Comparison of High, Intermediate, and Low Frequency Shock Wave Lithotripsy for Urinary Tract Stone Disease: Systematic Review and Network Meta-Analysis.

Science.gov (United States)

Kang, Dong Hyuk; Cho, Kang Su; Ham, Won Sik; Lee, Hyungmin; Kwon, Jong Kyou; Choi, Young Deuk; Lee, Joo Yong

2016-01-01

To perform a systematic review and network meta-analysis of randomized controlled trials (RCTs) to determine the optimal shock wave lithotripsy (SWL) frequency range for treating urinary stones, i.e., high-frequency (100-120 waves/minute), intermediate-frequency (80-90 waves/minute), and low-frequency (60-70 waves/minute) lithotripsy. Relevant RCTs were identified from electronic databases for meta-analysis of SWL success and complication rates. Using pairwise and network meta-analyses, comparisons were made by qualitative and quantitative syntheses. Outcome variables are provided as odds ratios (ORs) with 95% confidence intervals (CIs). Thirteen articles were included in the qualitative and quantitative synthesis using pairwise and network meta-analyses. On pairwise meta-analyses, comparable inter-study heterogeneity was observed for the success rate. On network meta-analyses, the success rates of low- (OR 2.2; 95% CI 1.5-2.6) and intermediate-frequency SWL (OR 2.5; 95% CI 1.3-4.6) were higher than high-frequency SWL. Forest plots from the network meta-analysis showed no significant differences in the success rate between low-frequency SWL versus intermediate-frequency SWL (OR 0.87; 95% CI 0.51-1.7). There were no differences in complication rate across different SWL frequency ranges. By rank-probability testing, intermediate-frequency SWL was ranked highest for success rate, followed by low-frequency and high-frequency SWL. Low-frequency SWL was also ranked highest for low complication rate, with high- and intermediate-frequency SWL ranked lower. Intermediate- and low-frequency SWL have better treatment outcomes than high-frequency SWL when considering both efficacy and complication.

High-energy extracorporeal shock wave therapy as a treatment for chronic noninsertional Achilles tendinopathy.

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Furia, John P

2008-03-01

High-energy extracorporeal shock wave therapy has been shown to be an effective treatment for chronic insertional Achilles tendinopathy. The results of high-energy shock wave therapy for chronic noninsertional Achilles tendinopathy have not been determined. Shock wave therapy is an effective treatment for noninsertional Achilles tendinopathy. Case control study; Level of evidence, 3. Thirty-four patients with chronic noninsertional Achilles tendinopathy were treated with a single dose of high-energy shock wave therapy (shock wave therapy group; 3000 shocks; 0.21 mJ/mm(2); total energy flux density, 604 mJ/mm(2)). Thirty-four patients with chronic noninsertional Achilles tendinopathy were treated not with shock wave therapy but with additional forms of nonoperative therapy (control group). All shock wave therapy procedures were performed using regional anesthesia. Evaluation was by change in visual analog score and by Roles and Maudsley score. One month, 3 months, and 12 months after treatment, the mean visual analog scores for the control and shock wave therapy groups were 8.4 and 4.4 (P wave therapy and control groups were 12 and 0 (P wave therapy group than in the control group (P wave therapy is an effective treatment for chronic noninsertional Achilles tendinopathy.

Long-wave plasma radiofrequency ablation for treatment of xanthelasma palpebrarum.

Science.gov (United States)

Baroni, Adone

2018-03-01

Xanthelasma palpebrarum is the most common type of xanthoma affecting the eyelids. It is characterized by asymptomatic soft yellowish macules, papules, or plaques over the upper and lower eyelids. Many treatments are available for management of xanthelasma palpebrarum, the most commonly used include surgical excision, ablative CO 2 or erbium lasers, nonablative Q-switched Nd:YAG laser, trichloroacetic acid peeling, and radiofrequency ablation. This study aims to evaluate the effectiveness of RF ablation in the treatment of xanthelasma palpebrarum, with D.A.S. Medical portable device (Technolux, Italia), a radiofrequency tool working with long-wave plasma energy and without anesthesia. Twenty patients, 15 female and 5 male, affected by xanthelasma palpebrarum, were enrolled for long-wave plasma radiofrequency ablation treatment. The treatment consisted of 3/4 sessions that were carried out at intervals of 30 days. Treatments were well tolerated by all patients with no adverse effects and optimal aesthetic results. The procedure is very fast and can be performed without anesthesia because of the low and tolerable pain stimulation. Long-wave plasma radiofrequency ablation is an effective option for treatment of xanthelasma palpebrarum and adds an additional tool to the increasing list of medical devices for aesthetic treatments. © 2018 Wiley Periodicals, Inc.

Radial shock wave treatment alone is less efficient than radial shock wave treatment combined with tissue-specific plantar fascia-stretching in patients with chronic plantar heel pain.

Science.gov (United States)

Rompe, Jan D; Furia, John; Cacchio, Angelo; Schmitz, Christoph; Maffulli, Nicola

2015-12-01

Whether shock wave therapy or shock wave therapy combined with plantar fascia-specific stretching is more efficient in treating chronic plantar heel pain remains unclear. The aim of the study was to test the null hypothesis of no difference of these two forms of management for patients who had unilateral plantar fasciopathy for a minimum duration of twelve months and which had failed at least three other forms of treatment. One hundred and fifty-two patients with chronic plantar fasciopathy were assigned to receive repetitive low-energy radial shock-wave therapy without local anesthesia, administered weekly for three weeks (Group 1, n = 73) or to receive the identical shock wave treatment and to perform an eight-week plantar fascia-specific stretching program (Group 2, n = 79). All patients completed the nine-item pain subscale of the validated Foot Function Index and a subject-relevant outcome questionnaire. Patients were evaluated at baseline, and at two, four, and twenty-four months after baseline. The primary outcome measures were a mean change in the Foot Function Index sum score at two months after baseline, a mean change in item 2 (pain during the first steps of walking in the morning) on this Index, and satisfaction with treatment. No difference in mean age, sex, weight or duration of symptoms was found between the groups at baseline. At two months after baseline, the Foot Function Index sum score showed significantly greater changes for the patients managed with shock-wave therapy plus plantar fascia-specific stretching than those managed with shock-wave therapy alone (p plantar fascia in combination with repetitive low-energy radial shock-wave therapy is more efficient than repetitive low-energy radial shock-wave therapy alone for the treatment of chronic symptoms of proximal plantar fasciopathy. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

Acoustic Wave Treatment For Cellulite—A New Approach

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Russe-Wilflingseder, Katharina; Russe, Elisabeth

2010-05-01

Background and Objectives: Cellulite is a biological caused modification of the female connective tissue. In extracorporeal shockwave therapy (ESWT) pulses are penetrating into the tissue without causing a thermal effect or micro lesions, but leading to a stimulation of tissue metabolism and blood circulation, inducing a natural repair process with cell activation and stem cells proliferation. Recently ESWT treatment showed evidence of remodelling collagen within the dermis and of stimulating microcirculation in fatty tissue. Study Design and Methods: The study was designed to assess acoustic wave treatment for cellulite by comparison treated vs. untreated side (upper-leg and buttock). Each individual served as its own control. 11 females with a BMI less then 30 and an age over 18 years were included. 6 treatments were given weekly with radial acoustic waves. Documentation was done before and 1, 4, 12 weeks after last treatment by standardized photo documentation, relaxed and with muscle contraction, measurement of body weight and circumference of the thigh, pinch test, and evaluation of hormonal status and lifestyle. The efficacy of AWT/EPAT was evaluated before and 1, 4, 12 weeks after last treatment. Patients rated the improvement of cellulite, overall satisfaction and acceptance. The therapist assessed improvement of cellulite, side effects and photo documentation treated vs. untreated side, before vs. after treatment. The blinded investigator evaluated the results using photo documentation right vs. left leg, before vs. after treatment in a frontal, lateral and dorsal view, relaxed and with muscle contraction. Results: The improvement of cellulite at the treated side was rated by patients with 27,3% at week 4 and 12, by the therapist with 34,1% at week 4 and 31,2% at week 12 after the last treatment The blinded investigator could verify an improvement of cellulite in an increasing number of patients with increasing time interval after treatment. No side

Finite element modeling of acoustic wave propagation and energy deposition in bone during extracorporeal shock wave treatment

Science.gov (United States)

Wang, Xiaofeng; Matula, Thomas J.; Ma, Yong; Liu, Zheng; Tu, Juan; Guo, Xiasheng; Zhang, Dong

2013-06-01

It is well known that extracorporeal shock wave treatment is capable of providing a non-surgical and relatively pain free alternative treatment modality for patients suffering from musculoskeletal disorders but do not respond well to conservative treatments. The major objective of current work is to investigate how the shock wave (SW) field would change if a bony structure exists in the path of the acoustic wave. Here, a model of finite element method (FEM) was developed based on linear elasticity and acoustic propagation equations to examine SW propagation and deflection near a mimic musculoskeletal bone. High-speed photography experiments were performed to record cavitation bubbles generated in SW field with the presence of mimic bone. By comparing experimental and simulated results, the effectiveness of FEM model could be verified and strain energy distributions in the bone were also predicted according to numerical simulations. The results show that (1) the SW field will be deflected with the presence of bony structure and varying deflection angles can be observed as the bone shifted up in the z-direction relative to SW geometric focus (F2 focus); (2) SW deflection angels predicted by the FEM model agree well with experimental results obtained from high-speed photographs; and (3) temporal evolutions of strain energy distribution in the bone can also be evaluated based on FEM model, with varied vertical distance between F2 focus and intended target point on the bone surface. The present studies indicate that, by combining MRI/CT scans and FEM modeling work, it is possible to better understand SW propagation characteristics and energy deposition in musculoskeletal structure during extracorporeal shock wave treatment, which is important for standardizing the treatment dosage, optimizing treatment protocols, and even providing patient-specific treatment guidance in clinic.

Treatment of Adolescent Eating Disorders: Progress and Challenges

Science.gov (United States)

Lock, James

2010-01-01

Objective Although eating disorders are common psychiatric disorders that usually onset during adolescence, few evidence-based treatments for this age group have been identified. A critical review of treatments used for Anorexia Nervosa (AN) and Bulimia Nervosa (BN) and related conditions (EDNOS) is provided that summarizes the rationale for the treatments, evidence of effectiveness available, and outcomes. Method Critical review of published randomized clinical trials (RCTs). Results There are only seven published RCTs of psychotherapy for AN in adolescents with a total of 480 subjects. There are only two published RCTs for outpatient psychotherapy for adolescent BN with a total of 165 subjects. There are no published RCTs examining medications for adolescent AN or BN. For adolescent AN, Family-Based Treatment (FBT) is the treatment with the most evidence supporting its use. Three RCTs suggest that FBT is superior to individual therapy at the end of treatment; however, at follow-up differences between individual and family approaches are generally reduced. For adolescent BN, one study found no differences between Cognitive Behavioral Therapy and FBT at the end of treatment or follow-up, while the other found FBT superior to individual therapy. Conclusions Although the evidence remains limited, FBT appears to be the first line treatment for adolescent AN. There is little evidence to support a specific treatment for adolescent BN. There is a need for additional studies of treatment of child and adolescent eating disorders. New treatments studies may build on current evidence as well as examine new approaches based on novel findings in the neurosciences about cognitive and emotional processes in eating disorders. PMID:21532979

Extracorporeal shock wave therapy for treatment of plantar fasciitis

International Nuclear Information System (INIS)

Dastgir, N.

2014-01-01

Objective: To explore the effect of extracorporeal shock wave therapy in patients with chronic plantar faciitis. Methods: The prospective study was conducted at Department of Orhopaedic, Regional Hospital, Limerick, Ireland from January to December 2004 and comprised 70 heels in 62 patients with chronic plantar fasciitis in whom conventional conservative treatment consisting of non-steroidal anti-inflammatory drugs, heel cup, orthoses and/or shoe modifications, local steroid injections had failed, and they were treated with low energy extracorporeal shock wave therapy. Patients were reviewed at 6, 12 and 24 weeks post treatment. Results: At follow-up there was significant decrease in pain on the visual analogue scale (p<0.027), with significant improvement in pain score (p<0.009) and in functional score (p<0.001). The comfortable walking distance had increased significantly and there were no reported side effects. Conclusion: Extracorporeal shock wave therapy is a new modality providing good pain relief and a satisfactory clinical outcome in patients with chronic plantar fasciitis. (author)

Cognitive enhancement treatments for bipolar disorder

DEFF Research Database (Denmark)

Miskowiak, Kamilla W; Carvalho, André F; Vieta, Eduard

2016-01-01

Cognitive dysfunction is an emerging treatment target in bipolar disorder (BD). Several trials have assessed the efficacy of novel pharmacological and psychological treatments on cognition in BD but the findings are contradictory and unclear. A systematic search following the PRISMA guidelines...... was conducted on PubMed and PsychInfo. Eligible articles reported randomized, controlled or open-label trials investigating pharmacological or psychological treatments targeting cognitive dysfunction in BD. The quality of the identified randomized controlled trials (RCTs) was evaluated with the Cochrane...... Collaboration's Risk of Bias tool. We identified 19 eligible studies of which 13 were RCTs and six were open-label or non-randomized studies. The findings regarding efficacy on cognition were overall disappointing or preliminary, possibly due to several methodological challenges. For the RCTs, the risk of bias...

Development of a framework to improve the process of recruitment to randomised controlled trials (RCTs): the SEAR (Screened, Eligible, Approached, Randomised) framework.

Science.gov (United States)

Wilson, Caroline; Rooshenas, Leila; Paramasivan, Sangeetha; Elliott, Daisy; Jepson, Marcus; Strong, Sean; Birtle, Alison; Beard, David J; Halliday, Alison; Hamdy, Freddie C; Lewis, Rebecca; Metcalfe, Chris; Rogers, Chris A; Stein, Robert C; Blazeby, Jane M; Donovan, Jenny L

2018-01-19

Research has shown that recruitment to trials is a process that stretches from identifying potentially eligible patients, through eligibility assessment, to obtaining informed consent. The length and complexity of this pathway means that many patients do not have the opportunity to consider participation. This article presents the development of a simple framework to document, understand and improve the process of trial recruitment. Eight RCTs integrated a QuinteT Recruitment Intervention (QRI) into the main trial, feasibility or pilot study. Part of the QRI required mapping the patient recruitment pathway using trial-specific screening and recruitment logs. A content analysis compared the logs to identify aspects of the recruitment pathway and process that were useful in monitoring and improving recruitment. Findings were synthesised to develop an optimised simple framework that can be used in a wide range of RCTs. The eight trials recorded basic information about patients screened for trial participation and randomisation outcome. Three trials systematically recorded reasons why an individual was not enrolled in the trial, and further details why they were not eligible or approached, or declined randomisation. A framework to facilitate clearer recording of the recruitment process and reasons for non-participation was developed: SEAR - Screening, to identify potentially eligible trial participants; Eligibility, assessed against the trial protocol inclusion/exclusion criteria; Approach, the provision of oral and written information and invitation to participate in the trial, and Randomised or not, with the outcome of randomisation or treatment received. The SEAR framework encourages the collection of information to identify recruitment obstacles and facilitate improvements to the recruitment process. SEAR can be adapted to monitor recruitment to most RCTs, but is likely to add most value in trials where recruitment problems are anticipated or evident. Further work

Recent Treatment Advances and New Trials in Adult Nephrotic Syndrome

Directory of Open Access Journals (Sweden)

Eva Königshausen

2017-01-01

Full Text Available The etiology of nephrotic syndrome is complex and ranges from primary glomerulonephritis to secondary forms. Patients with nephrotic syndrome often need immunosuppressive treatment with its side effects and may progress to end stage renal disease. This review focuses on recent advances in the treatment of primary causes of nephrotic syndrome (idiopathic membranous nephropathy (iMN, minimal change disease (MCD, and focal segmental glomerulosclerosis (FSGS since the publication of the KDIGO guidelines in 2012. Current treatment recommendations are mostly based on randomized controlled trials (RCTs in children, small RCTs, or case series in adults. Recently, only a few new RCTs have been published, such as the Gemritux trial evaluating rituximab treatment versus supportive antiproteinuric and antihypertensive therapy in iMN. Many RCTs are ongoing for iMN, MCD, and FSGS that will provide further information on the effectiveness of different treatment options for the causative disease. In addition to reviewing recent clinical studies, we provide insight into potential new targets for the treatment of nephrotic syndrome from recent basic science publications.

Comparison of mania patients suitable for treatment trials versus clinical treatment.

Science.gov (United States)

Talamo, Alessandra; Baldessarini, Ross J; Centorrino, Franca

2008-08-01

It remains uncertain whether bipolar disorder (BPD) patients in randomized-controlled trials (RCTs) are sufficiently representative of clinically encountered patients as to guide clinical-therapeutic practice. We complied inclusion/exclusion criteria by frequency from reports of 21 RCTs for mania, and applied them in a pilot study of patients hospitalized for DSM-IV BPD manic/mixed states to compare characteristics and clinical responses of patients who did versus did not meet exclusion criteria. From 27 initially identified inclusion/exclusion criteria ranked by citation frequency, we derived six inclusion, and 10 non-redundant-exclusion factors. Of 67 consecutive patients meeting inclusion criteria, 15 (22.4%) potential "research subjects" met all 10 exclusion criteria. The remaining 52 "clinical patients" differed markedly on exclusion criteria, including more psychiatric co-morbidity, substance abuse, involuntary hospitalization, and suicide attempts or violence, but were otherwise similar. In both groups responses to clinically determined inpatient treatments were similar, including improvement in mania ratings. Based on applying reported inclusion/exclusion criteria for RCTs to a pilot sample of hospitalized-manic patients, those likely to be included in modern RCTs were similar to patients who would be excluded, most notably in short-term antimanic-treatment responses. The findings encourage further comparisons of subjects included/excluded from RCTs to test potential clinical generalizability of research findings. The pilot study is limited in numbers and exposure times with which to test for the minor differences between "research subjects" and "clinical patients." (c) 2008 John Wiley & Sons, Ltd.

The ethics of public policy RCTs: The principle of policy equipoise.

Science.gov (United States)

MacKay, Douglas

2018-01-01

In this article, I ask whether a principle analogous to the principle of clinical equipoise should govern the design and conduct of RCTs evaluating the effectiveness of policy interventions. I answer this question affirmatively, and introduce and defend the principle of policy equipoise. According to this principle, all arms of a policy RCT must be, at minimum, in a state of equipoise with the best proven policy that is also morally and practically attainable and sustainable. For all arms of a policy RCT, policy experts must either (1) reasonably disagree about whether the trial arms are more effective than this policy, or (2) know that they are. © 2017 John Wiley & Sons Ltd.

Third-wave cognitive therapy versus mentalisation-based treatment for major depressive disorder

DEFF Research Database (Denmark)

Jakobsen, Janus Christian; Gluud, Christian; Kongerslev, Mickey

2014-01-01

OBJECTIVE: To compare the benefits and harms of third-wave cognitive therapy versus mentalisation-based therapy in a small sample of depressed participants. SETTING: The trial was conducted at an outpatient psychiatric clinic for non-psychotic patients in Roskilde, Denmark. PARTICIPANTS: 44...... consecutive adult participants diagnosed with major depressive disorder. INTERVENTIONS: 18 weeks of third-wave cognitive therapy (n=22) versus 18 weeks of mentalisation-based treatment (n=22). OUTCOMES: The primary outcome was the Hamilton Rating Scale for Depression (HDRS) at end of treatment (18 weeks...... for baseline HDRS score, the difference was favouring third-wave cognitive therapy (p=0.039). At 18 weeks, five of the third-wave participants (22.7%) were in remission versus none of the mentalisation-based participants (p=0.049). We recorded no suicide attempts or suicides during the intervention period...

Moxibustion for the treatment of chemotherapy-induced leukopenia: a systematic review of randomized clinical trials.

Science.gov (United States)

Choi, Tae-Young; Lee, Myeong Soo; Ernst, Edzard

2015-06-01

The purpose of this study is to assess the efficacy of moxibustion as a treatment of chemotherapy-induced leukopenia. Twelve databases were searched from their inception through June 2014, without a language restriction. Randomized clinical trials (RCTs) were included if moxibustion was used as the sole treatment or as a part of a combination therapy with conventional drugs for leukopenia induced by chemotherapy. Cochrane criteria were used to assess the risk of bias. Six RCTs with a total of 681 patients met our inclusion criteria. All of the included RCTs were associated with a high risk of bias. The trials included patients with various types of cancer receiving ongoing chemotherapy or after chemotherapy. The results of two RCTs suggested the effectiveness of moxibustion combined with chemotherapy vs. chemotherapy alone. In four RCTs, moxibustion was more effective than conventional drug therapy. Six RCTs showed that moxibustion was more effective than various types of control interventions in increasing white blood cell counts. There is low level of evidence based on these six trials that demonstrates the superiority of moxibustion over drug therapies in the treatment of chemotherapy-induced leukopenia. However, the number of trials, the total sample size, and the methodological quality are too low to draw firm conclusions. Future RCTs appear to be warranted.

Effect of the wave shocking treatment on the structure and strengthening of austenitic steels

International Nuclear Information System (INIS)

Blinov, V.M.; Chernogorova, O.P.; Drozdova, E.I.; Afanas'ev, I.A.

2006-01-01

The structure and hardening of austenitic manganese steels after shock wave treatment are studied. It is shown that the treatment results in the structure where an elementary cell size decreases with a pressure increase. The strain hardening resulted from shock wave loading can be estimated using a Hall-Petch equation. It is established that at similar degree of residual strains the shock wave loading compared to cold rolling gives rise to higher strengthening which value grows as austenite stacking fault energy decreases [ru

Symptomatic efficacy and safety of diacerein in the treatment of osteoarthritis

DEFF Research Database (Denmark)

Bartels, E. M.; Bliddal, Henning; Schøndorff, P. K.

2010-01-01

To estimate the efficacy and safety of diacerein as a pain-reducing agent in the treatment of osteoarthritis (OA), using meta-analysis of published randomized placebo-controlled trials (RCTs).......To estimate the efficacy and safety of diacerein as a pain-reducing agent in the treatment of osteoarthritis (OA), using meta-analysis of published randomized placebo-controlled trials (RCTs)....

Low Intensity Shock Wave Treatment for Erectile Dysfunction-How Long Does the Effect Last?

Science.gov (United States)

Kitrey, Noam D; Vardi, Yoram; Appel, Boaz; Shechter, Arik; Massarwi, Omar; Abu-Ghanem, Yasmin; Gruenwald, Ilan

2018-03-01

We studied the long-term efficacy of penile low intensity shock wave treatment 2 years after an initially successful outcome. Men with a successful outcome of low intensity shock wave treatment according to the minimal clinically important difference on the IIEF-EF (International Index of Erectile Function-Erectile Function) questionnaire were followed at 6, 12, 18 and 24 months. Efficacy was assessed by the IIEF-EF. Failure during followup was defined as a decrease in the IIEF-EF below the minimal clinically important difference. We screened a total of 156 patients who underwent the same treatment protocol but participated in different clinical studies. At 1 month treatment was successful in 99 patients (63.5%). During followup a gradual decrease in efficacy was observed. The beneficial effect was maintained after 2 years in only 53 of the 99 patients (53.5%) in whom success was initially achieved. Patients with severe erectile dysfunction were prone to earlier failure than those with nonsevere erectile dysfunction. During the 2-year followup the effect of low intensity shock wave treatment was lost in all patients with diabetes who had severe erectile dysfunction at baseline. On the other hand, patients with milder forms of erectile dysfunction without diabetes had a 76% chance that the beneficial effect of low intensity shock wave treatment would be preserved after 2 years. Low intensity shock wave treatment is effective in the short term but treatment efficacy was maintained after 2 years in only half of the patients. In patients with milder forms of erectile dysfunction the beneficial effect is more likely to be preserved. Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Extracorporeal shock wave lithotripsy (ESWL) versus ureteroscopic management for ureteric calculi.

Science.gov (United States)

Aboumarzouk, Omar M; Kata, Slawomir G; Keeley, Francis X; McClinton, Samuel; Nabi, Ghulam

2012-05-16

Ureteral stones frequently cause renal colic, and if left untreated, can lead to obstructive uropathy. Extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy, with or without intracorporeal lithotripsy, are the most common interventions used to treat ureteral stones. ESWL treatment is less invasive than ureteroscopy, but has some limitations such as a high retreatment rate, and is not available in all centres. Recent advances in ureteroscopy have increased success rates and reduced complication rates. To examine evidence from randomised controlled trials (RCTs) on the outcomes of ESWL or ureteroscopy in the treatment of ureteric calculi. We searched the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library Issue 2, 2011), MEDLINE (1966 to March 2011), EMBASE (1980 to March 2011), CINAHL, Clinicaltrials.gov, Google Scholar, reference lists of articles and abstracts from conference proceedings, all without language restriction. RCTs that compared ESWL with ureteroscopic retrieval of ureteric stones were included in this review. Study participants were adults with ureteric stones requiring intervention. Published and unpublished sources were considered for inclusion. Three authors independently assessed study quality, risk of bias, and extracted data. Statistical analyses were performed using the random-effects model. Results were expressed as risk ratios (RR) for dichotomous outcomes or mean differences (MD) for continuous data, both with 95% confidence intervals (CI). Seven RCTs (1205 patients) were included in the review. Stone-free rates were lower in patients who underwent ESWL (7 studies, 1205 participants: RR 0.84, 95% CI 0.73 to 0.96) but re-treatment rates were lower in ureteroscopy patients (6 studies, 1049 participants: RR 6.18, 95% CI 3.68 to 10.38. ESWL-treated patients had less need for auxiliary treatment (5 studies, 751 participants: RR 0.43, 95% CI 0.25 to 0.74; fewer complications (7 studies, 1205 participants: RR 0

Treatment efficacy for non-cardiovascular chest pain: a systematic review and meta-analysis.

Directory of Open Access Journals (Sweden)

Jakob M Burgstaller

Full Text Available BACKGROUND: Non-cardiovascular chest pain (NCCP leads to impaired quality of life and is associated with a high disease burden. Upon ruling out cardiovascular disease, only vague recommendations exist for further treatment. OBJECTIVES: To summarize treatment efficacy for patients presenting with NCCP. METHODS: Systematic review and meta-analysis. In July 2013, Medline, Web of Knowledge, Embase, EBSCOhost, Cochrane Reviews and Trials, and Scopus were searched. Hand and bibliography searches were also conducted. Randomized controlled trials (RCTs evaluating non-surgical treatments in patients with NCCP were included. Exclusion criteria were poor study quality and small sample size (<10 patients per group. RESULTS: Thirty eligible RCT's were included. Most studies assessed PPI efficacy for gastroesophageal reflux disorders (GERD, n = 10. Two RCTs included musculoskeletal chest pain, seven psychotropic drugs, and eleven various psychological interventions. Study quality was high in five RCTs and acceptable in 25. PPI treatment in patients with GERD (5 RCTs, 192 patients was more effective than placebo [pooled OR 11.7 (95% CI 5.5 to 25.0, heterogeneity I2 = 6.1%]. The pooled OR in GERD negative patients (4 RCTs, 156 patients was 0.8 (95% CI 0.2 to 2.8, heterogeneity I2 = 50.4%. In musculoskeletal NCCP (2 RCTs, 229 patients manual therapy was more effective than usual care but not than home exercise [pooled mean difference 0.5 (95% CI -0.3 to 1.3, heterogeneity I2 = 46.2%]. The findings for cognitive behavioral treatment, serotonin reuptake inhibitors, tricyclic antidepressants were mixed. Most evidence was available for cognitive behavioral treatment interventions. LIMITATIONS: Only a small number of studies were available. CONCLUSIONS: Timely diagnostic evaluation and treatment of the disease underlying NCCP is important. For patients with suspected GERD, high-dose treatment with PPI is effective. Only limited evidence was available

Intranasal fentanyl in the treatment of acute pain--a systematic review

DEFF Research Database (Denmark)

Hansen, M S; Mathiesen, O; Trautner, S

2012-01-01

Due to its non-invasive mode of administration, intranasal (IN) application of drugs may be a valuable alternative to non-invasive pain management. With characteristics that appear to be ideal for IN application, IN fentanyl may have a place in the out-of-hospital treatment and the paediatric...... population. The objective of this systematic review was to evaluate the current evidence of IN fentanyl in the treatment of acute pain. Reports of randomized controlled trials (RCTs) of IN fentanyl in treatment of pain were systematically sought using the PubMed database, Embase, Google scholar, Cochrane...... database, and Cumulative Index to Nursing and Allied Health Literature. Reports were considered for inclusion if they were double-blinded randomized controlled trials (RCTs) of IN fentanyl in the treatment of acute pain. Thirty-two RCTs were identified, and 16 were included in the final analysis...

Effect of Early Diagnosis and Treatment on the Prognosis of Children with Epilepsy Accompanied by Continuous Spikes and Waves during Slow Wave Sleep

Directory of Open Access Journals (Sweden)

Jiahua Ju

2014-03-01

Full Text Available Objective: To emphasize the importance of early diagnosis and treatment on the prognosis of children with epilepsy accompanied by continuous spikes and waves during slow wave sleep (CSCW. Methods: The clinical characteristics, electroencephalogram (ECG features, treatment and prognosis of 12 children with CSCW in our hospital were retrospectively analyzed, and the followup of 6 months to 4 years was given. Results: Imaging showed that 8 children suffered from brain lesions, while other 4 were normal. The initial onset of 10 children was at night, whereas 2 began with absence seizure in lucid interval, and they gradually appeared comprehensive brain function decline, meanwhile, ECG was characterized by continuous discharge during slow wave sleep. After 3 months of treatment with valproic acid, clonazepam, lamotrigine and hormones, the clinical symptoms and ECG of 10 children improved significantly, in which 3 ones recurred after 6 months of comprehensive treatment. Conclusion: The early manifestation of CSWS is untypical, and hence, early diagnosis and treatment can ameliorate the epileptic seizures of children, effectively inhibit epileptic electrical activity and has favorable prognosis.

ED-WAVE tool design approach: Case of a textile wastewater treatment plant in Blantyre, Malawi

Science.gov (United States)

Chipofya, V.; Kraslawski, A.; Avramenko, Y.

The ED-WAVE tool is a PC based package for imparting training on wastewater treatment technologies. The system consists of four modules viz. Reference Library, Process Builder, Case Study Manager, and Treatment Adviser. The principles of case-based design and case-based reasoning as applied in the ED-WAVE tool are utilised in this paper to evaluate the design approach of the wastewater treatment plant at Mapeto David Whitehead & Sons (MDW&S) textile and garments factory, Blantyre, Malawi. The case being compared with MDW&S in the ED-WAVE tool is Textile Case 4 in Sri Lanka (2003). Equalisation, coagulation and rotating biological contactors is the sequencing of treatment units at Textile Case 4 in Sri Lanka. Screening, oxidation ditches and sedimentation is the sequencing of treatment units at MDW&S textile and garments factory. The study suggests that aerobic biological treatment is necessary in the treatment of wastewater from a textile and garments factory. MDW&S incorporates a sedimentation process which is necessary for the removal of settleable matter before the effluent is discharged to the municipal wastewater treatment plant. The study confirmed the practical use of the ED-WAVE tool in the design of wastewater treatment systems, where after encountering a new situation; already collected decision scenarios (cases) are invoked and modified in order to arrive at a particular design alternative. What is necessary, however, is to appropriately modify the case arrived at through the Case Study Manager in order to come up with a design appropriate to the local situation taking into account technical, socio-economic and environmental aspects.

Randomised controlled trials of psychological & pharmacological treatments for body dysmorphic disorder: A systematic review.

Science.gov (United States)

Phillipou, Andrea; Rossell, Susan L; Wilding, Helen E; Castle, David J

2016-11-30

Treatment for body dysmorphic disorder (BDD) often involves a combination of psychological and pharmacological interventions. However, only a small number of randomised controlled trials (RCTs) have been undertaken examining the efficacy of different therapeutic interventions. The aim of this study was to systematically review the RCTs involving psychological and pharmacological interventions for the treatment of BDD. The literature was searched to June 2015, and studies were included if they were written in English, empirical research papers published in peer-review journals, specifically assessed BDD patients, and involved a RCT assessing BDD symptoms pre- and post-intervention. Nine studies were identified: six involving psychological and three involving pharmacological interventions. Cognitive behaviour therapy, metacognitive therapy and selective serotonin reuptake inhibitors were identified as treatments with potential benefit. The small number of RCTs and the heterogeneity of findings emphasises the need for more high quality RCTs assessing both psychological and pharmacological interventions for BDD. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Low-Level Laser Therapy in the Treatment of Recurrent Aphthous Ulcers: A Systematic Review

Directory of Open Access Journals (Sweden)

Fernando Alves Vale

2015-01-01

Full Text Available Recurrent aphthous ulcers (RAUs are the most common lesion found in the oral cavity. There is no definitive cure for RAUs and current treatments are aimed at minimizing symptoms. Since low-level laser therapy (LLLT modulates inflammatory responses, and promotes pain reduction and cellular biostimulation, LLLT can be suggested as an alternative treatment for RAUs. The literature concerning the potential of LLLT in the treatment of RAUs was evaluated. A systematic literature review identified 22 publications, of which only 2 studies were adopted. The eligibility criteria consisted of randomized controlled trials (RCTs. Both RCTs achieved significant results concerning LLLT and pain-level reductions and reduced healing times. Despite the variance in irradiation conditions applied in both studies, very similar wavelengths were adopted. There is accordingly strong evidence that wavelength plays an important role in RAU treatment. Taking into account the different parameters applied by selected RCTs, it is not possible to suggest that a specific protocol should be used. However, in light of the significant results found in both studies, LLLT can be suggested as an alternative for RAU treatment. Additional RCTs should be performed in order to reach a clinical protocol and better understand the application of LLLT in RAU treatment.

Salvianolate injection in the treatment of unstable angina pectoris

Science.gov (United States)

Zhang, Dan; Wu, Jiarui; Liu, Shi; Zhang, Xiaomeng; Zhang, Bing

2016-01-01

Abstract Background: To systematically evaluate the clinical efficacy and safety of Salvianolate injection in the treatment of unstable angina pectoris (UAP). Methods: Using literature databases, we conducted a thorough and systematic retrieval of randomized controlled trials (RCTs) that using Salvianolate injection for treating UAP. The Cochrane Risk of Bias Assessment Tool was used to evaluate the methodological quality of the RCTs, and then the data were extracted and meta-analyzed by RevMan5.2 software. Results: A total of 22 RCTs with 2050 participants were included. The meta-analysis indicated that the combined use of Salvianolate injection and western medicine (WM) in the treatment of UAP can achieve a superior effect in angina pectoris total effective rate (risk ratio [RR] = 1.22, 95% confidence interval [CI] (1.17, 1.27), Z = 10.15, P < 0.00001], and the total effectiveness rate of electrocardiogram [RR = 1.26, 95% CI (1.19,1.34), Z = 7.77, P < 0.00001]. In addition, Salvianolate injection can improve the nitroglycerin withdrawal rate and the serum level of NO, decrease high-sensitivity C-reactive protein. Adverse drug reactions (ADRs) or adverse drug events (ADEs) were reported in 6 RCTs involving 15 cases; however, there were no serious ADRs/ADEs. Conclusion: Based on the systematic review, the combined use of Salvianolate injection and WM in the treatment of UAP can achieve a better effect; however, there was no definitive conclusion about its safety. More the large-sample and multicenter RCTs are needed to support its clinical usage. PMID:28002341

Mixed states in bipolar disorder - changes in DSM-5 and current treatment recommendations.

Science.gov (United States)

Betzler, Felix; Stöver, Laura Apollonia; Sterzer, Philipp; Köhler, Stephan

2017-11-01

Mixed states in affective disorders represent a particular challenge in clinical routine, characterized by a complicated course of treatment and a worse treatment response. Clinical features of mixed states and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria are presented and critical discussed. We then performed a systematic review using the terms 'bipolar', 'mixed' and 'randomized' to evaluate current treatment options. For pharmacological treatment of mixed states in total, there is still insufficient data from RCTs. However, there is some evidence for efficacy in mixed states from RCTs for atypical antipsychotics, especially olanzapine, aripiprazole and asenapine as well as mood stabilizers as valproate and carbamazepine. Mixed states are of a high clinical relevance and the DSM-5 criteria substantially reduced the diagnostic threshold. Besides advantages of a better characterization of patients with former DSM-IV-defined mixed episodes, disadvantages arise for example differential diagnoses with a substantial overlap in symptoms such as borderline personality disorders. Atypical antipsychotics, valproate and carbamazepine demonstrated efficacy in a limited sample of RCTs. The number of RCTs in the treatment of mixed states is highly limited. Furthermore, nearly all studies were funded by pharmaceutical companies which may lead to an underestimation of classical mood stabilizers such as lithium.

Long-term effects of invasive treatment in patients with a post-thrombolytic Q-wave myocardial infarction

DEFF Research Database (Denmark)

Kofoed, Klaus F; Madsen, Jan Kyst; Grande, Peer

2010-01-01

Abstract Objectives. The aim of the present study was to assess the effect of a deferred invasive treatment strategy on long-term outcome in patients with a post-thrombolytic Q-wave myocardial infarction and inducible myocardial ischemia. Design. Patients (N=751) with post-thrombolytic Q-wave myo......Abstract Objectives. The aim of the present study was to assess the effect of a deferred invasive treatment strategy on long-term outcome in patients with a post-thrombolytic Q-wave myocardial infarction and inducible myocardial ischemia. Design. Patients (N=751) with post-thrombolytic Q...

The effect of progressive resistance training on lean body mass in post-treatment cancer patients - A systematic review

DEFF Research Database (Denmark)

Lønbro, Simon

2014-01-01

Loss of lean body mass is a common problem in many post-treatment cancer patients and may negatively affect physical capacity in terms of maximal muscle strength and functional performance. The purpose of this study was to systematically review the scientific evidence on the effect of progressive...... resistance training on lean body mass in post-treatment cancer patients. A comprehensive literature search was conducted and ultimately 12 studies were included. Methodological quality of the included studies was evaluated using the PEDro scale and the effect of progressive resistance training was reported...... as the range of mean changes among RCTs and non-RCTs. Six RCTs and six non-RCTs were included in the study. In the RCTs the change in lean body mass in the progressive resistance training groups relative to control groups ranged from -0.4% to 3.9%, and in four of six trials the training effect...

Focused tandem shock waves in water and their potential application in cancer treatment

Czech Academy of Sciences Publication Activity Database

Lukeš, Petr; Šunka, Pavel; Hoffer, Petr; Stelmashuk, Vitaliy; Poučková, P.; Zadinová, M.; Zeman, J.; Dibdiak, L.; Kolářová, H.; Tománková, K.; Binder, S.; Beneš, J.

2014-01-01

Roč. 24, č. 1 (2014), s. 51-57 ISSN 0938-1287. [International Symposium on Shock Waves/28./. Manchester, 17.07.2011-22.07.2011] R&D Projects: GA ČR GA202/09/1151 Institutional support: RVO:61389021 Keywords : focused shock waves * underwater discharge * cancer treatment Subject RIV: BL - Plasma and Gas Discharge Physics Impact factor: 0.885, year: 2014

Comparative efficacy and safety of approved treatments for macular oedema secondary to branch retinal vein occlusion

DEFF Research Database (Denmark)

Regnier, Stephane A; Larsen, Michael; Bezlyak, Vladimir

2015-01-01

OBJECTIVE: To compare the efficacy and safety of approved treatments for macular oedema secondary to branch retinal vein occlusion (BRVO). DESIGN: Randomised controlled trials (RCTs) evaluating the efficacy and safety of approved treatments for macular oedema secondary to BRVO were identified from...... an updated systematic review. SETTING: A Bayesian network meta-analysis of RCTs of treatments for macular oedema secondary to BRVO. INTERVENTIONS: Ranibizumab 0.5 mg pro re nata, aflibercept 2 mg monthly (2q4), dexamethasone 0.7 mg implant, laser photocoagulation, ranibizumab+laser, or sham intervention...... pressure (IOP)/ocular hypertension (OH). RESULTS: 8 RCTs were identified for inclusion with 1743 adult patients. The probability of being the most efficacious treatment at month 6 or 12 based on letters gained was 54% for ranibizumab monotherapy, 30% for aflibercept, 16% for ranibizumab plus laser...

A social network analysis of treatment discoveries in cancer.

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Athanasios Tsalatsanis

2011-03-01

Full Text Available Controlled clinical trials are widely considered to be the vehicle to treatment discovery in cancer that leads to significant improvements in health outcomes including an increase in life expectancy. We have previously shown that the pattern of therapeutic discovery in randomized controlled trials (RCTs can be described by a power law distribution. However, the mechanism generating this pattern is unknown. Here, we propose an explanation in terms of the social relations between researchers in RCTs. We use social network analysis to study the impact of interactions between RCTs on treatment success. Our dataset consists of 280 phase III RCTs conducted by the NCI from 1955 to 2006. The RCT networks are formed through trial interactions formed i at random, ii based on common characteristics, or iii based on treatment success. We analyze treatment success in terms of survival hazard ratio as a function of the network structures. Our results show that the discovery process displays power law if there are preferential interactions between trials that may stem from researchers' tendency to interact selectively with established and successful peers. Furthermore, the RCT networks are "small worlds": trials are connected through a small number of ties, yet there is much clustering among subsets of trials. We also find that treatment success (improved survival is proportional to the network centrality measures of closeness and betweenness. Negative correlation exists between survival and the extent to which trials operate within a limited scope of information. Finally, the trials testing curative treatments in solid tumors showed the highest centrality and the most influential group was the ECOG. We conclude that the chances of discovering life-saving treatments are directly related to the richness of social interactions between researchers inherent in a preferential interaction model.

The effectiveness of periodontal disease treatment during pregnancy in reducing the risk of experiencing preterm birth and low birth weight: a meta-analysis.

Science.gov (United States)

Uppal, Anna; Uppal, Shitanshu; Pinto, Andres; Dutta, Moushumi; Shrivatsa, Shwetha; Dandolu, Vani; Mupparapu, Mel

2010-12-01

Treating periodontal disease during pregnancy to improve outcomes is controversial, and the results of randomized controlled trials (RCTs) are conflicting. The authors performed meta-analysis of these RCTs to assess the overall effect of treating periodontal disease during pregnancy. The authors performed a meta-analysis of studies found by means of two database aggregators OvidSP (12 databases) and EBSCOhost (11 databases). They included RCTs in pregnant women with periodontal disease who were assigned to a treatment arm (scaling and root planing with polishing) or a control arm (no treatment or only prophylaxis). Ten RCTs met the inclusion criteria for preterm birth (PTB), and eight RCTs met the inclusion criteria for low birth weight (LBW). The odds ratio of PTB in the treatment group was 0.589 (95 percent confidence interval [CI] = 0.396-0.875) and of LBW was 0.717 (95 percent CI = 0.440-1.169). Level of bias was the only significant predictor (P periodontal disease during pregnancy.

Interventions for the treatment of Frey's syndrome.

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Li, Chunjie; Wu, Fanglong; Zhang, Qi; Gao, Qinghong; Shi, Zongdao; Li, Longjiang

2015-03-17

Frey's syndrome is a rare disorder, the symptoms of which include sweating, flushing and warming over the preauricular and temporal areas following a gustatory stimulus. It often occurs in patients who have undergone parotidectomy, submandibular gland surgery, radical neck dissection, infection and traumatic injury in the parotid region, and is caused by the aberrant regrowth of facial autonomic nerve fibres. Currently there are several options used to treat patients with Frey's syndrome; for example, the topical application of anticholinergics and antiperspirants, and the intradermal injection of botulinum toxin. It is uncertain which treatment is most effective and safe. To assess the efficacy and safety of different interventions for the treatment of Frey's syndrome. We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; ICTRP and additional sources for published and unpublished trials. The date of the search was 28 April 2014. We included randomised or quasi-randomised controlled trials (RCTs) in participants diagnosed with Frey's syndrome using a clinical standard such as Minor's starch-iodine test. We planned to include trials in which participants received any intervention versus no treatment (observation) or an alternative intervention, with or without a second active treatment. Our primary outcome measures were success rate (as assessed clinically by Minor's starch-iodine test, the iodine-sublimated paper histogram method, blotting paper technique or another method) and adverse events. Our secondary outcome measure was success rate as assessed by patients (disappearance or improvement of symptoms). We used the standard methodological procedures expected by The Cochrane Collaboration. We identified no RCTs or quasi-RCTs that fulfilled the inclusion criteria. Our searches retrieved eight potentially relevant studies, but after

Undergraduate Confidence When Undertaking Root Canal Treatment and Their Perception of the Quality of Their Endodontic Education

Directory of Open Access Journals (Sweden)

James Puryer

2016-12-01

Full Text Available The General Dental Council expects graduating dentists to be competent at treating pulpal disease. Previous studies have found dental undergraduates to have low levels of confidence with respect to endodontic treatments. The aim of this study was to investigate the confidence of undergraduate dental students at the University of Bristol when performing root canal treatment, and to investigate their perception of the quality of their endodontic education. An anonymous questionnaire, based upon one used in a 2015 study at Cardiff University, was distributed to all (n = 204 undergraduate students in Years 3–5 at the University of Bristol. The results were analysed using the Statistical Package for the Social Sciences software (SPSS. There was a 59% (n = 120 response rate and a significant (p < 0.01 difference in confidence levels for root canal treatments (RCTs completed between these students. All (100% Year-5 students felt confident in completing anterior RCTs, and 91% felt confident in completing posterior RCTs. The majority (93% of Year-4 students felt confident in completing anterior RCTs, and 77% felt confident in completing posterior RCTs. Over one-half (56% of Year-3 students felt confident in anterior RCTs and 17% in posterior RCTs. With respect to the individual stages of RCT (access cavity, cleaning and shaping of root canal system, and obturation/filling, results showed that there was a significant difference (p < 0.01 in confidence levels between year groups. Many students thought the amount of time spent on endodontic teaching and the quality of teaching to be satisfactory. Improvements suggested for future endodontic teaching included higher numbers of staff supervision and additional endodontic practice on extracted teeth before seeing patients. There was a strong association between students’ clinical experience and their levels of confidence when completing RCT. Increasing the amount of clinical experience of RCTs could

Identifying Important Gaps in Randomized Controlled Trials of Adult Cardiac Arrest Treatments: A Systematic Review of the Published Literature

Science.gov (United States)

Sinha, Shashank S.; Sukul, Devraj; Lazarus, John J.; Polavarapu, Vivek; Chan, Paul S.; Neumar, Robert W.; Nallamothu, Brahmajee K.

2016-01-01

Background Cardiac arrests are a major public health concern worldwide. The extent and types of randomized controlled trials (RCTs) – our most reliable source of clinical evidence – conducted in these high-risk patients over recent years are largely unknown. Methods and Results We performed a systematic review, identifying all RCTs published in PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Library from 1995 to 2014 that focused on acute treatment of non-traumatic cardiac arrest in adults. We then extracted data on the setting of study populations, types and timing of interventions studied, risk of bias, outcomes reported and how these factors have changed over time. Over this twenty-year period, 92 RCTs were published containing 64,309 patients (median, 225.5 per trial). Of these, 81 RCTs (88.0%) involved out-of-hospital cardiac arrest whereas 4 (4.3%) involved in-hospital cardiac arrest and 7 (7.6%) included both. Eighteen RCTs (19.6%) were performed in the U.S., 68 (73.9%) were performed outside the U.S., and 6 (6.5%) were performed in both settings. Thirty-eight RCTs (41.3%) evaluated drug therapy, 39 (42.4%) evaluated device therapy, and 15 (16.3%) evaluated protocol improvements. Seventy-four RCTs (80.4%) examined interventions during the cardiac arrest, 15 (16.3%) examined post-cardiac arrest treatment, and 3 (3.3%) studied both. Overall, reporting of risk of bias was limited. The most common outcome reported was ROSC: 86 (93.5%) with only 22 (23.9%) reporting survival beyond 6 months. Fifty-three RCTs (57.6%) reported global ordinal outcomes whereas 15 (16.3%) reported quality-of-life. RCTs in the last 5 years were more likely to be focused on protocol improvement and post-cardiac arrest care. Conclusions Important gaps in RCTs of cardiac arrest treatments exist, especially those examining in-hospital cardiac arrest, protocol improvement, post-cardiac arrest care, and long-term or quality-of-life outcomes. PMID:27756794

Shock wave treatment in medicine

Indian Academy of Sciences (India)

Home; Journals; Journal of Biosciences; Volume 30; Issue 2 ... In the present paper we discuss the basic theory and application of shock waves and its history in medicine. The idea behind using shock wave therapy for orthopedic diseases is the stimulation of healing in tendons, surrounding tissue and bones. This is a ...

The effect of progressive resistance training on lean body mass in post-treatment cancer patients – A systematic review

International Nuclear Information System (INIS)

Lønbro, Simon

2014-01-01

Loss of lean body mass is a common problem in many post-treatment cancer patients and may negatively affect physical capacity in terms of maximal muscle strength and functional performance. The purpose of this study was to systematically review the scientific evidence on the effect of progressive resistance training on lean body mass in post-treatment cancer patients. A comprehensive literature search was conducted and ultimately 12 studies were included. Methodological quality of the included studies was evaluated using the PEDro scale and the effect of progressive resistance training was reported as the range of mean changes among RCTs and non-RCTs. Six RCTs and six non-RCTs were included in the study. In the RCTs the change in lean body mass in the progressive resistance training groups relative to control groups ranged from −0.4% to 3.9%, and in four of six trials the training effect was significantly larger than the change in the control groups. In the six non-RCTs, the mean change in lean body mass over time ranged from −0.01 to 11.8% which was significant in two of the trials. The included studies reported no or very limited adverse events following progressive resistance training. Based on 12 heterogenic studies there is moderate evidence supporting a positive effect of progressive resistance training on lean body mass in post-treatment cancer patients

Photoelectron wave function in photoionization: plane wave or Coulomb wave?

Science.gov (United States)

Gozem, Samer; Gunina, Anastasia O; Ichino, Takatoshi; Osborn, David L; Stanton, John F; Krylov, Anna I

2015-11-19

The calculation of absolute total cross sections requires accurate wave functions of the photoelectron and of the initial and final states of the system. The essential information contained in the latter two can be condensed into a Dyson orbital. We employ correlated Dyson orbitals and test approximate treatments of the photoelectron wave function, that is, plane and Coulomb waves, by comparing computed and experimental photoionization and photodetachment spectra. We find that in anions, a plane wave treatment of the photoelectron provides a good description of photodetachment spectra. For photoionization of neutral atoms or molecules with one heavy atom, the photoelectron wave function must be treated as a Coulomb wave to account for the interaction of the photoelectron with the +1 charge of the ionized core. For larger molecules, the best agreement with experiment is often achieved by using a Coulomb wave with a partial (effective) charge smaller than unity. This likely derives from the fact that the effective charge at the centroid of the Dyson orbital, which serves as the origin of the spherical wave expansion, is smaller than the total charge of a polyatomic cation. The results suggest that accurate molecular photoionization cross sections can be computed with a modified central potential model that accounts for the nonspherical charge distribution of the core by adjusting the charge in the center of the expansion.

P wave duration and dispersion in patients with hyperthyroidism and the short-term effects of antithyroid treatment.

Science.gov (United States)

Guntekin, Unal; Gunes, Yilmaz; Simsek, Hakki; Tuncer, Mustafa; Arslan, Sevket

2009-09-01

Prolonged P wave duration and P wave dispersion (PWD) have been associated with an increased risk for atrial fibrillation (AF). Hyperthytodism is a frequent cause of atrial fibrillation (AF). Forty-two patients with newly diagnosed overt hyperthyroidism and 20 healthy people were enrolled in the study. Transthoracic echocardiography, 12 lead surface ECG and thyroid hormone levels were studied at the time of enrollment and after achievement of euthyroid state with propylthiouracil treatment. Maximum P wave duration (Pmax) (97.4+/-14.6 vs. 84.2+/-9.5 msec, phyperthyroid patients compared to control group. Pmax and PWD were significantly correlated with the presence of hyperthyroidism. Pmax (97.4+/-14.6 to 84.3+/-8.6 msec, phyperthyroidism. Diastolic dyfunction was seen in 5 patients at hyperthroid state but only in one patient at euthyroid state. Hyperthyroidism is associated with prolonged P wave duration and dispersion. Achievement of euthyroid state with propylthiouracil treatment results in shortening of P wave variables. Diastolic function may have a partial effect for the increased Pmax and PWD. Shortening of Pmax and PWD may be a marker for the prevention of AF with the anti-thyroid treatment.

EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY IN TREATMENT OF PEDIATRIC UROLITHIASIS

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Emilija Golubovic

2006-04-01

Full Text Available The paper presents the experiences in the treatment of urinary tract calculosis in 114 children aged 6 months to 14 years by means of extracorporeal shock wave lithotripsy (ESWL.The treatment was performed at the Institute of Radiology and the Clinic for Pediatric Surgery and Orthopedics in Nis, in the period 1988-2000 on Siemens Litostar lithotriptor. The children were treated after clinical, laboratory and radiological preparation, provided that the stone was not greater than 3 cm (measured in native urinary tract graph and that it was not located in the pelvic part of the ureter. In the present study, the success in application of ESWL for treating pediatric patients was 88%. The total clearance of fragments was found in 57% of patients, whereas retention of fragments smaller than 4 mm three months after the last treatment was present in 31% of patients. ESWL treatment failed in 12% of patients since they had retained fragments greater than 4 mm.The authors recommend this method as a method of choice in the treatment of renal and urethral calculi in children.

Comparison of central adjudication of outcomes and onsite outcome assessment on treatment effect estimates

DEFF Research Database (Denmark)

Ndounga Diakou, Lee A ymar; Trinquart, Ludovic; Hróbjartsson, Asbjørn

2016-01-01

) when AC assessed events identified independently from unblinded onsite assessors; and 1.11 (95% CI 0.96 to 1.27, I(2) = 0%, 10 RCTs) when AC assessed events identified by unblinded onsite assessors. However, there was a statistically significant interaction between these subgroups (P = 0.03) AUTHORS......, there was no difference in treatment effect estimates from onsite assessors and AC (combined ROR: 1.00, 95% confidence interval (CI) 0.97 to 1.04; I(2) = 0%, 47 RCTs). The combined ROR was 1.00 (95% CI 0.96 to 1.04; I(2) = 0%, 35 RCTs) when onsite assessors were blinded; 0.76 (95% CI 0.48 to 1.12, I(2) = 0%, two RCTs...

Extracorporeal shock wave treatment for shoulder calcific tendonitis: a systematic review

International Nuclear Information System (INIS)

Mouzopoulos, G.; Tzurbakis, M.; Stamatakos, M.; Mouzopoulos, D.

2007-01-01

The treatment of patients with calcific tendonitis is typically conservative, including physical therapy, iontophoresis, deep friction, local or systemic application of noninflammatory drugs, needle irrigation-aspiration of calcium deposit, and subacromial bursal steroid injection. If the pain becomes chronic or intermittent after several months of conservative treatment, arthroscopic and open procedures are available to curette the calcium deposit, and additional subacromial decompression can be performed if necessary. As an alternative, minimally invasive extracorporeal shock wave therapy (ESWT) has been postulated to be an effective treatment option for treating calcific tendinitis of the shoulder, before surgery. Herein we discuss the indications, mechanism of therapeutic effect, efficacy of treatment, and complications after ESWT application. (orig.)

Association of Unfinished Root Canal Treatments with the Risk of Pneumonia Hospitalization.

Science.gov (United States)

Lin, Po-Yen; Chiang, Yu-Chih; Chou, Yu-Ju; Chang, Hong-Ji; Chi, Lin-Yang

2017-01-01

The objective of root canal treatments (RCTs) is to control pulpal diseases and salvage infected teeth by eradicating microorganisms within the root canal system. However, an unfinished RCT can leave a space for bacterial accumulation, which can leak into the oral cavity and then aspirate into the lower respiratory tract and the lungs, causing infection. This study investigated the association of unfinished RCTs with the possible risk of pneumonia hospitalization using a nationwide population-based database. After a matching process, we recruited 116,490 subjects who received an initiated RCT and had no history of pneumonia before 2005 and observed until the end of 2011. An unfinished RCT was operationally defined as an endodontic session that was started on a tooth but had no subsequent completion records. Cox proportional hazards models and subgroup analyses were used to estimate the association of unfinished RCTs on the risk of pneumonia hospitalization. In total, 1285 subjects were hospitalized for pneumonia during 2005 to 2011 with an overall pneumonia hospitalization incidence rate of 0.22% per person year. After adjusting for confounding factors, the adjusted pneumonia hospitalization hazard ratio for subjects who had unfinished RCTs was 1.40 (95% confidence interval, 1.24-1.59) compared with subjects without unfinished RCTs (P endodontic treatments once started. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Varying effects of recommended treatments for heart failure with reduced ejection fraction

DEFF Research Database (Denmark)

Thomsen, Marius Mark; Lewinter, Christian; Køber, Lars

2016-01-01

The aim of this paper is to evaluate the treatment effects of recommended drugs and devices on key clinical outcomes for patients with heart failure with reduced ejection fraction (HFREF). Randomized controlled trials (RCTs) listed in the 2012 HF guideline from the European Society of Cardiology...... as well as the 2013 HF guideline from the American College of Cardiology Foundation and American Heart Association were evaluated for use in the meta-analysis. RCTs written in English evaluating recommended drugs and devices for the treatment of patients with HFREF were included. Meta-analyses, based...... on the outcomes of all-cause mortality and hospitalization because of HF, were performed with relative risk ratio as the effect size. In the identified 47 RCTs, patients were on average 63 years old and 22% were female. Drugs targeting the renin-angiotensin-aldosterone system, beta-blockers, cardiac...

Systematic Review of Randomized Clinical Trials on Safety and Efficacy of Pharmacological and Nonpharmacological Treatments for Retinitis Pigmentosa

Directory of Open Access Journals (Sweden)

Marta Sacchetti

2015-01-01

Full Text Available Aims. Several treatments have been proposed to slow down progression of Retinitis pigmentosa (RP, a hereditary retinal degenerative condition leading to severe visual impairment. The aim of this study is to systematically review data from randomized clinical trials (RCTs evaluating safety and efficacy of medical interventions for the treatment of RP. Methods. Randomized clinical trials on medical treatments for syndromic and nonsyndromic RP published up to December 2014 were included in the review. Visual acuity, visual field, electroretinogram, and adverse events were used as outcome measures. Results. The 19 RCTs included in this systematic review included trials on hyperbaric oxygen delivery, topical brimonidine tartrate, vitamins, docosahexaenoic acid, gangliosides, lutein, oral nilvadipine, ciliary neurotrophic factor, and valproic acid. All treatments proved safe but did not show significant benefit on visual function. Long term supplementation with vitamin A showed a significantly slower decline rate in electroretinogram amplitude. Conclusions. Although all medical treatments for RP appear safe, evidence emerging from RCTs is limited since they do not present comparable results suitable for quantitative statistical analysis. The limited number of RCTs, the poor clinical results, and the heterogeneity among studies negatively influence the strength of recommendations for the long term management of RP patients.

Involvement of Fathers in Pediatric Obesity Treatment and Prevention Trials: A Systematic Review.

Science.gov (United States)

Morgan, Philip J; Young, Myles D; Lloyd, Adam B; Wang, Monica L; Eather, Narelle; Miller, Andrew; Murtagh, Elaine M; Barnes, Alyce T; Pagoto, Sherry L

2017-02-01

Despite their important influence on child health, it is assumed that fathers are less likely than mothers to participate in pediatric obesity treatment and prevention research. This review investigated the involvement of fathers in obesity treatment and prevention programs targeting children and adolescents (0-18 years). A systematic review of English, peer-reviewed articles across 7 databases. Retrieved records included at least 1 search term from 2 groups: "participants" (eg, child*, parent*) and "outcomes": (eg, obes*, diet*). Randomized controlled trials (RCTs) assessing behavioral interventions to prevent or treat obesity in pediatric samples were eligible. Parents must have "actively participated" in the study. Two authors independently extracted data using a predefined template. The search retrieved 213 eligible RCTs. Of the RCTs that limited participation to 1 parent only (n = 80), fathers represented only 6% of parents. In RCTs in which participation was open to both parents (n = 133), 92% did not report objective data on father involvement. No study characteristics moderated the level of father involvement, with fathers underrepresented across all study types. Only 4 studies (2%) suggested that a lack of fathers was a possible limitation. Two studies (1%) reported explicit attempts to increase father involvement. The review was limited to RCTs published in English peer-reviewed journals over a 10-year period. Existing pediatric obesity treatment or prevention programs with parent involvement have not engaged fathers. Innovative strategies are needed to make participation more accessible and engaging for fathers. Copyright © 2017 by the American Academy of Pediatrics.

Use of extracorporeal shock waves in the treatment of tendinopathy and other orthopedic diseases

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Dushyant Nadar

2000-01-01

Full Text Available Objective: Use of extracorporeal shock waves in the treatment of tendinopathy and other orthopedic diseases. Patients and methods: 35 patients received shock wave therapy using Econolith 2000 lithotripter 19 patients had isolated lateral epicondylitis, 12 medical epicondylitis and 4 plantar fascitis. A total of 120 shock waves were given in the first sitting. Each patient received a total of three sittings with a gap of one week between each of them. Results: Based on the patients′ self-assessment, about 75% pain relief was observed in 60% of the patients. Fur-ther, in patients having isolated tendinopathies, the pain relief was better. Conclusion: The study indicated that the application of shock waves is not restricted to the fragmentation of urinary calculi. The shock waves can be effectively used for the pain relief in the common orthopedic diseases. Thus, the urologists can widen the application of lithotripters, in a cost-effective manner, to the other medical speciali-ties.

Fat type in phytosterol products influence their cholesterol-lowering potential: A systematic review and meta-analysis of RCTs.

Science.gov (United States)

Ferguson, Jessica J A; Stojanovski, Elizabeth; MacDonald-Wicks, Lesley; Garg, Manohar L

2016-10-01

The most common form of phytosterol (PS) fortified foods are fat spreads and dairy products. The predominant fats used are soybean/sunflower (SS) or rapeseed/canola (RC) oils and animal fat (D) in dairy products. This review aimed to investigate whether the carrier fat is a determinant of the hypocholesterolaemic effects of PS fortified foods. Databases were searched using relevant keywords and published RCTs from 1990 investigating the effects of dietary PS intervention (≥1.5g per day) on total cholesterol and LDL-C were included. After methodological quality assessment and data extraction, a total of 32 RCTs (RC, n=15; SS, n=9; D, n=8) were included. As expected, all fat groups significantly reduced TC and LDL-C (p<0.01). When compared across different carrier fats, RC as the main carrier fat, reduced LDL-C significantly more than the SS spreads (p=0.01). Therefore, a combination of monounsaturated fatty acid rich spread with adequate amounts of omega-3 fatty acids (as evident in RC spreads) may be the superior carrier fat for the delivery of PS for optimal blood cholesterol-lowering. The findings of this research provide useful evidence for optimising the hypocholesterolaemic effects of PS and support further investigation into the possible mechanisms behind these findings. Copyright © 2016 Elsevier B.V. All rights reserved.

Wave-packet treatment of reactor neutrino oscillation experiments and its implications on determining the neutrino mass hierarchy

Energy Technology Data Exchange (ETDEWEB)

Chan, Yat-Long; Chu, M.C.; Xu, Jianyi [The Chinese University of Hong Kong, Department of Physics, Shatin (China); Tsui, Ka Ming [University of Tokyo, RCCN, ICRR, Kashiwa, Chiba (Japan); Wong, Chan Fai [Sun Yat-Sen University, Guangzhou (China)

2016-06-15

We derive the neutrino flavor transition probabilities with the neutrino treated as a wave packet. The decoherence and dispersion effects from the wave-packet treatment show up as damping and phase-shifting of the plane-wave neutrino oscillation patterns. If the energy uncertainty in the initial neutrino wave packet is larger than around 0.01 of the neutrino energy, the decoherence and dispersion effects would degrade the sensitivity of reactor neutrino experiments to mass hierarchy measurement to lower than 3 σ confidence level. (orig.)

Plantar fascia-specific stretching versus radial shock-wave therapy as initial treatment of plantar fasciopathy.

