophageal reflux disease (GERD) combined with hiatal hernia (HH). The trial included 96 patients with GERD and HH who were divided into 2 groups. The principal difference between groups was the use of surgery in the main group and therapeutic treatment in the comparison group. The effectiveness of surgical treatment is superior to therapeutic treatment of GERD by more than 2.5 times. HH combined with GERD is an indication for surgical treatment. Fundoplication cuff should not lead to angular and rotational esophageal deformation. Nissen procedure in Donahue modification (Short Floppy Nissen) simulates optimally the geometry of esophago-gastric junction and His angle.

  8. Radioiodine treatment of non-toxic multinodular goitre: effects of combination with lithium

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    Vannucchi, Guia; Mannavola, Deborah; Dazzi, Davide; Beck-Peccoz, Paolo; Fugazzola, Laura [Ospedale Maggiore IRCCS (Pad. Granelli), Institute of Endocrine Sciences, Milan (Italy); Chiti, Arturo; Rodari, Marcello; Tadayyon, Sara [Istituto Clinico Humanitas, Nuclear Medicine Unit, Milan (Italy)

    2005-09-01

    This study aimed to evaluate the effects of radioiodine ({sup 131}I), alone or in combination with lithium, on thyroid volume and the prevention of radioiodine-induced thyrotoxicosis. This is the first clinical trial including only patients with multinodular goitre, normal TSH values and negative anti-thyroid auto-antibodies at baseline. Eighty consecutive patients were randomised to receive {sup 131}I plus lithium (group I+L) or {sup 131}I alone (group I). Thyroid ultrasonography and biochemical analyses were performed at baseline and at 1, 3, 6, 12 and 24 months after treatment. At 1-4 weeks after treatment, {sup 131}I-induced hyperthyroidism was observed in 58.8% of patients and was prevented by lithium administration. A low incidence of hypothyroidism (19%) was recorded at 24 months, whereas up to 44% of patients developed anti-thyroid antibodies. A significant reduction in thyroid volume was observed after {sup 131}I, with a mean decrease of 47.2% (median 48.2%) at 24 months, without differences between the groups. Moreover, it was shown that the decrease in thyroid volume after {sup 131}I was also due to the significant shrinkage of thyroid nodules. This demonstrates that adjunctive lithium is able to reduce radioiodine-induced hyperthyroidism. Therefore, such treatment appears to be safe in older patients and those with underlying cardiovascular disease. In the present large series, {sup 131}I therapy was demonstrated to be highly effective in reducing thyroid and nodular volume even in patients treated with low {sup 131}I doses (2.5 MBq/ml of thyroid tissue), further supporting the view that radioiodine therapy represents a real alternative to surgery. (orig.)

  9. Pain Reduction in Myofascial Pain Syndrome by Anodal Transcranial Direct Current Stimulation Combined with Standard Treatment: A Randomized Controlled Study

    Science.gov (United States)

    Sakrajai, Piyaraid; Janyacharoen, Taweesak; Jensen, Mark P.; Sawanyawisuth, Kittisak; Auvichayapat, Narong; Tunkamnerdthai, Orathai; Keeratitanont, Keattichai; Auvichayapat, Paradee

    2014-01-01

    Background Myofascial pain syndrome (MPS) in the shoulder is among the most prevalent pain problems in the middle-aged population worldwide. Evidence suggests that peripheral and central sensitization may play an important role in the development and maintenance of shoulder MPS. Given previous research supporting the potential efficacy of anodal transcranial direct current stimulation (tDCS) for modulating pain-related brain activity in individuals with refractory central pain, we hypothesized that anodal tDCS when applied over the primary motor cortex (M1) combined with standard treatment will be more effective for reducing pain in patients with MPS than standard treatment alone. Method Study participants were randomized to receive either (1) standard treatment with 5-consecutive days of 1 mA anodal tDCS over M1 for 20 min or (2) standard treatment plus sham tDCS. Measures of pain intensity, shoulder passive range of motion, analgesic medication use, and self-reported physical functioning were administered before treatment and again at post-treatment and 1-, 2-, 3-and 4-week follow-up. Results Thirty-one patients with MPS were enrolled. Participants assigned to the active tDCS condition reported significantly more pre- to post-treatment reductions in pain intensity that were maintained at 1-week post-treatment, and significant improvement in shoulder adduction PROM at 1-week follow-up than participants assigned to the sham tDCS condition. Conclusio