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Monitoring Response (monitoring + response)
Selected AbstractsImproving patient outlook in rheumatoid arthritis: Experience with abataceptJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 10 2008MA (Nurse Manager), Mary Coughlin RN Abstract Purpose: To examine the importance of improving patient outlook in rheumatoid arthritis (RA) and to discuss the role of the nurse practitioner (NP) who, through the assessment of patient-reported outcomes and in acting as an advocate for the patient with the wider healthcare team, has a crucial part to play in managing the overall well-being of the patient. This article will draw on the clinical experience to date with abatacept, a first-in-class therapy that has been approved for the treatment of RA in patients with an inadequate response to either traditional disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, or biological DMARDs, such as tumor necrosis factor-, antagonists. Data sources: A comprehensive literature search was performed using the National Library of Medicine (MEDLINE), EMBASE, and BIOSIS databases (restricted to articles posted between January 2000 and February 2007) with the search terms CTLA-4Ig, abatacept, and primary clinical trial publications in patients with RA. The clinical data are summarized in this review along with safety data presented in the prescribing information. Conclusions: Recent changes in the approach to RA treatment, particularly the advent of biological therapies, have impacted the role of the NP. The role of the NP is integral to the management of RA and in maximizing patient outcomes, through educating patients to make informed choices regarding their treatment, ensuring the safe administration of therapies and monitoring response to therapy, and in acting as an advocate for the patient within the wider healthcare team. Implications for practice: The use of more patient-centered measures of response are gaining increasing importance both in clinical trials and in clinical practice, and as such the NP has an important role in ensuring that both the physical and the psychological needs of patients are met. Clinical trials to date have shown that abatacept provides significant and clinically meaningful improvements in patient-reported outcomes, as well as demonstrating significant clinical benefits and a consistent safety profile, thus representing a valuable treatment option within the RA treatment armamentarium. [source] Metabolite quantification and high-field MRS in breast cancerNMR IN BIOMEDICINE, Issue 1 2009Ihab S. Haddadin Abstract In vivo1H MRS is rapidly developing as a clinical tool for diagnosing and characterizing breast cancers. Many in vivo and in vitro experiments have demonstrated that alterations in concentrations of choline-containing metabolites are associated with malignant transformation. In recent years, considerable efforts have been made to evaluate the role of 1H MRS measurements of total choline-containing compounds in the management of patients with breast cancer. Current technological developments, including the use of high-field MR scanners and quantitative spectroscopic analysis methods, promise to increase the sensitivity and accuracy of breast MRS. This article reviews the literature describing in vivo MRS in breast cancer, with an emphasis on the development of high-field MR scanning and quantitative methods. Potential applications of these technologies for diagnosing suspicious lesions and monitoring response to chemotherapy are discussed. Copyright © 2008 John Wiley & Sons, Ltd. [source] Water diffusion in the different microenvironments of breast cancerNMR IN BIOMEDICINE, Issue 4 2004Yael Paran Abstract The parameters that characterize the intricate water diffusion in tumors may serve to reveal their distinct pathology. Specifically, the application of diffusion magnetic resonance imaging (MRI) can aid in characterizing breast cancer, as well as monitoring response to therapy. We present here a non-invasive, quantitative MRI investigation, at high spatial resolution, of water diffusion in hormonal dependent MCF7 breast tumors implanted orthotopically in immunodeficient mice. Distinctive MRI protocols were designed in this study, utilizing a broad range of diffusion times and diffusion gradient strengths. Application of these protocols allowed water diffusion in the tissue extracellular and intracellular compartments to be distinguished, and the effect of restricted diffusion and water exchange on the water diffusion in these compartments to be evaluated. Pixel-by-pixel analysis yielded parametric maps of the estimated volume fraction and apparent diffusion coefficient of each compartment. The diffusion of the water in the extracellular microenvironment was approximately two fold slower than that of free water, and in the intracellular compartment was about one order of magnitude slower than that of free water and demonstrated restriction of water diffusion at long diffusion times. Mapping