Science.gov (United States)

Rompe, Jan D; Cacchio, Angelo; Weil, Lowell; Furia, John P; Haist, Joachim; Reiners, Volker; Schmitz, Christoph; Maffulli, Nicola

2010-11-03

Whether plantar fascia-specific stretching or shock-wave therapy is effective as an initial treatment for proximal plantar fasciopathy remains unclear. The aim of this study was to test the null hypothesis of no difference in the effectiveness of these two forms of treatment for patients who had unilateral plantar fasciopathy for a maximum duration of six weeks and which had not been treated previously. One hundred and two patients with acute plantar fasciopathy were randomly assigned to perform an eight-week plantar fascia-specific stretching program (Group I, n = 54) or to receive repetitive low-energy radial shock-wave therapy without local anesthesia, administered weekly for three weeks (Group II, n = 48). All patients completed the seven-item pain subscale of the validated Foot Function Index and a patient-relevant outcome questionnaire. Patients were evaluated at baseline and at two, four, and fifteen months after baseline. The primary outcome measures were a mean change in the Foot Function Index sum score at two months after baseline, a mean change in item 2 (pain during the first few steps of walking in the morning) on this index, and satisfaction with treatment. No difference in mean age, sex, weight, or duration of symptoms was found between the groups at baseline. At two months after baseline, the Foot Function Index sum score showed significantly greater changes for the patients managed with plantar fascia-specific stretching than for those managed with shock-wave therapy (p plantar fascia is superior to repetitive low-energy radial shock-wave therapy for the treatment of acute symptoms of proximal plantar fasciopathy.

Maca (Lepidium meyenii) for treatment of menopausal symptoms: A systematic review.

Science.gov (United States)

Lee, Myeong Soo; Shin, Byung-Cheul; Yang, Eun Jin; Lim, Hyun-Ja; Ernst, Edzard

2011-11-01

Maca (Lepidium meyenii), an Andean plant of the brassica (mustard) family has been used for centuries in the Andes as an adaptogenic plant to manage anemia, infertility and female hormone balance. The aim of this review was to assess the evidence for and against the effectiveness of the maca plant as a treatment for menopausal symptoms. We searched 17 databases from their inception up to June 2011 and included all randomized clinical trials (RCTs) that compared any type of maca-based intervention to a placebo for the treatment of menopausal symptoms. All studies were assessed for methodological quality using the Cochrane 'risk of bias' assessment tool. Four RCTs met all inclusion criteria. These RCTs tested the effects of maca on menopausal symptoms in healthy perimenopausal, early postmenopausal, and late postmenopausal women. Using the Kupperman Menopausal Index and the Greene Climacteric Score, all RCTs demonstrated favorable effects of maca. There have been very few rigorous trials of maca for menopausal symptoms. The results of our systematic review provide limited evidence for the effectiveness of maca as a treatment for menopausal symptoms. However, the total number of trials, the total sample size, and the average methodological quality of the primary studies, were too limited to draw firm conclusions. Furthermore, the safety has not been proved yet. Therefore, the efficacy and safety should be tested in larger studies. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Evidence-based review of lasers, light sources and photodynamic therapy in the treatment of acne vulgaris

DEFF Research Database (Denmark)

Hædersdal, Merete; Togsverd-Bo, Katrine; Wulf, Hans Chr.

2008-01-01

through searches in PubMed and the Cochrane Library. Results A total of 16 randomized controlled trials (RCT) and 3 controlled trials (CT) were identified, involving a total of 587 patients. Interventions included photodynamic therapy (PDT; 5 RCTs), infrared lasers (4 RCTs), broad-spectrum light sources...... outcomes for PDT. We recommend that patients are preoperatively informed of the existing evidence, which indicates that optical treatments today are not included among first line treatments Udgivelsesdato: 2008/3...

Randomized controlled trials of HIV/AIDS prevention and treatment in Africa: results from the Cochrane HIV/AIDS Specialized Register.

Directory of Open Access Journals (Sweden)

Babalwa Zani

Full Text Available INTRODUCTION: To effectively address HIV/AIDS in Africa, evidence on preventing new infections and providing effective treatment is needed. Ideally, decisions on which interventions are effective should be based on evidence from randomized controlled trials (RCTs. Our previous research described African RCTs of HIV/AIDS reported between 1987 and 2003. This study updates that analysis with RCTs published between 2004 and 2008. OBJECTIVES: To describe RCTs of HIV/AIDS conducted in Africa and reported between 2004 and 2008. METHODS: We searched the Cochrane HIV/AIDS Specialized Register in September 2009. Two researchers independently evaluated studies for inclusion and extracted data using standardized forms. Details included location of trials, interventions, methodological quality, location of principal investigators and funders. RESULTS: Our search identified 834 RCTs, with 68 conducted in Africa. Forty-three assessed prevention-interventions and 25 treatment-interventions. Fifteen of the 43 prevention RCTs focused on preventing mother-to-child HIV transmission. Thirteen of the 25 treatment trials focused on opportunistic infections. Trials were conducted in 16 countries with most in South Africa (20, Zambia (12 and Zimbabwe (9. The median sample size was 628 (range 33-9645. Methods used for the generation of the allocation sequence and allocation concealment were adequate in 38 and 32 trials, respectively, and 58 reports included a CONSORT recommended flow diagram. Twenty-nine principal investigators resided in the United States of America (USA and 18 were from African countries. Trials were co-funded by different agencies with most of the funding obtained from USA governmental and non-governmental agencies. Nineteen pharmaceutical companies provided partial funding to 15 RCTs and African agencies co-funded 17 RCTs. Ethical approval was reported in 65 trials and informed consent in 61 trials. CONCLUSION: Prevention trials dominate the trial

Holographic interferometric observation of shock wave focusing to extracorporeal shock wave lithotripsy

Science.gov (United States)

Takayama, Kazuyoshi; Obara, Tetsuro; Onodera, Osamu

1991-04-01

Underwater shock wave focusing is successfully applied to disintegrate and remove kidney stones or gallbladder stones without using surgical operations. This treatment is one of the most peaceful applications ofshock waves and is named as the Extracorporeal Shock Wave Lithotripsy. Ajoint research project is going on between the Institute ofFluid Science, Tohoku University and the School ofMedicine, Tohoku University. The paper describes a result of the fundamental research on the underwater shock wave focusing applied to the ESWL. Quantitatively to visualize the underwater shock waves, various optical flow visualization techniques were successfully used such as holographic interferometry, and shadowgraphs combined with Ima-Con high speed camera. Double exposure holographic interferometric observation revealed the mechanism of generation, propagation and focusing of underwater shock waves. The result of the present research was already used to manufacture a prototype machine and it has already been applied successfully to ESWL crinical treatments. However, despite of success in the clinical treatments, important fundamental questions still remain unsolved, i.e., effects of underwater shock wave focusing on tissue damage during the treatment. Model experiments were conducted to clarify mechanism of the tissue damage associated with the ESWL. Shock-bubble interactions were found responsible to the tissue damage during the ESWL treatment. In order to interprete experimental findings and to predict shock wave behavior and high pressures, a numerical simulation was carried. The numerical results agreed with the experiments.

Effectiveness and implementation aspects of interventions for preventing falls in elderly people in long-term care facilities: a systematic review of RCTs.

Science.gov (United States)

Neyens, Jacques C; van Haastregt, Jolanda C; Dijcks, Béatrice P; Martens, Mark; van den Heuvel, Wim J; de Witte, Luc P; Schols, Jos M

2011-07-01

There is extensive literature on interventions to prevent or reduce falls in elderly people. These findings, however, were based mainly on studies of community-living persons. The primary aim of the present study was to report the effectiveness and implementation aspects of interventions aimed at reducing falls in elderly residents in long-term care facilities: a systematic review of randomized controlled trials (RCTs). MEDLINE, EMBASE, CINAHL, and hand searching of reference lists of included RCTs. RCTs that assessed fall incidents (falls, fallers, recurrent fallers, fall-related injuries) among elderly residents in long-term care facilities were included in this narrative review. Two independent reviewers abstracted data: general program characteristics (setting, population, intervention program) and outcomes, detailed program characteristics (assessment, intervention content, individually tailored, multidisciplinary), and implementation aspects (feasibility, implications for practice). The CONSORT Statement 2001 Checklist was used regarding the quality of reporting RCTs. Twenty trials met the inclusion criteria. Seven trials, 4 multifactorial and 3 monofactorial, showed a significant reduction in the fall rate, the percentage of recurrent fallers, or both the fall rate and the percentage of persons sustaining femoral fractures. The positive effective programs were as follows: a comprehensive structured individual assessment with specific safety recommendations; a multidisciplinary program including general strategies tailored to the setting and strategies tailored specifically to residents; a multifaceted intervention including education, environmental adaptation, balance, resistance training, and hip protector; calcium plus vitamin D supplementation; vitamin D supplementation; a clinical medication review; and a multifactorial intervention (fall risk evaluation, specific and general interventions). In general, because of the limited number of included trials

Decrease of Salmonella typhimurium in skim milk and egg by heat and ultrasonic wave treatment

International Nuclear Information System (INIS)

Wrigley, D.M.; Llorca, N.G.

1992-01-01

Ultrasonic waves induce cavitation which is lethal for many bacteria. When Salmonella typhimurium was suspended in skim milk or brain heart infusion broth and placed in an ultrasonicating water bath, the number of bacteria decreased by 2 to 3 log CFU in a time dependent manner. The killing by ultrasonic waves was enhanced if the menstruum was simultaneously maintained at 50 degrees C. Ultrasonic reduction in S. typhimurium numbers in liquid whole egg ranged from 1-3 log CFU at 50 degrees C. The results indicate that indirect ultrasonic wave treatment is effective in killing Salmonella in some foods

Craving and illicit heroin use among patients in heroin-assisted treatment

NARCIS (Netherlands)

Blanken, Peter; Hendriks, Vincent M.; Koeter, Maarten W. J.; van Ree, Jan M.; van den Brink, Wim

2012-01-01

Aims: To investigate in heroin-assisted treatment (HAT) compared to methadone maintenance treatment (MMT): the course of heroin craving and illicit heroin use, their mutual association, and their association with multi-domain treatment response. Design: RCTs on the efficacy of 12 months

The optimization of treatment and management of schizophrenia in Europe (OPTiMiSE) trial

DEFF Research Database (Denmark)

Leucht, Stefan; Winter-van Rossum, Inge; Heres, Stephan

2015-01-01

Commission sponsored "Optimization of Treatment and Management of Schizophrenia in Europe" (OPTiMiSE) trial which aims to provide a treatment algorithm for patients with a first episode of schizophrenia. METHODS: We searched Pubmed (October 29, 2014) for randomized controlled trials (RCTs) that examined...... switching the drug in nonresponders to another antipsychotic. We described important methodological choices of the OPTiMiSE trial. RESULTS: We found 10 RCTs on switching antipsychotic drugs. No trial was conclusive and none was concerned with first-episode schizophrenia. In OPTiMiSE, 500 first episode...

Efficacy of extracorporeal shock wave therapy in the treatment of lateral epicondylitis.

Science.gov (United States)

Bayram, Korhan; Yesil, Hilal; Dogan, Erdal

2014-01-01

Lateral epicondylitis is one of the widely seen lesions of the arm characterized by pain localized over lateral epicondyle which is the insertion site of the wrist extensors, and extensor muscles of the forearm. It is easy to diagnose lateral epicondylitis but treatment involves some inherent drawbacks. Conservative management includes non-steroidal anti-inflammatory drugs, ultrasound therapy, steroid injections, functional bracing, laser therapy and extracorporeal shock wave therapy, however none of these modalities have been shown to be really effective based on evidence-based data. Our study is aimed to determine the efficacy of extracorporeal shock wave therapy (ESWT) therapy in the treatment of lateral epicondylitis. A total of 12 patients with the diagnosis of lateral epicondylitis were included in the study and 3 sessions of ESWT were applied (1 session per week). Maximum grip strength and pain scores were assessed before and at 1. month after the treatment. Spesific tests for lateral epicondylitis were utilized and Turkish version of the Patient Rated Tennis Elbow Evaluation (PRTEE-T) questionnaire was administered and data obtained were analyzed. Visual analog scale (VAS) scores were significantly lower (plateral epicondyilitis was found to be effective on reducing pain, and improving functional activities and quality of life.

A systematic review on the role of anticonvulsants in the treatment of acute bipolar depression.

Science.gov (United States)

Reinares, María; Rosa, Adriane R; Franco, Carolina; Goikolea, José Manuel; Fountoulakis, Kostas; Siamouli, Melina; Gonda, Xenia; Frangou, Sophia; Vieta, Eduard

2013-03-01

Despite the high morbidity and mortality associated with bipolar depression, the optimal treatment for this phase is still a matter of debate. The aim of the current review was to provide updated evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression. A comprehensive review of randomized controlled trials (RCTs) evaluating the use of anticonvulsants for the treatment of acute bipolar depression up to June 2011 was conducted by means of the PubMed-Medline database. Eligibility criteria included active comparator-controlled or placebo-controlled randomized studies involving monotherapy or combination therapy. A total of 18 RCTs fulfilled the inclusion criteria. Studies supported the efficacy of divalproex as monotherapy in acute bipolar depression but small sample size was a common methodological limitation. Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect. Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant. All anticonvulsants were generally well tolerated. No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine, licarbazepine, zonisamide, retigabine, pregabalin, tiagabine, felbamate and vigabatrine in the acute treatment of bipolar depression. To sum up, taking into consideration the efficacy and tolerability profiles of anticonvulsants, current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression. However, available data for most other anticonvulsants are inconclusive and further RCTs with larger sample sizes are needed before drawing firm conclusions.

Systematic review of treatments for atopic eczema.

Science.gov (United States)

Hoare, C; Li Wan Po, A; Williams, H

2000-01-01

Atopic eczema is the commonest inflammatory skin disease of childhood, affecting 15-20% of children in the UK at any one time. Adults make up about one-third of all community cases. Moderate-to-severe atopic eczema can have a profound effect on the quality of life for both sufferers and their families. In addition to the effects of intractable itching, skin damage, soreness, sleep loss and the social stigma of a visible skin disease, other factors such as frequent visits to doctors, special clothing and¿the need to constantly apply messy topical applications all add to the burden of disease. The cause of atopic eczema is unknown, though a genetic pre-disposition and a combination of allergic and non-allergic factors appear to be important in determining disease expression. Treatment of atopic eczema in the UK is characterised by a profusion of treatments aimed at disease control. The evidential basis of these treatments is often unclear. Most people with atopic eczema are managed in primary care where the least research has been done. The objectives of this scoping review are two-fold. To produce an up-to-date coverage 'map' of randomised controlled trials (RCTs) of treatments of atopic eczema. To assist in making treatment recommendations by summarising the available RCT evidence using qualitative and quantitative methods. Data sources included electronic searching of MEDLINE, EMBASE, the Cochrane Controlled Clinical Trials Register, the Cochrane Skin Group specialised register of trials, hand-searching of atopic eczema conference proceedings, follow-up of references in retrieved articles, contact with leading researchers and requests to relevant pharmaceutical companies. Only RCTs of therapeutic agents used in the prevention and treatment of people with atopic eczema of any age were considered for inclusion. Only studies where a physician diagnosed atopic eczema or atopic dermatitis were included. Data extraction was conducted by two observers onto abstraction

Low-energy Shock Wave Therapy-A Novel Treatment Option for Erectile Dysfunction in Men With Cardiovascular Disease.

Science.gov (United States)

Kałka, Dariusz; Gebala, Jana; Smoliński, Ryszard; Rusiecki, Lesław; Pilecki, Witold; Zdrojowy, Romuald

2017-11-01

Patients with cardiovascular disease (CVD) are prone to developing erectile dysfunction (ED) owing to the common risk factors and pathogenesis underlying ED and CVD. As a result, ED affects nearly 80% of male patients with CVD. The efficacy of phosphodiesterase type 5 inhibitors, vacuum erection devices, or intracavernosal injection of vasodilating agents is well established in the treatment of ED; however, their use is limited. Low-energy shock wave therapy is a novel modality that may become a causative treatment for ED. This review aims to assess the efficacy and safety of low-energy shock wave therapy in the treatment of ED in men with CVD. Copyright © 2017 Elsevier Inc. All rights reserved.

Is escitalopram really relevantly superior to citalopram in treatment of major depressive disorder? A meta-analysis of head-to-head randomized trials.

Science.gov (United States)

Trkulja, Vladimir

2010-02-01

To evaluate clinical relevance of differences between escitalopram and citalopram (equimolar) for major depressive disorder. Review and meta-analysis of comparative randomized controlled trials (RCT). Comparisons were in relation to Montgomery-Asberg depression rating scale (MADRS) score reduction at weeks 1 (5 RCTs), 4 (5 RCTs), 6 (4 RCTs), 8 (5 RCTs), and 24 (1 RCT); proportion of responders at weeks 2, 4, 6 (2 RCTs for each time point), 8 (5 RCTs), and 24 (1 RCT); clinical global impression-severity (CGI-S) reduction at weeks 6 (1 RCT), 8 (5 RCTs), and 24 (1 RCT), and discontinuation due to adverse events or inefficacy during short-term (up to 8 weeks) and medium-term (24 weeks) treatment. MADRS reduction was greater with escitalopram, but 95% confidence intervals (CI) around the mean difference were entirely or largely below 2 scale points (minimally important difference) and CI around the effect size (ES) was below 0.32 ("small") at all time points. Risk of response was higher with escitalopram at week 8 (relative risk, 1.14; 95% CI, 1.04 to 1.26) but number needed to treat was 14 (95% CI, 7 to 111). All 95% CIs around the mean difference and ES of CGI-S reduction at week 8 were below 0.32 points and the limit of "small," respectively. Data for severe patients (MADRS> or =30) are scarce (only 1 RCT), indicating somewhat greater efficacy (response rate and MADRS reduction at week 8, but not CGI-S reduction) of escitalopram, but without compelling evidence of clinically relevant differences. Discontinuations due to adverse events or inefficacy up to 8 weeks of treatment were comparable. Data for the period up to 24 weeks are scarce and inconclusive. Presently, the claims about clinically relevant superiority of escitalopram over citalopram in short-to-medium term treatment of major depressive disorder are not supported by evidence.

Acupuncture in the treatment of tinnitus: a systematic review and meta-analysis.

Science.gov (United States)

Liu, Fenye; Han, Xiuli; Li, Yunfeng; Yu, Shudong

2016-02-01

This study aimed at a systematic review and meta-analysis of all available randomized controlled trials (RCTs) using acupuncture to treat tinnitus. Five electronic databases, in both English and Chinese, were searched. All studies in our review and meta-analysis included parallel RCTs of tinnitus patients which compared subjects receiving acupuncture (or its other forms, such as electroacupuncture) to subjects receiving no treatment, sham treatment, drugs or basic medical therapy. Data from the articles were validated and extracted using a predefined data extraction form. Nearly all of Chinese studies reported positive results, while most of English studies reported negative results. Analysis of the combined data found that the acupuncture treatments seemed to provide some advantages over conventional therapies for tinnitus. It had difference in acupuncture points and sessions between Chinese studies and English studies. Methodological flaws were also found in many of the RCTs, especially in Chinese studies. The results of this review suggest that acupuncture therapy may offer subjective benefit to some tinnitus patients. Acupuncture points and sessions used in Chinese studies may be more appropriate, whereas these studies have many methodological flaws and risk bias, which prevents us making a definitive conclusion.

Effectiveness of Trigger Point Manual Treatment on the Frequency, Intensity, and Duration of Attacks in Primary Headaches: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Directory of Open Access Journals (Sweden)

Luca Falsiroli Maistrello

2018-04-01

Full Text Available BackgroundA variety of interventions has been proposed for symptomatology relief in primary headaches. Among these, manual trigger points (TrPs treatment gains popularity, but its effects have not been investigated yet.ObjectiveThe aim was to establish the effectiveness of manual TrP compared to minimal active or no active interventions in terms of frequency, intensity, and duration of attacks in adult people with primary headaches.MethodsWe searched MEDLINE, COCHRANE, Web Of Science, and PEDro databases up to November 2017 for randomized controlled trials (RCTs. Two independent reviewers appraised the risk-of-bias (RoB and the grading of recommendations, assessment, development, and evaluation (GRADE to evaluate the overall quality of evidence.ResultsSeven RCTs that compared manual treatment vs minimal active intervention were included: 5 focused on tension-type headache (TTH and 2 on Migraine (MH; 3 out of 7 RCTs had high RoB. Combined TTH and MH results show statistically significant reduction for all outcomes after treatment compared to controls, but the level of evidence was very low. Subgroup analysis showed a statistically significant reduction in attack frequency (no. of attacks per month after treatment in TTH (MD −3.50; 95% CI from −4.91 to −2.09; 4 RCTs and in MH (MD −1.92; 95% CI from −3.03 to −0.80; 2 RCTs. Pain intensity (0–100 scale was reduced in TTH (MD −12.83; 95% CI from −19.49 to −6.17; 4 RCTs and in MH (MD −13.60; 95% CI from −19.54 to −7.66; 2RCTs. Duration of attacks (hours was reduced in TTH (MD −0.51; 95% CI from −0.97 to −0.04; 2 RCTs and in MH (MD −10.68; 95% CI from −14.41 to −6.95; 1 RCT.ConclusionManual TrPs treatment of head and neck muscles may reduce frequency, intensity, and duration of attacks in TTH and MH, but the quality of evidence according to GRADE approach was very low for the presence of few studies, high RoB, and imprecision of results.

All-cause mortality and major cardiovascular outcomes comparing percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis

DEFF Research Database (Denmark)

Laukkanen, Jari A; Kunutsor, Setor K; Niemelä, Matti

2017-01-01

Objective: We compared percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) for the treatment of left main coronary artery (LMCA) disease by conducting a systematic review and meta-analysis of randomised controlled trials (RCTs). Methods: RCTs of PCI versus CABG in...

Relativistic wave mechanics

CERN Document Server

Corinaldesi, Ernesto

1963-01-01

Geared toward advanced undergraduate and graduate students of physics, this text provides readers with a background in relativistic wave mechanics and prepares them for the study of field theory. The treatment originated as a series of lectures from a course on advanced quantum mechanics that has been further amplified by student contributions.An introductory section related to particles and wave functions precedes the three-part treatment. An examination of particles of spin zero follows, addressing wave equation, Lagrangian formalism, physical quantities as mean values, translation and rotat

Semiclassical initial value treatment of wave functions

International Nuclear Information System (INIS)

Kay, Kenneth G.

2010-01-01

A semiclassical initial value approximation for time-independent wave functions, previously derived for integrable systems, is rederived in a form which allows it to be applied to more general systems. The wave function is expressed as an integral over a Lagrangian manifold that is constructed by propagating trajectories from an initial manifold formed on a Poincare surface. Even in the case of bound, integrable systems, it is unnecessary to identify action-angle variables or construct quantizing tori. The approximation is numerically tested for separable and highly chaotic two-dimensional quartic oscillator systems. For the separable (but highly anharmonic) system, the accuracy of the approximation is found to be excellent: overlaps of the semiclassical wave functions with the corresponding quantum wave functions exceed 0.999. For the chaotic system, semiclassical-quantum overlaps are found to range from 0.989 to 0.994, indicating accuracy that is still very good, despite the short classical trajectories used in the calculations.

Conservative treatment of urge urinary incontinence in women: a systematic review of randomized clinical trials.

Science.gov (United States)

Berghmans, L C; Hendriks, H J; De Bie, R A; van Waalwijk van Doorn, E S; Bø, K; van Kerrebroeck, P E

2000-02-01

To assess the efficacy of physical therapies for first-line use in the treatment of urge urinary incontinence (UUI) in women, using a systematic review of randomized clinical trials (RCTs). A computer-aided and manual search was carried out for RCTs published between 1980 and 1999 investigating the treatment of UUI defined by the keywords 'physical therapies', e.g. bladder (re)training (including 'behavioural' treatment), pelvic floor muscle (PFM) exercises, with or without biofeedback and/or electrical stimulation. The methodological quality of the included trials was assessed using methodological criteria, based on generally accepted principles of interventional research. Fifteen RCTs were identified; the methodological quality of the studies was moderate, with a median (range) score of 6 (3-8.5) (maximum possible 10). Eight RCTs were considered of sufficient quality, i.e. an internal validity score of >/= 5.5 points on a scale of 0-10, and were included in a further analysis. Based on levels-of-evidence criteria, there is weak evidence to suggest that bladder (re)training is more effective than no treatment (controls), and that bladder (re)training is better than drug therapy. Stimulation types and parameters in the studies of electrical stimulation were heterogeneous. There is insufficient evidence that electrical stimulation is more effective than sham electrical simulation. To date there are too few studies to evaluate effects of PFM exercise with or without biofeedback, and of toilet training for women with UUI. Although almost all studies included reported positive results in favour of physical therapies for the treatment of UUI, more research of high methodological quality is required to evaluate the effects of each method in the range of physical therapies.

Published and not fully published double-blind, randomised, controlled trials with oral naratriptan in the treatment of migraine

DEFF Research Database (Denmark)

Tfelt-Hansen, Peer Carsten

2011-01-01

Naratriptan 2.5 mg is now an over-the-counter drug in Germany. This should increase the interest in drug. The GSK Trial Register was searched for published and unpublished double-blind, randomised, controlled trials (RCTs) concerning the use of naratriptan in migraine. Only 7 of 17 RCTs are publi......Naratriptan 2.5 mg is now an over-the-counter drug in Germany. This should increase the interest in drug. The GSK Trial Register was searched for published and unpublished double-blind, randomised, controlled trials (RCTs) concerning the use of naratriptan in migraine. Only 7 of 17 RCTs...... are published in full. Naratriptan 2.5 mg is superior to placebo for acute migraine treatment in 6 RCTs, but inferior to sumatriptan 100 mg and rizatriptan 10 mg in one RCT each. This dose of naratriptan has no more adverse events than placebo. Naratriptan 1 mg b.i.d. has some effect in the short...

Kinetic treatment of magnetosonic wave reflection by minority gyroresonant ballistic waves in tokamak geometry

International Nuclear Information System (INIS)

Kaufman, A.N.; Brizard, A.J.; Cook, D.R.

1993-01-01

The analysis of the minority-ion gyroresonant heating process by a magnetosonic wave in a general magnetic field geometry with one ignorable spatial coordinate can be divided into several steps, each defined in terms of a precise mathematical problem to be solved. In this work, the authors focus their attention on the magnetosonic wave reflection problem in axisymmetric tokamak geometry; the conversion and absorption of the minority-ion gyroresonant ballistic waves are treated elsewhere. In contrast to their previous work, they employ a kinetic model based on the perturbation generating function S for the gyroresonant minority-ions. The bulk plasma response is represented by the perturbation magnetic vector potential A, corresponding to a shielded magnetosonic wave. The set of coupled equations for S and A can be derived from an action principle, which can also be used to derive explicit wave-action conservation laws in ray phase space. The reflection problem is solved in ray phase space by considering three separate steps. In the first step, the incident magnetosonic ray propagates towards the first linear mode conversion region, where action is transferred to the minority-ion gyroresonant ballistic waves. In the second step, the continuum of excited gyroresonant ballistic rays propagate towards the second linear mode conversion region. In the third step, the reflected magnetosonic wave field is excited by linear mode conversion from the minority gyroresonant ballistic rays

Potential misinterpretation of treatment effects due to use of odds ratios and logistic regression in randomized controlled trials.

Directory of Open Access Journals (Sweden)

Mirjam J Knol

Full Text Available BACKGROUND: In randomized controlled trials (RCTs, the odds ratio (OR can substantially overestimate the risk ratio (RR if the incidence of the outcome is over 10%. This study determined the frequency of use of ORs, the frequency of overestimation of the OR as compared with its accompanying RR in published RCTs, and we assessed how often regression models that calculate RRs were used. METHODS: We included 288 RCTs published in 2008 in five major general medical journals (Annals of Internal Medicine, British Medical Journal, Journal of the American Medical Association, Lancet, New England Journal of Medicine. If an OR was reported, we calculated the corresponding RR, and we calculated the percentage of overestimation by using the formula . RESULTS: Of 193 RCTs with a dichotomous primary outcome, 24 (12.4% presented a crude and/or adjusted OR for the primary outcome. In five RCTs (2.6%, the OR differed more than 100% from its accompanying RR on the log scale. Forty-one of all included RCTs (n = 288; 14.2% presented ORs for other outcomes, or for subgroup analyses. Nineteen of these RCTs (6.6% had at least one OR that deviated more than 100% from its accompanying RR on the log scale. Of 53 RCTs that adjusted for baseline variables, 15 used logistic regression. Alternative methods to estimate RRs were only used in four RCTs. CONCLUSION: ORs and logistic regression are often used in RCTs and in many articles the OR did not approximate the RR. Although the authors did not explicitly misinterpret these ORs as RRs, misinterpretation by readers can seriously affect treatment decisions and policy making.

Study of the wave packet treatment of neutrino oscillation at Daya Bay

Science.gov (United States)

Daya Bay Collaboration

2017-09-01

The disappearance of reactor \\bar{ν }_e observed by the Daya Bay experiment is examined in the framework of a model in which the neutrino is described by a wave packet with a relative intrinsic momentum dispersion σ _{rel}. Three pairs of nuclear reactors and eight antineutrino detectors, each with good energy resolution, distributed among three experimental halls, supply a high-statistics sample of \\bar{ν }_e acquired at nine different baselines. This provides a unique platform to test the effects which arise from the wave packet treatment of neutrino oscillation. The modified survival probability formula was used to fit Daya Bay data, providing the first experimental limits: 2.38 × 10^{-17}< σ _{rel} < 0.23. Treating the dimensions of the reactor cores and detectors as constraints, the limits are improved: 10^{-14} ≲ σ _ {rel} < 0.23, and an upper limit of σ _ {rel}<0.20 (which corresponds to σ _x ≳ 10^{-11} {cm }) is obtained. All limits correspond to a 95% C.L. Furthermore, the effect due to the wave packet nature of neutrino oscillation is found to be insignificant for reactor antineutrinos detected by the Daya Bay experiment thus ensuring an unbiased measurement of the oscillation parameters sin ^22θ _{13} and Δ m^2_{32} within the plane wave model.

Conservative treatment of stress urinary incontinence in women: a systematic review of randomized clinical trials.

Science.gov (United States)

Berghmans, L C; Hendriks, H J; Bo, K; Hay-Smith, E J; de Bie, R A; van Waalwijk van Doorn, E S

1998-08-01

To assess the efficacy of physical therapies for first-line use in the treatment and prevention of stress urinary incontinence (SUI) in women, using a systematic review of randomized clinical trials (RCTs). A computer-aided and manual search for published RCTs investigating treatment and prevention of SUI using physical therapies, e.g. pelvic floor muscle (PFM) exercises, with or without other treatment modalities, were carried out. The methodological quality of the included trials was assessed using criteria based on generally accepted principles of interventional research. Twenty-four RCTs (22 treatment and two prevention) were identified; the methodological quality of the studies included was moderate and 11 RCTs were of sufficient quality to be included in further analysis. Based on levels-of-evidence criteria, there is strong evidence to suggest that PFM exercises are effective in reducing the symptoms of SUI. There is limited evidence for the efficacy of high-intensity vs a low-intensity regimen of PFM exercises. Despite significant effects of biofeedback after testing as an adjunct to PFM exercises, there is no evidence that PFM exercises with biofeedback are more effective than PFM exercises alone. There is little consistency (of stimulation types and parameters) in the studies of electrical stimulation, but when the results are combined there is strong evidence to suggest that electrostimulation is superior to sham electrostimulation, and limited evidence that there is no difference between electrostimulation and other physical therapies. In the prevention of SUI the efficacy of PFM exercises, with or without other adjuncts, is uncertain.

Impact of Hydronephrosis on Treatment Outcome of Solitary Proximal Ureteral Stone After Extracorporeal Shock Wave Lithotripsy

Directory of Open Access Journals (Sweden)

Hsi-Lin Hsiao

2008-10-01

Full Text Available The purpose of this study was to investigate the impact of hydronephrosis on the treatment outcome of patients with a solitary proximal ureteral stone after extracorporeal shock wave lithotripsy (ESWL. A total of 182 consecutive patients who underwent ESWL for a solitary proximal ureteral stone of between 5 and 20 mm in size in our institution were included in this study. The degree of hydronephrosis was defined by renal ultrasonography. Patient data, stone size, shock wave numbers and shock wave energy were also recorded. Treatment outcome was evaluated 3 months after the first session of ESWL. In multivariate analysis, only the maximal stone length (odds ratio [OR], 0.15; 95% confidence interval [CI], 0.03–0.91; p = 0.04 and the degree of hydronephrosis (OR, 0.40; 95% CI, 0.16–0.98; p = 0.045 were significant predicting factors for stone-free status 3 months after ESWL. For stones ≤ 10 mm, the stone-free rate decreased from 80% in patients with mild hydronephrosis to 56.4% in those with moderate to severe hydro-nephrosis. For stones > 10 mm, the stone-free rate decreased further, from 65.2% in patients with mild hydronephrosis to 33.3% in those with moderate to severe hydronephrosis. In summary, patients with a solitary proximal ureteral stone and a stone > 10 mm, the treatment outcome after ESWL was not good if moderate to severe hydronephrosis was noted on ultrasonography. Alternative treatments, such as ureteroscopic lithotripsy, may be appropriate as initial treatment or after failure of one session of ESWL.

Spin in RCTs of anxiety medication with a positive primary outcome : A comparison of concerns expressed by the US FDA and in the published literature

NARCIS (Netherlands)

Beijers, Lian; Jeronimus, Bertus F; Turner, Erick H; de Jonge, Peter; Roest, Annelieke M

2017-01-01

Objectives: This study aimed to determine the presence of spin in papers on positive randomised clinical trials (RCTs) of antidepressant medication for anxiety disorders by comparing concerns expressed in the Food and Drug Administration (FDA) reviews with those expressed in the published paper.

Acupuncture for treatment of irritable bowel syndrome

Science.gov (United States)

Manheimer, Eric; Cheng, Ke; Wieland, L. Susan; Min, Li Shih; Shen, Xueyong; Berman, Brian M; Lao, Lixing

2013-01-01

Background Irritable bowel syndrome (IBS) is a common, costly, and difficult to treat disorder that impairs health-related quality of life and work productivity. Evidence-based treatment guidelines have been unable to provide guidance on the effects of acupuncture for IBS because the only previous systematic review included only small, heterogeneous and methodologically unsound trials. Objectives The primary objectives were to assess the efficacy and safety of acupuncture for treating IBS. Search methods MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, the Cumulative Index to Nursing and Allied Health, and the Chinese databases Sino-Med, CNKI, and VIP were searched through November 2011. Selection criteria Randomized controlled trials (RCTs) that compared acupuncture with sham acupuncture, other active treatments, or no (specific) treatment, and RCTs that evaluated acupuncture as an adjuvant to another treatment, in adults with IBS were included. Data collection and analysis Two authors independently assessed the risk of bias and extracted data. We extracted data for the outcomes overall IBS symptom severity and health-related quality of life. For dichotomous data (e.g. the IBS Adequate Relief Question), we calculated a pooled relative risk (RR) and 95% confidence interval (CI) for substantial improvement in symptom severity after treatment. For continuous data (e.g. the IBS Severity Scoring System), we calculated the standardized mean difference (SMD) and 95% CI in post-treatment scores between groups. Main results Seventeen RCTs (1806 participants) were included. Five RCTs compared acupuncture versus sham acupuncture. The risk of bias in these studies was low.We found no evidence of an improvement with acupuncture relative to sham (placebo) acupuncture for symptom severity (SMD-0.11, 95%CI −0.35 to 0.13; 4 RCTs; 281 patients) or quality of life (SMD = −0.03, 95%CI −0.27 to 0.22; 3 RCTs; 253 patients). Sensitivity analyses based on study

Comparison of treatment effect estimates of non-vitamin K antagonist oral anticoagulants versus warfarin between observational studies using propensity score methods and randomized controlled trials

International Nuclear Information System (INIS)

Li, Guowei; Holbrook, Anne; Jin, Yanling; Zhang, Yonghong; Levine, Mitchell A. H.; Mbuagbaw, Lawrence; Witt, Daniel M.; Crowther, Mark; Connolly, Stuart; Chai-Adisaksopha, Chatree; Wan, Zhongxiao; Cheng, Ji; Thabane, Lehana

2016-01-01

Emerging observational studies using propensity score (PS) methods assessed real-world comparative effectiveness of non-vitamin K antagonist oral anticoagulants (NOACs) versus warfarin in patients with non-valvular atrial fibrillation (AF). We aimed to compare treatment effect estimates of NOACs between PS studies and randomized controlled trials (RCTs). Electronic databases and conference proceedings were searched systematically. Primary outcomes included stroke or systemic embolism (SE) and major bleeding. A random-effects meta-analysis was performed to synthesize the data by pooling the PS- and RCT-derived hazard ratios (HRs) separately. The ratio of HRs (RHR) from the ratio of PS-derived HRs relative to RCT-derived HRs was used to determine whether there was a difference between estimates from PS studies and RCTs. There were 10 PS studies and 5 RCTs included for analysis. No significant difference of treatment effect estimates between the PS studies and RCTs was observed: RHR 1.11, 95 % CI 0.98–1.23 for stroke or SE; RHR 1.07, 95 % CI 0.87–1.34 for major bleeding. A significant association between NOACs and risk of stroke or SE was observed: HR 0.88, 95 % CI 0.83–0.94 for the PS studies; HR 0.79, 95 % CI 0.72–0.87 for the RCTs. However, no relationship between NOACs and risk of major bleeding was found: HR 0.91, 95 % CI 0.79–1.05 for the PS studies; HR 0.85, 95 % CI 0.73–1.00 for the RCTs. In this study, treatment effect estimates of NOACs versus warfarin in patients with non-valvular AF from PS studies are found to be in agreement with those from RCTs.

Systematic Review and Meta-Analysis of Randomized Controlled Trials of Xingnaojing Treatment for Stroke

Directory of Open Access Journals (Sweden)

Weijun Peng

2014-01-01

Full Text Available Objective. Xingnaojing injection (XNJ is a well-known traditional Chinese patent medicine (TCPM for stroke. The aim of this study is to assess the efficacy of XNJ for stroke including ischemic stroke, intracerebral hemorrhage (ICH, and subarachnoid hemorrhage (SAH. Methods. An extensive search was performed within using eight databases up to November 2013. Randomized controlled trials (RCTs on XNJ for treatment of stroke were collected. Study selection, data extraction, quality assessment, and meta-analysis were conducted according to the Cochrane standards, and RevMan5.0 was used for meta-analysis. Results. This review included 13 RCTs and a total of 1,514 subjects. The overall methodological quality was poor. The meta-analysis showed that XNJ combined with conventional treatment was more effective for total efficacy, neurological deficit improvement, and reduction of TNF-α levels compared with those of conventional treatment alone. Three trials reported adverse events, of these one trial reported mild impairment of kidney and liver function, whereas the other two studies failed to report specific adverse events. Conclusion. Despite the limitations of this review, we suggest that XNJ in combination with conventional medicines might be beneficial for the treatment of stroke. Currently there are various methodological problems in the studies. Therefore, high-quality, large-scale RCTs are urgently needed.

Application of Underwater Shock Wave Focusing to the Development of Extracorporeal Shock Wave Lithotripsy

Science.gov (United States)

Takayama, Kazuyoshi

1993-05-01

This paper describes a summary of a research project for the development of extracorporeal shock wave lithotripsy (ESWL), which has been carried out, under close collaboration between the Shock Wave Research Center of Tohoku University and the School of Medicine, Tohoku University. The ESWL is a noninvasive clinical treatment of disintegrating human calculi and one of the most peaceful applications of shock waves. Underwater spherical shock waves were generated by explosion of microexplosives. Characteristics of the underwater shock waves and of ultrasound focusing were studied by means of holographic interferometric flow visualization and polyvinyliden-difluoride (PVDF) pressure transducers. These focused pressures, when applied to clinical treatments, could effectively and noninvasively disintegrate urinary tract stones or gallbladder stones. However, despite clincal success, tissue damage occurs during ESWL treatments, and the possible mechanism of tissue damage is briefly described.

Revivals of Quantum Wave Packets

OpenAIRE

Bluhm, Robert; Kostelecky, Alan; Porter, James; Tudose, Bogdan

1997-01-01

We present a generic treatment of wave-packet revivals for quantum-mechanical systems. This treatment permits a classification of certain ideal revival types. For example, wave packets for a particle in a one-dimensional box are shown to exhibit perfect revivals. We also examine the revival structure of wave packets for quantum systems with energies that depend on two quantum numbers. Wave packets in these systems exhibit quantum beats in the initial motion as well as new types of long-term r...

Study of the wave packet treatment of neutrino oscillation at Daya Bay

Energy Technology Data Exchange (ETDEWEB)

An, F.P. [East China Univ. of Science and Technology, Shanghai (China). Inst. of Modern Physics; Balantekin, A.B. [Wisconsin Univ., Madison, WI (United States); Band, H.R. [Yale Univ., New Haven, CT (United States). Dept. of Physics; Collaboration: Daya Bay Collaboration; and others

2017-09-15

The disappearance of reactor anti ν{sub e} observed by the Daya Bay experiment is examined in the framework of a model in which the neutrino is described by a wave packet with a relative intrinsic momentum dispersion σ{sub rel}. Three pairs of nuclear reactors and eight antineutrino detectors, each with good energy resolution, distributed among three experimental halls, supply a high-statistics sample of anti ν{sub e} acquired at nine different baselines. This provides a unique platform to test the effects which arise from the wave packet treatment of neutrino oscillation. The modified survival probability formula was used to fit Daya Bay data, providing the first experimental limits: 2.38 x 10{sup -17} < σ{sub rel} < 0.23. Treating the dimensions of the reactor cores and detectors as constraints, the limits are improved: 10{sup -14} or similar 10{sup -11} cm) is obtained. All limits correspond to a 95% C.L. Furthermore, the effect due to the wave packet nature of neutrino oscillation is found to be insignificant for reactor antineutrinos detected by the Daya Bay experiment thus ensuring an unbiased measurement of the oscillation parameters sin{sup 2}2θ{sub 13} and Δm{sup 2}{sub 32} within the plane wave model. (orig.)

Fungicidal Effects of Plasma and Radio-Wave Pre-treatments on Seeds of Grain Crops and Legumes

Science.gov (United States)

Filatova, Irina; Azharonok, Viktor; Shik, Alexander; Antoniuk, Alexandra; Terletskaya, Natalia

An influence of RF plasma and RF electromagnetic field pre-treatments on level of fungal infection of some important agricultural plants has been studied. It is shown that pre-sowing plasma and radio-wave seeds treatments contribute to their germination enhancement and plant productivity improvement owing to stimulative and fungicidal effect of plasma and RF electromagnetic field irradiation.

Survey Email Scheduling and Monitoring in eRCTs (SESAMe): A Digital Tool to Improve Data Collection in Randomized Controlled Clinical Trials.

Science.gov (United States)

Skonnord, Trygve; Steen, Finn; Skjeie, Holgeir; Fetveit, Arne; Brekke, Mette; Klovning, Atle

2016-11-22

Electronic questionnaires can ease data collection in randomized controlled trials (RCTs) in clinical practice. We found no existing software that could automate the sending of emails to participants enrolled into an RCT at different study participant inclusion time points. Our aim was to develop suitable software to facilitate data collection in an ongoing multicenter RCT of low back pain (the Acuback study). For the Acuback study, we determined that we would need to send a total of 5130 emails to 270 patients recruited at different centers and at 19 different time points. The first version of the software was tested in a pilot study in November 2013 but was unable to deliver multiuser or Web-based access. We resolved these shortcomings in the next version, which we tested on the Web in February 2014. Our new version was able to schedule and send the required emails in the full-scale Acuback trial that started in March 2014. The system architecture evolved through an iterative, inductive process between the project study leader and the software programmer. The program was tested and updated when errors occurred. To evaluate the development of the software, we used a logbook, a research assistant dialogue, and Acuback trial participant queries. We have developed a Web-based app, Survey Email Scheduling and Monitoring in eRCTs (SESAMe), that monitors responses in electronic surveys and sends reminders by emails or text messages (short message service, SMS) to participants. The overall response rate for the 19 surveys in the Acuback study increased from 76.4% (655/857) before we introduced reminders to 93.11% (1149/1234) after the new function (P<.001). Further development will aim at securing encryption and data storage. The SESAMe software facilitates consecutive patient data collection in RCTs and can be used to increase response rates and quality of research, both in general practice and in other clinical trial settings. ©Trygve Skonnord, Finn Steen, Holgeir

Tamsulosin for treatment of lower urinary tract symptoms in women: a systematic review and meta-analysis.

Science.gov (United States)

Zhang, H L; Huang, Z G; Qiu, Y; Cheng, X; Zou, X Q; Liu, T T

2017-07-01

Tamsulosin has been used for the off-label treatment of lower urinary tract symptoms (LUTS) in women. Over the past few years, several randomized controlled trials (RCTs) have reported the clinical effectiveness and safety of tamsulosin for LUTS in women. Therefore, the aim of the present study was to perform a meta-analysis to evaluate the safety and efficacy of tamsulosin in treating LUTS in women, which may resolve some of the current controversies over use of the drug and provide more reliable evidence for the use of tamsulosin. A literature review was performed to identify all published RCTs of tamsulosin for the treatment of LUTS in women. The search included the following databases: PUBMED, EMBASE, the Cochrane Controlled Trail Register of Controlled Trials, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Chinese Science and Technique Journals Database (VIP) and Wanfang Database. A systematic review and meta-analysis were conducted. Six RCTs studies involving 764 female participants were included in the analysis. Four out of the six RCTs compared tamsulosin with placebo, one RCT compared tamsulosin with prazosin and the other study compared tamsulosin with tamsulosin combined with tolterodine. Two RCTs evaluated total International Prostate Symptom Score (IPSS) and improved total IPSS compared with the placebo (standardized mean difference=-4.08, 95% confidence interval=-5.93 to -2.23, Ptamsulosin improved the Overactive Bladder Questionnaire score when compared with placebo in only one RCT. For urodynamic parameters, tamsulosin improved the average flow rate and the post-void residual volume when compared with prazosin and tolterodine combined with tamsulosin, respectively. Beyond that, the other parameters showed no significant difference between the treatment and control groups. On the basis of the present evidence, tamsulosin is an effective treatment for the relief of LUTS in women when compared with placebo. However

QUINT : A tool to detect qualitative treatment-subgroup interactions in randomized controlled trials

NARCIS (Netherlands)

Doove, L.L.; Van Deun, K.; Dusseldorp, E.; van Mechelen, I.

2016-01-01

Objective: The detection of subgroups involved in qualitative treatment–subgroup interactions (i.e., for one subgroup of clients treatment A outperforms treatment B, whereas for another the reverse holds true) is crucial for personalized health. In typical Randomized Controlled Trials (RCTs), the

Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Science.gov (United States)

Sehatzadeh, Shayan; Tu, Hong Anh; Palimaka, Stefan; Yap, Belinda; O'Reilly, Daria; Bowen, Jim; Higgins, Caroline; Holubowich, Corinne

2016-01-01

Background To date, several randomized controlled trials (RCTs) have shown the efficacy of repetitive transcranial magnetic stimulation (rTMS) in the treatment of major depression. Objective This analysis examined the antidepressant efficacy of rTMS in patients with treatment-resistant unipolar depression. Methods A literature search was performed for RCTs published from January 1, 1994, to November 20, 2014. The search was updated on March 1, 2015. Two independent reviewers evaluated the abstracts for inclusion, reviewed full texts of eligible studies, and abstracted data. Meta-analyses were conducted to obtain summary estimates. The primary outcome was changes in depression scores measured by the Hamilton Rating Scale for Depression (HRSD), and we considered, a priori, the mean difference of 3.5 points to be a clinically important treatment effect. Remission and response to the treatment were secondary outcomes, and we calculated number needed to treat on the basis of these outcomes. We examined the possibility of publication bias by constructing funnel plots and by Begg's and Egger's tests. A meta-regression was undertaken to examine the effect of specific rTMS technical parameters on the treatment effects. Results Twenty-three RCTs compared rTMS with sham, and six RCTs compared rTMS with electroconvulsive therapy (ECT). Trials of rTMS versus sham showed a statistically significant improvement in depression scores with rTMS (weighted mean difference [WMD] 2.31, 95% CI 1.19–3.43; P transcranial magnetic stimulation had a small short-term effect for improving depression in comparison with sham, but follow-up studies did not show that the small effect will continue for longer periods. PMID:27099642

Albendazole and Corticosteroids for the Treatment of Solitary Cysticercus Granuloma: A Network Meta-analysis.

Science.gov (United States)

Zhao, Bing-Cheng; Jiang, Hong-Ye; Ma, Wei-Ying; Jin, Da-Di; Li, Hao-Miao; Lu, Hai; Nakajima, Hideaki; Huang, Tong-Yi; Sun, Kai-Yu; Chen, Shu-Ling; Chen, Ke-Bing

2016-02-01

Solitary cysticercus granuloma (SCG) is the commonest form of neurocysticercosis in the Indian subcontinent and in travelers. Several different treatment options exist for SCG. We conducted a Bayesian network meta-analysis of randomized clinical trials (RCTs) to identify the best treatment option to prevent seizure recurrence and promote lesion resolution for patients with SCG. PubMed, EMBASE and the Cochrane Library databases (up to June 1, 2015) were searched for RCTs that compared any anthelmintics or corticosteroids, alone or in combination, with placebo or head to head and reported on seizure recurrence and lesion resolution in patients with SCG. A total of 14 RCTs (1277 patients) were included in the quantitative analysis focusing on four different treatment options. A Bayesian network model computing odds ratios (OR) with 95% credible intervals (CrI) and probability of being best (Pbest) was used to compare all interventions simultaneously. Albendazole and corticosteroids combination therapy was the only regimen that significantly decreased the risk of seizure recurrence compared with conservative treatment (OR 0.32, 95% CrI 0.10-0.93, Pbest 73.3%). Albendazole and corticosteroids alone or in combination were all efficacious in hastening granuloma resolution, but the combined therapy remained the best option based on probability analysis (OR 3.05, 95% CrI 1.24-7.95, Pbest 53.9%). The superiority of the combination therapy changed little in RCTs with different follow-up durations and in sensitivity analyses. The limitations of this study include high risk of bias and short follow-up duration in most studies. Dual therapy of albendazole and corticosteroids was the most efficacious regimen that could prevent seizure recurrence and promote lesion resolution in a follow-up period of around one year. It should be recommended for the management of SCG until more high-quality evidence is available.

Symptomatic gallbladder stones. Cost-effectiveness of treatment with extracorporeal shock-wave lithotripsy, conventional and laparoscopic cholecystectomy

NARCIS (Netherlands)

Go, P. M.; Stolk, M. F.; Obertop, H.; Dirksen, C.; van der Elst, D. H.; Ament, A.; van Erpecum, K. J.; van Berge Henegouwen, G. P.; Gouma, D. J.

1995-01-01

In order to strike the most favorable balance between health benefits and costs, three treatment modalities for symptomatic cholelithiasis were compared in a cost-effectiveness study: extracorporeal shock-wave lithotripsy (ESWL), conventional cholecystectomy (CC), and laparoscopic cholecystectomy

Universal instability of dust ion-sound waves and dust-acoustic waves

International Nuclear Information System (INIS)

Tsytovich, V.N.; Watanabe, K.

2002-01-01

It is shown that the dust ion-sound waves (DISW) and the dust-acoustic waves (DAW) are universally unstable for wave numbers less than some critical wave number. The basic dusty plasma state is assumed to be quasi-neutral with balance of the plasma particle absorption on the dust particles and the ionization with the rate proportional to the electron density. An analytical expression for the critical wave numbers, for the frequencies and for the growth rates of DISW and DAW are found using the hydrodynamic description of dusty plasma components with self-consistent treatment of the dust charge variations and by taking into account the change of the ion and electron distributions in the dust charging process. Most of the previous treatment do not take into account the latter process and do not treat the basic state self-consistently. The critical lengths corresponding to these critical wave numbers can be easily achieved in the existing experiments. It is shown that at the wave numbers larger than the critical ones DISW and DAW have a large damping which was not treated previously and which can be also measured. The instabilities found in the present work on their non linear stage can lead to formation of different types of dust self-organized structures. (author)

Shock wave treatment in medicine

Indian Academy of Sciences (India)

Unknown

to open surgery, the cost of the ESWT is very reasonable. But nevertheless it is necessary to improve the basic un ... In second group, shock waves are used to measure distances because of the low energy loss over large distances ... pared to a piezoelectric hydrophone. The rise time of an electrohydraulic generated shock ...

Fundamentals of wave phenomena

CERN Document Server

Hirose, Akira

2010-01-01

This textbook provides a unified treatment of waves that either occur naturally or can be excited and propagated in various media. This includes both longitudinal and transverse waves. The book covers both mechanical and electrical waves, which are normally covered separately due to their differences in physical phenomena.

P Wave Duration And Dispersion In Patients With Hyperthyroidism And The Short-term Effects Of Antithyroid Treatment

Directory of Open Access Journals (Sweden)

Unal Guntekin

2009-09-01

Full Text Available Background: Prolonged P wave duration and P wave dispersion (PWD have been associated with an increased risk for atrial fibrillation (AF. Hyperthytodism is a frequent cause of atrial fibrillation (AF. Methods: Forty-two patients with newly diagnosed overt hyperthyroidism and 20 healthy people were enrolled in the study. Transthoracic echocardiography, 12 lead surface ECG and thyroid hormone levels were studied at the time of enrollment and after achievement of euthyroid state with propylthiouracil treatment. Results: Maximum P wave duration (Pmax (97.4±14.6 vs. 84.2±9.5 msec, p<0.001, PWD (42.9±10.7 vs. 31.0±6.2 msec, p<0.001, deceleration (DT (190.7±22.6 vs. 177.0±10.2 msec, p=0.013 and isovolumetric relaxation times (IVRT (90.9±11.2 vs. 79.6±10.5 msec, p<0.001 were significantly higher in hyperthyroid patients compared to control group. Pmax and PWD were significantly correlated with the presence of hyperthyroidism. Pmax (97.4±14.6 to 84.3±8.6 msec, p<0,001 Pmin (54.1±8.6 to 48.1±8.5 msec, p=0.002, PWD (42.9±10.7 to 35.9±8.1 msec, p=0.002 and DT (190.7±22.6 to 185.5±18.3, p=0.036 were significantly decreased after achievement of euthyroid state in patients with hyperthyroidism. Diastolic dyfunction was seen in 5 patients at hyperthroid state but only in one patient at euthyroid state. Conclusions: Hyperthyroidism is associated with prolonged P wave duration and dispersion. Achievement of euthyroid state with propylthiouracil treatment results in shortening of P wave variables. Diastolic function may have a partial effect for the increased Pmax and PWD. Shortening of Pmax and PWD may be a marker for the prevention of AF with the anti-thyroid treatment.

Evidence-Base Update of Psychosocial Treatments for Child and Adolescent Depression

Science.gov (United States)

Weersing, V. Robin; Jeffreys, Megan; Do, Minh-Chau T.; Schwartz, Karen T. G.; Bolano, Carl

2017-01-01

Depression in youth is prevalent and disabling and tends to presage a chronic and recurrent course of illness and impairment in adulthood. Clinical trial research in youth depression has a 30 year history, and evidence-based treatment reviews appeared in 1998 and 2008. The current review of 42 randomized controlled trials (RCTs) updates these reviews to include RCTs published between 2008 and 2014 (N = 14) and re-evaluates previously reviewed literature. Given the growing maturity of the field, this review utilized a stringent set of methodological criteria for trial inclusion, most notable for excluding trials based in sub-clinical samples of youth that had been included in previous reviews (N = 12) and including well-designed RCTs with null and negative findings (N = 8). Findings from the current review suggest that evidence for child treatments is notably weaker than for adolescent interventions, with no child treatments achieving well-established status and the evidentiary basis of treatments downgraded from previous reports. Cognitive behavioral therapy (CBT) for clinically depressed children appears to be possibly efficacious, with mixed findings across trials. For depressed adolescents, both CBT and Interpersonal Psychotherapy (IPT) are well-established interventions, with evidence of efficacy in multiple trials by independent investigative teams. This positive conclusion is tempered by the small size of the IPT literature (N = 6) and concern that CBT effects may be attenuated in clinically complicated samples and when compared against active control conditions. In conclusion, data on predictors, moderators, and mediators are examined and priorities for future research discussed. PMID:27870579

Evidence Base Update of Psychosocial Treatments for Child and Adolescent Depression.

Science.gov (United States)

Weersing, V Robin; Jeffreys, Megan; Do, Minh-Chau T; Schwartz, Karen T G; Bolano, Carl

2017-01-01

Depression in youth is prevalent and disabling and tends to presage a chronic and recurrent course of illness and impairment in adulthood. Clinical trial research in youth depression has a 30-year history, and evidence-based treatment reviews appeared in 1998 and 2008. The current review of 42 randomized controlled trials (RCTs) updates these reviews to include RCTs published between 2008 and 2014 (N = 14) and reevaluates previously reviewed literature. Given the growing maturity of the field, this review utilized a stringent set of methodological criteria for trial inclusion, most notable for excluding trials based in subclinical samples of youth that had been included in previous reviews (N = 12) and including well-designed RCTs with null and negative findings (N = 8). Findings from the current review suggest that evidence for child treatments is notably weaker than for adolescent interventions, with no child treatments achieving well-established status and the evidentiary basis of treatments downgraded from previous reports. Cognitive behavioral therapy (CBT) for clinically depressed children appears to be possibly efficacious, with mixed findings across trials. For depressed adolescents, both CBT and interpersonal psychotherapy are well-established interventions, with evidence of efficacy in multiple trials by independent investigative teams. This positive conclusion is tempered by the small size of the interpersonal psychotherapy literature (N = 6) and concern that CBT effects may be attenuated in clinically complicated samples and when compared against active control conditions. Data on predictors, moderators, and mediators are examined and priorities for future research discussed.

Reporting of symptoms in randomized controlled trials of atopic eczema treatments: a systematic review.

Science.gov (United States)

Gerbens, L A A; Chalmers, J R; Rogers, N K; Nankervis, H; Spuls, P I

2016-10-01

'Symptoms' is a core outcome domain for atopic eczema (AE) trials, agreed by consensus as part of the Harmonising Outcome Measures for Eczema (HOME) initiative. To standardize and validate the core domain symptoms and symptom instruments for AE trials the HOME roadmap is followed. Its first step is to establish if and how symptoms have been measured in published AE treatment trials. Therefore the Global Resource for Eczema Trials database was used to collect all randomized controlled trials (RCTs) of treatments for AE between January 2000 and April 2014. Study selection and data extraction were performed by three reviewers independently. We identified the use of symptoms in 295 of 378 trials (78%). Symptoms as a primary end point were applied by 147 RCTs (50%). Seventeen different symptoms were measured, but mostly itch and sleep loss. Symptoms were assessed by only 37% of trials by a stand-alone symptom measurement. Overall 63% of RCTs used a composite instrument, and 30 different instruments were identified. The Scoring Atopic Dermatitis (SCORAD) index was the most commonly applied, but only 23% of RCTs reported the SCORAD symptom score separately. This systematic review demonstrates that symptoms, most frequently itch and sleep loss, are commonly reported in AE treatment trials, but are measured using many different instruments. Often symptoms are evaluated as part of a composite instrument, and currently it is not possible to extract symptoms-only data from most published studies. Future trials should report symptom scores to permit meta-analysis of the core outcomes. © 2016 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.

A framework to assess the value of application of formal criteria to check clinical relevance in RCTs as part of a benefit assessment strategy.

Science.gov (United States)

Vach, Werner; Gladstone, Beryl Primrose

2016-01-01

Recently, the topic of assessing clinical relevance on top of statistical significance in the analysis of randomized control trials (RCTs) has got increasing attention, in particular as part of benefit assessments. Several formal criteria to serve this purpose have been published. In this paper, we present a framework to assess the value of the application of such criteria. We propose to quantify the need for the assessment of clinical relevance by the actual risk of having accepted a benefit for a treatment with an irrelevant effect in a successful RCT. We then study how this risk can be controlled by two popular criteria based on comparing the effect estimate or the lower bound of the confidence interval with a given threshold. We further propose to quantify the impact of using formal criteria by considering the expected costs when specifying error-specific costs for each of the three possible types of errors: A benefit may be accepted for a treatment, which is actually inferior, or which is not inferior, but only implies an irrelevant improvement, or a benefit may be rejected for a treatment implying a relevant improvement. This way we can demonstrate that the impact depends on parameters which are typically not explicitly defined in the frame of benefit assessments. Depending on the values of these parameters, formal checks of clinical relevance may imply better decisions on average, but they may also imply more harm than good on average. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Alternative pharmacological treatment options for agitation in Alzheimer’s disease

Directory of Open Access Journals (Sweden)

Francesco Panza

2015-11-01

Full Text Available In patients with dementia and Alzheimer’s disease (AD, treatment of neuropsychiatric symptoms (NPS is a major concern in the management of these devastating diseases. Among NPS in AD, agitation and aggression are common with earlier institutionalization, increased morbidity and mortality, and greater caregiver burden. Pharmacological treatments for AD-related agitation, specifically off-label use of atypical antipsychotics, showed only modest improvements, with increased side-effect burden and risk of mortality. Non-pharmacological treatment approaches have become the preferred firstline option. However, when such treatments fail, pharmacological options are often used. Therefore, there is an urgent need to identify effective and safe pharmacological treatments for agitation/aggression in AD and dementia. Unfortunately, progresses have been slow, with a small number of methodologically heterogeneous randomized controlled trials (RCTs, with disappointing results. However, evidence coming from recently completed RCTs on novel or repositioned drugs (mibampator, dextromethorphan/ quinidine, cannabinoids, and citalopram showed some promise in treating agitation in AD, but still with safety concerns. Further evidence will come from ongoing Phase II and III trials on promising novel drugs for treating these distressing symptoms in patients with AD and dementia.

A systematic review on zinc for the prevention and treatment of age-related macular degeneration.

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Vishwanathan, Rohini; Chung, Mei; Johnson, Elizabeth J

2013-06-12

The objective of this systematic review was to examine the evidence on zinc intake from foods and supplements in the primary prevention and treatment of AMD. Randomized controlled trials (RCTs), prospective cohort, retrospective cohort, and case-control studies that investigated zinc intake from foods and/or supplements, and AMD in men and women with a mean age of 50 years or older were included. Medline and Cochrane Central were searched from inception to February 2012 and November 2012, respectively. Data extraction and quality appraisal were done on all eligible studies. TEN STUDIES WERE INCLUDED: four RCTs, four prospective cohort, and two retrospective cohort studies. Age-related Eye Disease Study (AREDS) showed zinc treatment to significantly reduce the risk of progression to advanced AMD. The risk of visual acuity loss was of similar magnitude, but not statistically significant. Two RCTs reported statistically significant increases in visual acuity in early AMD patients and one RCT showed no effect of zinc treatment on visual acuity in advanced AMD patients. Results from six cohort studies on associations between zinc intake and incidence of AMD were inconsistent. Current evidence on zinc intake for the prevention of AMD is inconclusive. Based on the strength of AREDS, we can conclude that zinc treatment may be effective in preventing progression to advanced AMD. Zinc supplementation alone may not be sufficient to produce clinically meaningful changes in visual acuity.

The safety of available treatments of male hypogonadism in organic and functional hypogonadism.

Science.gov (United States)

Corona, G; Rastrelli, G; Reisman, Y; Sforza, A; Maggi, M

2018-03-01

In the case of primary male hypogonadism (HG), only testosterone (T) replacement therapy (TRT) is possible whereas when the problem is secondary to a pituitary or hypothalamus alteration both T production and fertility can be, theoretically, restored. We here systematically reviewed and discussed the advantages and limits of medications formally approved for the treatment of HG. Areas covered: Data derived from available meta-analyses of placebo controlled randomized trials (RCTs) were considered and analyzed. Gonadotropins are well-toleratedand their use is mainly limited by higher costs and a more cumbersome treatment schedule than TRT. Available RCTs on TRT suggest that cardiovascular (CV) and venous thromboembolism risk is not a major issue and that prostate safety is guaranteed. The risk of increased hematocrit is mainly limited to the use of short terminjectable preparations. Expert opinion: In the last few years the concept of 'organic' irreversible HG and 'functional' or age- and comorbidity-related HG has been introduced. This definition is not evidence-based. The majority of RCTs enrolled patients with 'functional' HG. Considering the significant improvement in body composition, glucose metabolism and sexual activity, TRT should not be limited to 'organic' HG, but also offered for 'functional'.

Shared decision-making for prostate cancer screening and treatment: a systematic review of randomised controlled trials.

