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Reduced Need (reduced + need)
Selected AbstractsADHESION TO LASER-PREPARED TOOTH STRUCTUREJOURNAL OF ESTHETIC AND RESTORATIVE DENTISTRY, Issue 6 2006MS Author, Thomas J. Hilton DMD The use of Er:YAG (erbium : yttrium aluminum garnet and Er,Cr:YAG (erbium, chromium : yttrium scandium gallium garnet) lasers for tooth preparation has received much attention in recent years. Several advantages have been attributed to these devices, including a reduced need for local anesthesia for tooth preparation, less vibration to the patient, and more conservative cavity preparation. Another purported advantage has been the contention that adhesion to tooth structure is enhanced compared with other means of cavity preparation, even to the point of eliminating the need for conditioning and/or etching prior to adhesive system application. As the use of bonded, esthetic restorations has increased, it is important to know if this purported bonding advantage is valid. This Critical Appraisal examines evidence in the peer-reviewed scientific literature that contradicts this contention, and discusses concerns regarding the use of lasers in cavity preparation. [source] Importance of pharmaceutical composition and evidence from clinical trials and pharmacological studies in determining effectiveness of chondroitin sulphate and other glycosaminoglycans: a critiqueJOURNAL OF PHARMACY AND PHARMACOLOGY: AN INTERNATI ONAL JOURNAL OF PHARMACEUTICAL SCIENCE, Issue 10 2009Professor K.D. Rainsford Abstract Objectives Chondroitin sulphate (CS) has attracted much interest over the past two decades or so as a biological agent for use in the relief of pain and joint symptoms in osteoarthritis. Earlier clinical investigations produced variable, if encouraging results. This variability was partly due to limitations on the study designs and the lack of availability of standardized CS. Recently, high quality and fully standardized CS (Condrosulf) has become available and its effects have been studied in large-scale osteoarthritis trials, which are discussed here. Key findings There is now evidence for symptom - and structure-modifying (radio-logically-observed) effects. These studies show that CS (a) has slow onset of response and that relief of pain may not be like that of the direct analgesic actions of non-steroidal anti-inflammatory drugs (NSAIDs), (b) there are indications of reduced need for intake of analgesics (e.g. NSAIDs) in patients taking CS, and (c) quality of life and cost-benefits may be associated with use of CS. Safety evaluations show that the incidence of adverse reactions is low. Pharmacokinetic studies indicate that although oral absorption is relatively fast CS has moderate oral bioavailability (15,24%) and that depolymerised and degraded CS that is evident after absorption, together with CS itself, may take some time to accumulate in target joints. The pharmacodynamic actions of CS indicate that it has anti-inflammatory effects that include multiple actions involving reduction of catabolic reactions and enhanced anabolic (proteoglycan) synthetic reactions in cartilage and may block osteoclast activation in bone. Further studies are required to (a) establish the effects of depolymerised and degraded CS on degradation of cartilage and bone in vitro, and (b) MRI and other investigations of the effects in osteoarthritis of long-term CS treatment. Summary The findings from this review show there may be potential value of CS in reducing the dependence on intake of NSAIDs and analgesics in patients with osteoarthritis, while at the same time having favourable safety. [source] Long-Term Controlled Normoglycemia in Diabetic Non-Human Primates After Transplantation with hCD46 Transgenic Porcine IsletsAMERICAN JOURNAL OF TRANSPLANTATION, Issue 12 2009D. J. Van Der Windt Xenotransplantation of porcine islets into diabetic non-human primates is characterized by (i) an initial massive graft loss possibly due to the instant blood-mediated inflammatory reaction and (ii) the requirement of intensive, clinically unfriendly immunosuppressive therapy. We investigated whether the transgenic expression of a human complement-regulatory protein (hCD46) on porcine islets would improve the outcome of islet xenotransplantation in streptozotocin-induced diabetic Cynomolgus monkeys. Immunosuppression consisted of thymoglobulin, anti-CD154 mAb for costimulation blockade, and mycophenolate mofetil. Following the transplantation of islets from wild-type pigs (n = 2) or from 1,3-galactosyltransferase gene-knockout pigs (n = 2), islets survived for a maximum of only 46 days, as evidenced by return to hyperglycemia and the need for exogenous insulin therapy. The transplantation of islets from hCD46 pigs resulted in graft survival and insulin-independent normoglycemia in four of five monkeys for the 3 months follow-up of the experiment. One normalized recipient, selected at random, was followed for >12 months. Inhibition of complement activation by the expression of hCD46 on the pig islets did not substantially reduce the initial loss of islet mass, rather was effective in limiting antibody-mediated rejection. This resulted in a