of the water fraction in each compartment was further employed to monitor changes during tumor progression and to assess tumor response to hormonal manipulation with a new antiestrogenic drug, tamoxifen methiodide (TMI). It was found that, in parallel to the growth arrest by this drug, the volume fraction of the slowly diffusing water increased, suggesting a TMI-induced cell swelling. This study can serve as a basis for extending diffusion breast MRI in the clinical setting. Copyright © 2004 John Wiley & Sons, Ltd. [source] Hydroxyurea therapy lowers circulating DNA levels in sickle cell anemia,AMERICAN JOURNAL OF HEMATOLOGY, Issue 9 2008Pinar Ulug Hydroxyurea reduces the frequency of acute pain in sickle cell disease (SCD). We sought to determine if hydroxyurea therapy affects cell free DNA (cfDNA) levels in SCD. cfDNA levels fell in all 10 patients studied; before hydroxyurea, mean was 1,879 (95% CI 1,104,3,199) GE/mL; after hydroxyurea, mean was 780 (95% CI, 634,959) GE/mL (P = 0.002). Mean cfDNA level in the 10 HbSS adults prior to starting hydroxyurea was also significantly higher than that in 115 HbSS case controls who had never taken hydroxyurea (1,879 vs 975 GE/mL, P = 0.02). cfDNA levels may be useful in monitoring response to hydroxyurea therapy in SCD. Am. J. Hematol., 2008. © 2008 Wiley-Liss, Inc. [source] Global angiographic scoring system for inflammatory diseasesACTA OPHTHALMOLOGICA, Issue 2009M KHAIRALLAH Purpose Fundus fluorescein and indocyanine green angiography are essential imaging techniques in the appraisal of posterior segment inflammation. A combined fluorescein and indocyanine green angiographic scoring system has been developed in order to provide semi-quantitative data for follow-up of disease progression, monitoring response to treatment, and comparison between clinical studies. We tested interobserver variations in the semi-quantitative scoring of dual fluorescein/indocyanine green angiograms. Methods Four observers scored 32 dual fluorescein and indocyanine green angiograms. Spearman rank correlation was used to analyze correlation between scores assigned to each angiographic sign. We used the Kappa statistics to test agreement between pairs of observers in comparative total fluorescein and indocyanine green angiographic scores. Results We found a significant correlation between pairs of observers in scores assigned to each fluorescein angiographic sign and the total score of fluorescein angiograms. A significant correlation was found only between 2 separate pairs of observers in scores assigned to early stromal vessel hyperfluoresence on indocyanine green angiography. However, a significant correlation was found in other indocyanine green angiographic signs and the total score of indocyanine green angiograms. There was a good agreement between observers in comparative fluorescein , indocyanine green angiographic total scores. Conclusion Further experience with the scoring system, especially with the indocyanine green angiographic scoring, may improve its reproducibility. [source] Serum levels of interferon-,, tumour necrosis factor-,, soluble interleukin-6R and soluble cell activation markers for monitoring response to treatment of leprosy reactionsCLINICAL & EXPERIMENTAL IMMUNOLOGY, Issue 2 2007A. Iyer Summary Identifying pathogen and host-related laboratory parameters are essential for the early diagnosis of leprosy reactions. The present study aimed to clarify the validity of measuring the profiles of serum cytokines [interleukin (IL)-4, IL-6, IL-10, interferon (IFN)-, and tumour necrosis factor (TNF)-,], the soluble IL-6 receptor (sIL-6R), soluble T cell (sCD27) and macrophage (neopterin) activation markers and Mycobacterium leprae -specific anti-PGL-I IgM antibodies in relation to the leprosy spectrum and reactions. Serum samples from 131 Indonesian leprosy patients (82 non-reactional leprosy patients and 49 reactional) and 112 healthy controls (HC) from the same endemic region were investigated. Forty-four (89·8%) of the reactional patients had erythema nodosum leprosum (ENL) while only five (10·2%) had reversal reaction (RR). Follow-up serum samples after corticosteroid treatment were also obtained from 17 of the patients with ENL and one with RR. A wide variability in cytokine levels was observed in the patient groups. However, IFN-, and sIL-6R were elevated significantly in ENL compared to non-ENL patients. Levels of IFN-,, TNF-, and sIL-6R declined significantly upon corticosteroid treatment of ENL. Thus, although the present study suggests limited applicability of serial measurement of IFN-,, TNF-, and sIL-6R in monitoring treatment efficacy of ENL, reactions it recommends a search for a wider panel of more disease-specific markers in future studies. [source] Continuous glucose monitoring in patients with insulinomaCLINICAL ENDOCRINOLOGY, Issue 6 2008Alia Munir Summary Background, Insulinomas are rare neuroendocrine tumours that are usually small and may take time to localize. They cause recurrent life-threatening