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Martínez-González, Nahara Anani; Plate, Andreas; Senn, Oliver; Markun, Stefan; Rosemann, Thomas; Neuner-Jehle, Stefan

2018-02-23

Men facing prostate cancer screening and treatment need to make critical and highly preference-sensitive decisions that involve a variety of potential benefits and risks. Shared decision-making (SDM) is considered fundamental for "preference-sensitive" medical decisions and it is guideline-recommended. There is no single definition of SDM however. We systematically reviewed the extent of SDM implementation in interventions to facilitate SDM for prostate cancer screening and treatment. We searched Medline Ovid, Embase (Elsevier), CINHAL (EBSCOHost), The Cochrane Library (Wiley), PsychINFO (EBSCOHost), Scopus, clinicaltrials.gov, ISRCTN registry, the WHO search portal, ohri.ca, opengrey.eu, Google Scholar, and the reference lists of included studies, clinical guidelines and relevant reviews. We also contacted the authors of relevant abstracts without available full text. We included primary peer-reviewed and grey literature of randomised controlled trials (RCTs) reported in English, conducted in primary and specialised care, addressing interventions aiming to facilitate SDM for prostate cancer screening and treatment. Two reviewers independently selected studies, appraised interventions and assessed the extent of SDM implementation based on the key features of SDM, namely information exchange, deliberation and implementation. We considered bi-directional deliberation as a central and mandatory component of SDM. We performed a narrative synthesis. Thirty-six RCTs including 19 196 randomised patients met the eligibility criteria; they were mainly conducted in North America (n = 28). The median year of publication was 2008 (1997-2015). Twenty-three RCTs addressed decision-making for screening, twelve for treatment and one for both screening and treatment for prostate cancer. Bi-directional interactions between healthcare providers and patients were verified in 31 RCTs, but only 14 fulfilled the three key SDM features, 14 had at least "deliberation", one had "unclear

Effectiveness of Manual Therapy Combined With Physical Therapy in Treatment of Patellofemoral Pain Syndrome: Systematic Review.

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Espí-López, Gemma Victoria; Arnal-Gómez, Anna; Balasch-Bernat, Mercè; Inglés, Marta

2017-06-01

The purpose of this study was to conduct a review of randomized controlled trials (RCTs) to determine the treatment effectiveness of the combination of manual therapy (MT) with other physical therapy techniques. Systematic searches of scientific literature were undertaken on PubMed and the Cochrane Library (2004-2014). The following terms were used: "patellofemoral pain syndrome," "physical therapy," "manual therapy," and "manipulation." RCTs that studied adults diagnosed with patellofemoral pain syndrome (PFPS) treated by MT and physical therapy approaches were included. The quality of the studies was assessed by the Jadad Scale. Five RCTs with an acceptable methodological quality (Jadad ≥ 3) were selected. The studies indicated that MT combined with physical therapy has some effect on reducing pain and improving function in PFPS, especially when applied on the full kinetic chain and when strengthening hip and knee muscles. The different combinations of MT and physical therapy programs analyzed in this review suggest that giving more emphasis to proximal stabilization and full kinetic chain treatments in PFPS will help better alleviation of symptoms.

Monitoring the lesion formation during histotripsy treatment using shear wave imaging

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Arnal, Bastien; Lee, Wei-Ning; Pernot, Mathieu; Fink, Mathias; Tanter, Mickael

2012-11-01

Monitoring the lesion formation induced by histotripsy has mainly relied on the quantitative change in backscatter intensity using ultrasound B-mode imaging. However, how the mechanical properties of the histotripsy-treated tissue region alter during the procedure is yet to be fully investigated. We thus proposed here to monitor such a therapeutic process based on shear modulus estimated by shear wave imaging (SWI). In the therapeutic procedure, a single-element piezo-composite focused transducer (Imasonic, Besançon, France) with a center frequency of 660 kHz, a focal length of 45 mm, and an fnumber of 1 was driven by a function generator (AFG 3101, Tektronix, Beaverton, OR) and a gated RF power amplifier (GA-2500A, RITEC Inc., USA) to generate ultrasound histotripsy pulses. Histotripsy pulses were delivered for 20 seconds and then followed by a 30-second pause and a rapid monitoring step. Such a treatment and monitoring scheme was repeated for 10 mins. Both the reference measurement and monitoring were realized by SWI, where plane shear waves were generated by an 8 MHz linear array probe connected to a prototype ultrasound scanner, and acquired at a frame rate of 10000 Hz. Shear modulus was estimated and mapped in 2D through a time-of-flight algorithm. Gelatin (8%)-agar (2%) phantoms and ex-vivo porcine liver samples were tested. Regions of interests (ROI's) of 2 mm-by-2 mm in both untreated and treated regions were selected to compute the contrast-to-noise ratio (CNR). In all three scenarios where different PD's and PRF's were implemented, during the first 100 seconds of the treatment, 50% decrease in the shear modulus within the histotripsy-targeted zone was already observed, and the CNR of the shear modulus increased by 18 dB. In contrast, the backscatter intensity began to reduce and the corresponding CNR was found to increase by 6 dB only after 120 seconds of treatment. The results demonstrated that SWI can map quantitatively the change of mechanical

Hypnosis Treatment of Gastrointestinal Disorders: A Comprehensive Review of the Empirical Evidence.

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Palsson, Olafur S

2015-10-01

Hypnotherapy has been investigated for 30 years as a treatment for gastrointestinal (GI) disorders. There are presently 35 studies in the published empirical literature, including 17 randomized controlled trials (RCTs) that have assessed clinical outcomes of such treatment. This body of research is reviewed comprehensively in this article. Twenty-four of the studies have tested hypnotherapy for adult irritable bowel syndrome (IBS) and 5 have focused on IBS or abdominal pain in children. All IBS hypnotherapy studies have reported significant improvement in gastrointestinal symptoms, and 7 out of 10 RCTs in adults and all 3 RCTs in pediatric patient samples found superior outcomes for hypnosis compared to control groups. Collectively this body of research shows unequivocally that for both adults and children with IBS, hypnosis treatment is highly efficacious in reducing bowel symptoms and can offer lasting and substantial symptom relief for a large proportion of patients who do not respond adequately to usual medical treatment approaches. For other GI disorders the evidence is more limited, but preliminary indications of therapeutic potential can be seen in the single randomized controlled trials published to date on hypnotherapy for functional dyspepsia, functional chest pain, and ulcerative colitis. Further controlled hypnotherapy trials in those three disorders should be a high priority. The mechanisms underlying the impact of hypnosis on GI problems are still unclear, but findings from a number of studies suggest that they involve both modulation of gut functioning and changes in the brain's handling of sensory signals from the GI tract.

High-energy versus low-energy extracorporeal shock wave therapy for calcifying tendinitis of the shoulder: which is superior? A meta-analysis.

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Verstraelen, F U; In den Kleef, N J H M; Jansen, L; Morrenhof, J W

2014-09-01

There are several treatment options for calcifying tendinitis of the shoulder. The next step treatment after conservative treatment fails is still a matter of dispute. Extracorporeal shock wave therapy (ESWT) has been shown to be a good alternative to surgery, but the best treatment intensity remains unknown. High-energy ESWT is much more painful, more expensive, and usually is done in an inpatient setting, whereas low-energy ESWT can be performed in an outpatient setting by a physical therapist. A systematic review and meta-analysis of randomized trials was performed to answer two clear research questions: (1) Is there a greater increase in the Constant-Murley score in patients treated with high-energy ESWT compared with those treated with low-energy ESWT by 3 months and by 6 months? (2) Is there a greater chance of complete resorption of the calcifications in patients treated with high-energy ESWT compared with those treated with low-energy ESWT by 3 months and by 6 months? Five relevant electronic online databases, Medline (through PubMed), EMBASE (through OVID), Cinahl (through EBSCO), Web of Science, and the Cochrane Central Register of Controlled Trials, were systematically searched. We also crosschecked the reference lists of articles and reviews for possible relevant studies. Eligible for inclusion were all randomized controlled trials (RCTs) that compared high-energy ESWT (> 0.28 mJ/mm(2)) with low-energy ESWT (energy ESWT compared with patients treated with low-energy ESWT at 3 and 6 months. The 3-month mean difference was 9.88 (95% CI, 9.04-10.72, p energy ESWT more often resulted in complete resorption of the deposits at 3 months. The corresponding odds ratio was 3.40 (95% CI, 1.35-8.58) and p = 0.009 (6-month data could not be pooled). When shock wave therapy is chosen, high-energy shock wave therapy is more likely to result in improved Constant-Murley score and resorption of the deposits compared with low-energy therapy. Level I, therapeutic study

Emerging treatment options for refractory angina pectoris: ranolazine, shock wave treatment, and cell-based therapies.

Science.gov (United States)

Gennari, Marco; Gambini, Elisa; Bassetti, Beatrice; Capogrossi, Maurizio; Pompilio, Giulio

2014-01-01

A challenge of modern cardiovascular medicine is to find new, effective treatments for patients with refractory angina pectoris, a clinical condition characterized by severe angina despite optimal medical therapy. These patients are not candidates for surgical or percutaneous revascularization. Herein we review the most up-to-date information regarding the modern approach to the patient with refractory angina pectoris, from conventional medical management to new medications and shock wave therapy, focusing on the use of endothelial precursor cells (EPCs) in the treatment of this condition. Clinical limitations of the efficiency of conventional approaches justify the search for new therapeutic options. Regenerative medicine is considered the next step in the evolution of organ replacement therapy. It is driven largely by the same health needs as transplantation and replacement therapies, but it aims further than traditional approaches, such as cell-based therapy. Increasing knowledge of the role of circulating cells derived from bone marrow (EPCs) on cardiovascular homeostasis in physiologic and pathologic conditions has prompted the clinical use of these cells to relieve ischemia. The current state of therapeutic angiogenesis still leaves many questions unanswered. It is of paramount importance that the treatment is delivered safely. Direct intramyocardial and intracoronary administration has demonstrated acceptable safety profiles in early trials, and may represent a major advance over surgical thoracotomy. The combined efforts of bench and clinical researchers will ultimately answer the question of whether cell therapy is a suitable strategy for treatment of patients with refractory angina.

A systematic review of electrical stimulation for pressure ulcer prevention and treatment in people with spinal cord injuries.

Science.gov (United States)

Liu, Liang Qin; Moody, Julie; Traynor, Michael; Dyson, Sue; Gall, Angela

2014-11-01

Electrical stimulation (ES) can confer benefit to pressure ulcer (PU) prevention and treatment in spinal cord injuries (SCIs). However, clinical guidelines regarding the use of ES for PU management in SCI remain limited. To critically appraise and synthesize the research evidence on ES for PU prevention and treatment in SCI. Review was limited to peer-reviewed studies published in English from 1970 to July 2013. Studies included randomized controlled trials (RCTs), non-RCTs, prospective cohort studies, case series, case control, and case report studies. Target population included adults with SCI. Interventions of any type of ES were accepted. Any outcome measuring effectiveness of PU prevention and treatment was included. Methodological quality was evaluated using established instruments. Twenty-seven studies were included, 9 of 27 studies were RCTs. Six RCTs were therapeutic trials. ES enhanced PU healing in all 11 therapeutic studies. Two types of ES modalities were identified in therapeutic studies (surface electrodes, anal probe), four types of modalities in preventive studies (surface electrodes, ES shorts, sacral anterior nerve root implant, neuromuscular ES implant). The methodological quality of the studies was poor, in particular for prevention studies. A significant effect of ES on enhancement of PU healing is shown in limited Grade I evidence. The great variability in ES parameters, stimulating locations, and outcome measure leads to an inability to advocate any one standard approach for PU therapy or prevention. Future research is suggested to improve the design of ES devices, standardize ES parameters, and conduct more rigorous trials.

Treatments for bulimia nervosa: a network meta-analysis.

Science.gov (United States)

Slade, Eric; Keeney, Edna; Mavranezouli, Ifigeneia; Dias, Sofia; Fou, Linyun; Stockton, Sarah; Saxon, Leanne; Waller, Glenn; Turner, Hannah; Serpell, Lucy; Fairburn, Christopher G; Kendall, Tim

2018-05-06

Bulimia nervosa (BN) is a severe eating disorder that can be managed using a variety of treatments including pharmacological, psychological, and combination treatments. We aimed to compare their effectiveness and to identify the most effective for the treatment of BN in adults. A search was conducted in Embase, Medline, PsycINFO, and Central from their inception to July 2016. Studies were included if they reported on treatments for adults who fulfilled diagnostic criteria for BN. Only randomised controlled trials (RCTs) that examined available psychological, pharmacological, or combination therapies licensed in the UK were included. We conducted a network meta-analysis (NMA) of RCTs. The outcome analysed was full remission at the end of treatment. We identified 21 eligible trials with 1828 participants involving 12 treatments, including wait list. The results of the NMA suggested that individual cognitive behavioural therapy (CBT) (specific to eating disorders) was most effective in achieving remission at the end of treatment compared with wait list (OR 3.89, 95% CrI 1.19-14.02), followed by guided cognitive behavioural self-help (OR 3.81, 95% CrI 1.51-10.90). Inconsistency checks did not identify any significant inconsistency between the direct and indirect evidence. The analysis suggested that the treatments that are most likely to achieve full remission are individual CBT (specific to eating disorders) and guided cognitive behavioural self-help, although no firm conclusions could be drawn due to the limited evidence base. There is a need for further research on the maintenance of treatment effects and the mediators of treatment outcome.

[Extracorporeal cardiac shock wave therapy for treatment of coronary artery disease].

Science.gov (United States)

Wang, Yu; Guo, Tao; Cai, Hong-Yan; Ma, Tie-Kun; Tao, Si-Ming; Chen, Ming-Qing; Gu, Yun; Pan, Jia-Hua; Xiao, Jian-Ming; Zhao, Ling; Yang, Xi-Yun; Yang, Chao

2010-08-01

To evaluate the feasibility and efficiency of extracorporeal cardiac shock wave therapy (CSWT) for treatment of coronary artery disease. Twenty-five patients with 1 - 16 years history of chronic angina pectoris underwent the CSWT. Before and after the treatment, low-dose Dobutamine stress echocardiography and (99)Tc(m)-MIBI myocardial perfusion SPECT were applied to locate the ischemic segments, detect the viable myocardium and evaluate the effect of CSWT. Under the guidance of echocardiography, CSWT was applied in R-wave-triggered manner with low energy (0.09 mJ/mm(2)) at 200 shoots/spot for 9 spots (-1-0-+1 combination). Patients were divided group A and group B. Sixteen patients in group A were applied 9 sessions on 29 segments within 3 month and nine patients in group B were applied 9 sessions on 13 segments within 1 month. Ten chronic angina pectoris patients receiving standard medication served as controls. All patients completed the 9 sessions without procedural complications or adverse effects. CSWT significantly improved symptoms as evaluated by NYHA, Canadian Cardiovascular Society (CCS) class sores, Seattle angina questionnaire (SAQ), 6-min walk and the use of nitroglycerin (P < 0.05). CSWT also improved myocardial perfusion and regional myocardium function as evaluated by rest SPECT and stress peak systolic strain rate (PSSR) (P < 0.01). Myocardial perfusion improvement was more significant in group A compared with group B (1.21 ± 0.86 vs. 0.83 ± 0.80, P < 0.01). All parameters remained unchanged in control group during follow up. These preliminary results indicate that CSWT is safe and effective on ameliorating anginal symptoms for chronic angina pectoris patients.

Effects of high- and low-energy radial shock waves therapy combined with physiotherapy in the treatment of rotator cuff tendinopathy: a retrospective study.

Science.gov (United States)

Su, Xiangzheng; Li, Zhongli; Liu, Zhengsheng; Shi, Teng; Xue, Chao

2017-06-09

The aim of this study was to investigate the efficacy of high- and low-energy radial shock waves combined with physiotherapy for rotator cuff tendinopathy patients. Data from rotator cuff tendinopathy patients received high- or low-energy radial shock waves combined with physiotherapy or physiotherapy alone were collected. The Constant and Murley score and visual analog scale score were collected to assess the effectiveness of treatment in three groups at 4, 8, 12, and 24 weeks. In total, 94 patients were involved for our retrospective study. All groups showed remarkable improvement in the visual analog scale and Constant and Murley score compared to baseline at 24 weeks. The high-energy radial shock waves group had more marked improvement in the Constant and Murley score compared to the physiotherapy group at 4 and 8 weeks and at 4 weeks when compared with low-energy group. Furthermore, high-energy radial shock waves group had superior results on the visual analog scale at 4, 8, and 12 weeks compared to low-energy and physiotherapy groups. This retrospective study supported the usage of high-energy radial shock waves as a supplementary therapy over physiotherapy alone for rotator cuff tendinopathy by relieving the symptoms rapidly and maintaining symptoms at a satisfactory level for 24 weeks. Implications for Rehabilitation High-energy radial shock waves can be a supplemental therapy to physiotherapy for rotator cuff tendinopathy. We recommend the usage of high-energy radial shock waves during the first 5 weeks, at an interval of 7 days, of physiotherapy treatment. High-energy radial shock waves treatment combined with physiotherapy can benefit rotator cuff tendinopathy by relieving symptoms rapidly and maintain these improvements at a satisfactory level for quite a long time.

The Effect on Treatment Adherence of Administering Drugs as Fixed-Dose Combinations versus as Separate Pills: Systematic Review and Meta-Analysis.

Science.gov (United States)

van Galen, Katy A; Nellen, Jeannine F; Nieuwkerk, Pythia T

2014-01-01

Administering drugs as fixed-dose combinations (FDCs) versus the same active drugs administered as separate pills is assumed to enhance treatment adherence. We synthesized evidence from randomized controlled trials (RCTs) about the effect of FDCs versus separate pills on adherence. We searched PubMed for RCTs comparing a FDC with the same active drugs administered as separate pills, including a quantitative estimate of treatment adherence, without restriction to medical condition. The odds ratio (OR) of optimal adherence with FDCs versus separate pills was used as common effect size and aggregated into a pooled effect estimate using a random effect model with inverse variance weights. Out of 1258 articles screened, only six studies fulfilled inclusion criteria. Across medical conditions, administering drugs as FDC significantly increased the likelihood of optimal adherence (OR 1.33 (95% CI, 1.03-1.71)). Within subgroups of specific medical conditions, the favourable effect of FDCs on adherence was of borderline statistical significance for HIV infection only (OR 1.46 (95% CI, 1.00-2.13)). We observed a remarkable paucity of RCTs comparing the effect on adherence of administering drugs as FDC versus as separate pills. Administering drugs as FDC improved medication adherence. However, this conclusion is based on a limited number of RCTs only.

Treatment of cannabis use among people with psychotic or depressive disorders: a systematic review.

Science.gov (United States)

Baker, Amanda L; Hides, Leanne; Lubman, Dan I

2010-03-01

This article systematically reviews the evidence from randomized controlled trials (RCTs) for pharmacologic and psychological approaches to the treatment of cannabis use among individuals with psychotic or depressive disorders. A systematic literature search was conducted using the PubMed and PsychINFO databases from inception to December 2008. Individual searches in cannabis use (search terms: marijuana, cannabis, marijuana abuse, cannabis abuse, marijuana usage, cannabis usage), mental disorders (search terms: mood disorders, affective disorders, anxiety disorders, anxiety, depressive disorder, depression, psychotic disorders, psychosis, mental disorders), and pharmacotherapy (search terms: medication, drug therapy, pharmacotherapy, psychopharmacology, clinical trials, drug trial, treatment trial) were conducted and limited to humans, adolescents and adults. A search combining the individual cannabis use, mental disorder and pharmacotherapy searches produced 1,713 articles (PubMed = 1,398; PsychINFO = 315). Combining the cannabis use and mental disorder searches while limiting them to English articles and RCTs produced a total of 286 articles (PubMed = 228; PsychINFO = 58). From this literature, there were 7 RCTs conducted among mental health clients that reported cannabis use outcomes using pharmacologic or psychological interventions. While few RCTs have been conducted, there is evidence that pharmacologic and psychological interventions are effective for reducing cannabis use in the short-term among people with psychotic disorders or depression. Although it is difficult to make evidence-based treatment recommendations due to the paucity of research in this area, available studies indicate that effectively treating the mental health disorder with standard pharmacotherapy may be associated with a reduction in cannabis use and that longer or more intensive psychological interventions rather than brief interventions may be required, particularly among heavier

Treatment of allergic rhinitis using mobile technology with real world data

DEFF Research Database (Denmark)

Bousquet, J; Arnavielhe, S; Bedbrook, A

2018-01-01

BACKGROUND: Large observational implementation studies are needed to triangulate the findings from randomized control trials (RCTs) as they reflect "real world" everyday practice. In a pilot study, we attempted to provide additional and complementary insights on the real life treatment of allergi...

Deep Downhole Seismic Testing at the Waste Treatment Plant Site, Hanford, WA. Volume I P-Wave Measurements in Borehole C4993 Seismic Records, Wave-Arrival Identifications and Interpreted P-Wave Velocity Profile.

Energy Technology Data Exchange (ETDEWEB)

Stokoe, Kenneth H.; Li, Song Cheng; Cox, Brady R.; Menq, Farn-Yuh

2007-07-06

In this volume (I), all P-wave measurements are presented that were performed in Borehole C4993 at the Waste Treatment Plant (WTP) with T-Rex as the seismic source and the Lawrence Berkeley National Laboratory (LBNL) 3-D wireline geophone as the at-depth borehole receiver. P-wave measurements were performed over the depth range of 370 to 1400 ft, typically in 10-ft intervals. However, in some interbeds, 5-ft depth intervals were used, while below about 1200 ft, depth intervals of 20 ft were used. Compression (P) waves were generated by moving the base plate of T-Rex for a given number of cycles at a fixed frequency as discussed in Section 2. This process was repeated so that signal averaging in the time domain was performed using 3 to about 15 averages, with 5 averages typically used. In addition to the LBNL 3-D geophone, called the lower receiver herein, a 3-D geophone from Redpath Geophysics was fixed at a depth of 22 ft in Borehole C4993, and a 3-D geophone from the University of Texas was embedded near the borehole at about 1.5 ft below the ground surface. This volume is organized into 12 sections as follows: Section 1: Introduction, Section 2: Explanation of Terminology, Section 3: Vp Profile at Borehole C4993, Sections 4 to 6: Unfiltered P-wave records of lower vertical receiver, reaction mass, and reference receiver, Sections 7 to 9: Filtered P-wave signals of lower vertical receiver, reaction mass and reference receiver, Section 10: Expanded and filtered P-wave signals of lower vertical receiver, and Sections 11 and 12: Waterfall plots of unfiltered and filtered lower vertical receiver signals.

Deep Downhole Seismic Testing at the Waste Treatment Plant Site, Hanford, WA. Volume III P-Wave Measurements in Borehole C4997 Seismic Records, Wave-Arrival Identifications and Interpreted P-Wave Velocity Profile.

Energy Technology Data Exchange (ETDEWEB)

Stokoe, Kenneth H.; Li, Song Cheng; Cox, Brady R.; Menq, Farn-Yuh

2007-06-06

In this volume (III), all P-wave measurements are presented that were performed in Borehole C4997 at the Waste Treatment Plant (WTP) with T-Rex as the seismic source and the Lawrence Berkeley National Laboratory (LBNL) 3-D wireline geophone as the at-depth borehole receiver. P-wave measurements were performed over the depth range of 390 to 1220 ft, typically in 10-ft intervals. However, in some interbeds, 5-ft depth intervals were used. Compression (P) waves were generated by moving the base plate of T-Rex for a given number of cycles at a fixed frequency as discussed in Section 2. This process was repeated so that signal averaging in the time domain was performed using 3 to about 15 averages, with 5 averages typically used. In addition to the LBNL 3-D geophone, called the lower receiver herein, a 3-D geophone from Redpath Geophysics was fixed at a depth of 40 ft (later relocated to 27.5 ft due to visibility in borehole after rain) in Borehole C4997, and a 3-D geophone from the University of Texas was embedded near the borehole at about 1.5 ft below the ground surface. This volume is organized into 12 sections as follows: Section 1: Introduction, Section 2: Explanation of Terminology, Section 3: Vp Profile at Borehole C4997, Sections 4 to 6: Unfiltered P-wave records of lower vertical receiver, reaction mass, and reference receiver, Sections 7 to 9: Filtered P-wave signals of lower vertical receiver, reaction mass and reference receiver, Section 10: Expanded and filtered P-wave signals of lower vertical receiver, and Sections 11 and 12: Waterfall plots of unfiltered and filtered lower vertical receiver signals.

Deep Downhole Seismic Testing at the Waste Treatment Plant Site, Hanford, WA. Volume II P-Wave Measurements in Borehole C4996 Seismic Records, Wave-Arrival Identifications and Interpreted P-Wave Velocity Profile.

Energy Technology Data Exchange (ETDEWEB)

Stokoe, Kenneth H.; Li, Song Cheng; Cox, Brady R.; Menq, Farn-Yuh

2007-07-06

In this volume (II), all P-wave measurements are presented that were performed in Borehole C4996 at the Waste Treatment Plant (WTP) with T-Rex as the seismic source and the Lawrence Berkeley National Laboratory (LBNL) 3-D wireline geophone as the at-depth borehole receiver. P-wave measurements were performed over the depth range of 360 to 1400 ft, typically in 10-ft intervals. However, in some interbeds, 5-ft depth intervals were used, while below about 1180 ft, depth intervals of 20 ft were used. Compression (P) waves were generated by moving the base plate of T-Rex for a given number of cycles at a fixed frequency as discussed in Section 2. This process was repeated so that signal averaging in the time domain was performed using 3 to about 15 averages, with 5 averages typically used. In addition to the LBNL 3-D geophone, called the lower receiver herein, a 3-D geophone from Redpath Geophysics was fixed at a depth of 22 ft in Borehole C4996, and a 3-D geophone from the University of Texas was embedded near the borehole at about 1.5 ft below the ground surface. This volume is organized into 12 sections as follows: Section 1: Introduction, Section 2: Explanation of Terminology, Section 3: Vp Profile at Borehole C4996, Sections 4 to 6: Unfiltered P-wave records of lower vertical receiver, reaction mass, and reference receiver, Sections 7 to 9: Filtered P-wave signals of lower vertical receiver, reaction mass and reference receiver, Section 10: Expanded and filtered P-wave signals of lower vertical receiver, and Sections 11 and 12: Waterfall plots of unfiltered and filtered lower vertical receiver signals.

Herbal treatments for alleviating premenstrual symptoms: a systematic review.

Science.gov (United States)

Dante, Giulia; Facchinetti, Fabio

2011-03-01

Premenstrual syndrome (PMS) is a condition of cyclical and recurrent physical and psychological discomfort occurring 1 to 2 weeks before menstrual period. More severe psychological symptoms have been described for the premenstrual dysphoric disorder (PMDD). No single treatment is universally recognised as effective and many patients often turn to therapeutic approaches outside of conventional medicine. This systematic review is aimed at analysing the effects of herb remedies in the above conditions. Systematic literature searches were performed in electronic databases, covering the period January 1980 to September 2010. Randomised controlled clinical trials (RCTs) were included. Papers quality was evaluated with the Jadad' scale. A further evaluation of PMS/PMDD diagnostic criteria was also done. Of 102 articles identified, 17 RCTs were eligible and 10 of them were included. The heterogeneity of population included, study design and outcome presentation refrained from a meta-analysis. Vitex agnus castus was the more investigated remedy (four trials, about 500 women), and it was reported to consistently ameliorate PMS better than placebo. Single trials also support the use of either Gingko biloba or Crocus sativus. On the contrary, neither evening primrose oil nor St. John's Wort show an effect different than placebo. None of the herbs was associated with major health risks, although the reduced number of tested patients does not allow definitive conclusions on safety. Some herb remedies seem useful for the treatment of PMS. However, more RCTs are required to account for the heterogeneity of the syndrome.

Patient Characteristics Associated With a Successful Response to Nurse-Led Care Programs Targeting the Oldest-Old: A Comparison of Two RCTs.

Science.gov (United States)

Bleijenberg, Nienke; Imhof, Lorenz; Mahrer-Imhof, Romy; Wallhagen, Margaret I; de Wit, Niek J; Schuurmans, Marieke J

2017-06-01

To improve the effectiveness of community-based care programs, especially those targeting the oldest-old population (80+), data are needed that elucidate those factors associated with a successful response to the intervention. Two comparable nurse-led care programs have been evaluated in two large randomized controlled trials (RCTs), one in Switzerland and one in the Netherlands. To identify common patient characteristics that are related to a successful response to proactive nurse-led care, we explored if and to what extent, identical factors were present in both study populations. A secondary data analysis using trial data from the intervention group of both RCTs was conducted. The study sample consisted 461 older adults, 230 from the U-PROFIT trial (the Netherlands) and 231 from the HPC trial (Switzerland). The mean age of the total sample was 85.1 years (SD 3.7). The UPROFIT intervention, delivered by registered nurses, included a frailty assessment and a comprehensive geriatric assessment (CGA) at home followed by an individualized evidence-based care plan, care coordination, and follow-up. The HCP intervention was delivered by advanced practice nurses consisting of four home visits and three phone calls, and was guided by the principles of health promotion, empowerment, partnership, and family-centeredness. A successful response was defined as "stable" or "no decline" in daily functioning at follow-up. Daily functioning was measured with 13 items of activities of daily living and instrumental activities of daily living. Multivariate logistic regression models were applied to calculate the association between individual characteristics and a successful response. Almost half of the participants in the U-PROFIT trial (50.9%), and two-thirds (65.7%) of the participants in the HCP trial had a successful response at follow-up. Fewer comorbidities and a better self-rated health had the strongest predictive value for benefiting from the intervention (OR = 0.83 [95

Guidelines for diagnosis, prevention and treatment of hand eczema

DEFF Research Database (Denmark)

Diepgen, Thomas L; Andersen, Klaus E; Chosidow, Oliver

2015-01-01

) for patients with severe chronic HE. Randomized control trials (RCT) are missing for other used systemic treatments and comparison of systemic drugs in “head-to-head” RCTs are needed.The guidelines development group is a working group of the European Society of Contact Dermatitis (ESCD) and has carefully tried...

The limitations of using randomised controlled trials as a basis for developing treatment guidelines.

Science.gov (United States)

Mulder, Roger; Singh, Ajeet B; Hamilton, Amber; Das, Pritha; Outhred, Tim; Morris, Grace; Bassett, Darryl; Baune, Bernhard T; Berk, Michael; Boyce, Philip; Lyndon, Bill; Parker, Gordon; Malhi, Gin S

2018-02-01

Randomised controlled trials (RCTs) are considered the 'gold standard' by which novel psychotropic medications and psychological interventions are evaluated and consequently adopted into widespread clinical practice. However, there are some limitations to using RCTs as the basis for developing treatment guidelines. While RCTs allow researchers to determine whether a given medication or intervention is effective in a specific patient sample, for practicing clinicians it is more important to know whether it will work for their particular patient in their particular setting. This information cannot be garnered from an RCT. These inherent limitations are exacerbated by biases in design, recruitment, sample populations and data analysis that are inevitable in real-world studies. While trial registration and CONSORT have been implemented to correct and improve these issues, it is worrying that many trials fail to achieve such standards and yet their findings are used to inform clinical decision making. This perspective piece questions the assumptions of RCTs and highlights the widespread distortion of findings that currently undermine the credibility of this powerful design. It is recommended that the clinical guidelines include advice as to what should be considered good and relevant evidence and that external bodies continue to monitor RCTs to ensure that the outcomes published indeed reflect reality. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Cognitive behavioural therapy versus other psychosocial treatments for schizophrenia

Science.gov (United States)

Jones, Christopher; Hacker, David; Cormac, Irene; Meaden, Alan; Irving, Claire B

2014-01-01

Background Cognitive behavioural therapy (CBT) is now a recommended treatment for people with schizophrenia. This approach helps to link the person’s distress and problem behaviours to underlying patterns of thinking. Objectives To review the effects of CBT for people with schizophrenia when compared with other psychological therapies. Search methods We searched the Cochrane Schizophrenia Group Trials Register (March 2010) which is based on regular searches of CINAHL, EMBASE, MEDLINE and PsycINFO. We inspected all references of the selected articles for further relevant trials, and, where appropriate, contacted authors. Selection criteria All relevant randomised controlled trials (RCTs) of CBT for people with schizophrenia-like illnesses. Data collection and analysis Studies were reliably selected and assessed for methodological quality. Two review authors, working independently, extracted data. We analysed dichotomous data on an intention-to-treat basis and continuous data with 65% completion rate are presented. Where possible, for dichotomous outcomes, we estimated a risk ratio (RR) with the 95% confidence interval (CI) along with the number needed to treat/harm. Main results Thirty one papers described 20 trials. Trials were often small and of limited quality. When CBT was compared with other psychosocial therapies, no difference was found for outcomes relevant to adverse effect/events (2 RCTs, n = 202, RR death 0.57 CI 0.12 to 2.60). Relapse was not reduced over any time period (5 RCTs, n = 183, RR long-term 0.91 CI 0.63 to 1.32) nor was rehospitalisation (5 RCTs, n = 294, RR in longer term 0.86 CI 0.62 to 1.21). Various global mental state measures failed to show difference (4 RCTs, n = 244, RR no important change in mental state 0.84 CI 0.64 to 1.09). More specific measures of mental state failed to show differential effects on positive or negative symptoms of schizophrenia but there may be some longer term effect for affective symptoms (2 RCTs, n = 105

Comparison of two extracorporeal shock wave therapy techniques for the treatment of painful subcalcaneal spur. A randomized controlled study.

Science.gov (United States)

Tornese, Davide; Mattei, Enrico; Lucchesi, Giampaolo; Bandi, Marco; Ricci, Gabriele; Melegati, Gianluca

2008-09-01

To describe and compare two extracorporeal shock wave therapy techniques for the treatment of painful subcalcaneal spur. Random assignment to two groups of treatment with two and eight months follow-up. The data were collected in outpatients. Forty-five subjects with a history of at least six months of heel pain were studied. Each subject received a three-session ultrasound-guided extracorporeal shock wave therapy (performed weekly). Perpendicular technique was used in group A (n=22, mean age 59.3 +/- 12 years) and tangential technique was used in group B (n= 23, mean age 58.8 +/- 12.3 years). Mayo Clinical Scoring System was used to evaluate each subject before the treatment and at two and eight months follow-up. Mayo Clinical Scoring System pretreatment scores were homogeneous between the groups (group A 55.2 +/-18.7; group B 53.5 +/- 20; P>0.05). In both groups there was a significant (Pwave therapy. The tangential technique was found to be better tolerated as regards treatment-induced pain, allowing higher energy dosages to be used.

A global wave-driven magnetohydrodynamic solar model with a unified treatment of open and closed magnetic field topologies

Energy Technology Data Exchange (ETDEWEB)

Oran, R.; Van der Holst, B.; Landi, E.; Jin, M.; Sokolov, I. V.; Gombosi, T. I., E-mail: oran@umich.edu [Atmospheric, Oceanic and Atmospheric Sciences, University of Michigan, 2455 Hayward, Ann Arbor, MI, 48105 (United States)

2013-12-01

We describe, analyze, and validate the recently developed Alfvén Wave Solar Model, a three-dimensional global model starting from the top of the chromosphere and extending into interplanetary space (out to 1-2 AU). This model solves the extended, two-temperature magnetohydrodynamics equations coupled to a wave kinetic equation for low-frequency Alfvén waves. In this picture, heating and acceleration of the plasma are due to wave dissipation and to wave pressure gradients, respectively. The dissipation process is described by a fully developed turbulent cascade of counterpropagating waves. We adopt a unified approach for calculating the wave dissipation in both open and closed magnetic field lines, allowing for a self-consistent treatment in any magnetic topology. Wave dissipation is the only heating mechanism assumed in the model; no geometric heating functions are invoked. Electron heat conduction and radiative cooling are also included. We demonstrate that the large-scale, steady state (in the corotating frame) properties of the solar environment are reproduced, using three adjustable parameters: the Poynting flux of chromospheric Alfvén waves, the perpendicular correlation length of the turbulence, and a pseudoreflection coefficient. We compare model results for Carrington rotation 2063 (2007 November-December) with remote observations in the extreme-ultraviolet and X-ray ranges from the Solar Terrestrial Relations Observatory, Solar and Heliospheric Observatory, and Hinode spacecraft and with in situ measurements by Ulysses. The results are in good agreement with observations. This is the first global simulation that is simultaneously consistent with observations of both the thermal structure of the lower corona and the wind structure beyond Earth's orbit.

Efficacy and safety of topical diquafosol ophthalmic solution for treatment of dry eye: a systematic review of randomized clinical trials.

Science.gov (United States)

Wu, Di; Chen, Wang Qi; Li, Ryan; Wang, Yan

2015-06-01

To evaluate the efficacy and safety of topical diquafosol ophthalmic solution for treatment of dry eye. Randomized clinical trials (RCTs) from MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) were identified to evaluate the efficacy and safety of topical administration of diquafosol to patients with dry eyes. Data evaluation was based on endpoints including Schirmer test, tear film break-up time, ocular surface staining score, subjective symptom score, and adverse events. A total of 8 RCTs involving 1516 patients were selected based on the prespecified criteria. Significant improvement of Schirmer test values and tear film break-up time were reported in 40% (2 of 5) and 80% (4 of 5) studies, respectively. Ocular surface staining scores significantly decreased in 100% (fluorescein corneal staining, 6 of 6; Rose Bengal corneal and conjunctival staining, 4 of 4) RCTs. Symptoms significantly improved in 75% (6 of 8) RCTs in patients with dry eyes. No severe adverse events were reported with the concentration of diquafosol from 0.5% to 5%. Heterogeneity in study design prevented meta-analysis from statistical integration and summarization. Topical diquafosol seems to be a safe therapeutic option for the treatment of dry eye. The high variability of the selected RCTs compromised the strength of evidence and limits the determination of efficacy. However, the topical administration of diquafosol seems to be beneficial in improving the integrity of the epithelial cell layer of the ocular surface and mucin secretion in patients with dry eyes. This review indicates a need for standardized criteria and methods for evaluation to assess the efficacy of diquafosol in the future clinical trials.

A new patient-focused approach to the treatment of metastatic renal cell carcinoma: establishing customized treatment options.

Science.gov (United States)

Bellmunt, Joaquim; Eisen, Tim; Szczylik, Cezary; Mulders, Peter; Porta, Camillo

2011-04-01

What's known on the subject? and What does the study add? • Six targeted agents--sorafenib, sunitinib, pazopanib, bevacizumab, temsirolimus and everolimus--have been approved for the treatment of advanced renal cell carcinoma (RCC) based on evidence from large randomized controlled trials (RCTs). However, no head-to-head trials have been conducted to evaluate the relative efficacy of these agents in this setting. • Patient populations included in clinical trials do not accurately reflect the wider population of patients with RCC, as certain subgroups, such as the elderly or those with co-morbidities, are typically under-represented. • The optimum choice of therapy should be based on patient characteristics, nature of disease, and history and aims of therapy; however, there is currently no clear guidance for physicians in this decision-making process. • A patient-focussed schema has been developed that acknowledges nine different patient-, disease-, and treatment-related factors relevant to clinical decision-making, and provides a visual indication of the strength of evidence with which a particular agent can be recommended for use in specific subgroups. • To demonstrate the applicability of this tool, a review of all available evidence (published articles, congress presentations and personal communications) for sorafenib in RCC was conducted by a panel of experts, findings from which showed that sorafenib can be recommended for use in various subgroups of differing age, prognosis, performance status, tumour burden and distribution, treatment history and co-morbidity. • This patient-focussed approach has broad application and can be used to assess other agents and tumour types. Randomized controlled trials (RCTs) show that six targeted agents--sorafenib, sunitinib, temsirolimus, everolimus, bevacizumab and pazopanib--improve outcome in advanced renal cell carcinoma (RCC). The populations enrolled in the pivotal phase III studies differed, and, to date

INSITU extracorporeal shock- wave lithotripsy as a primary treatment for ureteral stones

International Nuclear Information System (INIS)

Maghraby, Hisham

2003-01-01

The aim of the sudy was to evaluate the results ofextracorporeal shock-wave lithotripsy (ESWL) as a primary treatment for ureteral calculi at different levels. We treated 166 consecutive patients with solitary ureteral stones (73 at the upper, 4 at the middle and 89 at the lower ureter) by primary in situ ESWL on an outpatient basis. A maximum of three treatments were given individually before adopting ureteroscopy as an alternative treatment. The success rate was calculated on the basis of complete stone clearance and resolution of any associated obstruction. Re-treatment rates ,complications and time to complete stone clearence were recorded. Complete stone clearance was received in 152 patients (91.6%) after an average of 10.2 days ( range1-28). The average treatment rate was 1.3 sessions per patient. As whole groups, lower ureteral stones required more treatment sessions than those in the upper ureter , and the difference was statistically significant.However, differences in the final success rate and time to stone clearence were statistically nonsignificant. When stratified according to size, the success rate was lowest for lower ureteral stones >1 cm in diameter. We believe ESWL is a safe and simple non-invasive option of choice for most ureteral calculi at different levels. Ureteroscopy represents an alternative choice in case of ESWL failure, or in cases of larger stones in the lower ureter when it might be the first option. (author)

Metformin treatment before and during IVF or ICSI in women with polycystic ovary syndrome.

Science.gov (United States)

Tso, Leopoldo O; Costello, Michael F; Albuquerque, Luiz Eduardo T; Andriolo, Régis B; Macedo, Cristiane R

2014-11-18

The use of insulin-sensitising agents, such as metformin, in women with polycystic ovary syndrome (PCOS) who are undergoing ovulation induction or in vitro fertilisation (IVF) cycles has been widely studied. Metformin reduces hyperinsulinaemia and suppresses the excessive ovarian production of androgens. As a consequence, it is suggested that metformin could improve assisted reproductive techniques (ART) outcomes, such as ovarian hyperstimulation syndrome (OHSS), pregnancy and live birth rates. To determine the effectiveness and safety of metformin as a co-treatment during IVF or intracytoplasmic sperm injection (ICSI) in achieving pregnancy or live birth in women with PCOS. We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, LILACS, the metaRegister of Controlled Trials and reference lists of articles (up to 15 October 2014). Types of studies: randomised controlled trials (RCTs) comparing metformin treatment with placebo or no treatment in women with PCOS who underwent IVF or ICSI treatment. women of reproductive age with anovulation due to PCOS with or without co-existing infertility factors.Types of interventions: metformin administered before and during IVF or ICSI treatment.Types of outcome measures: live birth rate, clinical pregnancy rate, miscarriage rate, incidence of ovarian hyperstimulation syndrome , incidence of participant-reported side effects, serum oestradiol level on the day of trigger, serum androgen level, and fasting insulin and glucose levels. Two review authors independently selected the studies, extracted the data according to the protocol and assessed study quality. The overall quality of the evidence was assessed using GRADE methods. We included nine randomised controlled trials involving a total of 816 women with PCOS. When metformin was compared with placebo there was no clear evidence of a difference

A Systematic Review of Depression Treatments in Primary Care for Latino Adults

Science.gov (United States)

Cabassa, Leopoldo J.; Hansen, Marissa C.

2007-01-01

Objective: A systematic literature review of randomized clinical trials (RCTs) assessing depression treatments in primary care for Latinos is conducted. The authors rate the methodological quality of studies, examine cultural and linguistic adaptations, summarize clinical outcomes and cost-effectiveness findings, and draw conclusions for improving…

Application of MM wave therapy in radiology

Energy Technology Data Exchange (ETDEWEB)

Avakian, R.S. [Inst. of Radio Physics & Electronics, Ashtarack (Argentina); Gasparyan, L.V. [Republican Medical Centre Armenia, Yerevan (Argentina)

1995-12-31

The authors studied the effects of MM wave electromagnetic radiation influence on patients, affected by X-ray radiation during the reparation works after Chernobyl nuclear power plant exposure. They compared results of treatment of two groups of patients: (1) control group patients received only basis therapy; (2) testing group, 10 patients received basis therapy and MM wave influence. The authors used the wide band noise generator `Artsakh - 2` for local irradiation on the acupuncture points. Their data proved that low intensity MM waves have immunocorrective, antioxidant effects, and MM wave therapy is a perspective method for treatment of patients with radiological pathology.

Anti-inflammatory agents in the treatment of bipolar depression: a systematic review and meta-analysis.

Science.gov (United States)

Rosenblat, Joshua D; Kakar, Ron; Berk, Michael; Kessing, Lars V; Vinberg, Maj; Baune, Bernhard T; Mansur, Rodrigo B; Brietzke, Elisa; Goldstein, Benjamin I; McIntyre, Roger S

2016-03-01

Inflammation has been implicated in the risk, pathophysiology, and progression of mood disorders and, as such, has become a target of interest in the treatment of bipolar disorder (BD). Therefore, the objective of the current qualitative and quantitative review was to determine the overall antidepressant effect of adjunctive anti-inflammatory agents in the treatment of bipolar depression. Completed and ongoing clinical trials of anti-inflammatory agents for BD published prior to 15 May 15 2015 were identified through searching the PubMed, Embase, PsychINFO, and Clinicaltrials.gov databases. Data from randomized controlled trials (RCTs) assessing the antidepressant effect of adjunctive mechanistically diverse anti-inflammatory agents were pooled to determine standard mean differences (SMDs) compared with standard therapy alone. Ten RCTs were identified for qualitative review. Eight RCTs (n = 312) assessing adjunctive nonsteroidal anti-inflammatory drugs (n = 53), omega-3 polyunsaturated fatty acids (n = 140), N-acetylcysteine (n = 76), and pioglitazone (n = 44) in the treatment of BD met the inclusion criteria for quantitative analysis. The overall effect size of adjunctive anti-inflammatory agents on depressive symptoms was -0.40 (95% confidence interval -0.14 to -0.65, p = 0.002), indicative of a moderate and statistically significant antidepressant effect. The heterogeneity of the pooled sample was low (I² = 14%, p = 0.32). No manic/hypomanic induction or significant treatment-emergent adverse events were reported. Overall, a moderate antidepressant effect was observed for adjunctive anti-inflammatory agents compared with conventional therapy alone in the treatment of bipolar depression. The small number of studies, diversity of agents, and small sample sizes limited interpretation of the current analysis. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Treatment of mid- and lower ureteric calculi: extracorporeal shock-wave lithotripsy vs laser ureteroscopy. A comparison of costs, morbidity and effectiveness

NARCIS (Netherlands)

Bierkens, A. F.; Hendrikx, A. J.; de la Rosette, J. J.; Stultiens, G. N.; Beerlage, H. P.; Arends, A. J.; Debruyne, F. M.

1998-01-01

To determine the efficacy and costs of extracorporeal shock-wave lithotripsy (ESWL) compared with ureteroscopy (URS) in the treatment of mid- and lower ureteric calculi. The records of patients treated primarily by ESWL and URS were analysed retrospectively. Treatment with ESWL included 63 patients

Effectiveness of co-treatment with traditional Chinese medicine and letrozole for polycystic ovary syndrome: a meta-analysis.

Science.gov (United States)

Ma, Qian-Wen; Tan, Yong

2017-03-01

Polycystic ovary syndrome (PCOS) is an endocrine disease that affects gynecological health. Treatment of PCOS remains a big challenge for clinicians. This meta-analysis was developed to compare the efficacy of co-treatment with traditional Chinese medicine (TCM) and letrozole against letrozole monotherapy in the treatment of PCOS. Randomized controlled trials (RCTs) were electronically retrieved from PubMed, Cochrane Library, China Biomedical Literature Database, China National Knowledge Infrastructure and Wanfang Data; related papers that were not available electronically were manually checked. All papers were assessed according to the Cochrane Handbook for Systematic Reviews of Interventions and the valid data were analyzed using Revman software (The Cochrane Collaboration, Copenhagen, Denmark). We included RCTs that compared co-treatment with TCM and letrozole against letrozole monotherapy in women with PCOS, which was defined by anovulation, biochemical or clinical hyperandrogenemia and polycystic ovaries. We included trials from all sources. Two independent reviewers extracted data, and evaluated study quality according to the Cochrane Handbook for Systematic Reviews of Interventions criteria for RCT, including issues of patient randomization, blinding and bias. Eight RCTs, involving a total of 537 patients, were included in the present study. The meta-analysis showed that the cycle ovulation rate, the pregnancy rate and the total effective rate of symptom treatment were higher in treatments combining TCM with letrozole, compared with letrozole monotherapy. Although the rate of luteinizing hormone (LH)/follicle-stimulating hormone (FSH) and the body mass index of the group receiving combined therapy were lower than in letrozole monotherapy, no statistical difference was found in the LH and FSH level between the two groups. Available evidence showed that co-treatment with TCM and letrozole was more effective than letrozole monotherapy in the treatment of PCOS.

Efficacy and safety of extracorporeal shock wave therapy for acute and chronic soft tissue wounds: A systematic review and meta-analysis.

Science.gov (United States)

Zhang, Li; Fu, Xiao-Bing; Chen, Shuo; Zhao, Zhan-Bo; Schmitz, Christoph; Weng, Chang-Shui

2018-04-19

This study aimed to evaluate and compare the effects of extracorporeal shock wave therapy (ESWT) and conventional wound therapy (CWT) for acute and chronic soft tissue wounds. All English-language articles on ESWT for acute and chronic soft tissue wounds indexed in PubMed, Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Library, Physiotherapy Evidence Database, and HealthSTAR published prior to June 2017 were included, as well as corresponding articles cited in reference lists of related review articles. The methodological quality of the selected studies was assessed with the Cochrane Collaboration's "risk of bias" tool. Study design, subject demographics, wound aetiology, treatment protocols, assessment indexes, and follow-up duration were extracted. The fixed or random-effects model was used to calculate the pooled effect sizes according to studies' heterogeneity. Ten randomised controlled trials (RCTs) involving 473 patients were included in this systematic review and meta-analysis. The meta-analysis showed that ESWT statistically significantly increased the healing rate of acute and chronic soft tissue wounds 2.73-fold (odds ratio, OR = 3.73, 95% confidence interval, CI: 2.30-6.04, P SMD) = 30.45; 95% CI: 23.79-37.12; P SMD = -2.86, 95% CI:-3.78 to -1.95, P SMD = -19.11, 95% CI: -23.74 to -14.47, P infection by 53% (OR = 0.47, 95% CI: 0.24-0.92, P = .03) when compared with CWT alone. Serious adverse effects were not reported. ESWT showed better therapeutic effects on acute and chronic soft tissue wounds compared with CWT alone. However, higher-quality and well-controlled RCTs are needed to further assess the role of ESWT for acute and chronic soft tissue wounds. © 2018 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Evidence for short duration of antibiotic treatment for non-severe community acquired pneumonia (CAP in children - are we there yet? A systematic review of randomised controlled trials

Directory of Open Access Journals (Sweden)

Shalom Ben-Shimol

2014-03-01

Full Text Available Context: The ideal duration of antibiotic treatment for childhood community acquired pneumonia (CAP has not yet been established. Objective: A literature search was conducted to evaluate the efficacy of shorter than 7 days duration of oral antibiotic treatment for childhood non-severe CAP. Data sources: A systematic literature search was performed using the PubMed database. The search was limited to randomised controlled trials (RCTs conducted between January 1996 and May 2013 in children up to 18 years old. Search terms included pneumonia, treatment, duration, child, children, days, short, respiratory infection and non-severe (nonsevere. Study selection: Only RCTs of oral antibiotic treatment for non-severe CAP in children were included. Data extraction: Independent extraction of articles was done by 3 authors using a preformed questionnaire. Data synthesis: Eight articles meeting the selection criteria were identified: 7 from 2 developing countries (India and Pakistan, and 1 from a developed country (The Netherlands. Studies from developing countries used the World Health Organization clinical criteria for diagnosing CAP, which includes mainly tachypnoea. None of those studies included fever, chest radiography or any laboratory test in their case definition. The Dutch study case definition used laboratory tests and chest radiographies (x-rays in addition to clinical criteria. Five articles concluded that 3 days of treatment are sufficient for non-severe childhood CAP, 2 articles found 5 days treatment to be sufficient, and one article found no difference between 3 days of amoxicillin treatment and placebo. Conclusions: The efficacy of short duration oral antibiotic treatment for non-severe CAP in children has not been established in developed countries. Current RCTs from developing countries used clinical criteria that may have failed to appropriately identify children with true bacterial pneumonia necessitating antibiotic treatment. More RCTs

Lagrangian analysis of nonlinear wave-wave interactions in bounded plasmas

International Nuclear Information System (INIS)

Carr, A.R.

1979-01-01

In a weakly turbulent nonlinear wave-supporting medium, one of the important nonlinear processes which may occur is resonant three-wave interaction. Whitham's averaged Lagrangian method provides a general formulation of wave evolution laws which is easily adapted to nonlinear dispersive media. In this thesis, the strength of nonlinear interactions between three coherent, axisymmetric, low frequency, magnetohydrodynamic (Alfven) waves propagating in resonance along a cold cylindrical magnetized plasma column is calculated. Both a uniform and a parabolic density distribution have been considered. To account for a non-zero plasma temperature, pressure effects have been included. Distinctive features of the work are the use of cylindrical geometry, the presence of a finite rather than an infinite axial magnetic field, the treatment of a parabolic density distribution, and the inclusion of both ion and electron contributions in all expressions. Two astrophysical applications of the presented theory have been considered. In the first, the possibility of resonant three-wave coupling between geomagnetic micropulsations, which propagate as Alfven or magnetosonic waves along the Earth's magnetic field lines, has been investigated. The second case is the theory of energy transport through the solar chromosphere by upward propagating magnetohydrodynamic waves, which may then couple to heavily damped waves in the corona, causing the observed excess heating in that region

Integrative treatment for low back pain: An exploratory systematic review and meta-analysis of randomized controlled trials.

Science.gov (United States)

Hu, Xiao-Yang; Chen, Ni-Ni; Chai, Qian-Yun; Yang, Guo-Yan; Trevelyan, Esmé; Lorenc, Ava; Liu, Jian-Ping; Robinson, Nicola

2015-10-26

Low back pain (LBP) is a common musculoskeletal condition often treated using integrative medicine (IM). Most reviews have focused on a single complementary and alternative medicine (CAM) therapy for LBP rather than evaluating wider integrative approaches. This exploratory systematic review aimed to identify randomized controlled trials (RCTs) and provide evidence on the effectiveness, cost effectiveness and adverse effects of integrative treatment for LBP. A literature search was conducted in 12 English and Chinese databases. RCTs evaluating an integrative treatment for musculoskeletal related LBP were included. Reporting, methodological quality and relevant clinical characteristics were assessed and appraised. Metaanalyses were performed for outcomes where trials were sufficiently homogenous. Fifty-six RCTs were identified evaluating integrative treatment for LBP. Although reporting and methodological qualities were poor, meta-analysis showed a favourable effect for integrative treatment over conventional and CAM treatment for back pain and function at 3 months or less follow-up. Two trials investigated costs, reporting £ 5332 per quality adjusted life years with 6 Alexander technique lessons plus exercise at 12 months follow-up; and an increased total costs of $244 when giving an additional up to 15 sessions of CAM package of care at 12 weeks. Sixteen trials mentioned safety; no severe adverse effects were reported. Integrative treatment that combines CAM with conventional therapies appeared to have beneficial effects on pain and function. However, evidence is limited due to heterogeneity, the relatively small numbers available for subgroup analyses and the low methodological quality of the included trials. Identification of studies of true IM was not possible due to lack of reporting of the intervention details (registration No. CRD42013003916).

Down-titration of biologics for the treatment of rheumatoid arthritis: a systematic literature review.

Science.gov (United States)

Lau, Chak Sing; Gibofsky, Allan; Damjanov, Nemanja; Lula, Sadiq; Marshall, Lisa; Jones, Heather; Emery, Paul

2017-11-01

Biologic therapies have improved the management of rheumatoid arthritis (RA) and the treat-to-target approach has resulted in many patients achieving remission. In the current treatment landscape, clinicians have begun considering dose reduction/tapering for their patients. Rheumatology guidelines in Asia, Europe, and the United States include down-titration of biologics but admit that the level of evidence is moderate. We conducted a systematic literature review to assess the published studies that evaluate down-titration of biologics in RA. The published literature was searched for studies that down-titrated the following biologics: abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, rituximab, and tocilizumab. Eligible studies included randomized controlled trials (RCTs), non-RCTs, observational, and pharmacoeconomic studies. The outcomes of interest were (1) efficacy and health-related quality of life, (2) disease flares, and (3) impact on cost. Eleven full-text publications were identified; only three were RCTs. Study results suggest that dosing down may be an option in many patients who have achieved remission or low disease activity. However, some patients are likely to experience a disease flare. Across the studies, the definition of disease flare and the down-titration criteria were inconsistent, making it difficult to conclude which patients may be appropriate and when to attempt down-titration. Studies have evaluated the practice of dosing down biologic therapy in patients with RA; however, a relatively small number of RCTs have been published. Although down-titration may be an option for some patients in LDA or remission, additional RCTs are needed to provide guidance on this practice.

Shock wave treatment in medicine; J. Biosci. 30 269–275

Indian Academy of Sciences (India)

Unknown

269. Keywords. Acoustical energy; electromagnetic field; piezoelectric effect; shock wave ... life without being noticed. The sound of ... A typical pressure profile of a shock wave in the focus of an ... shock waves create low side effects on the way through muscles, fat- ... luation of the ESWT for orthopedic diseases many clini-.

Network meta-analysis incorporating randomized controlled trials and non-randomized comparative cohort studies for assessing the safety and effectiveness of medical treatments: challenges and opportunities

OpenAIRE

Cameron, Chris; Fireman, Bruce; Hutton, Brian; Clifford, Tammy; Coyle, Doug; Wells, George; Dormuth, Colin R.; Platt, Robert; Toh, Sengwee

2015-01-01

Network meta-analysis is increasingly used to allow comparison of multiple treatment alternatives simultaneously, some of which may not have been compared directly in primary research studies. The majority of network meta-analyses published to date have incorporated data from randomized controlled trials (RCTs) only; however, inclusion of non-randomized studies may sometimes be considered. Non-randomized studies can complement RCTs or address some of their limitations, such as short follow-up...

Book review: Extreme ocean waves

Science.gov (United States)

Geist, Eric L.

2011-01-01

‘‘Extreme Ocean Waves’’ is a collection of ten papers edited by Efim Pelinovsky and Christian Kharif that followed the April 2007 meeting of the General Assembly of the European Geosciences Union. A note on terminology: extreme waves in this volume broadly encompass different types of waves, includ- ing deep-water and shallow-water rogue waves (alternatively termed freak waves), storm surges from cyclones, and internal waves. Other types of waves such as tsunamis or rissaga (meteotsunamis) are not discussed in this volume. It is generally implied that ‘‘extreme’’ has a statistical connotation relative to the average or significant wave height specific to each type of wave. Throughout the book, in fact, the reader will find a combination of theoretical and statistical/ empirical treatment necessary for the complete examination of this subject. In the introduction, the editors underscore the importance of studying extreme waves, documenting several dramatic instances of damaging extreme waves that occurred in 2007. 

Nonlinear elastic waves in materials

CERN Document Server

Rushchitsky, Jeremiah J

2014-01-01

The main goal of the book is a coherent treatment of the theory of propagation in materials of nonlinearly elastic waves of displacements, which corresponds to one modern line of development of the nonlinear theory of elastic waves. The book is divided on five basic parts: the necessary information on waves and materials; the necessary information on nonlinear theory of elasticity and elastic materials; analysis of one-dimensional nonlinear elastic waves of displacement – longitudinal, vertically and horizontally polarized transverse plane nonlinear elastic waves of displacement; analysis of one-dimensional nonlinear elastic waves of displacement – cylindrical and torsional nonlinear elastic waves of displacement; analysis of two-dimensional nonlinear elastic waves of displacement – Rayleigh and Love nonlinear elastic surface waves. The book is addressed first of all to people working in solid mechanics – from the students at an advanced undergraduate and graduate level to the scientists, professional...

Meta-analysis of oral Chinese herbal medicine as an adjuvant treatment in relieving pain secondary to bone metastases.

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Wang, Shi-Jun; Xu, Juan; Gong, Dan-Dan; Man, Chang-Feng; Fan, Yu

2013-10-14

To assess the effectiveness of oral Chinese herbal medicine (CHM) in relieving pain secondary to bone metastases in patients. The searched electronic literature databases included both English and Chinese articles published in the MEDLINE, EMBASE, Wanfang database and China National Knowledge Infrastructure (up to December 2012). The studies included randomized controlled trials (RCTs) comparing CHM plus conventional treatment with conventional treatment alone for patients with pain secondary to bone metastases. The outcomes were the odds ratio (OR) with 95% confidence intervals (CI) for the pain-relief rate and adverse events. A total of 16 RCTs involving 1,008 patients were identified and analyzed. All of the included RCTs were associated with a moderate to high risk of bias. In the metaanalysis, CHM plus conventional treatment increased the pain-relief rate compared with the conventional treatment alone (OR, 2.59; 95% CI 1.95 to 3.45). In subgroup analysis, the pooled OR of the pain-relief rate of CHM plus conventional treatment compared with conventional treatment was 3.11 (95% CI 2.01 to 4.79) for CHM plus bisphosphonates, 2.24 (95% CI 1.33 to 3.78) for CHM plus analgesics, 2.28 (95% CI 1.09 to 4.79) for CHM plus radiotherapy, and 2.22 (95% CI 0.95 to 5.15) for CHM plus analgesics and bisphosphonates. The adverse events included nausea, vomiting, dizziness, fever, and constipation. No serious adverse events were reported in any of the included studies. CHM interventions appear to have beneficial effects on pain secondary to bone metastases in patients. However, published efficacy trials are small in size to draw any firm conclusions.

Effect comparison of metformin with insulin treatment for gestational diabetes: a meta-analysis based on RCTs.

Science.gov (United States)

Li, Genxia; Zhao, Shujun; Cui, Shihong; Li, Lei; Xu, Yajuan; Li, Yuanyuan

2015-07-01

To compare the effects of metformin with insulin on maternal and neonatal outcomes in gestational diabetes mellitus (GDM). A literature search in PUBMED, EMBASE, Science Direct, Springer link, and Cochrane library was conducted using the following search terms: "Gestational Diabetes" or "GDM", and "insulin" and "metformin". Quality assessment of included studies was determined with Quality Assessment of Diagnostic Accuracy Studies. Review Manger 5.2 was used to analyze mean difference (MD)/risk ratio (RR) and 95 % confidence interval (CI) in random-effects model or fixed-effects model depending on the level of heterogeneity. A total of 11 studies were identified. There was no significant difference of the effect on maternal outcomes between the two treatments in glycohemoglobin A1c levels (P = 0.37), fasting blood glucose (P = 0.66), and the incidence of preeclampsia (P = 0.26); whereas, significantly reduced results were found in the metformin group in pregnancy-induced hypertension (PIH) rate (RR = 0.53, 95 % CI 0.31-0.90, P = 0.02), average weight gains after enrollment (MD = -1.28, 95 % CI -1.54 to -1.01, P metformin presented significantly lower average birth weights (MD = -44.35, 95 % CI -85.79 to -2.90, P = 0.04), incidence of hypoglycemia (RR = 0.69, 95 % CI 0.55-0.87, P = 0.001) and neonatal intensive care unit (NICU) (RR = 0.82, 95 % CI 0.67-0.99, P = 0.04). Metformin can significantly reduce several adverse maternal and neonatal outcomes including PIH rate, incidence of hypoglycemia and NICU, thus it may be an effective and safe alternative or additional treatment to insulin for GDM women.

Polyphenol-based nutraceuticals for the prevention and treatment of cardiovascular disease: Review of human evidence.

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Tomé-Carneiro, Joao; Visioli, Francesco

2016-10-15

In addition to prescription drugs, nutraceuticals/functional foods/medical foods are being increasingly added as adjunct treatment of cardiovascular disease (CVD), even though most of them have been exclusively studied in vitro. We review the available evidence (focusing on when the amount of polyphenols' intake was measured) coming from randomized controlled trials (RCTs) of (poly)phenol-based supplements. We conclude that (poly)phenol-based nutraceuticals and functional foods might be indeed used as adjunct therapy of CVD, but additional long-term RCTs with adequate numerosity and with clinically relevant end points are needed to provide unequivocal evidence of their clinical usefulness. Copyright © 2015. Published by Elsevier GmbH.

Guided-wave acousto-optics interactions, devices, and applications

CERN Document Server

1990-01-01

The field of integrated- or guided-wave optics has experienced significant and continuous growth since its inception in the late 1960s. There has been a considerable increase in research and development activity in this field worldwide and some significant advances in the realization of working in­ tegrated optic devices and modules have been made in recent years. In fact, there have already been some commercial manufacturing and technical ap­ plications of such devices and modules. The guided-wave-acoustooptics involving Bragg interactions between guided optical waves and surface acoustic waves is one of the areas of in­ tegrated-optics that has reached some degree of scientific and technological maturity. This topical volume is devoted to an in-depth treatment of this emerging branch of science and technology. Presented in this volume are concise treatments on bulk-wave acoustooptics, guided-wave optics, and surface acoustic waves, and detailed studies of guided-wave acoustooptic Bragg diffraction in thr...

