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Untreated Subjects (untreated + subject)
Selected AbstractsSustained virologic response prevents the development of esophageal varices in compensated, Child-Pugh class A hepatitis C virus,induced cirrhosis.HEPATOLOGY, Issue 6 2010A 12-year prospective follow-up study The incidence of de novo development of esophageal varices (EV) in patients with compensated liver cirrhosis has been determined by few studies in the short term and never in the long term. The aims of the present study were to determine the incidence and the risk factors associated with the development of EV and to assess whether antiviral treatment and achievement of sustained virologic response (SVR) may prevent de novo EV development in patients with HCV-induced cirrhosis. We studied 218 patients with compensated EV-free, HCV-induced cirrhosis consecutively enrolled between 1989 and 1992 at three referral centers in Milan, Italy. Endoscopic surveillance was performed at 3-year intervals according to international guidelines. SVR was defined as undetectable serum HCV-RNA 24 weeks after treatment discontinuation. During a median follow-up of 11.4 years, 149/218 (68%) patients received antiviral treatment and 34 (22.8%) achieved SVR. None of the SVR patients developed EV compared with 22 (31.8%) of the 69 untreated subjects (P < 0.0001) and 45 (39.1%) of the 115 non-SVR patients (P < 0.0001). On multivariate analysis, HCV genotype 1b (hazard ratio [HR] 2.40; 95% confidence interval [CI] 1.17-4.90) and baseline model for end-stage liver disease (MELD) score (HR 1.20; 95% CI 1.07-1.35 for 1 point increase) were independent predictors of EV. Conclusion: In the long term, the achievement of SVR prevents the development of EV in patients with compensated HCV-induced cirrhosis. Therefore, in these patients, endoscopic surveillance can be safely delayed or avoided. Genotype 1b infection and MELD score identify the subset of patients at higher risk of EV development who need tailored endoscopic surveillance. Hepatology 2010 [source] Changes in immunological and virological parameters in HIV-1 infected subjects following leukapheresisJOURNAL OF CLINICAL APHERESIS, Issue 2 2003M.R. Boulassel Abstract In order to assess immune responses during HIV-1 therapeutic immunization, a large number of blood mononuclear cells (PBMC) are needed. Clinical tolerance and safety, as well as changes in immunological and virological parameters, were assessed, following leukapheresis in HIV-1 infected subjects with CD4+ cell count >200 × 106/l. PBMC were collected using a Fenwal CS3000 cell separator in 29 subjects with mean CD4+ cell counts of 503 × 106/l (range 172,1,119) and viral load of 2.5 log10 copies/ml (range <1.7,5.4). Twenty-four (83%) subjects were on antiretroviral therapy while 5 (17%) were untreated. The blood volume processed was 7 L over a period of 3 hours. A mean value (± standard error) of 82 ± 26 × 109/l lymphocytes was collected by a single apheresis in a mean volume of 200 ± 1.8 ml, containing 9.0 ± 1.3 × 109/l CD4+ and 10.2 ± 1.3 × 109/l CD8+ cells. The leukapheresis procedures were well tolerated and no immediate or delayed side effects were observed within 90 days of follow-up. No changes from blood pre-leukapheresis values were detected for white blood cells, lymphocytes, monocytes, CD8+, CD34+, naive and memory CD4+ cell counts immediately after, 1 h, 7 days, or within 90 days after leukapheresis. However, absolute CD4+ cell counts and percentage significantly increased from pre-leukapheresis values after 1 h (530 ± 43 vs. 700 ± 75 cell × 106/l; 32.6 ± 1.6 vs. 36.9 ± 1.9%; P < 0.001 for both paired t -tests) before returning to pre-leukapheresis levels on day 7. No significant changes in viral load from pre-leukapheresis levels in treated or untreated subjects were detected at any time points. We conclude that leukapheresis in HIV-1 infected subjects with CD4+ cell counts >200 × 106/l is safe and induces a transient increase in the absolute and percentage of CD4+ cell count without enhancing viral replication. J. Clin. Apheresis 18:55,60, 2003. © 2003 Wiley-Liss, Inc. [source] Twenty-four hour ambulatory blood pressure in a population of elderly menJOURNAL OF INTERNAL MEDICINE, Issue 6 2000K. Björklund Abstract. Björklund K, Lind L, Lithell H (University of Uppsala, Uppsala, Sweden). Twenty-four hour ambulatory blood pressure in a population of elderly men. J Intern Med 2000; 248: 503,512. Objectives. The principal aim was to study ambulatory and office blood pressure in a population of elderly men. We also wanted to describe the prevalence of hypertension and investigate the blood pressure control in treated elderly hypertensives. Design. A cross-sectional study of a population of elderly men, conducted between 1991 and 1995. Subjects. Seventy-year-old men (n = 1060), participants of a cohort study that began in 1970. Main outcome measures. Office and 24 h ambulatory blood pressure. Results. Average 24 h blood pressure in the population was 133 ± 16/75 ± 8 mmHg, and daytime blood pressure 140 ± 16/80 ± 9 mmHg. Corresponding values in untreated subjects (n = 685) were 131 ± 16/74 ± 7 and 139 ± 16/79 ± 8, respectively. An office recording of 140/90 mmHg corresponded to an ambulatory pressure of 130/78 (24 h) and 137/83 mmHg (daytime) in untreated subjects. In subjects identified as normotensives according to office blood pressure (n = 270), the 95th percentiles of average 24 h and daytime blood pressures were 142/80 and 153/85 mmHg, respectively. The prevalence of hypertension, defined as office blood pressure , 140/90 mmHg, was 66%. Despite treatment, treated hypertensives (n = 285) showed higher office (157/89 vs. 127/76 mmHg) and 24 h ambulatory (138/78 vs. 122/71 mmHg) pressures than normotensives (P < 0.05). Fourteen per cent of the treated hypertensives had an office blood pressure < 140/90 mmHg. Conclusions. Our results provide a basis for 24 h ambulatory blood pressure reference values in elderly men. The study confirms previous findings of a high prevalence of hypertension at older age. It also indicates that blood pressure is