spontaneous hypoglycaemia. Recurrent hypoglycaemia causes loss of hypoglycaemia awareness, putting the patient at further risk, but this has rarely been described in insulinoma. We describe the utility of continuous glucose monitoring (CGM) in patients with insulinoma. Patients and methods, Three patients, aged 72 years (patient 1), 37 years (patient 2) and 24 years (patient 3), with suspected insulinoma attended our investigation unit, in a university teaching hospital. Biochemical diagnosis was confirmed by elevated plasma insulin and C-peptide during biochemical hypoglycaemia [plasma glucose < 2·2 mM (40 mg/dl)]. Surgery confirmed histology in all. CGM was used to monitor frequency and time of hypoglycaemia during diagnosis and medical treatment, and after definitive surgical treatment. Results, All patients had evidence of hypoglycaemia unawareness. At diagnosis in patients 1,3, CGM revealed 6·1%, 21·9% and 71·0% of time spent in moderate hypoglycaemia (plasma glucose 2·2,3·0 mM), and 1·4%, 11·4% and 48·1% of time in severe hypoglycaemia (plasma glucose < 2·2 mM), respectively. On diazoxide this reduced to 0·6%, 5·4% and 5·7% time in moderate hypoglycaemia, and no severe hypoglycaemia in patients 1 and 3, and 0·5% in patient 2. Octreotide therapy in patients 2 and 3 resulted in 5·8% and 0% of time in moderate hypoglycaemia, respectively, and no severe hypoglycaemia. After surgical excision CGM confirmed cure in all. Conclusions, CGM in insulinoma is useful in detecting hypoglycaemia, and hypoglycaemia unawareness, monitoring response to medical therapy and for confirming cure postoperatively, and is useful in the management of this uncommon but dangerous condition. [source] Using Remote Sensing to Evaluate the Influence of Grassland Restoration Activities on Ecosystem Forage Provisioning ServicesRESTORATION ECOLOGY, Issue 4 2009Carolyn M. Malmstrom Abstract As valuation of ecosystem goods and services derived from ecological processes becomes increasingly important in environmental decision-making, the need to quantify how restoration activities influence ecosystem function has grown more urgent, particularly within income-generating or subsistence-providing landscapes where economic needs and biodiversity goals must be balanced. However, quantification of restoration effects is often hindered by logistical issues, which include (1) the difficulty of systematically monitoring responses over large areas and (2) lack or loss of comparison sites necessary for assessing treatment effect. We explored the use of remote sensing to quantify the effects of native grass seeding and prescribed burns on ecosystem forage provisioning services within a California (U.S.A.) rangeland landscape. We used Landsat time series to monitor forage (green biomass) dynamics within 296 ha of treatment areas,distributed throughout a 36-km2 watershed,for 6 years and to identify post hoc comparison areas when a priori comparisons were lacking. Remote sensing analysis documented gains and losses in forage provisioning services due to restoration efforts and provided critical information for adaptive management. Our results demonstrate the degree to which invaded grasslands can be resistant to change and suggest that increasing the functional complexity of restoration mixes might help increase forage availability and reduce opportunities for weed reinvasion. [source] Extracellular matrix metabolites as potential biomarkers of disease activity in wound fluid: lessons learned from other inflammatory diseases?BRITISH JOURNAL OF DERMATOLOGY, Issue 3 2004R. Moseley Summary The new era of pharmacogenetics has identified a potential for individuals to receive customized treatments for a variety of disease states. For such individualized treatments to fulfil their potential, it will be essential for clinicians to be able to monitor disease activity, ideally in a rapid, noninvasive fashion. The accessibility of the skin offers much potential to develop noninvasive tests of metabolic and disease activity for clinical use. Impaired human wound healing in the skin is a chronic inflammatory disorder in which the development of such tests has considerable potential, aiding clinical decision making and monitoring responses to treatment. This review article discusses how studies in other human diseases have highlighted potential biochemical markers (biomarkers) of disease activity in secreted biofluids, as aids to determining disease and metabolic activity within tissues. Using, as examples, lessons learned in the study of disease activity and prognosis of other chronic inflammatory conditions, such as osteoarthritis and periodontal disease, this review highlights the potential of dermal extracellular matrix (ECM) components (collagens, proteoglycans, hyaluronan and glycoproteins) for such uses. The limitations of currently utilized techniques and the concept that analysis of ECM components in wound fluid may represent useful biomarkers of disease activity are also discussed. [source] | ||||||||||