Extracorporeal shock wave lithotripsy in the treatment of renal pelvicalyceal stones in morbidly obese patients

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V. A. Mezentsev

2005-04-01

Full Text Available INTRODUCTION: Management of urolithiasis in morbidly obese patients is usually associated with higher morbidity and mortality compared to non-obese patients. In morbidly obese patients, since the kidney and stone are at a considerable distance from the skin (compared to non-obese patients difficulty may be found in positioning the patient so that the stone is situated at the focal point of the lithotripter. OBJECTIVE: To evaluate the outcomes and cost-efficiency of extracorporeal shock wave lithotripsy (ESWL in the treatment of renal pelvicalyceal stones sized between 6 and 20 mm in morbidly obese patients. MATERIALS AND METHODS: Using various aids, such as mobile overtable module, extended shock pathway and abdominal compression 37 patients with body mass index more than 40 kg/m2 were treated using the Siemens Lithostar-plus third generation lithotripter. The size of renal pelvicalyceal stones was between 6 and 20 mm. Treatment costs for shock wave lithotripsy were calculated. RESULTS: The overall stone free rate at 3 months of 73% was achieved. The mean number of treatments per patient was 2.1. The post-lithotripsy secondary procedures rate was 5.4%. No complications, such as subcapsular haematoma or acute pyelonephritis were recorded. The most effective (87% success rate and cost-efficient treatment was in the patients with pelvic stones. The treatment of the patients with low caliceal stones was effective in 60% only. The cost of the treatment of the patients with low calyceal stones was in 1.8 times higher than in the patients with pelvic stones. CONCLUSION: We conclude that ESWL with the Siemens Lithostar-plus is the most effective and cost-efficient in morbidly obese patients with pelvic stones sized between 6 and 20 mm. 87% success rate was achieved. The increased distance from the skin surface to the stone in those patients does not decrease the success rate provided the stone is positioned in the focal point or within 3 cm of it on the

Third Wave of Cognitive Behavioral Therapies

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Sevginar Vatan

Full Text Available The psychological functioning of an individual includes well-being, cognitions, emotions and behaviors as a whole. In the current models of psychopathologies, as similar to well-being, reciprocal interaction between emotions, behaviors and cognitions is emphasized. Notwithstanding that the effects of these three components on cognitive behavior therapies can be mentioned too, it can be claimed that emotions were remained in the background by the behaviors and cognitions until the third wave of cognitive behavior therapies. Emotions have became prominent with the third wave approaches in the field of cognitive behavior therapy. In this review article, similarities and differences of third wave of cognitive behavior therapy with other waves, the constructs of emotion and emotion regulation in the third wave and the impacts of these on treatment were included. Additionally, throughout this perspective, treatment processes focusing on emotion regulation skills were discussed. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2016; 8(3.000: 190-203

Differences in Funding Sources of Phase III Oncology Clinical Trials by Treatment Modality and Cancer Type.

Science.gov (United States)

Jairam, Vikram; Yu, James B; Aneja, Sanjay; Wilson, Lynn D; Lloyd, Shane

2017-06-01

Given the limited resources available to conduct clinical trials, it is important to understand how trial sponsorship differs among different therapeutic modalities and cancer types and to consider the ramifications of these differences. We searched clinicaltrials.gov for a cross-sectional register of active, phase III, randomized controlled trials (RCTs) studying treatment-related endpoints such as survival and recurrence for the 24 most prevalent malignancies. We classified the RCTs into 7 categories of therapeutic modality: (1) chemotherapy/other cancer-directed drugs, (2) targeted therapy, (3) surgery, (4) radiation therapy (RT), (5) RT with other modalities, (6) multimodality therapy without RT, and (7) other. RCTs were categorized as being funded by one or more of the following groups: (1) government, (2) hospital/university, (3) industry, and (4) other. χ analysis was performed to detect differences in funding source distribution between modalities and cancer types. The percentage of multimodality trials (5%) and radiation RCTs (4%) funded by industry was less than that for chemotherapy (32%, Pfunding than any of the other modalities (Pfunded by industry if they also studied targeted therapy (Pfunded by industry than trials studying multimodality therapy or radiation. The impact of industry funding versus institutional or governmental sources of funding for cancer research is unclear and requires further study.

Safety and efficacy of rasagiline in addition to levodopa for the treatment of idiopathic Parkinson's disease: a meta-analysis of randomised controlled trials.

Science.gov (United States)

Cai, Jiang-Ping; Chen, Wan-Jin; Lin, Yu; Cai, Bin; Wang, Ning

2015-01-01

To assess the safety and efficacy of rasagiline for the treatment of Parkinson's disease (PD) among individuals currently receiving levodopa. A systematic literature search was conducted to identify randomised controlled trials (RCT) comparing rasagiline with placebo/no treatment in individuals with PD currently receiving levodopa. Outcome measures included improvement in motor functions; symptomatic improvement; improvement in quality of life; adverse effects. Random-effect meta-analytical techniques were conducted for the outcome measure and subgroup analyses. Three RCTs were included (n = 1002). The results showed significantly greater improvements in daily 'on' time without dyskinesia in levodopa-treated participants with idiopathic PD receiving 1 mg/day rasagiline compared to placebo (n = 712, 2 RCTs, MD 0.80, CI 0.45 to 1.15; p rasagiline (0.5 mg/day: n = 282, MD -2.91, CI -4.59 to -1.23; p = 0.0007; 1 mg/day: n = 712, 2 RCTs, MD -2.91, CI -4.02 to -1.80; p rasagiline in addition to levodopa is a safe and well-tolerated combination therapy for individuals with Parkinson's disease.

Efficacy of lamivudine and thymosin alpha-1 combination therapy in treatment of HBeAg-positive chronic hepatitis B: a meta-analysis

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QI Youtao

2014-07-01

Full Text Available ObjectiveTo evaluate the efficacy of lamivudine and thymosin alpha-1 combination therapy in the treatment of HBeAg-positive chronic hepatitis B (CHB by meta-analysis. MethodsRandomized controlled trials (RCTs of lamivudine and thymosin alpha-1 combination therapy in treatment of HBeAg-positive CHB (follow-up for at least 24 weeks, from January 1998 to date, were identified by searching Cochrane Library, PubMed, EMBASE, EBSCO, CNKI, Wanfang Data, and CQVIP. Lamivudine monotherapy RCTs were searched for in the same way as control tests. Efficacy was measured by odds ratio. Meta-analysis was carried out with RevMan 5.2 software. ResultsNine RCTs involving 600 patients were included, with 320 cases in the combination therapy group and 280 in the control group. At the end of follow-up, the combination therapy group had significantly higher serum ALT recovery rate, HBV-DNA negative conversion rate, HBeAg negative conversion rate, and HBeAg seroconversion rate than the control group (P＜0.01 for all, with pooled odds ratios (95% confidence intervals of 4.84 (3.28, 7.16, 2.09 (1.45, 3.01, 5.32 (3.35, 8.46, and 6.22 (3.78, 10.25, respectively. ConclusionLamivudine and thymosin alpha-1 combination therapy is more likely to achieve sustained response rate than lamivudine monotherapy for HBeAg-positive CHB. More RCTs of high quality and large scale are required to verify this conclusion．

Variables influencing radiation exposure during extracorporeal shock wave lithotripsy. Review of 298 treatments

International Nuclear Information System (INIS)

Carter, H.B.; Naeslund, E.B.R.; Riehle, R.A. Jr.

1987-01-01

Retrospective review of 298 extracorporeal shock wave lithotripsy (ESWL) treatments was undertaken to determine the factors which influence radiation exposure during ESWL. Fluoroscopy time averaged 160 seconds (3-509), and the average number of spot films taken per patient was 26 (5-68). The average stone burden was 19.3 mm (3-64). Average calculated skin surface radiation exposure was 17.8 R per treatment. Radiation exposure increased with increasing stone burden and patient weight. Stones treated in the ureter resulted in a higher average patient radiation exposure than for renal stones (19 R vs 16 R), even though the average size of these ureteral stones (11.3 mm) was significantly less than the mean. However, type of anesthetic (general or regional) used was not a significant factor. Operator training, experience, and familiarity with radiation physics should significantly decrease the amount of imaging time and consequent patient radiation exposure during ESWL

Variables influencing radiation exposure during extracorporeal shock wave lithotripsy. Review of 298 treatments

Energy Technology Data Exchange (ETDEWEB)

Carter, H.B.; Naeslund, E.B.R.; Riehle, R.A. Jr.

1987-12-01

Retrospective review of 298 extracorporeal shock wave lithotripsy (ESWL) treatments was undertaken to determine the factors which influence radiation exposure during ESWL. Fluoroscopy time averaged 160 seconds (3-509), and the average number of spot films taken per patient was 26 (5-68). The average stone burden was 19.3 mm (3-64). Average calculated skin surface radiation exposure was 17.8 R per treatment. Radiation exposure increased with increasing stone burden and patient weight. Stones treated in the ureter resulted in a higher average patient radiation exposure than for renal stones (19 R vs 16 R), even though the average size of these ureteral stones (11.3 mm) was significantly less than the mean. However, type of anesthetic (general or regional) used was not a significant factor. Operator training, experience, and familiarity with radiation physics should significantly decrease the amount of imaging time and consequent patient radiation exposure during ESWL.

Effects of testosterone treatment on glucose metabolism and symptoms in men with type 2 diabetes and the metabolic syndrome: a systematic review and meta-analysis of randomized controlled clinical trials.

Science.gov (United States)

Grossmann, Mathis; Hoermann, Rudolf; Wittert, Gary; Yeap, Bu B

2015-09-01

The effects of testosterone treatment on glucose metabolism and other outcomes in men with type 2 diabetes (T2D) and/or the metabolic syndrome are controversial. To perform a systematic review and meta-analysis of placebo-controlled double-blind randomized controlled clinical trials (RCT) of testosterone treatment in men with T2D and/or the metabolic syndrome. A systematic search of RCTs was conducted using Medline, Embase and the Cochrane Register of controlled trials from inception to July 2014 followed by a manual review of the literature. Eligible studies were published placebo-controlled double-blind RCTs published in English. Two reviewers independently selected studies, determined study quality and extracted outcome and descriptive data. Of the 112 identified studies, seven RCTs including 833 men were eligible for the meta-analysis. In studies using a simple linear equation to calculate the homeostatic model assessment of insulin resistance (HOMA1), testosterone treatment modestly improved insulin resistance, compared to placebo, pooled mean difference (MD) -1·58 [-2·25, -0·91], P treatment effect was nonsignificant for RCTs using a more stringent computer-based equation (HOMA2), MD -0·19 [-0·86, 0·49], P = 0·58). Testosterone treatment did not improve glycaemic (HbA1c) control, MD -0·15 [-0·39, 0·10], P = 0·25, or constitutional symptoms, Aging Male Symptom score, MD -2·49 [-5·81, 0·83], P = 0·14). This meta-analysis does not support the routine use of testosterone treatment in men with T2D and/or the metabolic syndrome without classical hypogonadism. Additional studies are needed to determine whether hormonal interventions are warranted in selected men with T2D and/or the metabolic syndrome. © 2014 John Wiley & Sons Ltd.

Randomized Clinical Trial of Parent-Focused Treatment and Family-Based Treatment for Adolescent Anorexia Nervosa.

Science.gov (United States)

Le Grange, Daniel; Hughes, Elizabeth K; Court, Andrew; Yeo, Michele; Crosby, Ross D; Sawyer, Susan M

2016-08-01

There have been few randomized clinical trials (RCTs) for adolescents with anorexia nervosa (AN). Most of these posit that involving all family members in treatment supports favorable outcomes. However, at least 2 RCTs suggest that separate parent and adolescent sessions may be just as effective as conjoint treatment. This study compared the relative efficacy of family-based treatment (FBT) and parent-focused treatment (PFT). In PFT, the therapist meets with the parents only, while a nurse monitors the patient. Participants (N = 107) aged 12 to 18 years and meeting DSM 4(th)Edition criteria for AN or partial AN were randomized to either FBT or PFT. Participants were assessed at baseline, end of treatment (EOT), and at 6 and 12 months posttreatment. Treatments comprised 18 outpatient sessions over 6 months. The primary outcome was remission, defined as ≥95% of median body mass index and Eating Disorder Examination Global Score within 1 SD of community norms. Remission was higher in PFT than in FBT at EOT (43% versus 22%; p = .016, odds ratio [OR] = 3.03, 95% CI = 1.23-7.46), but did not differ statistically at 6-month (PFT 39% versus FBT 22%; p = .053, OR = 2.48, CI = 0.989-6.22), or 12-month (PFT 37% versus FBT 29%; p = .444, OR = 1.39, 95% CI = 0.60-3.21) follow-up. Several treatment effect moderators of primary outcome were identified. At EOT, PFT was more efficacious than FBT in bringing about remission in adolescents with AN. However, differences in remission rates between PFT and FBT at follow-up were not statistically significant. A Randomised Controlled Trial of Two Forms of Family-Based Treatment and the Effect on Percent Ideal Body Weight and Eating Disorders Symptoms in Adolescent Anorexia Nervosa; http://www.anzctr.org.au/; ACTRN12610000216011. Copyright © 2016 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Efficacy and safety of pharmacological interventions in second- or later-line treatment of patients with advanced soft tissue sarcoma: a systematic review

International Nuclear Information System (INIS)

Sharma, Sheetal; Takyar, Shweta; Manson, Stephanie C; Powell, Sarah; Penel, Nicolas

2013-01-01

Current guidelines recommend anthracycline-based chemotherapy primarily with doxorubicin either as monotherapy or in combination with ifosfamide as the first-line treatment for most advanced STS subtypes. Therapeutic options after failure of doxorubicin and/or ifosfamide are limited. This study aimed to comprehensively review available data on the activity and safety of interventions in second- or later-line treatment of advanced STS. Electronic literature databases (Embase ® , MEDLINE ® , MEDLINE ® In-Process, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews) were searched from 1980 to 01 March 2012 to identify randomised controlled trials (RCTs) and non-randomised studies (both prospective and retrospective) evaluating pharmacological interventions in patients with advanced STS pre-treated with anthracycline- and/or ifosfamide-based therapy. The review identified six RCTs (one phase III and five phase II trials) and 94 non-randomised studies. Based on the primary trial endpoints, RCTs demonstrated favourable efficacy for pazopanib over placebo (PFS: 4.6 months vs. 1.6 months), gemcitabine plus dacarbazine over dacarbazine monotherapy (3-month PFS rate: 54.2% vs. 35.2%), and trabectedin 3-weekly schedule over weekly schedule (TTP: 3.7 months vs. 2.3 months. The non-randomised studies demonstrated heterogeneity in efficacy and safety results. Across the RCTs, pazopanib over placebo, gemcitabine-dacarbazine over dacarbazine, and trabectedin 3-weekly over weekly regimen clearly demonstrated a PFS advantage in the second- and later-line treatment of advanced STS. With only one phase III trial in this setting, there is a clear need for additional comparative trials to better understand the risk: benefit ratios of available agents and combinations

Drug-Eluting Balloon versus New-Generation Drug-Eluting Stent for the Treatment of In-Stent Restenosis: An Updated Systematic Review and Meta-Analysis

Directory of Open Access Journals (Sweden)

Kong-Yong Cui

2018-01-01

Conclusions: The current meta-analysis showed that DEB and new-generation DES had comparable safety and efficacy for the treatment of ISR in RCTs. However, treatment with DEB was associated with higher risk of all-cause mortality in the real-world nonrandomized studies.

Efficacy of manual therapy in the treatment of tension-type headache. A systematic review from 2000-2013.

Science.gov (United States)

Lozano López, C; Mesa Jiménez, J; de la Hoz Aizpurúa, J L; Pareja Grande, J; Fernández de Las Peñas, C

2016-01-01

To study the efficacy of manual therapy in the treatment of tension-type headache (TTH) by assessing the quality of randomized control trials (RCTs) published from the year 2000 to April 2013. A search was performed in the following databases: MEDLINE, EBSCO, CINAHL, SCOPUS, PEDRO and OVID. An analysis was made of RCT including patients with TTH receiving any manual therapy, and assessing outcome measures including the intensity, and frequency or duration of the headache. Two independent referees reviewed the methodological quality of RCTs using the Jadad scale. Data from the studies were extracted by two different reviewers. A total of fourteen RCTs were selected. Twelve studies showed acceptable quality (Jadad scale ≥3), and the remaining 2 had low quality (Jadad=2). The studies showed positive results, including reduction in headache intensity and/or frequency, reduction of medication consumption, and improvement in quality of life. The effectiveness of manual therapy for TTH cannot be completely assessed due to the heterogeneity in study design, outcome measures, and different treatments. Nevertheless, the results suggest patients with TTH receiving manual therapies showed better progress than those receiving conventional treatment or placebo. Further studies of high quality using manual therapy protocols, and also including standardized outcome measures, are now needed to clarify the efficacy of manual therapy in the management of TTH. Copyright © 2013 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Alfven Waves in Gyrokinetic Plasmas

International Nuclear Information System (INIS)

Lee, W.W.; Qin, H.

2003-01-01

A brief comparison of the properties of Alfven waves that are based on the gyrokinetic description with those derived from the MHD equations is presented. The critical differences between these two approaches are the treatment of the ion polarization effects. As such, the compressional Alfven waves in a gyrokinetic plasma can be eliminated through frequency ordering, whereas geometric simplifications are needed to decouple the shear Alfven waves from the compressional Alfven waves within the context of MHD. Theoretical and numerical procedures of using gyrokinetic particle simulation for studying microturbulence and kinetic-MHD physics including finite Larmor radius effects are also presented

Effectiveness of balneotherapy and spa therapy for the treatment of chronic low back pain: a review on latest evidence.

Science.gov (United States)

Karagülle, Mine; Karagülle, Müfit Zeki

2015-02-01

In most European countries, balneotherapy and spa therapy are widely prescribed by physicians and preferred by European citizens for the treatment of musculoskeletal problems including chronic low back pain (LBP). We aimed to review and evaluate the recent evidence on the effectiveness of balneotherapy and spa therapy for patients with LBP. We comprehensively searched data bases for randomized controlled trials (RCTs) published in English between July 2005 and December 2013. We identified all trials testing balneotherapy or spa therapy for LBP that reported that the sequence of allocation was randomized. We finally included total of eight RCTs: two on balneotherapy and six on spa therapy. All reviewed trials reported that balneotherapy was superior in long term to tap water therapy in relieving pain and improving function and that spa therapy combining balneotherapy with mud pack therapy and/or exercise therapy, physiotherapy, and/or education was effective in the management of low back pain and superior or equally effective to the control treatments in short and long terms. We used Jadad scale to grade the methodological quality. Only three out of total eight had a score of above 3 indicating the good quality. The data from the RCTs indicates that overall evidence on effectiveness of balneotherapy and spa therapy in LBP is encouraging and reflects the consistency of previous evidence. However, the overall quality of trials is generally low. Better quality RCTs (well designed, conducted, and reported) are needed testing short- and long-term effects for relieving chronic back pain and proving broader beneficial effects.

Nonpharmacologic treatment of functional abdominal pain disorders: a systematic review.

Science.gov (United States)

Rutten, Juliette M T M; Korterink, Judith J; Venmans, Leonie M A J; Benninga, Marc A; Tabbers, Merit M

2015-03-01

Various nonpharmacologic treatments are available for pediatric abdominal pain-related functional gastrointestinal disorders (AP-FGIDs). Data on efficacy and safety are scarce. The goal of this study was to summarize the evidence regarding nonpharmacologic interventions for pediatric AP-FGIDs: lifestyle interventions, dietary interventions, behavioral interventions, prebiotics and probiotics, and alternative medicine. Searches were conducted of the Medline and Cochrane Library databases. Systematic reviews and randomized controlled trials (RCTs) concerning nonpharmacologic therapies in children (aged 3-18 years) with AP-FGIDs were included, and data were extracted on participants, interventions, and outcomes. The quality of evidence was assessed by using the GRADE approach. Twenty-four RCTs were found that included 1390 children. Significant improvement of abdominal pain was reported after hypnotherapy compared with standard care/wait-list approaches and after cognitive behavioral therapy compared with a variety of control treatments/wait-list approaches. Written self-disclosure improved pain frequency at the 6-month follow-up only. Compared with placebo, Lactobacillus rhamnosus GG (LGG) and VSL#3 were associated with significantly more treatment responders (LGG relative risk: 1.31 [95% confidence interval: 1.08 to 1.59]; VSL#3: P pediatric AP-FGIDs. Data on fiber supplements are inconclusive. Copyright © 2015 by the American Academy of Pediatrics.

On Collisionless Damping of Ion Acoustic Waves

DEFF Research Database (Denmark)

Jensen, Vagn Orla; Petersen, P.I.

1973-01-01

Exact theoretical treatments show that the damping of ion acoustic waves in collisionless plasmas does not vanish when the derivative of the undisturbed distribution function at the phase velocity equals zero.......Exact theoretical treatments show that the damping of ion acoustic waves in collisionless plasmas does not vanish when the derivative of the undisturbed distribution function at the phase velocity equals zero....

Novel and emerging treatments for autism spectrum disorders: a systematic review.

Science.gov (United States)

Rossignol, Daniel A

2009-01-01

Currently, only one medication (risperidone) is FDA-approved for the treatment of autism spectrum disorders (ASD). Perhaps for this reason, the use of novel, unconventional, and off-label treatments for ASD is common, with up to 74% of children with ASD using these treatments; however, treating physicians are often unaware of this usage. A systematic literature search of electronic scientific databases was performed to identify studies of novel and emerging treatments for ASD, including nutritional supplements, diets, medications, and nonbiological treatments. A grade of recommendation ("Grade") was then assigned to each treatment using a validated evidence-based guideline as outlined in this review: A: Supported by at least 2 prospective randomized controlled trials (RCTs) or 1 systematic review. B: Supported by at least 1 prospective RCT or 2 nonrandomized controlled trials. C: Supported by at least 1 nonrandomized controlled trial or 2 case series. D: Troublingly inconsistent or inconclusive studies or studies reporting no improvements. Potential adverse effects for each treatment were also reviewed. Grade A treatments for ASD include melatonin, acetylcholinesterase inhibitors, naltrexone, and music therapy. Grade B treatments include carnitine, tetrahydrobiopterin, vitamin C, alpha-2 adrenergic agonists, hyperbaric oxygen treatment, immunomodulation and anti-inflammatory treatments, oxytocin, and vision therapy. Grade C treatments for ASD include carnosine, multivitamin/mineral complex, piracetam, polyunsaturated fatty acids, vitamin B6/magnesium, elimination diets, chelation, cyproheptadine, famotidine, glutamate antagonists, acupuncture, auditory integration training, massage, and neurofeedback. The reviewed treatments for ASD are commonly used, and some are supported by prospective RCTs. Promising treatments include melatonin, antioxidants, acetylcholinesterase inhibitors, naltrexone, and music therapy. All of the reviewed treatments are currently considered

A Meta-Analysis of the Effectiveness of Different Cortical Targets Used in Repetitive Transcranial Magnetic Stimulation (rTMS) for the Treatment of Obsessive-Compulsive Disorder (OCD).

Science.gov (United States)

Rehn, Simone; Eslick, Guy D; Brakoulias, Vlasios

2018-02-09

Randomised and sham-controlled trials (RCTs) of repetitive transcranial magnetic stimulation (rTMS) in the treatment of obsessive-compulsive disorder (OCD) have yielded conflicting results, which may be due to the variability in rTMS parameters used. We performed an updated systematic review and meta-analysis on the effectiveness of rTMS for the treatment of OCD and aimed to determine whether certain rTMS parameters, such as cortical target, may be associated with higher treatment effectiveness. After conducting a systematic literature review for RCTs on rTMS for OCD through to 1 December 2016 using MEDLINE, PubMed, Web of Science, PsycINFO, Google, and Google Scholar, we performed a random-effects meta-analysis with the outcome measure as pre-post changes in Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores. To determine whether rTMS parameters may have influenced treatment effectiveness, studies were further analysed according to cortical target, stimulation frequency, and length of follow-up. Data were obtained from 18 RCTs on rTMS in the treatment of OCD. Overall, rTMS yielded a modest effect in reducing Y-BOCS scores with Hedge's g of 0.79 (95% CI = 0.43-1.15, p OCD. The therapeutic effects of rTMS also appear to persist post-treatment and may offer beneficial long-term effectiveness. With our findings, it is suggested that future large-scale studies focus on the supplementary motor area and include follow-up periods of 12 weeks or more.

Meta-analytic comparison of randomized and nonrandomized studies of breast cancer surgery.

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Edwards, Janet P; Kelly, Elizabeth J; Lin, Yongtao; Lenders, Taryn; Ghali, William A; Graham, Andrew J

2012-06-01

Randomized controlled trials (RCTs) are thought to provide the most accurate estimation of "true" treatment effect. The relative quality of effect estimates derived from nonrandomized studies (nRCTs) remains unclear, particularly in surgery, where the obstacles to performing high-quality RCTs are compounded. We performed a meta-analysis of effect estimates of RCTs comparing surgical procedures for breast cancer relative to those of corresponding nRCTs. English-language RCTs of breast cancer treatment in human patients published from 2003 to 2008 were identified in MEDLINE, EMBASE and Cochrane databases. We identified nRCTs using the National Library of Medicine's "related articles" function and reference lists. Two reviewers conducted all steps of study selection. We included studies comparing 2 surgical arms for the treatment of breast cancer. Information on treatment efficacy estimates, expressed as relative risk (RR) for outcomes of interest in both the RCTs and nRCTs was extracted. We identified 12 RCTs representing 10 topic/outcome combinations with comparable nRCTs. On visual inspection, 4 of 10 outcomes showed substantial differences in summary RR. The pooled RR estimates for RCTs versus nRCTs differed more than 2-fold in 2 of 10 outcomes and failed to demonstrate consistency of statistical differences in 3 of 10 cases. A statistically significant difference, as assessed by the z score, was not detected for any of the outcomes. Randomized controlled trials comparing surgical procedures for breast cancer may demonstrate clinically relevant differences in effect estimates in 20%-40% of cases relative to those generated by nRCTs, depending on which metric is used.

[Methodological quality evaluation of randomized controlled trials for traditional Chinese medicines for treatment of sub-health].

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Zhao, Jun; Liao, Xing; Zhao, Hui; Li, Zhi-Geng; Wang, Nan-Yue; Wang, Li-Min

2016-11-01

To evaluate the methodological quality of the randomized controlled trials(RCTs) for traditional Chinese medicines for treatment of sub-health, in order to provide a scientific basis for the improvement of clinical trials and systematic review. Such databases as CNKI, CBM, VIP, Wanfang, EMbase, Medline, Clinical Trials, Web of Science and Cochrane Library were searched for RCTS for traditional Chinese medicines for treatment of sub-health between the time of establishment and February 29, 2016. Cochrane Handbook 5.1 was used to screen literatures and extract data, and CONSORT statement and CONSORT for traditional Chinese medicine statement were adopted as the basis for quality evaluation. Among the 72 RCTs included in this study, 67 (93.05%) trials described the inter-group baseline data comparability, 39(54.17%) trials described the unified diagnostic criteria, 28(38.89%) trials described the unified standards of efficacy, 4 (5.55%) trials mentioned the multi-center study, 19(26.38%) trials disclosed the random distribution method, 6(8.33%) trials used the random distribution concealment, 15(20.83%) trials adopted the method of blindness, 3(4.17%) study reported the sample size estimation in details, 5 (6.94%) trials showed a sample size of more than two hundred, 19(26.38%) trials reported the number of withdrawal, defluxion cases and those lost to follow-up, but only 2 trials adopted the ITT analysis,10(13.89%) trials reported the follow-up results, none of the trial reported the test registration and the test protocol, 48(66.7%) trials reported all of the indicators of expected outcomes, 26(36.11%) trials reported the adverse reactions and adverse events, and 4(5.56%) trials reported patient compliance. The overall quality of these randomized controlled trials for traditional Chinese medicines for treatment of sub-health is low, with methodological defects in different degrees. Therefore, it is still necessary to emphasize the correct application of principles

EFFECT OF LOW ENERGY VERSUS MEDIUM ENERGY RADIAL SHOCK WAVE THERAPY IN THE TREATMENT OF CHRONIC PLANTER FASCIITIS

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Khaled Z. Fouda

2016-02-01

Full Text Available Background: Plantar fasciitis (PF is the most common cause of heel pain and it can often be a challenge for clinicians to treat successfully. Radial shock wave therapy (RSWT has been introduced recently for treatment of musculoskeletal disorders. Different energy levels of shock wave therapy have been used in the literatures for treatment of PF with no clear settled parameters. Therefore, the purpose of this study was intended to investigate and compare the efficacy of two different energy levels of RSWT on PF patients. Methods: Forty patients having unilateral chronic PF were recruited for the study from orthopedic outpatient clinics of Cairo University hospitals and National Institute of Neuromotor System Cairo Egypt, with a mean age of (47.15±4.57 years. Patients were randomly assigned into two equal groups. Group (A treated with low intensity level of 1.6 bars (0.16 mJ/mm2 RSWT and group (B treated with medium intensity level of 4 bars (0.38 mJ/mm2 RSWT. Functional assessment of the foot based on Foot Function Index (FFI and Present pain intensity was measured during rest by Visual Analogue Scale (VAS. Results: There was as significant decreased in the total FFI scores from (118.42 ±6.51 to (81.37 ±3.46 for group (A and from (118.93 ±6.85 to (58.50 ±3.22 for group (B. Also regarding VAS Scores there was as significant decreased in the pain intensity from (5.11 ±0.41 to (2.85 ±0.31 for group (A and from (4.95 ±0.39 to (2.05 ±0.22 for group (B. Conclusion: Radial shock wave therapy is an effective modality that should be considered in the treatment of chronic PF, while the medium energy level RSWT is better than the low energy level RSWT in regarding to the measured treatment outcomes.

Energy in one-dimensional linear waves

International Nuclear Information System (INIS)

Repetto, C E; Roatta, A; Welti, R J

2011-01-01

This work is based on propagation phenomena that conform to the classical wave equation. General expressions of power, the energy conservation equation in continuous media and densities of the kinetic and potential energies are presented. As an example, we study the waves in a string and focused attention on the case of standing waves. The treatment is applicable to introductory science textbooks. (letters and comment)

[Renal hematomas after extracorporeal shock-wave lithotripsy (ESWL)].

Science.gov (United States)

Pastor Navarro, Héctor; Carrión López, Pedro; Martínez Ruiz, Jesús; Pastor Guzmán, José Ma; Martínez Martín, Mariano; Virseda Rodríguez, Julio A

2009-03-01

The use of fragmentation due to shock- waves as a treatment of urinary stone was one of the most important therapeutics findings in the history of urology. It's the first election treatment for most of the calculus at renal and urethral location due to the fact that it is a low invasive treatment and it has a few number of complications, but this method also has a few negative side effects, it can caused a more or less important traumatic lesion at the organs which crosses the shock-waves, including the kidney where it can caused a small contusion or renal hematoma with different resolution and treatment. We reviewed 4815 extracorporeal shock-wave lithotripsy that we performed in our department in which we found six cases with subcapsular and perirenal hematoma which we followed up and treated. After the urological complications (pain, obstruction and infection) the renal and perirenal hematic collections are the most frequent adverse effects of shock-waves used in lithotripsy, these are related to the power of energy used and patient age. Between the years 1992-2007 we performed 4.815 extracorporeal shock-wave lithotripsy finding seven cases of severe hematoma, less then 1%. Treatment of these complications is usually not aggressive though sometimes it is necessary to perform surgical drainage and even nephrectomy.

Developmental programming: Prenatal BPA treatment disrupts timing of LH surge and ovarian follicular wave dynamics in adult sheep

International Nuclear Information System (INIS)

Veiga-Lopez, A.; Beckett, E.M.; Abi Salloum, B.; Ye, W.; Padmanabhan, V.

2014-01-01

Developmental exposure to BPA adversely affects reproductive function. In sheep, prenatal BPA treatment induces reproductive neuroendocrine defects, manifested as LH excess and dampened LH surge and perturbs early ovarian gene expression. In this study we hypothesized that prenatal BPA treatment will also disrupt ovarian follicular dynamics. Pregnant sheep were treated from days 30 to 90 of gestation with 3 different BPA doses (0.05, 0.5, or 5 mg/kg BW/day). All female offspring were estrus synchronized and transrectal ultrasonography was performed daily for 22 days to monitor ovarian follicular and corpora lutea dynamics. Blood samples were collected to assess preovulatory hormonal changes and luteal progesterone dynamics. Statistical analysis revealed that the time interval between the estradiol rise and the preovulatory LH surge was shortened in the BPA-treated females. None of the three BPA doses had an effect on corpora lutea, progestogenic cycles, and mean number or duration of ovulatory and non-ovulatory follicles. However, differences in follicular count trajectories were evident in all three follicular size classes (2–3 mm, 4–5 mm, and ≥ 6 mm) of prenatal BPA-treated animals compared to controls. Number of follicular waves tended also to be more variable in the prenatal BPA-treated groups ranging from 2 to 5 follicular waves per cycle, while this was restricted to 3 to 4 waves in control females. These changes in ovarian follicular dynamics coupled with defects in time interval between estradiol rise and preovulatory LH release are likely to lead to subfertility in prenatal BPA-treated females. - Highlights: • Prenatal BPA shortens interval between estradiol rise and preovulatory LH surge. • Prenatal BPA affects follicular count trajectory and follicular wave occurrence. • Prenatal BPA does not affect ovulatory rate and progesterone dynamics

Developmental programming: Prenatal BPA treatment disrupts timing of LH surge and ovarian follicular wave dynamics in adult sheep

Energy Technology Data Exchange (ETDEWEB)

Veiga-Lopez, A.; Beckett, E.M.; Abi Salloum, B. [Department of Pediatrics, University of Michigan, Ann Arbor, MI (United States); Ye, W. [Department of Biostatistics, University of Michigan, Ann Arbor, MI (United States); Padmanabhan, V., E-mail: vasantha@umich.edu [Department of Pediatrics, University of Michigan, Ann Arbor, MI (United States); The Reproductive Sciences Program, University of Michigan, Ann Arbor, MI (United States)

2014-09-01

Developmental exposure to BPA adversely affects reproductive function. In sheep, prenatal BPA treatment induces reproductive neuroendocrine defects, manifested as LH excess and dampened LH surge and perturbs early ovarian gene expression. In this study we hypothesized that prenatal BPA treatment will also disrupt ovarian follicular dynamics. Pregnant sheep were treated from days 30 to 90 of gestation with 3 different BPA doses (0.05, 0.5, or 5 mg/kg BW/day). All female offspring were estrus synchronized and transrectal ultrasonography was performed daily for 22 days to monitor ovarian follicular and corpora lutea dynamics. Blood samples were collected to assess preovulatory hormonal changes and luteal progesterone dynamics. Statistical analysis revealed that the time interval between the estradiol rise and the preovulatory LH surge was shortened in the BPA-treated females. None of the three BPA doses had an effect on corpora lutea, progestogenic cycles, and mean number or duration of ovulatory and non-ovulatory follicles. However, differences in follicular count trajectories were evident in all three follicular size classes (2–3 mm, 4–5 mm, and ≥ 6 mm) of prenatal BPA-treated animals compared to controls. Number of follicular waves tended also to be more variable in the prenatal BPA-treated groups ranging from 2 to 5 follicular waves per cycle, while this was restricted to 3 to 4 waves in control females. These changes in ovarian follicular dynamics coupled with defects in time interval between estradiol rise and preovulatory LH release are likely to lead to subfertility in prenatal BPA-treated females. - Highlights: • Prenatal BPA shortens interval between estradiol rise and preovulatory LH surge. • Prenatal BPA affects follicular count trajectory and follicular wave occurrence. • Prenatal BPA does not affect ovulatory rate and progesterone dynamics.

Topical vs. systemic treatments for acute otitis media.

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Thornton, Kathy; Parrish, Francie; Swords, Christine

2011-01-01

Acute otitis media (AOM) is a common condition in children that is often treated with systemic antibiotic therapy; however, research suggests that non-complicated AOM will resolve spontaneously using only eardrops. To determine best practice for the use of systematic antibiotics compared to topical treatment of AOM, a systematic review of evidence was conducted. Cochrane, Medline, CINAHL, and other databases were searched. Inclusion criteria were studies published from 1995-2010 that included children with AOM and were randomized controlled trials (RCTs). Five systematic reviews and five RCTs were included in the review. Current evidence recommends using topical and other alternative approaches for treating non-complicated AOM in children 2 years of age or older; however, many practitioners are not currently following these recommendations for various reasons. Additional research to address these reasons may help determine how to improve practitioner adherence to best practice evidence and guidelines to help reduce the unnecessary use of systemic antibiotics.

[Systematic review on methodology of randomized controlled trials of post-marketing Chinese patent drugs for treatment of type 2 diabetes].

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Ma, Li-xin; Wang, Yu-yi; Li, Xin-xue; Liu, Jian-ping

2012-03-01

Randomized controlled trial (RCT) is considered as the gold standard for the efficacy assessment of medicines. With the increasing number of Chinese patent drugs for treatment of type 2 diabetes, the methodology of post-marketing RCTs evaluating the efficacy and specific effect has become more important. To investigate post-marketing Chinese patent drugs for treatment of type 2 diabetes, as well as the methodological quality of post-marketing RCTs. Literature was searched from the books of Newly Compiled Traditional Chinese Patent Medicine and Chinese Pharmacopeia, the websites of the State Food and Drug Administration and the Ministry of Human Resources and Social Security of the People's Republic of China, China National Knowledge Infrastructure Database, Chongqing VIP Chinese Science and Technology Periodical Database, Chinese Biomedical Database (SinoMed) and Wanfang Data. The time period for searching ran from the commencement of each database to August 2011. RCTs of post-marketing Chinese patent drugs for treatment of type 2 diabetes with intervention course no less than 3 months. Two authors independently evaluated the research quality of the RCTs by the checklist of risk bias assessment and the data collection forms based on the CONSORT Statement. Independent double data-extraction was performed. The authors identified a total of 149 Chinese patent drugs for treatment of type 2 diabetes. According to different indicative syndromes, the Chinese patent drugs can be divided into the following types, namely, yin deficiency and interior heat (n=48, 32%), dual deficiency of qi and yin (n=58, 39%) and dual deficiency of qi and yin combined with blood stasis (n=22, 15%). A total of 41 RCTs meeting the inclusion criteria were included. Neither multicenter RCTs nor endpoint outcome reports were found. Risk bias analysis showed that 81% of the included studies reported randomization for grouping without sequence generation, 98% of these studies did not report

Diet as prophylaxis and treatment for venous thromboembolism?

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Cundiff David K

2010-08-01

Full Text Available Abstract Background Both prophylaxis and treatment of venous thromboembolism (VTE: deep venous thrombosis (DVT and pulmonary emboli (PE with anticoagulants are associated with significant risks of major and fatal hemorrhage. Anticoagulation treatment of VTE has been the standard of care in the USA since before 1962 when the U.S. Food and Drug Administration began requiring randomized controlled clinical trials (RCTs showing efficacy, so efficacy trials were never required for FDA approval. In clinical trials of 'high VTE risk' surgical patients before the 1980s, anticoagulant prophylaxis was clearly beneficial (fatal pulmonary emboli (FPE without anticoagulants = 0.99%, FPE with anticoagulants = 0.31%. However, observational studies and RCTs of 'high VTE risk' surgical patients from the 1980s until 2010 show that FPE deaths without anticoagulants are about one-fourth the rate that occurs during prophylaxis with anticoagulants (FPE without anticoagulants = 0.023%, FPE while receiving anticoagulant prophylaxis = 0.10%. Additionally, an FPE rate of about 0.012% (35/28,400 in patients receiving prophylactic anticoagulants can be attributed to 'rebound hypercoagulation' in the two months after stopping anticoagulants. Alternatives to anticoagulant prophylaxis should be explored. Methods and Findings The literature concerning dietary influences on VTE incidence was reviewed. Hypotheses concerning the etiology of VTE were critiqued in relationship to the rationale for dietary versus anticoagulant approaches to prophylaxis and treatment. Epidemiological evidence suggests that a diet with ample fruits and vegetables and little meat may substantially reduce the risk of VTE; vegetarian, vegan, or Mediterranean diets favorably affect serum markers of hemostasis and inflammation. The valve cusp hypoxia hypothesis of DVT/VTE etiology is consistent with the development of VTE being affected directly or indirectly by diet. However, it is less consistent with

Pelvic floor muscle training and adjunctive therapies for the treatment of stress urinary incontinence in women: a systematic review

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Neumann Patricia B

2006-06-01

Full Text Available Abstract Background Stress urinary incontinence (SUI is a prevalent and costly condition which may be treated surgically or by physical therapy. The aim of this review was to systematically assess the literature and present the best available evidence for the efficacy and effectiveness of pelvic floor muscle training (PFMT performed alone and together with adjunctive therapies (eg biofeedback, electrical stimulation, vaginal cones for the treatment of female SUI. Methods All major electronic sources of relevant information were systematically searched to identify peer-reviewed English language abstracts or papers published between 1995 and 2005. Randomised controlled trials (RCTs and other study designs eg non-randomised trials, cohort studies, case series, were considered for this review in order to source all the available evidence relevant to clinical practice. Studies of adult women with a urodynamic or clinical diagnosis of SUI were eligible for inclusion. Excluded were studies of women who were pregnant, immediately post-partum or with a diagnosis of mixed or urge incontinence. Studies with a PFMT protocol alone and in combination with adjunctive physical therapies were considered. Two independent reviewers assessed the eligibility of each study, its level of evidence and the methodological quality. Due to the heterogeneity of study designs, the results are presented in narrative format. Results Twenty four studies, including 17 RCTs and seven non-RCTs, met the inclusion criteria. The methodological quality of the studies varied but lower quality scores did not necessarily indicate studies from lower levels of evidence. This review found consistent evidence from a number of high quality RCTs that PFMT alone and in combination with adjunctive therapies is effective treatment for women with SUI with rates of 'cure' and 'cure/improvement' up to 73% and 97% respectively. The contribution of adjunctive therapies is unclear and there is limited

Deep Downhole Seismic Testing at the Waste Treatment Plant Site, Hanford, WA. Volume IV S-Wave Measurements in Borehole C4993 Seismic Records, Wave-Arrival Identifications and Interpreted S-Wave Velocity Profile.

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Stokoe, Kenneth H.; Li, Song Cheng; Cox, Brady R.; Menq, Farn-Yuh

2007-06-06

In this volume (IV), all S-wave measurements are presented that were performed in Borehole C4993 at the Waste Treatment Plant (WTP) with T-Rex as the seismic source and the Lawrence Berkeley National Laboratory (LBNL) 3-D wireline geophone as the at-depth borehole receiver. S-wave measurements were performed over the depth range of 370 to 1300 ft, typically in 10-ft intervals. However, in some interbeds, 5-ft depth intervals were used, while below about 1200 ft, depth intervals of 20 ft were used. Shear (S) waves were generated by moving the base plate of T-Rex for a given number of cycles at a fixed frequency as discussed in Section 2. This process was repeated so that signal averaging in the time domain was performed using 3 to about 15 averages, with 5 averages typically used. In addition, a second average shear wave record was recorded by reversing the polarity of the motion of the T-Rex base plate. In this sense, all the signals recorded in the field were averaged signals. In all cases, the base plate was moving perpendicular to a radial line between the base plate and the borehole which is in and out of the plane of the figure shown in Figure 1.1. The definition of “in-line”, “cross-line”, “forward”, and “reversed” directions in items 2 and 3 of Section 2 was based on the moving direction of the base plate. In addition to the LBNL 3-D geophone, called the lower receiver herein, a 3-D geophone from Redpath Geophysics was fixed at a depth of 22 ft in Borehole C4993, and a 3-D geophone from the University of Texas (UT) was embedded near the borehole at about 1.5 ft below the ground surface. The Redpath geophone and the UT geophone were properly aligned so that one of the horizontal components in each geophone was aligned with the direction of horizontal shaking of the T-Rex base plate. This volume is organized into 12 sections as follows. Section 1: Introduction, Section 2: Explanation of Terminology, Section 3: Vs Profile at Borehole C4993

21 CFR 876.5990 - Extracorporeal shock wave lithotripter.

Science.gov (United States)

2010-04-01

..., control console, imaging/localization system, and patient table. Prior to treatment, the urinary stone is targeted using either an integral or stand-alone localization/imaging system. Shock waves are typically... shock wave lithotripter. (a) Identification. An extracorporeal shock wave lithotripter is a device that...

Level of response and safety of pharmacological monotherapy in the treatment of acute bipolar I disorder phases: a systematic review and meta-analysis

Science.gov (United States)

Tamayo, Jorge M.; Zarate, Carlos A.; Vieta, Eduard; Vázquez, Gustavo; Tohen, Mauricio

2010-01-01

In recent years, combinations of pharmacological treatments have become common for the treatment of bipolar disorder type I (BP I); however, this practice is usually not evidence-based and rarely considers monotherapy drug regimen (MDR) as an option in the treatment of acute phases of BP I. Therefore, we evaluated comparative data of commonly prescribed MDRs for both manic and depressive phases of BP I. Medline, PsycINFO, EMBASE, the Cochrane Library, the ClinicalStudyResults.org and other data sources were searched from 1949 to March 2009 for placebo and active controlled randomized clinical trials (RCTs). Risk ratios (RRs) for response, remission, and discontinuation rates due to adverse events (AEs), lack of efficacy, or discontinuation due to any cause, and the number needed to treat or harm (NNT or NNH) were calculated for each medication individually and for all evaluable trials combined. The authors included 31 RCTs in the analyses comparing a MDR with placebo or with active treatment for acute mania, and 9 RCTs comparing a MDR with placebo or with active treatment for bipolar depression. According to the collected evidence, most of the MDRs when compared to placebo showed significant response and remission rates in acute mania. In the case of bipolar depression only quetiapine and, to a lesser extent, olanzapine showed efficacy as MDR. Overall, MDRs were well tolerated with low discontinuation rates due to any cause or AE, although AE profiles differed among treatments. We concluded that most MDRs were efficacious and safe in the treatment of manic episodes, but very few MDRs have demonstrated being efficacious for bipolar depressive episodes. PMID:20128953

Effectiveness of shock wave therapy as an alternative to the rotator cuff injury treatment

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Roberto Joaquín Del Gordo-D´Amato

2016-02-01

Full Text Available Rotator cuff injuries are reason for consultation frequent in elderly patients. Most of the time there are no background traumatic acute generating progressive limitations in activities of daily living (ADLS. The objective of this study is to show results in tendonitis of the rotator cuff, in patients treated with extracorporeal shock wave therapy (ESWT. It is a prospective descriptive observational study which presents clinical and functional outcomes in patients with described lesion, treated with ESWT with poor response to conventional treatments and clinical pictures of longstanding through implementing visual analog scale (VAS of pain and evaluation of range of motion. The greater presence of lesion is present in women 63.6%. Mostly affected shoulder was right in a 63.6%. Found significant changes in VAS pre and post treatment with averages of 7.9 and 0.5 respectively and different statistical p < 0.001. We were conclude that the ESWT is an effective method in the treatment of the tendonitis of the rotator cuff with relief from pain and return to functional levels.

Extracorporeal shock wave treatment of non- or delayed union of proximal metatarsal fractures.

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Alvarez, Richard G; Cincere, Brandon; Channappa, Chandra; Langerman, Richard; Schulte, Robert; Jaakkola, Juha; Melancon, Keith; Shereff, Michael; Cross, G Lee

2011-08-01

Nonunion or delayed union of fractures in the proximal aspect of metatarsals 1 to 4 and Zone 2 of the fifth metatarsal were treated by high energy extracorporeal shock wave treatment (ESWT) to study the safety and efficacy of this method of treatment in a FDA study of the Ossatron device. In a prospective single-arm, multi-center study, 34 fractures were treated in 32 patients (two subjects had two independent fractures) with ESWT. All fractures were at least 10 (range, 10 to 833) weeks after injury, with a median of 23 weeks. ESWT application was conducted using a protocol totaling 2,000 shocks for a total energy application of approximately 0.22 to 0.51 mJ/mm2 per treatment. The mean ESWT application time for each of the treatments was 24.6 +/- 16.6 minutes, and anesthesia time averaged 27.1 +/- 10.4 minutes. All subjects were followed for 1 year after treatment at intervals of 12 weeks, 6, 9, and 12 months. The overall success rate at the 12-week visit was 71% with low complications, significant pain improvement as well as improvement on the SF-36. The success/fail criteria was evaluated again at the 6- and 12-month followup, showing treatment success rates of 89% (23/26) and 90% (18/20), respectively. The most common adverse event was swelling in the foot, reported by five subjects (15.6%). High-energy ESWT appears to be effective and safe in patients for treatment of nonunion or a delayed healing of a proximal metatarsal, and in fifth metatarsal fractures in Zone 2.

Management of acute basilar artery occlusion: should any treatment strategy prevail?

Science.gov (United States)

Dornak, Tomas; Herzig, Roman; Sanak, Daniel; Skoloudik, David

2014-12-01

Acute basilar artery occlusion (BAO) is relatively infrequent form of acute ischemic stroke associated with severe and persisting neurological deficit and high mortality rate (to 86%). Early recanalization is essential for good clinical outcome but the most effective treatment approach remains unestablished. Several treatment strategies are currently available but their safety and efficacy have only been tested in retrospective/prospective case series. Randomized controlled trials (RCTs) are lacking. We searched the PubMed database for assessments of recanalization rate and clinical outcome in BAO patients treated with various treatment methods. The results show that antithrombotics are least effective while specific reperfusion therapies including intravenous thrombolysis (IVT) and various types of intra-arterial therapy (IAT) are more so. Less than half of BAO patients reach independent outcome following IVT with a recanalization rate 52-78%. Even though IAT recanalizes BAO more frequently (in up to 100%), the higher recanalization rate is not necessarily associated with better outcome. Good clinical outcome is strongly dependent on recanalization time. Thus, the concept of bridging therapy, combining widely available IVT with IAT, was introduced and is usually considered a rescue strategy in non-responders to IV alteplase. A trend to better outcome in patients treated with bridging therapy in some studies, has to be confirmed by large RCTs.

Efficacy and safety of oxcarbazepine in the treatment of children with epilepsy: a meta-analysis of randomized controlled trials.

Science.gov (United States)

Geng, Hua; Wang, Chengzhong

2017-01-01

To assess the efficacy and safety of oxcarbazepine (OXC) in the treatment of children with epilepsy. Randomized controlled trials (RCTs) published in PubMed, Embase, Web of Science, Cochrane Library, Scopus, SinoMed (Chinese BioMedical Literature Service System, China), and Chinese National Knowledge Infrastructure (China) database were systematically reviewed. Eligible studies were those that compared the efficacy and safety of OXC with other antiepileptic drugs in epilepsy. Risk ratio (RR) with 95% confidence intervals (95% CIs) was calculated using fixed-effects or random-effects model. Eleven RCTs with a total of 1,241 patients met the inclusion criteria and were included in this meta-analysis. Compared with other antiepileptic drugs (sodium valproate, levetiracetam, phenytoin, and placebo), OXC was associated with similar seizure-free rate (RR =1.06, 95% CI: 0.94, 1.20; P =0.366) and percentage reduction from baseline in seizure frequency (for ≥75% reduction: RR =1.15, 95% CI: 0.88, 1.49; P =0.310; for 50%-75% reduction: RR =1.12, 95% CI: 0.90, 1.39; P =0.301; for effects and safety as other antiepileptic drugs in the treatment of children with epilepsy. Further well-conducted, large-scale RCTs are needed to validate these findings.

Clinical and Demographic Profile of Patients Receiving Fingolimod in Clinical Practice in Germany and the Benefit-Risk Profile of Fingolimod After 1 Year of Treatment: Initial Results From the Observational, Noninterventional Study PANGAEA.

Science.gov (United States)

Ziemssen, Tjalf; Lang, Michael; Tackenberg, Björn; Schmidt, Stephan; Albrecht, Holger; Klotz, Luisa; Haas, Judith; Lassek, Christoph; Medin, Jennie; Cornelissen, Christian

2018-01-01

The population with multiple sclerosis receiving treatment in clinical practice differs from that in randomized controlled trials (RCTs). An assessment of the real-world benefit-risk profile of therapies is needed. This analysis used data from the large, noninterventional, observational German study Post-Authorization Non-interventional German sAfety study of GilEnyA (PANGAEA) to assess prospectively baseline characteristics and outcomes after 12 months (± 90 days) of fingolimod treatment. Patients were divided into 2 cohorts: fingolimod starter [first received fingolimod in PANGAEA (n = 3315)] and previous study [received fingolimod before enrollment in PANGAEA in RCTs (n = 875), some of whom also had baseline data at entry into RCTs (n = 505)]. At PANGAEA baseline, patients in the fingolimod starter versus the previous study cohort had a higher annualized relapse rate [ARR (95% confidence interval): 1.79 (1.75-1.83) vs 1.32 (1.25-1.40)] and Expanded Disability Status Scale score [3.11 (3.04-3.17) vs 2.55 (2.44-2.66)]. A greater proportion in the fingolimod starter versus previous study cohort had diabetes (2.0% vs 0.7%). After 12 months of fingolimod, ARRs were lower than in the 12 months before PANGAEA enrollment in the fingolimod starter [0.386 (0.360-0.414)] and previous study [0.276 (0.238-0.320)] cohorts. Expanded Disability Status Scale scores were stable versus baseline. Adverse events were experienced by similar proportions in both cohorts during fingolimod treatment. Relevant differences exist in disease activity and comorbidities between patients receiving fingolimod in clinical practice versus RCTs. Irrespective of baseline differences indicating a higher proportion at an advanced stage of multiple sclerosis in the real world versus RCTs, fingolimod remains effective, with a manageable safety profile.

[Dengzhan Xixin injection as an adjuvant treatment for angina pectoris: a systematic review and Meta-analysis of randomized controlled trials].

Science.gov (United States)

Wang, Feng-jiao; Xie, Yan-ming; Liao, Xing; Jia, Min

2015-08-01

The paper is to systematically evaluate the efficacy and safety of Deng Zhan Xi Xin injection ( DZXXI) as an adjuvant treatment for patients with angina pectoris. The Cochrane Library, Medline, EMbase, CBM, CNKI, VIP, and Wan fang Data base were searched. Randomized controlled trials (RCTs) of DZXXI combined with western medicine routine treatment versus western medicine routine treatment alone for angina pectoris patients were all included. All trials were assessed according to the Cochrane Reviewer' s Handbook 5.1 for Systematic Reviews of Intervention and Meta analyses were performed by RevMan 5. 2 Software. A total of 30RCTs (3 086 patients including 1 572 patients of treatment group and 1 514 patients of control group) were included. Meta-analysis of treatment group compared with control group showed superior effect over reducing cardiovascular events ( OR = 0.33; 95% CI: [0.16, 0.67], P = 0.002, improving effective rate of DZXXI as adjuvant treatment for angina pectoris patients (OR = 3.97; 95% CI: [3.15, 5.02]; P angina pectoris. But based on the limitations of the study, rigorous design with long follow up clinical trials are necessary for further evidence.

Nonlinear instability and chaos in plasma wave-wave interactions, I., Introduction

International Nuclear Information System (INIS)

Kueny, C.S.; Morrison, P.J.

1994-11-01

Conventional linear stability analyses may fail for fluid systems with an indefinite free energy functional. When such a system is linearly stable, it is said to possess negative energy modes. Instability may then occur either via dissipation of the negative energy modes, or nonlinearly via resonant wave-wave coupling, leading to explosive growth. In the dissipationless case, it is conjectured that intrinsic chaotic behavior may allow initially nonresonant systems to reach resonance by diffusion in phase space. In this and a companion paper [submitted to Physics of Plasmas], this phenomenon is demonstrated for a simple equilibrium involving cold counterstreaming ions. The system is described in the fluid approximation by a Hamiltonian functional and associated noncanonical Poisson bracket. By Fourier decomposition and appropriate coordinate transformations, the Hamiltonian for the perturbed energy is expressed in action-angle form. The normal modes correspond to Doppler-shifted ion-acoustic waves of positive and negative energy. Nonlinear coupling leads to decay instability via two-wave interactions, and to either decay or explosive instability via three-wave interactions. These instabilities are described for various (integrable) systems of waves interacting via single nonlinear terms. This discussion provides the foundation for the treatment of nonintegrable systems in the companion paper

Nonlinear instability and chaos in plasma wave--wave interactions. I. Introduction

International Nuclear Information System (INIS)

Kueny, C.S.; Morrison, P.J.

1995-01-01

Conventional linear stability analyses may fail for fluid systems with an indefinite free-energy functional. When such a system is linearly stable, it is said to possess negative energy modes. Instability may then occur either via dissipation of the negative energy modes, or nonlinearly via resonant wave--wave coupling, leading to explosive growth. In the dissipationless case, it is conjectured that intrinsic chaotic behavior may allow initially nonresonant systems to reach resonance by diffusion in phase space. In this and a companion paper (submitted to Phys. Plasmas), this phenomenon is demonstrated for a simple equilibrium involving cold counterstreaming ions. The system is described in the fluid approximation by a Hamiltonian functional and associated noncanonical Poisson bracket. By Fourier decomposition and appropriate coordinate transformations, the Hamiltonian for the perturbed energy is expressed in action-angle form. The normal modes correspond to Doppler-shifted ion-acoustic waves of positive and negative energy. Nonlinear coupling leads to decay instability via two-wave interactions, and to either decay or explosive instability via three-wave interactions. These instabilities are described for various integrable systems of waves interacting via single nonlinear terms. This discussion provides the foundation for the treatment of nonintegrable systems in the companion paper. copyright 1995 American Institute of Physics

Treatment of upper urinary tract stones with extracorporeal shock wave lithotripsy (ESWL) Sonolith vision.

Science.gov (United States)

Nakamura, Kogenta; Tobiume, Motoi; Narushima, Masahiro; Yoshizawa, Takahiko; Nishikawa, Genya; Kato, Yoshiharu; Katsuda, Remi; Zennami, Kenji; Aoki, Shigeyuki; Yamada, Yoshiaki; Honda, Nobuaki; Sumitomo, Makoto

2011-12-12

The aim was to retrospectively assess the results of treatment of upper urinary tract stones with the Sonolith vision manufactured by EDAP, and purchased in 2004. The subjects were 226 Japanese patients who underwent extracorporeal shock wave lithotripsy (ESWL) alone as an initial treatment and could be followed up for at least 3 months, selected from 277 candidate patients who underwent this therapy between 2004 and 2006. Treatment effect was evaluated by kidney, ureter, and bladder X-ray or renal ultrasonography at 1 and 3 months after treatment. A stone-free status or status of stone fragmentation to 4 mm or smaller was considered to indicate effective treatment. At 3 months after treatment, the stone-free rate was 69.4% and the efficacy rate was 77.4% for renal stones, while these rates were 91.5 and 93.3%, respectively for ureteral stones. Assessment of treatment effect classified by the location of stones revealed a stone-free rate of 94.6% and an efficacy rate of 94.6% for lower ureteral stones (4.0 mm or smaller, 1 subject; 4.1-10.0 mm, 31 subjects; 10.1-20.0 mm, 5 subjects: number of treatment sessions, 1 or 2 sessions [mean: 1.03 sessions]). Complications of this therapy included renal subcapsular hematoma and pyelonephritis in 1 case each. ESWL with the Sonolith vision manufactured by EDAP produced a treatment effect equivalent to those achieved with other models of ESWL equipment. ESWL seems to be an effective first-line treatment also in patients who have lower ureteral stones 10 mm or larger but do not wish to undergo TUL, if measures such as suitable positioning of the patient during treatment are taken.

Treatment of upper urinary tract stones with extracorporeal shock wave lithotripsy (ESWL Sonolith vision

Directory of Open Access Journals (Sweden)

Nakamura Kogenta

2011-12-01

Full Text Available Abstract Background The aim was to retrospectively assess the results of treatment of upper urinary tract stones with the Sonolith vision manufactured by EDAP, and purchased in 2004. Methods The subjects were 226 Japanese patients who underwent extracorporeal shock wave lithotripsy (ESWL alone as an initial treatment and could be followed up for at least 3 months, selected from 277 candidate patients who underwent this therapy between 2004 and 2006. Treatment effect was evaluated by kidney, ureter, and bladder X-ray or renal ultrasonography at 1 and 3 months after treatment. A stone-free status or status of stone fragmentation to 4 mm or smaller was considered to indicate effective treatment. Results At 3 months after treatment, the stone-free rate was 69.4% and the efficacy rate was 77.4% for renal stones, while these rates were 91.5 and 93.3%, respectively for ureteral stones. Assessment of treatment effect classified by the location of stones revealed a stone-free rate of 94.6% and an efficacy rate of 94.6% for lower ureteral stones (4.0 mm or smaller, 1 subject; 4.1-10.0 mm, 31 subjects; 10.1-20.0 mm, 5 subjects: number of treatment sessions, 1 or 2 sessions [mean: 1.03 sessions]. Complications of this therapy included renal subcapsular hematoma and pyelonephritis in 1 case each. Conclusions ESWL with the Sonolith vision manufactured by EDAP produced a treatment effect equivalent to those achieved with other models of ESWL equipment. ESWL seems to be an effective first-line treatment also in patients who have lower ureteral stones 10 mm or larger but do not wish to undergo TUL, if measures such as suitable positioning of the patient during treatment are taken.

Does Adjuvant Treatment With Ginkgo Biloba to Statins Have Additional Benefits in Patients With Dyslipidemia?

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Yu Fan

2018-06-01

Full Text Available Objective: Ginkgo biloba are widely used alone or in combination with other lipid-lowering agents in the treatment of dyslipidemia in China. We conducted this meta-analysis to investigate whether adjuvant treatment with ginkgo biloba leaves to statins has incremental benefits in patients with dyslipidemia.Methods: Potential studies were searched from PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, VIP, and Wanfang database up to October 2017. Only randomized controlled trials (RCTs comparing the efficacy and safety of ginkgo biloba leaves plus statins versus statins alone in patients with dyslipidemia were included.Results: Eight RCTs involving 664 patients were included. Compared with statins therapy alone, combination of statins and ginkgo biloba leaves therapy achieved greater reductions in triglycerides [mean difference (MD -0.32 mmol/L; 95% confidence interval (CI -0.43 to -0.20], total cholesterol (MD -0.61 mmol/L; 95% CI -0.90 to -0.33, or low-density lipoprotein cholesterol (LDL-C (MD -0.32 mmol/L; 95% CI -0.48 to -0.16, and a greater increment in high-density lipoprotein cholesterol (MD 0.26 mmol/L; 95% CI 0.15 to 0.37. Subgroup analyses showed that ginkgo biloba leaves plus simvastatin appeared to achieve a greater reduction in serum levels of triglycerides, total cholesterol, and LDL-C than in combination with atorvastatin therapy.Conclusion: This meta-analysis suggests that adjuvant treatment with ginkgo biloba leaves appears to improve blood lipid parameters than statins therapy alone. More well-designed RCTs are needed to investigate the benefits of the combination of statins and ginkgo biloba leaves.

Treatment of cystine stones: combined approach using open pyelolithotomy, percutaneous pyelolithotripsy, extracorporeal shock wave lithotripsy and chemolysis

DEFF Research Database (Denmark)

Aabech, J; Andersen, J T

1993-01-01

Treatment of cystine stones in the urinary tract can be difficult because of a high frequency of recurrence, resistance to Extracorporeal Shock Wave Lithotripsy (ESWL), difficulty in localization and access to peripheral stones during Percutaneous Nephrolithotripsy (PCNL), and the insufficient...... effect of oral chemolysis. We present two cases of urinary cystine calculi treated with a combination of pyelolithotomy, PCNL, ESWL and percutaneous irrigation chemolysis, using N-acetylcysteine and Tromethamine-E....

Treatment effects of massage therapy in depressed people: a meta-analysis.