inadequately controlled in elderly treated hypertensives. [source] Relationship between dental care and oral health in institutionalized elderly people in JapanJOURNAL OF ORAL REHABILITATION, Issue 9 2004Y. Shimazaki summary, This study examined the relationship between dental care and dental health status in institutionalized elderly people in Japan through a 6-year prospective cohort study. All the 719 subjects received both baseline and follow-up surveys. The uptake of dental care was examined at the follow-up survey. We examined the relationship between baseline variables and the provision of dental care, and the relationship between dental care and change of oral health status. About 47% of the subjects and about 60% of the baseline dentate subjects received some dental treatment during the 6-year follow-up period. The subjects who were in better systemic and dental health at baseline used dental services frequently. The number of teeth needing extraction decreased in the subjects who received dental treatment, and increased in the untreated subjects. Denture status was better in the treated subjects than in the untreated subjects. Dental care appears to be an important factor in maintaining a healthy oral status for the institutionalized elderly. [source] Some Methods of Propensity-Score Matching had Superior Performance to Others: Results of an Empirical Investigation and Monte Carlo simulationsBIOMETRICAL JOURNAL, Issue 1 2009Peter C. Austin Abstract Propensity-score matching is increasingly being used to reduce the impact of treatment-selection bias when estimating causal treatment effects using observational data. Several propensity-score matching methods are currently employed in the medical literature: matching on the logit of the propensity score using calipers of width either 0.2 or 0.6 of the standard deviation of the logit of the propensity score; matching on the propensity score using calipers of 0.005, 0.01, 0.02, 0.03, and 0.1; and 5 , 1 digit matching on the propensity score. We conducted empirical investigations and Monte Carlo simulations to investigate the relative performance of these competing methods. Using a large sample of patients hospitalized with a heart attack and with exposure being receipt of a statin prescription at hospital discharge, we found that the 8 different methods produced propensity-score matched samples in which qualitatively equivalent balance in measured baseline variables was achieved between treated and untreated subjects. Seven of the 8 propensity-score matched samples resulted in qualitatively similar estimates of the reduction in mortality due to statin exposure. 5 , 1 digit matching resulted in a qualitatively different estimate of relative risk reduction compared to the other 7 methods. Using Monte Carlo simulations, we found that matching using calipers of width of 0.2 of the standard deviation of the logit of the propensity score and the use of calipers of width 0.02 and 0.03 tended to have superior performance for estimating treatment effects (© 2009 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source] A functional magnetic resonance imaging study of cortical asymmetry in bipolar disorderBIPOLAR DISORDERS, Issue 3 2004Michael P Caligiuri Objectives:, Individuals with bipolar disorder (BPD) exhibit motor, perceptual, and cognitive disturbances involving predominantly right hemisphere dysfunction. This asymmetry has been used to advance the hypothesis that the pathogenesis of bipolar disorder may be related to disturbances of the right cerebral hemisphere. We employed functional magnetic resonance imaging to examine hemispheric asymmetries in manic and depressed BPD. A secondary goal of the study was to examine effects of psychotropic medications on blood volume changes in the motor cortices. Methods:, We studied 18 right-handed BPD and 13 right-handed normal healthy comparison subjects. Blood oxygen level dependent (BOLD) responses in the primary motor area (M1) and supplementary motor area (SMA) of both hemispheres were elicited during reaction time (RT) tasks. Results:, Healthy subjects activated the SMA in a reciprocal fashion with significantly greater activity in the left SMA for right hand trials and the right SMA for left hand trials. Depressed BPD subjects failed to show this normal reciprocity indicating a failure to suppress unwanted activity in the ipsilateral right SMA, whereas manic BPD subjects failed to suppress unwanted ipsilateral SMA activity in both hemispheres. Manic and depressed BPD subjects exhibited greater activity in the left primary motor area suggesting increased cortical excitability. BPD subjects treated with antipsychotics or mood-stabilizing medications exhibited longer RTs, lower BOLD responses in M1 and SMA, and a loss of normal hemispheric asymmetry in the SMA than untreated subjects. Conclusions:, The presence of a right hemisphere disturbance in BPD is consistent with the hypothesis that the right hemisphere may be dominant in mood regulation. The presence of both left and right hemisphere disturbances in mania may explain the coexisting psychotic and affective symptoms observed in this condition. [source] Anger Treatment for Adults: A Meta-Analytic ReviewCLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE, Issue 1 2003Raymond DiGiuseppe We included 50 between-group studies with control groups and 7 studies with only within-group data in a meta-analysis of adult anger treatments. Overall, we examined 92 treatment interventions that incorporated 1,841 subjects. Results showed that subjects who received treatment showed significant and moderate improvement compared to untreated subjects and a large amount of improvement when compared to pretest scores. In the group of controlled studies significant heterogeneity of variance and significant differences among effect sizes for different dependent variable categories were found. Anger interventions produced reductions in the affect of anger, reductions in aggressive behaviors, and increases in positive behaviors. An analysis of follow-up data suggested that treatment gains were maintained. [source] | ||||||||||