reduced need for immunosuppression to preserve a sufficient islet mass to maintain normoglycemia long-term. [source] Maternal Position at Midwife-Attended Birth and Perineal Trauma: Is There an Association?BIRTH, Issue 3 2005Barbara Soong RM, IBCLC ABSTRACT:,Background: Most women will sustain some degree of trauma to the genital tract after vaginal birth. This study aimed to examine the association between maternal position at birth and perineal outcome in women who had a midwife-attended, spontaneous vaginal birth and an uncomplicated pregnancy at term. Methods: Data from 3,756 births in a major public tertiary teaching hospital were eligible for analysis. The need for sutures in perineal trauma was evaluated and compared for each major factor studied (maternal age, first vaginal delivery, induction of labor, not occipitoanterior, use of regional anesthesia, deflexed head and newborn birthweight >3,500 g). Birth positions were compared against each other. Subgroup analysis determined whether birth positions mattered more or less in each of the major factors studied. The chi-square test was used to compare categorical variables. Results: Most women (65.9%) gave birth in the semi-recumbent position. Of the 1,679 women (44.5%) who required perineal suturing, semi-recumbent position was associated with the need for perineal sutures, whereas all-fours was associated with reduced need for sutures; these associations were more marked in first vaginal births and newborn birth weight over 3,500 g. When regional anesthesia was used, semi-recumbent position was associated with a need for suturing, and lateral position associated with a reduced need for suturing. The four major factors significantly related to perineal trauma included first vaginal birth, use of regional anesthesia, deflexed head, and newborn weight more than 3,500 g. Conclusions: Women should be given the choice to give birth in whatever position they find comfortable. Maternity practitioners have a responsibility to inform women of the likelihood of perineal trauma in the preferred birth position. Ongoing audit of all clinicians attending births is encouraged to further determine effects of maternal birth position and perineal trauma, to investigate women's perception of comfortable positioning at birth, and to measure changes to midwifery practice resulting from this study. [source] Preoperative topical non-steroidal anti-inflammatory drug or steroid and clinical outcomes after trabeculectomyACTA OPHTHALMOLOGICA, Issue 2009I STALMANS Purpose To investigate the benefit of preoperative topical non-steroidal anti-inflammatory drug (NSAID) or steroid after trabeculectomy. Methods In this prospective randomized placebo-controlled trial, 61 patients scheduled for trabeculectomy were randomized to one of 3 study medication groups: NSAID (ketorolac), steroid (fluorometholone) or placebo (artificial tears). Patients instilled one drop 4x daily for 1 month preoperatively and were examined on day 1, 2, at weeks 1, 2, and 4, and at months 3, 6, 12, 18 and 24 following trabeculectomy. Main outcome measures were incidence of postoperative interventions and IOP-lowering medications; complete and qualified success rate; final IOP and relative IOP reduction. Results Fifty-four eyes were entered for analysis. The percentage of patients requiring needling within the first year was 41% in the placebo, 6% in the NSAID and 5% in the steroid group (P = 0.006). The percentage of patients requiring IOP-lowering medication at one year was 24% in the placebo, 18% in the NSAID and 0% in the steroid group (P = 0.054 overall; P = 0.038 for steroids versus others). Log-rank test showed a significant (P = 0.019) difference in medication-free survival curves between the different groups; patients in the steroid group needed significantly less medication (P = 0.007). The inter-group differences in one-year IOP, relative IOP reduction and success rates were not significant. Conclusion Topical ketorolac or fluorometholone for one month preoperatively was associated with improved trabeculectomy outcomes in terms of likelihood of postoperative needling. Within the steroid group, there was a significant reduced need for postoperative IOP-lowering medication. [source] Nasal CPAP and surfactant for treatment of respiratory distress syndrome and prevention of bronchopulmonary dysplasiaACTA PAEDIATRICA, Issue 9 2009Henrik Verder Abstract The Scandinavian approach is an effective combined treatment for respiratory distress syndrome (RDS) and prevention of bronchopulmonary dysplasia (BPD). It is composed of many individual parts. Of significant importance is the early treatment with nasal continuous positive airway pressure (nCPAP) and surfactant treatment. The approach may be supplemented with caffeine citrate and non-invasive positive pressure ventilation for apnoea. The low incidence of BPD seen as a consequence of the treatment strategy is mainly due to a reduced need for mechanical ventilation (MV). Conclusion:, Early-postnatal treatment with nCPAP and surfactant decreases the severity and mortality of RDS and BPD. This is mainly due to a diminished use of MV in the first days of life. [source] | ||||||||||