Science.gov (United States)

Hou, Wen-Hsuan; Chiang, Pai-Tsung; Hsu, Tun-Yen; Chiu, Su-Ying; Yen, Yung-Chieh

2010-07-01

To systematically investigate the treatment effects of massage therapy in depressed people by incorporating data from recent studies. A meta-analysis of randomized controlled trials (RCTs) of massage therapy in depressed people was conducted using published studies from PubMed, EMBASE, PsycINFO, and CINAHL electronic database from inception until July 2008. The terms used for the search were derived from medical subheading term (MeSH) massage combined with MeSH depression. Hand searching was also checked for bibliographies of relevant articles. Retrieval articles were constrained to RCTs/clinical trials and human subjects. No language restrictions were imposed. We included 17 studies containing 786 persons from 246 retrieved references. Trials with other intervention, combined therapy, and massage on infants or pregnant women were excluded. Two reviewers independently performed initial screen and assessed quality indicators by Jadad scale. Data were extracted on publication year, participant characteristics, and outcomes by another single reviewer. All trials showed positive effect of massage therapy on depressed people. Seventeen RCTs were of moderate quality, with a mean quality score of 6.4 (SD = 0.85). The pooled standardized mean difference in fixed- and random-effects models were 0.76 (95% CI, 0.61-0.91) and 0.73 (95% CI, 0.52-0.93), respectively. Both indicated significant effectiveness in the treatment group compared with the control group. The variance between these studies revealed possible heterogeneity (tau(2) = 0.06, Cochran chi-squared(16) = 25.77, P = .06). Massage therapy is significantly associated with alleviated depressive symptoms. However, standardized protocols of massage therapy, various depression rating scales, and target populations in further studies are suggested. (c) Copyright 2010 Physicians Postgraduate Press, Inc.

Medicago Scutellata Seed Dormancy Breaking by Ultrasonic Waves

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Nazari Meisam

2014-12-01

Full Text Available In this study dormancy breaking of a hard-coated plant seed, Medicago scutellata, was investigated. The ultrasonic waves effect on the seed germination percentage, germination rate, radicle length and stalk length growth was assessed. Six treatments of waves exposure periods including 0, 1, 3, 5, 7, and 9 minutes were tested under laboratorial conditions. Statistical analyses were done at probability level of 0.01. Results revealed that the ultrasonic waves have a significantly positive effect on the seed dormancy breaking, but there was no linear correlation between the increasing times of exposure with any of the growth features. The best treatment for germination percentage and germination rate was the 7-minute one and the 3-minute one was the best for radicle length growth. Treatments of 3, 5 and 7 minutes had the same effect on stalk length growth and were better than all other treatments. The 9-minute treatment had a negative effect, even lessening the growth of all of the assessed features in comparison with the control treatment.

Developmental programming: Prenatal BPA treatment disrupts timing of LH surge and ovarian follicular wave dynamics in adult sheep

Science.gov (United States)

Veiga-Lopez, A; Beckett, EM; Abi Salloum, B; Ye, W; Padmanabhan, V

2014-01-01

Developmental exposure to BPA adversely affects reproductive function. In sheep, prenatal BPA treatment induces reproductive neuroendocrine defects, manifested as LH excess and dampened LH surge and perturbs early ovarian gene expression. In this study we hypothesized that prenatal BPA treatment will also disrupt ovarian follicular dynamics. Pregnant sheep were treated from days 30 to 90 of gestation with 3 different BPA doses (0.05, 0.5, or 5 mg/kg BW/day). All female offspring were estrus synchronized and transrectal ultrasonography was performed daily for 22 days to monitor ovarian follicular and corpora lutea dynamics. Blood samples were collected to assess hormonal preovulatory changes and luteal progesterone dynamics. Statistical analysis revealed that the time interval between the estradiol rise and the preovulatory LH surge was shortened in the BPA-treated females. None of the three BPA doses had an effect on corpora lutea, progestogenic cycles, and mean or duration of ovulatory and non-ovulatory follicles. However, differences in follicular count trajectories were evident in all three follicular size classes (2–3 mm, 4–5 mm, and ≥ 6 mm) of prenatal BPA-treated animals compared to controls. Number of follicular waves tended also to be more variable in the prenatal BPA-treated groups ranging from 2 to 5 follicular waves per cycle, while this was restricted to 3 to 4 waves in control females. These changes in ovarian follicular dynamics coupled with defects in time interval between estradiol rise and preovulatory LH release are likely to lead to subfertility in prenatal BPA-treated females. PMID:24923655

Arrhythmia during extracorporeal shock wave lithotripsy.

Science.gov (United States)

Zeng, Z R; Lindstedt, E; Roijer, A; Olsson, S B

1993-01-01

A prospective study of arrhythmia during extracorporeal shock wave lithotripsy (ESWL) was performed in 50 patients, using an EDAP LT01 piezoelectric lithotriptor. The 12-lead standard ECG was recorded continuously for 10 min before and during treatment. One or more atrial and/or ventricular ectopic beats occurred during ESWL in 15 cases (30%). The occurrence of arrhythmia was similar during right-sided and left-sided treatment. One patient developed multifocal ventricular premature beats and ventricular bigeminy; another had cardiac arrest for 13.5 s. It was found that various irregularities of the heart rhythm can be caused even by treatment with a lithotriptor using piezoelectric energy to create the shock wave. No evidence was found, however, that the shock wave itself rather than vagal activation and the action of sedo-analgesia was the cause of the arrhythmia. For patients with severe underlying heart disease and a history of complex arrhythmia, we suggest that the ECG be monitored during treatment. In other cases, we have found continuous monitoring of oxygen saturation and pulse rate with a pulse oximeter to be perfectly reliable for raising the alarm when depression of respiration and vaso-vagal reactions occur.

TIPS Evaluation Project Retrospective Study: Wave 1 and 2.

Science.gov (United States)

Hubbard, Susan M.; Mulvey, Kevin P.

2003-01-01

Measured substance abuse treatment professionals' knowledge, attitudes, and practices regarding the Treatment Improvement Protocol (TIP) series and the 28 TIPs. Results for 3,267 respondents in wave 1 and 1,028 in wave 2 indicate that almost half of all professionals were aware of the TIPs. Attitudes toward TIPs were positive, but professionals…

Nonlinear wave collapse and strong turbulence

International Nuclear Information System (INIS)

Robinson, P.A.

1997-01-01

The theory and applications of wave self-focusing, collapse, and strongly nonlinear wave turbulence are reviewed. In the last decade, the theory of these phenomena and experimental realizations have progressed rapidly. Various nonlinear wave systems are discussed, but the simplest case of collapse and strong turbulence of Langmuir waves in an unmagnetized plasma is primarily used in explaining the theory and illustrating the main ideas. First, an overview of the basic physics of linear waves and nonlinear wave-wave interactions is given from an introductory perspective. Wave-wave processes are then considered in more detail. Next, an introductory overview of the physics of wave collapse and strong turbulence is provided, followed by a more detailed theoretical treatment. Later sections cover numerical simulations of Langmuir collapse and strong turbulence and experimental applications to space, ionospheric, and laboratory plasmas, including laser-plasma and beam-plasma interactions. Generalizations to self-focusing, collapse, and strong turbulence of waves in other systems are also discussed, including nonlinear optics, solid-state systems, magnetized auroral and astrophysical plasmas, and deep-water waves. The review ends with a summary of the main ideas of wave collapse and strong-turbulence theory, a collection of open questions in the field, and a brief discussion of possible future research directions. copyright 1997 The American Physical Society

The 5-HT(1F) receptor agonist lasmiditan as a potential treatment of migraine attacks

DEFF Research Database (Denmark)

Tfelt-Hansen, Peer C; Olesen, Jes

2012-01-01

Lasmiditan is a novel selective 5-HT(1F) receptor agonist. It is both scientifically and clinically relevant to review whether a 5-HT(1F) receptor agonist is effective in the acute treatment of migraine. Two RCTs in the phase II development of lasmiditan was reviewed. In the intravenous placebo...

Methodological characteristics and treatment effect sizes in oral health randomised controlled trials: Is there a relationship? Protocol for a meta-epidemiological study.

Science.gov (United States)

Saltaji, Humam; Armijo-Olivo, Susan; Cummings, Greta G; Amin, Maryam; Flores-Mir, Carlos

2014-02-25

It is fundamental that randomised controlled trials (RCTs) are properly conducted in order to reach well-supported conclusions. However, there is emerging evidence that RCTs are subject to biases which can overestimate or underestimate the true treatment effect, due to flaws in the study design characteristics of such trials. The extent to which this holds true in oral health RCTs, which have some unique design characteristics compared to RCTs in other health fields, is unclear. As such, we aim to examine the empirical evidence quantifying the extent of bias associated with methodological and non-methodological characteristics in oral health RCTs. We plan to perform a meta-epidemiological study, where a sample size of 60 meta-analyses (MAs) including approximately 600 RCTs will be selected. The MAs will be randomly obtained from the Oral Health Database of Systematic Reviews using a random number table; and will be considered for inclusion if they include a minimum of five RCTs, and examine a therapeutic intervention related to one of the recognised dental specialties. RCTs identified in selected MAs will be subsequently included if their study design includes a comparison between an intervention group and a placebo group or another intervention group. Data will be extracted from selected trials included in MAs based on a number of methodological and non-methodological characteristics. Moreover, the risk of bias will be assessed using the Cochrane Risk of Bias tool. Effect size estimates and measures of variability for the main outcome will be extracted from each RCT included in selected MAs, and a two-level analysis will be conducted using a meta-meta-analytic approach with a random effects model to allow for intra-MA and inter-MA heterogeneity. The intended audiences of the findings will include dental clinicians, oral health researchers, policymakers and graduate students. The aforementioned will be introduced to the findings through workshops, seminars, round

Enhancement of the Effectiveness of Extracorporeal Shock Wave Therapy with Topical Corticosteroid in Treatment of Chronic Plantar Fasciitis: A Randomized Control Clinical Trial

Science.gov (United States)

Vahdatpour, Babak; Mokhtarian, Arghavan; Raeissadat, Seyed Ahmad; Dehghan, Farnaz; Nasr, Nafiseh; Mazaheri, Mahsa

2018-01-01

Background: Chronic recalcitrant plantar fasciitis is a disabling condition. We presumed if shock wave could increase the permeability of skin and facilitate penetration of topical corticosteroid through the skin; the combinational therapeutic effect would be stronger than using shock wave alone. The study purpose was to utilize the synergistic effect of shock wave and topical corticosteroid in treatment of plantar fasciitis. Materials and Methods: Patients in both groups (n = 40) received four sessions of shock wave with the same protocol at weekly intervals. At 30 min before each session, we used an occlusive dressing of topical clobetasol for the intervention group and Vaseline oil for the control group. Pain severity was assessed with visual analog scale (VAS) and modified Roles and Maudsley score (RMS) at baseline and 1 month and 3 months after intervention. Plantar fascia (PF) thickness was measured with ultrasonography at baseline and 3 months after intervention. Results: One month after intervention, VAS morning showed significant improvement in intervention group (P = 0.006) and RMS showed better improvement in intervention group (P = 0.026). There was no significant difference between the two groups after 3 months in RMS or VAS score. PF thickness was decreased significantly in both groups, but it was not significant between the two groups (P = 0.292). Conclusions: This combinational therapy yielded earlier pain reduction and functional improvement than using shock wave alone; topical corticosteroid could enhance the effectiveness of shockwave in short-term in the treatment of recalcitrant plantar fasciitis. PMID:29862211

Enhancement of the Effectiveness of Extracorporeal Shock Wave Therapy with Topical Corticosteroid in Treatment of Chronic Plantar Fasciitis: A Randomized Control Clinical Trial

Directory of Open Access Journals (Sweden)

Babak Vahdatpour

2018-01-01

Full Text Available Background: Chronic recalcitrant plantar fasciitis is a disabling condition. We presumed if shock wave could increase the permeability of skin and facilitate penetration of topical corticosteroid through the skin; the combinational therapeutic effect would be stronger than using shock wave alone. The study purpose was to utilize the synergistic effect of shock wave and topical corticosteroid in treatment of plantar fasciitis. Materials and Methods: Patients in both groups (n = 40 received four sessions of shock wave with the same protocol at weekly intervals. At 30 min before each session, we used an occlusive dressing of topical clobetasol for the intervention group and Vaseline oil for the control group. Pain severity was assessed with visual analog scale (VAS and modified Roles and Maudsley score (RMS at baseline and 1 month and 3 months after intervention. Plantar fascia (PF thickness was measured with ultrasonography at baseline and 3 months after intervention. Results: One month after intervention, VAS morning showed significant improvement in intervention group (P = 0.006 and RMS showed better improvement in intervention group (P = 0.026. There was no significant difference between the two groups after 3 months in RMS or VAS score. PF thickness was decreased significantly in both groups, but it was not significant between the two groups (P = 0.292. Conclusions: This combinational therapy yielded earlier pain reduction and functional improvement than using shock wave alone; topical corticosteroid could enhance the effectiveness of shockwave in short-term in the treatment of recalcitrant plantar fasciitis.

Fundamentals and Applications of Ultrasonic Waves

CERN Document Server

Cheeke, J David N

2012-01-01

Designed specifically for newcomers to the field, this fully updated second edition begins with fundamentals and quickly advances beyond general wave concepts into an in-depth treatment of ultrasonic waves in isotropic media. Focusing on the physics of acoustic waves, their propagation, technology, and applications, this accessible overview of ultrasonics includes accounts of viscoelasticity and multiple scattering. It examines new technologies, including atomic force acoustic microscopy, lasers, micro-acoustics, and nanotechnology. In addition, it highlights both direct and indirect applicati

Prognostic factors of success of extracorporeal shock wave lithotripsy (ESWL) in the treatment of renal stones.

Science.gov (United States)

Al-Ansari, Abdulla; As-Sadiq, Khalid; Al-Said, Sami; Younis, Nagy; Jaleel, Osama A; Shokeir, Ahmed A

2006-01-01

To evaluate the factors that affect the success rate of extracorporeal shock wave lithotripsy (ESWL) for treatment of renal stones. Between January 2000 and December 2003, 427 patients with single or multiple renal stones (ESWL monotherapy using Storz SL 20 lithotriptor. The results of treatment were evaluated after 3 months of follow-up. Treatment success was defined as complete clearance of the stones or presence of clinically insignificant residual fragments ESWL auxiliary procedures were required in 36 patients (8.4%). Post-ESWL complications were recorded in 16 patients (3.7%). Of the 10 prognostic factors studied, 5 had a significant impact on the success rate, namely: renal morphology, congenital anomalies, stone size, stone site and number of treated stones. Other factors including age, sex, nationality, stone nature (de novo or recurrent) and ureteric stenting had no significant impact on the success rate. The success rate of ESWL for the treatment of renal stones could be predicted by stone size, location and number, radiological renal features and congenital renal anomalies.

CPAP as treatment of sleep apnea after stroke: A meta-analysis of randomized trials.

Science.gov (United States)

Brill, Anne-Kathrin; Horvath, Thomas; Seiler, Andrea; Camilo, Millene; Haynes, Alan G; Ott, Sebastian R; Egger, Matthias; Bassetti, Claudio L

2018-04-03

To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) examining the effectiveness of continuous positive airway pressure (CPAP) in stroke patients with sleep disordered breathing (SDB). In a systematic literature search of electronic databases (MEDLINE, Embase, and the Cochrane Library) from 1980 to November 2016, we identified RCTs that assessed CPAP compared to standard care or sham CPAP in adult patients with stroke or TIA with SDB. Mean CPAP use, odds ratios (ORs), and standardized mean differences (SMDs) were calculated. The prespecified outcomes were adherence to CPAP, neurologic improvement, adverse events, new vascular events, and death. Ten RCTs (564 participants) with CPAP as intervention were included. Two studies compared CPAP with sham CPAP; 8 compared CPAP with usual care. Mean CPAP use across the trials was 4.53 hours per night (95% confidence interval [CI] 3.97-5.08). The OR of dropping out with CPAP was 1.83 (95% CI 1.05-3.21, p = 0.033). The combined analysis of the neurofunctional scales (NIH Stroke Scale and Canadian Neurological Scale) showed an overall neurofunctional improvement with CPAP (SMD 0.5406, 95% CI 0.0263-1.0548) but with a considerable heterogeneity ( I 2 = 78.9%, p = 0.0394) across the studies. Long-term survival was improved with CPAP in 1 trial. CPAP use after stroke is acceptable once the treatment is tolerated. The data indicate that CPAP might be beneficial for neurologic recovery, which justifies larger RCTs. © 2018 American Academy of Neurology.

Treatment of severe psoriasis in children: recommendations of an Italian expert group.

Science.gov (United States)

Fortina, Anna Belloni; Bardazzi, Federico; Berti, Samantha; Carnevale, Claudia; Di Lernia, Vito; El Hachem, Maya; Neri, Iria; Gelmetti, Carlo Mario; Lora, Viviana; Mazzatenta, Carlo; Milioto, Mirella; Moretta, Gaia; Patrizi, Annalisa; Peris, Ketty; Villani, Alberto

2017-10-01

This article provides comprehensive recommendations for the systemic treatment of severe pediatric psoriasis based on evidence obtained from a systematic review of the literature and the consensus opinion of expert dermatologists and pediatricians. For each systemic treatment, the grade of recommendation (A, B, C) based on the treatment's approval by the European Medicines Agency for childhood psoriasis and the experts' opinions is discussed. The grade of recommendation for narrow-band-ultraviolet B phototherapy, cyclosporine, and retinoids is C, while that for methotrexate is C/B. The use of adalimumab, etanercept, and ustekinumab has a grade A recommendation. No conventional systemic treatments are approved for pediatric psoriasis. Adalimumab is approved by the European Medicines Agency as a first-line treatment for severe chronic plaque psoriasis in children (≥ 4 years old) and adolescents. Etanercept and ustekinumab are approved as second-line therapy in children ≥ 6 and ≥ 12 years, respectively. A treatment algorithm as well as practical tools (i.e., tabular summaries of differential diagnoses, treatment mechanism of actions, dosing regimens, control parameters) are provided to assist in therapeutic reasoning and decision-making for individual patients. These treatment recommendations are endorsed by major Italian Pediatric and Dermatology Societies. What is Known: • Guidelines for the treatment of severe pediatric psoriasis are lacking and most traditional systemic treatments are not approved for use in young patients. Although there has been decades of experience with some of the traditional agents such as phototherapy, acitretin, and cyclosporine in children, there are no RCTs on their pediatric use while RCTs investigating new biologic agents have been performed. What is New: • In this manuscript, an Italian multidisciplinary team of experts focused on treatment recommendations for severe forms of psoriasis in children based on an up

Anti-inflammatory agents in the treatment of bipolar depression

DEFF Research Database (Denmark)

Rosenblat, Joshua D; Kakar, Ron; Berk, Michael

2016-01-01

for qualitative review. Eight RCTs (n = 312) assessing adjunctive nonsteroidal anti-inflammatory drugs (n = 53), omega-3 polyunsaturated fatty acids (n = 140), N-acetylcysteine (n = 76), and pioglitazone (n = 44) in the treatment of BD met the inclusion criteria for quantitative analysis. The overall effect size...... sample sizes limited interpretation of the current analysis.......OBJECTIVE: Inflammation has been implicated in the risk, pathophysiology, and progression of mood disorders and, as such, has become a target of interest in the treatment of bipolar disorder (BD). Therefore, the objective of the current qualitative and quantitative review was to determine...

Effects of probiotic type, dose and treatment duration on irritable bowel syndrome diagnosed by Rome III criteria: a meta-analysis.

Science.gov (United States)

Zhang, Yan; Li, Lixiang; Guo, Chuanguo; Mu, Dan; Feng, Bingcheng; Zuo, Xiuli; Li, Yanqing

2016-06-13

Irritable bowel syndrome (IBS) is one of the most common functional gastroenterological diseases, affecting 11.2 % of people worldwide. Previous studies have shown that probiotic treatment may benefit IBS patients. However, the effect of probiotics and the appropriate type, dose, and treatment duration for IBS are still unclear. The aim of the current study was to assess the efficacy of different probiotic types, doses and treatment durations in IBS patients diagnosed by Rome III criteria via a meta-analysis of randomized controlled trials (RCTs). Medline, EMBASE, and the Cochrane Central Register of Controlled Trials up to October 2015 were searched. RCTs including comparisons between the effects of probiotics and placebo on IBS patients diagnosed by Rome III criteria were eligible. Dichotomous data were pooled to obtain the relative risk (RR) with a 95 % confidence interval (CI), whereas continuous data were pooled using a standardized mean difference (SMD) with a 95 % CI. Twenty-one RCTs were included in this meta-analysis. Probiotic therapy was associated with more improvement than placebo administration in overall symptom response (RR: 1.82, 95 % CI 1.27 to 2.60) and quality of life (QoL) (SMD: 0.29, 95 % CI 0.08 to 0.50), but not in individual IBS symptoms. Single probiotics, a low dose, and a short treatment duration were more effective with respect to overall symptom response and QoL. No differences were detected in individual IBS symptoms in the subgroup analyses. Probiotics are an effective pharmacological therapy in IBS patients. Single probiotics at a low dose and with a short treatment duration appear to be more effective in improving overall symptom response and QoL, but more evidence for these effects is still needed.

Guide for health professionals addressing oral care for individuals in oncological treatment based on scientific evidence.

Science.gov (United States)

Carvalho, Caroline Gomes; Medeiros-Filho, João Batista; Ferreira, Meire Coelho

2018-02-22

Oncological treatment can cause changes in the oral cavity compromising oral functions. The aim of the study was, based on a systematic review, to draft a guide directed at the team of health professionals involved in the oral care of oncological patients. A systematic search of the literature was performed for articles published between 2000 and April 2017. Searches were made of electronic databases and hand search. The inclusion criteria were systematic reviews of randomized clinical trials (RCTs) and RCTs published in English, involving pediatric and adult oncological patients and focused on the prevention and treatment of oral complications as well as studies addressing the maintenance of oral health. Among the 1237 studies identified, 129 were pre-selected and 54 were selected to form the basis for the clinical guide. The studies analyzed stress the need for oral assessments as well as preventive and curative actions prior to oncological treatment. To minimize the severity of oral problems, the studies emphasize daily oral care, the treatment of xerostomia with saliva substitute and hydration, and low-level laser therapy, nystatin, acyclovir, respectively, for the prevention and treatment of oral mucositis, oral candidiasis, and infection by herpes simplex virus. Thus, the guide produced addresses oral assessments and professional and home care before, during, and after oncological treatment. The guide drafted has the function of assisting health professionals involved in the oral care of patients with cancer, enabling the prevention or treatment of oral complications stemming from oncological treatment.

Retrospective analyses versus RCTs: comparing like with like?

Directory of Open Access Journals (Sweden)

Baron R

2017-03-01

Full Text Available Ralf Baron,1 Lieven Nils Kennes,2 Christian Elling31Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Kiel Campus, Kiel, 2Department of Economics and Business Administration, University of Applied Sciences Stralsund, Stralsund, 3Grünenthal GmbH, Medical Affairs Europe and North America, Aachen, GermanyIn their recent retrospective analysis assessing oxycodone/naloxone (OXN vs. tapentadol (TAP treatment for chronic low-back pain with a neuropathic component, Ueberall and Mueller-Schwefe1 compare their results to the findings of an earlier phase 3b/4 study.2 In our opinion, a proper comparison to the prospective, randomized, controlled, open-label study by Baron and colleagues is scientifically not appropriate. Although Ueberall and Mueller-Schwefe use the terms “prospective,” “randomly,” and “blinded” and refer to the PROBE design (prospective, randomized, open-label, blinded endpoint,3 their database study is retrospective, nonrandomized, and nonblinded with the treatment choice left to the discretion of the physicians. In this context, the use of the term “intention-to-treat (ITT population” is inappropriate because ITT is unambiguously defined as including all randomized subjects and thus inseparable from true randomization (ICH E9.4View original paper by Ueberall and Mueller-Schwefe.

Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones.

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Srisubat, Attasit; Potisat, Somkiat; Lojanapiwat, Bannakij; Setthawong, Vasun; Laopaiboon, Malinee

2014-11-24

Stones in the urinary tract are a common medical problem in the general population. At present, the great expansion in minimally invasive techniques has led to the decrease in open surgery. Extracorporeal shock wave lithotripsy (ESWL) has been introduced as an alternative approach which disintegrates stones in the kidney and upper urinary tract through the use of shock waves. Nevertheless, as there are limitations with the success rate in ESWL, other minimally invasive modalities for kidney stones such as percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) are also widely applied. This is an update of a review first published in 2009. This review aimed to assess the effectiveness and complications of ESWL for kidney stones compared with PCNL or RIRS. We searched the Cochrane Renal Group's Specialised Register to 3 March 2014 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. Randomised controlled trials (RCTs) assessing the use of ESWL compared to PCNL or RIRS for kidney stone management. Two authors independently assessed all the studies for inclusion. Statistical analyses were performed using the random effects model and the results expressed as risk ratio (RR) for dichotomous outcomes or mean difference (MD) for continuous data with 95% confidence intervals (CI). Five studies (338 patients) were included, four studies compared ESWL to PCNL and one compared ESWL with RIRS. Random sequence generation was reported in three studies and unclear in two. Allocation concealment was not reported in any of the included studies. Blinding of participants and investigators could not be undertaken due to the nature of the interventions; blinding of outcome assessors was not reported. Reporting bias was judged to be low risk in all studies. One study was funded by industry and in one study the number of participants in each group was unbalanced.The success of treatment at three months was significantly

Deep Downhole Seismic Testing at the Waste Treatment Plant Site, Hanford, WA. Volume V S-Wave Measurements in Borehole C4996 Seismic Records, Wave-Arrival Identifications and Interpreted S-Wave Velocity Profile.

Energy Technology Data Exchange (ETDEWEB)

Stokoe, Kenneth H.; Li, Song Cheng; Cox, Brady R.; Menq, Farn-Yuh

2007-06-06

Velocity measurements in shallow sediments from ground surface to approximately 370 to 400 feet bgs were collected by Redpath Geophysics using impulsive S- and P-wave seismic sources (Redpath 2007). Measurements below this depth within basalt and sedimentary interbeds were made by UTA between October and December 2006 using the T-Rex vibratory seismic source in each of the three boreholes. Results of these measurements including seismic records, wave-arrival identifications and interpreted velocity profiles are presented in the following six volumes: I. P-Wave Measurements in Borehole C4993 II. P-Wave Measurements in Borehole C4996 III. P-Wave Measurements in Borehole C4997 IV. S-Wave Measurements in Borehole C4993 V. S-Wave Measurements in Borehole C4996 VI. S-Wave Measurements in Borehole C4997 In this volume (V), all S-wave measurements are presented that were performed in Borehole C4996 at the WTP with T-Rex as the seismic source and the Lawrence Berkeley National Laboratory (LBNL) 3-D wireline geophone as the at-depth borehole receiver.

Deep Downhole Seismic Testing at the Waste Treatment Plant Site, Hanford, WA. Volume VI S-Wave Measurements in Borehole C4997 Seismic Records, Wave-Arrival Identifications and Interpreted S-Wave Velocity Profile.

Energy Technology Data Exchange (ETDEWEB)

Stokoe, Kenneth H.; Li, Song Cheng; Cox, Brady R.; Menq, Farn-Yuh

2007-06-06

Velocity measurements in shallow sediments from ground surface to approximately 370 to 400 feet bgs were collected by Redpath Geophysics using impulsive S- and P-wave seismic sources (Redpath 2007). Measurements below this depth within basalt and sedimentary interbeds were made by UTA between October and December 2006 using the T-Rex vibratory seismic source in each of the three boreholes. Results of these measurements including seismic records, wave-arrival identifications and interpreted velocity profiles are presented in the following six volumes: I. P-Wave Measurements in Borehole C4993 II. P-Wave Measurements in Borehole C4996 III. P-Wave Measurements in Borehole C4997 IV. S-Wave Measurements in Borehole C4993 V. S-Wave Measurements in Borehole C4996 VI. S-Wave Measurements in Borehole C4997 In this volume (VI), all S-wave measurements are presented that were performed in Borehole C4997 at the WTP with T-Rex as the seismic source and the Lawrence Berkeley National Laboratory (LBNL) 3-D wireline geophone as the at-depth borehole receiver.

Chinese patent medicines for the treatment of the common cold: a systematic review of randomized clinical trials.

Science.gov (United States)

Chen, Wei; Liu, Bo; Wang, Li-qiong; Ren, Jun; Liu, Jian-ping

2014-07-30

Many Chinese patent medicines (CPMs) have been authorized by the Chinese State of Food and Drug Administration for the treatment of the common cold. A number of clinical trials have been conducted and published. However, there is no systematic review or meta-analysis on their efficacy and safety for the common cold to justify their clinical use. We searched CENTRAL, MEDLINE, EMBASE, SinoMed, CNKI, VIP, China Important Conference Papers Database, China Dissertation Database, and online clinical trial registry websites for published and unpublished randomized clinical trials (RCTs) of CPMs for the common cold till 31 March 2013. Revman 5.2 software was used for data analysis with effect estimate presented as relative risk (RR) and mean difference (MD) with a 95% confidence interval (CI). A total of five RCTs were identified. All of the RCTs were of high risk of bias with flawed study design and poor methodological quality. All RCTs included children aged between 6 months to 14 years. Results of individual trials showed that Shuanghuanglian oral liquid (RR 4.00; 95% CI: 2.26 to 7.08), and Xiaoer Resuqing oral liquid (RR 1.43; 95% CI: 1.15 to 1.77) had higher cure rates compared with antivirus drugs. Most of the trials did not report adverse events, and the safety of CPMs was still uncertain. Some CPMs showed a potential positive effect for the common cold on cure rate. However, due to the poor methodology quality and the defects in the clinical design of the included RCTs, such as the lack of placebo controlled trials, the inappropriate comparison intervention and outcome measurement, the confirmative conclusions on the beneficial effect of CPMs for the common cold could not be drawn.

WITHDRAWN: Hypnosis for children undergoing dental treatment.

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Al-Harasi, Sharifa; Ashley, Paul F; Moles, David R; Parekh, Susan; Walters, Val

2017-06-20

Managing children is a challenge that many dentists face. Many non-pharmacological techniques have been developed to manage anxiety and behavioural problems in children, such us: 'tell, show & do', positive reinforcement, modelling and hypnosis. The use of hypnosis is generally an overlooked area, hence the need for this review. This systematic review attempted to answer the question: What is the effectiveness of hypnosis (with or without sedation) for behaviour management of children who are receiving dental care in order to allow successful completion of treatment?Null hypothesis: Hypnosis has no effect on the outcome of dental treatment of children. We searched the Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE (OVID), EMBASE (OVID), and PsycINFO. Electronic and manual searches were performed using controlled vocabulary and free text terms with no language restrictions. Date of last search: 11th June 2010. All children and adolescents aged up to 16 years of age. Children having any dental treatment, such as: simple restorative treatment with or without local anaesthetic, simple extractions or management of dental trauma. Information regarding methods, participants, interventions, outcome measures and results were independently extracted, in duplicate, by two review authors. Authors of trials were contacted for details of randomisation and withdrawals and a quality assessment was carried out. The methodological quality of randomised controlled trials (RCTs) was assessed using the criteria described in the Cochrane Handbook for Systematic Reviews of Interventions 5.0.2. Only three RCTs (with 69 participants) fulfilled the inclusion criteria. Statistical analysis and meta-analysis were not possible due to insufficient number of studies. Although there are a considerable number of anecdotal accounts indicating the benefits of using hypnosis in paediatric dentistry, on the basis of the three studies meeting the inclusion criteria for this review there

The Effect of Chinese Herbal Medicine Gualouxiebaibanxia Decoction for the Treatment of Angina Pectoris: A Systematic Review

Science.gov (United States)

2016-01-01

We systematically assess the current clinical evidence of Gualouxiebaibanxia (GLXBBX) decoction for the treatment of angina pectoris (AP). We included RCTs testing GLXBBX against conventional drugs and GLXBBX combined with conventional drugs versus conventional drugs. 19 RCTs involving 1730 patients were finally identified, and the methodological quality was evaluated as generally low. The results of the meta-analysis showed that GLXBBX alone had significant effect on improving angina symptoms (RR: 1.24, 95% CI 1.14 to 1.35; P angina symptoms (RR: 1.17 [1.12,1.22]; P angina symptoms in participants with AP. However, the evidence remains weak due to the poor methodological quality of the included studies. More rigorous trials are needed to confirm the results. PMID:27777598

Symptomatic treatments for amyotrophic lateral sclerosis/motor neuron disease.

Science.gov (United States)

Ng, Louisa; Khan, Fary; Young, Carolyn A; Galea, Mary

2017-01-10

Motor neuron disease (MND), which is also known as amyotrophic lateral sclerosis (ALS), causes a wide range of symptoms but the evidence base for the effectiveness of the symptomatic treatment therapies is limited. To summarise the evidence from Cochrane Systematic Reviews of all symptomatic treatments for MND. We searched the Cochrane Database of Systematic Reviews (CDSR) on 15 November 2016 for systematic reviews of symptomatic treatments for MND. We assessed the methodological quality of the included reviews using the Assessment of Multiple Systematic Reviews (AMSTAR) tool and the GRADE approach. We followed standard Cochrane study (review) selection and data extraction procedures. We reported findings narratively and in tables. We included nine Cochrane Systematic Reviews of interventions to treat symptoms in people with MND. Three were empty reviews with no included randomised controlled trials (RCTs); however, all three reported on non-RCT evidence and the remaining six included mostly one or two studies. We deemed all of the included reviews of high methodological quality. Drug therapy for painThere is no RCT evidence in a Cochrane Systematic Review exploring the efficacy of drug therapy for pain in MND. Treatment for crampsThere is evidence (13 RCTs, N = 4012) that for the treatment of cramps in MND, compared to placebo:- memantine and tetrahydrocannabinol (THC) are probably ineffective (moderate-quality evidence);- vitamin E may have little or no effect (low-quality evidence); and- the effects of L-threonine, gabapentin, xaliproden, riluzole, and baclofen are uncertain as the evidence is either very low quality or the trial specified the outcome but did not report numerical data.The review reported adverse effects of riluzole, but it is not clear whether other interventions had adverse effects. Treatment for spasticityIt is uncertain whether an endurance-based exercise programme improved spasticity or quality of life, measured at three months after the

Interferon alpha for the adjuvant treatment of cutaneous melanoma.

Science.gov (United States)

Mocellin, Simone; Lens, Marko B; Pasquali, Sandro; Pilati, Pierluigi; Chiarion Sileni, Vanna

2013-06-18

Interferon alpha is the only agent approved for the postoperative adjuvant treatment of high-risk cutaneous melanoma. However, the survival advantage associated with this treatment is unclear, especially in terms of overall survival. Thus, adjuvant interferon is not universally considered a gold standard treatment by all oncologists. To assess the disease-free survival and overall survival effects of interferon alpha as adjuvant treatment for people with high-risk cutaneous melanoma. We searched the following databases up to August 2012: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2012, issue 8), MEDLINE (from 2005), EMBASE (from 2010), AMED (from 1985), and LILACS (from 1982). We also searched trials databases in 2011, and proceedings of the ASCO annual meeting from 2000 to 2011. We checked the reference lists of selected articles for further references to relevant trials. We included only randomised controlled trials (RCTs) comparing interferon alpha to observation (or any other treatment) for the postoperative (adjuvant) treatment of patients with high-risk skin melanoma, that is, people with regional lymph node metastasis (American Joint Committee on Cancer (AJCC) TNM (tumour, lymph node, metastasis) stage III) undergoing radical lymph node dissection, or people without nodal disease but with primary tumour thickness greater than 1 mm (AJCC TNM stage II). Two authors extracted data, and a third author independently verified the extracted data. The main outcome measure was the hazard ratio (HR), which is the ratio of the risk of the event occurring in the treatment arm (adjuvant interferon) compared to the control arm (no adjuvant interferon). The survival data were either entered directly into Review Manager (RevMan) or extrapolated from Kaplan-Meier plots and then entered into RevMan. Based on the presence of between-study heterogeneity, we applied a fixed-effect or random-effects model for calculating the pooled estimates

Systematic review and meta-analysis of the efficacy and safety of existing TNF blocking agents in treatment of rheumatoid arthritis.

Directory of Open Access Journals (Sweden)

Kalle J Aaltonen

Full Text Available Five-tumour necrosis factor (TNF-blockers (infliximab, etanercept, adalimumab, certolizumab pegol and golimumab are available for treatment of rheumatoid arthritis. Only few clinical trials compare one TNF-blocker to another. Hence, a systematic review is required to indirectly compare the substances. The aim of our study is to estimate the efficacy and the safety of TNF-blockers in the treatment of rheumatoid arthritis (RA and indirectly compare all five currently available blockers by combining the results from included randomized clinical trials (RCT.A systematic literature review was conducted using databases including: MEDLINE, SCOPUS (including EMBASE, Cochrane library and electronic search alerts. Only articles reporting double-blind RCTs of TNF-blockers vs. placebo, with or without concomitant methotrexate (MTX, in treatment of RA were selected. Data collected were information of patients, interventions, controls, outcomes, study methods and eventual sources of bias.Forty-one articles reporting on 26 RCTs were included in the systematic review and meta-analysis. Five RCTs studied infliximab, seven etanercept, eight adalimumab, three golimumab and three certolizumab. TNF-blockers were more efficacious than placebo at all time points but were comparable to MTX. TNF-blocker and MTX combination was superior to either MTX or TNF-blocker alone. Increasing doses did not improve the efficacy. TNF-blockers were relatively safe compared to either MTX or placebo.No single substance clearly rose above others in efficacy, but the results of the safety analyses suggest that etanercept might be the safest alternative. Interestingly, MTX performs nearly identically considering both efficacy and safety aspects with a margin of costs.

Instantaneous wave emission model

International Nuclear Information System (INIS)

Kruer, W.L.

1970-12-01

A useful treatment of electrostatic wave emission by fast particles in a plasma is given. First, the potential due to a fast particle is expressed as a simple integration over the particle orbit; several interesting results readily follow. The potential in the wake of an accelerating particle is shown to be essentially that produced through local excitation of the plasma by the particle free-streaming about its instantaneous orbit. Application is made to one dimension, and it is shown that the wave emission and adsorption synchronize to the instantaneous velocity distribution function. Guided by these calculations, we then formulate a test particle model for computing the instantaneous wave emission by fast particles in a Vlasov plasma. This model lends itself to physical interpretation and provides a direct approach to many problems. By adopting a Fokker-Planck description for the particle dynamics, we calculate the broadening of the wave-particle resonance due to velocity diffusion and drag

A first course in vibrations and waves

CERN Document Server

Samiullah, Mohammad

2015-01-01

This book builds on introductory physics and emphasizes understanding of vibratory motion and waves based on first principles. The book is divided into three parts. Part I contains a preliminary chapter that serves as a review of relevant ideas of mechanics and complex numbers. Part II is devoted to a detailed discussion of vibrations of mechanical systems. This part covers a simple harmonic oscillator, coupled oscillators, normal coordinates, beaded string, continuous string, standing waves, and Fourier series. Part II ends with a presentation of stationary solutions of driven finite systems. Part III is concerned with waves. Here, the emphasis is on the discussion of common aspects of all types of waves. The applications to sound, electromagnetic, and matter waves are illustrated. The book also includes examples from water waves and electromagnetic waves on a transmission line. The emphasis of the book is to bring out the similarities among various types of waves. The book includes treatment of reflection a...

Profile of aripiprazole in the treatment of bipolar disorder in children and adolescents

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Kirino E

2014-11-01

Full Text Available Eiji Kirino1–3 1Department of Psychiatry, Juntendo University School of Medicine, 2Department of Psychiatry, Juntendo University Shizuoka Hospital, 3Juntendo Institute of Mental Health, Shizuoka, Japan Abstract: Bipolar disorder is a pernicious illness. Compared with the later-onset form, early onset bipolar disorder is associated with worse psychosocial outcomes, and is characterized by rapid cycling and increased risks of substance abuse and suicide attempts. Controlling mood episodes and preventing relapse in this group of pediatric patients requires careful treatment. Here, we review the effectiveness of aripiprazole for bipolar disorder in children and adolescents, with discussion of this drug's unique pharmacological profile and various clinical study outcomes. Aripiprazole acts as a serotonin 5-HT2A receptor antagonist, as well as a partial agonist of the serotonin 5-HT1A and dopamine D2 receptors. It can be safely used in children and adolescents, as it is highly tolerated and shows lower rates of the side effects typically observed with other antipsychotic drugs, including sedation, weight gain, hyperprolactinemia, and extrapyramidal syndrome. The presently reviewed randomized controlled trials (RCTs and non-RCTs generally reported aripiprazole to be effective and well-tolerated in children and adolescents with bipolar disorder. However, due to the limited number of RCTs, the present conclusions must be evaluated cautiously. Furthermore, aripiprazole cannot yet be considered a preferred treatment for children and adolescents with bipolar disorder, as there is not yet evidence that aripiprazole shows greater efficacy compared to other second-generation antipsychotics. Additional data are needed from future head-to-head comparison studies. Keywords: child, mania, mixed state

Elastic waves at periodically-structured surfaces and interfaces of solids

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A. G. Every

2014-12-01

Full Text Available This paper presents a simple treatment of elastic wave scattering at periodically structured surfaces and interfaces of solids, and the existence and nature of surface acoustic waves (SAW and interfacial (IW waves at such structures. Our treatment is embodied in phenomenological models in which the periodicity resides in the boundary conditions. These yield zone folding and band gaps at the boundary of, and within the Brillouin zone. Above the transverse bulk wave threshold, there occur leaky or pseudo-SAW and pseudo-IW, which are attenuated via radiation into the bulk wave continuum. These have a pronounced effect on the transmission and reflection of bulk waves. We provide examples of pseudo-SAW and pseudo-IW for which the coupling to the bulk wave continuum vanishes at isloated points in the dispersion relation. These supersonic guided waves correspond to embedded discrete eigenvalues within a radiation continuum. We stress the generality of the phenomena that are exhibited at widely different scales of length and frequency, and their relevance to situations as diverse as the guiding of seismic waves in mine stopes, the metrology of periodic metal interconnect structures in the semiconductor industry, and elastic wave scattering by an array of coplanar cracks in a solid.

A comparative analysis of analgesic efficacy of ultrasound and shock wave therapy in the treatment of patients with inflammation of the attachment of the plantar fascia in the course of calcaneal spurs.

Science.gov (United States)

Krukowska, Jolanta; Wrona, Jacek; Sienkiewicz, Monika; Czernicki, Jan

2016-09-01

Troublesome heel spur is a nuisance condition that affects people of all ages. Treatment of patients with heel spur is a difficult and lengthy process requiring patience from both the patient and the therapist. Sometimes, the only and ultimate method of treatment is surgery, although spurs tend to recur. The aim of the study is a comparative analysis of the analgesic efficacy of ultrasound and shock wave therapy in patients with heel spur. The cause of pain in the course of calcaneal spur is inflammation of the attachment of the plantar fascia, which plays an important role in the process of walking and is seriously strained during different types of movement. Treatment of patients is a difficult and lengthy process. The study was conducted on a group of 47 patients of both sexes, aged 38-60 years (mean 51.3) with a plantar calcaneal spur confirmed by X-ray images. Patients were randomly assigned into two groups using a simple randomization: Group 1-ultrasound therapy group (a series of ten treatments) and Group 2-the radial shock wave group (series of four treatments). In all patients, pain intensity was assessed three times: before therapy, after the first and second weeks of treatment. A version of Laitinen's pain assessment questionnaire and the Huskisson visual analogue scale (VAS) were used. Of the group of studied respondents, 47 patients of both sexes and aged 38-60 years (mean age 51.3) with a heel spur (confirmed on X-rays), who had pain for at least a month, were randomly included in the study. The patients were classified into: Group 1-US therapeutic group (a series of ten treatments) and Group 2-with RSWT (a series of five treatments). Pain intensity was assessed three times: before the treatment, after the first and second week of the treatment with the application of the VAS and the Leitinen Pain Questionnaire. However, a decrease in pain sensation was reported in all test intervals, and its largest decrease occurred in both groups within 1�

The Effect on Treatment Adherence of Administering Drugs as Fixed-Dose Combinations versus as Separate Pills: Systematic Review and Meta-Analysis

NARCIS (Netherlands)

van Galen, Katy A.; Nellen, Jeannine F.; Nieuwkerk, Pythia T.

2014-01-01

Administering drugs as fixed-dose combinations (FDCs) versus the same active drugs administered as separate pills is assumed to enhance treatment adherence. We synthesized evidence from randomized controlled trials (RCTs) about the effect of FDCs versus separate pills on adherence. We searched

Huperzine A for treatment of cognitive impairment in major depressive disorder: a systematic review of randomized controlled trials.

Science.gov (United States)

Zheng, Wei; Xiang, Ying-Qiang; Ungvari, Gabor S; Chiu, F K Helen; H Ng, Chee; Wang, Ying; Xiang, Yu-Tao

2016-04-25

Acetylcholinesterase (AChE) inhibitors have been shown to be effective in treating cognitive impairment in animal models and in human subjects with major depressive disorder (MDD). Huperzine A (HupA), a Traditional Chinese Medicine derived from a genus of clubmosses known as Huperzineserrata, is a powerful AChE inhibitor that has been used as an adjunctive treatment for MDD, but no meta-analysis on HupA augmentation for MDD has yet been reported. Conduct a systematic review and meta-analysis of randomized controlled trials (RCTS) about HupA augmentation in the treatment of MDD to evaluate its efficacy and safety. Two evaluators independently searched nine English-language and Chinese-language databases, selected relevant studies that met pre-determined inclusion criteria, extracted data about outcome and safety, and conducted quality assessments and data synthesis. Three low-quality RCTs (pooled n=238) from China were identified that compared monotherapy antidepressant treatment for depression versus combined treatment with antidepressants and HupA. Participants in the studies ranged from 16 to 60 years of age. The average duration of adjunctive antidepressant and HupA treatment in the studies was only 6.7 weeks. All three studies were open label and non-blinded, so their overall quality was judged as poor. Meta-analysis of the pooled sample found no significant difference in the improvement in depressive symptoms between the two groups (weighted mean difference: -1.90 (95%CI: -4.23, 0.44), p=0.11). However, the adjunctive HupA group did have significantly greater improvement than the antidepressant only group in cognitive functioning (as assessed by the Wisconsin Card Sorting Test and the Wechsler Memory Scale-Revised) and in quality of life. There was no significant difference in the incidence of adverse drug reactions between groups. The data available on the effectiveness and safety of adjunctive treatment using HupA in patients with MDD who are receiving

Chinese Medicine Injection Qingkailing for Treatment of Acute Ischemia Stroke: A Systematic Review of Randomized Controlled Trials

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Fafeng Cheng

2012-01-01

Full Text Available Qingkailing (QKL injection was a famous traditional Chinese patent medicine, which was extensively used to treat the acute stages of cerebrovascular disease. The aim of this study was to assess the quantity, quality and overall strength of the evidence on QKL in the treatment of acute ischemic stroke. Methods. An extensive search was performed within MEDLINE, Cochrane, CNKI, Vip and Wan-Fang up to November 2011. Randomized controlled trails (RCTs on QKL for treatment of acute stroke were collected, irrespective of languages. Study selection, data extraction, quality assessment, and data analyses were conducted according to the Cochrane standards, and RevMan5 was used for data analysis. Results. 7 RCTs (545 patients were included and the methodological quality was evaluated as generally low. The pooled results showed that QKL combined with conventional treatment was more effective in effect rate, and the score of MESSS and TNF-α level compared with conventional treatment alone, but there was no significant difference in mortality of two groups. Only one trial reported routine life status. There were four trials reported adverse events, and no obvious adverse event occurred in three trials while one reported adverse events described as eruption and dizziness.

Optimizing the Use of Aripiprazole Augmentation in the Treatment of Major Depressive Disorder: From Clinical Trials to Clinical Practice

Science.gov (United States)

Han, Changsu; Wang, Sheng-Min; Lee, Soo-Jung; Jun, Tae-Youn

2015-01-01

Major depressive disorder (MDD) is a recurrent, chronic, and devastating disorder leading to serious impairment in functional capacity as well as increasing public health care costs. In the previous decade, switching therapy and dose adjustment of ongoing antidepressants was the most frequently chosen subsequent treatment option for MDD. However, such recommendations were not based on firmly proven efficacy data from well-designed, placebo-controlled, randomized clinical trials (RCTs) but on practical grounds and clinical reasoning. Aripiprazole augmentation has been dramatically increasing in clinical practice owing to its unique action mechanisms as well as proven efficacy and safety from adequately powered and well-controlled RCTs. Despite the increased use of aripiprazole in depression, limited clinical information and knowledge interfere with proper and efficient use of aripiprazole augmentation for MDD. The objective of the present review was to enhance clinicians' current understanding of aripiprazole augmentation and how to optimize the use of this therapy in the treatment of MDD. PMID:26306301

Full wave simulations of lower hybrid wave propagation in tokamaks

International Nuclear Information System (INIS)

Wright, J. C.; Bonoli, P. T.; Phillips, C. K.; Valeo, E.; Harvey, R. W.

2009-01-01

Lower hybrid (LH) waves have the attractive property of damping strongly via electron Landau resonance on relatively fast tail electrons at (2.5-3)xv te , where v te ≡ (2T e /m e ) 1/2 is the electron thermal speed. Consequently these waves are well-suited to driving current in the plasma periphery where the electron temperature is lower, making LH current drive (LHCD) a promising technique for off-axis (r/a≥0.60) current profile control in reactor grade plasmas. Established techniques for computing wave propagation and absorption use WKB expansions with non-Maxwellian self-consistent distributions.In typical plasma conditions with electron densities of several 10 19 m -3 and toroidal magnetic fields strengths of 4 Telsa, the perpendicular wavelength is of the order of 1 mm and the parallel wavelength is of the order of 1 cm. Even in a relatively small device such as Alcator C-Mod with a minor radius of 22 cm, the number of wavelengths that must be resolved requires large amounts of computational resources for the full wave treatment. These requirements are met with a massively parallel version of the TORIC full wave code that has been adapted specifically for the simulation of LH waves [J. C. Wright, et al., Commun. Comput. Phys., 4, 545 (2008), J. C. Wright, et al., Phys. Plasmas 16 July (2009)]. This model accurately represents the effects of focusing and diffraction that occur in LH propagation. It is also coupled with a Fokker-Planck solver, CQL3D, to provide self-consistent distribution functions for the plasma dielectric as well as a synthetic hard X-ray (HXR) diagnostic for direct comparisons with experimental measurements of LH waves.The wave solutions from the TORIC-LH zero FLR model will be compared to the results from ray tracing from the GENRAY/CQL3D code via the synthetic HXR diagnostic and power deposition.

On nonlinear periodic drift waves

International Nuclear Information System (INIS)

Kauschke, U.; Schlueter, H.

1990-09-01

Nonlinear periodic drift waves are investigated on the basis of a simple perturbation scheme for both the amplitude and inverse frequency. The coefficients for the generation of the forced harmonics are derived, a nonlinear dispersion relation is suggested and a criterion for the onset of the modulational instability is obtained. The results are compared with the ones obtained with the help of a standard KBM-treatment. Moreover cnoidal drift waves are suggested and compared to an experimental observation. (orig.)

Comparative Study between Slow Shock Wave Lithotripsy and Fast Shock Wave Lithotripsy in the Management of Renal Stone

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AKM Zamanul Islam Bhuiyan

2013-01-01

Full Text Available Background: Renal calculi are frequent causes of ureteric colic. Extracorporeal shock wave lithotripsy is the most common treatment of these stones. It uses focused sound waves to break up stones externally. Objective: To compare the efficiency of slow and fast delivery rate of shock waves on stone fragmentation and treatment outcome in patients with renal calculi. Materials and Methods: This prospective study was done in the department of Urology, National Institute of Kidney diseases and Urology, Sher-e-Bangla Nagar, Dhaka from July 2006 to June 2007. Total 90 patients were treated using the Storz Medical Modulith ® SLX lithotripter. Patients were divided into Group A, Group B and Group C – each group having 30 subjects. Group A was selected for extracorporeal shockwave lithotripsy (ESWL by 60 shock waves per minute, Group B by 90 shock waves per minute and Group C by 120 shock waves per minute. Results: Complete clearance of stone was observed in 24 patients in Group A and 13 patients in both Group B and Group C in first session. In Group A only 3 patients needed second session but in Group B and Group C, 12 and 8 patients needed second session. In Group A only one patient needed third session but third session was required for 3 patients in Group B and 5 patients in Group C for complete clearance of stone. In Group A, subsequent sessions were performed under spinal anesthesia and in Group B under sedation and analgesia (p>0.001. Mean number of sessions for full clearance of stones in group A was 1.37 ± 0.85, in Group B was 1.8 ± 0.887 and in Group C was 2.0 ± 1.083. Significant difference was observed in term of sessions among groups (p>0.05. In first follow-up, complete clearance of stones was seen in 24 patients in Group A and 13 in both Group B and Group C. In second follow-up, 3 patients in Group A, 12 in Group B and 8 in Group C showed complete clearance of stones. It was observed that rate of stone clearance was higher in Group A

Treatment of Ion-Atom Collisions Using a Partial-Wave Expansion of the Projectile Wavefunction

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Wong, T. G.; Foster, M.; Colgan, J.; Madison, D. H.

2009-01-01

We present calculations of ion-atom collisions using a partial-wave expansion of the projectile wavefunction. Most calculations of ion-atom collisions have typically used classical or plane-wave approximations for the projectile wavefunction, since partial-wave expansions are expected to require prohibitively large numbers of terms to converge…

Boundary mediated position control of traveling waves

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Martens, Steffen; Ziepke, Alexander; Engel, Harald

Reaction control is an essential task in biological systems and chemical process industry. Often, the excitable medium supporting wave propagation exhibits an irregular shape and/or is limited in size. In particular, the analytic treatment of wave phenomena is notoriously difficult due to the spatial modulation of the domain's. Recently, we have provided a first systematic treatment by applying asymptotic perturbation analysis leading to an approximate description that involves a reduction of dimensionality; the 3D RD equation with spatially dependent NFBCs on the reactants reduces to a 1D reaction-diffusion-advection equation. Here, we present a novel method to control the position ϕ (t) of traveling waves in modulated domains according to a prespecified protocol of motion. Given this protocol, the ``optimal'' geometry of reactive domains Q (x) is found as the solution of the perturbatively derived equation of motion. Noteworthy, such a boundary control can be expressed in terms of the uncontrolled wave profile and its propagation velocity, rendering detailed knowledge of the reaction kinetics unnecessary. German Science Foundation DFG through the SFB 910 ''Control of Self-Organizing Nonlinear Systems''.

Immunosuppressive treatment for nephrotic idiopathic membranous nephropathy: a meta-analysis based on Chinese adults.

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Guoqiang Xie

Full Text Available Idiopathic membranous nephropathy (IMN is the most common pathological type for nephrotic syndrome in adults in western countries and China. The benefits and harms of immunosuppressive treatment in IMN remain controversial.To assess the efficacy and safety of different immunosuppressive agents in the treatment of nephrotic syndrome caused by IMN.PubMed, EMBASE, Cochrane Library and wanfang, weipu, qinghuatongfang, were searched for relevant studies published before December 2011. Reference lists of nephrology textbooks, review articles were checked. A meta-analysis of randomized controlled trials (RCTs meeting the criteria was performed using Review Manager.17 studies were included, involving 696 patients. Calcineurin inhibitors had a better effect when compared to alkylating agents, on complete remission (RR 1.61, 95% CI 1.13, to 2.30 P = 0.008, partial or complete remission (effective (CR/PR, RR 1.29, 95% CI 1.09 to 1.52 P = 0.003, and fewer side effects. Among calcineurin inhibitors, tacrolimus (TAC was shown statistical significance in inducing more remissions. When compared to cyclophosphamide (CTX, leflunomide (LET showed no beneficial effect, mycophenolate mofetil (MMF showed significant beneficial on effectiveness (CR/PR, RR: 1.41, 95% CI 1.16 to 1.72 P = 0.0006 but not significant on complete remission (CR, RR: 1.38, 95% CI 0.89 to 2.13 P = 0.15.This analysis based on Chinese adults and short duration RCTs suggested calcineurin inhibitors, especially TAC, were more effective in proteinuria reduction in IMN with acceptable side effects. Long duration RCTs were needed to confirm the long-term effects of those agents in nephrotic IMN.

Huangqi Jianzhong Tang for Treatment of Chronic Gastritis: A Systematic Review of Randomized Clinical Trials

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Wei, Yue; Ma, Li-Xin; Yin, Sheng-Jun; An, Jing; Wei, Qi; Yang, Jin-Xiang

2015-01-01

To assess the clinical effects and safety of Huangqi Jianzhong Tang (HQJZ) for the treatment of chronic gastritis (CG), three English databases and four Chinese databases were searched through the inception to January 2015. In randomized controlled trials (RCTs) comparing HQJZ with placebo, no intervention and western medicine were included. A total of 9 RCTs involving 979 participants were identified. The methodological quality of the included trials was generally poor. Meta-analyses demonstrated that HQJZ plus conventional medicine was more effective in improving overall gastroscopy outcome than western medicine alone for treatment of chronic superficial gastritis with the pooling result of overall improvement [OR 3.78 (1.29,11.06), P = 0.02]. In addition, the combination of HQJZ with antibiotics has higher overall effect rate than antibiotics alone for the treatment of CG [OR 2.60 (1.49,4.54), P = 0.0007]. There were no serious adverse events reported in both the intervention and controlled groups. HQJZ has the potential of improvement of the patients' gastroscopy outcomes, Helicobacter pylori clearance rate, traditional Chinese Medicine syndromes, and overall effect rate alone or in combination use with conventional western medicine for chronic atrophic gastritis. However, due to poor methodological quality, the beneficial effect and safeties of HQJZ for CG could not be confirmed. PMID:26819622

Decimeter waves in complex treatment of patients with cerebral blood circulation insufficiency

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Strelkova, N.I.

Decimeter waves (DMW) were introduced into the therapeutic armamentarium relatively recently. The effect of DMW on the CNS was studied in the Division of Neurology at the Central Scientific Research Institute of Resort Science and Physiotherapy for a number of years on four groups of patients: (A) Parkinson's Disease Group, (B) patients with sequelae of open and closed craniocerebral injuries, (C) cerebral stroke patients basically of the ischemic type and (D) patients with transitory cerebral circulation disorders. The experience gained showed that the use of DMW improved cerebral circulation and aided in development of collateral circulation. It was found that in cases of tremor Parkinsonism and in epilepsy, DMW therapy should be applied to the collarbone area. Application of DMW in early stages of injury needs further study. Obviously, a single therapeutic intervention cannot provide complete recovery; a combined treatment must be applied, advisably under conditions of a resort spa. 11 references.

[An investigation of the statistical power of the effect size in randomized controlled trials for the treatment of patients with type 2 diabetes mellitus using Chinese medicine].

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Ma, Li-Xin; Liu, Jian-Ping

2012-01-01

To investigate whether the power of the effect size was based on adequate sample size in randomized controlled trials (RCTs) for the treatment of patients with type 2 diabetes mellitus (T2DM) using Chinese medicine. China Knowledge Resource Integrated Database (CNKI), VIP Database for Chinese Technical Periodicals (VIP), Chinese Biomedical Database (CBM), and Wangfang Data were systematically recruited using terms like "Xiaoke" or diabetes, Chinese herbal medicine, patent medicine, traditional Chinese medicine, randomized, controlled, blinded, and placebo-controlled. Limitation was set on the intervention course > or = 3 months in order to identify the information of outcome assessement and the sample size. Data collection forms were made according to the checking lists found in the CONSORT statement. Independent double data extractions were performed on all included trials. The statistical power of the effects size for each RCT study was assessed using sample size calculation equations. (1) A total of 207 RCTs were included, including 111 superiority trials and 96 non-inferiority trials. (2) Among the 111 superiority trials, fasting plasma glucose (FPG) and glycosylated hemoglobin HbA1c (HbA1c) outcome measure were reported in 9% and 12% of the RCTs respectively with the sample size > 150 in each trial. For the outcome of HbA1c, only 10% of the RCTs had more than 80% power. For FPG, 23% of the RCTs had more than 80% power. (3) In the 96 non-inferiority trials, the outcomes FPG and HbA1c were reported as 31% and 36% respectively. These RCTs had a samples size > 150. For HbA1c only 36% of the RCTs had more than 80% power. For FPG, only 27% of the studies had more than 80% power. The sample size for statistical analysis was distressingly low and most RCTs did not achieve 80% power. In order to obtain a sufficient statistic power, it is recommended that clinical trials should establish clear research objective and hypothesis first, and choose scientific and evidence

Theory of magnetohydrodynamic waves: The WKB approximation revisited

International Nuclear Information System (INIS)

Barnes, A.

1992-01-01

Past treatments of the eikonal or WKB theory of the propagation of magnetohydrodynamics waves have assumed a strictly isentropic background. IF in fact there is a gradient in the background entropy, then in second order in the WKB ordering, adiabatic fluctuations (in the Lagrangian sense) are not strictly isentropic in the Eulerian sense. This means that in the second order of the WKB expansion, which determines the variation of wave amplitude along rays, the violation of isentropy must be accounted for. The present paper revisits the derivation of the WKB approximation for small-amplitude magnetohydrodynamic waves, allowing for possible spatial variation of the background entropy. The equation of variation of wave amplitude is rederived; it is a bilinear equation which, it turns out, can be recast in the action conservation form. It is shown that this action conservation equation is in fact equivalent to the action conservation law obtained from Lagrangian treatments

Gravitational wave emission from a bounded source: A treatment in the full nonlinear regime

International Nuclear Information System (INIS)

Oliveiral, H.P. de; Damiao Soares, I.

2004-03-01

The dynamics of a bounded gravitational collapsing configuration emitting gravitational waves is studied. The exterior spacetime is described by Robinson-Trautman geometries and have the Schwarzschild black hole as its final gravitational configuration, when the gravitational wave emission ceases. The full nonlinear regime is examined by using the Galerkin method that allows us to reduce the equations governing the dynamics to a finite-dimensional dynamical system, after a proper truncation procedure. Gravitational wave emission patterns from given initial configurations are exhibited for several phases of the collapse and the mass-loss ratio that characterizes the amount of mass extracted by the gravitational wave emission is evaluated. We obtain that the smaller initial mass M init of the configuration, the more rapidly the Schwarzschild solution is attained and a larger fraction of M init is lost in the process of gravitational wave emission. Within all our numerical experiments, the distribution of the mass fraction extracted by gravitational wave emission is shown to satisfy the distribution law of nonextensive statistics and this result is independent of the initial configurations considered. (author)

Interventions for replacing missing teeth: treatment of peri-implantitis.

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Esposito, Marco; Grusovin, Maria Gabriella; Worthington, Helen V

2012-01-18

One of the key factors for the long-term success of oral implants is the maintenance of healthy tissues around them. Bacterial plaque accumulation induces inflammatory changes in the soft tissues surrounding oral implants and it may lead to their progressive destruction (peri-implantitis) and ultimately to implant failure. Different treatment strategies for peri-implantitis have been suggested, however it is unclear which are the most effective. To identify the most effective interventions for treating peri-implantitis around osseointegrated dental implants. We searched the Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE. Handsearching included several dental journals. We checked the bibliographies of the identified randomised controlled trials (RCTs) and relevant review articles for studies outside the handsearched journals. We wrote to authors of all identified RCTs, to more than 55 dental implant manufacturers and an Internet discussion group to find unpublished or ongoing RCTs. No language restrictions were applied. The last electronic search was conducted on 9 June 2011. All RCTs comparing agents or interventions for treating peri-implantitis around dental implants. Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. We contacted the authors for missing information. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals (CI). Heterogeneity was to be investigated including both clinical and methodological factors. Fifteen eligible trials were identified, but six were excluded. The following interventions were compared in the nine included studies: different non-surgical interventions (five trials); adjunctive treatments to non-surgical interventions (one trial); different surgical interventions (two trials

Advanced interferometric gravitational-wave detectors

CERN Document Server

Saulson, Peter R

2019-01-01

Gravitational waves are one of the most exciting and promising emerging areas of physics and astrophysics today. The detection of gravitational waves will rank among the most significant physics discoveries of the 21st century.Advanced Interferometric Gravitational-Wave Detectors brings together many of the world's top experts to deliver an authoritative and in-depth treatment on current and future detectors. Volume I is devoted to the essentials of gravitational-wave detectors, presenting the physical principles behind large-scale precision interferometry, the physics of the underlying noise sources that limit interferometer sensitivity, and an explanation of the key enabling technologies that are used in the detectors. Volume II provides an in-depth look at the Advanced LIGO and Advanced Virgo interferometers that have just finished construction, as well as examining future interferometric detector concepts. This two-volume set will provide students and researchers the comprehensive background needed to und...

Rest and treatment/rehabilitation following sport-related concussion: a systematic review.

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Schneider, Kathryn J; Leddy, John J; Guskiewicz, Kevin M; Seifert, Tad; McCrea, Michael; Silverberg, Noah D; Feddermann-Demont, Nina; Iverson, Grant L; Hayden, Alix; Makdissi, Michael

2017-06-01

The objective of this systematic review was to evaluate the evidence regarding rest and active treatment/rehabilitation following sport-related concussion (SRC). Systematic review. MEDLINE (OVID), CINAHL (EbscoHost), PsycInfo (OVID), Cochrane Central Register of Controlled Trials (OVID), SPORTDiscus (EbscoHost), EMBASE (OVID) and Proquest DissertationsandTheses Global (Proquest) were searched systematically. Studies were included if they met the following criteria: (1) original research; (2) reported SRC as the diagnosis; and (3) evaluated the effect of rest or active treatment/rehabilitation. Review articles were excluded. Twenty-eight studies met the inclusion criteria (9 regarding the effects of rest and 19 evaluating active treatment). The methodological quality of the literature was limited; only five randomised controlled trials (RCTs) met the eligibility criteria. Those RCTs included rest, cervical and vestibular rehabilitation, subsymptom threshold aerobic exercise and multifaceted collaborative care. A brief period (24-48 hours) of cognitive and physical rest is appropriate for most patients. Following this, patients should be encouraged to gradually increase activity. The exact amount and duration of rest are not yet well defined and require further investigation. The data support interventions including cervical and vestibular rehabilitation and multifaceted collaborative care. Closely monitored subsymptom threshold, submaximal exercise may be of benefit. PROSPERO 2016:CRD42016039570. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Surgery or conservative treatment for rotator cuff tear: a meta-analysis.

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Ryösä, Anssi; Laimi, Katri; Äärimaa, Ville; Lehtimäki, Kaisa; Kukkonen, Juha; Saltychev, Mikhail

2017-07-01

Comparative evidence on treating rotator cuff tear is inconclusive. The objective of this review was to evaluate the evidence on effectiveness of tendon repair in reducing pain and improving function of the shoulder when compared with conservative treatment of symptomatic rotator cuff tear. Search on CENTRAL, MEDLINE, EMBASE, CINAHL, Web of Science and Pedro databases. Randomised controlled trials (RCT) comparing surgery and conservative treatment of rotator cuff tear. Study selection and extraction based on the Cochrane Handbook for Systematic reviews of Interventions. Random effects meta-analysis. Three identified RCTs involved 252 participants (123 cases and 129 controls). The risk of bias was considered low for all three RCTs. For Constant score, statistically insignificant effect size was 5.6 (95% CI -0.41 to 11.62) points in 1-year follow up favouring surgery and below the level of minimal clinically important difference. The respective difference in pain reduction was -0.93 (95% CI -1.65 to -0.21) cm on a 0-10 pain visual analogue scale favouring surgery. The difference was statistically significant (p = 0.012) in 1-year follow up but below the level of minimal clinically important difference. There is limited evidence that surgery is not more effective in treating rotator cuff tear than conservative treatment alone. Thus, a conservative approach is advocated as the initial treatment modality. Implications for Rehabilitation There is limited evidence that surgery is not more effective in treating rotator cuff tear than conservative treatment alone. There was no clinically significant difference between surgery and active physiotherapy in 1-year follow-up in improving Constant score or reducing pain caused by rotator cuff tear. As physiotherapy is less proneness to complications and less expensive than surgery, a conservative approach is advocated as the initial treatment modality to rotator cuff tears.

Psychotherapeutic Treatment for Anorexia Nervosa: A Systematic Review and Network Meta-Analysis

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Almut Zeeck

2018-05-01

Full Text Available Background: The aim of the study was a systematic review of studies evaluating psychotherapeutic treatment approaches in anorexia nervosa and to compare their efficacy. Weight gain was chosen as the primary outcome criterion. We also aimed to compare treatment effects according to service level (inpatient vs. outpatient and age group (adolescents vs. adults.Methods:The data bases PubMed, Cochrane Library, Web of Science, Cinahl, and PsychInfo were used for a systematic literature search (until Feb 2017. Search terms were adapted for data base, combining versions of the search terms anorexia, treat*/therap* and controlled trial. Studies were selected using pre-defined in- and exclusion criteria. Data were extracted by two independent coders using piloted forms. Network-meta-analyses were conducted on all RCTs. For a comparison of service levels and age groups, standard mean change (SMC statistics were used and naturalistic, non-randomized studies included.Results: Eighteen RCTs (trials on adults: 622 participants; trials on adolescents: 625 participants were included in the network meta-analysis. SMC analyses were conducted with 38 studies (1,164 participants. While family-based approaches dominate interventions for adolescents, individual psychotherapy dominates in adults. There was no superiority of a specific approach. Weight gains were more rapid in adolescents and inpatient treatment.Conclusions: Several specialized psychotherapeutic interventions have been developed and can be recommended for AN. However, adult and adolescent patients should be distinguished, as groups differ in terms of treatment approaches considered suitable as well as treatment response. Future trials should replicate previous findings and be multi-center trials with large sample sizes to allow for subgroup analyses. Patient assessment should include variables that can be considered relevant moderators of treatment outcome. It is desirable to explore adaptive treatment

Thinner plantar fascia predicts decreased pain after extracorporeal shock wave therapy.

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Liang, Huey-Wen; Wang, Tyng-Guey; Chen, Wen-Shiang; Hou, Sheng-Mou

2007-07-01

Increased plantar fascia thickness is common with chronic plantar fasciitis, and reduction of the thickness after extracorporeal shock wave therapy or steroid injection has been reported. We hypothesized a decrease of plantar fascia thickness was associated with pain reduction after extracorporeal shock wave therapy. Fifty-three eligible patients with 78 symptomatic feet were randomly treated with piezoelectric-type extracorporeal shock wave therapy of two intensity levels (0.12 and 0.56 mJ/mm2). Two thousand shock waves for three consecutive sessions were applied at weekly intervals. A visual analog scale for pain, the Foot Function Index, the Short Form-36 Health Survey, and ultrasonographic measurement of plantar fascia thickness were evaluated at baseline and 3 and 6 months after treatment. We analyzed the association between pain level and plantar fascia thickness with generalized estimating equation analysis and adjusted for demographic and treatment-related variables. Patients with thinner plantar fascia experienced less pain after treatment; high-intensity treatment and regular exercise were associated with lower pain level. The overall success rates were 63% and 60% at the 3- and 6-month followups. High- and low-intensity treatments were associated with similar improvements in pain and function. Receiving high-intensity treatment, although associated with less pain at followup, did not provide a higher success rate.

Fractionated Repetitive Extracorporeal Shock Wave Therapy: A New Standard in Shock Wave Therapy?

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Tobias Kisch

2015-01-01

Full Text Available Background. ESWT has proven clinical benefit in dermatology and plastic surgery. It promotes wound healing and improves tissue regeneration, connective tissue disorders, and inflammatory skin diseases. However, a single treatment session or long intervals between sessions may reduce the therapeutic effect. The present study investigated the effects of fractionated repetitive treatment in skin microcirculation. Methods. 32 rats were randomly assigned to two groups and received either fractionated repetitive high-energy ESWT every ten minutes or placebo shock wave treatment, applied to the dorsal lower leg. Microcirculatory effects were continuously assessed by combined laser Doppler imaging and photospectrometry. Results. In experimental group, cutaneous tissue oxygen saturation was increased 1 minute after the first application and until the end of the measuring period at 80 minutes after the second treatment (P<0.05. The third ESWT application boosted the effect to its highest extent. Cutaneous capillary blood flow showed a significant increase after the second application which was sustained for 20 minutes after the third application (P<0.05. Placebo group showed no statistically significant differences. Conclusions. Fractionated repetitive extracorporeal shock wave therapy (frESWT boosts and prolongs the effects on cutaneous hemodynamics. The results indicate that frESWT may provide greater benefits in the treatment of distinct soft tissue disorders compared with single-session ESWT.

Diagnosis and Treatment of Neurological Disorders by Millimeter-Wave Stimulation

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Siegel, Peter H.; Pikov, Victor

2011-01-01

Increasingly, millimeter waves are being employed for telecomm, radar, and imaging applications. To date in the U.S, however, very few investigations on the impact of this radiation on biological systems at the cellular level have been undertaken. In the beginning, to examine the impact of millimeter waves on cellular processes, researchers discovered that cell membrane depolarization may be triggered by low levels of integrated power at these high frequencies. Such a situation could be used to advantage in the direct stimulation of neuronal cells for applications in neuroprosthetics and diagnosing or treating neurological disorders. An experimental system was set up to directly monitor cell response on exposure to continuous-wave, fixed-frequency, millimeter-wave radiation at low and modest power levels (0.1 to 100 safe exposure standards) between 50 and 100 GHz. Two immortalized cell lines derived from lung and neuronal tissue were transfected with green fluorescent protein (GFP) that locates on the inside of the cell membrane lipid bi-layer. Oxonol dye was added to the cell medium. When membrane depolarization occurs, the oxonal bound to the outer wall of the lipid bi-layer can penetrate close to the inner wall where the GFP resides. Under fluorescent excitation (488 nm), the normally green GFP (520 nm) optical signal quenches and gives rise to a red output when the oxonol comes close enough to the GFP to excite a fluorescence resonance energy transfer (FRET) with an output at 620 nm. The presence of a strong FRET signature upon exposures of 30 seconds to 2 minutes at 5-10 milliwatts per square centimeter RF power at 50 GHz, followed by a return to the normal 520-nm GFP signal after a few minutes indicating repolarization of the membrane, indicates that low levels of RF energy may be able to trigger non-destructive membrane depolarization without direct cell contact. Such a mechanism could be used to stimulate neuronal cells in the cortex without the need for

Antisocial Behavioral Syndromes in Adulthood and Alcohol Use Disorder Treatment over Three-Year Follow-Up: Results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions.

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Goldstein, Risë B; Dawson, Deborah A; Grant, Bridget F

2010-07-01

Antisocial personality disorder (ASPD) is associated with poorer treatment outcomes, but more help seeking, for alcohol use disorders (AUDs); however, associations of ASPD with AUD treatment in the general population have not been studied prospectively. To examine prediction of treatment over 3-year follow-up among adults with AUDs by baseline ASPD and syndromal adult antisocial behavior without conduct disorder before age 15 (AABS). Face-to-face interviews with 34,653 respondents to the National Epidemiologic Survey on Alcohol and Related Conditions, of whom 3875 had prevalent AUDs between Waves 1 and 2 and ASPD, AABS, or no antisocial syndrome at Wave 1. In unadjusted analyses, baseline ASPD predicted AUD treatment but AABS did not. After adjustment for additional need, predisposing, and enabling factors, antisocial syndromes did not predict treatment. Baseline predictors of treatment included more past-year AUD symptoms, and past-year nicotine dependence and AUD treatment. That baseline antisocial syndrome did not predict AUD treatment may reflect strong associations of antisociality with previously identified predictors of help seeking.

Shear Wave Elastographic Alterations in the Kidney After Extracorporeal Shock Wave Lithotripsy.

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Turkay, Rustu; Inci, Ercan; Bas, Derya; Atar, Arda

2018-03-01

Extracorporeal shock wave lithotripsy (ESWL) is a method used frequently for the treatment of renal stone disease. Although its safety is proven, there are still concerns about its unwanted effects on kidneys. In this prospective study, we aimed to evaluate renal tissue alterations with shear wave elastography (SWE) after ESWL. We also studied the correlation between SWE and resistive index (RI) changes. The study included 59 patients who underwent ESWL treatment for renal stone disease. We performed SWE and color Doppler ultrasonography to calculate SWE and RI values before, 1 hour after, and 1 week after lithotripsy treatment. A binary comparison was performed by the Bonferroni test. The correlation between SWE and RI values was evaluated by a Pearson correlation analysis. The patients included 26 women (44.1%) and 33 men (55.9%). Their ages ranged from 20 to 65 years (mean ± SD, 45.0 ± 1.1 years). Stone diameters ranged from 7 to 19 mm (mean, 13.0 ± 0.5 mm). There was a significant difference in SWE values before and 1 hour after lithotripsy treatment (P = .001; P  .99; P > .05). Resistive index values increased significantly 1 hour after lithotripsy treatment and returned to prelithotripsy values 1 week after treatment. In the correlation analysis, SWE and RI values were not correlated. Measurements of alterations in SWE values after ESWL can provide useful information about renal tissue injury. © 2017 by the American Institute of Ultrasound in Medicine.

Toxoplasma gondii and schizophrenia: a review of published RCTs.

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Chorlton, Sam D

2017-07-01

Over the last 60 years, accumulating evidence has suggested that acute, chronic, and maternal Toxoplasma gondii infections predispose to schizophrenia. More recent evidence suggests that chronically infected patients with schizophrenia present with more severe disease. After acute infection, parasites form walled cysts in the brain, leading to lifelong chronic infection and drug resistance to commonly used antiparasitics. Chronic infection is the most studied and closely linked with development and severity of schizophrenia. There are currently four published randomized controlled trials evaluating antiparasitic drugs, specifically azithromycin, trimethoprim, artemisinin, and artemether, in patients with schizophrenia. No trials have demonstrated a change in psychopathology with adjunctive treatment. Published trials have either selected drugs without evidence against chronic infection or used them at doses too low to reduce brain cyst burden. Furthermore, trials have failed to achieve sufficient power or account for confounders such as previous antipsychotic treatment, sex, age, or rhesus status on antiparasitic effect. There are currently no ongoing trials of anti-Toxoplasma therapy in schizophrenia despite ample evidence to justify further testing.

Adjusting for treatment switching in randomised controlled trials - A simulation study and a simplified two-stage method.

Science.gov (United States)

Latimer, Nicholas R; Abrams, K R; Lambert, P C; Crowther, M J; Wailoo, A J; Morden, J P; Akehurst, R L; Campbell, M J

2017-04-01

Estimates of the overall survival benefit of new cancer treatments are often confounded by treatment switching in randomised controlled trials (RCTs) - whereby patients randomised to the control group are permitted to switch onto the experimental treatment upon disease progression. In health technology assessment, estimates of the unconfounded overall survival benefit associated with the new treatment are needed. Several switching adjustment methods have been advocated in the literature, some of which have been used in health technology assessment. However, it is unclear which methods are likely to produce least bias in realistic RCT-based scenarios. We simulated RCTs in which switching, associated with patient prognosis, was permitted. Treatment effect size and time dependency, switching proportions and disease severity were varied across scenarios. We assessed the performance of alternative adjustment methods based upon bias, coverage and mean squared error, related to the estimation of true restricted mean survival in the absence of switching in the control group. We found that when the treatment effect was not time-dependent, rank preserving structural failure time models (RPSFTM) and iterative parameter estimation methods produced low levels of bias. However, in the presence of a time-dependent treatment effect, these methods produced higher levels of bias, similar to those produced by an inverse probability of censoring weights method. The inverse probability of censoring weights and structural nested models produced high levels of bias when switching proportions exceeded 85%. A simplified two-stage Weibull method produced low bias across all scenarios and provided the treatment switching mechanism is suitable, represents an appropriate adjustment method.

[The results of the combined application of extracorporeal shock-wave therapy and radon baths during the rehabilitative treatment of the patients presenting with gonarthrosis].

Science.gov (United States)

Razumov, A N; Puriga, A O; Yurova, O V

2015-01-01

Osteoarthritis (OA) is one of the leading diseases of the musculoskeletal system and the main cause of arthritic joint damage. The objective of the present study was to evaluate the effectiveness of the combined application of radon baths and shock-wave therapy in the patients suffering from knee OA. The study involved 75 patients at the age of 35 to 62 years with the confirmed diagnosis of stage II and III gonarthrosis; they were divided into 3 groups. The patients of the main group received the combined treatment including extracorporeal shock-wave therapy and radon baths The patients comprising the group of comparison were given the course of radon therapy alone while those in the control group were offered the standard treatment including physiotherapy, magnetic therapy, and NSAIDs. The study has demonstrated the high effectiveness of the combined application of the radon baths and extracorporeal shock-wave therapy for the rehabilitation of the patients with deforming arthrosis of the knee that was apparent from the substantial decrease of pain syndrome, the increase of the range of motions in the knee joints, and the overall improvement of the quality of life. These beneficial changes persisted for a period of up to 6 months. The results of the present study give reason to recommend the proposed method of the remedial treatment for the wide practical application as a component in the framework of the medical rehabilitation programs.

The anxious heart in whose mind? A systematic review and meta-regression of factors associated with anxiety disorder diagnosis, treatment and morbidity risk in coronary heart disease.

Science.gov (United States)

Tully, Phillip J; Cosh, Suzanne M; Baumeister, Harald

2014-12-01

To (1) report the prognostic association between anxiety disorder subtypes and major adverse cardiac events (MACE), (2) report anxiety disorder prevalence in coronary heart disease (CHD), and (3) report the efficacy of anxiety disorder treatments in CHD. A comprehensive electronic database search was performed in November 2013 for studies reporting anxiety disorder prevalence according to structured interview in CHD samples or MACE, and randomized controlled trials (RCTs) comparing anxiety disorder treatment with placebo or usual care. From 4041 articles 42 samples were selected for extraction (8 for MACE prognosis, 39 for prevalence, no RCTs were eligible). Five generalized anxiety disorder (GAD) studies reported 883 MACE events (combined n=2851). There was a non-significant association between GAD and MACE (risk ratio=1.20, 95% CI .86-1.68, P=.28) however the effect size was highly significant in outpatient samples (adjusted hazard ratio=1.94, 95% CI 1.45-2.60, Pversus DSM-IV taxonomies. The paucity of extant anxiety disorder RCTs, alongside MACE risk for GAD outpatients, should stimulate further anxiety disorder intervention in CHD populations. Research should focus on depression and anxiety, thereby unraveling disorder specific and more generic pathways. Copyright © 2014 Elsevier Inc. All rights reserved.

Internet-based self-help smoking cessation and alcohol moderation interventions for cancer survivors: a study protocol of two RCTs.

Science.gov (United States)

Mujcic, Ajla; Blankers, Matthijs; Boon, Brigitte; Engels, Rutger; van Laar, Margriet

2018-04-02

Brief interventions for smoking cessation and alcohol moderation may contribute considerably to the prevention of cancer among populations at risk, such as cancer survivors, in addition to improving their general wellbeing. There is accumulating evidence for the effectiveness of internet-based brief health behaviour interventions. The objective of this study is to assess the effectiveness, patient-level cost-effectiveness and cost-utility of two new online theory-based self-help interventions among adult cancer survivors in the Netherlands. One of the interventions focuses on alcohol moderation, the other on smoking cessation. Both interventions are tailored to cancer survivors. Effectiveness will be assessed in two separate, nearly identical 2-armed RCTs: alcohol moderation (AM RCT) and smoking cessation (SC RCT). Participants are randomly allocated to either the intervention groups or the control groups. In the intervention groups, participants have access to one of the newly developed interventions. In the control groups, participants receive an online static information brochure on alcohol (AM RCT) or smoking (SC RCT). Main study outcome parameters are the number of drinks post-randomisation (AM RCT) and tobacco abstinence (SC RCT). In addition, cost-data and possible effect moderators and mediators will be assessed. Both treatments are internet-based minimally guided self-help interventions: MyCourse - Moderate Drinking (in Dutch: MijnKoers - Minderen met Drinken) and MyCourse - Quit Smoking (MijnKoers - Stoppen met Roken). They are based on cognitive behaviour therapy (CBT), motivational interviewing (MI) and acceptance and commitment therapy (ACT). Both interventions are optimized in collaboration with the target population of cancer survivors in focus groups and interviews, and in collaboration with several experts on eHealth, smoking cessation, alcohol misuse and cancer survivorship. The present study will add to scientific knowledge on the (cost

[Clinical effect of anti-D immunoglobulin in treatment of childhood immune thrombocytopenia: a Meta analysis].

Science.gov (United States)

Qin, Wei; Huang, Shao-Ling; Li, Ting-Ting

2017-10-01

To investigate the clinical effect and safety of anti-D immunoglobulin (anti-D) in the treatment of children with newly diagnosed acute immune thrombocytopenia (ITP) through a Meta analysis. PubMed, EMBASE, Cohrane Library, Ovid, CNKI, and Wanfang Data were searched for randomized controlled trials (RCTs) published up to April 2017. Review Manager 5.3 was used for the Meta analysis. Seven RCTs were included. The Meta analysis showed that after 72 hours and 7 days of treatment, the intravenous immunoglobulin (IVIG) group had a significantly higher percentage of children who achieved platelet count >20×10 9 /L than the anti-D group (Panti-D (50 μg/kg) group and the IVIG group (P>0.05), and there were also no significant differences in platelet count after 24 hours and 7 days of treatment between the 50 μg/kg and 75 μg/kg anti-D groups (P>0.05). The anti-D group had a significantly greater reduction in the hemoglobin level than the IVIG group after treatment, but did not need transfusion. No children in the anti-D group or the IVIG group experienced serious adverse reactions. Intravenous injection of anti-D may have a similar effect as IVIG in improving platelet count in children with acute ITP, but it may be slightly inferior to IVIG in the rate of platelet increase after treatment. The anti-D dose of 50 μg/kg may have a similar effect as 75 μg/kg. The recommended dose of anti-D for treatment of ITP is safe.

A theory for the Langmuir waves in the electron foreshock

International Nuclear Information System (INIS)

Cairns, I.H.

1987-01-01

A theory for the Langmuir (L) waves observed in the electron foreshock is suggested. Free energy for the Langmuir wave growth is contained in cutoff distributions of energetic electrons streaming from the bow shock. These cutoff distributions drive Langmuir wave growth primarily by the kinetic version of the beam instability, and wave growth is limited by quasi-linear relaxation. The observed bump-on-tail electron distributions are interpreted as the remnants of cutoff distributions after quasi-linear relaxation has limited the wave growth. Only plausibility arguments for this theory are given since suitable treatments of quasi-linear relaxation are not presently available. However, it is shown that the wave processes L ± S → L' and L ± S → T (where S and T denote ion sound and transverse waves, respectively), refraction in steady-state density structures, diffusion due to interactions with ion sound turbulence, and effects due to wave convection and spatial gradients in the beam velocity, are unable to suppress the beam instability. The theory leads to natural interpretations of the Langmuir electric field waveforms observed and of the decrease in the Langmuir wave electric fields with increasing distance from the foreshock boundary. The theory for the beam instability is reviewed, and previous analytic and numerical treatments of the beam instability are related

Cannabinoids for treatment of chronic non-cancer pain; a systematic review of randomized trials

OpenAIRE

Lynch, Mary E; Campbell, Fiona

2011-01-01

Effective therapeutic options for patients living with chronic pain are limited. The pain relieving effect of cannabinoids remains unclear. A systematic review of randomized controlled trials (RCTs) examining cannabinoids in the treatment of chronic non-cancer pain was conducted according to the PRISMA statement update on the QUORUM guidelines for reporting systematic reviews that evaluate health care interventions. Cannabinoids studied included smoked cannabis, oromucosal extracts of cannabi...

Fundamentals of interferometric gravitational wave detectors

CERN Document Server

Saulson, Peter R

2017-01-01

LIGO's recent discovery of gravitational waves was headline news around the world. Many people will want to understand more about what a gravitational wave is, how LIGO works, and how LIGO functions as a detector of gravitational waves.This book aims to communicate the basic logic of interferometric gravitational wave detectors to students who are new to the field. It assumes that the reader has a basic knowledge of physics, but no special familiarity with gravitational waves, with general relativity, or with the special techniques of experimental physics. All of the necessary ideas are developed in the book.The first edition was published in 1994. Since the book is aimed at explaining the physical ideas behind the design of LIGO, it stands the test of time. For the second edition, an Epilogue has been added; it brings the treatment of technical details up to date, and provides references that would allow a student to become proficient with today's designs.

General relativity and gravitational waves

CERN Document Server

Weber, Johanna

1961-01-01

An internationally famous physicist and electrical engineer, the author of this text was a pioneer in the investigation of gravitational waves. Joseph Weber's General Relativity and Gravitational Waves offers a classic treatment of the subject. Appropriate for upper-level undergraduates and graduate students, this text remains ever relevant. Brief but thorough in its introduction to the foundations of general relativity, it also examines the elements of Riemannian geometry and tensor calculus applicable to this field.Approximately a quarter of the contents explores theoretical and experimenta

[Treatment of vascular dementia by Chinese herbal medicine: a systematic review of randomized controlled trials of clinical studies].

Science.gov (United States)

Jian, Wen-Jia; Shi, Jing; Tian, Jin-Zhou; Ni, Jing-Nian

2015-01-01

Chinese herbal medicine has been extensively used in the treatment of vascular dementia (VaD), but lacked systematic review on its efficacy and safety. So we conducted a systematic review to assess the efficacy and safety of Chinese herbal medicine in treating VaD. CNKI, CBM, PubMed, and Wiley Online Library were retrieved for randomized trials (RCTs) on Chinese herbal medicine treating VaD patients. Randomized parallel control trials by taking Chinese herbal medicine as one treatment method and placebos/cholinesterase inhibitors/Memantine hydrochloride as the control were included. Quality rating and data extraction were performed. RevMan5.2.0 Software was used for meta-analysis. Standardized mean difference (SMD) at 95% confidence interval (CI) was used to indicate effect indicators of results. Seven RCTs met the inclusive criteria. Totally 677 VaD patients were randomly assigned to the treatment group and the control group. Descriptive analyses were performed in inclusive trials. The cognitive function was assessed in all trials. Results showed Mini-Mental state examination (MMSE) score was better in the Chinese herbal medicine group than in the placebo group, but with no significant difference when compared with the donepezil group (P > 0.05). Adverse reactions were mainly manifested as gastrointestinal symptoms such as abdominal pain in the Chinese herbal medicine group. But they occurred more in the donepezil group than in the Chinese herbal medicine group. The methodological quality of included trials was poor with less samples. Results of different trials were lack of consistency. Present evidence is not sufficient to prove or disapprove the role of Chinese herbal medicine in improving clinical symptoms and outcome indicators of VaD patients. Their clinical efficacy and safety need to be supported by more higher quality RCTs.

On Current Drive and Wave Induced Bootstrap Current in Toroidal Plasmas

International Nuclear Information System (INIS)

Hellsten, T.; Johnson, T.

2008-01-01

A comprehensive treatment of wave-particle interactions in toroidal plasmas including collisional relaxation, applicable to heating or anomalous wave induced transport, has been obtained by using Monte Carlo operators satisfying quasi-neutrality. This approach enables a self-consistent treatment of wave-particle interactions applicable to the banana regime in the neoclassical theory. It allows an extension into a regime with large temperature and density gradients, losses and transport of particles by wave-particle interactions making the method applicable to transport barriers. It is found that at large gradients the relationship between radial electric field, parallel velocity, temperature and density gradient in the neoclassical theory is modified such that coefficient in front of the logarithmic ion temperature gradient, which in the standard neoclassical theory is small and counteracts the electric field caused by the density gradient, now changes sign and contributes to the built up of the radial electric field. The possibility to drive current by absorbing the waves on trapped particles has been studied and how the wave-particle interactions affect the bootstrap current. Two new current drive mechanisms are studied: current drive by wave induced bootstrap current and selective detrapping into passing orbits by directed waves.

A full wave code for ion cyclotron waves in toroidal plasmas

International Nuclear Information System (INIS)

Brambilla, M.

1996-02-01

The code TORIC solves the finite Larmor radius wave equations in the ion cyclotron frequency range in arbitrary axisymmetric toroidal geometry. The model used describes the compressional and torsional Alfven waves (or, depending on the parallel phase velocity, the kinetic counterpart of the latter), and ion Bernstein waves excited by mode conversion near the first ion cyclotron harmonic. In the ion response the broadening of the absorption regions due to the finite width of the cyclotron resonance of individual ions in toroidal geometry is taken into account. The parallel component of the wave electric field is evaluated on the same footing as the transverse ones; the response of the electrons includes Landau damping, Transit Time damping and the mixed term. The numerical approach uses a spectral representation of the solution in the poloidal angle θ, and cubic finite elements in the radial variable ψ. Great flexibility is provided in the way ion Bernstein waves excited by mode conversion are damped when their wavelength becomes comparable with the ion Larmor radius, in the regularization of Alfven resonances, and in the treatment of the outer plasma layers. As an option, we have also implemented the Order Reduction Algorithm, which provides a particularly fast, yet accurate evaluation of the power deposition profiles in toroidal geometry. Thee present report describes the model and its numerical implementation, and provides the information needed to use the code. A few examples illustrating applications of TORIC are also included. (orig.)

Borderline personality disorder and comorbid addiction: epidemiology and treatment.

Science.gov (United States)

Kienast, Thorsten; Stoffers, Jutta; Bermpohl, Felix; Lieb, Klaus

2014-04-18

Borderline personality disorder (BPD) affects 2.7% of adults. About 78% of adults with BPD also develop a substance-related disorder or addiction at some time in their lives. These persons are more impulsive and clinically less stable than BPD patients without substance dependency. They display suicidal behavior to a greater extent, drop out of treatment more often, and have shorter abstinence phases. The combination of borderline personality disorder with addiction requires a special therapeutic approach. This review is based on a selective literature search about the treatment of patients with BPD and addiction, with particular attention to Cochrane Reviews and randomized controlled trials (RCT). The available evidence is scant. In two RCTs, Dialectical Behavior Therapy for Substance Use Disorders (DBT-SUD) was found to improve patients' overall functional level (standardized mean difference, 1.07-1.78) and to increase the number of abstinence days (effect strength [ES], 1.03) and negative urine samples (ES, 0.75). Dual focus schema therapy (DFST) was evaluated in three RCTs. Because of methodological problems, however, no useful quantitative comparison across trials is possible. In one RCT, dynamic deconstructive psychotherapy (DDP) was found to have only a moderate, statistically insignificant effect. Only a single study provides data about potentially helpful drug therapy over the intermediate term. Patients with borderline personality disorder and comorbid addiction should be treated as early as possible for both conditions in a thematically hierarchical manner. There is no evidence for any restriction on drug therapy to prevent recurrent addiction in these patients. The psychotherapeutic techniques that can be used (despite the currently inadequate evidence base) include DBT-SUD, DFST, and DDP. These patients need qualified expert counseling in choosing a suitable type of psychotherapy. Specific treatment is available in only a few places, and the relevant

Acupuncture for irritable bowel syndrome: systematic review and meta-analysis

Science.gov (United States)

Manheimer, Eric; Wieland, L. Susan; Cheng, Ke; Li, Shih Min; Shen, Xueyong; Berman, Brian M.; Lao, Lixing

2013-01-01

Objective Evidence-based treatment guidelines have been unable to provide evidence-based guidance on the effects of acupuncture for irritable bowel syndrome (IBS) because the only previous systematic review included only small, heterogeneous and methodologically unsound trials. We conducted a new systematic review and meta-analysis of randomized controlled trials (RCTs) to estimate the effects of acupuncture for treating IBS. Methods MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, Cumulative Index to Nursing and Allied Health, and the Chinese databases Sino-Med, CNKI, and VIP were searched through November 2011. Eligible RCTs compared acupuncture with sham acupuncture, other active treatments, or no (specific) treatment, and evaluated acupuncture as an adjuvant to another treatment. Our outcomes were overall IBS symptom severity and health-related quality of life. Dichotomous data were pooled to provide a relative risk (RR) of substantial improvement after treatment, and continuous data were pooled to provide a standardized mean difference (SMD) in post-treatment scores between groups. Results Seventeen RCTs (N=1806) were included. We found no evidence of an improvement with acupuncture relative to sham acupuncture on symptom severity (SMD = −0.11, 95% confidence interval: −0.35 to 0.13; 4 RCTs) or quality of life (SMD = −0.03, −0.27 to 0.22; 3 RCTs). Because of the homogeneity of the results of the sham-controlled trials, results were unaffected by restriction to the 4 sham-controlled RCTs that used adequate randomization, blinding, and had few withdrawals/drop-outs. Among RCTs that did not use a placebo control, acupuncture was more effective than pharmacological therapy (RR of symptom improvement=1.28, 1.12 to 1.45; 5 RCTs) and no (specific) treatment (RR = 2.11, 1.18 to 3.79; 2 RCTs). There was no difference between acupuncture and Bifidobacterium (RR = 1.07, 0.90 to 1.27; 2 RCTs) or between acupuncture and psychotherapy (RR=1.05, 0

A comparison of nifedipine and tamsulosin as medical expulsive therapy for the management of lower ureteral stones without ESWL

Science.gov (United States)

Cao, Dehong; Yang, Lu; Liu, Liangren; Yuan, Haichao; Qian, Shenqiang; Lv, Xiao; Han, Pin; Wei, Qiang

2014-01-01

Administration of nifedipine or tamsulosin has been suggested to augment stone expulsion rates. We aimed to compare the stone expulsion rates and adverse effects associated with the use of nifedipine or tamsulosin as medical expulsive therapy (MET) for the management of lower ureteral stones (LUS) without extracorporeal shock wave lithotripsy (ESWL) via a literature review and meta-analysis. Relevant randomized controlled trials (RCTs) were identified from the Medline, EMBASE, Cochrane CENTRAL, and Google Scholar databases. Finally, a total of 7 RCTs with 3897 patients were included. Our meta-analysis showed that tamsulosin could significantly increase the stone expulsion rate relative to nifedipine in patients with LUS (random-effects model; risk ratio [RR] = 0.81; 95% confidence interval [CI] = 0.75–0.88; P tamsulosin was more effective than nifedipine in patients with LUS, as evidenced by the higher stone expulsion rate. Tamsulosin treatment should therefore be considered for patients with LUS. PMID:24919112

Extracorporeal shock wave lithotripsy of biliary and pancreatic stones

NARCIS (Netherlands)

R. den Toom (Rene)

1993-01-01

textabstractThe aim of the study was to answer the following questions: Is extracorporeal shock wave lithotripsy for gallbladder stones a safe and effective therapy? (Chapter 2) Is simultaneous treatment with extracorporeal shock wave lithotripsy and the solvent methyl te.rt-butyl ether feasible,

Informing hot flash treatment decisions for breast cancer survivors: a systematic review of randomized trials comparing active interventions.

Science.gov (United States)

Johns, Claire; Seav, Susan M; Dominick, Sally A; Gorman, Jessica R; Li, Hongying; Natarajan, Loki; Mao, Jun James; Irene Su, H

2016-04-01

Patient-centered decision making about hot flash treatments often incorporates a balance of efficacy and side effects in addition to patient preference. This systematic review examines randomized controlled trials (RCTs) comparing at least two non-hormonal hot flash treatments in breast cancer survivors. In July 2015, PubMed, SCOPUS, CINAHL, Cochrane, and Web of Science databases were searched for RCTs comparing active, non-hormonal hot flash treatments in female breast cancer survivors. Thirteen trials were included after identifying 906 potential studies. Four trials were dose comparison studies of pharmacologic treatments citalopram, venlafaxine, gabapentin, and paroxetine. Hot flash reduction did not differ by tamoxifen or aromatase inhibitor use. Citalopram 10, 20, and 30 mg daily had comparable outcomes. Venlafaxine 75 mg daily improved hot flashes without additional side effects from higher dosing. Gabapentin 900 mg daily improved hot flashes more than 300 mg. Paroxetine 10 mg daily had fewer side effects than 20 mg. Among four trials comparing different pharmacologic treatments, venlafaxine alleviated hot flash symptoms faster than clonidine; participants preferred venlafaxine over gabapentin. Five trials compared pharmacologic to non-pharmacologic treatments. Acupuncture had similar efficacy to venlafaxine and gabapentin but may have longer durability after completing treatment and fewer side effects. We could not perform a pooled meta-analysis because outcomes were not reported in comparable formats. Clinical trial data on non-hormonal hot flash treatments provide comparisons of hot flash efficacy and other patient important outcomes to guide clinical management. Clinicians can use the information to help patients select hot flash interventions.

Epicardial shock-wave therapy improves ventricular function in a porcine model of ischaemic heart disease.

Science.gov (United States)

Holfeld, Johannes; Zimpfer, Daniel; Albrecht-Schgoer, Karin; Stojadinovic, Alexander; Paulus, Patrick; Dumfarth, Julia; Thomas, Anita; Lobenwein, Daniela; Tepeköylü, Can; Rosenhek, Raphael; Schaden, Wolfgang; Kirchmair, Rudolf; Aharinejad, Seyedhossein; Grimm, Michael

2016-12-01

Previously we have shown that epicardial shock-wave therapy improves left ventricular ejection fraction (LVEF) in a rat model of myocardial infarction. In the present experiments we aimed to address the safety and efficacy of epicardial shock-wave therapy in a preclinical large animal model and to further evaluate mechanisms of action of this novel therapy. Four weeks after left anterior descending (LAD) artery ligation in pigs, the animals underwent re-thoracotomy with (shock-wave group, n = 6) or without (control group, n = 5) epicardial shock waves (300 impulses at 0.38 mJ/mm 2 ) applied to the infarcted anterior wall. Efficacy endpoints were improvement of LVEF and induction of angiogenesis 6 weeks after shock-wave therapy. Safety endpoints were haemodynamic stability during treatment and myocardial damage. Four weeks after LAD ligation, LVEF decreased in both the shock-wave (43 ± 3%, p wave animals 6 weeks after treatment (62 ± 9%, p = 0.006); no improvement was observed in controls (41 ± 4%, p = 0.36), yielding a significant difference. Quantitative histology revealed significant angiogenesis 6 weeks after treatment (controls 2 ± 0.4 arterioles/high-power field vs treatment group 9 ± 3; p = 0.004). No acute or chronic adverse effects were observed. As a potential mechanism of action in vitro experiments showed stimulation of VEGF receptors after shock-wave treatment in human coronary artery endothelial cells. Epicardial shock-wave treatment in a large animal model of ischaemic heart failure exerted a positive effect on LVEF improvement and did not show any adverse effects. Angiogenesis was induced by stimulation of VEGF receptors. Copyright © 2014 John Wiley & Sons, Ltd. Copyright © 2014 John Wiley & Sons, Ltd.

The Traditional Chinese Medicine and Relevant Treatment for the Efficacy and Safety of Atopic Dermatitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Science.gov (United States)

Shi, Zhao-feng; Song, Tie-bing; Xie, Juan; Yan, Yi-quan

2017-01-01

Background Atopic dermatitis (AD) has become a common skin disease that requires systematic and comprehensive treatment to achieve adequate clinical control. Traditional Chinese medicines and related treatments have shown clinical effects for AD in many studies. But the systematic reviews and meta-analyses for them are lacking. Objective The systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement were conducted to evaluate the efficacy and safety of traditional Chinese medicines and related treatments for AD treatment. Methods Randomized controlled trials (RCTs) were searched based on standardized searching rules in eight medical databases from the inception up to December 2016 and a total of 24 articles with 1,618 patients were enrolled in this meta-analysis. Results The results revealed that traditional Chinese medicines and related treatments did not show statistical differences in clinical effectiveness, SCORAD amelioration, and SSRI amelioration for AD treatment compared with control group. However, EASI amelioration of traditional Chinese medicines and related treatments for AD was superior to control group. Conclusion We need to make conclusion cautiously for the efficacy and safety of traditional Chinese medicine and related treatment on AD therapy. More standard, multicenter, double-blind randomized controlled trials (RCTs) of traditional Chinese medicine and related treatment for AD were required to be conducted for more clinical evidences providing in the future. PMID:28713436

Three-dimensional freak waves and higher-order wave-wave resonances

Science.gov (United States)

Badulin, S. I.; Ivonin, D. V.; Dulov, V. A.

2012-04-01

Quite often the freak wave phenomenon is associated with the mechanism of modulational (Benjamin-Feir) instability resulted from resonances of four waves with close directions and scales. This weakly nonlinear model reflects some important features of the phenomenon and is discussing in a great number of studies as initial stage of evolution of essentially nonlinear water waves. Higher-order wave-wave resonances attract incomparably less attention. More complicated mathematics and physics explain this disregard partially only. The true reason is a lack of adequate experimental background for the study of essentially three-dimensional water wave dynamics. We start our study with the classic example of New Year Wave. Two extreme events: the famous wave 26.5 meters and one of smaller 18.5 meters height (formally, not freak) of the same record, are shown to have pronounced features of essentially three-dimensional five-wave resonant interactions. The quasi-spectra approach is used for the data analysis in order to resolve adequately frequencies near the spectral peak fp ≈ 0.057Hz and, thus, to analyze possible modulations of the dominant wave component. In terms of the quasi-spectra the above two anomalous waves show co-existence of the peak harmonic and one at frequency f5w = 3/2fp that corresponds to maximum of five-wave instability of weakly nonlinear waves. No pronounced marks of usually discussed Benjamin-Feir instability are found in the record that is easy to explain: the spectral peak frequency fp corresponds to the non-dimensional depth parameter kD ≈ 0.92 (k - wavenumber, D ≈ 70 meters - depth at the Statoil platform Draupner site) that is well below the shallow water limit of the instability kD = 1.36. A unique data collection of wave records of the Marine Hydrophysical Institute in the Katsiveli platform (Black Sea) has been analyzed in view of the above findings of possible impact of the five-wave instability on freak wave occurrence. The data cover

Longitudinal predictors of addictions treatment utilization in treatment-naïve adults with alcohol use disorders.

Science.gov (United States)

Ilgen, Mark A; Price, Amanda M; Burnett-Zeigler, Inger; Perron, Brian; Islam, Khairul; Bohnert, Amy S B; Zivin, Kara

2011-01-15

Despite the substantial prevalence of alcohol use disorders (AUDs), prior research indicates that most people with AUDs never utilize either formal or informal treatment services. Several prior studies have examined the characteristics of individuals with AUDs who receive treatment; however, limited longitudinal data are available on the predictors of receiving AUD services in treatment-naive individuals with AUDs. This study utilized data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) to identify adults in Wave 1 who met criteria for an AUD within the last 12 months and reported no prior lifetime alcohol treatment (N = 2760). These individuals were surveyed again at Wave 2, approximately 3-4 years later (N = 2170). This study examined the Wave 1 demographic and psychiatric conditions that were associated with receipt of AUD treatment services between Waves 1 and 2. In multivariable analyses, use of AUD treatment services between Waves 1 and 2 was significantly more likely among those who were male, non-Caucasian, younger, had lower income, and who had health insurance. Additionally, those who met criteria for a baseline drug use disorder, anxiety disorder or a personality disorder were more likely to receive AUD treatment. Treatment was more often utilized in those who had more severe baseline psychopathology and in those with fewer economic resources. These findings highlight the need to broaden the types of care available to individuals with AUDs to increase the appeal of AUD services. Published by Elsevier Ireland Ltd.

How many individuals achieve symptom abstinence following psychological treatments for bulimia nervosa? A meta-analytic review.

Science.gov (United States)

Linardon, Jake; Wade, Tracey D

2018-04-01

It is unclear how many patients with bulimia nervosa (BN) completely abstain from the core behavioral symptoms after receiving psychological treatment. The present meta-analysis of randomized controlled trials (RCTs) aimed to (a) estimate the prevalence of patients who abstain from binge eating and/or purging following all psychological treatments for BN, and (b) test whether these abstinence estimates are moderated by the type of treatment modality delivered, the definition of abstinence applied, and trial quality. Forty-five RCTs were included, with 78 psychotherapy conditions. Pooled event rates were calculated using random effects models. At post-treatment, the total weighted percentage of treatment-completers who achieved abstinence was 35.4% (95% CI = 29.6, 41.7), while the total weighted percentage of abstinence for all randomized patients (intention-to-treat) was 29.9% (95% CI = 25.7, 33.2). Abstinence estimates were highest in trials that used behavioral-based treatments (e.g., cognitive-behavioral therapy, behavior therapy). There was also evidence that guided self-help interventions produced the lowest post-treatment abstinence rates, but with no difference at follow-up from clinician-led treatments, and studies that used a shorter timeframe for defining abstinence (i.e., 14 days symptom-free compared to 28-days symptom-free) produced the highest abstinence rates. Abstinence estimates at follow-up for both the completer (34.6%; 95% CI = 29.3, 40.2) and intention-to-treat (28.6%; 95% CI = 25.1, 32.3) analyses were essentially the same as the post-treatment estimates. Over 60% of patients fail to fully abstain from core BN symptoms even after receiving our most empirically-supported treatments. The present findings highlight the urgency toward improving the effectiveness of psychological treatments for BN. © 2018 Wiley Periodicals, Inc.

Potassium Dehydroandrographolide Succinate Injection for the treatment of child epidemic parotitis: A systematic review and meta-analysis.

Science.gov (United States)

Wu, Jia-rui; Zhang, Xiao-meng; Zhang, Bing

2015-11-01

To systematically evaluate the clinical efficacy and safety of Potassium Dehydroandrographolide Succinate Injection (PDSI) in the treatment of child epidemic parotitis (EP). Randomized controlled trials (RCTs) regarding PDSI in the treatment of child EP were searched in China National Knowledge Infrastructure, Wanfang Database, Chinese Biomedical Literature Database, PubMed, and Cochrane Library from inception to July 30, 2013. Two reviewers independently retrieved RCTs and extracted information. The Cochrane risk of bias method was used to assess the quality of included studies, and a meta-analysis was conducted with RevMan 5.2 software. A total of 11 studies with 818 participants were included. The quality of the studies was generally low, among which only one study mentioned the random method. The meta-analysis indicated that PDSI was more effective than the conventional therapy with Western medicine for EP in the outcomes of the total effective rate [relative risk (RR)=1.23, 95% confidence interval (CI) [1.14, 1.33], Preview, 2 of which were mainly represented rash and diarrhea in the experiment group, while another 4 ADRs occurred in the control group. Based on the systematic review, PDSI was effectiveness and relatively safety in the treatment of child EP. But further rigorously designed trials are warranted to determine its effectiveness.

Acupuncture for acute hordeolum

Science.gov (United States)

Cheng, Ke; Law, Andrew; Guo, Menghu; Wieland, L. Susan; Shen, Xueyong; Lao, Lixing

2017-01-01

Background Hordeolum is an acute, purulent inflammation of the eyelid margin usually caused by obstructed orifices of the sebaceous glands of the eyelid. The condition, which affects sebaceous glands internally or externally, is common. When the meibomian gland in the tarsal plate is affected, internal hordeolum occurs, while when the glands of Zeis or Moll associated with eyelash follicles are affected, external hordeolum, or stye occurs. The onset of hordeolum is usually self limited, and may resolve in about a week with spontaneous drainage of the abscess. When the condition is severe, it can spread to adjacent glands and tissues. Recurrences are very common. As long as an internal hordeolum remains unresolved, it can develop into a chalazion or generalized eyelid cellulitis. Acupuncture is a traditional Chinese medical therapy aimed to treat disease by using fine needles to stimulate specific points on the body. However, it is unclear if acupuncture is an effective and safe treatment for acute hordeolum. Objectives The objective of this review was to investigate the effectiveness and safety of acupuncture to treat acute hordeolum compared with no treatment, sham acupuncture, or other active treatment. We also compared the effectiveness and safety of acupuncture plus another treatment with that treatment alone. Search methods We searched CENTRAL, Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE, Embase, PubMed, Latin American and Caribbean Health Sciences Literature Database (LILACS), three major Chinese databases, as well as clinical trial registers all through 7 June 2016. We reviewed the reference lists from potentially eligible studies to identify additional randomised clinical trials (RCTs). Selection criteria We included RCTs of people diagnosed with acute internal or external hordeola. We included RCTs comparing acupuncture with sham acupuncture or no treatment, other active treatments, or

Fosfomycin versus other antibiotics for the treatment of cystitis: a meta-analysis of randomized controlled trials.

Science.gov (United States)

Falagas, Matthew E; Vouloumanou, Evridiki K; Togias, Antonios G; Karadima, Maria; Kapaskelis, Anastasios M; Rafailidis, Petros I; Athanasiou, Stavros

2010-09-01

Cystitis is a common infection. The alarmingly high resistance rates exhibited by contemporary uropathogens necessitate the re-evaluation of old antibiotics. To evaluate the effectiveness and safety of fosfomycin compared with other antibiotics for the treatment of patients with cystitis. We performed a meta-analysis of randomized controlled trials (RCTs), generated from searches performed in PubMed, Scopus and Cochrane CENTRAL, which involved patients with cystitis treated with fosfomycin versus other antibiotics. Twenty-seven trials (eight double-blind) were included. Sixteen of these 27 trials involved exclusively non-pregnant female patients, 3 involved adult mixed populations of older age, 5 involved pregnant patients and 3 involved paediatric patients. Regarding clinical success, no difference was found in the comprehensive analysis regarding all comparators combined [10 RCTs, 1657 patients, risk ratio (RR) = 1.00, 95% confidence interval (CI) = 0.98-1.03] in trials involving non-pregnant females and in trials involving mixed populations. Insufficient relevant data were provided from trials involving paediatric and pregnant patients. No difference between fosfomycin and comparators was also found in all comparisons regarding the remaining effectiveness outcomes (namely microbiological success/relapse/re-infection). Fosfomycin had a comparable safety profile with the evaluated comparators in non-pregnant women, mixed and paediatric populations, whereas it was associated with significantly fewer adverse events in pregnant women (4 RCTs, 507 patients, RR = 0.35, 95% CI = 0.12-0.97). In the era of high drug resistance rates, reported even among community-acquired uropathogens, fosfomycin may provide a valuable alternative option for the treatment of cystitis in non-pregnant and pregnant women and in elderly and paediatric patients.

Physical therapy interventions for knee pain secondary to osteoarthritis: a systematic review.

Science.gov (United States)

Wang, Shi-Yi; Olson-Kellogg, Becky; Shamliyan, Tatyana A; Choi, Jae-Young; Ramakrishnan, Rema; Kane, Robert L

2012-11-06

Osteoarthritis is a leading cause of disability. Nonsurgical treatment is a key first step. Systematic literature review of physical therapy (PT) interventions for community-dwelling adults with knee osteoarthritis. MEDLINE, the Cochrane Library, the Physiotherapy Evidence Database, Scirus, Allied and Complementary Medicine, and the Health and Psychosocial Instruments bibliography database. 193 randomized, controlled trials (RCTs) published in English from 1970 to 29 February 2012. Means of outcomes, PT interventions, and risk of bias were extracted to pool standardized mean differences. Disagreements between reviewers abstracting and checking data were resolved through discussion. Meta-analyses of 84 RCTs provided evidence for 13 PT interventions on pain (58 RCTs), physical function (36 RCTs), and disability (29 RCTs). Meta-analyses provided low-strength evidence that aerobic (11 RCTs) and aquatic (3 RCTs) exercise improved disability and that aerobic exercise (19 RCTs), strengthening exercise (17 RCTs), and ultrasonography (6 RCTs) reduced pain and improved function. Several individual RCTs demonstrated clinically important improvements in pain and disability with aerobic exercise. Other PT interventions demonstrated no sustained benefit. Individual RCTs showed similar benefits with aerobic, aquatic, and strengthening exercise. Adverse events were uncommon and did not deter participants from continuing treatment. Variability in PT interventions and outcomes measures hampered synthesis of evidence. Low-strength evidence suggested that only a few PT interventions were effective. Future studies should compare combined PT interventions (which is how PT is generally administered for pain associated with knee osteoarthritis). Agency for Healthcare Research and Quality.

Extracorporeal shock wave lithotripsy: What is new?

Science.gov (United States)

Bach, Christian; Karaolides, Theocharis; Buchholz, Noor

2012-01-01

Objectives Thirty years after its introduction, extracorporeal shockwave lithotripsy (ESWL) is still first-line treatment for more than half of all urinary tract stones, but machines and treatment strategies have significantly developed over time. In this review, we summarise the latest knowledge about the clinically important aspects of ESWL. Methods We searched PubMed to identify relevant reports and the latest European Association of Urology guidelines, and standard urological textbooks were consulted. Results New technical developments include: Twin-head and tandem-pulse shock-wave generators; wide-focus, low-pressure systems; optimised coupling; and automated location and acoustic tracking systems. Indications have been refined, making possible the identification of patients in whom ESWL treatment is likely to fail. By lowering the shock-wave rate, improving coupling, applying abdominal compression, power ‘ramping’ and postoperative medical expulsion therapy, treatment protocols have been optimised. Conclusions Promising new technical developments are under development, with the potential to increase the stone-free rate after ESWL. For optimal results, the refined indications need to be respected and optimised treatment protocols should be applied. PMID:26558039

Visual and refractive outcomes of LASIK with the SCHWIND ESIRIS and WaveLight ALLEGRETTO WAVE Eye-q excimer lasers: a prospective, contralateral study.

Science.gov (United States)

Mearza, Ali A; Muhtaseb, Mohammed; Aslanides, Ioannis M

2008-11-01

To compare the safety, efficacy, and predictability of LASIK with the SCHWIND ESIRIS and WaveLight ALLEGRETTO WAVE Eye-Q excimer laser platforms. This prospective study comprised 44 eyes of 22 consecutive patients who were treated with LASIK using the Moria M2 microkeratome. One eye was treated with the SCHWIND ESIRIS laser and the fellow eye treated with the WaveLight ALLEGRETTO WAVE Eye-Q laser. All eyes operated with the SCHWIND ESIRIS were treated with standard aspheric ablation, whereas the eyes operated with the WaveLight ALLEGRETTO WAVE Eye-Q received treatment with three different ablation types according to the common practice at our clinic. Outcome measures were uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, and proximity to target refraction at 6-month follow-up. At 6 months postoperative, mean decimal UCVA was 0.96+/-0.22 (range: 0.3 to 1.2) for ESIRIS eyes and 0.98+/-0.17 (range: 0.6 to 1.2) for ALLEGRETTO eyes (P=.57). Mean postoperative spherical equivalent refraction was -0.02+/-0.28 diopters (D) (range: -0.75 to +0.75 D) for ESIRIS eyes and 0.11+/-0.91 D (range: -1.00 to +3.88 D) for ALLEGRETTO eyes (P=.49). Of the ESIRIS eyes, 20/22 (91%) were within +/-1.00 D of target refraction and 20/22 (91%) were within +/-0.50 D of target refraction. Of the ALLEGRETTO eyes, 20/22 (91%) and 19/22 (86%) were within +/-1.00 D and +/-0.50 D, respectively, of target refraction. No patient lost > or =2 lines of BSCVA in either group. No differences were seen in safety and efficacy outcome parameters between the SCHWIND ESIRIS and WaveLight ALLEGRETTO WAVE Eye-Q excimer lasers when used according to a previously established treatment algorithm at our clinic in the treatment of refractive error.

Scattering of Rossby and Poincare waves off rough lateral boundaries

Digital Repository Service at National Institute of Oceanography (India)

Fernandes, A.A; Prahalad, Y.S.; Sengupta, D.

Unified treatment of wave scattering from a rough boundary, which was originally developed by Nakayama et al. is presented. The stationary nature of the boundary process is used to show that the wave field is also stationary, and therefore can...

Catching a Wave: The Hypnosis-Sensitive Transference-Based Treatment of Dissociative Identity Disorder (DID).

Science.gov (United States)

Brenner, Ira

2018-01-01

In this article, I will describe the way in which I work with enactment-prone dissociative patients in the transference. This approach requires an appreciation of the phenomena of hypnosis and the auto-hypnotic aspects of some forms of dissociation. Essentially, I learn from the patient and my interactions with the patient how hypnotic phenomena and auto-hypnotic defenses manifest themselves in the therapeutic relationship in order both to understand them and ultimately to bring them under conscious control. Because of the fluidity and turbulence of these states, I use the analogy of catching a wave, in which timing and balance are essential, albeit elusive factors in effecting a successful treatment. The importance of having experience with many patients, attending conferences, seeking supervision, and undergoing one's own therapy will be also discussed as important prerequisites for the clinician endeavoring to utilize this type of approach. This preparation, this quest for such a "balance," is modeled after the so-called tripartite model of training employed in psychoanalytic training institutes. I will offer clinical material to illustrate this approach, which I have described as "psychoactive psychotherapy." In such treatments, the clinician may be taken by surprise and is likely to be thrown "off balance" from time to time. The mutually shared understanding of such moments is essential to regaining clinical balance in the therapeutic setting, and can lead to if not create important turning points in the treatment process.

Metamaterials, from electromagnetic waves to water waves, bending waves and beyond

KAUST Repository

Dupont, G.

2015-08-04

We will review our recent work on metamaterials for different types of waves. Transposition of transform optics to water waves and bending waves on plates will be considered with potential applications of cloaking to water waves protection and anti-vibrating systems.

Helicon wave coupling to a chiral-plasma column

International Nuclear Information System (INIS)

Torres-Silva, H.; Reggiani, N.; Sakanaka, P.H.

1995-01-01

Inductive helicon wave coupling to a chiro-plasma column is studied numerically. In our theoretical model, the RF current distribution of the chiro-plasma is taken into account using the constitutive relations of a chiral-plasma. Computational results based on the data of present-day helicon devices are show. In particular, we discuss the role of magnetic-field-aligned electron landau damping for the helicon wave absorption. In many a see, the numerical findings can be understood reasonably in terms of the wavenumber spectra of the helicon wave dispersion relation for slow and fast wave of a chiral-plasma. In general however, the full electromagnetic treatment is necessary in order to describe and to understand the inductive coupling in the helicon wave regime. (author). 9 refs., 1 fig

Impact of Wave Dragon on Wave Climate

DEFF Research Database (Denmark)

Andersen, Thomas Lykke; Tedd, James; Kramer, Morten

This report is an advisory paper for use in determining the wave dragon effects on hydrography, by considering the effect on the wave climate in the region of a wave dragon. This is to be used in the impact assessment for the Wave Dragon pre-commercial demonstrator.......This report is an advisory paper for use in determining the wave dragon effects on hydrography, by considering the effect on the wave climate in the region of a wave dragon. This is to be used in the impact assessment for the Wave Dragon pre-commercial demonstrator....

Copepod Behavior Response in an Internal Wave Apparatus

Science.gov (United States)

Webster, D. R.; Jung, S.; Haas, K. A.

2017-11-01

This study is motivated to understand the bio-physical forcing in zooplankton transport in and near internal waves, where high levels of zooplankton densities have been observed in situ. A laboratory-scale internal wave apparatus was designed to create a standing internal wave for various physical arrangements that mimic conditions observed in the field. A theoretical analysis of a standing internal wave inside a two-layer stratification system including non-linear wave effects was conducted to derive the expressions for the independent variables controlling the wave motion. Focusing on a case with a density jump of 1.0 σt, a standing internal wave was generated with a clean interface and minimal mixing across the pycnocline. Spatial and frequency domain measurements of the internal wave were evaluated in the context of the theoretical analysis. Behavioral assays with a mixed population of three marine copepods were conducted in control (stagnant homogeneous fluid), stagnant density jump interface, and internal wave flow configurations. In the internal wave treatment, the copepods showed an acrobatic, orbital-like motion in and around the internal wave region (bounded by the crests and the troughs of the waves). Trajectories of passive, neutrally-buoyant particles in the internal wave flow reveal that they generally oscillate back-and-forth along fixed paths. Thus, we conclude that the looping, orbital trajectories of copepods in the region near the internal wave interface are due to animal behavior rather than passive transport.

Investigation of Wave Transmission from a Floating Wave Dragon Wave Energy Converter

DEFF Research Database (Denmark)

Nørgaard, Jørgen Harck; Andersen, Thomas Lykke

2012-01-01

This paper focuses on the calibration of the MIKE21BW model against the measured wave height reduction behind a 24 kW/m Wave Dragon (WD) wave energy converter. A numerical model is used to determine the wave transmission through the floating WD in varying wave conditions. The transmission obtained...

[Guideline-conform psychiatric psychotherapeutic treatment for patients with schizophrenia : A normative evaluation of necessary personnel requirements].

Science.gov (United States)

Mehl, S; Falkai, P; Berger, M; Löhr, M; Rujescu, D; Wolff, J; Kircher, T

2016-03-01

Although national treatment guidelines and current publications of the German Federal Joint Committee (Gemeinsamer Bundesausschuss) recommend cognitive behavior therapy for all patients with schizophrenia, the implementation of these recommendations in current inpatient and outpatient treatment is only rudimentary. The aim of this study was to systematically search randomized controlled studies (RCTs), meta-analyses and the guidelines of the German Association for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN) and the British National Institute for Health and Clinical Excellence (NICE) in order to assess the number of personnel necessary for psychiatric and therapeutic inpatient treatment in line with present guidelines. Moreover, the number of staff required was compared with the personnel resources designated by the German psychiatry personnel regulations (Psych-PV). The German and NICE guidelines, RCTs and meta-analyses were analyzed and an adequate weekly treatment plan for an inpatient unit was developed. Moreover, the number of personnel necessary to realize the treatment plan was calculated. In order to realize adequate inpatient treatment approximately 107 min extra for medical psychotherapeutic personnel per patient and week (of which 72 min for psychotherapy) and another 60 min for nursing staff per patient and week are required in addition to the current Psych-PV regulations. Thus, implementation in an open ward with 20 inpatients would require 3.62 positions for physicians, 0.7 positions in psychology and 12.85 positions for nursing staff (including management positions and night shifts). These evidence-based recommendations for precise specifications of inpatient treatment should lead to improved inpatient treatment in line with present guidelines. Moreover, outpatients and day patients could be included in this treatment model. The results should be considered in the construction of the future prospective payment system for

Research review: the role of diet in the treatment of attention-deficit/hyperactivity disorder--an appraisal of the evidence on efficacy and recommendations on the design of future studies

NARCIS (Netherlands)

Stevenson, J.; Buitelaar, J.K.; Cortese, S.; Ferrin, M.; Konofal, E.; Lecendreux, M.; Simonoff, E.; Wong, I.C.; Sonuga-Barke, E.

2014-01-01

BACKGROUND: The efficacy of three dietary treatments for ADHD has been repeatedly tested in randomized controlled trials (RCTs). These interventions are restricted elimination diets (RED), artificial food colour elimination (AFCE) and supplementation with free fatty acids (SFFA). There have been

Almost two-dimensional treatment of drift wave turbulence

International Nuclear Information System (INIS)

Albert, J.M.; Similon, P.L.; Sudan, R.N.

1990-01-01

The approximation of two-dimensionality is studied and extended for electrostatic drift wave turbulence in a three-dimensional, magnetized plasma. It is argued on the basis of the direct interaction approximation that in the absence of parallel viscosity, purely 2-D solutions exist for which only modes with k parallel =0 are excited, but that the 2-D spectrum is unstable to perturbations at nonzero k parallel . A 1-D equation for the parallel profile g k perpendicular (k parallel ) of the saturated spectrum at steady state is derived and solved, allowing for parallel viscosity; the spectrum has finite width in k parallel , and hence finite parallel correlation length, as a result of nonlinear coupling. The enhanced energy dissipation rate, a 3-D effect, may be incorporated in the 2-D approximation by a suitable renormalization of the linear dissipation term. An algorithm is presented that reduces the 3-D problem to coupled 1- and 2-D problems. Numerical results from a 2-D spectral direct simulation, thus modified, are compared with the results from the corresponding 3-D (unmodified) simulation for a specific model of drift wave excitation. Damping at high k parallel is included. It is verified that the 1-D solution for g k perpendicular (k parallel ) accurately describes the shape and width of the 3-D spectrum, and that the modified 2-D simulation gives a good estimate of the 3-D energy saturation level and distribution E(k perpendicular )

Development of a Novel Shock Wave Catheter Ablation System

Science.gov (United States)

Yamamoto, H.; Hasebe, Yuhi; Kondo, Masateru; Fukuda, Koji; Takayama, Kazuyoshi; Shimokawa, Hiroaki

Although radio-frequency catheter ablation (RFCA) is quite effective for the treatment tachyarrhythmias, it possesses two fundamental limitations, including limited efficacy for the treatment of ventricular tachyarrhythmias of epicardial origin and the risk of thromboembolism. Consequently, new method is required, which can eradicate arrhythmia source in deep part of cardiac muscle without heating. On the other hand, for a medical application of shock waves, extracorporeal shock wave lithotripter (ESWL) has been established [1]. It was demonstrated that the underwater shock focusing is one of most efficient method to generate a controlled high pressure in a small region [2]. In order to overcome limitations of existing methods, we aimed to develop a new catheter ablation system with underwater shock waves that can treat myocardium at arbitrary depth without causing heat.

Conditions for sustaining low-pressure plasma columns by travelling electromagnetic UHF waves

International Nuclear Information System (INIS)

Benova, E.; Zhelyazkov, I.

1997-01-01

The paper considers the conditions for sustaining low-pressure plasma columns by travelling electromagnetic waves in symmetric and dipolar modes, respectively. The treatment is fully electrodynamic. It is shown that the wave energy flux along the plasma column determines the conditions for sustaining the discharge. In particular as the plasma is sustained by a symmetric wave whose flux depends mainly on the radial distribution of the wave electric field whilst for a dipolar wave sustained plasma the flux is specified by the magnitude of the axial wave field component at the plasma-dielectric interface. (orig.)

Non-absorbable disaccharides versus placebo/no intervention and lactulose versus lactitol for the prevention and treatment of hepatic encephalopathy in people with cirrhosis

DEFF Research Database (Denmark)

Gluud, Lise Lotte; Vilstrup, Hendrik; Morgan, Marsha Y

2016-01-01

BACKGROUND: Non-absorbable disaccharides (lactulose and lactitol) are recommended as first-line treatment for hepatic encephalopathy. The previous (second) version of this review included 10 randomised clinical trials (RCTs) evaluating non-absorbable disaccharides versus placebo/no intervention...... and eight RCTs evaluating lactulose versus lactitol for people with cirrhosis and hepatic encephalopathy. The review found no evidence to either support or refute the use of the non-absorbable disaccharides and no differences between lactulose versus lactitol. OBJECTIVES: To assess the beneficial...... and harmful effects of i) non-absorbable disaccharides versus placebo/no intervention and ii) lactulose versus lactitol in people with cirrhosis and hepatic encephalopathy. SEARCH METHODS: We carried out electronic searches of the Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central...

Randomized controlled trials in evidence-based mental health care: getting the right answer to the right question.

Science.gov (United States)

Essock, Susan M; Drake, Robert E; Frank, Richard G; McGuire, Thomas G

2003-01-01

The purpose of clinical research is to answer this question: Would a new treatment, when added to the existing range of treatment options available in practice, help patients? Randomized controlled trials (RCTs)--in particular, double-blind RCTs--have important methodological advantages over observational studies for addressing this question. These advantages, however, come at a price. RCTs compare treatments using a particular allocation rule for assigning patients to treatments (random assignment) that does not mimic real-world practice. "Favorable" results from an RCT indicating that a new treatment is superior to existing treatments are neither necessary nor sufficient for establishing a "yes" answer to the question posed above. Modeled on an experimental design, RCTs are expensive in time and money and must compare simple differences in treatments. Findings have a high internal validity but may not address the needs of the field, particularly where treatment is complex and rapidly evolving. Design of clinical research needs to take account of the way treatments are allocated in actual practice and include flexible designs to answer important questions most effectively.

Scattering of electromagnetic waves by obstacles

CERN Document Server

Kristensson, Gerhard

2016-01-01

The main purpose of Scattering of Electromagnetic Waves by Obstacles is to give a theoretical treatment of the scattering phenomena, and to illustrate numerical computations of some canonical scattering problems for different geometries and materials.

Aromatherapy for treatment of postoperative nausea and vomiting.

Science.gov (United States)

Hines, Sonia; Steels, Elizabeth; Chang, Anne; Gibbons, Kristen

2012-04-18

Postoperative nausea and vomiting is a common and unpleasant phenomenon and current therapies are not always effective for all patients. Aromatherapy has been suggested as a possible addition to the available treatment strategies. This review sought to establish what effect the use of aromatherapy has on the severity and duration of established postoperative nausea and vomiting and whether aromatherapy can be used with safety and clinical effectiveness comparable to standard pharmacological treatments. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 3); MEDLINE; EMBASE; CINAHL; CAM on PubMed; Meditext; LILACS; and ISI Web of Science as well as grey literature sources and the reference lists of retrieved articles. We conducted database searches up to August 2011. We included all randomized controlled trials (RCTs) and controlled clinical trials (CCTs) where aromatherapy was used to treat postoperative nausea and vomiting. Interventions were all types of aromatherapy. Aromatherapy was defined as the inhalation of the vapours of any substance for the purposes of a therapeutic benefit. Primary outcomes were the severity and duration of postoperative nausea and vomiting. Secondary outcomes were adverse reactions, use of rescue anti-emetics and patient satisfaction with treatment. Two review authors assessed risk of bias in the included studies and extracted data. As all outcomes analysed were dichotomous, we used a fixed-effect model and calculated relative risk (RR) with associated 95% confidence interval (95% CI). The nine included studies comprised six RCTs and three CCTs with a total of 402 participants. The mean age and range data for all participants were not reported for all studies. The method of randomization in four of the six included RCTs was explicitly stated and was adequate. Incomplete reporting of data affected the completeness of the analysis. Compared with placebo, isopropyl alcohol vapour

Improving Propensity Score Methods in Pharmacoepidemiology

NARCIS (Netherlands)

Ali, M.S.

2014-01-01

Inferences about intended effects of treatments are ideally investigated using randomized control trials (RCTs). Randomization leads to comparability of treated and comparison groups on measured and unmeasured prognostic factors, except the treatment, thereby preventing confounding. RCTs, however,

Rogue and shock waves in nonlinear dispersive media

CERN Document Server

Resitori, Stefania; Baronio, Fabio

2016-01-01

This self-contained set of lectures addresses a gap in the literature by providing a systematic link between the theoretical foundations of the subject matter and cutting-edge applications in both geophysical fluid dynamics and nonlinear optics. Rogue and shock waves are phenomena that may occur in the propagation of waves in any nonlinear dispersive medium. Accordingly, they have been observed in disparate settings – as ocean waves, in nonlinear optics, in Bose-Einstein condensates, and in plasmas. Rogue and dispersive shock waves are both characterized by the development of extremes: for the former, the wave amplitude becomes unusually large, while for the latter, gradients reach extreme values. Both aspects strongly influence the statistical properties of the wave propagation and are thus considered together here in terms of their underlying theoretical treatment. This book offers a self-contained graduate-level text intended as both an introduction and reference guide for a new generation of scientists ...

Virtual reality exposure therapy for the treatment of anxiety disorders: an evaluation of research quality.

Science.gov (United States)

McCann, Russell A; Armstrong, Christina M; Skopp, Nancy A; Edwards-Stewart, Amanda; Smolenski, Derek J; June, Jennifer D; Metzger-Abamukong, Melinda; Reger, Greg M

2014-08-01

Randomized controlled trials (RCTs) support the effectiveness of virtual reality exposure therapy (VRET) for anxiety disorders; however, the overall quality of the VRET RCT literature base has yet to be evaluated. This study reviewed 27 VRET RCTs and the degree of adherence to 8 RCT research design criteria derived from existing standards. Adherence to the study quality criteria was generally low as the articles met an average 2.85 criteria (SD=1.56). None of the studies met more than six quality criteria. Study quality did not predict effect size; however, a reduction in effect size magnitude was observed for studies with larger sample sizes when comparing VRET to non-active control groups. VRET may be an effective method of treatment but caution should be exercised in interpreting the existing body of literature supporting VRET relative to existing standards of care. The need for well-designed VRET research is discussed. Copyright © 2014. Published by Elsevier Ltd.

Wave Equation Inversion of Skeletonized SurfaceWaves

KAUST Repository

Zhang, Zhendong

2015-08-19

We present a surface-wave inversion method that inverts for the S-wave velocity from the Rayleigh dispersion curve for the fundamental-mode. We call this wave equation inversion of skeletonized surface waves because the dispersion curve for the fundamental-mode Rayleigh wave is inverted using finite-difference solutions to the wave equation. The best match between the predicted and observed dispersion curves provides the optimal S-wave velocity model. Results with synthetic and field data illustrate the benefits and limitations of this method.

Meta-analysis of ceftriaxone compared with penicillin for the treatment of syphilis.

Science.gov (United States)

Liang, Zhen; Chen, Ya-Ping; Yang, Chun-Sheng; Guo, Wen; Jiang, Xiao-Xiao; Xu, Xi-Feng; Feng, Shou-Xin; Liu, Yan-Qun; Jiang, Guan

2016-01-01

Penicillin is the gold standard for treating syphilis. However, allergic reactions, poor drug tolerance and limited efficacy in patients remain a challenging problem. The objective of this meta-analysis was to compare the efficacy of ceftriaxone and penicillin based on data obtained from published randomised controlled trials (RCTs). The Cochrane Library, Medline, EBSCO, EMBASE and Ovid databases were searched for RCTs of ceftriaxone vs. penicillin for the treatment of syphilis. Estimated risk ratios (RRs) and 95% confidence intervals (CIs) were used to investigate the following outcome measures: 3-month response rate; 6-month response rate; 12-month response rate; relapse rate; serofast rate; and failure rate. Seven RCTs involving 281 participants (159 patients who received ceftriaxone and 122 patients who received penicillin) were included in the meta-analysis. There were no significant differences in 3-month response rate (RR=1.12, 95% CI 0.89-1.42), 6-month response rate (RR=1.02, 95% CI 0.75-1.38), 12-month response rate (RR=1.04, 95% CI 0.82-1.32), relapse rate (RR=0.91, 95% CI 0.45-1.84), serofast rate (RR=0.69, 95% CI 0.22-2.12) or failure rate (RR=0.66, 95% CI 0.03-15.76) in patients treated with ceftriaxone compared with those treated with penicillin. In conclusion, there is no evidence in the literature that ceftriaxone is less efficient than penicillin. Copyright © 2015 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

Efficient Wave Energy Amplification with Wave Reflectors

DEFF Research Database (Denmark)

Kramer, Morten Mejlhede; Frigaard, Peter Bak

2002-01-01

Wave Energy Converters (WEC's) extract wave energy from a limited area, often a single point or line even though the wave energy is generally spread out along the wave crest. By the use of wave reflectors (reflecting walls) the wave energy is effectively focused and increased to approximately 130......-140%. In the paper a procedure for calculating the efficiency and optimizing the geometry of wave reflectors are described, this by use of a 3D boundary element method. The calculations are verified by laboratory experiments and a very good agreement is found. The paper gives estimates of possible power benifit...... for different geometries of the wave reflectors and optimal geometrical design parameters are specified. On this basis inventors of WEC's can evaluate whether a specific WEC possible could benefit from wave reflectors....

Adiabatic theorem for the time-dependent wave operator

International Nuclear Information System (INIS)

Viennot, David; Jolicard, Georges; Killingbeck, John P.; Perrin, Marie-Yvonne

2005-01-01

The application of time-dependent wave operator theory to the development of a quantum adiabatic perturbation theory is treated both theoretically and numerically, with emphasis on the description of field-matter interactions which involve short laser pulses. It is first shown that the adiabatic limit of the time-dependent wave operator corresponds to a succession of instantaneous static Bloch wave operators. Wave operator theory is then shown to be compatible with the two-time Floquet theory of light-matter interaction, thus allowing the application of Floquet theory to cases which require the use of a degenerate active space. A numerical study of some problems shows that the perturbation strength associated with nonadiabatic processes can be reduced by using multidimensional active spaces and illustrates the capacity of the wave operator approach to produce a quasiadiabatic treatment of a nominally nonadiabatic Floquet dynamical system

The role of Gliadel wafers in the treatment of newly diagnosed GBM: a meta-analysis

Directory of Open Access Journals (Sweden)

Xing WK

2015-06-01

Full Text Available Wei-kang Xing,1 Chuan Shao,2 Zhen-yu Qi,1 Chao Yang,1 Zhong Wang1 1Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 2Department of Neurosurgery, The Second Clinical Medical College of North Sichuan Medical College, Nanchong, Sichuan, People’s Republic of China Background: Standard treatment for high-grade glioma (HGG includes surgery followed by radiotherapy and/or chemotherapy. Insertion of carmustine wafers into the resection cavity as a treatment for malignant glioma is currently a controversial topic among neurosurgeons. Our meta-analysis focused on whether carmustine wafer treatment could significantly benefit the survival of patients with newly diagnosed glioblastoma multiforme (GBM.Method: We searched the PubMed and Web of Science databases without any restrictions on language using the keywords “Gliadel wafers”, “carmustine wafers”, “BCNU wafers”, or “interstitial chemotherapy” in newly diagnosed GBM for the period from January 1990 to March 2015. Randomized controlled trials (RCTs and cohort studies/clinical trials that compared treatments designed with and without carmustine wafers and which reported overall survival or hazard ratio (HR or survival curves were included in this study. Moreover, the statistical analysis was conducted by the STATA 12.0 software.Results: Six studies including two RCTs and four cohort studies, enrolling a total of 513 patients (223 with and 290 without carmustine wafers, matched the selection criteria. Carmustine wafers showed a strong advantage when pooling all the included studies (HR =0.63, 95% confidence interval (CI =0.49–0.81; P=0.019. However, the two RCTs did not show a statistical increase in survival in the group with carmustine wafer compared to the group without it (HR =0.51, 95% CI =0.18–1.41; P=0.426, while the cohort studies demonstrated a significant survival increase (HR =0.59, 95% CI =0.44–0.79; P<0.0001.Conclusion

Theory of reflection reflection and transmission of electromagnetic, particle and acoustic waves

CERN Document Server

Lekner, John

2016-01-01

This book deals with the reflection of electromagnetic and particle waves by interfaces. The interfaces can be sharp or diffuse. The topics of the book contain absorption, inverse problems, anisotropy, pulses and finite beams, rough surfaces, matrix methods, numerical methods,  reflection of particle waves and neutron reflection. Exact general results are presented, followed by long wave reflection, variational theory, reflection amplitude equations of the Riccati type, and reflection of short waves. The Second Edition of the Theory of Reflection is an updated and much enlarged revision of the 1987 monograph. There are new chapters on periodically stratified media, ellipsometry, chiral media, neutron reflection and reflection of acoustic waves. The chapter on anisotropy is much extended, with a complete treatment of the reflection and transmission properties of arbitrarily oriented uniaxial crystals. The book gives a systematic and unified treatment reflection and transmission of electromagnetic and particle...

Assimilation of Wave Imaging Radar Observations for Real-Time Wave-by-Wave Forecasting

Science.gov (United States)

Haller, M. C.; Simpson, A. J.; Walker, D. T.; Lynett, P. J.; Pittman, R.; Honegger, D.

2016-02-01

It has been shown in various studies that a controls system can dramatically improve Wave Energy Converter (WEC) power production by tuning the device's oscillations to the incoming wave field, as well as protect WEC devices by decoupling them in extreme wave conditions. A requirement of the most efficient controls systems is a phase-resolved, "deterministic" surface elevation profile, alerting the device to what it will experience in the near future. The current study aims to demonstrate a deterministic method of wave forecasting through the pairing of an X-Band marine radar with a predictive Mild Slope Equation (MSE) wave model. Using the radar as a remote sensing technique, the wave field up to 1-4 km surrounding a WEC device can be resolved. Individual waves within the radar scan are imaged through the contrast between high intensity wave faces and low intensity wave troughs. Using a recently developed method, radar images are inverted into the radial component of surface slope, shown in the figure provided using radar data from Newport, Oregon. Then, resolved radial slope images are assimilated into the MSE wave model. This leads to a best-fit model hindcast of the waves within the domain. The hindcast is utilized as an initial condition for wave-by-wave forecasting with a target forecast horizon of 3-5 minutes (tens of wave periods). The methodology is currently being tested with synthetic data and comparisons with field data are imminent.

Hyperbaric oxygen for the treatment of diabetic foot ulcers: a systematic review

NARCIS (Netherlands)

Stoekenbroek, R. M.; Santema, T. B.; Legemate, D. A.; Ubbink, D. T.; van den Brink, A.; Koelemay, M. J. W.

2014-01-01

A systematic review of randomized clinical trials (RCTs) to assess the additional value of hyperbaric oxygen therapy (HBOT) in promoting the healing of diabetic foot ulcers and preventing amputations was performed. MEDLINE, Embase, and the Cochrane Library were searched to identify RCTs in patients

Lipid based nutrient supplements (LNS) for treatment of children (6 months to 59 months) with moderate acute malnutrition (MAM): A systematic review

Science.gov (United States)

Pena-Rosas, Juan Pablo; Boy-Mena, Evelyn; Sachdev, Harshpal S.

2017-01-01

Background Moderate acute malnutrition is a major public health problem affecting children from low- and middle-income countries. Lipid nutrient supplements have been proposed as a nutritional intervention for its treatment. Objectives To evaluate the effectiveness and safety of LNS for the treatment of MAM in infants and children 6 to 59 months of age. Study design Systematic review of randomized-controlled trials and controlled before-after studies. Results Data from nine trials showed that use of LNS, in comparison to specially formulated foods, improved the recovery rate (RR 1.08; 95% CI 1.02–1.14, 8 RCTs, 8934 participants, low quality evidence); decreased the chances of no recovery (RR 0.70; 95% CI 0.58–0.85, 7 RCTs, 8364 participants, low quality evidence) and the risk of deterioration into severe acute malnutrition (RR 0.87; 95% CI 0.73–1.03, 6 RCTs, 6788 participants, low quality evidence). There was little impact on mortality (RR 0.94, 95% CI 0.54–1.52, 8 RCTs, 8364 participants, very-low- quality evidence) or default rate (RR 1.32; 95% CI 0.73–2.4, 7 studies, 7570 participants, low quality evidence). There was improvement in weight gain, weight-for-height z-scores, height-for-age z-scores and mid-upper arm circumference. Subset analyses suggested higher recovery rates with greater amount of calories provided and with ready-to-use therapeutic foods, in comparison to ready-to-use supplementary foods. One study comparing LNS with nutritional counselling (very low quality evidence) showed higher chance of recovery, lower risk of deteriorating into severe acute malnutrition and lower default rate, with no impact on mortality, and no recovery. Conclusions Evidence restricted to the African regions suggests that LNS may be slightly more effective than specially formulated fortified foods or nutritional counselling in recovery from MAM, lowering the risk of deterioration into SAM, and improving weight gain with little impact on mortality or default

Proportion of contextual effects in the treatment of fibromyalgia-a meta-analysis of randomised controlled trials.

Science.gov (United States)

Whiteside, Nicola; Sarmanova, Aliya; Chen, Xi; Zou, Kun; Abdullah, Natasya; Doherty, Michael; Zhang, Weiya

2018-05-01

The objective of this study is to examine the proportion of the total treatment effect that is attributable to contextual effects in randomised controlled trials (RCTs) of treatments for fibromyalgia. A systematic literature search was undertaken in Medline, Web of Science, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Allied and Complementary Medicine in September 2015. The proportion of contextual effect (PCE) was calculated by dividing the improvement in the placebo arm by the improvement in the treatment arm. The measure was log-transformed for each trial and the random effects model was used to pool data. The primary outcome was pain. Secondary outcomes were fibromyalgia impact questionnaire (FIQ) total and fatigue. Heterogeneity was quantified using I 2 . Publication bias was assessed using a funnel plot and Egger's test. Subgroup analysis was undertaken to explore heterogeneity and potential determinants of the PCE. Fifty-one eligible trials (9599 participants) were identified. The PCE was 0.60 (95% CI 0·56 to 0·64) for pain, 0·57 (95% CI 0·53 to 0·61) for FIQ total, and 0·63 (95% CI 0·59 to 0·68) for fatigue. The I 2 was 99.4% for pain, 99.2% for FIQ total, and 97.6% for fatigue. More than half of the treatment effect in fibromyalgia RCTs results from non-specific contextual factors. This suggests that optimising contextual care may enhance treatment effects and improve outcomes. Reporting the total treatment effect and the proportion of contextual effect in trials may help to better translate research evidence into practice.

Platelet-rich plasma in clinical practice

African Journals Online (AJOL)

implants, PRP treatment for muscle, tendon, dermatology and skin renewal is gaining .... trials (RCTs) should lead to an improvement in the design of new. RCTs on ... and safety of PRP combined with micro needling for the treatment of ...

An integrative view of mechanisms underlying generalized spike-and-wave epileptic seizures and its implication on optimal therapeutic treatments.

Directory of Open Access Journals (Sweden)

Boyuan Yan

Full Text Available Many types of epileptic seizures are characterized by generalized spike-and-wave discharges. In the past, notable effort has been devoted to understanding seizure dynamics and various hypotheses have been proposed to explain the underlying mechanisms. In this paper, by taking an integrative view of the underlying mechanisms, we demonstrate that epileptic seizures can be generated by many different combinations of synaptic strengths and intrinsic membrane properties. This integrative view has important medical implications: the specific state of a patient characterized by a set of biophysical characteristics ultimately determines the optimal therapeutic treatment. Through the same view, we further demonstrate the potentiation effect of rational polypharmacy in the treatment of epilepsy and provide a new angle to resolve the debate on polypharmacy. Our results underscore the need for personalized medicine and demonstrate that computer modeling and simulation may play an important role in assisting the clinicians in selecting the optimal treatment on an individual basis.

Waves in geophysical fluids tsunamis, rogue waves, internal waves and internal tides

CERN Document Server

Schneider, Wilhelm; Trulsen, Karsten

2006-01-01

Waves in Geophysical Fluids describes: the forecasting and risk evaluation of tsunamis by tectonic motion, land slides, explosions, run-up, and maps the tsunami sources in the world's oceans; stochastic Monte-Carlo simulations and focusing mechanisms for rogue waves, nonlinear wave models, breather formulas, and the kinematics of the Draupner wave; the full story about the discovery of the very large oceanic internal waves, how the waves are visible from above through the signatures on the sea surface, and how to compute them; observations of energetic internal tides and hot spots from several field campaigns in all parts of the world's oceans, with interpretation of spectra. An essential work for students, scientists and engineers working with the fundamental and applied aspects of ocean waves.

Medical and biomedical applications of shock waves

CERN Document Server

Loske, Achim M

2017-01-01

This book provides current, comprehensive, and clear explanations of the physics behind medical and biomedical applications of shock waves. Extracorporeal shock wave lithotripsy is one of the greatest medical advances of our time, and its techniques and clinical devices are continuously evolving. Further research continues to improve the understanding of calculi fragmentation and tissue-damaging mechanisms. Shock waves are also used in orthopedics and traumatology. Possible applications in oncology, cardiology, dentistry, gene therapy, cell transfection, transformation of fungi and bacteria, as well as the inactivation of microorganisms are promising approaches for clinical treatment, industrial applications and research. Medical and Biomedical Applications of Shock Waves is useful as a guide for students, technicians and researchers working in universities and laboratories. Chemists, biologists, physicians and veterinarians, involved in research or clinical practice will find useful advice, but also engineer...

Prokinetics for the treatment of functional dyspepsia: Bayesian network meta-analysis.

Science.gov (United States)

Yang, Young Joo; Bang, Chang Seok; Baik, Gwang Ho; Park, Tae Young; Shin, Suk Pyo; Suk, Ki Tae; Kim, Dong Joon

2017-06-26

Controversies persist regarding the effect of prokinetics for the treatment of functional dyspepsia (FD). This study aimed to assess the comparative efficacy of prokinetic agents for the treatment of FD. Randomized controlled trials (RCTs) of prokinetics for the treatment of FD were identified from core databases. Symptom response rates were extracted and analyzed using odds ratios (ORs). A Bayesian network meta-analysis was performed using the Markov chain Monte Carlo method in WinBUGS and NetMetaXL. In total, 25 RCTs, which included 4473 patients with FD who were treated with 6 different prokinetics or placebo, were identified and analyzed. Metoclopramide showed the best surface under the cumulative ranking curve (SUCRA) probability (92.5%), followed by trimebutine (74.5%) and mosapride (63.3%). However, the therapeutic efficacy of metoclopramide was not significantly different from that of trimebutine (OR:1.32, 95% credible interval: 0.27-6.06), mosapride (OR: 1.99, 95% credible interval: 0.87-4.72), or domperidone (OR: 2.04, 95% credible interval: 0.92-4.60). Metoclopramide showed better efficacy than itopride (OR: 2.79, 95% credible interval: 1.29-6.21) and acotiamide (OR: 3.07, 95% credible interval: 1.43-6.75). Domperidone (SUCRA probability 62.9%) showed better efficacy than itopride (OR: 1.37, 95% credible interval: 1.07-1.77) and acotiamide (OR: 1.51, 95% credible interval: 1.04-2.18). Metoclopramide, trimebutine, mosapride, and domperidone showed better efficacy for the treatment of FD than itopride or acotiamide. Considering the adverse events related to metoclopramide or domperidone, the short-term use of these agents or the alternative use of trimebutine or mosapride could be recommended for the symptomatic relief of FD.

Is electroconvulsive therapy an evidence-based treatment for catatonia? A systematic review and meta-analysis.

Science.gov (United States)

Leroy, Arnaud; Naudet, Florian; Vaiva, Guillaume; Francis, Andrew; Thomas, Pierre; Amad, Ali

2017-06-21

We aimed to review and discuss the evidence-based arguments for the efficacy of electroconvulsive therapy (ECT) in the treatment of catatonia. Randomized controlled trials (RCTs) and observational studies focusing on the response to ECT in catatonia were selected in PubMed, the Cochrane Library, Embase, ClinicalTrials.gov and Current Controlled Trials through October 2016 and qualitatively described. Trials assessing pre-post differences using a catatonia or clinical improvement rating scale were pooled together using a random effect model. Secondary outcomes were adverse effects of anesthesia and seizure. 564 patients from 28 studies were included. RCTs were of low quality and were heterogeneous; therefore, it was not possible to combine their efficacy results. An improvement of catatonic symptoms after ECT treatment was evidenced in ten studies (SMD = -3.14, 95% CI [-3.95; -2.34]). The adverse effects that were reported in seven studies included mental confusion, memory loss, headache, or adverse effects associated with anesthesia. ECT protocols were heterogeneous. The literature consistently describes improvement in catatonic symptoms after ECT. However, the published studies fail to demonstrate efficacy and effectiveness. It is now crucial to design and perform a quality RCT to robustly validate the use of ECT in catatonia.Prospero registration information: PROSPERO 2016: CRD42016041660.

[Clinical randomized controlled trial on ultrashort wave and magnetic therapy for the treatment of early stage distal radius fractures].

Science.gov (United States)

Wang, Guan-Jie; Liu, Jia

2012-07-01

To explore the effect of application of ultrashort wave and magnetic therapy instrument on the swelling regression in distal radius fractures treated by splint external fixation in initial stage. From March 2007 to May 2010,90 patients with distal radial fracture were treated by manual reduction and splint external fixation. After manual reduction and small splints external fixation, these patients were randomly divided into electrical physical therapy group, western medicine group and the control group by the order of calling number, with 30 cases each group. In control group, there were 9 males and 21 females with an average age of (61.29 +/- 1.97) years, the patients raised and exercise the limb and fingers only. The other two groups also carried out this treatment. In electrical physical therapy group, there were 9 males and 21 females with an average age of (62.37 +/- 2.48) years, the patients were treated with ultrashort wave and magnetic therapy instrument for early intervention, once a day, 5 days for a course of treatment and three cycle were operated. In western medicine group,there were 8 males and 22 females with an average age of (60.12 +/- 2.87) years, the patients were injected with beta-aescin (20 mg, intravenous injection,once a day) for 5 days, followed by Danshen injection (20 ml, intravenous injection, once a day) for 10 days. The limb swelling of patients were assessed every day for 20 days after manual reduction and small splints external fixation. The time of swelling regression in electrical physical therapy group, western medicine group and the control group were respectively (9.62 +/- 3.32), (10.05 +/- 3.05) and (14.57 +/- 2.93) days. Both of that in electrical physical therapy group and western medicine group were shorter than that in the control group (P0.05). The effective rate of swelling regression in electrical physical therapy group, western medicine group and the control group were 86.67%, 80.00%, 46.66% respectively. There was no

Multimodal treatment in difficult sialolithiasis: Role of extracorporeal shock-wave lithotripsy and intraductal pneumatic lithotripsy.

Science.gov (United States)

Koch, Michael; Schapher, Mirco; Mantsopoulos, Konstantinos; von Scotti, Felix; Goncalves, Miguel; Iro, Heinrich

2017-12-15

To assess results after treatment of difficult/complex sialolithiasis with extracorporeal shock-wave lithotripsy (ESWL) and intraductal pneumatic lithotripsy (IPL). Retrospective study in a tertiary referral center. Altogether, 63 stones were diagnosed in 38 patients with difficult/complex sialolithiasis. Forty-nine stones were treated with fragmentation using both ESWL and IPL. Stones accessible with the sialendoscope were treated primarily with IPL in multiple sialolithiasis. Seventy-one ESWL procedures and 57 IPL were performed in our patients. Forty-nine stones were treated by 67 ESWL procedures and 52 IPL. ESWL converted sialoliths from sialendoscopically untreatable into sialendoscopically treatable cases in 94.7%; the treatment then was completed by a total of 52 IPL procedures. ESWL was performed before IPL (81.6%), in combination with IPL (7.9%) and after (10.5%). Complete fragmentation was achieved in 97.9%. Four stones each were treated with ESWL and IPL alone in multiple sialolithiasis. Altogether, 53 stones were treated by 57 IPL procedures. Complete fragmentation was achieved in 98.1% of the 53 stones. ESWL and IPL were the dominant treatment modalities in 84.1% of all 63 stones treated. Of all 38 patients, 92.1% became stone-free and all became symptom-free. All the glands were preserved. Multiple stones were treated in 34.2% of the patients; of these, 92.3% became stone-free. These results show that patients with difficult and complex sialolithiasis can be treated with high success rates of > 90% using a multimodal, minimally invasive, and gland-preserving treatment approach. ESWL and IPL played a key role in this multimodal treatment regime in > 80% of stones. 4. Laryngoscope, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Non-axial-symmetric Alfven waves in cylindrical, radial inhomogeneous plasmas

International Nuclear Information System (INIS)

Raeuchle, E.

1978-08-01

The propagation of nonaxialsymmetric Alfven waves is investigated theoretically. Eigenfunctions and dispersion relations are calculated numerically for radial inhomogeneous cylindrical plasmas. In the MHD treatment resistivity, neutral particle loading and ion cyclotron effects are included. The investigations are of importance for plasma heating by Alfven waves. (orig.) [de

Assimilation of Wave Imaging Radar Observations for Real-time Wave-by-Wave Forecasting

Energy Technology Data Exchange (ETDEWEB)

Simpson, Alexandra [Oregon State Univ., Corvallis, OR (United States); Haller, Merrick [Oregon State Univ., Corvallis, OR (United States). School of Civil & Construction Engineering; Walker, David [SRI International, Menlo Park, CA (United States); Lynett, Pat [Univ. of Southern California, Los Angeles, CA (United States)

2017-08-29

This project addressed Topic 3: “Wave Measurement Instrumentation for Feed Forward Controls” under the FOA number DE-FOA-0000971. The overall goal of the program was to develop a phase-resolving wave forecasting technique for application to the active control of Wave Energy Conversion (WEC) devices. We have developed an approach that couples a wave imaging marine radar with a phase-resolving linear wave model for real-time wave field reconstruction and forward propagation of the wave field in space and time. The scope of the project was to develop and assess the performance of this novel forecasting system. Specific project goals were as follows: Develop and verify a fast, GPU-based (Graphical Processing Unit) wave propagation model suitable for phase-resolved computation of nearshore wave transformation over variable bathymetry; Compare the accuracy and speed of performance of the wave model against a deep water model in their ability to predict wave field transformation in the intermediate water depths (50 to 70 m) typical of planned WEC sites; Develop and implement a variational assimilation algorithm that can ingest wave imaging radar observations and estimate the time-varying wave conditions offshore of the domain of interest such that the observed wave field is best reconstructed throughout the domain and then use this to produce model forecasts for a given WEC location; Collect wave-resolving marine radar data, along with relevant in situ wave data, at a suitable wave energy test site, apply the algorithm to the field data, assess performance, and identify any necessary improvements; and Develop a production cost estimate that addresses the affordability of the wave forecasting technology and include in the Final Report. The developed forecasting algorithm (“Wavecast”) was evaluated for both speed and accuracy against a substantial synthetic dataset. Early in the project, performance tests definitively demonstrated that the system was capable of

Attraction and repulsion of spiral waves by inhomogeneity of conduction anisotropy--a model of spiral wave interaction with electrical remodeling of heart tissue.

Science.gov (United States)

Kuklik, Pawel; Sanders, Prashanthan; Szumowski, Lukasz; Żebrowski, Jan J

2013-01-01

Various forms of heart disease are associated with remodeling of the heart muscle, which results in a perturbation of cell-to-cell electrical coupling. These perturbations may alter the trajectory of spiral wave drift in the heart muscle. We investigate the effect of spatially extended inhomogeneity of transverse cell coupling on the spiral wave trajectory using a simple active media model. The spiral wave was either attracted or repelled from the center of inhomogeneity as a function of cell excitability and gradient of the cell coupling. High levels of excitability resulted in an attraction of the wave to the center of inhomogeneity, whereas low levels resulted in an escape and termination of the spiral wave. The spiral wave drift velocity was related to the gradient of the coupling and the initial position of the wave. In a diseased heart, a region of altered transverse coupling corresponds with local gap junction remodeling that may be responsible for stabilization-destabilization of spiral waves and hence reflect potentially important targets in the treatment of heart arrhythmias.

Wave fronts of electromagnetic cyclotron harmonic waves

International Nuclear Information System (INIS)

Ohnuma, T.; Watanabe, T.

1982-01-01

In an inhomogeneous high-density magnetized plasma, the spatial properties of the wave fronts and ray trajectories of electromagnetic ordinary and extraordinary cyclotron harmonic waves are investigated. Those waves which are radiated from a local source are found to have wave fronts which are almost parallel to the magnetic field. Also, the reflective properties of the electromagnetic cyclotron harmonic waves are confirmed

Rays, waves, and scattering topics in classical mathematical physics

CERN Document Server

Adam, John A

2017-01-01

This one-of-a-kind book presents many of the mathematical concepts, structures, and techniques used in the study of rays, waves, and scattering. Panoramic in scope, it includes discussions of how ocean waves are refracted around islands and underwater ridges, how seismic waves are refracted in the earth's interior, how atmospheric waves are scattered by mountains and ridges, how the scattering of light waves produces the blue sky, and meteorological phenomena such as rainbows and coronas. Rays, Waves, and Scattering is a valuable resource for practitioners, graduate students, and advanced undergraduates in applied mathematics, theoretical physics, and engineering. Bridging the gap between advanced treatments of the subject written for specialists and less mathematical books aimed at beginners, this unique mathematical compendium features problems and exercises throughout that are geared to various levels of sophistication, covering everything from Ptolemy's theorem to Airy integrals (as well as more technica...

Efficacy and Safety of the Injection of the Traditional Chinese Medicine Puerarin for the Treatment of Diabetic Peripheral Neuropathy: A Systematic Review and Meta-Analysis of 53 Randomized Controlled Trials

Directory of Open Access Journals (Sweden)

Baocheng Xie

2018-01-01

Full Text Available Objective. The injection of the traditional Chinese patent medicine puerarin has been widely used in the treatment of various diseases such as angina pectoris or ischemic stroke. We aim to evaluate the efficacy and safety of puerarin injection for the treatment of diabetic peripheral neuropathy (DPN. Methods. A systematic literature search was performed in seven medical databases from their inception until June 2017. 53 studies with RCTs, totaling 3284 patients, were included in this meta-analysis. The included studies were assessed by the Cochrane risk of bias and analyzed by Review Manager 5.3 software. Results. The meta-analysis showed that puerarin injection for the treatment of DPN was significantly better compared with the control group in terms of the total effective rate. The result showed that puerarin injection for the treatment of DPN can significantly increase the probability of sensory nerve conduction velocity (SNCV and motor nerve conduction velocity (MNCV of the median and peroneal nerves. Conclusions. This meta-analysis demonstrated that puerarin injection may be more effective and safe for the treatment of DPN. However, further and higher quality RCTs are required to prove its efficacy and provide meaningful evidence for clinical treatment due to the poor methodological quality.

Wave Equation Inversion of Skeletonized SurfaceWaves

KAUST Repository

Zhang, Zhendong; Liu, Yike; Schuster, Gerard T.

2015-01-01

We present a surface-wave inversion method that inverts for the S-wave velocity from the Rayleigh dispersion curve for the fundamental-mode. We call this wave equation inversion of skeletonized surface waves because the dispersion curve

Research Review: The Role of Diet in the Treatment of Attention-Deficit/Hyperactivity Disorder--An Appraisal of the Evidence on Efficacy and Recommendations on the Design of Future Studies

Science.gov (United States)

Stevenson, Jim; Buitelaar, Jan; Cortese, Samuele; Ferrin, Maite; Konofal, Eric; Lecendreux, Michel; Simonoff, Emily; Wong, Ian C. K.; Sonuga-Barke, Edmund

2014-01-01

Background: The efficacy of three dietary treatments for ADHD has been repeatedly tested in randomized controlled trials (RCTs). These interventions are restricted elimination diets (RED), artificial food colour elimination (AFCE) and supplementation with free fatty acids (SFFA). There have been three systematic reviews and associated…

Efficacy, acceptability, and safety of adjunctive aripiprazole in treatment-resistant depression: a meta-analysis of randomized controlled trials

Directory of Open Access Journals (Sweden)

Luan SX

2018-02-01

Full Text Available Shuxin Luan,1,2 Hongquan Wan,2 Lei Zhang,3 Hua Zhao1,4 1Department of Physiology, College of Basic Medical Sciences, Jilin University, Changchun, China; 2Department of Mental Health, The First Hospital of Jilin University, Changchun, China; 3Department of Radiology, The First Hospital of Jilin University, Changchun, China; 4Neuroscience Research Center, The First Hospital of Jilin University, Changchun, China Background: Treatment-resistant depression (TRD is common and potentially life-threatening in adults, and the benefits and risks of adjunctive aripiprazole in these patients remain controversial. Therefore, we conducted a meta-analysis of randomized controlled trials (RCTs to assess the efficacy, acceptability, safety, and quality of life of adjunctive aripiprazole in patients with TRD.Methods: RCTs published in PubMed, Web of Science, and Embase were systematically reviewed to evaluate the efficacy and safety profiles of TRD patients who were treated with adjunctive aripiprazole. The main outcome measures included response rate, remission rate, changes from baseline in Montgomery–Asberg Depression Rating Scale (MADRS, Clinical Global Impression-severity (CGI-S, Clinical Global Impression-improvement (CGI-I, 17-Item Hamilton Rating Scale for Depression (HAM-D17, Sheehan Disability scale (SDS, and Inventory of Depressive Symptomatology Self-Report Scale (IDS-SR, discontinuation due to adverse events, and adverse events. Risk ratio (RR or weight mean difference with 95% confidence intervals (CIs were pooled using a fixed-effects or random-effects model according to the heterogeneity among studies.Results: A total of 8 RCTs involving 2,260 patients were included in this meta-analysis. Adjunctive aripiprazole was associated with a significantly higher remission rate (RR =1.64, 95% CI: 1.42 to 1.89; P<0.001 and response rate (RR =1.45, 95% CI: 1.13 to 1.87; P=0.004 than other treatments. Moreover, adjunctive aripiprazole had greater changes in

Wave-particle dualism of spiral waves dynamics.

Science.gov (United States)

Biktasheva, I V; Biktashev, V N

2003-02-01

We demonstrate and explain a wave-particle dualism of such classical macroscopic phenomena as spiral waves in active media. That means although spiral waves appear as nonlocal processes involving the whole medium, they respond to small perturbations as effectively localized entities. The dualism appears as an emergent property of a nonlinear field and is mathematically expressed in terms of the spiral waves response functions, which are essentially nonzero only in the vicinity of the spiral wave core. Knowledge of the response functions allows quantitatively accurate prediction of the spiral wave drift due to small perturbations of any nature, which makes them as fundamental characteristics for spiral waves as mass is for the condensed matter.

Experience with extracorporeal shock wave therapy (ESWT) in the United States

Science.gov (United States)

Furia, John P.

2005-04-01

The purpose of this presentation is to summarize the literature and to report on single treatment, high-energy ESWT for the treatment of chronic plantar fasciitis and lateral epicondylitis. Fifty-three patients (60 heels) were treated with 3800 shock waves. Sixteen patients (19 heels) were active, 21 (22 heels), were moderately active, and 16 (19 heels) were sedentary. Twelve weeks post treatment, mean visual analog scores (VAS) for the entire group improved from 9.2 to 2.4 (plateral epicondylitis were treated with 3200 shock waves. There were 9 workers compensation and 27 non-workers compensation patients. Twelve weeks post treatment, the mean VAS for the entire group improved from 8.0 to 2.5 (plateral epicondylitis.

The value of antibiotic prophylaxis during extracorporeal shock wave lithotripsy in the prevention of urinary tract infections in patients with urine proven sterile prior to treatment

NARCIS (Netherlands)

Bierkens, A. F.; Hendrikx, A. J.; Ezz el Din, K. E.; de la Rosette, J. J.; Horrevorts, A.; Doesburg, W.; Debruyne, F. M.

1997-01-01

There are controversies in the literature regarding the need for and duration of antibiotic prophylaxis in patients treated with extracorporeal shock wave lithotripsy (ESWL) who have a negative urine culture before treatment. In order to determine the efficacy of antibiotic prophylaxis in ESWL

On the mechanisms of interaction of low-intensity millimeter waves with biological objects

Energy Technology Data Exchange (ETDEWEB)

Betskii, O.V.

1994-07-01

The interaction of low-intensity millimeter-band electromagnetic waves with biological objects is examined. These waves are widely used in medical practice as a means of physiotherapy for the treatment of various human disorders. Principal attention is given to the mechanisms through which millimeter waves act on the human organism.

Corticosteroids vs corticosteroids plus antiviral agents in the treatment of Bell palsy: a systematic review and meta-analysis.

Science.gov (United States)

Goudakos, John K; Markou, Konstantinos D

2009-06-01

To review systematically and meta-analyze the results of all randomized controlled trials (RCTs) for the treatment of patients with Bell palsy with corticosteroids vs corticosteroids plus antiviral agents. A MEDLINE, EMBASE, Cochrane Library, and CENTRAL database search, followed by extensive hand-searching for the identification of relevant studies. No time and language limitations were applied. Prospective RCTs on the treatment of patients with Bell palsy. Odds ratios (ORs), 95% confidence intervals (CIs), and tests for heterogeneity were reported. Five studies were eventually identified and systematically reviewed. Meta-analysis was performed for 4 studies. Regarding the complete recovery rate of facial nerve paralysis 3 months after initiation of therapy, the current systematic review and meta-analysis suggests that the addition of an antiviral agent does not provide any benefit (OR, 1.03 [95% CI, 0.74-1.42]; P = .88). The same conclusion emerged at posterior (fourth, sixth, and ninth) months of assessment. Subgroup analysis, conducted on the basis of time point of therapy initiation, type of antiviral agent, and blindness of assessments did not change the results obtained. The occurrence rate of adverse effects attributable to therapy choice was not significantly different between patients receiving corticosteroids and those following combined treatment. The present systematic review and meta-analysis, based on the currently available evidence, suggests that the addition of an antiviral agent to corticosteroids for the treatment of Bell palsy is not associated with an increase in the complete recovery rate of the facial motor function.

Gravitational waves from supernova matter

International Nuclear Information System (INIS)

Scheidegger, S; Whitehouse, S C; Kaeppeli, R; Liebendoerfer, M

2010-01-01

We have performed a set of 11 three-dimensional magnetohydrodynamical (MHD) core-collapse supernova simulations in order to investigate the dependences of the gravitational wave signal on the progenitor's initial conditions. We study the effects of the initial central angular velocity and different variants of neutrino transport. Our models are started up from a 15M o-dot progenitor and incorporate an effective general relativistic gravitational potential and a finite temperature nuclear equation of state. Furthermore, the electron flavour neutrino transport is tracked by efficient algorithms for the radiative transfer of massless fermions. We find that non- and slowly rotating models show gravitational wave emission due to prompt- and lepton driven convection that reveals details about the hydrodynamical state of the fluid inside the protoneutron stars. Furthermore we show that protoneutron stars can become dynamically unstable to rotational instabilities at T/|W| values as low as ∼2% at core bounce. We point out that the inclusion of deleptonization during the postbounce phase is very important for the quantitative gravitational wave (GW) prediction, as it enhances the absolute values of the gravitational wave trains up to a factor of ten with respect to a lepton-conserving treatment.

CMS-Wave

Science.gov (United States)

2015-10-30

Coastal Inlets Research Program CMS -Wave CMS -Wave is a two-dimensional spectral wind-wave generation and transformation model that employs a forward...marching, finite-difference method to solve the wave action conservation equation. Capabilities of CMS -Wave include wave shoaling, refraction... CMS -Wave can be used in either on a half- or full-plane mode, with primary waves propagating from the seaward boundary toward shore. It can

Ruxolitinib for the treatment of myelofibrosis: a NICE single technology appraisal.

Science.gov (United States)

Wade, Ros; Rose, Micah; Neilson, Aileen Rae; Stirk, Lisa; Rodriguez-Lopez, Rocio; Bowen, David; Craig, Dawn; Woolacott, Nerys

2013-10-01

The National Institute for Health and Care Excellence (NICE) invited the manufacturer of ruxolitinib (Novartis) to submit clinical and cost-effectiveness evidence for ruxolitinib within its licensed indication (the treatment of disease-related splenomegaly or symptoms in adult patients with myelofibrosis), according to the Institute's Single Technology Appraisal process. The Centre for Reviews and Dissemination and Centre for Health Economics at the University of York were commissioned to act as the independent Evidence Review Group (ERG). This article provides a description of the company submission, the ERG review and the resulting NICE guidance TA289 issued in June 2013. The ERG critically reviewed the evidence presented in the manufacturer's submission and identified areas requiring clarification, for which the manufacturer provided additional evidence. The main clinical effectiveness data were derived from two phase III, multicentre, randomised controlled trials (RCTs): Controlled myelofibrosis study with oral JAK inhibitor treatment (COMFORT)-II compared ruxolitinib with best available therapy (BAT), and COMFORT-I compared ruxolitinib with placebo. These RCTs demonstrated that ruxolitinib confers significant benefits in terms of spleen size reduction and improvement in symptom burden. In the COMFORT-II trial, a reduction in spleen volume of ≥35 % was achieved in 28 % of ruxolitinib-treated patients compared with 0 % of patients in the BAT group (p Service (NHS) resources for treating disease-related splenomegaly or symptoms in adults with myelofibrosis. Ruxolitinib is not recommended for the treatment of disease-related splenomegaly or symptoms in adult patients with primary myelofibrosis (also known as chronic idiopathic myelofibrosis), post-polycythaemia vera myelofibrosis and post-essential thrombocythaemia myelofibrosis in NICE TA289.

Tandem shock wave cavitation enhancement for extracorporeal lithotripsy

Science.gov (United States)

Loske, Achim M.; Prieto, Fernando E.; Fernández, Francisco; van Cauwelaert, Javier

2002-11-01

Extracorporeal shock wave lithotripsy (ESWL) has been successful for more than twenty years in treating patients with kidney stones. Hundreds of underwater shock waves are generated outside the patient's body and focused on the kidney stone. Stones fracture mainly due to spalling, cavitation and layer separation. Cavitation bubbles are produced in the vicinity of the stone by the tensile phase of each shock wave. Bubbles expand, stabilize and finally collapse violently, creating stone-damaging secondary shock waves and microjets. Bubble collapse can be intensified by sending a second shock wave a few hundred microseconds after the first. A novel method of generating two piezoelectrically generated shock waves with an adjustable time delay between 50 and 950 µs is described and tested. The objective is to enhance cavitation-induced damage to kidney stones during ESWL in order to reduce treatment time. In vitro kidney stone model fragmentation efficiency and pressure measurements were compared with those for a standard ESWL system. Results indicate that fragmentation efficiency was significantly enhanced at a shock wave delay of about 400 and 250 µs using rectangular and spherical stone phantoms, respectively. The system presented here could be installed in clinical devices at relatively low cost, without the need for a second shock wave generator.

Paraxial WKB solution of a scalar wave equation

International Nuclear Information System (INIS)

Pereverzev, G.V.

1993-04-01

An asymptotic method of solving a scalar wave equation in inhomogeneous media is developed. This method is an extension of the WKB method to the multidimensional case. It reduces a general wave equation to a set of ordinary differential equations similar to that of the eikonal approach and includes the latter as a particular case. However, the WKB method makes use of another kind of asymptotic expansion and, unlike the eikonal approach, describes the wave properties, i.e. diffraction and interference. At the same time, the three-dimensional WKB method is more simple for numerical treatment because the number of equations is less than in the eikonal approach. The method developed may be used for a calculation of wave fields in problems of RF heating, current drive and plasma diagnostics with microwave beams. (orig.)

Infragravity Waves Produced by Wave Groups on Beaches

Institute of Scientific and Technical Information of China (English)

邹志利; 常梅

2003-01-01

The generation of low frequency waves by a single or double wave groups incident upon two plane beaches with the slope of 1/40 and 1/100 is investigated experimentally and numerically. A new type of wave maker signal is used to generate the groups, allowing the bound long wave (set-down) to be included in the group. The experiments show that the low frequency wave is generated during breaking and propagation to the shoreline of the wave group. This process of generation and propagation of low frequency waves is simulated numerically by solving the short-wave averaged mass and momentum conservation equations. The computed and measured results are in good agreement. The mechanism of generation of low frequency waves in the surf zone is examined and discussed.

Wave propagation in non-linear media

NARCIS (Netherlands)

Broer, L.J.F.

1965-01-01

The problem of the propagation of electromagnetic waves through solids is essentially one of interaction between light quanta and matter. The most fundamental and general treatment of this subject is therefore undoubtedly based on the quantummechanical theory of this interaction. Nevertheless, a

Clinical effect of probiotics in treatment of liver cirrhosis: a Meta-analysis

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SUN Yuanpei

2018-01-01

Full Text Available Objective To investigate the clinical effect of probiotics in the treatment of liver cirrhosis through a systematic review. Methods PubMed, Embase, Cochrane Library, Chinese Scientific Journal Full-Text Database, VIP, and Wanfang Data were searched for randomized controlled trials (RCTs of probiotics for the treatment of liver cirrhosis. RevMan 5.3 software was used for the meta-analysis of the articles screened out. Rate difference (RD and its 95% confidence interval (95% CI were used as effect size indicators for binary variables; weighted mean difference (WMD was used for evaluating continuous variables with the same unit, and standardized mean difference (SMD and its 95% CI were used for evaluating continuous variables with different units. Funnel plots were used to analyze publication bias. Results A total of 15 RCTs which met the inclusion criteria were included, and there were 1411 patients with liver cirrhosis in total (726 in treatment group and 685 in control group. Compared with the control group, the treatment group had significant improvements in overall response rate (RD=0.28, 95%CI：0.22-0.34, P＜0.001 and biochemical parameters for liver function including alanine aminotransferase (SMD=-0.90, 95%CI：-1.14 to -0.66, P＜0.001, total bilirubin (WMD=-15.99, 95%CI：-26.42 to -5.57, P＜0.001, albumin (SMD=0.66, 95%CI：0.40-0.93, P＜0.001, endotoxin (SMD=-1.13, 95%CI：-2.11 to -0.15, P＜0001, and blood ammonia (WMD=-15.86, 95%CI：-21.54 to -10.18, P＜0.001. Conclusion Probiotics can significantly improve liver function in patients with liver cirrhosis, effectively inhibit the progression of liver cirrhosis, reduce the risk of complications including hepatic encephalopathy, and increase overall response rate and have good tolerability.

Predictability of the individual clinical outcome of extracorporeal shock wave therapy for cellulite

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Schlaudraff KU

2014-05-01

Full Text Available Kai-Uwe Schlaudraff,1 Maren C Kiessling,2 Nikolaus BM Császár,2 Christoph Schmitz21Concept Clinic, Geneva, Switzerland; 2Department of Anatomy II, Ludwig-Maximilians-University of Munich, Munich, GermanyBackground: Extracorporeal shock wave therapy has been successfully introduced for the treatment of cellulite in recent years. However, it is still unknown whether the individual clinical outcome of cellulite treatment with extracorporeal shock wave therapy can be predicted by the patient's individual cellulite grade at baseline, individual patient age, body mass index (BMI, weight, and/or height.Methods: Fourteen Caucasian females with cellulite were enrolled in a prospective, single-center, randomized, open-label Phase II study. The mean (± standard error of the mean cellulite grade at baseline was 2.5±0.09 and mean BMI was 22.8±1.17. All patients were treated with radial extracorporeal shock waves using the Swiss DolorClast® device (Electro Medical Systems, S.A., Nyon, Switzerland. Patients were treated unilaterally with 2 weekly treatments for 4 weeks on a randomly selected side (left or right, totaling eight treatments on the selected side. Treatment was performed at 3.5–4.0 bar, with 15,000 impulses per session applied at 15 Hz. Impulses were homogeneously distributed over the posterior thigh and buttock area (resulting in 7,500 impulses per area. Treatment success was evaluated after the last treatment and 4 weeks later by clinical examination, photographic documentation, contact thermography, and patient satisfaction questionnaires.Results: The mean cellulite grade improved from 2.5±0.09 at baseline to 1.57±0.18 after the last treatment (ie, mean δ-1 was 0.93 cellulite grades and 1.68±0.16 at follow-up (ie, mean δ-2 was 0.82 cellulite grades. Compared with baseline, no patient's condition worsened, the treatment was well tolerated, and no unwanted side effects were observed. No statistically significant (ie, P<0

Nonlinear hyperbolic waves in multidimensions

CERN Document Server

Prasad, Phoolan

2001-01-01

The propagation of curved, nonlinear wavefronts and shock fronts are very complex phenomena. Since the 1993 publication of his work Propagation of a Curved Shock and Nonlinear Ray Theory, author Phoolan Prasad and his research group have made significant advances in the underlying theory of these phenomena. This volume presents their results and provides a self-contained account and gradual development of mathematical methods for studying successive positions of these fronts.Nonlinear Hyperbolic Waves in Multidimensions includes all introductory material on nonlinear hyperbolic waves and the theory of shock waves. The author derives the ray theory for a nonlinear wavefront, discusses kink phenomena, and develops a new theory for plane and curved shock propagation. He also derives a full set of conservation laws for a front propagating in two space dimensions, and uses these laws to obtain successive positions of a front with kinks. The treatment includes examples of the theory applied to converging wavefronts...

The influence of anti-infective periodontal treatment on C-reactive protein: a systematic review and meta-analysis of randomized controlled trials.

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Ryan T Demmer

Full Text Available Periodontal infections are hypothesized to increase the risk of adverse systemic outcomes through inflammatory mechanisms. The magnitude of effect, if any, of anti-infective periodontal treatment on systemic inflammation is unknown, as are the patient populations most likely to benefit. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs to test the hypothesis that anti-infective periodontal treatment reduces systemic c-reactive protein (CRP.MEDLINE, EMBASE, CENTRAL and CINAHL databases were searched using sensitivity-enhancing search terms. Eligible RCTs enrolled patients with periodontal infection, compared a clearly defined anti-infective periodontal intervention (experimental group to an "inactive control" (no periodontal intervention or to an "active control" (lower treatment intensity than the experimental group. Mean differences in final CRP values at the earliest post-treatment time point (typically 1-3 months between experimental and control groups were analyzed using random-effects regression. Among 2,753 possible studies 20 were selected, which included 2,561 randomized patients(median=57. Baseline CRP values were >3.0 mg/L in 40% of trials. Among studies with a control group receiving no treatment, the mean difference in CRP final values among experimental treatment vs. control groups was -0.37 mg/L [95%CI=-0.64, -0.11], (P=0.005, favoring experimental treatment. Trials for which the experimental group received antibiotics had stronger effects (P for interaction=0.03 and the mean difference in CRP final values among experimental treatment vs. control was -0.75 mg/L [95%CI=-1.17,-0.33]. No treatment effect was observed among studies using an active treatment comparator. Treatment effects were stronger for studies that included patients with co-morbidities vs. studies that included "systemically healthy" patients, although the interaction was not significant (P=0.48.Anti-infective periodontal

Treatment of Kidney Stones Using Extracorporeal Shock Wave Lithotripsy (ESWL) and Double-J Stent in Infants.

Science.gov (United States)

Younesi Rostami, Mehdi; Taghipour-Gorgikolai, Mehrdad; Sharifian, Rayka

2012-01-01

Background. Extracorporeal shock wave lithotripsy (ESWL) has progressively acquired popularity as being the gold standard treatment for upper urinary tract lithiasis in infants since 1980. Our aim was to evaluate the outcome of ESWL for kidney stones and the use of double-J stent in infants. Material and Methods. A prospective clinical trial study performed on 50 infants with renal calculi at pelvic admitted in the Urology ward of Shafa Hospital, Sari, Iran, between 2001 and 2010. Main outcome measure of our study was clearing stones after one or more consecutive sessions of ESWL. Results. The study included 50 patients with renal calculi at pelvic. Among them, there were 35 (70%) boys and 15 (30%) girls with the age ranging from 1 to 13 months (mean of 7 month ± 3 days). All of them were treated by standard ESWL using Simons Lithostor plus machine. The stone sizes ranged from 6 mm to 22 mm. Double-J stents were placed in 11 infants (22%) with stones larger than 13 mm. Most of the patients required only one ESWL session. Conclusion. Since there were no complications following ESWL treatment, we can conclude that, in short term, ESWL is an effective and safe treatment modality for renal lithiasis in infants. In addition, we recommend double-J stent in infants with stones larger than 13 mm.

Pressure waves in bubble, two-component, two-phase flows. Theoretical approach

International Nuclear Information System (INIS)

Micaelli, J.C.

1982-05-01

Common methods of modelling pressure waves (global or acoustic) and their inadequacy are described. A model is proposed, based on a stochastic treatment of the gaseous phase. Different mechanisms which affect pressure wave propagation are analysed. The importance of interfacial momentum and heat transfer is confirmed [fr

The Efficacy and Safety of the Combination of Total Glucosides of Peony and Leflunomide for the Treatment of Rheumatoid Arthritis: A Systemic Review and Meta-Analysis.

Science.gov (United States)

Feng, Zhitao; Xu, Juan; He, Guochao; Cao, Meiqun; Duan, Lihong; Chen, Liguo; Wu, Zhengzhi

2016-01-01

Objective. To evaluate the efficacy and safety of the total glucosides of peony (TGP) and leflunomide (LEF) for the treatment of rheumatoid arthritis (RA). Methods. Randomized controlled trials (RCTs) on the efficacy and safety of the combination of TGP and LEF versus LEF alone for the treatment of RA were retrieved by searching PubMed, EMBASE, Cochrane Library, the China National Knowledge Infrastructure database, and Wanfang database. Results. Eight RCTs including 643 RA patients were included in the present meta-analysis. The quality of included studies was poor. The levels of ESR (P TGP and LEF were significantly lower than RA patients who received LEF therapy alone. The pooled results suggest that the combination of TGP and LEF caused less abnormal liver function than LEF alone (P = 0.02). No significant difference in the gastrointestinal discomfort was identified between the combination of TGP and LEF and LEF alone groups (P = 0.18). Conclusion. The combination of TGP and LEF in treatment of RA presented the characteristics of notably decreasing the levels of laboratory indexes and higher safety in terms of liver function. However, this conclusion should be further investigated based on a larger sample size.

[Decimeter-wave physiotherapy in viral hepatitis].

Science.gov (United States)

Kents, V V; Mavrodiĭ, V M

1995-01-01

Effectiveness was evaluated of magnetotherapy, inductothermy, UNF electric field and electromagnetic waves of decimetric wave band (460 MHz) on the projection of the liver, adrenals and thyroid gland in controlled trials enrolling a total of 835 patients with viral hepatitis (type A, B, associated forms). A conclusion is reached that optimum effectiveness of decimetric field on the projection of the adrenals and thyroid gland can be achieved through the application of minimum power and everyday alternation of exposures. It has been estimated that as many as 69 percent of the patients derive benefit from the above treatment.

Wave propagation in a non-isothermal atmosphere and the solar five-minute oscillations. [Acoustic waves

Energy Technology Data Exchange (ETDEWEB)

Chiuderi, C; Giovanardi, C [Florence Univ. (Italy). Istituto di Astronomia

1979-11-01

This paper presents a detailed discussion of the properties of linear, periodic acoustic waves that propagate vertically in a non-isothermal atmosphere. In order to retain the basic feature of the solar atmosphere we have chosen a temperature profile presenting a minimum. An analytical solution of the problem is possible if T/..mu.., ..mu.. being the mean molecular weight, varies parabolically with height. The purpose of this study is to point out the qualitative differences existing between the case treated here and the customary analysis based on a locally isothermal treatment. The computed velocity amplitude and the temperature-perturbation as functions of the wave period exhibit a sharp peak in the region between 180 and 300 s, thus showing the possibility of interpreting the five-minute oscillations as a resonant phenomenon. The propagating or stationary nature of the waves is investigated by a study of the phase of the proposed analytical solution.

Comparison of efficacy between choledochoscopic gallbladder-preserving cholelithotomy and laparoscopic cholecystectomy in treatment of gallstones: a meta-analysis

Directory of Open Access Journals (Sweden)

FAN Hua

2015-10-01

Full Text Available ObjectiveTo systematically evaluate the advantages and disadvantages of choledochoscopic gallbladder-preserving cholelithotomy (CGPC and laparoscopic cholecystectomy (LC in the treatment of gallstones. MethodsThe databases of CBM, CNKI, VIP, Wanfang Data, PubMed, EMBASE, the Cochrane Library, and Web of Science were searched for randomized controlled trials (RCTs related to CGPC and LC in the treatment of gallstones published up to June 2015. Data extraction and quality evaluation were performed for the literature included, and Review Manager 5.3 was used for the meta-analysis. ResultsFive RCTs involving 685 patients were included. The results of the meta-analysis showed that CGPC group and LC group had significant differences in operation time (OR=8.85, 95% CI: 049-17.21, P=0.04 and incidence of postoperative diarrhea (OR=0.24, 95% CI: 0.11-0.53, P=0.000 4. However, no significant differences were seen between the two groups in intraoperative bleeding volume (OR=-12.37, 95% CI: -29.73-4.99, P=0.16, time to postoperative intestinal function recovery (OR=-7.19, 95% CI: -24.28-9.90, P=0.41, hospitalization days (OR=-0.17, 95% CI: -1.98-1.63, P=0.85, and hospital costs (OR=-1.14, 95% CI: -2.57-0.28, P=0.12. ConclusionThe operation time and incidence of postoperative diarrhea in CGPC are superior to those in LC, while no significant differences are observed in intraoperative bleeding volume, time to postoperative intestinal function recovery, hospitalization days, and hospital costs. Due to a limited number of articles included and publication bias, RCTs with a large sample size and high quality are needed to provide more effective data.

Transcutaneous electrical nerve stimulation for the treatment of chronic low back pain: a systematic review.

Science.gov (United States)

Khadilkar, Amole; Milne, Sarah; Brosseau, Lucie; Wells, George; Tugwell, Peter; Robinson, Vivian; Shea, Beverley; Saginur, Michael

2005-12-01

Systematic review. To determine the effectiveness of transcutaneous electrical nerve stimulation (TENS) in the management of chronic LBP. Chronic low back pain (LBP) affects a significant proportion of the population. TENS was introduced more than 30 years ago as an adjunct to pharmacologic pain management. However, despite its widespread use, the usefulness of TENS in chronic LBP is still controversial. We searched MEDLINE, EMBASE, PEDro, and the Cochrane Central Register of Controlled Trials (Issue 2, 2005), up to April 1, 2005. Only randomized controlled clinical trials (RCTs) evaluating the effect of TENS on chronic LBP were included. Two reviewers independently selected trials and extracted data using predetermined forms. Heterogeneity was tested with Cochrane's Q test. A fixed effect model was used throughout for calculating continuous variables, except where heterogeneity existed, in which case a random effects model was used. Results are presented as weighted mean differences with 95% confidence intervals (95% CI), where the difference between the treated and control groups was weighted by the inverse of the variance. Standardized mean differences were calculated by dividing the difference between the treated and control by the baseline variance. Standardized mean differences were used when different scales were used to measure the same concept. Dichotomous outcomes were analyzed with odds ratios. Two RCTs (175 patients) were included. They differed with respect to study design, methodologic quality, inclusion and exclusion criteria, characteristics of TENS application, treatment schedule, cointerventions, and measured outcomes. In one RCT, TENS produced significantly greater pain relief than the placebo control. However, in the other RCT, no statistically significant differences between treatment and control groups were shown for multiple outcome measures. Preplanned subgroup analyses, intended to examine the impact of different stimulation parameters

Effect of different hormonal combinations on follicular wave emergence and superovulatory response in sheep.

Science.gov (United States)

Souza-Fabjan, Joanna Maria Gonçalves; da Rosa, Rômulo Mendonça; Balaro, Mário Felipe Alvarez; Pinto, Pedro Henrique Nicolau; Dos Santos, Gustavo Bervian; Arashiro, Eduardo Kenji Nunes; da Fonseca, Jeferson Ferreira; Ungerfeld, Rodolfo; Brandão, Felipe Zandonadi

2017-11-01

The aim of the present study was to compare hormonal treatments to induce and synchronize follicular wave emergence to improve the results of superovulatory (SOV) treatments in ewes. In Experiment 1 (n = 66), ewes were treated with a progesterone intravaginal implant plus a PGF 2α analogue (group G P4 ), or with the same treatment plus estradiol benzoate (G P4+EB ), a GnRH agonist (G P4+GnRH ), or both, estradiol benzoate and a GnRH agonist (G P4+EB+GnRH ) in a 2 × 2 factorial arrangement. Follicular wave emergence was determined by ultrasound. Follicular wave did not emerge during the studied period in 10 females (one from G P4 , six from G P4+EB and three from G P4+EB+GnRH ). Follicular emergence was less synchronized (P = 0.007) when estradiol was administered (G P4+EB : 103.6 ± 22.0 h), without any interaction with GnRH treatment (G P4+EB+GnRH : 80.1 ± 21.4 h, G P4+GnRH : 52.5 ± 8.7 h, G P4 : 56.6 ± 10.4 h). Estradiol administration delayed the moment of follicular emergence (P = 0.007) and the follicular wave emergence moment in which follicular dominance was achieved (P = 0.009), without interactions between estradiol and GnRH in the moment of follicular wave emergence or dominance. In Experiment 2 (n = 22), two SOV protocols were compared: the best treatment of Experiment 1 (G P4 ) was used to synchronize follicular wave emergence, initiating the SOV treatment 2.5 days later; in the control treatment, SOV treatment started 80 h after a short-term protocol to synchronize ovulation (G control ). The number of corpora lutea (CL) and the evaluation of the collected embryos were performed six days after estrus. Blood samples were collected daily for plasma progesterone determination. Although the number of CL was similar in G control (7.1 ± 1.0) and G P4 (6.9 ± 5.1), the number of structures and viable embryos recovered were greater in G control (P synchronization of follicular wave emergence. When EB was used (alone or

Dermatologisk laser- og lysbehandling af ar

DEFF Research Database (Denmark)

Karmisholt, Katrine; Borch, Jakob E; Omland, Silje Haukali

2016-01-01

the highest available level of evidence from randomized controlled trials (RCTs) and introduces a guideline for laser treatment of scars. Twelve RCTs documented effect on acne, burn and surgical scars. It is recommended that laser- and light-based treatments are considered according to the scar type....

Does blood pressure lowering treatment prevents dementia or cognitive decline in patients with cardiovascular and cerebrovascular disease?

Science.gov (United States)

Feigin, Valery; Ratnasabapathy, Yogini; Anderson, Craig

2005-03-15

There is increasing evidence that both hypertension and stroke play important roles in the development of cognitive decline and dementia. Despite five high-quality randomised controlled trials (RCTs) in this area to date, there remains uncertainty about the role of blood pressure lowering therapy in the prevention of cognitive decline and dementia. It appears that lack of definitive results from these trials can be explained on the basis of (a) insufficient power to detect modest treatment effects; (b) measurement error in the diagnosis of dementia; (c) variations in the treatment effects between different types of antihypertensive agents; and (d) bias due to missing data, variation in baseline factors such as levels of blood pressure, and the inclusion of patients with cognitive impairment at entry. Preliminary meta-analysis of RCTs supports the hypothesis that blood pressure lowering may prevent dementia in high-risk patients, that is those with vascular disease. However, a meta-analysis of individual patient data (IPD) from these, and other relevant trials in patients with vascular disease, would provide much more reliable data. If the hypothesis were confirmed, it would certainly be of considerable importance not only in terms of our understanding of the aetiology of dementia, but also in promoting blood pressure lowering strategies for broader public health good.

BOOK REVIEW: Kinetic theory of plasma waves, homogeneous plasmas

Science.gov (United States)

Porkolab, Miklos

1998-11-01

The linear theory of plasma waves in homogeneous plasma is arguably the most mature and best understood branch of plasma physics. Given the recently revised version of Stix's excellent Waves in Plasmas (1992), one might ask whether another book on this subject is necessary only a few years later. The answer lies in the scope of this volume; it is somewhat more detailed in certain topics than, and complementary in many fusion research relevant areas to, Stix's book. (I am restricting these comments to the homogeneous plasma theory only, since the author promises a second volume on wave propagation in inhomogeneous plasmas.) This book is also much more of a theorist's approach to waves in plasmas, with the aim of developing the subject within the logical framework of kinetic theory. This may indeed be pleasing to the expert and to the specialist, but may be too difficult to the graduate student as an `introduction' to the subject (which the author explicitly states in the Preface). On the other hand, it may be entirely appropriate for a second course on plasma waves, after the student has mastered fluid theory and an introductory kinetic treatment of waves in a hot magnetized `Vlasov' plasma. For teaching purposes, my personal preference is to review the cold plasma wave treatment using the unified Stix formalism and notation (which the author wisely adopts in the present book, but only in Chapter 5). Such an approach allows one to deal with CMA diagrams early on, as well as to provide a framework to discuss electromagnetic wave propagation and accessibility in inhomogeneous plasmas (for which the cold plasma wave treatment is perfectly adequate). Such an approach does lack some of the rigour, however, that the author achieves with the present approach. As the author correctly shows, the fluid theory treatment of waves follows logically from kinetic theory in the cold plasma limit. I only question the pedagogical value of this approach. Otherwise, I welcome this

Long-term efficacy and safety of sodium-glucose cotransporter-2 inhibitors as add-on to metformin treatment in the management of type 2 diabetes mellitus

Science.gov (United States)

Li, Jian; Gong, Yanping; Li, Chunlin; Lu, Yanhui; Liu, Yu; Shao, Yinghong

2017-01-01

Abstract Background: Drug intensification is often required for patients with type 2 diabetes mellitus on stable metformin therapy. Among the potential candidates for a combination therapy, sodium-glucose transporter-2 (SGLT2) inhibitors have shown promising outcomes. This meta-analysis was performed to compare the efficacy and safety of SGLT2 inhibitors with non-SGLT2 combinations as add-on treatment to metformin. Methods: Literature search was carried out in multiple electronic databases for the acquisition of relevant randomized controlled trials (RCTs) by following a priori eligibility criteria. After the assessment of quality of the included RCTs, meta-analyses of mean differences or odds ratios (OR) were performed to achieve overall effect sizes of the changes from baseline in selected efficacy and safety endpoints reported in the individual studies. Between-studies heterogeneity was estimated with between-studies statistical heterogeneity (I2) index. Results: Six RCTs fulfilled the eligibility criteria. SGLT2 inhibitors as add-on to metformin treatment reduced % HbA1c significantly more than non-SGLT2 combinations after 52 weeks (P = .002) as well as after 104 weeks (P SGLT2 inhibitors also reduced fasting plasma glucose levels, body weight, systolic, and diastolic blood pressures after 52 weeks and 104 weeks significantly (P SGLT2 combinations. Incidence of hypoglycemia was significantly lower (P = .02) but incidence of suspected or confirmed genital tract infections was significantly higher (P SGLT2 inhibitors treated in comparison with non-SGLT2 combinations. Conclusion: As add-on to metformin treatment, SGLT2 inhibitors are found significantly more efficacious than non-SGLT2 inhibitor combinations in the management of type 2 diabetes mellitus, although, SGLT2 inhibitor therapy is associated with significantly higher incidence of suspected or confirmed genital tract infections. PMID:28682870

Intervention randomized controlled trials involving wrist and shoulder arthroscopy: a systematic review

Science.gov (United States)

2014-01-01

Background Although arthroscopy of upper extremity joints was initially a diagnostic tool, it is increasingly used for therapeutic interventions. Randomized controlled trials (RCTs) are considered the gold standard for assessing treatment efficacy. We aimed to review the literature for intervention RCTs involving wrist and shoulder arthroscopy. Methods We performed a systematic review for RCTs in which at least one arm was an intervention performed through wrist arthroscopy or shoulder arthroscopy. PubMed and Cochrane Library databases were searched up to December 2012. Two researchers reviewed each article and recorded the condition treated, randomization method, number of randomized participants, time of randomization, outcomes measures, blinding, and description of dropouts and withdrawals. We used the modified Jadad scale that considers the randomization method, blinding, and dropouts/withdrawals; score 0 (lowest quality) to 5 (highest quality). The scores for the wrist and shoulder RCTs were compared with the Mann–Whitney test. Results The first references to both wrist and shoulder arthroscopy appeared in the late 1970s. The search found 4 wrist arthroscopy intervention RCTs (Kienböck’s disease, dorsal wrist ganglia, volar wrist ganglia, and distal radius fracture; first 3 compared arthroscopic with open surgery). The median number of participants was 45. The search found 50 shoulder arthroscopy intervention RCTs (rotator cuff tears 22, instability 14, impingement 9, and other conditions 5). Of these, 31 compared different arthroscopic treatments, 12 compared arthroscopic with open treatment, and 7 compared arthroscopic with nonoperative treatment. The median number of participants was 60. The median modified Jadad score for the wrist RCTs was 0.5 (range 0–1) and for the shoulder RCTs 3.0 (range 0–5) (p = 0.012). Conclusion Despite the increasing use of wrist arthroscopy in the treatment of various wrist disorders the efficacy of arthroscopically

Wave Dragon Wave Energy Converters Used as Coastal Protection

DEFF Research Database (Denmark)

Nørgaard, Jørgen Harck; Andersen, Thomas Lykke; Kofoed, Jens Peter

2011-01-01

This paper deals with wave energy converters used to reduce the wave height along shorelines. For this study the Wave Dragon wave energy converter is chosen. The wave height reduction from a single device has been evaluated from physical model tests in scale 1:51.8 of the 260 x 150 m, 24 kW/m model...... Spain, to evaluate the potential for reducing wave heights close the shore by means of Wave Dragons....

Is sustained virological response a marker of treatment efficacy in patients with chronic hepatitis C viral infection with no response or relapse to previous antiviral intervention?

DEFF Research Database (Denmark)

Gurusamy, Kurinchi S; Wilson, Edward; Koretz, Ronald L

2013-01-01

Randomised clinical trials (RCTs) of antiviral interventions in patients with chronic hepatitis C virus (HCV) infection use sustained virological response (SVR) as the main outcome. There is sparse information on long-term mortality from RCTs.......Randomised clinical trials (RCTs) of antiviral interventions in patients with chronic hepatitis C virus (HCV) infection use sustained virological response (SVR) as the main outcome. There is sparse information on long-term mortality from RCTs....

Electromagnetic waves in gravitational wave spacetimes

International Nuclear Information System (INIS)

Haney, M.; Bini, D.; Ortolan, A.; Fortini, P.

2013-01-01

We have considered the propagation of electromagnetic waves in a space-time representing an exact gravitational plane wave and calculated the induced changes on the four-potential field Aμ of a plane electromagnetic wave. By choosing a suitable photon round-trip in a Michelson interferometer, we have been able to identify the physical effects of the exact gravitational wave on the electromagnetic field, i.e. phase shift, change of the polarization vector, angular deflection and delay. These results have been exploited to study the response of an interferometric gravitational wave detector beyond the linear approximation of the general theory of relativity. A much more detailed examination of this problem can be found in our paper recently published in Classical and Quantum Gravity (28 (2011) 235007).

Reporting bias inflates the reputation of medical treatments: A comparison of outcomes in clinical trials and online product reviews.

Science.gov (United States)

de Barra, Mícheál

2017-03-01

People often hold unduly positive expectations about the outcomes of medicines and other healthcare products. Here the following explanation is tested: people who have a positive outcome tend to tell more people about their disease/treatment than people with poor or average outcomes. Akin to the file drawer problem in science, this systematically and positively distorts the information available to others. If people with good treatment outcomes are more inclined to tell others, then they should also be more inclined to write online medical product reviews. Therefore, average treatment outcomes in these reviews should be more positive than those found in randomised controlled trials (RCTs). Data on duration of treatment and outcome (i.e., weight/cholesterol change) were extracted from user-generated health product reviews on Amazon.com and compared to RCT data for the same treatments using ANOVA. The sample included 1675 reviews of cholesterol reduction (Benecol, CholestOff) and weight loss (Orlistat) treatments and the primary outcome was cholesterol change (Bencol and CholestOff) or weight change (Orlistat). In three independent tests, average outcomes reported in the reviews were substantially more positive than the outcomes reported in the medical literature (η 2  = 0.01 to 0.06; p = 0.04 to 0.001). For example, average cholesterol change following use of Benecol is -14 mg/dl in RCTs and -45 mg/dl in online reviews. People with good treatment outcomes are more inclined to share information about their treatment, which distorts the information available to others. People who rely on word of mouth reputation, electronic or real life, are likely to develop unduly positive expectations. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Stopping randomized trials early for benefit: a protocol of the Study Of Trial Policy Of Interim Truncation-2 (STOPIT-2)

Science.gov (United States)

Briel, Matthias; Lane, Melanie; Montori, Victor M; Bassler, Dirk; Glasziou, Paul; Malaga, German; Akl, Elie A; Ferreira-Gonzalez, Ignacio; Alonso-Coello, Pablo; Urrutia, Gerard; Kunz, Regina; Culebro, Carolina Ruiz; da Silva, Suzana Alves; Flynn, David N; Elamin, Mohamed B; Strahm, Brigitte; Murad, M Hassan; Djulbegovic, Benjamin; Adhikari, Neill KJ; Mills, Edward J; Gwadry-Sridhar, Femida; Kirpalani, Haresh; Soares, Heloisa P; Elnour, Nisrin O Abu; You, John J; Karanicolas, Paul J; Bucher, Heiner C; Lampropulos, Julianna F; Nordmann, Alain J; Burns, Karen EA; Mulla, Sohail M; Raatz, Heike; Sood, Amit; Kaur, Jagdeep; Bankhead, Clare R; Mullan, Rebecca J; Nerenberg, Kara A; Vandvik, Per Olav; Coto-Yglesias, Fernando; Schünemann, Holger; Tuche, Fabio; Chrispim, Pedro Paulo M; Cook, Deborah J; Lutz, Kristina; Ribic, Christine M; Vale, Noah; Erwin, Patricia J; Perera, Rafael; Zhou, Qi; Heels-Ansdell, Diane; Ramsay, Tim; Walter, Stephen D; Guyatt, Gordon H

2009-01-01

Background Randomized clinical trials (RCTs) stopped early for benefit often receive great attention and affect clinical practice, but pose interpretational challenges for clinicians, researchers, and policy makers. Because the decision to stop the trial may arise from catching the treatment effect at a random high, truncated RCTs (tRCTs) may overestimate the true treatment effect. The Study Of Trial Policy Of Interim Truncation (STOPIT-1), which systematically reviewed the epidemiology and reporting quality of tRCTs, found that such trials are becoming more common, but that reporting of stopping rules and decisions were often deficient. Most importantly, treatment effects were often implausibly large and inversely related to the number of the events accrued. The aim of STOPIT-2 is to determine the magnitude and determinants of possible bias introduced by stopping RCTs early for benefit. Methods/Design We will use sensitive strategies to search for systematic reviews addressing the same clinical question as each of the tRCTs identified in STOPIT-1 and in a subsequent literature search. We will check all RCTs included in each systematic review to determine their similarity to the index tRCT in terms of participants, interventions, and outcome definition, and conduct new meta-analyses addressing the outcome that led to early termination of the tRCT. For each pair of tRCT and systematic review of corresponding non-tRCTs we will estimate the ratio of relative risks, and hence estimate the degree of bias. We will use hierarchical multivariable regression to determine the factors associated with the magnitude of this ratio. Factors explored will include the presence and quality of a stopping rule, the methodological quality of the trials, and the number of total events that had occurred at the time of truncation. Finally, we will evaluate whether Bayesian methods using conservative informative priors to "regress to the mean" overoptimistic tRCTs can correct observed

Stopping randomized trials early for benefit: a protocol of the Study Of Trial Policy Of Interim Truncation-2 (STOPIT-2

Directory of Open Access Journals (Sweden)

Mullan Rebecca J

2009-07-01

Full Text Available Abstract Background Randomized clinical trials (RCTs stopped early for benefit often receive great attention and affect clinical practice, but pose interpretational challenges for clinicians, researchers, and policy makers. Because the decision to stop the trial may arise from catching the treatment effect at a random high, truncated RCTs (tRCTs may overestimate the true treatment effect. The Study Of Trial Policy Of Interim Truncation (STOPIT-1, which systematically reviewed the epidemiology and reporting quality of tRCTs, found that such trials are becoming more common, but that reporting of stopping rules and decisions were often deficient. Most importantly, treatment effects were often implausibly large and inversely related to the number of the events accrued. The aim of STOPIT-2 is to determine the magnitude and determinants of possible bias introduced by stopping RCTs early for benefit. Methods/Design We will use sensitive strategies to search for systematic reviews addressing the same clinical question as each of the tRCTs identified in STOPIT-1 and in a subsequent literature search. We will check all RCTs included in each systematic review to determine their similarity to the index tRCT in terms of participants, interventions, and outcome definition, and conduct new meta-analyses addressing the outcome that led to early termination of the tRCT. For each pair of tRCT and systematic review of corresponding non-tRCTs we will estimate the ratio of relative risks, and hence estimate the degree of bias. We will use hierarchical multivariable regression to determine the factors associated with the magnitude of this ratio. Factors explored will include the presence and quality of a stopping rule, the methodological quality of the trials, and the number of total events that had occurred at the time of truncation. Finally, we will evaluate whether Bayesian methods using conservative informative priors to "regress to the mean" overoptimistic tRCTs

Benefits of up-wave measurements in linear short-term wave forecasting for wave energy applications

OpenAIRE

Paparella, Francesco; Monk, Kieran; Winands, Victor; Lopes, Miguel; Conley, Daniel; Ringwood, John

2014-01-01

The real-time control of wave energy converters requires the prediction of the wave elevation at the location of the device in order to maximize the power extracted from the waves. One possibility is to predict the future wave elevation by combining its past history with the spatial information coming from a sensor which measures the free surface elevation upwave of the wave energy converter. As an application example, the paper focuses on the prediction of the wave eleva...

Shock wave attenuation in a micro-channel

Science.gov (United States)

Giordano, J.; Perrier, P.; Meister, L.; Brouillette, M.

2018-05-01

This work presents optical measurements of shock wave attenuation in a glass micro-channel. This transparent facility, with a cross section ranging from 1 mm× 150 μm to 1 mm× 500 μm, allowed for the use of high-speed schlieren videography to visualize the propagation of a shock wave within the entire micro-channel and to quantify velocity attenuation of the wave due to wall effects. In this paper, we present the experimental technique and the relevant data treatment we have used to increase the sensitivity of shock wave detection. Then, we compared our experimental results for different channel widths, lengths, and shock wave velocities with the analytical model for shock attenuation proposed by Russell (J Fluid Mech 27(2):305-314, 1967), which assumes laminar flow, and by Mirels (Attenuation in a shock tube due to unsteady-boundary-layer action, NACA Report 1333, 1957) for turbulent flow. We found that these models are inadequate to predict the observed data, owing to the presence of fully developed flow which violates the basic assumption of these models. The data are also compared with the empirical shock attenuation models proposed by Zeitoun (Phys Fluids 27(1):011701, 2015) and Deshpande and Puranik (Shock Waves 26(4):465-475, 2016), where better agreement is observed. Finally, we presented experimental data for the flow field behind the shock wave from measurements of the Mach wave angle which shows globally decreasing flow Mach numbers due to viscous wall effects.

Relevance of randomised controlled trials in oncology.

Science.gov (United States)

Tannock, Ian F; Amir, Eitan; Booth, Christopher M; Niraula, Saroj; Ocana, Alberto; Seruga, Bostjan; Templeton, Arnoud J; Vera-Badillo, Francisco

2016-12-01

Well-designed randomised controlled trials (RCTs) can prevent bias in the comparison of treatments and provide a sound basis for changes in clinical practice. However, the design and reporting of many RCTs can render their results of little relevance to clinical practice. In this Personal View, we discuss the limitations of RCT data and suggest some ways to improve the clinical relevance of RCTs in the everyday management of patients with cancer. RCTs should ask questions of clinical rather than commercial interest, avoid non-validated surrogate endpoints in registration trials, and have entry criteria that allow inclusion of all patients who are fit to receive treatment. Furthermore, RCTs should be reported with complete accounting of frequency and management of toxicities, and with strict guidelines to ensure freedom from bias. Premature reporting of results should be avoided. The bar for clinical benefit should be raised for drug registration, which should require publication and review of mature data from RCTs, post-marketing health outcome studies, and value-based pricing. Copyright © 2016 Elsevier Ltd. All rights reserved.

Efficacy and safety of oxcarbazepine in the treatment of children with epilepsy: a meta-analysis of randomized controlled trials

Directory of Open Access Journals (Sweden)

Geng H

2017-03-01

Full Text Available Hua Geng, Chengzhong Wang Department of Pediatrics, Maternal and Child Health Hospital of Yancheng, Yancheng City, People’s Republic of China Background: To assess the efficacy and safety of oxcarbazepine (OXC in the treatment of children with epilepsy.Methods: Randomized controlled trials (RCTs published in PubMed, Embase, Web of Science, Cochrane Library, Scopus, SinoMed (Chinese BioMedical Literature Service System, China, and Chinese National Knowledge Infrastructure (China database were systematically reviewed. Eligible studies were those that compared the efficacy and safety of OXC with other antiepileptic drugs in epilepsy. Risk ratio (RR with 95% confidence intervals (95% CIs was calculated using fixed-effects or random-effects model.Results: Eleven RCTs with a total of 1,241 patients met the inclusion criteria and were included in this meta-analysis. Compared with other antiepileptic drugs (sodium valproate, levetiracetam, phenytoin, and placebo, OXC was associated with similar seizure-free rate (RR =1.06, 95% CI: 0.94, 1.20; P=0.366 and percentage reduction from baseline in seizure frequency (for ≥75% reduction: RR =1.15, 95% CI: 0.88, 1.49; P=0.310; for 50%–75% reduction: RR =1.12, 95% CI: 0.90, 1.39; P=0.301; for <50% reduction: RR =0.79, 95% CI: 0.56, 1.12; P=0.179. Moreover, patients treated with OXC had a comparable incidence of adverse events compared with those treated with other antiepileptic drugs (RR =1.01, 95% CI: 0.92, 1.11; P=0.760.Conclusion: OXC showed similar effects and safety as other antiepileptic drugs in the treatment of children with epilepsy. Further well-conducted, large-scale RCTs are needed to validate these findings. Keywords: epilepsy, children, oxcarbazepine, meta-analysis

'Oscillator-wave' model: properties and heuristic instances

International Nuclear Information System (INIS)

Damgov, Vladimir; Trenchev, Plamen; Sheiretsky, Kostadin

2003-01-01

The article considers a generalized model of an oscillator, subjected to the influence of an external wave. It is shown that the systems of diverse physical background, which this model encompasses by their nature, should belong to the broader, proposed in previous works class of 'kick-excited self-adaptive dynamical systems'. The theoretical treatment includes an analytic approach to the conditions for emergence of small and large amplitudes, i.e. weak and strong non-linearity of the system. Derived also are generalized conditions for the transition of systems of this 'oscillator-wave' type to non-regular and chaotic behaviour. For the purpose of demonstrating the heuristic properties of the generalized oscillator-wave model from this point of view are considered the relevant systems and phenomena of the quantized cyclotron resonance and the megaquantum resonance-wave model of the Solar System. We point to a number of other natural and scientific phenomena, which can be effectively analyzed from the point of view of the developed approach. In particular we stress on the possibility for development and the wide applicability of specific wave influences, for example for the improvement and the speeding up of technological processes

Wave-equation Qs Inversion of Skeletonized Surface Waves

KAUST Repository

Li, Jing

2017-02-08

We present a skeletonized inversion method that inverts surface-wave data for the Qs quality factor. Similar to the inversion of dispersion curves for the S-wave velocity model, the complicated surface-wave arrivals are skeletonized as simpler data, namely the amplitude spectra of the windowed Rayleigh-wave arrivals. The optimal Qs model is the one that minimizes the difference in the peak frequencies of the predicted and observed Rayleigh wave arrivals using a gradient-based wave-equation optimization method. Solutions to the viscoelastic wave-equation are used to compute the predicted Rayleigh-wave arrivals and the misfit gradient at every iteration. This procedure, denoted as wave-equation Qs inversion (WQs), does not require the assumption of a layered model and tends to have fast and robust convergence compared to full waveform inversion (FWI). Numerical examples with synthetic and field data demonstrate that the WQs method can accurately invert for a smoothed approximation to the subsurface Qs distribution as long as the Vs model is known with sufficient accuracy.

Skeletonized wave-equation Qs tomography using surface waves

KAUST Repository

Li, Jing

2017-08-17

We present a skeletonized inversion method that inverts surface-wave data for the Qs quality factor. Similar to the inversion of dispersion curves for the S-wave velocity model, the complicated surface-wave arrivals are skeletonized as simpler data, namely the amplitude spectra of the windowed Rayleigh-wave arrivals. The optimal Qs model is then found that minimizes the difference in the peak frequencies of the predicted and observed Rayleigh wave arrivals using a gradient-based wave-equation optimization method. Solutions to the viscoelastic wave-equation are used to compute the predicted Rayleigh-wave arrivals and the misfit gradient at every iteration. This procedure, denoted as wave-equation Qs tomography (WQs), does not require the assumption of a layered model and tends to have fast and robust convergence compared to Q full waveform inversion (Q-FWI). Numerical examples with synthetic and field data demonstrate that the WQs method can accurately invert for a smoothed approximation to the subsur-face Qs distribution as long as the Vs model is known with sufficient accuracy.

Wave-equation Qs Inversion of Skeletonized Surface Waves

KAUST Repository

Li, Jing; Dutta, Gaurav; Schuster, Gerard T.

2017-01-01

We present a skeletonized inversion method that inverts surface-wave data for the Qs quality factor. Similar to the inversion of dispersion curves for the S-wave velocity model, the complicated surface-wave arrivals are skeletonized as simpler data, namely the amplitude spectra of the windowed Rayleigh-wave arrivals. The optimal Qs model is the one that minimizes the difference in the peak frequencies of the predicted and observed Rayleigh wave arrivals using a gradient-based wave-equation optimization method. Solutions to the viscoelastic wave-equation are used to compute the predicted Rayleigh-wave arrivals and the misfit gradient at every iteration. This procedure, denoted as wave-equation Qs inversion (WQs), does not require the assumption of a layered model and tends to have fast and robust convergence compared to full waveform inversion (FWI). Numerical examples with synthetic and field data demonstrate that the WQs method can accurately invert for a smoothed approximation to the subsurface Qs distribution as long as the Vs model is known with sufficient accuracy.

Elementary wave optics

CERN Document Server

Webb, Robert H

2005-01-01

This undergraduate textbook presents thorough coverage of the standard topics of classical optics and optical instrument design; it also offers significant details regarding the concepts of modern optics. Its survey of the mathematical tools of optics grants students insights into the physical principles of quantum mechanics.Two principal concepts occur throughout: a treatment of scattering from real scatterers (leading to Huygens' principles, diffraction theory, the index of refraction, and related topics); and the difference between coherent and noncoherent wave phenomena. Examinations of su

Nonlinear wave equation with intrinsic wave particle dualism

International Nuclear Information System (INIS)

Klein, J.J.

1976-01-01

A nonlinear wave equation derived from the sine-Gordon equation is shown to possess a variety of solutions, the most interesting of which is a solution that describes a wave packet travelling with velocity usub(e) modulating a carrier wave travelling with velocity usub(c). The envelop and carrier wave speeds agree precisely with the group and phase velocities found by de Broglie for matter waves. No spreading is exhibited by the soliton, so that it behaves exactly like a particle in classical mechanics. Moreover, the classically computed energy E of the disturbance turns out to be exactly equal to the frequency ω of the carrier wave, so that the Planck relation is automatically satisfied without postulating a particle-wave dualism. (author)

Homeopathy in the Age of Antimicrobial Resistance: Is It a Viable Treatment for Upper Respiratory Tract Infections?

Science.gov (United States)

Fixsen, Alison

2018-05-01

 Acute upper respiratory tract infections (URTIs) and their complications are the most frequent cause of antibiotic prescribing in primary care. With multi-resistant organisms proliferating, appropriate alternative treatments to these conditions are urgently required. Homeopathy presents one solution; however, there are many methods of homeopathic prescribing. This review of the literature considers firstly whether homeopathy offers a viable alternative therapeutic solution for acute URTIs and their complications, and secondly how such homeopathic intervention might take place.  Critical review of post 1994 clinical studies featuring homeopathic treatment of acute URTIs and their complications. Study design, treatment intervention, cohort group, measurement and outcome were considered. Discussion focused on the extent to which homeopathy is used to treat URTIs, rate of improvement and tolerability of the treatment, complications of URTIs, prophylactic and long-term effects, and the use of combination versus single homeopathic remedies.  Multiple peer-reviewed studies were found in which homeopathy had been used to treat URTIs and associated symptoms (cough, pharyngitis, tonsillitis, otitis media, acute sinusitis, etc.). Nine randomised controlled trials (RCTs) and 8 observational/cohort studies were analysed, 7 of which were paediatric studies. Seven RCTs used combination remedies with multiple constituents. Results for homeopathy treatment were positive overall, with faster resolution, reduced use of antibiotics and possible prophylactic and longer-term benefits.  Variations in size, location, cohort and outcome measures make comparisons and generalisations concerning homeopathic clinical trials for URTIs problematic. Nevertheless, study findings suggest at least equivalence between homeopathy and conventional treatment for uncomplicated URTI cases, with fewer adverse events and potentially broader therapeutic outcomes. The use of non

Millimeter wave and terahertz wave transmission characteristics in plasma

International Nuclear Information System (INIS)

Ma Ping; Qin Long; Chen Weijun; Zhao Qing; Shi Anhua; Huang Jie

2013-01-01

An experiment was conducted on the shock tube to explore the transmission characteristics of millimeter wave and terahertz wave in high density plasmas, in order to meet the communication requirement of hypersonic vehicles during blackout. The transmission attenuation curves of millimeter wave and terahertz wave in different electron density and collision frequency were obtained. The experiment was also simulated by auxiliary differential equation finite-difference time-domain (ADE-FDTD) methods. The experimental and numerical results show that the transmission attenuation of terahertz wave in the plasma is smaller than that of millimeter wave under the same conditions. The transmission attenuation of terahertz wave in the plasma is enhanced with the increase of electron density. The terahertz wave is a promising alternative to the electromagnetic wave propagation in high density plasmas. (authors)

Homeopathy for treatment of irritable bowel syndrome.

Science.gov (United States)

Peckham, Emily J; Nelson, E Andrea; Greenhalgh, Joanne; Cooper, Katy; Roberts, E Rachel; Agrawal, Anurag

2013-11-13

Irritable bowel syndrome (IBS) is a common, chronic disorder that leads to decreased health-related quality of life and work productivity. Evidence-based treatment guidelines have not been able to give guidance on the effects of homeopathic treatment for IBS because no systematic reviews have been carried out to assess the effectiveness of homeopathic treatment for IBS. Two types of homeopathic treatment were evaluated in this systematic review. In clinical homeopathy a specific remedy is prescribed for a specific condition. This differs from individualised homeopathic treatment, where a homeopathic remedy based on a person's individual symptoms is prescribed after a detailed consultation. To assess the effectiveness and safety of homeopathic treatment for treating IBS. We searched MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Allied and Complementary Medicine Database (AMED), Cochrane IBD/FBD Group Specialised Register, Cochrane Complementary Medicine Field Specialised Register and the database of the Homeopathic Library (Hom-inform) from inception to February 2013. Randomised controlled trials (RCTs), cohort and case-control studies that compared homeopathic treatment with placebo, other control treatments, or usual care, in adults with IBS were considered for inclusion. Two authors independently assessed the risk of bias and extracted data. The primary outcome was global improvement in IBS. The overall quality of the evidence supporting this outcome was assessed using the GRADE criteria. We calculated the mean difference (MD) and 95% confidence interval (CI) for continuous outcomes and the risk ratio (RR) and 95% CI for dichotomous outcomes. Three RCTs (213 participants) were included. No cohort or case-control studies were identified. Two studies published in 1976 and 1979 compared clinical homeopathy (homeopathic remedy) to placebo for constipation-predominant IBS

Effects of music therapy and music-based interventions in the treatment of substance use disorders: A systematic review

Science.gov (United States)

Hohmann, Louisa; Bradt, Joke; Stegemann, Thomas; Koelsch, Stefan

2017-01-01

Music therapy (MT) and music-based interventions (MBIs) are increasingly used for the treatment of substance use disorders (SUD). Previous reviews on the efficacy of MT emphasized the dearth of research evidence for this topic, although various positive effects were identified. Therefore, we conducted a systematic search on published articles examining effects of music, MT and MBIs and found 34 quantitative and six qualitative studies. There was a clear increase in the number of randomized controlled trials (RCTs) during the past few years. We had planned for a meta-analysis, but due to the diversity of the quantitative studies, effect sizes were not computed. Beneficial effects of MT/ MBI on emotional and motivational outcomes, participation, locus of control, and perceived helpfulness were reported, but results were inconsistent across studies. Furthermore, many RCTs focused on effects of single sessions. No published longitudinal trials could be found. The analysis of the qualitative studies revealed four themes: emotional expression, group interaction, development of skills, and improvement of quality of life. Considering these issues for quantitative research, there is a need to examine social and health variables in future studies. In conclusion, due to the heterogeneity of the studies, the efficacy of MT/ MBI in SUD treatment still remains unclear. PMID:29141012

Effect of Stretching Combined With Ultrashort Wave Diathermy on Joint Function and Its Possible Mechanism in a Rabbit Knee Contracture Model.

Science.gov (United States)

Zhang, Quan Bing; Zhou, Yun; Zhong, Hua Zhang; Liu, Yi

2018-05-01

The aim of this study was to investigate the therapeutic effect of stretching combined with ultrashort wave on joint contracture and explore its possible mechanism. Thirty-two rabbits underwent unilateral immobilization of a knee joint at full extension to cause joint contracture. At 6 wks after immobilization, the rabbits were randomly divided into the following four groups: natural recovery group, stretching treatment group, ultrashort wave treatment group, and combined treatment group. For comparison, eight control group animals of corresponding age were also examined. The effect of stretching and ultrashort wave treatment on joint contracture was assessed by measuring the joint range of motion, evaluating the collagen deposition of joint capsule and assessing the mRNA and protein levels for transforming growth factor β1 in the joint capsule. The combined treatment group led to the best recovery of joint function. The combined treatment with stretching and ultrashort wave was more effective than stretching or ultrashort wave treatment alone against the synovial thickening of suprapatellar joint capsule, the collagen deposition of anterior joint capsule, and the elevated expression of transforming growth factor β1 in the joint capsule. Stretching combined with ultrashort wave treatment was effective in improving joint range of motion, reducing the biomechanical, histological, and molecular manifestations of joint capsule fibrosis in a rabbit model of extending joint contracture.

Predictability of the individual clinical outcome of extracorporeal shock wave therapy for cellulite

OpenAIRE

Schlaudraff, Kai-Uwe; Kiessling, Maren C; Császár, Nikolaus BM; Schmitz, Christoph

2014-01-01

Kai-Uwe Schlaudraff,1 Maren C Kiessling,2 Nikolaus BM Császár,2 Christoph Schmitz21Concept Clinic, Geneva, Switzerland; 2Department of Anatomy II, Ludwig-Maximilians-University of Munich, Munich, GermanyBackground: Extracorporeal shock wave therapy has been successfully introduced for the treatment of cellulite in recent years. However, it is still unknown whether the individual clinical outcome of cellulite treatment with extracorporeal shock wave therapy can be predict...

Effect of non-surgical periodontal treatment on HbA1c: a meta-analysis of randomized controlled trials.

Science.gov (United States)

Liew, A K C; Punnanithinont, N; Lee, Y-C; Yang, J

2013-09-01

A meta-analysis of randomized clinical trials (RCTs) was conducted to evaluate whether non-surgical periodontal treatment can reduce the HbA1c% level in type 2 diabetic patients. Recent accumulation of RCTs necessitates updating of the findings of previous reviews. A search of the literature on English publications was conducted in Cochrane CENTRAL, Medline and EMBASE (until 31 March 2012). An RCT was selected if the study population was type 2 diabetic patients (≥16 years old) diagnosed with periodontitis, and compared HbA1c% change with or without non-surgical periodontal treatment for at least three months of the study duration. Weighted mean differences for pooled data and antibiotic use strata were calculated. Heterogeneity and publication bias were explored. A total of 358 articles were identified but only six were suitable. Compared to the control group, the pooled analysis (n = 422) showed -0.41% (95% CI: -0.73% to -0.09%, p = 0.013) absolute difference in HbA1c% with treatment. Studies without adjunctive antibiotic had HbA1c% change of -0.64% (95% CI: -1.06% to -0.23%, p = 0.002), but we could not conclude on the effect of adjunctive antibiotic use (p = 0.734). Publication bias was significant with Egger's test (p = 0.014) but not with Begg's test (p = 0.06). The meta-analysis suggested that non-surgical periodontal treatment was associated with a reduction in HbA1c%. © 2013 Australian Dental Association.

The effect of heat waves, elevated [CO2 ] and low soil water availability on northern red oak (Quercus rubra L.) seedlings.

Science.gov (United States)

Bauweraerts, Ingvar; Wertin, Timothy M; Ameye, Maarten; McGuire, Mary Anne; Teskey, Robert O; Steppe, Kathy

2013-02-01

The frequency and intensity of heat waves are predicted to increase. This study investigates whether heat waves would have the same impact as a constant increase in temperature with the same heat sum, and whether there would be any interactive effects of elevated [CO2 ] and soil moisture content. We grew Quercus rubra seedlings in treatment chambers maintained at either ambient or elevated [CO2 ] (380 or 700 μmol CO2 mol(-1) ) with temperature treatments of ambient, ambient +3 °C, moderate heat wave (+6 °C every other week) or severe heat wave (+12 °C every fourth week) temperatures. Averaged over a 4-week period, and the entire growing season, the three elevated temperature treatments had the same average temperature and heat sum. Half the seedlings were watered to a soil water content near field capacity, half to about 50% of this value. Foliar gas exchange measurements were performed morning and afternoon (9:00 and 15:00 hours) before, during and after an applied heat wave in August 2010. Biomass accumulation was measured after five heat wave cycles. Under ambient [CO2 ] and well-watered conditions, biomass accumulation was highest in the +3 °C treatment, intermediate in the +6 °C heat wave and lowest in the +12 °C heat wave treatment. This response was mitigated by elevated [CO2 ]. Low soil moisture significantly decreased net photosynthesis (Anet ) and biomass in all [CO2 ] and temperature treatments. The +12 °C heat wave reduced afternoon Anet by 23% in ambient [CO2 ]. Although this reduction was relatively greater under elevated [CO2 ], Anet values during this heat wave were still 34% higher than under ambient [CO2 ]. We concluded that heat waves affected biomass growth differently than the same amount of heat applied uniformly over the growing season, and that the plant response to heat waves also depends on [CO2 ] and soil moisture conditions. © 2012 Blackwell Publishing Ltd.

Wave Generation Theory

DEFF Research Database (Denmark)

Frigaard, Peter; Høgedal, Michael; Christensen, Morten

The intention of this manual is to provide some formulas and techniques which can be used for generating waves in hydraulic laboratories. Both long crested waves (2-D waves) and short crested waves (3-D waves) are considered.......The intention of this manual is to provide some formulas and techniques which can be used for generating waves in hydraulic laboratories. Both long crested waves (2-D waves) and short crested waves (3-D waves) are considered....

Lisdexamfetamine in the treatment of moderate-to-severe binge eating disorder in adults: systematic review and exploratory meta-analysis of publicly available placebo-controlled, randomized clinical trials

Directory of Open Access Journals (Sweden)

Fornaro M

2016-07-01

Full Text Available Michele Fornaro,1,2 Marco Solmi,3–5 Giampaolo Perna,2,6 Domenico De Berardis,2,7 Nicola Veronese,5,8 Laura Orsolini,2,9 Licinia Ganança,1,10 Brendon Stubbs11,12 1New York State Psychiatric Institute, Columbia University, New York City, NY, USA; 2Polyedra Research Group®, Ascoli, 3Department of Neurosciences, University of Padua, 4Department of Mental Health, National Health Service, Padova, 5IREM Institute for Clinical Research and Education in Medicine, Padova, 6Department of Clinical Neurosciences, Hermanas Hospitalarias – Villa San Benedetto Menni Hospital, FoRiPsi, Albese con Cassano, Como, 7Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, National Health Service, Hospital “G Mazzini”, Teramo, 8Department of Medicine (DIMED, University of Padua, Padova, Italy; 9Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Herts, UK; 10Department of Psychiatry, School of Medicine, University of Lisbon, Lisbon, Portugal; 11Department of Health Service and Population Research, Institute of Psychiatry, King’s College London, 12Department of Physiotherapy, South London and Maudsley NHS Foundation Trust, London, UK Background: Preliminary placebo-controlled evidence paved the ground to the US Food and Drug Administration approval extension of lisdexamfetamine for the treatment of moderate-to-severe binge eating disorder (BED in adults.Objectives: To provide a preliminary qualitative and quantitative synthesis of the placebo-controlled, randomized clinical trials (RCTs considering the efficacy and tolerability of lisdexamfetamine in the acute and/or maintenance treatment of moderate-to-severe BED in adults.Methods: A preliminary, yet comprehensive, systematic review was performed by accessing a broad range of resources providing publicly available data about lisdexamfetamine at the time of inquiry (March 2016. Study

The wave of the future - Searching for gravity waves

International Nuclear Information System (INIS)

Goldsmith, D.

1991-01-01

Research on gravity waves conducted by such scientists as Gamov, Wheeler, Weber and Zel'dovich is discussed. Particular attention is given to current trends in the theoretical analysis of gravity waves carried out by theorists Kip Thorne and Leonid Grishchuk. The problems discussed include the search for gravity waves; calculation of the types of gravity waves; the possibility of detecting gravity waves from localized sources, e.g., from the collision of two black holes in a distant galaxy or the collapse of a star, through the Laser Interferometer Gravitational Wave Observatory; and detection primordial gravity waves from the big bang

Calcium waves.

Science.gov (United States)

Jaffe, Lionel F

2008-04-12

Waves through living systems are best characterized by their speeds at 20 degrees C. These speeds vary from those of calcium action potentials to those of ultraslow ones which move at 1-10 and/or 10-20 nm s(-1). All such waves are known or inferred to be calcium waves. The two classes of calcium waves which include ones with important morphogenetic effects are slow waves that move at 0.2-2 microm s(-1) and ultraslow ones. Both may be propagated by cycles in which the entry of calcium through the plasma membrane induces subsurface contraction. This contraction opens nearby stretch-sensitive calcium channels. Calcium entry through these channels propagates the calcium wave. Many slow waves are seen as waves of indentation. Some are considered to act via cellular peristalsis; for example, those which seem to drive the germ plasm to the vegetal pole of the Xenopus egg. Other good examples of morphogenetic slow waves are ones through fertilizing maize eggs, through developing barnacle eggs and through axolotl embryos during neural induction. Good examples of ultraslow morphogenetic waves are ones during inversion in developing Volvox embryos and across developing Drosophila eye discs. Morphogenetic waves may be best pursued by imaging their calcium with aequorins.

A prospective study of levetiracetam efficacy in epileptic syndromes with continuous spikes-waves during slow sleep

DEFF Research Database (Denmark)

Atkins, Mary; Nikanorova, Marina

2011-01-01

To evaluate the add-on effect of levetiracetam (LEV) treatment on the EEG and clinical status of children with continuous spikes-waves during slow sleep (CSWS).......To evaluate the add-on effect of levetiracetam (LEV) treatment on the EEG and clinical status of children with continuous spikes-waves during slow sleep (CSWS)....

Sensitivity of Middle Atmospheric Temperature and Circulation in the UIUC Mesosphere-Stratosphere-Troposphere GCM to the Treatment of Subgrid-Scale Gravity-Wave Breaking

Science.gov (United States)

Yang, Fanglin; Schlesinger, Michael E.; Andranova, Natasha; Zubov, Vladimir A.; Rozanov, Eugene V.; Callis, Lin B.

2003-01-01

The sensitivity of the middle atmospheric temperature and circulation to the treatment of mean- flow forcing due to breaking gravity waves was investigated using the University of Illinois at Urbana-Champaign 40-layer Mesosphere-Stratosphere-Troposphere General Circulation Model (MST-GCM). Three GCM experiments were performed. The gravity-wave forcing was represented first by Rayleigh friction, and then by the Alexander and Dunkerton (AD) parameterization with weak and strong breaking effects of gravity waves. In all experiments, the Palmer et al. parameterization was included to treat the breaking of topographic gravity waves in the troposphere and lower stratosphere. Overall, the experiment with the strong breaking effect simulates best the middle atmospheric temperature and circulation. With Rayleigh friction and the weak breaking effect, a large warm bias of up to 60 C was found in the summer upper mesosphere and lower thermosphere. This warm bias was linked to the inability of the GCM to simulate the reversal of the zonal winds from easterly to westerly crossing the mesopause in the summer hemisphere. With the strong breaking effect, the GCM was able to simulate this reversal, and essentially eliminated the warm bias. This improvement was the result of a much stronger meridional transport circulation that possesses a strong vertical ascending branch in the summer upper mesosphere, and hence large adiabatic cooling. Budget analysis indicates that 'in the middle atmosphere the forces that act to maintain a steady zonal-mean zonal wind are primarily those associated with the meridional transport circulation and breaking gravity waves. Contributions from the interaction of the model-resolved eddies with the mean flow are small. To obtain a transport circulation in the mesosphere of the UIUC MST-GCM that is strong enough to produce the observed cold summer mesopause, gravity-wave forcing larger than 100 m/s/day in magnitude is required near the summer mesopause. In

Prototype Testing of the Wave Energy Converter Wave Dragon

DEFF Research Database (Denmark)

Kofoed, Jens Peter; Frigaard, Peter; Friis-Madsen, Erik

2006-01-01

The Wave Dragon is an offshore wave energy converter of the overtopping type. It consists of two wave reflectors focusing the incoming waves towards a ramp, a reservoir for collecting the overtopping water and a number of hydro turbines for converting the pressure head into power. In the period...... from 1998 to 2001 extensive wave tank testing on a scale model was carried at Aalborg University. Then, a 57!27 m wide and 237 tonnes heavy (incl. ballast) prototype of the Wave Dragon, placed in Nissum Bredning, Denmark, was grid connected in May 2003 as the world’s first offshore wave energy...... converter. The prototype is fully equipped with hydro turbines and automatic control systems, and is instrumented in order to monitor power production, wave climate, forces in mooring lines, stresses in the structure and movements of the Wave Dragon. In the period May 2003 to January 2005 an extensive...

Prototype Testing of the Wave Energy Converter Wave Dragon

DEFF Research Database (Denmark)

Kofoed, Jens Peter; Frigaard, Peter Bak; Friis-Madsen, Erik

2004-01-01

The Wave Dragon is an offshore wave energy converter of the overtopping type. It consists of two wave reflectors focusing the incoming waves towards a ramp, a reservoir for collecting the overtopping water and a number of hydro turbines for converting the pressure head into power. In the period...... from 1998 to 2001 extensive wave tank testing on a scale model was carried at Aalborg University. Then, a 57 x 27 m wide and 237 tonnes heavy (incl. ballast) prototype of the Wave Dragon, placed in Nissum Bredning, Denmark, was grid connected in May 2003 as the world's first offshore wave energy...... converter. The prototype is fully equipped with hydro turbines and automatic control systems, and is instrumented in order to monitor power production, wave climate, forces in mooring lines, stresses in the structure and movements of the Wave Dragon. During the last months, extensive testing has started...

Experiments on the WavePiston, Wave Energy Converter

DEFF Research Database (Denmark)

Angelelli, E.; Zanuttigh, B.; Kofoed, Jens Peter

2011-01-01

This paper analyses the performance of a new Wave Energy Converter (WEC) of the Oscillating Water Column type (OWC), named WavePiston. This near-shore floating device is composed of plates (i.e. energy collectors) sliding around a cylinder, that is placed perpendicular to the shore. Tests...... in the wave basin at Aalborg University allowed to investigate power production in the North Sea typical wave climate, with varying design parameters such as plate dimensions and their mutual distance. The power produced per meter by each collector is about the 5% of the available wave power. Experimental...... results and survivability considerations suggest that the WavePiston would be particularly suited for installations in milder seas. An example application is therefore presented in the Mediterranean Sea, off-shore the island of Sicily. In this case, each collector harvests the 10% of the available wave...

Rogue waves, rational solitons and wave turbulence theory

International Nuclear Information System (INIS)

Kibler, Bertrand; Hammani, Kamal; Michel, Claire; Finot, Christophe; Picozzi, Antonio

2011-01-01

Considering a simple one-dimensional nonlinear Schroedinger optical model, we study the existence of rogue wave events in the highly incoherent state of the system and compare them with the recently identified hierarchy of rational soliton solutions. We show that rogue waves can emerge in the genuine turbulent regime and that their coherent deterministic description provided by the rational soliton solutions is compatible with an accurate statistical description of the random wave provided by the wave turbulence theory. Furthermore, the simulations reveal that even in the weakly nonlinear regime, the nonlinearity can play a key role in the emergence of an individual rogue wave event in a turbulent environment. -- Highlights: → Rogue wave events are studied in the highly incoherent regime of interaction. → We show that rogue waves can emerge in the genuine turbulent regime. → Their coherent deterministic description is provided by the rational solutions. → It coexists with a statistical description provided of the random wave. → The nonlinearity plays a key role even in a turbulent environment.

Hyperbaric oxygen therapy in the treatment of osteonecrosis of the femoral head: a review of the current literature.

Science.gov (United States)

Uzun, Gunalp; Mutluoglu, Mesut; Ersen, Omer; Yildiz, Senol

2016-01-01

To review the current literature on the use of hyperbaric oxygen (HBO₂) therapy in the treatment of osteonecrosis of the femoral head (ONFH). We searched PubMed, Directory of Open Access Journals (DOAJ), EMBASE, Web of Science, Academic Search Complete, CINAHL and MEDLINE through April 2015. We hand-searched relevant textbooks, conference proceedings and the reference lists of review articles and clinical studies Randomized controlled trials (RCT) and observational studies (cohort study, case-control study, case series) that reported the outcome of patients who received HBO₂therapy for ONFH were included. Only English-language articles were included. Study quality was not used as an exclusion criterion. Two authors independently assessed trials for inclusion, extracted data and presented to other authors. Disagreements were resolved by consensus. We identified eight clinical studies; two randomized controlled trials (RCTs); one historically controlled study; and five case series. The majority of the studies were small-scale, heterogeneous and methodologically weak. In four of the studies HBO₂therapy was combined with other treatment modalities, making it impossible to draw firm conclusions on the specific effects of HBO₂therapy. Hip survivorship in studies wherein HBO₂therapy was used alone was 95.5% in Steinberg Stage I lesions, 89% in Steinberg Stage II lesions and 100% in Ficat Stage II lesions. There is a room for HBO₂therapy in the management ONFH. Further RCTs, however, are required to better elucidate the role of HBO₂therapy in the treatment of ONFH.

Low Frequency Waves Detected in a Large Wave Flume under Irregular Waves with Different Grouping Factor and Combination of Regular Waves

Directory of Open Access Journals (Sweden)

Luigia Riefolo

2018-02-01

Full Text Available This paper describes a set of experiments undertaken at Universitat Politècnica de Catalunya in the large wave flume of the Maritime Engineering Laboratory. The purpose of this study is to highlight the effects of wave grouping and long-wave short-wave combinations regimes on low frequency generations. An eigen-value decomposition has been performed to discriminate low frequencies. In particular, measured eigen modes, determined through the spectral analysis, have been compared with calculated modes by means of eigen analysis. The low frequencies detection appears to confirm the dependence on groupiness of the modal amplitudes generated in the wave flume. Some evidence of the influence of low frequency waves on runup and transport patterns are shown. In particular, the generation and evolution of secondary bedforms are consistent with energy transferred between the standing wave modes.

Generating gravity waves with matter and electromagnetic waves

International Nuclear Information System (INIS)

Barrabes, C.; Hogan, P A.

2008-01-01

If a homogeneous plane lightlike shell collides head on with a homogeneous plane electromagnetic shock wave having a step-function profile then no backscattered gravitational waves are produced. We demonstrate, by explicit calculation, that if the matter is accompanied by a homogeneous plane electromagnetic shock wave with a step-function profile then backscattered gravitational waves appear after the collision

Focused and Radial Shock Wave Therapy in the Treatment of Tennis Elbow: A Pilot Randomised Controlled Study

Directory of Open Access Journals (Sweden)

Król Piotr

2015-09-01

Full Text Available The purpose of this article was to evaluate and compare the efficacy of radial and focused shock wave therapies applied to treat tennis elbow. Patients with tennis elbow were randomized into two comparative groups: focused shock wave therapy (FSWT; n=25 and radial shock wave therapy (RSWT; n=25. Subjects in the FSWT and RSWT groups were applied with a focused shock wave (3 sessions, 2000 shocks, 4 Hz, 0.2 mJ/mm2 and a radial shock wave (3 sessions, 2000 + 2000 shocks, 8 Hz, 2.5 bar, respectively. The primary study endpoints were pain relief and functional improvement (muscle strength one week after therapy. The secondary endpoint consisted of the results of the follow-up observation (3, 6 and 12 weeks after the study. Successive measurements showed that the amount of pain patients felt decreased in both groups. At the same time grip strength as well as strength of wrist extensors and flexors of the affected extremity improved significantly. Both focused and radial shock wave therapies can comparably and gradually reduce pain in subjects with tennis elbow. This process is accompanied by steadily improved strength of the affected extremity.

Velocity-space diffusion due to resonant wave-wave scattering of electromagnetic and electrostatic waves in a plasma

International Nuclear Information System (INIS)

Sugaya, Reija

1991-01-01

The velocity-space diffusion equation describing distortion of the velocity distribution function due to resonant wave-wave scattering of electromagnetic and electrostatic waves in an unmagnetized plasma is derived from the Vlasov-Maxwell equations by perturbation theory. The conservation laws for total energy and momentum densities of waves and particles are verified, and the time evolutions of the energy and momentum densities of particles are given in terms of the nonlinear wave-wave coupling coefficient in the kinetic wave equation. (author)

Treatment of selective mutism based on cognitive behavioural therapy, psychopharmacology and combination therapy - a systematic review.

Science.gov (United States)

Østergaard, Kasper Rud

2018-02-15

Selective mutism (SM) is a debilitating childhood anxiety disorder characterized by a persistent lack of speech in certain social settings and is considered hard to treat. Cognitive behavioral therapy (CBT) and pharmacological treatments are the best described treatments in the literature. To test whether there is evidence on treatment based on CBT, medication or a combination of these. Systematic and critical review of the literature on CBT and/or pharmacological treatments of SM. Literature was sought on PubMed, Embase and Psycinfo in March 2017. Of the included studies, six examined CBT, seven pharmacologic treatment and two a combination of these. Using CBT 53/60 children improved symptomatically whilst respectively 55/67 and 6/7 improved using pharmacologic- and combination-treatment. Pharmacologic treatment and especially CBT showed promising results supported by some degree of evidence, which combination treatment lacks. Yet small numbers, few RCTs, heterogeneous study designs, lack of consistent measures, short treatment and follow-up periods, generally limits the evidence. This needs focus in future research.

Comparison of the effectiveness of local corticosteroid injection and extracorporeal shock wave therapy in patients with lateral epicondylitis.

Science.gov (United States)

Beyazal, Münevver Serdaroğlu; Devrimsel, Gül

2015-12-01

[Purpose] This study aimed to determine and compare the effectiveness of extracorporeal shock wave therapy and local corticosteroid injection in patients with lateral epicondylitis. [Subjects and Methods] Sixty-four patients with lateral epicondylitis were randomly divided into extracorporeal shock wave therapy and steroid injection groups. Patients were evaluated using hand grip strength, visual analog scale, and short-form McGill pain questionnaire at baseline and at 4 and 12 weeks post-treatment. [Results] Both groups showed statistically significant increase in hand grip strength and decreases on the visual analog scale and short form McGill pain questionnaire overtime. There was no statistically significant difference in the percentage of improvement in hand grip strength and on the short-form McGill pain questionnaire between groups at 4 weeks post-treatment, whereas the extracorporeal shock wave therapy group showed better results on the visual analog scale. The percentages of improvements in all 3 parameters were higher in the extracorporeal shock wave therapy group than in the injection group at 12 weeks post-treatment. [Conclusion] Both the extracorporeal shock wave therapy and steroid injection were safe and effective in the treatment of lateral epicondylitis. However, extracorporeal shock wave therapy demonstrated better outcomes than steroid injection at the long-term follow-up.

Statistical power in parallel group point exposure studies with time-to-event outcomes: an empirical comparison of the performance of randomized controlled trials and the inverse probability of treatment weighting (IPTW) approach.

Science.gov (United States)

Austin, Peter C; Schuster, Tibor; Platt, Robert W

2015-10-15

Estimating statistical power is an important component of the design of both randomized controlled trials (RCTs) and observational studies. Methods for estimating statistical power in RCTs have been well described and can be implemented simply. In observational studies, statistical methods must be used to remove the effects of confounding that can occur due to non-random treatment assignment. Inverse probability of treatment weighting (IPTW) using the propensity score is an attractive method for estimating the effects of treatment using observational data. However, sample size and power calculations have not been adequately described for these methods. We used an extensive series of Monte Carlo simulations to compare the statistical power of an IPTW analysis of an observational study with time-to-event outcomes with that of an analysis of a similarly-structured RCT. We examined the impact of four factors on the statistical power function: number of observed events, prevalence of treatment, the marginal hazard ratio, and the strength of the treatment-selection process. We found that, on average, an IPTW analysis had lower statistical power compared to an analysis of a similarly-structured RCT. The difference in statistical power increased as the magnitude of the treatment-selection model increased. The statistical power of an IPTW analysis tended to be lower than the statistical power of a similarly-structured RCT.

Application of holographic interferometric studies of underwater shock-wave focusing to medicine

Science.gov (United States)

Takayama, Kazuyoshi; Nagoya, H.; Obara, Tetsuro; Kuwahara, M.

1993-01-01

Holographic interferometric flow visualization was successfully applied to underwater shock wave focusing and its application to extracorporeal shock wave lithotripsy (ESWL). Real time diffuse holograms revealed the shock wave focusing process in an ellipsoidal reflector made from PMMA and double exposure holographic interferometry also clarified quantitatively the shock focusing process. Disintegration of urinary tract stones and gallbladder stones was observed by high speed photogrammetry. Tissue damage associated with the ESWL treatment is discussed in some detail.

Plasma waves

CERN Document Server

Swanson, DG

1989-01-01

Plasma Waves discusses the basic development and equations for the many aspects of plasma waves. The book is organized into two major parts, examining both linear and nonlinear plasma waves in the eight chapters it encompasses. After briefly discussing the properties and applications of plasma wave, the book goes on examining the wave types in a cold, magnetized plasma and the general forms of the dispersion relation that characterize the waves and label the various types of solutions. Chapters 3 and 4 analyze the acoustic phenomena through the fluid model of plasma and the kinetic effects. Th

Experimental Study on the WavePiston Wave Energy Converter

DEFF Research Database (Denmark)

Pecher, Arthur; Kofoed, Jens Peter; Angelelli, E.

This report presents the results of an experimental study of the power performance of the WavePiston wave energy converter. It focuses mainly on evaluating the power generating capabilities of the device and the effect of the following issues: Scaling ratios PTO loading Wave height and wave period...... dependency Oblique incoming waves Distance between plates During the study, the model supplied by the client, WavePiston, has been rigorously tested as all the anticipated tests have been done thoroughly and during all tests, good quality data has been obtained from all the sensors....

Early orthodontic treatment for Class III malocclusion: A systematic review and meta-analysis.

Science.gov (United States)

Woon, See Choong; Thiruvenkatachari, Badri

2017-01-01

Class III malocclusion affects between 5% and 15% of our population. The 2 most common dilemmas surrounding Class III treatment are the timing of treatment and the type of appliance. A number of appliances have been used to correct a Class III skeletal discrepancy, but there is little evidence available on their effectiveness in the long term. Similarly, early treatment of Class III malocclusion has been practiced with increasing interest. However, there has been no solid evidence on the benefits in the long term. The aim of this systematic review was to evaluate the effectiveness of orthodontic/orthopedic methods used in the early treatment of Class III malocclusion in the short and long terms. Several sources were used to identify all relevant studies independently of language. The Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase (Ovid), and MEDLINE (Ovid) were searched to June 2016. The selection criteria included randomized controlled trials (RCTs) and prospective controlled clinical trials (CCTs) of children between the ages of 7 and 12 years on early treatment with any type of orthodontic/orthopedic appliance compared with another appliance to correct Class III malocclusion or with an untreated control group. The primary outcome measure was correction of reverse overjet, and the secondary outcomes included skeletal changes, soft tissue changes, quality of life, patient compliance, adverse effect, Peer Assessment Rating score, and treatment time. The search results were screened for inclusion, and the data extracted by 2 independent authors. The data were analyzed using software (version 5.1, Review Manager; The Nordic Cochrane Centre, The Cochrane Collaboration; Copenhagen, Denmark). The mean differences with 95% confidence intervals were expressed for the continuous data. Random effects were carried out with high levels of clinical or statistical heterogeneity and fixed affects when the heterogeneity was low

Temporomandibular disorders in growing patients after treatment of class II and III malocclusion with orthopaedic appliances: a systematic review.

Science.gov (United States)

Jiménez-Silva, Antonio; Carnevali-Arellano, Romano; Venegas-Aguilera, Matías; Tobar-Reyes, Julio; Palomino-Montenegro, Hernán

2018-05-01

To determine if the use of orthopaedic appliances in growing patients applied to correct Class II and III malocclusion is related to the development of temporomandibular disorders (TMD). A systematic review was conducted between 1960 and July 2017, based on electronic databases: PubMed, Cochrane Library, Embase, Medline, Scopus, EBSCOhost, Scielo, Lilacs and Bireme. Controlled clinical trials (CCTs) and randomized controlled trials (RCTs) were identified. The articles were selected and analyzed by two authors independently. The quality of the evidence was determined according to the guidelines of the Cochrane Risk Bias Assessment Tool and the Cochrane Quality Study Guide. Seven articles were included, four CCTs and three RCTs. The studies were grouped according to malocclusion treatment in (a) class II appliances (n = 4) and (b) class III appliances (n = 3). The quality of evidence was low due to the high risk of bias, independent of the association reported. All studies concluded that the use of orthopaedic appliances would not contribute to the development of TMD. The quality of evidence available is insufficient to establish definitive conclusions, since the studies were very heterogeneous and presented a high risk of bias. However, it is suggested that the use of orthopaedic appliances to correct class II and III malocclusion in growing patients would not be considered as a risk factor for the development of TMD. High-quality RCTs are required to draw any definitive conclusions.

Predictability of the individual clinical outcome of extracorporeal shock wave therapy for cellulite.

Science.gov (United States)

Schlaudraff, Kai-Uwe; Kiessling, Maren C; Császár, Nikolaus Bm; Schmitz, Christoph

2014-01-01

Extracorporeal shock wave therapy has been successfully introduced for the treatment of cellulite in recent years. However, it is still unknown whether the individual clinical outcome of cellulite treatment with extracorporeal shock wave therapy can be predicted by the patient's individual cellulite grade at baseline, individual patient age, body mass index (BMI), weight, and/or height. Fourteen Caucasian females with cellulite were enrolled in a prospective, single-center, randomized, open-label Phase II study. The mean (± standard error of the mean) cellulite grade at baseline was 2.5±0.09 and mean BMI was 22.8±1.17. All patients were treated with radial extracorporeal shock waves using the Swiss DolorClast(®) device (Electro Medical Systems, S.A., Nyon, Switzerland). Patients were treated unilaterally with 2 weekly treatments for 4 weeks on a randomly selected side (left or right), totaling eight treatments on the selected side. Treatment was performed at 3.5-4.0 bar, with 15,000 impulses per session applied at 15 Hz. Impulses were homogeneously distributed over the posterior thigh and buttock area (resulting in 7,500 impulses per area). Treatment success was evaluated after the last treatment and 4 weeks later by clinical examination, photographic documentation, contact thermography, and patient satisfaction questionnaires. The mean cellulite grade improved from 2.5±0.09 at baseline to 1.57±0.18 after the last treatment (ie, mean δ-1 was 0.93 cellulite grades) and 1.68±0.16 at follow-up (ie, mean δ-2 was 0.82 cellulite grades). Compared with baseline, no patient's condition worsened, the treatment was well tolerated, and no unwanted side effects were observed. No statistically significant (ie, Pcellulite grade at baseline, BMI, weight, height, or age. Radial shock wave therapy is a safe and effective treatment option for cellulite. The individual clinical outcome cannot be predicted by the patient's individual cellulite grade at baseline, BMI, weight

Extracorporeal shock wave therapy in periodontics: A new paradigm.